“Foolish the doctor who despises the knowledge acquired by the ancients.”
Meeting ‘Tiddy’ was a momentous and stupifying event for me.
In middle school, about half a century back, we were a gang of three. The gang of Tiddy, Lambu and Motu was infamous for all the mischief that happened in the class. I was Motu, the sluggish one, who liked making plans. The other two were the active ones – the muscles. The name Tiddy (a grasshopper) was given because of his small frame and his penchant for pole-vaulting as a sport.Those were our most fun-filled days.
In the decades that followed, Lambu and I had remained in touch. We had lost track of Tiddy completely.
The chance meeting while waiting for a local TV’s educational talk show on ‘pain abdomen’ was a pleasant surprise. Both of us were invited to answer questions about how best to deal with pain abdomen in children. I was a gastroenterologist, while SKS (Tiddy) was a famous practising Ayurvedachrya. We recognised each other soon after meeting but remained formal before and during the talk show.
The inevitable Baba Ramdev
After the talk show, we broke the protocol to hug each other and decided to sit in the waiting room to catch up on the lost time. What started with reminisces about our fun-filled childhood, ended up in a debate on Ayurveda versus Scientific medicine! Did that affect the bonhomie between two long lost friends? Let’s see.
I was the culprit. I was the one who brought up the name of the famous Yoga Guru, Baba Ramdev!
Almost an hour had passed but neither one of us wanted to leave. Our exchange of information about our families and other major life events was over. We had reached that momentary silence when we couldn’t muster up any more personal questions. At this juncture, I remarked, “Your Baba Ramdev says that allopathy has killed more patients than COVID-19 itself.”
Prof SKS was no more a Tiddy now! Diminutive and marasmic in childhood, he had grown 4 inches taller than me to become a 6 footer and was still very athletic at this age. Must be the effect of Yoga practices I surmised.
SKS Laughed, “Baba is playing Aikido”
“What is that?” I asked.
He replied mirthfully, “Aikido is Japanese martial art that focuses on tenkan (turning) movements among other techniques. It is done to redirect the opponent’s attack momentum against him.” 2
“I am impressed by your Japanese knowledge!” I said playfully.
He did not pay any attention to that, “You may prefer to call it vitanda! As per Nyāyasūtras, vitaṇḍā is a method of debate where you exclusively talk about opponent’s weakness to win the argument.[https://www.wisdomlib.org/definition/vitanda] Not like you!”
“What do you mean – not like you? What have I done?” I was taken back.
Ayurveda versus Allopathy
“AC, you were the one to glorify Swami Ramdev earlier!” 3
I was glad he did not address me as Motu! I had written a paper in 2007 about how Swami Ramdev can help our patients. But I had never glorified him. Tiddy’s remark also told me that at least since 2007, he knew where I was and had made no attempt to contact me.
I repeated my point, “How can he say that allopathy has killed more patients than COVID-19 itself.”
He calmly replied, “Well, statistics will prove it. It is not just a rhetoric.”
I wanted to keep the discussion light, “Does anyone have statistics in India about COVID-19 at the macro level? These are strictly controlled by the Government, possibly to avoid panic in the public. I think he said it just as a means to promote Ayurveda!”
SKS was unmoved, “It’s a clever way to put it. But his assessment is likely to be correct!”
“What?” I was now up in arms.”Et tu, Tiddy?”
“SKS, that is an honest audit with an aim to improve the system! You can’t quote it out of context.” I could not believe it.
“AC, may I remind you of the Israel story?” He retorted with a mischievous smile.
“What is that?” I asked. But I knew what was coming and I was afraid it would cut my argument down to size,
SKS responded, “The number of deaths during the doctor’s strike had drastically fallen. So much so that morticians fearing a huge loss of revenue brokered the ending of the strike. 9 This is not an isolated incident. One wonders why death rates always fall whenever doctors go on strike!10,11,12
I was now feeling irritated. “You will side with him anyway, isn’t it?”
“I have no reason to side with anyone.” He was defensive for a moment.”If I was in his place, I would not say that.”
“Why?” I asked.
“Because everyone can see through his motive. He is an interested party, with an axe to grind.” He replied.
“I am not clear. What do you mean?” I asked him to clarify.
He explained. “AC, Baba Ramdev is the brand ambassador for Patanjali, the FMCG company. The company is rapidly losing market space due to declining sales.13,48,14,15 So he has to stir up something to remain in news!”
“But do you think he is right?” I confronted him again.
“AC, almost everyone with severe COVID-19 has been treated in hospitals by scientific medicine. We refer to it as allopathy in colloquial language.16 Nearly all deaths due to COVID-19 patients would be occuring either in your hospitals or while waiting for admissions in your hospitals. Meanwhile, you also had people dying with other diseases in your hospitals.” He was patching up the statistics for argument.
I defended my stance. “Does that give him the right to say that more people must have died at our hands than total deaths due to Covid-19? As a poetic justice, he was forced to apologise for it the very next day when IMA confronted him.”
“That would be a tactical withdrawal,” SKS said in a cool voice. “Let me also try my hand at Aikido! I will quote you some of your writings so that you cannot refute me. You have accepted in the past that the way you practice medicine is full of loopholes, isn’t it? Anyone with some knowledge can point fingers at you.”17
Where does Ayurveda Stand?
“So, you are now a proponent of complimentary and alternative medicine?” I asked. I was realising that his tactic of quoting me was going to make it difficult for me to give a rebuttal.
“Obviously! I have taught Ayurveda all my life. But you allopaths have always viewed us as quacks!” He was still unperturbed.
I too affirmed my faith in our system, “Personally, I swear by scientific medicine. The best thing about it is that we accept our shortcomings. That is the first step in eliminating them. Ayurveda has never come forward to accept its limitations.”
“What limitations? Today’s BAMS (Bachelor of Ayurvedic Medicine and Surgery) is a 5.5 years long undergraduate course that covers the study of the integrated system of modern medicine and traditional Ayurveda. 18 In addition to Ayurveda, we also teach anatomy, physiology, pathology & diagnostic procedures, principles of medicine, pharmacology, toxicology, forensic medicine, E.N.T, gynecology & obstetrics, ophthalmology and principles of surgery from modern medicine.19 It is meant to create holistic doctors.”
Ayurveda can be toxic
He replied,”Don’t your so called scientific medicines cause hepatoxicity too? They, in fact, cause toxicity in all organs. Over and above that, they cause grave financial toxicity!”25
In my heart, I knew he was not wrong. I remained quiet. There were medicines that were sold for several thousand US dollars for just one tablet!26
Is Scientific Medicine Better?
“Do you think scientific medicine is better than Ayurveda?” SKS challenged me.
“Absolutely! Thousands of people used to die of cholera, smallpox, tuberculosis, malnutrition and a score of other diseases when Ayurveda was available but scientific medicine was not. Even people close to Swami Ramdev are rushed to AIIMS, when they develop a heart problem! Do I need to say more?” I replied.
SKS said, “Yes, I concede. But you are good only in emergencies and in vaccinations! Baba also agrees with you! He has agreed to take COVID-19 vaccine and calls you God’s envoys.27 Also don’t forget the way your medicine is being practiced.28
I retorted, “Baba is just a yoga teacher. I do not think he has any degree in Ayurveda.”
“But he is a celebrity! A torch bearer!” SKS smiled.
I laughed, “A poet has expressed beautifully. “Baba ne kaha -kam-dhandha chodo, yoga karo! Ham sabne kam-dhandha chod diya yoga ke liye aur baba ne kam-dhandha shuru kar diya!” (Baba said – leave your daily business and do yoga. We left our business to start yoga and baba started his business on the side.) He is basically a businessman now, selling his wares!29
“Where do you stand on Ayurveda?” SKS asked me a direct question.
I chose my words carefully,“Ayurveda is a prehistoric knowledge from the Vedic period. It was a wise plan for a healthy lifestyle in those days and was very useful in that era.30 Its basic tenet is to achieve balance among three constituents of our being i.e. Vata, Pitta and kuffa. But, over the last few hundred years or so, science has made giant strides and set-up new benchmarks. Ayurveda has yet to stand up to those standards of scientific medicine.”
SKS smiled, “Your John Hopkin’s Hospital (USA) accepts that it was Ayurveda that gave the concept of universal interconnectedness. The imbalance between the body’s constitution (prakriti), and life forces (doshas) is the primary basis of ill health. This hospital’s website says that Ayurveda can have positive effects when used as a complementary therapy in combination with standard, conventional medical care.”31
I questioned,”How can you merge the two entirely diverse systems?”
Is Integration possible?
“You mean you practice both systems?” I was puzzled.
He replied “Yes, I practice and teach an integrated system and we call it holistic medicine. But I accept that an average newly passed BAMS practitioner fails to do that well. Just as an average newly qualified MBBS doctor does not understand the nuances of specialised medicine or surgery.”
I continued my tirade, “I feel it is unfair for Ayurveda to use our scientific terminology for diagnosis, which did not exist in the Vedic period.”
He was unruffled,”AC, you don’t own the knowledge! Science is universal!”
I asked, “Why don’t you use your own methods exclusively?”
SKS replied. “I can also ask, why don’t you learn about your own heritage? We do what we think will help our patient. Your literature is replete with papers on the limitations of your science. Ayurveda does have answers to many of those problems. If you were even a bit open minded, you will realise the wisdom of our ancient Rishis!”
I was still worked up, “Ayurveda is characterised today as pseudoscience. 34,49,35 It is known for contradictory, exaggerated and tall claims; reliance on confirmation bias rather than rigorous attempts at refutation; lack of openness to evaluation by independent experts.”50
SKS laughed, “AC, that’s a European point of view. Nearly 80% of people in India have faith in Ayurveda.36,51 And you pseudointellectuals stubbornly decide to remain blind to your own traditional wisdom”
Sheltered by Government
I decided to be more aggressive. “In 1970, the Indian Medical Central Council Act was passed by the Parliament of India. It aimed to standardise qualifications for Ayurveda practitioners and provide accredited institutions for its study and research . 37 In 1971, the Central Council of Indian Medicine (CCIM) was established under the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha medicine and Homoeopathy (AYUSH), Ministry of Health and Family welfare, to monitor higher education in Ayurveda in India. 52 But Instead of putting it on a scientific pedestal, the government has been busy promoting it and institutionalising its practice in an ad-lib manner. In 2013, India had over 180 training centres offering degrees in traditional Ayurvedic medicine. Your medicines do not need to undergo stringent tests that our medicines need to undergo.”
SKS showed no aggression. “Yes, I am aware. I agree that there are no matching rules to market Ayurvedic formulations as there are for scientific medicines. But that is because of the nature of the medicines used.”
I attacked further, “The state-sponsored Central Council for Research in Ayurvedic Sciences (CCRAS) was designed to do research on Ayurveda. 38 But it did little to establish Ayurveda as a scientific discipline.”
Shades of Grey
SKS countered, “It is easy to criticise others. What has your ICMR done? Doesn’t it abandon all principles of ethical research? 39 You underplay all the good that is being done. Even Ayurveda is being updated.” 40,41 And then he got up to go. I had to keep quiet again as he was quoting my blog.
His parting remark was a personal attack, “Since you suffered from hepatitis, your viewpoint has also become jaundiced.”42 And he quoted another paper of mine.
The crooked smile on his face as he looked back at me was hurting me. I swallowed my pride and asked, “I thought you people follow ancient texts, the Charaka Samhita, the Sushruta Samhita and the Bhela Samhita even today?”
SKS said, “Yes AC, they remain the backbone of Ayurveda. Dr Gopal Basishta, a Senior Rheumatologist in USA, with the unique approach of Symbio Health, has been working on the idea of rewriting Charaka Samhita by incorporating modern technologies in it.”43 As we walked towards the stairs, he continued, “I personally think India needs both. Your system is inviting medical tourism. Our system is providing solace to people who cannot afford your medicines. Remember, the majority of India’s population would fall in the latter category.”
Going down the stairs towards the exit I made another attempt,”Don’t you think Scientific Medicine is the way to go?”
He stopped next to a shining black sapphire BMW-X6 parked on the porch, as a uniformed chauffeur rushed to open the rear door for him. He turned towards me and said, “None of us needs to be insecure. China has successfully experimented with barefoot doctors. India’s current healthcare system has a lot of gaps to be filled as you yourself have pointed out. 44,45,46 I feel BAMS practitioners have a role to play especially where your scientific doctors are refusing to. Only your insecurities are preventing them!”
I looked at him as he again quoted my own papers. He had kept in touch with scientific medicine, while I knew hardly anything about Ayurveda.
With a curt “Okay, bye. Will meet again when you are ready to drop your prejudices.”, he sat in his car and closed the door .
His BMW silently slinked off. In its place my institutional Swift Dzire chugged in to pick me up.
On the way back, I was wondering if Tiddy and I will ever be in the same gang again?
[Note: As always, the names of the characters are fictitious but the issues are real.]
|↑3||Anand AC. Swami Ramdev and scientific medicine: losing is fine, but the lesson should not be lost! Natl Med J India. 2007 Sep-Oct;20(5):256-9. PMID: 18254525.|
|↑6||Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.|
|↑7||Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. (Updated 2021 Jan 4). In: StatPearls (Internet) Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/|
|↑9||Siegel-Itzkovich J. Doctors’ strike in Israel may be good for health. BMJ. 2000;320(7249):1561. doi:10.1136/bmj.320.7249.1561|
|↑11||Cunningham SA, Mitchell K, Narayan KM, Yusuf S. Doctors’ strikes and mortality: a review. Soc Sci Med. 2008 Dec;67(11):1784-8. doi: 10.1016/j.socscimed.2008.09.044. Epub 2008 Oct 10. PMID: 18849101.|
|↑17||Anand AC. Glass-houses and bioresonance therapy. Natl Med J India. 2012 Nov-Dec;25(6):365-8. PMID: 23998870.|
|↑20||Anand AC. When a hepatologist develops hepatitis! Trop Gastroenterol. 1998 Jan-Mar;19(1):26-8. PMID: 9641031.|
|↑21||Panda AK, Debnath SK. Overdose effect of aconite containing Ayurvedic Medicine (‘Mahashankha Vati’). Int J Ayurveda Res. 2010;1(3):183-186. doi:10.4103/0974-7788.72493.|
|↑22||Devarbhavi, H. Ayurvedic and herbal medicine-induced liver injury: It is time to wake up and take notice. Indian J Gastroenterol 37, 5–7 (2018). https://doi.org/10.1007/s12664-018-0820-6.|
|↑24||Philips CA, Ahamed R, Rajesh S, George T, Mohanan M, Augustine P. Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs. World J Hepatol. 2020 Sep 27;12(9):574-595. doi: 10.4254/wjh.v12.i9.574. PMID: 33033566; PMCID: PMC7522561.|
|↑25||Desai A, Gyawali B. Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions. EClinicalMedicine. 2020 Jan 31;20:100269. doi: 10.1016/j.eclinm.2020.100269. PMID: 32300733; PMCID: PMC7152810.|
|↑32, ↑40, ↑43||Chandola HM. New challenges for Ayurveda: How it will stand?. Ayu. 2012;33(2):165-166. doi:10.4103/0974-8520.105231|
|↑33, ↑41||Chaurasiya S, Godbole A, Prajapati S, Awasthi HH. Role of modern prameters in Ayurvedic researches. J Ayu Herb Med 2017;3(2):108-112.|
|↑34||Kaufman, Allison B.; Kaufman, James C., eds. (2018). Pseudoscience: The Conspiracy Against Science. MIT Press. p. 293. ISBN 978-0-262-03742-6.|
|↑35||Quack, Johannes (2011). Disenchanting India: Organized Rationalism and Criticism of Religion in India. Oxford University Press. pp. 213, 3. ISBN 978-0-19-981260-8.|
|↑36||Dargan, Paul I.; Gawarammana, Indika B.; Archer, John R.H.; House, Ivan M.; Shaw, Debbie; Wood, David M. (2008). “Heavy metal poisoning from Ayurvedic traditional medicines: An emerging problem?”. International Journal of Environment and Health. 2 (3/4): 463. doi:10.1504/IJENVH.2008.020936.|
|↑37||Wujastyk, D. (2003a). The Roots of Ayurveda: Selections from Sanskrit Medical Writings. Penguin Books. ISBN 978-0-14-044824-5.|
|↑42||Anand AC.When a hepatologist develops hepatitis. Tropical Gastroenterology. 1998; 19(1): 26-28.|
|↑44||Anand AC. Indian healthcare at crossroads (Part 1): Deteriorating doctor-patient relationship. Natl Med J India. 2019 Jan-Feb;32(1):41-45. doi: 10.4103/0970-258X.272117. PMID: 31823941.|
|↑45||Anand AC. Indian healthcare at crossroads (Part 2): Social and environmental influences. Natl Med J India. 2019 Mar-Apr;32(2):109-112. doi: 10.4103/0970-258X.275354. PMID: 31939411.|
|↑46||Anand A C. Indian healthcare at crossroads (part 3): Quo vadis?. Natl Med J India 2019;32:175-80|
|↑47||Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991 Feb 07;324(6):377-84.|
|↑49||Semple D, Smyth R (2019). Chapter 1: Thinking about psychiatry. Oxford Handbook of Psychiatry (4th ed.). Oxford University Press. p. 24. doi:10.1093/med/9780198795551.003.0001. ISBN 978-0-19-879555-1.|
|↑51||“Ayurvedic Medicine: An Introduction”. U.S. Department of Health & Human Services, National Institutes of Health National Center for Complementary and Integrative Health (NCCIH). August 2008.|