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Op-Ed: AYUSH above scientific investigation?

Should India’s traditional forms of medicine — covered under AYUSH — be held above scientific scrutiny?

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Yoga is among the therapies promoted under AYUSH

An advisory note issued by the Union AYUSH Ministry, dated May 2nd, referred to the systems of alternative and traditional medicine included under the AYUSH banner as an “integral part of the country’s healthcare delivery work…not at all comparable to the modern medicine system.”

This statement alone is no major cause for concern — though the investment into systems of medicine that often remain all but unproven could be seen as a detriment when the financial backing comes at the expense of proven public healthcare methods. What has sparked concern among India’s scientific community is the phrasing under which the Ministry has proposed changes to AYUSH therapies may be tested.

The AYUSH umbrella term covers the following – ayurvedic, unani, siddha, naturopathy, homoeopathy, and yoga. These treatments have often found themselves and their sometimes bold claims to be at odds with modern medicine. The advisory note has caused concern by stating that any research conducted by scientists working outside of the AYUSH disciplines must include a contribution from an AYUSH practitioner. If this is not the case, the note encourages journals to reject papers on AYUSH treatments and drugs.

It is this aspect of the note in particular that is the most worrying. Dissuasion of data being published over such a matter – by a government body, no less – is tantamount to an authoritarian overreach into scientific information with the potential to hold back Indian research groups and stymie the research necessary to guarantee patient safety. For example, if a currently used ayurvedic treatment was found by a study to have negative impacts or an as of yet unknown level of toxicity, it would it be silenced unless it met the above mentioned requirements in order to not bring AYUSH therapies into disrepute.


Undermining both the scientific method and AYUSH itself

Such a prospect undermines the scientific process. Any guise of impartiality is lifted and only those with a vested interest will, under the recommendation of the AYUSH Ministry, be even allowed to publish information on the matter unless working in tandem with AYUSH researchers.

Simply put, this is not how scientific data should be recorded. If a concept is to be recorded as scientific knowledge, then it must stand to criticism. Without this criticism it is impossible to either scrutinise or improve upon current medical knowledge. Worse still, further studies are based upon, and reference, prior studies. Any future studies could be misdirected or simply hit dead ends if they are based on previous studies that have simply been funnelled through the publication pipeline based on ideological reasons.

The Ministry assures that this is a necessary precaution to prevent “damage to the image of traditional healthcare systems” which could result from “arbitrary statements and unfounded conclusions” by non-AYUSH practitioners.

What this effectively does it to politicise the scientific process. The priority of the studies must therefore shift from scrutinising AYUSH therapies and finding those most beneficial to the public, or even improving upon existing knowledge, simply to improving public perception.

In essence, this does more to damage the potentials of AYUSH therapies — those that are proven to work — than it does to improve the system. Critiques of the policy have echoed such sentiments.


AYUSH as an evolving system

Ayurvedic treatments are often turned aside by those who practice modern medicine as simply relics of the past. Often this is not the case. While the knowledge is ancient, much of it is no less valid. Many modern-day medicines and therapies are derived from chemicals found in herbs and plants. Many ayurvedic treatments simply use the plants directly.

It is natural that the AYUSH Ministry is defensive of the practice. Ayurveda originated in India. The practice is thought to date back as far as 400 BC to around 200 AD, making it one of the most ancient forms of medical therapy.

Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya of Vagbhata (~400 BC–200 AD)  are some of the main classics, which give detailed descriptions of over 700 herbs and 6,000 formulations. Madhav Nidan written later at around 800 AD provides over 5,000 signs and symptoms.

The practice was created and refined over a period of time spanning more than a thousand years. The practice has a long history that is constantly evolving. As a living practice there is no need to define the 21st century as the period of time in which this practice stops and begins to look only backwards.

Some studying the concept of ayurveda have agreed on this point, noting that the success of ayurveda was due to its capacity to build upon existing knowledge. “Heritage pride and past glory-based emotional attitudes seem to be predominant among practitioners as against evidence-based quest of scientific research,” the writer of the study says, “There seems to be an evident complacency, defensive and dogmatic attitude and often pure sentimentalism rather than a pragmatic scientific outlook.”

Ayurveda, as well as other practices falling under AYUSH, need to be brought into the modern world. By applying the same criteria and standards as is applied to modern medicine, those practices which are effective among the many thousands of therapies falling under the AYUSH banner may be selected and refined.

However, by freeing anything considered to be an AYUSH therapy from outside criticism and scientific validation the bar is set lower for these treatments. In this manner many potential pseudo-scientific practices and substandard medicines may be safely protected from criticism. This is what will bring AYUSH into disrepute, not scientific analysis.

“The actual disrepute to the traditional Indian healthcare systems, including Ayurveda, is caused by the mushrooming of low-quality journals which publish poor-quality pseudo-research,” says scientists Subhash Lakhotia, Kishor Patwardhan, and Sanjeev Rastogi in Current Sciences.


Double-blind, placebo controlled studies

To not allow scrutiny to take place immediately places all AYUSH therapies into question. Many AYUSH practices are scientifically validated through peer reviewed studies, however, to place a banner such as this over all AYUSH therapies lumps these validated treatments in with the likes of websites citing testimonials that the cow urine that they sell has cured — among others — cancer, AIDS, the common cold, asthma, heart disease and “woman’s problems”.

As the scientific team speaking to Current Sciences mentions, many low quality journals with dubious methods of data validation are pumping out alarming numbers of questionable studies which could be misconstrued by some as genuine medical advice. Holding them to a lower standard and burying any research which does not include the works of an AYUSH scientist that may not be impartial is likely to allow more of these studies to remain unscrutinised.

A simple search of scientific databases such as PubMed reveals that double-blind controlled trials are conducted on ayurvedic treatments frequently. Many published results show positive results in this highly controlled system of studying their efficacy, indicating that AYUSH therapies do not need to be protected from criticism in order to show their value.

The concept of a double-blind study is that the treatment undergoing the trial is tested against a placebo. In order to remove any potential bias neither the patients nor those administering the treatment know whether the treatment being given is the placebo or not. In this way any forms of confirmation bias — such as intentionally favouring the group receiving the treatment — can be removed.

One treatment that consistently achieves positive results in this manner is curcumin. Curcumin is a chemical found within the spice turmeric. It is a staple found within Indian cuisine that has powerful anti-inflammatory effects. Double-blind studies have proven its efficacy against conditions such as rheumatoid arthritis.

Turmeric, and hence its medicinal properties, is found as a common ingredient in Indian food. This is just one example of where the holistic approach of ayurveda, in which even food is viewed as a therapy, can prove effective as a treatment.


As with any medical system, patients must come first

Any medical system, AYUSH or otherwise, which places its own image and public perception above the health of its patients is doomed to failure. By allowing sub-par and invalidated treatments to be grouped together with therapies that have been scientifically validated, patients are placed in danger.

In the long run such a decision will inevitably backfire. Declaring AYUSH to be above criticism as a means to idolise history simply allows treatments that could bring the concept into disrepute to flourish. There are plenty of examples in which AYUSH therapies prove their worth under rigorous scientific testing. Surely this is a testament to ancient knowledge. That individuals in India thousands of years ago devised medical knowledge that still holds up today is testament to their wisdom. To declare that some of the thousand year old practices are either outdated or exaggerated does not invalidate them all.

The concept of AYUSH has not retained its flexibility in recent years. Once developing medical knowledge that was far in advance of that used in areas such as Europe — often by centuries — it is now only turning inwards and shielding its views from criticism rather than using criticism and investigation to evolve.

India created ayurveda. It must be the country to apply modern standards of scientific practice to its ancient traditions and lead the way to further developments.

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