Just what the doctor ordered

Dinesh C Sharma
Science commentator

The pandemic has exposed, and deepened, existing fault lines between modern and traditional systems of medicine. The tussle is well exemplified in the public spat between the Indian Medical Association (IMA) and Ramdev, founder of Patanjali Ayurved. Ramdev is harping on the fact that modern medicine has no ‘cure’ to offer for Covid-19 and that available vaccines are not capable of fully preventing infection. He rubbishes the modern system as a conspiracy of pharmaceutical companies and hospitals to fleece people. On the other hand, the IMA has accused him of peddling pseudoscience and promoting vaccine hesitancy. The utterances from the two sides give an impression that the fight is about the merits and demerits of allopathic and ayurvedic systems. The focus on the so-called supremacy of different systems of knowledge is superficial and misleading. It should instead be on evidence or lack of it and about yardsticks to measure the evidence acceptable to all.

The use of natural products for the treatment of human ailments has been prevalent in societies all over the world for ages. In this long timeline, modern medicine is a new entrant. Several blockbuster drugs that changed the face of medicine in the last century originated from natural sources. They got inducted as modern drugs after going through a long process — identification of active ingredients, pre-clinical studies, understanding the mechanism of action, study of side-effects and large clinical testing. Till the middle of the 20th century, hypertension had no specific treatment except a low-salt diet. Kaviraj Gananath Sen and Kartick Chandra Bose from Kolkata had reported in 1931 that an alkaloid extracted from sarpagandha could treat hypertension. After this, Dr Salimuzzaman Siddiqui in Delhi’s Tibbia College isolated five crystalline alkaloids from the herb and tested them on frogs and cats. Building upon this, Dr Rutom Jal Vakil, a Bombay cardiologist, conducted a small study on hypertension patients and published his findings in the British Medical Journal in 1949. The paper took the medical world by storm and changed the face of hypertension management globally.

Contrast the experience of sarpagandha with that of another wonder herb brahmi in the 1990s. The Central Drug Research Institute (CDRI) of the Council of Scientific and Industrial Research (CSIR), developed a memory enhancer using baccopa monnieri extracted from brahmi. The technology was transferred to a Chennai firm that marketed it as Memory Plus. The drug was launched by Prime Minister PV Narasimha Rao and endorsed by his successor IK Gujral who said he was using it himself. A few years down the line, the CDRI found that Memory Plus had very low availability of the active compound and its effect was no better than grass growing in backyards. The licence of the company was revoked.

These examples show that everything mentioned in ancient texts cannot be marketed as drugs in modern times till evidence is generated about their efficacy and safety based on well-accepted criteria. This is what is problematic for some proponents of the traditional systems and their supporters. A recent example is B Anandaiah of Krishnapatnam in Andhra Pradesh who has been doling out to thousands of people a ‘magic cure’ for Covid-19 which he claims to have prepared from locally available herbs. This week the state government got the concoction tested and found that it had no side effects, though its efficacy on Covid-19 still remains unknown. Yet, he had been allowed to continue with the distribution of his concoction. Similar is the case of Coronil launched by Patanjali and endorsed by Health Minister Harsh Vardhan and other ministers. It was first marketed as a cure for Covid-19 and later was downgraded to an ‘immunity booster.’ In all such cases, evidence is either lacking or is dodgy.

The likes of Ramdev and Anandaiah want their concoctions and potions to be labelled as ‘scientific’ but without going through the rigours of science. Ramdev has realised that wider acceptance of his medical products would need the label of theirs being ‘scientifically proven.’ Patanjali now has a ‘drug discovery and development division’ which publishes research papers in scientific journals. The effort is to somehow produce evidence to substantiate the tall claims Ramdev makes. The papers published till now cover certain analytical methods and animal models and not about the efficacy of ayurvedic drugs. Many of them are published in journals considered predatory and not mainstream. It is such research papers that Ramdev uses to create a façade of doing science, masking the fact that none of them are based on clinical studies and randomised clinical trials. If truly interested in generating evidence for his claims of cure for everything ranging from backache to cancer, he would do well to collaborate with leading institutes and hospitals to conduct detailed studies and publish in reputed journals.

Science evolves based on evidence. It is not dogmatic like ancient texts. This explains constant revision in the guidance on the administration of plasma therapy, HCQ and Ivermectin during the pandemic. It is a sign of strength and not a weakness of this knowledge system. At the same time, there are loopholes in the system which some researchers and drug companies use to circumvent laid down procedures in order to push their products without sufficient evidence. Unscrupulous people can fudge data and fool medical journals. The use of irrational combinations and antibiotics is rampant. Regulatory systems are grappling with such challenges, creating room for course correction. In a country like India with layered health systems and cultural beliefs, it would be unwise to completely reject traditional systems in favour of modern medicine. All systems should be allowed to exist based on evidence of efficacy and safety of individual drugs and formulations. We need to develop a necessary regulatory mechanism, teaching standards, licensing system and marketing norms that apply to all systems uniformly. Evidence-based medicine is the way to go, be it allopathic, ayurvedic or other systems.