As India struggles with one of the world’s worst COVID-19 outbreaks, thousands of doctors across the nation fighting to save patients amid shortages of oxygen, medicine, and vaccines wore black armbands on June 1 to call for the arrest of India's most popular yoga televangelist. Baba Ramdev, founder of a traditional medicine empire, is peddling unproven herbal pills and yoga cures for COVID-19, while calling modern drugs “stupid" and blaming the country’s hundreds of thousands of coronavirus deaths on modern medicine.
But far from being fringe, Ramdev has close ties to India’s Hindu nationalist government and has enjoyed the support of the health minister. Since the pandemic began last year, Prime Minister Narendra Modi’s government has been aggressively promoting Ayurveda—a traditional system of medicine with deep links to Hinduism that originated 5,000 years ago and is still widely practiced by hundreds of millions of Indians. Ayurveda uses plant-derived products, yoga, diet, and behavior changes to treat the mind and body, and is included in India’s official COVID-19 management protocol as a prevention and cure for the pandemic.
Recently, as vaccination has stalled in India due to drug shortages, the government began distributing a free, unproven formulation called “AYUSH 64,” an Ayurvedic pill made from four herbs that the government claims has "anti-inflammatory and immunomodulatory activities.” (The pill shares its name with the acronym for the government ministry of traditional medicine, which also means “long life.”) Some ruling party-linked lawmakers and religious groups have even advocated drinking cow urine and smearing oneself with cow dung to safeguard against the virus.
But as a second wave of the coronavirus has claimed the lives of 335,000 Indians as of June 2, according to the New York Times, alternative remedies that lack scientific evidence of efficacy are under fire from modern medicine doctors and even some prominent Ayurveda practitioners.
Ayurveda “was [India’s] first attempt at science," says M. Shafi Kuchay, an endocrinologist at the Medanta hospital in Gurugram, a technology hub outside the Indian capital. "But today it is inefficient,” he says, “especially in the absence of credible studies."
Hemant Toshikhane, one of India’s leading professors of Ayurveda, was among many who used to believe the ancient remedies could guard against the deadly coronavirus pandemic.
Starting in March last year, the Parul Institute of Ayurved & Research, which Toshikhane runs, distributed traditional herbs for fever and digestive disorders and medicated nasal drops to faculty and students to ward off the virus. There were some COVID-19 infections recorded last year in Waghodia, in the western state of Gujarat, where the institute is located, but none among anyone who received the kits, according to Toshikhane.
A year later, a devastating second wave of the pandemic has swept through India, bringing the number of deaths to some 4,000 people nearly every day from mid-April through May. Toshikhane dutifully handed out the herbal kits again, but this time, most people got sick anyway, he says, “so I stopped.”
Ayurveda, which translates from Sanskrit as “knowledge of life,” is based on the principle that the body is composed of the same five elements that make up the universe—air, fire, water, earth, and ether—“represented in the human body as doshas,” or problems, explains Toshikhane. “If the three main doshas—Vata, Pitta and Kapha—are not balanced, it leads to diseases.” Rebalancing these doshas is done by modifying lifestyle and diet. The three mental doshas—Sattva, Rajas, and Tamas—are treated with yoga and meditation. Ayurveda practitioners also treat disease with herb- and mineral-based medicines and surgery.
But there have never been conclusive studies on the efficacy of these treatments for chronic or infectious diseases. According to the National Center for Complementary and Integrative Health, part of the U.S. National Institutes of Health, aside from treating some pains and a few symptoms of type 2 diabetes, “there is little scientific evidence on Ayurveda’s value for other health issues.” Many studies on Ayurveda’s effectiveness are small, and few are published in peer-reviewed Western medical journals.
Even so, a large majority of Indians place faith in this ancient medical system. Nearly 80 percent used Ayurveda in 2018, up from 69 percent in 2015, according to a PricewaterhouseCoopers’ report on the resurgence of Ayurveda in India. The report predicts the country’s Ayurveda market will grow from $2.5 billion in 2015 to $8 billion in 2022.
India’s Hindu nationalist ruling party has long touted the healing powers of yoga and Ayurveda and in 2014, soon after taking office, Prime Minister Modi upgraded a department dedicated to the study of traditional medicine to the Ministry of Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy, abbreviated as AYUSH. These therapies got an additional boost when the World Health Organization greenlit trials for alternative COVID-19 therapies last September. India answered the call with more than 100 different studies examining the efficacy of various traditional medicines, including everything from therapeutic yoga positions to Kadha, a type of herbal tea consumed to fight coughs and colds.
But Rajan Sharma, an orthopedic surgeon and former president of the Indian Medical Association, says the studies lack credibility because of very small sample sizes. The pilot study on AYUSH 64, for example, was led by mostly government researchers and included only 140 people. The researchers concluded the herbal pill could treat COVID-19 because another study in the Journal of Ayurveda and Integrative Medicine found it effective for influenza-like respiratory illnesses. Even Ayurveda experts are now calling this into question.
A letter in the same journal noted the AYUSH 64/influenza trial studied a mix of modern and Ayurvedic medicines, making the claims of efficacy against flu-like illness “scientifically untenable since it is not possible to identify the drug that actually cured or brought relief to patients.”
Doctors have warned that unscientific practices, like smearing cow dung on one’s body, could be dangerous, leading to other infections, such as mucormycosis, known as black fungus. (Read about a rare black fungus infecting India’s COVID-19 patients.)
In 2008, the U.S. Food and Drug Administration cautioned Americans against using Ayurvedic products, because one-fifth were contaminated with lead, mercury, or arsenic. In 2017, the FDA had issued a safety alert against specific Ayurvedic medicines linked to two cases of lead poisoning in Michigan.
Hepatologists have long warned of the harmful effects of Ayurvedic and other traditional medicines on the liver. In a 2019 study, Jawad Ahmad, a professor of medicine specializing in liver diseases at Mount Sinai Hospital in New York, warned of rising liver injury and failure from increased use of herbal supplements, especially in Asia.
Ahmad notes people turn to herbal remedies because there are few options, and they want to "maximize their chances of survival," he says. "That’s just human nature."
This is exactly what happened in India. As COVID-19 cases surged, along with a shortage of hospital beds, drugs, and oxygen, so have Internet searches by those desperate for herbal remedies that might help.
Sharma, the former head of the Indian Medical Association, sees hypocrisy in pushing Ayurvedic pills and potions. Last year, when Shripad Naik, the minister of alternative medicines, tested positive for COVID-19, he opted for modern medical treatment at a private hospital.