The case filed by a manufacturer of indigenous drugs against a medical practitioner on the grounds that his social media thread affected their business has become a cause celebrè in medical circles.
Without going into the specifics of this particular case, let us examine certain general aspects. What is the position of traditional medicine in a modern world? What is evidence-based medicine? How does one evaluate a therapy and what steps, if any, should governments take to ensure the health of the population?
Modern medicine
It is a fact that irrespective of the advances of modern medicine, several systems which lay claim to healing, and which all fall under the broad category of alternative medicine, exist. Certain systems such as Ayurveda, Unani, and Siddha have their own pharmacopeia in India.
It is important to note here that modern medicine is not allopathy (which means “opposed to symptoms”), a term coined by Hahnemann in the 18th century, and used pejoratively, to differentiate it from his newly invented system, homeopathy. Modern medicine really became science-based only from the late 19th century when advances in technology made not only the study of the functioning of the human body in health and disease more accurate, but also led to safe anaesthesia and surgery. Later, this process led to marvels such as dialysis for kidney failure and the heart-lung machine which made surgery on the heart a daily affair.
The development of scientific thought in the 20th century, including the Popperian idea of falsifiability, led to advances in evaluating medical therapies. Subjected to the methods of modern science, which are continually being refined, many therapies were found to be ineffective and abandoned. This is the strength of the modern method, the recognition that science continually advances and self-corrects. Modern medicine is western only geographically and not epistemically. Modern medicine, a part of modern science, tests every new therapy and accepts it into the canon if found effective. Due to the greater scientific capabilities of the West, which are a result of their richer economies and the post-renaissance historical realities, a great part of modern technology has been developed there, but it is false to think that there is anything epistemically “western” about it. One of the great triumphs of the post-World War II phase of human civilisation is the greater and quicker flow of ideas across the world.
The physiological basis of Ayurveda is not sound, but that does not ipso facto mean that its therapies are not sound either. Like many traditional medical systems everywhere, Ayurveda was constrained in its understanding of how the human body works by the lack of available technology. However, the Ayurveda classics were constant in their emphasis on the need to base diagnoses and therapies on a sound understanding of the human body. A reason-based world view is what differentiates Ayurveda epistemologically from the erstwhile faith-based forms of the Atharva Veda. Proponents of Ayurveda who claim that everything was already known to the ancient people do it a great disservice and stultify its growth and development. One of the greatest triumphs of modern epistemology is its ability to synthesise ideas from across the world to build a coherent system of how the world functions. This is an ongoing process, subject to corrections and improvements as thought and technology improve, building on past knowledge.
In modern drug development, the commonly used method is to isolate the active principle. Thus, most modern medicines are single ingredient and only a few are combinations. Also, the exact amount of the active principle is carefully calculated. Ayurvedic medicines are commonly combinations, and it is uncertain how these combinations interact with each other. It would increase the acceptability of Ayurvedic medicines in the scientific community if they were evaluated by the methods of modern science in a way that does not compromise with the wholeness of Ayurvedic formulations. New investigational methods and trial designs which can evaluate Ayurvedic therapies without undermining the classical bases of administering them must be worked out. The Ministry of AYUSH must facilitate this.
The purpose of government policy is to make life better for the people. The health of the people should not be hostage to false ideas of nationalism. The aim should be to carry out an evidence-based appraisal of all traditional medical systems, retain and develop what is useful, and integrate them into one cogent system of medicine available to all.
A disservice
A few individuals do a disservice to the cause of evidence-based medicine by denouncing traditional medical systems wholesale. Science requires open-mindedness disciplined by scepticism. Denouncing traditional systems in toto would result is a hasty dismissal of valuable medical experience that has undergone repeated, albeit informal, verifications at the hands of generations of practitioners. Ignoring such time-honoured knowledge bases in the name of science is a disservice to the scientific attitude as also to the cultural achievements of yore. It must be remembered that the Nobel-winning anti-malarial artemisinin was synthesised thanks to investigators who were open-minded enough to take cues from a 1,600-year-old text of Traditional Chinese Medicine.
George Thomas is an orthopaedic surgeon and former editor of The Indian Journal of Medical Ethics; G. L. Krishna, an ayurveda physician, is a Homi Bhabha Fellow and a visiting scholar at the Indian Institute of Science, Bengaluru
