Over the past fortnight, the Ministry of AYUSH has released a series of health advisories recommending alternative medicines to be taken to prevent dengue and chikungunya
infections as well as others to be taken with the onset of symptoms such as fever and joint pains. But doctors have criticised this step, saying that that the government is promoting self-medication of treatments that have little scientific basis.
The AYUSH ministry aims to ensure the development and spread of ayurveda, yoga and naturopathy, unani, siddha and homoeopathy. The department has five councils under its purview, one for each of these traditional systems of treatment.
Allopathic doctors do not believe that the ministry should be issuing advisories this way. “Health advisories should focus on broader prevention strategies and not prescribe treatments,” said Dr Anant Bhan, a researcher on global health and policy. “What if someone gets confused and takes all forms of prophylaxis advised by different councils. There could be side-effects.”
This is not the the first time that government authorities have recommended alternative medicine for viral fever outbreaks. Since 2013, the Tamil Nadu health and AYUSH departments have been providing a prophylaxis treatment to communities affected by dengue and chikungunya with a herbal siddha drug called Nilavembu kudineer. “The drug has been proved for its anti-inflammatory and analgesic effects,” claimed Dr P Sathiya Rajeswaran, assistant director, Central Council for Research in Siddha who helps run the dengue control programme in the state. “This drug is also effective in preventing swine flu and leptospirosis.”
This time, the Central Council for Research in Siddha has issued an advisory mentioning the name of medications to be taken for prevention of chikungunya. It also prescribes six different types of siddha medicines for fever and joint-pain management along with the exact dosage and duration. These medicines have already been approved by the AYUSH ministry and are being sold in India.
Rajeswaran said that the drug has distributed among the general population and no adverse events have been reported so far. However, he also said that there have been no clinical trials to test the efficacy and safety of the medicines but are recommending the Siddha treatment based on references in Siddha literature.
Advice without evidence
Franklin L Khobung, director of AYUSH, explained that this year’s advisories were issued as a measure to counter the recent surge in chikungunya and dengue cases. According to the National Vector Borne Disease Control Programme, more than 22,000 of suspected chikungunya cases were reported across the country between January and August 20. At the same time, 36,000 cases of dengue were recorded.
Asked if the advisories were a strategy to popularise these traditional forms of medicine, Khobung insisted that the government wants to give citizens different choices of treatment. “We want people to know that these forms of medicine exist and they have been recommended only after their validity is proven,” he said.
However, Khobung refused to reveal details on the studies and research that the ministry of AYUSH has conducted before recommending names of medicines which can prevent and treat mosquito borne diseases including chikungunya and dengue.
To understand the quality of their research, Scroll.in contacted representatives of the research councils under the AYUSH ministry. These councils have issued the advisories but interviews with the heads of the councils did not indicate that there is a satisfactory basis for the department’s recommendations.
Professor KS Dhiman, director general of Central Council for Research in Ayurvedic Sciences said that symptoms exhibited in chikungunya are similar to medical conditions defined in the Ayurvedic textbooks that used for bachelor’s courses in Ayurvedic Medicine and Surgery. “The clinical picture of chikungunya resembles another medical condition described in the ayurvedic textbooks,” said Dhiman. “Hence, we have prescribed the time-tested ayurveda drugs for chikungunya in the advisory.”
Dhiman did not cite any research for the advisory recommendations.
Similarly, Dr RK Manchanda, director general of the Central Council for Research in Homeopathy said that the advisory is based on “traditional knowledge” gathered over centuries. “These medicines mentioned in the advisory have been found to be useful in preventing dengue and chikungunya,” he said.
Where are the clinical trials?
Manchanda said that there are no “vaccine-trial like studies conducted” but there was an expert group that framed the advisories. “I cannot disclose the names of the institutes but there are several research studies going on.”
Manchanda added that the department felt the need to name the medicines in the advisory to ensure that practitioners of ayurveda also prescribe the drugs that the government is recommending. He referred to an editorial he has authored in the Indian Journal of Research in Homeopathy for the basis of the recommendations. In the editorial, however, he simply makes a case for more rigorous studies to be conducted on the use of homeopathy for the treatment of dengue. Manchanda quotes several studies from around the world, which by his own admission in the article, “had some or the other limitations ranging from small sample size, poor research design or abrupt withdrawal of study”. Nonetheless, he concluded: “...the data are sufficient to invoke more studies with better methodology and compliance.”
There is a heated debate globally about the efficacy of alternative forms of medicine. For example, studies have highlighted the presence of toxic heavy metals in Ayurvedic medicines. Allopathic doctors have publicly argued that the treatments administered by these disciplines are not efficient. “We have to ask [the AYUSH ministry] on what evidence are they relying on for promoting these treatments,” said Dr Jayesh Lele, state secretary of Maharashtra’s Indian Medical Association. “These are old sciences and the medical conditions they are claiming to prevent through these prophylaxis doses are relatively new. How did they gather evidence?”
Drugs used in modern medicine must clear clinical trials for efficacy and safety before getting marketing approval. The larger problem with the government’s recommendation of alternative medicine is the lack of clinical data.
“We need a neutral body that looks at the data and studies,” said Bhan. “The problem here is that these advisories are directly coming from the government.”
The government’s health advisories suggest that people with symptoms of viral fever take the alternative medicines listed under the supervision of a registered doctor. However, a senior doctor from Mumbai said that by listing the names of alternative medicines the AYUSH Ministry is encouraging people to medicate themselves. “If a patient takes these medicines and his condition deteriorates and there is delay in seeking treatment, then who will be responsible?” he asked. “Already in India, people self-medicate, such an irresponsible step on the part of the government will make matters worse.”