Arya Vaidya Pharmacy, India

AVTAR has initiated the RUDRA (Random Uninterrupted Documentation for Retrospective Analysis) Program to generate practice based evidence in the field of Ayurvedic clinical practice. There is an urgent need to initiate systematic practice based evidence (PBE) in the field of traditional medicine (TM). In the case of conventional medicine, researched knowledge gets translated into practice as a rule whereas in the context of traditional medicine, a tradition of clinical practice that has a continuity of several thousand years is already existent. This tradition of clinical practice is a heterogeneous mixture of partly verified clinical knowledge and partly innovative clinical experimentation. The challenge is to generate reliable knowledge through research on ongoing clinical practice in traditional medicine. In other words, there is a need to promote PBE in TM.

Evidence based medicine or EBM as it is called has become the corner stone of clinical practice in conventional medicine. EBM insists that clinical practice be based on research generated evidence. In this model, the flow of knowledge is from the research laboratory to the clinic. However, it is being increasingly realized that the clinical scenario cannot be completely controlled by EBM. New knowledge is discovered in the context of clinical practice that has not been previously discovered by research. In other words, EBM has to be supplemented with inputs from PBR even in the case of conventional medicine.

TM has a rich resource base of clinical expertise but not an equally rigorous body of researched knowledge to back up the clinical practice that has been in vogue for thousands of years.

Continuity of use cannot by itself be the criteria to establish safety and efficacy of TM. The expressions of clinical practice in TM are so rich and diverse that it would be a Herculean task to conduct prospective clinical studies to build up an evidence base to substantiate them. Without preliminary clinical documentation, it would be impossible to even identify the most potential areas in the TM practices for more rigorous clinical research.

Scattered and isolated attempts at PBE by a few clinical centers or hospitals in TM will not be able to meet the challenge of creating a comprehensive evidence base that can address safety and efficacy concerns in the wake of globalization of TM. Therefore, there is a need to create a network of PBE based clinics in TM. Centres of excellence in TM practice should be identified and networked to implement a uniform protocol based clinical documentation program with a view to generate epidemiological data and evidence of safety and efficacy.