How many people each year suffer some type of preventable harm that contributes to their death after a hospital visit?
| ||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. Bhattacharya has an interesting resume. She's been in integrative care since 1989. Bhattacharya runs the department of complementary medicine for the Wyckoff Heights Medical Center in Brooklyn. She's on the board of the South Asian Public Health Association. Her work with Ayurveda was included in a Discovery Channel feature. She shared with me that we'd almost met nearly a decade ago when she worked for a firm that she urged to purchase my hard-copy newsletter, the Integrator for the Business of Alternative Medicine. Clearly, this was a medical professional with insight and taste!
We were not in contact again until I recently received this submission on the elements of a sustainable integrative practice. The ideas presented here are based on a presentation by PR Krishnakumar, the managing trustee of the Arya Vaidya
Pharmacy, Chikitsalyam and Research Institute in Coimbatore, India, which Bhattacharya calls "one of the oldest
and most respected names in ayurveda in India." Her sharing of ideas was stimulated by an Integrator article from December 2007 in which I commented on the measures of sustainability. The 12 characteristics Bhattacharya presents are from the experience at the firm's hospital and retreat center in India that has been "economically viable since 1941."
Last January at the Integrative Healthcare Symposium in New York City I met
Bhaswati Bhattacharya, MD, MPH, MA
Comment: This is, one way you look at it, a long advertisement. One senses over-statement, the selective memory for success which most humans favor. Yet it's a fetching, somewhat eccentric list that catches one sideways and moves one out of the typical channels of consultation. Here is a strong nod to the whole system that helps heal. Hooray for the success against the patent claim! Interesting to see the selective list of US integrative physicians named. The column - thank you Dr. Bhattacharya! - also leaves us with two utterly new questions for our dialogue: How would the process of integration have gone over the last 15 years if all integrative clinic consultants for hospitals and health systems had been required to first be softened by submergence in healing oils? How would our future change if the practice began today?
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."
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.
The judge of "reality" is whether
patients get better, and
affects the ecological system
as indexed by the economics.
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
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,
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.
AVP just works to make good
products and treat
and heal them here in the
60-bed hospital. And they
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.
The hospital does not charge top dollar,
or rupee. They give a lot for what they charge, and they do a lot of charity
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.
parts of plants and they know
their plants. Every health care person on
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.
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?
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
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
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.
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
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.
Rather than isolating the person
the world, ayurveda encourages
them to integrate their personal
into their healing.
Each room has two beds, one for
the patient, and one for a
member to stay and help or
accompany the patient.
12. OHE – Optimal Healing Environment
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.
Bhaswati Bhattacharya, MD
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