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In his 2006 book, In Spite of The Gods, Edward Luce recounted his visit to the Vishwa Hindu Parishad’s Cow Product Research Centre outside Nagpur. The centre’s essential faith in the protean curative properties of cow products – milk, cow urine, dung – seemed to Luce, India correspondent for the Financial Times at the time, to be “utterly sincere” and “an example of textbook fundamentalism”. “You take the beliefs that people in the (long distant) past accepted as symbolic and hold them to be literally true and even scientifically demonstrable,” he wrote. Indeed, his host at the centre told the journalist that there was no medicine outside of the Vedas that was worth using.

There is, however, no prospect yet of a cow product-based cure for any specific disease, despite years of research and backing from the Indian government. And mainstream scientists have thankfully spoken out against the craziness of the unshakably persistent belief in “cowpathy”. All this hasn’t prevented the Hindu fundamentalist government from using the coronavirus pandemic – which has killed over 1,26,000 people in the country so far – as yet another opportunity for promoting the pseudoscience of AYUSH.

AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. Started in 2014, the ministry of AYUSH has set up research councils, issued guidelines on Covid management, put out messages purporting to promote health on social media, and entered into international agreements for collaboration in traditional medicine systems of foreign countries .

I devoted a previous column to discussing the false and unfounded claims of Ayurveda having a scientific basis grounded in rigorous research. As of now, it simply doesn’t have the evidence to make such claims. Yes it is ancient, it is in the Vedas, and it is uniquely Indian. But none of that makes it remotely scientific, not in the sense in which we understand the modern scientific enterprise.

Science is a set of ideas, hypotheses and results that are testable and tested, and either accepted or discarded depending on the objective evidence gathered in research studies that meet certain standards of reproducibility and repeatability.

This may potentially change now that the AYUSH ministry has entered into an agreement with the United States to collaborate in research to establish a role for Ayurveda and other ancient forms of medicine in the modern world. One of the lesser-known agreements signed during the recent visit to India of the US secretaries of state and defence was a Letter of Intent between the AYUSH ministry and America's Office of Cancer Complementary and Alternative Medicine, or OCCAM.

This is not the first time India and the US have signed an agreement to work together on what the Americans refer to as “traditional medicine systems”. In January 2015, when President Barack Obama visited India, the joint statement referred to “capacity building in...complementary and traditional medicine”, and to the desire to “encourage dialogue” between the health departments of the two countries “on traditional medicine”.

From the Indian side, the 2020 agreement will be led by the Central Council for Research in Ayurvedic Sciences, or CCRAS, which aims to develop by 2030 a solid research-driven evidence base for Ayurveda. The implied need to develop evidence did not prevent the CCRAS from publishing a 100-page report in 2014 entitled, “Evidence Based Ayurvedic Practice”, which suggested treatments for a range of conditions – anemia, asthma, piles, heart disease, epilepsy, lipid disorders, rheumatoid disease, sciatica, renal stones, and even paraplegia. The report cites mainly old publications and there’s not a single mention of a randomised controlled trial.

Still, the 2020 agreement should be welcomed. It could at best serve as the means for Ayurveda to get international research attention. Much will depend on how well such efforts are resourced and the openness with which both sides approach the collaboration.

Resources and scientific approach

The AYUSH ministry has a budget of Rs 2,122 crore ($284 million) for 2020-21, of which the CCRAS gets Rs 297 crore ($40 million).

According to its website, OCCAM was set up in 1998 by the National Cancer Institute, which is one of the largest and best-funded (2020 budget is $6.44 billion) sub-divisions of the vast National Institutes of Health (2020 budget is almost $42 billion). The NIH spends 10 percent of its budget on research by its 6,000 research staff, doling out the rest to 3,00,000 researchers in 2,500 academic and medical centres throughout the country.

Clearly, at first glance and going by relative access to money and other resources, this collaboration is like the coming together of a minnow and an elephant. OCCAM is focused on cancer; it seeks not to compete with modern medicine by aiming to discover a “cure” but rather to complement it. By focusing on the patient experience, it hopes to ease the patient’s journey through a treatment regimen that is often a gruelling marathon of radiation, surgery, and chemotherapy.

Ayurveda, on the other hand, claims to be a truly comprehensive medical approach with treatments for almost the whole range of disease groups that can afflict humans. Such is the level of hubris about Ayurveda in AYUSH circles that they published evidence-free guidelines for the clinical management of Covid at a time when the practitioners of modern medicine were admitting that it was a new illness they needed to research and understand.

Shape of the collaboration

Given their different sizes, pedigrees and priorities, what might the collaboration between OCCAM and CCRAS look like? An early clue comes from a joint workshop held in New Delhi in March 2016 for scientists and administrators of the National Cancer Institute and AYUSH ministry. The ideas and proposals for collaboration that came out of the meeting were published online in 2017 and in the print edition of the Journal of Global Oncology the following year.

The key recommendations:

• To apply rational and scientific approaches for drug development.

• To standardise traditional medicine products and procedures to ensure reliability and reproducibility.

• To promote collaboration between Indian traditional medicine practitioners and researchers, and US researchers.

• To integrate evidence-based traditional medicine practices with mainstream medical practices in India.

• To develop training programs between AYUSH and NCI to facilitate cross training.

Clearly, the Institute is pursuing hard science and modern medicine rather more vigorously than the AYUSH ministry might be prepared for.

The paper gives examples of research projects funded by the National Cancer Institute to study AYUSH herbal products. In 2014, no less than 37 such grants were made to various academic departments in the US.

The track record of research programmes in India on AYUSH products is poor. Not one clinical trial has been conducted that would meet the reporting criteria widely accepted by premier research funding bodies and journals. Most papers start and end by quoting scriptural texts as sufficient justification. Some papers quote in-vitro studies that claim to show potentially useful effects in cell models. The detailed process of extracting the active ingredient from a herb or plant, studying and recording its properties first in cell models, then in animal models, and finally in human trials has just not been done.

The irony is that if this process were successfully followed, the remedy being researched would no longer be an Ayurvedic product but a new chemical entity. At that point, it would have transitioned from traditional to mainstream medicine.

Traditional medicine is here to stay

Despite the lack of scientific rigour, there will always be a place for traditional medicines both in India and around the world. Traditional Chinese medicine is big business and enjoys state support. In the West, there is a thriving market for complementary and alternative medicine worth scores of billions of dollars.

Except in the eyes of the committed AYUSH faithful, modern medicine is not at loggerheads with traditional medicine. The debate is between scientific rigour and scepticism on the one hand and non-scientific belief systems and practices on the other.

The collaboration with OCCAM may or may not prove fruitful, but until then it is unlikely that the quality of research currently being pursued by India’s Aurvedic centres will deliver anything more than self-fulfilling studies in low-impact journals as the health journalist Anoo Bhuyan has described.

For now, the best we can hope for is that AYUSH markets itself on the basis of faith and belief. Bodies that represent modern science should continue to call out unsubstantiated claims while, at the same time, root out bad science and poor practice in their midst to get their own house in order.

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