by Wayne Jonas
Aadi told me that each time he visited the hospital, the treatments largely eliminated his symptoms. The first time, the improvement lasted almost two years. Gradually he had gotten busy and not returned to the doctor. He began to drop off the program of meditation, special diets, herbs, and oil massages that had been prescribed for him to follow. Slowly his symptoms returned. This time, he volunteered to come back for a “booster” treatment. Although he admitted that he was not cured—the tremor was not completely gone—nevertheless he was now fully functional and ready to return home. And he was off all other medications. “Magic,” he said, with a smile and a shrug. He still didn’t believe in magic, but he knew this worked.
Aadi let me examine him. A full neurological exam showed only a minor tremor that came out with certain tests, and minor dysfunction in his reflexes. Everything else was normal. Had I seen him in my office, I would not have diagnosed him with Parkinson’s. Aadi said he went back to the Ayurvedic hospital every twelve to eighteen months for a month of intensive treatment. “What kind of treatment do they provide?” I asked. “Well,” said Aadi, “you must ask Dr. Manu about that; he is the head doctor here. I do a lot of things, but most of it seems to be directed toward getting my head back on straight; helping me see what is important in life. In the business of my normal life when I forget who I really am, that is when I get sick. I come here to find out why I was born. They also do a lot of ‘cleansing’ of my body—with cathartics, oil massages, herbs, and things. I have stopped asking the details. I just know it works. Dr. Manu can explain it better, I am sure,” he shrugged. “Go talk to him.”
MANU
Dr. Manu Padimadi—or Dr. Manu, as they called him at the Ayurvedic hospital—is a tall, confident man. When he speaks to you, he looks at you intensely, as if he is peering into your soul. It is a bit unsettling. He had managed the hospital for seven years, after fourteen years of study. His father and grandfather had run the hospital before him. His English was an impeccable high British, which, I learned later, he perfected while studying chemistry and molecular biology at Oxford. I didn’t know that the first time we met. I was at his hospital in southern India as part of my job as director of a WHO Collaborating Center for Traditional Medicine, seeking to further the scientific understanding of traditional healing systems like Ayurveda. Dr. Manu had set up a process for collecting data on Ayurvedic treatments and was eager to advance research on it. He explained the basic philosophy and approach of ayurveda to me. The primary goal of Ayurveda, he said, was to help the mind experience “universal consciousness.” Once that was experienced, he explained, healing arises “because you have found your true self.” Aadi, he said, had lost the purpose of his life, pursuing business at the expense of his family, his community, and even his own personal health and growth. Ayurveda began with a spiritual exploration for why he had fallen away from his divine purpose and then designed practices to help bring both his mind and body into better alignment with that purpose. It did this by evaluating the balance of a person’s doshas. Doshas, Manu explained, are a combination of constitutional characteristics that define each individual. Made up of characteristics of body type and a person’s mental and emotional nature, they serve as guides for “personalizing” each patient’s path to wellness. In Ayurveda, he explained, there is no distinction between mind and body. Physiology and spiritual elements are all interacting parts of a whole person. In addition, the person needs to be “nudged” toward healing by using small stresses, such as cathartics and herbs. Slightly toxic substances were given infrequently. Fasting and exercise—especially yoga—were also part of the healing regime.
The goal of these treatments, Manu went on, was to “wake up” a person’s inherent healing processes—to create mental and physical disturbances that, when applied in the context of life’s purpose and direction, helped the person reorder himself or herself, become more whole, and heal. When people had the right elements around them to nourish their bodies, minds, and spirits, and those elements were stimulated to heal in this manner, he explained, patients recover and find new levels of balance and health. “Once wholeness is achieved, it can only be maintained if they continue to connect their actions—including their treatments—to the core meaning in their life,” Manu said. “This is what increases the probability that they remain well.” Profound stuff, I thought, but what did it mean in daily life?
Each morning, Aadi would get up early and go through a series of rituals and prayers to help him center and become more mindful. He was on a special diet, designed to help balance his dosha energy, and took various herbs and exercises designed to relax and cleanse the body and mind. Breathing and meditation, yoga and fasting were all part of the program. After a month of such a routine, his body would have come back into “balance” and heal itself. Aadi had experienced this now three times. And his Parkinson’s had all but resolved each time.
While Dr. Manu’s explanation of creating the right meaning and context made sense from my experiences with Norma, Bill, Sergeant Martin, and other patients, the description of doshas, the use of cathartics and small doses of toxins, and especially the role of astrology in guiding treatments seemed like superstition and nonsense. I told Dr. Manu that. Had any of these treatments been rigorously studied or proven in randomized, controlled trials? Had ayurvedic physicians shown that any of them actually caused the healing and recovery they claimed? Was there proof that doshas existed? Could they be measured and manipulated? We knew that Parkinson’s disease was caused by low dopamine production in a specific part of the brain—the substantia nigra. Had any of the treatments been shown to increase dopamine in that part of the brain, I asked?
No, Manu admitted, they had not measured the production of dopamine in the brain produced by Ayurvedic treatments. He was open to that. In fact, he said, if there was a noninvasive way to track the biochemical markers of disease improvement for the conditions they treated, he imagined this would markedly help them improve and personalize this ancient system more—and make it more scientific. But, he warned, simply focusing on what produced a rise of dopamine in one area of the brain over a short period of time would be misguided. What was needed to properly study Ayurveda, he explained, was a research approach to monitoring the response of the whole person. More objective ways of tracking that response would be welcome as long as they were not used in ways that interfered with the ability of the whole person to respond as a complex, adaptive system. “Looking at only one small part of a person’s disease and treating only that is harmful. First, do no harm,” he said with a flash of irony, repeating part of the Hippocratic oath that all Western doctors repeat when they get their degrees.
I was skeptical and a bit annoyed to receive a lecture on the science and ethics of Western medicine from a non-Western doctor in the middle of rural India. Surely, I thought, some of what Aadi was being subjected to was harmful. I had seen studies of toxic heavy metals in Ayurvedic herbs and couldn’t imagine how inducing diarrhea and vomiting with cathartics could be good for you. I pointed this out to him.
“Look,” said Manu with a slight sigh, “forget the doshas and the astrology and the cathartics for a minute.” He went to a whiteboard on the wall of his office and began drawing. “Every major healing system, including modern Western medicine, acknowledges that a person is more than just their body and biochemistry; that to truly treat the whole person, we must acknowledge that they are physical, social, mental, and spiritual.” He drew a series of concentric circles on the whiteboard. “Well-being and healing arise when a person is both treated and experiences themselves as a whole person. Our job as physicians is to assist them to understand and make those connections—to find out what is deeply meaningful for them—and then nudge their body and mind with treatments to help them respond in a way that restores balance and wholeness.”
Manu drew a line from the outside circle—the one representing the body—down through the other layers of a person to the spiritual level and then back again
. “When this connection is made, wholeness and healing happen. After all, the word heal comes from the Old English word haelan, from which we also get the words whole and holy.”
I was again struck by the irony that an Indian doctor in an ancient healing center in rural India was giving me an English lesson.
“When Aadi leaves the hospital tomorrow,” he continued, “he will leave experiencing that sense of wholeness, balance, and well-being. He will be 90% better in the symptoms of his Parkinson’s disease also. Even if I could show you that one of the herbs he takes increases dopamine in the substantia nigra of his brain by 100%, I would still need to deliver that therapy within the context of his whole life to make it work well. His challenge, when he leaves, will be to try and maintain meaning, wholeness, balance, and even holiness in his daily life and reinforce it with behaviors such as periodic fasting and yoga to keep those healing processes active.”
XIAO AND MR. COUSINS
I had to admit that some of what Manu said made sense. We are not just bags of chemicals; at any rate, we cannot treat ourselves that way without causing harm. But Manu was proposing a universal process for healing, not requiring knowledge of the specific effect of a treatment on a biological mechanism or outcome. Whatever the explanation for Aadi’s remarkable improvement, one thing was clear: he had tapped into it repeatedly, and he was much better than before he engaged in this ancient healing system. Although I was glad to see Aadi’s improvement from an otherwise incurable disease, I was distressed at Manu’s explanation of how it happened.
Clearly, Dr. Manu was well educated in Western science and medicine as well as ancient Ayurvedic practices. He was one of those rare individuals fully trained in two entirely different systems.
While Manu’s explanation made intuitive sense, what bothered me was that I could find practically no evidence to support that his treatments improved Parkinson’s disease. And that I could not accept. One of the hallmarks of good scientific evidence in medicine is being able to isolate and prove that a specific treatment produces a specific effect through a specific mechanism. If you looked at all the interventions and treatments Aadi underwent, there were no clinical studies or even basic science studies indicating that those treatments influenced the core biological problem in Parkinson’s—the level of dopamine in the substantia nigra part of the brain. Instead, the treatments appeared to be for general wellness enhancement or to stress his system and induce a reactive response not specific to Parkinson’s. A review of his interventions revealed that only one had been shown to produce dopamine in the brain. This was a dietary intervention using lentils as part of his meals. A small clinical study found that this food improved dopamine production, but not to a sufficient extent to explain Aadi’s remarkable improvement. In addition, dopamine production can be produced by many things, including placebo interventions, as long as the patient expects them to work. There was no reason to think that the herb was any more effective than any other treatments Aadi had done, provided he believed—and the culture believed—that they were going to help him. From what I could tell, Aadi had gotten better because he had some basic health and wellness support (nutrition, exercise, rest), a physiological stress or two to get his system changing (fasting, cathartics, toxins), and manipulation of his belief by a bunch of placebos.
This pattern was not isolated to Ayurvedic. But how common was it? To find out, I set up a program to travel around the world and explore a variety of healing systems. As director of both a WHO Center for Traditional Medicine and the NIH Office of Alternative Medicine, I was specifically interested in examining these systems for their impact on patient outcomes and the scientific foundation they might have. The pattern I saw at the Ayurvedic clinic with Aadi turned out to be quite common within other systems, each of which had its own unique framework, set of interventions, explanations, and rituals. Yet all seemed to follow a basic pattern.
An example was a visit to the Great Wall Hospital outside of Beijing, China, which specializes in treating a disease called ankylosing spondylitis (AK). AK is a progressive autoimmune disease that causes erosion, fibrosis, sclerosis, and freezing of the joints, especially of the spine. It is a genetic disease that affects males more than females, reducing strong, energetic boys and men to invalids in a matter of a few years. In AK, there is a general weakening of the person with an increase in inflammation and pain and a decrease in motion and function. There are no effective treatments. Readers may recall seeing a story by the writer Norman Cousins, who claimed to have cured himself of ankylosing spondylitis with high doses of vitamin C and laughter therapy, neither of which had been proven to reverse the disease. At the Great Wall Hospital, they provided several treatments, but the primary one was a flat-needled microsurgery technique that broke up the fibrosis around the spine. The technique looked very painful, as long, flat acupuncture needles were placed along the spine and wiggled until they broke up the connective tissue. This “microsurgery” was repeated weekly, providing a rather strong nudge—more like a jolt—to the body from which it had to recover and repair itself. These microsurgeries were delivered, however, within a context very similar to what I had seen at Aadi’s Ayurvedic Clinic. Families were present everywhere, providing food and care for the patients, supporting and encouraging them as they underwent the therapy. Physical manipulation called tui na—a type of body massage (very different from the massages Aadi had undergone)—was also provided. Daily exercise in the form of tai chi was prescribed, along with long periods of rest and sleep between treatments. The herbal medicines given were mixtures said to encourage a proper “balance of chi” or “life energy” and to calm the immune system after the needle treatments. All this was guided by determining how each patient’s life energy was impacted by the environment, the seasons, his family, and the stars. Each of these factors was said to guide the chi and to reorder, balance, and heal the patient.
I remember following a young man of twenty-four named Xiao who had progressive and advancing AK. As an only boy in China’s one-child policy system, he was prized and doted on by his entire extended family. Quite a gifted athlete, he had joined the track and field team at school and at one point was even being considered for the Olympic team in pole vaulting. But at eighteen-years-old he noticed an increasing pain in his pelvis and back. When heat and physical therapy did not help, his parents took him to the Beijing hospital. X-rays of the spine revealed the characteristic cloudiness of AK between spinal disks and the pelvis. A blood test confirmed that he had HLA-27, a gene associated with 25% of those with the disease—and usually the more severe type. By age twenty-four, Xiao had progressed further, now with more stiffness (called a bamboo spine in medical circles), fatigue, inflammation in the eye (also a rare symptom of AK), and some early cardiac symptoms. When we first met, Xiao joked, “I used to bend the pole in track and field—now I am the pole.”
Xiao’s mother saw my uncertainty in how to react to this statement. Was he being sarcastic? She put me at ease. “Typical Xiao,” she said with a smile, “always joking. Even with advancing disease, he has kept his humor.”
“I was lucky to be born into this family,” he would say. “I may not be able to vault my body any more to new heights, but I can still vault my spirit.”
When Xiao first arrived at the Great Wall Hospital, his family said he was in a wheelchair and unable to walk. He could not turn from right to left or bend forward more than twenty degrees. He was totally dependent on their care. When I examined him, six weeks after he came to the Great Wall Hospital, he was up on his own feet and walking with a cane. He could now turn almost forty-five degrees from side to side. He said he was much better: happier, with more energy, and significantly less pain. He would be there about two more months undergoing other traditional Chinese medicine treatments. Dr. Yu Chen, the hospital director, told me that they got about 60% excellent improvement in patients with ankylosing spondylitis after one to three months of treatment. When I followed Xiao around, the parallels to o
ther medical approaches that produced healing were uncanny: teams of caregivers, including doctors and family members, and specialists in spiritual therapy (Chinese medicine has no psychotherapy as we know it in the West, but uses astrology as in India). Special diets high in spices were prescribed, and combinations of Chinese herbs, some of which contained toxic materials (as do some Ayurvedic treatments), were given. And there was a lot of exercise in the form of tai chi, exposure to the natural environment, and rest and sleep. Xiao and his family were overjoyed at the improvement he had sustained. Dr. Chen said that about half the patients maintain these good effects for several years, but others regress. He had no data to back up any of his claims and had done no clinical trials to demonstrate that this overall procedure worked. A few of the spices and herbal products had been studied in the laboratory for their immune modulation ability, but none of them had been studied in clinical trials with AK patients.
After seeing Xiao I reflected on what Norman Cousins wrote about his own treatment of ankylosing spondylitis. Unable to find an integrative center in the United States, he essentially created his own treatment plan—visiting specialists at UCLA and “alternative” practitioners separately, and then putting together a general health enhancement program involving high-dose vitamin C and laughter over a period of several months. The laughter involved watching old comedy movies such as those of Charlie Chaplin, followed by significant rest and sleep. Strangely, it seemed that both Xiao and Norman Cousins came to laughter as a treatment for their disease. They had other things in common. Cousins was also surrounded by family and friends and mentioned the importance of immersing himself in a natural environment that induced calm—a relaxation response—during what was otherwise a very stressful time. Xiao would take daily walks and do his tai chi in the woods—often with one of his aunts or hospital friends.
