By DR. Harinder Bali Government has allowed AYUSH postgraduate doctors to perform many surgeries which come exclusively in the domain of modern medicine. Government has justified this move by arguing that these doctors are trained during their MS course to perform these surgeries, modern medicine doctors are reluctant to serve in the rural areas and these are relatively simple surgeries. This move of the Government can have disastrous consequences for the country, and the notification needs to be rescinded immediately. Ayurveda, inarguably, is the oldest science of treating patients. it finds mention in great detail in the Vedas as well as in many of our holy scriptures. Ayurveda was a state religion for many centuries producing some of the finest Vaids and surgeons whose contribution has been recognized, the world over. Sushruta is regarded as the father of modern surgery and is revered the world over. His statue is proudly displayed prominently in the main lobbies of many hospitals not only in India but also in many hospitals of the world. Similarly, the contribution of many other physicians and surgeons is not only recognized but also celebrated worldwide. The name of great physician Charak, the author of Charaka Samhita, readily comes to mind. Likewise, other medical streams like Unani, Homeopathy, Tibetan medicine, Chinese medicine, Naturopathy and many others have their own very illustrious histories and heritage. All these different medical streams need to be encouraged and promoted so they can progress in their own right and become a viable alternative to modern medicine stream. I don't think anyone, including the practitioners of modern medicine, has an issue with recognizing the contribution of these alternative systems of medicines nor in the state helping them to improve their systems to advance their growth. The problem has only arisen when the Government by notification has tried to completely subvert and undermine the system and allow practitioners of these alternative systems of medicine to start performing surgeries which fall exclusively and specifically in the domain of modern medicine. Let me make a few points unambiguously clear at the very outset a) I have the highest regard for Ayurveda and all other alternative medicines. I have done some research on Yoga. I have written a comprehensive review in the Indian heart Journal on cardiovascular effects of Yoga. I am convinced that Yoga is an excellent science with enormous potential not only to prevent risk factors from developing but also in managing patients with heart disease. Beyond that, I have no great competence or expertise to comment on any of the alternative streams as I haven't studied any one of them in great detail. b) I believe with great conviction that AYUSH has a critical role to play in preventive medicine and also in many chronic diseases like allergies, skin disorders, joint disorders and psychosomatic illnesses c) I have no problem in the state promoting AYUSH in a big way by setting up more institutes, promoting research and introducing sub-subject specialization d) I have no issues with any AYUSH doctors. Some of my closest and dearest friends are AYUSH doctors. I respect their expertise and also value their friendship enormously. e) Problem is only in them doing surgeries which are in the domain of modern medicine. f) I have more than thirty years of experience and can say with all the conviction at my command that each one of these surgeries demands intensive knowledge and extreme competence. There is so much super specialization within super specialization that it is neither ethical nor moral to do procedures beyond one's core competence. I, for one, don't even do paediatric cardiac interventions nor Electrophysiology in my speciality of interventional cardiology. I promptly refer these patients to those who are experts in treating them. I can't even begin to imagine to venture into such procedures like endoscopy, laparoscopy Etc. Therefore, I believe every patient irrespective of his background, education level, caste, creed, or colour deserves the best and should be treated by the most competent doctor in that speciality. This notification allowing AYUSH MS doctors to conduct surgeries will be an unmitigated disaster: a) Ayurveda and other alternative streams stopped growing at least a thousand years ago. Successive governments for a variety of reasons stopped patronizing Ayurveda, stopped funding it as well as denied jobs to practitioners of this science. Consequently, once a flourishing medical stream stopped growing with progressively fewer people pursuing it as a career and even fewer seeking treatment from those practising it. Same information and knowledge that was described thousand years ago in the Vedas continue to be guiding principle even now. To the best of my knowledge, no major addition has been made either in the diagnostic or therapeutic fields. No one has made any effort to identify the active ingredients in different herbs or to systematically identify long term good or harmful effects of these medicines on various systems of the body. These alternative sciences have been lying dormant for centuries with no real progress to make them relevant to the contemporary world. Besides, there are very few institutes teaching these streams of medicine. The existing ones are grossly short of funds to carry out any meaningful teaching or research. Diagnosis is limited only to history taking, and no modern investigative tool is available for making an accurate diagnosis. There is no practice of conducting clinical trials, randomization in trials or of systematically analyzing data to see efficacy or lack of it ,of the prescribed medicines. There is no imaging modality available to aid in diagnosis. b) Modern medicine in the last two hundred years has made astronomical strides to reach to present level. It is making continuous progress even as I write this column. Right from the very beginning, it chose the path of objectivity, documentation, systematic trials, publication in peer-reviewed journals, periodic and continuous up-gradation of textbooks and constant reevaluation of already existing knowledge in the light of newer information. Old modalities of treatment were discarded as soon as the more recent and improved techniques of diagnosing and treating patients became available. It evolved a system of imparting knowledge to budding doctors both formally and informally and continuously encouraging them to question everything and anything till they were satisfied. The Government set up a large number of medical colleges, and medical Institutes not only to impart existing knowledge but to carry out research to continuously enhance knowledge. Students were encouraged to publish their research and experiences in peer-reviewed journals. Students learnt to evaluate every new observation and information scientifically before incorporating it in their clinical practice. This systematic evaluation and constant endeavour to improve all the time is the hallmark of modern medicine. Whereas formal education in a medical college is only a prerequisite to understand the already known facts about the human body and different diseases, the education of a doctor continues all his life. Every doctor is trained to intuitively observe, analyze and imbibe any and every new information and critically analyze it for its significance. Modern medicine has been continuously incorporating technological advances in diagnostics and therapeutics. In the last thirty years ultrasound, CT scans and MRI have revolutionized the way doctors carry out investigations for diagnosis. These investigative capabilities and their constant improvement has taken medicine to an entirely new level. To become a surgeon, not only one has to have thorough knowledge in that specific field but also prolonged practical experience under the close and watchful eyes of an experienced surgeon. Every surgeon has vast experience in recognizing and treating all types of complications and the ability to innovate at a split second in case of any unexpected observation/occurrence during surgery. It takes at least ten to fifteen years after obtaining a formal postgraduate or speciality degree ( MCh, DM ) to be able to become an expert surgeon. Additionally, every surgeon possesses a thorough knowledge of anaesthesia, pharmacology and many other sister specialities. He gets comprehensive training to recognize and treat the various adverse reaction of medicines, critically evaluate and interpret all laboratory investigations and prescribe medication in proper dose and strength. Can an AYUSH MS doctor do it? c) To perform surgery, one would need some form of anaesthesia, local, spinal, epidural or general. Anaesthesiology is a modern medical speciality. Where and how is an AYUSH surgeon going to use it? So who would give the anaesthesia? d) AYUSH doctors are being permitted by the notification to perform surgery for benign tumours. Who would decide a particular tumour is benign or malignant? In addition to histopathology, a pathologist studies immunohistochemistry ,cell of origin and also receptors on the cell to decide best treatment for a particular patient .To the best of my knowledge, there is no concept of microscopic evaluation of tumours in AYUSH. Who would decide whether a specific tumour is benign or malignant? f) Surgery involves the use of antibiotics as prophylaxis and for treatment if and when an infection occurs. What antibiotics and based on what investigations are the AYUSH doctors going to prescribe these antibiotics? To prescribe these medicines would involve optimum training in microbiology and pharmacology. g) Human anatomy is not the same in every individual. There are different types of anomalies, aberrancies and abnormal courses and branching pattern of arteries, veins, nerves which a surgeon knows by training, experience and clinical observation. What would an AYUSH surgeon do, should he come across uncommon anatomy? He could end up injuring or cutting one of the structures with disastrous consequences for the patient. H) Should a complication occur in the hands of an AYUSH surgeon who is going to handle it? Another AYUSH doctor or a surgeon practising modern medicine? The Government has argued that these AYUSH surgeons would be willing to provide much-needed healthcare in the rural areas where allopathic doctors are reluctant to go. It means that there would be different types of doctors for urban and rural areas. Modern medicine doctors with proper qualification serving the urban and elite population.While inadequately qualified doctors would be treating the rural population and those living in remote areas. This concept raises a fundamental question. Are rural people not entitled to quality healthcare just like their urban counterparts? Quality healthcare, just like the right to life, should be a fundamental right of every citizen. No state which claims to be a welfare state should deny it's citizens quality healthcare merely based on residence, education level or any other criteria. This notification permitting AYUSH MS doctors to conduct surgeries will be disastrous, may hurt many people and cause enormous harm to millions. The Government should immediately withdraw it. Such notification will not improve the condition of AYUSH doctors but will undoubtedly cause massive damage to practitioners of modern medicine and accelerate the process of brain drain. It is an extremely retrogressive step and would make doctors of our country a laughing stock in front of the whole world. The right course of action to improve AYUSH streams is to improve funding for setting up good institutes and to encourage students to take up those streams. Each of these streams must conduct large trials, systematically analyze results and publish them in peer-reviewed journals to show the safety and efficacy of everymedicine. It sure is a long road, but a beginning has to be made. Short cuts will not do. ( The writer is associated with Paras Hospital, Panchkula. Views are personal. )