India is a country where medical
pluralism is officially recognized and encouraged. Currently India recognizes
six different healthcare systems along with the conventional medicine (Allopathy
or Biomedicine). India follows a ‘parallel’ kind of policy model where the
conventional medicine and other indigenous systems of medicine (referred collectively
as ASU- Ayurveda, Siddha and Unani or, ISM-Indian Systems of Medicine), are
placed ‘parallel to each other’. Because of such a policy, however, there is no
official provision for cross-talk between the professionals belonging to these different
streams during medical education, research and practice. This has in fact given
rise to mutual misgivings among these healthcare professionals regarding the
strengths and weaknesses of each other.
In this write-up, I argue that it is
the right time to encourage some kind of cross-talk among the professionals of
different streams of healthcare systems in the Indian context to enable our
country to take care of its varied healthcare needs effectively. I further
suggest that introducing an ASU module in the current MBBS curriculum would be
one such concrete step that would help in building an atmosphere of mutual
trust and mutual respect among the healthcare professionals of various streams,
which would improve the healthcare delivery system of the country. Encouraging
ASU institutions to hire biomedicine experts to give instructions in the areas
of their expertise is another suggestion that will be discussed.
The current scenario of ASU education in India:
According to a recent report, there
are currently more than 300 undergraduate colleges and more than 50
postgraduate colleges that produce graduates in ASU streams of medicine in
India. The syllabi of these programs contain a huge number of topics related to
conventional biomedicine. However, the number of ASU institutions asking the biomedicine
experts to teach these topics to their students is extremely low. The governing
body CCIM too doesn’t make it compulsory for such topics to be taught by the
experts in the relevant fields. Therefore, the teachers teaching some ASU subjects
also teach the relevant biomedical subjects such as anatomy, biochemistry, pathology,
physiology, surgery. Therefore, it can be assumed that the quality of
instruction in these topics that ASU students receive is possibly inferior.
The scenario is different in the
medical colleges, because, the governing council, MCI does not think it
necessary to include even the essentials of ASU related topics in the undergraduate
or post graduate curricula. Therefore, there exists a perceivable gap between ASU
and conventional healthcare professionals when it comes to ‘awareness about the
domain knowledge of each other’.
Problems with the existing system of medical education and practice:
1. MBBS graduates don’t know what interventions
their patients might have been subjected to
It is estimated that about 60-70% of
the population in India resorts to one or the other ASU modalities of
interventions for their healthcare needs. ASU systems employ various kinds of
interventions like Panchakarma, dietetics, herbal preparations, herbo-mineral preparations
and so on. Graduates in conventional medicine, however, are not aware of these
interventions. They are neither exposed to the theoretical constructs of ASU
systems, nor to their possible health benefits. They are not even exposed to
their possible adverse effects. There is increasingly available literature on
herb-drug interactions, food-drug interaction and drug-drug interactions, and therefore,
in all possibilities, these are being overlooked by the medical practitioners
currently. This not only creates hindrances in the anticipated outcome, but
also puts patients at increased health risks.
2. MBBS graduates don’t know when to
refer their patients to ASU practitioners
While there are several reports
highlighting the positive outcome associated with ASU interventions in several
health conditions, especially those related with chronic non infectious
diseases, graduates in conventional medicine don’t know what kind of cases can be
referred to ASU hospitals. Conditions like fistula in ano, for example, are
better treated with Ksharasutra therapy than with many other conventional
methods. However, the referral taking place even in such cases is only marginal.
Similarly, several studies on the effect of Ayurveda interventions in conditions
like rheumatoid arthritis have been published, to which, conventional medical
graduates are not introduced.
3. MBBS graduates are not introduced to
ASU modalities that can complement and enhance the clinical outcome
There are several studies indicating
the possible beneficial role of ASU interventions when administered as ‘adjuvant’
or ‘complementary’ to the conventional therapies. Dietary interventions,
Panchakarma and lifestyle modifications as per ASU modalities, for instance,
can at least be supplemented along with many biomedicine interventions to
enhance the clinical outcome.
4. MBBS graduates are not introduced to
the recent advances that are taking place in ASU systems.
Several interesting research
findings related to ASU interventions are being reported widely in recent years
in peer-reviewed scholarly journals. Graduates in conventional medicine need to
know some of these key advances so as to help their patients.
5. MBBS graduates are not introduced to
the medical heritage of their own country
ASU systems are historically
integrated into social and cultural domains of commoner’s life in India.
Certain terms such as ‘heat’, and ‘gas’ that are commonly expressed by
patients, have got their roots situated in such cultural connections. Similarly,
Sushruta’s practice of rhinoplasty was a milestone in the evolution of surgical
practices. Therefore, having some knowledge in the history and heritage of
one’s own country definitely adds value to the medical practice.
6. ASU graduates don’t receive instructions
from qualified experts in the topics related to conventional medicine
In one of our earlier studies, we
have noticed that Ayurveda students are not trained well in the essentials of
physiology, pathology and clinical diagnosis in general, and this possibly
holds true for Siddha and Unani students as well. The reason for this situation
in all probability is that ASU students don’t receive these instructions from
the experts in these fields.
7. Inadequate involvement of
Biomedicine experts in ASU research
An ideal research
protocol for ASU streams needs the involvement of biomedicine experts, however,
only a few biomedicine experts are currently interested and involved in pursuing
research related to ASU systems. This is because they are not routinely
exposed to these systems during their formal education. It is to be noted that ASU
systems can still guide many areas of current sciences because they provide a
larger fundamental conceptual framework that is in alignment with ‘systems
thinking’.
Suggested solutions:
1.
Introduce ASU module in MBBS curriculum
Introducing an ASU module in MBBS curriculum that
contains the essential introduction to these systems would help in solving most
of these problems. This module ideally must cover the following components:
a. Fundamental
principles and theories on the basis of which ASU systems are practiced
b. Historical
evolution of ASU systems in India and the important contributions of these
systems to the current sciences
c. Introduction
to the essentials of commonly practiced ASU interventions like Panchakarma
d. Essentials
of ASU pharmaceutics: common methods of preparation of ASU formulations, their key
ingredients
e. Recent
advances (fundamental and clinical) that have taken place in ASU streams
f. Essential
information regarding herb-drug / food-drug/ drug-drug interactions related to
commonly used herbs/drugs/dietary compounds.
g. Pharmaco-vigilance
program of ASU and the major centers coordinating it
2. Encourage instructions by bio-medicine experts to ASU students in the
relevant topics
Institutions
like Banaras Hindu University have since long introduced such a practice.
During their postgraduate years of study, Ayurveda students receive
instructions by experts in Anatomy, Physiology, Pharmacology, Pathology,
Microbiology, Biochemistry and Medicinal Chemistry. However, such a practice
needs to be encouraged everywhere so that ASU students receive standard
instructions.
Suggested Road-map:
a. The
government of India may identify a few institutions where ASU module could be
introduced on an experimental basis. These institutions should preferably have
a medical college and an A/S/U college under the same management, preferably in
the same campus. Institutions such as Banaras Hindu University, where three
faculties (Medicine, Ayurveda and Dental sciences) work under the same umbrella
of IMS (Institute of Medical Sciences) are ideal for such a venture to begin
with. A few other institutions with a similar set up could be identified.
b. A
group of experts may be asked to frame a module. This group should consist of experts
from ASU, pharmacology, clinical research and sociology. This group may be
asked to come up with a course module containing the essential information in
the form of an e-book. This should also include the links and addresses of important
organizations and institutions that can facilitate the acquisition of the
required information on the issues addressed.
c. This
module may be introduced either during final MBBS or during the internship
period. Initially, fifty hours of contact lectures may be allotted and feedback
from the instructors and students can be obtained. Alternatively, during every
semester of MBBS ten hours of contact lectures can be introduced to lessen the
burden.
d. Governing
bodies like CCIM should come up with norms making it essential for biomedicine experts
to be recruited in ASU colleges to give instructions in their area of
expertise.
e. As
a long-term measure, a 10-year integrated MBBS/MD/PhD ‘triple degree program’ in
integrative medicine might be introduced, wherein the essentials of all major streams
of healthcare systems can be incorporated along with a research project. This would certainly encourage more
researchers to involve themselves with ASU systems.
(I thank Dr.Madan Thangavelu from Cambridge, for his suggestion to include a 10-year integrated triple degree program under the list of "suggested road-map".)
