Can ‘alternative medicine’ do harm?

By Dr Upul Wijayawardhana

Whatever the intervention, be it drugs, devices or surgery, it has the potential to do harm: this is an accepted dictum in science-based modern medicine. However, no intervention is recommended unless benefits far outweigh any potential harm. Further, there is continuing surveillance to spot any unexpected dangers, a higher degree of observation being mandated for any new interventions. In the British National Formulary (BNF), which lists all drugs approved for use, some drugs have a ‘black triangle’ to indicate that they are under enhanced surveillance. All drugs are dispensed in the UK with patient information leaflets. The most important method of surveillance used in the UK is the ‘Yellow card scheme’, which is run by the Medicines and Healthcare products Regulatory Agency (MHRA). Any adverse event can be reported to the MHRA, on this readily accessible system, by any healthcare professional, a patient or even a carer. MRHA monitors these adverse events and takes whatever action necessary which may amount, in rare instances, to even the total withdrawal of the drug.

Such safeguards, whether they exist in ‘alternative medicine’ or who applies them, is a moot point at the present time as many wonder drugs are being paraded a cure for COVID-19, which has snuffed out almost one and a half million lives around the world. Some may argue that ‘alternative medicine’ does not need such safeguards as they use natural products. But, are all-natural products safe? Not so! What is conveniently forgotten is that many plants have highly toxic compounds. After all, the belladonna plant, which belongs to the same family as tomatoes, potatoes and brinjal, is called deadly nightshade as it can kill. However, atropine extracted from it is widely used in modern medicine. Sweet potato, though called a potato, does not belong to the nightshade family and that is why we can enjoy a ‘mallum’ made out of the leaves though we cannot do the same with potato leaves. I dare not eat wild mushrooms that sprout in my garden as I lack the expertise to identify what may kill me! I can cite many more examples.

School holidays were what we longed for in our childhood although we had to undergo a ritual purge! My parents were teachers, but they were heavily influenced by Ayurveda, perhaps because one of my paternal aunts was married to an Ayurvedic physician. Ayurveda recommends cleansing the bowel, perhaps, due to the lack of understanding of the basic physiology that the normal bowel is always clean. We had to have a purgative, usually aralu infused king coconut water, at least once a year. Even the worst food poisoning I have had never produced such a violent diarrhoea. I still remember this unnecessary, misguided torture which could have killed us, but we survived, maybe because the human body has evolved to face dangers!

During my working life in Sri Lanka, I saw many patients who had complications, the commonest being jaundice, which may have been caused by Ayurvedic preparations but, unfortunately, there was no authority to report to and no action could be taken. I am sure many morbidities are simply overlooked due to the total lack of any surveillance.

I remember a patient whose heart was seriously affected by medication used in another ‘alternative medicine’ system. Before coronary angiography (taking x-ray pictures after injecting a radio-opaque dye to the arteries that supply blood to the heart muscle) was started in Sri Lanka and at a time when medicine in Singapore was not that advanced, one of my professional ‘risks’ was having to accompany VIPs and friends to London for this procedure. I had to take my own leave for these trips and I never charged a penny from any Sri Lankan but that is another story. This was a rich businessman who was married to a much younger beautiful woman. I was with him when his coronary angiogram was done in a private hospital in London, and it was normal except that heart muscle function was severely impaired. On detailed questioning he admitted to taking a medication which he said he obtained from a ‘native physician’ as he did not want to disappoint his young wife, in the pre-Viagra era! I could not investigate as he refused to divulge any further details.

As heavy metals can impair heart muscle function, my suspicion was that my friend was using a preparation with a compound of a heavy metal and advised him strongly to stop it, pointing out that if he continued, he would develop severe heart failure. He took my advice and the function of his heart muscle improved gradually, which I could demonstrate by serial echocardiography, a procedure using reflected ultrasound to produce a 2D picture of the heart. Over two years, his heart muscle function normalised and he was overjoyed. When I reviewed him a year later, I found that his heart muscle function to be impaired again. When I asked him whether he had started that again, his response was “How did you know?” Thus, there was no doubt that his heart muscle dysfunction was due to that particular drug.

Science-based modern medicine we practise has evolved from empirical systems of the past and uses many drugs but they undergo a process of rigorous testing. When a drug is considered to be useful, it undergoes testing in at least three phases, as I mentioned in my article, “Peddling snake oil” (The Island, 17 October). Therefore, I was taken aback when wide publicity was given in the media that an Ayurvedic physician had developed a drug that cured Covid-19. In fact, The Island of December 3 carried a photograph of our Health Minister tasting the decoction but I doubt anybody taking her seriously. After all, she is the one who kissed the Chinese lady off with COVID-19 and dropped pots in rivers at the behset of a faith healer. Rather than allowing experts, who have the knowledge of the behaviour of this deadly virus, to do their job, playing politics is not only laughable but dangerous. Media reports stated that this decoction was tested by some specialist physicians in the government sector and they found that PCR positive patients tested negative after this decoction. That simply is the wrong yardstick to use as all who recover would become PCR negative, as the body develops antibodies to get rid of the virus. After extensive trials, it was shown that the antiviral remdesivir may shorten the duration of the illness and that dexamethasone significantly reduced the death rate in hospitalised patients. To claim that any drug is a cure without testing it properly is the height of absurdity and supporting these wild claims only amounts to misleading the public. Compared to many other countries, Sri Lanka is still doing very well and the best way to fight this deadly virus is preventing its spread by physical distancing, wearing masks and washing hands, till an affordable vaccine becomes available.

Now it transpires that this ‘physician’ is just a kapuwa in a kovil! Are we living in a fool’s paradise?