It gives me immense pleasure to welcome all the learned delegates to this notable conference on an all important theme, which is bound to be of consequence and relevance to the fate and future of nature of medicine in the interest of men and mankind. I am grateful to the World Medical Association (WMA) for vesting this onus and responsibility on the Indian Medical Association. The trust and faith posed therein would be upheld in all its manifestations.

Speaking on the theme, it is worthwhile to note that functional medicine is the future of conventional medicine. It identifies and addresses the root causes of disease, and views the body as one integrated system, not a collection of independent organs divided up by medical specialties. It treats the person and not just the symptoms. Individual responses differ when it comes to affliction with non-communicable diseases on the cardinal consideration that the nature of clinical response varies from individual to individual.

In dispensation of functional medicine the doctor spends time not only with the patient but also with the parents and other associates relevant and vital and takes into consideration the interactions of genetic, environmental, and lifestyle factors.

Functional medicine addresses the underlying causes of the disease, availing a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership of its type.

By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms, which by itself is a great paradigm shift with respect to pattern of presently operational medicine as against functional medicine.

India is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases such as diabetes, heart disease, cancer, mental illness, and auto-immune disorders like rheumatoid arthritis. The system of modern medicine practice is oriented towards acute care, the diagnosis and treatment of trauma or illness that is of short duration and in need of urgent care, such as appendicitis or a broken leg. Physicians apply specific, prescribed treatments such as drugs or surgery that aim to treat the immediate problem or symptom. This invariably amounts to not taking cognizance of the root cause which remains unattended in the present operational pattern of medicine.

Unfortunately, the acute-care approach to medicine lacks the proper methodology and tools for preventing and treating complex, chronic disease because of the material reality that the core emphasis is on ‘curative domain’ with preventive and promotive domains remaining totally neglected and unattended. At the most with curative domain, rehabilitative arena is taken care of but not necessarily in its totalistic contours.

In most cases it does not take into account the unique genetic makeup of each individual or factors such as environmental exposures to toxins and the aspects of today’s lifestyle that have a direct influence on the rise in chronic disease in modern Western society.

Most physicians are not adequately trained to assess the underlying causes of complex, chronic disease and to apply strategies such as nutrition, diet, and exercise to both treat and prevent these illnesses in their patients.

Thus, functional medicine involves understanding of the origins, prevention, and treatment of complex, chronic disease. The special attributes thereto are that:

1. It is patient-centered care
2. It is an integrative, science-based healthcare approach.
3. It integrates best medical practices.

Modern Medicine

The causation of the disorders which are put under the generic rubric of ‘lifestyle disorders’ are primarily attributable to alterations including aberrations which are due to environmental and life style factors in unison. The notable illustrative examples would be in the form of:

Environmental and Lifestyle factors such as:

1. Level of exposure to noise pollution
2. Level of exposure to or pollution
3. Salt intake in the family
4. Exercise pattern
5. Level of trans-fat intake by the family
6. Joint vs nuclear family stress
7. Job dissatisfaction
8. Relational disharmony
9. Smoking patterns vs switching to harm reduction
10. Alcohol intake
11. Drugs addiction

The list is illustrative in character and not exhaustive in nature.

Yet another aspect which is of significant importance in the context of the present theme is that the extended care itself differs from person to person. The classical examples that can be availed to drive this point home could be:

1. Family history of CAD,
2. Being an Indian: Indians get heart disease 10 years earlier than in the west
3. Race: Blacks have resistant hypertension
4. Dravidians vs Aryans: Dravidians have high incidence of heart disease
5. Religion: People who believe in religion and follow it judiciously may have lower incidence of heart disease
6. Islamic believers eat red meat but their incidence of heart disease is no different
7. Type A personality has more chances of developing CAD
8. Some people are aspirin resistant
9. Some people show clopidogrel resistance

Looking at these aspects of subjective variations and the impact of environmental factors per se on individuals and their differential responses thereto, one is required to turn back to the core ethos, philosophy and approach incorporated in Indian System of Medicine, which is depicted as an Upveda of the Atharva Veda.

Realistically speaking Ayurveda is a classical example of functional medicine where the approach is to treat the patient and not the disease on the core cardinal considerations included in Charak Samhita, which is a treatise on the said medicine to the effect that –

1. Your personality is decided at birth
2. Vata personality people have more hypertension
3. Pitta personality people have more heart attacks
4. Kapha personality people have more heart failure

Likewise the principles and approach as availed in classical Indian System of Medicine, which has stood the test of time ever since its inception in the Vedic Age itself till date, the Homeopathy as an approach of medicine also holds the same ethos as Ayurveda in as much as that it aims at treating the patient and not symptoms. This is testimonized from the fact that every individual is different and needs different treatment in as much as that ‘Psora’ people behave like ‘Vata’, ‘Syphilis’ patients like ‘Pitta’ and ‘Psychosis’ people like ‘Kapha’ as contemplated in ayurveda.

Yet another arena, which needs to be taken note of, is the ancient Vedic Medicine, which contemplates that Prarabdha karmas and Sanchit karmas decide one’s disease pattern.  However, but they can be changed by proper lifestyle. The edifice on which it stands is deciphered on the strength of the fact that -

1. Indian have more chances of metabolic syndrome and hence the need for fasting
2. Indian women have more chances of heart disease than Indian men and hence the need for weekly fast

Personalized Genomics

With the rapid pace of progress in the fields of biotechnology, genetics, and genomics, molecular genetic profiling may soon become an integral tool for clinicians to guide individualized management of many medical conditions.

Personalized medicine (also termed personalized genomics, genomic medicine, or precision medicine) refers to the application of patient-specific profiles, incorporating genetic and genomic data as well as clinical and environmental factors, to assess individual risks and tailor prevention and disease-management strategies.

Personalized medicine involves the use of an individuals information or genetic profile to guide decisions made in regards to the prevention, diagnosis, and treatment of disease.

Examples in non-communicable diseases include dose modification of medicines depending on single nucleotide polymorphisms (SNPs) that determine drug metabolism speed and individualized screening for effective therapies in cancer.

It is used for improved medical decision-making; delivery of appropriate therapies that are tailored to a patients sequence variants or genotype rather than the general population; optimized disease prevention strategies, including lifestyle and behavioral modification, as well as pharmaco-prevention; reduced exposure to or avoidance of medications of lower efficacy; reduced exposure to medications that have the potential for greater toxicity, with resulting lower incidence of treatment-related complications; reduced healthcare costs and enhanced patient satisfaction with the treatment process, improved tolerance of therapy, and better compliance. The classical examples which bear out the same are:

1. Individuals who were homozygous for an alpha-1-antitrypsin null allele with severe deficiency of the resulting protein are more likely to attempt to quit smoking (59%) than either mutation carriers (heterozygotes; 34%) or individuals with a normal genotype (26%).
2. Smokers who were informed of having genetic risk factors for heart disease are more likely to report an inclination to quit smoking than individuals in a high-risk (but non-genetic) group.
3. In carriers of mutations that cause familial hypercholesterolemia (ascertained through an affected relative), cholesterol-lowering medication use increases from 51 to 81 percent two years after learning genotype status.

Cancer

In the domain of cancers it is noteworthy that the gene expression profiling may help to stratify the need for therapy or the type of therapy in patients with early-stage cancer. Examples include breast, lung, and colon cancer. Gene expression profiling has been especially useful in classifying lymphomas, which allows distinction among a number of subtypes of disease that cannot be reliably distinguished histologically.

Types of genetic tests

1. Specific single gene tests: Most gene-specific tests are performed as part of a focused risk evaluation for heritable disease or for diagnostic considerations. Examples include BRCA1and BRCA2 gene sequencing for carrier identification in at-risk individuals with a strong family history of breast cancer, or pharmacogenetic testing to guide dosing of chemotherapeutic agents in individuals with sequence variants that affect drug metabolism.
2. Specific gene panels: Panels that provide sequence variant information for multiple genes have been developed for clinical testing. Examples include panels to test for genetic causes of intellectual disability, epilepsy, autism, and hereditary deafness.
3. Genotyping panels of selected susceptibility variants: These panels are often bundled as direct-to-consumer (DTC) genetic tests and include SNPs that have been associated with common, complex diseases such as type 2 diabetes, autoimmune disease and metabolic traits.
4. Whole genome or exome sequencing: High-throughput sequencing platforms (often referred to as next-generation sequencing [NGS]) enable sequencing of the coding regions of the entire human exome (i.e. all regions of the genome that encode proteins)
5. Pharmacogenetic testing: Also referred to as pharmacogenomics. The most extensively studied pharmacogenetic variants are those of the cytochrome P450 drug metabolizing liver enzymes (CYPs). Fifty-eight CYPs have been characterized in humans, and functional SNPs that alter functional activity have been identified for many CYPs.

Other personalized medicine platforms

Apart from genetic-based tests other "omic" approaches are being developed that will provide a more complete characterization of risk that includes variation between individuals in gene regulation, epigenetics, and cellular metabolism.

1. Gene expression profiling (also referred to as transcriptomics): Analysis of mRNA (of either individual genes or panels of gene targets)
2. Proteomics: Qualitative and quantitative analysis of the collection of protein constituents in a biological sample. These methods provide measures of the types and abundance of proteins in a biological sample.
3. Metabolomics: The characterization of metabolic profiles
4. Lipidomics: Characterization of the complete collection of lipids.
5. Epigenomics: Profile of the modifications to DNA (often, methylation) that control gene expression.
6. Exposomics: The sum of exposures an individual incurs over a period of time. These may include nutrients, foods, toxins, stresses, exercise, vaccinations, medications, and other exposures.
7. Microbiomics: Characterization of the microbes (typically, bacteria) that reside in or on an individual. A common example is the gut microbiome, which might influence adiposity and/or immunity.

Thus, the vistas of functional medicine are wide and varied. They need to be deciphered with better degree of clarity for the purposes of fostering a desired level of understanding at the levels of safety, efficacy including effectivity and entailment of cost considerations thereto. In a World, which is plagued by inequity and differential disbursement of resources, with curative medicine turning out to be unaffordable to a vast multitude of human population across the Globe, functional medicine therefore, turns out to be a real ray of hope full of glitter and illumination intrinsically in it.

I am sure that the discussion and deliberation on various aspects of the same in the conference would definitely bring out newer dimensions of use and utility, scope and relevance for the wider benefit of men and mankind and thereby resulting in genuine actualization of health as a fundamental right of every Global citizen, rather than it remaining a perceptible human right.