I happened to read an interesting article written by an old colleague of mine, which emphasises the reasons as to why we should turn for a substantiated form of medicine rather than for a supernatural form. Unfortunately, he has inserted a few lines, which are totally irrelevant into a noteworthy article and consequently ruined its organic unity. However, his position on the theme of his article is remarkable. It is a pleasure after all discordances to be on the same grounds with our old ally. His propositions in defence of allopathic medicine as a relatively accurate and effective science are commendable and unassailable.
This article is written as an adjunct to support his propositions regarding the relative versatility of allopathic medicine. The content of this article focuses on a comparative analysis of several traditions of medical practice in Sri Lanka. It is based on Western (allopathic) medicine with relevant reference to Ayurveda.
Ayurveda has a solid foundation although its origin is somewhat mythical (at least in the way it has been told in Sushruta Samhita). I wonder whether Dhanvantri brought the “knowledge of life” from “the heavens” into this world! As a classical Marxist, it is very hard for me to entertain such a fantastic if not fanatic claim. Despite its legendary origin, Ayurveda has a wealth of literature written in Sanskrit. The works of great ancient scholars in Ayurveda such as Sushruta, Charaka, Nagarjuna et al have been truly magnificent. Ayurveda not only has mighty archives of medical literature of its own, but also its modern day scholars have been prudent to incorporate a great deal of Western medical knowledge into the principles and practice of Ayurvedic medicine. If the formal education in Ayurveda had been confined to what the great genius Gabriel Perera Wickramaarachchi learnt from India and imparted to his bright students in Sri Lanka, Ayurveda would not have survived in this country so long.
Unfortunately, there are hardly any compendia of indigenous medicine in Sri Lanka to consider substantial or even to validate its practice. Whatever the knowledge remaining in the ola-leaf manuscripts does not possess a methodical system of principles to guide a comprehensive practice of indigenous medicine. The inconsistency of the literature on the principles of indigenous medicine has led to a non-standardised practice highly depending on the individual preferences. There is no consensus on the principles and practice of indigenous medicine. The treatment for a disease condition varies significantly from one practitioner to another so that there is hardly any agreement on the practice amongst the indigenous medical practitioners. Consequently, the idiosyncrasies of practitioners have become prominent conferring legendary status to some practitioners. Whatever those peculiar practices may be, they do not survive for another generation as they are buried with the bones of practitioners at the end. Since such peculiar practices are not followed by many, they are not tested extensively either. As my old colleague has quite correctly mentioned in his article, indigenous medical practice has failed to evolve in this country over several centuries. Perhaps, indigenous medicine had had a potential to serve the medical needs of an era in the past. However, it has lost its path to the modern era with the same potential. The heterogeneous knowledge that constitutes indigenous medicine in Sri Lanka is non-consistent, non-systematic and non-standardised.
Let me enlighten you briefly and simply about the philosophy of Western medicine as practiced today. The principles and practice of western medicine is firmly based on reasoning. The fundamental step in the development of Western medical knowledge has been the observation of the characteristics of diseases. Meticulous observation leads to the postulation of how those characteristics have been brought about. In other words, reliable explanations about how a disease brings about various characteristics are proposed. These proposed explanations, which can be called hypotheses are extensively and thoroughly tested using scientific methods by the means of experiments, research etc. The hypotheses that are validated by scientific methods can be accepted as theories into the knowledge base. The theories that are consistent over a long period of time are considered laws. The principles of Western medicine are formulated in such sophistication, exhibiting methodical, reproducible, testable and transparent qualities. There is not any magical or wizardly synthesis of knowledge in Western medicine.
The practice of Western medicine is based on the theories and laws that explain the disease processes, which bring about the characteristics. These characteristics are called clinical features, which include symptoms (what the patient complains) and signs (what the doctor elicits).
Clinical medicine is the science and art of methodically applying the medical principles into practice. Abnormalities in the normal functioning of human body are described as diseases (conditions with well-defined causes and features) and syndromes (conditions with a constellation of correlated symptoms and signs without well-defined causes). Diseases (as well as syndromes) are studied in Western medicine considering pathophysiology (how an abnormality is brought about as per Western medical principles), aetiology (what causes an abnormality), clinical features (what the symptoms and signs of an abnormality are), diagnosis (how to determine or prove that an abnormality is due to a specific disease or a specific syndrome), treatment (how to cure or control an abnormality), epidemiology (how common an abnormal condition is in the population and how it is distributed across various groups in the population), prognosis (what the probable course and outcome of an abnormal condition is i.e. the chance of recovery) and prevention (how to prevent recurrences of an abnormal condition). The practice of Western medicine is based on such a methodical approach.
A well-trained and qualified doctor has to consider all these aspects in a short time when treating a patient. This is why it takes a great commitment to master Western medicine. The practice of modern Western medicine is well standardised so that every practitioner follows the same principles with minimum idiosyncrasies. It is true that the individual skills may differ to a certain extent from one practitioner to another. However, the principles they follow will be and ought to be the same so that any other practitioner can understand and interpret the treatment carried out by a particular practitioner.
In fact, Ayurveda and perhaps indigenous medicine have also been based on some of the above methods. The observation of characteristics of diseases and the postulation of how those characteristics have been brought about are initial steps in Ayurveda as well. Of course, the pathophysiology in Ayurveda, based on the imbalance of the so-called doshas (Vaata, Pitta and Kapa) is different to that of Western medicine. One should not forget the fact that the pathophysiology in Western medicine is also postulations just as in Ayurveda. Earliest descriptions of diseases and how they are brought about in Western medicine were also solely based on observations.
So, what could be the difference between Western medicine and Ayurveda (as well as indigenous medicine which shares many teachings of Ayurveda)?
Western medicine has been continuously and incessantly revised in the light of new discoveries and advances in the modern sciences. For an instance what Celsus, the great ancient medical writer described as inflammation on mere observations, have been developed over the centuries into a basic pathological process that describes an array of disease conditions such as cellulitis, hepatitis, gastritis, arthritis etc. As a result of scientific research and experiments on that ancient concept of inflammation, today, we talk about various inflammatory markers to diagnose various diseases as well as about various inflammatory substances that can be targeted by specific drugs to treat those diseases. Whereas, Ayurveda and especially indigenous medicine (which is probably a loose derivative of Ayurveda) still keeps on repeating Vaata, Pitta and Kapa in the same manner that they were written millennia ago.
The principles and practice of Western medicine can be readily subjected to investigation by scientific methods, a fact that empowers Western medicine to boast itself as a scientific discipline. Despite a few deficiencies in Bacon’s scientific method, we need to accept his methodology as a very useful tool to establish the fidelity of a proposition. People who are intellectually blind with anti-Western sentiments such as Nalin de Silva will disregard the need for a Baconian scientific legitimacy of the medical knowledge (Let them be in peace with their ideological jouissance!). Whereas, ordinary people like my old colleague and I, would surely look for the best available medicine in our illnesses. Thus, we are interested in the most verified practice of medicine.
One of the most important aspects in Western medicine, developed in the last century has been the concept called “the evidence-based medicine”. It refers to the practice of medicine that has been supported extensively by quality evidence, which is drawn primarily from well-designed and well-conducted clinical trials and research. Thorough analyses of various clinical cases are also taken into consideration. The individual expert opinions are not totally ignored but utilised judicially. There are several levels of evidence depending on the strength. Guidelines are compiled using such evidence to guide the practitioners for good clinical practice. Those guidelines contain recommendations, which are also categorised into several levels depending on the risks and benefits.
What about Ayurveda and indigenous medicine regarding the scientific nature of their practice? Ayurveda has not shown promising results to validate its effectiveness in various diseases according to the handful of research carried out so far. The principles of Ayurvedic medicine are not so readily compatible with high quality scientific research methodologies either. Consequently, Ayurveda is not regarded as a genuine science. The general consensus is to consider it as a pseudoscience. What is the situation of indigenous medicine in Sri Lanka as a science? The answer is shockingly traumatic. I wonder whether we can consider the principles and practice of indigenous medicine at least as a pseudoscience. It has become more supernatural and magical. Some of the treatment modalities are hilarious and ridiculous, as my old colleague has pointed out in his article. There have been practitioners who treat patients using occultism in combination with indigenous medicine. When occultism joins indigenous medicine, the discipline becomes more mysterious. Occultism is not something strange to Ayurveda either. Butavidya, which deals with the mental disorders, is one of the eight components (astanga cikitsa) of Ayurveda. However, this concept of butavidya is also misused for commercial purposes at present, just as panchakarma cikitsa has been misused at spas.
Let me touch a few MYTHS held firmly by certain fractions of the public regarding Ayurveda and indigenous medicine:
1. The treatments in Ayurveda and indigenous medicine are harmless and safer than the treatments in Western medicine.
This is not a rational claim at all. Perhaps, and this myth is supported by the misconception that the herbal medicines are free of adverse effects or side effects. Herbal medicines are not as safe as they were thought to be. The results of research on the aetiology and the epidemiology of many diseases, have suggested that the herbal medicines can cause a host of diseases. In contrast, the treatments (including the drugs) used in Western medicine are well tested and validated at various stages from their introduction (clinical trials) to their use (research and surveillance) for efficacy and safety. Whenever there is a clinically significant undesirable outcome identified by such processes, the use of the relevant treatment or the drug may be restricted, modified or discontinued accordingly. There are no such clinical trials, research or surveillance regarding the treatments in Ayurveda or indigenous medicine.
2. Ayurveda and indigenous medicine can treat the cause of disease whereas Western medicine only treats the symptoms.
This is a very interesting myth that was popularised in Sri Lanka. This is not only a myth but also a hoax. As we have discussed above, both Ayurveda and indigenous medicine do not have a scientifically proven or validated principles regarding the diseases. How can Ayurveda and indigenous medicine treat the cause of a disease, when they do not possess a solid explanation on what happens in that disease? In contrast, Western medicine has its explanations, which are validated to a great extent by scientific methods. In addition, it has a mighty support from the continuous and incessant research, which repeatedly tests the accuracy of its principles. As a result, Western medicine almost always explores the root causes of diseases and treats those causes. In Western medicine, most of the drugs have well-established documentations about what they do to the body (pharmacodynamics) as well as what the body does to the drugs (pharmacokinetics). Such understanding assists to target the treatment towards the cause of the disease. .
Properly trained and qualified practitioners of Western medicine do not treat the symptoms as the primary objective except in a few cases. Doctors do not prescribe just for the symptoms such as fever, cough, chest pain etc. Doctors listen to the symptoms of the patients, elicit the physical signs, formulate differential diagnosis, request relevant investigation (when they are needed to confirm the diagnosis) and start the treatment targeted towards the diagnosis. When, the diagnosis cannot be established on clinical grounds per se, they will start the treatment targeted towards the most probable diagnosis until the investigation reports are available. If a patient presents with cough, a properly trained doctor will not just prescribe a medication to suppress the cough. Instead, the doctor will establish a diagnosis as to why the patient developed the cough and will specifically treat the cause. For an instance cough may be due to bronchial asthma, tuberculosis, pneumonia etc. Of course, in some life threatening conditions and certain complicated cases doctors will have to attend to the presenting symptoms and signs initially and to treat the cause later. But still the focus is on correcting the cause of the disease. A person, who just utters false-statements that Western medicine can only treat the symptoms, exhibits his hopeless ignorance and ideological antagonism towards Western medicine. Perhaps, such a myth is due to superficial interpretation of what laymen see i.e. a patient consulted a doctor for cough and the doctor gave a medicine that relieved the cough.
3. Ayurveda and indigenous medicine can treat the diseases that cannot be treated by Western medicine.
This is also a false premise. In medicine, there are diseases that can be cured (such as pneumonia or cellulitis); there are diseases that cannot be cured but can be controlled (such as diabetes mellitus or hypertension); there are diseases that cannot be cured or controlled once you get them (such as rabies). Certain diseases that cannot be cured at present, may be cured in the future due to the on-going research in Western medicine.
There are many diseases that may resolve without any specific medical intervention (according to some estimates, such diseases may account for about 25% of all cases). For an instance, most of the viral infections do not have a specific treatment. They resolve on their own in the natural course of the disease. What doctors do is to look after the patients until the recovery, giving attention for the possible complications and other associated conditions. People who have the wrong idea that the treatment of a disease is just to administer several drugs or other substances, may perceive such watchful waiting as a lack of treatments. If a patient who suffers from such a disease is taken to an indigenous practitioner, there is a high probability that the patient may still recover irrespective of the treatment. People who do not analyse this sort of cases are tempted to conclude that indigenous medicine cures the patient!
There are some diseases that take time to recover such as fractures and strokes. It takes several weeks to months for fractures to heal. After assessing for the complications and the extent of the fracture both clinically and radiologically, doctors treat them accordingly. The principle is to reduce the fracture according to the fracture mechanism, to align bones properly and to stabilise the fracture until it heals (for which purpose Plaster of Paris casts are placed in some cases). Once the patient is sent home, he/she may consult an indigenous practitioner such as the one my old colleague has mentioned in his article. If the patient is lucky, he/she will survive the additional trauma inflicted by the indigenous practitioner. The fracture will heal naturally in such cases (but in most cases, patient’s fracture will be complicated by inappropriate manipulation). When the fracture heals, people conclude that it is cured by indigenous medicine! A similar scenario can be observed regarding strokes. Most patients improve the disability with physiotherapy following strokes. When the patient is sent home after arranging regular physiotherapy, the relatives may take the patient to an indigenous medical practitioner. What the practitioner does, is to apply oil and continue the physiotherapy until recovery. People conclude that the stroke is cured by indigenous medicine!
There is no scientific evidence that indigenous medicine has cured fatal diseases such as rabies or disseminated malignancies (cancers that have spread to several parts of the body) for which there is no cure in Western medicine. There may be anecdotal reports based on cock and bull stories, however there are no scientific case reports available.
Of course, there are many diseases, which cannot be managed by Ayurveda or indigenous medicine. What can Ayurveda or indigenous medicine offer for the treatment of acute myocardial infarction (“heart attack”)? What can Ayurveda or indigenous medicine offer for the treatment of bacterial meningitis (a serious bacterial infection of the coverings of the brain)? What can Ayurveda or indigenous medicine offer for the management of diabetic ketoacidosis (a serious complication of type 1 diabetes mellitus, which needs treatment with insulin)? Answer is: “hardly anything effective”!!!
If Ayurveda and indigenous medicine can cure such fatal diseases, the practitioners and scholars of such disciplines should publish them in proper ways. If the Ayurveda and indigenous medicine have treatments superior to what we have in Western medicine, the practitioners and scholars of such disciplines should statistically prove that superiority. Just a mere difference, which is statistically insignificant, is most likely to be due to chance.
To conclude our lengthy discussion let me suggest that you do not risk your own life by pursuing the treatments of unproven effectiveness. The Morris Minor was a superb car in the past. But should you go for an old Morris Minor, when you have Toyotas, Nissans and Hondas with more advanced locomotive technologies readily available at present?
My old colleague should be appreciated for bringing a vital topic into discourse. I hope that I wrote nothing for which I would be penalised on charges of blasphemy to the most celestial entity of my old colleague!