India is not a developing nation. It was once at the pinnacle of development, fell, and is rising again. Thus, we have valuable traditional knowledge that is yet to undergo modern scientific evaluation and is not considered evidence-based. In the realm of health, ayurveda is rich in sustainable living practices that are now being echoed by modern medicine. For example, it emphasises gut health and various health properties of food types and cooking methods; modern science has only recently caught up with how diet and gut microbiomes impact health.
But traditional wisdom can be tainted with superstitions and misconceptions that must be filtered for individual and social harm. In medicine, the burden of proof is high due to the potential human costs of wrong advice. Increasing cases of liver injury in otherwise healthy people due to herbal supplements of dubious benefit is a case in point. The best approach is healthy scepticism, where we are open to new ideas, irrespective of the source, but question them rigorously.
Any unproven new idea of seeming benefit should be tested against a three-pronged benchmark. First, scientific plausibility. Second, consideration of harm. And third, given the scientific probability, the possibility of generation of evidence towards incorporation into scientific medical practice. Pursuing truth via science and the scientific method is the essence of future integrative medical science. Such a pathway has been recommended by many organisations, ranging from those who debunk superstitions to those who are guiding the transformation of India, such as the NITI Aayog. However, this can be challenging.
Recently, media reports chronicled an integrative medicine meeting of maternal and child health practitioners, including senior faculty from the All Institute of Medical Sciences (AIIMS), Delhi, my alma mater. Troublingly, the narrative seems to have been non-scientific in some parts. The idea that gender expectations of mothers could lead to homosexuality in children — for example, a pregnant woman wanting a girl child may cause a male child to grow up as homosexual — is laughable. Suggestions that women follow the example of Jija Bai’s prayers during pregnancy so that they may have children with qualities of “Hindu rulers” is disturbing. There were also discussions on the importance of studying the scriptures during pregnancy and how children of modern parents were increasingly being born with birth disorders and autism, due to a lack of sanskar (cultural traditions). This thinking is wrong at many scientific, social and ethical levels. So, how do we move forward to ensure that the final integrative whole is not less than the sum of its parts?
Many ayurveda colleagues dismissed this discussion as a distorted fringe-element version of garbha sanskar, which speaks of the importance of healthy practices during pregnancy as determinants of future child health, perhaps via epigenetic influences. While most members of an alum group of AIIMS-trained doctors were alarmed at these media reports, a few considered such thinking or practices harmless. They rationalised that people can take the good parts of such reports and discard the rest. In their view, the absence of evidence is not evidence of absence, and that we should not be too critical of traditions. While the second approach may superficially seem more conducive to integrative research in India, I differ.
Ayurgenomics, an intersection of ayurvedic concepts and genomic investigations, was successfully led by AIIMS because we had honest scientific discussions where we could set evidence challenges for the ayurveda team. When experts on one side choose not to question the other, it is disingenuous and is likely to lead to long-term harm. We need to articulate the boundaries of scientific possibilities during collaborations, revisit them frequently, and consider new knowledge. This accelerates meaningful collaboration and culls the meaningless ones. Beyond this, we need to view all output in the context of the realities of our heterogeneous society, where women often face the consequences of misinformation.
Wrong beliefs articulated by senior experts have consequences. In the example above, such discussions will either lead to the mother being blamed for the different abilities or sexual orientation of the child, or even put societal pressure on pregnant women. Every doctor should be aware of the traditional blaming of women for their child’s gender. It is disconcerting when doctors cannot connect misinformation propagation to such social ills. For a country where Article 51 A(h) of the Constitution makes it a fundamental duty to develop scientific temper, humanism and the spirit of inquiry and reform, much needs to be done by medical professionals.
To question or challenge a practice, a senior or a teacher is considered disrespectful in India, including in modern medical institutions. Consequently, we have too much faith and not enough scientific temper. That must change. Only after setting our house in order will we have the confidence to engage with others, scientifically questioning their practices in the same hard way we do ourselves. In the end, there is no magic, it’s all science.
Anurag Agrawal is dean, BioSciences and Health Research, Trivedi School of Biosciences, Ashoka University The views expressed are personal