COMMENTARY

When Ancient Treatments Meet Western Medicine

Seema Yasmin, MD

Disclosures

April 23, 2018

A popular Ayurvedic dispensary in Gujarat.

On a trip to India in 2012, my uncle made an appointment with a sugar doctor. The sugar doctors here are so good, our relatives in the village told him. They're so good that you can stop swallowing your Western medicine. They will make your diabetes fly away.

My uncle had been diagnosed with diabetes in 1984 by his general practitioner (GP) in England. Nearly 30 years after that diagnosis was made in a National Health Service (NHS) clinic, he gripped the handrail of a rickshaw and trundled along the road towards Navsari, a city in the Indian state of Gujarat.

Back in England, his GP had followed the guidelines, starting him on metformin and then insulin when pills alone couldn't control his sugar. Still, my uncle's blood sugar levels peaked and crashed weekly; and sitting in the rickshaw, he felt hopeful that traditional healers could fix him.

There were two sugar doctors in Navsari who were especially revered. Visitors came from Canada, the United States, and England to sit at their feet, absorb the ancient wisdom, and replace insulin injections with ground-up herbs and roots.

My uncle knew that his GP wouldn't be impressed, but the sugar doctor was convincing. He spoke of a 3000-year-old medical system that originated in India before there was an NHS in England. The sugar doctor took note of my uncle's medical history and the fact that sugar ran in his blood and in our family. He counted the pills my uncle took to treat hypertension, arthritis, and hypercholesterolemia. He shook his head.

He asked about my uncle's doshas, or constitution, an Ayurvedic practice that takes into consideration a patient's diet and environment. Western medicines are for Westerners, some sugar doctors said. You must make medicine from the things that grow in the country of your birth.

When the consultation was over, the sugar doctor handed my uncle plastic bags and boxes filled with tablets and a bill for 37,000 rupees (close to $600). This was a large sum by my uncle's standards, given that his NHS medicines cost around $10 each. But the sugar doctor promised him glycemic control unlike anything Western medicine could achieve—if he stopped taking his English medicines.

My uncle followed orders. Giving up the insulin was easy, but he wondered if quitting all of his pills was a good idea. Then he remembered how many people in our community, both in the village in India and in England, used traditional medicine. Consulting hakeems—wise men who offer medical and life advice—was as common as making an appointment for an annual flu shot.

Customers await their orders at Hakeem ChiChi dispensary.

On a trip to India in 2017, I visited a popular Ayurvedic dispensary in Gujarat. I had grown up hearing stories about Hakeem ChiChi, an especially popular Ayurvedic dispensary whose tonics rattled in the door of our English fridge next to pasteurized milk and orange juice. Hakeem ChiChi's pharmacy sits above a more conventional-looking pharmacy on the first floor of dusty building in Surat. As you ascend the narrow stairway to the second floor, a hazy cloud of ground spices infiltrates your nose and burns the lining of your mucous membranes. Glass jars line the walls of Hakeem ChiChi's dispensary, and in the center of the room, little boys weep and rub their stinging eyes, while grown men sneeze into handkerchiefs.

Ground Ayurvedic herbs and spices.

Behind the counters, men prepare herbs, weigh powders, and fill orders for the two dozen people waiting in the small space. There is a collective belief in the power of these tonics to heal and fix every ailment that has eluded Western medicine.

Back in England, those who can't travel to India place orders over the phone and await shipments. They stuff the pills into their weekly dispensers along with the day's beta blockers and aspirin. Others eschew Western medicines altogether in favor of pills made from vegetables, roots, and herbs.

When my uncle returned to England, the skies were gray and his forehead clammy. He shivered beneath a blanket even with the central heating cranked up. Some mornings the room spun, and he felt too light-headed to get out of bed. One day, at the urging of my aunt, he went looking for professional help—not from his GP but from his pharmacist. He walked the hundred yards to the local chemist and confessed his Indian adventure. The pharmacist was a safer bet than the doctor, he thought. What if the GP refused to treat complications caused by non-NHS medicines? What if he got in trouble for using Ayurvedic medicine?

The pharmacist had heard the story before. More than half of Brits surveyed in a 2015 government poll said they believed that herbal medicines were "genuinely effective at treating illnesses," and nearly a quarter said that herbal medicines should be offered free on the NHS. Forty percent believed that Chinese medicines were effective, and 39% said the same about homeopathy.

In the United States, almost 1 in 5 adults uses complementary or alternative treatment, although these official data from the National Center on Health Statistics lump together treatments including homeopathy, yoga, and massage. In 2012, Americans spent more than $30 billion on complementary treatments, an average of $500 per person.

The pharmacist was not surprised by my uncle's confession. Up and down the street, his customers came back from India sporting new treatments and strange symptoms. The pharmacist shook his head. "You shouldn't have done that," he said. "You should never stop taking the medicines your doctor has prescribed. Go and see your GP straight away."

My uncle mustered the courage to face his doctor, who promptly restarted his medications and warned him against the dangers of swallowing unlicensed and often untested drugs.

Ayurvedic medicines have started to be evaluated in placebo-controlled clinical trials. In a 2011 study by the US National Center for Complementary and Integrative Health, Ayurvedic medicines were found to be as effective as methotrexate for the treatment of rheumatoid arthritis. One study found that a compound in frankincense offered better pain relief to osteoarthritis sufferers compared with placebo.

But too often Ayurvedic medicines contain dangerous levels of lead, arsenic, mercury, and other toxins that have caused outbreaks of poisoning. Users of Ayurvedic medicines are also prone to stopping their usual medicines and keeping their Ayurvedic treatments a secret from their doctor.

You might think that the Indian episode was my uncle's first and final foray into complementary medicines, but there was a second incident in England involving samosas and a white van.

In our community, sweetmeats and savory delicacies are sold out of vans that travel down English streets and stop outside the houses of brown people. One van sold spicy samosas alongside a powder touted as a natural treatment for diabetes, arthritis, and other ailments. "Desi dawa," said the young man, meaning, "native medicine," as he spooned the powder into small plastic bags and pressed it into the hands of elders. "It's all natural."

The elders were pleased with the treatment. Their aching joints were soothed, and even their fluctuating blood sugars seemed to settle. But when authorities got hold of the powder and analyzed it, they found it wasn't roots and herbs but a mixture of crushed acetaminophen and metformin.

After that, my uncle grudgingly stuck to his English medicines and vowed to be more skeptical about alternative treatments. But when I visit my community in England and in India, people speak in confident and excited tones about the power of Ayurvedic medicines. They tell stories about the man whose vision returned; the child whose kidney function was restored; and, of course, the many who have been supposedly cured of diabetes. Desi dawa, they say.

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