Bhaswati Bhattacharya, MD: Lessons from an Ayurvedic Experience of Sustainable Integration

Summary:  Bhaswati Bhattacharya, MD, MPH, MA, an veteran integrative and ayurvedic practitioner and educator based in Brooklyn, New York, is consulting with an ayurvedic healing center in India which has been "economically viable since 1941." Aware of the sustainability issues with integrative care in the United States, Bhattacharya deconstructs the experience at the Arya Vaidya Pharmacy, Chikitsalyam and Research Institute into 12 characteristics which she asserts are guides to quality, sustainable care. Hers is un unusual list, with a few exotic touches. Anyone for softening all consultants through submergence in healing oil?  

Bhaswati Bhattacharya, MD, MPH, MA

Last January at the Integrative Healthcare Symposium in New York City I met

An Ayurvedic View of Elements of Sustainable Integration

- Bhaswati Bhattacharya, MD, MPH, MA
based on the comments of PR Krishnakumar

I was stringing to an old blog of yours and found in the Dec 13, 2007 issue: "Lest my friends and other skeptics accuse me of naïve idealism, let me quickly add that the touchstone of 'who wins and who loses' in the race towards sustainable integration will, in the final analysis, be determined by two measures: clinical effectiveness outcomes and economic outcomes."

	The judge of "reality" is whether patients get better, and whether the model/practice/therapy affects the ecological system of providing health care, as indexed by the economics.

So many questions come up for me when I analyze what is happening in the "Business, Education Policy and Practice of Integrative Medicine" but ULTIMATELY what you say is true:  the judge of "reality" is whether patients get better, and whether the model/practice/therapy affects the ecological system of providing health care, as indexed by the economics.  As a clinician, researcher and educator in the "CAM" field since 1989, I have been discontentedly watching through my 5 degrees of formal education, 4 certifications, and countless CME courses, for who is doing that sustainable integration.

Currently, I am doing some work at AVP, the Arya Vaidya Pharmacy, Chikitsalyam and Research Institute in Coimbatore, one of the oldest and most respected names in ayurveda in India. I am pleased to say that they are doing the doable: a long-term practice in sustainable integration.  How do they maintain the sustainability and integration?

PR Krishnakumar, the Managing Trustee, put it best last week speaking to a group of my students from The Dinacharya Institute. He said that they just do it quietly and consistently, without seeking fanfare, praise, or making private time for healing a public affair. Many,

AVP just works to make good products and treat patients and heal them here in the 60-bed hospital. And they are also economically quite viable, since 1941.

many Americans have come to visit, tour, stay, and research here. AVP has shared an NIH grant with the Univ of Washington, under the guidance of Dr. Mano Venkatraman, PhD. People from the Samueli Institute and from Bastyr have come to visit. They see the work; they discuss; but most westerners seeking gold cannot get how they do it here, because it does not involve the chase for recognition, fame and success as measured by the West. AVP just works to make good products and treat patients and heal them here in the 60-bed hospital. And they are also economically quite viable, since 1941.

When they make a product well, a patient heals. That is joy enough. I have seen clinical outcomes here that I have not seen in my 24 years in the biomedical-industrial complex, with all its technology, drug development and clinical tools. Dr. Raveendran, the medical director, can take someone's pulse and tell about their organs and prescribe herbs and work with allopathy diagnoses side by side. But he does not boast about it. He simply says, "I am just observing the patient. S/he is telling me the answers. I just have to listen."

The problems to westerners are several and they address some of the big underlying issues of why Integrative Medicine is stumbling in its pace to help patients and change the system.

1. Ego vs. Teamwork

The ability to excel and practice here REQUIRES that the practitioner let go of his/her ego and allow practice as part of a team. The team includes the patient, the doctor, the family/environment, and the medicine, and ALL are responsible for the healing. Healing is not the genius of the doctor.

AVP does not put the Medical Doctor first. The MD has to acknowledge that the healing is also due to touch (done by the ayurvedic massage therapists, sometimes 7 working on one patient), the diet (created by the full-time chefs using organic and healthy ingredients, no GMO), the environment (the hospital is located near a spiritual center), and the medicine (created by AVP).

2. Career Development

When the doctors get awards, they give them to the group and don't covet them for themselves to further their own careers. The need to be recognized, to name things after one's own discovery, is strange to authentic ayurveda. Modern ayurvedic vaidyas easily acknowledge that the wisdom in the ancient texts is too vast for them to say that they can now discovered something new. Career advancement comes from understanding disease better and being able to help more patients. Rewards come from heartfelt connections, not money or crystal award plaques.

3. Abundance

The hospital does not charge top dollar, or rupee. They give a lot for what they charge, and they do a lot of charity work.

They also receive a lot of goodwill and donations because of it. They also receive the abundance of the Universe, which is more than any money payments would yield. But in the end the attitude is about abundance and "Health is Wealth" not about Cost-Benefit Analysis.

	The medicinal herbs are in the water, the food, the oils, the multi-daily pills or drinks and in the hygiene and self-care. They use parts of plants and they know their plants. Every health care person on the campus knows some level of botany.

4. The Active Ingredient

Biomedical paradigms necessitate isolating the component of the chemical medicine as proof of what works. One of the biggest obstacles for MDs coming here is understanding the medicinal preparations. One neurologist from NYU was here recently and I showed him a case of mine, a man with ALS (Lou Gehrig's Disease) Stage 4. He came in a wheelchair on a mechanical respirator, almost died in the flight here. He is now moving his legs and feet. I asked the neurologist. He quipped, 'Well, tell me what's in the stuff you make him drink and I'll tell you what is helping." The presumption that knowing the chemical will elucidate the reason for cure of a "terminal illness" reflected the ignorance.

The medicinal herbs are in the water, the food, the oils, the multi-daily pills or drinks and in the hygiene and self-care. They use parts of plants and they know their plants. Every health care person on the campus knows some level of botany. They know not to just put any part of the plant in a compound, measure it by HPLC and say it should work. They understand the method for preparing a recipe, like cooking a dish.

5.  Listening

Most practitioners in the West are not listening to the patient. They are seeking to be heard. The ones that do listen are great practitioners (Bethany Hays, George Guess, Ann McCombs) in the US. Here at AVP, listening is valued and required. Doctors are required to spend time in self-care as part of their ability to develop a viable skill set for practice.

6. True Ecology

What if it is the whole ecological system that is creating the healing? What if you cannot isolate the element that is the curative agent?  What will biopharmaceutical, double-blinded, placebo-controlled, RCTs do then? If you cover the eyes (blinding) of the healer, then with what ignorance will s/he heal?

7. Language

While the documentation done here is meticulous, and the software program they use is impressive, the language of Vata-Pitta-Kapha and the concepts of physiology that are acknowledged in many CAM fields are not acknowledged by biomedicine. MDs come here and are lost, yet don't find the value in learning new paradigms for understanding the human body…

8. OIL 

Americans have a fear of oil. They covet the stuff to put in their cars, and they fear the stuff to put into their bodies.

Americans have a fear of oil. They covet the stuff to put in their cars, and they fear the stuff to put into their bodies. While nutritionists and biochemists have confirmed that our bodies need oil, most Americans are still obsessed with low-fat, no-fat. Here, people are doused in oil each day for an hour or two. Oils carry the lipophilic medicinal components.

There is a saying in Sanskrit that the most brittle branch that would crack and break with the pressure of the wind can be softened by submerging it in oil for a week. So with the most brittle of diseases and egos and mental imbalances. After all, the nervous system is cradled in glia, which are essentially modified fat cells.

9. Using vs. Owning Nature's Pharmacopoeia

AVP is more interested in how medicines work than in owning and patenting them. They know the time-tested tradition for preparing the medicines, which is probably more important than the components themselves. In the west, profit-based incentive has caused people to try to usurp ancient ayurvedic knowledge, which by consensus in India, is universally owned by the field of ayurveda and cannot be owned by one person. Many researchers visit the campus to usurp the secrets and take them back to America to publish them. To date, none have succeeded.

In December 1993, the Univ of Mississippi Medical Center had a patent issued to them by the US Patents and Trademarks Office on the use of turmeric (U.S. patent No. 5,401,504) for healing. The patent was contested by India's industrial research organization, Council for Scientific and Industrial Research (CSIR), on the grounds that traditional ayurvedic practitioners were already aware of the healing properties of turmeric and have been for millennia, as documented in ancient Sanskrit medical texts, making this patent a case of bio-piracy. After a complex legal battle, the U.S. PTO ruled on August 14, 1997 that the patent was invalid because it was not a novel invention, giving the intellectual property rights to the principle back to the traditional practitioners of Ayurveda.

Several Pharmaceutical companies and Academic Institutions in the west have come into conflict with Indian academic institutions and traditional Ayurvedic practitioners over the intellectual property rights of herbal products researched by the western agencies, such as neem, tulsi, amla, pomegranate. The Ayurvedic practitioners have known about the efficacy of such products for ages and so contend that they carry precedence with regards to patent rights on such products. (Source: wikipedia.org – ayurveda)

10. Industrial Chemicals

The use of chemical detergents for cleaning rooms, treatment facilities, patients, and food preparation is minimized. Natural ash and plant-based chemicals are preferred. So is water and heat.

11. Relationship

	Rather than isolating the person from the world, ayurveda encourages them to integrate their personal relationships into their healing. Each room has two beds, one for the patient, and one for a family member to stay and help or accompany the patient.

Rather than isolating the person from the world, ayurveda encourages them to integrate their personal relationships into their healing. Each room has two beds, one for the patient, and one for a family member to stay and help or accompany the patient. It is assumed that working on one's relationships is part of the healing that needs to occur to gain mental strength and confront one's issues.

12. OHE – Optimal Healing Environment

Many westerners that visit are surprised at the campus. It is purposefully created by PR Krishnakumar, with every centimeter created with purpose. There is open air on the corridors where patients can sit along a balcony overlooking trees. There are windows in each room. There are plants and walking paths in the grove. There is a botanical garden, a chapel and a fruit juice canteen. There are cultural performances and a shop to buy healing music. Some westerners have decided it is a novel concept to classify what a healing environment would look like, how to finance it and how to prove that yellow is better than white on the walls. But why not surrender to the ebbs and flows of nature and create a nature-featured environs? Save the money for OHE consultations on something else. And put the consultants in some oil.

Best wishes,

Bhaswati Bhattacharya, MD