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 country, 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 constructed 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 childhood 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 estimated to have killed some 500
million people in the twentieth century alone!
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 thrombosis 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 opportunity 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 experienced 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 visiting scientist. I mention this episode to illustrate how modern medicine, and
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 characteristic 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 medicine in the treatment of chronic diseases, such as diabetes and rheumatoid arthritis. Working with a team of medical doctors and senior Ayurvedic physicians was a great challenge. The medical team insisted on statistical sampling, double-blind trials, and evaluation based on statistical testing. The Ayurvedic team, despite their perseverance, could not comprehend or utilize 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 education 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 International Conference on Primary Health Care, where the Declaration of Alma-Ata was adopted in 1978. I subsequently joined the WHO as a staff member.
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—accepting 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 traditional 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 project 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 ramifications in development, disarmament, public safety, disaster relief, human rights, and the environment.
Modern medicine has powerful healing powers, bordering almost on the miraculous, 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 revisiting 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
Unites States’ health care system, which—while still being the most sophisticated 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 spiritual 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 empiricism, 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, consistent 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
his expertise in ancient Sanskrit sourcebooks of Ayurveda and Yoga have been great assets to us.
Even after the arduous effort of writing this book, we are already discussing the need for another book. This book would explore the life sciences through a perspective which melds science with the principles of ancient philosophy, and what the ancients have to tell us about the nature of life and the human system. In our flights of fancy, we imagined calling the book From Genome to OM; whether this idea will remain a dream or become reality is another story.
Dr Gururaj Mutalik, Sarasota, Florida, United States