In July, a division bench of the Supreme Court directed the Kerala government, the Union ministry of Ayush (Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homoeopathy) and the Central Council for Research in Homoeopathy, a research organisation funded by the ministry, to respond to a petition filed by a Kerala doctor questioning the large-scale distribution of the homoeopathic medicine Arsenicum album in the state during the covid-19 pandemic.

It was a small institutional win in an ongoing war that is usually fought on the slippery battleground of social media—its wins and losses measured in hesitant individual acknowledgements of doubt about the efficacy of traditional medical systems, or in the number of death threats received by science communicators on any given day.

While delivering the notice to respond to the government bodies, one of the judges on the division bench, Justice Aniruddha Bose, noted that he also “sometimes takes such medicines”, but contradicted the Union ministry’s stand on the issue that it is harmless, saying it could be poisonous depending on the “level of dilution”.

Arsenicum album is a peculiar medicine in homoeopathy’s cabinet—if prepared in the classical way, the final product would contain exactly zero molecules of arsenic, making it about as effective as tap water; but if prepared more, let’s say, enthusiastically, it could end up poisoning people as the active ingredient is, indeed, the known poison arsenic.

Traditional medicine systems like Ayurveda do work with plant-based ingredients that have formed the basis of drug discovery over the ages, from aspirin to atropine and quinine, but there is a lack of certified practitioners, rigorous clinical trials and standardised doses; “unknown herb-herb and herb-drug interactions, adulteration of Ayurvedic drugs with other prescription medicines, and contamination due to poor manufacturing practices”, as a 2020 review of hepatotoxicity associated with traditional Indian Ayurvedic herbs noted.

It’s also a fact that people take it unquestioningly, as they do homoeopathy, because these traditional remedies are widely believed to be “harmless”. “Even if it doesn’t help, it won’t cause side effects, unlike allopathic medicines” is the general belief—and the reason millions of Indians rely on these treatment systems every day over seeing allopathic doctors for diseases as grave as cardiac issues and cancer. But are things changing, even if in ways almost as minuscule as the amount of active ingredient in a homoeopathic remedy?

Cyriac Abby Philips, the Kerala doctor who filed the petition in this case and a well-known crusader against pseudoscience, believes that the very fact that we are having this conversation is a win. For decades, he says, the systems went unquestioned. They were given further legitimacy by the conversion of a department for traditional medicine, formed in 1995 by the Union government, into a formal ministry in 2014.

“In my mind, the main indicator of a changing mindset is the multitude of people directly telling me that they have stopped using homoeopathy because they now understand what medicine is and what quackery is; are more aware of herbal liver injuries due to untested and unregulated Ayurvedic medicines; and have thrown away their non-beneficial dietary supplements,” says Dr Philips, a specialist in hepatology and liver transplant medicine at The Liver Institute at the Rajagiri Hospital in Aluva, Kerala.

Dr Philips, better known as The Liver Doctor on social media, has published over 160 peer-reviewed scientific papers in established medical journals, including several on Ayurvedic medicines causing liver injury. He led the 2020 hepatotoxicity study.

For five years, he managed to self-fund a lab that tested Ayurvedic and other traditional formulations cleared by the ministry of Ayush. “We conducted large-scale chemical and toxicology analyses of various Ayush formulations retrieved from patients. It was paid for from my own pocket, for informing the public of the dangers of untested and unregulated formulations. We voluntarily ended it this year but public discussion around our transparent results were the most significant victories. They led to people learning about and changing their thinking around alternative medicine-related misinformation,” says Dr Philips, who has a rock-star persona on social media—as much venerated as reviled for his no-nonsense, evidence-backed posts about the potential harm of pseudoscientific remedies.

Over the years, others have joined the crusade. “There is so much harmful pseudoscientific content out there that we need more and more rational thinkers to call it out,” says Pranav Radhakrishnan, an engineer-turned-science communicator and content creator whose channel, Science is Dope, debunks myths about nutrition on YouTube and Instagram.

Dr Cyriac Abby Philips (left) and Pranav Radhakrishnan

“People have figured out that if you combine misinformation with scaremongering, you get a lot of views very quickly. This kind of unregulated content is dangerous,” says Radhakrishnan, who believes that there has been a significant leap in the amount of pseudoscientific content since the covid-19 pandemic, though there has also been a growth in the number of people who debunk this—maybe not at the same pace. “But the good thing is, you need very little rational thought to take down a lot of irrational thought. Once you nudge people towards logical thinking and looking for evidence, it can change mindsets and habits exponentially,” says Radhakrishnan.

There is a large and growing community of people debunking health misinformation in India today, like the Malayalam channel Lucy Malayalam; a pseudoscience-busting Telegram and Clubhouse group, The Science Brigade; the Kerala-based rationalist group Essence Global, which runs a YouTube channel, Nueronz, that often features videos on pseudoscientific medical practices; the Kolkata-based Breakthrough Science Society; and several regional-language YouTube content creators like Mr GK in Tamil and Aastha Mukti and Arpit Explains in Hindi.

Many of them build upon the work done by rationalist organisations that have operated for decades—and while debunking health misinformation is not their primary agenda, it forms a large part of their communication efforts.

There are baby steps being taken towards an institutional response as well. Dr Philips and several others from the community of myth-busters recently registered a non-profit called Mission for Ethics and Science in Healthcare (MESH) to advocate good public health practices and battle health misinformation.

“It is no more a battle in the shadows—it has become an all-out, full-blown, transparent education of the masses through instillation of scientific temperament, critical thinking and rationality,” says Dr Philips. “The machinery that we have currently to fight against health misinformation, pseudoscientific practices and quackery in India is small but it is strong, and it is growing, because the common person has entered the equation.”