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Ministry of Ayush

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Ministry of Ayush
Branch of Government of India
Ministry of Ayush
Ministry overview
Formed9 November 2014
(10 years ago)
 (2014-11-09)
JurisdictionGovernment of India
Annual budget3,647.50 crore (US$440 million)
(FY2023–24)[1]
Minister responsible
Ministry executive
Websiteayush.gov.in

The Ministry of Ayush, a ministry of the Government of India, is responsible for developing education, research and propagation of traditional medicine and alternative medicine systems in India. Ayush is a name devised from the names of the alternative healthcare systems covered by the ministry: ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa, and homeopathy.[2]

The Department of Indian Systems of Medicine and Homeopathy (ISM&H) was first established in 1995 under the Ministry of Health and Family Welfare.[3] ISM&H was renamed as the Department of AYUSH. The department was made into an official ministry by the Modi government in 2014.[2][3][4]

The ministry of Ayush has faced significant criticism for funding systems that lack biological plausibility and are either untested or conclusively proven as ineffective. Quality of research has been poor, and drugs have been launched without rigorous pharmacological studies and meaningful clinical trials on ayurveda or other alternative healthcare systems.[2][5] The ministry has been accused of promoting pseudoscience.[6][7]

History

[edit]

Emphasis on indigenous healthcare models

[edit]

Successive Five-Year Plans of India (produced by the Planning Commission of India and later the NITI Aayog) allotted considerable focus to alternative, especially indigenous, forms of medicine within the healthcare sector. The Government of India set up a number of committees for healthcare sector development, including Bhore (1946), Mudaliar (1961), and Srivastava (1975), that emphasized the need for improvement of traditional systems of Indian medicine.[8] The National Health Policy (1983), National Education Policy in Health Sciences (1989), and National Health Policy (2002) further elaborated on the role of the Indian System of Medicine (ISM) and Homeopathy (H) as a means to facilitate healthcare access in rural areas where many Indians lack adequate health services.[9]

Educational courses and ISM&H

[edit]

A diploma course in ayurveda was launched in the third (1961–1966) five-year plan.[10] The Central Council of Indian Medicine was established in 1971.[11] followed by Central Council of Homeopathy in 1973.[12] The sixth (1980–1985) and seventh (1985–1990) five-year plans aimed at developing novel ISM&H drugs.[10] The eighth (1992–1997) five-year plan lent considerable emphasis on the mainstreaming of Ayush.[citation needed] The Department of Indian System of Medicine and Homeopathy was launched in March 1995, under the Ministry of Health and Family Welfare.[13][2]

The ninth five-year plan (1998–2002) ensured for its integration with western medicine.[citation needed] It was the first to tackle different aspects of the Ayush system in a standalone manner which focused on overall development including investment in human resource development, preservation and cultivation of medicinal plants, establish a more complete pharmacopoeia, and outline good manufacturing processes.[citation needed] The acronym AYUSH was devised in 2003.[2] The department of Indian System of Medicine and Homeopathy was renamed the department of AYUSH in November 2003.[13]

The National Rural Health Mission was launched in 2005 with the stated aim of integrating Ayush practitioners into national health programs, including in primary health care (Ayush medical officers at community health centers, para-professionals et al.) and to provide support for research in the field.[14] The National Rural Health Mission listed the mainstreaming of Ayush as one of its priorities.[15]

After 2014

[edit]

Observers noted an increased focus on Ayush healthcare after the 2014 Indian general elections, which brought the Bharatiya Janata Party (BJP) to power.[4] On 9 November 2014 the previous government department for traditional Indian medicine was elevated by the administration of Narendra Modi into a standing ministry that includes the promotion of yoga practice and the use of Ayurvedic products.[16][2][4] The allotted budget for Ayush had more than doubled since 2013–14, and stood at ₹ 1428.7 crore for 2017–18.[17]

Activities

[edit]

Healthcare

[edit]

The ministry runs multiple healthcare programs; primarily aimed at the rural population.

Ayush is supposed to form an integral backbone of the Ayushman Bharat Yojana[18] and the ministry had long worked for integrating the different systems of Ayush with modern medicine, in what has been described as 'a type of "cross-pathy"'.[3] More than 50,000 children have been enrolled in 'Homeopathy for Healthy Child'.[19] It observes different days to raise general awareness about Ayush and promote each of the systems.[20]

The ministry had collaborated with the Council for Scientific and Industrial Research (CSIR) to set up the Traditional Knowledge Digital Library (TKDL) in 2001, on codified traditional knowledge on Indian systems of medicines such as ayurveda, Unani, Siddha and yoga as a means of preventing grant of "bed" patents on traditional knowledge and thus counter biopiracy.[21]

Institutions

[edit]

The ministry is also at the aegis of several professional research institutes and academic faculties devoted to various forms of alternative medicine:[22]

The ministry also monitors two semi-autonomous regulatory bodies:-

Economics

[edit]

As of March 2015, there were nearly 800,000 Ayush practitioners, over 90 per cent of whom practiced homeopathy or ayurveda.[3] A 2018 study by the Confederation of Indian Industry (CII) estimated the market share of Ayush medicines at around US$3 billion and that India exported Ayush products of a net worth US$401.68 million in the fiscal year 2016–17.[32]

The Department of Pharmaceuticals had allocated a budget of ₹1.44 billion to the ministry for 2018-2020 for manufacture of alternative medicines.[33] The average expenditure for drugs on Ayush and scientifically based medicine has been found to not vary widely.[9]

Cabinet Ministers

[edit]
  • Note: MoS, I/C – Minister of State (Independent Charge)
No. Portrait Minister
(Birth-Death)
Constituency
Term of office Political party Ministry Prime Minister
From To Period
1 Shripad Naik
(born 1952)
MP for North Goa

(MoS, I/C)
9 November
2014
30 May
2019
6 years, 240 days Bharatiya Janata Party Modi I Narendra Modi
31 May
2019
7 July
2021
Modi II
2 Sarbananda Sonowal
(born 1962)
Rajya Sabha MP for Assam
7 July
2021
10 June
2024
2 years, 339 days
3 Prataprao Ganpatrao Jadhav
(born 1960)
MP for Buldhana

(MoS, I/C)
10 June
2024
Incumbent 166 days Shiv Sena Modi III

Ministers of State

[edit]
No. Portrait Minister
(Birth-Death)
Constituency
Term of office Political party Ministry Prime Minister
From To Period
1 Mahendra Munjapara
(born 1968)
MP for Surendranagar
7 July
2021
9 June
2024
2 years, 338 days Bharatiya Janata Party Modi II Narendra Modi

Criticism

[edit]

Pseudoscience

[edit]

A strong consensus prevails among the scientific community that homeopathy is a pseudo-scientific,[34][35][36][37] unethical[38][39] and implausible line of treatment.[40][41][42][43] Ayurveda is deemed to be pseudoscientific[44][45][46] but is occasionally considered a protoscience, or trans-science system instead.[47][48] Naturopathy is considered to be a form of pseudoscientific quackery,[49] ineffective and possibly harmful,[50][51] with numerous ethical concerns about the practice.[52][53][54] Much of the research on postural yoga has taken the form of preliminary studies or clinical trials of low methodological quality;[55][56][57] there is no conclusive therapeutic effect except in back pain.[58] Unani lacks biological plausibility and is considered to be pseudoscientific quackery, as well.[59][60]

There is no credible efficacy or scientific basis for any of these forms of treatment.[61]

Research

[edit]

Two systematic reviews, one by The Lancet in 2005 and the other by the Australian government's National Health and Medical Research Council (NHMRC) in 2015, found no evidence that homeopathy was more effective than a placebo.[3] In a comprehensive review of alternative medicine (including ayurveda and homeopathy) conducted in 2000, the UK House of Lords Committee on Science and Technology was unable to find evidence to support the value of these treatments. Randomized control trials or RCTs for ayurveda and homeopathy have been extremely limited as of 2017.[3] Multiple systemic reviews have highlighted several methodological problems with the studies and trials conducted by Ayush and its associates in relation to developing an ayurvedic drug for diabetes.[62] A tendency to publish in dubious predatory journals and non-reproducibility by independent studies has also been noted.[63][64] The Hindu reported in 2015 that India had yet to conduct a systematic review of any of the systems of medicine under the purview of Ayush.[3]

Drugs

[edit]

The ministry (in conjunction with other national laboratories) has been subject to heavy criticism for developing, advocating and commercializing multiple sham-drugs (BGR-34, IME9, Dalzbone, Ayush-64 et al.) and treatment-regimes for a variety of diseases including dengue,[65][18][66][67] chikungunya, swine flu,[68] asthma, autism,[69] diabetes, malaria,[70] AIDS,[71] cancer,[72] COVID-19[73][74][75] and others despite an absence of rigorous pharmacological studies and meaningful clinical trials.[63][64][76]

A 2018 systematic review of traditional and AYUSH medicine noted the existing regulations to be inadequate for ensuring the safety, quality, efficacy and standardized rational use of these forms of treatment. Researchers also noted a lack of monitoring for adverse effects from the usage of these drugs and of contraindication trials.[8]

The ministry recommended the herb giloy as an "immune booster against" COVID-19[77] and issued multiple press releases during the COVID-19 pandemic claiming the herb was safe. Later, multiple cases of liver damage was found in those with a history of giloy consumption.[78] However, the ministry backed its statement by pointing out that neither the content of the herb usage nor the authenticity of the plant, which could be identified with similar-looking plants, was analyzed.[79][80]

Miscellaneous

[edit]

The Washington Post noted the efforts behind the revival of ayurveda as a part of the ruling party's rhetoric of restoring India's past glory to achieve prosperity in the future.[4] It also noted of the ayurveda-industry being largely non-standardized and that its critics associated the aggressive integration of ayurveda into healthcare services with the Hindu nationalist ideology of the ruling party.[4] There have been allegations coming out of right-to-information requests that it is the Ayush ministries official policy to not hire Muslims as trainers.[81]

Some researchers have argued that the provision of Ayush services is an example of "forced pluralism" which often leads to disbursal of incompetent healthcare services by unqualified practitioners.[8][82] Ayushman Bharat has been noted to increase privatization of state healthcare facilities and compel rural populace into preferentially choosing alternative medicine, raising concerns about ethics.[17][83] The proposal of integrating Ayush with western medicine has been criticized.[84] The Indian Medical Association (IMA) has expressed strong opposition to integrated medicine,[3][85][86][4] often by using the term "mixopathy".[87][88] In 2020 and 2021, the IMA held nationwide protests to demonstrate against federal changes issued by the Ministry of Ayush that permit ayurvedic practitioners to perform minor surgical procedures.[89][90][91]

The ministry had attracted widespread criticism after publishing a pamphlet titled Mother and Child Care through Yoga and Naturopathy which asked pregnant women to abstain from eating meat and eggs, shun desire and lust, hang beautiful photos in the bedroom and to nurture spiritual and 'pure' thoughts among other advice.[92][93] In the aftermath of the COVID-19 pandemic, the ministry recommended Arsenicum album 30 as a preventive drug; the claim was without any scientific basis or evidence, and was widely criticized.[94][95][96]

Response

[edit]

The ministry rejected the NHMRC's 2016 study on homeopathy which was regarded as the most rigorous and reliable investigation into homeopathy to date.[97][98] In 2017, the ministry set up a committee at the Central Council for Research in Homeopathy (CCRH) to counter claimed western propaganda against homeopathy; the committee was ill-received.[19][99][76]

Reception

[edit]

A NSSO survey in 2014 found that only 6.9% of the population favored Ayush (3.5% ISM and 3.0% homeopathy) over conventional mainstream medicine and that the urban population was slightly more conducive to seeking Ayush forms of treatment than their rural counterparts; another survey in 2016 reiterated the same findings, approximately.[100][9][101] A 2014 study did not report any significant difference between the usage of Ayush services by rural and urban populace, after adjusting for socioeconomic and demographic variables.[9] Low-income households exhibited the highest tendency for Ayush followed by high-income households and on an overall, Ayush lines of treatment were majorly used to treat chronic diseases.[9] The treatments were more used among females in rural India but no gender-differential was observed in the urban populations.[9] Chhattisgarh (15.4%), Kerala (13.7%), and West Bengal (11.6%) displayed the highest Ayush utilization levels.[9]

A 2018 review article noted that the states exhibited differential preference for particular Ayush systems. Ayurveda and Siddha respectively show greater popularities in Kerala and Tamil Nadu. Unani was well received in Hyderabad region and among Muslims whilst homeopathy was highly popular in Bengal and Odisha. It further noted that the preference among the general population for usage of Ayush revolved around a perceived "distrust or frustration with modern medicine, cost effectiveness, accessibility, non-availability of other options and less side effects of Ayush medicines".[8]

References

[edit]
  1. ^ "DEMANDS FOR GRANTS, 2023-24 MINISTRY OF AYUSH" (PDF). Union budget of India. 1 February 2023. Retrieved 1 February 2023.
  2. ^ a b c d e f Rathee, Pranshu (20 November 2018). "What is AYUSH and the controversy around it?". Deccan Herald. The Printers (Mysore). Archived from the original on 22 November 2020. Retrieved 4 April 2021.
  3. ^ a b c d e f g h Shrinivasan, Rukmini (26 April 2015). "Questions over science swirl, but AYUSH stands firm". The Hindu. ISSN 0971-751X. Retrieved 22 January 2019.
  4. ^ a b c d e f Doshi, Vidhi (29 January 2018). "How ghee, turmeric and aloe vera became India's new instruments of soft power". The Washington Post. Retrieved 18 February 2019.
  5. ^ Narayanan, Kavya (1 July 2020). "AYUSH Ministry is endangering people, jeopardising Ayurveda with lax response to Patanjali's Coronil and COVID-19, warn experts". Firstpost. Archived from the original on 21 November 2020.
  6. ^ Kumar, Ruchi (27 April 2020). "Face It: The Indian Government Is Peddling Pseudoscience – The Wire Science". Retrieved 10 April 2022.
  7. ^ Krishnan, Vidya (18 August 2020). "Where Pseudoscience Is Spreading". The Atlantic. Retrieved 10 April 2022.
  8. ^ a b c d Samal, Janmejaya; Dehury, Ranjit Kumar (18 October 2018). "Utilization, preference, perception and characteristics of people adopting traditional and AYUSH systems of medicine in India: a systematic review". Journal of Complementary and Integrative Medicine. 16 (2). doi:10.1515/jcim-2018-0020. PMID 30352037. S2CID 53024438.
  9. ^ a b c d e f g Rudra, Shalini; Kalra, Aakshi; Kumar, Abhishek; Joe, William (4 May 2017). "Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014". PLOS ONE. 12 (5): e0176916. Bibcode:2017PLoSO..1276916R. doi:10.1371/journal.pone.0176916. ISSN 1932-6203. PMC 5417584. PMID 28472197.
  10. ^ a b Samal, Janmejaya; Dehury, Ranjit Kumar (May 2016). "An Evaluation on Medical Education, Research and Development of AYUSH Systems of Medicine through Five Year Plans of India". Journal of Clinical and Diagnostic Research. 10 (5): IE01–IE05. doi:10.7860/JCDR/2016/18194.7793. ISSN 2249-782X. PMC 4948421. PMID 27437245.
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  12. ^ Ghosh, Ajoy Kumar (April 2010). "A short history of the development of homeopathy in India". Homeopathy: The Journal of the Faculty of Homeopathy. 99 (2): 130–136. doi:10.1016/j.homp.2009.10.001. ISSN 1476-4245. PMID 20471616. S2CID 3758540.
  13. ^ a b "About the Ministry". Ministry of AYUSH.
  14. ^ Lakshmi, J. K. (January 2012). "Less equal than others? Experiences of AYUSH medical officers in primary health centres in Andhra Pradesh". Indian Journal of Medical Ethics. 9 (1): 18–21. doi:10.20529/IJME.2012.005. ISSN 0974-8466. PMID 22319847.
  15. ^ Gopichandran, Vijayaprasad; Satish Kumar, Ch (October 2012). "Mainstreaming AYUSH: an ethical analysis". Indian Journal of Medical Ethics. 9 (4): 272–277. doi:10.20529/IJME.2012.091. ISSN 0974-8466. PMID 23099604.
  16. ^ Bhatia, Rahul; Lasseter, Tom (23 May 2017). McBride, Janet; Hirschberg, Peter (eds.). "Modi's Yogi". Reuters. Retrieved 29 May 2022.
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  18. ^ a b "Clinical trials on Ayurvedic medicine against dengue underway: Shripad Naik". The Economic Times. PTI. 4 November 2018. Retrieved 22 January 2019.
  19. ^ a b Bhuyan, Anoo (9 August 2017). "AYUSH Ministry Writes to Nobel Laureate Against His 'False Propaganda' on Homeopathy". The Wire. Retrieved 23 January 2019.
  20. ^ "First Naturopathy day celebrated by Ayush ministry seeking to promote drug-less system of medicine". Hindustan Times. 19 November 2018. Retrieved 31 January 2019.
  21. ^ "Know Instances of Patenting on the UES of Medicinal Plants in India". PIB, Ministry of Environment and Forests, Government of India. 6 May 2010. Retrieved 21 May 2010.
  22. ^ "Institutes under AYUSH" (PDF). Archived from the original (PDF) on 3 June 2021. Retrieved 17 January 2020.
  23. ^ a b "About Us". NATIONAL INSTITUTE OF HOMOEOPATHY.
  24. ^ a b Manikandan, K. (1 September 2005). "National Institute of Siddha a milestone in health care". The Hindu. Chennai. Archived from the original on 7 November 2007. Retrieved 16 October 2011.
  25. ^ India Systems of Medicine & Homoeopathy Annual Report 2000-2001 (PDF). Retrieved 16 October 2011.
  26. ^ "Siddha hospital to get new OPD building". The Hindu. Chennai. 3 May 2018. Retrieved 4 May 2018.
  27. ^ a b Madhavan, D. (20 December 2012). "National Institute of Siddha modifies expansion plan". The Hindu. Chennai. Retrieved 23 December 2012.
  28. ^ "National Institute of Unani Medicine, Bangalore". AYUSH. Archived from the original on 20 December 2013. Retrieved 20 December 2013.
  29. ^ "Courses". National Institute of Unani Medicine. Archived from the original on 27 November 2013. Retrieved 20 December 2013.
  30. ^ "Institutions". CENTRAL COUNCIL FOR RESEARCH IN AYURVEDIC SCIENCES. CCRAS. Archived from the original on 24 April 2023. Retrieved 28 November 2022.
  31. ^ "National Commission for Indian System of Medicine". 11 August 2022.
  32. ^ "AYUSH ministry aims to triple market share of its medicines, services". The Times of India. 2 November 2018. Retrieved 31 January 2019.
  33. ^ Sharma, Neetu Chandra (20 October 2018). "Govt allocates ₹144 crore to AYUSH ministry for alternative medicines". Mint. Retrieved 31 January 2019.
  34. ^ Tuomela, R (1987). "Science, Protoscience, and Pseudoscience". In Pitt JC, Marcello P (eds.). Rational Changes in Science. Boston Studies in the Philosophy of Science. Vol. 98. Springer. pp. 83–101. doi:10.1007/978-94-009-3779-6_4. ISBN 978-94-010-8181-8.
  35. ^ Smith K (2012). "Homeopathy is Unscientific and Unethical". Bioethics. 26 (9): 508–12. doi:10.1111/j.1467-8519.2011.01956.x. S2CID 143067523.
  36. ^ Baran GR, Kiana MF, Samuel SP (2014). "Science, Pseudoscience, and Not Science: How do They Differ?". Healthcare and Biomedical Technology in the 21st Century. Springer. pp. 19–57. doi:10.1007/978-1-4614-8541-4_2. ISBN 978-1-4614-8540-7. within the traditional medical community it is considered to be quackery
  37. ^ Ladyman J (2013). "Chapter 3: Towards a Demarcation of Science from Pseudoscience". In Pigliucci M, Boudry M (eds.). Philosophy of Pseudoscience: Reconsidering the Demarcation Problem. University of Chicago Press. pp. 48–49. ISBN 978-0-226-05196-3. Yet homeopathy is a paradigmatic example of pseudoscience. It is neither simply bad science nor science fraud, but rather profoundly departs from scientific method and theories while being described as scientific by some of its adherents (often sincerely).
  38. ^ Shaw, DM (2010). "Homeopathy is where the harm is: Five unethical effects of funding unscientific 'remedies'". Journal of Medical Ethics. 36 (3): 130–31. doi:10.1136/jme.2009.034959. PMID 20211989.
  39. ^ Sample, Ian (21 July 2008). "Pharmacists urged to 'tell the truth' about homeopathic remedies". The Guardian. London.
  40. ^ "Homeopathy: Complementary therapy". Cancer Research UK. Retrieved 1 May 2022.
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  43. ^ "Homeopathic products and practices: assessing the evidence and ensuring consistency in regulating medical claims in the EU" (PDF). European Academies' Science Advisory Council. September 2017. p. 1. Retrieved 1 October 2017. ... we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect.
  44. ^ Semple D, Smyth R (2013). Chapter 1: Psychomythology (3rd ed.). Oxford University Press. p. 20. ISBN 978-0-19-969388-7. {{cite book}}: |work= ignored (help)
  45. ^ Kaufman, Allison B.; Kaufman, James C. (12 January 2018). Pseudoscience: The Conspiracy Against Science. MIT Press. ISBN 978-0-262-03742-6.
  46. ^ "13-10-09". Skeptic. 9 October 2013 [2011]. Retrieved 31 January 2019.
  47. ^ Quack, Johannes (2011). Disenchanting India: Organized Rationalism and Criticism of Religion in India. Oxford University Press. pp. 3, 213. ISBN 978-0-19-981260-8.
  48. ^ Manohar, P. Ram (2009). "The blending of science and spirituality in the Ayurvedic healing tradition". In Paranjape, Makarand R. (ed.). Science, Spirituality and the Modernization of India. Anthem Press. pp. 172–3. ISBN 978-1-84331-776-0.
  49. ^ Sources documenting the same:
  50. ^ Carroll, Robert (26 November 2012). "Natural". The Skeptic's Dictionary. Retrieved 8 September 2013.
  51. ^ "NCAHF Position Paper on Over the Counter Herbal Remedies (1995)". National Council Against Health Fraud. 1995. Retrieved 17 April 2009.
  52. ^ Atwood, Kimball C. IV (2003). "Naturopathy: A critical appraisal". Medscape General Medicine. 5 (4): 39. PMID 14745386.(registration required)
  53. ^ Gorski, David H. (18 September 2014). "Integrative oncology: really the best of both worlds?". Nature Reviews Cancer. 14 (10): 692–700. doi:10.1038/nrc3822. PMID 25230880. S2CID 33539406.
  54. ^ Singh S, Ernst E (2009). Naturopathy. Transworld. pp. 197–. ISBN 978-1-4090-8180-7. many naturopaths are against mainstream medicine and advise their patients accordingly – for instance many are not in favour of vaccination. {{cite book}}: |work= ignored (help)
  55. ^ Krisanaprakornkit, T.; Ngamjarus, C.; Witoonchart, C.; Piyavhatkul, N. (2010). "Meditation therapies for attention-deficit/hyperactivity disorder (ADHD)". Cochrane Database of Systematic Reviews. 2010 (6): CD006507. doi:10.1002/14651858.CD006507.pub2. PMC 6823216. PMID 20556767.
  56. ^ Ospina, M. B.; Bond, K.; Karkhaneh, M.; et al. (2008). "Clinical trials of meditation practices in health care: characteristics and quality". Journal of Alternative and Complementary Medicine. 14 (10): 199–213. doi:10.1089/acm.2008.0307. PMID 19123875. S2CID 43745958.
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  62. ^ Misra, Anoop; Gulati, Seema; Luthra, Atul (2016). "Alternative medicines for diabetes in India: Maximum hype, minimum science". The Lancet Diabetes & Endocrinology. 4 (4): 302–303. doi:10.1016/S2213-8587(15)00515-X. PMID 27016323.
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  77. ^ Malathy Iyer (4 July 2021). "Mumbai: Study says liver damage likely due to autoimmune response to giloy". Mumbai News - Times of India.
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  79. ^ "Relating Giloy to Liver Damage is completely Misleading, Says Ministry of Ayush". Ayush. 7 July 2021.
  80. ^ Mordani, Sneha (6 July 2021). "Liver injury seen in patients using excessive herbal immune boosters like giloy in Covid time".
  81. ^ "Ayush minister rejects RTI response of no-Muslim hire policy". Hindustan Times. 12 March 2016. Retrieved 20 June 2020.
  82. ^ Sheehan, Helen E. (2009). "Medical pluralism in India: patient choice or no other options? | Indian Journal of Medical Ethics". Indian Journal of Medical Ethics. 6 (3): 138–41. doi:10.20529/ijme.2009.045. PMID 19653589. S2CID 6339140.
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