|Year : 2015 | Volume
| Issue : 4 | Page : 235-237
A Conversation with Dr. (Med.) Valdis Pirags, Head of Internal Medicine Department, Paula Stradiņa Klīniskā Universitātes Slimnīca, Riga, Latvia
|Date of Web Publication||15-Jul-2015|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. A Conversation with Dr. (Med.) Valdis Pirags, Head of Internal Medicine Department, Paula Stradiņa Klīniskā Universitātes Slimnīca, Riga, Latvia. Ancient Sci Life 2015;34:235-7
What is the future of Ayurveda in European countries?
I see that future of Ayurveda is bright. This needs an explanation. First, there is a desperate need for new approaches in disease prevention and the current approach being used to treat clinically manifested diseases is wrong and too expensive. Many people actually get diagnosed too late and their subclinical stages are not treated properly. First, Ayurveda has this unique way of disease diagnosis even if the disease is in not in typical expression. Moreover, by mere balancing of doṣas you can eliminate typical clinical traits of a disease. Second is the economic aspect. It seems as though even the richest western countries like United States cannot afford expenses of medical care specially, if so many people are not living according to rules of healthy life and are constantly stressed, follow wrong dietary habits, have addictions, etc. Ayurveda has documented over a long period of time the principles of healthy living not just for Indians, to everybody in the world. Therefore, there is enthusiasm among people for traditional medicine, especially Ayurveda, because it really change the way how we are preventing and treating many diseases especially in their early stages of development.
What made you interested in Ayurveda?
There is no single answer. As many young people of my time, I was reading books on yoga and healthy lifestyle written by Indian authors. At that time, I was really deep into medical research. In Western Europe, my teachers were interested to explore Ayurveda not only in treating diseases, but to use it to prevent diseases. They were also interested in ways of changing the people's thinking and to influence people not just physically but also spiritually. They always taught me that treating people spiritually should always be a part of treatment. At that time, that is, about 3 years ago, one of my students came to me and asked me, "Professor, would you be interested to be the supervisor of my thesis on Ayurveda?" I told her that I was interested. She was quite energetic. She then brought me to the Arya Vaidya Pharmacy (AVP) in Coimbatore, India and I met the managing director Dr. Krishna Kumar, and we decided to start a project in clinical research on diabetes mellitus. I'm very glad to say how that this project has evolved into a successful one. I feel that this is the sign that the time is right to take up similar projects. I'm happy that I can use clinical experience and skills. This is how my interest in Ayurveda got kindled and sustained.
At what level of Ayurveda research are you engaged in?
My specialties are endocrinology and diabetology in particular. Diabetes mellitus is amongst most serious problems in the current world, because in every country, especially India, the number of diabetic is rapidly increasing because of lifestyle changes and increased stress, etc. I have wide experience conducting randomized clinical trials on diabetic people. I have been involved in more than 50 international large-scale clinical studies in many countries around the world including India and I have given lectures around the world about the results of the clinical studies and new anti-diabetic treatments approaches. Six years ago, I was invited to deliver a lecture in the Congress of Diabetes in Bangalore, India. I was happy that I could help the research center in Coimbatore to design clinical studies. I deeply believe that research on Ayurveda needs different and innovative clinical design. Let explain why: In Allopathic medicine the principle is always that all people with the same diagnosis should be given the same active drug or placebo and then compared with respect to very clear outcomes which are measurable: Viz. change in blood glucose, platelet, hemoglobin, etc. We should also compare the number of adverse of the clinical outcomes. But in Ayurveda, there needs to be a completely different approach. In Ayurveda, there is no single treatment for each and every person who has the same disease. In Ayurveda, the principle is that in every patient the same disease is caused and manifested in different ways. For example, in diabetes it could be influenced by very different imbalances in the regulatory system despite the fact that the outcome that is, increase in the blood glucose is the same. Therefore, randomized blinded clinical trials in Ayurveda should be customized, this is number one. Second, the outcomes should not be measured on the whole group of people with same diagnosis, but subgroups according to the principles of three doṣas. In Ayurveda, the subgroup analysis is more important than in Western medicine. Third, we have to set up the right outcomes to be measured. Here we cannot impose that always there will be the same outcome in the same period of treatment, it can be very different in different subject. Hence, taking into account those three principles, I think we need to design new approaches to do clinical randomized studies in Ayurveda. It is only then that we can generate strong evidence and do comparative studies in different fields in Ayurveda.
What are the difficulties and obstacles that come in the way of mainstreaming Ayurveda in the West?
I think the most significant obstacle is the lack of understanding of Ayurveda in clinical practice and also the terms which are used in Ayurveda. What we need in western medicine is that those who are trying to integrate Ayurveda in the daily practice should really first understand what Ayurveda is. In my opinion, they need to study it at least for 2 years or more with good teachers who really know what authentic Ayurveda is. This is number one requirement. Second, I think there is also a lack of authentic Ayurvedic medicine supplied in Europe and the United States. There should be proper standardization of Ayurvedic drugs. There should be proper safety and efficacy evidence proved by specific clinical randomized placebo-controlled trials. We should set up new standards for this new age of clinical trials.
Will studies and research help mainstreaming Ayurveda?
The main criticism in Western Europe about Ayurveda is based on the simple thesis: "Show me the evidence, where is the evidence." Some call it as pseudoscience and quackery. Those two terms, pseudoscience and quackery, are deeply embedded in the perception of Western Medicine practitioners against those who practicing wrong and dangerous medicine before the age of clinical trials came into the light. Pseudoscience and quackery were widespread in 19 th and early 20 th century. After that, a new philosophy emerged which laid the emphasis that every clinical approach in medicine should be proven by proper evidence. Unfortunately nowadays, many practitioners probably very aggressive to diversity of approaches in the treatment of people are using those words quackery and pseudoscience against Ayurveda. In many cases, we have to admit there is lack of evidence. Hence, this is our task to generate a new type of evidence.
Do you think that systems like Ayurveda will get absorbed as a branch of biomedicine, like integrated system or is there a hope for Ayurveda medicine to sustain itself as an independent stream?
I think that there is no danger if it really develops Ayurveda as a proper knowledge based medicine. But there is still more, one needs to know the actual tradition of Ayurveda based on the ancient texts in Sanskrit and also in other languages. Ayurveda in the modern times is more open to the current developments and it should not lose its fundamental principles and should not fear anything from the new developments in research. They should be properly applied to Ayurveda. Among many papers on Ayurveda currently being published, many are about what could be the modern scientific interpretation behind the Ayurvedic treatment effects including efficacy and safety issues. I strongly believe that there is a need for more of such research. Hence, I think we should not be afraid from the modern science, but instead use it to show the effects of treatment based on the understanding which is commonly accepted in the western science.
What are the kinds of programs that are going on in the University of Latvia related to Ayurveda?
According to recent surveys University of Latvia is among the 1000 most reputed research-based universities in the world. This semester we have completed first Introductory Course in Ayurveda for postgraduate medical specialists. More then 40 students attended. The largest interest was amongst gynecologists and pediatricians.
We have decided to use a three-tier principle. First is to educate people, what Ayurveda actually is and not just do some superficial courses in Ayurveda but to give good training to those who are interested in Ayurveda. This will be aimed to create a new kind of Ayurveda specialist in Europe. These specialists will practice Ayurveda properly, this is our first tier. Second tier will be to work with Indian Research Institutions like AVP, for example, to generate scientific evidence to prove treatments to be effective and safe, the indications to treat patients, etc. This is the clinical research which will bring about changes in legislation which will probably take a longer time. We will educate the people but what authentic Ayurveda is. Then we will generate proper clinical evidence that Ayurveda is effective and safe if it applied in the proper customized way and we can change the way how Ayurveda is implemented in a health care system in European countries. This is because, currently in Europe, doctors use Ayurveda as part of complementary medicine as a supplement and not as the main line. I don't think this is appropriate. Of course, there are issues against several Ayurvedic drugs as potentially dangerous and among those, the ones which contain heavy metals. This again needs clinical research and I think it is very important is to create proper pharmacovigilance system in India because you have millions and millions of people using Ayurveda. Efficacy and side effects should be properly recorded as far as possible accurately on online databases. Then it will become possible to examine the databases and publish research papers based analysis of potential, safety, side effects, toxicity, etc. We should also not avoid animal models, etc.
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Conflicts of interest
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