By the early 20th century, the science of ayurveda had been all but banished from the theatre of medicine in India. In the early 21st, just when its recovery seems viable, a new threat looms through the World Health Organization
By Rahul Goswamy
In his beneficent aspect, Rudra, whose normal state is powerful and terrible, is also celebrated as a doctor and it is in the Yajurveda that he is referred to as the “first divine doctor”. In the Rgveda too Rudra is supplicated as the “best among the doctors”. Yet it is the twin Asvins who are known far and wide as the doctors of the gods, who revealed various healing formulae and inspired the composition of several treatises on medicine and healing.
The Mahabharata mentions them, through the tale of their rescue of Upamanyu. It was the Asvins who replaced the broken teeth of Pusan, the lost eyes of Bhaga, and who treated the paralysis of the arm of Indra. In this way too they are described by Caraka in whose samhita on ayurveda the teachings of Atreya Punarvasu, through his foremost disciple Agnivesa, are organised and presented.
India’s tradition of Ayurveda reaches far back into antiquity. As a system of knowledge, it has been practised continuously for thousands of years. When the colonial British occupiers of India introduced western medicine, which they considered a superior form of medical treatment, Ayurveda was suppressed, and its practice discouraged.
Despite the extremely inimical circumstances, Ayurveda survived as a spiritual and intellectual tradition thanks to the lifelong dedication of those people who, over generations, did not allow the practice to falter nor the transmission of its teaching to be interrupted, no matter how grave the opposition.
Under the East India Company, British surgeons came to India to treat the colonial soldiery for both disease and the injuries resulting from frequent warfare. From 1760, a Subordinate Medical Service was created in each colonial presidency (Indian assistants were trained by the British and called ‘native doctors’). In 1792, the first hospital in Calcutta (Kolkata) was opened to the general Indian public.
In 1822, the British set up the Native Medical Institution to prepare medical staff for the Subordinate Service. Two years later, in both Calcutta and Bombay, training institutions were set up to supply the colonial army with sub-assistant surgeons, (wounds and injuries) dressers and apothecaries. Calcutta’s Native Medical Institution provided the Company with a regular supply of ‘native doctors’, taught through the vernaculars and through translations of English textbooks, but with parallel instruction in the indigenous medical systems.
Such an instruction (including Ayurveda and Unani) was considered the attraction Native Medical Institutions must possess to attract recruits from the vaidyas and other communities that practised traditional medicine. The reasoning was that when practising according to institutional guidelines, they would see for themselves and accept the superiority of western medicine, and it then wouldn’t matter that they used cheap ‘native remedies’ instead of expensive imported drugs, for the ‘native’ medicine would be subsumed within the western medicinal system.
The apparent tolerance by the colonial British for ‘native’ medicine quickly evaporated. Under governor-general William Bentinck, all support of the Indian medical systems (including Ayurveda) was stopped, the Native Medical Institution was abolished in 1835 and the Calcutta Medical College was established to impart western medicine in English. Likewise, medical colleges were opened in Bombay and Madras. James Ranald Martin, surgeon in the Bengal Army and Surgeon to the Native Hospital, compared the creation of the Medical Colleges as being of signal importance to “prove one of the most direct and impressive modes of demonstrating to the natives, the superiority of European knowledge”.
Finally, the Indian Medical Service was formed in 1897 and thus by the turn of the 20th century, many Indians had followed this passage to western medicine in India, and succumbed to the lure of quick fixes, ‘shots’, pills and drugs, like their western counterparts avoiding personal responsibility for their own health, which was invariably at the core of the instruction they received from ayurvedic vaidyas.
Unbeknownst to most Indian vaidyas of the second half of the 19th century, and indeed until the first of the several Indian ayurvedic conferences were convened in the first 20 years of the 20th century, a categorical surveying of the diseases known to western medicine was taking place which would have a profound impact on the practice and perception of ayurveda three generations later.
An Australian statistician, George Knibbs, is credited with first attempting to classify diseases known to the western medical tradition. William Farr, a British medical statistician, initiated efforts to standardise nomenclature and disease classification. At the International Statistical Congress at Brussels in 1853, Farr and Marc D’Espine (a Swiss classifier of diseases) were tasked with preparing a uniform classification of causes of death, which could be applicable internationally, that is, to every region known to the colonial power of Europe.
Not surprisingly, there was no consensus about the classificatory system for a long time. But in 1900, the first revision was completed and would be known as ICD-1 (ICD for international classification of diseases). Many European countries, and the United States of America, Australia, and Japan accepted ICD-1 by 1909. A few new diseases of the endocrine glands, as well as parasitic diseases were added in the third revision, ICD-3, which was adopted by more than 40 countries. The fourth revision added various types of cancers, nutritional, and rheumatic diseases. When the World Health Organization was established in 1948, it took over the coordination of the ICD.
Now a new threat to ayurveda has emerged. It is 21 years since the World Health Organization formulated its first ‘traditional medicine strategy’ for all its members countries. Since then, the WHO has sought to influence and shape the policies of countries on what it calls ‘traditional, complementary and integrative medicine’ (which for India means ayurveda, yoga, siddha, unani, naturopathy and homeopathy).
In 2013, the health ministers of countries in the WHO South-East Asia Region issued the ‘Delhi Declaration on Traditional Medicine’, a prelude to their endorsement of the WHO Traditional Medicine Strategy for 2014-23. Two paragraphs in the declaration are important to note. Paragraph 3 (“to pursue a harmonised approach for the education, practice, research, documentation, and regulation of traditional medicine and involvement of traditional medicine practitioners in health services”) and paragraph 5 (“to encourage development of common reference documents of traditional medicine for South-East Asian countries”).
That same year, the WHO published its document, ‘WHO traditional medicine strategy: 2014-2023’. In this, the inter-governmental health agency laid out its framework for a global approach to what it calls traditional and complementary medicine (T&CM). “Traditional medicine of proven quality, safety, and efficacy, contributes to the goal of ensuring that all people have access to care,” the document stated. “A global strategy to foster its appropriate integration, regulation and supervision will be useful to countries wishing to develop a proactive policy towards this important – and often vibrant and expanding – part of health care.”
In the WHO prognosis, which is what determines how its strategy has been designed, both governments and consumers want to see traditional and complementary medicine being “integrated into health service delivery”, which then leads WHO to provide its advice about practices and practitioners of T&CM. This advice follows through three “strategic objectives” provided and they are: “1) building the knowledge base and formulating national policies; 2) strengthening safety, quality and effectiveness through regulation; and, 3) promoting universal health coverage by integrating T&CM services and self-health care into national health systems.”
Armed with the Delhi Declaration, and supported by the regular activities sanctioned for the 2014-23 strategy by its regional office (the WHO South-East Asia Regional Office, SEARO), the WHO has herded our ministry of health (together with those of other countries in the region) into ‘monitoring’ traditional medicine, commissioning research on its organisation and management, and ‘capacity building’ of its practitioners (our vaidyas). The keywords are ‘integration’ and ‘health service delivery’.
The integrationist impulse when considering the two systems of medicine, ayurveda and western, is not a WHO invention. “It is clear that both the Western and Indian systems have much to give to each other, and that keeping them exclusively in water-tight compartments will be detrimental to the growth of medicine, and for humanity. It needs no stressing that mankind has a right to all that is best in the sciences of health and healing.” So stated the authors of the Report of the Committee on Indigenous Systems of Medicine, which had been commissioned by the Ministry of Health of the then newly independent India, and published by it (in two volumes) in 1948.
Chapter 6 of the 1948 report, titled ‘Synthesis of medicine’, urged that “utmost efforts should therefore be made to put together the best in both the systems, and to evolve one unified system for the advancement of Medicine and the benefit of mankind.” Doing so, the Committee said, “will give our people (i) all the benefits of the advances that Western medicine has made and (ii) at the same time provide them with a system which will be more in keeping with their habits, tastes and requirements, and (iii) which from its comparatively cheaper medicines will be more suitable to their economic circumstances as well.”
The WHO section on Traditional, Complementary and Integrative Medicine has been busy in India through the WHO India office and with the backing of its South-East Asia regional headquarters. Through the period 2016-20, the WHO and the Ministry of Ayush have “collaborated on a project on the promotion of quality, safe and effective traditional and complementary medicine”. In 2017 WHO published a set of what it calls ‘standardised core and reference indicators’ for T&CM, which is meant to supply health policymakers material “to develop or revise national policies and to review programmes”.
In 2018, WHO conducted a regional baseline survey on ‘pharmacovigilance for traditional medicine products’. During 2019, with four years remaining till the end of its traditional medicine strategy time-frame, the WHO stepped up its engagement with the Ministry of Ayush in a programme to ‘standardise diagnosis and terminologies’ in ayurveda and other medicinal knowledge systems that are the subjects of the ministry. It is this that must set the alarm bells ringing for India’s large community of ayurvedic practitioners, treatment centres large and small, and teaching institutions whether gurukulas or colleges.
It is “standardised core and reference indicators” and “‘standardise diagnosis and terminologies” that signal what WHO is working to change. Under the guise of examining terminologies the WHO is intent on setting new standards and protocols for ayurveda through its three objectives stated in its traditional medicine strategy for 2014-23. The UN health agency has systematically been advancing these objectives by, so far successfully, convincing the health ministries and administrations of its member states that revisions of their entire traditional medicinal knowledge base is required. Ignored by WHO altogether are the sophisticated diagnostic and prophylactic methods of ayurveda as transmitted and practised by our medicinal tradition, resting as they do upon sound philosophical and elemental foundations.
Such a collaboration should never have been entertained by the Ministry of Ayush, for the science that is ayurveda cannot have its distinct ontologies tampered with by foreign agencies, and especially not one which, long before the coronavirus crisis, the WHO was criticised by doctors of western medicine, and by civil society groups in the west and developing countries, for the weighty and overt influence exerted upon it by the international pharmaceuticals industry and its partners.
As recently as May 2018, detailed criticism was made of the majority of members of the 25-member Civil Society Working Group on the third High Level Meeting of the UN General Assembly on non-communicable diseases, having links with the pharmaceutical or medical device industry. This was despite the adoption in 2016 by the World Health Assembly (of ministers from WHO members states) of the Framework on Engagement with Non-State Actors which brought a promise from the WHO that issues related to conflict of interest would be addressed and that the health agency’s standard-setting activities would be free of corporate influence.
Within just two years, that promise was found to be empty. The Ministry of Ayush is certainly not ignorant of this and other well-founded criticisms about how WHO works in practice Yes neither at the start of its collaboration on this subject in 2016, nor at any time since and not in 2020 has our ministry sought to explain to – let alone consult with – vaidyas and ayurvedic practitioners all over India as to what is meant by WHO when it says “standardise diagnosis and terminologies”. This is standardisation imposed from outside, and there are more than enough grounds for finding it influenced (if not wholly directed) by forces that are today more dangerous to ayurveda than Bentinck and his Native Hospital surgeons ever were.
One of the forces was revealed in June 2019, when the WHO approved a new version of its International Classification of Diseases (ICD). The ICD categorises and assigns codes to medical conditions and is used internationally to decide how doctors diagnose conditions and whether insurance companies will pay to treat them. The latest version, ICD-11, is the first to include a chapter on Traditional Chinese Medicine (TCM). The chapter includes no other kind of traditional medicine.
Immediately after that momentous inclusion, many T&CM practitioners around the world celebrated its incorporation into the document as crucial for the international spread of other medicinal traditions. But the new chapter in the new ICD also brought forth a barrage of criticism. An editorial in the well-known and influential journal Nature stated, “On the one hand, China advertises a belief in evidence-based medicine and has invested millions of yuan in programmes devoted to the modernisation and standardisation of TCM. That’s welcome, but so far, these programmes have only given a veneer of legitimacy to treatments that have not been rigorously tested in randomised, controlled clinical trials. On the other hand, TCM is big business that receives strong government support.”
A far more censorious view came in November 2019 in the form of a joint statement on the new chapter in the new revision of the ICD by the European Academies’ Science Advisory Council and the Federation of European Academies of Medicine. “Research and innovation must be at the heart of medicine. The WHO ICD-11 initiative risks stimulating an indiscriminate acceptance of products and diagnostic practices that have not been sufficiently investigated by standardised procedures and whose scientific justification is weak.”
Statements like these, help to pull away the veil of inter-governmental consensus on health matters and show the system for what it really is, a contest between states with powerful financial and scientific resources, as much as between the difference blocs of the pharmaceuticals and medical devices industries. In between are donor agencies and academic research consortia, themselves partners with different players on both sides. And there is the one donor whose contribution to the WHO’s General Fund outstrips that of the big guns of the global pharmaceutical industry combined, and whose contribution is second only to that of the largest contributor, the government of the USA, and that donor is the Gates Foundation.
It is inconceivable that even if the Ministry of Ayush is unaware of these powerful interests that surround the WHO, the Ministry of Health and Family Welfare is not (for its minister has only recently been appointed the head of the WHO Executive Board) and that even if the MoHFW is unaware, the Ministry of External Affairs and the Prime Minister’s Office are not.
Yet in early February 2020, the Ministry of Ayush hosted an ‘International Conference on Standardisation of Diagnosis and Terminologies in Ayurveda, Siddha and Unani System of Medicine’. This produced a declaration which had seven points, five of which are about the WHO’s ICD (International Classification of Diseases). Point 7 of the declaration said it plain and blunt: “Affirm our commitment to take appropriate policy measures to facilitate the implementation of ICD-11 in our health information system”.
What the Ministry of Ayush has committed to implement is a definition of indigenous medicine, as in was called during the days of the British East India Company doctors, that has nothing whatsoever to do with ayurveda. Instead it has everything to do with our vaidyas being re-educated to follow standards and terminologies for ayurveda that are set by a foreign agency which is itself controlled by forces that want to see the practice of ayurveda as we know it today extinct, and who want to see the extensive ayurvedic knowledge system and the application of its pharmacopoeia being restricted to supplying the ingredients for a lucrative global ‘wellness’ industry.
The stakes are high for the forces that control and influence the UN health agency, some of which have been at work for more than two decades, some whose appearance is more recent. The size of the global ayurveda market was estimated by a report, issued in November 2018 by the Confederation of Indian Industry (CII) and the consulting firm Price Waterhouse Coopers (PWC) as being US$ 3.4 billion in 2015 and US$ 6.2 billion in 2019 (about INR 43,500 crore) with the market size of ayurvedic products in India estimated at US$ 2.5 billion in 2015 and US$ 4.9 billion in 2019 (about INR 34,500 crore). But even these estimates shrink by several orders of magnitude when compared with the estimates for the value of the global traditional and complementary medicine market, US$ 350 billion.
The T&CM campaign by the WHO must be recognised for what it truly is and halted immediately. If it is not, there is no doubt that within two generations the structures of the ayurvedic knowledge system, the means with which their value is transmitted, the abilities to exercise extra-material perception about disease or its absence, and the capacious specialist vocabularies used for its eight limbs will have been altered beyond recognition.
As inheritors of a knowledge system that is the most profound medicinal tradition the world has ever known – handed down by Caraka, Susruta, Vagbhata, Bhela, Jivaka and their disciples – it is imperative that our ayurvedic tradition be protected from being appropriated and be safeguarded on Indian, not foreign, terms.
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