Brotherhood Dharma, Destiny and the American Dream (40 page)

I looked at all his computerized results and, lo and behold, the PCR test, which can detect even minute traces of the virus, came back negative.

“This is a miracle,” I said. “It’s possible you’re cured. I want to repeat this test in three months and again in a year, and if both those tests come back with no trace of the virus, then you’re cured.”

That is exactly what happened. A year later his liver enzymes remained completely normal and the most sophisticated possible test for the hepatitis C virus detected nothing. When I told him that he no longer needed to see me, he smiled.

“Dr. Chopra, is this a new treatment for chronic hepatitis C? Get a tick bite, get deathly ill, survive, and wipe out the virus?”

“No, that’s not the treatment,” I said. “But clearly there is an important clue here.” What likely happened is that in fighting the three life-threatening infections at once, his immune system had waged a majestic interferon response and wiped out the virus. The basis of
scientific evidence is that something is repeatable, and this certainly was not. In answer to my initial statement, there are no studies that showed this would work. It just did.

For me personally, I have also experienced things as a patient that I can’t explain scientifically. I have a herniated disk in my back as well as mild spinal stenosis. At times it got extremely painful, and to deal with it I was receiving an epidural of Novocain and long-acting steroids, treatment that provided substantial relief—but only for about a month.

In 2008 I was giving a lecture to four thousand clinicians in Houston. After answering several questions I stepped down from the podium to speak with several physicians who had stayed behind to ask me some follow-up questions. Before the last person asked his question, he noticed that I was looking extremely uncomfortable. I explained to him that I was experiencing pain in my lower back and I really needed to sit down. I invited him to join me in the faculty lounge for lunch.

When I told him about my lower back problems he offered to show me a form of Chinese exercise that he had used successfully with many patients. I was polite—I had been to some of the most knowledgeable doctors in the world and they had not been able to afford much relief. I certainly didn’t expect any better results from him. But right there and then, on the floor of the convention center, he demonstrated what he was talking about: Basically it consisted of bending at the knees and doing a hula hoop–type maneuver, left to right twenty-seven times, then right to left twenty-seven times. It had to be twenty-seven times, he explained. I tried it then and there and to my surprise felt significant relief. I made it part of my daily routine. I do it in the morning and on occasion in the evening—and since that time I have seldom needed an epidural. I have no idea how it works. There are no studies that show this mechanism, but it does work for me. I have a saying: I don’t argue with success.

The late South African writer Lyall Watson defined nonsense as “that which from our present state of mind is unintelligible.” Five
hundred years ago, if someone had predicted man would one day walk on the surface of the moon, it would have been considered blasphemy, and the man might have been hung in the public square. I’ve learned that just because we don’t have a mechanistic explanation doesn’t mean something is hogwash. The relief I experience from back pain tells me that every day.

So I listened to my brother speaking and I read his books and I paid attention to what he was saying. I think Deepak has a lot of wisdom and is able to connect the dots. He has also met and collaborated with some amazingly brilliant scientists and has been more than willing to conduct a dialogue with his critics. He ardently seeks out folks who are supportive of what he is saying as well as his fiercest critics. I very much admire that. I understand what he is saying in somewhat simplistic terms, and I recognize that it has become important for health care professionals to have an understanding of his philosophy.

There is one place where we are in complete agreement, and we should be, because it was the strongest lesson taught to us by our father. All medicine should start with the healer—whether it is a physician, a nurse, a nurse practitioner, an Ayurvedic physician—listening to the patient. It starts with listening to their story, listening with heart as well as mind. As he often said, every patient has a story to tell. In 2012 a lecture I had given often was published as the book
Leadership by Example: The Ten Key Principles of All Great Leaders.
The basis of the lecture and the book is that each letter of the word “leadership” stands for a memorable quality common to great leaders. The first one,
L,
stands for listening.

A colleague of mine, Dr. Richard Mollica, who heads the Harvard Program in Refugee Trauma, was treating a Cambodian woman who was suffering from myriad common symptoms, but he couldn’t seem to find the root cause. Finally he asked her to tell him about her family. She broke down and told him that most of her family had been massacred by the Khmer Rouge. She and one of her sons had somehow managed to survive and come to America—and then her son had died tragically. My colleague had asked; he had listened with
compassion. He held her hand and they prayed silently. After many years and scores of doctor visits, none of which had helped her, her healing began that day.

In Western medicine we haven’t learned how to listen to our patients. We ask the basic questions: How do you feel? What hurts? How long have you felt that way? We ask the same questions: What’s the major complaint, history of past illnesses, current medications, social history, occupational history—and then we write it all down and recommend a procedure or prescribe a pill. We may never find out that the reason they have those severe headaches is because they are tense and deeply depressed. We stop the headaches, but we have not addressed the root cause.

This is changing. My colleagues are beginning to understand they have to bring the patient into the conversation. Give them an opportunity to tell their story, and it may help discover the root cause. Western medicine has some wonderful medicines, and we are able to affect some miraculous cures. But too often in the past we relieved the symptoms without addressing the cause. That’s not a good fix.

This certainly is evidence of the impact Deepak and a number of the practitioners of complementary medicine, among them Dr. Dean Ornish and Andy Weil, have had on the medicine I practice. I sometimes think about the state of American medicine when we arrived in this country and how it has changed since then. We’ve moved a great distance from almost purely curative to recognizing the physician’s role in prevention. The medical community has become much more open to at least examining alternative therapies. There is little doubt that Deepak has been a leading force behind the acceptance of these once ignored or even ridiculed techniques. In the late Nineties I was working with my colleagues, Martin Abrahamson and the chairman of the Department of Medicine at Beth Israel Deaconess Medical Center, Dr. Robert Glickman, planning our annual Update in Internal Medicine conference. Dr. Glickman suggested we invite Deepak to speak, and every year since then he’s spoken as guest faculty and delivered the keynote address. It’s often a two-and-a-half-hour session on spirituality and healing, or a new paradigm of understanding
consciousness and how it can affect the way we deal with our patients. Many of the attendees consider it one of the highlights of the course.

As faculty dean for continuing education it is my honor and privilege to have 275 postgraduate courses come under my jurisdiction. In aggregate we reach out to seventy thousand clinicians each year. We are continually changing our presentation to reflect the evolution of medical thinking. A few years ago, for example, we added to our curriculum a new course directed by Dr. David Eisenberg that probably would not have been offered by Harvard Medical School in the past. This course is entitled Healthy Kitchens, Healthy Lives and recognizes the critical importance of diet in good health. The attendees learn medicine but are also taught to cook healthy meals. Indeed, half of the syllabus provided consists of recipes. They are encouraged to try them out and also share them with their patients.

For me that is simply additional evidence that modern medicine willingly embraces any techniques that can be proved to be beneficial to our patients. As Deepak has acknowledged, none of these mind-body systems are meant to be a replacement for sound medical practice, but rather they are meant to be integrated into our lives where they might help prevent or ameliorate disease.

There is no substitute for sound medical practice, based on a vast body of research, evidence, and experience. The musician Steven Tyler wrote about me in his autobiography. I received a call one day from his primary care physician, who asked if I’d ever heard of Tyler. I hadn’t. He explained that he was the lead singer of Aerosmith, that he was very famous, and that he was sick.

When I went out into my waiting room he was surrounded, not just by other patients waiting to see me but also by our staff. I took a detailed history, performed a physical examination, did some tests, and a few weeks later performed a liver biopsy. A few weeks later I diagnosed him as having a mild case of chronic hepatitis C. At that time the success rate for treatment—which consisted of six months of interferon injections—was pretty abysmal, no more than 10 percent. The appropriate decision at that time was to defer treatment. I
explained to him that there was substantial research into this disease being done in many academic centers throughout the world to refine treatments for his condition, and I recommended we wait and he see me on a yearly basis. Then I told him in very clear terms that he absolutely could not drink any alcohol.

“We have two eyes,” I said, “two lungs, two kidneys and—” and before I could finish the sentence he interrupted.

“Yeah, Doc. One liver.”

“You can’t even look at alcohol.” He was the rock star who couldn’t drink. I would monitor his condition as we awaited refinement in treatment. He had the advantage of being perfectly fit; there wasn’t an ounce of fat on his body. Over several years the treatment had evolved; with the strain of hepatitis C with which he was afflicted we had now reached a juncture where there was a 40 percent cure rate. This is how medical science marches forward.

“Steven, we should try the treatment now,” I suggested. “Neither time nor the Ganges waits.” There were side effects to consider: He would not be able to tour because he would need to see me frequently to be monitored, especially in the first three months because there were potentially significant and serious side effects. Those side effects included bone marrow suppression, nausea, vomiting, headaches, malaise, fevers, and hair loss.

Hair loss?

He was concerned about that. I assured him that my experience had been that hair always came back, and that it might even come back curly.

The treatment took a year. Steven was a dutiful patient. He kept every appointment. He adhered to the treatment. He was tenacious and handled the side effects very well. To reduce the discomfort I tell my patients they should be vigorously hydrated, try moderate exercise and massage, and then to help with the flulike symptoms caused by interferon, take up to four extra-strength Tylenol a day. When I talk to my patients about the Tylenol they are often astounded. Invariably they tell me that their primary care doctor warned them that Tylenol can cause liver damage and that they should never take it. That’s true,
I explained, but only when taken in much larger doses. You can take up to two grams a day, the equivalent of four extra-strength Tylenol. I insist that they record how much they take and when they take it, to prevent them from accidentally taking more than those two grams. Interferon can also cause some befuddlement, a mind fog, and I don’t want to chance any of my patients losing track of their dosage. Medicine is a science but also an art. That is the beauty of it.

The only chronic viral infection in human beings that we can eradicate is chronic hepatitis C. Every other chronic virus we can suppress but not eliminate. For example, if a patient had chickenpox as a child, it lives dormant in ganglion cells and under certain circumstances it can reappear as herpes zoster, commonly known as shingles.

After a year of treatment there was no detectable hepatitis C in Steven Tyler’s blood. More importantly, twenty-four weeks after stopping treatment his blood came back again with no detectable virus. In medical terminology this is called a sustained virological response, but what it really means is that the virus has been eradicated. Perhaps the most fulfilling thing in medicine is sitting with a patient who has been saddled with a chronic disease for years and had lots of concerns about cirrhosis, liver failure, the possibility of having to have a liver transplant, the possibly of developing cancer in the liver, a patient who has fought through a year-long treatment with side effects including sleep disturbances, irritability, a mental fog and being able to tell him, “Mr. Tyler, you’re cured. You don’t need to see me again.”

That’s an amazing word, “cured,” and it is the best of what modern medicine can offer. And while I appreciate the potential benefits of integrative medicine, I will continue to practice the medicine that I know works best.

The best doctors in the world offer compassionate care for their patients whether they are rich or poor. Over the years I’ve been privileged to care for rock stars, royalty, and famous CEOs, while I’ve also been privileged to take care of poor patients who had no insurance and for whom I and the hospital I work for provided free care. Some years ago a patient of mine with chronic hepatitis C that had progressed
to cirrhosis of the liver and had not responded to treatment asked me on a visit, “Dr. Chopra, do I need a liver transplant, and what does it cost?”

I told him he didn’t need a liver transplant at the moment. He might need it down the road and we would take care of it.

He persisted: “But what does it cost?”

I answered truthfully. “Between one hundred thousand and a quarter million dollars.”