Early on in her movement disorders practice, Indu Subramanian, MD, realized that classic Western medicine was missing something. “It wasn’t serving my patients—or me—that well,” she said. She found that classic Western medicine was only good at fixing: people come to their doctor with a specific complaint, and the doctor’s job is to focus on that complaint—and that complaint only. This complaint translates into a billing code and, hopefully, a plan to “fix it”. “It’s a very formulaic encounter,” she said.
But in neurodegenerative diseases like Parkinson’s, there is no “fix.” There are therapeutics to manage symptoms, but disease management alone often fails to account for the full person. “As a physician,” Dr. Subramanian said, “it felt like a lot of the responsibility to fix the complaint was in my hands.” It felt “reactionary” and, more critically, wasn’t cooperative. What happens, she wondered, if we empower people living with these diseases to be their own “agents of change”? If we offer them tools that don’t fix, necessarily, but heal—that account for the ways they want to live, for their hopes, for their humanity? Undaunted by the magnitude of her question, she followed it.
Today, Dr. Subramanian’s accomplishments are prolific: for starters, she’s a Clinical Professor of Neurology at UCLA as well as the Director of the South West PADRECC Center of Excellence in Parkinson Disease. But the roots of her journey into movement disorders—and into questioning the scope of conventional medicine—stem from her childhood. Her mom was a family doctor and raised her kids on an Ayurvedic lifestyle. “I didn’t even know what that was,” Indu said, “just that when I got sick with a GI bug, my mom would make something with ginger for nausea. We respected the herbs and spices, and ate things that were in season.”
By the time Dr. Subramian was raising her own kids, she started to think more deeply about what complemented traditional health care in her own life, the practices that fostered whole-body, whole-being wellness. “I was a young mom trying to balance work, life, kids, and the ever-growing needs of my patients and my practice,” she said. “To do it all was a lot.” It forced her to understand what was depleting her and what was fueling her. “I started trying to figure out what health was and what my mental health was,” she said. “I realized that I felt better if I got a good night’s sleep or was able to detach myself from the craziness of life and work and take some time on my yoga mat. It wasn’t rocket science; it was just me exploring in my own body. I was my own petri dish.”
Not rocket science, but still novel. “We spent no time in medical school talking about this,” Dr. Subramanian said, referring to considering the role of mind-body approaches, of exercise, sleep, and mental health. Never one to remain on the surface, Dr. Subramanian went deeper: she underwent a 200 hour yoga teacher training and studied mindfulness at the VA through Insight LA. She got board certified in integrative medicine, which seeks to unite the power of conventional Western medicine with holistic and complementary ways of approaching wellbeing. What started as an exploration in her own body to help her balance young motherhood and her career and the isolation of all of that eventually morphed into something she could use to help her patients. She found herself offering mind-body advice as she fervently sought to understand the holistic medicine that would help her patients with movement disorders live better each day.
As PMD Alliance emerged as an innovative organization in the southwest region where she practiced, Dr. Subramanian took note. Even before the pandemic, she said, “PMD Alliance had been savvy with Zoom.” So when they began mulling over an idea for a new webinar series led by Dr. Subramanian, it felt like a natural fit: “PMD Alliance was really flexible and accommodating with my interests,” Dr. Subramanian said. They told me, ‘If you want to do this, we’ll jump in and help you.’” A marriage was born. Together, they launched wHolistic, a live-streaming (and now on-demand) series designed to talk about people with movement disorders from a whole-body, whole-being perspective. At the time, this was cutting edge; few medical providers or organizations were deep-diving into this less trodden terrain.
As the series started to air, they saw this wasn’t just some niche passion project; people living and loving someone with a movement disorder were hungry for these alternative topics. So she and PMD Alliance leaned in. “We decided to do things increasingly around mental health,” Dr. Subramanian said, “and looking at who wasn’t being served.”
In 2022, when they launched an episode in the webinar series about global perspectives in Parkinson’s, Dr. Subramanian knew there might be pushback. “I think the nation was very divided. A lot of viewers may have thought, ‘Who cares what’s happening in Africa?’ But that’s not who I am. I wasn’t going to change my dialogue to make it more comfortable for some people.” Dr. Subramanian was determined to lift patient voices across the globe, highlighting disparities and, more importantly, illuminating the opportunity this presented for all of us to improve access to treatment for everyone, everywhere.
Turns out, people were hungry for this conversation, too. Dr. Subramanian would continually get supportive emails from the people “not included in most rooms” or from those who serve them. This was just the beginning.
Recently, Dr. Subramanian, alongside nearly twenty colleagues across the globe and across disciplines, published a paper that would take what she began exploring on the periphery into the mainstream. The paper was a collective effort of the Movement Disorder Society’s Task Force on Wellness, a task force, she said, that was still in its dawn after taking “years to get accepted.” Titled, “A Holistic Wellness Prescription for Parkinson’s Disease: Evidence-Based Perspectives and Unmet Needs,” it dares to bring together a wide range of voices to identify gaps in conventional movement disorders care and establish a framework that integrates wellness into the holistic care of people with Parkinson’s.
In the traditional medical care model, a patient, the paper’s authors write, “is often a passive recipient of care.” Physicians are tasked with reacting to a symptom or complaint in a compartmentalized way. And their interactions with their patients are sporadic; “patients often see their neurologist for only one 15 to 30-minute appointment every 6 months,” they write. In some places, a neurologist or healthcare professional is not accessible at all. On the contrary, the wellness model centers the person living with Parkinson’s, tailoring their goals to what they consider most important for their quality of life. Most importantly, it takes their unique life and context into consideration, helping the patient take an active role in making choices that meet them where they are culturally, economically, socially, and spiritually. One size does not fit all.
“Our tenet,” Dr. Subramanian said, “was: What can you do, not what can you buy. Everything we did was rooted in accessibility, in practitioners understanding who the person in front of them is, and in thinking about mental health as a core part of care…We wanted to frame it as: What can you do if you don’t have money or even a doctor or even a confirmed Parkinson’s diagnosis yet? What can we start with in even the worst case scenario?”
She gave examples of how a physician might offer this prescription with intentionality: “Say it’s a young mom in front of you who goes to church with her kids and church really fuels her. How can we grow that if it brings her comfort? Maybe it’s prescribing a walk with your best friend for half an hour a couple times a week, or grabbing something delicious with your sorority sister. We have to start somewhere.”
A few weeks ago, Dr. Subramanian flew to a gym in Cleveland to give a talk to people impacted by Parkinson’s disease. And she started as she almost always does, by acknowledging the diversity in the room—and being intentional about who wasn’t in the room. “Let’s look around,” she said. “Who are the veterans in the room?” The veterans raised their hands. “Who are the women?” Eventually she asked, “Who’s not in the room?” Because, she insists, “that’s who we need to figure out. Who’s not comfortable being in the room? Or who can’t leave the house because they’re so immobile? We have to look at the grassroots.”
She went on, “PMD Alliance makes me happy because they’re trying to bring those mom-and-pop shops in and give them the tools. They’re not just like, ‘Can you fundraise for us and bring in the big bucks?’” It’s about creating a space where everyone belongs, where everyone knows there’s a place for you here. “We haven’t served the full community of Parkinson’s patients until everyone with Parkinson’s on the planet has their needs met.” To do this, she said, “we must reinvent the models.”
Dr. Subramanian isn’t satisfied—and that propels her. “I’m a very curious person,” she said. “If I have passion for something and I want to say something about it, I’ll do a whole year of training on it. I’ve studied yoga, mindfulness, how to tell stories. I did a journalism fellowship. I’ve done advocacy training, leadership training. I’m constantly pushing boundaries and being outside the box.” She’s constantly trying to answer the question: How do I do “the things I was put on this earth to do by a life force bigger than me? I’m trying to figure out how to better serve. What’s my next iteration?”
“If someone gave me a bazillion dollars,” she said, “and I could do whatever I wanted, I would still want to change something about Parkinson’s. That still feeds my soul. I think I would travel and see, globally, what’s being done in places where they’re making an impact—like the Netherlands, Australia, parts of Asia and Africa. And I want to meet the people I’ve interviewed”—over 120 for her recent paper alone— “in their own environment. Then I want to come back and really operationalize what we’ve learned. How do we actually get change to happen? How do we get people to do better and live better every day?”
When she looks to the horizon, it is bright. “The world is my oyster,” she said. She acknowledges the privilege of her circumstances, letting it stoke her responsibility. She is unrelenting. If we, collectively, are going to create change, it will undoubtedly be alongside Dr. Subramanian. We don’t need to have all the answers yet, just a willingness to ask the big questions and, like her, the courage to follow them.
