Editorial of the Day: India needs evidence-based, ethics-driven medicine (The Hindu)

Context: The article is discussing the recent push to integrate ‘AYUSH’ medicinal systems into mainstream healthcare to achieve universal health coverage and ‘decolonise medicine.’ The push to integrate these systems is driven by the idea of embracing pluralism in healthcare and recognizing the traditional knowledge and practices of these systems. However, for such integration to be successful and safe, the article suggests that it would require every participating system to meet basic safety and efficacy standards. The article also points out that Homeopathy, which is one of the components of the AYUSH system, does not meet the necessary safety and efficacy standards. Despite this, its supporters have been advocating for its expanded use by citing demand and the goal of decolonizing medicine. Overall, the article discusses the tension between integrating AYUSH medicinal systems, including Homeopathy, into mainstream healthcare for achieving universal health coverage and decolonizing medicine, and the need to ensure that all participating systems meet basic safety and efficacy standards, particularly addressing the lack of evidence for Homeopathy’s efficacy.

Background

Decoding the Editorial

The article is discussing the recent push to integrate the ‘AYUSH’ system of medicine into mainstream healthcare to achieve universal health coverage and ‘decolonise medicine.’

• The concept of decolonizing medicine refers to challenging and moving away from Western-dominated medical paradigms and giving more recognition to traditional and indigenous medical systems.
• AYUSH stands for Ayurveda, Yoga, Unani, Siddha, and Homeopathy, which are traditional medicinal systems practiced in India and some other countries.

Efficacy and safety of homoeopathy:

Homeopathy has been a subject of controversy in the scientific and medical communities due to the absence of robust evidence supporting its effectiveness in treating various medical conditions.

• Lack of Evidence:
• • The evidence on homeopathy’s efficacy is weak.
  • Multiple systematic reviews and meta-analyses have consistently found that homeopathic treatments lack clinically significant effects across various ailments, population groups, study types, and treatment regimes.
• Historical Doubt:
  • The very first carefully conducted and well-reported double-blind randomized controlled trial on homeopathy, the Nuremberg Salt Test (1835), noted that the claimed effects of homeopathic medicines were likely due to imagination, self-deception, preconceived opinions, or possibly fraud.
• Unregistered Trials:
  • A significant number of homeopathic trials conducted in the last two decades were not registered, and these unregistered trials tended to show some evidence of efficacy.
  • However, registered trials did not show the same evidence, suggesting potential reporting bias and problematic practices in the generation of evidence.
• World Health Organization (WHO) Warning:
  • The WHO has warned against using homeopathic treatments for serious conditions like HIV, tuberculosis, malaria, as well as flu and diarrhea in infants, stating that it has no place in their treatment.
  • This suggests that there is concern about the safety and efficacy of homeopathy for such conditions.
• Ineffectiveness in Cancer Treatment:
  • There is accumulating evidence that homeopathy does not work for treating cancers and may not help reduce the adverse effects of cancer treatments, contrary to lay belief. Instead, there have been reports of both non-fatal and fatal adverse events and aggravation of conditions associated with homeopathic treatments.
• Delay in Evidence-based Clinical Care: Seeking homeopathic care has been shown to delay the application of evidence-based clinical care, which could potentially lead to negative health outcomes in some cases.

Argument against homeopathy and its integration into mainstream medicine:

• Standards in Evidence-Based Medicine:
• • The standards used in evidence-based medicine are not arbitrarily chosen by practitioners of allopathic medicine for their benefit.
  • They are collaboratively set and updated by a global community of researchers and experts from various disciplines, including epidemiologists, biostatisticians, quality improvement researchers, and implementation managers, among others.
  • These methods have been effective in weeding out practices in allopathic medicine that failed to meet evidence criteria.
• Lack of Valid Alternative Evidence Synthesis Frameworks:
  • Homeopathy advocates have not been able to propose valid alternative evidence synthesis frameworks that can adequately test the efficacy and safety of homeopathy and are also acceptable to critics.
• Holistic and Reductionist Approaches:
  • The claim that homeopathy is holistic and evidence-based medicine is reductionist is refuted.
  • Evidence-based medicine practitioners are aware and accepting of biopsychosocial approaches to health endorsed by the World Health Organization (WHO).
• Lack of Mechanistic Evidence:
  • Despite being practiced for over a century, there is no concrete evidence to explain the proposed mechanisms of action for homeopathy, such as “like cures like,” “extreme dilution,” and “dematerialized spiritual force.”
  • In contrast, modern medicine practices have updated themselves based on growing scientific evidence.
• Decolonization and Traditional Tag:
  • Homeopathy’s introduction in India during the colonial period for colonial benefit challenges its claim as a traditional medical system.
  • While adopting a pluralistic approach in medicine can decolonize medicine, the inclusion of homeopathy in this context is at odds with its colonial history.
• Lack of Substantive Evidence:
  • The argument against homeopathy is not solely based on its colonial history but is chiefly centered on the lack of evidence for efficacy, limited evidence for safety, lack of progress on mechanisms of action, and the use of escapist arguments by homeopathic practitioners.
• Testimonials and Decolonization:
  • Testimonials from historical figures like Gandhi and Tagore are offered by homeopathy’s supporters, but there is limited archival evidence to support their endorsements.
  • Therefore, decolonization is not a strong reason to support homeopathy.
• Evidence-Based and Ethics-Driven Medicine: The path to universal health care in India is suggested to be grounded in evidence-based and ethics-driven medicine, implying that treatments should be supported by scientific evidence and adhere to ethical principles.

Beyond the Editorial

Government Initiatives for AYUSH Systems

• Government of India is implementing Centrally Sponsored Scheme of National AYUSH Mission (NAM) for promotion of AYUSH system.
  • Grant-in-aid is being provided to State Governments for development and promotion of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy.
  • Ayurveda, Siddha, Unani and Homoeopathy Pharmacies and Drug Testing Laboratories are being established in States.
  •  Support cultivation of medicinal plants by adopting Good Agricultural Practices (GAPs)  to provide sustained supply of quality raw-materials.
• WHO – Global Center for Traditional Medicine is the first and only center of its kind in Jamnagar, Gujarat which focuses on innovation and technology to optimize the contribution of traditional medicine to global health and sustainable development.
• The government has a special Ayush Visa category for foreign nationals, who want to come to India to take advantage of Ayush therapy.
• A special Ayush mark for Ayush products and network of Ayush parks has been undertaken to encourage the promotion, research and manufacturing of Ayush products in India.
• A new category named ‘Ayush Aahar’ has been announced which will facilitate the producers of Ayurvedic nutritional supplements.
• With the aim of boosting infrastructure and promoting research in traditional medicine, three National Ayush Institutes have been established in Goa.
•  Ministry of Electronics and Information Technology  is providing technical support for digitalisation of Ayush Sector under the Ayush Grid project.
• The Traditional Knowledge Digital Library has been created which contains information about Ayurveda, Unani, Siddha, Sowa Rigpa and Yoga. The information is documented in a digitized format in five international languages which are English, German, French, Japanese and Spanish.

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