Year : 2017 | Volume
: 38 | Issue : 2 | Page : 95--96
Need of systematic review of clinical trials in Ayurveda
Associate Professor, Department of Kayachikitsa, IPGT and RA, Jamnagar, Gujarat, India
Associate Professor, Department of Kayachikitsa, IPGT and RA, Jamnagar, Gujarat
|How to cite this article:|
Goyal M. Need of systematic review of clinical trials in Ayurveda.AYU 2017;38:95-96
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Goyal M. Need of systematic review of clinical trials in Ayurveda. AYU [serial online] 2017 [cited 2019 Sep 23 ];38:95-96
Available from: http://www.ayujournal.org/text.asp?2017/38/2/95/239943
Nearly five decades have traversed and abundant of clinical trials has been conducted at various postgraduate institutes and research centers of Ayurved, to generate evidence-based data. The trials aimed at revalidating efficacy of either single or polyherbal or herbo mineral preparations mentioned in classics or to find the efficacy of new formulated preparations. Efforts were also made to incorporate new drugs from traditional or folklore treasures to enrich existing Materia Medica or to find out substitute of such drugs which are the verge of extinction or are not currently available. In spite of the exhausting efforts, it seems a final layout of drugs which can be choice of drug for a particular disease or particular state of that disease is still awaited. One of the reasons for this may be lack of proper reviewing of previous researches and each time conducting a new clinical trial with different approaches without considering the outcomes and shortcomings of previous work. Hence, time has come to look behind and reanalyze the data that have been already generated, so quality outcome on the effectiveness and appropriateness of large number of clinical studies can be done.
A systematic review can be the solution of it which is the process where evidence from a number of studies are gathered together in one report and the available data is analyzed to assess the strength of the evidence and resulting reports. Such reviews are better at assessing the strength of evidence than single studies as it attempts to bring the same level of precision to review research evidence as should be used in producing that research evidence in the first place. The conclusions of such reviews are more reliable than those of individual studies. Consulting a review removes the need to try and understand the differences between results from various items of research. It also minimizes bias when scientists reach conclusions and are less costly to carry out than a new set of experiments, and they take less time.
Classics are full of information regarding the diagnostic and management aspect of almost all the diseases which are prevailing in today's era, and exploring of these topics reveals that for single condition, multiple herbal or herbomineral preparations have been mentioned again with multiple indications and rarely its contraindications. Take an example of Kushtha: where first 18 varieties of it are mentioned according to Dosha dominance, and later, in treatment aspect, many preparations are stated again with multiple indications. For example, indication of Mustadi Churna includes Kushtha (skin aliments), Shotha (Edema), Pandu (anemia), Arsha (hemorrhoids), and Bhagandra (fistula in ano). These types of indications always confuse the researcher that whether this preparation is indicated in a Kushtha patient who is also suffering from all such diseases or it can also be given to the patients other than Kushtha suffering from either of these conditions. Further, many a times, single preparation is indicated for more than two or more presentations of the same disease. As Ayurveda is aiming at individualistic approach rather than treating only disease, researchers in Ayurveda have to also concentrate on the finding that the trial drug is best in which specific condition of the disease and why? Recent studies on the concept of phenotype and genotype have given support to the concept of Ayurveda that no individual is similar to another individual, and thus, planning of diet, drugs, and lifestyle on individual basis is must. Even before planning of medicine or therapeutic schedule to any patient needs analysis at individual level, for which various types of clinical methods and questionnaire have been mentioned in classics. Planning on this basis can avoid various side effects or adverse reactions of drugs and can be lead to develop pharmacogenetics or designer medicine. Concluding of clinical trial on these bases may give answers to the questions that why the same drug does not produce similar effect in different individuals; why few people develop adverse drugs reaction; which patients will be best benefited by a particular medicine.
With the popularizing of internet and other electronic access and pooling of published articles in recent years, it becomes difficult to keep up with primary research evidence, and even in a single disease, it is not unusual for the number of published studies to run into 50 or more. Hand search of previous works on diabetes mellitus in Ayurveda reveals that till date, many clinical trials have been done trying almost all single or poly herbomineral drug mentioned in classic or as folklore, and all these studies have ended up with satisfactory results, but this information is still not sufficient to say that which is the most potent antidiabetic drug and in which stage of disease. There is a substantive question, several primary studies – perhaps with dissimilar findings and substantial uncertainty. These again indicates that there is need of re strategize clinical trials or to properly review them.
One of the biggest challenges within scientific research is also to interpret the results of individual studies in the context of other research that has been done. This is especially important for decisions about whether a medical treatment works and for decisions about what further studies should be done.
At this juncture, we also cannot say that reviewing was not at all carried out by previous scholars, but the method adopted was traditional narrative reviews trying to collect existing knowledge and expert commentaries which merely summarized the presented data. These can be termed as narrative reviews or critical reviews. It was also noticed that different reviewers were reaching different conclusions for the same research base, and often, the findings reported had more to do with the specialty of reviewer than with the underlying evidence.
As said earlier, too much of work on the same problem or haphazardly reaching a conclusion where the results do not match the aim of the clinical trial creates confusion, and systematic review may help to end such confusion or let us know where there is neither enough evidence nor lacuna in the present system of clinical trial. Ultimately, it will help reduce the influence of flaws or errors in a single study. Further, it may yield new sights by combining finding from different studies. These types of review also allow establishing clinical and cost-effectiveness of an intervention or drug.
Especially, in the institutes where clinical trials are continuously planned as a part of research training, this type of exercise will help propose future research agenda when the existing agenda has failed to address a clinical problem. It may also help the researcher who wants to secure grant funding for primary health-care research. Obviously, it should also be a part of student dissertation or postgraduate theses. In the end, these types of meta-analyses are very important to health-care practitioners who need to keep abreast of the medical literature and make informed decisions. This goal can be achieved by enriching our existing research data repositories.
In the end, it can be said that every time, conducting a new clinical trial without considering the efforts and results of work already conducted always leads to addition of information but never helps to reach a conclusion. Hence, systemic review must also start in Ayurveda as a part of research where large quantities of information can be reduced into palatable pieces for digestion. It may help us to answer the questions where the result is uncertain and to explain why there are variations in practice. Further, it will also confirm the appropriateness of current practice and whether there is need to change our approach.
Useful websites for systematic reviews study:
The Cochrane Library: www.cochrane.orgThe Joanna Briggs Institute: www.joannabriggs.edu.au/pubs/systematic_reviews.phpThe Campbell Collaboration: www.campbellcollaboration.orgThe Centre for Evidence-Based Medicine: www.cebm.netThe NHS Centre for Reviews and Dissemination: www.york.ac.uk/inst/crdBandolier: www.medicine.ox.ac.uk/bandolierPubMed Clinical Queries: Find systematic reviewswww.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtmlhttp://www.systematicreviewinayurveda.org/.