Charaka Shapath, Yoga, Planting Herbs – Open Letter to NMC on its Purported Decisions [Feb 15, 2022]
ಶ್ome images/documents titled ‘Highlights of Today’s VC by NMC’, ‘Minutes of NMC discussion with all Medical Colleges of India’ have been widely circulating in the social media, and news reports regarding the said decisions of NMC to replace the Hippocratic Oath with what has been termed as Charak Shapath have been reported in the mainstream media as well. Since there has been no clarification or denial of the same by the National Medical Commission, and since some news reports have quoted unnamed members of the NMC, these images/documents may be construed to be true documents and the reports to be genuine. These developments, therefore, are causes for dismay and grave concern and the National Medical Commission must immediately reconsider and rescind any such decisions if already taken.
Replacing ‘Hippocratic Oath’ with ‘Charaka Shapath’:
According to these ‘Highlights’ and ‘Minutes’, it has been decided by the NMC on ‘Replacement of Hippocrates Oath with Charak Shapath as Charak belonged to our motherland -Oath taking to be conducted during White Coat Ceremony in local language/ vernaculars’ [During white coat ceremony (with parents) the oath will be ‘Maharshi Charak Shapath’ present in NMC website].
However, as of now, no such ‘Maharshi Charak Shapath’ is present on NMC website. On the contrary, some images titled as ‘Maharshi Charak Shapath’, published in the name of one National Medicos Organisation, is widely circulating in the social media, with statements suggesting that the same has been introduced by the NMC. We also find that one National Medicos Organisation, on its Twitter handle @NMOBharat has published two tweets
and https://twitter.com/NMOBharat/status/1491567870752395266] attaching the Highlights of the VC, and its own versions of Maharshi Charak Shapath and also thanking the NMC for ‘adopting NMO’s vision’.
If the decision is indeed true, the NMC must immediately publish the ORIGINAL Charak Shapath on its website, as has been mentioned in the Minutes, and call for suggestions/objections. The NMC must also clarify whether the ORIGINAL Charak Shapath is under consideration or other modified versions, like the one circulated in the name of National Medicos Organisation, and also whether anyone can modify or truncate the original Charak Shapath and circulate any such modified Charak Shapath, and also claim that such modified Charak Shapath has been published by the NMC.
With regard to the purported decision to replace the Hippocratic Oath with Charak Shapath, citing the reason that Charak belonged to our motherland, its necessary to bring to the kind notice of the NMC the fact that the NMC is concerned with imparting modern scientific medicine and that the modern scientific medicine belongs to the whole world, including India, and that it has continuously evolved, and evolving, absorbing the best of medical knowledge from ancient times, including Ayurveda, Greek Medicine, Chinese Medicine, Persian Medicine etc. Similarly, the Oath of Medical Ethics, that every practitioner of modern medicine swears by, has also evolved keeping pace with changing times and socio-political systems, from the ancient times of Charaka to Hippocrates to the modern pledge adopted as the Declaration of Geneva, the latest one being adopted by the World Medical Association in 2017. All these Oaths are appended here below, and it becomes clear that the contents have changed over the last 3000 years, from the time of Charaka Samhitha to the modern days, with considerations to the governance pattern, from Kings to Constitutional democracies, and to liberty and equality of all, particularly women.
It can be seen that the Charaka Shapath mandates growing of beard and hair, paying for cows and Brahmins, not treating those who are in opposition to the King or whom the physician or society may despise, and also not giving any priority or any treatment at all to those who are gravely ill. While the ancient Hippocratic oath makes a physician duty bound to his patients, without considering political positions or gender, it restrains from performing abortions. The modern oaths, belonging to the present, with tremendous advances in modern sciences and establishment of liberal democratic social structures, make it very clear that every human shall be treated equally, and the physicians must be committed to treat fellow humans to the best of their abilities under any circumstances.
As the graduates of modern scientific medicine are now taking the modern pledge, and not the ancient Hippocratic oath, which is actually not in use now, replacing the modern oath, by erroneously terming it as Hippocratic Oath, with what is being termed as Maharshi Charaka Shapath, which is completely out of sync with modern scientific medicine, modern social practices, and modern socio-political values, is not only unnecessary, but will also be impossible to implement or even lead to ridiculous situations. For example, implementing the original Charaka Shapath would automatically disable every woman medical graduate from practising, making it only men’s profession, who in turn would need to grow beard and hair and follow the other norms as was mandated in the ancient oath. As the change is apparently being made to show respect to Charaka, the ancient oath cannot be modified, for doing so would defeat the very purpose of making the replacement; also, as we are already using the much modified modern pledge, modifying the Charaka Shapath to attune it to the modern pledge or simply naming the modern pledge as Charaka Shapath will all be insults to the ancient and original Charaka Shapath. Also, no one has the authority to rewrite a text such as Charaka Samhita that is considered as sacred. Considering all these, the NMC should reconsider and rescind the decision to replace the modern oath.
Some of the other decisions listed in the Highlights/Minutes are also equally shocking.
‘Yoga’ for Depression, Suicides:
It is stated therein that ‘Yoga – To be implanted (?) at National level. For this, 10 days of yoga training by allotting 1 hr/day for all the batches in a college in the form of surya namaskar, pranayam, breathing exercise, meditation etc. At the end of 10 days, International Yoga Day to be celebrated on 21st June every year. AYUSH – will provide guidelines on yoga. This is done to allay depression, suicidal tendencies. Ragging activities along with de-stressing the Faculty & everybody in the loop.’ (sic)
This decision is highly objectionable. The NMC regulates the education and practice of modern scientific medicine, which is evidence-based. It is appalling that the NMC is mandating unproven and unrelated methods such as yoga, surya namaskar, pranayam, breathing exercise, meditation etc., for the students and faculty of modern scientific medicine inside the institutes of modern medicine as a part of their curriculum, when no country in the world has such a curriculum.
It is even more shocking and dangerous that the same are being suggested as methods to allay depression, anxiety, and suicidal tendencies, for stress management, and even for ragging! This is completely ridiculous and not based on any evidence. While prevention of ragging needs stringent law enforcement, management of depression, anxiety, suicidal tendencies require well-proven methods in modern scientific medicine. Severe depression and suicidal thoughts require urgent attention and treatment only from psychiatrists and no one else. A recent systematic review and meta-analysis has also conclusively shown the efficacy and acceptability of antidepressants in the treatment of depressive disorders.[The Lancet, 7 April 2018] The effectiveness of cognitive behavioural therapy in preventing suicides have also been proven. Several studies have been conducted on depression, anxiety, and stress among medical students and have comprehensively detailed the causes and relevant remedial measures. On the other hand, there is so far no conclusive evidence to support the use of yoga or meditation in the prevention or treatment of mental disorders, and these methods do not even find a mention in any of the evidence-based protocols for prevention or treatment of mental disorders or for the promotion of mental health. The National Mental Health Progamme and the National Mental Health Policy 2014 also do not mention yoga or meditation.
Therefore, including yoga in MBBS curriculum, making it mandatory for students as well as faculty, and promoting it as a remedy for preventing/treating depression, anxiety, suicides and ragging are completely unscientific, illogical, dangerous and therefore should be immediately withdrawn. Further, modern medical colleges cannot be made to create spectacles of Surya Namaskars etc on International Yoga Day, with medical and nursing students along with faculties performing yoga inside the campuses of medical colleges. No AYUSH trainer can be employed in a modern medical college, under the pretext of teaching yoga or anything else, and that decision also should be withdrawn.
The documents in circulation further suggest that decision has been taken on ‘Replacement of Computer skills training and ECE with Family Adoption Program at the outreach of Medical Colleges; One family to be designated to each student and data collection in terms of communication, empathetic behavior, living conditions etc. through monthly visits; This program is to be incorporated into the subject of CM further. Progress chart to be maintained as per Log Book records by CM at the end of 4 years that how much clinical experience has been achieved in terms of certain parameters — Hb%, BP, Blood Sugar, Malaria & other parasitic infestations etc. It further mentions of Tree plantations – Herbs to be planted by the students – data to be recorded regarding environmental consciousness as of closeness and adaptive to nature in Family Adoption Program itself.
These decisions are also retrograde, ridiculous and unnecessary, besides being potentially problematic. World over, imparting computer skills and early exposure to clinical skills have become the norm in medical education and such a curriculum would have helped our medical students too, not only to be on par with other students elsewhere in the world, but also to be future-ready. Replacing these with absolutely useless exercises such as planting herbs and visiting a house once a month will make our medical education a laughingstock and from what is now a fairly well respected medical curriculum globally, it will be reduced to a joke. Modern medical education has nothing to do with planting herbal saplings, nor would this help in acquiring any environmental consciousness as of ‘closeness and adaptive to nature’, whatever that means!
If indeed the NMC is serious about imparting environmental education, which is welcome, modules on environmental health can be developed, but that would not have any place for planting herbal saplings. Adopting a family is not going to help in gaining experience in Hb%, BP, Blood Sugar, Malaria & other parasitic infestations etc., which can be and should be learned at bedside by seeing as many patients as possible, which this new curriculum actually deprives of! Besides, such adoption of a family will amount to intrusion into the privacy and liberty of the concerned family.
Therefore, this entire list of decisions purportedly taken by the NMC smacks of efforts mooted in the NEP, envisaged by Niti Ayog, supported by NMO, of disrupting and even destroying modern medical education, and also the future of modern medicine in India, imperilling not only the careers of all the future graduates of modern medicine, but also the delivery of healthcare in India. Also, it will completely destroy the identity of AYUSH too. Therefore, all these decisions must be immediately withdrawn, and efforts should be made to impart high quality modern medical education on par with international curricula, devoid of any AYUSH elements. While it is impossible to practice the original Charaka Shapath, any modification of the same will neither serve any purpose other than mere symbolism of no value and also such modification will be a travesty of the history of Ayurveda and even an insult to the ancient system. Therefore, all these decisions must be immediately withdrawn in toto.
World Medical Association Declaration of Geneva: The Physician’s PledgeAS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely, and upon my honour.
I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer’s oath, but to nobody else.
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.
Charaka Shapatha, Charaka Samhita, Vimana Sthana, Chapter 8, Rogabhishagjitiya Vimana, Verse 13, 14
[Caraka Samhita, Vol II, By Sharma RK, Dash B. pp 223-225]
In front of the fire, brahmanas and physicians, the preceptor should instruct his disciples as below:
- You should observe brahmacarya (celibacy), maintain your beard, speak the truth, not eat meat (take vegetarian food), resort to such food and regimens as are conducive to the promotion of intellect, refrain from envy and carry no weapon with you.
- You should always obey my instructions except when they go against the ruler of the land, or they are directed towards your death or they involve sinful commitments considerably or bring about calamity. You should always be devoted to me, surrender yourself to my superiority, be subordinate to me and behave in a manner which will be pleasant and useful to me. You should pay due regards to me as if you are my son, servant or supplicant. You should act without ego, with cares and affection with undisturbed mind, with modesty, with proper vigilance, without jealousy and with obedience for my instructions. Acting either at my instance or otherwise, you should first of all try to collect to the best of your ability the things desired by your preceptor.
- If you want to achieve success in your medical profession, earn wealth as well as fame and attain heaven after death, you should in all circumstances pay for the well-being of cows, brahmanas and all other living beings.
- Day and night, however you may be engaged, you shall endeavour for the relief of patients with all your heart and soul. You shall not desert or injure your patient for the sake of your life or your living.
- You should not even think of committing adultery and should not aspire for any property belonging to others. Your appearance and apparel should make you look modest. You should not take wine, commit sins or have association with committing sinful acts. Your speech should be pleasant, pure, righteous, blissful, excellent, truthful, useful and moderate. Your behaviour should be in conformity with the time and place, based on the recollections of the past experience. You should always make efforts for the upliftment of your knowledge and adoption of such methods as would give you good health.
- You should not prescribe medicines for those who are despised by the King or noble persons and those who despise the King or noble persons. You should not treat all those who are excessively artificial in their behaviour, are wicked or are of miserable conduct and behaviour or who have not been absolved of the allegations against them or who are going to succumb to death.
- Women in the absence of their husbands and guardians should not be treated by you. You should not accept any joyable thing given by a woman without the permission of her husband or guardian.
- You should enter the residence of the patient accompanied by a person who knows the place and who on his part, has obtained permission to enter there. While doing so you should be well clad, with your head bowed down, having a good memory, having concentration of mind and acting with proper thinking. After having entered there your speech, mind, intellect and senses should be entirely devoted to nothing except the welfare of the patient and allied matters.
- Family customs (secrets) should not be disclosed by you to outsiders. Even having known that the patient’s span of life has come to a close, you should not disclose this to the patient himself or to the son or father etc. of the patient because it may cause shock to the patient or to his relatives.
- Even though actually possessed of wisdom, you should not exhibit it to others. Many people get very much irritated to hear such self-praise even from a saint.
- It is not easy to acquire comprehensive knowledge of the “Science of Life”. Therefore, one should make honest efforts to be in constant touch with this science. One should strive to acquire qualities, one should learn similar noble qualities even from his enemies without having any sense of jealousy. The wise consider the entire universe as their preceptor; it is only the unwise who consider it to be their enemy. One should, therefore, have the advice which brings fame, which promotes longevity and proper nourishment and which is acceptable to the people. Such advice can be had even from an enemy and be adopted in practice.
Thereafter, the preceptor should say, “Always behave well with gods, fire, brahmanas, preceptors, elders, persons who have attained perfection and teachers. If you do so, fire, all types of smells, tastes, jewels, seeds and the gods will bless you. Otherwise, they will be unfavourably disposed towards you”
To the preceptor advising as above, the disciple should say, “tatha”, i.e., I shall act accordingly
Highlights of VC by NMC:
Minutes of NMC Meeting [Feb 7, 2022]:
Maharshi Charaka Shapath (modified) by NMO:
Maharshi Charaka Shapath (modified) by NMO, claiming to have been introduced by NMC:
NMO’s tweet thankg NMC for adopting NMO’s vision [Feb 10, 2022]:
NMO’s letter welcoming all the decisions taken by the NMC [Feb 16, 2022]:
NMC’s Notice Stating that the meeting was held by UGMEB, not NMC [Feb 17, 2022]
Media Reports on the Open Letter
Feb 15, 2022
Feb 16, 2022
Charak Shapath is regressive: Karnataka doctors write to NMC against changes to oath
Feb 12, 2022