We have to ensure that Uttarakhand’s new project stays true to the spirit of a scientific pursuit and doesn’t end up being yet another botched experiment.
Ayurveda has its takers as well as its success stories, but some of its manifestations of late have left much to be desired. The most recent case was of BGR-34, the state-sponsored anti-diabetic drug whose clinical trials were anything but; whose marketing strategy reeked of incompetence at least; and whose patent is nonexistent. Nonetheless, Ayurveda’s practice persistently strives to seem rigorous and logical. A quick scan of the literature throws up many papers trying to explain how it works – not all of them are faffing (and we’ve underestimated the conviction of many of those who are).
However, a lot of the legitimacy that has remained with this indigenous system in the age of evidence-based medicine goes out of the window when its supporters commit a rookie mistake: being convinced of an answer and then drafting the question that will fit it. A case in point being the Uttarakhand government’s announcement that it will invest Rs 25 crore starting August 2016 in looking for the mythical plant sanjeevani booti, described in the Ramayana as being able to deliver even an ailing god from the edge of death to the prime of life.
This, no matter that Ayurveda, Unani, allopathy, homeopathy, phytotherapy, etc. has always been wary of claims of something so pharmacologically versatile. As Uttarakhand’s minister of traditional medicines, Surendra Singh Negi, put it: “We have to try, and it will never go to waste. If we are determined we will certainly find it.” He is hopeful his determination alone will conjure up the cure-all, demonstrating a persuasion that forestalls the scientific method’s ability to keep us from fooling ourselves.
This announcement wouldn’t be worth discussing if not for its backing and the investment of Rs 25 crore. There are enough people around the country with goofy claims of plants being able to do incredible things. It only begins to hurt when they get access to unsuspecting people’s lives, to power and money. The amount (equal to what was spent in 2014 to modernise Ahmedabad’s police force) may not seem like much relative to what the pharmaceutical industry invests every year in discovering new drugs, but it does have a more intangible implication: of validating whatever it is going to be spent on. And it is this implication that we must persist in scrutinising.
Potential for integrative medicine
The search for sanjeevani is not unprecedented. In 2008, Acharya Balkrishna announced that he and his colleagues at Patanjali Yogpeeth, the yoga centre in Haridwar run by Baba Ramdev, had discovered a particularly potent version of the plant called mrit sanjeevani. And though Balkrishna declares that a patent was filed for it, a search of the IP India database says nothing of the sort was granted. No surprises there: how do you patent a plant? And worse than in the BGR-34 case, no records of the plant being tested on humans or other animals are available.
In the wake of Uttarakhand’s announcement, Balkrishna and his associates have said they’re looking forward to what other plant will be found.
In 2014, a scientist out of the Defence Institute of High Altitude Research, Leh, similarly claimed that another plant, Rhodiola rosea, could cure altitude sickness, alleviate depression and protect against gamma radiation arising from biochemical warfare. The last one is a very drastic claim to make and for which little evidence was presented. It was on the back of this that the scientist suggested the plant could be sanjeevani.
Competition is good only in controlled environments where people can’t act arbitrarily and there are attainable incentives. The revival of Ayurveda that came with the Modi government’s election in 2014, however, seems to have been a boost for the many interested only in the revival itself. These ‘practitioners’ refuse to subscribe to any of the means by which humankind has come to manufacture accessible medicines that work in a largely predictable way. Competition in a sphere that rejects these means – of double-blind clinical trials, robust statistical analyses and open access to well-formatted data –is a race for something else, not any truths.
Worse, such acts delegitimise whatever constructive and meaningful experiments there have been to find Ayurvedic solutions. And this has been done simply by repeatedly rejecting the legitimate means of amassing evidence. As the mathematician Manjul Bhargava has argued, what this means is that we are only qualified to reject certain studies that claim Ayurveda can do X or Y, not reject Ayurveda itself. He’s right – most of us don’t exactly understand what’s going on. At the same time, time and money continue to be limited.
The July 25 issue of the journal Current Science has a special section on integrative medicine: using Ayurvedic formulations to enhance allopathic treatments. In a preface, its authors make three relevant points:
- The outcomes of integrative medicine studies should be comparable in quality to those of a conventional randomised control trial (RCT).
- “A large case series using objective outcome measures could only be possible subject to improved funding opportunities in India.”
- Despite funding limitations, some institutions have been able to conduct studies with outcomes comparable to that of an RCT.
They then go on to report a slew of such studies as well as complementary efforts to make them more reliable. These include efforts to improve patient selection, use good experimental guidelines, improve understanding of the pathophysiology of diseases, persist with intense clinical work, and incorporate known pharmacological techniques to improve results. Even if the same preface notes that the WHO has acknowledged double-blind techniques are insufficiently equipped to resolve issues in traditional medicines research, it also takes the logical next step: to discuss why these flaws arise and what alternate systems of investigation can be put in place.
Consider one search for sanjeevani, conducted in 2005 by researchers from Andhra Pradesh, Madhya Pradesh and Bihar. They identified a plant, Selaginella bryopteris, known to grow in the Aravali range of mountains in India’s northwest, and the ability of an aqueous solution of its extract to mitigate “stress-induced complications”. Though they weren’t able to explain how exactly the extract had these effects (in rats), they wrote: “… the presence of certain ingredient(s) with antioxidant and mitogenic properties is possible in the herbal extract. These ingredients may try to maintain the integrity of mitochondrial membrane by scavenging [reactive oxygen intermediates]. This is supported by results of chemical analysis of the herbal extract that revealed the presence of a number of components, including sugar, phosphate and protein.”
At the time, G.S. Mudur quoted Sumar Khanuja, director of the Central Institute of Medicinal and Aromatic Plants, Lucknow, in The Telegraph as saying, “Many plants with dark green leaves make a class of substances called complex terpenoids which have anti-oxidant properties. But there is no hard evidence to label either this plant or any other plant as sanjeevani.”
Toward measurable, verifiable outcomes
A subsequent investigation by three researchers from the University of Agricultural Science, Bengaluru, and the College of Forestry, Sirsi, in 2009 addressed just this question. Their paper reporting the results includes this representative and reassuring line in the introduction: “… the spirit of science shall be to capture on these possibilities [of the plant’s existence], however meagre they could be, than to wrongly assume that all things unknown to science do not stand a chance.”
The trio enlists the help of historiographic, linguistic, geographical and botanical wisdom to shortlist two candidates for sanjeevani: Desmotrichum fimbriatum and S. bryopteris. As an ultimate arbiter, they then apply the ‘doctrine of signature’, popularly known as the tenet ‘similar cures similar’, to figure sanjeevani – akin to its effect in humans – must appear to be able to resurrect itself. This left a sole winner: S. bryopteris. The paper concludes thus:
“… we have not addressed here the issue of whether or not sanjeevani exists. Rather we have proceeded on the assumption that if it be true, we should not miss out on such an important resource and on the logic that the cost of searching is worth even if we fail in our attempts compared to the benefits we may derive if it be true. Further, we are aware that our search may not be complete and our approach may not be the best; there may be other, better ways of searching which we think are worth attempting. However, with the criteria and we set up for the search, it appears there are at least two species, viz. S. bryopteris and D. fimbriatum as potential species representing sanjeevani, on which more work could be attempted.”
In effect, the authors of the study haven’t attempted to find out if the plant works the way it does nor that it has the effects the Ramayana claims it has (assuming it is in fact the plant we’re looking for). So we still don’t have a final word (insofar as a final word is possible) if sanjeevani exists, even as Negi the minister seems to think it does. But then, we do have the next best thing: a reliable clue.
It’s in the interest of public administration to have measurable, verifiable outcomes. This is not just so we can hold decision-makers accountable but also to ensure that a project stays true to the spirit of a scientific pursuit and doesn’t end up being yet another botched experiment. To this end, the Uttarakhand government has to place in the public domain, at all times and for no cost, the details of the search. This includes but isn’t limited to the basis for the search, how the plants are being identified, what tests the samples are being subjected to, the experimental guidelines being followed, the experiments that are being conducted, the data collected in all these tests, and the contact details of those involved in the project.