Simple Medicine. Best Medicine

Words: Dr Sanjeev RASTOGI & Prof Ram Harsh SINGH

The SARS-CoV-2 [COVID-19] pandemic and strategies to containing it and adopted by various nations have invited a great debate vis-à-vis their respective successes, failures and/or underlying reasons. Science was seen as the great rescuer at the onset of the pandemic; it was believed that sooner, or later, man would conquer as he always has in several such preceding occasions in history.

Unfortunately, that expectation has not come true; we are still living in a state of fear and uncertainty. The pandemic is not yet over, and a real cure is yet to be seen. Every new strain of COVID-19 brings fresh waves of panic and makes us shiver till it recedes naturally. Such helpless situations have not been seen in recent history, more so since science started scripting the fate of the human race.

This pandemic, besides raising questions on how evolved we are in terms of science and technology of healthcare, also raises the question of whether truly adopted science can really prevent — or, at least minimise — the impact of every such situation. Greater questions are of equal concern today — of how scientific advances have impacted policy making, in general, for the well-being of the nation, and how they have been utilised during emergency conditions to averting the possibility of any such catastrophe.

Looking at the strategies adopted by various nations, during the pandemic, we find a great divide between chosen methods of mitigation, prevention and protection. Every nation has its own understanding of the recommendations given by global, or local, advisory agencies. Each has eventually adopted individualised measures to suit its own needs.

We are aware that every country has a system of governance where decisions are made by key functionaries, irrespective of the source of their authority. The basic question is: what influences decision making at the national level? Also, whether such decisions are truly evidence-based? Or, are they driven through collective evidences collated from the past? Or, how scientific are decision making processes at the governance level?

Conventional science has looked at a narrow perspective of experiments and observations within the confines of laboratories. Scientists are often projected as people apart from the world, not well-acquainted with the worldly affairs of common people.

Plentiful Evidence

History, however, reveals the contrary. There is plentiful evidence of cases where worldly problems were attempted rationally, systematically and scientifically in an unbiased manner to reaching the ‘perfect’ solution. In a global, also Indian context, the ‘Green Revolution’ and ‘White Revolution’ are the brightest examples of involving science in policy making and to meeting the demands of food and milk for our country’s exponentially growing population.

The ‘Green Revolution,’ which included introduction of dwarfing genes, enabled dramatic increase in yield, through the use of fertiliser and improved irrigation; it also added to disease resistance. To meet the growing demand for food as the human population rose, a continual increase in cereal production was needed to maintaining a constant per capita cereal supply. The ‘Green Revolution’ was primarily a recognition that global needs of food cannot be met by increasing the farm area. Rather, methods of increasing yield without increasing farm area are essential for a higher purpose — to feeding more and more people.

This was led by agricultural scientist Dr M S Swaminathan in India — the revolution was, in effect, part of a larger endeavour initiated by Dr Norman E Borlaug. It leveraged agricultural technology research to increase global agricultural productivity, especially in the developing world.

‘Operation Flood,’ also known as the ‘White Revolution,’ was no less remarkable. Launched in 1970, it was the world’s largest dairy development programme, a landmark project of India’s National Dairy Development Board [NDDB]. It transformed India from a milk-deficient nation into one among the world’s largest milk producers. It made dairy farming India’s largest self-sustainable employment segment, in less than three decades, in terms of rural area, while doubling the milk available per person nationally.

We clearly see that such mega-tasks of making a country self-sustainable in terms of cereal and milk production, in order to meeting the ever-increasing demands of its population, would not have been possible without logical, systematic and scientific support. Such examples of efficient problem solving could be recreated in almost every area that has been troubling governments for decades. Areas, like waste and sewage disposal, energy production, efficient and affordable healthcare, and recycling of used materials, are in urgent need of experimental solutions by appropriately merging science with policy making.

Needed: A Scientific Booster Dose

A careful exploration of traditional healthcare wisdom prevailing in Asia could be a game-changer in healthcare delivery provided policy making is given its due, also priority. In the case of the COVID-19 pandemic, Ayurveda interventions, although diversely used, would probably have changed the scenario with serious scientific exploration. Mass applications of simple interventions, from yoga to Ayurveda, could have been explored for their ability to prevent both infections and complications, like mucormycosis. Jala neti [saline nasal irrigation] was one such low-cost, non-invasive, simple procedure extensively reported for its beneficial effects in recurrent rhino-sinus infections. It is evidenced to reduce viral load substantially, either alone with isotonic saline nasal irrigation, or with a routinely used disinfectant, like povidone iodine.

Evidence suggests that patients who initiated isotonic saline nasal irrigation after a positive COVID-19 PCR test were 19 times less likely to be hospitalised than controls. Adding such a simple measure to primary care in all exposed and suspected cases of COVID-19 could have resulted in a substantial reduction in the number of mild-to-moderate cases converting to severe ones, requiring hospitalisation and ICU care. Unfortunately, the conventional, also default, understanding has been that the more expensive and more cumbersome the intervention is, the more beneficial it may be assumed to be. As a result, simple interventions failed to find a place in policy despite their objective value. Their simplicity and low-cost gave them perceptions of low therapeutic potential. This presumption needs to be changed, so that policy can incorporate simple, yet powerful, low-cost remedies originating in indigenous technology and wisdom.

Conclusion

We need to let science and the scientific frame of mind be the driving principles governing our country. Aptitudes for plausible hypothesis generation, making pilot testing, and creating evidence of effectiveness associated with generalisability should drive adoption of new policies. The country should never be driven by mere belief. Rather, it should choose a path of governance guided by reliable evidence generated rationally, transparently, and reproducibly. Many countries in the world, which are highly placed in global indexes related to standard of living, are actually doing that. It is high time India profited from such global experiences.

Dr SANJEEV RASTOGI, MD, PhD, is with the Department of Kaya Chikitsa, State Ayurvedic College and Hospital, Lucknow University, Lucknow, India. Dr RAM HARSH SINGH, ABMS [BHU], MD [Hons], PhD, DLitt, FNAIM, is Distinguished Professor, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, India. This article [Science, Scientific Temper and Policy Making: Shall There Be a Greater Togetherness?] was first published in Annals of Ayurvedic Medicine, 2022; 11[1] 2-4, DOI:10.5455/AAM.21714, under the terms of the Creative Commons Attribution Non-Commercial License 4.0.

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