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The twain should meet

Healthcare seems to be moving backwards in India even as the country marches forward in many spheres. Periodically murky medical practices are revealed by the media and it is evident that Indian healthcare suffers from a credibility deficit. Pricey and inconsiderate medical care is not uncommon. The large population, unhygienic and malnutrition-hit conditions, a paradigm shift in the work culture, an illness-friendly lifestyle and food habits, proliferation of medical insurance, rise in middle class prosperity, lure of medical tourism, spurt in medical and paramedical personnel, lack of self-regulation and tenuous regulatory controls have made healthcare one of the ‘sunrise’ industries. Consequently, super-speciality hospitals, diagnostic centres and pharmacies have sprung up in large numbers. All these factors have immense potential to make the remedy worse than the disease rather than making healthcare more compassionate. Let us look at some of the issues plaguing healthcare.

Modern Medicine

In modern medicine, that is, allopathy, the line of treatment for any illness often follows an established framework. An effort to infer the interaction among diverse aetiological agents and the consequent causation of disease, particularly chronic illness, is rarely seen. The trend in diagnosis is to conduct all the possible tests and tag the disease. Standard remedy then follows. For example, for cancer, the common prescription is a combination of chemotherapy, radiation and surgery. In the case of renal disorders, it is dialysis or transplantation. Seeking a second opinion has become inconceivable, as most doctors endorse the other. Regeneration of the organ or avoiding surgery is seldom thought of. In fact, statistics on surgeries/transplantation done in a hospital are often highlighted to portray a hospital’s level of competence, while statistics on the number of surgeries/transplantation avoided would be more appropriate.

In the U.S., a public service campaign was launched by key medical associations and consumer groups on various commonly conducted medical tests. This group questioned the overuse of these medical tests and expressed the opinion that many tests serve no purpose except to add costs and anxiety to the patients besides exposing them to potentially harmful radiation from certain tests, although these tests sometimes can be life-savers.

Indian healthcare has generously adopted this practice, which also stems from the fact that after installing costly equipment, concern for the hospital’s health eclipses that for patients’ health. Hence, the patients are engulfed by many specialists and test equipment — the hospital may call it one-stop healthcare. Patients should be freed from the over-use of tests, specialists and drugs.

The U.S. study also pointed to the fact that tests are no substitute for a thorough check of the patient’s medical history and physical examination by a skilled doctor. With an array of electronic medical instruments around, most doctors today tend to rely on what could be termed ‘e-telligence’ rather than on intelligence. Admittedly, other professions are also bitten by the e-bug. In this process, doctors today treat a disease, not A’s disease. Treating A’s disease rather than a disease is crucial to healthcare, as humans are not manufactured under any quality management system unlike in the case of machine-made objects. Each person is unique and each is constitutionally different from the other. Consequently, genetic susceptibility and immunity to various diseases can vastly differ from one to another.

Seemingly, doctors hardly take cognizance of it while treating patients. Unwarranted and prolonged hospitalisation is another unsavoury practice that patients face, making them and their families sicker than they actually are. All these things have snowballed to make healthcare a market commodity.

In the U.S., the number of “iatrogenic” deaths, caused by medical errors, adverse drug reactions, or hospital-acquired infections, is estimated to be around 225,000 a year. A similar figure for India would be alarming. It is the fallout from the collapse of good old family-physician system, which was the epitome of Indian healthcare, should be revived. It will also displace the present money metrics rule.

Indian systems

People suffering from ailments such as diabetes and hypertension are tied to certain drugs for life, which drains their wealth as well as their health due to a variety of side effects caused by the drugs. Is there no alternative to this life-long drug therapy? In general, is there any alternative to modern medicine? Unlike most other countries, India has been endowed with its own age-old complementary and alternative medicine and therapy systems such as Ayurveda, Yoga, and Siddha. These can provide effective and affordable solutions to many critical diseases. Although Ayurveda, Siddha and Yoga originated in India, they are yet to take deep roots in the Indian healthcare scene. Take Ayurveda. It basks in the pride of its antiquity, but no concerted attempt has been made to make it an effective alternative healthcare tool and spread it globally. The potential of Ayurveda is yet to be unleashed. Homeopathy, which came only in the 19th century, is today more global than Ayurveda or Siddha. Like Materia Medica for homeopathy, Ayurveda or Siddha does not yet have a comprehensive and widely accepted pharmacopoeia.

Practitioners of complementary and alternative medicine who lack formal educational exposure are not uncommon and such practitioners rely solely on inherited learning. Even the degree of effectiveness of the qualified practitioners are constrained by their scrimpy grip on subjects such as phytochemistry, biochemistry and radiology. Consequently, their inclination towards modern pathological tests and also grasp of these tests are limited and they rely solely on their traditional diagnosing tool, such as nadi. Such a situation inhibits people from seeking out complementary and alternative medicine.

Holistic approach

A unique feature of Ayurveda and Siddha is that it is holistic, and hence treatment aims to set right the body as a whole so that the body’s immune system is strengthened. Unfortunately, quite often such a holistic approach overwhelms the focus on a patient’s specific problems and hence, particularly in chronic cases, the patient’s main issue gets side-lined. Consequently, the aspect of reducing the distress of the patient is overlooked, and eventually the patient loses confidence in the treatment regime. In essence, the potential of India’s age-old medical systems are yet to be harnessed as a major healthcare tool.

Lack of standardisation and quality control with regard to drugs used in complementary and alternative medicine systems is another impediment to their widespread acceptance. It is found that soil conditions, the growing environment, climate and so on play a crucial role in the purity and efficacy of the components that go into Ayurveda drugs. Evaluating all the drugs in terms of safety, efficacy and quality control should become a priority for the regulatory authorities. The absence of post-market surveillance and the paucity of testing lab facilities make quality control of Ayurveda medicines exceedingly difficult.

Ayurvedic practices such as prakritis, panchakarma and rasayanas are used to determine the manifestation of diseases, detoxify the body, and speed up the healing process respectively. But, how they work in terms of biological changes inside the body is yet to be established through modern science. Dr. M.S. Valiathan calls it Ayurvedic biology. He has called for coordination among agencies such as AYUSH, the Department of Science and Technology, the Indian Council for Medical Research and the Council of Scientific and Industrial Research with specific targets. Such coordination can help centre stage Indian medical systems and provide affordable quality healthcare to a large segment of the Indian population who remain deprived of it. Indeed, complementary and alternative medicine has to go a long way to come out from the past and cope with the present. Regardless of the system of medicine, present-day health care is hardly patient-centric.

Integration of systems

Another needed initiative is to integrate both modern medicine and complementary and alternative medicine in order that they complement each other. Yoga and Homeopathy, for instance, could be integrated easily with any system of medicines, and this could efficaciously minimise the use of drugs and provide permanent cure to many ailments — diabetes and respiratory disorders, for example. Yoga can liberate patients from the life-long tie-up with drugs and their side-effects and activate the affected organ gradually.

Appropriate training programmes for the respective sets of practitioners, students, researchers, and pharmacists are essential for this initiative to fructify. Now we face our axiom: Never the twain shall meet. It should, and it can. All speciality hospitals should come forward to have a section for complementary and alternative medicine and initiate this integration process. Then, appropriate changes should be made in the curriculum of these different streams of medicine.

Sounds too lofty? Not necessarily. The government’s proposal to open an Ayurveda section at the All India Institute of Medical Sciences is a step in this direction. Let us be optimistic: there is better healthcare is ahead.

mrkrishnan70@hotmail.com

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Printable version | Aug 13, 2020 3:47:37 AM | https://www.thehindu.com/opinion/open-page/the-twain-should-meet/article17450381.ece

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