Tawa tawa: The anti dengue plant

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BACOLOD CITY – There are nights that father would bring a lot of stuff home. Things he ordered online and some he’d bought off from Chinatown.

I actually enjoy one of them. An herbal alkaline coffee, which tastes mildly sweet. I always remind him to buy one of those, especially during exam week.

Tawa tawa plant. The anti dengue plant.
Tawa tawa plant. The anti dengue plant.

The rest are a plethora of various herbal meds. From a fiber enhanced supplement that is said to alleviate constipation to antioxidant capsules that claim to fight diabetes and hypertension. Then there are things you mix into water and wash on joint areas to fight arthritis. All with obscure claims, supported by video testimonials on Youtube and Facebook or have brochures with an overuse of scientific jargon.

All of their videos are 10% vague explanation on how their products work, 10% testimonials and the rest are actually instructions on how to join them in reselling the product.

I’ll stop there before I lose myself criticizing this bad business venture.

There’s a lot of discourse about herbal / alternative medications since it is estimated that up to four billion people living in the developing world rely on herbal medicinal products as a primary source of healthcare in a 2006 study.

And as with everything in this world, there’s a lot of misinformation about it.

Let us talk about a famous plant in relation to the current national epidemic. Euphorbia hirta more commonly known as tawa-tawa vs dengue.

How true, and if so, how effective?

For those new to the trend, tawa-tawa is a famous folk medicine used to cure dengue fever by people in rural areas of the Philippines. Leaves are made into a decoction that is believed to alleviate viral infection and associated fever symptoms.

The most common thing you hear around people though would be the fear of lowered platelet counts and how the plant alleviates this.

There are studies that prove that tawa-tawa extracts increase the platelet count in animal models. Bleeding times lowered, clotting times have been altered… and… holy crap, why are we not funding this?! They increase the platelet count! Whoa, so it’s a cure then?! No, it’s not.

First, how it does this is not fully understood, as well as what the dengue virus itself does to the platelets (which at this time of writing, still being studied).

Second, and probably more important is the fact that its properties have little to no effect on arguably what really makes dengue dangerous in the first place — dehydration. The dengue virus’ tendency to lower the platelet count (as of current knowledge) only actually serves as one in many markers that give healthcare professionals the signs that the patient potentially has dengue, but the lowered platelet count itself is not the main threat.

Severe cases like dengue shock syndrome or dengue hemorrhagic syndrome are rare. Some possibly undocumented, some possibly died due to an accompaniment of another disease. And these are cases that the wee plant could probably offer its aid. But to give it simply for the bleeding when a patient has a lot of other factors to consider like liver enzymes, oxygen saturation even drug allergies in the management, it could get quite bothersome to add it to the already tried, tested and proven plans and regimens in the hospital. Plus, there’s better treatment for bleeding which is blood transfusion.

Remember that this plant has not reached human trials with regard to its potential. And people have their dengue managed, many times over in the clinics. Again the more common cause of deaths are dehydration or fluid overload. And again this is more probably due to delayed treatment. So why do patients sometimes feel relieved after the tawa-tawa concoction binge? Why did they get “cured”?

Simply by other means. They must have better immune systems. And what’s a tawa-tawa solution without water? They are hydrating themselves through it, thus doing basically what has to be done to counter-act the effects of dengue infection — fighting dehydration, regardless of the tawa-tawa extract in the liquid they’re drinking.

Just because one of dengue’s markers is lowered platelet count does not mean it is the reason why people die. Dengue, as with all viruses has various markers: lowered White Blood Cell counts on the 1st to 3rd day and increased Hematocrit.  It just so happened that the lowering of platelets is a very easy marker to detect and follow thus can sometimes be misinterpreted / misheard by the lay folk as something urgent to ease.

So with this knowledge, and without full context, people are trying to alleviate low platelet count, thinking it is the one that they should be alarmed about. Then they drink the boiled tawa-tawa solution not realizing it’s the water and not the plant extract that’s helping them.

Meanwhile, people are dying in medical care due to a lot of factors and when they see people who didn’t seek medical care, alive — stating they just imbibed this remedy or drank a magic concoction. It’s a phenomenon called survivorship bias.

Survivorship bias is the logical error of concentrating on people or things that made it past some selection process — overlooking those that did not, mostly due to their lack of visibility. This leads to false conclusions.

Like “Wow, I should drop out of school too cause Mark Zuckerberg was a billionaire drop out” not realizing that only those who survived that are the ones all over the media and not the millions who followed through dropping out and didn’t become successful.

Herbal remedies can result in indirect health risks when they delay or replace a more effective form of conventional treatment or when they compromise the efficacy of conventional medicines. Liver failures, kidney failures and cancers: all those could be aggravated by the consumption of herbal meds, and people forget to mention this all because those who survived their ailments while drinking herbal meds got well without mentioning other factors that probably did it to begin with (*cue testimonials)

That’s survivorship bias in a nutshell.

So in the context of dengue, while a lot of sources claim that tawa-tawa has a lot of potential, such claims could be biased.

It’s good advice for everyone to be wary of things they treat themselves or others with, especially if it’s with little to no medical support.

Personally I’d be really happy to be disproven with evidence that there’s a dengue cure from plants found on the roadside, I mean who would not want that?

On a more supportive note to our folkloric herb, there is an FDA-approved food supplement derived from tawa-tawa that is out now by a local company called Herbanext, but that too comes with a disclaimer (No approved therapeutic claims).  It is not recommended for children and the drug’s manufacturer still urges everyone to get proper medical treatment as the supplement is not a replacement medication for dengue or any disease.

As for the tawa-tawa plant, while it’s marketed as a platelet count reliever, that property is not really helpful as is established in this article. And I believe that the few studies of its antiviral properties are more important to note and keep track of more than its platelet increasing properties, but this too is not fully understood.

So I still hold firmly with resolve that our current regimen in the clinics is effective enough and instead we should strengthen our efforts to get patients to the hospital earlier, as that is by far a more common problem.

I am not, however, saying that I don’t support plant-based researches, as these endeavors are to properly and scientifically re/introduce herbal medications to help with our unified fight against a common enemy. But always, let us continue to be vigilant with our battle against misinformation as they sometimes kill more than the disease.

This is, after all, for the betterment of our overall healthcare.

The anti-dengue cure is not yet discovered.

For now.

References:

  • Bandaranayake W. M. (2006). “Quality control, screening, toxicity, and regulation of herbal drugs,’’ in Modern Phytomedicine. Turning Medicinal Plants into Drugs
  • S. L. Abd Kadir, et al (2013) “Potential anti-dengue medicinal plants: A review,” Journal of Natural Medicines, vol. 67, no. 4, pp. 677–689.
  • J. G. Apostol, et al. (2012) “Platelet-increasing effects of Euphorbia hirta Linn. (Euphorbiaceae) in ethanol-induced thrombocytopenic rat models,” International Journal of Pharmaceutical Frontier Research
  • “Value Of Peripheral Blood Count For Dengue Severity Prediction” by Udaya Ralapanawa-A, et al
  • Michael Shermer (2014-08-19). “How the Survivor Bias Distorts Reality”. Scientific American.
  • W. C. Tayone, et al. (2014) “Isolation and structure elucidation of potential Anti-Dengue metabolites from Tawa-Tawa (Euphorbia hirta Linn.),” Walailak Journal of Science and Technology, vol. 11, no. 10, pp. 825–832, 2014.

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