Retrospectives
Another year-Europe was certified polio-free; the national tuberculosis program received a boost with the presentation of the new integrated policy for the control of the disease; poliovirus was synthesized from mail-order materials in a New York laboratory; the West Nile virus wreaked havoc in many parts of the United States; medical malpractice became one of the most widely debated topics in the national medical community. Aside from these medical conventions were held, drug trials conducted, new public health programs launched, health indicators evaluated.
In short, the health care community put in another year of hard work.
More work, of course, has been done: following are some of the year's most important medical work, as documented by MEDICAL OBSERVER.
GUT FEEL (January)
From ulcers to gastroesophageal reflux disease to hepatitis to gastrointestinal cancer-quite a number of conditions continue to threaten the health of the digestive system. Some of these conditions are pretty common, with ulcers being seen in as many as half a million people every year, and with gastroesophageal reflux happening in as many as 40 percent of healthy adults every month.
Some people consider ulcers and GERD conditions that people have no choice but to live with for the rest of their lives. But there are effective ways to manage them. For instance, proton pump inhibitors have been considered the drug of choice both for the diagnosis and management of gastroesophageal reflux disease; they have also been found to be equally potent against peptic ulcers.
Hepatitis is one of the most feared diseases of the liver-more so the fact that the disease has a wide spectrum covering the letters A to H. The disease, often transmitted parenterally or through the oral-fecal route, has been found to afflict millions of people worldwide. In the Philippines alone, about 5.4 million have been estimated to be carriers of the hepatitis B virus. And if the problem were not stemmed, many hepatitis B patients could see their condition progressing to hepatitis C, or even hepatocellular carcinoma.
Dr. Ernesto Domingo, head of the Philippine Liver Study Group, said that vaccines are available (at least to A, B, and E). But despite the incorporation of hepa B vaccination in the Expanded Program on Immunization, the coverage remains low, owing to the cost of the vaccine and the number of people not quite willing to get the shot. Also, Dr. Domingo warned against hepatitis C. In a paper he wrote, Dr. Domingo found that the incidence of hepatitis C is only seven percent. But the problem is, nearly all of these patients had a history of hepatitis B infection-and no vaccine is available against hepatitis C.
THREE TERRORS (February)
They are known as lifestyle diseases-and until recently people from the poorer countries of the world thought these diseases would not trouble them, being still plagued by infectious diseases. By the 1980s, however, noncommunicable diseases started climbing up the roster of the ten most killing diseases in the country-despite the fact that infectious diseases haven't really started leaving us. So now what we have is what medical practitioners call the double burden of disease.
Of the noncommunicable diseases troubling our country today, hypertension, type 2 diabetes, and heart diseases pose a triple trouble-not only do they pose individual health threats, usually their interaction becomes even more troubling. Says Dr. Mary Anne Lim-Abrahan, professor of endocrinology at the University of the Philippines-Philippine General Hospital: "The effects are not just additive but synergistic."
It has been proved that having one condition could make the risk of falling ill to another disease rise-and if they all come together, trouble becomes even more pronounced. Says Dr. Ramon Abarquez, professor of cardiology at the UP-PGH: "The risk of heart failure becomes higher in a person if you increase the number of comorbid factors: diabetes, dyslipidemia, hypertension, weight excess and obesity, and cigarette smoking."
That's why time and again, health and medical experts have been repeatedly emphasizing the necessity of sticking to a healthy diet, getting involved in physical activity, the limiting of alcohol intake, and the cessation of smoking. It may be a cliché now, but it is a cliché that should never lose its bite-prevention will always be better than cure.
POOR MEN (March)
Men have their share of serious problems, although most of the time they don't make a show of it. The silence-whether because of fear, shame, the fear of expressing shame, or the shame of expressing fear-has of course led to more problems.
One of these problems is erectile dysfunction. Suffice it to say that in the country no data on the incidence of ED are available-it could be brought about by the shame of admitting that there is a problem, or by denying that there is a problem at all.
Says urologist Dr. Dante Dator: "There are people who will not admit to having ED because…of the macho attitude." Adds psychiatrist Dr. Lou Querubin: "Doctors themselves, because of their own feelings of inadequacy or their own biases, are unable to open the topic with their patients." Which sometimes leads to more problems, and brings a large number of men suffering in silence.
Benign prostatic hyperplasia is another scourge to ageing men. Although some say that the enlargement of the prostate is just as normal as the graying of the hair, and in half of the cases the symptoms are not all that bothersome, the other half will still need medical attention.
So what needs to be done is to pay attention to one's body, and see whether such symptoms as frequent urination, weak interrupted flow, incomplete bladder emptying, feeling of urinary delay, urgency to urinate, and incontinence are present-and seek medical attention immediately.
After all, the first thing to solving a problem is to admit there is one in the first place.
LEGAL MINDS (April)
The American Psychiatric Association says: "A mental illness may explain a person's behavior. It seldom excuses it." This pretty much demolishes the idea presented in many soap operas and movies that a criminal who admits to insanity would get away scot-free.
For one, anybody who pleads "not guilty by reason of insanity" and actually wins isn't set free; they have to be committed to an institution, which could last even longer than the jail time recommended for the crime they're accused of.
For another, proving legal insanity is difficult. A lawyer explains that if one is accused of a crime and uses insanity as a defense, it practically amounts to an admission of having committed the crime.
And the medical and legal definitions of insanity could be wildly different. Continues the APA statement: "The vast majority of people with a mental illness would be judged 'sane' if current legal tests for insanity were applied to them."
And so it becomes doubly difficult when the two camps intersect. Dr. A. Efren Reyes, psychiatrist from the National Center for Mental Health, says, "It would be difficult outside brief reactive psychosis or schizophrenia-psychotic conditions-to prove insanity." After all, legal terms and medical terms don't have a one to one correspondence.
But changes are slowly taking place. For one, law schools are beginning to incorporate behavioral science courses in their curriculum, while the Philippine Psychiatric Association has prepared a shortlist of psychiatrists that courts could refer to for cases needing expert witnesses.
PAIN METER (May)
No one is spared from pain-although it is unpleasant, it is a very good indicator that something is not quite right with our bodies. But with the change in how the medical community (especially in the West) perceives pain-from merely a symptom to a condition in itself, prompting the American Pain Association to consider it as the fifth vital sign-people are now looking at it from a different perspective.
Nine out of 10 people experience headaches at least once a year, while 40 percent of them report worse headaches. Although most of them are benign in nature, at least five percent of all headache cases could be traced to some underlying condition, like neoplasm, meningitis, or others.
Of the chronic headaches, one of the most common is migraine-it affects about 15 percent of women and six percent of men. Usually, it is accompanied by such symptoms as nausea and vomiting.
Dr. Darwin Dasig, neurologist from the Makati Medical Center, said that a lot of things have been proved to trigger migraine attacks-from such substances as MSG, tyramine in cheeses, and octopamine in citrus fruits, to such states as anxiety and lack of sleep-but theories about the condition still abound. Also, the classical cases of migraine are fairly easy to identify, but its grayer shades may take more time and effort to diagnose.
He said: "Migraine equivalents are hard to define. There is even a controversy as to whether they exist independently or are truly part of the migraine mainly because of the absence of a headache." That's why, he explained, establishing the presence of migraine will help in initiating therapy and thus control the attacks.
PREGNANT POSSIBILITIES (June)
Who says pregnancy is easy? For a woman whose pregnancy is deemed "normal" it is difficult enough-what more for those who are going through complicated pregnancies?
As recently as 1995, the United Nations reports that one out of 75 Filipino women have the risk of dying at childbirth. The reasons for these deaths are largely preventable; in fact two-fifths of the deaths happen at normal delivery. In fact, not only deaths are preventable. Says Dr. Virgilio Ramos of the University of Santo Tomas Hospital High-risk Unit: "if pregnant women come to us and then are managed properly, there should be no reason for complications."
But by complications one is not only referring to the threats during pregnancy, such as iron deficiency anemia or gestational diabetes-one should also look forward to what comes after the pregnancy. And usually, it's the postpartum blues, which could progress to depression if not paid attention to early enough. Most women-about 85 percent-experience the blues for a few weeks right after giving birth, says Dr. Elizabeth Espinosa-Rondain, psychiatrist from the Makati Medical Center. Postpartum depression, however, affects only 10 percent of women, which is definitely more serious. That's why she explains, families and doctors should know about possible problems that could arise from and after pregnancy. Not only would possible problems be identified and solved immediately, the experience of bringing life into the world could also be shared.
Which could also help during a woman's "paglilihi." Although there is no sufficient scientific basis for a woman's craving for specific foods during pregnancy-let alone the belief that the characteristics of the food a woman craved for during pregnancy would reflect in the child-but from a sociological viewpoint, this could actually be a good thing. Says anthropologist and professor Maria Luisa Lucas Fernan of the Ateneo de Manila: "This craving for food is a way of involving, of sharing the experience of pregnancy with the husband, the other members of the family, community, kin groups."
FLU FLIGHT (July)
The flu may very well be one of the few diseases we tolerate despite the over 50 million people who died because of it in the last hundred years.
Because it had been ignored in favor of the more obvious demands of the First World War, nearly 40 million people died of the flu in 1918 alone. In fact, of the 60,000 American soldiers who died during World War I, 60 percent did not die on the battlefield, but in flu wards.
Although the severity of the Spanish flu incident of 1918 has not been repeated since, some observers believe that another pandemic of a similar magnitude is due anytime soon.
However, there is a complex and highly efficient machinery that practically covers the entire world that not only keeps track of the movement of flu strains every year, but identifies which populations are at high risk of getting infected.
Unlike smallpox or poliovirus, which mass immunization could render extinct with one fell swoop, the flu virus has the ability to mutate much too quickly. Meaning to say, one standard drug or vaccine could not prove effective against all the changing strains of the virus.
Which is not to say that all people are left to do is succumb to the disease. Every year, the World Health Organization comes up with recommendations on the type of flu vaccine to manufacture, based on which flu strain may bring about the trouble. And everybody should be vaccinated.
Says Dr. Benilda Galvez of the Philippine College of Chest Physicians: "Anybody-from the very young to the very old, the rich to the poor-is equally susceptible to the flu virus."
WHEEZING BOUTS (August)
"You'll outgrow it," is one of the things parents tell their asthmatic kids; and then they are subjected to increasingly strange home remedies to cure them. Dr. Charles Yu of the De La Salle University Medical Center has received patients who were fed lizards. Although a lot of people may find this without any scientific basis, Dr. Yu found out that the "lizard as asthma cure" folk belief might actually have some scientific basis. "Some" is the operative word.
Dr. Yu said that when he visited China some years ago, he found that gecko tails and ephedrine from the herb Ma-huang was widely used as treatment for asthma. And then he found that lizards actually possess epinephrine-like substances-and epinephrine really used to be indicated for asthma for its capacity to innervate the muscles of the lungs and the airways.
However, it must be stressed that just one lizard can't have that much epinephrine in it to have an impact, adds allopathic medicine practitioner Ruben Galang.
The scientific basis of the lizard cure notwithstanding, there are other therapeutic methods that actually have solider experimental and clinical support. As has always been stressed, managing the condition requires short-term symptom relief and maintenance medication. For immediate relief, alpha-2-agonists are used, while for maintenance, inhaled corticosteroids are recommended.
But no matter the efficacy and safety of drugs and the expertise of the attending physician, a patient and his immediate family will have to exert some effort in understanding his condition and in working to achieve a better quality of life.
Says Dr. Madeleine Sumpaico, president of the National Asthma Movement: "Patients now realize what their disease is-that they can handle it, that they can live a normal life despite their being asthmatics."
BABY FOOD (September)
Breast milk is still best for babies," people have constantly been told. But because of some factors, such as the baby's growth and his changing needs, he eventually moves on to other kinds of foods, first to breast milk substitutes, then semisolid food, then solid food.
But of the breast milk substitutes available in the market today, how well do they compare to breast milk? Says Dr. Cynthia Cuayo-Juico, head of the pediatrics department of the Manila Doctors' Hospital: "Infant formulas are approximating mother's milk, but none of them can exactly copy breast milk." And with the number of add-ons to the great number of infant formulas available today, all of them making scientifically backed claims of helping optimize infant growth and development, one may need some help in determining which would be best for one's child. Says Dr. Herminia Lopez-Cifra, head of the pediatric intensive care unit of the Philippine Children's Medical Center: "It really depends on the individual infant's need…and it is the pediatrician who is well-positioned to decide on the most appropriate formula for the baby."
By the time a child gets old enough to eat solid food, the increase in nutritional options also brings about attendant dangers. One of the biggest concerns of parents who care about their children's nutritional well-being is the presence and wide availability of junk foods. Especially when one's child is already of school age, parents can no longer strictly monitor their kids' eating habits. Good thing quite a number of schools have strict rules on what items are to be sold in school canteens-junk foods, as much as possible, are not sold.
Another dietary concern is the wide popularity of fast food-the burger-soda-and-fries combo, in particular. While they may seem harmless if consumed only in very limited amounts, a child-or even an adult-must never make it his daily fare, as this may bring about health problems sooner than one expects.
DROP SHOT (October-November)
One of the greatest success stories of the 20th century is the eradication of smallpox in the 1970s. The 21st century's, meanwhile, may be the expected eradication of polio. All of these are due to the intensified use of vaccines. Since the discovery of the first vaccine way back in the late 1700s, more vaccines have been developed, others are under development-and many diseases have found their match. Although many people still continue to die because of infectious diseases-particularly in the poorer countries of the world-the damage these diseases bring about is no longer anywhere near the dead-in-a-few-minutes effect prevalent during the dark age of pandemics.
Despite these developments, however, there always remains a room for improvement. For the country, one of the issues is further expanding immunization coverage. While the national coverage for the diseases (tuberculosis, diphtheria, tetanus, whooping cough, polio, and measles) included in the Expanded Program on Immunization is very high, other important diseases require better attention. For instance, nearly 5.4 million people are believed to be hepatitis B carriers, and a significant percentage of these progresses to the disease stage, mass immunization against hepatitis B are done only when funds are available. Says Dr. Nina Gloriani Barzaga, director of the University of the Philippines-Institute for Molecular Biology and Biotechnology: "The hepatitis B vaccine should be given free. Ninety percent or more of the target population should already be receiving this."
And it is not just hepatitis B that needs attention-another will have to be typhoid fever, which is not included in the EPI, and the Philippine Pediatric Society vaccination schedule considers nonessential. Dr. Lulu Bravo, president of the Philippine Foundation for Vaccination, reports that the World Health Organization recommends vaccination against typhoid in places where it is endemic and has a high incidence. Although there are no definitive data on local typhoid incidence, Dr. Bravo believes that the disease is endemic in the country, and a lot of cases continue to go unreported.
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