NITI Aayog Vice-Chairperson Rajiv Kumar recently informed us of the Union government’s plan to establish a National Council of Integrated Medicine (NCIM), “which will prepare new curriculum for traditional medicine system”. A tweet, earlier in the year, from NITI Aayog’s official Twitter account read, “The time is ripe to promote & mainstream integrative medicine, an approach that combines modern medicine with alternative systems like #Ayurveda and #Yoga. Combining #AYUSH with modern medicine will be effective for treating non-communicable diseases.”
The United States National Center for Complementary and Integrative Health (NCCIH) tells us that while “complementary” health means “a non-mainstream practice .. used together with conventional medicine”, “integrative” (the US term for “integrated” in this case) health care “often brings conventional and complementary approaches together in a coordinated way. It emphasizes a holistic, patient-focused approach to health care and wellness—often including mental, emotional, functional, spiritual, social, and community aspects—and treating the whole person rather than, for example, one organ system. It aims for well-coordinated care between different providers and institutions.” A 1999 op-ed in the Western Journal of Medicine gives us further insight into what integrative medicine is about: “…
“It is much more important to know what sort of patient has a disease than what sort of a disease a patient has“….. Integrative medicine focuses on the need of each individual human being, asking the questions, “What do you love? What gives you strength in times of trouble? What gives your life purpose or meaning?” Although not typical questions asked during a physician visit, these questions are essential in integrative medicine, because they allow providers to understand their patients’ values and the context in which they live. It is then possible to design a unique treatment plan.” It also adds that, “Complementary and alternative medicine is practiced by both physicians and non-physicians – by far more non-doctors than physicians in most countries.”
These definitions of “integrated medicine” imply that conventional, scientific-evidence-based treatments are incomplete in a certain sense because they are impersonal and don’t focus on the individual being treated; that they only relieve the patient of the symptoms of disease while leaving the person unhealed and craving human touch. Practitioners and proponents of “integrated medicine” claim that their favoured trade helps bridge this gap – which could be of a psychological or spiritual nature. All of this will sound rather seductive to the average person. Life is hard. When one becomes ill, it becomes just a wee bit harder. Anyone who is ill loves to be comforted and to have their emotional needs paid attention to. Modern medical practice (“allopathy”) leaves doctors with little time to attend to these needs of patients – they typically and largely perform the essential task of diagnosing diseases and prescribing medicines, although there are exceptions. And here is where integrated medicine (IM) enters the scene. IM is essentially rebranded complementary medicine. By giving patients much more time than the average doctor, IM practitioners provide them with the attention they need. Ideally, friends and family should be the ones doing that. However, the apparent seriousness with which IM practitioners ask questions that patients want asked, and given that the sight of someone with medical authority is in itself a placebo, patients feel a lot more reassured when the same kind of care is shown by an IM practitioner.
In India, complementary and alternative medicine (CAM) is sought to be covered by the umbrella term AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. There is a Union Ministry dedicated to AYUSH since 2014. In addition, the central government has also provided recognition to acupuncture recently – an alternative, purportedly Chinese form of medicine which proposes to heal by channeling a mythical life essence known as “qi” (pronounced as “chee“) using needles to pierce the skin at specific ‘qi points’ in an attempt to diversify the field.
The mission of IM is to bring about a synergy of modern and traditional/alternative forms of medicine, appealing to best of both worlds approach. This suggests that there are certain features of CAM that have been neglected by mainstream medicine and a ‘holistic’ approach would be to combine these features with the latter. To this end, the National Health Policy of 2017 promotes the idea of “medical pluralism” (VIII of 2.2, pg. 5) which proposes to allow patients to “choose, and when appropriate, … have access to AYUSH care providers based on documented and validated local, home and community-based practices“. AYUSH is touted as “safe and cost-effective“. The AYUSH Ministry, for example, has been promoting an ‘anti-diabetic’ Ayurvedic drug named IME-9 as cheap, safe and effective. All this is seen as emblematic of India’s tradition of “accommodating… diverse and even foreign knowledge systems and pluralistic in its choices and practice of healthcare”. Healthcare is thus seen here as a synthesis of a variety of “knowledge systems”, like in art, philosophy, and culture.
Although it is obvious that the major thrust of the IM mission is on promoting Ayurveda and Yoga (see linked tweet above), “integration” also involves ideas like providing one-year bridge courses to AYUSH professionals so that they can become “mid-level care provider”, or in other words, be able to prescribe essential “allopathic” medicine to patients, something that only MBBS doctors are otherwise equipped and authorised to do (more on this later). Although the recently introduced National Medical Commission Bill has seemingly scrapped such bridge courses, it has a rather curious twist in it.
Under section 32 of the National Medical Commission (NMC) Act 2019, which talks about the role of the community health provider, it states: “The commission may grant limited license to practice medicine at mid-level as a community health provider to such person connected with modern scientific medical profession who qualify such criteria as specified by the regulations: “provided that the limited license to be granted under this subsection shall not exceed more than one-third of the total number of licensed medical practitioners registered under sub-section (1) of section 31.” Section 31 of the Act pertains to maintaining a national register of all the recognized medical practitioners by the Ethics and Medical Registration Board.
First, this clearly acknowledges that modern medicine is “scientific” – which by implication suggests that AYUSH is not scientific. Since everything we know about human health comes from scientific knowledge, why allow treatments that are not scientific? Second, the vagueness of the term “connected with modern scientific medical profession” means that even though bridge courses have temporarily been dispensed with, we are in the dark about who exactly will be deemed qualified to become community health providers. A Reuters report from 2015 has revealed this: “About 45 percent of the people in India who practice medicine have no formal training, according to the Indian Medical Association. These 700,000 unqualified doctors have been found practicing at some of India’s biggest hospitals, giving diagnoses, prescribing medicines and even conducting surgery.” Additionally, it reveals how purveyors of fake medical degrees – one in Delhi catered to about 50,000 seekers, pocketing around 7000 bucks for each – consider themselves to be doing a public service because they are “helping people with some medical experience get jobs“.
A 2018 report suggests it’s not just about fake degrees. Sometimes people ‘connected with modern scientific medical profession’, like those possessing both Bachelor of Ayurvedic Medicine and Surgery (BAMS) and MBBS degrees (which by the NMC Bill’s definition, is a mixture of science and non-science), to “treat [patients] with both systems of medicine” in a freestyle abuse of trust and exploitation of the medical ignorance of their patients. This is part of a wider cultural problem in India where the concept of consent in most cases simply does not exist, let alone of informed consent. A corollary of that is widespread corruption and coercion, which has not left medical practice unaffected. So what does the Bill do to protect patients from such “community health providers”? It seems that in a country where you can barely call a spade a spade, you are left ill-equipped to call a quack a quack.