Times Face-off: Is Boosting Alternative Medicine Risky In The Covid Pandemic? | India News
Giving unproven remedies to vulnerable people in a pandemic violates ethics
By Lancelot Pinto
The scientific method is agnostic to the belief system or school of thought being tested. In clinical medicine, scientific practice evolves from a biological plausibility or series of observations that then leads to small clinical trials, promising results that spur larger trials, which then prove or disprove a hypothesis. Most of the drugs for Covid-19 have gone through these routes.
An example of biological plausibility is the question “is it plausible that a drug developed to combat one virus works in another?” This led to the testing of drugs such as Lopinavir-Ritonavir (used for HIV) and Remdesivir (originally developed to treat hepatitis C).
A similar question: “Will a drug that acts on the virus in high doses work in humans in a laboratory?” Ivermectin being tested as a potential cure. The observation that people with autoimmune diseases who are being treated with hydroxychloroquine might have a lower incidence of Covid-19 led to testing the drug as a potential cure. Despite being such biologically plausible or promising, none of these drugs have been shown to work for Covid-19.
Why then should we applaud a medical system that has had so many failures in giving us a drug for Covid-19? Because at the core of the scientific method of medicine are ethical principles firmly rooted in the first principle of ‘primum non nocere’. The “null hypothesis” that is the starting point for each drug trial is that the treatment is no better than placebo. The burden of proof is on the treatment to demonstrate its value “beyond reasonable doubt” (reflected in the principle of statistical and clinical significance).
The phases of a drug trial are also designed to ensure maximum safety, before the drug reaches large numbers of people and can potentially cause irreparable harm. People who participate in these trials also do so with voluntary consent and without incentives, thus avoiding experimentation and exploitation.
The above principles should apply to any form of medicine and, when rigorously applied, could possibly lead to the discovery of new remedies that have traditionally been used in a non-standardized way. Unfortunately, most traditional medicines do not go through the same level of scrutiny. This is risky.
It is assumed that something that is “traditional” or “natural” cannot hurt. There are several examples to the contrary. St. John’s wort (Hypericum perforatum) is a flowering plant that was used by herbalists for a thousand years for a variety of ailments. We now know that this can cause life-threatening reactions and interactions with multiple drugs. Herbalists used foxglove, a group of plants, until it was discovered that the difference between a useful dose and a lethal one was not much.
Inhalation of steam, previously thought to be safe, is now being questioned as a contributor to the mucormycosis pandemic, as the high temperature could burn out the natural defense mechanisms that the nostrils have against the fungus. As a pulmonologist, I have treated patients where inhaling ghee / oil has led to lipoid pneumonia.
When traditional medicines are prescribed as effective (without undergoing methodologically rigorous testing) during a pandemic, several ethical principles could be violated. The novelty of the disease, coupled with widespread fear and paranoia, which is now reinforced not only by the news, but also by personal experiences of loss and witnessed tragedies, make people extremely vulnerable.
Vulnerable people have a compromised capacity to consent, especially in a field like medicine, where knowledge asymmetry is marked. If these people are offered remedies that have not been rigorously tested, they are actually being experimented on without their consent.
The argument that an individual has free will does not really apply in such a scenario, since in today’s “do whatever it takes” environment, individuals cannot be expected to make rational judgments. That is why it is extremely important that regulators step in and avoid promoting unproven solutions.
Is it risky to promote or promote traditional medicine in a pandemic? As risky as it is to push unproven conventional drugs out of the scope of a clinical trial. More than criticizing any system of medicine, it is necessary to audit the rigor with which the efficacy of a treatment has been demonstrated beyond any doubt, the transparency with which the possible adverse effects of the treatment have been reported, the conflicts of interest that they may have said report and the peer review that the report has undergone.
I end with a quote from Carl Sagan: “Extraordinary claims require extraordinary proof.” A pandemic and the need for an early cure should not lower the bar for the safety and efficacy of any system of medicine.
– The author is a Consultant Respirologist, PD Hinduja National Hospital and Medical Research Center, Mumbai
Clinical practice is proof that Ayurveda helps manage Covid, so let’s break the silos
By Darshan Shankar
Can traditional medicine systems like Ayurveda help in the Covid pandemic? There is increasing evidence that they do.
The prestigious medical journal (J-AIM) administered by the Center of Excellence for Integrative Health, Pune University, has compiled peer-reviewed case studies from different states on the Ayurvedic management of Covid, indicating that doctors effectively manage respiratory symptoms, fever, fatigue, metabolic disorders and low saturation with classic and safe formulations . The scale of the interventions is small due to policy limitations and because the case studies form the base of the pyramid of evidence.
At first, I would like to state categorically that in my opinion it is wrong for traditional doctors to state that Ayurvedic pharmacopoeia has antivirals for the treatment of Covid. So how does Ayurveda help without antimicrobials? To understand this phenomenon, it is necessary to break the myth that antivirals are the only means to control the symptoms of Covid.
It may be helpful to take a look at the ideas of transdisciplinary scientific collaboration between Ayurveda and biology. In 2005, a pioneering article published by Professor Bhushan Patwardhan (Professor of Health Sciences, University of Pune) demonstrated the correlation between Ayurveda phenotypes and genotypes (HLA gene polymorphism). This was a milestone in the history of biology, since Ayu-Genomics illustrated that the biological concepts of classification of human populations, derived from different cultural views of nature (panchmahabhutas and molecular biology) could converge to create new knowledge of contemporary relevance. . A 10-year research program on Ayurveda-Biology, endorsed by the Indian National Academy of Sciences and led by the distinguished cardiac surgeon Prof MS Valiathan followed Patwardhan’s work, with strategic results published in renowned journals related to metabolism, the immunity and regenerative biology.
Moving from examples of the scientific potential of Ayurveda to the basic reality of clinical practice, it is evident that Ayurveda and other traditional systems clinically manage dozens of health conditions, along with an understanding of their ‘systemic’ etiologies, which correspond in biomedicine to ‘infectious’. diseases such as diarrhea, herpes zoster, urinary tract infections, gangrenous wounds, viral fever and mycosis, without the use of conventional antimicrobials.
While it is justified to treat Covid-19 and other infections with appropriate antimicrobials in biomedicine, it is irrational to insist that they must be managed similarly by another system of medicine, which has a different way of understanding biological change. I can be forgiven for resorting to a musical analogy; consider how absurd it would be for a dominant community of musicians to insist that only jazz, symphonies, or sonatas can be music.
Ayurveda has a ‘systemic’ biological theory (dosha vichar) to diagnose and treat complex physiological imbalances. It has an incredibly large arsenal of 400,000 herbal and herbal-mineral formulations documented in the GOI-CSIR database called Traditional Knowledge Digital Library (TKDL).
Policymakers must realize that the testing of any knowledge is not based on any single method or concept, however profound, but rather by assessing whether competing theories and practice can be applied consistently to transform and solve real life problems. To reject and ignore a solution because its mode of action logic is different from a particular dominant knowledge framework is pure prejudice and ignorance of plurality and its implications.
Furthermore, while evidence from high-quality outcome data is indeed a credible way to establish effectiveness, it should be noted that absence of data does not equate to lack of evidence. The data is directly a function of public investment in clinical research, and the truth is that such investment in AYUSH has been pathetically low. The recent Clinical Case Repository Portal designed by the Ministry of AYUSH is the first step in this direction.
Requiring clinical trial data as the sole prerequisite for establishing credibility, without a substantial investment in data generation, is like asking great chefs from non-competitive ethnic communities to produce a Michelin award to certify their competence, when this It is evident from the fact that millions consume ethnic delicacies with relish.
Ayurveda is the living cultural heritage of India. Doctors are only its carriers. The entire “public interest” scientific community must assume ownership and responsibility for its revalidation. The analysis of data from the last 10 years on real life clinical practice, from the clinical records of at least one hundred good Ayurvedic hospitals and thousands of clinics should be the first “joint” venture in health sciences.
We need to break down the silos in medical streams. More immediately, it is necessary to bury narrow interests and, in the public interest, to recalibrate the national Covid management policy to adopt integrative health care protocols. This is especially important for post-Covid syndrome where antivirals may be irrelevant.
– The writer is Vice Chancellor of the University of Transdisciplinary Health Sciences and Technology, Bengaluru