The controversy
There have often been Ayurveda and modern systems of medicine. Recently this debate kicked off after controversial remarks of Baba Ramdev ridiculing modern medicine as ‘stupid’ and questioning its ineffectiveness as many doctors lost their lives to it. These remarks during the pandemic were dangerous as it undermined the faith of the public in the proven scientific interventions which saved many lives during unprecedented times of misery and death. Modern medicine’s contribution to improve health and longevity cannot be denied. An average Indian’s life is around 70 years today compared to around 32 years at the time of independence. The substantial decline in infant, child and maternal mortality, eradication of smallpox, yaws and polio and elimination of neonatal and maternal tetanus to name a few achievements of modern medicine.
The current debate tends to further polarise – either you are with Ayurveda or allopathy—there is no room for the majority of people who think that both methods are beneficial to the public.
The Health Ministry promptly expressed its disapproval over Ramdev’s remarks, issuing a letter to the Yoga Guru to retract his statements. Ramdev complied with it and withdrew his statement. But he continues to ask questions on effectiveness of allopathy in treating various diseases in his Yoga training sessions and other platforms. The current debate tends to further polarise – either you are with Ayurveda or allopathy—there is no room for the majority of people who think that both methods are beneficial to the public. In India, the public has a deep rooted, millennia-old belief in Ayurveda. It is reflected in sociocultural traditional health practices seen in almost every household in India. Though modern medicine has saved millions of lives, it can certainly be further enriched with evidence-based Ayurvedic philosophy, practices, and treatments. It is a marvelous achievement of modern science to have developed effective vaccines to prevent COVID-19.
India’s western-influenced education system, inherited from Lord Macauley, labels all traditional wisdom including Ayurveda as unscientific and inferior. This mindset needs to change to scientifically evaluate practices and treatment in Ayurveda and other traditional systems of medicine and accept these to maximise the benefit to the common man.
Strengthening evidence-based practice of Ayurveda and Allopathy
Doctors who follow science believe that modern medical practice is evidence-based and continuously evolving as we learn from research and other sources including traditional systems. Ayurveda (Charak Samhita) also has a system of verification and is different from modern medicine and it looks for proof (pramana) which includes Aaprtopdesha (expert opinion), pratyaksham (observation), anumaan (inference) and yukti (reason and experimentation). In modern medicine the power of evidence from these ‘pramana’ in considered low as compared to evidence that emerges from randomized controlled double-blind trials, meta-analysis, and systematic reviews. The Ayurvedic system of pramana (proof) can be strengthened with modern medicine’s approach of strengthening evidence using these recent methods to improve its credibility, acceptance and trust.
People want both Ayurveda and Allopathy to treat their health problems:
The Ayurvedic philosophy and beliefs are widely accepted not only in India but are gaining more acceptance even in the western world. A study across 18 states in India (NHSRC, 2010) showed that 73% of people used home remedies, mostly influenced by Ayurveda, for treatment of their most recent sickness episode. For common ailments such as cough, cold, diarrhoea, minor cuts, burns, insect bites etc, 50-98% used home remedies, mostly Ayurvedic practices. The reasons ascribed by the people for this include; previous experience in family and community as it worked; strong belief that it heals; easy to use; inexpensive; easy availability etc. The public has deep-rooted faith in Ayurveda. They often use these together. Local health traditions and customs, influenced by Ayurveda for thousands of years, have become part of home remedies and become an important way of life in both health and sickness.
Both Ayurveda and Allopathy may not be perfect systems by themselves but together offer a better chance to prevent and alleviate suffering and misery of people from diseases. To build credibility, we need to avoid premature claims of effectiveness of various treatments. These premature claims were seen both by Ayurveda and modern medicine during COVID pandemic. The claims of effectiveness of interventions such as hydroxychloroquine in prevention and plasma therapy in treatment of COVID were dropped when evidence suggested that these do not work. Ayurvedic practitioners at times are adamant that ayurvedic treatments and practices are never harmful. There is a need to be open, honest and transparent to build credibility of a system. NHSRC (2010) study also found high utilization of AYUSH services in states such as Tamil Nadu and Kerala refuting the argument that people resort to them because of inaccessible or unaffordable modern health services. The study found that 70% of the allopathic doctors in the government system felt that AYUSH systems are not redundant and can be strengthened. They emphasized the need for research and documentation in AYUSH.
Need for a better understanding of Ayurveda and Allopathy
Ayurveda is a comprehensive system of medicine that evolved in India which uses a range of treatments, including panchakarma (‘five actions’), yoga, massage, acupuncture, and herbal medicine, to encourage health and wellbeing. Ayurveda makes use of natural herbs, extracts, plants, and some metals and claims that ‘all Ayurvedic remedies are close to nature and do no harm’. Though modern medicine practitioners have seen serious side effects of some ayurvedic medicines such as those treatments containing lead and other heavy metals.
Need for a better understanding of Ayurveda and Allopathy
Contrary to the common belief especially among Ayurveda practitioners, Allopathy not only works to treat symptoms and illness but also has effective interventions, such as vaccines, to prevent diseases. Pharmaceutical drugs play a major role in allopathy. The modern medicine, as it is practiced today, is very different from Allopathy which had its origins in Greece about 2,400 years ago, when it included purgatives, catharsis, bloodletting etc. Most of these practices have been discarded, as modern medicine looks for evidence on effectiveness of interventions based on research. There is always a profound discussion on proving which intervention is better and a biased conclusion may be counterproductive and undermine public trust. Pharmaceutical drugs play a major role in allopathy. Drugs are developed either to alleviate the symptoms of the diseases directly or alter the way the body responds to it. Drugs do generally cure diseases but sometimes their side effects affect the patient adversely.
AI is helping modern medicine practitioners in many ways. The evidence-based AYUSH interventions for common health conditions can be integrated into these.
| Approach | Addresses the root cause as understood in Ayurveda | compounds, medical devices and surgical interventions Achieves cure and prevention through antibiotics, address physiological processes and vaccines. |
| Treatment | Facilitates natural healing process which may take more time | Quicker relief in acute and life-threatening ailments and control of disease and symptoms |
| Side Effects | Claim no side effects. However, side effects of preparations such as heavy metals used are well known when these patients go for treatment in modern medicine | The side effects of each medicine and intervention and their frequency are documented. Hence side effects are well known. |
| Evidence for medicines and treatments | Anecdotal evidence. The process may lead to inefficiency and irreversible side effects which are not acknowledged | Each intervention is tested during the elaborate trials in animals and humans and even when in use in the market. Only when benefits outweigh side effects are these medicines approved. |
| Cost | Inexpensive | Expensive and the cost of treatment is going up over time. |
| Malpractices | Less common | Pharmaceutical companies and corporate hospitals often ‘blamed’ for putting commercial interest above patient’s interest |
As India is still grappling with the resurgent coronavirus outbreak and persistent increase in non-communicable diseases, both the Ayurveda and Allopathy practitioners need to realise that both treatments coexist, without the need to discredit the other. Ayurveda and Allopathy have unique characteristics that distinguish one from the other. It, however, does not mean that there should be a debate over the supremacy of one treatment over the other. Each of them has proven beneficial in treating patients, and therefore they both deserve to serve humanity in their own way. The debate, if at all, should be on how best to integrate the two systems to benefit the public.
Ayurvedic and Allopathy as complementary systems
Modern medicine is the perfect tool in cases of serious illnesses. Ayurveda looks at keeping people healthy and correcting the imbalance which is the cause of diseases. For non-communicable diseases Ayurveda with Yoga and meditation can effectively improve life style and Allopathic provide medications such as metformin to a weary pancreas, in diabetes, to release more insulin or give insulin and for high blood pressure give medicines which bring it down and prevent damage it causes to heart, brain, kidneys and eyes. Thus complementing each other to improve outcome and improve quality of life.
Under the National Health Mission, the government has collaborated with AYUSH and modern medicine practitioners in the government health facilities. The government also encourages cross referral of cases from Ayurveda and other AYUSH systems to modern medicine and vice versa to benefit the public.There is collaborative research being done in institutions such as AIIMS Delhi and new AIIMS. Kshar Sutra, an Ayurvedic treatment for piles emerged as an effective and easy treatment that could be tried before resorting to surgery.
Many new AIIMS have herbal gardens in the campus to grow herbal ayurvedic medicines and promote research and complementary approaches to treat patients. Ayurveda promotion should be based on science and not politics. Political will is needed but too much politicization becomes counterproductive
Both Ayurvedic physicians and MBBS doctors take oaths (Charak Shapath and Hippocratic oath) to act in the best interest of the patients.
Technology to promote Ayurveda and modern medicine for public benefit
The government plans to roll out a ‘One Nation, One Health System’ policy by 2030, to integrate modern and traditional systems of medicine like allopathy, homoeopathy and Ayurveda in medical practice, education and research. Technology can be an effective vehicle for this integration for the population to get the maximum benefits from various systems of medicine. The government has taken many initiatives to bring technology to improve healthcare in both AYUSH and the Ministry of Health and Family Welfare. However, there are hardly any initiatives to use technology to integrate various systems of medicine. The technology can help in accelerating the integration in various systems of medicine and its smooth operationalization to move towards ‘One Nation, One Health System’ policy. Given below are some suggestions:
- Health and Wellbeing: Yoga and meditation have proven their utility to improve health and wellbeing of the people. The current government has helped the UN to have International Yoga Day on 21st June to promote yoga across the world. Yoga can be integrated with other initiatives of modern medicine to address current epidemic of life style related noncommunicable diseases such as high blood pressure, diabetes, cancer, cerebrovascular diseases such as stroke, mental health problems. Improved health and wellbeing will also reduce probability of infectious diseases and mortality.
- Integrated AI based treatment protocols: AI is helping modern medicine practitioners in many ways. The evidence-based AYUSH interventions for common health conditions can be integrated into these. The AI experts need to work with joint medical teams drawn from the relevant systems of medicine.
- Online Orientation of the current medical and Ayurveda practitioners and medical students of all systems of medicine to understand basics of other systems of medicine in prevention and treatment of common conditions during their basic and speciality trainings. This will help them understand the philosophy and approaches of other systems of medicine in the best interest of the patient.
- Integrate the current technology initiatives including technology incubators and Health Technology Assessment (HTA) to improve quality and access to health care are being run parallel in Ayurveda and modern medicine. There is a need to engage practitioners of other systems of medicine for better integration from the initial stages of application of technology in healthcare.
- Digitization of all medicines from all systems of medicine at one platform. It should include all medicines from drug trial stage to use that will bring transparency, standardization, drug control, quality control, decision support and continuity of care.
- Uniform standards of drug trial: The drug trial registries of both AYUSH and MoHFW should be brought together and be available to the general public on one digital platform. This will build trust among practitioners and the general public that indigenous medicines are subject to the same standards.
- Standardization and Quality Control of Ayurvedic drugs as per modern medicine standards. This will strengthen scientific validation of ayurvedic medicines and increase the trust of the public and practitioners of modern medicine.
- Use modern scientific technological approaches in Ayurveda such as nanotechnology, molecular docking, molecular dynamics etc to strengthen the efficacy of Ayurvedic medicines.
The current debate is unnecessary, short sighted, discriminatory, counterproductive and self-protective. It must change how the two systems can work together for the larger benefit of the society. Both Ayurvedic physicians and MBBS doctors take oaths (Charak Shapath and Hippocratic oath) to act in the best interest of the patients. The best interest of the patients can be served only if they use the best available treatment irrespective of the system it comes from. The general public will benefit more if the two systems work closely together. The debate should shift to how to bring the two systems together to accelerate improvement in health of the people. Technology is being used in a big way to improve quality and access to health in both traditional and modern medicine. Both the Ministry of AYUSH and Ministry of Health and Family Welfare are spearheading the use of technology. There is a strong need to use technology to integrate the various systems to maximize health benefits to the public and accelerate the government’s policy of ‘One Country, One System’ by 2030.
Composed by: “Dr Sanjiv Kumar is a public health physician with 45 years of experience across more than 30 countries in South Asia,Africa, Central Asia and Central eastern Europe. He was Dean and later Director, International Institute of Health Management Research. New Delhi. He was also Executive Director at National Health Systems Resource Centre, Ministry of Health and Family Welfare, India. He led development of many policy and strategic documents to improve health in India including Guidelines for treatment of conditions of public health significance and National Health Policy 2017 and was a member of the core group to prepare National Health Research Policy, 2021. He has contributed to 125 scientific literature, books and chapters and has also been conferred with many accolades including UNICEF awards for his professional contribution. Presently he is the Founder Chairperson and Managing Trustee, Three Domain Health Leadership Foundation and develops and conducts training in leadership. “
“Prof Neeta Kumar did MD in Pathology from the AIIMS, New Delhi and worked in progressively responsible positions at national and international at AIIMS and MAMC. She was Visiting Professor at University Hospital of Geneva and Aga Khan University Hospital, Nairobi. She was a consultant to WHO HQ in many areas especially in cancer control. Currently she is working as Professor and Head, General Pathology, Jamia Millia Islamia, New Delhi. She has special interest in medical education and research. She is Course Co- director for the various training workshops for since 2013. She was also chairperson of the internal research review committee at Jamia. She is a prolific scientific writer and has published more than 150 scientific papers, contributed chapters in WHO publications.”
“Dr Debleena Bhattacharya is presently Assistant Professor in Marwadi University (MU), Rajkot, Gujarat. Prior to joining MU, she has worked as Project coordinator for BIRAC-SRISTI PMU, a joint venture of Govt. of India and NGO located in Gujarat. She received her doctoral degree from IIT Dhanbad and her area of interest is wastewater treatment, environmental biotechnology, and molecular genomics. She has authored a book published by CRC Press, U.S.A alongwith scientific papers & book chapters.”
