Last January, at the Integrative Healthcare Symposium in New York
City, I met Bhaswati Bhattacharya, MD, MPH, MA. Bhattacharya has
an interesting résumé. She's been in integrative care
since 1989. Bhattacharya runs the division 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 shej urged to purchase my hard-copy newsletter,
the Integrator for the Business of Alternative
Medicine. Clearly, this was a medical professional with insight
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 P. R. Krishna Kumar,
managing trustee of the Arya Vaidya Pharmacy/ Chikitsalayam &
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 pharmacy's hospital and retreat center
in India that has been "economically viable since 1941."
Ayurvedic View of Elements of Sustainable Integration by Bhaswati
Bhattacharya, MD, MPH, MA
based on the comments of P. R. Krishna
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 [complementary and alternative medicine]
field since 1989, I have been discontentedly watching through my
5 degrees of formal education, 4 certifications, and countless CME
[continuing medical education] courses, for who is doing that sustainable
Currently, I am doing some work at the Arya Vaidya Pharmacy [AVP]/Chikitsalayam
& 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?
P. R. Krishna Kumar, 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 fanfare,
seeking 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 University 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 allopathic 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
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.
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).
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 [physicians]
easily acknowledge that the wisdom in the ancient texts is too vast
for them to say that they can now discover 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 work.
They do 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
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 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.
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 [randomized controlled trials] 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 body. …
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
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.
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 University of Mississippi Medical Center had
a patent issued to it by the US Patents and Trademarks Office on
the use of turmeric for healing (No. 5,401,504). 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 biopiracy.
After a complex legal battle, the patents office ruled on August
14, 1997, that the patent was invalid because it was not a novel
invention, giving the intellectual property rights over 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 over herbal products such as neem, tulsi, amla, and 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 over such products. (Source: Wikipedia.org:
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 are water and heat.
Rather than isolating people 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
– Optimal Healing Environment
Many Westerners who visit are surprised at the campus. Every centimeter
has been purposefully created by P. R. Krishna Kumar. 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 that 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
is, one way you look at it, a long advertisement. One senses overstatement,
the selective memory for success that 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?