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