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Is Allowing Ayurveda Practitioners To Perform Surgeries a Step Too Far?

Is Allowing Ayurveda Practitioners To Perform Surgeries a Step Too Far?

Photo: Clay Banks/Unsplash.

In surgery, we are taught that learning what not to cut is more important than learning what to cut.

The Central Council of Indian Medicine (CCIM), India’s principal regulatory body for Ayurveda education, recently released a notification that allows postgraduate Ayurveda practitioners to perform 58 types of surgeries. The move has created a stir in the community of allopathic doctors, many of whom have asked if CCIM’s notification was really necessary.

It has also set a dangerous precedent, with the Indian Society of Dental Surgeons requesting the Dental Council of India to formulate an ‘Integrated Modern Medicine and Dental Curriculum’ that will allow undergraduate dental graduates to be general practitioners.

Various Ayurveda practitioners have claimed that performing surgery has been an integral part of Ayurveda since the time of Susruta. Policy decisions that allow practitioners of alternative medical paradigms to prescribe allopathic drugs in rural areas often cite a shortage of healthcare workers. But according to the 2019 Rural Health Statistics, there is a shortfall of 1,484 allopathic doctors in all of India’s primary health centres (PHCs).

Of these vacancies, a fraction is due to non-recruitment instead of unavailability. The apprehension over doctor shortage is not borne out by the data.

However, it is likely that instead of opening more colleges to train modern-medicine specialists, the government may try to fulfil the specialists’ shortage in rural healthcare by employing Ayurveda surgeons at community health centres.

And if an Ayurveda practitioner is being allowed to perform modern surgeries, we must ask if Ayurveda colleges are well-equipped to teach students these procedures.

Generally speaking, in India, private medical colleges don’t train students as well as state-funded institutions do. Most UG and PG Ayurveda colleges are privately owned.

A little over a thousand UG Ayurveda students and teachers from 18 states said in a 2011 survey that Ayurveda UGs are not trained to handle primary-level clinical emergencies using Ayurvedic methods. Their clinical exposure to certain basic procedures like incisions, drainage, suturing and catheterisation is poor.

The minimum standards of Ayurveda UG and PG colleges, as mandated by the CCIM, are more lenient compared to those set by the erstwhile Medical Council of India (MCI). The CCIM has also allowed Ayurveda colleges to function with up to 10% of faculty positions lying vacant – while the MCI deems it desirable for medical colleges to have 20% more faculty members than required.

The number of patients at these institutions is also low due to availability of better care through modern medicine. The quality of faculties is even worse, with over 80% of senior teaching positions in Ayurveda colleges in India still lying vacant. This directly reflects the more relaxed norms for teachers at Ayurveda colleges, relative to allopathic colleges

Licensed practitioners of modern medicine in India are bound by the Code of Medical Ethics, formulated by the Medical Council of India (MCI) in 2002. Similarly, Ayurveda practitioners are bound by the CCIM Code of Medical Ethics 1982. But while the former is regularly updated, most recently in 2016, the Ayurvedic counterpart has remained the same for 38 years.

The MCI code is also more robust. For example, an Ayurveda practitioner can do the following:

* Accept gifts, travel facilities, cash or monetary grants from the pharmaceutical industry

* Prescribe secret remedial agents of unknown composition

* Claim to be a specialist without the requisite qualifications

* Open a shop to sell drugs prescribed by other practitioners

* Not follow Indian Council of Medical Research guidelines while conducting a study

* Not maintain patient records for three years, and

* Self-advertise in the press

All of these activities are forms of misconduct for allopathic practitioners, and they will receive warnings and risk losing their licenses.

If we allow Ayurveda practitioners to perform modern surgeries, we should also expect them to be able to do so within the same moral and ethical framework. And it’s worrying, to put it mildly, that such a framework isn’t in place.

Integrated medicine

Complementary and alternative medicine (CAM) are healthcare practices that aren’t part of conventional medicine, and which derive their precepts from methods other than the scientific one. In India, these would include the so-called ‘AYUSH’ traditions: Ayurveda, yoga, Unani, Siddha and homeopathy.

Integrated medicine is a paradigm that selectively incorporates CAM into treatment plans alongside modern methods of diagnosis and treatment. On December 9 this year, India’s Ministry of AYUSH and AIIMS Delhi announced they will collaborate to establish a new department of integrative medicine at the famous hospital.

More broadly, the Narendra Modi government plans to roll out a ‘One Nation, One Health System’ by 2030, with a mix of modern and traditional systems of medicine vis-à-vis both research and education.

The National Education Policy 2020, the National Health Policy 2017, the National Medical Commission Act 2019, the National Commission for Indian System of Medicine Act 2020 and the National Commission for Homeopathy Act 2020 all talk of medical pluralism. These three commissions will decide on approving specific pedagogic modules for UG and PG courses across medical systems. Simply put, they want students of allopathic medicine to learn AYUSH, and vice versa.

The Indian Medical Association’s fears that these provisions will only institutionalise quackery are not unfounded. The spectre of the case of Ashwini Patel still haunts the community. Patel was a homeopathy practitioner who prescribed allopathic medicines to an individual who subsequently died. The victim’s wife filed a case of negligence against Patel. When the Supreme Court of India heard the case in 1996, Patel said that since both Ayurvedic and allopathic practitioners are taught the same basic pre- and para-clinical subjects, she could prescribe allopathic medicine.

The court rejected the argument – but it raised the issue of CAM practitioners prescribing allopathic medicine with impunity.

There is already evidence that Ayurveda practitioners prescribe allopathic drugs and that the CCIM notification simply furthers a long-standing practice.

According to a study published in the Indian Journal of Pharmacology in 2007, Ayurveda practitioners prescribed significantly more antibiotics and drugs for acidity than allopathic doctors. Such irrational practices can give way to antibiotic resistance and increase cost for patients. Another study reported in 1997 that Ayurveda doctors prescribed steroids more often than their allopathic counterparts for acute respiratory illnesses.

Ultimately, the various legal instruments and national policies don’t seem to acknowledge the fact that they are only as good as the ‘cross-teaching’ that students will receive.

For example, until students of homeopathy are also taught the physiology of cellular receptors – a theory that homeopathy rejects – teaching them about types of allopathic drugs will be useless. Moreover, simply studying the theory of pharmacology won’t qualify them to prescribe modern drugs. They will also need to learn to use modern drugs in different contexts of medicine, surgery, paediatrics, etc.

Note that integrating Ayurveda and allopathy will be a setback to Ayurveda as well. In its 11th Five Year Plan, the Planning Commission said AYUSH students spend less than is necessary learning AYUSH modalities. As a result, these students lack confidence, knowledge and skills in using AYUSH-specific ideas and therapies, and tend to prefer their modern counterparts even if they haven’t been fully trained on that front.

The Government of India should desist from shoehorning Ayurveda practitioners into the national health programme for whatever reason – but least of all for a shortage of doctors at PHCs. The country’s healthcare can improve only by robust, long-term investment in good-quality service and infrastructure. India’s per capita expenditure on healthcare is among the world’s lowest, at Rs 1,112 per person per year – around Rs 3 per day.

Against this background, increasing the number of PG seats and training more specialists is important, not giving under-qualified and unqualified enthusiasts a free rein to perform potentially dangerous medical procedures.

Aakash Sethi and Gayatri Laha are third-year MBBS students at the Government Medical College, Baroda. They are active on Instagram here and here.

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