Homeopathy for covid-19: panacea or false hope?
Despite doubts over efficacy, the Ayush ministry has initiated clinical trials to explore the use of homoeopathy for covid-19 prevention and treatment
Pradeep Gupta isn’t afraid of the coronavirus. “It’s a simple flu virus in terms of symptoms," says the principal of Naiminath Homoeopathic Medical College in Agra, Uttar Pradesh. But he is quick to add a note of caution: “It’s a lot more infectious though."
Soon after the first case was reported in India in late January, Dr Gupta, a homoeopath, had wanted a greater role for homoeopathy in covid-19 treatment. He claims to have pitched the idea to officials from the Union ministry of health, the ministry of Ayush (Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy) and even Narendra Modi, through the NaMo app. “I am ready to work anywhere in any hospital of modern medicine along with homoeopathic medicine as an integrated approach," he wrote to the prime minister. “For which I do not need anything other than permission."
The permission came on 21 April, as a gazette notification from the ministry of Ayush. It had received a number of proposals claiming possible treatment for covid-19, the notification said. “At the same time," it added, “it is also essential to have scientific evidence on use of any Ayush formulation on prevention/management of covid-19". To generate such evidence, qualified and registered practitioners could undertake research using alternative medicine systems. Such trials could only be conducted on asymptomatic patients or those with mild symptoms.
Starting 5 May, Dr Gupta treated 50 patients admitted to Agra’s FH Hospital, located just next to his college. Their consent was taken and the treatment administered under the supervision of allopathic doctors. The first batch of 25 was prescribed the approved set of allopathic drugs and homoeopathic pills, mainly Bryonia Alba. The second batch of 25 was given allopathic drugs and a placebo.
The first batch, Dr Gupta says, became symptom-free in two-three days and tested negative for covid-19 in six-seven days. The second batch needed three-five weeks to recover. Mint couldn’t independently verify this claim.
But it isn’t enough, of course, to reach any conclusions. Reason one, 50 patients make for too small a sample. Two, the homoeopathic pills were prescribed along with allopathic drugs—an approach known as “adjuvant therapy". This, at best, would prove that they helped accelerate recovery. Three, those treated were either asymptomatic or had only mild symptoms. But, most importantly, Dr Gupta’s process did not conform to the gold standard in clinical trials: double-blinded randomized testing, where neither the doctor nor the patient can tell the placebo from the medicine. Only the researcher can.
Dr Gupta acknowledges the gaps. “I don’t claim this is a cure," he says. “I just say it’s an option. And, at the moment, it seems like a good option."
Besides, he points out, this is only the first step. His colleagues are carrying out a second set of trials, supervised by another researcher. Eventually, they will go for double-blinded trials too. “This pandemic is severe and our medicine is without any side effects," he says. “If this is a breakthrough, we would save billions of rupees on vaccine research and production."
‘ALTERNATIVE’ TO ALLOPATHY?
Apart from Cuba, India is the only country to officially explore homoeopathy as part of its covid-19 prevention, treatment and research protocol. In an interview with Mint, Anil Khurana, director general of the Central Council for Research in Homoeopathy (CCRH), an autonomous research body under the ministry of Ayush, says his organization has been conducting trials in the use of homoeopathy as an adjuvant treatment in four hospitals since last month: KEM Hospital and Ruby Hall Clinic in Pune, Government Homoeopathic Medical College and Hospital in Bhopal, and Naiminath Homeopathic Hospital in Agra. So far, it has only been on mild and asymptomatic patients. But soon, he adds, they will start testing homoeopathy add-on medicines on patients with severe symptoms as well.
The CCRH has also been supervising trials exploring the efficacy of homoeopathy as a prophylactic (or preventive) among nearly 30,000 people in 10 covid-19 hot spots. The subjects are given the Ayush-sanctioned medicine Arsenic Album 30. Its effects will be analysed vis-a-vis the spread of covid-19 in those areas.
The CCRH aims to finish this trial by June-end and have the analysis ready by 31 July. If successful, says Dr Khurana, it could eventually lead to homoeopathy becoming a part of India’s covid-19 treatment protocol as an adjuvant therapy. “I can’t claim anything right now because I will have to wait for statistical results and calculation. But so far it has been working in a highly positive manner," he adds. Most of CCRH’s ₹138 crore budget for the ongoing year will be spent on covid-19 research. Subsequent tests are expected to follow the double-blinded randomized trial protocol.
It won’t be the first time homoeopathy is subjected to scientific rigour. Over the years, scientists and researchers in several countries have studied and rejected homoeopathy, some going so far as to describe it as quackery. In the UK, a 2010 House of Commons report said there was no evidence that it works any better than a placebo. In Australia, a 2015 study by the National Health and Medical Research Council, the country’s top medical research body, declared it was ineffective.
Yet, homoeopathy enjoys widespread acceptability in India. Over 100 million depend on it for medical care, making it the “second most popular system of medicine in the country" according to the Ayush ministry. Upgraded from a department to a full-fledged ministry in 2014, the ministry’s budget of ₹1,200 crore in its first year has risen to ₹2,122 crore for 2020-21. Today, a number of allopathic hospitals use homoeopaths as the second-line workforce. Several such homeopaths are known to branch out independently and begin prescribing allopathic medicines, especially in rural areas. The practice, though illegal, is often allowed to continue due to a shortage of qualified doctors; this was one of the reasons a six-month “bridge course" to train them in modern medicine was introduced a few years ago.
“It’s true homoeopathy has no scientific basis, nor any high-quality empirical evidence that its medicines work," says Sanjiv Kumar, chairperson of the Indian Academy of Public Health who trained at the All India Institute of Medical Sciences in Delhi. In India, he adds, most traditional medicines thrive on anecdotes about their healing properties. Homoeopathic pills come cheap, which adds to their popularity. But many Indian doctors are starting to refer patients to homoeopaths for integrated treatment, he adds. “In my experience too, patients with allergic disorders or asthma respond to homoeopathy."
Dr Kumar doesn’t want to “blindly" dismiss homoeopathy trials for covid-19 as non-scientific. “We need to go intervention by intervention," he says. Test homoeopathic medicines for their efficacy in treatment, hold this up to scientific rigour, and then draw inferences. “Ultimately, it is about curing people."
NEED FOR BETTER IMMUNITY
Ever since the Ayush ministry recommended the use of Arsenic Album 30 as an immunity booster in January, politicians, industrialists, NGOs, even some state governments have been distributing the pills on a large scale. There’s no nodal agency monitoring such distribution but media reports suggest millions of people have received the pills, sometimes through door-to-door distribution.
There’s no evidence to prove the pills work, say scientists. Myths about its efficacy can end up giving people a false sense of security. “Some people wrongly assume that they won’t be affected by covid-19 any more, leading to dangerous behaviours like not washing hands or using masks," reads a statement from the Indian Scientists’ Response to CoViD-19, a collective of over 500 scientists tracking the country’s response to the pandemic. On 3 April, the Ayush ministry too warned against the spread of misinformation, asking regulatory bodies “to stop and prevent publicity and advertisement of AYUSH-related claims for COVID-19 treatment". For the medicine recommended by it is only supposed to boost immunity.
Towards the end of May, the Bhopal-based Government Homoeopathic Medical College and Hospital issued a press release claiming “a huge success" in covid-19 treatment, referring to the “rapid improvement" in six positive patients treated with homoeopathy. The claim came under so much criticism that the hospital had to retract it. But the principal, S.K. Mishra, insists that recovery was seen on the basis of just homoeopathic pills.
Around 46 covid-19-positivepatients admitted to his hospital tested negative after using Arsenic Album 30 and a combination of other homoeopathic pills, Mishra claims. It has led him to believe Arsenic Album 30’s properties go beyond boosting immunity: “It is preventive and curative also." This is not the government stand, however.
Like in other tests, the patients Mishra treated were either asymptomatic or had only mild symptoms. But over 75% of covid-19 patients in India are believed to fall in this category and recover in any case. So, given the increasing number of covid-19 cases and the absence of allopathic treatment, argue homeopaths, can they really be faulted for attempting to find a preventive or treatment? “This virus won’t go, we have to learn to live with it," says Asok Das, a former professor at the National Institute of Homoeopathy, Kolkata. “For that, we need long-term immunity, which homoeopathy can provide."
Das is part of the team that has received permission from the Ayush ministry to undertake a double-blinded trial on 16,000 people across India. The aim: to study the use of homoeopathy as a prophylactic. A set of homeopathic medicines will be given to residents of red zones in six states who don’t have any covid-19-like symptoms. Its effects—or the covid-19 spread—will then be tracked for three months. “Our hypothesis is, this increases immunity, that’s why it’s a preventive," says Das.
A JURY DIVIDED
At the core of differences between homoeopaths and allopaths is the differing approach to disease management.While modern medicine is primarily focused on a better understanding of the virus, with the aim of finding a treatment and creating a vaccine, homoeopathy trials are aimed at symptom management. At present, there’s no allopathic drug to specifically treat covid-19. The ones used to treat the patients, like HCQ or Remdesivir, too target the symptoms.
“So we are pleading with the government to allow us (to treat) the patients," says Piyush Joshi, secretary general of the Homoeopathic Medical Association of India. “Let that be evaluated by allopathic doctors. Let them do whatever tests they want to do. Have a scientific approach. I am earnestly telling you, we can prove it is efficient, economic and rapid."
The problem is, homoeopathy hasn’t had the best record in evidence-based cures. “Even if it has, not much is in the public domain," says Subhash Salunke, part of Maharashtra’s covid-19 task force. Ayush ministry circulars, like the one recommending Arsenic Album 30 as immunity boosters, don’t inspire confidence either, he adds. “If it works, if standards are followed, you should say it in those terms. Otherwise, some say even chanting mantras can work as ‘immunity boosters’."
The world is still months, if not years, away from a covid-19 vaccine. The mass-immunization programme that would follow will take even longer. Until then, homoeopaths are looking to fight the pandemic on an equal footing. Even if they lose out on evidence-based efficacy, they would have won the battle for legitimacy.