The State of Ayurveda: Examining the Evidence
Charaka Samhita, the ancient textbook of Ayurveda (third or second centuries BCE), doesn’t mince words when it comes to the subject of quacks. Charaka, the legendary healer from India’s antiquity and the editor of the Samhita (compendium) that bears his name, calls them “imposters who wear the garb of physicians… [who] walk the earth like messengers of death.” These fake doctors are “unlearned in scriptures, experience and knowledge of curative operations…. but like to boast of their skills before the uneducated…” Wise patients, Charaka advises, “should always avoid those foolish men with a show of learning … they are like snakes subsisting on air.”
These words, written more than two thousand years ago, bring to mind those who like to play doctor on Indian TV these days. The most famous of all, Swami Ramdev, doles out medical advice to millions of Indians who tune into his TV show, attend his yoga camps and buy his Ayurvedic drugs. He offers “complete cure,” “in weeks, if not in days,” of “diseases from A to Z,” from “common cold to cancers,” including cholera, diabetes, glaucoma, heart disease, kidney disease, leprosy, liver disease….so on and so forth. There is practically nothing that his method of Divya Yoga, alone, or in combination with his Ayurvedic formulations, does not promise to cure. And all his “miraculous” cures are not merely “confirmed by science,” but are, indeed, “science in its purest form.” (All quotations are from the official website of Swami Ramdev.). The swami is not alone in making such fantastic claims. Yoga and Ayurveda are being mass-marketed to India’s growing middle classes as never before. Putting on a “show of learning” by “wearing the garb” of healers and scientists seems to improve the sales-pitch.
The recent exposé of false labeling of drugs and exploitation of workers at the Swami’s Haridwar-based pharmacy created a huge uproar, laying bare the limitations of all parties involved. But all the noise and sloganeering is drowning out the real questions that must be asked not just of Ramdev, but of all traditional or alternative medicines: How effective are these medicines in curing the diseases they claim to cure? Can their medical claims pass the muster of rigorously conducted clinical tests? Even if the label on the bottle scrupulously identified each and every ingredient, the question still remains if the drugs are effective and safe, when measured by the standards that apply to conventional, “allopathic” medicines.
THE FACTS OF the controversy regarding Swami Ramdev are well-known. In April 2005, Swami Ramdev’s Divya Yoga Mandir Trust fired 115 workers who had been protesting against poor wages and deplorable working conditions. These workers complained of having to collect and manually grind human skulls and bones, otter (udbialo) testicles and antelope horns – work that Brahmins amongst them found polluting. Acting on these complaints, Brinda Karat, Communist Party leader, Member of Parliament and feminist, sent samples of two formulations meant to treat epilepsy and sexual weakness to relevant government authorities for testing. In January 2006 the results came out positive: the samples were found to contain human and animal DNA. The Swami’s “herbal medicines” had been delivering something not very herbal to countless consumers, many of whom happen to be fastidious vegetarians.
What happened after that was a spectacle to behold. Incredibly, the same Swadeshi-Hindutva-vegetarian gang that attacked McDonald’s eateries in Mumbai upon discovering a small amount of beef flavoring in their fries sold in the USA (but not in India), saw no problem with ingesting drugs containing roasted and powdered human skulls. Equally incredibly, Karat, the Communists, and other left groups – lifelong critics of neo-liberal globalization and multinational companies – were accused by Ramdev and his allies as puppets of multinational pharmaceutical companies who, apparently, felt threatened by the growing popularity of yoga and Ayurveda. Rather than answer questions about his own deceptive practices, Ramdev, with the help of his allies, succeeded in putting the Left on trial.
And when the subject is Ayurveda and yoga, can Hindu nationalists be far behind? Predictably, many members of the Hindutva parivar rose to defend the Swami as a symbol of Hinduism and the Indian nation. They equated Karat’s criticism of Divya Yoga Pharmacy’s dubious labeling practices with criticism of the ancient and glorious Hindu civilization itself. Uma Bharati’s jab that “Communists have attacked Ramdev because they have always been against the nation,” was typical of the Hindutva camp. Karat and her allies were left to defend their Swadeshi credentials by professing high regard for yoga, Ayurveda and traditional knowledge in general. The debate got framed entirely in terms of defense of the nation and its traditions, with no room for raising any questions about the objectivity of the medical claims that were being made on behalf of the traditional healing practices.
In the middle of it all, the regulatory agencies of the government of India were found sleeping at the wheel. Despite endless repetitions of pious intentions for “ensuring affordable AYUSH drugs that are safe and efficacious,” and providing “scientific validation” of traditional medicines, the government does not have much to show for itself. Today in India, anyone can walk up to his or her neighborhood drug-store, or even the grocer, and buy Ayurvedic medicines containing any of the 25 ingredients (including red oxides of lead and mercury, arsenic, copper sulfate, snake poison and cannabis) which are supposed to be “taken under medical supervision.” The new safety measures and the so-called “golden triangle” research initiatives the government has announced in recent years are driven largely by export markets, and ignore the issues of safety, effectiveness and good manufacturing practices at home.
IN THE END, the great Ramdev-Karat controversy turned out to be a storm in a teacup. Swami Ramdev is well within the Ayurvedic tradition in using ingredients derived from humans and other animals.
The Ayurvedic tradition considers all substances, whether they come from animals, vegetables, or the earth (i.e. minerals) as medicines, provided they are applied in a proper way and for specific purposes. The ancient doctors recommend the use of the following as ingredients in medical concoctions: bile, fat, marrow, blood, flesh, excreta, urine, skin, semen, bones, tendons, horns, nails, hoofs, hair, bristles and pigments obtained from a variety of animals, depending upon the ailment. This follows as a logical consequence of the Ayurvedic philosophy that like-nourishes-the-like: flesh is nourished by flesh, blood by blood, fat by fat, bones by cartilage, marrow by marrow, semen by semen, fetus by eggs…and so on. Various classics of Ayurveda recommend a variety of medical treatments which make liberal use of animal products, including cow urine cooked in ghee for treatment of epilepsy, skull bones mixed with cow’s urine as a cure for ulcers, and beef, to quote Charaka Samhita, for “rhinitis, irregular fever, dry cough, fatigue, heightened digestion, and wasting of muscles.” Contemporary ayurvedic medicines routinely –and legally – use 75 ingredients derived from animals, in addition to 2,500 ingredients of plant origin, and 150 ingredients derived from processed and/or unprocessed minerals (including heavy metals like mercury, lead and arsenic, well-known for their toxicity).
So it turned out that on the issue of non-vegetarian ingredients, Ramdev was on the right side of the tradition after all.
At the end of the entire Ramdev-Karat ruckus, the Swami could be faulted only for not labeling his products properly. But here the Drug and Cosmetics Act (DCA) of 1940 that regulates traditional medicine sends contradictory signals. On the one hand, it exempts Ayurvedic, Siddha and Unani medicines from listing all the ingredients as long as they include a reference to the recipe used in any of the 56 DCA-approved ancient texts on its label. On the other hand, the government has recently started demanding full disclosure of all ingredients. This confusion over labeling is not a trivial matter, for consumers have a right to know what goes into the drugs they depend upon to take care of their ailments. Karat and the workers of Divya Yoga Trust have brought an important issue to light.
BUT PROPER LABELING should be the beginning, not the end, of a serious investigation of the medical claims that are routinely made for Ayurvedic remedies and yogic asanas.
Let us imagine that by some miracle, each and every one of the 400,000 licensed Ayurvedic doctors in India begins to abide by the new law requiring full disclosure and good manufacturing practices. Let us stipulate that all the loopholes have been closed and that all Ayurvedic preparations, meant for export or for sale at home, come with detailed information of traditional and botanical names of all the herbs, the names and amounts of all animal and mineral ingredients, the traditional recipes according to which they are made, the batch number, the date of expiry, the risks and contra-indications. Let us also imagine that every Ayurvedic drug manufacturer faithfully follows every minute detail of the traditional formulae approved by the Drugs and Cosmetics Act. (This is not to deny that there are some enlightened Ayurvedic institutions in the country that are already providing all the information and following good manufacturing practices. But old and highly respected institutions like Arya Vaidya Sala of Kottakkal, Kerala, are exceptions that prove the rule.)
The unanswered question is this: Is full disclosure enough? It is of course necessary, but is it sufficient? Unless the ingredients and methods followed by traditional Ayurvedic books themselves have been subjected to rigorous clinical and laboratory tests, mere disclosure and good manufacturing practices can not ensure that the drugs are effective and safe. Without an objective understanding of the fundamentals of Ayurveda, and without rigorous clinical tests of the ancient Ayurvedic formulations, we may end up faithfully replicating many of their limitations and dangers, as well as many of their possible benefits.
The simple truth is that there is a lack of good quality research on the fundamental bases of Ayurveda. Even staunch supporters of traditional medicine like M.S. Valiathan admit that “clinical studies that would satisfy the liberal criteria of WHO have been alarmingly few from India, in spite of patients crowding in Ayurvedic hospitals.” (India generally follows WHO standards which do not demand stringent clinical tests for those traditional medical systems which have long historical traditions behind them.) The general consensus of international experts, to quote from the National Center for Complementary and Alternative Medicine (NCCAM) in the USA, is that “most clinical trials of Ayurvedic approaches have been small, had problems with research designs, lacked appropriate control groups, or had other issues that affected how meaningful the results were.” Indeed, the poor quality of research is part of the reason why Ayurveda was not included in recent reviews of traditional medicine either in the more technical New England Journal of Medicine, or in the popular Time magazine.
It is true that the attraction of cornering a bigger share of the huge (and growing) global market in herbal medicines is eroding the long-standing resistance to applying modern standards of clinical research to traditional medicine. There is much talk about developing “evidence-based” support for the claims of traditional medicine among flagship Ayurvedic companies including Dabur, Zandu, Himalaya and others. Indeed, even Swami Ramdev glibly invokes “double-blind studies” as evidence for the scientific nature of the Divya brand of ayurvedic drugs he sells. Inspired by the CSIR chief Dr. R.A. Mashelkar’s recent call for “building a golden triangle between traditional Indian medicine, modern medicine and modern science,” the Indian government has started funding collaborative research between scientists, modern medical doctors and Ayurvedic practitioners.
This new willingness to seek scientific evidence can be a very good thing if, and only if, it is done in a genuine spirit of skepticism which can overcome the deep-seated – and often nationalistic – tendency of Indian researchers to look only for evidence that confirms the truth of our ancient knowledge. A brief look at the problem of confirmation bias in Ayurvedic research can give an idea of the problems that need to be overcome for the new and expensive “golden triangle” research initiatives to succeed.
THERE SEEMS TO be a curious split running through the development of Ayurveda in the modern era. On the one hand, we hear repeated promises from Indian policy-makers and AYUSH bureaucrats for “massive research and development” for the purpose of finding scientific evidence for how and why Ayurvedic drugs work. On the other hand, we hear repeated claims from traditional healers and modern gurus alike that no amount of research can alter or refute the “Eternal and Absolute Truths” of Ayurveda which were supposedly revealed to the Vedic seers at the very “beginning of time.” Even AYUSH, the government agency responsible for scientific research, describes Ayurveda as having “originated with the origin of the universe itself.” (What could this possibly mean?)
The desire to appear scientific while desperately seeking to affirm pre-scientific traditions has led to a deep and wide-spread confirmation bias in research on traditional medicine and other traditional sciences. That is to say that those studying ayurvedic remedies tend to look for and notice only what confirms their existing beliefs, while they either do not look for, or ignore and explain away the evidence that contradicts their beliefs. While this kind of advocacy “research” is good for stoking Indians’ national pride, it has prevented an honest sifting of the grains of truth from the obsolete and false ideas that exists in India’s traditional sciences. All sciences, including modern science and modern medicine, tend to accumulate fallacies and dogmas with time. All scientific knowledge – whether it is comes out of the Holy Vedas, the Holy Koran or the Holy Bible, or whether it comes out of the world’s most advanced laboratories – requires constant testing and self-correction.
Indian scientists have tended to use the supposedly “holistic” nature of traditional Vedic sciences to reject the central pillar of modern medicine, namely, double-blind clinical studies. Double-blind studies are designed to ensure that the reported benefits of a medicine are actually coming from the active ingredients of the medicine itself, and not from the biases of the patients and doctors. These studies require drugs and medical procedures to be tested in randomly selected test and control groups, in which neither the subjects nor the researchers know who is getting the drug and who is getting a placebo (i.e., a treatment that looks and feels like the drug being tested, but lacks the active ingredient.) It is true that it is harder to find placebos for some Ayurvedic practices (enemas, for example). In such situations, single-blind studies, in which only the researchers do not know who is receiving the treatment and who is not, are acceptable.
But the problem of finding acceptable placebos is not insurmountable. Indeed, Chinese medicine, no less holistic than traditional Indian medicine, has been able to open up to stringent, FDA standards of double-blind tests for many of its traditional remedies. Even acupuncture which – like Ayurvedic massage and yoga – was long considered to be beyond the scope of placebo-controlled double-blind studies, has now been subjected to rigorous scientific tests, using control groups who get fake acupuncture from needles which feel like real acupuncture needles, but do not actually penetrate the skin. The result: real acupuncture was found to be no better in its ability to reduce pain than fake acupuncture from fake needles. If Chinese medicine can overcome its confirmation bias and open its holistic traditions to rigorous test, there is no reason why India should not, or can not. If acupuncture, the most revered component of traditional Chinese medicine can be put to rigorous testing – and found to be no better than a dummy treatment – there is no reason why controlled trials for yoga and parnayam cannot be designed.
Having avoided double-blind tests for so long, traditional Indian medicine has a big problem at hand. The problem is that traditional medical formulae and recipes, many of them thousands of years old, have never been put to a systematic test for safety and efficacy using the best available scientific knowledge, methodology and instrumentation. Their claims for curing diseases are entirely based upon traditional lore, anecdotal evidence and the authority of gurus and other “holy” men and women. Intellectuals and scientists in India have been too ready to simply find analogies and fanciful equations between advances in modern biology with the traditional concepts of body and disease. As a result, many obsolete and even harmful chemicals, methods of diagnosis and procedures still continue to be prescribed. What is worse, many of them are presented to the public as if they have been validated by advances in modern science and medicine. As Dr. Mashelkar recommended in his famous “Golden Triangle” speech cited before, there is a need to “trim” Ayurvedic products so that we can rationally understand what works and what does not, what is healthful and what is harmful, what is living and what is dead in traditional Indian medicine.
This issue of scientific evaluation of the medical claims of Ayurveda is extremely important. Unlike in the West where traditional Indian and Chinese medicines are used by a small minority of relatively wealthy yuppies, ex-hippies and New Agers who have access to conventional doctors and hospitals, it is mostly millions of poor, especially in rural areas, who depend upon traditional medicine as their primary, and often the only, source of health care. According to the official AYUSH data, close to 80 percent of India’s people use Ayurveda through 361, 881 registered ayurvedic medical practitioners, in 14,252 dispensaries and 2,189 hospitals in the country. The West can afford to indulge in “alternative medicine” sold as dietary supplements which need not meet the tough standards of clinical tests for conventional drugs. (This unregulated market is not without serious problems in the West either: there have been fatalities among those using herbal weight-loss products and drug reactions with scientific medicines are becoming routine.) But the already under-served and poor consumers of traditional medicines cannot afford to take chances. Efficacy and safety of these traditional medicines is literally a matter of life and death.
UNFORTUNATELY, RATIONAL, EVIDENCE-BASED evaluation is nowhere in sight in the kind of popular mass-marketing of Ayurveda practiced by Swami Ramdev and other peddlers of traditional medicine and yoga in India and in the West. Indeed the many miraculous cures that Swami Ramdev promises, and the “scientific evidence” he cites for them, offer a window into the dismal state of scientific understanding of Ayurveda. Let us look at some cases including, but not limited to, Swami Ramdev.
The first example comes from Swami Ramdev himself. According to the media reports, the famous udbilao (otter) testicles that the workers at Divya Yoga Pharmacy were made to collect and crush were meant for a poly-“herbal”-mineral formula sold under the name “Divya YauvanamrataVati.” Ramdev’s pharmacy advertises it as a tonic for enhancing men’s “staying power” and for “increasing sperm” – a cure for what is politely described in India as “sexual weakness.
The otters’ humble contribution to men’s sexual prowess is, of course, not included in the ten ingredients listed for Yauvanamrata Vati. This omission was the source of the Ramdev-Karat controversy. But one of the ingredients that is disclosed is “swarna bhasam,” or a herbal ash made out of gold. This swarna bhasam is not without its own set of problems and needs a closer look.
On closer inspection, Swami Ramdev’s YauvanamrataVati looks like a form of “Ayurvedic Viagra.” There is a booming global market, mostly on the internet, for herbal substitutes for Viagra, all promising to enhance men’s sexual experience. These products have two things in common: they all contain gold bhasams and, as a result, they are all quite expensive. Swami Ramdev’s trademarked Divya Yuavanamrata sells for Rs 210 (about 5 US dollars) for just 5 grams, about the size of a tablet of aspirin. Divya Yoga pharmacy also sells gold bhasam separately, as Divya Swarna Bhasam for 1,600 rupees (about 40 US dollars) for a gram. (His pharmacy sells an even more expensive bhasam, this one made out of diamonds and selling for 2,000 rupees, about 50 US dollars, for a gram. This “Heerak bhasam” is supposed to cure cancers.)
Swami Ramdev makes grand claims for his gold bhasam. When taken as a part of Yauvanamrata Vati, it is supposed to cure sexual weakness, but when taken alone, it is supposed to “work as a miracle in TB, chronic fever and nervous debility,” and it is supposed to be useful in cases of “poisoning, … gout, kalagar (sic) fever (probably kala-azar) fever and mdaria fever (sic)” and it is supposed to purify blood and remove toxins.
The problem is not one of these claims is substantiated by properly gathered and tested scientific evidence. It is true that Charaka Samhita recommends the use of gold, along with five other metals (silver, copper, lead, tin and iron) and minerals like arsenic, antimony, sand, lime and red chalk as having medicinal value. It is also true that tantric alchemy, which equates gold with immortality, has left its influence on Ayurveda. And it is fair to surmise that these complex herbal-mineral bhasams must have shown some medicinal value over the centuries, for if they brought no relief at all, it is hard to explain how they could have survived the test of time.
But this traditional lore is all we have. There is no clinical evidence backing any one of the claims, nor is there any causal explanation of how and why gold in this particular bhasam form has all these curative properties. The only well established use of gold in modern medicine, as far as clinical studies have been able to establish, is for treatment of rheumatoid arthritis. According to Dr. P. Viswanathan, an Ayurvedic physician at Kottakkal Arya Vaidya Sala Agency in Hyderabad, who was consulted for this essay, “ Gold bhasams are useful in auto-immune diseases. Gold is also used in modern medicine for arthritis. I think there is no substance in the various claims being made for gold bhasams. I think gold bhasams being used for sexual power is just a marketing strategy.” Selling expensive, gold-laced drugs, with promises of “miracle cures” for “tuberculosis, chronic fever, nervous debility,” without adequate evidence, is unethical, to say the least.
While gold bhasam, alone and/or in brand-name drug formulations, is being sold at exorbitant prices and extraordinary claims about its curative powers are routinely made, no one seems to know if it is gold or the herbs, or the undisclosed otter testicles, or something else entirely that is doing the healing (if there is any). Perhaps the Yuyanamrata vati that Swami Ramdev sells would be as effective (or ineffective) in curing impotence with gold as without it? Perhaps it is the otter testicles men should be consuming, instead of the gold and/or the herbs? We simply do not know. Such studies have not been done. After years of promising “scientific validation” we are no closer to knowing to what extent these medicines actually work, what their active ingredients are, and what side-effects do they have.
If these cures are real, it is high time to demonstrate their effectiveness and study their side-effects. If we are able to demonstrate any effectiveness, then it is high time to demonstrate what the active ingredient(s) is/are and how it/they work. (Isolating the active ingredient is not a sign of “Western reductionist science.” It is useful in eliminating ingredients that may be harmful, expensive or simply useless.) And if we fail to demonstrate the effectiveness and safety of the drugs, then it is high time to stop prescribing them to people who are ill and suffering. Government oversight has to extend to the scientific validity of the claims being made for Ayurvedic medicines, and not just to proper labeling and good manufacturing practices.
THE SUBJECT OF gold bhasams brings us to the next issue of concern, namely, heavy metals. The 2004 study published in the Journal of American Medical Association found significant levels of toxic heavy metals such as mercury, lead, and arsenic in 20 percent of Ayurvedic preparations that were made in India for sale in America (see figure 1). The situation is far worse in India where 64 percent of sample collected were found to contain significant amounts of mercury, arsenic and cadmium. (See table).
In the wake of the bad publicity created by the JAMA report, the Indian government has started requiring all export quality drugs to certify that their heavy metal content is within the acceptable limits. Ironically, drugs intended for domestic consumption are to remain free from such requirements, at least until the time that more testing labs are established.
It is in the attempt to explain and control the toxic levels of heavy metals that the lack of rigorous science shows up. Some of the contamination could no doubt be due to environmental pollution and “unsatisfactory agricultural and cultivation practices,” as AYUSH has tried to explain. But at the same time, by agreeing to initiate chemical analysis and animal studies for toxicity of eight bhasams, AYUSH has tacitly admitted that the problem could be integral to these medicines themselves. (According to Dr. P. Viswanathan, an Ayurvedic doctor practicing in India who provided background information and expert opinion for this essay, all eight formulations contain heavy metals which are known for their toxicity. The formulations include: Kajjali, a powder of mercury and sulfur; Rasmanikya, a tri-sulfide of arsenic; Nag Bhasama, a bhasam of lead; Rasasindoor, a bhasam containing mercury and sulfur; Basantkusumkar Ras, Arogyavardhini Vati, Mahayograj Guggul and Mahalaxmi Vilas Ras, the last four containing mixtures of all common bhasams. The last four medicines are extensively used for diabetes, liver disease, arthritis and respiratory diseases.)
The presence of mercury, arsenic and lead in ayurvedic preparations is not surprising. There is a long tradition in Ayurveda, as well as in tantric and Siddha alchemy, for ingesting mercury and gold for medicinal purposes. Charaka and Susurta Samhitas permit the use of mercury, but for external use only. Vagbhatta (6th -7th century AD) recommends internal uses of mercury for therapeutic ends. Marco Polo in the late 13th century reportedly met “ciugi” (yogis or jogis) who apparently lived long and healthy lives because they consumed a drink made of mercury and sulfur. The French traveler Francois Bernier who visited India at the close of the 17th century has left behind a record of Hindu holy men who knew how to make gold and prepare mercury for health purposes. In this Siddha alchemical tradition that Marco Polo and Bernier observed, mercury and gold were considered elixirs of life which could confer immortality. The Ayurvedic tradition incorporated many of these alchemical ideas over time. Gradually complex processes of making bhasams evolved through which mercury, gold, arsenic, lead and precious stones were first purified by repeatedly heating and cooling them in herbal extracts (a process called sodhana) and then grinding them with herbs and heating them in closed earthen crucibles by burning cow dung cakes (a process called bhasmikaran).
There is thus a long and well-respected tradition of using heavy metals in Ayurveda. But, after so many years of promising us scientific account of Ayurveda, we know practically nothing about what happens to these metals when they are subjected to the traditional processes of sodhana and bhasmikaran. We constantly hear assurances from the proponents of Ayurveda that the process of turning heavy metals into bhasams detoxifies them and makes them harmless. The message is that if the manufacturers faithfully followed the instructions in the classic Ayurvedic texts, there would be no problem of toxicity.
But we are supposed to accept these assurances of faith alone, for they are not based upon any actual research. It is not clear if the process of making bhasams turns these heavy metals into oxides or some other kind of compound altogether. According to Dr. C. Viswanathan, an allopathic doctor at Government Medical College, Thrissur, Kerala, who was consulted for this essay, “oxide of mercury is certainly toxic and is a health problem…. I think it is just wishful thinking to suggest that any amount of baking with herbs is going to make mercury non poisonous.” The Dr. P. Viswanathan, the Ayurvedic expert consulted for this essay states that, “as far as I know, there has been no tests that proved that the mercury used in bhasams is safe for human consumption. The end products of mercury in bhasams have not been studied for their toxicity.”
Simply following age-old recipes is no guarantee of safety. The fundamental processes and the concepts on which these ancient processes are based must be exposed to serious experimental investigation.
AS THE THIRD and the final case, let us look at Swami Ramdev’s prescription of parnayam as a “miraculous” cure for “all diseases, from A to Z.” Ramdev lists some 260 conditions, including infectious diseases (cholera, leprosy, syphilis), hormonal disorders (diabetes, thyroid disorders), and complex, life-threatening, systemic diseases of heart, liver, kidneys, brain, reproductive system. Yoga and parnayam (deep breathing exercises) alone, he promises, can “completely” cure all of these ailments. He claims that patients show significant improvements in their blood-sugar level, blood pressure, cholesterol and triglyceride levels, lung functioning and obesity by only eight days of doing yoga and parnayam in the “yoga-science” camps he organized periodically through 2004-2005.
There are undeniable benefits of yoga. But curing diabetes? Curing infectious diseases? There is no credible evidence for any of these claims. In the refereed medical literature, yoga has only shown some benefit for reducing hypertension (that too, only in combination with aerobic exercises and extremely low-fat diets). There are also some reports that show marginal and short-lived improvement for asthma and carpal tunnel syndrome. Yoga is also shown to improve strength and flexibility, but not any more than other physical exercises, including walking.
Can Ramdev’s claims for “miraculous cures” be trusted? His “scientific evidence” simply does not meet even the most minimum standards of clinical trials. There were no controls, it is not clear if all the patients he followed for only eight days were on the same diets or not, or if they even had the same disease to begin with. How do we know that any other kind of physical exercise and/or relaxation therapy could not have brought about the “miracles” he claims?
But the poor quality of evidence seems to be almost beside the point in the debates about Ayurveda that take place in the public sphere in India. The majority of those who believe in Swami Ramdev’s cures, or in traditional remedies more generally, seem to be convinced by anecdotes and personal stories they hear from friends, relatives and those who testify on TV shows. One cannot, however, put too much confidence in anecdotal evidence and personal testimonies. As Dr. C. Viswanathan explains, going by testimonies alone, one will have to grant that all kinds of miracles work. After all, there are many people who testify to all kinds of cures by prayer alone. The problem with anecdotal evidence, according to Dr. C. Viswanathan is that many times the patients and the doctors are not familiar with the natural history of the disease, and they end up giving unwarranted credit to some treatment method for a ‘cure,’ which would have occurred naturally. Moreover, it is a well-recognized fact of medical science that even when a treatment does not work, it helps people to reinterpret their symptoms and experience them as less severe. (That is why clinical trials include controls who receive fake treatments or placebos.) Anecdotal evidence of people reporting that they are feeling better can not provide sufficient grounds for “scientific” validation of Ayurveda or any other kind of medicine.
WE HAVE HEARD many claims of Ayurveda and yoga being “complete” and “highest” sciences. It is time now to actually expose these ancient sciences to the test of medical and biological sciences, as we understand them today.
Toward that end, it will be useful to keep in mind the wise words of Marcia Angell and Jerome Kassirer from their famous 1998 editorial in the New England Journal of Medicine: “There cannot be two kinds of medicines – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculations and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.”
Charaka would have certainly agreed. After all, it was Charaka who advised his fellow healers to “always strive to acquire knowledge. There is no end of medical science. Hence, heedfully thou shouldst devote thyself to it… And even if possessed of sufficient knowledge, thou shouldst not boast of that knowledge.”
The author would like to thank Dr. C. Viswanathan, M.S. (Ortho), Senior Lecturer in Orthopedics, Government Medical College, Thrissur, Kerala and Dr. P. Viswanathan, M.D. (Ayurveda), Consultant Physician, Kottakkal Arya Vaidya Sala Agency, Hyderabad. They provided valuable medical opinion.
A longer version of this essay, complete with references, will appear in the Economic and Political Weekly (India).
1 AYUSH stands for Ayurveda, Yoga and Naturopathy, Yunani, Siddha and Homeopathic medicines. The Government of India funds research and education in all these traditional medical systems through its deparment of AYUSH which is a part of the Ministry of Health and Family Welfare. The details of the kind of projects AYUSH funds can be found at its official website.
2 CSIR stands for the Council of Scientific and Industrial Research. The agency funds basic and applied research in all scientific disciplines.
3 Bhasam is the Hindi/Sanskrit word for ashes. Ayurvedic bhasams are made by an elaborate process requiring slow heating of metals with herbs. The heated mixture is ground into a fine powder.