Scope and potential of Integrative Medicine in current Heal PowerPoint Presentation

Scope and potential of Integrative Medicine in current Heal PowerPoint Presentation

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Dr. Ashwinikumar A. Raut . MD (. Ayurveda-Kayachikitsa). Director Clinical Research & Integrative Medicine. Medical Research Centre of Kasturba Health Society. ICMR Advanced Centre of Reverse Pharmacology in Traditional Medicine. ID: 546000

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Presentations text content in Scope and potential of Integrative Medicine in current Heal

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Scope and potential of Integrative Medicine in current Healthcare Scenario

Dr. Ashwinikumar A. Raut MD (Ayurveda-Kayachikitsa)Director Clinical Research & Integrative MedicineMedical Research Centre of Kasturba Health SocietyICMR Advanced Centre of Reverse Pharmacology in Traditional MedicineVile-Parle, Mumbai – 400056, Indiaashuraut@gmail.com

Samyukti

2013An Evidence Based Approach in integrating Ayurveda and AllopathyOrganized by MS Ramaiah Academy of Health and Applied Sciences, Bangalore Institute of Transdisciplinary Health Science and Technology (IHST) - FRLHT, Bangalore

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Presentation structure

Integration of Ayurveda & Allopathy: A Tale of Two CenturiesCurrent Healthcare Scenario: Facts and FiguresEvidence Based Medicine: Complementary to Ayurveda Ethos Integrative Drug Development: Reverse Pharmacology PathRenaissance in Ayurveda: Integrative EndeavourConclusion and Future Path

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Integration of Ayurveda & Allopathy: A Tale of Two Centuries

1822 first integrated National medical Institute in Calcutta by East India Company with Bengal Vaidyas, 1827, 1833, 18351878 Dayanand Maharshi College at Lahor1877 Ayurvedic institute, 1896 Prabhuram college at Mumbai by Dr. Bhadkamkar, Dr. Bhau Daji Lad and Dr. Popat PrabhuramSeveral colleges across the country Ayurveda/Integrated started following Indian National Congress Resolution in 1920 at Nagpur 1927 at BHU, Ayurvedacharya with medicine and Surgery 1935 College of Indigenous Medicine at Madras1956 Integrated Medical Act by Govt. of Madras1969 CCRIMH, 1970 IMCC act, 1971 CCIM, Integrated/Ayurveda curriculum, 1973 Homeopathy ActDept of ISM&H (1995), Dept. of AYUSH (2003)

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Six formally recognized parallel Medical systems Modern Medicine & AYUSH systems

MMC 1835

GMC 1845

CMC 1907

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Current Healthcare Scenario: Facts & Figures

Western Allopathy Medicine transformed into Mainstream Modern MedicineGlobal uniformity in Allopathy practices, education, research & its publicationsMost of the advancing biomedical & paramedical branches subscribe to the tenets of AllopathyGlobal spending on prescription drugs; US $ 954billion (2011), expected to reach $ 1.1 trillion (2014)Iatrogenic diseases 3rd leading cause of deaths in US, estimated annual mortality (783,936), medical cost ($282 billion)Approximately 56 percent of the population of the United States, have been treated unnecessarily by the medical industry In many developed countries, 70% to 80% of the population has used some form of alternative or complementary medicine

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Current Healthcare Scenario: Facts & Figures

In some Asian and African countries, 80% of the population depend on traditional medicine for primary health careMore than 100 countries have regulations for herbal medicines WHO has projected that the global herbal market will grow to $5 trillion by 2050In India more than 500 million people use AYUSH medicinesWorldwide, the Ayurvedic industry is put at US $3 billionAyurvedic doctors(>500,000), Drug companies (>8,000), Hospitals (>2500), Colleges (> 250) in IndiaStandardization of Ayurvedic products, practices, training demand more thrust in quality

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Scope for Integrative Medicine through Evidence Based Approach

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Evidence Based Medicine

The conscientious, explicit & judicious use of current best evidence in making decisions about the care of individual patients.The practice of evidence based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patients unique values & circumstances

Patient preference

Research Evidence

Clinical state & circumstances

&

ana

bauiQdp`idpona

yaao naaivaSait t%vaivat .Aatursyaantra%maanaM na sa raogaaMiXcaik%sait ..ca iva 4.12

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Current Reality : Need for Integration

Clinical expertise

Patient preference

Clinical state & circumstances

Research evidence

Clinical state & circumstances

Clinical expertise

Research evidence

Patient preference

Modern Medicine

Ayurveda

Pragmatic & practical

Futuristic medicine

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Conventional Drug Development Path(Classical Pharmacology)

Hypothesis

Theory &

Postulation

Basic

ResearchBiology &chemistry

Preclinical testingInvitro & invivo

Clinical testing Human Trials

AccepteddrugFDA approval

Cost 1 to 1.8 billion dollars

Time 10 to 12 years

HTPS 100000 molecules to 1

Post marketing withdrawals

Need to look back at Nature

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

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Traditional Medicine Drug Development Path

Classical

texts & references

Basic principles

Analogy & inferences

Para-clinical

testing

Clinical

testing

Accepted drug

FDA Approval

Evidence base

through

relevant science

yaui>p`maaNa

Sabd

Anaumaana va ]pmaana

p`%yaxa

vyavahar

Demand to move forward

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Home remedies

NutraceuticalsOTC productsTM products( QA,QC & SOP )

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Need for Different Path in Drug Development

Demand to go forward

Need to look back at nature

Reduction in Total costTotal duration Undesired screening Toxicity & withdrawal

Reverse Pharmacology Path

Application ofConventional correlatesRelevant scienceModern Technology Predictability & reproducibility

TM

MM

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Definition: Reverse pharmacology is the science of integrating documented clinical/experiential hits, into leads by transdisciplinary exploratory studies and further developing these into drug candidates by experimental and clinical research. Scope: The scope of reverse pharmacology is to understand the mechanisms of action at multiple levels of biological organization and to optimize safety, efficacy and acceptability of the leads in natural products, based on relevant science.

Reverse Pharmacology

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Pragmatic integration of observational therapeutics, relevant science & drug discovery

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Reverse Pharmacology Discipline

Experience

Experiments

Evidence

Exploratory

Explanatory

Serendipity

Tradition

Translated Medicine

for community / clinical practice

Techno centric

Pharmacocentric

Therapy centric

Person centric

Dynamic, Self perpetuating Trans-Discipline

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Significant Research Contributions

Plant / FormulationsIndicationActivityImpactArogyawardhini/ kutakiHepatitisHepato-protectivePicroliv - Product KapikacchuParkinson’s Diseases Motor activityCognitive corrections Plasma levelsPhase I - US FDADouble blind crossover studyYograj GugguluRheumatoid arthritisAnti-inflammatorySteroid withdrawalAmrut BhallatakOsteoarthritisChondroprotection better adherence than GSDisease modifyingHaridra Oral Submucous Fibrosis Micronuclei reductionAnticancer studies

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Significant Research Contributions

Plant / ProductIndicationActivityImpactParijatMalariaAnti-parasiteAnti-cytokineDisease modifyingMamejawaType 2 DMLipemic control Anti-oxidantDNA protectionComplication PreventionPanchavalkalLeucorrhoeaVaginal infectionsAyurvedic Vaginal CreamAshokaMenorrhagiaOvulatory DUBSubset identificationYashtimadhuAshwagandhaPerimenopausal syndromeVasomotorAntioxidantNon-hormonal product

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Cellular Effects Of Ayurvedic plants

Ayurvedic PlantActive PrinciplesCellular effectsMucuna pruriens L-dopa, indole alkaloidsDA receptors in CNSPicrorrhiza kurroaPicrosides, cucurbitacinsHydrocoloretic & aquaporinsTinospora cordifoliaPolysaccharides,alkaloidsB lymphocytes, AGF Curcuma longaCurcuminoids,turmeronepolysaccharidesNFkB, GSH & COX-1Commiphora wightiiGuggulsterones, Myrrhanone FXR,BSEP,CytokinesGlycyrrhiza glabraGlabridin, glycyrrhizinE2 & Aldost recptors,

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RP Drug Development: Prerequisites & Spectrum

Analogues & Derivatives

TraditionalFormulations

Traditional

Extracts

Non Traditional

Extracts

Bioactive

Fractions

Active

Principles

Pharmaceutical Excellence

Safety & Efficacy

Formally Regulated

Picrosides

Picroliv

Arogyawardhini

Kutaki

NCE

Diverse Utility and Safety profile

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Protocols for Ayurvedic Clinical TrialsUnique / pertinent

Product-relatedAyurvedic kalpa (Classical form) Aushadhi prayoga (Dosage regimen) Aushadhi kala (Dosage schedule) Anupana (Vehicle for administration) Ahara – Vihara (diet & behavioral regimen)

Patient-relatedRugna Prakriti (Patient’s constitution) Shat-kriyakala (Stage of a disease) Samutthana-Vishesha (Causative/ precipitating factors)Dosh-Dushya-Adhishthan (Patho-physiological factors) Vyadhi Lakshana (clinical features)

Countable Determinants not Confounding Variables

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Allopathy – Ayurveda: Enrichment Feedback

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REDUCTINISTModern MedicineHolistic

HOLISTICAyurvedaReductionist

Molecule–Cell–Organ–Individual–Ecosystem

Multidisciplinary Management

Chikitsadhikruta

Purusha

Molecular Biology

Anuparamanu

Sidhhanta

IntegrativeMedicine

Integrative

Ayurveda

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Integrative Ayurveda : Ayurvidya

Definition : It is an active and open ended interface of Ayurveda with advancing modern sciences, especially biomedical sciences to continuously facilitate the incorporation of emerging new knowledge in the mainstream of Ayurveda while maintaining the fidelity to Ayurvedic fundamental principlesScope : Such a heuristic approach would promote the global acceptance of Ayurveda’s “science of life” potentials which has the added ability to identify novel paths for further development of biomedicine

Ashwinikumar A Raut, J-A IM | Jan-Mar 2011 | Vol 2 | Issue 1

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Integrative Medicine v/s Integrative Ayurveda

TenetsIntegrative MedicineIntegrative AyurvedaEthosTherapeutic UtilityAyurvedic Validity Bridge CAM & TSM Remedies Advancing KnowledgeR & DUnderstanding Molecular MechanismsUnderstanding Systems BiologyGoalMolecules from Natural productsSynergy with Nature of ManExpertisePhysician – InvestigatorVaidya - Scientist

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Epistemological Variance

ArthritisSandhivatDenotes inflammationDenotes pain & loss of functionGenetic predisposition/EnvironmentAgnimandya/ApathyaImmune complexesAama accumulationInflammatory cytokinesAmavisha & Vishiated DoshaBone & Cartilage DamageAsthi-Sandhi HananAntiinflammatory & ImmunosupresiveAmapachak & VatashamakSymptomatic & PalliativeSampraptivighatan & NidanparivarjanReparative & RehabilitativeRasayana & Apunarbhav Reconstructive Surgery Literature & Anecdotes Patient education & Group therapySatvavajay & Daivavyapashraya

Complement strengths and overcome weaknesses

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Potentials:Interface of Ayurveda with Diverse Disciplines

Ayurvedic FundamentalsInterfacing Scientific DisciplinesIntegrative Ayurveda DisciplinesSankhya SiddhantaCosmogenesisAyurontologyPanchamahabhutaElemental-PhysicsAyurphysicsPrakrutiGenomicsAyurgenomicsDosha-Dhatu-MalaSystems BiologySystems AyurvedaPradnyaparadhPsyco-SomaticsAyurcyberneticsDravya-Guna-KarmaPharmaco Kinetic-DynamicAushadhi DynamicsBheshaja AnubhavaEpidemiologyAy Pharmaco-epidemiologyBheshaja Nirupana Drug Discovery SciencesReverse PharmacologyPathyapathya AaharNutritional BiochemistryAyurceuticsPramana ManaQuantitative BiostatisticsAyurvedic Statistics

Modified from figure published in ‘Vaidya-scientists: catalysing Ayurveda Renaissance’, CURRENT SCIENCE, VOL. 100, NO. 4, 25 FEBRUARY 2011 ;Bhushan Patwardhan, Vishnu Joglekar, Namyata Pathak and Ashok Vaidya

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conclusion

India’s ‘Medical Pluralism’ should become a strength if we embark an integrative ethos of ‘Unity in Diversity’Current healthcare scenario has two sides; one is bright and another is dark! As stakeholders of healthcare sector we need to ensure that Brightness grows and Darkness subduesEvidence based approach is desirable to cultivate harmony between Community, Clinicians & ResearchersReverse Pharmacology would provide safe & predictable products and also facilitate integrative culture of Bedside to Bench & Vice versaIntegrative Medicine and Integrative Ayurveda are mutually enriching approaches which should accelerate the growth and development of Biomedical sciences

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

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Thank You !

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