Evidence Based Practice defines the quality of standard of care provided by the physicians of every recognised medical system of the world. The quality of clinical practice guidelines which the patients receive must be ensured by evidence of what is but a matter of utmost importance. When we are attempting to solve a problem in Mathematics or Physics, it is absolutely mandatory that we must attain the fundamental knowledge in respective sciences as prerequisite before attempting to solve them. Without knowing the fundamental logics of the particular discipline of Science with clarity and objectivity and instead by knowing the fundamentals of probabilistic Biostatistics, it is never possible to practically solve a problem and reach a valid conclusion in a deterministic science.

Ayurveda belongs to the category of  such kind of deterministic sciences where inbuilt theorems, logics, laws and principles of Health, Disease and Life are explained to understand man in relation to the peculiarities of his external environment and thereby intervene upon his unique internal environment which constantly modifies in accordance to the exterior. So, in order to choose a valid treatment decision, it is vital to know the finest aspects of scientific substratum of core science of diagnosis, differential diagnosis and management of Ayurveda. How ever the information of Randomised Control Trials of empirical compound administration in a random population by counting the temporary benefit risks observed there then cannot be counted as valid evidence for the physicians in deterministic medical sciences.

Randomized controlled trials that demonstrate the comparative effectiveness of one treatment over another simply tell us that without any inbuilt rationality to anticipate how a specific treatment may be better than the other in a population merely led by the temporary data of benefit risk led observations in population. This kind of casual observation led results are but strongly recommended to be abandoned in Ayurvedic science by the ancient scientists of the same addressing it as “ Yadrichaasiddhi” (random results) because they are unscientific and not a valid trust worthy substratum for clinical decision making. To make results scientific, the application is to be sensible and logical first and to ensure the sensible application, the knowledge and practice of core science and its innate logics of application are extremely vital. Hence the very practice of inbuilt Evidence Based Medicine led by the rational evidences of algorithms of Science Based Medicine is extremely crucial in the case of deterministic medical sciences like Ayurveda. No medicine can be made universally suited to the same disease in a population. There always personalised variations in patients with same disease in their cause and nature of mode of onset, progress, aggravation and alleviation, co morbidities etc and hence “ This medicine in that disease” consideration is very illogical and substandard. A patient’s improvement and recovery is led by several factors other than mere medication/ treatment alone but rather his diet and lifestyle, the multiple pathologies if present and their existing mode of management. Hence the very concept of New Drug development itself is very unethical as every new drug is later getting discarded for its potent harm and side effects and this is why new drugs are always required to be developed. It means that human beings are always meant to stay as Guinea pigs or rat specimens to test and fail various drugs and treatments and more badly it is purely a luck that decides who will get more benefits and whom risks and whether they get interchanged also. As the entire so-called Evidence Based Medicine of Western Medicine is led by probability and uncertainity, many physicians may be nudged to provide wrong treatments (Biostatistically wrong also) for their patients. More over Statistical significance of a treatment does never mean that it is clinically significant in a realistic situation which in simple terms convey that proven drug does never mean proven recovery and health. But unfortunately a large majority of world population still believe that Western Medicine as emerging scientifically proven drugs and treatments they are best protected by them .

Ultimately, the successful application of evidence-based medicine is an art that requires first and foremost, an awareness of logics and principles of inbuilt Science Based Medicine, and also an ability to pre determine how well the particular logical decision impacts every individual patient , why and how. A physician who follows  Science Based -evidence-based guidelines of Ayurveda 100% of the time is likely to have better aggregate outcomes than one who never follows  Science Based Evidence based guidelines, since the guideline will steer a physician intelligence  to comprehend what is intended to be done in the particular clinical status of the patient instead of blindly doing trial and error with different medications and treatments for benefit risks. But, the optimal application of evidence (principles) is as important as awareness of that evidence, and physicians must be scientists of this science of Ayurveda, using their best judgment to determine which evidence applies best and which treatments will most likely benefit individual patients.

This is why Science Based Evidence Based Ayurveda only deserves to be addressed as Evidence Based Practice in Ayurvedic System of Medicine.

                            Dr.Remya Krishnan MD PhD, The pioneer of Science Based Evidence Based Ayurveda

Evidence Based Practice defines the quality of standard of care provided by the physicians of every recognised medical system of the world. The quality of clinical practice guidelines which the patients receive must be ensured by evidence of what is but a matter of utmost importance. When we are attempting to solve a problem in Mathematics of Physics, it is absolutely mandatory that we must attain the fundamental knowledge in respective sciences as prerequisite before attempting to solve them. Without knowing the fundamental logics of a particular discipline of Science with clarity and objectivity and instead by knowing the fundamentals of probabilistic Biostatistics, it is never possible to practically solve a problem and reach a valid conclusion in a deterministic science.

Ayurveda belongs to the category of deterministic sciences where inbuilt theorems, logics, laws and principles of Health, Disease and Life are explained to understand man in relation to the peculiarities of his external environment and thereby intervene upon his unique internal environment which constantly modifies in accordance to the exterior. So, in order to choose a valid treatment decision, it is vital to know the finest aspects of scientific substratum of core science of diagnosis, differential diagnosis and management of Ayurveda. How ever the information of Randomised Control Trials of empirical compound administration in a random population by counting the temporary benefit risks observed there then cannot be counted as valid evidence for the physicians in deterministic medical sciences.

Randomized controlled trials that demonstrate the comparative effectiveness of one treatment over another simply tell us that without any inbuilt rationality to anticipate how a specific treatment may be better than the other in a population merely led by the temporary data of benefit risk led observations in population. This kind of casual observation led results are but strongly recommended to be abandoned in Ayurvedic science by the ancient scientists of the same addressing it as “ Yadrichaasiddhi” (random results) because they are unscientific and not a valid trust worthy substratum for clinical decision making. To make results scientific, the application is to be sensible and logical first and to ensure the sensible application, the knowledge and practice of core science and its innate logics of application are extremely vital. Hence the very practice of inbuilt Evidence Based Medicine led by the rational evidences of algorithms of Science Based Medicine is extremely crucial in the case of deterministic medical sciences like Ayurveda. No medicine can be made universally suited to the same disease in a population. There always personalised variations in patients with same disease in their cause and nature of mode of onset, progress, aggravation and alleviation, co morbidities etc and hence “ This medicine in that disease” consideration is very illogical and substandard. A patient’s improvement and recovery is led by several factors other than mere medication/ treatment alone but rather his diet and lifestyle, the multiple pathologies if present and their existing mode of management. Hence the very concept of New Drug development itself is very unethical as every new drug is later getting discarded for its potent harm and side effects and this is why new drugs are always required to be developed. It means that human beings are always meant to stay as Guinea pigs or rat specimens to test and fail various drugs and treatments and more badly it is purely a luck that decides who will get more benefits and whom risks and whether they get interchanged also. As the entire so-called Evidence Based Medicine of Western Medicine is led by probability and uncertainity, many physicians may be nudged to provide wrong treatments (Biostatistically wrong also) for their patients. More over Statistical significance of a treatment does never mean that it is clinically significant in a realistic situation which in simple terms convey that proven drug does never mean proven recovery and health. But unfortunately a large majority of world population still believe that Western Medicine as emerging scientifically proven drugs and treatments they are best protected by them .

Ultimately, the successful application of evidence-based medicine is an art that requires first and foremost, an awareness of logics and principles of inbuilt Science Based Medicine, and also an ability to pre determine how well the particular logical decision impacts every individual patient , why and how. A physician who follows  Science Based -evidence-based guidelines of Ayurveda 100% of the time is likely to have better aggregate outcomes than one who never follows  Science Based Evidence based guidelines, since the guideline will steer a physician intelligence  to comprehend what is intended to be done in the particular clinical status of the patient instead of blindly doing trial and error with different medications and treatments for benefit risks. But, the optimal application of evidence (principles) is as important as awareness of that evidence, and physicians must be scientists of this science of Ayurveda, using their best judgment to determine which evidence applies best and which treatments will most likely benefit individual patients.

This is why Science Based Evidence Based Ayurveda only deserves to be addressed as Evidence Based Practice in Ayurvedic System of Medicine.

                            Dr.Remya Krishnan MD PhD, The pioneer of Science Based Evidence Based Ayurveda

Whenever I engage in a conversation with my conventional Ayurveda colleagues, I frequently find many of their faces getting disappointed or frowning at me. My fellow physicians are unhappy to hear my words on the need for crucial updating of the system and the quality of performance of Ayurveda physicians as they take it personalized criticism against them and that I am an arrogant personality. What I  understand from this after such a long period of receiving this attitude from many in my professional community is that the Ayurvedic community is raised in medical colleges in such a way that they should surrender their intelligence and common sense to anything and everything which they listen to under the label Ayurveda from faculties and real humbleness is doing that without any queries of clarification. As Ayurvedic biology is quite unfamiliar to fresh students of Ayurveda, it is natural for them to get too many queries. But their inquisitive mind is suppressed from the very first year by telling that Ayurveda is a highly controversial philosophy where variable opinions of different so-called “experts” (expertise does not have quality parameters defined in  conventional Ayurveda) are very much acceptable for the same context and that we should not question anything. So, there is no wonder that any faculty who encourages them to keep asking and arguing for clarity and confirmation would be considered as the one who is trafficking in Anti Ayurveda. According to these large majority of faculties who wish to stay in their comfort zones permanently, anything which contradicts their thoughts, beliefs and blind experiences is Anti Ayurveda. Obviously, anything which stay static in brains sealed and double insulated would deteriorate eventually and Ayurveda professional community forgets to think and apply the innate common sense in the science of Ayurveda as they do not get specific education and motivation to do that. Thus they become eternal diffident slaves to themselves and society and in spite of prescribing to hundred patients a day also, they become incapable to reverse their own infective fever confidently.

The people who are conferred “expert” titles in Ayurveda mostly secure it by big political influence or business and not based on an unbiased evaluation of their knowledge of expertise and quality performance. Unfortunately, once few people are entitled as experts in the above said manner, they will be only continuously given opportunities in policy changes with regard to professional education, research and clinical practice and hence any dedicated medical professional who genuinely proposes some out of the box ideas and methodologies to consider in policy will be naturally suppressed or blocked by the already selected “expert panel” as this new proposal is rationally challenging the existing policies with effective practical solutions to revise them. This is why I believe SBEBA proposals which offer promising Health future to this science ,humanity and national economy continue to stay without serious appraisal and response.

Science Based Evidence Based Ayurveda (SBEBA) practises the Science Based Medicine in place of conventional Ayurveda practice which is based on different beliefs, ideas, experience and individual opinions of “legends”. Ayurveda strictly advocates to practice Science-Based Medicine (Jnana Poorva Karma), but as the conventional Ayurveda does not do the same, conventional Ayurveda cannot be counted as Rational Ayurveda.Ayurvedic science being highly complex and vast , strictly advocate its practitioners to constantly culture their intelligence in the innate theorems, logics and principles of Ayurveda which is technically speaking “ Shaasthraarthakarmaanusheelana”. But currently it is not adopted and instead the practice of “This medicine in that disease” is encouraged in different policies of education, research and clinical practice. In Ayurveda, it is the innate intelligence of physician that requires constant enhancement and refinement and artificial intelligence can absolutely do nothing to promote natural intelligence of humanbeing. Ayurveda being a deterministic science led by deductive logics, inductive reasoning based on the results of statistical data of empirical drug administration is of no value in the same. Attaining high-level intelligence in the knowledge and application of Science Based Medicine by development of certain innate methodologies is what is done by the SBEBA pioneers for the past decade and more and large number of physicians who have undergone training through workshops of SBEBA are aware of the difference in the precision and quality of their mode of clinical practice before and now.

The fundamental principles of the deterministic science of Ayurveda like Mathematics can specifically predict whether the particular treatment works to produce the “intended effects” (not mere Benefit- Risks) in the particular patient in a particular condition by answering specifically the questions “HOW and WHY” and thus SBEBA deserves to be addressed as Science Based Medicine. Science refers to the knowledge of precision and certainity and not data of probability and confusion and Ayurveda is such a science that explains in detail the methods and logic to abandon confusion and uncertainity in choice and application of its logic. Therefore, applying Randomised Control Trial studies in such deterministic sciences is arguably unethical because the very fundamental requirement of any clinical trial is to establish that the particular treatment is grounded in good science which explains its cause and consequences.
If SBEBA is suspicious to anyone, SBEBA has to be professionally challenged through scientific debates and discourses instead of baseless blaming, backbiting, and personalized defamation of the pioneers of the same. The wide revolutionary ideas and evidence of SBEBA overturn much of the what is presently known and adopted as Ayurveda and hence it is natural to feel uncomfortable with this. But uncritical rejection is equally pathetic and dangerous as uncritical acceptance and doing it will arrest the intended professional renaissance of the Ayurveda community and the timely updation of this medical system

                                                                                                                                                                                    Dr. Remya Krishnan MD PhD

AYURVEDA - WHERE IS THE EVIDENCE?

By this small write up, I honestly would like to analyse the ethicality of so addressed scientificity of evidence of medical system as such, before coming to Ayurvedic system of Medicine. As a physician, faculty and scientist of Ayurveda, I have been working on professional solutions to the challenges faced by Ayurveda medical professionals today among which the predominant one is “Evidence” of Evidence Based Medicine. Evidence is undoubtedly the corner stone of the scientificity of a medical system. Evidence literally means proof employed to back-up or refute arguments allowing us to work out what is effective and what is not. Now let us take an example of lock and key system used to open a door. To open a door-lock, we need to use only one key which is aptly suited to do the same and if that right key is with us, there is no need and absolutely no use of doing trial and error with key after key. The process of trial and error with many unsuited keys may lead to damage of the lock and sometimes the door itself and hence it is important that first of all, we need to comprehend the highly specific and specialised details of the door and lock in-order to find out the right key for the same. The right key once chosen, is not opening the door with any probability but it opens the door every-time with precision and certainity. Any medical system is ultimately intended to heal man and not as trial and error system with different keys. The process of healing can never be associated with risks because healing is innately natural and unique for the reversal of cause-mechanisms of disease(s) in the subject thereby facilitating health. Hence the very proof of working of a medical system is the proof of showing in a live setting that the person is healing hour by hour, day by day and thereby attaining health. This is the real evidence to substantiate that the system of Medicine is scientific. A scientific medical system describes the innate process of healing leading to fastest recovery by reversal of pathogenesis.

Unlike a machine, which is primarily complex and secondarily simple (artificial), man is primarily simple but secondarily highly complex. In-order to prove that something works to resolve a problem in man (naturally complex),  the comparative benefit-risk ratio and statistical significance of an unknown compound trial in population cannot be considered as a proof for an effective solution to the problem as the effective solution is only that which leads to the intended outcome of reversal of cause-mechanisms of disease leading to emergence of health in every individual subject. A man in real life situation can be morbid in a highly variable and complex way. There can be multiple pathologies working at the same time or sometimes one alone or sometimes one pathology leading to the other or even wrong ways of dealing with old pathologies leading to newly emerging pathologies. So, there is absolutely no point to begin the research to solve a clinical problem in a variable population with the same unknown compound and check for its working by the process of masking, blocking, suppressing or altering different intrinsic pathways, enzymes or ion channels or chemicals inside the body. Multiple unique factors play at the same time interacting in dynamic and unpredictable ways in an active pathology in the body and hence it is extremely crucial that an integral estimation of man and disease(s) as well, are to be done to ultimately reverse the problem. Definitely, masking, blocking and suppression are not ethically approved working in the process of healing the man. If the purpose of medical research is reversal of disease, then definitely, “a fit for purpose scientific paradigm” is required to be adopted in medical research to be addressed as scientific medical system.

Ayurveda is Science of man and hence it explains the process of problem solving in man within man and not outside. Hence the science addresses how to comprehend the nature of different clinical problems along with the crucial hints to probe into the underlying dysfunction of subtle-most functional classification of structures in man and HOW and WHY of the dysfunction unique to the particular subject. Ayurveda is thus not a Medicine Based Science, rather it is Science Based Medicine. The evidence in Ayurveda are hence inbuilt science led answers to know what happened in the patient, how and why and what exactly is to be done to reverse the same (how to choose the right key). There are no benefit-risk oriented evidences in Ayurveda because Ayurveda is meant to produce intended effect of healing the disease and not blocking, masking or suppression of the same. Evidence in Ayurveda is meant for right decision making of physician resulting in intended effects in every individual patient and not the blind trial and error hunt of drug after drug for marketing approval.

In short, Evidence in Ayurveda entirely lies in the Natural Applied Science and the Science Based Medicine of Ayurveda itself and not in the data sheets emerged by the practice of probability-based trial and error hunt of Statistical Medicine. Statistical Medicine can never be the Scientific Medicine in healing man. Now let me conclude by this open question to every one - “Western Medicine - Where is the evidence of healing?”

                                     Dr. Remya Krishnan MD PhD 

Honestly, Research in healthcare is meant to advance knowledge for good of the society, to improve the health of people worldwide, and to discover the optimized ways to treat and prevent disease But is this what the reality is with regard to medical research happening today? The research funders have adopted a long drawn-out bureaucratic process for their grant giving.  The Ayurvedic Research Fund system operates within the accepted framework of thinking of western research methodologies which are incompatible with the fundamental nature, attitude, approach, and goals of Ayurvedic research. Any outside-the-box ideas and proposals oriented toward Ayurvedic research and clinical methodologies are seen as uncritically rejected and opposed. Eminence Based Medicine and Experience Based Medicine is seen as widely accepted today and conventional Ayurveda practice is entirely based on decisions of opaque peers and "experts" assessments though experts are never assessed. It is high time to stop and reflect on how we can restructure and reframe the research, clinical practice, and education of Ayurveda strictly based on the inbuilt rational standards of the independent Science of Ayurveda itself and this is what Science Based Evidence Based Ayurveda is aimed to achieve. Meaningful impact in research is more important than profitful impact of research in healthcare. Western Medicine has always aspired to be scientific but the Science of Western Medicine is probabilistic data-oriented conclusions on the benefit- risks of unknown compounds and not the rational knowledge to explain the deep and complex pathophysiological mechanisms happening in the patient in accordance to the nature, state, and stage of his morbidity. 

The mission of Science Based Evidence Based Ayurveda ( SBEBA) is to educate medical students in accordance with the highest professional standards to intellectually prepare them to practice the "Patient-centered Medicine" of the highest standard to identify and answer the fundamental questions in identifying the cause mechanism and treatment of diseases in accordance to the state and stage of patients. The goal of SBEBA is to emerge the leaders of Ayurvedic Medicine who will take the foundation of Ayurvedic Science to rationalize, evolve and emerge the finest quality in patient care, research, and education. SBEBA-oriented education enables them to apply the scientific principles of Ayurveda to the diagnosis, management, and prevention of diseases of the present and future. It also enables them to understand the subtlest changes happening in the body of the patient in accordance with the variations in stage and stage of their disease and thereby critical evaluation of the patient is possible in relation to his all activities. This process of critical appraisal will emerge the finest quality algorithms for treatment decisions. Thus SBEBA will enable Ayurvedic medical professionals to obtain a sufficient level of optimized medical knowledge vital to understand the basic facts, concepts, and principles of Ayurveda which are crucial for competent medical practice in Ayurveda. Data of the impact of conventional Ayurveda practice in relation to SBEBA-oriented practice are available in large volumes to explicit the reality about the relevance of the practice of Science-Based Medicine in Ayurveda.

 SBEBA promotes Professionalism 

SBEBA-oriented education in BAMS and MD and higher education will abolish the existing diffidence and slavery of Ayurveda medical professionals and help them to build up compassion, honesty, and integrity in their profession. This will also result in adherence to the highest ethical standards of professional judgment and conduct advised by the ancient scientists of Ayurveda in place of currently adopted mere business standards and conduct in the Ayurvedic healthcare system. It also helps to emerge a constant critical self-appraisal attitude towards self-knowledge and practice of the system and thereby emerges a healthy professional spirit and integrity among Ayurveda medical professionals. The rational standards of SBEBA could be applied to emerge prescription audit and clinical audit and thereby implement a standardized decision-making process a reality in Ayurveda. It enhances the spirit to constantly work hard in the principles of Science-Based Medicine of Ayurveda and thereby culture and refine their intelligence to upgrade their knowledge and professional skills and stay as responsible medical professionals in the society 

                                                                                                                                                                                                       Dr. Remya Krishnan MD PhD( Ay)

                                                                                                                                                                                                       The Co Pioneer of SBEBA 

Science-Based Evidence Based Ayurveda ( SBEBA ) is a new paradigm for performing scientifically standardised clinical practice by the Ayurveda practitioners for the first time in the history of Ayurveda.SBEBA de- emphasizes unsystematic beliefs, self and shared experiences with medicines and treatments ,intuitions and empirical observations in patients and data sheets as sufficient grounds for clinical decision-making in Ayurveda and stresses the knowledge and practice of inbuilt logics and algorithms of Ayurvedic science in their place. The practice of SBEBA requires new and improvised knowledge and skills for learning and comprehending Ayurvedic scientific literature and its optimized mode of translation into the unique patient environment.
An important goal of SBEBA education is the practice of systematic and Precision oriented Ayurvedic Science-Based Medicine (SBM) in place of the current unsystematic and unscientific practice of Tradition oriented beliefs and experiences.SBEBA is thus an important mandatory tool for social justice by Ayurveda. It has immense potential to save man-days and thus improve the national and global economy.SBEBA has also a prominent role in national healthcare policy-making by implementing its inbuilt tools and methodologies based on the science of Ayurveda to inform the clinical decisions of physicians in a science-led standardized manner.
The clinical decisions are to be entirely based on evidence. But the evidence is to be based on precision logic in the Science of Ayurveda as Ayurveda is fundamentally a deterministic Science and Science led Medicine and not Probabilistic unknown compound-led data-oriented practice. Hence the best proof to demonstrate the scientificity and potential of Ayurveda is possible only by the inevitably sensible application of the science of Ayurveda. The most valid evidence to demarcate Scientific Medicine and charlatanism is the basement knowledge of Ayurvedic science itself which are transparent and reproducible in every period. 

Teaching in Ayurveda 
It is important that professional education of Ayurveda is to be redesigned and optimized by the knowledge of principles and practice of Science-Based Medicine in place of existing unsystematic Eminence Based Medicine or Experience Based Medicine. For that, the faculties of all disciplines should be first and foremost passionate in their system of practice and again for that they require continuous orientation programs to understand and apply science-based principles and algorithms. Learning science and acquiring professional degrees is what is happening today but to become an effective faculty or clinician beneficial to society as a medical professional/ faculty, one has to acquire the accurate comprehension of Shaasthraarthas ( the true intention of scientific verses) explained in Samhitas of Ayurveda and their sensible application. This is never taught and demonstrated ever in Ayurveda colleges and hence the existing curriculum is emerging medical graduates as diffident slaves who cannot even take care of the healthcare needs of themselves and their families. Here are the crucial necessities for Ayurveda faculties to become worthy for their students and society:

a. Faculties should possess sufficient clarity and objectivity in the concepts of this science that they teach and are supposed to train. If they cannot quickly explain and simplify the core principles and basics of the science of Ayurveda to their students, the students will never be able to grasp the intentions of what the faculties are delivering in class. Everything merely appears as stories and not Science and this is what is happening today.

b.Questioning to check the understanding of students in a particular topic is to be done by the faculties .instead of asking to reproduce verses alone ( learning scientific verses and byhearting them are also crucial but comprehending their real intentions and sensible application is vital). Hence applied questions are to be asked to students to encourage to develop a scientific temper in them which will uplift their true professional spirit.

c.Graphical representations - Codes, mind maps, and flow charts after teaching science help to summarise what they have grasped sensibly without losing the interrelationship between the different components. This will enable them to keep their comprehension of the topic alive in their brains.

d.Practice " Right" things-The scientific knowledge in Ayurveda is entirely practical and not crude and abstract theories and hence Ayurveda is a complete science. Hence students of BAMS itself should be constantly practicing what they are taught and demonstrated in a realistic patient environment, constantly verifying and analyzing the results of the same from time to time with simultaneous analysis of concepts and their logical application. This process is intended to scientifically sharpen and culture their intelligence and systems thinking technically termed " Shaastraarthakarmaanusheelana" which is inevitable to become a scientific practitioner( Bhishak) of Ayurveda.

e. Feedback to students on their particular tasks instead of praise- Today faculties are seen praising students mostly with vested interests and motives. If a faculty is genuinely interested in the intellectual progress of students, they care to recognize the individual strength and flaws with identical minds and advocate highly specific and specialized personalized strategies for their intended knowledge and progress. Thus they help students to develop integrity, professional spirits, and confidence in their system of Medicine.

f. Tasks to improve productivity- Quiz, workshops, debates, and different publishing initiatives will be constantly encouraged for students to incorporate problem-solving skills which serve as motivation for students in their process of learning and evolving 

CONCLUSION
SBEBA is oriented based on the above kind of approach to emerging scientific practitioners in Ayurveda in place of current medicine prescribers and sellers. Ayurveda is Science-Based Medicine and not Medicine Based Science and healing ( responsibility) and not mere prescribing ( duty) is strictly advocated for Ayurveda physicians by the ancient Ayurveda scientists. Continuous learning, research, teaching, and practice and simultaneously required for an Ayurveda physician for his constant intellectual upliftment to do sensible practice and justice.

We can observe a lot by just watching but cannot learn anything. A factual conclusion about any of our observations is possible only if we know the “Why & How” behind these observations. Science is that which incorporates knowledge for us to do reasoning in all our observations. Once we do inductive reasoning (observation-oriented reasoning) led by this Science (knowledge of laws of nature of man and universe), then there are fruitful conclusions or else it is similar to the observations made by a dog when it visits a market. It does not have any idea regarding the purpose of the visit and hence will roam here and there without any definite objective. Medical research is meant to save lives and the health of the patients by comprehending human body and the active cause mechanisms behind the morbidity and not merely do trial and error with unknown drugs and compounds. Testing new drugs by discarding the old ones because of detrimental side effects in many subjects led by observational research like what is happened in the case of the drug Remdesivir used in COVID-19 patients is a perfect example of unethical medical research led by empirical observation.
Testing a drug in modern times is that it is tested by randomized Control trials done in a  random population observing for benefits and risks and such trials are counted as the golden standard of medical research today. Laboratory serendipity based on temporary observations of some identified benefits and identified and unidentified risks are getting approval as drugs in the Western Medicine market for use in human beings to block, mask, suppress or alter disease mechanisms addressed as “Treatments”. After the patients with an infective fever worsen hour by hour and day by day because nothing is known to be done to reverse the intrinsic cause of the progress of infection in tissues and claiming to study the disease by mere observation and empirical drug administration allowing the subject to die is not research but rather crime. COVID-19 is like any other viral fever and it is not the virus but rather the fever (immune response to the virus) that is addressed as disease. An infective fever can manifest and progress in accordance to multiple interlinked cause mechanisms active in the subject responsible for the progress of infection and the true culprit here is not really the non-living particle of the virus.  Unless and until nothing is done in favor of the immune mechanisms of the subject to facilitate recovery, any time and every time, the infection can escalate to emergency. Instead of conducting a crucial study of multiple components impacting the progression of infection in the host, sharing external observations of different clinical manifestations in the patients through presentations and case reports putting blame on so believed to be a non-living thing as real culprit is not at all a desirable endeavour of a medical science. I do not consider it as progression in medical research, rather it is regression. Mere observations without attempting to understand the underlying subtle most and interlinked cause mechanisms will never improve the care of patients, no matter how much expensive technological interventions are used in observation. Research in Medicine should be an honest attempt to explore and conclude without disturbing the natural environment as much thus enabling to reach valid conclusions instead of uncertain observations.
When the patients of COVID -19 suffered from dry cough, difficult breathing, fever and fatigue, what is most important is to logically intervene upon the intrinsic cause mechanisms of infection which originally led them to the pathetic state and reverse them instantaneously by adopting precise strategies in favour of the immune mechanisms to naturally eliminate infection instead of researching on whether mechanical ventilation is better than rendering pure oxygen. It is so silly and primitive idea  and worsely unethical to leave the patient to oxygen and uncertainity by doing nothing against the active pathogenesis which led them to the state. Another silly observational study is observing blood clots in patients with moderate to severe COVID Infection. If they had clots that they never had before  the reason for the clotting is an undesirable immune response which could be either infection or immunization against infection or both. An honest research in the basic Science of immune system, infection ,and immunization will help to explore the reality and this was what is required in place of recommending  risky blood thinning drugs to all moderate to severely infected patients.
Finally the observation led  research in COVID-19 patients never led to any successful outcome in saving patients by reversal of disease or preventing illness in them and still possibility of endless mutations possible in every human being endless times open up new challenges for researchers. The more uncertainity-led treatments emerge, the more uncertainity led emergencies would also set in naturally as a consequence. Thus with the latest COVID-19 example itself, it is easy to prove that we can observe a lot by watching but can do nothing to reverse an ailment by merely watching

                                                    Dr. Remya Krishnan MD PhD( Ay)

To have the right application of medical science, pure science must guide the choice and application of treatment Hence to have the sensible application of medical science, a science of “healing” must exist. Why do we neglect to seek the comprehension of a completely natural phenomenon of the emergence of the particular nature of the disease in man ( a natural creation) and blindly seek some unnatural means to block, mask or suppress ailments? Is it not a reductionist mode of approach to attempt to solve a natural problem by absolutely deviating from the causal mechanisms and nature of the problem and thinking of some external means to block, mask or alter the same?

India being addressed as a wise and civilized nation from the olden days must sensibly think of adopting those pure sciences which deal with healing diseases in man in place of the sciences selling unknown compounds under the label of Medicine. Everybody can earn millions of rupees by selling anything if they know business and marketing strategies but how few can heal people and stabilize their health fast and without messing with the knowledge and skills in the Science of healing! In fact the latter community deserves to be addressed as physicians as what they apply are sensible logic of Science of healing and not unstable data of unknown compounds

Science is not about empirical observation; it is very much about logical reasoning to understand and solve a problem in its own natural setting. We do not need statistics to understand why and how fever develops in man and for the same reason, we do not need statistics that emerge compounds to block fever. The intended therapeutic action in fever is to resolve fever along with its cause mechanisms and heal the subject as quick as possible and not block or mask the same.This is simple common sense to know. Disrupting a natural environment by some artificial means and calling it science is real nonsense. Science is the knowledge of the laws of nature. As diseases are natural phenomena in human beings, their solutions are also meant to be natural and that facilitates natural healing by the body itself by rendering Science led support in the diet and regimen of the sick subject and that is what medical science is intended to do. Statistics f unknown compounds show data of benefits and risks. Data can only help to show temporary benefit risks of unknown compounds and never help to “know “ WHY and HOW” the disease and WHY and HOW healing is possible. But if WHY and HOW are explored, the results of the sensible application of the healing process will originally show the Science of Healing instead of casual observations. Medicine without statistics would rationally explain the knowledge of healing. This knowledge of healing disease is crucial for anything to be addressed as treatment. Thus we do not need statistics to understand and reverse a disease but for that we crucially need the Science of man and the Science of healing in man.
When statistics is employed to analyse compounds for benefit risks also, there is no certainity that the compound will heal the subject. Then what is the benefit of knowing the compound and its mode of blocking disease along with risks ?? Statistics help pharma companies to sell their products effectively but there is no guarantee to heal man effectively. Thus a medical science is to emerge based on the Science of healing to deserve to be called a medical science  and scientific publications of medical science must discuss this very science of healing instead of benefits risks of blocking, masking, and suppressing ailments
              Dr. Remya Krishnan Ph.D. (Ay)

              Assocaite professor & Head

             Dept of Clinical Pharmacology,

             RGAMC,Mahe

Even though we are forced to believe that COVID 19 is going to end ,in the past two years we have seen multiple lives lost and multiple sufferers comprising of atleast one in every home by some or other way. For the sufferers, it is not mere data but instead true suffering itself. And people have watched their dearest ones getting steadily sicker and often breathing their last. All these two years, we the Indians were pressurised to follow the guidelines of a single medical system for getting rid of infection. People were both threatened and frightened of new virus and its endless possible mutations by this system and inspite of the fact that there is so much that they do not understand about this viral fever, they were seeking all attention and appreciation from Government for all their experimental trial and error games irrespective of the fact that people are in eternal suffering and many dying continuously. They even successfully created an impact to such a detrimental level that oxygen cylinder deficit is the real reason for increased mortality in viral fever by enabling people to wash away their common sense from themselves for ever.

Western Medicine was given the entire rights and privileges to handle patients while other recognised medical systems were sidelined in India . There were medical systems like Ayurveda who counted viral fever as healthy immune response against virus (irrespective of the name and variety of virus)and immune system winning virus is counted as recovery by health which is possible by the scientific strategies of Science Based Evidence Based Ayurveda . We, the SBEBA practitioners do not mind whether it is old or new virus because we are learning to intervene upon the immune response and enabling to make it in favour of subject for his fast recovery from our medical science. But we were denied our own rights to handle the patients and enable them to get back to healthy lives but still we have enabled many who reached us without letting ourselves and them as well getting bothered about name of the infection. Who cares it is COVID 17 , 18 or 19 , only what matters is whether we enabled the patient to get back to his health in less than 2-3 days  and  this is what as physicians we are meant to do by our science. Nobody beat plates for us when we enabled patients who were in severe stages unresponsive to all the cocktail experimental drugs reverse to health and life fast, but we got deeply satisfied within for what we do in this panic stricken world when we find our healthy patients smile at us ready to face fearless life ahead. It was hard to watch many doctors getting sick and dying by still doing the best of what they know and do in themselves and covid 19 era enabled us to deeply recognise the value , quality and purity  of our own medical system which guard us continuously when we attend patients absolutely without any worries for getting self infected even when we work in the midst of different kinds of patients without any PPE kits or face shields. When doctors feared deadly variants and their potent fatal impact, our own medical science ensured us that all is well as long as we meticulously take care of our innate immune intelligence.

When we seal our homes and sit inside , there is no guarantee that thieves will not enter our homes. Also when we seal our homes and sit permanently at home fearing thieves without doing anything  , we may fall into panic or depression or anxiety and other physical problems too. To ensure protection from thieves, we need to improve security of our homes, efficient alert devices working and lock the thieves if at all entered by efficient man power and intelligence. Ultimately it  is the  thieves that are to be locked and not the homes and people living there .As long as a viral fever is considered , body has innate immune soldiers to fight and win all kinds of viral fevers and any infective fevers and our duty is to improve their efficiency constantly to cut down virulence of any pathogen and shut it down . For our immune system, name and strain of virus is immaterial and we have inbuilt mechanisms to destroy them and eliminate any kind of viral fever by our immune system and this simple straight common sense fact  is thoroughly educated in the 5000 years old science of Ayurveda. It is not mere immune boosting that is recommended , rather it is highly specific and specialised  immune efficiency improvement. In viral fever, destroying virus leads to recovery and health and not any post viral stage. Post covid stage itself is the clear cut evidence of mismanagement of the viral infection.

The present agony of people in the form of several old and new diseases  inspite of all the so called interventions clearly reveal that still Modern Medicine has long way ahead to become prepared to handle a viral fever patient and people must finally know that this mere weakness of Modern Medicine should not be counted as virulence of virus or poor compliance of people to the guidelines of Modern Medicine. Unless this system gets ready to look inward , unlearn and relearn Infective fevers and biological immune response to different pathogens in living humans, this catastrophe will continue for ever.

                                                                                Dr. Remya Krishnan MD PhD( Ay)  

                                                                                The Pioneer & Practitioner, SBEBA

Scientific thinking is the process of translating an observable phenomenon  in man or universe into a demonstrable, reproducible and measurable phenomenon based on individual unique cause circumstances. Objectivity and rationality are compulsory part of scientific thinking and scientific thinking of all kinds are intended to obtain conclusions regarding the laws of nature that govern man and universe regardless of interests and opinions of people. Scientific thinking also inculcate demonstrability and verifiability of cause mechanisms of all conclusions by logical arguments by an orderly explainable procedure which is rational and analyzable based on inbuilt knowledge of the phenomenon. Accuracy in understanding and communicability are crucial components of scientific thinking .

Value of understanding

In science , understanding matters more than discovery of something. Understanding reality may require to think freely from every kind of prejudice that is ingrained in conventional modality and the only purpose of understanding is exploring truth as it is . Understanding is interesting and more over exciting part of research because it is absolutely free from vested interests and career ambitions and therefore completely unbiased the purpose of which is to acquire command in the method of knowing the reality in its natural scenario.In Medical research, when I ask my students to do thesis on medicines , Iam not allowing them to explore the science of diagnosis and treatment of the situation because treatment is not equal to medicine ,treatment refers solely to the process of reversal of disease.When old medicines are discarded or new medicines are developed , it does never guarantee that treatment is fair or better as the latter happens only by deepening of the highly specific and specialized mode of understanding of cause mechanisms of disease and its mode of reversal. The old mistakes in comprehending and reversing the cause mechanisms of clinical situations can be recognized and rectified if and only when the clinical situations are lively studied and explored instead of going behind medications. This is what exactly scientific thinking in Medicine is intended to be . It is intended to save man and render protection to him by the scientifically accurate decision making thoughts and deeds of the physician and for this reason in Ayurveda, every physician is recommended to be a clinical scientists who pertinently employs the algorithms in science in variable clinical situations by constant research and refining of intelligence .

The theorems, laws and principles of a settled science like Ayurveda are not something which can be changed and hence they are meant to be comprehended rightly and seriously and judiciously learnt to apply in variable clinical situations.This is what exactly scientific method is and not sailing in the ocean of uncertainity endlessly.Scientific method is the constant process of refining natural intelligence and common sense of the scientists based on the existing knowledge of theorems , laws and principles of that particular system of science thereby enhancing the clarity and objectivity in their application and not randomly picking some idea, hypothesizing and testing it blindly and display the observations . Science has absolutely nothing to do assembling data and analysing , rather it has everything to do with the way we understand and apply the established logics in realistic situations for recognizing and solving problems.The past knowledge is the chief ingredient of our basement knowledge and understanding of any new problem.Only knowledge take us ahead  in research and not any blind guess work or imagination. The latter are worth for making stories and not meant to explore and establish truth.Scientific method is not constantly flushing off and replacing old by  junk by new junk rather it is an educated journey of taming common sense in science.It is the method of  science led exploration of adopting most reliable methods to know and apply science and not statistics. It is not based on probability rather it is based on reliability. The rational demonstrable and verifiable logics pertaining to the phenomenon is the subject of scientific thinking and not blind observational data of may be- may not be. Science is not about data collection and analysis rather it is all about understanding laws of nature of man and universe and its accurate application for problem solving.

Misinterpreting statistical methods as scientific method in natural sciences is height of absurdity

                                                                             Dr. Remya Krishnan MD PhD

                                                                             The co pioneer of SBEBA

Rejection of absolutely irrational , superstitious beliefs which are prima facie is inevitable for social health and wellbeing . Social progress originally happens with honest and dedicated efforts of society to develop higher standards of scrutiny for any rigid rules imposed by the power of rule. In an era of lies and evil marketing , it is important that every citizen must learn to culture basic common sense to distinguish truth from fake to safeguard themselves from falling prey to dangerous agendas.

It is important to keep in mind that science is not the exclusive of domain of certain so called scientists who have pursued the path of science in their career.  Health Science for example refers to the basic knowledge of laws of nature, man and the interaction between both. If we closely observe the changes in our body itself in accordance to our variable activities like eating , starving, exercising, different emotions , before and after bowel movement, state of being hungry or not hungry etc, we get different clues regarding what makes you basically well or not and it is practically possible for each one of us to cultivate the habit of developing common sense to know when to eat, when to drink water, when to sleep, when to wake up, when to exercise, when to stop exercise etc if we follow these clues of our own body wisely by ourselves. No definition of health is taught to school students but at the same time, they learn about germs and antibiotics. They are never taught how immune system fight germs ,but rather they are imposed regarding how antibiotics fight germs. So for these children , they get a false notion that antibiotics are needed to kill germs  in the body just as we spray cockroach repellants in the room to kill cockroaches. So here what happens is that certain beliefs and vested interests of a single particular system of Medicine regarding  mode and manifestation of infections is forcibly imposed on these innocent kids thus shutting down their curiosity regarding how they fall sick by infection. Infection is not invasion of germs in the body .If it is so, then we would have been sick almost every time in life as germs are always present in our body. Infection is a healthy immune response to destroy any harmful germs or toxins and hence nature of  this crucial immune response determines whether you will fall sick by infection and if sick also, in how much time you will need to recover, why and how. Today none of the people have clear cut idea regarding all these crucial matters and hence they endlessly suffer throughout their life. The crucial knowledge regarding what exactly that which is inside our body which make us prone to any infection and how we can resist it or win it are all explained in the science of Ayurveda . Germs are immaterial and hence not explained in this advanced and cultured science , infection is rather explained. This knowledge explained in this science did not emerge from superstitions or beliefs or ideas but are developed by brilliant ancient scientists of life science who had immense power of logical reasoning of cause effect relationship who conducted live experiments in populations for many years in multiple ways and the conclusive rationale behind different natural phenomena are proven and established thereby emerging theorems and laws of science. These fundamental theorems of Ayurveda are not tempting a true scientist of Ayurveda to close their inquisition but rather eternally open it for further inquiry by providing a much stable a solid scientific foundation of broad wholistic perspective of human body and its functioning. Religious dogma is built upon philosophy of ego and ignorance while shasthra or science tries to determine the unknown by a well educated method of enquiry which is constant and omnipresent.

Scientific temper:

Scientific temper is originally the process of Science ( knowledge) based reasoning , questioning and being open to questions after acquiring the fundamental knowledge of laws of nature .Scientific temper is not accepting something without appropriate logical reasoning done based on laws of nature of the particular instance with material facts for verification and confirmation. Material explanations are transparent and repeatable and not anything hidden or obscure. Shasthra sahita tarka ( science based reasoning) is mentioned as the best tool of clinical decision making by Acharya Charaka, the ancient clinician scientist of Ayurveda. He also recommended that any therapeutic accomplishment without rational justification based on principles of basic and applied science is just spontaneous cure with no credit to physician and should be abandoned. This very well points out to the fact that Ayurveda is developed by true scholars with highest form of unbiased scientific temper and selfless spirit for universal health and wellbeing. Every theorem, logic and principles of Ayurvedic science open multidimensional diagnostic and therapeutic inquiries in accordance to conventional healthcare scenario and requirements and this serve as best scientific foundation for  natural updation of this medical system in every period , today and tomorrow as well. Such brilliant bottom layers  and inputs are the structure of scientific substratum of Ayurveda.

Scientific inquiry

The hallmark of scientific inquiry is that the only reason to believe anything in real world is if evidence can be furnished for it. But at the same time there is no much clarity regarding the nature of emergence of evidence, the nature of clarity and quality of evidence emerged after testing through experiment and observation. The mode of emergence, clarity and quality are but very crucial components which originally determine the validity of an outbuilt evidence. For example we want to study coconut and we have taken different specimens of chestnuts and palm fruits to study coconut . We do not know anything about coconuts and not seen them but after hearing about the details we hypothesise that either chest nuts or palm fruits may be coconut and we initiate collecting data of them . Even when we perform impartial, unbiased and objective analysis of data of chestnut and palmfruit for hundred years also and classify and analyse them, it not possible to attain even a minimal knowledge about the real object of inquiry coconut even after a century and this happens because the researchers have absolutely no basic knowledge regarding the specific details of coconut and by  blindly experimenting the unknown with something, it is not possible to explore the reality. Ultimately research is meant to explore the reality and not for blindly disproving hypothesis after hypothesis . That is only staying in fool’s paradise and not research. Research should be always backed by accurate knowledge of fundamental details of subject of research which is to be kept as standard for guidance and operation. The knowledge of laws of nature of man and universe did not emerge by falsification, they have emerged by testing and verifying logics of respective sciences by multiple scientists by multiple ways are fundamental truths established by cause effect relationship. Hence Physics, Chemistry, Mathematics etc are real sciences which deserve for applied research to explore further by their innate logics, theorems and principles which can be traversed from general to specific most details ( not specific to general) with explanatory adequacy of inbuilt logics and repeatable by other learnt persons  also which is another  important hallmark of scientific method.

So what I mean to say is that blind experimentation and observational data of the same does no way guarantee that research gets fruitful and meaningful in future. There can be variable observations by the same experiment performed in variable environment and man is a perfect example for variable internal and external environment. So cause mechanisms of results give meaning to research rather than mere observational data oriented results of the research. The cause mechanisms (WHY and HOW) are to be replicated to understand the real logic of working of phenomena subjected to research rather than mere data of observations. Every drug of Western medicine produces some benefits and risks for sure as they are targeted to certain receptors for blocking , masking, suppressing, altering etc of different enzymes, hormones and channels and that does never mean they are the ultimate solutions for different disease conditions . Working for  temporary data of benefits and risks are not same as working for reversal of cause mechanisms of disease . For an unknown compound drug to be known as scientific medicine,  there should be innate logics of working of the medicine to reverse the cause mechanisms of the disease and thereby intended to reverse the disease. Astronauts are space scientists who apply science of astronautics to practical use of their work and in the same way medical doctors are to apply the Science of humanbeing and Science of identification and reversal of disease to heal people to be called as scientific Medicine. When statistics is applied in place of Science of man, it becomes only “statistical medicine” and never scientific and this is what is happening today.

Science is not doing experiement , rather it is knowing to do experiment by knowledge foundation of theorems , laws of principles of working of man and nature. The knowledge of Science is not falsifiable simply because the laws of nature are not falsifiable.They are objective and universal truths , it is true and works true everywhere regardless of whether one approves or not. For example, by applying Newton’s laws of motion, humans travelled to Moon and satellites are sent to orbits around the earth. So the scientific experimental missions follow science and not the empitical data sheets of statistics.

Knowledge begins from  Science and ends in Science

Albert Einstein once told ;” If I had an hour to solve a problem, I would spend 55 minutes thinking about the problem and five minutes thinking about the solutions” and this is what a  genuine scientist does . Solutions emerge from problems and not from outside. This medicine in that disease approach of research focuses on new drug development from unknown compounds by biostatistics   instead of going deep into the disease and its nature of origin, onset and manifestation in the host. This is reductionist, unscientific and unethical in solving health hazards of man which is a dynamic  natural creation on earth. When we ponder into the problem by understanding the nature of problem, we discover that there are multiple facets to the problem and we need to study these multiple facets in man itself instead isolated setting inorder to emerge solutions which may or may not even require any drugs . Disease is not deficiency of drugs in the body. How to think what to do to solve the problem in specific in specific condition is explanable only by a natural science and never by a reductionist tool of statistics.

Conclusion

 Scientific method is following science and not data sheets of statistics. When scientific discoveries of Medicine are put to use, it benefits the entire humanity by saving lives and health of people instead of producing uncertainity led falsifiable benefit risks of unknown compounds. For Modern Medicine where the treatment is always unknown compounds to suppress, mask or alter  diseases , Biostatistics is mandatory to prove that drugs work by producing benefits and risks but that is not the case of Science Based Medicine like Ayurveda which is based on solid science of man and explain logics solely for  healing man  and not do any adjustments. Developing scientific temper is the process of cultivating true knowledge about what is science and scientific method right from childhood and promote true rationalism in place of pseudorationalism and their critical thought process. It will be a true tribute to ancient scholarly scientists of the world who cared to emerge truth by their research instead of emerging results with vested interests

                                 Dr. Remya Krishnan MD PhD ( Ay)