Conceptual frame work for new models of Integrative Healthcare

Darshan Shankar Advisor

Institute of Trans-Disciplinary Health Sciences and Technology (IHST)

A State (private) University

Does India have a truly modern healthcare program

• The answer is no.

• We have imported the western health sciences, technology and delivery models in healthcare. This strategy alone is incomplete for an Indian modernization process.

• After 65 years of adoption we have certainly benefited in surgery, emergency care, management of infection in new emerging healthcare technologies in a number of fields including stem-cells.

• Effective management of chronic diseases, universal coverage in primary healthcare and substantial strategies for wellness, have not been achieved.

What constitutes modernity

• Modern is what works.

• The experience of modernity in Europe clearly reveals that it is natural for a large part of modernity to be derived from one’s own roots.

• Open minded to learn from others is progressive.

• It is suicidal to destroy our own roots.

Are Ayurveda, Siddha, Swa-rigpa, Unani and Yoga modern and contemporary ?• Evidence primarily from growing size of clinical practice, reveals that

traditional healthcare is increasingly serving healthcare needs in rural and urban India and even globally.

• In the last decade there is also new evidence (limited by the extent of bold support) emerging from basic and clinical research that points to promise of ISM contributing to new game changing paradigms in both medicine and life sciences.

What should be our vision for 21st century healthcare in India

• A modern 21st century healthcare model for India must be an evolving framework of Ayurveda, Siddha, Swa-rigpa, Unani and Yoga integrated with modern bio-medical sciences and technology.

• This vision needs to be supported by three initiatives.a) Research initiatives in both basic sciences and clinical studies to discover

foundational relationships.b) Educational initiatives in medical schools to develop trans-disciplinary content in

all medical disciplines. c) Integrative clinical establishments at the primary, secondary and

tertiary levels.

The complexity of building an Indian model of Integrative healthcare

• Complexity arises because Indian health sciences and western bio-medical sciences have different perspective on nature and the human body.

• We therefore have to reconcile the foundational theories of Indian Shastras and modern science. -Panch mahabuth siddhant and tridosh vichar with modern chemistry and biology: (it can be done, example ayugenomics)

-Logical systems of Nyaya and vaisheka with aristolean logic (not attempted)

-Systemic theories of health and diseases of Ayurveda with structural theories of western bio medical sciences (beginning to happen example, management of RA, interpretation of rasayana, pathogenesis, prakrti and gut micro flora, aam and cellular degeneration)

-New design for comparative studies both in experimental and clinical pharmacology (beginning to happen example ayurvedic biology)

-Innovative statistical methods going beyond conventional RCTs

The challenge of bridging

• In simplistic terms the challenge of developing Integrative models to bridge Shastra and Science, lies in exploring the relationship between the whole and the part.

• Between the systemic theory of Ayurveda and the structural theory of science. • They are not equivalent but yet they can be correlated.

• Therefore the key advice in this creative journey is to explore the relationship without reducing holistic concepts, strategies of Ayurveda to the reductionist concepts of science.

Examples of misconceptions

• Prakrti type is not equal to geno type even though there is a correlation.

• Med-hara action is not confined to, cholesterol lowering activity, but they correlate.

• The pathogenesis of malaria is not the same as that of visham jwara but they correlate. We should therefore be looking for several modes of action for Ayurveda Malaria strategy and not only for anti-parasitical drugs.

Positive developments

• In clinical context Integrative hospitals are beginning to appear in the country (example several colleges of ISM, AVP CBE, I-AIM Bangalore, Medanta New Delhi and several other smaller initiatives in many states).

• In educational context although in UK and US all medical schools have introduced modules on CAM, this has not happened in India in the allopathic stream.

The future of healthcare

Indeed “epistemologically informed” Integrative models of healthcare is the direction for

modernization of India’s healthcare in 21st century.