Indian liver doctor Dr Cyriac Abby Philips’ Twitter account was once mainly populated with photos of his family and favourite food, and used to catch up on the news. It took a viral thread on the diet supplement company Herbalife for the Kerala doctor to realise that social media was an important platform in his effort to raise awareness about the harmful impact of poorly regulated traditional medicine and popular nutritional supplements that cause liver damage. In August 2018, Philips published a peer-reviewed, co-authored paper on the first Asia-Pacific case study of a woman who died after taking dietary supplements by Herbalife, a US$1.65 billion California-based corporation which responded with such a fierce legal threat that The Journal of Clinical and Experimental Hepatology removed the paper from it website. Two years later, after a gastroenterologist tweeted about the potential harm caused by workout supplements, Philips replied to the post cautioning people about the influence of the pill industry. His thread in December 2020, highlighting his experience being shut down by Herbalife, caused an immediate storm in the medical community and elsewhere, with his follower count for @TheLiverDr shooting up virtually overnight from about 400 to more than 5,000. 1/ Dr.Thakur, this is a huge issue. Big industry. Powerful lobby. They crush critique wit money power. I hav experienced it first hand. Here is my story. Last year March, I published this article based on my experience wit a patient who died after consuming herbalife products https://t.co/UBZRjWxIKE pic.twitter.com/VcMgAjejEs — TheLiverDoc (@theliverdr) December 20, 2020 “My little, but depressing, story on how money took down science became important news which travelled from my Twitter handle to across the world in just a few days,” Philips said via email. “This is when I understood how Twitter was an important tool to make unseen things seen.” His revelation drove Dutch microbiologist Elisabeth Bik to publish the Herbalife paper on her blog. Two days later the website Retractionwatch, a scientific research watchdog with funding from the US-based Macarthur Foundation that supports non-profit organisations, also highlighted the incident with a link to the paper. The study that vanished from the internet due to pressure from Herbalife was suddenly back online. Traditional medicine push Around 2016, Philips saw almost three dozen patients at his liver clinic over six months who reported hepatitis or liver injuries from no apparent known cause. On investigation, he found that they were caused by the consumption of traditional medicines, typically ayurvedic. More than half his patients with chronic liver disease, or cirrhosis, had injuries caused by traditional drugs. But no one seemed to be talking about it. These were often impossible to diagnose because the patterns of damage were almost entirely unknown. There is no official data for liver damage caused by traditional medicine in India, a fact that motivated Philips to study the area seriously. Ayurveda, which originated in India , is a system of traditional medicine that takes a natural and holistic approach to physical and mental health. Companies have taken advantage of its increasing popularity in recent decades to push out wellness programmes and health supplements vaguely linked to the ancient tradition. Indian cough syrup linked to deaths of 20 children was circulating for months Philips says he is “completely against” that trend in the wellness industry, because the principles and practice of ayurveda are based on “essentially primitive, untested, observations from an ancient past which lack scientific rigour”. While ayurveda, homeopathy, and other local forms of traditional medicine have been practised in India for centuries, they got a boost with the 2014 election of Prime Minister Narendra Modi and his Hindu-nationalist Bharatiya Janata Party. The new government elevated the department of Ayush – an acronym for ayurveda, yoga and naturopathy, unani, siddha and homeopathy – to a central government ministry. While traditional medicine became heavily promoted, the level of safety assessments remained the same. Packaged ayurveda and homeopathic drugs go through a testing process in India, but this is less rigorous than the global framework of clinical trials laid out for the pharmaceutical industry. The central government’s confidence in traditional medicine grew to such an extent that in February 2021, when the Covid-19 vaccine was only available to senior citizens and healthcare workers, then-national health minister Dr Harsh Vardhan attended the launch of a drug called Coronil, manufactured and marketed as a “Covid-19 cure” by the Indian company Patanjali. The firm, co-founded by yoga guru Baba Ramdev, claimed it had a certificate that was equivalent to the World Health Organization’s approval legitimising the drug. But the UN health body said it had not approved any traditional medicine formulation as a cure for Covid-19. Using @TheLiverDr, Philips aims to debunk unverified claims about Ayush, detailing cases of liver injuries in the format of a detective story to garner interest on Twitter and YouTube, on top of his work publishing his findings in medical journals. I publish in medical journals ... and then I use Twitter to take my research to a wider audience Dr Cyriac Abby Philips, @TheLiverDr “Many people think I am a social media star. But I do both. I publish in medical journals – I try for high-impact journals – and then I use Twitter to take my research to a wider audience,” Philips said. “Traditionally, doctors only take the route of journals and conferences. But I believe in both credibility and reach.” He said Indian officials should be wary of promoting traditional medicine. “Instead of promoting belief-based, untested herbal supplements, the Ayush ministry must first remember the dictum ‘Do no harm’,” he said. “They should start regulating potentially harmful practices and put in place a rigorous pharmacovigilance system.” Defamation suits While Philips’ Twitter threads have attracted thousands of followers and garnered him interviews on YouTube channels, he has also faced trolling for being anti-Hindu and complaints from organisations accusing him of defamation, including The Ayurveda Medical Association of India, ayurvedic medicine manufacturers, departments of the Kerala state government, and Herbalife. One company called Pankajakasthuri Herbals Pvt Ltd lodged a police report against him for criminal defamation, prompting local officers to show up at Philips’ hospital clinic to question him. Nothing came of the complaint, leading him to believe it was an act of intimidation. The ministry of Ayush did not respond to queries on the status of its complaints against Philips. he is prepared, however, should any of these cases make it to trial. A “science-minded” lawyer has agreed to help him pro bono, while former practitioners of homeopathy and ayurveda have joined his research team to help document the effects of traditional medicine. Bowel cleanse for better DNA: the nonsense science of Modi’s India “I actually get some referrals from ayurveda practitioners now,” Philips said. “I think they understand that I speak against the lack of scientific rigour in the system, I don’t mean all practitioners are ill-intentioned.” Indian medical experts have praised Philips’ work highlighting the harmful effects of ayurveda and homeopathy, but also pointed out his failure to recognise the limitations of the country’s health system, such as the lack of resources that have pushed people to seek alternative, often cheaper, forms of treatment. “Unless Western science-based medicine becomes more humble and introspects on how to become more accessible to the wider community, these alternate systems will continue to exist, and that is not necessarily a bad thing,” said public health doctor and researcher Dr Sylvia Karpagam.