RRP ISA Survey Results


    Rumors of Toxicity, Ridicule and Racism

    I was talking to an otolaryngologist a few days ago before an unsubstantiated rumor flew across the RRPF listserv (no blame whatsoever to the RRPF, whose listserv is helping to network people), that artemisinin is toxic. This, despite the fact that the World Health Organization recommends it for kids as young as two years old.

    The otolaryngologist and I shared similar speculations. Such rumors spread with viral speed on the Internet. The person who posted it absolutely meant no harm. He was merely passing along an opinion (itself unsubstantiated) from another person.

    It is important to address it forthwith, however. Also, a small number of patients have reported that they discussed using artemisinin with their physicians, but were shot down. I wasn't present, and I couldn't say for sure what happened, but these patients reported that they felt ridiculed.

    First, let's look at the rumor of "toxicity."

    Our website states very clearly that one must be very careful in dosing. I am not a physician, however, and am not qualified to dispense medical advice. The WMD-guideline may or may not be optimal for other patients. More testing needs to occur to determine optimal dosing schedules. You are reminded to check with your physician if you have questions, and always consult with him or her in using any adjunctive treatment for RRP, including artemisinin.

    The World Health recommends artemisinin for children as young as two years old. A two year old DID take ART for RRP, and his mother said said she followed the guidelines as posted on the website. Keith's son followed the guidelines and nothing untoward happened. Others have reportedly done this as well. As far I know, our dosing guidelines are generally within treatment guidelines for the use of ART for malaria. Toxicities don't seem to be an issue.

    Yet given the allegations of ridicule, however, something else may be happening. First of all, let us say that physicians naturally are reluctant to endorse herbs and naturopathic remedies not approved by the FDA. But off-label use of drugs that have been FDA approved--even cidofovir, for example--occurs all the time. The FDA takes an average of over 10-13 years to approve a drug. It rarely looks at off-label usage.  The mystique of FDA approval, therefore, only goes so far.

    Artemisinin is already endorsed by the World Health Organization, and approved by medical authorities all over the world. It is not considered by these agents to be naturopathic. One can reasonably expect hat it has been thoroughly tested in malaria-stricken countries. It is manufactured for use overseas by established pharmaceutical houses, similar to Merck, etc.

    As our website says, it is also being used with increasing frequency in oncology circles and articles have been published in respected journals showing that in some cases, it is at least as effective as chemotherapy. Our point is that artemisinin is not a untested article, and any physician claiming to be even marginally informed on the subject should already know this.

    So let's ask what the actual resistance to the use of artemisinin might be amongst those who have ridiculed it.

    One basis for resistance is doubt about the sourcing of the artemisinin. It is entirely reasonable for a physician or patient to at least have the following thoughts:

    Hmmm.  This medication is apparently outside the U.S. pharmacopoeia, somewhat like the long list of herbal remedies that one can obtain here without a prescription. My understanding is that not only have these herbs not been systematically tested for benefit, but in some cases, spot checks have revealed that some formulations don't even contain what the bottle says they do . . . Hmmm.  Salmonella on tomatoes; lead in the paint used on toys; Hmmm . . .

    I don't think one can avoid having some musings like this. They're fully in keeping with issues relating to "due diligence."

    Part of the basis for further resistance to use artemisinin is also the relative lack of data on its use in RRP. But interesting data already exists, as you can see from reading the material on RRP ISA's website (www.rrpwebsite.org) under Learn>Novel Therapies, and pages appended to that section. Many RRP patients have in fact reported that they responded positively to ART

    Where things become concerning is when patients receive ridicule from their physicians for suggesting artemisinin as a possibility. Ridicule isn't an established scientific method. It goes beyond mere skepticism. What would account for an attitude of ridicule or summary dismissal?

    Could it be that there might not ALSO be yet another kind bias that's perhaps also fueling some of the "resistance" amongst certain physicians or patients who approach the subject of artemisinin? This would be a kind of bias that might never be discussed out loud. It is almost certainly unconscious, and its roots may very-well be racist in origin.

    Unfortunately, what isn't data-driven in America is all too often characterized in medicine as either superstition, witchcraft or fluff. Is that kind of exclusionary attitude really justified, however?

    To regard ART as just a "Chinese folk remedy for malaria," however, reflects a depth of ignorance and an unconscious attitude that is essentially prejudicial. I am not asserting that this is in fact the basis of resistance to ART as an adjunctive tool for RRP. It most likely isn't very often.

    But yes, this could one of several dynamics at work. It certainly would explain some of the ridicule.