Aatma – the Ayurvedic Centre

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AATMA – THE AYURVEDIC CENTRE

Ajith Paninchukunnath, Doctoral Candidate, Marketing Area, MDI, Gurgaon Professor Vinod Kalia, Professor of Marketing, MDI, Gurgaon

Abstract Aatma was a traditional ayurvedic centre in Kerala (India). It was started by Dr. Mooss to offer holistic and authentic ayurvedic treatment. Kerala Tourism Development Corporation’s focus on ayurveda to drive tourism growth, and, the lack of proper legislation on quality control has led to the proliferation of new ayurvedic centers. A majority of them do not have sufficient expertise to offer ayurvedic services in a scientific way as prescribed in medical texts. Aatma never deviated from its values; it followed ethical practices and treated only patients. Dr. Mooss was in a dilemma whether to attract healthy tourists who are mostly pleasure and fun seekers; as compared to cure seeking patients whom Aatma targeted. This case is centered on the importance of positioning, holistic service, and ethics in the marketing context.

Key Words: Positioning, Marketing Ethics, Stakeholders, Ethical Values, Services Marketing, Ayurvedic Medical Care

Introduction Aatma Ayurvedic Private Limited (henceforth Aatma) was a new entrant in the ayurvedic healthcare service sector in late 1999. Kerala (a state in India), is world famous for ayurvedic healthcare service. Ashtavaidyan E.T.Ravi Mooss (henceforth Mooss), the MD of Aatma managed the day to-day activities and his father Ashtavaidyan E.T Divakaran Mooss was the Chairman. Both of them belonged to the Mooss family reputed for ashtavaidya and for the role that they have played to preserve and promote Ayurveda across Kerala and India. The Director of Aatma was Dr. Arya R. Mooss. She was the wife of the MD. In Kerala, ayurvedic healthcare was mainly provided by traditional ayurvedic physicians who had learnt ayurveda from their forefathers, or by physicians in government hospitals. Around the time Aatma came into existence, the Kerala Tourism Development Corporation (KTDC) started using ayurveda as a unique selling proposition to promote Kerala Tourism. This led to the mushrooming of small ayurvedic centres in Kerala .With no concrete system to regulate the ayurvedic centres, the tourists were lured by fly- by- night operators who adopted unethical practices to acquire customers and exploit them. The lack of any guidelines on how to choose an authentic ayurvedic centre, and with no accreditation system in place, tourists were at the mercy of tour operators, many of which had a nexus with such small ayurvedic centres.

Right from its inception, Aatma catered only to patients. Over a period of eight years, Aatma continued to remain a dedicated centre for authentic ayurvedic treatments and admitted only patients (not healthy tourists) and practiced healthcare delivery in a holistic and ethical way.

The sudden boom in the number of tourists visiting the state to experience authentic ayurveda was an opportunity for Aatma provided the tourists were willing to spend requisite time at Aatma to follow the regimen as mentioned in the ayurvedic texts. Since most of the tourists were short of time, they demanded modification in the original procedures many of which were against the principles of ayurveda and some of them could even be harmful. In July 2007 Mooss was grappling with a decision on whether to attract healthy tourists who are mostly pleasure and fun seeking compared to cure seeking patients whom Aatma targeted. He wondered whether Aatma should miss this opportunity or dilute the Ayurveda that they practiced to suit the new and fast growing segment.

Kerala- God’s Own Country Kerala is located on the south-western tip of India and enjoys unique geographical features. At the national level Kerala Tourism won the Government of India’s award for the Best Performing State for a record eighth time as well as the Best Village Tourism Project and the Best Website Awards. National Geographic Adventure chose the romantic houseboat of Kerala as “one of the most perfect places in the world to propose to your loved one”. Travel and Leisure of the UK classified it as one of the hundred great trips of the 21st century. International awards that came Kerala’s way include the prestigious Pacific Asia Travel association (PATA) Grand Award for Environment and the PATA Gold Award for

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Ecotourism and Publication. It also won the Galileo Award for the Best Tourism Board. Kerala is the only destination superbrand in Asia. The National Geographic Traveler magazine published by the National Geographic Society, the largest nonprofit scientific and educational institution in the world, lists Kerala among the 50 must see locations in the world. The Kerala Tourism Development Corporation (KTDC) spent 10 to 15 crore rupees every year for advertising and was actively promoting Ayurveda as a part of its ABC (Ayurveda, Backwater, Cuisine) based strategy to attract more tourists. The tagline of KTDC’s marketing campaign is- “God’s Own Country”.

Ayurvedic Health Care – Kerala System Ayurveda is an ancient healing system from India that dates back some 5,000 years or more. In this system, the physician diagnosed the constitution of the person and then the disease. Due to variation in body constitution, the medicines and treatment may be different for two people with the same illness. Healthcare through ayurveda (see Exhibit 1) was deep rooted in the culture and life of the people of Kerala. The Kerala System of Ayurvedic treatment developed along its own lines through the patronage of ruling princes and the selfless devotion of the Ashta Vaidyans (see Exhibit 2). It has developed into a full-fledged system of treatment with unique characteristics.

Ayurvedic Health Care in Kerala – Scenario in 2007 Ayurvedic health care is provided by a wide variety of hospitals, nursing homes and doctors and these can be categorized into four categories of firms which differed in their approach, target audience, focus and social image (see Exhibit 3). This sector has seen consistent growth in the last ten years due to a boom in the number of tourists visiting Kerala. More than eighty per cent of the players are in the private sector.

The first category consists of traditional players. They strictly followed ancient ayurvedic texts and focus only on patients. They insist on following a complete and strict regimen including diet and enjoy an excellent social image. Aatma belongs to this category. Government hospitals form the second category. They also follow the style of traditional playes. They have doctors who learned ayurveda from medical colleges and have bachelor’s or master’s degrees in Ayurveda. They also enjoy a good social image. Around 1997 when the tourism boom started in Kerala, many new ayurvedic centers (henceforth NACs) started operation. They are the third category of players. Most of them are without a traditional background in ayurveda and lack proper infrastructure facilities. They focus mainly on healthy tourists and use mainly body massage. They are lax on regimens like duration of care, diet, rest or proper daily routine. The fourth category is the ayurvedic resorts or spas. They are mainly attached to hotels and focus only on healthy tourists.

Consumer Behaviour Dr. Deepa S.(2001), Institute of Economic Growth- New Delhi, studied the role of allopathic and alternative health systems in health care. Studying patterns in Kerala, she noted that in acute cases of aches and pains, 86 per cent of people opted for allopathic treatment. These numbers were reversed when patients were subject to chronic aches and pain – 44 per cent stuck to allopathic care while 54 per cent opted for ayurvedic treatment. Dermatological treatment registered the same trends. A whopping 81 per cent opted for allopathic treatment in acute dermatological distress. But in chronic cases, the numbers opting for ayurvedic care rose to 43 per cent. For chronic handicap, 64 per cent opted for ayurvedic care, while only 28 per cent went in for allopathic treatment. For problems related to the reproductive system, 57 per cent opted for ayurvedic treatment. The study found that while allopathy was more popular, most people favoured ayurvedic care for chronic problems. Thus we can conclude that allopathic and alternative systems of medicines are demanded and used according to the type and nature of the disease. The findings showed that people are not choosing the ayurvedic or homeopathic systems as alternatives to modern medicines or as the last resort; rather, they have specific purpose for choosing them as patients distinguish certain systems of medicines as better suited for the treatment of specific diseases.

Increasing Competition – Thrissur District is a Hot Bed For over a century, Thrissur has had a tradition in drug manufacturing and treatment. From the Ashtavaidya tradition, Thaikkattu Mooss Vaidyaratnam Oushadhasala, SNA Oushadhasala, Vaidyamadhaom Vaidyasala etc. are located in Thrissur. Oushadhi, Kerala Government's ayurvedic drug manufacturing company is also located here. All these firms have been instrumental in spreading the fame of Kerala Ayurveda, especially because of the treatment of thousands of overseas patients who visit the Ayurvedic treatment facilities in and around Thrissur every year. Out of the 850 odd ayurvedic drug-manufacturing units in Kerala, about 150 units, including some of the major ayurvedic

86 ©Summer Internship Society Online access @ www.publishingindia.com Management Prudence Journal drug manufacturers in the state are located in and around the Thrissur district. There are five government funded and eight private ayurvedic medical colleges in Kerala. With 7,000 private and 500 government clinics and hospitals as well as 59 Ayruvedic Spa Resorts, the competition for patients and healthy tourists is increasing. With Kerala having reached a saturation point, many ayurvedic practitioners are moving into other tourist-frequented states of India. Many have set up clinics in Goa. In India, Kerala is next only to Karnataka in the number of ayurvedic hospitals (see Exhibit 4). As per Mooss, the new 20 bedded hospital of AAPL which is getting ready at Anandapuram in Thrissur district, could be used only to treat patients, or could be a centre for both patients and healthy tourists.

The Social Cost - Growing Unethical Practices. Most of the NACs without traditional background offer a one- size- fits all approach which is against Ayurvedic principles, which recommended customized treatment for every patient since every patient is different in psycho-physiological constitution. Succumbing to the time pressure of tourists who visit ayurvedic centres, offering quick and incomplete procedures which were not as per original medical texts can cause side effects and is thus considered unethical. This could create a bad name for Ayurveda and indirectly affect the Ayurvedic medical tourism for which Kerala is world famous. Dilution of Ayurveda to meet consumer’s (tourist’s) special demands is unethical and dangerous for the reputation of the State and Ayurveda according to Mooss. He worries about this trend and the possibility of Ayurveda receiving a bad name and India losing medical tourists to Sri Lanka and other neighbouring countries.

Even the Government of Kerala is concerned and this is reflected by the statement “Ayurveda should not be propagated as a mere body massage system in the name of promoting tourism”. This view shared by one of the ministers of Kerala highlighted the concern which the policy makers have when looking at the rapidly mushrooming NACs with poor expertise, infrastructure and commitment to patient care. Mooss narrated a few of the unethical practices adopted by the NACs started mostly to take advantage of the tourism generated boom in the last ten years. Over charging, over promising, not appointing trained and qualified ayurvedic physicians, masseurs, nursing and other paramedical staffs. Releasing advertisements which were false, misleading, indecent and some of which were unfair to competition. Offering body massage by staff of opposite gender, reuse of medicated oils, use of low quality medicines, mentioning a long list of consultants as panel doctors many of whom don’t even visit the centre etc. are very common.

Recommending procedures which were not suited to the individual, recommending costly procedures when less costly procedures could achieve the same objective and not revealing the names of medicines or brands of medicines used. False claims of number of customers who visited and who availed of services in the past. Paying commission to tour operators to include the visit to their ayurvedic centre and making it a compulsory part of the tour and making tourist pay in advance without giving full details of the procedure and the ways in which the procedure would benefit them.

Thus, as per Mooss, with Ayurvedic centres promising everything from a cure for chronic diseases to prevention with one or two procedures in one session (a quick fix), the dissatisfaction among customers has increased and is adversely affecting the reputation of Kerala as a destination for authentic Ayurveda. The statement by Mooss- “Ayurveda has a message, not just a massage.” expresses the holistic nature of Ayurveda which is practiced in a myopic and irrational way by the NACs across the state. This view by Mooss was supported by a study done by Jyotis et al. (2008) among medical tourists visiting NACs in Kerala. They found that all the five service quality dimensions were negative which clearly proved the dissatisfaction with NACs among medical tourists.

AATMA-The Center for Traditional Kerala Ayurvedic Treatments AATMA stood for Approach of Ashtavaidyan Thaikkattu Mooss to Ayurveda. In October 1999, Mooss started a clinic at his home in Anandapuram (a place in Thrissur district of Kerala) and converted it into a nursing home (February 2004) at new premises in Thrissur district. As the cultural capital of Kerala and also the seat of Mooss family and tradition, Thrissur stands out as the hub for experiencing true Kerala culture and tradition. International medical tourists constitute 35% to 40% of patients treated at Aatma. In 2006 the firm achieved US $ 36,000 turnover and expects to increase it fivefold by 2010.To achieve the above objective, a new 20 bedded ayurvedic centre is under construction at Anandapuram.

The Holistic Ayurvedic Treatment by AATMA

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By 2007 Aatma had emerged as a centre for holistic and authentic ayurvedic treatment, located in a non polluted place. Food played a key role in the treatment regimen. The patients were provided only satvik (vegetarian) food which was customized as per each patient’s needs and medicines (made by Vaidyaraj Oushadashala, Anandapuram - produced under the direct supervision of Aatma’s physicians) during their stay. Aatma provides a family atmosphere with good care and compassion which helps patients recover quickly .All the staff members take good care and perform all functions relating to patient care. All ten staff members are well trained in multiple ayurvedic procedures so that no procedure is postponed due to lack of staff. Male patients are provided massage only by masseurs and females by masseuse. A common kitchen is maintained to prepare food for all. Aatma can cater up to four inpatients at a time. Mooss adopted a family approach to manage Aatma. He feels that all the four vital components- physician, obedient patient, medicines and obedient and clever nursing staff – all have equal importance and should work in synergy in a serene atmosphere to ensure proper service delivery.

Full inpatient treatment for any disease takes a minimum of 28 days. Till date 150 patients have been treated as inpatients. Aatma has four private rooms for in-patients and two common rooms with TV which can be used by patients to walk and relax. Two newspapers and magazines like Aarogyam, Reader’s Digest, Men’s Health, Filmstar, and Femina are provided. The mission of Aatma is to give Ashtangavaidya tradition based ayurvedic treatment and cure in a family atmosphere. Aatma offeres a total package of care which includes stay, food, medicines and nursing. Education to general public was provided on Ashtangavaidya which Mooss felt was the social responsibility of Aatma apart from educating staff and patients.

Quality, cleanliness, availability of full time consultants and nursing staff, personal care, discipline, following scientific regimen as per astangavaidyam and a family approach to patient care are the values of Aatma. It is strategically located in a pollution free area which hastens the healing and recovery process of in house patients. Mooss contributes towards protecting authentic ayurveda and demonstrates social commitment through the exemplary functioning of Aatma. To address the social concern of depleting herbal resources, a herbal garden is maintained by Aatma which cultivates, protects and preserves rare and important medicinal herbs.

Mooss knows very well that if Aatma is running smoothly, it is due to the cooperation from his colleagues, staff, patients and the local community. Taking decisions by respecting all the above stakeholders is a challenge which he is handling as a socially aware and responsible manager. The shared vision of Aatma is to be the best centre in Thrissur district for holistic healing by offering authentic ayurveda and serving the community with a strong social orientation and a human touch. Mooss tries to make his treatment at Aatma a good experience for each patient by spending maximum time with patients. His special focus on Adhraviya chikatsya (treatment with minimum use of medicines) and his ability to attract foreign patients helped Aatma stand out among other such ayurvedic centres. Of all patients, Mooss focused more on genuine, severe and chronic cases which could be cured through panjakarma (see Exhibit 5).

Among patients who visited Aatma, 80% came after receiving positive word of mouth and the balance after visiting the website. The website of Aatma is ‘www.mooss.com’ and provide information about Ayurveda, Astavaidya and the Mooss family. Free consulting, both online and off line, is also done to educate as well as to attract patients towards Aatma. Before admitting any patient, Mooss explains all the aspects of the disease, the treatment regimen, the daily routine to be followed and the expected treatment cost. If a disease cannot be cured, the same is explained clearly to the patient at the beginning so that the patient can decide whether to undergo treatment at Aatma (ayurvedic) or search for other systems of medicine (like allopathy, homoeopathy etc.). Aatma has a uniform pricing for Indian and foreign patients. The service mix had been designed keeping middle class patients and their affordability as a benchmark. 9 The staff members are instructed not to accept any gifts or money from any patients or their relatives

Strong Credentials of AATMA The Mooss family, to which Ashtavaidyan E.T.Ravi Mooss belongs, has played a very crucial role in preserving and promoting this holistic science. Mooss, the MD and the chief physician of Aatma, born into the Eledath Thaikkattu Mooss family (see Exhibit 6), well known in Kerala for Ashtavaidyam wanted to continue the family tradition. Apart from the knowledge he has gained from his father Vaidyaraj Ashtavaidyan E.T Divakaran Mooss, he took his degree in Ayurveda from the Tamilnadu Dr.MGR Medical University. Being a fourth generation member of this reputed family, he

88 ©Summer Internship Society Online access @ www.publishingindia.com Management Prudence Journal wanted to continue the family tradition of providing holistic ayurvedic care to patients. Two of his predecessors had received national honors for their meritorious services to suffering patients across the nation. Ashtavaidyan E. T. Narayanan Mooss was conferred the prestigious title “Vaidya Ratnam” (gem among physicians) in the year 1924 by the then Viceroy of British India, Lord Reading. Another famous physician of the Mooss family was E.T. Neelakandhan Mooss who was honoured with the Padma Shri by the Government of India, in 1992. Ashtavaidyan E.T Divakaran Mooss apart from being the Chairman of Aatma, is also the Chief physician and the Managing Partner of Vaidyaraj Oushadhasala, Anandapuram. Vaidyaraj Oushadhasala is a reputed ayurvedic medicine manufacturing and marketing firm. Vaidyaraj products are exported to Europe, the Middle East and to Far Eastern countries. Aatma procures all medicines for their in-house patient care from Vaidyaraj. Ashtavaidyan E.T Divakaran Mooss is also the Chief Physician of Maharishi Vedic University, The Netherlands. This University has branches in many countries. Ashtavaidyan E.T Divakaran Mooss is available for consultation at Aatma for a few days each year but guides his son Mooss in handling chronic and rare medical cases throughout the year. Some of his foreign patients are also sent to Aatma for special procedures which can be best administered only in a tropical climate such as the one in Kerala.

Emergence of a New and Dominant Segment - The Healthy Tourists An editorial published in 1998 in The Journal of the American Medical Association (JAMA) was the first to note the increasing popularity of alternative medicine. It reported a 47 per cent increase in US- based patients turning to alternate health practitioners. JAMA attributed this growing shift to grave public concern about escalating costs of conventional medicine and its adverse effects. Some 50 million Americans who are not covered by insurance in their country have made Asian countries their destination for healthcare. India has been a major beneficiary of this emerging trend.

In 2006 around 6.6 million tourists visited Kerala. Foreign tourists registered a 23.68% increase over last year and touched a whopping 4, 23,534. Domestic tourist arrivals too recorded a huge jump, 5.47% increase from the previous year (62, 71,724). Kerala is benchmarked as India’s yardstick for success in tourism. Almost five lakh tourists come to Kerala annually for Ayurvedic treatments. During the first quarter of 2007, as per Ministry of Tourism (Government of India), 1.42 million foreign tourists visited India recording a 14.4% growth. According to the World Travel and Tourism Council, Indian tourism is expected to grow annually at 8.8% till 2015.The Ministry of Tourism (Government of India) expects foreign exchange earnings from tourism to cross US $ 12 billion by the end of year 2012. The tourism boom generated revenues worth US $ 120.42 crore which was a more than 14.26% growth from 2005. Foreign exchange earnings grew by 28.09% over 2005 touching US $ 48.95 crore.

The Dilemma of Mooss - Preservation versus Dilution. Mooss was reading the 21st May, 2007 edition of the Outlook magazine. It contained a spotlight feature on Kerala Government’s achievements in 2006. Among the achievements, the tourism department’s achievements were specially highlighted. The Outlook magazine article reminded Mooss of the urgent decision he had to take regarding the admission of healthy tourists who sought quick procedures since they have limited time and the ethical dimension of offering such procedures by deviating from the regimen prescribed in authentic ayurvedic texts. Mooss was facing a dilemma. Aatma would not be able to survive and grow in a cluttered and fiercely competitive environment if it did not attract entertainment, fun and pleasure seeking healthy individuals who visit ayurvedic centres as domestic or foreign tourists. As the new 20 bedded hospital of Aatma is reaching its finishing stages, attracting enough patients throughout the year to match the capacity is a challenge. Being a member of famous the Mooss family and also one of the few who practice the traditional and original system of Ashtangavaidya, father being a Vaidyaraj and Aatma being located in Thrissur district, deviating from the ethical path to grow was like working against his own family, culture and values. One of the missions of Aatma is the propagation of the benefits of authentic ayurveda and healthy tourists being a good target group for the same, how to target them and make them experience authentic ayurveda without affecting the current positioning of Aatma is the challenging problem in front of Mooss.

EXHIBIT 1 – THE AYURVEDA SYSTEM OF MEDICINE

Ayurvedic medicine is an ancient system of health care that is native to the Indian subcontinent. The word "Ayurveda" is a tatpurusha compound of the word āyus meaning "life" or "life principle", and the word veda, which refers to a system of "knowledge". Thus "Ayurveda" roughly translates as the "knowledge of life". According to Charaka, "life" itself is defined as the "combination of the body,

89 ©Summer Internship Society Online access @ www.publishingindia.com Management Prudence Journal sense organs, mind and soul, the factor responsible for preventing decay and death, which sustains the body over time, and guides the processes of rebirth". According to this perspective, Ayurveda is concerned with measures to protect "ayus", which includes healthy living along with therapeutic measures that relate to physical, mental, social and spiritual harmony. Ayurveda is also one among the few traditional systems of medicine to contain a sophisticated system of surgery (which is referred to as "salya-chikitsa"). Sushrut Samhita together with Charaka Samhitā, served as the textual material within the ancient Universities of Takshashila and Nalanda. These texts are believed to have been written around the beginning of the Common Era, and is based on a holistic approach rooted in the philosophy of the Vedas and Vedic culture.

Gurukul System of Ayurveda In the earlier days of its conception, the system of Ayurvedic medicine was orally transferred via the Gurukul system until a written script came into existence.In this system, the Guru gave a solemn address where he directed the students to a life of chastity, honesty, and vegetarianism. The student was to strive with all his being to heal the sick. He was not to betray patients for his own advantage. He was required to dress modestly and avoid alcohol or drugs. He was to be collected and self-controlled, measured in speech at all times. He was to constantly improve his knowledge and technical skill. At the patient's home, he was to be courteous and modest, directing all attention to the patient's welfare. He was not to divulge any knowledge about the patient and his family. If the patient was incurable, he was to keep this to himself if it was likely to harm the patient or others.

The normal length of the student's training appears to have been seven years. Before graduation, the student was to pass a test. But the physician was to continue to learn through texts, direct observation (pratyaksha), and through inference (anumāna). In addition, the vaidyas attended meetings where knowledge was exchanged. The practitioners also gained knowledge of unusual remedies from laypeople who were outside the Ayurvedic community such as hillsmen, herdsmen, and forest- dwellers.

Source: Adapted from- www.mooss.com (Accessed May 2007) and inputs from Mooss and Dr. Arya R. Mooss

EXHIBIT 2 – ASHTAVAIDYA Ashtavaidyas are so known by virtue of their proficiency in all eight branches of Ayurveda.

Eight Branches of Ayurveda • Internal medicine - Kayachikitsa Tantra • Surgery - Shalya Tantra • Ears, eyes, nose and throat - Shalakya Tantra • Pediatrics - Kaumarabhritya Tantra • Toxicology - Agada Tantra • Purification of the genetic organs - Bajikarana Tantra • Health and Longevity - Rasayana Tantra • Spiritual Healing - Bhuta Vidya

Ashta Vaidya of Kerala In Kerala, the family of "Ashta Vaidya" is famous and traditionally provide Ayurvedic and Siddha treatment to the sick. The forefathers of these Asta vaidyas are still today serving in the same manner as centuries ago. This family worships Lord Dhanvantari. Some family members have built temples inside their houses while others have built proper temples in his honour. Near Kotakkalat Pulamantol village, here is a family of Ashta Vaidya. This family has a temple of Lord Dhanvantari. Vaidya Madam is near Vadakkancheri. Here the Ashta Vaidya Matra dattan have a statue of Dhanvantri, made of a mixture of five metals. In Trishura's Perungva, a big temple is here built by Ashta vaidya. The Ashta Vaidya families are in the following places. 1) Aalyittur 2) Kuttancheri 3) Taikkad 4) Vayaskara 5) Vellod 6) Chirattaman. It seems that tradition of Lord Dhanwantri worshipping is still present in all the above families. Source: Adapted from - www.mooss.com (Accessed May 2007) and inputs from Mooss and Dr. Arya R. Mooss

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EXHIBIT 3 : AYURVEDIC HEALTH CARE OF KERALA - MAJOR CATEGORIES

Category and Players Focus Insist on Side effects No. of Social image treatment days (A) Traditional-Strictly Treatment, Cure, Diet control, Nil Minimum Excellent follow ancient ayurvedic Palliative ( Medicines, of 7-28 texts. Only Patients ) Ayurvedic days Eg. Kottakkal, Thaikkad procedures, Mooss, Aatma etc. Rest, Strict daily routine (B) Government Treatment, Cure Diet control, Nil Minimum Good ayurvedic hospitals, Old Palliative Medicines, of 7-28 and well established ( Only Patients ) Ayurvedic days ayurvedic hospitals and procedures, Nursing homes Rest, Strict daily routine

(C) NACs ( New Rejuvenation Mainly body Sometimes Few hours Doubtful of ayurvedic centers- since experience ( massage ( Due to deviation to few days quality 1997 ) most of them Mainly Tourists ) based from original ( Local people without traditional regimen ) avoid visiting background and proper such centers ) facilities

(D) Ayurvedic Resorts / Fun, Pleasure, Mainly body No major side Few hours Poor ( Since Spas Relaxation, massage effects since impact to few days there is no ( Mainly attached to Entertainment based on body is transient permanent Hotels ) ( 100% Tourists ) health benefit)

Source: Prepared by authors based on inputs from Mooss and Dr. Arya R. Mooss

EXHIBIT 4 - STATEWISE AYURVEDA HOSPITALS AND BED STRENGTH OF INDIA (AS ON 1/5/07)

No of S.No States/Uts/Others Hospitals Bed Strength 1 Andhra Pradesh 8 464 2 Arunachal Pradesh 1 10 3 Assam 1 100 4 Bihar 11 1090 5 Chhatisgarh 8 420 6 Delhi 10 643 7 Goa 1 40 8 Gujarat 48 1850 9 Haryana 8 835 10 Him. Pradesh 24 420 11 Jammu & Kashmir 2 100 12 Jharkhand 1 160 13 Karnataka 122 8147 14 Kerala 120 3432 15 Madhya Pradesh 32 1345 16 Maharashtra 51 7673 21 Orissa 8 488 22 Punjab 15 1181 23 Rajasthan 84 834 24 Sikkim 1 10 25 Tamil Nadu 7 630 26 Tripura 1 10 27 Uttar Pradesh 151 3727 28 Uttranchal 7 319 29 West Bengal 5 509 31 Chandigarh 1 120 36 C.G.H.S. 1 25 37 Research Councils 24 600 TOTAL 753 35182 Source: http://indianmedicine.nic.in/html/ayurveda/asma in. htm [Accessed May 2007]

EXHIBIT 5 – PANCHAKARMA Panchakarma is Ayurveda's primary purification and detoxification treatment. Panchakarma means the "five therapies". It is a comprehensive system of knowledge and practices to purify the body of toxins and restore it to balance with natural law. These five therapeutic means of eliminating toxins from the body are Vamana, Virechana, Nasya, Basti and Raktamoskshana. This series of five therapies help remove deep-rooted stress and illness causing toxins from the body while balancing the doshas (energies that govern all biological functions). Panchakarma is ineffective if special detoxification diet is not given along with the treatments. Panchakarma plays a vital role in Ayurvedic medicine, both in health as well as in disease. Although panchakarma is often thought of as the entire procedure, it really is only one part of a group of therapies belonging to a class of cleansing procedures called shodan. There is also a group of milder techniques called shaman for those not strong enough for shodan. In today's world when more and more people are falling prey to the adverse effects of stress and anxiety, which is leading to diseases like improper digestion, lack of sleep, allergies, chronic fatigue, cancer, heart diseases, diabetes, osteoporosis etc. The importance of pancha karma in ayurveda is borne out by the fact that it is applicable to all cases covering a wide range of preventive, curative, and promotive conditions. These diseases are caused mainly due to deeply seated toxins. With the process of Panchakarma it eliminates these toxins from the body, allowing healing permanently of tissues, channels, digestion and mental functions. In Ayurveda, the treatment is broadly divided into two categories: Shodhana and Shamana. Curing the disease by cleaning out the impurities is called Shodhana chikitsa, which is the principle of

Panchakarma. It involves the clearing of vitiated doshas (vata, pitta and kapha) which cause the disease and thereby the restoration of equilibrium of doshas. Panchakarma includes the following five purification therapies: • Vamana (emesis), • Virechana (purgation), • Basti (enema), • Nasya (nasal insufflation) and • Raktamokshan (blood-letting).

Source: Adapted from - http://ayurveda.iloveindia.com/panchakarma/index.html and www.mooss.com [Accessed May 2007] and inputs from Mooss and Dr. Arya R. Mooss

ANNEXURE-1 ( To be given only after the case discussion by groups )

American Marketing Association-Code of Ethics ETHICAL NORMS AND VALUES FOR MARKETERS

Preamble The American Marketing Association commits itself to promoting the highest standard of professional ethical norms and values for its members. Norms are established standards of conduct that are expected and maintained by society and/or professional organizations. Values represent the collective conception of what people find desirable, important and morally proper. Values serve as the criteria for evaluating the actions of others. Marketing practitioners must recognize that they not only serve their enterprises but also act as stewards of society in creating, facilitating and executing the efficient and effective transactions that are part of the greater economy. In this role, marketers should embrace the highest ethical norms of practicing professionals and the ethical values implied by their responsibility toward stakeholders (e.g., customers, employees, investors, channel members, regulators and the host community). General Norms 1. Marketers must do no harm- This means doing work for which they are appropriately trained or experienced so that they can actively add value to their organizations and customers. It also means adhering to all applicable laws and regulations and embodying high ethical standards in the choices they make. 2. Marketers must foster trust in the marketing system- This means that products are appropriate for their intended and promoted uses. It requires that marketing communications about goods and services are not intentionally deceptive or misleading. It suggests building relationships that provide for the equitable adjustment and/or redress of customer grievances. It implies striving for good faith and fair dealing so as to contribute toward the efficacy of the exchange process. 3. Marketers must embrace, communicate and practice the fundamental ethical values that will improve consumer confidence in the integrity of the marketing exchange system. These basic values are intentionally aspirational and include honesty, responsibility, fairness, respect, openness and citizenship. Ethical Values 1. Honesty—to be truthful and forthright in our dealings with customers and stakeholders. We will tell the truth in all situations and at all times. We will offer products of value that do what we claim in our communications. We will stand behind our products if they fail to deliver their claimed benefits. We will honor our explicit and implicit commitments and promises. 2. Responsibility—to accept the consequences of our marketing decisions and strategies. We will make strenuous efforts to serve the needs of our customers. We will avoid using coercion with all stakeholders. We will acknowledge the social obligations to stakeholders that come with increased marketing and economic power. We will recognize our special commitments to economically vulnerable segments of the market such as children, the elderly and others who may be substantially disadvantaged. 3. Fairness—to try to balance justly the needs of the buyer with the interests of the seller. We will represent our products in a clear way in selling, advertising and other forms of communication; this includes the avoidance of false, misleading and deceptive promotion. We will reject manipulations and sales tactics that harm customer trust. We will not engage in price fixing, predatory pricing, price gouging or “bait-and-switch” tactics. We will not knowingly participate in material conflicts of interest.

4. Respect—to acknowledge the basic human dignity of all stakeholders. We will value individual differences even as we avoid stereotyping customers or depicting demographic groups (e.g., gender, race, sexual orientation) in a negative or dehumanizing way in our promotions. We will listen to the needs of our customers and make all reasonable efforts to monitor and improve their satisfaction on an ongoing basis. We will make a special effort to understand suppliers, intermediaries and distributors from other cultures. We will appropriately acknowledge the contributions of others, such as consultants, employees and coworkers, to our marketing endeavors. 5. Openness—to create transparency in our marketing operations. We will strive to communicate clearly with all our constituencies. We will accept constructive criticism from our customers and other stakeholders. We will explain significant product or service risks, component substitutions or other foreseeable eventualities that could affect customers or their perception of the purchase decision. We will fully disclose list prices and terms of financing as well as available price deals and adjustments. 6. Citizenship—to fulfill the economic, legal, philanthropic and societal responsibilities that serve stakeholders in a strategic manner. We will strive to protect the natural environment in the execution of marketing campaigns. We will give back to the community through volunteerism and charitable donations. We will work to contribute to the overall betterment of marketing and its reputation. We will encourage supply chain members to ensure that trade is fair for all participants, including producers in developing countries.

Source: The website of American Marketing Association- http://www.marketingpower.com/content21013.php - [Accessed 10th June 2007]

Ashtavaidyan E.T Narayanan Mooss

Ashtavaidyan Ashtavaidyan E.T Neelakandhan Mooss E.T.Ravi Mooss

Born Before 1900 Ashtavaidyan “Vaidya Ratnam” ( Title from Ashtavaidyan AD Viceroy of British India-1924 ) E.T Narayanan Mooss E.T.Divakaran Mooss 1875-1942 1875-1942

Ashtavaidyan Padma Shri (1992) Ashtavaidyan Ashtavaidyan E.T.Neelakandhan Mooss E.T.Ravi Mooss E.T.Divakaran Aryan 1904-1997 1918-1958 Mooss (1922-1983)

Ashtavaidyan E.T Narayanan Mooss Ashtavaidyan Ashtavaidyan (Vaidyaraj)E.T.Divakaran E.T Narayanan Mooss Mooss (Chairman of AAPL) AshtavaidyanE.T AshtavaidyanE.T Neelakandhan Mooss Parameswaran Mooss Ashtavaidyan E.T.Ravi Mooss, BAMS ( MD of AAPL )

EXHIBIT 6 - FAMILY TREE OF THAIKATU MOOSS FAMILY (Only male members are shown since only they are imparted the skill as per the Mooss family tradition) Source: Adapted from - www.mooss.com (Accessed May 2007 ) and inputs from Mooss and Dr. Arya R. Mooss