Context: Patanjali Ayurveda’s claimed cure for COVID-19 has been criticised for making unsubstantiated claims of efficacy. However, can ayurveda, or alternative medicine in general, be evaluated in the same way as modern medicine (Allopathy)?
Ayurveda Vs. Allopathy
Modern medicine is obsessed with a cell, or an organ, or a disease, which is a part of a body, while ayurveda considers the person as a whole and believes that the whole is more important than some of the parts that it is composed of.
- Ayurveda relies on assessment of disease in ayurvedic style, which is not only about focusing on the virus, but also looks at the baseline health parameters like diet and sleep.
- A strength of modern medicine is that it looks very strongly at endpoints like saving lives and recovery.
- Ayurveda is said to be a highly personalised system of medicine. Modern medicine has a generalist approach, on the other hand, it recommends a drug for anyone who presents a certain set of conditions.
The process of testing a new investigational drug in ayurveda:
There are two aspects to the use of ayurvedic drugs for clinical use which are described in classical text and listed in the Drugs and Cosmetics Act of India.
- If Ayurvedic drugs are to be used for a new condition as in the case of COVID-19, and there is some textual evidence for their efficacy, then they can progress to human trials without studies on toxicity.
- If the drug is an entirely new formula, then it has to follow the same path of toxicity, pre-clinical efficacy and subsequent clinical trials.
No difference in testing standards for Ayurveda and Allopathic medicine:
- As per the CCRS (Central Council for Research in Ayurvedic Sciences) guidelines the drug must not ignore the parameters on which it is judged by modern medicine.
- Passing “Placebo effect” test: Ayurvedic medicines should not have a placebo effect. A placebo is anything that seems to be a "real" medical treatment but isn't. It could be a pill, a shot, or some other type of "fake" treatment.
Process of allopathic drug trials: Drugs are evaluated based on what specific endpoint is expected. Any drug or any intervention must figure out if the drug is safe and effective.
- Commercialization: However, medicinal products are frequently in the hands of commercial pharmaceutical companies, who deploy similar means to sell more and extol benefits over harm.
- Absence of peer review: In the pharmaceutical world, normally what happens is, results of a trial are peer-reviewed and published in a journal. Independent experts can then evaluate the drug’s benefits or non-efficacy. There is a problem in that ayurvedic research publications don’t appear as frequently in high-impact journals.
- The principles of science and ethics: The way the Patanjali trial was publicised, the results were shared with the media without getting published. Their claims were disproportionate to what was clinically proved.
- Personalisation refers to the disease type or the stage of severity. However the one-drug-fits-all notion in modern medicine is itself getting challenged everyday.
- No critical cases for Ayurvedic drug testing: There aren’t tests allowed anywhere where ayurveda can be tested in severe or critically ill situations which could improve outcomes.
Way forward: An integrated approach will create a win-win situation for both ayurveda and allopathy.
- Technological interventions: When disease reaches a certain level, you need technological interventions like, in the case of COVID-19, ventilators and pulse oximeters.
- More integration of modern methods should be integrated into the ayurvedic framework.
- A confidence has to be built in the modern medical world as well as in society that these things can be tested in those conditions as well.
- Peer review in Ayurveda: There is definitely the case that this reporting needs to be upgraded and the quality of Ayurvedic journals improved.
Checking commercialization: Most people in our country can never afford an expensive drug. We must, at this time, de-link this nexus between pharmaceutical companies and medicine.
Image Source: Times of India