‘Pseudo-medicine’ Vs ‘Scientific Medicine’ In India: Part II

In a better world where there is no adulteration, MBBS students graduate after five-and-a-half years of learning, including a compulsory one-year residential internship programme, which is where they pick up real-world skills. The syllabus comprises subject areas like Anatomy, Bio-chemistry, Physiology, Pathology, Pharmacology, Microbiology, Psychiatry, Dermatology, etc. Students learn different stages of treatment and standard protocols like disease history, examination, diagnosing, and patient management etc during their practical classes. The first phase of the course is pre-clinical, which covers mainly the first two semesters of the course focusing on the basic knowledge of various subjects like anatomy, physiology, etc. The second phase is the Para-Clinical which spans three semesters (one and a half years), focuses on the teaching of subjects like forensic medicine, pathology, etc. along with the essential aspect of the course- Community Medicine. The third phase is the Clinical phase which focuses on practical knowledge and practice along with subjects like psychiatry, pediatrics, etc.

Compare this with the syllabus of BAMS. It is divided into three sections, each of which has one-and-a-half years of time devoted to it. A lot of time is spent in each phase learning stuff like the history of Ayurveda, Ayurvedic philosophy, ancient texts like Charaka Samhita, etc, which might enthuse philologists and historians of Ayurveda, but is not germane to the understanding of human, animal or plant health in modern scientific parlance. This is taught alongside seemingly scientific subjects like pathology. So let us bore deeper into the syllabuses and briefly investigate what kind of stuff is actually taught under the rubric of “pathology” in each course. The MBBS course at AIIMS teaches under pathology (pg. 50 to 56) disease mechanisms in detail, equipping a trainee doctor with all the necessary knowledge and skills to identify symptoms of various diseases in every part of the body. At the level of primary healthcare, this ability is crucial for early detection and treatment wherever possible and making referrals to specialists wherever necessary. Without detailed knowledge of pathophysiology, it is very difficult to carry out this essential medical task. Now let us find out what BAMS teaches under pathology (called “rog vigyan evum vikriti vigyan” in Ayurveda). A lot of focus (pg. 59 to 65) is on the ancient “dosha” concept of disease, which would be in direct epistemological conflict with modern ideas about disease mechanism, especially the germ theory of disease. As for scientific pathology, an afterthought appears to have been spared whereby “introductions” to diseases and pathogens are made to students. All this means that a lot of time and mental resources are spent by a BAMS undergraduate learning and conceptualizing irrelevant and unscientific stuff, while the scientific stuff, which is what the MBBS undergrads learn, is incidental learning for them. Which kind of graduate is more likely to make an accurate diagnosis of, say, genital tuberculosis?

Inclusion of modern scientific diagnostics in the practicals of the BAMS course clearly repudiates any appeal to cultural originality that Ayurveda’s proponents tend to make. Even if, theoretically, it has any cultural originality, for practical efficacy, it has to pretend to meet scientific standards. Nor is existing Ayurvedic research of much value. As the linked systematic review concludes, “several limitations relate to clinical research on Ayurveda. Well-planned, well-conducted and well-published trials are warranted to improve the evidence for Ayurvedic interventions.” It is true that some plants and herbs used as Ayurvedic medicine are effective. This is mainly because those plants contain the chemicals – or drugs – necessary to cure or mitigate a particular disease. What modern pharmaceutical concerns do in principle is isolate those chemicals – the “active ingredients” – from a plethora of other unnecessary ones in the plant, concentrate them and find out the best form of drug delivery through pharmacokinetic research. These drugs are then required to pass four-phase clinical trials for safety and efficacy – standards for which are quite high – before being legally allowed to be marketed as products. All this, in addition to skulduggery encouraged by monopolistic competition, tends to drive up the costs of most patented drugs. So yeah, patented drugs are expensive (this is why we in India need to fight to save our generics from the depredations of the West), but also much more likely to be effective than Ayurvedic drugs which have little quality research to support either their safety or efficacy.

So, is IME-9 “cheap, safe and effective“? No. There is thin evidence available for the tall claims made by IME-9 hustlers. The “research” and “trials” bit they talk about is mostly window dressing to try and convince the skeptics, while the product is pitched to laypeople mostly on cultural appeal, and on the idea that it has no side-effects. Yet, there is no available evidence for any clinical trial or any research based on which the product makes its fantastical claims of “curing” diabetes. Nor is the product “cheap” if one does all the cold calculations. Also, many Ayurvedic formulations have been found to have a heavy metal problem. Heavy metals like lead, arsenic, and mercury, all of which are known to cause, among other things, major neurological disorders and multiple organ failure in humans, are seen as having medicinal qualities by practitioners of Ayurveda. This sheds light on the troubling fact that Ayurveda is not scientific and probably has no standards for safety or efficacy. If you end up ingesting heavy metals believing that your magic pill will cause no side-effects, you have been conned badly. And, the Ministry of AYUSH is enabling it.

Yet, Ayurveda is still probably the most effective con. Others in the AYUSH umbrella – Unani and Siddha – have far less evidence of working. To whatever extent either works, is due to the use of plants and herbs just like Ayurveda. Yoga, despite all the expensive and aggressive global promotional campaigns, and stripped of all its mysticism, is just mild to moderate exercise. Despite claims made by proponents about its supposed mental health benefits, there is very little conclusive evidence to support them. Naturopathy is relatively recent, and not Indian, in origin. It has elements of many kinds of pseudomedicine, like hydrotherapy, homeopathy (back to this shortly) etc. It’s basically a pseudomedical mongrel. Its con starts with its deceptive nomenclature. It tries to take advantage of the fact that most people view anything “natural” as necessarily “good” – never mind all those poisons that are also “natural”. Naturopaths tend to be dangerous and abusive cons, in that they discourage people from accessing all the benefits that modern medicine brings.

All things considered, however, it’s homeopathy, AYUSH’s crown jewel, German in origin, that takes the cake for its quackery. It’s based on the principle of “like cures like”, the idea that what causes a disease can, in a diluted form, also cure the disease. This might sound a bit like how vaccination works, in which a pathogen in its mostly-harmless avatar (dead, inactivated etc.) is introduced into the body to provoke an immune response and create a “memory” of the antigen, which is to be made use of in the future when there is an actual attack from the same pathogen. But there are crucial differences. For one thing, vaccines mostly don’t cure disease (although there are curative cancer vaccines in the early stages of development), they only prevent it.

Homeopathy proposes to not just cure the disease, but also the “whole person” – whatever that means. The key thing is that vaccines are based on the germ theory of disease, whereas homeopathy is based on the “miasma” theory, which, for example, is how malaria (literal meaning “bad air”) gets its name despite not being an airborne disease. This is the reason why the idea of “like cures like” in homeopathy is that whatever causes symptoms similar to a disease provides, in an ultra-diluted form, a cure for the disease. So, if you are allergic to pollen, homeopaths might prescribe hyperdiluted pollen as a cure for your sneezing from a bout of common cold. What does “ultra-dilute” mean in the context of homeopathy? Dilutions in homeopathy typically come in the form of “X”, “C” or “M”, which refer to one-tenth, one-hundredth and one-thousandth dilution, respectively, of the supposed “active ingredient”, the healing poison. So, a homeopathic potion labelled “20C” is a dilution of one-hundredth performed 20 times. Avogadro’s number is 6.023 X 1023, which is the approximate number of molecules contained within one mole (molecular mass in grams) of a chemical compound. Assuming one starts with the molar mass of the “active ingredient”, a 20C dilution would reduce its concentration to the order of 10-40, which would make the probability of finding one molecule of the ingredient in a typical 20C homeopathic preparation vanishingly small. In other words, homeopathy is just succussed water, or ethanol, which is used for the dilutions.

What is ‘succussion’? After every dilution, the container is shaken or struck against a surface violently – succussed – in a ritual manner to increase its “potency”. If this were not absurd enough, homeopaths claim that the greater the dilution of a homeopathic preparation, the “stronger” it is, presumably because of the greater number of succussions. So, a 30M homeopathic preparation, for which the probability to find one molecule of its active ingredient is one in 1090, is one of the “strongest” medical preparations – never mind the fact that the entire universe has been estimated to have around 1080 particles, which means that it’s literally impossible to find the active ingredient in a 30M preparation anywhere in the universe. “Strong” indeed. Further, traditional homeopathy doesn’t bother with double-blind clinical trials to test safety and efficacy, choosing instead to rely on entirely subjective and unscientific “provings“, which involves administration of homeopathic water/alcohol to healthy subjects to check for “signs of ill-health”.

The problem with all this is that homeopathy is extremely popular in India, owing mostly to the fact that is quite cheap. That it is cheap is no surprise, because it doesn’t require a lot in the way of capital investment, nor does homeopathy have to deal with all those pesky high standards expected of scientific medicine. There is barely any research cost, for reasons not difficult to discern. Another reason why it is so popular is that it has been successfully branded as a “natural” form of healthcare, even though many of its preparations have near-zero probability of ever having their purported active ingredient found anywhere in nature. “No side-effects” is the other mesmeric mantra that enthralls patrons of water quackery. It is true that pharmaceutical drugs cause side-effects in many patients, and many of these are extremely unpleasant. But the problem is that unlike scientific medicine, homeopathy (like all of CAM/AYUSH sisterhood) has no definite standards. A homeo-potion could be (and mostly is) just water/alcohol, or a poisonous solution that was diluted inadequately by a lazy or adventurous ‘succusser’. Or there could be adulterations that end up taking lives. The other problem with the ‘side-effects’ myth is that while real medicine partially or fully addresses the relevant health problems, homeopathy has never been proven to work.

Not better than placebo anyway – and anything that works only as good as placebo is as effective as your mother praying for you is at curing, say, tuberculosis. So if, for example, one has a cancerous tumour in one of their lungs, and they give up chemotherapy and take up homeopathy because they hate losing hair and retching all day (terrible situation to be in, one has to admit), then that’s a fatal decision they’ve made. Cancer will grow and metastasize, lead to irreparable and horrible decay, and eventually a painful, regretful, totally avoidable death. Is there a worse side-effect than death? Now try and imagine what those homeopaths who wanted to cure Ebola had in mind.

Readers Can Access Part I and Part III Here.

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