Integrative Approaches for Health: Biomedical Research, Ayurveda and Yoga

367 Pages·2015·12.515 MB·English

by  Bhushan Patwardhan, Gururaj Mutalik MD, Girish Tillu

Dedication
Creative writing gives immense pleasure to authors but
creates a testing time for many dear ones.
Authors dedicate this book to their spouses for their life long
support and inspiration for our work
…
The late Dr Mukta Mutalik
Bhagyada Patwardhan
Neelima Tillu
Integrative Approaches for
Health
Biomedical Research, Ayurveda
and Yoga
Bhushan Patwardhan, PhD, FAMS
Interdisciplinary School of Health Sciences
Savitribai Phule Pune University
Ganeshkind, Pune, India
Gururaj Mutalik, MD, FAMS
Jijnyasa Foundation for Education and Research
Sarasota, FL, USA
Girish Tillu, MD
Interdisciplinary School of Health Sciences
Savitribai Phule Pune University
Ganeshkind, Pune, India
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About the Authors
The authors represent the three generations of scientific progress. The first
generation of Dr Gururaj Mutalik has seen dreadful epidemics like plague and
small pox when there were no antibiotics. The second generation of Dr Bhushan
Patwardhan has seen rapid progress of biomedical sciences and emergence of
omics technologies. The new generation of Dr Girish Tillu has grown with
information technology and artificial intelligence, when the world is realizing
the value of systems view, ethics, and peace. The authors also bring a unique
blend of domain expertise in each of the three components of this book Bio-
medical Research, Ayurveda and Yoga.
BIOMEDICAL SCIENCES
Bhushan Patwardhan, PhD, received his degrees in biochemistry. He is
a professor and the Director of the Interdisciplinary School of Health
Sciences, Savitribai Phule Pune University, India, where he is engaged
in research in biomedical sciences, pharmaceutical biology, and evi-
dence-based Ayurveda. He is a Fellow of the National Academy of Med-
ical Sciences (India) and the recipient of many prestigious orations. He
is founder and Editor in Chief of the Journal of Ayurveda and Integrative
Medicine. He has published over 100 scientific papers, over 4000 cita-
tions and holds eight international patents. His research on drug dis-
covery and genomics has received high acclaim.
xi
xii About the Authors
MODERN MEDICINE
Gururaj Mutalik, MD, received formal education in modern medicine
and is a distinguished physician with insights in Ayurveda, who has wit-
nessed transformations in clinical medicine for about six decades. He
was a dean and professor of medicine at Byramjee Jeejeebhoy Medical
College, Pune, India. He directed health services as well as medical
education and research departments for the State of Maharashtra. He
worked as a postdoctoral fellow in human genetics at Johns Hopkins
University School of Medicine. He served as the Director of the World
Health Organization at the United Nations in the New York City. He
was Chief Executive Officer of International Physicians for the Preven-
tion of Nuclear War, a Boston-based, international organization of
physicians, which received Nobel Peace Prize in 1985. Presently, he is
engaged in research in Indian knowledge systems.
AYURVEDA AND YOGA
Girish Tillu, MD, is trained in Ayurvedic medicine, and pursuing
research at the Interdisciplinary School of Health Sciences, Savitribai
Phule University of Pune, India. He worked as a scientist at the Center
for Development of Advanced Computing, Pune and was instru-
mental in the development of the innovative software suite, AyuSoft,
which is a decision-support system based on logic, and knowledge
base of Ayurveda. He is involved in the study of Ayurveda and Yoga
through interdisciplinary approaches comprising epidemiology, clin-
ical pharmacology, and informatics. He is recipient of Vaidya Scientist
Fellowship.
Foreword
As this book is being published, I am celebrating the seventy-sixth year of my
close encounter with biomedicine, and Ayurveda and Yoga—as a school boy,
student, researcher, practicing physician, chairman of a department of internal
medicine, dean of a medical school, and public health administrator. I worked
at national and international levels, on three different continents. I have been
a patient, and medical doctor at a primary health center in a developing coun-
try, and at one of the leading hospitals in the United States. Several valuable
experiences and the lessons I learned during this period are the foundation
for this book and the major inspiration for my imagining the shape of future
health care.
I was born in 1929 into a traditional Indian family, in a small village with
no electricity, no piped water, no sanitation, and where every house was con-
structed with thick mud walls. There were no modern doctors in the village.
The only one who provided medical services to the community was my father.
My father Vaidyaraj Shrinivasrao taught me Yoga and Sanskrit, enabling me
to understand basic tenets of Ayurveda. The intimate exposure I had in child-
hood to Ayurveda and Yoga left me with a lasting perspective: while the age-old
systems lack remedies for acute infections and conditions requiring surgery,
they have remedies for common illnesses—remedies which are safe, widely
accessible, and effective. Ayurveda and Yoga in addition contain in their core,
proven principles of prevention of disease, promotion of health, restoration of
vitality—a recipe for fitness and longevity.
Two childhood episodes are firmly rooted in my memory. The first was when I
was 9 years old, and my entire village was evacuated because of a raging epidemic
of bubonic plague, which in that pre-antibiotic era killed 70% of those who
contracted the disease. The WHO estimates that this disease has claimed some
200 million lives in the course of its history! The other experience which left its
impression upon me was the cases of smallpox that I would see in my father’s
medical practice. Most of those who contracted the disease either succumbed
or bore lifelong scars on their faces and elsewhere. This disease, too, is esti-
mated to have killed some 500 million people in the twentieth century alone! xiii
xiv Foreword
It was not until 1978 that smallpox was vanquished in a “military style,” global
campaign, using a simple piece of technology like the bifid needle. The vaccine
was effective, but the epidemiological strategy of identifying and immunizing
all the contacts of each patient was crucial. We have not been so fortunate in
dealing with HIV/AIDS, and even less so with the current challenge of Ebola;
it is hoped that public health education, an understanding of epidemiology,
and breakthrough discoveries in the genomics of the viruses will soon make
a difference in these challenges as well.
I was admitted to the medical college in Pune in 1947—the year of India’s
independence. In 1949, I contracted typhoid fever. There were no antibiotics
available. As a treatment, I received a once-a-day, 200 mL, intravenous injection
of glucose solution, which produced exceedingly painful widespread throm-
bosis of the veins. This was how modern medicine was being practiced in a
developing country like India. Finally, my body’s immunity won, spontaneous
remission took place, the threat to life was over, and destiny gave me an oppor-
tunity to contribute to the health and welfare of society.
I received my MBBS (Bachelor of Medicine and Bachelor of Surgery—1952)
and MD (Doctor of Medicine—1955). In 1956 I married Mukta my classmate
I was courting for 5 years—who provided me lifelong love and inspiration to
give my best in whatever I undertook. I worked as a medical officer, and expe-
rienced the realities of life in rural India. After my work as a medical officer,
I became an assistant professor of medicine and 3 years later a professor at
Sassoon Hospital, a historic medical institution in Pune. This was a time when
modern medicine was developing new arsenals of antibiotics, and drugs to
deal with cardiovascular and neurological diseases; and making great advances
in surgery and other specialties.
INFLUENCE OF JOHNS HOPKINS
In 1965, I studied medical genetics under Professor Victor McKusick at the
Moore Clinic at Johns Hopkins School of Medicine, Baltimore—a world-
renowned center of excellence. I was exposed to basic techniques of human
genetics: cytogenetics, biochemical genetics, and population genetics. I
returned to India and established a human genetics center at my own institute.
This work was modeled on the exemplary studies that Professor McKusick did
on the Amish community at Lancaster County, PA. The center offered genetic
counseling services and cytogenetic studies, in addition to epidemiological
studies on hemoglobinopathies among tribal population in endemic areas.
I was instrumental in establishing the Human Genetic Society of India, and
served as its first secretary. I organized the first international conference at my
institute at Pune. Professor Victor McKusick was the guest of honor, as a visit-
ing scientist. I mention this episode to illustrate how modern medicine, and
Foreword xv
its specialties, are spread globally by individuals who have the opportunity to
receive training at global centers of excellence, and how the influence of such
exchanges endures.
I learned much from the grand rounds at Johns Hopkins, especially the value
of clinical acumen, which we have discussed in this book. In Baltimore, the
School of Medicine, and the School of Public Health at Johns Hopkins are
separated by Wolf Street. Professor E.A. Murphy, an Irish physician with char-
acteristic Irish humor, once said “… more than a street stretches between the
School of Health and the School of Public Health!” This medicine/public
health disconnect continues to remain the one of the greatest challenge for us
to overcome in the modern world. This divide is similar to that which exists
between modern medicine and traditional medicine like Ayurveda and Yoga. It
is my belief that the significant move toward these disciplines’ convergence is
the beginning of a paradigm shift that augurs well for the betterment of global
health. We have discussed these aspects in the book.
BACK TO INDIA
In 1971, I became dean of the medical school at the Pune University. Among
other projects, I established a research unit to study using traditional med-
icine in the treatment of chronic diseases, such as diabetes and rheumatoid
arthritis. Working with a team of medical doctors and senior Ayurvedic phy-
sicians was a great challenge. The medical team insisted on statistical sam-
pling, double-blind trials, and evaluation based on statistical testing. The
Ayurvedic team, despite their perseverance, could not comprehend or uti-
lize the methods of the medical team; they worked from empirical evidence,
instinct, and the patients’ reporting of subjective feelings of better or worse.
This divide in methodologies has yet to be overcome. We have dwelt upon
this subject in the book.
Later, I worked as the Director of Health Services and director of medical educa-
tion of the State of Maharashtra. Here, I witnessed the dichotomy and distance
between the medical schools and the health services establishments, including
district and subdistrict hospitals and numerous primary health care centers at
the village level. It was then, and is now, my belief that this divide is artificial
and counterproductive. In an initiative to bring together medical education
and public health services, we trained village housewives as primary health
workers to work as barefoot doctors, emulating the Chinese experiment. Three
years later, such experiments were numerous in India, and similar work was
being done in Bangladesh, Thailand, and other South Asian countries. During
this period, I was fortunate to be able to participate in the historic Interna-
tional Conference on Primary Health Care, where the Declaration of Alma-Ata
was adopted in 1978. I subsequently joined the WHO as a staff member.
xvi Foreword
AT THE WORLD HEALTH ORGANIZATION
I served the WHO for two decades, working at its regional office New
Delhi (1975–1980), and then at its headquarters in Geneva, Switzerland
(1980–1985). I was Director of the Office of the WHO at the United Nations,
in New York City (1985–1991). During my time with the WHO, I was afforded
insight into the gross disparity in health care that exists across the world. Sovereign
nations inevitably treated advice from these bodies as mere policy advice—accept-
ing the global mandates at their assemblies, but delaying implementation. In only
one instance—during the smallpox eradication campaign—were the governments
persuaded to treat the mandates of the WHO as a supranational dictate. The result
of this dictate was the eradication of a terrible, historic disease, which killed and
maimed millions in many parts of the world. In my position as a state director of
health, I did play a small role in this historic saga.
During my tenure at the Southeast Asia office, I contributed to advancing the
role of traditional medicine in the global health care system. From the regional
office, we supported a research project at an Ayurvedic center in Kerala, which
was a clinical trial of Ayurvedic and Yoga therapy for rheumatoid arthritis. This
led the global office of the WHO at Geneva to establish a department of tra-
ditional medicine to promote traditional systems of medicine in health care.
In 1991, I retired from the WHO and worked as a consultant to a Carnegie proj-
ect designed to provide a platform for dialogue between United States health
care leaders and those in other countries. During the 1990s, I served 5 years
as executive director and later as CEO, to the International Physicians for the
Prevention of Nuclear War (IPPNW), an organization which had received the
Nobel Peace Prize (1985) for its advocacy against spread of nuclear weapons;
this organization had positioned its advocacy as a public health issue. Indeed,
public health is not only concerned with health and disease, but has rami-
fications in development, disarmament, public safety, disaster relief, human
rights, and the environment.
Modern medicine has powerful healing powers, bordering almost on the mirac-
ulous, but even the best specialists can make a misdiagnosis if they are focused
only on their own superspecialty. I have learned this from my own experience
when I was misdiagnosed in the United States. Had I undergone the wrong
procedure, in hindsight, I can see the possibility of total paralysis, of revis-
iting the surgery, of being confined to a wheelchair, or even facing untimely
death due to the progression of tumor. It cost my insurance $65,000 to get
me back on my feet—from the time I was admitted to hospital to when I was
discharged. I wondered what would happen to an uninsured person (and also
a lay person) who landed in a similar situation. Had I not insisted on another
MRI, and had I followed the doctor’s advice, what would the result have been?
These questions reflect on the need to rectify the major shortcomings of the
Foreword xvii
Unites States’ health care system, which—while still being the most sophisti-
cated in the world—has multiple shortcomings from the patient’s perspective.
Medicine has always been regarded as a noble profession, both in the West
and the East. It is spiritually rooted in the urge to heal and reduce suffering.
Today’s practice of medicine has departed from the teachings of Hippocrates,
and Osler. Ayurveda and Yoga evolved from the precious teachings of the great
sages, shaped by the perennial philosophy of the Bhagavad Gita and the spir-
itual genius of Patanjali, who gave Yoga to the world. These disciplines, too,
have fallen prey to the commercialization of the West, to the rigidity of empir-
icism, and to a reliance on blind faith and dogma.
Leading medical centers in the West have adopted Yoga and meditation to
complement their arsenals of healing. Integrative medicine indeed is on the
way. The demand from the public and the pressure from consumers will ensure
the continued momentum toward integration.
In the last 6 years I have had much to do with projects involving health care
of the elderly, and advocating for the use of Ayurveda and Yoga. I work with a
nonprofit organization, the Janaseva Foundation, which provides services to
over 40 villages near Pune.
Today, at the age of 85, I am physically and mentally fit. I work even more
hours daily than I did in my preretirement career, thanks to the practice of Yoga
and a disciplined life that my father bestowed upon me through his example
and instruction.
Over the years, I have seen curative medicine marching with newer and more
and more powerful drugs, which in their wake kill as much as they cure and
sometimes reduce the quality of life. The basic secret of health and wellness in
many ways still eludes us. Ayurveda and Yoga have these secrets embedded in
their very core, but they need multidisciplinary scientific research to unearth
their systemic details for further progress. As we have emphasized in our book,
a paradigm shift is in the making, but can only be hastened if the mainstream
medical and biomedical scientists work in concert with experts in Ayurveda
and yogic science. This cooperation will transform the very fabric of medical
science in the near future, for the benefit of humanity.
Writing this book has been a labor of love. I hold Dr Bhushan Patwardhan
in very high esteem. He is one of the foremost biomedical scientists in India
today. No one has done more for the advancement of Ayurveda and Yoga in
the modern age. In his career, he has endeavored to bring the spirit of science
to his advocacy for the ancient systems to evolve their own evidence base, con-
sistent with its epistemology. I have also been fortunate to be associated with
Girish Tillu, an extraordinary individual who knows Ayurveda in depth, and
practices it as well. His humility and deep desire to contribute to research, and