coronil-case-and-need-for-integrating-ayurveda-and-allopathy

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. 

Concerns:

  • 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