Ashlesha, a 27 year old woman from Pune was diagnosed with diabetes when she was 8-9 years old. Desperate to get rid of her insulin doses, she looked up for alternative practitioners who promised a complete cure for the incurable Type 1 diabetes. “I was vulnerable enough to fall for it,” she told Decode.
She started taking kadhas (a mixture of various herbs and spices), juices, along with regular doses of unlabeled pills by a local unlicensed Ayurveda practitioner in the hopes of getting cured.
Within days, Ashlesha went on to lose a drastic amount of weight and was frequently hospitalised due to fainting spells. “It was only after I stopped taking those medicines, and resumed proper treatment that my condition normalised. This experience was a clear eye-opener for me,” she said.
Dr. Ritesh Gupta, Additional Director at Fortis CDOC Hospital for Diabetes and Endocrinology, told Decode about his own experience with patients: “The emphasis on a healthier lifestyle emanating from traditional systems might help, but when people give up their medications and seek alternative remedies, they sometimes experience adverse effects. I recently had a patient whose diabetes was very well controlled; he went to an Ayurvedic centre and started taking those medicines. His sugars went up very high and he had to be hospitalised.”
As many of these medicines come unlabeled, it is difficult to assess the full extent of their harm due to a lack of standardisation in the manufacturing of traditional drugs. “Some of these medicines even contain steroids, leading to a spike in hunger levels, and increasing body weight,” Dr. Gupta added.
Last month, the Supreme Court passed an order temporarily banning Patanjali, India’s premiere Ayurvedic products manufacturer, from publishing any further advertisements promoting its medicinal products. Meanwhile, the budget for the National Ayush Mission (NAM) has doubled in the 2023-24 budget, even as the health budget stagnates. These statistics have grave implications when it comes to public rationality.
As witnessed during the pandemic, health misinformation is rampant in India, bolstered by the unregulated landscape of alternative medicine and naturopathy. The popular embrace of traditional medicine in the global south has been difficult to refute, as it regularly comes under the garb of decolonization of medicinal knowledge, wrapped in bad-faith arguments around cultural reclamation, and not as a competing system of medicinal knowledge standing on its own merits. Away from this grim reality, misleading claims on social media continue to gain legitimacy, through fear-mongering and unsubstantiated, anecdotal success stories.
Figure 1. A paid ad claiming a kidney patient’s recovery through Ayurveda in 20 days. Figure 2. News report of a patient’s heart blockage getting cured through Ayurvedic therapy.
In February, over 100 scientists from the All India People’s Science Network (AIPSN) released a statement urging the need for a renewed commitment to evidence-based reasoning and the promotion of scientific temper in the country.
Especially during the Coronavirus pandemic, the lure of the curative abilities of low-effort, DIY remedies attracted a lot of traffic on the web, demonstrating a distrust in modern health systems. Google Trends indicates this spiking interest coinciding with the periods when cases peaked in the country during 2021-2022.
Figure 3. Spikes in search engine results for "home remedy" in 2020 and 2021, corresponding with periodical increases in Covid cases in India.
A survey conducted by Cyber Media Research (CMR) on behalf of an Indian health-related fact-checking platform, The Healthy Indian Project (THIP), revealed that three out five Indians were susceptible to misinformation when it comes to health advice. Sudipta Sengupta, founder and CEO of THIP, says the challenges of combating health misinformation in India are multi-faceted.
He pins it to a variety of issues, from the conflation of home made remedies for disease treatment, to unhindered branding of ‘herbal’ of ‘AYUSH-based’ tags to increase market value. “Thirdly,” Sengupta tells Decode, “the absence of research supporting what the texts of alternative medicine claims, this is the most tricky area. A majority of alternative medicine procedures can be written off just because of the absence of research supporting them. The challenge here is should fact checkers label them as ‘False’ because research evidence is absent OR should we consider the aspect of ‘documentary evidence’ and being ‘time tested’? Can we call what is written in the books of alternative medicines as ‘false’ while it is an approved medicinal field in India? This area leads to experts colliding with each other on public forums thereby creating more confusion among citizens.”
This confusion is long-standing, and is compounded by problems of standardisation.
Devika Malik, who has served as Meta’s public policy manager for South Asia, told Decode about roadblocks to more robust health-based fact-checking. “Reliance on third-party fact checkers to enforce on misinformation limits the company's capability to contain health misinformation at scale,” she said. “Local fact-checking organisations are constrained by and often struggle to obtain IFCN accreditation which is required to be on-boarded as a Fact-checking partner with Meta so the company has a smaller pool of organisations to help with fact-checks on many jurisdictions in the global south. Fact-checking health misinformation requires specialised expertise - few independent fact-checkers are able to build that expertise and workstream and are focused on political/ social misinformation which is relatively easier to verify. In markets like India where there is a multiplicity of local languages, it's even harder to find qualifying partners that have regional language competence and socio-cultural context.”
The Trouble With The ‘Decolonization’ In Medicine
Several indigenous scholars have warned repeatedly against using the term ‘decolonization’ too broadly and carelessly, devoid of practical concerns about its implications. Meera Nanda, a historian of science, talks about the postcolonial scholarship that was complicit in the generalisation of the universal consensus around Western science as a simplistic assertion of colonial hegemony. Hence, any challenge to this evidence-based paradigm of science would be seen to come from a decolonial lens. Nanda notes that the origins of pseudoscience in India played a two-faced game:
“This two-step dance – claiming scientific legitimacy but avoiding scientific scrutiny – is precisely the operating principle of the AYUSH ministry. The same ministry that was furiously whipping out “scientific” evidence for COVID medicines, has no compunction in declaring Ayurveda to be a “holistic science” that can’t be tested by double-blind clinical studies.”
This analysis sits well with what is happening today. When clinical trials are conducted for Ayurvedic drugs, they do not match up in terms of robustness of procedure.
In 2021, a group of doctors and public health activists wrote to the Medical Council of India (MCI), concerned about the violation of ethical norms in the clinical trial of Coronil, which was being promoted as an Ayurvedic cure for Covid. The concerns included the absence of a risk-benefit analysis (mandatory before study authorization), as well as inclusion of subjects who had not even tested positive for Covid through PCR tests.
Patanjali was later asked to stop advertising the cure; they then rebranded it as an immunity booster, despite having faced severe public backlash.
As explained in this thread, a study conducted by Ronak Borana, analysing 9143 clinical studies registered in the Clinical Trial Registry of India (CTRI) between 2007 and 2021, raises serious questions. The resulting comparison between Ayurvedic and modern pharmaceutical drugs showed gaps in sample sizes and experimental parameters, among other things. Hence, unsubstantial evidence is both claimed to provide scientific grounding and explained away as a way of the exceptionalism claimed by tradition.
Dinesh Thakur, whose organisation, Thakur Foundation, funded the study, was also part of a group of concerned persons who wrote to the Medical Council of India (MCI) about the disregard of ethical norms during Coronil’s clinical trials. Decode asked Thakur if there have been any updates. “There has been no acknowledgement, much less a response from the MCI. More importantly, the Ministry of Ayush, which has actively promoted and spent public tax money on this supposed ‘cure’ hasn't uttered a word yet about how it was developed, promoted and sold to unsuspecting people.”
Unregulated Ads Feeding Into a Growing Infodemic
Regulation has been lax when it comes to countering dubious advertisements contradicting the Drugs and Magic Remedies (Objectionable Advertisements) Act of 1954. The law prohibits any advertising dealing with “remedies alleged to possess magical qualities” that give a false impression to the public with regards to diagnosis or curative abilities. This includes 54 diseases, such as cancer, plague, epilepsy, and sexual potency.
However, social media remains replete with accounts and platforms confidently peddling drugs and supplements without any evidentiary benefits.
Figure 4. A video screenshot Satvic Movement's YouTube channel, advising on a 4-step method to reverse diabetes.
A channel run by a health-influencer couple, Satvic Movement, aims to promote a lifestyle based on Ayurvedic principles. In one of their videos, they claim that reversing diabetes through their prescribed 4-step model is possible. With a following of 6.34M on YouTube, they garner significant views, and sale items on their official website include enema kits to ‘cleanse’ the intestine through self-administration. The channel, which promotes itself as a ‘holistic health education platform’ has recently gained momentum on its Instagram page as well, touching base with 1.6M followers.
The channel did not respond to Decode's queries regarding veracity of some of its claims and health advice being prescribed for a variety of ailments.
Youtube’s medical misinformation framework takes into account three things: prevention, treatment and denial-based health misinformation. In their long-term vision, Youtube notes that while “medical guidance can change over time as we learn more”, the company is committed to ensuring that when it comes to “areas of well-studied scientific consensus”, the platform is not used to spread harmful information.
Heightened expectations from platforms for improving their handling of health information might be misplaced, as the post-pandemic reality is treated differently. As Devika Malik, who is also part of the Stanford Internet Observatory’s Trust and Safety Teaching Consortium, added, “In a global health emergency like Covid-19, these external signals are clearer and more readily available from centralised, standardised, authoritative information sources like the WHO. The company also instituted more granular policies around vaccine-hesitancy, covid-denial etc, so that covered a broader sweep of harmful content. From the prevalence of intuitively false content on the platform [...] it would appear that policies and processes around non-covid related health misinformation are weaker in effect.”
The Burden of Countering Health Misinformation
Dr. Cyriac Philips, who goes by the X handle @theliverdr is one of the few medical professionals who is fighting back. His account regularly attempts to dispel myths surrounding alternative medicinal cures in India. And in response, he regularly receives threats and abuses.
In this tweet, he talks about a patient who was prescribed a herbal concoction by an Ayurvedic practitioner, packaged in brown paper, without an ingredient list or any medical labelling. The person soon contracted jaundice.
Another doctor, an oncologist, lists the needless suffering of a patient who delayed seeking conventional treatment for treating rectal cancer. The result was severe anaemia, loss of vision and damaged kidneys. Countless other such accounts flood the internet.
Figure 3. Source: @Geeky_Foodie
Under the banner of “holistic health”, method-based diagnosis is being sidelined, luring populations into thinking that “chemical free” and “herbal” routes to reversing serious diseases are viable options. Instagram influencers with hyperlocal reach have been instrumental in making the doctor’s opinion irrelevant, encouraging people to self-diagnose, regularly marketed with a sales pitch ready to deliver you from your health concerns.
In 2017, the AYUSH Ministry signed a Memorandum of Understanding (MoU) with the Advertising Council of India (ASCI), to rein in misleading ads made in print and TV media. However, repeated petitions by drug manufacturing bodies have deterred the adoption of a legal clause inserted to ensure pre-clearances for advertisements. ASCI data published for April-September revealed healthcare to be the most violative sector, with a 22% rise in ads boasting of magical remedies, both directly illegal and promoting misinformed public opinion.
Decode spoke to Manisha Kapoor, the CEO and Secretary General of ASCI, who affirmed that unsubstantiated claims through social media influencers must ensure that “the information they share is accurate, evidence-based, and in line with regulatory guidelines.”
Kapoor further told Decode, “To address testimonials or anecdotal promotion of any product, it is crucial to know if the claims can be substantiated. Advertisers need to furnish strong evidence to substantiate any claims regarding the effectiveness or advantages of the products they advertise. [...] ASCI continuously monitors influencer advertising and guides to ensure compliance with advertising standards.”
While these aren’t novel, post-pandemic anxieties have further aided traditional medicine, which has been able to successfully leverage vulnerabilities of existing public health infrastructure. Without regulators and fact-checking organisations catching up, alternative medicine runs the risk of not just running a parallel healthcare ecosystem, but overtaking it, when it comes to public trust and reliance.
Alternative medicine has a history of providing patchy, low-quality, anecdotal evidence as final proof, banking on its historicity and cultural value. This mixture of nationalistic claims of civilizational superiority and politicisation of the scientific method is a fatal one.