Irrational prescribing is one big crime undetected in Ayurveda !!

1. IRRATIONAL PRESCRIBING – AN UNRECOGNISED
CRIME IN AYURVEDA
Dr. Remya Krishnan MD PhD
Ayurveda physician & Faculty
Rajiv Gandhi Ayurveda Medical College
( Govt of Puducherry)
Mahe

2. 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

3. 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 .

4. 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 )

5. 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

6. • 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 .

7. • 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 .

8. 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

9. • 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!

10. 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

11. 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

13. 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)

15. 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

18. 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

19. 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

20. 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 .

21. 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

23. BETTER LATE THAN NEVER
Thank you