Justification for IMA to be pluralistic with rise in the DALYs and cost per DALY with modern medicine: Swami Ramdev on NCDs and need for exclusive Ministry for AYUSH

Recently the Indian Medical Association (IMA) served a defamation notice on yoga acharya Swami Ramdev for alleged disparaging remarks on modern medicine and medical practitioners (MMP) seeking an apology demanding a compensation of Rs 1,000 crore. IMA’s first objective is ‘To promote and advance medical and allied sciences in all their different branches and to promote the improvement of public health and medical education in India’. What may be Baba Ramdev’s points for his remarks? In one of the articles in Lancet (2017), Prof Simon Hay and associates of Institute of Health Metrics and Evaluation, USA have systematically analysed Global Burden of Disease 1990-2016 and clearly offer how modern medicine has performed using Global, regional and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016. The study has computed DALYs by adding years of life lost and years of life lived with disability for each location, age group, sex, and year. The HALE was estimated using age-specific death rates and years of life lived with disability per capita.

Several populations globally are facing increasing functional health loss. Hence, country-specific drivers of disease burden especially for causes with higher DALYs, should sensitise health policies, health system improvement initiatives, prevention efforts, financial and research investments. This suggests the need for increased scrutiny for proven examples of best practices including traditional / indigenous / alternate health systems, which can help to extend gains and the need for extra attention to health systems that need more robust support.

Failure in tackling Non-Communicable Diseases

While MMP would be jubilant to highlight the fall in DALYs due to communicable, maternal, neonatal, and nutritional (CMNN) diseases, but will accept their limitations addressing with non-communicable diseases (NCDs). The Global DALYs have increased due to non-communicable diseases (NCDs) and clearly unable to reduce the DALYs for ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, which comprise 16% of all DALYs.

Shocking increases in NCDs

Between 1990 and 2016, the Global DALYs for NCDs increased by 37% and Neoplasms (benign or Cancer) increased by 41%; cardiovascular diseases by 32%, chronic respiratory diseases by 6%, Cirrhosis and other chronic liver diseases by 38%, digestive diseases by 6%, Neurological disorders by 59%, Alzheimer’s disease and other dementias by 120%, Parkinson’s disease by 148%, Migraine by 51%, Mental and substance use disorders by 46%, Alcohol use disorders by 44%, drug use disorders by 43%, eating disorders by 56%, Autism by 38%, Diabetes, urogenital, blood, and endocrine diseases by 64%, Diabetes mellitus by 108%, chronic kidney disease by 62% (of which due to Diabetes Melitus is 86%, of which due to hyper tension is 90%), Urinary diseases and male infertility by 54%, female infertility by 73%, Musculoskeletal disorders by 61%, Rheumatoid arthritis by 67%, Osteo arthritis by 105%, Low back pain by 47%, neck pain by 72%.

Major diseases causing DALYs in India

For India, even though the Life Expectancy at Birth (and HALE) has increased from 60 to 70 years (51 to 60 years) for females and from 58 to 67 years (51 to 58 years) for males, the DALYs have increased correspondingly due to major ten leading causes such as Ischemic heart disease, Chronic obstructive pulmonary disease, Diarrhoea, Lower respiratory infections, Stroke, Iron deficiency anaemia, neonatal preterm birth complications, Tuberculosis, sense organ diseases, Road injuries.

Cost per DALY averted

Cost per DALY averted which can taken as Cost per DALY has been estimated (Daroudi, 2021) using data on DALYs, per capita health expenditure (HE), Human Development Index (HDI), and GDP per capita for 176 countries for the years 2000 to 2016. The study found that Age-standardized rate (ASR) DALY (per 100,000 population) was inversely related with HE per capita. For a one percent increase in HE per capita there was a decrease of 0.28%, 0.24%, 0.18%, and 0.27% in the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. The cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. In medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively.

IMA may introspect and respect pluralism

For India with the medium HDI of 0.647, the cost per DALY is $6522 (or Rs. 4.7 lakhs). However, the GDP per capita itself is $ 2100. Hence this is only an indicative cost as $6522 is as an average for all countries with medium HDI. Thus, for India (World) with HDI of 0.647 (0.731), with income share of the poorest 40% being 19.8% (17.7%), income share of the richest 10% being 30.1% (30.2%), the IMA with its claims of modern system of medicine is increasing cost of treating Non communicable diseases. Accordingly appreciating the role of AYUSH in not only keeping DALYs low but also in keeping cost per DALY affordable for the poor and middle class is crucial. In addition, the modern medicine will also appreciate the absence of side effects of AYUSH in comparison with modern medicine which will further bring down the DALYs and the cost per DALY according to AYUSH. Swami Ramdev’s questions on ability of modern medicine and claims in addressing NCDs are accordingly genuine enabling IMA to introspect and be pluralistic.

Need for separate ministry for AYUSH

This calls for separation of MMP and AYUSH to form separate health ministry one for modern medicine and one for AYUSH respecting such a vast theory and knowledge as in the Charaka Samhitha, Sushrutha Samhitha, Madhava Nidhana, Ashtana Hridaya, Sarangadhara Samhitha, Bhava Prakasha, Ashtanga Sangraha, Vagbhata. Who else needs to recognize them, if India does not recognize?



Views expressed above are the author’s own.



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