Brotherhood Dharma, Destiny and the American Dream (37 page)

Doctors, being highly trained technicians, scorn the kinds of objections I am raising as metaphysics. To them, healing the body requires no philosophy. What counts are results. But I knew that the results were fraying around the edges. One glaring area was heart disease. Every year around half a million heart patients undergo CABGs (coronary artery bypass grafts), pronounced
cabbages,
to correct their clogged arteries. Sometimes the patient is a middle-aged man who feels chest pain, the classic symptom of angina pectoris. More likely he has no pain but becomes winded with mild exertion or does poorly on a treadmill stress test.

He has friends his age who have undergone bypass surgery. They tell him that it hurts like hell for a while, but modern surgical techniques have you up and walking within a day of the procedure. The surgeon pulls a clean artery from elsewhere in the body, usually the leg, and once it is sewn into place, the heart receives an unimpeded flow of blood. The procedure entails few risks; it’s almost become a midlife rite of passage. So with some anxiety but lots of reassurance, the man has the surgery, paying on average $100,000. A whopping amount, he thinks, but his life is at stake.

It would upset the apple cart—and should—if he knew that only 3 percent of patients are actually given a longer lifespan by having bypass surgery. From the start it was conceded that CABGs should be used in limited cases, chiefly when the heart’s left descending main artery is so blocked that the risk of a fatal heart attack is high. Otherwise, the procedure largely improves only the patient’s symptoms, and within two months the newly implanted artery has become clogged again, unless the patient has undertaken drastic lifestyle changes—and few do, since after all they expect the surgery to cure them.

Having your chest cracked open is frightening, and there is another
procedure that doesn’t involve open-heart surgery: coronary angioplasty, where a tiny balloon is inserted in a coronary artery and inflated. The point is to expand the constricted blood vessel and allow better flow of oxygen to the heart. Usually a stent is inserted to keep the vessel open. As of 2006, 1.3 million angioplasties were done annually, at an average cost of around $48,000. In actuality, however, balloon angioplasty and stents benefit only 5 percent of patients in terms of added longevity. The procedure carries the very real risk of dislodging some of the hardened plaque inside the clogged artery. When even a speck of plaque floats free, it can lead to stroke or a pulmonary embolism (a clog in the lungs’ blood supply).

On all fronts the number of unnecessary surgeries and office procedures performed every year is in the hundreds of thousands—the precise number is a matter of controversy. Drugs are far less efficacious than they are advertised to be. In recent years the distressing news came out that the most popular antidepressants, all of them billion-dollar drugs, are little more effective than placebos in mild to moderate depression. That’s only the latest instance of a continuing story as miracle drugs lose their gleaming reputation.

Add to this the number of people who die from mistakes that doctors make. Between 1999 and 2012, as I am writing, the number of deaths related to medical error rose from nearly 98,000 to an estimated 200,000, making it a leading cause of death in this country. Such errors are caused by various factors, including overwork and the increasing complexity of modern medical procedures. Yet ironically, doctors are trying to avoid mistakes by running endless tests. In the period from 1996 to 2012, the number of visits to the doctor that resulted in five or more medical tests tripled, and the number of MRI brain scans, often for no valid medical reason, quadrupled.

Raising such objections irks the medical establishment, and I knew that if I continued, my credibility would suffer. There is only so much criticism that a system can bear before the whistleblowers are punished. When I was the public face of Maharishi Ayurveda, my role was so far outside the mainstream that such worries were irrelevant. Fortunately I could carry my shield with me. If I was satisfied
with being a New Age doctor, perhaps
the
New Age doctor, everyone would know the niche I belonged in. America is tolerant of eccentric lifestyles and oddball beliefs. At a science-fiction movie the audience laughed when one character turns to another and says, “I think Jerry’s channeling Deepak Chopra?” I laughed, too. But the silent pressure inside me wouldn’t stop.

Rita was anxious about my abrupt move away from TM, but she has wonderful powers of adaptation. Our friends in Boston were still mostly Indian doctors, and if they raised their eyebrows over Ayurveda, fame was another matter. It brings a golden silence when the phone rings and your wife says, “Deepak, it’s Madonna,” or anything in that vicinity. Thanks to their mother, Mallika and Gautam grew up in a stable, loving home with complete insulation from the media machine that chewed around the fringes of my life. Maharishi himself took an enigmatic attitude toward me. I was invited to celebrate his birthday every January, and if he had any medical problems, his relatives called me up as if I were his private physician. The consternation that was felt in the TM movement after I left was what you’d expect when a true believer turns into an apostate. The biggest favor that anyone had ever done for me was Maharishi’s offer to let me move beyond the conventional drugs-and-surgery lockstep. This only increased the great letdown over my change of heart. As the old guard closed ranks in the aftermath, some privately understood my situation. Most didn’t.

They were captivated by everything implied in the phrase “enlightened master.” No matter what Maharishi told them, he could never be wrong. But I kept alive in my heart a belief that was the ultimate in culture clashes: Maharishi knows what I’m doing. This is my dharma, and he wants me to follow it.

There is no separation between dharma and Dharma, the big and the little. If an individual heeds a calling, the same voice speaks to everyone. We each play a different role, but on the wider front we evolve together. I sincerely believed that, and my driving ambition to change mainstream medicine hardly made me isolated. By 1992 the facade of drugs-and-surgery medicine was crumbling. Pioneering researchers
like Dean Ornish at Harvard were proving that lifestyle disorders were treatable without drugs and surgery. Heart disease, diabetes, prostate cancer, breast cancer, and obesity account for three-quarters of American health care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle.

No one with a conscience could stand by idly and watch American medicine become a crushing financial burden to millions of people when the alternative was inexpensive and available to virtually everyone. A study published in 2004 in the leading British medical journal,
The Lancet,
followed thirty thousand men and women on six continents and found that changing your lifestyle could prevent at least 90 percent of all heart disease. Yet for every dollar spent on health care in America, ninety-five cents goes to treat a disease
after
it has occurred.

We exist, the Vedic scriptures say, to undergo a second birth in the name of spirit. In a strange way, that would happen for me only if I attended the birth pangs of a new medicine.

If reinventing the body was still a faraway hope, reinventing myself was an urgent need that had to be met right away. My private practice had been sold off. It wasn’t feasible for me to return to endocrinology as if nothing had happened over the past seven years. Is it possible to have an interrupted destiny?

Strangely I don’t remember discussing alternative medicine with Sanjiv at any length. It just became my department, as he had his. He was worried, as I recall, about people being drawn away from the proven treatments of mainstream medicine. He was echoing a familiar establishment warning that has never held water with me. It implies that a doctor like me, working outside the box, is encouraging his patients to forgo “real” medicine. Sanjiv wasn’t saying that. But he was definitely a rising figure in establishment medicine. To an outsider we were a strange pair: one brother becoming an authority on a single organ, the liver, while the other brother devoted all his attention to treating the whole person.

It wasn’t clear that my viewpoint would ever be accepted. Meanwhile Sanjiv had thrived by being a specialist. If you want a real mouthful, how about “holistic gastroenterologist”? If I could have shown Sanjiv that such a thing was possible, he might have had his doubts eased. (We had no way of knowing that twenty years later there would be doctors using that title.) Why shouldn’t the gut, which is what gastroenterologists treat, be intimate to every cell of the body? Our gut feelings are chemically transported from the abdomen to the brain. It can’t be a one-way telephone line.

On the one hand, the stark contrast between us was undeniable. I fervently believed in the holistic approach and valued farseeing visions of the future. Sanjiv believed in the scientific method and trusted that it would be just as strong in the future as it is today. These were matters of deep conviction. On the other hand, there was no real rift between us because we trusted each other. I trusted Sanjiv’s scientific knowledge; he trusted that I would never say a word to harm a patient, no matter how far-fetched my thinking got to be, as viewed by the very skeptical mainstream. I’m sure he was as amused as I was whenever an irate doctor would challenge me and be floored that I actually knew conventional Western medicine. (Did I keep a strain of my father’s determination when the British ignored him on grand rounds, such that he had to be twice the doctor they were?) At a certain point I told my book publishers to leave off the MD after my name. It wasn’t worth it to keep proving to other physicians that I had respectable credentials. (Later on I also gave up charging patients for consultations, just to avoid any hint of profiting from their distress through false hope.)

Somehow, a niche was made so that I could put all the pieces together. At an Ayurveda conference I met Dr. David Simon, a neurologist who was also a trained TM teacher. We hit it off immediately, beginning when he came out unexpectedly with his favorite Jewish doctor joke:

Two Jewish friends are arguing over when a fetus becomes a human being.

“I know,” one says to the other, “let’s ask a rabbi.”

They find a group of wise old rabbis and pose their question. The rabbis put their heads together and find an answer.

“A fetus becomes a human being,” they said, “when it graduates from medical school.”

David was a human being by rabbinical standards. He was whippet thin, with glasses, an enthusiastic demeanor, and a sharp mind. He had devoted more years than I had to a deep study of alternative treatments, and they had become his passion. He also knew what it was like to be an outsider in his field.

“If you’re interested in consciousness,” he said, “the last person to ask is a neurologist. They’re all brain mechanics.”

David had begun meditating long before we met, when he was a seventeen-year-old anthropology student at the University of Chicago, focusing on the role of shamans in non-Western cultures. In a short time he invited me to do grand rounds at his hospital in San Diego, one of several run by Sharp HealthCare. I spoke about the mind-body connection to some assembled doctors and staff. Some were interested, and I was already accustomed to the hints of professional disdain from the rest.

Then invisible wheels began to turn. The CEO at Sharp, Peter Ellsworth, had a sense of where medicine should be moving. He foresaw the merging of mind, body, and spirit into an integrated whole. David recommended that he visit Lancaster. Ellsworth brought two colleagues, and their experience was positive. He felt that I might be the point man he was looking for. When they got back home, Ellsworth proposed to Sharp that they open a center for “integrative medicine,” a term barely used at the time. So far as we knew, this was the first center of its kind in America. I was to be the director. David, who was chief of staff for Sharp Memorial Hospital, would be codirector.

On the face of it the proposal was too radical to get past the complex politics of a major hospital. But CEOs are persuasive, and I told Rita that we had been pulled out of limbo. My new job was as a salaried doctor for a health care provider twenty-six hundred miles away.
Since the children were still in school, we would have to be a bicoastal family for a while, and I recall that the new house in La Jolla gained its furnishings gradually, a sign of caution on Rita’s part. There was the human factor, too, since Rita had endured with good grace the role of grass widow to a husband who traveled three hundred days a year. The Little India in Jamaica Plain had become a Chopra colony in the nice suburbs. Rita had friends and family around her in Boston—her sister Gita and her husband had also come over by now after ten years living in England.

For two years, during the time that Sharp funded our center, David and I had complete freedom to teach patients how to go beyond being healthy. The mind-body connection, we were convinced, made well-being possible, and well-being meant a fulfilled life. At first the patients were mostly drawn from readers of my books. But David was the engine behind changing their lives in practical terms. They were taught meditation and yoga. They learned about breathing exercises and diet. They were given personal programs based on Ayurvedic body types; even the mantras were personalized, using ancient formulations from the
Shiva Sutras.

David had followed the same arc that I had. His enthusiasm for Ayurveda, stoked by the revival Maharishi envisioned, turned to frustration with the movement’s constraints. At the Sharp center he could soar, with only one small difficulty: We didn’t make money. Outside the people who had read my books, nobody seemed very interested. The other doctors at Sharp were mostly dismissive as well.

I deeply admired David’s way with sick people, which was both precise and caring. Once, at an alternative medical conference, a patient in her forties was presented with intractable inflammatory bowel disease. She had almost constant pain and had been recently hospitalized. I was in the audience while David was on the panel. Each practitioner was asked how he would treat this woman.