Remedies at a homeopathic pharmacy in Varanasi, India. Photo: formulatehealth.com/Flickr, CC BY 2.0.
Kochi: As the novel coronavirus repeatedly spread through the world’s populations, in some countries in as many as three waves, and governments responded by enforcing lockdowns of varying degrees of strictness, people everywhere became increasingly fixated on their own immune systems.
The COVID-19 pandemic easily overwhelmed the healthcare systems of most countries, including the US and the UK, whose expenditure on healthcare is relatively much higher. Where there was a surplus of drugs that experts and politicians alike speculated could be useful to tame the infection, only a few have survived closer scrutiny, such as the steroid dexamethasone, and for limited use-cases. In this time, complementary and alternative therapies also became more popular.
In India, entrepreneurs, businesspeople and political leaders briskly pushed Ayurvedic and drugs of other provenance to people in the name of “better” or “stronger” immunity. The most popular among them, promoted by the country’s Ministry of AYUSH, included ‘Ayush Kwath’ and ‘Arsenicum album 30′.
Thanks to such pushes, pharmaceutical and FMCG companies supposedly manufacturing Ayurvedic products have been able to substantially increase their turnover.
P. Ramkumar, president of the Ayurveda Medicine Manufacturers’ Organisation of India, said that thanks to the lockdown, it was a difficult year for most drug-makers until the Kerala government included Ayurvedic drugs in its list of ‘essential items’.
While ‘classical drugs’ – formulations described in Ayurveda’s classical texts – are generally more popular, manufacturers of products that marketed ‘immunity’ had a field day last year.
High demand, high sales
Some Ayurveda pharmaceuticals with efficient marketing networks achieved higher sales last year than in other years thanks to Ayurvedic products, K. Sreekumar, a marketing consultant for such companies pharmaceuticals with 20 years’ experience, said.
According to him, the turnover for 2019-2020 for Ayurveda products alone in Kerala was over Rs 500 crore. Kerala’s Ayurveda market, including products and hospital treatment, is estimated to be worth over Rs 800 crore a year.
Saji Kumar S., past chairman of the Confederation of Indian Industries, Kerala, and managing director of Dhathri Ayurveda, added that sales of Ayurvedic products are expected to grow 20% in the current financial year — up from 10-15% in previous years. Apart from ‘immunity boosters’, the demand for single-drug extractions under Ayurveda has also climbed, according to him.
After the COVID-19 outbreak began, popular products included herbal masks, herbal hand wash, herbal sanitisers, herbal soaps and ‘immunity-boosting’ nutraceuticals. The deputy drug controller (Ayurveda) in Kerala, Jaya V. Dev, said almost every licence-holder for Ayurveda drug-manufacturing in Kerala – around 700 entities – could make ‘Ayush Kwath’ and sanitisers.
COVID-19 also affected the availability and distribution channels of medicines, so companies reorganised their operations to maximise sales of Ayurvedic products, Sreekumar said.
Some of the more successful companies, apart from smaller local entities, included Himalaya, Dabur, Charak and Zandu. Their and others’ products that included the ‘immunity’ tag were available over the counter at allopathic pharmacies. Some pharmacies also devoted a separate shelf for their products.
But in a time when more people are seeking treatment at Ayurveda clinics, Ayurveda hospitals and resorts have been having a tough time after the pandemic began, according to Dr Itoozhi Unnikrishnan, general secretary of Ayurveda Hospital Management Association.
The twist lies in the costs. Unnikrishnan estimated that unless hospitals and resorts achieve 40% occupancy of beds, they may not be able to break even – and this is hard because many people are still reluctant to travel.
“We are getting a lot of enquiries, even from outside Kerala, but these are not getting realised as the threat of the pandemic is continuing,” Unnikrishnan said.
Questions about efficacy
Quite a few physicians this correspondent spoke to said it’s easy to produce the data to show, on paper, that news products and therapies work. The challenge is to show that they do in real-life settings.
Some identified some over-the-counter products as well as a few new offerings that don’t have references in classical texts as “unscientific”. Others said ‘Ayush Kwath’ couldn’t be prescribed willy-nilly because its preparation includes herbs that may not be good for people with diabetes or hypertension.
Members of the scientific community have also raised questions about whether ‘immunity’ pills could be brought under Ayurveda and if the classical texts refer to pandemics.
Many Ayurvedic texts mention characteristics of illnesses that are synonymous with infectious and/or communicable ailments. For example, the Charaka Samhita contains the term ‘janapadoudhamsam‘, meaning ‘disintegration of settlements’. The Sushruta Samhita talks about fevers that cause the loss of smell, fevers brought by ‘outsiders’ and illnesses that spread when people hug each other or use others’ clothes. The texts also prescribe certain personal hygiene practices that could assist with prevention.
At the same time, revenue reports indicate the lay population isn’t concerned with the availability, or not, of evidence.
According to the WHO’s guidelines on ‘General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine’, published in 2000:
“The concepts in the use of traditional medicine should be taken into account with its cultural aspect as well. … When there is no documentation of long historical use of a herbal medicine, or when doubts exist about its safety, additional toxicity studies should be performed.”
In light of this, let’s consider ‘Ayush Kwath’, which the Ministry of AYUSH has been promoting.
‘Food as medicine’
According to Dr P. Rammanohar, director of the Amrita Advanced Ayurveda Research Centre and a member of the AYUSH Ministry Task Force for COVID-19, ‘Ayush Kwath’ was never promoted as a drug against the disease.
Instead, in his telling, the ministry pushed ‘Ayush Kwath’ to address a panic among people without seeding a false sense of complacency.
Dr S. Gopakumar, head of the department of aetiology at the Government Ayurveda Medical College, Thiruvananthapuram, said that food as medicine has been a mainstay of Indian cuisine for many centuries. According to him, the underlying concept is that ingredients in the food act as immunomodulators – substances that regulate the immune system — and vitalise the body’s organs. Ayurveda captures this in the concept of sarira balam (‘body strength’).
It’s a different issue that many pharmaceutical companies have been exploiting the situation with their own versions of ‘immunity’ drugs, he added.
However, the consensus in the medical research community – Ayurvedic and otherwise – is that it’s not possible to acquire better immunity overnight. Dr Gopakumar said such strength is the product of a person’s aahara (food), vihara (regimen), achara (habits) and vikara (emotions). This holistic approach to healthcare, he suggested, is reflected in modern medicine’s study of psychoneuroimmunology.
Dr Sharmad Khan, a senior medical officer at one of Kerala’s 810 government Ayurveda dispensaries, added that an Ayurvedic concept called vyadhikshamatvam deals with preventive care, and here, medicines are only a part of the sarira balam picture. According to him, a person’s ‘immunity’ can be breached by a derangement of their three doshas (vata, pitta and kapha). Axiomatically, the body that deals with such derangement better is also said to be equipped better in the face of illnesses.
COVID-19 care in Kerala
In Kerala, the state government distributed a ‘COVID Care’ kit to people in quarantine. The kit contained known drugs like indukantam, sudarshanam, vilwadi gulika, shadangam and aparajitha choorna dhoopam, Dr V. Rajmohan, the coordinator of the State Ayurveda COVID-19 Response Cell (SACRC), said. Since the Ayurvedic approach is individual-specific, and if a person reported a specific condition, the kit’s constituents would be changed accordingly.
Dr Rajmohan said the state obtained consent ‘digitally’ – via whatsApp – “from the people who were open to Ayurveda before sending them the kit. The response to the kit grew gradually.”
While COVID-19 reportedly manifests predominantly in the form of respiratory issues, Ayurvedic practitioners in Kerala have focused on treating its effects on gastrointestinal and respiratory-tract systems. The practitioners also conducted some ‘immunity clinics’ in the state.
But an important problem with Ayurveda treatments thus far has been the lack of documentation about care-recipients, according to Dr Rajmohan. The SACRC has filled this gap to some extent by logging observational data of people in quarantine under a project called ‘Amrutham’. Later, its ‘Punarjani’ project followed a rehabilitation programme for those who had recovered from COVID-19.
According to Dr Rajmohan, the reports have been “encouraging” and have been submitted to the state government. They are yet to be published, however.
K.K. Shailaja, the state’s health minister, told this correspondent that Ayurveda presented a good prognosis in both the ‘Amrutham’ and ‘Punarjani’ projects, and that the government will soon be publishing the results. “It is the lack of time and not the lack of intent that is delaying the publication of the data,” she added.
This report was supported by a grant from Thakur Family Foundation. The foundation did not exercise any editorial control over the contents of this report
Shyama Rajagopal is an independent journalist in Kochi. She previously worked with The Hindu as a health correspondent for 20 years.