A blueprint for research in Ayurveda: Edzard Ernst

Personalised Ayurvedic interventions have demonstrated clinically significant improvement in rheumatoid arthritis on a par with allopathy treatment with the added advantage of lesser side-effects, according to a study. The study was conducted by the University of Washington, Seattle, and the University of Los Angeles, California, with funding from the National Institutes of Health in the U.S. and the Arya Vaidya Pharmacy (AVP), Coimbatore.

The project, to evaluate the efficacy of Ayurvedic medicines, was a randomised double-blinded, placebo (inert tablets)-controlled study, which is the gold standard for clinical research in modern medicine, said the research team headed by P. Ram Manohar, Director, Research, AVP and principal investigator (Indian side).

“We cannot make any tall claims with the results since it was a pilot study and the sample size was small. However, the study got a major stimulus when Dr. Edzard Ernst, the first professor of complementary medicine, called it a blueprint for research in Ayurveda,” Dr. Ram Manohar told The Hindu over telephone.

The study was published in the Journal of Clinical Rheumatology in June 2011 can be accessed through PubMed of the United States National Library of Medicine at the National Institutes of Health. This provides the Ayurveda stream of medical management with a much-needed boost for its hitherto lack of evidence-based medicine techniques.

The nine-month treatment and evaluation period had three groups with about 15 patients each, who were treated with the focus on rheumatoid arthritis. While one group was given only Ayurvedic medicines along with a placebo of allopathic medicine, another group was administered only allopathic medicines with placebos of Ayurvedic medicines and the third group was given a combination of Ayurveda and allopathic medicines.

Even the doctors prescribing the medicines were not aware of the medicines being given, said K. G. Ravindran, treating physician at the AVP, who was part of the research project.

It was a challenge to make standardised placebos for Ayurvedic medicines, said Reshmi Sarin, research co-ordinator at the AVP. In fact, the PubMed abstract mentions the development of the placebos as a unique feature of the study. Different combinations of internal and external Ayurvedic medicines were prescribed to the patients but the allopathic treatment consisted of standard doses of the drug Methotrexate. All patients were treated in the out-patient ward and no massage or ‘dhara' or any other in-patient treatment method was applied.

While the study was specific to rheumatoid arthritis, it also looked into whether complex Ayurvedic interventions could be studied in a clinical trial. The double-dummy, double-blind randomised clinical study has clearly shown the feasibility of further studies of this kind.

With a grant of Rs. 1.2 crore, the three-year study, begun in 2005 and completed in 2008, was fully published in June. Two milestones were a poster presentation of the study in November 2010 at the annual scientific meeting of the American College of Rheumatology and a research letter in the Annals of the Rheumatic Diseases.

Daniel E. Furst, Master of American College of Rheumatology, was the clinical lead investigator who designed the study. Another principal investigator from the U.S. was Cathryn Booth, University of Washington, Seattle. P.R. Krishna Kumar, MD of the AVP was the project director, and Dr. Manorama Venkatraman, University of Washington, Seattle, was the programme director.