The truth about Philippine Gold

 (Published ENRICH magazine, 2023)

I LOVE GOLD. Many of you do, too, I'd wager.

Owning gold, either in the form of fine jewelry or 24 karat gold bars 99.5% pure, makes you feel special; like you're a SOMEBODY whatever your station in life might be. It's as if gold opens an escape hatch away from this shithole called Earth and into a problem-free golden world -- if only for a few minutes of joyful fantasy.

And the exhilarating FEEL of cold, pure gold in your hands can ignite an ecstasy almost similar to an orgasm. Gold is utterly beautiful. Thank God for gold. It's still the next best investment after cash.

A woman's chastity cover made of gold crafted by Filipinos..

Golden Filipinos

The Filipinos' affinity for gold is as enduring as it is cultural. It dates back centuries to before the arrival of the rapacious Spaniards in 1521.

Gold was extensively used by pre-Hispanic tribes in Luzon, the Visayas and Mindanao. Items of gold were symbols of power among the maharlika and badges of status among tribes.

Ancient Filipinos widely used gold as jewelry, body ornaments, accoutrements, clothing, currency, works of art and gilding for weapons. The popularity of gold is well documented by archaeological records and in many written accounts from pre-colonial and the early Spanish colonial period.  Gold, however, led to our subjugation by the Spaniards.

Even today, it's not well-known that gold was the main reason why Spain set out to conquer the Philippines. It was never about Spain spreading Roman Catholicism and the word of Christ to the heathen natives. This is pure nonsense. It was all about stealing gold from innocent Filipinos and enslaving them in the process.

The extensive use of gold and the incredible artistry of our ancient jewelry makers were on full display for the world to marvel at during an exhibit entitled "Philippine Gold: Treasures of Forgotten Kingdoms" held 2016 in New York City.

This widely applauded event showcased magnificent works of gold discovered over the past half-century in Luzon, the Visayas and Mindanao. On display were jewelry, regalia, ceremonial weapons, ritualistic and funerary objects from the 10th to the 13th centuries.

Hammered gold plaques created by ancient Filipinos displayed at “Philippine Gold Treasures of Forgotten Kingdoms” held 2016 at New York City..

The golden treasures included necklaces, pendants, bracelets, finger rings, pectorals, “kamagi,” waistbands, dishes and bowls. Such was the excellent craftsmanship of Filipino goldsmiths that they created wee ornaments so minute it’s almost impossible to discern their intricate details with the naked eye.

Of keen interest to visitors were the "chastity covers," which are triangular pieces of gold with rounded corners and engraved with floral motifs. It was worn by Filipino women over their genitalia. Hailed as the star of this exhibit, however, was a stunning golden sash (or caste cord) made entirely of gold beads. This five-foot long masterpiece weighing four kilograms was worn over one shoulder and across the chest. It extended to the hip and was adorned by a now lost finial.

Gold was a most popular metal used in jewelry-making because this precious metal was readily available throughout the archipelago. Our ancestors, therefore, flaunted their gold with freedom and abandon, which we sadly can't say for their descendants today.

Then, as now, the most important gold mining sites are the Cordillera Mountain Range in North Luzon; Camarines Norte (the “gold town” of Paracale) in the Bicol Region; Masbate in the Visayas, and Davao de Oro (literally “Davao of Gold”) and the Butuan-Surigao enclave along the Agusan River in Mindanao.

There are gold mines in 40 of our country's 81 provinces. Of the 40, 15 provinces are identified as "gold-rich" by the national government.

The Philippines today sits on the world's second-largest gold deposits, said a 2019 report by the Investing News Network (INN), a Canadian investment news website. This hoard has remained mostly untapped since 2017 due to a ban on open-pit metal mining. Our country was ranked 24th in global gold production in 2018, producing 36.8 tonnes (metric tons or MT). It will soon move-up in this ranking.

A golden sash or caste cord.

Gold fever

The good news is that the next few years should be a golden era for Filipino gold-lovers. Much of our golden wealth is about to come out of the ground and into the light.

This impending new gold rush has been unlocked by a national government order reinstating open-pit mining throughout the Philippines. In December 2021, the Department of Environment and Natural Resources (DENR) reversed the four-year-old ban on open-pit metal mining implemented in 2017 by the late DENR Secretary Gina Lopez, an environmentalist and mining industry foe who died in 2019.

Lopez's ban on open-pit mining included gold, silver, copper and complex ores. It was intended to “protect the environment," said Lopez. She also criticized open-pit mines as “perpetual liabilities” for the Philippine government.

Department of Environment and Natural Resources (DENR) Administrative Order (DAO) 2021-40 signed by former Secretary Roy Cimatu formally repealed DAO 2017-10 that imposed the mining ban.

Brushing aside loud protests against DAO 2021-40, DENR claimed lifting the ban will “revitalize the mining industry and usher in significant economic benefits to the country by providing raw materials for the construction and development of other industries and by increasing employment opportunities in rural areas where there are mining activities thereby stimulating countryside development.”

The mining industry hasn't lived-up to its full potential because it's been “mired since the 1980s in klutzy laws, environmental battles and land rights issues,” noted a story in Forbes magazine. In addition, most indigenous peoples in the country (especially those in Mindanao) are against mining. The indigenous also have special rights that allow them to veto mining projects in their lands.

The national government, which isn’t earning as much as it should from gold mining, and commercial miners are eager to exploit the country's remaining untapped gold deposits. The mining industry contributed only PhP31 billion ($600 million) to the Philippine economy in 2020 by way of taxes, fees and royalties paid to the national and local governments, said the Mines and Geosciences Bureau (MGB).

In contrast, the Philippine business process outsourcing (BPO) industry plows-in some PhP1.63 trillion ($30 billion) into the economy each year, according to Nexford University, a fully online university based in the United States.

MGB data also reveals the Philippines produced 20.8 MT of gold worth $866.7 million in 2018. The country produced 22.8 MT of gold valued at $894.6 million in 2017. In March 2019, the government estimated the value of the country's remaining gold deposits as ranging from $9 billion to $11.2 billion.

On the other hand, the Philippine Statistics Authority (PSA) estimated our gold reserves in January 1998 at 101.6 million MT of gold ore, equivalent to around 240 MT of gold. The government said 27.7 million MT of gold ore containing 36 MT of gold was extracted from 1988 to 1994. This is equivalent to extracting 3.9 million MT of gold ore, or 5.14 MT of gold, every year.

The Philippines is studded with mineral mines. Fully 25% (or 764,000 hectares) of the country's 30 million hectare total land area were subject to mining concessions as of July 2021. More than nine million hectares are said to be laden with large quantities of valuable mineral deposits.

These mineral deposits are worth more than $1 trillion, estimated Mongabay, a conservation news web portal based in the U.S. Most of these minerals are copper, gold, nickel, aluminum and chromite. Our country exported metallic and non-metallic minerals worth $5.2 billion in 2020. Copper, gold and nickel were the three top metallic exports in that order. 

The Philippines is the third largest gold-producing country in Southeast Asia after Australia and Indonesia. China, Australia and Russia are the world's largest producers of gold, said INN.

Half of the world's gold production goes to jewelry. Around 10% is used industrially while a third goes into gold bars and gold coins owned by monetary authorities and central banks around the world.

Gold bars

Only the rich get rich from gold mining

This wealth from gold is restricted to a few in our country, however. It's because small miners that comprise the Artisanal and Small-scale Gold Mining (ASGM) sector dominate local gold mining.

ASGM accounts for 70% of the Philippines' gold production, said the planetGOLD program. The remaining 30% goes to the commercial or large-scale miners like Philex Mining Corporation, the largest publicly-held gold and copper producer in the country.  PlanetGOLD is a multi-sectoral program that works to improve ASGM production practices and work environments in nine countries, including the Philippines.

ASGM also employs more than 500,000 miners and provides livelihoods for over two million Filipinos, most of them poor. On the other hand, gold mines are traditionally controlled by local oligarchs and local warlords that either employ ASGM miners or receive payment from miners for the right to mine their land. Hence, the wealth from gold mining stays in the hands of a very few.

There is a difference between "Artisanal" and "Small-scale" mining. The former refers to unorganized mining that doesn't use sophisticated machinery. It uses brawn, muscle power and other rudimentary methods to extract and process minerals and metals on a small-scale. Small-scale mining refers to more organized miners that may or may not use sophisticated machinery. These miners make a lot more money than artisanal miners.

Artisanal miners also frequently use toxic materials -- especially mercury which is a neurotoxin that damages the nerves -- to extract gold from ore using the mercury amalgamation process. This process also releases toxic materials into the surrounding environment, posing dangerous health risks to miners, their families and nearby communities.

Artisanal gold mining is one of the most significant sources of mercury pollution in our country and in other developing countries such as those in Africa.

Yamashita's Gold

The Philippines never runs out of tall tales about fabulous gold hoards with wealth (much of it gold) beyond imagination.

Our Baby Boomer generation (Pinoys born from 1946 to 1964) and Generation X (1965 to 1985) were regaled by the fantastic tale of the multi-million dollar "Yamashita Treasure" said to have been buried in 1945 by the Imperial Japanese Army somewhere in the mountains of North Luzon.

There's also the fabulous "Golden Buddha," a three-foot tall statue said to be made of pure gold discovered in 1971 by treasure hunter Rogelio Roxas. Roxas claimed to have found the Golden Buddha and crates filled with gold bullion that were part of the Yamashita Treasure.

He later filed a lawsuit in Hawaii against former president Ferdinand Marcos and his wife, Imelda, for the theft of this statue and the treasure he discovered. He also sued the couple for abusing his human rights by ordering his torture.

Roxas, a former soldier, died in 1993. In 1996, his estate and the Golden Buddha Corporation received what was then the largest judgment ever awarded in history -- $22 billion. Interest increased this huge sum even further to $40.5 billion.

The Hawaii Supreme Court in 1998 said there was sufficient evidence to support the jury's finding that Roxas found the treasure and that Marcos stole it.

The court, however, later reduced the award for damages. The final judgment against Imelda Marcos (her husband died in 1989) ordered her to pay the Golden Buddha Corporation $13.3 million while Roxas’ estate was awarded a $6 million judgment on the claim for human rights abuse.

The U.S. Ninth Circuit Court of Appeals determined "The Yamashita Treasure was found by Roxas and stolen from Roxas by Marcos' men."

Fool’s Gold

Millennials and Generation Z have to contend with the even taller tale of "Tallano Gold." The many and massive lies that comprise this scam and conspiracy theory beggar the imagination.

The myth that is the Tallano gold was resurrected by followers of the current president during the presidential campaign of 2022. His supporters insist the wealth of the Marcos family comes from gold bars that were paid to the president's late father by an entity called the "Tallano-Tagean Royal Family."

This fictional family was alleged to have ruled the "Maharlikan Empire" that owned pre-Spanish Philippines and also ruled Sabah, South Borneo, the Spratly Islands and Hawaii. It paid the late president more than 400,000 tons of gold for the legal services he supposedly provided them.

Jose Victor Torres, a professor of history at the De La Salle University Manila, said the Tallano gold is a "historical hoax." This lie has been kept alive by Filipinos that hope to get rich quick despite not being proven by any historical document.

"It's because of money," said Torres in January 2022. "No matter what you say that it's fake or not, pagtitiyagaan talaga iyan ... People are willing to sacrifice the truth for money."

History professor Francis Gealogo, former head of the Department of History at the Ateneo de Manila University, said there are no historical accounts to prove these claims. President Ferdinand Marcos Jr. himself has disavowed the existence of the Tallano gold.

“Walang ginto. Walang ginto,” said Marcos Jr. in February 2022 when asked to confirm if their family owns metric tons of gold and if they’d give it to his supporters.

He previously asserted he hasn't seen the Tallano gold in his entire life. He jokingly said the public should tell him about the location of the Tallano gold.

“Baka may alam sila, sabihan ako," he said. "Kailangan ko iyong gold."

 

 

From overpopulation to depopulation: the Philippines a century hence

 (Published in ENRICH magazine, 2023)

THE WORLD'S EIGHTH BILLIONTH person was born in the Philippines on November 15, 2022. This symbolic milestone was announced to Filipinos by the Commission on Population and Development (PopCom).

PopCom said the eighth billionth person is a girl, Vinice Mabansag, of Tondo, Manila. The agency gifted the mother and child with a “welcome cake” to mark the historic occasion.

"The world has reached another population milestone after a baby girl born in Tondo, Manila was chosen to symbolically mark the eighth billionth person in the world," said PopCom in a Facebook post. "Baby Vinice was welcomed on Nov. 15 by nurses at Dr. Jose Fabella Memorial Hospital, as well as representatives from the Commission on Population and Development".

United Nations Secretary General Antonio Guterres described the event as an "occasion to celebrate diversity and advancements while considering humanity's shared responsibility for the planet". In a statement, the UN said the steady growth in the global population is due to higher fertility rates, especially in the world's poorest countries (many of which are in Africa), and to people living longer thanks to advances in medicine, public health, nutrition and personal hygiene.

New born baby Vinice Mabansag, the world's eighth billionth person

Good news?

This landmark event, however, might herald an end to the pronatalism and its focus of child-bearing and parenthood that has been a hallmark of Philippine society since the end of the Second World War.

A relentless drop in fertility since 1946 means the Philippines will eventually come to grips with the perils of depopulation or population collapse. Depopulation has the power to make the Philippines old before it can even become rich. It might also put paid to the Philippines' cherished dream of becoming a First World country.

When a country's total fertility rate (TFR or births per woman) persistently falls below the replacement fertility level of 2.1 children per woman, its population grows older and shrinks. This outcome can slow economic growth and endanger pensions for the elderly.

Depopulation will also trigger slower growth in living standards, argues Prof. Charles Jones in a new study, “The End of Economic Growth?”, published in 2020.

He contends depopulation will give rise to a vicious cycle in which low fertility in one generation causes low fertility in the next. The end result will be a downward spiral in population. This scenario had earlier been given the name, the “Low-Fertility Trap Hypothesis”, by demographer Wolfgang Lutz and colleagues in a paper published in 2006.

Lower birth rates will also result in a smaller pool of young people entering the labor force. Coupled with an ageing population, the dearth of young people will strain a country's economic resources and might see a decline in growth. Rapid population ageing is a consequence of low fertility.

Japan’s labor force, for example, will drop from 68 million to 46 million (a 32% decline) by 2050 if present demographic trends continue. Germany will see a plunge from 41 million to 28 million.

China, however, is the poster boy for the crippling dangers of negative long-term population decline. Its population (now at 1.412 billion persons) is forecast to shrink to 1.411 billion by 2023, according to Statista. This drop is the offshoot of China's disastrous One Child Policy implemented in 1980 when its TFR stood at 3.01 births per woman. The One Child Policy triggered a precipitous fall in China's fertility rate to 1.15 births per woman by 2021.

China, the world's most populous country, is now facing a population collapse that will write finis to its grand ambition of becoming the world's leading economic and military power by the 2040s. Also as a result, China might never become a First World country.

Early demographic data suggests an absolute decline in China's population in 2022 -- the first reduction in 60 years. China's National Bureau of Statistics (NBS) said the country's population grew by a puny 480,000 people in 2021, a record low increase that brought its population to 1.412 billion. In contrast, China's annual population growth stood at around eight million only a decade ago.

By 2050, China's population will decrease to 1.317 billion from today's 1.412 billion. This loss of some 100 million Chinese is depopulation on a massive scale and one from which China might never recover. On the other hand, India should have a population of 1.668 billion by 2050. It is widely expected to become the world's most populous country in 2023.

China population pyramid 2020

Becoming China

The Philippines is now faced with the potentially crippling phenomena where low fertility and a low birth rate reminiscent to that of China's become major barriers to economic prosperity.

The Philippines’ fertility rate in 2022 dropped to 1.9 children per woman between 15 and 49 years-old compared to 2.7 in 2017, according to the Philippine Statistics Authority (PSA) in November. That’s below the replacement level of 2.1 offspring per woman, which is the point at which a population replaces itself from one generation to the next.

It's the first time the country's fertility rate has fallen below the replacement level of 2.1 based on government data. The Philippines' fertility rate stood at 7.5 births per woman in 1950, falling by half to 3.8 by the year 2000. It has consistently decreased every year from 1950 to 2021.

The country’s birth rate is also on the decline. It fell to 19.778 births per 1,000 individuals in 2022, a 1% drop from 19.978 births per 1,000 people in 2021, said the PSA. The 2021 birth rate for Philippines was 0.99% lower than that for 2020 with its 20.177 births per 1,000 people. The 2020 birth rate was 0.98% smaller than that for 2019.

In comparison, China's birth rate plummeted to a record low of 7.52 per 1,000 people in 2021 compared to 8.52 in 2020, said the NBS. It’s been decreasing since 2017.

The birth rate and fertility rate are two different measures. The former refers to the total number of annual births per 1,000 individuals. On the other hand, the fertility rate counts the total number of births in a year per 1,000 women of reproductive age in a population.

Birth rates ranging from 10 to 20 births per 1,000 are considered low, and the Philippines now fits into this category. Rates from 40 to 50 births per 1,000 are considered high.

Steep fertility drop

The unexpectedly large drop in fertility is “the sharpest ever recorded,” said PopCom Executive Director Lolito Tacardon in November. Tacardon also said the reasons for the decline include easier access to family planning and birth control and a desire among half of currently married Filipinas to no longer bear more children.

Tacardon said the steep drop in fertility also means the Philippines now has the third lowest fertility rate in Southeast Asia after Singapore (1.1 children per woman) and Thailand (1.5). He noted the average Asian fertility rate is 2.2.

He claimed there are “more pros than cons” to the Philippines falling below the replacement fertility level. He saw the decrease as a "demographic transition" giving the country an opportunity to “hasten socioeconomic development”.

The country's population grew by a scant 900,000 persons in 2020 and 324,000 in 2021 compared to 1.5 million in 2019, the year before the advent of COVID-19 pandemic. The birth rate in 2021 was the smallest annual natural increase since 1946 when the country's total population grew by only 254,000 persons.

The government, however, is showing no alarm at these changes. It said the low population growth in 2020 and 2021 gives the country a greater chance to recover from the COVID-19 pandemic. PopCom Executive Director Dr. Juan Perez III said this might also improve the services provided by the national and local governments.

“Filipinos remained prudent by continuing to delay having children or forming families during the combined economic crisis and Covid-19 health emergency," said Perez in December 2021. "Couples in growing numbers continue to avail of family planning commodities and services in all regions of the country, with eight million users of modern family planning methods in 2020, or an addition of about 500,000 from 2019".

PopCom in August 2022 revealed the country's population of children had fallen over the last two decades due to "lower levels of fertility". The Philippines is also seeing a lower percentage of younger people in its total population of 110 million.

PopCom said the population of Filipino children below 5 years-old had dipped to 10.2% in 2020 from 10.8% in 2015 and 12.6% in 2000, based on data from the PSA. The percentage of Filipinos below 15 also decreased, from 37% in 2000 to 30.7% in 2020.

Perez attributed the lower number of children born since 2015 to "the effectiveness of the Philippines’ family planning program".

He said this trend should be considered good news given the Philippines' persistent overpopulation problem. He argued there was “nothing wrong with the low birth rate” in 2020 and 2021 and described these outcomes as a welcome demographic transition.

“There were fewer births because avoidance of pregnancy, unplanned pregnancies, unintended pregnancies were the aim of most women, and the economic crisis as well is (showing) that whenever there is an economic downturn, births go down,” said Perez.

Based on the latest data, PopCom estimated the Philippine population at 109,991,095 for 2021. This new estimate is two million persons lower than earlier projections and is based on a 1.63% population growth rate.

“If integrated population and development measures are sustained, we can look forward to a more stable population that can effectively support Philippine development," noted Perez. "Smaller family sizes need to be supported by a national living wage structure that also allows parents to save for their households’ unmet needs in food, housing, and education".

Philippine population pyramid 2020

Rapid depopulation

The biggest downside to low fertility's is it reduces a country's population only among the young and not among other age groups. Persistent low fertility also creates the conditions for future population decline. Overpopulation will no longer be a problem for the Philippines.

Demographers say a slide in fertility must be halted if a population is to be demographically sustainable. Depopulation is a situation the Philippines might face if it's not careful and if fertility continues to decrease year after year.

It's been seen that countries suffering from low fertility can experience depopulation at an extremely fast rate. The example of South Korea is a dire warning to our country.

South Korea in 2021 reported the world lowest fertility rate of only 0.81 births per woman compared to the global average of 2.32. If this chronically low fertility rate continues, South Korea will see its current population of 52 million persons plunge to only 38 million by 2070, according to Statistics Korea. That's an almost 40% drop in a mere 50 years. The last time South Korea had a 38 million population was in 1980/81.

Japan is also in the same boat at South Korea as one of the few Asian countries experiencing depopulation. Its population is forecast to decrease from 126.5 million in 2020 to 105.8 million in 2050. This is a 16.3% population reduction. Japan's population is shrinking rapidly and the main reason is its low fertility rate, which stood at 1.37 births per woman in 2021. That same year saw only 811,604 babies born, the lowest number since Japan began keeping records in 1899.

By 2050, populations will decrease in more than half the European countries. Interestingly, some 60% of the global population resides in countries like ours where fertility rates have dropped below the replacement level of 2.1 births per woman.

One more chance

It’s  odd that despite the Philippines ’ low  fertility rate of 1.9 children per woman, our country was still listed by the United Nations in its World Population Prospects 2022 as among the eight countries that will account for more than half of the projected increase in global population up to 2050.

The estimated Philippine population in 2050 will be 157.9 billion compared to today's 110 million, or an increase of 48 million Filipinos over the next three decades. This seems to explain why the UN included the Philippines among the top eight countries driving global population growth by 2050. Compare to this to Japan whose population will shrink by more than 20 million in 2050 from today's 126.5 million.

Our population will peak at 180.8 billion in 2090 before decreasing in the succeeding years to 180.1 million by the year 2100, according to the UN. The new UN estimates are significantly higher than those projected by the 2019 edition of its World Population Prospects.

The other seven countries that will drive global population growth in 2050 are the Democratic Republic of the Congo, Egypt, Ethiopia, India, Nigeria, Pakistan and Tanzania. The report also estimated the global population at 8.5 billion in 2030, 9.7 billion in 2050 and 10.4 billion in 2100.

The UN report also said the rate of new people being born around the world is definitely slowing down. The global population, however, is expected to continue increasing for many more decades. Population changes gradually over time, so countries like the Philippines facing future depopulation should have enough time to reverse course -- if they want to.

Demographers say the longer a low fertility rate persists; the harder it becomes to reverse depopulation. Countries wanting to avoid depopulation have to make higher levels of fertility a priority national goal while their demographics still allow for population growth.

The Philippines has an easy choice to make given it has the rest of this century to act. But can it be trusted to make the right decision?

Philippine median age 2020

"Malas" causes cancer -- or does it?

 (Published in ENRICH magazine, 2022)

THE CONTENTIOUS CLAIM most adult cancers are due to "bad luck" or "malas" shouldn't be seen as a death sentence. Neither should it be regarded as a Gospel truth that deters us from doing all the good stuff proven to prevent cancer and extending our healthspans.

This unending hue and cry over the allegedly huge role chance (or is it Fate) plays in the development of cancer was triggered by a research paper published January 2015 in the peer-reviewed journal, Science. The paper suggested that cancer as a whole occurs by chance and can't be attributed mostly to heredity or lifestyle risk factors such as smoking and alcohol use.

The study asserts that two-thirds of adult cancers across different tissues are simply the result of sheer “bad luck”. Bad luck in this case refers to random DNA mutations occurring in genes that later progress into cancer.  You're lucky if these mutations don't trigger cancer. If not, it's your bad luck.

These random and potentially harmful DNA mutations accumulate in our bodies when stem cells (cells that generate all other cells with specialized functions) divide into various tissues, explained Dr. Cristian Tomasetti, an eminent cancer biologist and an associate professor of oncology and biostatistics at Johns Hopkins University who is one of the study's two authors.

Dr. Bert Vogelstein, a professor of oncology and Howard Hughes Medical Institute investigator at The Johns Hopkins Medical School, is co-author of the paper, "Variation in cancer risk among tissues can be explained by the number of stem cell divisions".

The study is a technical description of how cancer rates vary in different tissues and is based on data from the United States. It did not focus on cancer prevention or on lifestyle changes that deter cancer.

The study suggests our inherited genes, environmental factors and risky lifestyle choices such as smoking, alcoholism or eating too much red meat play a small role in cancer development.

"Here, we show that the lifetime risk of cancers of many different types is strongly correlated (0.81) with the total number of divisions of the normal self-renewing cells maintaining that tissue's homeostasis," wrote Tomasetti and Vogelstein.

"These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions.

"The majority is due to 'bad luck,' that is, random mutations arising during DNA replication in normal, noncancerous stem cells. This is important not only for understanding the disease but also for designing strategies to limit the mortality it causes".

Tomasetti and Vogelstein found a strong relationship between how often certain cells divide in different kinds of human tissue and the lifetime chance cancer will develop in those tissues. They confirmed the more often cells divide, the more likely this tissue will develop cancer since duplicating DNA can lead to mistakes, and DNA mistakes can cause cancer.

Tissues with stem cells that divide a lot tend to develop higher rates of cancer. That's why colon cancer is more common than brain cancer. On the other hand, stem cells that rarely divide are likely to have lower cancer rates.

Vogelstein explained that cancer occurs when tissue-specific stem cells mutate or make random mistakes. These mistakes occur when one chemical letter (Adenine, Thymine, Guanine or Cytosine) in our DNA is incorrectly exchanged for another during the replication process in cell division. The massive accumulation of these mistakes over time increases the risk cells will grow unchecked into cancer.

"All cancers are caused by a combination of bad luck, the environment and heredity, and we've created a model that may help quantify how much of these three factors contribute to cancer development," said Vogelstein.

Bad luck causes cancer

Unlucky 22

A layman’s knee-jerk reaction to the “bad luck” conclusion is to ask "What's the use of a healthy lifestyle if there's practically nothing you can do to prevent cancer"?

Does this mean we should abide by the Epicurean blandishment to "Eat, live and be merry for tomorrow we die"? It's a tempting course of action given the study, but one that's wrong on all counts.

"If two-thirds of cancer incidence across tissues is explained by random DNA mutations that occur when stem cells divide, then changing our lifestyle and habits will be a huge help in preventing certain cancers, but this may not be as effective for a variety of others," said Tomasetti.

Tomasetti and Vogelstein found that 22 of the 31 cancer types they studied could largely be explained by the "bad luck" of random DNA mutations during cell division. There are more than 100 types of cancer, of which carcinoma is the most common.

The 22 "bad luck" cancers identified by Tomasetti and Vogelstein are those in which “primary prevention measures are not likely to be as effective”. Primary prevention measures, which involve screening, seek limiting our exposure to carcinogens to prevent the start and spread of cancer.

They include lifestyle interventions (such as regular physical activity and not smoking) and medical interventions (vaccinations). Tomasetti and Vogelstein also said the early detection of cancer is a viable secondary prevention measure for some cancers that can't be overcome by prevention.

 he 22 "bad luck" cancers consist of head osteosarcoma, glioblastoma, medulloblastoma, head and neck, thyroid medullary, lung (for non-smokers), esophageal, osteosarcoma of the arms, hepatocellular carcinoma, pancreatic ductal adenocarcinoma, pancreatic islet tumors, gall bladder, duodenum, small intestine, pelvis osteosarcoma, ovarian germ cell, testicular germ cell, melanoma, osteosarcoma, leg osteosarcoma, chronic lymphocytic leukemia and acute myeloid leukemia.

The other nine cancer types are due to bad luck plus environmental or inherited factors. These include basal cell carcinoma, HPV-16 (human papillomavirus-16) head and neck, thyroid follicular, lung (smokers), HCV (hepatitis C virus) hepatocellular, colorectal adenocarcinoma, Lynch colorectal and familial adenomatous polyposis or FAP colorectal.

Extrinsic factors

The conclusions of the paper by Tomasetti and Vogelstein are still hotly debated. The study continues to draw withering criticism and outrage from its foes, especially cancer prevention doctors who see it as negating the message that most cancers can be prevented. The furor has escalated with the publication of new studies seeking to counteract the "bad luck" hypothesis.

Eleven months after Tomasetti and Vogelstein's study, a team of cancer biologists and statisticians published a study in Nature, the British weekly scientific journal, detailing the contrary opinion using mathematical, epidemiological and molecular evidence.

“A majority of cancers are due to extrinsic factors,” declared Dr. Yusuf Hannun, director of the cancer center at Stony Brook University in New York State and senior author of the paper in response to the contention most cancers are the result of random biological mistakes.

“External factors can influence the rate of stem-cell division and the number of mutations", Hannun added.

The rebuttal explained that cancers are more prevalent than can be explained by cell division alone. This can be seen by the huge geographical variation in rates of different cancers, which suggest cancers are triggered by much more than intrinsic factors like cell division.

For example, prostate cancer is 25 times more common in Australia than south-central Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka) while breast cancer is five times more common in Western Europe compared to East Asia (China, Japan, Mongolia, North Korea, South Korea, and Taiwan).

The Stony Brook study also said the non-inclusion of common cancers such as prostate and stomach cancer might have skewed the conclusion about the importance of cell division in explaining which tissues likely develop cancers. It pointed out cancers due to cell-division errors form the base to which cancers due to other causes are added.

The paper concluded that “unavoidable intrinsic risk factors (such as cell division) contribute only modestly, less than 10-30 percent, to the development of many common cancers”.

Doubling down

Partly in response to the Stony Brook study, Tomasetti and Vogelstein in 2017 released another paper (also published in Science) that defended their original findings and also sought to correct what they saw were widespread misinterpretations about it.

Based on health records from 69 countries, the new study argues that 66% of cancer-causing genetic mutations arise from the “bad luck” of healthy, dividing cells making random mistakes when copying their own DNA. This time, the new study admitted the cause of many cancers might be environmental factors.

It analyzed cancer genomes in a United Kingdom database to classify if cancer-causing mutations are hereditary, if they originate from the environment or are random DNA-copying mistakes.

Tomasetti and Vogelstein now pointed out their new conclusion does not mean that two-thirds of cancers can't be prevented. Vogelstein said understanding the role of unforced errors “could provide comfort to the millions of patients who developed cancer but led near-perfect (healthy) lifestyles”.

“This is particularly true for parents of children who have cancer” and who might blame the tragedy on the genes they passed on to their child or the environment they provided.

Hannun, however, was skeptical of the new study and remarked he wasn’t “very impressed with the overall conclusion”.

Cancer can be prevented

Prevention still matters since some 42% of cancers are preventable. Tomasetti and Vogelstein admitted as much in their original study when they said "One of the most promising avenues for reducing cancer deaths is through prevention". They also said the early detection of cancer is a viable secondary prevention measure for cancers that can't be controlled by prevention.

We must take heart from the knowledge our chances of not developing cancer are affected by the lifestyle choices we make. We have to do the right thing. The Mayo Clinic, which has been consistently ranked among the best hospitals in the United States, offers these cancer-prevention tips.

* Don’t use any type of tobacco to avoid lung, throat, mouth, larynx, pancreas, bladder, cervix and kidney cancer.

* Maintaining a healthy weight and being physically active helps fight cancer. A healthy weight might lower the risk of breast, prostate, lung, colon and kidney cancer, among others. Physical activity might lower the risk of breast cancer and colon cancer.

* You've also got to go on a healthy diet by eating lots of fruits and vegetables. Also limit your intake of processed meats such as ham, bacon and frankfurters since eating lots of this stuff can slightly increase the risk of colorectal cancers and other chronic diseases.

* Regular medical examinations boost the chances of discovering skin, colon, cervix and breast cancer early on. Early discovery increases the likelihood of successful treatment of early stage cancer.

* Vaccinate yourself against Hepatitis B, which can increase the risk of developing liver cancer. Also vaccinate against the Human papillomavirus (HPV) that can lead to cervical cancer, squamous cell cancers of the head and neck and other genital cancers.

* Avoid risky behaviors such as unsafe sex with multiple partners to preclude acquiring sexually transmitted infections like HIV or HPV. People with HIV or AIDS are at a higher risk of cancer of the anus, liver and lungs. HPV increases the risk of cervical cancer, cancer of the anus, penis, throat, vulva and vagina.

* Protect yourself from skin cancer, one of the most common types, by avoiding the midday sun, staying in the shade and using sunscreen when needed.

Cancerous cells

About cancer

Cancer, which can begin in almost any of the more than 37 trillion cells in the human body, is basically uncontrolled cell growth. A growing mass of cancerous cells can later develop into a tumor.

In the Philippines, 189 of every 100,000 Filipinos were afflicted with cancer in 2012. Four Filipinos died of cancer every hour or 96 cancer patients per day, according to a study conducted by the University of the Philippines’ Institute of Human Genetics, National Institutes of Health.

Cancer is one of the five leading causes of death in the Philippines with lung cancer due to smoking causing the most cancer deaths. Lung cancer caused by tobacco remains the biggest single cause of cancer deaths worldwide (six million deaths annually).  There were an estimated 1.1 billion smokers on our planet in 2019.

The five most common cancers globally are carcinomas that attack organs and glands such as the lungs, breasts and skin. There's leukemia, which affects the body’s blood forming tissues. Sarcoma affects soft or connective tissues such as muscle, fat, bone and blood vessels.

Melanoma occurs in cells that pigment the skin. Lymphoma attacks the lymphatic system, which is part of the body's germ-fighting network.

Advancing age is the top risk factor for developing cancer with people over 65 running the greatest risk of acquiring the disease. The median age of a cancer diagnosis in the U.S. is 66 years-old.

For many of us, cancer will be in our future. One in two women and one in three men in the U.S. will develop cancer in their lifetime based on 2015 data. It’s equally grim in the United Kingdom where one in two men and women will be diagnosed with cancer. Cancer prevention starts now.

Height does matter, and in more ways than one

 (Published in ENRICH magazine, 2022)

IN THE PHILIPPINES, the phrase "stand tall" should be taken with a figurative, and not literal, meaning.

That's because Filipinos still retain the dubious honor of being one of the world's shortest people in average population height, average female height and average male height. On average, Filipino men and women are a mere 156.41 cm (5 feet 1.57 inches) tall, according to data released in 2019 by NCD Risk Factor Collaboration (NCD-RisC), a project linked to Imperial College London. This made Filipinos the fifth shortest people in the world based on NCD-RisC reckoning.

The same data also showed the average Filipino man with a height of 163.22 cm (5 feet 4.25 inches). That's as tall as Hollywood stars Michael J. Fox and Kevin Hart. The average Filipina is 149.60 cm (4 feet 10.89 inches) tall. Heightwise, that’s similar to former President Gloria Macapagal-Arroyo, superstar Nora Aunor and the late Hollywood legend Judy Garland.

Filipinos are only marginally taller than citizens of Timor-Leste, which topped the shortest stature list of NCD-RisC. The average height of both males and females from Timor-Leste was 155.47 cm (5 feet 1.28 inches). The average Timorese man stands 159.79 cm (5 feet 2.90 inches) tall while the average woman gets to 151.15 cm (4 feet 11.50 inches).

On the other hand, the average Timorese woman (151.15 cm) is taller than the average Filipina (149.60 cm). This makes Filipinas the second shortest in the world behind the women of Guatemala, who have an average height of 149.38 cm (4 feet 10.81 inches).

NCD-RisC is a global network of health scientists that provides timely data on major risk factors for non-communicable diseases for all countries.

The question now is why are we still of such short stature when this problem has been with us for generations? There are short and easy answers to this question.

Basically, it boils down mostly to genetics (or biological factors) coupled with the right food and adequate nutrition (or socioeconomic factors), especially in childhood.

Some scientists estimate that genetics accounts for more than 60% of a person's height. This being the case, a relatively well-to-do Filipino couple whose height is above average will likely sire taller than average children.  The reverse is also true.

The hereditary advantage conferred by tall parents who have enough money to regularly feed their children more protein (generally meat) than carbohydrates (rice) in their kids' growing years should see much taller children. Most Filipinos, however, are neither tall nor rich. The consequences of these realities are what we see daily on our streets: a sea of short and poor Filipinos.

Stunted, poor and malnourished

Height matters, and not only because of bragging rights. It turns out "height is a proxy indicator of how well the Philippines is doing as a society to reduce childhood poverty and improve access to nutrition," according to a report released in 2015 by Save the Children Philippines. It appears the Philippines is failing in this task.

"If the Philippines is to progress economically, we must not leave the poorest children behind," said the report with the title, "Sizing Up the Stunting and Malnutrition Problem in the Philippines".

World Atlas, an educational geography website online since 1996, publishes its own set of global stature statistics. In 2017, it estimated the average height of Filipinos at only 154.9 cm (5 feet 1.5 inches), a full 8.3 cm (3.3 inches) shorter than the estimate from NCD-RisC.

This made the Philippines the country with the third shortest population in the world. Instead of Timor-Leste, World Atlas said Bolivia had the world's shortest population. It placed the height of the average Bolivian at 151.1 cm (4 feet 11.5 inches).

What makes the estimate by World Atlas remarkable is that it attributed the short stature of Filipinos to "severe malnutrition problems ... especially prevalent in the event early age pregnancies, where the mother is not fully physically equipped for childbirth and childcare".

It noted the Department of Education (DepEd) admitting 1.8 million malnourished Filipino children are in danger from abnormalities such as stunting.

"The result is that the likelihood of this situation being repeated in the next generation is high. Although feeding programs have been launched, funds are not adequate enough," it reported.

It appears the DepEd estimate is off the mark. A report published by the Philippine Daily Inquirer in 2015 claimed 30% of all Filipino children under the age of five were stunted or short for their age. In numbers, this is an astonishing 3.6 million children, the ninth largest number of any country at the time.

"This is not a theoretical problem; this is a nutritional emergency," said the story.

At 63%, the Autonomous Region in Muslim Mindanao (ARMM) had the highest level of stunting among children in the entire country. Childhood stunting in Mindanao comes to 40%. This figure is equivalent to the average for all of sub-Saharan Africa consisting mostly of black African countries.

The report defined "stunted" as a child chronically malnourished during the first 1,000 days of its life, or from conception until the second birthday. This is the critical growth period for any child.

The World Health Organization (WHO) asserts stunting is the irreversible outcome of inadequate nutrition and repeated infections during the first 1,000 days of a child’s life.

The latest data about stunted Filipino children remains troubling and points to a neglect of the problem by both the national and local governments. The World Bank estimated 29% of Filipino children in 2019 age five and below were stunted.

It said the Philippines is still plagued by childhood stunting because of undernutrition, which it labeled "the silent pandemic". Stunting keeps most children in poverty for their entire lives while poverty creates the conditions leading to stunting.

In 2015, poverty meant 1.5 million Filipino children went through a day without a full meal. Some 2.7 million Filipino children missed a meal because their families don't have enough money for three meals a day. This situation has remained rampant.

In 2018, the Department of Health (DOH) estimated there were 4.2 million stunted Filipino children and more than 300,000 children under five years that are severely wasted, or thin for their height. Severely wasted children have at least nine to 12 times an increased risk of death.

The toll taken by malnutrition on Filipino children is gruesome and heartbreaking. UNICEF Philippines estimates 95 Filipino children die every day from malnutrition.

Another indignity: 27 out of 1,000 Filipino children do not live past their fifth birthday. And still another:  a third of Filipino children are stunted, and stunting after two years of age can be permanent, irreversible -- and even fatal. We must put a stop to this!

Bad for the brain

Malnutrition and poverty are also bad for the brain. A poor and stunted Filipino child will unlikely achieve his full cognitive and intellectual potential.

WHO and the United Nations Children's Fund (UNICEF) both agree stunting affects the cognitive development of children, which can be seen in their paltry academic results at school.

Nine out of 10 Filipino children at age 10 cannot read or understand a simple story by the age of 10. This translates into a record high "learning poverty" of 90.5%. The inability of Filipino children to read by 10 years-old will also mean they face huge obstacles to learning math, science and a host of other more difficult subjects.

 Learning poverty is defined by the World Bank as a child being unable to read and understand simple text by age 10. Also called "galloping illiteracy", learning poverty will later translate into economic poverty.

 It has gotten far worst over the past two years due to the cancellation of face-to-face classes in the aftermath of COVID-19. Before COVID-19 struck in early 2020, learning poverty in the Philippines was lower at 69.5%.

Malnourished Filipino children

First 1,000 days

During the presidential campaign 2016, candidates were asked to support the “First 1,000 Days Act,” a piece of legislation pending in Congress whose goal was to make reducing stunting and improving nutrition nationwide a presidential priority.

The man that won the presidential race, Rodrigo Duterte, did do something: he signed laws aiming to address the malnutrition problem. In the middle of his six-year long administration that bowed out on June 30, 2022, he signed Republic Act 11148 into law on November 29, 2018.

RA 11148, or the “Kalusugan at Nutrisyon ng Mag-Nanay Act," is more popularly known as the First 1,000 Days Law.  It seeks to boost national and local health and nutrition programs through an integrated strategy for maternal, neonatal, child health and nutrition in the first 1,000 days of a child's life.

"This law will complement the much-awaited Universal Health Care Law to further boost the country’s health status on our way to make Filipinos the healthiest in Southeast Asia by 2022 and in Asia in 2040,” boasted DOH Secretary Francisco Duque III.

Over three years later or in June 2022, the national government announced its intent to borrow $178.1 million from the World Bank to further support RA 11148.

It said the loan will “increase the utilization of a package of nutrition-specific and nutrition-sensitive interventions and improve key behaviors and practices known to reduce stunting in targeted local governments”. The project will be jointly implemented by the DOH and the Department of Social Welfare and Development (DSWD).

“It’s important that we focus on the health and nutrition of children starting in their mother's womb, especially because it has a big effect on their capacity to learn,” said Sen. Sherwin Gatchalian, who co-authored RA 11148.

“We should make sure that our communities have enough participation and capability, together with the local government, in order to ensure the good health of Filipino children”.

RA 11148 complements Republic Act No. 11037 (or the Masustansyang Pagkain Para sa Batang Pilipino Act) signed into law on June 2018. This is a law "Institutionalizing a National Feeding Program for Undernourished Children in Public Day Care, Kindergarten and Elementary Schools to Combat Hunger and Undernutrition among Filipino Children and Appropriating Funds Therefor".

Both laws are part of the national government's bid to eliminate hunger and reduce all forms of malnutrition. They also intend to secure healthy lives, promote the well-being of Filipinos, and end hunger and food insecurity.

Up and down

Up until his death in 2020, Junrey Balawing from Sindangan, Zamboanga del Norte was the shortest living man in the Philippines and the world. He stood tall at 56.0 cm (22.0 inches), as verified by Guinness World Records in 2012.

He became the world's shortest non-mobile person after the death of Chandra Bahadur Dangi from Nepal in September 2015. Chandra measured 54.6 cm (21.5 inches). Balawing was only 27 at the time of his death in the City of Dapitan.

On the opposite end of the scale, the tallest indigenous Pinoy on record is Raul Dillo standing at an eye-popping 221 cm (7 feet 3 inches), a height he hit when he was only 17 years-old. Now 30 years-old, this giant used to play basketball in college and in the defunct Metropolitan Basketball Association but never shone despite his height advantage.

Dillo later played bit roles in a number of Filipino movies where he was predictably typecast as a giant. Asked about the downside to being gigantic in 2012, he replied: “Sa transportation ang hirap. Kung bus, okay pa. Pero tulad ng tricycle, mahirap.”

The tallest home-grown Philippine Basketball Association (PBA) player is center Edward Joseph "E. J." Feihl, whose ceiling was 215.9 cm (7 feet 1 inch).  The second overall pick in the 1995 PBA draft, Feihl played for Ginebra San Miguel and six other teams until his retirement in 2007.

Feihl was born in Santa Barbara, Pangasinan to a Filipino mother and a German father. He’s 52 years-old.

The dearth of six-foot tall home-grown Filipino giants is a reason why the PBA is riddled with towering imports. In 2021, the PBA implemented a height limit of 198 cm (6 feet 6 inches) on imports to prevent the favorite Pinoy sport from being completely dominated by foreign skyscrapers.

 

Raul Dillo

Have you heard of this new disease called ageing?

 

(Published in ENRICH magazine, 2022)

A MOMENTOUS DEBATE raging in the global medical community will profoundly alter the way we perceive and treat the many diseases and infirmities that inevitably come with growing old.

At issue is the vexed question: "Is ageing a disease"?

It is a conundrum the informed Filipino layman will likely answer with, "Of course, not". In his world view, ageing is not a disease because he knows of no disease or medical condition called ageing. But he does realize chronic diseases like cancer, diabetes, stroke, arthritis, heart disease and Alzheimer's are prevalent among his old parents and even older grandparents.

The World Health Organization (WHO), however, no longer holds with certainty the view that ageing is not a disease. In January 2022, WHO effectively paved the way for defining ageing, specifically biological ageing or senescence, as a disease in the 11th revision of the International Classification of Diseases (ICD-11).

Its reasoning: old age gives rise to biological changes that make people more vulnerable to diseases that worsen with age like cancer and arthritis. Some experts contend ageing is the biggest risk factor for heart disease, cancer and dementia.

WHO, therefore, has apparently redefined ageing as a treatable condition that can be delayed and cured like a disease. It likely sees "ageing itself" as the principal cause of the myriad of illnesses linked to old age.

This redefinition of ageing as a disease should also lead doctors and scientists to address not only the effects of ageing but the underlying causes of the symptoms linked to ageing.

It's known that the processes underlying age-related diseases probably overlap. Therefore, if scientists can determine what biological processes make people more susceptible to age-related diseases such as heart disease and Alzheimer’s, a treatment might be found that can potentially treat multiple diseases at once instead of one at a time.

Age-related diseases are deadly. Of the 150,000 people that die every day across our planet, about two-thirds (close to 100,000) die from age-related causes. Even wars can't kill as many people. Some 27,000 people died daily in World War 2, the deadliest war in human history.

What exactly is ageing?

This festering dispute among the learned leads us to the question as to what ageing -- or the process of becoming older -- really is.

A medical definition describes chronological ageing as a time-dependent functional decline marked by a progressive loss of physiological integrity. This attenuation leads to the impairment of bodily functions and increases one's vulnerability to death. In other words, the older you get, the weaker and sicker you become. But is this due to the cumulative effects of individual age-related diseases, or to ageing as a disease? That is the question.

At the biological level, ageing is caused by the gradual accumulation of molecular and cellular damage over a person’s lifetime. These molecular level changes trigger a decline in mental and physical function and increase the risk of disease and death.

Then, there's the role cellular senescence plays in ageing. Ageing is also defined as the accumulation of senescent cells. Senescent cells cause many of the degenerative changes we perceive as ageing, as well as age-related diseases.

Cellular senescence is the process in which cells age and stop dividing permanently -- but don't die. Over time, massive numbers of old, or senescent, cells accumulate in our body tissues.

These "living-dead" cells or zombies release a range of inflammatory factors and enzymes that destroy the tissues in which they reside. As a result, our immune cells attack and kill senescent cells, thereby changing our tissues for better or worse.

In one fell swoop

ICD, the tool that ignited the ageing firestorm, is a globally used diagnostic tool published by WHO to help doctors and healthcare professionals identify diseases. It is a healthcare classification system providing diagnostic codes for classifying diseases.

The specific changes to ICD-11 about ageing involve general symptoms (code “MG2A”) and in the causality section of “XT9T”.  ICD-11 classifies "old age" as a specific disease in contrast to ICD-10 where old age is classified as a “general symptom”. Another contentious change was replacing the code for “senile debility” with the code MG2A, which originally stood for “old age”.

WHO also implemented an extension code (or a new category of codes) for "ageing related", or XT9T diseases. These are diseases “caused by pathological processes which persistently lead to the loss of organism’s adaptation and progress in older ages”. Extension codes provide additional information on a disease, injury or disorder.

The new code XT9T can be immediately applied to relevant conditions listed in ICD-11, as well as to future relevant medical conditions.

On the other hand, the implementation of the extension code XT9T in ICD-11 "is not tantamount to formal recognition of ageing as a disease," asserts an editorial in the peer-reviewed scientific journal, The Lancet. The advent of XT9T does, however, "signal acknowledgment by WHO of ageing as a major disease risk factor and of the considerable public health problem posed by ageing-related diseases".

The new proposals in ICD-11 intend to ensure ICD has a complete list of pathologies and disorders related to ageing. It also seeks to guarantee and account for the full spectrum of degenerative changes.

Accomplishing this means all ageing-related pathologies will have to be included in disease or disorder classifications, which wasn't the case previously. This omission meant an ageing diseases classified and assessed for the level of severity in one organ can be unclassified in another. It is a confusing situation at best.

More seriously, the absence of classifications and staging can result in less than ideal treatments since pathological ageing changes are not included in ICD.

The ageing-related changes to ICD-11 came from a joint proposal submitted to WHO’s ICD-11 Task Force by the Biogerontology Research Foundation, the International Longevity Alliance, and the Council for Public Health and the Problems of Demography.

Cellular senescence

Raging storm

The release of ICD-11 quickly ignited a storm of controversy, splitting medical professionals involved in gerontology, longevity science and other disciplines having to do with ageing into pro-disease and anti-disease factions.

Advocates for classifying ageing as a disease have long argued ageing is the biggest risk factor for chronic diseases, which are today treated individually as a matter of course. They contend ageing is not a deviation from the normal state as can be expected from a disease.

Treatments that focus on the underlying ageing process will “in one fell swoop, intervene in several or many chronic diseases of ageing,” claims Dr. Alexander Fleming, the founder of Kinexum (a company that develops drugs and biotech products).

Dr. David Sinclair, professor of genetics at Harvard Medical School and one of the better known longevity scientists, agrees that ageing is the main cause of all major diseases in society today.

"I'd argue that just because ageing happens to more than half of us, is no reason to not include it as a disease," he noted. "In fact, I would say it's even more important that we work on trying to combat it, because ageing is the main cause of all major diseases in society now.”

This line of thinking mirrors that made by Dr. Leonard Hayflick, professor of anatomy at the University of California San Francisco School of Medicine, back in 1962.

At the time, Dr. Hayflick argued that if old age is a risk factor for nearly all of the diseases likely to kill us, "why then are we not devoting significantly greater resources to understanding what … increase(s) vulnerability to all age-associated pathology?"

He said the lack of distinction between ageing and age-related diseases “is the most serious impediment to our understanding of the ageing process.”

Dr. Hayflick gained fame by discovering a limit to how many times human cells divide before they become senescent. His name is inextricably linked to the discovery of the key role telomeres play in the ageing process.

The declaration by WHO seems a belated acknowledgement of a landmark study about ageing published in February 1954 by Dr. Robert Perlman in which he described ageing as a “disease complex" while emphasizing the etiologic significance of both internal and external environmental stress.

Perlman's study, “The Ageing Syndrome”, published in the Journal of American Geriatrics Society has slowly gained adherents over the past half century.

In 2015, a team of international researchers published a study in the online biomedical and life sciences journal PubMed Central with the provocative title, “It is time to classify biological ageing as a disease.” It sees "the ageing process as the underlying cause for the chronic diseases affecting the elderly".

Alarm bells

The ageing-related revisions in ICD-11 were met with alarm by medical professionals holding the contrary but majority view. Current thinking contends ageing is a natural process and not a disease, and "should not be considered a disease in and of itself."

A paper published in The Lancet in October 2021 took WHO to task for supporting moves to classify ageing as a disease.

"We argue that simply equating old age as a disease in the ICD-11 is potentially detrimental and deleterious from clinical, research, and humanitarian points of view, and propose alternate productive solutions," wrote the study authors.

They argue chronological age has limited use in diagnosis, prognostication, and treatment guidance. In addition, “age by itself is of limited use for the assessment of population health, for the evaluation of initiatives designed to promote healthy ageing, and for health or social care planning. “

Instead on harping on ageing, the authors "propose that frailty should be included as a clinical disorder instead of old age." They ask WHO "develop the reporting of frailty in the ICD classification system" and argue that frailty "is a much more homogeneous and better-defined clinical entity" compared to old age.

They claim ICD-11 branding ageing as a disease will potentially magnify the socioenvironmental disadvantages in terms of equality in healthcare provision endured by the elderly.  Ageing as a disease will also reinforce commonly held ageistic beliefs in society and the medical community.  Validation of ageistic beliefs will also stand to worsen the societal marginalization and discrimination against the elderly.

The International Association of Gerontology and Geriatrics based in Belgium and comprising 84 national societies from 72 countries has also assailed the inclusion of old age as a pathological criterion in ICD-11. Others are urging WHO to revise the ICD-11 classification of old age.

What's at stake

Behind the fire and fury engulfing those for and against the proposition is a deep concern for the plight of the elderly. The implications of the WHO declaration that ageing is a disease -- which many medical professionals dispute or dismiss -- will massively affect the healthcare provided the elderly and the development of drugs needed to combat diseases of ageing.

The protagonists don't dispute ageing is a one-way street culminating in six feet of subterranean real estate. What they can't agree on is how to make this final journey more tolerable, which means an emphasis on healthy ageing or our healthspan.

Those that contend ageing should be classified as a disease want to goad governments and pharmaceutical firms into emphasizing the development of therapeutic interventions targeting ageing and ageing-related diseases.

They argue that new therapeutic interventions for ageing will lead to the acceptance of ageing as a disease. This acknowledgement will help ensure treatments are covered by health insurance providers, especially those in the West. It is also critical to boost funding from grant-awarding organizations for ageing research.

The poorest of Filipinos

The implications of this debate on ageing in the Philippines will be huge.

The country has an elderly population age 60 up of more than 12 million persons. This total comprises 11% of the total population of 110.8 million persons, estimated the Commission on Population and Development (PopCom).

In 2015, PopCom said the country’s population will begin to age by 2025 to 2030. It was because of this former PopCom executive director Juan Antonio Perez III said he was gravely concerned that “social protection systems have yet to catch up with social conditions”.

“People are living longer but in poorer health and socio-economic conditions," said Perez.  "They are only partially reaping the benefits of better health and social conditions."

He warned the government has only 10 years to craft programs for the elderly that address healthcare, rehabilitation, depression and daily activities, among others.

He emphasized senior citizens will need the government’s help as they will be “the poorest members of the population because usually their pensions are not enough for them”. Not much has occurred since 2015 to negate this warning.

In 2017, the Philippines was ranked 60th out of 191 countries in WHO’s Ranking of the World's Health System. The country with the world’s best healthcare was France; Singapore had Asia’s best healthcare system.

Hell on Earth might just be around the corner

 (Published in ENRICH magazine, 2021)

"LUCIFER HEATWAVE." It’s the hellish name for a heat dome where searing temperatures in excess of 40 degrees Celsius (104 degrees Fahrenheit) linger on land and torment people for days on end.

The catastrophic outcomes of a Lucifer heatwave include record-breaking temperature highs that can cause heat-related illnesses and deaths, and trigger horrific forest fires. Ten countries in southern and eastern Europe, as well as four states in the western United States (Arizona, California, Colorado and Utah) are still reeling from the mind-numbing heat and wildfire damage inflicted by Lucifer heatwaves from June to September this year.

A recently published study asserts Lucifer heatwaves will become normal in southern Europe by 2050 if no effective action against global warming is taken.

"It is unbearable," said one resident of Seville, Spain about the terrific heatwave. "We are used to it in Andalusia but this is reaching a horrendous point. We don't manage to get any rest at night or during the day."

This Spaniard had good reason to gripe. The State Meteorological Agency, Spain’s national weather service, on July 31 warned people about high temperatures reaching 44°C (111.2°F) in 31 of the country’s 50 provinces. Less than two weeks later, or on August 11, Lucifer produced the hottest temperature ever recorded in Europe -- an astounding 48.8°C -- measured in Sicily, Italy.

The severity of this peak can be appreciated by comparing it to the hottest global temperature recorded this year. On July 9, the temperature at Death Valley National Park's Furnace Creek Visitor Center in California hit an incredible 54.4°C (130.0°F). Lucifer might also have had a hand in bringing about this record-breaking result.

Europeans coined the phrase "Lucifer heatwave" to describe the sizzling 2017 summer heatwaves in Western Europe and the Mediterranean region. The first-named Lucifer struck in early August in southeastern Europe. This extreme heat assault lasted three days and broke numerous records, including several all time high temperatures.

Both Europe and the U.S. have been savaged by Lucifer heatwaves and will suffer again as global warming continues mostly unchecked due to a combination of human apathy and inaction.

For Filipinos, the question is, "Will there be Lucifer heatwaves in our future?"

The short answer is, "Yes."

The last nine years were the warmest on record globally

It's getting a lot hotter in the Philippines

Filipinos are used to hot weather due to the pervasive relative humidity and heat in our country. No Filipino this year, however, has experienced the agony of a heatwave hitting and exceeding a dry-bulb temperature (which doesn't include relative humidity) of 40°C.

The hottest daily temperature in the Philippines in 2021 was a blistering 37.8°C and it occurred at Tuguegarao City, capital of Cagayan, on May 14, said the Philippine Atmospheric, Geophysical, and Astronomical Services Administration (PAGASA). The relative humidity in Tuguegarao came to 37% that day, thereby producing a heat index of 42°C.

On the other hand, our hottest day as measured by the heat index was also May 14, when a reading of 53°C was recorded at Dagupan City, Pangasinan. Dagupan's dry air temperature was 37.4°C but its relative humidity was far higher at 61%. May is traditionally the Philippines' hottest month with April the second hottest. Our dry season extends from March to May.

Hottest day in the Philippines in 2021

Average annual temperatures in the Philippines normally range from 21°C to 32°C. The average yearly temperature is about 26.6°C.

Historical temperature data seem to confirm a much hotter Philippines. The country's average mean annual temperature in 1901 stood at a cool 25.4°C (77.7°F). This tolerable level increased only slightly over the next 100 years to 26.3°C (79.3°F) at the end of the 20th century, according to a study from the World Bank.

In 2020, however, the country's average mean annual temperature jumped to 27.1°C (80.8°F). An increase of 0.8°C in only 20 years might not sound dire but the United Nations has warned even half a degree (0.5°C) rise stands to expose tens of millions more people worldwide to life-threatening heatwaves, more drinking water shortages and increased coastal flooding due to sea level rise.

Inevitable heatwaves

The new heat danger now facing Filipinos is not atmospheric heat per se but heatwaves such as Lucifer. Heatwaves are dangerous and lethal because hot weather and high humidity, both of which exist hand-in-hand in the Philippines, boost body temperatures and open the door to life threatening conditions for the unwary.

Our bodies can only work and effectively function if our core body temperatures remain in the healthy region of 36.8°C. Heatwaves disrupt this ideal state and can lead to unwanted afflictions such as heat stroke, heat exhaustion, dehydration and death from excessive water loss. These ills are especially dangerous for the elderly and infants that have problems maintaining ideal body temperatures.

A heatwave is a period of unnaturally hot weather typically lasting two or more days. To be considered a heatwave, temperatures have to be higher than the historical average for a given area. Thresholds vary from area to area but are typically around 29°C to 32°C.

PAGASA, however, defines a heatwave as an extreme heat event lasting at least five straight days. Its definition follows that of the World Meteorological Organization (WMO), which defines a heatwave as five or more consecutive days during which the daily maximum temperature surpasses the average maximum temperature by 5°C (9°F) or more. PAGASA's definition means Filipinos will have to endure the unimaginable for five days before the agency declares a heatwave emergency.

Should PAGASA wait that long since the Philippines, "will face more than 300 potentially lethal heatwave days each year under the business-as-usual emissions trajectory known as RCP 8.5," according to a published report from Prof. Rolando Talampas, Officer-in-Charge of the Asian Center, University of the Philippines Diliman.

RCP 8.5 refers to the concentration of carbon dioxide in the atmosphere that delivers global warming at an average of 8.5 watts per square meter across the Earth. Unchecked, RCP 8.5 can trigger a temperature increase of about 4.3˚C above pre-industrial temperatures by the year 2100 . It's a worst case scenario for climate change.

Drought in the Philippines caused by El Nino

Heat mortality

Another study, this one a "heat health risk" assessment of Philippine cities by Prof. Ronald Estoque, PhD, and his Japanese colleagues, found the 16 cities comprising Metro Manila are at high, or very high risk, from heatwaves. It focused on the phenomenon called the "urban heat island,” which is basically a heat dome enclosing a city, in 139 Philippine cities seen as having very high heat hazard index values.

The study revealed heat health risk is already a key risk in the Philippines. Therefore, it argues adaptation to heat-related health impacts should be one of the main priorities of government, The report also dwelt on the minimum temperature thresholds that place people at heat health risk. It "found a minimum mortality temperature (MMT) threshold of 38.3°C for daytime and 24.3°C for nighttime."

Getting worse

Another troubling study says the already painful summer heat is only going to worsen in the years ahead. This study published in the peer-reviewed journal, Nature Climate Change, estimates some 74% of the world’s population will be hit by deadly future heatwaves. 

Even more distressing is the finding that nearly half of the world will still be assailed by heatwaves even if emissions from greenhouse gases such as CO2 are reduced. Some 30% of the world is in danger due to global warming conditions.

"We are running out of choices for the future," said study lead author Camilo Mora, associate professor of Geography in the College of Social Sciences at the University of Hawaii at Manoa.

"For heatwaves, our options are now between bad or terrible. Many people around the world are already paying the ultimate price of heatwaves, and while models suggest that this is likely to continue, it could be much worse if emissions are not considerably reduced."

The online tool, ThinkHazard!, contends there's a more than 25% chance of at least one period of prolonged exposure to a heatwave in the Philippines over the next five years. It also classifies the extreme heat hazard in the Philippines as "medium" based on modeled heat information.

World on fire

It goes without saying the Philippines is getting painfully hotter. We feel it every year and the data bears out our worst fears. The coming heatwaves mean Filipinos are going to have to find better ways to protect their health and those of their loved ones.

The Philippines' hotter climate also reflects the global effects of climate change, which keeps producing the hottest years since global records began being kept by scientists in 1880.

In July 2016, NASA (the National Aeronautics and Space Administration) announced the five hottest months globally up to that time were recorded in July 2016, July 2011, July 2015, July 2009 and August 2014.

July 2016 was then the hottest month ever in recorded history while the first six months of 2016 were the hottest in history. It was 0.84°C warmer than the global average temperature from 1950 to 1980.

These records were bested this year. In August 2021, the National Oceanic and Atmospheric Administration (NOAA) said July 2021 displaced July 2016 as the world’s hottest month on record.

Globally, the combined land and ocean-surface temperature in July was 0.93°C above the 20th century average of 15.8°C. This made July 2021 the hottest July since records began. July's temperature was also 0.01 of a degree Centigrade higher than the previous record set in July 2016, whose record was tied in 2019 and 2020.

Asia also posted its hottest July on record, thereby eclipsing the previous record set in 2010. Europe had its second-hottest July on record in 2021.

“July is typically the world’s warmest month of the year, but July 2021 outdid itself as the hottest July and month ever recorded," said NOAA Administrator Dr. Rick Spinrad PhD. "This new record adds to the disturbing and disruptive path that climate change has set for the globe.”

July is the Philippines' fourth warmest month, however. The average mean temperature this July came to 27.7°C with daytime temperatures hitting a sweltering 31.4°C.

Historically, July has a mean average temperature of 27.5°C and a high of 31°C. As a reminder, the country's average mean annual temperature in 2020 was 27.1°C.

Today's Earth is the sweltering planet some scientists predicted should have appeared by 2026 at the latest. Why? Because the world reached 1.2° Celsius of warming in 2020. This means there's now a 90% chance of exceeding the red-line threshold 1.5°C of warming before 2026.

The Paris Agreement of 2015 saw the international community pledge to keep global temperature rise this century well below 2.0°C above pre-industrial levels to keep climate change in check. This level was later modified to 1.5°C above pre-industrial levels.

The strident warning issued in June 2021 by the WMO, a specialized agency of the United Nations, confirmed the world reached 1.2°C of warming in 2020.

The WMO warning is far worse than the conclusions of a paper published in the weekly scientific journal Nature in 2018 that predicted the world reaching 1.5°C of warming by 2030. It's also more disheartening than the estimate made by the Intergovernmental Panel on Climate Change (IPCC) that this red line might be reached by 2040.

The heat will only get worse

In May 2020, the World Economic Forum issued a report saying that by 2070, 3.5 billion people might be forced to endure unlivable heat in places that will become as hot as the Sahara Desert (30°C mean temperature) is today.

It projected the world's mean annual temperature jumping to 29°C compared to 13°C today, a level far outside the livable climatic envelope of human development. By 2070, the world's population is estimated at 9.5 billion compared to today's 7.6 billion.

This dire forecast spells out what's in store for one in three people in the world unless countries take decisive action to control global warming. The report said less than 1% of the Earth's land surface currently experiences climate where the mean temperature is 30°C.

By 2070, almost 20% of the Earth's land area will be affected by this higher temperature. Also by 2070, the average person will be living in temperatures 7.5°C hotter than pre-industrial times if climate change goes unchecked.

And then, there's Lucifer to contend with. Hell is in our future.

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