New Delhi: The Indian Medical Association (IMA), the largest body of modern medicine doctors, has given a call for protests Tuesday at 10,000 locations across India against a government notification listing surgeries that Ayurveda practitioners can perform.
Calling it ‘mixopathy’, the IMA has also threatened to withdraw all non-essential, non-Covid services in hospitals on 11 December. The body has called for the demonstrations to be held Tuesday from 12 noon to 2 pm.
— Indian Medical Association (@IMAIndiaOrg) December 7, 2020
The government notification issued on 20 November listed 58 varieties of surgeries that postgraduate Ayurveda medical students must be “practically trained to acquaint with, as well as to independently perform”. These surgeries include general surgery, orthopaedic, ophthalmology, ENT and dental surgeries.
The IMA has criticised the move and questioned the competence of Ayurveda medical students to carry out these procedures.
The term ‘mixopathy’, which doesn’t have a legal definition, is used to describe vital parts of modern medicine being mixed with Ayurveda or homeopathy. The IMA used the term in the current context of allowing Ayurveda postgraduates to perform the 58 surgeries.
The gazette notification issued by the Central Council of Indian Medicine (CCIM), a statutory body under the AYUSH Ministry, listed 39 general surgery procedures and 19 other procedures, involving the eye, ear, nose and throat, by amending the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016.
Postgraduation in Ayurveda comes under the ambit of these regulations that are framed from time to time, and the November notification was an amendment to the 2016 framework.
AYUSH Ministry Secretary Vaidya Rajesh Kotecha had stated last month the CCIM notification doesn’t entail any policy deviation and that the “notification is more of the nature of a clarification”.
“It streamlines the existing regulation relating to postgraduate education in Ayurveda with respect to the specified procedures,” Kotecha said.
He had further clarified that the notification does not open up the entire field of surgery to Ayurveda practitioners.
“It outlines that not all postgraduates of Ayurveda can perform these procedures. Only those specialised in Shalya and Shalakya (branches of Ayurveda) are allowed to perform these surgical procedures,” Kotecha added.
While modern medicine doctors have severely criticised the government move, Ayurvedic doctors said they have been performing surgeries since decades, and in terms of competence, medical students of Ayurveda are very well-trained.
‘Another step to legitimise mixopathy’
In a statement on 1 December, the IMA opposed and condemned the government notification, calling it “predatory poaching on modern medicine and its surgical disciplines”.
“IMA will resist and fight back this criminal plagiarism. This is another step to legitimise ‘mixopathy’,” the IMA stated.
Dr Hemanga Baishya, a Guwahati-based gynaecologist and IMA secretary, Assam, told ThePrint the government’s notification is an “attempt to mix modern medicine with Ayurveda”.
“‘Mixopathy’ describes the mixture of different forms of medical practices and education,” said Dr Baishya.
“The courses are different — modern medicine has continuous research. Ayurveda’s reach and research is only India-based. As modern medicine doctors, we worry how it will affect the patients,” Dr Baishya said.
‘Mixopathy’ may not have a legal definition, but there is a practice called ‘Crosspathy’ in which homeopathic and ayurvedic drugs are prescribed along with allopathic medicines. It is a punishable offence under the Delhi Bharatiya Chikitsa Parishad Act, 1988.
Dr Baishya said there’s “no point in mixing all into one” as it will harm the patients.
“Who will teach the Ayurveda students the basics like injecting anaesthesia to patients and under what circumstances? How will they know what antibiotics to give the patients? We aren’t against Ayurveda, but there is no point in mixing all into one. We aren’t objecting to their earlier surgeries, but now they have added many others like cataract, which was never their job. If one patient suffers infection, then he or she might turn blind … who will take the responsibility?” Dr Baishya added.
Dr Rajan Sharma, IMA national president, said that Ayurveda practitioners are allowed to prescribe modern medicine drugs and refer to modern medicine textbooks, but for doctors of modern medicine, it goes against their “code of ethics” to use Ayurveda.
“We don’t need to use Ayurveda … the question now is whether they will use herbal anaesthesia,” Dr Sharma said.
“I am an orthopaedic surgeon, I am not allowed to perform a general surgery. I can be dragged to the courts for doing it. Then why is Ayurveda an exception?” he said.
Dr Baishya echoed similar sentiments, saying “there have been instances in the past when a doctor of modern medicine prescribed Ayurveda and that led him into legal trouble”.
Surgery not alien to Ayurveda
Surgery is, however, not an alien subject or practice for Ayurveda practitioners, the origins of which go back to the ancient Indian sage and physician Sushruta.
Sushruta’s medical book ‘Sushruta Samhita’ not only describes various illnesses and cures but also has accounts of surgical procedures.
According to the book, Shalya Tantra and Shalakya Tantra are the two branches of Ayurveda, which are also taught to students of Ayurveda.
Shalya Tantra refers to general surgery related to non-healing wounds, ulcers, muscle tears, and anorectal conditions, while Shalakya Tantra refers to surgeries related to the nose, ears, eyes, throat and teeth.
Dr Rajiv Vashudevan, founder and CEO of the AyurVAID chain of hospitals for Ayurveda, said that the Ayurveda course already educates and prepares students, specifically postgraduate students, to perform surgeries as those of modern medicine.
“The notification mentions postgraduate students, not graduate ones. Moreover, Ayurveda students practise and perform a set of surgeries. We aren’t talking about super specialised surgeries like the brain. Students study Shalakya Tantra and Shalya Tantra, and are well-equipped with performing incisions just like modern doctors,” he said.
“They pass through the National Eligibility-cum-Entrance Test, so one can’t question competence here. Calling for a nationwide protest over this is regressive and being territorial,” Dr Vashudevan said.
“We have patients who switch to Ayurveda from Allopathy because they feel they can’t be cured and in some cases it’s true. Ayurveda has numerous cures. Moreover, the surgeries mentioned in the notification were already learnt during the course,” he added.
Dr Danish Chandra Pandya, former director of AYUSH, Gujarat, and chief physician at Neuropanch Ayurved Hospital in Gandhinagar, said that “Sushruta” is the “father of surgery”.
“Ayurvedic doctors have been performing surgeries since decades. It is not a new thing, it might be that we aren’t familiar with a particular modern instrument. But in terms of competence, medical students of Ayurveda were very well-trained and equipped. The notification mentions that students will also be further trained. We have the department and the experience,” he added.
The Ayurveda graduation course stretches for four-and-a-half years, followed by one year of internship, six months of which are at an Ayurveda hospital and the remaining at a civil, general or public healthcare centre. For post-graduation, students need to study for another three years and have clinical postings as well.
Under the 2016 regulations, postgraduate medical students of Ayurveda specialise in Shalakya Tantra, Shalya Tantra, and Prasuti and Stree Roga (Obstetrics and Gynaecology). Students passing these three disciplines are granted a master degree in surgery in Ayurveda.
According to Dr Sarang Goswami, an Ayurveda practitioner, the recent notification only puts more light on the skill set of an Ayurveda practitioner.