Alcove

Science, culture, complexity

Tag: Ayurveda

  • CSIR touts dubious ‘Ayurveda’ product for diabetes

    At 6 am on September 13, the CSIR handle on X.com published the following post about an “anti-diabetic medicine” called either “Daiba 250” or “Diabe 250”, developed at the CSIR-Indian Institute of Integrative Medicine (IIIM):

    Its “key features”, according to the CSIR, are that it created more than 250 jobs and that Prime Minister Narendra Modi “mentioned the startup” to which it has been licensed in his podcast ‘Mann ki Baat’. What of the clinical credentials of Diabe-250, however?

    Diabe-250 is being marketed on India-based online pharmacies like Tata 1mg as an “Ayurvedic” over-the-counter tablet “for diabetes support/healthy sugar levels”. The listing also claims Diabe-250 is backed by a US patent granted to an Innoveda Biological Solutions Pvt. Ltd. Contrary to the CSIR post calling Diabe-250 “medicine”, some listings also carry the disclaimer that it’s “a dietary nutritional supplement, not for medicinal use”.

    (“Ayurveda” is within double-quotes throughout this post because, like most products like Diabe-250 in the market that are also licensed by the Ministry of AYUSH, there’s no evidence that they’re actually Ayurvedic. They may be, they may not be — and until there’s credible proof, the Ayurvedic identity is just another claim.)

    Second, while e-commerce and brand pages use the spellings “Diabe 250” or “Diabe-250” (without or without the hyphen), the CSIR’s social media posts refer to it as “Daiba 250”. The latter also describe it as an anti-diabetic developed/produced with the CSIR-IIIM in the context of incubation and licensing. These communications don’t constitute clinical evidence but they might be the clearest public basis to link the “Daiba” or “Diabe” spellings with the CSIR.

    Multiple product pages also credit Innoveda Biological Solutions Pvt. Ltd. as a marketer and manufacturer. Corporate registry aggregators corroborate the firm’s existence; its CIN is U24239DL2008PTC178821). Similarly, the claim that Diabe-250 is backed by a US patent can be traced most directly to US8163312B2 for “Herbal formulation for prevention and treatment of diabetes and associated complications”. Its inventor is listed as a G. Geetha Krishnan and Innoveda Biological Solutions (P) Ltd. is listed as the current assignee.

    The patent text describes combinations of Indian herbs for diabetes and some complications. Of course no patent is proof of efficacy for any specific branded product or dose.

    The ingredients in Diabe-250 vary by retailer and there’s no consistent, quantitative per-tablet composition on public pages. This said, multiple listings name the following ingredients:

    • “Vidanga” (Embelia ribes)
    • “Gorakh buti” (Aerva lanata)
    • “Raj patha” (Cyclea peltata)
    • “Vairi” or “salacia” (often Salacia oblonga), and
    • “Lajalu” (Biophytum sensitivum)

    The brand page also asserts a “unique combination of 16 herbs” and describes additional “Ayurveda” staples such as berberine source, turmeric, and jamun. However, there doesn’t appear to be a full label image or a quantitative breakdown of the composition of Diabe-250.

    Retail and brand pages also claim Diabe-250 “helps maintain healthy sugar levels”, “improves lipid profile/reduces cholesterol”, and “reduces diabetic complications”, sometimes also including non-glycaemic effects such as “better sleep” and “regular bowel movement”. Several pages also include the caveat that it’s a “dietary nutritional supplement” and that it’s “not for medicinal use”. However, none of these source cite a peer-reviewed clinical trial of Diabe-250 itself.

    In fact, there appear to be no peer-reviewed, product-specific clinical trials of Diabe-250 or Daiba-250 in humans; there are also no clinical trial registry records that were specific to this brand. If such a trial exists and its results were published in a peer-reviewed journal, it hasn’t been cited on the sellers’ or brand pages or in accessible databases.

    Some ingredient classes in Diabe-250 are interesting even if they don’t validate Diabe-250 as a finished product. For instance, Salacia spp., especially S. reticulata, S. oblonga, and S. chinensis have been known to be α-glucosidase inhibitors. In vitro studies and chemistry reviews have also described Salacia spp. can be potent inhibitors of maltase, sucrase, and isomaltase.

    In one triple-blind, randomised crossover trial in 2023, biscuits fortified with S. reticulata extract reduced HbA1c levels by around 0.25% (2.7 mmol/mol) over three months versus the placebo, with an acceptable safety profile.In post-prandial studies involving healthy volunteers and type 2 diabetes, several randomised crossover designs had lower post-meal glucose and insulin area under the curve when Salacia extract was co-ingested along with carbohydrate.

    Similarly, berberine-based neutraceuticals (such as those including Berberis aristata) have shown glycaemic improvements in the clinical literature (at large, not specific to Diabe-250) in people with type 2 diabetes. However, these effects were often reported in combination with other compounds and which researchers also indicated depended strongly on formulation and dose.

    Finally, a 2022 systematic review of “Ayurvedic” medicines in people with type 2 diabetes reported heterogeneous evidence, including some promising signals, but also emphasised methodological limitations and the need for randomised controlled trials of higher quality.

    Right now, if Diabe-250 works as advertised, there’s no scientific proof in the public domain, especially in the form of product-specific clinical trials that define its composition, dosage, and endpoints.

    In India, Ayurvedic drugs come under the Drugs & Cosmetics Rules 1945. Labelling provisions under Section 161 require details such as the manufacturer’s address, batch, and manufacturing and expiry dates while practice guides also note the product license number on the label for “Ayurvedic” drugs. However, several retail pages for Diabe-250 display it as a “dietary nutritional supplement” and add that it’s “not for medicinal use”, implying that it’s being marketed with supplement-style claims rather than as an Ayurvedic “medicine” in the narrow regulatory sense — which runs against the claim in the CSIR post on X.com. Public pages also didn’t display an AYUSH license number for Diabe-250. I haven’t checked a physical pack.

    A well-known study in JAMA in 2008, of “Ayurvedic” products purchased over the internet, found that around 20% of them contained lead, mercury or arsenic, and public-health advisories and case reports that have appeared since have echoed these concerns. This isn’t a claim about Diabe-250 specifically but a category-level risk of “Ayurvedic” products that are available to buy online and which are compounded by the unclear composition of Diabe-250. The inconsistent naming also opens the door to counterfeit products that are also more likely to be contaminated.

    Materials published by the Indian and state governments, including the Ministry of AYUSH, have framed “Ayurveda” as complementary to allopathic medicine. For example, if a person with diabetes chooses to try “Ayurvedic” support, the standard advice is to not discontinue prescribed therapy and to monitor one’s glucose, especially if the individual is using α-glucosidase-like agents that alter the post-prandial response.

    In sum, Diabe-250 is a multi-herb “Ayurvedic” tablet marketed by Innoveda for glycaemic support and has often been promoted with a related US patent owned by the company. However, patents are not clinical trials and patent offices don’t clinically evaluate drugs described in patent applications. That information can only come from clinical trials, especially when a drug is being touted as “science-led”, as the CSIR has vis-à-vis Diabe-250. But there are no published clinical trials of the product. And while there’s some evidence for some of its constituents, particularly Salacia, to reduce postprandial glucose and to effect small changes in the HbA1c levels over a few months, there’s no product-specific proof.

  • Government by Supreme Court

    On February 27, a bench of the Supreme Court upbraided Patanjali Ayurved and its chairman Acharya Balkrishna for continuing to disparage systems of medicine other than Ayurveda (technically, what it calls Ayurveda) and claiming its products offer “permanent relief” from “blood pressure, diabetes, arthritis, asthma and obesity” in its advertisements, despite having assured the court in November 2023 that it won’t do so. The Indian Medical Association had filed the case in August 2022 alleging that Patanjali Ayurved had flouted the Drugs and Magic Remedies (Objectionable Advertisements) Act 1954 and its Rules.

    It’s a straightforward case with an understandable outcome, but it isn’t unsurprising. That Patanjali Ayurved so openly violated the Act and the Rules – but also good sense, as Pushpa Mitra Bhargava pointed out in an excoriating essay in 2016 – forced the IMA to approach the court, and for some time now the courts have been the last democratic institutions in India interested in upholding the law (and even then it’s iffy). The ‘backstop’ the courts have offered against advertisements in particular running away with bullshit has been particularly useful because the laws are not so much outdated as unable to respond to the new ways in which advertisers are twisting words, taking advantage of grey areas, and, generally, “telling a lie in a way that it appears to be the truth,” in Bhargava’s words.

    More importantly, advertisement regulation in India is weak. As Kaushik Moitra and Shreya Sircar wrote in 2022 (emphasis added):

    Advertisers must address complaints regarding deviations from the ASCI Code. If such complaints are not remedied, ASCI may take coercive steps to regulate the (allegedly) offending advertisement. Illustratively, ASCI may recommend that broadcasters not air the offending advertisement and may also publish instances of non-compliance by advertisers on its website. ASCI may also report infractions to the Ministry of Information and Broadcasting.

    Additionally, – and uniquely for a self-regulatory organisation in India – ASCI has been recognised as a self-regulator under the Cable Television Networks (Amendment) Rules, 2021. ASCI promulgations are advisory and can neither supplant nor supersede the law. Moreover, ASCI cannot compel compliance. However, any action brought against an advertiser for breach of ASCI promulgations will proceed on the basis that ASCIs position has statutory endorsement.

    It’s ultimately up to some government agency to take action and to advertisers to check themselves. In 2010, ASCI had flagged more than “50 campaigns by ayurvedic and homeopathic drug makers offering a cure for COVID-19 in April alone” to the government. The charge was grounded not in the 1954 Act but in a Ministry of AYUSH order earlier that month prohibiting the advertisement of AYUSH-related claims about curing COVID-19.

    In fact, between April 2014 and July 2024, a portal of the Department of Consumer Affairs said it had logged more than 1,400 misleading advertisements pertaining to AYUSH products and services. Similarly, the Pharmacovigilance Centres for Ayurveda, Siddha, Unani and Homeopathy Drugs reported 18,812 “objectionable advertisements” between 2018 and 2021. In 2022, the ASCI also reported 1,229 misleading AYUSH-related advertisements between 2017 and 2019. Yet the same ministry is unconcerned when Patanjali Ayurved offers unsubstantiated (possibly intentionally ambiguous) “permanent relief” from a variety of conditions. In fact, “unconcerned” is inaccurate. On February 19, 2021, the then Union health minister Harsh Vardhan endorsed a ‘drug’ developed by Patanjali Ayurved, called Coronil, and which the minister, Balkrishna (the chairman), and Baba Ramdev claimed was the “first evidence-based medicine for coronavirus”. It wasn’t; it was an untested quack-remedy backed by spurious claims that the WHO had certified it.

    Such circumstances force those who are concerned about the effects of these advertisements to approach the courts for relief, and it is heartening that the courts among all institutions retain some sense. Yet this is also a tragedy: if the regulations that the government has put in place are followed and enforced properly by regulatory agencies, people wouldn’t have to approach courts for every remedy. Courts are already burdened with a large number of cases; equally, judges – while being equipped to examine the propriety of processes and adherence to the law and Constitutional principles – are not subject experts.

    In the Patanjali Ayurved case, of course, the company was advancing clearly pseudoscientific claims backed by non-existent data, and its defence was easy to dismiss. What would happen when, say, the government approves a poorly tested vaccine with a known risk of injury in the event of a self-determined emergency; a civil society group files a petition asking for the approval to be rolled back; and the government contends that the group is spreading vaccine hesitancy? The court shouldn’t be expected to be able to examine the results of clinical trials, yet it may have to. In fact, contemporary environmental governance offers a real example of such a problem in action.

    Unlike a specialised expert tribunal, Constitutional courts don’t possess the necessary skill and expertise to examine the technical and scientific correctness of any project. Judges are trained to examine and adjudicate on the legality and propriety of the decision-making process.

    Environmental lawyer Ritwick Dutta wrote this in The Hindu following the Joshimath disaster, when the Union government halted work on the Helang-Marwari bypass. This work had received a green signal from the Supreme Court in 2022 to proceed, raising “questions about the validity of the apex court’s decision” (not that the Union government was opposed to the project).

    The separation of powers is a division of labour, rendered more critical than other such divisions by the need to keep the greatest powers of the land in check. Yet it has often been flouted, such as the Supreme Court’s decision to set up the Central Empowered Committee, which stands in between the Standing Committee of the National Board for Wildlife and the Union Cabinet when approvals for non-forest use of sanctuaries and national parks are at stake. If this committee disagrees with a decision of the Standing Committee, the committee can forward it to the Supreme Court with its own opinion for the apex court to take the final call – a clear violation of the separation of powers.

    However, not everyone would have thought so at the time many such measures were instituted. The environment ministry created the committee in 2002 following a Supreme Court direction in T.N. Godavarman, “for the purposes of monitoring and ensuring compliance of the orders of the … Supreme Court covering the subject matter of environment, forest and wildlife, and related issues arising out of the said orders and to suggest measures and recommendations generally to the State, as well as Central Government, for more effective implementation of the [Environment (Protection)] Act and other orders of the Court” (source).

    Since then, however, and in keeping with Dutta’s assessment, the Supreme Court has adjudicated on the “technical and scientific correct” of various projects. That the environment ministry has parallelly and persistently weakened safeguards to protect the country’s natural resources to favour ‘ease of business’ has only allowed the court to intervene further. But at the same time, because the politically instituted mechanisms to protect the lives and livelihoods of people and the well-being of flora and fauna living near sites of resource extraction exist more and more only in theory, researchers, activists, and others have also welcomed the court’s interventions to nix deleterious project proposals. (In September 2023, in fact, the environment minister replaced the Supreme Court’s committee with a new one of the same name, populated fully with members that report to the ministry.)

    Simplistically, those in charge are making bad decisions and those not supposed to be in charge are making good decisions.

  • Marginalia: Romila on textbooks, Rapido ad, Nobel nonsense

    We may go on deleting sections of our history but in the world outside where there are multiple centres of research into the Indian past, and many scholars, there these expunged sections from books used in India will continue to be studied. They will be subjected to new methods of analyses, will be commented upon, will enrich the understanding of India with new knowledge, and all this will be incorporated into the history of India that will be taught everywhere except in India. We in India will not know anything about that section of Indian history which has been deleted from our books.

    Outside India, the multiple cultures of India and their achievements will be studied as part of Indian history and Indian culture, irrespective of the religion of the dynasties that may have presided over the achievements. They will be studied in universities, libraries and museums dedicated to the study of India, as a continuation of not only the Indian past but also of the past pertaining to happenings current in various parts of the world. These will have pride of place not only in the history of India but in the history of human achievements. But we in India will be entirely ignorant of their significance since we shall not know them as a part of Indian history nor as a part of other histories of the world. These would have been cultures that we once recognised as those to which we once contributed, and with which we once had exchanges, when we created the Indian civilisation of past times.

    ‘If NCERT Has its Way, the Study of Indian History Will Move Entirely Outside of India’, Romila Thapar, The Wire

    Well written by historian Romila Thapar, on the NCERT’s decision to excise some important parts of Indian history from school textbooks. First, it’s hard not to come away after reading this being struck by how reminiscent this ‘moving out’ of scholarship is of what colonialism inflicted on India, especially in terms of the natural resources that were transferred from India to the United Kingdom, never to be returned – resources that both the left and the right like to thump their chests over. Self-inflicted colonialism is worse than tragedy. I did think the “we in India will not know anything about that section of Indian history which has been deleted from our books” part was a bit of a reach because I know from experience that as long as you have access to uncensored information on the internet and a few people in your familial or social circles to nudge you to access it, it’s possible to start questioning ideologies, privileges, faith, assumptions, etc. This said, I don’t claim to understand the consequences of depriving relatively very young people of a wholesome history education, which only heightens the risk of ignorance if the people around them agree with their syllabus. Third, while alt-history edits to school textbooks have really brought the problem home, they have been preceded in time by, among others, the Vedas and Ayurvedic texts. They weren’t literary edited; however, the government changed what most people believed their contents to be. And I suspect it will be possible to see in the textbooks’ fate parallels to what befell the Vedas and Ayurveda: one fed Hindutva myths about the mythical achievements of ‘ancient India’ while the other helped pro-party businessmen commercialise these myths.

    Rapido’s ads continue to be nonsensical, or appeal to sensibilities that on the face of it have nothing to do with public transport and commuting. Last time, the ad with Allu Arjun and Ranbir Kapoor (among others) took a cynical view of road traffic, asking commuters to opt for Rapido’s ‘bike taxis’ because they could cut through traffic and wouldn’t “mince” them up like public buses might, effectively discouraging encouraging unsafe driving on roads and discouraging, to quote myself, “civic disengagement from the task of improving public transport”. A new ad that’s been airing for a week or so has the tagline, “bike-wali taxi, sabse saxi“, to the accompaniment of visual narratives in which there is a long queue of people waiting to catch an auto and a bus packed to the rafters with people. So… I’m to take bike taxis because they’re “sexy?” I don’t get it. Maybe the purpose of the new ad is to be an ad for an ad’s sake, to let people know that such a thing exists, but I’m not sold. It’s still a lot like the first ad, and both of which are like Elon Musk’s comments in the context of his Hyperloop idea: that we should desist from using public transport because we might be travelling with a serial killer (and his hope that someone else will build a Hyperloop provided a high-speed rail line in California, and its higher carrying capacity, is cancelled). In all cases, we have people being asked to take the easy way out, in favour of corporate entities invested in people being concerned only with their own comfort, over forcing the government to do better. The latter is always only going to be hard, requiring public organisation and mobilisation, but never opting for this path just opens the door wider to self-serving companies and further undermine the centrality of public transport to a healthy democracy. If India’s status as a democracy is fading, as even The Lancet noted earlier today, we’re contributing, too.

    Also how much are these bike-wali drivers paid?

    “This is embarrassing,” [Charles Lieber] said at his trial. “Every scientist wants to win a Nobel Prize.”

    ‘Charles Lieber, Ex-Harvard Professor, Sentenced in China Ties Case’, Gina Kolata, The New York Times

    An obligatory reminder that the Nobel Prizes influence how science is practiced – rather than being a completely isolated entity that just selects some arbitrarily defined “best scientific endeavour” and gives it a medal, a certificate, and lots of money. We’ve seen this before with Brian Keating, who made a big mistake before acknowledging it and coming clean. Now that Charles Lieber has committed his blunder, I hope he’ll stop pursuing a Nobel Prize as well and just pursue good science instead. But the ideal, but seemingly also very unlikely, thing to happen would be for scientists at large to understand a) why trying to win a Nobel Prize is not trying to do good science even though the former claims to exclusively reward the latter and b) that almost all ‘prestigious’ honours concerned with scientific work – including the universities to work at, the grants to win, and the journals in which to publish – will over time distort the desirability of different fields of study (and even scientists’ estimate of which questions are worth answering), the contents of the scientific literature, what constitutes ‘success’ (e.g. positive results v. negative results), and who can be considered to be successful. (Pseudo-prestigious awards might be even more dangerous.)

  • What about the celebrities in food ads?

    The row over Bournvita last month was spurred by a social-media influencer’s viral video of the product’s allegedly unhealthy sugar content. Following a legal threat from Mondelez International India, which makes Bournvita, the influencer deleted his video and apologised. But on April 26, the National Commission on the Protection of Child Rights issued a letter to Mondelez alleging violations of various Sections of the Consumer Protection Act 2019 and to withdraw all “misleading” advertisements of and packaging on its product.

    The issue spotlighted, among other things, the difference between what is advertised and what is presented in fine print.

    India has one of the world’s largest burdens of diabetes. Of late, diabetes incidence in rural India has been found to be increasing as well, possibly driven by a stronger correlation between diabetes incidence and awareness (using literacy as a proxy) rather than wealth. Diabetes is a noncommunicable disease rooted in, among other things, lethargic lifestyles, lack of exercise, and the consumption of processed foods and foods of low nutritional value, typically called ‘junk food’. Historically, advertisements of this product type have often resorted to deceptive marketing tactics.

    In an apparent effort to curb such tactics on social media platforms, in January 2023, the Department of Consumer Affairs (DoCA) announced guidelines for ‘influencers’ who promote health and wellness products. One of them was that influencers have to disclose their qualifications, implying that if the people at large see that if an influencer has a degree in geology but is promoting a cream to prevent hair loss, they will take the claims with a pinch of salt. But will they?

    Bad ads

    Every advertisement for a food product is a combination of testing and quality control, marketing and consumer behaviour, and safety and regulations. While the purposes of these forces have been discussed at length, the second merits a closer look for the part played by one particular actor.

    During a press conference in June 2021, footballer Cristiano Ronaldo replaced two bottles of Coca Cola from the podium in front of him with a bottle of water, saying “agua”, Portuguese for “water”. His gesture took the world by storm – but it also stood in stark contrast to an advertisement just a month later in which cricketer Jasprit Bumrah appeared in an advertisement in India for a popular aerated beverage.

    Similarly, mainstream Bollywood actors have appeared in advertisements for certain products, only terminating their contracts after significant public backlash and/or allegations of surrogate-advertising. At least one of these advertisements continues to air on TV with the same personalities (all of whom are Padma awardees). Some ‘stars’ also appear in advertisements promoting the consumption of aerated beverages and packaged sugary drinks and for FMCG goods that claim to be “Ayurvedic”.

    Indeed, there is no “Ayurvedic herb” in traditional medicine at large because herbs are not exclusive to Ayurveda. Yet there are products on the market, like toothpastes, that claim to bring some arbitrary ‘Ayurvedic benefit’ just by including “Ayurvedic herbs” like spices in the admixture. Who checks these claims? Where are the results of the tests of such incremental innovation, if they are conducted at all, published? Who monitors compliance?

    Despite the uncertainty over answers to these questions, such products are still marketed and sold because personality-driven marketing is just as potent, if not more, as evidence-based marketing. And the DoCA guidelines need to respond to this fact. Otherwise, only public-spirited scientists and engaged consumers, often operating with fewer resources than those required to meet an FMCG behemoth in court, are left asking the tough questions.

    Taste the medicine

    We must also ask whether personalities consume the products they advertise – less as evidence of their “due diligence”, in the DoCA’s words, and more because of the class-stratified access to healthy foods as well as to the knowledge required to interpret the information presented in food labels, in India.

    Even when the actual nutritional information is printed in small font on the back of a bottle or packet, not everyone possesses the literacy to understand and interpret that information right.

    For example, say a large study (that is subsequently also replicated) reports in a major journal that substance X is associated with a significant adverse effect. In order to avoid a food product that contains X in future (assuming India’s food standards are yet to catch up), a person will have to locate and read the label, understand and properly interpret the metric details, and be aware of the journal, the paper, and its findings. This requires at least good news literacy and ideally scientific literacy. The persons we can expect to have the former, if not the latter, are the country’s wealthier, more learned citizens.

    Sportspersons and film actors place a premium on their fitness and work with specialists like nutritionists and physical therapists to tailor and optimise their eating habits. Do these habits include sugary drinks et al.? Because if they don’t, these individuals should think twice before agreeing to promote these products in the first place, rather than backing out after advertisements have been filmed and aired.

    After the Bournvita row erupted, experts and activists berated the Food Safety and Standards Authority of India for its lacklustre monitoring of compliance by food business operators and unwillingness to initiate punitive action. Between these concerns and the DoCA stopping short of empowering those producing evidence-based criticism of unhealthy foods, there is a mismatch between advertising practices and consumer safety, and effectively India’s efforts to curb the rise of diabetes and other similar diseases.

    The people at large could use the help of their celebrities to bridge this gap.

  • The devil’s lassi

    ‘The Devil’s Milkshake’, Tarence Ray in The Baffler, February 23, 2023:

    You’ve seen it before. An industrial disaster poisons a town’s food or water supply. Residents get angry. Public officials try to dispel that anger through a public act of self-sacrifice, of reassurance. They convene a press conference, whereupon some hapless courtier brings forth a chalice of the supposedly poisoned material. And then, in front of God and the television cameras, the public official imbibes. …

    Years ago, I surveyed the literature looking for a name or term to describe this phenomenon of consuming potentially tainted materials. After all, it seemed to be increasing in frequency, and I’d even started witnessing it at the level of local politics. But if there was a name, I couldn’t find it. So I gave it one: the Devil’s Milkshake. …

    I don’t think there have been public officials in India who have rushed to drink possibly contaminated water to convince their constituents that it is safe to consume, but I could well be wrong. All that comes to mind is ministers flogging ‘Ayurvedic’ cures* for COVID-19, but when they get COVID-19 and the time comes to imbibe the concoctions, they’re rushed instead to the local AIIMS to be treated by the wonders of “western medicine” at public expense.

    One more thing also comes to mind: ‘Devil’s Milkshake’ practices in the US are reminiscent of rationalists’ gimmicks in India to consume food en masse in public during a solar eclipse, apparently to dispel superstitious beliefs (largely among Hindus) that doing so during an eclipse could have ill effects on the body. I don’t know if they have ever succeeded in changing minds if only because their actions have been completely devoid of empathy, and because they seem to believe (erroneously) that whatever knowledge underlies the belief is fragile, inelastic, and disorganised enough to be overturned by a simple, one-time demonstration. As such, the superstitious people in my extended circles have only ever been amused by such eclipse-time events – speaking to one more thing Ray wrote vis-à-vis ‘Devil’s Milkshake’ stunts:

    The Devil’s Milkshake can also be an effective way for a public official to shirk any commitment to doing something about the conditions that gave rise to the disaster in the first place.

    If the disaster is bad, specifically disempowering, knowledge, then both the rationalists (the ones on TV as well as the many others who claim science offers the “one true way” to understand the world) and the ministers are doing nothing to plug the fount of such knowledge in the first place; one mocks while the other… also mocks. They are both guilty of moving the devil’s merch, which would be fair if they didn’t seem themselves as participants in (what could have been) a deliberative democracy as much as overlords overseeing a contemptible populace:

    Its recent proliferation must be seen as proof of a ruling class desperate to uphold the illusion of democracy. It is the last gasp of a dying order, drinking and eating its way to the grave, restrained or unwilling to fix anything, and thus doomed to play act a fantasy before klieg lights and newscasters. The dizzying amount of Devil’s Milkshake footage issuing from East Palestine [the site of the ongoing socio-environmental disaster in Ohio] only proves their desperation: these people could not be more unlike you. In fact, the only thing you have left in common with them is the fact that they, too, still have to eat food and drink water to stay alive. That’s it. The Devil’s Milkshake is a measure of the gaping chasm between you and them.

    * Wherever I’ve used the term ‘Ayurveda’, I’ve meant the ‘Ayurveda’ that the BJP government and its votaries, including Baba Ramdev, have peddled, and not the Ayurveda that originated in ancient India, quite simply because most of us don’t know what the latter even looks like or says.

  • Poverty, psychology and pseudoscience

    From the abstract of ‘Why Do People Stay Poor? Evidence on Poverty Traps from Rural Bangladesh’, November 24, 2020:

    There are two broad views as to why people stay poor. One emphasizes differences in fundamentals, such as ability, talent or motivation. The other, poverty traps view, differences in opportunities stemming from differences in wealth. We exploit a large-scale, randomized asset transfer and panel data on 6000 households over an 11 year period to test between these two views. The data supports the poverty traps view — we identify a threshold level of initial assets above which households accumulate assets, take on better occupations and grow out of poverty. The reverse happens for those below the threshold.

    In the resulting worldview this ‘condition’ imposes on people, it’s tempting to see justification for the existence of pseudoscientific enterprises like astrology. Actually, a faith-based binary like ‘requiring faith’ v. ‘not requiring faith’ may be more appropriate here than a science-based binary (‘scientific’ v. ‘unscientific’), if only to emphasise the presence of faith here over the absence of scientific reasoning. So that is, while I can’t ascertain a causal relationship between conditions like the poverty trap and opaque practices like astrology, there’s enough of a correlation here to understand astrology et al as the means by which people rationalise their shared predicament – a predicament that refuses to be allayed by their own efforts.

    For example, astrology could provide social, mental and moral incentives for individuals to believe – without having to know – that they were denied any opportunities because ‘their time isn’t right’ and/or that they will continue to luck out, while social realities instead of the alignment of their stars will ensure this is true in some measure. Such faith could also subdue or redirect individuals’ anger or sense of wrongdoing at forces beyond their control, creating ground for social conditions that tolerate oppression more than it ought to be.

    Another observation this paper brings to mind is from the work of Sendhil Mullainathan, among others. Researchers from various fields have reported differences in the way poor people make decisions, compared to those who aren’t poor – as if they were less intelligent. However, this perception arises from a sort of cognitive John-Henryism: that is, just as disadvantaged members of society – like Black people in the US – can incur a physical toll imposed by the need to fight for their rights, poor people incur a cognitive toll brought on by the limited availability of resources and the short-lived nature of good fortune.

    This doesn’t mean poor people become or are less intelligent, or anything nonsensical like that. Instead, it means poor people’s priorities are different – for example the need for discounts on products, and to maximise absolute savings over percentage savings – in a way that those who aren’t poor may not find optimal for their needs, and that more tasks compete for their attention when they are short on the resources required to execute all of them. As Alice Walton wrote for the Chicago Booth Review in 2018,

    In the Wheel of Fortune–style game, the researchers [including Mullainathan] measured how cognitively fatigued the players became. Logic would predict that rich players would be more fatigued, since they were allowed more turns to make more guesses. Instead, the researchers observed that poor players, having received fewer tries to guess at the answers, were more fatigued, having put more effort into each guess.

    In an Angry Birds–style game in which people tried to shoot targets, rich players were given more chances to train a virtual slingshot on a target. Poor players, given fewer attempts, spent longer lining up their shots, and many scored more points per shot than rich players. For all the extra shots rich players had, they didn’t do as well, proportionally. “It seems that to understand the psychology of scarcity, we must also appreciate the psychology of abundance. If scarcity can engage us too much, abundance might engage us too little,” the researchers write.

    This toll subsequently compromises future choices, and effectively installs another barrier, or trap, in front of people trying to go from being poor in one resource – money, in poverty’s case – to being rich. Walton offers a few examples of policymakers building on these findings to devise better schemes and improve uptake.

    In India, where sugarcane farmers are paid annually after the harvest, farmers’ attention scores were the equivalent of 10 IQ points higher than just before the harvest, when farmers were relatively poor, according to data from the 2013 Science study…

    Offering subsidies or other incentives when people are more receptive to and have the spare capacity to consider them, such as after a harvest or a payday, may make a difference over the long run. One effort, in Tanzania, asked people to sign up for health insurance at cashpoint locations right after payday, and the timing led to a 20 percentage point increase in health-insurance use.

    Introducing cognitive aids can help address the limited capacity for attention that may constrain people in poverty. In one study, it helped to show farmers research regarding the most productive ways to plant their crops. When poor, stressed, and in a scarcity mind-set, farmers had a harder time taking in the information. “This result has nothing to do with the intelligence of the farmers,” writes Bryan’s team. “A fact is only obvious if the observer has the spare attentional capacity to notice it.”

    I wonder if the converse could also be true: that when homeopaths, phytotherapists, many Ayurveda practitioners and other quack healers offer dubious ways out of difficult healthcare situations, people who are short on attentional space could be likelier to buy into them in order to free up space for other tasks. If so, governments and activists may also need to consider fighting superstition and pseudoscience in healthcare by ensuring more legitimate outcomes – like visiting the local clinic or being able to procure a given drug – require as little cognitive bandwidth as possible.

  • Ayurveda is not a science – but what does that mean?

    This post has benefited immensely with inputs from Om Prasad.

    Calling something ‘not a science’ has become a pejorative, an insult. You say Ayurveda is not a science and suddenly, its loudest supporters demand to know what the problem is, what your problem is, and that you can go fuck yourself.

    But Ayurveda is not a science.

    First, science itself didn’t exist when Ayurveda was first born (whenever that was but I’m assuming it was at least a millennium ago), and they were both outcomes of different perceived needs. So claiming ‘Ayurveda is a science’ makes little sense. You could counter that 5 didn’t stop being a number just because the number line came much later – but that wouldn’t make sense either because the relationship between 5 and the number line is nothing like the relationship between science and Ayurveda.

    It’s more like claiming Carl Linnaeus’s choice of topics to study was normal: it wouldn’t at all be normal today but in his time and his particular circumstances, they were considered acceptable. Similarly, Ayurveda was the product of a different time, technologies and social needs. Transplanting it without ‘updating’ it in any way is obviously going to make it seem inchoate, stunted. At the same time, ‘updating’ it may not be so productive either.

    Claiming ‘Ayurveda is a science’ is to assert two things: that science is a qualifier of systems, and that Ayurveda once qualified by science’s methods becomes a science. But neither is true for the same reason: if you want one of them to be like the other, it becomes the other. They are two distinct ways of organising knowledge and making predictions about natural processes, and which grew to assume their most mature forms along different historical trajectories. Part of science’s vaunted stature in society today is that it is an important qualifier of knowledge, but it isn’t of knowledge systems. This is ultimately why Ayurveda and science are simply incompatible.

    One of them has become less effective and less popular over time – which should be expected because human technologies and geopolitical and social boundaries have changed dramatically – while the other is relatively more adolescent, more multidisciplinary (with the right opportunities) and more resource-intensive – which should be expected because science, engineering, capitalism and industrialism rapidly co-evolved in the last 150 years.

    Second, ‘Ayurveda is a science’ is a curious statement because those who utter it typically wish to elevate it to the status science enjoys and at the same time wish to supplant answers that modern science has provided to some questions with answers by Ayurveda. Of course, I’m speaking about the average bhakt here – more specifically a Bharatiya Janata Party supporter seemingly sick of non-Indian, especially Western, influences on Indian industry, politics, culture (loosely defined) and the Indian identity itself, and who may be actively seeking homegrown substitutes. However, their desire to validate Ayurveda according to the practices of modern science is really an admission that modern science is superior to Ayurveda despite all their objections to it.

    The bhakt‘s indignation when confronted with the line that ‘Ayurveda is not a science’ is possibly rooted in the impression that ‘science’ is a status signal – a label attached to a collection of precepts capable of together solving particular problems, irrespective of more fundamental philosophical requirements. However, the only science we know of is the modern one, and to the bhakt the ‘Western’ one – both in provenance and its ongoing administration – and the label and the thing to which it applies, i.e. the thing as well as the name of the thing, are convergent.

    There is no other way of doing science; there is no science with a different set of methods that claims to arrive at the same or ‘better’ scientific truths. (I’m curious at this point if, assuming a Kuhnian view, science itself is unfalsifiable as it attributes inconsistencies in its constituent claims to extra-scientific causes than to flaws in its methods themselves – so as a result science as a system can reach wrong conclusions from time to time but still be valid at all times.)

    It wouldn’t be remiss to say modern science, thus science itself, is to the nationalistic bhakt as Ayurveda is to the nationalistic far-right American: a foreign way of doing things that must be resisted, and substituted with the ‘native’ way, however that nativity is defined. It’s just that science, specifically allopathy, is more in favour today because, aside from its own efficacy (a necessary but not sufficient condition), all the things it needs to work – drug discovery processes, manufacturing, logistics and distribution, well-trained health workers, medical research, a profitable publishing industry, etc. – are modelled on institutions and political economies exported by the West and embedded around the world through colonial and imperial conquests.

    Third: I suspect a part of why saying ‘Ayurveda is not a science’ is hurtful is that Indian society at large has come to privilege science over other disciplines, especially the social sciences. I know too many people who associate the work of many of India’s scientists with objectivity, a moral or political nowhereness*, intellectual prominence, pride and, perhaps most importantly, a willingness to play along with the state’s plans for economic growth. To be denied the ‘science’ tag is to be denied these attributes, desirable for their implicit value as much as for the opportunities they are seen to present in the state’s nationalist (and even authoritarian) project.

    On the other hand, social scientists are regularly cast in opposition to these attributes – and more broadly by the BJP in opposition to normative – i.e. pro-Hindu, pro-rich – views of economic and cultural development, and dismissed as such. This ‘science v. fairness’ dichotomy is only a proxy battle in the contest between respecting and denying human rights – which in turn is also represented in the differences between allopathy and Ayurveda, especially when they are addressed as scientific as well as social systems.

    Compared to allopathy and allopathy’s intended outcomes, Ayurveda is considerably flawed and very minimally desirable as an alternative. But on the flip side, uptake of alternative traditions is motivated not just by their desirability but also by the undesirable characteristics of allopathy itself. Modern allopathic methods are isolating (requiring care at a designated facility and time away from other tasks, irrespective of the extent to which that is epidemiologically warranted), care is disempowering and fraught with difficult contradictions (“We expect family members to make decisions about their loved ones after a ten-minute briefing that we’re agonising over even with years of medical experience”**), quality of care is cost-stratified, and treatments are condition-specific and so require repeated hospital visits in the course of a lifetime.

    Many of those who seek alternatives in the first place do so for these reasons – and these reasons are not problems with the underlying science itself. They’re problems with how medical care is delivered, how medical knowledge is shared, how medical research is funded, how medical workers are trained – all subjects that social scientists deal with, not scientists. As such, any alternative to allopathy will become automatically preferred if it can solve these economic, political, social, welfare, etc. problems while delivering the same standard of care.

    Such a system won’t be an entirely scientific enterprise, considering it would combine the suggestions of the sciences as well as the social sciences into a unified whole such that it treated individual ailments without incurring societal ones. Now, say you’ve developed such an alternative system, called PXQY. The care model at its heart isn’t allopathy but something else – and its efficacy is highest when it is practised and administered as part of the PXQY setup, instead of through standalone procedures. Would you still call this paradigm of medical care a science?

    * Akin to the ‘view from nowhere’.
    ** House, S. 2, E 18.

    Featured image credit: hue 12 photography/Unsplash.

  • A trumpet for Ramdev

    The Print published an article entitled ‘Ramdev’s Patanjali does a ‘first’, its Sanskrit paper makes it to international journal’ on February 5, 2020. Excerpt:

    In a first, international science journal MDPI has published a research paper in the Sanskrit language. Yoga guru Baba Ramdev’s FMCG firm Patanjali Ayurveda had submitted the paper. Switzerland’s Basel-based MDPI … published a paper in Sanskrit for the first time. Biomolecules, one of the peer-reviewed journals under MDPI, has carried video abstracts of the paper on a medicinal herb, but with English subtitles. … The Patanjali research paper, published on 25 January in a special issue of the journal titled ‘Pharmacology of Medicinal Plants’, is on medicinal herb ‘Withania somnifera’, commonly known as ‘ashwagandha’.

    This article is painfully flawed.

    1. MDPI is a publisher, not a journal. It featured on Beall’s list (with the customary caveats) and has published some obviously problematic papers. I’ve heard good things about some of its titles and bad things about others. The journalist needed to have delineated this aspect instead of taking the simpler fact of publication in a journal at face value. Even then, qualifying a journal as “peer-reviewed” doesn’t cut it anymore. In a time when peer-review can be hacked (thanks to its relative opacity) and the whole publishing process subverted for profit, all journalists writing on matters of science – as opposed to just science journalists – need to perform their own checks to certify the genealogy of a published paper, especially if the name of the journal(s) and its exercise of peer-review are being employed in the narrative as markers of authority.

    2. People want to publish research in English so others can discover and build on it. A paper written in Sanskrit is a gimmick. The journalist should have clarified this point instead of letting Ramdev’s minions (among the authors of the paper) claim brownie points for their feat. It’s a waste of effort, time and resources. More importantly The Print has conjured a virtue out of thin air and broadcast asinine claims like “This is the first step towards the acceptance of ‘Sanskrit language’ in the field of research among the international community.”

    3. The article has zero critique of the paper’s findings, no independent comments and no information about the study’s experimental design. This is the sort of nonsense that an unquestioning commitment to objectivity in news allows: reporters can’t just write someone said something if what they said is wrong, misleading, harmful or all three. Magnifying potentially indefensible claims relating to scientific knowledge – or knowledge that desires the authority of science’s approval – without contextualising them and fact-checking them if necessary may be objective but it is also a public bad. It pays to work with the assumption (even when it doesn’t apply) that at least 50% of your readers don’t know better. That way, even if 1% (an extremely conservative estimate for audiences in India) doesn’t know better, which can easily run into the thousands, you avoid misinforming them by not communicating enough.

    4. A worryingly tendentious statement appears in the middle of the piece: “The study proves that WS seeds help reduce psoriasis,” the journalist writes, without presenting any evidence that she checked. It seems possible that the journalist believes she is simply reporting the occurrence of a localised event – in the form of the context-limited proof published in a paper – without acknowledging that the act of proving a hypothesis is a process, not an event, in that it is ongoing. This character is somewhat agnostic of the certainty of the experiment’s conclusions as well: even if one scientist has established with 100% confidence that the experiment they designed has sustained their hypothesis and published their results in a legitimate preprint repository and/or a journal, other scientists will need to replicate the test and even others are likely to have questions they’ll need answered.

    5. The experiment was conducted in mice, not humans. Cf. @justsaysinmice

    6. “‘We will definitely monetise the findings. We will be using the findings to launch our own products under the cosmetics and medicine category,’ Acharya [the lead author] told ThePrint.” It’s worrying to discover that the authors of the paper, and Baba Ramdev, who funded them, plan to market a product based on just one study, in mice, in a possibly questionable paper, without any independent comments about the findings’ robustness or tenability, to many humans who may not know better. But the journalist hasn’t pressed Acharya or any of the other authors on questions about the experiment or their attempt to grab eyeballs by writing and speaking in Sanskrit, or on how they plan to convince the FSSAI to certify a product for humans based on a study in mice.

  • An upvote for Ayurveda from the Swiss government – alongside homeopathy

    The Wire
    May 15, 2015

    Despite the unsubstantiated science behind it, the Ayurveda medicine system was granted a vote of confidence by the Swiss government, swissinfo.ch reported on May 12. According to updates made to the Swiss Regulation of Complementary Medicine, Ayurveda practitioners will now be able to obtain a national diploma after passing a state-administered exam.

    The updates followed intense lobbying after Ayurveda wasn’t included in a list of alternative therapies that could be covered by Swiss health insurance providers in 2005. They were anthroposophic medicine, phylotherapy, neural therapies, traditional Chinese medicine and homeopathy. Until 2017, they will be included under basic health insurance packages on a trial basis.

    Among others, anthroposophic medicine involves using mistletoe to cure cancer while neural therapies are based on injecting anaesthetics near nerve-centres. Phylotherapy is herbal medicine.

    Ayurveda proponents had been asked to wait until 2017 before being considered again, according to the Swiss Professional Association for Ayurveda Practitioners and Therapists. Instead, the Ayurveda lobby had worked to induct it under the national diploma program.

    Now, practitioners without a medical degree can obtain a professional qualification through the exam and gain legitimacy in the eyes of the health insurance sector. More, practitioners of three other systems of alternative medicine are now eligible for the exam: Chinese and European traditional medicine, and homeopathy.

    Although seekers of alternative therapies can now pay a visit to someone who has passed a national exam instead of some other arbitrary test, it is Ayurveda’s dubious company that belies the credibility of the Swiss government’s decision. Homeopathy amongst them has been widely discredited for being pseudoscience and international government support has been largely withheld.

    Without focusing on a single system, scientists believe the biggest effect of the Swiss government’s decision to recognise and fund alternative medicine – as opposed to evidence-based medicine – will be the credibility it will accrue without having presented objective proofs of effectiveness. Even if the Swiss government has said it will conduct independent investigations into whether the claims of alternative systems are dependable, many feel political pressure might lead to evaluators registering false-positives.

    The situation parallels one in India, where Ayurveda has a market worth Rs.8,000 crore (2013) but is backed by research or data that is neither coherent nor of quality at par with that behind allopathic medicine, attributes that do nothing to allay the deep-seated and prevalent prejudice against non-Western medicine. Further, the Central Council for Research into Ayurvedic Sciences – which coordinates pharmacological research into alternative medicine systems in the country –does not conduct placebo-controlled clinical trials, the touchstone of medical research.

    Simultaneously, the Council of Scientific and Industrial Research continues to support research into areas like ayurgenomics – the use of ayurvedic principles to determine genetic predispositions to some diseases. Ayurgenomics in particular featured prominently in the manifesto that the BJP put out ahead of the 2014 Lok Sabha elections, and which the party has continued to unabashedly support since it came to power. The result is the risk of legitimate practitioners of Ayurveda eschewing rigour in favour of political timing. The effect of political pressure is often to make the two indistinguishable.

    In fact, the 2005 decision in Switzerland followed by a referendum in 2009, when not any scientific committee but 67 per cent of the Swiss electorate voted to include the five alternative systems under the basic health insurance package. In response to the verdict, Ignazio Cassis, then vice-chair of the Swiss Medical Association, had told New Scientist in 2011, “This isn’t science, it’s Swiss politics.”

    As of 2011, Switzerland had 17,200 registered practitioners of complementary and alternative medicine, the most per capita in the world.