Why India’s Bid to ‘Decolonize’ Medicine With AYUSH Is Dangerous
All AIIMS hospitals will have AYUSH departments, a Union Minister said -- showing the increasing influence of alternative medicine in India.
AIIMS hospitals – India’s premier medical institutions – will soon have dedicated AYUSH departments, Union AYUSH Minister Sarbanand Sonowal recently said while delivering the inaugural address at an Ayurveda conference. The Centre has been taking determined steps to promote AYUSH – a traditional system of medicine that stands for Ayurveda, Yoga, Unani, Naturopathy, Siddha, and Homeopathy. Minister of State for AYUSH, Munjpara Mahendrabhai, recently said that they are working on setting up 12,500 Ayush Health and Wellness Centres (AHWCs) under the National Ayush Mission by 2023-24.
These concerted efforts to bring traditional medicine to the forefront have long been painted as a move to decolonize our health system by offering alternative treatments to reduce our reliance on modern medicine, considered an import of the West. “In the past few years, the Indian government has also taken several steps to ‘decolonize’ India’s health system by trying to integrate modern Western medicine with ayurveda, a traditional system of medicine in the subcontinent,” New Lines magazine noted.
“In the colonial period of India, these systems of medicine faced some negligence. But soon after independence the Government of India shows indulgence in AYUSH,” the official website states. Since establishing a ministry for it in 2014, the government has allocated significant budgetary funding to AYUSH. Many officials even use the language of indigeneity and ancestry to reclaim these practices as legitimate options for treatment. “There is a need for larger awareness in ayurveda. It can’t be limited to a doctor only. Our ancestors made good health a part of life,” the Prime Minister said in 2014.
Criticism of AYUSH revolves around the fact that this system is not backed by scientific evidence – only a “few Ayurvedic treatments have been successfully validated by well-designed randomised controlled trials (RCTs),” noted an article in Observer Research Foundation. One fifth of Ayurvedic medicines manufactured in India and the US contain heavy metals, according to a Lancet study. Clinical trials are reportedly not necessary for the sale and marketing of these medicines, reports Deccan Herald.
Concern has also been raised over moves such as the gazette notification by Central Council of Indian Medicine (CCIM) that announced a list of surgeries that Ayurvedic doctors could perform. There was also considerable outrage over Ayurvedic practitioners prescribing allopathic medicines without adequate qualifications or expertise for the same. As The Caravan notes, urban citizens – who rely primarily on modern medicine – are mostly unaffected by this push. It is in the rural areas, where access to healthcare continues to be limited, that the efforts to mainstream traditional medicine are concentrated. Except, pushing alternative treatments that lack scientific support creates a disregard and dismissal of evidence-based healthcare and increases mistrust in the system, which only serves to jeopardize public health in India further.
Cut to this year: the government just introduced a new visa category for foreign nationals seeking AYUSH treatments in India. “This initiative will strengthen our endeavor to accomplish PM Narendra Modi’s vision for making Indian traditional medicine a global phenomenon,” said Union minister of Ayush and Ports, Shipping & Waterways, Sarbananda Sonowal.
The framing of pushing AYUSH as a decolonization move fundamentally mischaracterizes what is colonial about medicine and public health to begin with: it isn’t the kind of medicine, it is the structures of and access to medicine. A colonial framework looks at health as an individual state of well-being, rather than taking community and environmental factors into account. As Dr. Rupa Marya and Raj Patel argue in their book Inflamed: Deep Medicine and the Anatomy of Injustice, modern environmental and systemic stressors like discrimination, homelessness, violence, and pollution all play a role in heightening the body’s inflammatory response, which in turn leads to long-term health complications.
Health, they argue, is political and systemic, but colonial traditions of individualizing it have led to the overwhelming treatment of symptoms or individual diseases rather than addressing the causes. “It is short-sighted to see these diseases as caused by individual poor choices in the context of a genetic predisposition. I see them as diseases that are virtually impossible to avoid because of the system in which we live, which generates a biological milieu of inflammation through trauma, chronic stress, environmental degradation, and damaged food systems. I see these as diseases of colonization,” Dr. Marya noted.
However, in its push to validate “traditional” medicine (and, more often than not, Hindu ritualistic practices) as superior to what’s perceived to be Western medicine, the Indian government is not only endorsing AYUSH but also blatant pseudoscience like cow-urine containing healing properties.
A look at each of the components of AYUSH shows how they all fall short of serving as effective medical alternatives. It’s true that yoga has positive effects on the body, and that meditation may be good for us. Some studies have affirmed this. But yoga remains an individualistic practice, wholly dependent on the environment, time, capital and resources an individual has to be able to practice it the way it is intended. More importantly, yoga is not medicine, it only has medicinal effects. That means yoga cannot be used as a treatment or cure for most diseases. Yet, government health bodies continue to fuel this notion, leading to adverse outcomes. Many advocates of yoga have begun trying to prove that it isn’t just palliative but also curative, working as effective treatment for diabetes, hypertension, and even cancer.
Homeopathy – which is often mistaken as traditional despite being invented in Germany and coming to India in the 18th century –is another form of treatment touted by many as a better alternative to allopathy with fewer side effects. The evidence, however, is just not there.
Ayurveda is arguably the most popular yet most controversial form of alternative medicine. There has been no conclusive evidence about the efficacy of Ayurveda in treating diseases. Moreover, several studies have found that many Ayurvedic products cause heavy metal poisoning: one showed that one in five Ayurvedic products purchased online contained lead, mercury, or arsenic. This is because some of the herbs used in Ayurveda are grown in contaminated soil.
But, more worryingly, small quantities of these metals are believed to have healing effects on the body. "[They're] mostly made from metal ashes. Those are called rasa products," Nisha Saini, an Ayurvedic practitioner, explained to NPR. In the US, these products are heavily regulated. One study found that half the samples containing mercury, 36% of those containing lead, and 39% of those containing arsenic had levels of these respective metals that were several thousand times higher than the recommended daily intake of pharmaceutical impurities. But in India, they remain unregulated and widely available.
In general, many of these therapies have been associated with renal failure. An estimated one third of patients with renal problems have a history of using Ayurveda, Unani, or homeopathy. “Most of these patients develop chronic kidney disease (CKD) - a life-threatening disease that leads to complete renal failure besides causing neurological and cardiological complications," said nephrologist Prof RK Sharma, director of the Sanjay Gandhi Post Graduate institute of Medical Sciences.
The decolonization myth, however, leads to these practices being pushed over modern medicine, which is considered Western. The method of scientific research employed to assess the efficacy of any other alternative forms of medicine are also dismissed as Western and, as a result, rigorous forms of evidence-based analyses and peer review are discredited. For instance, systematic reviews and meta-analyses, Siddhesh Zadey, Lokesh Krishna, write in The Hindu, are the gold standard in evidence-based medicine. These are research methods that evaluate all existing studies on a particular subject to test whether it holds up to scrutiny. Homeopathy, they point out, does not. Many of the 193 homeopathy trials in the last two decades were unregistered; the few registered trials did not show any efficacy. And further, “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.”
So what does decolonizing health actually mean? Recent literature has looked at recentering indigenous knowledge systems in public health, but contrary to popular perception, this doesn’t mean alternative medicine. Instead, it refers to the perspective of focusing on “planetary health,” wherein medical practitioners recognize the effects of systemic disenfranchisement, climate change, and environmental degradation on communities of people. “We conclude that encouraging healthcare educators and professionals to adopt a 'decolonising attitude' can address the complex power imbalances in health and further improve person-centered care,” notes one study.
Moreover, colonial practices of global health manifest in the way public health governance treats marginalized people: displacing or controlling the movements of certain communities in the name of infection or disease control; using bad science to justify racial or ethnic superiority; or eugenics. Global power structures also define how resources are allocated or what conditions get more attention, which is a hallmark of imperialism. “A significant barrier to progress in the field of global health is that most leaders and leading institutions are located in high-income countries, thereby defining the global standard,” an article on public health states. Another example of a colonial remnant in global health is the focus on communicable diseases over non-communicable diseases, despite the fact that low-middle income countries suffer a disproportionate burden of the latter. And even then, “many aid for health projects are still donor driven and not locally owned, despite strong advocate for the contrary from global health scholars and recipient governments,” one review points out, meaning that communities who suffer from illnesses – often systemically – have no say in how resources to alleviate the disease are allocated, whether in terms of quantity, location, or access.
In other words, decolonizing medicine would entail dismantling power structures and systemic barriers to medicine and healing that keep some communities systemically ill and others well based on their quality of life.
In fact, the Indian government’s rhetoric of decolonization when it comes to medicine replicates the same structures of colonialism. “A critical analysis of colonialism is fundamentally intersectional and must locate its construction, and thus, deconstruction, at the intersection of white supremacy, global anti-Blackness, patriarchy, capitalism, ableism, classism, homo/transphobia, fatphobia, and xenophobia,” writes Dr. Ijeoma Opara, noting the need for decolonizing the decolonization movement in global health. Add casteism to the list, and it shows how India’s push for alternative medicines also ignores the structural gaps that keep marginalized caste and tribal communities out of public health initiatives.
Perhaps most importantly, there’s no such thing as “Western” medicine. “The history of that long war [against smallpox] proves that there is no such thing as Western medicine, for innovations in Asia were important early steps in the development of the vaccine,” notes Girish Shahane. In fact, many facets of modern medicine today were born out of the exchange of knowledge across cultures, but colonialism paved the way for Europeans to appropriate knowledge (and its production and distribution) for themselves.
Decolonizing public health, further, would mean dismantling the system of hierarchy that presumes the doctor to be above nurses, healthcare workers, and patients. A case study in Uganda found that decolonizing public health systems by way of fostering greater community participation and democratic decision-making led to better health outcomes, noting “colonization distorts community participation, which is critical for building a strong state and a responsive health system. Participation processes grounded in the principles of democracy and the right to health increase public trust in health governance.” Colonial laws also continue to have a lasting impact on public health, the study points out, such as laws criminalizing homosexuality and abortion.
But in India, medical education is increasingly inaccessible. The implementation of the NEET has been criticized for excluding marginalized communities. As of this week, ASHA workers continue protests over low wages and precarious working conditions. These are systemic factors that preclude community participation in health and prevent holistic treatments for preventable diseases. Decolonizing, then, would disrupt the hierarchical systems that privilege the idea of the authoritative doctor over health workers and patients, and foster a participatory and ecological approach to health which accounts for injustice and interdependence. Rather than democratizing medicine and disrupting colonial power structures, AYUSH keeps caste-colonial hierarchies intact and, instead, shifts the focus back to individualistic practices. The obscurity and mysticism associated with AYUSH, moreover, presumes the authority of the expert as unquestionable, promoting a culture of incorporating practices through faith and trust rather than evidence.
Rohitha Naraharisetty is a Senior Associate Editor at The Swaddle. She writes about the intersection of gender, caste, social movements, and pop culture. She can be found on Instagram at @rohitha_97 or on Twitter at @romimacaronii.