Is there a magic bullet against malaria?

Statement regarding the film: “Das Fieber” [The Fever]

That'd be nice.

https://commons.wikimedia.org/wiki/File:Artemisia_annua.jpeg#/media/Datei:Artemisia_annua.jpeg
https://commons.wikimedia.org/wiki/File:Artemisia_annua.jpeg#/media/Datei:Artemisia_annua.jpeg

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Teas containing artemisinin are unsuitable for malaria prophylaxis.

Artemisinin is extracted from annual mugwort (Artemisia annua). Artemisinin is an anti-malarial. Teas containing artemisinin are not suitable for prophylaxis, to prevent malaria. This is the unanimous opinion of all professional medical associations and also of the World Health Organization.

  • Artemisinin preparations are used in treatment, but not in prevention. They are much needed for the treatment of malaria.
  • When ingesting teas for prevention of malaria, one can expect that underdose or overdose concentrations promote resistance.

In Southeast Asia, the resistance to combination preparations containing artemisinin (ACT, medicines that have been proven to be affective against malaria in different ways) has already increased significantly. Preparations with a single active ingredient in non-pharmacological, changing dosages can play a significant role in the development of resistance, regardless of vector.

That'd be nice: Alternative Facts

In recent years, there has been an increase in the advertisement of so-called “alternative approaches” in malaria prevention and treatment. Scientific evidence is lacking for these recommendations. Evidence-based medicine looks for reliable answers to promote health, prevent illness and keeping people healthy. Evidence-based medicine therefore relies on scientific evidence, not on the opinions, conjecture or experiences of individual parties.

The conspiracy theory allegation is often expressed, that representatives of evidence-based medicine are “bought” by the pharmaceutical industry and are not independent. This is incorrect: plan:g has signed the no-thank-you-Charter and is completely independent of the pharmaceutical industry.

In actuality, even hard-hitting economic interests are behind the idealisation of artemisinin: The teas are marketed as nutritional supplements for the prevention of malaria, for cancer prevention and treatment and even recently against COVID-19. The narrative of a side-effect free natural medicine – which doesn't exist – becomes a replacement religion in times of great uncertainty and serious threats to global health, which can make good money.

Artemisinin is marketed as “the best immune stimulant for fighting infections and corrupted cells”. Serious scientific research is reported completely out of context, falsified or truncated. Even researchers who have a good sense of market opportunities and susceptibility to enticement of their fellow human beings are involved, even though they should know better.

Because on closer examination, many of the “alternative approaches” are based on easy ignorance, a very great burden of suffering or on a fundamentally racist human image. They thwart the human right to the best possible medical care, overlook the complex epidemiology of malaria, idealise a utopian natural state and mask the social conditions of health and disease.

Artemisinin preparations are also marketed as nutritional supplements. The sales pitch: “Are you sick? It's your own fault, if you don't have a healthy diet.” That is, on the one hand, a cynical use of fear in order to make money. On the other hand, believing in artemisinin is comforting, because it is an easy to comprehend solution for the great health challenges of our time.

Easy understandability is the essence of many conspiracy theories. The addiction for simple solutions present great communicative challenges for both medicine and theology.

Das Fieber [The Fever]

This is also clear using the example "Das Fieber", the attempt at a documentary search for clues about malaria. The Austrian film-maker Katharina Weingartner mixes big questions and necessary information into great misunderstandings with fleeting answers.

The film addresses important core problems: Over one thousand people a day die of malaria, nearly a half a million per year. The number of new malaria infections is estimated to be over 200 million per year. The film correctly refers to the injustice in our economic system: Many essential medications are much too expensive in many parts of the world, not enough people have access to them.

Would it be good if there was an effective prophylaxis against this disease that you could grow in your own garden? The film poses this question and the answer is clear: That would be very good. However: No such plant exists according to current scientific knowledge, especially not one that is reliable and none that have no side effects.

Mass experiments with teas containing artemisinin ignore the present evidence with regard to the mechanisms that lead to resistance: This is negligent and endangers human life.

Appeal to the ORF Viewers Council

In the report on the film “Das Fieber, the ORF violated the set quality criteria in the news report “Zeit im Bild” ZIB1 on September 22, 2020. Therefore, the regulatory must attend to this failure – especially against the background of the current COVID-19 pandemic: The inclusion of medical expertise in health reporting must be better guaranteed both in the current case and on an ongoing basis, in order to avoid undermining health education in Austria (and in the German-speaking countries).

Sign petition here

What is evident: Artemisinin is no onion juice

A reliable prophylaxis must be based on more than the active ingredient principle. There is no scientific evidence for the suggested polytherapeutic property of the tea. Thus the massive use of artemisinin tea for prophylaxis would lead to resistance according to current scientific knowledge, thus to big problems in malaria treatment. Therefore, this type of use cannot be compared at the current time with the generally valid ethical standards of medical practice and scientific research.

Because artemisinin preparations cannot be compared to harmless home remedies. Is onion juice not only effective for colds, but also against COVID-19? If you try it at home during quarantine, it won't hurt anyone. But with massive use of artemisinin preparations, it's a completely different story.

Even the supposed anti-colonialistic message of the film is not true, because natural medicines are played off against pharmaceutical doses in an undifferentiated manner. Thus not only the tea, but also the uncritical reporting has significant inadvertent side effects regarding this. The differentiated reporting and the understanding of evidence based science fall by the wayside. This is very alarming in times of the pandemic. Because evidence-based science cannot be based on the experiential values of individuals, but required a systematised approach.

The WHO recognizes that herbal remedies are and were an important source of anti-malarial medications. It is possible that further research of healing herbs may lead to the discovery of components of future malaria medications. However, all research involving human subjects must respect the ethical fundamentals of medical-scientific research and be approved by ethics committees. It must be performed based on a thorough knowledge of the scientific literature, other relevant sources of information and suitable laboratory experiments.

Courage in Uncertainty and Courage for Differentiation

Only through more research can the effects, side effects and long-term consequences be discovered in various target groups, in women, men, children, people elsewhere and also Austrians. That takes time. In addition, some research is prohibited on ethical grounds. This includes research of resistance development by large-scale use of artemisinin tea. Because this would not only endanger the target group, but all people under threat of malaria. This is unethical, comparable to a study design in which there are two randomly assigned groups of pregnant women, one of which receives schnapps, and the other water, to examine the effects of alcohol consumption in pregnancy.

There are some studies on the effect of artemisinin, whose effect on malaria is uncontested. Further research is necessary, but the example shows that not every study design is sensible or ethically possible, and that the effect alone cannot lead to propagation of certain pharmaceutical forms without attention to the side effects.

A good story consists of black and white contrasts. But many differentiated grey areas exist in the world: This understanding is essential for promoting health and controlling malaria.

Informations

Präparate in nicht-pharmakologischer Doesierung gefährden Reisende:

Lagarce L. Lerolle N, Asfa P et al. A non-pharmaceutical form of Artemisia annua is not effective in preventing Plasmodium falciparum malaria. Journal of Travel Med 2016:23
DOI: 10.1093/jtm/taw049 PMID: 27432906

Artemisinin-haltige Tees gefährden die Anstrengungen zur Überwindung der Malaria:
Pays JF. Threats to the Effectiveness of Malaria Treatment. Bull Soc Pathol Exot 2018: 111: 197 - 198
doi:10.3166/bspe-2018-0046

Stellungnahme der WHO:
Die Weltgesundheitsorganisation (WHO) hat das Phänomen der Tee gründlich analysiert und 2019 ein technisches Dokument dazu herausgegeben:
WHO Reference Number: WHO/CDS/GMP/2019.14
https://www.who.int/publications/i/item/the-use-of-non-pharmaceutical-forms-of-artemisia

Leitlinie der DTG:
Die Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit e.V. (DTG) ist die federführende Fachgesellschaft und zuständig für die Entwicklung der deutschen Leitlinie:
Auf Leitlinien.net findet sich die jeweils letzte Fassung der Leitlinie zur Diagnostik und Therapie der Malaria herausgegeben von der DTG.