In 1835, T B Macaulay arguing against the teaching of Sanskrit said, “We are to teach it (Sanskrit) because it is fruitful of monstrous superstitions. We are to teach false history, false astronomy, false medicine...” This disparaging statement about Sanskrit texts of Ayurveda were then followed with self-serving reforms aimed at easing the British life into India, including stopping the patronage for traditional systems of medicine.
Macaulay’s minute and William Bentinck’s resolution closed the destiny and the good work of the Native Medical Institution in Calcutta, and the medical classes offered at the Sanskrit College and at the Madrasah were discontinued in 1835.
At the same time, medical colleges were established to fight India’s health burden and thus began a new period of imparting western medical education. Rapidly, the western system of medicine became the mainstream of healthcare in India.
Nearly two centuries later, Prime Minister Narendra Modi restored the glory and strengths of the traditional medicine systems by increasing allocation, focus, and setting up a separate ministry for AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy). These timely efforts are laudable since Yoga and Ayurveda have again emerged as the central focus of wellness in India.
However, the grand vision of the prime minister seems to have least impressed the thinktanks elsewhere in the government. Recently, high-ranking policy experts reviewing government schemes have suggested that AYUSH doctors be allowed to prescribe essential medicines (albeit after a bridge course).
Doctors trained in modern medicine (allopathy) are not available to work at remote and rural areas. So, understandably, policymakers are strained to try several solutions in vain. However, using AYUSH practitioners neither as mainstream nor as substitute, but to practice allopathy is flawed on several counts.
First, requiring AYUSH practitioners to prescribe modern medicines will not strengthen the system but weaken it further. It amounts to apparent lack of trust in Indian systems of medicine. The strength of Yoga, for example, is to provide holistic improvements in quality of life, and therefore prevent majority of the diseases. If the proponents of AYUSH end up learning and prescribing modern medicine, then the emphasis on wellness is defeated.
Second, it is fallacious and unreasonable to postulate that using drugs from modern medicine is a panacea for common ailments. If this is not the premise, then there is no necessity for a resolve to influence other streams of medicines to prescribe allopathic drugs. Instead, the Centre should actively provide AYUSH services at every level. This will offer multiple choices catering to the pluralistic needs of our society.
Third, leading AYUSH practitioners concede that lack of standard teaching and adequate training at AYUSH colleges have resulted in several unskilled professionals. This problem is not unique to AYUSH but rather affects most professional courses. So, the only hope for them is to practice any system of medicine that supports the livelihood, often with diminutive understanding of contents of medicine or their adverse consequences.
Advocating the prescription of modern medicines by such practitioners is of greatest disservice. How can a doctor who has not mastered AYUSH be a good practitioner of modern medicine? The logic behind pushing AYUSH practitioners to prescribe modern medicine is, therefore, borne out of flawed premise. Evidence suggests that AYUSH medical officers were found to be less competent in primary care involving modern medicine.
However, as the group experts suggested, the strategy involving the nurses as the mainstay of delivering primary healthcare in modern medicine is of high value. Except for nurses, doctors from any stream of medicine are seldom willing to stay in remote areas.
A nurse would also possess the requisite training and skill in modern medicine and hence, it is not difficult to train them for prescribing essential modern medicines. The Nursing Council of India has already published the curriculum for a nurse practitioner in primary care; so there is a legal framework that already exists for immediate implementation.
Using AYUSH practitioners to prescribe modern medicine is a waste of the deductive logic. Put simply, would you like an aeronautical engineer to repair your motorcycle? Would you like your Kannada teacher to teach German? Would you love a chef with expertise in Italian cuisine to prepare dal khichdi? If not, our health is better off in the company of experts of their own discipline.
(The writer is Additional Professor at Indian Institute of Public Health, PHFI, Bengaluru)