Evidence-based medicines are built on three pillars – patient choice, doctor experience and the latest available evidence. Misinformation weakens all three and this is what makes the Patanjali case going on in the Supreme Court critical. In an affidavit filed in the Supreme Court this week, the Uttarakhand State Licensing Authority said it has suspended the manufacturing licenses of 14 products of Patanjali Ayurved Limited and its associate company Divya Pharmacy. It is noteworthy that this action was taken after the Supreme Court strongly criticized the state authority for not taking action against Patanjali. In November 2023, Patanjali assured the Supreme Court that it will no longer stop advertising its products. Or will not violate any law in branding. Also, anything claiming efficacy of the drug or against any medical system will not be released to the media in any form. But the company continued to publish misleading advertisements. These made false promises of treating many health conditions, including high blood pressure and diabetes, and also criticized the failings of Western medicine. In February this year, the Supreme Court had issued a contempt notice against Patanjali. The company had continued to publish advertisements for products violating the rules even though it had given an undertaking to the court in November. After this, Patanjali had to publish an unconditional apology in major newspapers.
ahead of patanjali
Patanjali’s advertisements also claim that they have proven the efficacy of their formulations through research. The problem with many such research citations is that they lack the necessary conditions and are insufficient to support claims of ‘cures’ for various diseases. This particular pharma industry has issues with patents and proprietary drugs. These formulations are not mentioned in the classical textbooks of Ayurveda but contain the mentioned ingredients in varying quantities and combinations. Also the safety and efficacy standards set by various state authorities for licensing the formulations are also not very stringent.
The safety of the formulations, as recorded directly in classical Ayurveda textbooks, is already under debate due to the presence of large amounts of metals and other potentially toxic ingredients. Reliable data are needed before new formulations can be brought to market. Recently UP had banned more than 30 Ayurveda products. This was because steroids, pain relievers and oral hypoglycemic agents were found in many of these products. The Ayurveda establishment needs to seriously reconsider the issue of counterfeit and adulterated products to avoid further risk to public health.
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beyond ayurveda
This problem is not limited to just the AYUSH sector. In recent years there have been several cases of the pharmaceutical industry ignoring public health for the sake of commercial interests. This debate should be given priority instead of focusing only on Patanjali. Consider some recent cases that highlight the conflict between industry and public health. British-Swedish multinational pharma company AstraZeneca recently admitted in court documents that its Covid vaccine may cause thrombocytopenia syndrome, a rare side effect. TTS can form blood clots that can lead to deep vein thrombosis, heart attacks, and stroke. This side effect is known for all adenovirus vector-based vaccines. Many countries stopped or age-restricted these vaccines as soon as they discovered this.
Similarly, a UK authority recently ruled that Pfizer promoted its unlicensed Covid vaccine on Twitter but did not disclose anything about its side-effects. This company was fined in UK. A company spokesperson said the company deeply regrets and is fully aware of and accepts the points raised in the authority’s decision. The third example that should draw attention to our public health concerns is that EU food safety agencies have reported the presence of cancer-causing ethylene oxide in more than 500 food products exported from India.
The couple who gave loan to Baba Ramdev to start a company, donated an island, where does he live?
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The industry contributes to the country’s economy but it is important to strike a balance between commercial interests and public health. The industry cannot take health lightly under any circumstances. Electoral Bond data points to a possible nexus between the pharmaceutical industry and political parties. Non-pharma activities related to lifestyle changes, physical activity and dietary modification do not get much attention because no one promotes them.
Now coming back to the concept of evidence-based medicine. In India, it is weak because patient choices about healthcare are often driven by misinformation. It is rampant on social media. Besides, poverty and illiteracy also play an important role in this. AYUSH and modern medicine work differently, making an informed choice almost impossible. Claiming that AYUSH has no side effects and provides complete treatment is not correct. Doctors do not tell about its limitations. It has misled the public and caused harm. AYUSH establishment should prioritize ‘evidence building’ over ‘popularity’ to improve outcomes. Making authentic information about health easily available to all citizens is a challenging task. But this is the only solution.
(The author is Professor of Ayurveda, Banaras Hindu University. These are his personal views.)