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Wednesday, October 3, 2018

Global acceptance of Siddha Medical Practice – Scope and Challenges


Traditional Medicine of proven quality, safety, and efficacy, contribute to the goal of ensuring that all people have access to care. The traditional systems are valued mostly because of its closeness culturally to the practices of people. Most of the concepts of wellbeing as propounded in the traditional medicine are readily understandable by common man due to the closeness to their social, cultural features and as well as the plants used in medicine and food are familiar to them. They are also valued because of the fact that is close to homes, accessible and affordable.
Large numbers of people trust in the healing power of the traditional medicine. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health-care costs and nearly universal austerity. Traditional medicine also stands out as a way of coping with the relentless rise of chronic non-communicable diseases. Regardless of reasons for seeking out traditional medicine, there is little doubt that interest has grown, and will almost certainly continue to grow, around the world. Siddha medicine, one of the two codified systems of India, the principles and practices that are well conceptually structured and well documented is also now slowly gaining attention in the vast expanse of land where south Indian population have migrated and settled but also among researchers of traditional medicine, anthropology and Public health.

Siddha medicine one among the well codified traditional system of medicine, though considered as a Tamil system of medicine is in fact pan global in nature for the following reasons. The Cittars who made the existing knowledge into codified health science by authoring treatises, originated or travelled to different parts of the world, particularly the Asia (Bogar, Pulipanni. Yacobu, Korakar, Thirumoolar, Dhanvantri to name a few. All the herbs and other material used in the drugs of the system do not belong to the current day south India alone or even the Indian subcontinent, various herbs (Asefodieta, Guggulu, Licorice) and inorganic including mercury are from outside the region. Most of all the basic concepts of Siddha are applicable throughout the world.
More over the current trend clearly suggests governments and consumers are interested not just in herbal medicines but are now beginning to consider aspects of traditional practices and practitioners and whether they should be integrated into health service delivery. Today Traditional medicine products and practices from one region are used throughout the world to complement local health care service delivery, making them a truly global phenomenon. The other factor why there is a need for global acceptance is because of the fact individuals move freely from country to country in order to live and work. This in turn requires availability of Siddha medicines globally and also a better understanding of the consistency and safety of practitioners’ ability to deliver health care in the new environment and cultural variations.

We need continues work on defining and supporting access to safe products and practices. The awareness about Siddha medicine among the Indian Diaspora (not just Tamils, many Malayalees after the opening of a college in Trivandrum and among Kannadigas and Telugu speaking population due to a large presence in Bangalore, Vizag and other towns and in the Indian neighborhoods in many countries (UAE, US and UK) where people temporarily travel and stay for work. The ethnic Tamil population that migrated to Europe and Canada from Sri Lanka in the past century and earlier migration to Malaysia, Singapore, Indonesia, Vietnam, Cambodia, South Africa have now realized the need to incorporate Siddha system into healthcare.

Health systems around the world are experiencing increased levels of chronic illness and escalating health care costs. Patients and health care providers alike are demanding that health care services be revitalized, with a stronger emphasis on individualized, person-centric care.
The emergence of life style disorders (Non communicable diseases) throughout the world has drawn attention to the usefulness of Siddha medical system, as the following basic understanding is the way to live healthy and reverse these non communicable disorders
·         Living in harmony with nature – understanding the relationship/ commonality of human and the environment – Five primordial elements
·         The understanding on the body- mind relationship in health and disease – Anthakaranas and Astaragas
·         Food and Health- Age, Activity, appropriate food for recovery from disease
·         Lifestyle, habits, physical activities and health – Daily regimen and Seasonal regimen – cleansing therapy
·         Uniqueness of the individual
These concepts are applicable to every living being in the world and could be practiced for better health in any part of the world.
Most of the Southeast Asian countries still reel under problems of Malaria, dengue and other viral diseases and some of the Siddha medicines which have shown promise will be readily accepted after certain data are generated and provided as these countries are also looking for solutions to these epidemics.
The popularity of physical manipulative therapy including therapeutic varma is gaining grounds as it does not require a great list of medicines to practice and the skill of the physician is the most important thing and it can be practiced in a small centre in any geographical location of the world. The role of varma is significant in three areas- pain management, correction of postural disorders and Sleep disorders. Certain external therapies do require a proper evaluation of safety and efficacy, but by and large can be adopted in most of the countries.

The herbs that are used frequently in Siddha medicine include a wide range of spices and condiments used in daily food across Asia, Eurosia and by Indian Diasporas even in the western world and could be readily locally manufactured in those countries itself. Many of the tropical herbs are also available in most of the Asian countries and governments will have no hesitation in permitting manufacture of the Siddha medicines based on these herbs and spices locally used and also permit import from India with proper product dossier. The principle of drug selection is based on Taste, Property, Potency, After taste and Unique action can be applied even to European herbs and instead of currently used Siddha herbs, newer herbs could be chosen based on these principles as even in the past herbs that are not native to South India have also been included in Siddha. Many of the Siddha herbs individually have been well investigated by different university departments and research centers and enough data on safety, efficacy at appropriate dose is already available and little more efforts on these formulations will make them acceptable globally. Initial choice should be simple formulations with fewer ingredients which are safe. This will make Siddha medicine entry easy in many countries
As much scope we have in making Siddha medical practice a global phenomenon, as Siddha medicine becomes more popular, it is important to balance the need to protect the intellectual property rights of our indigenous practitioners and their health care heritage while ensuring access to  Siddha knowledge and fostering research, development and innovation. Any actions should follow the global strategy and plan of action on public health, innovation and intellectual property Policy makers and consumers should consider how Siddha may improve patient experience and population health. Important questions of access as well as population and public health issues must be addressed.
Since practices vary widely from country to country with certain practices regarded differently depending on the culture, understanding and accessibility of conventional medicine, this system also need to fine tune to the local needs, environment – climate, weather, food and lifestyle.
 A practice where significant progress has been made is acupuncture. Although acupuncture was originally a feature of traditional Chinese medicine, it is now used worldwide. According to reports supplied by 129 countries, 80% of them now recognize the use of acupuncture.

The Challenges for making Siddha medical practice acceptable globally lies in convincing the governments about the quality of practitioners, practice and drugs.
The Siddha practitioners have a similar qualification and regulation like Ayurveda and the regulatory body being same, countries which have already permitted practice of the other Indian medical system will have lesser queries when approached by Siddha practitioners willing to establish practice. Some of the countries specify specific years of prior clinical experience immediately before applying for permission to establish practice and also requires a pre registration test mostly on public health, policy and safety, attitude. Aspiring Siddha practitioners needs to be trained on that. Even in a country where practice of Varma is allowed, Siddha medicines are yet to be permitted for use. Product registration is mandatory based on the product dossier, which should contain the details of ingredients, their safety profile, data on clinical efficacy, the Standard operating procedures adopted during manufacture, GMP status of the factory etc., Necessary precautions needs to be adopted in the choice of ingredients – herbs even, and local regulatory frame work on their status like- list of toxic herbs, narcotic drugs etc in the country of use. WHO limits of microbial load and heavy metal limits needs to be strictly adopted. But these challenges also provide an opportunity to ensure safe efficacious drugs for local users too. Yet another challenge for acceptance of Siddha Medical practice is the perception that it is linked with certain religious faith, philosophy, tantric and mystic practice. The use of inorganic too may pose a challenge initially and once we have enough data on their safety profile that could also be overcome. Today’s Overseas Indian generation gets all the awareness about Siddha either from TV shows or Social media posts which most of the time misrepresent the facts above Siddha. So proper awareness needs to be created based on evidence and reliable facts should be disseminated to them
Risk as perceived by people on use Traditional medicine as listed by WHO is applicable to Siddha practice also. Some countries have also found it difficult to regulate due to
·         Use of poor quality, adulterated or counterfeit products;
·         Unqualified practitioners
·          Misdiagnosis, delayed diagnosis, or failure to use effective conventional
treatments;
·         Exposure to misleading or unreliable information;
·         Direct adverse events, side effects or unwanted treatment interactions

To conclude Siddha medical practice can be made acceptable globally if Practitioners, Practice and products quality is properly regulated with the help of Ministry of AYUSH, our regulator body and research council.

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