According to missionary accounts, a wide range of Tibetan patients were attracted to the 18th century form of Western medicine offered by the Capuchins in Lhasa. Other European travellers in the pre-modern period record a similar demand for their medical services, but it is difficult to assess the rationale for that demand in the absence of more extensive and balanced sources. Greater overall efficacy seems doubtful in an era before the biomedical revolution of the late 19th century, but their availability and their offering of professional services without monetary aims must have been factors, along with a certain novelty.

The advances in biomedical science, however, transformed the equation. Both missionary and government medical initiatives introduced on the Indo-Tibetan frontier in the wake of the British imperial advance northwards towards Tibet found considerable appeal. While the adoption and subsequent indigenisation of biomedicine was a process which took several generations, and it was one which transformed rather than eliminated the local medical world, there does now seem to have been a general transformation; what was once the last resort is now first, and what was once first, is now last.

As they advanced into the Himalayan states, the British-Indian government used medicine primarily as a political/diplomatic weapon to win the support of the recently conquered indigenous peoples and the consent of their ruling elites. But while there were one-off grants for immediate humanitarian relief and occasional supplies of free medicine surplus to requirements in India, imperial funds were not normally given for indigenous medical development. The single greatest expenditure involved in medical provision was the salary of the IMS officer there and his primary responsibility was actually the health of the Political Officer and his staff.

This lack of development assistance was, however, at least partly a result of treaties under which the British agreed not to interfere in the internal affairs of the local states. Medical intervention could be seen, at least technically, as a breach of such agreements, with the result that medical developments were not imposed on the Indo-Tibetan frontier, but generally arose to a large degree as the result of local demand by influential individuals or groups, particularly but not exclusively from the elite classes.