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Dr. Ashwinikumar A. Raut MD (Ayurveda-Kayachikitsa)

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Presentation on theme: "Dr. Ashwinikumar A. Raut MD (Ayurveda-Kayachikitsa)"— Presentation transcript:

1 Scope and potential of Integrative Medicine in current Healthcare Scenario
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 – , 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 1/8/2013 Samyukti2013 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 1/8/2013 Samyukti2013 Bangalore/AAR

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) MMC 1835 GMC 1845 Six formally recognized parallel Medical systems Modern Medicine & AYUSH systems CMC 1907 1/8/2013 Samyukti2013 Bangalore/AAR

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 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 1/8/2013 Samyukti2013 Bangalore/AAR

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

6 Evidence Based Medicine
Patient preference Research Evidence 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 &anabauiQdp`idpona yaao naaivaSait t%vaivat .Aatursyaantra%maanaM na sa raogaaMiXcaik%sait iva 4.12 1/8/2013 Samyukti2013 Bangalore/AAR

7 Current Reality : Need for Integration
Clinical expertise Patient preference Clinical state & circumstances Research evidence Modern Medicine Ayurveda Pragmatic & practical Futuristic medicine 1/8/2013 Samyukti2013 Bangalore/AAR

8 Conventional Drug Development Path (Classical Pharmacology)
Hypothesis Theory & Postulation Basic Research Biology & chemistry Preclinical testing Invitro & invivo Clinical Human Trials Accepted drug FDA approval Cost 1 to 1.8 billion dollars HTPS 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 1/8/2013 Samyukti2013 Bangalore/AAR

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

10 Need for Different Path in Drug Development
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 Demand to go forward Need to look back at nature 1/8/2013 Samyukti2013 Bangalore/AAR

11 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 1/8/2013 Samyukti2013 Bangalore/AAR

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

13 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 Chondroprotection better adherence than GS Disease modifying Haridra Oral Submucous Fibrosis Micronuclei reduction Anticancer studies Samyukti2013 Bangalore/AAR 1/8/2013

14 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 1/8/2013 Samyukti2013 Bangalore/AAR

15 Cellular Effects Of Ayurvedic plants
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,turmerone polysaccharides NFkB, GSH & COX-1 Commiphora wightii Guggulsterones, Myrrhanone FXR,BSEP,Cytokines Glycyrrhiza glabra Glabridin, glycyrrhizin E2 & Aldost recptors, 1/8/2013 Samyukti2013 Bangalore/AAR

16 RP Drug Development: Prerequisites & Spectrum
Traditional Extracts Non Traditional Bioactive Fractions Active Principles Pharmaceutical Excellence Safety & Efficacy Formally Regulated Picrosides Picroliv Arogyawardhini Kutaki NCE Analogues & Derivatives Traditional Formulations Diverse Utility and Safety profile 1/8/2013 Samyukti2013 Bangalore/AAR

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 1/8/2013 Samyukti2013 Bangalore/AAR

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

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 1/8/2013 Samyukti2013 Bangalore/AAR

20 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 1/8/2013 Samyukti2013 Bangalore/AAR

21 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 1/8/2013 Samyukti2013 Bangalore/AAR

22 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 1/8/2013 Samyukti2013 Bangalore/AAR

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 1/8/2013 Samyukti2013 Bangalore/AAR

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

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

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