Exclusive online interview reveals insights into Unani Medicine by Dr. Muzamil Rehman

JAMMU: In a groundbreaking online interview conducted by Ajmer Alam Wani, Editor-in-Chief of JK Monitor (www.jkmonitor.org), Dr. Muzamil Rehman, Chief Medical Officer (Unani) for the Central Government Health Scheme (CGHS) under the Ministry of Health and Family Welfare, Government of India, unveiled the profound potential of the Unani System of Medicine in revolutionizing healthcare across India.

Dr. Rehman commenced the discussion by highlighting India's rich heritage in traditional medicine, emphasizing the Unani System's holistic approach towards preventive and curative healthcare. She articulated how the integration of Indian Systems of Medicines, now consolidated under AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy), into the national healthcare framework has been a pivotal focus since the inception of the National Health Policy in 1983.

The interview delved into the strategic measures adopted by the Government of India, including the co-location of AYUSH facilities at primary health centers, community health centers, and district hospitals, thus providing patients with a spectrum of healthcare options under one roof. Dr. Rehman underscored the significant strides made in integrating AYUSH systems with various healthcare institutions, including the prestigious AIIMS establishments.

A noteworthy aspect of the discussion centered around the incorporation of Unani practices into the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), signaling a pivotal recognition of the system's comprehensive nature.

Furthermore, Dr. Rehman shed light on the operational dynamics of the CGHS, elucidating the online procurement mechanism for Unani medicines, facilitated through the Unani Medical Store Depot in New Delhi and the Indian Medicines Pharmaceutical Corporation Limited (IMPCL). She elucidated the systematic approach employed in dispensing medicines to patients, ensuring transparency and efficiency.

The interview also touched upon the crucial role of standardization in promoting the global visibility of Ayush systems, with Dr. Rehman elaborating on her involvement in standardizing Unani terminologies and therapies through the Bureau of Indian Standards (BIS).

Dr. Rehman's insights extended to regulatory and quality control provisions for Ayurveda, Siddha, Unani, and Homeopathy (ASU&H) drugs, emphasizing the paramount importance of pharmacovigilance and combatting misleading advertisements in ensuring public safety.

Moreover, she underscored the significance of capacity-building initiatives in enhancing regulatory compliance and professional competency within the Unani sector, advocating for continuous learning and knowledge exchange.

The interview culminated with Dr. Rehman reaffirming the indispensable role of the Unani System of Medicine in addressing diverse healthcare needs with its personalized, holistic approach. She emphasized its relevance in promoting well-being, preventing diseases, and managing chronic conditions, thereby aligning with contemporary healthcare trends and emerging global healthcare demands.

In essence, Dr. Muzamil Rehman's illuminating discourse epitomized the transformative potential of the Unani System of Medicine in ushering in a new era of holistic healthcare delivery in India and beyond.

For the detailed interview, read questions and answers below till end:-

1. Dr Muzamil Rehman, given your extensive experience in the field of Unani medicine, how do you perceive the integration of traditional systems of medicine, such as Unani, within the broader framework of modern healthcare delivery systems, particularly in a diverse country like India? 

Ans: India possesses an unparalleled heritage in the form of its ancient systems of medicine which are a treasure house of knowledge for both preventive and curative healthcare. Because of its holistic approach the Unani System of Medicine holds the potential to play an essential role in the prevention and management of diseases and the promotion of a healthy lifestyle among the masses in addressing all determinants of health and disease.

As an inclusive measure National Health Policy, 1983, emphasized the need for a meaningful phased integration of Indian Systems of Medicines, now called AYUSH systems, with the modern medicines in National Health Care system. In 2014 the Ministry of AYUSH was created with a vision of reviving the profound knowledge of our ancient systems of medicine and ensuring the optimal development and propagation of the AYUSH systems of healthcare. Government of India has adopted a strategy of co-location of AYUSH facilities at Primary Health Centers (PHCs), Community Health Centers (CHCs) and District Hospitals (DHs), thus providing a choice to the patients for different systems of medicines under a single window.

As per the information available, as on September 30, 2023,AYUSH services have been allocated at 470 DHs, 3,149 CHCs, 204 health facilities other than CHC at or above block level but below district level, 6,891 PHCs and 2,894 health facilities above Sub-centre (SC) but below blocks level. Also, Integration of AYUSH with various new and upcoming  AIIMS established under the Ministry of Health and Family Welfare is also a step forward in this attempt.

The incorporation of Unani practices into the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) signifies the recognition of the system's comprehensive nature. The accessibility, affordability, broad acceptance by a section of the general public, comparatively low cost and growing economic value of AYUSH systems have great potentials to make them providers of health care. WHO's Traditional Medicine Strategy for 2014–2023 emphasizes the role of traditional medicines in providing accessible, culturally acceptable, and affordable healthcare, particularly when faced with rising healthcare costs and universal austerity. Therefore integration of AYUSH into mainstream public healthcare system is imperative for the excellent healthcare delivery as it offers the strengths of both conventional medicine and AYUSH system.

2. As the Chief Medical Officer (Unani) for the Central Government Health Scheme, what challenges have you encountered in ensuring the accessibility and affordability of Unani medicine to the masses, and how have you addressed?

Ans: Central Government Health Scheme (CGHS) is a contributory health scheme for serving / retired Central Government employees and their families, sitting and ex MPS, judges, etc. There is an inbuilt online mechanism for the procurement of medicines. The Unani Medical Store Depot, New Delhi procures the medicines as per the formulary of drugs for use in Unani Wellness Centers. Indian Medicines Pharmaceutical Corporation Limited (IMPCL) is a CPSE under the administrative control of Ministry of AYUSH, Govt. of India which is engaged in manufacturing and marketing of Ayurvedic and Unani Medicines. IMPCL fulfils the needs of CGHS in addition to Central/ State government institution(s) for the continuous supply of Ayurvedic & Unani Medicines as per their requirements.

Accordingly, the Wellness Centre store the medicines for dispensing to the patients as prescribed by a doctor.. However, in the instances, if the prescribed medicine is not available in the Wellness Center, a request is initiated, known as an indent, to an authorized local chemist for the supply of the required medicine.. Upon receiving the medicines from the authorized local chemist, the prescribed medicine is then dispensed to the patient. This online mechanism ensures a systematic, transparent and hassle-free approach for providing necessary medications to patients.

3. Your role as a Technical Committee member at the Bureau of Indian Standards (BIS) highlights your involvement in developing standards in the AYUSH sector. Could you elaborate on the specific standards you have contributed to, particularly concerning Unani medicine, and the impact they have had on regulating quality and safety within the India?

Ans: BIS is the National Standards Body of India and is involved in developing National Standards on products, processes, and services which are known as Indian Standards. At present, the Ayush systems are growing in the paradigm of modern scientific, technological, and medical parameters. Therefore, the globalization of Ayush calls for standardization – Not only at National but also at international level in terms of terminology; clinical examination; diagnosis; interventions in form of herbs, herbal/herbo-mineral formulations, diet and lifestyle etc.

BIS has created a dedicated department of standardization in the AYUSH systems. AYUSH Division Council, chaired by the Secretary of the Ministry of AYUSH, has been created, guiding standardization efforts at both the national and international levels, including within the ISO framework. Formulation of Indian Standards as well as ISO deliverables is aimed at making available safe and effective Ayush interventions at the global market. This will aid in expanding the global visibility of Ayush systems.

I am a member of the Unani Sectional Committee (USC), which has been constituted with a scope of Standardization in the field of Unani including traditional and modern aspects of products and services. My role is to contribute in the preparation the standards and provide technical inputs on the standards being formulated. Presently the work of standardising the Unani terminologies and few therapies is under process. Once published these standards would guide the stakeholders of Unani like researchers, manufactures, academicians, regulators, clinical practitioners and others alike.

BIS certification scheme is basically voluntary in nature. However, for a number of products compliances to Indian Standards is made compulsory by the Central Government under various considerations viz. public interest, protection of human, animal or plant health, safety of environment, prevention of unfair trade practices and national security. "Drugs and Cosmetics Act, 1940" and the Rules there under provides a regulatory framework for Ayurveda, Siddha Unani (ASU) Medicines. The Unani Pharmacopoeia of India (UPI) and the National Formulary of Unani Medicine are the regulatory compendia, published in accordance with this Act for quality standards and manufacturing of Unani medicines, respectively.

4. With your background in both clinical practice and regulatory affairs, how do you navigate the balance between upholding traditional principles of Unani medicine while ensuring compliance with modern regulatory standards and requirements?

Ans: Well, guiding principles are already in place in the respective acts. The National Commission for Indian System of Medicine Act, 2020 is an Act to provide for a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high-quality medical professionals of Indian System of Medicine in all parts of the country.

This enforces high ethical standards in all aspects of medical services of Indian systems of Medicine. Drugs and Cosmetics Act, 1940" and the rules thereunder provide a regulatory framework for Ayurveda, Siddha Unani (ASU) Medicines. Therefore, once a professional is registered as a graduate or postgraduate of ISM, the relevant laws are accordingly applicable to the professional and the compliance and adherence to them is mandatory in all kinds of medical services of ISM. Moreover, Healthcare system is a state subject. Rights and privileges are enforced by the Sate Govt. These may vary from state to state in our country.

5. Participating in international conferences such as the AYUSH International Conference in Dubai underscores your engagement on a global platform. How do you perceive the global acceptance and integration of traditional systems of medicine like Unani, and what strategies do you employ to promote cross-cultural exchange and collaboration in this regard?

Ans: You know, India holds a very strong position in according the official recognition to multiple systems of medicine other than the allopathic system and the Regulatory framework pertaining to all the systems is also robust. These systems are poised to get globalised. Therefore, participation in the international conferences or the workshops not only offers a platform for showcasing the strengths of Ayush systems, but also contributes to a deeper understanding of India's unique healthcare delivery system, its rich heritage in traditional medicine and holistic healthcare approach.

These events also provide the opportunities for the exchange of knowledge and experiences in the field of traditional healthcare of different nations, which further promotes cross-cultural understanding and multilateral collaboration in the global healthcare.

6. Muzamil, could you discuss any specific initiatives or programs you have been involved in the promotion and development within the field of Unani medicine, particularly in addressing contemporary healthcare challenges or filling knowledge gaps?

Ans: While I was posted at Ministry of AYUSH, in addition to the other assignments, I was involved with the Regulatory & Quality Control Provisions for ASU under the purview of Drugs &Cosmetic Act, the Central Sector Scheme of Pharmacovigilance for ASU&H drugs, , the provisions related to the misleading advertisements of ASU drugs under the purview of Drugs and Magic Remedies (Objectionable Advertisements) Act 1954.

As it necessary in the interest of the public health to oversee the impact of ASU&H drugs consumed by the people from the perspective of their safety profile, these initiatives facilitate the detection of potentially unsafe ASU&H medicines and misleading advertisements for taking regulatory action against them. I also contributed to the preparation of documents such as on GMP guidelines for ASU drugs manufacturers and Essential Unani drug list for mental health etc.

7. As someone who has served in various capacities within the Ministry of AYUSH and contributed to training programs for ASU stakeholders, what do you consider to be the most pressing educational needs or capacity-building priorities for professionals within the Unani medicine sector, both at the national and international levels?

Ans: As you know that, capacity building is a process of developing and strengthening the skills, abilities, processes and resources, that organisation needs. Thes programs enable individuals to embark on a continuous process of learning. During my posting as Asst Adviser in MoA and a desingated Central Drugs Inspector, I was actively involved in various regulatory training programs for ASU&H Drug regulators, Industry personnel, & other stakeholders that were held in different parts of the country.

These programmes were aimed at capacity-building of ASU ASU&H Drug regulators, Industry personnel, & other stakeholders. Such programs offer a regulatory perspective to the Unani stakeholders. Capacity Building & Continuing Medical Education (CME) in Ayush will definitely fill the knowledge gaps.  Regular updation of the knowledge regarding the new regulations and the scientific advancements in the sector will further meet the professional requirements.

8. Muzamil, in your opinion, what are the key advantages of Unani medicine compared to other traditional systems of medicine, and how can these strengths be leveraged to improve healthcare outcomes and address public health challenges?

Ans: The Unani System of Medicine plays an essential role in addressing various aspects of health and disease. This System is known for its holistic approach and with a history dating back to centuries; it incorporates traditional wisdom and time-tested practices into preventive healthcare and holistic living. It considers the body, mind, and spirit as interconnected elements. Therefore, it strives to achieve a balance among these components to promote overall well-being. Here are some key points highlighting the significance of the Unani System of Medicine:

• Unani medicine's holistic and individualized treatment approach resonates with patients seeking personalized care.
• Since it is comprehensive in its approach, it aims at balancing and harmonizing all determinants of health. It incorporates preventive, promotive, curative, and rehabilitative components of treatment and this approach ensures a versatile strategy for maintaining and restoring health.
• One of the major strengths is the organ specific tonics like liver tonics, cardiac, tonics, brain tonics, etc. Accordingly it offers treatment for wide range of chronic ailments like arthritis, gout, gastrointestinal, hepato-biliary disorders, respiratory disorders, skin disorders, sexual disorders etc. It emphasizes on lifestyle modifications, dietary guidelines, and therapeutic interventions, through the application of concept of maintenance and balance of Asbab-e-Sitta Zarooriyah i.e six essentials of life, to address the root causes of various lifestyle disorders/NCDs like diabetes, cardiovascular issues, and more.
• What makes the treatment plan unique is that it is personalized based on an individual's unique constitution, which is determined by the assessment of temperament (Mizaj). The assessment of temperament and then the customisation of treatment plan takes into account the person's physical, mental, and emotional characteristics.
• One of the thrust areas of Unani system is the immune modulation. In Unani literature, many single drugs and compound formulations like, khameeras have been used for their immuno-modulatory effect, apart from other therapeutic properties.
• Regimenal Therapy (Ilaj-Bil-Tadbeer) is one of the principles of management in Unani system of medicine. Different methods of Ilaj Bil-Tadbeer are Hijamah(cupping),Taleeq(leeching), Fasd(venesection),Imala (diversion of morbid material),Riyazat(exercise),Hammam(Turkishbath) etc.
• Unani medicine lays great emphasis on treating certain ailments through dietotherapy, by prescribing specific diets or by regulating the quality and quantity of food.Correct diet and digestion are assumed to produce correct balance of humours and maintain progress of health, whereas faulty diet and digestion derange the balance and produce disease.

9. Given the diverse cultural and regional variations within India, how do you ensure that Unani medicine is adapted and tailored to meet the specific needs and preferences of different communities while maintaining its authenticity and effectiveness?

Ans: India is a diverse country; therefore cultural and regional variations are obvious, but healthcare needs of the people across regions remain almost same, there is no difference between the healthcare needs of different regions, or cultures or communities. However, at the same time, people from different regions and communities are exposed to different environmental conditions, different food habits, different cultural norms, different climatic variations etc.

Therefore, their temperaments are also different. Accordingly, the treatment is tailored based on the specific needs after a detailed assessment of the patient, while maintaining its authenticity and effectiveness. As I mentioned above, Unani system provides an individualised treatment plan based on an individual's unique constitution, which is determined by the assessment of temperament (Mizaj).It does not work on “one shoe fits all” system. It takes cultural and social factors influencing healthcare decisions into consideration.

10. With the increasing interest in holistic healthcare approaches, how do you advocate for the integration of Unani medicine alongside other traditional and modern medical practices within the mainstream healthcare system, and what policy changes or institutional reforms do you believe are necessary to facilitate this integration effectively?

Ans: As interest in traditional and alternative medicine is growing globally, there is an increased focus on integrating Unani system of medicine alongside other traditional and modern medical practices within the mainstream healthcare system in our country. Understanding how Unani medicine is utilized provides insights into its acceptance and integration within broader healthcare systems.

Through the two flagship programs of Central Govt, i.e. National Health Mission and National AYUSH mission, the strategy of mainstreaming of AYUSH has been adopted with which outreach of AYUSH Services has expanded. As a result, co-location of AYUSH facilities at Primary Health Centers (PHCs), Community Health Centers (CHCs) and District Hospitals (DHs) has been done; thus, giving an extensive  the choice to the patients for different systems of medicines under a single window.

AYUSH systems have been integrated with various Healthcare Institutions at Centre level as well as State level. CGHS also has various AYUSH Wellness Centres integrated with Allopathic ones. Boosting the functional integration in addition to the physical integration among different AYUSH system and the modern medical systems will provide a rational approach towards the path of coveted integration of healthcare system.

In a nutshell, the holistic philosophy of Unani System of Medicine presents it as a valuable resource for promoting health, preventing diseases, and managing chronic conditions. Its emphasis on lifestyle, natural interventions, and individualized care aligns with contemporary healthcare trends & needs and makes it a relevant and significant contributor to the well-being of the masses on a larger scale.