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Source: Hindu

Context

The recent debate on X between a hepatologist and an Indian chess Grand Master over whether practitioners of traditional medicine can claim to be doctors has sparked much discussion about the role and status of practitioners of traditional Indian medicine systems such as Ayurveda and Unani in India.

About AYUSH

• Ayurveda is a 3000+ year old Indian traditional medical practice that emphasizes body balance through diet, lifestyle modifications, and herbs.
• Yoga and Naturopathy: Yoga comprises exercises and breathing techniques, but naturopathy relies on natural means of healing.
• Unani is an ancient medicinal system that originated in Greece and Arabia.
• Siddha is a traditional system followed predominantly in South India.
• Homoeopathy: A German alternative approach based on the 'like cures like' idea.

Evolution of the Legal Framework

• Early Committees and Differing Views: The 1946 Bhore Committee advocated for contemporary evidence-based medicine while limiting traditional medicine. In contrast, the 1948 Committee on Indigenous Systems employed Hindu nationalist language to defend Ayurveda, saying that its demise was caused by foreign dominance.
• Government Recognition and Laws: While formal recognition was denied during the Nehru era, the Indian Medicine Central Council Act was passed by the Indira Gandhi government in 1970. It acknowledged Ayurveda, Siddha, and Unani. The National Commission for Indian System of Medicine Act took effect in 2020, replacing this legislation.
• Ayurvedic Curriculum Contradictions: The Ayurvedic syllabus incorporates both metaphysical concepts such as doshas and atmas as well as scientific topics like as anatomy and cell physiology. These theories fundamentally contradict, rendering integrative medicine impossible owing to irreconcilable foundations.

Concerns with Ayurvedic Doctors Prescribing Modern Drugs

• Lack of Scientific Training:
  Ayurvedic doctors often do not have formal training in modern pharmacology or diagnostic techniques. This may lead to inappropriate prescriptions, such as giving steroids or antibiotics without understanding correct dosages or side effects.
  
  
• Violation of Legal Norms:
  As per the Supreme Court's Dr. Mukhtiar Chand case judgment, non-MBBS doctors cannot prescribe allopathic medicines. However, conflicting state-level orders have created legal confusion.
  
  
• Consumer Deception and Litigation:
  Patients may mistake Ayurvedic doctors for MBBS practitioners when they are prescribed modern drugs. This has resulted in lawsuits, such as a Delhi case where a doctor’s qualification was challenged in court.
  
  
• Risks in Critical Care:
  Some private hospitals hire BAMS doctors in emergency settings to reduce costs. This can lead to patient harm due to delayed or incorrect treatments, especially in life-threatening situations.
  
  
• Undermining Rational Drug Use:
  Unchecked use of modern drugs by Ayurvedic doctors leads to antibiotic resistance and irrational prescriptions. A Uttar Pradesh health audit revealed widespread use of modern medicines by AYUSH doctors without oversight.
  

Evolution of Traditional Medicine Regulation in India

• Recognition of AYUSH Systems:
  India officially recognized Ayurveda, Yoga, Unani, Siddha, and Homeopathy post-independence. The Department of ISM&H (1995) was later upgraded to the Ministry of AYUSH (2014).
  
• Legal Frameworks:
  The Indian Medicine Central Council Act (1970) established the Central Council of Indian Medicine (CCIM). It was replaced by the National Commission for Indian System of Medicine (NCISM) under the NCISM Act, 2020.
  
  
• Integration with Healthcare:
  Traditional medicine is now part of public health through the National Health Policy (2017) and initiatives like AYUSH Health and Wellness Centres under Ayushman Bharat, promoting pluralistic healthcare governance.

AYUSH (specifically Ayurveda) Vs Modern Medicine:

Aspect	AYUSH (Ayurveda)	Modern Medicine
Theoretical Framework	Based on the balance of doshas – Vata, Pitta, Kapha	Based on cell biology, physiology, anatomy, and pathogens (bacteria, viruses)
View of Disease	Illness is caused by imbalance in doshas	Illness is caused by germs, infections, organ dysfunctions, etc.
Spiritual Dimensions	Integrates concepts like Paramatma (supreme soul) and Jeevatma (individual soul)	Primarily biological and scientific, minimal or no spiritual consideration
Diagnosis Approach	Diagnosis through pulse reading, observation, and prakriti (body constitution)	Diagnosis via lab tests, imaging (MRI, CT), and clinical investigations
Treatment Methods	Includes herbs, diet, lifestyle changes, and detox therapies (Panchakarma)	Includes pharmaceutical drugs, surgeries, vaccines, and evidence-based therapies
Philosophical Basis	Rooted in holistic, natural, and ancient Indian philosophy	Rooted in Western scientific method and empirical research
Integration Challenges	Conceptual differences make integrative medicine difficult	Integration faces resistance due to lack of common scientific grounding
Common Belief	“Both cannot run together” – due to incompatible foundations	Integration seen as possible only with scientific validation of traditional practices

Why is there a controversy over Rule 2(ee) of the Drugs and Cosmetics Rules?

• Rule 2(ee) defines "registered medical practitioners" as those with the authority to prescribe contemporary medications. It gives state governments the authority to include non-MBBS practitioners under specific conditions. This gap allows Ayurvedic and Unani doctors to prescribe contemporary medicines.
• Although the Supreme Court ruled in the Dr. Mukhtiar Chand case that this was unlawful, many states continue to do so. The Indian Medical Association routinely challenges such usage in court.

Legal Stance on Prescription Rights

• Drugs and Cosmetic Rules, 1945:
  
  
• Under Rule 2, Section EE, a Registered Medical Practitioner is anyone officially licensed by a recognized medical system.
  
  
• This rule permits state governments to register practitioners to prescribe modern medicines, not exclusively MBBS doctors.
  
  
• Supreme Court Ruling (1998):
  
  
• In Dr. Mukhtiar Chand & Others vs. State of Punjab & Others, the Supreme Court held that
  
  
• Doctors can only prescribe medicines within their own system of medicine.
  
  
• AYUSH doctors (Ayurveda, Unani, etc.) cannot prescribe modern allopathic drugs.
  
  
• Continued Non-Compliance:
  
  
• Despite this ruling, many state governments allow AYUSH doctors to prescribe allopathic medicines.
  
  
• This is often due to political pressure from AYUSH practitioners.
  
  
• The Indian Medical Association (IMA) has challenged such permissions in multiple High Courts.
  

The Debate Over Surgical Procedures

• Hospital Practices:
  
  
• Many private hospitals employ BAMS doctors (Ayurveda) instead of MBBS doctors to cut salary costs.
  
  
• These doctors sometimes perform medical procedures despite limited training in allopathic practices.
  
  
• Government Order (2020):
  
  
• The government issued a notification allowing Ayurvedic PG doctors to perform 58 types of surgeries.
  
  
• These include procedures like gall bladder removal, appendix surgery, and benign tumour removal.
  
  
• The order is currently challenged in court.
  
  
• Key Concern:
  
  
• These surgeries require the use of anaesthesia, antibiotics, and other modern techniques.
  
  
• AYUSH education does not cover these areas adequately, raising concerns about patient safety and medical ethics.
  
  

What is AYUSH's impact on public health insurance?

• Inclusion into Ayushman Bharat: AYUSH systems have been integrated in the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), allowing beneficiaries to receive treatment at AYUSH hospitals. This increased the availability of services, particularly in rural and impoverished areas where traditional medicine is generally accepted.
• Cost-effective Care Delivery: Treatments with AYUSH are frequently less expensive than allopathic procedures. For example, Panchakarma therapy for lifestyle problems and Ayurvedic therapies for arthritis are less expensive, decreasing the financial load on insurance companies and the government.
• Increased utilization and trust: With AYUSH covered by insurance, more people are turning to traditional medicine. This has increased the use of AYUSH healthcare facilities and encouraged medical pluralism, resulting in a greater public health reach in India.

Way forward:

• Strengthen Evidence-Based Integration: Create an independent regulatory agency for traditional medicine that oversees scientific validation, clinical trials, and safety monitoring prior to public endorsement or inclusion in health plans. This helps to retain credibility and public trust.
• Depoliticize Health Governance: Develop traditional medicine policies through expert-led groups that include representatives from all health systems and are free of political involvement. This promotes balanced development, equitable support, and a consistent integration into the national health framework.

Practice Question Q. Examine the legal, educational, and political challenges associated with allowing Ayurvedic practitioners to prescribe and perform modern medical treatments in India.