"We aren't questioning Ayurveda at all, we're questioning Ayurveda's effectiveness in COVID-19. Even with modern medicines, people are questioning its effectiveness," said Dr R V Asokan, secretary general of the Indian Medical Association.
The Indian Medical Association wrote an open letter to the Union Health Minister, Dr. Harsh Vardhan, questioning the validity about the AYUSH clinical management protocol for prevention and treatment of COVID-19 that was released on October 6, 2020. Dr R V Asokan, in an interview with BOOM, discussed the effectiveness of Ayurveda to treat COVID-19 since it was not subject to the same studies for its efficacy like other modern medicine drugs.
While the Health Ministry advocates the use of Ayurveda for patients who are asymptomatic or have moderate symptoms, Dr R V Asokan doesn't think immune-boosting medicine, even Ayurveda can help combat COVID.
"There is a hyperimmune reaction from the body, or the exaggerated immune reaction of the body. So here we have a status, which is called a hyperimmune status, which is the patient's own immunity is killing the patient. So it is not a question of immune deficiencies, it's about the hyperimmune status. So this scientific principle has to be accepted. And it's well known. The Union Health Minister should keep this in his mind because he is a modern medicine doctor," said Dr R V Asokan.
The interview can be watched here.
Edited excerpts of the interview can be read below.
What is your concern or problem with these new guidelines from the government on Ayurveda or yoga?
The concern is on behalf of the patients, it's not a concern of the medical professional alone. The point that we are making here is that the government can make protocols, and it can be from any system of medicine but it should be supported by evidence, and any science has to have evidence. And if these protocols cannot be different for modern medicine, they cannot be different for Ayurveda. All systems have to have the same level of inspection and scrutiny. So we personally feel the strength of the evidence is important. For example, there was a huge discussion on the effectiveness of hydroxychloroquine. This was transparent and in the public domain, about what were the side effects, what the dose should be, what are the limitations and why it is not being prescribed in the Western countries while the ICMR is propagating it? So we need that sort of transparency in data here as well.
But the Union Minister for Health, Dr Harshvardhan, who released these guidelines says that these are in sync with ICMR (Indian Council for Medical Research) and Council for Scientific and Industrial Research in India.
Dr Harshvardhan himself said this is empirical if you read his statement. What this word 'empirical' means is anecdotal — which means suppose I feel some medicine is good, then I may use it in my practice. This cannot be accepted as a national protocol; because a national protocol has to have two important scientific standards. One, it should be replicable anywhere in the world by a team which does not have a bias or any conflict of interest; and second, it should pass through a double-blind control study.
Can you explain what a double-blind control study is? You've used this term in the past as well.
The doctor, who is using the medicine on the patient, and the patient, both of them do not know what medicine is used, it can be the placebo or a dummy pill. A double-blind study uses both in a group which is being studied, a placebo or a dummy pill, as well as the drug which is under investigation. So at the end of this randomised study, all the data points are pulled together, and then only a call is taken on whether the drug has been effective, more than the placebo.
You also call it a prospective study, why is that? When you say it is 'an independent prospective, double-blinded study,' does that have any relevance?
Prospective, means from day one, it will start now. Retrospective is when you go back and fiddle with some data and then produce it. When they say prospective, they have to design a study where people have to participate from now or from tomorrow.
So in this case, are you saying that drugs that we hear of — you mentioned hydroxychloroquine, or even dexamethasone, or remdesivir, they've all gone through the similar perspective, double-blind control studies?
Yes, absolutely, all drugs of modern medicine, go through all these studies and only then does the drug controller release these medicines.
So let me ask you the same question from a slightly different angle. So is there any evidence that shows that some of these medicines that have been recommended in the Ayurvedic context particularly are bad? Or have they done any harm or damage?
No, it's not about questioning Ayurveda at all. it's a question of a drug being effective in COVID. In relation to this particular illness, even with modern medicines, people are questioning its effectiveness. But all these things come from studies, thousands of studies have been published on COVID and other drugs across the world now. So that is how we know that methylprednisolone is effective, that dexamethasone is effective, all these things have come from double-blind control studies. So we are not questioning the drugs at all, we are saying that in COVID, what is their relation? Which studies have been used? What does the data on it say?
But if they (the ministry) are making a point about immunity about the use of Ayurveda medicines. Like saying how sipping hot turmeric milk, which many homes in India do in any case, helps boost immunity. This is done anyway in anticipation of flu or other seasonal diseases. Would you have a problem with this statement too?
It's for them to bring in the evidence, and especially in COVID. I think the layman has to understand a very particular thing. There are two stages. The first stage is the viral infection, the initial base, after that, there is a transitory phase, where it is quiet, nothing happens. After that, there is a hyperimmune reaction from the body, or the exaggerated immune reaction of the body. So here we have a status, which is called a hyperimmune status, which is the patient's own immunity is killing the patient. So it is not a question of immune deficiencies, it's about the hyperimmune status. So this scientific principle has to be accepted. And it's well known. The Union Health Minister should keep this in his mind because he is a modern medicine doctor. He knows what a hyperimmune reaction is.
But the wording here is more about addressing mild to no symptoms, which means that you may be positive or you may not even be positive, you may likely test positive later. This is not saying that this is trying to cure an advanced stage of COVID or let's say moderate to severe symptoms.
So, any disease can progress from mild to moderate to severe. How do you predict that this patient will not progress to severe illness? Today we know from day one when you diagnose COVID-19 in a patient, steroids or low molecular weight heparin, which is an anticoagulant, has to be sorted. There are two things which are happening, there is an acute lung injury, kidney injury, which is happening due to the immune reaction, which is an immune-suppression, not increasing the immunity, but decreasing the immunity by using steroids from day one. And this also causes clotting inside the blood vessels, throat, mainly in lungs, but blood clotting can be caused anywhere in the body. This clotting is the cause of all this morbidity and mortality. So for that, we are using anticoagulants, low molecular heparin.
This is in consonance with what I think everyone would say, at least in modern medicine, but the sense I'm getting from the government's position is that at this stage, when when you talk about unleashing the immune system or the immune system going haywire, or the cytokine storm, as it is known, perhaps, that comes later. All of this is really to maybe try and even prevent it and keep your immune system strong in a general sense of immunity. If it goes beyond that, I'm assuming even the Ayurvedic proposition here would say that now you have to hand over the case to a regular doctor or allopathic doctor.
Do you want one of the complications to manifest and then act? For example, if you test positive and would you wait for a cytokine storm to set in, or would you prevent it? There is enough evidence that steroids and low molecular weight heparin reduce the mortality count and morbidity. We have also seen that even as they recover if we had not used steroids or low molecular weight heparin, they'd have problems like pulmonary fibrosis and their capacity to live, maybe the life expectancy would have also gone down.
Let me then phrase the question differently. So, are you saying that if a patient tests positive, then this should not apply, but if a patient is not positive, which is regular life, the way we lead it, then some of these Ayurvedic medicines are okay?
Then they have to bring the evidence that in COVID these medicines produce a preventable effect. We are only asking for evidence, we are not degrading any system of medicine. We haven't used any word which is derogatory, we are asking only for evidence because if people ask for evidence from modern medicine, then every system of medicine should bring evidence (of prevention or cure.)
Right. So, Dr Asokan, its is now almost seven months up since the first case started coming in. What's your sense, as you look back? I mean, how much of this, even as a practitioner of modern medicine, how much of a better sense do we have in terms of understanding the progression of this disease. What is your advice to those who are watching in terms of what kind of precautions they should be taking even at this point, because after all, we have unlocked much more, even in the last maybe eight weeks or so?
The locking and unlocking have happened in the correct time. I think the role of the epidemiologists and the public health specialists at this stage of the epidemic is very limited, there is no longer a need to flatten the curve or anything. Right now its all about saving lives, and this is in the hands of clinicians. Even testing beyond a point has not produced any change or any materialistic change, for example, in United States has it reduced mortality? Now the only point is, we have to reduce the mortality, and it is the role of the clinicians to reduce mortality. Even testing should be only on the demand of the clinician or the treating doctor.
What is your advice to everyone who is watching? Should they take any Ayurvedic medicine or how do you keep yourself safe and reasonably well protected in these times?
The only way to protect yourself is to wear a mask properly. Because I find that many people don't wear it correctly — they don't wear it on the nose, and not wear it properly when you talk. So that is one. The second is hand hygiene. Wash your hands with soap and water, and do more than 10 to 15 times a day. These are two known scientific evidence-based advice.
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