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

Samyukti2013 Bangalore/AAR 1

Scope and potential of Integrative Medicine in current Healthcare Scenario

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

Director Clinical Research & Integrative MedicineMedical Research Centre of Kasturba Health Society

ICMR Advanced Centre of Reverse Pharmacology in Traditional MedicineVile-Parle, Mumbai – 400056, India

[email protected]

Samyukti 2013An 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


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 Path1/8/2013


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)

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Six formally recognized parallel Medical systems Modern Medicine & AYUSH systems

MMC 1835

GMC 1845

CMC 1907


Current Healthcare Scenario: Facts & FiguresWestern 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

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Scope for Integrative Medicine through Evidence Based Approach


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 raogaaMiXcaik%sait ..ca iva 4.121/8/2013


Current Reality : Need for Integration

Clinical expertise

Patient preference


Research evidence


Clinical expertise

Research evidence

Patient preference

Modern Medicine

Ayurveda

Pragmatic & practical

Futuristic medicine1/8/2013


Conventional Drug Development Path(Classical Pharmacology)

HypothesisTheory &

Postulation

Basic Research

Biology &chemistry

Preclinical testing

Invitro & invivo

Clinical testing

Human Trials

Accepteddrug

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

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Estimate 2007, 63% NCE developed were resourced/ inspired from Natural products


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 scienceyaui>p`maaN

a

SabdAnaumaana va ]pmaana p`%yaxa vyavahar

Demand to move forward 1/8/2013

Home remediesNutraceuticalsOTC productsTM products( QA,QC & SOP )


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

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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.

Reverse Pharmacology

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Pragmatic integration of observational therapeutics, relevant science & drug discovery

12

Reverse Pharmacology Discipline

Experience Experiments

Evidence

Exploratory

ExplanatorySerendipity

Tradition

Translated Medicine for community / clinical practice

Techno centric

Pharmacocentric Therapy centric

Person centric

Dynamic, Self perpetuating Trans-Discipline1/8/2013 Samyukti2013 Bangalore/AAR

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Significant Research Contributions

Plant / Formulations

Indication Activity Impact

Arogyawardhini/ kutaki

Hepatitis Hepato-protective

Picroliv - Product

Kapikacchu Parkinson’s Diseases

Motor activityCognitive corrections Plasma levels

Phase I - US FDADouble 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

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Samyukti2013 Bangalore/AAR


Significant Research Contributions

Plant / Product

Indication Activity Impact

Parijat Malaria Anti-parasiteAnti-cytokine

Disease modifying

Mamejawa Type 2 DM Lipemic control Anti-oxidantDNA protection

Complication Prevention

Panchavalkal Leucorrhoea Vaginal infections

Ayurvedic Vaginal Cream

Ashoka Menorrhagia Ovulatory DUB

Subset identification

YashtimadhuAshwagandha

Perimenopausal syndrome

VasomotorAntioxidant

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,alkal

oids

B lymphocytes,

AGF

Curcuma longa Curcuminoids,turmer

one

polysaccharides

NFkB, GSH &

COX-1

Commiphora

wightii

Guggulsterones,

Myrrhanone

FXR,BSEP,Cytokines

Glycyrrhiza

glabra

Glabridin,

glycyrrhizin

E2 & Aldost

recptors,

1/8/2013


RP Drug Development: Prerequisites & Spectrum

Analogues & DerivativesTraditional

FormulationsTraditionalExtracts

Non TraditionalExtracts

BioactiveFractions

ActivePrinciples

Pharmaceutical Excellence

Safety & Efficacy

Formally Regulated

PicrosidesPicrolivArogyawardhini Kutaki NCE

Diverse Utility and Safety profile

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Protocols for Ayurvedic Clinical TrialsUnique / 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 Variables1/8/2013


Allopathy – Ayurveda: Enrichment Feedback

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REDUCTINISTModern Medicine

Holistic

HOLISTICAyurvedaReductionist

Molecule–Cell–Organ–Individual–Ecosystem

Multidisc

iplinary

Management

Chikitsadhikruta

Purusha

Molecular BiologyAnupara

manu Sidhhanta

IntegrativeMedicine

IntegrativeAyurveda


Integrative Ayurveda : AyurvidyaDefinition :

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


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 VarianceArthritis 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 & DaivavyapashrayaComplement strengths and overcome weaknesses

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Potentials:Interface of Ayurveda with Diverse DisciplinesAyurvedic

FundamentalsInterfacing

Scientific DisciplinesIntegrative 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


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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Samyukti2013 Bangalore/AAR 241/8/2013

Aa naao Bad`a: k``tvaao yantu ivaSvat:

25

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

Documents

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