Sunday, November 9, 2008

A false dichotomy

It is a slightly different post today, folks. I suppose it could be said that I’m guest blogging for myself. As well as all the nifty reviews and yoga diaries, I’d like to get a little deeper into all the elements that surround Yoga, and being as I’ve been trained as a scientist, that’s probably why I chose to write this little piece.

On medicine, western and eastern

We argue. We argue a lot.

We argue about a great many subjects- the morality of abortion and stem cell research, the existence of God, the role of science in spiritual systems.

We do, often enough, harm ourselves when we argue, blocking communication channels when we needn’t and-most importantly- shouldn’t. Take Eastern vs. Western medicine.

Much like the two-party political system in America, the concepts of strictly Eastern and strictly Western medicine is a false dichotomy. There are platforms common to both, and both retain the same goal. In politics, the goal is to govern the people. In medicine, it is to treat the disease. Let us deconstruct these notions, with the intention of recognizing that both have their merits, and-most importantly- could both benefit by removing the blockage and coupling their respective strengths to each other.

As this is a treatise on Yoga, it well serves our purpose to focus on Ayurvedic practice as our resident Eastern medicine.

The word “Ayurveda” retains a holy-grail-type mysticism among health-food shoppers and Californian über-spiritual fitness experts alike. It is a measure of how much an alternative medicinal system was accepted here in the west, that the practice- and subsequently the word -is unquestionably accepted as ‘good’, and has been exploited by current manufacturers of holistic health products. It may help to debunk the notion of inherent ‘goodness’ if we take a look at how these labels are marketed on their native soil: Both toothpaste- a product you don’t actually consume, is purported to be ayurvedic. A popular brand of ayurvedic soap, Chandrika, purports to “ ensure your personal charm”. The Indian version of cornflakes have “Added Shakti!” much in the same way that we fortify our breakfast cereals, albeit with the mystic power of the Tri-devi feminine force. How that force is distilled and added to cornmeal remains undocumented.

Let’s start this dissection simply. Ayurveda could loosely be paralleled to another holistic favorite ‘Chinese Medicine” – it was more or less the governing medical practice for centuries in India. Like the oft lauded ‘Chinese Medicine’, it is a holistic view that relies upon what it available- both in terms of diagnosis and of available treatments. Herein lies the false “east/west” dichotomy- it isn’t necessarily a difference of philosophy- both treat ailments- that lead to the different approaches, but rather a difference of tools.

We need a metaphor for disease, and what better than a pastime everyone is familiar with?

Imagine a pool table.

Imagine three cue balls at one end, an eight ball at the other. In between these, imagine and array of pool balls, configured to a specific shape. And now, cover the table with a tarp- not completely mind you- the cue balls and the eight ball can still be seen , but all the others are obscured by the tarp.

Let us label our metaphor- the eight ball represents the manifest symptoms of the disease. The #1-15 balls represent the internal mechanics- the specific biological molecules and pathway of the disease, and the cue balls represent the tools available to the physician. The specific configuration of the remaining pool balls represent the biological pathway of the disease- it is the same every time, in every person.

The physician’s job is to sink the eight ball- to treat the disease- and in early medicinal tradition, there was really no way to gain an obvious, molecular insight as to how the disease occurred. We simply didn’t have the tools to visualize these molecules. This didn’t mean the disease was untreatable- in fact, through trial and error, a good practioner- this might be a better term than ‘physician’ even though both served the same purpose- could devise a system that at least stood a good chance of sinking the eight ball, at least more reliably than chance. If the practioner fires a cue ball at the right angle, the eight ball can still be sunk- fairly reliably- whether or not you can see what is happening under the tarp.

Geometry is geometry and treatments are treatments- the practioner didn’t need to know what was happening under the tarp to know that it worked. That is not to say that they weren’t curious or didn’t learn anything- our analogy still serves, as you can certainly hear the impact of the billiard balls, and probably locate points of trajectory and intersection. It is speculation, certainly, but it seems natural to assume that this where the concepts of Chakras and acupuncture points came from- they simply are locations where internal energies and anatomical systems coalesce. They only aspect we need to keep in mind, however, is that all these observations were external. Certainly, dissection gave us an idea of internal anatomy, but if the early practioners wanted to see this happening ‘in the flesh’ as it were, they needed live subjects, and live subjects often resist being carved into, at least while they are still conscious.

Enter tools, technology, and the western physician. In reality, there came microscopes, anaethesia, germ theory and biochemistry. In our analogy, we shall summarize the development of medical technology and finely calibrated scientific as a pair of scissors.

With the scissors, physicians- and I think it is fair to introduce the term, although we may need to include a large contingent of research scientists, lab rats, and a host of other medical professionals who don’t and never will work directly with patients- could start to see what was happening with that particular array of billiard balls, the disease. The problem being it was a painstakingly long and tedious process. For the purposes of our analogy, we shall say that they could cut away a 3”x3” window at one time, each window being a culmination of decades of work. You can imagine that many of these windows would be useless- the only thing to report would be that this was a bad place to look.

Careers in science are based upon this ‘non-knowledge’- much of scientific literature could be summed up as “ we looked here, found nothing, don’t bother”. Once in a great while, a window might be cut above a useful location- perhaps here the 2 ball hits the 5 ball, sending it towards the NW corner- but that’s all. And we might even be reasonable in saying that each window cut represents thousands of patients, patients that we can learn from, but not necessarily treat.

This is where the ‘western’ physician gets a bad reputation. In seems cruel to us that this person, our doctor- purported to have taken the medical vow- could be so callous and uncaring as to see patients as data sets- but really it is a failure perception, coupled with the fear of being diagnosed with a chronic or fatal disease. It takes tremendous vision and patience to acknowledge and pursue a higher goal- to eradicate the disease in its entirety, to systematically elucidate every aspect so that nothing is left to chance- so that eventually no one will need suffer. The only problem being, it relies on those suffering NOW to acknowledge that nothing can currently be done- within this system at least. It asks the sufferers to acknowledge that they may well die, and nothing can be done for them, and to STILL volunteer themselves for the betterment of strangers, even hypothetical future strangers. A tough sell, to say the least.

This may be why we perceive traditional practices as more humane- the aim being to treat the patient rather than the abstract concept of the disease. It might be good to note, while we have the pool table in front of us, that these aren’t diametrically opposed methods of practice- this is the same pool table after all- just different points of focus. It may well be that if the early medicinal practitioners had access to the same sorts of tools, they may have done the same- they were also looking systematically after all, hence all the chakra charts and acupressure point maps.

It is also for lack of ‘official’ and ‘scientific’ sounding treatments that ayurvedic practices seem nebulous- diagnosis and treatments relied on what was available, and often seemed steeped in esoteric mysticism. It is again, however, a failure of imagination that led us to make distrust traditional medicine and make critical mistakes. Take Malaria, for example.

The indigenous people - in Chris Columbus parlance, ‘Indians’- of the Amazon flood basin figured out a cure well before western medicine did. In fact, western medicine never did- in merely refined the active compound in the herbal treatments of the Indians, and eventually came up with a synthetic analog. This turned out to be a critical oversight.

While the Indians had little or no conception of the molecular mechanics of the disease- they simply knew if they hit the cue ball in a certain direction, the disease went away.

Enter the synthetic analog. Western medicine, as we all know too well, is subject to marketplace forces, and American pharmaceutical companies generally aren’t willing to pay for imported compounds if they can make serviceable replacements in the lab, as hundreds of thousands of Organic Chemistry students know. They figured it would work just fine.

They were right- to a point. The quinine analog certainly did halt the progress of malaria, but the analog had a problem- for whatever reason, it allowed the parasite to become resistant very quickly- a matter of decades, while natural quinine had worked for thousands of years. In many regions, the local strains of malaria are completely resistant to the quinine analog, and travelers must take harsher psychoactive drugs like chloroquine and laramine*. What western physicians did, essentially, was to take an effective ‘primitive’ treatment for malaria and render it useless through its own arrogance and false confidence in molecular medicine.

Let us not indict western medicine entirely- the proliference of snake oil and charlatanism in ‘holistic’ medicine runs rampant, and are too numerous to bother documenting- it’s certainly been done before, to the point where ‘homeopathic’ has become a blanket term meaning ‘found at Whole Foods, in the Health and Beauty section’ rather than it’s original latin derivation, that of ‘same disease agent.’ **

All this to say- we, as a culture, would do well to bridge the gap between these methods. In a system where upwards of 50% of pharmaceuticals are derived directly from plant compounds, and the vast majority of the rest are simply synthetic doppelgangers of chemicals that were originally derived from plants, it may be time to acknowledge that the vast majority of our medicinal arsenal has its roots in , well, roots. On the same token, we might need to acknowledge that a steady diet of cayenne pepper, honey, and lemon juice condensed into pill form, labeled ayurvedic and marked up 400% may not cure cancer. We need to allow- and encourage- practitioners of both systems to work together, to bridge the perceived gap between the disciplines, for the betterment of the profession and the world.

*Laramine is said to make the traveler paranoid. If personal experience is any measure, laramine can make you believe that the shoeshine boys, eager to make a few pennies from you, are stalking the café, waiting to punch you in the kidneys, steal your wallet, and leave you in the gutter. The average shoeshine boy in Iquitos, Peru is about 8 years old.
**Homeopathy uses, as its lynchpin, the idea that minute quantities of a pathogen or allergen introduced to the body will lead the immune system to recognize it. For example, microscopic amounts of the allergen in poison ivy taken internally, may help the body to become ‘accustomed’ to it, and subsequently circumvent an allergic reaction then next time it is encountered en masse, so to speak, during a hike in the woods or otherwise. It is not, as many holistic commercial endeavors would lead you to believe, anything that doesn’t come directly from the pharmacy.

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