12 Transformation Needed
Transformation Needed Observing Integration of Health Services in China
283
Promoting Research under the Aegis of NCCAM
283
Promoting High Quality Research and Publications
283
Acting Against Exaggerated Advertisements that Make Medical Claims
284
Uniform Policy on Reimbursement of AYUSH Treatment
285
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12 Transformation Needed Observing Integration of Health Services in China One of the important goals of NRHM and the overall health policy has been to mainstream AYUSH services into overall healthcare delivery. China achieved integration of modern medicine and traditional Chinese medicine decades ago. Although several delegations have visited China, this aspect has not been amplified in terms of managerial inputs. There is therefore a need to send a cross-section of health system managers namely a Medical Superintendent of a Central Government hospital, and selected State Directors General and Directors of Health Services to visit China to understand how integration of TCM at different levels of health care delivery have taken place. Time needs to be spent on specifically viewing how integration has been provided for at the patient’s level, instead of making a general visit. A team comprising one modern medicine Doctor, an AYUSH physician and a hospital administrator may be asked to prepare a paper on how cross referrals are managed in China after initial registration in the outpatient department. This needs to be studied keeping in mind specific medical conditions so that the operating procedures that are followed when modern medicine and TCM are used together are clear. Promoting Research under the Aegis of NCCAM It would be useful to select a team of AYUSH doctors who are already publishing papers
(the Banaras Hindu University, Department of Ayurveda has several such faculty members) to conduct an up-to-date search of Complementary and Alternative Medicine (CAM) projects that have been funded by the National Centre for Complementary and Alternative medicine (NCCAM) of the National Institutes of Health (NIH), USA. As a sequel to this exercise the subject areas, countries and institutions that have been awarded research projects needs to be gleaned. With the help of ICMR the effort should be to get good research proposals accepted by NCCAM; also to suggest avenues for foreign medical researchers interested in conducting collaborative research in India. This is permissible under the protocols that are already available in the Department of Health and the Ministry of External Affairs. ICMR is the Secretariat for doing such research and the requirements are well known to ICMR. A number of AYUSH doctors say they do not need any endorsement from Foreign institutions and this mindset must be changed as world recognition depends on the platform used for research and publications. Promoting High Quality Research and Publications In the last seven years several efforts have been made to assist the process of integration but the picture is not as satisfactory as one might have expected, given the sustained interest in promoting the AYUSH systems at a policy level. The fundamental weakness of the AYUSH system is the lack of high quality published research and the tendency to make exaggerated claims. This has to
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be confronted if any significant change is expected. A promising beginning has already been made by a few good journals which are helping to publish and disseminate research findings. Quality journals have begun to be published which are being accessed internationally. These include International Journal of Ayurvedic Research (IJAR), an official publication of Department of AYUSH, Government of India; AYU journal of Gujarat Ayurveda University, Jamnagar; Journal of Ayurveda and Integrative medicine (J-AIM) of Institute of Ayurveda & Integrative Medicine, Bengaluru; Ancient Science of Life of The Ayurvedic Trust, Coimbatore. Even so, one of the leading initiatives has met with some avoidable impediments1. Recently at the initiative of the Department of AYUSH and WHO a publication called “Standardization of Terminologies of AYUSH systems” has been completed which should help adoption of standard terminology. The portal of the National Institute of Medical Heritage has begun to upload the details of research undertaken by the Research Councils of Ayurveda, Unani and Siddha medicine after putting the research papers through a fresh review. These steps create ground for increasing knowledge and understanding of the Indian systems of medicine but continuous efforts are needed not only to publish but to examine the impact factor critically. In Part I of the Status Report, several suggestions had been made after bringing out what has been achieved by various research bodies
working under the Government of India. As recommended by the Steering Committee set up for the 12th plan, all the AYUSH Research councils need to function in close co-ordination with ICMR instead of working in independent silos. The need for publication in high impact journals should be emphasised and funding linked to such quality research chiefly in the areas of clinical research. There is little chance that the research done will improve incrementally unless high standards are set and outcomes monitored by a multidisciplinary group of research experts that are familiar with standards expected by quality journals. ICMR can be a route to understand the processes to be followed. However it may be worthwhile to identify people from the private sector or from different Universities to join the effort. A search committee should identify such experts. Acting Against Exaggerated Advertisements that make Medical Claims Despite some laudable initiatives taken by the private sector the bulk of small manufacturers are ignoring the codes on advertising medical cures. Countrywide there are instances of advertisements of therapies and medication under the AYUSH systems which are defying the Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954. Claiming to have a cure for scheduled intractable diseases and conditions is expressly forbidden by law and is a punishable offence. This is one area where no visible deterrent action has been initiated. With the large-scale use of the
1. Numerous people mentioned to the PI that the publication of a journal called “International Journal of Ayurveda Research (IJAR) had been announced in 2008. Funds were released for the first year and the Journal became the first Ayurvedic journal to be indexed with Pubmed. However in the subsequent years the funding was restricted to almost half of what was needed for one online version. It appears the Journal has not made any further headway because the editors are unable to manage the editorial work within the budget provided. At the time when the work came to a halt, there were apparently around 300 papers being processed. It is important to give continuous support to good journals because they bring credibility to the research work that is being done which will help raise the credibility and acceptance for the systems and also promote further research and published work.
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Internet, claims for curing cancer and other diseases are being spread through websites and social network sites. For several years the subject has come up for discussion both in the Department of AYUSH and with the state governments. No overt action which has resulted in effective enforcement of the law appears to have been taken. The public needs to be forewarned about such advertisements and claims because no such cures for certain diseases have been discovered by any system of medicine. If AYUSH drugs require a different list then it requires a change of law. It is the function of state Drugs Controllers to inform the public and to set up a system for monitoring misleading and exaggerated claims. But because AYUSH is seen as “separate “ and the AYUSH Drugs personnel are not in charge of administering the law which generally comes under the Health Departments, this has become “no man’s land”. As a result the public often gets duped. A mechanism should be introduced whereby the Departments of AYUSH at the state level warn the public periodically through newspaper advertisements and on television that there are centres as well as manufacturers of medicine that make claims about curing intractable diseases like Cancer and HIV/ AIDS. This is a public safety hazard. The public should be asked to seek advice from an All-India toll-free number to check about the credibility of the claims made when in doubt. Far from detracting from the value of AYUSH treatment and medication, the public would recognize that there is a reliable way of checking on exaggerated and false claims. Standard responses should be available on the monitor for help-line staff to give guidance. These should be prepared by experts but converted into commonly used English and Hindi. All Ayurvedic and AYUSH hospitals, centres
and individual issuing advertisements about curing certain intractable diseases should be given a written warning and a report about the publication of misleading advertisements taken up with the Press Council of India. The State governments need to be given guidelines which are legally sound on how they should deal with such advertisements. Uniform Policy on Reimbursement of AYUSH Treatment Background In the aftermath of the terrorist attack in Mumbai a peculiar case came to light of the Shourya Chakra awardee PV Mahesh, an NSG commando who killed a terrorist but was hit by a grenade that left three shrapnel in his head. As a result he was in coma for 6 months and his right side was paralysed. Later he is reported to have availed of Ayurvedic Panchakarma treatment from a private Ayurvedic hospital situated 300 Kms from his village in Kerala. This reportedly resulted in speedy recovery according to the patient’s own claim. He was however refused reimbursement of the expenses as the Army authorities did not recognise the Ayurvedic system of medicine. A PIL was filed in the Delhi High Court seeking directions to the Armed Forces to frame a policy for medical treatment/reimbursement to officers/employees who wish to avail of Ayurvedic or other alternate systems of medicine keeping in view that such treatment is provided in Government hospitals across the country free of cost or at negligible cost. Further the Central Government had framed a policy in 2002 called the National Policy on Indian Systems of Medicine & Homeopathy 2002 emphasising that medical reimbursement should be provided to employees availing Ayurvedic treatment.
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The Delhi High Court directed the Army authorities to consider framing a policy in light of the National Policy on Indian Systems of Medicine & Homeopathy 2002. The latest position of the particular case is not known and is beyond the scope of this report. Recommendations The Department of AYUSH needs to convince all Ministries and Departments to reimburse medical expenses on AYUSH treatment of employees if availed of for specific conditions and in recognized facilities. A list of such facilities should be drawn up at least in the cities which have CGHS cover which cater to large populations of Central government servants. The rest of the employees are covered by the CSMA Rules. AYUSH treatment should be permissible in any recognised AYUSH facility for which a list needs to be available in all CGHS centres, and clinics. However in the case of an employee requiring rehabilitation after undergoing an accident or injury suffered in the course of performing duty, there should be an understanding that he can avail of Ayurvedic treatment in any facility as per his convenience at rates accepted for recognised
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facilities. This would facilitate such patients who are paralysed or incapacitated to select facilities which are conveniently placed. In the case of other employees of central government, package deals should be recognized upto a specified amount to be undertaken in hospitals recognized by Department of AYUSH. This is already being done but perhaps needs to be reviewed annually so that more facilities can be recognised. While the Armed Forces will no doubt have their own policies for serving soldiers including officers and other ranks, cases requiring rehabilitation particularly on becoming paralysed or incapacitated because of an injury suffered on duty, need to be treated differently. Permission to avail of Ayurvedic treatment should be given liberally for paraplegics, hemiplegics and those who suffer from chronic musculoskeletal problems which are the result of injuries that occured while on duty. In these circumstances Ayurvedic treatment should not be denied to any soldier or uniformed employee who desires to avail of such treatment for rehabilitation. The cost involved would be too small to even try and compute limits on expenditure.