Central idea

• In a recent development, the Indian Council of Medical Research (ICMR) and the Ministry of Ayush have agreed to enhance cooperation in health research related to integrated medicine. This collaboration aims to establish Ayush departments within prestigious medical institutions like AIIMS. However, this move has sparked a debate regarding the efficacy and viability of an integrated system of medicine.

What is integrated system of medicine?

• An integrated system of medicine refers to an approach that combines elements from different healthcare systems or modalities, such as conventional medicine and traditional or complementary/alternative medicine, with the goal of providing comprehensive and patient-centered care.

Common features of integrated system of medicine

• Holistic Approach: An integrated system of medicine takes a holistic approach to healthcare, recognizing the interconnectedness of various aspects of health, including physical, mental, emotional, and spiritual well-being. It considers the whole person rather than focusing solely on symptoms or specific diseases.
• Multiple Healthcare Modalities: It incorporates multiple healthcare modalities and disciplines, such as conventional medicine, traditional medicine systems (e.g., Ayurveda, Traditional Chinese Medicine), complementary and alternative medicine (e.g., acupuncture, herbal medicine), mind-body practices (e.g., yoga, meditation), and other evidence-based therapies.
• Collaborative and Interdisciplinary Care: An integrated system of medicine encourages collaboration and cooperation among healthcare providers from different disciplines. This interdisciplinary approach allows for a comprehensive assessment of the patient’s needs and the development of personalized treatment plans.
• Evidence-Based Practice: The integration of different healthcare modalities is based on scientific evidence, research, and clinical guidelines. It emphasizes the use of evidence-based practices, ensuring that treatments and interventions are safe, effective, and supported by reliable data.
• Individualized Treatment: An integrated system of medicine recognizes that each person is unique and may require personalized treatment approaches. It considers individual circumstances, preferences, and goals when developing treatment plans, allowing for customized care.
• Emphasis on Prevention and Wellness: It places importance on preventive measures, health promotion, and wellness-oriented approaches. It aims to identify and address underlying factors that contribute to illness, focusing on strategies to prevent disease and promote optimal health.
• Patient-Centered Care: An integrated system of medicine prioritizes the patient’s needs, preferences, and values. It involves active patient participation in healthcare decision-making, education, and self-care practices. The patient is viewed as a partner in their own healthcare journey.
• Continuity of Care and Care Coordination: An integrated system of medicine strives for seamless coordination and continuity of care across different healthcare modalities. It emphasizes effective communication, information sharing, and collaborative management to ensure comprehensive and well-coordinated healthcare.

Ayush inpatient and outpatient departments at Central government hospitals

• Dedicated AYUSH departments: The Ayush Ministry has decided to open dedicated AYUSH inpatient and outpatient departments at Central government hospitals to provide services related to Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (collectively known as Ayush systems of medicine).
• Aims to provide wider range of treatment options: This initiative aims to integrate traditional and complementary medicine practices into mainstream healthcare, offering patients a wider range of treatment options and promoting holistic healthcare approaches.
• Aims to promote and preserve traditional healthcare: The decision to establish these departments reflects the government’s recognition of the growing popularity and acceptance of Ayush systems of medicine in India. It aligns with the ministry’s goal of promoting and preserving traditional healthcare practices, while ensuring their integration within the broader healthcare framework.
• Facilitate and a boost to research: Opening Ayush departments in Central government hospitals also facilitates research, as it allows for the investigation of the effectiveness and safety of Ayush treatments in conjunction with conventional medical practices. This collaboration between Ayush and modern medicine can lead to the development of standardized protocols, better understanding of the potential benefits, and improved patient outcomes.

Facts for prelims

What is mean by complementary and alternative medicine (CAM)?

• Complementary and alternative medicine CAM refers to medical practices and treatments that are not considered part of conventional mainstream medicine.
• It encompasses a broad range of practices, systems, and therapies, which may include herbal medicine, traditional healing practices, acupuncture, homeopathy, naturopathy, chiropractic care, Ayurveda, and traditional Chinese medicine, among others.
• These practices often have their roots in ancient cultural and traditional healing systems.

Prevalence of complementary and alternative medicine (CAM)

• Global Acceptance: Alternative medicine practices are popular and widely accepted in many countries worldwide. Traditional healing systems, herbal remedies, and other alternative therapies have been part of various cultures for centuries.
• Regional Variations: The prevalence of alternative medicine varies across regions and countries. Some regions have a long-standing cultural and historical association with specific traditional healing practices, while others have seen increased adoption due to globalization and growing interest in holistic health approaches.
• High Usage Rates: Surveys indicate that a significant portion of the population in various countries has used alternative medicine at some point in their lives. The prevalence rates can range from around 30% to over 70%, depending on the country and the specific therapies or practices included in the survey.
• Specific Modalities: Different alternative medicine modalities may have varying levels of popularity. Practices such as acupuncture, herbal medicine, chiropractic care, and traditional medicine systems like Ayurveda and traditional Chinese medicine are among the commonly used modalities.
• Complementary Use: Many individuals use alternative medicine alongside conventional medical treatments. This approach, known as complementary medicine, involves integrating alternative therapies with standard medical care to address a broader range of health concerns.
• Health Conditions: Alternative medicine is sought for various health conditions, including chronic pain, mental health issues, musculoskeletal problems, gastrointestinal disorders, and general well-being. People often turn to alternative medicine when conventional treatments have been unsatisfactory or to explore more holistic and natural approaches.
• Wellness and Prevention: Alternative medicine is also used for wellness promotion and preventive care. Practices such as yoga, meditation, and dietary supplements are frequently utilized to support overall health and prevent illness.
• Global Trends: The prevalence of alternative medicine continues to grow globally. Factors such as increased awareness, patient empowerment, access to information, and a desire for more personalized and holistic healthcare contribute to this trend.

Why do patients gravitate towards complementary/alternative medicine?

• Holistic Approach: Complementary/alternative medicine often takes a holistic approach to healthcare, considering the physical, mental, emotional, and spiritual aspects of a person’s well-being. It focuses on treating the whole person rather than just the symptoms or specific diseases.
• Dissatisfaction with Conventional Medicine: Some patients may have had unsatisfactory experiences with conventional medicine, such as ineffective treatments, adverse effects, or limited time with healthcare providers. As a result, they may seek alternative options that offer a different approach and more personalized care.
• Desire for Natural and Non-Invasive Treatments: Complementary/alternative medicine often emphasizes natural remedies, herbal therapies, nutritional interventions, and non-invasive techniques. Patients who prefer a more natural or gentle approach may be drawn to these methods, especially when conventional treatments involve pharmaceutical drugs or invasive procedures.
• Empowerment and Active Participation: Complementary/alternative medicine often encourages patients to take an active role in their health and treatment decisions. Patients may feel empowered by being involved in the decision-making process, exploring lifestyle modifications, and engaging in self-care practices.
• Prevention and Wellness Focus: Many complementary/alternative medicine practices emphasize preventive measures and lifestyle modifications to promote overall health and wellness. Patients who are interested in maintaining good health and preventing future illnesses may be attracted to these approaches.
• Cultural or Traditional Beliefs: Certain complementary/alternative medicine systems have deep cultural or traditional roots. Patients from specific cultural backgrounds may have a strong belief in the efficacy of these practices and may choose them based on cultural heritage or family traditions.
• Perception of Individualized Care: Complementary/alternative medicine often places importance on individualized care, taking into account the unique needs and circumstances of each patient. This personalized approach may resonate with patients who value a more tailored and comprehensive treatment plan.
• Perception of Fewer Side Effects: Some patients perceive complementary/alternative medicine to have fewer side effects compared to conventional medicine. They may be concerned about the potential adverse effects of pharmaceutical drugs and prefer to explore alternative options that are perceived as safer.

Does the sale of these medicines need to be regulated?

• Safety and Efficacy: Regulation helps ensure that alternative medicines meet certain safety standards and have demonstrated efficacy. This is important to protect consumers from potential harm or ineffective treatments.
• Quality Control: Regulation helps maintain consistent quality in the production and distribution of alternative medicines. It can include measures to ensure proper sourcing of ingredients, good manufacturing practices, quality testing, and adherence to labeling requirements.
• Consumer Protection: Regulation provides a framework for consumer protection by establishing rules and guidelines for marketing, advertising, and claims made by manufacturers and practitioners of alternative medicines. This helps prevent misleading or false information and ensures that consumers can make informed choices.
• Standardization: Regulation facilitates the standardization of formulations and practices within alternative medicine systems. Standardization helps establish consistency, reliability, and reproducibility of treatments, allowing for better comparisons and research in the field.
• Adverse Event Reporting: Regulatory oversight enables the monitoring and reporting of adverse events associated with the use of alternative medicines. This helps identify potential risks and allows for timely interventions to protect public health.
• Integration with Conventional Medicine: Regulation promotes the integration of alternative medicine with conventional healthcare systems. It establishes frameworks for collaboration, communication, and referral between practitioners of different modalities, ensuring coordinated and safe care for patients.
• Professional Accountability: Regulatory measures can include licensing, certification, and registration requirements for practitioners of alternative medicine. This helps ensure that practitioners meet certain educational and competency standards, promoting professionalism and accountability in the field.
• Public Confidence: Regulation helps build public trust and confidence in alternative medicine. Clear regulations and oversight mechanisms provide reassurance to consumers, healthcare professionals, and policymakers that alternative medicines are subject to scrutiny and oversight, contributing to the credibility and acceptance of these practices.

Value addition box from Civilsdaily: Differences between Naturopathy and Allopathy

Conclusion

• The debate on the integration of Ayush practices within mainstream healthcare reflects contrasting perspectives. While there are immense potential benefits of an integrated system it also raises concerns about the scientific validity and safety of alternative medicine. Striking a balance between evidence-based medicine, patient preferences, and regulatory oversight is essential.

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Central Idea

• Ayurveda graduates face significant challenges in pursuing a career in Ayurvedic practice due to widespread scepticism about the efficacy of Ayurvedic theories and practices. Despite the publicity campaigns to promote Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH), the fact is that there is a trust-deficit in these systems.

What is National AYUSH Mission?

• Department of AYUSH, Ministry of Health and Family Welfare, Government of India has launched National AYUSH Mission (NAM) during 12th Plan for im­plementing through States/UTs.
• The basic objective of NAM is to promote AYUSH medical systems through cost effective AYUSH services, strengthening of educational systems, facilitate the enforcement of quality control of ASU &H drugs and sustainable availability of ASU & H raw-materials.
• It envisages flexibility of implementation of the programmes which will lead to substantial participation of the State Governments/UT.
• The NAM contemplates establishment of a National Mission as well as corresponding Missions in the State level.

What is Ayurveda?

• Sanskrit word: Ayu means life, and Veda means knowledge or science Hence it is “The Science of Life.”
• Ayurveda is a traditional system of medicine that originated in India more than 5,000 years ago.
• It was taught orally from one generation to another by accomplished masters.
• Some of this knowledge was later put into writing, but much of it remains inaccessible.
• The principles of many natural healing systems, including Homeopathy and Polarity Therapy, have their roots in Ayurveda.

What are the reasons for the public’s skepticism towards Ayurveda?

• Failed to keep the pace: The Ayurveda establishment has failed to keep pace with the intellectual and scientific advances of the times.
• Archaic theories and lack of evidence-based quality: Archaic theories that are apt to arouse suspicion in the minds of educated patients are peddled as sophisticated dogmas. Treatments are not subjected to straightforward testing as they are claimed to be based on these theories
• Perception that Ayurvedic treatments are slow to heal: Ayurveda treatments are slow to heal is another common view that characterises the public image of Ayurveda.

What are the challenges faced by Ayurveda graduates in pursuing a career in practice?

• Practical usability is limited: Limited practical usability of ancient medical wisdom taught in college training
• Lack of vibrant ecosystem of Research: Dependence on personal experimentation due to a lack of a vibrant ecosystem of science and research. The Research process involves a lot of trial and error with patients and predictably leads to an erosion of the practitioner’s reputation.
• Necessity of complementing Ayurveda with modern medicine: Inability to treat all primary-care illnesses, necessitating complementing with modern medicine, which is prohibited in most states.
• Unhealthy competition and advertisements: Competition from gimmickry and publicity-based practitioners.

How can appropriate policy-making help solve these challenges?

• Proper training: Rejuvenating primary care by training Ayurveda graduates to become good primary-care doctors.
• Evidence-based appraisal of Ayurveda: Conducting a vigorous evidence-based appraisal of Ayurvedic theories and practices to sift the usable from the obsolete
• Practice modern medicines: Statutory decision to allow Ayurveda graduates to practice modern medicine in stipulated primary care areas

Conclusion

• Ayurveda prioritizes patient benefit over gratification and emphasizes prevention through balance, diet, lifestyle, and herbs. Sustainable treatment requires a gradual transition to wellness. Ayurveda, science, and public welfare all stand to gain. What is needed is sincerity, straight-thinking, and some adventurism on the part of stakeholders.

Mains Question

Q. What is Ayurveda? Despite of the efforts to promote Ayurveda, the graduates face significant challenges in pursuing a career in Ayurvedic practice. Discuss.

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Context

• Prime Minister Narendra Modi commended the recent growth of traditional medicine (TM), and Ayurveda in particular, while addressing the World Ayurveda Congress 2022 (WAC) earlier this month. Noting the lag in evidence despite considerable research, he gave a clarion call “to bring together medical data, research, and journals and verify claims (benefit) using modern science parameters”.

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All you need to know about World Ayurveda Congress (WAC)

• Platform by World Ayurveda foundation: The World Ayurveda Congress (WAC) is a platform established by World Ayurveda Foundation to propagate Ayurveda globally in its true sense.
• Platform to connect various stakeholders in medicine: World Ayurveda Congress (WAC) is a platform to connect Ayurveda practitioners, medicine manufacturers, enthusiasts and academicians.
• What is the mandate: World Ayurveda Congress (WAC) & Arogya Expo monitors progress and initiate missions and collect feedbacks.

World Ayurveda Congress (WAC), 2022

• 9th edition of WAC held at Panjim, Goa: The 9th edition of World Ayurveda Congress (WAC) & Arogya Expo was organized at PANJIM, GOA.
• Organised by Ministry of AYSUSH on the principle of whole government approach (WGA): The WAC organised by the Ministry of AYUSH on the ‘Whole Government Approach’ (WGA) to foster and strengthen the research ecosystem for AYUSH systems.
• What is Whole System Approach (WSA): The concept of WGA is in consonance with the “Whole System Approach” (WSA). WSA encompasses integrated and network participation of several stakeholders (including patients and the community) for better solutions (treatment outcomes) in a challenging and complex situation. IM is an important component of WSA in the current context.
• Active Participation: The event witnessed the active participation of more than 40 countries and all states of India.
• PM’s vision: To transform the healthcare system of the country and to develop a healthy society, there is a need to think holistically and integrate the Traditional medicine (TM) and modern medicine system (MM).

World Ayurveda Foundation (WAF)

• Aim of WAF: WAF is an initiative by Vijnana Bharati aimed at global propagation of Ayurveda, founded in 2011.
• Objective and core principle: The objectives of WAF reflect global scope, propagation and encouragement of all activities scientific and Ayurveda related are the core principles.
• Focus Areas: Support to research, health-care programmes through camps, clinics and sanatoriums, documentation, organization of study groups, seminars, exhibitions and knowledge initiatives to popularize Ayurveda in the far corners of the world are the broad latitudes of focus at WAF.

What is Traditional Medicine?

• According to WHO: The WHO describes traditional medicine as 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”.
• Culmination of multiple ancient practices: Its reach encompasses ancient practices such as acupuncture, ayurvedic medicine and herbal mixtures as well as modern medicines.
• Percentage of people use traditional medicine: of According to WHO estimates, 80% of the world’s population uses traditional medicine.

Traditional medicine in India

• It is often 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.
• The Siddha system is followed predominantly in Tamil Nadu and Kerala.
• The Sowa-Rigpa System is practised mainly in Leh-Ladakh and Himalayan regions such as Sikkim, Arunachal Pradesh, Darjeeling, Lahaul & Spiti.

How TM modalities (such as Ayurveda or homoeopathy) can scientifically align with MM for a better outcome?

• Remarkable success in treating neurological diseases: A recently established Department of IM in NIMHANS continued to show remarkable success in treating difficult neurological diseases with a team of Ayurvedic and MM physicians and carefully planned and monitored IM strategy.
• CRD projects: Modern rheumatology practice in the Centre for Rheumatic Diseases (CRD) model includes critical elements of TM and Ayurveda, which have shown unequivocal evidence in CRD research projects
• Evaluation based on other protocols: Several controlled protocols-based evaluations of standardised Ayurvedic drugs and other TM modalities (such as diet, exercise, yoga, and counselling), often in conjunction with MM, in arthritis patients, were completed.
• Sustained clinical improvement in patients suffering from active Rheumatoid arthritis (RA): RA is a severely painful crippling lifelong autoimmune condition, mostly seen in women, and universally acknowledged as difficult to treat. Supervised and monitored IM intervention (including Ayurvedic drugs) over several years showed a consistently superior and sustained clinical improvement in patients suffering from active RA.

Relationship between AYUSH and Modern medicines

• AYUSH systems include Ayurveda, Homeopathy, Unani, Siddha, and other TM.
• AYUSH systems and MM differ radically in several ways or so it seems.
• Modern scientific research in Ayurveda is often at variance with classical Ayurveda.
• Unlike MM, TM has at its core a personalised approach. MM is dominantly reductionist.
• The ambitious futuristic programme of TM and IM by AYUSH is well-intended and in the right direction.

Conclusion

• TM and Ayurveda need to respond to the new world order, which has changed substantially recently. It is reasonably certain that MM and TM in the current format will continue to treat several medical disorders and altered health states. But evidence-based medicine will become the new mantra. Also, informed and empowered patients and people will continue to make the right choices.

Mains question

Q. What is World Ayurveda congress? What is tradition medicines? How Traditional medicines can align with modern medicines to treat several serious medical disorders.

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