Practice-Based Evidence in Ayurveda

Ayurveda, when dismissed as a system of medicine with not much evidence, this dismissal presents an irony of how much evidence is, evidence and what is exactly is evidence. The gold standards of evidence in medicine had been “well-controlled” randomized controlled trials (RCTs). The concept of these RCTs as the gold “standard” of medicine was on the basis that everything in medical practice is based on standardized procedures and standardized diagnoses. The epistemological differences[¹] between Ayurveda and other systems of medicine in how diagnoses are made, how diseases are staged, and how treatments are administered actually leave no room for objective standardization of the “medical encounter” process, making it nearly impossible to do as expected in the typical RCT methodologies. Ayurveda-based treatment is always personalized and needs customization of medications and therapies.

The dissent from the concept that RCTs are the standards for medicine has already been a discussion among conventional medicine journals. Jones and Poldolsky, in an article, said, “this religious fervour of those who would sanctify randomized studies as the only means of learning the truth.”[²] This chauvinistic fervor for RCTs would not only prevent the personalization of medicine but would also prevent the right of access to the best possible options for the management of disease being denied to the patient. The concept of personalized medicine, which had been the standard in Ayurveda, is no longer alien to conventional medicine,[³] and this makes the conversation between both experts easier now.

The emphasis on RCTs led to Evidence-based Practice (EBP), which in turn led to the development of Disease Management Protocols, or otherwise, EBP eventually produced protocols in health care. These protocols often limit the possibilities and negate the existence of scope of multiple ways in which a condition may be managed, the possibilities of personalization, and thus, the best of medicine does not reach the needy. This is where the importance of Practice-based Evidence as a continuum to the evidence of safety and efficacy and the protocols should give way for only guidelines ensuring the safety and efficacy at the same time the flexibility of personalized care. Way more in Ayurveda, these aspects become more important because of its own epistemological peculiarities such as prakrti- and vikrti-based treatment approaches from person to person.

In this scenario, the use of data gathered from electronic medical records and such patient registries becomes extremely promising and important. The concept of “Practice-Based Evidence” as nurtured by Dr. P.R. Krishnakumar, to reinforce the efficacy of Ayurveda and the effort made by him through a Practice-based Evidence generation program titled Random Uninterrupted Documentation for Retrospective Analysis which was spearheaded by Dr. P Ram Manohar, had made a good beginning in Ayurveda. The future of evidence on Ayurveda would completely depend on such initiatives.[⁴]

Ayurveda, when criticized as a medical system without evidence, the fact that the classical texts referred to in the 'Drugs and Cosmetics Act, Schedule I',[⁵] itself is a published content worth to be treated as evidence. Certain aspects in it may not be contemporary and thus vouch for revalidation, that is why, once again, each clinical encounter becomes important to be reported. Promoting evidence base for Ayurveda has always been a need, and the concern of efficacy of these medications can rightly be addressed through Practice-based Evidence.[⁶]

Undoubtedly, the importance of case reports being published with the epistemological thought process or yukti of personalization would become the new gold standard of evidence in Ayurveda. These approaches not only bring evidence on the practices but would also give enough room for the epistemological differences and personalization of medical encounters and would give way to a more comprehensive “evidence.” Case reports though conventionally the lowest component among others in the evidence pyramid, in Practice based Evidence, this would become the most important aspect and would thrive as an evidence engine of Practice based Evidence in Ayurveda. Ancient Science of Life had been committed to encouraging publishing case reports and this editorial is a call for more and more case reports in Ayurveda.