The only way to do this is by presenting evidence to the scientific community that Ayurveda works.
Ayurveda It has gained popularity in recent years, but there is still a lot to be done to make sure it stands up to the scrutiny of science. NS covid-19 pandemic There has been a great challenge to science in general and hence, ‘How did Ayurveda deal with the pandemic?’ becomes a relevant question. In the following paragraphs I share my views as a teacher of Ayurveda with over 20 years of experience.
widespread misinformation
During the pandemic, we encouraged self-medication among the masses by advocating for decoction-like preparations. Thus, the message was lost that dishonest, excessive and prolonged use of any drug can be harmful. We did not educate the public on identifying the right herbs, although we did encourage 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 dalchini, which can be harmful.
Almost every Ayurveda practitioner came up with their own formulations as a purported cure for COVID-19. Several laboratory reports suggesting clinical improvement with Ayurveda interventions were shared on various social media platforms. However, most of them could not make it to the peer-reviewed journal. Thousands of COVID-19 cases treated by Ayurveda practitioners could have yielded good data which could be 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.
Several clinical trials have emerged and some have been published to test Ayurveda interventions for COVID-19. To show the effectiveness of a new intervention in a situation where spontaneous recovery is greater than 95%, one requires a large sample size and a robust study design. In most of these trials, Ayurveda interventions were either in addition to the Indian Council of Medical Research (ICMR) protocols or, when used as independent interventions, were administered only in mild to moderate cases. Even government agencies widely promoted some patented and proprietary formulations that were inadequately tested, and there was criticism 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 patented and proprietary formulation, which reportedly boosted immunity. The general public was convinced that AYUSH interventions were safe, of preventive value and effective in the treatment of the disease. But most of these claims lacked credible evidence.
In my view, the Ayurveda sector should not have succumbed to the pressure of showing that Ayurveda works in the treatment of COVID-19. Instead, the sector could be seen as a potential workforce. People could be roped in to manage various functions such as telephonic triaging, teleconsultation and counselling, monitoring of home-quarantined patients and coordination of referral services. Although some AYUSH hospitals were converted into COVID-19 care centres, most of these facilities were successful only in mild to moderate cases. This is where the collaboration between AYUSH and traditional health professionals was needed. The protocols of ICMR and AYUSH were disconnected and that is one of the reasons why there was no coordination. In addition, this workforce could have been used to meet the needs of non-COVID-19 patients, who suffered the most due to various restrictions.
questions to ask
A group of scientists and physicians have recently started a social media campaign calling all AYUSH systems as ‘pseudo-sciences’. These workers chemically analyze several AYUSH formulations and demonstrate that many of these products contain high doses of inappropriate components such as antibiotics, corticosteroids and heavy metals. They also publicly share scanned images of unscientific and outdated material in textbooks of AYUSH undergraduate programmes. They also publish and share various clinical case reports where adverse events are reported after exposure to AYUSH interventions. These activities are important and require at least the support of those who believe in rational Ayurveda. This will motivate AYUSH academicians and policy makers to seriously introspect about the present system. Academics are currently making Ayurveda a pseudoscience by teaching young students that whatever is written in ancient texts is the ultimate truth and cannot be challenged. This non-falsification makes the system unscientific.
The only way to make Ayurveda a true science is to present evidence to the scientific community that it works. The absence of a uniform protocol for diagnosis or intervention makes Ayurveda very subjective and diverse. An objective assessment of complex Ayurveda practices in the standard accepted format of ‘double blind randomized controlled trials’ is very difficult. The practical option is to go for longitudinal observational studies. Initially, about 20 different clinical conditions involving different organ systems can be identified, which physicians are confident of treating. A large sample size with long-term follow-up in a multi-centered design would go a long way in establishing the usefulness of Ayurveda. Much of the knowledge we now have about ischemic heart disease comes from an ongoing single longitudinal study since 1948, demonstrating the value of observational studies.
need for regulation
Formally, we never teach patented and proprietary formulations to our graduates. However, as these graduates establish their clinical practice, they begin to prescribe these formulations. Most of these products are not supported by reliable tests or even pre-clinical and toxicity data. The number of pharmacies manufacturing classical formulations has reduced over the years to a minimum, which shows how commercialization has taken over the area. This aspect needs to be regulated to ensure that such products undergo robust pre-marketing studies. Even classical formulations that contain toxic substances such as heavy metals need to be regulated.
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Furthermore, it is necessary to maintain only a manageable number of colleges to ensure that all students have good clinical performance. Another concern is the indiscriminate development of new AYUSH colleges.
Kishore Patwardhan works in the Department of Kriya Body, Faculty of Ayurveda, Banaras Hindu University, and is the coordinator of the Ayurveda Network
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