India needs evidence-based, ethics-driven medicine

General Studies Paper 2

Context

• The recent push to integrate ‘AYUSH’ medicinal systems into mainstream health care to achieve universal health coverage and ‘decolonise medicine’ is a pluralistic approach that would require every participating system to meet basic safety and efficacy standards.

Efficacy and safety of homoeopathy

• Evidence on homoeopathy’s efficacy is weak.
• The first carefully conducted and well-reported double-blind randomised controlled trial (RCT), the Nuremberg Salt Test (1835), noted that “the symptoms or changes which the homeopaths claimed to observe as an effect of their medicines were the fruit of imagination, self-deception and preconceived opinion — if not fraud.”
• Multiple systematic reviews and meta-analyses have found that, across ailments, population groups (adults versus children), study types (placebo-controlled versus other trial types), and treatment regimes (individualised versus non-individualised), homoeopathic treatments lack clinically significant effects.
• Recently, researchers demonstrated that more than half of the 193 homoeopathic trials in the last two decades were not registered.
• Unregistered trials showed some evidence of efficacy but registered trials did not. There was reporting bias and other problematic practices, throwing the validity and reliability of evidence thus generated into doubt.
• Further, the World Health Organization (WHO) has warned against homoeopathic treatments for HIV, tuberculosis, and malaria, as well as flu and diarrhoea in infants, saying it has “no place” in their treatment.
• Evidence is accumulating that homoeopathy does not work for cancers and may not help to reduce the adverse effects of cancer treatments, contrary to lay belief.
• Instead, treatments have been linked to both non-fatal and fatal adverse events as well as their aggravation.
• Seeking homoeopathic care also delays the application of evidence-based clinical care. In several cases, it has caused injuries and sometimes death.

On standards

• Homoeopathy’s supporters argue that the standards commonly used in evidence-based medicine are not suitable for judging the “holistic effects” of homoeopathy. This claim can be debunked.
• First, the standards are not conveniently chosen by practitioners of allopathic medicine for themselves.
• Second, Homoeopathy advocates have failed to invent valid alternative evidence synthesis frameworks suited for testing its efficacy and safety, which are also acceptable to the critics.
• Third, the claim about homoeopathy being holistic is typically paired with evidence-based medicine being “reductionist”.
• Fourth, evidence-based medicine does not and should not stop at establishing empirical evidence. The quest is also to discover and explain the mechanisms underlying the evidence. In the last century, there has been no concrete evidence for proposed mechanisms of action for homoeopathy.
• No mechanistic ( molecular, physiological, biochemical, or otherwise) evidence to explain how concepts such as “like cures like”, “extreme dilution”, and “dematerialised spiritual force” result in better health.
• In the same period, several allopathic/modern medicine practices have updated themselves based on growing scientific evidence.

The right approach

• Adopting a pluralistic approach in medicine can decolonise medicine. In India, homoeopathy is at odds with this.
• Homoeopathy was introduced in 1839 in India by Austrian physician J.M. Honigberger.
• Of course, not all colonial-era practices need to be surrendered. Those with health and developmental benefits such as evidence-based elements of allopathic medicine and gender role and caste reforms should be retained.

Conclusion

• The argument to reject homoeopathy is not just based on its coloniality, but chiefly on the lack of evidence for efficacy, some evidence for lack of safety, no substantive progress on mechanisms of action in the last century, and homoeopathic practitioners’ escapist arguments. India’s path to universal health care must be grounded in evidence-based and ethics-driven medicine.