India needs evidence-based, ethics-driven medicine (GS Paper 2, Health)
Context:
- The recent push to integrate ‘AYUSH’ medicinal systems into mainstream health care to achieve universal health coverage and ‘decolonise medicine’ is a pluralistic approach that would require every participating system to meet basic safety and efficacy standards.
- Homoeopathy does not meet these standards. But its supporters have argued for expanding its use by citing demand and decolonisation, disregarding its flaws.
Evolution of Homeopathy:
- Homeopathy is made of two Greek words, Homois meaning similar and pathos for suffering. It was in the 19th century that homeopathy started developing scientifically.
- The credit for this goes to the German physician, Dr Samuel Hahnemann (1755-1843).
Efficacy and safety of homoeopathy:
Low evidence quality:
- Multiple systematic reviews and meta-analyses have found that, across ailments, population groups (adults versus children), study types (placebo-controlled versus other trial types), and treatment regimes (individualised versus non-individualised), homoeopathic treatments lack clinically significant effects. Reviews that somewhat support homoeopathy’s efficacy also caution over the low evidence quality and raise concerns about its clinical use.
Unregistered trials:
- Recently, researchers demonstrated that more than half of the 193 homoeopathic trials in the last two decades were not registered.
- Unregistered trials showed some evidence of efficacy but registered trials did not. There was reporting bias and other problematic practices, throwing the validity and reliability of evidence thus generated into doubt.
Lack of confidence:
- Further, the World Health Organization (WHO) has warned against homoeopathic treatments for HIV, tuberculosis, and malaria, as well as flu and diarrhoea in infants, saying it has “no place” in their treatment.
- Instead, treatments have been linked to both non-fatal and fatal adverse events as well as their aggravation.
Arguments by Homoeopathy’s supporters:
- They argue that the standards commonly used in evidence-based medicine are not suitable for judging the “holistic effects” of homoeopathy. This claim can be debunked.
- The standards are not conveniently chosen by practitioners of allopathic medicine for themselves.
- Randomized controlled trial (RCTs) and other methods for collecting and assessing evidence are collaboratively set and updated by a global community pushing for evidence-based medicine that includes epidemiologists, biostatisticians, quality improvement researchers, implementation managers, and several others, beyond clinicians.
- Further, multiple disciplines such as psychology, economics, community health, implementation science, and public policy, beyond medicine have successfully adapted evidence synthesis methods to establish their claims.
- The claim about homoeopathy being holistic is typically paired with evidence-based medicine being “reductionist”. In 2023, most exponents of evidence-based medicine are aware and accepting of biopsychosocial approaches toward health endorsed by WHO, predominantly composed of evidence-based medicine practitioners and supporters.
Empirical evidence:
- The evidence-based medicine does not and should not stop at establishing empirical evidence. The quest is also to discover and explain the mechanisms underlying the evidence.
- Several allopathic/modern medicine practices have updated themselves based on growing scientific evidence.
Pluralistic approach:
- Adopting a pluralistic approach in medicine can decolonise medicine. Homoeopathy was introduced in 1839 in India by Austrian physician J.M. Honigberger.
- While defining traditional medicine can be subjective, homoeopathy was introduced quite recently in India’s history during the colonial period for colonial benefit. Hence, its traditional tag is untenable.
- The argument to reject homoeopathy is not just based on its coloniality, but chiefly on the lack of evidence for efficacy, some evidence for lack of safety, no substantive progress on mechanisms of action in the last century, and homoeopathic practitioners’ escapist arguments.
Conclusion:
- Homoeopathy’s supporters offer testimonials from luminaries such as Gandhi and Tagore. But Gandhi’s writings have scant mentions.
- India’s path to universal health care must be grounded in evidence-based and ethics-driven medicine.
