Ksr ebm-16-12-16

EBM- Evidences to bring forward in Ayurveda
EBMEBM
“The Evidences to bring forward in Ayurveda Medicine”
Dr KSR PrasadDr KSR Prasad
On 16-12-2016@PG Induction-2016, Wardha
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/

EBM
EBM ‐ “The Evidences to bring forward in Ayurveda Medicine”
Dr KSR Prasad
On 16-12-2016@PG Induction-2016 WardhaOn 16-12-2016@PG Induction-2016, Wardha

Wh t i E id B d M di i
What is Evidence Based Medicine
• Evidence based medicine is the integration of• Evidence based medicine is the integration of
best relevant scientific research evidences
i h li i l i j d d iwith clinical expertise judgments and patient
values and preferences

I t d ti
Introduction
• Ayurveda being the traditional medicine,
present day scientific world feels that is do not p y
have any EBM based structures and Evidences
of concepts and treatmentsof concepts and treatments
• Ayurveda is not a household or folklore
bl b lltreatment publicities but it is a well
constructed therapeutics built on validated
concepts after through discussions

T th t
Truth story
P t d i tifi l li i• Present day scientific values are lingering
around the truth
• It is like a three blind rats running for the• It is like a three blind rats running for the
search of truth
– They can never see the truth– They can never see the truth
» Ayurveda has a specific system of
balancing the Dosha and Dhatug
to bring in to normalcy through a
sequence of procedure – at
present it is called as “Block‐Box”present it is called as Block‐Box
method of research

?
• Assume that you are the health professional
• A community in your area is concerned with
its high rate of childhood obesity andits high rate of childhood obesity and
requests your help.
• How do you proceed?
– You need an Evidence for your statementYou need an Evidence for your statement
• It is Evidence Based Medicine

EBM
EBM
• At present era first described in 1992
– As a new approach to teaching medicinepp g
– Called as a “revolution” in medical practice
All h th t d l ith P ti t• All approaches that deals with a Patient,
Physician, Nursing and Medicine (Chikitsa
Chatushpada) are the components of EBM
– Not a new trend at least for Ayurveday

D fi iti
Definition
• Evidence based medicine (EBM) was
originally defined as the conscientious, g y
explicit, and judicious use of current
best evidence in making decisions about thebest evidence in making decisions about the
care of individual patients.
h “ h f b h• Otherwise – “The integration of best research
evidence with clinical expertise and patient
values.”

St t EBM
Steps to EBM
• Make a need in to an answerable question
• Search for the best evidenceSearch for the best evidence
• Assess the evidence
• Check how one’s clinical expertise on an
individual patient is possible p p
• Evaluate the entire scenario
• You get the EBM

C iti i EBM
Criticism on EBM
• De‐emphasizes patient values
– Doshabeda “Vikara”
• Doesn’t account for individual variation
P k i– eg: Prakruti
• Devalues clinical judgmentj g
– Swasa as a symptom and disease do not have
similar treatment in generalsimilar treatment in general
• Leads to therapeutic nihilism = ?

Th ti ihili
Therapeutic nihilism
• Therapeutic nihilism is a contention that
curing people, or societies, of their ills by g p p y
treatment is impossible.
• In medicine it was connected to the idea that• In medicine, it was connected to the idea that
many "cures" do more harm than good, and
h h l h bthat one should instead encourage the body
to heal itself.
– Eg: Radiation therapy

P di hift
Paradigm shift
• A clinical experience is thought as an unsystematicA clinical experience is thought as an unsystematic
observations and instrumental diagnosis is brought as
ultimate
• Understanding the basic physiological mechanisms
shift as pathology and its result oriented observationalp gy
studies are thought as outdated
• In an article only "Introduction" and "Discussion"y
are considered as appropriate and relevant
• one must be cautious in the interpretation ofp
information derived from clinical experience and
intuition, for it may at times be misleading.

Wh EBM
Why EBM
N f id (i l / h i l)  New types of evidence (instrumental /chemical)
are being generated which can create changes in
th ti t t t dthe way patients are treated
 Although evidence is needed on a daily basis,
ll h dusually physicians don’t get it. Reasons are many ‐
1. Lack of time (busy practice)
2. Out-of-date textbooks (Ayurveda is 2000 years old), and
3. The disorganization of information3 e d so ga at o o o at o
4. Printing of non reliable articles in predatory medical journals

using evidence more critically
validity: most articles should be ignored
using evidence more critically
EBM Journal Process
• 140+ journals scanned
Number Needed to Read
to find 1 valid is 20+140 journals scanned
– 60,000 articles
• Is it valid? (<5%)
– Intervention: RCTIntervention: RCT
– Prognosis: inception cohort
– Etc
• Is it relevant?Is it relevant?
– 6‐12 GPs & specialists asked:
Relevant? Newsworthy?
N b N d d t R d• < 0.5% selected Number Needed to Read
to find 1 valid & relevant is 200+
more critically EBP: informing decisions with the best up‐to‐date evidence

Wh EBM i A d i i d
Why EBM in Ayurveda is in need
• There is a need of showing the Ayurveda traditional
Knowledge statistically and clinically significant
ith t ti l ti b twithout any negative correlation between a
physician’s knowledge for up to date care of patient
It i t k th t th h i i d h d• It is to know that the physician do have good care
knowledge after so many years of leaving his medical
school because of the 2000 years time tested valuesschool because of the 2000 years time tested values
• EBM makes Knowledge translation – increasing the
uptake of the best available evidence into practiceuptake of the best available evidence into practice –
which is always a challenge

T t t
Treatment
h b k• There are many books
writes classical
Be aware that
treatment options
should be based on
prescriptions or guides
themselves as markers
should be based on
clinical need and the
effectiveness of
• In fact the prescriptions
are derived at only with
treatment options,
and that decisions y
the consensus of patient
after concluding the
should be arrived at
through assessment
and discussion withafter concluding the
concerns and needs
and discussion with
the patient

R ibili & Skill d l
Responsibility & Skill development
i h ibili f• It is the responsibility of
the concerned physician to
ll t th i f ti
Must be aware of
their responsibility to
maintain theircollect the information
regarding the patients
condition and the suitable
maintain their
knowledge and skills
throughout there
condition and the suitable
skills or therapeutics
prescribed to the patient
throughout there
careers.
prescribed to the patient
looking at his disease
severity and economical
Scholars are expected
to keep up to date and
to apply knowledgeseverity and economical
conditions
to apply knowledge
necessary for good
clinical care.
clinical care.

Wh t id / kill t d l
What evidences /skills to develop
f h i h kill d l k• Most of the time the skill development takes a
duration of time and half of it becomes mostly
td t d ithi 5 f d tioutdated within 5 years of duration
– But the 2000 years Ayurveda is not outdated
• The other half is not bothered by any body as it
never comes in to lime light or implemented by
h b dthe Governing bodies
– Thus the skills development is an uninterrupted
ill i h d fprocess till we are in the concerned area of
“Recommending a therapeutics for Patient”

Level I:     Meta‐analysis of
multiple RCTs
(‘ ld d d’)(‘gold standard’)
Level II:   Individual RCTs
Level III: Quasi‐experimental
Level IV:  Non‐experimental;
qualitative
Level V:   Program evaluation;
QI; RU; case reports
Level VI: Opinion of respected p p
authorities

using evidence more
systematically
Total mortality from trials of β‐
blockers in 2° prevention after MI.
systematically
blockers in 2 prevention after MI.
Black square & horizontal line
correspond to odds ratio (OR) &
95% confidence interval (CI) for
each trial. The size of the black
square reflects the weight of eachsquare reflects the weight of each
trial. The diamond represents the
combined OR & 95 CI, showing a
22% reduction in odds of death
Egger, M. et al. BMJ 1997;315:1533‐1537
22% reduction in odds of death

P ti EBM
Practice EBM
• 1. Ask a focused question.q
• 2. Acquire (systematically search for) epidemiological
evidence to help answer question.
• 3. Appraise evidence found for its validity, effect size,
precision (ideally all the relevant evidence)
• 4. Apply the evidence in practice:
– a. amalgamate the valid evidence with other relevant
information (values & preferences, clinical/health issues, &
system issues) and make an evidence‐based decision; and
b act (implement) the decision in practice– b. act (implement) the decision in practice
• 5. Assess your performance (write an article)

Cli i l Q ti “PICO”
Clinical Questions ‐ “PICO”
lExample:
• In a 5 year old child with conjunctivitis y j
(patient) will topical antibiotics (intervention)
compared to no treatment (comparison) lead p ( p )
to quicker symptom relief (outcome)?
• In a 5 year old child with conjunctivitisIn a 5 year old child with conjunctivitis
(patient) will topical antibiotics (intervention)
compared to no treatment (comparison) leadcompared to no treatment (comparison) lead
to improved cure rates (outcome)?

EBP E id B d P ti
EBP – Evidence Based Practice

Take Home Message
• Try to ask one patient for ‐
1. What causes the disease?
2 How was the disease diagnosed?2. How was the disease diagnosed?
3. How was the patient treated?
4 Wh i h l hi f h di ?4. What is the natural history of the disease?
5. Consider formulating a PICO
And try to find some evidence for it

Thank YouThank You

Ksr ebm-16-12-16

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