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The Evolution of Malaria Treatments: a Vision For the Future

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This is the title of an unpublished work by Yvette Parès. With her own experiences and scientific background and a starting point, she explores the history of malaria, the evolution of its treatment, and most of all, she proposes European plant-based remedies in keeping with the method Parès learned from her Peul teacher. The following passages are excerpts from the book.

I believe that a comparison between traditional anti-malaria treatments and those used today guides us towards a different vision of the struggle against the disease, and would allow us to undertake concrete and valuable initiatives.
Since the beginning of time, malaria has struck populations around the world. Ancient medical books from Asia and Europe describe intermittent fevers and the attacks that occur with a predictable regularity.

In the current day, malaria has taken a heavy toll on four continents. In the course of the 19th century, it was strongly feared in marshland regions: rice fields, peatlands, and along streams, while modern cases in Europe stem from travels in endemic areas.

Malaria remains something to be feared, and it has become even more so in the wake of the treatments that left their mark on the second half of the 20th century.

The evolution of treatments in Europe

Throughout its history, Europe has been hit with malaria outbreaks. From the Baltic Sea to the banks of the Mediterranean, from the Atlantic Ocean to the immensity of Russia, each country has confronted the disease, which struck every year, causing intermittent fevers in the spring and autumn.
Across these regions, traditional teachings, the knowledge of healers in rural areas, and the art of medicine came together to create treatments based on medicinal plants from their own environment. A major step forward was made in the 17th century with the introduction of quinine, a tree bark from Peru that was used in native medicine. Treatments made using this bark were once considered to be important remedies for malaria outbreaks. However, as quinine came from a far-off land, it often became extremely expensive and sought-after. Even its normal, more moderate cost, rendered it inaccessible to poor rural populations. It thus became indispensable to create substitutes. Practical and intelligent doctors judged it necessary for each country to find, among its own medicinal plants, the means to treat patients.

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Quinine leaves

Several important events marked the end of the 19th century, such as the discovery of blood parasites, which are responsible for malaria, and the understanding of the complex cycle of the disease and the role of mosquitoes in its transmission. In parallel, the rapidly expanding reliance on chemistry pushed pharmaceutics and anti-malaria treatments towards synthetic products. The history of malaria was forever changed.

Thoughts on the active principles

The study of the chemical composition of medicinal plants allows us to understand the complexity of their components and to classify them into various families: alkaloid, glycosides, flavonoids, anthocyanins, tannins, terpenes, etc. This approach satisfies the analytic mind, but it is by no means essential to the art of pharmaceutics and medicine. This is demonstrated by Chinese medicine, which has more than one hundred thousand formulas at its disposal, as well as by doctors from other continents with their vast patrimony of treatments.

The major error, which began in the 19th century, was the extraction of the “active substance” — the principal component — which contains the majority of a plant’s effectiveness and can be dosed and manipulated according to the mode of action. “Empiricism” — a pejorative term commonly used by the domain of science, which indicates a lack of understanding of certain fundamental concepts — would thus be eliminated.

This arbitrary isolation, which tears the active substance away from all that accompanies it, also rejects the complementary properties of medicinal plants. According to Chinese medicine, this active substance represents the emperor, but when he is deprived of his ministers — who complement and guide his decisions — he is left with an incomplete, unruly, and often brutal reign, which can lead to undesirable side effects.

We are faced with the paradox of needing to add tannin with quinine sulfate and gentian in order to achieve the maximum effects.

Despite our awareness of these anomalies, this heresy has continued up until the current day. It has cut off Western medicine from its roots, and from nature, all the while contributing to the devastation of medicinal flora across the world.

Our planet represents a harmonious whole. Why should we subject it to barbaric treatments and chemical manipulations — which are costly and pollute the earth — in order to extract a single component, with all the deficiencies that characterize it?

The isolation of active substances also led the way for what would later become “molecular therapy”, especially in the fields of infectious diseases and parasites. This approach already contained the seed of the disasters that would come in the second half of the 20th century, with the resistance of micro-organisms looming dangerously on the horizon.

The disappearance of malaria in Europe put an end to the use of active substances extracted from anti-malaria plants. If their use had continued, Plasmodia would have paved the way for rebel strains to develop.
Our hope is to return to a respectful use of plants and their multiple virtues. This would come about by means of an exacting simplicity and a broad knowledge. Traditional forms of medicine constitute living examples, which have much to teach us to remediate the errors of the 20th century.

Ancient treatments

A long path, spanning both centuries and natural states, has led us to discover the extensive diversity of treatments used in Europe to fight malarial fever. Some of them, such as those relying of the sap of fresh plants, could only be used in rural regions, but many other simple methods of preparation were suited to all locations. This information from the past, which is far from being out of date, constitutes a basis for the creation of natural treatments adapted to the realities of our era.

The development of efficient “cocktails” that would take into account the observations of our predecessors would bring about a renewal in the struggle against malaria. The art of pharmaceutics and of medicine would thus recover both its soul and spirit of service, and the commodification of our health would be pushed back. This path is possible, but it is up to us to struggle to turn it into a reality. Methods for this are proposed further on.

Synthetic antimalarial treatments

After a fruitful journey in the treatment of malaria, in touch with the riches of nature, the transition to the 20th century — the “full-chemical” era — proves to be a striking contrast. We entered an arid desert ripe with danger, which will lead to the explosion of an endemic and to a therapeutic dead-end that science and mainstream medicine prove incapable of overcoming.

Pharmaceutical companies have synthesized a limited number of antimalarial molecules. The arrival of such products was hailed as a great step forward in the struggle against malaria. As these treatments are ready-to-use, they could be distributed in areas struck by an endemic, which would then be controlled, if not fully eradicated. Yet there was a flaw: the capacity of Plasmodia to adapt under adversity.

Thoughts on synthetic antimalarial treatments

These antimalarial treatments devised on a faulty basis have not attained the desired objective.

- In an entirely rational approach, chemists sought out very specific active molecules in order to destroy parasites according to perfectly enlightened methods. However, this form of reasoning was based on incomplete scientific concepts. We were unaware of phenomena of the haematozoic resistance — some of them are far from being controlled and win out in this combat and give birth to more virulent strains which spread across the world.

- The reductive scientific spirit only took into account the molecule-Plasmodium duo while forgetting an essential detail: the human organism can also have venerable zones where the product has a noxious influence. This is how undesirable effects of varying levels of seriousness — at time even causing death — can occur, which can increase the discomfort of malaria cases.

- The highly ephemeral effectiveness of antimalarial molecules offers a contrast with the persistence of medicinal plants, which were once prescribed in Europe against intermittent fevers. We can think of chamomile, for example — recommended by Hippocrates, as it still conserves its effectiveness after two millennia.

- Scientific information concerning antimalarial drugs exists in large numbers: chemical families, molecular formulas, ways in which membranes of erythrocytic parasites or enzyme inhibitors are affected. This information, which satisfies the mind, implies a broad knowledge. In reality, it is simply a deceptive illusion, which diminishes the force of the conclusion concerning the failure of these treatments. Furthermore, it pushes us further away from the modesty that would make it possible to undertake critical measures, which would represent one step forward towards new forms of knowledge and a return to the ancient teachings of Europe.

- Science is not indispensible to the art of medicine, which is something that has been forgotten. Our predecessors, alongside all practitioners of traditional medicine in areas prone to malaria — who had nothing to guide them but the clinical signs — put in place beneficial treatments that were without danger. By what mysterious path did they achieve this? There are no “empirical” treatments, simply effective or ineffective ones.

- The prescription of synthetic antimalarial drugs affects fever attacks but no indications are given concerning interruptions, complications, and treatments of consolidation. These notions are on the contrary taken account of by ancient treatments.

- The synthesis of antimalarial drugs requires laborious and expensive research and is a source of pollution because of the reagents used and the residue of reactions that are pushed out into the atmosphere. These long manipulations have only led to molecules that are without future and that have transformed malaria — which has plagued humanity for thousands of years — into an even more fearsome and deadly disease. Mainstream medicine has attempted to replace treatments that are traditionally used in malaria-endemic areas, but they have continued to exist in the shadows and have saved lives. To put them back into wide use would allow us to remedy the errors that were committed throughout the 20th century.

Therapeutic propositions

Malaria died out in Europe in the beginning of the 20th century. It would seem that these therapeutic propositions no longer have any reason to exist, but one must not forget those who return each year contaminated by strains of resistant and multi-resistant Plasmodia after traveling in a malaria-endemic zone. The severity of the symptoms brings them to hospitals or tropical medicine clinics, yet despite the treatments they are given, deaths still occur.

Couldn’t other forms of treatment save human lives? It is from this perspective that a number of methods have been developed. Their basis is twofold:

- The successful treatments carried out by our predecessors — Cazin and others we have discussed — with important antimalarial plants as well as those who were able to bring intermittent fevers under control by means of quinine sulphate.

- The experience acquired in practicing traditional medicine in Senegal, where the art of pharmaceutics is associated with a mastery of the use of synergetic and complementary plants.

These methods are to be seen as an alternative to antimalarial treatments for drug-resistant attacks with a complementary advantage: the absence of undesirable side effects. They can be separated into several categories:
- Decoctions, infusions, macerations (DIM)
- Medicinal waters,
- Essential oils
- Medicinal wines

This book is based on ancient European teachings alongside a long-term experience in Senegal working with traditional African medicine. Its goal is to provide food for thought aimed at creating a new struggle against malaria across the world. Another goal is to provide assistance to European patients who return heavily stricken from malaria-endemic zones. Methods have been proposed by building on the knowledge of our predecessors, Dr. Cazin, and the successes of the doctors he cited in fighting intermittent fevers.

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