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vendredi 17 juin 2011


The predominant discourse about Health in this world, in the developed and developing world is Western Medicine or called “Conventional Medicine”, the major aspect of which is Biomedicine or Biologically oriented medicine. In the early 16th century, at the beginning of the Renaissance, Siglo de la Luz, The Enlightenment, Descartes, French Philosopher and Mathematician, wanted to pry the control of the body away from the strict rules of the Church. Thus the Cartesian dichotomy was born, Doctors and Intellectuals in charge of the body and The Church in charge of the Soul.
This dichotomy has had deep influences in the practice of modern medicine, leading to a complete separation of Body and Mind. If you go to a Medical Practitioner, it is very rarely he/she would be interested in the socio/psychological/cultural aspects of you as a person, but would be deeply interested in the dysfunction in the structures of your body. Very seldom would they even admit to the influences of the mind on the body. This negation leads to a complete ignorance of such effects and leads to neglect and failures in the healing and curing portions of a Physician.
Along with migration of Non European people into Europe and other European culture dominant countries, the immigrants brought their forms of healing and curing systems as well.
The Immigration is such a recent phenomenon that its growth has startled every one. Just a few years ago, “Hispanics” accounted just 5 per cent of the US population and they are already in the majority in some states and are now second only to the White/Europeans and by 2035 is said be the dominant race in the USA. There are people who were born in Miami and had never heard a word of Spanish before 1962, now struggle to hear English in public places like Supermarkets or shops!
What is Conventional in one country and within one culture would be considered Alternative or Complimentary in other, depending upon the predominant culture. In China, herbal medicine is perfectly acceptable, is mainstream but is considered fringe in almost everywhere else in the world.
Ayurveda and Yoga are ancient  traditions of healing and prevention so they are also not Alternative in their Healing Capacities. Acupuncture is well established in China and in many other countries and it is considered Conventional Therapy within that cultural context.
Ancient forms of wisdom of healing exist among many indigenous groups of people scattered around the world. The best three examples would be the symbolic usage of nature and relationships to assist in the healing of illnesses by Medicine Men among the American Indians, Kalahari San and Australian Aboriginals. These three groups are considered the oldest of the continuously living cultures of this planet.
In my opinion, the Philosophy of Yoga and the Symbolism of American Indian Healing systems are more ideologies than techniques that dominate the conventional and alternative medicine landscape. (Yoga is a combination of ideology (based on Samkya philosophy and deep psychology) and tools/ techniques for better living)
First of all, the semantics. Alternative Medicine intends an option to the existing form of health care whereas Complimentary Medicine denotes a form of treatment that adds to the current conventional mode of treatment. In China, chemotherapy for Cancer may be considered Complimentary Medicine whereas in the Western World, they are considered evidence based and Conventional.
As Merleau-Ponty had suggested: Context is important. Senator Benjamin Franklin would evoke Sin for his Gout whereas nowadays we would evoke Fructose consumption for the same symptoms. So the changing grand metaphors of the society are also important.
I am trained as an Endocrinologist, one of the more thinking aspect of Conventional Medical Care where we are given problems to solve without much help from invasive techniques or investigations. So you can truly consider this an epitome of the Western Bio Medicine.
But my professional life has been spent with Indigenous peoples of this world and I have been exposed to a fair amount of Symbolic Healing and the philosophy behind it.
Being a frequent visitor to Cochin, in Kerala India, I have had various encounters with professionals in the field of Ayurveda and had more than my share of preventive therapy using Ayurveda.
Lately I have been introduced to the philosophy of Raja Yoga by my best friend in Asia, MunChing.
Thus you could detect these three major but divergent influences in Health Care and Disease Prevention in my notes.
Endocrinology is all about dysfunction or lack of balance of minute amounts of hormones that circulate in our bodies, some in pictogram amounts, that is ten to the power of minus 12 grams! Taking Thyroid disease as an example, until quite recently, the aetiology of hypo functioning of this gland was an internal one, mostly an autoimmune  defect. It was straight forward enough and taking a strict biomedical viewpoint was important and also produced excellent results. But as practicing physicians and suffering patients know, the lack of balance now has external chemical source, mainly the chemicals using in herbicides and pesticides. Ignorance or lack of regard for this one fact would lead to wrong diagnosis and unsuccessful treatment.
In my opinion, Endocrine Dysfunction has become the major metabolic abnormality of our times. 2/3 of Americans are obese or overweight, just to give you the scope of this problem.
There is a strong social element to these dysfunctions and health care providers continue to ignore it and thus driving the frustrated patients to loose faith and seek other forms of feeling better.
Two ideas I introduce here are
Before condemning en masse those in the thousands who practice and benefit from various forms of alternative forms of treatments, such as
Chakra alignment
Shamanic Treatment
Crystal Therapy
The list is a very long one,
We have to place the problem in context of
Ignorance of those in power to help
And loss of Faith in general in the society.

One idea that is helpful to distinguish between a valid health care modality and a way of the charlatans is to distinguish them:
Is this a technique?
Does this promise you the wonderful results you are seeking, if only you would buy this or pay into it?
Exercise Machines, Single Minerals, Nutritional Supplements all come under this. You can think of very many techniques which had been marketed ever since the entrepreneurial class invented Liver Tonic, snake Venom among other things
The number of Exercise machines languishing in the basements of homes in the developed nations is staggering.
When my sister in Miami was diagnosed with Cancer, a slew of emails arrived advising her to drink tea from the mountains of Jamaica, to eat Macrobiotic Diet and to make sure that she had all the elements of the periodic table in her blood! Of course she ignored all that and listened to her doctor who prescribed strong chemotherapy and at the end of the course of therapy, there was no physical or chemical evidence of cancer.
People who had gone on a specific diet or another, each year amount to millions. No single “Diet” can be considered successful in face of increasing Obesity!
I won’t confuse “diet” with neither “Nutrition” nor “exercise” with Diversion.
Health is not just an absence of Disease. It includes the well being of self, of those who you care and are around you. It also includes your situation at work, the country and the place where you live and most importantly the society you live in. Societies in Conflict, someone had remarked, show that conflict in the bodies of the individuals within that society. American Indians, Australian Aboriginals are the best examples of that dictum and you can find examples in your own countries among immigrants, marginalized people, excluded people, exiles.
It also includes knowing WHO you are and finding the balance in your life and have faith, but not necessarily religion, and be surrounded by love and affection of your friends and relatives. To the American Indians, Relationships, not just connected with blood, but shared earth, nature and universe are also part of their health. Mitakuye Oyasin (“We are all related’), they say this prayer often.
In a society where “WHAT you are”, is the measuring stick, many would  find themselves measuring using some other yardsticks other than their own. This is a sure way to find unhappiness and label you a Failure.
The rise of alternative forms of therapy has risen in parallel with the lack of trust patients and people have on those who are in charge of their health in their societies. Doctors and patients who think that they are independent of the powerful forces of the society, such as the Drug companies, are only deluding themselves.
Just in the past week alone, two medications used in diabetes have shown to be dangerous and a third one in higher dosages. There is a healthy skepticism of drug companies and their agents, the doctors, not all of them, by swathes of people in every society.
When you are unwell, you really want to trust someone or something, which would help you in an extraordinary fashion to regain your health. Descartes took the priest and the church out of the picture and a recent survey showed that up to 60 per cent of the Europeans have no faith in organized religion or its agents.
Politicians who were once held up in great esteem also have fallen down from their pedestals. Society that has become materialistic has no time to reflect what the philosophers and other thinkers in the society propound. Faster your life, slower your attention to philosophical matters.
Someone arriving with a miracle cure, mildly disguised as science, has an ocean of people to draw from.
In a couple of articles, published this month in the magazine, The Economist, they proposed that the success of many of the alternative forms of therapy, and not necessarily of their outcome, is related to the fact that these practitioners have a precious commodity in their hands! TIME!
The average medical consultation is around 8 minutes and during that time the easiest of the evidence is dealt with, that easy evidence is the results of the blood tests, not the narrative of the patient who has not been given the time, nor the concerns of the patients in the greater context than his body and society.
I knew the value of this precious gift, taught to me by the American Indians. The first year I began working with them as a Doctor, I was able to conduct two studies. The first one included a group of elderly members of the tribe who gathered every Monday morning; we shared jokes, family news and gossip and had a reasonably “healthy” snack. At the end of the fourth session, their Blood Pressure and Blood Sugars all had improved and even their total cholesterol had come down and A1C, which is a measure of Diabetes control, had improved. This without any medical intervention, except my presence at these meetings and I don't remember talking about any diseases at all.
Second study I did was to compare the outcome of Indian patients when they went to see an Indian Health Care Provider as against a White or Black Health care provider. Over and over again it could be seen that the Indian health care providers had the edge on better outcomes.
So there are intangible aspects to nursing someone back to their normal health and the Western Medicine does not have a monopoly on that. As less and less attention is paid to those intangibles, patients and others who suffer or wish to prevent future suffering would migrate to the care of people who offer them counseling, spend time with them, listen to them and accept the patients explanation while offering one of their own.
What most patients want when they are thinking of preventing future suffering by paying attention to the lack of balance in their life is kind, considerate respectful advice in the context of their professional life and social life in the respective countries in which they live in.
There are many ways to achieve this balance and the evidence based western medicine is only 25 per cent of the treatment of the chronic suffering of patients. Like life has to be balanced, one has to balance various forms of treatments as well, most of which do not include pharmaceutical therapies.
Will write more on achieving inner balance in another blog…