The Sciences

For Sick Indians, Modi Government's Ayurvedic 'Surgery' Order is the Unkindest Cut

Ayurveda supporters' appeals to the label of science are nothing but attempts to take a shortcut to credibility that is otherwise unattainable.

The Ministry of AYUSH has been a nuisance during the COVID-19 pandemic. Perhaps it has always been a nuisance but during the pandemic, while any other ministry might have stepped carefully, avoided panic and guided the sick and the confused through uncertainty, the Ministry of AYUSH has been doing the opposite. In fact, its decisions in this time are so far removed from the established precepts of practising medicine that it’s reasonable to wonder if its only agenda is to do the opposite of what is right.

First, there was the ill-considered advisory to consume untested substances prepared according to homeopathic and purportedly Ayurvedic recipes, and which the ministry said could cure a disease that we don’t fully understand even in November 2020 but which the ministry had presumed ancient Indians had known everything about. Then there were dubious claims that Prince Charles had recovered from COVID-19 using Ayurvedic medicine, the AYUSH minister choosing to be treated the allopathic way when he got COVID-19, and a glut of other recommendations from the ministry about using herbal remedies to evade the novel coronavirus.

As Anoo Bhuyan subsequently reported for IndiaSpend, these actions “lent legitimacy to home remedies and added to confusion over COVID-19” as well as “made frontline workers’ jobs more difficult”.

The latest salvo in this ill-conceived barrage was launched on November 20. A gazette notification by the Central Council of Indian Medicine (CCIM), a Ministry of AYUSH statutory body, formally authorises postgraduate students of certain ‘streams’ of Ayurvedic study to perform 58 surgical procedures (including various excisions, drainages and -ectomies; full list here).

The notification amends the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations 2016. And according to the amendment, “during the period of study, postgraduate scholars of Shalya and Shalakya shall be practically trained to acquaint with as well as to independently perform the [said] activities so that after completion of his PG degree, he is able to perform [said] procedures independently”.

The website of the National Institute of Ayurveda states that its “Shalya Tantra department” deals with various “surgical and parasurgical procedures”. It also says “Shalakya Tantra” refers to the branch of Ayurveda dealing with “diseases situated above the clavicle,” including “disorders of the ears, nose, throat, eyes, [teeth], head and neck”. Finally, the institute appears to be well-equipped, with general surgeons, anaesthesiologists, surgical specimens, teaching material and models, projectors and a library of “nearly 1,000 books”.

False credibility

The problem, however, lies not with technology but with regulation, which in this context stands for the responsibility to ensure a sick person receives well-tested, good-quality medical care in a fair and ethical manner when they need it. As the numerous examples attest, the brand of Ayurveda that the Ministry of AYUSH has been peddling in the last six years is neither.

The Ayurveda in Narendra Modi’s tenure as India’s prime minister has been markedly pseudoscientific. (Beyond pedagogy) Ayurveda practitioners have appealed to descriptions and recipes in various historical treatises but there doesn’t seem to be a common, standardised list of texts based on which they can operate – and therefore no one way to check the truth of their claims. Many practitioners have also said their research has been published – but this is a meaningless statement. Even I can publish my research if I’m willing to publish my own journal and get my friends to review. Where studies are published and under what terms matter.

It also doesn’t help that Ayurvedic education is rife with concepts and theories that have been debunked. As G.L. Krishna, an Ayurveda practitioner in Bengaluru, wrote for The Wire Science, the prevailing pedagogic ecosystem “legitimises superstitions and incentivises scientific dullness. Outdated pathophysiological ideas constitute a major portion of training in the current Ayurveda degree course. Ancient medical conjectures like blood acquiring its redness in the stomach or semen originating in the bone-marrow are taught to students at the university level! Even the more recent postgraduate entrance tests unabashedly ask questions about these ‘facts’. Ayurvedic journals also carry articles that build on such tooth-fairy science.”

But the principal reason this Ayurveda stokes concerns is that its exponents have tried to establish their credibility by using a method that wasn’t designed to test the credibility of Ayurveda: modern science. Ayurveda and homeopathy quacks are often prone to claim their methods are “scientific” and that they follow the scientific method. But it’s impossible for these systems of medicine to be verified by science because the way they obtain, organise and validate knowledge is entirely different.

Also read: A Homeopathic Defence Against COVID-19 Is No Defence at All

For example, as far as medicine is concerned, consuming acetylsalicylic acid (Aspirin) is likely to make moderate headaches more tolerable in a large fraction of the general population. But Ayurveda and homeopathy both insist on keeping medicine ‘personal’ – preparing treatments and therapeutic regimens that are customised to each individual’s predispositions and lifestyle – as well as less instantaneous. So while it’s readily possible to test the efficacy and safety of acetylsalicylic acid in a large clinical trial, such trials are bound to be useless for any Ayurvedic or homeopathic concoctions that purport to work only together with a variety of lifestyle changes and other preparations.

In fact, Ayurveda and allopathy are so incommensurable that, to quote Dr Jammi Nagaraj Rao writing in News Laundry, if the “process of extracting the active ingredient from a herb or plant, studying and recording its properties first in cell models, then in animal models, and finally in human trials … were successfully followed, the remedy being researched would no longer be an Ayurvedic product but a new chemical entity. At that point, it would have transitioned from traditional to mainstream medicine.”

This is why appeals to the label of science – without any parallel efforts to develop alternative methods of validation – are nothing but attempts to take a shortcut to credibility, credibility that is otherwise unattainable. The Indian Medical Association (IMA) has recognised this as well. As PTI reported, “Demanding that the order be withdrawn, the IMA urged the CCIM to develop their own surgical disciplines from their own ancient texts and not claim the surgical disciplines of modern medicine as their own.”

Indeed, surgical methods have also been tested together with the drugs and techniques available to achieve various outcomes, so grafting Ayurvedic concepts onto allopathic substrates can easily become disastrous. As Dr Koushik Chaki, a member of the West Bengal Doctors’ Forum, told The Hindu: “For surgery you need anaesthesia and antibiotics. Does Ayurveda have them? If Ayurveda develops its own anaesthesia and antibiotics, I am fine with it; if people choose to get operated upon by an Ayurveda practitioner, I am fine with that too. But you cannot accord legal status to what we call crosspathy or mixopathy.”

In a previous statement, published on November 5, the IMA had taken aim at NITI Aayog’s efforts to integrate multiple systems of medicine in India. According to the statement, doing so to produce a “khichdi medical system” would only “legalise quackery”, “produce hybrid doctors who are nowhere”, and deprive patients of the choice to opt for allopathic care in some cases and Ayurvedic care in others.

Shortage of healthcare workers

Regulation also raises its head in the context of practice. India has a well-known shortage of doctors and other healthcare workers. Priyanka Pulla reported in 2015 that some NGOs in India are attempting to retrain rural medical practitioners, who practice their own versions of medicine and are completely unregulated, to provide basic healthcare services like prescribe simple antibiotics and treat common illnesses.

The IMA has been opposed to this idea but other doctors have supported it because while rural practitioners lack any medical training, they are often present where trained doctors aren’t, in India’s more remote areas. One such retraining programme requires its graduates to drop the prefix ‘Dr’ from their names and stop prescribing Schedule H and X drugs – in exchange for greater legitimacy in the eyes of the state and more support.

The CCIM’s ambition, however, seems to avoid even this excuse. India’s shortage of doctors is more than reflected in its shortage of specialist doctors, including general surgeons. But the Ministry of AYUSH, as well as the CCIM, have seemed more intent in couching their moves in a wider narrative of dragging similes of Ayurveda and other medicinal traditions into the mainstream than in helping India improve its doctor-patient ratio without sacrificing the quality of medical care.

Also read: ‘Inflicting Fraud’: IMA Questions Centre on Ayurveda, Yoga Treatments for COVID-19

The retraining programme tries to mitigate the risk of visiting rural medical practitioners by offering legitimacy as an incentive. That is, the ultimate goal – even though it may be far and perhaps too idealistic – is to integrate people into a well-known system. The CCIM move, on the other hand, presents surgical wards at allopathic hospitals with a larger pool of people to hire from as well as allows Ayurveda practitioners – registered or otherwise, legitimate or otherwise – to start performing fairly unknown surgical procedures with legal sanction.

The only way the new amendment can play out without a hitch is if it is complemented by the same legal and regulatory instruments surrounding the provision of allopathic surgical care – including ethics checks, fixed protocols for different medical conditions (instead of different methods sourced from different texts), assurances of quality and safety, regularised post-operative care, and grievance redressal. This in turn would mean taking the right first steps first – developing more suitable testing methods, creating a common list of source texts, enforcing NABH standards, turning away from ‘mixopathy’, etc.

However, if the goal here is to (falsely) advertise that ‘Bharat’ knew something before everyone else, or that it’s anti-national to not prefer Ayurveda, these demands may be too much for the Ministry of AYUSH to accommodate. It would much rather be left doing the opposite of what the country needs right now.