 "Ayush ministry to observe National Ayurveda Day tomorrow")
Back in 2006, Naresh Trehan, Chairman Medanta, thought of a novel approach to clinical treatment, by introducing integrative medicine in his yet to be set up hospital. He believed alternative systems of medicine had a significant place in treating patients. By bringing together Ayurveda and yoga along with homoeopathy, Unani and Siddha, it was possible to offer holistic medical solutions that would work together.
G Geetha Krishnan, a senior ayurvedic practitioner joined his company, Global Health Private Limited, even before Medanta the Medicity was set up. The idea behind integrative medicine is to combine modern and traditional therapeutic practices to give the patient holistic wellness. “It was not just about offering patients a choice of treatment, or setting up of a shop within a shop. The effort was to offer a complete wellness solution with the combination of different systems of medicines after clinical studies and creating proof of concept.”
Bringing in scientific proof and insurance
In 2014, the Ministry of Ayush came up with a concrete plan to encourage alternative medicine such as Ayurveda, Unani and homoeopathy. Besides regularising the curriculum, the ministry encouraged clinical studies and brought in transparency and accurate calibration to bring these systems into the mainstream. At the same time, National Accreditation Board for Hospitals (NABH) was roped in to bring in quality standards for hospitals offering Ayurvedic treatment. This was an effort to separate the thousands of Ayurvedic Spas and wellness centres from hospitals, which offered treatment for disease. There are 68 such accredited hospitals and centres listed on the Ayush site so far.
Similarly, Insurance companies were urged to cover the cost of treatment if the patient wanted to try the alternative treatment route.
Constant presentations and lobbying by Ayurvedic drug makers and industry bodies like CII and Ficci, and representations to the Insurance regulatory Authority of India (Irdai) led to the ministry of Ayush coming out with guidelines for insurers to start offering coverage in 2014. Fifteen insurance companies are listed with the ministry of Ayush and cover treatments given under Ayurveda.
An indicative list of pricing for 97 treatments has been created with the participation of public and private health insurers. These therapies have accepted protocols and lines of treatment that have been mapped out and accepted.
”It is a good start but it is still work in progress,” Says Krishnan. He believes if Insurance companies actively promoted policies incorporating alternative treatment, there would be more takers. However health insurance is not compulsory, and most patients are first-time buyers of protection who do not pay attention to what are they buying.
Although there is no standalone cover for Ayurveda, the cover is part of a standard insurance policy. New India assurance offers coverage up to 25 per cent of the sum assured while private insurers such as Chola offer 7.5 per cent of sum insured with 20 per cent co-payment. Tata AIG offers around Rs 20,000 if sum insured is 5 lakh, while HDFC Ergo health suraksha pays for in-patient treatment, Star health offers up to a maximum of 25 per cent of the sum insured and Apollo Munich covers all costs with a cap of Rs 50,000. The treatment is cashless. Policy holders, however, have to read the fine print.
Till now, Ayurveda has mostly been in the realm of wellness treatments and spas. That is definitely not something insurance companies would want to cover. But though coverage is limited, Ayurveda practitioners are happy that a beginning has been made.
“For lifestyle diseases like pre diabetes, Ayurveda has treatments that work,” Says Kavita Sharma, an independent Ayurveda doctor. The treatment includes herbal medication as well as in-patient procedures such as massages, purgation and steam. However these treatments can only be undertaken under the strict supervision of a qualified doctor. Laxmi Sharma, 51, was a borderline diabetic. She kept a close eye on her Hb2ic, and as her values started changing, she decided to opt for alternative treatment. She undertook a 15-day regime of outpatient treatment, and an aggressive detox which led to reversal of diabetes. Now, she monitors her blood sugar monthly and continues to take the Hb2ic every three months. Kamal Dhingra found himself with depleted lung capacity. An x-ray revealed a patch on his lung which his doctor said could be managed but not reversed. Extremely health conscious, he certainly did want to remain on medication for the rest of his life. Referral to a doctor in Mohali led him to seek treatment. A year later, x-rays revealed that the patch was gone and his lung fully healed.
Traditional medicine goes back 3,000 years but has little in terms of scientific studies and clinical proof as demanded by modern medicine. The approach of an ayurvedic doctor is different from that of an allopathic practioner. The latter treats symptoms, while the former looks at the root cause and the medicines prescribed are different for each patient. Since traditional medicines are herb based and personalised with dose iteration done to suit each person, it is not possible to have large studies, therefore the system has been regarded as unscientific. “A heart attack or a stroke can be managed immediately by surgery. Traditional medicine, on the other hand, will manage the after-effects of a stroke or a surgery, including neuralgia (pain in the scars left by surgery) effectively,” says Krishnan, who is currently on deputation at the World Health Organization in Geneva as technical expert. He claims even Parkinson has a solution in Ayurveda.
Back to the basics: Major hospitals show the way
Medanta did not offer ayurvedic treatment as a shop within a shop to begin with. A number of clinical trials and studies were undertaken by Medanta’s ayurvedic centre under Krishnan, along with doctors and surgeons of modern medicine. A study of 290 patients who suffered strokes and responded to ayurvedic treatment was done. In another study, patients who suffered a severe restriction to bowel movement after open heart surgery were given ayurvedic medicine which helped tremendously. Similarly, 90 patients who were admitted for dengue with chances of complication were put on Ayurveda treatment and none but one developed complications. “Once clinical studies demonstrated the efficacy of the treatment, it was adopted as a clinical protocol,” says Dr Pooja Sharma, head of research at Medanta.
The patients were offered alternative therapy with the doctor in western medicine participating in the treatment. “We were skeptical of the medicines and treatments to begin with, but when we got the outcomes, it was a different story,” Says Sharma.
The coming together of two systems of medicine would have been great for integrative medicine but failing to find a replacement for Krishnan, Medanta entered into an agreement with Ayurvaid, a Bengaluru-based hospital that focuses largely on limited wellness therapies.
Just last month, Kochi-based Amrita Institute of Medical Sciences (AIMS) inaugurated its centre for integrated medicine.
Traditional medicine is now moving towards providing scientific evidence as well, through clinical trials and double blind studies.
Chinese, Tibetan, Unani, Brazilian, Korean, Japanese, African and European forms of traditional medicine have existed for years. Homoeopathy and Ayurveda are fairly established and accepted traditional therapies. Besides light, flower and colour therapies are also being used. The US, however, has many business-driven courses that are also being offered. As we move away from the limited answers that western medicine provides, people are choosing alternative medicine to address their health needs. The World Health Organization is trying to work with countries to work out a framework for practicing alternative medicine, which includes, among other things, defining a curriculum, standardising manufacturing of drugs, and establishing clinical protocols.
We've made huge strides in proving the efficacy of Ayurveda: Rajesh Kotecha
In a Q&A, Rajesh Kotecha, Secretary, Ministry of Ayush, dwells on stringent quality norms, including heavy penalties on rogue manufacturers operating in the area of alternative medicines.
Is there a concerted and conscious effort to mainstream AYUSH?
In 2017, a policy to mainstream AYUSH was declared by the Government of India. The department of Ayush was formed in 2014 and the work done by the ministry led to the policy document.
Till date AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) has published over 300,000 papers after doing clinical trials in Pubmed. These are studies done by research councils, public hospitals, government, labs as well as private colleges.
What is integrative medicine?
For complete wellness of the patient, when different systems of medicine come together, it becomes integrative medicine. We have done a number of studies, working with the practitioners of modern medicine. A study in AIIMS and the research council of AYUSH has just concluded, in which patients of breast cancer who have had to take radiation suffer side effects or tolerance or even bio-availability of the medicine. So when we added an Ayurvedic medicine to the modern treatment, it improved their quality of life, increased their life span and the medicine worked more effectively. It is adjutant care.
Another study being done is on dengue medicine. There is no treatment for dengue. We have to standardise the formulation, and do safety study on experimental basis. Now we are doing a multi-centric trial and a medicine for Ayurveda will come out. A similar study was done at Medanta based on this experience.
There is an Ayurveda biological programme. We have taken the challenge of proving the safety and efficacy of Ayurvedic medicine. The safety studies, especially of medicines with heavy metals are done by CSIR labs and the Department of AYUSH and we are publishing the results. Medicines with heavy metals are very safe.
There are two types of medicines in Ayurveda -- one that has heavy metals in the form of 'bhasmas' as part of formulation and the other is herbal. The heavy metals are in the form of sulphides, not oxides. When heavy metal oxides have a tendency to be deposited in our system. As sulphides, heavy metals act as catalysts for other herbs, which are part of the formulation, to work effectively.
Safety studies are being done to counter incorrect publicity.
Since AYUSH is an ancient science, is there a list of formulations that conform to one standard?
We have a pharmacopoeia commission which publishes the standards of medicines, it is in the public domain. So the state FDAs can check the formulations manufactured in their state. If the medicine is not up to the standards prescribed by Ayush, the manufacturer can be heavily penalised, and the manufacturing license can be cancelled.
How do the raw materials – the herbs which go into manufacturing -- conform to a standard?
To ensure quality, the department of AYUSH has set up an NMPD, the National Medicinal Plant Board.
In the past ten years, 50 per cent of the herbs needed for formulations were grown and 50 per cent were collected from forest. Now, there has been a ten-fold increase in cultivation. We are also creating standards for sustainable supply according to the required standards.
The board also tracks how and where plants are grown.
How is AYUSH participating in public health delivery?
Under the National Ayush Mission which works alongside the National Health mission, we will mainstream the AYUSH system. The goals of Ayushman Bharat are preventive, promotive and curative. The first two will be undertaken by AYUSH focusing on yoga, encouraging better eating habits etc.
Co-location, and having both modern Ayush systems at one location so patients have a choice of treatment is one way.
Besides that, 10 per cent of the 150,000 health and wellness centres -- about 12,000-15,000 -- will be exclusive AYUSH centres. Since Unani is popular in Kashmir, it will have more centres offering it and since homeopathy is popular in east India, there will be more centres in that region.
We are on track to rolling out 4,000 centres this year.
How are you mainstreaming AYUSH systems besides doing clinical trials?
We have established quality benchmarks. Right now, only 68 hospitals have received NABH accreditation. We want thousands of hospitals to get accredited. We support a number of scientific studies.
We are creating an Ayush Grid. It is a complex IT network for research, publication, hospital management system, regulatory control and permissions. It is the IT backbone and we have started many things, The AYUSH Hospital information management system has outcome parameters, and we have devised common morbidity codes. We have launched a portal about the codes, and are talking to WHO about them and including them in ICD-11 (International classication of Disease-11. This is a listing of diseases by clinical symptoms). In the Namaste Portal (National Ayush Morbidity and Standardized Terminologies Electronic Portal, namstp.ayush.gov.in), we are adding the standardised codes to the A-HIMS (Ayush-Hospital Information Management System), trying to generate patient data. Hospitals will use it, insurers to hospitals which use it will help, and anyone who takes assistance from AYUSH will have to use it so that we are able to generate data. We are seeing a phenomenal number of patients every year in central and state AYUSH facilities.
We are also working on standardisation of education and regulation in the national AYUSH grid.
Remember the pathology tests used by doctors of modern medicines are also used by us, the tests are interpretation of what is happening in the body and Ayurveda doctors use that information as well.
We will be helping set up quality centres that offer therapies using AYUSH with soft loans.
Right now, 41 products cover Ayush treatments. We are in talks with Insurance Regulatory and Development Authority of India (IRDAI) to offer OPD coverage and not just in-patient treatment.
Can you share some of the significant studies?
We have done a joint study with a University in Germany with patients suffering from arthritis of the knees. Our research council was the partner here and it has been proved that simple Ayurvedic intervention can help patient recover without surgery.
A study conducted by Maharishi Institute based out of the Netherlands proved through markers that Panchkarma treatment eliminates pesticides that enter our body through the food chain by 50 per cent.
Ayush conducted a huge study in six districts all over India and screened 10 million patients. We identified about 250,000 who needed intervention because of diabetes, hypertension and high cholesterol. We Introduced yoga, diet modification and added some simple medicine, and followed the patients for three years. In three years we found, that their quality of life had improved and doctors reduced the dosage. The patients they have fewer complications. It is the largest study and we are getting third party assessment.
National Institute of Health (NIH) supported a study in AYUSH. It is a gold standard -- a double-blind multi-centric study on treatment of Panchkarma for patients of rheumatoid arthritis. Over nine months patients were observed for effects of Ayurveda treatment. It gave proof of concept and is published in the journal of rheumatoid arthritis.
Then a study of the DNA of patients with a specific prakriti shows in the phenotyping or mapping of their genetic patterns. It has been conducted by the institute of genomics.
Slowly we are gathering scientific evidence to show that AYUSH is an exact science.
In fact we are planning a transformative programme to launch a national prakriti pariksha programme, which will inform all persons on their dominant prakriti which will help them follow simple lifestyle changes to stay healthier.
How do you stop infringement of the knowledge in the public domain?
In 2002, we started listing all formulations under AYUSH in a repository called Traditional Knowledge Digital Library (TDKL), set up by CSIR and AYUSH. We have one million users currently and it is available to patent offices worldwide, so it prevents infringement and helps save our public knowledge. It is a closed database, searchable. Now we want to open it for our researchers.
We have 30 institutes across the country and more than 100 labs, and are setting up a centre of excellence for laboratories who do studies and publish papers.
