In 2012, Dr.Remya Krishnan defined Evidence-based medicine (SBEBA, henceforth) in Ayurvedic Science as the “conscientious, explicit, and judicious use of most pertinent Science Based Evidence to the unique cause circumstances of every individual subject  in making decisions about their diagnostic and therapeutic care (Evidence Based Ayurveda & Rational Prescribing, First Edition, 2012). But today what Ayurvedic fraternity is doing is conducting research based on randomized control trials, systematic reviews and other types of population data oriented  research of empirically chosen medicines  which is nothing but the practice of the very unscientific cook book medicine when originally Ayurveda recommends solely the practice of Science Based Medicine .It should be noted here that at the same time, physicians are not clinically adopting these evidences of benefits and risks of known and unknown compounds  but rather  follow their blind intuitions ,self and shared experiences and Eminence Based Medicine . Then why RCTs are done is expected  to prove medicine after medicine aimlessly and baselessly for benefits and risks and at the same time, patients are treated by physicians  entirely not based on this but  based on other trial and error means.

KNOWLEDGE MATTERS BEFORE STUDY

The fundamental proposition of Evidence Based Medicine in Ayurveda is primarily to attain clarity and confirmation regarding what to know and how to do in every individual subject infront of physician, why and how and all these are answered best by the theorems, algorithms and logics  explained within the science of Ayurveda itself and not anywhere else. Recording observations based on personal clinical experiences is outbuilt evidence but what is crucial in determining the quality and purity of these outbuilt evidence is the accuracy in choice and  application of Science Based Evidence in the subject , a fact which is unknown to Ayurvedic fraternity today. A pudding gets truly relishing and tempting only if the ingredients and method of preparation is accurate and not merely when data of pudding consumers are compiled and shown .Growing data of pudding consumers no way guarantee that every person gets the rightly cooked pudding by looking at the data of number of consumers. For that the method of making pudding with right proportion of ingredients in the right way is to be learnt and this is explained in the background knowledge of pudding making and not in foreground knowledge of data of number of consumers. So learning accurately what to do in a clinical situation matters a lot in rightly intervening upon the same.Hence Science Based Evidence Based Medicine is crucial to establish the scientific evidence based practice of Ayurveda . It is not the medicine  that matter in the practice of Science Based Medicine but rather the clarity and objectivity for deciding the medicine in particular situation and whether it served the objective or not. For that in Ayurveda, the practice is to be entirely guided by background science itself and that is what is Evidence Based practice is intended to be in the system.

If Evidence Based Medicine is a concept intended with good intentions to reach the right decisions from the medical science to intervene upon man, then definitely it should not be some outbuilt indefinite unknown compound oriented temporary data of benefit- risks applied in trial and error terms by embracing the fool’s paradise of falsifiability. Ayurvedic science recommends a physician to constantly culture his intelligence in Science Based Evidences so as to resolve the endless confusions which are common in the process of clinical decision making. Also Ayurveda does not recommend multi- disciplinary approach in handling a patient, rather it advocates that every physician has to individually equip himself in the knowledge and  judicious practice of Science Based Medicine to intervene upon a patient on the whole in the scenario of complexity of real clinical cases and reverse their entire  morbidity instead of fragmented intervention focused on any structure and its function alone. When it is the background science which directs clinical actions on individual patients, then on what basis it is considered today in Ayurveda that external evidence are to inform scientificity of medicine ? Does it make any sense really to say so?

PROVE APPLICATION OF SCIENCE AND NOT MEDICINE

There is a very crucial thing missed by current Ayurveda fraternity. Unlike Modern Medicine in Ayurveda, there is absolutely no need to prove treatment after treatment or classical medicine after medicine to establish their safety primarily because there are existing documented evidences regarding the manufacturing, quality control procedures in manufacturing and science led algorithms and guidelines regarding where to use a particular treatment or compound, why and how, when , what all to consider while employing the same, what all to follow in the patient, and how to interpret the results . Instead of adopting this higly scientific innate methodology of science how does blind RCT of a new or old compound help to attain clarity and objectivity in Ayurvedic research. If a compound is established to be safe and beneficial in such a way in a random population, what is the certainity that it will guarantee the “intended results” ( Ayurvedic science recommends to produce only intended result and not benefit risks) in an individual patient in real clinical situations??? How do the population level of current EBM studies of baselessly chosen compounds  or treatments applies  to individual level in realistic clinical situations ???Let me know please !

Where is Ayurveda fraternity heading to? Guidelines of clinical decision making are to serve as accurate piece of advices appropriate to the particular clinical situation in the particular subject and not to  blindly emerge  compounds of cook book medicine. How does the current mimicry of Ayurveda to that of Western Medicine in the matter of hunt for Evidence Based Medicine end up in valid and effective conclusive decisions beneficial to save and protect every patient who seeks Ayurveda? Gawande’s popular science book summarizes it well: “A statistical formula may be highly successful in predicting whether or not a person will go to a movie in the next week. But someone who knows that this person is laid up with a broken leg will beat the formula. No formula can take into account the infinite range of such exceptional events. Despite of having a vast and deep science in hand , going behind these reductionist biostatistics to prove scientificity of Ayurvedic practice is  entirely idiotic and detrimental to the very existance and identity of this medical system Ayurveda. There is no wonder that physicians  still need to adopt aimless and baseless self and shared experiences or mixopathy or expert opinions ( experts are not standardised) as they  are never equipped in the knowledge and practice of Science Based Medicine but at the same time need  to survive in their profession by some fair or unfair means.

In Ayurveda, Medicine is a practice of Science in the background and not the data in the foreground because fundamentally Ayurveda is Science Based Medicine and not Medicine based science.Science is the proven and established knowledge of man in Ayurveda which explains what- why- where- when- how- why not etc of fundamental aspects of health, disease, diagnosis, differential diagnosis, prognosis and management and there is nothing truly "scientific" possible by entirely deviating from this very basic Science of man. Science originally refers to the knowledge of proven and established rationale of  precision and certainity and not  merely the number sets  of probability and uncertainity.Hence for the purpose of scientific research, diagnostic and treatment principles are to be derived from this back ground science to be applied pertinently in every clinical situation and this kind of translational research is  first and foremost done by Science Based Evidence Based Ayurveda pioneers , Dr. Rajkumar KC and Dr. Remya Krishnan, the outputs of same which are published in their four  scientific publications so far and trained for hundreds of practitioners whose variation in  evidences of former and latter clinical practice( after receiving training) speak the accuracy of the outcome of this most intended form of  Science led Evidence based practice . We can trust and act in a rational way in our patients when Science Based Evidence Based Ayurveda ( SBEBA) is learnt and practised in place of current uncertainity led empirical ways of biostatistics or follow blind intuitions or experience or believed to be experts . Also it is important to know that getting evidence for treatment and diagnostics will involve getting  “accurate knowledge about the circumstances of individual patient”  which causally relevant factor might affect the interaction with the treatment and this is exactly what Science Based Evidence Based Ayurveda offers in place of current cook book medicine oriented practice of Ayurveda. Human judgers are fallible and so are doctors. Hence it is crucial that some rational standards which are proven and established based on logics are vital to be adopted in the practice of Evidence Based Medicine and such rational standards are available in the rational science of man Ayurveda.Transparency and predictability, the two components of scientificity are possible by Science Based Evidence Based Ayurveda (SBEBA). One has to rightly comprehend and learn to apply them is the only big challenge and SBEBA has already developed tools and techniques to train the physicians to overcome this big challenge. Statistics have very limited roles in proving the application of Ayurvedic science , all that it can do is only show and not “ know”. Knowing is possible only from background knowledge and anything that is shown without knowing background application is scientifically invalid in Ayurveda.
CONCLUSION

In short, the evidence in Evidence Based Medicine of Ayurveda must consider Ayurvedic scientific infrastructure itself  to create a clear structured set of inbuilt science led decisions for individual patients in place of  current epidemiological study oriented Biostatistical approach . Evidence Based Medicine is ultimately meant for patient cure and care and not for new drug development in the case of Ayurveda. Here we need" new intelligence development" for physicians in the knowledge and practice of Science Based Medicine and not any new medicines or treatments . This work is already started authentically and systematically by the pioneers of Science Based Evidence Based Ayurveda which forms the  very foundation for an era of renaissance of professional Ayurveda.

                                                                                                                                                                         Dr. Remya Krishnan PhD( Ayurveda)

                                                                                                                                                                          Associate Professor& Head

                                                                                                                                                                          Rajiv Gandhi Ayurveda Medical College

                                                                                                                                                                          Govt of Puducherry Institution

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                                                                                                                                                                          This email address is being protected from spambots. You need JavaScript enabled to view it.

Carl Popper who died in 1994 is today hailed as one of the most important philosopher of science and his book “ The Logic of scientific discovery” is counted as the most importantbook of the century. He is known for his principle of falsifiability which is based on the idea that science progress based on conjectures ( incomplete observations) and refutations ( the action of proving a statement/ theory wrong or false). According to him , a theory becomes scientific by exposing itself to the possibility of proving false. Anything which cannot be proven false is counted as pseudoscience based on dogma and superstition.

SCIENCE IN MEDICINE
The term “Science” is derived from  Latin name “Scientia”(knowledge) which refers to knowledge of precision and certainity applying universal laws of nature where basic rules pertaining to man and universe everywhere are same. For example, the principles of motion and gravitation are same as principles of falling objects which are also employed to explain the moon, planets , nuclear particles, sail boats , bullets and light rays . When ever and where ever, modification of concepts happened in further research, it is to be noted that only “modification” had happened and not out right rejection by proving false. So the real scientific arguments must conform to the principles of logical precision and reasoning and possess the quality of continuity or stability.Ayurveda which is the Science of man fundamentally comprises of theorems and laws to explain the regularity of nature of structure and functioning of man in relation to the external environment as long as man exist as man. The theorems , logics and laws explained in real science provide answers to WHY, HOW, WHAT, WHEN, WHERE , WHY NOT etc and thus enables to train the common sense of learner of science in developing fundamental knowledge and creative insight in his theme of study. When variable observations which are unexpected are observed in further experiment based on a logic, under what conditions, such observations resulted will need to be scrutinized and comprehended. All the scientific arguments must ultimately confirm to the principles of  innate logical reasoning of that particular science. Current falsifiable theories derived by doing baseless experiments of unknown compounds are not based on a single fact compatible to law of nature. For example, if  the research behind paracetamol is meant to be a scientific research, first and foremost, the objectivity of the Paracetamol should be addressing the “ real cause mechanisms” of rise of body temperature instead of merely blocking the chemical messengers responsible for increasing body temperature. Rise of body temperature is a natural healthy signal of immune system of the body to show that something is wrong somewhere and it is time to correct that something and Paracetamol is not meant to do this. Paracetamol is just an example and all the drugs in western medical system are working by “masking, blocking, suppressing, altering etc “ of enzymes, hormones, neuronal pathways and channels. When antacid  which is given to neutralize acid in stomach does not relieve acidity after withdrawing the drug, then on what basis it is counted as a scientific remedy for acidity? “Scientific” is intended to be “ Science Based” which means it should address the cause mechanisms of the phenomenon and explain innate logics to rectify them instead of mere suppression of symptoms .If such kind of compounds are not borne from a science (knowledge based on logical reasoning addressing cause mechanisms), then how do they get ethical clearance and approval for even experimenting in man??? Ultimately fever in man is not by the deficiency of Paracetamol in the body and acidity is caused not by the deficiency of antacids. In such a situation, it is utterly useless, waste of time and dangerous in counting benefit risks of any  complete unknown compounds  with some what known compound for use in man because as someone rightly told , half of what is true today is going to be incorrect in next two years and worst of all, nobody knows which half that is going to be. Popper forgets the real fact that even falsifiability is a falsifiable one!

SCIENCE IS NOT STORY

What shows up in laboratory or animals or isolated tissues are not the same thing  intended to happen in realistic situation in body of human being. Hence it is extremely important to understand the basic nature of response of human body to adverse conditions , no matter whether it be climatic conditions or dietary or regimen factors or pathogens or toxins. The body’s innate mechanisms to defend these adverse factors are to be studied deeply and those logics which are derived by conducting basic and applied research in man are to be applied as primary tools to intervene upon various clinical problems in man. This is what is exactly recommended to be done in Ayurveda, The Science of man which explains logics, laws, theorems and principles to understand the fundamental nature of clinical problem in its unique natural setting and intervene upon the same to reverse it in the same natural setting as fast as possible to attain homeostasis. The proponents of Ayurveda were great scientists as they stood unbiased  for proving , repeatedly verifying and establishing the fundamental biology of man in man and documented all the logics they have explored in a systematic manner for further basic and clinical research. Everything explained in Sanskrit 5000 years ago does never mean it is not science and modernity and  falsifiability do not merely make anything science . Science is too complicated for falsifiability . Tempting to seek a simple single aspect and explaining the outcome based on the same is analytical reductionism . Man unlike machine is highly complicated inside even if appear simple from outside. Hence repair and restoration are more scientific and advanced process in man and not removal and replacement as counted by the world today.

SCIENCE IS NOT OBSERVATIONS
A scientific theorem unlike a theory is developed after verifying , proving and establishing all the cause mechanisms behind and stays eternally true unlike an imperfect theory which is valid only for the moment. Theorem cannot be falsified do not mean theorems are unscientific . Ayurveda and Mathematics are certain sciences which comprise of theorems. They are called deterministic sciences , they provide the fundamental infrastructure to understand and solve a problem. Data are based on external observations after experiment and not based on internal logics applied in performing experiments. Hence data are only temporary incomplete imperfect observations which can easily be falsified by different observations in future. But in matter of science , it is not mere observation that matters but rather “how -what- why- when- where ” of these observations and merely classifying  and analysing  the observations for making interpretations do not explore the foresaid questions. Hence the observation get falsified easily and that is because the method of research adopted was not knowledge based but rather data based. Modern scientists call  such research as query of truth and science but I would call it nonsense why because it is like a boy incessantly trying to insert a real  elephant into a match box . No matter how much failure happens, somebody told him that failure is path to real success and he keeps trying endlessly and even after growth with moustache and beard !!! The current scientific method reminds me of this elephant boy story.

When a theoretical prediction disagrees with experimental data, it could be by several reasons . Either the logic in the theory is wrong or the premises could be wrong or the interpretation could be wrong or the observations are too much generalised as derived from a highly variable population. Statistics cannot explain man and it inevitably requires Science of man and this very simple straight fact is but unknown to modern scientists . Just what Einstein rightly said:” so many people today -and even the professional scientists – seem to me like somebody who has seen thousands of trees but has never seen a forest .”Infact science is the knowledge of precision based on laws of nature in its natural circumstance which provides confidence and creative insight to the scientist to proceed in the process of seeking truth known as research instead of killing both eternally and proceed aimlessly.

CONCLUSION

By the process of falsification, the journey is only through the false and hence the truth hardly comes to limelight. Also in medical science today unfortunately anything which is repeatedly proven falsifiable are not getting discarded also but instead promoted many times by creating spin in data. Infact a single risk exposed is enough to discard a drug in terms of falsifiability and in such a case on what basis modern medical science decided to proceed by counting benefits outweighing risks?? When according to them , the important characteristic of a scientist is the ability to accept when he is proven wrong and change course and that is what humility is meant to be , why such a course of action is not observed from their side??? Why the proven false things are not still discarded  and why no humility shown???? The answers to these questions are to be readily provided by them because they themselves tell repeatedly that falsifiability cause progress in science .

Last but not the least I would say with emphasis that if a myth story is passed on from generation to generation without any cost , it can solidify into a fact and not story anymore and this had happened in the case of story of falsifiability. No where in the history of science it is written as science is based on falsifiability , even the very definition of science is distorted by myth story for long. Remember we have’nt learnt falsifiable stuffs in Science  and Mathematics class rooms in Schools and none of our teachers showed “humility” to us when we ever wrote wrong answers

                                                                                                          Dr. Remya Krishnan MD PhD(Ay)

                                                                                                           Associate Professor

                                                                                                           Rajiv Gandhi Ayurveda Medical College

                                                                                                           Govt of Puducherry Institution

                                                                                                            Mahe  (This email address is being protected from spambots. You need JavaScript enabled to view it.)

a.Ayurveda well deserves to be an independent mainstream Medicine of India. Instead it is evolved under AYUSH stream of Complementary and Alternative system which destroy the very identity and independent quality and potential of this system

b.Ayurveda is taught with many hypothetical contents with-out any scientific basement and deep infrastructure of core science is hardly known to faculties owing to deeply flawed education and training.

c.Nobody in policy making is exactly aware of how to judiciously employ the curriculum of Modern Medicine in Ayurveda so ast emerge rational standards for  optimised knowledge and practice of Science Based Medicine of Ayurveda. Little knowledge is also very dangerous.

d.Available textbooks followed by  both BAMS and MD students are  very substandard and based on faulty perception, comprehension and beliefs of the author in the scientific concepts and not based on rational standards of science of Ayurveda. No standard learning or reading stuff is available for students.

e.When compound oriented data oriented RCT oriented research is encouraged in Ayurveda which is innately Science Based Medicine and not Medicine based Science, such research based applications will not go in compliance this scientific algoithms of clinical decision making explained in Ayurvedic science . This fact is unknown to curriculum makers and probabilistic statistics is forcibly induced in the curriculum to substantiate the application of deterministic Ayurvedic science which has its own solid settled theorems, laws and algorithms to prove its action and application. This absurd way of teaching by neglecting innate scientific clinical and research methodologies of Ayurveda have led to utter failure in establishing scientific evidence based practice of Ayurveda .

f. The quality of  both theory and practical examination of students to evaluate their clinical competence and practical knowledge is zero in the current scenario and this results in nil chance of producing competent Ayurveda clinicians.

g.Extreme poor and faulty content of curriculum in all disciplines which include faulty interpretation of many scientific aspects and absence of Hands on Training for students of contents in curriculum are serious lacunae in the present mode of education . For this reason, the students are not even prepared to handle primary healthcare .

h. Though Ayurveda has independent immense scope in the practice of Emergency care , as the knowledge and practice of Science Based Medicine of Ayurveda is unknown to faculties, emergency care is given with quack practice of Western Medicine by Ayurveda practitioners or referring them to the latter. This utter shameful act which represent as best evidence for deeply flawed education of Ayurveda.

i.Even when there is unform curriculum implemented under regulations of Central Council of Indian Medicine, different states of India follow different acts of Ayurveda practice. There is no clinical audit or quality control of clinical decision making in Ayurveda after 75 years of independence also. Many practice mixopathy or Modern Medicine which is complete quackery and nothing is done to resolve the underlying anomalies all these years.

j. Unprofessional Ayurveda education is encouraged by several means abroad as certificate courses and other quack practices under the label of Ayurveda which is never regulated by Government of India ever. Besides graduates and postgraduates of Western Medicine are invited by certain reputed Ayurveda universities to do MD of  Ayurveda which is highly ridiculous and utter defaming of  this system.

                                                                                                                                                               Dr.Remya Krishnan MD PhD 

                                                                                                                                                               Co-pioneer, SBEBA 

When human body is viewed as a collection of components, any abnormality with regard to a specific component will be observed and studied in an entirely isolated setting  and this is exactly what the western medicine is doing . Just like the mechanic of a damaged car focus on the damaged part, a physician is entirely focusing upon the  isolatable abnormality only. For example in infection which is originally not a bite of pathogen but rather an immune response of the body towars the pathogen where pathogen is merely counted , in the case of cancer, tumour is only counted and in the case of bleeding from GIT, only the bleeding vessel or ulcer is counted . every person who has variable immune, metabolic, digestive  and drainage mechanisms , variable load of toxins in system, variable co -morbidities will be treated in a unform mode of setting without considering any of the foresaid factors. The contemporary analytical tools of Western Medicine are not advanced to deal with complex questions like “ how do a person’s metabolic status influenced by specific components in his food and life style become solid reasons for his atherosclerosis and coronary vessel block despite of him taking statin and Losartan. They ignore that part nicely and go ahead with further set of medications and interventions

Homeostasis is tissues is a vital underlying cause of health of human being.It is incorporated in clinical practice of western medicine in 1865 by Claude Bernard but at the same time is very much explained in a very elaborative manner in the science of Ayurveda. Illness is defined as failed homeostatic mechanisms of all structures and their independent and co-ordinated functions in the body the nature and cause mechanisms of which are easily comprehensible by certain parameters explained in the science of Ayurveda. Hence treatment is aimed at rectification of well identifiable cause mechanisms of even the subtle most level of pathogenesis happening inside the gross structures and their functioning in every medical conditions prevalent in society today” .

“ One risk factor” in one disease approach is a very unfair deal with any disease as disease has to be explored right from its onset in the body along with its all  intrinsic and extrinsic factors responsible for the same which is impossible if there is no solid knowledge basement which explain fundamental and  subtle-most  cause mechanism effect relationship of different pathologies. The inability to trace exact initiating factors of pathologies along with individual and multiple components of the patient’s lifestyle which impact the state and stage of his disease is the real cause of all time every time failure of western medicine in reversing the disease instead of blocking, masking or suppressing it. In a patient with multiple diseases, if every disease present in a subject at the same time is treated individually, it completely neglects the complex interplay between several components which are commonly working in multiple pathologies.Instead of knowing this when every disease is separately attempted to mask, bloc, suppress etc by benefit risk oriented compounds , any kind of predictable and unpredictable harm could happen to the subject in the form of emergence of new pathologies or worsening or complications of the older ones.The scientists from molecular biology, computational science, engineering, physics, chemistry and biostatistics together cannot resolve the health issues of man and it inevitably requires in-depth study, re-search and judicious application of “The one and only Science of man”, Ayurveda  itself without any compromise.

                                                                                             Dr. Remya Krishnan MD PhD( Ay)

                                                                                              SBEBA Co-pioneer& Faculty

 THE BEST RESEARCH EVIDENCE IN MEDICINE

Research evidence is currently counted as methodologically sound and statistically relevant research about the effectiveness and safety of treatment. When an unknown compound is subjected to clinical research , what is first and foremost important is to appraise the very objective of that compound in the subject who is being researched and whether the objective  logically contribute to the purpose of reversing the “cause- mechanism” of the particular clinical condition in particular subject. This part of enquiry has high ethical impact in research. If a compound is logically targeted not to reverse any disease ,then why and how the compound gets approved for clinical trial is  question of great concern which is but absolutely neglected today. If the answer of this is that if any particular disease as such is irreversible and hence considering the prevention of progress , something is required and so the trial is ethically right , it is not really an ethical answer to the problem. How was it decided that the disease is irreversible? Chiefly it was decided based on the reason that the true aetiopathogenesis of the disease is unknown to Western Medicine and for this reason it is judged as irreversible. But here the main point is this. If the true aetiopathogenesis of a disease is unknown , then is it not the primary step to explore the true aetiopathogenesis  of any disease itself before seeking drugs for the same? How is it possible to discover a real  therapeutic solution for a problem which is not fairly comprehended? In Western Medicine , most of the diseases are unexplored for their initiating cause mechanisms but at the same time , drugs are prescribed in the label of control or modify disease. Infact this is purely unethical as  a disease process cannot be justified to be controlled even when the lab parameters are controlled by different suppressants as nothing is done originally to reverse the initiating cause mechanisms which favour  silent progress of the disease .  For example, blocking / masking immune response might control the symptoms to certain extent with predictable and unpredictable risks but it never controls the disease process as such.  Clinical Re-search is originally meant for exploring the cause mechanisms of the disease and reversing the same because clinical research is meant for ultimately saving and protecting the patient and not for developing drugs. So clinically relevant research is when research outcome logically work against the  intrinsic cause and course of the disease  and thereby contribute to stabilise health of the subject. Hence it should be logically sound (approved by logics from Science of man to consider application in man) and intended to produce health and not a mix of  benefit risks. Medicine is intended to nothing else but  reverse disease and produce health. How is it decided that medicine is something which will cause  a mix of  interchangeable benefits and risks and the latter is because the drugs are working ?? Any stuff which is put into mouth or introduced to blood will certainly work by some or other means and “working” merely does not mean that it is a medicine . Something better working than the other by more benefits and less risks are approved everytime for treatment by so called re-search but what is originally intended to reverse the disease and emerge health is hardly contemplated ever! How can it become ethical research?
Science of man must guide research in man

When research is targeted to manufacture antying drugs and not for understanding  and reversing disease in the subject in his unique setting , then obviously drug approval and not disease reversal will be the prime objective of research and this is what is happening today. As intrinsic multitangled cause mechanisms unique to the subject cannot be even imagined to be explored by western medicine for a patient with multiple diseases at the same time , they target at suppressing different diseases  by different drugs by different specialists , the interaction of which in the subject also is least explored . There are people who get a chain of diseases after initiating drugs for one disease and later multiple drugs become part of their lifestyle which cause different problems for which again new list of drugs are prescribed. As there is no approval by any sound logics from science of man to recommend the use of these drug suppressant in a subject , it is completely unscientific research in the scientific perspective of Ayurveda. Ayurveda is Science Based Medicine and any kind of therapeutic decision in Ayurveda has to be first and foremost approved by the pertinent logic of science of Ayurveda as compatible to the clinical situation. There is absolutely no necessity for trial and error with medicines and treatments in Ayurveda because every medicine or treatment recommended in this science has its own highly specific and specialized background research done based on logics of Science Based Medicine with clearly specified indications and contraindications. Nothing other than the process of  reversal of cause mechanisms deserve to be addressed as  treatment in Ayurveda. Treating for one disease if emerging another risk, it is counted as impure / unscientific treatment in Ayurveda. The evidence of scientific treatment is naturally manifested in every subject in the form of recovery of disease and emergence of health in diseases of reversible category and enable the patient to lead a problem free healthy life on minimum medicine or life style discipline in the case of those which require lifelong  therapeutic support . Ayurveda consider man as a single unit and every kind of morbidity present at the same time can be interconnected and comprehended by applying the innate logics of this science and thereby reverse by most minimum medicine without the need of any interdepartmental transfer. So the Science Based logically sound evidence is the best evidence for a human subject to be applied  to make fair clinical decision in a subject for a physician as Science of Ayurveda unlike western medicine recommend means for the patient to reverse disease and not for the pharma to approve drugs.

Patient satisfaction emerges from health

What are these shared values mentioned in Evidence Based Medicine? Patient satisfaction ultimately comes from fast recovery from disease at reduced cost and this is undoubtedly  their expectation on reaching a physician. Their preference is neither pain killer nor surgery , rather it is reversal of cause of pain without much interventions and reverse back to health. In such a case , if the medical system has nothing to offer to reverse other than pain killer or replacement, it has to be specifically confined to the system alone and not as generalised approved  fact .There are other independent systems of Medicine with their own innate set of logics to work upon in the patient and evaluate the prognosis of the same which are unknown to western medicine practitioners.

CONCLUSION
Best research evidence must consider these questions with prime importance

1.Does the drug evidence contribute to natural  reversal of cause mechanisms of disease ,equilibrium and health?
2.Is  the drug proven to work based on a rational method to solve the clinical morbidity of the subject in entirety?
3. Does the drug evidence substantiate producing “Intended effect” in place of benefit risks in the patient infront of physician?

4.Does the drug evidence ensure safety and protection of the patient infront of the physician?

5.Does the drug evidence specifically ensure safety of immune system, digestion,metabolism, circulation and drainage mechanisms in the subject?
6. Does the drug evidence enable the subject to get out of drugs after reversal of the problem and stabilising health?
7. Does the drug ensure no undesirable interaction with other  different drugs consumed by the same subject at the same time ?

If the answer to any or all these are no, then it is not scientific clinical research beneficial to patient and it is unethical research in the scientific perspective of Ayurveda. Currently Ayurveda community are seen   mesmerised at the kind of research adopted by western medicine and copy it as it is to develop new medicines in Ayurveda. This is a worst form of insult to this brilliant system of man.

                                                                  Dr. Remya Krishnan MD PhD

                                                                   Associate Professor & Head

                                                                   Dept of Applied Pharmacology

                                                                    RGAMC

                                                                    This email address is being protected from spambots. You need JavaScript enabled to view it.

Today science is counted as something with fallibility holding that everything will keep on proving false. I defend a more confident view; science refers to knowledge of precision and certainity and much of what a science is telling about man and universe is settled. Science incorporates repeatable fundamental logics for practical reliability and predictability. Infact such kind of sciences originally contribute to internal prosperity of man and his healthy survival on earth. And well established and repeatable observational results are paradigmatic examples of settled science . One best example is of Ayurvedic science winning pathogens by employing 5000 years old logics much faster than western Medicine. Being a clinician and scientist myself, Iam viewing this impact in my daily clinical practice.

Settled Science
Settled sciences comprise of theorems and no theories. Theories are imperfect derivations based on present available generalised observational data to explain natural phenomena while theorems or siddhanthas are proven and established facts transparent and verifiable by observational data in every period , yesterday, today and tomorrow . Hence theorems which fundamentally explain the cause- mechanism- effect relationship are able to predict the future observations and thus naturally stable and credible. Theories on the other hand possess no guarantee of stability and might require complete modification or outright dismissal. When theories are rusted, what is considered as true today might turn upside down the next day when new data of observations come to light. Theorems can explain the cause mechanisms of variable data emerging at variable period with precision and hence theorems are put forward only by settled sciences like Ayurveda and Mathematics. Settled science is not that which keeps changing rather it is that which rationally explain changes and their reasons with solid base.

Medicine must inevitably follow the logics of Science of man because Medicine is vitally meant for healing man and not for emerging drugs. Man is a settled creation on earth which means all the fundamental aspects of structure and function of man remain constant as long as man exists in the form of man. The subtle-most composition of structure and both individual and co-ordinated functioning of several tissues, organs and structures of human body are highly standardized based on certain rational logics and laws of nature at times of health and disease as long as man exist fundamentally as man in universe. Irrespective of variable external environment and internal environment, there are standardised laws to explain the mode of interaction between internal and external environment of man in settled science of man called Ayurveda. Ayurveda explains all those subtlemost invisible network of channels to modern technological aids to understand how our cells function and communicate in relation to external environment , howviable pathologies emerge in man and how to reverse them naturally by understanding logics behind with or without medications These knowledge inputs of settled science of Ayurveda are a true treasure of the times as they fill up the huge gaps in conventional understanding of behaviour of host immune system in infective disorders, metabolic diseases , circulatory and hormonal diseases etc and pertinently guide a Science Based Evidence Based Ayurveda practitioner to handle the patient by enabling him to get connected to the specific internal environment of the subject handled. These fundamental brilliant discoveries in Ayurveda remind us of the importance of understanding morbidity of any patient in totality in place of doing baseless analytic reductionism .I myself understand that counting benefit risks by applying a partially known compound in man intended to block, mask, suppress, alter etc of different enzymes, immune system,channels or hormones is utter stupidity only because I was able to learn Ayurvedic science which is technically enabling me to handle the multiple intertangled pathogenesis in a subject with confidence and predictability by employing 5000 years old laws and logics of the science .

The problems of policy makers ignoring settled science

COVID 19 is currently a social pandemic which force politicians , researchers and the public to make health decisions based on unsettled sciences which adopt falsifiability as a hallmark of their medical decisions .Allowing complete freedom to unsettled medical science of Western Medicine to possess unanimous control of people in the country is unfortunate as in Western Medicine , there is long standing impulse to prescribe a range of treatments for the sake of doing something even in cases where medical evidence is fairly clear that it is ineffective and harmful. In a democratic country like India, innate medical systems which possess core independent scientific infrastructure of settled nature are currently denied to execute their independent policies in the patients who wish for the same in pandemic and this is detrimental to humanity. FDA is an agency of Western Medicine whose intention is to produce benefits outweighing risks for the moment while Ayurvedic medical system focus on innate logical principles to DO THE INTENDED and enable to reverse disease and produce health which is fundamentally mismatching to the objective of Western Medicine. When experimental unproven drugs are used in the patients , there is clear violation of motto of “DO NO HARM” .Every medical system deserves freedom to do independent research based on their own technical scientific infrastructure of theorems, axioms, laws and logics to tackle the pandemic and one cannot be made superior to others in framing policies and action plans for pandemic. Besides, settled medical science of Ayurveda has to be given priority first because it is based on a settled science with proven and established fundamental science to guide Medicine and second because it has such a lot to offer in preventing people reach ICUs by the potential to instantaneously reverse their morbidity back to health. Ayurveda is Science Based Medicine and not medicine based science where reductionist search for a pharmaceutical cure is being continuously done based on trial and error approach.

CONCLUSION

Settled medical science of man Ayurveda undoubtedly deserves priority in handling pandemic of man and hence confident qualified people of the system are to be called upon by the Government to make urgent policies and action plans instead of doing watch and wait for aimless period by constantly adhering to policies of unsettled sciences.It has been more than a year and a half that people are suffering and WHO is speaking that we need to live with the pandemic. Every time mutation can happen to any virus and more deadly forms of virus can emerge any time and every time and hence it is high time to turn towards a settled science of man Ayurveda which does not count pathogens but explains thoroughly how to intervene upon an infected host and enable him to win infection as quick as possible and stay healthy. Do we really deserve to to err more on the side of doing something in the face of uncertain Medicine or increase the potential of intended effects of fast recovery and health of our citizens? Originally what types of evidence do we need collectively to prove that a treatment is effective or in-effective ? Do we really need temporarily valid evidences of benefit risk ratio of trial and error drugs after drugs published in so called peer reviewed journals or a live evidence of growing community of healthy self realised people in the country not only devoid of any kind of infections, but also enlightened of their own crucial role in reversing their infections ? The imperative to get independent rights to Ayurvedic system for therapeutic decisions and policies is especially high in this current scenario where future waves of COVID infection and many other viral infections are anticipated. Bringing true confident experts of the system of Ayurveda who can prove the potential of the system are to be brought to the table with administration for discussion and implementation at the earliest possible. COVID 19 could serve as the best moment for unlearning and relearning the role settled sciences in acute infections based on certainity led Science Based evidences . The earlier it is done, the better it is to save humanity

                                                                                   Dr. Remya Krishnan MD PhD(Ay)

                                                                                  Associate Professor & Head

                                                                                   Dept of Dravyagunavijnana

                                                                                    RGAMC, Mahe

WHY MODERN MEDICINE CANNOT BE SCIENCE?

Data worship

Data is just a collection of numbers , words, measurements , observations etc that can be translated into a form that computers can process. It is by collection of data that a business or management has quality information that they need to make informed decisions from further analysis and research .

Currently it is believed that health data can be used to better understand diseases and conditions in-order to make amendment to improve healthcare . But logically thinking, this belief is untrue  first because healthcare is not a business, rather it is a mission . To understand the process of onset and manifestation of disease in a subject it is important that the subjects has to be studied deeply based on his unique internal and external environment and not  data of population of hundred subjects with the disease who  are deeply influenced by several disease modifiable factors continuously in process in the body which originally determine the state, stage and prognosis of the disease in himself. So in-order to understand a disease , the disease is to be studied wholistically in his individual  unique setting especially  if the final objective of the very study is nothing but to reverse the disease and thus enable the subject to be healthy. This logic applies to all kinds of diseases because even though the nature of onset, signs and symptoms of a particular disease is nearly common in all subjects, the impact of the same and hence their mode of reversal might significantly vary from individual to individual. Data is all that which display the observations and not  anything with regard to the cause mechanisms of the observations. If we identify 50 spoiled jelebies in a pack of 150 jelebies , all that we can understand is that 50 got spoiled among 150 and nothing pertaining to  HOW and WHY spoiled . So if a solution has to emerge to resolve a problem, knowing both WHY and HOW  of the problem is extremely important and re- search is originally meant to be the process to explore and explain this “WHY and HOW” of the  phenomenon which happened with finest details . The observations as such would definitely provide some  clues of probability to  reasons  but the phenomenon has to be  thoroughly known  based on the subtle most aspects of several components of the phenomenon and their intertangled functioning   to establish the logical reasons  with precision and certainity. For that, data is not sufficient but rather a complete science of man is needed to guide pertinently in every stage of appraisal of the problem.

In the case of a disease when we consider population data, it is highly reductionist method of going from specific to general. The more generalised our analysis go, the more reductionist the result will be as several crucial deterministic logical components of analysis are missed from top to bottom in such a reductionist kind of knowledge exploration in man. The data of every individual needs separate analysis to understand the nature of impact of disease in the subject and such a kind of study would eventually emerge a series  several new knowledge inputs to save the same subject and others. This kind of re- search is but only worth when there is sufficient solid knowledge base available to know the rational standards of exploring the cause mechanisms of a particular pathogenesis and its impact. Ayurveda is such a vast and subtle most science of man which explains tools and algorithms to explore any new or old disease happening to man in any period as long as man exist fundamentally as man . There are logical methods to explore by  both basic and applied re-search in Ayurveda to understand any disease process happening in man and thus the system of Ayurveda has endless possibilities to help mankind in all the present day diseases including the latest emerged infective fevers and inflammatory conditions. So the crucial point is that knowledge about WHY and HOW will only help to resolve any disease in a subject and most effective and smartest medicine / treatment is best informed by an inbuilt solid background science and not an outbuilt vapour foreground data .

What do patients exactly need from a medical system?

It is not really so important for each patient to know  live data every day regarding  how many of them are sick in total , how many are in fatal status and how many died. Infact that kind of show information induce nothing apart from stress in the patient community which will further adversely affect their immune ,metabolic and circulatory status. What public in times of pandemic need are highly specific and highly specialized information and  knowledge insight regarding how they can help themselves to get out of illness at the moment they realise that they are not well, quickly reverse the disease process and attain health. For this  current statistical literacy must be switched over to essential  health science literacy which enable ordinary people to understand how they get infected , how their immune system fight and resolve infections  and how about their own crucial role in rendering scientific support to their immune system to reverse / prevent illness as fast as possible so that they will not escalate to complications which necessitate shift to hospital  and critical care.

Only Ayurvedic science has explained these facts so meticulously based on logical demonstrable theorems and principles of precision which can be easily educated to common man for his fast and healthy recovery and all time healthy survival from pandemic. Data of benefits and risks of unknown compounds help Western Medicine to emerge new trial and error drugs which are a mandatory part of Western Medicine but this is not the case of Ayurveda. Ayurveda is Science Based Medicine and not medicine-based science. Ayurveda is a deterministic science and has a solid basement of proven and established theorems and logical algorithms to first of all understand a named or unnamed disease by its very nature of manifestation  and explore  its etiopathogenesis. It is the primary duty and responsibility of practitioner of Ayurveda to judiciously employ these tools and algorithms in the patient, estimate his morbidity and arrive at rational therapeutic decisions to reverse the entire morbidity ( single or multiple pathologies existing together affecting each other) and take him out of both the drugs and the disease(s). The very objective of Ayurveda is not just doing the reductionist benefit- risk ratio counting by unknown medicines  but rather reverse the intrinsic cause mechanisms of illness and thus protect the patient by all means by innate logics of known and established science of Ayurveda . So public health strategies begins with private health strategies for every subject at home and thereby extending to the whole world by creating awareness regarding how to instantaneously cut down virulence of any kind of pathogen “inside his body” by adopting scientific routine for a specific short period till health is stabilized. If this is widely done all over the nation and the world, then the need of hospital admissions dramatically cut down, there will be tremendous improvement even in the status of co- morbidities like metabolic and immune disorders along with resolution of infection and inflammation , death rate by viral fever will be nearly nil and national/ global economy will improve fast and active

Data only provides probabilistic statistically meaningful prevention and  treatment strategies while the solid science of man Ayurveda provides realistic scientifically meaningful strategies to originally  save and protect man in any stage of pandemic. Smart and personalized self-centered healthcare emerges by implementing the strategies of Science Based Medicine of Ayurveda are required by means of which every  citizen of the nation and the world  becomes strong, productive and self sufficient inside out.

Logical fallacies about Scientific Medicine in the present scenario

Today the term “scientific” in Medicine is interpreted as that which is led by data and not science. Originally “scientific” is that pertaining to science and not data and science emerges from the term “scientia” which refers to knowledge and not data. Science of man (Ayurveda) consider man as a vast single system in which the basic rules of working of man are same in man anywhere, everywhere . There are standardised   logical parameters to estimate the nature and aetiopathogenesis of any kind of malfunction in the working of body tissues and systems from subtlemost level and mode of rectification of the same explained in Ayurvedic science. In the case of data driven treatment , old data gets discarded and new data based on new generation drugs keep emerging  from time to time. But in Ayurvedic research, as the very fundamental logics to comprehend a patient and nature of disease and mode management in accordance to the pathogenesis always remain standardized , there is only modification in  the very application of logics in accordance to the patient and his unique disease circumstances.Research in settled sciences like Ayurveda  is not outright rejection of existing ideas of settled proofs of treatment principles  but rather deepening their applied knowledge in accordance to the conventional healthcare needs. Continuity and stability are the hallmarks of settled sciences like Ayurveda. Background knowledge and creative insight  are employed by a real physician scientist of settled sciences to recognize the core essence  of any disease  which appears new and different. All the scientific arguments must conform to the principles of logical reasoning in inbuilt rational standards of science of Ayurveda and not based on  blind probabilistic theories of Biostatistics. Ayurvedic science incorporate axioms which are absolute truths pertaining to man. Transparency and repeatability are required to be verified  for axioms and logics  of science and not the data of observations in clinical research . Ayurveda is thus hundred percent  real science which has incorporated a very vast systematic knowledge pertaining to man organized by established logics and prinicipes with the characteristics of precision and certainity. True science explains causation and not correlation and applies deductive reasoning , i.e from general to specific unlike the inductive reasoning of probability led statistics.

Conclusion

 Though Modern Medicine apply various scientific disciplines like Physics, chemistry , Biology, Biotechnology etc in drug  development , patient evaluation etc , Modern Medicine ( treatment) is chosen and applied based on Biostatistics and not Science of man by counting benefit risk ratio of benefit risks of unknown or partially known compounds and there is constant falsifiability of theories emerging from temporary valid observational data of benefit risks. They rely on population oriented statistical evidence to shape guidelines for every individual patient who approach them and call it Evidence Based Medicine , though originally what they follow is reverse which is medicine based evidence. Medicine/ treatment is fundamentally intended to follow the Science of man and  modify the unique internal and external environment of the subject in favour of his recovery , but Modern Medicine primarily follows Science of drugs to block, mask, suppress and alter enzymes, hormones , neuronal pathways  and diseases  and claim to make patients comfortable , delay symptoms , delay complications all with the risk of all time and anytime complications. Modern Medicine is thus better addressed as  art of adjustments instead of science of healing of man.

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