Green Signal to Ayurvedic Surgery: ‘Mixopathy’ or Medical Pluralism?

by- Kudrat Mann and Utkarsh Sharma

Introduction

At a time when the COVID graph is soaring high, the doctors of the country took to streets to protest against the Central Council of Indian Medicine’s (CCIM) notification allowing Ayurvedic postgraduate medical students to gain practical skill and independently perform surgeries mentioned in the exhaustive list. The Indian Medical Association has since been up in arms alleging the move to be an attempt at ‘mixopathy’ and a corrupt arrogation of allopathy. The CCIM exercising its powers conferred by Section 36(1)(i), (j) and (k) of Indian Medicine Central Council Act, 1970 (hereinafter referred to as ‘the Act’) passed the Indian Medicine Central Council (Post Graduate Ayurveda Education) Amendment Regulations, 2020 (‘the Regulations’). The article is an attempt to analyse this move which has been received as an affront of the highest order. The article seeks to compare the ‘mixopathy allegations’ with medical pluralism and the legality and further impact of this order.

Scrutiny through Medico-Legal Prism

The Regulations lists out 58 surgeries including ENT, Dental procedures and general surgeries that an Ayurvedic postgraduate scholar can independently perform after the enforcement of the aforesaid regulations. The comprehensive list includes allopathic terminology with the IMA condemning it as ‘Criminal Plagiarism’. Albeit the Ayurveda practitioners claim Sushruta’s legacy, there is little historical evidence to show that these practices persisted beyond the time of the composition of the Samhita.  The Regulation is an effort towards ‘One Nation, One System’ plan of the Centre. However, it is imperative to note that neither the Regulations nor the 1970 Act empowers a rulemaking authority to integrate one system of medicine with the other.

The Indian Medical Council Act, 1956 defines medicine as “modern scientific medicine in all its branches and includes surgery”. While there is no legal definition of ‘mixopathy’, cross pathy is a punishable offence under the Delhi Bharatiya Chikitsa Parishad Act 1988. The need to examine cross pathy arises because surgeries include an anaesthetic and pre-operative and post-operative drugs and with anaesthesia no longer remaining a separate branch in Ayurveda, this would induce cross pathy. The problem further aggravates with the fact that the pharmacology of both the branches is fundamentally different and Ayurveda profoundly rejects the study of cellular receptors which is necessary to administer allopathic drugs. The Indian Medical Council (Professional Conduct, Etiquette, Ethics) Rules, 2002 clearly demarcate that “No person other than a doctor having qualification recognised by Medical Council of India and registered with Medical Council of India/State Medical Council(s) is allowed to practice the modern system of medicine or surgery. A person obtaining a qualification in any other system of medicine is not allowed to practice the modern system of medicine in any form.”

In the LCEH Doctors’[1] case the Court noted that the Secretary to the Government stated in 2011 that ‘various enactments, as well as rulings, did not allow cross pathy practice “until such doctors are fully trained in allopathic medicine”.’ However, in the Mukhtiar Chand[2]case, the Court citing lack of availability of allopathic doctors in rural areas allowed non-allopathic practitioners to practice modern medicine by registering themselves in the State Medical Register. The Court opined in Poonam Verma[3]that merely because the Anatomy and Physiology are similar, it does not mean that a person having studied one System of Medicine can claim to treat the patient by drugs of another System which he might not have studied at any stage.

The Regulations in Practice

On paper, while the Regulations appear to be a step towards medical pluralism, it is exigent to explore the implications of its practice. For this, we need to examine the standard of care adopted by Allopathic and Ayurvedic systems of medicine. The 1970 Act does not mention the power of the CCIM to authorize training conditions in surgeries so as to enable PG graduates to independently perform those. In the words of Acharya Charak, “even the best drug becomes a potent poison if used badly”. Every person in the medical profession undertakes to use a fair, reasonable and competent degree of skill[4] and exercise a duty of care[5] The Bolam Test[6] has been in use to exemplify the duty of care to be used by doctors. In invasive procedures like surgery, the degree of care is higher and it is more important to learn what not to cut instead of what to cut.

Allopathic system employs continuous research and advancement, an aspect in which the Ayurvedic system terribly lacks. The 11^th Five Year Plan, discovered the dilapidated standard of facilities, education, hospitals, drugs etc. in Indian System of Medicine. The Planning Commission observed that since the AYUSH practitioners tend to prefer their modern counterparts spending less on AYUSH modalities, they lack confidence in AYUSH specific therapies.

The decrepit state of Ayurveda training facilities can be highlighted by the fact that in PG colleges, for every 60 beds for general surgery and gynaecology in allopathic colleges, there are only 12 and 13 beds in Ayurvedic colleges respectively. Similarly, for every 30 beds for ENT treatment in Allopathy, there are only 13 in Ayurveda.[7]

Another greater cause for concern is that the Regulations might lead to unfair trade practices by false representation.  A patient is under the belief that he is being treated by a qualified doctor under the 1956 Act[8]and a person pretending to have the knowledge of another system of medicine is nothing but a charlatan.[9]

Way Forward & Conclusion

Right to Healthcare, incorporated under Article 21, simply cannot be compromised. The medical pluralism model has been highly successful in countries like China, Japan, Sri Lanka and India, with its rich heritage of traditional medicine and incessant advancement in allopathy, has the requisite apparatus for the same. The Regulations, though aimed at medical pluralism, seems to have a shoehorning of mainstream traditional system of medicine if the current plan of execution is emphasised. The Regulations in their present form has many ramifications which must be curbed if India wants an Integrated System of Medicine.

Medical Diversity instead of Pluralism would be more suited to India. It implies mutual borrowing of ideas, practices and styles between different systems of medicine.[10]India is far behind the WHO prescribed norm of 1 doctor for 1,000 patients. Medical diversity can help curb this ratio and generate greater Right to Choose amongst patients which have been also reiterated by the Honourable Supreme Court in the Common Cause v Union of India[11] that it is the inherent right of an individual under Article 21 of the Constitution to choose the treatment that they desire and the right to refuse or reject any form of treatment, which is integral to the “right of self-determination and individual autonomy”. Placebo has proven to be effective in medicine likewise the autonomy of patients in choosing their own health service will surely be more effective. The Right to Choice follows the Right to Informed Consent and it should be enforced effectively to avoid false representation in healthcare.

There is a need to ensure that Ayurvedic treatments and practices conform to the global standards before integration is even attempted. Instead of a quantum leap, the steps should be made in a phased manner by attempting to ensure academic discussions, evidence-based research in Ayurveda, ensuring a higher degree of care and skill in Indian system of Medicine while keeping the philosophies of both the systems in mind. The stakeholders should be well-informed before any decision of the sort is made. The integration should be done at more than just infrastructural level with mutual respect amongst practitioners of both the systems of medicine allowing for ethical cross-referrals and consultations in the greater interest of the patient. Instead of veering towards allopathy, Ayurvedic practitioners should work to enhance their core competency without compromising their authenticity. India being the proud heir of Sushruta and Charak, needs to focus on refreshing and upgrading its research calibre in traditional systems of medicine. The lessons from the Chopra Committee to evolve and enrich into an integrated system of medicine report should be adopted according to contemporary needs.

Endnotes

1. Writ Petition No. 1208 of 2011
2. (1998) 7 SCC 579.
3. 1996) SCC  332.
4. (1969) 1 SCR 206.
5. [1957] 2 All ER 118.
6. https://public.flourish.studio/visualisation/4662251/?utm_source=showcase&utm_campaign=visualisation/4662251(Visited on December 22, 2020).
7. O.P. No. 214 of 1007
8. (2018) 5 SCC 1

Authors:

Kudrat Mann and Utkarsh Sharma, 2nd Year Students of B.A.LL.B. (Hons.), Dr. B.R. Ambedkar National Law University, Rai, Sonipat, Haryana.