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Story Publication logo March 6, 2015

India: Eat, Pray, Leeches


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Doctors have demanded fixes to India's public hospitals for years, but have been stifled by...

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Mushtaq Ahmed, 60, lies on a massage table as he receives an oil rub while fellow 1984 Bhopal gas disaster survivor Akbar Khan (background R), 70, sits inside a steam box as part of their rehabilitation using traditional Ayurvedic treatment at the Sambhavna Trust Clinic in Bhopal. Image by Indranil Mukherjee/ AFP/ Getty Images. India, 2014.

MUMBAI — In March of 2014, during the heat of India's national election campaign, an article published in the Indian business paper Mint highlighted a small but crucial difference between India's soon-to-be prime minister, Narendra Modi, and Rahul Gandhi, the political scion and Congress Party candidate he was running against at the time.

"What keeps the 63-year-old Narendra Modi spirited through this strenuous campaign trail?" the article asked. "His aides credit his ascetic lifestyle and regular yoga exercises." Gandhi, meanwhile, "gets his energy from his evening runs and his occasional lessons in aikido, a Japanese martial arts form."

It was a subtle dig, but Indian voters understood the subtext: Gandhi was a social elite who, even in his workouts, dabbled in the exotic. Modi, who begins his day with an hour-long yoga session and ends it with meditation, came from working-class roots, and embraced all things Indian, down to the country's health care traditions and exercise routines.

India — a country that exports so many doctors to the West that the American Association of Physicians of Indian Origin claims that one in seven American doctors is of Indian heritage — has long had a complicated relationship with its own traditional medicines, dating back to the colonial period, when Western medicine first arrived in the subcontinent and became the treatment of choice for the region's elite. Today, a patient choosing between Western or traditional medicine in India is informed by issues of class, religious tradition, accessibility, and identity.

But Modi — an Indian heritage booster who addresses the United Nations in Hindi and is even pushing the promotion of Sanskrit — has made the government's embrace of traditional medicine official. Last fall, he announced the creation of the new ministry of AYUSH — an acronym whose letters stand for an array of traditional Indian systems. ("Ayush" is also derived from a word that means "long life" in Sanskrit.) The cabinet-level office is tasked with reviving and promoting Indian traditional health remedies, covering everything from yoga — by now a well-known export — to Siddha, an ancient Tamil system of medicine believed to be founded in what is now the state of Tamil Nadu, and Unani, a Greek-Arabic medicine also practiced in parts of South Asia.

Most prominently, the new ministry has also been charged with overseeing the revival of the traditional Hindu medicine system known as ayurveda, the most high-profile of India's ancient medical traditions.

"In the emerging world of lifestyle-related disorders and chronic diseases … standalone modern medicine may not be sufficient to cater to the demands of the ailing society," said Shripad Yesso Naik, the new head of the ministry, at an inauguration of a holistic treatment center in Kerala last December. India should build health facilities dedicated to pursuing an "integrative approach" to treatment, he said, that incorporates systems like ayurveda and yoga.

Just what this integrative approach will look like remains somewhat mysterious. Naik declined to comment for this article, and the ministry has been all but silent since its November creation, save for hosting a "health fair" in Raipur, a district located in the northern state of Chhattisgarh. Advocates say more attention for ayurveda and other systems is an opportunity to demonstrate the effectiveness of Indian medicine — to show that it can stand up to rigorous scientific scrutiny.

"All ayurvedic medicine needs to be evidence-based and put to trial side by side with Western drugs," said Bhushan Patwardhan, editor of the Journal of Ayurveda and Integrative Medicine, and the director of the School of Health Science at Savitribai Phule Pune University. "Let's prove that they promote health."

But many remain skeptical that medicinal systems that include treatments with ingredients like lead and leeches have a place in modern India.

* * *

Ayurveda, often called an "alternative" form of medicine by proponents, has roots that trace back to the Vedic period in the northern Indus Valley, and the very origins of Hinduism — around 1750 B.C. The first syllable comes from the Sanskrit word "ayus," meaning life, and the second from the word, "veda," roughly meaning knowledge, or science. The practice, which incorporates herbs and other natural substance-based medicines, special diets, and massage, is based on a preventative, as opposed to curative, approach to health. By about 500 A.D., ayurveda had developed into a formidable system of medicine that included surgical techniques, pediatrics, and even dentistry.

Ayurveda and other traditional forms of medicine flourished with limited competition until the arrival of Western powers on the subcontinent in the early 17th century. Modi and other proponents of India's medical heritage argue that British rule marginalized systems such as ayurveda, Siddha, and Unani: Social elites adapted Western attitudes to health care and practitioners of traditional medicines saw their influence wane. In promoting AYUSH, they say, Modi's government is restoring these remedies to their rightful place.

Even if it lost ground under colonial rule, ayurveda remains woven into the fabric of modern Indian society. In urban India, ayurvedic pills created by ubiquitous brands like Himalaya can be found at local pharmacies, and are recommended to patients for everything from relieving diarrhea to stopping hair loss. There are ayurveda colleges located throughout India and occasionally departments within government hospitals will have their own wing dedicated to ayurvedic treatment.

Even within cities, however, oversight is limited at best. The standards for ayurveda degrees and medicine are set by the Central Council of Indian Medicine, a body created in 1970, when the country's department of AYUSH was still a sub-ministry of the Ministry of Health. But the council only has power over medical students who receive official accreditation from an institution, and has no authority over the many local practitioners of traditional medicine who never seek degrees or accreditation, finding their patients by reputation or word of mouth.

India, unlike America, lacks a federal Food and Drug Administration to review ayurvedic tablets, and instead relies on oversight from the Department of Food and Drug Administration of individual state governments. But these bodies lack the capacity to regulate the type of small-time operations that sell drugs outside of registered pharmacies. In rural villages, ayurvedic doctors often practice medicine using the same techniques and settings as their ancestors, serving clients from open-door vans parked along highly trafficked roads, and grinding herbs using stone mortar-and-pestle sets that look as if they could have been handed down over generations.

Indian doctors trained in Western medicine are among the loudest voices opposed to a larger platform for ayurveda. The Indian Medical Association, for instance, a voluntary body of doctors that advocates for health standards on behalf of "the community at large," has been an outspoken critic of ayurvedic colleges and doctors, even urging local governments to pass "anti-quackery" legislation in different states, as it did unsuccessfully in the state of Karnataka in October 2014. But the medicine these doctors practice is also not always accessible to most of India's population.

Prasanna Shah, 44, is a gastroenterologist at Breach Candy Hospital, a private facility situated in Mumbai on the blue coastline of the Arabian Sea, where the city's wealthy come for treatment that occasionally comes with an oceanfront view. One-time visits to Shah's clinic cost 1,000 rupees, or about $16, a figure that would take some Mumbai residents months to accrue. More serious procedures — intestinal surgery, for instance — at Breach Candy can cost upwards of $1,000 dollars.

Shah calls the propagation of ayurvedic treatments in India "rubbish" and sees the research on them to be a waste of valuable government resources.

"You see proponents of ayurveda claiming that Western medicine is only poison, because they know the side effects, but then they hail ayurvedic medicine as an alternative without knowing anything about the side effects of those tablets whatsoever," Shah says. "So many times we have kids come here poisoned with lead that was found in some ayurvedic mixture or other. Then some of these natural drugs, other ones, are primarily just steroids."

Shah's complaints about steroids are a common concern among critics of traditional medicines, and fears about lead poisoning have prompted Western countries to take action at times to protect consumers from Indian imports. Health officials in Australia raided Indian grocery stores in Sydney in July 2014 because of fears that certain tablets contained lead. In 2012, two children fell victim to lead poisoning in New York City due to the intake of ayurvedic medicines said to boost brain function.

But pooh-poohing ayurveda from the halls of Breach Candy is a tricky business. Social elites may dabble in alternative medicine in India while still receiving Western treatment in private hospitals, but systems like ayurveda at times may be the primary form of treatment available to India's poor, due to the failures of the country's government-run health care system. In some rural villages, there are as few as two government doctors available to a local population of 150,000 patients, leading many to seek out practitioners without any formal training — Western or ayurvedic. It's an alternative that can lead to misdiagnosis, exacerbated illnesses, and sometimes death.

In an interview with the Deccan Herald, Naik, the new ministry head, said he plans to place a greater emphasis on creating higher, more formalized standards for degrees at colleges of ayurvedic medicine, saying that "the existence of quacks has been one of the biggest challenges that the [alternative medicine] industry is facing." But whether a push for standardized degrees will provide much protection for the residents of say, Burdwan, in West Bengal, a farming district where infants regularly die of malnutrition-related illnesses, remains to be seen.

In addition, shortly after the government announced its plans to devote more resources to ayurveda — Modi has boosted funding for ayurvedic medicine by 36 percent in his first budget — it also said it will cut funding for India's already fragile health care system, including from its HIV/AIDS program. (India spends only about 1 percent of its GDP on health care — less than countries like China and Egypt, according to figures produced by the World Bank — and faces some of the worst rates of malnutrition and infant mortality in the world.)

Still, the view of ayurvedic medicine from some prominent doctors at King Edward Memorial Hospital (KEM) in Mumbai, one of India's best-regarded government hospitals, looks very different than from plush Breach Candy.

Ravindra Bapat, 73, a gastroenterologist who has been working at KEM for 55 years, is also one of India's largest proponents of ayurvedic medicine. Bapat spearheaded the establishment of the first formal ayurvedic research center at KEM in 1989, and has presented on the virtues of ayurvedic medicine in London, Boston, and Hong Kong.

Sitting in his office at KEM, surrounded by ornate statues of the Hindu god Ganesh, Bapat said he was optimistic that the new ministry could help to promote the kind of natural medicine he feels is too often labeled as "quackery," and might offer an opportunity to demonstrate its value through the kind of rigorous research and testing he says he has done throughout his career.

Bapat led the research team behind the drug Immumod, an ayurveda-inspired creation formed from the herbaceous vine Tinospora cordifolia and produced by the prominent Indian pharmaceutical and technology company Wockhardt, that purports to bolster the immune system of patients — something Bapat claims can aid in the treatment of everything from stomach infections to breast cancer. Bapat oversaw the testing of the drug in a study at Tata Memorial, a prominent cancer hospital in Mumbai — an example of the sort of "aggressive approach" to research and testing of ancient remedies that he would like to see more of.

There are diseases for which Western medicine has no answers, said Bapat: autoimmune diseases like Crohn's disease, for example. And it's here where traditional medicines could have an impact. "The right approach there is to try something different, something natural," he said. "If the Indian government is investing money in ayurveda, let it be to prove the worth of such drugs to the world — so we can get them into the hands of all the people, all over the world, who need them."


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