Fit for the Future

THERE ARE MOMENTS IN HISTORY WHEN medicine takes a giant leap forward. After penicillin was first discovered, the antibiotics revolution began and it increased the average age of human beings by decades because now there was finally an answer to infectious diseases, a major killer. For another instance in more recent times, there are the mRNA vaccines which, due to Covid and the emergency it created, were pri­oritised as a medical tool. The technology is not being limited to vaccines now and will soon target diseases like cancer. Last year was also the harbinger of another revolutionary medi­cal process—gene therapy. Just as 2023 was about to end came news that the Food and Drug Administration (USFDA) of the US, following a similar action by the UK, had approved the first therapy using a gene editing technology that goes by the acronym CRISPR. It now moves from laboratory and trials to mainstream usage. The approval is for the treatment of Sickle Cell Disease, a hereditary disorder that prevents haemoglobin in blood from carrying oxygen. Anyone afflicted with it had to live with it because there was no treatment. The gene therapy, known as exa-cel, seems to work for at least a year. As Scientific American wrote after the USFDA approval, “In the new therapy, physicians remove a person’s own bone marrow stem cells, edit them with exa-cel, destroy the rest of the person’s untreated bone marrow and then reinfuse the edited cells. Because these edited cells eventually repopulate the body, exa-cel is consid­ered a ‘curative’ therapy that will theoretically last the rest of the recipient’s life, although Vertex and CRISPR Therapeutics have followed most of their trial participants for less than two years.”

Because sickle cell is a relatively rare disease, gene therapy’s impact is yet to be appreciated. But 2024 will be the year when there will be more recognition of how radical it is. It upends much of what medicine stands for today because gene editing is potentially a one and done process. Since genes are the code that governs the human body’s growth and functions, the po­tential of its applications is limitless, from targeting disease to extending life. All those benefits are some way off but animal studies are already showing promise. The journal Nature, in its December issue, had an article that said gene therapy might eventually lead to a treatment for Alzheimer’s but would also come initially with high costs. The article said, “As with other gene therapies, high treatment costs could present a challenge further down the line, says Gerold Schmitt-Ulms, who studies protein function in Alzheimer’s at the University of Toronto. ‘At the current rate of innovation in this area, transformative treatments are only a few years away,’ he says. ‘At that time, the biggest challenge will be to make these personalized and costly treatments available to the masses.’” A survey by Global Data titled ‘State of the Biopharmaceutical Industry in 2024’ found that healthcare professionals expected cell and gene therapy to be the biggest trend in pharmaceuticals for this year and one of the reasons is Covid because “genomics has helped in track­ing and understanding the spread of COVID-19, which further heightened its popularity and increased investments by the biopharmaceutical industry in this trend.”

A forecast for India in medicine for 2024 would be related to weight loss. A shortcut to losing fat that the West discovered in the last couple of years was a new category of medicines that led to loss of appetite. Weight reduction happened without any ef­fort. This medication, called semaglutide with brand names like Ozempic and Wegovy, was initially targeted at control of blood sugar in diabetes but soon began to be prescribed for obesity. Once taken, they imitate a hormone that makes the body feel full and the desire to eat is considerably reduced. People who used these drugs found the results startling and all through last year it went on to be one of the biggest fads in developed Western coun­tries. Even though a doctor is needed to access these medicines, it is now being widely used not just for obesity but for general weight loss. In India, the trend has only just begun and it will pick up steam now. An article in The Print last October had said: “Rybelsus Semaglutide was approved last year in India to treat Type-2 diabetes. The injectables are yet to enter the local market, but are covertly procured by a small section of society. Given the hype, semaglutide is gaining traction across India with the requests pouring in—more so in private, luxury clinics—their clients are also able to get their hands on Ozempic and Wegovy, injections that are yet to be approved in India. It is still not a game changer of mythic proportions, but it represents hope for those battling obesity and body image issues.” One of the reasons why it might have a limited market here is because presently these medicines are very expensive but that is set to change. Already, Indian pharmaceutical companies, seeing how much demand there is, are scrambling to make cheaper generics. There are con­cerns about the long-term effects of these medicines given that it has only been in the market for a short time but it has not made a dent on demand.

The year will also see fitness related trends when it comes to health. A clear one is even more melding in of technology. With the artificial intelligence (AI) era having begun, the use of AI as an aid in individual fitness goals is a given. There are other patterns too. The American College of Sports Medicine (ACSM) came out with a list of fitness trends expected for 2024 after conducting a survey of 2,000 experts. The No 1 was wearable technology, the use of trackers, monitors that correlate physical markers with exercise. It has remained in their surveys as a top-three trend since 2016. ACSM identified other trends which included an increasing emphasis on heath programmes at the workplace, the responsibility that companies feel towards em­ployee wellness. Another trend was older people having fitness programmes designed for them. This was a demography that till some decades back didn’t focus much on physical exercise but now, even in India, increasingly large numbers of senior citizens feel it necessary to be fit to better their quality of life. A trend that made it to the ACSM top ten for the first time this year was the idea that mental health could be improved by physical activity and so has become one of the goals of exercise.

An interesting phenomenon is the rise of slow cardio. For some time now, workouts like High Intensity Interval Training or Crossfit, which demand extreme effort, have been in vogue. Slow cardio inverts the idea and claims that doing something at a low intensity for longer periods is just equally beneficial and it is finding a lot of takers. When the magazine Men’s Journal got a team of experts to predict what was becoming vogue in fitness, this was one of the trends they identified. Low-intensity training can be as easy as walking at a brisk pace. One of the advantages of this form of exercise is that it is easier to keep up with. Otherwise, there is a graveyard of millions of New Year resolutions to start working out in earnest because their makers found it unable to sustain and part of the reason is that the more punishing some­thing is, the more the mind will try to get out of it. Steady-state or low-intensity cardio asks for no such sacrifices.

A label for it that became viral on TikTok last year because of social media influencer Hope Zukerbrow was Cozy Cardio. She put up her own life story of wanting to lose weight by the usual fitness drill and finding that a lot of the kilograms lost would then pile up again when she fell off the wagon. So she changed strategy to initially just start walking in comfort, first slowly and then faster, with time. In an article on her and cozy cardio, CNN wrote about its advantages: “Replacing 30 minutes a day of sedentary time with light-intensity physical activity was associated with an 11% reduction in all-cause mortality and a 24% reduction in cardiovascular mortality, according to a January 2018 study. Another study of low-intensity walking, published in February 2019, showed beneficial effects on blood pressure and heart rate, suggesting it may be an appropriate form of exercise for hypertension management, especially for those who are frail or have a chronic illness.” Perhaps the moral of the story to carry through 2024 is that what matters is not testing your limits, instead going at a pace that you know can become a lifelong habit.

About The Author

Madhavankutty Pillai

Madhavankutty Pillai has no specialisations whatsoever. He is among the last of the generalists. And also Open chief of bureau, Mumbai  

•