My Journey from the Mechanistic to Systemic Part 1
I entered the exam room to greet the first patient of the day—Mr. “Smith,” my patient of two years. A 52-year-old, 250-pound male, he was leaning uncomfortably back on the examining table, his belly straining his shirt buttons. He was sweating, his face reflecting anxiety and discomfort.
Mr Smith’s medical problems were difficult to treat. His wife had died two years before and his three children were scattered across the country. So he lived alone, and his job as a mid level manager was extremely stressful. When he saw me, he forced a smile. He did not want to disappoint me by feeling bad, but lately he’d been a bit more short of breath, and his ankles kept on swelling.
In the next few minutes, I had to be the healer for this person who trusted me to do something—though he and I both knew that things were going in the wrong direction. But perhaps I could bring him some temporary relief. The odds were stacked against both of us!
The computer screen stared up at me with its litany of familiar diagnoses: hypertension, obesity, coronary artery disease, previous myocardial Infarctions, diabetes, chronic renal failure, and mild congestive heart failure. He was on more than a dozen medications.
Mr. Smith’s weight was up another five pounds, and he admitted that he often ate out because he was too tired to go home and cook. His blood pressure was still inching up, and when I listened to his lungs, it was clear that his congestive heart failure was worse. Perhaps it would help to double his dose of diuretic for a day or two. I once again gave him my two minute lecture on salt restriction, and we agreed he would come back in two weeks, when we’d also do a lab test to see how well his failing kidneys were doing with all the diuretics. This perfunctory visit had taken more than 30 minutes, so I was already running behind.
This scene I repeated many times daily, so no wonder I was frustrated in my role as a “healer.” Was I really healing? No. I knew I was only dealing with symptoms, using temporary fixes—pills and potions that might or might not prolong lives, but that mostly decreased the patient’s quality of life. The problem was not only their side effects, though these could be serious, but also the sorry fact that we could seldom address the root causes of the ailments. Problems like stress, loneliness and psychosocial problems cannot be addressed in the time allotted. Toxins in our air, food, and water that had over time accumulated my patient’s bodies and brains could not be budged by anything I had to offer. As an allopathic physician, I had become a “disease technician,” an expert in treating the symptoms that showed up in different ”parts” of the patient’s body. The “person” in the body and his “wellness” were beyond our scope of practice.
This was not what I had visualized when I dreamed as a girl of life as a healer—though at this point in time, the middle years of my practice, I saw nothing to do but keep on muddling through. I cherished and was grateful of everything I had learnt and how it could help people in acute situations, help and cure in some cases, and often save lives. However, I was also woefully aware of Modern medicine’s severe limitations. Giving up my practice and abandoning patients was not a choice- I’d just have to keep doing the best I could and keep my mind open for other options that might help.
A few years later, however, the journey became personal. A member of my immediate family was struck with a serious illness and had to undergo powerful chemotherapy. It was at this time that the limitations of Western medicine really came home to me. This chemotherapy, though it had saved his life, had also left life-threatening poisons within him. The effects were making him sick in serious ways: severe weight gain from steroids, crippling fatigue, depression, PTSD… not to mention potential heart damage that could become permanent and the increased probability of malignancy in the future. I was desperate to find ways to detox his mind and body.
After twenty years of practicing as an American trained physician in America, I saw that Western medicine had failed me. How little it had to offer in the way of true cures and wellness! As always, we had treated the symptom but knew very little of what caused the disease or how to treat that cause.
In my desperation, I started looking into alternative, ancient therapies including the thousands-of-years-old medical science of my native India—Ayurveda—and I found that the Ayurvedic approach was entirely different from the medicine I had been practicing: it sought to correct imbalances to make all systems in the whole person work together. For example, therapies that keep the immune system healthy can actually prevent infections, cancer, and numerous autoimmune diseases. In addition, by using a series of detoxifying and balancing treatments Ayurveda can address chronic causes of disease such as a fouled environment or poor diet, and even body-mind-spirit factors like chronic stress and lack of fulfillment in life.
The more I studied Ayurveda, the more I became convinced that we need both approaches. For example, surgery when it’s needed is a wonderful thing, a prime example of how modern allopathic medicine excels in treating disease after it has manifested. But we also need ancient Ayurvedic and the way it aims to eradicate the causes before disease can develop.
The key to the problem, I’ve come to think, is that symptom-based medicine, by its very nature, will always come too late. That’s an overstatement, of course, but it’s close to true, as a case study I remember from my training as a medical student in American will illustrate. The professor called it the “Mayo Clinic Effect.”
A young female patient presented with a recurrent headache daily for about a month. After a very thorough history and physical examination, which did not reveal any objective physical problems, her doctor concluded that the headache was most likely “benign,” in other words something that perhaps is caused by a non-physical cause, something like stress, lack of sleep, eating wrong foods, etc. She was asked to take over-the-counter Tylenol- or Ibuprofen- like drugs, practice sleep hygiene, and was also given some stress management strategies.
After about a month the patient returned with similar but slightly worsening symptoms, again with no findings during the examination. However, because of her progressive symptoms, her doctor ordered some basic lab tests and also did an MRI of her head to make sure she did not have a lesion, such as a tumor, increased fluid, etc. Once again, everything came back negative and the patient was sent home, with similar recommendations but also a referral to Neurology, which again did not reveal any serious findings. She was once more treated symptomatically, this time with stronger pain medications.
Two months later, her pain even worse, the patient got frustrated with her own physician and decided to go to the Mayo Clinic, which is a well known institution for solving and treating difficult cases. There the first thing they did was to repeat the MRI scan of her head—and this time they found a tiny 3 mm tumor in the brain.
So what had gone wrong during this woman’s visits with her primary physician and the neurologist? The answer is, NOTHING! Had she gone back to her own doctor one more time, he too would have repeated the MRI (because her headaches were getting worse) and found the tumor.
This case demonstrates a fundamental limitation of modern “mechanistic” medicine.
First of all, the human body’s ability to notice any abnormality within itself is much more sophisticated than that of an MRI machine. The patient’s headaches were a warning signal that the body had generated, long before the tumor got big enough to show on an MRI. Perhaps the headaches manifested even before the tumor was physically present (in detectable form). In either case, the headaches were the body’s warning that something was going wrong, something that would make conditions right for a disease process to take root and manifest. In other words: Symptoms typically precede detectable disease!
Can we improve our medical machines? Some of them, probably. That does not alter the fact that a human being is a living organism, and as such functions by the internal interactions of complex, dynamic, and often non-material systems—in an environment that is also complex and changeable. It’s hard to even imagine a tool that could continuously measure all our internal imbalances or fluctuations, whereas the internal systems we already have are constantly “aware” of one another. They don’t need to be turned on, or told which “system” to look at, or updated, for example, when a patient is pregnant. They’re already aware of it all.
In short, modern medicine is limited by its tools, which are not sophisticated enough to detect or measure problems in dynamic living systems. Therefore they cannot detect the earliest “cause” of a disease.
So what of Ayurveda? Well, that’s the subject of my next blog. I’m excited to share what I’ve learned with you all.