It is an honour and privilege for me to be addressing you all on the occasion of the Fifth Giridhar Memorial lecture. Giridhar, in his short life, was an inspiration to many of us, both young and old. He had an insatiable curiosity and desire to learn about different aspects of life, starting from when he was a school child. He had a fantastic ability to master different topics and made a mark in so many areas. This is an occasion to celebrate the life of this wonderful person.
Many Things Unknown
There are many things that are beyond anybody’s control and there are still a lot of diseases for which we do not have a complete understanding of the causation or the pathogenesis. Unless we understand that, it’s not possible to find treatment. For instance, there is a huge amount of ongoing research on neurological diseases including multiple sclerosis. It is one of the most difficult areas in medicine and it is difficult to understand how it starts, what happens and what the risk factors are. Many things are multifactorial. They could involve both genetics and environmental risk factors.
Diseases like dementia could be increasing globally as lifespan increases, including in India. It’s good that our lifespan has increased from 33 years when we got independence to almost 70 years today when we celebrate the 75th Independence Day. (Life span is a little bit higher for women than men.) This is thanks to the advances in medicines including immunisation and the power of vaccines. Vaccination, probably one of the greatest discoveries of the 20th century, has saved millions of lives, especially that of children.
Prevention Is Better Than Cure
When we talk about longevity, it’s a question of living a life that is free of disease and having a good quality of life. When we discuss a disease, we at once talk about medical care, hospitals, diagnosis and treatment. We think and do much less about prevention and promotion of good health and well-being. Prevention is very much part of our traditional systems of medicine. Ayurveda, for example, has a very holistic approach to health. It is not only about treating diseases but also promoting health and living a healthy life.
The whole concept of life includes a healthy diet and practising good habits like exercising and doing yoga and staying away from habits which are harmful to health like consuming tobacco and alcohol. The concept of well-being includes not only physical health but also mental and spiritual health. Each of us has some potential but that can only be achieved if the environment is right.
Promoting good health and well-being is part of the WHO’s agenda. It is also a central part of the UN Sustainable Development Goals 2030 (SDGs). We are less than nine years away and the pandemic definitely has had major impacts on all aspects of our life. We have to work doubly hard to get to the SDGs.
Many Branches of Medicine
There are many areas of traditional systems of medicine like Siddha, Unani, Homeopathy and Naturopathy in the Indian system. There are also the Chinese traditional systems of medicine. The complementary medicines are those which are used along with the standard treatment of allopathy. In diseases like cancer or other incurable diseases, they can be used to improve the patient’s quality of life. They can give some relief from the side effects of cancer medicines, improve appetite, give relief from pain or give better sleep. The alternate systems of medicine are not used in addition to allopathy but as alternatives, as the name suggests and there are different systems.
There are also herbal supplements or dietary supplements. In Indian tradition, we use things like turmeric, ginger, tulsi and pepper which have medicinal properties. Many of these are now available either as home remedies or in the form of capsules, syrup, etc. Ashwagandha is another example. They are not regulated by the Drug Regulator of India as they are sold as dietary supplements. You can walk into a shop and buy them and take it yourself.
Beware of Interactions
We must remember that they are not entirely harmless. If you are taking other medicines, there may be drug interactions. Some herbal dietary supplements were very popular in the US. It was later found that they had an interaction with cancer drugs and they lowered the blood levels of those drugs. So, if you are taking many medicines, doctors need to know what all you take, so that they can look into these drug interactions.
Then we have energy therapy, Reiki and other forms of healing touch and massage therapies and acupuncture. We have therapies which try to change our mind and body nexus and train our mind to do certain things like cognitive behavioral therapy, hypnosis and meditation.
As far as WHO is concerned, the traditional medicines of proven quality, safety and efficacy contribute to the goal of ensuring that everybody has access to care.
Safety, Quality and Efficacy
As far as WHO is concerned, the traditional medicines of proven quality, safety and efficacy contribute to the goal of ensuring that everybody has access to care. The alternative and complementary medicines are often used more widely by people in many parts of the world than allopathic medicines because they are closer to home, accessible, affordable and also culturally more acceptable and therefore it makes them quite attractive. So for the last many years, WHO has been encouraging countries to consider and include traditional medicines into their national health systems.
We believe that traditional and complementary systems of medicine can make a significant contribution to the goal of universal health coverage and that they can be provided in essential health service packages.
Every country has a planning process. The policy-making has to be based on data and evidence. We need a system to regulate these types of therapies, practitioners, products and practices. We need trained people who can practice these forms of medicine. The products and processes must be quality assured.
Centre for Traditional Medicines
We encourage a lot of research and innovation in this area. Recently, the Director General of WHO and our Honourable Prime Minister Shri Narendra Modi had a conversation and decided to set up a Global Centre for Traditional Medicines in India. The Centre will have three focus areas, namely:
- Synthesizing the available knowledge and providing policy inputs.
- To promote high-quality research in the areas of traditional and complementary medicines
- Training, capacity building and advocacy.
The discussions are at an advanced stage and I hope that very soon this Center for Traditional Medicines will be inaugurated in India. It will be not only for India but also for all the 194 member states in the WHO.
There have been surveys done by WHO periodically. The last survey was done around 2016 and there was a report published in 2019 on the traditional and complementary medicines, in which 88% of the countries have said that they use traditional and complementary medicines; 98 countries have formal policies, laws, regulations and programs for traditional medicine. Some countries have included these medicines in their essential medicines list.
Pandemic and Comorbidities
The pandemic obviously has made us aware of the gaps and challenges in our health system. But one of the findings has been that people with non-communicable diseases like diabetes, hypertension or underlying kidney, neurological and cardiovascular diseases have been at a much higher risk of getting the infection and also of getting seriously ill when they get Covid-19. This has become very clear through the surveys that have been done in India including the survey done by ICMR on non-communicable diseases.
Some people can change while some are not able to change their lifestyles. It requires both personal effort at an individual level and behavior change.
Lack of Awareness
The National Family Health Survey has found that 25 to 30% of young adult Indians in the age group of 20 to 45 have diabetes or hypertension or both. The majority of these people are either not aware that they have these or are not on treatment which means that their diabetes and hypertension are not under control. This is the biggest risk factor in India because untreated hypertension and diabetes affect many different organs of the body–the heart, kidneys, eyes, brain and nerves.
We need to make people aware that these are treatable and preventable conditions. People should get their blood pressure and blood sugar checked regularly. They need to be on treatment if their levels are high.
We should also do things to prevent people from getting hypertension and diabetes at a young age. There are risk factors, genetic factors and modifiable lifestyle factors. By doing the right things, we can keep postponing the onset of these diseases. Regular exercise, a healthy, nutritious and balanced diet, keeping body weight under control, taking less of sugar and salt are vital to good health.
Mental health is also very important. We should not underestimate the impact of mental stress in bringing on some of these lifestyle diseases. Some people can change while some are not able to change their lifestyles. It requires both personal effort at an individual level and behavior change. For somebody who is a smoker, giving up smoking is not easy and the individual may need help. The health system has to provide that support.
Policy Level Interventions
There are some policy level changes needed too. For example, we must make it easier for people to walk and to cycle rather than use the car. One of the things I enjoy about living in Geneva is the fact that I can cycle and walk everywhere or take a bus. I don’t need a car and I don’t own a car. The system has been set up in that way.
We need cycle roads, more greenery, more parks and more open spaces. We need affordable, nutritious food. How many people can afford fruits and vegetables to be taken in quantities that are healthy? I am very happy to see in the Tamil Nadu budget announcements that millets will now be included in the public distribution system. The Tamil Nadu Chief Minister and the Health Minister are physical fitness conscious people. The Health Minister Mr. Ma. Subramanian is apparently a marathon runner. I hope that with this kind of leadership, we will see promotion of physical activities because Tamil Nadu is, unfortunately, becoming the diabetes capital of the world. That is not a welcome distinction.
The global pandemic has doubled people’s burden. Here the role of Ayurveda, yoga and our traditional knowledge on food eating habits and diets can be significant. Much of it has changed. I remember when we were young, we ate only homemade food. What our children eat today is different.
Rather than thinking about allopathy and complementary and alternative systems of medicine as competing, we should think of them as an integrated system. Both have their places. There are many diseases and ailments for which there is no treatment available in allopathy and for which, more of a symptomatic treatment is given. That is where the traditional systems come in.
It is not the length of life but the quality of life which is really very critical. That brings me back to Giridhar because his length of life was very short. But he was able to do and achieve many things and give back to society.
Technology and Assistive Devices
Because of the increasing lifespan, there will be more diseases as we age that will require support. We need rehabilitation, palliation and physiotherapy. We also need support services as well as assistive devices. There is a lot of technology that is available for people who cannot see or hear but access to such technologies is very limited.
Dr. Sujatha at IIT Madras has developed special wheelchairs that can make wheelchair-dependent people to not just sit on it but also to stand. As a pediatrician, I have cared for children with muscular dystrophy and neurological diseases which put them in a very difficult situation early in life. While they are paralysed, they are mentally alert and can go to school and college and become productive members of society, if we are able to give them assistive devices that they need.
There is a huge gap globally in the need and availability of assistive devices, mainly spectacles, hearing aids, canes and wheelchairs. We take simple things like that for granted but if we don’t have access to them when there is a need, then it completely changes our life.
Quality Is What Matters
So when we think about health and health systems, we must think all the way from promotion of health, prevention of disease, diagnosis management and treatment, management of pain, rehabilitation, palliation and end-of-life care.
We need a workforce that is trained to provide these services. We need products and devices and, of course, the financing as a large number of people in our country are dependent on government health services.
It is not the length of life but the quality of life which is really very critical. That brings me back to Giridhar because his length of life was very short. But he was able to do and achieve many things and give back to society. He has left a mark in all of us. So what everybody should strive to achieve is the quality of life.
We now have nuclear families which do not have access to the wisdom from a joint family about alternative medicines. At the drop of a hat, people rush to a medical practitioner or check online. How can we educate them?
Dr Sowmya: Yes, most people now get their information from Dr.Google and decide what is to be done. Doctors too find it difficult nowadays to counsel their patients. We need behavior change.
We need to promote complementary medicine and living a healthy life. It should be supported by a combination of government policies–not just policies in the health sector but in other sectors also. When I talk about cycling, walking, greenery in our cities or promoting sports in schools and colleges, many departments must come together. It is what we call ‘health in all policies.’
The quality of air that we breathe is unfortunately becoming one of the major factors for many health issues. 90% of people living in cities across the world are not breathing air meeting the WHO standards. Some of the most polluted cities are in India.
The home remedies may be dying out now amidst infodemic–an overload of information. We have to go for tried and tested products. We need innovation in this area and it has to be followed up with very rigorous research to get data and evidence. The Chinese have done that effectively with their traditional medicine. They conducted large randomised, clinical trials which showed that certain products are useful. We need to do that in India.
One should go by whatever the approved regimen is–which is basically two doses of the same vaccine at intervals recommended by the government. In some cases, if the second dose is not available, you may give the other one. What is clear is it doesn’t cause any harm but whether it is as good as or better than the two doses of the same batch, we don’t know yet.
What is your take on cocktails of Covid vaccines?
This is an area where there is still a lot of research going on but we have very little data as yet. From the data we have, for only one combination, which is AstraZeneca Oxford vaccine (Covishield in India), followed by mRNA vaccines, the results are good.
Without data, it is very hard to say whether it is good or not at this point of time. One should go by whatever the approved regimen is–which is basically two doses of the same vaccine at intervals recommended by the government. In some cases, if the second dose is not available, you may give the other one. What is clear is it doesn’t cause any harm but whether it is as good as or better than the two doses of the same batch, we don’t know yet. People should not experiment on their own. They should wait for the research and guidelines and then the government policy.
What is your advice to the younger generation on maintaining good health, especially since WFH is becoming the norm?
In the first few months of the pandemic in 2020, it was an extremely stressful time for us in the WHO. We worked for very long hours and could not get much sleep at night. I found that doing 20 minutes of yoga in the morning, making sure that I took on time healthy meals–home-cooked, with a lot of salads, vegetables and fruits; and having a long 45 minutes walk in the evening really relieved my stress. That was the only way I could sleep at night. Some people would like to do meditation before going to bed at night. Some like to listen to music.
With WFH, the work life and home life have all merged into one. People are constantly with a device. This is not very healthy. We have to give ourselves a break. Our brains need time to recharge and we should not be connected to devices all the time.
Young people must be off devices when they go outdoors. They must do some exercise or do something relaxing. It could be music, dance or watching a film. It has to take the mind away from work.
Work culture also needs to respect this. Many offices are now realising that putting pressure on people to work for 24 hours is not the way for productivity. Productivity can be enhanced when people have a balance in life. We have to pursue our hobbies.
Though we are missing physical social interactions, online meets have become a good substitute and we are able to reach more people. There are many zoom family calls, zoom classmates and alumni meets happening in the last two years.
Everybody’s mental health has been affected, especially young people who are finishing school or college. They are anxious about the insecurities in their life. We have to recognise that. Unfortunately, it is a gap in our health systems that we don’t have good mental support available as much as we have for physical.
While we may not be able to necessarily produce more and more psychiatrists, there are other ways of providing mental health support, and one of them is reaching out to your friends and family members to say hello, making sure to check up on people if they are okay and encourage people to talk about their stress and strain when they feel depressed. The best way is to talk about it and get help.