In pursuit of evidence: A need to transform Ayurvedic education

Abstract

There is a loud call nationally and internationally to strengthen the evidence base for traditional medicine. Ayurveda, like other traditional systems, is often criticized for its lack of evidence upto the standard expected for modern day healthcare drugs and practices. This gap in evidence has led to Ayurveda being viewed as inferior to biomedicine. Therefore, producing high-quality evidence is essential not only for the credibility of Ayurveda but also to elevate its inclusion in standard of care practices globally. Yet, how can this evidence be generated if Ayurvedic researchers and practitioners are not formally taught about the advantages and means of evidence synthesis? The prevailing research culture in Ayurveda largely emphasizes validating ayurvedic formulations by substituting them into well-established clinical protocols for modern disease descriptors, rather than focusing on hypothesis-driven research using ayurvedic vocabulary. We argue that this arises in part from an outdated curriculum, poorly trained teachers, insufficient investment in research infrastructure at teaching colleges, and a paucity of policies to encourage cross-disciplinary learning. To address these gaps, we propose a comprehensive transformation of Ayurvedic education by including biomedical credit courses into the curriculum, practical internships to provide hands-on-experience, recruitment of teachers with biomedical expertise and funds to upgrade Ayurveda colleges. These ideas will help develop a cohort of Ayurveda graduates who are not only familiar with modern biomedicine, but also have the fundamental knowledge to develop, and test new ideas. India can emerge as a global leader in the area of integrative medicine, with its repository of several indigenous medical systems, and talented human capital in biomedical sciences. It is time we take the plunge.

The last decade has seen an accelerated push for AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) in public health, both nationally and internationally. The sustained political will culminated in India becoming the host country for the WHO's Centre for Traditional Medicine. A key goal of the first global summit held under the aegis of this organisation was “to look anew at the application of rigorous scientific methods to unlock the vast potential of traditional, complementary and integrative medicine (TCIM)” [1]. This is a laudable pursuit, as traditional medical knowledge has generally been considered inferior to modern medicine; a perception shaped by colonialism, social structures and advances in modern medical healthcare. Often, a lack of evidence, notably in the language and framework deployed in present biomedical science, is provided as a reason to ignore traditional medicine. But, how is this research evidence to be generated, if the students, educators and practitioners of traditional medicine receive superficial training in biomedical science? Here, we use Ayurveda as an example to illustrate how strengthening the capacity of its educational ecosystem can accelerate the generation of quality evidence.

1. Why is capacity building needed to generate evidence?

Historically, training in traditional knowledge whether in medical or other fields, was discrete, fragmented and non-standard. The system revolved around a guru and the transmission of knowledge from teacher to student, or a small group of students. The gurukula system is a progression, where learning begins with teacher assistance and advances to self-learning [2]. There was no explicit framework or process for evidence generation; knowledge grew empirically by practice and due to lack of documentation, sometimes died with the practitioner.

Modern biomedical and clinical science have evolved a structured framework for evidence generation in the last century. The “scientific method”, although variable in implementation from field to field, is a well-established process to validate observations, test hypotheses and develop protocols that are replicable [3]. Equally valuable is the opposing view of the scientific method proposed by Karl Popper: empirical falsifiability [[4], [5], [6]]. Either process offers a method for scientific investigations that is testable. Regrettably, both the need and advantages of testing knowledge have not been addressed in the Ayurvedic curriculum.

Faced with criticism regarding efficacy, toxicity and standardisation, the AYUSH establishment has tried to present evidence of its formulations and practices. What is ironic is that this evidence is presented in the language of biomedical science, which is largely not formally taught to those trained in AYUSH. This leads to sub-standard clinical trial designs, inadequately reasoned laboratory investigations as supportive evidence and publications that can be easily dismissed on scientific grounds. Therefore, to build a robust evidence base for traditional medicine in the language of modern biology, it is essential to introduce modern biomedical science across the entire ayurvedic educational ecosystem [7]. For a budding physician, this would include subjects such as biochemistry, genetics, infectious diseases, immunology, dietetics, bioinformatics, and biomedical instrumentation, with both theory and practical covered in the syllabus. Electives can include subjects such as advanced multi-omic sciences, clinical biochemistry, nutritional biochemistry, pathology, neurobiology, programming and data science.

2. How can we build research capacity in Ayurveda in a quality manner?

2.1. For the student: Revising curriculum and evaluation methods

The National Commission for Indian System of Medicine, set up in 2020 by the Ministry of AYUSH, proposed a standardised curriculum that blends sufficient depth in classical texts and practical knowledge, to which further enhancements are required [8]. Indians seek pluralistic treatments and a lack of fundamental knowledge in subjects such as genetics, biochemistry and immunology impairs ayurvedic physicians from interrogating, and evaluating their patient treatment strategies with the tools available in modern medicine. The present curriculum focuses more on application of these sciences to medical practice but without a thorough understanding of first principles, the application will be superficial. To bridge this gap, subjects such as those listed above, should be incorporated as standalone credit courses rather than short modules. This will help practitioners communicate with patients in a contemporary medical language and encourage the use of digital tools to keep better patient records. At present, the value of case study reports and digital methods to generate real-world clinical evidence is not obvious to the ayurvedic student.

Theoretical differences in Ayurveda lead to widely varying treatment plans shaped by individual clinical experiences. This variability complicates the analysis of treatment efficacy and standardization for clinical trials, once more underscoring the need for systematic documentation of practices to generate robust evidence [9]. Also, unfortunately, the assessment system tests rote memorization, rather than problem-solving and critical thinking skills. Intensive rotatory internships and minimal practical eligibility tests after each departmental posting would ensure that students gain hands-on experience before becoming practitioners. The ayurvedic student should emerge from their training with skills to not only practice ayurveda in contemporary times, but also the knowledge of how rigorous documentation can help in their overall practice.

2.2. For the teacher: Policies to improve pedagogy and hiring faculty from non-ayurvedic background

A major obstacle to new thinking is the imposition of solely Ayurvedic qualifications to make faculty eligible to teach at Ayurvedic colleges. If the faculty themselves have only been exposed to siloed Ayurvedic training with limited exposure to scientific inquiry, and cross-disciplinary learning, how will they inspire students? Introducing formal positions that allow the hiring of faculty with biomedical background, both clinical and non-clinical, to teach subjects like research methodology, statistics, genetics, molecular biology, instrumentation, nutrition, informatics, computational biology etc., would not only ensure effective curriculum delivery but also allow for organic interactions between faculty trained in different sciences.

Creative use of faculty development programs, year-long exchanges between Ayurveda and biomedical institutions, and joint workshops, would facilitate cross-disciplinary interactions, addressing gaps in both Ayurvedic and biomedical education. Teachers should also be incentivized to continuously expand their expertise through workshops, collaborative research, and seeking the participation of biomedical scientists as external supervisors for postgraduate research projects [10].

2.3. For the medical college: Funds to enhance institutional research capacity

India lacks a cadre of physician scientists, both in modern as well as ayurvedic medicine. The loss for Ayurveda however is more acute as the goal of most clinical and laboratory research in Ayurvedic sciences is overwhelmingly limited to validation. Instead, with the right training, research in Ayurveda could also become a path to discovering new biology. The adoption of a defensive strategy that research must prove that Ayurvedic treatments work has costs. Due to this biased attitude, study designs and methodology are often flawed as they seek to import wholesale the study design and molecular readouts for the specific modern disease descriptors. The genesis of this culture starts with training. Research as an activity is only introduced at the post-graduate level, where students are guided by faculty who themselves have little formal training in research. When the purpose of research is merely to complete degree formalities, quality suffers. This is exacerbated by a lack of advanced analytical instruments and laboratory infrastructure. It is not unheard of PG students paying pharmacy colleges to conduct animal studies that are part of their thesis. This is not only because most colleges lack an animal house, but also because of limited networking and research understanding of the faculty supervising the research. Invertebrate models such as worms and flies, are cheaper and easier alternatives to rat and mice studies; the infrastructure investment for these models is also substantially lower than vertebrate models. If encouraged in Ayurveda colleges, these models can be utilised for teaching as well as pre-clinical purposes. Thus, an overall strengthening of research capacity both at personnel and institutional level can be transformative for generating an evidence-base in traditional medicine. To create a research environment, laboratory-based courses along with structured courses for reading and discussion of peer-reviewed research publications are necessary to develop skills in students to challenge assumptions. Funding for upgradation of institutional infrastructure should be provided along with workshops on how to utilise, maintain and exploit these resources for teaching and research.

2.4. Challenges for enhanced inclusion of biomedical science in ayurvedic training

Firstly, there is resistance to change within the traditional Ayurveda community, where some educators and practitioners may view modern science as undermining classical Ayurvedic principles. The corollary is that biomedical scientists and clinicians may not welcome a thrust on traditional medicine due to inherent bias. Sensitisation and encouragement is necessary. We cannot expect new views to be accepted overnight. Policies and mechanisms that will allow the two parties to come together in events like exchange programs, joint-conferences, joint student competitions etc., can be considered.

Secondly, teaching in an Ayurveda college is not financially remunerative. Hence it attracts teachers with mediocre theoretical understanding, whose intent is merely to complete the syllabus. Such professors may not fully grasp the depth and concepts of the classical texts; a deficiency they make up by discouraging students from inquiry and creating a culture that asserts that whatever is written in the classical textbooks is not to be questioned [11]. Ironically, a lack of proficient teachers also hurts the ayurvedic component of the syllabus: the idea and procedures associated with practices like nadi, marma and rasayana that are part of the current syllabus are superficially addressed. Incentives such as cash prizes, money to travel to conferences etc., can be tested. Further, before and after hiring, teaching style can be evaluated by management and by students anonymously.

Third, the process to set up research infrastructure can feel onerous both financially and technically. Placing topics and experiments in the curriculum without ensuring that Ayurveda colleges will have the means to execute them will backfire on the intention of change. A one-time grant may be necessary for colleges to up-grade their infrastructure.

3. Conclusion

In the quest for effective healthcare, bridging traditional Ayurvedic knowledge with modern biomedical science requires proactive steps: standardized curricula, research-oriented training, and upgraded infrastructure. This ecosystem-led developmental effort is essential, and behoves all stakeholders to take concrete actions: policymakers should facilitate funding, educational institutions must innovate curricula, and practitioners need to have the tools to participate in evidence-generation should they wish to do so. To unlock its full potential, Ayurveda must evolve within the context of both historical significance and contemporary healthcare demands. The time has come for Ayurveda to meaningfully contribute to a holistic medical landscape. This need for constant evolution is advocated within the Charak Samhita itself, which advises a wise physician to perceive the world as a universal teacher and embrace knowledge from all sources to promote health and well-being, regardless of its origin; failure to do so is a disservice to their patients [12].

Authors' contribution

Sruthi G: Writing – original draft, Writing – review and editing.

Megha: Conceptualization, Writing – review and editing, Supervision.

Declaration of generative AI in scientific writing

None.

Funding sources

None.

Conflict of interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr Megha reports a relationship with The University of Trans-disciplinary Health Sciences and Technology that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.