A paradigm for research into traditional medicine called ‘whole systems research’ started to catch on around the new millennium. Its aim was to surmount the difficulties arising out of traditional systems not fitting in with the modern medical research paradigm. It endeavoured to study traditional medical interventions as ones that embraced the complex ‘context’ in which they operated.
The potential of traditional systems has often been severely underplayed in the very countries where they originated. India is no exception. Our model of integrating modern and traditional medicine has been one that led to the subjugation of the latter in favour of the former, thereby worsening the existing institutional conflict between them. The goal of integration of the two streams remains distant. The decision to allow ayurvedic postgraduates to perform certain surgeries and the resultant clamour are a case in point.
A policy of ‘one nation, one health system’ has, however, been announced. Under this initiative, the government aims to integrate modern and traditional medicine in such relevant aspects as education, research and practice, fostering a two-way exchange. While this is a commendable step, the challenges are colossal.
A notable example of integration from the East is China. China went about integrating Western medicine and Traditional Chinese Medicine in the 1950s. Doctors trained in either stream would learn a fair deal about the other as part of the curriculum; clinic practices would include a substantial share of doctors practising the two systems together; nearly every hospital would provide care in both systems in varying proportions. The failure of India’s early attempts at integrating traditional and modern medicine is worth examining. After Independence, some states did initiate integrated courses inspired by the recommendations of the Sokhey, Chopra and Dave Committees, but these attempts were thwarted by partisan and purist interests.
The biggest roadblock is likely to be the demand for ‘evidence’ by the modern medicine lobby. However, the demand for evidence should not undermine the considerations of public welfare. The need for evidence should be balanced against other factors, such as the prevailing public satisfaction with traditional systems, cost-effectiveness, and the long-established empirical efficacy and safety of certain interventions. It shouldn’t be forgotten that evidence-based medicine is a recent accretion. Modern medicine has not achieved scientific perfection; nor is all modern medicine backed up by evidence.
Then, there are technical challenges. Given that instruction and practice of traditional medicine have increasingly embraced the principles of modern medicine, practitioners of this system are reasonably acclimatized with the latter. But the same cannot be said about their modern medical counterparts. An integrated model would need to educate modern medical doctors about holistic, non-reductionist approaches that are typical of traditional systems. Such a holistic approach endorses interaction between patient and physician. They would also have to be taught about the need to strike the right balance between the disparate approaches.
Conceptual incompatibilities between modern and traditional medicine present yet another formidable challenge. Medical education will need to embrace a pluralist paradigm of understanding. This is easier said than done. But successful examples do exist. Evidence from Korea indicates that integrated teaching and practice of both systems by the same individual can overcome problems arising out of such incompatibilities.
Needless to say, an integrative model would need a greater share of public funds for traditional medicine as it becomes a significant component of the healthcare agenda. But the rise in investment would need to be justified against the limited evidence of traditional medicine. Financing disparate medicine systems under a universal insurance plan would lead to complexities, particularly in deciding the terms of reimbursement, when both systems are practised together.
The task at hand is Herculean; but it could pay off fairly well in several ways.
