aapi journal may 04 - patent analysis & market … to be over valentine’s day and the theme,...

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May 2004 The Journal of Indian American Physicians Crossing the Borders A Few Major Health Care Issues AAPI Leadership visits Johnson & Johnson: “Exploring New Opportunities” Is it time to change our CME format? When We Need a Godfather AAPI DAY AAPI DAY May 2004 Crossing the Borders A Few Major Health Care Issues AAPI Leadership visits Johnson & Johnson: “Exploring New Opportunities” Is it time to change our CME format? When We Need a Godfather How HIPAA Electronic Data Interchange Can Help Physicians AAPI Spring Governing Body Meeting Our Legislative Day at the Capitol Special Series: Complementary and Alternative Medicine How HIPAA Electronic Data Interchange Can Help Physicians AAPI Spring Governing Body Meeting Our Legislative Day at the Capitol Special Series: Complementary and Alternative Medicine

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Page 1: AAPI Journal May 04 - Patent Analysis & Market … to be over Valentine’s Day and the theme, aptly, was ‘Bring Your Valentine to CME’. Dr. Sudhir Mehta, Chair AAPI CME, did a

May 2004

T h e J o u r n a l o f I n d i a n A m e r i c a n P h y s i c i a n s

• Crossing the Borders• A Few Major Health Care Issues• AAPI Leadership visits Johnson &

Johnson: “Exploring New Opportunities”• Is it time to change our CME format?• When We Need a Godfather

AAPI DAYAAPI DAY

May 2004

• Crossing the Borders• A Few Major Health Care Issues• AAPI Leadership visits Johnson &

Johnson: “Exploring New Opportunities”• Is it time to change our CME format?• When We Need a Godfather

• How HIPAA Electronic Data Interchange Can Help Physicians

• AAPI Spring Governing Body Meeting

• Our Legislative Day at the Capitol• Special Series:• Complementary and Alternative Medicine

• How HIPAA Electronic Data Interchange Can Help Physicians

• AAPI Spring Governing Body Meeting

• Our Legislative Day at the Capitol• Special Series:• Complementary and Alternative Medicine

Page 2: AAPI Journal May 04 - Patent Analysis & Market … to be over Valentine’s Day and the theme, aptly, was ‘Bring Your Valentine to CME’. Dr. Sudhir Mehta, Chair AAPI CME, did a

AAPI Journal May/June 2004 3

AAPI (American Association of Physicians of Indian Origin)

President: Sharad Lakhanpal, M.D.

17W300 22nd StreetSuite 300A

Oakbrook Terrace, IL 60181-4490Phone: 630-530-2277Fax: 630-530-2475

AAPI Journal Editor

M. P. Ravindra Nathan MD, FACCHernando Heart Clinic14555 Cortez Blvd.

Brooksville, FL 34613Phone (352) 796-6000Fax (352) 796-8157

[email protected]

The AAPI Journal is published quarterly by the AmericanAssociation of Physicians of Indian Origin (AAPI). This publi-cation may not be reproduced in whole or in part without theexpress written permission of the AAPI.

All articles published including editorials, letters andbook reviews represent the opinions of the authors and donot reflect the official policy of AAPI.

Copyright © 2003 AAPI. All rights reserved.

Designed & Printed by:

GR GRAPHICS, INC.Tampa, Florida

(813) 886-4500

•A

MERICAN ASSOCIATION

OF

PH

YSICIANS OF INDIAN ORIGIN

ABOUT THE COVER

Sea Gulls in Flight, Puerto Rico

Photo by Sanku Rao MD

➢ President’s ReportAAPI Day By: Sharad Lakhanpal, M.D. .................. 5

➢ New Patron Members List .............................................................................. 6

➢ From the Editor’s DeskCrossing the Borders By: M. P. Ravindra Nathan, M.D. ................ 7

➢ Convention Chair’s Report By: Ajeet R. Singhvi, M.D. ........................ 8

➢ Vice President's ReportA Few Major Health Care Issues By: Akshay M. Desai, M.D. .......................... 9

➢ Secretary's ReportAAPI Spring Governing Body Meeting By: Sampat S. Shivangi, M.D. .................. 16

FEATURES

➢ AAPI Leadership visits Johnson & Johnson By: Hemant Patel, M.D. “Exploring New Opportunities” & Jayesh Kanuga, M.D. .............................. 10

➢ Is It Time to Change our CME Format? By: Sudhir Ken Mehta, M.D. .................. 11

➢ When We Need a Godfather By: S. Jay Jayasankar, M.D. .................... 12

➢ How HIPAA Electronic Data Interchange Can Help Physicians By: A. Hassan Mohaideen, M.D. .......... 15

➢ Saving Medical Practice By: Vijay Koli, M.D. ................................ 21

AAPI AT THE CAPITOL

➢ Honoring AAPI .................................................................... 23

➢ Our Legislative Day at the Capitol By: Rakesh Shreedhar, M.D. & Anurag Varma, J.D. ................................ 24

Special SeriesCOMPLEMENTARY AND ALTERNATIVE MEDICINE

➢ Introduction By: Hari Sharma, M.D. ............................ 26

➢ The Need to Support Ayurveda By: Dr. David Frawley ............................ 26

➢ Ayurvedic Skin Care By: Suhas Kshirsagar, M.D. .................... 28

➢ Ayurvedic Concept of AMA(Toxin Accumulation) By: Hari Sharma, M.D. ............................ 29

➢ 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

➢ First AAPI Ayurveda Conference By: Hari Sharma, M.D. ............................ 38

DEPARTMENTS➢ Book Review

CT & MRI Pathology - A Procket Atlas By: Michael L. Grey, M.D. & Jagan Ailinani, M.D. ............................ 39

➢ The Best of AAPI HumorDid You Have Your Colonoscopy? By: P. K. Paul, M.D................................... 40

➢ Members in the News .................................................................... 42

Page 3: AAPI Journal May 04 - Patent Analysis & Market … to be over Valentine’s Day and the theme, aptly, was ‘Bring Your Valentine to CME’. Dr. Sudhir Mehta, Chair AAPI CME, did a

AAPI Journal May/June 2004 5

After the busy sojourn to India inthe winter, the AAPI has kept afairly active schedule back home.

The Annual AAPI CME was heldin Puerto Rico at the beautifulIntercontinental Hotel and Resortfrom Feb. 13 to 16, 2004. This hap-pened to be over Valentine’s Day andthe theme, aptly, was ‘Bring YourValentine to CME’. Dr. Sudhir Mehta,Chair AAPI CME, did a superb joborganizing the program as he alwaysdoes. The CME was of very high cal-iber (please see report on p. 11).

The AAPI Spring Governing Bodymeeting was an astounding success. Itwas held in New Orleans from March 5to 7, 2004. Dr. Surendra Purohit, PastChair, AAPI BOT, coordinated theevent, which was hosted by theLouisiana Chapter of AAPI under theleadership of their President, Dr. TilakMallik. The entire event, from the wel-come Mardi Gras style party to theAAPI Business Meeting, from theCME to the Saturday night Gala, wasbeautifully orchestrated and had theflair and the style of Southern hospital-ity that is classic Dr. Purohit. The AAPIis thankful to the Louisiana Chapter ofAAPI for hosting such a lovely func-tion. (Please see report on p. 16).

The first AAPI Ayurveda Seminarwas held in Orlando, Fl, from March19 to 21, 2004. This was very ablyorganized by Dr. Hari Sharma, ChairAAPI Integrated MedicineCommittee, with an outstanding facul-ty of speakers. (Please see report on p.38).

Dr. Hussain Malik, President-elect of APPNA, came to the AAPIGoverning Body Meeting in NewOrleans. His message of friendshipand AAPI and APPNA workingtogether was well received. I was invit-

ed to the APPNA Executive CouncilMeeting in New York on March 20.The message from AAPI was receivedenthusiastically by the APPNA mem-bers. We look forward to workingtogether on issues affecting our mem-bers. Dr. Omar Atiq, President ofAPPNA was very effusive and warm inhis response.

The Annual AAPI Legislative Daywas held on March 30, 2004, inWashington, D.C. It was extremelywell received. Dr. Rakesh Shreedhar,Chair AAPI Legislative Committee,and Mr. Anurag Varma, AAPILegislative Director, put in a lot ofeffort to ensure its success. The SenateMajority Leader Senator Bill Frist (R-TN) addressed health care issues.Senator John Corvyn (R-TX)announced the formation of Friends ofIndia Caucus in the U.S. Senate.Congressman Frank Pallone (D-NJ)and 26 other congresspersons in abipartisan move introduced H.Res.579in the U.S. Congress to honor AAPIand have requested declaration of an“AAPI DAY.” (Please see report on p.24).

The enactment of “AAPI DAY” bythe U.S. Congress will be a significantachievement for the Indian-Americancommunity in general and the IndianAmerican medical fraternity in partic-ular. This will symbolize the acknowl-edgement and recognition of the con-tributions of the Indian Americanphysicians to the healthcare of thepeople of America. I urge each andevery one of you to please call or writeto your congressperson(s) to become asponsor of H.Res.579.

The AAPI-DIA project has beensuccessfully completed. I met withPfizer officials in New York and theAAPI-DIA report has been satisfacto-rily submitted. The AAPI and Pfizerlook forward to a mutually beneficialrelationship moving into the future.

The AAPI Annual election seasonis here. The Patron and annual duespaid members of AAPI shall be gettingballots in the mail towards the end ofApril 2004. I encourage all of you toparticipate in this very important dem-ocratic electoral process. Your choiceof responsible leaders will ensure thefuture of AAPI. Every vote is impor-tant. Please return your ballot beforethe deadline.

The AAPI Pacific LeadershipRetreat will be held in Asilomar,California, from May 7 to 9, 2004. Dr.Subroto Kundu, Pacific RegionalDirector of AAPI, is working tirelesslyto put together an exciting program.Please plan to attend.

The 22nd Annual AAPIConvention will be held at theManchester Grand Hyatt Hotel in SanDiego, CA, from June 23 to 27, 2004.We hope to see you all there. It will bea memorable event!

◆ ◆ ◆ ◆ ◆ ◆

PRESIDENT’S REPORT

AAPI DAYSharad Lakhanpal, M.D.

President, AAPI

Page 4: AAPI Journal May 04 - Patent Analysis & Market … to be over Valentine’s Day and the theme, aptly, was ‘Bring Your Valentine to CME’. Dr. Sudhir Mehta, Chair AAPI CME, did a

6 AAPI Journal May/June 2004

AAPI Annual Convention - San Diego, CaliforniaContinuing Medical Education Program: June 23-27, 2004

“TRANSLATING RESEARCH ADVANCES TO PATIENT CARE”

As the title of the CME Program suggests, the emphasis for this year’s educational experiencewill 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 anexceptional 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 researchadvances. 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 experienceare 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 memorableexperience 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]

Manju AgarwalBoca Raton, FL

Shanti, AgarwalBoca Raton, FL

Sreenivas AmaraEdison, NJ

Lalitha AnanthFountain Valley, CA

Madhu AroraJackson, MI

Rajendra BansalJupiter, FL

Ramji BaraiyaSan Jacinto, CA

Bipinchandra BhagatVictorville, CA

Ashvinchandra, BhutwalaHesperia, CA

Nanda BiswasApple Valley, CA

Savithribai BonalaEdison, NJ

Ushasri ChallaWichita, KS

Anuj ChandraChattanooga, TN

Vikas ChitnavisRoanoke, VA

Natvarlal DalsaniaTitusville, FL

Venkat DevineniApple Valley, CA

Darshan DhimanHemet, CA

Prasuna DoddapaneniGreenlawn, NY

Sakuntala, DuttaOklahoma City, OKSanyasi Ganta

Hemet, CANancy Gourishankar

Livingston, NJ

Amal GuhaApple Valley, CA

Lakshmi, GullapalliFort Wayne, IN

Rakesh GuptaCenterville, OH

Rajini IyerAnaheim, CALucky JainAtlanta, GA

Shabnam JainAtlanta, GA

Vijaya JujjavarapuDunlap, IL

Nirmala KamnaniPampa, TX

Rajan KarnaniApple Valley, CAAjai KhannaSan Diego, CA

Poornima KhannaSan Diego, CA

Pragna KhannaElmsford, NY

Suresh KhannaElmsford, NY

Subhash KhaterpaulWarren, OH

Anil KudchadkarWinnsboro, SC

Shubhalaxmi KudchadkarWinnsboro, SCArun KumarFreehold, NJ

Kapil KwatraGirard, OH

Gopal MadabhushiHemet, CA

Paresh MehtaWarren, OHBrij Mishra

Fayetteville, NY

Urmila MistryTequesta, FL

Arvind ModawalCincinnati, OH

Swapna MukherjeaTampa, FL

Manjula MuniyappaSan Diego, CAAshok NaikBatavia, NY

Jagat NarulaPenn Valley, PAMina Narula

Rancho Mirage, CAMohender NarulaRancho Mirage, CANavneet Narula

Penn Valley, PANarinder Nat

Canyon Country, CAPrasad Neerukonda

Oak Brook, ILSujatha Neerukonda

Oak Brook, ILRekha Padubidri

Canfield, OHLotika PanditChattanooga, TN

Sushma ParekhPort Saint Lucie, FL

Ashok PatelLargo, FL

Jagdish PatelHuntington Beach, CAKiritkumar Patel

Largo, FLKirti PatelLargo, FL

Mukeshchandra PatelApple Valley, CAPrakash PatelFramingham, MA

Swarajya PerniHubbard, OH

Veeraiah PerniHubbard, OH

Lovsho PhenBoardman, OHKiran Prabhu

Oklahoma City, OKSantosh PrabhuOklahoma City, OKVijaya PrabhuSan Diego, CA

Geetha PuriVictorville, CARajiv Puri

Victorville, CAManikanda Raja

Hemet, CASavita RajgiriSuwanee, GA

Vishweshwara Ranga Las Vegas, NVAnil Rastogi

Hemet, CAMakala ReddyApple Valley, CA

Venkamma ReddyVictorville, CA

Vodur ReddyApple Valley, CAHemang ShahPortsmouth, VAKruti Shah

Youngstown, OHNandkishor Shah

Pinellas Park, FLSonal Shah

Pinellas Park, FLAkhil SharmaVictorville, CA

Anupama SharmaApple Valley, CA

Aparna SharmaVictorville, CA

Archana ShethRiverside, CA

Kalyanam ShivkumarLos Angeles, CADigvijay Singh

Canfield, OHParduman Singh

Boardman, OHArchana SoodApple Valley, CA

Om SoodApple Valley, CA

Preethi SrikanthanLos Angeles, CA

Chivukula SubbaraoWichita, KS

Yash SubherwalHuntingtn Beach, CA

M. SukumarDarnestown, MDRajiv Taneja

Youngstown, OHReema TanejaYoungstown, OH

Purnima ThakranApple Valley, CA

Bhoodev TiwariHemet, CA

Usha WaghNew York, NY

Chakri YarlagaddaYoungstown, OH

Bhanu YenamandraApple Valley, CA

Suryanarayana YenamandraVictorville, CA

N E W P A T R O N ( L I F E ) M E M B E R S

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AAPI Journal May/June 2004 7

FROM THE EDITOR’S DESK

Aspecial event occurred onMarch 6, 2004, during theAAPI Governing Body

Meeting in New Orleans…we had avisit from the President-Elect of theAssociation of Pakistani Physicians ofNorth America (APPNA), Dr.Hussain Malik.

“We must be the change we wishto be,” Dr. Malik quoted fromMahatma Gandhi, as he addressedthe audience. He also outlined hisplans of how the two greatorganizations – AAPI andAPPNA – can collaborate onmany projects beneficial toour motherlands.

“We have so much incommon; if we can worktogether, we can be a verysuccessful role model forother similar organizations,”he reminded us. The samefeelings were echoed by ourPresident Dr. SharadLakhanpal, at whose invitation thissummit of minds happened.

Around this time, Pakistan andIndia were bonding through cricket,after a lapse of some 15 years. Thefans in the stadium in Karachi duringthis historic cricket match wavedboth Indian and Pakistani flags andactually didn’t care who won.

“Peace breaks out at APPNA,”was the headline at the websitewww.pakistanlink.com to commemo-rate the historic visit of AAPIPresident Dr. Lakhanpal during theAPPNA’s Executive Council Meetingon March 20, 2004, in New York. Inaddition, the author Dr. M. ShahidYousuf wrote:

“With open arms, APPNAextended hospitality to its guestfrom AAPI. The ExecutiveCouncil (EC) had just finisheddebating about the proposal tohave a speaker appointment sothat the meetings could be conduct-ed by the speaker. It was at this junc-ture that Dr. Lakhanpal strode intothe meeting. Everything changedafter that. The EC was suspended togreet the guest. Only once before

was APPNA EC session suspendedmid-session when former PakistaniAmbassador to the USA, Mr. NajmuddinShaikh, addressed the gathering.”

Thus a new chapter to improveIndo-Pakistani relations was writteninto the annals of AAPI. I have oftenwondered that until 1947, we wereone nation, so why can’t we continueto be the brothers and sisters that weonce were? I guess the answer is notthat simple. However, as passionatelyas we believe in our association’s newcoalition plans, we must be part ofcatalyzing these unifying reactionsand changes. So, let us all be thoseagents of change and learn to fosternew friendships.

Now, on to other things. TheEditorial Committee and executiveCommittee members met for anhour in New Orleans prior to theGoverning Body Meeting to discussthe various aspects of AAPI Journal

operations. The increase inthe volume of submissionscoupled with more frequentpublications has resulted inconsiderably more work forall. The position of a non-medical editorial assistantwith a background in jour-nalism has been approved.

I received a letter froma freelance journalist/politi-cal activist of Indian back-ground expressing an inter-est to write for our journal.

She wrote: “I found the AAPI journalto be very interesting and informa-tive and have forwarded the addressto my brother (a physician), as well asother medical friends. I am activelyinvolved in linking Indian groupstogether to develop a stronger voiceon policy issues.” A Washingtonjournalist specializing in health carepolicy has also shown some interestin writing for the Journal and wouldperiodically update us on the newMedicare/Medicaid developments.

It’s nice to know our readershipbase is flowing into non-medicalranks.

* Courtesy: Pakistan Link

◆ ◆ ◆ ◆ ◆ ◆

Crossing the BordersM. P. Ravindra Nathan, M.D.

Editor-In-Chief, AAPI Journal [email protected]

Dr. Omar Atiq (APPNA President - in the center) with Dr. SharadLakhanpal and APPNA President-Elect Dr. Hussain Malik (2nd

from left)*

Drs. S. Lakhanpal, Hussain Malik & Ravindra Nathan

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Friends,

The 22nd Annual Conventionof AAPI is around the cornerand we are ready to welcome

all the delegates. Our focus has beento get the maximum members andnon-members who have never beento an AAPI convention before, to SanDiego this time. They will have afirst hand look at AAPI in action, andmake a lot of new friends.

We have arranged a good CME,delicious food, a variety of social pro-grams, entertainment, and a host ofwell respected guests for you.MSR/F and YPS will have the best ofboth worlds. A large number of ven-dors from the US and abroad areexpected and they will have extended

hours each day, so you should be ableto find ample time to shop and net-work. We encourage you to supportour sponsors.

If you have not registered yetplease do so. Our early bird package(until June 7th, 2004) is just $485.00per person for all the ticketed events.All the delegates are welcome toattend CME at no charge, and if youneed a certificate it will only cost$50.00.

Our team has put in a lot of workto give you an experience which youwill cherish for a long time. SanDiego in June is at its best. Thevenue is right on the bay, for you toenjoy. Maybe you can jog in the

morning or take a leisurely late nightstroll, but keep the day for us.

◆ ◆ ◆ ◆ ◆ ◆

8 AAPI Journal May/June 2004

Ajeet R. Singhvi, M.D.Chair, 2004 AAPI Convention

2004 CONVENTION CHAIR’S REPORT

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

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 bannedgraduates from certain offshore schools. The medical training in these schools is being investigated. Each state will thenmake 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 takethe 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 Indiais not facing an unnecessary hurdle.

Prasad Srinivasan, MDPresident, Connecticut Association of Physicians of Indian Origin

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AAPI Journal May/June 2004 9

Iam taking this opportunity to sharewith you some of the major health-care issues on the horizon. Last

month, I was fortunate to be invited toattend the World HealthCare Congressin Washington, D.C. It was a very highlevel conference attended by health-care industry leaders to discuss thefuture of healthcare. Speakers includedHealth Secretary Tommy Thompson,Senate Majority Leader Bill Frist,Senator Hillary Clinton, FormerTreasure Secretary Paul O’Neil andmany other powerful decision makersfrom the government, the private sec-tor, hospitals and physician groups,who shared their respective perspec-tive. I believe this will have a tremen-dous impact on the practice of medi-cine in the coming years.

I would like to take a moment togive you some over-arching issueswhich were discussed for 2 days.

1. Consumerism in HealthcareAmericans have demanded high quali-ty medicine with choice and freedomto obtain healthcare. To address this,the private sector is going to allow largevarieties of individuals and grouphealth plans which could be cus-tomized according to an individual’sdesire. Employers will give definedcontributions towards health insuranceinstead of the current approach ofdefined benefits. The public willreceive information and ratings aboutdifferent health plans from a variety ofdifferent sources, including the federaland state governments, consumerreports, J.D. Power and Associates andmany other industry standard bearers.

2. Pay for PerformanceRecently, the Centers for Medicareand Medicaid (CMS) has embarkedupon rewarding better quality withhigher pay for hospitals. A currentdemonstration project addresses out-

comes of Coronary Artery Bypass Graft(CABG) surgery. Hospitals achievingpre-defined quality criteria will receivehigher reimbursement. There is a planto achieve a similar approach for physi-cians. Physicians who comply withquality criteria such as HEDIS scores,preventive services and other well-established high quality practiceparameters will be reimbursed higherand those whose practice would fallbelow these pre-defined quality meas-urements will be paid less. In the pri-vate sector, several insurance compa-nies on the east and west coast havealready implemented “pay for perform-ance” for their physicians’ network.

3. Information TechnologyThere will be increased funding fromthe Federal Government to bringhealthcare record keeping in the 21stcentury and eliminate paper recordkeeping by 2010. Senator HillaryClinton has introduced a bill to have automated medical records which areportable, available, accessible, user-friendly, standardized, consistent andkeep health information confidential.Senate Majority Leader Bill Frist issupportive of this bill.

It will also provide some federalfunding to achieve this. Cost estimatesfor transforming paper records intoelectronic format are around $100 bil-lion. It will require commitments fromthe federal and state governments, thepharmaceutical industry and physi-cians. In the private sector, KaiserHealthPlan from California had madethe commitment to invest $3 billion toachieve that. With electronic informa-tion, the rate of medical errors willdecrease and will reduce 80,000 deathsper year attributed to medical errors.There is a strong push from all partiesto capitalize on the revolution in infor-mation technology.

4. Medicare Modernization Act(MMA)The recently signed MMA will bringprescription drug benefits underMedicare for our seniors. This benefitis voluntary, generous to most seniorsand comprehensive for 12 million low-income seniors. It protects existingemployer coverage, speeds sales ofgeneric drugs and is endorsed by theAmerican Medical Association. It alsogives physicians a 1.5% increase inMedicare reimbursement for theirservices instead of a 4.5% reduction.It, by no means, addresses all the cov-erage issues, but is a voluntaryenhancement of the Medicare programand is a first step in the right directionfor our seniors.

5. Disease Management People with chronic diseases such asDiabetes, Asthma, Congestive HeartFailure, Coronary Artery Disease andEnd-Stage Renal Disease are majorcost drivers in current healthcare sys-tems. Several companies have beenformed to provide education and closemonitoring of their disease processes.On top of this, lifestyle modifications toreduce incidents of obesity, smoking,unsafe sex and exercise will result inbetter healthcare for all and reducedcost of healthcare for us, as taxpayers.If any one of you has the desire formore details on any of these issues,please contact me at [email protected] and I will give you hardcopies of state-of-the-art material pre-sented at this conference.

◆ ◆ ◆ ◆ ◆ ◆

VICE PRESIDENT’S REPORT

A Few Major Healthcare Issues

Akshay M. Desai, M.D., M.P.H.Vice President, AAPI

Chair, Membership Committee

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On March 19, 2004, JanssenPharmaceutica Products,LP, an Operating

Company of Johnson & JohnsonFamily of Companies, in partner-ship with Dr. Hemant Patel,President of NY Federation andTreasurer of National AAPI organ-ized a one-day conference,“Exploring New Opportunities”.The conference took place at theJanssen Pharmaceutica Products,L.P., campus in Titusville, NewJersey, and examined future part-nership opportunities betweenAAPI and the Johnson & Johnsonoperating companies. Dr HemantPatel presented an overview of AAPIorganization and discussed many waysAAPI can partner with Johnson &Johnson. Dr. Jayesh Kanuga,President Elect, NY Federation ofAAPI accompanied Dr. Hemant Patelon this very important visit.

Gary Pruden, Vice President,CNS /ElderCare, JanssenPharmaceutica Products LP intro-duced South Asian ProfessionalNetwork & Association (SAPNA) ofJohnson & Johnson and kicked off theconference by providing backgroundinformation and the program’s agen-da. “SAPNA is a relatively new initia-tive at Johnson & Johnson,” said Mr.Pruden. “This council was created topromote cultural diversity within theJohnson & Johnson family of compa-nies and leverage the growing SouthAsian customer segment for broader,more effective business results.”SAPNA was conceived in June 2002.Surya Vangala, SAPNA Chapter Co-chair at Janssen had organized a nicedisplay of South Asia leaders profilesand regional costumes, literature and

Handicraft souvenirs in the lobby ofJanssen Pharmaceutica, L.P. as a prel-ude to AAPI visit. The SAPNAMembership includes people andorganizations from the followingsouth Asian countries: Bangladesh,Bhutan, Myanmar, India, Nepal,Pakistan, and Sri Lanka.

Anwar Feroz, Executive Directorof ElderCare and Long-Term Care,and Haresh Kaneriya, BusinessManager-Long-Term Care at JanssenPharmaceutica Products, L.P.,explained “We have been workingwith AAPI for five years, and theorganization and its physician mem-bers represent a very large potentialfor Johnson & Johnson.” Mr. AnwarFeroz is also Chair of SAPNAChapter at Janssen. Dr. Hemant Patelhas led the efforts of partnership withJohnson & Johnson since the AAPIannual convention of 2000 in NewYork City. “AAPI has tremendous pro-fessional expertise to offer thePharmaceutical Industry”, suggestedHaresh Kaneriya, also the Vice Chair-Business Alliances, SAPNA atJohnson & Johnson. Mr. Kaneriya has

been a strong advocate of AAPI atJohnson & Johnson and has pro-vided his business expertise andguidance to AAPI in many waysover the last five years. DaveButler, National Sales Director,was in attendance at the meetingand has been an advocate of newopportunities at Johnson &Johnson and has supported AAPIinitiatives at various local andregional levels. Dr. Jayesh Kanugaaddressed questions from Janssenattendees after the closingremarks by Vice President GaryPruden.

Dr. Patel reminded the audiencethat the large Indian population in theUnited States continues to grow rap-idly, including the number of physi-cians and medical students. Theseindividuals represent the future ofAAPI’s membership and should be avery important channel of profession-al partnership for Johnson & Johnson.This visit to a large J&J Operatingcompany is a new beginning of explor-ing opportunities for AAPI as anorganization, and Dr. Hemant Patelstarted the SAPNA initiative at J&Jwith a positive new era of harnessingSouth Asian Diversity in CorporateAmerica. During the meeting, variousissues were discussed including theJ&J participation at the upcomingAnnual Convention in San Diego, CA.Dr. Hemant Patel will continue tolead the AAPI team with Johnson &Johnson for future partnership oppor-tunities and provide necessary guid-ance to the AAPI leadership to workwith many Pharmaceutical Industrypartners in metro NY/NJ area.

◆ ◆ ◆ ◆ ◆ ◆

10 AAPI Journal May/June 2004

FEATURE

AAPI Leadership visits Johnson & Johnson:“Exploring New Opportunities”

Dr. Hemant Patel, Treasurer-AAPI & Dr. Jayesh Kanuga, President Elect, NY AAPI Federation

Anwar Feroz, Dr. Hemant Patel, Peter Ciszewski, Sangeeta Goel,Dave Butler, Surya Vangala, Dr. Jayesh Kanuga, Dr. Atul

Mahabaleshwarkar, & Haresh Kaneriya.

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AAPI Journal May/June 2004 11

FEATURE

We stand to learn everyday.

As most speakers would tellyou, every time they give aconference they learn some-

thing new. My recent experience atthe AAPI CME meeting at San Juan,Puerto Rico, however, exceeded mywildest imaginations in this regard.The program “Recent Trends inMedicine and Surgery” on February14- 15, 2004 at the beautiful HotelIntercontinental, San Juan, PuertoRico, attracted a lot of attendance. Iwas pleasantly surprised to see whatparticipants could teach me. A simplegesture on my part brought us a gen-erous gift of knowledge that AAPImembers openly and willingly sharedwith all the speakers. Not only theparticipants liked the CME, but thespeakers were excited to learn some-thing from the AAPI members. Theparticipants’ knowledge and experi-ence clearly showed in their interac-tions, comments, and questions.

I hope the following commentsfrom the attendees will help futureCME chairs, not only in selecting thetopics, but also in paying close atten-tion to the timeliness of their talks andpermitting enough time to encourageactive and open interaction.

“It was a win-win situation foreveryone. Excellent presentationsand active participation by the atten-dees were a perfect match for thisValentine Day weekend,” PrasadSrinivasan, MD.

“AAPI CME was very informa-tive, substantive, timely, and a verywell organized educational experi-ence,” Akshay Desai, MD.

“This CME meeting was wellcoordinated, planned, and conductedby Dr. Mehta and Dr. Lakhanpal.Also very informative and stimulat-

ing to the mind and heart. Dr.Mehta’s earnestness, caring and deepsense of righteous behaviors, all werequite obvious. I do appreciate Dr.Lakhanpal’s leadership in taken careof all of us.” Ranjit R. Singh, MD.

“Exceptional quality CME with abalance of common and unique top-ics.” Kiran Joag, MD.

“The whole stay at Puerto Ricowas well beyond my expectation. Wewere pleasantly surprised with thearrangements made by AAPI. Specialthanks to Dr. Lakhanpal, Dr. Mehtaand Dhrumal.” Suman Meshra, MD

“This was my first CME confer-ence with AAPI; very reasonabletuition for high quality CME with anenjoyable overall program. I will belooking for the next AAPI CME meet-ing.” Kanti Havaldar, MD.

“We attended our first AAPIsponsored CME and realized whatwe missed all these years…we had nohesitation in becoming life members

of AAPI on the spot,” ShubhaKudchadkar, MD.

“My husband Kush and I greatlyenjoyed it. The talks were excellent,the hospitality perfect, and San Juanscenic and worth visiting. Thanks.”Rita Frenchman, MD.

“Excellent conference. Very wellplanned with topics covering medicaland ethical issues; would like toattend similar CME conferences inthe future.” Ronika Desai, MD.

The above remarks say it all aboutthe CME conference at San Juan,Puerto Rico. Despite the attractionsoutside - inviting green and bluebeaches, Latin music, para-sailing, jetskiing, and swimming - most physi-cians chose to attend the conference.Needless to say the speakers - Drs.Sharad Lakhanpal, ChitranjanRanawat, Gita Mehta, Sudhir Mehta,Prasad Srinivasan, and PramodWasudev – were very impressed withthis dedication. I believe time hascome when CME directors andspeakers need to make special effortsto meet or exceed the expectations ofAAPI members in selecting the righttopics, and making them interesting,concise, and relevant. A 20-30 minutetalk with ample time for active dia-logue between the speakers and theparticipants would be most ideal.

This trip offered plenty more.Pearly white seashores with clearblue waters, a Mexican dinner on theboardwalk, a city tour along the nar-

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

Sudhir Ken Mehta, M.D., MBAChair CME, AAPI

(Continued on page 27)

Beautiful Puerto Rico

CME in Progress

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12 AAPI Journal May/June 2004

FEATURE

Aneuropathologist in Bostonwas offered a coveted posi-tion in Providence, RI, across

the border. The Rhode Islandlicense board wrote her medicalschool in India for documents -Primary Source Verification (PSV).Who knows where my friend’s fadingrecords are, lying somewhere inPune under generations of dust cov-ered documents! What she neededwas a Godfather.

The hospital finally took thenext candidate in line. Sad! She isnot alone. I bet you know friendswho let go of opportunities fromjust this fear. Or keep renewinglicenses in many states- afraid togive up, just in case!

You have a friend in your AMA– IMG Section. Your Section, withAMA help, even created an IMGseat at the ECFMG Board and isnow on the way to seating IMGs onthe NRMP (National ResidentMatching Program) board - thingsunimaginable only yesterday!

We have gotten the FSMB(Federation of State MedicalBoards) to coordinate PSV with theECFMG. The FSMB has agreed tosoon accept the ECFMG verifica-tion rather than conduct a secondPSV of its own, reducing our mis-ery.

Visionary IMG leaders startedyour AMA - IMG Section, initially asan advisory committee from 1989and finally as the Section from 1997.You have the power to enhance ourinfluence on AMA by joining theAMA and your Section- out of180,000 IMGs nationally, only 43,000are members of the AMA. Can youeven imagine our potential if we just

get half of us to join?

So many of you called me look-ing for avenues for J1 visa waiver(which many of us avail of to not haveto return to India for 2 years afterresidency) since its discontinuanceafter 9/11! Your Section got theAMA to advocate for J1 visa waiver.

HHS (Health and Human Services)has not only reinstituted it, but also isreworking J1 waiver to address physi-cian shortages. Such is the power ofparticipation in democracy!

So many ECFMG certifiedIMGs are unable to find residencypositions year after year. YourSection got the AMA to revise its pol-icy assumption of physician oversup-ply and recognize shortages. This

and the about to be releasedCOGME (Committee on GraduateMedical Education) report shouldsoon increase entry level residencyslots to about 25,000 (from 21,500).We can make a difference!

A fellow Indian had a job offerand needed ECFMG credentialsverified. He was about to lose theposition from delayed ECFMGresponse. Your Section intervenedand saved him his job. Your Sectionis working proactively with theFSMB to ease license portabilityproblem and to eliminate differ-ences in licensure requirements forIMGs. This is the time to beinvolved, for we are on the cusp offar reaching changes in licensure.

AMA is very democratic. We canset the desired policy if we join andcan persuade our colleagues in theHOD (House of Delegates). Whileas a group we IMGs are participatingincreasingly and have 70 members inthe AMA HOD it is such a small frac-

tion of the total of over 1,100 in theHOD. That is just a miniscule pres-ence for a group that numbers a quar-ter of all physicians. The choice to joinand empower us is in your own hands.

Your Section’s strategy aims atincreasing leadership role of IMGs atcounty, state and national levels -through encouragement, mentoringand leadership training programs -One was held in Philadelphia in

When We Need a Godfather

S. Jay Jayasankar, M.D.Chair AMA – IMG Section

Past President, AAPI

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AAPI Journal May/June 2004 13

POLICIES AND GUIDELINE FOR WRITERS

Policies and Guidelines for Writers in AAPI Journal AAPI Journal seeksoriginal, previously unpublished articles from members on medical

and social matters, memorable experiences in your life, practice tips andtechniques meaningful to the readers and more. Articles should be sentpreferably as e-mail (Microsoft word, if possible) attachments. Featurearticles should be about 1 -1.5 pages (500 - 750 words), and news itemsabout 1/4 a page (100 words). Stories should be written in a conversa-tional style, easy to read. Please also add full author information and con-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 issueis “ MSR/ YPS AAPI Journal.” We encourage submissions for the reg-ular columns “Members in the News”, “A Glimpse of My Life,”“The best of AAPI humor,” “AAPI and Poetry,” “AAPITravelogues,” and “A Very Interesting Case.” Also, you may sendquotes, anecdotes, jokes, etc. which can be used as fillers. Submission ofgood quality photographs including author’s and activity photos whichillustrate the article are encouraged.

Cover Art: Original good quality photographs - 3.4” x 5” or bigger, hor-izontally formatted with details, or paintings for cover, from members andtheir spouses are needed. The Editorial committee reserves the right toaccept or reject any articles and edit all accepted articles as needed. Pleasevisit our web site www.aapiusa.org for detailed instructions.

Editor, AAPI Journal ([email protected])Hernando Heart Clinic • Brooksville, FL 34613

October, 2003 and another inHonolulu in December, 2003. YourSection has just succeeded in creat-ing 10 all expenses paid scholarshipsfor IMGs in the renowned AMAFoundation Leadership Program andthe first 10 scholars participated inthe program in March 2004 inWashington DC. We plan a day lead-ership meeting in Chicago onJune11th. Seek leadership positionsin your county, state and nationalsocieties. If not we will have onlyourselves to blame if our needs arenot met.

Most of you know about Dr.Virmani who lost his privilegesthrough abuse of peer review. TheAAPI filed a successful amicus briefwhose outcome has created a newlegal precedent. It should not havehappened in the first place. As Chairof the MMS (Massachusetts MedicalSociety) Committee on MedicalService, I was able to develop“Principles for Peer Review” and dis-seminate it to all hospitals in

Massachusetts to lessen the chancesof peer review abuse. The AMA isreviewing adoption of MMS“Principles for Peer Review” and dis-seminating it to all hospitals in theUS. To be effective, your member-ship at the AMA is crucial. Justthrowing stones is futile.

I agree that AMA dues of $420 isa lot when we have other duesbesides. And our reimbursements arenot going up and, in fact, are being cutover and again. Medicare wanted tocut reimbursement by 4.5% for 2003and over again for the next two years.The AMA speaking as our unifiednational voice along with our specialtysocieties, reversed some time ago thecut for 2003 and got us a 1.5% raiseinstead. That has put $3,000 in ourpockets in 2003 instead of $9,000 outof our pockets. And now with a sec-ond victory for the next 2 years weeach are better off by an average of$12,000 a year for the next two years!Now, the $420 dues, in perspective,are not high at all.

The question is not whether wecan afford to join the AMA butrather, whether we can afford not tojoin he AMA. AMA is leading ourbattle for tort reform, HIPAA,EMTALA and all kinds of regulatoryrelief and at your section’s request onsorting out the post 9/11 visa prob-lems, license and parity issues ourconstituents face. Your Section istirelessly advancing your issues andsolutions - we have a good thinggoing, but it cannot last without yourmembership and involvement.

Your participation at all levels isthe IMGs’ Godfather.

For more information or helpcontact: Ashish Bajaj, Staff Liaison:(312) 464-4743; [email protected] S, Jay Jayasankar 781-790-1007; [email protected]

* Dr. Jay Jayasankar is an alternate delegate tothe AMA from Massachusetts and the Presidentof the prestigious Boston Medical Library.

◆ ◆ ◆ ◆ ◆ ◆

www.saforchoice.orgSouth Asians for Women’s LivesDelegation for the March for Women’s Lives

April 25th, 2004 • Washington, DCAt a time when women’s rights are under attack, we join together asSouth Asians and South Asian Americans to express our overwhelmingsupport for the health and reproductive rights of all women.

South Asians for Women’s Lives has been endorsed by a number ofprominent organizations, including ASHA, the Asian AmericanPublic Policy Institute, International Planned Parenthood Federation,and the South Asian Public Health Association.Please join us in supporting women’s rights by registering atwww.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, DCon April 25, 2004 at the most significant and massive reproductiverights march in over a decade!

We believe that health and reproductive rights are fundamentaltenets of freedom and are central to women’s equality.

We recognize that individual communities face unique barriers inexercising their rights, and therefore hope to include the voicesof South Asians and South Asian Americans in the dialogue con-cerning women’s health.

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Physicians and their office staffare tired of calling insurancecompanies to inquire about the

status of their claims. They oftenspend endless hours on phone calls,only to be told that the “claim is beingprocessed” or the “check is in themail”. Busy surgeons or procedureoriented practitioners call and gothrough a long process to obtainauthorization for procedures - manypractices requiring additional staff forthis purpose. In addition, differenthealth plans utilize different codes -for anything from procedures to rea-sons for denials and changes in reim-bursement. Each plan also assigns adifferent ID number to a participatingprovider. Now, under the HealthInsurance Portability and Account-ability Act (HIPAA) rules, a singlecoding system must be used by allhealthcare payers.

While most physicians and otherhealthcare practitioners are painfullyaware of the HIPAA rules of securityand confidentiality, they are not awareof the critically advantageous rules ofHIPAA - electronic data interchange(EDI) in a standard format.

The federal government estimatessavings of billions of dollars in health-care administrative costs in the nextfive to ten years when standardizedEDI is widely adopted by healthcarepayers and providers.

Under HIPAA regulations, alltransactions between healthcare pay-ers and providers must be in a stan-dard electronic format, with the use ofstandard codes and identificationnumbers for payers and providers.Previously, the healthcare industryhad been using up to 150 different for-mats for electronic transmissions and

did not have success in standardiza-tion. Hence, the government steppedin to dictate a single format for trans-mission of claims, Explanations OfBenefits (EOBs), pre-authorizationsand other transactions. The followingis a list of electronic transactions thatare of particular importance to thephysician community:

• Eligibility query and response (HIPAA 270/271) - Permits theprovider to obtain information on patient eligibility for a proposed test or procedure prior to rendering service.

• Claim status query and response(HIPAA 276/277) - Permits theprovider to determine the status of a claim submitted to a payer.

• Claim transmission and EOB (HIPAA 837/835) - Permits the provider to send claims and receiveEOBs in electronic format, includ-ing direct deposit of payment to aprovider’s bank account.

• Pre-authorization for procedures from payers (HIPAA 278/278R) - Permits the provider to send a pre-authorization request and obtain aresponse.

In this era of increasing costs ofmaintaining a physician practice withdecreasing reimbursement, physicianscan reduce their overhead expensesconsiderably by taking advantage ofHIPAA regulations. HIPAA regula-tions mandated that all payers be fullycompliant with the EDI rules byOctober 16, 2003. While providersare not mandated to comply with theEDI rules of submission to the payers,Medicare is expected to require EDIclaim submission by all providerswithin a year. But, why wait?Physicians can take advantage of the

law and start using the electronictransmissions.

For example, a gastroenterologistwho plans to examine a new patientcan verify the eligibility of the patient- not just for coverage, but alsowhether the health plan will reim-burse for a specific procedure. She nolonger has to rely on the validity of theinsurance card carried by the patient.After examination of the patient, ifpre-certification for a procedure isrequired, she can send an electronicfile to obtain such authorization. Shethen performs the planned procedure,electronically files the claim the sameday, and obtains payment by check ordirect deposit to a bank along with anelectronic EOB, all within a shortperiod. The insecurity that currentlyexists regarding eligibility of thepatient, acknowledgment of claimsmailed, and status of claims sent to thepayer will no longer exist when physi-cians start using HIPAA mandatedEDI transactions.

How can physicians take fulladvantage of HIPAA regulated EDI,providing for quick confirmation ofeligibility and written approval of pro-cedures, as well as confirmation ofreceipt of claims and prompt pay-ment? Physicians will need to eitherpurchase software that has all HIPAAEDI functions incorporated or con-tract with a billing company to providethe necessary EDI services.Sophisticated software systems are

AAPI Journal May/June 2004 15

FEATURE

How HIPAA Electronic Data Interchange Can Help Physicians

A. Hassan Mohaideen, M.D.M.B.A., F.R.C.S., F.A.C.S.

(Continued on page 27)

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16 AAPI Journal May/June 2004

SECRETARY'S REPORT

The AAPI Governing BodyMeeting, held in the excitingcity of New Orleans, LA,

(March 5-6, 2004) with warmth andabundant southern hospitality, was anevent to remember.

Dr. Surendra Purohit, Past-Chairof AAPI BOT and President of AAPILouisiana Dr. Tilak Malik, welcomedgoverning body members with openarms.

One of the highlights was a specialsession, “Information Technology forAAPI” on Friday, March 5. Dr. SubrotoKundu, chair of IT task force that hasenvisioned 21st-century technology,presented the feasibility of a project,which will put AAPI on par or exceedother organizations. The proposal fore-sees a new IT platform custom-builtfor AAPI, including full web servicesfor AAPI and all individual memberorganizations, alumni association andspecialty groups. Further, all AAPImembers would receive an e-mailaddress to communicate within theorganization and also have personal-ized and customized Web pages. The“backbone” of the IT services wouldoffer detailed member databaseenabling the AAPI leadership toaddress legislative, public health, char-itable and other services. The databasewill start current by auto correctingmember information. The hazards ofspam, anonymous e-mail and lack ofconfidentiality have spurred the needfor electronic communication. Manythanks to Dr. Kundu for an outstandingpresentation, which wasapplauded bythe governing body.

Dr. Ravindra Nathan, ChairPublication Committee, presented sug-gestions to improve the quality of theAAPI Journal and hire part-time staffto share the increasing workload of thejournal, which was approved.

In the evening, the host committeeheld a unique New Orleans-style MardiGras party. Dr. Sharad Lakhanpal andMrs. Rashmi Lakhanpal were crownedas the King and Queen of the night andwere giving honorary citizenship of NewOrleans in a written decree by theMayor. The new Orleans jazz and bluesentertainment was out of this world.

The next day, on March 6,President Dr. Sharad Lakhanpal calledthe well-attended meeting to order. Inhis report, Dr. Lakhanpal highlightedthe progress AAPI has made in the lastnine months, especially successfulseries of CME in Goa, Lucknow,Jaipur, New Delhi, Peru and PuertoRico. He spoke about the meeting theAAPI delegation had with HonorableAbdul Kalam, President of India, ShriL.K. Advani, Deputy Prime Ministerand Smt. Sushma Swaraj, HealthMinister. At the Pravasi BharatiyaDivas venue, a special health care ses-sion was moderated by Dr. Lakhanpal,where AAPI members were the lead-ing participants. Dr. Lakhanpal alsoannounced that charitable clinicswould open shortly in Lucknow andJaipur.

Dr. Jagan Alinani, President elect,presented the proposed bylaw changes,which were approved previously by thegeneral body through mail-in ballots.He stressed that efforts continue toinclude dentists and scientists of Indianorigin under AAPI umbrella.

Dr. Akshay Desai, Vice President,pointed out that AAPI had achieved totalpaid membership of more than 10,000.

Besides submitting his report, Dr.Sampat Shivangi, Secretary, spoke aboutefforts to modernize the AAPI officeequipment and IT infrastructure toachieve higher effciency with the help ofDr. Kundu, Chair IT Task Force.

Dr. Hemant Patel, Treasurer, pre-

sented AAPI’s finances and good newsof a positive balance.

Dr. Haranath Reddy, Chair BOT,stated that AAPI operating loan of$109,000 was repaid to the patronaccount for the first time in the associ-ation’s history. Total investments havegrown by $30,000.

Dr. Deepa Patel, president YPS,and Dr. Saumil Oza, MSR president,presented their reports too. Reportsfrom regional directors and variouscommittee chairs also were submitted.

The other important issue broughtto the governing body was the possibil-ity of outsourcing the AAPI office toMichigan State Medical Society. Itsdirectors, who were present, offeredsome reasons AAPI should consideroutsourcing its office to MSMS.

After long and meaningful delibera-tions, the governing body decided againstconsidering the proposal at this time.Executive Committee also met with YPSand MSR sections to discuss their con-cerns, especially convention issues.

A grand banquet was organizedthat evening with AmbassadorAgnihotri and the Director ofLouisiana Health Services as chiefguests. Entertainment followed thebanquet. The governing body meetingended with a brunch and CME of theLouisiana chapter.

Our sincere appreciation andthanks to the Louisiana host committeefor a memorable event and a meaning-ful governing body meeting.

AAPI Spring Governing Body Meeting

SAMPAT S. SHIVANGI, MDSECRETARY of AAPI

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AAPI Journal May/June 2004 17

AAPIGOVERNING

BODY MEETINGNEW ORLEANS

MARCH 5-6, 2004

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AAPI Journal May/June 2004 21

The ultimate reason why we needto fix the liability system has alittle to do with physicians, but a

lot to do with our patients, to protectAccess to Care in their hour of need.

Medical Liability reform remains akey priority of physicians. A recent rallyin Chicago chanting “Tort ReformNow” is one of many that have takenplace across the country this year.Physicians have joined forces to pushlawmakers to enact reforms to sta-bilize or even reduce insurancerates. AMA considers 19 states tobe “states in Crisis”, only six statesare safe from tort issues.

There is no evidence of anycorrelation between lawsuitawards or settlements and negli-gence; besides lawsuits do noth-ing to enhance patient safety.What physicians desire are basicfairness and a level playing field.So far the system is faulty, in thatthe patient will loose access tocare as doctors are unwilling orunable to take care of them. Themajor objective in a malpractice actionis to shift responsibility for damagesincurred from the patient to the per-son or persons responsible for the dam-ages. The current malpractice litigationsystems are not aligned with the pur-pose of compensating injured patients.

Liability insurance premium hikesthat affected physicians in high risk spe-cialties such as obstetrics and neuro-surgery are now encroaching primarycare physicians who take care of nursinghome patients. Almost 22% of physi-cians who take care of nursing homepatients are unable to get or renew theirmalpractice insurance coverage.

The skyrocketing malpracticeinsurance premiums have forced physi-cians to limit the scope of their practice

or to move to another state. The otheroption which was popular many yearsago, “Going Bare” is not always feasi-ble. At least 13 states require physi-cians to carry liability insurance inorder to keep their medical license.Also hospitals often require minimumlevel of insurance be carried by physi-cians to be on the staff. Health plansinvariably will not allow a physician tobe on their panel without coverage.Favorable homestead exemption laws

may lure physicians to go bare but thebig question is whether one can go tosleep at night taking such a risk.

AMA has made tort reform its No.1 legislative priority. It will eventuallypass if there is sufficient pressure fromthe public. A recent survey of nearly4,000 medical students in 45 statesshowed that 86 % of students believethat medical liability crisis is a majorproblem. It has become a key factor inchoosing a specialty and also choosing astate in which to practice. There is areal concern that if the liability crisis isnot fixed, there could be shortage ofphysicians in certain specialties.

As a member of the top team ofTexas Medical Association for theReform, I was invited to meet withthe governor of Texas, Rick Perry to

discuss medical liability reform. I con-tacted the 7,500 IMG physicians inTexas to work on this issue. The victory

for Prop 12 in Texas has set thetone for other states to be success-ful. Recent passage of theProposition 12, enacted by theTexas Legislature is already payingdividends for physicians and theirpatients. The constitutionalamendment to cap non economicdamages ensures the caps are notoverturned in the courts. This hasprompted the Texas MedicalLiability Trust to lower its premi-ums across the board by 12%. Asanother positive spinoff, it haslured a few more insurance carri-ers to come to Texas.

The Liability reform was a pivotalissue on the minds of everyone whoattended the AAPI’s seventh AnnualLegislative Conference in Washington,DC in March. . The legislative meet-ing provides an avenue to voice ourconcerns to the lawmakers, however inorder to be more effective, a soundcomprehensive approach is necessary.Although all politics are local, AAPI asan eminent organization will need todevelop a system which will supportand enhance advocacy on key issues atthe national level and leverage the con-siderable clout it has through the grass-roots organizations and individuals.Senator Bill Frist, MD addressing thegathering of AAPI members at the leg-

FEATURE

Saving Medical Practice…

(Continued on page 35)

Vijay Koli with Rick Perry, Governor of Texas

Vijay Koli, MDChair, AAPI Committee on Liaison with AMA.

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AAPI Journal May/June 2004 23

108th CONGRESS 2nd SessionH. RES. 579

Honoring the American Association of Physicians of Indian Origin and expressing the sense of the House ofRepresentatives that an American Association of Physicians of Indian Origin Day should be established.

IN THE HOUSE OF REPRESENTATIVESMarch 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

RESOLUTIONHonoring 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 theUnited 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 inunderserved rural and inner-city communities across the Nation;

Whereas the American Association of Physicians of Indian Origin Charitable Foundation operates 14 freemedical 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 gatheringdata on diseases that disproportionately affect Indian Americans, such as diabetes, coronary artery disease, andosteoporosis;

Whereas the American Association of Physicians of Indian Origin has successfully secured $500,000 inFederal funding to conduct a study and education program on diabetes and coronary artery disease in IndianAmericans and is continuing to work with the Congress to fund a more detailed study and education program inthis field of research;

Whereas the American Association of Physicians of Indian Origin publishes a bimonthly AAPI Journal, hostscontinuing medical education programs, hosts an annual national convention for thousands of its members in amajor 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 conferenceon 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 toquality, 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.

◆ ◆ ◆ ◆ ◆ ◆

HONORING AAPI

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24 AAPI Journal May/June 2004

AAPI AT THE CAPITOL

On March 29-30, the AAPI heldits 7th Annual LegislativeConference in Washington,

D.C. Over the years, the LegislativeConference has served as a tremendousopportunity for AAPI leaders to (1) edu-cate themselves on policy issues affect-ing the American health care sector,Indian American health and Indo-U.S.relations, and (2) meet with Congressionallawmaker to express the concerns ofphysicians of Indian origin and of theIndian American community as a whole.This year’s event not only accomplishedthese goals but, in fact, proved thatAAPI’s accomplishments on Capitol Hillhave moved to new heights.

The conference began on theevening of Monday, March 29th, with areception for Congressional stafferssponsored by the Indian MedicalAssociation of Maryland and GreaterWashington, D.C., led by its President,Dr. Jayesh Dayal. The reception, heldat a Capitol Hill restaurant, providedAAPI leaders with an opportunity tomeet and mingle with Congressionalstaff who regularly provide “behind-the-scenes” support for AAPI. As anadded treat, Congressman Joe Wilson(R-SC), Co-Chair of the CongressionalCaucus on India and Indian Americans(“India Caucus”), made a surprise visit.

On Tuesday, March 30th, AAPImembers began their work of dis-cussing legislative issues by participat-ing in consecutive workshops on “TheFuture of Indo-U.S. Relations” and“Health Care Issues Before the 108thCongress and Indian AmericanHleathcare Issues.” These discussions

began after a welcoming address fromDr. Rakesh Shreedhar, Chair, AAPILegislative Affairs Committee, and apresentation of AAPI’s legislative agen-da by the association’s President, Dr.Sharad Lakhanpal. The “Indo-U.S.Relations” workshop featured suchnotable speakers as Congressman JoeWilson, Dana Dillon (Scholar, theHeritage Foundation, a political think-tank), Richard Verma (Senior ForeignPolicy Aide to the Senate DemocraticLeadership and Sen. Harry Reid (D-NV)), Ashok Sajjanhar (PoliticalMinister, Embassy of India). The spir-ited discussion was moderated by Dr.Krishna Reddy, President of the IndianAmerican Friendship Council, andcovered such topics as the U.S. decla-ration of Pakistan as a major non-Natoally, the Indian government’s publicrelations effectiveness in the U.S.media, and outsourcing.

The “Health Care Issues” panel,moderated by the former Chair ofAAPI’s Legislative Affairs Committee,Dr. Krishan Aggarwal, presented theAAPI members in attendance with ataste of the vastness of health careissues discussed on Capitol Hill. Theesteemed speakers included,Congressman Frank Pallone (D-NJ)(founder of the India Caucus andmember of the Health Subcommitteeof the House Energy and CommerceCommittee), David Fisher (HealthCare aide to Senator Judd Gregg (R-NH), author of the recently-defeatedSenate tort reform bill), Dr. CardenJohnston (President of the AmericanAcademy of Pediatrics), ShaliniVallabhan (Director of South AsiaPrograms for the American CancerSociety), Dr. Thakor Patel, Advisor ofthe AAPI Public Health Committeeand a leader of the AAPI DiabetesAmong Indian American study, and Dr.Ranga Reddy, Past President of AAPI.

As its lunchtime keynote speaker,AAPI was honored to have AmbassadorBhishma Agnihotri, India’s GlobalAmbassador-at-Large for NRIs/PIOs.Spending quality time with AAPI lead-ers, Ambassador Agnihotri urged AAPIto not only join, but lead, the growingmovement to create a national Councilof Indian American Associations to stim-ulate communication and collaborativeactivities amongst all Indian Americans.

As part of the LegislativeConference’s advocacy efforts, theAAPI leadership held separate meetingswith the Majority and Minorty Whips ofthe U.S. House of Representatives. TheWhip position in both parties is held byits 2nd highest ranking member, in thiscase, Tom DeLay (R-TX) and StenyHoyer (D-MD). During the meetingswith Congressmen DeLay and Hoyer,the primary issue for AAPI was theorganization’s request for $2 million tocontinue funding its study of diabetesamong Indian Americans. This request,which has been submitted to theHouse Appropriations Committee onbehalf of AAPI by Rep. Pallone, followsup on the historic $500,000 appropriat-ed by the U.S. Congress to AAPI in2003, the first time an Indian Americanorganization has been awarded thistype of direct grant.

The crown jewel of AAPI’sLegislative Conference was its 2ndAnnual Capitol Hill Gala Dinner, heldin a beautiful, oak-paneled hearingroom in the Senate Hart Building.During the cocktail reception preced-ing dinner, a number of U.S. Senators

OUR LEGISLATIVE DAY AT THE CAPITOL

(Continued on page 37)

Anurag Varma, JDLegislative Director, AAPI

Rakesh Shreedhar, M.D.Chair Legislative Affairs Committee, AAPI

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AAPI Journal May/June 2004 25

Photos by: Mohammed Jaffer-Snapsindia

Congressman Joe Crowely speaking

Congressman Joe Crowley adjusting pin of young Indian Physician Dr. Shah

Dr. Ranga Reddy asking a question toSenate Majority Leader Bill Frist

Senator Paul Sarbanes

Dr. Desai and Senator Paul Sarbanes

Senator Thad Cochran, Drs. Sudhir Parikh, SharadLakhanpal, Rakesh Shreedhar

Drs. Sampat Shivangi, Sudhir Parikh, Akshay Desai, SenatorPaul Sarbanes and AAPI President Dr. Sharad Lakhanpal

Mrs. Sharad Lakhanpal congradulated Co-Chair "Friends of India" inU.S. Senate Republican Senator from Texas John Cornyn

Senate Majority Leader Bill Frist with AAPI ExecutiveCommittee

Senate Majority Leader Bill Frist recived by the AAPI executive committee mem-bers right to left Drs. Desai, Lakhanpal, Bill Frist,Vijaynager, Congressman Joe

Crowley, Shivangi, Jain, Parikh, Singhvi

Drs. Vijaynager, Sharad Lakhanpal welcome Senate MajorityLeader Bill Frist

Senate Majority Leader Bill Frist speaking

Co-Chair "Friends of India" in U.S. Senate Republican Senator from Texas John Cornynbeing introduced to India's Ambassador to U.S Lalit Mansingh, by Dr. Sharad

Lakhanpal. Ambassador at large Bhishma Agnihotri in center

Congressman Frank Pallone with Drs: Lakhanpal and Ailinani

Ambassador Lalit Mansingh Speaking

Ambassador Lalit Mansingh and Ambassador at large Bhishma Agnihotri with AAPI Leadership

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26 AAPI Journal May/June 2004

Special Series:

Complementary and Alternative Medicine

Eighty percent of the globalpopulation (5 billion people)use traditional practices to

meet their primary healthcare needs.This trend has now made its way tothe U.S. as well. The way in whichmedicine is practiced in the U.S. israpidly changing, as evidenced by thefollowing statistics:

• Expenditures for Complementaryand Alternative Medicine (CAM)were $82.4 billion in the U.S. in 2003.

• 79% of patients surveyed in 2001 said a combination of CAM and conventional medicine is superior

to either one alone.

• 35-50% of conventional physiciansreferred their patients to IntegrativeClinics in 2001.

• An estimated 50-66% of the nation’sinsurers are offering some form of coverage for CAM practices.

• 75 medical schools in the U.S. are teaching CAM modalities and the NIH has increased the budget for research on CAM modalities to$116 million in 2004.

In line with these changingtrends in medicine, the AAPIIntegrated Medicine Committeeorganized a Conference on Ayurveda

in Orlando, Florida, so practitionerscould learn new health concepts thatcan easily be incorporated into theirexisting practice to benefit them andtheir patients. This issue of the AAPIJournal also offers a series of articleson Integrated Medicine to give ataste of what this rapidly expandingfield has to offer.

◆ ◆ ◆ ◆ ◆ ◆

Introduction

NRIs in America commonlyrun into many old stereo-types and distortions about

India and, more specifically, about theHindu tradition. India is identifiedwith poverty, overpopulation andbackwardness, though historicallyIndia was usually among the mostadvanced and affluent countries in theworld. The Hindu religion is reducedto caste, cows and curry, with littleregard for its great Yoga and Vedantictradition, though these have had sig-nificant followings in the West fordecades. The Indian contribution toscience from physics to medicine isignored, though it was considerablefrom Aryabhatta to Sushruta, startingeven with the Vedas.

Most NRIs, including medicaldoctors, are aware of the deeperaspects of the Indic tradition andwould like to see these distortions cor-rected. Most of them follow gurus,practice pujas or meditation, donateto temples, and go on pilgrimages to

India, continuing their own personalconnection to this great tradition.

Ayurvedic medicine is anotherimportant aspect of the Indic tradi-tion that has been similarly distortedand denigrated. Of course, theBritish closing down of Ayurvedicschools during the colonial periodhad a lot to do with this. Yet evenmodern India, though it has restoredsome degree of Ayurvedic education,allots only minimal resources toAyurveda. The result is thatAyurvedic schools and hospitalsappear quite substandard relative tomodern medicine, which receives amuch greater government and edu-cational regard. The best medicalminds of India today do not go intoAyurveda but into modern medicine,which also keeps the standard ofAyurveda from becoming as high as itcould be. While this may cause peo-ple, including Indian medical doc-tors, to look down upon Ayurveda asa science, the problem is more this

lack of support, than some funda-mental flaw in Ayurveda itself.

The result is that many Indo-American doctors respect the Indictradition, but few of them recognizethe importance of Ayurveda withinthat tradition. Many value Yoga orVedanta but not Ayurveda. This iseven the case with those who havecome from older Ayurvedic familiesthemselves, but have lost track oftheir own family traditions.

The Chinese community andChinese medical doctors, on theother hand, have been much moresupportive of Traditional ChineseMedicine and have made sure that it

The Need to Support Ayurveda

(Continued on next page)

Hari Sharma, M.D., FRCPCChair, Integrated Medicine Committee, AAPI

Email: [email protected]

Dr. David FrawleyDirector, American Institute of Vedic Studies

Santa Fe, New Mexico Email: [email protected] • Website: www.vedanet.com

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AAPI Journal May/June 2004 27

has gained recognition worldwide.Ayurveda is not any less older or lesssophisticated than Chinese medicine,or less capable of getting worldwiderecognition. It is just as worthy of thesupport of the Indo-American com-munity as Chinese medicine is of theChinese-American community – andjust as dependent upon it.

Ayurveda shows the practicalaspect of Vedic, Yogic and Vedanticknowledge, how to use these greatdharmic principles of harmony withboth Spirit and Nature (Purusha andPrakriti) for health and well-being ofbody and mind, including proper dietand life-style relative to both individ-ual constitution and our special socialand environmental conditions in theworld today. Ayurveda is an integralpart of all Yogic and Vedantic disci-plines. Many of modern India’sgreater gurus have emphasized thevalue of Ayurveda. Many of theirashrams offer Ayurvedic treatment.

Ayurveda has a materia medica ofherbs and minerals perhaps larger thanany other in the world, which alsodeserves greater examination. In thehistory of medicine, practices from cos-

metic surgery to immunization werepioneered by Ayurvedic doctors.

Ayurvedic literature, both inclassical Sanskrit, starting withSushruta, and in the local dialects ofIndia, is enormous and containsmany secrets of both physical andspiritual healing.

Today there is a new interest inAyurveda in the United States and inthe western world as a whole, butmainly among non-Indians. Severaldozen books on the subject havebeen published, some becomingnational best sellers. European coun-tries like Germany and Russia nowhave recognized the practice ofAyurveda. In some form or anotherAyurveda can now be found on all thecontinents of the world.

Movements are underway to grantcredibility and seek legalization ofAyurveda in the United States as well.Notably, the National AyurvedicMedical Association just had its firstnational conference in Florida andproves to become an important mouth-piece for Ayurveda in this country.However, compared to such organiza-tions as AAPI, it remains quite smalland with very limited resources.

Without the support of the NRIcommunity and Indo-American doc-tors, Ayurveda is unlikely to be licensedin America. With such support, howev-er, Ayurveda will not only gain credibil-ity but also bring more regard to theentire dharmic tradition of India thatincludes not only spirituality but alsoscience together in an integral harmo-ny of knowledge and wisdom.

Ayurveda is an important aspectof the Indian tradition which deservesstudy, support and patronage, as wellas further research and practice.Should Ayurveda gain the attentionand regard it deserves, it can aid theworld in a renaissance of mind-bodymedicine. The Ayurvedic communityboth in the West and in India wouldtherefore encourage AAPI to take upthe cause of Ayurveda, not simply as acultural concern but also in pursuit ofthe real truth of healing, in which con-sciousness is as important as any outertreatment modality. Ayurveda’s eco-logical view of the need to harmonizethe individual, society, and nature isalso becoming increasingly relevant aswe move more into a planetary age.

◆ ◆ ◆ ◆ ◆ ◆

The Need… Continued

How HIPAA Electronic Data InterchangeCan Help Physicians

Continued from page 15

now available that perform all HIPAA required EDI trans-actions in addition to all the current medical managementfunctions required by a practice. Other options exist, whereHIPAA compliant EDI software modules are purchased tocomplement existing medical management software that aprovider uses.

It is time that physicians start reducing their overheadexpenses to maximize income – by using HIPAA EDI.

AAPI member Dr. A. Hassan Mohaideen is a vascular andgeneral surgeon, and currently is the President and CEO ofHealth Plan Systems, a healthcare administrative softwarefirm. Along with his partner Dr. D. Venkatanathan, a formerNASA scientist, Dr. Mohaideen has been creating softwarefor healthcare providers and payers for the past fifteenyears. Dr. Mohaideen can be contacted at [email protected] by calling (201) 556-9430.

◆ ◆ ◆ ◆ ◆ ◆

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

Continued from page 11

row streets of San Juan, a private boat cruise to a small islandwith people singing Hindi songs in chorus and finally havingan evening dinner where all the ladies got a beautiful longstemmed rose as they became Dr. Sharad Lakhanpal’s valen-tine and gentlemen got a box of chocolates as they becameMrs. Rashmi Lakhanpal’s valentine…yes, indeed, this was oneCME, the memories of which will linger on for a time.

For me, the meeting ended on another high note. On thelast day, I had the pleasure of looking at the “NRI Today” mag-azine which featured AAPI and its president, SharadLakhanpal on the front cover. If we continue along this path, Isee nothing but a shining future for AAPI. Our strength willcontinue to increase through high caliber programs, active par-ticipation from members, great leadership from the top, and astrong will to succeed. If you have been waiting to become amember of AAPI, you could not ask for a better time.

Let us move forward one step at a time with unity. ◆ ◆ ◆ ◆ ◆ ◆

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28 AAPI Journal May/June 2004

Ayurveda is a 5000 year-oldholistic Vedic tradition thatliterally means ‘science of life

or longevity.’ Knowledge of Ayurvedaenables one to create balance ofbody, mind, and consciousnessaccording to one's own constitution.According to Ayurveda, every indi-vidual has a unique combination ofphysical, mental, and emotionalcharacteristics that is his or her con-stitution. Body, mind, and conscious-ness work together to maintain adynamic balance. Internal and exter-nal factors can disturb one’s constitu-tional balance. Both physical andmental imbalances are reflected inthe skin.

Ayurveda identifies three basicoperating principles or doshas thatare present in everyone: Vata, Pittaand Kapha. According to Ayurvedicphilosophy the universe is composedof the energies of the five elements--Space, Air, Fire, Water and Earth.The doshas are comprised of theenergies of these elements as follows:

• Vata (Space and Air)• Pitta (Fire and Water)• Kapha (Earth and Water)

Ayurveda dictates that everyindividual is a unique combination ofthe three doshas; this combinationdetermines each person’s psy-chophysiological constitution (skin,body, and mind type).

Ayurveda and Skin Care

Ayurveda was first 'seen' by rishisand sages who radiated beauty fromthe core of their being. Ayurveda wasthe tool they used to bring balanceand clarity to the body and mind. It isexplained in Ayurveda that beauty isthe result of vibrant health achievedby balancing the doshas. Ayurvedicbeauty treatments restore health tothe skin by utilizing the same princi-

ples as those prescribed to heal thewhole person.

The wisdom of Ayurveda recog-nizes that to achieve balance we mustbe in tune with our environment.Since the environment is alwayschanging (seasons, travels, lifespan,even mental attitudes), the treat-ments required to keep our skinhealthy also change. Just as each ofus has a dominant energy or dosha,so does each season. Springtime isdominated by Kapha, summertimeby Pitta, and winter is predominantlyVata in Nature as well as the humanphysiology.

The Ayurvedic concept ofRituacharya, or seasonal routine,advises taking our cue from the uni-verse's natural cycles. As the sapmoves from the branches of a treeinto its roots during early winter, sodoes our skin experience a period ofdryness. This means our winterbeauty treatments must focus onwarm, nurturing emollients to mini-mize cold, dry (Vata) skin. Duringsummer's heat our skin benefits fromlight, cooling skin care products tobalance the heat (Pitta).

Ayurveda provides abundantresources for those who want to radi-ate true beauty. Herbs like Turmeric,Saffron, Sandalwood, and Triphala,treasured by Indian women for cen-turies for their healing propertiesand beauty benefits, are part of itsnumerous gifts. Ayurveda's recom-mendation is to stay in tune with theever-changing environment and inte-grate its teachings to maintain healthand beauty.

Vata Skin

Vata skin reflects the elements ofair and space so it is thin, fine-pored,delicate, and cool to the touch. Dueto the absence of the water element

it tends toward dryness. If Vata doshais imbalanced, the skin will becomeprone to excessive dryness and mayeven be rough and flaky. The greatestbeauty challenge is a disposition tosymptoms of early aging such aswrinkles. In addition, Vata skin isprone to dry eczema and fungusinfections, and if digestion is not inbalance the skin will begin to lookdull and gray even early in life.

The key word for balance is‘lubrication.’ The skin needs to berehydrated both from internal andexternal sources. To hydrate the skinfrom inside, try to drink at least eightglasses of water a day and eat plentyof sweet, juicy fruits. Externally, usea high-quality moisturizing creamtwice a day.

Pitta Skin

Pitta dosha is composed mostly offire, so the qualities of this elementsuch as redness, heat, and sharpnesswill be reflected in the skin. Pitta skinis fair, soft, warm, and medium thick-ness. The complexion tends towardpink or reddish. There may be a copi-ous dose of freckles or moles. Pittaskin often mirrors the emotions –there is a tendency to blush easilywhen embarrassed or angry.Conversely, when happy and balanced,Pitta skin is glowing and radiant.

The main beauty challengesinclude a tendency to develop rashes,

AYURVEDIC SKIN CARE

(Continued on next page)

Suhas Kshirsagar, M.D.(Ayurved, India), BAMS

Dean, Aloha Ayurveda AcademyAyurvedic Physician, Kauai Holistic Medicine

Email: [email protected]

Special Series:

Complementary and Alternative Medicine

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Ama is a concept of Ayurvedathat can be understood asaccumulated toxic substances

at different levels of the physiology.At the level of gross digestion, poorlydigested food results in a thick, slimymaterial that lines the walls of thebowel, impeding absorption andassimilation of nutrients. At the cellu-lar level, during functioning of thephysiology there is accumulation ofimpurities and toxins. These impuri-ties come from both inside and out-side the body. From inside the bodycome internal metabolic and cellularwaste products, such as free radical-damaged cells and tissues, and fromoutside come external impurities andtoxins, such as pollutants and toxinsthat occur naturally in food. All theseimpurities are collectively referred toas ‘Ama’ in Vedic terminology.

Ama in the blood vessels can beunderstood as the accumulation oflipids and other substances in thewalls of the blood vessels, which caus-es plaque formation that results inblockage of blood flow. At the cellularlevel, damage from Ama can occur atvarious sites. Damage to the cellmembranes results in the inability ofexchange of substances, includingnutrients, between the intracellularand extracellular environments.Damage to cell receptors hinders theaction of hormones and other impor-tant biochemicals at the cellular level.Damage to mitochondria interfereswith energy production at the cellularlevel. Damage to DNA causes muta-tion and can result in initiation of thecancer process. Cellular damage atthese various sites results in the initi-ation of the disease process in most

diseases and disorders.

From the Ayurvedic point ofview, Ama is produced from improp-erly digested material at different lev-els of the physiology due to an imbal-ance in Agni. Agni is translated as‘fire’ or ‘flame.’ It governs the meta-bolic and endocrine systems, andassociated transformations in thephysiology, e.g. digestion, metabolictransformations, and hormonal andbiochemical changes. Agni in thehuman physiology is managed by gov-erning principles of the physiologyknown as the doshas: Vata, Pitta, andKapha. Thus, any imbalance in Vata,Pitta, and Kapha will produce animbalance in Agni. No disease canmanifest without a disturbance inAgni. Examples of Ama productionare:

1. Ama due to increased Vata withhigh Agni or low Agni

2. Ama causing heaviness in the phys-iology – due to increased Kaphawith low Agni

3. Highly reactive Ama – due toincreased Pitta with sharp Agni.

The primary source of Ama is thedigestive system but Ama can also beproduced in the liver or at other tis-sue levels, depending on the etiologi-cal factor. Agni disturbance in thedigestive system is responsible for thecreation of Ama that leads to 80% ofall disease processes.

Symptoms of Common Ama

• Excess fatigue or sleepiness after lunch

• Coated tongue• Stiffness in joints and muscles

AAPI Journal May/June 2004 29

(Continued on next page)

AYURVEDIC CONCEPT OF AMA (TOXIN ACCUMULATION)

Hari Sharma, M.D., FRCPCChair, Integrated Medicine Committee, AAPI

Email: [email protected]

rosacea, acne, liver spots, and break-outs or pigment disorders. Pitta skindoes not tolerate heat or the sun verywell. The key word for balance is ‘cool-ing.’ The emphasis should be on thera-pies that have a calming influence onthe skin. Synthetic chemicals should beavoided. A moisturizer with herbs suchas Sensitive Plant should be used.Flame of Forest helps protect againstphotosensitivity. Hot spicy foods, vine-gar, and fried foods should be avoided.

Kapha Skin

Kapha dosha is composed ofearth and water so the main qualitiesof Kapha are heavy, cold, slow, andoily. Kapha complexion tends to bepale and the skin is oily, soft, and coolto the touch. This type of skin hasless of a tendency to create wrinkles.

When Kapha skin is imbalancedit can result in enlarged pores, exces-sively oily skin, moist types ofeczema, blackheads or pimples, andwater retention. The key word forbalance is ‘cleansing.’ Kapha skintends to accumulate toxins and needsfrequent in-depth cleansing. A prop-er Ayurvedic cleanser that exfoliateswithout removing the natural mois-ture of the skin is best. Ayurveda rec-ommends first loosening the impuri-ties by lubricating the skin with anourishing substance such as herbal-ized oil, milk, etc. and then applyinga mask which has both cleansing andnourishing effects. Excessive use ofoils and a diet of overly sweet foodsare not recommended.

Education courses in Ayurvedacover details of the management ofskin disorders. Ancient Ayurvedic wis-dom, the most comprehensive sci-ence of health and prevention, can bevery helpful in common as well aschronic skin conditions in this mod-ern age.

◆ ◆ ◆ ◆ ◆ ◆

Ayurvedic Skin Care… Continued

Special Series:

Complementary and Alternative Medicine

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• Decreased immunity, e.g. getting flu, colds, or infections easily

• Cold hands and feet; decreased blood circulation

• Drowsiness• A feeling of slowness or sluggish-

ness in activity• Heaviness and headache• Lack of handling stress• Discoloration of skin• Slower functioning of eyes and

organs• Constipation, diarrhea, slower or

sluggish digestion

Management of Common Ama

1. Nidan Parivarjan – identifying theetiological factor and correcting it.

The etiological factor could be related to diet, daily routine, behavior, or seasonal imbalance.

2. Pacify the dosha (Vata, Pitta, orKapha) that is the root cause of Ama:

A.Proper Diet

• Eat according to Ayurvedic constitutional body type

• Avoid:_ Leftovers, highly processed

foods, foods with artificial ingredients or additives, andfast foods

_ Mutually contradictory foods, e.g. mixing milk with other foods

_ Eating an excess of foods with a single taste

_ Eating foods that are too hot or too cold

_ Ice-cold beverages and foods_ Overeating, even if eating

wholesome food_ Eating before previous meal is

digested_ Skipping meals; maintain a reg-

ular eating schedule_ Eating too quickly_ Eating when mentally or emo-

tionally disturbed, or physicallyexhausted

B. Daily Routine

• Early to bed (by 10 or 10:30 PM)and early to rise (6 or 6:30 AM)

• Avoid daytime naps

• Light breakfast (before 8 AM)and light dinner (before 6 PM)

• Main meal of the day should be at or near Noon

• Moderate exercise (exerting to half of one’s maximum capacity) – morning is best time, from sunrise to 10 AM

C. Behavior

• If mentally or emotionally dis-turbed, or physically exhausted, breathe deeply and slowly toregain balance in the system.

• Maintain coordination betweenthe mind, heart, senses, and spirit.

Ways to do this:

- Yoga

- Meditation

- Sattvic life – Achara Rasayana (Behavior Rasayana):

Behaviors and attitudes to be maxi-mized:

- Love

- Compassion

- Speech that uplifts people

- Cleanliness

- Charity and regular donation

- Religious observance

- Respect towards teachers and elders

- Being positive

- Moderation and self-control, especially with regard to alco-hol and sex

- Simplicity

Behaviors and attitudes to be avoid-ed:

- Anger

- Violence

- Harsh or hurtful speech

- Conceit

- Speaking ill of others behindtheir backs

- Egotism

- Dishonesty

- Coveting another’s spouse or wealth

D. Seasonal Imbalance

Each season exhibits predomi-nance of one dosha, which requiresbalancing according to Ayurvedicbody type.

3. Ama Pachana (Digesting Ama)

A. Diet

• Drink plenty of warm fluids

• Eat lighter foods accordingto Ayurvedic body type

• Cumin is the best spice forAma Pachana

• Spice mixture (powder): Mixtogether equal parts ofcumin, coriander, fennel,and turmeric. Use 1 teaspoon of this spice mixtureper person per meal when cooking vegetables or soups.

• Eat a slice of fresh ginger root with lime juice and salt just before lunch and dinner.

• Digestive preparations.

4. Shodhana – Detoxification orclearing Ama from the physiology.

This involves regulating bowelmovement by diet and herbal mix-tures, and Panchakarma (Ayurvedicpurification and rejuvenation proce-dure).

In conclusion, according toAyurveda the prevention of Amaaccumulation in the physiology is ofutmost importance in the preventionof disease.

◆ ◆ ◆ ◆ ◆ ◆

30 AAPI Journal May/June 2004

AYURVEDIC CONCEPT… Continued

Special Series:

Complementary and Alternative Medicine

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AAPI Journal May/June 2004 31

Marma therapy is one ofAyurveda’s best keptsecrets. It is the science of

utilizing vital energy points for heal-ing the body, mind, and spirit.Marma is defined as a vulnerablearea or a secretive, hidden, or deli-cate point. Marma is the singularform and marmani the plural form.There are a total of 108 primary mar-mani on the body surface.

Knowledge of marmani can betraced back to Vedic times when cer-tain martial arts schools in India usedthese energy points to inflict damageon opponents in battle and for self-healing purposes to recover frombodily injuries. Kaleri martial artsschool and Dhanurvidya, the schoolof ancient Vedic archery, are the twomost well known examples. Marma isderived from the etymological rootmar which means to kill. Pressure atcertain vital marmani located at theheart, trachea, or testicles can causeinstant death.

Sushruta, a famous Ayurvedicphysician, is recognized for integrat-ing the science of marmani into themedical system of Ayurveda. Alsoheralded as the father of surgery,Sushruta applied this knowledge tohis field. He believed that marmaniwere vital because of the increasedflow of Prana to those areas. Thus, hestressed the importance of precisesurgical incisions to avoid injury tothe marmani and minimal distur-bance to the flow of Prana. In thesharirasthanam section of theSushruta Samhita he elaborates onmarmani locations and indications.Due to Sushruta’s contributions, theknowledge of marmani spread andwas assimilated in Ayurveda.

As this information was passed

down through a lineage of guru todisciple, Ayurvedic clinicians furtherdeveloped the association betweenindividual marmani and their effecton the bodily doshas, dhatus (tis-sues), srotas (channels), and organs.They experimented with stimulatingthese points through pressure, mas-sage, and application of herbal oilsand pastes. Marmani science wasintegrated especially within theframework of panchakarma massage.Panchakarma is a detoxification andrejuvenation process that aims to bal-ance the body’s doshas and return thebody and mind to optimal health.During the massage, skilled thera-pists give special emphasis to themarmani enhancing the flow ofPrana.

The first signs of Acupuncturewere also discovered in ancientIndia. The marmani were stimulatedwith metal rods: gold for vata, silverfor pitta, and bronze or copper forkapha. Suchi is the Ayurvedic termfor needle, implying the points werepunctured for therapeutic purposes.This science did not develop furtherin India because of the concept ofahimsa- non-violence. Many practi-tioners believed gentle pressure onthe points was sufficient for healing.

The Chinese enhanced theAyurvedic understanding of energypoints and took this science to adeeper level. They documented 361primary acupoints. Seventy of the108 marmani correspond exactly tothese primary acupoints. Many of theremaining marmani are in close prox-imity to acupoints while only a few ofthem do not correspond at all. Theprimary acupoints are those locatedon the fourteen principal meridians.Meridians are channels of energyflow that have exterior pathways on

the body surface and interior path-ways linking them to the internalorgans. The Chinese also document-ed innumerable extra points that arenot located on the meridian path-ways. Acupuncture, a subset ofTraditional Chinese Medicine(TCM), originated 3000 years ago,whereas Ayurveda is 5000 years old.

The principle of acupuncturetherapy is that by stimulating acu-points the flow of Qi (pronouncedchi) is regulated. A disruption in theflow of Qi can create pain, stagna-tion, and many other signs and symp-toms. This correlates to Sushruta’sunderstanding of Pranic flow to theenergy points and how this flow,when disrupted, can harm the bodyor mind. The ancient rishis of Indiaalso mapped out Pranic flow withinthe body’s 72,000 nadis or subtlechannels of energy. These nadis dif-fer from meridians in that they areinternal pathways not mapped ontothe body surface. Thus, marmani andacupoints are similar in that they reg-ulate the flow of Qi or Prana, therebypromoting health and balance.

These points have several impor-tant functions that shed light on whythey are so instrumental in healing.Marmani serve as vehicles for com-munication because they enhancethe flow of Prana, the body’s intelli-gence. They can be used for diagno-sis by simple palpation to detect dis-turbance of doshas, dhatus, srotas, ororgans. Similarly, these same pointscan be used therapeutically to

MARMA THERAPY AND ACUPUNCTURE

Anisha Tambay, Dipl.Ac, M.S.O.M.Email: [email protected]

Special Series:

Complementary and Alternative Medicine

(Continued on page 33)

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32 AAPI Journal May/June 2004

Modern allopathic medicinehas made significantprogress during the 20th

century in the fields of disease diag-nosis, surgery, and the invention ofnew pharmaceutical drugs.However, if you read the instructionsgiven with each modern pharmaceu-tical drug, the list of side effects arelonger than its curative properties.This is rather unfortunate. It hasbeen recently reported that over 30%of the diseases today are due to sideeffects caused by the use of FDA-approved or over-the-counter allo-pathic drugs. An allopathic practi-tioner is trained to determine the eti-ology of disease so that he/she cantreat the core cause. Unfortunately,the etiology of some diseases is hardto pinpoint in a short span of timeand the etiology of some diseases isnot known. Consequently, allopathicpractitioners are forced to treat thesymptoms of disease with availablemedicines rather than treating thecore cause of the disease.

Some alternative medicines treatthe whole body in order to alleviatedisease. This is called a holistic med-ical approach. In my opinion, a treat-ment should be aimed at alleviatingthe core cause of the disease ratherthan reduction of symptoms.Ayurveda is one form of alternativemedicine that is gaining popularity inthis decade. I would like to introducea new alternative treatment calledProbiotic therapy. Perhaps Probiotictherapy cannot stand alone. It shouldbe complemented with other thera-pies on a routine basis. This paper

deals with Probiotics that comple-ment Ayurvedic therapy to treatchronic diseases that allopathic med-icine or Ayurvedic therapy by them-selves are not able to treat. Before weproceed further let us review thebenefits of Probiotics and Ayurvedaindividually.

ProbioticsAs early as 1907 Dr.

Metchnikoff, a Russian doctor,hypothesized and discovered thatlactic acid-producing bacteria such asLactobacillus acidophilus adminis-tered orally stopped intestinal ail-ments in humans. A tremendousamount of research was done in thisarea to prove the beneficial effects oflactic acid-producing bacteria inhumans.

The word Probiotic is derivedfrom two Greek words meaning “forlife.” Fuller in 1989 redefinedProbiotics as live microbial supple-ments that bestow beneficial effectson the host by improving the intes-tinal microbial balance. The mainmedical uses of Probiotics are as fol-lows:

1. To increase bioavailability of vita-mins and minerals by lowering the colonic pH.

2. To provide a source (the bacterial mass) for nutrients such as thi-amine, riboflavin, folic acid, vita-min B12, pantothenic acid, and short-chain fatty acids.

3. To reduce the production of bacte-rial enzymes in feces by suppress-ing bacteria that produce enzymes and convert procarcinogens to car-

cinogens. Probiotics help to pre-vent colon cancer by suppressing the organisms that produce these enzymes and reactions.

4. To improve lactose intolerance inthose who cannot digest lactose.

5. To suppress Rotavirus diarrhea and Traveler’s diarrhea.

6. To produce immunomodulation leading to the production ofImmunoglobulin A in Rotavirus infection, thus enhancing phagocy-tosis.

7. To reduce the recurrence of super-ficial bladder cancer, prolong the survival time in cervical cancer,and reduce re-infection in bacteri-al vaginosis.

8. To displace pathogenic organismsby competing for nutrients and adherence to cells in the gastroin-testinal tract.

9. To decrease serum cholesterol bydirect interference with choles-terol absorption.

10. To produce an immunomodulato-ry effect through macrophages andlymphoid cells by the productionof metabolites.

The selection criteria for desiredProbiotic organisms are as follows:

1. Must be of human origin, if intended for human use

2. High acid and bile stability3. Adhesion to intestinal mucosa4. Safe for food and clinical use (Gras

status)

PROBIOTICS, BIOTECHNOLOGY, AND AYURVEDIC HERBS

M.S. Reddy, Ph.D., IMAC, Inc., Denver, CO, USAand

D.R.K. Reddy, ADFAC Labs, Pvt. Ltd., Hyderabad, A.P., IndiaEmail: [email protected]

Special Series:

Complementary and Alternative Medicine

(Continued on next page)

M.S. Reddy, Ph.D.

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AAPI Journal May/June 2004 33

5. Clinically validated and document-ed health effects

6. Good technological properties.

AyurvedaAyurveda is an ancient system of

medicine that originated in Indiaaround or before 2500 B.C. The termAyurveda means “knowledge of life.”It is a form of holistic therapy thatalso uses combinations of herbs totreat ailments. The belief is thatherbs will have the active principlecome into contact with nutrients andbuffers. Such a preparation will notgive any side effects when consumedbecause the active therapeutic prin-ciple is naturally buffered. Generally,Ayurvedic preparations are formulat-ed by blending several complemen-tary herbs. The idea is to counteractthe adverse effect of one herb withthe other. Consequently the host willnot have any side effects from theherbs. Ayurvedic preparations areexcellent for treating chronic dis-eases.

With the introduction of allo-pathic medicines, the popularity ofAyurveda progressively declined inthe twentieth century. The fast-act-ing allopathic medicines became thetreatment of choice for medical prac-titioners. Another factor that con-tributed to the decrease in popularityof Ayurvedic preparations was aninconsistency in their efficacy. Thiswas due to lack of compliance ingood manufacturing practices.Perhaps it was also due to thedestruction of specific microorgan-isms present on a particular herb. Itis possible that the main therapeuticeffect of the Ayurvedic herb was dueto a synergy between the naturallyinhabited microorganism and the

herb.

The above scenario makes sensebecause we have discovered thatAyurvedic preparations blended withbeneficial Probiotics have exhibitedenhanced drug activity and effective-ness without any side effects.Perhaps herbs also serve as prebi-otics to improve the beneficial bacte-rial cell population in the human gas-trointestinal tract. The Prebiotic,unlike the Probiotic, is a non-viableentity and a non-digestible foodingredient that beneficially affectsthe host by selectively stimulating thegrowth and/or activity of one or a lim-ited number of bacteria in the colonthat can improve the health of thehost.

Our invention of enhancedAyurvedic herb activity with addedProbiotics may be due to synbioticeffect. A synbiotic is a combination ofProbiotic and Prebiotic, where a livemicrobial addition may be used inconjunction with a specific substratefor the growth.

To summarize, Probiotic therapyis not a replacement for allopathy orAyurveda or any other system ofmedicine. It is a complementarytherapy which should go hand inhand with allopathic and alternativemedicine to improve the efficacy oftreatments and decrease unwantedside effects.

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Special Series:

Complementary and Alternative Medicine

PROBIOTICS, … Continued

MARMA THERAPY AND ACUPUNCTURE

Continued from page 31

address these disturbances. Marmastimulation can provide local painrelief. They also kindle agni (the fireprinciple) and thereby cleanse thebody by eliminating toxins. In addition,marmani help to calm the mind andbalance emotions. Regular stimulationof marmani can also be used for pre-ventive care.

On a spiritual level, these energypoints enhance awareness. Duringshaktipat, spiritual initiation, the gurutransmits higher awareness into a disci-ple by stimulating Ajnya marma, locat-ed at the third eye. Thus, the ability ofmarmani to awaken spiritual energyhas been well known in India sinceancient times. Marmani also correlateto the chakra system. Each energy cen-ter is connected to the pranic nadisthat also link to individual marmani.

Treatment of these points can befairly easily and routinely done in con-ventional clinical settings by physiciansand therapists for commonly occurringproblems such as back pain,headaches, and anxiety amongst oth-ers. The patients can also be educatedabout these points and how to do a self-treatment. There is a vast scope for uti-lizing marma therapy in all healing pro-fessions.

In conclusion, marma therapy is aprofound science. Originating inancient India, it inspired the develop-ment of acupuncture and still hasdiverse applications for medicinetoday. Marma science can be integrat-ed with modern medical knowledge ineach physician’s respective field.Patients will benefit from studyingmarmani for their own self-healing andto achieve balance between body,mind, and spirit. For comprehensiveinformation on marma therapy, Dr.Vasant Lad and Anisha Tambay havewritten a reference book that is due inprint in 2004.

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34 AAPI Journal May/June 2004

Since time immemorial differentmedical systems have beenintegrated. Several systems of

Complementary and AlternativeMedicine (CAM) integrate herbs anddrugs successfully. Herbs are phar-macologically active natural productsand are often taken with drugs. Thechances of interactions are very like-ly. This article provides informationabout the integration of herbs withdrugs.

The modalities of modern medi-cine have resulted in several adverseand toxic side effects. Do we practice"Do no harm" medicine? Ayurvedarecommended this before any othersystem of medicine. People are nowdetouring from modern medicine tofind a safer system. Herbs and otherCAM modalities have made a come-back, along with many new sciences.Some of the reasons that promptedpeople to look for alternatives are:

(a) Unwanted side effects of drugs

(b) Inability to manage chronicailments

(c) Surgery was not always suc-cessful in improving healthcondition

(d) Several research studies have proven that CAM modalities are safe and effective

(e) Inclination toward self-health-care; improvement in diet and lifestyle.

Patients are taking herbs alongwith drugs because herbs are saferand generally do not have toxic sideeffects. There is a dilemma amongpractitioners as to whether integrat-ed medicine is safe or not. However,many physicians are cooperatingwith patients who use these modali-ties and an increasing number of

physicians want to learn about CAM. For many health problems patientsprefer herbs because they providebenefits that drugs do not, while forother health conditions patientsdepend on prescription drugs as theonly source of relief. Herbs anddrugs can be taken together for cer-tain health problems, but cautionshould be exercised when integratingherbs and drugs, just as caution isrequired when taking two or moredrugs together. There is a lack ofresearch on the interaction of drugsand herbs. Understanding the phar-macology of drugs and herbs and themechanisms by which their interac-tions proceed can assist in predictingor allowing early recognition of drug-herb interactions. It is a vast area butcertain issues and concerns must beaddressed. The interactions of herbsand drugs can be categorized as fol-lows:

(a) Positive interactions: Herbs supporting drug functions

(b) Adverse drug interactions(c) No interactions

Some common examples ofherb-drug interactions are discussedbelow.

Anticoagulant effects: Butchersbroom, feverfew, alfalfa, sweetclover, chamomile, cayenne, licorice,dong quai, garlic, ginger, ginseng,gingko biloba, and kava kava show ananticoagulant effect. Dosage adjust-ment and monitoring of coagulationtime are needed when anticoagulantdrugs are taken along with theseherbs.

Anticoagulants can also alter thetransport of medicine due to low vis-cosity of the blood. This can hastenthe elimination time or increase thetoxic effects of herbs and drugs on

the organs and organ systems.

Cardiovascular effects: Hawthorncan be used in mild cardiac insuffi-ciency, mild forms of bradycardialarrythmias, and to regulate bloodpressure. Arjuna, an Ayurvedic herb,has also been reported as good fortreating heart conditions. It is used asa cardiac tonic and for cardiac failureand dropsy. It also relieves hyperten-sion. Use caution when taking theseherbs in conjunction with drugs forcardiac conditions.

Ginseng may interfere with theaction of digoxin. St. John’s wort mayincrease blood pressure and causeconfusion and drowsiness. Blackcohosh may decrease blood pressure.

Diuretic effects: The followingherbs possess diuretic action:berberis, corn silk, couch grass, dan-delion, horsetail, parsley, juniperberry, and uva-ursi. Dosages ofdiuretic drugs should be adjustedwhen these herbs are taken. In addi-tion to diuretic properties theseherbs have other benefits for whichpatients are inclined to take them.For example, parsley is nutritive,dandelion is a liver tonic, juniperberry and uva-ursi are anti-infective,and corn silk helps treat inconti-nence.

Estrogenic activity: Use of estro-

INTEGRATED MEDICINE: HERBS AND DRUGS

Ranvir Pahwa, PhD, PGDTox, HD,DrAc, RClH

Clinical Assistant Professor, Department ofPathology, College of Medicine,

University of Saskatchewan, Saskatoon, CanadaEmail: [email protected]

Special Series:

Complementary and Alternative Medicine

(Continued on next page)

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AAPI Journal May/June 2004 35

genic herbs such as black cohosh,dong quai, chaste berry, red clover,and wild yam should be monitoredin patients taking hormone replace-ment therapy drugs.

Anti-cold and Anti-cough medi-cines: Herbal and aromatic oils aresometimes incorporated into coldand cough medicines. Recently theherb Echinacea has been incorpo-rated into over-the-counter coughsyrup. Echinacea boosts theimmune system and is reported toincrease T- and B-lymphocytes. Itmay have positive effects afterchemotherapy also. Echinacea mayshow adverse effects in patientswith autoimmune disorders and itmay negate the effects of immuno-suppressants such as cyclosporine.

Miscellaneous:(a) Patients undergoing surgery

have possible risks if taking the herbs mentioned abovethat affect coagulation timeand blood pressure. In addi-tion, licorice may cause

hypokalemia. (b) Uva-ursi may interfere with

the absorption of several alkaloid drugs.

(c) Tannic acids in St. John’s wort and Saw Palmetto may inhibitiron absorption, underminingthe benefits of prescribed anemia drugs.

(d) Ginseng may cause headaches,tremulousness, and manic episodes if taken with the anti-depressant phenelzine sulfate.

(e) Milk thistle has been reported to reduce and prevent toxicside effects in the liver caused by drugs.

There are no reports of adverseinteractions for many herbs, howev-er caution should still be exercised.Caution should also be exercised inprescribing herbs during pregnancy.

Other valuable suggestions:(a) Do liver and/or kidney func-

tion tests before, during, and after the use of herbs to check for any toxicity.

(b) Herbal energetics: Westernherbal formulas are not basedon the energy principles of

combining herbs as inAyurvedic and Chinese medi-cine. Combining herbs withoutthe knowledge of their energy can lead to toxic side effects.Recently a formula for post-menopausal syndrome that contained all the availableestrogenic herbs caused severediarrhea (personal communication).

(c) It is important to know that herbs can interact with otherherbs in the same way thatdrugs can interact with otherdrugs. The chance of interac-tions is enhanced by the pur-chase of over-the-counterproducts by people who arenot knowledgeable about herbs.

Healthcare practitioners areresponsible for finding better andsafer ways to integrate medicineand must exercise sound judgmentin this area. We encourage health-care providers to expand theirknowledge of herbs through educa-tion courses and thereby preventunintended interactions.

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Special Series:

Complementary and Alternative Medicine

INTEGRATED …Continued

Saving Medical Practice…Continued from page 21

islative session in Washington said, “A medical liabilitybill could return to the Senate in the next few weeks.However, fixing the liability problem at the national leveldoes 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 physicianswant liability reform to pass in the next session ofCongress, they need to get busy in U.S. Senate racesacross the country to change the representation in theU.S. Senate.

A meaningful liability reform is necessary for usto continue to practice medicine in ones chosen special-ty, geographic location and the patients we want to serve.

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AAPI EXECUTIVE OFFICE17W300 22nd Street, Suite 300A • Oakbrook Terrace, IL 60181-4490

Telephone: 630-530-2277 • Toll Free 1-800-622-7499Fax: 630-530-2475 • Email: [email protected]

Website: www.aapiusa.org

AAPI LEGISLATIVE OFFICE1818 N Street NW, Suite 700 • Washington, DC 20036

Telephone: 202-331-0343Fax: 202-331-9306 • Email: [email protected]

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“Happiness is freedom from fear”

The science of Yoga is holisticliving and spiritual thinking. Itis Consciousness based. It pro-

vides healthy contented living, joyfuldisposition and progressive under-standing of subtleties of the universe.

The meaning and very existenceof life unfolds as one progresses andthen no mundane pleasures seemessential or important. The meaningof “Love” starts unfolding.

The word “Freedom” becomesmuch more meaningful and “Self”shines with all its glory, unparallel,absolute and infinite, “one withoutsecond”.

Sri Shankaracharya, the greatguru and visionary of SanatanaDharma has said that three thingsare the most valuable and rare tofind. The human birth, desire to getliberated (moksha) and sat-sang.“Sat-Sang” is company of spiritualpeople, which by their presence andvibrations lead the people towardsjoy and bliss.

All human pursuits are forachieving happiness in life, but everyminute one finds oneself falling shortfrom this goal. One starts with adesire, works hard to achieve it andno sooner it is fulfilled, one feelsempty or the urge to start with a newpassion and thus it is an endless chainof passion. One is never contentedand always running in circlesthroughout life. Worldly passionseems to cause scientific progressand avails sensual pleasures, but tobe truly happy, one needs highergoals and deeper understanding.Then what is the solution? How doesone stop this cycle of discontent andthe rat race? It is through the science

and understanding of Yoga.

Yoga is defined as “Yogaha,Chitta, Vrutti, Nirodhaha” “YogaSutra Of Patanjali” (1:2), whichmeans that one is a yogi, who has nomodifications of mind, one who hasequanimity in all the circumstancesgood-bad, success-failure andthrough all the dualities. “Yogaha

Samatvam Uchyate” Bhagavad Gita(2:48). It leads one to perfection inwork “Yogaha Karmasu Kaushalam”Bhagavad Gita (2:50)

Yoga come from the word “Yuj “meaning “union”. It is one of the sixphilosophies of Sanatana Dharma.Many sages have expounded on it.One in particular was Lord Krishna.He imparted different philosophiesand types of yoga mainly Gnana Yogaor Yoga of knowledge, Karma Yoga orYoga of action, Bhakti Yoga or Yogaof devotion and Raja Yoga or Yoga ofcontrolling mind to his beloved disci-

ple, Arjuna during his discourse onthe battlefield in Mahabharata inBhagavad Gita. Another very wellknown book and step-by-stepapproach to control the mind, whichis “Raja Yoga”, is “Yoga Sutra ofPatanjali”.

With the crowning of SwamiVivekananda as the best speaker in“Parliament of Religion” in 1893 inChicago, all aspects of Vendanta andYoga were introduced and recognizedin U.S.A. Sri YoganandaParamahansa, author of the well-known great book “Autobiography ofa Yogi” also followed to enhance thedepth of these principles and intro-duced fellowship through his lovingtechniques. Swami Rama Tirth gavegreat stimulus to people on this topic.

In the modern timesVivekananda Yoga Research andApplication, Bangalore based Yogainstitution and its branches in U.S.A.called “VYASA”, Pandit RajmaniTiguniat of Himalayan Institute, PA.Dr. Shivananda and his disciples Pu.Swami Vishnu Devananda withShivananda center in Canada. Pu.Sacchidananda of Lotus temple inWest Virginia (Dr. Dean Ornish’sGuru), Pu. Jyotirmayananda inMiami, Shri Yogi Hari in Miami andSri Sri Ravi Shankar through “Art ofLiving Foundation” are doing greatwork in teaching Yoga and throughYoga – World Peace.

36 AAPI Journal May/June 2004

(Continued on next page)

SELF-ECOLOGY WITH YOGA

Veena S. Gandhi, M.D.

Special Series:

Complementary and Alternative Medicine

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AAPI Journal May/June 2004 37

How to start “YOGA”

No matter who you are, at what astage in your life, whatever may beyour religion, race or nationality, youcan start Yoga. It is a self-ecology.

To learn basic yoga and to start,you can look for the authentic Yogacenter in your city. If none is avail-able, then take a little time out for 5-7 days and go to a Yoga retreat at thecenters mentioned in the previousparagraph. They all will give a greatstart and subsequently you will find awhole Yoga world where number ofplaces and people are associated.

Guide Lines For Yoga Session

Once basic is learned, set aside atime to do it everyday. It can be evensmall sessions of 15 to 20 minutes.Consistency will be of great help. Ideally30 minutes in the morning and/orevening before dinner will be great.

The practice should includesome postures, which can varydepending on your physical staminaat that time of the day, somePranayama and meditation. Finishall-important chores and telephonesbefore you start; let your family knowyour routines, so that you have com-plete peace and freedom.

Set aside a clean and quiet place.Also do not take food in that area. Youmay keep other stimulating aidsaround, like burning incense, your IstaDeva’s picture, other natural synergiesor soothing music in the beginning.

Do it only on an empty stomach atleast for two hours. You may take clearliquid. Wear loose comfortable clothes.Try to do it in open space, if possible.Postures should be started with center-ing and loosening exercises. Posturesshould always be coordinated withbreathing. Do few Pranayama in thebeginning to quiet the mind.Mindfulness or awareness is a “MUST”.

Do them to the best of yourcapacity. Do Not Become OverEnthusiastic, Take time. End withdeep relaxation. Short or long medita-tion session is very fulfilling. Now youmay vary the duration of Asanas,Pranayama and Mediation. You willfind a great joy as you advance andwill have your own routines. At timesyou may feel lazy to do it for a day ordays. Try your best – do not ever getdisheartened. You will restart again.Such cycles are common to all.Include your family if possible forYoga retreats. Later on, chanting ses-sions, seminars, reading books onYoga all enhance the growth.

It is really an essence of our“Being”. It is a reconditioning – so thata lot of your mundane habits willchange and drop out. Your intuitionsimproves. Your inner strength and con-fidence leads to better decisions. Itimproves will power and helps inimproving vices. Your emotions bal-ance better and your mind starts enjoy-ing solitude and peace. A lot of physicalhealing also takes place and commonailments start improving. You are withthe world, but still you learn to be byyourself in this journey of life.

The postures (asanas), thebreathing techniques (pranayama)and meditation leads to joy that areincomparable to any joy in the world.Treasure is within.

As a practicing physician it is nowtime to progress towards “Yoga ther-apy”. Yoga therapy is a complimenta-ry medicine, which benefits in all thecommon diseases like diabetes,bronchial asthma, essential hyperten-sion, myocardial infarction, depres-sion, anxiety, irritable bowel syn-drome and of course day-to-daystress and strains of modern life.

Let us humbly resolve in our ownheart to progress and grow fromchaos to calm, efficient, contentedand joyful living with Yoga.

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SELF-ECOLOGY … Continued

Special Series:

Complementary and Alternative Medicine OUR LEGISLATIVE DAY AT THE CAPITOL Continued

took time out to welcome the AAPImembers to Washington, D.C. This listincluded the distinguished SenatorsThad Cochran (R-MS), Paul Sarbanes(D-MD), and, most importantly, theSenate Majority Leader, Bill Frist (R-TX). Senator Frist, a physician, dis-cussed a host of health care-relatedissues with the AAPI audience. Alsojoining them were Congressmen ChrisVan Hollen (D-MD) and Phil Gingrey(R-GA). The dinner program featuredwelcome addresses from Dr. SharadLakhanpal and Dr. Rakesh Shreedhar,Congressmen Joe Wilson (R-SC) andJoe Crowley (D-NY), Co-Chairs of theIndia Caucus, and uplifting remarksfrom India’s Ambassador to the UnitedStates, the Honorable Lalit Mansingh.

Particularly remarkable was the trib-ute AAPI received from Congress-manPallone who, along with a bipartisangroup of 26 other members of Congress,introduced a resolution before the U.S.House of Representatives (H.Res. 579)honoring AAPI and requesting the U.S.Congress establish an “AAPI Day”. Withyour help, we hope other members ofCongress will co-sponsor this resolutionin the coming months to ensure its suc-cess!

The highlight of the dinner, andarguably of the entire conference, wasthe keynote speech by Senator JohnCornyn (R-TX), during which he for-mally announced the formation of theU.S. Senate “Friends of India”, a bodyto serve as the Senate counterpart tothe House of Representatives’ IndiaCaucus. The spectacular eveningended with noteworthy remarks fromAmbassador Agnihotri and a vote ofthanks from the Chair of the AAPIBoard of Trustees, V.H. Reddy.

Overall, although AAPI’s 7thAnnual Legislative Conference was asmashing success, we fully expect the2005 event to be even better!

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38 AAPI Journal May/June 2004

AAPI held its firstAyurvedaConference on

March 19-21, 2004 inOrlando, Florida. This wasthe first conference com-pletely devoted toAyurveda, the compre-hensive system of naturalhealth care that originatedin India. The AyurvedaConference was attendedby 33 participants andproved to be a completesuccess.

Most of the participants werepracticing physicians, with a fewmedical residents, nurses, and phar-macists also in attendance. Theycame from all across the U.S., includ-ing the state of Washington,Massachusetts, Florida, Ohio, NewJersey, Kentucky, New Mexico,Colorado, Pennsylvania, Michigan,Maine, and Texas. Every participantwas very happy they attended thisconference. They got a taste ofAyurveda starting with the basic fun-damentals and the eight differentways of examining the patient.Participants were especially interest-ed in finding out how much informa-tion can be gained through observa-tion of the patient’s general appear-ance, tongue examination, urineexamination, and particularly theAyurvedic method of pulse examina-tion. Most of the participants alsolearned mseditation and were happyand excited to have this profoundtechnology for their personal use.Constitutional typing, the diet (indetail), and management of commongastrointestinal, skin, and gynecolog-ical disorders were other topics thatintrigued and fascinated those in

attendance. The role of probioticswas also an eye-opener to everyone.The participants were extremelyimpressed with the abundance of sci-entific validation that was presentedat the Conference.

There was lively interactionbetween the faculty and participants.Many questions were asked and dis-cussed at length, showing the depthof knowledge that was present andavailable to all there. Everyone thatattended wants to learn more aboutAyurveda and indicated intenseinterest in having more conferenceson this topic. They all wanted tocome back for more and bring theirfriends with them.

Some of the comments from theConference participants were:

• “For me, a potentially life-trans-forming exposure to Ayurveda.”

• “Truly a great conference! Therewas a lot of practical take-homeinformation. The topics were excel-lent. The presenters were knowl-edgeable and dynamic.”

• “A must for anyone interested inAyurveda. It is a great beginningstep for medical students, resi-

dents, and any other pri-mary health careproviders.”

• “I would request theAyurvedic ExecutiveCommittee and also theAAPI Governing Body toorganize more Ayurvedaconferences not only forthe AAPI members but forall those who are interest-ed in Ayurveda, Yoga, orMeditation. There is

increasing awareness aboutthese ancient Indian sci-

ences in the U.S. and the world pop-ulation in general. We, as Indiansneed to take the lead in educatingthe world about our ancient sci-ences and our rich Indian, heritagerather than being taught our ownscience by others. And thereforethere is a great need for such con-ferences. There should also be moreexposure, advertisement, fundingfor such conferences, so that inter-ested people can be exposed andattend and learn from these won-derful conferences.”

Some of the points raised at theConference include the following:

1. There was a suggestion to createan Ayurveda Education andResearch Committee within AAPIand have a series of educationalseminars to provide certification inAyurveda.

2. Some medical residents andpracticing physicians expressedinterest in spending 3-6 monthsstudying Ayurveda.

3. The medical residents want tostart a sub-chapter within the AAPIIntegrated Medicine Committee to

FIRST AAPI AYURVEDA CONFERENCEHari Sharma, M.D., FRCPC

Chair, Integrated Medicine Committee, AAPIEmail: [email protected]

Special Series:

Complementary and Alternative Medicine

(Continued on next page)

The faculty and the participants with the President of AAPI

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AAPI Journal May/June 2004 39

promot research and education in Ayurveda. They alsosuggested starting 4 resident scholarships of $1000.00each 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 Ayurvedicphysician 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 inAyurvedic education, research, and streamlining the cre-dentialing requirements for Ayurveda practice in the U.S.

6. A suggestion was raised for a liaison with IndianAyurvedic Universities and the Government of India tofinally start a certification program in Ayurveda in associa-tion with AAPI.

7. It was suggested that there be an Ayurveda section aspart of the AAPI website.

The AAPI Integrated Medicine Committee is veryhappy and thrilled by the enthusiasm, interest, and supportfor Ayurveda shown at the Conference. The Committeeplans to have more Ayurveda conferences in the near future.Members will be informed via the AAPI Journal and e-mail.

◆ ◆ ◆ ◆ ◆ ◆

FIRST AAPI … Continued

BOOK REVIEW

Radiology is a dynamic field, everchanging with new modalities of

imaging added periodically. CT andMRI have virtually conquered ourminds and have become the mostoften used diagnostic tool in evalua-tion of a host of diseases. For theyoung medical students and residentswho ask “what book can you recom-mend me for quick reference tounderstand CT and MRI scans whileI see patients on the floor,” theanswer may be this pocket atlas. Infact, while we were residents some20 years ago, we always carried theindispensable Washington Manual.Since imaging has become such an

integral part of patient work up, thetrainees in the new millennium willcertainly need a quick referencesource on this modality as well.

The book opens with a chapteron principles on Computed Tomo-graphy and Magnetic ResonanceImaging. The basic physics underly-ing these two modalities areexplained in a simple fashion, easy tounderstand. This is the only chapterfor didactic reading.

The rest of the book is simplypictures, reproductions of images ofmany representative diseases whichone comes across in the routine care

of the patients. All systems are cov-ered well.

Reviewed by:

Meghal Antani, MD

Attending, Department of RadiologyWashington Hospital Center,Washington, DC

◆ ◆ ◆ ◆ ◆ ◆

CT & MRI Pathology – A Pocket AtlasMcGraw- Hill Professional 2003,

255 pagesby: Michael L. Grey and Jagan Ailinani

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40 AAPI Journal May/June 2004

Over 50? Ask us about ScreeningColonoscopy for Colon Polyps.

Reads the sign posted in ouroffice waiting room. Afriendly patient asked me one

day, “Doc, when did you have yours?”I didn’t realize the sign had thepotential to backfire. His next ques-tion blew me off, “Is there a Do-ityourself kit available?

In the United States, PresidentReagan’s colonoscopy jump startedthe demand for the procedure, andrecently most insurance companiesstarted paying for the screeningcolonoscopy, so it made a lot of sensewhen an elderly woman asked meduring the middle of hercolonoscopy, “Does your motherknow what you do for a living?”

We tell our patients that prepar-ing for a colonoscopy is the worstpart. Two days of liquid diet anddrinking a gallon of that soda stuffcan really bloat one up. “Pour it intodifferent glasses, like a cognac, wine,champagne, beer, etc. to make itmore appealing and then drink it oneby one.” This was the advice from apatient of mine who works as a bar-tender. Another elderly patientdecided to put a small bed in herbathroom on the night of the colonpreparation.

Each gastroenterologist has hisown way of colon prep. In our prac-tice, two days of liquid diet and 3ounces of Fleets phosphosoda on theevening before the procedure haveworked extremely well. Patientswere happy to forget about the gallondrink.

Generally, colonoscopies last

about half an hour, and most are per-formed in an outpatient set up.Conscious sedation with IV Demeroland versed or lately IV Diprivan(anesthesiologists choice) are usedjust before the procedure. Heartrate, blood pressure, and O2 satura-tion are all monitored. Twoendoscopy assistants are required toaid with biopsies and polypectomies.

The mood in the scope room is

generally light. Occasionally we getpatients practicing their stand-upcomedy routines

• “If you find gold in there, half ismine” - patient• “Are we there yet?” – tired nurseduring a lengthy colonoscopy• “Is it going to come out of mythroat?” – patient• “Where do they meet?” – patientduring a combined upper and lower endoscopy procedure.

Patients are generally observedfor about one hour after the proce-dure. The anesthesia people love to“recover” them.

“Can I drive back home after my

colonoscopy?”, a frequently askedquestion. Our endoscopy nursedrove home after her colonoscopyand the next morning she could notremember driving home at all. I’verecomended that patients arrange fortheir own transportation after theprocedure, and now our hospital hasmade that a policy.

Most recently radiologists havebeen trying to take over our businesswith virtual colonoscopy, which issimilar to a CAT scan. If they findsomething suspicious, the patient stillmust undergo the conventionalcolonoscopy to confirm the findingand resolve the problem. My ques-tion to them is, “Can you diagnosethe live, wiggly worm shown in thispicture?” This was taken during oneof my recently performed colono-scopies. I caught the worm by thetail using biopsy forceps and pre-sented it to the pathologist. Shenamed it (see picture) StrongyloidesStercoralis. And a course of Mintezol500 mg bid for 5 days – patientcured.

My conclusion in comparing thevirtual to conventional colonoscopy isthat, unlike virtual colonoscopy, realcolonoscopy is both diagnostic andtherapeutic.

◆ ◆ ◆ ◆ ◆ ◆

P. K. Paul, MD, FACGBrooksville, FL

DID YOU HAVE YOUR COLONOSCOPY?

THE BEST OF AAPI HUMOR

Live and wiggly worms!

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42 AAPI Journal May/June 2004

MEMBERS IN THE NEWS

Five AAPI doctors win prestigious AMALeadership Recognition

Drs. Marella Hanumadass, Rajendra Gupta,Nick Shroff, Nalin Tolia, P. K. Vedanthan

Drs. MarellaHanumadass of

Chicago, RajendraGupta of New Jersey,Nick Shroff and NalinTolia of Texas, and Dr.P. K. Vedanthan ofColorado were five ofthe physicians honoredby the AMA (American Medical Association) in the AMA -IMG Leadership recognition program for their leadershipqualities. They participated, by invitation, in the renownedAMA Leadership Training Program in Washington DC at theend of March. At the instance of the AMA – IMG Section,this year, for the first time, 10 outstanding IMGs were select-ed for this honor five out of whom are AAPI members.

★ ★ ★ ★ ★ ★ ★

BASIL VARKEY, M.D.

Basil Varkey, M.D., Professor ofMedicine in Pulmonary and Critical

Care at Medical College of Wisconsin wasinducted into the College’s Society ofTeaching Scholars in 2000 and the AlphaOmega Alpha Honor Society in 2001. Hewas named Best Teacher of the Year threetimes including the Ernest O. HenschelClinical Teaching Award from the 2001 senior class. Dr. Varkeydirected the Pulmonary Fellowship Training Program for sevenyears and was Associate Program Director for the InternalMedicine Residency Program for eight years. In recognition ofhis clinical accomplishments and his devotion to educationalexcellence, the Medical College of Wisconsin conferred uponBasil Varkey recently its Distinguished Service Award.

★ ★ ★ ★ ★ ★ ★

Prof. Bala V. Manyam

US Secretary of Health and HumanServices, Tommy Thompson has

appointed Dr. Bala V. Manyam,Professor, Texas A & M University SystemHealth Science Center College ofMedicine and Director, PlummerMovement Disorders Center to theNational Institutes of Health’s NationalAdvisory Council for Complementary and AlternativeMedicine (NIH/NCCAM) for a four-year term. Dr. Manyamwould be participating in matters related to the conduct andsupport of the research, training and health information dis-semination recommendations to the Secretary of H& HS andthe Director of NIH/NCCAM.

★ ★ ★ ★ ★ ★ ★

Young AAPI Member Wins Special Honors

Vasant Jayasankar, M.D.

Dr. Vasant Jayasankar’s article onexperimental work using human

growth hormone to prevent heart fail-ure following myocardial infarction(MI) is the lead article and cover pageof the April issue of the prestigiousJournal of Cellular and MolecularCardiology. He did this work at theUniversity of Pennsylvania as a recipi-ent of an NIH grant. Dr. Jayasankar’s novel therapeutic tech-nique employs a virus vector to transfer and over expresshuman growth hormone in a rat model of post-MI heart fail-ure. This therapeutic modality may in the future be a usefuladjunct to therapies following an MI. Dr. Jayasankar plans tostart cardiac surgery fellowship in 2005.

His many accolades include the Young InvestigatorAward of the American College of Cardiology, Finalist in theVivien Thomas Young Investigator’s Award of the AmericanHeart Association, and the Young Investigator’s Award of theInternational Society for Heart Research, US SurgicalResident Award for 1999, 2002 and 2003 and the AAPIYoung Investigator Award.

★ ★ ★ ★ ★ ★ ★

Dr. Surendra Purohit

Surendra Purohit, MD, FACS is the 2004 recipient of the award for OustandingPhysicians, dedicated service to the comunity, and dedicated service to AAPI,

which was awarded by the Louisiana Chapter of AAPI at the National AAPI Governingbody 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 thebanquetand presented Dr. Purohit with the award. Dr. Purohit is one of the top Generaland Vascular Surgeons in private practice in New Orleans, 0