Gasping for relief

HYDERABAD · June 2026

Each year, as the monsoon gathers over the Deccan, a peculiar ritual unfolds at the Numaish exhibition grounds in Hyderabad. Heads tilt back, mouths open wide, and a live murrel fingerling—its gullet packed with a secret yellow herbal paste—is slid down the throat. The patient gulps. The fish wriggles its way to the stomach. And, the faithful believe, asthma loosens its grip.

This June the spectacle drew a crowd that would shame many a public-health campaign. According to the Deccan Chronicle, more than 1.2 lakh people received the so-called fish prasadam on its second day alone, queuing across 38 lines under rain-proof canopies, monitored by the state fisheries department. The Bathini family, which has administered the remedy since 1845, asks recipients to return for three consecutive years and to follow a prescribed diet. There is no charge, no prescription and no shortage of takers.

Here lies the uncomfortable paradox. Hyderabad is, by common consent, among the best-served cities in India for medical care, dense with tertiary hospitals, pulmonologists and pharmacies stocked with every modern inhaler. Effective, inexpensive, evidence-based asthma treatment exists within a few kilometres of the Numaish grounds. Yet lakhs of citizens choose to swallow a live fish instead. That choice is not merely a quaint survival of folk medicine. It is a verdict on how badly modern medicine has failed to communicate, persuade and reach.

A heavy national burden

The scale of India’s asthma problem makes the misallocation tragic. Roughly 35m Indians live with asthma—the largest national caseload on earth. India is home to about 13% of the world’s asthma patients, yet it accounts for a staggering 42% of global asthma deaths, according to the Global Asthma Report. The disease burden, measured in disability-adjusted life years per case, runs roughly 2.4 times the global average.

The reason is not a lack of medicine but a failure to use it. Fewer than 30% of those with active wheeze have ever had asthma confirmed by a doctor. Among those who are diagnosed, daily use of inhaled corticosteroids—the cheap, front-line controller that prevents attacks—sits below 10%. The predictable consequence: more than a quarter of Indian asthmatics are hospitalised at least once a year, largely for want of treatment they could have taken at home for pennies a day. India, in short, has a control problem, not a cure problem.

Why the fish wins

To dismiss the Numaish queue as superstition is to miss the diagnosis. The fish prasadam has no controlled scientific evidence behind it; the Indian Medical Association has opposed it for years, and pulmonologists are blunt that there is no proof it works. But the remedy succeeds at everything modern asthma care fumbles. It is free. It is accessible, dispensed in a single, well-organised festival. It carries no stigma—quite the opposite, it is a communal act of faith. And it is wrapped in a clear, confident story of relief.

Contrast that with the inhaler. Though corticosteroid and combination inhalers are sold in every pharmacy, they cost far more than oral tablets, and most patients lack health insurance to soften the blow. Worse, the device itself is freighted with myth. Many Indians believe inhalers are addictive, a “last resort” for the gravely ill, or a mark of weakness to be hidden from neighbours and prospective in-laws. The prescription of an inhaler is, in much of the country, perceived as a stigma rather than as routine prevention. A large share of patients conceal the diagnosis altogether. When the choice is framed as a shameful, costly daily puff versus a free, festive swallow once a year, it is little wonder which option draws 1.2 lakh people.

The real prescription

The fish queue, then, is best read as market research. It reveals exactly where formal medicine has lost ground—on cost, on access and, above all, on trust—and therefore where the remedy lies. Three interventions follow directly.

First, and most important, is communication. The single greatest gap in Indian asthma care is not pharmacological but educational. Patients must be told, in plain language and local idiom, that asthma is a controllable chronic condition; that inhalers are preventive, not addictive; that delivering medicine directly to the lungs is safer than swallowing it; and that there is no shame in a device one carries for life, much as a diabetic carries insulin. Doctors who spend two minutes on a prescription and none on persuasion are ceding the field to a folk healer who offers certainty and ceremony.

Second is affordability and access. No amount of education will help a labourer who cannot spare a few hundred rupees a month. Closing the gap means subsidised or pooled procurement of essential inhalers, their inclusion in public insurance and primary-health dispensing, and distribution that reaches small towns and villages rather than stopping at the metros. This is the logic behind initiatives such as the Right to Inhalation movement, which holds that no patient should be denied inhalation therapy because of cost, distance or ignorance—that the inhaler should be as reliably available as the fish.

Third is introspection within the profession itself. When lakhs of one’s patients prefer a live fish to a proven treatment, the failing belongs at least partly to those who hold the prescription pad. Pulmonologists, drug-makers and public-health officials need to meet patients where their fears and their wallets actually are—through community outreach, demystified messaging and devices priced for the many, not the few.

None of this requires discrediting the Bathini family or banning a beloved tradition; campaigns that simply mock folk remedies tend to harden faith in them. The smarter response is to make modern care so cheap, so available and so clearly explained that the inhaler becomes the obvious companion to the fish, and eventually its replacement. Until then, every monsoon will deliver the same indictment: in a country with some of the world’s finest hospitals, lakhs of citizens will keep tilting back their heads and swallowing—not because medicine has failed to invent a cure, but because it has failed to deliver one.