1/ Breaking: Our new peer-reviewed paper is out. It may anger you, make you sad or even numb you.
During the start of the pandemic, various governments published national guidelines on management of #COVID19
Guidelines from India was unique.
2/ Apart from featuring science-based data, it also featured prevention and treatment options for Covid from The Ministry of Ayush, the apex pseudoscience promoter in the country.
Ayush stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy.
3/ None of these "guidelines" were based on empirical evidence, none based on clinical trials & efficacy/safety of traditional practices against a pandemic of extreme proportions remained unknown.
Because it was promoted by major authorities, people fell for it.
4/ People fell for the "natural & safe" ways to combat Covid-hook, line & sinker
But didnt realize is that unscientific ways of health-seeking behavior always come with a price
Which is what we show in our new paper, out in Medicine®, published by Lippincott Williams & Wilkins
5/ Ayush industry used the scientifically-sounding, but rationally deprived and illogical word "immune-boosting" to trick people into believing that herbal and dietary supplements could help people combat Covid.
Patients with chronic disease are always easily tricked into...
6/ ...using short-cuts to "boost" their health, in the presence of growing science-denialism and anti vaccine movements across the country.
In our study, we looked at cirrhosis patients who availed "immune boosting" to prevent Covid and describe their outcomes.
7/ Close to 10% of STABLE cirrhosis patients who used immunity boosting developed severe and progressive liver failure and associated complications.
Most developed jaundice, fluid in abdomen and developed brain failure.
42% of these patients DIED without a liver transplant.
8/ The most common used immune-boosting was Ayurvedic, followed by Homeopathy.
Agents causing severe liver injury were:
Giloy
Ashwagandha
Turmeric
Neem
Indian goosberry (Amla)
Holy basil (Tulsi)
Arsenic trioxide
Both traditional and company (Patanjali) made preparations.
9/
We also analyzed products that we retrieved from some patients and found that they contained direct liver toxic plant chemicals such as glycosides, terpenes, coumarans and also insecticides, pesticides and industrial solvents.
10/
We also performed liver biopsies of patients who consented to the same and found that their already weakened liver had large areas damaged and devoid of liver cells due to severe inflammatory damage from multi-herbal insults on the liver.
11/ Our paper signifies the importance of scientific communications in public health.
All the patients who died in our study would have been alive if they did not opt for such unscientific practices which were promoted by supposed health regulators and also print & visual media.
12/ With the Indian Govt's plans to "integrate" pseudoscientific primal practices into modern medicine, we can only expect more of disease burden among the Indian patient and general community in coming years - most of them ending up as data on studies like this. Great tragedy.
13/ There is no role of unscientific promotion of healthcare among the public how much ever it has traditional, cultural or nationalistic values.
Medical science is the method closest to the truth and requires scientific temperament in its promotion, communication & acceptance.
14/
Many thanks to @arifhussaintm and Vaid. Resmi R for their uncompromising work on collating and collecting the data from a large database of patients.
You can read our full paper and all analytical data at this link.
All the Ayurveda and Homeopathy sympathizers and pseudoscience apologists commenting on this thread twisting and misinterpreting facts about Covid vaccines, use of steroids and other scientifically proven methods that saved millions worldwide, including themselves… twitter.com/i/web/status/1…
This is what science-illiteracy and blind-faith nationalism on steroids look like.
Dont be like them.
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A few years ago, a patient was referred to me because he was diagnosed with complicated cirrhosis. He had an infection which led to a condition called hepatic encephalopathy (brain failure due to high ammonia levels). The treatment largely involved ammonia reducing therapies. One drug was central to this - Rifaximin - a non-absorbable antibiotic that reduced ammonia in the body. I prescribed him Rifaximin for 6 weeks and advised him follow-up.
He came back to me, not after six weeks, but in 4 weeks, this time, in liver coma (worst stage of brain failure - due to very high ammonia). He spent two days in the ICU and six days in total in the hospital. His hospital bill was close to INR 80,000. He had no insurance and his wife borrowed the money from neighbors and friends to clear hospital dues.
Upon questioning, I found that he was not taking the Rifaximin drug I had prescribed. He was only on the other two drugs (one, a syrup called lactulose for improving ammonia clearance in gut). I was furious, because the patient spent a whole week unecessarily in the ICU and wasted so much money that he never had - just because he was "not compliant" to my orders. I decided it was time for me to school him a bit.
But I was wrong. He was compliant. He had purchased Rifaximin and was on it. For 15 days. Thereafter, he could not afford it. He was an autorickshaw driver who shuttled school children every morning and evening. He could hardly make ends meet. He had two children of his own. The Rifaximin brand I prescribed him was 42 rupees per tablet. He had to consume two a day - which would mean 2520 rupees a month. He just did not have that money - so he skipped it - to not compromise on other important matters - childrens education and food.
He was confused and scared about opting for a cheaper version of Rifaximin because one, he was unsure about the quality of Rifaximin that was not prescribed by me and two, he was "scared" that I would scold him for buying a cheaper Rifaximin and if that got him into trouble.
I was confused and scared about prescribing a cheaper version of Rifaximin because one, I was unsure about the quality of Rifaximin that was not "a good promoted brand" and two, I was "scared" that his family would scold me for prescribing a cheaper Rifaximin and if that got him into trouble.
It is heartbreaking that many doctors still simply don’t trust generic medicines. Too often, they worry that these cheaper options are lower quality or might cause more problems than the big, famous brands. This fear leads them to prescribe expensive drugs instead, and the real tragedy is that it pushes vital healthcare out of reach for the ordinary people who need it most - like my patient.
This narrative, that generic drugs 'are never good' and that only big pharmaceutical marketed drugs are what works has been deeply ingrained into doctors and patients alike - I do not know by whom and since when. Looking back, these strong emotions were based on either opinions, testimonials or second- and third-hand information. Not evidence.
Like I said. Stay with me. This is life changing and will disrupt the drug market in India. Here are the results of The Citizens Generic vs. Brand Drugs Quality Project.
1/11
With your help, we analyzed 131 different medicine samples from pharmacies - ranging from expensive top brands to "free" government generics.
This included the highest prescribed and selling (most expensive) branded drugs, generics marketed by the same big brands (branded and local pharma generics), government supplied generics [Central Govt. - Jan Aushadi and State Government - Kerala Medical Services Corporation Limited (KMSCL)], and trade generics [sold at hospital pharmacies and special generic pharmacies - Dava India, Generic Aadhar)
The question: Is the expensive stuff actually better?
2/11
The Test
We took 22 types of common (essential) medicines (for heart, pain, antibiotics, liver, sugar) from these 7 different sources, and sent them to an accredited lab - Eureka Analytical Services Pvt. Ltd. in Kundli, Sonipat, an FSSAI-notified and US-FDA and NABL/ISO 17025 accredited laboratory providing comprehensive pharmaceutical, API, and drug testing services.
We tested 5 quality parameters according to standards of Indian Pharmacopeia:
✅ Drug content or assay
✅ Dissolution
✅ Uniformity
✅ Impurities
✅ Physical appearance
3/11
1/15
Our important work, The Citizens Protein Project 2 that analysed "hospital/doctor" prescribed whey protein vs. nutraceutical/fitness industry marketed whey protein is now peer-reviewed and published. Please share with your doctor!
We recently published our independent analysis of Homeopathic practitioner commonly prescribed and popular over-the-counter 134 Homeopathy products marketed and sold as "medicine."
The Placebo Project: An observational study and comprehensive analysis of 134 commonly prescribed homeopathic remedies in India uncovers potential for hepatotoxicity: journals.lww.com/md-journal/ful…
Here is our plain language and visual abstract summary of what these Homeopathy products are and what we found in them.