Times of India
26 April 2010
By Chidanand Rajghatta

What The US Thinks of Ayurveda
Growing healthcare costs in the West is spurring new interest in India’s indigenous systems of medicine, such as ayurveda, yoga and naturopathy, unani, siddha and homoepathy, or AYUSH in short. Long viewed with a jaundiced eye – and still in the crosshairs of modern medical practitioners for its lack of rigor and standards, alternative medicine is being viewed with more interest. But, even though Americans spend some $40 billion on alternative therapy (a sliver of the country’s $2 trillion healthcare bill), Indian systems account for just a fraction.

One reason for this short–sell: AYUSH just hasn’t been able to meet the evidentiary standards required by a country that prefers solid proof to blind faith. “The benchmark for evidence in the US is high because it is a litigious society. You can’t accept something just because it is a 5,000 year–old system,” says Dr Navin Shah, a Maryland urologist and a founder–president of the Association of American Physicians of Indian origin (AAPI). Shah is leading the push to make AYUSH (the west calls it “complementary and alternative medicine” or CAM) more acceptable in the US. His advice: if you want to become a player in the medical and pharma industry, you have to match evidentiary standards acceptable globally.

Early this year, Shah organized the visit to India of a six–member delegation, including CAM directors of major US medical schools. They came to learn about and examine Indian claims with respect to AYUSH’s of “solid” evidence–based treatment for diabetes, arthritis, obesity, depression, menopause and high blood pressure. They heard more than 60 Indian AYUSH experts present evidence. They were distinctly underwhelmed. “It was a little disappointing,” Dr Aviad Haramati of Georgetown University Medical School, who coordinated the trip from the US side, admitted cautiously. “There is lot of data, but the level of evidence is in its infancy, perhaps too low right now to meet FDA (Food and Drug Administration) standards.” This is partly due to the cultural mismatch, Haramati feels. Much of AYUSH is premised on belief than facts.

Shah adds, “Monitoring 25 patients over a six–month period won’t cut it; there has to be a better standard of evidence.”

It is a view that finds conscientious dissent even within the group that visited India. Dr Victoria Maizes, whose University of Arizona Medical School is wellknown for developing education programmes for integrative medicine, including ayurveda, agrees many challenges need to be overcome for AYUSH to be acceptable to the west. But she says, “There have been multiple reviews of western medicine and much of it does not meet evidentiary standards; so there is a double standard.” On the flip side, Shah maintains that most of the “alternative medicines” sold in the US as ‘supplements’ are useless. Some 15–20% of ayurvedic supplements have been found to have high lead and mercury content and are considered downright dangerous. “Of course, some of the panchakarma will sound foreign to Americans,” contends Maizes.

Such differences aside, the delegation agrees it is not an insurmountable problem getting Americans to accept AYUSH. Under growing pressure to curtail healthcare costs, FDA and professional organizations such as American Medical Association and American Association of Medical Colleges are now open to evidence–based CAM. With new surveys showing that four in 10 people in the US have used CAM in the last year, insurance companies are also recognizing some aspects of it. “There’s tremendous interest,” says Maizes. “Close to a third of the 126 US medical schools have a synthesis of western and other systems.” The delegation has invited ayurveda professors to visit six US colleges to teach evidence–based ayurveda and consider projects to study Indian medicinal plants with Harvard’s Dr David Eisenberg. He is also researching Chinese medicinal plants.

Haramati wants substantial Indian participation in the Global Integrative Medicine Conference he is organizing in Denver next year. “India should publish its best findings and practices in western literature, as it has a big audience and market.” Clearly, if India wants to aim for the multi–trillion dollar universal healthcare pie, it will have to match global standards. Alternatively, it could stay with the multi–billion domestic bonanza.