Editorial of the Day: Can an Integrated System of Medicine Work? (The Hindu)

• Integrated medicine refers to using alternative medicine systems such as ayurveda, yoga, naturopathy, unani, siddha and homeopathy with orthodox systems as part of a treatment.
• The significance of Yoga, Ayurveda, Homeopathy, Siddha and Unani medical systems have grown especially due to the challenges of Non-Communicable Diseases (NCDs), multidrug-resistant diseases, lifestyle disorders, and long term diseases.

Importance

• Integrative medicine is aimed at harnessing the potential of India’s rich heritage and medical knowledge, along with using modern advancements in allopathy.
• Opening Integrative Medicine Centres at all government medical establishments will help in initiating co-location of practitioners of Indian system and modern medicine.
• Integrative Medicine Centres can be crucial in providing services like Panchakarma therapies & concomitant medicines which will provide a promotive, preventive, curative and rehabilitative therapy.
• Both traditional and modern medical practices would help in providing better avenues of health and wellness.

• Traditional Medicine Systems:  As per WHO, it is the total sum of the “knowledge, skills and practices indigenous and different cultures have used over time to maintain health and prevent, diagnose and treat physical and mental illness”.
• In India, traditional medicine is defined as including practices and therapies such as yoga, Ayurveda, Siddha that have been part of Indian tradition historically, as well as others such as homeopathy — that became part of Indian tradition over the years.
• • Ayurveda and yoga are practised widely across the country.
  • Siddha system is followed predominantly in Tamil Nadu and Kerala.
  • Sowa-Rigpa system is practised mainly in Leh-Ladakh and Himalayan regions such as Sikkim, Arunachal Pradesh, Darjeeling, Lahaul & Spiti.

Major Bottlenecks in Traditional Systems

• Trust-Deficit: There is a major trust-deficit in the soundness of Ayurvedic theories and the fruitfulness of its practices. Ayurveda is not the medical system of first choice for many people.
• Lack of Scientific Validation: Ayurveda has failed to keep pace with the intellectual and scientific advances of the times. So, it has diminished evidence-based quality.
• Sub Standard Courses: Ayurvedic practitioners’ graduation courses are often substandard and the post-graduate courses offered at most of their institutes are of extremely poor quality.
• Lack of Practice: While MBBS graduates and post-graduates from public hospitals have to mandatorily serve a specified bond period in rural areas, graduates and post-graduates from AYUSH public hospitals are not subjected to any such restrictions.
• Lack of Ecosystem: Ayurveda lacks a vibrant ecosystem of science and research.
• Trial and Error Methods: Ayurvedic practitioners have to discover treatments and approaches that actually work. It involves a lot of trial and error with patients and leads to an erosion of the practitioner’s reputation.
• Lack of Investment:  Despite numerous efforts made by individuals and organizations to conduct research, the lack of investment into Ayurvedic research has been a major setback.
• Less Integration with Modern Medicine: Ayurveda can be used safely and efficiently only in about 60%-70% of primary-care illnesses. For rest, Ayurveda needs to be integrated with modern medicine.
• Overuse of AYUSH Medicine: Ayurveda medicines are sold as over the counter products and nutraceuticals to avoid regulation. Ayurvedic stores do not have a legal requirement of a pharmacist to dispense the medications unlike pharmacies selling modern medicine.

Orthodox Medicine Systems:  It is a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery.

• It is also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and Western medicine.

Major Bottlenecks in Orthodox Systems

• Lack of infrastructure: India has been struggling with deficient infrastructure in the form of lack of well-equipped medical institutes with a low rate of building such medical teaching or training facilities.
• Shortage of efficient and trained manpower: One of the most pressing problems in India remains a severe shortage of trained manpower in the medical stream.
• Unmanageable patient-load: There is a need to adopt technology wherever possible to streamline the operational and clinical processes for healthcare facilities in order to manage efficient patient flow.
• High out-of-pocket expenditure remains a stress factor: While public hospitals offer free health services, these facilities are understaffed, poorly equipped, and located mainly in urban areas.

• Ayush Ministry’s move to open inpatient and outpatient departments at Central government hospitals:
  • A positive view regarding the collaboration between the Ayush Ministry and the Central government to open inpatient and outpatient departments in the hospital is that it is a step in the right direction as it will enhance the treatments offered under one roof.
    • It is  important to have  harmonised protocols for clinical care research, particularly for non-communicable diseases.
    • Also, Ayurveda and yoga are important components of integrative medicine.
  • On the other hand, it is argued that integrative medicine is not part of scientifically progressive societies, as it involves mixing practices that have no scientific evidence with those that do work.
    • Also, experts opine that Ayurveda and homoeopathy to be pseudo-scientific practices with no evidence supporting their use as preventives or treatments for any disease condition.
    • They also express that the proposal for integrative medicine arises in countries like India due to a lack of affordable healthcare options and is a means of misleading the population.
• Prevalence of the use of alternative medicine:
  • One faction of the scientific community acknowledges that the use of complementary/alternative medicine is a global phenomenon, not restricted to India.
    • It recognizes the concerns about erroneous products and the potential harm they can cause to the body, particularly when they are available over the counter.
    • However, it also highlights the size and significance of the nutraceutical industry, which is larger than the pharmaceutical industry worldwide.
    • There must be room for sensible use and practice of alternative medicine but there is also the need for its regulation.
    • Thus, this faction suggests that all formulations, including alternative medicines, should be subject to the same standards to ensure safety and quality.
  • Other Faction,
    • Expresses concern about the high prevalence of complementary/alternative medicine usage, stating that about 50% of people use it, and over 70% have used it at some point in their lifetime.
    • This widespread usage is due to promotion and advertising, despite the lack of evidence-based benefits.
    • This faction suggests that the availability of these medicines over the counter without proper regulation leads to safety issues, with many people experiencing side effects and adverse events.
    • Specifically the risk of liver injury due to adulteration, contamination, or direct toxicity of herbs in these products is a matter of concern.
    • It should also be noted that there is a lack of pharmacovigilance in monitoring the safety and efficacy of these medicines.
• Quality control and standardization of formulations:
  • On one hand,
    • There has been emphasis on the importance of quality control and standardization of formulations across all domains, including traditional medicine.
    • The randomized controlled trials (RCTs) that  are the gold standard for drug formulations are acknowledged but the challenges of conducting RCTs for non-pharmacological therapies in certain domains like autism, dementia, and chronic diseases must also be focussed on.
    • It is believed that not everything in modern medicine is fantastic, and traditional medicine can have its merits.
  • On the other hand,
    • It is argued that standardization of formulations should only be considered for practices that have been identified as potentially useful for patients.
    • There have been questions about the need for standardizing formulations or practices that have not conclusively proven to be beneficial and also concerns expressed about health misinformation and the negative impact it can have on individuals.
    • Experts acknowledge the importance of standardization to reduce the health burden but assert that RCTs are the gold standard for diagnosing and improving conditions, and alternative/complementary medicine tends to avoid them.

Views on Modern Medicine:

• • Some suggest that proponents of complementary/alternative medicine often misrepresent modern medicine as solely focused on prescribing pills.
    • It is argued that modern medicine encompasses preventive measures, effective lifestyle changes, and various external treatments that go beyond medication.
  • Also, it is important to help people understand the right healthcare choices with minimal risk within evidence-based guidelines.

The article mentions the reasons for people to gravitate towards complementary/alternative medicine for various reasons:

• Lack of satisfactory results with conventional medicine: Some individuals with chronic diseases or conditions may have tried multiple conventional treatments without experiencing desired outcomes. When conventional pharmacotherapy does not provide relief, patients may turn to alternative medicine in the hope of finding effective solutions.
• Seeking additional options: Patients may seek alternative medicine as an additional option alongside conventional treatments. They may believe that combining different approaches can provide a more holistic and comprehensive approach to their healthcare.
• Desire for a more personalized and compassionate approach: Alternative medicine practices often emphasize a more patient-centered and holistic approach to healthcare. Patients may be drawn to the longer consultations and perceived empathy and compassion provided by practitioners of alternative medicine.
• Dissatisfaction with the healthcare system: Patients may feel that the conventional healthcare system is impersonal, rushed, or lacks sufficient communication. They may turn to alternative medicine as an alternative that offers a more attentive and individualized approach to their health concerns.
• Cultural and historical beliefs: Traditional systems of medicine, such as Ayurveda and Traditional Chinese Medicine, have deep cultural and historical roots. Some individuals may have grown up with these practices and believe in their efficacy based on cultural beliefs and anecdotal evidence.

• Government of India is implementing the Centrally Sponsored Scheme of National AYUSH Mission (NAM) for promotion of AYUSH system.
• • Grant-in-aid is being provided to State Governments for development and promotion of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy.
  • NAM also supports cultivation of medical plants, production of quality and standardized ingredient for supply of Ayush, integration of medicinal plants in farming systems and increasing export of value added items of medicinal plants.
• WHO – Global Center for Traditional Medicine is the first and only center of its kind in Jamnagar, Gujarat which focuses on innovation and technology to optimize the contribution of traditional medicine to global health and sustainable development.
• The government has a special Ayush Visa category for foreign nationals, who want to come to India to take advantage of Ayush therapy.
• A special Ayush mark for Ayush products and network of Ayush parks has been undertaken to encourage the promotion, research and manufacturing of Ayush products in India.
• A new category named ‘Ayush Aahar’ has been announced which facilitates the producers of Ayurvedic nutritional supplements.
• With the aim of boosting infrastructure and promoting research in traditional medicine, three National Ayush Institutes have been established:
• • All India Institute of Ayurveda (AIIA), Goa, National Institute of Unani Medicine (NIUM), Ghaziabad and the National Institute of Homoeopathy (NIH) have been set up.
• The Ministry of Electronics and Information Technology is providing technical support for digitalisation of Ayush Sector under the Ayush Grid project.
• The Traditional Knowledge Digital Library has been created which contains information about Ayurveda, Unani, Siddha, Sowa Rigpa and Yoga.

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