Daily Archives: June 20, 2022

Complementary and alternative medicines were promoted as health supplements, immune-boosters and COVID-19 preventive drugs through visual, print, and social media, during the pandemic. In this context, specifically in India, the homeopathic remedy, Arsenicum Album 30C prepared from arsenic trioxide was widely prescribed and publicly supplied through government agencies among adults and school-going children. Inorganic arsenic, known as the king of poisons is a highly toxic substance with the potential to cause acute as well as chronic injury to multiple organ systems, mainly skin, lung, liver, and kidneys. Acute liver injury due to arsenic-containing formulations is seldom reported. We present three cases of acute liver injury, leading to death in one patient with underlying non-alcoholic steatohepatitis (NASH) cirrhosis, after consumption of the homeopathic remedy AA30 for COVID-19 prevention.

The novel coronavirus disease 2019 (COVID-19) challenged the scientific community to discover preventive and therapeutic measures to ameliorate morbidity and mortality associated with the unanticipated pandemic. In developing countries, complementary and alternative medical (CAM) systems were promoted and pushed to the forefront via visual, print, and social media, as supposed COVID-19 preventive measures that were advertised as immune-boosters (IB). In India, a homeopathic remedy, Arsenicum Album 30C (AA30, from arsenic trioxide) was widely promoted, prescribed, and publicly supplied through government agencies from house to house as an IB and COVID-19 preventive in adults and school-going children [1]. The Indian Ayush Ministry guideline recommended dose of AA30 for COVID-19 prevention is four pills or three drops of liquid formulation in one spoon of water for three consecutive days, repeated every 21 days until end of pandemic [2]. We report a novel association of acute severe liver injury attributable to AA30 in three patients.

A 70-year-old man with compensated non-alcoholic steatohepatitis (NASH)-related cirrhosis and diabetes mellitus consumed the homeopathic IB AA30 as prescribed for 12 weeks prior to the onset of symptoms. He presented with jaundice and abdominal distension within four weeks after the onset of loss of appetite and well-being. The patient was not on any other hepatotoxic agents, over-the-counter medications, or herbal and dietary supplements. Investigations revealed the presence of conjugated hyperbilirubinemia, ascites, and abnormal coagulation, suggestive of acute-on-chronic liver failure (ACLF). Further investigations to identify known causes of acute deterioration of underlying cirrhosis were performed, including a transjugular liver biopsy. All competing causes for acute liver injury were meticulously ruled out. These included infections-tests for immunoglobulin M (IgM) for viral hepatitis A and E; hepatitis Bsurface antigen and IgM antibody to hepatitis B core antigen; nucleic acid tests via polymerase chain reaction for hepatitis C; IgM for herpes zoster and herpes simplex, cytomegalovirus, parvovirus, Epstein-Barr virus. Complete auto-antibody testing for autoimmune hepatitis (AIH) was negative. The Roussel Uclaf Causality Assessment (RUCAM) demonstrated probable (score 7) drug-induced liver injury (DILI) and simplified AIH score was less than 5, revealing the cause of acute liver injury leading to ACLF as the homeopathic remedy, AA30.The liver biopsy revealed multiacinar hepatocyte necrosis, lymphocytic, neutrophilic, and eosinophilic inflammation in the absence of interface hepatitis, which were predominantly portal-based in the background of cirrhosis, suggestive of DILI. Analysis of drugs consumed could not be performed in view of inadequate sample availability. The patient and family consented to arsenic analysis in nail and hair samples which revealed extremely high levels of the heavy metal, supportive of arsenic toxicity and associated liver injury in the patient.Evaluation of hair and hair samples of two family members (below detection limits, method detection limit being 0.1 mg/kg), staying in the same household did not reveal levels signifying cluster arsenic poisoning from water or soil sources. The patient succumbed to complications related to ACLF, nine months after the initial diagnosis.

A 68-year-old male with systemic hypertension controlled on telmisartan who ingested AA30 as prescribed for four weeks prior to the onset of symptoms. There was no associated jaundice or cholestatic symptoms, but liver tests revealed acute hepatitis with an elevation of liver enzymes. The patient was not on any other hepatotoxic agents, over-the-counter medications, or herbal and dietary supplements. Further investigations did not reveal the presence of underlying chronic liver disease or portal hypertension.All competing causes for acute liver injury were meticulously ruled out similar to the extensive workup that was done in case one. The RUCAM demonstrated probable (score 8) DILI and simplified AIH score was less than 5, revealing the cause of acute non-icteric hepatitis as the homeopathic remedy, AA30. The liver biopsy revealed perivenular hepatocyte necrosis, with predominantly portal-based mixed cellular inflammation consisting of plasma cells, eosinophils, lymphocytes, and scattered neutrophils. Additionally, ballooning of hepatocytes was marked with scattered rosettes and moderate interphase hepatitis in the presence of mild portal and sinusoidal fibrosis suggestive of DILI. Acute hepatitis resolved after drug withdrawal and finite course of steroids within three months, without any recurrence on follow-up.

A 48-year-old overweight woman consumed homeopathic AA30 pills as COVID-19 preventive for one week prior to the onset of her symptoms of cholestatic jaundice. Prior to the development of jaundice, she had nonspecific gastrointestinal symptoms such as nausea and progressive loss of appetite. Liver tests revealed conjugated hyperbilirubinemia with highly raised liver enzymes. The patient was not on any other hepatotoxic prescription drugs, over-the-counter medications, or herbal and dietary supplements. Further investigations did not reveal the presence of underlying chronic liver disease or portal hypertension.All competing causes for acute liver injury were meticulously ruled out similar to the extensive workup that was done in case one. The RUCAM demonstrated probable (score 7) DILI and simplified AIH score was less than 5, revealing the cause of acute cholestatic hepatitis as the homeopathic remedy, AA30. The liver biopsy revealed spotty, focal hepatocyte necrosis, with predominantly portal-based neutrophilic and eosinophil-rich inflammation, moderate steatosis, and mild interface hepatitis with underlying mild perisinusoidal fibrosis, suggestive of DILI. The acute cholestatic hepatitis resolved after drug withdrawal and a finite course of steroids within six months, without any recurrence on follow-up.Chemical analysis and toxicology (inductively coupled optical emission spectroscopy and triple-quadrupole gas chromatography with tandem mass spectroscopy method) on two sets of AA30 samples retrieved from case three revealed D-mannose, and melezitose, and arsenic respectively, demonstrating batch-to-batch variation due to poor manufacturing practices. The pertinent, representational liver biopsy findings are shown in Figure 1.

The at-presentation clinical, investigational parameters, pertinent treatments, and clinical outcomes of all three patients are shown in Table 1.

The liver histology findings of all three patients are shown in Table 2.

Table 3 shows chemical and toxicology analyses performed on the three patients.

Cases one and two patients were vaccinated against COVID-19 infection with a single dose while case three did not undergo vaccination at all prior to symptomatic presentation. The first patient did not complete the vaccination schedule, whilecase twocompleted the second dose of vaccine, and case three initiated scheduled vaccination on follow-up of 2-3 weeks after complete resolution of DILI.

Complementary and alternative medicines, specifically Ayurvedic and Homeopathic supplements were promoted as COVID-19 preventive drugs during the pandemic. The homeopathic remedy, AA30 prepared from mother compound arsenic trioxide was touted as an immunity booster and vaccine-equivalent by alternative medicine practitioners, was supplied via government agencies among adults and school-going children as a preventive measure. Acute liver injury due to arsenic-containing formulations is reported rarely. We presented three cases of acute hepatitis leading to death in one patient with underlying NASH cirrhosis, after consumption of the homeopathic remedy AA30 for COVID-19 prevention. We have meticulously excluded all other major competing causes for acute liver injury in our cohort of patients, including underlying AIH through systematic clinical, investigational, and histopathology evaluations. Homeopathic medicines in high dilutions, even though ineffective for any disease condition, are probably safe and unlikely to provoke severe adverse reactions. Nonetheless, systematic reviews have shown that Homeopathy has the potential to harm patients and consumers in both direct and indirect ways. The incidence of adverse effects of homeopathic drugs was not uncommon and was at times greater than placebo in some controlled clinical trials [3,4]. Arsenic toxicity from Homeopathic drugs is well described in the literature, but the acute liver injury is seldom reported [5-7]. Arsenic occurs in two oxidative forms-the trivalent arsenite and arsenate, the pentavalent form. The former is 60 times more toxic than the latter. Organic arsenic is nontoxic whereas inorganic arsenic (arsenic trioxide, the mother compound used in homeopathic AA30) is toxic. Arsenic toxicity occurs in the presence of reactive oxygen intermediates generation during redox cycling and metabolic activation processes resulting in lipid peroxidation. Arsenic trioxide binds thiol or sulfhydryl groups in tissue proteins of the liver, lungs, kidney, gastrointestinal mucosa, and keratin-rich tissues such as skin, hair, and nails [6,7]. Acute severe exposure to large amounts of arsenical compounds produces predominantly gastrointestinal symptoms which was classically absent in our patients except for case three who presented with liver and gastrointestinal symptoms within a short duration of exposure. Exposure to inorganic arsenic through drinking water is a major public health problem in both developing and developed countries. The United States Environmental Protection Agencys safe cut-off value for arsenic exposure in drinking water is 10 g/L. Drugs and health supplements are ideally not supposed to contain arsenic and hence safe limits or cut-off remain undefined. In acute exposure, the maximal deposition of arsenic occurs within the kidneys and liver and in the hair and nails after two weeks of ingestion. Arsenic toxicity leads to hepatomegaly, steatosis, hepatocyte necrosis, and portal fibrosis and arsenic exposure in steatotic livers is associated with necro-inflammatory changes and progressive liver damage, a notable finding in our group of patients with underlying fatty liver disease [8]. The liver is usually vulnerable to prolonged exposure to small amounts of arsenic. Nonetheless, liver-related injury and response to arsenic from person to person cannot be predicted due to idiosyncratic type of injury. The earliest description of arsenic-induced liver disease was reported by Bang in the 18th century in a patient who developed ascites due to prolonged use of therapeutic doses of liquid arsenic. Subsequently, an outbreak of liver disease among beer drinkers in the north of England, where arsenopyrite had been used to produce beer from starch was described by a group of investigators. Acute liver injury and jaundice after consuming therapeutic doses of arsenicals,similar to the current patient cohort, were also described in 1945 [9]. AA30 was found ineffective as a preventive of COVID-19 infection in a randomized placebo-controlled trial [10].

In our series, certain limitations require further deliberation. AA30 as a definite cause of DILI could not be ascertained due to lack of rechallenge which is also currently not recommended by experts. The empirical decision to not use steroids in the first case was due to the presence of underlying cirrhosis, suspected secondary bacterial infection, and diabetes mellitus in the elderly gentleman. A diagnosis of DILI does not require a demonstration of the potential toxic agent in the affected patient and a causality assessment, even in the presence of its limitations, is a strong and accepted method to identify drug-related liver damage along with the exclusion of competent causes. Even though other members of the family in case one consumed AA30, this was only for a very short duration, unlike the patient, who consumed it for close to 90 days.

Health regulatory authorities, physicians, general and patient population must be aware of the potential harms associated with the large-scale promotion of untested, alternative medical systems during a medical emergency so as to prevent an epidemic of avoidable DILI within the ongoing pandemic. Even though ultra-diluted homeopathic remedies, found ineffective as shown in large-scale meta-analysis, are considered safe for use due to the absence of any active compound beyond 12C dilution. Nonetheless, poor manufacturing practices, use of concentrated tincture formulations, and adulteration and contamination of homeopathic remedies can still pose considerable toxicity in predisposed persons. From a scientific and evidence-based standpoint, it is imperative that the general population and at-risk persons understand that vaccination, and not untested, misleading IBs, remainsthe best available armamentarium against COVID-19 which helps in fighting back the pandemic.

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Dangerous Placebo During the COVID-19 Pandemic: A Series of Homoeopathic Arsenicum Album-Induced Liver Injury - Cureus

Before the advent of formal medicine, people largely depended on herbal plant knowledge that has been passed through generations of families. From poultices for wounds and bruises to tinctures and concentrated oils for disease treatments, herbal medicine has been around since time immemorial. Ancient civilizations were known to have relied on the power of herbal medicines, with evidence pointing to herbal medicine being practiced by Sumerians and the Ancient Chinese. Because of the proven effect of herbal medicine, its practice has survived the test of time and is now still part of modern practices in the Philippines and around the world, with medicinal plants and herbs figuring largely in alternative medicine.

In the Philippines where herbal plant species abound, it is customary for Filipinos to use them in nursing minor sicknesses such as cough, colds, flu, infections, and other skin infections. Though there are still many Pinoys who still question the efficacy of these plants, medical research and studies have already acknowledged their value in the world of medicine. Following the establishment of the efficacy of these herbal medicines in the Philippines, the Department of Health (DOH) and Department of Science and Technology (DOST) have released their recommended list of herbal plants found in the Philippines and the health benefits they provide, further concretizing the role of alternative medicine in medical practice.

In this article, weve compiled some of the most well-known herbal and medicinal plants in the Philippines, the conditions that theyve been proven to be effective against, as well as their folk medicinal applications.

Among the medicinal uses and benefits of lagundi are to stop coughing, relieve asthma, facilitate the discharge of phlegm and lower fever due to colds or flu. It is also a pain reliever for headaches and toothache.

For cough, asthma and fever, heres how to prepare lagundi leaves. Boil lagundi leaves in two glasses of water for at least 15 minutes. This boiled mixture is called among experts as decoction. To stop coughing, take glass of decoction three times a day. In addition, drink at least eight glasses of water a day to further help loosen phlegm.

If youre suffering from asthma, take 1/3 glass of decoction three times a day. However, if your asthma does not improve after one dose of the decoction or when the attack is severe, consult your physician right away.

For fever, take glass of decoction every three hours, or as needed. To relieve headache, heat enough fresh lagundi leaves over a fire until slightly wilted. Then crush the leaves and apply the poultice to the forehead and temples. Bandage the leaves in place. Change the dressing every four hours when needed.

A known antitussive and antipyretic, ampalaya leaf juice is known to assist the human body to clear viral infections that often lead to cough and colds. To use ampalaya to alleviate cough, grind and juice ampalaya leaves every day. Drink a spoonful of concentrated ampalaya leaf juice every day. However, if youre planning on taking ampalaya as a treatment option when youre pregnant, its best that you first ask for a health experts opinion.

Also known as gatas-gatas, tawa-tawa is a powerful herbal medicine that is used in the Philippines to treat viral infections, including colds and cough, and fever symptoms. Aside from its antiviral properties, tawa-tawa is also a well-known anti-bacterial, antifungal, and anti-inflammatory. To use this herb, you can boil its leaves and drink it as a tea to help relieve respiratory symptoms associated with cough and even asthma.

Sambong is an effective antipyretic that can aid in lowering high temperatures brought on by fevers. To utilize sambong leaves, soak the leaves in cold water and wring them out. Place the leaves on clean cloths, and apply the cloths to the feverish persons armpits and forehead.

Sambong is a medicinal herb that is well-known in the Philippines for its useful traits in treating kidney stones, wounds, and cuts. It can be helpful as well in healing rheumatism, colds, coughs, and acts as an anti-diarrhea and anti-spasmodic.

Patients with kidney problems are familiar with sambong, as its popular to carry diuretic treatment for hypertension. It also regulates uric acid in the body, making it a great preventive for gout.

To use sambong to ease arthritic pain, crush or grind sambong leaves into a paste and directly apply it to your sore joints and muscles.

Relieve arthritis pain with Yerba Buenas anti-inflammatory properties. Heat fresh Yerba Buena leaves over a fire, then pound them into a rough paste. While still warm, apply the poultice to your affected joints. Tie a bandage around over the Yerba Buena leaf pastes, and change the dressing every four hours or as needed.

Scientific studies have shown the efficacy of pansit-pansitan as a conjunct treatment for arthritic pain, thanks to its anti-inflammatory and analgesic characteristics. Aside from these, this herbal plant from the Philippines is also able to keep uric acid in balance, thus lowering the chances of gout development.

To use this plant, you can either add it to salads or cook it with other vegetables, or you can drink it as pansit-pansitan tea. Brew your own pansit-pansitan tea by gathering fresh leaves and boiling them for 10 to 15 minutes. Strain the concoction and drink half a cup of this tea 3 times a day.

Also called kalabonog, maramara, semente and buyo-buyo, tsaang-gubat is a Philippine herbal plant that may be utilized to treat diarrhea or LBM (loose bowel movement). To treat LBM using tsaang-gubat, boil dried or fresh leaves in two glasses of water for 15 minutes. Let cool, then strain and divide into four parts. Drink one part every two hours (until stool becomes solid).

While Lagundi leaves are known to alleviate cough symptoms, the plants flowers may also play an important role in easing diarrhea symptoms. To use Lagundi to stop loose bowel movement, extract the juices of the Lagundi flowers and take the extracts until your diarrhea symptoms are eased.

Also known as the Rangoon Creeper, Niyog-niyogan offers numerous benefits, including working as an effective remedy for diarrhea and loose bowel movement. To use this Philippine medicinal plant, harvest its ripe fruits and roast them. Take them internally until your symptoms subside. This plant may also aid in expelling intestinal parasites and worms. Get dried niyog-niyogan seeds and take 4 to 7 seeds orally.

If youre looking for a natural and calming remedy for diarrhea, sambong tea is a good choice. Used to help bulk up stool and treat stomach cramps and spasms, sambong tea can be prepared by gathering fresh sambong leaves and steeping them in hot water for 10 minutes. Drink up to 4 glasses of sambong tea a day and wait for your symptoms to be alleviated.

Tsaang-gubat is a versatile plant that can treat numerous conditions, depending on how it is prepared. Because it boasts anti-inflammatory and antibacterial properties, this Philippine herbal plant can help promote wound healing and shorten the healing time. To use this herb, pound tsaang-gubat leaves and boil them for about 10 to 15 minutes. Use the cooled-down tea to clean and disinfect the wound periodically.

Known for their antiseptic properties, bayabas leaves have been used since time immemorial to treat wounds and cure bacterial infections. To create an astringent and antibacterial wash out of this Philippine herbal plant, boil clean leaves for 8 to 10 minutes and let cool. Wash the affected area with the bayabas tea 2 to 3 times a day until the wound is completely healed.

Aside from the conditions and disorders mentioned above that herbal medicine may effectively treat, there are also other uses that herbal plants have. These include purposes for daily hygiene as well as for nutritional supplementation. Here are a few of the other uses of some traditional Filipino herbal plants:

There are hundreds of home remedies, thousands maybe from our grasses, plants, bushes, shrubs and trees. Some time ago, we read that a Chinese scientist compiled herbal plants in China and his list ran close to 6,000 to 7,700. Our very own, the late Filipino scientist Eduardo Quisumbing, had a book on medicinal plants and trees. It has been reprinted and is now sold in bookstores.

This means that while this list includes some of the herbal plants in the Philippines deemed effective by both the Philippines Department of Health and Department of Science and Technology, the country is gifted with hundreds more of medicinal plants that people can utilize for a more natural way of treating minor ailments and health problems. Together with modern technology and medical practice, alternative medicine can not only help prolong life, but it can also improve quality of life as well as general healthcare.

Image credits: Wasana Jaigunta | Dreamstime.com, Ppy2010ha | Dreamstime.com

Originally posted here:

Herbal Plants in the Philippines for Effective Alternative Medicine - BusinessMirror

Though COVID-19 vaccines didnt end the pandemic, they have helped beat back the virus, preventing an estimated 66 million infections and 2.2 million deaths in the United States alone, according to the Commonwealth Fund.

But the vaccines dont provide equal protection for all. If youre one of the estimated 3 percent of the population who are moderately or severely immunocompromised, you are still very much at risk for severe disease, hospitalization, and worse even after two doses of the Pfizer-BioNTech or Moderna mRNA vaccines.

Fortunately, the outlook is improving, thanks to vaccine boosters and medications that the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have okayed to treat COVID-19 in high-risk groups and prevent infection in exceptionally vulnerable people.

Shireesha Dhanireddy, MD, a professor of medicine in the division of allergy and infectious diseases and an infectious-disease specialist with UW Medicine in Seattle, explains how immunocompromised people can protect themselves.

When we say someone is immunocompromised, generally what it means is the person isnt able to mount a good immune response to the [COVID-19] vaccine for whatever reason, says Dr. Dhanireddy.

That could be due to an underlying medical problem that makes the immune system weaker, or a medication that weakens or suppresses the immune system, she adds.

Theres a broad range of people who are considered immunocompromised, Dhanireddy says. Usually, these individuals would be under the care of a provider who would be managing their chronic condition.

According to the University of Pittsburgh Medical Center, you may be considered immunocompromised if you:

This is not a comprehensive list of immune-system issues that might dramatically increase your COVID-19 risk. Talk to your doctor if you are unsure about your status.

Vaccine recommendations for the immunocompromised are special because both laboratory studies and real-world data have shown these individuals are less likely to respond well to immunization, says Dhanireddy.

A meta-analysis published in December 2021 in the Journal of Infection found that although COVID-19 vaccines were effective against symptomatic COVID-19 in immunocompromised people, the protective antibodies they generated were much lower than in people with normally functioning immune systems.

While most people get two doses of the Pfizer or Moderna vaccine for their so-called primary series, immunocompromised individuals should get three, according to current public-health guidelines. Studies have noted that there was very low response in terms of antibodies after two doses for immunocompromised individuals, particularly in solid organ transplant patients, but a third primary dose led to a much more significant response, Dhanireddy says.

People who are immunocompromised are now eligible for a second COVID-19 booster, which means that some of these individuals will be getting five doses of vaccine, says Dhanireddy. People who are moderately to severely immunocompromised can get a second booster if they got their first booster at least four months before, according to the CDC.

The CDC states that the Pfizer and Moderna mRNA vaccines are preferable to the Johnson & Johnson (J&J)/Janssen vaccine in most cases. If a person does receive the J&J vaccine for whatever reason, the CDC advises that anyone age 18 and older who is moderately or severely immunocompromised get a single primary dose, followed by a second (additional) dose of an mRNA COVID-19 vaccine at least 28 days (four weeks) later.

The agency recommends a single booster dose at least two months after the second (additional) dose, for a total of three doses (one J&J vaccine dose followed by one additional mRNA vaccine dose, then one booster dose).

Some individuals who may have been on heavy immunosuppressants around a transplant period, or those who were vaccinated pre-transplant and then had to take immunosuppressive medications that wiped out their immune system, may actually have to restart their vaccinations and get another primary series, says Dhanireddy.

It can get a little complicated for these individuals regarding timing of these medications and whether to restart that series or not; thats something they should discuss with their doctor, she says.

Evusheld (tixagevimab and cilgavimab) is a monoclonal antibody treatment administered by injection that is designed to prevent COVID-19 in vulnerable and immunocompromised people who may not have an adequate immune response to COVID-19 vaccination.

The FDA granted the drug emergency use authorization (EUA) in December of 2021 for pre-exposure prophylaxis meaning its not intended for people who already have COVID-19.

Evusheld is authorized for individuals who are immunosuppressed and for those who cant tolerate COVID-19 immunization because of severe allergies to components in the vaccine, says Dhanireddy.

Evusheld can provide an extra boost to immunocompromised people who didnt get a robust immune response from vaccination. These lab-created antibodies are given by injection to be ready to fight against the virus in case of infection, says Dhanireddy.

Protection is estimated to last between three and six months, but data is still forthcoming, Dhanireddy adds.

Experts are recommending a two-pronged approach both vaccination and Evusheld to provide maximum protection for immunocompromised people, notes an article published April 27 in JAMA.

According to a spokesperson from the U.S. Department of Health and Human Services (HHS) whose remarks were reported in the JAMA commentary, the federal governments supply of Evusheld currently exceeds demand from states and territories.

If you are eligible to receive Evusheld, contact your healthcare provider or your local health department. The federal government will pay for the drug, but you may be charged for the products administration, depending on the health system and your insurance coverage.

Immunocompromised people should be aware that two different drugs can be taken in pill form after COVID-19 symptoms emerge, in order to prevent severe disease and hospitalization: molnupiravir (sold under the brand name Lagerviro) and Paxlovid.

There are also treatments that can be administered by injection or IV: the antiviral drug remdesivir and the monoclonal antibody therapy bebtelovimab.

PaxlovidThis antiviral medication combines two generic drugs, nirmatrelvir and ritonavir. The FDA granted it emergency use authorization (EUA) in December 2021, and the National Institutes of Health (NIH) has prioritized it over all other available treatments for people with a current COVID-19 infection.

The drug was 89 percent effective against hospitalization and death in the clinical trial that led to its approval and that study included both vaccinated and unvaccinated individuals. Its a five-day course of medication that has to be given within five days of when symptoms develop, says Dhanireddy.

Paxlovid can interact with other medications, including blood thinners and cholesterol medicines, so it may not be a good choice for everyone. This drug can be especially problematic for solid organ transplant patients Paxlovid is not a great option for them, says Dhanireddy.

MolnupiravirThis oral antiviral is 30 percent effective at preventing hospitalization and death in people with COVID-19. The drug is still effective, but the efficacy is lower than some of the other available treatments, says Dhanireddy.

The CDC did not authorize the medication for people who are pregnant, and anyone of childbearing age needs to use it with caution, Dhanireddy says. It is also not known if the drug may impact sperm.

Doctors should prescribe molnupiravir only when Paxlovid and the medication remdesivir are not available, feasible to use, or clinically appropriate, per theNIH.

As with Paxlovid, treatment with molnupiravir must begin within five days of symptom onset.

RemdesivirSold under the brand name Veklury, remdesivir is the first (and so far only) COVID-19 therapy to have full FDA approval for treatment of critically ill COVID-19 patients who are hospitalized.

Earlier this year, the drug was also granted authorization to be used for a shorter course of therapy three days for patients with mild to moderate COVID-19 who are recovering at home.

Remdesivir provides an 87 percent reduction in risk of hospitalization in nonhospitalized people who received the three-day dose, according to a study published in January 2022 in the New England Journal of Medicine.

Logistics for this are a little bit difficult because its three days in a row of IV medication that has to be delivered in a healthcare setting, Dhanireddy says.

Patients must begin treatment within seven days of the onset of symptoms.

BebtelovimabIn February 2022 the FDA authorized this monoclonal antibody treatment for people with a current COVID-19 infection.

Not all monoclonal antibodies have been effective against all variants, but data indicates that bebtelovimab is effective against omicron and its BA.2 subvariant, says Dhanireddy.

To be eligible for bebtelovimab, people must be at high risk for severe COVID-19.

Bebtelovimab is considered an alternative treatment and should be used only when Paxlovid and remdesivir are not available, feasible to use, or clinically appropriate, according to theNIH.

The medication must be administered by injection within seven days of symptom onset.

A well-fitting N95 or KN95 mask provides a good defense against COVID-19 infection, says Dhanireddy. Although two-way masking is best, there is evidence that a high quality mask offers substantial protection even if others arent wearing face coverings, according to a modeling study published in December 2021 in the journal PNAS.

When youre immunocompromised, you want to try to reduce your risk as much as possible, says Dhanireddy. She calls using multiple approaches such as vaccines, boosters, medications, and masking creating a cocoon of protection around yourself.

The cocoon should also include those in your household or close circle, who should all be mitigating their risk to keep you safe by protecting themselves with masking and other measures, Dhanireddy says.

The CDC has created a COVID-19 tool kit designed to help people understand the risk COVID-19 poses in their community, and it includes information on where to find free masks and Test-to-Treat programs where you can get tested and obtain treatment if you are diagnosed with COVID-19.

Visit link:

Immunocompromised in the COVID-19 Era: Vaccines, Prevention, Treatment - Everyday Health

Its been making a big splash in the oncology world and outside itthe news that a drug in the monoclonal antibody class has been effective in producing a durable remission lasting up to 25 months (to date) in just over a dozen rectal cancer patients. My inbox has been flooded with people sending me links to the many media reports on this stunning development. A cure for cancer! A cure!

While I am thrilled at the news, nowadays I know enough about cancer to view it with a few grains of caution, which I have shared with my friends.

The data need to be examined by third parties and the study must be replicated. It is not unheard of for research teams to make significant errors with their data or downright lie. So scientific due process needs to happen to be sure that this is really real.

"Cancer is not just one disease. It is a category of diseases that share similar features in general but that also vary quite widely in specific mutations, cellular errors, metabolic defects, etc. Thats why what works like a charm for one patient with X diagnosis may hardly work at all (or not work) for the next patient with the exact same diagnosis.

For instance, breast cancer isnt just one thing. It has types that are quite distinct and can make a big difference in how certain treatments work or dont work. And more to the point, breast cancer isnt the same as colon cancer. Theyre both cancers and both share certain qualities that make them cancer. But the exact nature of some of those defects is not totally identical between the two.

What worked like gangbusters for rectal cancer may not work for all cancers.

However, the fact that this drug produced such wonderful results for this one very small segment of the cancer world serves as a kind of proof of concept. A similar method might be able to be developed for other types of cancers, to the improvement of all.

For example, chemotherapy was first tried in just a very, very few types of cancers that, back in the day, had no real treatments that had any effect. It wasnt a cure-all, but in a setting where there were virtually no remissions, much less cures, it was a huge step forward (and did, in fact, cure a small handful of lucky patients back then), and gradually different kinds of chemotherapies were developed that worked better (or worse) on different kinds of cancers. We take chemo for granted, today. But it wasnt always this way.

So the monoclonal antibody technology that these researchers have used to create this treatment may be applied to other cancers, similar to chemo cracking open and letting us have a peek inside. We just need to learn how to make the crack wide enough for more cancer patients with more types of cancers to walk through.

A complete clinical response is not necessarily a cure, meaning that the cancer wont ever come back because its gone forever. But theyve followed patients for up to 25 months (at the time the study results were reported) and there were no signs of recurrence yet. Thats a very good thing, and definitely a reason to hope.

I find it interesting to note that this is happening within an industry that is routinely vilified by alternative-medicine-only types for not really wanting to cure cancer. If we adopt the a-miracle-occurred"stance toward this research, I guess wed have to say that the cancer industry is making two mistakes at the same time: first in having found something that may possibly do exactly what the cancer industry never really wanted in the first place (to which I think, then why fund the research at all?) and second in publicizing the positive findings instead of keeping them tightly under wraps in a sealed vault deep in the heart of some government fortress in the guts of a hollowed-out mountain somewhere.

Ah, but take heart. (Tongue now firmly in cheek.) Replication studies may not work, or (drum roll for the conspiratorial mindset, here) may be able to be manipulated to appear as if they arent working, so that this incredible breakthrough can be suppressed. After all, theres never so much fun as when youve gotten the hopes of the gullible masses all pumped up, and then you can dash them again, right? What a thrill!

OK. Im done with snarky.

I do agree with my friends. This is very good news and very hopeful news. Ive been watching with some surprise over the last dozen years since I completed my own treatment for inflammatory breast cancer. The newer systemic treatments that are being developed are game changers, as are the improved ways to detect recurrence earlier and the effort to find ways to make that discovery meaningful in extending the lives of terminal patients who we lose todaypossibly, one day, to extend them even to the point of cure.

Cancer treatment seems to be entering a new era. Im glad that Im still here to see it.

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As We Enter a New Era of Cancer Treatment, I'm Taking Caution in Headlines Highlighting a Cure - Curetoday.com

SINGAPORE Iris Koh, the founder of controversial anti-vaccine group Healing the Divide, sought permission from a district court on Friday (June 17) to travel to Malaysia in order to seek "alternative" medical treatment for her thyroid cancer.

However, a judge asked for more details of her treatmentafter noting that her condition does not appear to be life-threatening at the moment, based on her current documentation.

Koh made the request to leave Singapore while she is on bail for an ongoing court case.

The 46-year-old faces a criminal charge of conspiring with a doctor to defraud the Ministry of Health (MOH) over fake Covid-19 vaccination records, and another charge of obstructing a police officer by refusing to sign and tearing up a charge sheet.

When she was first hauled to court in January, she was denied bail twice and warded in Singapore General Hospital (SGH) for hyperthyroidism, a pre-existing condition for her.

She was also diagnosed with Graves' disease,an autoimmune disease that affects thethyroidgland. It is a common cause of hyperthyroidism.

She has remained out on a S$20,000 bail since Feb 4.Her husband Raymond Ng, who serves as her bailor, was also present in court.

On Friday, her new defence counsel Wee Pan Lee told the court that SGH doctors found cancer in a thyroid nodule, which is an unusual growth of cells in the thyroid gland.

She was then advised to undergo surgery to remove her thyroid glands. However, she wants a second opinion from foreign doctors to "find a way to save" them, Mr Wee said.

She has therefore made appointments at Mahkota Medical Centre in the city of Malacca, as well as at Aenon Health Care inthe western Malaysian state of Negeri Sembilan, Mr Wee added.

Koh sought to travel there by car and will be in Malaysia for a month from Sunday to July 22. The programme at Mahkota runs until June 29 and a doctor there will recommend a course of therapy treatment at Aenon, Mr Wee told the court.

In response, Deputy Public Prosecutor (DPP) Jiang Ke-Yue asked for clarifications to firm up the prosecution's position on Koh's application.

The prosecutor said that the defence has provided supporting documents that "raise more questions than answers", which "lends itself to the inference that there could be a potential flight risk".

He told the court that he has asked Mr Wee for details on the nature of Kohs treatment, whether she has explored alternative treatment options in Singapore, and the need to go to two places in Malaysia for a month.

DPP Jiang said that the prosecution does not wish to stand in Koh's way to seek alternative treatment of her choosing. However, he argued that the documents do not show any link between the two medical institutions in Malaysia.

Mr Wee also filed a document this morning from a third Malaysian institution Spectrum Of Life Integrated Wellness Centre in Kuala Lumpur. DPP Jiang said that the lawyer has similarly not explained how it is linked to the other institutions.

When the prosecutor questioned why the application and documents were filed at the eleventh hour, Mr Wee said that Koh had been "devastated" by her diagnosis.

"Upon recommendation that there is an alternative, she seized the chance but was unable to go. This doctor was prepared to see her... That's why we made the application as soon as possible," the lawyer added.

District Judge Ng Peng Hong said that based on the documents he was given, Koh's condition "doesn't appear to be life-threatening at this point".

He then agreed with the prosecution that more detailsof her treatmentshould be given. The case will be heard again on June 22.

Koh is said to have worked with general practitioner Jipson Quahto defraud MOH between July last year and January this year, by agreeing to dishonestly make false representations to MOH that people were vaccinated with the Sinopharm vaccine when they were not.

Quah and his clinic assistant, Thomas Chua Cheng Soon, have also been charged with fraud by false representation. Both men remain out on bail.

The police previously said that Koh had allegedly referred clients, believed to be members of Healing the Divide, to Quah and had also suggested administering something else in lieu of the vaccine to patients.

Quah has been suspended from practising medicine for 18 months, after the Singapore Medical Council found that he allegedly administered saline solution to some 15 people in place of a Covid-19 vaccine.

He then uploaded false vaccination statuses into the National Immunisation Registry system of MOH. He also purportedly charged up to S$1,500 for these fake jabs.

Quah is said to have conspired with Chua and a woman named Mehrajunnisha to lie to MOH that she received the Sinopharm vaccine when she did not. It is unclear if Mehrajunnisha was a member of Healing the Divide.

A 43-year-old Australian, David Christopher Newton, was charged last week with conspiring with Quah and Chua to receive a vaccination certificate when he had not received the Sinopharm vaccine.

Quah does not face any charges of conspiring with Koh at the moment. However, prosecutors had said that investigations were ongoing and that they were unsure if more alleged offences would be uncovered.

If convicted of conspiring to dishonestly make false representations to MOH, Koh could be jailed up to 20 years or fined, or punished with both.

Those convicted of obstructing a public servant in discharge of their public functions can be jailed up to three months or fined up to S$2,500, or both.

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Healing the Divide founder Iris Koh seeks permission to travel abroad for alternative cancer treatment while on bail - TODAY

Mary Nnah

Chief Executive Officer of Santis by Paelon, Dr. Patrick Chukwumah, has said Concierge Healthcare is becoming an increasingly popular alternative to traditional healthcare among both patients and their physicians.

Santis by Paelon is a luxury membership-based medical concierge service that seamlessly prioritises the health needs of clients, to ensure their quick, comfortable, and discreet attendance inside and indeed outside Nigeria.

Speaking recently with THISDAY, its CEO expressed that medical services are rapidly evolving both locally and internationally especially with Covid-related demands on the medical community while new models on how to properly deliver 21st-century medicine to patients who seek treatment outside of their hometowns or home countries are extensively being explored.

Chukwumah who claimed that the emergence of concierge medicine is no surprise, added, many people feel alienated by the current system, bouncing between doctors and struggling to make appointments.

Even once they make it to the clinic; they feel overlooked in favour of ushering in the next patient on the list. Now, recent events have further increased the demand for at-home services.

He revealed therefore that patients and providers were increasingly turning to concierge medicine a direct relationship between a patient and a provider- as an alternative care delivery model.

Describing this recent development as a game-changer for patients and providers, the medical practitioner held that the concept seems simple, adding, that patients spend more time with their physician in exchange for an annual fee or retainer.

According to recent studies, personalised care and close relationships with physicians are what patients are looking for.

Those in favour of a concierge model said the potential benefits for both patients and physicians are many, which can range from benefits such as 24/7 patient care, convenient contact through telemedicine, access to physicians by phone or email, preventative care and wellness plans, same-day or next-day appointments to physicians and referred specialists.

Chukwumah revealed further that the trend is already on the rise in Africa, with the emergence of companies like Santis Medical Concierge, which boasts of a high-level structure and network, offering patients personalised medicine, patient-centered medicine, and preventive care.

Some medical schools and hospital networks are also currently embracing concierge medicine for their patients.

Santis Medical Concierge offers a range of services that focuses on preventative care while also addressing episodic care and disease management. Being proactive can potentially save the patient future health care costs.

The Santis Medical Concierge boss said that since most chronic diseases are curable if caught early or in some cases preventable altogether, preventative measures can save the patient not just money, but the heartache of chronic disease, adding, even if a patient doesnt have any major health concerns, research shows that those who stay abreast of their health live longer.

Typically, concierge medicine provides a level of access to a physician that is unachievable in a traditional doctor-patient arrangement. It allows your physician to significantly limit the number of patients they accept into their practice, to those with relevant diseases in line with their specialisation.

The Concierge medicine programme filters patients complaints and refers them appropriately to the relevant specialist physician.

According to Chukwumah, the goal of the concierge physician is to develop a relationship with the patient so that they can offer a level of service that is missing in the traditional model.

These physicians are often focused on solving the patients problem by determining the root cause. At its core, the concierge model is designed to help people live longer and healthier lives.

For Chukwumah, Concierge Medicine is no doubt solving a big problem in the medical field today in the sense that access to quality health care has been increasingly hard to find. The pandemic has only amplified this deficit. Since the availability of a primary care physician has a direct correlation to the overall lifespan of a patient, this is a problem that must be addressed.

He believes that the system, which for far too long has hindered the patient/doctor relationship, is not going to be fixed any time soon if at all, adding that concierge medicine offers patients a workaround to the system and puts them back in the drivers seat.

Patients in a concierge practice appreciate the immediate access to their physician by cell phone, e-mail, and same-day appointments, and minimal waiting time in private, pleasant waiting rooms. Visits are 30 minutes or longer and allow patients to present all their concerns. The physician coordinates care with other providers, with follow-up calls after specialist visits or hospitalisations, Chukwumah pointed out.

Speaking further, he said that the concierge medicine model is more about the patient experience and thus companies like Santis have curated a range of service offers to best suit the different needs of their patients. With offerings such as the Everest packages which provide patients with access to preventive care procedures for Cardiac Health, Pancreas Health, Liver Health, Gastro-Intestinal Health, Respiratory Health, Renal Health, Prostate Health, and much more.

The package also offers travel Medicine consult (International Travel), Home Visit (Primary Health Care), Local evacuation (within Lagos), Corporate Health Talks (Where necessary), Physiotherapy sessions, and also some lifestyle services, such as access to discounted Dietician/Nutritionist Consult, Access to discounted GYM membership, Access to discounted TRU Check Cancer Screening. These offerings are scaled in the Everest plus package to include access to Solice Health- a bespoke medical concierge in the UK, USA, and Europe.

Chukwumah expressed that generally; concierge provides access and personalisation that restores the bond necessary for an individual, proactive approach, adding Given the obvious advantages of concierge medicine to physicians and their patients, concierge medicine will continue to grow. If you havent yet explored the concierge model of medicine, now is a good time to do so as establishments such as Santis By Paelon present an array of concierge care options.

Concierge medicine is the solution for a growing number of specialist physicians to be able to practice the highest quality medical care. This trend is only likely to intensify going forwards, he noted further.

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Concierge Medicine, Alternative Experience to Health Care Management, Says, Expert - THISDAY Newspapers

A group of leading doctors has launched the Beyond Pills campaign, calling on the government to tackle overprescribing in the UK health system by advocating represcribing and social prescribing.

Launched by the College of Medicine, the campaign echoes the recommendations made in the National Overprescribing Review published in September 2021 by the UK government.

Led by a group of healthcare leaders and senior politicians including Dr Michael Dixon (chair of the College of Medicine), Lord Crisp (chair of All-Party Parliamentary Group on Global Health) and Stephen Dorrell (former secretary of state for Health & Social Care) the campaign aims to reduce drug prescription, expand the number of social prescribing link workers, save crucial funds, and provide support to individuals and local communities hampered by health inequalities.

Social prescribing is a way for local agencies to refer people to a link worker, who encourages patients to participate actively in their own health or, in some cases, take a holistic approach to their health and well-being. Link workers work with patients to co-design a social, non-medical, community-based intervention in order to address specific issues and long-term health conditions.

Commenting on the launch of the campaign, Dr Michael Dixon, chair of the College of Medicine, said: Medicine, as we know it, is no longer affordable or sustainable. Nor is it able to curb the increase in obesity, mental health problems and most long-term diseases... An adjustment to the system now will provide a long-term, sustainable solution for the NHS to meet the ever-increasing demand for funding and healthcare professionals.

As part of the Review, former chief pharmaceutical officer for England, Dr Keith Ridge, found that 10% of prescription items dispensed through primary care are either inappropriate for patients needs or that they could be better served with alternative treatments.

The Review also found that 15% of the population take more than five separate medicines daily, and 1 in 5 hospital admissions for those over 65 is due to an adverse drug reaction.

Dr Bogdan Chiva Giurca, College of Medicine Council member and founder of NHS Social Prescribing Champion Scheme, said: As a young doctor, social prescribing link workers provide hope to me and my colleagues who are unable to support the ever-growing psychological, social, emotional and practical needs of our dear patients.

"A truly biopsychosocial approach is needed more than ever and our aim is that by 2030, young healthcare students and newly qualified healthcare professionals will have access to education and guidelines not only regarding deprescribing, but also providing knowledge of new tools that they can readily use, such as social prescribing.

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College of Medicine launches Beyond Pills campaign to tackle overprescribing in UK health system - PMLiVE

Ommm. Come June 21 and the collective cosmic hum will resonate through the nation once again. Like it did last year, when 200 million Indians twisted, turned and upended themselves into incredible postures, setting two Guinness World Records on the first International Day of Yoga. Leading 37,000 enthusiasts under the arching shadow of India Gate on Rajpath in Delhi was Prime Minister Narendra Modi, dressed in pristine white with a tricolour scarf. "Yoga is not for contorting your body. Then, circus people would be called yogis," his words floated in the warm June air. "Yoga is a part of everyday life."

Is it? Yoga has been with India for at least 5,000 years: Mohenjodaro stone seals depict figures in yoga poses, Krishna uses the word yoga over a hundred times in the Bhagvad Gita, Buddha asks his monks to control hunger, thirst and desire by pressing the tongue against the palate, the Svetasvatara Upanishad talks about the death-defying 'fire of yoga', Patanjali weaves together meditation, practical asanas and spirituality in his Yoga Sutra, while medieval traditions of yogi Gorakhnath focus on bodily disciplines of hatha yoga. But in the 21st century, India seems unsure about the scope of its enormous ancient legacy. Yoga has become a cherished icon of Indian civilisation and cultural glory, but what is its purpose in modern life: sublime transcendence, magical power or plain good health? Statistics tell the story: just about 14.3 million Indians do yoga, a puny 10 per cent of the population, records a 2015 Assocham report.

What has changed in the 123 years since Swami Vivekananda introduced yoga at the Parliament of Religions in Chicago in 1893 is the dramatic popularity of yoga in the West. The newly released 2016 'Yoga in America' study by the Yoga Journal and Yoga Alliance shows that the number of yoga practitioners in the US has zoomed by almost 50 per cent from 20.4 million in 2012 to over 36 million. The annual spend on yoga classes, clothing, equipment and accessories has gone up from $10 billion to $16 billion in the past four years.

Beyond yoga's global popularity is a new landscape of health. Wellness revolution is the new metaphor for life in balance. Scratch beneath the surface and you have an unsettling world of long work-hours, strict deadlines, sleep debt, a precipitous drop in physical activity, an unholy reliance on fat-laden convenience foods, vicious stress loop at home and work-all spiralling down into an abyss of chronic lifestyle disorders. No wonder global corporate biggies are getting into wellness reward systems: if IBM does so for healthy eating, exercise and curbing smoking, PepsiCo does the same for losing flab. In the midst of this gloomy picture, yoga has emerged as the new prescription: stretches, twists and bends moored to a philosophy of life that can prevent disease and promote well-being.

The changing form and significance of yoga echo the fascinating story of modern science. As Princeton University medical anthropology scholar Joseph S. Alter argues in his 2004 book Yoga in Modern India, "Yoga's transformation into a popular activity idolised for its health value is based on modern ideas about science and medicine." The current interpretations of yoga and practitioners of yogic medicine and fitness, he points out, combine the ideas of biology, physiology and anatomy with those of metaphysics. As Dr Andrew Weil, physician, bestselling author and a messiah of wellness in America told India Today, "I've become known as one of the few physicians who teaches doctors to use breathing as a primary therapy. But I learnt none of this in medical school. I learnt about this from several sources, the first being yoga, where one division, pranayam, is about breathing."

Ask Dr Dean Ornish, pioneer of the wellness revolution whose journey began when as a medical student in the '70s, he trained with yogi Swami Satchidananda. Ornish was the first to prove through evidence-based study that a plant-based diet, combined with mind-body stimulations like yoga, can stop or even reverse the progression of heart disease, Type 2 diabetes and even early stages of some cancers. "From the data of thousands of patients, we have found it improves blood flow, reduces inflammation, turns on about 500 genes that protect against diseases in just three months and lengthens the life-enhancing telomerase in chromosomes," he told INDIA TODAY.

Modern western medicine tends to reject alternative ways of healing as 'pseudo-science', with 'no valid scientific evidence'. Yet, with diabetes, heart disease and cancer rates rising across the world, researchers are turning to other systems of medicine. And an explosion of scientific studies points towards yoga as a possible way to quality life in the future. From back pain to asthma, heart attacks to blood pressure, depression to anti-ageing, sexual dysfunction to hypertension-yoga seems to hold a key that may open up a new scientific paradigm. But without a lot more evidence, randomised controlled clinical trials, it will remain, at best, an exercise in navel-gazing.

Here is our selection of ideas, practices and new rules of yoga to help you navigate your way through an ancient bequest that we need to take seriously.

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Doc, I have switched to yoga to shed weight and boost my blood sugar profile. And, yes, I've stopped that 45-minute aerobic activity I was doing every day. It's ok, no?" Sorry, that's a mistake. It's relinquishing a scientifically proven physical activity regime and replacing it with a yet unproven entity-though the latter has an 'Indian' tag to it and hence is emotionally close and culturally appropriate for all of us.

The problem with our ancient practices and therapies-be it yoga or ayurvedic medicines-is that we take what is written in our ancient treatises as gospel truth. Once, while conversing with an Ayurveda specialist, I was shocked to hear his view that modern and 'gold standard' methods of clinical trials should not be applied to ayurvedic drugs/ancient yogic practices, since they are already "proven" beyond doubt-in our ancient treatises.

According to Panini, yoga meant "yujsamadhau" or to concentrate-spiritually, physically, or for attaining a particular goal. It ultimately translates to a 'disciplined and purer' way of life-by way of balanced diet, meditation and stretching and static exercises. Isn't that what is required to prevent and manage obesity and diabetes? Maybe we could add aerobic exercise to it, which many 'modern' yoga techniques, say, 'power yoga', incorporate. Current practices (popular in the 21st century) of physical activity in yoga, which might have influence on body weight, are derived from Hatha ('force') yoga, believed to be founded by Lord Shiva himself.

The increasing popularity of yoga worldwide has raised scientific curiosity. Despite that, scientific studies on the links between yoga and obesity remain dismal. Putting key words like "yoga and obesity" in the Pubmed search engine (National Library of Medicine, USA) yields only 14 references. A meta-analysis of 25 trials carried out on patients with diabetes showed some benefits on body weight and waist circumference with yoga, comparable to moderate intensity physical activity regime in a few trials, while other trials did not show any benefit. One suitable place for yoga could be with elderly individuals who have a handicap that prevents them from doing aerobic physical activity. Careful asanas could maintain or improve stability of lower limbs and improve dwindling muscle tone.

By Dr Anoop Misra, executive chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, New Delhi

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The practice of yoga has been known in the Indian subcontinent for several millennia now. The declaration of International Yoga Day on June 21, after an impassioned call for it at the United Nations General Assembly by Prime Minister Narendra Modi, has given it second wind in many ways.

The role of yoga in promoting well-being and disease prevention has long been considered intuitively obvious. This is especially true since modern-age 'lifestyle' diseases are an epidemic the world over. In a developing country like ours, we face the wrath of these diseases at a much younger age due to our susceptibility to cardiovascular diseases.

However, for the modern scientific medical world to accept yoga as a preventive and therapeutic tool for cardiovascular diseases requires robust physiological mechanistic studies and clinical trials to prove its benefits. An amalgam of 10 studies suggested yoga led to better exercise capacity and quality of life in patients with chronic disease. Another review of asana-based yoga, published in the European Journal of Preventive Cardiology, found yoga better than no exercise at all and similar in benefit to traditional exercises like cycling and brisk walking.

Asanas led to significant reductions in BMI, blood pressure, LDL (bad) cholesterol and improvement in HDL (good) cholesterol. The benefits were hypothesised to be due to improved neuro-endocrine, metabolic and cardio-vagal functioning. The advantage of yoga over other forms of exercise is its greater acceptability and accessibility. Yogic asanas need no expensive equipment and can be done by even those with limited mobility or with no outdoor activity.

However, credible studies are limited, as is evident from the fact that the cited review was based on 37 small studies of just 2,768 subjects. The scientific community would demand larger multi-centric, randomised clinical trials. The ongoing Yoga-CaRe trial, through Indo-UK collaboration, is looking at both the physiological effects and the clinical outcomes of yoga as a cardiac rehabilitation tool.

As we move on, we need many such clinical trials in several diseases, where yoga intuitively seems to be of potential benefit, such as in high BP, heart failure or heart rhythm abnormalities for us to be on firmer ground in promoting it to the scientific world. This research obviously would best come from India and government agencies need to proactively promote and fund such research. This would also enable India to take a lead through 'Made in India' research and increase India's soft power on the world stage!

By Dr Ambuj Roy, additional professor of cardiology at the All India Institute of Medical Sciences, New Delhi

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India is on track to become the world's most populous nation in less than a decade, according to the UN. Yet, the elephant in the bedroom is that infertility cuts across all sections of our society. The issues might be different in different geographical areas, but for about 10-12 per cent Indians, childlessness and infertility are no longer private sorrows, they are a blatant and obvious anomaly and rising dramatically in the cities.

A variety of healing approaches and therapies from around the world-that have historically not been included in conventional western medicine-are being used in infertility treatment now, largely under the rubric of complementary and alternative medical therapies (CAM). They may not provide an answer to everything, but they can play a role in enhancing the success of infertility treatments. And yoga is one such.

Many women undergoing infertility treatment feel a sense of control while doing yoga. It is believed to control negative thought, which might arise out of hormonal imbalance. Yoga practitioners feel that certain asanas help with infertility by opening up the pelvis and hip joints, increasing blood flow to the pelvis, and rebalancing hormones.

Urban India suffers from what I call voluntary infertility. Both partners work these days, come back exhausted, perhaps eat takeaway food and sleep right after dinner. Educated women also defer marriage or childbearing till they can afford a maid, a car, a driver and a three-bedroom apartment. By which time the biological clock slows down.

The Shirshasana or head stand, Sarvangasana or shoulder stand, Chakrasana or the wheel pose and Titliasana or the butterfly pose-are the recommended asanas for fertility enhancement. The Kapalbhati and Anulom-Vilom breathing techniques improve the immune system.

I practise yoga myself and have recommended it to several patients. We looked at eight women who performed immunity strengthening asanas, such as Shirshasana, Sarvangasana, Bhujangasana and Dhanurasana for 8-9 months and took no other immunity modifying medication. We observed a small decrease in the antibody levels of three women. But it's too small a sample, large multi-centric trials are needed to authenticate yoga's benefits on fertility management.

By Dr Firuza R. Parikh is director, Department of Assisted Reproduction, Jaslok Hospital, Mumbai

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MENTAL AGILITY: Boosts brain function.

CARDIAC FITNESS: Significantly lowers risk of heart disease.

BLOOD FLOW: Improves circulation, blood sugar, blood pressure.

FLEXIBILITY: Strengthens bones, muscles, improves flexibility, balance, spine elasticity, and prevents back pain.

WEIGHT: Helps reduce and maintain healthy weight.

HAPPINESS: Helps battle depression by raising serotonin hormone levels that regulates sleep, appetite and mood.

BREATHING: Brings down respiratory rate, lungs work better, keeps asthma, bronchitis at bay.

ANTI-AGEING: Head, hand and shoulder stands help retain youthfulness.

STRESS RELIEF: Alters gene expression, protects against stress, hypertension and stress-related cancers.

SEXUALITY: Improves sexual function.

FITNESS: Reduces side-effects of menopause.

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Five cure-all asanas that help combat a whole gamut of ailments

1. Balasana (CHILD POSE)Eases headaches and lower back pain.

2. Uttamasana (STANDING FORWARD BEND)Helps relieve stress, depression, indigestion and sleeplessness.

3. Bhujangasana (COBRA POSE)Useful for lower back pain, weight loss, boosting sex life

4. Trikonasana (TRIANGLE POSE)Helps burn fat, battles back pain, stress, boosts sex life

5. Virbhadrasana (WARRIOR POSE)Builds stamina, balance, relieves backache, sciatica and indigestion

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Good for brain gain: Yoga and meditation are more effective than crosswords and memory games for combating the mental decline that often precedes Alzheimers, reports the April 2016 issue of Journal of Alzheimers Disease.

Not just a stretch: The latest Harvard Heart Letter reports a study in which people who did yoga regularly lost about five pounds in weight, five points off blood pressure and harmful LDL cholesterol by 12 points.

Fight MS fatigue: Swiss scientists from the University of Basel report that yoga has a positive impact on those suffering from the auto-immune disorder multiple sclerosis (MS): less fatigue, depression, pins and needles, itchiness and numbness.

For cancer patients: Yoga works the best at improving quality of life for breast cancer patients suffering from sleep disorders arising out of drug side-effects or anxiety, report researchers from the University of Rochester in New York.

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From the archives (2016): Its time for a little bit of Yoga in our lives - India Today

A few weeks ago my house had a septic-tank emergency, which is as awful as it sounds. As unspeakable things began to burble up from my shower drain, I did what any smartphone-dependent person would: I frantically Googled something along the lines of poop coming from shower drain bad what to do. I was met with a slew of cookie-cutter websites, most of which appeared hastily generated and were choked with enough repetitive buzzwords as to be barely readable. Virtually everything I found was unhelpful, so we did the old-fashioned thing and called a professional. The emergency came and went, but I kept thinking about those middling search resultshow they typified a zombified internet wasteland.

Like many, I use Google to answer most of the mundane questions that pop up in my day-to-day life. And yet that first page of search results feels like its been surfacing fewer satisfying answers lately. Im not alone; the frustration has become a persistent meme: that Google Search, what many consider an indispensable tool of modern life, is dead or dying. For the past few years, across various forums and social-media platforms, people have been claiming in viral posts that Googles flagship product is broken. Search google dying on Twitter or Reddit and you can see people grousing about it going back to the mid 2010s. Lately, though, the criticisms have grown louder.

In February, an engineer named Dmitri Brereton wrote a blog post about Googles search-engine decay, rounding up leading theories for why the products results have gone to shit. The post quickly shot to the top of tech forums such as Hacker News and was widely shared on Twitter and even prompted a PR response from Googles Search liaison, Danny Sullivan, refuting one of Breretons claims. You said in the post that quotes dont give exact matches. They really do. Honest, Sullivan wrote in a series of tweets.

Read: Be careful what you Google

Breretons most intriguing argument for the demise of Google Search was that savvy users of the platform no longer type instinctive keywords into the search bar and hit Enter. The best Googlersthe ones looking for actionable or niche information, product reviews, and interesting discussionsknow a cheat code to bypass the sea of corporate search results clogging the top third of the screen. Most of the web has become too inauthentic to trust, Brereton argued, therefore we resort to using Google, and appending the word reddit to the end of our queries. Brereton cited Google Trends data that show that people are searching the word reddit on Google more than ever before.

Instead of scrolling through long posts littered with pop-up ads and paragraphs of barely coherent SEO chum to get to a review or a recipe, clever searchers got lively threads with testimonials from real people debating and interacting with one another. Most who use the Reddit hack are doing so for practical reasons, but its also a small act of protesta way to stick it to the Search Engine Optimization and Online Ad Industrial Complex and to attempt to access a part of the internet that feels freer and more human.

Google has built wildly successful mobile operating systems, mapped the world, changed how we email and store photos, and tried, with varying success, to build cars that drive themselves. This story, for example, was researched, in part, through countless Google Search queries and some Google Chrome browsing, written in a Google Doc, and filed to my editor via Gmail. Along the way, the company has collected an unfathomable amount of data on billions of people (frequently unbeknownst to them)but Googles parent company, Alphabet, is still primarily an advertising business. In 2020, the company made $147 billion in revenue off ads alone, which is roughly 80 percent of its total revenue. Most of the tech companys productsMaps, Gmailare Trojan horses for a gargantuan personalized-advertising business, and Search is the one that started it all. It is the modern template for what the technology critic Shoshana Zuboff termed surveillance capitalism.

The internet has grown exponentially and Google has expanded with it, helping usher in some of the webs greediest, most extractive tendencies. But scale is not always a blessing for technology products. Are we wringing our hands over nothing, or is Google a victim of its own success, rendering its flagship productSearchless useful?

One cant really overstate the way that Google Search, when it rolled out in 1997, changed how people used the internet. Before Google came out with its goal to crawl the entire web and organize the worlds information, search engines were moderately useful at best. And yet, in the early days, there was much more search competition than there is now; Yahoo, Altavista, and Lycos were popular online destinations. But Googles PageRank ranking algorithm helped crack the problem. The algorithm counted and indexed the number and quality of links that pointed to a given website. Rather than use a simple keyword match, PageRank figured that the best results would be websites that were linked to by many other high-quality websites. The algorithm worked, and the Google of the late 1990s seemed almost magical: You typed in what you were looking for, and what you got back felt not just relevant but intuitive. The machine understood.

Most people dont need a history lesson to know that Google has changed; they feel it. Try searching for a product on your smartphone and youll see that what was once a small teal bar featuring one sponsored link is now a hard-to-decipher, multi-scroll slog, filled with paid-product carousels; multiple paid-link ads; the dreaded, algorithmically generated People also ask box; another paid carousel; a sponsored buying guide; and a Maps widget showing stores selling products near your location. Once youve scrolled through that, multiple screen lengths below, youll find the unpaid search results. Like much of the internet in 2022, it feels monetized to death, soulless, and exhausting.

There are all kinds of theories for those ever-intrusive ads. One is that the cost-per-click rates that Google charges advertisers are down, because of competition from Facebook and Amazon (Google is rolling out larger commerce-search ad widgets in response this year) as well as a slowdown in paid-search-result spending. Another issue may stem from cookie-tracking changes that Google is implementing in response to privacy laws such as Europes General Data Protection Regulation and the California Consumer Privacy Act. For the past two years, Google has been planning to remove third-party cookies from its Chrome browser. And though Google Search wont be affected by the cookie ban, the glut of search ads might be an attempt to recoup some of the money that Google stands to lose in the changes to Chrome. If so, this is an example of fixing one problem while creating another. But when I suggested this to Google, the company was unequivocal, arguing that there is no connection between Chromes plans to phase out support for third-party cookies and Search ads. The company also said that the number of ads it shows in search results has been capped for several years, and we have not made any changes. Google claims that, on average over the past four years, 80 percent of searches on Google havent had any ads at the top of search results.

Any hunt for answers about Googles Search algorithms will lead you into the world of SEO experts like Marie Haynes. Haynes is a consultant who has been studying Googles algorithms obsessively since 2008. Part of her job is to keep up with every small change made by the companys engineers and public communication by Googles Search-team blog. Companies that can divine the whims of Googles constantly updated algorithms are rewarded with coveted page real estate. Ranking high means more attention, which theoretically means more money. When Google announced in October 2020 that it would begin rolling out passage indexinga new way for the company to pull out and rank discrete passages from websitesHaynes tried to figure out how it would change what people ultimately see when they query. Rather than reverse engineer posts to sound like bot-written babble, she and her team attempt to balance maintaining a pages integrity while also appealing to the algorithm. And though Google provides SEO insiders with frequent updates, the companys Search algorithms are a black box (a trade secret that it doesnt want to give to competitors or to spammers who will use it to manipulate the product), which means that knowing what kind of information Google will privilege takes a lot of educated guesswork and trial and error.

Haynes agrees that ads presence on Search is worse than ever and the companys decision to prioritize its own products and features over organic results is frustrating. But she argues that Googles flagship product has actually gotten better and much more complex over time. That complexity, she suggests, might be why searching feels different right now. Were in this transition phase, she told me, noting that the company has made significant advancements in artificial intelligence and machine learning to decipher user queries. Those technical changes have caused it to move away from the PageRank paradigm. But those efforts, she suggested, are in their infancy and perhaps still working out their kinks. In May 2021, Google announced MUM (short for Multitask Unified Model), a natural-language-processing technology for Search that is 1,000 times more powerful than its predecessor.

The AI attempts to understand not just what the searcher is typing, but what the searcher is trying to get at, Haynes told me. Its trying to understand the content inside pages and inside queries, and that will change the type of result people get. Googles focus on searcher intent could mean that when people type in keywords, theyre not getting as many direct word matches. Instead, Google is trying to scan the query, make meaning from it, and surface pages that it thinks match that meaning. Despite being a bit sci-fi and creepy, the shift might feel like a loss of agency for searchers. Search used to feel like a tool that you controlled, but Google may start to behave more like, well, a persona concierge that has its own ideas and processes. The problematic effects of increased AI inference over time are easy to imagine (while I was writing this article, a Google researcher went viral claiming hed been placed on administrative leave after notifying the company that one of its AI chatbotspowered by different technologyhad become sentient, though the company disagrees). Google could use such technology to continue to lead people away from their intended searches and toward its own products and paid ads with greater frequency. Or, less deviously, it could simply gently algorithmically nudge people in unexpected directions. Imagine all the life decisions that you make in a given year based on information you process after Googling. This means that the stakes of Googles AI interpreting a searchers intent are high.

Read: Googles sentient chatbot is our self-deceiving future

But some of Googles lifeless results are made by humans. Zach Verbit knows what its like to serve at the pleasure of Googles Search algorithms. After college, Verbit took a freelance-writing gig with the HOTH, a marketing company that specializes in search-engine optimization. Verbits soul crushing job at the HOTH was to write blog posts that would help clients sites rank highly. He spent hours composing listicles with titles like 10 Things to Do When Your Air-Conditioning Stopped Working. Verbit wrote posts that sounded robotic or like they were written by somebody whod just discovered language. He had to write up to 10 posts a day on subjects he knew nothing about. Quickly, he started repurposing old posts for other clients blogs. Those posts that sound like an AI wrote them? Sometimes theyre from real people trying to jam in as many keywords as possible, Verbit told me.

That his hastily researched posts appeared high in search results left him dispirited. He quit the job after a year, describing the industry of search-gaming as a house of cards. His time in the SEO mines signaled to him the decline of Google Search, arguably the simplest, most effective, and most revolutionary product of the modern internet. The more I did the job, the more I realized that Google Search is completely useless now, he said. HOTHs CEO, Marc Hardgrove disputed the notion that its client blog posts were over-optimized for SEO purposes and that the company discourages jargony posts as they dont rank as high. Overusing keywords and creating un-compelling content would be detrimental to our success as an SEO company, he wrote in an email. Thats why The HOTH does not require, or even encourage, the writers we work with to overuse keywords into their blog posts to help with optimization.

Google is still useful for many, but the harder question is why its results feel more sterile than they did five years ago. Hayness theory is that this is the result of Google trying to crack down on misinformation and low-quality contentespecially around consequential search topics. In 2017, the company started talking publicly about a Search initiative called EAT, which stands for expertise, authoritativeness, and trustworthiness. The company has rolled out numerous quality rater guidelines, which help judge content to determine authenticity. One such effort, titled Your Money or Your Life, applies rigorous standards to any pages that show up when users search for medical or financial information.

Take crypto, Haynes explained. Its an area with a lot of fraud, so unless a site has a big presence around the web and Google gets the sense theyre known for expertise on that topic, itll be difficult to get them to rank. What this means, though, is that Googles results on any topic deemed sensitive enough will likely be from established sources. Medical queries are far more likely to return WebMD or Mayo Clinic pages, instead of personal testimonials. This, Haynes said, is especially challenging for people looking for homeopathic or alternative-medicine remedies.

Theres a strange irony to all of this. For years, researchers, technologists, politicians, and journalists have agonized and cautioned against the wildness of the internet and its penchant for amplifying conspiracy theories, divisive subject matter, and flat-out false information. Many people, myself included, have argued for platforms to surface quality, authoritative information above all else, even at the expense of profit. And its possible that Google has, in some sense, listened (albeit after far too much inaction) and, maybe, partly succeeded in showing higher-quality results in a number of contentious categories. But instead of ushering in an era of perfect information, the changes might be behind the complainers sense that Google Search has stopped delivering interesting results. In theory, we crave authoritative information, but authoritative information can be dry and boring. It reads more like a government form or a textbook than a novel. The internet that many people know and love is the oppositeit is messy, chaotic, unpredictable. It is exhausting, unending, and always a little bit dangerous. It is profoundly human.

But its worth remembering what that humanity looked like inside search results. Rand Fishkin, the founder of the software company SparkToro, who has been writing and thinking about search since 2004, believes that Google has gotten better at not amplifying conspiracy theories and hate speech, but that it took the company far too long. I dont know if you searched for holocaust information between 2000 and 2008, but deniers routinely showed up in the top results, he told me. The same was true for Sandy Hook hoaxersin fact, campaigns from the Sandy Hook families to fight the conspiracy theories led to some of the search engines changes. Whenever somebody says, Hey, Google doesnt feel as human anymore, all I can say is that I bet they dont want a return to that, Fishkin said.

Google Search might be worse now because, like much of the internet, it has matured and has been ruthlessly commercialized. In an attempt to avoid regulation and be corporate-friendly, parts of it might be less wild. But some of what feels dead or dying about Google might be our own nostalgia for a smaller, less mature internet. Sullivan, the Search liaison, understands this longing for the past, but told me that what feels like a Google change is also the search engine responding to the evolution of the web. Some of that blog-style content has migrated over time to closed forums or social media. Sometimes the blog post were hoping to find isnt there. Sullivan believes that some of the recent frustrations with Google Search actually reflect just how good its become. We search for things today we didnt imagine we could search for 15 years ago and we believe well find exactly what we want, he said. Our expectations have continued to grow. So we demand more of the tool. Its an interesting, albeit convenient, response.

From the July/August 2008 issue: Is Google making us stupid?

Google has rewired us, transforming the way that we evaluate, process, access, and even conceive of information. I cant live without that stuff as my brain is now conditioned to remember only snippets for Google to fill in, one Reddit user wrote while discussing Breretons Google Is Dying post. Similarly, Google users shape Search. The younger generation searches really differently than I do, Haynes told me. They basically speak to Google like its a person, whereas I do keyword searching, which is old-school. But these quirks, tics, and varying behaviors are just data for the search giant. When younger generations intuitively start talking to Google like its a person, the tool starts to anticipate that and begins to behave like one (this is part of the reason behind the rise of humanized AI voice assistants).

Fishkin argues that Google Searchand many of Googles other productswould be better with some competition and that Searchs quality improved the most from 1998 to 2007, which he attributes to the companys need to compete for market share. Since then, he said, Googles biggest search innovation has been to put more Google products up front in results. He argues that this strategy has actually led to a slew of underwhelming Google products. Are Google Flights or Google Weather or Googles stocks widget better than competitors? No, but nobody can really compete, thanks to the Search monopoly.

Is Google Search dying? is a frivolous question. We care about Searchs fate on a practical levelit is still a primary way to tap into the internets promise of unlimited information on demand. But I think we also care on an existential levelbecause Googles first product is a placeholder to explore our hopes and fears about technologys place in our life. We yearn for more convenience, more innovation, more possibility. But when we get it, often we can only see what weve lost in the process. That loss is real and deeply felt. Its like losing a piece of our humanity. Search, because of its utility, is even more fraught.

Most people dont want their information mediated by bloated, monopolistic, surveilling tech companies, but they also dont want to go all the way back to a time before them. What we really want is something in between. The evolution of Google Search is unsettling because it seems to suggest that, on the internet weve built, theres very little room for equilibrium or compromise.

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Is Google Dying? Or Did the Web Grow Up? - The Atlantic