Re: Ayurvedic doctors prescribing ARV drugs !?

[Guest guest]

Dear FORUM,

I think that this represents as much of an opportunity as it does a

potential threat. Indeed, there are " physicians " who are incompetent,

poorly trained or otherwise not acting in the best interests of their

patients. This can be the case in any nation, in any system of medicine.

However, the integration of allopathic and traditional systems of medicine

provides enormous opportunities for outreach into communities affected by

HIV/AIDS. Identifying individuals and groups of Ayurvedice, Siddha, Tibetan

or Unani practitioners who are interested in working with allopathic

physicians may make up for the serious shortages of allopathic physicians

that are in India--let alone the potential for helping to overcome stigma

and discrimination.

On the one hand, such persons can act as a bridge to care. They may be the

first and often ONLY practitioner many people can afford to see. They may

be able to work with AIDS service organizations and community groups to

help supply prevention information. They may represent an opportunity to

identify fraudulent practitioners. They can be trained in best methods for

providing ARV (though I know there is often discrimination by practitioners

of any tradition with that of other traditions--this doesn't help those of

us living with chronic infections). They may help families and communities

to overcome stigma and discrimination.

Finally, the interventions that these great and ancient traditions have may

provide opportunities for research and care. Many botanical agents have

been characterized for their anti-HIV activity (e.g., Momordica charantia,

Curcuma longa, Glycyrrhiza glabra, Sutherlandia frutescens). Clinical

studies of such agents may show whether they may slow HIV disease

progression, have antiviral activity, improve CD4 counts, offset symptoms

(fatigue, diarrhea) or manage ARV side effects (as ARV becomes more widely

available). Indeed, some 25% of allopathic pharmaceutical agents are still

derived from their natural sources. Many others originate from natural

sources--even AZT was originally isolated from a Caribbean sponge!

Importantly, intellectual property must be protected and held by local

practitioners/groups and community. Should such agents be shown to be

helpful in some way, then we must consider a range of issues from

conservation of natural products to how best to make these agents

commercially available, such that their identity, potency and purity are

assured. I favor the FAIR TRADE approaches being used so successfully for

coffee, chocolate and other products to assure that community-identified

needs are being met should such agents be made available on the global market.

I say this from a consumer perspective, as a person living with chronic

Hepatitis C infection. It does me little good to have entire ranges of

possibilities simply discarded by the intense bigotry that may arise by

this false dichotomy of " allopathic vs. traditional systems of medicine. "

We must overcome this nonsense, even as we fight for access against the

vile and genocidal hegemony of a western-based pharmaceutical industry that

would as soon see millions die as sacrifice a dime in order to prop up the

evil notion that intellectual property rights trump human life.

M.

E-mail: <fiar@...>

[Guest guest]

Dear All,

This has indeed been a vexing problem in India. Different schools of medicine

have in time acquired credibility in their own spheres of approach and

competence. In this day and age, it has been the role of the HIV to signal

humanity the need to introspect and rediscover their humanity.

I believe that different schools of medicine actually enhance the potential of

mankind to address its frailty in health and provision different modalities of

care.

In the early years of the epidemic in India, many mistakes have been committed

with regrads to ART use by untrained hands.

With such considerations in mind, it has been the approach of the

Wockhardt-Harvard Medical International AIDS Education & Research Foundation

(WHARF) in Mumbai, to conduct a monthly program of training at a basic levelin

the Epidemiology, Virology and Natural History, Diagnosis, Clinical aspects and

National / International guidelines, Voluntary Confidential Counseling and

Testing, Anti Retroviral Theray, Prevention 0f Parent to Child Transmission and

Biowaste Management/ Post Exposure Prophylaxis.

The day long program is followed up with a six weeks practical and social

research based hands -on training directed at case and contact facilitation.

This course is open to primary care physicians from all the government

recognized schools of medicine, counselors, nurses and social services

professionals.

In three years, significant gains have been made in providing competencies in

these areas of HIV-AIDS care. Perhaps this is a suitable modality provided the

medical fraternity in general and the participants in particular are able to

overcome their inhibitions and develop an approach to becoming genuine

caregivers.

Experientially in such a situation, an aproach of inclusion is preferable

to exclusion.

Dr M.Shashi Menon, MD.

Major (Retd) AMC.

Founding Faculty (Mumbai)WHARF.

E-mail: <msmenon@...>

[Guest guest]

Dear Deepak Dobhal and the FORUM

I think this is the right time to decide what to do with Doctors of

ISM (Indian system of Medicine). Because on one hand we r involving

them in RCH programme and want to utilise them in our programme. And

on other side your experience.

And we all know the MBBS doctors are not going in rural area only

these ISM doctors are providing services since years. so i think we

should not neglate them. This issue really needs further debating.

Niraj

E-mail: <drpam_pandit@...>

[Guest guest]

Re: Ayurvedic doctors prescribing ARV drugs !?

Dear all,

's email was well put. I would like to make two additions. The first

relates to the recognition of gender dimensions of the debate and the second is

a point of caution.

Local health practices, including access to traditional systems of medicine and

practitioners, home based remedies, birth attendants and the often demonised

shamans or witch doctors, are accessed in many parts of South Asia.

Multiple health practices, understandings of the body and health and treatment

options co-exist and intermingle in the South Asian context. The choices of

which services to access are gendered. For example, where accessing 'modern'

medicine requires more resources and entails hidden costs, the low priority on

women’s health within the family means that often it is only very late in

experiences of illness that women get access to modern medicine (Bharat et al

2003, NFHS - 2).

The treatment of these practices by the state and modern medicine has often been

negative and based on a colonial ‘tradition’ versus €˜modernity’ dualism,

including through criminalisation of such practices.

It is perhaps more appropriate to engage such health seeking behaviour in more

positive terms if we are to ensure effective treatment options available to

those whose health needs find low priority in the care economy.

The point of caution is this - the approach to ayurveda and unani systems of

medicines in the present national health policy in india recogninses the need

for promoting them but does so in a particular and restricted manner. These

systems of medicine are seen to need 'scientific proof' with respect to efficacy

and safety, this through markers and methodologies typical of allopathy.

In other words, ayurveda and unani systems of medicine are to be acceptable only

if they make sense in allopathic terms. This implies that these systems of

medicine become merely variations of allopathy - the issue becomes about the

efficacy of ayurvedic drugs.

This goes to the heart of the system of medicine, its understadning of the body,

of health, of illness and of disease. for example, whereas allopathy is

invariably a system of medicine that is responsive to ill-health (this despite

the alma ata declaration and the definition of 'health' by the WHO as being 'not

merely the absence of disease'), whereas ayurveda is constituted of regular

everyday practices focussed on moving towards better health, irrespective of the

presence of illness.

In other words, whereas allopathy is based on pathology, ayurveda (or some

forms of it) is based on an ontology of good health. (Alter, 1999).

Bringing ayurveda to be simply another name for new-age, 'traditional' drugs

could be a way in which it is killed over a period of time and the hegemony of

allopathic pharmaceutical companies is fortified.

The significance of these systems of medicine need to be understood in terms of

their diverse understandings of the body and not limited to simply their ability

to provide 'innovative' drugs. In this context it is necessary to point out that

the national health policy's recognition of the significance of ayurveda is

related to the objective of creating a global market for drugs rather than on

promoting the development of these systems of medicine in their own terms,

somehting that i find extremely problematic.

Best

Akshay

E-mail: <133789@...>

References:

Alter, ph S., “Heaps of Health, Metaphysical Fitness: Ayurveda and the

Onthology of Good Health in Medical Anthropologyâ€, Current Anthropology, Vol.

40, Supplement: Special Issue: Culture. A Second Chance?. (Feb., 1999), pp.

S43-S66.

Bharat, S. et al, 2003, Social Assessment of Reproductive and Child Health

Program - A Study in 5 Indian States - Assam, Haryana, Maharashtra,

Orissa and Uttaranchal, TISS, Mumbai.

International Institute for Population Sciences, 2000, National Family Health

Survey -2, 1998-99, Mumbai, India