‘Misleading and unscientific,’ says IMA in response to Minister’s nod for Ayurvedic doctors to perform surgeries

The decision by the Indian Health Minister on December 23 to permit Ayurvedic doctors, specifically those who have completed postgraduate courses in surgical studies, to perform select surgeries marks a pivotal moment in India's healthcare landscape. This move, aimed at integrating Indian traditional medicine with modern treatment methods, has ignited a fierce debate, primarily with the Indian Medical Association (IMA) labeling it as "misleading and unscientific."

**Background and Historical Context:** India has a rich heritage of traditional medicine systems, prominently Ayurveda, Siddha, Unani, Yoga, and Naturopathy (collectively known as AYUSH). For centuries, these systems provided primary healthcare to the populace. Post-independence, while modern allopathic medicine gained prominence, efforts were also made to preserve and promote traditional systems. The establishment of the Ministry of AYUSH in 2014 underscored the government's commitment to developing education, research, and propagation of indigenous medicine. This recent decision isn't an isolated event but rather an acceleration of the long-standing policy goal of medical pluralism and integration, as articulated in the National Health Policy (NHP) 2017, which explicitly advocates for 'mainstreaming the AYUSH systems'.

**What Happened:** The Central Council of Indian Medicine (CCIM), a statutory body under the Ministry of AYUSH, issued a notification on November 20, 2020 (later affirmed by the Health Minister), amending the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016. This amendment specified 39 surgical procedures that postgraduate students of Shalya (general surgery) and Shalakya (diseases of ear, nose, throat, and ophthalmology) streams of Ayurveda would be trained to perform. The government's rationale is that these practitioners undergo rigorous training in these specific procedures as part of their curriculum, making them competent to perform them.

**Key Stakeholders and Their Stances:**

* **Government (Ministry of AYUSH, Ministry of Health):** The primary proponent, viewing this as a step towards integrating traditional and modern medicine, expanding healthcare access, and giving due recognition to AYUSH practitioners. They argue that specialized training justifies the permission.

* **Ayurvedic Practitioners/Colleges:** Largely supportive, as it enhances their professional scope, recognition, and potentially their income. They see it as an affirmation of Ayurveda's scientific validity and a means to address the shortage of surgeons, particularly in rural areas.

* **Indian Medical Association (IMA) / Allopathic Doctors:** The most vocal opponents. The IMA views this as 'mixopathy' – a dangerous dilution of medical standards, compromising patient safety, and blurring the lines between different medical systems. They argue that the training methodologies, pharmacological principles, and anatomical understanding in Ayurveda are fundamentally different from modern surgery, making such integration unscientific and unethical.

* **Public/Patients:** Divided. Some may welcome increased access to healthcare, especially in underserved regions, or prefer traditional approaches. Others express concerns about safety, efficacy, and the quality of care, relying on the established scientific validation of modern medicine.

**Significance for India:** This decision has profound implications. Socially, it reignites the debate on medical pluralism versus pure scientific validation. For a country with diverse healthcare needs and significant rural-urban disparities, leveraging traditional systems could theoretically expand healthcare access. Economically, it could boost the AYUSH sector, including education, research, and potentially medical tourism. Politically, it aligns with the government's broader agenda of promoting India's indigenous heritage. However, if not implemented carefully, it risks creating a fragmented healthcare system, potentially undermining public trust in both traditional and modern medicine due to perceived compromises on standards.

**Constitutional and Policy Framework:** The directive aligns with **Article 47 of the Indian Constitution**, which mandates the State's duty to raise the level of nutrition and the standard of living and to improve public health. The National Health Policy (NHP) 2017 explicitly calls for 'mainstreaming the AYUSH systems by strengthening infrastructural facilities, teaching, and research in AYUSH systems and facilitating their integration into the public health delivery system.' The **Indian Medicine Central Council Act, 1970**, established the CCIM to regulate the education and practice of Indian Medicine. The current notification is an amendment under this very act, giving it legal backing, though its scientific validity remains contested.

**Future Implications:** The immediate future may see legal challenges from the IMA, further public debate, and potentially a recalibration of training protocols for Ayurvedic surgeons. Long-term implications could include a more integrated healthcare workforce, particularly in primary and secondary care settings. It could also spur more rigorous scientific research into traditional surgical practices and foster a more evidence-based approach within AYUSH. Conversely, if not managed with robust regulatory oversight, it could lead to concerns regarding patient safety, ethical dilemmas, and a decline in the perceived quality of medical care. The success or failure of this integration will heavily influence future health policies and the trajectory of medical education in India, demanding a delicate balance between tradition, modernity, and scientific rigor.