Scope of Medical Activities for AYUSH Practitioners in India: Legal and Policy Insights

Context:
The debate over the scope of medical activities for AYUSH practitioners—particularly regarding their right to use the title “doctor” and prescribe modern medicines—has intensified in India. This growing controversy highlights deep-rooted tensions between evidence-based allopathic medicine and traditional systems like Ayurveda and Unani, setting the stage for the broader AYUSH vs Allopathy legal and ethical discourse. Rooted in historical reports such as the Bhore Committee of 1946, the debate is shaped by laws, judicial rulings, and policy challenges.

1. Historical and Legislative Evolution:

a) Bhore Committee (1946)

• Promoted a cohesive public health framework based on contemporary, evidence-driven medicine.
• Observed that numerous nations were discontinuing traditional systems, encouraging Indian states to define the role of native practices.

b) Committee on Indigenous Systems of Medicine (1948)

• Established in reaction to demonstrations by practitioners of traditional medicine.
• Positioned Ayurveda as essential to Hindu nationalism, associating its decline with "foreign domination."

c) Indian Medicine Central Council Act (1970) and National Commission for Indian System of Medicine Act (2020)

• The 1970 Act officially acknowledged and regulated Ayurveda, Siddha, and Unani.
• The 2020 Act updated regulatory frameworks while maintaining extensive recognition of AYUSH qualifications.

2. Prescribing Modern Medicines: Rule 2(ee)

• The Drugs & Cosmetics Rules of 1945, specifically Rule 2(ee), grants authority to states to designate non-MBBS practitioners as "registered medical practitioners" authorized to prescribe allopathic medications.
• Numerous states have released notifications permitting graduates of Ayurveda and Unani to prescribe antibiotics, anesthetics, and various other contemporary medicines within primary and community health centers.
• This development stands in direct opposition to the Supreme Court's decision in the case of Dr. Mukhtiar Chand & Ors vs. State of Punjab & Ors (1998), which determined that the rights to prescribe are inherently linked to the practice of a specific medical system.

3. Judicial Interventions and Litigation

• Supreme Court (1998): Ayurvedic practitioners are prohibited from prescribing allopathic medications, as this constitutes the practice of modern medicine without the necessary qualifications.
• High Courts and State Orders: In spite of the ruling from the apex court, numerous state notifications continue to be in effect. The Indian Medical Association regularly contests these orders, and High Courts frequently annul them.
• Consumer Courts: Patients have successfully taken legal action against AYUSH practitioners for misrepresentation when they were under the impression that they were receiving treatment from an MBBS doctor, highlighting the potential for deception in rural areas and among populations with low literacy.

4. Scope of Clinical Procedures

• A notification issued by the government in 2020 allows postgraduate Ayurvedic practitioners to conduct 58 minor surgical procedures, such as appendectomy and cholecystectomy.
• Uncertainties persist regarding their legal capacity to provide anaesthesia and post-operative antibiotics—procedures that have typically been the domain of allopathic surgeons.
• This uncertainty prompts worries about patient safety, the quality of surgical training, and the management of antibiotics in a nation that is already facing increasing antimicrobial resistance.

Public Health and Political Dimensions

• The AYUSH lobby presents legal expansions as a manifestation of "Hindu pride," merging medical practices with nationalist discourse and complicating impartial policy discussions.
• Both leading national parties have incorporated AYUSH into their election manifestos, committing to support all medical systems instead of emphasizing evidence-based methodologies.
• Initiatives to integrate AYUSH therapies into the Ayushman Bharat insurance scheme and the ongoing multi-billion rupee funding for AYUSH research councils, despite their minimal scientific contributions, pose a risk of reallocating resources away from established public health strategies.

Conclusion

The push to blur boundaries between traditional and modern medicine in India underscores a complex interplay of history, law, politics, and public health. While Ayurveda, Unani, and other systems merit respectful preservation and rigorous research, patient safety and evidence-based standards must guide any expansion of scope. Clear statutory definitions, uniform enforcement of judicial directives, and robust curricular reforms are essential to safeguard citizens and ensure that all practitioners operate within their legitimate competencies.