Need of Big Data Analytics in Integrated Medicine Approach

 Dr. SR Narahari, Director, Institute of Applied Dermatology, Kasaragod, Kerala

Integrative Medicine must use big data analytics and reverse pharmacology to enhance clinical potential of Ayurveda formulations

Western biomedicine's success in infection control and acute care made it an instantly popular health care system in India sidelining Indian traditional systems of medicine that existed for millennia. Demand for biomedicine services increased in proportion to the rising population. When the Indian economy gradually opened its doors to global markets (post-1992) our banks liberally extended loans to allopathic hospitals. Corporate hospitals welcomed many new technology-driven health care protocols that were commercially viable. With this development, the wisdom of biomedical research trickled in and patients began realizing the limitations of technology-based medicine especially in chronic care. The department of AYUSH (Acronym for Ayurveda, Yoga, Unani, Siddha, and Homoeopathy) was established in 1995 and upgraded as Ministry in 2004. It supported a few Ayurveda establishments through Government grants and Indian research policymakers began paying attention to traditional Ayurveda treatments. Many provincial states of India allowed junior Ayurveda doctors to undergo short-term training courses at biomedical hospitals. As a result, numerous English translations of Ayurveda terminologies and accounts of its practices were and are being published in India as continuing medical education articles, historical translations, or medical textbooks, albeit not all supported by clinical studies.

IAD Model of Integrating Biomedical Dermatology and Ayurveda, Yoga, and Homeopathy 

Despite great enthusiasm and liberal funding, Ayurveda is in decline due to a lack of evidence. This has further encouraged increased funding of high technology-driven research under the scheme 'Ayurveda biology' which by and large ignores the principles of patient-oriented research that would have transformed the existing practice into 'Evidence-Based Ayurveda'. IAD model of integrating biomedical dermatology and Ayurveda, Yoga, and homeopathy is built on the Cochrane model sans emphasis on randomized control trials. It differs from the mainstream advocacy and current funding policy of Ayurveda and Integrative Medicine in India. At IAD we believe in a clinical-investigator-led approach, a concept supported by the views of the British Medical Journal. We use clinical illustrations, by examining a patient by the bedside, involving an Ayurveda doctor, nurse, yoga expert, and biomedical dermatologist (as team leader). This has resulted in the quick adoption of therapeutics encompassing all systems of medicine for a given disease. Patients have been monitored using patient safety measures of biomedicine / WHO guidelines. We have thus far seen a positive outcome in lymphedema (Lymphatic Filariasis) patients.

As clinical investigators, we always work with patients. We try to discuss patients' problems and suggest solutions as clinicians and collaborate with basic scientists. We aspire to a 'reverse pharmacology' approach coupled with 'physician scientist' experiments to expand Integrative Medicine studies. This would be most beneficial for chronic disease management that has no readymade interventions available in biomedicine. We, the integrative medicine clinical investigators, are 'bewitched, bothered and bewildered'. We often don't fit into existing study centers in India or fail to convince grant-making bodies that are focused on quantitative studies or scientist-led investigations. We have always lived in 'poverty of grants' thereby having to use our self-generated funds to finance pilot studies. IAD's vision for expanding Integrative Medicine research requires clinicians to work with pathologists, scientists, and big data analysts. Our institution is India's lead clinical facility for Integrative Medicine in dermatology. We are in dire need of funding to improve related areas; where expertise is not available we wish to work with experienced scientists and data analysts who would like to contribute to our life-changing research. All this necessitates special funding with an 'out of the box thinking' - large grants with lots of flexibility and money allotted for travel.

One of our greater wishes is to improve the structure of clinical data available at IAD (amounting to nearly 4500 patients who received Integrative Medicine treatment for lymphedema, Vitiligo, Lichen Planus, Psoriasis, and several other diseases). Advanced computing and statistical methods must be applied to distill more answers to daunting medical questions on these diseases. Clinical and therapeutics data obtained from each treating doctor belonging to different systems of medicine need to be correlated to published literature (Ontology) to deduce from treatment outcomes. This would require big data analysis systems and mathematical algorithms. Such a data-driven reversal of pathology hypothesis (different from subjective investigator hypothesis for which large funding is available) could later be tested simultaneously in pathology and molecular biology laboratories on human samples obtained from patients who received Integrative Medicine treatment.

This approach requires clinical investigators to work with patients and collaborate with big data analysts, molecular biologists, and pathologists. Discussions with them would result in greater insights into data analysis and thereby disease reversal mechanisms. This will, in turn, lead to inter-sectoral collaborations through inter-institutional links and help in the capacity building of all collaborating institutions. The coming together of such institutions will bring in the much-required expertise, which is non-existent in individual teams, to the clinical investigator-led programs. The success of this research model would create a structure of utilizing whole drug formulations of Ayurveda with enhanced clinical potential with a protocol of integrative medicine treatment. These drugs could be quickly adopted into the existing practice of Ayurveda and biomedicine.