Dr Subarna Royclarifies where traditional medicine does and does not belong in snakebite care
Dr Subarna Roy, Director of the ICMR–National Institute of Traditional Medicine (NITM), Belagavi, leads one of India’s few centres explicitly tasked with putting traditional snakebite remedies under modern scientific scrutiny. A career ICMR scientist with expertise in microbiology and pharmacovigilance, he has positioned NITM at the intersection of ethnopharmacology, toxinology and public health—probing folk formulations from the Western Ghats in vitro and in animal models while unequivocally affirming anti‑snake‑venom serum as the only proven life‑saving therapy for acute envenoming. His perspective is crucial to understanding how integrative medicine can be explored without compromising scientific rigour or patient safety.
In this exclusive interview with Naresh Nunna of Neo Science Hub, he clarifies where traditional medicine does and does not belong in snakebite care, explains NITM’s laboratory work on folk formulations from the Western Ghats, and defends a “reverse pharmacology” approach that complements—not competes with—recombinant and region‑specific antivenoms. He also highlights safety concerns around herb–venom–antivenom interactions and argues for strict evidentiary standards before any adjunctive use.
Snakebite envenoming is already recognised as a major public‑health challenge. Where, in your view, does traditional medicine realistically fit into its management today?
Snakebite envenoming remains a neglected public‑health emergency in India, particularly for rural communities, despite the availability of Anti‑Snake‑Venom serum (ASV). At present, traditional medicine has no role in the acute neutralisation of circulating venom toxins, and we unequivocally advocate ASV as the first‑line and only proven life‑saving therapy in that phase. Any delay in administering ASV can be fatal, and we do not propose any traditional intervention as a substitute in this setting.
However, a large proportion of rural India continues to turn first to traditional healers for reasons of geography, cost and culture. Ignoring this reality does not make it disappear; it merely pushes these practices further outside scientific scrutiny. Our work therefore aims to scientifically evaluate select traditional formulations—not to legitimise unregulated use, but to understand whether any have plausible adjunctive or supportive value, especially in contexts where delays in reaching formal care are unavoidable.
What exactly is ICMR–NITM Belagavi doing on traditional remedies for snakebite—and what is it not doing?
Our work in this area is relatively recent and deliberately limited in scope. We focus on traditional formulations drawn from non‑codified folk practices of the Western Ghats and literature reports, which are distinct from the codified AYUSH systems. These are being evaluated only in laboratory and small‑animal models, using computational docking, in vitro enzyme and toxin inhibition assays, and controlled mouse studies.
Some plant extracts have shown limited but encouraging inhibitory activity against key venom enzymes and toxins from major vipers and elapids, suggesting a potential to modestly extend the “golden hour” or reduce early systemic damage. But at this stage, these are hypothesis‑generating signals, not clinical endorsements. We are not using these formulations in patients, nor recommending them for the acute management of envenoming.
The next planned step is to test standardised combinations in large‑animal models, with the narrow objective of seeing whether an orally administered adjunct could extend survival time or reduce morbidity until ASV is given. Even if those data are promising, they would still need to pass through rigorous toxicology, pharmacokinetic and efficacy evaluations before any human use could be contemplated.
How do you respond to concerns that validating traditional remedies might distract from, or delay, advanced biotechnological solutions like recombinant or region‑specific antivenoms?
We see this as a false dichotomy. Ethnopharmacology‑driven “reverse pharmacology” and molecular toxinology answer different but complementary questions. Precision‑engineered antivenoms—recombinant, monoclonal, or region‑specific—aim for definitive neutralisation of venom components and must remain the central biomedical solution. Our ethnopharmacological work asks a different question: are there traditional practices which, once rigorously tested, could play a supportive or adjunctive role in real‑world settings where patients still present late or rely initially on folk healers?
ICMR–NITM does not advocate bypassing proven biotech tools. Any traditional intervention we study is evaluated explicitly against existing biomedical evidence, not in competition with it. In fact, global experience shows that, even after decades of effort, there is no universally accepted alternative to antivenom; small‑molecule inhibitors like marimastat and varespladib are themselves being explored only as adjuncts. The message is clear: snakebite is too complex to be solved by any single approach—traditional or modern—in isolation.
What are the main safety, regulatory and policy issues you believe must be addressed before any traditional formulation is even considered as an adjunct in snakebite care?
One of the most under‑discussed risks is herb–venom and herb–antivenom interaction. Snakebite is unlike chronic disease: highly bioactive toxins are circulating rapidly, and adding plant metabolites may produce unpredictable synergistic or antagonistic effects. Our ongoing work prioritises identifying potential toxicities, studying co‑administration with ASV, and strengthening pharmacovigilance and surveillance systems. Scientifically, there is a strong case to insist on formal pharmacokinetic and safety studies before any traditional formulation is considered even for adjunctive use alongside antivenom.
On the policy side, frameworks like the National Action Plan for Snakebite Envenoming (NAPSE) rightly prioritise evidence‑based biomedical interventions, but they must also be informed by social realities—including persistent reliance on traditional healers. Our approach has been to keep traditional‑medicine research clearly separate from clinical recommendations, using scientific evaluation as a tool to validate, refine or decisively rule out specific claims.
Looking ahead, the responsible path lies in integrative research without shortcuts: traditional knowledge must meet the same evidentiary standards as any modern therapeutic claim, with patient safety and public health as non‑negotiable guiding principles. Antivenom will remain the cornerstone of treatment until robust, reproducible and clinically validated alternatives—or adjuncts—are proven; anything less would be unethical.
