The New Straits Times, June 25, 2000
By Prof Dzulkifli Abdul Razak
THE recent announcement by the Health Ministry not to use adulterated traditional medicines should be taken seriously (NST, June 21).
Five years ago, the Pharmacy Enforcement Division of the Health Ministry detected eight traditional medicines in the form of makjun, jamu and Chinese herbs containing scheduled poisons like steroids and indomethacin, a non-steroidal anti-inflammatory agent (NSAIDS).
What are steroids? And why are they used as adulterants?
Steroids are naturally occurring and synthetic fat-soluble chemicals. They include hydrocortisone, cortisone, betamethasone, dexamethasome, prednisolone and progesterone, as well as the female and male sex hormones.
In most oral contraceptives, female sex hormones are used to inhibit ovulation. Collectively, in the body, they play a number of significant and diverse physiological roles.
As medicines, perhaps the most widely used steroids are from the group known as corticosteroids, used for a variety of skin ailments, rheumatoid arthritis, asthma and allergies, and various eye diseases, and in cases of the malfunctioning of the adrenal gland.
Anabolic steroids are commonly abused by athletes to induce weight and muscle gain.
Originally developed to help cancer patients and starvation victims, they are derived from the male sex hormone testosterone. The International Olympics Committee banned the use of steroids in 1974.
Steroids are not without risks. Some of the known adverse effects are: osteoporosis, diabetes, hypertension, sodium and water retention. Muscle wasting and euphoria have also been reported. In high doses, steroids may cause Cushing's Syndrome resulting in rounded 'moon' face.
The link between steroid use and fracture is one that cannot be overemphasised. According to a new study, frequent use of oral steroids can increase the risk of fracture by 70 per cent. This is considered a much faster rate of "bone-wasting" than previously predicted.
The drugs associated with this increased risk, the oral corticosteroids, are prescribed for a number of inflammatory conditions such as asthma, joint disorders, and inflammatory bowel disorder. The study also suggests that when the drugs are stopped, the risk decreases with similar speed.
Steroids seem to be a preferred adulterant maybe because of rapid onset of action to relieve symptoms.
Thus, some may have mistaken it for an effective cure, although generally, steroids do not treat or cure the underlying cause of the disease. But this misconception usually helps in the sales of the product. As traditional medicines are usually associated with long-term use for chronic illnesses, quick relief will further boost sales.
such as lead and mercury are also common adulterants. For example, tests on 2,700 samples of traditional medicines by the National Pharmaceutical Control Bureau, between 1993 and 1995 indicated that about 12 per cent failed to comply with the limit test for lead.
The increasing popularity of traditional medicines makes them tempting targets. While the unscrupulous have few qualms about riding on this trend, most users are not aware of any contamination. This could be due to the perceived image that traditional medicines have been proven safe and efficacious over hundreds of years.
Such perception tends to be enhanced as traditional medicines get into the mainstream modern pharmaceutical outlets, presented in well-packaged modern dosage forms. When placed alongside other modern (allopathic) medicines, it further gives the impression of that the potency of traditional cures are comparable to that of the modern counterparts, while the risks are negligible.
Unlike modern medications, some of these traditional medicines possess a range of tantalising claims - arthritis, depression, diabetes, menstrual irregularity, and pulmonary conditions. Many more imply that they are good for sexual prowness.
Traditional medicines are considered harmless due their close association with food. Familar items like garlic, onion, celery, ginger have been presented both as traditional medicines as well as food substances. The blurring of boundaries between the two tends to give traditional medicines the image of safety.
In reality, users are not sufficiently informed about the multiple ingredients that many traditional medicines contain. The impact on our health is not well established or documented (NST, Poison Control, March 12).
Thus, any contaminant can be added with relative ease among the many undeclared components. This is more so when the product is of a heterogenous nature.
Moreover much about the potential side-effects of traditional medicines is still unknown. Thus, any effects arising from adulteration could be passed off as due to any of the components, perhaps a desired and expected one. All these make traditional medicines very vulnerable but still a popular choice of therapy.
In the medical literature there is an increasing body of evidence on the adverse effects of herbal remedies which form an important part of traditional medicine. Examples of such effects include allergic reactions, toxic reactions, even possible mutagenic effects. Jaundice is a common effect on the liver arising from the use of herbs after the delivery of babies.
With the increasing use of traditional medicines, the public is faced with an increasing risk of harm if their proliferation remains unchecked. Insufficient documentation, poor product and warning labelling, as well as the gullibilty of the consumers, are among the other factors that must be put right.
As the Ministry is short on resources to monitor the situation, consumers must exercise vigilance when using traditional medicinal products. They will not only protect themselves, but also help protect our own medicinal heritage from being corrupted and destroyed.
