The recent advisory from the Ministry of AYUSH on treatments available in traditional medicine against the new COVID-19 epidemic rightfully created an uproar. There is no scientific evidence that the prescribed medicines work. Indeed, at the time all classical medical texts were collated, people didn’t have an understanding of a virus. What there was instead, and which still guides treatment in these medical systems, is a holistic plant-based approach to managing symptoms; in the case of the advisory, for respiratory conditions. So why did the ministry publish unscientific statements? And what drives the almost instantaneously binary reaction to claims from traditional knowledge practices?
To answer this, it’s necessary to understand the history of medical education in India. Like all education before colonial times, Ayurveda too was also taught in the guru-shishya parampara, a system in which the student was immersed in the guru’s household and practice, with a strong hands-on training component. Modern medicine came with the colonialists. In 1822, instructions in western and Indian medicine (Unani and Ayurveda) commenced in Calcutta, but by 1835 Thomas Macaulay effected a policy to withdraw support for instructions in native languages as well as for native medical practices.
Hereon, the colonial and later Indian governments undertook investments to increase the number of medical colleges offering education in western medicine in the country. The Medical Council of India Act of 1956 institutionalised this process, and has since decided on the MBBS degree curriculum. Meanwhile, it was predominantly princely endowments that helped the Indian state setup institutions to train students in traditional medicine. The Maharaja of Travancore had established one of the oldest in 1889 in Thiruvananthapuram, and which has since become the Government Ayurveda Medical College. However, it was not until 1970, with the passing of the Indian Medicine Central Council Act, that Ayurveda and Unani training became institutionalised.
This regulatory divide at the top ensured that from the very start of professional training, modern and traditional medical practitioners are kept separated. To this day, an MBBS degree includes no courses in traditional medicine and vice versa, although Ayurveda doctors do study modern anatomy and physiology. While modern biological sciences like biochemistry, genetics, microbiology, etc. are part of an MBBS education, they find no mention in a BAMS degree. Each group is siloed off, and further divided by socio-cultural imprints, with a rather ungenerous “alternate” label attached to traditional medicinal practices. Even on campuses that have a cluster of excellent science research departments, there is no exchange of staff and students between the Ayurveda college and the rest of the sciences. Structural bifurcation doesn’t stop at medical education: it also extends to biomedical research.
In 2014, the government decided to hive off what was until then the Department AYUSH as a separate ministry to boost teaching, research and engagement with India’s traditional medical systems. This would have been an excellent policy decision had it not resulted in programmes where, once again, researchers and practitioners of modern biology are not actively involved in grant-giving committees or policy discussions. It’s almost certain that the AYUSH ministry did not run their new advisory by any virologist in the country either, not because there aren’t any but because they don’t feature on their rolodex of experts.
Thus we have a treasure trove of information on medical practices that have not been examined in a system that we know as the scientific method. The practice of testing hypotheses and rigorously demonstrating cause and effect has not permeated AYUSH. A favourite refrain of traditional medical practitioners is that it is difficult to perform clinical trials in the strict reductionist approach of modern science because, by philosophy, traditional medicine is personalised.
This is only the start of differences in vocabulary that then precipitate a binary situation: ‘either believe in traditional medicine or don’t’. But what if we removed belief from this conversation? We must embrace openness and look for commonalities, the most important being that both streams are about saving lives and improving the quality of life. Modern medicine needs to acknowledge that it doesn’t have a treatment for all diseases just as much as traditional medicine needs to acknowledge the same thing. We need more conversations between practitioners and researchers of both medical streams to start unpacking the potential of integrative treatments: the success of traditional medicine for chronic illnesses plus the superior surgical skills and life-saving technologies of modern medicine.
Further, we need to reimagine clinical trials to include personalised approaches to healing with metrics that include formulations as well as single chemical entities. We need the participation of the research fraternity, from biologists to statisticians and engineers, to describe new metrics to measure the efficacy of traditional medicine. Unfortunately, the only way an Ayurveda vaidya interacts with these professions today is in the form of a patient.
A lack of cohesive policymaking that aims to rigorously evaluate and integrate knowledge streams for human wellbeing is preventing us from reaping the full potential of the two. Remarkably, the Charaka Samhita, a basic textbook in Ayurveda, describes a good physician as one who is dynamic and constantly evolving. It’s time to take this classical advice seriously.
Megha is an assistant professor at the Centre for Ayurveda Biology and Holistic Nutrition, The University for Trans-Disciplinary Health Sciences and Technology, Bengaluru. The views expressed here are personal.