|Year : 2015 | Volume
| Issue : 4 | Page : 185-187
Backing up Ayurveda with good science: The modus operandi
P Ram Manohar
Director and CSO, AVP Research Foundation, Coimbatore, Tamil Nadu, India
|Date of Web Publication||15-Jul-2015|
P Ram Manohar
Director and CSO, AVP Research Foundation, Coimbatore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Manohar P R. Backing up Ayurveda with good science: The modus operandi. Ancient Sci Life 2015;34:185-7
The only way in which unfair criticism and skepticism about Ayurveda can be addressed is by nurturing good science to lend greater credibility to it. This seems to be without doubt, the need of the hour. While discerning minds have started converging to pursue this goal, there would be divergent ways of thinking about the modus operandi. It will also be fair to ask ourselves as to how do we establish greater credibility to Ayurveda.
For many, it is all a matter of research publications coming of age in Ayurveda. Moreover, this means to reach the point where papers get published in the so-called high impact peer-reviewed journals. On the other hand, there is the problem of many spurious journals blacklisted by Beall as predatory that is published in the field of Ayurveda.  These journals do not meet acceptable editorial standards and are not indexed in the major databases. There are only three Medline indexed research journals devoted exclusively to Ayurveda. Will the entry of Ayurveda into the elite club of high impact research journals then herald a new era of scientific publishing that would give greater credibility to Ayurveda? The answer seems a mix of yes and no.
In the April 11, 2015 edition of Lancet,  the UK's leading medical journal, its editor-in-chief Richard Horton stated: "The case against science is straightforward: Much of the scientific literature, perhaps half, may simply be untrue." The alarm has been sounded few decades ago. But over the years, the evidence has been building up and as John P.A. Loannidis puts it, "in modern research, false findings may be the majority or even the vast majority of published research claims." 
Horton goes on to explain further, "afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn toward darkness."
Dr. Marcia Angell, a physician and long-time Editor in Chief of the New England Journal of Medicine (NEJM), echoes these sentiments "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the NEJM." 
"Science has taken a turn toward darkness" - this statement is an absolute shocker. We dismiss studies that are not published in "peer-reviewed" journals without "impact factor" as unreliable. However, it looks like the tags "peer-reviewed" and "impact factor" do not mean much anymore. The amount of bad research published even in the reputed journals is alarmingly high. Moreover, the situation seems worse because there is no systematic effort being taken to correct the bad practices.
At least the Stanford University has taken a big step forward to bring about reforms. To prevent the influx of bad science, Stanford University is launching the Meta-Research Innovation Centre (METRIC) to verify the findings of scientific research.  METRIC is led by Stanford Professor John Loannidis, an epidemiologist who in 2005 famously wrote "Why most published research findings are false," a paper that sought to prove that research can and is often marred by sloppy statistical findings and shoddy ideas. The situation is perhaps even worse than we imagine.
Linus Pauling, Nobel Prize Winner in Chemistry warns about the series of cancer studies conducted at Mayo Clinic "The Mayo article is misleading and dishonest. It might be described as fraudulent. It purported to be a repetition of Dr. Cameron's study, but it was greatly different, in a way that the Mayo Clinic investigators succeeded in hiding from the readers of their paper." 
A matter of great concern is the publication bias, which is much more serious than we may have imagined. Ben Goldacre in his book "Bad Pharma" gives shocking examples of numerous instances where negative results were withheld from publication misleading clinicians into taking decisions that could prove dangerous for the patients.  Surely, we must ensure that outcomes of all trials are published, not just the ones with positive outcomes. When clinical trials are registered in a central database, it becomes easy to trace out the trials that have not been published. At least the summary of the trial outcomes must be made available in the central registry so that systematic reviews will include all possible studies in question.
Where does Ayurveda stand in this scenario? When it comes to publication of bad science, it seems as though the difference between Ayurveda and mainstream science is only in degrees. An absolute absence of any kind of audit of published papers makes it difficult to understand the consequences of the poor quality of research and scientific publishing in the field of Ayurveda.
If research on Ayurveda is to come of age, I think we have to think beyond just peer review and impact factor. We have to cultivate a research culture in the academic environment of Ayurveda with a focus on rigor in research as well as honest reporting of research results. It appears that quality can be assured only by stringent audit and review of the research extending to the post publication stage. Only those papers that survive the most stringent audit can be considered to be based on good science.
This calls for a radical change in the research environment of Ayurveda. Perhaps we can benefit by looking back to the origins of Ayurveda in the classical knowledge systems known as darśanas. The epistemological foundations of Ayurveda have been derived from these systems which consider knowledge building as a process of measurement or evaluation though which we sift through valid and invalid experiences. The measurement (prakarṣeṇa mānam) of experience (anubhava) to distinguish between valid experience (yathārtha anubhava) and invalid experience (ayathārtha anubhava) helps to build knowledge (pramā) that is credible.  Credible knowledge brings about predictable results (niścitaphalavat vijñānotpādakatvaṃ).  The classical Ayurvedic texts emphasize that the authenticity of the text rests on demonstrable evidence (pratyakṣaphala). 
In the knowledge building exercise, the classical knowledge systems also emphasize on the need to go beyond association to establish causation. Ayurveda is often accused of interpreting associations as evidence of causation. In the process of anumāna (inference aided by direct perception), one has to go beyond association (vyāpti) to causation (vyāptiviśiṣṭapakṣadharmatā) which is achieved by examining the experimental hypothesis (pakṣa) against the positive control (sapakṣa) and negative control (vipakṣa). 
We are reminded of Caraka when he warns us that any claim of clinical success it to be dismissed as accidental if it cannot stand the scrutiny of scientific criticism (vinā tarkeṇa yā siddhir yadṛcchā siddhireva sā). 
In the tradition of Ayurveda, knowledge attains a state of finality when it survives the stringent review of many critical minds. When it has been examined in every possible manner by the best minds in the field, we can consider it to be close to the truth. Such conclusions were known as Siddhānta, which means that we have reached the end of possible criticism and examination.  This kind of scrutiny may be termed as meta-review, which is more comprehensive than just the limited peer review that research submissions are subjected during the editorial processing in research journals.
In conclusion, it can be said that efforts have to be taken by researchers in the Ayurvedic community to greatly improve the quality of their research as well as the publications. Considering the ills that modern research reporting is plagued with, we have to aim beyond just publication in "peer reviewed" or "high impact" research journals. We have to nurture a research culture that will aim to distill the truth of the matter by getting to the end of the road of critical review -the meta review of published research papers.
It is with great pleasure that I submit to our readers that due to the dedicated efforts put in by the editorial team, we have been able to overcome the recent hiccups in publishing the journal on time. We assure you that ASL will be on time from now on.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Horton R. Offline: What is medicine′s 5 stigma? Lancet 2015;385:1380.
Ioannidis JP. Why most published research findings are false. PLoS Med 2005;2:e124.
Marcovitch H. Editors, publishers, impact factors, and reprint income. PLoS Med 2010;7:e1000355.
Goldacre B. Bad Pharma. London: Fourth Estate; 2012. p. 5, 7, 13, 19, 20.
Annambhatta. Tarkasangraha. Mumbai: Nirnayasagara Press; 1976. p. 18-20.
Swami A. Sankara′s Teachings in his Own Words. 5 th
ed. Mumbai: Bharatiya Vidya Bhavan; 1989. p. 35.
Sadasiva SH. Aṣṭāṅgahṛdayam. Varanasi: Chaukhambha Sanskrit Sansthan; 2011. p. 954.
Annambhatta. Tarkasangraha. Mumbai: Nirnayasagara Press; 1976. p.24.
Yadavji T. Carakasamhitā. Varanasi: Chaukhambha Prakashan; 2013. p. 690.
Yadavji T. Carakasamhitā. Varanasi: Chaukhambha Prakashan; 2013. p.268.