Salves and balms

I am doing an article today that will seem rather cold in the beginning, much like December weather, but I want to assure you I am going to end on a warm note, more like the season’s spirit.

I am writing today about the use of medicines, and will start by saying that my thinking here is simple: the fewer the better, and none would be best.

That philosophy comes from some 30 years of working with medicines, in consumer and health NGOs, and with the Department of Health.  I have seen how corruption in the DOH during the Marcos era created a situation where we ended up with thousands of medicines, many of questionable safety and efficacy. We were too slow to remove such medicines, and too quick to allow new ones in.

Dangerous drugs

The situation has improved over the years, especially during the term of Health Secretary Alfredo Bengzon with the vigilant Dr. Alberto Romualdez, later to become health secretary himself, looking after the medicines.  Many dangerous drugs were removed, often accompanied by the filing of lawsuits against drug companies.

Later, sitting with the National Drug Committee, which reviewed the medicines to include in a National Drug Formulary, I had to update myself on medicines not even approved in the Philippines and to learn from seasoned pharmacologists like Dr. Nelia Cortes Maramba and Dr. Esther Paje-Villar.

Unfortunately, the drug market remains a difficult one to navigate with too many products and an overworked Food and Drugs Administration.  Yet I know I have to be even more vigilant with the medicines because I am raising very young children and caring for very elderly parents, the very young and the very old being particularly vulnerable when it comes to adverse effects of medicines.

The problems are compounded today by the proliferation of medicines claiming to be “herbal” or “natural.”  I put those words in quotation marks because many of these preparations, for example, glutathione, are not herbal at all and “natural” is not an accurate a term either.

There is a demand for these supplements, spurred by advertisements and by the consumers’ fears of the side effects of “Western” medicines.  But many of the problems with “synthetic” medicines are found as well today in our so-called “natural” medicines.

Most of these preparations are not approved as medicines by governments and are instead registered as “food supplements,” which means they don’t have to go through the more stringent tests for efficacy.  That is the reason too that these drugs have to carry on their labels, “No Therapeutic Claims Approved.”  Yet the supplements are advertised with all kinds of therapeutic claims, sometimes even with a mandatory but split-second “No Therapeutic Claims Approved” after naming all the diseases.  An exasperated Dr. Esperanza Cabral, during her term as health secretary, issued an order that would have required an even stricter “Hindi ito gamot” label but she was blocked by a lawsuit.

These supplements are not cheap either. Some are even more expensive than “synthetic” ones, and it is the poor, desperate for solutions to their health problems, who end up paying more, as a percentage of their tiny household budgets, for these nostrums.

People crave for medicines—“natural” or “artificial,” “Western” or “traditional”—because they want health, and they want relief from pains and illnesses. Yet, underlying the effectiveness of many of these chemicals is what we medical anthropologists call “a total drug effect,” the medicine’s action being due not just to its active ingredients but also because of the drug preparation’s name, packaging, labeling, even color and taste. This total drug effect includes a placebo component, meaning that even if you gave a substance without any active ingredient, it would still have a beneficial effect for the patient.  And over the years, I have come to appreciate the importance of another component to this total drug effect: the providers of the medicine.

‘Haplos’

The prescribing physician is all-important here, prescriptions taking almost magical qualities because they symbolize a doctor’s knowledge and power.  So too is the dispenser, the pharmacist or clerk in the drugstore.  But the provider can also be the person giving the medicine. This was captured by that classic ad for Vicks Vaporub showing a mother rubbing on the medicine on a child, with a warm voice extolling the healing power of Vicks combined with  “haplos ng ina.”

I used to tell my medical students to note how that haplos is distinctly female. It is a gentle touch, filled with affection and care and, for some reason, we don’t usually associate that touch with fathers.  My students would laugh out loud and suggest that all they got from their fathers were sampal(a slap), or palo(spanking), rather than haplos.

Now a father myself and still a firm believer in the rational use of medicines, I have come to appreciate the contribution of haplos to the efficacy of particular medicines: those we call salves and balms. Vicks Vaporub is one such preparation, which many doctors scoff at. Yet I came to appreciate its value one cold December month when I had to bring my kids to Cagayan de Oro.  One of my daughters developed a hacking cough that worsened during the night.  I had to rush off looking for a drugstore and bought cough medicines (which I rarely use myself). Then it occurred to me, why not Vicks?

Rubbing the Vicks on my daughter brought back memories of my own childhood, the comforting effects of the rub—and my mother’s own haplos.  My daughter’s crying subsided, and soon she was asleep.

I am certain that it was the oral medicine that reduced the coughing, but I take Vicks with me now whenever I travel with the kids. I also bring aceite manzanilla (chamomile oil),  a really old-fashioned drug which, like Vicks, is no longer considered effective by many doctors.  Yet it remains a popular remedy for colic or gas pains, something I rediscovered with my own children.

My son was especially prone to colic and when older relatives suggested the oil, I smiled and wondered if it would help.  Yet when I first poured the oil on my palm, childhood memories returned and I found myself rubbing my palms together to warm up the oil, as my mother did.  And as I applied the oil on my son, the relief seemed almost instantaneous.

There are times now when my son sometimes fakes gas pains to get the rub, and when he does, I know he is asking for attention.  I use the aceite manzanilla anyway, with haplos ni tatay and a bit of talking therapy.

The pharmacological effects of these salves and balms—they don’t have to be Vicks or Efficascent Oil—come from their aromatic oils, which do relieve pains and itches, bring up phlegm, dispel colic.  So when I use these salves and balms, I am  still sticking to my philosophy of rational use of medicines, knowing that the healing comes in part from the physiological effects of the active ingredients, but that would not be as effective without the human nurturing and warmth, the human touch, that comes with applying the medicines.