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Evidence Based Ayurveda in realityDR.REMYA KRISHNAN MD(AY) PHDASSOCIATE PROFESSOR & HODDEPARTMENT OF DRAVYAGUNA, RGAMC , MAHE.
FACTS, SOLUTIONS AND DIRECTIONS FOR: Would be Doctors Doctors who are just starting out their career. Doctors who are in the thick of Medical practise. Doctors who are at the sharp end of difficult decision in the clinic.
AIM OF THE BOOK• To enable the physician to enjoy his patients .• To enable the physician to practise “Science based Medicine” instead of “Medicine based Science”.• To inspire a Medical student/House surgeon/ Doctor of any age “to constantly inspire himself” to do the best in the Science for the patient .
WHAT THE BOOK SPEAKS• Ayurvedic evidence?! How can we best ﬁnd it, interpret it, and contribute to it?• The crucial role of Basic science of Ayurveda in its evidence structure.• How can we sort of ways for which we can think of and apply evidence in our practise and research?• “How” to choose an Evidence Based medicine (More important than what to choose )
OBJECTIVE OF THE BOOK• Exercise judgement on the best estimates of diagnosis, prognosis , cure and prevention.• Accurately project the scientificity of this Medical system .• World wide recognition of what is called EVIDENCE BASED AYURVEDA.
WHAT IS THIS “EVIDENCE” ???• Evidence simply means proof .• Evidence is required for the “SCIENCE FORWARDED MEDICINE” and not for the “Medicine forwarded Science”• Evidence (Proven Science) behind ,the medicine originally determines the strength of proof of a medicine .• Medicine forwarded science starts from an “unknown compound for an unknown disease“ and hence is not necessarily proven.
PROVEN MEDICINEProven Medicine DOES NOT MEAN ProvenMedical Science.Proven Medical Science can only narrateETERNALLY PROVEN MEDICINES .Proven Medicine with no proven sciencebehind makes it “UNCERTAIN medicine”.Proven Medicine with no proven sciencebehind is INVALID PROOF.
MEDICAL EVIDENCE TODAYThe current medical research is focussedon “medicine” and not on “Science”The core of current research evidence isRandomised Control Study and Probabilitybased Statistics . Probability Based Evidence - Physician’sdetachment from the dynamic principlesof Basic science which best explains thenature of patient and disease.
Medical(Mechanical)evidenceUnderstanding - The physician is made deprivedof “Science based reasoning .Wisdom – The physician is not allowed to applywisdom .
What is lacking ?? DISSATISFIED DOCTOR• Medicine not led by Proven Science can turn harmful in any moment.• The medicine is applied based on “Statistics” and not “ Science”.• Today’s medicine can turn out to be tomorrow’s venom• MODERNITY DOES NOT NECESSARILY MEAN VALIDITY OF MEDICINE
Is today’s EBM “evident”?? Today’s EBM is not the real EBM . In true EBM, Evidence (Proven Science) must lead the Applied Medicine .In current EBM , ‘Medicinebased proof ’ is leading theApplied Medicine .Today’s EBM is originallyjust MBE ( MedicineBased Evidence)
A comparison of evidenceModern Medicine (MBE) Ayurveda (EBM)Evidence resources are Evidence resources arepublished DRUG reports and published and peer reviewedjournal articles (Pubmed/ LIFE SCIENCE theorems &Medline) principles to guide Applied MedicineApplied Research Evidence Basic research EvidenceMedicine Based Evidence Based MedicineEvidences(MBE) (EBM)Temporarily valid Permananantly valid
Evidence Based AyurvedaEvidence Based Ayurveda is AyurvedicMedical decision making and action based onsystematic scientific critical appraisal of BasicScience( Ayurvedic) Evidences in patienthealth care .
Present scenario• Poorly recognised by the majority of physicians of Ayurveda in India .• No specific knowledge regarding EBA to medical students and physicians .• Absence of EBA Physicians provides little stimulus for the development of specific protocols of EBA .
Bruhathrayees• Imperative resource for medical decision making .• Evidences formed after scientific evaluation and best peer reviewed for over centuries.• Evidences based on “ Basic science of human life ”.• Evidences deemed safest and effective by unbiased scientists .• Evidences which aptly guide Applied Medicine .
VALIDITYThe most scientific theories do not change in their fundamental understanding. No amendment possible means “truly scientific” .Could be best simplified and applied on target.
Five fold evidences in Ayurveda Scientific Principles• Roga tatwas- Disease oriented principles• Rogi tatwas- Patient oriented principles• Bheshaja tatwas- Treatment Principles• Kaala tatwas – State and stage (disease and patient) oriented principles• Phala tatwas- Effect determinant principles
Current Ayurvedic research• Disconnected from basic science.• Deviated from Five- fold evidences.• Absence of scientific reasoning (Tarka).• Probability based statistics.• Unscientific Double blind studies and Placebo control
What to re-search?Appraisal of Evidence Application of Evidence.Optimization of Evidence in new health care requirements . Science based Quality control of Ayurvedic drugs & formulations.
Current problem in Ayurveda Ignorance of Evidence Based Medicine Blind hunt of Medicine Based EvidenceThe Drug action is unpredictable without Evidence Based Medicine .
Medicine Based Evidence Conflicting opinions Misinterpretation of research outcome by Modern scientific parameters. Research outcome mostly benefit Modern Medicine. Research outcome immaterial to Ayurveda
WHAT DO WE LACK??WE HAVE STABLE EVIDENCE OF BASIC RESEARCH WE LACK : APPRAISAL OF EVIDENCE APLICATION OF EVIDENCE INFACT IT IS’’ WE ‘’WHO ARE LACKING , NOT OUR SCIENCE
EVIDENCE APPRAISAL Evidence appraisal refers to the process of systematised examination and analysis of Five fold evidence to evolve scientific standards from them relevant to the medical context to streamline the therapeutics for attaining effectiveness of therapies A Novel scientific technique for appraisal of evidences are mentioned for the first time in Ayurveda in this book known as EVIDENCE TRIAD APPROACH (ETA)
WHY EVIDENCE APPRAISAL?!• Trains you for “on the target prescribing”.• Transforms you into a true “Bhishak”.• Enables you to choose the simplest & best Evidence Based intervention for your patient.• Minimises the number of drugs in your prescription just to one or two.
When EBA is practised No separate logic of treatment for each specialist. Each specialist would be the best Doctor integrator of various systemic pathologies. Diagnosis of one integral disease behind multiple symptoms is possible. Implementation of the best appropriate evidence .
Why do we mimic Modern Medicine? Obsessed by Western charm Ignorance . Misunderstanding. Diffidence . Excessive commercial interest.
Only Solution• TRAINING& WORKSHOPS ON PRACTISE OF EVIDENCE BASED AYURVEDA.• ALL IDEAS ARE USELESS UNLESS WE APPLY THEM .• THIS BOOK INCORORATES SOME BEST PRACTICAL SOLUTIONS .• THIS BOOK INCORPORATES SIMPLE AND DIRECT STEPS FOR GUIDANCE IN PRACTISE OF EBA.
Finding Evidence-Based Answers to Clinical QuestionsI need Example Evidence resources to consider How to evolve the Five fold Evidence An overview of a pathogenesis ofparticular disease, Dengue fever incondition or Ayurvedic terms?background I have a Dengueinformation suspicious patient , hence need an immediate overview of the conditionDrug action Which Treatment Five fold evidence Principle is appropriate for my patient with HTN?
Finding Evidence-Based Answers to Clinical Questions Best recommendations What is the best Treatment Five fold for disease Principle for my patient with evidence management DUB ? How to decipher the patient particular samprapti in Ayurveda?To solve confusions : Why does Amrutharishta fail to Five fold check fever in my patient? evidence What should I understand when my patient’s joint pain shoot up after Sneha sweda?? What specific Pathya should I Five foldInformation to share suggest to my patient ? evidencewith patients What Apathya should I ask him to avoid ?
ART OF PRESCRIBING Abandon This medicine – That disease Approach.Adopt Treatment Principle (Evidence) basedClinical Practise & Research .
Medicine Based PrescribingUnscientificUnpredictableDangerousDestructive
Why not Evidence Based Ayurveda????? Commercial gain EBA “HEALTH FOR ALL” World wide acceptanceToday, world is not accepting Ayurveda, onlybecause it is practiced ‘Medicine Based’ and not‘Evidence Based’
EVIDENCE BASED AYURVEDA Why not practise EBA??
Modern Medicine –PROBABILITY BASEDModern Medicine isonly MEDICINEBASED EVIDENCE .
SALIENT FEATURES OF BOOK“EBA&RP”• ENABLES YOU TO KNOW AND PRACTISE EVIDENCE BASED AYURVEDA .• INCORPORATES NEW TECHNIQUES ON HOW TO MAKE THE BEST USE OF OUR EVIDENCES .• EMPHASIS ON HOW TO DEAL WITH THE COMMON CONFUSIONS IN MEDICAL DECISION MAKING.• GREATER COVERAGE OF APPLIED ASPECTS IN MEDICINE• MAKE US COMPETENT AND CONFIDENT IN OUR CAREER
Conclusion Let us stop living in science as if we are asleep !! Let us ponder into our Basic Science and streamline evidence by their organized application! Let us recognize and practise Evidence Based Medicine ! Let us adopt the best scientific ways to serve the mankind!
ATTENTION PLEASE! ONLY WE CAN PRACTISE EVIDENCE BASED MEDICINE IN REALITYLET US SHOW THE WORLDTHE WORLDTHE STRENGTH OFEVIDENCE BASED AYURVEDA