As the pandemic spread around the world, the President of Madagascar, Andry Rajoelina, made a startling announcement. He launched a new drink, COVID-Organics, developed by Malagasy scientists, which was purported to cure the new disease. The evidence of its efficacy was slight, but the basis behind it was linked to a history of local herbal lore and an existing treatment for malaria*, combined with an association with a modern-style research institute.
Already several African states, including Tanzania, Guinea-Bissau and Congo-Brazzaville, have invested scarce resources on importing the new treatment, and it’s being rolled out across Madagascar, some of which is at national expense. It’s easy to understand why. Western medicines are often unaffordable at the best of times, and in the international scramble for resources they are now simply out of reach. COVID Organics is available on the doorstep. Moreover, there is a strong desire to support native expertise, despite most international scientists advising caution in the absence of any reliable evidence. Every society looks to its own authority figures for hope and guidance. We shouldn’t criticise desperate people for trying whatever remedy is actually available.
The claim of a wonder treatment was however met with scepticism from medical experts. President Rajoelina has hit out at critics from the Global North, accusing them of a condescending attitude towards African expertise. At the same time there is a reluctance by many to openly dismiss a treatment that has been promoted as an indigenous African solution drawn from a respected tradition. Even the WHO did so only obliquely.
I am on record as being strongly in favour of recognising and valuing alternative approaches to the development of knowledge beyond the frequently colonial attitudes we are responsible for perpetuating. In this case, however, I’m not inclined to mince my words. COVID-Organics on its own will probably do no harm, but there’s very little chance that it will do any good. By all means test it like any other potential drug, but its provenance doesn’t make it any more plausible as a candidate treatment. And if it takes the place of known, genuinely effective interventions (social distancing, hand washing etc.), or wastes money that could be spent on proven medical care, then it will become positively dangerous to health.
Why am I so sceptical? Those who advocate herbal medicine as an alternative to conventional treatment usually follow one of two lines of argument in support. The first is that it is an ancient practice, based on thousands of years of development, and that this long duration has ensured the transmission of only the most effective cures.
It’s easy to pick this apart. Firstly, the foundations of herbal medicine were derived from theoretical grounds which we now know to have been fundamentally flawed. In its Western form these include the Doctrine of Signatures, which states that God indicated the medical uses of plants through their physical characteristics, or treating symptoms as manifestations of the four humours. Such methods of identifying possible plants and matching them to conditions is little better than random. We shouldn’t expect paradigms that predate germ theory to stumble on insights into a novel threat.
Second, herbalists will often advocate their art by picking out those remedies which have gone on to be important medical drugs. It’s a classic case of the prosecutor’s dilemma; a number of effective treatments have come from plants, but not all medical plants are effective. One which is usually rolled out is the Madagascar periwinkle, which gave rise to a lucrative pharmaceutical used to treat a common form of childhood leukemia. This is however completely unrelated to its traditional usage as a largely ineffective treatment for diabetes. That it yielded such a valuable modern drug owes as much to serendipity as herbal medicine.
Finally, the legend that tropical forests contain a fabled pharmacopeia whose secrets are held by traditional healers has been comprehensively demolished by prolonged enquiry. The story remains persistent because of its connection to a number of beloved folk images rather than any basis in evidence. We have probably taken all the low-hanging medical fruit from the plant kingdom already. A forest-dwelling shaman won’t solve our new problem, not least because remote tribal people live at such low densities that they tend not to suffer from contagious viruses.
Should we instead be scouring the plant kingdom for potential COVID cures? To do so would almost certainly be a waste of time and resources. Not that I’m sure some unscrupulous or naive researchers are putting in grant applications to do exactly that right now. Note that most major pharmaceutical companies gave up on this approach to drug research many years ago after wasting spectacular sums in the process. If it worked then Big Pharma would be doing it already for the diseases we already have.
OK, you might ask, but what if one of these herbal cures turned out to actually work? Medical plants contain a vast number of chemicals. Identifying, purifying and testing the active ingredients is a long process. Sometimes physiological effects rely on complex interactions with other constituents which mean that the individual chemicals don’t act quite the same in isolation. Controlled dosages of herbal medicines are almost impossible to achieve. And there is a high risk that one or other component will be allergenic or otherwise harmful. Demonstrating efficacy and comprehensive safety of a botanical treatment is therefore much harder than for any single component drug.
To summarise, it is possible that herbal medicine might eventually lead to a cure for COVID-19, but it is much less likely to do so than conventional scientific approaches. Even if a cure does eventually arrive through the herbal route, it will take much longer, likely many years, and the lack of any precedents in the modern era is not encouraging. We haven’t found a herbal cure for any other virus yet, and not for want of trying. Maybe Madagascar really has stumbled on the solution to the world’s greatest current problem. Until we have some solid evidence, however, I wouldn’t bet on it. We are all desperate for a cure to appear but wasting time and scarce resources on dead ends will ultimately cost lives.
* Is it coincidence that both the presidents of Madagascar and the United States have promoted the use of treatments for malaria, a fever caused by parasitic infection, as supposed cures for an entirely unrelated virus?