Can the great divide between traditional and allopathic medicines ever be bridged?
Mary-Rose Abraham: You may remember that when we released Episode 2 a couple of months ago, we included a little recipe …
Annamma Spudich: We almost daily drink an extract of turmeric, ginger, honey and lemon juice in sparkling water.
Gayathri Vaidyanathan: This may sound like just another healthy shake or wellness drink, but it’s actually much more, according to Annamma Spudich.
AS: Because the combination, now there is basic scientific evidence that these have anti-infective properties for example, and they’re also rejuvenating. And I honestly believe that the combination of vitamin C, the curcumin and the pepper is certainly not doing any harm. And the combination certainly seems to have seemed to have helped, you know, helped me to, because I have very fewer colds and minor irritations than many of my contemporaries, and I believe that that I’m right about this. And of course there is now accumulating scientific evidence that turmeric has a number of important properties.
GV: The curcumin that Annamma mentioned is the main active ingredient in turmeric and is proven to fight off inflammation at the molecular level, and act as an antioxidant in the body.
MRA: Turmeric, of course, has long been a staple in Indian cooking and in traditional medicine. Spices like turmeric and other plants known to ancient cultures, formed the basis for lots of modern medicines, such as aspirin, codeine and ipecac. Annamma brings a unique background to learning about those traditional systems.
AS: I am a PhD from Stanford in cell and molecular biology. About 15 years ago I left the experimental science lab to explore knowledge systems of India, especially in the botanical medical sciences, and its applications to current biological medical issues.
GV: And during this conversation with a scientist, maybe we’ll bridge, just a tiny little bit, the great divide between traditional and modern medicines. This is your bonus episode of Scrolls & Leaves … called “Chatroom.” I’m Gayathri.
MRA: And I’m Mary-Rose. Just some quick notes before we hear from Annamma. Scrolls & Leaves will be back with the rest of Season 1 next year. We’re researching episodes now and we’re also looking for supporters. In the meantime, thank you for listening, writing in and really making us feel part of a community. And it would really make our day if you could tell a friend about Scrolls & Leaves … or maybe even rate and review us on Apple Podcasts or Spotify … thank you!
GV: Back to our chat. It’s no surprise that Annamma was drawn to study traditional systems. They were part of her daily life, while growing up in Kerala.
AS: I grew up in a, you know, in a family where Western medical professionals were all around. And yet, every single day, there were always references to traditional knowledge that as is applied to daily life, especially plant based food, you know, medicines, for cures for ordinary illnesses, all of this were always very much part of our life. And, you know, I’m very well aware of the advantages of the traditional knowledge systems in all different directions in my life.
GV: Interesting. Can you give us an example, maybe there was one particular treatment that your mom used all the time or when you got sick, something that was given to you? Is there a little story there that you can tell us?
AS: Yes, most often if you got a minor cold for example, we would get something called mullagu thani. Mullagu is pepper, thani is water. Basically it is an extract or a little or you can call it the clear broth, made with ground black pepper, tamarind and maybe some tomato or other things to make it a little more sour or give it some texture. And of course, turmeric was an essential ingredient in this so there would be turmeric, black pepper and tamarind and maybe curry leaves and this was an extract or soup, vellam, mullagu thani, was supposed to help you with the cold, some minor fevers and so on. And this was routinely part of our regimen and of course having grown up and learned biochemistry and molecular biology and so on. Now you realize that actually pepper, black pepper, contains a very, very important small molecule called piperine.
But the more important thing that occurred to me later when I was reading about traditional medicine and its manifestations in different forms is that now we know that piperine is an essential small molecule that makes access of other small molecules into the intestinal tract. Basically it binds with the surface molecules on the small, and opens up pores that other molecules can enter into the system. So, this kind of, you know, combination, these were figured out very long time ago.
And this was very much part of our daily life. And another example is, you know, when you had aches and pains, basically we would get an oil bath. The oil bath of course, the thailam was of course, was an oil that was made from many different medicines, many different ingredients. And, you know, they were used for reducing swelling, or joint pains and so on. So every day in one’s life, there were always, you know, use of traditional medicines in one form or another. Of course, we didn’t consider them as medicines. We just considered them as part of, you know, daily lives in essentials.
MRA: The Indian government has a whole department, the AYUSH Ministry, which is dedicated to traditional medicine. And since the pandemic began, this ministry is promoting a lot of Ayurveda medicine and even doing some clinical trials. It’s gotten a mixed reaction of course. What are your thoughts? Do you think there might be some worth to doing these trials or giving these alternative treatments?
AS: I have no doubt that traditional medicine has value. Fifty of the single molecule drugs we use now, in Western medicine, originally were derived from plants that include starting with aspirin. And, but then many of them were either, some of them are still made from plants. Others were actually then to be structures were identified and they were synthesized, now are chemically synthesized.
But, but the one important issue here is scientifically or documenting, by outcome based studies, at least, that these traditional best traditional therapies are valuable for which condition. In many cases, traditional medicine actually has a tremendous amount of benefit in chronic illnesses. If you have, you know, appendicitis you need to go and have your appendix fixed right? And, but if you have arthritis, inflammatory diseases, if you have various types of chronic illnesses, traditional medicine has a tremendous amount of value. In many cases, single drug remedies, which are used for long term chronic illnesses have also significant side effects. So what traditional medical therapies and formulation seems to do is to bring together modulating molecules or effects that subdue or deal with some of the side effects.
But the problem is that in India there are factions which are so committed to one thing or another. The people who are trained in Western medicine want, do not want to acknowledge the capability of the, you know, the possibilities of traditional medicine. And people who are committed to traditional medicine want traditional medicine not to be subjected to outcome based studies that actually validate their significance. I think if these two groups could come together and set up controlled studies. I think that is very, very important, but unfortunately, the factions are separated and are very often in their own corners and unwilling to collaborate and cooperate.
GV: Just following this thread. Traditional medicine or ayurvedic medicine comes with its own intellectual background and when you’re sort of trying to do these clinical trials with them are you not taking one kind of knowledge or scientific thinking and trying to fit it within the constraints of another kind of scientific knowledge or method? What is, sort of, the benefits of that or are they essentially two different systems, each with their own merit and two ways of thinking about the human body and how to go about proving their efficacy?
AS: Yeah, it’s a question that has been brought up many times. But for me the outcome of either of both types of therapies is wellness, is dealing with disease. And so even though each system is based on different ideas. You know, the molecular medicine looks at diseases in terms of molecules that are aberrant or mutations that have, is causing aberrant molecules to be made in the body. Traditional medicine looks at the wellness in terms of doshas. Of course, you know, today, the concept of dosha is probably more difficult to define. But on the other hand, the purpose of both is to give wellness. So, we now have molecular methods of measuring wellness, right? I mean, if I have, if I have diabetes, right, you can calibrate the sugar in my blood. Now, whether the lowering of my diabetes is brought about by injecting insulin, which also has side effects or by using traditional medical decoction. So over a period of time because the concentrations of active ingredients in those may be smaller, my goal would be to reduce my diabetes. So, I am of the opinion that clinical studies can be set up, that could be set up carefully. So that outcome can be studied.
Of course, understanding exactly how the traditional medical extract works to bring about control of, you know, blood sugar will be more complicated because unlike insulin, the plant extract contains many compounds. And they may be acting on, you know, every disease pathway has many sub pathways. And so in traditional medicine, maybe acting at different places along the pathway, and that may be one reason why the outcome is slower. But on the other hand, it may also be the reason why there are fewer side effects to many traditional medical therapies.
GV: Because the outcome is slower then these clinical trials would have to extend for longer, very long periods of time …
AS: Yes, clinical trials have to be but of course, the problem, the other problem with traditional medicine is that the way the traditional medicine is provided nowadays is very different from the classical traditions. Because in the sense that we know that the conditions under which a plant is cultivated changes the chemical composition of the plant, the time at which the plant is harvested, what part of the plant is used, how it’s harvested, how it is extracted? Yeah. If you take for example, a plant that you extracted in water, you extracted in alcohol, you extract it in some, you know, some of the traditional medicines are made by boiling it in oil. All of these makes a very big difference in what compounds are being extracted. So the challenge is to cultivate medicines, harvest them and extract them in the traditional way. So that and then characterize it.
Now there are ways in which you can take a water extract, you can put it through a hydro, you know, an HPLC column and you can see what are the peaks even though you don’t know, you may not identify the peaks, so that there’s ways of standardizing it.
MRA: I want to ask you about your visits with traditional practitioners in Kerala. You’ve spent quite a lot of time learning from them. Can you tell us more about that?
AS: I spent three or four years visiting the late great Ashtavaidya Chiratham Narayanamoos. He was an Ayurvedic physician from a traditional Ayurvedic family, Chirataman and family, Chiratham Narayananmoos. He was a distinguished ashtavaidya. He has passed away since then. And their family were raja vaidya to the maharaja of Kochi. And they, you know, I got in touch with him when I left UCSF and Stanford to study traditional medicine and not study traditional medicine but to learn about traditional medicine. And of course, he was at first very disdainful of somebody like me. I don’t know if you know Malayalam. So when I went there first he said to me, what did you come for? For four years I met him at least three times a year. And I have extensive notes of my interactions with him, I would actually like to publish them somewhere because this was a scholar physician, the traditional kind of, and it was an amazing source of knowledge. But he told me one day, he and I went out into the medicinal garden, he showed me three different plants side by side. And he plucked leaves from three of them, and he said to me, smell them. And I do, but one of them had a very different smell than the other two. And he said, you know, this is the medicine. The other two are related plants, but are not medicines. So the accuracy of the identification of traditional medicine. And he also told me that there are medicines that have to be plucked, collected at a certain time.
I also interviewed a folk medical practitioner in my father’s village many years ago. And he had, he was someone who specialized in the treatment of a disease called mana sega rhogam, with diseases of the mind. And while he was a very old man when I saw him, probably not as old as I am now, but it seemed to me that very old and he told me he hadn’t, he was not practicing anymore. So among all the conversations, I asked him, why, and he said, well, his major therapy had to do with some type of what might be schizophrenia. But you know, he didn’t have that name for it, but the description of the disease sounded like schizophrenia. He said, but the medicine is a plant, which is an epic and a parasite plant that grows on a tree and he said the plant has to be collected by a naked man. Now, of course, it sounds like the height of superstition right? And so I heard, I smiled, I wrote it down and I went away. Years later when I started looking into plant bio, I realized that medicines and the medicinal plants, the concentration of various chemicals go up, change during the time of day with sunlight, temperature, the harvesting season etc., right? That’s a time when plants flower and you know, they have a different set of chemicals in the plant. So in this case, I realized the reason why he probably wanted, said he had to climb the tree at night, is that probably in the problem? Here a naked man had to climb the tree because he probably had to climb the tree at night. Because the temperature in the tropical environment is much lower at night, right? And maybe the active ingredient was at a higher concentration when in the cooler temperature and of course in in many ways, traditional medical you know, this story is not in the Ayurvedic texts but in in traditional, in folk medicine is transferred as stories, as legends and as little episodes that people will remember.
GV: So why did the man have to be naked?
AS: That’s what I’m trying to say. He has to. I realize now the reason he had to be naked is the only time he probably will climb a tree naked is in the middle of the night and the village asleep, right?
GV: Ah, so instead of saying collect it in the middle of the night.
AS: Yeah, probably there, you know, somebody wouldn’t have paid any attention if one said climb it in the middle of the night. You have to be naked. So at least this is my interpretation. This is the kind of thing that made traditional medicine difficult because there are legends and stories associated with it, and identifying, you know the details of the extraction and making a traditional medicine is something that has been lost because most of the Ayurvedic education these days, four year colleges are actually taught from texts which have been translated over and over again. So a lot of work has to go into making traditional therapies reliably and widely available.
MRA: You were listening to Annamma Spudich on Chatroom on Scrolls & Leaves. If you want to learn more about the topics we discussed today, you can find some links on our website, www.scrollsandleaves.com. We’ll be back in a couple of weeks for another Chatroom. See you then!