Modern healthcare professionals are being asked to be more open to traditional and alternative medical systems and move toward integrative medicine for the greater good of patients. Although fundamentally appealing, we recommend that you consider the practical issues involved. Depending on the level of integration, there are three possible scenarios for the existence of these two treatment systems.
Although we recognize the possibility of hybrid scenarios, for simplicity we will refer to them as competition, coexistence, and cooperation.
In the competitive model, the two health systems exhibit an adversarial relationship. Individual professionals can always do whatever they want, but in this scenario, blame also occurs at the system or professional association level.
Professional associations and professional councils will sue each other. Both systems compete to lure patients to their system by pointing out their strengths and the weaknesses of the other system. These may be related to product efficacy, side effects, and extraneous factors such as nationalism or commercialism. In short, “all is fair in war.”
In the “coexistence” model, each system recognizes the legitimacy of the other and chooses clear boundaries to ensure that they can coexist without violating the domain or territory of the other system. Most modern medical practitioners let the patient decide whether or not to undergo AYUSH treatment. They will advise the patient whether to continue the medication or accept responsibility for discontinuation. If AYUSH is effective, the dosage of the drug will be automatically reduced.
Ayurvedic and homeopathic practitioners typically ask patients to discontinue modern medicine if they wish to begin treatment. In this model, these practitioners may be co-located in a facility, with each treatment modality having its own separate system. However, there is no mutual introduction. In a nutshell, the principle is “live and let live.”
The “collaborative” mode is an ideal integrated care model in which the two streams recognize the strengths of the other system and work together as a team to provide the best care for the patient. This has the potential to improve the prevention and promotion elements of modern medicine, which focus too much on medicine.
I think there are 4 sets of challenges so far. The first is a lack of trust between the two groups. There are many examples of patients whose disease was well or poorly controlled with one treatment and whose disease worsened or improved when they switched to another treatment. Most of this is anecdotal evidence and can be cited to justify whatever view you hold. This situation is further exacerbated by AYUSH proponents claiming effective treatments for diabetes and cancer without sufficient evidence to support them.
The technical challenge is that AYUSH is a heterogeneous group and each of these treatment areas must be treated separately, requiring different decisions. Increasing evidence of yoga’s effectiveness in managing and preventing a variety of health conditions has led to its increasing acceptance among modern medical practitioners.
Non-pharmacological aspects may be easier to integrate once evidence is generated. Prescription of medicine (Ayurveda/Homeopathy) will continue to be a point of contention. Can the dosha-based management proposed by Ayurveda align with the standard management protocols promoted by modern medicine?
When it comes to operational challenges, working in a team-based approach requires team members to understand their own limitations and recognize the strengths of others in the area. Modern medical practitioners have no understanding of his AYUSH flow and are unable to make informed decisions in this regard. They have to accept what AYUSH practitioners say at face value, which is difficult given the lack of trust. Patients themselves are not given enough information to make these decisions, and it is inappropriate to leave these decisions up to them.
However, the most difficult aspect of this integration will be its regulation. Many modern practitioners prescribe Ayurvedic medicines without understanding how they work. This is unacceptable and accordingly AYUSH practitioners should not practice modern medicine. Although this seems reasonable, its enforcement is currently very weak. These areas are under the jurisdiction of their respective professional councils. Unfortunately, the City Council has not been able to instill confidence in demanding professional accountability. Who is responsible if something goes wrong with the patient?
So how do we move forward? The first step is to obtain better evidence for AYUSH treatment. Only this can fill the lack of trust. Also, use this opportunity to eliminate ineffective treatments from AYUSH. Once the evidence is available, it may be possible to construct composite standard treatment guidelines that combine the best of the two streams. However, the evidence benchmarks that apply to modern medicine must apply to AYUSH therapy as well. This is one of the big points in this discussion. I believe that if we consider the evidence without being influenced by extraneous considerations, we can reach a consensus about certain chronic diseases. These can be a good starting point for a larger discussion.
Would it be helpful to teach these subjects to other streams? In the Ayurveda course, you will learn some modern medical concepts. Should MBBS students also be taught all her AYUSH subjects? The MBBS curriculum itself is very heavy and there is never-ending pressure to focus on particular subjects. Adding her AYUSH subjects to MBBS makes the situation even worse. One way is to not test these subjects or to make them optional. However, there’s a good chance it won’t be read at all, and your purpose may not be achieved. This course is not recommended.
A good regulatory framework that establishes rules/guidelines for collaboration, communication, and referrals between practitioners of different therapies, clearly delineates accountability, and ensures coordinated and safe care for patients is desperately needed. It is being It will be necessary to define acceptable interventions and the manner in which they are determined. Other regulatory issues will relate to claims, compensation, medicines and quality of medicines. This could be within the framework of health technology assessment already available in India. The bottom line is that our approach must be evidence-based. While some issues can be addressed and evaluated in pilot projects, they will not work without a strong regulatory framework.
The author is Professor of Community Medicine, All India Institute of Medical Sciences, New Delhi.views are personal
