History
Emphasis on indigenous healthcare models
Successive five year plans had allotted considerable focus to alternative, especially indigenous, forms of medicine within the healthcare sector.[2] Numerous committees set up by the Government of India for the development of the healthcare sector (Bhore (1946), Mudaliar (1961) and Srivastava (1975)) which emphasized upon the improvement of traditional systems of medicine in India.[3] The National Health Policy (1983), National Education Policy in Health Sciences (1989) and National Health Policy (2002) highlighted the role of Indian School of Medicine (ISM) and Homeopathy (H) in improving healthcare access and asked for enabling its penetration to the rural masses.[4]
Educational courses and ISM&H
A diploma course in Ayurveda was launched in the 3rd (1961–1966) five-year plan and the Central Council of Indian Medicine was established in 1970 followed by Central Council of Homeopathy in 1973.[2] The 6th (1980–1985) and 7th (1985–1990) five year plans aimed at developing novel ISM&H drugs and utilizing ISM&H practitioners in rural family healthcare.[2] The 8th (1992–1997) five-year plan lend considerable emphasis on the mainstreaming of AYUSH.[2] The Department of Indian System of Medicine and Homoeopathy (ISM&H) was thus launched in March 1995, under the Ministry of Health and Family Welfare.[5][2]
Mainstreaming and AYUSH
The ninth five-year plan (1998-2002) ensured for its integration with western medicine and was also the first to tackle different aspects of the AYUSH system in a standalone manner and focused on an overall development ranging from investing in human resource development and preservation and cultivation of medicinal plants to completing a pharmacopoeia and outlining good manufacturing processes.[2] The department was renamed to AYUSH in November 2003.[5][2] The National Rural Health Mission was subsequently launched in 2005 to integrate AYUSH practitioners in national health programmes esp. in primary health care (AYUSH medical officers at community health centers, para-professionals et al.) and provide support for research in the field.[6]
After 2014
Observers have noted an increased focus on AYUSH healthcare after the 2014 Indian general elections, which brought Bharatiya Janata Party to power.[7] On 9 November 2014 it became a ministry in its own right; by 2017–18, the allotted budget was ₹ 1428.7 crore and has more than doubled than that in 2013–14.[8]
Activities
Healthcare
The ministry runs multiple healthcare programs; primarily aimed at the rural population.
AYUSH is supposed to form an integral backbone of the Ayushman Bharat Yojana[9] and the ministry had long worked for integrating the different systems of AYUSH with modern medicine, in what has been described as 'a type of “cross-pathy”'.[10] More than 50,000 children have been enrolled in ‘Homeopathy for Healthy Child'.[11] It observes different days to raise general awareness about AYUSH and promote each of the systems.[12]
The ministry had collaborated with the Council for Scientific and Industrial Research (CSIR) to set up the Traditional Knowledge Digital Library (TKDL) in 2001, on codified traditional knowledge on Indian systems of medicines such as Ayurveda, Unani, Siddha and Yoga, as a means of preventing grant of "bed" patents on traditional knowledge and thus counter biopiracy.[13]
Institutions
The ministry is also at the aegis of several professional research institutes and academic faculties devoted to various forms of alternative medicine[14]:-
National Institute of Homeopathy - Established on 10 December 1975 in Kolkata as an autonomous organisation under the Ministry of Health and Family Welfare.[15] Conducts degree course in Homeopathy (UG since 1987 and PG since 1998); affiliated to the West Bengal University of Health Sciences.[15]
National Institute of Siddha - Was established at Chennai for an estimated cost of ₹ 470 million; inaugurated in November 2005.[16] A joint venture between Government of India and Government of Tamil Nadu, the proposal was approved, in principle, during the 9th Five Year Plan period.[17][16] Affiliated to the Tamil Nadu Dr. M.G.R. Medical University and also the national headquarters of the Central Council of Research in Siddha (CCRS). Has an attached hospital—Ayothidoss Pandithar Hospital; on an average, 2,174 patients were reported per day (2017-18) whilst there's an in-patient (IP) department with a capacity of 120 beds.[18][19] Further expansions are in progress.[19]
National Institute of Unani Medicine - Established in 1984 at Bangalore, as a joint venture between Government of India and Government of Karnataka.[20] Initially offered research facilities but academic courses were set up from 2004. Currently offers post graduate courses (MD in Unani) in eight different specialties; affiliated to Rajiv Gandhi University of Health Sciences.[21]
National Research Institute for Panchakarma - Set up in 1971 at Cheruthuruthy. Undertakes research activities as well as provides professional and academic training.
National Institute of Ayurveda - Set up in 1976 at Jaipur, by the Ministry of Health & Family Welfare an refurbished extension of the Government Ayurvedic College, Jaipur which was established by the Government of Rajasthan in 1946. Offers research as well academic facilities; affiliated with Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University.
All India Institute of Ayurveda - Established in 2009 at Delhi; offers research as well academic facilities. Brainchild of Atal Bihari Vajpayee. Runs a secondary institute Rashtriya Ayurved Vidyapeeth.
National institute of Naturopathy -
Morarji Desai National Institute of Yoga - Promotes Yoga philosophy and facilitates training and advanced research, as well. The Institute was started in 1970, in the form a hospital, by the now defunct Central Council for Research in Indian Systems of Medicine and Homoeopathy, under the Vishwayatan Yogashram. The hospital was later converted into an institute, by name, Central Research Institute for Yoga (CRIY) in 1976, to provide free training to people and to organize research on yoga. In 1988, the institute was renamed to its current name.
North Eastern Institute of Ayurveda & Homoeopathy - Established in 2016 at Mawdiangdiang, Shillong. Offers a four and a half year degree course in Bachelor of Ayurvedic Medicine and Surgery and Bachelor of Homeopathic Medicine and Surgery.
North Eastern Institute of Folk Medicine -
The ministry also monitors two semi-autonomous regulatory bodies:-
Central Council of Indian Medicine - One of the Professional councils under University Grants Commission (UGC) to regulate higher education in Ayurveda, Siddha, Unani and Sowa-Rigpa. It suggests the professional benchmarks and practices for medical professionals in these systems, as well.
Central Council of Homeopathy - One of the Professional councils under University Grants Commission (UGC) to regulate higher education in Homeopathy. Maintains central registers of homeopaths.
Economics
As of March 2015, there were nearly eight lakh AYUSH practitioners, over 90 per cent of whom practiced homeopathy or ayurveda.[10] A 2018 study by the Confederation of Indian Industry (CII) estimated the market share of AYUSH medicines at around US$3 billion and that India exported AYUSH products of a net worth US$401.68 million in the fiscal year 2016–17.[22]
The Department of Pharmaceuticals had allocated a budget of ₹ 144 crore to the ministry for 2018-2020 for manufacture of alternative medicines.[23] The average expenditure for drugs on AYUSH and allopathy has been found to not vary widely.[4]
Reception
Criticism
Pseudoscience
There is no credible efficacy or scientific basis of any of these forms of treatment.[24]
A strong consensus prevails among the scientific community that Homeopathy is a pseudo-scientific,[25][26][27][28] non-ethical[29][30] and implausible line of treatment.[31][32][33][34] Ayurveda is deemed to be pseudoscientific[35][36][37] but is occasionally considered a protoscience, or trans-science system instead.[38][39] Naturopathy is considered to be a form of pseudo-scientific quackery,[40] ineffective and possibly harmful,[41][42] with a plethora of ethical concerns about the very practice.[43][44][45] Much of the research on postural yoga has taken the form of preliminary studies or clinical trials of low methodological quality[46][47][48]; there is no conclusive therapeutic effect except in back pain.[49] Unani lacks biological plausibility and is considered to be pseudo-scientific quackery, as well.[50][51]
Research
The quality of the research done by the ministry has been heavily criticized.[by whom?] Clinical trials of homeopathic drugs, conducted by their research wings were rejected in totality by the Lancet and National Health and Medical Research Council, Australia. There has been an acute dearth of RCTs on Ayurveda[10] and multiple systemic reviews have highlighted several methodological problems with the studies and trials conducted by AYUSH and its associates in relation to developing an Ayurvedic drug for diabetes.[52] A tendency to publish in dubious predatory journals and non-reproducibility by independent studies has also been noted.[53][54] India is also yet to conduct a systematic review of any of the systems of medicine under the purview of AYUSH.[10]
Drugs
The ministry (in conjunction with other national laboratories) has been subject to heavy criticism for developing, advocating and commercializing multiple sham-drugs (BGR-34, IME9, Dalzbone, Ayush-64 et al.) and treatment-regimes for a variety of diseases including dengue,[55][9][56][57] chikungunya, swine flu,[58] asthma, autism,[59] diabetes, malaria,[60] AIDS,[61] cancer et cetera[62] despite a complete absence of rigorous pharmacological studies and/or meaningful clinical trials.[63][64][65][66][67][53][68][54][69][70][71][excessive citations]
A 2018 review article noted the existing regulations to be in-adequate for ensuring the safety, quality, efficacy and standardized rational use of these forms of treatment. Monitoring of adverse effects from the usage of these drugs and contraindication trials were absent, too.[3]
Miscellaneous
The Washington Post noted the efforts behind the revival of Ayurveda as a part of the ruling party's rhetoric of restoring India's past glory to achieve prosperity in the future.[7] It also noted of the Ayurveda-industry being largely non-standardized and that its critics associated the aggressive integration of Ayurveda into healthcare services with the Hindu nationalist ideology of the ruling party.[7]
Some researchers have argued that the provision of AYUSH services is an example of “forced pluralism” which often leads to disbursal of incompetent healthcare services by unqualified practitioners.[3][72] Ayushman Bharat has been noted to increase privatization of state healthcare facilities and compel rural populace into preferentially choosing alternative medicine, raising concerns about ethics.[8][73] The proposal of integrating AYUSH with western medicine has been widely criticized[74] and the Indian Medical Association remains strongly opposed to it.[10][75][76][7]
The ministry had attracted widespread criticism after publishing a pamphlet titled Mother and Child Care through Yoga and Naturopathy which asked pregnant women to abstain from eating meat and eggs, shun desire and lust, hang beautiful photos in the bedroom and to nurture spiritual and ‘pure’ thoughts among other advices.[64][77] In the aftermath of the 2019–20 coronavirus pandemic, the ministry recommended Arsenicum album 30 as a preventive drug; the claim was without any scientific basis or evidence, and was widely criticised.[78][79][80]
Response
The ministry had rejected the claims of inefficacy.
It had rejected the NHMRC's study on homeopathy; despite its critical acclaim as the most rigorous and reliable investigation into homeopathy ever[81][82] and in 2017, set up a committee at the Central Council for Research in Homeopathy (CCRH) to counter claimed western propaganda against homeopathy; the committee was ill-received.[11][83][70][84]
Reception
A NSSO survey in 2014 found that only 6.9% of the population favored AYUSH (3.5% ISM and 3.0% homeopathy) over conventional mainstream medicine and that the urban population was slightly more conducive to seeking AYUSH forms of treatment than their rural counterparts; another survey in 2016 reiterated the same findings, approximately.[85][4][86] A 2014 study did not report any significant difference between the usage of AYUSH services by rural and urban populace, after adjusting for socioeconomic and demographic variables.[4] Low-income households exhibited the highest tendency for AYUSH followed by high-income households and on an overall, AYUSH lines of treatment were majorly used to treat chronic diseases.[4] The treatments were more used among females in rural India but no gender-differential was observed in the urban populations.[4] Chhattisgarh (15.4%), Kerala (13.7%), and West Bengal (11.6%) displayed the highest AYUSH utilization levels.[4]
A 2018 review article noted that the states exhibited differential preference for particular AYUSH systems. Ayurveda and Siddha respectively show greater popularities in Kerala and Tamil Nadu. Unani was well-received in Hyderabad region and among Muslims whilst Homeopathy was highly popular in Bengal and Odisha. It further noted that the preference among the general population for usage of AYUSH revolved around a perceived "distrust or frustration with allopathic medicine, cost effectiveness, accessibility, non-availability of other options and less side effects of AYUSH medicines"
