After the original launch of Patanjali’s Coronil on June 23, 2020 was met with uproar over its overblown claims, the drug returned again in February 2021 with more dubious research. This time, it carries the endorsement of two union ministers and a misleading WHO certification claim.

Despite the previous objections, Patanjali managed to sell 85 lakh units of Coronil and its components by the end of October 2020. This is not surprising, even though the herbal medicine industry in India has been repeatedly criticised for lack of manufacturing, regulatory or pharmacovigilance oversight.

So, are you wondering how to sell your own untested ayurvedic drugs? Here are some tried and tested tricks from the playbook of India’s $10 billion ayurveda industry.

Sloppy science

One quick way to get bragging rights of having “scientific evidence” is to do animal studies and exaggerate their results. Patanjali Ayurveda’s marketed products for dengue, stroke and heart ailments, dementia, arthritis, asthma, pain management, and jaundice have not been tested in humans, but only on mice, zebrafish and computer programmes.

These are preclinical studies that are done before we test in humans and they tell us very little about a drug's on-ground efficacy. In the pharmaceutical industry, only 0.1 percent of successful preclinical trial candidates end up as licensed drugs, the rest all fail. Animal studies are therefore a quick and cheap way to hype your ayurvedic concoction.

Animal studies are notorious for being unreliable. One of the translational research’s guiding principles is “mice lie and monkeys exaggerate”. Their persistent undependability is a running joke in the scientific community.

If you are adventurous and want to test your ayurvedic concoction in humans, you can use a range of sloppy tricks like ridiculously low sample size, no blinding or randomisation, poor design, and lack of control among other flaws documented in ayurvedic human trials.

Bad practices

There is a range of bad research practices that can help you arm-twist your way to scientific publication. The most common way is to get yourself published in a predatory journal – journals that will publish any article without diligence or peer review.

Another way to bulldoze your way to publication is by not declaring a conflict of interest. Many journal editors are wary of publishing papers that are industry-sponsored papers or with a significant conflict of interest.

All Patanjali-related research papers indexed on the PubMed database are by researchers from the University of Patanjali and the Patanjali Research Institute. Acharya Balakrishna, the managing director of Patanjali Ayurveda, is the first author of almost all these papers. The study, therefore, is funded by an organisation that commercially benefits from the study’s conclusion. It’s a textbook example of a conflict of interest that Patanjali researchers didn’t disclose.

Another niche way to get more publication is salami slicing, which is when you do a single experiment, but squeeze as many research papers out of it as you can. Patanjali has two papers for its anti-arthritis drugs Aswashila and Divya Amvatari Ras tested on the rodent model. Both the studies were essentially a single multi-arm experiment that was published as two different papers. This explains why both papers shared the same pictures of mice feet.

Photoshopping results

The next step is scientific misconduct. Image manipulation is by far the most popular one. Here, researchers duplicate, recycle or manipulate evidence images like micrographs and tumour pictures to get favourable results.

For example, Dr Yogeshwar Shukla, a chief scientist at the Council of Scientific and Industrial Research-Indian Institute of Toxicology Research, has more than 40 papers that have been flagged for image manipulation, several of which are now retracted. Shukla’s papers mainly dealt with using fruit extracts to treat ailments like cancer in rats.

Shukla’s is not an isolated case. Around 35 papers from CSIR-CDRI have been flagged for manipulation too. This practise is so widespread that Annamalai University in Tamil Nadu alone has 229 papers marked for plagiarism, data and image manipulation.

Patanjali is guilty of it too. Two papers by Patanjali researchers have been flagged for image duplication. Acharya Balkrishna, the MD of Patanjali Ayurveda, is the first author in both papers.

Monopolise the plant kingdom

Plants have an impeccable image. They are the Tom Hanks of the living world. They literally convert invisible air to give us fruits, flowers, timber and drugs. This makes them a good target for ayurvedic opportunists. As compared to the dangerous “synthetic chemicals” made by Big Pharma, ayurvedic concoctions are simply plants, after all!

This argument hinges on many assumptions. One is that Big Pharma, which is equally greedy and opportunist, does not use natural sources for drug development. This is wrong. Many drugs like aspirin, morphine, quinine and even anti-cancer drugs like paclitaxel and camptothecin are derived from plants. Several antibiotics are fermented out of bacteria and fungi.

Any beneficial chemical in a plant does not have much value on its own unless it's sequestered, purified, dosed and tested. Squeeze any plant and you’ll find hundreds of antioxidants, phytochemicals, provitamins, anti-inflammatory agents, and so on. But in that state, they have little value.

Here’s a summary of some major reactions that take place in each of our 37 trillion human cells. In this map, there are a dozen antioxidants, and it’s naïve to assume that biting on a tulsi leaf will affect any of them. You can’t game millions of years of evolution with backyard plants. And if you think you can, please bring forth the supporting data from human trials.

Piggybacking on the reputation of the plant kingdom, Hindu civilisation, or union ministers is standard industry practice in the ayurveda business. Another reliable option is to bolster public image by spending massive amounts of advertisement money on news channels in exchange for some primetime fawning.

Vagueing out of questions

Ambiguity is your friend. It will allow you to escape accountability.

Suppose XYZ plants relieve respiratory distress. But what about the aetiology or the origin of distress? Is it bacterial pneumonia? A virus? Asthma? Bronchitis? COPD? Tumour? Embolism? Pleural effusion?

Doesn’t matter. XYZ takes a holistic approach.

Patanjali’s Aswashila, for example, is marketed for sexual weakness, fatigue, stress, generalized weakness, asthma, allergy, diabetes, diabetic neuropathy, and urinary disorders. What is its mechanism of action, you ask? A holistic approach.

Another trick is to build misleading targets and celebrate when you clear them. Patanjali’s GermiX sanitiser is a case in point. Sanitisers and hand rubs are usually made up of alcohol, an excellent disinfectant. Patanjali’s paper on GermiX shows that it's just as good as any other alcohol-based sanitisers. But when you look at its composition, GermiX is made up of alcohol too! It just has some extra seasoning of neem, tulsi and aloe vera for its ayurveda branding.

Domesticated plants

Ayurvedic formulations have a long-standing ill repute for containing many toxic, untested ingredients and heavy metals. You mitigate this risk by sticking to just a handful of assembly-line ayurvedic plants. Most ayurvedic drugs are simply made up of different combinations of factory-scale domesticated plants like ashwagandha, tulsi, neem, giloy, amla, and so on.

Rare species are hard to cultivate and are expensive to procure. Therefore, just stick to the production-scale commoners listed above. Unsurprisingly, they also happen to be the composition of Coronil.

Ayurveda can only be salvaged if it’s rigorously researched, tested and regulated like other pharmaceutical drugs. Any drug for human consumption should have equal efficacy standards, whether or not they’re 200 years old or 2,000.

Another persistent argument in favour of ayurveda is that it does not have side effects (a function of not having any effect at all) and are therefore innocuous. But a neem leaf is no longer harmless if it allows your manageable cancer to progress to an incurable one. Time spent with ayurveda is often the time spent without evidence-based medicine.

Ayurveda’s central premise is that the human body is made up of earth, water, fire, air and vacuum. Homeopathy hinges on the belief that individual water molecules have memory. For both of them to be right, our entire understanding of fundamental chemistry and physics has to be wrong.

Ayurveda and AYUSH treatments exist within the sharp inequities of our societies. While the privileged can afford the loot of Big Pharma, it's often the more unsuspecting disadvantaged patients who are let at the mercy of inexpensive AYUSH voodoo. As long as the government doesn't remedy the existing regulatory oversight, AYUSH will be nothing more than a bitter placebo pill.