Context
A recent controversy on X (formerly Twitter) between a hepatologist and an Indian chess Grand Master over whether practitioners of traditional medicine can be called doctors has revived a long-standing debate. It concerns the role, legitimacy, and boundaries of traditional Indian systems of medicine such as Ayurveda, Siddha, and Unani, vis-à-vis modern scientific medicine in India.
Historical Background of the Debate
- The debate is decades old, dating back to the Bhore Committee (1946).
- Bhore Committee, 1946:
- Strongly favoured modern evidence-based medicine.
- Highlighted that other countries were phasing out traditional medicine systems.
- Recommended that states decide on the extent of role for traditional medicine in public health.
- Opposition from Traditional Practitioners: Argued for the preservation of Ayurveda and Unani.
- Committee on Indigenous Systems of Medicine, 1948: Recognized traditional systems, linking them to Hindu nationalist narratives.
- Indian Medicine Central Council Act, 1970:
- Enacted under Indira Gandhi government.
- Granted recognition to practitioners of Ayurveda, Siddha, and Unani.
- Replaced by the National Commission for Indian System of Medicine Act, 2020.
Confused Curriculum and Contradictory Concepts
- Mixed Syllabus: Combines doshas, prakriti, atma with basic modern science (cell physiology, anatomy).
- Conflicting Theories:
- Ayurveda → Illness due to imbalance of tridosha.
- Modern medicine → Illness explained through germ theory and evidence-based diagnosis.
- Integrative Medicine Debate: Considered illogical as both systems are based on entirely different epistemologies.
Points of Friction Between Modern and Traditional Practitioners
- Boundaries of Practice
- Recognition of AYUSH raises doubts on scope of practice vis-à-vis allopathy.
- Prescription Rights
- AYUSH practitioners demand rights to prescribe modern medicines like antibiotics.
- Rule 2(ee) of Drugs and Cosmetics Rules, 1945:
- Defines who can prescribe modern medicine.
- Delegates powers to state governments to recognize AYUSH doctors for prescribing.
- Many states used this to allow AYUSH practitioners to prescribe modern drugs.
- Judicial Intervention
- Mukhtiar Chand vs State of Punjab (1998): Court held that AYUSH practitioners cannot prescribe allopathic medicines.
- Despite this, state governments continue to issue orders, leading to frequent litigation by the Indian Medical Association.
- Litigation by Patients
- Patients sue AYUSH practitioners, claiming misrepresentation as MBBS doctors.
- Medical Procedures and Surgeries
- Debate on whether AYUSH practitioners can legally perform procedures like intubation.
- 2020 Notification: Permitted postgraduate Ayurvedic doctors to perform 58 minor surgeries (appendix, gall bladder, benign tumours).
- Constitutionality of this notification is pending in courts.
- Employment Practices
- Many hospitals employ BAMS graduates at lower salaries, replacing MBBS doctors → raises ethical and safety concerns.
Key Challenges
- Drug Use in Surgeries
- If AYUSH practitioners can perform surgeries, can they legally and safely use anaesthesia and antibiotics?
- Unscientific Arguments
- Claim that modern surgeries existed in ancient texts risks compromising public health standards.
- Political Factors
- Most political parties, for cultural reasons, support AYUSH, even at the cost of rational medical practice.
- Government Policies
- Considering inclusion of AYUSH treatments in Ayushman Bharat insurance.
- Huge Spending
- Around ₹20,000 crore spent on AYUSH research councils, despite limited scientific validation.
Conclusion
The blind promotion of traditional medicine without adequate evidence may endanger public health and patient safety. While India’s cultural heritage in Ayurveda, Unani, and Siddha should be preserved and researched, policy must ensure that:
- Evidence-based medicine remains the backbone of healthcare.
- Boundaries of practice are clearly defined to avoid legal and ethical conflicts.
- Patient safety, informed consent, and scientific integrity are prioritized in shaping the future of AYUSH in India.
Source : The Hindu
