What is AYUSH and the controversy around it?

On Tuesday, November 20, DH reported that patients with borderline diabetes, hypertension and osteoarthritis will be prescribed Ayush system of medicines. And they will be taught yoga and meditation at the government’s 200-odd non-communicable disease (NCD) centres across Karnataka.

So what is the AYUSH? What is the controversy around it?
AYUSH, which stands for Ayurveda, Yoga, Unani, Naturopathy, Siddha and Homeopathy, is an acronym devised in 2003 to change the name of the Department of Indian Systems of Medicine and Homoeopathy (ISM & H). ISM & H was created in March 1995 under the Ministry of Health and Family Welfare.

But on November 9, 2014, the Narendra Modi government, elevated AYUSH to a separate ministry.

Over time, AYUSH ministry’s budget has doubled to Rs 1,428.7 crore in 2017-2018. Today, there are reportedly 195 undergraduate colleges for homoeopathy in India, and 43 for post-graduate education.

AYUSH recommendations
Under the leadership of Shripad Yesso Naik, the union minister of state for AYUSH, several big budget initiatives have been announced. They are as listed below.

• 100 AYUSH hospitals across the country are proposed, including the creation of an All India Institute of Ayurveda modelled on the idea of AIIMS.
• Institute of Naturopathy in Pune at the cost of Rs 1,000 crore.
• Posting 4,000 AYUSH practitioners across the country.
• Setting up of days to commemorate and celebrate alternative treatment systems. Such as Homoeopathy Day in April, Yoga Day in June, National Ayurveda Day in November.

Bad press
In August 2017, a pamphlet published by AYUSH came under fire from health journalists, doctors and the general public for its rather bizarre and unscientific advice for pregnant mothers. The pamphlet titled Mother and Child Care through Yoga and Naturopathy asked pregnant women to stop eating meat, eggs, and even having sex, and also asked them to nurture spiritual and ‘pure’ thoughts.

Other news reports, published in September 2017, showed that AYUSH issued health advisories recommending alternative medicines to treat or prevent dengue and chikungunya. Doctors, however, maintain that the medicines that were recommended have little to no scientific basis.

In September 2018, it was reported that the Central Bureau of Investigation (CBI) arrested an undersecretary in the Ministry of Ayush for allegedly taking a bribe of Rs 10 lakh from a person for clearing his pending bills.

AYUSH Vs Science
Central to the arguments by the critics of AYUSH is the lack of a scientific and evidence-based system in the alternative treatments offered. It is for the same reason that the scientific and medical community, by and large, considers homoeopathy to be a pseudoscience, and dismisses it as quackery. At best, benefits shown by it has been chalked up as placebo.

Medicines prescribed by AYUSH for diabetes, namely BGR-34 and IME-9 have both recorded major side effects, including increasing patient’s blood glucose to dangerously high levels. The monthly cost of the drug was also reportedly found to be higher than the cost of metformin, a widely prescribed anti-diabetic drug.

Why the scientific community rejects homoeopathy

Founded in 1796 in Germany by the physician Samuel Hahnemann, homoeopathy rests on the understanding that “like cures like”. It means that a substance that may cause harm in large doses can cure casual symptoms when taken in minuscule doses. The lowest amount of the “remedy” or drug is mixed with large volumes of water or alcohol and poured over sugar pills. The upper limits of this prescribed dilution yield a ratio of 1:10,00,00,00,00,000, I.e., a batch of 1,00,00,00,000 litres will contain about 1 millilitre of the remedy, according to an article written by Sumaiya Shaikh in a recent issue of the Caravan magazine. Another erroneous principle is the idea that water molecules hold a “ memory” of the properties of substances they are kept in contact with. Homoeopathy's popularity is based on anecdotal evidence and the fact that it emerged at a time when a large number of diseases were unknown. In time, it gained popularity in regions which have a prevalent culture of traditional therapies, such as India and China.

Globally, the scientific community is still expressing its criticism of Ayurveda, Homeopathy and alternative medicine. “We need to end unnecessary expense to give us a bigger therapeutic bang for the NHS buck, so we cut the fat and build the therapeutic muscle,” said the medical director of NHS, UK, Sir Bruce Keogh, on their decision to stop prescribing homoeopathy. Nobel laureate Venkatraman Ramakrishnan, in 2016, said that homoeopathy and astrology were “bogus”. “No one in chemistry believes in homoeopathy. It works because of the placebo effect,” he said. Meanwhile, AYUSH’s Central Council for Research in Homoeopathy (CCRH) wrote a rebuttal to him. It was also reported last year that the AYUSH’s CCRH has set up a high-level committee to tackle false propaganda against homoeopathy.

Though Ayurveda recommends bitter gourd for patients with diabetes in studies published in predatory journals, a Lancet study, ‘Alternative medicines for diabetes in India', said it is 'maximum hype, minimum science’ rejecting the associated benefits. “Based on current scientific data, there is scant scientific basis for the use of these products in the management of diabetes,” concluded the report.

The Lancet study also cautions about the safety of Ayurvedic preparations as it points to several reports of heavy metal toxicity due to these drugs. A fifth of Ayurvedic medicines manufactured in the USA and India contained detectable lead, mercury, or arsenic compounds, which exceeded one or more standards for acceptable daily intake of toxic metals, said the Lancet report citing another study. Alarmingly, reports say, no clinical trial is required for the marketing and sale of these drugs if they are based on ancient Ayurvedic texts.