by Dr. Helmy Haja Mydin. First published in The New Straits Times 7 May 2015

Dato Lee Chong Wei’s has been handed an eight-month ban for doping as a result of consuming Cordyceps supplements that contained dexamethasone, a form of steroids. The case serves to highlight the importance of consuming medication and supplements from trusted resources, especially when it comes to the use of traditional and herbal remedies.

The use of herbal remedies is widespread in Malaysia. Both traditional and social media are filled with tales of remedies that purport to have a cure for a range of illnesses. While every patient has the right to decide what is best for his or her own situation, it is however vital that they make fully informed decisions.

One of the commonest misconception is that herbal remedies are better because they are ‘natural’. A 2013 study of 460 pregnant women in Kelantan found that 77% of them perceived herbal medicines as being safe and effective purely because they are ‘natural’ and (supposedly) do not contain any dangerous chemicals. This is not strictly true – many medical treatments are based on substances from nature, from the humble paracetamol to modern forms of chemotherapy. On the flip side, many poisonous items such as cyanide can be found in nature.

Herbal remedies can contain toxic ‘natural’ substances. For example, the rhizome of Smilax luzonensis (akar banar), often eaten as an aphrodisiac, has been known to be sold in supplements that contain mercury. The lack of quality control, unlike the strict codes adhered to by the pharmaceutical industry, also means that there is a risk of microbial contamination. The report into Dato’ Lee’s case stated that ‘How the contamination occurred is not known, but most likely occurred during the process of grinding the raw Cordyceps into powder and putting this powdered Cordyceps into the gelatin capsules in the shop in Kuala Lumpur’. Unsurprisingly the proprietor of the shop was unwilling to step forward for fear of damage to his business.

In more malicious circumstances, substances such as steroids and diuretics are purposely added to herbal remedies or supplements. These are done with the aim of inducing a positive therapeutic effect (e.g. provide more energy or to help lose weight) but do not take into account the detrimental effects of unsupervised long-term use. Substances as diverse as Bao Ling capsules to Ikan Haruan extracts have been known to contain steroids. Unnecessary prolonged use can lead to a variety of diseases such as the development of diabetes, osteoporosis, and adrenal suppression.

I get particularly upset when patients fall victim to unscrupulous individuals who promote or market a product based on flimsy scientific evidence. A patient of mine recently purchased pomegranate seeds for the price of RM250 a box after she was convinced by the salesperson that it would cure her lung cancer. Pomegranate juice has antioxidants called polyphenols, which have been show to inhibit growth of lung cancer cells in the laboratory. Many individuals look for a cure or miracle but positive results in a petri dish do not automatically transfer to positive results in human beings. The high number of variables in a disease as complex as cancer is one of the reasons why clinical trials are necessary to assess the efficacy of a treatment before it can be recommended for general use.

The majority of individuals take a herbal or traditional remedy on the basis of a friend’s or relative’s recommendations. Most are given on the basis of anecdotal evidence, which falls far from the standards we expect from doctors. If a product can affect the human body and lays claim to beneficial health outcomes, then it should be regulated by the appropriate body and monitored accordingly.

One could also argue that the manner in which pharmaceutical companies are made accountable for their claims should be applied to producers of traditional treatment. Similarly, those who give advice on treatment should be held to the same high standards that a doctor is i.e. to take responsibility for the advice they give as it affects health decision-making and can quite literally kill.

Malaysia is blessed with a rich culture and biodiversity which has led to a huge variety of herbal and traditional remedies. It is becoming increasingly clear that the options made available to the consumer should be close examined with well-conducted clinical trials as well as the implementation of quality standards to protect the consumer from inadvertent side effects.

Until then, consumers must understand that there is no such thing as a miracle cure, that all medicine have side effects. If it sounds too good to be true, it probably is. As the comedian Tim Minchin said, ‘You know what they call alternative medicine that’s been proved to work? – Medicine.’.

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Dr Helmy Haja Mydin is an Associate of the Institute for Democracy and Economic Affairs and an Associate Professor at Universiti Malaya.

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