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 Table of Contents  
GUEST EDITORIAL
Year : 2020  |  Volume : 14  |  Issue : 4  |  Page : 3-7

Answering a critical question: Are Ayurvedic medicines against COVID-19 Placebos?


Department of Environment, Government of Rajasthan, Jaipur, Rajasthan, India

Date of Submission02-Aug-2020
Date of Decision04-Nov-2020
Date of Acceptance05-Nov-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Deep Narayan Pandey
Department of Environment, Government of Rajasthan, Secretariat, Jaipur - 302 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_274_20

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How to cite this article:
Pandey DN. Answering a critical question: Are Ayurvedic medicines against COVID-19 Placebos?. J Ayurveda 2020;14:3-7

How to cite this URL:
Pandey DN. Answering a critical question: Are Ayurvedic medicines against COVID-19 Placebos?. J Ayurveda [serial online] 2020 [cited 2021 Apr 13];14:3-7. Available from: http://www.journayu.in/text.asp?2020/14/4/3/304914




  Introduction Top


The first case of the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome–related coronavirus 2 (SARS-COV-2) was reported by China in December 2019.[1],[2],[3] The pandemic has spread globally with more than 45.42 million confirmed cases and 1.18 million deaths as of November 1, 2020. In India, there are 8.13 million cases and 0.12 million deaths during the same period. Despite worldwide research efforts, and more than 65,862 research publications in the Scopus database, there is still no known, clinically proven, and evidence-based medicine or vaccination against COVID-19 in any system of health care. Widespread failure of so called mainstream conventional medicine is evident globally now. Thus, available drugs from all systems of medicine, including Ayurveda, must be explored and employed against COVID-19. Like other systems of medicine large efforts are underway on preclinical and clinical research in Ayurveda. A great deal of progress has been made.

Interestingly, claim made by some sections of conventional medical practitioners that Ayurvedic drugs were no better than placebos[4] is erroneous, flawed, and motivated. Indeed, what may turn out to be placebo is the standard protocol being promoted by modern medicine (also called biomedicine, conventional medicine, mainstream medicine, orthodox medicine, Western medicine, or allopathy) against COVID-19 in India. These medical practitioners continue to use drugs such as hydroxychloroquine (HCQ) for COVID-19, even though there is neither any evidence for their efficacy nor they are safe for patients. Drawing on the Ayurveda classics, contemporary scientific studies, and experiential knowledge, here, we provide an analysis of COVID-19 and Ayurveda. We hope this will help further employ Ayurveda to serve the humanity in times of pandemic.


  Ayurveda Perspective on COVID-19 Top


In Ayurveda classics, there is an elaborate description of causation and management of epidemic (Janapadodhwamsa).[5],[6],[7] Clinical profiling of COVID-19 is necessary to provide both preventive and therapeutic insights. Research efforts have now established clinical profile, although there is no unanimity as yet. One of the most important efforts by a team of Vaidyas and physicians from biomedical system suggests that the disease should be considered as vātakapha dominant sannipātajvara of āgantu origin with pittānubandha.[8] This study also described the asymptomatic, presymptomatic, mild, moderate, severe, and critical stages of COVID-19 along with differences in clinical presentations on the basis of nidāna, doṣa, dūṣya, nidānapañcaka, and ṣaṭkriyākāla.[8] Many studies have arrived at similar conclusions.[9],[10],[11],[12] Another important study by the team of Vaidyas and scientists from the National Institute of Ayurveda has suggested that COVID-19 has an analogy with the Rajayakshma with suboptimal immune response.[13]

On the scope for Ayurveda against COVID-19, in one of the earliest publications on the subject, a plan for graded response, depending on the stage of infection among individuals, in a population was proposed. This pragmatic strategy classified people into four groups – unexposed asymptomatic, exposed asymptomatic and quarantined, with mild COVID-19 symptoms, and with moderate-to-severe COVID-19 symptoms – and accordingly provided a management regime.[12] It has also been argued that the supremacy conferred on biomedicine, notwithstanding the fact that it does not have a proven cure, required that Ayurveda interventions must be allowed on similar principles. Despite having a large potential, and despite having kept India reasonably healthy for 5000 years, if Indian people fail to extensively employ the world's longest surviving health-care system to treat COVID-19, it will be a great loss to humanity.[12] There are a reasonable number of publications that provide enough guidance and evidence that Ayurveda may indeed be helpful in the treatment of COVID-19 patients. These publications include both prophylaxis and therapeutic interventions. On prophylactic or preventive aspects, scientific evidence based on long-term research indicates that Ayurveda rasayanas and other Indian medicines can be a potential candidate for the management of COVID-19 cases.[14],[15],[16],[17],[18],[19] A protocol along with supporting evidence has been presented on prophylaxis which also analyzes and supports the guidelines issued by the Ministry of AYUSH, Government of India.[18] Potential usefulness of Ayurvedic and Unani herbs against COVID-19 has also been described.[20],[21],[22] The evidence of known case of a COVID-19-positive patient treated entirely with Ayurveda is also available.[10] Thus, there is every reason that Ayurveda must continue to be employed for the treatment of COVID-19.


  On the Fear of Self-Medication Top


A fear has been raised that promoting Ayurveda may increase self-medication and thus hamper public health efforts. Such claims are common and require careful examination. It has been recently contended that any claims on the part of traditional health-care systems such as Ayurveda may promote self-medication, particularly among those with symptoms of acute respiratory illness, fever cough, or shortness of breath, and therefore, exacerbate the risk of spread of infections. This may hamper public health efforts to contain transmission and thus may be detrimental to screening, quarantine, and surveillance, as well as a hindrance to promote research and practice of integrative medicine.[23] These are valid assumptions but discriminatory against Ayurveda. Condemnation that self-medication is entirely a problem of traditional medicine constitutes an epistemic injustice in itself. Self-medication is not only the problem of Ayurveda. Indeed, deep concerns have been raised that an endorsement by the highest scientific body of India as well as the political leadership in the USA created an overly optimistic belief of the effectiveness of HCQ among masses.[24] Consequently, due to self-medication, markets in the USA went into short supply of both HCQ and chloroquine. India is no exception to this dangerous self-medication of by the public.[24] Indeed, in times of COVID-19 pandemic, self-medication with conventional medicine is a global challenge.[25] Accordingly, blaming Ayurveda alone and ignoring the widespread self-medication in conventional medicine are flawed. Determined efforts in educating the population at large about this menace of self-medication may prove useful instead of the blame game.


  Are Ayurveda Medicines no More than Placebos and Conventional Medical Guidelines Unequivocally Evidence-Based? Top


As noted in the beginning, a surprising statement was recently made by some organizations from the conventional bio-medical establishment that Ayurvedic drugs are merely placebo.[26] It is worthwhile and ethical to ask a counter question: Which of the 65,862 papers published on COVID-19 till November 1, 2020, have supplied the evidence used to support the prevailing standard medical guidelines and practices followed in India for the management of COVID-19?[27] Indeed, it would be in larger public interest that organizations making erroneous and flawed statements against Ayurveda remain humble. One finds that the prevailing guidelines and practices that have been promoted over the course of a pandemic by conventional medical establishment do not have any support in published science. To our knowledge, no meta-analysis of clinical trials provides any evidence whatsoever that one can quote unequivocally in favor of standard COVID-19 protocol. Indeed, the evidence for contrary is now large. For example, results of a systematic review and meta-analysis of 53 randomized trials in COVID-19 and other diseases find that HCQ is associated with a high total risk of adverse effects compared with the placebo or no intervention in the overall population.[28] Furthermore, SOLIDARITY Therapeutics Trial, coordinated by the World Health Organization, indicates that remdesivir, HCQ, lopinavir, and interferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.[29]

Indeed, reviewing all the studies is beyond the scope here, but suffice it to say that there are a large number of robust studies providing evidence that several guidelines and practice of standard care are indeed not based on reasonable scientific evidence.[30],[31],[32],[33],[34] Results of a recent meta-analysis suggest that HCQ alone did not reduce mortality in hospitalized COVID-19 patients, and further, the combination of HCQ and azithromycin significantly increased mortality.[35] Furthermore, another meta-analysis showed no benefit on viral clearance, although a significant increase in death was observed with HCQ in patients with COVID-19, compared to controls.[36] HCQ actually is no different than the standard of care alone in patients admitted to hospital with mainly persistent mild-to-moderate COVID-19. In addition, treatment resulted in higher adverse events in HCQ recipients than in non-recipients.[37] HCQ has failed even as prophylaxis. After high-risk or moderate-risk exposure to COVID-19, HCQ did not prevent illness compatible with COVID-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.[38] Hence, in the interest of global common good, it is always desirable to respect science, avoid promoting pseudoscientific treatments in the COVID-19 pandemic, be modest to accept, and let every system of health care serves the humanity.

This officially endowed supremacy to conventional medicine, regardless of the fact that it does not have a proven cure, demonstrates the epistemic injustice against Ayurveda. It is a common knowledge that Ayurveda originated in India several thousand years ago and continues to serve the humanity. This injustice against Ayurveda, and aggressive promotion of conventional biomedical system, may be disastrous in the long term. This epistemic injustice requires to be corrected forthwith.[39]


  Studies in Ayurveda and COVID-19 Top


While there are a large number of studies on various medicinal herbs and formulations that have been published, clinical studies are currently limited because clinical trials in Ayurveda did not receive the required facilitation from the early days of the pandemic. There are a large number of clinical trials registered in the Clinical Trials Registry of India,[40] and it is expected that outcome of these researches would become available in public domain soon. However, a few studies that have already appeared provide useful insights into the usefulness of Ayurveda and integrative approach.

That known case of a COVID-19 positive patient who was the first to treated entirely with Ayurveda[10] should have actually encouraged the health-care policymakers to quickly use Ayurveda to bring the COVID-19 pandemic under control in India, as they seemed to have demonstrated it in China with Traditional Chinese Medicine.[10] Another case report on the outcomes of Ayurvedic care in a COVID-19 patient with hypoxia may provide useful guidance.[41] The report provides for the first time, the successful outcomes of Ayurvedic intervention in a COVID-19 patient with severe hypoxia requiring supportive oxygen therapy. This provides hope that Ayurveda care may be useful as a first-line cost-effective and efficacious option for COVID-19 patients presenting with hypoxia in an integrative setup. Since the patient had a high risk for progression to severe disease condition because of many comorbidities, the favorable outcomes with Ayurvedic treatment are significant.[41] Another useful prospective clinical study of an Ayurveda regimen in COVID 19 patients has recently appeared.[42] In this study, 112 patients were screened as per the inclusion criteria, 11 failed the screening, and finally, 101 patients were recruited in the trial. Two patients complained about difficulty in swallowing the tablets and were discontinued on day 3. Ultimately, among those 99 patients that completed the study, 60 patients received Ayurveda regime as add on and 39 patients received only standard care. The study found that the median day of admission from the onset of symptoms was 6th (range: 1st–12th) in the treatment group, while it was 5th day (range 1st–16th) in the control group. Patients with comorbidities such as diabetes and hypertension were 90.04%. Asthma and hypothyroidism were observed as other comorbidities among the rest. The patients suffering from breathlessness fell from 53% to 16% to 1.6% on days 1, 3, and 7, respectively, in the treatment group. In the control group, the percentage fell from 46% to 38% to 28% only. Ageusia reduced from 75% to 25% to 3.3% in the treatment group. In the control group, it dropped from 46% to 36% to 26%. Overall, prompt clinical improvement in breathlessness was seen with the add-on Ayurveda regimen. The duration of hospital stay was also reduced. Thus, insights from this study demonstrate the potential of Ayurvedic therapy in treating COVID-19 patients.

Even the widely promoted nonpharmaceutical interventions against COVID-19 including quarantine, cordon sanitaire, and social distancing and healthy lifestyles have their origin in Ayurveda.[43],[44],[45] These are erroneously thought to date back to the 14th-century Europe.[46],[47] In reality, these originated in India back in the 5th century BC. In a city now known as Varanasi, a legendary teacher and king of Kashi, Lord Dhanvantari explained to a class of his students about how infectious diseases spread and what needs to be done to contain social spread of infections. The renowned scholar of Ayurveda and surgery, Sushruta, was one of the students in the class. He compiled one of the most ancient scientific treatises of surgery and science of life known to humanity. This treatise, now known as Sushruta Samhita, made Sushruta the father of surgery. About the infectious diseases, Sushruta notes contact with the body of the infected person; breathing in the air containing the exhaled air of patient; eating, sleeping, and sitting together; and using cloths, garlands, and cosmetics used by an infected person – all these actions transmit diseases such as skin infections, fever due to infections, pulmonary tuberculosis, ophthalmia or conjunctivitis, and other contagious diseases from one person to the other (Su. Ni. 5.33-34). Consequently, complete avoidance of these actions is necessary to prevent the transmission of infectious diseases in community.


  Way Forward Top


Scientific advancements occur only when the knowledge produced by a scientific enterprise is robust, irrefutable, and unequivocal.[48] This applies equally to both Ayurveda and conventional medicine. This is important to understand that every health-care system existing and practiced in the world has a primary motive of providing optimal health care to their followers. A health-care system having an uninterrupted history of its practice and knowledge transference for over five millennia itself speaks about the potential utility it may possess. There can be epistemological differences of looking at the same phenomena which are understandable on the basis of historical evolution of the knowledge, but knowledge cannot be refuted simply for the reason that it is not understandable by the people who believe in another set of philosophy. It is now high time that perpetual animosities between Vaidyas and Allopaths should end for the common good of the humanity. The solutions to resolve the COVID-19 pandemic are complex, multifaceted, and recalcitrant and therefore require evidence-based decision-making on multiple fronts. A way forward would be to acknowledge that scientific research has strengthened evidence base, yet if Ayurveda was nonscientific, it would not have survived 5000 years. Denial of this evidence, as well as evidence from the contemporary studies, is indeed a form of pseudoscience. We must draw on all systems of knowledge rather than be enslaved by western medicine that currently lacks both evidence and directions.

Acknowledgements

I am grateful to Prof. Dr. Sanjeev Rastogi, Department of Kaya Chikitsa, State Ayurvedic College and Hospital, Lucknow; Prof. Dr. Pawan Kumar Godatwar, Department of Roga Nidana, National Institute of Ayurveda, Jaipur; and Neha Pandey Prakash, Yajurvid Pharma, Jaipur for their insightful suggestions. The views expressed here are personal and driven by the Principle of Global Common Good. They do not in any way represent the views of the institution or service to which author belongs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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