Medical Pluralism and the truth about Ayurveda.

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mintNovember 4, 2014

Manik was suffering from a hacking cough triggered by an unidentified allergy. A long list of prescribed drugs had left her heavy-headed and lethargic. It was her good fortune that she found a fine Ayurvedic doctor who gave her talishadi powder. Honeyed over, the paste soothed her hoarseness and she was her normal self soon enough, minus any side-effects.

That India accepts medical pluralism and five drug-based systems-Allopathy, Ayurveda, Unani, Siddha, Homeopathy- are all covered by the Drugs & Cosmetics Act (D&C) 1940 is not commonly known. These systems have been in regular use for centuries but were given statutory recognition more than four decades ago. All medicine (unless prepared by an individual Vaidya or Hakim) has to be li censed and follow the pharmacopoeial standards and quality control regulations set out in the D&C Act. But it is also true that barring some twenty renowned Ayurvedic companies, hundreds of concoctions making wild claims and skirting quality control regulations are marketed in all states with shifting degrees of enforcement. This naturally deters a discerning public from using the Indian systems, unsure both about the presence of essential ingredients and the absence of impurities.

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Government institutions like Banaras Hindu University, the Gujarat Ayurvedic University and the Tilak Mahavidyalaya, Pune among others conduct the finest Ayurvedic teaching and practice but like most government institutions, unless one knows an insider, inefficiencies abound. Family concerns like AVS Kottakal, AVP Coimbatore and Shree Dhootapapeshwar (some more than 100 years old) manufacture high qualitquality drugs that adhere to the original Ayurvedic classical recipes. Some run excellent hospitals which draw patients from round the world. A score of other corporate ventures have engaged excellent vaidyas, invested in R&D and gained country-wide respect quality of their proprietary products. But finding the physician-bridge continues to present a challenge for the consumer, particularly one who has had no family tradition of using Ayurveda.

Responding to this situation, companies like Himalaya, Dabur and Charak erected a bridge to the consumer by adopting the “ethical marketing” route. Sales representatives educate the modern medicine doctor about the constitution of the drugs, their therapeutic action and indications and contra-indications- exactly as they do for modern drugs. Regular CMEs are organised for special therapeutic segments and publications in quality journals shared with practitioners. Experience has shown that once they see the treatment data, modern medicine doctors add Ayurvedic items to the prescription to alleviate symptoms. All such items are in any case freely available without prescription.

Peoples’ health-seeking behaviour is also changing. Consumers are opting for medication that is natural and free from synthetic substances .Ayurvedic treatment is increasingly being used as adjuvant therapy because it restores good health while often reducing the dosage of strong medicine. Concerned about the side-effects of allopathic drugs it is natural for consumers to repose greater faith in formulations which are ninety percent plant based. But once again a bridge is needed – one which is reliable but also conversant with modern diagnostics and clinical findings.

In response to this,in 2010, Medanta a multispeciality hospital in Gurgaon erected that bridge by establishing a Department of Integrative Medicine. Here Ayurvedic treatment is offered on par with specialised allopathic treatment even as the rooms for panchakarma (a complex protocol for de-toxification) are located alongside other clinics as for dialysis and endoscopy.

At Medanta, the Departments of respiratory and sleep medicine, cardiothoracic surgery, critical care, bone and joint disorders, neurosciences and minimally invasive thoracic surgery have been the most receptive to the concept of integrative medicine. As the Head of Integrative Medicine at Medanta Dr Geethakrishnan puts it, “the first step was to educate the bio medical doctor. Creating databases of authentic clinical outcomes made the process of integration that much easier. The hospital opened that opportunity.”

Contemporary Ayurveda then is a response to public demand for gentler, safer remedies. But building bridges to modern medicine has ruffled many feathers backed less by concern for the consumer but more by commercial pulls. Lobbies are furiously at work to prevent an allopathic doctor from suggesting an Ayurvedic packaged formulation although it is available off –the –shelf to any citizen. As a result the public could be denied access to formulations which physicians in scores of countries prescribe freely for their patients. The patient’s consumer rights are being fettered because of larger commercial interests which are at stake.

This situation would not have arisen had the Ayurvedic graduates stuck to their own system. The extent of modern medicine practiced by Ayurvedic doctors has taken away from the shine of an ancient and time-honoured system. It has confused the public and accounts for much of the distrust that surrounds Ayurveda and other Indian systems of medicine. We need competent and committed practitioners who can satisfy a modern, internet savvy public. That in turn requires published research undertaken by multi-disciplinary teams to tell people not just that Ayurveda is effective but how its therapies and drugs stimulate the nervous system.

If India hopes to be a front-runner in the practice of integrative medicine, resting on a few good examples will not suffice. It will take much more than rhetoric to convince a discerning public that a combination of therapies can in fact heal faster and better.

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