When India’s traditional medicine ministry, the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH), issued an advisory in late January listing several ayurvedic, homeopathic and unani treatments for the new coronavirus, it rightly caused an uproar. There is no scientific evidence that the prescribed medicines — such as Shadanga Paniya, an ayurvedic concoction of six herbs — work.
Indeed, at the time all classical medical texts were collated, people didn’t have an understanding of a virus. What guides treatment in these medical systems is a holistic plant-based approach to managing symptoms; in the case of the advisory, for respiratory conditions. So why did the ministry publish unscientific statements? And what drives the almost instantaneously binary reaction to claims from traditional knowledge practices?
To answer this, it’s necessary to understand the history of medical education in India. Like all education before colonial times, ayurveda was taught in the guru-shishya parampara (teacher-student tradition), a system in which the student was immersed in the guru’s household and practice, with a strong hands-on training component. Modern medicine came with the colonialists. In 1822, instruction in Western and Indian medicine (unani and ayurveda) commenced in Calcutta, but the British then withdrew support for instruction in native languages as well as for native medical practices.
From then on, the colonial and, later, Indian governments undertook investments to increase the number of medical colleges offering education in Western medicine in the country. The Indian Medical Council Act of 1956 institutionalized this process. Meanwhile, it was predominantly endowments from royal families that helped the Indian state set up institutions to train students in traditional medicine. The maharaja of Travancore had established one of the oldest, in 1889, in Thiruvananthapuram, today known as the Government Ayurveda Medical College. However, it was not until 1970, with the passing of the Indian Medicine Central Council Act, that ayurveda and unani training became institutionalized.
It’s almost certain that AYUSH did not run its new advisory by any virologist in the country, not because there aren’t any but because they aren’t in the ministry’s Rolodex of experts.
This regulatory divide at the top ensured that from the very start of professional training, modern and traditional medical practitioners are kept separated. To this day, a degree in allopathy includes no courses in traditional medicine and vice versa, although ayurvedic doctors do study modern anatomy and physiology. While modern biological sciences like biochemistry, genetics and microbiology are part of an allopathic education, they find no mention in a traditional medicine degree. Even on campuses that have a cluster of excellent science research departments, there is no exchange of staff and students between the ayurveda college and the rest of the sciences. Structural bifurcation doesn’t stop at medical education: It also extends to biomedical research.
It’s almost certain that AYUSH did not run it new advisory by any virologist in the country, not because there aren’t any but because they aren’t in the ministry’s Rolodex of experts.
Thus we have a treasure trove of information on medical practices that have not been examined in a system that we know as the scientific method. The practice of testing hypotheses and rigorously demonstrating cause and effect has not permeated AYUSH. A favorite refrain of traditional medical practitioners is that it’s difficult to perform clinical trials in the strict reductionist approach of modern science because, by philosophy, traditional medicine is personalized.
This is only the start of differences in vocabulary that then precipitate a binary situation: “Either believe in traditional medicine or don’t.” But what if we removed belief from this conversation? We must embrace openness and look for commonalities, the most important being that both streams are about saving lives and improving the quality of life. Modern medicine needs to acknowledge that it doesn’t have a treatment for all diseases just as much as traditional medicine needs to acknowledge the same thing. We need more conversations between practitioners and researchers of both medical streams to start unpacking the potential of integrative treatments: the success of traditional medicine for chronic illnesses plus the superior surgical skills and lifesaving technologies of modern medicine.
Further, we need to reimagine clinical trials to assess personalized approaches to healing by including metrics that test formulations — common in traditional medicine — as well as single chemical entities. We need the participation of the research fraternity, from biologists to statisticians and engineers, to describe new metrics to measure the efficacy of traditional medicine.
A lack of cohesive policymaking that aims to rigorously evaluate and integrate knowledge streams for human well-being is preventing us from reaping the full potential of the two. Remarkably, the Charaka Samhita, a historic ayurvedic textbook, describes a good physician as one who is dynamic and constantly evolving. It’s time to take this classical advice seriously.
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