Ayurveda has gained popularity in recent years, but a lot is still to be done to ensure that it stands the scrutiny of science. The COVID-19 pandemic has been a major challenge for science in general and hence, ‘How did Ayurveda deal with the pandemic?’ becomes a pertinent question to ask. In the following paragraphs I share my views as a teacher of Ayurveda with 20 years of experience.
Rampant misinformation
During the pandemic, we encouraged self-medication among the public by advocating preparations like decoctions. Thus, the message that unscrupulous, excessive and prolonged use of any medicine could be harmful was lost. We did not educate the public on the identification of the correct herbs, though we encouraged their consumption. For example, Giloy (Tinospora cordifolia) and Dalchini (Cinnamomum zeylanicum) are two plants where correct identification matters. Sometimes, Tinospora crispa and Cassia cinnamon are mistakenly identified as Giloy and Dalichini, which could be harmful.
Almost every Ayurveda physician came up with his/her own formulations as a purported cure for COVID-19. Many lab reports suggesting clinical improvements with Ayurveda interventions were shared on different social media platforms. However, most of them could not make it to peer-reviewed journals. Thousands of COVID-19 cases treated by Ayurveda physicians could have provided good data that could have been further analysed. Even though the Ministry of Ayush came up with an online case registry, our fraternity could not make any meaningful use of it.
Many clinical trials for testing Ayurveda interventions came up for COVID-19 and a few even got published. To show the efficacy of a new intervention in a condition where spontaneous recovery is more than 95%, one needs a large sample size and a robust study design. In most of these trials, the Ayurveda interventions were either in addition to Indian Council of Medical Research (ICMR) protocols or, when used as independent interventions, they were administered in mild to moderate cases only. Even governmental agencies widely publicised a few patent and proprietary formulations that were tested insufficiently, and drew flak from the scientific community for doing so.
Scientifically speaking, ‘immune boosting’ is a vague and potentially misleading term. During the pandemic, every other Ayurveda pharmacy came up with its own patent and proprietary formulation that supposedly boosted immunity. The common public was made to believe that Ayush interventions were safe, of preventive value, and effective in treating the disease. But most of these claims lacked credible evidence.
In my view, the Ayurveda sector should not have succumbed to the pressure to show that Ayurveda works in the treatment of COVID-19. Instead, the sector could have been visualised as a potential workforce. People could have been roped in for managing various tasks such as telephonic triaging, teleconsultations and counselling, monitoring home-quarantined patients, and coordinating referral services. Though some Ayush hospitals were converted into COVID-19 care centres, most of these facilities managed only mild to moderate cases. This is where a collaboration was required, between Ayush and conventional healthcare professionals. The protocols of ICMR and Ayush were disconnected and this is one of the reasons why there was no coordination. Moreover, this workforce could have been used to address the needs of non-COVID-19 patients who suffered the most because of various restrictions.
Questions to be asked
A group of scientists and physicians has recently started a social media campaign calling all Ayush systems ‘pseudoscience’. These activists conduct chemical analysis of many Ayush formulations and demonstrate that many of these products contain high doses of unwarranted constituents such as antibiotics, corticosteroids and heavy metals. They also share publicly the scanned images of the unscientific and outdated content in the textbooks of Ayush graduate programmes. They also publish and share various clinical case reports where adverse events are reported after exposure to Ayush interventions. These activities are crucial and need the support from at least those who believe in rational Ayurveda. This would make Ayush academicians and policymakers introspect seriously about the current system. Academia, at present, has made Ayurveda a pseudoscience by teaching the young students that whatever is written in ancient texts is the ultimate truth and cannot be challenged. This non-falsifiability renders the system unscientific.
The only way to make Ayurveda a real science is to present evidence before the scientific community showing that it works. Absence of uniform protocols either for diagnosis or for interventions make Ayurveda too subjective and diverse. An objective evaluation of complex Ayurveda practices is very difficult in the standard accepted format of ‘double blind randomised controlled trials’. The practical alternative is to go for longitudinal observational studies. Initially, around 20 different clinical conditions involving different organ systems can be identified, which practitioners are confident of treating. A large sample size with a long-term follow-up in a multi-centric design would go a long way in establishing the usefulness of Ayurveda. Most of the knowledge we now have about ischemic heart disease comes from a single longitudinal study going on since 1948, which demonstrates the value of observational studies.
Need for regulation
Formally, we never teach our graduates patent and proprietary formulations. However, as these graduates set up their clinical practice, they start prescribing these formulations. Most of these products are not backed by reliable trials or even pre-clinical and toxicity data. The number of pharmacies that manufacture classical formulations has reduced to a bare minimum over the years, which shows how commercialisation has taken over the sector. This aspect needs to be regulated to ensure that such products go through robust pre-marketing studies. Even classical formulations that contain toxic substances such as heavy metals need to be regulated.
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Further, maintaining only a manageable number of colleges is essential to ensure that all students get good clinical exposure. The indiscriminate growth of new Ayush colleges is another matter of concern.
Kishor Patwardhan works at the Department of Kriya Sharir, Faculty of Ayurveda, Banaras Hindu University, and is Coordinator, Ayurveda Network
