|Year : 2015 | Volume
| Issue : 3 | Page : 123-125
The integration quagmire: Why we need to watch our steps
P Ram Manohar1, Antonio Morandi2, Antonella Delle Fave3
1 Director and CSO, AVP Research Foundation, Coimbatore, Tamil Nadu, India
2 Director, Ayurvedic Point, Milan, Italy
3 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
|Date of Web Publication||18-May-2015|
P Ram Manohar
Director and CSO, AVP Research Foundation, Coimbatore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Manohar P R, Morandi A, Fave AD. The integration quagmire: Why we need to watch our steps. Ancient Sci Life 2015;34:123-5
We step into the year 2015 with important developments at the editorial office of the journal. We are happy to announce the setting up of the International Editorial Office of Ancient Science of Life (ASL) in Europe. This is a significant milestone in the journey of ASL in networking with and engaging scientists, academicians and practitioners to further the dialog and scientific debate on integrating and positioning Ayurveda in the global health care scenario. The International Editorial Board of ASL is constituted by a group of high profile academicians from diverse backgrounds. Heading the editorial office is Antonio Morandi, MD, a successful Neurologist from Italy who now practices only Ayurveda. He brings with him a rich experience of insights in interfacing Ayurveda and conventional medicine. The board composes of eminent personalities such as Daniel Furst, MD, who is an accomplished rheumatologist from the University of California, Los Angeles, United States and was the lead investigator in the first ever National Institutes of Health (NIH) funded clinical trial to evaluate the efficacy of Ayurvedic treatment of rheumatoid arthritis. Nereo Bresolin is a renowned Neurologist at the University of Milano, Italy and is currently involved in a study to evaluate the efficacy of Ayurveda in Duchenne Muscular Dystrophy. Valdis Pirags MD, is Diabetologist at the University of Latvia and is presently engaged in a study evaluating the efficacy of Ayurvedic treatment in Diabetes mellitus. Antonella Delle Fave, MD is Clinical Psychologist at the University of Milano, Italy and also trained in Ayurveda. She has looked at the concept of the constitution in Ayurveda and its clinical assessment. Vijayendra Murthy, MD in Ayurveda is based in London and is engaged in CAM research and teaching of Ayurveda in New Zealand and Australia. Anand Dhruva, MD is an Oncologist at University of California, San Francisco, trained in Ayurveda and engaged in research on breast cancer and Ayurveda. Paolo Roberti di Sarsina, MD, is Chairman and founder of the Charity Association for Person Centered Medicine. Carlos Chesta, MD is engaged in teaching and research on Ayurveda at Rosario Argentina and Jorge Luis Berra, MD is also engaged in Ayurveda teaching and research at Buenos Aires, Argentina.
In the country of its origin, Ayurveda is witnessing some unprecedented developments. For the first time in the history of modern India, we have a separate Ministry to regulate the Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) sector.  There is an earnest attempt to bridge the gap between conventional medicine and the AYUSH systems, with an emphasis on enhancing the scientific credibility and acceptance of the AYUSH medical systems. In the valedictory session of the 6 th World Ayurveda Congress, the Prime Minister of India pointed to the need for setting the house in order to bestow on Ayurveda a wider presence in the global scenario through scientific publications. 
In spite of these encouraging developments, there is hue and cry from the representatives of the mainstream medicine who unfairly lament that wrong priorities are being set to propagate healthcare practices that have no scientific backing. They point out that if AYUSH systems are promoted, a collection of untested, doubtful and potentially harmful medicines and interventions will masquerade as authentic medicine and threaten public health. 
The situation in India mirrors the state of affairs in the western countries, which have been witnessing an emergence of the so-called Complementary and Alternative Medicine (CAM). CAM practices are becoming widespread and popular albeit for very specific diseases. With visits to CAM practitioners increasing in numbers and people paying out of pocket to meet related treatment expenses, health care regulators were forced to take stock of the situation and examine the validity of CAM practices.  The response has been varied. Sceptics have outrightly dismissed CAM practices as a new incarnation of those peddling snake oil and sham therapies that deserve no better place than the trash can. For example, in the USA, the establishment of the Office of Alternative Medicine (OAM) sparked strong criticism and uproar in the field of mainstream medicine. Nevertheless, OAM survived and became the National Centre for Complementary and Alternative Medicine (NCCAM). However, the existence of the NCCAM has been repeatedly questioned, and there has been pressure to bring higher legitimacy to the activities of the NCCAM.
There are the advocates of a single system of medicine, who do not accept CAM. According to them, there is but one medicine, the medicine that works. Such an approach implies the denial of the very notion of CAM. It is based on the assumption that anything or everything worthwhile in CAM should be part of conventional medicine anyway if they stand the test of scientific scrutiny. Although this approach acknowledges the possible usefulness of at least some of the CAM practices, it completely neglects the epistemological framework and conceptual differences that underpin these practices. Even the word "complementary" was added to alternative medicine to show that alternative medicine would complement rather than replace conventional medicine.
In the last decades, the words "integrative" and "integrated" are slowly replacing terms like alternative and traditional medicine. For instance, the US NIH renamed the NCCAM as National Centre for Complementary and Integrative Health (NCCIH).. 
However, for the skeptics, the word Integrative is just a clever use of language to give a sense of legitimacy to CAM. In their vocabulary, there is no space for anything other than "science-based" conventional medicine.
The proponents of integrative medicine, on the other hand, claim that it works by taking the good stuff from so-called CAM and integrating it into mainstream medicine with the backup of science. In the process, conventional medicine expands its perspective to look at the patient as an integrated whole of the body, mind, and self. 
As a matter of fact, integrative medicine contributes to the process of assimilation of CAM into mainstream medicine. While it is very desirable to have scientific backing for CAM practices, it would be disastrous to force fit these methods of healing into the scientific framework without considering their epistemological background and origins.
Much of the richness of Ayurveda would be lost in any process of assimilation into conventional medicine. Therefore, there is a need to look at integration from a fresh perspective, without the pressure of having to conform to the established norms of conventional medicine. We believe that such an exercise can be done without compromising good science. However, this calls for a willingness to acknowledge and accept the conceptual and epistemological peculiarities characterizing different approaches to health care. This would mean, for example, adoption of research methods that are better suited than the conventional ones to evaluate complex systems of medicine like Ayurveda.
We often hear Ayurveda being accused of not having scientific evidence to back its claims. However, we fail to enquire whether sufficient efforts have been taken to generate such evidence for CAM systems including Ayurveda. There is hardly any support for research on Ayurveda. With less than 4% of the healthcare budget allocated for the entire activities of the AYUSH sector, negligible funding is left for research. Therefore, we can see that Ayurveda is being challenged not because of negative evidence against it, but because of lack of evidence. Outright dismissal does not solve this problem. Rather we have to take steps to generate evidence using methodologies that adequately address the complexity of Ayurveda.
What we need is an approach of integration that will allow for the co-existence of different medical systems. We need a system of integration that will allow practitioners of different medical systems to collaborate in executing health care interventions in the interest of the patient. In order to bring such collaboration into practice, we need to nurture collaboration in education, as well as research.
In September 2014, an International Scientific Network was constituted during the International Research Seminar on Ayurveda held at European Academy of Ayurveda, Birstein, Germany to serve as a think tank and facilitate the development of a collaborative approach to interface Ayurveda and biomedicine. 
India could serve as a crucible to nurture such a collaborative approach to integrative medicine because of its pluralistic health care system, which has officially recognized the individual identity of different medical traditions under the AYUSH stream. During the 6 th World Ayurveda Congress Antonio Morandi discussed about a collaborative approach to medicine and science. The Ancient Science of Life (ASL) will take up this topic for discussion and continue the debate in the future issues.
| References|| |
Valedictory Address at 6 th
World Ayurveda Congress by Prime Minister Narendra Modi. J Ayurveda Integr Med 2014;5:201-4.
Witt CM, Barth J, Canella C. The future of complementary and integrative medicine research - International Perspectives. Forsch Komplementmed 2015;22:125-7.
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