I have always been sceptical about infusions, concoctions, teas, herbal remedies and all other unscientific treatments, as Eye readers are well aware. There are 2 types of medicine: those that work and those that don’t work. If something works, then why not conduct a proper trial with thousands of people and get proper data on how many live, how many die, how many get better how fast, and what side effects occur? Then if it is proven to be safe and effective, everyone should know, and the treatment or procedure becomes mainline practice. If enthusiasts for a particular treatment do not want their favourite remedy exposed to critical review, then the obvious question is, why not? The answer is usually because they know that their treatment doesn’t actually work, but they don’t want to believe it. As to the belief that everything herbal is safe, just ask Socrates. Another belief that everything manufactured is artificial

and therefore isn’t safe, or somehow inferior to true natural remedies, is obviously nonsense. Over half the drugs we use are natural, derived in some way from plants. Almost all antibiotics, for example, are derived from naturally occurring soil fungi, and most antimalarials are derived from trees or plants.

So what is an ideal drug?

Take malaria for example. The ideal antimalarial would be safe, have no side effects, and be tasteless or at least have a fairly pleasant taste. It should work both in the liver, where the parasite incubates, and in the blood--or be so long-lasting that a single dose is effective. It should also be cheap, and, even better, be safely taken as a tea grown in everyone’s garden. It doesn’t exist. But we are close.

For the last 10 years the drug of choice for malaria has been artemether derivatives, from the plant artemether annua, known in China as Quinghaosu. Quinine (from the bark of the Cinchona tree) and almost all other antimalarials are also derived from plants. The difference between chewing 2 inches of Cinchona bark and swallowing 2 tablets of quinine is that with the tablets you know what you get. Two inches of bark may have very variable amounts of the actual active ingredient: they may have a lot of other nasty active poisons in them, and you may either overdose or underdose, depending on whether the tree grew beside a river, in a dry place, in winter or summer and whether the bark was old or new.

Not so with Quinghaosu. The artemether annua strain that has been developed to grow in Africa is very consistent and stable. The leaves contain between 1 and 1.5% artemether, regardless of where it grows, how old it is or the season in which it has been harvested. Furthermore, artemether is an incredibly safe drug, being safe at 4 times the therapeutic dose. So, if you drink too much it really doesn’t matter. Unfortunately, it does not work on the hepatic cycle.

In order to understand treatment, you have to understand the cycle of the parasite in the human. On average, a mosquito injects 15 sporozoites in each bite. The little sporozoites circulate in the blood for a very short time and are taken up into liver cells within half an hour. They stay in the liver cells dividing for 5 to 7 days multiplying to about 40,000 new ones each. On the 5th or 6th day after being injected, about half a million are released into the blood stream to find red cells and begin growth. They are now called trophozoites. The symptoms start 2 days later, when the parasites in the first cycle of the blood stage divide and rupture the red cell, releasing the toxins responsible for the fever. These trophozoites are killed very quickly by artemether but very slowly by quinine. The problem is that not all the parasites come out of the liver in the first wave. They continue to dribble out for another 7 days and occasionally even longer. So, one dose may kill all the parasites, but more come out each day. Therefore, unless it is a very long-acting drug, the new parasites from the liver will cause a relapse in 1-2 weeks. Chloroquin and Mephloquin are very long-acting drugs, and one short course is enough. Artemether is not; in fact, it lasts only a few hours.

So, the latest idea of WHO is to advocate combination drugs, artemether and another long-acting drug in a single tablet, or one that kills the malaria in the liver, such as Malarone. Good idea, except that the current favourite, artemether and lumafantrine (Coartem) doesn’t quite make perfect sense. Neither drug kills the liver cycle, and lumafantrine only lasts 3 or 4 days, so you still need to take it for a week. A packet that gives you a 3-day course is bound to result in relapses. Indeed, trials have shown 25% of non-immune patients given the new combination will relapse. So, we always follow the Coartem with doxycyclin for 10 days. So far we have had 100% permanent cure.

But what about artemether alone for long enough? Why not?

Absolutely. Why not? And indeed for pregnant women that is what we do: Artenam 2 packets and continue to take 2 daily for a total of 10 days.
However, it is then pretty expensive, close to Malarone price, and you could almost buy a buy a beer at Emin Pasha’s for that. So people will be tempted to take it until they get better, then stop to save money. This means relapses, and low doses encourage the development of resistance.

So here comes the tea.

Artemether has a number of rare attributes. First, it is a very safe drug. So, if you take too much it doesn’t matter. It also has a unique way of killing parasites, including malaria and bilharzia, but also others. It acts like hydrogen peroxide, forcing an extra oxygen molecule onto a particular site on the parasite and killing it. It is difficult for the parasite to learn to become resistant to that. As I have already said, it is pretty consistent in its strength, and even more remarkable, it is very stable. Just like getting theophyline and caffeine out of ordinary breakfast tea, you can boil it and make tea without affecting the molecule, and you get a very stable and consistent infusion every time. Also like proper tea, the leaves do not contain any other poisonous chemicals in sensible doses.

So Artemether tea is now on the market and available for treating malaria. You make a litre of tea using a measured 50 grams of dried and crushed leaves, and drink it as 4 cups during the day. So you get a killer dose of artemether in your blood for 4 hours, 4 times each day--which is actually a more sensible and scientific way of killing the parasite then the standard once-a-day dose. You can buy it in 50-gram packets, 10 of them for a 10-day course, or you can grow it in the garden and measure 50 grams using a full film canister. We use them for stool samples, but can wash them out and give them to you afterwards if you like.

It is also fairly effective as a treatment for bilharzia, and may make Praziquantal more effective if taken simultaneously. Taken for 14 days, it prevents bilharzia if used immediately after exposure.

Sounds good? Well, every silver lining has a cloud. It tastes awful. My wife says it is worse than the stuff her mother put on her thumbs to stop her sucking her thumb as a child. It is certainly every bit as bitter as quinine, whereas Artenam tablets are almost tasteless. I much prefer tea. Or coffee. Or beer--but they don’t cure malaria. Kim Bowerman claims it’s not bad with honey or sugar, children may prefer it, but I’d rather just chuck it down, grimace and go and have a chocolate bar.

So if you want to go the cheap natural route here’s what you do:
buy the seedlings, grow them for 6 months and harvest your own. It stores well if dried and powdered and kept dry. Use a film canister to measure 50 grams of dried, powdered leaf and make a litre of tea. Drink 1 cup 4 times a day, which should be the full litre. Or, you can buy 10 measured sachets of tea from a shop near you. There is an organization called Anamed that can give you all the information you need.

Or you can buy a packet of Artenam or Coartem and 10 doxycyclin tablets, and do it the old fashioned way. Artenam is tasteless and children can just chew the tablets without any problem. Doxycyclin, by the way, is a derivative of tetracycline, which is also a naturally occurring antibiotic, like streptomycin and many others derived from soil saprophytes. So it’s natural, herbal and safe, just like tea, tobacco and hemlock.

As in all good ideas there is of course the same problem. Most people with fever do not have malaria, and most people diagnosed with malaria do not have malaria. So I repeat the same advice we always give: use a malaria rapid kit. If it is negative, do not take antimalarials, look for another cause of the fever. If you are still ill the next day, and even more importantly, if you get another severe fever 48 hours after the first, then repeat the malaria rapid test. Very early malaria may be missed the first time, but a second negative after a full day or longer is pretty conclusive that it is not malaria.

Summary:
If you have a fever, use a malaria rapid kit.
If it is negative, repeat after a full day, and look for another cause of fever.

If it is positive, these treatment regimes are effective and safe:
1. Artenam for 10 days, or
2. Artenam for the standard 5 days plus doxycyclin for 14 days, or
3. Coartem for 3 days followed by doxycyclin for 10 days, or
4. Artemether tea 1 litre a day for 10 days.