Dr van Schalkwyk and his colleagues are right to alert the profession to contaminated preparations (Ayurvedic medicine: patients in peril from plumbism; http://www.nzma.org.nz/journal/119-1233/1958) in the 5 May 2006 issue of the NZMJ, but they overstep the mark when they cast aspersions upon one of the World’s major medical traditions.

When they state...

...they appear to be unaware that Ayurvedic medicine consists of a great deal more than “a particular form of herbal remedy.”

Herbal remedies form a part of Ayurveda, but to taint Ayurvedic medicine and, by implication, its practitioners as a “threat to wellbeing” based on their findings in eight isolated cases is unfair. The preparations in the cases cited appear to have come from unaccredited facilities and should not be taken as representative of all Ayurvedic herbal preparations, nor of Ayurvedic medicine in general.

For example I have visited the Maharishi Ayurveda Products Laboratory (MAPL) run by Maharishi Mahesh Yogi’s organisation in Delhi. I was impressed by the management’s systematic approach. MAPL holds Certification of Compliance ISO/IEC 17025: 1999. This relates to product standardisation and the exclusion of heavy metals and residual pesticides. MAPL also holds ISO-9001-2000, HACCP, WHO-GMP, and the National GMP certificates. As holder of these certificates, MAPL is regularly audited by independent authorities. The only metals used in MAPL products are iron and zinc.

Ayurvedic medicine is a vast compendium of medical knowledge representing a tradition of some 4000 years found in India, Sri Lanka, and Thailand. Within the classical treatise, the Charaka Samhita, are detailed techniques of diagnosis, a knowledge of anatomy, instructions on dietetics, a system of aetiology and pathogenesis from which we could learn much, a classification of diseases, therapeutics including lifestyle interventions, and a clear definition of health. Ayurvedic medical therapy takes into account individual body type, time of life, and seasonal variations in its treatments.

The Charaka includes ethical considerations and regulations for the dispensing of preparations derived from detailed knowledge of the actions and uses of the 10,000 or so herbs contained in the Ayurvedic pharmacopoeia. Ayurvedic medicine suffered greatly during Indian occupation, tending to become scattered with a loss of standardisation. During the last 20 years, a number of organisations, including the World Health Organization have been involved in its revival. In particular, the Indian sage and scholar Maharishi Mahesh Yogi has thrown new light on Ayurveda and made an invaluable contribution to its proper and widespread understanding.1

I suggest, in keeping with the trend towards cultural awareness, we remain mindful of the well-known advice concerning motes and planks when evaluating another medical tradition. After all, there is also a common belief among the public that use of ‘Western medicine’ is harmless.

With iatrogenesis now ranked as a major cause of death in the United States,2 this assumption is far from the truth—further indeed than any such assertion about Ayurvedic medicine. The roster of adverse effects from Western preparations is long and sometimes disastrous—as we saw recently in the case of TGN1412 when it was trialed in the UK.

Properly practised, and its preparations correctly prepared and dispensed, the long-established tradition of Ayurvedic medicine is benign when compared to the unedifying mortality and morbidity that has accrued under the fledgling Western tradition.

Dr Lovell-Smith refers to the preparations we described in our paper as contaminated, but he fails to address the issue (stated in our paper) that traditional Ayurvedic medicine appears to attribute beneficial therapeutic effects to administration of carefully prepared heavy metals. It would seem that according to Ayurvedic tradition, heavy metals are deliberately introduced for therapeutic effect. The presence of lead in the amount of 20% by weight (Case 1) can hardly be seen as ‘contamination’.

We are pleased that the organisation he commends appears to have broken with Ayurvedic tradition in excluding lead from their preparations. Until all practitioners of Ayurvedic medicine similarly exclude heavy metals from their products, it would seem wise to exercise caution with such products.

The quality controls Dr Lovell-Smith mentions are also important. Even a generally well-informed consumer of Ayurvedic medicine may well not be aware of the importance of accredited testing in laboratories implementing ISO/IEC 17025—one of the cases we described was a pharmacist (Case 8)! It is worth mentioning that ISO/IEC 17025 (General Requirements for the Competence of Calibration and Testing Laboratories) is largely a product of Western science, not Ayurvedic tradition.