An uneasy relationship
P. Ravi Shankar
Kuala Lumpur, Malaysia
|Photo by lil artsy on Pexels|
My paternal grandmother lived for nearly ninety-three years. She was a strong woman who faced life with courage and dignity. She developed some medical conditions later in life but was active, could carry out her activities of daily living, and lived a very disciplined life. Like many others in India, she accepted and used prescribed Western allopathic medicines for her conditions. However, she was also a firm believer in Ayurveda, the ancient Indian system of medicine.
I studied Western allopathic medicine in the Southern Indian state of Kerala and did my residency training in the northern Indian city of Chandigarh. My attitude toward indigenous systems of medicine at that time was more negative than today. I believed that other systems suffered from a lack of research and were based on continuous re-reading and interpretation of ancient texts. Ayurveda (literally, the “science of life”) was commonly used throughout India and in many other countries. Many patients used both Western medicine and indigenous medicine together. The belief among laypeople was that traditional systems were better for chronic conditions and that Ayurvedic medicines did not have any side effects.1
Even after independence from British rule, traditional systems of medicine suffered for decades from underinvestment and the political dominance of allopathic medicine. Recently, the government in India has been investing more in these systems of medicine and a department of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) has been set up to promote and regulate other systems of medicine.2 There is now pride in yoga and systems of healthy living practiced by ancient Indians. In South Asia, various systems of medicine were developed through interactions with other civilizations, and religion also played an important role.
Western medicine was first introduced to India by the Portuguese and later by other colonizing European powers. During the ensuing five centuries, it has seen tremendous growth. During the initial period of British colonial rule, instruction in both Western and local medical systems was offered by the government. In the mid-nineteenth century, the minutes of Thomas Macaulay recommended the government no longer fund instruction in native medical systems nor offer instruction in languages other than English.3 The lack of government support sealed the fate of many institutions offering instruction in native systems.
Allopathy is the dominant medical system in South Asia today. The successes of the system are well documented. Allopathic medicine attracts the brightest students and the lion’s share of the health education and healthcare budget. Students of allopathy regard their medical system as superior and scientific and practiced by powerful Western societies. Governments at both provincial and federal levels in India and of other countries in the region have made periodic attempts to promote indigenous systems.
Many of these attempts emphasized integrating traditional medicine practitioners into existing health systems. There was a proposal in Kerala to appoint traditional practitioners as medical officers in the government system after brief training. One of the fears of Western practitioners is that these people will practice mostly allopathic medicine without adequate training or knowledge. Many private allopathic hospitals and nursing homes employ graduates in Ayurveda and homeopathy as medical officers and resident doctors despite this not being legal. These doctors are cheaper to hire.
Many of us were strongly against the method of integration of different medical systems when we were students and thought it was a method to weaken the health system and introduce indigenous systems through the back door. There was a long student strike against this move in Kerala. Even today, most of my batchmates practicing in the state are strongly against other medical systems. They are of the opinion that these are unscientific and cause more harm than good. With the advent of tourism, there has been an increasing demand for Ayurvedic treatments. The question of which system of medicine is practiced by practitioners of other systems remains. Do most of them use Western remedies despite not having been trained to use them properly?
I was involved in pharmacovigilance and adverse drug reaction monitoring for over a decade. The premise that Ayurvedic and natural medicines do not have side effects is unfortunately not true. There can also be interactions between Western medicines and traditional remedies. Pharmacovigilance, especially in Ayurveda, faces several challenges.4 Both practitioners and patients should be aware of this possibility and know how to use these different medical systems in a safer manner. Many patients may be more culturally attuned to traditional remedies and may prefer to use them along with Western medicines. They also know that most allopathic doctors look negatively on these remedies and their use of traditional medicines is unlikely to be volunteered. Cultural humility and empathy are required.
Faith healing has also attracted negative press. Exorcism rituals are common throughout South Asia. Many saints, gods, and shrines are supposed to have miraculous healing powers. Belief in a higher power and some of the rituals may be beneficial in certain cases of psychosomatic and mental illness.5 What should be the attitude of Western medicine practitioners toward these practices?
I often question whether the term “Western medicine” is still appropriate. The system may have originated in Europe but over the intervening centuries, other regions have made significant contributions to its growth and development. This medical system has become an integral part of the health system of different countries. What should be their relationship with pre-existing indigenous medical systems? What about homeopathy, a Western system that is popular in many countries? Can different systems work together to promote health and relieve suffering? How can they do so?
Traditional medicine preparations are difficult to standardize. Many herbal preparations are administered for their holistic value and have an array of chemical ingredients with complex chemical formulae.6 The same is also true for other traditional medicine preparations. This lack of standardization creates problems for regulatory approval and for the conduct of clinical trials.
I also think about the current situation of students of allopathic medicine and allopathic practitioners in many parts of Asia. The medium of instruction continues to be English. Many textbooks and resources are from the West. What should be our attitude toward our indigenous knowledge and our belief systems? Recent studies have shown that there may be solid science behind many rituals and behaviors. Can we move forward and make a significant contribution to allopathic medicine while also remaining rooted in our traditional beliefs and medical systems?
As I have grown older, I have become increasingly accepting of other medical systems. I have come to realize the rich cultural and knowledge traditions of South Asia. As said by Rudyard Kipling in his novel Kim, the Sahibs may not have all the world’s wisdom. Some medical systems have opposing philosophical bases. I am not sure that they can be used together. A major area requiring greater research is how to use different medical systems together for the benefit of humanity, though reconciling this uneasy and often fractious relationship will not be an easy task.
- Sanjeev Rastogi, et al. “A survey of patients visiting an Ayurvedic teaching hospital for factors influencing the decision to choose ayurveda as a health care provider,” Journal of Ayurveda and Integrative Medicine(2022): 100539.
- Pulok K Mukherjee, et al. “Development of Ayurveda–tradition to trend,” Journal of Ethnopharmacology197 (2017): 10-24.
- Anshu Supe, “Evolution of medical education in India: The impact of colonialism,” Journal of Postgraduate Medicine62, no. 4 (2016): 255.
- Sanjeev Rastogi, “Why and how? Addressing to the two most pertinent questions about pharmacovigilance in Ayurveda,” International Journal of Ayurveda Research2, no. 1 (2011): 48.
- Simon Dein, “Religious healing and mental health,” Mental Health, Religion & Culture23, no. 8 (2020): 657-665.
- MS Wani, SR Parakh, and MH Dehghan, “Herbal medicine and its standardization,” Pharmaceutical Reviews 5, no. 6 (2007).
DR. P. RAVI SHANKAR is a medical doctor, member of the ORCID Research Advisory Council (ORAC), and a member of the World Association of Medical Editors (WAME). He has been published 750 times in various journals, written twelve book chapters in seven books, and has reviewed over 800 research papers. He was among the top 2% of scientists globally through 2019–2021. His areas of research are the health humanities, rational use of medicines, pharmacovigilance, and small-group learning, among others. He enjoys traveling and is a creative writer and photographer.