Diluting Medical Care

In July 2010 the Madras High Court, in a landmark judgment, ruled that doctors qualified in Ayurveda, Siddha and Unani systems of medicine can practice ‘modern scientific medicine’ along with their respective systems. This Judgment was further buttressed by a Government Order (GO) issued by the Department of Health, Government of Tamilnadu, permitting practitioners of traditional systems of medicine to prescribe allopathic drugs and perform a range of surgical procedures including orthopedics, gynaecology, ENT, Ophthalmology etc. To understand the grave dangers posed by this unfortunate decision, one must understand the evolution of traditional and ‘modern’ medicine.

Conventional medicine that is practiced around the world is often referred to as modern medicine in India. About two hundred years ago western medicine was poorly developed and many of the practices like bloodletting caused more harm than good. It was in this setting that Samuel Hahnemann introduced the philosophy of Homeopathy in 1796 . Homeopathy became popular not because it was highly effective but because it was perceived as not being as dangerous as the conventional medical system of the time. In fact it was Samuel Hahnemann who referred to ‘the other treatment’ as Allopathy.

It was only in the last two hundred years with the discovery of microbes, antibiotics, anaesthesia, immunization, modern pharmacology and other aspects of medicine that conventional medical care in the West overtook the traditional practices all over the world. Unfortunately many traditional systems in India and China did not evolve with the times and remained rooted in ancient practices. Today Ayurveda, Siddha and Unani do have limited patronage in India. Their adherents are usually those who are wary of modern systems and perceive them as being unnatural and therefore dangerous. In fact these traditional medical systems have capitalized on the very same sentiments to promote themselves as an alternate system of medicine. For others, traditional systems carry a heritage charm of being ancient and therefore exotic - in fact, esoteric.

Unlike traditional systems that have strong cultural and religious overtones, popular modern medicine has freely rendered itself to change and criticism. Modern systems evolved because they are not steeped in ancient traditions that have a way of being sacrosanct and rigid.

It is therefore surprising that these traditional systems are now asking to obtain privileges for prescribing the very same drugs that were denounced by them as being foreign, dangerous and unsuitable to our heritage. The foundation of Ayurveda, Unani and Siddha systems are alien to conventional medicine. For example, the concept of health and disease is based on the balance of the three humors namely Vatha, Piththa and Kapa in Ayurveda and Siddha. While these concepts may have merit for those who wish to follow them, they are meaningless to the practitioners of modern conventional medicine. A medical graduate in Ayurveda or Unani, tutored in these tenets will not be capable of practicing a science that has a totally different outlook to disease and treatment.

The judicial as well as executive decisions to allow traditional practitioners the privilege of practicing conventional - Allopathic - medicine is obviously based on the interpretations of the word ‘modern.’ The argument that traditional medicine is ‘modern’ is based on the specious argument that the syllabi of degrees such as BAMS and BSMS include ‘modern’ medical subjects like anatomy, physiology and pathology. Modernity in medical terms does not mean the knowledge of subjects alone. It refers to the application of modern methods in diagnosis and treatment based on well documented concepts. Drugs used in modern medicine and the rationale for their use is certainly in conflict with traditional medical systems. Systems like Siddha, Ayurveda and Unani that do not recognize microorganisms as the cause for infections cannot prescribe antibiotics. The defining aspect of modernity in conventional healthcare is evidence-based medicine (EBM). All drugs in modern medicine go through a rigorous process from drug discovery to phase trials to marketing. Even advances in surgery are based on recent developments in infection control, anaesthesia and operating devices that have been developed on the basis of principles that are alien to traditional medicine.

In this context the decision of the Tamil Nadu state government to allow traditional medical graduates to practice modern medicine, even while they adhere to different concepts about basic physiology and pathology, is a dangerous tryst with the destiny of healthcare in India. If the adherents of traditional medicine feel the necessity to practice modern medicine and prescribe drugs that are unfamiliar to their system, they are free to do so if they obtain a regular medical degree like the MBBS. Alternate medicine degrees like BAMS and BSMS cannot be used as a shortcut to practice modern medicine. One cannot have the cake and eat it too!!