Don’t read too much into National Sample Survey Organization survey results

Sir,

This is in response to the recently published results of 71^st round of the survey conducted by the National Sample Survey Organization highlighting the Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy and Sowarigpa (AYUSH) use among the Indian citizens. As soon as these results were released, all the major national newspapers carried the story emphasizing the fact that 90% of Indians preferred allopathy over AYUSH.[1,2] Following this, huge discussions and debates started all around the nation. For instance, the Times of India carried the “times view” and “counter view” on the following day, wherein the future policy decisions that the Government of India needs to take were suggested on the basis of these results.[3]

In this communication, I argue that one must not read too much into these results. This survey is not worthy to be taken note of as far as the policy decisions on AYUSH sector are concerned.

What was the survey all about?

The survey has only evaluated the social consumption of industrially produced AYUSH products in our country. The survey was not aimed at evaluating how much should the funding of AYUSH Ministry be, or whether the Ministry of AYUSH should continue to exist or not? If it is just the survey of social consumption of AYUSH products, then it is not the right survey to be used for formulating the policies related to the funding of AYUSH, because AYUSH is not just about marketed products. The situation became so grave that some of us even jumped on to suggest that the AYUSH Ministry must be removed. The content of the survey and the context in which it was performed were not meant for these interpretations. The survey was not done in a suitable manner, with appropriate tools and right means to arrive at the conclusions that we are arriving at.

We need to have the right perspective from which this issue should be viewed at. For instance, the title of the survey itself reveals many vital facts:“Key indicators of social consumption in India: Health.”[4,5,6] Hence, it was a “consumer survey” with its objectives and focus on understanding the “expenditure” of the consumers and “health” was only a part of it.

With a survey having focus on the consumption, we cannot take policy decisions related to the funding and existence of AYUSH Ministry because these two are entirely different issues. If we really want to know the actual prevalence of AYUSH use, we need to do a different kind of survey on the lines similar to the one performed by Singh et al.[7] Such a survey must have questions such as, “Do you use, pepper, turmeric, coriander, cardamom, and ginger to address your day-to-day healthcare needs?” or “Do you use home remedies such as oil massage, hot fomentation, decoctions containing ginger/pepper/turmeric etc., when someone in your family falls ill?”

This is because, if we ask questions such as “What are the AYUSH medicines that you use?” or “Has anyone in your family ever consulted an AYUSH physician?” a commoner may say “No”, because he/she may not comprehend the intention of this question. On the other hand, if we ask “Do you use jeera (cumin), adrak (ginger) etc., as home remedies?” The person is likely to know what is the meaning of the question being asked and is most likely to say “Yes.”

Seeking a doctor's advice is not the only kind of AYUSH intervention, nor is it the only help that AYUSH systems provide. In fact, AYUSH is imbibed in the sociocultural aspect of our lives in the form of home remedies, Yoga, cooking and various other facets of our daily living in India. Even if a mother is giving turmeric milk (Haldi ka doodh) to drink, that's an Ayurvedic intervention. If a person is doing Yoga, going for a morning walk or following a healthy lifestyle, that's an AYUSH intervention.

We have to direct our focus on the fact that we are relying on AYUSH for our daily healthcare needs, but we may not be spending on its marketed products, as many of these are naturally and freely available.

India has the unique distinction of having seven recognized systems of medicine as AYUSH. During the colonial period, despite public belief and strength of our Indian systems, AYUSH systems were dominated by Western medicine. As a result, only Western medicine came to be recognized as legitimate and Indian systems got neglected. At the dawn of 20^th century, with the rise of nationalism, zest in Indian art and science reawakened and Indian systems of medicine began its gradual revival.[8]

However, today AYUSH is facing many challenges like heavy metal toxicity, quality control, standardization of drugs, pharmacovigilance, and so on. Further, there is a dearth of quality clinical trials showing the efficacy and safety of AYUSH interventions. The quality of AYUSH education is another challenge.[9] The entire globe is performing researches for Western medicine, but doing research on our own system of medicine is our own responsibility. Our Indian traditional system of medicine needs even more funding and high-quality workforce to help it rise to the level of Western medicine, as this system has tremendous scope which is just needed to be tapped upon effectively.[10,11,12]