RESHAPING HEALTH CARE

International Consultation on Medical Anthropology and Alternative Systems of Healing

Some Conclusions and Recommendations

Contents

1. Introduction
2. The evolution of western culture and western medicine
3. The present and future of traditional systems of healing
4. What constitutes valid evidence for efficiency and safety of any system?
5. Recommendations

1. To National Governments
2. To the World Health Organization and other UN agencies
3. To the general public and to the voluntary agencies
4. To corporations, insurance companies etc.
5. To the Media

I. Introduction

The International Consultation on MEDICAL ANTHROPOLOGY AND ALTERNATIVE SYSTEMS OF HEALING brought together some 50 healers and thinkers from various countries including USA, Germany, Japan, New Zealand, Russia, India, Oman and Tibet for a one-week consultation at the Hotel Raj Hans, Surajkund, Haryana (near New Delhi), India from February 20th to 27th, 1995. The Consultation had four major objectives:

• to make a preliminary assessment of the views of reality and perceptions of what constitutes a human person as implied or expressed in various healing systems developed by different cultures of the world. This, rather than any particular academic discipline, is what was meant by the term "medical anthropology";

• to make a cursory examination of the development of modern western medicine and of the reasons why more and more people are turning away from the western medical system of Allopathy and resorting to Traditional Healing Systems or to Homeopathy for their health care needs;

• to make an assessment of the state of Traditional Healing Systems and Homoeopathy, and explore ways and means to make the immense wealth of these rich traditions more easily and effectively accessible to people;

• to suggest changes in existing patterns of health care, and to make other suggestions and recommendations to governments, to healing-related private sector enterprises, to the healing profession, to voluntary organisations, and to the general public.

We had the benefit of a rich input in the form of presentations, demonstrations and discussions. The free consultation clinics for the public, which ran for three consecutive afternoons from the 23rd to 24th in Ayurveda, Unani, Homoeo­pathy, the Japanese system of Jorei, Naturopathy, Yoga, Tibetan Medicine, Russian Traditional Medicine, Pranic Healing, High Genki, Acupressure, and Massage techniques were utilised by participants as well as by hundreds of visitors from Delhi and Haryana. Participants thus had an opportunity to observe the actual practice of Traditional Healing Systems and Homoeopathy, in addition to some highly informative presentations on the various healing systems. They also saw how widespread was the public interest in these traditional healing systems and homoeopathy. 

In his erudite inaugural address, the Government of India's Minister of State for Health and Family Welfare, the Hon'ble Dr. C Silvera said, 

"As a system Allopathy has its own plus points. But it has certain obvious pitfalls as well. The cost factor, non-availability to a vast majority of the people, hospital-induced illnesses, overuse of chemicals in pharmacopoeia and prescriptions, indiscriminate use of anti-biotics, the over-technologisation of both diagnosis and therapy, and consequent impersonalisation of healing are some of these. " 

The Minister announced that "very soon a separate Department for Indian Systems of Medicine and Homoeopathy will be created under the Ministry of Health and Family Welfare". This new Department will seek among other things: 

The Minister continued to stress the drawbacks in the present situation, including the inadequate level of training administered in colleges for these systems, their insufficiently developed theoretical framework, practice by healers of substandard training, tonics and patent medicines not conforming to standard or even to the labels. He said: 

"However, there is no gainsaying the fact that we need to enforce stricter standards than is presently the case. Let me assure you that this is an issue to which my Ministry will address itself with all seriousness".

We were served a rich feast of knowledge and wisdom in the form of papers and presentations, including the Presidential Address of the Co-chairperson, Prof. R M Verma, former Director of the National Institute of Mental Health and Neurological Sciences, the incredibly rich keynote address by Prof. Srinath Reddy of the Department of Cardiology of The All India Institute of Medical Sciences, the thought provoking addresses by Prof. Manmohan Singh of Southern Illinois University School of Medicine, Prof. J S Neki, the leading Indian Guru of Psychiatry and Psychosomatic Medicine and many others. The skilful chairing and the many wise and insightful interventions of our distinguished, learned, and inspiring Co-chair Dr. Paulos Mar Gregorios have been a major factor in the incredible success of the Seminar in opening up new vistas and providing comprehensive visions of cosmic as well as historical reality. Leading intellectuals like Smt. Kapila Vatsyayan, Sri Chaturvedi Badrinath, Prof Anil Gupta and others enriched the discussion by their responses to the main addresses. 

Participants expressed their deep satisfaction that such a pioneering seminar was held at such an opportune time and in such a comprehensive manner, and they congratulated the organisers for this timely and richly rewarding effort.

II. THE EVOLUTION OF WESTERN CULTURE AND WESTERN MEDICINE

Some understanding of the transition of Europe from the Medieval Christian (Roman Catholic) culture to the Modem Secular culture is necessary if we want to come to terms with what looks like an apparent conflict between Modern Western medicine on the one hand and Traditional Healing Systems and Homoeopathy on the other.

Medieval Christendom (ca 800 to ca 1800) was, at least on the surface, a homogeneous religious culture, with the authority of the Church (after the Protestant Reformation of 1517ff, of the Church and the Bible, but still of some form of western Christianity) ruling supreme at least in theory. Enormous socio-economic and anti-clerical conflicts simmered under the calm looking surface of a society which had suddenly become affluent, through trade, piracy, colonialism and imperialism. The old structures of a feudal society was already coming apart at the seams, with the advance of the Industrial Revolution and the rise of the bourgeoisie as the newly dominant class replacing the feudal barons and nobles.

It was in this context that in the 18th century Europe and later in America, a process called "Secularisation" spread, overthrowing the control of the Church over property, ideas and institutions, including medical and educational institutions run by monks and priests - the 13th century medical schools in Salerno and Montpelier, Paris and Bologna, Padua and Leiden. Great theological and spiritual Masters like the monk Roger Bacon and the abbot Albertus Magnus (teacher of Thomas Aquinas) were also great physicians. Other great healers were attached to Popes and Kings. Secularisation took medicine away from the Church and the monks, and established the foundations of a medical system without conscious grounding in any religious world view.

The decisive event of this process was what we call the European Enlightenment, one of whose great symbols was the French Revolution in 1789 with its slogan of Liberty, Equality and Fraternity, directed against the Church's domination, inequality and paternalism. The European Enlightenment of the 18th and 19th centuries boldly asserted the freedom and autonomy of the individual, against the unfreedom and theonomy or heteronomy of religion and tradition. In pre-18th century European Christendom, religious notions like the Kingdom of God provided the basic framework for unifying all experience. This religious authority and tradition was what Secularisation and the Enlightenment totally and completely repudiated as an affront to the freedom and autonomy of the human person.

The unifying principle of all experiences was no longer to be supplied by religion or tradition; human reason was its own authority over which the Enlightenment would acknowledge no higher authority. Human rationality was capable of grasping reality and transforming it to serve humanity's interests. It was in this milieu that modem science and technology were born; modem western medicine, based on science and technology, was also born in this matrix of repudiating all authority outside of human rationality, rejecting practically all agencies except human agency. Science, the major instrument of human rationality, and technology as tool for human control of the world, together became now the unifying principle of experience. What was not knowable by the methods of science was not knowledge. Everything that needs to be done can somehow be accomplished by technological know-how.

This meant also the marginalisation of art, philosophy, and religion as knowledge gathering and communicating symbol systems. The new Positivist Philosophy, articulated by Auguste Comte, affirmed that all European knowledge, and therefore by extrapolation all human knowledge, has passed through three progressive stages of development: the theological/religious, the philosophical/metaphysical, and finally the scientific/positive. Only the last was true adult knowledge because it was not dependent on any external authority. The theological/religious belonged to the infancy of humanity, and the philosophical/metaphysical belonged to humanity's adolescence. The adult, in order to affirm his/her own freedom and authority, must abandon what belonged to the child and the adolescent.

   For western science, till recently, Traditional Systems of Healing belonged to that childhood or adolescence of humanity, and are to be assigned to the outer margins of civilised society, where people live without modem education and scientific thinking, and therefore without the benefit of the European Enlightenment and its rationality, such as in non-western cultures and in the lower uneducated classes of western society. If anything in these Traditional Systems of healing is to be accepted by adult, free human beings, they have to be tested on the anvil of scientific rationality and experimental validation.

We should acknowledge the fact that modern western medicine, even when based on the Cartesian-Mechanistic-Reductionist model, has enormous successes to its credit. It has liberated humanity, at least in some measure, from its fear of unknown and unknowable external or internal forces like superstition, fatalism, karma, and demonic agencies. It has overcome epidemics and contributed to longer life expectancy. Many diseases, previously thought incurable, have been brought under partial control.                                       

Allopathy acknowledges, at least in theory, its origins in Hippocratic thought and practice. It has, however come to neglect some of the main themes of Hippocratic medicine: e.g., health as a state of balance, the importance of environmental influences, body mind interdependence, nature's inherent healing power. Instead it chose the Cartesian model, which is dualistic, reductionist and mechanistic. It separated body and mind, assigning the body to physicians and surgeons, and the mind to psychiatrists and psychoanalysts. It saw the body on the analogy of a machine composed of different parts, and attributed disease to organ dysfunctions or invasions by bacteria which had to be exterminated. Diagnosis and therapy were based on simplistic single cause explanation, leading to treatment of that single cause. This single cause effect understanding was reinforced by developments in laboratory medicine and medical technology. The cost of treatment arose enormously as medical technology advanced. There was failure to recognize fully the inter-dependence of body-mind-environment, and to understand the human person as subsisting only in relation to various other subsystems which affected illness and wellness.

The system was tardy in recognising and nurturing the inherent healing powers in nature and in the human body. Excessive use of anti-biotics led to unexpected consequences like reduced resistance to disease, enfeeblement of the immune system, and the rise of strains of new bacteria resistant to all known antibiotics and hence as lethal as AIDS. The pace of increasing sophistication and complexity in diagnostic technology not only raises health care costs to exorbitantly high levels, but also progressively marginalises the physician patient interaction, so essential to health and healing. The proliferation of often unnecessary chemical drugs, combined with the overuse of chemical fertilizers, pesticides, food preservatives and detergents, increases toxicity in the human body and lowers the general health level of people. We note that in certain countries some pharmaceutical companies, insurance companies, and some medical professionals together constitute a highly exploitative and unjust "health business". These are factors that urgently call for remedy and rectification in western medicine.

At the same time there have been many positive developments in the theory and practice of modern western medicine. The growth of epidemiology as a discipline and public health as a service have led to a better recognition of the multifactorial and interactive approach to illness and health, taking social, environmental and even cultural factors into account. The emphasis on preventive medicine, on community health delivery, and the "health for the millions" approach have helped broaden out the perceptions of western medicine into nutritional practices and environmental factors. The new emphasis on "life-style related diseases" helped the understanding of heart diseases, cancer, diabetes, mental illness and other stress related disorders. The role of diet, exercise and relaxation techniques is now better recognised. Socio-economic deprivation as a major contributor to ill health, links health care today with the wider aspects of the political economy. The recent emergence of 'evolutionary epidemiology' draws attention to the fact of cultural change and the consequent erosion of the protective practices of the old culture as a major cause of ill health and epidemics.

Technology itself has helped in the unravelling of the complex interplay of myriad interdependent systems in the body and in the world, from cell to cosmos, which keep a person healthy. Psychosomatic medicine and Psychoneuroimmunology emerging as new inter-disciplinary systems of knowledge and the emergence of bio­feedback technology, have revealed how the mind and will affect the body through neuro­humoral influences and by mental states.

There is a growing recognition of the role of faith and spirituality in health and healing. The power of prayer to heal is now well documented.

All these combine to initiate some radical changes in modem western medicine, bringing it closer to the reality perceptions of the Traditional Systems of Healing. There is a new paradigm emerging -- one that integrates the physical, mental, environmental, social, and spiritual domains. Its articulation is progressing very slowly; the conception itself is still in evolution. Medical Anthropology, or our understanding of how the human person functions in relation to the rest of the universe calls for clearer formulation, incorporating the role, not only of science, but also of art, philosophy and religion, in health and healing.

As this paradigm shift grows to maturity, we can expect a creative regeneration in modern western medicine. This process will not take place independently of a better understanding of and cooperation with Traditional Systems of Healing; it will also facilitate that necessary understanding and cooperation in the interests of the health and  of the well-being of the whole of humanity.

III. THE PRESENT AND FUTURE OF TRADITIONAL SYSTEMS OF HEALING

It is by no means easy to produce an exhaustive list of the Traditional Systems of Healing. We want first to suggest that we abandon the use of the term "Alternative Systems of Healing". It seems to imply that one system, namely Allopathy, is normative and the others are simply alternatives. 

When we speak of "Traditional Systems of Healing (TSH)" we mean the traditions of healing and health care of all cultures -- of China and Japan, of India and Tibet, of the Arab World, of Europe and the Americas, of all of Africa, Asia, Australia and New Zealand. We should include Homoeopathy, though it is rather modem in origin. We also include a plethora of newly emerging healing systems such as Pranic Healing, Jorei, High Genki, Reflexology, Magnetology, Cheiropractic, Osteopathy, Cranio-Sacral Therapy and so on, all of which seem to have some roots in Ancient Traditions.

 We note the growing recognition of TSH by Allopathy, and the selective and partial incorporation of some of its techniques into Allopathic medicine as an adjunct to it. This is not what matters, however, from the perspective of the people's health needs. We are convinced that the resuscitation and promotion of Traditional Systems in their own right is absolutely necessary for the welfare of humanity; we affirm that we cannot begin to meet the health needs of the whole of humanity without the aid of TSH.

The TSH have a claim for preferential treatment, because

It is a fact however that TSH have been surviving for the past two hundred years on the margins of public life. The European Enlightenment and its secular civilisation banished them from the official public arena, along with all tradition and all religion. Allopathy which conformed to the standards of western science took over the centre of the public health care system.  

No marginalized community can live and flourish normally; this is true for women, for Adivasis and aboriginals, for blacks and native Americans; it is also true for religion, which has not done well in the past two hundred years as compared to earlier periods. Traditional Healing Systems were cast out along with the religions which were their matrix.

Prolonged marginalisation distorts everything; TSH are no exception. The State gives primary attention to the Allopathic system, casting an occasional crumb from its sumptuous tables to the household pets of TSH. Their potential is not recognised or sufficiently utilised in primary health care or in hospitals and systems of training medical and paramedical personnel. With the waning of State recognition and support, some people lose confidence in their own healing traditions. Allopathic physicians and nurses, by virtue of their training school education, tend to look down upon the practitioners of TSH. On the other hand there is a groundswell of new demand for these Traditional Systems on the part of people everywhere. Their respect for these systems is growing.

What should we do to bring these TSH back to life and help them fulfill their true function? First, we need to do certain things both for TSH and also for Allopathy:

A major problem in relation to TSH was that of standards for training practitioners and their licensing or accreditation. The traditional method in these systems is apprenticeship or guru-sishya parampara or handing over the knowledge from teacher to disciple, in a system where theory and practice are never separated. This system is difficult to practise on a large scale, when there is need for thousands of practitioners to bring health care to the people.

Training in TSH therefore can be best achieved in small scale participatory teacher student patterns in the setting of local cultures. However large scale colleges for Ayurveda, Homoeopathy, Unani, Siddha, Naturopathy, Yoga therapy, Chinese Medicine and other systems are already in existence. These institutions now seek to imitate the pattern of Allopathic medical schools; sometimes even the subjects and text books of Allopathy are utilised. The end result is major distortions in the authenticity of the TSH.

One thing we notice is that each system remains in isolation. The practitioner of one system knows very little about other systems. This defect should be remedied at the training stage itself, by short courses of exposure to other systems, preferably in the latter's clinics and institutions. The curriculum of Allopathic medical schools should definitely include such exposure to TSH. But the same has to be done in the training programme of each Traditional System as well.

We saw the need for culturally adapted multi-system healing centres in all countries and all regions of each country. Some of the existing clinics and hospitals could incorporate more systems into their present structure. The multi-system centres could be designed in such a way that there is creative interaction between the various systems. A multi-system diagnostic team could screen each person coming for healing, and assign a suitable programme of treatment in one or more systems, according to need and preference. It is desirable that large buildings are avoided, regimentation reduced to a minimum, and convivial living conditions provided for all, preferably in open country, in sylvan settings where possible, plenty of gardens and open spaces provided, with flowing streams and winding lanes, and clubs and cafes for creative interaction among patients and healers. Costs have to be kept as low as possible, so that ordinary people can benefit from them. State and private sector subsidies should be sought and utilised, especially to help the poor.

These centres can also play a central role in gathering information and establishing a data base about the efficacy, safety and cost of the various systems. They could besides serve as internship hospitals for trainees in various systems. In some cases these centres can also undertake or promote research in the various systems. They can also serve as referral centres for patients from other centres. Such centres can co-operate with other similar centres, so that each can learn from the other.

One question which seemed central is the extent to which the standards of modem science should be applied to the testing of Traditional Systems.

IV. WHAT CONSTITUTES VALID EVIDENCE FOR EFFICACY AND SAFETY OF ANY SYSTEM?

It is clear that all healing systems should be tested for their efficacy and safety. This applies to the Allopathic system as well. We were told of the Weinberg study, according to which only 20 % of the cures effected in allopathy can be attributed to the treatment applied, 30% is placebo effect, 25% due to some form of catharsis, and the remaining 25 % due to what is called the X Factor, which may include faith and prayer. Whatever be the validity of this report, it is clear that strict laboratory evidence cannot be obtained for all these factors involved in healing. In the case of all systems, whether Allopathy or Traditional, the following principles can guide our thinking about efficacy and safety.

V. RECOMMENDATIONS

 We address our modest suggestions and recommendations to governments, intergovernmental bodies,  voluntary agencies, inter-national Non-governmental Agencies, Corporations, Insurance companies,  professional healers, the general public, and to the communications media.

A. TO NATIONAL GOVERNMENTS

1.  Many governments recognize only a few select Traditional Healing Systems for support and promotion; we recommend that they should seek to be as inclusive as possible, and not to neglect the scores of systems now coming back to life, including traditional Chinese, Japanese, Tibetan, Native American and Indian systems, as well as the newly emerging systems like Cranio-sacral therapy, Macrobiotics, Reflexology, Magnetology and so on. Governments directly or through other public bodies should evaluate and assess by appropriate methods the efficacy and safety of all systems, and take into consideration their easy availability to people as well as cost factors.

2.  In setting up or supporting high quality training centres for the various systems, special attention should be given to the culture-specific ambiance of each system. Most traditional systems do better in small scale settings and rural conditions. Since their future participation in nation-wide health programmes is in view, the urban setting is often uncongenial.           

3. Governments should promote or establish testing facilities and centres appropriate to each system for the continuing monitoring of quality and standards of pharmaceuticals and other medical products in traditional systems. No product should be sold in the market without certification of quality.

4.  Governments should set up or promote high quality multi-system healing centres, where there is coordination and continuous interaction among the various systems. These new institutions should be centres of comparative study, of multi-system treatment, evaluation, standard-setting for accreditation, documentation and research, for Traditional Systems of Healing, Homoeopathy, and Emerging New Systems.

5.  Governments should fund and promote research in Traditional Healing Systems, using also the multi-system centres and testing facilities. Research in TSH, when attached to Allopathy-dominated institutions should not remain at the margins of the programme of such institutes, but should promote continuous interaction among THS and Allopathy.

6.  Governments should legislate for proper monitoring of THS products and for the licensing and registration of TSH practitioners. Norms of training and qualification should be established and strictly implemented, suitably disciplining violators and mal-practitioners. Governments should also pass and enforce appropriate legislation to regulate the large scale export of the herbal resources of the country.

B. TO THE WORLD HEALTH ORGANISATION AND OTHER UN AGENCIES

1. The World Health Organisation (WHO) should initiate effective programmes for the comparative study and assessment of the world-wide use of Traditional Healing Systems, Homoeopathy and Emerging New Therapies, which are all already playing a major role in the health care of the people.

2. WHO should support the setting up of a World Association of Traditional Healers, on the patterns of the existing CIOMS which brings together national health associations. To this end the WHO should encourage member governments who have not already done so to set up national associations of traditional healers in each country.

3.  Other UN agencies like UNICEF and UNDP should take into account the role of Traditional Systems of Healing in supporting development programmes and projects, and especially in caring for the health of infants and mothers.

4.  WHO should take initiatives to promote creative interaction between Allopathy and Traditional Healing Systems, as well as to promote the recognition and use of TSH in all countries, in order to fulfill its own commitment to "Health for the Millions by the Year 2000" (Alma Ata Declaration, 1978).

C. TO THE GENERAL PUBLIC, AND ESPECIALLY TO VOLUNTARY AGENCIES AND NONGOVERNMENT ORGANISATIONS, NATIONAL AS WELL AS INTERNATIONAL, IN THE FIELD OF HEALTH DELIVERY AND CARE. 

1.  High Priority should be given to awareness building among the general public, first about the basic factors contributing to human health and well-being (Health Awareness Programmes), and secondly about the existence, efficacy and availability at low cost of Traditional Healing Systems.

2.  Every effort should be made for maximising the use of THS in primary health care and in urban and rural health delivery systems.

3.  Support should be given for the starting of multi-system healing centres in urban and rural areas.

4. A meeting of all voluntary organisations and NGOs working in the field of health should be convoked to consider ways and means of promoting THS.

5.  Take initiatives for setting up international and national non-governmen­tal bodies to promote THS, and for the networking of practitioners.

6.  There is urgent need for a manual of Traditional Systems of Healing, Homoeopathy and Emerging New Systems, with brief introductions to some 20 of the most important systems (about 20-25 pages for each discipline) among these, choosing those with proven efficacy, easy availability, and low cost. The essays must be competently written by experts in each field, with a view to being used as a textbook in all institutions of medical training, allopathic, traditional or new. Perhaps a two-volume edition, affordable, should be made available also to the general public.

D. TO CORPORATIONS, INSURANCE COMPANIES AND OTHERS

1.  We recognised the fact that economic power to effect some of these measures was not primarily in the hands of governmental bodies. We saw the positive role that private sector corporations could play in promoting universal health care making maximum use of Traditional Systems of Healing, Homoeopathy, and the Newly Emerging Systems of Healing. Their economic power and organisational resources should be optimally used to promote TSH. This is particularly so, in the context of increasing privatisation of medicine and healing, and the entry of corporations into large scale manufacturing and marketing of pharmaceuticals for TSH.

2.  We felt the need for the corporations, in consultation with public interest bodies and persons, formulating a code of conduct to be observed by all private sector enterprises in the field of health and healing. Such a code should give priority to the interests of the public and only secondarily to the conventional private sector interest of profit and power. The corporations should pledge themselves not to engage in the manufacture or marketing of any products or services harmful to the health and well being of the people, or beyond the means of ordinary people.

3.  The Corporations should jointly or individually set up endowments, funds and foundations, for promoting Traditional Systems of Healing, Homoeopathy and Emerging New Therapies, and for maximising their use in the health care of the common people. This would be in the interest of Health Insurance companies in all lands, as the use of TSH will substantially reduce morbidity and mortality. They should set aside and wisely use funds for setting up multisystem centres of healing, research and documenta­tion.

4.  The corporations should take special care to see that the natural herbal resources of countries are not depleted or destroyed by over-exploitation. They should make it a point to ensure that for every herbal plant plucked up two are immediately planted, as is done in afforestation programmes.  

E. TO THE MEDIA -- PRINT, ELECTRONIC, AND OTHER

1.  Health for All is just as important as Food and Clothing for All, or a as part of the movement for a Sustainable Life Environment, and for Peace, Justice, Freedom and Dignity for All. A workable programme for ensuring Health for All must necessarily include the renewal and full utilisation of Traditional Systems of Healing, Homoeopathy, and the Newly Emerging Therapies. We appeal to all media to intensify their efforts to promote public awareness of these systems and to disseminate accurate information about them. We make a special appeal to local language media to highlight these systems and their capacity to prevent illness and promote health.

2.  We appeal especially to teachers, doctors, literary writers, poets, painters, musicians, dancers, and other artists to help in the dissemination of knowledge about the basic principles of health, and to fulfill the potential role of all media in creating greater awareness about the possibilities and advantages of TSH.

3.  We welcome projects to start global media channels and networks which specialise, on a nonprofit, non-commercial basis, in promoting information on Transcultural Health Care, projecting particularly some of the essential sub-cultural aspects of TSH, and drawing special attention also to the spiritual aspects of health and healing.

4.  The Media should promote debate and discussion to bring about better mutual understanding between western medicine and TSH, and to dispel prevailing ignorance and wrong notions.

5. As multi-system healing centres develop all over the world, the media should promote awareness about these centres as a significant move in the advance towards Health for All.