Science: COVID-19 Special, Paradigm Shift

 

The Japanese honeysuckle (Lonicera japonica, Caprifoliaceae) is used since ancient times as a traditional Chinese medicine to cure symptoms of what would later be described as respiratory virus infection, almost a thousand years later! Is it a snake oil or something valuable?

 

The COVID-19 pandemic has shown the world that how unprepared humanity can be when faced with a novel virus capable of mass destruction. At least 3.5 million deaths are attributed to COVID-19 at the time of writing (May 2021), and it's most likely a conservative and under-reported figure. I'm not an economist, but the damage to economy by this pandemic has forced poor people to seek poisons to end their lives, and it's for a whole family. It is all a sad set of affairs, and in part due to human greed and ignorance. Not just politicians or lowly educated society, but the very scientists and doctors who are at the forefronts of fighting the COVID-19 pandemic. 

You see, I'm a chemist working in the line of phytochemistry (plant-chemistry), aiming to obtain novel natural products useful to treat diseases. Novel here refers to chemical compounds that have never been characterised before, perhaps containing wildly new chemical connectivity or functional groups. That then goes into publication in science journals, which may or may not be peer reviewed, but believe it or not, it increases my key performance index in academia. In turn, the science journals are rated according to the numbers of citations (references made by other researchers) they accumulate. Know this, research is extremely expensive, but the output cannot be guaranteed to be always impactful. That leads to serious flaws in academia, but it's the way it is. Now, in the face of a rapidly evolving situation like COVID-19 pandemic, the value of novelty in science research has been put into perspective. Novel vaccines, novel drug delivery methods, novel computer designed small molecule drugs, countless science journal articles are published everyday to offer novel solutions. Some of them are so promising, the journals decide to publish them as pre-prints that have not been peer-reviewed. Moreover, for the pharmaceutical industry, novel products get a patent, and that turns into big business! This is certainly an age of information, but I'm left to wonder how many of these novel solutions actually work, or are they even replicable? Most importantly, when they are applied in real life, are they safe? What happens if we face novel side effects? Then how do we deal with them? For instance, we are barely beginning to understand the detrimental pro-inflammation, pro-thrombotic effects of the COVID-19 viral spike protein, but it's part of the novel solution we offer via mRNA vaccines. While I do not deny the need and urgency to explore novel therapeutic approaches, and I am certainly not an anti-vaxxer, I wonder what value remains for old drugs, or conventional vaccines during this pandemic?

Turns out, they are very valuable! That's because we already know how they would behave, as we have studied their chemical and safety profiles to the extent where highly rated science journals wouldn't normally accept them nowadays. However, in the face of COVID, many old drugs including small molecule natural products like colchicine and ivermectin have been  repurposed according to our new found knowledge on viral pathophysiology (mechanism of disease). Numerous studies have shown that old drugs like ivermectin could alleviate and reduce COVID deaths to a marked or at least significant extent. There are of course counter-evidences and biases for every study, but look at the big picture and I suppose the evidence is pretty clear. This should be very good news for countries and people who cannot afford to pay for novel vaccines or patented drugs, because old drugs like ivermectin all but have their patents expired. While everyone in the scientific world is striving to practice evidence based medicine, the leading authorities seem to be all too careful about their statements. If anything, these are potentially promising drugs, cheap and worthy to be used in larger trials, their safety profiles are well-known, and they can be used in conjunction with mass vaccination to reduce healthcare burden and deaths. What prevents the authorities from giving them a try? I honestly don't know, but I hope it's not because old drugs don't generate business without a patent. One can argue the same for the conventional attenuated COVID-19 vaccines. I don't understand why we have so much media attention, research funding, and publications on the novel vector vaccines, while the relatively few but very promising results of conventional attenuated vaccines got little to no attention? Again, are we biased or worse, misguided  into giving too much hope and positivity to research novelty, yet overlooked the old but gold solution? Even in my line of work, I just realised that my highest impact article wasn't about any novel compounds or novel plants. It's about an age old known compound that has been repurposed to fight cancer. I'm not trying to point fingers at any parties, but this is how the pandemic made me feel about the meaning of my own work.

 

And then there is science from China and traditional Chinese medicine (TCM), but let me first explain the problem. The golden rule of pharmaceutical chemistry is to produce pure chemical compounds or drugs that can be tested and measured in an accurate dose, in line with the ethos of pharmacy, to safeguard the dose of drugs and do no harm. That being said, I used to be very doubtful of alternative medicines, even attacking their lack of accuracy for being pseudoscience. I've always been faced with arguments such as the antiquity claim, 'if something lasts so long it must work', and I would brush them off professionally. But recently having been locked down in home, I started to consider the role of alternative medicines, specifically TCM, something that never crossed my mind. After all, I practice evidence based medicine, relying on whatever that is proven to work and is safe in treating a disease. Proven not by hear-say, not by individual claims, but rigorous testing from the test-tubes to the real human body, which takes about 12 years believe it or not. Needless to say, that takes a lot of resources, teamwork, and honest reporting. Countless drug candidates simply didn't make it through in their first year. Wasteful it may be, but that's the sort of idea that ensured the safety and efficacy of so called western medicine, to the point that it can consider others as alternatives, often viewed as inferior due to a lack of evidence. 

 

A close friend of mine who has a doctorate degree in TCM once said this to me, 'if you view (study) TCM the way you view western medicine, you will never get anything useful out of it because TCM doesn't work that way.' Well of course I said, not that it's really useful. Thinking back, how naive I was! This time, I am viewing TCM more seriously. Looking at the statistics of the COVID-19 mortality in China vs. the western countries or even the world, it's remarkably different. I am going to trust that China has nothing to hide because they really don't need to. The Chinese have  done very well if not the best in handling this pandemic, so we should humbly learn from them. One of the things that I have greatly overlooked is the potential benefit of TCM. As I understand from my colleague in China, they adopted a combination of TCM and western approach to treat COVID-19 patients. Often in the very early stages, they prescribe patients TCM, aiming to reduce disease severity. Apparently based on many accounts, and articles published in China's medical journals (mostly written in Chinese), it worked. I understand Chinese, and I can tell you that their journal articles are just as good as western science. Seriously, if you still think China is this Barbarian country with communists and genocidal tyrants, think again and unwash your brain from the propaganda of western media.

 

In fact, this TCM is no secret either, it was developed during the SARS epidemic and now, it's making a much anticipated come back. It's called Lian-Hua-Qing-Wen (连花清瘟). One of the herbs used (about 15 of them) is the one you see up here in the picture, Lonicera japonica. Unlike western medicine, 连花清瘟 is a mixture of herbs with thousands upon thousands of chemical components. No one knows exactly which is the active chemical but the fact is they need to be in a mixture to be most effective, perhaps they work in synergy? It is this aspect that makes TCM fundamentally incompatible with western medicine. It is very hard if not impossible to quantify from TCM a uniform dosage of pure component, which may remain unknown. Regardless of what we think and the little I know about TCM, it plays a pivotal role in China's fight against the COVID-19 pandemic, which turned out to be the most successful. Don't look down on TCM because the drug that won the 2015 Nobel prize in medicine, artemisinin (anti-malarial) was discovered via TCM phytochemical research. Artemisinin has saved countless lives in the tropics, but Western media seldom focus on its success because after all, malaria remains a 'third world' disease. Think about it!

 

All in all, the COVID-19 pandemic showed us that what we know as collective human knowledge is always limited. While it is imperative for us to seek novel solutions, it would be foolish to ignore the role of old medicines, conventional strategies, or even traditional Chinese medicine in this rapidly evolving pandemic. If anything, they deserve more research and attention! In fact, most of them are well-known to be relatively low risk, so that's all but more reasons for us to study them. How, I asked myself? First and foremost, I've got to be more humble, open minded, critical, and accepting.

NB: I am NOT promoting the use alternative medicines like homeopathy that are proven to be non-effective in treating diseases. I am solely referring to TCM in this article, which deserves more research interest and/or clinical trials. Unlike homeopathy, herbs do contain pharmacologically active or even toxic compounds, which are often time the basis of modern medicine. My honest opinion is that we take what is good out of TCM and leave out the less efficient aspects. In a way, we improve on both sides.