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Sunday, November 19, 2017

Dangerous trend

Wednesday, 08 November 2017 11:49
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Continuing to face the worst dengue epidemics this year, the Tamil Nadu government has adopted a very retrograde system of freely distributing a herbal solution concoction 'Nilavembu Kudineer' recommended for fevers under the ancient Siddha system of medicine. Even though there is no scientific evidence of its efficacy, alternative remedies such as papaya leaf juice for dengue and many takers during epidemic outbreak. Unfortunately, this practice has been adopted by the government and how many patients have been treated is not known in the figures doled out by so far in the public domain. While it may be hard for the government agencies to curb such practices, what they should never do is endorse them. Sadly, there are growing instances of exactly this happening with endorsement from the government and its healthcare department. For example, last year also the Council of Scientific and Industrial Research launched an anti-diabetic herbal pill called BGR-34 on the strength of what appeared to be very poor evidence. One of the several ingredients of 'Nilavembu Kudineer' comes from a plant called Andrographis paniculata, which appears in herbal medicine systems across South Asia. Like other cases with such herbs, some evidence exists for its potency against a range of illnesses. In this case, A. paniculata is known to inhibit the dengue virus in animal cells in a laboratory, and to reduce symptoms of respiratory tract infections in small human trials. But many other herbal remedies also show such early promise. Unfortunately, only a tiny handful of these remedies go on to prove their efficacy in large-scale, placebo-controlled human trials, the gold standard of modern medicine. This is because the science of developing drugs from medicinal plants is complicated. Poly-herbal remedies like 'Nilavembu Kudineer' are a mix of several compounds, while most of the modern medicines rely on single-compounds. In addition to this, the amount of the active ingredient - the compound in a herb that acts against an illness - varies across plants. So drugmakers have to find a way to identify this ingredient and test it in large-scale trials. This exercise requires not only massive financial investment but also intellectual honesty. Apart from an earnest attempt to find scientific evidence about the efficacy of the herbal medicines, the government and its agencies also need to find cure and prevention against such epidemics. Unfortunately, many attempts in India by the government to validate traditional medicine have been driven less by honesty and more by blind faith. In fact, such blind faiths have been promoted more by the NDA-government took over three and a half years back. Instead of doing so, there is need for gearing up entire infra-structure for providing healthcare at the doorsteps of the people. The modus operandi adopted by the NDA-government has led to the promotion of herbal remedies with scant or no evidentiary basis. In this background, the endorsement of 'Nilavembu Kodineer' - even if it is not pushed as an alternative to allopathic medicine - has its consequences in the face of a deadly epidemic. It is possible that people will misconstrue a supplement for a cure when they are known to provide relief to the patients. The risk of patients who need medical attention, such as those with dengue haemorrhagic fever, opting for this drug instead of rushing to a hospital should not be underestimated. So far dengue has made over 88,000 persons sick across the country, while killing over 150. Both numbers are underestimations, given the government's poor surveillance systems. At a time when modern medicine is advancing towards greater transparency and replicability in clinical evidence, the government's claims on 'Nilavembu Kodineer' aren't fooling anyone in the scientific community. But these are misleading ignorant common masses in ways that can hurt them. This is a matter of shame not only for the government but also its agencies charged with the responsibility of treating the patients with utmost care and proper medicines.


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