Biomedicine in the Indo-Tibetan world today is part of a pluralist world of medicine comprising elements of various traditions and practices. Its structures and personnel have been largely indigenised and no Western doctors hold permanent appointments there. Biomedicine is recognised as being of foreign origin and has associations with local and global modernities rather than indigenous religio-cultural traditions. But it has become firmly rooted in the local medical world following practical concessions to local cultural understandings and the adoption of many aspects of its practice and theory by indigenous medical practitioners.

Reflecting wider social responses to modernity, the medico-cultural fractures induced by the introduction of biomedicine have resulted in a reformulated medical world. But medical cultures are intrinsically dynamic and constantly evolving. While biomedicine is structurally dominant at the state (or exile-state) level, indigenous medicine also receives state support in much of the region we have considered and it increasingly profits from the growing global interest in Traditional Medicine.

With Western biomedicine indigenised and Tibetan Medicine systemised and internationalised, the boundaries between systems have blurred. Both actively promote their benefits and at least implicitly critique other medical forms, but patients routinely switch between, or combine, therapies. In recognition of that reality, there is increasing communication between the various competing practitioners in this medical world, and even a growing sense of shared community indicative of a fully-formulated cultural system.

Such pluralism seems historically characteristic of medical encounters in this region, and is consistent with the conclusions of scholars such as Charles Leslie whose findings indicate that ‘patients are, almost without exception, pragmatic, and see nothing inconsistent about liberally combining different forms of therapy in their quest for restored health’ Craig Janes, for example, in a groundbreaking study of contemporary resort to biomedicine in the Tibetan Autonomous Region of China, indicates that patients there pragmatically continue to use a variety of health care resources according to their understanding of what resources best address what symptom, and an understanding of how the nature of the illness, its onset and duration, dictates how it should be handled.