Introduction:

On 11^th May 2023, in a significant development, a Memorandum of Agreement (MoA) was signed between the Indian Council of Medical Research (ICMR), under the Union Ministry of Health and Family Welfare, and the Union Ministry of Ayush, (Ayush standing for Ayurveda, yoga, unani, siddha and homeopathy), to promote and collaborate on integrative health care and research. The MoA will enable both parties to jointly establish Ayush-ICMR Centres for Advanced Research in Integrative Health at the All India Institutes of Medical Sciences (AIIMS), in India. Inpatient and outpatient services will be established in the new Integrated Medicine departments of all 23 ‘functioning’ AIIMS which earlier served only as Ayush service departments. The studies will  extend to areas of public health as well. This initiative is planned to place integrative medicine  on a firmer footing  and for it to justifiably gain wider acceptance.

ICMR proposes to strengthen evidence-based research capacity of the team. Research methodology needs a face lift even at undergraduate levels in India. Establishing a working committee of experts and workshops and training programs across the centres will enhance the co-learning process and organizational stability. ICMR plans to update The National Ethical Guidelines for Biomedical and Health Research Involving Human Participants’ 2017 with a developed comprehensive section on Integrative Medicine ethics, based on research inputs from the newly established ICMR-Ayush centres.

Can an Integrated System of Medicine Work?

The Hindu Podcast  ‘Can an Integrated System of Medicine Work?’ on 19^th May,2023,(follow podcast link and write up given here), featured Dr.Cyriac Abby Philips, Senior Consultant and Clinical Scientist in Hepatology, Rajagiri Hospital, Kochi, opposing the move and Dr. Ennapadam S. Krishnamoorthy, Founder and Neuropsychiatric Consultant, Buddhi Clinic, Chennai, as the proponent. Buddhi Clinic offers Neuropsychiatric care and management by a multidisciplinary team following the modern medicine approach, and integrates it with some non-pharmacological therapies. The host, Ms. Zubeda Hamid, initiated the dialogue seeking  the two consultants’ views on the above Union Government initiative. They had diametrically opposite view in some areas of Integrative Medicine, but came together in one voice on  randomised controlled trials as gold standard and the standardisation of formulations critical to uniformity of dosage. Dr.Philip’s misgivings were based on the side effects of some Ayush medications, and the very rare hepatotoxicity with liver injury as an adverse event. The NIH, USA, has expressed concern over cases of heavy metal poisoning with Ayurvedic formulations.

The dramatic global growth of the Traditional Complementary and Alternative Medicine (T-CAM) movement during the last 3 decades is also a people’s movement to seek alternative therapies to relieve unrelenting pain or to have possible respite from the travails of chronic illness. It also comes with the realization that though modern medicine offers evidence-based healthcare, the latest technologies, and has no substitute in emergency care, it does not have all the answers and 20% of patients can be non-responders. CAM is a global phenomenon, WHO reporting that 80% of the global population have opted for it at some stage in their life. In this context, foreign governments and regulatory bodies also appear to have accepted the call for broader approaches to healthcare. The latest global collaborative move in this direction, is the signing of the MoU and  onsite launch of WHO Global Centre for Traditional Medicine, Jamnagar, India, which  took place between the Ministry of Ayush and WHO on 21^st April 2022, to establish  WHO – GCTM, with India as the host country. It is planned to start functioning by mid-2024. This new ‘pluraristic approach’ to healthcare goes with the caveat that all new, potentially useful healthcare interventions, must establish their safety, quality and efficacy.

The overall aim of drug standardization is to ensure the quality, efficacy and uniformity of the products, in terms of their chemical and biological properties. Ayurvedic formulations are designed and manufactured based on unique principles of Ayurveda pharmacology, many of which exert a multi-drug-multi-target mode of action effect, due to the presence of several bioactive molecules in its natural form. This is different from the single-drug-single-target action of modern molecular drugs. This complicates evidence-based research in herbal formulations, and even standardization can be difficult. The active medicinal molecule may be isolated through chromatographic methods, but the identification and role of the other bioactive molecules may remain unknown.

There are several peer-reviewed international journals on Integrative Medicine. Two leading Indian online international journals, both open access, peer-reviewed, quarterly publications are:  Journal of Ayurveda and Integrative Medicine, established in 2010, (published jointly by The Institute of Trans-disciplinary Health Sciences and Technology and The World Ayurveda Foundation and published on Elsevier) and   Indian Journal of Integrative Medicine, which started publication about 4 years back.

Integrative Health Research must aim at a transdisciplinary approach. ‘Transdisciplinary’ involves the integration and transformation of fields of knowledge from multiple perspectives in order to define, address, and resolve complex  problems, the integration transcending individual disciplines.  National Health Policy (2017) in ‘Mainstreaming the Potential of AYUSH’ puts focus on sensitizing practitioners of each system to respect the strengths of the other.

There is a wealth of wisdom and ancient traditions which can be incorporated  sensibly and safely, for the well­being of the human race. A systematic, goal-directed  approach, (within time frames), under the Union Government umbrella, with comfortable levels of funding, common training programs, pooling the multicentre data of clinical findings under intention to treat in  standard method against Ayush approaches, longitudinal studies, phytochemical analysis, all under a strong leadership and committed stakeholders, must yield results. The challenge is to ‘modernize’ Ayush and make it relevant and contextual and to  create a  robust  interface between Ayush and modern science. The strength of ancient systems lie in promotive and preventive health, treatment of NCDs,  regenerative medicine and mind-body science in mental health. Not to be forgotten is the in situ conservation of wild gene pools of medicinal herbs and the benefits of integrative research reaching the poor of our country.