May 2004

The Journal of Indian American Physicians

AAPI DAY

• Crossing the Borders • How HIPAA Electronic Data Interchange • A Few Major Health Care Issues Can Help Physicians • AAPI Leadership visits Johnson & • AAPI Spring Governing Body Meeting Johnson: “Exploring New Opportunities” • Our Legislative Day at the Capitol • Is it time to change our CME format? • Special Series: • When We Need a Godfather • Complementary and Alternative Medicine ASSOC CAN IAT RI IO E N M O A F

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N Y I S G IC I I R AN O S OF INDIAN

AAPI (American Association ➢ President’s Report of Physicians of Indian Origin) AAPI Day By: Sharad Lakhanpal, M.D...... 5 ➢ New Patron Members List ...... 6 President: Sharad Lakhanpal, M.D. ➢ From the Editor’s Desk Crossing the Borders By: M. P. Ravindra Nathan, M.D...... 7 17W300 22nd Street ➢ Suite 300A Convention Chair’s Report By: Ajeet R. Singhvi, M.D...... 8 Oakbrook Terrace, IL 60181-4490 ➢ Vice President's Report Phone: 630-530-2277 A Few Major Health Care Issues By: Akshay M. Desai, M.D...... 9 Fax: 630-530-2475 ➢ Secretary's Report AAPI Spring Governing Body Meeting By: Sampat S. Shivangi, M.D...... 16

FEATURES

AAPI Journal Editor ➢ AAPI Leadership visits Johnson & Johnson By: Hemant Patel, M.D. “Exploring New Opportunities” & Jayesh Kanuga, M.D...... 10 M. P. Ravindra Nathan MD, FACC ➢ Is It Time to Change our CME Format? By: Sudhir Ken Mehta, M.D...... 11 Hernando Heart Clinic ➢ 14555 Cortez Blvd. When We Need a Godfather By: S. Jay Jayasankar, M.D...... 12 Brooksville, FL 34613 ➢ How HIPAA Electronic Data Phone (352) 796-6000 Interchange Can Help Physicians By: A. Hassan Mohaideen, M.D...... 15 Fax (352) 796-8157 ➢ Saving Medical Practice By: Vijay Koli, M.D...... 21 [email protected] AAPI AT THE CAPITOL

➢ Honoring AAPI ...... 23 ➢ Our Legislative Day at the Capitol By: Rakesh Shreedhar, M.D. & Anurag Varma, J.D...... 24 The AAPI Journal is published quarterly by the American Association of Physicians of Indian Origin (AAPI). This publi- Special Series cation may not be reproduced in whole or in part without the COMPLEMENTARY AND ALTERNATIVE MEDICINE express written permission of the AAPI. ➢ Introduction By: Hari Sharma, M.D...... 26 All articles published including editorials, letters and ➢ book reviews represent the opinions of the authors and do The Need to Support Ayurveda By: Dr. David Frawley ...... 26 not reflect the official policy of AAPI. ➢ Ayurvedic Skin Care By: Suhas Kshirsagar, M.D...... 28 ➢ Ayurvedic Concept of AMA (Toxin Accumulation) By: Hari Sharma, M.D...... 29 Copyright © 2003 AAPI. All rights reserved. ➢ Marma Therapy and Acupuncture By: Anisha Tambay, Dipl.Ac, M.S.O.M. 31 ➢ Probiotics, Biotechnology, and Ayurvedic Herbs By: M.S. Reddy, Ph.D. & D.R.K. Reddy 32 ➢ Integrated Medicine: Herbs and Drugs By: Ranvir Pahwa, PhD...... 34 ➢ Self-Ecology with Yoga By: Veena S. Gandhi, M.D...... 36 Designed & Printed by: ➢ First AAPI Ayurveda Conference By: Hari Sharma, M.D...... 38 GR GRAPHICS, INC. Tampa, Florida DEPARTMENTS (813) 886-4500 ➢ Book Review CT & MRI Pathology - A Procket Atlas By: Michael L. Grey, M.D. & Jagan Ailinani, M.D...... 39 ➢ The Best of AAPI Humor ABOUT THE COVER Did You Have Your Colonoscopy? By: P. K. Paul, M.D...... 40 Sea Gulls in Flight, Puerto Rico ➢ Members in the News ...... 42

Photo by Sanku Rao MD

AAPI Journal May/June 2004 3 PRESIDENT’S REPORT

AAPI DAY Sharad Lakhanpal, M.D. President, AAPI

fter the busy sojourn to India in The enactment of “AAPI DAY” by the winter, the AAPI has kept a the U.S. Congress will be a significant fairly active schedule back home. achievement for the Indian-American A community in general and the Indian The Annual AAPI CME was held American medical fraternity in partic- in Puerto Rico at the beautiful ular. This will symbolize the acknowl- Intercontinental Hotel and Resort edgement and recognition of the con- from Feb. 13 to 16, 2004. This hap- tributions of the Indian American pened to be over Valentine’s Day and physicians to the healthcare of the the theme, aptly, was ‘Bring Your people of America. I urge each and Valentine to CME’. Dr. Sudhir Mehta, every one of you to please call or write Chair AAPI CME, did a superb job to your congressperson(s) to become a organizing the program as he always sponsor of H.Res.579. does. The CME was of very high cal- iber (please see report on p. 11). The AAPI-DIA project has been successfully completed. I met with The AAPI Spring Governing Body Pfizer officials in New York and the meeting was an astounding success. It AAPI-DIA report has been satisfacto- was held in New Orleans from March 5 rily submitted. The AAPI and Pfizer to 7, 2004. Dr. Surendra Purohit, Past ed to the APPNA Executive Council look forward to a mutually beneficial Chair, AAPI BOT, coordinated the Meeting in New York on March 20. relationship moving into the future. event, which was hosted by the The message from AAPI was received Louisiana Chapter of AAPI under the The AAPI Annual election season enthusiastically by the APPNA mem- is here. The Patron and annual dues leadership of their President, Dr. Tilak bers. We look forward to working Mallik. The entire event, from the wel- paid members of AAPI shall be getting together on issues affecting our mem- ballots in the mail towards the end of come Mardi Gras style party to the bers. Dr. Omar Atiq, President of AAPI Business Meeting, from the April 2004. I encourage all of you to APPNA was very effusive and warm in participate in this very important dem- CME to the Saturday night Gala, was his response. beautifully orchestrated and had the ocratic electoral process. Your choice flair and the style of Southern hospital- The Annual AAPI Legislative Day of responsible leaders will ensure the ity that is classic Dr. Purohit. The AAPI was held on March 30, 2004, in future of AAPI. Every vote is impor- is thankful to the Louisiana Chapter of Washington, D.C. It was extremely tant. Please return your ballot before AAPI for hosting such a lovely func- well received. Dr. Rakesh Shreedhar, the deadline. tion. (Please see report on p. 16). Chair AAPI Legislative Committee, The AAPI Pacific Leadership and Mr. Anurag Varma, AAPI The first AAPI Ayurveda Seminar Retreat will be held in Asilomar, Legislative Director, put in a lot of California, from May 7 to 9, 2004. Dr. was held in Orlando, Fl, from March effort to ensure its success. The Senate 19 to 21, 2004. This was very ably Subroto Kundu, Pacific Regional Majority Leader Senator Bill Frist (R- Director of AAPI, is working tirelessly organized by Dr. Hari Sharma, Chair TN) addressed health care issues. AAPI Integrated Medicine to put together an exciting program. Senator John Corvyn (R-TX) Please plan to attend. Committee, with an outstanding facul- announced the formation of Friends of ty of speakers. (Please see report on p. India Caucus in the U.S. Senate. The 22nd Annual AAPI 38). Congressman Frank Pallone (D-NJ) Convention will be held at the Dr. Hussain Malik, President- and 26 other congresspersons in a Manchester Grand Hyatt Hotel in San elect of APPNA, came to the AAPI bipartisan move introduced H.Res.579 Diego, CA, from June 23 to 27, 2004. Governing Body Meeting in New in the U.S. Congress to honor AAPI We hope to see you all there. It will be Orleans. His message of friendship and have requested declaration of an a memorable event! and AAPI and APPNA working “AAPI DAY.” (Please see report on p. together was well received. I was invit- 24). ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 5 NEW PATRON (LIFE) MEMBERS

Manju Agarwal Amal Guha Urmila Mistry Swarajya Perni Boca Raton, FL Apple Valley, CA Tequesta, FL Hubbard, OH Aparna Sharma Shanti, Agarwal Lakshmi, Gullapalli Arvind Modawal Veeraiah Perni Victorville, CA Boca Raton, FL Fort Wayne, IN Cincinnati, OH Hubbard, OH Archana Sheth Sreenivas Amara Rakesh Gupta Swapna Mukherjea Lovsho Phen Riverside, CA Edison, NJ Centerville, OH Tampa, FL Boardman, OH Kalyanam Shivkumar Lalitha Ananth Rajini Iyer Manjula Muniyappa Kiran Prabhu Los Angeles, CA Fountain Valley, CA Anaheim, CA San Diego, CA Oklahoma City, OK Digvijay Singh Madhu Arora Lucky Jain Ashok Naik Santosh Prabhu Canfield, OH Jackson, MI Atlanta, GA Batavia, NY Oklahoma City, OK Parduman Singh Rajendra Bansal Shabnam Jain Jagat Narula Vijaya Prabhu Boardman, OH Jupiter, FL Atlanta, GA Penn Valley, PA San Diego, CA Archana Sood Ramji Baraiya Vijaya Jujjavarapu Mina Narula Geetha Puri Apple Valley, CA San Jacinto, CA Dunlap, IL Rancho Mirage, CA Victorville, CA Om Sood Bipinchandra Bhagat Nirmala Kamnani Mohender Narula Rajiv Puri Apple Valley, CA Victorville, CA Pampa, TX Rancho Mirage, CA Victorville, CA Preethi Srikanthan Ashvinchandra, Bhutwala Rajan Karnani Navneet Narula Manikanda Raja Los Angeles, CA Hesperia, CA Apple Valley, CA Penn Valley, PA Hemet, CA Chivukula Subbarao Nanda Biswas Ajai Khanna Narinder Nat Savita Rajgiri Wichita, KS Apple Valley, CA San Diego, CA Canyon Country, CA Suwanee, GA Yash Subherwal Savithribai Bonala Poornima Khanna Prasad Neerukonda Vishweshwara Ranga Huntingtn Beach, CA Edison, NJ San Diego, CA Oak Brook, IL Las Vegas, NV M. Sukumar Ushasri Challa Pragna Khanna Sujatha Neerukonda Anil Rastogi Darnestown, MD Wichita, KS Elmsford, NY Oak Brook, IL Hemet, CA Rajiv Taneja Anuj Chandra Suresh Khanna Rekha Padubidri Makala Reddy Youngstown, OH Chattanooga, TN Elmsford, NY Canfield, OH Apple Valley, CA Reema Taneja Vikas Chitnavis Subhash Khaterpaul Lotika Pandit Venkamma Reddy Youngstown, OH Roanoke, VA Warren, OH Chattanooga, TN Victorville, CA Purnima Thakran Natvarlal Dalsania Anil Kudchadkar Sushma Parekh Vodur Reddy Apple Valley, CA Titusville, FL Winnsboro, SC Port Saint Lucie, FL Apple Valley, CA Bhoodev Tiwari Venkat Devineni Shubhalaxmi Kudchadkar Ashok Patel Hemang Shah Hemet, CA Apple Valley, CA Winnsboro, SC Largo, FL Portsmouth, VA Usha Wagh Darshan Dhiman Arun Kumar Jagdish Patel Kruti Shah New York, NY Hemet, CA Freehold, NJ Huntington Beach, CA Youngstown, OH Chakri Yarlagadda Prasuna Doddapaneni Kapil Kwatra Kiritkumar Patel Nandkishor Shah Youngstown, OH Greenlawn, NY Girard, OH Largo, FL Pinellas Park, FL Bhanu Yenamandra Sakuntala, Dutta Gopal Madabhushi Kirti Patel Sonal Shah Apple Valley, CA Oklahoma City, OK Hemet, CA Largo, FL Pinellas Park, FL Suryanarayana Yenamandra Sanyasi Ganta Paresh Mehta Mukeshchandra Patel Akhil Sharma Victorville, CA Hemet, CA Warren, OH Apple Valley, CA Victorville, CA Nancy Gourishankar Brij Mishra Prakash Patel Anupama Sharma Livingston, NJ Fayetteville, NY Framingham, MA Apple Valley, CA

AAPI Annual Convention - San Diego, California Continuing Medical Education Program: June 23-27, 2004 “TRANSLATING RESEARCH ADVANCES TO PATIENT CARE” s the title of the CME Program suggests, the emphasis for this year’s educational experience Awill be to provide the audience an understanding of the research advances and how it applies to patient care in varied disciplines of medicine. The CME Committee is pleased to present an exceptional program this year. We are fortunate that outstanding Indian Physicians who are lead- ers and experts in their respective fields will interpret and translate some of the important research advances. In addition, there will be state of the art lectures where leading edge research will be pre- sented in an enjoyable and understandable format. A special highlight of the educational experience are the “Meet the Nobel Laureates” program organized by Jagat Narula MD and “Meet the Deans” program arranged by Sudhir Gupta MD. This educational offering promises to be a memorable experience for the participant. We look forward to seeing you in San Diego. Jacob Korula MD, Chair Venu Prabaker MD, Co-Chair Telephone 626.447.5339 Telephone 619.698.0606 Email: [email protected] Email: [email protected]

6 AAPI Journal May/June 2004 FROM THE EDITOR’S DESK

Crossing the Borders M. P. Ravindra Nathan, M.D. Editor-In-Chief, AAPI Journal [email protected]

special event occurred on “With open arms, APPNA March 6, 2004, during the extended hospitality to its guest AAPI Governing Body from AAPI. The Executive A Council (EC) had just finished Meeting in New Orleans…we had a Drs. S. Lakhanpal, Hussain Malik visit from the President-Elect of the debating about the proposal to & Ravindra Nathan Association of Pakistani Physicians of have a speaker appointment so Now, on to other things. The North America (APPNA), Dr. that the meetings could be conduct- Editorial Committee and executive Hussain Malik. ed by the speaker. It was at this junc- ture that Dr. Lakhanpal strode into Committee members met for an “We must be the change we wish the meeting. Everything changed hour in New Orleans prior to the to be,” Dr. Malik quoted from after that. The EC was suspended to Governing Body Meeting to discuss Mahatma Gandhi, as he addressed greet the guest. Only once before the various aspects of AAPI Journal the audience. He also outlined his operations. The increase in plans of how the two great the volume of submissions organizations – AAPI and coupled with more frequent APPNA – can collaborate on publications has resulted in many projects beneficial to considerably more work for our motherlands. all. The position of a non- “We have so much in medical editorial assistant common; if we can work with a background in jour- together, we can be a very nalism has been approved. successful role model for I received a letter from other similar organizations,” a freelance journalist/politi- he reminded us. The same Dr. Omar Atiq (APPNA President - in the center) with Dr. Sharad cal activist of Indian back- feelings were echoed by our Lakhanpal and APPNA President-Elect Dr. Hussain Malik (2nd ground expressing an inter- from left)* President Dr. Sharad est to write for our journal. Lakhanpal, at whose invitation this was APPNA EC session suspended She wrote: “I found the AAPI journal summit of minds happened. mid-session when former Pakistani to be very interesting and informa- Around this time, Pakistan and Ambassador to the USA, Mr. Najmuddin tive and have forwarded the address India were bonding through cricket, Shaikh, addressed the gathering.” to my brother (a physician), as well as after a lapse of some 15 years. The Thus a new chapter to improve other medical friends. I am actively fans in the stadium in Karachi during Indo-Pakistani relations was written involved in linking Indian groups this historic cricket match waved into the annals of AAPI. I have often together to develop a stronger voice both Indian and Pakistani flags and wondered that until 1947, we were on policy issues.” A Washington actually didn’t care who won. one nation, so why can’t we continue journalist specializing in health care policy has also shown some interest “Peace breaks out at APPNA,” to be the brothers and sisters that we in writing for the Journal and would was the headline at the website once were? I guess the answer is not periodically update us on the new www.pakistanlink.com to commemo- that simple. However, as passionately Medicare/Medicaid developments. rate the historic visit of AAPI as we believe in our association’s new President Dr. Lakhanpal during the coalition plans, we must be part of It’s nice to know our readership APPNA’s Executive Council Meeting catalyzing these unifying reactions base is flowing into non-medical ranks. on March 20, 2004, in New York. In and changes. So, let us all be those addition, the author Dr. M. Shahid agents of change and learn to foster * Courtesy: Pakistan Link Yousuf wrote: new friendships. ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 7 2004 CONVENTION CHAIR’S REPORT

Friends,

he 22nd Annual Convention hours each day, so you should be able of AAPI is around the corner to find ample time to shop and net- Tand we are ready to welcome work. We encourage you to support all the delegates. Our focus has been our sponsors. Ajeet R. Singhvi, M.D. to get the maximum members and If you have not registered yet Chair, 2004 AAPI Convention non-members who have never been please do so. Our early bird package to an AAPI convention before, to San (until June 7th, 2004) is just $485.00 Diego this time. They will have a per person for all the ticketed events. morning or take a leisurely late night first hand look at AAPI in action, and All the delegates are welcome to stroll, but keep the day for us. make a lot of new friends. attend CME at no charge, and if you We have arranged a good CME, need a certificate it will only cost ◆ ◆ ◆ ◆ ◆ ◆ delicious food, a variety of social pro- $50.00. grams, entertainment, and a host of Our team has put in a lot of work well respected guests for you. to give you an experience which you MSR/F and YPS will have the best of will cherish for a long time. San both worlds. A large number of ven- Diego in June is at its best. The dors from the US and abroad are venue is right on the bay, for you to expected and they will have extended enjoy. Maybe you can jog in the

Letter to the Editor

Substandard Medical Training: in Offshore Medical Schools ?

The medical training in some offshore medical schools is believed to be substandard. Several states have banned graduates from certain offshore schools. The medical training in these schools is being investigated. Each state will then make its decision. It is important to stress to the licensing board and state department that there is a world of difference in the train- ing in the “offshore medical schools.” All medical training outside the USA borders cannot be lumped into one category. My concern is that graduates from schools in India will have an extra layer of scrutiny. This extra resistance is unneces- sary and uncalled for. Our patients are extremely satisfied with the quality of our care. We have been thanked again and again for our com- passion and for our generosity. We have hence done very well in this country. We are now faced with 2 choices; to take the path of least resistance, look the other way and do nothing. The alternative is to be proactive and make the effort; meet with members of the licensing department, to make sure that the road to the US for these young doctors from India is not facing an unnecessary hurdle.

Prasad Srinivasan, MD President, Connecticut Association of Physicians of Indian Origin

CORRECTION: In the January 2004 issue of AAPI Journal, Eid was unintentionally omitted from the list of celebrations in the last sentence of my editorial. M. P. Ravindra Nathan, M.D., Editor

8 AAPI Journal May/June 2004 VICE PRESIDENT’S REPORT

A Few Major Healthcare Issues

am taking this opportunity to share comes of Coronary Artery Bypass Graft with you some of the major health- (CABG) surgery. Hospitals achieving care issues on the horizon. Last pre-defined quality criteria will receive I higher reimbursement. There is a plan month, I was fortunate to be invited to attend the World HealthCare Congress to achieve a similar approach for physi- in Washington, D.C. It was a very high cians. Physicians who comply with Akshay M. Desai, M.D., M.P.H. level conference attended by health- quality criteria such as HEDIS scores, Vice President, AAPI care industry leaders to discuss the preventive services and other well- Chair, Membership Committee established high quality practice future of healthcare. Speakers included 4. Medicare Modernization Act parameters will be reimbursed higher Health Secretary Tommy Thompson, (MMA) and those whose practice would fall Senate Majority Leader Bill Frist, The recently signed MMA will bring below these pre-defined quality meas- Senator Hillary Clinton, Former prescription drug benefits under urements will be paid less. In the pri- Treasure Secretary Paul O’Neil and Medicare for our seniors. This benefit vate sector, several insurance compa- many other powerful decision makers is voluntary, generous to most seniors nies on the east and west coast have from the government, the private sec- and comprehensive for 12 million low- already implemented “pay for perform- tor, hospitals and physician groups, income seniors. It protects existing ance” for their physicians’ network. who shared their respective perspec- employer coverage, speeds sales of tive. I believe this will have a tremen- 3. Information Technology generic drugs and is endorsed by the dous impact on the practice of medi- There will be increased funding from American Medical Association. It also cine in the coming years. the Federal Government to bring gives physicians a 1.5% increase in I would like to take a moment to healthcare record keeping in the 21st Medicare reimbursement for their give you some over-arching issues century and eliminate paper record services instead of a 4.5% reduction. which were discussed for 2 days. keeping by 2010. Senator Hillary It, by no means, addresses all the cov- 1. Consumerism in Healthcare Clinton has introduced a bill to have erage issues, but is a voluntary automated medical records which are enhancement of the Medicare program Americans have demanded high quali- portable, available, accessible, user- and is a first step in the right direction ty medicine with choice and freedom friendly, standardized, consistent and for our seniors. to obtain healthcare. To address this, keep health information confidential. the private sector is going to allow large 5. Disease Management Senate Majority Leader Bill Frist is varieties of individuals and group People with chronic diseases such as supportive of this bill. health plans which could be cus- Diabetes, Asthma, Congestive Heart tomized according to an individual’s It will also provide some federal Failure, Coronary Artery Disease and desire. Employers will give defined funding to achieve this. Cost estimates End-Stage Renal Disease are major contributions towards health insurance for transforming paper records into cost drivers in current healthcare sys- instead of the current approach of electronic format are around $100 bil- tems. Several companies have been defined benefits. The public will lion. It will require commitments from formed to provide education and close receive information and ratings about the federal and state governments, the monitoring of their disease processes. different health plans from a variety of pharmaceutical industry and physi- On top of this, lifestyle modifications to different sources, including the federal cians. In the private sector, Kaiser reduce incidents of obesity, smoking, and state governments, consumer HealthPlan from California had made unsafe sex and exercise will result in reports, J.D. Power and Associates and the commitment to invest $3 billion to better healthcare for all and reduced many other industry standard bearers. achieve that. With electronic informa- cost of healthcare for us, as taxpayers. tion, the rate of medical errors will If any one of you has the desire for 2. Pay for Performance decrease and will reduce 80,000 deaths more details on any of these issues, Recently, the Centers for Medicare per year attributed to medical errors. please contact me at drdesai@afg- and Medicaid (CMS) has embarked There is a strong push from all parties care.com and I will give you hard upon rewarding better quality with to capitalize on the revolution in infor- copies of state-of-the-art material pre- higher pay for hospitals. A current mation technology. sented at this conference. demonstration project addresses out- ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 9 FEATURE

AAPI Leadership visits Johnson & Johnson: “Exploring New Opportunities” Dr. Hemant Patel, Treasurer-AAPI & Dr. Jayesh Kanuga, President Elect, NY AAPI Federation

n March 19, 2004, Janssen been a strong advocate of AAPI at Pharmaceutica Products, Johnson & Johnson and has pro- LP, an Operating vided his business expertise and O guidance to AAPI in many ways Company of Johnson & Johnson Family of Companies, in partner- over the last five years. Dave ship with Dr. Hemant Patel, Butler, National Sales Director, President of NY Federation and was in attendance at the meeting Treasurer of National AAPI organ- and has been an advocate of new ized a one-day conference, opportunities at Johnson & “Exploring New Opportunities”. Johnson and has supported AAPI The conference took place at the initiatives at various local and Janssen Pharmaceutica Products, regional levels. Dr. Jayesh Kanuga L.P., campus in Titusville, New addressed questions from Janssen Jersey, and examined future part- Anwar Feroz, Dr. Hemant Patel, Peter Ciszewski, Sangeeta Goel, attendees after the closing nership opportunities between Dave Butler, Surya Vangala, Dr. Jayesh Kanuga, Dr. Atul remarks by Vice President Gary Mahabaleshwarkar, & Haresh Kaneriya. AAPI and the Johnson & Johnson Pruden. operating companies. Dr Hemant Handicraft souvenirs in the lobby of Dr. Patel reminded the audience Patel presented an overview of AAPI Janssen Pharmaceutica, L.P. as a prel- that the large Indian population in the organization and discussed many ways ude to AAPI visit. The SAPNA United States continues to grow rap- AAPI can partner with Johnson & Membership includes people and idly, including the number of physi- Johnson. Dr. Jayesh Kanuga, organizations from the following cians and medical students. These President Elect, NY Federation of south Asian countries: Bangladesh, individuals represent the future of AAPI accompanied Dr. Hemant Patel Bhutan, Myanmar, India, Nepal, AAPI’s membership and should be a on this very important visit. Pakistan, and Sri Lanka. very important channel of profession- Gary Pruden, Vice President, Anwar Feroz, Executive Director al partnership for Johnson & Johnson. CNS /ElderCare, Janssen of ElderCare and Long-Term Care, This visit to a large J&J Operating Pharmaceutica Products LP intro- and Haresh Kaneriya, Business company is a new beginning of explor- duced South Asian Professional Manager-Long-Term Care at Janssen ing opportunities for AAPI as an Network & Association (SAPNA) of Pharmaceutica Products, L.P., organization, and Dr. Hemant Patel Johnson & Johnson and kicked off the explained “We have been working started the SAPNA initiative at J&J conference by providing background with AAPI for five years, and the with a positive new era of harnessing information and the program’s agen- organization and its physician mem- South Asian Diversity in Corporate da. “SAPNA is a relatively new initia- bers represent a very large potential America. During the meeting, various tive at Johnson & Johnson,” said Mr. for Johnson & Johnson.” Mr. Anwar issues were discussed including the Pruden. “This council was created to Feroz is also Chair of SAPNA J&J participation at the upcoming promote cultural diversity within the Chapter at Janssen. Dr. Hemant Patel Annual Convention in San Diego, CA. Johnson & Johnson family of compa- has led the efforts of partnership with Dr. Hemant Patel will continue to nies and leverage the growing South Johnson & Johnson since the AAPI lead the AAPI team with Johnson & Asian customer segment for broader, annual convention of 2000 in New Johnson for future partnership oppor- more effective business results.” York City. “AAPI has tremendous pro- tunities and provide necessary guid- SAPNA was conceived in June 2002. fessional expertise to offer the ance to the AAPI leadership to work Surya Vangala, SAPNA Chapter Co- Pharmaceutical Industry”, suggested with many Pharmaceutical Industry chair at Janssen had organized a nice Haresh Kaneriya, also the Vice Chair- partners in metro NY/NJ area. display of South Asia leaders profiles Business Alliances, SAPNA at ◆ ◆ ◆ ◆ ◆ ◆ and regional costumes, literature and Johnson & Johnson. Mr. Kaneriya has

10 AAPI Journal May/June 2004 FEATURE

Is it time to change our CME format? Lessons learned from AAPI CME, San Juan, Puerto Rico

We stand to learn everyday. ing to the mind and heart. Dr. Mehta’s earnestness, caring and deep s most speakers would tell sense of righteous behaviors, all were you, every time they give a quite obvious. I do appreciate Dr. conference they learn some- A Lakhanpal’s leadership in taken care Sudhir Ken Mehta, M.D., MBA thing new. My recent experience at of all of us.” Ranjit R. Singh, MD. Chair CME, AAPI the AAPI CME meeting at San Juan, Puerto Rico, however, exceeded my wildest imaginations in this regard. of AAPI on the spot,” Shubha The program “Recent Trends in Kudchadkar, MD. Medicine and Surgery” on February “My husband Kush and I greatly 14- 15, 2004 at the beautiful Hotel enjoyed it. The talks were excellent, Intercontinental, San Juan, Puerto the hospitality perfect, and San Juan Rico, attracted a lot of attendance. I scenic and worth visiting. Thanks.” was pleasantly surprised to see what Rita Frenchman, MD. participants could teach me. A simple “Excellent conference. Very well gesture on my part brought us a gen- Beautiful Puerto Rico planned with topics covering medical erous gift of knowledge that AAPI and ethical issues; would like to members openly and willingly shared attend similar CME conferences in with all the speakers. Not only the the future.” Ronika Desai, MD. participants liked the CME, but the The above remarks say it all about speakers were excited to learn some- the CME conference at San Juan, thing from the AAPI members. The Puerto Rico. Despite the attractions participants’ knowledge and experi- outside - inviting green and blue ence clearly showed in their interac- beaches, Latin music, para-sailing, jet tions, comments, and questions. skiing, and swimming - most physi- I hope the following comments CME in Progress cians chose to attend the conference. from the attendees will help future Needless to say the speakers - Drs. “Exceptional quality CME with a CME chairs, not only in selecting the Sharad Lakhanpal, Chitranjan balance of common and unique top- topics, but also in paying close atten- Ranawat, Gita Mehta, Sudhir Mehta, ics.” Kiran Joag, MD. tion to the timeliness of their talks and Prasad Srinivasan, and Pramod permitting enough time to encourage “The whole stay at Puerto Rico Wasudev – were very impressed with active and open interaction. was well beyond my expectation. We this dedication. I believe time has were pleasantly surprised with the “It was a win-win situation for come when CME directors and arrangements made by AAPI. Special everyone. Excellent presentations speakers need to make special efforts thanks to Dr. Lakhanpal, Dr. Mehta and active participation by the atten- to meet or exceed the expectations of and Dhrumal.” Suman Meshra, MD dees were a perfect match for this AAPI members in selecting the right Valentine Day weekend,” Prasad “This was my first CME confer- topics, and making them interesting, Srinivasan, MD. ence with AAPI; very reasonable concise, and relevant. A 20-30 minute tuition for high quality CME with an “AAPI CME was very informa- talk with ample time for active dia- enjoyable overall program. I will be tive, substantive, timely, and a very logue between the speakers and the looking for the next AAPI CME meet- well organized educational experi- participants would be most ideal. ing.” Kanti Havaldar, MD. ence,” Akshay Desai, MD. This trip offered plenty more. “We attended our first AAPI “This CME meeting was well Pearly white seashores with clear sponsored CME and realized what coordinated, planned, and conducted blue waters, a Mexican dinner on the we missed all these years…we had no by Dr. Mehta and Dr. Lakhanpal. boardwalk, a city tour along the nar- hesitation in becoming life members Also very informative and stimulat- (Continued on page 27)

AAPI Journal May/June 2004 11 FEATURE

When We Need a Godfather

neuropathologist in Boston get half of us to join? was offered a coveted posi- So many of you called me look- Ation in Providence, RI, across ing for avenues for J1 visa waiver the border. The Rhode Island (which many of us avail of to not have license board wrote her medical to return to India for 2 years after school in India for documents - residency) since its discontinuance S. Jay Jayasankar, M.D. Primary Source Verification (PSV). after 9/11! Your Section got the Chair AMA – IMG Section Past President, AAPI Who knows where my friend’s fading AMA to advocate for J1 visa waiver. records are, lying somewhere in and the about to be released Pune under generations of dust cov- COGME (Committee on Graduate ered documents! What she needed Medical Education) report should was a Godfather. soon increase entry level residency The hospital finally took the slots to about 25,000 (from 21,500). next candidate in line. Sad! She is We can make a difference! not alone. I bet you know friends A fellow Indian had a job offer who let go of opportunities from and needed ECFMG credentials just this fear. Or keep renewing verified. He was about to lose the licenses in many states- afraid to position from delayed ECFMG give up, just in case! response. Your Section intervened You have a friend in your AMA and saved him his job. Your Section – IMG Section. Your Section, with is working proactively with the AMA help, even created an IMG FSMB to ease license portability seat at the ECFMG Board and is problem and to eliminate differ- now on the way to seating IMGs on ences in licensure requirements for the NRMP (National Resident IMGs. This is the time to be Matching Program) board - things involved, for we are on the cusp of unimaginable only yesterday! far reaching changes in licensure. We have gotten the FSMB AMA is very democratic. We can (Federation of State Medical set the desired policy if we join and Boards) to coordinate PSV with the can persuade our colleagues in the ECFMG. The FSMB has agreed to HOD (House of Delegates). While soon accept the ECFMG verifica- as a group we IMGs are participating tion rather than conduct a second increasingly and have 70 members in PSV of its own, reducing our mis- the AMA HOD it is such a small frac- ery. HHS (Health and Human Services) tion of the total of over 1,100 in the Visionary IMG leaders started has not only reinstituted it, but also is HOD. That is just a miniscule pres- your AMA - IMG Section, initially as reworking J1 waiver to address physi- ence for a group that numbers a quar- an advisory committee from 1989 cian shortages. Such is the power of ter of all physicians. The choice to join and finally as the Section from 1997. participation in democracy! and empower us is in your own hands. You have the power to enhance our So many ECFMG certified Your Section’s strategy aims at influence on AMA by joining the IMGs are unable to find residency increasing leadership role of IMGs at AMA and your Section- out of positions year after year. Your county, state and national levels - 180,000 IMGs nationally, only 43,000 Section got the AMA to revise its pol- through encouragement, mentoring are members of the AMA. Can you icy assumption of physician oversup- and leadership training programs - even imagine our potential if we just ply and recognize shortages. This One was held in Philadelphia in

12 AAPI Journal May/June 2004 October, 2003 and another in Massachusetts to lessen the chances The question is not whether we Honolulu in December, 2003. Your of peer review abuse. The AMA is can afford to join the AMA but Section has just succeeded in creat- reviewing adoption of MMS rather, whether we can afford not to ing 10 all expenses paid scholarships “Principles for Peer Review” and dis- join he AMA. AMA is leading our for IMGs in the renowned AMA seminating it to all hospitals in the battle for tort reform, HIPAA, Foundation Leadership Program and US. To be effective, your member- EMTALA and all kinds of regulatory the first 10 scholars participated in ship at the AMA is crucial. Just relief and at your section’s request on the program in March 2004 in throwing stones is futile. sorting out the post 9/11 visa prob- Washington DC. We plan a day lead- I agree that AMA dues of $420 is lems, license and parity issues our ership meeting in Chicago on a lot when we have other dues constituents face. Your Section is June11th. Seek leadership positions besides. And our reimbursements are tirelessly advancing your issues and in your county, state and national not going up and, in fact, are being cut solutions - we have a good thing societies. If not we will have only over and again. Medicare wanted to going, but it cannot last without your ourselves to blame if our needs are cut reimbursement by 4.5% for 2003 membership and involvement. not met. and over again for the next two years. Your participation at all levels is Most of you know about Dr. The AMA speaking as our unified the IMGs’ Godfather. Virmani who lost his privileges national voice along with our specialty For more information or help through abuse of peer review. The societies, reversed some time ago the contact: Ashish Bajaj, Staff Liaison: AAPI filed a successful amicus brief cut for 2003 and got us a 1.5% raise (312) 464-4743; ashish_bajaj@ama- whose outcome has created a new instead. That has put $3,000 in our assn.org S, Jay Jayasankar 781-790- legal precedent. It should not have pockets in 2003 instead of $9,000 out 1007; [email protected] happened in the first place. As Chair of our pockets. And now with a sec- * Dr. Jay Jayasankar is an alternate delegate to of the MMS (Massachusetts Medical ond victory for the next 2 years we the AMA from Massachusetts and the President Society) Committee on Medical each are better off by an average of of the prestigious Boston Medical Library. Service, I was able to develop $12,000 a year for the next two years! “Principles for Peer Review” and dis- Now, the $420 dues, in perspective, seminate it to all hospitals in are not high at all. ◆ ◆ ◆ ◆ ◆ ◆

POLICIES AND GUIDELINE FOR WRITERS www.saforchoice.org olicies and Guidelines for Writers in AAPI Journal AAPI Journal seeks South Asians for Women’s Lives Poriginal, previously unpublished articles from members on medical Delegation for the March for Women’s Lives and social matters, memorable experiences in your life, practice tips and techniques meaningful to the readers and more. Articles should be sent April 25th, 2004 ¥ Washington, DC preferably as e-mail (Microsoft word, if possible) attachments. Feature articles should be about 1 -1.5 pages (500 - 750 words), and news items At a time when women’s rights are under attack, we join together as about 1/4 a page (100 words). Stories should be written in a conversa- South Asians and South Asian Americans to express our overwhelming tional style, easy to read. Please also add full author information and con- support for the health and reproductive rights of all women. tact details. Kindly do not send any scientific papers and research reports. Part of each journal is devoted to a theme. The theme for the next issue We believe that health and reproductive rights are fundamental tenets of freedom and are central to women’s equality. is “ MSR/ YPS AAPI Journal.” We encourage submissions for the reg- ular columns “Members in the News”, “A Glimpse of My Life,” We recognize that individual communities face unique barriers in “The best of AAPI humor,” “AAPI and Poetry,” “AAPI exercising their rights, and therefore hope to include the voices Travelogues,” and “A Very Interesting Case.” Also, you may send of South Asians and South Asian Americans in the dialogue con- quotes, anecdotes, jokes, etc. which can be used as fillers. Submission of cerning women’s health. good quality photographs including author’s and activity photos which illustrate the article are encouraged. South Asians for Women’s Lives has been endorsed by a number of Cover Art: Original good quality photographs - 3.4” x 5” or bigger, hor- prominent organizations, including ASHA, the Asian American izontally formatted with details, or paintings for cover, from members and Public Policy Institute, International Planned Parenthood Federation, their spouses are needed. The Editorial committee reserves the right to and the South Asian Public Health Association. accept or reject any articles and edit all accepted articles as needed. Please Please join us in supporting women’s rights by registering at visit our web site www.aapiusa.org for detailed instructions. www.saforchoice.org, where over 450 individuals have already reg- istered their support. Your name, along with every other supporter, will be printed onto a banner and carried through Washington, DC Editor, AAPI Journal ([email protected]) on April 25, 2004 at the most significant and massive reproductive Hernando Heart Clinic ¥ Brooksville, FL 34613 rights march in over a decade!

AAPI Journal May/June 2004 13 FEATURE

How HIPAA Electronic Data Interchange Can Help Physicians

hysicians and their office staff did not have success in standardiza- are tired of calling insurance tion. Hence, the government stepped companies to inquire about the in to dictate a single format for trans- P mission of claims, Explanations Of status of their claims. They often A. Hassan Mohaideen, M.D. Benefits (EOBs), pre-authorizations spend endless hours on phone calls, M.B.A., F.R.C.S., F.A.C.S. only to be told that the “claim is being and other transactions. The following processed” or the “check is in the is a list of electronic transactions that mail”. Busy surgeons or procedure are of particular importance to the law and start using the electronic oriented practitioners call and go physician community: transmissions. through a long process to obtain • Eligibility query and response For example, a gastroenterologist authorization for procedures - many (HIPAA 270/271) - Permits the who plans to examine a new patient practices requiring additional staff for provider to obtain information on can verify the eligibility of the patient this purpose. In addition, different patient eligibility for a proposed test - not just for coverage, but also health plans utilize different codes - or procedure prior to rendering whether the health plan will reim- for anything from procedures to rea- service. burse for a specific procedure. She no sons for denials and changes in reim- • Claim status query and response longer has to rely on the validity of the bursement. Each plan also assigns a (HIPAA 276/277) - Permits the insurance card carried by the patient. different ID number to a participating provider to determine the status of After examination of the patient, if provider. Now, under the Health a claim submitted to a payer. pre-certification for a procedure is Insurance Portability and Account- required, she can send an electronic • Claim transmission and EOB ability Act (HIPAA) rules, a single file to obtain such authorization. She (HIPAA 837/835) - Permits the coding system must be used by all then performs the planned procedure, provider to send claims and receive healthcare payers. electronically files the claim the same EOBs in electronic format, includ- While most physicians and other day, and obtains payment by check or ing direct deposit of payment to a healthcare practitioners are painfully direct deposit to a bank along with an provider’s bank account. aware of the HIPAA rules of security electronic EOB, all within a short and confidentiality, they are not aware •Pre-authorization for procedures period. The insecurity that currently of the critically advantageous rules of from payers (HIPAA 278/278R) - exists regarding eligibility of the HIPAA - electronic data interchange Permits the provider to send a pre- patient, acknowledgment of claims (EDI) in a standard format. authorization request and obtain a mailed, and status of claims sent to the response. payer will no longer exist when physi- The federal government estimates cians start using HIPAA mandated savings of billions of dollars in health- In this era of increasing costs of EDI transactions. care administrative costs in the next maintaining a physician practice with five to ten years when standardized decreasing reimbursement, physicians How can physicians take full EDI is widely adopted by healthcare can reduce their overhead expenses advantage of HIPAA regulated EDI, payers and providers. considerably by taking advantage of providing for quick confirmation of HIPAA regulations. HIPAA regula- eligibility and written approval of pro- Under HIPAA regulations, all tions mandated that all payers be fully cedures, as well as confirmation of transactions between healthcare pay- compliant with the EDI rules by receipt of claims and prompt pay- ers and providers must be in a stan- October 16, 2003. While providers ment? Physicians will need to either dard electronic format, with the use of are not mandated to comply with the purchase software that has all HIPAA standard codes and identification EDI rules of submission to the payers, EDI functions incorporated or con- numbers for payers and providers. Medicare is expected to require EDI tract with a billing company to provide Previously, the healthcare industry claim submission by all providers the necessary EDI services. had been using up to 150 different for- within a year. But, why wait? Sophisticated software systems are mats for electronic transmissions and Physicians can take advantage of the (Continued on page 27)

AAPI Journal May/June 2004 15 SECRETARY'S REPORT

AAPI Spring Governing Body Meeting

he AAPI Governing Body In the evening, the host committee Meeting, held in the exciting held a unique New Orleans-style Mardi city of New Orleans, LA, Gras party. Dr. Sharad Lakhanpal and T Mrs. Rashmi Lakhanpal were crowned (March 5-6, 2004) with warmth and abundant southern hospitality, was an as the King and Queen of the night and event to remember. were giving honorary citizenship of New SAMPAT S. SHIVANGI, MD Orleans in a written decree by the Dr. Surendra Purohit, Past-Chair Mayor. The new Orleans jazz and blues SECRETARY of AAPI of AAPI BOT and President of AAPI entertainment was out of this world. Louisiana Dr. Tilak Malik, welcomed sented AAPI’s finances and good news governing body members with open The next day, on March 6, of a positive balance. arms. President Dr. Sharad Lakhanpal called Dr. Haranath Reddy, Chair BOT, the well-attended meeting to order. In One of the highlights was a special stated that AAPI operating loan of his report, Dr. Lakhanpal highlighted session, “Information Technology for $109,000 was repaid to the patron the progress AAPI has made in the last AAPI” on Friday, March 5. Dr. Subroto account for the first time in the associ- nine months, especially successful Kundu, chair of IT task force that has ation’s history. Total investments have series of CME in Goa, Lucknow, envisioned 21st-century technology, grown by $30,000. Jaipur, New Delhi, Peru and Puerto presented the feasibility of a project, Rico. He spoke about the meeting the Dr. Deepa Patel, president YPS, which will put AAPI on par or exceed AAPI delegation had with Honorable and Dr. Saumil Oza, MSR president, other organizations. The proposal fore- Abdul Kalam, President of India, Shri presented their reports too. Reports sees a new IT platform custom-built L.K. Advani, Deputy Prime Minister from regional directors and various for AAPI, including full web services and Smt. Sushma Swaraj, Health committee chairs also were submitted. for AAPI and all individual member Minister. At the Pravasi Bharatiya The other important issue brought organizations, alumni association and Divas venue, a special health care ses- to the governing body was the possibil- specialty groups. Further, all AAPI sion was moderated by Dr. Lakhanpal, ity of outsourcing the AAPI office to members would receive an e-mail where AAPI members were the lead- Michigan State Medical Society. Its address to communicate within the ing participants. Dr. Lakhanpal also directors, who were present, offered organization and also have personal- announced that charitable clinics some reasons AAPI should consider ized and customized Web pages. The would open shortly in Lucknow and outsourcing its office to MSMS. “backbone” of the IT services would Jaipur. offer detailed member database After long and meaningful delibera- enabling the AAPI leadership to Dr. Jagan Alinani, President elect, tions, the governing body decided against address legislative, public health, char- presented the proposed bylaw changes, considering the proposal at this time. itable and other services. The database which were approved previously by the Executive Committee also met with YPS will start current by auto correcting general body through mail-in ballots. and MSR sections to discuss their con- member information. The hazards of He stressed that efforts continue to cerns, especially convention issues. spam, anonymous e-mail and lack of include dentists and scientists of Indian A grand banquet was organized confidentiality have spurred the need origin under AAPI umbrella. that evening with Ambassador for electronic communication. Many Dr. Akshay Desai, Vice President, Agnihotri and the Director of thanks to Dr. Kundu for an outstanding pointed out that AAPI had achieved total Louisiana Health Services as chief presentation, which wasapplauded by paid membership of more than 10,000. guests. Entertainment followed the the governing body. Besides submitting his report, Dr. banquet. The governing body meeting Dr. Ravindra Nathan, Chair Sampat Shivangi, Secretary, spoke about ended with a brunch and CME of the Publication Committee, presented sug- efforts to modernize the AAPI office Louisiana chapter. gestions to improve the quality of the equipment and IT infrastructure to Our sincere appreciation and AAPI Journal and hire part-time staff achieve higher effciency with the help of thanks to the Louisiana host committee to share the increasing workload of the Dr. Kundu, Chair IT Task Force. for a memorable event and a meaning- journal, which was approved. Dr. Hemant Patel, Treasurer, pre- ful governing body meeting.

16 AAPI Journal May/June 2004 AAPI GOVERNING BODY MEETING NEW ORLEANS MARCH 5-6, 2004

AAPI Journal May/June 2004 17 FEATURE

Saving Medical Practice…

he ultimate reason why we need or to move to another state. The other to fix the liability system has a option which was popular many years little to do with physicians, but a ago, “Going Bare” is not always feasi- T ble. At least 13 states require physi- lot to do with our patients, to protect Access to Care in their hour of need. cians to carry liability insurance in order to keep their medical license. Vijay Koli, MD Medical Liability reform remains a Also hospitals often require minimum Chair, AAPI Committee on Liaison with AMA. key priority of physicians. A recent rally level of insurance be carried by physi- in Chicago chanting “Tort Reform cians to be on the staff. Health plans Now” is one of many that have taken discuss medical liability reform. I con- invariably will not allow a physician to place across the country this year. tacted the 7,500 IMG physicians in be on their panel without coverage. Physicians have joined forces to push Texas to work on this issue. The victory Favorable homestead exemption laws lawmakers to enact reforms to sta- for Prop 12 in Texas has set the bilize or even reduce insurance tone for other states to be success- rates. AMA considers 19 states to ful. Recent passage of the be “states in Crisis”, only six states Proposition 12, enacted by the are safe from tort issues. Texas Legislature is already paying dividends for physicians and their There is no evidence of any patients. The constitutional correlation between lawsuit amendment to cap non economic awards or settlements and negli- damages ensures the caps are not gence; besides lawsuits do noth- overturned in the courts. This has ing to enhance patient safety. prompted the Texas Medical What physicians desire are basic Liability Trust to lower its premi- fairness and a level playing field. ums across the board by 12%. As So far the system is faulty, in that another positive spinoff, it has the patient will loose access to Vijay Koli with Rick Perry, Governor of Texas lured a few more insurance carri- care as doctors are unwilling or ers to come to Texas. unable to take care of them. The may lure physicians to go bare but the major objective in a malpractice action big question is whether one can go to The Liability reform was a pivotal is to shift responsibility for damages sleep at night taking such a risk. issue on the minds of everyone who incurred from the patient to the per- attended the AAPI’s seventh Annual AMA has made tort reform its No. son or persons responsible for the dam- Legislative Conference in Washington, 1 legislative priority. It will eventually ages. The current malpractice litigation DC in March. . The legislative meet- pass if there is sufficient pressure from systems are not aligned with the pur- ing provides an avenue to voice our the public. A recent survey of nearly pose of compensating injured patients. concerns to the lawmakers, however in 4,000 medical students in 45 states order to be more effective, a sound Liability insurance premium hikes showed that 86 % of students believe comprehensive approach is necessary. that affected physicians in high risk spe- that medical liability crisis is a major Although all politics are local, AAPI as cialties such as obstetrics and neuro- problem. It has become a key factor in an eminent organization will need to surgery are now encroaching primary choosing a specialty and also choosing a develop a system which will support care physicians who take care of nursing state in which to practice. There is a and enhance advocacy on key issues at home patients. Almost 22% of physi- real concern that if the liability crisis is the national level and leverage the con- cians who take care of nursing home not fixed, there could be shortage of siderable clout it has through the grass- patients are unable to get or renew their physicians in certain specialties. roots organizations and individuals. malpractice insurance coverage. As a member of the top team of Senator Bill Frist, MD addressing the The skyrocketing malpractice Texas Medical Association for the gathering of AAPI members at the leg- insurance premiums have forced physi- Reform, I was invited to meet with cians to limit the scope of their practice the governor of Texas, Rick Perry to (Continued on page 35)

AAPI Journal May/June 2004 21

HONORING AAPI

108th CONGRESS 2nd Session H. RES. 579

Honoring the American Association of Physicians of Indian Origin and expressing the sense of the House of Representatives that an American Association of Physicians of Indian Origin Day should be established. IN THE HOUSE OF REPRESENTATIVES March 25, 2004

Mr. PALLONE (for himself, Mr. CROWLEY, Mr. WILSON of South Carolina, Mr. LANTOS, Mr. WHIT- FIELD, Mr. ABERCROMBIE, Mr. MEEKS of New York, Mr. MCDERMOTT, Mr. PAYNE, Mr. LAMPSON, Mr. MCNULTY, Mr. MCINTYRE, Mr. ISRAEL, Ms. JACKSON-LEE of Texas, Mr. LEVIN, Mr. DAVIS of Illinois, Mr. ENGEL, Mr. WEXLER, Mr. HOYER, Mr. GINGREY, Mr. BROWN of Ohio, Mr. ACKERMAN, Mr. BELL, Ms. MAJETTE, Mr. HASTINGS of Florida, Mr. DAVIS of Florida, and Ms. MILLENDER-MCDONALD) sub- mitted the following resolution; which was referred to the Committee on Energy and Commerce

RESOLUTION Honoring the American Association of Physicians of Indian Origin and expressing the sense of the House of Representatives that an American Association of Physicians of Indian Origin Day should be established. Whereas the American Association of Physicians of Indian Origin was established in 1982 and represents the interests of 38,000 physicians and 12,000 medical students and residents; Whereas, with almost 100 member organizations across the Nation, the American Association of Physicians of Indian Origin is the largest Indian American membership organization and the largest ethnic medical associa- tion in the United States; Whereas the American Association of Physicians of Indian Origin is committed to improving access to quali- ty, affordable healthcare and to enhancing awareness and action on issues affecting Indian American health; Whereas the American Association of Physicians of Indian Origin performs charitable work throughout the United States and has established free clinics in Illinois, Michigan, New Jersey, and Texas; Whereas many members of the American Association of Physicians of Indian Origin practice medicine in underserved rural and inner-city communities across the Nation; Whereas the American Association of Physicians of Indian Origin Charitable Foundation operates 14 free medical clinics in India that serve thousands of patients and is active in disaster relief efforts when needed; Whereas the American Association of Physicians of Indian Origin has taken a leadership role in gathering data on diseases that disproportionately affect Indian Americans, such as diabetes, coronary artery disease, and osteoporosis; Whereas the American Association of Physicians of Indian Origin has successfully secured $500,000 in Federal funding to conduct a study and education program on diabetes and coronary artery disease in Indian Americans and is continuing to work with the Congress to fund a more detailed study and education program in this field of research; Whereas the American Association of Physicians of Indian Origin publishes a bimonthly AAPI Journal, hosts continuing medical education programs, hosts an annual national convention for thousands of its members in a major city in the United States, and hosts an annual legislative conference in Washington, DC; and Whereas the American Association of Physicians of Indian Origin is hosting its annual legislative conference on March 30, 2004: Now, therefore, be it Resolved, That the House of Representatives— ` (1) honors the American Association of Physicians of Indian Origin for its commitment to improving access to quality, affordable healthcare and to enhancing awareness and action on issues affecting Indian American health; and (2) expresses its sense that an American Association of Physicians of Indian Origin Day should be established. ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 23 AAPI AT THE CAPITOL OUR LEGISLATIVE DAY AT THE CAPITOL began after a welcoming address from Dr. Rakesh Shreedhar, Chair, AAPI Legislative Affairs Committee, and a presentation of AAPI’s legislative agen- da by the association’s President, Dr. Rakesh Shreedhar, M.D. Sharad Lakhanpal. The “Indo-U.S. Anurag Varma, JD Chair Legislative Affairs Committee, AAPI Relations” workshop featured such Legislative Director, AAPI n March 29-30, the AAPI held notable speakers as Congressman Joe As its lunchtime keynote speaker, its 7th Annual Legislative Wilson, Dana Dillon (Scholar, the AAPI was honored to have Ambassador Conference in Washington, Heritage Foundation, a political think- Bhishma Agnihotri, India’s Global O tank), Richard Verma (Senior Foreign Ambassador-at-Large for NRIs/PIOs. D.C. Over the years, the Legislative Conference has served as a tremendous Policy Aide to the Senate Democratic Spending quality time with AAPI lead- opportunity for AAPI leaders to (1) edu- Leadership and Sen. Harry Reid (D- ers, Ambassador Agnihotri urged AAPI cate themselves on policy issues affect- NV)), Ashok Sajjanhar (Political to not only join, but lead, the growing ing the American health care sector, Minister, Embassy of India). The spir- movement to create a national Council Indian American health and Indo-U.S. ited discussion was moderated by Dr. of Indian American Associations to stim- relations, and (2) meet with Congressional Krishna Reddy, President of the Indian ulate communication and collaborative lawmaker to express the concerns of American Friendship Council, and activities amongst all Indian Americans. physicians of Indian origin and of the covered such topics as the U.S. decla- As part of the Legislative Indian American community as a whole. ration of Pakistan as a major non-Nato Conference’s advocacy efforts, the This year’s event not only accomplished ally, the Indian government’s public AAPI leadership held separate meetings these goals but, in fact, proved that relations effectiveness in the U.S. with the Majority and Minorty Whips of AAPI’s accomplishments on Capitol Hill media, and outsourcing. the U.S. House of Representatives. The have moved to new heights. The “Health Care Issues” panel, Whip position in both parties is held by The conference began on the moderated by the former Chair of its 2nd highest ranking member, in this evening of Monday, March 29th, with a AAPI’s Legislative Affairs Committee, case, Tom DeLay (R-TX) and Steny reception for Congressional staffers Dr. Krishan Aggarwal, presented the Hoyer (D-MD). During the meetings sponsored by the Indian Medical AAPI members in attendance with a with Congressmen DeLay and Hoyer, Association of Maryland and Greater taste of the vastness of health care the primary issue for AAPI was the Washington, D.C., led by its President, issues discussed on Capitol Hill. The organization’s request for $2 million to Dr. Jayesh Dayal. The reception, held esteemed speakers included, continue funding its study of diabetes at a Capitol Hill restaurant, provided Congressman Frank Pallone (D-NJ) among Indian Americans. This request, AAPI leaders with an opportunity to (founder of the India Caucus and which has been submitted to the meet and mingle with Congressional member of the Health Subcommittee House Appropriations Committee on staff who regularly provide “behind- of the House Energy and Commerce behalf of AAPI by Rep. Pallone, follows the-scenes” support for AAPI. As an Committee), David Fisher (Health up on the historic $500,000 appropriat- added treat, Congressman Joe Wilson Care aide to Senator Judd Gregg (R- ed by the U.S. Congress to AAPI in (R-SC), Co-Chair of the Congressional NH), author of the recently-defeated 2003, the first time an Indian American Caucus on India and Indian Americans Senate tort reform bill), Dr. Carden organization has been awarded this (“India Caucus”), made a surprise visit. Johnston (President of the American type of direct grant. On Tuesday, March 30th, AAPI Academy of Pediatrics), Shalini The crown jewel of AAPI’s members began their work of dis- Vallabhan (Director of South Asia Legislative Conference was its 2nd cussing legislative issues by participat- Programs for the American Cancer Annual Capitol Hill Gala Dinner, held ing in consecutive workshops on “The Society), Dr. Thakor Patel, Advisor of in a beautiful, oak-paneled hearing Future of Indo-U.S. Relations” and the AAPI Public Health Committee room in the Senate Hart Building. “Health Care Issues Before the 108th and a leader of the AAPI Diabetes During the cocktail reception preced- Congress and Indian American Among Indian American study, and Dr. ing dinner, a number of U.S. Senators Ranga Reddy, Past President of AAPI. Hleathcare Issues.” These discussions (Continued on page 37) 24 AAPI Journal May/June 2004 Co-Chair "Friends of India" in U.S. Senate Republican Senator from Texas John Cornyn Ambassador Lalit Mansingh and Ambassador at large Senate Majority Leader Bill Frist recived by the AAPI executive committee mem- being introduced to India's Ambassador to U.S Lalit Mansingh, by Dr. Sharad Bhishma Agnihotri with AAPI Leadership bers right to left Drs. Desai, Lakhanpal, Bill Frist,Vijaynager, Congressman Joe Crowley, Shivangi, Jain, Parikh, Singhvi Lakhanpal. Ambassador at large Bhishma Agnihotri in center

Drs. Vijaynager, Sharad Lakhanpal welcome Senate Majority Senate Majority Leader Bill Frist speaking Senate Majority Leader Bill Frist with AAPI Executive Leader Bill Frist Committee

Congressman Frank Pallone with Senator Thad Cochran, Drs. Sudhir Parikh, Sharad Congressman Joe Crowely speaking Drs: Lakhanpal and Ailinani Lakhanpal, Rakesh Shreedhar

Ambassador Lalit Mansingh Speaking Senator Paul Sarbanes Dr. Ranga Reddy asking a question to Congressman Joe Crowley adjusting pin Senate Majority Leader Bill Frist of young Indian Physician Dr. Shah

Drs. Sampat Shivangi, Sudhir Parikh, Akshay Desai, Senator Mrs. Sharad Lakhanpal congradulated Co-Chair "Friends of India" in Dr. Desai and Senator Paul Sarbanes Paul Sarbanes and AAPI President Dr. Sharad Lakhanpal U.S. Senate Republican Senator from Texas John Cornyn Photos by: Mohammed Jaffer-Snapsindia

AAPI Journal May/June 2004 25 Special Series: Complementary and Alternative Medicine

Introduction

ighty percent of the global to either one alone. population (5 billion people) • 35-50% of conventional physicians Euse traditional practices to referred their patients to Integrative meet their primary healthcare needs. Clinics in 2001. This trend has now made its way to Hari Sharma, M.D., FRCPC • An estimated 50-66% of the nation’s the U.S. as well. The way in which Chair, Integrated Medicine Committee, AAPI insurers are offering some form of medicine is practiced in the U.S. is Email: [email protected] coverage for CAM practices. rapidly changing, as evidenced by the in Orlando, Florida, so practitioners following statistics: • 75 medical schools in the U.S. are could learn new health concepts that teaching CAM modalities and the can easily be incorporated into their • Expenditures for Complementary NIH has increased the budget for existing practice to benefit them and and Alternative Medicine (CAM) research on CAM modalities to their patients. This issue of the AAPI were $82.4 billion in the U.S. in $116 million in 2004. Journal also offers a series of articles 2003. In line with these changing on Integrated Medicine to give a • 79% of patients surveyed in 2001 trends in medicine, the AAPI taste of what this rapidly expanding said a combination of CAM and Integrated Medicine Committee field has to offer. conventional medicine is superior organized a Conference on Ayurveda ◆ ◆ ◆ ◆ ◆ ◆

The Need to Support Ayurveda

RIs in America commonly India, continuing their own personal run into many old stereo- connection to this great tradition. Ntypes and distortions about Ayurvedic medicine is another India and, more specifically, about the important aspect of the Indic tradi- Hindu tradition. India is identified tion that has been similarly distorted with poverty, overpopulation and and denigrated. Of course, the Dr. David Frawley Director, American Institute of Vedic Studies backwardness, though historically British closing down of Ayurvedic Santa Fe, New Mexico India was usually among the most schools during the colonial period Email: [email protected] • Website: www.vedanet.com advanced and affluent countries in the had a lot to do with this. Yet even lack of support, than some funda- world. The Hindu religion is reduced modern India, though it has restored mental flaw in Ayurveda itself. to caste, cows and curry, with little some degree of Ayurvedic education, The result is that many Indo- regard for its great Yoga and Vedantic allots only minimal resources to American doctors respect the Indic tradition, though these have had sig- Ayurveda. The result is that tradition, but few of them recognize nificant followings in the West for Ayurvedic schools and hospitals the importance of Ayurveda within decades. The Indian contribution to appear quite substandard relative to that tradition. Many value Yoga or science from physics to medicine is modern medicine, which receives a Vedanta but not Ayurveda. This is ignored, though it was considerable much greater government and edu- even the case with those who have from Aryabhatta to Sushruta, starting cational regard. The best medical come from older Ayurvedic families even with the Vedas. minds of India today do not go into themselves, but have lost track of Ayurveda but into modern medicine, Most NRIs, including medical their own family traditions. doctors, are aware of the deeper which also keeps the standard of aspects of the Indic tradition and Ayurveda from becoming as high as it The Chinese community and would like to see these distortions cor- could be. While this may cause peo- Chinese medical doctors, on the rected. Most of them follow gurus, ple, including Indian medical doc- other hand, have been much more practice pujas or meditation, donate tors, to look down upon Ayurveda as supportive of Traditional Chinese to temples, and go on pilgrimages to a science, the problem is more this Medicine and have made sure that it (Continued on next page)

26 AAPI Journal May/June 2004 The Need… Continued metic surgery to immunization were Without the support of the NRI pioneered by Ayurvedic doctors. community and Indo-American doc- has gained recognition worldwide. tors, Ayurveda is unlikely to be licensed Ayurveda is not any less older or less Ayurvedic literature, both in in America. With such support, howev- sophisticated than Chinese medicine, classical Sanskrit, starting with er, Ayurveda will not only gain credibil- or less capable of getting worldwide Sushruta, and in the local dialects of ity but also bring more regard to the recognition. It is just as worthy of the India, is enormous and contains entire dharmic tradition of India that support of the Indo-American com- many secrets of both physical and includes not only spirituality but also munity as Chinese medicine is of the spiritual healing. science together in an integral harmo- Chinese-American community – and Today there is a new interest in ny of knowledge and wisdom. just as dependent upon it. Ayurveda in the United States and in Ayurveda is an important aspect Ayurveda shows the practical the western world as a whole, but of the Indian tradition which deserves aspect of Vedic, Yogic and Vedantic mainly among non-Indians. Several study, support and patronage, as well knowledge, how to use these great dozen books on the subject have as further research and practice. dharmic principles of harmony with been published, some becoming Should Ayurveda gain the attention both Spirit and Nature (Purusha and national best sellers. European coun- and regard it deserves, it can aid the Prakriti) for health and well-being of tries like Germany and Russia now world in a renaissance of mind-body body and mind, including proper diet have recognized the practice of medicine. The Ayurvedic community and life-style relative to both individ- Ayurveda. In some form or another both in the West and in India would ual constitution and our special social Ayurveda can now be found on all the therefore encourage AAPI to take up and environmental conditions in the continents of the world. the cause of Ayurveda, not simply as a world today. Ayurveda is an integral Movements are underway to grant cultural concern but also in pursuit of part of all Yogic and Vedantic disci- credibility and seek legalization of the real truth of healing, in which con- plines. Many of modern India’s Ayurveda in the United States as well. sciousness is as important as any outer greater gurus have emphasized the Notably, the National Ayurvedic treatment modality. Ayurveda’s eco- value of Ayurveda. Many of their Medical Association just had its first logical view of the need to harmonize ashrams offer Ayurvedic treatment. national conference in Florida and the individual, society, and nature is Ayurveda has a materia medica of proves to become an important mouth- also becoming increasingly relevant as herbs and minerals perhaps larger than piece for Ayurveda in this country. we move more into a planetary age. any other in the world, which also However, compared to such organiza- deserves greater examination. In the tions as AAPI, it remains quite small ◆ ◆ ◆ ◆ ◆ ◆ history of medicine, practices from cos- and with very limited resources.

Is it time to change our CME format? How HIPAA Electronic Data Interchange Lessons learned from AAPI CME, San Juan, Puerto Rico Can Help Physicians Continued from page 11 Continued from page 15 row streets of San Juan, a private boat cruise to a small island with people singing Hindi songs in chorus and finally having now available that perform all HIPAA required EDI trans- an evening dinner where all the ladies got a beautiful long actions in addition to all the current medical management stemmed rose as they became Dr. Sharad Lakhanpal’s valen- functions required by a practice. Other options exist, where tine and gentlemen got a box of chocolates as they became HIPAA compliant EDI software modules are purchased to Mrs. Rashmi Lakhanpal’s valentine…yes, indeed, this was one complement existing medical management software that a CME, the memories of which will linger on for a time. provider uses. For me, the meeting ended on another high note. On the It is time that physicians start reducing their overhead last day, I had the pleasure of looking at the “NRI Today” mag- expenses to maximize income – by using HIPAA EDI. azine which featured AAPI and its president, Sharad AAPI member Dr. A. Hassan Mohaideen is a vascular and Lakhanpal on the front cover. If we continue along this path, I general surgeon, and currently is the President and CEO of see nothing but a shining future for AAPI. Our strength will Health Plan Systems, a healthcare administrative software continue to increase through high caliber programs, active par- firm. Along with his partner Dr. D. Venkatanathan, a former ticipation from members, great leadership from the top, and a NASA scientist, Dr. Mohaideen has been creating software strong will to succeed. If you have been waiting to become a for healthcare providers and payers for the past fifteen member of AAPI, you could not ask for a better time. years. Dr. Mohaideen can be contacted at [email protected] Let us move forward one step at a time with unity. or by calling (201) 556-9430. ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 27 Special Series: Complementary and Alternative Medicine

AYURVEDIC SKIN CARE

yurveda is a 5000 year-old ples as those prescribed to heal the holistic Vedic tradition that whole person. literally means ‘science of life The wisdom of Ayurveda recog- A nizes that to achieve balance we must or longevity.’ Knowledge of Ayurveda enables one to create balance of be in tune with our environment. body, mind, and consciousness Since the environment is always Suhas Kshirsagar, M.D. according to one's own constitution. changing (seasons, travels, lifespan, (Ayurved, India), BAMS According to Ayurveda, every indi- even mental attitudes), the treat- Dean, Aloha Ayurveda Academy ments required to keep our skin Ayurvedic Physician, Kauai Holistic Medicine vidual has a unique combination of Email: [email protected] physical, mental, and emotional healthy also change. Just as each of characteristics that is his or her con- us has a dominant energy or dosha, it tends toward dryness. If Vata dosha stitution. Body, mind, and conscious- so does each season. Springtime is is imbalanced, the skin will become ness work together to maintain a dominated by Kapha, summertime prone to excessive dryness and may dynamic balance. Internal and exter- by Pitta, and winter is predominantly even be rough and flaky. The greatest nal factors can disturb one’s constitu- Vata in Nature as well as the human beauty challenge is a disposition to tional balance. Both physical and physiology. symptoms of early aging such as mental imbalances are reflected in The Ayurvedic concept of wrinkles. In addition, Vata skin is the skin. Rituacharya, or seasonal routine, prone to dry eczema and fungus infections, and if digestion is not in Ayurveda identifies three basic advises taking our cue from the uni- verse's natural cycles. As the sap balance the skin will begin to look operating principles or doshas that dull and gray even early in life. are present in everyone: Vata, Pitta moves from the branches of a tree and Kapha. According to Ayurvedic into its roots during early winter, so The key word for balance is philosophy the universe is composed does our skin experience a period of ‘lubrication.’ The skin needs to be of the energies of the five elements-- dryness. This means our winter rehydrated both from internal and Space, Air, Fire, Water and Earth. beauty treatments must focus on external sources. To hydrate the skin The doshas are comprised of the warm, nurturing emollients to mini- from inside, try to drink at least eight energies of these elements as follows: mize cold, dry (Vata) skin. During glasses of water a day and eat plenty summer's heat our skin benefits from of sweet, juicy fruits. Externally, use • Vata (Space and Air) light, cooling skin care products to a high-quality moisturizing cream • Pitta (Fire and Water) balance the heat (Pitta). twice a day. • Kapha (Earth and Water) Ayurveda provides abundant Pitta Skin Ayurveda dictates that every resources for those who want to radi- individual is a unique combination of Pitta dosha is composed mostly of ate true beauty. Herbs like Turmeric, the three doshas; this combination fire, so the qualities of this element Saffron, Sandalwood, and Triphala, determines each person’s psy- such as redness, heat, and sharpness treasured by Indian women for cen- chophysiological constitution (skin, will be reflected in the skin. Pitta skin turies for their healing properties body, and mind type). is fair, soft, warm, and medium thick- and beauty benefits, are part of its ness. The complexion tends toward Ayurveda and Skin Care numerous gifts. Ayurveda's recom- pink or reddish. There may be a copi- Ayurveda was first 'seen' by rishis mendation is to stay in tune with the ous dose of freckles or moles. Pitta and sages who radiated beauty from ever-changing environment and inte- skin often mirrors the emotions – the core of their being. Ayurveda was grate its teachings to maintain health there is a tendency to blush easily the tool they used to bring balance and beauty. when embarrassed or angry. and clarity to the body and mind. It is Vata Skin Conversely, when happy and balanced, explained in Ayurveda that beauty is Vata skin reflects the elements of Pitta skin is glowing and radiant. the result of vibrant health achieved air and space so it is thin, fine-pored, The main beauty challenges by balancing the doshas. Ayurvedic delicate, and cool to the touch. Due include a tendency to develop rashes, beauty treatments restore health to to the absence of the water element the skin by utilizing the same princi- (Continued on next page) 28 AAPI Journal May/June 2004 Special Series: Complementary and Alternative Medicine

Ayurvedic Skin Care… Continued AYURVEDIC CONCEPT OF AMA (TOXIN rosacea, acne, liver spots, and break- ACCUMULATION) outs or pigment disorders. Pitta skin does not tolerate heat or the sun very Hari Sharma, M.D., FRCPC well. The key word for balance is ‘cool- Chair, Integrated Medicine Committee, AAPI ing.’ The emphasis should be on thera- Email: [email protected] pies that have a calming influence on the skin. Synthetic chemicals should be ma is a concept of Ayurveda diseases and disorders. avoided. A moisturizer with herbs such that can be understood as From the Ayurvedic point of as Sensitive Plant should be used. Aaccumulated toxic substances view, Ama is produced from improp- Flame of Forest helps protect against at different levels of the physiology. erly digested material at different lev- photosensitivity. Hot spicy foods, vine- At the level of gross digestion, poorly els of the physiology due to an imbal- gar, and fried foods should be avoided. digested food results in a thick, slimy ance in Agni. Agni is translated as material that lines the walls of the ‘fire’ or ‘flame.’ It governs the meta- Kapha Skin bowel, impeding absorption and bolic and endocrine systems, and Kapha dosha is composed of assimilation of nutrients. At the cellu- associated transformations in the earth and water so the main qualities lar level, during functioning of the physiology, e.g. digestion, metabolic of Kapha are heavy, cold, slow, and physiology there is accumulation of transformations, and hormonal and oily. Kapha complexion tends to be impurities and toxins. These impuri- biochemical changes. Agni in the pale and the skin is oily, soft, and cool ties come from both inside and out- human physiology is managed by gov- to the touch. This type of skin has side the body. From inside the body erning principles of the physiology less of a tendency to create wrinkles. come internal metabolic and cellular known as the doshas: Vata, Pitta, and waste products, such as free radical- Kapha. Thus, any imbalance in Vata, When Kapha skin is imbalanced damaged cells and tissues, and from Pitta, and Kapha will produce an it can result in enlarged pores, exces- outside come external impurities and imbalance in Agni. No disease can sively oily skin, moist types of toxins, such as pollutants and toxins manifest without a disturbance in eczema, blackheads or pimples, and that occur naturally in food. All these Agni. Examples of Ama production water retention. The key word for impurities are collectively referred to are: balance is ‘cleansing.’ Kapha skin as ‘Ama’ in Vedic terminology. tends to accumulate toxins and needs 1. Ama due to increased Vata with frequent in-depth cleansing. A prop- Ama in the blood vessels can be high Agni or low Agni understood as the accumulation of er Ayurvedic cleanser that exfoliates 2. Ama causing heaviness in the phys- lipids and other substances in the without removing the natural mois- iology – due to increased Kapha walls of the blood vessels, which caus- ture of the skin is best. Ayurveda rec- with low Agni ommends first loosening the impuri- es plaque formation that results in blockage of blood flow. At the cellular 3. Highly reactive Ama – due to ties by lubricating the skin with a increased Pitta with sharp Agni. nourishing substance such as herbal- level, damage from Ama can occur at ized oil, milk, etc. and then applying various sites. Damage to the cell The primary source of Ama is the a mask which has both cleansing and membranes results in the inability of digestive system but Ama can also be nourishing effects. Excessive use of exchange of substances, including produced in the liver or at other tis- oils and a diet of overly sweet foods nutrients, between the intracellular sue levels, depending on the etiologi- are not recommended. and extracellular environments. cal factor. Agni disturbance in the Damage to cell receptors hinders the digestive system is responsible for the Education courses in Ayurveda action of hormones and other impor- creation of Ama that leads to 80% of cover details of the management of tant biochemicals at the cellular level. all disease processes. skin disorders. Ancient Ayurvedic wis- Damage to mitochondria interferes Symptoms of Common Ama dom, the most comprehensive sci- with energy production at the cellular ence of health and prevention, can be level. Damage to DNA causes muta- • Excess fatigue or sleepiness after very helpful in common as well as tion and can result in initiation of the lunch chronic skin conditions in this mod- cancer process. Cellular damage at • Coated tongue ern age. these various sites results in the initi- • Stiffness in joints and muscles ◆ ◆ ◆ ◆ ◆ ◆ ation of the disease process in most (Continued on next page)

AAPI Journal May/June 2004 29 Special Series: Complementary and Alternative Medicine

AYURVEDIC CONCEPT… Continued B. Daily Routine - Violence • Early to bed (by 10 or 10:30 PM) - Harsh or hurtful speech • Decreased immunity, e.g. getting and early to rise (6 or 6:30 AM) flu, colds, or infections easily - Conceit • Cold hands and feet; decreased • Avoid daytime naps - Speaking ill of others behind blood circulation • Light breakfast (before 8 AM) their backs • Drowsiness and light dinner (before 6 PM) - Egotism • A feeling of slowness or sluggish- • Main meal of the day should be ness in activity - Dishonesty at or near Noon • Heaviness and headache - Coveting another’s spouse or • Lack of handling stress • Moderate exercise (exerting to wealth • Discoloration of skin half of one’s maximum capacity) D. Seasonal Imbalance • Slower functioning of eyes and – morning is best time, from organs sunrise to 10 AM Each season exhibits predomi- • Constipation, diarrhea, slower or C. Behavior nance of one dosha, which requires sluggish digestion balancing according to Ayurvedic • If mentally or emotionally dis- body type. Management of Common Ama turbed, or physically exhausted, breathe deeply and slowly to 3. Ama Pachana (Digesting Ama) 1. Nidan Parivarjan – identifying the regain balance in the system. A. Diet etiological factor and correcting it. • Maintain coordination between ¥ Drink plenty of warm fluids The etiological factor could be the mind, heart, senses, and ¥ Eat lighter foods according related to diet, daily routine, spirit. behavior, or seasonal imbalance. to Ayurvedic body type Ways to do this: 2. Pacify the dosha (Vata, Pitta, or ¥ Cumin is the best spice for Kapha) that is the root cause of Ama: - Yoga Ama Pachana A.Proper Diet - Meditation ¥ Spice mixture (powder): Mix together equal parts of • Eat according to Ayurvedic con - Sattvic life – Achara Rasayana (Behavior Rasayana): cumin, coriander, fennel, stitutional body type and turmeric. Use 1 tea • Avoid: Behaviors and attitudes to be maxi- spoon of this spice mixture _ Leftovers, highly processed mized: per person per meal when foods, foods with artificial - Love cooking vegetables or soups. ingredients or additives, and - Compassion ¥ Eat a slice of fresh ginger fast foods - Speech that uplifts people root with lime juice and salt _Mutually contradictory foods, just before lunch and dinner. e.g. mixing milk with other foods - Cleanliness ¥ Digestive preparations. _ Eating an excess of foods with a - Charity and regular donation single taste 4. Shodhana – Detoxification or _ Eating foods that are too hot or - Religious observance clearing Ama from the physiology. too cold - Respect towards teachers and This involves regulating bowel _ Ice-cold beverages and foods elders movement by diet and herbal mix- _ Overeating, even if eating - Being positive tures, and Panchakarma (Ayurvedic wholesome food - Moderation and self-control, purification and rejuvenation proce- _ Eating before previous meal is dure). digested especially with regard to alco- _ Skipping meals; maintain a reg- hol and sex In conclusion, according to ular eating schedule - Simplicity Ayurveda the prevention of Ama _ Eating too quickly accumulation in the physiology is of Behaviors and attitudes to be avoid- utmost importance in the prevention _ Eating when mentally or emo- ed: tionally disturbed, or physically of disease. exhausted - Anger ◆ ◆ ◆ ◆ ◆ ◆ 30 AAPI Journal May/June 2004 Special Series: Complementary and Alternative Medicine

MARMA THERAPY AND ACUPUNCTURE

arma therapy is one of down through a lineage of guru to Ayurveda’s best kept disciple, Ayurvedic clinicians further secrets. It is the science of developed the association between M individual marmani and their effect utilizing vital energy points for heal- ing the body, mind, and spirit. on the bodily doshas, dhatus (tis- Anisha Tambay, Dipl.Ac, M.S.O.M. Marma is defined as a vulnerable sues), srotas (channels), and organs. Email: [email protected] They experimented with stimulating area or a secretive, hidden, or deli- the body surface and interior path- these points through pressure, mas- cate point. Marma is the singular ways linking them to the internal sage, and application of herbal oils form and marmani the plural form. organs. The Chinese also document- and pastes. Marmani science was There are a total of 108 primary mar- ed innumerable extra points that are integrated especially within the mani on the body surface. not located on the meridian path- framework of panchakarma massage. Knowledge of marmani can be ways. Acupuncture, a subset of Panchakarma is a detoxification and traced back to Vedic times when cer- Traditional Chinese Medicine rejuvenation process that aims to bal- tain martial arts schools in India used (TCM), originated 3000 years ago, ance the body’s doshas and return the these energy points to inflict damage whereas Ayurveda is 5000 years old. body and mind to optimal health. on opponents in battle and for self- During the massage, skilled thera- The principle of acupuncture healing purposes to recover from pists give special emphasis to the therapy is that by stimulating acu- bodily injuries. Kaleri martial arts marmani enhancing the flow of points the flow of Qi (pronounced school and Dhanurvidya, the school Prana. chi) is regulated. A disruption in the of ancient Vedic archery, are the two flow of Qi can create pain, stagna- The first signs of Acupuncture most well known examples. Marma is tion, and many other signs and symp- were also discovered in ancient derived from the etymological root toms. This correlates to Sushruta’s India. The marmani were stimulated mar which means to kill. Pressure at understanding of Pranic flow to the with metal rods: gold for vata, silver certain vital marmani located at the energy points and how this flow, for pitta, and bronze or copper for heart, trachea, or testicles can cause when disrupted, can harm the body kapha. Suchi is the Ayurvedic term instant death. or mind. The ancient rishis of India for needle, implying the points were Sushruta, a famous Ayurvedic also mapped out Pranic flow within punctured for therapeutic purposes. physician, is recognized for integrat- the body’s 72,000 nadis or subtle This science did not develop further ing the science of marmani into the channels of energy. These nadis dif- in India because of the concept of medical system of Ayurveda. Also fer from meridians in that they are ahimsa- non-violence. Many practi- heralded as the father of surgery, internal pathways not mapped onto tioners believed gentle pressure on Sushruta applied this knowledge to the body surface. Thus, marmani and the points was sufficient for healing. his field. He believed that marmani acupoints are similar in that they reg- were vital because of the increased The Chinese enhanced the ulate the flow of Qi or Prana, thereby flow of Prana to those areas. Thus, he Ayurvedic understanding of energy promoting health and balance. points and took this science to a stressed the importance of precise These points have several impor- deeper level. They documented 361 surgical incisions to avoid injury to tant functions that shed light on why primary acupoints. Seventy of the the marmani and minimal distur- they are so instrumental in healing. 108 marmani correspond exactly to bance to the flow of Prana. In the Marmani serve as vehicles for com- these primary acupoints. Many of the sharirasthanam section of the munication because they enhance remaining marmani are in close prox- Sushruta Samhita he elaborates on the flow of Prana, the body’s intelli- imity to acupoints while only a few of marmani locations and indications. gence. They can be used for diagno- them do not correspond at all. The Due to Sushruta’s contributions, the sis by simple palpation to detect dis- primary acupoints are those located knowledge of marmani spread and turbance of doshas, dhatus, srotas, or on the fourteen principal meridians. was assimilated in Ayurveda. organs. Similarly, these same points Meridians are channels of energy As this information was passed can be used therapeutically to flow that have exterior pathways on (Continued on page 33) AAPI Journal May/June 2004 31 Special Series: Complementary and Alternative Medicine

PROBIOTICS, BIOTECHNOLOGY, AND AYURVEDIC HERBS M.S. Reddy, Ph.D., IMAC, Inc., Denver, CO, USA and D.R.K. Reddy, ADFAC Labs, Pvt. Ltd., Hyderabad, A.P., India Email: [email protected]

M.S. Reddy, Ph.D. odern allopathic medicine deals with Probiotics that comple- has made significant ment Ayurvedic therapy to treat progress during the 20th chronic diseases that allopathic med- M icine or Ayurvedic therapy by them- century in the fields of disease diag- cinogens. Probiotics help to pre- nosis, surgery, and the invention of selves are not able to treat. Before we vent colon cancer by suppressing new pharmaceutical drugs. proceed further let us review the the organisms that produce these However, if you read the instructions benefits of Probiotics and Ayurveda enzymes and reactions. given with each modern pharmaceu- individually. 4. To improve lactose intolerance in tical drug, the list of side effects are those who cannot digest lactose. longer than its curative properties. Probiotics 5. To suppress Rotavirus diarrhea This is rather unfortunate. It has As early as 1907 Dr. and Traveler’s diarrhea. been recently reported that over 30% Metchnikoff, a Russian doctor, 6. To produce immunomodulation of the diseases today are due to side hypothesized and discovered that leading to the production of effects caused by the use of FDA- lactic acid-producing bacteria such as Immunoglobulin A in Rotavirus approved or over-the-counter allo- Lactobacillus acidophilus adminis- infection, thus enhancing phagocy- pathic drugs. An allopathic practi- tered orally stopped intestinal ail- tosis. tioner is trained to determine the eti- ments in humans. A tremendous 7. To reduce the recurrence of super- ology of disease so that he/she can amount of research was done in this ficial bladder cancer, prolong the treat the core cause. Unfortunately, area to prove the beneficial effects of survival time in cervical cancer, the etiology of some diseases is hard lactic acid-producing bacteria in and reduce re-infection in bacteri- to pinpoint in a short span of time humans. al vaginosis. and the etiology of some diseases is The word Probiotic is derived 8. To displace pathogenic organisms not known. Consequently, allopathic from two Greek words meaning “for by competing for nutrients and practitioners are forced to treat the life.” Fuller in 1989 redefined adherence to cells in the gastroin- symptoms of disease with available Probiotics as live microbial supple- testinal tract. medicines rather than treating the ments that bestow beneficial effects 9. To decrease serum cholesterol by core cause of the disease. on the host by improving the intes- direct interference with choles- Some alternative medicines treat tinal microbial balance. The main terol absorption. the whole body in order to alleviate medical uses of Probiotics are as fol- 10. To produce an immunomodulato- disease. This is called a holistic med- lows: ry effect through macrophages and ical approach. In my opinion, a treat- 1. To increase bioavailability of vita- lymphoid cells by the production ment should be aimed at alleviating mins and minerals by lowering the of metabolites. the core cause of the disease rather colonic pH. The selection criteria for desired than reduction of symptoms. 2. To provide a source (the bacterial Probiotic organisms are as follows: Ayurveda is one form of alternative mass) for nutrients such as thi- 1. Must be of human origin, if medicine that is gaining popularity in amine, riboflavin, folic acid, vita- intended for human use this decade. I would like to introduce min B12, pantothenic acid, and 2. High acid and bile stability a new alternative treatment called short-chain fatty acids. 3. Adhesion to intestinal mucosa Probiotic therapy. Perhaps Probiotic 3. To reduce the production of bacte- 4. Safe for food and clinical use (Gras therapy cannot stand alone. It should rial enzymes in feces by suppress- status) be complemented with other thera- ing bacteria that produce enzymes pies on a routine basis. This paper and convert procarcinogens to car- (Continued on next page) 32 AAPI Journal May/June 2004 Special Series: Complementary and Alternative Medicine MARMA THERAPY AND ACUPUNCTURE Continued from page 31

PROBIOTICS, … Continued address these disturbances. Marma stimulation can provide local pain relief. They also kindle agni (the fire principle) and thereby cleanse the 5. Clinically validated and document- herb. body by eliminating toxins. In addition, ed health effects The above scenario makes sense marmani help to calm the mind and 6. Good technological properties. because we have discovered that balance emotions. Regular stimulation Ayurvedic preparations blended with of marmani can also be used for pre- Ayurveda beneficial Probiotics have exhibited ventive care. Ayurveda is an ancient system of enhanced drug activity and effective- On a spiritual level, these energy medicine that originated in India ness without any side effects. points enhance awareness. During around or before 2500 B.C. The term Perhaps herbs also serve as prebi- shaktipat, spiritual initiation, the guru Ayurveda means “knowledge of life.” otics to improve the beneficial bacte- transmits higher awareness into a disci- It is a form of holistic therapy that rial cell population in the human gas- ple by stimulating Ajnya marma, locat- also uses combinations of herbs to trointestinal tract. The Prebiotic, ed at the third eye. Thus, the ability of treat ailments. The belief is that unlike the Probiotic, is a non-viable marmani to awaken spiritual energy herbs will have the active principle entity and a non-digestible food has been well known in India since come into contact with nutrients and ingredient that beneficially affects ancient times. Marmani also correlate buffers. Such a preparation will not the host by selectively stimulating the to the chakra system. Each energy cen- give any side effects when consumed growth and/or activity of one or a lim- ter is connected to the pranic nadis because the active therapeutic prin- ited number of bacteria in the colon that also link to individual marmani. ciple is naturally buffered. Generally, that can improve the health of the Ayurvedic preparations are formulat- host. Treatment of these points can be ed by blending several complemen- fairly easily and routinely done in con- Our invention of enhanced tary herbs. The idea is to counteract ventional clinical settings by physicians Ayurvedic herb activity with added the adverse effect of one herb with and therapists for commonly occurring Probiotics may be due to synbiotic the other. Consequently the host will problems such as back pain, effect. A synbiotic is a combination of not have any side effects from the headaches, and anxiety amongst oth- Probiotic and Prebiotic, where a live herbs. Ayurvedic preparations are ers. The patients can also be educated microbial addition may be used in excellent for treating chronic dis- about these points and how to do a self- conjunction with a specific substrate eases. treatment. There is a vast scope for uti- for the growth. With the introduction of allo- lizing marma therapy in all healing pro- pathic medicines, the popularity of To summarize, Probiotic therapy fessions. is not a replacement for allopathy or Ayurveda progressively declined in In conclusion, marma therapy is a Ayurveda or any other system of the twentieth century. The fast-act- profound science. Originating in medicine. It is a complementary ing allopathic medicines became the ancient India, it inspired the develop- therapy which should go hand in treatment of choice for medical prac- ment of acupuncture and still has hand with allopathic and alternative titioners. Another factor that con- diverse applications for medicine medicine to improve the efficacy of tributed to the decrease in popularity today. Marma science can be integrat- treatments and decrease unwanted of Ayurvedic preparations was an ed with modern medical knowledge in side effects. inconsistency in their efficacy. This each physician’s respective field. was due to lack of compliance in ◆ ◆ ◆ ◆ ◆ ◆ Patients will benefit from studying good manufacturing practices. marmani for their own self-healing and Perhaps it was also due to the to achieve balance between body, destruction of specific microorgan- mind, and spirit. For comprehensive isms present on a particular herb. It information on marma therapy, Dr. is possible that the main therapeutic Vasant Lad and Anisha Tambay have effect of the Ayurvedic herb was due written a reference book that is due in to a synergy between the naturally print in 2004. inhabited microorganism and the ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 33 Special Series: Complementary and Alternative Medicine

INTEGRATED MEDICINE: HERBS AND DRUGS

ince time immemorial different physicians want to learn about CAM. medical systems have been For many health problems patients integrated. Several systems of prefer herbs because they provide S benefits that drugs do not, while for Complementary and Alternative Medicine (CAM) integrate herbs and other health conditions patients Ranvir Pahwa, PhD, PGDTox, HD, drugs successfully. Herbs are phar- depend on prescription drugs as the DrAc, RClH only source of relief. Herbs and Clinical Assistant Professor, Department of macologically active natural products Pathology, College of Medicine, and are often taken with drugs. The drugs can be taken together for cer- University of Saskatchewan, Saskatoon, Canada chances of interactions are very like- tain health problems, but caution Email: [email protected] ly. This article provides information should be exercised when integrating about the integration of herbs with herbs and drugs, just as caution is the organs and organ systems. required when taking two or more drugs. Cardiovascular effects: Hawthorn drugs together. There is a lack of The modalities of modern medi- can be used in mild cardiac insuffi- research on the interaction of drugs cine have resulted in several adverse ciency, mild forms of bradycardial and herbs. Understanding the phar- and toxic side effects. Do we practice arrythmias, and to regulate blood macology of drugs and herbs and the "Do no harm" medicine? Ayurveda pressure. Arjuna, an Ayurvedic herb, mechanisms by which their interac- recommended this before any other has also been reported as good for tions proceed can assist in predicting system of medicine. People are now treating heart conditions. It is used as or allowing early recognition of drug- detouring from modern medicine to a cardiac tonic and for cardiac failure herb interactions. It is a vast area but find a safer system. Herbs and other and dropsy. It also relieves hyperten- certain issues and concerns must be CAM modalities have made a come- sion. Use caution when taking these addressed. The interactions of herbs back, along with many new sciences. herbs in conjunction with drugs for and drugs can be categorized as fol- Some of the reasons that prompted cardiac conditions. lows: people to look for alternatives are: (a) Positive interactions: Herbs Ginseng may interfere with the (a) Unwanted side effects of supporting drug functions action of digoxin. St. John’s wort may drugs (b) Adverse drug interactions increase blood pressure and cause (b) Inability to manage chronic (c) No interactions confusion and drowsiness. Black ailments cohosh may decrease blood pressure. Some common examples of (c) Surgery was not always suc- herb-drug interactions are discussed Diuretic effects: The following cessful in improving health below. herbs possess diuretic action: condition berberis, corn silk, couch grass, dan- Anticoagulant effects: Butchers (d) Several research studies have delion, horsetail, parsley, juniper broom, feverfew, alfalfa, sweet proven that CAM modalities berry, and uva-ursi. Dosages of clover, chamomile, cayenne, licorice, are safe and effective diuretic drugs should be adjusted dong quai, garlic, ginger, ginseng, (e) Inclination toward self-health- when these herbs are taken. In addi- gingko biloba, and kava kava show an care; improvement in diet and tion to diuretic properties these anticoagulant effect. Dosage adjust- lifestyle. herbs have other benefits for which ment and monitoring of coagulation Patients are taking herbs along patients are inclined to take them. time are needed when anticoagulant with drugs because herbs are safer For example, parsley is nutritive, drugs are taken along with these and generally do not have toxic side dandelion is a liver tonic, juniper herbs. effects. There is a dilemma among berry and uva-ursi are anti-infective, practitioners as to whether integrat- Anticoagulants can also alter the and corn silk helps treat inconti- ed medicine is safe or not. However, transport of medicine due to low vis- nence. many physicians are cooperating cosity of the blood. This can hasten with patients who use these modali- the elimination time or increase the Estrogenic activity: Use of estro- ties and an increasing number of toxic effects of herbs and drugs on (Continued on next page)

34 AAPI Journal May/June 2004 Special Series: Complementary and Alternative Medicine

INTEGRATED … hypokalemia. combining herbs as in Continued (b) Uva-ursi may interfere with Ayurvedic and Chinese medi- the absorption of several alka cine. Combining herbs without genic herbs such as black cohosh, loid drugs. the knowledge of their energy dong quai, chaste berry, red clover, (c) Tannic acids in St. John’s wort can lead to toxic side effects. and wild yam should be monitored and Saw Palmetto may inhibit Recently a formula for post- in patients taking hormone replace- iron absorption, undermining menopausal syndrome that ment therapy drugs. the benefits of prescribed contained all the available Anti-cold and Anti-cough medi- anemia drugs. estrogenic herbs caused severe cines: Herbal and aromatic oils are (d) Ginseng may cause headaches, diarrhea (personal communi sometimes incorporated into cold tremulousness, and manic cation). and cough medicines. Recently the episodes if taken with the anti- (c) It is important to know that herb Echinacea has been incorpo- depressant phenelzine sulfate. herbs can interact with other rated into over-the-counter cough (e) Milk thistle has been reported herbs in the same way that syrup. Echinacea boosts the to reduce and prevent toxic drugs can interact with other immune system and is reported to side effects in the liver caused drugs. The chance of interac- increase T- and B-lymphocytes. It by drugs. tions is enhanced by the pur- may have positive effects after There are no reports of adverse chase of over-the-counter chemotherapy also. Echinacea may interactions for many herbs, howev- products by people who are show adverse effects in patients er caution should still be exercised. not knowledgeable about herbs. with autoimmune disorders and it Caution should also be exercised in Healthcare practitioners are may negate the effects of immuno- prescribing herbs during pregnancy. responsible for finding better and suppressants such as cyclosporine. safer ways to integrate medicine Other valuable suggestions: and must exercise sound judgment Miscellaneous: (a) Do liver and/or kidney func- in this area. We encourage health- (a) Patients undergoing surgery tion tests before, during, and care providers to expand their have possible risks if taking after the use of herbs to check knowledge of herbs through educa- the herbs mentioned above for any toxicity. tion courses and thereby prevent that affect coagulation time (b) Herbal energetics: Western unintended interactions. and blood pressure. In addi- herbal formulas are not based tion, licorice may cause on the energy principles of ◆ ◆ ◆ ◆ ◆ ◆

Saving Medical Practice… Continued from page 21

islative session in Washington said, “A medical liability bill could return to the Senate in the next few weeks. However, fixing the liability problem at the national level does not appear to be happening soon without a signifi- cant change in the political makeup of the U.S. Senate. This has turned into a partisan fight and we need to gar- ner support from both sides of the aisle. If physicians want liability reform to pass in the next session of Congress, they need to get busy in U.S. Senate races AAPI EXECUTIVE OFFICE across the country to change the representation in the 17W300 22nd Street, Suite 300A • Oakbrook Terrace, IL 60181-4490 U.S. Senate. Telephone: 630-530-2277 • Toll Free 1-800-622-7499 Fax: 630-530-2475 • Email: [email protected] A meaningful liability reform is necessary for us Website: www.aapiusa.org to continue to practice medicine in ones chosen special- AAPI LEGISLATIVE OFFICE ty, geographic location and the patients we want to serve. 1818 N Street NW, Suite 700 • Washington, DC 20036 ◆ ◆ ◆ ◆ ◆ ◆ Telephone: 202-331-0343 Fax: 202-331-9306 • Email: [email protected]

AAPI Journal May/June 2004 35 Special Series: Complementary and Alternative Medicine

SELF-ECOLOGY WITH YOGA

“Happiness is freedom from fear” and understanding of Yoga. Yoga is defined as “Yogaha, he science of Yoga is holistic Chitta, Vrutti, Nirodhaha” “Yoga living and spiritual thinking. It Sutra Of Patanjali” (1:2), which Tis Consciousness based. It pro- means that one is a yogi, who has no Veena S. Gandhi, M.D. vides healthy contented living, joyful modifications of mind, one who has disposition and progressive under- equanimity in all the circumstances standing of subtleties of the universe. good-bad, success-failure and ple, Arjuna during his discourse on The meaning and very existence through all the dualities. “Yogaha the battlefield in Mahabharata in of life unfolds as one progresses and Bhagavad Gita. Another very well then no mundane pleasures seem known book and step-by-step essential or important. The meaning approach to control the mind, which of “Love” starts unfolding. is “Raja Yoga”, is “Yoga Sutra of Patanjali”. The word “Freedom” becomes much more meaningful and “Self” With the crowning of Swami shines with all its glory, unparallel, Vivekananda as the best speaker in absolute and infinite, “one without “Parliament of Religion” in 1893 in second”. Chicago, all aspects of Vendanta and Yoga were introduced and recognized Sri Shankaracharya, the great in U.S.A. Sri Yogananda guru and visionary of Sanatana Paramahansa, author of the well- Dharma has said that three things known great book “Autobiography of are the most valuable and rare to a Yogi” also followed to enhance the find. The human birth, desire to get depth of these principles and intro- liberated (moksha) and sat-sang. duced fellowship through his loving “Sat-Sang” is company of spiritual techniques. Swami Rama Tirth gave people, which by their presence and great stimulus to people on this topic. vibrations lead the people towards joy and bliss. In the modern times Vivekananda Yoga Research and All human pursuits are for Application, Bangalore based Yoga achieving happiness in life, but every institution and its branches in U.S.A. minute one finds oneself falling short called “VYASA”, Pandit Rajmani from this goal. One starts with a Samatvam Uchyate” Bhagavad Gita Tiguniat of Himalayan Institute, PA. desire, works hard to achieve it and (2:48). It leads one to perfection in Dr. Shivananda and his disciples Pu. no sooner it is fulfilled, one feels work “Yogaha Karmasu Kaushalam” Swami Vishnu Devananda with empty or the urge to start with a new Bhagavad Gita (2:50) Shivananda center in Canada. Pu. passion and thus it is an endless chain Yoga come from the word “Yuj “ Sacchidananda of Lotus temple in of passion. One is never contented meaning “union”. It is one of the six West Virginia (Dr. Dean Ornish’s and always running in circles philosophies of Sanatana Dharma. Guru), Pu. Jyotirmayananda in throughout life. Worldly passion Many sages have expounded on it. Miami, Shri Yogi Hari in Miami and seems to cause scientific progress One in particular was Lord Krishna. Sri Sri Ravi Shankar through “Art of and avails sensual pleasures, but to He imparted different philosophies Living Foundation” are doing great be truly happy, one needs higher and types of yoga mainly Gnana Yoga work in teaching Yoga and through goals and deeper understanding. or Yoga of knowledge, Karma Yoga or Yoga – World Peace. Then what is the solution? How does Yoga of action, Bhakti Yoga or Yoga one stop this cycle of discontent and of devotion and Raja Yoga or Yoga of the rat race? It is through the science controlling mind to his beloved disci- (Continued on next page)

36 AAPI Journal May/June 2004 Special Series: Complementary and Alternative Medicine OUR LEGISLATIVE DAY AT THE CAPITOL Continued

SELF-ECOLOGY … Continued Do them to the best of your capacity. Do Not Become Over took time out to welcome the AAPI members to Washington, D.C. This list How to start “YOGA” Enthusiastic, Take time. End with deep relaxation. Short or long medita- included the distinguished Senators No matter who you are, at what a tion session is very fulfilling. Now you Thad Cochran (R-MS), Paul Sarbanes stage in your life, whatever may be may vary the duration of Asanas, (D-MD), and, most importantly, the your religion, race or nationality, you Pranayama and Mediation. You will Senate Majority Leader, Bill Frist (R- can start Yoga. It is a self-ecology. find a great joy as you advance and TX). Senator Frist, a physician, dis- To learn basic yoga and to start, will have your own routines. At times cussed a host of health care-related you can look for the authentic Yoga you may feel lazy to do it for a day or issues with the AAPI audience. Also center in your city. If none is avail- days. Try your best – do not ever get joining them were Congressmen Chris able, then take a little time out for 5- disheartened. You will restart again. Van Hollen (D-MD) and Phil Gingrey 7 days and go to a Yoga retreat at the Such cycles are common to all. (R-GA). The dinner program featured centers mentioned in the previous Include your family if possible for welcome addresses from Dr. Sharad paragraph. They all will give a great Yoga retreats. Later on, chanting ses- Lakhanpal and Dr. Rakesh Shreedhar, start and subsequently you will find a sions, seminars, reading books on Congressmen Joe Wilson (R-SC) and whole Yoga world where number of Yoga all enhance the growth. Joe Crowley (D-NY), Co-Chairs of the places and people are associated. India Caucus, and uplifting remarks It is really an essence of our from India’s Ambassador to the United Guide Lines For Yoga Session “Being”. It is a reconditioning – so that States, the Honorable Lalit Mansingh. Once basic is learned, set aside a a lot of your mundane habits will Particularly remarkable was the trib- time to do it everyday. It can be even change and drop out. Your intuitions ute AAPI received from Congress-man small sessions of 15 to 20 minutes. improves. Your inner strength and con- Pallone who, along with a bipartisan Consistency will be of great help. Ideally fidence leads to better decisions. It group of 26 other members of Congress, 30 minutes in the morning and/or improves will power and helps in introduced a resolution before the U.S. evening before dinner will be great. improving vices. Your emotions bal- House of Representatives (H.Res. 579) ance better and your mind starts enjoy- The practice should include honoring AAPI and requesting the U.S. ing solitude and peace. A lot of physical some postures, which can vary Congress establish an “AAPI Day”. With healing also takes place and common depending on your physical stamina your help, we hope other members of ailments start improving. You are with at that time of the day, some Congress will co-sponsor this resolution the world, but still you learn to be by Pranayama and meditation. Finish in the coming months to ensure its suc- yourself in this journey of life. all-important chores and telephones cess! before you start; let your family know The postures (asanas), the The highlight of the dinner, and your routines, so that you have com- breathing techniques (pranayama) arguably of the entire conference, was plete peace and freedom. and meditation leads to joy that are the keynote speech by Senator John incomparable to any joy in the world. Cornyn (R-TX), during which he for- Set aside a clean and quiet place. Treasure is within. mally announced the formation of the Also do not take food in that area. You U.S. Senate “Friends of India”, a body may keep other stimulating aids As a practicing physician it is now to serve as the Senate counterpart to around, like burning incense, your Ista time to progress towards “Yoga ther- the House of Representatives’ India Deva’s picture, other natural synergies apy”. Yoga therapy is a complimenta- Caucus. The spectacular evening or soothing music in the beginning. ry medicine, which benefits in all the common diseases like diabetes, ended with noteworthy remarks from Do it only on an empty stomach at bronchial asthma, essential hyperten- Ambassador Agnihotri and a vote of least for two hours. You may take clear sion, myocardial infarction, depres- thanks from the Chair of the AAPI liquid. Wear loose comfortable clothes. sion, anxiety, irritable bowel syn- Board of Trustees, V.H. Reddy. Try to do it in open space, if possible. drome and of course day-to-day Overall, although AAPI’s 7th Postures should be started with center- stress and strains of modern life. Annual Legislative Conference was a ing and loosening exercises. Postures smashing success, we fully expect the should always be coordinated with Let us humbly resolve in our own 2005 event to be even better! breathing. Do few Pranayama in the heart to progress and grow from beginning to quiet the mind. chaos to calm, efficient, contented ◆ ◆ ◆ ◆ ◆ ◆ Mindfulness or awareness is a “MUST”. and joyful living with Yoga. ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 37 Special Series: Complementary and Alternative Medicine

FIRST AAPI AYURVEDA CONFERENCE Hari Sharma, M.D., FRCPC Chair, Integrated Medicine Committee, AAPI Email: [email protected]

API held its first dents, and any other pri- Ayurveda mary health care AConference on providers.” March 19-21, 2004 in • “I would request the Orlando, Florida. This was Ayurvedic Executive the first conference com- Committee and also the pletely devoted to AAPI Governing Body to Ayurveda, the compre- organize more Ayurveda hensive system of natural conferences not only for health care that originated the AAPI members but for in India. The Ayurveda all those who are interest- Conference was attended ed in Ayurveda, Yoga, or by 33 participants and Meditation. There is proved to be a complete The faculty and the participants with the President of AAPI increasing awareness about success. attendance. The role of probiotics these ancient Indian sci- Most of the participants were was also an eye-opener to everyone. ences in the U.S. and the world pop- practicing physicians, with a few The participants were extremely ulation in general. We, as Indians medical residents, nurses, and phar- impressed with the abundance of sci- need to take the lead in educating macists also in attendance. They entific validation that was presented the world about our ancient sci- came from all across the U.S., includ- at the Conference. ences and our rich Indian, heritage rather than being taught our own ing the state of Washington, There was lively interaction science by others. And therefore Massachusetts, Florida, Ohio, New between the faculty and participants. there is a great need for such con- Jersey, Kentucky, New Mexico, Many questions were asked and dis- ferences. There should also be more Colorado, Pennsylvania, Michigan, cussed at length, showing the depth exposure, advertisement, funding Maine, and Texas. Every participant of knowledge that was present and for such conferences, so that inter- was very happy they attended this available to all there. Everyone that ested people can be exposed and conference. They got a taste of attended wants to learn more about attend and learn from these won- Ayurveda starting with the basic fun- Ayurveda and indicated intense derful conferences.” damentals and the eight different interest in having more conferences ways of examining the patient. on this topic. They all wanted to Some of the points raised at the Participants were especially interest- come back for more and bring their Conference include the following: ed in finding out how much informa- friends with them. 1. There was a suggestion to create tion can be gained through observa- Some of the comments from the an Ayurveda Education and tion of the patient’s general appear- Conference participants were: Research Committee within AAPI ance, tongue examination, urine and have a series of educational examination, and particularly the • “For me, a potentially life-trans- seminars to provide certification in Ayurvedic method of pulse examina- forming exposure to Ayurveda.” Ayurveda. tion. Most of the participants also • “Truly a great conference! There 2. Some medical residents and learned mseditation and were happy was a lot of practical take-home practicing physicians expressed and excited to have this profound information. The topics were excel- interest in spending 3-6 months technology for their personal use. lent. The presenters were knowl- studying Ayurveda. Constitutional typing, the diet (in edgeable and dynamic.” detail), and management of common 3. The medical residents want to • “A must for anyone interested in gastrointestinal, skin, and gynecolog- start a sub-chapter within the AAPI Ayurveda. It is a great beginning ical disorders were other topics that Integrated Medicine Committee to step for medical students, resi- intrigued and fascinated those in (Continued on next page)

38 AAPI Journal May/June 2004 BOOK REVIEW

CT & MRI Pathology – A Pocket Atlas McGraw- Hill Professional 2003, 255 pages by: Michael L. Grey and Jagan Ailinani

adiology is a dynamic field, ever integral part of patient work up, the Rchanging with new modalities of trainees in the new millennium will imaging added periodically. CT and certainly need a quick reference MRI have virtually conquered our source on this modality as well. minds and have become the most The book opens with a chapter often used diagnostic tool in evalua- on principles on Computed Tomo- tion of a host of diseases. For the graphy and Magnetic Resonance young medical students and residents Imaging. The basic physics underly- of the patients. All systems are cov- who ask “what book can you recom- ing these two modalities are ered well. mend me for quick reference to explained in a simple fashion, easy to understand CT and MRI scans while Reviewed by: understand. This is the only chapter I see patients on the floor,” the for didactic reading. Meghal Antani, MD answer may be this pocket atlas. In fact, while we were residents some The rest of the book is simply Attending, Department of Radiology 20 years ago, we always carried the pictures, reproductions of images of Washington Hospital Center, indispensable Washington Manual. many representative diseases which Washington, DC Since imaging has become such an one comes across in the routine care ◆ ◆ ◆ ◆ ◆ ◆

FIRST AAPI … Continued promot research and education in Ayurveda. They also suggested starting 4 resident scholarships of $1000.00 each by donations from AAPI MDs or from grant funding. They were encouraged to work on these areas in associa- tion with the AAPI Integrated Medicine Committee. 4. There was a question raised regarding how an Ayurvedic physician can become an AAPI member and also regard- ing membership for non-Indians. 5. The National Ayurvedic Medical Association (NAMA) wants to actively work with AAPI to consolidate efforts in Ayurvedic education, research, and streamlining the cre- dentialing requirements for Ayurveda practice in the U.S. 6. A suggestion was raised for a liaison with Indian Ayurvedic Universities and the Government of India to finally start a certification program in Ayurveda in associa- tion with AAPI. 7. It was suggested that there be an Ayurveda section as part of the AAPI website. The AAPI Integrated Medicine Committee is very happy and thrilled by the enthusiasm, interest, and support for Ayurveda shown at the Conference. The Committee plans to have more Ayurveda conferences in the near future. Members will be informed via the AAPI Journal and e-mail. ◆ ◆ ◆ ◆ ◆ ◆

AAPI Journal May/June 2004 39 THE BEST OF AAPI HUMOR

DID YOU HAVE YOUR COLONOSCOPY?

Over 50? Ask us about Screening about half an hour, and most are per- Colonoscopy for Colon Polyps. formed in an outpatient set up. Conscious sedation with IV Demerol and versed or lately IV Diprivan P. K. Paul, MD, FACG eads the sign posted in our (anesthesiologists choice) are used Brooksville, FL office waiting room. A just before the procedure. Heart friendly patient asked me one R rate, blood pressure, and O2 satura- day, “Doc, when did you have yours?” tion are all monitored. Two colonoscopy?”, a frequently asked I didn’t realize the sign had the endoscopy assistants are required to question. Our endoscopy nurse potential to backfire. His next ques- aid with biopsies and polypectomies. drove home after her colonoscopy tion blew me off, “Is there a Do-it and the next morning she could not The mood in the scope room is yourself kit available? remember driving home at all. I’ve In the United States, President recomended that patients arrange for Reagan’s colonoscopy jump started their own transportation after the the demand for the procedure, and procedure, and now our hospital has recently most insurance companies made that a policy. started paying for the screening colonoscopy, so it made a lot of sense Most recently radiologists have when an elderly woman asked me been trying to take over our business during the middle of her with virtual colonoscopy, which is colonoscopy, “Does your mother similar to a CAT scan. If they find know what you do for a living?” something suspicious, the patient still must undergo the conventional We tell our patients that prepar- colonoscopy to confirm the finding ing for a colonoscopy is the worst and resolve the problem. My ques- part. Two days of liquid diet and tion to them is, “Can you diagnose drinking a gallon of that soda stuff Live and wiggly worms! the live, wiggly worm shown in this can really bloat one up. “Pour it into picture?” This was taken during one different glasses, like a cognac, wine, generally light. Occasionally we get of my recently performed colono- champagne, beer, etc. to make it patients practicing their stand-up scopies. I caught the worm by the more appealing and then drink it one comedy routines tail using biopsy forceps and pre- by one.” This was the advice from a sented it to the pathologist. She • “If you find gold in there, half is patient of mine who works as a bar- named it (see picture) Strongyloides mine” - patient tender. Another elderly patient Stercoralis. And a course of Mintezol • “Are we there yet?” – tired nurse decided to put a small bed in her 500 mg bid for 5 days – patient during a lengthy colonoscopy bathroom on the night of the colon cured. preparation. • “Is it going to come out of my throat?” – patient My conclusion in comparing the Each gastroenterologist has his • “Where do they meet?” – patient virtual to conventional colonoscopy is own way of colon prep. In our prac- during a combined upper and lower that, unlike virtual colonoscopy, real tice, two days of liquid diet and 3 endoscopy procedure. colonoscopy is both diagnostic and ounces of Fleets phosphosoda on the therapeutic. evening before the procedure have Patients are generally observed worked extremely well. Patients for about one hour after the proce- were happy to forget about the gallon dure. The anesthesia people love to ◆ ◆ ◆ ◆ ◆ ◆ drink. “recover” them. Generally, colonoscopies last “Can I drive back home after my

40 AAPI Journal May/June 2004 MEMBERS IN THE NEWS

Five AAPI doctors win prestigious AMA Prof. Bala V. Manyam Leadership Recognition S Secretary of Health and Human Drs. Marella Hanumadass, Rajendra Gupta, UServices, Tommy Thompson has Nick Shroff, Nalin Tolia, P. K. Vedanthan appointed Dr. Bala V. Manyam, Professor, Texas A & M University System rs. Marella Health Science Center College of DHanumadass of Medicine and Director, Plummer Chicago, Rajendra Movement Disorders Center to the Gupta of New Jersey, National Institutes of Health’s National Nick Shroff and Nalin Advisory Council for Complementary and Alternative Tolia of Texas, and Dr. Medicine (NIH/NCCAM) for a four-year term. Dr. Manyam P. K. Vedanthan of would be participating in matters related to the conduct and Colorado were five of support of the research, training and health information dis- the physicians honored semination recommendations to the Secretary of H& HS and by the AMA (American Medical Association) in the AMA - the Director of NIH/NCCAM. IMG Leadership recognition program for their leadership ★★★★★★★ qualities. They participated, by invitation, in the renowned AMA Leadership Training Program in Washington DC at the Young AAPI Member Wins Special Honors end of March. At the instance of the AMA – IMG Section, Vasant Jayasankar, M.D. this year, for the first time, 10 outstanding IMGs were select- ed for this honor five out of whom are AAPI members. r. Vasant Jayasankar’s article on ★★★★★★★ Dexperimental work using human growth hormone to prevent heart fail- BASIL VARKEY, M.D. ure following myocardial infarction (MI) is the lead article and cover page asil Varkey, M.D., Professor of of the April issue of the prestigious BMedicine in Pulmonary and Critical Journal of Cellular and Molecular Care at Medical College of Wisconsin was Cardiology. He did this work at the inducted into the College’s Society of University of Pennsylvania as a recipi- Teaching Scholars in 2000 and the Alpha ent of an NIH grant. Dr. Jayasankar’s novel therapeutic tech- Omega Alpha Honor Society in 2001. He nique employs a virus vector to transfer and over express was named Best Teacher of the Year three human growth hormone in a rat model of post-MI heart fail- times including the Ernest O. Henschel ure. This therapeutic modality may in the future be a useful Clinical Teaching Award from the 2001 senior class. Dr. Varkey adjunct to therapies following an MI. Dr. Jayasankar plans to directed the Pulmonary Fellowship Training Program for seven start cardiac surgery fellowship in 2005. years and was Associate Program Director for the Internal His many accolades include the Young Investigator Medicine Residency Program for eight years. In recognition of Award of the American College of Cardiology, Finalist in the his clinical accomplishments and his devotion to educational Vivien Thomas Young Investigator’s Award of the American excellence, the Medical College of Wisconsin conferred upon Heart Association, and the Young Investigator’s Award of the Basil Varkey recently its Distinguished Service Award. International Society for Heart Research, US Surgical Resident Award for 1999, 2002 and 2003 and the AAPI ★★★★★★★ Young Investigator Award. ★★★★★★★

Dr. Surendra Purohit urendra Purohit, MD, FACS is the 2004 recipient of the award for Oustanding SPhysicians, dedicated service to the comunity, and dedicated service to AAPI, which was awarded by the Louisiana Chapter of AAPI at the National AAPI Governing body Meeting held at the Sheraton Hotel in New Orleans, LA on March 6th, 2004. Honorable Ambassador-at Large Bishma Agnihotri was the Chief Guest of thebanquet and presented Dr. Purohit with the award. Dr. Purohit is one of the top General and Vascular Surgeons in private practice in New Orleans, 0

42 AAPI Journal May/June 2004