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The Siddha system is often celebrated in Tamil Nadu just as Ayurveda is being upheld elsewhere in the country. Recently a few months back while we were limping back to normalcy from the epidemic, there was a judgement in Madras High court that went largely unnoticed. In the judgement given in July this year, the Madras High Court quashed criminal proceedings against a doctor registered with State Homoeopathy Medical Council who was found practising allopathy medicine.
At present Homoeopathy, Ayurveda, Siddha and Unani practitioners are registered in the Tamil Nadu Board of Indian Medicine.
Soon after this judgement inmathi.com published an interview with Dr. K. Sivaraman who is a well known Siddha practitioner and also a member of Tamilnadu state development policy council.
This is not a unique judgement. Madras high court had earlier passed a judgement in 2010 that allowed registered practitioners of Ayurveda, Siddha, Unani and homoeopathy to practise allopathic disciplines of surgery, obstetrics, anaesthesia etc..
This is in line with the direction the current government in the centre is trying to take. Currently we have a department for alternate medicines in the name of Ayush, as a separate ministry within the government of India. This is in addition to the Ministry of Health and family welfare we have already. The aim of this new ministry is to promote alternate traditional medicinal practices.
Alternative medical practices do not follow the similar systematic rigour in testing as in allopathy.
Now looking at the trend and the steps the government has taken, let us understand where it is heading and why that is problematic, especially for the stated cause of public healthcare.
For starters, a place where anyone would look at is the Ayush website that the government of India has. On a first look it appears impressive with a lot of information about any of these alternative medicinal practices. It even has guidelines for medicinal usage for each of the systems. It also lists the testing facilities for such medicines. But most importantly it also has information about the amendments made for the last two years on the medicine and drug related laws which are already there. If one goes through that list, we could notice that it not only lists amendments that facilitate alternate medicinal practice, but also the changes in important issues like regulatory mechanisms that (e.g. Rule 170) have been relaxed to the needs of these new systems.
One important aspect of these alternate medicinal practices that contradicts with the rational and logical application of medication that had evolved across the globe is the rigour in testing for any medicine used for treatment. Alternative medical practices do not follow the similar systematic rigour in testing as in allopathy. This is where these systems contradict with evidence-based science that is the driving factor behind the safe and effective use of allopathic medicines.
Over time, we have established logical and systematic methods of testing medicines. Doctors by training are familiar with such systematic test results to identify the right medicine for any treatment that they prescribe. Granted, there are greedy Pharma companies that bend the testing results and lazy unscrupulous doctors who choose what a medical representative suggests. However, these are exceptions and not a rule. By design the training doctors undergo provides means for the doctors to analyse and identify any distortion of test data by the companies. Also there is a practice of proper publication of such data that gets scrutinised by doctors, medical boards and proper authorities before the drug is allowed.
This largely prevents any wrong use of medicines. There are, of course, unscrupulous Pharma companies that try to pass off substandard or harmful drugs by doctoring the test data. However these incidents are getting fewer and farther apart over time, largely due to elaborate and systematic scrutiny mechanisms and practices. This goes a long way in providing transparency and consistency of medicines and treatment.
The main bone of contention with alternative medicinal practice is the tendency of their proponents to brush away the question of systematic testing either by providing insufficient or improper test results or their outright refusal to the practice of testing. Instead they pass off anecdotal references as test results. They have historically rejected scientific allopathic methods and techniques as not being ‘natural’, “overtly extreme” and “downright harmful”. They have also rejected systematic methods of research, testing and documentation as against “higher tradition”.
The government also, on its part, while seeking to give mainstream space to such alternate practices, seems to have not given importance to apply the proper, scientific testing and research of alternative medicinal drugs. The various guidelines published for each of these systems ( e.g. Guideline for Ayurvedic drug development published by Ayush ministry) have quite detailed points however without any regulatory or certification mechanism behind it.
In this light, the series of judgements and the above mentioned amendments assume greater importance and concern.
Any amendments in the current Drug and Cosmetics Act compromising the testing and regulation will have implications that would jeopardise the healthcare of millions of people in this country.
Also the decision of the court to allow such alternative medicinal practitioners who have historically refused to submit to the fundamental basis of allopathy to practice allopathy does not just sound illogical and conflicting. It is dangerous and calamitous.
We have to have infrastructure for systematic and strong research built on evidence based science
Even in the earlier interview given, Dr. K.Sivaraman acknowledges this issue. Additionally he presents another dimension to this issue where such alternative practitioners could be employed as allopathic practitioners in unscrupulous hospitals and establishments. In such cases the patients would neither be aware of the switch nor the risks involved.
Over time, Allopathy evolved through many wrong turns simply by adhering to systematic and scientific research. The development was primarily driven in the West by Pharma companies which started there by simply being early adherents to industrialization. It also started with the basis of the established treatment practices including traditional practices there. By rigorous and systematic process those treatment methods were qualified and refined to reach the point we are today. Post globalisation, the Indian Pharma industry, which was largely a generic medicine producer, started investing in research of new medicines. So the argument that Allopathy is entirely an Western Pharma construct does not hold water anymore.
Hence if the advocates of these traditional medicinal systems seriously want them to reach that point, they have to submit to systematic evidence-based processes with sound documentation. Considering the fact that these systems originate here, we cannot inherit the benefits of research done elsewhere and build over it, like in the case of Allopathy. Hence we have to have infrastructure for systematic and strong research built on evidence based science. As a foremost proponent of alternate medicinal processes, the government has to kickstart that by providing the regulatory and certification body.
Until then, such Mixopathy would be like giving a complicated weapon in the hands of the untrained.
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