29 October,2023 07:57 AM IST | Mumbai | Jane Borges
An elderly man seen sells ayurvedic medicines at the roadside in New Delhi. Ayurvedic doctors caution against consuming “ayurvedic medicines without a prescription”. Pic/Getty Images
On X, Dr Cyriac Abby Philips is waging a war - countering what he calls misinformation about alternative medicine. It's coming at a great cost, he tells us. Every day, he appears to be dodging a new bullet: "From the benign and wasteful online trolling, harassment and abuses, to actual, realistic physical threats and vile legal recourse and litigation". "In a country deeply invested in traditional, cultural and religious outlook towards healthcare, [this] can become a harrowing experience," says Philips, who is senior consultant and physician-scientist, clinical hepatology at The Liver Institute in Kochi.
With 204K followers, the hepatologist who goes by the handle, TheLiverDr, is among the more popular health educators on social media. But his takedown of the government-backed AYUSH (ayurveda, yoga and naturopathy, unani, siddha and homeopathy) has left many miffed. His X account was also briefly suspended when Indian multinational personal care and pharma firm Himalaya Wellness had secured a court order against him, restraining him from posting "defamatory remarks" about their products. "They are all pseudoscientific systems of alternative medicine that borrow principles for diagnosis and treatment from primitive observations, faith-based healing, illogical theories, un-testable hypotheses, magical thinking and sometimes practices that are an insult to rationality and intelligence," he tells mid-day in an email interview.
Philips has his reasons. "During my initial days of clinical practice as a hepatologist, I came across a multitude of patients with new onset liver disease and worsening of pre-existing liver disease solely due to the use of alternative medicines, especially ayurveda and homeopathic practice," he says. Among the many cases, he has witnessed severe alcohol-associated liver disease in a young girl (due to alcoholic herbal supplements), alcohol-related liver disease in a teetotaler (due to homeopathic formulations) and heavy metals poisoning in "apparently healthy persons".
These patients, he adds, had to spend large sums of money to recover from severe liver disease, some progressed to liver failure and died or required a liver transplant to survive, he claims. Philips' group has even published peer-reviewed, scientific papers on the harms caused due to AYUSH-based healthcare practices from India. "The liver disease burden in these patients was avoidable. The financial burden on these patients was avoidable," he insists.
Dr Sanjith Saseedharan, consultant and head-critical care, SL Raheja Hospital, Mahim-A Fortis Associate, says that the rampant abuse and overuse of complementary, alternative medicines has become a pernicious problem. "Most of these supplements tend to affect the liver and kidney. In at least five per cent of the cases of patients coming in with liver failure, the cause is often alternative medicines. And they are the patients who tend to suffer severely," Dr Saseedharan says. "When we try to identify which particular medicine may have led to this, it becomes nearly impossible, because most of these complementary medicines are combinations of a number of plants or herbs. It's hard to pinpoint which ingredient may have exacerbated the condition." The condition is called drug-induced liver injury (DILI), and India, which is the seat of many alternative therapies, he says, is facing the heat.
During COVID-19, Saseedharan was part of a group that was researching science-based medicines to treat the viral disease. "At the time, there were a whole lot of alternative medicines doing the rounds. One of these was the homeopathic medicine Arsenicum album 30C, which is used to treat anxiety," he says. The Ministry of Ayush, Government of India, even declared Arsenicum album 30C (AA30), "prepared from mother compound arsenic trioxide", as a prophylactic for COVID-19 and it was widely distributed via government agencies. "As a medical doctor, I found it to be obnoxious," he says. A quick search on the Internet will also show a few studies that claim that AA30 provided some protection against probable and laboratory-confirmed COVID-19. "Many people started using this regularly as a preventive measure against COVID-19. Now, if you consume this continuously for two years of COVID, without understanding the long-term side effects, it is going to be dangerous," says Saseedharan.
In a 2022 paper, Dangerous Placebo During the COVID-19 Pandemic, authored by Dr Arif H Theruvath, Dr Resmi Raveendran, and Dr Cyriac Abby Philips, the doctors cited three case studies of acute hepatitis leading to death in one patient with underlying NASH (nonalcoholic steatohepatitis) cirrhosis, after consumption of the homeopathic remedy AA30 for COVID-19 prevention. The researchers also pointed out that while ultra-diluted homeopathic remedies "are considered safe⦠poor manufacturing practices, use of concentrated tincture formulations, and adulteration and contamination of homeopathic remedies can still pose considerable toxicity in predisposed persons".
OOn the other side are ayurvedic doctors, homeopaths and alternative therapists who say such narratives unfairly peddle half-truths.
Thiruvananthapuram-based Dr Alka Vijayan, who graduated from the Government Ayurveda College, and specialises in thyroid hormone dysfunction, gynaecology ailments and gut health reinstatement, feels that there's a general lack of understanding about ayurveda.
Vata, Pitta and Kapha, principles that guide ayurveda, are not merely based on the idea that air, mucus and bile imbalance could lead to disease. "It is a subject worth a lifetime, because it's very deep and profound. These three terminologies stand for a tool called âtridoshas' that help us understand the human body at the physical, mental and cognitive plane in relationship with nature - an umbrella classification system for the anatomical and physiological functionalities in the body," says Dr Vijayan.
According to her, ayurveda is not as much a field of medicine, as a "science of life", which teaches you first how to lead a healthy life through dinacharya (a healthy daily routine to service the body for better performance during the day and prevent falling prey to illness), ratricharya (a healthy night routine for good sleep), ritucharya (precautions to be taken during each season to help the body acclimatise to the changes better). "And then it talks about diseases and their treatment, if one falls sick upon not following these routines."
New York-based ayurvedic doctor Nidhi Pandya says that in the last 10 years alone, the US Food and Drug Administration (FDA), which is responsible for protecting public health by ensuring the safety, efficacy and security of human and veterinary drugs, has had more than 14,000 drug recalls. "This means that they were initially considered âsafe' for use, before being recalled," she says, adding, "Ayurveda is a 5,000-year-old science, which is also time-tested. And while there may be concerns about who is using it, how it's being administered and processed, we've never really seen a case, in all these years, of a particular substance that's deemed to be absolutely unsafe to the point that it's banned," says Pandya.
Ayurveda, shares Dr Vijayan, works best with acute as well as chronic conditions. "Gut disorders, migraines, acute and chronic infections, inflammations, hormone disorders like thyroid dysfunction, metabolic disorders like obesity, diabetes, autoimmune conditions like Hashimoto's Thyroiditis and psoriasis respond well to ayurvedic management. In fact, they can be treated and reversed, and if at all not reversed, quality of life improved from a scale of two to nine, out of 10, in any case," says Dr Vijayan, adding that "conditions like road traffic accidents, and those which require emergency care like cardiac arrest and stroke are of course best managed by modern medicine, in my personal experience."
Bengaluru-based homeopath Dr Sheetal Bidri says homeopathy was a system founded by German physician Samuel Hahnemann, over 200 years ago, following his dissatisfaction with the state of allopathy back then.
A small diversion here would perhaps be needed to put things into perspective. Dr Cyriac Abby Philips says that allopathy, which is currently synonymous with, but erroneously used for science-based medicine, was actually an obsolete "system of medical practices in medieval Europe that was based on crude forms of treatments such as blood-letting, bone drilling, skin burning, leech-therapy, inducing vomiting and enema therapies performed to let out âpoisons and toxins' and heal a person".
Hahnemann gave up his doctor's robe to translate books instead. "In one of the books [Cullen's Materia Medica], he came across a claim that the cinchona bark was effective in treating malaria because of its bitterness," says Dr Bidri. He got curious and decided to research its effect on the human body by self-application and trying it on those around him. "Hahnemann noticed that it induced malaria-like symptoms in almost everyone." After further research, he concluded that the bark did not cure malaria because it was bitter, but because it was able to create same symptoms of the disease, when given in material doses. This - "similia similibus curentur" or "like cures like" - forms the principle of homeopathy.
This alternative therapy, she believes, can be used to treat everything from a common cold to cancers (of earlier stages). But ER physicians are recommended for emergencies and surgery-related cases.
Dr Bidri argues that the drugs used for treating conditions have undergone systematic pathogenetic trials, which is called "Drug Proving". Basically, the pathogenetic effects of a drug substance are ascertained on the basis of their effects on healthy human beings of both sexes. "The drug substance is given to healthy human volunteers in controlled conditions, and the symptoms [objective and subjective] produced are carefully documented to evolve the Drug Picture."
There is also criticism around the diagnostic and therapeutic practices adopted by alternative therapies. Dr Philips describes it as "dangerous nonsense".
However, Dr Bidri says that a "homeopath studies all the allied subjects that an MBBS doctor does; the only difference is treatment". "The scientific basis of a diagnosis is the same for us too. For example, if we're treating a year-long runny nose, we would do a physical examination to evaluate if there is a visible cause or might need a test of at least a CBC with AEC [absolute eosinophilic count] to rule out eosinophilia. Or a patient who has pain in the abdomen and shows tenderness at a specific area which we suspect to be appendicitis, would be immediately rushed for an USG abdomen to get a clear diagnosis." The treatment protocol, however, is different. "We spend some more time trying to understand the individuality of the person in a particular disease, because we treat the person as a whole and not just the disease," she shares.
Nidhi Pandya says that ayurvedic doctors also rely on modern-day diagnostics. "This means that most of us are taught how to read reports, interpret conditions, and keep up with newer medical developments. But our diagnosis involves a combination of things, including causative factors, the diet, existing lifestyle, mindset," says Pandya.
Dr Vijayan explains: "We take the symptoms from head to foot, including emotional and cognitive ones, into account, try to understand what triggered [nidana] it in the first place and how it has evolved over time [samprapti], then examine the patient for âashtasthana pareeksha' which includes nadi pareeksha. We also look for âdasha vidha pareeksha'."
According to Dr Philips, many AYUSH-related brands have been for decades selling products under the garb of healthcare "without any scientific validity, recommendation or approvals from credible clinical societies or healthcare organisations". "Most of such products which I have been vocal about, have been banned in various scientifically progressive countries," he says.
Pseudoscientific claims, he says, rely on confirmation bias and anecdotal experiences rather than rigorously performed, conclusive objective evidence and shies away from attempts at refutation.
Saseedharan shares a similar concern. "These [complementary] medicines are promoted as being ânatural and safe', and hence, without side effects. But there is no data to either support or refute [such claims]," he says. That most of these supplements are Food Safety and Standards Authority of India-approved, and don't come with an FDA stamp is the other issue. Science-based medicines, he says, on the other hand, undergo randomised and controlled trials with voluminous data, and are registered with a proper clinical governing body.
AYUSH practitioners say its not the medicines, but self-medication that is the problem. Dr Bidri says that this has given homeopathy a bad name. "Homeopathy has no side effects, provided you have taken the medicine from a certified homeopath," she says. Dr Bidri, who through her Instagram handle, has been trying to raise awareness about this, says, "There is a lot of misguidance on YouTube channels today. Some of the so-called experts on these channels are prescribing ridiculous dosages, without following the set scientific principles of homeopathy [there are seven cardinal principle of homeopathy]," she says, "One of the principles is the Law of Minimum, which is giving a simple, minimum dose for a certain duration of time [which] is sufficient for healing." Homeopathy doesn't have side effects, she insists again, but it can have extra effects, when the dosage is unregulated. She alludes to Hahnemann's guiding theory of "like cures like". "If the dosage is not regulated, it can create the same symptoms that you are being treated for. Only homeopaths understand and analyse the actual pathology of the case, the doses and potency of the remedy required, based on the individualisation."
Dr Vijayan also cautions against consuming "ayurvedic medicines without a prescription". "Either you can go wrong with the choice of herb required for âyour body' or the duration to be continued," she says, adding, "One of the most abused ayurvedic medicine is triphala and laxatives of the sort. They do give instant relief from constipation, but in the long run, they could lead to complications like dry skin, as they are not meant to be used continuously." Another abused plant, she says, is turmeric, which is used for its anti-inflammatory property. "But it is also hot in potency, which causes complications like heat rashes, acidity and bleeding disorders in those prone to it, depending on their predominant dosha. Turmeric, for example, can have a different effect on a kapha type as opposed to a pitta or vata type person," says Vijayan, who also has a wellness brand, TANMATRA Ayurveda, which offers ethically-curated ayurvedic consumables and Kerala panchakarma therapies.
Rachana Gupta, who is the co-founder of Mumbai-headquartered Gynoveda, which offers ayurvedic solutions that promote fertility, tackle PCOS, regulate periods, weight, pigmentation, among other lifestyle conditions, says it's important to understand why many sceptics are now turning to alternative therapies. "Because they are working," insists Gupta, whose own family converted to ayurveda over a decade ago, after her husband Vishal, who was suffering from chronic psoriasis - a skin disease that causes a rash with itchy and scaly patches, often on the knees, elbows and scalp - made the switch to kadhas and herbal concoctions. "Many of the women who are coming to us [with fertility issues] are so frustrated with what modern medicine is offering them that they surrender to a more natural, self-healing medicine system. That's where ayurveda wins," she says. "But there's a long way for ayurveda to be considered a first-choice of healthcare. It's still the last choice."
Gynoveda, which was launched in 2020, has around 40 supplements, used by over five lakh consumers. Earlier this week, they even launched their first clinic in Malad. "Our formulations come from the Charaka Samhita [Sanskrit text on ayurveda], but they all undergo rigorous trials and testing through FDA.
In addition, they have a Good Manufacturing Practices (GMP) certification. Over and above this, we do constant quality control to check toxicity and stability," says Gupta, adding that every supplement from ideation to manufacture takes about four-and-a-half months. They have also published details of their clinical trials for a few supplements. For some of their products, she says, they teamed up with the European Journal of Pharmaceutical and Medical Research to administer the trials.
Dr Philips, though, is not convinced. "Ayurveda had everything good, going thousands of years ago, but now, in a scientifically progressive society, people must understand that ayurveda's place is inside a âHistory of Medicine in India' museum," he says.
