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Taking A Position: A Call To Regulate Yoga In India
Trained practitioners warn that unregulated yoga can be detrimental to people's health. The government in India, where the ancient practice was invented, knows this very well — yet continues to postpone regulation.
Prime Minister Modi at a mass yoga demonstration in Lucknow, India
NEW DELHI — Prime Minister Narendra Modi led the observance of the eighth International Yoga Day from Mysuru, in southwestern India, early on the morning of June 21. Together with his colleagues from the Bharatiya Janata Party, he set out to mark the occasion in various parts of the country — reviving an annual ritual that had to take a break for the first two years of the COVID-19 pandemic.
Yoga is one of the five kinds of alternative Indian medicine listed under India’s AYUSH efforts — standing for "Ayurveda, Yoga, Unani, Siddha and naturopathy, and Homeopathy." Among them, only yoga is yet to be regulated under any Act of Parliament: All other practices are governed by the National Commission for Indian System of Medicine (NCISM), Act 2020.
Yoga and naturopathy are taught at the undergraduate level in 70 medical colleges across 14 Indian states. The Mangalore University in Karnataka first launched this course in 1989; today, these subjects are also taught at the postgraduate level.
The institutes that offer these classes aren’t considered on the fringe and the National Institute of Mental Health and Neurosciences also offers PhD courses on the topic.
Yet, despite this history of formal training, yoga and naturopathy practitioners aren’t required by any national Act to register before they start practicing. Meaning that no one can be held liable for practicing without a licence — whether they have completed a full-time course, have a few weeks’ certificate course under their belt, or haven't studied anything at all.
Seventeen states have passed their own registration laws, but in the absence of a national Act, a practitioner registered in one state cannot practice in another, making the effect of the registrations uneven.
The remaining states don’t have any regulations in any case — which could allow “a number of quack practitioners” to mushroom “with the growing demand for yoga and naturopathy clinical practice, putting the public at large at risk of malpractice and bad health,” as a Parliamentary committee had warned back in November 2019.
Dosage, warnings: Yoga should be treated like a drug
The Indian Naturopathy and Yoga Graduates’ Medical Association (INYGMA) has been aware of these ill-effects in the course of its work. Its president, Naveen Visweswaraiah, and vice-president, Rajesh Kumar Singh, said they encounter people almost every day suffering from a condition that was made worse by a misguided, unregistered practitioner.
“If a person with hypertension practices Kapalbhati, their blood pressure will shoot up,” Visweswaraiah told The Wire Science. They “may also get a stroke, but untrained or insufficiently-trained yoga practitioners don’t tell this to people.”
India, the country that gave the world yoga, is not interested in regulating its practice.
Similarly, Bhastrika (also known as hyperventilation) can trigger seizures in people suffering from epilepsy, he said. “Now when [a person suffering from seizures] comes to us, we make them do Bhastrika while we run an electroencephalogram , so we know which part of their brain is creating the problem. "But," he added, "we do this in the extremely controlled settings of a lab. If an [undiagnosed] patient is sitting in a yoga class, they can actually get a seizure because of Bhastrika. They can die. And people will think it happened just like that.”
According to Singh, the vice-president: “There are centres distributing brochures that claim they can 100% treat a disease with yoga, while it might not be possible in that condition. All this is happening and we, the trained doctors, are helpless.”
It is not difficult to understand why yoga needs to be regulated, Visweswaraiah and Singh said, comparing yoga to a drug: Just as a drug has contraindications and dose limits, so does the practice of yoga. "More is better" doesn’t work and is often harmful.
But in the absence of registration — let alone a law governing the practice of yoga — discussing dosage, indications and side-effects if off the table right now.
The UK, the U.S. and Australia have been reporting the potential adverse effects of yoga. But India, the country that gave the world yoga, is not interested in regulating its practice — both as a fitness regimen and as a medicinal system.
Moving goal posts
The Indian government might disagree, however. [AYUSH Ministry Secretary Rajesh Kotecha is yet to respond to a list of questions The Wire Science had sent him.] This is because the government has been kicking the yoga regulation can down the road for eight years.
Narendra Modi became India’s prime minister for the first time in May 2014; by December of that year, had transformed the Department of AYUSH into a Union ministry. But in the meantime, the Department had sent a letter to the health secretaries of all states, warning them that the Union government was planning on regulating the teaching and practice of yoga under the same Act that covered all other alternative systems.
This was the Indian Medical Central Council Act 1970. But fast forward six years, when the government replaced this Act with the NCISM Act (with no significant progress in the time that had elapsed), regulating yoga and naturopathy was no longer part of the document's scope.
The government’s rationale, which was provided to a standing committee in charge of evaluating the NCISM Bill, was that yoga and naturopathy are “drugless” — unlike the other AYUSH practices, meaning they couldn’t be regulated by the same bill.
“The committee is not at all convinced by the reasons given by the ministry,” the committee members wrote in their report, which ended with a recommendation to include a specific clause, in the same bill, pertaining to yoga and naturopathy.
The AYUSH ministry ignored this recommendation. It also ignored a 2017 NITI Aayog report which said, “Given the increasing recognition for yoga and naturopathy in potentially making an important contribution towards health promotion, well-being and disease prevention, we have recommended their inclusion in the NCISM.”
It seems like the AYUSH Ministry made a point of overlooking the recommendations of a wealth of reports. More than 50 members of Parliament, from both sides of the political spectrum, wrote to Prime Minister Modi in 2020 asking him to regulate the practice of yoga and naturopathy. The Indian Naturopathy and Yoga Graduates’ Medical Association has also appeared before several government committees and made representations to the AYUSH ministry.
[The Wire Science has copies of all the relevant reports and the letters by some of the MPs.]
A special bill for yoga and naturopathy
On May 19, 2022, the Union ministry wrote that “A [separate] bill with respect to regulating and standardizing the education and practice of Yoga and Naturopathy is under consideration in this Ministry.”
The same ministry had told a Parliamentary committee three years earlier that it had decided to not have a separate Bill “to empower the existing mechanism of National Board for Promotion and Development of Yoga and Naturopathy under Ministry of AYUSH to strengthen the aspects of regulating education and practice of yoga and naturopathy”.
This is like certifying quacks even if they don’t become doctors.
“It's a lollipop that has been served to us for ages now,” INYGMA’s Kumar said. “They have never shared a draft [of this bill]” nor specified “which government board or committee recommended to them that a separate bill be needed.”
If the ministry had been serious, Kumar added, it would have at least consulted INYGMA and other similar groups, since they have been fighting for regulations for almost a decade under the Modi government.
Kumar himself doesn’t want a separate bill — just like the Parliamentary committee didn’t. Their reason is that doing so would require a separate commission to monitor its implementation, which in turn would have significant financial implications for a sector that concerns fewer than 3,000 people.
The ministry also said that yoga and naturopathy were not fit to be considered Indian "systems of medicine’" because, once again, they don't involve drugs. This is a strange argument, especially since Prime Minister Modi has made yoga a staple of his message of national pride.
This said, the AYUSH ministry created a "Yoga Certification Board" through a simple communiqué in 2018. This board introduced multiple certificate courses ranging from a few hours to a couple weeks. The courses have no prerequisite qualifications, except having graduated from high school.
“This is like certifying quacks even if they don’t become doctors,” Visweswaraiah said.
This board isn’t much different from other centers around the country — and all of them still function beyond the remit of a law or policy that specifies what is good yoga and what isn’t. This in turn keeps the spotlight on the absence of such law or policy and the Indian government’s reluctance to regulate yoga.
Prime Minister Modi used the first and second Yoga Days to build soft power for India and included other countries in its observance. But if yoga practitioners are demanding something as basic as regulation on the eighth Yoga Day, it’s hard to believe the difficulties lie in framing the text, especially for a government as shrewd as the current one.
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