Reporting for this story was supported by a journalism grant from the Thakur Family Foundation, which has not exercised any editorial control over the contents of this report.
The Indian health ministry has begun recommending traditional remedies to tackle the country’s COVID-19 outbreak, dismaying many Indian doctors and scientists. On 6 October, health minister Harsh Vardhan released recommendations for preventing COVID-19 and treating mild cases based on Ayurveda, India’s millennia-old system of herbal medicine, triggering sharp criticism from the Indian Medical Association (IMA), a group of over a quarter million modern medicine practitioners.
In a press release, IMA demanded that Vardhan produce evidence of the treatments’ efficacy; if he’s unable to do so, the association wrote, Vardhan is “inflicting a fraud on the nation and gullible patients by calling placebos as drugs.” Recommending any drug without evidence for a deadly disease that has claimed over 100,000 Indian lives is “a dangerous trend,” adds C S Pramesh, a thoracic surgeon and the director of Mumbai’s Tata Memorial Hospital. The government has no shortage of studies to point to, but Pramesh and others dismiss them as unconvincing.
The Indian government’s push for Ayurveda is in line with the ruling Bhartiya Janata Party’s mission to revive traditional medicine. Since 2014, when the Hindu nationalist party was elected to power, it has upgraded a government department for alternative medicine to the Ministry of AYUSH (for the traditional healing systems Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy), and more than tripled its annual budget to almost $290 million.
Developed by the AYUSH ministry, the COVID-19 advisory includes treatments such as clarified butter applied inside the nostrils; a hot concoction of pepper, ginger, and other herbs; and a patented formulation called Ayush-64. The latter, a mixture of four herbs, was developed in the 1980s for malaria by the Central Council for Research in Ayurvedic Sciences, now a body under the AYUSH ministry.
While last week’s protocol only recommends the remedies for mild disease, it says moderately and severely ill patients can make an “informed choice” about using Ayurveda as well, and refers readers to another Ayurveda guideline document that prescribes similar herbal interventions for people with severe manifestations of COVID-19 such as respiratory distress and pneumonia. During a recent press conference, the AYUSH ministry’s secretary, Vaidya Rajesh Kotecha, claimed that the remedies were supported by dozens of in-vitro, animal, and human studies, listed in a report on the ministry’s website.
But almost all the human studies are small and uncontrolled, critics say. “These are con-trials and faked studies,” says Cyriac Abby Phillips, a hepatologist at Kerala’s Ernakulam Medical Centre.
For example, in one of the studies the AYUSH ministry cites as support for Ayush-64, published in the Journal of Ayurveda and Integrative Medicine, the investigators gave the drug to 38 patients with flu symptoms. There was no control arm, and some of the patients on Ayush-64 also received paracetamol and other modern drugs, making it impossible to tease out the effects of each.
In another study, published in 1982, investigators gave 29 malaria patients Ayush-64, while 30 received modern antimalarials, including chloroquine. The investigators noted that while all the patients on modern drugs were cured, only 72% on Ayush-64 responded. Nothing about the study supports Ayush-64’s efficacy in malaria, says Phillips.
And in any case, clinical studies for malaria and other diseases cannot be extrapolated to COVID-19, says Gagandeep Kang, a microbiologist at Vellore’s Christian Medical College, who helped develop and test India’s first rotavirus vaccine. “All diseases are not the same,” she says.
N Srikanth, an Ayurvedic practitioner and a deputy director general at the Central Council for Research in Ayurvedic Sciences, tells Science that trials of Ayurvedic therapies for COVID-19 are underway. And on 9 October, an association of government Ayurvedic scientists said IMA’s claim that Ayurvedic drugs were no better than placebos was “rigorously condemnable.” They pointed out that some modern medical practitioners continue to use drugs like hydroxychloroquine for COVID-19 even though there is little evidence for their efficacy. (India’s health ministry recommended hydroxychloroquine both as treatment and prevention for the pandemic virus in March, based on a few small and inconclusive clinical trials, a decision it didn’t roll back after subsequent larger studies failed to bear out their advice.)
Pramesh dismisses that argument as “whataboutery.” Any system of medicine, whether modern or alternative, must back up claims of efficacy with well-conducted trials, he says. “And I have seen very little actual data that shows the medicines being recommended by the AYUSH ministry to be useful.”