The Gerson Institute of Ayurvedic Medicine

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The interview below took place in either 2008 or 2009 in at The Indian Consulate in New York City following a conference on Ayurveda at which Dr. Gerson was a speaker. It was conducted by Radha Awasthi who was kind enough to provide us with this transcript. Portions were published in Times of India.

After receiving his formal Ayurvedic medical education in India, graduating from Tilak Ayurved Mahavidyalaya in Pune, Dr. Scott Gerson began treating patients in his Ayurvedic medical practice in NYC in the 1980’s, while simultaneously completing his internal medicine training at New York-Presbyterian Lower ManhattanHospital. It was one of the first integrative medical practices to exist in the United States, although that term had not yet entered the vernacular. At the time of this interview, Dr. Gerson had cared for more than twenty thousand patients suffering from a variety of mostly chronic diseases.


In 2001, showing gratitude for service to the Ayurvedic community, The Institute of Indian Medicine in Pune presented Dr. Gerson with the H.N. Phadnis Award, in recognition of his achievements in both research and clinical Ayurvedic medicine. In 2004, Dr. Gerson formed a non-profit foundation that provided financial assistance for a laboratory at Pune University devoted exclusively to Ayurvedic basic research. Over the years, Dr. Gerson has addressed the United Nations, many medical schools, Indian Consulates, National Institutes of Health, and numerous conferences and organizations here in the U.S. and abroad enlightening listeners on the scope, practical value and majesty of Ayurvedic medicine.

Radha: Let’s start with the early days. How did your Ayurvedic practice begin and what was it like at the beginning?

When I returned to New York from India, I gravitated toward the Greenwich Village neighborhood where I had spent a lot of my youth. I felt it would be the absolute best place to establish a non-conventional form of medicine like Ayurveda. There was only one yoga center downtown at the time, Integral Yoga, and that became both my personal and professional hub. It was there that I met many like-minded people, some of whom became my original patients. Since we frequently had the same friends, ate the same foods, and moved in the same circles, I learned the great advantage of a physician being intimate with his patients. My Greenwich Village period was not only formative in my education of what it means to be a physician, but it also set the tone and principles for my entire career which stays with me even to this day. There was definitely a sense of energy, mass and purpose infusing the Yoga community in Lower Manhattan in those days. There were meditation groups, occult bookstores like Samuel Weiser’s, new Indian restaurants, macrobiotic places, and a general exploding health food movement. I felt I was part of a wave of new consciousness that would change the practice of medicine forever.

Radha: So after such an auspicious start, why hasn’t Ayurvedic Medicine become more widely known and practiced in the United States?

Dr. Gerson: I believe that doctors have lost their way and have forgotten the true meaning of being a healer. It happened slowly as the cumulative result of many detrimental factors: the increasing loss of independence of the physician, the amalgamation of doctors into large “group practices,” the economic pressure and paperwork jungle required to satisfy the Rulers of American Medicine: the insurance companies, and finally doctors’ narcissistic sense of superiority and unwillingness to integrate their profession with all the other disciplines that deliver healthcare.

In other words, Ahamkara--the Ego. Doctors have historically had this tremendous ego, which is a huge protective bubble for them. Unfortunately, not only is it undeserved and misplaced ego, but it serves to obscure the truth about health and disease and destroys any possibility for real medical insight into a medical problem. It creates a scenario where if the patient shares information that the physician doesn't understand, the patient is the problem. If the doctor either does not listen or doesn’t make sense of a patient with complex, multi-system medical issues, often involving both body and mind, that patient is put (either consciously or subconsciously) into one of three big categories—fibromyalgia, chronic fatigue or psychiatric. And that’s not only naïve but also ignorant because life and medicine are more individual and sophisticated than that.

The Charaka Samhita, one of the principle ancient textbooks of Ayurveda, strongly warns us that arrogance undermines even the most brilliant of doctors. An arrogant person exalts his or her importance, knowledge, and value and thinks himself to be higher in status than others. Arrogance in a physician totally destroys the doctor-patient relationship. And the chasm between patient and doctor has been magnified since we entered the information age, because patients have access to medical and scientific information they didn't have in the past.

Radha: Dr. Gerson, you’ve been in practice for thirty years. Did you not think that, with the increasing burden of chronic disease affecting our aging population, and the inability of conventional medicine to address it, Ayurveda would come to the attention of the American public by now?

Dr. Gerson: Yes, modern medicine does an abysmal job of dealing with chronic illness. In a strange way, the current surge we are seeing in cancer and autoimmune-related disease—despite decades of trying to address it in the old paradigm—may be the straw that finally breaks the camel’s back because so many baby-boomers are affected that it's going to force us to eventually change our approach. Some of the conditions I’m seeing in my office don’t even have names or fit into any modern category of disease. They have aspects of many different chronic degenerative systemic disease but they are not true Alzheimers, nor Parkinsons, nor Multiple Sclerosis, nor anything. If modern medicine continues with its reductionist approach which tries to divide diseases into separate groups of cells or tissues instead of seeing human beings as whole systems of mind and body which are also interrelated to environment, we will not meet the challenges of chronic disease.

I think the recent presidential election reflects on a larger scale the way in which our health care system is broken. The way in which a society deals with marginalized populations, such as Islam or other immigrants, is the signature and indelible stamp of that society's character. The analogy here is to modern medicine’s approach to cancer or auto-immune disease.

The sad irony about the current epidemic of chronic disease is that despite spending more and more on health insurance people find that their doctors are almost clueless about the true nature of their illness. As more and more of us seek treatment for these conditions it may soon change how we look at chronic illness. We're going to have to get out of the “patch-and-pay” model that we have and focus on the true nature of diseases. I still cannot believe how we treat diseases like hypertension in this country—giving drugs which temporarily mask the symptom without much effort to understand the systemic, holistic root cause of this disease.

Radha: Are you involved in any research into the effectiveness of Ayurvedic Medicine?

Dr. Gerson: Well as you know, medical research requires an enormous amount of funding, especially the kind of epigenetic research that I am interested in pursuing. Our current research efforts are following two different strategies. One strategy is basic data collection regarding many aspects of our treatment protocols. So we’re documenting the effects of dietary recommendations, herbal medicines, exercise regimens and meditation practices and measuring where possible the outcomes of these interventions.

The other strategy involves much more sophisticated research and funds. It involves exploring the medicinal qualities of Ayurvedic plants grown here in the United States. This will ultimately require collaboration with a number of scientists and access to technology like HPLC, mass spectroscopy, high throughput analyses, and other tools for molecular biology. I’m confident we can one day make this happen. Right now our clinic’s greatest research asset is our patient population—some of whom have been following Ayurvedic lifestyles and treatment protocols for more than twenty years. The real key to medical research of any kind is knowing what questions to ask--since there are literally thousands of potential questions that need to be explored. I’m particularly interested in understanding the epigenetic effects of both herbal medicines and meditation practices. Both of these natural and inexpensive interventions modify the way genes express themselves. I'm very anxious to collaborate with people who are much smarter than me who can help ask these questions in a scientifically meaningful way. If this kind of research project ever gets capitalized, a lot of practical and immediately applicable knowledge will emerge.

However, based on my PhD research and later as a seasoned basic science investigator of several aspects of natural medicine, my opinion is that we know next to nothing when it comes to most chronic illnesses. So research into the mechanisms of chronic disease will not be easy and probably it will take decades to fully understand the etiopathogenesis, molecular biology and full nature of chronic disease.

What I tell people is that between environmental pollution, our food choices and the poor quality of our foods, and mental and emotional stress, we're all on the verge of developing some form of degenerative chronic disease. And I believe that. I think our biosphere has already made some sort of transition, not in a good direction. Furthermore, I think it involves more than just the physical realm of life but mental and energetic realms as well and I think we're all affected. So, we need to adapt a whole new paradigm in medicine, a whole new set of basic assumptions about life and health. Probably the worst nightmare for U.S. medicine would be nationalized health care, which would give the government the power to shape our policies and ideas about medicine. We need to change the way we approach medicine, and it's frightening that we're talking about nationalized health care. As horrible as our current health care system is, with nationalized health care, medicine would be the last nail in the coffin for any hope of the revolution needed for diagnosis and treatment of chronic illnesses.

Radha: Do you ever treat people with acute conditions?

Dr. Gerson: Yes of course but mostly, I see chronic illness. When you understand how most disease processes are initiated, I think most of my patients are imbalanced well ahead of the defining or recognized clinical event and sustained illness that brings them to my office. That recognized illness is generally a condition of imbalance and toxicity which has stayed “pre-clinical” for quite some time and then reaches a threshold and becomes manifest due to some form of mental, physical, or environmental life stressor. This may or may not be related to a physical factor or event (e.g. trauma, viral infection, etc.). In fact in my experience the trigger is more often related to a prolonged period of multifactorial stress (family, job, home, financial, social, etc). This happens because, even though we can't measure it, there is a clear and certain energetic frailty associated with subacute chronic illness. In Ayurveda, we perceive it as a doshic deviation away from one’s Prakriti (essential nature). Once that tipping point is reached the unmanifest imbalances become manifest and the recognizable disease process proceeds. Sometimes it is a slowly evolving process and sometimes people leapfrog.

Radha: What are some of the most important clinical observations and Ayurvedic treatment recommendations you have made with regard to chronic illness?

Dr. Gerson: I always carefully check to see if a patient has the prodromal or overt clinical signs of ama accumulation. Ama is the putrefied and partially fermented product of incomplete and suboptimal digestion and is the root cause of many chronic syndromes. It also makes these conditions more resistant to treatment. So the first step in treating any chronic illness is to remove ama from the tissues if it is present. Its presence is initially signaled as a loss or shift in appetite, constipation, excessive sleep, stiffness, mental dullness, and an aversion toward play. This is a concept completely foreign to modern medicine. Factors which produce ama are too extensive to list here but include: excessive intake of heavy or sweet foods and drinks, alcohol, sticky foods, excessive dry and raw foods, and psychological factors such as anger, greed, and attachment.

Radha: That’s so interesting. Anything else you’d care to mention?

Dr. Gerson: I’ve learned the virtues of combinations of therapies where the whole is greater than the sum of its individual parts. When you're dealing with a complex human being who has become metabolically and/or emotionally imbalanced, there's no one herb, diet or mantra that's going to effectively restore homeostasis. It's all about putting your innate bodily wisdom back in charge. That wisdom, once restored, operates through the human mind, digestive, immune, endocrine and nervous systems. If the patient and physician collaborate to eliminate the source of the doshic imbalance and toxic accumulation and the mind-body system re-establishes balance, you've done your job.

As physicians, we can help people in such a profound way just by our ability to understand. It all starts with our willingness to listen. I mean to really listen. As if it were your own daughter who was trying to explain her illness to you. I honestly didn't always have an ear for listening in the beginning, but I learned this skill as my meditation practice matured and I gained experience in caring for the very ill.

Everyone who's suffering from an illness certainly needs nutritional support, herbal support, metabolic support, emotional support and they usually benefit from some degree of detoxification therapy (Panchakarma). But you can't prescribe any of these therapeutic approaches therapy in a vacuum or in a cookie cutter fashion (i.e. “the diabetes regimen”, “the hypertension regimen”, “the ulcerative colitis regimen,” etc.)…that's flagrantly simplistic and intellectually dishonest. We are, after all, treating multiple tissues, agnis, shrotas, marmas with stubborn imbalances in an psycho-neuro-immuno-compromised and toxified individual.

Our goal as Ayurvedic physicians is not to see how many days of Panchakarma or herbal medicines we can administer, but to administer the fewest days needed in order to restore and reestablish balance. Towards that end, we need to understand the nidanas (root causes) in order to keep patients out of conditions that are going to perpetuate the patient's chronic illness. In some cases, it is even unwise to begin therapy until these destabilizing stressors are eliminated or at least reduced--whether the stressor is as basic as poor sleep patterns or a food addiction or is more complex and involves a bad support system, psychiatric issues, or substance abuse.

Radha: How long does Ayurvedic medicine take to cure most chronic diseases?

Dr. Gerson: Of course its not possible to say with great accuracy and my usual response to this question is it will take as long as Nature needs. It greatly depends on the qualities of the individual and the nature and strength of the disease. But an average range is between nine and eighteen months. I also think it's very important for people to periodically interrupt therapy (stop the herbal medicines and self-massages, relax the diet, reduce exercise, etc) on an intermittent basis for one or two weeks at a time every few months. Those windows are very important times to see how much physiologic vigor they have recovered. For many years now, I have learned to “pulse” herbal medications in certain patterns, and I have modified the Ayurvedic clinical approach from observing and learning about the unique patterns and tempo of the disease in a given individual.

Often you learn more about yourself when you're off treatment than when you are strictly following an Ayurvedic treatment regimen. That’s why I love when my patient go on vacations. I tell them to “do as the Romans do” for those couple of weeks. These 'holidays' provide valuable windows for observation and, if you repeat these holidays regularly, sometimes show reproducible patterns of response.

Radha: Dr. Gerson, you truly are a remarkable source of inspiration and guidance. But despite all your knowledge and experience, why is it that not all people recover from their illnesses?

Dr. Gerson: I learned a long time ago that the disease process and its reversal depends on many different factors which are out of the control of even the most brilliant medical system or physician. That being said, the most common reason for people not to get better is inadequate treatment of accumulated internal toxicity. Throughout one’s life, products of normal metabolism are produced in the tissues and are carried away for elimination. Normally the body has the innate ability to efficiently process and remove these waste materials, includ­ing the vitiated doshas. However due to one's repeated dietary indiscretions, poor exercise patterns, lifestyle, and genetic predisposition the digestive enzymes, metabolic co‑factors, and hormones which regulate the body's natural detoxification process become disorganized. This can lead to the accumulation and spread of toxins throughout the physiology‑‑resulting in disease.

Furthermore, when a person regains normal physiological function and the immune system activates, a patient can actually get temporarily more toxic due to release of stored toxins, so we have to know how to recognize and manage that. It's part of the art of medicine in terms of learning how to balance the toxicity generated and the fact that patients need to detoxify. In fact, I feel proper and comprehensive detoxification may be more critical to outcomes than diet, herbs, and lifestyle regimens combined.

Radha: How are you received by your medical colleagues here in the U.S.? Do most conventional doctors you know at least value Ayurveda? Do you ever get referrals?

Dr. Gerson: Truthfully, most physicians I interact with are too rigid in their ideology to understand the Ayurvedic approach to health. You just cannot be rigid, for we need to just admit that we only know a fraction of a percent about the human mind-body and medicine. Much of what we know today is going to change anyway. Ayurveda emphasizes the need to always continue learning and if you have success, to try to understand your success and your failures, too. And if you can do that, then you grow as a doctor and you get so much satisfaction out of helping patients.


Radha: And do you find that Americans are generally able to follow the Ayurvedic recommendations you give them? Are they put off by all the required patient participation which Ayurveda is known for?

Dr. Gerson: As a doctor, you need to understand how each patient paints their own picture of their life for you. And if you listen, you may not understand it the first or second hour, but when you hear it your impression and concept of them are accurately formed. It's like learning a new language, a language with a new alphabet. Only its not Spanish or Norwegian—it’s the language and syntax of “Mary Jones.” And you don't learn it overnight. Which is why a consultation does not end when the patient physically leaves the office. There are subsequent period of reflection and space for your knowledge of the patient and impressions to digest. Soon I am able to communicate in this unique new way with each person. No conventional doctors have time for this nor see its value.


But by approaching each patient in this intimate way, an Ayurvedic physician can see the connections and patterns. We become very comfortable with even complex issues because we understand the underlying imbalance and the capacities of each individual. There is still so much more to learn, and that's really what's fascinating. I'm having a certain amount of success as well as my share of failures and the questions I’m asking today are much different from those of thirty years ago. You have reach the point where it's okay to say that you don't know something. What's really important is that you continue to learn. If you do that, it all comes together by the grace of the Absolute. Patients really get that. Then you don't have insecurity and dishonesty that creates a doctor-patient chasm. It's just so much easier to say "I don't know, but let's learn together. Right now here's what I do know about this."


If you continue deeply study and practice Ayurvedic medicine you will undoubtedly re-discover things for yourself that have been known for centuries.


For example, I have seen case reports of a benign skin condition called acanthosis nigrans as an early sign of insulin resistance and risk factor for developing type 2 diabetes. It’s seen as areas of dark velvety areas of skin near the neck, armpits, or groin area thought to be due to insulin stimulating skin cells. In Ayurveda, this observation was long ago identified as a purvaroopa of madhumeha (prodromal sign of diabetes). It's things like that that I know already from the clinical setting. The complexity of the human being demands that all physicians know alot about neurology, psychology, endocrinology, dermatology, and all the other “so-called sub-specialties,” a term I strongly dislike. It absolves doctors from knowing anything except their own little niche and gives them implicit permission to ignore the patient as a whole. And while I know that the doctors in these sub-specialties that I've mentioned are incredibly bright, they seem sort of frozen and locked into their ideology. And the more intense the ideology, the more unreceptive the specialist becomes when confronted with something which challenges them. “What do you mean the steroid cream I prescribed didn’t relieve your itchiness? You must be doing something wrong or its all in your mind.” This prevailing attitude of false pride (ahamkara) is part of the pathology we see contributing to the failure of today's medical system.


Radha: But Dr. Gerson surely you’re not saying that all doctors are that narrow-minded? You do see the advantage in some situations of seeing a specialist, don’t you?

 
Dr. Gerson: Yes, of course, of course. However, if your medical practice becomes habitual and you resort to set algorithms for treating this or treating that, that is bad medicine. I acknowledge that we must have some guidelines for the way we practice medicine, of course, but always understand that we need to understand the unique individuality of every patient and every disease. Some conventional Western doctors will view a patient based on their own empiric experience and their instincts borne of that experience, rather than what's printed in a textbook or medical journal--and those are the really good, true physicians.