Unregulated use of Artemisia in cancer patients in Libya: an emerging ethical and public health concern

ABSTRACT

A concerning trend has recently emerged in Libya where cancer patients are seeking unproven herbal remedies derived from local Artemisia species driven by circulating claims on social media. These unregulated traditional medicines can interact with standard cancer treatments such as chemotherapy and radiation therapy. Scientific evidence suggests that Artemisia compounds can alter drug metabolism through enzymatic pathways (notably the CYP450 system), potentially neutralizing treatment efficacy or exacerbating systemic toxicity. This letter evaluates the toxicological profile of Artemisia and proposes an ethical framework for patient protection and public health intervention in Libya.

In Libya, a concerning recent trend has emerged where cancer patients are turning to unproven herbal remedies made from local Artemisia species and coffee; often before, alongside, or instead of evidence-based treatments [1]. This surge in interest appears to be driven by circulating claims on social media that promote the mixture as a cure for cancer, leading to widespread demand, particularly in eastern Libya [2]. Herbal remedies are often perceived by the general public as natural cures driven by a combination of necessity and cultural beliefs, despite a lack of clinical validation. Unapproved traditional medicines can interact with conventional cancer treatments such as chemotherapy and radiation therapy, potentially reducing their effectiveness or increasing their toxicity [3]. Artemisia compounds modulate CYP450 enzymes and may interfere with oxidative stress mechanisms critical to standard oncology treatments [4]. Crude preparations contain numerous unstandardized phytochemicals that may produce unpredictable pharmacological effects [4]. The hepatotoxicity associated with Artemisia species is primarily linked to bioactive compounds such as essential oils, terpenoids, flavonoids, and other phytochemicals [5]. Prolonged administration of certain Artemisia species for more than 7 days may induce hepatocellular injury and, in severe cases, can lead to liver cirrhosis [6] (Table 1). Even outside a therapeutic context, extracts should be professionally prepared and carefully dosed, as uncontrolled use can result in overdosage or intoxication due to minor toxic constituents within the plant [7].

Table 1.

Summary of potential risks associated with unregulated herbal use among cancer patients.

Category of risk	Clinical consequence/mechanism
Reduced treatment efficacy	Pharmacodynamic interference: antioxidant properties may neutralize reactive oxygen species essential for chemotherapy/radiotherapy to kill cancer cells.
Increased toxicity	Pharmacokinetic interaction: Artemisia extract constituents modulate drug-metabolizing enzymes (CYP450), leading to altered metabolism and accumulation of chemotherapy agents.
Direct organ toxicity	Compounds such as thujone or high doses of essential oils can cause intrinsic damage to the brain and liver.
Treatment delay	Patient reliance on unproven remedies leads to treatment postponement, allowing the cancer to progress to a less treatable stage.
Financial/ethical exploitation	Targeting vulnerable patients with unproven claims, diverting financial resources away from effective, evidence-based care.

While preclinical studies on North African Artemisia species (e.g. Artemisia campestris, Artemisia herba-alba) reported in vitro cytotoxic effects against cancer cells, their extract profiles also revealed the presence of neurotoxic compounds such as thujone, which pose a significant risk of toxicity and an uncontrolled dosage when used in traditional preparations [8–10]. Cytotoxic effects are mediated through mechanisms such as the induction of apoptosis, cell cycle arrest, the inhibition of cell migration and invasion, and the modulation of key signalling pathways [11–13]. Even though cytotoxic effects have been observed in cancer cells, Artemisia compounds are not superior to conventional chemotherapy [8]. A decaffeinated coffee product containing Artemisia annua is currently being evaluated in a small phase I trial for ovarian cancer, while a phase II trial involving 30 patients is ongoing for prostate cancer [14]. However, no Artemisia-based cancer treatment has been clinically approved [15], and poor methodological quality remains a barrier to safe integration into oncology care [13].

Global policy initiatives such as the WHO Traditional Medicine Strategy 2025–2034 reflect the growing interest in traditional medicines [16]. The Nobel Prize awarded to Tu Youyou for discovering artemisinin (derived from Artemisia annua), a compound isolated through regulated pharmacological research for the treatment of malaria, starkly contrasts with the uncontrolled use of crude Artemisia extracts in oncology [17].

Libya’s healthcare system continues to face substantial challenges, prompting some patients to seek care abroad or resort to unproven alternatives. This trend raises major ethical concerns, as vulnerable patients may fall victim to misinformation and commercial exploitation. The ethical imperative to protect these patients is reinforced by the Declaration of Helsinki, which mandates that ‘unproven interventions’ be utilized only as a last resort, guided by expert advice, informed consent, and data collection to prevent the circumvention of patient protection [18]. Oncologists also face challenges when beliefs in alternative therapies complicate shared decision-making [3].

Strategies to mitigate unregulated use of herbal remedies include strengthening cancer care services and improving cancer drugs availability and affordability. Furthermore, scientists must exercise greater caution in how preclinical findings, particularly on ‘natural cures’, are communicated to the public. High-quality pre-clinical and rigorous clinical research on local medicinal plants is critical which could potentially lead to the discovery of new agents [14]. We also highlight the need for studies that define the hepatotoxic thresholds of key Artemisia compounds to establish evidence-based dosing parameters.

We call for ethics committees to urgently issue clear guidelines for oncologists navigating these complex patient‒doctor discussions and for national health authorities to launch an immediate public awareness campaign. Healthcare professionals, pharmacists, and local media play a crucial role in raising awareness through public education and combating misinformation about herbal therapies. Regulatory bodies must control the informal promotion and sale of herbal products to protect vulnerable patients. Addressing Artemisia misuse is both a public health and ethical imperative.

Disclosure statements

The authors declare that they have no conflict of interest related to the submission of this letter. Specifically, the authors report no affiliation, financial relationship, or current involvement with any herbal medicine centres, traditional medicine commercial entities, or companies marketing Artemisia-based products or supplements.