The story, seeming like an urban myth, even made it to the pages of Asiaweek Magazine: a wealthy Filipino executive in his 60s took his mistress to a plastic surgeon to make her look like his wife when he married her. Unknowingly, the wife went to the same doctor to undergo cosmetic surgery herself, in a bid to keep her husband. After all the nipping and tucking, the wealthy husband left his mistress to return to the surgically rejuvenated wife – but only after undergoing surgery himself, as he started feeling insecure about his own aging appearance.
In a society that is willing to pay the top price for a youthful look, over $160 billion is spent annually worldwide on cosmetic and toiletry products, including deodorants, shampoos and soaps, makeup, lotions, and fragrances. In 2002, Filipinos spent P70 billion for the same, with the figure estimated to reach P89 billion in 2007.
However, more belatedly, cosmetic surgery has become the somewhat simple, yet long-term answer to the pursuit for beauty. Having a hard time losing the gut despite hundreds of sit-ups every day? Opt for abdominal liposuction (price starts at $1,400). There are even muscle implants for the gym body without ever lifting a gym equipment. Losing hair too fast? Consider hair transplant (from $1,500). Insecure about your manhood? Have a penile enlargement and/or lengthening operation (from $450). For women, the vaginal opening can be tightened (from $550) for another “Like a Virgin” experience. Getting edged by younger guys simply because they look better – and, well, younger? Mull over facelift (from $1,000). And, while doing so, you may consider adding a dimple and a cleft chin (from $360) for the Brad Pitt/Alec Baldwin look.
Once derided as vanity medicine, cosmetic surgery has gone a long way, as it is now largely recognized as a legitimate arm of medicine. While it was once only discussed in hushed voices, now anybody who underwent one or more cosmetic surgical procedures actually boasts of having them – men and women alike.
According to former Philippine Medical Association (PMA) president Bu C. Castro, M.D., Ll.B., FPSP, the Philippines is actually a premier destination when it comes to availing of cosmetic surgical procedures, among others. In fact, balikbayans (returning overseas Filipinos) are known to come home to undergo such treatments “Overseas Filipino workers (OFWs), especially those in the entertainment industry, (are among the biggest markets of cosmetic surgery in the Philippines, as it allows them) to level with their competitors, particularly Caucasians, (by giving them similar physical attributes),” he says.
Plastic and reconstructive surgeon Carlos I. Lasa Jr., M.D. agrees. “First, comparing (our costs with) the costs (of medical treatment) where they are working right now, say in London or New York or Japan, where the charges are very high, they can save by coming here,” he says. The balikbayans are also familiar with the Philippine medical system, so they “have more or less this trust in our medical system.” And third, the treatments are merely side trips when they come over to take a vacation, so their visit becomes one trip for everything.
The general acceptability of cosmetic surgery helped spawn an industry all its own – medical tourism, which pits the medical practitioners of developed countries, once regarded as the elite bastions of medical expertise, with the developing countries, now also offering highly qualified and well-trained medical professionals using the most advanced in technology.
“This is a $4 billion industry, which is said to be growing at a 30% rate per annum,” Eddie Uy of rxpinoy.com, the first online community of Filipino doctors and dentists that serves to connect various sectors with the health industry, says. Combined with affiliated industries like tourism, India’s BusinessWorld Magazine estimated that millions of travelers actually spend over $40 billion a year. “We should – and can – break into that.”
The local industry has been changing over time, however. According to Uy, although OFWs continue to be the major market of cosmetic procedures, their portal had been receiving inquiries on these procedures from Europeans, particularly from Germany and Denmark. Also, other procedures mainly attract foreign nationals, such as Australians for dentistry, Japanese and Koreans for ophthalmology, and Americans and Europeans for bariatric surgery.
The biggest edge of the Philippines over other countries, particularly in Asia, is its relatively cheap rates for the procedures. For example, breast augmentation could cost up to $5,043 in the US, and at a much lower price of $2,500 in Thailand’s Preecha Aesthetic Institute, but would only cost $2,100 in the Philippines. Similarly, full facelift could cost up to $5,000 in the US, and $4,000 in Thailand, but only $2,500 in the Philippines.
“Among others, there’s an interest in general surgery and cardiovascular surgery because (if they have the surgeries in their home countries) they are sometimes required to co-pay, which they can’t afford, and cosmetic surgery because it is not covered by medical insurance offered to them abroad. So they see (us),” Lasa says. He nonetheless stressed, “The reality is we can’t have fees as high as our counterparts in US and Europe. We also have to have fees that are affordable to the local patients. So when I put up my rates and publish them on the website, it was with due cognizance of the rates in other countries, and of course, the prevailing rates in the Philippines.”
“If you compare the (rates) in peso, (they may look expensive),” Castro says. “But if you go to Singapore, (it’s even more expensive). Even (compared to) Hong Kong, we’re still cheaper when you convert (the rates) to peso. A P150,000 procedure here could cost P250,000 in Hong Kong, and even more in Singapore and Thailand.”
It helps, too, that the standard of living is cheaper in the Philippines by foreign standards. “The Philippines’ highly favorable exchange rate can benefit both local and foreign patients,” Lasa says. With the foreign exchange rate averaging at P56 per $1, the amount brought in by a foreigner visiting the Philippines “can get more for less.”
Another advantage Lasa sees is that “over Thailand and India, the language barrier is non-existent (in the Philippines) for those who speak English well.”
Dr. Castro, however, believes that the country’s biggest edge is the expertise of the Filipino medical practitioners. “We can be competitive – especially with the skills we have. For example, the medical education in China is only four years, (while) ours is 16 years. So how could you rate their qualifications with ours?” he says.
“And with many of our professionals trained abroad, they don’t mind coming here for their treatments,” adds Lasa.
However, while the Philippine government acknowledges that medical tourism is a potential source of dollar income, there are currently no “nationally palpable efforts done (to advance it), so we’re still off the radar of most Europeans, Americans and other nationals (who are considering availing of medical services outside their home countries),” Lasa says.
Lasa contends that government support will help develop a young industry. “For example, the Indian government (gives certain) incentive to dollar earners,” he says. “We need something like that to really promote (medical tourism in the Philippines). As it is right now, we just (get involved in medical tourism) as part of our regular practices.”
That Philippine government has, in fact, included the medical profession in the expanded value added tax (E-VAT). “The government thinks that by taxing, they can generate more income. Actually, they may be mistaken in that assumption,” Lasa says.
“Necessarily, we’ll have to increase the prices also – we’ll have to throw to the patients the costs of the E-VAT. That’s the problem,” Castro says. “The E-VAT has a negative effect on medical tourism – it will jack up the prices. But it will be costly not only to medical tourism but to local patients, who will primarily bear the burden because of the E-VAT.”
Lasa, however, said that while not necessarily translating to increase in prices, “the implementation of E-VAT will mean a decrease in our net income – it will amount to that.”
A bigger problem bothering the local medical tourism industry is its lack of cohesion. “Aside from the medical, dental, cosmetic and other procedures, medical tourism actually bundles hotel stays, destination tours, concierge services including interpreters, caregivers and tourist guides, and many others” Uy of rxpinoy.com says. “But at the moment, most of these (related) industries and sectors (go it alone).”
Castro recommends the establishment of a national call center for medical tourism, preferably with the assistance of medical staff because they would know what the industry is all about and has to offer. “When prospective clients would call up to ask specific questions, our agents should be able to answer them. Else, they’d ask their questions elsewhere – it could be India, Singapore or Thailand – then end up going there,” he says.
While there are entrepreneurs interested to open services like Singapore’s MNC, a one-stop information center for all medical services offered by the country state, “they want it to be outright business operations, not service-oriented, which increases the prices,” Castro says. “If that happens, then we lose our competitive advantage over our competitors.”
Pinoyrx.com is gearing towards the establishment of a “specific hub for medical tourism” when it recently established http://mtpshow.rxpinoy.com, which lists accredited hospitals, current rates and the credentials of Filipino practitioners. “But beyond that, we would like to cross sell other services in the country – if a person undergoes dental implant that requires for him to stay for up to 10 days in the country, then he has to choose accommodation. While here, he could go on tour. And while touring, he may need other services. rxpinoy.com could help arrange all those,” Uy says.
Another problem the industry is facing is the lack of “related infrastructure,” Lasa says. In Thailand, for example, Bumrungrad Hospital has its own hotel facility, connected by a walkway to the hospital, so families can be close to a family member undergoing treatment. “If local hospitals can afford such facilities, it will definitely help promote our medical tourism,” he says.
The urgency to address this situation varies, nonetheless, says Castro. “Makati City, for example, has hotels not far from hospitals. It is in other places like Quezon City that problems arise, since they are far from each other,” he says. Already, however, efforts are already done to establish a hospital cum accommodation facility in Subic Bay Metropolitan Area, among others.
The lack of solidity in the industry also poses a problem when it comes to regulating practitioners. “The Philippine law allows all licensed doctors to do any kind of surgery – mainly, this is to allow doctors in provinces to be able to give emergency treatments without worrying about legal consequences,” Lasa says. “This is good for the provinces, but (in cosmopolitan areas) this is problematic.”
While the PMA and other professional associations can regulate medical practitioners, their grasps are limited only to members. “(Medical tourism) is a very good concept,” Castro says. “But it could be subject to abuse with the sprouting of fly-by-night cosmetic centers that we need to control. The government should issue a listing on the qualified and accredited (practitioners). There should be some kind of a regulation to tell the customer that they are also protected.”
At the end of the day, Castro believes it all boils down to marketing. “When you say tourism, marketing is very important,” he says. “And when you say medical tourism, you’re not only marketing the medical services, but the Philippines itself – places to go to, accommodations and services, everything. We should realize that marketing is an indispensable arm of medical tourism.”
“I think there is a future (for medical tourism in the Philippines),” Lasa says. “Definitely, as long as there is an economic need for people abroad, as long as there is a perceived benefit of coming (here) to have treatments given by competent – let me emphasize competent – practitioners, there will always be people coming here for such reasons, so medical tourism will continue to prosper.”
Uy says that people live longer, “and you need to provide people to look after them (as they age).” “Coupled that with the escalating cost of health care – instead of chasing the expenses, they might as well outsource it,” he says. “With the advent of technology, information has become fluid, so it helps our cause (to promote the Philippine medical tourism). Who knows, this may just avert the brain drain of our medical professionals.”
While arguing that a concerted effort needs to be done in order for the local industry to realize its full potential, “I do not conduct my practice with grandiose visions – I conduct my practice with a simple philosophy: providing excellent patient care on a one-to-one basis. I don’t regard this as a business. I went into this field because I like treating patients on a one-to-one basis. If dadami ang patients ko (the number of my patients grow) because (they were referred to me by satisfied patients) then well and good,” Lasa says. “In the end, it is because of how good we are at our profession that is the driving force of people coming to avail of our services.”
Having less sex linked to earlier menopause
Women who reported engaging in sexual activity weekly were 28% less likely to have experienced menopause at any given age than women who engaged in sexual activity less than monthly.
Women who engage in sexual activity weekly or monthly have a lower risk of entering menopause early relative to those who report having some form of sex less than monthly, according to a new UCL study.
The researchers observed that women, who reported engaging in sexual activity weekly, were 28% less likely to have experienced menopause at any given age than women who engaged in sexual activity less than monthly. Sexual activity includes sexual intercourse, oral sex, sexual touching and caressing or self-stimulation.
The research, published in Royal Society Open Science, is based on data from the USA’s Study of Women’s Health Across the Nation (SWAN). It’s the largest, most diverse and most representative longitudinal cohort study available to research aspects of the menopause transition.
First author on the study, PhD candidate Megan Arnot (UCL Anthropology), said: “The findings of our study suggest that if a woman is not having sex, and there is no chance of pregnancy, then the body ‘chooses’ not to invest in ovulation, as it would be pointless. There may be a biological energetic trade-off between investing energy into ovulation and investing elsewhere, such as keeping active by looking after grandchildren.
“The idea that women cease fertility in order to invest more time in their family is known as the Grandmother Hypothesis, which predicts that the menopause originally evolved in humans to reduce reproductive conflict between different generations of females, and allow women to increase their inclusive fitness through investing in their grandchildren.”
During ovulation, the woman’s immune function is impaired, making the body more susceptible to disease. Given a pregnancy is unlikely due to a lack of sexual activity, then it would not be beneficial to allocate energy to a costly process, especially if there is the option to invest resources into existing kin.
The research is based on data collected from 2,936 women, recruited as the baseline cohort for the SWAN study in 1996/1997.
The mean age at first interview was 45 years old. Non-Hispanic Caucasian women were most represented in the sample (48%), and the majority of women were educated to above a high school level. On average they had two children, were mostly married or in a relationship (78%), and living with their partner (68%).
The women were asked to respond to several questions, including whether they had engaged in sex with their partner in the past six months, the frequency of sex including whether they engaged in sexual intercourse, oral sex, sexual touching or caressing in the last six months and whether they had engaged in self-stimulation in the past six months. The most frequent pattern of sexual activity was weekly (64%).
None of the women had yet entered menopause, but 46% were in early peri-menopause (starting to experience menopause symptoms, such as changes in period cycle and hot flashes) and 54% were pre-menopausal (having regular cycles and showing no symptoms of peri-menopause or menopause).
Interviews were carried out over a ten-year follow-up period, during which 1,324 (45%) of the 2,936 women experienced a natural menopause at an average age of 52.
By modelling the relationship between sexual frequency and the age of natural menopause, women of any age who had sex weekly had a hazard ratio of 0.72, whereas women of any age who had sex monthly had a hazard ratio of 0.81.
This provided a likelihood whereby women of any age who had sex weekly were 28% less likely to experience the menopause compared to those who had sex less than monthly. Likewise, those who had sex monthly were 19% less likely to experience menopause at any given age compared to those who had sex less than monthly.
The researchers controlled for characteristics including oestrogen level, education, BMI, race, smoking habits, age at first occurrence of menstruation, age at first interview and overall health.
The study also tested whether living with a male partner affected menopause as a proxy to test whether exposure to male pheromones delayed menopause. The researchers found no correlation, regardless of whether the male was present in the household or not. Last author, Professor Ruth Mace (UCL Anthropology), added: “The menopause is, of course, an inevitability for women, and there is no behavioural intervention that will prevent reproductive cessation. Nonetheless, these results are an initial indication that menopause timing may be adaptive in response to the likelihood of becoming pregnant.”
Transgender students face higher levels of substance abuse
This misuse of drugs by transgender individuals is thought not to be anything to do with their non-gender conformity but with the discrimination that they, as transgender individuals, face on a daily basis.
A study by The Journal of School Health has found transgender students to be 2.5 times more likely to try and use drugs such as methamphetamines and cocaine than their non-transgender peers. Transgender students were also found to be twice as likely to misuse prescription medication than other students their age.
This misuse of drugs by transgender individuals is thought not to be anything to do with their non-gender conformity but with the discrimination that they, as transgender individuals, face on a daily basis, with stigma being one of the primary drivers of transgender mental health issues across the world.
In the US more than 50% of transgender individuals report suffering from depression or anxiety and LGBTQ individuals are also 7 times more likely to consider death by suicide than heterosexual gender-conforming individuals.
At home, 19% of transgender individuals have experienced domestic violence as a result of their gender nonconformity and at work, more than 50% of transgender individuals have experienced discrimination.
With so much stigma at home, on the street and in the workplace it’s no wonder that some transgender individuals are turning to narcotics as a way to numb the pain and escape their realities.
Dr. Pedro, a scientist who helped conduct the drug use study has said “When it comes to transgender teens, it’s the transphobia that impacts [their use of drugs], not being transgender. In order to reduce the likelihood of a kid to resort to drugs as a means to cope, there has to be some sort of social support mechanism,”
Evidence from initiatives in the US supports the idea that better support systems and less stigmatizing communities can have a positive impact on the mental health of transgender individuals. Simply providing transgender individuals with appropriate toilet facilities was found to reduce the likelihood of transgender teens committing suicide by a staggering 45% and the introduction of same-sex marriage saw a huge drop in suicide attempts by 134,000.
So what else can be done to help support transgender individuals and reduce their need to rely on narcotics?
The evidence provided by initiatives in the US proves that removing the stigma surrounding being transgender is key to reducing suicide rates and improving transgender mental health but this won’t happen overnight. We need to see an introduction of more support systems for transgender people in the form of support groups and access to counseling and we need to provide transgender people with access to inpatient drug rehab centers if they have already fallen too far.
To remove stigma in the community, schools and governors need to focus on transgender awareness and education, helping friends, families, and co-workers to understand what it means to be transgender and how they can help to ease the weight that their loved one, friend or colleague is carrying. Education also needs to start far earlier and be taught in schools to help students grow up into compassionate individuals with a wider understanding of the LGBTQ community and the challenges it faces.
Hidden sexual-arousal disorder can compromise mental health
It’s important that people know of this medical condition and that it is primarily a neurological problem, not a psychiatric one.
Persistent genital arousal disorder (PGAD)–which is almost exclusively experienced by females and characterized by spontaneous and unwanted sexual arousal unrelated to desire–can compromise individuals’ mental health and well-being and severely damage relationships with partners. Results from a new study by investigators at Massachusetts General Hospital (MGH) indicate that PGAD can be caused by altered firing of nerves that carry sensations from the genitalia or by damage to the lowest parts of the spinal cord. The study also found that neurological treatments benefit many patients.
“It’s important that people know of this medical condition and that it is primarily a neurological problem, not a psychiatric one,” said senior author Bruce Price, MD, an MGH Department of Neurology investigator who is also chief of Neurology at McLean Hospital. “Many affected women are silent and undercover–it’s in no way a fun condition, and it is difficult for patients to address their symptoms with their doctors, who have typically never heard of PGAD.” The problem can be especially troubling for adolescents, causing confusion, shame, and fear.
The study, published in PAIN Reports, included 10 females whose PGAD symptoms began between ages 11 to 70 years. Although the study involved only a small number of patients, it’s still one of the first to carefully examine PGAD in a thorough and scientific manner.
Spinal nerve-root cysts were detected in four patients and generalized sensory nerve damage (neuropathy) in two. One patient with symptoms since childhood was born with a small defect in her lowest spinal cord, one had a lumbosacral herniated disc in the lower back, and another developed short-lived PGAD when she abruptly stopped a prescribed antidepressant medication.
All psychiatric and gynecological treatments were ineffective, and injecting local anesthetics had no lasting benefit. In contrast, neurological treatments–such as cyst removal and treating nerve damage–were effective in 80% of patients.
“Physicians need to be aware of PGAD and inquire about it when patients experience other pelvic pain or urological symptoms that often accompany PGAD,” said first author Anne Louise Oaklander, MD, PhD, an investigator in the Department of Neurology at MGH. “It’s treatable, but the treatment depends on the cause. By identifying some common causes–and localizing them to specific regions of the sacral nervous system–our study provides direction on how to help patients and to guide future research.”
Women with single dose of HPV vaccine gain similar protection as multiple doses
While results of the paper showed that a single dose may be as effective as the currently recommended two- or three-dose series, it’s too early for people to rely on a single dose of the vaccine for protection.
A new study revealed that one dose of the HPV vaccine may prevent infection from the potential cancer-causing virus, according to research published in JAMA Network Open from The University of Texas Health Science Center at Houston (UTHealth).
According to the Centers for Disease Control (CDC), 34,800 new cancer diagnoses are linked to human papillomavirus (HPV) annually. The virus is thought to account for more than 90% of all cervical and anal cancers, more than 60% of all penile cancers, and approximately 70% of all oral cancers.
While results of the paper showed that a single dose may be as effective as the currently recommended two- or three-dose series, it’s too early for people to rely on a single dose of the vaccine for protection, according to senior author Ashish A. Deshmukh, PhD, MPH, an assistant professor at UTHealth School of Public Health.
“HPV vaccine coverage is less than 10% globally because of poor vaccine uptake rates in many resource-limited countries. Ensuring boys and girls receive their first dose is a big challenge in several countries and a majority of adolescents are not able to complete the recommended series due to a lack of intensive infrastructure needed to administer two or three doses,” Deshmukh said. “If ongoing clinical trials provide evidence regarding sustained benefits of a one-dose regimen, then implications of single-dose strategy could be substantial for reducing the burden of these cancers globally.”
Although the study participants included only women, the CDC recommends a two-dose regimen for all children starting the series before age 15 or a three-dose regimen if the series is started between ages 16 to 26. The latest generation of HPV vaccine can protect against nearly 90% of cancer-causing HPV infections. Yet, current vaccinations rates are less than ideal – half of people in the U.S. are not vaccinated against this common sexually transmitted infection.
“The current HPV vaccine dosing regimen can be cumbersome for people to understand. If one dose is proven effective in trials, the vaccine regimen will be simplified. This will help improve the coverage rate among adolescents that are currently below the Healthy People 2020 goal and possibly will also increase the momentum of uptake in the newly approved age group,” said lead author Kalyani Sonawane, PhD, who is an assistant professor at UTHealth School of Public Health.
Michael D. Swartz, PhD, of UTHealth co-authored the study, along with Alan G. Nyitray, PhD, of the Medical College of Wisconsin; and Gizem S. Nemutlu, PhD, and Jagpreet Chhatwal, PhD, from Harvard Medical School.
Diet has rapid effects on sperm quality
Sperm quality can be harmed by several environmental and lifestyle factors, of which obesity and related diseases, such as type 2 diabetes, are well-known risk factors for poor sperm quality.
Sperm are influenced by diet, and the effects arise rapidly. This is the conclusion of a study by researchers at Linköping University, in which healthy young men were fed a diet rich in sugar. The study, which has been published in PLOS Biology, gives new insight into the function of sperm, and may in the long term contribute to new diagnostic methods to measure sperm quality.
“We see that diet influences the motility of the sperm, and we can link the changes to specific molecules in them. Our study has revealed rapid effects that are noticeable after one to two weeks”, says Anita Öst, senior lecturer in the Department of Clinical and Experimental Medicine at Linköping University, and head of the study.
Sperm quality can be harmed by several environmental and lifestyle factors, of which obesity and related diseases, such as type 2 diabetes, are well-known risk factors for poor sperm quality. The research group that carried out the new study is interested in epigenetic phenomena, which involve physical properties or levels of gene expression changing, even when the genetic material, the DNA sequence, is not changed. In certain cases such epigenetic changes can lead to properties being transferred from a parent to offspring via the sperm or the egg.
In a previous study, the scientists showed that male fruit flies which had consumed excess sugar shortly before mating more often produced offspring who became overweight. Similar studies on mice have suggested that small fragments of RNA known as tsRNA play a role in these epigenetic phenomena that appear in the next generation. These RNA fragments are present in unusually large amounts in the sperm of many species, including humans, fruit flies and mice. So far, their function has not been examined in detail. Scientists have speculated that the RNA fragments in sperm may be involved in epigenetic phenomena, but it is too early to say whether this is the case in humans. The new study was initiated by the researchers to investigate whether a high consumption of sugar affects the RNA fragments in human sperm.
The study examined 15 normal, non-smoking young men, who followed a diet in which they were given all food from the scientists for two weeks. The diet was based on the Nordic Nutrition Recommendations for healthy eating with one exception: during the second week the researchers added sugar, corresponding to around 3.5 litres of fizzy drinks, or 450 grammes of confectionery, every day. The sperm quality and other indicators of the participants’ health were investigated at the start of the study, after the first week (during which they ate a healthy diet), and after the second week (when the participants had additionally consumed large amounts of sugar).
At the beginning of the study, one third of the participants had low sperm motility. Motility is one of several factors that influence sperm quality, and the fraction of people with low sperm motility in the study corresponded to that in the general population. The researchers were surprised to discover that the sperm motility of all participants became normal during the study.
“The study shows that sperm motility can be changed in a short period, and seems to be closely coupled to diet. This has important clinical implications. But we can’t say whether it was the sugar that caused the effect, since it may be a component of the basic healthly diet that has a positive effect on the sperm”, says Anita Öst.
The researchers also found that the small RNA fragments, which are linked to sperm motility, also changed. They are now planning to continue the work and investigate whether there is a link between male fertility and the RNA fragments in sperm. They will also determine whether the RNA code can be used for new diagnostic methods to measure sperm quality during in vitro fertilisation.
The study has been carried out in collaboration with the Reproductive Medicine Center at Linköping University Hospital, with financial support from the Swedish Research Council, the Knut and Alice Wallenberg Foundation, and the Ragnar Söderberg Foundation.
The article – “Human Sperm Displays Rapid Responses to Diet” by Daniel Nätt, Unn Kugelberg, Eduard Casas, Elizabeth Nedstrand, Stefan Zalavary, Pontus Henriksson, Carola Nijm, Julia Jäderquist, Johanna Sandborg, Eva Flinke, Rashmi Ramesh, Lovisa Örkenby, Filip Appelkvist, Thomas Lingg, Nicola Guzzi, Cristian Bellodi, Marie Löf, Tanya Vavouri and Anita Öst -= appeared in PLOS Biology.
Depression and suicide risk linked to air pollution
Reducing global average exposure to fine particulate matter (PM2.5) air pollution from 44 micrograms per metre cubed (μg/m3) to 25μg/m3 could result in a 15% reduction in depression risk worldwide.
People exposed to higher levels of air pollution are more likely to experience depression or die by suicide, finds a new analysis led by UCL.
The first systematic review and meta-analysis of evidence connecting air pollution and a range of mental health problems, published in Environmental Health Perspectives, reviewed study data from 16 countries.
The researchers found that, if the relationship with depression reported in some of these studies is causal, then reducing global average exposure to fine particulate matter (PM2.5) air pollution from 44 micrograms per metre cubed (μg/m3) to 25μg/m3 could result in a 15% reduction in depression risk worldwide.
The World Health Organization guidelines recommend that fine particulate matter pollution – small airborne particles that can include dust and soot – should be kept under 10μg/m3.
“We already know that air pollution is bad for people’s health, with numerous physical health risks ranging from heart and lung disease to stroke and a higher risk of dementia,” said the study’s lead author, Dr Isobel Braithwaite (UCL Psychiatry and UCL Institute of Health Informatics). “Here, we’re showing that air pollution could be causing substantial harm to our mental health as well, making the case for cleaning up the air we breathe even more urgent.”
The research team searched for studies that had investigated the association between particulate matter pollution and five different adverse mental health outcomes in adults. They identified 25 studies that fitted their criteria, nine of which were included in the primary analyses.
Five studies looking at long-term particulate matter exposure and depression were included in one meta-analysis. By pooling the results, they found that a 10μg/m3 (microgram per metre cubed) increase in the average level of fine particulate matter (PM2.5) air pollution people were exposed to over long periods was associated with an approximately 10% increase in their odds of depression.
“We found quite consistent results across the studies we reviewed that analysed the relationship between long-term air pollution exposure and depression, even after adjustment for many other factors which could explain the association. The association seems to be similar in magnitude to those that have been found for some physical health impacts of particulate matter, such as all-cause mortality,” Dr Braithwaite said.
Global city PM2.5 levels range from 114 and 97 in Delhi and Dhaka, to 6 in Ottawa and Wellington.
In UK cities, the average particulate matter level that people are exposed to is 12.8μg/m3. The researchers estimate that lowering average air pollution levels to the WHO recommended limit of 10μg/m3 could reduce urban UK residents’ depression risk by roughly 2.5%.
The researchers also found evidence of a connection between short-term changes in coarse particulate air pollution (PM10)* exposure and the number of suicides, from pooling the results of four different studies in a meta-analysis. The risk of suicide appears to be measurably higher on days when PM10 levels have been high over a three-day period than after less polluted periods.
The studies into short-term changes in suicide risk accounted for confounding factors such as weather changes, and day of the week. The relationship is not affected by other neighbourhood or socioeconomic factors given that the comparisons being made are among the same individuals on days with different pollution levels.
The researchers say the evidence was particularly strong for the suicide risk link, but the effect was smaller than for depression (an increase in suicide risk of 2% for each 10μg/m3 increase in the average coarse particulate pollution level over a three-day period).
The researchers say they cannot yet confirm whether air pollution directly causes mental ill health, but say there is evidence to suggest possible causal mechanisms.
“We know that the finest particulates from dirty air can reach the brain via both the bloodstream and the nose, and air pollution has been implicated in increased neuroinflammation, damage to nerve cells and to changes in stress hormone production, which have been linked to poor mental health,” Dr Braithwaite said.
The study’s senior author, Dr Joseph Hayes (UCL Psychiatry and Camden and Islington NHS Foundation Trust), said: “Our findings correspond with other studies that have come out this year, with further evidence in young people and in other mental health conditions. While we cannot yet say that this relationship is causal, the evidence is highly suggestive that air pollution itself increases the risk of adverse mental health outcomes.”
He added: “A lot of what we can do to reduce air pollution can also benefit our mental health in other ways, such as enabling people to cycle or walk rather than drive, and enhancing access to parks, so this adds support to the promotion of active travel and urban green spaces.”
Despite global issues re the environment, it is worth noting that the earth may be facing a major crisis, and yet there are some men who do not want to do anything because they are afraid that people may think they are gay. This is according to research published in Sex Roles, which noted that many men opt out from recycling and using cotton bags because they’re afraid of what people may think of them by questioning their… masculinity.
*The two main types of particulate matter pollution are differentiated by being under 2.5 micrometres in diameter (fine particulate matter, or PM2.5), and between 2.5 and 10 micrometres in diameter (coarse particulate matter, or PM10). Some, like smoke, are visible, while others are too small to be seen by the naked eye. Sources can include road transport, burning of fuels such as for heating or cooking, heavy industry and more.
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Tinder is a waste of time for most people
Community sewing center for Quezon City women
Depression and suicide risk linked to air pollution
When possibility of sex looms, people more likely to tweak truth
Gender norms affect attitudes towards gay men and lesbian women globally
Pregnant women with HIV often not given recommended treatment
Having to defend one’s sexuality increases fear of childbirth
Supreme Court junks with finality petition for same-sex marriage
And this, too, shall pass…
Phl reported 36 new HIV cases per day as of end-August 2019
Lesbian and intersex
And this, too, shall pass…
Expression of faith
‘Ang laban ng LGBT ay laban ng mamamayan’
‘Kitilin ang diskriminasyon’
Surrounded by art
Divided US Supreme Court to decide whether Civil Rights Act should also protect LGBT workers
#KaraniwangLGBT2 weeks ago
And this, too, shall pass…
Travel2 weeks ago
Marriage equality, trans rights upheld in Costa Rica
Health & Wellness2 weeks ago
Women with single dose of HPV vaccine gain similar protection as multiple doses
NEWSMAKERS1 week ago
Progressive gender beliefs in teen boys may be protective against violence