The Covid-19 pandemic has affected world nations since the last few months, stalling all normal economic activities like never before. The fight against the pandemic has witnessed varying levels of ups and downs, bringing into focus not only the containment strategies adopted by governments but also the treatment approaches. In the desperation for an effective treatment, there is a scramble to whatever looks promising. The early prospective solution in Hydroxychloroquine saw a mad rush before the WHO suspended its clinical trials on safety grounds.
The world with all its distinct populations, cultures and traditions is here fighting a pan-global disease, all on the same lines of thinking. Today’s world is small and capable of making a disease anywhere, into a global pandemic and therefore the prospects of finding an effective cure can be improved when people confront the disease from different perspectives.
Such pandemic situations have and could reoccur again. Would the situation been better had we had various treatment systems that have different fundamentals involving medications and treatment methods. The Covid pandemic has led to renewed calls for a major revival of traditional or native medicines. Native medicinal and health ingredients including ginger, green tea, and garlic demand has increased in these lockdown days. Whatever happened to the native treatment systems that were standard care before the introduction of the modern medicine or allopathy, referred by many as the western medicine? The question now is can a major revival of native medical systems help? If so how?
In a paper titled, Harmony or hegemony? The rise and fall of the native medical institution, Calcutta; 1822-35 published in 2001 in South Asia Research, Zhaleh Khaleeli notes that in post-colonial countries writers helped by post-modern theories, undermined the imperialists and pushed them to a marginal status. However such moves in medicine did not find success.
The simultaneous imposition of English and western medicine only raised the dependence on Britain. Khaleeli notes that moves to revive the Indian medicine notably the ancient Hindu medicinal system Ayurvedu, did not find support of the educated elite and could not compete with western medicine in India. The Native Medical Institution (NMI) established in Calcutta in 1822 to teach both indigenous and western medicine was abolished in 1835. This ended state support for indigenous medicine and was a turning point in Indian Medicine. It is speculated that the move to abolish the institution was not in line with the benefits evident and was a ploy to discredit indigenous medicine.
In an increasingly materialistic world, the service or charity inclined indigenous medicine succumbed to the western medicine. The western medicine became the preferred medical education not just in India but worldwide. The Indian medical fraternity today plays a significant role in leveraging western medicine to newer heights, given the quality of personnel, research and the pharma involved.
These are of no match to the torch bearers of the Indian native medical systems. Apart from the lure of western medicine, native medical systems were caught off guard with emerging lifestyle diseases like sugar, BP and occupational health which had an impact on its drug effectiveness.
In their paper, Indian Systems of Medicine: A Brief Profile published in the African Journal of Traditional, Complementary and Alternative Medicines, Ravishankar and Shukla note that there are six recognized systems of medicine in India, (AYUSH) namely Ayurveda, Siddha, Unani, Yoga, Naturopathy and Homoeopathy.
Ayurveda is a holistic medical system that looks into the physical, psychological, philosophical, ethical and spiritual wellbeing, emphasizing to live in harmony with the universe. Like modern medicine of today, Ayurveda too had specialities including Kaumar Bhritya (Pediatrics), Bhootavidya (Psychiatry), Kayachikitsa (Internal Medicine), and Shalya (Surgery).
The Siddha system is more prevalent in South India, particularly Tamil Nadu. The materia medica or remedial substances of Siddha system depends to a large extent on drugs of metal and mineral origin in contrast to Ayurveda of earlier period, which was mainly dependent upon drugs of vegetable origin. Animal and plant based preparations in Siddha system are quite similar to that in the Ayurveda system.
Binorkar et al. highlight in their paper Ayurveda education & research in India–present scenario, challenges & solutions that Ayurveda being holistic in nature, people from all over the world are now attracted towards this ancient system of medicine. The 2007 National Health Interview Survey (NHIS) conducted in the United States reveal that approximately 38% of American adults are following complementary and Alternative Medicine (CAM) and Ayurveda is one among it.
However Binorkar et al note that nowadays the medical education and health care systems including Ayurveda in India are facing serious challenges in regards to its merits and proficiency. Ayurveda education is passing through a crucial stage. Qualities of education and research among the Ayurveda institutes all over India have become a matter of debate. Even though Ayurveda is being observed as a foundation of new drug development, questions on safety and efficacy of Ayurvedic products are also being raised from time to time.
The Indian Ayurveda market in 2018 was INR 300 billion and is expected to touch INR 710 billion by 2024. There are over two hundred colleges today that offer a four and a half year Ayurveda course apart from post graduate courses. However this phenomenal Ayurveda growth means little apart from the economics involved. The industry is largely driven as a wellness or health supplemental industry rather than a disease directed curative industry.
Two challenges to the sector pointed out by a CII study are a shortage of manpower and shortage of quality raw materials. The industry is facing a shortage of skilled professionals including doctors, paramedical staff, therapists and nurses and there appears to be a lack of uniformity in skill and knowledge among the available manpower. On the raw materials front too, there are wide variations in the quality of raw materials.
Although functioning of native medical systems today is more organized and regulated, it has a long way to go to become a choice for effective treatment. There is speculation on the ability of native systems to ever rise up to the evolving health challenges that only the western medicine is confronting today. The developments and shortcomings are easily evident. There is sadly a lack of skill and professionalism that can even buy public confidence.
Quacks and aggressive marketing of cures is evident with pills promising instant relief for almost anything. In February this year, the President of Tamil Nadu Homeopathy Medical Council made a police complaint that many people are cashing in on COVID-19 claiming to have medicines and warned people to not believe them. One such discoverer had even accused the western medicine fraternity that they couldn’t tolerate a cure coming from him, before he was arrested too.
Calling it, Traditional Indian medicine and homeopathy (TIMH), Frits et al. conducted a literature review, Traditional Indian medicine and homeopathy for HIV/AIDS: a review of the literature, published in AIDS Research and Therapy about a decade back. Their observations throw light on the shortcomings of Indian Medicine. “Overall, the studies reported positive effects and even “cure” and reversal of HIV infection, but frequent methodological flaws call into question their internal and external validity.
The review noted that common reasons for poor quality included small sample sizes, high drop-out rates, design flaws such as selection of inappropriate or weak outcome measures, flaws in statistical analysis, and reporting flaws such as lack of details on products and their standardization, poor or no description of randomization, and incomplete reporting of study results. The findings resonate the concern on quality of education and research in Ayurveda.
A paper by Vandana Rao, Time to sensitize medical graduates to the Indian Systems of Medicine and Homeopathy published in the Indian Journal of Pharmacology notes that these native systems also take into consideration psychological, ethical, philosophical and spiritual well-being of a person. They encourage healthy living, which is living in harmony with nature. These concepts resonate with the World Health Organization’s definition of health.
Rao adds that there is a lack of understanding and even awareness about native systems among practitioners of Allopathic medicine. Also confusion prevails regarding prescribing of medicines by practitioners of different systems of medicines or cross-pathy. Rao makes a valid point that when a person has not received training in a particular system of medicine, he or she would not be fully informed and hence, not be in a position to prescribe a medicine from that system.
The healthcare scenario of today warrants a multi-directional approach to drug development that could broaden scope of drug discovery. While Integrated medicines of native and western is gaining popularity by improving each other’s efficiency, the emerging need would be more on finding cures. The native medicine could hold untested potential that had not been explored in modern times. The key to this new approach could rest on the feasibility of modern medicine to delve into native systems right from fundamentals.
Each native medical system by itself or in some combination with modern medicine could hold potential solutions for the evolving complex world that can only be leveraged by complex modern medicine. The goal of integration should be to explore possibilities in native medicine by leveraging on modern medicine.
Incorporating native medical systems as a specialization area or in advanced modern medicine could open doors to a new realm of drug development. Accessing the exhaustive literature and ongoing developments in native medicine by bridging with native medical institutions could help advance the efforts.
The intention here is to introduce the mature and refined systems that propel the western medicine to benefit native medicines. It needs to be emphasized here that the new approach would be more beneficial if directed at drug development where western medicine is either in the dark or taking baby steps. The news of a new Swine Flu taking off even before Covid-19 has got a perfect cure, heralds a new world; a world where ‘cure-hunt’ could always be an on-going process.
