Medical systems, modern and ancient, clash over who can operate on patients in India

The conflict is an extension of the gulf between the two streams of medicine. PHOTO: AFP

KOCHI - The Indian government on Nov 19 authorised practitioners of Ayurveda, an ancient Indian medical system, to be trained to perform some surgical procedures. The move has alarmed doctors practising modern medicine and many among the public.

The Indian Medical Association (IMA), an influential voluntary body representing doctors, demanded on Nov 22 that the notification be withdrawn, calling it a "retrograde step of mixing" modern and alternative systems of medicine.

The following day, the government clarified that the notification "did not signify any policy shift" as Ayurvedic practitioners already performed surgical procedures according to their techniques, which are based on a natural and holistic approach to physical and mental health.

The conflict is an extension of the gulf between the two streams of medicine, exacerbated by concerns among modern doctors about the Indian government promoting alternative medical practices.

In addition to India's Ministry of Health and Family Welfare, in November 2014, the government under nationalist Prime Minister Narendra Modi formed an exclusive ministry to develop and propagate indigenous and alternative medicine systems such as Ayurveda, yoga and naturopathy, Unani, Siddha and homeopathy (Ayush).

The Central Council of Indian Medicine (CCIM), which issued the Nov 19 notification about Ayurvedic surgery, is a statutory body under the Ayush Ministry to regulate the alternative systems of medicine. It listed 58 surgical procedures that postgraduate Ayurveda practitioners would be trained to perform, including removal of benign tumours, amputation of gangrene, and nasal and cataract operations.

The Ayush ministry clarified that Ayurveda colleges already had independent departments of Shalya (surgery) and Shalakya (otorhinolaryngology and ophthalmology - the studies of nose and eye disorders) that legally performed such surgical procedures.

This month's notification was issued "in overall public interest" only "to specify in clearer terms than a 2016 regulation" the techniques and procedures Ayurvedic postgraduates would have to be trained in.

CCIM chairman Vaidya Jayant Deopujari told The Straits Times that Ayurvedic practitioners doing surgery is not new and postgraduate courses have been teaching them for 20 years. While Ayurveda colleges did not perform cardiothoracic, neurological or spinal surgery, he said they often did cataract, cyst removal, gynaecological and abdominal procedures.

"Many allopathic practitioners have not informed themselves about medical plurality, or even the fact that we have been empowered to train postgraduate students (for) 20 years," said Mr Deopujari, a senior Ayurvedic practitioner himself.

"Ayurveda is not strong on antibiotics and doesn't do advanced surgeries. But traditional is not synonymous with unscientific... We use modern instruments, anaesthesia (with trained modern anaesthetists mandatory on staff), and the latest technology that is for all medical practitioners to use," he added.

To the IMA's objection to the use of surgical terminology, the Ayush ministry said "technical terms and modern developments are a common heritage of mankind".

Many Indians adopt a fluid balance of all streams of medicine, often using alternative ones for chronic and mild ailments.

A 2018 report by the Confederation of Indian Industry found that 77 per cent of Indians used Ayurvedic products, compared with 67 per cent in 2015. Rising awareness about healthy lifestyles and increasing preference for chemical-free natural products, in addition to favourable government initiatives since 2014, have boosted the use of Ayurveda in India.

But practitioners of the different fields have often collided, most recently during the pandemic. Public health experts were concerned about confusing messages from the Health and Ayush ministries during the pandemic.

For instance, while the health ministry's modern medicine protocol said that hypoxia (loss of blood-oxygen) and breathlessness were "moderate" Covid symptoms and such patients should get immediate medical attention at a Covid centre, the Ayush protocol suggested that the same symptoms were signs of "mild" Covid, and could be treated by consuming Ayurvedic herbal formulations at home.

IMA national president Rajan Sharma said the amendments about surgery could not be seen in isolation. "The National Education Policy 2020 speaks of medical pluralism and lateral entry (of Ayurvedic doctors into modern medical schools) laying the foundation for legitimising mixopathy," he said.

However, votaries of medical plurality - the coexistence of modern and alternative systems to treat illnesses - believe it is a way to give more people access to healthcare.

The pandemic has drawn attention to India's crumbling, top-heavy healthcare system. There is an official recommendation to double India's public health expenditure next year.

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