Alternative medicine

Times Face-off: Is it risky to push alternative medicine in the Covid pandemic? | India News

Modern and alternative medicine have coexisted in India for years, but is it risky to push the latter into a pandemic? Two practitioners weigh
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Giving untested remedies to vulnerable people during a pandemic violates ethics
By Lancelot Pinto
The scientific method is independent of the belief system or school of thought being tested. In clinical medicine, scientific practice evolves from either biological plausibility or a series of observations which then lead to small clinical trials, the promising results of which stimulate larger trials, which then prove or disprove a hypothesis. Most drugs for Covid-19 have come through these routes.

An example of biological plausibility is the question “Is it plausible that a drug developed to fight one virus works on another?” This led to the testing of drugs such as Lopinavir-Ritonavir (used for HIV) and Remdesivir (originally developed to treat hepatitis C).
A similar question: “Will a drug that works in high doses on the virus in a lab work in humans” led to testing ivermectin as a potential cure. The observation that people with autoimmune diseases treated with hydroxychloroquine might have a lower incidence of Covid-19 has led to the drug being tested as a potential cure. Despite having such biological plausibility or showing promise, none of these drugs have been shown to be effective for Covid-19.
Why then should we applaud a system of medicine that has failed so much in giving us a drug for Covid-19? Because at the heart of the scientific method of medicine are ethical principles firmly anchored in the first principle of “primum non nocere”. The “null hypothesis” that is the starting point of every drug trial is that the treatment is no better than the placebo. The burden of proof is on the treatment to prove its value “beyond reasonable doubt” (reflected in the principle of statistical and clinical significance).
The phases of a drug trial are also designed to ensure maximum safety, before the drug reaches large numbers of people and can potentially cause irreparable harm. People participating in these trials also do so with their voluntary consent and without prompting, preventing experimentation and exploitation.
The above principles should apply to any form of medicine and, when applied with rigor, could eventually lead to the discovery of new remedies that have traditionally been used in a non-standardized way. Unfortunately, the majority of traditional medicines do not go through the same level of scrutiny. It’s risky.
It is assumed that something that is “traditional” or “natural” can’t hurt. There are several examples to the contrary. St. John’s Wort (Hypericum perforatum) is a flowering plant that has been used by herbalists for a thousand years for a variety of ailments. We now know that it can cause life-threatening reactions and interactions with several drugs. Foxgloves, a group of plants, were used by herbalists until it was discovered that the difference between a useful dose and a lethal dose was not very great.
Steam inhalation, which was previously thought to be harmless, is now questioned as contributing to the mucormycosis pandemic, as the high temperature could potentially burn out the nasal passages’ natural defense mechanisms against the fungus. As a pulmonologist, I have treated patients in whom sniffing ghee/oil resulted in lipoid pneumonia.
When traditional medicines are prescribed as effective (without undergoing methodologically rigorous testing) during a pandemic, several ethical principles could be violated. The novelty of the disease, coupled with the widespread fear and paranoia, now reinforced not only by the news, but also by the personal experiences of loss and the tragedies they have witnessed, make individuals extremely vulnerable.
Vulnerable people have a compromised capacity to consent, especially in a field like medicine, where knowledge asymmetry is glaring. If these people are offered remedies that have not been rigorously tested, they are in fact being experimented on without their consent.
The argument that an individual has free will doesn’t really apply in such a scenario, because in today’s “do whatever it takes” environment, individuals cannot be expected to make rational judgments. This is why it is extremely important for regulators to step in and prevent unproven solutions from being put in place.
Is it risky to push or promote traditional medicine in the event of a pandemic? As risky as it is to push conventional, unproven drugs out of a clinical trial setting. Rather than criticizing any system of medicine, one should audit the rigor with which the effectiveness of a treatment has been proven beyond doubt, the transparency with which the potential adverse effects of treatment have been reported, the conflicts of interests that may have influenced these reports and the peer review to which the report was subjected.
I end with a quote from Carl Sagan: “Extraordinary claims require extraordinary evidence”. A pandemic and the need for an early cure should not lower the bar for the safety and effectiveness of any system of medicine.
– The author is Consultant Pulmonologist, PD Hinduja National Hospital and Medical Research Centre, Mumbai
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Clinical practice is proof that Ayurveda helps manage Covid, so let’s break down the silos
By Darshan Shankar
Can traditional medicine systems like Ayurveda help in the Covid pandemic? There is growing evidence that they do.
The reputable medical journal (J-AIM) run by the Center of Excellence for Integrative Health, University of Pune, has compiled peer-reviewed case studies from different states on Ayurvedic management of Covid, which indicate that physicians effectively manage respiratory symptoms, fevers, fatigue, metabolic disturbances, and low saturation with safe, conventional formulations. The scale of interventions is small due to political constraints and because the case studies form the foundation of the pyramid of evidence.

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To begin, I would like to state categorically that in my opinion, it is incorrect for traditional doctors to claim that the Ayurvedic pharmacopoeia has antivirals for the management of Covid. So how does Ayurveda help without antimicrobials? To understand this phenomenon, it is necessary to break the myth that anti-virals are the only way to manage the symptoms of Covid.
An insight into the insights gained from transdisciplinary scientific collaboration between Ayurveda and biology can help. In 2005, a groundbreaking paper published by Prof. Bhushan Patwardhan (Professor of Health Sciences, University of Pune) demonstrated the correlation between Ayurvedic phenotypes and genotypes (HLA gene polymorphism). This was a milestone in the history of biology, as Ayu-Genomics illustrated that biological concepts of classification of human populations, derived from different cultural views of nature (panchmahabhutas and molecular biology) could converge to create new knowledge topical. A decade-long research program on Ayurveda-Biology, endorsed by the National Academy of Sciences of India and led by the eminent Cardiac Surgeon, Prof. M. S. Valiathan, has followed Patwardhan’s work, with published strategic results in reputable journals related to metabolism, immunity and regenerative biology.
Moving from examples of the scientific potential of Ayurveda to the ground reality of clinical practice, it is evident that Ayurveda and other traditional systems clinically manage dozens of health conditions, alongside an understanding of their etiologies. “systemic”, which correspond in biomedicine to “infectious” diseases. diseases such as diarrhea, shingles, urinary tract infections, gangrenous wounds, viral fever and fungal infections, without using conventional antimicrobials.
While it is justified to treat Covid-19 and other infections with appropriate antimicrobials in biomedicine, it is irrational to insist that they should be similarly managed by another system of medicine, which has a different way of understanding biological change. I may be forgiven for resorting to a musical analogy — think how absurd it would be for a dominant community of musicians to insist that only jazz, symphonies or sonatas can be music.
Ayurveda has a “systemic” biological theory (dosha vichar) for diagnosing and treating complex physiological imbalances. He has an incredibly vast arsenal of 400,000 herbal and herbal-mineral formulations documented in the GOI-CSIR database called the Traditional Knowledge Digital Library (TKDL).
Policy makers must realize that the test of all knowledge is not based on a single method or concepts, no matter how profound, but by assessing whether competing theories and practices can be consistently applied to transform and solve real life problems. To reject and ignore a solution because its mode of action logic is different from a particular dominant knowledge framework is pure prejudice and ignorance of plurality and its implications.
Also, while evidence from high-quality outcome data is indeed a credible way to establish effectiveness, it should be realized that lack of data does not equate to lack of evidence. The data is a direct function of public investment in clinical research and the truth is that such investment in AYUSH has been pathetically low. The recent clinical case repository portal designed by the Ministry of AYUSH is the first step in this direction.
Requiring clinical trial data as the only prerequisite for establishing credibility, without substantial investment in generating data, is like asking top chefs from ethnic communities not exposed to competition to produce a Michelin award to certify their competence. , while this is apparent from the fact that millions consume ethnic delicacies with delight.
Ayurveda is the living cultural heritage of India. Doctors are only its carriers. The entire scientific community in the “public interest” must assume ownership and responsibility for its revalidation. The analysis of data from the last 10 years on actual clinical practice, from the clinical records of at least a hundred good Ayurvedic hospitals and thousands of clinics, should be the first “joint” endeavor in the health sciences.
We need to break down silos between medical pathways. More immediately, there is a need to bury narrow interests and, in the public interest, recalibrate national Covid management policy to embrace integrative healthcare protocols. This is particularly important for post-Covid syndrome where antivirals may not be relevant.
– The author is Vice Chancellor of University of Transdisciplinary Health Sciences and Technology, Bengaluru