Sunday, October 22, 2017

Dengue fever? Nilavembu Kudineer herbal concoction? Treatment Score = Zero = No Data

According to reports, over 150 people have died in India from an epidemic of dengue fever. No doubt, the death toll will have risen by the time you read this blog post.

Dengue fever results from a virus spread by a mosquito (Aedes aegypti). Interestingly, there is a discussion going on in India over one of the alleged treatments for dengue fever called Nilavembu, which is a combination of herbs.

SYMPTOMS
Dengue fever is easily mistaken for the common flu (influenza). Dengue fever can cause high fever, chills, headache, swollen glands, nausea, vomiting, aches and pains of the muscles and joints, fatigue, a rash, bruising, and so on. Dengue fever can progress in severity until it kills you. Dengue fever can turn into dengue hemorrhagic fever, which can cause severe bleeding. It’s a horrible death.

Naturally, anyone near an outbreak would want a medication to prevent or cure dengue fever.

KAMAL HAASAN
The famous actor and director, Kamal Haasan, reportedly tweeted:
“Till proper research results come let us not distribute Nilavembu concoction.” (Note, when I search Twitter I cannot find this tweet, but it might have been deleted, because of the ensuing controversy, or might not be searchable from the USA.)
https://www.ndtv.com/tamil-nadu-news/no-medicine-without-doctors-advice-kamal-haasan-on-dengue-treatment-1764890

GOVERNMENT
The local Health Minister said: “Nilavembu is a proven medicine, we have tested it in King Institute in Guindy, it increased the platelets and immunity, it is proven…..”
http://www.india.com/news/india/dengue-menace-kamal-haasan-tamil-nadu-government-trade-punches-over-nilavembu-kudineer-complaint-filed-against-actor-2545942/

The “…Director of Public Health and Preventive Medicine, said, ‘There's tacit knowledge, for thousands of years our ancestors have huge knowledge. If you ask of scientific evidence, how come several drugs get banned after being used for several years?’
https://www.ndtv.com/tamil-nadu-news/no-medicine-without-doctors-advice-kamal-haasan-on-dengue-treatment-1764890

MEDICAL STUDIES
What do medical studies say? I searched the medical literature on treating dengue fever with the herbal preparation Nilavembu Kudineer, added them up, and came up with a Treatment Score of zero. Zero in this case meaning there is no data. I could not find any studies with human beings that gave treatment effects showing Nilavaembu Kudineer to be effective at either treating or preventing dengue fever.

GRAPHIC
The graphic shows the final result. In the software, you can click through the graphic to get all the original data.


HOW I DID THE TREATMENT SCORE
To come up with the Treatment Score, I searched PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) and only found two medical studies on Nilavembu. One study was in mice, and one study was "in silico," which means a laboratory study using computers that have silicon chips. There were no human studies. I also search the medical literature via the Trip Database (https://www.tripdatabase.com) and found zero studies of "quality" for Nilavembu. In addition, I searched Google Scholar, and while finding some interesting non-human studies, I found no human studies.

THIS REVIEW MAY BE FLAWED
If anyone knows of any important HUMAN studies on Nilavembu, please let me know. There may be studies in Indian medical journals to which I do not have access. Please review and critique this review, and suggest other studies that need to be considered. One good quality study would change the Treatment Score. I would love to collaborate. Let’s work together.

BETTER STUDIES
Ideally, quintuple blinded, randomized controlled trials need to be done comparing the Nilavembu Kudineer herbal concoction with placebo. It would be great if Kamal Haasan collaborated with the government to get studies done. If Nilavembu Kudineer proved to be effective in randomized controlled trials at either prevention or cure of dengue fever it would be a major discovery. Sometimes herbal therapies hold up in experimental studies. We all need to know, because science is how new and better treatments are discovered.

WORLD NEEDS TO WORK TOGETHER
Patients, doctors, nurses, and journalists around the world need to start working together to create better treatment transparency. We all need to be better science communicators. We can do this using Treatment Scores. The Treatment Score = the net treatment benefit for the patient, as summarized from the existing medical literature.

HERBAL PREPARATIONS
One of the problems with studying herbal preparations is that they often have many names and different ingredients. This means they often have different doses of the different ingredients. For example, Nilavembu Kudineer may also be called Nilavembu Kashayam, or Nilavembu Kudineer Choornam (Churna). It’s not entirely clear.

NINE INGREDIENTS 
One website lists the ingredients of Nilavembu Kudineer, if it is the same product as Nilavembu Kudineer Choornam (Churna), which I have quoted below:

“Nilavembu Kudineer Choornam (Churna) contains nine ingredients mixed in equal proportion in powdered form.” 
https://www.ayurtimes.com/nilavembu-kudineer-nilavembu-kashayam/#ingredients-composition

I have created a numbered list of the ingredients from that website:

  1. Nilavembu (Kalmegh, Bhunimba or Indian Echinacea) - Andrographis Paniculata
  2. Vilamichai Ver - Plectranthus Vettiveroides
  3. Vetiver (Ushira or Khas) - Vetiveria Zizanioides
  4. Chukku - Sonth - Zingiber Officinale
  5. Milagu - Kali Mirch (Black pepper) - Piper Nigrum
  6. Korai Kizhangu - Mustak (Nut Grass) - Cyperus Rotundus
  7. Santanam - Safed Chandan (White Sandalwood) - Santalum Album
  8. Peyputtal (Chichonda) - Trichosanthes Cucumerina (Snake Gourd)
  9. Parpadagam - Mollugo Cerviana

SIDE EFFECTS
When I calculated the Treatment Score for Nilavembu Kudineer, I could not find any statistics for the side effects. Specifically, I found no “event rates” for any side effects. These studies need to be done, if they have not been done. The side effect of infertility is interesting, because it may not be a side effect at all, but may possibly be an Internet rumor - another reason why high quality studies are needed.

CONCLUSION
The Treatment Score for Dengue fever for Nilavembu Kudineer = Zero = No Data. High-quality clinical studies need to be done. Patients, doctors, nurses, and journalists need to become better science communicators by using evidence-based medicine

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Treatments Scores, Inc. and associated individuals do not claim to diagnose, cure, treat, or prevent any disease. Treatment Scores are an educational system to help you figure out the science of medicine behind treatments, which should be the starting point for shared decision-making for all diagnoses. The information on this website should never be used as a substitute for the advice of a qualified, licensed physician or healthcare professional. We are not advocating any treatment, physician, medication, or any other entity. We are informational or educational only. We do not form physician-patient or doctor-patient relationships. Contact your physician for medical treatment. Call 911 if you may have an emergency or go to the Emergency Department. We are not responsible for any delays in care from information obtained from our site, nor for any consequential damages of any nature whatsoever, either directly or indirectly related to the use of this site, or from assumptions made. We cannot predict the future, we are only trying to do a better job of quantifying and reviewing what has happened in the past. We claim ZERO accuracy. We claim zero accuracy, because in medicine every patient is different, every statistic is a flawed statistic in some way, there are always estimations, and there is always bad or missing data. Averages may be used and no patient is average, every patient is unique. We make no promises or warranties whatsoever. SEE YOUR OWN PHYSICIAN FOR TREATMENT.

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