The New Straits Times, March 12, 2000
Prof Dzulkifli Abdul Razak
First a "ginseng-sponsored" ladies golf tournament, then a ginseng exhibition (NST, Feb. 26). Now a Grand Opening Unbeatable Promotion (NST, March 2).
Various claims are being made - invariably something for the family. One advertisement reads: "For the elderly, to prevent ageing; for the children, to improve memory; and for the whole family, total nourishing goodness. In addition for man to stay fit and vigorous, while for woman/expecting mom (sic): to stay youthful/better resistant against diseases".
Another brochure talked about stimulation of the production of immunoglobulins (IgA, IgG, IgM) that combat viruses and bacteria. For the skeptics, some even provide 'guarantees.'
While the claims looked like an exact science in themselves, many of the effects of ginseng remained invalidated scientifically.
In fact, using the criteria of pharmaceutical sciences, the story seems to be quite different.
The literature suggests that the scientific evidence for some of the claims given to ginseng root extract is, at best, weak.
This verdict came after a systematic review of randomised double-blind placebo-clinical trials (RCTs) involving "mono-treatment" of ginseng, that is, the use of ginseng is not combined with other medicinal substances.
Generally, it was concluded that "the efficacy of ginseng root extract is not established beyond reasonable doubt" for any of the alleged indications.
RCT is one of the vital hurdle that needs to be cleared when confirming the therapeutic value of a medicine.
This is to ensure that the effects of any potential medicinal substance are objectively assessed, without any preconceived bias - psychological or otherwise.
It clarifies and differentiates between specific therapeutic effects of the substance compared to the non-specific effects, such as the natural course of the disease.
Thus, those failing RCT, or not being subjected to one, in all likelihood will not be given any serious consideration to further develop the product to public use.
Unfortunately this practice is more confined to modern medicines, and not so for traditional ones - even those packed in modern forms.
Indeed many traditional medicines survive mainly based on its long history of use. Their claims are based largely on uncontrolled or non-randomised studies.
So what happen when they are subjected to such acid tests, like RCTs?
This precisely what the review is all about. Published in the European Journal of Clinical Pharmacology (1999) the authorsscrutinised studies involving ginseng used singly for various purported treatments.
These include those found in several well-established databases. They also contacted manufacturers and experts in herbal medicine.
Altogether there were 57 studies involving ginseng, but only 16 were RCTs using mono-treatment ginseng root extract alone, Panax or Eleutherococcus.
Indeed the reminder were not reported as double blind (one important criteria in RCTs), and therefore opened to bias.
This generally indicates that most claims attached to ginseng may not have been stringently validated.
Of the 16 RCTs, 7 studies related to physical performance, involving healthy people, sportsmen or athletes with ages mostly under 40 years. Four of the studies, found no statistical benefit for ginseng. In other words, the claim for improve physical performances, for man and woman, is not well substantiated.
The effects of ginseng on psychomotor and cognitive function seemed to fare better. Of the five trials evaluated, four with healthy volunteers (one of which included people over 60 years), three of them were found to be of a statistical benefit in favour of ginseng.
Needless to say there are many more tests where the benefits remained vague.
RCTs for the effect of ginseng on diabetes (type-II) and herpes were reportedly positive; the former found a significant improvement in glycosylated haemoglobin, while the latter found a significant improvement in frequency, severity and duration of herpes episodes. Again these were not too convincing since there were only one study reported to date for each case.
Ginseng's effect on immune-modulation in blood was even less convincing, there was no evidence that ginseng slowed the aging process or helped mental or physical functioning in the elderly.
No mentioned were made about the action of ginseng on memory, youthfulness or "total nourishing goodness" as far as RCT was concern. Until the respective RCTs are done, such claims have to be viewed with caution.
More importantly, from the review of ginseng, information on adverse effects were also extracted from the trials with other evidences from the literature.
Ginseng which is usually regarded as benign, with no known adverse effects. Nevertheless, acute toxic reactions like "explosive" headaches, chest tightness and cerebral arteritis have been cited. So too, "ginseng-abuse syndrome".
Many local root extracts probably face the same predicament, with the many claims being bandied around. For example, Tongkat Ali - dubbed the Malaysian ginseng - is said to be good for high blood pressure, ulcer, diabetes and malaria, among others. It is also mixed in coffee and tea, supposedly to enhance alertness.
Although Tongkat Ali claims to raise the level of the male hormone, testosterone, it is not explained how this helps to treat the various ailments. Is there any scientific evidence?
Scientifically, therefore, is difficult to put our full trust on the numerous claims heaped on local herbal plants like Tongkat Ali.
This is not to say that they have no medicinal value, or are inferior. But one must be able to separate "the chaff from the wheat" based on good scientific evidences.
Be extra cautious when listening to the pharmaco-entrepreneurs - they are quite willing to exaggarate their claims for profits, regardless of the health consequences.
Consumers be more aware, and less gullible when evaluating the many glowing marketing claims on such herbal products.
