THURSDAY, APRIL 25, 2024
Gladstone D’Costa
The World Health Organisation (WHO) describes Traditional Medicine (TM) as “the knowledge skills and indigenous practices, that various cultures have used over time to maintain health and prevent, diagnose and treat physical and mental illness”. It includes ancient practices such as acupuncture, ayurveda, herbal mixtures as well as modern medicine. In India it further includes yoga, which is practised across the country, Siddha mainly in Tamil Nadu and Kerala, Unani, of Greek origin, and the Sowa-Rigpa system practised mainly in the NE regions like Leh, Ladak, Sikkim and Darjeeling. Internationally, the WHO estimates that 80% of the world’s population, and 170 of the 194 WHO member states use TM. Such realities therefore, can no longer be ignored particularly when these member states have asked for the formation of an organisation to provide “reliable evidence and data on TM practices and products”. The fact remains, that around 40% of today’s pharmaceutical products owe their origins to natural products. Willow bark (aspirin) contraceptive pill (roots of wild yam), cancer (rosy periwinkle) cinchona and dhatura are some of the many examples. MRI scans have established the efficacy of yoga and meditation in dealing with mental health issues and as stress busters. It was therefore inevitable that the WHO should set up a Global Centre for Traditional Medicine (GCTM). Its location in Jamnagar, Gujarat, was merely a reflection of our PM’s enthusiasm for the issue, committing $250 million to support the establishment, operations and infrastructure of the GCTM; dare we say, in preference to allopathic medicine.
The main area of focus is intended to be establishing evidence-based research, and data analysis; “to develop norms, standards and guidelines in technical areas relating to traditional medicine”. This is most welcome. All too often there have been reports of Ayurvedic medication being found to contain unacceptable and harmful ingredients. Recently, the German Medical Weekly reported a patient admitted as an emergency having taken two capsules daily of an Ayush medication. Analysis revealed that the capsules contained 34mg. of lead; 136 times the permissible dose. Further enquiries revealed that around “20% of Ayurvedic remedies contained at least one heavy metal at a potentially toxic dose; lead being the most often detected”.
This is certainly not the first time Ayush medicines have invited a ban. Advertising by the Patanjali group has crossed all boundaries and norms. The current farce relates to lotions for restoration of hair growth contrary to all available scientific evidence. It was therefore reassuring to see the PM announcing the setting up of Ayush Mark for quality certification of products. For his part, in his address, the WHO DG Tedros Ghebreyesus underlined the need for further study and clinical trials to “help bring the benefits of traditional and complementary medicine into wider use, as appropriate, in health systems”.
For this purpose, “The inclusion of traditional medicine in the 11th revision of the International Classification of Diseases by WHO will help to establish reliable data on the use of traditional medicine,” he said.
Another angle to this thrust was the announcement that the Government of India will soon introduce a special category of visa for foreigners arriving in India for Ayush treatment. This is aimed at giving medical tourism a boost in much the same way as has happened in Kerala. A network of Ayush Parks is also envisaged in the country to popularise Ayush products, encourage manufacturing and R&D. The Ayush Mark as a quality certification for Ayush products will “build consumer confidence on Ayush products and provide global recognition through exports” under recently-set up Ayush Export Promotion Council. This recognises the fact that the market for the Ayush products has grown from about $3 billion in 2014, to about $18.2 billion today. As a follow on, the WHO DG announced holding an annual international meet for TM in Gujarat; the first being scheduled for next year, when WHO and India together celebrate 75 years.
The attempts to introduce a semblance of accountability and standards is commendable. However, there remains a basic confusion with Ayush remedies. The term itself covers Ayurveda, Yoga, Unani, Siddha and Homeopathy. Known as the fifth Veda, Ayurveda is based on the philosophy of disease being a result of an imbalance between the three “doshas” Vata (air), Pitta (fire) and Kapha (water). Unani on the other hand is based on the 4 Humors, Dam, Balgham, Safra, and Sauda. Siddha identifies the “panchabhuthas” or five elements of gold, lead, copper, zinc and iron. Hence metals are used in therapy. With such fundamental differences in their philosophies, it is difficult to imagine a common umbrella for the regulation. But there are more basic issues. Practitioners are prone to make outlandish claims like those made by Patanjali Ayurved during the Covid pandemic. Practitioners of TM are on occasion unqualified or indulge in cross practice both of which give TM a bad reputation.
If as envisaged, the GCTM can establish a database for traditional knowledge systems, and create international standards for testing, certification and setting up protocols for TM products, this would go a long way to improve confidence in these medicines.
With the added platform for research and exchange of ideas by global experts sharing experiences at conferences, a firm foundation would be laid for a wider range of acceptability.
Let us hope for an element of scientific rationality in Traditional Medicines in the future.
(The writer is a founder member of VHAG)
