In the battle between Eastern medicines, India’s herbal treatments and oil massages have tended to lag behind the more popular acupuncture techniques coming from China. Though both traditional health systems are more than 3,000 years old, Chinese medicine has enjoyed greater acceptance, especially from the Western medical establishment.
But the Indian government wants the downward-facing dogs of yoga to change that perception and become a gateway to holistic healing. In Israel, it is doing that by targeting local institutions, HMOs and universities, hoping the country’s open attitude towards alternative medicine will bring more prominence to Ayurveda.
Ayurveda treatment — “Ayu” means life and “veda” means knowledge in Sanskrit — starts with a consultation session to determine a patient’s “type.” In follow-up sessions, the Ayurveda practitioner then recommends specific diets, herbs, massages and exercises that are tailored to a patient’s type. Similar to Chinese medicine, Ayurveda focuses on achieving balance within the body and its environs.
“Ayurveda is the ancient heritage of India which is the knowledge of life, how you can lead a healthy and meaningful and peaceful life,” said Dr. Anju Kumar, the deputy chief of mission at the Indian Embassy in Israel.
She said the past decade has seen a revival of local interest across India about Ayurveda, and Indian traditional knowledge and healing. With that renewal is a government-level push to begin promoting Ayurveda internationally on the same level as ancient Chinese medicine, which is practiced widely around the world.
“The Chinese have invested much more in promoting their systems in acupuncture and other things, while we in India kind of lost track of [Ayurveda] and didn’t invest so much in it,” said Kumar.
In November, the Indian Ministry of AYUSH — the government body that promotes Ayurveda — signed a memorandum of understanding with Israeli health institutions, including Ichilov Hospital in Tel Aviv, the Technion in Haifa, and HMOs Meuhedet and Clalit, to begin incorporating Ayurveda medicine into Israeli medical research. In coming years, they hope it may even form part of the holistic treatment options offered by the major HMOs.
Dr. Shahar Lev-Ari, the director of Integrative Medicine Research Laboratory at Ichilov Hospital/Tel Aviv Sourasky Medical Center, said his lab will begin looking for ways to collaborate with Indian research institutions, including designing and implementing clinical studies which will take place in both Israel and India. Studies carried out in two or more countries are considered more scientifically sound because of the diversity of patients.
Lev-Ari’s laboratory has already published dozens of papers looking at the anti-inflammatory and anti-cancer properties of turmeric, a common herb used in Ayurvedic medicine.
A major part of the Ayurveda revival in India is standardizing the knowledge and treatments to transition the practice from folk remedies to proved science. “Ayurvedic medicine has huge potential, which is not realized or validated in scientific research,” said Lev-Ari.
The ability to standardize and prove certain aspects of Ayurvedic medicine through international clinical trials means doctors may take the treatments more seriously and people may be more willing to try them.
“There have been large studies about the beneficial efficacy of yoga for cancer patients, like one study on more than 400 patients found that yoga exercise is better than sleeping pills,” said Lev-Ari. “So why not, in the medical system, give a prescription to cancer survivors to do yoga and not to take sleeping pills? We know sleeping pills have [negative] side effects. This is the kind of research we’re looking to promote, to validate that all the traditional knowledge about Ayurveda medicine.”
“Why not give a prescription to cancer survivors to do yoga and not to take sleeping pills?”
Internationally, the National Institutes of Health in the United States is one of the leaders for standardizing complementary health practices and ensuring that adequate scientific research backs up any holistic health claims. In 2013, it spent $233 million researching various types of alternative medicine.
In the US, holistic medicine, including Ayurveda, is a $34 billion industry, but less than a third of the practices have been tested for safety and effectiveness, according to Paul Offit, the chief of infectious diseases at the Philadelphia Children’s Hospital. Offit wrote the book “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine,” warning against widespread use of alternative treatments before they have been properly tested and scientifically vetted.
Herbs and HMOs
Israel has a long history with holistic medicine. The first formal outpatient clinic for complementary alternative medicine was established in 1991 in cooperation with Assaf HaRofeh Medical Center near Rishon Lezion. By 1993, about six percent of Israelis had consulted with a holistic medicine practitioner. That number grew to almost 10% by 2000 and 12.5% by 2009, the latest figures available.
Every Israeli HMO (health maintenance organization), or “kupat holim,” offers holistic medicine through its clinics, but the clinics still struggle to get the doctors to recommend their services outright. Patients interested in alternative therapies often must be proactive to find out what kind of treatment or refund they can receive from their insurance for holistic medicine.
While the treatments through HMOs require additional payment, they usually cost about one-third the price of private treatment, said Dr. Yehuda Schwartz, the senior director of Meuhedet’s Complementary Medicine in the Jerusalem District.
The public health sector in Israel, including both the HMOs and hospitals, provides approximately two-thirds of holistic medicine treatments in the country. Lev-Ari noted that every major hospital in Israel now offers integrative medicine, often on the same campus. “It’s synced, there’s the oncology department and in the same building is the integrative medicine,” he said.
Even more important than physical proximity, Lev-Ari said, is doctors working together in official capacities with holistic medicine providers to address all aspects of a patient’s health. “It’s the same file, the oncologist can see the herbs they take and the massage sessions,” he said.
According to a 2012 study on integrative medicine in Israel, the most frequently used therapy was acupuncture, which accounted for 37% of all treatments. About a third of the patients received reflexology treatment, 29% used homeopathy and 26% used massage.
Acupuncture, reflexology and homeopathy all derive from traditional Chinese medicine.
Even traditional medicine isn’t free
Schwartz, who attended a conference on Ayurveda in Calcutta last November as a guest of the Indian Embassy, said he hopes to convince Meuhedet to offer Ayurveda, but a major part of the decision hangs on the economics. “If it can be profitable, they’ll do it,” he said. At Meuhedet, as with many other HMOs, the integrative medicine is an independent entity within the organization and is expected to be fiscally viable, Schwartz said.
Creating profitable clinics requires that there be a demand for those services. “The reason we offer Chinese medicine is that it came from below, the public wanted it,” said Schwartz. He added that the HMOs will be more likely to offer Ayurveda if the Indian government helps them promote the practice among the Israeli public, who are much less familiar with Ayurveda than other integrative medicine systems.
“We’ve agreed that [Ayurveda] helps, but how do I market it?” Schwartz asked. “It took years to bring Chinese medicine [to the HMOs]. In the beginning, conventional doctors opposed it.” As more research proved the effectiveness of the treatments, people began to warm to the idea, he said. “Western medicine wasn’t able to give them answers, so people did their own research into Chinese medicine and demanded it.”
“It’s like medical marijuana,” Schwartz continued. “There were lots of clinical trials, and it takes decades. Ten years ago I would have said ‘no way’ that we would have medical marijuana.” He said it will likely take years for the HMOs to offer Ayurveda services, but he does expect it to happen.
Lev-Ari also believes that the Israeli public and doctors will embrace Ayurveda as they continue to learn about it, as they have embraced other types of traditional healing over the years.
“I think the attitude has changed,” he said, evidenced by the language used to talk about this type of medicine. “If you look 30 years ago, they talk about ‘alternative medicine’ like there’s conventional medicine and alternative voodoo spiritual non-scientific medicine. About 20 years ago, they changed it in all the literature to ‘complementary medicine,’ medicine that is complementary to conventional medicine. And then it changed to ‘integrative medicine,’ which since 2000 is the preferred term in the US and Europe and Israel.”
This emphasis on integration is key, said Lev-Ari. “From the beginning, from day one, you use chemotherapy and yoga,” he said.
There’s also an economic advantage: Ayurveda is becoming a big industry in India, with several multi-million dollar companies creating herbal dietary supplements and oils. In China, traditional medicine manufacturing is a $31 billion industry growing at a rate of 15% per year and employs 150,000 people.
The Indian drug manufacturing industry currently stands at a little over $1 billion per year. Lack of regulation and quality assurance of the raw materials are the major hurdles, which have kept Indian herbal exports at less than 1% of the global market. But, growing government support for regulation and research could help the industry grow quickly.
Kumar said although there is some friendly competition with Chinese medicine, the Indian government wants to promote Ayurveda for altruistic rather than political gains. Indian embassies around the world also sponsor the International Day of Yoga on June 21 for the same reason, she said.
The International Day of Yoga is a two-year old initiative through the United Nations to promote yoga around the world, an initiative supported by 177 countries. “It does a lot of good for mankind, especially in troubled societies,” she said. “Outer violence is just a reflection of inner violence, and unless inner violence is curbed from within it will show external form.”
“It’s not a buy and sell kind of a deal where we have a product and want to sell it,” she added. “We genuinely believe it is for the benefit of humankind, that it will give you the internal peace and synergy between nature and humans and different societies and religions.”