Geoff writes in:

A friend recently told me that this product was very effective for arthritis. I have tried it and the pain relief is excellent. However I read that this is a product that should be avoided. Can you please tell me if it is safe to take or should be avoided. I am an ex pat living in malaysia. Many thanks.

Hi Geoff. First of all, I would like to point out that the Malaysian Medical Resources provides Search facilities either using the custom Google search box above centre or the WordPress search box in the upper right of the main page. If you search for “tian ma tu chung seven leaves ginsengs” (without the quotes) you would note that we mentioned this product in a previous post Beware of suspect medicines

The Drug Control Authority has warned the public to stay away from 15 suspect medicinal products.
They are: Pil Tupai Jantan Asli, Jamu Ajaib, Maajun Petani Tongkat Ali, Kuku Bima Ginseng, Kuku Bima Ginseng & Kuda Laut, Crush Stone Super Kapsul, Obat Kuat Helbeh, Capsul Obat Kuat, Jamu Kuda, Tangkur Buaya, Tablet Kina, Oskadon — Obat Sakit Kepala, Paramex — Obat Sakit Kepala, Tian Ma Tu Chung Seven Leave Ginsengs and Mistura Xiao Chai Hu.
A DCA official has warned that some of them contain potent western medicinal drugs which are regulated under the Poisons Act. He said these drugs can cause harm if they are taken on a long term basis.

Adulteration of so-called traditional or herbal medicines in this region with potent pharmaceutical agents is rampant. Just do a Google search for Adulterated traditional medicine Malaysia and you’ll see what I mean. Pain relief is often remarkable because these “medicines” actually contain steroids with or without powerful NSAIDs. Indeed I have personally seen a number of unfortunate patients ending up Cushingoid after taking Chinese medicines for long periods for arthritic disorders like gout which could have been easily managed without steroids.
Pharmacy.gov.my has a News section which gives some warning on adulterated items that have been detected, but as you can imagine, this is only likely the tip of the proverbial iceberg as I suspect many more go undetected in this country. You consume “traditional medicines” in Malaysia at your own risk.

Sometimes doctors feel so exasperated. After talking to half an hour trying to explain concepts of say a particular cancer (about the disease, the plan of management etc) to patients, they will steadfastly stick to their beliefs. Take this thread on Discussion about Cancer in the USJ forums. Here are some of the rather outlandish beliefs of people participating in the forum

“There’s no cure for cancer, chemo is not a cure, it is just a temporary measure to slow down the spread of cancer cells.” (absolute crock)

“The fact is it has a lot to do with diet, you can’t just throw everything into your stomach. There are many reports on thestar newspaper that avoided cancer after changing their diet without going through the ‘cancer specialist’.” (there’s a very strong obsession with our local population about disease and diet – everything must be linked to food)

“The star articles was cancer patients and not healthy patients. They were saved from the cancer by changing their diet and not going to chemo” (more absolute crock)

“Chemo will only kill the bad and good cells temporarily, the bad cells can grow back. You’re not treating the root cause of the problem which is the diet.” (yup, the obsession with food again)

“a systematic cure for cancer still eludes us. the critical factor would be awareness and early detection. it would be helpful if u keep in touch with ur cells to prevent them from becoming rogue, by having a healthy mind.” (the mind is all-powerful. I am told you can even bring down a Qantas jet with mind power)

They call it Bullshit. Here’s the Youtube series (via Dr Anony)

I notice some of the alternative centres in town including “foot reflexology” centres offer Ear Candling as a service. I can’t imagine how “lighting one end of a hollow candle and placing the other end in the ear canal” can improve one’s well being other than it being a placebo effect.
Now the FDA has come out with a warning to Stay Away from Ear Candling

FDA believes that injuries associated with ear candles are likely underreported, and encourages consumers and health care professionals to report such injuries to FDA’s MedWatch Adverse Event Reporting program
Over the past decade, FDA has received reports of burns, punctured eardrums, and blockage of the ear canal which required outpatient surgery from the use of ear candles.
In its testing, Health Canada found that ear candles produce no measurable effect in the ear and have no therapeutic value.

A recent medical review advises that Herbal remedies, heart drugs don’t mix

Some herbal remedies may increase the potency of prescription drugs for heart disease or make them less effective, a team of experts concluded.
Mixing herbs and drugs also could cause serious heart rhythm problems and bleeding, according to the review published in the Journal of the American College of Cardiology.
Use of herbal supplements among elderly patients is especially concerning because they typically have more than one disease, take multiple medications and already are at greater risk of bleeding, the report said.
Previous studies have sounded alarms about use of herbal supplements which are not regulated like traditional medicines. This review examined how supplements and cardiovascular drugs may interact.
“We can see the effect of some of these herb-drug interactions — some of which can be life-threatening — on tests for blood clotting, liver enzymes and, with some medications, on electrocardiogram,” Dr. Arshad Jahangir of the Mayo Clinic in Arizona said in a telephone interview.
Many patients fail to disclose their use of herbal remedies so healthcare providers should be more probing, Jahangir said in a telephone interview.

This applies especially to herbal drugs like Ginkgo which also “thin the blood” so be warned.

Those with epilepsy or seizures should take heed of a current warning that Gingkgo biloba may increase the tendency to get fits ot sezures. The BBC reports

People with epilepsy should be warned that using a popular herbal remedy may increase the risk of seizures, researchers say.
German scientists, writing in the Journal of Natural Products, said they had found 10 written reports of seizures linked to ginkgo biloba.
They said they were convinced the herb could have a “detrimental effect”.
A leading UK epilepsy charity said the evidence was not yet compelling, although it said care was needed.

Related MMR posts on Ginkgo:
In a GEM of a study, another alternative treatment bites the dust
Another unclear study on Ginkgo
Gingko may not aid memory in healthy older adults
Ginkgo and Bruising

Ever noticed the mushrooming of shop-lots with the gaudy “feet” signage proclaiming that Reflexology services are available?
While the foot massage may be relaxing, it however fails the scientific test when it comes to an analysis of clinical trials

18 RCTs met all the inclusion criteria. The studies examined a range of conditions: anovulation, asthma, back pain, dementia, diabetes, cancer, foot oedema in pregnancy, headache, irritable bowel syndrome, menopause, multiple sclerosis, the postoperative state and premenstrual syndrome. There were > 1 studies for asthma, the postoperative state, cancer palliation and multiple sclerosis. Five RCTs yielded positive results. Methodological quality was evaluated using the Jadad scale. The methodological quality was often poor, and sample sizes were generally low. Most higher-quality trials did not generate positive findings. CONCLUSION: The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition.

Now I wonder if the MOH will implement “foot reflexology” in their designated CAM hospitals?

Interesting post by Dr. Rob who says it’s because Alternative medicine promises Magic

The answer, I believe, is summed up in a single word: magic. There are three facts that explain why so many people turn to alternative therapies:

1. People want their problems to magically go away.
2. Conventional medicine is not magical.
3. Alternative medicine promises magic.

A Cochrane review suggests that some Chinese herbal medicines may help to prevent diabetes (together with lifestyle changes) but more research is needed

The researchers considered data from 16 clinical trials including 1,391 people who received 15 different herbal formulations. According to their findings, combining herbal medicines with lifestyle changes is twice as effective as lifestyle changes alone at normalising patients’ blood sugar levels. Those given the herbal formulations were less likely to develop full blown diabetes during the study period. Trials included in the review lasted from one month to two years. No adverse effects were reported in any of the trials.
“Our results suggest that some Chinese herbal medicines can help to prevent diabetes, but we really need more research before we can confidently say that these treatments work,” says Grant. “The real value of the study is as guidance for further trials. We need to see more trials that make comparisons with placebos and other types of drugs, and better reporting on the outcomes of these trials.”

Australia’s judicial system has found baby Gloria’s parents guilty of failing to get proper medical attention for their child who had ezcema and have been sentenced to jail (via Digg.com)

The couple’s infant daughter died from an infection her weakened immune system could not fight off in May 2002, after her parents watched her health “deteriorate before their eyes.”
The Sams, from Earlwood, were found guilty by a Supreme Court jury in June of their daughter’s manslaughter by gross criminal negligence.
The jury found the couple had breached their duty of care as parents by persisting with alternative remedies for their daughter’s skin condition which “plainly weren’t working” instead of seeking conventional medical help.

Adults can make their own decisions but what when it comes to children? Now I can’t help thinking of what if it had been Malaysia. Seeking “alternative treatment” for serious illnesses like cancer rather than proper medical care is not unheard of, and it may be until the child is gravely ill from advanced disease beyond salvage. Will Malaysian courts find parents guilty like the unfortunate Sams?

For those who take red yeast rice to lower cholesterol or are thinking of doing so, you might want to read this article in Science-Based Medicine

While red yeast rice reduces LDL cholesterol levels and reduces the rate of major coronary events. The Medical Letter consultants concluded that it works, but they don’t recommend it.

Why? Read on…

Physician’s First Watch reports Chinese Herb Appears Better Than Standard Treatment for Rheumatoid Arthritis

Tripterygium wilfordii Hook F (TwHF) extract offers better symptom relief than sulfasalazine in patients with rheumatoid arthritis, reports Annals of Internal Medicine. (TwHF — also known as “thunder god vine” or “lei gong teng” — is used in traditional Chinese medicine to treat inflammatory conditions.)
U.S. researchers randomized some 120 adults with active rheumatoid arthritis to receive the extract (180 mg) or sulfasalazine (2 g) daily for 24 weeks. Participants were allowed to use stable prednisone dosing (up to 7.5 mg/day) but not disease-modifying antirheumatic drugs.
In intent-to-treat analyses, significantly more patients assigned to TwHF versus sulfasalazine achieved at least a 20% improvement in arthritis symptoms (65% vs. 33%). In analyses limited to the roughly 50% of patients who completed the study, results were similar. Adverse events did not differ between the two groups.
The authors write that three of TwHF’s metabolites — triptolide, tripdiolide, and triptonide — may account for its anti-inflammatory and immunosuppressive effects.

Ref: Comparison of Tripterygium wilfordii Hook F Versus Sulfasalazine in the Treatment of Rheumatoid Arthritis Ann Int Med 18 August 2009 Volume 151 Issue 4 229-240