Dr K K Aggarwal

eMedinewS Editorial

What is evidence–based medicine?

I was recently called to attend an Ayurvedic Workshop on Arishta Vigyan (science which deals with sign and symptoms of sure future death). One of the points that come up was ‘What is the definition of evidence-based medicine?’

In terms of medicine, to put it simply, anything which is published in Medline is evidence–based. But when we talk in a more strict sense, an authentic evidence–based medicine means either a meta–analysis or the results of a randomized control trial. Eighty percent of the medical literature today will not be based on either of the two. A large number of medical literature will be based on observational studies and observational data. In fact, no research is possible unless there is some observational data available. An observation, therefore, is the basic necessary background material for any research.

When it comes to Ayurveda, in those times when Ayurveda texts were written, there was no concept of meta–analyses or randomized control trials. Most of the texts were based on scientific observations with or without valid explanation.

Even in Allopathy, we have drugs whose actions can be scientifically validated but there are many uses of drugs where we find no scientific explanation. The empirical use of drugs falls in this category. The use of these drugs is justified by looking at the results of the observational studies. Every fact of Ayurveda written in standard text can be traced back to an observation by the Ayurvedic physicians of that era which has been validated by others with observations in their practice, and therefore, cannot be challenged.

These observations should be studied by Allopathic doctors and if found correct, should be adopted in the modern methodology. Most of these observations relate to prognosis and diagnosis of a disease. These aspects of Ayurveda with consensus can be incorporated in the modern therapeutic systems.
Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

Integrated Versus Adulterated

These two terms are often misused and misunderstood when we talk about various pathies in treating a disease. When an ayurvedic doctor prescribes an allopathic drug or an allopathic doctor prescribes and homeopathic drug, it is not integrated medical practice but adulterated medical practice. On many occasions, even the Supreme Court of India has clearly said that the person will not prescribe a drug from other pathy which he or she has not studied in great detail.

There is a loophole in this definition as today most of the ayurvedic drugs have been researched the allopathic way and their references are available in Pubmed-medline. Once these are researched the allopathic way, they no more will remain in the domain of ayurved alone and can be prescribed by allopathic doctors. For example – red yeast rice – an herbal drug, has lovastatin as a constituent and now is being prescribed in allopathy as a statin substitute. Drugs like saw palmetto has fenestrate like action. Fenestrate is used both for prostate enlargement and hair loss. Similarly, saw palmetto is also used both for hair loss and prostate enlargement. Today, saw palmetto has been researched the allopathic way and prescribed scientifically by allopathic doctors. Similarly cretegus in homeopathy has ACE inhibitor like action.

In ayurveda, it is allowed to study ECG, ultrasound, colour Doppler, TMT, laboratory tests etc. The same should be true for understanding panchkarma, nadi vigyan, concepts of ayurvedic prognosis, the concepts of vata, pitta and kapha in ayurved and the concept of sora syphlis and sycosis in homeopathy etc.

In Chanakya Niti, it is clearly written that to become a better professional, you need to know the strength and weaknesses of your competitor. Therefore, it should be customary for an allopathic student to be taught the strengths and weaknesses of ayurveda and homeopathy. One should use their weaknesses as your strength and their strength as your associates so that the patient can get the best of the two.

I personally feel if we understand the difference between adulteration and integration, the fight between various medical and ayurvedic councils will be over. While adulterated practice should not be promoted there is no way any law can prohibit an integrated medical practice where a medical doctor is taking help of pranayama, relaxation techniques, meditation, jalnaiti, yoga, panchkarma, nadi vigyan, arishtha vigyan etc.
FDA Okays Shingles Vaccine for Younger Age Group

The FDA has approved use of the varicella zoster vaccine Zostavax in patients ages 50 to 59 for prevention of shingles. The vaccine was approved in 2006 for prevention of shingles in patients 60 and older. Approval for the new indication was based on a 22,000-patient multicenter study in the U.S. and four other countries. Patients ages 50 to 59 were randomized equally to the vaccine or placebo and were followed for a year. Shingles risk was 70% lower in the treatment group than in the placebo group. Adverse events in the study included injection site redness, pain, and swelling, as well as headache.

Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

Obesity gastric bands may cause more complications than weight loss

Almost half of patients undergoing gastric banding for obesity needed to have the device removed, according to an online–first study published in the Archives of Surgery.

About 60 percent of the 82 patients with the device, Allergan Inc.‘s Lap–Band, followed over 12 years or more needed additional operations. The minimally invasive surgery led to weight loss in roughly 18 percent of the patients. About 40% of the 82 patients had major complications. Another 22 percent experienced relatively minor complications, and almost 50 percent had to have the bands entirely removed. In all but a few cases, inadequate weight loss or device breakdown was the reason for band removal. The mean reduction in body mass index was 7.8 points.

Dr KK Aggarwal
Editor in Chief