Category Archives: Alternative Medicine

New Delhi: Every year, thousands of Indians with medical degrees from foreign universities appear for the Foreign Medical Graduate Exam (FMGE) a screening test conducted by the National Board of Examination (NBE) and mandated by the National Medical Commission (previously Medical Council of India) to qualify for practise in their own country.

On an average, less than 20 per cent of them are able to clear it, according to NBE data.

Foreign medical graduates from countries like Russia, Ukraine, China, the Philippines, Bangladesh and Nepal, among others, are allowed to practise in India only after they have cleared the FMGE. However, MBBS graduates from the US, UK, Australia, Canada and New Zealand do not need to take the exam.

In 2019, 25.79 per cent of foreign graduates cleared the FMGE, while the percentage was 14.68 in 2020 and 23.83 in 2021. The figures in years preceding 2019 were even lower.

So, what do the nearly 80 per cent graduates do after failing to clear this test? While some give up on their dream to pursue medicine and adopt a different career path, others cling to it, especially since there is no cap on the number of attempts for the biannual FMGE.

ThePrint caught up with some foreign medical graduates who spoke on condition of anonymity as they signed a non-disclosure agreement with the NBE while applying for the FMGE.

Also Read: Students Ukraine nightmare triggers furore over medical fees in Bihar, Nitish cant do much

A 32-year-old from Mumbai, who completed her MBBS (Bachelor of Medicine and Bachelor of Surgery) degree in Russias Ryazan oblast around eight years ago, said she could not clear the FMGE despite 10 attempts. She is now pursuing hospital management at an institute in Mumbai.

I am studying hospital management, but I have not given up on my dream to practise medicine. I appeared for the FMGE yet again this year and am waiting for the results, she told ThePrint.

She also claimed that there were errors in the question paper this year and that questions worth 12 marks were wrong, for which students should have been awarded marks. The students have now petitioned the NBE regarding the same.

Asked why she chose to pursue medicine from a university in Russia, she said that while she was mulling over where to apply, she was told that the institute is one of the best in that country.

Its been many years so I dont remember the exact fee that I paid, but it was definitely less than what I would have paid in a private medical college in India, so I went for it, she added.

Asked if the exam had become any easier for her after 10 attempts, she said: The syllabus of FMGE is not fixedthey can ask anything and not just from the UG level, but the PG level as well. No matter how much we study, it just seems impossible to crack and not just because its tough, but also because there is no transparency about this exam.

A candidate cannot apply for revaluation, rechecking, or get the answer sheetall this makes it more difficult for us, she added.

Another medical graduate, who completed her MBBS from a university in Shandong, China, four years ago, attempts the FMGE exam every year but has not had success so far.

Speaking to ThePrint, she said she decided not to divert energy into anything else and has been solely focusing on preparing for her next shot at the exam.

My score has improved every time in the last four attempts. I believe I will be able to clear the exam this time, added the 27-year-old Noida resident.

She also spoke about the lack of a defined syllabus: No books are prescribed to us by NBE, there is no defined syllabus that we can refer to while preparing for the exam. All this makes the exam more difficult for us.

However, not everyone is able to retain their interest in the profession after many failed attempts at clearing the exam. A 35-year-old businessman from Jind, Haryana, is one such example.

After attempting the FMGE five times following an MBBS degree from a university in the Russian capital Moscow in 2014, he finally gave up the idea of being a doctor three years ago. He now handles his familys business of manufacturing perfumes.

My father wanted me to be a doctor and sent me to Russia because I could not qualify for a medical seat in India. I tried a lot to clear the screening test and get a licence to practise medicine, but could not succeed. Hence, I decided to give up on it and join my family business instead of wasting more time, he told ThePrint.

Some consultants ThePrint spoke to also said that most people are left with no choice but to take up alternative professions after repeated failed attempts at clearing the exam.

Vineet Tiwari, who runs a consultancy in Delhi that helps students choose a medical college and prepare their application, said: These foreign graduates cannot practise in India but they can practise in the country they studied from. Those who have the means and connections, get internships in China, Russia, and then start practising there. This was, however, only possible pre-pandemic.

Others who are not able to get such opportunities would either take up an alternative career path or work at a clinic where licensed professionals are not required, in remote areas, villages or small towns, he added.

Neeraj Chaurasiya, another consultant based in Noida, said many graduates keep trying repeatedly to clear the exam.

Most people make repeated attempts to clear the exam but those who cannot clear it take up related careers if they have to stay in India. Those who can, go to countries where they can practise medicine, he further said.

Former NBE executive director Dr Vipin Batra said the idea of a screening exam came up around 1998-99, when what was earlier a diplomatic window the government would nominate students for PG medical education in the erstwhile USSR and then CIS (Commonwealth of Independent States) countries gradually became a commercial venture with more and more colleges in the region opening their doors to Indian students.

The demand-supply mismatch in medical education has always been a problem for India. Initially, medical education in the USSR was part of a diplomatic exchange programme when the government would nominate [students]. In 1998, the MCI for the first time passed a resolution derecognising foreign medical graduates, Dr Batra told ThePrint.

But that received a setback and the Pokhran nuclear test happened in 1998 and Russia was the only country standing with India through the sanctions. There was a lot of diplomatic pressure against derecognising degrees from a country that stood with India in those times, so finally, in 2001, a middle path was devised. This was the screening test, he said.

However, the test was met with some opposition. Some medical graduates moved the Supreme Court seeking an order to limit the ambit of questions asked to just clinical subjects. The apex court, in its verdict, allowed some relaxations, including removal of the cap on number of attempts allowed.

The first FMGE happened in 2004 March and it has been happening for the last 16 years. But new international players came into the picture in the millennium decade and countries like China and Philippines also opened their doors to Indian students. Currently, we send as many students to study medicine in China as to the erstwhile CIS countries. The Philippines has an advantage because it is English-speaking, he added.

Doctors who have experience working with foreign medical graduates, however, claim that even those who clear the screening test are often found wanting in clinical and practical skills.

There are times we encounter graduates who cannot even put a cannula on a patient, a senior doctor from Delhis Indraprastha Apollo Hospital told ThePrint.

There is a reason that the examination is so tough, and India is not the only country requiring foreign graduates to clear a screening test, say experts.

Former Kerala chief secretary Dr Vishwas Mehta, who dealt with medical education during his stint as joint secretary in the Union health ministry, told ThePrint: I have been to medical colleges in Armenia, Georgia and Russia. There is no entrance test and the fees are reasonable so a lot of people end up there. But there are very strict laws, so students are never allowed to touch a patient, so they often do not know how to put a catheter or injection or even do a delivery.

The standards are very different. Also, there is no reciprocal arrangement with these countries for recognising their degrees. Even the US required medical graduates going from India to appear for the USMLE (United States Medical Licensing Examination).

(Edited by Gitanjali Das)

Also Read: Ticket out of despair: How agents fuel the boom in Indians wanting to study medicine abroad

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80% foreign medical graduates fail India's licence exam. Here's what they end up doing instead - ThePrint

Introduction: The teaching of human anatomy, a medical subject that relies heavily on live teaching, teacher-student interactivity, and visuospatial skills, has suffered tremendously since the COVID-19 pandemic mandated the shutting down of medical institutions. The medical education fraternity was compelled to replace the traditional teaching method of hands-on cadaveric dissections (HOCDs) with online education to overcome this new challenge, but it came at the cost of reduced student engagement and lesser spatial orientation.

Method: In this cross-sectional, questionnaire-based study, we designed anovel online dissection courseon lower limb anatomy and collected student feedback on the same fromconsenting Phase I Bachelor of Medicine, Bachelor of Surgery (MBBS) students of Symbiosis Medical College for Women, Pune, India. The course design consisted of three different modes: a live Zoom session using a handheld camera phone, a pre-recorded video dissection uploaded on the institute learning management system, and a Powerpoint presentation with high-resolution photographs of each dissected layer; and the feedback intended to find outwhat works best for the students. Overall feedback regarding their preferences in terms of presentation design, use of background music in pre-recorded videos, and overall learning experience was also collected. Thecourse consisted of six two-hour teaching sessions. The first three sessions each used a different mode of teaching, repeating the same pattern in the next three sessions. The first mode of teaching implemented was a live Zoom session where instructors used a hand-held cell phone camera to show specimens that had been dissected a day prior. The second mode involved a pre-recorded video showing step-by-step dissection performed by the instructor which was then uploaded on the Institute Learning Management System. Of the two pre-recorded videos, background music consisting of a low-volume instrumental track was added to the second video. The third mode utilized Powerpoint presentations containing high-resolution photographs of each dissected layer on a separate slide along with labeling. The presentations were shown to the students over a Zoom call. A Google Form (GF) questionnaire was created after validation by subject experts to gather the students feedback on the teaching and learning of anatomy via these sessions. The GF responses were collected and analyzed using Microsoft Excel.

Results: 41.7% of students recommended the use of a combination of all three modes in the same session, while 36.7% favored pre-recorded videos. 86.7% of students said that a good quality presentation design helps in keeping them engaged and only23%of students favored the use of background music for increasing their ability to concentrate. 63.3% of students found the learning experience highly satisfactory.

Conclusion: Although virtual dissection teaching methods may not be able to completely replace HOCDs, a well-planned online dissection course incorporating multiple modes of online dissections with an emphasis on good quality presentation design and frequent teacher-student interactivity can provide a strong impetus for learning in the absence of live teaching methods.

Human anatomy is one of the basic sciences that is taught in themedical curriculum worldwide [1,2]. For many years this subject has been taught using traditional teaching methods such as didactic lectures, demonstrations, small group discussions, and cadaveric dissections. With pedagogical evolution, anatomical education started witnessing the ingraining of newer, creative teaching methods which incorporated computer-assisted learning [3]. Online educational content delivered through websites such as YouTube has been shown to augment students learning experiences [4]. The inclination towards such teaching tools was further accentuated after restrictions on the live classroom teaching setup due to the 2020 COVID-19 pandemic [5]. Distance education became the new norm and replacing old school methods with newer modalities like streaming video platforms, web conferencing tools, and much recently, virtual anatomy atlas software, was no longer just an evolutionary trend but an absolute necessity [6,7]. Furthermore, the incorporation of learning management systems such as Google Classroom [8] and Moodle [9,10] in medical education has made it possible to facilitate the teaching and learning of this complex subject in an orderly manner, in spite of the physical distance. Two important drawbacks are to be considered in this new wave of teaching, however: the first being the lack of live face-to-face interaction [11,12], the second a deprivation of visuospatial learning that is a hallmark feature of anatomy learning, especially in hands-on cadaveric dissections (HOCDs) [13]. The understanding of visual and spatial relationships amongst structures offered by HOCDs has always made this method an integral, irreplaceable part of anatomy teaching and learning[14]. The inability to conduct such sessions during institutional lockdowns is a matter of concern for anatomy education [15,16]. Students perspectives on the very same matter have been studied in recent times [17,18]. In March 2020, Diaz et al. ran an online anatomy practical course consisting of 20 pre-recorded videos of prosected cadaveric specimens with a positive response and statistically significant rise in academic scores [19]. Since then, various other methods have been used such as virtual dissection tables, dissection audio-visual resources (DAVR), and dissection educational videos (DEVs) [20-24]. In spite of multiple studies focussing on student feedback on online anatomy education, no studies have collected feedback by comparing multiple modes of online dissection within the same course. Whether the touch-and-feel based learning of HOCDs can ever be replaced by virtual dissections remains an issue of debate, but an effort to keep an online dissection session as real as possible can be done in todays times, thanks to the availability of enhanced digital audio-video creation technology. In this study, the authors have attempted to understand students perspectives on a novel online lower limb dissection course that they designed and deliveredduring the pandemic. The course encompasses various possible modes of online dissection teaching. Factors such as preferred mode of lecture delivery, presentation design, the scope for background music in online sessions, and overall learning experience have been considered.

This was aquestionnaire-based study exploring students perspectives on a novel online dissection course on lower limb anatomy. The course was a part of the online anatomy curriculum of a Phase I MBBS batch at Symbiosis Medical College for Women, Pune. It was mentioned in the student consent form that the feedback will be collected anonymously for purposes of medical education research and curricular development. Sixty students gave consent and were included in the study. Before collecting the data, the study plan was proposed to the Institute Research Committee at Symbiosis Medical College for Women and the approval number received was SMCW/IRC/Fac Res/52/2022. As per Table 4.2, Serial Number 1 of the National Ethical Guidelines for Biomedical and Health Research involving Human Participants of the Indian Council of Medical Research, New Delhi, studies involving comparison of instructional techniques, curricula, or classroom management methods are exempted from Ethical Committee review.

The course consisted of six two-hour teaching sessions, conducted for the entire batch. Three sessions were conducted initially, each one using a different mode of teaching (Tables 1, 2). The same pattern was repeated for the next three sessions.

Live Zoom Session Over the Cellphone

In this mode, the dissection was done a day prior by the instructor. The prosected specimen was then shown over a live Zoom session by two teachers. One teacher held the cellphone (Redmi Note 9 Pro Max; Xiaomi, Beijing, China) whose camera was used to show the specimen while the other teacher taught with the use of forceps for pointing and grasping the necessary structures. Students had the liberty to interrupt the teacher in the middle of the session by unmuting themselves and asking questions, whenever needed. The total duration of the session was two hours.

Pre-recorded Videos Uploaded on Institutes Learning Management System

In this mode, the dissection was done a day prior by the instructor. The entire video was first recorded using the high-definition DJI Osmo Pocket Handheld 12 MP camera (DJI, Shenzhen, China). The video consisted of a moving camera format with close-ups on certain structures as well as a fixed camera format when the concerned regional anatomy was summarized. The video was then edited using LumaFusion for iPad and exported with the specifications of 1920 x 1080 pixels at 30 frames per second.During the editing, while the parts of the video wherein the instructor is teaching were kept at normal speed, the parts of the video where the instructor is dissecting in real-time were sped up significantly. This way, the unnecessary length of dissection time was shortened, yet various layers of the dissection were demonstrated step-by-step to the viewers. Of the two videos (Table 2, Numbers 2 and 5), each of 40 minutes duration, that were produced with this method, an instrumental track in low volume was added as background music in the second video. Both of these videos were further divided into two halves of 20 minutes duration. Thus, two 20 minute videos were shown to the students in each session. Both the sessions started with the instructor navigating the students through the LMS in a 10-minute online briefing over Zoom call. The students were then given 30 minutes to watch the first part of the video on their respective devices. This was followed by a 30-minute live interactive Question and Answer (Q&A) session over Zoom call. The students then watched the second part of the video over the next 30 minutes, again on their respective devices, followed by yet another live question and answer session over the same Zoom call. The total duration of the session was two hours.

PowerPoint Presentation

In this mode, dissection was done a day prior by the instructor, and high-resolution photographs were taken using a Canon DSLR PowerShot SX70 HS camera (Canon, Tokyo, Japan). The presentation consisted of a step-by-step dissection with the photograph of each dissected layer on a separate slide along with labeling. The presentation was screen-shared live over the videoconferencing application Zoom. Students had the liberty to interrupt the teacher in the middle of the session by unmuting themselves and asking questions, whenever needed. The total duration of the session was two hours.

A Google Form (GF) questionnaire was created to gather the students feedback on the teaching and learning of anatomy in these sessions. It had three sections. The first section consisted of consent. It was mentioned here that the feedback will be used anonymously for purposes of research and improved delivery of online anatomical education in the future. The second section consisted of feedback on lower limb dissection sessions in relation to student preferences on the mode of teaching, the effect of presentation design and annotations on students ability to stay focussed, and students' perception of the use of background music in pre-recorded dissection videos. The third section collected overall feedback on the session regarding parameters such as speed of lecture, degree of repetition of information, level of teacher-student interaction in the session, comprehensibility of the topic taught, and overall quality of the students learning experience. After thorough validation by subject experts, this questionnaire was distributed toPhase I MBBS students of Symbiosis Medical College for Women, Pune. The students not willing to participate in the study were given the opportunity to withdraw from the study.

The GF responses were collected and analyzed using Microsoft Excel. An ascending Likert scale was used to assessstudents' comprehension of the taught topics and overall learning experience. This data was visuallyrepresented as bar charts. Pie charts were used to represent thestudent responses on preferred session mode, perception of design and annotation use in PowerPoint presentations, and student views on the use of background music in pre-recorded videos.

The results showed that 53.3% of students rated comprehension of the topics taught as a 4 on a 5-point ascending Likert scale. Similarly, 63.3% of students found the overall learning experience highly satisfactory (Figures 1, 2).

In terms of mode of lecture delivery, 41.7% of students recommended that the instructor use a combination of all three modes in the same lecture. 36.7% of students preferred the PR videos, 15% preferred the live ZS, and 6.6% preferred a PPT (Figure 3).

56.7% of participants rated the PowerPoint presentation design as a 4 on a 5-point ascending Likert scale. 86.7% of students opined that the quality of presentation design directly correlates with their ability to stay focused during the lecture. 95% of students said that the annotations helped enhance their understanding of the presentation content (Figures 4, 5, 6).

Out of two PR videos used in the study, the background music was added to the second one. The research attempted to assess how this affected student engagement (Figure 7).

Forty-five percent of students were indifferent to the usage of background music in the dissection videos and perceived no effect on their engagement with the video. 23.3% thought that the music increased engagement, whereas 31.7% considered it as an unnecessary distraction.

The present study aimed atunderstanding student preferences in online dissection sessions on lower limb anatomy with the objective of improving curricular design for future online learning sessions based on the feedback collected. The course incorporated three modes of online dissections: live Zoom sessions, pre-recorded videos of dissection, and PowerPoint presentations of the dissected specimens.

Most students suggested that the instructor incorporate a combination of all modes in the same online session (Figure 3). However, if they had to choose one, 36.7% of students favored pre-recorded videos. In a similar study by Choi-Lundberg et al. on the effectiveness of using DAVR as a preliminary mode of learning dissection, the authors reported that implementing DAVR resulted in higher scores among undergraduate medical students. A positive correlation was noted between scores and the number and total time of DAVR viewed [22]. PPTs were the least preferred modes of teaching online dissection. The following factors could be responsible for greater student preference for PR videos:

Control of Video Playback

Students could pause, replay, speed up or slow down the pre-recorded videos on their own devices. This gave them the liberty to focus on different parts of the dissection as per their understanding. The live videos had the teacher progressing at a fixed pace, with no option to pause or replay. The PPTs had static images which might have failed to capture visuospatial intricacies, leading to low preference. Fidalgo et al. conducted a similar study to assess the use of alternative learning methods among students in which students clearly preferred a video format over PPTs. However, they concluded that the most beneficial way to aid most students learning would be to administer a combination of different alternative teaching methods [25].

Elimination of Internet Bandwidth Issues

A major drawback of the live ZS could be the reduced video quality, audio delay, and buffering experienced due to server overload. These problems do not arise while viewing pre-recorded content. In a similar study by John et al. [26], nearly 60% of students preferred PR videos over live videos due to this very reason.

Reduced Dissection Time

The parts of the PR video where the teacher was dissecting in real-time were sped up in order to reduce the length of dissection time.However, while demonstrating the various layers and structures, the video speed was brought back to normal. Not only was this the closest imitation of an actual HOCD, but it also allowed the students to focus on important anatomical structures better.

More Teacher-Student Interaction

Two slots of 30 minutes each were allotted purely for interactive Q&A sessions over Zoom call after watching the first and second parts of the PR videos. In the live ZS as well as the PPT modes, students had to unmute and interrupt the teacher to ask questions. This might have prevented students from asking a lot of questions. A study by Nolan et al. on a neuroanatomy course suggests that sessions focusing on student interaction yield better attendance as opposed to traditional didactic lecture-taking methods [27]. A large-scale study took students perceptions of 73 teaching courses into consideration with respect to the course design. It was found that feedback from instructors and active discussion were the two most important factors that improved students perceptions of a course [28]. Although the live ZS allowed for immediate resolution of doubts, this came at the cost of affecting the teachers flow of thought, which might have led to hesitation from the students' side.

Two factors, namely design of the PPT and use of annotations were favored by students for increasing focus and comprehension (Figures 4, 5, 6). Modern educators need to put more effort into the design of PPTs and actively annotate on the slide being displayed to improve student appeal and engagement.

Angel et al. reported that background music can have significant effects on cognitive performance. Using fast-tempo music and standardized test batteries, Angel et al. demonstrated that background music increased spatial and linguistic processing skills [29]. Evidently, the development of these skills among students is of utmost importance to facilitate their learning. Fassbender et al. established that using background music while delivering lectures to students can result in a significantly higher recall of facts [30]. In a similar vein, the authors wanted to find out how medical students would react to the presence of background music while studying a complex subject like anatomy. Student opinions were mixed, with 23% of students finding the background music as a necessary aid to improve engagement (Figure 7).Further studies are needed to analyze the effects of using different types of music in online medical lectures.

In summary, online dissection sessions need to be designed by incorporating a healthy mix of the flexibility provided by high-quality pre-recorded videos, the interaction provided via live Zoom sessions, and a well-designed PPT with generous use of annotations to give students a wholesome anatomy learning experience. Forthcoming studies need to assess the merits of such a combination. This study has one limitation. Only the inferior extremity was dissected as a part of this study. Teaching other parts, especially those having smaller anatomical structures and needing finer dissection need to be conducted to further explore the student preferences on the various possible modes for teaching anatomical dissections online.

Although virtual dissection teaching methods may not be able to completely replace HOCDs, these results indicate that they can provide a strong impetus for learning in the absence of HOCDs. What needs to be kept in mind however is the incorporation of multiple modes within the same session to increase student engagement. The use of pre-recorded videos covering the most important parts of online dissection sessions enables the students to revisit the more complex concepts that they might miss while learning across the screen in the absence of a face-to-face give and take. It also eliminates the distraction and disengagement that arises due to internet bandwidth problems in the live video conferencing sessions. Maintaining a high level of teacher-student interaction by deliberately dividing longer online sessions into smaller subdivisions with frequent question-answer exchanges is pivotal to encourage student participation. Lastly, while the use of superior quality design and aggressive annotation in online presentations attracts students attention, the use of background music and its implications needs to be studied in more detail considering several factors such as the volume, tempo, genre, and other musical parameters that could influence student attention.

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A Novel Online Dissection Course on Lower Limb Anatomy During the COVID-19 Pandemic - Cureus

The National Health Security Office (NHSO) and the Rajavithi hospital are speeding up the mailing out of anti-viral Favipiravir medicine to more than 3,500 COVID-19 patients in Bangkok and surrounding areas who are unable to access the home isolation program.

NHSO Secretary-General Dr. Jadet Thammathat-Aree explained yesterday (Thursday) that the main reason that this group of patients have been unable to get help from the NHSO so far is because its 1330 hotline system has been so overwhelmed with calls from patients that they cannot get through, and existing isolation facilities are full, causing another problem, which is a backlog of waiting patients who have already registered for isolation facilities.

After being made to wait for help for several days, he said that many registered patients have tried to contact the NHSO again via the hotlines and other channels, further overwhelming the system.

Dr. Jadet said that the NHSO has already increased the hotline lines and more people have been recruited to answer calls from the patients. They have also sought help from private call centres to ease the workload at the NHSOs call centre, but still the hotline system is overwhelmed.

For the 3,500 plus patients who are waiting for help, he said that it would take about five days for the NHSO and Rajavithi Hospital to mail them the Favipiravir medicine, if their condition is not serious.

After having received and taken the medication, he recommends that patients stay home in isolation for about ten days.

Besides Favipiravir, the NHSO, in cooperation with the Department of Thai Traditional and Alternative Medicine and the Army Region 1, have distributed more than 40,000 sets of Fah Talai Jone herbal tablets to more than 900 communities in Bangkok, for distribution to registered patients who are yet to get a response from the NHSO.

These patients, he said, can approach their community leaders or public health volunteers to receive the herbal medicine.

The Ministry of Public Health has distributed Favipiravir anti-rival medicine, Fah Talai Jone herbal medicine and other drugs to more than 8,000 COVID-19 patients in the four days since the launch on March 4th of the out-patient medical service program, known as found, distribute, done.

Besides state and medical college hospitals, which have been providing out-patient medical services to between 200-300 patients each per day, he said that hospitals in provinces around Bangkok have also been instructed to provide similar services, via their acute respiratory infection (ARI) clinics, to accommodate as many as 18,000 patients who are yet to get access to help via the NHSOs hotline system.

Dr. Kiattibhoom said the out-patient service program has reduced the calls to the 1330 hotline system of the NHSO from about 70,000 to about 50,000.

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Thailand to expedite mailing of Favipiravir to COVID-19 patients - Thai PBS World

COVID-19 Vaccine Janssen: small vessel vasculitis added as a side effect

EMAs medicines safety committee (PRAC) has recommended that small vessel vasculitis with cutaneous manifestations (inflammation of blood vessels in the skin which may result in a rash, pointed or flat, red spots under the skins surface and bruising) should be added to the product information of COVID-19 Vaccine Janssen as a possible side effect of unknown frequency.

Small vessel vasculitis can be caused by viral or bacterial infections as well as by medicines and vaccines. Generally, manifestations of the disease spontaneously resolve over time with appropriate supportive care.

PRAC has reviewed a total of 21 cases reported globally in the context of the latest summary safety report, including 10 cases consistent with the established definition of single organ cutaneous vasculitis (vasculitis affecting a single organ). For most of these 10 cases no other obvious explanation was identified; eight of these cases occurred soon after the administration of the vaccine.

As of 31 December 2021, approximately 42.5 million doses of the vaccine had been administered worldwide.

The PRAC will continue to monitor for cases of vasculitis and will communicate further if new information becomes available.

The PRAC has recommended that a warning for flare-ups of capillary leak syndrome (CLS) should be added to the product information for the COVID-19 vaccine Spikevax.

CLS is an extremely rare, serious condition that causes fluid leakage from small blood vessels (capillaries), resulting in rapid swelling of the arms and legs, sudden weight gain, feeling faint, thickening of the blood, low blood levels of albumin (an important blood protein) and low blood pressure. CLS is frequently related to viral infections, some blood cancers, inflammatory diseases and some treatments.

The PRAC assessed all the available data as well as all the cases of CLS reported in the Eudravigilance database after the administration of the mRNA vaccines Spikevax and Comirnaty.

The Committee concluded that there was insufficient evidence to establish a causal association between the two vaccines and the onset of new cases of CLS. However, the PRAC recommended the inclusion of a warning in the product information for Spikevax to raise awareness of the potential risk of flare-ups among healthcare professionals and patients. The Committee recommended this warning as some cases of flare-ups of CLS pointed towards an association with Spikevax, while the cases reported after vaccination with Comirnaty did not support such association.

Healthcare professionals should be aware of the signs and symptoms of CLS and of a possible risk of flare-ups in people with a history of CLS. Vaccinated individuals with a history of CLS should consult their treating physician when planning their vaccination.

In total 55 reported cases of CLS were reviewed, 11 with Spikevax and 44 with Comirnaty. Global exposure at the time of the assessment was estimated at approximately 559 million doses for Spikevax and 2 billion doses for Comirnaty.

As part of its advice on safety-related aspects to other EMA committees, thePRACdiscussed a direct healthcare professional communication (DHPC) containing important safety information for dexmedetomidine.

Dexmedetomidine: Increased risk of mortality in intensive care unit patients aged 65 years and less

This DHPC aims to inform healthcare professionals of the increased risk of mortality when administering dexmedetomidine in intensive care unit (ICU) patients aged 65 years and less, compared with alternative sedatives.

Dexmedetomidine is a medicine authorised for light sedation (a state of calm or feeling sleepy) of adult patients in ICUs, allowing the patient to stay awake and respond to verbal stimulation for diagnostic or surgical procedures.

SPICE III study was a randomised clinical trial comparing the effect of sedation with dexmedetomidine on all-cause mortality (deaths from any cause) with the effect of usual standard of care in 3,904 critically ill adult ICU patients in need of mechanical ventilation. The study showed no difference in the overall 90-day mortality between dexmedetomidine and alternative sedatives (propofol, midazolam). However, dexmedetomidine was associated with an increased risk of mortality in patients aged 65 years and less, compared with alternative sedatives.

The product information for dexmedetomidine is being updated with a warning describing the evidence and risk factors. Healthcare professionals are being advised to weigh these findings against the expected clinical benefit of dexmedetomidine compared to alternative sedatives in this age group.

The DHPC for dexmedetomidine will be forwarded to EMAs human medicines committee, theCHMP. Following theCHMPdecision, the DHPC will be disseminated to healthcare professionals by themarketing authorisation holder, according to an agreed communication plan, and published on theDirect healthcare professional communicationspage and innational registersin EU Member States.

Read more:

Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 7-10 March 2022 | European Medicines Agency - European Medicines Agency...

Thirty-nine-year-old Avneet Bhatia is a true believer in natural healing. Hailing from an army family, fitness and sports were deep-rooted in the SOM, IIT Bombay alumnus.

At a certain stage in her life, Avneet adopted yoga and Ayurveda and found herself recovered from her ailments and completely transformed.She wanted to bring these benefits of natural therapies to more people, and eventually, she pursued a course for a year.

This initiative is like giving back to society. It can heal everybody, and more people find it accessible to find a brand they can trust to heal them naturally, Avneet tells YourStory.

Avneet Bhatia, Founder, NatureFit

Mumbai-headquartered NatureFit is an app-based digital platform that guides users towards natural therapies. One can opt from 15 therapies available, including Ayurveda, Homeopathy, Yoga, Dieticians, Physiotherapy, and Psychology, among others. Avneet says, these therapies come with no flyers or other binders suggesting no side effects.

The platform also has free health tools such as BMI Calculator, stress level, and Prakruti analysis, which tracks users sleep cycle, water intake, meals, exercise, and help them better know their health conditions.

Through its community platform Fitbook, NatureFit connects users with other nature cure lovers and health-conscious people in a fun and engaging way.

Users can create groups, share their views, take up challenges, and track their progress through the apps self-motivating health and progress tracking features, Avneet says.

Besides, NatureFit also provides 100 percent natural and herbal products in healthcare, food, grocery, beauty, and baby care segments.

Screenshot of the platform

The preventive healthcare startup available on Android and website has 3,000 doctors, 7,000 app installsand over 75 brands on its platform.

NatureFit will soon launch the iOS version of the app. As part of this launch, NatureFit is offering its users one-time free consultation with doctors and practitioners till April 1.

From April onwards, the startup will also charge a subscription fee to its doctors to use the platform. At present, it is free for all doctors.

The startup also providesB2B corporate wellness plans and has onboarded two clients with two to three more in the pipeline.

NatureFits B2C ecommerce platform has completed around 100 orders, clocking revenue of Rs 50,000. In the last two months, the startup has generated a revenue of Rs 15 lakh.

In the last few years, the Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) ministry has been seeing good growth. At present, over 7.7 lakh registered AYUSH doctors practice in India.

According to the Research and Information System for Developing Countries (RIS), its market size has grown 17 percent in 2014-20. Despite the slump in economic activity due to the pandemic in 2020, the industry is projected to reach $20.6 billion in 2021 and $23.3 billion in 2022.

Avneet says,The interest in these products was fueled by the recommendations from the Ministry of AYUSH to fight COVID-19. AYUSH signifies the combination of an alternative system of medicine, which was earlier known as the Indian System of Medicine.

Bootstrapped with nearly Rs 90 lakh, the healthcare startup aims to reach 30,000 doctors in the next two years. NatureFit is targeting one lakh app installs and plans to onboard 300 brands by the end of 2022.

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This Mumbai-based healthcare startup provides natural therapies to products all in one app - YourStory

I believe that taking periodic breaks from the news can promote mental calm and help renew your spirits. In this way, the anxiety and overstimulation catalyzed by the media may be minimized, and your body will function better. Dr. Andrew Weil, the bushy-bearded, alternative-medicine doc, proposing news fasts in his 1995 book Spontaneous Healing.

REGULAR PERSON: Whats unfolding in Ukraine is unbelievable. It happened so fast, its shocking and awful, and I cant stop watching the news and reading about it all day long. Im exhausted.

PERSON ON A NEWS FAST: What?

REGULAR PERSON: Its just horrible. The humanitarian crisis is heartbreaking, sometimes I just burst into tears. What if the war spreads across Europe? Or worse? Putin has nuclear weapons!

PERSON ON A NEWS FAST: What?

REGULAR PERSON: And I hope theres not another coronavirus variant anytime soon. Just as COVID starts to wane for now a terrifying war breaks out. Cant we get a break? Im not sure I can take any more. My neck is so stiff, I can barely turn my head.

PERSON ON A NEWS FAST (playing Sudoku): What?

REGULAR PERSON: And dont get me started on threats to our democracy. Can you believe these new voting laws in Texas, Georgia, and elsewhere? Creating confusion and designed to keep people from voting? All fueled by Trumps metastatic Big Lie about the 2020 election? Oh my god, look at my arm. Those hives werent there a minute ago.

PERSON ON A NEWS FAST (smiling at a beam of sunlight warming a kitten asleep on some laundry): What?

REGULAR PERSON: And now theyre banning books about sexuality, gender, and racism! And passing laws that could send teachers and librarians to jail. My mouth tastes like metal.

PERSON ON A NEWS FAST: What?

REGULAR PERSON: What?

PERSON ON A NEWS FAST: What?

REGULAR PERSON: And what if Trump is reelected in 2024? He just suggested bombing Russia with planes made to look like Chinese aircraft to start a war between Russia and China. This is a serious, dangerous time thats filled with unserious, dangerous people. I cant breathe.

PERSON ON A NEWS FAST (gazing at a vase of fresh-cut flowers): What?

REGULAR PERSON: And just this morning I read about the massive mental-health crisis in America, made much worse during COVID. Stress, anxiety, grief, loneliness, isolation, uncertainty, sleeping problems, and more. Our kids are suffering, were suffering, everyones suffering. I wake up from nightmares every night at 3 a.m. And why are my feet always cold?

PERSON ON A NEWS FAST: What?

REGULAR PERSON: And now a war thats broadcast 24/7, scenes of real-life violence played on infinite loop, delivered by the networks almost like entertainment, interspersed with commercials for Downy and personal-finance apps and restaurants serving all-you-can-eat chicken tenders. Its jarring to see war, entertainment, and commercials intermingled that way. Its like no one read Neil Postmans Amusing Ourselves to Death.

PERSON ON A NEWS FAST: What? Who?

REGULAR PERSON: In his 1985 book, Postman compared George Orwells 1984 to Aldous Huxleys Brave New World and, among other insights, concluded that weve become exactly what Huxley predicted: Orwell feared that the truth would be concealed from us. Huxley feared the truth would be drowned in a sea of irrelevance.

PERSON ON A NEWS FAST: Sorry, did you say something? I was watching people dance in sync on TikTok. Look at them go!

REGULAR PERSON: Uh, Mr. Van Winkle? Do you know that your long, white beard looks just like Dr. Andrew Weils long white beard? And that Ive never seen you together?

PERSON ON A NEWS FAST: Sorry, dont know anyone named Weil. Wait! Is he Dutch? Because the last thing I remember is drinking some liquor from a Dutchmans keg, playing a few rounds of nine pins, and then falling asleep under this enormous old tree.

REGULAR PERSON: Thats a lovely tree. Its an ash. I hope it isnt killed by the invasive emerald ash borer thats devastating trees across the Berkshires. Why cant I shake this dull headache?

PERSON ON A NEWS FAST (yawning): What?

Bill Shein doesnt have a bushy white beard, but over the last few weeks his hair has grayed at twice the usual rate.

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REASON GONE MAD: Reality overwhelms - theberkshireedge.com

Andrii Yalanskyi/iStock via Getty Images

The PTAB's ruling against UC Berkley turned the CRISPR space upside down. Sleepy biotechs such as Editas Medicine (NASDAQ:EDIT) became popular overnight (at least for a few days), while favorites like Intellia Therapeutics (NASDAQ:NTLA) and CRISPR (NASDAQ:CRSP) saw their shares drop. Pundits believe that NTLA and CRSP, who license CRISPR/Cas9 tech from UC Berkely, will need to negotiate a new license from the Broad Institute of Harvard and MIT. In a recent press release published last Friday, NTLA alluded to this prospect. However, NTLA will likely wait before seeking a new license until UC Berkley's appeal result comes out. It doesn't make sense to sign a license with the Broad Institute only for an appeal to reverse the verdict back in UC Berkley's favor. Second, there is uncertainty over the willingness of the Broad to license CRISPR/Cas9 tech, at least in certain areas, given its contract provisions with EDIT. For example, NTLA and EDIT have hemoglobinopathies programs targeting Sickle Cell Disease "SCD" and Beta-Thalassemia Major "TDT." The Broad Institute/EDIT license contains provisions that limit the Broad institute's ability to license CRISPR/Cas9 for products under development by EDIT.

I expect NTLA's management to talk down the long-term impact of the ruling, similar to UC Berkely, which stated that it still maintains 40 foundational patents, aside from the thirteen covered by the verdict. However, I believe that our previous investment thesis is no longer valid, and while I continue holding NTLA shares, my speculative trade has become more uncertain.

NTLA projected leadership in the CRISPR space, with an aggressive pipeline that seemed to mirror an entrepreneurial spirit, manifested in its flagship ATTR investigational drug, the first in-vivo therapy targeting liver cells. Promising clinical data from the ATTR program solidified this image, outpacing competitors such as CRSP, whose in-vivo liver programs are still in the pre-clinical stage. EDIT chose a more trodden path, focusing on well-studied areas, namely hemoglobinopathies and ocular diseases, two popular choices in the industry due to ease of delivery and established literature, increasing chances of clinical trial success.

However, the recent ruling unveiled weaknesses around its technological prowess. For example, NTLA's strategy for treating genetic diseases mirrors limitations of CRISPR/Cas9, contrary to what Dr Jennifer Doudna and Dr Emmanuell Charpentier led us to believe, depicting CRISPR as an ultimate tool for gene editing. Many scientists now think that gene treatments will take multiple forms and technologies.

NTLA-2002, NTLA's latest program to enter the clinical stage, is one example. Hereditary Angioedema "HAE" is caused by a mutation in the SERPING1 gene, leading to deficiency in the C1 inhibitor protein and a subsequent buildup of bradykinin. Instead of fixing the SERPING1 gene, NTLA-2002 aims to knock out the kallikrein B1 gene, the DNA responsible for producing bradykinin to achieve a biological balance. Another example is NTLA's NTLA-2001 program. Instead of fixing the mutated TTR gene, the investigational drug completely knocks it out, solving the problem of ATTR accumulation but causing problems around vitamin A deficiency, reducing the number of times its edge over alternative therapies. Gene knockout is also the industry's strategy to treat SCD and B-Thal. Instead of fixing the root of the problem, the companies created a gene treatment to knockout a different gene to increase the production of fetal hemoglobin, which also reflects the nascent stage of the in-vivo programs.

Moreover, NTLA is not the first company to deliver genetic material to liver cells. Alnylam (NASDAQ:ALNY) developed Onpattro, which temporarily silences the TTR gene breaking down its mRNA. Similar did Ionis (NASDAQ:IONS) when it created Tegsedi. These two therapies also use Lipid coating to deliver the drug, similar to NTLA-2001, which licenses the Lipid Nanp Particle "LNP" tech from Novartis (NYSE:NVS). I believe these technological limitations restrict the valuation of NTLA.

From a financial perspective, the recent ruling casts uncertainty over how much NTLA will have to pay for a CRISPR license if UC Berkley loses its appeal. Beyond patent disputes, each of NTLA's programs has its unique commercial prospects, influenced by many factors, including disease prevalence, severity, availability of alternative therapies, and convenience to patients and physicians. bluebird bio's (NASDAQ:BLUE) failure to commercialize Zynteglo and ABECMA in Europe -the latter now owned and marketed by 2seventy (NASDAQ:TSVT)- gives a somber warning that clinical success and regulatory approval don't mean commercial success.

I believe that NTLA's two in-vivo programs targeting liver tissue have enough prevalence to achieve commercial success. Other alternative therapies with less efficacy and convenience generate millions to other biotechs. For example, Shire (private British biotech) generated $699.3 million from Cinryze, a C1 inhibitor for the treatment of HAE, in 2018. Unlike NTLA-2002, Cinryze is a life-long medicine costing $350,000 annually. Given that NTLA is a one-time treatment, NTLA's management will be able to negotiate a higher price if and when NTAL-2002 is approved.

NTLA-2001 also makes commercial sense, albeit not as much as NTLA-2002, ruefully for Regeneron (NASDAQ:REGN), NTLA's partner in NTLA-2001( NTLA runs NTLA-2002 independently). As mentioned above, NTLA-2001 could be very profitable. Alternative therapies such as Onpattro generated 120 million in Q3 2021, translating to $480 million annually. NTLA-2001 is also more convenient as a one-time therapy compared to Onpattro, a life-long treatment administered periodically in a clinic through an IV, a process that takes hours. However, the amount insurance companies will be willing to pay is limited, given that ATTRv is also mostly diagnosed in mature individuals (Median age at diagnosis is 62). These dynamics will factor in the pricing of NTLA-2001 if and when it is approved.

The nature of NTLA's therapies as one-time medicines could have implications on its long-run profitabilities. Although revenue might spike initially, revenue will depreciate as the patient pool starts to dry out in the long run. Eventually, NTLA-2001 revenue will be proportional to annual incidence, which is pretty low.

NTLA's other clinical-stage programs are ex-vivo therapies in Hemoglobinopathies and acute myeloid leukemia. Novartis is leading the SCD program, funded by the Bill and Melinda Gates Foundation, which procured NVS to create an affordable SCD therapy in developing countries where the disease is most prevalent. BLUE's effort to commercialize Zynteglo failed because of production cost and the concentration of B-Thal in developing nations that cannot pay for Zynteglo, which BLUE priced at $1.8 million per injection. Notably, European National Health Services also refused to pay. Hopefully, NTLA and NVS will succeed in creating a low-cost SCD therapy, which could help market the therapy given the crowdedness of the field. Almost all CRISPR biotechs have hemoglobinopathies programs, namely SCD and B-thal, and all main CRISPR biotechs use the same strategy; increasing fetal hemoglobin. Thus, price differentiation could be a critical factor for marketing.

NTLA's Acute Myeloid Leukemia "AML" program has a high commercial potential, given the limitations of current therapies, high death rates, and difficulty in treatment. In 2020, more than 20,000 new cases were diagnosed in the US. The company only recently received acceptance for its IND and began screening for trial patients. Investors should expect the first data in the first half of 2023.

NTLA stood out from the crowd with a differentiated pipeline with a market image as an entrepreneurial force in the CRISPR space. However, the current PTAB ruling revealed weaknesses in its IP portfolio, and it appears that its technological prowess is overrated.

I don't believe NTLA will outperform the market this year. Investors should expect volatility until the CRISPR/Cas9 license issue is sorted. I expect management to talk down the effect of the ruling during Barclays Global Health Conference scheduled for March 15, 2022.

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Intellia: One Patent Ruling Turns The Industry Upside Down - Seeking Alpha

A charity that promoted complementary and alternative medicine to cancer patients has decided to wind down following engagement with the Charity Commission.

Gerson Support Group, which aimed to promote treatments based on diet, nutritional supplements and enemas, has been removed from the charity register after the regulator opened a compliance case into its work.

Charities that promote alternative medicine or therapies must provide objective, scientific evidence in support of their claims, according to commission guidance which was updated in 2018.

The commission said GSGs own board acknowledged it would not meet the criteria for registration if it applied today.

GSG was registered as a charity in 1997 to support cancer patients and advance Gerson nutritional therapy.

The commission opened a case to scrutinise GSG in 2019, a year after concluding a consultation into public benefit offered by alternative therapy charities.

That consultation recommended that charities offering alternative cures and treatments must provide scientific evidence to back their claims.

The regulator said that during its assessment it identified concerns about the extent to which GSG provided public benefit, and that the charitys trustees also acknowledged that the evidence to support Gerson nutritional therapy would not now meet the commissions criteria for registration as a charity.

Helen Earner, director of regulatory services at the commission, said: I welcome the decision by the trustees of GSG to wind it up, having recognised our concerns regarding its claims to cure people from life-threatening diseases.

Charitable status is a special status that comes with clear expectations and responsibilities. The law is clear that all organisations which wish to hold that status must demonstrate public benefit.

It is right that, following the commissions intervention, the organisation has been removed from the register of charities.

The regulator said that there was a number of other ongoing cases concerning other alternative therapy charities and that it would take firm and robust action where necessary.

A spokesperson for GSG told Third Sector: The trustees of the Gerson Support Group are extremely sad that the charity had to close down.

They are aware of many thousands of people worldwide who have been helped by Dr Gersons therapy, and personally know people who believe they would not be alive today but for Dr Gersons work.

The commission decided to review its guidance on alternative therapy charities shortly after the Good Thinking Society, which says it battles against irrationality and pseudoscience, threatened to bring legal action over the regulators stance.

Michael Marshall, project director of the Good Thinking Society, said: It is extremely encouraging to see that the GSG will no longer be able to use their charitable status to promote a disproven and wholly ineffective therapy to vulnerable cancer patients.

As the Charity Commission has noted, however, this is far from the only example of an organisation using its charitable status to encourage the public to put their trust in unproven and potentially harmful forms of treatment. It is not even the only charity spreading misinformation about cancer.

Marshall described todays news as a good first step in protecting the public and the reputation of the charity sector as a whole but it is only the first step. We will be watching with keen interest what steps follow.

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Alternative medicine charity winds down after regulator 'identified concerns' about its public benefit - Third Sector

Another massive study has shown the power mindfulness-based therapy can have on the brain.

A randomized clinical trial by Utah researchers compared the efficacy of mindfulness-based therapy withcognitive behavioral therapy (CBT) in reducing both opioid use and pain in chronic pain patients.

The trial, published in JAMA Internal Medicine in February 2022, was the latest in a series of studies that use mindfulness-based techniques to reduce pain and opioid use in people with chronic pain. The lead study author,Eric Garland, PhD, a licensed clinical social worker, distinguished professor, and the director of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah in Salt Lake City, designed the Mindfulness-Oriented Recovery Enhancement (MORE) approach. It combines mindfulness training, changes to the course of negative thoughts, relearning how to appreciate positive experiences, and positive psychology, which encourages people to focus on their strengths rather than weaknesses.

The randomized clinical trial included 250 adults with chronic pain who were misusing the opioids they were prescribed to treat their pain. Half met criteria for opioid use disorder (OUD) at the time they were enrolled in the trial. Roughly half the patients underwent group mindfulness training for eight weeks using MORE. The control group received standard CBT in a group setting.

The researchers encouraged the patients to do what was right for them and did not force anyone to wean themselves off medication. For patients who wanted or needed to remain on opioids, MORE helped them reduce their risk of misuse and relieved pain.

Opioid misuse decreased by an average of 45 percent in the MORE group, double that of the CBT group. More than 35 percent of people in the MORE group cut their opioid use by at least half. The people in the MORE group also reported less pain, opioid cravings, and emotional distress, even though they were taking fewer pain pills. The effects lasted at least until the researchers nine-month follow-up period. And although the effects appeared to plateau between six and nine months for the MORE group, the effects of CBT actually waned in the control group.

Its difficult to make blanket statements about chronic pain since its so different in everyone, but there seems to be a way of modulating how ones relationship with pain modulates the amount of craving they have for a drug, saysFadel Zeidan, PhD, an associate professor of anesthesiology at the University of California in San Diego and the director of the Pain, Health, and Mindfulness Lab, who was not involved in the new research.

Dr. Garland and his colleagues also asked the participants to record their own mindfulness practices for the first month following their eight-week treatment.

Those data show that the more people practice, the greater the benefit they get, says Garland, noting that future research will focus on the longevity of mindfulness-based treatment for chronic pain and opioid use.

The new research was the longest and most advanced of the trials that tested the specifically designed mindfulness intervention in chronic pain patients who misused opioids. The goal with these patients is twofold: Reduce opioid dependence and still manage pain.

We need adjunctive, non-opioid therapies that are safe and effective that can help address unrelieved pain, says Garland. This study demonstrates the efficacy of an intervention that can help people who are prescribed opioids continue to get the adequate pain relief they need while reducing opioid-related risks and harm.

According to Dr. Zeidan, what makes the MORE approach unique is its focus on helping people who have used opioids long-term learn how to savor pleasure again.

Because of opioids, their reward systems are completely out of whack. The physiology has been changed in a way where the drive for the drug has taken over their reward pathways, he says. Garland is showing that this component of savoring, something that opiate-using chronic pain patients have a deficiency in, can be modulated through this very multimodal approach.

One thing Garland notes is that despite relatively high doses of opioids, people in the trial were still suffering from high levels of chronic pain.

Thats because opiates dont work for chronic pain, says Zeidan.

Rather, opiates like morphine can relieve acute pain that is temporary, such as post-surgery pain. Chronic pain, on the other hand, is often lifelong. According to Zeidan, this makes mindfulness a particularly good modality for helping people cope with chronic pain.

From the research weve seen to date, the immediate effect that mindfulness can have is on pain, says Zeidan. It's one of the only techniques that can immediately reduce pain, and were just now starting to understand that.

According to Zeidan, research has so far shown that the effect mindfulness has on pain perception is not just a placebo effect, and unlike other pain-relieving modalities, it appears to work outside the bodys internal opioid system.

Medications like prescription opioids, and even over-the-counter pain relievers like ibuprofen, work within the bodys opioid system to block signals from reaching the brain, where they are processed and perceived as pain.

Mindfulness engages neural and physiological processes that are quite unique. The theory is we cannot relieve pain outside of the opioid system using any other method, says Zeidan.

In recent years, theres been a debate about whether chronic pain has psychological origins.

I take issue with this idea that chronic pain is mostly psychological, says Garland. There are certainly psychological factors that influence people's pain, but people also suffer from medical conditions that are very painful, and we shouldnt reduce all their pain to being psychological.

Even when pain is coming from a purely physiological source, like a herniated disk or an arthritic knee, mindfulness can still be a great way to reduce pain.

That is not because pain is psychological. Its because all pain is processed in the brain and mindfulness changes how the brain processes the signals of damage from the body, says Garland.

The latest MORE trial showed that mindfulness can also quell the emotional side effects of living with chronic pain. At the beginning of the trial, nearly 70 percent of patients met criteria for major depressive disorder (MDD). By the end of the trial, people treated with MORE showed reduced symptoms of depression that no longer qualified as MDD.

According to Zeidan, this effect is just as important as pain relief and reduced dependence on opioids.

In chronic pain patients, the pain will always be there. The pain is not the problem; its the snowball effect of the depression, anxiety, sleeplessness, suffering, and inability to savor the joys in life that makes you become your pain, he says.

Zeidan views a multimodal approach,rather than pain medications, to be the core of chronic pain management.

I dont think of mindfulness-based therapies, physical therapy, or exercise as alternative therapies, says Zeidan. They are central.

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Mindfulness Reduces Opioid Misuse for Chronic Pain - Everyday Health

Women are evolving in every part of the world with their unswerving dedication and out-of-the-box approach. There is no doubt that if a woman tries, she can surely succeed in building something of an empire. Making us believe that the importance of womens emancipation cannot be limited.

As we celebrate International Womens Day, we bring forward strong opinions about women showing great courage by making their mark in the health industry. These influential women have an unshakeable desire to push their boundaries and create an impact.Below are the opinions of female doctors and coaches from different domains guiding people on the route to a healthy lifestyle. As they say building a healthy lifestyle should be a continuous process, not a one-time event.

Ojaswini Kapoor, CEO Bloom IVF Group, Indias leading chain of fertility & IVF centres

Todays women are reaching newer heights every moment and juggling countless responsibilities in the process. It is heartening to see the recognition of women's intellect and power in all industries and fields. Along with opting for unconventional career paths, women are also aware & decisive about their lifestyle and reproductive choices. However, I strongly feel that women often tend to ignore their own wellness and mental health needs. It is crucial to give attention to a healthy diet and an exercise regime with yoga & meditation. This really aids you to be more productive while taking care of yourself at the same time.

DrRichika Sahay, Founder - India IVF Clinic & Fertility

While a woman is labeled as "barren", we choose to overlook the fact that men also play a fairly crucial role in conception, as the ever-dominant male ego goes into self-denial. DrRichika said. This led her to start the Flertility and India IVF clinic, which has a scientifically validated complete end-to-end, holistic, emotional, medical management, and support solution. It has created a platform that doesnt look scary, alien, or medical, but clear, fresh, and "normal," packed full of trusted information. She is convinced she can bring happiness with her dedication and hard work. Dr. Richika is an IVF specialist and a gynecological laparoscopic surgeon with over 20 years of experience. She wants to help couple to dream of having their perfect family.

Neha Sawhney, a certified happiness coach and founder of happy Heads

Many women in India suffer from mental disorders like depression or anxiety. Due to a lack of awareness, these issues are considered taboo. As a result, people refrain from seeking professional help. I suffered from acute depression myself, due to which my life got upside down. But I fought it with my might. From there, my journey to happiness began.

A healthy mind can lead to a healthy life and a much happier life. Happy Heads is an initiative that focuses on improving mental health with games, affirmation cards, etc. My ultimate goal is to launch a free to use Mobile App to provide support and therapies for kids, teens, and adults suffering from mental disorders. We wish to make a difference with Happy Heads.

Kanu Priya Sekhri a coach and therapist Kindlywithkanu

Many women have grown up feeling not fair enough, not tall enough, not thin enough, not intelligent enough the list is endless. But it basically feels like I am not enough. This impacts our mental health and sometimes our physical health and we may not even realise it. Often no one else is saying anything about us anymore. But that voice has become our voice and we keep feeling not enough. This has an impact on our work and our relationships. We need to heal and release that voice inside us and then we can achieve anything.

Kanu is a coach and therapist. She led a transformation program, The Heartbeat Solution, with participants from all over the world to learn mind-set techniques.

Dr Neha Harneja, founder Therapies by Neha/ Tarot.temple

"Where there is a strong woman, there is magic."

My husband passed away, and I took over his electronics business. People around me gave me two years. I survived for fifteen. I survived because I stopped believing it was a mans world. Not only that, I studied to become a doctor in alternative medicine, an energy therapist, and a trauma manager. Today as a energy shifter I provide bio field therapies like Reiki, Pranic healing, psychological acupressure EFT, Bach flower therapy to deal and heal with all kinds of trauma-physical, emotional or relational. I also offer tarot card readings for extra guidance. I am here to make a difference!

Indeed having a healthy routine is beneficial for the long term as it maintains your body functioning along with making you fit and ready to fight every day. On the occasion of Womens day, above listed leading ladies have explained and talked about the importance of a healthy lifestyle not just for women but for each and every person. So, take their advice and start your healthy routine from today.

Happy Womens Day!!

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International Womens Day: How These Women Are Transforming The Healthcare Industry - Outlook India