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Maharishi Ayur-Veda I do not understand the phrases "theistic interpretation" and
SiR,—Your Round the World correspondent (Oct 27, p 1060) fails
todiscuss the wealth of scientific data on Ayur-Veda, but attempts
instead to discredit this natural system of medicine through
inaccuracies, omissions, derogatory personal allegations, and
bizarre "theological" speculation.
Your correspondent refers to "rumours" of General Medical
Council proceedings. No proceedings are taking place, and I know
of no grounds for anticipating them. The report does not make clear
that the journalist who challenged me about such rumours is the
same journalist whose articles in the national press disseminated the
rumours in the first place. Any doctor could be made the target of
such allegations, however baseless. Repetition of such
unconfinnable, defamatory rumour is unworthy of The Lancet.
It is alleged that I have no publications that justify the wording of
my entry in the Medical Directory. This is untrue.,2 It is said that
my "only first-author publication from 1980 onwards, cited in
Index Medicus, is a letter to the British Medical Journaf. How did
your searcher miss a first-author paper from 1981 in The Lancet
itself ? The Medical Directorys "Papers on..."format is meant to
be brief and no stipulation is made about first authorship.
Incidentally, I qualified in 1979, not 1980.
Maharishi Mahesh Yogi does not "claim to lead" Ayur-Vedic
Medicine. He has, however, inspired a revival of the system,
working closely with Dr B. D. Triguna, president of the All-India
Ayur-Veda Congress, and many leading Ayur-Vedic physicians
and scholars. These experts chose the name "Maharishi Ayur-
Veda" to denote this revival, which incorporates important aspects
of the original science that had been lost or obscured over the
centuries.
There are now many well-designed studies of transcendental
meditation (TM), including prospective randomised trials, controls
for expectation and placebo response, and comparison with other
meditation procedures and relaxation techniques (as Dr Bodeker
notes in his Nov 17 letter). Every good study will raise new
questions, but to dismiss this body of research in one sweeping
statement is unscientific. By the same logic almost everything in
orthodox medicine would be discarded.
TM has consistently been shown to produce benefits, including
reduction in anxiety, depression, insomnia, smoking, alcohol, and
drugs; improvement in asthma; lowering of cholesterol and blood
pressure; and improved mental and physical health and longevity in
the elderly3-8 (selected recent references; full list available from me).
Many of these effects are in areas where orthodox therapy is
unsatisfactory. In a randomised prospective study TM was
significantly more effective than psychotherapy in all aspects of
post-traumatic stress disorder, including anxiety, depression,
insomnia, alcohol use, family problems, and difficulty in obtaining a
job. If a drug had even one of these effects we would be using it
widely. Scientists at the Japanese National Institute of Industrial
Health conducted a prospective controlled study in 798 workers in a
large manufacturing company.9 After 5 months, the group who had
learned TM showed fewer general physical complaints, improved
emotional stability, and reduced neuroticism and anxiety.
An analysis of health insurance statistics on over 2000 people
practising TM over a five-year period found that they consistently
had fewer than half the doctor visits and hospital admissions of
control groups of comparable age, sex, and occupation.10
Reductions in inpatient care were 87% for heart disease, 55% for
tumours, and 73% for respiratory disorders.
The discussion of MA-4 and MA-5 fails to mention
antineoplastic effects in vivo," enhanced T-cell proliferative
responses,12 and preventive effects on human platelet aggregation
and lipid peroxide generation in vitro.13 Conferences on Maharishi
Ayur-Veda and its herbal compounds have been approved for
Continuing Medical Education credits by the American College of
Preventive Medicine, which can be used towards recognition by the
American Medical Association and for medical re-licensure in
many states. It is said that I "admitted that patients with AIDS had
been treated with MA-4 and MA-5". I clearly corrected this error at
the press conference. The Lancet report grossly exaggerates the
price of MA-4 and MA-5.
"beyond normal experience". The aim of Maharishi Ayur-Veda is
to allow mind and body to function with full efficiency, free from
stress, fatigue, and imbalance. This is nothing more than normal
human life. The practice of TM requires no allegiance or belief, not
even that the technique will be effective. Does taking medically
prescribed drugs regularly represent "an oath of allegiance" to the
drug industry?
A prevention-oriented system of health care is urgently needed.
The addition of systematic training in Maharishi Ayur-Veda to our
existing excellent medical education will enable the National Health
Service to achieve fundamental goals that currently elude it. That is
why we are establishing the Maharishi Ayur-Veda College of
Natural Medicine.
20 Wimpole Street,
London W1, UK ROGER A. CHALMERS
1. Chalmers RA, Mashiter K, Joplin GF. Residual adrenocortical function after bilateral
"total" adrenalectomy for Cushings disease. Lancet 1981; ii 1196-99.
2. Werner OR, Wallace RK, Charles B, Janssen G, Stryker T, Chalmers RA. Long-term
endocrinologic changes in subjects practicising the transcendental meditation and
TM-Sidhi program. Psychosom Med 1986; 48: 59-66.
3. Eppley K, Abrams A, Shear J. Differential effects of relaxation techniques on trait
anxiety. a meta-analysis.J Clin Psychol 1989; 45: 957-74.
4. Brooks JS, Scarano T. Transcendental meditation in the treatment of post-Vietnam
adjustment. J Counselling Devel 1986; 64: 212-15.
5. Monahan R. Secondary prevention of drug dependency through the transcendental
meditation programme in metropolitan Philadelphia. Int J Addict 1977; 12:
729-54.
6. Alexander CN, Langer EJ, Newman RI, Chandler HM, Davies JL. Transcendental
meditation, mindfulness, and longevity: an experimental study with the elderly
J Personal Soc Psychol 1989; 57: 950-64.
7. Kember P. The transcendental meditation technique and postgraduate academic
performance Br J Educat Psychol 1985; 55: 164-66.
8. Tumbull M, Norris H. Effects of transcendental meditation on self-identity indices
and personality Br J Psychol 1982; 73: 57-69.
9. Haratani T, Henmi T Transcendental meditation and mental health in industry
workers. Presented at conference of the Society of Industrial Hygiene (Kumamoto,
Japan, April 6, 1990).
10. Orme-Johnson DW. Medical care utilization and the transcendental meditation
program. Psychosom Med 1987; 49: 493-507
11. Sharma HM, Dwivedi C, Satter BC, Gudehitihlu HA, Malarkey W, Tejwani GA.
Anti-neoplastic properties of Maharishi 4, against DMBA-induced mammary
tumors m rats Pharmacol Biochem Behav 1990; 35: 767-73.
12. Dileepan KN, Patel U, Sharma HM, Stechschulte DJ. Priming of splenic
lymphocytes after ingestion of Ayur-Vedic an herbal food supplement: evidence for
an immunomodulatory effect. Biochem Arch 1990; 6: 267-74.
13. Sharma HM, Feng Y, Panganamala RU. Maharishi Amrit Kalash (MAK) prevents
human platelet aggregation. Clin Ter Cardiovasc 1989; 3: 227-30.
SIR,-As a hospital doctor and nephrologist I have been using
Maharishi Ayur-Veda, including the TM programme, to improve
the mental and physical wellbeing of my patients. Your Round the
World article does not do justice to research on this therapeutic
modality over the past 20 years. For readers not familiar with
publications on Maharishi Ayur-Veda and TM, the references in
Orme-Johnsons article1 will reveal the almost universal use of
controls. The claim that most studies of TM are uncontrolled is
incorrect. Another claim is that TM cannot be compared with other
techniques. Eppley and colleagues meta-analysis2 on relaxation
techniques in trait anxiety showed that TM was superior to other
relaxation techniques. Alexander and colleagues trial in 80-year-
old nursing home residents of TM, another relaxation technique,
mindfulness training, and no treatment showed that the TM group
improved most on cognitive and behavioural flexibility, learning,
mental health, and blood pressure, and survival was greatest in the
TM group.33
MA-4 and MA-5 cost$50 a month, not$500; and the chemical
ingredients of MA-4 and MA-5 are not "unknown" because they
are clearly written on the label.
While your Round the World correspondent cites the positive
effect of the TM programme on measures of collective health in
society in order to deride it, published work on this effect was
merely ignored. I cite two papers4 to acquaint readers with these
well-controlled studies.
Suite 311, 300 Mount Auburn Street,
Cambridge, Massachusetts 02238, USA,
Harvard Medical School
and Mt Auburn Hospital, Cambridge STEELE BELOK

1. Orme-Johnson DW. Medical care utilization and the transcendental meditation
program. Psychosom Med 1987; 49: 493-507.
2. Eppley KR, Abrams AI, Shear J. Differential effects of relaxation techniques on trait
anxiety: a meta-analysis. J Clin Psychol 1989; 45: 957-74.
3. Alexander CN, Langer EJ, Newman RI, Chandler HM, Davies JL. Transcendental
meditation, mindfulness, and longevity an experimental study with the elderly.
J Personal Soc Psychol 1989; 57: 950-64.
4. Dillbeck MC, Banus CB, Polanzi C, LandrithIII GS. Test of a field model of
consciousness and social change: the transcendental meditation and TM-Sidhi
program and decreased urgan crime. J Mind Behav 1988; 9: 457-86.
5. Orme-Johnson DW, Alexander CN, Davies JL, Chandler HM, Larimore WE.
International peace project in the Middle East. J Conflict Resolut 1988; 32: 776-812.
Bristol Cancer Help Centre
S!R,—The flurry of publicity and correspondence following the
Institute of Cancer Research (ICR) study of patients with breast
cancer treated at the Bristol Cancer Help Centre (BCHC) has
highlighted the dangers inherent in all non-randomised
comparative studies. Surely the most important conclusion to be
drawn is that reliable data on potentially valuable new interventions
for people with cancer will come only from well-conducted
prospectively randomised trials, unpalatable though this might
seem.
It does seem rather brazen of the BCHC to claim that the study
was "seriously flawed" because it was non-randomised, since the
initial recommendation to them was that a randomised study was
much the best way forward. On a lighter note, it reminded us both of
the apocryphal story of the Jewish boy who slew both his parents,
then threw himself at the mercy of the court on the grounds that he
was now an orphan. Such chutzpah!
Nevertheless the one clear point to emerge, even with the most
generous interpretation of the study (Nov 10 correspondence), is
that the result fails to demonstrate that the patients on the BCHC
regimen live longer. The question still remains whether they live
better.
One of us (M. B.) has recently enjoyed the warm and friendly
hospitality of the BCHC and can vouch for the fact that the
atmosphere (a cross between a convent and a health farm) induces a
sense of wellbeing. Whether this feeling results from a retreat from
the National Health Service, a walk over the Clifton suspension
bridge, or delightful companionship is a subject for future research.
The important question of course is whether this translates into a
genuine long-term improvement in the quality of life. This
possibility clearly needs to be subjected to critical review since it is
equally possible to construct an alternative hypothesis-namely,
that a short-lived sense of wellbeing and control may deteriorate
when the BCHC regimen starts to become a daily reminder that the
person remains a cancer patient, and not like other people. Daily
ritual and eccentric diets have been in use for millennia to separate
out one class of human beings from their fellows. This may be fine
for religion, but is it right for cancer?
Department of Radiotherapy and Oncology,
University College Hospital,
London WC1 E 6AU, UK JEFFREY S. TOBIAS
Department of Surgery,
Royal Marsden Hospital,
Sutton, Surrey MICHAEL BAUM
Pancreatic islet transplantation
SIR,-I read Dr Tzakis and colleagues report (Aug 18, p 402) of
pancreatic islet transplantation after upper abdominal exenteration
and liver replacement with mounting horror. Abdominal
exenteration sounds mild until one realises that the reality was
removal of the liver, pancreas, spleen, stomach, duodenum,
proximal jejunum, and terminal ileum, and, in three patients, the
ascending and transverse colon.
I thought that this sort of mutilating surgery, reminiscent of hind
quarter and lower trunk amputations, had ceased long ago. How
many more cruel and inhumane operations will be done in the name
of advancement of science? How much longer will the human body
be viewed as a mechanical plumbing system that needs bits
removing and replacing?
Not once is the patients quality of life mentioned. Not once are
the patients views on the procedure elicited. The closest that Tzakis
1323
et al come to discussing what it must be like for the patients is three
lines indicating that even on resumption of diet, parenteral infusions
overnight were frequently needed to prevent malnutrition-some
life!
This practice is not good medicine. It is not caring for your
patient. It is doctors trying, by any means, to keep their patients
alive for as long as possible, irrespective of the consequences. It is
unethical and immoral and disregards mans spirituality and
ineffectually tries to deny his mortality.
It is time that rampant scientific endeavour was brought under
some humane and ethical control. Reasonable efforts to prolong life
and, more importantly, promote quality of life are our business.
Death is not a failure, it is a natural process. Operations such as that
described by Tzakis et al should have no place in the practice of
medicine.
92 Ryelands Street,
Hereford HR4 OLD, UK MICHAEL BARKER
*** This letter has been shown to Professor Starzl and Dr Tzakis,
whose reply follows.-ED. L.
SiR,—The so-called cluster resection operations along with
assessments of their morbidity have been described fully
elsewhere.1-3 In the past, patients with extensive pancreatic,
duodenal, or hepatic tumours that have spread regionally to other
organs of this complex have been regarded as untreatable.
Consequently, it is hard to understand nihilistic reactions, or even
outrage, about attempts at definitive therapy. The surviving
patients from the cohort treated with cluster resections and organ
replacement have reached or passed the two-year follow-up, with
half still alive. Many are tumour free and have been socially and
vocationally rehabilitated. The same is true for several patients in
our Aug 18 report, whose care routinely included gradual weaning
and discontinuance of the supplemental parenteral support.
However, our aim was to describe islet cell transplantation as a
successful expedient to eliminate our source of postoperative
morbidity. The technology developed for this objective, and
demonstration of its efficacy, have ramifications for the treatment of
patients with diabetes mellitus.
Department of Surgery,
University Health Center of Pittsburgh,
University of Pittsburgh, THOMAS E. STARZL
Pittsburgh, PA 15213, USA ANDREAS G. TZAKIS
1. StarzlTE, Todo S, Tzakis A, et al. Abdominal organ cluster transplantation for the
treatment of upper abdominal malignancies. Ann Surg 1989; 210: 374-86.
2. Mieles L, Todo S, Tzakis A, Starzl TE. Treatment of upper abdominal malignancies
with organ cluster procedures. Clin Transplantation 1990; 4: 63-67.
3. Tzakis AG, Todo S, Madanaga J, Tzoracoeleftherakis E, Fung JJ, Starzl TE Upper
abdominal exenteration in transplantation for extensive malignancies of the upper
abdomen: an update. Transplantation (in press).
Medical care for Palestinians
SiR,—It is astonishing that The Lancet should not have perceived
that, in printing Dr Farouk Abdul-Rahims letter (Oct 20, p 1013),
it was being used as a vehicle for Palestine Liberation Organisation
propaganda disguised as a problem of medical care.
There was never any need to protect Jerusalems mosques from
"an Orthodox Jewish sect". That "sect" is a small fringe group that
had been denied access to the Temple Mount by the Israel Supreme
Court. When they approached the Old City they were stopped by
police outside the walls. The tragic event had been prepared for
some time with the public summoning of the "protectors" and
accumulation of rocks, and the action began with the hurling of
these missiles onto worshippers in the Western Wall area below. It
was then that the police intervened. If there was a fault it was not to
have prohibited the rioters from entering the Old City and in not
sending strong reinforcements when the preparations were evident.
To assertthat ambulances were not allowed easy access is
astonishing, since we were able to see ambulances at work in the
television news bulletins. In the Old City access is not easy, even
without a riot.
The Charitable Hospital, Mount of Olives, from which your
correspondent writes is known to be in difficulty with the cessation