Tag: Ayurveda

Government by Supreme Court

On February 27, a bench of the Supreme Court upbraided Patanjali Ayurved and its chairman Acharya Balkrishna for continuing to disparage systems of medicine other than Ayurveda (technically, what it calls Ayurveda) and claiming its products offer “permanent relief” from “blood pressure, diabetes, arthritis, asthma and obesity” in its advertisements, despite having assured the court in November 2023 that it won’t do so. The Indian Medical Association had filed the case in August 2022 alleging that Patanjali Ayurved had flouted the Drugs and Magic Remedies (Objectionable Advertisements) Act 1954 and its Rules.

It’s a straightforward case with an understandable outcome, but it isn’t unsurprising. That Patanjali Ayurved so openly violated the Act and the Rules – but also good sense, as Pushpa Mitra Bhargava pointed out in an excoriating essay in 2016 – forced the IMA to approach the court, and for some time now the courts have been the last democratic institutions in India interested in upholding the law (and even then it’s iffy). The ‘backstop’ the courts have offered against advertisements in particular running away with bullshit has been particularly useful because the laws are not so much outdated as unable to respond to the new ways in which advertisers are twisting words, taking advantage of grey areas, and, generally, “telling a lie in a way that it appears to be the truth,” in Bhargava’s words.

More importantly, advertisement regulation in India is weak. As Kaushik Moitra and Shreya Sircar wrote in 2022 (emphasis added):

Advertisers must address complaints regarding deviations from the ASCI Code. If such complaints are not remedied, ASCI may take coercive steps to regulate the (allegedly) offending advertisement. Illustratively, ASCI may recommend that broadcasters not air the offending advertisement and may also publish instances of non-compliance by advertisers on its website. ASCI may also report infractions to the Ministry of Information and Broadcasting.

Additionally, – and uniquely for a self-regulatory organisation in India – ASCI has been recognised as a self-regulator under the Cable Television Networks (Amendment) Rules, 2021. ASCI promulgations are advisory and can neither supplant nor supersede the law. Moreover, ASCI cannot compel compliance. However, any action brought against an advertiser for breach of ASCI promulgations will proceed on the basis that ASCIs position has statutory endorsement.

It’s ultimately up to some government agency to take action and to advertisers to check themselves. In 2010, ASCI had flagged more than “50 campaigns by ayurvedic and homeopathic drug makers offering a cure for COVID-19 in April alone” to the government. The charge was grounded not in the 1954 Act but in a Ministry of AYUSH order earlier that month prohibiting the advertisement of AYUSH-related claims about curing COVID-19.

In fact, between April 2014 and July 2024, a portal of the Department of Consumer Affairs said it had logged more than 1,400 misleading advertisements pertaining to AYUSH products and services. Similarly, the Pharmacovigilance Centres for Ayurveda, Siddha, Unani and Homeopathy Drugs reported 18,812 “objectionable advertisements” between 2018 and 2021. In 2022, the ASCI also reported 1,229 misleading AYUSH-related advertisements between 2017 and 2019. Yet the same ministry is unconcerned when Patanjali Ayurved offers unsubstantiated (possibly intentionally ambiguous) “permanent relief” from a variety of conditions. In fact, “unconcerned” is inaccurate. On February 19, 2021, the then Union health minister Harsh Vardhan endorsed a ‘drug’ developed by Patanjali Ayurved, called Coronil, and which the minister, Balkrishna (the chairman), and Baba Ramdev claimed was the “first evidence-based medicine for coronavirus”. It wasn’t; it was an untested quack-remedy backed by spurious claims that the WHO had certified it.

Such circumstances force those who are concerned about the effects of these advertisements to approach the courts for relief, and it is heartening that the courts among all institutions retain some sense. Yet this is also a tragedy: if the regulations that the government has put in place are followed and enforced properly by regulatory agencies, people wouldn’t have to approach courts for every remedy. Courts are already burdened with a large number of cases; equally, judges – while being equipped to examine the propriety of processes and adherence to the law and Constitutional principles – are not subject experts.

In the Patanjali Ayurved case, of course, the company was advancing clearly pseudoscientific claims backed by non-existent data, and its defence was easy to dismiss. What would happen when, say, the government approves a poorly tested vaccine with a known risk of injury in the event of a self-determined emergency; a civil society group files a petition asking for the approval to be rolled back; and the government contends that the group is spreading vaccine hesitancy? The court shouldn’t be expected to be able to examine the results of clinical trials, yet it may have to. In fact, contemporary environmental governance offers a real example of such a problem in action.

Unlike a specialised expert tribunal, Constitutional courts don’t possess the necessary skill and expertise to examine the technical and scientific correctness of any project. Judges are trained to examine and adjudicate on the legality and propriety of the decision-making process.

Environmental lawyer Ritwick Dutta wrote this in The Hindu following the Joshimath disaster, when the Union government halted work on the Helang-Marwari bypass. This work had received a green signal from the Supreme Court in 2022 to proceed, raising “questions about the validity of the apex court’s decision” (not that the Union government was opposed to the project).

The separation of powers is a division of labour, rendered more critical than other such divisions by the need to keep the greatest powers of the land in check. Yet it has often been flouted, such as the Supreme Court’s decision to set up the Central Empowered Committee, which stands in between the Standing Committee of the National Board for Wildlife and the Union Cabinet when approvals for non-forest use of sanctuaries and national parks are at stake. If this committee disagrees with a decision of the Standing Committee, the committee can forward it to the Supreme Court with its own opinion for the apex court to take the final call – a clear violation of the separation of powers.

However, not everyone would have thought so at the time many such measures were instituted. The environment ministry created the committee in 2002 following a Supreme Court direction in T.N. Godavarman, “for the purposes of monitoring and ensuring compliance of the orders of the … Supreme Court covering the subject matter of environment, forest and wildlife, and related issues arising out of the said orders and to suggest measures and recommendations generally to the State, as well as Central Government, for more effective implementation of the [Environment (Protection)] Act and other orders of the Court” (source).

Since then, however, and in keeping with Dutta’s assessment, the Supreme Court has adjudicated on the “technical and scientific correct” of various projects. That the environment ministry has parallelly and persistently weakened safeguards to protect the country’s natural resources to favour ‘ease of business’ has only allowed the court to intervene further. But at the same time, because the politically instituted mechanisms to protect the lives and livelihoods of people and the well-being of flora and fauna living near sites of resource extraction exist more and more only in theory, researchers, activists, and others have also welcomed the court’s interventions to nix deleterious project proposals. (In September 2023, in fact, the environment minister replaced the Supreme Court’s committee with a new one of the same name, populated fully with members that report to the ministry.)

Simplistically, those in charge are making bad decisions and those not supposed to be in charge are making good decisions.

Poverty, psychology and pseudoscience

From the abstract of ‘Why Do People Stay Poor? Evidence on Poverty Traps from Rural Bangladesh’, November 24, 2020:

There are two broad views as to why people stay poor. One emphasizes differences in fundamentals, such as ability, talent or motivation. The other, poverty traps view, differences in opportunities stemming from differences in wealth. We exploit a large-scale, randomized asset transfer and panel data on 6000 households over an 11 year period to test between these two views. The data supports the poverty traps view — we identify a threshold level of initial assets above which households accumulate assets, take on better occupations and grow out of poverty. The reverse happens for those below the threshold.

In the resulting worldview this ‘condition’ imposes on people, it’s tempting to see justification for the existence of pseudoscientific enterprises like astrology. Actually, a faith-based binary like ‘requiring faith’ v. ‘not requiring faith’ may be more appropriate here than a science-based binary (‘scientific’ v. ‘unscientific’), if only to emphasise the presence of faith here over the absence of scientific reasoning. So that is, while I can’t ascertain a causal relationship between conditions like the poverty trap and opaque practices like astrology, there’s enough of a correlation here to understand astrology et al as the means by which people rationalise their shared predicament – a predicament that refuses to be allayed by their own efforts.

For example, astrology could provide social, mental and moral incentives for individuals to believe – without having to know – that they were denied any opportunities because ‘their time isn’t right’ and/or that they will continue to luck out, while social realities instead of the alignment of their stars will ensure this is true in some measure. Such faith could also subdue or redirect individuals’ anger or sense of wrongdoing at forces beyond their control, creating ground for social conditions that tolerate oppression more than it ought to be.

Another observation this paper brings to mind is from the work of Sendhil Mullainathan, among others. Researchers from various fields have reported differences in the way poor people make decisions, compared to those who aren’t poor – as if they were less intelligent. However, this perception arises from a sort of cognitive John-Henryism: that is, just as disadvantaged members of society – like Black people in the US – can incur a physical toll imposed by the need to fight for their rights, poor people incur a cognitive toll brought on by the limited availability of resources and the short-lived nature of good fortune.

This doesn’t mean poor people become or are less intelligent, or anything nonsensical like that. Instead, it means poor people’s priorities are different – for example the need for discounts on products, and to maximise absolute savings over percentage savings – in a way that those who aren’t poor may not find optimal for their needs, and that more tasks compete for their attention when they are short on the resources required to execute all of them. As Alice Walton wrote for the Chicago Booth Review in 2018,

In the Wheel of Fortune–style game, the researchers [including Mullainathan] measured how cognitively fatigued the players became. Logic would predict that rich players would be more fatigued, since they were allowed more turns to make more guesses. Instead, the researchers observed that poor players, having received fewer tries to guess at the answers, were more fatigued, having put more effort into each guess.

In an Angry Birds–style game in which people tried to shoot targets, rich players were given more chances to train a virtual slingshot on a target. Poor players, given fewer attempts, spent longer lining up their shots, and many scored more points per shot than rich players. For all the extra shots rich players had, they didn’t do as well, proportionally. “It seems that to understand the psychology of scarcity, we must also appreciate the psychology of abundance. If scarcity can engage us too much, abundance might engage us too little,” the researchers write.

This toll subsequently compromises future choices, and effectively installs another barrier, or trap, in front of people trying to go from being poor in one resource – money, in poverty’s case – to being rich. Walton offers a few examples of policymakers building on these findings to devise better schemes and improve uptake.

In India, where sugarcane farmers are paid annually after the harvest, farmers’ attention scores were the equivalent of 10 IQ points higher than just before the harvest, when farmers were relatively poor, according to data from the 2013 Science study…

Offering subsidies or other incentives when people are more receptive to and have the spare capacity to consider them, such as after a harvest or a payday, may make a difference over the long run. One effort, in Tanzania, asked people to sign up for health insurance at cashpoint locations right after payday, and the timing led to a 20 percentage point increase in health-insurance use.

Introducing cognitive aids can help address the limited capacity for attention that may constrain people in poverty. In one study, it helped to show farmers research regarding the most productive ways to plant their crops. When poor, stressed, and in a scarcity mind-set, farmers had a harder time taking in the information. “This result has nothing to do with the intelligence of the farmers,” writes Bryan’s team. “A fact is only obvious if the observer has the spare attentional capacity to notice it.”

I wonder if the converse could also be true: that when homeopaths, phytotherapists, many Ayurveda practitioners and other quack healers offer dubious ways out of difficult healthcare situations, people who are short on attentional space could be likelier to buy into them in order to free up space for other tasks. If so, governments and activists may also need to consider fighting superstition and pseudoscience in healthcare by ensuring more legitimate outcomes – like visiting the local clinic or being able to procure a given drug – require as little cognitive bandwidth as possible.

Ayurveda is not a science – but what does that mean?

This post has benefited immensely with inputs from Om Prasad.

Calling something ‘not a science’ has become a pejorative, an insult. You say Ayurveda is not a science and suddenly, its loudest supporters demand to know what the problem is, what your problem is, and that you can go fuck yourself.

But Ayurveda is not a science.

First, science itself didn’t exist when Ayurveda was first born (whenever that was but I’m assuming it was at least a millennium ago), and they were both outcomes of different perceived needs. So claiming ‘Ayurveda is a science’ makes little sense. You could counter that 5 didn’t stop being a number just because the number line came much later – but that wouldn’t make sense either because the relationship between 5 and the number line is nothing like the relationship between science and Ayurveda.

It’s more like claiming Carl Linnaeus’s choice of topics to study was normal: it wouldn’t at all be normal today but in his time and his particular circumstances, they were considered acceptable. Similarly, Ayurveda was the product of a different time, technologies and social needs. Transplanting it without ‘updating’ it in any way is obviously going to make it seem inchoate, stunted. At the same time, ‘updating’ it may not be so productive either.

Claiming ‘Ayurveda is a science’ is to assert two things: that science is a qualifier of systems, and that Ayurveda once qualified by science’s methods becomes a science. But neither is true for the same reason: if you want one of them to be like the other, it becomes the other. They are two distinct ways of organising knowledge and making predictions about natural processes, and which grew to assume their most mature forms along different historical trajectories. Part of science’s vaunted stature in society today is that it is an important qualifier of knowledge, but it isn’t of knowledge systems. This is ultimately why Ayurveda and science are simply incompatible.

One of them has become less effective and less popular over time – which should be expected because human technologies and geopolitical and social boundaries have changed dramatically – while the other is relatively more adolescent, more multidisciplinary (with the right opportunities) and more resource-intensive – which should be expected because science, engineering, capitalism and industrialism rapidly co-evolved in the last 150 years.

Second, ‘Ayurveda is a science’ is a curious statement because those who utter it typically wish to elevate it to the status science enjoys and at the same time wish to supplant answers that modern science has provided to some questions with answers by Ayurveda. Of course, I’m speaking about the average bhakt here – more specifically a Bharatiya Janata Party supporter seemingly sick of non-Indian, especially Western, influences on Indian industry, politics, culture (loosely defined) and the Indian identity itself, and who may be actively seeking homegrown substitutes. However, their desire to validate Ayurveda according to the practices of modern science is really an admission that modern science is superior to Ayurveda despite all their objections to it.

The bhakt‘s indignation when confronted with the line that ‘Ayurveda is not a science’ is possibly rooted in the impression that ‘science’ is a status signal – a label attached to a collection of precepts capable of together solving particular problems, irrespective of more fundamental philosophical requirements. However, the only science we know of is the modern one, and to the bhakt the ‘Western’ one – both in provenance and its ongoing administration – and the label and the thing to which it applies, i.e. the thing as well as the name of the thing, are convergent.

There is no other way of doing science; there is no science with a different set of methods that claims to arrive at the same or ‘better’ scientific truths. (I’m curious at this point if, assuming a Kuhnian view, science itself is unfalsifiable as it attributes inconsistencies in its constituent claims to extra-scientific causes than to flaws in its methods themselves – so as a result science as a system can reach wrong conclusions from time to time but still be valid at all times.)

It wouldn’t be remiss to say modern science, thus science itself, is to the nationalistic bhakt as Ayurveda is to the nationalistic far-right American: a foreign way of doing things that must be resisted, and substituted with the ‘native’ way, however that nativity is defined. It’s just that science, specifically allopathy, is more in favour today because, aside from its own efficacy (a necessary but not sufficient condition), all the things it needs to work – drug discovery processes, manufacturing, logistics and distribution, well-trained health workers, medical research, a profitable publishing industry, etc. – are modelled on institutions and political economies exported by the West and embedded around the world through colonial and imperial conquests.

Third: I suspect a part of why saying ‘Ayurveda is not a science’ is hurtful is that Indian society at large has come to privilege science over other disciplines, especially the social sciences. I know too many people who associate the work of many of India’s scientists with objectivity, a moral or political nowhereness*, intellectual prominence, pride and, perhaps most importantly, a willingness to play along with the state’s plans for economic growth. To be denied the ‘science’ tag is to be denied these attributes, desirable for their implicit value as much as for the opportunities they are seen to present in the state’s nationalist (and even authoritarian) project.

On the other hand, social scientists are regularly cast in opposition to these attributes – and more broadly by the BJP in opposition to normative – i.e. pro-Hindu, pro-rich – views of economic and cultural development, and dismissed as such. This ‘science v. fairness’ dichotomy is only a proxy battle in the contest between respecting and denying human rights – which in turn is also represented in the differences between allopathy and Ayurveda, especially when they are addressed as scientific as well as social systems.

Compared to allopathy and allopathy’s intended outcomes, Ayurveda is considerably flawed and very minimally desirable as an alternative. But on the flip side, uptake of alternative traditions is motivated not just by their desirability but also by the undesirable characteristics of allopathy itself. Modern allopathic methods are isolating (requiring care at a designated facility and time away from other tasks, irrespective of the extent to which that is epidemiologically warranted), care is disempowering and fraught with difficult contradictions (“We expect family members to make decisions about their loved ones after a ten-minute briefing that we’re agonising over even with years of medical experience”**), quality of care is cost-stratified, and treatments are condition-specific and so require repeated hospital visits in the course of a lifetime.

Many of those who seek alternatives in the first place do so for these reasons – and these reasons are not problems with the underlying science itself. They’re problems with how medical care is delivered, how medical knowledge is shared, how medical research is funded, how medical workers are trained – all subjects that social scientists deal with, not scientists. As such, any alternative to allopathy will become automatically preferred if it can solve these economic, political, social, welfare, etc. problems while delivering the same standard of care.

Such a system won’t be an entirely scientific enterprise, considering it would combine the suggestions of the sciences as well as the social sciences into a unified whole such that it treated individual ailments without incurring societal ones. Now, say you’ve developed such an alternative system, called PXQY. The care model at its heart isn’t allopathy but something else – and its efficacy is highest when it is practised and administered as part of the PXQY setup, instead of through standalone procedures. Would you still call this paradigm of medical care a science?

* Akin to the ‘view from nowhere’.
** House, S. 2, E 18.

Featured image credit: hue 12 photography/Unsplash.

A trumpet for Ramdev

The Print published an article entitled ‘Ramdev’s Patanjali does a ‘first’, its Sanskrit paper makes it to international journal’ on February 5, 2020. Excerpt:

In a first, international science journal MDPI has published a research paper in the Sanskrit language. Yoga guru Baba Ramdev’s FMCG firm Patanjali Ayurveda had submitted the paper. Switzerland’s Basel-based MDPI … published a paper in Sanskrit for the first time. Biomolecules, one of the peer-reviewed journals under MDPI, has carried video abstracts of the paper on a medicinal herb, but with English subtitles. … The Patanjali research paper, published on 25 January in a special issue of the journal titled ‘Pharmacology of Medicinal Plants’, is on medicinal herb ‘Withania somnifera’, commonly known as ‘ashwagandha’.

This article is painfully flawed.

1. MDPI is a publisher, not a journal. It featured on Beall’s list (with the customary caveats) and has published some obviously problematic papers. I’ve heard good things about some of its titles and bad things about others. The journalist needed to have delineated this aspect instead of taking the simpler fact of publication in a journal at face value. Even then, qualifying a journal as “peer-reviewed” doesn’t cut it anymore. In a time when peer-review can be hacked (thanks to its relative opacity) and the whole publishing process subverted for profit, all journalists writing on matters of science – as opposed to just science journalists – need to perform their own checks to certify the genealogy of a published paper, especially if the name of the journal(s) and its exercise of peer-review are being employed in the narrative as markers of authority.

2. People want to publish research in English so others can discover and build on it. A paper written in Sanskrit is a gimmick. The journalist should have clarified this point instead of letting Ramdev’s minions (among the authors of the paper) claim brownie points for their feat. It’s a waste of effort, time and resources. More importantly The Print has conjured a virtue out of thin air and broadcast asinine claims like “This is the first step towards the acceptance of ‘Sanskrit language’ in the field of research among the international community.”

3. The article has zero critique of the paper’s findings, no independent comments and no information about the study’s experimental design. This is the sort of nonsense that an unquestioning commitment to objectivity in news allows: reporters can’t just write someone said something if what they said is wrong, misleading, harmful or all three. Magnifying potentially indefensible claims relating to scientific knowledge – or knowledge that desires the authority of science’s approval – without contextualising them and fact-checking them if necessary may be objective but it is also a public bad. It pays to work with the assumption (even when it doesn’t apply) that at least 50% of your readers don’t know better. That way, even if 1% (an extremely conservative estimate for audiences in India) doesn’t know better, which can easily run into the thousands, you avoid misinforming them by not communicating enough.

4. A worryingly tendentious statement appears in the middle of the piece: “The study proves that WS seeds help reduce psoriasis,” the journalist writes, without presenting any evidence that she checked. It seems possible that the journalist believes she is simply reporting the occurrence of a localised event – in the form of the context-limited proof published in a paper – without acknowledging that the act of proving a hypothesis is a process, not an event, in that it is ongoing. This character is somewhat agnostic of the certainty of the experiment’s conclusions as well: even if one scientist has established with 100% confidence that the experiment they designed has sustained their hypothesis and published their results in a legitimate preprint repository and/or a journal, other scientists will need to replicate the test and even others are likely to have questions they’ll need answered.

5. The experiment was conducted in mice, not humans. Cf. @justsaysinmice

6. “‘We will definitely monetise the findings. We will be using the findings to launch our own products under the cosmetics and medicine category,’ Acharya [the lead author] told ThePrint.” It’s worrying to discover that the authors of the paper, and Baba Ramdev, who funded them, plan to market a product based on just one study, in mice, in a possibly questionable paper, without any independent comments about the findings’ robustness or tenability, to many humans who may not know better. But the journalist hasn’t pressed Acharya or any of the other authors on questions about the experiment or their attempt to grab eyeballs by writing and speaking in Sanskrit, or on how they plan to convince the FSSAI to certify a product for humans based on a study in mice.

An upvote for Ayurveda from the Swiss government – alongside homeopathy

The Wire
May 15, 2015

Despite the unsubstantiated science behind it, the Ayurveda medicine system was granted a vote of confidence by the Swiss government, swissinfo.ch reported on May 12. According to updates made to the Swiss Regulation of Complementary Medicine, Ayurveda practitioners will now be able to obtain a national diploma after passing a state-administered exam.

The updates followed intense lobbying after Ayurveda wasn’t included in a list of alternative therapies that could be covered by Swiss health insurance providers in 2005. They were anthroposophic medicine, phylotherapy, neural therapies, traditional Chinese medicine and homeopathy. Until 2017, they will be included under basic health insurance packages on a trial basis.

Among others, anthroposophic medicine involves using mistletoe to cure cancer while neural therapies are based on injecting anaesthetics near nerve-centres. Phylotherapy is herbal medicine.

Ayurveda proponents had been asked to wait until 2017 before being considered again, according to the Swiss Professional Association for Ayurveda Practitioners and Therapists. Instead, the Ayurveda lobby had worked to induct it under the national diploma program.

Now, practitioners without a medical degree can obtain a professional qualification through the exam and gain legitimacy in the eyes of the health insurance sector. More, practitioners of three other systems of alternative medicine are now eligible for the exam: Chinese and European traditional medicine, and homeopathy.

Although seekers of alternative therapies can now pay a visit to someone who has passed a national exam instead of some other arbitrary test, it is Ayurveda’s dubious company that belies the credibility of the Swiss government’s decision. Homeopathy amongst them has been widely discredited for being pseudoscience and international government support has been largely withheld.

Without focusing on a single system, scientists believe the biggest effect of the Swiss government’s decision to recognise and fund alternative medicine – as opposed to evidence-based medicine – will be the credibility it will accrue without having presented objective proofs of effectiveness. Even if the Swiss government has said it will conduct independent investigations into whether the claims of alternative systems are dependable, many feel political pressure might lead to evaluators registering false-positives.

The situation parallels one in India, where Ayurveda has a market worth Rs.8,000 crore (2013) but is backed by research or data that is neither coherent nor of quality at par with that behind allopathic medicine, attributes that do nothing to allay the deep-seated and prevalent prejudice against non-Western medicine. Further, the Central Council for Research into Ayurvedic Sciences – which coordinates pharmacological research into alternative medicine systems in the country –does not conduct placebo-controlled clinical trials, the touchstone of medical research.

Simultaneously, the Council of Scientific and Industrial Research continues to support research into areas like ayurgenomics – the use of ayurvedic principles to determine genetic predispositions to some diseases. Ayurgenomics in particular featured prominently in the manifesto that the BJP put out ahead of the 2014 Lok Sabha elections, and which the party has continued to unabashedly support since it came to power. The result is the risk of legitimate practitioners of Ayurveda eschewing rigour in favour of political timing. The effect of political pressure is often to make the two indistinguishable.

In fact, the 2005 decision in Switzerland followed by a referendum in 2009, when not any scientific committee but 67 per cent of the Swiss electorate voted to include the five alternative systems under the basic health insurance package. In response to the verdict, Ignazio Cassis, then vice-chair of the Swiss Medical Association, had told New Scientist in 2011, “This isn’t science, it’s Swiss politics.”

As of 2011, Switzerland had 17,200 registered practitioners of complementary and alternative medicine, the most per capita in the world.