Sat Mag
Peddling ‘snake oil’?
By Dr Upul Wijayawardhana
“I was born in the wagon of a travelling showMy mama had to dance for the money they throwPapa would do whatever he couldPreach a little gospel, sell a couple of bottles of Doctor’s good”
This haunting, lilting, 1971 comeback single of the American actress and songstress Cher reversed her flagging fortunes and was declared “one of the 20th century’s greatest songs” by Billboard magazine. Not surprising, considering that in addition to the beautiful singing and haunting music there was a powerful message in the lyrics too; referring to racism, prostitution and teenage pregnancy. However, during this gloomy era of the Covid-19 pandemic, what made me think of this beautiful song was the bit “sell a couple bottles of Doctor’s good”. After all, from the world’s most powerful person’ downwards, many including our Leader of the Opposition seem to be indulging in this art! There is no end of experts giving advice!!
‘Doctor’s good’ is a sarcastic reference to so-called ‘patent medicines’; commercial products advertised, usually heavily, as over-the-counter medicines without much concern for effectiveness. Some may be totally ineffective or effective for a different disease; others have products based on pseudoscience with claims of cure for every known malady! It beats me even to imagine how the same ‘medicine’ can cure diabetes, blood pressure and cancer but perusing through many a Sinhala newspaper I found plenty of products advertised with these claims! However, our chaps are not the first to do so. They are simply following a tradition started in USA in the nineteenth century!
Perhaps, advertising started way back in our civilisation but it became a major force in capitalist economies around the middle of the 19th century with newspaper advertisements. Now, it is done through various media; radio, television, direct mail and internet. You cannot access a website without advertisements popping around. Watching TV is painful as on top of prolonged add-breaks there are crawlers at the bottom of the screen. ‘Patent medicines’ were among the first major product categories to benefit from the advertising industry and it is said that many advertising and sales techniques the patent medicine promoters pioneered were later used for other products. One of the first products promoted as a medical panacea, cure-all, were the liniments supposed to contain snake oil. A liniment is a topical preparation applied to the skin, often rubbed to promote the penetration of the active ingredients. However, some contain hardly any active ingredients and, in fact, many snake oil liniments, which were petroleum-based mineral oil products, did not have any snake derived ingredient at all! Therefore, it is not surprising that ‘Snake oil’ became a euphemism for deceptive marketing, healthcare frauds, etc. and ‘snake oil salesman’ a term to describe a charlatan. Looking round, we have many. One of them was supposed to go to India, in a special flight sent by the Indian government, to help fight the raging Covid-19 epidemic there. This was the claim made in one of the Sinhala newspapers a couple of weeks ago. Maybe, the temporary absence of this gifted saviour, who is performing miracles in India, is the reason for resurgence of the epidemic here!
With the setting up of drugs regulatory authorities in many countries it became increasingly difficult for ‘patent medicines’ with dubious claims to be promoted but clever businessmen adopt various ruses. In the West these are promoted as nutritional products and dietary supplements. We do not seem to have adequate regulations to prevent the public from being duped!
Drugs in use today have to undergo a rigorous process of testing before they are permitted to be prescribed unlike many ‘patent medicines’ which were patented without any proof of effect. Drugs can be identified to be useful in many ways, the oldest method being observation. Pioneers in the field like William Withering, the 18th century English Physician, who pioneered the use of digoxin in heart disease, had to labour to find the active compound. Though many stories have been written on his discovery, it is very likely he was able to identify digoxin by the careful analysis of a polyherbal preparation consisting of around 20 herbs. In modern drug development computer models are often used when specific abnormalities are identified as the cause of the illness.
Once a drug is deemed useful it undergoes a series of trials, often starting with preliminary trials in animals. Many drugs do not go past this stage and if it passes this stage, it goes through a series of clinical trials.
Phase I trials:
usually in healthy volunteers to determine safety and dosing
Phase II trials:
Phase III trials:
large, pivotal trials to determine safety and efficacy in sufficiently large numbers of patients with the targeted disease. If the drug is shown to be effective and safe, an application is made to the regulatory agency for approval. Once the drug is approved it could be promoted for use.
Phase IV trials:
sometimes the regulatory authorities stipulate that post-approval trials are also needed to ensure safety. They are called post-market surveillance studies.
In addition to efficacy, manufacturers must ensure that any long-term or chronic toxicities are well-defined, including effects on fertility, reproduction, immune system etc. They must also test the compound for its potential to cause cancer.
Drug development is a costly exercise which is time consuming too. On average, it takes more than five years for a drug to be introduced to the market. Phase III trials conducted in many centres, often around the world, can be very costly and a drug manufacturer may have to spend up to a billion US dollars, before the drug is marketed.
In this scenario, our Ayurvedic Research Institute announcing that they were ready with a Covid-19 cure, at the very beginning of the epidemic and launching two drugs recently is rather perplexing. When they made the announcement earlier in the year, they stated the drug was ready but they could not test it as there were no patients!
I do not deny there may be supplemental benefits of some of these preparations but they are not curing. In fact, so far there is no cure and we can only control. These introductions should not be allowed to dilute the preventive health messages, which have been shown to be very effective:
1. Keep a meter’s distance
2. Wear a mask
3. Wash hands frequently with soap and water (Any soap would do for viruses and there is no need for expensive anti-bacterial soaps)
By the way, we have had dengue for a very long period which has debilitated thousands and has killed many, much more than by Covid-19 had done. Where are the cures?