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Several of my friends think Ayurvedic and Homeopathic medicines have no side effects. They are wrong in their reasoning. Because...

"The fact is that Ayurvedic medicines cause thousands of cases of drug induced liver injuries every year in India (this might be an under-estimate). Last month we watched a 27 year old lady die of acute liver failure after taking an ayurvedic medicine for weight loss. She died within 24 hours of admission to hospital (she had been sick for a week but only reached us when she was nearly dead). There was no time to do a liver transplant. Herbal supplements are known to cause veno-occlusive disease. The small veins of the liver get scarred and the liver gets congested because blood cannot drain out of it properly. Eventually liver failure occurs. Unfortunately families of such patients are often unwilling to talk about it. Partly denial to avoid guilt I suppose. I had given the names and phone numbers of several victims of AYUSH to a reporter. Nothing happened. I wrote an article (invited) about AYUSH for the news portal They took an editorial decision not to publish. It seems all the newspapers know that it may be unhealthy to write anything but glowing testimonials about AYUSH to please some people."

When a liver transplant surgeon told me this I told him I will publish this.

The doctor also gave me these references to read and consider:

Herb-Induced Liver Injury in the Berlin Case-Control Surveillance S...

A rare case of acute hepatitis induced by use of Babchi seeds as an Ayurvedic remedy for vitiligo.

Luffa echinata: healer plant or potential killer.

Review article: herbal and dietary supplement hepatotoxicity.

Herbal hepatotoxicity: a tabular compilation of reported cases.

Acute renal failure secondary to ingestion of alternative medicatio...

Acute renal failure secondary to ingestion of ayurvedic medicine containing mercury.

and also told me ...

  1. Ayurvedic medicines can cause end organ damage. They can damage the liver, kidneys, bone marrow etc. Note: the case report stating ‘rare case of acute hepatitis is from Britain. In India this is a common cause of acute liver injury.’
  2. These medicines can be fatal. I have seen fatal drug induced liver injury with Ayurvedic medicines. Another mechanism of death is by delaying effective treatment (surgery for cancer for instance) while undergoing futile Ayurvedic treatment.

The same doctor told this story too...

A 42 year old patient from the state of Gujarat developed cirrhosis of the liver due to the excessively easy access to alcohol there . He had, of course, been taking Liv 52 to ensure that he would not get cirrhosis. However, having developed decompensated cirrhosis, he did stop drinking and he improved somewhat over the next 3 months.

Although he was feeling better, his liver function tests were still abnormal and due to his elevated bilirubin level, he was looking distinctly jaundiced. He, therefore, turned to Ayurvedic medicine since his Gastroenterologist was not telling him anything encouraging about his long term prospects.

The Vaid was much more encouraging and assured him that with the medicines he was going to give him, the jaundice would soon go away. After a month of the medicine, during which he did not see his Gastroenterologist, he became confused and drowsy and required an emergency admission to hospital. His liver functions were much worse which was unexpected since he had stopped drinking. This looked like DILI (Drug Induced Liver Injury) which is known to occur with Ayurvedic medicines. At this point it was obvious that his liver was not going to recover and that he needed a liver transplant.

Meanwhile his family were looking for alternatives to a transplant and they came across the website of a clinic which was offering 'stem-cell therapy' for the treatment of liver disease.

He was moved to the clinic. Interestingly, in India, solid organ transplantation requires a rigorous process of inspection and authorization and periodic renewal of permission. On the other hand, bone marrow transplantation and so-called stem-cell therapies are completely unregulated.

He underwent the stem-cell therapy and became even worse. By the time he came to us for a liver transplant, he was too sick with multi-organ failure and sepsis. He died. Without having a chance of being transplanted.

There are several other reports that say some of these medicines are harmful ( 1,2,3).

We ourselves had very bad experience with some of these medicines. My mother used to take several ayurvedic medicines prescribed by well qualified ayurvedic doctors for her knee problems. Some 15 years back she developed severe diabetes with her blood sugar levels going up to 500 - 600 mg/dL. The main stream doctors when consulted asked us about the medicines she was taking. When told about the ayurvedic medicines, they asked us to immediately stop using them. They told us some of them contain steroids that enhance the diabetic conditions several fold if people are vulnerable and genetically predisposed to them.

My sister consulted doctors who practice Homeopathy for her sciatic problem. Even after taking the medicines for six months, there wasn't any improvement in her condition. Only exercises and prescribed medicines from mainstream doctors could help her in the end to better her condition.

Several people ask me why there are colleges that still teach and train students  in these alternate medical practices if they are not reliable. Yes, why? I tell them not all old medical systems are bad. Some of them are good too. But each one of the claims in these systems has to be tested scientifically and only when evidence clarifies that they are good, we can adopt and use them.

Ayurveda is considered as protoscience or a primitive one. It has to be developed into a full fledged one to make it fully authentic.  

Bitter truth: Hundreds of 'doctors' dealing with these medicines will go jobless if thorough scientific research is conducted on these medicines and truth is brought before the world and they agitate. Several of the colleges and clinics  that deal with these medical practices will have to be closed down creating chaos. So people who can take decisions think it is better to close their eyes. And make people suffer in the process!

But now some of the scientists are analyzing these medicines. Soon we can hear the verdict on several of these medicines based on 'ancient wisdom'.

And this is what a Consultant Vascular Interventional Radiologist at The Vein Center told us...

This story is about a stupid decision by a homeopath 10 years ago to treat a Varicose Ulcer using sugar coated pills and convincing the patient that things are getting better.

I had a patient, a well read lady, PhD in Literature with a huge Venous Ulcer on her leg that kept getting bigger inspite of the Homeopathic “medicines” that she was taking.

This is what she was living with

After she came to us when Homeopathy treatment failed, we followed our protocol, did a Venous Doppler right there in the OPD, found out that this is a Venous Ulcer.

She underwent the Endovenous Laser Ablation procedure followed by Skin grafting.

3 months later, her leg was like this:

She suffered for 10 years from a condition that could easily have been treated much earlier and with relative ease with modern medicines but choose to go Homeopathic way and faced the consequences.

Such misery could easily have been prevented had she received proper guidance 10 years ago.

According to these doctors... the original constituents of homoeopathic medicines are diluted so many times that the end product is unlikely to have even a single molecule of the compound. They claim that the water molecules retain a memory of the compound which was dissolved in it but this is not compatible with what we know of Physics or Chemistry. They then dry the water as well and give you what is basically just tiny pills made of sugar.

Oh, my!

I myself have read several research papers that say Homeopathy just has a placebo effect and nothing else.

Some Governments themselves say this and gave guidelines and analysis of various research reports(4,5,6). Homeopathy has long been considered a pseudoscience, and several studies have failed to detect any effect of homeopathic treatments. 

Other cases of alternative medical practitioners harming patients...

Did chiropractic manipulation of her neck cause Katie May’s stroke?

Chiropractic Manipulation and Stroke: A Population-Based Case-Contr... 

Steve Jobs 'regretted trying to beat cancer with alternative medici... 

The site  What's The Harm? has hundreds of stories of harm caused by alternative medical practices. There are over 400 stories under homeopathic medicine alone: What's the harm in homeopathy?

The site  Quackwatch is a fairly comprehensive reference locus for information about quacks.

A review of FDA records obtained by STAT under the Freedom of Information Act paint a far grimmer picture: Babies who were given Hyland’s teething products turned blue and died. Babies had repeated seizures. Babies became delirious. Babies were airlifted to the hospital, where emergency room staff tried to figure out what had caused their legs and arms to start twitching.

Over a 10-year period, from 2006 to 2016, the FDA collected reports of “adverse events” in more than 370 children who had used Hyland’s homeopathic teething tablets or gel, a similar product that is applied directly to a baby’s gums. Agency records show eight cases in which babies were reported to have died after taking Hyland’s products, though the FDA says the question of whether those products caused the deaths is still under review (7).

I am getting these stories from several  are a few...

When I was a final year medical student at one of the big Government Medical Colleges in Southern India , I came across the following case during our Pediatrics rotation.

The patient was a 6 year old boy who was admitted following complaints of extreme fatigue , failure to thrive , poor oral intake and breathlessness both at rest and on exertion for 6 months.

According to his mother, everything was fine till 1.5 years ago when he developed a high grade fever with a sore throat. The parents decided to treat the seemingly minor throat infection with OTC medication and also with "home remedies" .

A few weeks later the child started to develop joint pains in the elbows knees and shoulders.

The parents, mind you , we're both graduates, well educated with a solid upper middle class background.

Instead of referring the child to a pediatrician , they took the advice of their friends and relatives who recommended that allopathic medicine is useless in these cases and referred them to one of southern Indians largest Ayurvedic facilities ; The Kottakal  Ayurvedic centre. (Ayurveda is Indian traditional medicine)

There the child was subjected to all manner of hot oil massages to alleviate his joint pains.

All this afforded minor relief for the joint pains. (Some practitioners are known to surreptiously administer allopathic drugs by crushing the tablets with a mortar and pestle and offering the powder as traditional medicine.)

For a few months , the child remained asymptomatic.

He then began to develop frequent chest infections , breathlessness on exertion then later on at rest. This was followed by  progressive lethargy which manifested later as refusal to eat food or goto school

At this stage the parents decided to seek specialist attention. So they approached the chief of Pediatrics of my teaching hospital , a tough no nonsense woman who didn't suffer fools gladly.

I still remember the torrent of abuse that our chief rained down on those hapless parents for acting so foolishly and endangering their son. It's pretty common in India that doctors can get away with severely chiding patients and their attendants.

Those of you with the benefit of a medical education may have already guessed what had happened.

The child's initial sore throat and fever  and subsequent joint pains were manifestations of  Acute Rheumatic Fever.

Which was shockingly left untreated..

The child subsequently developed rheumatic carditis. He had  a severe mitral and aortic regurgitation.

.His heart murmur was so severe we could feel it through his little chest. At presentation he was listless, didn't react much to the huge crowd of medical students who had thronged the ward to examine the 'rare case'.

Chief said the boy didn't have much in the way of a prognosis. There was talk of surgery etc but the estimated costs were much more than the parents could afford.

The standard treatment for rheumatic fever is benzathine penicillin which is available for a few rupees. So you can gauge the magnitude of the crime committed by the parents who neglected to take the child for specialist referral at the outset, all in the name of alternative medicine.

I heard from my juniors later that the child died in the pediatric intensive care unit.

Another one...

While on a paediatrics duty, I saw a case of 8 yr old child who presented with fever, neck and jaw muscle paraesis, and problem in swallowing.

Parents gave a detailed account of how it had happened after eating fish, and initially thought that something had stuck in his throat. Then they thought about a possible food poisoning.
Until the child developed weakness in both upper limbs.

Differentials of meningitis and encephalitis were considered, but since the coagulation profile was pathetic, a confirmatory lumbar puncture couldn't be done and symptomatic management with intravenous antibiotics was started.

I examined him again and again, and suddenly realised that since he had a dilated pupil and ptosis, and then developed pharyngeal weakness which progressed to the limbs, it could be the progressive descending paralysis seen in a snake bite. I examined the kid but couldn't find a bite mark.

I ran to the parents.  But parents had left the kid in the ward to go to a temple and pray. I finally found a relative and asked if there was a snake anywhere in the picture. The aunt was like "well yes the child saw a snake in the kitchen and was bitten but obviously we had taken him to the ojha (a kind of witchdoctor) and the jhad-phuk (chanting and spell casting) was done, so he's safe and we didn't think it was significant enough to tell you."

Now, anti snake venom works only when given in the first 24 hrs after snake bite. I called my seniors and they started the treatment but it was too late. The child died that very day.

So be cautious while using alternate medicines and going to 'doctors' who deal with alternate medical practices.

After reading this article of mine several people started asking me several Qs.  I am posting one such Q and my reply here:

Q: After reading your article "This is what a liver transplant surgeon told me", I really got scared. Because we use ayurvedic medicines in our home. Are they really that bad? Is any research going on them to find out the truth?

Krishna: I will not say all of the ayurvedic medicines are bad. Some might have good qualities too. Until you test them scientifically you will never know about their qualities - good or bad. 

Yes, some people in the West have tested these medicines and found some bad qualities like my article states. But some Indian scientists and doctors too are studying the qualities of these medicines. 

I have been given this list:

1). Padma Vibushan and Chitra Cardiac valve inventor and World renowned cardiologist Dr. M.S.Valiathan [MBBSMSFRCS (England)FRCS (Edin.),FRCPS(C)FRCP( Lon)D.Sc (h.c)] who is into serious research in Ayurveda for the past 12 years.

2). Padma Bhushan Dr. B M Hegde [M.B.B.S from Stanley Medical College(Madras), a M.D. from King George Medical College (Lucknow), FRCP from Royal College of Physicians, London, Glasgow, Edinburgh, and Dublin. He also has a FACC and FAMS. He also received training in cardiology from Harvard Medical School under Bernard Lown, a Nobel Laureate.,} world renowned Cardiologist and researcher of Ayurveda - member editorial board of J-AIM (Ayurveda Journal), Ex-Vice Chancellor, Manipal Academy of Higher Education.

3). Dr. Bhushan Patavardhan - Director - Interdisciplinary School of Health Sciences, Pune University and the Chief editor of the Journal of Ayurveda and Integrated medicine (J-AIM) - published by Elsevier - link - You may look at the prestigious and distinguished Doctors and Medical science researchers (who review Ayurveda articles and research papers /reports) in the Editorial board of Journal of Ayurveda and Integrative Medicine Editorial Board

4). Dr. G Gangadharan (Ayurvedacharya, FAIP(USA), PhD, MoM (McGill, Canada), Director, Ramaiah Indic SpecialityAyurveda - See more at: Dr.G G Gangadharan at 3rd International Congress on Ayurveda | Rama...- who as part of 22 member Sr. research team proved and published a research on Ayurvedic Prakriti based on Genome-wide Analysis (paper here: Genome-wide analysis correlates Ayurveda Prakriti)

5). Dr. Thelma B.K, who a Human Geneticist and HoD - Dept. of Genetics at University of Delhi and published papers on Ayurgenomics (one paper here Potential of Ayurgenomics Approach in Complex Trait Research: Leads...)

6). NCBI /PubMed (of US Govt) which contains peer reviewed 6000+ research papers and clinical trial reports on Ayurveda system /herbs /formulations (In addition to over 190,000 papers on Complimentary and Alternative medicine)… some links on scientific validations of Ayurvedic formulations and Herbs here (a). Guduchi Inhibition of proinflammatory pathways by bioactive fraction of Tin..., (b). Ashwagandha Comprehensive assessment of the genes involved in withanolide biosy...., (c). Brahmi Bacopa monnieri extract increases rat coronary flow and protects ag..., (d) Various Ayurvedic formulations for Innate anti-oxidant activity (oxidative stress is a main cause of Cancer)Innate antioxidant activity of some traditional formulations., (e). Traditional Ayurvedic Medicines: Pathway to develop anti-cancer drugs: Traditional Ayurvedic medicines: Pathway to develop anti-cancer drugs

7). Nobel Laureate Dr. Tu You You, who won Nobel prize in 2015 for TCM (Traditional Chinese Medicine) - who is now an inspirations to all Alternative medicine researchers - I’m sure the day is not far away where Ayurveda finds total cure for a stain of Cancer or any other life threatening disease without the side effects & costs of the so called modern medicine system and associated widespread international recognition.

8). ICMR-NIMS-Clinical Trials Registry has over 400 clinical trials reports of various Ayurvedic formulations and Drugs - link: Search Result,Clinical Trials Registry - This is for those who say there is no scientific basis for Ayurveda !.

9). Clinical trials in Ayurvedic Drugs /Reverse Pharmacology method: This is about why we shouldn’t be harping only on Clinical trials for Ayurveda

10). NIMHANS (National Institute of Mental Health and Neurosciences) Ayurvedic centerAdvanced Centre for Ayurveda

11). Manipal University A multi-centric project supported by the AYUSH Foundation and DST, Govt. of India, this program deals with understanding the underlying scientific principles of Ayurveda, an Indian traditional medicine. Work carried out in our labs is focused on deciphering possible molecular (genetic and epigenetic), metabolic and biochemical clues to the various Prakriti classifications of Ayurveda, as well as its treatment modalities for quality ageing, improving mental abilities etc. Science initiatives in Ayurveda

12). What Doctors Don't Get to Study in Medical School - by Dr. B. M. Hegde, This is not a textbook as the author says but, in my opinion, this is a "Holy Text" of medicine and is a must read for everyone who deals with sickness. Richard Smith, MD, FRCP Former Editor, British Medical Journal, London. Here, laid out clearly and concisely, are all the well-established potholes and pitfalls in current medical thinking and practice. It is a thought provoking challenge to modern medical practice and research. Dr Hegde confronts the issue, and proposes an alternative humanistic attitude to education and treatment. Drawing on a huge range of resources from Sanskrit texts, Green and European philosophers, ancient and modern healers, to the most up-to-date Western research and publications. He has written a book that is both scholarly yet easy to read, and which will appeal to everyone involved in medicine whether students, practitioners or patients

This book provides part of the important and formative reading a medical student must do outside the prescribed requirements for a degree, and is also equally valuable to qualified practitioners and medical professionals. Here, laid out clearly and concisely, are all the well-established potholes and pitfalls in current medical thinking and practice. It is a thought provoking challenge to modern medical practice and research and is intended to encourage us to consider the way medicine is taught. Modern medical practices are driven by science, technology and consumerism, with the cost of treatment weighted in favour of the doctor rather than to the benefit of the patient. What Doctors Don't Get to Study in Medical School

However, several mainstream doctors I spoke to say - 

Unless Ayurvedic practitioners and researchers come up with decent basic science research which are publish worthy with authentic data and then go on to publish in reputed peer reviewed journals like Nature or Lancet- all of their supposed “research” will be considered low quality. Clinical research is for confirming basic science research and not the other way round as Ayurvedic practitioners seem to be doing these days in the name of research.

You can't say for example, “This seems to work so there must be some science to it” and create a weird theory to fit in the conflicting data. One usually needs the hypothesis first and then your experiments need to confirm the hypothesis. After one proves the hypothesis do scientists apply the hypothesis in the real world. This is how real science works.

The modern drugs go through 4 phases of Clinical Trials (8)

  • Phase 1 is to assess the safety profile of the drug being tested and its side effects. Involves a few healthy volunteers (<100) and needs several months to complete.
  • Phase 2 - Efficacy and effectiveness of a drug is done here. This phase also determines the treating dosage and toxic levels. A placebo may also be used as a control arm. A few hundred healthy volunteers are required and this may take a few years to complete
  • Phase 3 is Randomized Controlled Trials (RCTs) where therapeutic dosage is given to a large sample of people suffering from a specific ailment or disease and comparing with a control arm which use the placebo in double-blindfashion so that both the patient nor the investigator knows who is getting the tested drug and who is getting the placebo. This eliminates bias. This typically takes several years to complete. RCTs is the most robust form of evidence that a drug works. No Ayurvedic or Homeopathic drug has cleared this phase till date.
  • Phase 4 is when the drug goes into consumer market. Data is collected regarding long-term effects of the new drug, over longer durations and on larger number of people than could be achieved via clinical trials. Many drugs have been banned after reaching the consumer market if the side effects did not make the benefit-to-cost ratio favourable to the general public. The drugs were withdrawn fully or partially depending on its usage eg: Rofecoxib or Thalidomide.

At every phase, the investigators and researchers publish several scientific papers and review articles in reputed peer reviewed journals to support the use of a particular drug in a particular disease /ailment along with the side effects of the drugs that need to be factored in. Every drug has a lot of this information especially about adverse effects mentioned on the drug’s packaging. So the process is very transparent for all to know.

If you apply these principles to Ayurveda one can see why this is not really possible without proper basic science research first. If curcumin (present in Turmeric) is the active ingredient which has anti-cancer properties, you can't really test a recipe containing 100s of ingredients including turmeric without having a confounding bias in that study. It is curcumin only which needs to be extracted, studied and tested further.

Low quality/ non-existent basic science research leads to low quality clinical research. Moreover a lot of “Ayurvedic research” is shrouded in mystery with many of their theses filled with fantastical tales and engaging anecdotes to cater to the lowest common denominator in intelligence. Basically dumbing down science by oversimplification so that they can sell the drugs.

Levels of evidence

There are various levels of evidence in medical research depending on the strength of the evidence and the bias in the data collection and statistics. Level I being the best and Level V being the least

As you can see in the above table, anecdotal evidence (expert opinion) though useful many times to discover new drugs- is the poorest form of evidence at level V.

Q: What steps should be taken to improve the quality of Ayurveda research?  

Krishna: Scientific research in any field should follow strict scientific methodology. Otherwise there won’t be any difference between science and pseudo-science.

Several Western scientific communities complain that …

"We find it difficult to reproduce the results published in papers from Asia most of the time. Most Asian researchers show a bit of favouritism for things said in their cultures and religion and while doing research they try to authenticate it using manipulated data and biased reasoning. They don't publish their results in high class journals and find dubious journals favourable for their work. The peer-reviewers there too are prejudiced and recommend these papers. I can give an example of research with regard to an ancient treatment called Acupuncture. The papers published in China and other Eastern countries say it works. But when these were tested in the West, we failed to get the same results. Papers published in Asia are not reliable.”

Acupuncture Doesn’t Work

Can Acupuncture Treat Depression?

Unlike what Indian Ayurvedic practitioners say, these are the results obtained by ‘other people’ with regard to Ayurveda:

Herb-Induced Liver Injury in the Berlin Case-Control Surveillance S...

A rare case of acute hepatitis induced by use of Babchi seeds as an...

Luffa echinata: healer plant or potential killer.

Review article: herbal and dietary supplement hepatotoxicity.

Herbal hepatotoxicity: a tabular compilation of reported cases.

Acute renal failure secondary to ingestion of alternative medicatio...

Acute renal failure secondary to ingestion of ayurvedic medicine co...

Who do you believe? Lay men get confused.

I would recommend papers published in high quality journals like BMJ, Lancet, Nature and e-life. Forget about dubious journals. Science becomes science only after several people authenticate it after reproducing the results. A single person’s testimony is not useful for scientific knowledge, which requires reproducibility.

Ayurvedic researchers should publish their papers in peer-reviewed high quality journals by following standard scientific methodology and then claim their work is scientific. Until then…they cannot avoid skepticism.










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