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Dr Ketan Desai 22 November 2018
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:
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:
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:
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 –
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 -
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:
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
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.
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.
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