Bachelor of medicine
Illustration of eucalyptus and eucalyptus essential oil (Shutterstock.com/File)
The Agriculture Ministry’s recent Introduction of its "anti-coronavirus eucalyptus necklace" has prompted a paradigm shift in public response to the information they receive. The ensuing public debate and skepticism show that people are starting to check their facts as they called for clarification from manufacturers, researchers and the mass media.
The initial claim was that the necklace would kill a certain percentage of the SARS-CoV-2 virus that causes COVID-19 if it was worn for a specific duration. A later clarification said that the eucalyptus necklace was jamu (traditional herbal medicine) that had passed preclinical tests and was intended as aromatherapy to provide an uplifting effect.
“We were not overclaiming it as 'anti-coronavirus', as this was not stated in the BPOM [Food and Drug Monitoring Agency] license for the necklace and inhaler. We registered it as jamu, and did not test it for [treating] COVID-19 directly, but for all coronaviruses,” Fajdry Jufry, who heads the ministry's research and development division, said during a press conference earlier this week.
Amid the government's constantly flip-flopping stance and conflicting views, the public has been prompted to investigate jamu and herbal therapies on their own: Are herbal medicines really effective in curing disease? Where do they stand with respect to modern medicines? To what extent are they being used in Indonesia?
Indonesia has prided itself on its vast wealth in natural resources, including native plant species with medicinal properties. According to the BPOM, Indonesia is home to more than 30,000 native plant and algae species that contain alimentary compounds. These compounds have cytotoxic, anti-inflammatory or anti-pathogenic properties with potential applications as alternative medicine, pending scientific research conducted in an objective and standardized manner.
By February, 23 phytopharmaceuticals and 62 standardized herbal medicines – informally referred to as "obat herbal" (herbal medicine) or "jamu" – had been registered with the BPOM.
Not to be confused, phytopharmaceuticals are herbal medicines that have passed standardized clinical trials in humans, while "standardized herbal medicine" refers to plant derivatives that have passed preclinical trials in a laboratory setting.
Passing a preclinical trial does not mean that a substance has been proven effective and safe for human use. Subjective testimonies from individuals or nonstandardized groups does not prove applicability to the majority of a general population. This is why clinical trials are necessary to adjust the substance's dose and dosage form (tablet, capsule, oral suspension, etc.) for consumption by the general population.
While phytopharmaceuticals and standardized herbal drugs have long been defined in ministerial and BPOM regulations, the public and the media had only recently started regarding the two as distinct medicinal types.
Although the field of phytopharmaceutical research is growing, Indonesia still has a long way to go in developing its medicinal herbs as phytopharmaceuticals, with around 9,600 plant species still needing research on their potential medicinal applications. That Indonesia produces more herbal medicines than phytopharmaceuticals is perhaps inevitable, as clinical trials are much more complex in terms of the resources required and the significance of their results than preclinical trials.
The good news is, Indonesia is actively pursuing research on herbal therapies. In 2019 alone, 19 herbal species researched under BPOM supervision were licensed, while eight trials comprising five preclinical trials and three clinical trials were conducted.
Knowing the facts, it is still disappointing to see that public exposure tends to focus on recently registered herbal drugs instead of phytopharmaceuticals that have been licensed for safe use in humans. The spotlight is always reserved for researches claiming to have produced "significant results", regardless of the current phase or methodology of the research.
As vague as it may be, people still want to hear of alternative means of treating diseases that are more affordable and more culturally acceptable. This has often led to the premature release of the results of researches on herbal medicines, most of which are not ready for clinical use.
In addition to the risk of misinformation, prematurely publishing research results might end up overshadowing and devaluing standardized researches into other herbal medicines in terms of public perception. People might end up developing trust issues regarding all herbal therapy researches, due to earlier publicized studies that caused controversy and misrepresentation of the entire field. This is a shame, because Indonesia has great potential in the medicinal plant industry.
“It was [called] anti-coronavirus because it is just a prototype. It serves to encourage researchers that we are getting closer [to developing anti-coronavirus treatment],” Fadjry told kompas.com.
Using the same premise of altruistic intentions, Health Minister Terawan Agus Putranto told detik.com, ”[Regardless of the effectivity of the contents] that "the most important thing is [that] it lifts our spirits psychologically and mentally, and also boosts our immune system”.
Does recognizing the potential of herbal medicines as anti-coronavirus treatment justify the premature publication and promotion of herbal drugs, even they have not been proven to be clinically effective and safe?
This is a common phenomenon around the globe, with the World Health Organization's (WHO's) Africa branch stating that many herbals were touted and promoted socially with only minimal evidence of their quality, safety and efficacy. WHO Africa implied that the danger of this phenomenon was that unproven traditional medicines claiming to be treatments for COVID-19 gave people a false sense of security, distracted them from following proven preventive and curative measures, and increased instances of self-medication.
As with the eucalyptus necklace, premature publication and commercialization can only be justified if it did not lead to public misperception and belief in a false cure that then caused people to neglect physical distancing, hand washing and prescribed evidence-based medicines. While the placebo effect is an empirical concept – in which the state of our minds affect our physical health – and may lead to public acceptance of the eucalyptus necklace, the question still remains: Can it replace clinically proven and evidence-based medicines?
Ari Fachryal Syam, the dean of the University of Indonesia medical school, has suggested an appropriate mindset for this situation: “Do not overreact, but do not be skeptical [either].”
This situation is a reminder for us to be supportive to the development of herbal drugs for its vast potential, while serving as the check-and-balance system by being selective consumers.
Therefore, critical analysis of newly publicized traditional solutions should be put into habit, and hopefully, it will inspire essential stakeholders to be wiser in dealing with similar matters in the future. (kes)
The writer is a bachelor of medicine currently researching targeted herbal therapies for breast cancer on her clinical rotation under the University of Indonesia medical school-Cipto Mangunkusumo hospital (FKUI-RSCM) program. She is passionate about phytochemistry, bioinformatics and internal medicine, and has published an article on alternative therapies for sleeping disorders.
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Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.