Of herbalists and scientists

The speech was first presented at the Toxicological Society of Southern Africa (TOXSA) Conference

It is an honour and a privilege to have been invited to TOXSA to give this talk. My expertise lies in pharmacognosy and analytical chemistry – having spent the past 10 years doing work on the pharmacology and chemistry of medicinal plants. As for traditional medicines, not only have I been involved with them from a scientific aspect, but I am a product of that culture and I can remember using herbal medicines from as far back as I can remember remembering – in other words from my earliest memories.
Traditional medicine has a long history of use world-wide and has not only survived various assaults by Christendom, colonial authorities westernization and urbanization, but to-day thrives and is widely used in all its many and varied forms. The WHO estimates that 70 – 80% of the world population (mostly in the developing world) uses traditional medicines exclusively to meet their health needs.
Traditional medicine remains popular for various reasons – it is a cultural heritage which is closely tied with many ritualistic and religious aspects of life from birth to death and everything between.
- It is more easily accessible for many poor people of the world.
- Traditional medical practitioners are respected members of their communities and provide holistic solutions to the health-care needs of their people unlike over-worked and poorly-resourced western-trained health personnel who tend to medicalize everything. This explains why herbalism which is the cornerstone of traditional medicine now appeals more and more to citizens of Europe and North America. It offers individuals the opportunity to self-medicate and be in control of their own health.
- There is also a general disillusionment and frustration with the failure of allopathic medicines to offer a curative solution to many of the ills of modern society e.g. depression, cancer, and HIV / AIDS. Most modern medicines only offer symptomatic relief (rather than cure) and their use has many side effects.

In the public’s mind traditional is safe because of its length / history of use. In the US surveys have suggested an increase of people reporting use of botanicals or non-vitamin/ non-mineral supplements from 2.5% in 1990 to 12.7% in 1997. 38% of cancer patients and between 14 – 29% of children have used herbal / botanical medicines.
South Africa as is readily acknowledged, is endowed with a rich plant biodiversity – 24,000 indigenous species – strong. 70 -80% of our population use traditional medicine. This correlates to figures from elsewhere in the developing world. In SA, more than 200 000 traditional healers are believed to be practising. Unlike other countries in the SADC region, notably Zimbabwe where one may only practise upon registration with a professional body (akin to the health professions council) in SA anyone can prescribe and dispense traditional medication even when they have no training or claim to the art and science. This may be part of the problem.
But then again, what is a traditional healer. African traditional medicine is generally practiced at three main levels (specializations, if you like), or combinations thereof.

• Diviners / Spiritualists – magico-spiritual, invoke spirits of the ancestors and uses plants, animal parts, rocks or water
• Traditional Birth Attendants (Gynaecologists and Obstetricians, if you like), they are knowledgeable in ante-natal issues and mother and child care
• Herbalist s– use knowledge passed on from generation to generation based on empirical observations. By far the most useful for biological prospectors and pharmaceutical drug discovery.

Regulation of medicines in SA is by the Medicines and Related Substances Act 101 of 1965 with subsequent amendments and this is administered by the Medicines Control Council. Traditional medicine falls outside of this Act for historical reasons however, and this has created many problems. There are ongoing efforts within the MCC to create legal space for traditional and complementary medicines and their practitioners.
Because of the prevailing legal situation and South Africa’s new found enthuasism for all things African, not uncommon in post-colonial Africa, as well as political expediency the terrain of traditional medicine became a battlefield. This battle was largely fought over this society’s response to HIV/ AIDS with activists such as the TAC, politicians, scientists, healers, quacks and pretenders all ranked against one another. And there were no winners – just losers all around.
But this battle royale is also being fought elsewhere albeit on different issues. In the UK the battle pitches HRH Prince Charles and a coterie of GPs and complementary healers against the “medical establishment”.
A few years ago the Prince in addressing the WHO said, “Many of to-day’s complementary therapies are rooted in ancient traditions that intuitively understood the need to maintain balance and harmony with our minds, bodies and the natural world”.
When challenged to produce evidence to support the use of complementary and alternative medicine in the public health sector on of the Prince’s supporters said "I think what this suggestion amounts to is a form of medical apartheid: any therapy which can't trace its origins to what is called the biochemical model should be excluded from the NHS […] The weight of the evidence does suggest that homeopathy is effective."
But then the British can afford to fight in this way and there is certainly no health crisis of the nature we have in Southern Africa. In South Africa while we fought people are dying. Almost everyday the media splashes stories about this or that cure for AIDS or this or that healer making unfounded claims about his treatment.

Let me be clear at this stage and say that we must debunk three myths here
1- that traditional medicine is primitive and has no place in the days of our lives. If this were true it would have long fallen out of use. We know that traditional medicine is a potential asset and in fact provides up to 50% of the pharmaceuticals that have transformed health care in the past century.
2- with regards to pharmaceuticals, advocates of traditional medicine claim that they are toxic and traditional medicine is not. Anti-retrovirals have been called “toxic” and “poisonous” by one camp and “lifesavers” by AIDS treatment activists. We know from basic pharmacology that everything that is ingested has some adverse effect – even water!
3 – that traditional medicine is an alternative science with it’s own principles and laws which are in a different paradigm to so-called western science. This myth is propagated by people who want to discourage enquiry into the use of some of these herbs without proper scientific evaluation.

The then South African Minister of Health in motivating for the Act to govern complementary, alternative, African traditional medicine said “We cannot transplant models designed for scientific validation of allopathic medicine and apply it to other remedies.”
The rejoinder to that would be – if you are going to treat disease which can be explained and diagnosed by allopathic medicine and talk for instance of CD4 and viral loads then that supposed cure should also stand up to the scrutiny of conventional science.
We need to move away from the either or syndrome that is gripping the South Africa. Traditional medicine has a vital role to play; however that role is limited and should be defined. Traditional medicine cannot and should not transplant medical and scientific enquiry. It needs to be put into perspective. And that starts with putting science and ethics into this whole debate.
And the science and ethics of science says that if you are to put out a medicine into the public domain then there must be certain assurances that it is meets three criteria
- that it is efficacious,
- that it is of good and acceptable quality
- and that it’s toxicity profile is understood.

These issues must be addressed in some manner with regards to traditional medicine.