If you are a regular radio listener or tele-radyo viewer, station-scanning will inevitably bring you to one selling herbal or dietary supplements, likely touting a cure-all for many of the aches and pains and maladies of daily life: headaches, tiredness, dysmenorrhea, asthma, arthritis, hypertension, asthma, high cholesterol, diabetes, etcetera, some claiming disappearance of cysts and regression of tumors; or the commerce of skin whitening and height-enhancing products feeding off the cultural stigmas of dark skin and short stature. Listen a little bit longer and you will likely hear a testimonial or two, one boasting to have discontinued all prescription medicines in lieu of their newly discovered herbal miracle.

The adverts will be embellished with words like "pure, 100% natural, and safe"; many will throw in "antioxidant!"; maybe a claim of "FDA approved", real or not; "holistic" is a favorite; one or two, a money-back guarantee. And you're slowly getting hooked, and thinking: "Wow! Maybe this is worth a try!. . . " Then you hear this:

   Mahalagang paalaala, ito ay hindi gamot at
   hindi dapat gamitin sa ano mang kasakitan.

In English, it translates into: An important reminder. This product is not a medicine and should not used as treatment for any kind of ailment or malady. It is the obligatory disclaimer, which, almost always, will speed through with an unintelligible Tagalog garble. (If there is a "speed law" for talking too fast, this will merit a speeding ticket.) It's not meant to be clear, but just to fulfill the requirement of law, to replace the "No Therapeutic Claims" or "No approved Therapeutic Claims" disclaimer. It matters not, anyway; by that time, you're hooked, and ready to shell out your hard-earned money on this wow-of-a-product.

Adverts, testimonials and messengers
In this New Age of health awareness, nutraceuticals, vitamins, herbal supplements, and alternative treatment and holistic modalities have waged a battle with Big Pharma and western medicine for a slice in the lucrative commerce of health and longevity. In 2021, the global herbal supplements Market size was valued at 5.9 billion USD, with an expected growth rate of 6.5%. In Asia Pacific, the 2021 market was valued at 2.63 billion USD; in the Philippines, 11.57 million USD in 2023, at 6.7% from 2023 to 2030 to 18.22 million USD (about a billion in pesos).

Adverts sell and tout products for almost  every imaginable malady, sequing into cautionary reminders for those dreaded condtions: diabetes, stroke, heart attacks, kidney failure, or dialysis, almost always embellished with a paella of New Age come-on words: "Holistic, pure, 100% natural, probiotics, antioxidants."

And, of course, there are the testimonials. It matters not that the public is forewarned with "No Therapeutic Claims" or "Mahalagang Paalala" warnings—the testimonial is the hook that win the gullible, the hopeful, and the desperate over.

Testimonials are indispensable to the commerce of supplements. While some—a few, at the least—may be true, many, I believe, are fake, some bordering on the absurd, and, inevitably, dangerous. And in this age of trolls, bots, and social media disinformation, truth is the underdog. I have found myself in a web testimonial, photo and all (!), giving kudos for someone I have never met, and endorsement for medicinal products I would never support.

Of course, there is also the problem with the messengers: "Doctors", real or dressed up in their clinical white lab coats with stethoscopes slung around the necks, celebrities and celebrity newscasters who use their image and popularity delivering their 30-second endorsements of herbal products and supplements. In my small and informal boondock survey, "doctors" rate high in credibility, over 90%: "Pag sinabi nang doctor, totoo iyon. Magsisinungaling ba ang doctor? Celebrities are a not too distant second. In a study on motivations to herbal supplement use, positive testimonials and endorsements by celebrities and healthcare professionals (41.46% and 12.66% respectively) added up to 54% (10).

I have often wondered if the "messengers" ever vet what they sell, or just read off written advert text. Or are "messengers" ever vetted? Once, after a half-hour of agonized listening to medical misinformation, I texted the station's number and asked: Why do you allow a guest speaker to spew such medical falsities. The reply: I'm not responsible for what they say. I am only in charge of inviting the guests.

The good, the bad, the ugly.
The good
About 80% of the world population, especially developing countries, rely on predominantly plant-based traditional medicine for their primary health care needs, as dispensed by Ayurveda, Unani, and many other indigenous systems of medicine.

The cost and side-effects of prescription pharmaceuticals and the allure of alternative medicine have caused an burgeoning interest in herbal medicine. In the Philippines, unfortunately, herbal medicine, long in the purview of albularyos, medicos, and alternative healers, has been slowly disappearing, taken over by the commercial entrepreneurs and cottage industry of herbal production,the latter boosted by home-based capsule formulations of medicinal plants, such as malunggay, luyang dilaw, banaba, insulin plant, and many herbal teas.

Yes, we are surrounded by the good. Well, not in the flora-deprived concrete-paved environs of urban-suburban existence, where medicinal plants are packaged into a commerce of herbal supplements, often expensive, sometimes unaffordable, invariably promising too much, but  all labeled with "No Therapeutic Claims".

But in the provinces, there are Edens of herbal plenitude of plants, weeds, leaves, roots, and fruits with medicinal benefits, mostly trampled on, unappreciated for its many health benefits, left to the fauna to feast on the flora.

Flavier's list of ten medicinal plants—akapulko, ampalaya, bawang, bayabas, lagundi, niyog-niyogan, pansit-pansitan, sambong, tsaang-gubat, yerba buena—which was suppose to provide a legitimizing jump-start to a Philippine alternative movement, with "rolling stores" to bring accessible herbal products to the boondocks, sputtered, stalled, and died. A few are struggling to survive through the commerce of capsulized products.

The Philippines ranks 5th in the number of plant species and maintains 5% of the world's flora. In my two decades work on compilation of medicinal plants in the Philippines, more than 1500 at present, I have plowed through hundreds of thousands of scientific studies on medicinal plants' phytoconstituents, biologic activities, and medicinal properties, which included many clinical trials, affirming and supporting their traditional medicine use. In countless eureka moments I found myself wowed, but at the same time saddened at the unexplored potential of hundreds of herbal medicinal plants, the science and thousands of studies wasted and dumped into a dustbin of to-be-forgotten-benefits.

There is a lot of the "good" in that list of 1500 medicinal plants, hundreds more than Flavier's list of ten, as accessible, as potent or more potent, but sadly, neglected and unappreciated. Hundreds have been long in folkloric medicinal use, many evaluated in animal studies, many proven in clinical trials to have potential application for human needs. While many continue to regard the use of herbal medicinal plants as faith-based medicine, countless animal studies and many clinical trials are providing science to an increasing number of folkloric medicinal plants.There is this incredible trove of medicinal plants, supported by scientific studies, waiting to be merged with the pharmaceutics of mainstream medicine. 

The bad
There is the common perception that herbal plants and supplements are safe. Alas, untrue and misleading. While most are safe, many can cause adverse side effects. Unfortunately, there are no easily available information and reliable guideline for safe usage. Even familiar vitamin and mineral supplements can cause adverse reactions, especially in the elderly. For medicinal plants, from the wild or commercialized capsules, tablets, tinctures and teas, there is a dearth of information. While hundreds of plants -- weeds, roots, leaves, shrubs -- pulled off the ground or capsulized can be beneficial to health, some are toxic and may have dangerous interactions with prescription medicines, a few even reportedly used with homicidal intent. Some plants can increase the hypotensive, hypoglycemic, and anticoagulant effects of prescriptions drugs.

I will dare say, it is the rare breed of physician who will have the knowledge or the time to advise patients on their use of medicinal plants and supplements. Sadly, many in the medical community look at herbs and supplements with disdain. It is often a jaundiced and biased opinion, often based on ignorance, rather than intelligent appraisal. And furthermore, in the time-constrained visit to the doctor, there is little or no time to be spent advising on herbal or supplement use.

Packaging and labeling of herbal and medicinal supplements are also woefully lacking in information. Only a few phytoconstituents and contents. Some claim only  proprietary ingredients. Many just list various plant constituents without specifying specific plant parts used. I have not been able to find any independent studies done on supplements confirming actual constituents and quantified ingredients.

The ugly
The New Age decades of health awareness and the search for health, beauty and longevity have spawned a gold-mine commerce of herbal supplements, energy and immune boosters, anti-aging, skin-whitening, height-augmenting products. For sure, some are legit, supported by scientific studies in animals or clinical trials in humans, with contents quantitatively certified by laboratory testing. But, alas, some can qualify as "snake oils', many with unsubstantiated claims, and the real ugly, some containing none of the labeled or claimed contents.

Caveat emptor
Yes, buyers beware.
How can you be sure the product you're buying contains what they purport to have? Some simply label the content as "proprietary ingredients". Some labels list names of plant ingredients without specifying plants, some include constituents but invariably unquantified. Some labels don't even list ingredients.

In the U.S., in an investigation of popular herbal supplements sold by prominent national retailers (GNC, Target, Walgreens and Walmart), four of five products tested showed none of any of the herbs listed on the labels. A product claiming to promote "physical endurance and vitality" contained only powdered garlic and rice. Some were found contaminated with unlisted ingredients, including some that may be hazardous to people with allergies. In another study, 60% of herbal products tested contained plant substances not listed on the label, and 20% containing fillers of rice, wheat, or soybeans. Some found no plant DNA bar-coding (short gene sequences that indicate a particular species), which manufacturers countered as having been destroyed by processing. Another study found 50% contained no active ingredient, 30% contained contaminants and fillers. The question was raised: If such well-known brands are found fraudulent, could the problem infect the entire industry?

Those were U.S. studies. Can such fraudulent enterprise exist in the Philippines?

Unfortunately, dietary and herbal supplements do not undergo the stringent regulatory oversight given to prescription pharmaceuticals. While the FDA publishes advisories, debunkings, and listing of unregistered products, the FDA does not test dietary or herbal supplements for alleged contents or verify claims on biologic activities before they are sold to consumers. The FDA has publishes advisories (FDA Advisory: 2013-063: published 12 December 2013, is a cautionary read that still applies today.) and 101s on High-Foods (Draft Approach on High-Risk Foods). Most of the people contemplating use of a herbal supplement do not have the time nor the ability to sift through the morass of information, which are not user friendly nor info-helpful for the particular supplement being searched. In the battle of testimonials, social media, and adverts on one side and a few exasperated rants of skeptics and advisories on the other side, the testimonial-gang wins hands down.

Back to the good.

Plant Pharma
Herbs have been used for treatment since times of antiquity: Archaeological evidence indicates use of medicinal plants dating back to Paleolithic age, about 60,000 years ago; the Summerians with written evidence of use over 5,000 years ago; the Chinese since 2700 BC; the Egyptians since 1550 BC, with over 700 medicinal formulas contained in the Ebers papyrus; early Ayurvedic texts on medicine from India date back to about 2,500 BC; and De Materia Medica, a five-volume compilation of 500 plants and describing preparation of about 1000 simple drugs date back to AD 60. Fast-forward to modern times: About 80% of the world population, especially developing countries, rely on predominantly plant-based traditional medicine for their primary health care needs. And, to boot, this estimate: A full 40% (or 50% or more) of drugs in the pharmacist's counter in the Western world is derived from plants that people have used for centuries, including the top 20 best selling prescription drugs in the United States today. (4)

There should be no debate as to the deserved status of herbal medicinal plants—Plant Pharma —in medical therapeutics. It should be included in curriculum of Medical education, to be studied, taught, appreciated, and fostered for its myriad of potential benefits, rather than suffer the chronic disdain birthed from ignorance and prejudice of the medical establishment.

When I ask the often-idle and underutilized barangay health workers what and how they teach the local folk on the use of medicinal plants, the response, almost always: We don't know how to teach and what to teach. These health workers should be mobilized and schooled into the preparation and use of decoctions, infusions, tinctures, ointments, and poultices, then unleashed to educate the rural and boondock populations.

The early promise of "rolling stores" that will bring accessible and affordable herbal medicinal plants to the ruralfolk sputtered and died before it could take roots. Entreprenurial commerce reincarnated the noble idea into the unregulated gold-mine industry of herbal supplements with adverts and testimonials teeming and oozing with promise of cure for this-and-that and whatever-malady you're afflicted with.

There should be regulations on the legality and validity of claims made regarding herbal and dietary supplements. There should be banning of fake reviews and testimonials. With their motivating powers, messengers of reviews, testimonials, and adverts—celebrities, white-coat sellers, and commentators—should know what they are selling, rather than just reading scripted texts promising miracle cures. Owners or managers of herbal and supplement products should be prohibited from writing or controlling content of reviews and testimonials on their own products. Material connections between endorser and relationship to the company should be disclosed.

Herbal products/supplements should be submitted to an FDA accredited laboratories for qualitative and quatitative verification of alleged ingredient list and net contents, with web-based accessibility of results, ratings, reviews, and advice in a language comprehensible to herbal supplement users.

But, yes . . . wishful thinking, all.

And in the chaotic, unregulated ecosystem of herbal and medicinal supplements, fake reviews and bogus testimonials, and the coming of AI-generated testimonials, well . . . good luck.

Alas, for now we're on your own, to figure out what is safe, what works, which is true green or snake oil. Although use of commercial herbal products is faith-based, it won't hurt to educate yourself. Despite its pockets of misinformation, the Web is still a great source of readily available info on hundreds of herbal medicinal plants, possible contraindications or interactions with prescribed medications, and forums, blogs, and postings on their pros and cons and suspected snake oils and scams. Read the labels and watch for side effects or allergic reactions. Mention your herbal supplement use on your next healthcare provider visit, who might have time time or knowledge to advise. Choose a reputable manufacturer's brand, preferring standardized products and brands that provide information on ingredients, side effects, and precautions (good luck on the search). And click-off testimonials of miracle cures or those that promise too much.

If the herbal supplement delivers on its promise, well and good; but many do not have immediate discernible effects, and many will not have clinically measurable long-term benefits. If it is a sham product, at the very least, it provided for expensive urine.

I am still hopeful for a plant-based renaissance in health care, for affordable plant pharma to benefit one and all, but more so, the poor and marginalized who are barely surviving with hand-to-mouth existence, dreading the visitation of illness and unaffordable therapies of pharmaceutical and mainstream medicine. It might require a seismic shift in the paradigms of teaching, to bring medicinal plants into the curiculum of medical education, to merge folklore with science, to merge traditional medicine with western medicine, to encourage scientific studies on hundreds of endemic flora, to mobilize barangay health care workers into the rural and boondock areas to teach the wildcrafted use of plants.

A hope lingers. A dream continues.

(1)
Don’t Count it Out Just Yet: Radio Still Gets Turned On / Aye Ubaldo
(2)
Xanthones in Mangosteen Juice Are Absorbed and Partially Conjugated by Healthy Adults / Chureeporn Chitchumroonchokchai, Kenneth M. Riedl et al / J Nutr. 2012 Apr; 142(4): 675–680.  / doi:  10.3945/jn.111.156992
(3)
Biological Activities and Bioavailability of Mangosteen Xanthones: A Critical Review of the Current Evidence / Fabiola Gutierrez / Nutrients 2013 , 5 , 3163 - 3183 / doi: 110.3390/nnu5083163
(3)
New York Attorney General Targets Supplements at Major Retailers / Anahad O'Connor / Well, 2015
(4)
Medicinal Botany / USDA: United States Department of Agriculture
(5)
FDA Advisory: No 2013 - 063: Subject: Public Warning against Health Scams in the Internet / FDA
(6)
FDA’s Draft Approach for Designating High-Risk Foods as Required by Section 204 of FSMA February 2014
(7)
High Risk Food Products - FDA Verification Portal
(8)
Regulatory issues on traditionally used herbal products, herbal medicines and food supplements in the Philippines / Yolanda R Robles, Imelda G Peña, Monet M Loquias, Roderick L Salenga, Karen C Tan, Edwin C Ruamero Jr / JAASP, 2012; 1(3): pp 170-179
(9)
Regulatory landscape of dietary supplements and herbal medicines from a global perspective / Shraddha Thakkar, Elke Anklam, Alex Xu, Weida Tong et al / DOI: 10.1016/j.yrtph.2020.104647
(10)
Social and Personal Determinants of Herbal Supplement Use in Metro Cebu, the Philippines / Gerard Lee L See, Florencio V ARce Jr, Gea Abigail U Ecoy, Mark Niño B Melgo, Delia E Belleza et al / Philippine Journal of Science, 2024; 153(4): pp 1315-1328 / ISSN: 0031-7683
(11)
FTC Finalizes Rule Banning Fake Reviews and Testimonials / PerkinsCoie