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One system, four practices

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There are amusingly diverse trends in the way Ayurveda is treated by its practitioners

Ayurveda, the traditional medical system of India, developed about 2,000 years ago and was codified in the classics of Charaka and Sushruta. It is a living medical tradition that continues to serve the health needs of millions of Indians even today. Being an ayurvedic physician myself, I have been able to observe amusingly diverse trends in its practice.

Four major trends that I have come across, I thought, are worth writing about. Although immensely valuable for the wealth of clinical observations and therapeutic experience it documents, Ayurveda is, by current standards of scientific rigour, a proto-science. Converting a proto-science into a practical system that meets today’s health needs is not merely a theoretical challenge. It requires a vibrant ecosystem of scientific workers that experiments, verifies and educates the individual clinician about best medical practices.

Ayurveda sadly lacks such an ecosystem and consequently, the individual clinician is left to himself to figure out what qualifies as good science in the vast mass of ancient medical literature that is generously handed over to him. This figuring out is guided by theoretical plausibilities, practice trends, and of course, a robust common sense. But it is also often misguided by cognitive biases and wishful thinking. Clinical decision-making in such a scenario sometimes becomes just a little more than an educated guess. A caring and knowledgeable clinician, acutely aware of these limitations, employs his ayurvedic knowledge after adequate safety-netting in order to deliver the best possible patient care. Such well-meaning clinicians whose approach to ancient medical classics is seasoned by scientific thinking, though a minority, constitute the very cream of the crop.

The second group of practitioners are those who are rather simple-minded and credulous. Credulous doctors who have an uncompromising faith in their theories and practices tend to be successful. As Richard Asher wrote, “If you can believe fervently in your treatment, even though controlled tests show that it is quite useless, then your results are much better, and your income is much better too. I believe this accounts for the remarkable success of some of the less gifted, but more credulous members of our profession, and also for the violent dislike of statistics and controlled tests which fashionable and successful doctors are accustomed to display.” This curious phenomenon, attributable to the placebo effect, stretches across medical systems and is not unique to Ayurveda. It is due to this phenomenon that dogmatic Ayurvedic practitioners with a disdain for science often become successful in constructing a large clientele.

And then, there are the ubiquitous publicity-seekers who load newspaper columns and television shows with a melange of sense and nonsense. A practitioner of a traditional medical system has a peculiar advantage here — he is not accountable to science because his system is “classical and trans-scientific”; he is not accountable to Ayurveda either because the Ayurvedic academia scarcely has an agreed-upon version of what constitutes good medical practice. The fluidity of an unsettled science can be a surprisingly lucrative commercial proposition and this group of publicity-seeking practitioners know it only too well. Any new disease, your TV doctor is ready with his herbal prescription! Any new herb, your newspaper columnist is ready with a list of diseases it works against!

Finally, the funny but dangerous group of gimmick mongers. From pulse reading to medical astrology

and religious rituals, this group operates with impunity. Religious ideas exist in Ayurvedic classics as vestiges and these vestiges are what this group of quacks thrive upon. Be it the monthly “ayurvedic immunisation” for children in tandem with auspicious stellar events, or instilling nose-drops to pregnant woman to alter the sex of her foetus, or prescribing yoga to rid the client of his homosexuality, this group is wanton in its approach! They use such science-like terms as “quantum physiology” and “consciousness-based healing” to garb their gimmicks. With the rich and mighty as their clients, they become so cocky that reticent whispers of their saner colleagues get pushed into oblivion. What is unusual about fools rushing in where angels fear to tread?

These, then, are the four major trends in current ayurvedic practice. Of those who study Ayurveda, only an insignificant minority get into actual ayurvedic practice. And of those who do, only a handful turn out to become conscientious practitioners of this ancient medical system. Such a situation can be fixed only when stakeholders realise that more important than aggressively promoting Ayurveda is aggressively promoting ideology-free research in Ayurveda.

gl.krishna@icloud.com

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Printable version | Dec 12, 2019 2:19:43 AM | https://www.thehindu.com/opinion/open-page/one-system-four-practices/article29813865.ece

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