We need evidence based traditional medicine

General Studies Paper 2

Context:

• The case filed by a manufacturer of indigenous drugs against a medical practitioner on the grounds that his social media thread affected their business has become a cause celebrè in medical circles.

Modern medicine

• It is a fact that irrespective of the advances of modern medicine, several systems which lay claim to healing, and which all fall under the broad category of alternative medicine, exist. Certain systems such as Ayurveda, Unani, and Siddha have their own pharmacopeia in India.
• Modern medicine really became science based only from the late 19th century when advances in technology made not only the study of the functioning of the human body in health and disease more accurate, but also led to safe anaesthesia and surgery.
• Later, this process led to marvels such as dialysis for kidney failure and the heartlung machine which made surgery on the heart a daily affair. The development of scientific thought in the 20th century, including the Popperian idea of falsifiability, led to advances in evaluating medical therapies.
• Subjected to the methods of modern science, which are continually being refined, many therapies were found to be ineffective and abandoned. This is the strength of the modern method, the recognition that science continually advances and self corrects.
• The Nobel Winning antimalarial artemisinin was synthesised thanks to investigators who were open minded enough to take cues from a 1,600 yearold text of Traditional Chinese Medicine.

The case of Ayurveda

• The physiological basis of Ayurveda is not sound, but that does not ipso facto mean that its therapies are not sound either. Like many traditional medical systems everywhere, Ayurveda was constrained in its understanding of how the human body works by the lack of available technology.
• A reason based world view is what differentiates Ayurveda epistemologically from the erstwhile faith based forms of the Atharva Veda. Proponents of Ayurveda who claim that everything was already known to the ancient people do it a great disservice and stultify its growth and development.
• One of the greatest triumphs of modern epistemology is its ability to synthesise ideas from across the world to build a coherent system of how the world functions. This is an ongoing process, subject to corrections and improvements as thought and technology improve, building on past knowledge.
• In modern drug development, the commonly used method is to isolate the active principle. Thus, most modern medicines are single ingredient and only a few are combinations. Also, the exact amount of the active principle is carefully calculated.
• Ayurvedic medicines are commonly combinations, and it is uncertain how these combinations interact with each other. It would increase the acceptability of Ayurvedic medicines in the scientific community if they were evaluated by the methods of modern science in a way that does not compromise with the wholeness of Ayurvedic formulations.

Way forward:

• New investigational methods and trial designs which can evaluate Ayurvedic therapies without undermining the classical bases of administering them must be worked out. The Ministry of AYUSH must facilitate this.
• The purpose of government policy is to make life better for the people. The health of the people should not be hostage to false ideas of nationalism. The aim should be to carry out an evidence based appraisal of all traditional medical systems, retain and develop what is useful, and integrate them into one cogent system of medicine available to all.

Conclusion:

• A few individuals do a disservice to the cause of evidence based medicine by denouncing traditional medical systems wholesale. Science requires open mindedness disciplined by scepticism. Denouncing traditional systems in toto would result is a hasty dismissal of valuable medical experience that has undergone repeated, albeit informal, verifications at the hands of generations of practitioners