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Why is WHO opposed to an effective anti-malarial tea ?

April 6, 2013 - 08:14 -- Pierre Lutgen

The following article was published in SLATE Magazine on April 4 by Brendan Borrell. Our association IFBV-BELHERB from Luxembourg is glad to read that some independent voices recognize the merit of Artemisia annua herbal medicine and proud to see that through R&D at their universities Africans will find their own solutions in the fight against tropical diseases. Hereafter excerpts from the paper. The full text is available at www.slate.com/.../wormwood_tea_to_treat_malaria

Why is the WHO opposed to an effective anti-malarial tea

For once, an herbal remedy actually works. Why are malaria experts against it?

ENTEBBE, Uganda It's a little after 9 a.m. on the Wagagai Flower Farm, and Robert Watsusi pedals a bicycle laden with two 3-gallon jugs of a hot, bitter black tea. As he rounds a corner, workers emerge from football field–size growing houses to imbibe their weekly dose of the elixir they say keeps them free from malaria. … The tea comes from sweet wormwood (Artemisia annua), the Chinese plant that is a source for the world's most powerful anti-malarial treatments, which combine artemisinin derivatives with an older class of drugs. It can also be grown in wetter parts of Africa, and a year’s supply costs no more than a few dollars. Although the tea itself has traditionally been used in treatment, not prevention, in China, a randomized clinical trial on this farm showed that workers who drank it regularly reduced their risk of suffering from multiple episodes of malaria by one-third. For a group of people who were once waylaid by this mosquito-borne disease four or more times per year, the tea is a godsend.

Which is why you may be surprised to learn that the World Health Organization and a majority of malaria researchers are adamantly opposed to it. To be fair, there are compelling reasons not to endorse an herbal tea in a fight against a potentially deadly disease. After all, conventional single-molecule drugs are honed through chemistry to be safer, more specific, and more effective than their herbal progenitors. More critically, malaria experts worry that unregulated use of this tea could cause the malaria parasite to develop resistance to artemisinin drugs.

But the tea’s mere existence and its rapid spread challenges the view that conventional pharmaceuticals are the best and only way of managing Africa’s health care problems. After all, experts in the international aid world talk a lot about sustainability, and nothing is more sustainable than a drug grown on a shrub… The story of artemisinin demonstrates that even the best malaria drugs are worthless if they are not getting to the people who need them. …

Today, although ACTs are heavily subsidized by the international aid community, local clinics frequently run out of stock, and Africans often end up with substandard, ineffective, and sometimes counterfeit medications. Long before ACTs were available in Uganda, rumors of Artemisia’s powers began to spread. In 1998, a German organization called Action for Natural Medicine (Anamed) began distributing seeds and cuttings from Artemisia including a potent hybrid called A3, in 75 different countries. ….

However, no organization I know of has taken things quite as far as the Dutch-owned Wagagai Flower Farm. In 2005, the farm’s owners were struggling because more than one-third of their 1,500 workers were falling ill with malaria each year. The Tororo Botanical Garden in Fort Portal provided Artemisia seeds, and the owners began distributing the tea for free, not for treatment but for prevention of malaria episodes. Soon afterward, a researcher named Patrick Ogwang with the Ugandan Ministry of Health documented a decline of malaria incidence among almost 300 workers drinking the tea, and followed up with the randomized controlled trial demonstrating the tea’s effectiveness. Today, workers like Peter Osire, an irrigation supervisor, tell me it has been years since they had a fever. While the workers are effusive about the tea, malaria experts have taken less kindly to it.

When Ogwang tried to publish the results in Malaria Journal a reviewer largely praised the quality of the science but nixed publication out of concern that use of the tea could render ACTs ineffective. It’s a remarkably patronizing recommendation: that a scientific journal should keep the latest evidence out of the hands of Africans, lest they begin treating themselves. Marcel Hommel, editor in chief of the journal, defends the decision, saying, “It is the responsibility of an editor to avoid publishing papers that promote interventions which could potentially put patients at risk.” Ogwang eventually published his results in a less prestigious journal. …

The tea has become widespread enough that last year the WHO published a statement opposing it for either treatment or prevention of malaria, and an online survey of malaria experts found that 72 percent were opposed to its use in prevention. Their view is that low-dose, persistent use could breed resistance, which would be disastrous. But we’re not talking about pumping pigs full of unnecessary antibiotics. We’re talking about desperate people trying to live normal lives. And, in Wagagai, after years of preventive use, resistance has not sprung up. Ogwang says that may be because the tea, like other herbal products, contains multiple active compounds besides artemisinin. Cinchona bark is still effective after hundreds of years even though chloroquine (a derivative) is not. The Chinese have been using wormwood for more than 1,500 years for a variety of ailments, but the only place where we’ve seen signs of artemisinin resistance is on the Thai-Cambodian border, where conventional ACT artemisinin drugs are used….

Ogwang is now trying to test whether the tea remains effective for prevention even if the artemisinin is eliminated, an idea that sounds crazy but that could eliminate the objection that the tea could stimulate resistance. …Some herbs do have medically active compounds, albeit with varying levels of efficacy, and Africans are choosing to go that route because they know that drug supply won’t be cut off by war or corruption or bureaucratic incompetence. Herbs are not always going to be the right strategy, but the data about these unconventional interventions should be shared and discussed. In the case of malaria,…there have long been indications that using a cruder, cheaper whole-plant extract could potentially be more effective and cheaper..

In a study conducted in rats last year, University of Massachusetts researchers compared a single dose of pure artemisinin to dried whole leaves, and found that the whole plant was better at killing malaria parasites…

Brendan Borrell