Respectful Insolence

“Ayurgenomics”: The return of woo-omics

Every so often, I come across something in the world of woo that leaves my jaw dangling from its joint in utter astonishment that anyone could think such a thing was a good idea. Sometimes these things are investigations into various paranormal phenomena. Sometimes, it’s the latest anti-science denialist screed from a creationist. Other times, it’s a contortion of science so egregious that I can’t believe anyone would actually do it–or that anyone would actually mistake that woo for good science.

This time around, it’s genomics that’s being abused.

This is a topic that, although I don’t write about it very often, irritates the crap out of me, and that’s the abuse of new genomics technologies. I first started noticing it when Dean Ornish reported the results of a rather poorly designed cDNA microarray experiment as evidence that his dietary manipulation changed expression levels of genes related to carcinogenesis. Around the same time, I noticed that the National Center for Complementary and Alternative Medicine (NCCAM) was soliciting applications for applying genomics and other “omics” technologies to existing clinical samples from previous clinical trials of “complementary and alternative medicine” (CAM) therapies. I was so impressed by this Request for Applications (RFA) that I referred to it as “woo-omics.” After that, there wasn’t much about woo-omics; so I didn’t write about it, although I did write a fair amount about the application of genomics technologies to science-based medicine and putting the results of the Human Genome Project and Cancer Genome Atlas into perspective. I found all of this very interesting, but it had nothing to do with alternative medicine or CAM. And it was good.

At least, it was good until this weekend, when I came across a misapplication that led the term “woo-omics” to come back into my brain.

I don’t remember how this came to my attention, but it did. It’s an article that appeared in ACS Chemical Biology entitled Ayurgenomics: A New Way of Threading Molecular Variability for Stratified Medicine. I kid you not. It’s courtesy of Mitali Mukerji at the Institute of Genomics & Integrative Biology (IGIB) in New Delhi, India. Her webpage on the IGIB website even lists her interests as the pplication of polymorphisms in mapping mutations and disease origins in SCAs; Ayur-genomics: exploring the principles of predictive medicine in Ayurveda; and Alu elements in genome organization and function. It all sounds so science-y, and–who knows?–interest numbers one and three sound reasonable enough. But interest number two? Not so much. In fact, it sounds about as far from science as you can get. Think of it this way: It sounds like science; it acts like science; it tries to use the language of science; but it’s not science. Get a load of the rationale for the article. After discussing the difficulties in genome-wide association studies in “pinning down human physiology to a few loci,” Mukerji writes:

We found this challenge very stimulating, and our understanding of population-wide variability across Indian populations (IGV Consortium)(6) provided a major thrust to further our quest for understanding the variability in healthy individuals. The head start came from the fact that there exists an exquisitely elaborate system of predictive and personalized medicine in India, i.e., Ayurveda, which has been practiced for over 3500 years. The system already has a built-in framework for stratifying healthy individuals who differ in susceptibility to disease and response to drug and environment. In contrast to the empirical approach of contemporary medicine, the Ayurveda therapeutic regimen is tailored to an individual’s physiology. Though this system has fueled many drug discovery approaches and some attempts into its integration in pharmacogenetics have been made,(7, 8) a systematic analysis of underlying principles has been lacking. In order to undertake integration of this most ancient system of medicine, which is scripted in Sanskrit, with the language of modern genomics and medicine, we undertook this endeavor with a trans-disciplinary team of researchers. For the first time we could demonstrate molecular evidence for these concepts and build a framework for “Ayurgenomics”, which can provide impetus to personalized medicine.(9, 10) We provide a perspective of the concepts and also the further prospects in this field (Figure 1). The original Sanskrit verses with their meanings are available as supplementary online material in our prior publications.

Now, it was news to me that Ayurveda had “fueled many drug discovery approaches”; so I looked up the two articles referenced. Like Mukerji’s article, these references looked at the three major constitutions postulated in Ayurveda under the Prakriti classification. One article was in a woo journal of highly dubious value and postulated a “reasonable” correlation between Prakriti classification and certain Prakriti types, while the other article was a commentary suggesting using Prakriti and asserts that the “concept of Prakriti or human constitution plays a central role in understanding health and disease in Ayurveda, which is similar to modern pharmacogenomics.” Basically, the whole article argues that, because a few useful compounds from Ayurveda, that Ayurveda could be useful as a basis for drug discovery and the development of “personalized medicine.”

Not knowing what the heck Prakriti is, I decided to look it up. Thanks to Wikipedia and other sources, I now know that in Hinduism Prakriti is the “basic nature of intelligence by which the universe exists and functions” and the “primal motive force.” In Ayurveda, it’s used to refer to a body type in Ayurveda. Here is a test to determine one’s Prakriti. Based on the results, one is classified according to three Doshas: Vata, Pitta and Kapha. These three Doshas can be combined into ten ways to produce ten body types. Now, certainly some of these characteristics likely have something to do with health (“overweight, difficult to lose weight,” for instance, or “fair skin, sun burns easily,” the latter of which could indicate susceptibility to skin cancer). However, just because body types based on a system of classification that is more or less based on an Indian form of vitalism (“primal motive force” or “basic nature of instelligence”) might coincidentally have something to do with discoveries found later does not mean that the basis of the system upon which these body types are based has any external scientific validity. One might as well perform omics analyses on people to predict responses to homeopathy. Yet somehow Mukerji thinks that somehow using integrating knowledge of these Doshas into genomics will lead to better control groups and the discovery of biomarkers of disease whose utility will be accentuated by using them in concert with information about Doshas:

An individual’s basic constitution, Prakriti, is described to be a consequence of the relative proportion of Vata, Pitta, and Kapha. These proportions of Tridoshas are not only genetically determined (Shukra Shonita) but also influenced by the environment during development, especially maternal diet and lifestyle. Prakriti is fixed at the time of birth and remains invariant throughout the individual’s lifespan. Ethnicity (Jatiprasakta), familial characteristics (Kulanupatini), and geo-climatic regions (Deshanupatini) are also implicated in influencing phenotypic variability through their effect on Tridoshas and Prakriti. Thus, most of the factors such as ethnicity, geography, and environment that contribute to interindividual variability at the genetic or epigenetic levels are embedded in Ayurveda’s concept of Prakriti. In an individual, the Tridoshas work in conjunction and maintain homeostasis throughout the lifetime of the individual.

Why it is necessary to use a religion-based system in order to ascertain information about a patient’s body habitus, familial characteristics, ethnicity, and other traits relevant to disease, I don’t know, but apparently Mukerji thinks that we do. None of this prevents Mukerji from proposing this system for “weaving the threads of molecular variability through Ayurgenomics”:

This is proposed even though Mukerji basically points out that Prakriti is basically very much like the four humors in “Western” medicine and the five elements in traditional Chinese medicine:

Ayurvedic practitioners deconvolute the “mixture impression” thus obtained to identify proportions of Vata, Pitta, and Kapha in an individual’s Prakriti. This “subjective” assessment (which was objectivized to a scoring system through a questionnaire) considers different phenotypic attributes of an individual and links these multiple windows to create intraindividual phenotype-to-phenotype links. A disease according to Ayurveda is a perturbation of Vata, Pitta, and Kapha in an individual from his or her homeostatic state. Ayurvedic treatment aims to bring it back to its native state by appropriate dietary and therapeutic regime.

“Bring it back to its native state”? That sounds a lot to me like “bringing the humors back into balance” or, if you’re an aficionado of traditional Chinese medicine, bringing the five elements back into balance. I do like the science-y sounding referencs to “different phenotypic attributes” and somehow creating “intraindividual phenotype-to-phenotype links.” It’s the sort of meaningless gobbledygook that impresses those who don’t know anything about the subject but leads those who do to collapse in fits of hysterical giggling.

Mukerji continues:

Ayurveda describes not only the functional attributes of Vata, Pitta, and Kapha but also their contribution on different scales in seven different constitutions. Therefore, Ayurveda already has a stratified approach as its basic tenet for personalizing therapy. Thus we felt that integration of this stratified approach could complement approaches to development of personalized medicine while gaining insights into systems biology. We realized that before making any attempt toward this endeavor we would have to address an ontological challenge in connecting together the literature from Ayurveda, modern medicine, and molecular biology.

Again, why combining Ayurvedic literature with modern medicine and molecular biology would be a good thing is not explained. To me, that would be a lot like taking the writings of Hippocrates and combining them with the latest cutting edge molecular and systems biology techniques. It would be highly unlikely to be informative or helpful. One might as well take the Edwin Smith papyrus, which described ancient Egyptian medicine, and combine it with the latest omics techniques. The priest-physicians of ancient Egypt would probably have as much or more to say to modern scientists than the writers of the ancient texts of Ayurveda. One wonders why somewhere, somehow, someone doesn’t try to resurrect ancient Egyptian medicine.

Not surprisingly, Mukerji cites a lot of her own work in this review article, including an article from 2008 entitled Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurveda, which Steve Salzberg, a systems biologist and skeptic, looked at in 2008. He was not impressed, and neither was I when I read the paper. Basically, Mukerji and her co-investigators partitioned subjects into the three Doshas based on Ayurvedic principles, but in reality the vast majority of the classification is simply based on body type and body habitus. That’s why, when the authors found that genes associated with an elevated risk of cardiovascular disease are more highly expressed in Kapha males, it’s not particularly surprising, given that Deepak Chopra and others characterizes Kapha as prone to obesity. In other words, so what if Mukerji found differences in gene expression based on Ayurvedic body types. They’re different body types, and we already know that people with different body habitus can be prone to different kinds of diseases. Ayurveda adds nothing new to this knowledge, much less suggests a rationale upon which to base a new “omics” discipline. Taking studies like this and proposing something as ridiculous as “Ayurgenomics” does nothing more than show how far believers in pseudoscience will go to try to conjure up a seemingly scientific justification for their woo. Remember, Doshas resemble, more than anything else, the Indian version of the Four Humors. Do we try to fit humoral theory into a new “omics” discipline? No, we don’t, although I fear that some day someone might try.

Unfortunately, as Steve Salzberg points out, NCCAM is funding grants like R21AT001969, which funds the “Ayurvedic Center for Collaborative Research.” A quick search for NCCAM grants funding Ayurveda on NIH Reporter reveals several grants in Ayurvedic medicine funded by NCCAM, including Ayurvedic alternatives in autoimmunity and A whole systems approach to the study of Ayurveda for cancer survivorship. One wonders how long it will be before NCCAM starts funding “Ayurgenomics” projects.

I fear it won’t be long.

More importantly, I want to know how crap like this finds its way into decent journals like ACS Chemical Biology and PNAS (which one of Mukerji’s articles also found its way into). If you want to point to a failure of peer review, there’s the place to start.

Comments

  1. #1 xyz
    November 21, 2011

    It does seem like a lot of extra motion in between biological inputs and results. However, if the final result correlates -omic results with ayurvedic herbal extracts and therapeutic diet, progress would be involved.

  2. #2 Chrisj
    November 21, 2011

    this is a model of reason and sanity compared to some gene – themed woo. i was recently introduced to “12 strand DNA activation”. i still have a band aid on my chin.

  3. #3 jrkrideau
    November 21, 2011

    I am proud ? to announce that I am a PITTA-VATA Prakriti!

    I am sure this has at least as much meaning as my four letter code from the Myers-Briggs Type Indicator.

    One wonders why somewhere, somehow, someone doesn’t try to resurrect ancient Egyptian medicine.

    I was wondering about a second career: This may be it especially if I can get a tax deduction on the air fare and hotel bills for trips to Luxor, especially in the winter time.

  4. #4 Mary
    November 21, 2011

    Sigh. Bookmarked into my ever-expanding “genome woo” files. I’m becoming quite the connoisseur of this now, paired with a side of genomic conspiracies.

  5. #5 Denice Walter
    November 21, 2011

    Oh boy! I hope that she doesn’t ever meet up with Bruce Lipton because their collaboration might fore-shadow the end of intelligent life on this planet.

    I predict that she will promote a diet book/ website based on the differing needs of people dependent on their dosha: ( -btw- don’t confuse “dosha” with “dosa”- a tasty lentil pancake) maybe advocating vegetarian for one, higher protein for another, like those blood-type diets ( Adamo). I can easily imagine this translated into Indian menu-ese- and am laughing considering the possibilities!

    Note to the uninitiated: no matter how middle-of-the-road-traditional-white-person you might be- don’t be afraid of trying Indian food. It isn’t all “too hot” or based on spices you don’t like. Everyone likes naan bread, basmati rice, and Tandoori chicken. Trust me.

  6. #6 anarchic teapot
    November 21, 2011

    Just for a laugh, I took their Prakriti. The questions are weird, including one about faith. Then they told me I was naturally stocky (wrong) and a devoted follower, presumably of some guru (in the largest sense of the term).

    The cardamom-faloured dessert they suggested sounded tasty tough.

    More to the point, isn’t Ayurveda the system that’s just been skewered for using heavy metals and other toxics ingredients in its “remedies”?

  7. #7 ArtK
    November 21, 2011

    That “test” to determine one’s Prakriti was amusing. Lots of possibilities for features were left out — there’s a distinct bias towards features found in India.

    Some interesting aesthetic biases in there as well. For instance, under “eyes” we have the choice between:
    * Small, black, sunken, dry, active
    * Yellow, bright, grey, green
    * Big, beautiful, blue, calm, loving

    (I’m not sure where “yellow” comes in for eye color. If your eyes are turning yellow, see your doctor and have your liver function checked — right now!)

  8. #8 Bronze Dog
    November 21, 2011

    One wonders why somewhere, somehow, someone doesn’t try to resurrect ancient Egyptian medicine.

    Looking back, I’m only surprised it’s not one of the most popular quackeries out there. I think back to all the sci-fi and fantasy media (and so-called “documentaries”) that revolve around the idea that ancient Egypt had access to powerful magic, alien technology, or whatever. You would expect some people to believe they had super-duper medicine.

    I have no reason to doubt that someone probably has attempted a revival. If no one has, just give it time.

  9. #9 lilady
    November 21, 2011

    @ anarchic teapot:

    “More to the point, isn’t Ayurveda the system that’s just been skewered for using heavy metals and other toxics ingredients in its “remedies”?

    I’m sure you could locate more recent reports about heavy metals contamination found in Ayurvedic “medicines”:

    Concerns About Heavy Metals

    The presence of metals in some Ayurvedic products makes them potentially harmful. A study published in the August 27, 2008, issue of the Journal of the American Medical Association (JAMA), demonstrated that one-fifth of U.S.-manufactured and Indian-manufactured Ayurvedic products bought on the Internet contained detectable lead, mercury, or arsenic.

    Researchers found 25 Web sites selling Ayurvedic products. After identifying 673 products, they randomly selected 230 for purchase. Of those, they received and analyzed 193 products. Nearly 21 percent were found to contain detectable levels of lead, mercury, or arsenic.

    All metal-containing products exceeded one or more standards for acceptable daily metal intake. The researchers concluded that several Indian-manufactured products could result in lead and/or mercury ingestions 100 to 100,000 times greater than acceptable limits.

    This study followed a previous study published in JAMA on December 15, 2004, which found that one out of five Ayurvedic “herbal medicine products” produced in South Asia and available in South Asian grocery stores in Boston contained potentially harmful levels of lead, mercury, and/or arsenic.

    (FDA-”Use Caution With Ayurvedic Products” October 16, 2008)

  10. #10 LovleAnjel
    November 21, 2011

    Well, the survey suggested I would excel in academia, and told me to get more water & sleep every day. My last issue of Glamour told me the exact same thing.

  11. #11 Militant Agnostic
    November 21, 2011

    Bronze Dog @7

    Orac has done a couple of posts on Ancient Egyptian Medicine as topic of historical interest rather than as woo. Perhaps he was setting the stage for a defection to the dark side?

    After all, his grant applications could be rejected and a backup plan would be a good idea :)

  12. #12 Roadstergal
    November 21, 2011

    In contrast to the empirical approach of contemporary medicine,

    That sentence ends in a complete non sequitur, so my mind automatically finished it with “it’s completely fucking made up.”

    The opposite of ‘empirical’ isn’t ‘holistic,’ it’s ‘disconnected from reality.’

  13. #13 adelady
    November 21, 2011

    roadstergal “The opposite of ‘empirical’ isn’t ‘holistic,’ it’s ‘disconnected from reality.’”

    Well, it’s the triumph of over-thinking really. Until very recently, and still for much of the world’s population, the only available medicine has been herbal … with benefits.

    So chewing willowbark relieves pain. But not enough, not for everyone and not for every pain. So we thinking apes have to ‘explain’ this. Do we just think it simply depends on the type and location of the tree, the type and location of the pain, the preexisting health of the person? NosirreeBob, not a bit of it.

    It’s the phase of the moon, it’s a curse from the nasty old lady down the road, it’s the devil, it’s the failure of the sufferer, it’s those awful people from the other side of the hill/ valley/ whatever, it’s some other mysterious sounding guff we just made up.

    And we keep on adding details, but still making it up. Until we finish up with an “exquisitely elaborate system of predictive and personalized medicine”. Sometimes described as counting the angels fitting on the head of a pin.

    I understand the urge to try to explain stuff. The big problem is not accepting a better explanation when it comes along.

  14. #14 The Very Reverend Battleaxe of Knowledge
    November 21, 2011

    Nobody’s going to revive Ancient Egyptian medicine because it’s just too reasonable—if you go by the Edwin Smith papyrus and our few other sources. It was way ahead of traditional Chinese medicine or Ayurveda, which came along much later. (If Mukerji thinks Ayurveda is 3500 years old, she’s out of her mind. But anyway, the Edwin Smith papyrus is a copy of an Old Kingdom original—maybe 4500 years old.)

    Actually, it would probably be the late 19th century before you’d be any better off, results-wise, putting yourself in the hands of a European or American doctor vs. whoever wrote Edwin Smith.

  15. #15 DLC
    November 22, 2011

    What next, a national science foundation grant for studying alchemy ? Can I get my Lead-into-gold paper published in a peer reviewed chemistry journal ?

  16. #16 LW
    November 22, 2011

    I took the survey and had the same observation as ArtK, namely that sometimes none of the choices fit. But the result is that I have a VATA-KAPHA Prakriti and I should “avoid hard work”. I’ll have to bring that up to my manager at the next performance review.

  17. #17 WaffleMaster
    November 22, 2011

    “One wonders why somewhere, somehow, someone doesn’t try to resurrect ancient Egyptian medicine.” I would say it’s because we are not ignorant enough to base our decisions and modern healthcare practices on magic and outdated methods of managing injuries and disease……oh right, never mind.

  18. #18 T-reg
    November 23, 2011

    Ah! One of my pet peeves: Ayurveda…
    First a little bit of context:
    The whole obsession with resurrection of Ayurveda is in part an attempt to reject the “western” medicine and take “pride” in the Indian tradition. Indians (Hindus in particular) look up to Sanskrit and ancient Indian culture in the same way as Europeans looked up to Latin and Greek and the corresponding ancient cultures, during the Renaissance.

    While there are a lot of contributions by Indian culture which we are definitely proud of (especially when we put it in the context of the period in history when those accomplishments were made) resurrecting Ayurveda in this day and age is just plain stupid.

    The weirdest part is that many of the Ayur-Pharma giants are actually conducting research into how the Ayurvedic preparations work by apparently taking a science based approach. I recently came across a drug called “Rumalaya Forte”, marketed by “Himalaya”. The pamphlet inside the packaging reads:

    Rumalaya forte tablet has potent anti-inflammatory and analgesic activities by inhibiting leukotriene(LT) biosynthesis, inhibiting prostaglandin E, and COX-2 activity and preventing TNF-α-induced expression and activity of MMP-3, MMP-10 and MMP-12. It protects against lipid peroxidation by its high reactivity towards 2,2-Diphenyl-1-Picrylhydrazyl, superoxide and hydroxyl radicals and supports with anti-oxidant activities.

    Now, considering that plants often contain pharmaco-active compounds, it is possible that this effect maybe seen.

    My point is that if they are taking a science based approach to understand how a herbal mixture works (totally rejecting the ideas found in Ayurveda), why do they still insist on calling themselves Ayurvedic? Instead of focusing on herb mixtures, it makes more sense to isolate the active compounds to study and administer them. I’m sure a lot of new drug molecules could be discovered or engineered from the compounds found in these herbs. So, Why not go the whole hog and embrace SBM completely instead of maintaining this ridiculous charade??

  19. #19 rw23
    November 24, 2011

    One wonders why somewhere, somehow, someone doesn’t try to resurrect ancient Egyptian medicine.

    Noooo, please don’t go giving them any more ideas!

    When I was 12 or 13 I read that pyramids (even little ones made out of cardboard) had the amazing properties of both sharpening razor blades and of keeping food fresh.

    I would like to take this opportunity to publicly thank my mum and dad for contributing to the experiments in which I learnt that I wouldn’t yet need to shave for another two years and that bacon really does stink when left in a conservatory over a summer weekend.

  20. #20 labki
    November 30, 2011

    The comments by Orac is simply overdone. The argument that Mitali Mukherjee was overt in mixing up the terms of genomics with Ayurveda may be correct. But the comments on Ayurveda are factually wrong. The medical system called Ayurveda has documented historical evolution and a present status where millions of patients are making use of the system for ailments that conventional medicine has nothing to offer. The physicians of Ayurveda in India are institutionally qualified, having a basic medical degree of 5 1/2 years stint. There are masters and doctorals, making specialist consultants in different branches of Medicine.
    I believe the comments of Orac is based on dogma, prejudice and some experirnces with ‘much publicised Ayurvedists’ in the United States.
    Well, science can have its own turs, which is unpredictable. Let’s not rush with over-estimates of anything that is new. Let there be no contempt for what is simply OLD!!
    labki, Thrissur, Kerala, India

  21. #21 Beamup
    November 30, 2011

    One observes that labki presents no evidence that Ayurveda actually works, just a run-of-the-mill ad populum with a dose of the appeal to authority.