When a government minister places a tiny, gilded drop of swarna bhasma - a paste of purified gold, ghee, honey, and herbs - on an infant's tongue, the act is more than ceremonial.

It is a gesture that seeks to merge Nepal's ancestral medical traditions with the authority of the modern state. Yet this golden tonic, now distributed nationally through the Swarna Bindu Prashan campaign, exposes a tension at the heart of public health: honoring culture while ensuring interventions for the most vulnerable meet rigorous standards of safety and evidence.

This tension highlights a fundamental problem - cultural legitimacy cannot replace clinical proof when offering treatments at scale to healthy children.

Health ministry officials hail the tonic as an ancient Ayurvedic immunity booster, even likening it to vaccination. Dr. Shyambabu Yadav, Director-General of the Department of Ayurveda, cites classical texts and claims modern studies confirm the immunomodulatory and neuroprotective properties of gold and herbs.

Proponents maintain that swarna prashan - a classical Ayurvedic tonic believed to bolster strength and intellect - is part of Nepal's living medical heritage and a gesture of state attention toward children often overlooked by fragile health systems. That sentiment is powerful. Especially in communities where access to clinics, nutritious food and reliable vaccines remains uneven, a familiar ritual endorsed by health authorities can feel like inclusion.

Pediatricians, however, caution that the campaign remains unproven. The Nepal Pediatrics Society calls for a halt, citing a 2019 Indian trial of 102 infants -which found no immunity or growth advantage over a placebo of ghee and honey- and notes that other small pediatric reviews remain low-quality and inconclusive.

This uncertainty is reflected by the extremely thin and methodically weak clinical literature on gold-based pediatric tonics. Small trials, short follow-ups and outcomes limited to laboratory markers or caregiver reports that do not demonstrate reductions in hospitalizations, infections or long-term neurodevelopmental harms. In the absence of strong evidence, the default obligation of public health authorities should be exercising prudence. Policy scaled to the population level - especially interventions directed at infants and young children - must answer the most practical questions: Is this safe? Does it help? Is it consistently produced to the standards we enforce for other medicines?

Safety concerns are not abstract. Analyses of some traditional and rasa-śāstra preparations sold internationally have detected lead, arsenic and mercury - contaminants with well-documented, irreversible harms to the developing brain. Even when metals are the intended ingredient, their processing, particle size and purity determine biological fate. Traditional purification techniques are not equivalent to batch-specific chemical assays. And then there is honey: a component of many such tonics that carries a recognized risk of infant botulism and is contraindicated for babies under one year. Combining a nonessential metal compound with a food that is unsafe for infants multiplies ethical dilemmas.

Regulatory frameworks further complicate the matter. In Nepal, Ayurvedic products are often registered on the basis of classical texts and traditional use rather than randomized controlled trials. Globally, public-health bodies urge integration of traditional medicine in ways that are evidence-informed and people-centered - not exceptional. When a state decides to mainstream a traditional product, it bears responsibility for proving batch safety, publishing testing data, and commissioning independent clinical studies before a program becomes a routine part of child health services.

Beyond technicalities, the political appeal of symbolic acts is real: a golden drop is photographable, memorable and legible to voters. But symbolic policy becomes perilous when its symbolism substitutes for the slow, costly work of scientific validation.

UNICEF still reports preventable diarrhea killing children in Nepal. Procedures at hospitals like Narayani hospital sometimes still proceed under emergency lights. Traditional healers still mutilate patients -poison them, whip them, brand them with hot iron- and sometimes kill them. In a country with limited funds, public-health investments should be directed towards priorities with proven impacts. After all, culture cannot be preserved at the cost of lives-least of all those of children; their innocence demands protection from the state, not ritualised risk.

Regmi is a student, advocating for evidence-based health policy and pursuing higher studies in biomedicine.