Why no stream of medicine is pleased with Centre's DM Ayurveda courses

The Union government recently issued a gazette notification specifying the "Minimum Essential Standards and Minimum Standards of Education for Institutions or Departments offering Super Speciality Programme (Doctorate of Medicine, Ayurveda)."

Three-year DM Ayurveda shall be conducted in six specialties, it said — "DM Manasaroga (Ayurveda Psychiatry), DM Vajikarana (Reproductive Medicine and Epigenetics in Ayurveda), DM Asthi and Sandhi (Orthopedics and Arthrology in Ayurveda), DM Arbuda Vijnana (Ayurveda Oncology), DM Jara Chikitsa (Ayurveda Gerontology), and DM Yakrit Vikara (Ayurveda Hepatology)."

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Medicos concerned

This move has sparked off concerns in the medical fraternity, with doctors terming the move “wasteful”, while others believe that it spells “doom” for the ancient system of Ayurveda.

The Deccan Herald quoted Subhash Lakhotia, a distinguished professor at the Banaras Hindu University (BHU), as saying: "Unfortunately, the Ayush community by and large does not appear to believe that unbiased research and experimental/ clinical evidence are needed. Such courses, without the due academic vigour, would do more damage not only for the patient care but for Ayurveda itself."

Ayurvedic physicians appear none too pleased with the DM Ayurveda courses. They, too, are concerned about the government's move.

GL Krishna, an Ayurvedic physician and researcher, who is a visiting scholar at the National Centre for Biological Sciences, describes it as a ‘reckless’ move, which misinforms the public by exaggerating Ayurveda's role in the management of serious illnesses.

Krishna, who has long been battling the “pseudoscientific” outlook of the Ayurvedic academia, told The Federal that if the common man hears of a super speciality degree in Ayurvedic oncology, he will possibly be “misled” to believe Ayurveda has a major role in cancer management.

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“This may lead to false hopes and sometimes even make them reject standard care. Health-related misinformation is often a public health hazard,” he pointed out.

Soft evidence

In his view, traditional medical systems like Ayurveda are backed only by soft evidence, and it will be “imprudent” to use their prescriptions as standalone treatments in high-risk clinical situations.

He gives the example of mild depression cases, which can be treated effectively with the interventions of Ayurveda and yoga. But, when it comes to severe depression with psychotic symptoms and suicidal risk, this usually requires an urgent referral to specialists trained in psychiatry, he said.

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“Ayurveda and yoga are good to use only as complementary systems in the management of severe cases; they cannot serve as alternatives to conventional management,” Krishna wrote in the BMJ Medical Humanities blog.

According to Krishna, Ayurveda’s sketchy understanding of life processes, its diagnoses based on ancient heuristics, and the soft evidence that backs its prescriptions are features that diminish its role in specialty areas.

Unmissable lacunae

Dr Cyriac Abby Philips, a hepatologist who goes by the handle 'The Liver Doctor' on the social media platform X, said the Centre ought to focus on improving science-based educational infrastructure and primary and super-specialty healthcare rather than spend resources on "wasteful" activities. "There is nothing to specialise in Ayurveda. The whole of Ayurveda is based on texts written 2,000 years ago that has not changed at all," he argued.

The Deccan Chronicle article quoted Kishor Patwardhan, a professor of Ayurveda at the BHU, as saying the current level of evidence is not sufficient to justify DM courses in Ayurveda.

"You start super specialty courses where there is overwhelming information about a particular subject, which can’t be contained in a single discipline. It's not the other way, where you create the courses first and then look for information," he said.

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Krishna took the example of a super specialty DM hepatology course in Ayurveda. It would be based on a system that had only a vague understanding of liver functions and pathologies, he said. Similarly, a DM oncology course based on ancient texts would not work since our forefathers didn't even have a remote idea of cancer being a generic pathology.

“Merely supplementing ayurvedic texts with current science will not rectify these lacunae,” he said.

So, when is Ayurveda helpful? “It can be really helpful to people if it focuses on its core strengths of self-healing. Its philosophy is to support the body's innate healing potential in the process of healing," Krishna said.

Natural healing

Medical care is meant to assist, and not substitute natural healing, he said, pointing out that Ayurveda interventions are meant to be “gentle and holistic”. A “simple approach” as pursued by the eminent Ayurveda scholar Raghavan Thirumulpad would be beneficial, he added.

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In fact, Thirumulpad strongly advocates removing the causative factors of diseases by applying pathya or corrective life and food, and ‘discover the doctor within’ themselves. Authentic Ayurvedic practice seeks to make the patient as self-reliant as is safely possible, said Krishna.

“Ayurveda is humble in its outlook and relies on drugs and measures that are inexpensive. It is therefore well-suited for primary care in India. But, even here it must be adopted after careful safety netting and with scientific prudence,” he cautioned.

Rash zeal

Policymakers' “misdirected zeal” is behind the Centre's recent move in bringing in DM courses in Ayurveda, said Krishna. There is also a lack of clear understanding about the strengths and limitations of Ayurveda, he said, advising policymakers to go by scholarly inputs, and not on “ill-informed enthusiasts”.

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In its rash zeal to promote Ayurveda, may the Central regulatory agency, the National Commission for Indian System of Medicine, not end up becoming an unwitting supporter of the type of fraudulent physicians whom Charaka despised, he said.

What's interesting is that Krishna, who completed his bachelor’s degree at the Government Ayurveda Medical College in Bengaluru, opted out of pursuing a postgraduate degree since he realised the “central bane” of Ayurveda education today is the “grossly unscientific approach” the academia has unwittingly adopted to its study.

Ancient ayurvedic classics contain a melange of verified medical experiences, heuristical theories, pathophysiological conjectures, philosophical utterances, and socio-religious beliefs. But if we want to use these ancient Ayurvedic texts for current practice, it first requires a sifting of usable medical information from conjectures and speculations, he said.