From public buses to social media in Nigeria, herbal medicines are boisterously advertised as miracle cures. They are not short of takers, even as medical experts urge caution. Is there a clash between traditional medicine and science?
Need a "solution" for miscarriage? Reach for the amaranth plant. Suffering from rheumatoid arthritis? A paste of mango bark and onion should do the trick. Hepatitis B? No worry, drink a mix of herbs, spices and camel urine. Your child having convulsions? A combination of onion, ginger, garlic and oil will end them. Then there's the herbal remedy for the coronavirus from Madagascar that captured the continent's attention.
In our fact-checking work in Nigeria, we come across scores of these treatments every year.
We constantly debunk these unproven cures but they continue to proliferate, enthusiastically received on social media, perhaps reflecting Nigerians' strong belief in traditional medicine. Some say it is a huge industry in the continent's most populous country.
Given the scepticism, is there a clash of culture between the two approaches? And is the gap unbridgeable?
Quicker and cheaper treatments
The World Health Organization defines traditional medicine as the "knowledge and practices based on theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health".
In many countries it is also known as alternative or complementary medicine, the international health agency says. The most common ingredients are herbs, with as many as 80% in Africa having used these methods for their primary care.
Online, these alternative approaches are offered as quicker and cheaper treatments for a variety of ailments and life-threatening diseases.
We asked medical practitioners in Nigeria to tell us their core concerns about traditional medicines.
Some of the dangers include the lack of standardisation on dosage and frequency of use, Oyewale Tomori, a professor of virology, told Africa Check.
There is also often little information about the ingredients used in them or an understanding of their function, Tomori, who is also a former vice-chancellor of the Redeemer's University in south-western Nigeria, added.
Marycelin Baba is a professor of medical virology and microbiology at the University of Maiduguri in northern Nigeria. She told Africa Check that traditional medicine combined plants that had not been subjected to research, which could be dangerous.
"Not all plants can be combined or consumed," she said. "Some are toxic and can lead to death. Before anyone comes out with a claim about a mixture serving as a treatment, it must be thoroughly researched and tested."
Cultural acceptance and weak health systems
Given these significant shortcomings, why does alternative medicine thrive in Nigeria?
Prof Tanimola Akande is a public health physician at the University of Ilorin Teaching Hospital. He said some reasons for the enduring belief in alternative medicine were cultural acceptability, poor and weak health systems that made access to orthodox medicine challenging, and the unregulated promotion of traditional medicine by practitioners.
Oladimeji Okunola, a principal nutritionist, agreed that the high cost of quality healthcare was a factor. Accessing proper medical care in Nigeria was not cheap, he said, as public healthcare was weak and, for example, lacked equipment. Many Nigerians are therefore forced to consider private hospitals, which in many instances have higher costs.
And government hospitals are overcrowded and underfunded. "There are more patients and fewer doctors or specialists. One would have to book in advance just to see a specialist. If one doesn't want to battle with these factors and more, the next option is traditional medicine, which is so much cheaper."
Public figures also fan the growth of traditional medicine. In April 2020, Oyo state governor Seyi Makinde revealed that he fought Covid-19 by taking vitamin C and black seed oil mixed with honey.
An unregulated industry
Akande has also chaired the Association of Public Health Physicians of Nigeria. He confirmed there was a conflict between science-based and traditional medicine.
In his view, the popularity of unproven treatments could be doing more harm than good to Nigerians' health. "A high level of complications resulting from traditional medicine is seen in orthodox medicine and most present too late for meaningful remedies," he told Africa Check.
"Traditional medicine in Nigeria has so much secrecy and [practitioners] do not subject their products to scientific research for evidence of efficacy."
Regulation would help. "The current situation where anyone can claim they are traditional practitioners is not helpful to the health system since this is susceptible to abuse and quackery."
Bringing science and tradition together
But traditional medicine had a role in medical care, both in Nigeria and elsewhere in the world, Akande said. Some are derived from herbs, and have medicinal value.
So how can the two approaches be brought closer together?
"The gap can be bridged if traditional medicine is ready to subject its products for verification of efficacy," Akande said. This would help refine them and define a standard dosage.
"Traditional medicine should grow to a level where practitioners can be certified to practise based on their knowledge and skills or training."
She agreed that there could be a closer relationship between science and traditional medicine.
"Traditional medicine relies on natural-based materials such as extracts from foods. These extracts contain phytochemicals that are useful to the body. The issue with the medicines is that the processes used to prepare treatments may not conform to some standards. Some components they use are not refined. They also lack knowledge of the dosage."
The way forward was orientation, Karim said. Traditional sellers should be educated on modern treatment methods.
"The pharmaceutical sector should step in to enlighten them on dosage, quality and quantity of components," she said. Practitioners should also be taught to detect and mitigate the side effects of their ingredients.
A role for safe traditional medicine - WHO
The WHO says because up to a third of the population in Africa lacks access to essential medicines, "the provision of safe and effective traditional and alternative remedies could become an important way of increasing access to health care services".
The agency has said it "recognises that traditional, complementary and alternative medicine has many benefits and Africa has a long history of traditional medicine and practitioners".
"Africans deserve to use medicines tested to the same standards as people in the rest of the world. Even if therapies are derived from traditional practice and natural, establishing their efficacy and safety through rigorous clinical trials is critical."
It appears that until this is done the chasm between orthodox and traditional medicine will remain a yawning one.