Ayurveda insiders have questioned a central regulatory authority’s decision to start superspeciality postgraduate ayurveda courses in six subjects, including cancer, psychiatry, and reproductive medicine, saying traditional medicine can claim no major role in superspecialities.

Sections of ayurveda physicians have expressed concern that the decision on superspeciality courses by the National Commission of Indian System of Medicine (NCISM) has come without adequate groundwork and could expose this traditional medicine system to amplified criticism.

G.L. Krishna, currently a research scholar at the National Centre for Biological Sciences, Bangalore, has described the decision as “misdirected zeal” that could mislead the public.

The NCISM had last month notified in a central government gazette the “minimum essential standards” for ayurveda medical colleges to offer superspeciality courses in hepatology, geriatric care, oncology, orthopaedics, psychiatry, and reproductive medicine. The courses leading to Doctorate of Medicine (DM) degrees are “intended to produce superspecialists with deep understanding in ayurveda classics with updated knowledge in contemporary sciences”, the NCISM notification had said.

Krishna, writing earlier this week in BMJ Blogs, a digital platform from the UK-based BMJ Publishing Group, has criticised the notification, arguing that classical ayurveda lacked adequate knowledge of either liver function or cancer mechanisms for superspeciality courses in hepatology or oncology.

He said the superspeciality courses have the potential to mislead the public by suggesting ayurveda has a major role in managing patients with serious illnesses such as cancer or major psychotic disorders.

“Misinformation of this sort would lend credence to the overblown claims that charlatans make time and again,” Krishna wrote in his blog.

He said the 150-200 BC text named Charaka Samhita written by Charaka, a key contributor to ayurveda, had itself expressed contempt for fraudulent physicians with the words: “Fraudulent physicians blow their own trumpet and move from place to place in search of victims … they are the envoys of death.”

In its zeal to promote ayurveda, Krishna wrote, the NCISM may become “an unwitting supporter of the type of fraudulent physicians whom Charaka despised”.

India has over 400 ayurveda colleges that each year produce around 45,000 graduates and 10,000 postgraduates. A nationwide 2022-23 survey by the Centre’s National Sample Survey Organisation had found that 46 per cent of rural residents and 53 per cent urban residents used ayurveda for prevention or treatment.

Email queries sent by this newspaper to the NCISM secretary and chairperson of the NCISM’s ayurveda board seeking responses to the concerns articulated by Krishna have not evoked any response. But other ayurveda physicians have said they share those concerns.

Kishor Patwardhan, professor in the faculty of ayurveda at the Banaras Hindu University, Varanasi, cautioned that the superspeciality ayurveda courses may foster a misleading sense of equivalence with modern medicine given the “grossly inadequate” evidence to support the proposed courses.

“I’m perplexed that they have gone ahead with this plan,” Patwardhan said. Patwardhan had himself expressed concern that there is insufficient medical research and literature to justify the launch of superspeciality courses last year when the NCISM had circulated a draft notification.

Patwardhan had illustrated the lack of evidence through a search of medical literature on PubMed, a global database of medical research. PubMed, he had pointed out, contains only some 100 papers on ayurveda and rheumatology and only 70 papers on ayurveda and reproductive medicine.

“This is grossly inadequate to start new superspeciality branches considering that many of these papers are review papers and contain hypothesis-based arguments,” Patwardhan had written in a series of posts on X.

In contrast, a keyword-based PubMed search shows over 5,85,000 papers or publications on orthopaedics and over 1,62,000 on reproductive medicine.

Sanjeev Rastogi, founder-director of India’s first superspeciality ayurveda centre for arthritis in Lucknow, argues that superspeciality courses are needed in ayurveda to meet public demand for specialists and to allow ayurveda to enrich itself through clinical research and evidence.

“Patients increasingly ask for specialists and superspecialists in traditional medicine. We can’t turn away from this growing unmet demand,” said Rastogi, former director of the Rashtriya Ayurveda Vidyapeeth (National Academy of Ayurveda).

But Rastogi said he would favour a slow, planned introduction of superspeciality courses based on the availability of teachers, patients, and adequate evidence to support clinical practice rather than the “rushed umbrella notification” from the NCISM to initiate courses in six disciplines in one go.

“The start of superspeciality courses needs to be preceded by sufficient preparatory work, such as the generation of robust evidence to guide clinical practice to treat complicated health conditions likely to be seen by superspecialists ,” said Rastogi, whose arthritis centre in Lucknow has since 2018 treated thousands of patients with musculoskeletal disorders and published over a dozen high impact research papers.

“Jumping into DM superspeciality degrees without desired preparation will not help improve the current state of clinical practice in ayurveda, but rather harm ayurveda’s image if superspecialists fail to do differently what is currently being done in ayurveda,” he said.

Sections of modern medical doctors view the ayurveda superspeciality courses as part of efforts by the Narendra Modi government to elevate traditional medicine systems through superficial means rather than through research to generate evidence.

“The plan for superspeciality courses is a reckless decision,” said K.V. Babu, an ophthalmologist in Kerala who is among modern medicine doctors urging proponents of ayurveda to generate quality evidence based on rigorous clinical trials.

Krishna, in his blog, said that the DM courses appear to be an attempt to mimic the academic hierarchy of modern medicine which offers superspeciality DM courses in areas such as cardiology, neurosurgery, or endocrinology.

“Medicine is not mimicry,” Krishna wrote.