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Excerpts from the Presidential Address delivered by Dr. Sunil Seneviratne Epa on the occasion of his induction as the new president of the Sri Lanka Medical Association on 18th January 2003 at the Sri Lanka Foundation Institute, Colombo.

"A woman who conquered her cancer through meditation" - a newspaper report.

This is a story of a woman who conquered her cancer through meditation. I wrote this story 16 years ago, to a Sinhalese daily based on a case report published in the Journal of the Royal College of Obstetricians and Gynaecologists at that time. What is your reaction when you see a story like this?

The health model we follow today is what is called Biomedical or Mechanistic Health model. Rene Descartes of 17th century was the architect of this model. He proposed the philosophical separation of body and mind which lead to the concept of Body-Mind Dualism. For him body and mind were two separate entities with no interaction. We in 21st century still follow the same model.

We failed to grasp the reality that body and mind too can have such an interaction as with matter and energy and that they too can simultaneously exist together.

Pattichasamuppadaya or the theory of Origination or Interconnectedness of All is the part of Buddhist teaching dealing with the subject of mind and body. Both body and mind are referred to collectively in the context of six sensory organs. Five sensory organs are in the body and the sixth one is in the mind or is the mind itself. Different impulses can arise in any of the five bodily sensory organs or in the mind itself which is the sixth sensory organ. Such impulses, be they from body or from mind, produce the same result. The result is the origin of a sensation. Body and mind are at cross roads at the level of origin of sensations.

Beyond the level of sensations, body-mind distinction ceases to exist. Buddhist teaching of life is how we deal with these sensations which keep constantly arising from the six sensory organs. What is important is not the origin of sensations, be it from body or from mind, rather how we deal with them. How we deal with these sensations is beyond the scope of this address. This basically is the crux of Buddhist teaching.

Let us now look at more mundane things. Let me take the case of two medical practices situated in the same locality. One is brimming with patients and the other one, almost empty. Both doctors have the same qualifications. Yet see the difference. If you ask a layman to explain this difference he would say Athgunaya or Athvasiya of the doctor at the busy practice. We doctors might say it is his good PR. Whatever term we use to explain this phenomenon, the fact is that there is a difference in the two practices. The doctor at the busy practice appears to be having a better healing power to attract so many patients. Does this difference come from the medicine that doctor prescribes or from the confidence and trust he creates in the mind of his patients? I leave it to you to ponder.

If it is the latter we have to accept the power of mind in healing. Unfortunately not many of us believe in Athvasiya and not many of us have it either.

Let me show another example where mind can have a healing power. The Placebo effect mere thought of taking a medicine can produce the very same clinical effects of that medicine in a patient. It is unfortunate that we use the term "Dummy Pill Effect" just to discard this effect.

Mind can also produce the opposite effect of healing - i.e. causing illness.

Let me show you an example. The woman in white in the picture who is grieving her husband's death is more likely to die of a breast cancer than her friend who is standing behind with the husband. This is an established scientific truth. A woman is more likely the develop a breast cancer after her husband's death.

This brings us to the question of how the mind influences the body. One clear mechanism is through immune modulation. Depression produces immune suppression through its effects on Natural Killer (NK) cells. These NK cells are responsible for host defence. This is how the widows become more vulnerable to cancers.

Occupational hazards like work place accidents are often due to lack of concentration. Studies have shown that people who take regular exercises are less prone to work place injuries because they have better mental concentration. A surgeon losing concentration at work can certainly be dreadful. The woman on your left in this picture who takes regular physical activity is less likely to die of a colon or breast cancer than her neighbour who stays seated most of the time watching TV.

This brings us to subject of immune enhancement and cancer prevention by physical activity. Earlier we saw how immune suppression caused cancer. This brings us back again to the NK cells. Physical activity produces immune enhancement by increasing the activity of NK cells. This is the mechanism through which physical activity prevents cancer. Meditation too enhances immunity again thorough increased activity of NK cells. This may be how the woman in my story conquered her cancer through meditation. So both these activities physical activity and meditation, produce the same effect on immune system. This sounds strange again, yet it is true. This is due to the interconnection or interaction between body and mind.

Immune modulation is not the only mechanism of interaction between body and mind. Neuro endocrine systems too can be involved.

The state of mind influences the level of MSH in the brain and this explains the link between mind and skin which I will refer to later.

Recognition of PNIE system has resulted in greater interest in body-mind research. There is now a body-mind institute at Harvard Medical School. Herbert Benson at Harvard is the pioneer in this field. He is the one who demonstrated what is called Relaxation response during meditation. During this response there is lowering of blood pressure and reduction of O2 consumption among many other physiological changes during this response.

It is common knowledge that stress worsens eczema. Similarly relaxation and meditation improve this condition. I have already mentioned to you the role of alpha MSH hormone which has anti inflammatory activity on the skin.

Psychological interventions are being increasingly tried out with success in conditions which were not thought to be amenable to such treatments earlier. Infertility and diabetes are only two such examples which are now being treated through psychological intervention. Relief of pain through meditation is another good example. The author of the book titled 'Full Catastrophe Living,' Dr. Kabat Sing, describes how he uses Buddhist meditation technique to relieve intractable cancer pain at Massachusetts Hospital's Pain clinic in the USA.

What we now need is to acknowledge the fact that patients have what is called inner resources of healings or inner healing capacity. This is the power of mind in healing. The challenge we face in the 21st century is to find ways and means of enhancing the healing powers of mind. As the evidence point out, spiritual practices certainly seem to be one way of promoting such powers of mind. Such an assumption would not be unscientific any more in view of the mounting evidence in this direction now.

Around the same time there was a similar thinking in the east and an Indian doctor called Dr. Bisht proposed to the WHO to include a spiritual dimension in the definition of health. He called this the fourth dimension of health. So the proposed a new definition of health which should read as follows:

"A state of complete physical, mental, spiritual and social well-being and not merely absence of disease or infirmity."

This in fact marked a significant milestone in the recognition of body-mind interaction in health. What we need today is a health model which recognizes this new dimension - the Spiritual dimension of health. There is already enough evidence that the trend towards spiritual health has already started in the 21st century. Let me show few examples. 'Reader's Digest' carries the phrase "The Science of God" in the front cover of its March 2002 issue. 'New Scientist' in its cover page of 21st April 2001 issue poses the question "Can your brain really tune into God?" Recently, there were several write ups in newspapers.

In fact there was a news item in one of the newspapers of a meditation programme conducted by an australian for cure of cancer. 'Time' magazine this week has issued a special supplement on body-mind interaction. Cover page of this issue says, "How your mind can heal your body." Let me add the icing to the cake. The prestigious "British Medical Journal" in a recent issue carries a leading article on the subject of spiritual health. The title is "Spirituality and clinical care." Conclusion is that spiritual values and skills are increasingly recognized as necessary aspects of clinical care. It in fact draws a parallel between nutritional and spiritual deficiencies, both of which retard healing.

I wish to make the following recommendations for recognizing the spiritual dimension in health in Sri Lanka.

1) We need to openly acknowledge the compelling evidence of the existence of the spiritual dimension of health.

2) we need to train doctors and other health professionals at undergraduate and post graduate levels to address this issue.

For this we need to make changes to the existing medical curriculum. I am pleased to note that Colombo and Kelaniya Medical Schools have already incorporated a module on Behavioural Medicine in their undergraduate curriculum. Behavioural Medicine is relatively a new speciality where there is an attempt to expand the traditional health model by incorporating aspects such as beliefs, emotions and behaviour in health. Eliciting spiritual history for example can be part of medical history taking as is already being done in some US medical school.

3) Relaxation, meditation and spiritual involvement should be recognized as health promoting activities as much as physical activity promotes good health. Currently the health promoting activities are based on Ottawa charter of 1986 and there is no provision for a spiritual dimension in this. Therefore we need to appropriately modify this charter to include the health promoting effects of spiritual practices.

4) Patients should be educated on the healing powers of relaxation, meditation and other spiritual practices.

5) We should undertake more scientific research to define and quantify the effects of meditation on health. This should not be very difficult as we have a rich culture of Buddhist meditation in this country. This should be the responsibility of the medical profession and should not be confined only to religious leaders any more.

6) These practices are not to be regarded as an alternative to the orthodox medicine, rather to be considered as complementary to it.

7) Spiritual dimension should be recognized as a universal issue in health and should not however be confined to any particular medical speciality.

8) Hospitals should be made an environment which promotes and nourishes patients' inner capacity for healing by providing appropriate spiritual support.

How to manipulate mind for better health should be the theme for a 21st century health model. We saw the ushering of the new millennium just two years ago. Now we should also see the ushering of a new health model to replace the 17th century Biomedical Health model... I propose to name this new health model as Medicospiritual Health Model.

Let me conclude by quoting a famous Sinhalese poet Munidasa Kumarathunga.

"A nation with no innovative skills would never rise."

So let us be innovative and show the rest of the world a new direction in health by adopting this Medicospiritual Health Model in Sri Lanka.

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