Towards integrating traditional and western medicine

Traditional and indigenous systems of medicine have long played second fiddle to western medicine in India, perhaps a legacy of our colonial past. Traditional medicine was viewed favourably by the colonial Indian government initially, but gradually this support decreased and was withdrawn altogether in 1835.  A number of medical regulations between 1912 and 1917 made it illegal for a registered medical practitioner to be associated with 'Indian medicine'! The Bhore Health Committee of 1946 topped it all by keeping traditional medical practitioners out of the organised public health system, as they felt these systems were static compared to western medicine. Energised by the Indian nationalist movement during this period, the revivalists of traditional systems struggled to bring their systems on par with western medicine by professionalising themselves in similar ways -- setting up their own colleges, councils and associations.

The Indian government's inclusionary policies have, over the years, helped create a unique but separate identity for traditional systems called AYUSH (Ayurveda, Unani, Siddha, Homeopathy), and never a common platform for formally integrating the traditional with the western, such as in China where integration of Chinese and western medicine has created a new system that is commonly taught in medical schools and practiced in many hospitals. There even exists a Chinese Journal of Integrative Medicine published by Springer and indexed in SCOPUS, EMBASE and other international databases. Glancing through the research articles one can see the influence of western empirical research on the growth and refinement of Chinese medicine and reverse benefits for innovating treatments in western medicine.

In a world where the benefits of western medicine are slowly being eroded due to its overuse and the apocalyptic rise of multi-drug resistance, I see the National Medical Commission's proposal to set up a joint sitting between the different Councils as a path for syncretic evolution for both systems. With the right creative capital, this platform could leapfrog us into new medical frontiers like explorations into the anti-bacterial properties of natural ingredients like turmeric, and development of a robust evidence base for AYUSH therapies and treatments that could be integrated into the western pharmacopeia, and vice versa.

This, and another suggestion of the NMC -- to allow AYUSH practitioners to prescribe some allopathic drugs after a 6-month training -- are being strongly opposed by practitioners of western medicine. This is not surprising given that turf protection is practised by most professions. However, it is also common knowledge that most types of allopathic drugs, including the restricted 'prescription only' antibiotics, are freely available and sold over-the-counter at most pharmacies in India, licensed or unlicensed. AYUSH practitioners already use a wide variety of allopathic drugs; so do informal providers who do not have any medical qualification but are the mainstay of rural healthcare. Formal doctors are just as guilty of over-prescription and inappropriate use of drugs, especially antibiotics. Antibiotics are being used indiscriminately not only in humans but also in animals, for disease prevention and growth promotion. Regulations either do not exist or are poorly enforced due to political reasons and resource limitations faced by regulatory authorities.    

I am in favour of allowing AYUSH practitioners to work within a range of essential allopathic drugs including antibiotics, for two reasons. One, this could potentially rationalise their present unregulated use of allopathic drugs. The move would allow the development of guidelines for better quality and regulated primary healthcare. The World Health Organisation has come up with a new categorisation of antibiotics into Access, Watch and Reserve categories, which could be used to further develop and implement guidelines for drug usage by different types of practitioners.

In a country the size and diversity of India, bans and punitive legislation cannot be entirely successful because of the magnitude of the healthcare needs we face. Such strategies are also unethical because if strictly enforced, a majority of the population will lose access to life-saving drugs. The issue of 'access' to essential drugs for the poorest is as important as 'excess' use of drugs in low and middle income countries like India. It is high time the medical establishment realises that current medico-legal frameworks, with high barriers, are harming more than protecting the health of citizens.

Second, AYUSH practitioners with an integrated training could be more usefully deployed in the public health system at the primary level such as in sub-centres and primary health centres that are facing human resource shortages. Placing them here would be no use if they were not allowed to, for example, treat a child suffering from severe pneumonia with life-saving antibiotics.

Having said this, I must emphasise that this initiative is by no means a comprehensive or sustainable solution to the human resource deficiencies in the public health system in India. Maybe I am wrong, but this provision seems to be more a response to the AYUSH lobby's longstanding demand for using allopathic drugs, rather than a well-planned strategy for increasing human resources in rural areas. Most AYUSH graduates, like their western medicine counterparts, practise in cities or in peri-urban locations. Only a small percentage -- about 10% -- may be found in the rural areas. So, the NMC provision should also be linked with appropriate deployment of the trained AYUSH practitioners in rural health facilities.

These are small and positive steps in the right direction, but there is also an urgent need to bring them together in a comprehensive blueprint for a revitalised and efficient public health system in the country.

(The writer is Research Fellow in Health Systems and Policy, London School of Hygiene and Tropical Medicine).