Dr Geetha Krishnan, HoD Integrative Medicine, Medanta – The Medicity, envisages that integration would usher in an era where medical science would offer better patient care
India is credited to be at the frontiers of medicine since immemorial time, until about 150 years ago, when the world was swept by a healthcare revolution that largely advocated a negation of the past. However, new studies have increasingly found merit in many areas of traditional medicine and spurred the revival of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in our country. However, modern healthcare cannot be treated as a simple binary of traditional (AYUSH) vs. modern medicine anymore. The answer lies in integrating AYUSH in mainstream healthcare, which involves two distinct streams, firstly including AYUSH services within mainstream healthcare infrastructure, and secondly integrating AYUSH within the mainstream healthcare programmes. The former is similar to the existence of two branded shops for the same commodity, working inside the premises of the same mall. Existing, but not working together and often spawning unhealthy competition. The latter is like a supermarket, where both the brands available simultaneously, with an added informative guide cum advisor available to the customer— in this case the patient-advising her on the right choice of products, or a mix and match of it, based on her needs.
Inclusion of AYUSH services within the mainstream healthcare infrastructure is a process which has been initiated more than two decades ago, by several governments, including the one at the centre. There are PHC/ CGHS/ ESI dispensaries, where more than one AYUSH system has been co-located with modern medical infrastructure. There are thousands of patients, thus being served with the freedom to decide, of which system to choose for their ailments. Patients approaching these centres take decisions based on their current but layman understanding of the strengths and weaknesses of each system. Many of them usually decide to try more than one; often all systems available within the premises, with the hope that at least one of them will help.
Personalised healthcare
Integrating medical systems is an expert-guided process. It relies on evidence-based medicine and takes into consideration, the strength of evidence available for each treatment possibility across multiple systems. It also considers the patient’s requirement holistically and calls for judicious integration of therapeutics. For example a diabetic patient, whose blood sugar levels are very well managed under the care of a particular system’s medication and lifestyle advice, might not require another medication to control blood sugar levels. In such a case, addition of another anti-diabetic drug is warranted only if the current medication, though effective in blood sugar control, is causing an unwanted side-effect to the patient, or is unable to prevent and manage the complications of diabetes, or is unaffordable to the patient. Thus integrative medicine is a professional advice from patient perspective, and considers possible benefits and adversities from her perspective. The hallmark of such an advice should be (1) better clinical outcomes, (2) fewer side-effects of medications, and (3) lesser costs. An integration process without the promise of any of the above three – if not all – would be futile and more of a cosmetic venture.
Integrative medicine: How India merges two streams of medicine
“The aim of integration is to offer the best possible cure, care, and management to the patient”, advises Dr Naresh Trehan, cardiothoracic surgeon and Chairman, Medanta Group of Hospitals. Dr Trehan is the most ardent proponent of integrative medicine and has been trying to find a degree of clarity to the idea of integrating AYUSH systems into mainstream medicine, since many years. He envisages that integration would usher in an era where medical science would offer better patient care through prudent combination of strengths of different medical systems. In his own words he is, ‘a true believer’ who from his heart wishes to see the evolution of the ‘One Medicine’ from India, which combines the strengths of the west and east. Western medicine or allopathy, in his words, cures from outside. It uses everything in its capacity to eradicate the cause of the diseases and cover-up its symptoms. In the process it cuts, burns and poisons, often leading to trauma or outcomes, more severe than the disease itself. Whereas eastern medicine, like Ayurveda, and Yoga heals from within. It enhances the body’s strengths and helps it overcome the disease. He compares the two to the air force (Allopathy) and the army (AYUSH systems). He says effective win in any war lies in the use of both, synchronised and simultaneous. It is with this vision that he created the first integrative medicine department in the country, built into the functional dynamics of his new mega venture, the Medanta.
The Department of Integrative Medicine at Medanta, since its inception six years before, has catered to more than 14,000 individual patients. Co-located within one of the most modern medical facilities of the world, the department is unique through the success of functional integration achieved. Nearly 100 different diseases are managed by the department making use of Ayurveda, including all its aspects such as Yoga, drugs, therapeutics, Panchakarma, and life regimen advices. The department, services the needs of three different kinds of patients. Those who independently approach the department (30 per cent), those who are referred by allopathic practitioners (50 per cent), and those who are enrolled in integrative medicine programmes (20 per cent).
Proof points: How has AYUSH integration in healthcare helped?
The Medanta department of Integrative Medicine successfully and efficiently treats patients with back pain- including vertebral bone and disc diseases, osteoarthritis knee, rheumatoid arthritis, migraine, sinusitis, fibromyalgia, melasma (hyper-pigmentation of skin), hair-fall, acne, constipation, hyperacidity (GERD), allergic dermatitis, frequent upper respiratory infections, and stress among many others. On several occasions it remains a matter of pride for the department, that patients select the system over the best of allopathic options available to them, or after trying modern medical interventions over considerable periods of time, to find success in systematic Ayurvedic care.
Another set of patients who approach the department are referred by Allopathic practitioners aimed at achieving specific clinical end-points. Major categories in this group are gastric symptoms including constipation post coronary bypass surgery, long standing pain of neurogenic origin post thoracic surgery, pelvic pain syndrome – a type of moderate to debilitating pain, usually occurring in men and associated with urination, in the lower abdomen, groin and perineum, inflammation of the inner lining of the mouth during radiation therapy and neck muscle stiffness – post radiation therapy, breast cancer patients under concurrent radiation / chemo therapy, reduced platelet count in Dengue fever, insomnia, along with many referrals for back and knee joint pain. These referrals have been built over a period of time, through systematic collection of data, independent analysis of the same, and discussion and dissemination of results (positive and negatives) as part of the ongoing outcomes research efforts of the hospital.
Yet another group of patients cared for in the department are enrolled under integrative medicine programmes, designed and implemented in the hospital. There are four such programmes being explored in the hospital. It includes heart disease reversal programme under Dr Ravi Kasliwal, Chief Cardiologist of the hospital, where we are exploring the possibilities of reversing the heart diseases of patients identified with very early changes in the cardiac blood vessels. Addition of Yoga before and after major cardiothoracic surgeries is another attempt in generating improved clinical outcomes, which involves working with Dr Yatin Mehta, chief of critical care, and Dr Ali Zamir Khan, Director Robotic thoracic surgery and led by Dr Naresh Trehan himself. The department also runs an integrative programme with the Institute of Neurology under Dr Arun Garg, Director and specialist in Stroke management. The programme improves recovery outcomes among stroke patients, with the addition of Ayurvedic medicines and therapies introduced early in stroke management, together with a consistently high standard of personalised care. The department also runs an integrative programme with the preventive health and wellness centre of the hospital, offering Prakruti-based advises on ‘Predictive, Preventive medicine and Promotive healthcare’. This approach, focusing on improving the quality of life and longevity has altered the prevailing trends of preventive health check-up, which boulders down to analysing one’s lab reports and writing a paragraph explaining the tabular data, for easy understanding.
There are many attributes, in the Medanta model of Integrative medicine, which are laudable and replicable in a wider social spectrum. One example is in the management of knee-joint pain – a simple five week protocol, which has been found effective in hundreds of patients. A very large number of patients who were identified with early osteoarthritic changes, were administered this protocol so as to save them the trauma of a future knee replacement surgery. In my capacity as head of the Department of Integrative Medicine at Medanta – The Medicity, I was acutely aware of the substantial savings in costs – financial, human capital and lost work hours. An example of such savings can be seen in the pan-India campaign we have proposed, along with the Ministry of AYUSH, for mitigating the need for knee surgery by employing AYUSH-based treatments. The ‘Save Your Knee’ campaign will be the first and largest private-sector led initiative with a pan India presence, when fully implemented in the field of integrative medicine. The management of migraines and sinusitis are two other areas which can and should be handed over to Ayurveda, before any other system. So are fibromyalgia, early sleep disturbance, GERD and constipation.
The way forward for AYUSH
Integrative medicine is one which needs to be implemented in all PHCs across the country, no doubt. Nevertheless, its baby steps should be taken in large private hospitals, where the practice can grow, gain social acceptance, and gradually flow down to the PHCs. It would be a clear top down model of growth, as is with most of the advanced medical technology. The involvement of the private sector is an irreplaceable step in the growth and public utility of Integrative medicine.
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