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The case for anamed’s work – in the light of the current catastrophe in Zimbabwe and a recent report about malaria treatment in Uganda. December 2008 The value of Natural Medicine in crisis At the present moment the urgency of anamed and Natural Medicine is seen nowhere better than in Zimbabwe, where almost all systems have broken down – in many places there is no water, no waste water treatment, almost no health services and, in many places, no seeds for planting. Without utilising traditional skills or knowledge of nutritional and healing plants, and without working cooperatively, survival in such a situation is impossible. Tragic as the situation in Zimbabwe is, one could mention Nord Kivu in Congo, Darfur in Sudan, the camps of Internally Displaced People in Uganda and many other locations in Africa where the greed and power lust of politicians and industrial corporations brutally ignore the suffering of ordinary people. In Zimbabwe today there is a cholera epidemic. The anamed teaching on water purification and treatments of cholera is a lifeline for those who have attended our seminars. The value of Natural Medicine where the formal structures fail to deliver drugs and treatment Recent reports and publications have demonstrated that sometimes the structures that are in place to provide health care fail to deliver. Sometimes that is because the priorities of the organisations concerned are not concerned first and foremost with patient care. 1. Effective malaria medicines are not available to the poor in Africa. A recent report of the Medicines for Malaria Venture (MMV) showed very clearly how, although very effective malaria medicines (ACT drugs) are now manufactured and theoretically available, they are not reaching the poor in Uganda (1). This report was summarised in the British Medical Journal in November this year (2). This article writes: An entire new class of effective antimalarial drugs will have little effect on the prevalence of the disease unless they are made more affordable. Research by the government of Uganda and the non-governmental organisation Medicines for Malaria Venture shows that such drugs are "too expensive and not widely available for millions in Africa." The report concludes by saying that the ACT drugs must be made affordable. This would seem to be a veiled request for more aid. One of the researchers is quoted as saying: the only way that the new treatments would replace ineffective remedies was with massive subsidies from the private sector: "The only way we can make ACTs more accessible to the poor is if these are priced at the same level as chloroquine so that people can afford them." 2. The limitations of aid programmes: As anamed, we do not believe that this approach is the solution to the problem. A great danger of subsidies is that they create dependence, and not independence. The difficulty of targeting aid so that it really helps, and really reaches the poor, was recently emphasised by the Sierra Leone investigative journalist Sorious Samura (3). Over the last 50 years Western governments have paid out more than £400bn of tax payers' money in aid to Africa, but according to figures released by the World Bank this year, half of sub-Saharan Africans still live in extreme poverty, a figure which has not changed since 1981. And though foreign aid has helped lift millions of Africans out of poverty by helping developing economies to grow, for the poorest Africans little has changed. 3. Support for anamed: anamed believes that a better way is the “bottom-up” approach. We are thankful to Dr Simon Challand and Dr Merlin Willcox, who made a rapid response to the article in the BMJ (4). Anamed (Action for Natural Medicine) has promoted the cultivation and use of an artemisia hybrid in over 70 countries so that rural people affected by malaria have an affordable antimalarial option. More research is needed to develop an evidence base for the use of Artemisia annua and other traditional antimalarial plants to support the work of anamed and similar grassroots organisations. A network which seeks to do this is the Research Initiative on Traditional Antimalarial Methods (RITAM) comprising of over 200 researchers from at least 30 countries working together to validate the use of medicinal plants for malaria. These are small initiatives with tiny budgets but they provide a glimmer of hope in the desperate struggle against malaria. Dr FelixKonotey Ahulu, an eminent Ghanaian doctor, developed this theme further (5): Simon Challand and Mervin Willcox are absolutely right to emphasize the importance of encouraging us Africans to develop Artemisia annua and other natural antimalarial agents. .. my advice for what it is worth as from an African native with decades of experience of attempts at malaria control is this; “Do not seek international donor help with its built in contradictions, but continue with the grassroots upwards approach to education, and emphasis on public health measures as we witnessed in the Colonial Days. Evidence of your success will encourage us to help ourselves without relying on imported drugs that are unaffordable”. Encouraging support for the use of artemisia tea has come from the University of Leiden in the Netherlands (6). In their article in the 8 December 2008 edition of the Journal of Pharmacology, the authors write, “This self-reliant treatment includes the local production practices of A. annua followed by the possibilities for using traditional prepared teas from A. annua as an effective treatment for malaria.” 4. The limitations of the pharmaceutical industry: In today’s world, the first priority of the pharmaceutical industry, like any other industry, is not so much to save lives as to make a profit. That is one of the hard facts of life. This was recently stated very clearly by the Director of Roche in South Korea. When challenged to reduce the price of AIDS drugs, he said “We are not in business to save lives, but to earn money –saving lives is not our concern” (7). 5. Encouragement from the World Health Organisation: In September 2008, the Community Health Global Network (CHGN) based in London held a consultation with the WHO. The report (8) of this meeting includes the following: .. since governments provide less than 30% of health care, WHO now recognises the need to partner with the private sector, NGOs and FBOs (Faith based organisations). Such partnerships will help to integrate health care services, and enable NGOs to have a genuine influence in health planning and strategy, rather than just being service providers and advocates. We take this as encouragement to link as closely as possible with the WHO in the countries in which anamed is active. The need for scientifically sound research into artemisia tea. First and foremost, anamed believes in working with doctors, healers and other active in the community. As they are trained in Natural Medicine, the work is rooted in the rural areas and, whatever the political and structural problems, as the message spreads increasing numbers of people enjoy better health. The numbers of people who would benefit from Natural Medicine (as defined by anamed) would increase dramatically if the formal health structures (the WHO, Ministries of Health) were to recognise its value and efficacy. A first step would be to conduct thorough clinical studies of the use of artemisia tea for malaria. Some studies have already been conducted, but with disappointing outcomes that are quite contrary to anamed’s experience. For example, a clinical study, conducted in Tanzania, has been reported in the journal “Tropical Doctor” (9). The study compared the use of artemisia tea for malaria using 5g per day with 9g per day and with Fansidar. Regrettably, the authors wrote, “We conclude that mono-therapy with a tea preparation of Aa cannot be recommended for the treatment of uncomplicated falciparum malaria in adults.” The very recent paper in the Journal of Ethnopharmacology mentioned above is a great encouragement in the face of such conservative and, in our view, over cautious remarks. The case for the use of artemisia tea to treat malaria As always, we justify our continued promotion of artemisia tea as a treatment for malaria as follows:
A. Artemisia tea is absolutely not a monotherapy, as artemisia contains almost 300 substances, of B. In many areas artemisia tea is the only treatment available. If you say that to take artemisia tea is not C. Signs of resistance have already been reported to isolated artemisinin in the form of Artesunate. Now The reports we receive indicate that artemisia tea is effective in between 80% and 100% of cases. Following treatment with artemisia tea, patients may develop malaria again (although most reports indicate that patients remain free of malaria for longer than they did in the past). If they do contract malaria again, it is not a failure of the treatment, but a new infection. Artemisinin remains in the blood for a few hours only, in contrast to the longer established treatment Fansidar, which remains in the blood for several weeks. We would now welcome clinical studies that would give us a comparison between three alternative treatments: Group 1: Amodiaquine tablets and Artesunate tablets for three days (a usual therapy today). Group 2: Amodiaquine tablets for three days and also artemisia tea for these 3 days. Group 3: Amodiaquine tablets for three days and artemisia tea for a total of 7 days. If the results from groups 2 and 3 were at least comparable to the results from group 1, then African people could, with confidence, enjoy having an effective and affordable cure for malaria.
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