If we accept this, the path before us is very clear.

The first goal of medicine is to see to it that no one has to reach a hospital or a clinic. This is what I mean by prevention. [Technically called primary prevention; not of course ruling out the importance of secondary prevention (early detection and prompt treatment) and tertiary prevention (restoring function and reducing disability)]. This should be the very first goal, not the last; which means, health promotion/education activities along with clean water, nutritious food, clean and disaster free habitation, proper sanitation, control of pollution, poverty alleviation, empowerment of the deprived and disadvantaged, life-style modifications. A tall order, which involves multiple agencies, not in control of medicine and its movers. That is one prime reason why it is not top of the agenda, perhaps. And of course because it cuts at the very root of the justification for the medical establishment, and its proliferation. But medicine has as much a treatment orientation as a social perspective. For health is a means to well-being, and health can be achieved for all only when all are mobilized for health and become conscious of what should be its legitimate thrust (Singh and Singh, 2004). Moreover, prevention, understood as preventing a disease from occurring, also means, finding out vaccines, and other preventive measures, for all its diseases, not just the infectious. Let this stop sounding ludicrous. It is comforting to note that work on vaccines is underway, especially for diabetes (Phillips et al., 2008; Richardson et al., 2009), hypertension (Mitka, 2007; Ambhl et al., 2007; Phisitkul, 2009), cancers (especially cervical: Jenkins, 2008; Keam and Harper, 2008; Schwarz, 2008), and at least suggested for schizophrenia and other mental disorders (Tomlinson et al., 2009). And, related to this, it must research and highlight life style changes which prevent disease, and tackle diseases of poverty and of lifestyle (Singh and Singh, 2008). Some work in this field is already on, for example, in cancers (Anand et al., 2008), Type 2 Diabetes (Misra, 2009), cardiovascular disease (Pischke et al., 2008), ulcerative colitis (Langhorst et al., 2007); as also the beneficial effects of a vegetarian diet in lifestyle diseases (Segasothy and Phillips, 1999). Preventive psychiatry also needs a boost, for psychiatry, and overall for medicine, for do we not know that psychological distress is at the root of common medical problems that reach a primary care physician, and complicate many manifestations of other disorders at all levels of their manifestation. The complex relationships between gene-environment interactions, particularly the interplay of vulnerability and resilience factors within a persons biography need close scrutiny in individualized preventive psychiatry (Mller-Spahn, 2008), as does reduction of stigma in secondary prevention (Reeder and Pryor, 2008). The role of health psychology and the related field of behavioural medicine which focus on the interplay among biological dispositions, behaviour, and social context also need enthusiastic backing as a means to health promoting behaviours and preventing health damaging ones (Kaplan, 2009). Modern medicine must look closely at, and not pooh pooh, the claims of alternative and complementary medicine, including yoga, meditation and spirituality, just because one is put off by their tall sounding claims, and some charlatans in the group. Rather, it must submit their claims to rigorous scientific and experimental scrutiny. Some recent studies in yoga in general (Lipton, 2008; Bijlani, 2008; Corliss, 2001; Oken et al., 2006; Brown and Gerbarg, 2005; Shapiro et al., 2007; Flegal et al. 2007), and yoga in cancers (Culos-Reed et al., 2006; Bower et al., 2005; Smith and Pukall, 2009; Danhauer et al., 2009) are promising in this direction. Studies of meditation as an adjunct to modern medicine deserve special mention here. Some promising leads are in works on Longevity and health through yogic meditation (Bushell, 2009), and meditation in general (Bushell and Thiese, 2009); meditative practices for health (Ospina et al., 2007), and their clinical trials (Ospina et al., 2008); Sudarshan kriya in stress, anxiety and depression (Brown and Gerbarg, 2009); Transcendental Meditation and longevity (Alexander et al., 1989); meditation and slowing of aging, (Epel et al., 2009); mindfulness and distress (Jain et al., 2007); and mindfulness and well-being (Shapiro et al., 2008). Spirituality and its various scientific studies need a close scrutiny too. Some areas of spirituality which have interested researchers in recent times are positive emotions and spirituality (Vaillant, 2008), its neurobiology (Mohandas, 2008), healing presence (McDonough-Means et al., 2004), spiritual encounter and complementary treatment (Foster, 2006), spirituality and psychiatry (Mohr, 2006), health and spirituality in critical care (Puchalski, 2004), spirituality and critical care holistic nursing (Carpenter et al., 2008), difficulty in talking about spirituality in a medical setting (Molzahn and Sheilds, 2008) etc. To promote rigorous scientific scrutiny of claims in Complementary and Alternative medicine [CAM], laudable efforts are on by relatively new Journals in the field like Evidenced Based Complementary and Alternative Medicine (an Oxford Journal, since June 2004, http://ecam.oxfordjournals.org), BMC Complementary and Alternative Medicine (Published by BioMed Central, since 2001, http://www.biomedcentral.com/bmccomplementalternmed), Alternative Therapies in Health and Medicine (since 1995, first journal in the field of CAM to be indexed with NLM http://www.alternative-therapies.com), Journal of Alternative and Complementary Medicine (since 1995, Official Journal of the International society for Complementary Medicine Research, http://www.liebertpub.com/products/product.aspx?pid=26). Some notable relatively recent work in CAM in the field in anxiety and depression (van der Watt et al., 2008), depression in women (Manber et al., 2002), menopausal women (Kronenberg and Fugh-Berman, 2002), sleep disorders in the elderly (Gooneratne, 2008), osteoarthritis (Ernst, 2006), asthma (Pretorius, 2009) etc, should not go unnoticed. And while all this happens, the preventive and social medicine guys from mainstream medicine need to awaken and clean up their act. To stop being sidelined, and point out how they matter. And of course, to re-emphasize that prevention is better than cure (Phakathi, 2009, where it is in relation to child sexual abuse, but applicable elsewhere too).

The third is to closely study and report on longevity and well-being studies. Well-being implies the presence of (1) positive emotions and the absence of negative ones; (2) mature character traits, including self-directedness, cooperativeness, and self-transcendence; (3) life satisfaction or quality of life; and (4) character strengths and virtues, such as hope, compassion, and courage, all of which are now measurable by scales (Cloninger, 2008). Some relatively recent literature focuses on telomeres and longevity (Haussmann and Mauck, 2008); sex differences in longevity, (Franceschi et al., 2000); Immunology and longevity (Candore et al., 2006); psychosocial factors and longevity (Darviri et al., 2009) etc. The paradigm of Reorganizational healing [ROH] is an interesting recent work in the field of wellness, behaviour change, holistic practice and healing (Epstein et al., 2009). Anyone who has not visited a hospital and is over 60 years is a precious commodity to research. Anyone who has none of the lifestyle diseases till 60 is also similarly precious. All those who are 90 and active physically and mentally, even if diseased, form another very precious group. And all centenarians are the most precious group to study. It is fascinating to see the breadth of studies on this topic. There is a burgeoning research on centenarians in the last decade, some of promise and interest are in the areas of Centenarians and healthy aging (Engberg et al., 2009); antioxidants and healthy centenarians (Mecocci et al., 2000); nonagenarians and centenarians in China, (Ye et al., 2009); centenarians in Bama (Xiao et al., 1996); quality of life and longevity, (Jeune, 2002); Danish centenarians, not necessarily healthy but still autonomous (Andersen-Ranberg et al., 2001); and not necessarily having dementia, (Andersen-Ranberg et al., 2006); centenarians and their cognitive functions, (Silver et al., 2001); dementia free centenarians (Perls, 2004a, 2004b); centenarians being different (Perls 2006); cognitive states of Centenarians, (Luczywek et al., 2007); successful aging in centenarians: myths and reality, (Motta et al., 2005); physical activity and centenarians (Antonini et al., 2008); centenarians aging gracefully (Willcox et al., 2007) etc.

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Modern Medicine: Towards Prevention, Cure, Well-being and ...