|Year : 2021 | Volume
| Issue : 2 | Page : 243-245
Much ado about AYUSH notification
Ex Medical Officer ESIS, Jabalpur MP, Advocate, MP High Court Hon. Executive Editor "EcoTalk, India
|Date of Submission||15-Dec-2020|
|Date of Decision||15-Dec-2020|
|Date of Acceptance||16-Dec-2020|
|Date of Web Publication||3-Mar-2021|
1007, Sanjivani Nagar, Garha, Jabalpur, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shrivastava Y. Much ado about AYUSH notification. Med J DY Patil Vidyapeeth 2021;14:243-5
In India, unreasonable and ambiguous health-care policies keep on surfacing at regular intervals, creating confusion and chaos. The recent Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) Notification is another such step which has disturbed the allopathic community. However, the modern medicine is quite competent and well equipped to overcome such challenges. In fact, the much-debated notification is not going to cause any adverse effect on surgeons practicing modern medicine.
On November 20, 2020, the government issued a notification authorizing postgraduate (PG) practitioners in specified streams of Ayurveda to be trained to perform various surgical procedures, and this move has drawn flak from the modern medicine fraternity. Gazette notification by the Central Council of Indian Medicine (CCIM), a statutory body under the AYUSH Ministry to regulate the Indian systems of medicine, issued amendment in the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016, and listed as many as 39 general surgery procedures and 19 procedures involving the eye, ear, nose, and throat under Shalya Tantra and Shalakya Tantra branches of ayurvedic surgery.
The last two to three decades have seen governments taking bizarre steps to improve the health-care system. As a result of multiple wrong medicines, our government health-care system is almost on deathbed. The private sector has been alleged to be costly, cruel, and callous, but actually, this private sector has now become the backbone of health care in India. The recent notification is an effort to send a message to the public that they are being provided a wider choice of treatment in order to prevent them from incurring huge expenses on treatment by the allopathic doctors. In a nutshell, it is only a political gimmick rather than a well-thought-out policy.
This step to impart training to AYUSH doctors to perform various surgeries caused confusion and chaos in the already-sick health-care sector. The general perception was that the AYUSH doctors were being allowed to perform surgeries for the first time, whereas the reality is different. In fact, Ayurveda practitioners also get training in surgeries and perform them. Their methods and practices are traced back to Sushruta, an ancient Indian sage and physician. He authored “Sushruta Samhita” (600 BC), an important ancient medical text, to represent the process of rhinoplasty. As one of the earliest documented plastic surgeons, he also described procedures for treating hemorrhoids and fistulae, as well as cataract surgery. For his valuable contributions, Sushruta is described the “father of surgery.”
The Indian Medical Association (IMA) has raised strong objections against the CCIM notification and organized a nationwide protest on December 08. The IMA opposed the decision to “mix” modern medicine with the traditional systems of AYUSH and expressed concern that an integrative system of medicine would create a “khichdi medical system” or “mixopathy” and produce hybrid doctors. Over 3.5 lakh doctors also observed a strike across the country on December 11 to protest against “mixopathy.”
The AYUSH Ministry was quick to respond and issue a clarification regarding an earlier government notification which allowed Ayurveda PG students to undergo training in general surgery; orthopedic; ophthalmology; ears, nose and throat (ENT); and dental procedures. “The notification specifies (in clearer terms than the earlier notification on the subject) a total of 58 surgical procedures that PG scholars of these streams (cumulatively) need to be practically trained in, so as to enable them to independently perform the said activities after completion of their PG degree,” the ministry said in its clarification statement.
The allopathic community anticipates that the AYUSH doctors may take the advantage of the ambiguity of the notification and may perform all surgeries after they get “training” during their PG course. This apprehension is not unfounded as the government machinery has failed to contain malpractice and quackery and there can be no mechanism to continuously vigil AYUSH doctors to ensure that the surgeries are restricted to the notified list. It is no secret that thousands of quack “doctors” are undertaking all kinds of treatment and “operations” in rural areas all over the country, which is well within the knowledge of the concerned authorities. Therefore, license for surgeries to AYUSH doctors will blur the boundary between legal and illegal surgeries in due course.
It would have been sensible on the part of CCIM to issue the notification, after consultation with the National Medical Commission because enumerated surgical procedures require appropriate medical infrastructure and experienced faculty. Training in Ayurveda institutes cannot match the taxing curriculum in PG studies of modern medicine, therefore it will be disastrous to produce “surgeons” without proper education, training, and experience. Hence, the notification of CCIM regarding modern medicine training for Ayurveda graduates is senseless and illogical.
Despite the vehement objections from various organizations of allopathic doctors, particularly IMA, the government's stance is hardly going to change because we are ruled by ill-informed politicians and arrogant bureaucrats. However, there seems to be unnecessary commotion among the modern medicine fraternity because this law will not cause any substantial effect on the health-care scene or any adverse effect on doctors practicing modern medicine. Reasons are many.
The recent notification says:
In the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016, in regulation 10, after sub-regulation (8), the following sub-regulation shall be inserted, namely:-
―(9) During the period of study, the PG scholar of Shalya and Shalakya shall be practically trained to acquaint with as well as to independently perform the following activities so that after completion of his PG degree, he is able to perform the following procedures independently:-
The list included 39 procedures in general surgery and 19 procedures in ENT/ophthal/dental branches.
This, in fact, is a revised version of a previous notification issued in 2016. That notification said:
10(8) In the specialties of Shalya, Shalakya and Prasuti-Stri Roga, the student shall undergo training of investigative procedures, techniques and surgical performance of procedures and management in the respective specialty.
Although this was a vague provision but legally speaking, it had a wider scope which allowed AYUSH doctors to perform all kinds of surgeries because clauses 10 (5) says, In clinical subjects, students shall undertake responsibility in management and treatment of patients independently and deal with emergencies and 10 (7) says In the clinical training, the student shall have to acquire knowledge of independent work as a specialist.
The extended meaning of “training of management and treatment” and “of independent work as a specialist” mentioned in clauses 10 (5) and 10 (7) of 2016 notification is obviously the license to perform surgeries in practice. Therefore, the 2020 notification has actually restricted the surgeries to 58 only, whereas a wider scope is already implied in the 2016 notification.
There are very few Ayurveda hospitals, mainly government teaching institutions, where surgeries are performed and training is imparted. Building private hospitals with necessary facilities for surgeries requires huge investments and it takes years to break-even, therefore no AYUSH doctor will dare such costly venture independently like most of their allopathic counterparts. Needless to say, allopathic hospitals will never entertain AYUSH doctors for surgeries for the sake of their reputation.
Consumer cases will be another strong deterrent to AYUSH surgeons who have not yet tasted the costly and bitter fruit of the amended Consumer Protection Act. If they cross the boundary and operate beyond their legal license, one or two cases in the consumer courts will dampen the spirit of the whole AYUSH community. Insurance companies will obviously refrain from issuing indemnity policy to AYUSH surgeons and may go a step further to categorically put such surgeries in “exclusion clauses” of Mediclaim policy, making it impossible for the patients to claim for expenses incurred on AYUSH surgeries.
In view of the limitation of surgeries to 58 only for AYUSH doctors, that too legally questionable, the entire field of surgery is still open for allopathic surgeons. There is a fear that people may be befooled by incomplete information about the operating surgeons, but nowadays the public is well informed about the qualifications, reputation, and efficiency of consultants. Hence, people are unlikely to go to AYUSH surgeons for surgeries. After much publicity about the recent notification, they will make sure that the operation is performed by the actually qualified allopathic surgeon. Nevertheless, in a country where the business of healing is substantially shared by Babas, Ojhas, Tantrik Gurus, Astrologers, Quacks, etc., public prudence and system's incompetence are not debatable. Ultimately, it is patients' prerogative to consult the surgeon of their choice, and Indian patients are undoubtedly the smartest of all consumers.
The Supreme Court has repeatedly observed in various judgments that “crosspathy” or “mixopathy” cannot be allowed in view of the MCI regulations. In few states, that permission is limited to prescribing allopathic medicines only if the AYUSH doctors have received the knowledge during their education and training. Therefore, it will be interesting to see how the government responds if the matter is brought before the court of law. It is almost impossible for AYUSH doctors to perform surgeries without using antibiotics, medicines, equipment, anesthetic agents, etc., which are commonly used in modern medicine, therefore they will attract legal actions. Recently, two doctors in Pune have been sentenced to simple imprisonment for 10 years for culpable homicide not amounting to murder under Indian Penal Code Section 304. The conviction was over the death of a 21-year-old woman who had succumbed to postsurgery complications after a cesarean delivery and tubectomy performed on her in 2012 at a hospital by doctors who have degrees in Ayurveda. One of them possessed a PG degree of MS in Ayurveda Shalya Tantra.
Confrontation continues and allopathic doctors intend to move court in view of the government's apathy toward the objections and apprehensions raised by them. Irrespective of the outcome, things are going to remain the same. We have seen in past that modern medicine is not so incompetent or ill equipped to be affected by unreasonable and ambiguous policies of the governments. The government edict will not be able to cause any negative effect on the survival and progress of modern medicine, but it has definitely provided an opportunity to the allopathic community to consolidate their solidarity and create trust in the mindset of people. This is high time that more important issues such as falling standard of medical education, doctor–patient ratio, rural health care, health expenditure, and quackery should be addressed by modern medicine organizations rather than becoming excessively concerned for a notification which will definitely turn out to be a damp squib.
| References|| |
Indian Medicine Central Council (Post Graduate Ayurveda Education 2016, Notification No. 4-90/2016-P.G. Regulation, dated 07-11-2016. Available at Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016 (bareactslive.com) (Last accessed on 2021 Feb 27).