Integrating Ayurveda: Clinical Studies on the Ayurvedic Treatment of Rheumatoid Arthritis Offer New Perspectives.

Author(s) Olivier Talpain1
Affiliation(s) 1 Associate researcher at the University Institute of History of Medicine and Public Health in Lausanne, Switzerland
Country - ies of focus India
Relevant to the conference tracks Education and Research
Summary From the Ayurvedic point of view, Ayurveda is largely underused despite the fact that it has much to offer, for chronic diseases for example.How could this be recognised? Is modern research the best way? Could it be assessed as a whole system? How could it be integrated into global health solutions?

This ethnographic case study presents modern clinical studies that positively assessed the Ayurvedic treatment of rheumatoid arthritis. It shows that, due to a recent paradigm shift in modern clinical research, Ayurvedic and conventional physicians can collaborate successfully to conduct research that can assess the relative efficacy of individualised and multimodal Ayurvedic treatments.

Background The main traditional system of medicine of India, Ayurveda, considers to be largely underutilised as it has much to offer globally, especially to prevent and treat chronic diseases.Ayurveda uses its own knowledge system / epistemology (a specific way to the acquisition and validation of knowledge) whose underlying principles have remained unchanged for millennia. It applies to life in general (human, animal, vegetal), and is said to be remarkably adept at addressing complexity –considering living beings in a holistic manner from diagnosis to treatment– and particularly cost effective and accessible:

-       It enables early diagnosis (assessing energy imbalance), helping to maintain health before pathological symptoms arise;

-       It stresses on prevention;

-       It primarily uses simple technology / low-tech approaches (relying mainly on dietary / life style change, herbal remedies and manual therapies).

Although Ayurveda is increasingly used globally, it is relative to modern medicine still marginal, even in India.

Good up-to-date clinical research showed promising results.

So why has Ayurveda not yet been part of integrated health solutions – especially in the west but also in India?

Objectives Considering what Ayurvedic physicians and researchers claim Ayurveda can offer globally and the positive results of clinical trials, why is this seemingly powerful and promising health system currently so marginal?Since Ayurveda has been observed and studied by the West for centuries –especially in the modern era by the British who governed India–, one might hastily conclude that modern research has shown no advantage of Ayurveda compared to conventional medicine. However, the answer is more complex, ensuing from the relations between India and the West, Ayurveda and modern medicine, and in the history of these systems of medicine.

This study aims to understand why there is such a gap between what Ayurveda claims and shows through modern clinical research on the one hand, and the way it is used and considered globally on the other hand. Specifically, we aim to answer the following questions: How could Ayurveda be recognised in cases where it offers a positive alternative to conventional medicine? How could it be recognised as a whole and specific system of medicine? How could it be integrated as part of global health solutions?

Methodology Social sciences / In the fieldUsing an ethnographical approach, the study was conducted in South India where Ayurveda is the most widely accepted and used.

Interviews and visits

A series of interviews were conducted to understand the overall situation of Ayurveda and, more specifically, its relation with modern medicine and research. Interviews of over 50 Ayurvedic (registered) physicians and about 50 researchers, teachers, students, and managers of public and private health services were conducted between 2006 and 2013. Visits to hospitals and pharmaceutical factories and laboratories that subscribed to the Ayurvedic system also contributed to the study.

Literature review

A review of scientific literature related to Ayurveda was conducted in 2012 (forthcoming) by the AVP Research Foundation using its specific online database (dharaonline.org). This offered a valuable and concrete insight into the history of research on Ayurveda.

History of modern medicine

Further literature review and interviews with researchers of conventional and complementary and alternative medicine (CAM) shed light on the evolution and current position of modern research vis-a-vis CAM.

Results First, it is apparent that the marginalisation of Ayurveda, both in India and in the West, is a result of its historical relation with modern medicine and more widely from societal modernisation. That is, in a modern globalised world, also in India, patients expect modern scientific evidence regarding traditional medicine. The Indian Ayurvedic community largely considers its recognition by modern science the best way to gain validation and recognition on a global scale. Thus, a lack of modern scientific evidence about Ayurveda contributes to its marginalisation independently of its efficacy.Why has Ayurveda hardly been assessed by modern medical research?

We observed that almost all the modern research on Ayurveda did not aim at assessing its clinical value, but its pharmacopoeia. Historically, modern scientific research into Ayurveda has been driven by a pharmacological approach to identify active principles of the Ayurvedic drugs.

The biomedical approach that largely dominated the medical field in the 20th century might partly explain this situation. Such a radically different and complex system of medicine as Ayurveda may not be well suited to the biomedical approach. Ayurvedic formulations often comprise tens of substances, which in turn contain numerous active principles, and Ayurvedic practice is individualised, and multimodal (medicines, massage, diet, etc.). Even with the understanding of its specific theories, the task of bio-molecular explanation of its treatments appears colossal.

In the last decades, a paradigm shift has occurred in conventional medical research: the clinical assessment of any treatment can in principle now be valued even in the absence of a bio-molecular explanation (Evidence-based medicine). This allows the assessment of complex treatments like Ayurveda.

Taking an integrative perspective, the assessment of a treatment alone is not enough; it needs to be compared to other treatments. Through our case study, it was observed that comparing a complex Ayurvedic treatment to a conventional medical treatment through the best current standards of clinical research is possible. In fact, the NIH-NCCAM case study has been considered a blueprint for further clinical research on CAM, as a double-blind comparison was previously thought to be too difficult with such a complex treatment. The innovation of that study lies in the use of seven placebos, each of them representing a type of Ayurvedic medicine (tablets, decoctions, etc.).

Conclusion With the evidence-based approach, as a result, modern clinical research can assess Ayurvedic treatments like that of rheumatoid arthritis. Ayurveda, a complex system of medicine that delivers individualised and multimodal treatments, can on this basis get better and wider recognition in India and around the world.The challenge for modern clinical research lies in designing effective clinical trials that can assess all types of Ayurvedic treatments. For example, in the NIH-NCCAM case study, a major modality of the classic Ayurvedic treatment of rheumatoid arthritis –enema with medicated oil– has not been used because of the difficulty of double-blinding. Nevertheless, even the partial Ayurvedic treatment showed comparable results to Methotrexate with fewer undesirable side effects. Once the whole Ayurvedic treatment can be assessed, it may show different results.

Still further questions remain.

How can research on Ayurveda evolve? How is the support to this research defined? How can international collaboration take place to enhance research on Ayurveda?

When assessing and integrating Ayurvedic treatments into an evidence-based modern health system, how would the difficult-to-assess Ayurvedic practices be evaluated? How to avoid neglecting or rejecting the Ayurvedic practices that would be more difficult to assess?

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