|Year : 2013 | Volume
| Issue : 1 | Page : 50-52
Acceptance of Ayurveda in the United States: The way forward
Daniel E Furst
Carl M. Pearson Professor of Rheumatology, David Geffen School of Medicine, University of California in Los Angeles, California, USA
|Date of Web Publication||23-May-2013|
Daniel E Furst
University of California in Los Angeles, 1000 Veteran Ave Rm 32-59, Los Angeles, CA 90095-1670
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Furst DE. Acceptance of Ayurveda in the United States: The way forward. ASL Muscuskel Dis 2013;1:50-2
| Introduction|| |
Daniel E. Furst is the first Carl M. Pearson Professor of Medicine at the University of California, Los Angeles (UCLA), Medical Center. Dr. Furst received his MD from Johns Hopkins University and two fellowships (Rheumatology in clinical pharmacology).
Dr. Furst has been on a number of national committees concerned with rheumatic therapeutics. He recently was co-leader of the ACR recommendations for the use of non-biologic and biologic therapies in RA and is a Master of the ACR. Dr. Furst has published more than 450 articles and 14 books, including more than 220 research articles. Dr. Furst's areas of research interest include the clinical pharmacology of anti-rheumatic drugs and biologics, and the pathophysiology, and treatment of systemic sclerosis.
In this interview, Dr. Furst responds to the questions from the editors of the Journal of Musculoskeletal Diseases in Ayurveda and provides his views on the scope for Ayurveda and the possibility of Ayurveda being accepted and regulated in a country like the United States.
| Questions and Responses|| |
The scope and relevance for Ayurveda in Rheumatology and the United States
Q. As a world renowned Rheumatologist contributing to the latest advancements in the field, what scope do you see for a traditional system of medicine like Ayurveda to offer alternative treatment approaches in rheumatological/rheumatic diseases?
A. I believe it is most important that traditional and holistic therapies be a significant part of treatments available for our patients.
Q. Do you see the chance for a sustained long-term interest in systems of medicine like Ayurveda in the field of rheumatology in the wake of newer developments and advancements in the field of modern medicine?
A. Yes, all of us are always looking for more and better treatments for our patients.
The most suitable research designs for testing Ayurveda
Q. What are the major hurdles that come in the way of acceptance of Ayurveda from a regulatory and scientific point of view in a country like the United States?
A. In countries like the United States and the countries of Europe, there are rules/regulations, which govern regulatory acceptance. Specifically, they require "well controlled" and replicated studies for regulatory acceptance. This requires randomized, double blind, controlled trials and nearly always (devices excepted) requires at least two trials. From a scientific point of view, too, the standard is randomized, double blind, controlled studies. When positively controlled (i.e., versus a known therapy), the positive control has to be one which has itself been shown to be effective in well-controlled trials. Thus, it will require such a study design for Ayurveda to begin to be accepted. Coincidentally, there has been one such trial for Ayurveda.  While only a pilot trial, which cannot be accepted for full regulatory purposes, it shows that well-controlled trials are possible using "Western" standards.
Q. What research design is most suited to study Ayurveda scientifically without distorting its holistic approach?
A. Since Ayurvedic medicine requires changing and individualized treatments for each patient, a design for well-controlled trials requires sufficient placebos so that the Ayurvedic physicians can freely change their therapy as needed without revealing which group (control or verum) is being treated. In the controlled pilot trial by Furst et al.,  for example, six different placebos had to be made, one for each of the different treatment forms-jams, decoctions, etc. We learned that blinding is maintained even when different herbal preparations, etc. are used within that treatment form. Thus, it is possible to remain blinded while allowing the full range of treatments within the Ayurvedic armamentarium.
Q. Is the evidence generated out of clinical trials sufficient for acceptance of Ayurveda as a credible system of medicine?
A. There is already a wellspring of positive attitude toward certain aspects of Ayurvedic medicine in the United States. Thus, the herbal preparations, which are part of Ayurveda, are sometimes used as part of the many complementary and alternative medicine approaches in the USA. Once well-controlled, double blinded trials show the place of Ayurveda in the total medical armamentarium, I believe it will be accepted. For example, well-controlled trials, although difficult, have been done using acupuncture, and acupuncture has been accepted for certain indications in the United States. It is, as a matter of fact, also accepted by insurances so that it is available without great cost. It should be stated, on the other hand, that not all of the well-controlled trials have shown efficacy when using acupuncture and so its acceptance is limited to the instances where well-controlled trials have been positive.
Q. Will the complexity of multi-formulation, multi-therapy interventions of Ayurveda be acceptable to modern biomedical researchers?
A. The idea of a holistic approach to medical care is accepted in many quarters. Thus the idea of individualized treatment with multi-formulation, multi-therapy interventions is not at all foreign. Our study was enthusiastically and generously supported by the Ayurvedic Trust in Coimbatore and by their medicinal factories in Kerala, and they have enabled us to complete this well-controlled, double blind, randomized pilot study for outpatient treatment of rheumatoid arthritis. Our next step is to seek funds for a statistically powered clinical trial, which can definitively show the place of Ayurveda in the treatment of rheumatoid arthritis (it should be noted that the definition of rheumatoid arthritis in allopathic medicine has close correlates, although named differently, in Ayurvedic medicine).
Q. How important and feasible are studies on the biological mechanisms of Ayurvedic interventions?
A. It is always highly desirable to understand therapies and this is, of course, also true for Ayurvedic medicine. Based on an understanding of inflammation and immunity in the G.I. tract, for example, it might be possible to understand therapies of a given illness within the Ayurvedic approach. The tools for understanding molecular actions are now available, although expensive, and at least an initial attempt to understand the biologic mechanisms underlying Ayurveda would be highly desirable. Certainly, it would make Ayurveda's worldwide acceptance much easier.
Q. What are the relevance and scope for placebo controlled studies in evaluating classical Ayurvedic treatment? Is it possible to have placebos for external manual treatments?
A. We have already shown that placebo controls for individualized treatment according to Ayurvedic tradition are possible. This approach is also easily transferable to the use of enemas, of course. The approach to dietary changes is more complex but also quite possible. The use of oils and massage is inherently more difficult. While the oils can be given in placebo formulations, the smell and consistency of the oils may be difficult to reproduce as placebos. Furthermore, the massage that is part of Ayurveda would pose challenges. Nevertheless, I think that the whole panoply of Ayurvedic intervention can be controlled in a way that well-controlled trials of other aspects of Ayurvedic intervention can be tested.
Thoughts on how Ayurveda can position itself in a country like United States
Q. How do you see Ayurveda positioning itself in a country like United States in the future? As an independent alternate medical system or a complementary system, with scientifically tested practices integrated into mainstream conventional medicine?
A. Ayurvedic intervention can be integrated into mainstream conventional medicine or can be presented as an alternative medical system. This will depend on the kind and quality of the studies which are completed, and on the place within the larger medical system that Ayurveda wants.
Q. If Ayurveda were to gain acceptance in the United States, can we look forward to a future in which doctors of conventional medicine study and practice scientifically tested Ayurvedic interventions?
A. There is no doubt in my mind that scientifically tested Ayurvedic interventions can be accepted and can be taught within the standard medical curriculum. Other aspects of complementary medicine are beginning to be used, particularly as they pertain to a holistic approach to the patient. As for Ayurveda, its acceptance is dependent upon the completion of high-quality, scientifically credible studies. The pilot study, which we have completed, shows the wonderful possibilities. Not only did it demonstrate that well-controlled scientifically valid studies can be done but it also showed the great degree of rapport and collaboration, which can characterize cooperative work between Ayurvedic and allopathic practitioners.
| References|| |
|1.||Furst DE, Venkatraman MM, McGann M, Manohar PR, Booth-LaForce C, Sarin R, et al. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol 2011;17:185-92. |