Dengue…

Rain, at least in Metro Manila and in other parts of the country, pours almost uninterruptedly for the last 7 days causing not only the perennial problem of flooding but the dengue scare. The Department of Health has been warning the public that H1N1 epidemic aside, dengue has to be taken with equal seriousness as a public health concern. Many died of dengue this year compared with the casualties of H1N1. Part of the problem is behavioral, that is, residents both in urban and rural areas, are often less alarmed-into-action for example with regard to how stagnant water can turn into a danger dwelling-zone for mosquitoes responsible for the transmission of the virus to human beings. Another part of the problem, or at least the solution to the problem is social, that is, the kind of specific remedy or medication often embedded within a larger social playgrounds inhabited by government agencies, climate of research, pharmaceutical companies, medical establishments, or indigenous attitudes towards local resources such as medicinal plants to say the least.

Let’s deal with some facts for a while. Here’s what the World Health Organization (WHO) had declared about dengue:

“Dengue is the most important emerging tropical viral disease of humans in the world today. It is estimated that there are between 50 and 100 million cases of dengue fever (DF) and about 500,000 cases of dengue haemorrhagic fever (DHF) each year which require hospitalization. Over the last 10-15 years, DF/DHF has become a leading cause of hospitalization and death among children in the South-East Asia Region of WHO, following diarrhoeal diseases and acute respiratory infections.”

Secretary Francisco Duque III of the Department of Health was quoted for this last week’s news:

“Duque said that in 2007, the country had more than 45,300 dengue cases and 416 deaths. It was also the third straight year that the country had been trying to push back an alarming rise in reported dengue cases, he added.

The health secretary described the pattern as unusual because they were reporting dengue cases even at the start of the year, which was outside the peak season of the ailment.”

I wish to tackle a bit of the social embeddednes of the dengue cure (or the search for it) and set aside the behavioral factor I curtly mentioned because it deserves a separate closer take. My facts are not that exhaustive as I rely entirely on online data available and stitch those through my personal perspective and exposure in social science and health.

I think we can agree on this: no one must die out of a mosquito bite. But given the circumstances of morbidity and mortality in the face of mosquito attacks, people living in tropical countries still grapple in the dark for an easement from the burden of the disease. Why? For the simple reason that no “scientific cure” in the form of vaccine or some potent drug are available. The WHO could only recommend this far as easement from the fatal blow of dengue:

– Bed rest
– Keep the body temperature below 390
– Paracetamol-Yes**
– Aspirin-No
– Brufen-No
– Oral fluids and electrolyte therapy
– Follow-up for any change in platelet/haematocrit

Very fine enough and understandable for a non-diagnostician. But for further diagnosis of dengue, the WHO guideline, standard as it is, is actually more pro-diagnostician than pro-ordinary patients, especially when it comes to laboratory analyses for example of platelet levels, determining the plasma leakage, or the febrile from the afebrile state of the patient. There is always that part of the medical world that remains strange to ordinary patients regardless of the very personal experience of illness. When things get worse, said the WHO, visit your nearest hospital, but don’t expect too much beyond those temporary balm mentioned above:

“Patients and households should be informed that severe abdominal pain, passage of black stools, bleeding into the skin or from the nose or gums, sweating, and cold skin are danger signs. If any of these signs is noticed, the patient should be taken to the hospital.”

Even in the caring hands of diagnosticians and doctors, patients and their families still will grapple in the constricting rooms of confinement or perhaps financial grip. That’s the truth! How many times have we heard families of dengue patients being informed by diagnosticians of the end of the medical rope that hospital dismissal would be the more humane recourse over dengue’s incurability. You bet what are patients’ and their families last recourse outside the medical parameters – a whisper of a prayer? some miracle? a visit to the Baclaran Church? It’s equally important, even if it borders on turning God into an instant magician from time to time more than a Faithful Companion in life and death.

I had encountered a few dengue cases even in my current job and casual time outside it, often with a sense of panic to find those desperate measures for dengue. And I dare to recommend one thing outside the medical commonsense of prescribing only from the authority of a professional template: TRY TAWA TAWA. They listen and they came back with some good news of being cured from dengue. So what’s stopping the medical establishment from turning it into an essential part of the treatment modality? The answer: scientific dogmatism. If a particular medicinal plant has not gone through the rigor of clinical trials to prove its value, which by the way has 4 tedious phases, then it should not be prescribed to patients. We understand where science operates from – method and proof, logic and evidence-based literature. Fine enough. But how often do we hear of science’s humble admission of its social conditioning, that is, its attitude towards methods and proofs being influenced by the larger social entities it subscribe to for a number of reasons?

Let’s take tawa-tawa, with a scientific name euphorbia hirta L., as a case in point.

I scoured the net for a couple of days in search of any scientific studies of its pharmacological values on this ordinary plant. PubMed, a database based in the National Institute of Health of the US, and perhaps the most generous and extensive health research database on the net, provided 41 scientific clinical research on euphorbia hirta but none relates to dengue. For local studies, I did the same thing and google gave me a troika of data on tawa-tawa and dengue research. As reported last year, the news from Sun Davao says:

“THE health department has still not concluded its study on the feasibility of the tawa-tawa plant (Euphorbia pilulifera) as herbal remedy for dengue.”

In the news, there is no mention on who specifically conducts or sponsors the research. I am curious so I contacted first the Philippine Council on Health Research and Development (PCHRD), an arm of the Department of Science and Technology who is “responsible for coordinating and monitoring health research activities in the country.” I was directed to their online health research database Herdin, only to admit that the said research is not within their purview. Next, I contacted the Department of Health, and spoke to their chief librarian but nowhere could he find in their file the research on dengue I was looking for. Instead, I was directed to another arm of the Department of Health, the PITAHC or the Philippine Institute of Alternative and Traditional Health Care mandated by Congress under the Republic Act No. 8423 of 1997, and whose one main task is “to encourage scientific research on and develop traditional and alternative health care systems that have direct impact on public health care”. There is no way entering their site. But if the DOH database has no record of it, could it possibly be held by its arm without the head knowing about it? Just asking. Anyway, one thing is sure – PITAHC, who now has 4 large herbal plantations and pharmaceutical processing plants in Tacloban (36 hectares), Cagayan Valley, Davao and Cotabato could not simply manufacture medicinal plants for public use without the approval of the DOH. For example – out of the 13,000 species of Philippine herbs, only 500 have been properly identified and only 10 have been studied and promoted by DOH. Of these 10, only four (lagundi, sambong, tsaang gubat, yerba buena) have validated therapeutic value.

And here’s one interesting piece Google had served me: a prize-winning research done by high school students from Xavier University of Cagayan de Oro City, an investigatory study on “The Effectivity of Euphorbia hirta L. (Tawa-tawa), Prepared in Teabag Form, on Increasing Platelet Levels in Mus musculus (White Mice)”.

I remain curious because so far, there has been no announcement by the media of the scientific results of the said research. What’s the drag all about? Lack of support from pharmaceutical companies around? Bureaucracy? Shortage of clinical experts? Within this seemingly silence of the scientific community, there are also some implicit messages hanging around. I give you one: Tawa tawa is a very ordinary plant one can pick up along the street. They can grow up anywhere; we have those here in our ground. Perhaps, they really are ordinary enough, familiar enough it could drive away the exotic shoot for unmitigated profits for pharmaceutical companies.

Here’s the third thing Google has served me – clinical experts in India have actually unlocked the phytochemistry and pharmacological values of tawa tawa and had published it in a peer-reviewed journal The Journal of Pharmaceutical Research and Health Care. So what’s the drag on the Philippine health research on dengue all about? Power and profit struggle buffered by scientific dogmatism?

I can only remain curious, but pretty much hanging on to my personal belief that tawa tawa is as efficacious as a God-given resource!