India’s alternative medicine boom: quackery or decolonial justice?

India’s alternative medicine boom: quackery or decolonial justice?

India’s rightwing have incorporated the promotion of alternative medicine into their nationalist politics, but at what cost, asks Yusra Khan.

Herbal eye drops to ‘cure’ cataract, coffee enemas for detoxification, magnet therapy for pain relief – alternative medicine promising quick fixes has long been popular in India. However over the last decade such treatments – which can be outright quackery – have had their status boosted by the nationalist nostalgia pushed by a hardline government. Empirical science is often loudly trashed by people in positions of power; the risk to public health is evident.

In India’s academic circles it is increasingly common for ‘decolonization’ to be a mast upon which the Hindu Right hoists its flag. These hardliners have successfully pushed for a forced linearity between anti-imperialism and modern hyper-nationalism, and medicine is a convenient frontier on which these battles are being fought.

The euphoric narrative of cultural reclamation set by India’s far right leadership has been strengthened by inventive marketing. Just half a year after he was first elected as prime minister in May 2014 Narendra Modi elevated AYUSH, formally a government department, into a ministry with a hefty budgetary allocation. The acronym stands for Ayurveda, Yoga, Unani, Siddhi and Homeopathy and encompasses a wide array of time-honoured alternative health systems that serve as a first resort for roughly 70 per cent of India’s population.

Ayurveda, a form of medical care that dates back thousands of years, talks about the body’s internal healing system, and relies on its constitution (prakriti) and life forces (doshas) as a primary basis for treatment. Relying heavily on the authority of ancient texts, in India its practice has managed to get state patronage and escape basic requirements to establish efficacy through statistically sound methods.

The support of prominent officials has served as further promotion, with sometimes disastrous consequences. For example, the ministry of AYUSH has continued to ignore the problem of heavy metals in Ayurvedic concoctions, despite research showing the potential for liver injury from their use.

The government enthusiasm for AYUSH has a strong ideological impetus, promoting a monolithic concept of the past to support the current claims of healing power. Investment is strongly tied to the framing of ancient medicine, with Ayurveda central to this narrative, as an example of India’s glorious past. This glorification of Hindu history is vital to the far right religious ideology of Hindutva as espoused by the state under Modi’s regime.

The ubiquity of misinformation when it comes to health was never as pronounced as that witnessed during the peak of the Covid-19 pandemic. From prescribing home remedies made up of kitchen spices to serve as a prophylactic measure, to organizing parties to imbibe cow urine (the cow holding an exalted position for Hindus), elected representatives of the government have made international headlines.

Ayush 64, an ayurvedic medicine in tablet form, which was earlier prescribed to cure malaria, was refashioned and advertised as an antiviral to treat mild Covid. Mobilizing scarce resources, a nationwide campaign was launched to distribute the drug en masse. Critics have argued that evidence backing the drug has been flimsy, owing to low-quality, small sample trials, which is also emblematic of the regulatory issues plaguing the AYUSH pharmaceutical industry.

Baba Ramdev, a yogic practitioner with a sprawling business empire and friends in both the ruling Bharatiya Janata Party (BJP) and its lapdog media, made big bucks pushing a herbal concoction called Coronil, which he claimed prevented and cured Covid-19 infections – with deadly consequences. Ramdev has long made inflammatory statements, which get widely amplified by the media, trashing allopathic medicine and promoting his ‘cures’ for a variety of ailments, including cancers.

Lack of scrutiny

Colonization had a devastating impact on India – killing millions, stealing wealth, crushing and dividing peoples. In theory, the call to ‘decolonize’ – to in some way undo colonialism and its impacts – is a positive move. But Narendra Modi and the nationalist Right have hijacked the ideas to promote their own religious nationalism and a politics that has continued to divide and rule.

Historical grievances over colonialism, both qualified and distorted, have helped form a protective shield against criticism of AYUSH-based methods as more mainstream approaches are written off as Western influence. Meanwhile, public funds are poured into a medicinal system which continues to evade accountability.

In theory, the call to ‘decolonize’ – to in some way undo colonialism and its impacts – is a positive move. But Narendra Modi and the nationalist Right have hijacked the ideas to promote their own religious nationalism and a politics that has continued to divide and rule.

Meera Nanda, a historian of science, has been a vocal critic of Hindutva. She explains why the current moment is different to the official patronage for alternative medicine which has always existed in India. ‘The way this government has gone about institutionalizing traditional medicine and censoring any critical voice is uniquely dangerous,’ she explains. ‘While Congress and other non-BJP parties may pay lip-service to Indigenous traditions, the BJP has turned it into the first principle of its social policy.’

Brajesh Pathak, the Deputy Chief Minister of Uttar Pradesh – India’s most populous state – claimed in 2023 that homoeopathy, which has German roots and came to India in the early 19th century, can cure second stage cancer without any side effects.

Baba Ramdev demonstrates yoga at Sangam, the confluence of three sacred rivers, the Ganges, Yamuna and the mythologized Saraswati , during the Kumbh Mela festival in Prayagraj, India , on 28 January 2019. RAJESH KUMAR SINGH/ASSOCIATED PRESS/ALAMY

Baba Ramdev demonstrates yoga at Sangam, the confluence of three sacred rivers, the Ganges, Yamuna and the mythologized Saraswati, during the Kumbh Mela festival in Prayagraj, India, on 28 January 2019. RAJESH KUMAR SINGH/ASSOCIATED PRESS/ALAMY

Nanda adds that the strong current of almost religious faith in Ayurveda and other traditional medicines cuts across class and educational levels. ‘It rests on two assumptions: one, that Ayurveda is “natural” and therefore safe, while modern medicine is “chemical” and therefore alien to the body and full of unexpected risks and side effects; and two, that traditional medicine has been time-tested over centuries and therefore cannot but be safe and effective.’ This idea is being further reinforced by the government through a steady rhetoric of cultural superiority that places Indigenous practices under a halo, discounting an evidence-based scientific approach to them and removing them from the ambit of public scrutiny.

Pseudoscience

When critiquing the far Right’s fevered enthusiasm for alternative medicine, we must be careful not to throw the baby out with the bathwater. There are many who push back against generalizations that might undermine access to well-established non-allopathic medicines.

Madhulika Banerjee, who teaches at the Department of Political Science at the University of Delhi, has done significant work in the area of alternative knowledge systems, mainly Ayurveda. Banerjee says one has to ‘step out of the narrow frame of reference that the current regime has instituted… These are systems with large bases of both practice and manufacture, of which the former is very old and even the latter is over 100 years old. It would be very poor analysis to tar all of them with the same brush and club them with the charlatans who are being protected by the current government’.

Blending pseudoscientific health claims with spirituality provides several benefits for the Right: moral righteousness and a lack of answerability being chief among them. The former is plentiful in the government’s rhetoric and the confidence of alternative medicine’s marketers, while the latter is, alas, codified in Indian policy and law.

Under the Drugs and Cosmetics Act, 1940, rules for issuing of manufacturing licenses for ASU (Ayurveda, Siddhi and Unani) drugs, in comparison to allopathic formulations, are relatively lax and rudimentary. The government confirmed this in a notice issued in July 2018, saying that clinical trials and safety study reports are not mandatory for patent and proprietary ASU drugs.

In 2022 a large retrospective multicentre study corroborated earlier findings about a quiet but insidious uptick in herb-induced liver injury due to the prized Ayurvedic herb, giloy, or guduchi. This heart-leaved herbaceous vine is native to the Indian sub-continent, with several nutritional properties but the relentless push for ‘immunity boosters’ has led to ill-thought-out usage of this and many over-the-counter herbal products. At the peak of the pandemic Haridwar-headquartered Ayurveda giant Patanjali, which sells several such products, saw a meteoric rise in its consumer goods business, growing its sales by almost 25 per cent between 2021 and 2022.

In a rare instance of accountability the company, which was founded by Baba Ramdev, is currently being grilled in Indian courtrooms for its long history of misleading advertisements. In 2022 the Indian Medical Association filed a petition against dangerous claims made by Ramdev which denigrated modern medical systems. In a viral video, published in the middle of an ongoing global pandemic, the yogi turned business czar proclaimed: ‘Far more people have died due to allopathic treatment than due to shortage of oxygen’ to a large gathering of followers, finally prompting the doctors’ body to take action.

Tapping into the – often-justified – reservoir of public distrust in Big Pharma, he hit a nerve. In a country where anti-science sentiment has gained significant ground in recent years, and alternative medicine can be less expensive for people to access than more modern alternatives, the dangers of this brand of cultural reclamation became clear.

Figures published in 2020 showed that India spends less than four per cent of its budget on health, among the lowest in the world. Nanda says that it is not clear if the continuing popularity of traditional medicine reflects real agency or pragmatic decision-making: ‘In the name of preserving traditions and “decolonizing” India of Western influences, the current government is pouring money into setting up Ayurvedic clinics instead of providing real healthcare. The irony is how the bigwigs themselves check into the most modern medical facilities when they fall ill! It is a cruel joke.’ 

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