Speculative Medicine: What Can it Hurt?

covid-19 public health Mar 16, 2020

Uncertainty is difficult. In a situation where the entire planet is facing the threat of a brand new virus, we want solutions. And perhaps this is worsened in the Information Age. We expect answers to exist somewhere if we only Google long enough. 

This creates the perfect environment for the incubation of disinformation–a dangerous foe in times like this. During a global public health crisis, factual information–or the lack thereof–can be the difference between life and death. 

In a situation where we are desperate for hope, we tend to turn towards what is familiar. For natural health enthusiasts and professionals, this typically means our trusted elderberry syrup, anti-inflammatory herbs, protocols for related viruses, essential oils, and more. After all, what can it hurt? We can't be expected to sit here and do nothing. But desperation in a situation like this can often lead to mistakes. 

While this crisis is the first of its kind most of us have seen in our lifetimes, it's hardly the first our planet has seen. And while a global pandemic takes the world by surprise, it's the exact situation epidemiologists and public health professionals have been preparing for since... always. 

One of the greatest tools we have in the field of epidemiology is to study and learn from past outbreaks, epidemics, and pandemics. Much has been said recently about the 1918 flu and the mistakes that were made, but little attention is paid to how it was treated. In the natural health community, it's critical to study these mistakes so history doesn't repeat itself. To do that, we have to look at aspirin–a pharmaceutical with herbal medicine origins. 

History of Aspirin 

Aspirin was to the early 1900s what elderberry syrup is to the early 2000s–the cure-all wonder drug. Plants rich in salicylic acid, the active ingredient in willow extract, have been used medicinally since ancient times. The active ingredient was isolated in the early 1800s, and early research demonstrated the efficacy of this active herbal ingredient. Its uses, however, were limited because moderate to large doses caused gastrointestinal complaints.

This would all change in 1897 when Felix Hoffman, a German chemist for Bayer, found that adding an acetyl group to salicylic acid eliminates those irritant actions. The resulting substance–acetylsalicyclic acid–was patented by Bayer.

This rapidly expanded its consumer acceptance and public use. 

In its early days with Bayer, it was available through prescription. But by 1915, aspirin (aka acetylsalicylic acid) was being marketed and sold by countless brands around the world as an over the counter treatment. 

Aspirin & Influenza 

By the time the 1918 flu pandemic appeared, aspirin was the latest and greatest drug of choice. It reduced fevers, had powerful anti-inflammatory actions, and treated the muscle aches and pains associated with influenza. It seemed to be the perfect match for this frightening global pandemic. 

Thanks to the development of this non-irritating preparation, large doses were now possible. People felt better. It alleviated many of the symptoms. And as a result, became a recommended treatment. Even the US Surgeon General recommended using aspirin, and the Journal of the American Medical Association published recommendations in 1918. 

Despite a lack of specific research on the use of aspirin for this new illness, doctors endorsed its use out of desperation to offer something that would help. Not unlike today's "what could it hurt?" approach to trying a myriad of dietary supplements shown to be useful for related conditions, families desperate to try something, anything tend to ignore the risks of the unknown in uncertain times. 

This "what could it hurt?" approach is a natural human inclination. Disease has the power to make us feel helpless, and it is within our nature to want to take action. This drives us to use whatever tools we have. After all, what can it hurt? 

During times of panic, we tend to overestimate the potential benefit of interventions and to underestimate the potential risks. 

We don't have treatments for the novel coronavirus? Let's throw what we know at it: elderberry, vitamin C, echinacea, essential oils, specialty diets... try everything; surely it can't hurt. And, like with aspirin, we may even feel better in the immediate days to follow. Our anecdotal experience tells us this is all working! 

Unless it all goes wrong

But facts don't always match our subjective experiences. More often than not, what we perceive to be happening is not what is actually occurring. In medicine, this lesson is one that must be learned time and time again. From miasmas to blood letting to aspirin, objective research often reveals that our perceptions are not only inaccurate, they've been harming us. 

In the case of the 1918 flu, contemporary physicians noted that some cases of death revealed fluid buildup that was unusual. Dr. LeCount, consulting pathologist to the United States Public Health Service, found that the lung damage he observed in early autopsies did not reflect the norm and that the "thin and watery bloody exúdate in the lung tissue" may be caused by some other factor(s).

More recently, Dr. Karen Starko, an infectious disease specialist, has linked these symptoms with the extremely high doses of aspirin recommended at the time. We now know that the doses of aspirin recommended can lead to salicylate-induced pulmonary edema.

Aspirin, the wonder drug recommended for the flu pandemic, appears to have worsened the situation and increased the death rate. The extent to which this approach caused harm is not clear; the pandemic was over 100 years ago, the world was in a crisis, and medical records are nothing near what today's researchers expect with regards to quality of data. 

Learning From the Past 

We like to use hindsight to look at the past and mock their approaches. "How stupid they must have been! We would never do that today! We know aspirin doesn't cure COVID-19!" Yet, if we don't look at the mistakes of the past and, most importantly, learn from them we are doomed to repeat them. 

COVID-19 is a brand new virus. It did not exist a year ago. Protocols at this stage are speculative and theoretical.

Speculative protocols, if part of a clinical trial, provide useful information about what helps and what hurts. Within the context of a clinical trial, patients have the benefit of informed consent, ethics committee oversight, data collection, analysis, and knowledge generation. If the study finds that the protocol hurts, it is halted. And patients are given a full overview of the risks and benefits of the intervention. 

Speculative medicine, as part of a protocol or anecdote shared on social media or from herbalists and aromatherapists, takes us back to 1918. Without the patient protection present in a controlled clinical trial, we gamble with the lives of our loved ones. 

Could elderberry, echinacea, or oregano be the cure for COVID-19? Sure. But to take a scientific approach, we have to acknowledge that, given the utter lack of knowledge about the virus, it is possible that such treatments for these patients are harmful in ways we've yet to discover. 

The best approach in a pandemic is to leave the speculative medicine in the clinical trials and focus on the measures we know provide benefit. Right now, the greatest benefits we have include hand hygiene and social distancing. 

Resources

Glisson, J. K., Vesa, T. S., & Bowling, M. R. (2011). Current management of salicylate-induced pulmonary edema. Southern medical journal104(3), 225-232.

LeCount, E. R. (1919). The pathologic anatomy of influenzal bronchopneumonia. Journal of the American Medical Association72(9), 650-652.

Shimazu, T. (2009). Aspirin in the 1918 pandemic. Bmj338, b2398.

Starko, K. M. (2009). Salicylates and pandemic influenza mortality, 1918–1919 pharmacology, pathology, and historic evidence. Clinical Infectious Diseases49(9), 1405-1410.

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