Self immolation or cannibalization, the ISM suffers the worst from cross-pathy

The question of the institutionally qualified Siddha private practitioners prescribing allopathic drugs is legal or illegal is in the medical realm ever since independence. The issue would come up for discussion and debate only when an untoward incident is reported due to the prescription of a wrong allopathic drug by a Siddha clinician. Soon the public outcry would settle and the Siddha clinician who had been prescribing allopathic drugs swiftly reverts back to allopathic practice, albeit legally and or illegally.

The Siddha System of Medicine and its fundamental approaches towards the health care, if the Siddha private practitioners remember and follow, the question of their right and legitimacy for prescribing allopathic medicines would never arise.

The Siddha System of Medicine primarily focuses in correcting the imbalances in the human system and thereby brings about the wellbeing. The Siddha System only rarely use the words ‘treatment’ or ‘cure’ of a disease, rather they go by the approach of restoring the health and wellbeing of the patients. They always approach the problem holistically than seeing the problem in isolation. Their approach is so natural, blend with nature and always go with nature. That is why they consider even ‘food as medicine’ Unavae Marunthu. The Siddha clinicians those who have not understood and believe in this strong philosophy and tenets of the time tested Siddha System of Medicine are the ones who prescribe allopathic drugs and destroying the system as inferred from the statement of Dr Thyagi, former President of CCIM.

The present day generation suffers a lot of health problems more due life style changes than due to any other reasons. Diabetes mellitus, obesity etc., are some of the best examples. For treating life style associated health problems, more than treatment, Siddha intervention is desirable. Siddha System of Medicine and Siddha Clinicians has lot to offer and contribute to the health problems of the present generation.

But unfortunately, it appears some institutionally qualified Siddha private practitioenrs instead of having self belief and belief in the ancient system of medicine that they have studied (BSMS, MD-Siddha), are going after prescribing allopathic drugs.

Right versus Righteousness

When some institutionally qualified Siddha private practitioners fight for their right to prescribe allopathic drugs, one has to view it from different angle. Despite having qualified with BSMS and or MD in Siddha, they look for allopathic drugs means, they lack sufficient knowledge in the fundamentals of the system of medicine they have studied. What they have studied for 5-7 years is not clear to them means, what would be the fate of patients if such Siddha doctors are allowed to prescribe allopathic drugs? Who would suffer the worst? The patients and the ‘Siddha System of Medicine only will suffer.

Both the State and Union Government are spending considerable amount of tax payers’ money to support, sustain and develop Siddha System of Medicine. National Institute of Siddha in Chennai, Central Council of Research in Siddha etc., are constituted only for the above purpose.

Even if the Siddha private practitioners are given training to prescribe allopathic drugs, then what would happen to their main stream system of medicine? It may help some Siddha private practitioners to have a harvest from their practice but it will not help either the system or the patient.

Many new diseases, new clinical manifestations etc., needs proper documentation and so is every death. Such epidemiological documentation alone will help the country to understand the changing trends in various health problems and to evolve the right health care policy for our nation. When Siddha doctors are given training in modern pharmacology, what about the diagnosis of the diseases? Diagnosis of the disease by Siddha System of Medicine follows different methods than the Allopathic System. The former (Siddha system) focuses on the predisposing factors – Vatha, Pitta, Kapha (patient specific factors) while the later focuses on the causative factors (aetiology). This would warrant the Siddha doctors to study the diagnostic aspects as well. If such training is also given, then why the nation needs MBBS and Siddha System of Medicine separately?

Anatomy of Siddha drugs – Does Siddha doctors missing the track

In truth, most Siddha drugs can only be used for support therapy to limited number of diseases. However, such benefits need through scientific evaluation. For example, Neelavembu kudineer or Neer kovai mathirai etc., offers only ‘least’ benefit to the problems. The stand alone treatment value any Siddha drugs in general is skeptical. May be, in combination therapy, Siddha drugs may offer some benefit. They may help to restore the health than treating any diseases.

It is like how Insulin and rigorous discipline in diet are equally important for managing the diabetes mellitus. Unfortunately, such distinction is not well understood by many. May be due to the above reasons, some Siddha doctors believe that Siddha drugs are not effective and hence prescribe allopathic drugs as they offer quick relief. Siddha doctors must understand their role that they are for larger interest of the patients than earning. Their role is to offer the best health care practice to the patients based on the individual constitution and need. Only because of some Siddha doctors miss this track and compare themselves with allopathic clinicians, confusion starts. The Siddha System has a significant role in providing better health to the patients than treating the diseases. It is absolutely a paramedical science.

Aspiration versus Acceptance

The aspiration of Siddha doctors in the society cannot be denied. They naturally aspire to have a life as equal to any allopathic clinician. While accepting the aspiration of Siddha doctors, the uniqueness and strength of Siddha System also, the Siddha doctors have to accept. Siddha System addresses the total health and not just the disease.

The educational institutions imparting graduate and MD courses in Siddha System have to educate this philosophy upon their pupils. Unfortunately some Siddha doctors carry low self esteem and self belief as they think Siddha drugs lack curative power. Siddha drugs are supportive (paramedical) in nature and are for restoring the health. If this distinction is understood and accepted, naturally they can meet their aspiration as well. No disease can affect the healthy system. Therefore having healthy system is inevitable to all more than the treatment.

Credence and Believability

Credence and believability should never be based on comparison. Like how every individual human being in the several billion people on earth are unique, the Siddha System is definitely and absolutely different from allopathic system of medicine. When Siddha System addresses the health and wellbeing, Allopathic System offers treatment and cure. Both have to compliment and not conflict, combat or contradict. The credence and believability to Siddha System can be gained only if the institutionally qualified Siddha private practitioners promote, popularize, practice and prescribe Siddha approaches than asking for right to practice allopathic drugs. In the sense, Siddha doctors must remain with their own identity.

Modern versus Ancient

Siddha doctors believe that the society would treat them ancient if they do not adapt to the modern techniques/tools of diagnosis and treatment. A simple touch of the doctor, a gentle talk, knowing and understanding the problems of the patients will offer better treatment than passing the patients straight through CT or MRI Scan or X ray scanning. Most patients want their doctors to listen to their problem than concluding the diagnosis and writing the prescription.

Even the HIV infection to reach the proportion of full blown AIDS takes different time periods according to the constitution of patients. Therefore the same disease does vary in its manifestation from one patient to other. If such subtle differences are understood, sometime even the treatment strategy itself can be made simpler than costly and complicated. The Siddha doctors have to be different and unique in their approach. They should approach the patients through the Siddha doctrine so that they can learn a lot about the health of the patients. Instead of using stethoscope, BP apparatus, use the principle of Noi nidhanam and treat your patients.

Contemporariness only defines what is modern and ancient. For understanding the health problems of the modern world, to know the real health problem of the patient, the Siddha doctors can make the difference at the primary level. Therefore the Siddha doctors must reaffirm their faith in their system first and must pledge to practice only Siddha drugs.

Emergency Care

Most Siddha doctors claim that they ask for the right to prescribe allopathic drugs only when the patients’ life is in danger or an emergency care is inevitable. In any emergency situation, quickly reaching the patient to the hands of an expert is inevitable. Hence, in any emergency situation, the care and treatment by non- experts (whether ISM or Allopathic doctors) should be limited to providing the first aid and quickly the patient must be transferred to the experts where the complete treatment facility is available.

Unfortunately, the definition of ‘emergency’ situation and emergency care are not clearly defined and so are the list of emergency drugs and hence the Siddha doctors who want to prescribe allopathic drugs can easily call even common cold and throat infections as ‘emergency’ conditions under the existing law.

Siddha System has no role to play in the emergency care or treatment. Siddha System of Medicine have only paramedical /supportive role and the main stream of medicine as far as the treatment of any disease is concerned is allopathic system of medicine.

Siddha System offers health and allopathic system offers treatment/cure. If the definition is clear, confusion can be limited, so are conflicts and fights.

Who really cares Siddha System of Medicine?

The one who benefit the most from Siddha System only will care the Siddha System the most. The major beneficiaries of Siddha System are the people who are in the Government establishments like, PHC’s, CCRS. NIS, AYUSH etc.. Naturally they have to speak high about Siddha as they work in Siddha departments.

Unfortunately, this group of people although appears to care the Siddha System a lot especially when they talk, seems to have done little to the system. They have not been able to enthuse and rejuvenate the institutionally qualified Siddha private practitioners to propagate the Siddha System of Medicine and not to prescribe allopathic medicine. If they have done so, the Siddha doctors will not fight for the right to prescribe allopathic drugs.

None of the above Government Siddha institutions have done great research in Siddha and have published even a single research article in top ranking journals like Lancet, Nature, Science, PNAS, EMBO etc.

Government should obtain yearly commitment from the Head of these institutions about what they intent to achieve for the year and must evaluate whether they have achieved it or not. If they have achieved, they have to be shown the door.

Other major beneficiary of Siddha System is the Siddha drug manufacturing and marketing industries. The industry really cares the Siddha System because they make huge revenue from marketing Siddha drugs. Interestingly, still small population in our country believes in Siddha System much more than some Siddha doctors do. Hence, the industry rightly and righteously catches the magic word - ‘Siddha’ and promotes their products. Often the tall claims of the industry are well heard by the ‘believers’ and thereby still Siddha drugs are doing good business for the industry. Only a handful of Siddha products manufacturing companies are doing good research.

Proprietary versus Generic Siddha drugs

Most industries smartly convolute the generic formulations either with an addition of an extra herb or deleting one and would make it ‘proprietary formulations’. Comfortably they use the benefit of the generic claims for promoting the proprietary formulations. When the new norms were introduced by the State Drug Licensing Authority for the issuance of license to new proprietary drugs, most companies appears to be shy to venture into new proprietary formulations. To bring new proprietary Siddha drugs, the companies have to spent money for toxicological and clinical evaluation of the drugs. Earlier, the licensing system was frivolous and unscientific. The institutionally qualified Siddha private practitioners would easily give away clinical trial reports for just a few thousand rupees. The drug wound not even seen by those who have given such clinical reports.

Goodness, Quality and Efficacy

Interestingly most of the generic Siddha drugs are prescribed for treating multiple diseases. Further, when the indications of the drugs are vague, its real efficacy is difficult to measure. Even the Nilavembu kudineer is reported to have antipyretic and analgesic effects. Definitely it may have some effect but the efficacy can never be compared with Acetaminophen. Further, the Nilavembu kudineer is never prescribed as stand alone drug but is always given along with many other Siddha drugs. When someone question about the efficacy of Siddha drugs, the people concerned become very generous and luxuriant in talking about the safety of Siddha drugs or would get highly emotional and angry. For an ordinary man, safety reaches faster than efficacy as anything that is safe is believed to be good.

The quality standards for Siddha drugs are although available but are as vague as the efficacy of most Siddha drugs.

No single Siddha drug, as on date is known with the exact active principle responsible for the therapeutics.

Most of the Siddha drugs are conglomeration of different herbs, either as choornams (powders), preparations in water or oils as kashyam and thailams, with some sweeteners as lehiyam etc.

Metals and minerals based preparations are also available in plenty in Siddha System of Medicine and that is how this system differs from Ayurveda.

The secondary metabolites in the plants are largely tapped in most Siddha drugs. The production of secondary metabolites in plants is influenced by several factors in the environment where the plant lives. Hence the same plant grown in different areas will definitely differ qualitatively and quantitatively in their secondary metabolites. A conglomeration of plants collected from different areas therefore will not give same effect.

Although the Siddha System of Medicine follows some basic norms for collection of plants, the norms are highly observation centric, subjective and have least validation scope. Even if the metabolites are estimated by TLC or HPTLC etc., which chemical compound is therapeutically effective and active is still elusive.

Modern science knows how much raw plant is required to isolate 1g of vincristin and vinblastin. Unfortunately such knowledge system is not available till date for the Siddha drugs.

How to prevent confusion from contradiction – a possible road map for future

If we look at the Siddha System of Medicine from an impartial end, it is full of contradictions and incredible promises. Health providing system (paramedical science) is contradicted and interpreted as curative or treatment system and is promoted as system of medicine.

The quality standards to the extent of knowing the active compound is still far from near. With this abundant and inborn contradiction in Siddha system, if the institutionally qualified Siddha private practitioners are allowed to prescribe allopathic drugs, only confusion and disaster becomes the counter product.

Both the respective state and the Union Government have to recognize the above and also the growing health problems due to the changing life style of the modern generation. The government has to put the Siddha System on its track and should destroy the health care system of India by producing new breed of ‘allopathic drug prescribing Siddha doctors’ through back door.

Regulatory Requirements

Clinical Establishment Bill must be implemented rigorously and every Siddha clinician must document the drugs prescribed by them, the type of diseases seen, the treatment success achieved etc. From such document, the Siddha Council and AYUSH can evolve right strategy for the system. Further, by declaring the Siddha System of Medicine as paramedical science, the system can be saved from death.

Once such re-positioning is done, the Siddha clinicians can find employment opportunity in hospitals and clinic setups easily as health care providers. Today every clinic has physiotherapist, nutrition and dietetic specialist, audio-visual therapist, optometrician etc., Siddha doctors also can easily fine their important paramedical niche in hospitals.

If the institutions like NIS, CCRS etc., does not stand firm against Siddha clinicians prescribing allopathic drugs, the system would die soon. The Homeopathy Council and different Homeopathy Associations recently opposed to some Homeopathy clinicians prescribing allopathic drugs as they argue that if such practice is legalized and allowed, the system would die. Similarly an eminent Ayurveda doctor and former Director of FRLHST, Bangalore also viewed against Ayurveda doctors practice allopathic drugs.

Dr S Ranganathan, Scientist, based at Chennai.
Dr.Abdul Abbas, MD-Siddha (Kuzhanthai Maruthuvam)