Download Dr. Ashwinikumar Raut - Scope and potential of Integrative Medicine

Dr. Ashwinikumar A. Raut
MD (Ayurveda-Kayachikitsa)
Director Clinical Research & Integrative Medicine
Medical Research Centre of Kasturba Health Society
ICMR Advanced Centre of Reverse Pharmacology in Traditional Medicine
Vile-Parle, Mumbai – 400056, India
[email protected]
Samyukti 2013
An Evidence Based Approach in integrating Ayurveda and Allopathy
Organized by
MS Ramaiah Academy of Health and Applied Sciences, Bangalore
Institute of Transdisciplinary Health Science and Technology (IHST) - FRLHT, Bangalore
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Presentation structure
 Integration of Ayurveda & Allopathy: A Tale of Two Centuries
 Current Healthcare Scenario: Facts and Figures
 Evidence Based Medicine: Complementary to Ayurveda Ethos
 Integrative Drug Development: Reverse Pharmacology Path
 Renaissance in Ayurveda: Integrative Endeavour
 Conclusion and Future Path
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Integration of Ayurveda & Allopathy:
A Tale of Two Centuries
 1822 first integrated National medical Institute in Calcutta by East India
Company with Bengal Vaidyas, 1827, 1833, 1835
 1878 Dayanand Maharshi College at Lahor
 1877 Ayurvedic institute, 1896 Prabhuram college at Mumbai by Dr.
Bhadkamkar, Dr. Bhau Daji Lad and Dr. Popat Prabhuram
MMC 1835
 Several colleges across the country Ayurveda/Integrated started following
Indian National Congress Resolution in 1920 at Nagpur
 1927 at BHU, Ayurvedacharya with medicine and Surgery
 1935 College of Indigenous Medicine at Madras
 1956 Integrated Medical Act by Govt. of Madras
GMC 1845
 1969 CCRIMH, 1970 IMCC act, 1971 CCIM, Integrated/Ayurveda
curriculum, 1973 Homeopathy Act
 Dept of ISM&H (1995), Dept. of AYUSH (2003)
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Six formally recognized parallel Medical systems
Modern Medicine & AYUSH systems
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CMC 1907
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Current Healthcare Scenario: Facts & Figures
 Western Allopathy Medicine transformed into Mainstream Modern
Medicine
 Global uniformity in Allopathy practices, education, research & its
publications
 Most of the advancing biomedical & paramedical branches subscribe to
the tenets of Allopathy
 Global spending on prescription drugs; US $ 954billion (2011), expected
to reach $ 1.1 trillion (2014)
 Iatrogenic diseases 3rd leading cause of deaths in US, estimated annual
mortality (783,936), medical cost ($282 billion)
 Approximately 56 percent of the population of the United States, have
been treated unnecessarily by the medical industry
 In many developed countries, 70% to 80% of the population has used
some form of alternative or complementary medicine
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Current Healthcare Scenario: Facts & Figures
 In some Asian and African countries, 80% of the population depend on
traditional medicine for primary health care
 More than 100 countries have regulations for herbal medicines
 WHO has projected that the global herbal market will grow to $5
trillion by 2050
 In India more than 500 million people use AYUSH medicines
 Worldwide, the Ayurvedic industry is put at US $3 billion
 Ayurvedic doctors(>500,000), Drug companies (>8,000), Hospitals
(>2500), Colleges (> 250) in India
 Standardization of Ayurvedic products, practices, training demand
more thrust in quality
Scope for Integrative Medicine through Evidence Based Approach
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Evidence Based Medicine
Clinical state & circumstances
The conscientious, explicit &
judicious use of current best
evidence in making decisions
about the care of individual
patients.The practice of evidence
based medicine requires the
integration of individual clinical
expertise with the best available
external clinical evidence from
systematic research and patients
unique values & circumstances
Patient preference
Research Evidence
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raogaaMiXcaik%sait ..ca iva 4.12
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Current Reality : Need for Integration
Clinical state & circumstances
Clinical state & circumstances
Clinical expertise
Clinical expertise
Research evidence
Patient preference
Patient preference
Research evidence
Ayurveda
Modern Medicine
Pragmatic & practical
Futuristic medicine
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Conventional Drug Development Path
(Classical Pharmacology)
Hypothesis
Theory &
Postulation
Basic
Research
Biology &
chemistry
Preclinical
testing
Clinical
testing
Accepted
drug
Invitro & invivo
Human Trials
FDA approval
Cost 1 to 1.8 billion dollars
HTPS 100000 molecules to 1
Time 10 to 12 years
Post marketing withdrawals
Need to look back at Nature
Estimate 2007, 63% NCE developed were resourced/ inspired from Natural products
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Traditional Medicine Drug Development Path
Classical
texts &
references
Sabd
Home remedies
Nutraceuticals
OTC products
TM products
( QA,QC & SOP )
Basic
principles
Analogy &
inferences
Para-clinical
Clinical
testing
testing
Accepted
drug
FDA Approval
Anaumaana va ]pmaana
p`%yaxa
vyavahar
Evidence base
through
relevant science
yaui>p`maa
Na
Demand to move forward
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Need for Different Path in Drug Development
• Application of
• Reduction in
Conventional correlates
Total cost
Relevant science
Total duration
Modern Technology
Undesired screening
• Predictability & reproducibility
• Toxicity & withdrawal
TM
Demand to go forward
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MM
Reverse Pharmacology Path
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Need to look back at nature
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Reverse Pharmacology
Definition:
Reverse pharmacology is the science of integrating documented
clinical/experiential hits, into leads by transdisciplinary exploratory
studies and further developing these into drug candidates by
experimental and clinical research.
Scope:
The scope of reverse pharmacology is to understand the mechanisms of
action at multiple levels of biological organization and to optimize
safety, efficacy and acceptability of the leads in natural products, based
on relevant science.
Pragmatic integration of observational therapeutics, relevant science & drug discovery
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Reverse Pharmacology Discipline
Exploratory
Tradition
Experience
Serendipity
Experiments
Explanatory
Evidence
Translated Medicine for community / clinical practice
Techno centric
Person centric
Pharmacocentric
Therapy centric
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Dynamic, Self perpetuating Trans-Discipline
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Significant Research Contributions
Plant /
Formulations
Indication
Activity
Impact
Arogyawardhini/
kutaki
Hepatitis
Hepato-protective
Picroliv - Product
Kapikacchu
Parkinson’s
Diseases
Motor activity
Cognitive
corrections
Plasma levels
Phase I - US FDA
Double blind
crossover study
Yograj Guggulu
Rheumatoid
arthritis
Anti-inflammatory Steroid withdrawal
Amrut Bhallatak
Osteoarthritis
Chondroprotectio
n better adherence
than GS
Disease modifying
Haridra
Oral Submucous
Fibrosis
Micronuclei
reduction
Anticancer studies
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Significant Research Contributions
Plant / Product
Indication
Activity
Impact
Parijat
Malaria
Anti-parasite
Anti-cytokine
Disease
modifying
Mamejawa
Type 2 DM
Lipemic control
Anti-oxidant
DNA protection
Complication
Prevention
Panchavalkal
Leucorrhoea
Vaginal
infections
Ayurvedic
Vaginal Cream
Ashoka
Menorrhagia
Ovulatory DUB
Subset
identification
Yashtimadhu
Ashwagandha
Perimenopausal
syndrome
Vasomotor
Antioxidant
Non-hormonal
product
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Cellular Effects Of Ayurvedic plants
Ayurvedic Plant
Active Principles
Cellular effects
Mucuna pruriens
L-dopa, indole alkaloids
DA receptors in CNS
Picrorrhiza kurroa
Picrosides, cucurbitacins
Hydrocoloretic &
aquaporins
Tinospora cordifolia Polysaccharides,alkaloids
B lymphocytes, AGF
Curcuma longa
NFkB, GSH & COX-1
Curcuminoids,turmerone
polysaccharides
Commiphora wightii Guggulsterones, Myrrhanone
FXR,BSEP,Cytokines
Glycyrrhiza glabra
E2 & Aldost recptors,
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Glabridin, glycyrrhizin
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RP Drug Development: Prerequisites & Spectrum
Pharmaceutical Excellence
Formally Regulated
Safety & Efficacy
Traditional Traditional
Formulations Extracts
Arogyawardhini
Non Traditional
Extracts
Kutaki
Bioactive
Fractions
Picroliv
Active
Principles
Picrosides
Analogues &
Derivatives
NCE
Diverse Utility and Safety profile
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Protocols for Ayurvedic Clinical Trials
Unique / pertinent
Product-related
Patient-related
 Ayurvedic kalpa
 Rugna Prakriti




(Classical form)
Aushadhi prayoga
(Dosage regimen)
Aushadhi kala
(Dosage schedule)
Anupana
(Vehicle for administration)
Ahara – Vihara
(diet & behavioral regimen)
(Patient’s constitution)
 Shat-kriyakala
(Stage of a disease)
 Samutthana-Vishesha
(Causative/ precipitating factors)
 Dosh-Dushya-Adhishthan
(Patho-physiological factors)
 Vyadhi Lakshana
(clinical features)
Countable Determinants not Confounding Variables
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Allopathy – Ayurveda: Enrichment Feedback
Integrative
Medicine
REDUCTINIST
Modern Medicine
HOLISTIC
Molecule–Cell–Organ–Individual–Ecosystem
Holistic
Ayurveda
Reductionist
Integrative
Ayurveda
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Integrative Ayurveda : Ayurvidya
Definition :
It is an active and open ended interface of Ayurveda with advancing
modern sciences, especially biomedical sciences to continuously
facilitate the incorporation of emerging new knowledge in the
mainstream of Ayurveda while maintaining the fidelity to Ayurvedic
fundamental principles
Scope :
Such a heuristic approach would promote the global acceptance of
Ayurveda’s “science of life” potentials which has the added ability to
identify novel paths for further development of biomedicine
Ashwinikumar A Raut,
J-A IM | Jan-Mar 2011 | Vol 2 | Issue 1
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Integrative Medicine v/s Integrative Ayurveda
Tenets
Integrative Medicine
Integrative Ayurveda
Ethos
Therapeutic Utility
Ayurvedic Validity
Bridge
CAM & TSM Remedies
Advancing Knowledge
R&D
Understanding Molecular
Mechanisms
Understanding Systems Biology
Goal
Molecules from Natural
products
Synergy with Nature of Man
Expertise
Physician – Investigator
Vaidya - Scientist
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Epistemological Variance
Arthritis
Sandhivat
Denotes inflammation
Denotes pain & loss of function
Genetic predisposition/Environment
Agnimandya/Apathya
Immune complexes
Aama accumulation
Inflammatory cytokines
Amavisha & Vishiated Dosha
Bone & Cartilage Damage
Asthi-Sandhi Hanan
Antiinflammatory & Immunosupresive
Amapachak & Vatashamak
Symptomatic & Palliative
Sampraptivighatan & Nidanparivarjan
Reparative & Rehabilitative
Rasayana & Apunarbhav
Reconstructive Surgery
Literature & Anecdotes
Patient education & Group therapy
Satvavajay & Daivavyapashraya
Complement strengths and overcome weaknesses
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Potentials:
Interface of Ayurveda with Diverse Disciplines
Ayurvedic
Fundamentals
Interfacing
Scientific Disciplines
Integrative Ayurveda
Disciplines
Sankhya Siddhanta
Cosmogenesis
Ayurontology
Panchamahabhuta
Elemental-Physics
Ayurphysics
Prakruti
Genomics
Ayurgenomics
Dosha-Dhatu-Mala
Systems Biology
Systems Ayurveda
Pradnyaparadh
Psyco-Somatics
Ayurcybernetics
Dravya-Guna-Karma
Pharmaco Kinetic-Dynamic
Aushadhi Dynamics
Bheshaja Anubhava
Epidemiology
Ay Pharmaco-epidemiology
Bheshaja Nirupana
Drug Discovery Sciences
Reverse Pharmacology
Pathyapathya Aahar
Nutritional Biochemistry
Ayurceutics
Pramana Mana
Quantitative Biostatistics
Ayurvedic Statistics
Modified from figure published in ‘Vaidya-scientists: catalysing Ayurveda Renaissance’, CURRENT SCIENCE, VOL. 100, NO. 4, 25
FEBRUARY 2011 ;Bhushan Patwardhan, Vishnu Joglekar, Namyata Pathak and Ashok Vaidya
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conclusion
 India’s ‘Medical Pluralism’ should become a strength if we embark an
integrative ethos of ‘Unity in Diversity’
 Current healthcare scenario has two sides; one is bright and another is
dark! As stakeholders of healthcare sector we need to ensure that
Brightness grows and Darkness subdues
 Evidence based approach is desirable to cultivate harmony between
Community, Clinicians & Researchers
 Reverse Pharmacology would provide safe & predictable products and
also facilitate integrative culture of Bedside to Bench & Vice versa
 Integrative Medicine and Integrative Ayurveda are mutually enriching
approaches which should accelerate the growth and development of
Biomedical sciences
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Aa naao Bad`a: k``tvaao yantu ivaSvat:
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Thank You !
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