It’s hard to not agree with Mark Twain’s supposed commentary that history rhymes, if it doesn’t actually repeat.
The current campaign by the so-called group Friends of Science in Medicine in 2012 seems to echo some previous attempts to discredit natural or traditional folk medicine almost exactly a century before.
You wonder how that story has turned out?
Interesting in at least one case for sure.
In 1909 the British Medical Association (BMA) put out a small book called Secret Remedies in an attempt to discredit what they saw as nine of the main ”quack remedies” of the day. A primary target of their campaign and book was one Stevens Consumption Cure, aka Umckaloabo or Lungsava (Newsom 2002).
The product was made and marketed by a company run by a Charles Henry Stevens who ‘discovered’ the herb through his own treatment for his ‘consumption’ or TB as we call it now.
After being diagnosed at 17 in Birmingham (in 1897), he went to South Africa on doctor’s advice, for the benefit of the warmer drier climate and a lack of any effective treatment. However, whilst there he met an indigenous healer, reportedly a Zulu called Mike Chichitse, who offered him a local herb remedy, which induced a ”marvellous recovery” within months (Newsom 2002).
After experiencing the efficacy of the remedy he had been given, Stevens went on to establish a business back in England in 1907 to produce extracts of the herb, from material he imported from South Africa. Like many other remedies of the time he advertised in the press using testimonials from patients and doctors to spread the news and claims about this herb in regard to ‘consumption’. TB was an endemic problem in most European cities and societies and one of the most significant diseases of the day (Newsom 2002).
Stevens had a huge potential market, or a significant number of fellow citizens in need of some effective medicine. Safe to say there’d be a range of views depending perhaps upon your own distant perspective and biases on his motivations and what should be done in such a circumstance, in the context of having felt yourself cured of a socially burdensome and at the time generally fatal disease.
The BMA published an analysis of the Stevens Cure by their chemist which described it as nothing more than kino or rhatany root (another more common herb) and fraudulent quackery, accusing Stevens of swindling people in their campaign. Whilst the BMA were apparently unhappy about the lack of response at first, the book and campaign started to dent the reputation of the Stevens Cure over the next few years (Newsom 2002).
So Stevens later took the BMA to court for libel, and on the face of it he seems to have had something of a case according to Newsom reviewing the case in the Journal of the Royal Society for Medicine in 2002. The BMA chemist analysis was completely erroneous and Stevens was able to provide actual plant materials to the court to prove it. The chemist withdrew his accusation of swindling in court. Stevens also had doctors and patients testify to the efficacy of the cure. Convened in front of a jury, the first case in 1912 was abandoned when the jurors determined they would never agree on a verdict (Newsom 2002). The case in London was noteworthy enough at the time to be reported in the NY Times in November 1912, and perhaps remarkably in this digital age the full text of that report is available as a pdf online to anyone.
The second court case in 1914 went badly for Stevens, the BMA had now identified that the plant was not in the British Pharmacopoeia at the time and suggested he was acting under false pretences in selling it. He lost the case and had to pay costs for himself and the BMA, some £2000, a small fortune at the time (Newsom 2002, Bladt & Wagner 2007).
The first world war intervened in further developments for a while, Stevens is reported to have served in the Royal Flying Corps with distinction and survived the war ending up as a major. Though it seems he continued the production of Stevens Cure up until at least 1939 and it seems to have been available in England up until 1953. By 1931 Stevens business reportedly employed some 50 people. Evidently there were enough satisfied customers and enthusiasm for the treatment to keep production going (Newsom 2002).
However, the exact identity of and constituents in the herb remained unclear, probably in part due to hostility from the BMA towards the product and any research about it, or between Stevens and the medical establishment. Indeed it was not until the mid 1970s that any clear botanical and chemical descriptions were published of the herb utilised by Stevens (Bladt & Wagner 2007).
Sechehaye book cover via Newsom, J Royal Soc. Med. 2002
The most significant developments in understanding and application of the herb occurred in Europe after the publication of The Treatment of Tuberculosis with Umckaloabo (Stevens’ Cure) by Dr Adrien Sechehaye of Geneva in 1930. Originally in French, then German and English, the text is a collection of 64 case studies (out of hundreds more) using Umckaloabo for TB. A companion English version was published anonymously by a doctor reputed to be a medical writer for a major newspaper of the time. The original company was sold by Stevens son sometime after his death in 1942 to a German medicine company (Newsom 2002, Brendler & van Wyk 2008).
Pelargonium sidoides via Wikipedia
The identification of Umckaloabo as the root of a species of Pelargonium did not occur until the mid 1970s, from the work of a German researcher (Dr Sabine Bladt) sponsored by a German company (ISO-Arzneimittel). Eventually identifying the primary source as being Pelargonium sidoides, a plant first described as early as 1685, which was also ascribed by some as a subspecies of the similar Pelargonium reniform (Bladt & Wagner 2007).
Since the early 1990’s liquid and other extracts of P. sidoides root have entered the herbal medicines market, particularly in Germany. It has grown to be one of the most popular over the counter respiratory infection treatments in Germany with a turnover of some €80 million in 2006. Various P. sidoides extracts and products are also now available in Russia, Ukraine, the US and Mexico, as well as in its source country South Africa. However, the German market is the most significant and developed (Brendler & van Wyk, 2008).
An array of chemical and pharmacological studies have identified the major classes and specific constituents and investigated their activities in vitro and in vivo. Clinical trials, observational and placebo controlled, primarily involving a proprietary liquid extract, in both adults and children have occurred. These report significant activity compared to placebo in acute bronchitis with very high tolerance and acceptance by patients. Other trials indicate benefits in sinusitis and other respiratory tract infections (Newsom 2002, Brendler & van Wyk 2008).
Pharmacological studies indicate significant immuno-modulatory (eg. increased phagocytosis, altered cytokine levels) rather than direct anti-microbial activity as the primary basis for action (Brendler & van Wyk, 2008).
Even a recent meta-analysis by the now well known CAM sceptic Edzard Ernst concludes on the basis of well done randomly controlled clinical trials that there is evidence that P. sidoides, aka Umckaloabo, is a safe and effective medicine for children and adults with acute bronchitis. With less adverse events than placebo in the trials conducted (Agbabiaka, Guo & Ernst 2008).
A few Pelargonium species are documented as utilised by indigenous peoples in Southern Africa, though it has been a long tortuous path for modern science to get its head around what this was and why it was used by the indigenous people (Brendler & van Wyk, 2008). Particularly it seems in the English-speaking world.
This is just one herb, out of thousands identified by people from almost every human culture. Despite institutional hostility for the best part of a century (at least in the Anglosphere), it has continued to be sought out and used by people and scientific investigations (outside the Anglosphere) have identified a range of pharmacological properties that are quite clearly of interest and benefit to people. Clinical evidence supports its safety and efficacy for what are very widespread and common conditions that impact significantly on people.
For anyone in science to now believe that they or anyone else would’ve had any inkling to the value of this herb or its constituents without the original knowledge imparted by others is completely disingenuous. The source people, Khoi, Xhosa or Zulu, were probably illiterate and uneducated by modern measures, but obviously intelligent and capable people to survive for millennia in their lands. Without their traditional knowledge none of this history would’ve been possible. The existence of this apparently cheap and safe natural medicine for people in highly educated developed societies would never have occurred.
It does also seem ironic that in an age where so much time and legal resources of corporations, or governments at their behest, are devoted to the notion of intellectual property, where individual copying of files or an idea is declared as piracy or counterfeiting, suitable for fines and imprisonment. That so little acknowledgement is given of the intellectual property established by traditional local herbalists and healers the world over.
Medicine it seems is keen to exploit or lay claim to any fruits of this great human endeavour spanning millennia and many cultures. To own and control everything associated with human dis-ease. Whilst at the same time ridiculing or attacking the very existence of what has historically been the source code for the vast majority of modern pharmacy and much of our historical understanding of pharmacology. Is it a surprise that more informed and experienced indigenous and traditional medicine people are more wary of science (or more specifically industry) and researchers these days (Rosenthal 2007).
There is no evidence I can find that Stevens was ever shown or identified the Pelargonium plant he used. There is no evidence that the BMA made any real effort to identify the material, their so-called analysis was merely a manufactured result aimed at discrediting Stevens Cure.
If anything, the Zulu and other indigenous healers of South Africa probably had most reason and justification for keeping their intellectual property, herbal knowledge, close to their chests.
[PS, in 2010 an African NGO and other parties were the first ever Africans to successfully appeal to the European Patent Office, in the case to revoke a German company’s patent in regard to P. sidoides, due to lack of inventiveness]
As it turns out Pelargonium seems to have been a regular part of the local herb trade and the identification was eventually made simply through the fact that an informed open-minded researcher actually went to South Africa. In contrast to the ideologically or wilfully ignorant BMA of the early 20th century it seems.
If nothing else this story reflects many of the complexities of human relationships with plants, in particular medicinal herbs, which includes but also transcends simple scientific analysis.
It seems to me to also reflect the follies of trying to repress and attack others armed with only your own limited perspective, no matter who you are. This merely seems to exacerbate everyone’s collective stupidity and ignorance. Even without all the uninformed hostility, a detailed scientific understanding of even a single herbal can take a long time and much effort from many people.
I’d bet the BMA and probably Stevens never could have imagined the outcome of it all 100 years later. In the case of the former they might feel somewhat disappointed, and the latter somewhat vindicated.
Actually the BMJ ran an editorial lamenting the presence of all manner of herbals in 2009, wondering why things had hardly changed. Apparently oblivious to further developments and their evidently unsound attack on this herbal remedy (Pelargonium sidoides) they wrongly and unscientifically slammed as quackery a century before.