Integrative Medicine and Healthcare: Opportunities and Challenges

Every system of medicine and healthcare rests on the broad principles of diagnosis, treatment and prevention. Most practitioners and people agree that prevention is by far the best approach for achieving optimal healthcare. The famous Chinese metaphor echoes that a good physician treats the disease, and a superior doctor prevents the disease. This is absolutely true across many regional or ethnic systems of medicine referred to as traditional medicine, notably the Ayurveda, Chinese traditional medicine, Unani and Arabic, and many more. Most of these traditional medicine systems developed over several hundreds and thousands of years in diverse, and often extremely restrictive environments. Despite having a strong conceptual basis of diagnosis and treatment, progress was not as dramatic as would be expected. In contrast, the Western world had the advantage of scientific advances powered by targeted translational and applied research that allowed preferential evidence-based recognition as a better system of medicine compared to most traditional medical and healthcare philosophy and practice. Gradually, over several years huge gulf developed between traditional medicine systems and the modern western style medicine.

The gap between traditional and Western systems grew to much higher proportions, leading to virtually non-existent traditional healthcare in many countries. Alarmingly, this pattern became more obvious in core native countries or regions where the core traditional medical healthcare systems developed, predominantly in India, China and the Arabian region. Inevitably, this growing gulf led to a gradual decline in the number of skilled practitioners, dedicated clinics and hospitals, a shortage of carefully managed traditional drugs and appliances, combined with significant socio-economic consequences. In contrast to the evidence-based approach of the western medicine equipped with applied research and randomised clinical trials, traditional medicine systems continued to use age-old concepts of disease causation, identification and interpretation of symptoms and signs, reliance on subjective evidence, and using ancient anecdotal treatment methods. This gradual decline and avoidance of traditional healing methods led to the establishment of the western medicine as the mainstream medical and healthcare system. It became almost impossible and untenable for traditional medicine to present as a viable option as an alternative medicine system. In fact, claims from stalwarts of traditional medicine systems could not be sustained for public acceptance as an alternative medicine provider to the mainstream Western medicine models.

Resistance to the choice of traditional medicine and healthcare systems as alternative medicine led to the argument to find areas where some of the traditional healthcare approaches might be complementary. In this context, applications and universal acceptance of Yoga as a supportive and complementary approach to a number of physical and mental health conditions. Yoga, being the hallmark of the Ayurvedic traditional Indian system of medicine, established itself within the realms of Western-style mainstream medicine and healthcare. This success, along with many other examples, facilitated the concept of complementary applications of traditional medical and healthcare systems. In 2013, the World Health Organization (WHO) first published the traditional medicine strategy for the period, which is based on the concept of achieving optimal healthcare through integration of traditional healthcare with the mainstream medicine system as complementary, referred to as ‘traditional, complementary integrative healthcare (TCIH)’.^[1,2] This strategic development is based on core generic issues rather than specific diseases or body systems.

The current issue of the Apollo Medicine includes a selection of solicited articles on the critical question of the basis and spectrum of TCIH. Professor Rao, in his impressive article,^[3] has laid down core components of integrative medicine and healthcare on the central principle of a patient-centred approach to health care that combines the best of conventional (mainstream, evidence-based) medicine with complementary and alternative therapies, provided they are proven safe and effective.^[4] It emphasises whole-person care, addressing not just disease symptoms but also the physical, emotional, mental, social, spiritual, and lifestyle factors that influence health and healing. However, it is absolutely essential to follow the format of an evidence-based approach to achieve and sustain a viable integrative medicine and healthcare system that is fit for purpose. The system would maintain and develop conventional medical and surgical treatments alongside scientifically supported evidence-based complementary practices (such as acupuncture, meditation, Yoga, nutrition counselling, massage, or herbal medicine). The therapeutic relationship would need to be strong, mutually beneficial, non-controversial, with emphasis on the partnership between patient and provider, with shared decision-making. The strength of the successful integration would be judged on the basis of a whole-person focus promoting overall wellness, preventing the disease rather than only managing symptoms. Personalisation would be the key factor tailored to each individual’s unique health needs, preferences, and values. Finally, the lifestyle modifications and emphasis on self-care would need to be addressed in all stages, encouraging adequate and appropriate nutrition, physical activity, stress management, and other healthy behaviours as core aspects of treatment.

Amongst many grounds and facets for integration, the evolution of future surgical practices offers a unique opportunity for integrative healthcare. There is huge potential for remarkable surgical healthcare through the integration of ancient Ayurvedic surgical practices with modern digital and artificial intelligence-driven specialist surgical approaches.^[5] India’s rich surgical heritage, documented in the Sushruta Samhita as early as 1500 BCE, is globally acknowledged. This article argues that historical legacy alone does not justify maintaining a separate and suboptimal surgical domain under Ayurveda in the 21st century. Ironically, around 330 trained Ayurvedic surgeons practice outside the domain of modern surgical specialities. Undeniably, these represent small numbers; it is important to expand with a revised and upgraded evidence-based surgical training curriculum. There is an urgent need to review current MS/ MCh curricula and develop focused post-graduate surgical education and training programmes in keeping with the emerging needs of multi-organ surgical specialities.

Mental health is undoubtedly a major global health problem, particularly in less-resourced and low-income countries. There are a multitude of factors that span a wide span of human life in the context of geographic parameters, socio-cultural diversity, socio-economic infrastructure, spiritual beliefs and customs. Apart from specific psychiatric disorders and treatment, most mental health issues require a mundane approach. The article by Satish and Chandran introduces the bio-psycho-social model (BPSM) for holistic mental health care. Authors successfully argue for the inclusion of Ayurvedic principles along with BPSM for optimal mental health preservation and enhancement. In fact, it is argued that Ayurveda’s classical therapeutic triad, the Trividha Chikitsa (Yuktivyapasraya, Satavajaya, and Daiva Vyapasraya), predates the BPSM approach.^[6]

Every healthcare delivery system would need to be user-friendly, culturally sensitive and ethically acceptable to the majority of the people. It would need to be compatible with the current legal and moral standards. Ethics in integrative medicine would need to follow the same core principles as conventional medicine, including beneficence (doing good), nonmaleficence (doing no harm), autonomy (patient choice), and justice (fairness). The main ethical challenges arise from the need to rigorously test the safety and efficacy of non-conventional therapies, ensure informed consent for multimodal treatments, and navigate potential conflicts of interest when combining different approaches. Integrating non-conventional therapies presents huge ethical challenges since randomisation might be problematic. There is thus an urgent need to devise alternative approaches to meet the ethical requirements in planning and conducting research and clinical trials for traditional-conventional integrative medicine and healthcare.^[7]

The success of integrating modern medicine with traditional AYUSH healthcare systems requires a thorough inspection of the current medical and healthcare education and training strategy and a futuristic approach.^[8] Further, active and efficient integration would need to be robust in keeping with the rapidly advancing digital applications, particularly artificial intelligence (AI). Massive infrastructure developments, creation of ‘big data’ resources and dedicated complex algorithms are needed for AI based future integrative healthcare system.^[9] Globally, there is no disagreement on the concept and need to integrate traditional medicine systems with modern, scientifically advanced medical and surgical systems; the central question remains on the strategic process and implementation for achieving the main goal. Extensive literature searches clearly indicate sustained growth with international collaboration for developing the TCIM. International collaborations are essential for strategic funding, standardisation and global integration to further enhance research output and evidence-based healthcare applications.^[10] It is anticipated that this special issue would generate positive introspection and constructive dialogue amongst healthcare professionals, providers and the public at large for the development of integrative, adoptable and sustainable healthcare strategies and implementation.