Doctors of the modern system of medicine across the nation are expressing resentment against 'mixopathy', a newly coined term for the integration of different systems of medicines or treatment- Ayurvedic, Homeopathic, Unani, Siddha, Yoga and Naturopathy with Allopathic (modern) system of medicine. Dr. AP Setia explains why the matter is important for both doctors and patients, who will be the 'ultimate sufferers’ of the practice.

The background of the mixopathy process was initiated with provisions in section 50 of the National Medical Commission Act 2020, according to which, educational modules for the interface between the modern system of medicine, homoeopathy and Ayurveda, shall be prepared by joint meetings of the Central Council of Indian System of Medicine, Homeopathic Council, and National Medical Commission, thus promoting pluralism in medical education. The National Education Policy 2020 in its medical education component lays emphasis on the holistic approach and pluralism as well.

Mixopathy

As per a news report published in The Hindu, on 25th October 2020, government think tank, NITI Aayog is looking at many reform ideas in the health sector, including aligning traditional and modern approaches for a ‘larger good’. Its member, Dr. V.K.Paul told PTI, “It makes eminent logic that the best of traditional medicine and best of modern medicine therapies be brought together for the larger good of the people and there are ways of practising integrated medicine." Mr. Paul pointed out that it has already happened to an extent, as yoga is now part of our practice in several conditions like hypertension.
 
NITI Aayog has formed four committees to integrate all systems of medicine. These committees are in the area of medical education, clinical practice, public health, medical research and administration. But the concept for the integration of different systems of medicine, put forward by policymakers, is a dilemma for intellectuals to understand, under the prevailing scenario.

India is a unique nation having unity in diversity. We have different cultures in different parts of India, different languages, customs, and traditions, and similarly, different systems of treatment for various ailments. Each system has its own unique method of diagnosis, reasoning for causation, and protocols for treatment.

How is it possible to integrate all such systems?

Modern medicine is an internationally recognised system of treatment, whereas other systems have regional acceptance and dominance. The way different regional languages from the nation, cannot be integrated to make one language, similarly, it is not possible to integrate and formulate one common system of treatment.

There are contradictory views on certain aspects as well. For example, how can the antimicrobial concept of the modern medicine system, can be integrated with Tridossa theory of Ayurveda? How can the concept of Homeopathy, which says, dilution increases the potency of a biologically active substance, find integration with modern pharmacology? As per Homeopathy principles, less is more; dilution and shaking (succussion) leave some imprints of the original substance, on the solution (dynamises the remedy). The concept that substances retain memory on dilution, has not stood the scrutiny of biology, chemistry, physics and related sciences. It is aptly described as 'delusion of dilution'. How should one explain the logic of the Yogic concept of alternate nostril breathing (Anulom Vilom) to a student of modern anatomy and physiology, because both nostrils have identical structures?

Further, it is not possible to administer, treatment to one patient simultaneously from different systems. Because, scientists and clinicians are yet to unfold, the drug interactions between medicines from different systems, inside the complex human machine, which may be undergoing different metabolic changes due to the stress of trauma or operative procedures or recovery from anaesthetic agents, apart from the onslaught of infections and immune factors. All such issues need to be sorted out, by scientific research both in experimental laboratories as well as in clinical practice, before any type of integration exercise is put into action, by independent expert groups, or else, we shall be putting the proverbial cart, before the horse. Unlike the modern system of medicine, the indigenous systems, of therapy are not evidence-based. And hence, have no common grounds to meet and mix. 

The shortage of qualified doctors has often been cited as the reason for such integration, but since nearly 80,000 MBBS doctors are now being trained by 642 medical colleges per year, such an argument may not be valid any more. Rather, there may be many unemployed young MBBS doctors, in a few years from now. Regarding postgraduates doctors too, 36,192 MD and MS seats were available for the year 2020-21. And another nearly 8,000 seats for DNB. Thus, more than 44,000 specialist doctors are being prepared by medical colleges and 60 exclusive postgraduate medical institutes, every year.

Another reasoning pointed out in this context is that the doctors of the modern system of medicine are not keen to provide services in remote or underdeveloped areas. The non-availability of qualified doctors in rural areas is more because of the non-availability of other essential services as well. The basic amenities, as per the expectations of the general public, are not available in these locations, which has led to a growing trend amongst the rural population migrating to cities, in search of better living conditions. The qualified doctors would love to serve the ailing masses in rural areas if infrastructure and social milieu to practise modern medicine is made available by the government.

The policymakers need to ponder over correcting the basic lacunae regarding infrastructure first, rather than making stopgap, arrangements to meet the demand-supply gap, if any, by either integrating different systems of treatment or by imparting modern surgical training to Ayurvedic graduates, as per the CCIM notification, (Amendment Rules 2016) dated 19th November 2020. It is my humble suggestion that the policymakers should not dilute the basic standards of care for those residing in rural areas.

A possible solution

Let each system of treatment, be developed, in an individual manner, by established scientific research methodology, to make it evidence-based and acceptable by those with a scientific temperament. Mixopathy is unscientific, unrealistic, unreasonable, and onslaught on the uniqueness of individual systems of treatment. Let diversity of different systems prevail and flourish.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. A.P. Setia is a General Surgeon from Haryana.