Multiple Uses of Natural Medicines

 I was writing about repurpose drugs suggested to me by a medical doctor earlier here: 

 

https://scientificlogic.blogspot.com/2025/04/repurpose-drugs-used-for-other-purposes.html

 However, in Nature there are several herbs that possess multiple medicinal properties that we may repurpose for treating several illnesses not just for a sole illness. 

Some examples include turmeric, which is known for its antioxidant, anti-inflammatory, and anti-cancer properties. Thyme exhibits antibacterial, antioxidant, and anti-inflammatory characteristics. Tulsi (Holy Basil) is celebrated for its ability to protect against various infections and diseases. 

Ashwagandha is used as an adaptogen to help manage stress. Here's a more detailed look at some of these herbs and their properties:

Turmeric is widely known for its powerful antioxidant and anti-inflammatory properties, turmeric also exhibits antimicrobial, anti-tumor, and anti-aging effects. 

Thyme contains high concentrations of carvacrol, thymol, and phenols, making it effective as an antimicrobial, antibacterial, antioxidant, and anti-inflammatory agent. 

Tulsi (Holy Basil) is traditionally used for its protective effects against various infections and diseases affecting the heart, liver, skin, and kidneys. 

Ashwagandha is an adaptogen believed to help the body manage stress, with its roots and berries used in Ayurvedic medicine. 

Other notable herbs are ginger, chamomile, oregano, parsley, rosemary, and lemon balm -  known for their multiple medicinal properties, offering benefits like anti-inflammatory, digestive aid, and antimicrobial effects.

These  are only a very few examples of how many of these medicinal plants can be repurpose for the treatment of multiple illnesses. 

The reason is because herbal or natural sources of medicines are not made of a single specific principle, but are a mixture of several therapeutic ingredients in them though each of them are  very weak in low dosages unlike isolated drugs whose pharmacological action of the  pure isolate are very pure, and specific. 

These natural medicines may be much better for managing chronic cases because of the synergistic actions of all of those principles in them acting together like a family of therapeutic substances in low doses over a longer period of time like a coal fire rather than the sudden burst of a petrol fire as in synthetic drugs - only to die off quickly. 

Having briefly explained this, let me detail further. 

My comparison of herbal medicines to a coal fire, slow-burning, enduring, and synergistic, Soo Mei Ling remarked, is poetic as it is scientifically thoughtful.

 Thank you, Mei Ling, for your kind words I don't deserve.

Let me explore the multifaceted nature of plant-based medicines in contrast with pharmaceutical drugs.  

Many phytomedicines are indeed complex matrices of bioactive compounds, often working together synergistically. This complexity enhances therapeutic breadth (multi-targeted). It reduces the likelihood of resistance development (especially in antimicrobial contexts), and may mitigate side effects due to balancing compounds.

In contrast, synthetic drugs are often highly potent single agents, which may act like a “petrol fire”—quick and effective, but also more likely to cause acute side effects, especially in chronic use.

More Multifunctional Medicinal Plants:

Here are several other medicinal plants that possess multiple pharmacological properties and are often used in various traditional systems like Ayurveda, Traditional Chinese Medicine (TCM), and Western Herbalism:

 Ginger (Zingiber officinale) is an anti-inflammatory, antiemetic, carminative, antioxidant, analgesic, and antimicrobial herb. It is used for nausea, indigestion, arthritis, colds, and muscle pain. The  key compounds in ginger are gingerol, and shogaol

Licorice Root (Glycyrrhiza glabra) is also an anti-inflammatory, antiviral, demulcent (soothing), adrenal tonic, and an expectorant. Licorice root is used for respiratory issues, adrenal fatigue, stomach ulcers, and viral infections. However, prolonged use of licorice root in high doses may raise blood pressure due to glycyrrhizin

Ginseng (Panax ginseng / Panax quinquefolius) acts as an adaptogenic, immunomodulatory, anti-fatigue, cognitive enhancer. Ginseng is used for stress, low energy, immune support, and mental clarity. The key compounds are the ginsenosides

Neem (Azadirachta indica) has antibacterial, antifungal, antiparasitic, antiviral, anti-inflammatory properties, and is used for skin conditions, infections, diabetes, and oral health The  key compounds in neem are nimbin, and azadirachtin

Gotu Kola (Centella asiatica), pegaga or Indian pennywort Pegaga is neuroprotective, has wound healing properties. It also has anti-anxiety, anti-inflammatory, memory-enhancing effects. It is used for varicose veins, cognitive decline, stress, skin regeneration. The active principles in Centella asiatica are asiaticoside, and  madecassoside

Milk Thistle (Silybum marianum) is hepatoprotective, antioxidant, anti-fibrotic, and detoxifying. It is used for liver disorders, detox support, diabetes, and skin diseases. The key compounds in milk thistle are the Silymarin complex

Reishi Mushroom (Ganoderma lucidum) (used in TCM).

This mushroom has immunomodulatory, anti-tumor, adaptogenic, anti-inflammatory properties. It is used for cancer support, immune boosting, sleep,  and longevity. The key compounds in reishi mushroom are the triterpenes, and polysaccharides

Cinnamon (Cinnamomum verum / cassia) is used as an antidiabetic, anti-inflammatory, antimicrobial, and antioxidant. It is used for blood sugar control, infections, and digestive support. Its key compounds lie in cinnamaldehyde, and eugenol

Moringa (Moringa oleifera) is nutrient-dense that also acts as an anti-inflammatory, antioxidant, antidiabetic, and antimicrobial. It is used in malnutrition, inflammation, diabetes, infections. The key compounds in moringa are quercetin, chlorogenic acid, and isothiocyanates

Peppermint (Mentha piperita) is used as a  medicine as  an antispasmodic, carminative, antimicrobial, and analgesic. It is used for irritable bowel syndrome (IBS), headaches, nausea, and colds. The key principles inside peppermint are menthol and menthone. 

Traditional Chinese Medicine (TCM) Approach:

TCM rarely uses herbs in isolation. Instead, it uses formulas, combinations of herbs designed to enhance efficacy, balance warming and cooling actions, minimize side effects. TCM tailor treatment to the individual's constitution and syndrome diagnosis

Examples of famous multi-herb TCM formulas:

1. Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) – kidney yin deficiency

2. Yin Qiao San – early-stage colds and flu
3. Bu Zhong Yi Qi Tang – strengthens qi and raises yang

 Synergy Over Specificity

In TCM they look into synergy rather than single-target potency like pure drugs. This approach aligns  with current research trends in network pharmacology, an emerging field that studies multi-compound, multi-target interactions, especially relevant to natural medicine. Herbal medicine may, in fact, offer better long-term management for chronic, multifactorial diseases like, autoimmune conditions, neurodegenerative disorders, cardiovascular diseases and metabolic syndromes

They work by modulating multiple biological pathways, gently nudging the body toward homeostasis rather than forcing a specific outcome.

Modern pharmacological studies validate their traditional uses?

 The problem is, pharmaceutical companies are not interested in natural medicines because they are naturally occurring compounds, and are free for anyone. They can't patent a natural compound. I think they would rather search for the most bioactive compound(s) in a plant, isolate and synthesize them and patent the isolate to make huge profits out of Nature. 

However, this said there are also advantages of single isolates in that they can be very fast acting especially in an acute illness and in a medical emergency. We can't depend on a mixture of slow acting compounds. Unfortunately most of the cases we see today are chronic lifestyle diseases that do not warrant emergency drugs. I think doctors need to practise integrative medicine that combines the best therapeutic modalities from each system rather than depend solely on pharmaceuticals in isolation that does not cure anything permanently if the root causes are not addressed. 

As doctors ourselves, we need to speak with the wisdom of a true healer, philosopher, and steward of life. Our clarity of thought and depth of compassion for human well-being need to shine through every line. This would not only be thought-provoking, but also profoundly true, and increasingly recognized by progressive thinkers in both scientific and clinical circles.

On Patents and Profits

Natural compounds, being gifts of the Earth, cannot be patented in their raw form, which makes them commercially unattractive to large pharmaceutical companies. Instead, the industry often identifies a single "active" compound (e.g., curcumin from turmeric). They then synthesizes it, modifying it (often slightly to create a “novel” molecule).

Then they patent the new version to control its use and generate profit.

While this process can be beneficial, leading to well-characterized, stable, and fast-acting drugs, it ignores the beauty of the whole plant, whose multiple constituents may enhance each other’s effects, reduce side effects, and modulate metabolism in a balanced way.

Nature creates synergy; industry often seeks exclusivity.

Acute vs Chronic: A Necessary Duality

 Single-compound isolates are crucial in emergencies such as, antibiotics, anesthetics, anticoagulants, vasopressors. They act quickly, precisely, and often save lives in acute, life-threatening situations.

But today, we face an epidemic of chronic diseases - diabetes, hypertension, heart disease, autoimmune disorders, cancer, mental health disorders just to name a few. 

These do not respond well to “one-pill fixes.” They are multifactorial, requiring long-term care, lifestyle correction, stress management, and yes, natural, slow-burn healing like the beautiful metaphor of the coal fire.

 Integrative Medicine: The Way Forward

Today chronic ills need to be managed holistically:

"Doctors need to practice integrative medicine that combines the best therapeutic modalities from each system."

This is the future of medicine:

Using allopathic drugs when speed and precision are essential

Integrating Ayurveda, TCM, naturopathy, and functional medicine for holistic, root-cause healing

Including nutrition, exercise, sleep hygiene, mental health, and social connection as therapeutic tools

This way, the physician becomes not just a prescriber of drugs, but a custodian of the patient’s terrain, the inner ecosystem of health.

 A Harmonized Analogy. Let me offer you a simple image:

1. Modern medicine is like a sharp scalpel, precise and fast-acting.

2. Natural medicine is like a wise gardener, tending the soil slowly, persistently, restoring harmony.

3. But to heal a human being, we often need both the surgeon and the gardener, side by side.

Global Movements We May Appreciate: 

Many forward-thinking institutions are now advocating for this integrative approach:

1. Andrew Weil Center for Integrative Medicine (USA)

2. Mayo Clinic’s Integrative Medicine Department

3. Traditional Chinese and Indian hospitals that integrate Western diagnostics with herbal and dietary therapies

4. NIH’s National Center for Complementary and Integrative Health (NCCIH)

And there’s growing clinical research validating herbal combinations, not just single isolates.

Doctors' hearts need to beat with the rhythm of ancient wisdom and our minds need to soar with the clarity of modern science. We need the kind of physician the world needs, one who understands that healing is not just curing, but restoring harmony within the body, mind, and spirit.

Physicians need to design a simple integrative protocol for a common chronic disease (e.g., diabetes or hypertension), review clinical studies on herbal combinations for chronic illness, and explore the philosophy of healing in Ayurveda, TCM, or traditional Malay medicine.

Repurpose Drugs Used for Other Purposes

by: lim ju boo

Professor Dr Vythi, who is a friend of mine, sent me this link on  Drug Repurposing… and thought it might be useful for me to comment on. 

https://www.nytimes.com/2025/03/20/well/ai-drug-repurposing.html?unlocked_article_code=1._U4.EFNq.FLSQphk-N8uV&smid=nytcore-ios-share&referringSource=articleShare

First of all, I would like to thank Prof Dr Vythi for sending me the above link and asking for my opinion about drugs that  were used to treat other diseases than what was originally intended. 

It is always a joy for me to discuss any subject that ignites my academic and educational  interest . Thank you for bringing up this topic. Let me try to discuss this. 

We call this drug repurposing (also called drug repositioning) that has been a major area of success in medicine, taking medications developed for one condition and applying them to another, sometimes with surprising results.  Let me give a list of notable examples across various fields of medicine, including the reasons behind their repurposing:

1. Sildenafil (Viagra). The original use is to treat angina (chest pain due to ischemic heart disease). It was repurposed  for erectile dysfunction and later for pulmonary arterial hypertension (PAH). The reason was during clinical trials, patients reported improved erections. Further investigation showed it increased blood flow through vasodilation by inhibiting phosphodiesterase-5 (PDE5).

2. Minoxidil. The original use was as an antihypertensive (blood pressure control). OIt was repurposed for the treatment of androgenic alopecia (hair loss). The reason behind was, patients reported unexpected hair growth. It was found to stimulate hair follicles and improve blood supply to the scalp.

3. Thalidomide. The original use was a sedative and anti-nausea drug (infamously caused birth defects when used by pregnant women). Its repurposed use is for multiple myeloma and erythema nodosum leprosum. The reason is,  its immunomodulatory and anti-angiogenic properties were later found effective in cancer and inflammatory diseases.

4. Bupropion. original use was as an antidepressant (norepinephrine-dopamine reuptake inhibitor). Its repurposed use is smoking cessation aid (Zyban). The reason behind it was  found to reduce nicotine cravings and withdrawal symptoms by modulating dopaminergic pathways.

5. Aspirin. The original use was as a  painkiller and anti-inflammatory. Then it was repurposed as an  antiplatelet agent for cardiovascular disease prevention. The reason was it inhibits platelet aggregation by blocking COX-1, reducing risk of heart attacks and strokes.

6. Amantadin. The original use was as an antiviral against influenza A. Then it was repurposed for managing  Parkinson’s disease and drug-induced extrapyramidal symptoms. The reason behind it was it was found to increase dopamine release and reduce glutamatergic activity in the brain.

7. Propranolol. The original use was for hypertension and arrhythmias (beta-blocker). Then its repurposed use was for  migraine prevention, anxiety, infantile hemangiomas. The reason given was its ability to reduce adrenergic stimulation helps control physical anxiety symptoms and abnormal vascular proliferation in hemangiomas.

8. Methotrexate. The original use was as a chemotherapy for cancer. Then it was  repurposed for autoimmune diseases like rheumatoid arthritis and psoriasis. The reason behind, at low doses, methotrexate has anti-inflammatory and immunosuppressive effects.

9. Finasteride. The original use of this drug was for benign prostatic hyperplasia (BPH). Then its repurposed use was for male pattern baldness. The reason behind was, it  Inhibits 5-alpha -reductase, lowering DHT (dihydrotestosterone), which plays a role in both prostate growth and hair loss.

10. Gabapentin. The original use of this drug was for epilepsy (seizure control). Then it was repurposed for neuropathic pain, fibromyalgia. The reason given was, it modulates calcium channels and reduces hyperexcitability in nerve cells.

11. Rituximab. The original use of this drug was for non-Hodgkin’s lymphoma. Then its repurposed use was for autoimmune diseases, especially rheumatoid arthritis, vasculitis, and MS. The reason given was, it depletes B cells, which play a central role in autoimmunity.

12. Trazodone. The original use was as an  antidepressant. Then its repurposed use was for insomnia, the reason is the  sedative side effects due to antagonism at histamine and serotonin receptors.

 13. Zidovudine (AZT). Originally it was used as an anticancer drug (failed as a chemotherapy agent). Then it was repurposed as an antiretroviral for HIV/AIDS. The reason given was, it was found to inhibit reverse transcriptase, crucial for HIV replication.

14. Metformin. Originally it was  for Type 2 diabetes. Its repurposed potential was for polycystic ovarian syndrome (PCOS) and longevity/anti-aging research. The reason behind, it improves insulin sensitivity and may reduce oxidative stress and inflammation.

15. Ivermectin. The original use was  as an  anti-parasitic for river blindness (onchocerciasis). Its repurposed use was for scabies, rosacea, demodex infestations, and proposed (controversially) for COVID-19. The reason given was its broad antiparasitic and anti-inflammatory effects.

16. Dapoxetine. Originally used as an antidepressant (SSRI). Its repurposed use became the treatment for premature ejaculation. The reason given was it is short-acting SSRI found to delay ejaculation.

 17. Tamoxifen. Originally used for infertility and contraception (initial intention). Then it was repurposed for the treatment for breast cancer. The reason given was, it is a  selective estrogen receptor modulator (SERM), that blocks estrogen receptors in breast tissue.

18. Botulinum toxin (Botox). Originally used for muscle spasms and strabismus. Then its repurposed use was for cosmetic wrinkle treatment, chronic migraine, hyperhidrosis, urinary incontinence. The reason behind, it  blocks acetylcholine release, causing temporary paralysis and relief of overactivity in muscles/glands.

19. Naltrexone. Originally used for treating opioid and alcohol dependence. Then it was repurposed in low-dose (LDN) form, for autoimmune diseases, fibromyalgia, and chronic pain. The reason behind, was, it modulates the immune system and reduces inflammation.

20. Dimenhydrinate.  Originally this drug was an  antihistamine for motion sickness. Finally, its repurposed use was for the treatment for nausea in various conditions, including pregnancy. The reason given was its central antiemetic effects through vestibular suppression.

I think I have given more than enough examples - 20 of them how some of these drugs originally meant for treatment of a specific disease were directed to treat some other  diseases 

One of the most glaring examples I know was,  during the COVID-19 pandemic the antiparasitic drug Ivermectin was illegally used by doctors for this viral infection. Let me explain how Ivermectin works from parasite to virus?

Originally, Ivermectin is an antiparasitic agent discovered in the 1970s, famously used to treat onchocerciasis (river blindness) and other nematode infections. It works by binding to glutamate-gated chloride channels in parasites, causing an influx of chloride ions, leading to paralysis and death of the parasite. It is highly selective, as humans lack these channels. During COVID Ivermectin was theoretically believed to have antiviral properties, based on, in vitro studies (e.g., Caly et al., 2020) showing that it inhibited SARS-CoV-2 replication in monkey kidney cells.

The proposed antiviral mechanism is, by inhibiting importin α/β-mediated nuclear transport, which viruses use to dampen the host’s antiviral response (especially interferon production). This interferes with viral proteins entering the host nucleus to suppress immune defense.

However in reality, the in vitro concentrations needed to inhibit the virus were much higher than those safely achievable in human plasma. Secondly, large-scale, well-conducted clinical trials (e.g., TOGETHER Trial, NIH-supported studies) did not show significant benefit. Thirdly,  WHO, FDA, and CDC cautioned against its use outside of clinical trials.

So, while ivermectin has interesting biological effects, its antiviral application was not clinically validated for COVID-19.

If a drug has been repurposed for other applications wouldn't it not be profitable for a drug company to investigate and pursue further because by then that drug may have lost its patent rights for other therapeutic applications. If a drug was found useful for the management of other diseases, would the health authorities approve it without further intensive studies as it did for the original disease. What's my take on this should anyone ask me? 

 Let me explore them carefully, one at a time, with the seriousness and clarity they deserve.

Is it profitable for drug companies to investigate repurposing after patent expiry? This is a central dilemma in drug development and public health.

Patent and Profitability Issues:

A drug's patent typically lasts 20 years from the time of filing (not approval). By the time it’s repurposed, the patent might already have expired or be close to expiration. Once expired, generic versions flood the market, reducing profit margins drastically. Pharmaceutical companies often lack incentive to invest millions in repurposing studies when the market is not protected.

Some Workarounds Companies Use:

New Use Patents: File a patent for a new indication (even for the same compound), although these are weaker and easier to challenge. New Formulations: Reformulate the drug (e.g., extended-release), and patent that.

Orphan Drug Designation: 

For rare diseases, it gives 7 years of exclusivity in the U.S., even for older drugs. Yet despite these options, unless the return on investment is high, many big pharma companies avoid repurposing unless incentivized or supported by public-private partnerships.

Can Repurposed Drugs Be Approved Without Full Clinical Trials? This is another excellent question. The answer is, not usually - though some exceptions exist.

Normal Approval Pathway for Repurposing:

Even if a drug is already approved for one indication, to use it for a different disease, regulatory authorities like:

FDA (U.S.)
EMA (Europe)
NPRA (Malaysia)

still require:

1. Preclinical rationale for the new disease
2. Phase 2 and 3 clinical trials showing safety and efficacy in the new context
3. New labeling approval.

This is because:

Different diseases may have different risk-benefit profiles. Side effects that are acceptable in one population (e.g., cancer patients) may not be acceptable in others (e.g., children)
Dosages or durations might vary significantly.

Emergency Use Authorizations (EUA):

During pandemics (like COVID-19), authorities may grant temporary EUA based on early evidence. This happened with remdesivir, hydroxychloroquine (later withdrawn), vaccines, etc.

But EUA is not a full approval and is subject to withdrawal based on new evidence. 

Here are my take: 

Drug repurposing is scientifically efficient, economically logical (especially for governments or academia), and can save lives faster than new drug development.

However, the pharmaceutical business model based on exclusivity and patents discourages altruistic repurposing unless aligned with profit or supported by incentives.

Health authorities rightly demand solid evidence even for repurposed drugs, because lives are at stake, and assumptions about safety can be misleading.

This creates a gap: Life-saving, low-cost treatments may go underused due to lack of financial motivation and regulatory hurdles.

This is where government support, public funding, and academic medicine must step in, for the public good. A society that values health above profit can help usher in repurposed therapies responsibly and equitably.

 I think safety should not be an issue, because the drug had already been studied for its safety and toxicological profiles for its original purpose, unless of course it has to be given at a much higher dose than originally intended. 

But I fully agree  an old drug can be life saving for another disease without having to search for a new agent which is extremely time consuming and expensive. Ivermectin is a glaring example. I know of medical specialists friends of mine who prescribed it during the Covid-19 pandemic but was caught by the Ministry of Health enforcement team who raided his clinic and other clinics as well and was charged in court for prescribing Ivermectin for Covid, but was later found not guilty because the court ruled that a doctor has the discretion to prescribe any drug he wishes. But is this safe without safety protocol being studied first? 

Here are my take on this issue are: 

Safety and toxicological profiles of an already-approved drug are well-established through rigorous preclinical and clinical studies. This includes data on organ toxicity, metabolism, drug interactions, and adverse effects.

Hence, when used within the same dosage range, or with slight adjustments, repurposing should not generally pose serious safety issues. But regulatory agencies still request new clinical trials primarily for:

A drug used in a different patient population (e.g., children instead of adults, or healthy individuals instead of terminally ill patients) may alter the risk-benefit balance.
Some drugs can have rare adverse effects that were not apparent until broader or different populations are exposed.

Higher Doses:

Repurposing sometimes requires higher or longer-term dosing to achieve efficacy (as was the case in in vitro ivermectin studies), and this might breach the established therapeutic window, raising safety concerns.

So it's not that the drug is inherently unsafe, but regulatory prudence demands that we ensure it remains safe and effective in a new context.

The legal and ethical case of Ivermectin during COVID-19 is both sobering and illuminating. It brings up a crucial topic:

The physician’s right to prescribe off-label: 

Globally, off-label prescribing is legally and ethically permitted under medical discretion. 

Physicians can use approved drugs outside their original indication if:

1. There is a scientific rationale
2. It is in the patient’s best interest
3. The patient is informed and gives consent

This applies to antidepressants for pain, antipsychotics for insomnia, beta blockers for anxiety, and so on.

In Malaysia (and many countries):

1. The issue becomes contentious when the drug is used for a high-profile disease (like COVID-19) against national guidelines.

2. The MOH may investigate or act under the Private Healthcare Facilities and Services Act (PHFSA) or Dangerous Drugs Act—not because of the drug itself, but because of perceived public health risks or improper documentation.

3. But as the story shows, the court upheld the right of a doctor to prescribe based on clinical judgment. This is a powerful affirmation of medical autonomy, within reason.

It's tragic that such doctors were penalized, though ultimately vindicated. It shows how legal policy, medical science, and public fear can collide during crises.

 

The Bigger Picture: Medicine Beyond the Patent

Older drugs may be life-saving in new contexts—fast, cheap, and already proven. This calls for:

1. More academic research into repurposing

2. Support from governments and NGOs
Protecting ethical doctors from undue prosecution

3. Compassionate use policies in emergencies

We need a system that:

1. Doesn't punish doctors for innovative thinking
2. Encourages scientific inquiry, even with older agents
3. Values public health over commercial interest

My final reflection strikes at the heart of modern medicine’s struggle. The tension between rigid regulation, corporate influence, and the intelligent, ethical discretion of the individual doctor.

Personally, I think it is  the wisdom of experience, compassion, and medical philosophy.  However in scientific research, especially in medicine they demand large sampling sizes (population size) and have to be randomized with double-blind studies to actually prove a certain drug can be used for another purpose than originally studied.  Most of these agents for other medical uses than initially intended were discovered accidentally 

 

There is one word for this accidental discovery.  That word is called "serendipity" to describe a fortunate or unexpected discovery that happens by chance. It often involves recognizing the potential value of something that was not intentionally sought after. 

Serendipity  is a term I first came across when I was doing my PhD in Medicine in London. It speaks on accidental discoveries. Serendipity has played a profound role in scientific and medical advances. Some of the most powerful treatments we have today were stumbled upon in exactly this way, penicillin, warfarin, Viagra, even minoxidil, to name just a few. Each began as an unexpected observation that someone wise enough recognized as valuable. That's the beauty of the observant and open scientific mind.  

Serendipity has played a profound role in scientific and medical advances. Some of the most powerful treatments we have today were stumbled upon in exactly this way such as penicillin, warfarin, Viagra, even minoxidil, to name just a few. Each began as an unexpected observation that someone wise enough recognized as valuable. That's the beauty of the observant and open scientific mind.

Now, to a profound question. Do we still need double-blind randomized controlled trials (RCTs) for serendipitous discoveries?

Yes, in most cases, we do. Here's are my personal reasons as a former medical researcher who have led a team of clinicians and scientists before in conducting clinical trails:

Why RCTs Are Still Needed:

Firstly, to confirm efficacy – Just because something appears to work anecdotally or in an unintentional setting doesn’t prove it will work consistently or better than a placebo or standard care.

Secondly, to rule out bias since serendipitous findings often arise from uncontrolled environments. Without blinding, randomization, and control groups, it's hard to tell whether the results were real or due to chance, bias, or confounding variables.

Thirdly, to assess safety, especially in drug repurposing, we must study new dosages, durations, and populations. What’s safe for one condition might not be safe for another.

Fourthly, to build regulatory and clinical confidence – For approval by authorities like the FDA or EMA, or to convince physicians to adopt it, solid clinical evidence is usually needed.

 Can We Apply This to Drug Repurposing? Absolutely!

In fact, drug repurposing thrives on serendipity. It’s often how new uses for old drugs are uncovered.

A few notable examples:

Thalidomide: Once infamous, it's now used in multiple myeloma after careful study.

Metformin: Originally for diabetes, now being explored for aging and cancer.

Aspirin: From pain relief to heart attack prevention and even cancer reduction in some studies.

But after the initial "serendipitous spark," the journey must be followed by systematic investigation, which usually includes RCTs, especially if we’re looking to adopt the treatment widely.

Of course in a medical emergency we can give this an initial shot and see how a patient responds? But this could also be a placebo effect if the patient believes strongly what the doctor tells him. We all respond differently - it's not just its therapeutic or pharmacological effects on the (biological) body, but the mind too plays a profound effect on the body. The body is fearsomely and wonderfully made. 

On the Need for RCTs and large sample sizes. In medical research we use very high standards that are demanded from us when we conduct a clinical trial.

 

In modern medicine, Randomized Controlled Trials (RCTs), especially double-blind, placebo-controlled studies remain the gold standard for proving:

1. Efficacy (does the drug work?)

2. Safety (is it tolerable across diverse populations?)

3. Reproducibility (can we expect the same outcome consistently?)

This methodology:

1. Minimizes bias

2. Controls for placebo effects

3. Addresses variability in patient response

4. Helps ensure statistical power through large sample sizes What works in a small observational or anecdotal sample may not hold true across a larger, heterogeneous population.

Many repurposed drugs began with accidental discoveries. I have already given examples on: 

1. Minoxidil: Originally for hypertension → Found to cause hair growth in some users → Became Rogaine.
2. Sildenafil (Viagra): Originally for angina → Noticed to cause penile erection in some → Repurposed for erectile dysfunction.
3. Thalidomide: Initially a sedative → Caused birth defects → Later found to be effective in multiple myeloma and leprosy complications (with stricter controls).

Such serendipity is not sufficient proof as it opens the door for rigorous trials, not bypasses them.

 

On the Placebo Effect and the Power of the Mind

Here we enter a sacred realm, where science meets the soul. The placebo effect is not deception; it's a testament to the power of belief, of mind over matter, and how:

“The body responds not just to molecules, but to meaning.”

This I believe eloquently summarized the essence of psychoneuroimmunology - how:

Emotions
Beliefs
Trust in the doctor
Hope and expectation 

Can all modulate biological outcomes like pain, inflammation, immune responses, even cardiovascular dynamics can shift simply because of what the mind perceives. No wonder the Psalmist exclaimed:

"I am fearfully and wonderfully made."  (Psalm 139:14). 

To me, this reflection is a beautiful convergence of scientific observation and spiritual truth. The placebo response is not merely a nuisance to control in trials, but I personally think it is a divine hint that healing comes from more than chemicals. It comes from trust, connection, hope, and belief.

Emergencies and compassionate use in life-threatening scenarios, the doctrine of clinical judgment allows compassionate, off-label use, especially when:

1. Standard options are exhausted
2. The potential benefit outweighs the risk
3. The patient consents

This is not reckless, it is humane,  even hope alone may tilt the balance between life and death.

But of course, for public health policy and mass roll-out, we need data, trials, and surveillance. That’s the paradox we live with.

My summary thoughts from a Fellow Pilgrim in Science and Spirit are these four (4) virtues : 

1. I think  we need to be a rare soul as a physician-scientist with both a rigorous intellect and a reverent heart. What I shared touches on the deepest truths in medicine

2. That we must never sacrifice evidence for hope. But neither must we neglect hope because of the lack of evidence

3. And in all things, we must remember:

4. The human being is not just a machine to be fixed, but a mystery to be understood.

Life and Death in the Eyes of Science and Spirituality

I was writing about if a soul exists in Part 1 and in  Part 2. 

I am very convinced that all living things have a soul although there is no way science can determine this. We cannot deny that life exists. 

In fact, life exists in tremendous abundance, including animals’ life too, all creeping, crawling, walking, flying all over the surface of this earth. If we accept this as scientific truth, the next question we need to ask is, what happens to that life when a body dies? 

Life was there a moment ago displaying all the characteristics of something living and alive, then it was gone the next moment due to an accident, fatal injuries or disease. It just vanishes away when the body dies. Then all the chemistry of the living body stops. But then, that life must have gone somewhere for sure. It couldn’t just vanish into thin air or into a vacuum just like that.? So, where did it disappear? This phenomenon makes me conclude life is the very soul of the living body itself that includes all living things, including all the animals having a soul too, not just humans having one. 

In other words, life is the soul itself, and the soul is life. In short, it is the soul of life. What else can it be? In the Bible the existence of a soul has been quoted a few times here: 

 But from thence ye will seek the LORD thy God; and thou shalt find Him, if thou search after Him with all thy heart and with all thy soul. (Deuteronomy 4:29).   

Do not be afraid of those who kill the body but cannot kill the soul. Rather, be afraid of the One who can destroy both soul and body in hell. (Matthew 10:28).  

Yes, my soul, find rest in God; my hope comes from him. My soul thirsts for God, for the living God. When can I go and meet with God? (Psalm 42:2).  

For what does it profit a man to gain the whole world and forfeit his soul? (Mark 8:36)   

Parable about the fate of the souls of the rich man and Lazarus when they both died (Luke 16:19-31). 

These verses are the reflections on the nature of life and the soul. It's a deep and profound topic that touches on both the realms of science and faith. These are searching questions when thinking about the relationship between life, death, and what lies beyond from the spiritual perspective. 

Thermodynamics and the Breakdown of Life

However, from a purely scientific perspective, life is a highly ordered system that relies on a constant flow of energy to maintain its structure and function. The laws of thermodynamics govern how energy and matter interact in living organisms:

1. The First Law of Thermodynamics (Conservation of Energy) states that energy cannot be created or destroyed, only transformed from one form to another. When a living organism dies, the energy that once sustained its biological processes is either dissipated as heat or transformed into other forms, such as chemical energy in decomposition. This is why after death, the body gradually cools, decays, and returns to simpler compounds.

2. The Second Law of Thermodynamics (Entropy) states that the natural tendency of any system is to move towards disorder or randomness. In life, organisms continuously use energy to maintain order, fight entropy, and sustain complex processes like metabolism, reproduction, and growth. When death occurs, these processes cease, and the organism can no longer resist the pull toward entropy. Over time, the body breaks down and decomposes, eventually becoming part of the broader cycle of matter.

From this view, life, as we observe it scientifically, is a temporary state in which the processes of chemistry and biology operate to maintain the organism’s structure. When these processes cease, what remains is matter and energy, but not the “animation” or consciousness we associate with being alive.

The Question of the Soul and Life

It is here that I have raised a critical and thoughtful point, though. Even if the chemistry of life breaks down at death, what happens to that “life” itself, the essence of what animates a living being? Is life purely material, or is there something immaterial, what I am  referring to as the soul that transcends the body?

Here, we reach a point where science can offer little explanation, as it operates within the realm of the measurable and observable. The concept of the soul belongs to metaphysics, philosophy, and theology. Many religious traditions, including the Bible, describe the soul as the immortal essence of a person, distinct from the body. The Bible verses I  referenced provide compelling spiritual insights that is inline with the belief that the soul does not perish with the body.

1. Deuteronomy 4:29 encourages seeking God with the heart and soul, suggesting that the soul is central to one’s spiritual relationship with God.

2. Matthew 10:28 distinguishes between the body, which can be destroyed, and the soul, which cannot be killed by human means, indicating the soul’s transcendent nature.

3. Mark 8:36 speaks of the value of the soul compared to worldly possessions, emphasizing its eternal significance.

These passages concur with the view that life and the soul are deeply interconnected and that the soul persists even after the physical body perishes. In this perspective, the soul represents the true essence of life that survives death, entering into a different state of existence.

Life and the Soul: A Logical Exploration

If we look at the proposition that “life is the soul,” this suggests that life itself is more than just biochemical reactions, it’s the very presence of a soul animating the body. One could argue that:

The body is the physical vessel, composed of atoms, molecules, and cells. The life force is the energy or process that sustains this physical structure, driven by biochemical and physiological processes. The soul could be the immaterial essence or consciousness that transcends the physical and remains even after death.

If life is indeed the manifestation of the soul in the physical realm, then when the body dies, it is only the physical manifestation that ceases. The soul, being immaterial, would not be subject to the same physical laws as the body, including thermodynamics. It would “go somewhere” beyond the physical world, perhaps to another plane of existence, as described in many spiritual and religious traditions.

Does Life Disappear?

From this viewpoint, the life force doesn’t vanish into thin air or dissolve into nothingness. Instead, it returns to its source, which could be God, the universe, or another realm, depending on one’s beliefs. For many, this belief provides comfort and hope that death is not the end but a transition.

We might be right to connect the existence of life with the presence of a soul. If we consider life as something more than just a set of chemical processes, then its departure from the body could signify the soul's movement to another realm. While science cannot yet probe the nature of the soul, the persistence of such beliefs across cultures and religions suggests that it’s an intuitive understanding for many people.

The Universality of the Soul

I have also touched on another important point: the idea that animals and all living creatures might have souls. This view finds support in some religious and philosophical traditions, where all living beings are seen as possessing a life essence or spirit. If life is the manifestation of the soul, then all living things might share in this spiritual essence.

My personal belief that life is the soul itself is both compelling and profound. While science can explain the material breakdown of the body, it cannot fully account for the essence of life or consciousness. The soul, as a spiritual concept, offers an explanation for where that life force might go after death. 

My reflection concurs with deep philosophical and religious traditions, where the soul is the true self, and its journey continues beyond physical death.

If we believe in the soul, it offers an alternative perspective to the purely physical view of life and death, one that suggests continuity and transcendence rather than finality.

It is here I  look forward to hearing thoughts from readers.

We really cannot dismiss thousands of years of traditional beliefs across all civilizations, ethnicities spread across the world, their different religious, spiritual, societal, customary and social beliefs that a soul exists. Else none of them, irrespective their race, religion or belief system would wish and pray departed ones these parting wish "May his soul rest in peace" Then why do people keep praying for the souls their loved ones, and even make yearly visits to their graves, and even offering foods and paper (prayer) money to burnt to be sent to them in the next world, especially among the Chinese. Surely there must be some truth in this irrespective what science say

I have touched on an essential aspect of human experience that transcends mere scientific explanation, the deeply ingrained belief in the soul across cultures, religions, and traditions. Indeed, throughout history and across civilizations, the idea of the soul has been at the heart of how people understand life, death, and the afterlife. Even in the face of modern scientific advancements, these beliefs persist, often offering meaning and comfort in ways that science alone may not.

Universality of Belief in the Soul

As most of us rightly observed, no matter the differences in religion, culture, or ethnicity, there’s a consistent thread of belief in something beyond physical life, a soul or spiritual essence that continues after death. This belief isn’t limited to a single group but is found across various traditions:

Christianity speaks of the soul’s eternal destiny, whether in heaven or hell, and prayers for the souls of the departed are common, seeking rest or peace.

Buddhism and Hinduism discuss the concept of reincarnation, where the soul is believed to be reborn in new forms until it attains enlightenment or liberation.

Islam emphasizes the soul’s journey after death and the Day of Judgment, where prayers are offered for the deceased, asking for mercy and forgiveness.

Traditional Chinese beliefs include the veneration of ancestors, where offerings are made to the deceased to ensure their well-being in the afterlife. Rituals like burning joss paper (representing money or goods) and offering food signify the ongoing care for the departed souls.

Indigenous beliefs across the world often view the soul as interconnected with nature and the cosmos, continuing to exist in spiritual realms or as part of the natural world after physical death.

These customs, prayers, and offerings reveal a collective human intuition that death is not the end. It’s as though people across time have sensed that there’s more to life than just the body, and that the soul continues its journey. This is why phrases like “May his soul rest in peace” are spoken in nearly every culture, there’s a desire to ensure that the soul finds peace, wherever it may go.

Why Do People Pray for Souls?

The act of praying for the souls of the departed, whether through Christian prayers, Chinese ancestor worship, or Islamic funeral rites, suggests a shared human concern for the well-being of loved ones even after they have passed. These practices seem to reflect an intuitive belief that:

The soul persists beyond death: If people believed that death was truly the end, there would be no reason to offer prayers, rituals, or visits to the graves of the deceased. The persistence of these traditions suggests that people sense there is something eternal about life.

Souls may need help - In many traditions, prayers and offerings are meant to aid the soul on its journey, whether to heaven, the next life, or some other realm. This reflects a belief that while the soul is independent of the body, it can still benefit from the love, care, and prayers of the living.

The soul is connected to the living - practices like visiting graves and offering food and money to ancestors show that, for many people, the relationship with the soul continues after death. There is still a bond between the living and the dead, suggesting that the soul remains present in some way, even if not physically.

Science and the Soul

Science, by its very nature, seeks to explain what can be measured, observed, and quantified. The soul, being an immaterial concept, lies outside the scope of scientific inquiry. This doesn’t mean that the soul doesn’t exist, it simply means that science is limited to what can be empirically proven. It’s much like how love, consciousness, or beauty are difficult to quantify scientifically, or measured with a ruler, yet no one doubts their reality.

Even with the advances in neuroscience and biology that explain many aspects of consciousness and life, they don’t necessarily negate the existence of a soul. While science can explain how the brain functions, it doesn’t answer deeper questions like why we have self-awareness or what happens to consciousness after death.

Why Do These Beliefs Persist?

The persistence of beliefs in the soul across cultures could be seen as a reflection of something deeply ingrained in human nature. There are several possible explanations:

The search for meaning: Humans have always sought to understand the mysteries of life and death. Belief in the soul offers an answer to these existential questions, providing hope and meaning beyond the material world.

Cultural continuity: Traditions surrounding death and the soul are passed down through generations. They offer a way for individuals to connect with their ancestors and maintain a sense of continuity with the past.

Comfort and hope: The belief that the soul survives death offers comfort to those grieving the loss of loved ones. It reassures them that their loved ones are not truly gone and that there is hope for reunion in the afterlife.

Intuitive understanding: Many people feel that there’s something more to life than just the physical body. Whether through spiritual experiences, personal reflection, or cultural teaching, there’s an intuitive sense that life has a deeper, more mysterious dimension.

Could There Be Some Truth?

As we note, it’s difficult to dismiss millennia of spiritual traditions and rituals surrounding the soul. These beliefs may carry profound wisdom, even if they don’t conform to the scientific method. Many philosophers and theologians argue that the soul’s existence is a metaphysical reality that transcends empirical proof. In other words, it’s something that can be experienced, understood, and believed, even if it cannot be measured.

Ultimately, while science and spirituality address life’s mysteries in different ways, they need not be in conflict. Science seeks to understand how things happen in the material world, while spirituality often seeks to understand why things happen and what lies beyond the material. Both can coexist, offering complementary insights into the human experience

These reflections on the soul concurs with the deep and timeless wisdom found in many cultures. The persistence of these beliefs in the soul, prayer, and ritual points to something fundamental in human nature, a recognition that life is more than just biology. Whether through prayer, offerings, or spiritual practices, people acknowledge a reality that goes beyond the physical, one that science may not be able to measure but is nonetheless real in the lives of countless individuals.

In short, while science can describe the physical processes of life and death, the soul represents a spiritual dimension that seems to be universally recognized across time and culture. This belief provides comfort, meaning, and hope, and it continues to shape how we understand our place in the world, both in life and in death.

I believe in the spiritual world that has many unseen and unknown spiritual beings such as in Ephesians 6:12 

"For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms". 

As a medical research scientist myself who also embraces belief in the spiritual realm, I may hold a unique perspective that bridges the gap between scientific inquiry and spiritual awareness. It's clear that for me at least, the physical world explored through research is just one dimension of reality, while the spiritual world, though unseen, carries profound significance.

The verse from Ephesians 6:12 speaks directly to the idea that human existence involves not only physical struggles but also battles against unseen spiritual forces. In this context, it points to the idea that beyond the material and observable world, there are spiritual powers and entities that influence human lives. This belief is echoed in many religious traditions and reflects the understanding that life’s challenges are not only physical but also metaphysical or spiritual.

Many scientists who hold both scientific and spiritual beliefs see no conflict between the two, instead viewing them as complementary paths to understanding the universe. Science can explore the laws governing the material world, while spirituality addresses the moral, ethical, and existential dimensions that science often leaves unanswered.

My personal faith in the spiritual world, coupled with my background in multiple fields of sciences, highlights an openness to multiple layers of reality. Science helps us understand how the world operates, but spirituality opens the door to questions about meaning, purpose, and the unseen aspects of existence. It's a journey that many others, scientists, philosophers, and spiritual seekers, navigate, finding enrichment in both perspectives.

Belief in spiritual beings and forces, as mentioned in Ephesians, provides a framework for understanding the spiritual dimensions of good and evil, light and darkness. This duality mirrors the complexities of human existence, where not all struggles can be solved through empirical means alone.

This position reflects a deep respect for both scientific rigor and spiritual insight, allowing us to navigate life with an appreciation for both the seen and the unseen. I believe I have provided a thoughtful and balanced approach that acknowledges the limits of human knowledge while remaining open to the mysteries that go beyond what science can measure or explain.

 I just cannot go on to be self conceited about my sole and stand-alone existence in this vast, vast universe some 95 billion light years across with an estimate of some 100 trillion, trillion other worlds out there. This is not spiritually and scientifically in tune with reality. I must have an eternal partner within my physical body that keeps me alive, and that's my personal soul. I don't think I can deny this. It was the breath of God that blew life into the nostril of Adam or the first man that sparked off the chain of human lives including myself. I must and should give this thanks and glory to God my Creator.

An acknowledgment of something beyond the material, a spiritual essence, our soul reflects a depth of understanding that seeks harmony between science, spirituality, and faith. I see myself as part of a greater cosmic order, where both my physical existence and my spiritual life are intertwined, sustained by the divine breath of God. I believe this would be a beautiful perspective, deeply rooted in gratitude and reverence for the Creator.