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Dr. Ashwinikumar A. Raut MD (Ayurveda-Kayachikitsa) Director Clinical Research & Integrative Medicine Medical Research Centre of Kasturba Health Society.

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Presentation on theme: "Dr. Ashwinikumar A. Raut MD (Ayurveda-Kayachikitsa) Director Clinical Research & Integrative Medicine Medical Research Centre of Kasturba Health Society."— Presentation transcript:

1 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 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 1/8/20131Samyukti2013 Bangalore/AAR

2 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 1/8/2013Samyukti2013 Bangalore/AAR2

3 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 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 1969 CCRIMH, 1970 IMCC act, 1971 CCIM, Integrated/Ayurveda curriculum, 1973 Homeopathy Act Dept of ISM&H (1995), Dept. of AYUSH (2003) 1/8/2013Samyukti2013 Bangalore/AAR3 Six formally recognized parallel Medical systems Modern Medicine & AYUSH systems MMC 1835 GMC 1845 CMC 1907

4 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 3 rd 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 1/8/2013Samyukti2013 Bangalore/AAR4

5 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 1/8/2013Samyukti2013 Bangalore/AAR5 Scope for Integrative Medicine through Evidence Based Approach

6 Evidence Based Medicine 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 Clinical state & circumstances &anabauiQdp`idpona yaao naaivaSait t%vaivat.Aatursyaantra%maanaM na sa iva 4.12 1/8/20136Samyukti2013 Bangalore/AAR

7 Current Reality : Need for Integration Clinical expertise Patient preference Clinical state & circumstances Research evidence Clinical state & circumstances Clinical expertise Research evidence Patient preference Modern MedicineAyurveda Pragmatic & practical Futuristic medicine 1/8/20137Samyukti2013 Bangalore/AAR

8 Conventional Drug Development Path (Classical Pharmacology) Hypothesis Theory & Postulation Basic Research Biology & chemistry Preclinical testing Invitro & invivo Clinical testing Human Trials Accepted drug FDA approval Cost 1 to 1.8 billion dollars Time 10 to 12 years HTPS 100000 molecules to 1 Post marketing withdrawals Need to look back at Nature 1/8/2013Samyukti2013 Bangalore/AAR Estimate 2007, 63% NCE developed were resourced/ inspired from Natural products 8

9 Traditional Medicine Drug Development Path Classical texts & references Basic principles Analogy & inferences Para-clinical testing Clinical testing Accepted drug FDA Approval Evidence base through relevant science yaui>p` maaNa SabdAnaumaana va ]pmaana p`%yaxavyavahar Demand to move forward 1/8/2013Samyukti2013 Bangalore/AAR Home remedies Nutraceuticals OTC products TM products ( QA,QC & SOP ) 9

10 Need for Different Path in Drug Development Demand to go forward Need to look back at nature Reduction in Total cost Total duration Undesired screening Toxicity & withdrawal Reverse Pharmacology Path Application of Conventional correlates Relevant science Modern Technology Predictability & reproducibility TM MM 1/8/2013Samyukti2013 Bangalore/AAR10

11 Definition: Reverse pharmacology is the science of integrating documented clinical/experiential hits, into leads by exploratory studies and further developing these into by experimental and clinical research. 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 at multiple levels of biological organization and to optimize and of the leads in natural products, based on. 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. Reverse Pharmacology 1/8/2013Samyukti2013 Bangalore/AAR Pragmatic integration of observational therapeutics, relevant science & drug discovery 11

12 Reverse Pharmacology Discipline ExperienceExperiments Evidence Exploratory Explanatory Serendipity Tradition Translated Medicine for community / clinical practice Techno centric PharmacocentricTherapy centric Person centric Dynamic, Self perpetuating Trans-Discipline 1/8/2013 Samyukti2013 Bangalore/AAR 12

13 Significant Research Contributions Plant / Formulations IndicationActivityImpact Arogyawardhini/ kutaki HepatitisHepato-protectivePicroliv - Product KapikacchuParkinson’s Diseases Motor activity Cognitive corrections Plasma levels Phase I - US FDA Double blind crossover study Yograj GugguluRheumatoid arthritis Anti-inflammatorySteroid withdrawal Amrut BhallatakOsteoarthritisChondroprotectio n better adherence than GS Disease modifying HaridraOral Submucous Fibrosis Micronuclei reduction Anticancer studies 131/8/2013 Samyukti2013 Bangalore/AAR

14 Significant Research Contributions Plant / ProductIndicationActivityImpact ParijatMalariaAnti-parasite Anti-cytokine Disease modifying MamejawaType 2 DMLipemic control Anti-oxidant DNA protection Complication Prevention PanchavalkalLeucorrhoeaVaginal infections Ayurvedic Vaginal Cream AshokaMenorrhagiaOvulatory DUBSubset identification Yashtimadhu Ashwagandha Perimenopausal syndrome Vasomotor Antioxidant Non-hormonal product 141/8/2013Samyukti2013 Bangalore/AAR

15 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 Curcuminoids,turmeronepolysaccharides NFkB, GSH & COX-1 Commiphora wightii Guggulsterones, Guggulsterones, Myrrhanone FXR, FXR, BSEP,Cytokines Glycyrrhiza glabra Glabridin, glycyrrhizin E2 & Aldost recptors, 1/8/201315Samyukti2013 Bangalore/AAR

16 RP Drug Development: Prerequisites & Spectrum Analogues & Derivatives Traditional Formulations Traditional Extracts Non Traditional Extracts Bioactive Fractions Active Principles Pharmaceutical Excellence Safety & Efficacy Formally Regulated Picrosides Picroliv ArogyawardhiniKutakiNCE Diverse Utility and Safety profile 1/8/201316Samyukti2013 Bangalore/AAR

17 17 Protocols for Ayurvedic Clinical Trials Unique / pertinent Product-related  Ayurvedic kalpa (Classical form)  Aushadhi prayoga (Dosage regimen)  Aushadhi kala (Dosage schedule)  Anupana (Vehicle for administration)  Ahara – Vihara (diet & behavioral regimen) Patient-related  Rugna Prakriti (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 1/8/2013Samyukti2013 Bangalore/AAR

18 Allopathy – Ayurveda: Enrichment Feedback 1/8/2013Samyukti2013 Bangalore/AAR18 REDUCTINIST Modern Medicine Holistic HOLISTIC Ayurveda Reductionist Molecule–Cell–Organ–Individual–Ecosystem Multidisciplinary Management Chikitsadhikruta Purusha Molecular Biology Anuparamanu Sidhhanta Integrative Medicine Integrative Ayurveda

19 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 1/8/201319Samyukti2013 Bangalore/AAR

20 Integrative Medicine v/s Integrative Ayurveda TenetsIntegrative MedicineIntegrative Ayurveda EthosTherapeutic UtilityAyurvedic 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 ExpertisePhysician – InvestigatorVaidya - Scientist 1/8/2013Samyukti2013 Bangalore/AAR20

21 Epistemological Variance ArthritisSandhivat Denotes inflammationDenotes pain & loss of function Genetic predisposition/EnvironmentAgnimandya/Apathya Immune complexesAama accumulation Inflammatory cytokinesAmavisha & Vishiated Dosha Bone & Cartilage DamageAsthi-Sandhi Hanan Antiinflammatory & ImmunosupresiveAmapachak & Vatashamak Symptomatic & PalliativeSampraptivighatan & Nidanparivarjan Reparative & RehabilitativeRasayana & Apunarbhav Reconstructive Surgery Literature & Anecdotes Patient education & Group therapySatvavajay & Daivavyapashraya Complement strengths and overcome weaknesses 1/8/201321Samyukti2013 Bangalore/AAR

22 Potentials: Interface of Ayurveda with Diverse Disciplines Ayurvedic Fundamentals Interfacing Scientific Disciplines Integrative Ayurveda Disciplines Sankhya SiddhantaCosmogenesisAyurontology PanchamahabhutaElemental-PhysicsAyurphysics PrakrutiGenomicsAyurgenomics Dosha-Dhatu-MalaSystems BiologySystems Ayurveda PradnyaparadhPsyco-SomaticsAyurcybernetics Dravya-Guna-KarmaPharmaco Kinetic-DynamicAushadhi Dynamics Bheshaja AnubhavaEpidemiologyAy Pharmaco-epidemiology Bheshaja NirupanaDrug Discovery SciencesReverse Pharmacology Pathyapathya AaharNutritional BiochemistryAyurceutics Pramana ManaQuantitative BiostatisticsAyurvedic 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 1/8/2013Samyukti2013 Bangalore/AAR22

23 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 1/8/2013Samyukti2013 Bangalore/AAR23

24 1/8/2013Samyukti2013 Bangalore/AAR24 Aa naao Bad`a: k``tvaao yantu ivaSvat:

25 25 Thank You ! 1/8/2013Samyukti2013 Bangalore/AAR

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