With aging populations, the costs of drugs and institutionalised healthcare continually rising, and government drug funding agencies such as Pharmac always under the pump, it’s time to take a look at just what our taxpayer dollars are funding, and whether the current paradigm is working.

Total expenditure by New Zealand District Health Boards (Pharmac) on Drugs to the year ending 30 June 2018, was $870 million⁽¹⁾.

Health economists and policy advisers know it is unrealistic and unsustainable for governments to continue spending more and more of the GDP on the healthcare budget, and that shifting some of the growing burden of responsibility onto the population to take better care of their own health and wellness (‘self-care’), is a good strategy. However, the increasingly wide gap between those who can and can not afford the best available modern healthcare treatments and interventions, is very worrying. A ‘two tier’ health service in which the quality of state-funded services declines, as more and more pressure mounts on it, is inherently and morally wrong.

Primary care health services are not just those provided by General Practitioners, but also include a wide array of other inputs such as those by Pharmacists, Nurse Practitioners, Social Workers, Occupational Therapists and Drug Counsellors. These are aimed at disease prevention, health education and screening, and avoiding the need for hospital based care. A strong primary health care system is critical to improve the health of all New Zealanders, and reduce health inequalities between different groups⁽²⁾.

However, the current primary health care system is neither keeping pace with nor adequately addressing the health needs of our population. Increasing challenges and treatment deficits are emerging particularly in areas such as mental health, substance dependency, diabetes prevention, disability services, dementia and infectious disease management. Too many New Zealanders are falling through the gaps or requiring repeated treatments, for recurring health problems^(3,4), and health care staff stress levels and recruitment challenges, are worsening.

In New Zealand, most Medical herbalists and Naturopaths have undergone a 3 or 4 year course of study to the level of a degree. Apart from their high level of expertise in the use of specific plant-based medicines to help optimise health and overcome many illnesses, their training in nutrition and herb-drug interactions, and ability to take a ‘wholistic’, more integrative and preventive approach to an individual’s health, means they are well suited to advise and educate, on self-care and wellness interventions.

The estimated cost of a day’s hospital care in New Zealand during an influenza pandemic was put at $2,595 per patient in 2009⁽¹⁸⁾, and current costs are probably in the range of $3,000 to $5,000, depending on the treatment required.  Compare this to the approximate $1,200 per year cost of a daily herbal tonic tailor-made to the patient’s needs and often focussed on prophylaxis. Even if it takes 3 years of such treatment to prevent a single night’s stay in hospital, it is a more cost-effective intervention, and with additional benefits.

Well-educated, higher socio-economic income bracketed and very sick people currently make up the bulk of patients seen by Medical Herbalists and Naturopaths in New Zealand. Meanwhile those on lower incomes who may benefit the most from its numerous inputs, are often unable to afford any non-subsidised treatment, and are effectively being excluded from having natural health as an option available to them.

Despite many holding the view that the benefits of natural health interventions are unproven, there is now compelling evidence from good quality scientific studies, supporting the use of specific herbal medicines when taken as adjuncts to drug medications being used for cancer, diabetes, heart failure, alcohol or drug dependency, and schizophrenia^(5-16). There are several potential benefits of herbal medicine when appropriately prescribed to patients receiving conventional treatment for these and other conditions. They include improved patient outcomes, a reduction in the need for drug-based or other expensive medical care options, and thus a lower frequency of drug-related side effects and overall costs⁽¹⁷⁾. Savings in the current drug budget alone, would enable an improved ability to fund new drugs or other healthcare interventions, including more emphasis on the most cost-effective approach, of disease prevention rather than treatment.

New Zealand’s commitment as a signatory to the World Health Organisation “Traditional Medicine Strategy, 2017-2023”⁽¹⁹⁾, puts an obligation on the government to both further research into the area of traditional and plant-based medicines, and to progress statutory regulation of complementary medicine practitioners. There is an urgent need for more research into this area, and for political and funding support to enable the introduction of some such treatments in a regulated manner, into clinical practice.

However, in the case of Medical Herbalists, since 2005, successive New Zealand governments have rebuffed efforts to achieve statutory regulation as a profession under the Health Practitioners Competence Assurance (HPCA) Act. Despite a high level of professionalism shown by their national association, and comprehensive degree level courses being provided by training institutions, there seems little willingness on the part of the state to validate this profession, or ensure appropriate standards are in place to protect public safety, by progressing its latest application for statutory regulation lodged in 2016.

With the government’s so-called ‘Wellness Budget’ soon to be announced, it would be nice to know that more thought is being applied to preventing unwellness, and identifying ways to take some of the pressure off existing healthcare services. By finally recognising the untapped potential of well-trained and professionally registered Medical Herbalists and Naturopaths to make a greater contribution to future NZ healthcare options, we would at last see signs of a genuine commitment to the WHO Traditional Medicine Strategy, and a comprehensive health and wellness strategy for New Zealanders.

 

References:

1. Pharmac. Pharmaceutical Management Agency Annual Report for the year ended 30 June 2018, 2018.
2. https://www.health.govt.nz/our-work/primary-health-care
3. New Zealand Herald 17 Feb, 2016. Fears Canterbury mental health services may be slashed amid budget cutbacks.
4. New Zealand Herald, 21 April 2019. Limited showers, no meal prep: ‘Ruthless’ plans to cut disabled care revealed.
5. Rasmussen PL, Eur. J. Herbal Med. 3(1):11-21, 1997
6. Rasmussen PL, Eur. J. Herbal Med. 3(2):13-19, 1997
7. Pittler MH et al, Am J Med 2003; 114(8): 665-674.
8. Doruk A et al. A placebo-controlled study of extract of ginkgo biloba added to clozapine in patients with treatment-resistant schizophrenia. Int Clin Psychopharmacol. 2008 Jul;23(4):223-7.
9. Barton DL et al, Support Care Cancer 2010; 18(2):179-187.
10. Barton DL et al, J Natl Cancer Inst 2013; 105(16):1230-1238.
11. Biswal BM et al, Integr Cancer Ther 2013; 12(4):312-322.
12. Chen EYH et al, Phytother Res 2012; 26:1166-1172.
13. Zhang XY et al, J Clin Psychiatry 2001; 62(11):878-883
14. Zhang XY et al, Psychopharmacology 2006; 188(1):12-17;
15. Atmaca M et al, Psychiatry Clin Neurosci 2005; 59(6):652-6.
16. Li J et al, Wuzhi Tablet (Schisandra sphenanthera Extract) is a Promising Tacrolimus-Sparing Agent for Renal Transplant Recipients Who are CYP3A5 Expressers: a Two-Phase Prospective Study. Drug Metab Dispos. 2017 Nov;45(11):1114-1119
17. Rasmussen PL, Potentially beneficial herb-drug interactions. Practitioner Seminar, July 2016, Phytomed Medicinal Herbs Ltd, Auckland, New Zealand
18. Wilson N et al, NZMJ 9 November 2012, Vol 125 No 1365; ISSN 1175 8716
19. WHO Traditional Medicine Strategy: 2014-2023.http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en

 

 

Ribwort (narrow leaved plantain) is commonly seen in pastures, lawns and street verges, and once positively identified, is rarely forgotten. One of the most useful and endemic “weeds”, its young fresh leaves have been used for centuries as a healing ointment and treatment for slow healing wounds, bites and haemorrhoids, by people from many different parts of the world.

Seed husks of its botanical relative Plantago ovata (commonly known as Psyllium seed), are used as a bulking laxative and for digestive health.

The other main application of Ribwort leaves, is to improve the health and function of the mucous membranes in the respiratory tract. A particular characteristic of this plant, when harvested and prepared in the optimal way, and applied or taken in sufficient doses, is its gentle nurturing and nutritive, but also protective barrier effects on delicate mucous membranes of the nasal passage and other sensitive skin areas of the body. These mucous membranes help protect the sinuses and bronchial tract from invading micro-organisms and other insults, and foods and herbs that optimise their function, can help protect against and manage a wide range of upper respiratory tract conditions.

The diverse phytochemistry of ribwort, which includes polysaccharide hydrocolloids (mucilaginous compounds), phenylethinoid glycosides, flavonoids, coumarins, cinnamic and other phenolic acids, contributes to its anti-inflammatory, antioxidant and antimicrobial activities. This combination of herbal actions makes it a valuable addition to the treatment of inflamed sinuses, catarrh or blocked noses. Research has also found ribwort in large doses to be comparable or superior to the drugs ranitidine and misopristol, in an animal model of peptic ulcer ⁽¹⁾.

 

Human influences on the health of this plant

As a common and fairly fast growing plant, ribwort is one of a number of plant species being studied by plant and environmental scientists, for the effects of pollutants on its health and physiology. Recent studies have found ribwort grown near mines, smelting plants and other contaminated areas, accumulates high levels of cadmium, lead and other heavy metals^(2-4). Heavy metal contamination of ribwort, dandelion and birch growing in urban areas of Poland with considerable air and soil pollution, has also been shown to be high⁽⁵⁾.

In animal farming, anthelmintics (anti-worming drugs) are regularly applied to control gastrointestinal nematodes, and these are excreted from animals into pastures and the wider environment. Along with other drugs such as antibiotics, anthelmintics have become one of a new class of micro-pollutants that disturb the environment. The anthelmintic drugs albenazole, flubendazole and flenbendazole for example, widely used in conventional animal farming, are taken up by and metabolised by ribwort. However, they also produce, in the plant, a significant increase in concentrations of proline (a well-known stress marker), and activities of several antioxidant enzymes. This suggests a possible risk of oxidative damage in this and other plants influenced by these drugs, and is a growing cause of concern^(6,7).

Anthelmintic drugs excreted into pastures and taken up by plants also have the potential to impede seed germination negatively, thus affecting affect the regeneration of ribwort and other plants⁽⁸⁾.

These studies reinforce the sensitivity of ribwort and other plants to environmental contaminants as a result of human activity, in this case mining, city air pollution, and conventional animal farming. As we are only beginning to discover such delicate links between environmental pollutants and plant health, the importance of growing this plant (and probably numerous others) in certified organic soil as opposed to purchasing it from non-organic, so-called ‘wildcrafted’ or trade broker sources, is highlighted.

Refs:

1. Melese E et al. Evaluation of the antipeptic ulcer activity of the leaf extract of Plantago lanceolata L. in rodents. Phytother Res. 2011 Aug;25(8):1174-80. doi: 10.1002/ptr.3411. Epub 2011 Feb 7.
2. Tamás J, Kovács A.Vegetation pattern and heavy metal accumulation at a mine tailing at Gyöngyösoroszi, hungary. Z Naturforsch C. 2005 Mar-Apr;60(3-4):362-7.
3. Tinkov AA et al. Comparative Analysis of the Trace Element Content of the Leaves and Roots of Three Plantago Species. Biol Trace Elem Res. 2016 Sep;173(1):225-30.
4. Drava G et al.Trace elements in Plantago lanceolata L., a plant used for herbal and food preparations: new data and literature review. Environ Sci Pollut Res Int. 2019 Jan;26(3):2305-2313.
5. Nadgórska-Socha A. Air pollution tolerance index and heavy metal bioaccumulation in selected plant species from urban biotopes. Chemosphere. 2017 Sep;183:471-482.
6. Stuchlíková Raisová L et al. Evaluation of drug uptake and deactivation in plant: Fate of albendazole in ribwort plantain (Plantago lanceolata) cells and regenerants. Ecotoxicol Environ Saf. 2017 Jul;141:37-42.
7. Stuchlíková LR et al, Biotransformation of flubendazole and fenbendazole and their effects in the ribwort plantain (Plantago lanceolata). Ecotoxicol Environ Saf. 2018 Jan;147:681-687.
8. Eichberg C et al. The Anthelmintic Ingredient Moxidectin Negatively Affects Seed Germination of Three Temperate Grassland Species. PLoS One. 2016 Nov 15;11(11): e0166366. doi: 10.1371/journal.pone.0166366. eCollection 2016.