From Hippocrates to Charaka: Post-pandemic medical ethics in India and the world

The other day in discussion with a former clinician student of mine, I learnt about how doctors worldwide and India may be suffering from post facto guilt having endured Covid-19 and its harmful effects on health systems providers. He shared that he had at least five patients who went away in his hospital with myocardial infarction after Covid-19 and pondered the effectiveness of monoclonal antibodies in treating them.

I checked with him if there might be then a pang of general guilt in the ecosystem; if it might be worth doing a medical ethics survey post-Covid-19. He noted, for sure, especially with younger residents who saw it all from the front lines. Meanwhile, one also observes debates on whether hospitals and doctors should treat unvaccinated patients globally.

This brings us all into ongoing worldwide conversations on the future of medical ethics post Covid-19, both in developed and developing economies. If one perused recent articles in medical journals, an emerging strand in this conversation relates to the Hippocratic Oath itself.

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Intriguingly, the National Medical Council (NMC) in India has now suggested that there needs to be a move towards using the 'Charaka Samhita' to replace the Hippocratic Oath for graduating medical students. These discussions are not new. India's illiberal Hindutva pivot last few years has meant that this conversation has appeared even if sporadically in public conversations piggybacking on a larger aspiration to recover old glories of ancient India. The examples are many, so best left alone instead of regurgitating them once again.

But what is funny to observe is that it is now a first-order priority among medical policymakers in India. When the Omicron wave is still not done with, and when one still does not know the risk of new variants going forward or deals with residual vaccine hesitancy and gender distortions in the population for vaccination. This is also happening even as in Covid-19, doctors used steroids, antibiotics, medicines like HCQ, Ivermectin or advanced therapeutics, like MABs in panic perhaps, with insufficient stable evidence. It is like the eight blind men trying to touch an elephant at various parts and speculating on the formation of the animal, my student reminded me, perhaps in sarcasm.

To be clear, though, the 'Charaka Samhita' being recommended by the NMC, historians indicate, predates the Hippocratic Oath. Some even argue that the 'Charaka Samhita' might have influenced the Pythagorean traditions in ancient Greece (that influenced the Hippocratic Oath). But it comes from Charaka and the ayurveda system of medicine, where events like endorsing the consumption of Giloy have been controversial in India during Covid-19 times. In general, too, ayurveda has not had any big-ticket accomplishment as a medical panacea to its credit over the decades, more so during the last couple of pandemic years.

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Hence, while it is undeniable that medical ethics lie at an inflexion point, going back to ancient paths inspired by untested systems of medicine is an unnerving anti-science shift in Indian healthcare and deserves special concern. It also comes dangerously when even in the Union Budget 2022, many raised alarms about the apathy exhibited by the current government towards allocations in public health expenditure. Bring in a digital health ID, forget releasing data on vaccine adverse events or Corona Kavach health insurance claims, toss in a new insurance scheme around elections named after a great leader (but don't share data to study its effects on health outcomes) and bingo. Malaises exposed in Indian healthcare during the Covid-19 years will be automatically ameliorated, so it seems the thinking in Delhi.

Primum non nocere (or first, do no harm), one of the central constructs in the Hippocratic Oath, meanwhile seems to be facing a zeitgeist in modern Indian medicine. Its manipulation resulted in the use of humans as guinea pigs in the Nazi experiments in the 1930s, leading to the Nuremberg Doctors Trial and a post World War 2 debate on medical ethics around the Nuremberg Code. Is India finding inspiration from that manipulation? How will its community of medical students and clinicians respond? That too when health systems in India are already suffering. As a perfect storm to incentivise more brain drain to happen in the profession from India, perhaps? Maybe, if Delhi refuses to care about clinicians like my former student above.

(The author is a health economist, a Reader in Economics of Innovation at SPRU-Sussex, University of Sussex, Visiting Fellow at Hoover Institution, Stanford University & Visiting Adjunct Professor in Economics at IIM-Ahmedabad, India)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH

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