In the Bonesetter's Waiting Room (11 page)

I was surprised that Darshan had had heart surgery so recently. He came across as being very healthy. He was slim, he looked well and he was full of enthusiasm and energy.

‘Pluralistic choices have set the stage for people to ask questions and take different options when no one system has the answers,' he continued, ‘but educational and healthcare institutes have not caught up. Forty to seventy per cent of people are exercising that choice, the World Health Organisation report on the use of traditional medicines shows that. I'm not talking about practitioners, but for the public – sometimes they are well informed, sometimes they are not. So sometimes there will be good outcomes, sometimes not. In a nutshell, today, for whatever political and sociological reasons, Western knowledge systems are dominant in all parts of the world. So you have a system prevailing in Asia, Africa, Europe, America – everywhere – where Western traditions dominate. Its strength is that Western science has incredible knowledge of detail – the fundamental units of the physical world,
but
you don't have a picture of the whole.'

I was interested (though, with my geneticist's hat on, unconvinced) to hear from Darshan that in 2003, an Indian scientist, Professor Bhushan Patwardan classified a random population based on an Ayurvedic schematic and he showed that the three
doshas
(bodily constitutions) corresponded with specific genotypes (genetic compositions). ‘For us,' Darshan told me, ‘this has opened the doorway to pharmacogenomics [the role of genetics in drug response] – it is known now as Ayugenomics. But Ayurveda doesn't need to do research in the same way as modern science. We are not testing a drug, we are testing a system of diagnosis and treatment.

‘Such testing has been going on at least since the 1970s, when there was a study on the management of rheumatoid arthritis in Coimbatore, in Tamil Nadu. Ayurveda is known to be efficient in the management of this disease. The musician Ravi Shankar had participated in the study when the condition meant he could no longer play the sitar and in a few months he was cured. But the 1970s trials designed by World Health Organisation scientists aimed only to assess one narrow measure of success: to decide whether the Ayurvedic treatment did or did not work. The Ayurvedic doctor in Coimbatore said that he would have used fifty measures. The trial was abandoned as unworkable, but in 2011 the University of California, Los Angeles came back to repeat the study, testing Ayurvedic management against the best allopathic drug, methotrexate, in a well-designed study. They found that outcomes were the same under both systems, but there were fewer side effects with Ayurveda. So there is now a framework available to counter reductionist designs of conventional clinical trials. We don't test only one parameter.

‘See, it costs millions of US dollars to do biomedical research,' said Darshan. ‘But Ayurveda has survived for centuries and was created by a long history, not by science. There are 5,000 medical manuscripts in Siddha, there are 100,000 in Ayurveda, covering aspects of medicine and surgery. It's highly, highly sophisticated. What Ayurveda needs to progress is to use modern tools. So the way we are working now is like this – the theory will be Ayurveda, the tools will be modern. And traditional theory must also grow in parallel otherwise it will lose its autonomy. If Ayurveda wants to come out of its marginalisation, today I have no option but to talk to the dominant medical system. In the future, in this age, we should be able to use modern methods to detect
kapha
,
vāta
and
pitta doshas
on a cellular level.'

I left to talk to some of Dr Shankar's research scientists, visit their botanical gardens and investigate the thriving integrated medicine hospital across the way. I thought, on the short walk over, about the point Darshan had made and what this would mean for the future of Ayurveda in India. In order to compete with the dominant ‘allopathic' system, as he believes it is necessary to do, India's traditional systems require a different level of understanding and the development of new characteristics. While knowledge of its foundations will remain necessary, new applications of Ayurvedic medicine must see what changes are occurring on a cellular level, just as scientific medicine is doing. I was also very clear on what he thought the benefits of integration were.

‘It is important to revitalise traditional medicine because of the marginalisation of traditional knowledge,' he had told me, ‘for three reasons – because depressed traditional communities will get visibility; because patients will benefit; and because the frontiers of knowledge will expand.' Dr Shankar's thoughts reminded me rather of Hendrik van Rheede's comments over 300 years earlier. The demise of Ayurveda has been a concern for centuries, but it has always survived.

As I walked around the hospital guided by Dr Dhrudev Vyas, head of its operations and new initiatives, it felt like the realisation of a dream that had been sketched out multiple times since India's colonisation and after its independence. The hospital seemed strangely unlike a hospital: there was an air of calm and orderliness and a distinct absence of the ominous smells of antiseptic and disease normally so all-pervasive. Wards were comfortable and spotless. The doctors were a mix of allopathic-trained and Ayurvedic and there were also pharmacists, physiotherapists, surgeons, acupuncturists, radiologists, yoga experts and biomedical scientists to process patient samples. The nurses' stations, above which were signboards listing patients' rooms by the Ayurvedic diets their occupants had been prescribed, were manned by conventionally trained nurses and auxiliaries, sharply dressed in shirts and trousers.

On ward rounds, doctors both observed patients (by eye, for external clues and through biomedical measurements) and talked at length to them. Through questioning, they assessed the various dimensions important in Ayurveda for understanding what, for any particular patient, was normal or pathological function. Part of this was looking at the
doshas
(bodily constitution): – there might be an excess of
pitta
(bile, or heat), for example, but the patient's background – factors like their genetics, geographic origins and history of infectious disease – could mean that this make-up was unexceptional for that individual. One person's medicine could be another's poison.

Dosages, too, were very much tailored to the individual. Dispelling the popular perception that Ayurveda is slow to work, doctors at the hospital told me it simply takes time to optimise each patient's treatments because each regimen is personalised. Doctors also ascertain which of the patient's disease-causing imbalances might be be related to diet, activity and even the way they think. Without imbalances, they say, no disease can manifest. Equally, correcting a disease is not enough – success is achieved not when the problem the patient initially presents with has gone, rather, when all functions – sleep, appetite, digestion, metabolism – return to harmony.

Dhrudev himself had trained in biotechnology and microbiology and talked me through departments as we passed them. ‘The integrative model is the key,' he explained, ‘we have facilities for ECGs, radiography, a pathology lab: haematology, serology, microbiology, immunology – when patients have diabetes, we still want to know what their blood sugar level is. Our inpatients stay three to thirteen days typically and they come from all over India, as well as abroad. People hear about us by word of mouth. Even so, we also get two and a half thousand walk-ins per month.'

‘So who comes here and with what conditions?'

‘People come from all walks of life, all religions come, all communities – we have different price plans and subsidies. People below the poverty line will have up to one hundred per cent of their treatment paid for. We also run health camps once a month in rural areas – that programme was endowed by Tata.'

I had noticed that many innovative initiatives, hospital buildings and health programmes around India also bore evidence of the Tata Group's philanthropy. The enterprise, best known in the West as a steel company but which owns a multitude of business ventures in India, from hotels to jewellery shops to instant coffee and also counts Jaguar Land Rover and Tetley tea among their brands, contributes significantly to the arts, education, culture and health in India.

‘You know, traditional practices have come into disrepute often because of bad practitioners, people who are self-proclaimed doctors. Other than rural areas, where folk healers are used possibly because they might be the most accessible, urban people will always preferentially go to allopathic doctors. So what you'll find is we will have people coming here for physiotherapy, rehabilitation, palliative care; after road accidents, cancer, or stroke. When there's nothing they [the allopaths] can do, we get a lot of those patients. We see many autistic kids. We also look after many patients presenting with stress or poor weight management; infertility, pre-conception, pregnancy.'

Dhrudev took me to the first floor, where the smell of fresh paint announced their new maternity ward, still being finished. Inside, he showed me the rooms for giving birth without conventional intervention, as well as one fully equipped for surgery, should that become inevitable. ‘Because there has been a loss of traditional practice, people living in the city, away from their extended families – mothers, grandmothers – more women now don't have that support and guidance. We are seeing a rapid increase in caesareans in India now. That is why we are building this unit, so women can have natural, healthy pregnancies and birth.

‘In this kind of integrated approach, there are a lot of good initiatives happening across India of late. There are some other places similar to what we are doing here, or there are some really top-of-the-range private allopathic clinics that have now integrated traditional medicine. There is a lot that Ayurveda can do.'

While the integrated approach might be revolutionising patient care, it might also have wider implications for the medicine across the globe.

‘Over the years, India has indeed seen an increasing interest in its medical traditions,' Dhrudev continued, ‘and in its sources of traditional medicines: plants and parts of plants, seeds and fruits for perfumes and pharmacy, Ayurvedic and Unani medicines sold in bulk and traditional medicines for retail.' In the mid-1990s (when Indian law did not allow agricultural and medicinal products to be patented), there had been wranglings with the US Department of Agriculture, together with US multinationals – famously over products from
Azadirachta indica
, the neem tree, from which seventy products had been patented. The corporate monopoly this threatened meant that neem-related patents allowed the holders to make major financial gains, while levying huge cost increases for the tree's traditional users. In India, neem had been used for millennia for medicine, toiletries, timber, contraception and fuel, and in agriculture as a pesticide and for the care of livestock. There were also legal challenges made over the genes of other plants, like nutmeg and camphor. Between then and 2003, the export of Ayurvedic and Unani products increased five per cent annually and exports to the US shot up from just ten per cent of total exports of these products in 1997 to an astounding sixty-five per cent.

I thought back to something Annamma Spudich had mentioned, about the low success rates of random search methods used in biotechnological drug discovery, despite the vast amounts of money spent on it. From her role as visiting scientist at Genentech, a Californian biotech giant, and from her days in experimental science, she had explained to me the standard procedure used to identify a new molecule that might potentially be beneficial in the treatment of a disease. It required determining the chemistry of a disease, sifting through vast numbers of randomly generated molecules created in line with that chemistry and then looking to see whether any of those molecules had an accelerating or inhibiting effect. But that random approach had not been particularly successful. ‘A relatively small number of successful molecules have been found. It's really staggering, the amount spent,' she said.

I recalled that Darshan Shankar, from his Ayurvedic research perspective had also flagged up a similar thought: ‘So it's important to go back to old therapeutic methodologies to see if there are easier or more successful ways to find solutions. At this stage in the history of the world we've largely managed to conquer infectious disease, therefore, the real problem is how to deal with chronic diseases. Chronic conditions are treated with single-molecule drugs and people are living with the by-products of these.'

In India, an enormous body of knowledge – centuries of records detailing what conditions these plant products are used for – are there for the taking. And now, with the comprehensive information on plants and medical traditions kept in databases like Darshan's at the Foundation for the Revitalisation of Health Traditions and the collections at the Department of AYUSH's Government Central Pharmacy, future foreign patent claims on the pharmacopoeia of India's flora may be easier to quash. Like the battles over neem products and the ever-present legal challenges and bans of India's production of generic pharmaceutical drugs, the dramas played out in courtrooms about medicines deriving from any part of the country's healthcare system has the potential to affect an enormous number of lives – both in India and in the developing countries that depend on her for cheap, accessible medication.

I had seen plenty of evidence of a concerted drive, backed by the Indian government, to capitalise on traditional medical innovations that biomedicine may have been blind to. If it bears fruit, it is possible that the types of Ayurvedic medicine which will increasingly be produced for use in India and abroad will be single-drug formulations, closer to the rapid-acting ‘magic bullets' which are a feature of Western-style pharmaceuticals: easy to test and validate in the conventional ‘reductionist' way, widely preferred by patients and targeted at chronic diseases. Perhaps also, like Ayurveda's management of rheumatoid arthritis, there will be clinical studies more suited to the old ways, so that other traditional treatments can be tested and validated for adoption by both Western and Eastern worlds. And if these emerge, the integration of India's rich variety of ways to manage health and the bringing together of the ancient knowledge of plants and modern scientific tools may go some way to informing the quest that all patients have – to manage their illness, or to cure it – affordably and with the fewest possible side effects.