Envisioning AYUSH: Historic Opportunity for Innovation and Revitalization

Change is the only constant parameter in this dynamic world. Even the composition of Mahabhutas in all physical and biological objects does not remain the same for two consecutive moments. In the transition from life to death it is only the atman that remains unchanged – even the soul evolves from lifetime-to-lifetime. Change is indeed the reality of nature.

Today India is poised for a transformational revolution. Among many other priorities, the new Government is expected to focus on rediscovery of the contemporary relevance of our cultural identity, indigenous capabilities and aspirations of our people. Thus, during 2014-19 South Asian health sciences like Ayurveda, Yoga, Unani, Siddha, and Sowarigpa are likely to receive a big boost. For India, this is an historic prospect to envision a new, innovative and integrative strategy for the health sector. The AYUSH sector may also receive seed funding from the State governments. This big opportunity also brings a bigger responsibility to ensure that scientific attitude and meritocracy prevails over emotional outcry and mediocrity. This certainly calls for a clear vision and roadmap with time-bound achievable goals.

MEDICALIZATION OF SOCIETY

During this century, health and wellness, as opposed to curative healthcare, has emerged as one of the most difficult societal challenges - not just for India but for the entire world. The over medicalization of society is a global phenomenon. At present, global healthcare is dominated by modern medicine i.e. allopathy. Compromised policies seem have given way to pharmaceutical companies, who are defining health as disease management and are dictating healthcare strategies. Cost of medication is going beyond the reach of rich people let alone the poor. On the other hand, communities need safe, effective, affordable and accessible healthcare. People need simple ways to achieve health and prevent diseases. People need healthy diet and healthy lifestyle. People need mental peace and relaxation. The global focus seems to be shifting from ‘alternative medicine’ to ‘integrative health’. A recent step taken by the National Institutes of Health in the United States to change the name ‘National Center for Complementary and Alternative Medicine’ to ‘The National Center for Complementary and Integrative Health’ is indicative of future trends. The holistic wisdom of Ayurveda, Yoga and other ancient health systems offer the necessary wisdom, experience and capabilities that are crucial for such transformational change. Innovative approaches where Indian health systems and modern medicine synergize together can realize the dream of futuristic integrative health systems, most reassuring for rest of the world. However, it is naive to think that the strengths that they hold can be realized without effort, and that required changes will happen automatically.

INNOVATING AYURVEDIC WISDOM

Although mainstream healthcare today is dominated by modern medicine, Indian people are culturally and emotionally connected with AYUSH. When the new government is sympathetic the easiest path for pseudo-change agents is to promote AYUSH based on emotions and past glory uncritically. Already enthusiastic people are making petitions to upgrade the Department of AYUSH to an independent ministry, as also demands for new Universities, new research institutes, new industries, new clinical establishments exclusively for AYUSH. One can take the emotional stand that AYUSH is indigenous, divine and time tested. Raising any questions about evidence of efficacy, theory or practice may not be tolerated. Embracing modern methods, scientific investigation and innovations to explore and enhance ancient wisdom may be seen as an insult to its prestige and exalted status. Such an uncritical approach is not likely to lead to the desired revitalization of AYUSH in the long-term, nor to meaningful change in the health sector. Such an easy route of resisting contemporary medical trends would lead to stagnancy, and would be detrimental to the long-term sustenance and growth of AYUSH.

ENABLING PRATIMSAMSKARA

While basic principles of a major AYUSH system like Ayurveda may be valid even today, research for newer applications is needed. The geo-climatic environment has changed over the last two millennia, and natural materials may also have undergone many changes and transformations. In the evolutionary process, plants, animals and microbes have changed. The nature of disease has changed. Human behavior, life-style and genetics have changed. Clearly, classical Ayurveda of yester year cannot be blindly practiced without needed modifications to today's context. Continuous research on safety, quality and efficacy of medicines and procedures is needed. Systematic documentation and analysis of clinical practice by Vaidyas will play a vital role in much needed innovation. The real change agents need to follow a critical and difficult, yet unavoidable path for the revitalization of Ayurveda in the 21^st century.

HEALTH AS A UNIVERSAL VALUE

Today, the world is an inter-connected global village. It is opening, becoming more collaborative, mutually respective and integrative. India may be the only country, with two ‘national health policies’, one for Allopathy, and the other for indigenous systems like AYUSH! How can we have different national health policies in the same society? How can we divide public health into such compartments? Is this intended to satisfy two diverse sections of medical professionals? In any case, such ‘separatist thinking’ may not allow healthy interchange between modern sciences and ancient wisdom. It is unlikely that AYUSH can grow healthily in isolation. A myopic view may probably result in intensification of marginalization, enhanced insecurity and self-pride based complacency in the sector. Countries like China and Korea have very boldly integrated traditional and modern medicines. India also may need to discover its own model of integration. In this context, it is a welcome change to see open-minded views and affirmative steps from the new leadership at the Department of AYUSH to liberate Ayurveda from the 57 books in the schedule and show respect towards scientific integrative approaches.[1] Ayurveda has universal value and potential to provide innovative, holistic and affordable healthcare. This is possible not by any political declaration but only if an open, scientific, critical, approach and a continuous quest for right evidence is practiced.

INTEGRATIVE MEDICINE AND MEDICAL EDUCATION

It is a sad reality that AYUSH professionals are discriminated in our country. A mutually respectable professional culture is missing. Ayurveda and Yoga need to be introduced in modern medical schools and Universities. AYUSH practitioners are humiliated by saying that they do not know modern science, and that they do not conduct any research. Efforts to incorporate modern sciences into Ayurveda curricula are being pushed under the pretext of allowing them to use modern drugs. Such haphazard efforts may lead to irreparable damage to Indian knowledge systems. A rational policy for promoting integrative medical practice based on new models of medical education needs to be formulated and promoted.

LARGER CANVAS AND WIDER VISION

We need to break down professional ‘silos’ in the health sector. Expectations from stakeholders in the sector need to be redefined. Ayurveda should not be limited merely to herbal drugs, panchakarma or massage and Yoga should not be restricted to asanas and pranayama. Ayurveda professionals should be doing their classical practice with criticality and an open mind. AYUSH professionals should be encouraged to do robust documentation of clinical experiences, observations, case studies and procedures, so that sufficient evidence for practice is established. Information technology tools, suitable software, the internet and cloud technologies need to be made available to the AYUSH sector. AYUSH research deserves a prominent place in national science laboratories and modern medical schools. The onus of modern research on Ayurveda may be taken by the modern scientific community. At present, many mainstream scientists are looking for new ideas for research. Major national institutes may think of special programs focused on research on Indian knowledge systems. Scientific research in AYUSH should be broad-based and not limited to narrow fields like Ayugenomics and drug discovery. Given our national strength in biology, bio-medicine and AYUSH, efforts should be directed to develop a national agenda for transdisciplinary research to achieve global scientific leadership in complementary and integrative healthcare.

Inadequate funding and lack of political had been considered as road blocks in the past. However, the real blocks have been more about absence of clear vision and leadership. Now with the advent of the new Government, funds are unlikely to be a constraint. However, the AYUSH sector cannot depend on Government alone to provide vision and leadership, but will have to be proactively developed by stakeholders. For this purpose, Government-blessed think tanks and missions consisting of extraordinary strategists and visionaries from research, education, clinical practice, regulations, institutional building and industry are necessary.

VAIDYA-SCIENTISTS AND SCIENTIST-VAIDYAS

We have to look at the bigger picture of Ayurveda as culture and science. Sanskrit savvy professionals are not the only custodians of ancient knowledge. We cannot ignore the Prakrit traditions represented by uncodified local health traditions whose carriers are millions of households and village-based healers. We expect Ayurveda professionals to know modern sciences, chemistry, biology, pharmacy and even biotech or nanotech. In contrast, we do not expect Indian scientists to know Indian knowledge systems like Ayurveda and Yoga. That is not just fair; it is grossly inequitable. Exploration and the quest for new knowledge should be considered a joint responsibility of all Indians, be they Vaidyas, doctors or scientists. There is urgent need to revive exemplary initiatives like Vaidya Scientists.[2] We need more Vaidya Scientists like G V Satyavati, who after graduation in Ayurveda, pursued research career in modern pharmacology and reached to the top level as Director General of Indian Council of Medical Research. India also needs Scientist Vaidyas like M S Valiathan, an eminent scientist, cardiac surgeon and former President of Indian National Science Academy who authored the Legacy of Charaka, Sushruta and Vagbhata or scholars like Rama Jayasundar, a Cambridge PhD Graduate in Physics who completed full-time degree program in Ayurveda before joining as faculty at All India Institute of Medical Sciences, New Delhi and Bhaswati Bhattacharya a modern medicine graduate from the United States and senior Fulbright scholar working at Banaras Hindu University Varanasi aspiring to do PhD in Ayurveda. There may be few more living examples but such cross-fertilization between Ayurveda, modern medicine and science must be systematically enhanced and encouraged on priority. For the revitalization of Ayurveda and health systems, in general, a large number of Vaidya Scientists and Scientist Vaidyas are needed as the real-change agents.

BENCHMARKING AND MAPPING AYURVEDIC DIVERSITY

At present, the Ayurveda sector is fragmented into traditions, schools of thoughts, and regional styles of practice and teaching. This diversity may be a unique strength, accommodating best practices, which have evolved to accommodate the important variables of climate and diversity of culture, land and peoples. However, collaborative efforts and exchange of experiences in alignment to meet national priorities is lacking. Despite the huge potential available in voluntary, private and government sectors, a well-organized visionary plan is yet to be conceived as a national agenda. We are yet to think of the big picture and to prepare for the inspirational radical change and revitalization. For instance, modern tools and techniques from the world of information and communication technologies can help hone the professional human resource further.

Education reforms for AYUSH are long overdue. The mindset of our education systems still belongs to the pre 18^th century. At present, the health sector is diverse and fragmented. This diversity is a strength, but it needs to be integrated in an epistemologically informed way. The professional human resource for healthcare in the 21^st century needs a new integrative education to deliver people's expectations. India needs new models of integrative health education. This is a complex task but a worthy challenge for the health and human resource ministries of the new Government.

THE CULTURAL AND SCIENTIFIC IMPERATIVE

We should look at the bigger picture of AYUSH also as a social system. Scholars and intellectuals are not the only custodians of knowledge. Revitalization of AYUSH must revitalize both the codified systems of knowledge and the community-based oral traditions of healthcare. Despite the huge potential available in voluntary, private and government sectors, a well-organized visionary plan and national agenda are yet to be conceived. We have to look at a big picture in order to prepare for radical change in healthcare.

We need to recognize that emotions, experience and evidence are not mutually exclusive. Thousands of well-meaning people literally worship Ayurveda. This goodwill and energy needs to be properly channeled. We should be proud of our heritage and culture. At the same time, we need an open mind to recognize and respect scientific advances happening around us. We need contemporary practices and models for healthcare that bring confluence of Ayurveda and modern science. Becoming modern is not a crime; it does not prevent us from maintaining our own cultural identity. For instance, Charaka would not have ignored technologies like electron microscope if they had been available during his time. No traditions is a static entity; modernity results from evolving traditions. However, this fine balance between holistic and reductionist approaches is not easy to assimilate and work with, but it can certainly be made to work when like-minded professionals and voluntary organizations work together with sensitive and supportive Governments. Today, we seem to have been fortunate to get all the stars aligned for a resurgent India, and we must not leave any stone unturned to contribute our bit to the process of transformation. Lucidly expressed words of wisdom by Bhartruhari say this “Actions of great people are accomplished by their inner strength”.

Let us work together to unleash the true potential of Indian health systems. In the past, Journal of Ayurveda and Integrative Medicine has offered pointers to strategies, policies and action points in several editorials.[3] Through this Editorial, we wish to appeal to our readers to send specific suggestions, innovative ideas and out of the box approaches to expedite the long awaited revitalization of AYUSH systems. We wish to prepare a strategy paper for wider consultations between the stakeholders with a hope that the new Government will create conducive environment to expedite revitalization of Indian health traditions for the global good. On behalf of the Editorial Board, I wish to extend our commitment and best wishes to the new Government. Seriously, good days seem to be ahead.