RESHAPING HEALTH CARE
International Consultation on Medical Anthropology and Alternative Systems of Healing
Some Conclusions and Recommendations
February 26, 1995
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:
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.
(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.
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
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.
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
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.
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.
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
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.
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
The TSH have a claim for preferential
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.
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
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.
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.
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
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.
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
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.
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.
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
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.
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.
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
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,
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.
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
effort should be made for maximising the use of THS in primary health
care and in urban and rural health delivery systems.
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.
initiatives for setting up international and national non-governmental
bodies to promote THS, and for the networking of practitioners.
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
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
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.
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.
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,
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.
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.
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.
.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.