‘If we mix cow urine with apple juice, the cow urine does not get better…’ : ‘The Liver Doc’

Dr. Cyriac Abby Philps aka “The Liver Doc” is an hepatologist known for his critical views of alternative medicine. He is active on social media debunking myths about alternative medicine. He’s been a doctor for 17 years, focusing on liver problems for the past 15 years, and a top liver specialist for the last 8.

And he’s not just showing off awards (which includes a gold medal from the President of India in 2016). Dr. Philips is shaking things up! He’s taking on big companies that sell health products and debunking popular myths about staying healthy.

In an Interview with the newindianexpress.com he explains his stand on various issues ranging from the importance of evidence-based medicine to the need for empowering individuals to critically evaluate health information online.

Q: Dr. Philips, there is a growing interest in personalised medicine. Do you see a future where traditional and modern medicine work together to create individualized  treatment plans? 

A: The future of personalized medicine lies in the realm of advanced  diagnostics, cutting-edge technology, and scientifically validated treatments, rather  than in the integration of traditional medicine.

While personalized  medicine is set to revolutionise healthcare through improved diagnosis and targeted  therapies, the unscientific and anecdotal nature of traditional medicine precludes it from being a viable component of this advanced, patient-centric approach. To simplify – “If we mix cow urine with apple juice, the cow urine does not get better, but the  apple juice gets worse.” 

Q: How can modern medicine learn from traditional systems like Ayurveda to offer a more holistic approach to patient care? 

A: Modern medicine stands to gain very little, if any, value from traditional  systems like Ayurveda in its quest to offer a holistic approach to patient care. For instance, Ayurveda cannot and does not  identify a root cause to diseases like science-based medicine does. Integrating these  unscientific methods risks diluting the reliability and effectiveness of standard,  conventional healthcare.

Q: How can people differentiate between legitimate Ayurvedic products and those  based on unfounded claims? 

A: All Ayurvedic products and formulations are based on unfounded claims because the whole of Ayurvedic practice is based on pseudo-scientifically-driven unfounded theories. A ‘legitimate’ Ayurvedic product is akin to “healthy alcohol.”  Such a thing does not exist.

Q: Many modern medicines are derived from plants. How does this link back to the  concept of natural remedies? Is there a difference between traditional plant use and scientifically derived medications?  

A: While many modern medicines are indeed derived from plants, the key  difference between these modern drugs and traditional plant use lies in the rigorous  scientific processes involved. This scientific  rigor not only identifies the active compounds but also optimizes their efficacy and  minimizes side effects through precise dosage and formulation.

Traditional plant (containing 1000s of chemical compounds) use, on the other hand, is often  unscientific and based on anecdotal evidence, lacking proper testing and validation. Such unverified remedies can be harmful, as they do not undergo the stringent drug discovery processes that scientifically derived medications do.

Q. Kottakkal Ayurveda is a popular household name in Kerala. However, concerns exist about  their products’ efficacy. Can you provide a scientific analysis of Kottakkal’s  Kashayams, Thailams, and immunity boosters? 

A: Kottakkal Ayurveda has garnered significant popularity within the  Ayurveda and alternative medicine endorsing, health-illiterate lay populace. However, common sense reveals that these products are largely based on pseudoscientific  claims lacking robust empirical evidence. Most Ayurvedic formulations, including  those from Kottakkal, do not undergo the rigorous clinical trials and validation  processes that modern pharmaceuticals undergo, raising serious concerns about their efficacy and safety.

Additionally, Kottakkal Ayurveda often employs double standards, marketing these  products in India under traditional and cultural legitimacy while facing stringent  scrutiny abroad. In many countries with rigorous regulatory standards, Kottakkal’s products are not recognized as effective medicine due to  insufficient scientific proof of their claims.

Q. There is a debate about Ayurveda’s future. Do you see it evolving alongside  modern medicine to create a more comprehensive healthcare system? 

A: Ayurveda is a 2000-year-old “pseudoscience” which is stuck in time, based  on primal faith & religious beliefs and untested observations. It has never evolved and  will never evolve. While integrating Ayurveda with modern medicine could theoretically offer a more holistic approach to healthcare – this remains a pipe dream  and will never see the light of the day. The primary concern is the lack of rigorous scientific validation for many Ayurvedic treatments and the absence of validation of  Ayurvedic principles from a scientific standpoint.

The standardization and  quality control of Ayurvedic remedies are often inconsistent, leading to potential risks  of direct toxicity, contamination, and unknown dosages.  

Q: Can traditional medicine like Ayurveda benefit from incorporating principles of  evidence-based research into its practices?

A: Incorporating principles of evidence-based research into Ayurveda will  shed light on significant facts that will pry open and erode its value as a healthcare  option and the presence of lacklustre traditional practices. Applying evidence-based research would  likely reveal that Ayurvedic treatments are ineffective or even harmful, leading to a  fundamental conflict with its core practice & principles.

Q: Beyond Ayurveda, what are your thoughts on the role of other complementary  and alternative medicine systems in modern healthcare?

A: Other complementary and alternative medicine (CAM) systems such as  Siddha, Unani, Naturopathy, Homeopathy, Tibetan Medicine, and such, hold no value  in standard healthcare, as they lack scientific validation and rigorous testing, which  are essential for ensuring patient safety and treatment efficacy. The proliferation of these alternative therapies  often stems more from their profitability within the healthcare industry than from any  genuine therapeutic benefit.

Q: You are known for advocating evidence-based medicine. Can you  tell us about your journey and what inspired you to speak out against unfounded  health claims? 

A: The rise of the internet and social media has made it easier than ever for healthcare misinformation to spread. Unfounded health claims can lead to dangerous  practices, prevent individuals from seeking proper medical treatment, and erode trust  in legitimate healthcare providers.

I have been unfortunately, consistently  witness to avoidable deaths from liver failure when patients were misinformed on  healthcare choices – such as patient endorsement of ‘claimed,’ but non-evidence  based unscientific and pseudoscientific practices such as Ayurveda, Siddha, Unani, Naturopathy and Homeopathy.

By countering misinformation with accurate,  evidence-based information, I aim to protect public health at all costs, promote  scientific literacy among patient community and public and support healthcare  professionals to provide effective care and as well as stand for science.  

Q: How do you navigate the challenges of  being a vocal advocate for scientific medicine in a world with diverse healthcare  beliefs? 

A: Medical practitioners like me navigate the challenges of advocating for  scientific medicine by combining education, effective communication, and empathy – by doing medical science communication without remorse or regrets, in black-and white and with substantial evidence to back up that communication. Education in this  context is not just putting up information, but providing evidence to claims of harm or  ineffectiveness through directly discussing real patient stories and factual, substantive anecdotes.

I strive to promote evidence-based healthcare while  rationally disrupting healthcare “beliefs.” One may ‘believe in God,’ but we must ‘trust the Science.’ The aim is to improve public health, public’s perception of  beneficial healthcare and drive the public to embrace Science-based care rather than  belief-based treatments. 

Q: We see a constant stream of home remedies on social media, often leading people  to forgo professional medical advice. How can we empower individuals to  critically evaluate health information online? 

A: Empowering individuals to critically evaluate health information online is  crucial in an era where health misinformation spreads rapidly, unchecked and without  accountability. Various strategies can help people develop critical thinking skills and understand reliable information from unreliable sources – these include, verifying the credibility of the source, looking for evidence and cross-checking information with real experts in the field. Individuals must also be taught to access curated lists of trusted sources,  use credible fact-checking websites (e.g. for herbal & dietary  supplements evidence) and have open communication with their doctor(s). Additionally, individuals  must also be educated about common red flags in health misinformation, such as  promises of quick fixes, miracle cures, and sensationalist language and to be cautious  of personal stories and testimonials, which can be compelling but are not scientifically  reliable. 

Q. What role do medical professionals have in fostering responsible health  communication through social media and public outreach?

A: Medical professionals play a crucial role in fostering responsible health  communication through social media and public outreach by providing accurate,  evidence-based information, correcting misinformation without fear or prejudice, and  engaging with the public in a transparent and empathetic manner.

By building trust and promoting scientific literacy,  medical professionals can help the public make informed health decisions and counter the spread of misinformation. This is a hill that dedicated medical science  communicators such as myself are willing to die on.  

Q: Misinformation is not limited to social media. How can we address the spread of  myths and misconceptions within communities and families? 

A: To address the spread of myths and misconceptions within communities  and families, the first and foremost point is to be consistent in imparting scientific education and debunk health misinformation to improve critical thinking skills within the family. Among other things, school-based health education programs are also vital, as  they can equip young people with critical thinking skills to question misinformation. 

Q: What advice would you give to young medical students who might face pressure  to endorse unproven treatments? 

A: Young medical students who endorse unproven treatments must prioritize  scientific reasoning over cultural, religious, or traditional beliefs in medical practice.  Upholding the principles of evidence-based medicine is essential for ensuring patient  safety and maintaining the integrity of the healthcare profession. Medical students should rely on peer-reviewed research, clinical  trials, and established medical guidelines when recommending treatments. It is also  vital to engage in continuous education and stay updated on the latest scientific  advancements or listen to credible sources who provide such information.

Q: What are some key steps individuals can take to be proactive about their health  and make informed decisions when seeking treatment? 

A: Individuals should prioritize science and health literacy by educating  themselves on the basics of evidence-based medicine and understanding how to  evaluate medical information critically. It is essential to seek information from  credible healthcare sources, such as peer-reviewed medical journals; reputable, unprejudiced, straight-talking health organizations, and certified healthcare  professionals, rather than relying on anecdotal evidence or unverified claims – to  simplify, talk to your doctor, the real one. Furthermore, identifying and rejecting  pseudoscientific practices is crucial which involves being sceptical of treatments that  lack scientific validation and avoiding those that promise quick fixes or miracle cures.  Shutting out health advice from social media influencers and “armchair scientists”  who moonlight as podcast doctors is also vital, as these sources often disseminate  misinformation.

Q: You have spoken out against pseudoscience, but some view it as cultural heritage.  How can we strike a balance between respecting traditions and promoting  evidence-based healthcare? 

A: While cultural heritage and traditions hold significant value in many  societies, healthcare must prioritize empirical evidence and scientific rigor to ensure safety and efficacy. Promoting evidence-based healthcare involves fearlessly  challenging and disrupting dogmatic views on healthcare from cultural, traditional, and religious practices, which lack scientific validation.

Q: Looking ahead, what are your hopes for the future of evidence-based healthcare  communication and public education in India? 

A: The future of evidence-based healthcare communication and public  education in India appears bleak, as majority of people here remain deeply entrenched  in cultural, traditional, religious, and political beliefs rather than placing trust in sound  science and rationalism – when it comes to informed healthcare choices.

Current efforts are insufficient to combat the pervasive and  expanding influence of pseudoscience and dogmatic views that dominate public  discourse and it is exhausting…