Journal of Integrative Medicine xxx (xxxx) xxx

Contents lists available at ScienceDirect

Journal of Integrative Medicine

journal homepage: www.jcimjournal.com/jim
www.journals.elsevier.com/journal-of-integrative-medicine

Commentary

Dangers of scientific bias against herbal drugs for coronavirus disease

2019
Jonathan M. Fields
Integrative Medicine US, Tamarac, FL 33321, USA

a r t i c l e i n f o a b s t r a c t

Article history: On May 15, 2020, the Lancet published an article titled Use of Herbal Drugs to Treat COVID-19 Should be
Received 1 June 2020 with Caution. While this is true of all drugs, herbal and otherwise, the data may be biased and deserve
Accepted 28 August 2020 a scientific response. We believe these types of reports will unfairly and negatively impact the field of
Available online xxxx
integrative medicine as a whole, and must be answered with facts and statistics that more accurately
represent the current situation.
Keywords:
Herbal
Coronavirus Please cite this article as: J.M. Fields Dangers of scientific bias against herbal drugs for coronavirus disease
COVID-19 2019. J Integr Med. 2020; xx(x): xxx–xxx
SARS-CoV-2 Ó 2020 Shanghai Changhai Hospital. Published by ELSEVIER B.V. All rights reserved.
Medicine, Chinese traditional
Complementary therapies

1. Introduction COVID-19 shares 79.5% of its genome sequence. There have been
many other smaller studies published as well.
The author of the Lancet submission [1] took issue with three The author claims these studies are based on anecdotal clinical
herbal drugs that were approved in China for the treatment of data. While partially true, this is a large-scale study. Further, many
coronavirus disease 2019 (COVID-19). They cited lack of evidence studies are currently being conducted in Europe and other places.
for their efficacy and safety concerns, but also voiced other reasons It is also based on current data for an ongoing epidemic. It is not
why China should not have approved these herbal drugs for treat- realistic to expect that any of these would exist for herbal drugs
ing respiratory symptoms of COVID-19. This critique was overly or conventional drugs at the moment because this is all happening
harsh, partially inaccurate and relied on data that had been taken real time. We do not have the luxury to wait.
out of context. The following is a point by point rebuttal of the arti- Furthermore, the same logic also dictates that no pharmaceuti-
cle, and an explanation of why herbal drugs are safe and effective. cal medications are safe or effective for COVID-19 either, as there
have been no large-scale, high-quality, peer-reviewed randomized
clinical trials of Western drugs for the treatment of COVID-19.

2. Existing peer reviewed studies 3. Safety concerns

The Lancet author claims that there have been no high-quality, The author quotes safety concerns about herbal remedies. First,
rigorously peer-reviewed clinical trials of herbal drugs published he cites a study from the 1990’s of an herbal weight loss product
in internationally recognized journals. However, The International that caused injury to nine women who participated in the study
Journal of Biological Sciences published a review on March 15, [3]. The clinic had previously been providing herbal therapies for
2015 [2] that reported how 85% of the 72,528 patients included over 15 years without incident. This is a prime example of the type
in the study had been treated with herbal remedies, including of anecdotal clinical data that the author condemns, and he does
some of the patent herbal drugs in question, in addition to stan- not even mention if any of these herbs are in the current COVID-
dard drug therapy. The study also cites the success of herbal reme- 19 treatments.
dies and positive results from many studies of the 2002–2003 He says that further investigation revealed the culprit was ‘‘aris-
severe acute respiratory syndrome (SARS), with which the current tolochic acid, a compound found in many traditional herbs.” This is
simply false. There are thousands of traditional herbs, about 200 or
E-mail address: [email protected] so in common use, and only about 5 or 6 are known to contain this

https://doi.org/10.1016/j.joim.2020.09.005
2095-4964/Ó 2020 Shanghai Changhai Hospital. Published by ELSEVIER B.V. All rights reserved.

Please cite this article as: J. M. Fields, Dangers of scientific bias against herbal drugs for coronavirus disease 2019, Journal of Integrative Medicine, https://
doi.org/10.1016/j.joim.2020.09.005
J.M. Fields Journal of Integrative Medicine xxx (xxxx) xxx

compound [4]. These herbs are rarely used and some are banned in Lastly, according the World Health Organization global report on
the United States and Europe. Even when they are prescribed, they traditional and complementary medicine in 2019 [9], ‘‘Traditional
are commonly used in micro-doses in combination with other medicine has a long history. It is the sum total of the knowledge, skill
herbs and are processed in ways to mitigate toxicity. and practices based on the theories, beliefs and experiences indige-
While this is concerning, nonsteroidal anti-inflammatory drugs nous to different cultures, whether explicable or not, used in the
(NSAIDs) like aspirin, ibuprofen and acetaminophen cause over maintenance of health as well as in the prevention, diagnosis,
7600 deaths per year in the United States alone, and their use improvement or treatment of physical and mental illness.”
results in internal bleeding in many more cases [5].
This entire point can be invalidated very quickly with the fol- 6. Molecular mechanisms and efficacy
lowing questions: (1) How many people have died on record last
year from herbal drugs? Maybe a handful. (2) Do we have proof The author complains about the molecular mechanism being
of even one? They certainly did not list any evidence to suggest obscure, yet they openly admit that some of these patent herbal
so, only a study from nearly 30 years ago with nine injuries and drugs have wide spectrum anti-viral and anti-inflammatory effects
no deaths. (3) How many people died last year from prescription and cite the respective studies [10,11].
opioids, NSAIDs and medication errors in hospitals in the United The fact is that almost every single pharmaceutical drug in use
States alone? Hundreds of thousands [5–7]. (4) How many drugs today is based on compounds extracted from herbs. That we do not
have been recalled after being thoroughly researched in exactly know the exact method of action for each compound of each herb
the type of high-quality studies they are requesting, yet went on does not mean that it is not safe or effective. Quite the opposite is
to kill hundreds of thousands of people before being pulled from true. We have thousands of years of actual clinical experience, as
the market? Viox, Losartan, Fen-Phen, Baycol, Posicor, Bextra and well as the recent data collected during this outbreak and the ini-
more. tial SARS outbreak of 2002, that proves it is safe and effective. We
So scientifically speaking and based on all the statistics we have, do not know exactly how safe or how effective, but tens of thou-
herbal drugs are infinitely safer than pharmaceuticals will ever be. sands of lives are at stake now on a daily basis. We cannot afford
He advocates for more evidence through controlled clinical trials. to hold herbal drugs to impossible standards that are even more
We wholeheartedly agree. We would like to see the same for all stringent than pharmaceuticals based on prejudice. We need solu-
medications being used to treat COVID-19 as well. But should we tions immediately and herbal drugs are proven to be much safer
try nothing until they are all proven to be safe and efficacious? than conventional drugs.
The author states that ‘‘limited experimental cell cultures and
4. Customized remedies animal studies cannot guarantee safety and efficacy.” But the
whole world is currently testing pharmaceutical medications and
The author takes issue with herbal remedies being tailored to vaccines on people without any of these same studies.
the individual. However, we clearly know the allopathic, Western An excellent reminder, is the 2015 Chinese Nobel Prize winner,
pharmaceutical, one-size-fits-all model does not always work. Peo- Professor Youyou Tu. She saved millions of lives from drug resis-
ple have to switch medications all the time due to issues like aller- tant malaria with an herbal drug based on traditional Chinese
gies, side effects and adverse reactions. Sometimes, no matter what medicine [12]. Due to the time-crunch, she tested the safety of
they try, the medicine does not produce positive treatment out- the final drug on herself and her team before going into produc-
comes. An integrative approach is quickly becoming more common tion. Had they waited for lengthy clinical trials, millions would
in conventional settings because of its demonstrated scientific have perished in the meantime, even though they had a perfectly
success. working prototype.

7. Over-the-counter availability
5. Historical use

Finally, the author claims that having a remedy available ‘‘over

The author argues that ‘‘thousands of years of usage and faith
the counter” will delay people from seeking proper medical diag-
cannot be taken as evidence for efficacy of traditional herbs.” While
nosis and treatment of the disease and making it harder to trace.
there is ample reason to be concerned about blind faith in sub-
Sure, in the same way Tylenol, Sudafed, NyQuil, Ibuprofen and
stances, thousands of years of well-documented clinical data,
every other over-the-counter medicine does just that as well. So,
tested on billions of people, should not be completely discarded
should we pull them all off the shelves worldwide when 80% to
as unscientific. We literally have case studies from thousands of
90% of the cases are mild and the symptoms are effectively man-
years ago, and a growing body of evidence from the last 50 years
aged by these medicines?
of modern laboratory research.
During the early stages of the outbreak in the United States and
Furthermore, the European model for standard registration of
Europe, citizens were encouraged not to go to the hospital or seek
herbal medicines clearly allows for herbal medicines to be used
treatment unless they had severe symptoms. They were told to
when they have shown to be safe and effective, even without clin-
stay home, self-quarantine, and use over-the-counter drug reme-
ical trials. The Committee on Herbal Medicinal Products issues sci-
dies. Testing was not widely available. That is still the current rec-
entific opinions on herbal substances and preparations, along with
ommendation, with the only difference being that testing is
information on recommended uses and safe conditions, on behalf
available and can be used for tracing. In times like these, it is com-
of the European Medicines Agency. Traditional use registration is
mon sense to stock up on just-in-case remedies and over-the-
granted (Article 16a(1) of Directive 2001/83/EC) [8]: ‘‘No clinical
counter products. Yet the author seems to only discourage the
tests and trials on safety and efficacy are required as long as suffi-
use of herbal products and completely disregard the alternatives.
cient safety data and plausible efficacy are demonstrated involving
assessment of mostly bibliographic safety and efficacy data. Must
have been used for at least 30 years, including at least 15 years 8. Conclusion
within the European Union. Are intended to be used without the
supervision of a medical practitioner and are not administered by We believe that articles such as this try to exaggerate the risks
injection.” of herbal drugs compared to pharmaceuticals. Unfortunately, many
2
J.M. Fields Journal of Integrative Medicine xxx (xxxx) xxx

readers see the headlines, skim the articles and improperly assume [3] Vanherweghem JL, Depierreux M, Tielemans C, Abramowicz D, Dratwa M,
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2012.
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Conflicts of interest complementary medicine 2019. (2019) [2020-5-31]. https://apps.who.int/
iris/handle/10665/312342.
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