Editorial: Don't flirt with mixopathy

In another turn of the screw towards integration of ‘modern’ and ‘traditional’ systems of medicine, the Union government has decided to introduce a hybrid degree combining the curricula currently taught to medical students in either stream. Plausibly, we’ll soon have young doctors with somewhat chimerical suffixes. It’s still only in the course design stage, and the experiment will be conducted first at JIPMER Puducherry and then offered nationwide.

The Indian Medical Association, the guild of doctors in India, is on the warpath against this integration, which it says will result in a bastard system called ‘mixopathy’. It’s true that this move is part of the BJP’s agenda of creating more space and acceptance for alternative systems of medicine, chiefly, ayurveda, and stems from its well-known distaste for ‘western’ empirical sciences in general.

However, this is not the first step towards integration. That began with the removal of ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy from the Ministry of Health and Family Welfare and placing them under umbrella Ministry of Ayush. In 2022, the National Medical Commission made it mandatory for medical colleges to have a Department of Integrative Medicine and Research and went a step further next year by stipulating that the MBBS curriculum must orient students towards alternative health systems as well.

The current move to fuse the two curricula for a hybrid degree is the next step in that process, but it is not going to be as easy to carry out. The two streams, inaccurately called western and alternative, are based on entirely different foundational principles. Integrating a system based on an experimental approach and another based on received knowledge is fraught with difficulties and potential distortions. It’s not evident that the government has thought these problems through.

Resolving curriculum conflicts would be a huge challenge. What, for example, would be the correct ‘integrated’ treatment for liver cirrhosis? While the MBBS side of it might recommend a strictly evidence-based approach targeting biochemical pathways, the ayurvedic approach would be to detoxify using natural substances like turmeric without consulting any research data on their active ingredients. An MBBS doctor would restrict salt to a cirrhosis patient to prevent fluid retention, while an ayurvedic practitioner might recommend rock salt, believing that it balances fluids. Which system must be followed when there is an emergency care dilemma? At what stage will a treatment of humours be abandoned and the patient referred to surgical intervention? If such protocols are not rigorously designed, we may end up producing confused students and conflicted doctors working in an ambiguous regulatory and ethical environment.

The IMA says integration of modern and traditional systems of medicine has been a failure in China. That’s a useful pointer that the Centre would do well to study. China is one country that has gone further than any other in promoting alternative systems alongside modern medicine. Traditional systems account for 40 per cent of the healthcare ecosystem of that country, and there is at least 50 years of experience to benefit from. Not only has China avidly promoted traditional medicine, but it invested massively in research, education and treatment infrastructure. Yet, hospitals offering traditional Chinese medicine remain underutilised and survive on government subsidies.

Instead of rushing into integration, it might be wiser for the Centre to let alternative medicine remain in its distinct identity, offering an option to the public. Instead, it could fund deep research into alternative treatments, as well as the consequences.