Progress made in India in the past decade in digitization, banking reforms, and economic structuring has been phenomenal. However, there seems to be an inversely proportional relationship between economic/technological advancement and health/education in the present-day political India. It seems that the concept of going back to one’s roots has been exclusively reserved for health and education.
We live in an era of evidence-based medicine, whereby the best available research is combined with the physician’s knowledge and patient’s preferences to deliver systematic health care (Akobeng 2005). The aim of evaluating an intervention is not only testing its effectiveness but—most importantly—ruling out adverse effects in concert with the first principle of medical management: “Do no harm.” Such a stringent monitoring system leads to only 10 percent of investigated drugs getting marketing approval.
Ayurvedic medicine is a medical science based on writings from ancient Indian texts. There are a wide variety of plants and root-based formulations used in preparing the medicines. As a result, these agents can lead to heavy metal poisoning, especially from lead and mercury, presenting with lethargy, headache, and liver and kidney failure (Minnesota Department of Health 2022). According to an ayurvedic physician, the process of purification of the herbs with ashes, by repeating the process nearly a hundred times, is needed to get rid of the heavy metals (TNN 2017). The overall expansion of the ayurvedic industry by 17 percent between 2014 and 2020 with an annual increase of 5.7 percent calls for more stringent application of evidence-based processes to screen for safety of these products (Ayush 2021). A recent systematic review of 219 articles evaluating ninety-eight ayurvedic products used in the management of diabetes revealed poor quality of data, hence the need to strengthen the evidence base (Chattopadhyay et al. 2022). However, instead of implementing these scientific methods of evaluation in the field of ayurveda, we find that these scientific methods of evaluation are being increasingly challenged today.
We are faced with a movement that champions decoloniality over postmodernity (Deepak 2021). Decoloniality relates to delinking the source of knowledge from the ones laid down by colonizers. The work of prominent sociologists Walter D. Mignolo and Aníbal Quijano linking rationality and modernity with “coloniality”—the indoctrination of the indigenous mind with the principles of their colonial masters—provides the inspiration for this decolonization movement (Mignolo 2007; Quijano and Ennis 2000). From an Indian perspective, the aim seems to rid ourselves of the principles of modernity and rationality emerging out of the European Renaissance.
Several terminologies were introduced to indicate the direction that needs to be followed to achieve this decolonization. The recovery of geographical and political space from the colonizers do not immediately lead to a state of complete freedom. Rather it is a state of “post coloniality,” whereby the colonial mindset is still prevalent. Hence, the final step to complete freedom is freeing the mindset from the Western construct, defined as decoloniality. Although we have freed ourselves from our Middle Eastern and European colonizers, we have not been able to get rid of the mentality ingrained in the Indian system of administration and education. While there are merits to some of the issues raised by the proponents of decoloniality, there has always been a fear of missing out on the actual benefits and falling into the trap of hyper nationalism. The modernization of the education system, infrastructure, and medical and legal framework were some of the positive developments encountered in the colonial periods. How does decolonization reconcile with these benefits?
This conflict is particularly visible in the field of medicine in India. Do we integrate our indigenous values into the prevalent system, which is global in nature, or do we dismantle all that is considered modern, rational, and progressive by the global definition and introduce a new system based on the cultural traditions dating back thousands of years? The latter strategy has the propensity to lead to nationalism as evidenced by the statement of Acharya Shri Balkrishna (a prominent figure spearheading the Ayurvedic movement in India): “Amongst all the cultures of the world, Indian culture is not only the oldest of all, but it is also the best and incomparable” (Balkrishnaji 2009). This mixture of culture, nationalism, and medicine can be seen in the introduction of ayurvedic clinics and hospitals independently, as well as integrated into the existing hospital system by the current government.1
Modernization of Science in India: Lack of Acknowledgment?
Science can be understood as a system to acquire knowledge. In medicine, the scientific method typically involves inductive and deductive phases. The inductive reasoning leads to generalization from the specific. In medical science, it involves accumulating data and exposing it to statistical analysis, leading to an inference that then can be implemented on a larger population. The deductive process starts off with generation of a hypothesis that forms the basis on which the design of the experiment is constructed. Then data is collected and analyzed. The final product is a specific outcome intended for a specific population with a specific set of baseline characteristics.
In India, traditionalists are challenging the scientific method as a Western construct. This objection stems from the fact that Eastern methods of acquiring knowledge are not dependent on observational phenomena but rather on the methods involving the mind as indicated in ancient Vedic literature. Attacks on existing scientific methods frequently leads to infamous nationalistic statements akin to the one made by a minister of Ayush (the government agency responsible for the propagation of traditional health methods), Shripad Yesso Naik, depicting all physicians prescribing non-ayurvedic medications as anti-nationals (TNN 2017).
We learn from history that the advent of skeptical inquiry and deductive reasoning was the forerunner of the development of scientific methods. And in this aspect, there were more similarities than differences between Greek methodologies and those developed in ancient India. For example, the classical Greek humors (blood, phlegm, yellow bile, and black bile) that formed the basis of the Hippocratic principles in the fifth century BCE are similar to the “Tridosha theory”—the premise that illness is caused by defects related to three substances: vata, pitta, and kapha (wind, bile, and phlegm)—one of the basic principles of ayurveda (1500–500 BCE) (Bynum 2013; Jaiswal and Williams 2016).
In contrast with the Western Hippocratic tradition, the Indian medical tradition is identified with the Charak Samhita (100 BCE to 200 CE). It is customary for all medical graduates joining medical school in India to take the Hippocratic oath, but in recent years this oath has been challenged by some of the traditionalists who have advocated for the “Charak sapath” instead of the Hippocratic oath (Chakraborty 2022). The documented history of science, as published in the West, has rarely acknowledged the contributions from India, giving some support for the traditionalist’s point of view.
Evolution of the Scientific Methods
Historically, the modern methods of acquiring knowledge have gone from a phase of inductive reasoning to a phase of deductive reasoning, culminating in modern methods that include a mixture of both approaches. The process of deduction—arguing from general principles to a specific conclusion—was formally introduced by Aristotle through his well-known syllogism: “All men are mortal. Socrates is a man. Therefore, Socrates is mortal.” It was around the first or second century CE that the Nyāya Sūtras were composed by Akṣapāda Gautama in ancient India, which dealt with the principles of logic and the theory of knowledge that was dependent upon the method of Pramāṇa, or proof (Chatterjee 2015). This method was very similar to the deductive process introduced by Aristotle.
The deductive form of evaluation dominated the scientific landscape until it was superseded by the inductive methodology introduced by Francis Bacon in the sixteenth century (Horton 1973). The process of induction moves from specific observations, from which general principles are drawn. During this entire period, in which inductive reasoning led to logical positivism, India was under prolonged colonial rule and devoid of significant indigenous achievements. The Western influence on all aspects of public life, including science, was identified as “materialism,” and “Indianness” was equated to “spiritualism.” However, the concept of materialism can be traced back to the sixth century BCE in India in the form of the principles of Lokāyata or Cārvāka (Gokhale 2015).
The evolution of scientific methods shows that there were more similarities among the different schools of thought up to the twelfth century CE. The brutal suppression of the Indian indigenous community from the twelfth century CE to independence in 1947 resulted in people becoming suspicious of every aspect of the colonizers’ contributions, even when some of the policies contributed positively to their lives.
Modern Scientific Methods Assessing Medical Science
Like any other scientific discipline, the process of scientific assessment in medicine starts with a hypothesis (disease), which is then tested through a deductive process culminating with the collection of appropriate data (risk factors). After the identification of the risk factors associated with the disease, a treatment must be identified to address the risk factors, alter the disease, or do both. The gold standard scientific method in assessing the utility of a treatment is a randomized controlled trial (RCT). This is a way of designing an experiment whereby the participants for the trial are chosen at random and divided into an intervention arm and a placebo arm. The medicines prescribed to participants in both arms are unknown both to the patients as well as the physicians (double-blind method). This randomized, double-blinded method minimizes the risk of bias associated with conducting the trial and hence makes it superior to an observational trial, where neither the process is randomized nor the participants blinded to the intervention used. Another important aspect of assessing a therapeutic agent is documenting its safety. To summarize, throughout the globe, physicians utilize processes of deduction and induction to follow a standardized scientific method for assessing risk factors for a disease and the agents used to modify those risk factors or the disease.
The basic principles of evaluation of intervention in ayurveda is not grossly different from the above construct. The three tools utilized for research are Pratyaksha (direct observation), Anumana (inference), and Aptopadesha (literature). However, there are significant differences as far as understanding the body and its functions are concerned. For example, the ayurvedic biology depends on the knowledge of channels within the body (Srotovijnana), which act as a transport system for bodily functions. The main aim therefore is to purify the body by rectifying these flow channels (Samshodhana). However, the means of achieving the same is based on the writings of the ancient texts without any systematic process of evaluation. As was correctly pointed out by a review publication, it is time to replace faith and suppositions with scientific reasoning (Chauhan et al. 2015).
In view of the criticism leveled against these modern methods, indigenous drugs and their associated medical management strategies have been given free rein. Indigenous medical products (ayurvedic agents)—much like health supplements in the United States—have been exempted from scientific scrutiny and are freely available on the market. To make matters worse, these drugs have been dubbed “natural” and free of side effects, in contrast to modern medicines, which are associated with chemicals having the potential to cause harm (Bhardwaj 2022). It is extremely interesting to note that today’s government has launched a ministry of Ayush to promote ayurveda, yoga, naturopathy, Unani, Siddha, and homoeopathy. Guidelines have been published online by this ministry about how COVID-19 management is to be accomplished through alternative medicine (Ayush n.d.). On one hand, a plethora of observational and RCT data has been accumulated to identify preventive as well as therapeutic methods of managing the morbidities and mortality associated with COVID-19, while on the other hand these alternative medicines have been allowed on the market without any scientific scrutiny.
The dangers of politicizing medicine are profound. A recent advertisement at the Delhi International Airport created a flutter in the medical community. A baba Ramdev (ayurvedic and yogic healer) claimed to have a cure for most chronic diseases, including type 1 diabetes. The claims made were in direct violation of the Drugs and Cosmetics Act of 1940 and the Drugs and Magic Remedies Act of 1954 (Mukunth 2022). However, with the patronage of the present-day government as well as the support of the traditionalists, the battle has shifted from the gross violation of medical ethics and science to an issue between traditional medicines and “allopathy” (modern medicine). In the process, the scrutiny of scientific methods has been targeted, thereby shielding all forms of indigenous therapy from skeptical inquiry. Denying the application of modern strategies to evaluate medications is keeping indigenous medicines from the purview of the central drug controlling authority (DCGI) (Bhatt 2016).
If the tension between scientific methods and traditionalists were merely about the gross lack of acknowledgment of earlier Indian medical history, it would be easy to address this problem. The proponents of decoloniality might have a valid point with respect to this aspect of the controversy. However, if the issue continues to involve challenging or scuttling the scientific method to ensure a smooth backdoor entry of untested traditional medicine to the market, we have a grave and much larger problem at hand.
Note
- For a list of NABH accredited Ayush hospitals, see https://www.nhp.gov.in/nabh-accredited-ayush-hospitals_mtl.
References
Akobeng, A.K. 2005. Principles of evidence based medicine. Archives of Disease in Childhood 90: 837–840. Online at https://adc.bmj.com/content/archdischild/90/8/837.full.pdf.
Ayush. 2021. Promotion of ayurvedic medicines at global level (December 17). Online at https://pib.gov.in/PressReleasePage.aspx?PRID=1782666.
———. N.d. National clinical management protocol based on ayurveda and yoga for management of covid-19. Government of India. Online at https://www.ayush.gov.in/docs/ayush-Protocol-covid-19.pdf.
Balkrishnaji, Maharaj AS. 2009. Ayurveda: Its Principles and Philosophy. Haridwar, India: Divya Yoga Mandir Trust.
Bhardwaj, Tarun. 2022. Ayurveda is growing due to consumer preference towards chemical-free herbal health & personal care products: Vishal Kaushik, Upakarma Ayurveda. Financial Express Healthcare (January 7). Online at https://www.financialexpress.com/healthcare/wellness/ayurveda-is-growing-due-to-consumer-preference-towards-chemical-free-herbal-health-personal-care-products-vishal-kaushik-upakarma-ayurveda/2400986/.
Bhatt, Arun. 2016. DCGI approval not required for clinical trial of herbal products. Pharmabiz.com (April 6). Online at http://test.pharmabiz.com/good%20clinical%20practices/dcgi-approval-not-required-for-clinical-trial-of-herbal-products-94431.
Bynum, William. 2013. A Little History of Science. New Haven, CT: Yale University Press.
Chakraborty, Abhishek. 2022. Why is Charaka Shapath so controversial? Why is it not permitted at medical colleges? India Today (May 5). Online at https://www.indiatoday.in/india/story/why-is-charaka-shapath-controversial-hippocratic-oath-in-medical-colleges-1945322-2022-05-04.
Chatterjee, Satischandra. 2015. Nyāya Theory of Knowledge. New Delhi, India: Rupa Publications.
Chattopadhyay, K., et al. 2022. Effectiveness and safety of ayurvedic medicines in type 2 diabetes mellitus management: A systematic review and meta-analysis. Frontiers in Pharmacology 13: 821810. Online at https://www.frontiersin.org/articles/10.3389/fphar.2022.821810/full.
Chauhan, A., et al. 2015. Ayurvedic research and methodology: Present status and future strategies. Ayu 36(4): 364–369. Online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041382/.
Deepak, J. Sai. 2021. India That Is Bharat. New Delhi, India: Bloomsbury Publishing India.
Gokhale, Pradeep P. 2015. Lokayata/Carvaka: A Philosophical Inquiry. Oxford, UK: Oxford University Press.
Horton, Mary. 1973. In defence of Francis Bacon: A criticism of the critics of the inductive method. Studies in History and Philosophy of Science Part A 4(3): 241–278. Online at https://www.sciencedirect.com/science/article/abs/pii/0039368173900101.
Jaiswal, Y.S., and L.L. Williams. 2016. A glimpse of Ayurveda—the forgotten history and principles of Indian traditional medicine. Journal of Traditional and Complementary Medicine 7(1): 50–53. Online at https://www.sciencedirect.com/science/article/pii/S2225411016000250?via%3Dihub.
Mignolo, Walter D. 2007. Delinking: The rhetoric of modernity, the logic of coloniality and the grammar of de-coloniality. Cultural Studies 21(2): 449–514. Online at https://docs.ufpr.br/~clarissa/pdfs/DeLinking_Mignolo2007.pdf.
Minnesota Department of Health. 2022. Metal toxicity from ayurvedic medications. Online at https://www.health.state.mn.us/communities/environment/lead/fs/ayurvedic.html.
Mukunth, Vasudevan. 2022. Patanjali anti-allopathy ad, a window into all that’s wrong with our healthcare. The Wire Science (July 11). Online at https://science.thewire.in/health/patanjali-advertisement-evidence-based-medicine/.
Quijano, Aníbal, and Michael Ennis. 2000. Coloniality of power, Eurocentrism, and Latin America. Nepantla 1(3): 553–580. Online at https://edisciplinas.usp.br/pluginfile.php/347342/mod_resource/content/1/Quijano%20(2000)%20Colinality%20of%20power.pdf.
TNN. 2017. Poison in ayurvedic drugs. Times of India (March 31). Online at https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/poison-in-ayurvedic-drugs/articleshow/57934912.cms.