Daya R. Varma
Summary: Witchcraft, Ayurveda, homeopathy and allopathy evolved over time and exist today. While witchcraft was based on the belief that evil spirits inflicts disease, Ayurveda in India and Yin-Yang in China introduced the concept that the cause of disease is physical and not supernatural, which led to a search for physical remedies from plants, animals and soil. Homeopathy recognized that drugs assist the body to cure itself. Allopathy is not a conceptual advance over Ayurveda and Yin-Yang but it is based on all existing knowledge and constantly attempts to verify conjectures through rigorous experimentation. Given the complexity of the biological system and disease processes, none of the medical disciplines can fully meet the expectations of the patient and therefore have managed to survive until now.
1. Introduction
In no other area of knowledge are myth and reality, rationality and irrationality so intertwined, each claiming to be superior to the other, as in medicine. Because people expect from medicine both what is possible and what is not, there is always a stream of people who are eager to be preyed upon. Both the clientele and the healers have mushroomed in recent years. The market is created by the understandable desire of the people to be cured regardless of the nature and pathology of the disease. It is easier to exploit the limits of medicine than its merits. So we have practitioners of Ayurveda, homeopathy, acupuncture, naturopathy, alternative medicine and so on. All these professionals may or may not have something to offer; however, unlike an ethical practitioner of medical science who may simply tell the patient that she or he has no more than few days or months to live, the unethical ones claim no limit to their art.
Medicine and other branches of biology deal with a highly complex system; it is not surprising then that biology does not achieve the same precision, as do the physical sciences. In one sense, however, biology itself may be considered to be the most complex part of physics and chemistry. In the final analysis, fundamental particles in some complex combination and interaction with each other create living organisms, which can be as tiny as a virus or as big as an elephant.
We do not hear of different disciplines within physics and chemistry, only subspecialties. Yet all branches of science have a similar history. Until 1845, chemists believed that organic compounds were produced under the influence of a “vital force” and could not be made artificially. Only when Kolbe synthesized acetic acid in 1845 from its elements could the vital force theory be discarded. But there is no doubt that it was discarded. There is no branch of chemistry now that is based on vital force theory. Medicine, somehow, is different.
2. The Origin of Medical Science as Witchcraft
All systems of knowledge, rational or irrational, speculate on the causes of an event and a method to appropriately use the event to their advantage. Medicine is no exception. Disease is as ancient as human kind; so is the human desire to be rid of the disease. The early humans had little knowledge of science but were witness to natural blessings and havocs of one kind or another. Naturally they believed that illness is a curse of an evil spirit. So they came up with an explanation for the disease. In a way this process was revolutionary because it is based on enquiry, the fact that the answer was wrong is a different matter. Because our ancestors speculated that the disease was caused by the devil, the treatment naturally was to satiate the evil spirit. This was the origin of Witchcraft. In its own way this is a complete system linking theory with practice. There is a cause and there is a cure. The approach is scientific even if its foundation is faulty. So the first stage of medicine was the science of witchcraft. It lasted for the longest time and still exists.
3. Materialist theory of disease: Ayurveda, Yang-Yin and Egyptian-Greek physicians
As time passed and human knowledge increased, it was postulated that disease is physical and not supernatural so the cause must be physical. This was the second and the most important phase in the evolution of medicine. It is not surprising that this breakthrough came from two of the oldest living civilizations, India and China. Indian scientists of that time came up with a new theory of disease. According to them, the cause of disease was not the curse of evil spirits but an imbalance between three systems (Tridoshas), termed “Bayu, Pitta and Kapha” (respiratory, circulatory and digestive system in the broadest sense). China came up with the theory of interaction between two opposites-Yang and Yin, similar to the dialectical concept of unity of opposites. These were milestones in the progress of medical science. The contributions of Egyptian and Greek physicians were in specific areas and related to the description of diseases and possible cures and toxicity of drugs. These concepts were developed to a high level of detail by Hippocrates (468-377 BC).
Just as Darwin (1809-1882), a thousand years later, provided a biological basis for evolution in his celebrated treatise “The Origin of Species” (1859), Ayurveda presented a physical as opposed to a mythical basis of disease. So did the theory of Yin-Yang. And just as the spiritual basis of disease led to witchcraft, the theory of the physical basis of disease led to the exploration of physical means of alleviation of disease. Thus began the search for remedies from plants, animals and soil. The selection of different remedies in Ayurveda or the Chinese medical system was scientific and based on some empirical data. It might be worth speculating that experimentation was a way of life for our ancient ancestors, which is not the case in an era of abundant supply (if one can afford it) of ready-to-use goods requiring only the reading labels, if at all.
Ayurveda also ventured into devising a method for the diagnosis. It recognized that there exists pulsation at the wrist and that these pulsations can vary from one disease to the other. Thus a circle was completed. What causes a disease, how a disease can be diagnosed and how it can be cured. Between 300-400 BC, Greek and Egyptian physicians also developed a materialistic view of medicine; their description of the symptoms of disease has stood the test of time and the Hippocratic oath is still held to be the ultimate test of medical ethics. Since Greek and Egyptian medicine became a continuum of modern medicine, it did not germinate into a separate disciple like Ayurveda. I should hasten to say that is not only the story of Ayurveda; due to the stagnation of Arab and Iranian society they got stuck with Hikmat, Hakeem and Yunani (original Greek, since Yunan is Arabic for Greece) medicine.
3.1. Achievements of Ayurveda
The principal achievement of Ayurveda, as stated above, is to provide a materialist approach to disease. In addition it attempted to identify remedies, mainly from vegetation; this is also a scientific approach. During the evolutionary process, humans, animals and vegetation have been in constant interaction with the environment and in turn changing the environment. Therefore there is always a probability that plants, animals, metals and other matter in nature can cure or kill. The knowledge of which of these can do what must have required a mammoth amount of experimentation just as a lot of trial and error must underlie the identification of edible and non-edible foods.
3.2. Limits of Ayurveda
Charaka is considered to be the founder of Ayurveda and believed to be pre-Vedic, 5,000-6,000 years old or even older.
A major limit of Ayurveda is ingrained in its very origin. The world population 6,000-7,000 years ago (approximate origin of Ayurveda) is estimated to be perhaps100 million. Greater India’s population could have been 20 million scattered sparsely. Longevity was short. Many diseases have made their way with increase in population. Consequently, Ayurvedic or Chinese physicians could not have visualized the medical needs of today. On the other hand, diseases share symptoms, which are fewer than diseases, and a variety of diseases can produce similar or identical symptoms (e.g., pain either localized or general, diarrhea or constipation, emaciation, fever, loss of consciousness, etc). All infections produce fever. Cancer, tuberculosis, AIDS and many others cause emaciation.
There is no one single originator of allopathy, physics, chemistry and mathematics. These sciences started as nascent knowledge and can almost never reach a state of perfection. In contrast, Ayurveda and homeopathy, like religion, are the brainchild of single geniuses. Could there have been a genius 6,000 years ago who could have supplied the correct and final answer to all ailments like the prophets have done?
Medical science like any other branch needs continuous revision, experimentation and each new advance poses new questions requiring new tools for both investigation and the discovery of solutions. In this sense, Ayurveda ceased to be a living science long time ago and several factors contributed to this state of affairs; the most important ones include the practice of transferring knowledge to select few than to general population known as the “Guru-Shishya” (teacher-pupil) culture, the culture of secrecy in knowledge transfer, resistance against renovation and the stagnation of Indian society.
3.3. Can the efficacy of Ayurvedic medicines be established?
A pharmacological dictum is that therapeutic, toxic and placebo effects are properties of many drugs but toxic and placebo effects are common to all drugs. So there cannot be a drug without toxicity. A drug is good if it produces toxicity in quantities much greater than that required to produce therapeutic effect. Given this definition, the safest drug known so far is penicillin; but even small doses of penicillin can kill if the subject is allergic to it. In general, the higher the dose the greater is the probability of producing unacceptable toxicity. The nature of Ayurvedic formulations are such that quantities required to treat the disease are often too bulky to cause toxicity; by the same token, they might be ineffective even if they do contain therapeutic potential.
If the efficacy of an Ayurvedic medicine can be scientifically established, it gets incorporated in modern medicine. However, an evaluation of the therapeutic efficacy of drugs is a complex process, which is costly and often imperfect. The efficacy of drugs can only be fully appreciated when it goes into general use and not when it is tested in a selected population during what is called Phase 1, 2 and 3 Clinical trials.
Even within the limitations stated in the above paragraph, the formulations of Ayurvedic medicine are such that it makes their evaluation quite difficult. One can start with the assumption that well-known Ayurvedic medicines, which have been used over time, are as safe within limits as allopathic medicines. In fact, sometimes Ayurvedic as well as homeopathic medicines become toxic because the practitioner adulterates them with allopathic drugs, commonly steroids and antibiotics. Therapeutic efficacy of Ayurvedic drugs could be evaluated if a rigorous protocol of its usage and effects are recorded and the outcome statistically analyzed; this is quite different from the technique of evaluating new drugs. The evaluation of Ayurvedic drugs according to the current protocol used to evaluate new drugs by the pharmaceutical industry is impractical and costly. Indeed, the high cost of evaluation is an advantage to big pharmaceuticals because it has practically eliminated small entrepreneurs and individual scientists as discoverers of new drugs from the beginning to the end.
4. Homeopathy
Thousands of years after Ayurveda and Yin-Yang, Samuel Hahnemann (1755-1843) came up with the theory that like treats like and instead of treating a specific ailment such as pneumonia, you treat the entire body for which you can administer symptom-simulating drugs in the tiniest amount, almost 10 to the power minus 20 (10-20) or even minus 33 (10-30). The term “like” is too vague to scrutinize the concept of like treats like. Penicillin can cure infection in any part of the body caused by gram-positive bacteria but on its own it produces no effect even at doses ten or 20 times greater than that needed to cure. Drugs cannot simulate the symptoms of the majority of diseases and many diseases have no symptoms whatsoever until very late, if at all. Ordinarily, high blood pressure produces no symptoms, and if it does the symptom may just be headache, blurred vision or erectile dysfunction. Which symptom to simulate and at what stage of the disease a homeopath should intervene are difficult issues for homeopathy. In order for symptoms to become apparent, the disease has to progress to some extent; often enough it may have progressed so far that treatment is not possible. Moreover the potency of the drug advised in homeopathy is like throwing a single dose in the Pacific Ocean, hoping that some molecules will be present in water samples near both San Francisco and Hong Kong. Notwithstanding these basic limits, homeopathy implies that drugs do not cure; they only boost the ability of the body to deal with the illness. This is true and is also a recognized principle of modern drug therapy.
5. Modern medicine
Modern medicine is not a conceptual advance over Ayurveda. It incorporates all systems of medicine, is in continuum with them and has advanced over all of them to the most rational stage possible. The use of vaccines to boost body defenses against potential diseases has some superficial similarity to homeopathy. How does then modern medicine differ from all other forms of medicine? Suffice to say that modern medicine, like all other branches of science, is based on constant enquiry and renovation determined by careful experimentation and observation. Take for example the case of tuberculosis. Modern medicine considered tuberculosis to be a constitutional disease, giving rise to the term “consumption” only about 100 years ago and the only treatment was going to sanatoria. As soon as it was recognized that the disease is caused by Mycobacterirum tubercule, the old theory was discarded.
The essence of medical science is to discard what cannot be proved to merit for which it has been used or prescribed; this is done from laboratory study using animals or tissues to clinical trials and reevaluations once the drug is in general use. This is not to say that modern medicine evolved without going through prejudice and skepticism. Some of them are as horrendous as Church’s indignation against Galileo (1564-1642), though short of proclaiming execution. Sterilization during surgery and childbirth is perhaps the greatest advance in medical science. Nothing has saved more lives and nothing has decreased puerperal sepsis and neonatal mortality as much as washing hands and boiling surgical instruments. And yet, when the Hungarian-Austrian physician Ignaz Semmelweis (1818-1865) proposed in 1846 that surgeons should wash their hands before handling wounds or births, he was ridiculed; surgeons argued that washing hands before surgery will waste precious time.
The essence of medical science is not that it uses synthetic as opposed to natural drugs. Indeed almost all medications used by the allopath until the end of 19th century were derived from plants or metals. Many remained popular even till quite late, many are still used and many are being added. Take for example the use of arsenic for the treatment of syphilis. It was the only medication available until the discovery of penicillin soon after World War II. There are other examples. Vitamins, which are essential for life but cannot be made by human body, are solely derived from foods. Many naturally occurring drugs such as quinine for malaria, emetine for amebiasis, digitalis for heart failure, quinidine for heart irregularities, ergot for migraine, caffeine and ephedrine for asthma, vinca alkaloids for cancer, atropine for reducing secretions and intestinal spasm, colchicines for gout and so on are still in use. In short, source of drug (herbs, plants, metal, living organism) does not distinguish Ayurveda from allopathy; what distinguishes the two is that one is based on evidence and the other on tradition with unproven or half-proven value.
Indeed the major contributions of modern medical science are not in the area of drug discovery but rather in the area of diagnostics and the pathology of diseases, neither of which are a solace to the patient who needs cure more than diagnosis.
6. Why do different systems of medicine persist?
The reason for the survival of Ayurveda, homeopathy and other branches are not the same as the reasons for the persistence of bullock-carts in the era of trucks, trains and airplanes.
The first and foremost of factor leading to the survival of different medical disciplines is the limits of medical science. Modern medicine or allopathic medicine cannot cure all existing diseases or even safely relieve all unpleasant symptoms. Diseases are a part of biology; some treatable some not. Some were untreatable before but have become treatable now. For example there was no cure for tuberculosis when Kamla Nehru had it but the discovery of effective anti-tubercular drugs has made it possible to cure tuberculosis. On the other hand many common ailments like essential hypertension and diabetes can be controlled but cannot be cured even now. Cancer, AIDS, heart failure are other areas where complete breakthrough has not been achieved despite much effort.
However, the limitation of medical science is not acceptable to the patient who will, naturally and justifiably, search for cure. They are likely to try anything and there would always be an Ayurvedic practitioner or homeopath that will promise a cure.
Unlike many consumer goods, which arrive from major centers, treatment must be available in proximity of the sick especially during acute serious illnesses. In a place like India, where public healthcare is in disarray in favor of fancy modern private profit-making hospitals in major cities, the marginalized population has little to choose between an allopathic and Ayurvedic doctor. Ayurvedic practitioner is always available and usually develops better rapport with the patient and patient’s family and charges less than an allopathic doctor.
An unintended offshoot of the vibrant environment movement is reinforcement of the mythical greatness of the past; sometimes it tends to become anti-science and anti-progress. Since ignorance and religion cater to ultra-nationalism, age-old traditions find a favorable climate for assertion or reassertion. It is true everywhere including in India and China. However, religion has a weak base in China and not encouraged by the state. So the Chinese take a philosophical view of Yang-Yin and experiment with traditional method of treatment such as acupuncture before adopting them as a part of healthcare system. India with strong religious influence gave Ayurveda a mythical status; many hold that the system is fully developed and correct forever and needs reinforcement and not change. Some political figures even consider that patriotism requires promoting Ayurveda.
Finally, biological systems have an inbuilt method of correcting abnormal episodes. Indeed Darwin would have had nothing to write if species did not have the natural ability to deal with adversity and evolve. Humans cannot grow severed finger like reptiles do but there exists a mechanism of repair, fighting infections, preventing infection, correcting changes in blood pressure, suppressing cancer etc. It is a common knowledge that people recover from episodes of fever without taking medication and often without even knowing the cause of the fever. No epidemic kills every body; some survive, why? Childhood asthma has increased dramatically in the West, perhaps because of industrial pollution; however, many of these children completely recover, as they grow older. Given this situation, a great majority of common diseases can be cured by any drug, provided the drug itself does not cause toxicity. So the physician of any branch of medicine has a good chance of satisfying a good percentage of her/his patients. That is a part of the reason why a number of practitioners without training in any type of medicine can carry on with their business in India successfully. This is also part of the reason why placebos are used as some form of control in drug evaluations because all medications have placebo effect and that many only have placebo effects.
Most importantly, survival of spurious disciplines of medicine is rooted in the total disarray in public healthcare system in India. The modern medical healthcare system was introduced in India in late 19th century during the British colonial rule. This system comprised of primary health centers located sparsely in villages, a large size hospital in district headquarters and even bigger ones in major cities; a number of medical schools attached to major hospitals were also started. Some research was done and the crowning point of this was the discovery of the malarial parasite and its transmission by mosquitoes. The healthcare system stipulated referral from primary to secondary to tertiary healthcare centers. Hospitals were free. The principle is sound and has reached near perfection in Cuba, where healthcare is not only universal but health centers treat the patients as well as maintain vital statistics and ensure prevention of diseases and its complications as best as is physically possible. The opposite happened in India. While India increased number of medical school and started formal schools of indigenous medicine, it allowed a total collapse of free healthcare system in favor of highly modern, profit-making hospitals in major cities like Delhi, Mumbai, Hyderabad, Bangalore etc, which cater to the 150-200 million rich and even attract foreigners. The public healthcare system provides practically nothing so that nearly 85% of healthcare is provided by moneymaking institutions (hospitals and nursing homes) to the 15% of the population; 85% of the population relies on dismal services. A sound healthcare system has implications far beyond health and beyond the scope of this note. Suffice it to say that nothing makes poor feel helpless, marginalized and victims of loan sharks more than sickness in the family, especially of the children.
Finally a sound healthcare system is not contingent upon role of multinationals, WTO and TRIPS. Even a capitalist country like Canada can do it, so why not India? Nothing is more crucial than a free universal healthcare system to the vast majority of India’s marginalized population. Yet it is surprising that this issue does not constitute a major platform of political parties including the left parties. In any case, this deterioration in public healthcare is an important reason for survival of all systems of medicine including witchcraft and unethical medical practices both indigenous and modern.
