Traditional Medicine in India: Less About Medicine, More About India

 Dear all,

This has been quite an interesting, insightful debate. I did not want to engage with any of the specific points and arguments that were made. However I feel that keeping this discussion in mind, it may not be inappropriate now to make some general points about health, healthcare and health science from a public health perspective.  

I think all these three categories need to be understood as concrete historical entities with their internal contradictions. There is no health, healthcare, health science as such, as abstract entities but all these three have existed in specific historical form, in all the stages of development of human society - hunting, gathering society, in predominantly agricultural feudal society and in modern, capitalist society.  Let me elaborate a little bit the first point about historical nature of these three entities and then about the point about contradictions -

1)            Firstly, the historically concrete forms of these categories. The social determinants of health and consequently health status have been different in these three types of societies. Physical and social milieu in pre modern tribal or feudal societies and modern capitalist society has been quite different. Hence the epidemiological picture of a society of hunters and gatherers and of feudal primarily agriculturalist was vastly different from that of the current industrial, capitalist societies. 

Remedies invented in these societies are bound to be quite different. Remedies by pre-modern therapies cannot be expected to address the current, predominantly new health problems. We cannot expect in folk medicine or Ayurvedic medicine for example, remedies for current occupational health problems or current lifestyle health problems of modern industrial capitalist society. Maybe some pre modern therapies of some kinds can be of some use in some of our temporary symptoms or some age-old problems like osteoarthritis, rheumatoid arthritis. (On a personal note, for the last more than 40 years, I have been using for myself and advising my friends and relatives, along with ORS, a home remedy for simple diarrhea for first 2-3 days–“methya” (fenugreek seeds) granules to be roasted and then powdered –a quarter teaspoon three times a day. Along with other measures, I have been advising “Adulsa” syrup to facilitate sputum liquefaction in a productive cough.)  Yoga can be of some help in some of the modern health problems. Placebo effect and pre-placebo or 'Hawthorne Effect' (the feeling that one is being treated) are quite important even in the modern era as a contributory factor in the relief that patients get. But at the same time, as a matter of course, the basic causes like pollution, unhealthy job conditions, unhealthy life-styles including domestic violence, needs to be tackled simultaneously. Given the overall epidemiological picture in India, of rising epidemic of diabetes, hypertension, premature cardio-vascular problems, depression, stress-induced and pollution induced occupational health problems, premature malignancies, iatrogenic health problems etc etc there cannot a big role for pre-modern therapies in today’s world because they evolved to address by and large, very different sets and types of health challenges.

Modern health science consists of epidemiologically driven preventive, promotive, curative/ symptomatic measures both at individual and social level as well as rehabilitative measures. All these are based on modern biology, modern chemistry and other whole range of modern sciences and technologies based on these sciences. Hence modern health science is bound to be superior, more effective to deal with modern health problems of the current capitalist world system.

Pre-modern health care interventions like folk remedies, the systematic approach like the Ayurveda in feudal India (I do not know about Unani approach) and the approach of the modern “allopathic” system are vastly different. Yet, all of us modernists should be interested in explorations in pre-modern therapies (excluding those remedies based on superstitious beliefs) from a research perspective to find out which of these are effective and safe in today’s world. Secondly, even today, traditional ideas about health and disease very much influence a vast number of people and a study of these can tell us whether and how any of these can be harnessed in our approach to health problems in our society.

All of this has to be done certainly not with any arrogance or paternalistic attitude but with an approach of humble scientists knowing that our ancestors were as much intelligent, creative as the modern humans are, even though the means at their command were very limited. Secondly in pre-modern sciences belief in supernatural powers, god was intermixed with empirical hypothesis (for example, concept of “Tridosh” in Ayurveda) which was tested with empirical observations. Yet, folk medicines or Aurveda is largely based on a materialist approach and is not premised on existence of god/supernatural forces. There were proto-sciences and not be kept aside thinking them to be mere beliefs without any empirical, logical basis. We should try to find out what we can learn from these therapies even though they cannot be expected to play a large role in today’s world. At the same time, we cannot be oblivious of the fact that dominant casteist, brahmhinical patriarchal ideology in feudalism also affected these health care interventions.

2)            Secondly we need to understand the internal contradictions of these entities and their dynamics – For example, we all know that medicines have desirable and undesirable effects and as is widely known, the balance between the two becomes unfavorable if these medicines are unnecessarily or excessively or wrongly used. The latter scenario is because of the money/profit orientation which predominates over rational use (driven by honesty and adherence to science of clinical medicine.) There is therefore no point in talking only about the science and technology of modern medicines as such without taking into consideration the dominant commercialization, corporatization of healthcare. Iatrogenic health damage by allopathic practitioners (including those who hold non-allopathic degrees but engage in unrestricted use of allopathic medicines) in India has been a great problem and needs a separate discussion. Modern medicine is also adversely affected by varying degrees, capitalist patriarchy. The unique feature of capitalist patriarchy is to use the woman's body as one more ground for unnecessary medication and surgery for commercial, profit-hungry entities.

Given the above situation the issue is not merely to assess modern medicine as such but to assess it in it’s concrete historical form in which it exists and to grasp its internal contradictions. Taking note of this contradiction, we need to look forward to and try to foster modern medicine stripped of its profit-hungryness unlike Evan Ilich, the author of Medical Nemesis or the anti-vaccine lobby which rejects vaccination.   

Not only the practice of modern medicine but also the science of modern medicine is one the one hand promoted by the profit-hungry of corporations as they invest huge amounts for research and of course for production of medicines and their propagation. But on the contrary, the ill-effects of this profit-hungriness on the very development of beneficial, least harmful, cost-effective medical interventions is well known. The way forward is to understand this contradiction, its dynamics and put forth, work for measures to move ahead by transcending this contradiction.

Similar is the case with the contradictions in the socio-economic structure, which shape social determinants of health and ill-health. In capitalism the unprecedented development of social production has shaped social determinants of health and ill-health in a vastly different way. Thus in today’s advanced capitalism, (which dominates in India also) on the one hand, the potential for occupational injuries and other health-insults in all stages of production and consumption has increased vastly. At the same time, the technology to prevent these health-insults and to create healthy working conditions as well as the S&T for it, has also developed a great deal. Which of these two contradictory possibilities predominates depends upon the balance of power between the capitalists and the working class, the people. In this case also the way forward is to understand this contradiction, its dynamics and put forth, work for measures to move ahead by transcending this contradiction.

In a sense, there is nothing new in what I have said above. But I thought that it may be worthwhile to revisit it in the context of the interesting, insightful recent debate on the MFC e Forum.

Anant Phadke