IRRATIONAL PRESCRIBING – AN UNRECOGNISED CRIME IN AYURVEDA

Dr. Remya Krishnan MD PhD Ayurveda physician & Faculty Rajiv Gandhi Ayurveda Medical College ( Govt of Puducherry) Mahe

Rational ??

• Rational treatment in Ayurveda requires that patients who seek this system of Medicine are subjected to guidelines of decision making strictly based on inbuilt science led standards explained in Ayurvedic basic and applied science in accordance to the state and stage of the patient and the disease .

• All the practices which are not based on the above standards leading to medically inappropriate and economically ineffective use of drug resources is irrational treatment

Consequences • Misexploitation and wastage of precious raw drug resources • Adverse clinical consequences including fatal ones in

patients • Out of five patients who reach me , four of them have

unpleasant and terrible experiences with former Ayurvedic treatment

• Neither the doctor nor the patient knows how and why it has happened .

Several ways

• Misuse• Unscientific drug manufacturing• Uncertainity based prescribing• Polytherapy• Prescribing Ayurvedic medicines as adjuvants

for drugs in Modern Medicine in existing use ( dangerous and unpredictable drug interactions )

A few examples

• Prescribing wrong medicines( medicines not intended by science led guidelines for the situation)

• Taking Agasthyarasayana in an infective productive cough

• Taking turmeric in milk at times of allergy• Performing nasya (nasal drops) in acute sinusitis • Hair oil in hair fall

• Prescibing empirical set of medicines and no scientific diet and regimen strictly advocated by science for the situation .

• Joint pain with Diabetes – Three herbal medicines- Two kashayas+ Arishta + Tablets + patents+ Panchakarma

• Patient will be taking vegetarian diet, dairy, fruits, diluted milk , fruit juices etc with a false notion that it is “ scientific ”diet .

• The manufacture of irrational combination of herbs or minerals not compatible with evidence based guidelines of science for the situation

• Patent drugs containing Arjuna , Bala , Dasamoola, Jatamansi, sarpagandha etc in hypertension. There are large number of examples .

Lack of patient education and councelling regarding the cause- mechanism- effect of his status and his crucial role in recovery process

• This happens by the ignorance of physician in the above matters .

• This medicine- that disease approach is encouraged in public by Ayurvedic medicine manufacturers in the form of cook- book medicine publications for public

• The irrational employment of unnecessary expensive medicines , treatments and Panchakarma procedures leading to huge financial loss and unhealthy and undesirable health consequences in the patients .

• More than 95% of all acute and chronic diseases do not require any Panchakarma procedures for recovery .

• Empirical treatments of 10 times and even more cost than what is required for science led intended treatment is being done in Ayurveda today!

ILLITERACY IN SCIENCE BASED MEDICINE

• Ignorance of doctors in standards of practice of Science Based Medicine of Ayurveda is the chief most factor leading to this detrimental situation.

• Too many unscientific formulations are being marketed every day which influence the public as well as the ignorant prescribers to readily recommend/ use them and invite complications

• No implementation of management, regulatory or training interventions to check irrational prescribing in Ayurveda

Defective education

• No educational interventions to train the students, internees , practitioners and specialists , the very intended Science Based Evidence Based Ayurveda .

• Science Based Evidence Based Ayurveda (SBEBA) is defined as conscientious explicit judicious employment of inbuilt science based evidences ( guidelines and core principles) which are the evidence base for decision making in diagnosis and management

SBEBA

• SBEBA incorporates standardised science led evidence based decision making tools and strategies developed by physicians and faculties Dr. Rajkumar and Dr. Remya krishnan and the specific technique which is the golden standard for decision making termed as “ Evidence Triad Approach” is explained in the book “Evidence Based Ayurveda &Rational prescribing “ authored by Dr. Remya krishnan (2012)

BHARAT MISSION BHISHAK• In pilot studies conducted in a group of physicians from different

parts of India after training them on SBEBA tools and strategies , their clinical performance after attending training showed remarkable improvement in quality and accuracy in comparison to the former status .

• Some of their self experiences after initiating training in SBEBA is available in fb group of SBEBA Wisdom series and you tube links in sbeba.org

• The SBEBA wisdom series is a systematic training programme for physicians and students to understand and practice the inbuilt tools and methodologies of Evidence Based Medicine in Ayurveda which is science Based, the programme is titled BHARAT MISSION BHISHAK

CURRENT PROBLEMS Hospitals &nursing homes Prescribers (Physician) Patients

Lack of enforced regulations and co-ordination based on science led evidence based standards

Poor knowledge and skills in the practice of Science Based Medicine of Ayurveda

Unable to differentiate tradition and grandma’s medicine from Ayurveda.

Lack of monitoring and evaluating progress in status of patients

No CMEs on Science Based Medicine . The current CMEs focus on Medicine Based Science which is not intended in Ayurveda.

Misled beliefs on the system of Medicine

Unqualified people like dispensing staff etc treating patients

Empirical polytherapy, uncertainity based diagnsosis and treatmentd ecision making

Cultural practices are misinterpreted as Ayurveda.

Poor hygiene Self medication

Unavailability of scientific diet to patients owing to ignorance of physicians

Telemedicine and its potent hazards

What we need in Ayurveda for reformation ?

• A specific national body EXCLUSIVELY for Ayurveda to take up and co-ordinate the policies and practice of Science Based Evidence Based Ayurveda

• Science Based Evidence Based guidelines for compulsory training and physician for every Ayurveda medical practitioner

• To have a list of essential classical medicines ( 15 number)which serve multipurpose based on recommendations in science made available in every part of India

What we need in Ayurveda for reformation ?

• Continuing Medical Education in SBEBA should be made as a compulsory requirement for licensure of practitioners .

• SBEBA awareness campaigns for public in every part of India

• Adequate funding for developing infrastructure and availability of medicines and SBEBA healthcare personnels

• SBEBA cells in all Ayurveda teaching institutes and hospitals to evaluate the decision making standards adopted in both OPD and IPD .

SBEBA proposal which is submitted to Ministry of AYUSH should be urgently taken up for discussion and implementation .

Knowledge is the only way to ward off the existing problems

Intense training should be initiated and effects monitored at regular intervals

BETTER LATE THAN NEVER

Thank you