Dr.Abijith Venu & Dr. Skanthesh L
The ongoing Covid-19 pandemic must otherwise be called the 'pandemic of chaos. The mere fact that the complications can vary from one individual to other tells us how dangerous the virus is. Apart from complications such as mental traumas, lack of access to livelihood and even death, the impact of alienation of man, the 'social animal' from his 'society' is nowhere discussed. "We'll do everything humanly possible to stop this pandemic" was a statement from the authorities that gave everyone a glimmer of hope amidst the chaos. Did they actually do everything humanly possible? Atleast the practitioners and beneficiaries of traditional medicine would say no. Apart from a few guidelines and 'home remedies' from the Ministry of Ayush, the traditional systems of medicine were literally 'quarantined' from the covid-19 scene. Are the 'scientific' world trying to downplay Ayurveda's efficacy? Does it have a role to play in subduing the pandemic? The Widening Gap Between Bat and Pad In Cricket, the key to success is the batsman's ability to narrow down the gap between bat and pad. The batsman must keep the bat close to the pad to prevent the ball from hitting his wicket. Comparably, According to Natalie W Paul, there exists a gap between medicine's stock of knowledge and medical practice known as ‘Hiatus Theoreticus’. This inherent conflict becomes more evident when encountering a Novel disease. The ultimate aim of science must be to bridge the gap between theory and praxis to avert the outcome of ‘getting out bowled’ It is a well known fact that it was evidence based medicine, a branch of science, that gave us Cochrane Collaboration and a new paradigm of medical practice. But it must not be forgotten that a reasonable number of health care treatments we follow today lacks concrete evidence. Medicine, as Dr. William Osler, one of the four founding Professors of Johns Hopkins Hospital put it, is an "art of probabilities," or at best, a "science of uncertainty." The Covid-19 conundrum has made this conflict evident to all of us. Richard Horton, the editor-in-chief of The Lancet Magazine, had the audacity to write that “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue." He also accused researchers of using the pandemic as an excuse to justify their unethical involvement in medical literatures. A deep look into the medications and treatment protocols of Covid-19 would be enough to unveil the biases and inaccuracies. The 'magic' drug hydroxychloroquine, Remdesivir, Favipiravir, Vitamin C, Steroids, the list of unproven drugs that are hailed as 'scientific' could go on. In other words, the gap between bat and pad still remains separated. Much to our dismay, 4 among these drugs that failed WHO's solidarity clinical are still being used widely as a 'cure' to covid-19. Ayurveda and Science: Complimentary, not ‘Contradictory’ The Covid-19 situation has underpinned the significance of multifaceted treatment protocols in handling pandemics. A single medical system wouldn't be enough to tackle such an outbreak even in the future. Our experience also tells us that the fundamental understanding of mode of transmission of this disease and its pathophysiology may not hold true in number of cases. The accuracy of the tests is also of huge concern. Experts have found even the PCR-based tests to be inaccurate at times. Consequently, these snags have put an excess burden on both the Healthcare workers and Governments. The time has come for us to look for ‘everything humanly possible’ including traditional medicine. One possible reason that's stopping us from doing that is the long-standing obsession with western epistemology. The decline in popularity of eastern epistemology has lot to do with colonialism. It was only until recently that a black medical student wrote a book to help medics recognise symptoms on Black and Asian skin tones. We must also be vary of the narratives of Pharma Corporations and immature rants of Modern Medical Association representatives (The ‘diktat’ from a Medical Association Representative to abandon all ongoing researches in AYUSH, is one such example), if we are to find out whether complimentary medicine is, in effect, 'contradictory' as some claim. Indian medicine, aka Ayurveda, has got its own version of treatment modalities that suits well to the concept of personalized medicine. As Anuradha Singh of University of Allahabad put it, "It is the science of experienced body as well as that of experienced matter, the actionable experiential reasoning is at the foundations of Ayurveda". The Ayurvedic medicine we see today is a compendium of Samhithas and Folklore from the Indian Subcontinent. The theory of Tridosha explains the fundamental functions of an organism. Dr. Siva Ayyadurai made a successful attempt to give substance to the theory by conclusively validating the scientific foundation of Ayurveda based on modern control systems engineering. The paper was published in the International Journal of Systems of Systems Engineering (IJSSE) Those who try to deride Ayurveda as a mere computation of Tridoshas often ignores the vast amount of references it has regarding Diet, Life style, Biodiversity, Drugs of plant and animal origin, Mental health, Communal practices, Classification of diseases, Diagnostic protocols and Treatment protocols. Theoretical Physicist Alex Hankey calls the validity of clinical protocols in Ayurveda as 'empirical'. Ayurveda relies heavily on application-oriented methods and experimental reasoning, making praxis and theory inseparable. It tries to pursue the theory behind the experience of action. This may not be new to people who have an idea of Hegelian philosophy. British General Practitioner Trisha Greenhalgh asserts the importance of embracing 21st-century epistemology and methods to study how best to cope with uncertainty, unpredictability and non-linear causality at a population and system level. The plausibility of the Ayurvedic theory of fundamental functions may come in handy here, especially while handling a novel disease. If given an opportunity, Ayurveda can be the perfect batting partner to bio-medicine in the fight against pandemic. Evidence Gathering: A Police and Thief Game Critics of complementary medicine often tend to downplay the contribution of other systems of medicine by exalting 'evidence based medicine' as the sole contributor to the overall progress of mankind. They eschew the fact that the first publications of a randomised clinical trial occurred only in the late 1940s. In recent times, There has also been a surge in the number of people who can't distinguish between Science and Scientism. Sadly, The ones who denounced Ayurvedic treatment protocols as ineffective against Covid-19, have no issues with unproven drugs/therapies such as Hydroxycholoquine and Convalescent plasma. Much to our amazement, the sole reason to recommend Blood plasma therapy in Covid-19 management was its ‘time-tested’ efficacy. We are still left with the question as to why a 3000 year old, ‘time-tested’ system is being left out. Is Ayurveda really a pseudoscience as some claim? There’s no written explanation as to what exactly defines pseudoscience. If a reasonable number of researches and publications mean anything, its inapt to call Ayurveda by that name. They should unleash the power of their innovative mind and come up with better names such as trans-science/Emerging-science. The number of Ayurvedic researches in peer reviewed and biomedical journals has only gone up in the recent past. Not to mention, the WHO approved black-box studies showcasing Ayurveda's efficacy in managing Rheumatoid Arthritis, NIH approved study on Journal of Rheumatology and Study on its effectiveness in Osteoarthritis. Advanced research methods such as phytochemistry, Network Pharmacology, Computational studies have also helped scientist evaluate the efficacy and safety of Single and Poly herbal Ayurvedic medications. Do Ayurvedic drugs have immunomodulatory action? "Allopathic drugs of unknown efficacy are being tried to treat COVID-19, shouldn't the same courtesy be extended to herbal preparations with plausible mechanisms of action and with fewer side effects?"Asks Public Health Professor Dr. Ritu Priya and Sociologist V Sujatha in their article for 'The Wire'. They have also mentioned the impact Chinese medicine had in subduing the situation in China. Ayurvedic drugs such as Ginger, Aswagandha, Basil, Turmeric etc are proven Immunomodulators. Research papers that confirm the efficacy of these medicines are available online. The poly-herbal combinations in Ayurveda could also stabilize the elevated Cytokine, a possible after-effect of Covid-19. Researchers have also managed to develop a preliminary clinical profiling of COVID-19 based on review of modern medical and classical Ayurvedic literature with inputs from clinicians treating Covid-19 patients. What kind of research design will best suit Ayurveda? The collection of evidence, clinical trials and research must go hand in hand with the epistemology of Ayurveda. For example, A Poly-herbal combination, unlike a single drug, is expected to produce better results due to the presence of plants with varying potency that engender Positive herb-herb interaction and pharmacodynamic synergism. In this case, Contemporary research methods such as Black box method and Practice-based evidence may yield better results than randomised control trials (RCT). Experts such as Vincanne Adams even went to the extent of calling RCTs Randomised Control Crime. The effectiveness of RCTs, however needs further discussion and clarification. Evidence Gathering methods on the other hand must adhere to the principles of Moral Justice as proffered by Philosopher John Rawls in his theory ‘Justice as Fairness’. The power structure that condones the authority of bio medicine over other systems of medicine and their tendency to draw out only the ‘Active Ingredient’ of a poly-herbal preparation without an evaluation of the medicine’s potency as a ‘coherent whole’ may come as serious impediments to scientific progress. Democracy and Progressivism, the inherent values of civilization, shouldn't be confined to politics. Access to Primary Healthcare is a right, not a privilege! According to the household consumption expenditure reported in the Periodic Labour Force Survey (PLFS), 2017-18 (which replaces the employment-unemployment surveys of the National Sample Survey Office) and applying State-specific poverty lines, about 42% of the population aka 56 crore people were deemed ‘officially’ poor. The unexpected lock-down just added insult to injury. If we are to emulate the success of Chinese medicine and community based management, a blueprint that integrates Ayurveda and bio medicine is necessary. A considerable number of population who cannot afford private healthcare may benefit from an Ayurvedic diet and knowledge of local biodiversity. The safety and effectiveness of this model can be made sure by deploying healthcare professionals at the forefront, thereby protecting the fundamental right of a community to control their own health. The pandemic has raised many questions, but one concern we cannot turn a blind eye to is that of a viable public health model. The integrated model of community based primary care and local biodiversity will really come in handy when we face the inevitable climate change induced hazards in the future. The IPCC report on climate change calls for cooperation and co-production of scientific knowledge, Indigenous Knowledge and Local Knowledge as a last ditch effort to sustain life and save the planet from a possible apocalypse. If science doesn’t have progressive values of its own, it must be borrowed from outside! The Indian Constitution considers ethos such as Justice, Liberty and Equality to be the lynchpin to our country's success. A considerable number of our population have always defended those values during hardships, be it beef ban or Aadhar imposition. It is a matter of discussion whether we have raised our voice to defend the right of an Individual to choose the system of medicine he believes in. It may come as a surprise that some of the Covid treatment centres in Kerala kept denying the requests of patients to avail Ayurvedic treatment! The final report of Government's prestigious Amritham project, a program to improve the immunity of general population hasn't seen the light of day either. British Philosopher Isaiah Berlin called the opposition between equality and freedom as "intrinsic, irremovable element in human life". When the concepts of egalitarianism are applied to medicine, our aim must be to find the right balance between equality and freedom. Complete disregard to a medical system with ample scientific backing, though, will not help. The United Nation's Declaration on the Rights of Indigenous People is of utmost importance in this context: "Indigenous people have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals." In the United Nations report on 'State of the world's indigenous people', Dr. Mukta Lama complains about the weak political and cultural representations of Indigenous people. Lama's report best suits the plight of traditional medicine in our country. It may come as a surprise that Kerala, the land of Ayurveda, a model worth emulating, has only little representation of Traditional Medicine Practitioners in Health Policy Making and Public Health. Covid-19 has brought us an unparalleled health crisis. The old normal remains a distant dream, If the words of Tedros Adhanom are to be trusted. Our only choice is to adjust to the new normal through solidarity and consensus with people who can be allies.. The immaturity and inaction of some of the scientific establishments may cost hundreds of lives and deprive us an opportunity to work towards the greater good. The maximum number of days a person must quarantine if he/she has the virus/symptom is twenty eight. Ayurveda, even after contributing 60% to Clinical trial registry of India (CTRI) the covid-19 drug researches in India , has been put on a forced quarantine ever since the outbreak of the pandemic. Would at least Kerala, the land of Ayurveda, lift the embargo on Ayurveda for its people? One can only hope!