Special issue with the Sunday Magazine
From the publishers of THE HINDU

MILLENNIUM : January 23, 2000

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The brave new world of health and healing

Peg Jordan

The History of Medicine 2000 BC Here, eat this root. 1000 BC That root is heathen. Here, say this prayer. 1805 AD That prayer is superstition. Here, drink this potion. 1940 AD That potion is snake oil. Here, swallow this pill. 1985 AD That pill is ineffective. Here, take this antibiotic. 2000 AD That antibiotic doesn't work anymore. Here, eat this root. Anonymous

There is no better evidence that we are entering the age of complexity than the dawn of this new health era. Complexity theory, better known as chaos theory, is the recognition that the world is inherently unpredictable due to the constantly changing, non-linear dynamics of all living things. There is no single solution, no easy answers, no guiding path that will lead us from an unhealthy here to a healthy there. When it comes to solving the world's chief health problems, that complexity becomes vividly clear. As a result, health care in the future will continue to progress in multiple directions all at once. We will witness parallel growth in the use of low-tech, cost-effective interventions, side by side with sophisticated new technologies. Here is a quick overview of just how varied and complex that future will be.

T.A.Hafeez

Behavioural Medicine

In affluent areas, the chief killers are diseases of lifestyle, namely, sedentary living, non-nutritious diets, high stress and smoking. The shining promise of the previous decade that the advances in technology would solve the significant diseases of our time has definitely begun to tarnish. Chronic, debilitating illnesses such as heart disease, certain cancers, hypertension, obesity, diabetes, auto-immune conditions and arthritis, are largely caused by unhealthy choices people make on a day-to-day basis. Tobacco use, poor diet, physical inactivity and high stress levels are the top culprits that rob people of vitality and longevity. On that front, simple changes in lifestyle can do more to prevent or alter the course of a chronic illness than many of the heroic surgical procedures or pharmaceutical agents. Getting people to make the changes that will favourably impact their health, now there's the rub. Rising to the challenge is the new science of behavioural medicine. Doctors and scientists in this field explore new techniques of motivational psychology, while medical anthropologists chart the cultural influences toward health-enhancing or disease-prone actions. How do we motivate people to adopt family planning measures? To practise safe sex in the face of growing sexually transmitted diseases? To value human life and halt the selective infanticide of female babies? To eliminate smoking on international flights? In many cases, the journey toward a healthy, vibrant life is ultimately based on personal choices. Other advances in this area stem from the new field of psychoneuroimmunology (PNI). Scientists explore how our thoughts and emotions have a profound effect on the immune system, which serves as a guardian to the entire functioning of all other systems. People who exhibit chronic hostility may be undergoing a damaging wear-and-tear of their immune system and cardiovascular arterial system, leading to an increased risk of gastric disorders, auto-immune illnesses, heart attacks, hypertension or stroke.

In the past decades, medicine looked at cardiac patients from a set of lab findings, such as, enzyme levels, electrocardiogram readings, and cholesterol profiles. In the future, holistic views will gain some momentum over this fragmented portrait. Physicians will take into account the emotional status, connection with community, spirit and family ties. All of these facets of a life once considered "unscientific" are now making their way into major books such as Love and Survival by Dean Ornish, and Heartbreak and Heart Disease by Stephen Sinatra.

Despite the undeniable significance of personal choices and actions, other factors such as societal norms, family pressures, cultural patterns and the condition of the surrounding environment will also continue to either impede, or support, our health.

Shyam Jagota

Partnerships of civic ecology and health

Ultimately, we may only be as healthy as our planet and community. In poor regions, health and longevity are still limited by problems that have plagued them for centuries: infectious disease, respiratory infections, polluted water and the endless stream of bad bugs, microbes, bacteria and parasites. The prescription for a healthy global future depends on your access to education, health services, clean water and a balanced and nutritious variety of food. But even with all this in your environment, without a doubt, the single most important determinant of your lifespan and the quality of those years is your socio-economic standing, according to the United Nations World Health Organisation. It is estimated within two decades, cities and villages that lack the resources to create safe drinking water will endanger roughly two-thirds of the world's population. At that point, a staff of civic engineers, a well executed plan and sufficient municipal funds become the gods of good health.

The glamour of high-tech medicine

Medicine in the new millennium will enter a fast lane with the advent of nanotechnology, which is the use of microscopic robotics that will enter the bloodstream, detect illnesses, communicate with surgeons and repair cells. High-tech uses of lasers that can now resurface the skin of the aged to restore youthful appearances, will also be able to repair clogged arteries to prepubescent conditions, whether in the heart or the brain. Modern medicine marches on, nonetheless, and the advances that make headlines in most parts of the industrialised world are the ones that remain incredibly expensive, reserved for the privileged, and unattainable by most of the world's population. Some of the predictions for medicine in the next millennium include:

Shashi Shetye

Finding longevity genes.

The international human genome project (mapping out the specific expression each gene on the 23 pairs of human chromosomes) has many scientists racing to discover which genes function as human clocks, ticking away, and dictating how long we should live. Confident that they can trace how certain genes tell protein caps within cellular structures whether or not to decompose, genetic scientists are predicting that the lifespan should easily be extended to 125 by the year 2050. Today we have six billion people looking for elbow room on the planet. If the world's population reaches 10 billion as some experts predict, do we really want everybody living until 125? Most would vote for a higher quality of life, versus quantity of years.

Harvesting new body parts.

Another mind-boggling and futuristic medical adventure is the genetic cloning of "spare" parts, often grown from one's own DNA. Scientists foresee the ability to clone needed organs to replace worn or diseased ones, regenerated corneas for the blind, healthier neural tissues for the senile, and even more handsome noses for the beautiful and wealthy. How silly, you say. However, science has never once backed down from doing what could be done. With hundreds of thousands of test-tube babies born every year to people undergoing fertility clinic procedures, we can expect more genetic miracles.

Scientists are predicting that we will know how to regenerate neural, spinal and brain tissue, basically eliminating paralysis, para - and quadriplegia, Alzheimers and other degenerative diseases of the nervous system.

Holism and natural medicine gain more respect

T.A.Hafeez

Holistic medicine is a catch-all phrase that refers to any healing modality, which focusses on the whole person - mind, body and spirit. It can be ancient, such as Ayurvedics or Traditional Chinese Medicine, or contemporary, such as biofeedback, colour and sound therapy and guided imagery. Whatever the lineage, holistic therapies seem to have certain traits in common; they work gently, slowly, do no harm, can be used with conventional modern medicine, and are valued for the comfort and empowered decision-making role they afford people. They are also cost-effective and gaining widespread acceptance for their effectiveness.

The rising demand for complementary and alternative medicine over the past decade is a true grassroots phenomenon. People pay out of their pocket for these services in many parts of the world, because insurance still does not cover anything other than conventional medical practices. According to one survey at Stanford University, people who use chiropractors, acupuncturists, herbalists, energy healers and other holistic practitioners, do so because they are seeking caring practitioners who spend time listening to their patients, and treat the whole person, not just the "sick part." Respondents in the survey compared much of modern medicine to an impersonal assembly line, offering the limited options of drugs with unwanted side effects or surgery. Holistic health does not try to "fix" the body, but instead, helps super-charge the body's self-healing capacity.

Major medical institutions and universities in India, Britain and the U.S. are integrating these holistic techniques into their coursework and practical experience. Included in the new line-up of "integrated medicine" are:

• Relaxation; meditation techniques
• Support groups
• Therapeutic massage
• Diet and nutrition
• Exercise and movement therapy
• Herbal medicine
• Acupuncture
• Spirituality
• Homoeopathy
• Cognitive restructuring
• Vibrational medicine or bio-electromagnetic therapies

Vision of health

It would be a pleasure to conclude that health will be a democratic domain, and that access, affordability, convenience and quality to good care will be realised in the future. However, the last decade has witnessed no particular gains in equitable distribution of health care. "Miracle" surgeries continue to get media attention, making heroes of surgeons and institutions, and creating headlines for one in a million lucky enough to get some life-saving, high-tech, costly surgery.

Just in the last year, donor livers were packed in frozen containers and flown across continents to rescue the rich and famous from impending death due to an alcoholic liver. At the same moment, another infant dies a needless death in a city slum, to a young mother, among the vast numbers of poor who receive no prenatal care.

What is your vision of health in the future? Chances are if you are wise enough to have a vision for it, then you will be able to improve your living conditions, thereby, improving your chances for a healthier, longer life. Multiple systems of medicine and healing will co-exist, and we will be better off for it.

When you are faced with a catastrophic injury or illness, you will be glad to have the most modern medicine, complete with a full range of technological services available. And if you find yourself feeling with a chronic symptom that most doctors cannot seem to pinpoint, then you might just try the resourceful tools of traditional and holistic health practitioners, and be surprised to feel better than ever. The brave new world of health will be a complex landscape offering many avenues to travel. Just remember that vibrant health is not a matter of luck, but of smart choices and healthy living practices, so eat right, exercise and take time to smell the roses. The future of your health is pretty much up to you.