Reviving traditional medicare a challenge

Soham D Bhaduri

Health Policy Expert

THE early years of 20th-century India witnessed a fervent revival of interest in traditional medicine, chiefly ayurveda. This was preceded and backed by the massive campaign of translating and making accessible recondite ancient texts during the British rule, which adumbrated a glorious past of ancient Indian medicine that unfortunately had failed to keep pace with modernity. Spurred further by nationalistic sentiments, this led to spirited attempts by proponents of traditional Indian medicine to lend greater credence to their systems via the ways dictated by modern medicine — namely, modern scientific research and innovation. This didn’t last long, and the newly independent India couldn’t go beyond a few initial, forlorn attempts to integrate traditional and modern systems.

With the present political dispensation coming to power, it appeared to many that a new phase of traditional medicine revival had finally begun. In 2014, a Central ministry dedicated to Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) was established to promote Ayush research, innovation and dissemination. Attempts to mainstream Ayush in the public healthcare system, including a greater integration of Ayush practitioners into mainstream healthcare, were visibly accentuated. More recently, the government has strongly pushed for enabling Ayush practitioners to practise allopathy to increasing degrees, and a vision of “one health, one health system” has also been enunciated for fostering a two-way exchange between modern medicine and Ayush. But is this revival really headed in the right direction?

Recently, the Prime Minister, while inaugurating the global Ayush investment and innovation summit, exhorted for greater investments in the Ayush sector, to help it turn into a big brand in India that attracts start-ups, medical tourists and greater exports. The unprecedented growth in the production of Ayush formulations, supplements and cosmetics was hailed, as was the power of investments to further Ayush. An ‘Ayush mark’ to hallmark export-quality and authentic Ayush products, and a special visa category to facilitate medical tourism in Ayush, were also proclaimed. An examination of these propositions would bring out exactly what is amiss.

In mainstream healthcare, at least as far as the scope of population health goes, free markets operating along market principles are looked at with scepticism. Free markets in healthcare have traditionally been known to be imperfect and tend to fail owing to umpteen factors — information asymmetry, lack of product and price homogeneity, externalities, barriers to entry, and the like. The thought of attracting large-scale private investments in healthcare as a matter of formal public policy is largely shunned, at least ostensibly, in favour of increased public funding to healthcare. While many would rightly argue that Indian healthcare is predominantly privatised and under-regulated, the Ayush sector today stands out as having the most laissez-faire within the larger health ecosystem.

Private investments are driven by supply and demand factors, irrespective of their broader significance for the nation’s health. If allowed to flow in freely, albeit in the presence of only basic regulatory arrangements such as quality checks — treatments and interventions with the most favourable public perception would attract the maximum investments. This is regardless of whether there is enough evidence to back them, or whether population health goals are served. The Covid-19 pandemic has given ample precedents of this. Particularly in the early stages of the pandemic, the blatant promotion and sale of certain dubious ‘immune boosters’ cascaded even throughout major cities like Mumbai. Such perceptions are hard to put away and are hardly conducive to the spirit and intent of public health. Also, such increased investments cannot be termed salubrious. In a less extreme sense, this has always been the case with the Ayush sector in India, and only stands to be accentuated in the face of the more laissez-faire policies being pursued lately.

Such a laissez-faire approach is unfortunately at the heart of the current Ayush revival movement, baring few exceptions. Between 2015 (the year after the Ministry of Ayush was convened) and 2022, the budgetary allocation for the Ayush ministry increased at an unremarkable CAGR (compound annual growth rate) of 16 per cent (actuals to budget estimates). No wonder that in the persistent absence of enough evidence to back their efficacy, large scale investments in Ayush stand prone to popular scepticism, which constrains the room available for the government to increase investments in Ayush. Given this, private investments remain the only major avenue.

The way this stands to further distance the modern and traditional systems in mainstream healthcare is highly poignant to note. Today, for most democratic governments including India, universal healthcare fuelled by public funds or insurance is the holy grail, at least purportedly so. Justifying a consequential inclusion of Ayush interventions under public health insurance becomes highly challenging and untenable, in the face of ever rising healthcare costs and crunch of public funds. Our few, shaky attempts to mainstream Ayush in primary healthcare can do little to hold up. The resultant untoward commercialisation of Ayush medicines and formulations is already widely known. Failing to provide widely accepted and acknowledged mainstream therapeutic options, the larger stock of Ayush today has stood disposed to be channelled into fancy and inessential sundries such as nutraceuticals and cosmeceuticals that drain the country of an array of potentially vital medical compounds. The current focus on export promotion of Ayush products only stands to aggravate this.

There is a need to rethink the entire paradigm of the current Ayush revival in the country, lest it risks being permanently relegated to an exotic choice for foreigners and a few believing countrymen. At least in spirit, there is much to learn from countries such as China, which did a remarkable job to integrate the education and practice of modern and traditional medical systems. The prescribed right way to do things is the long and difficult route that comprises scientifically validating traditional medical approaches, purging the redundant, keeping the worthy, and integrating them as an inalienable part of the well-regulated mainstream healthcare — while not allowing them to fall prey to the blandishments of the free market. Only this can rightfully constitute the spirit of an Ayush revival. It is well understood today that traditional systems don’t readily yield to conventional research methods, and the alternative approaches to investigating them are largely in infancy. However, it is still too early to give in and acquiesce in the notion that traditional systems are scientifically irredeemable.

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