American Bee Journal • October 2016 Vol. 156 No. 10 • Peter Molan: The Research Giant Who Brought Us Medical-Grade Manuka

On Sept. 16, 2015 Peter Molan, the foremost advocate for the medical use of honey, passed away. While many have proclaimed the beneficial properties of honey, Peter Molan was unique in seeking out the scientific underpinnings of how and why honey was effective. Before the advent of antibiotics, honey enjoyed widespread use as a wound treatment. Peter worked tirelessly to return honey to a doctor’s medical toolkit. He strongly disliked how many books and reports on honey relied on anecdotal evidence. During our conversations he explained how succumbing to hearsay devalued the product and turned honey into just another snake oil. By researching why honey worked and underscoring the sound, scientific evidence of its effectiveness, Peter Molan created a unique medical niche for manuka honey.

Prior to Peter’s research, manuka honey was the bane of New Zealand beekeepers. When bees filled combs with this gelatinous honey, beekeepers had difficulty extracting it. Even once extracted, manuka honey sold poorly because of its strong, earthy flavor. Full frames of troublesome manuka were sometimes traded as bee feed in exchange for empty combs. Peter Molan’s research into the light and heat stable antibacterial properties of manuka honey stimulated the rapid acceleration of its value, which now commands some of the highest prices in the industry. Highly active manuka honey can wholesale for more than $40 per lb, making airlifting hives by helicopter into remote locations feasible. While Peter did not discover what gave manuka honey its antibacterial properties—originally dubbed the Unique Manuka Factor (UMF)—a research team in Germany uncovered that methylglyoxal was the active ingredient.

My husband, Michael, and I visited Peter and his delightful, cheery wife Alyson at their home in Hamilton, New Zealand in June 2010, when we were invited to speak at the New Zealand annual bee conference. Below follows an excerpt from our long conversations during our three-day visit.

Peter Molan (PM): I always tell people: Firstly, in wound care, any honey is better than none, any sort of honey at all. However, if you’re trying to clear an established infection, then honey with a tested high-level of anti-bacterial activity is best. Against an infection, you’ll have much better activity with a high-activity manuka honey than with a different variety that only has a high-peroxide activity.

Is that because the wound produces catalase that can inactivate the peroxide activity, but not the non-peroxide activity in manuka? Honey isn’t commonly used in the United States for wound care.

PM: Yes, that’s right. I’ve been told by the wound care specialists—nurses I’ve worked with—that have worked in the United States that wound care there is quite primitive. The leading research on wound care is elsewhere. Australia is one of the leading places for innovative research for wound care.

In the US, there is a tendency to over apply antibiotics. If one doesn’t work, we often hit it with another one. Staph infections are becoming a problem in the ICU, especially with the superbug MRSA (Methicillin- resistant Staphylococcus aureus).

PM: That’s totally unnecessary. In New Zealand, I’m told doctors receive 20 minutes of their whole medical education on wound care. The nurses are the ones who learn about wound care and do most of it.

I’ve worked with the large Waikato hospital for a long time to develop honey dressings. Early on, one of the nurses in charge of the ward used honey on one case. I actually made the dressing for her, because nothing else was working. The whole of the lower leg had become seriously inflamed. It was in danger of becoming necrotizing fasciitis—a flesh eating condition.

I made a dressing in that sort of shape, just to wrap around and encase the leg. The honey dressing cleared that up overnight. It probably saved the person’s life. It certainly fixed the problem within 24 hours. Then the doctor in charge of the patient filed a formal complaint for the nurse treating it with honey.

Something similar happened to Dr. Eddy in the US. She recommended honey for a diabetic patient with a festering wound on the foot when he refused amputation of his leg. The honey worked, but then the patient’s nurse refused to continue with it because it was non-standard care. The patient’s wife then continued to dress the wound with supermarket honey until it cleared. How often do you change a honey wound dressing?

PM: It depends on the wound. It depends entirely on how much fluid is coming out of the wound. If you don’t change it often enough, it will never get any better. With a really wet wound, you may need to change it three times in the first day. But if you do that, you won’t need to change it frequently afterward.

The anti-inflammatory action is so potent. It’s the inflammation that causes the blood vessels to open and let the fluid out. You can stop that inflammation. It just needs 24 hours to stop the inflammation if you keep the honey there. Then you can be changing it maybe every three days. Do that a couple of times. Then once a week. But if you don’t change it often enough at the start, you will never improve that situation, because the honey keeps getting washed away.

We often hear about the antibacterial properties of honey, but less about the anti-inflammatory. Can you tell us more?

PM: All honeys have anti-inflammatory properties. Manuka honey—we’ve shown with the cell-based work we’re doing—is a lot better. But the intriguing thing is not all manuka honey is equally effective. The anti-inflammatory properties are not related to the antibacterial properties. We’ve had a higher level of anti-inflammatory material from a manuka honey with an anti-bacterial rating of 8 compared to one with a rating of 30.

PM: What you really need to do is rate each batch for the anti-inflammatory and antibacterial properties. We’ve got the testing method to be able to do that.

Manuka wound dressings were supposed to be rolled onto the market in the United States, but it appears as if there have been delays.

Yes, it’s slow. The dressing currently on the market in the US is more than 10 years old in terms of technology. It doesn’t hold all that much fluid. It’s one that my university patented and then Comvita bought it and never made it to work. I’ve developed a new one.

This new one holds much more fluid. What’s on the US market is for low-exuding wounds. In the marketing materials they state don’t put it on a wet wound. It’s inferior.

Tom Buckley from Links Medical was interested in manuka honey. I told him there is a New Zealand company that I’ve been working with that’s developing a really good dressing. Do you want me to put you in touch with each other?

We needed to make a different product because of patents. Something super absorbent like the diaper. (My good friend and close collaborator) Denis Watson found on the internet the same material in the form of a fiber, like in pants. It was already approved for use as a moisture absorbing wound dressing. So we put the honey into that instead of the granules. It makes a dressing that’s really nice to handle. I came up with the idea of coating it, so it’s not sticky to handle, it’s like a gel. You’ve got something that absorbs more fluid. The honey stays there and doesn’t wash away. It’s almost through the FDA. They’ve taken on extra staff, two wound care nurses. They had me over there for two days to answer questions.

They are not allowed to mention any therapeutic effects under the FDA regulations. But I have academic freedom. I can educate people. I’m not financially tied up with any company, which means I am completely free to make whatever claims I want about any product.

PM: I got the big hospital to do a trial with honey. Fortunately the head of dermatology had worked with honey. They did a trial, putting the honey on and then putting a dressing on top. The honey was running out, but it was having a noticeable effect. But the nurses don’t have time. The nurses want something they can rip out of a packet and slap on. So we tried to make something using the kitchen blender and sphagnum moss. But the honey was still washing out. Then we came up with the idea of using calcium alginate. That soaks up the fluid. It soaks up the sodium from the wound and it turns into sodium alginate, which is like a soppy wet gel and it keeps the honey there.

I had in my mind that I wanted something solid. I had been told by the confectionary industry that you can’t gel honey. But I don’t accept can’t. I tried various ways and actually developed one form of candy. Working from that I used the sodium alginate. There are a lot of different types of alginate. It depends on the type of seaweed.

PM: This is the gel. It’s completely edible. Alginate is used as a food thickener. I’ll put some on a wet towel. That’s the other version currently on the market in the US. It’s almost impossible to handle.

Peter Molan placed two squares of wound dressings on paper towels on a saucer. The one was the dressing currently available on the uS market, the other was his newly designed dressing. He poured water onto the paper towels and let both dressings start soaking up fluid.

PM: This is the new one that Links Medical will be using. It’s just waiting to get the final clearance from the FDA. When it gets wet on the wound, it turns to a gel. It slowly releases the acidity of honey into the wound. In 10% of patients the acidity actually stings. So the gel slows the release of the acidity and stops the stinging. It soaks fluid up slowly. You won’t see any change happening while you’re watching.

You’ve collaborated with Denis Watson for many years. Can you tell us more about how you two met?

PM: Denis Watson is a chemist. He’s one of these exceptional teachers. He would have his students do research projects. He was doing beekeeping as a hobby. I sent him some ideas for research projects for his high school students. I also sent him some papers. He got so interested, he decided to give up teaching and get into manuka honey production. Not to make money selling honey. His objective right from the start was to get into this sort of thing. He wants to make honey dressings for the third world. But being realistic, he knows you have to get money from somewhere to do that. He gives away a tremendous amount of stuff, even at this early stage.

Think about it. In a disaster area, if honey was just dropped by parachute, you wouldn’t need any language. You could just have pictures. Someone ripping a shirt or something and putting the honey on it. That would keep them medically stable until there was some proper medical treatment later.

PM: You could incorporate a fine layer of fabric mesh on the surface. It will turn into a thick slime if really wet. The mesh would allow you to lift it off. But when it gets to that slimy stage, it rinses off quite easily. Prior to picking up that much moisture, it will peel off.

A problem with traditional dressings in severe wound care is removing the bandages because it becomes so painful.

PM: What happens is the serum that comes out of a wound is like blood without the red cells in it, so it clots. It actually clots into the dressing. All the cells in the wound that repair and migrate get caught in the clot. If you don’t have the fibers of the clot, you won’t get any repair. The cells have to attach to the fibers to multiply, to migrate. If you take a dressing off that has been clotted into, you’re tearing off all the new growth. It’s not only painful, it’s stopping repair.

When you have honey there, it actually breaks down the clot. Instead it’s just slough. To clean out a wound, you need that clot detached. I have a post-doc working on the mechanism. What we found is that honey actually activates a protein that’s in the wound. It breaks down the clot, but doesn’t destroy the fibers.

PM: Yes, exactly. The honey just diffuses out of the dressings. If you put them in an agar plate, you’ll see the honey move out and kill the bacteria. If you put it on somewhere that’s inflamed, the anti-inflammatory activity takes down the pain and the swelling. It goes right through the skin. It’s really phenomenal.

PM: I get lots of people contacting me when they’re in a “no other hope” state. They want to know if honey would help. One of them had fibrosis in the lung, a chronic inflammatory respiratory condition. He was having severe breathing difficulties. There was nothing that could be done to help him. I knew what we’d been doing for respiratory infections, nebulizing honey to get a fine mist. I suggested he try that. I recently had an email from him saying it’s just been astounding. He said nothing is going to cure it, but he’s had 70% improvement on his breathing. He can socialize again and do things he couldn’t do before. The nebulizer creates a fine mist, which gives much better penetration into the lungs.

There’s one I’m helping at the moment. They ended up with an infection after surgery, resulting in a football size cavity that’s infected with MRSA. They were told there is nothing that can be done for it. Honey would work, but how do you physically dress a football size cavity. They could never afford to buy enough honey to fill it. I thought why don’t you get some sort of medical balloon and fill most of the cavity with air, then you could put a more modest quantity of honey around it and keep it in contact with the wound. I still have to persuade the hospital doctors.

PM: They try the “Ah well, the patients are diabetic, so we can’t use honey.” Which has to be an excuse, because if somebody’s life is at risk, and they were diabetic, and you give them a lot of sugar to eat, so that their blood glucose level go up for the few days while you’re doing so, it would have no noticeable effect on them. It’s only long-term that high blood sugar levels are a problem. So even if it did raise blood sugar levels, it wouldn’t matter, but it doesn’t.

PM: Yes, but the surface area for absorbing in the gut is phenomenal. The gut itself, the wall is like lots of little fingers. Each of those fingers is covered with cells. You have a huge surface area for absorbing, compared with the surface area of a wound, where it’s negligible. We’ve tried measuring blood glucose levels in the early days and there was never any noticeable effect on the blood sugar. You just don’t have a large enough absorptive area for the glucose to be absorbed.

It’s just that prejudice I’m working against. It needs education. When I’ve given lectures to medical audiences, once they’ve been presented with the facts there is no resistance at all. It’s when people are working without the facts.

There’s a great quote from an Australian bee journal back in the 1940s. “Prejudice is a great time saver. It allows one to form opinions without having to spend time finding the facts.”

PM: Mandatory retirement has been removed in New Zealand. I’m 66. I’m having too much fun. It’s getting more and more interesting. I love teaching. My lectures now are better than they’ve ever been, because I’ve learned so much more.

Peter Molan was relentlessly inquisitive. He continually tried to find solutions to medical problems, combining determination and curiosity into workable, practical results. Throughout his career he was kind and generous, freely sharing information with others. His lab was home to students from around the world. Some came for a brief visit, while others stayed to pursue a degree. When I was considering applying to graduate school, he invited me to study at the University of Waikato. I ended up pursuing my PhD in the United States, but we remained in touch. He encouraged my research into honey, offered feedback on chapters and ultimately wrote the foreword to my book “Two Million Blossoms”, for which I am most grateful. His quiet wit and dogged persistence on uncovering the benefits of honey will be greatly missed. Peter was a research giant, who never personally profited from the vibrant manuka honey industry he helped create.

Kirsten S. Traynor is the author of two Million Blossoms and co-author of Simple, Smart Beekeeping. Both books are available from Dadant. She earned her PhD in honey bee biology and currently investigates the impacts of pesticides on colony health. Sign up for her free beekeeping newsletter www.mdbee.com/freebee.html, or follow her on Twitter @FlowersLoveBees and Facebook www.facebook.com/Flickerwood.