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Epilogue
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Epilogue This report has dealt with the here and now of Indian medicine. Until now it conveyed no vision and made no attempt to deal with globalisation. Perhaps the Epilogue is the place to project what could really make an impact. Since Ayurveda is a globally recognised name and one that represents 85 percent of Indian medicine, it is being used here as a generic term. Commission on Propagation and Globalisation of Ayurveda Ayurveda is not only about health and medicine. It is a natural way of living; its beneficiaries are not restricted to the clientele of the Health sector alone but include several more. There is a need to give a thrust to the propagation and globalisation of Ayurveda by establishing a high-level Commission like the LM Singhvi Commission, which addressed issues related to NRI/PIOs. Several institutions concerned with agriculture, animal husbandry, fertilisers and forestry, besides a whole host of scientific bodies, have a stake in Ayurveda. The Defence Research and Development Organisation (DRDO) had conducted extensive research into Ayurvedic drugs (for enhancing immunity and reducing high-altitude sickness). The Departments of Insurance, Commerce and Tourism, all can gain pre-eminence by promoting a business model for medical insurance and tourism through Ayurveda. Kerala has already done wonders for propagating Ayurvedic tourism. Rural Development and Tribal Affairs can level the playing field for the poorest segments of the supply chain that collect the plants – tribal folk, women and children. Ayurvedic medicine has been shown to enhance stamina and endurance among athletes – which arguably does not amount to doping. The protection of biodiversity requires legal knowledge for which the Ministry of Environment and Forests can be the guide. A Commission with an overarching mandate can help leverage the enormous potential and capacities we already possess but which lie scattered. Comparison with Traditional Chinese Medicine (TCM) The Chinese have taken their indigenous system of medicine very seriously and since 1972 have made
systematic efforts to gain acceptance and recognition, primarily for acupuncture and herbal Chinese medicine. The website of the US National Institute of Health (NIH) and the National Center for Complementary and Alternative Medicine (NCCAM) (http://nccam.nih.gov/health/ whatiscam/chinesemed.htm) indicate that traditional Chinese Medicine (TCM) is widely used in the United States. According to the 2007 National Health Interview Survey, which included questions on the use of various Complementary and Alternative (CAM) therapies, an estimated 3.1 million US adults had used acupuncture in the previous year. The survey notes that approximately 17 percent of adults use natural products, including herbal, making it the most commonly used therapy. The federally recognized Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) accredits schools that teach acupuncture and TCM. About a third of the US states that license acupuncture require graduation from an ACAOMaccredited school. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) offers separate certification programs in acupuncture, Chinese herbology, and Oriental bodywork. Almost all licensing states require completion of NCCAOM’s national written examination; some states also require a practical examination. Positioning Panchakarma like Acupuncture Instead of positioning Ayurveda through the route of college degrees or supporting drug discovery efforts, there is a need to reposition Panchakarma as a recognised therapy for muskulo-skeletal and neurological problems including rheumatoid arthritis, Parkinsonianism and in Behavioural Science. A beginning could be made by demonstrating Panchakarma procedures on veterans suffering from post-trauma stress disorder (PTSD) to be observed by Veteran Affairs (VA) Department of US Defence.Were a high-level policy decision to be announced- for example if Indian Railways as the biggest employer in the public sector recognized Ayurvedic treatment for insuring accident cases, it would instill confidence. Our missions abroad stock few CDs and leaflets here and there but efforts to market Indian medicine
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have been lack-lustre and unconvincing. The propagation of Ayurveda which is well known worldwide (just by its name) could have been launched in innumerable ways by now but efforts, such as they were, have been too small and too sporadic to have had much impact. There needs to be an understanding that the propagation of Ayurveda is in the country’s larger interest-that we are losing the opportunity to establish primacy in a field where we have all the credentials and goodwill to succeed. A Commission for the propagation and globalization of Ayurveda with a Secretariat located in the Department of AYUSH could bring dynamism into this sector; but it has to be viewed in a perspective that includes but transcends health and medicine. Research When all is said and done, only clinical outcomes published in international journals would lead to recognition for Ayurveda including Panchakarma. The ground reality is that there is no legal scope to practice Ayurveda in most countries of the world, including the USA, primarily because of a lack of credible research. Also, there is an absence of a demonstrated will to break down barriers where they exist. India has also not persevered to obtain international funding available for research. This calls for a change of track before it is too late. The single drug, molecular approach adopted over the last 40 years needs to see a paradigm shift, not by abandoning it altogether but by an infusion of comparative clinical studies to evaluate the effectiveness of Ayurveda. The present research orients itself to drug constituents rather than at clinical protocols. Clinical research needs to focus on the effectiveness of Ayurvedic treatment, not just drugs. Indian groups need to seek support for research into specific areas (identified in the Research Chapter) and which are huge areas of current medical interest worldwide. The NCCAM-funded research on Chinese medicine includes investigating pelvic pain, irritable bowel syndrome and temporomandibular (jaw) disorders, and evaluating the effectiveness of Chinese herbal medicine for food allergies and osteoarthritis of the knee. There are several Ayurvedic regimens that can be similarly posed for international research funding, starting with Panchakarma for given conditions. Education We need to offer postgraduate interdisciplinary
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training to modern scientists including medical anthropologists to increase the dialogue between Ayurveda and modern science. The focus has to be on producing peer reviewed research that can influence policymakers and consumers. This can happen if an opportunity is created for PhDs in modern medicine to take up special courses in Indian medicine and for Ayurvedic graduates to learn about high quality research methodologies to bring credibility to their work. A stated policy is required to overcome resistance by supporting multi-disciplinary projects in parallel. Export Potential Years ago it was reported that India’s earnings from this sector are less than two percent of what China earns from TCM. Things have not changed for the better. Policies and strategies that the Chinese have adopted over the years for globalisation of Chinese medicine need to be studied and documented. It would be worthwhile if the Indian Embassy in Washington DC identified a US-trained trade expert and a medical anthropologist familiar with the use of Chinese herbal medicine. Such people can help understand the most important reasons for the country’s primacy in the field of traditional medicine in the US; also how India could leap-frog across many barriers that have already been overcome by the Chinese. Closing Words This vision is not new. It is a repetition of what we as Indians often say to each other, hoping someone else will take the initiative. However no single Department, leave alone a body of persons, can achieve this. It requires the ability to see how the country can leverage the goodness of Ayurveda in a manner that benefits the Indian public and also gives us global recognition. Nowadays the American Medical Association (AMA) and its publication JAMA (Journal of the American Medical Association) are hugely exercised about heavy metal content in Ayurvedic formulations. This issue alone is enough to distort the globalisation discourse for a very long time. It already occupies centre-stage on the NCCAM’s website on Ayurveda. The situation demands that massive attention be paid to GMP and testing for heavy metals and impurities, without which few will take us seriously. The 12th Five Year Plan is on the anvil. The time to act is now.