The Blue Vanguard Vol.17

2020 Vol.17

MAIN ARTICLES Hunsik Wang, CEO of GLPharmTech Current status and perspectives of biobetters PillPack, a game changer in pharmaceutical ind.

Editor's note

Park Seo Woo

Change is inevitable. Some of this change can be positive developments in the pharmaceutical industry in terms of technology and practices. At times, however, it can be painful facing the huge shifts in our lives as we fight against COVID-19. In this regard, Yonsei Pharmacy’s Blue Vanguard focused on covering various changes for the better in the pharmacy field and in our lives. An interview with GLPharmTech introduces formulation technologies for improved adverse drug effects and prospects of the hormonal product market in Korea. In the same vein, biobetters will be introduced as next-generation medicines in Korean pharmaceuticals. Furthermore, PillPack which is the first in industry to add delivery service to medicines, will be covered as a significant shift in the pharmaceutical industry. Lastly, infectious diseases, which are highly intertwined with our lives, will be covered from the past to the present ongoing global catastrophe.

Blue Vanguardians, as student pharmacists, consistently assimilate changes and give our best effort to provide informative, enjoyable articles on healthcare and pharmaceutical trends. I hope this edition provides opportunities for readers to acquire knowledge and gain a deeper insight into the changes in various fields, especially the pharmaceutical sector. I also want to appreciate my fellow Blue Vanguardians, who displayed great effort and perseverance despite the unexpected difficulties and hardships this epidemic has presented. With that said, I am delighted to introduce the 17th edition of the Blue Vanguard magazine.

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CONTENTS 1) Interview

- Hunsik Wang, CEO of GLPharmTech : 4-5p

2) Pharmaceuticals

- Current Status and Prospects of BioBetters : 6-7p - How Cells Sense and Adapt to Oxygen Availability : 8-9p - Animal Venoms Into Medicine : 10-11p - See the Forest for the Trees : About 'Functional Medicine' : 12-13p

3) Column

- Can DTC Genetic Testing Give Us the Answers? : 14-15p - Infectious Diseases Striked the 21st Century of South Korea : 16-17p - Periodontal Disease: Gingivitis and Periodontitis : 18-19p

4) National issues

- Green Changes in Cafes, Disposable Plastics Restriction : 20-21p - Pharmacophobia : 22-23p

5) International issues

- PillPack, a Game Changer in Pharmaceutical Retail Business : 24-25p - Outbreak of the COVID-19 : 26-27p - The Big Blue Gap in the Green New Deal : 28-29p - Electronic Cigarettes, Are They Really Safe? : 30-31p

6) Life issues

- Vegan and Cruelty Free : 32-33p - Eating Disorder: Cycle of Overeating and Fasting : 34-35p - DIY Mask & Hand Sanitizer : 36-37p

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INTERVIEW

Hunsik Wang,

Ceo of GLPharmTech Seo Woo Park

pinkwoo97@naver.com

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LPharmTech is a pharmaceutical company specializing in incrementally modified drugs under the mission, “Creative Innovation For Better Healthy Life.” On the basis of advanced formulation technology, the company has focused on developing incrementally modified drugs and gained a substantial leverage in the field of pharmaceutical research and development. Notably, it possesses a production plant for sex hormone drugs, which is one of only three available in Korea. On March of 2020, the BlueVanguards of Yonsei Pharmacy interviewed HunSik Wang, the CEO of GLPharmTech. During the interview, Mr. Wang offered sincere advice to our pharmacy students.

Q: What are your beliefs as a researcher and CEO of the company?

Be innovative, without thinking about future rewards. My experience during the past 25 years while working in the Korean pharma industry tells me that there is no correlation between the effort to be innovative in sectors such as R&D and financial returns. Regardless, I hope you keep trying. It may sound foolish and naïve; it actually is. Whether the coveted rewards follow our efforts are not within our scope. Nevertheless, that is what made us to be what we are now.

Q: I wonder what research is focused on in each department of GLPharmTech Research Center.

The research center of GLPharmTech is divided into three teams: formulation science, research quality, and analysis research team. Formulation science team develops drug formulations and delivery technologies; GLARS, MUCRS and ERIS are representative technologies of our company. Research quality team assures that the formulation team follows the related regulations. Analysis research team analyzes drugs and the finished products.

To be specific, it develops analytical method validation with reproducibility. For example, Timing™, our caffeine drug product that prevents drowsiness is expected to be relaunched the coming 2nd quarter of this year. Our analysis research team set up a method to measure the content of caffeine per each tablet with trust.

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INTERVIEW

Q: Various formulation technologies have been developed by GLPharmTech. Please introduce GLARS as a representative for the subscribers of BlueVanguard.

GLARS (Geometrically Long Absorption Regulated System) is composed of triple layered tablets, like a hamburger.

The upper and bottom layer, which consist of solvent-attractive macromolecules, swell as soon as they are exposed to the nearby solvent. The middle layer consists of highly hydrophilic excipient and stimulates the solvent to quickly permeate into the tablet. Since the technology enhances the absorption of the drug in the small intestines, it improves the convenience of taking medication by reducing the number of administrations.

Our proprietary landmark product, Kabalin CR™, is an application of this technology, which enables the incorporated API (Active Pharmaceutical Ingredients), Pregabalin, to be sustainably absorbed during nighttime by taking the pill only once a day. It consistently manages neuropathic pain, like post-Shingles neuralgia or diabetic neuropathy. Considering that Pfizer’s Lyrica™, a product with the same API that produced a record-breaking 5 billion revenue, requires one to take the pill twice a day. Kabalin CR™ is a great option with improved administration convenience for patients.

Q: Hormonal products such as birth control pills have strict separation standards for production, but GLPharma, a subsidiary of GL PharmTech, is known to have specialized facilities for hormone product. What do you think of the future of the hormone market in Korea?

Imported products such as Mercilon™(Alvogen) and Myvlar™(Dong-a) have dominated more than 95% of the domestic market share. This is mainly due to the limited number of eligible companies who are capable of manufacturing such highly potent products. Out of about 400 pharmaceutical companies in Korea, GL Pharma is among the three that possess these facilities. The reason why there are few specialized facilities for hormonal drugs in Korea is that the production facility must be thoroughly separated from any other space and operated as a separate plant.

According to IQVIA data, formerly known as IMS Health data, Korea’s pharma market is not small, ranking about 11th to 12th place in terms of market size. However, the importing companies have always been in trouble to easily access the product supply whenever they wanted products from foreign hormone product manufacturers. As an example, you might find it difficult to buy Myvlar® since the companies are running behind supply allocation priority over other bigger countries. This phenomenon motivated us to be an alternative manufacturing supplier of the product to Dong-a.

Starting with this event, the company is looking forward to expanding its domestic market share.

Q: Can you give some advice for pharmacy students?

Pharmaceutical R&D is a very interesting and challenging field to work for. If you are interested in designing a drug product while devising a strategy to achieve a target performance, this would be a right fit for you. Also, I would recommend working for a pharma company with a rich history as your first footstep in pharma industry. There are distinct internal codes and practices in pharma companies regarding planning, development, research, and sales. You will naturally learn the codes and systems, but you may not realize them. It is like something you have already got in Yonsei University which you cannot deny nor realize well. It is frequently called “culture” or “virtue”. B

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Current Status and Prospects of BioBetters Lee EunChan

bihs1@naver.com

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s Korean pharmaceuticals have been showing tangible results with biosimilar in the global market, “biobetter“ is in the limelight. While biosimilars are generic drugs of expired original biologics, biobetters build upon the initial drug’s compounds to tout improvements in the form of increased safety, quicker action, lower dose, delivery method or among others. So, biobetters are improved biologics by applying new technologies. Judging biobetters can create value equivalent to new drugs, Korean pharmaceuticals have been jumping into development of biobetters as next-generation medicines.

Strengths of biobetter

There are many strengths of biobetter, making it to be a next “battleground”. Basically, it is easier to develop than new biologics whereas is valued more than biosimilar. First, it has price competitiveness. While the price of biosimilar is lower than the originator because it is just generic, biobetter is about two to three times more expensive than the originator with some improvement. Second, the ‘patent’ issue is considered to be great strength. While biosimilar can only come to the market when originator’s patent expires, biobettor can be granted an independent patent because of the new applied technology. Moreover, biobetter is patented for 20 years, just like other original drugs. Third, because there are no strong leading players in the biobetter market so far, occupying the market can be easier than biosimilar market which is already competitive. There are currently only about 10 types of biobetters since Amzen released neutropenia treatment, Neulasta® in 2002.

Current status of biobetter

Due to biobetters’ strengths and positive market prospects, multinational pharmaceuticals have been already working on all-out strategies, strengthening pipelines to secure biobetters. Especially, Korean pharmaceuticals have secured competitiveness and know-hows through the development of many biosimilars, making it possible for biobetter to be the area where they can show the most capabilities in the future. Fueled by government’s biologics promotion policy, pharmaceuticals are accelerating research and development regarding biobetters.

Currently, biobetters mainly can be divided into ‘long duration technology’ and ‘ADC’(Antibody-Drug Conjugates) technology. First, ‘long duration technology’ focuses on keeping the drug in the body for a longer time. Various products have been developed with applying this technology, including neutropenia treatments, xeroma treatment, growth hormones and anti-cancer agents. Second, ADC technology links an antibody which selectively binds to cancer cells and a powerful cytotoxin. In that sense, ADC can be seen as a combination of first-generation cytotoxic anti-cancer agent and secondgeneration targeted anti-cancer agent. By linking the antibody and the cytotoxin, anti-cancer cytotoxins only destroy specific cancer cells, overcoming non-selective cytotoxicity of the former generation anti-cancer agents.

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Examples of biobetter

While multinational pharmas are expressing interest in developing biobetter pipelines with some striking acquisition or technology transfer, Korean pharmaceuticals are also leading the way. Here are some examples of biobetters which domestic pharmas have developed or are currently developing. ⓵ RemsimaSC® of Celltrion

Celltrion successfully developed Remsima® which is a biosimilar of autoimmune disease drug Remicade®(Infliximab) of Janssen in 2013. In addition to this, Celltrion developed RemsimaSC®, a biobetter of its own biosimilar Remsima® by changing formulation. The new drug touts a superior feature over the original in that it can be administered subcutaneously, indicating the drug can be self-injected at home. The self-injectable method proves superior to the intravenous injections of both the original Remicade and its biosimilar. Celltrion received marketing authorization for RemsimaSC® from the European Medicines Agency(EMA) in 2019. Moreover, it is currently on sale in Germany. ⓶ Neulapeg® of GC Pharma

GC Pharma is carving out its territory as a leading biobetter developer in Korea, gaining approval for Hunterase, biobetter of Shire’s hunter syndrome treatment Elaprase® in 2012. Then, GC Pharma launched the second-generation anti-cancer drug Neulapeg® in 2015. Neulapeg® is a biobetter of Amgen’s neutropenia treatment, Neulasta®. It applied a unique ‘PEGylation’ technology which increases half-life of the drug. Moreover, PEGylation showed additional strengths in terms of purity, safety and efficacy. Neulapeg® is expected to occupy global market share, proving its superiority above that of originator through clinical tests. ⓷ ALT-P7 of Alteogen

ALT-P7 is a candidate material for gastric and breast cancers, using antibody-drug conjugate(ADC) technology.

It is based on Roche’s Herceptin®(Trastuzumab) which can treat HER2-positive breast cancer. Especially, ALT-P7 is distinguished from other anti-cancer biologics by utilizing the company’s unique “NexMabTM” platform technology which is a next-generation site-specific conjugation methodology.

First-generation ADC technology had disadvantages of non-specific binding of anti-cancer drugs to antibodies,

resulting in inconsistent ‘Drug and Antibody Ratios(DAR)’, low antibody safety and high probability of aggregate formation. Alteogen has developed a second-generation ADC technology that complements these shortcomings by enabling anti-cancer drugs to selectively attach to the antibodies with specific peptides. ALT-P7 is expected not only to maintain constant DAR but also to have high productivity and anti-cancer effects by applying this technology. It has completed phase I clinical trials as breast anti-cancer agent and is expected to greatly threaten the market share of Kadcyla® of Roche, a first-generation ADC breast cancer treatment.

What to overcome

There exist some obstacles for biobetter to lead the next generation of biologics market. First, biobetter has the task of proving “better” aspects than the originator. Unlike biosimilar which is just replicant of originator, advanced technology and research investment are essential for development of biobetter which is closer to the new drug.

That’s why pharmaceuticals which try to develop biobetters are significantly investing in technology. If biobetter does not show significant improvement over an originator, it is evident reality that it can’t surpass biosimilar as well as the originator.

Second, in the biologics market where biosimilars are staying ahead in terms of market-share, aggressive marketing of biobetter is required to increase awareness of ‘better’ features of it. It will take time even for doctors and patients to recognize the benefits of biobetter.

However, no one can define the potential of biobetters in the biologics market. If the company correctly identifies the unmet need associated with the originator and improves current shortcomings, biobetter can be seen as a significantly differentiated product. Market share will depend very much on the improvements of the biobetter versus the originator. If these are significant, it may be possible to take a very high market share. B

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Pharmaceuticals

How cells sense and adapt to oxygen availability 2019 Nobel prize in Physiology or Medicine & related drugs in development

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Su Min Yoon

jenny.yoon@yonsei.ac.kr

hat do two New York-born professors and one English research center director have in common? There are three things: One, their unquenchable thirst for knowledge surrounding the topic of oxygen for over 20 years.

Second, the stage they shared at the Karolinska Institutet in Solna, Sweden, to present their journeys through their Nobel Prize lecture in December of 2019. Finally, their legacy can be seen in drug development, which manifests the new found knowledge. This is the story shared by the three Nobel laureates Gregg Semenza, William Kaelin Jr and Sir Peter Ratcliffe.

The journey started as early as1990s. Gregg Semenza identified a key transcription factor that regulates oxygendependent responses, as well as an oxygen sensitivity moiety. Around the same time, William Kaelin Jr was studying the von Hippel-Lindau (VHL) tumor suppressor gene. Ratcliffe was the last to embark on this journey, when he showed that there was an association between VHL gene and HIF-1alpha. Soon after, Kaelin and Ratcliffe simultaneously showed that changes in oxygen levels in animal cells influence VHL-regulated degradation of HIF-1alpha. Just like pieces in a puzzle, each of the three Nobel laureates’ findings contributed to the groundbreaking discovery.

Semenza: the giver of names

Born in 1956, Gregg L. Semenza grew up in New York. In his adolescent years, his biology teacher, Rose Nelson, inspired him to study the sciences. Another turning point was when a family friend gave birth to a child with Down syndrome, which spurred him towards medical genetics and led to his enrollment in the MD/PhD program at the University of Pennsylvania. In 1992, Semenza identified a 50-base pair enhancer at the 3’ end of the erythropoietin gene that prompts hypoxia-inducible reporter gene expression. He termed this enhancer the “hypoxia response element” (HRE), which turned out to bind a nuclear factor that was induced by hypoxia. Subsequently, he termed this the “hypoxia-inducible factor” (HIF). By 1995, he discovered that HIF consisted of two gene products, one of which was the regulator of oxygen responsiveness, which he decided to name “HIF-1alpha” (HIF-1a).

Kaelin: reveals a second player, the VHL gene By 1979, Kaelin had earned his bachelor degree in mathematics and chemistry from Duke University, subsequently earning a medical degree from the same university in 1982. Kaelin set up his own research laboratory in 1992 and became interested in the gene underlying a rare familial cancer known as von Hippel-Lindau (VHL) syndrome. In 1995, Kaelin published the first full length sequence of the VHL tumor suppressor gene. He was able to show that it prevents tumors in renal carcinoma cell lines from developing and became the first person to do so. In the following year, while characterizing the VHL gene, the collaboration between Kaelin and Mark Goldberg revealed that a number of HIF target genes were over-expressed in VHL mutant cell lines. Together, they concluded that there was a possible link between VHL-linked tumorigenesis and HIF response.

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Pharmaceuticals

Ratcliffe: demonstrates interaction between HIF-1a and VHL complex As a physician scientist, Ratcliffe moved to Oxford to specialize in renal medicine in 1978. Ten years later, he founded the Hypoxia Biology laboratory in Oxford that explored the regulation of erythropoietin, which is turned on in kidney cells due to oxygen deprivation. Ratcliffe showed in 1999 that HIF-1a levels were regulated by changes in protein stability and not by changes in gene transcription of protein synthesis. Although it was known at the time that HIF-1a is eliminated by proteasomal degradation at normoxia, how it was inhibited during hypoxia was unknown.

This remained a mystery until Ratcliffe published in his landmark paper that the VHL complex is involved in HIF-1a proteolysis. The paper showed that VHL acts as a recognition component of a ubiquitin E3 ligase in the process.

The missing piece: How oxygen fits into the big picture

The remaining question was how oxygen regulates VHL-HIF-1a interaction and HIF-1a degradation. This spurred the search for oxygen-dependent chemical modification of HIF-1a that enables VHL binding and the enzymes involved.

It was known at the time that oxygen-dependent protein hydroxylation occurs in collagen proteins, mediated by collagen prolyl-4-hydroxylase. This aided the discovery, published back-to-back by Ratcliffe and Kaelin, that oxygendependent hydroxylation of proline residues in HIF-1a results in a conformational change; thereby increasing the VHL complex’s binding affinity to HIF. Under hypoxia, this post-translational regulation of HIF-1a does not occur, and VHL does not recognize HIF-1a. Consequently, HIF-1a is not ubiquitinated, thus avoiding proteasomal degradation and activating hypoxia-induced gene expression. In 2001, Semenza discovered a second oxygen-dependent mechanism that inhibits HIF-1a as a transcription factor and the factor involved called FIH-1. Therefore, it was concluded that oxygen does not just promote HIF-1a degradation by prolyl-hydroxylation, but it also inhibits transcriptional function of undegraded HIF-1a, in two separate mechanisms.

Doors of oppurtunity that their discoveries opened Several companies are developing small molecule oral drugs to block HIF prolyl-hydroxylase, thereby increasing the production of red blood cells even under normal oxygen levels. HIF prolyl-hydroxylase inhibitors (HIF-PHIs) are being developed to treat Chronic Kidney Disease(CKD)-related anemia, and are in Phase 3 clinical development.

Anemia is common in CKD patients since the kidneys fail to produce enough erythropoietin. Thus, HIF-PHIs trigger the body’s adaptation to hypoxia and cause the bone marrow to make more red blood cells. One example of the application of the leaurates’ discoveries is shown in the anemia drug daprodustat, which GlaxoSmithKline Plc has already filed the Japanese approval for. Another example with the same mechanism is a drug co-developed by AstraZeneca Plc and Fibrogen Inc, called Roxadustat. Mene Pangalos, the executive vice president of biopharmaceutical research said AstraZeneca is close to bringing the drug to patients, and that this “would never have been possible without early breakthroughs of this year’s Nobel winners”. B 2020 VOL.17

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Animal venoms into medicine

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Donghwan Lee

donglee1009@naver.com

nimals have various ways to protect themselves. While some animals have sharp claws and teeth, protective coloration, some animals use venoms to protect themselves or hunt prey. For example, poison arrow frog has a strong poison that can paralyze predators. However, humans do not make any venoms to protect themselves or hunt other animals. Instead, we use other animals’ venoms. For instance, natives in Latin America used poison from poison frog to hunt animals. Nowadays, we use animal venoms to save lives rather than killing something. Many scientists try to utilize the venoms into medicines. In an aspect that venoms cause metabolic changes in injected animal, they seem quite similar to hormones. Now we are going to see some animals which have venoms that can be used as medicines, and how venoms work as medicines.

Platypus The platypus is a very unique animal. It has a bill that looks like a duck’s and a flat tail that looks like beaver’s. If it is difficult to imagine, just think of a ‘Psyduck’ in ‘Pokemon’, Japanese famous game. Classified as an monotreme, they are egg-laying mammals and suckle babies. Also, the platypus is one of few mammals that carries venom in its body.

Male platypus has spurs on the hind legs, which secrete venom. The reason why only the male has a venom has been unknown. However, considering that the venom is secreted only during the mating season, it seems like the venom is related to competition for mate, not for protection or hunting. The platypus venom usually cause severe pain to animals.

By contrast, scientists found that this venom could be used to treat diabetes.

In 2016, researchers at University of Adelaide and Flinders University discovered that platypus venom carries Glucagon like peptide 1 (GLP-1). GLP-1 is a hormone that is also found in humans and other animals. As an incretin, GLP-1 stimulates insulin release and inhibits glucagon release, consequently reduces blood sugar level. Plus, GLP1 is active in type 2 diabetes patients, unlike another incretins. However, human GLP-1 is very susceptible to dipeptidyl peptidase-4 (DDP-4), which degrades GLP-1. This could be a problem to make GLP-1 into a medicine, because it might not be able to sustain a consistent therapeutic level. On the other hand, GLP-1 from platypus venom is less susceptible to DPP-4 and lasts for longer time even in other animals. This can be possible because a gene that encodes platypus’ GLP-1 has undergone many changes unlike other animals’. Although it might take a long time to commercialize, platypus venom might be a new solution to type 2 diabetes.

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Black Mamba The Black mamba is one of the most dangerous snake. It is the longest venomous snake in Africa, and the world’s second longest venomous snake, followed by king cobra. Black mamba can grow up to 3m in common, and move up to 20km per hour, which makes the black mamba the world’s fastest snake in the world. Then how dangerous is black mamba? According to the Nature, a Public Broadcasting service, 20,000 people die from the black mamba’s bites every year. The black mamba usually does not attack first, but when it feels threatened, it aggressively attacks with its very toxic venom. As a neurotoxin, when intoxicated by this venom, people feel nausea, lose their consciousness, and might face death by respiratory failure and cardiovascular collapse.

The black mamba venom contains postsynaptic dendrotoxins, fasciculins, and other muscarinic toxins. Dendrotoxin is named after Dendroaspis, a genus name of mambas. This venom blocks voltage-gated channel in motor neurons, and makes neurons stay in depolarized state by inhibiting repolarization. This leads neurons to release more acetylcholine at neuromuscular junctions. On the other hand, the fasciculin inhibits acetylcholinesterase(AchE), which degrades acetylcholine. These two toxins both have effects on increasing acetylcholine level in synapse, and this could help treating Alzheimer’s disease. Patients suffering from Alzheimer’s disease usually have acetylcholine deficency, because protein plaques accumulate in neurons and activate AchE. As more research proceeds on these venoms to use as medicines, black mamba might get a new nickname instead of ‘killer snake’.

Magical Cone (Conus magus) Conus genus is a cone snail that lives under the sea. This genus has a spiral cone with various color patterns on.

Also, unlike the earth-living snail, cone snail feeds other animals such as fish, worm or cone snails themselves. The cone snail catches prey using venoms. First, it smells where the prey is by siphon. When the cone snail finds the location of the prey, it slowly stretches out the proboscis to the prey. The proboscis has a harpoon in it. When it is ready, the cone snail pumps out the venom from venom bulb to proboscis. Muscles of proboscis contract and the pressure in the proboscis increases. When the muscles relaxes, the harpoon penetrates the prey, and the venoms are injected. The prey is paralyzed and the snail swallows the whole prey with its rostrum.

What is interesting is that the cone snail makes venom by mixing various “conotoxins” like a cocktail. Each species and each individual has unique combinations of venoms. Some species have a venom which is strong enough to paralyze or kill humans. However, like other animal venoms, cone snail venoms also have potential to be used as medicines. Conus magus, also known as magical cone, has ω-conotoxins in its venom. One of the ω-conotoxins is a “ziconotide”. The Ziconotide is a peptide that blocks the N-type voltage gated calcium channel on the central nervous system(CNS). This eventually inhibits the release of pain neurochemical such as substance P and glutamate. Actually, it is 1000 times stronger painkiller than morphine, and was approved by Food and Drug Administration(FDA) in 2004.

Also, MVIIC, one of the ω-conotoxins, can be used as a medicine for CNS ischemia or spinal cord injury(SCI). When SCI occurs, calcium concentration increases, and this can lead to secondary problem such as apoptosis. As a calcium channel blocker, MVIIC decreases the influx of calcium and attenuates the release of glutamate. Thus, MVIIC protects the cells from apoptosis and helps recovery from ischemia or SCI. B

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See The Forest For The Trees : About ‘Functional Medicine’ ChiHo Jeon

chiho2006@naver.com

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ave you ever wondered why many people are visiting hospital repeatedly for same phenomena like migraine, chronic fatigue and major depression disorders which are known as Multiple Medically Unexplained Symptoms (MMUS). Some of you suffering from MMUS might have been to hospital as well. However, you might have just come back home with some medicine without getting any treatment. As public being interested in health, needs for fundamental treatment of diseases are raised. ‘Functional medicine’, new paradigm for future medicine, can serve the needs.

Blind Spot of ‘Modern Medicine’ The current medical service is commonly called ‘Modern medicine’. Modern medicine is subdivided into various departments and the concept of ‘medical specialist’ appears. The medical term seems to be positive and has actually made significant outcome in various fields. Doctors are now able to diagnose diseases more accurately. However, specialization of the departments is a double-edged sword. As the professionals focus on their majors, their view of whole human body gets narrow. Pf. Lee Deuk Joo said “Each organ of our body is connected organically, so it is constantly affected by each other”. Therefore, if there is an abnormality in one organ, symptoms will appear not only in that area but also in seemingly unrelated areas. In other words, it is unable to find the underlying cause simply by symptoms. For example, a man has a migraine whenever he works late. As migraine gets worse, he suffers from dizziness, stomachache and indigestion as well. He thus decides to visit several hospitals. Neurologist prescribes painkillers, calling the phenomena ‘tension type headache’.

Gastroenterologist diagnoses it as ‘Irritable Bowel Syndrome (IBS)’. Thus, specialists in different departments make different diagnoses for same symptom. This situation only makes the patient more stuffy. It means that modern medicine can’t see the forest for the trees.

What is ‘Functional Medicine’?

Functional Medicine can provide solutions to the patients suffering from vague phenomena. The goal is to treat multiple symptoms through a personalized and holistic approach with fewer side effects. Today’s health care is nothing more than disease treatment but functional medicine should move toward caring the whole human body and change food culture, lifestyle and socio-psychological aspects in the view of preventive medicine.

This new paradigm includes some important factors that today’s health care system overlooks: stress, lack of exercise, deficiency of nutrient elements, bad eating habits, numerous endocrine disrupters, etc. While we rely on technology and drugs, the factors that directly affect our bodies are

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being ignored. When the new concept was first introduced, many Western scientists regarded it as a part of ‘Alternative Medicine’ which is thought to be baseless. However, with the recent development of equipment capable of examining a person’s basic biochemical processes, changes before and after treatment can be viewed reliably through various methods.

How Functional Medicine treats diseases Generally, when patients are diagnosed with diseases, they are prescribed medicine to relieve symptoms. Taking the medicine can help patients achieve the desired symptom relief effect, but there are many unexpected side effects. Functional medicine consists of a variety of treatments which worth trying due to free of side effects. Here are some treatments.

Many Koreans suffer from Atopic Dermatitis (AD). According to Health Insurance Review & Assessment Service (HIRA), the number of patients in their 20s and older suffering from AD increased 19 percent from about 360,000 in 2014 to 430,000 in 2019. Many atopic patients are accompanied by food allergy symptoms and functional medicine treats patients with Skin Prick test which can detect Delayed Allergic Reactions. During the test, skin is exposed to suspected allergy-causing substances and checked if there are any signs of an allergic reaction. Through the test, patients can identify the ingredients that cause allergic reactions and avoid irritating AD simply by avoiding such factors.

Hair tissue mineral analysis (TMA) is being used to treat MMUSs such as chronic fatigue, major depression disorder and immunosuppression. Hair is the second highest metabolic tissue in the human body that reflects metabolic processes that occur in extracellular fluid, blood and lymphatic fluid. The TMA consists of a Nutritional Mineral test and a Hair Heavy Metal test. Through these tests, the minerals accumulated in hair are scientifically analyzed to measure the imbalance state of nutritional minerals in the body and the interaction between heavy metal contamination and minerals. Then doctors prevent diseases by using these results and promote health through nutritional prescriptions tailored to the patient’s situation.

Pharmacist function in the new medical paradigm Doctors in functional medicine say that in many cases, nutritional imbalance is the cause of MMUSs. However, patients are not experts, so they cannot diagnose themselves for lack of nutrition.

There are many ways to diagnose nutrition, but the disadvantage is its cost. Therefore, in an easily accessible pharmacy, pharmacists can help patients. Pharmacists, who are experts of health and medical services, study numerous research results related to nutrition and health care. Therefore, they can identify medical imbalance of patients by analyzing medication chart and suggest other reasonable recommendations of healthy functional foods. Such pharmacist’s role could prevent patients from getting worse in the early stages and improve the overall health of society by teaching them new knowledge about nutrition. B

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COLUMN

Can DTC Genetic Testing Give Us the Answers?

Kyungeun Lee

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kyungeun0217@gmail.com

he advance of technological innovation enables us to learn more about ourselves than ever. We can handily track steps, monitor heart rates and check blood glucose levels. Now, we can even find out what our DNA says by directto-consumer (DTC) genetic tests. Everyone can get their hands on DTC genetic tests online and in shops without involvement of health care providers. As people send their saliva and urine samples to the DTC company for analysis, they expect to know about not only disease risks, but also personality, athletic ability and child talent. However, when it comes to disease risks, “quick and easy” may mean “inadequate and misleading”, or even “dangerous.”

DTC genetic tests generally do not sequence the whole genome, but analyze single nucleotide polymorphisms (SNPs) by a method called SNP-chip genotyping. In the early 2000s, researchers discovered that sets of SNPs within distinct regions of the chromosomes tend to be inherited together. Most SNPs do not have biologic effects, so individual impact of single SNP on disease risk is negligible. However, in combination, certain patterns of SNPs can convey significant risks.

By using the HapMap, a catalogue of SNPs commonly found in consensus human genome and their locations within the genome, researchers can conduct a genome-wide association study (GWAS) to check the presence of specific variants of SNPs. By SNP-chip genotyping, DTC companies find out the pathogenic or predisposing patterns in consumers’ genes and provide a variety of health information.

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Polygenic Risk Scores combine many common variants across the genome to place each consumer in a broad risk category and compare to the average.

“Your genes predispose you to weigh about 15% more than average.”

Genetic Health Risk detects specific genetic variants that increase the chance of developing particular disease.

“You have two copies of the ε4 variant in the APOE gene, so you have increased risk of developing late onset Alzheimer’s disease.”

Carrier Screening finds specific variants to identify carriers of particular recessive genetic conditions.

“You have one variant detected in the CFTR gene. If you and your partner are both carriers, each child may have a 25% chance of having this condition.”

Pharmacogenetics Test looks at genetic variants that affect consumer’s reaction to drugs, such as how drugs are metabolized, or whether the consumer is likely to have adverse reactions against certain drugs.

“You have rs2241160 and rs2241161 intronic variants in CEP68 gene, so you might have NSAIDs hypersensitivity.”

THE BLUE VANGUARD

COLUMN

With such information provided by the DTC genetic tests, consumers can be more aware of their own health.

As the result shows the predictive genetic risk assessment for various complex diseases, such as diabetes, cancer and heart disease, consumers can prepare for the potential risk by getting regular health check-ups, exercising daily and carefully monitoring their diets. These proactive changes in lifestyles will ultimately empower consumers to optimize and take charge of their own health.

However, this is the best case scenario when the test results are accurate and reliable. Although SNPchip genotyping can be a powerful source of genetic susceptibility to disease, so far it only explains a very small fraction of heritability and fails to capture other contributing factors. For example, chemical changes in base pairs and physical changes in chromosome structure can notably alter the phenotypic expression but they are often not heritable. Thus, SNP-chip genotyping is a weak forecaster of individual consumer’s susceptibility to genetic disorders.

Furthermore, interpretation of genetic data is complicated and sensitive so DTC genetic tests may produce false positive and false negative results. The SNP-chip genotyping is unreliable for testing very rare pathogenic genetic variants. According to the UK Biobank study looking at BRCA1 and BRCA2 genes, 96% of very rare disease-causing variants identified by SNP-chip genotyping were false positives.

In screening programs, false positives and false negative are unavoidable. The bigger danger lies on the misconception of consumers. DTC genetic tests are sold as if they are providing answers, and consumers would believe that their results will clearly predict their future health. These expectations, driven by marketing and media coverage, leave people at risk of over-interpreting results from DTC genetic tests. Moreover, consumer alone can have an access to the test without discussion with a health professional. Relevantly important information about the limitations of the test is explained on the websites but many consumers perceive it as extensive and tedious list of terms and conditions. Therefore, they would be barely aware of the potential mismatches between expectation and reality about the tests, leading the misinterpretation and blind faith of the test result to put consumers’ health in danger.

Overall, while the DTC genetic tests can lead consumers to be more engaged in their overall health and lifestyle decisions, the test results should not be the sole basis of any type of medical decision making. Tests are not an alternative to either recommended screenings or appropriate follow-up. Consumers should not solely use the test results to determine any treatments but discuss with the results with health care provider. Lifelong well-being is too important to rely on a recreational genetic test when other medically appropriate tests for your particular health are available. B

2020 VOL.17

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COLUMN

Infectious diseases Striked 21st Century Of South Korea

C

HeeYoun Yang

hyyang11@yonsei.ac.kr

OVID-19 which began in Wuhan, China in late 2019, is currently declared as a pandemic by World Health Organization (WHO). COVID-19 had 213,839 confirmed cases and 8,728 deaths in 164 countries worldwide on March 19, 2020.

South Korea also had 8,565 confirmed cases and 152 new confirmed cases per day. There is no sign of this infection to be terminated, and it is still actively spreading. It is yet to be determined exactly how the virus first spread from Wuhan, the epicenter of the virus. At this column, we will look into three infectious diseases that have caused a great sensation in Korean society since 2000 just as COVID-19 has.

SARS Severe acute respiratory syndrome(SARS) was a new type of infection caused by SARS-associated coronavirus (SARS-coV) in 2002. It is caused as the virus intrudes into human respiratory organs. The most common symptoms are fever, coughing, headache and joint pain, followed by difficulty in breathing and diarrhea. The fatality rate is about 11%.

Although it was found to have originated from musk cats used for food in Guangdong Province, a new study in 2017 showed that it was first derived from Chinese tubular bats.

It spread to Hong Kong, Taiwan, Singapore and Vietnam for several months after its outbreak in the winter of 2002. It was popular from November 2002 to July 2003 and was officially exterminated in July 2004. There were 8,096 confirmed cases and 774 deaths. In South Korea, three people were infected and completely cured.

Unlike conventional coronavirus infection, SARS-coV was found to be a genetically new type. It has been identified to be spread by direct and indirect contact of mucous membranes through the patient’s respiratory sarcoma or contaminated medium.

Since vaccines or preventive drugs are not yet developed, they are treated with a preservation support therapy to relieve symptoms, such as oxygen supply and antimicrobial agent.

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Swine Flu (Influenza A) (H1N1) Swine flu was caused by a new mutated type of influenza virus. It started in Mexico in March 2009 and was declared as a pandemic by WHO on June 2009. There is a statistical data showing that 759,678 people were infected from 2009 to 2010 worldwide and 270 died in South Korea. The public health center at George Washington University in the US announced that the death toll was at least 123,000 up to 203,000 people. Transmission routes of infection include inhalation of viral particles released from respiratory tract of infected patients by coughing and sneezing, and contact with body fluids such as diarrhea. Systemic symptoms are accompanied by sudden high fever, muscle aches, headaches, chills and respiratory symptoms such as dry coughs and sore throat which are similar to the characteristics of the common influenza. In the case of swine flu, vomiting and diarrhea are also common. Symptoms of the influenza virus progress rapidly, causing pneumonia as the virus invades the lungs. RT-PCR is used for the samples obtained from the patient’s throat to confirm the disease. It is treated by administering oseltamivir, also known as Tamiflu, and antibiotics are also administered in the event of complications from bacterial pneumonia. Most patients get better without treatment, whereas patients with viral or bacterial pneumonia, impaired immune function, or old age can be led to death. Influenza viruses can be vaccinated annually against the annual epidemic of the virus.

MERS It’s an abbreviation of ‘Middle East Respiratory Syndrome’ and was newly found in Saudi Arabia on September 24, 2012. As of June 2015, South Korea’s official number of infected was 186 and 39 dead, ranking second in the world after Saudi Arabia, the origin country. MERS-CoV, a species of beta-corona virus is known to be the cause of the disease.

The Ministry of Health and Welfare stated that there is a high risk of infection due to secretions within 2.5 meters of patients (coughs, phlegm, etc.). There are no existing precautions. Except for the cases of South Korea in 2015, it usually occurs only in the Middle East and Africa. Thus multinational pharmaceutical companies remain passive about vaccine development. Also, due to the nature of the RNA virus, it is more difficult to develop a remedy as mutations easily occur.

No antiviral drugs have been developed yet and the treatment to alleviate symptoms is vital in the case of infection.

Since the strain of the virus is same as SARS, the symptoms are similar. It includes the symptoms of mild cold but as the disease progresses, high fever, cough, and difficulty in breathing occur. The chronic invalid and immunodeficiency patients can die from multiple organ failures. The complications such as pneumonia, acute renal failure, clotting in the hematopoietic vessels and pericarditis increase the risk. This is due to the property of the virus that goes for the deep lungs and the kidney, which is called ‘LRT-tropism’ and ‘renal-tropism’. The majority of deaths were people with existing basal diseases but some healthy people were reported to have deteriorated dramatically, leaving complications or deaths by the factors known as cytokine storms. To diagnose patients, qRT-PCR is used to directly check the presence of RNA of a virus. Checking for the presence of antibodies against the virus also can be used. Although often found in camels in the Middle East, the contact between camels and bats is expected to be the main cause and research is still in progress.

The path and the process of initial transmission to humans are also yet to be determined.

Who’s Next?

In human history, epidemics have periodically visited mankind. Viruses appear to be just small pieces of protein but they take the lives of countless creatures in a blink. The state of COVID-19 doesn’t seem like to be over soon. The important point is, even after the escape from COVID-19, the human race will continue to confront with another protein particle visitors forever. We should learn lessons from this situation and the others in the history rather than simply finding a way out of the present. Or next time, there may really be a generational shift on Earth. B

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COLUMN

Periodontal Disease : Gingivitis and Periodontitis

P

Junseo Oh

ojoojo1194@naver.com

eriodontitis, also commonly called gum disease or periodontal disease, begins with bacterial growth in your mouth. If not properly treated, it may end up with tooth loss due to destruction of the tissue that surrounds your teeth.

What is the Difference Between Gingivitis and Periodontitis?

Gingivitis, which is referred to as gum inflammation, usually precedes periodontitis, also known as gum disease. However, it is important to know that not all gingivitis progresses to periodontitis.

In the early stage of gingivitis, bacteria of plaque cause the gums to become inflamed and bleed easily during brushing. Although the gums may be hurt, the teeth are still firmly planted in their gums. Irreversible bone or other tissue damage has not occurred at this stage.

When gingivitis is left untreated, it can proceed to periodontitis. In a person with periodontitis, the inner layer of the gum and bone push each other out. These small spaces between teeth and gums allow debris to be accumulated and those hollows slowly become infected.

Our immune system fights off the bacteria as the plaque spreads and grows below the gum line.

Immune cells in plaque that are fighting with bacteria toxins start to break down teeth and connective tissue that hold teeth in place. As the disease progresses, the cavities are more deepened and gum tissues are more destroyed.

When these appear, teeth are no longer anchored in place, they become loose, and teeth loss occurs. In short, gum diseases are the leading cause of teeth loss.

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What Causes Gum Disease?

Plaque is the primary cause of gum disease. However, other factors such as hormonal changes, illnesses, medications and bad habits can contribute to periodontal disease. Hormonal changes, such as those occurring during pregnancy, puberty, menopause, and monthly menstruation, make gums more sensitive, which makes it easier for gingivitis to develop. Diseases such as cancer or HIV interfere with the immune system and cause dental problem. Medications can affect flow of saliva which has a protective effect on teeth and gums. Some drugs such as phenytoin that are used on convulsion and nifedipine that are used on hypertension can cause abnormal growth of gum tissue. Bad habits such as smoking, not brushing and flossing on a daily basis can be risk factors.

COLUMN

What are the Symptoms of Gum Disease?

How Can Gum Disease be Prevented?

Gum disease may progress painlessly, producing few clear signs, even in the late stages of the disease.

Symptoms of periodontal disease are often subtle, but these events do not completely appear without warning signs. Certain symptoms may hint some form of the disease. The symptoms of gum disease include bleeding gum during or after brushing, swollen gums, bad breath or bad taste in the mouth, vanishing gums etc. However, even if you don’t feel any symptoms, you may still have some degree of gum diseases. In some people, gum disease may affect only certain teeth, such as the molars.

Gingivitis can be reversed and the progression of gum disease can be stopped in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional scaling at least twice a year. Daily brushing removes food particles and plaque between the teeth and under the gum line. Also, oral gargling can reduce the number of bacteria that cause plaque and gum disease.

Other health and lifestyle changes such as stopping smoking, reducing stress, maintaining a well-balanced diet and avoiding clenching and grinding your teeth will decrease the risk, severity, and speed of gum disease development.

Despite of following good oral hygiene practices and making other healthy lifestyle choices, the American Academy of Periodontology says that up to 30% of Americans may be genetically susceptible to gum disease.

And those who are genetically predisposed may be up to six times more likely to develop some form of gum disease. If anyone in your family has gum disease, it may mean that you are at higher risk, as well. If you are more susceptible to gum disease, more frequent check-ups, cleanings, and treatments are recommended for better management of the condition. B

Is Gum Disease Linked to Other Health Problems?

According to the Centers for Disease Control and Prevention, researchers have uncovered potential links between gum disease and other serious health problems.

In the case of people with healthy immune systems, the oral bacteria that flows into the bloodstream are usually harmless. But to people with underlying health problems, these germs are associated with diseases such as stroke and heart disease. Diabetes is a risk factor for gum disease, and vice versa. Because diabetes affects the body’s ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease and cavities.

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NATIONAL ISSUES

Green changes in Cafés disposable plastics restriction

A

SoYeon Choi choisoyeun@yonsei.ac.kr

t some points, you may have had a familiar pattern of conversation with the café staff. Now customers are accustomed to get their coffee in mugs, not disposable plastics, unless they have a takeaway.

But when the law was implemented in August 2018, it was not this way from the beginning. Many customers felt much discomfort when café stop offering disposable plastic cups strictly under the amendment of environmental law. What kind of changes have there been in the use of disposable plastics in café?

“Hello. May I take your order?”

“One iced decaf americano, please.”

“Is this here or to-go?”

“For here, please.”

“May I serve it in a mug?”

“Yes, of course.”

Status and Current State Plastics have been called a ‘gift of 20th centruy’ for the past 150 years, because of their good durability with low cost and light weight. Especially, the consumption of plastic cups has increased as the coffee consumption in café increased.

Unfortunately, the plastic waste has accumulated more and more in proportion to convenient usage of disposable cups.

Korea has the second highest consumption of total plastic per capita in 2015 according to ‘Eplastics resin production and consumption in 63 countries worldwide’ by European Plastics and Rubber Machinery(EUROMAP). The real figures were astronomical; the usage of only plastic cup was 3.3 billion in 2015. Its scale was approximately 1% of the total plastics in Korea, however, this figure was not small, given that it accounted for fully 40% of plastic usage except plastic bags.

With the need of environmental protection, the Department of the Environment have proposed to ban offering disposable plastic cups indoor since May 2018. After 3 months of grace period, café caught offering plastics cups to is fined 50,000 to 500,000 won according to its floor space. In fact, the use of plastic cups has been prohibited legally since 1994, however, its uses have been increased explosively because there was no eye of surveillance.

Each café franchise proposes its idea to actively encourage customers to use mugs and personal cups in order to reduce the use of disposables. Café franchises have constantly tried using reusable mug cups with environmental-friendly management to reduce the use of disposable products. Otherwise, some cafés offer discounts to customer using personal tumblers or cups. Furthermore, we can see the efforts on reducing all of plastic products like cutleries as well as plastic cups. Several franchises announced that they use paper straws instead of existing plastic straws, along with straw-free cups which have a drinkable hole on coffee lid. In fact, it is said that the plastic straw and stirring rod will be banned from 2022 as these products will be subject to the regulation. As a result of collaborative efforts of many cafés including large franchises and customers, the annual consumption of plastic cups has decreased by 14.4%.

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Limitations There are three main limitations to the current system of disposable plastics restriction in cafés. Although paper cups have emerged as a serious problem in recent years, the paper cup usage increased because it is not included in the target of control. In other words, the regulation of the Department of the Environment is limited to the plastics only, not including papers. In the past, if only hot drinks were put in paper cups, even cold drinks are now served in paper cups, too. The regulation of paper cups is not compelled by law, but of a certainty it defeats the purpose of environmental protection.

Secondly, double use problems occur in packing left beverage into plastic cups. Especially, business men who take a cup of coffee quickly in busy lunch time often put the leftover in a disposable cup when they get a coffee in a mug and go out of café again. What makes the matter worse, unwashed plastic cups cannot be recycled because of a coffee stain on a cup.

Next, the effectiveness of plastic regulation is being questioned because only the café owners have to pay penalty fees and customers using plastic cups do not need to pay fines. Some customers have coffee with a disposable cup in the café after spurious order as a takeaway shamelessly. Each time, a store owner or café staff is in an awkward situation to be caught because of impudent customers.

Solutions The effective ways to make a change for the better are the inclusion of paper cups into the target of disposables regulation and plastic cup deposit system. According to the paragraph of Limitations, the rapid increase of paper cups has been more evident lately. Perhaps, the regulation of paper cups with plastic cups must be a radical solution against its increase. It can also awaken customers that paper cups do not differ much from plastics. Moreover, some people argue that the ‘disposable cup deposit system’ should be restored. The disposable cup deposit system is that people who return their used plastic cups get a certain deposit back. This system is not new. It was introduced in 2002 but abolished with poor participation caused by a small amount of deposits in 2008. Actually, coffee price can be raised because it will be priced with extra deposit, so temporary coffee price hike must be overcome before the implementation of the new system.

However, it is certain that the disposable cup deposit system will be an effective way to reduce disposable consumption.

In order to implement this system successfully, customers need to have a strong intention to return their disposable cups to cafés. If the system works well, we anticipate positive effects with increase of the usage of reusable cups.

Conclusion With the advent of regulation of disposable plastics, not a few consumers said they felt a lot discomfort and expressed complaints as well. However, they have been quickly accustomed to using mugs or their own tumblers in cafés at some point, and now they might be more comfortable in this situation. Keeping the momentum, we can look forward to more eco-friendly habits using all disposable plastic products in restaurants also. We should remember, it must be of absolutely no use without customers’ awareness and coorporation no matter how good system or law is. It is our hope that effective disposable regulation will be achieved through customers’ active participation and support under the law.

“Earth is not ours, it is borrowed from our descendants.” B

2020 VOL.17

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National nationalissues issues

Pharmacophobia Especially about anaki

P

JaYeon Heo

2016194011@yonsei.ac.kr

What is pharmacophobia?

harmacophobia means the irrational fear of using pharmacological treatments or avoidance of medicines. Having a phobia of medications can cause serious harmful effects on patient health. They refuse to get necessary pharmacological interventions and lead to problems with medication compliance. Pharmacophobia can present in parents who are concerned about giving medications to their children, fearing that the medications will do more harm than good.

Pharmacophobia in Korea One of the most famous cases of medication phobia in Korea is the internet cafe which name is ‘Bring up children without medicine’. (AnAKi in Korean) AnAKi Cafe was opened by Kim Hyo-jin, an oriental medicine doctor who has operated her own oriental medicine clinic in Daegu for 31 years. The members of AnAKi insist dangers and unnecessariness of using pharmacological treatments, especially preventive treatment and vaccines. Among them, not going to the hospital is called ‘naturalistic parenting’ or ‘home management’. The controversial problem is that not only do they reject treatment and vaccines, but also follow a variety of untested alternative treatments.

Is it naturalism or child abuse?

Naturalism is an argument that children can ultimately improve immunity by recovering naturally.

It seems to be true but why is it quite controversial?

Despite of the need to receive treatment for their children, members of AnAKi have often taken a leap of faith in natural healing and refused to cure their child in time. In particular, forcing children who cannot speak and have no right to self-determination to take extreme natural therapies is obviously child abuse.

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national

issues

The civic group sued them in charge of violating the medical service Act and child welfare Act. However the operator Kim complained that she had fulfilled her duty of conscience as a medical doctor, she was just a victim of this witch-hunts.

Let’s take a look at some representative examples of AnAKi and figure out who’s the victim.

Case 1: Chickenpox (varicella) party

Case 2: Feeding charcoal powder

The gist of having chickenpox party is developing your children’s self-immunity by letting them play with the kids who already got chickenpox. Kim, the movement leader said she wants to hold chickenpox parties for the whole people of the country. It is ironic that they reject vaccines as this is the most fundamental principle of the vaccine. It’s not over when just chickenpox has passed; the virus can regress into the internal muscle nervous system and become active again if the immune system becomes weak. The Korea Centers for Disease Control and Prevention says that even if chickenpox passes lightly, it can cause dangerous complications such as encephalitis and pneumonia.

If an ‘AnAKi’ child refuses to eat charcoal powder, his/her parents feed their child it with honey. People should never give honey to a child under 12 months because it can cause infant botulinum syndrome.

Botulinum syndrome is a fatal disease that has a 99 percent mortality rate even when treated at a hospital.

In addition to these cases, they recommend adding salt water when your child has pus in the ear or putting the burnt skin in 40 degrees of hot water. If you search the AnAKi victims, you can easily find photos of young infants and toddlers not properly treated, clinging pus and dirt to their faces, and seriously damaged by burns.

Eventually...

AnAKi operator Kim‘s doctor license was revoked on January 31, 2020. The reason for the ruling is the contravention of the Food Sanitation Act and the Pharmacist Act. - vomits and organic residues were found in the charcoal she sold, and the parts of the pine trees (which is the raw material of the charcoal) were rotten or moldy. She also violated the Act on Special Measures for the Control of Health Crimes because she sold medicinal herbs that she fermented, mixed and processed at her house without any prescription.

Medical students swear the Hippocrates oath and pharmacy students swear the Dioscorides oath. Why do they take an oath? Because they have an oblige to put the patient first. Nevertheless, some health care providers are putting patients at risk due to their misbelief, incorrect knowledge and greed for money. Just as the case of the surgeon who refused his patients to receive a blood transfusions or surgery because of his own religious beliefs, which can threaten the patient’s health, even life. As a pharmacist, one of the professional health care providers, we should behave with a sense of obligation and also as a pharmacist and make effort to improve the awareness of medication phobia. B

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INTERNATIONAL ISSUES

PillPack, a Game Changer in Pharmaceutical Retail Business Ji Eun Ryoo

W

ginaryoo21@gmail.com

e offer a better, simpler pharmacy that enables people to take the right medication at the right time — resulting in healthier, happier customers who have more time to spend living well instead of managing medications.

- PillPack Providers -

What is PillPack?

PillPack is an online pharmacy that ships drugs packaged in presorted doses to patients all over the United States. T. J. Parker and Elliot Cohen first founded it in 2013. In 2018, Amazon purchased the company for 753 million US dollars. A year later, PillPack acquired a new name, PillPack by Amazon Pharmacy. Simply put, it is an online pharmacy with delivery service based in Manchester, New Hampshire, United States. It is speculated that Amazon will expand its drug delivery system to other countries. For instance, Amazon Pharmacy is now trying to apply its trademark in countries including Canada, UK and Australia. Although it might take some time before PillPack launches its service in those countries, its application process hints its ultimate goals. PillPack would later attempt to expand its boundaries to surgical and dental instruments.

What kind of products does PillPack provide?

According to TJ Parker, CEO and co-founder of PillPack, it provides prescription medicines, over-the-counter medicines and vitamins all over the continental US. The ordered products are safely delivered in pre-sorted packages every two weeks. With clearly written labels, patients can easily understand what they are receiving. PillPack manages to work this out with the help of robots. Yet pharmacists do occupy and are available over phone and internet 24 hours a day. Like other pharmacies offline, PillPack is covered by most of the insurance plans including Medicare Part D. If PillPack is included in one’s insurance plan, it does not require extra charge for signing up. Anyone interested may register online at www.pillpack.com, or by phone at 844-745-5725. In addition, it provides text messages as friendly reminders for any information and confirmation of changes to orders.

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INTERNATIONAL ISSUES

Advantages of PillPack When patients take medicines from many different pharmacies, they may mistakenly take same types of drugs in high doses or be exposed to some drugs that should not be taken together. Serving as a centralized provider of all medicines, PillPack would save patients from issues of overdoses and unwanted drug interactions that arise from using several pharmacies. PillPack is most welcomed by seniors because it relieves customers’ burdens to go back to pharmacy to get refills and worries over overdoses and forgetting to take medicines. It was reported that average seniors take four prescription medicines and two over-the-counter drugs or vitamins daily. Many seniors tend to be forgetful about their medicines and lack transportation system to get to pharmacies. According to one statistics result, up to 25% of the seniors get into nursing home because of not taking medicines properly on time. Since seniors usually take multiple prescription medicines, some unwanted drug-drug interactions may occur if not carefully attended. PillPack takes care of these concerns of seniors by delivering carefully assorted medicines to their doorsteps on time.

Controversies over PillPack Despite the advantages of PillPack discussed above, it is also facing severe criticisms. First, PillPack might endanger corner drug stores. It is expected they will soon attract regular visitors to local pharmacies by its convenience. Second, PillPack’s effort to take over the drug supply chain might trigger high-rise in medicines price. Without doubt, higher drug costs will affect customers the most. About six out of ten Americans take at least one prescription medicine and about one in four take more than three. Higher costs of medicine might cause people to cut down medicines that they need necessarily. One of the biggest problems of Amazon’s PillPack is that it will not be able to offer specialty drugs.

Specialty drugs are medicine that help treat complex chronic diseases and account for one-third of US pharmacy’s total profits. They are more expensive than most other prescription drugs and require more caution and care for administrations. While some are taken orally, some must be injected by specialists. Therefore, it comes as no surprise that specialty drugs go beyond the capabilities of PillPack and some argue PillPack would not help patients a great deal because of this shortcoming.

Concluding thoughts Although PillPack is the first in industry to add delivery service to medicines, some big pharmaceutical companies might catch up in such service. Therefore, it would be interesting to see how PillPack would manage to survive in the business despite its weaknesses, including lack of face-to-face interactions with customers, and change pharmaceutical landscape in upcoming years. B

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INTERNATIONAL ISSUES

Outbreak OF THE COVID-19 Sang Soo Na

sangsoo66@yonsei.ac.kr

O

n the 17th of November 2019, a patient with apparent signs of mild cold walked into a hospital located in Hubei province of the People’s Republic of China. The symptoms were mild and the patient expected the illness to be benign. Even the healthcare and medical professionals did not recognize the droplets dispersed from the patient’s cough were a lethal foreshadow of the novel coronavirus. By the time Chinese Health officials informed the World Health Organization (WHO) on the 31st of December 2019, already 41 patients were infected with the mysterious pneumonia. As of April 2020, almost 2 million people have been diagnosed around the globe, leading the WHO to declare the ongoing disease a ‘Pandemic.’ This signifies the current virus is in the most hazardous stage of the six phages defined by the WHO.

So, What is the Disease?

Pneumonia is a disease caused by various infections in lungs, mainly from bacteria or viruses. COVID-19, the official title of the coronavirus disease that emerged in 2019, is a type of pneumonia resulting from coronavirus as its name suggests. Under the Baltimore classification that categorizes viruses based on their life cycles, coronavirus falls into Group IV. Their genetic information is saved on a single positive RNA strand, which is replicated by its own RNA dependent RNA polymerase with the help of hosts’ enzymes. One common characteristic that all RNA viruses share is that they are remarkably unstable and are prone to errors. In most cases, these errors end up in dysfunctional characteristics and lead to death.

These errors, however, can seldom mutate an organism and give rise to novel attributes that help the entity to withstand selective forces of the nature. Mutations in already-existing coronaviruses enabled the virus to pass on from animals to humans, and this is the evidence why professionals suspect the Wuhan South China Seafood Wholesale Market to be the prime origin point of the novel virus. Unhygienic consumption of wild animals allowed viruses to enter and proliferate in human bodies.

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This is not the first time that coronavirus caused epidemics. Severe Acute Respiratory Syndrome (SARS) and Middle Ease Respiratory Syndrome (MERS), emerged in 2002 and 2012 respectively, are both diseases resulting from coronavirus infections. In particular, COVID-19 appears to have 89.1% nucleotide homology to SARS-like coronavirus that had previously found to be originated from bats in China. All three viruses are infected by respiratory organs and accompany typical symptoms of pneumonia: fever, cough, and muscular pain. They do not have a specific drug developed for cure, and thus only symptomatic treatment is done to aid the human immune system to overcome the disease by itself.

These three, however, are definitely distinguishable from one another. COVID-19 has low mortality rate of around 6.29% as of 13th April 2020, which is less than one fifth of MERS. On the other hand, low mortality can also mean rapid propagation. It enables patients to become perfect virus carriers and spread the disease without death. Furthermore, one exceptional characteristic of the novel coronavirus is that it shows asymptomatic infection, allowing it to spread even during the incubation period without apparent signs of the disease.

INTERNATIONAL ISSUES

Adding Fuel to the Fire

Where We Are Heading to

What raised harsh criticism was the lackadaisical initial response of governments and organizations. First, the Chinese government attempted to conceal the crisis.

Li Wenliang, the first doctor to recognize COVID-19, warned his colleagues about a possible outbreak of a new virus, but he met threats from the government for spreading canards. The WHO called the emergency committee only after a month from the outbreak and officially announced. Tedros Adhanom, the DirectorGeneral of the WHO, then announced that “this is, though, an emergency in China. But it has not yet become a global health emergency.” His words brought delayed responses from countries all over the globe. The United States also exacerbated the pandemic. Jerome Adams, the US Surgeon General, discouraged citizens from wearing masks in late February 2020. In addition, Robert R. Redfield, the Director of Centers for Disease Control and Prevention, also answered “no” to the question on whether healthy people should wear masks on the very same week. Now, COVID-19 infectees in the United States is almost 3.5 times Spain with the second most cases reported.

Incalculable sacrifice is put into bringing the COVID-19 to an end. Healthcare professionals in South Korea have invented reverse transcriptase polymerase chain reaction (RT-PCR) test kits for diagnosis in only a few hours. They have received Emergency Use Authorization by the Food and Drug Administration (FDA) and are being utilized all over the world. Doctors and nurses are toiling day and night to help patients recover. With the tremendous effort, the novel virus will consequently and eventually be under control and come to an end.

What we need more, however, is clarity of information and investment in prevention. When the current circumstance becomes stable, it is too early to be complacent. We need to learn from our mistakes and educate ourselves from outbreaks of epidemics.

Appropriate information resolves chaos. Not only should healthcare authorities be responsible for their words and actions, but also should ordinary citizens have an eye to differentiate facts and rumors. Furthermore, human race can only last so long if appropriate measures are not taken towards epidemics. As Jared Dimond argues in his writing Guns, Germs, and Steel, a large portion of humanity’s fate is heavily dependent germs. On one hand, astronomical amount of money is invested to control the ‘guns,’ including nuclear technologies. If so, should not preventing biochemical agents be subsidized as much prior to tragedies? B

2020 VOL.17

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INTERNATIONAL ISSUES

The big blue gap in the green new deal Jiyoun Son

kikijenny1203@gmail.com

C

hildren are skipping school to protest climate change, millennials are going vegan for the environment. These days, people are becoming more aware of environmental issues and so is the government. This “green” paradigm shift puts pressure on activities that businesses, government agencies as well as communities and families perform daily. To save ourselves and our loved ones from the environmental crisis, the government needs to make practical changes by politics and legislation to protect the environment. The most profound example of this sort of change is the Green New Deal.

What is the Green New Deal?

This green proposal is a congressional resolution proposing ambitious plans to fight climate change. A proposal put forward by two New York Democrats, Alexandria Ocasio-Cortez and Massachusetts Senate Edward J. Markey, called on the government to stop fossil fuel use and limit greenhouse gas emissions. It also aims to provide high-paying new jobs in the clean energy industry for our own good. Therefore, the Green New Deal states that the world must achieve net-zero carbon emissions by 2050 and that the United States must play a leading role in achieving this goal. To achieve these goals, the plan calls for a “decade-long mobilization” to reduce US carbon emissions. It aims to obtain 100% of public electricity from renewable energy sources and to improve the energy efficiency of buildings and transportations. For social justice and promotion, the resolution says the government has responsibility to provide training on the labor market and economic support, especially for communities that currently rely on employment in the fossil fuel industry.

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INTERNATIONAL ISSUES

The Blue Gap in the Green New Deal Such green waves have become a global phenomenon in international law and politics, yet many people criticize the Green New Deal. They say that it is unrealistic and impossible to achieve these goals in such short time. However, we do need radical changes to stop environmental meltdown. The Green New Deal is clearly a positive attempt, whereas it does require some improvements. One of those improvements should be filling in the “blue” gap.

The ocean covers 70.8% of the earth’s surface and is home for many species of life, more than the green land. However, what have we done to this vast blue reservoir? More than 90% of the world’s fish resources are fully exploited or overfished. On the other hand, 93% of the heat by greenhouse gas emissions were absorbed into the ocean which led to disruption of migration patterns, bleached coral reefs, and increased sea levels and temperatures. About 30% of the carbon pollution in the air is being absorbed into our oceans, which acidifies the ocean and changes the chemical property of the water. Soil pollution from factories, agriculture and plastic waste have made “dead zones” in lakes and directly affects our own dinner plate.

Also, the blue economy including fishing, marine agriculture, transportation, tourism and recreation support millions of jobs and billions of annual income to most countries. However, these communities are threatened by the blue destructions. In decades, sea level rise may reach 6 feet, which will change the population distribution and put people at risk of migration.

However, the Green New Deal never mentioned our ocean. Although the result of devastating ocean is less obvious than that of land, the recovery must be taken.

The Blue New Deal The following is some of the recommendations for the “Blue New Deal.”

First, rebuild the coastline and re-green it. Seaweeds and wetlands can absorb up to five times more carbon per acre than green forests. The blue ecosystem also provides better and cheaper protection from storms than man made walls. Investments in restoring coastal lines will not only benefit the animals and plants, but also protect residents prone to be affected by climate change. In order to protect the ocean, it is necessary to designate and protect ecologically important ocean areas, just like we do with national parks. We should also reduce ocean trash and end offshore drilling, especially in these protected areas. The government should drastically fight marine plastic pollution by limiting the production of disposable plastics and make more use of recyclable material.

Investing in technologies that generate electricity by offshore wind and wave energy is also beneficial to the Green New Deal. Generating electricity across the country using renewable zero-emission technologies is literally one of the deal’s main goal. Wave and offshore energy can significantly help meet our zero-emission energy needs and the industry can create clean jobs. In order to promote this clean energy production, funding technology research would definitely help.

Meanwhile, we need to modernize our shipping process. The shipping industry is one of the largest greenhouse gas emitters around the world. Many of these emissions come from fossil fuels used in international waters and ports. We need to establish extreme emission standards for marine fuels for both domestic and foreign fuel transportation and digitize our ports.

We can’t overlook the ocean anymore. The rising sea level and its change in marine ecosystem are real threat to our human world. However if we give it a twist it means that the ocean can be an important part of the environmental solution. Marine protection benefits the blue ecosystem itself as well as people who live and depend on coastal areas, not to mention our food, jobs, economy and culture. So now, we need to recover it by filling in the blue gap.

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INTERNATIONAL ISSUES

Electronic cigarettes, are they really safe?

Ye Ji Jeon

yejijeon97@naver.com

F

or smokers, quitting smoking would be a real grind. It might be a difficult decision making for them to choose between the satisfaction they can earn from smoking and high-quality healthy life by quitting smoking. Then about ten years ago, the savior appeared and let smokers achieve both, which is electronic cigarettes, commonly known as ‘E-cigarettes’. A solid trust on the safety of E-cigarettes was first aroused by the research conducted by David J Nutt in England, 2014. It mentioned that E-cigarettes are 95% safer than the normal one which actually has to burn. This research has played a significant role in forming a positive perspective on E-cigarettes and let smokers smoke as much as they want without worrying their health. However, the safety of E-cigarettes has been controversial after the first death related to E-cigarettes with liquid was unveiled. Many experts are doubting the safeness of E-cigarettes. These criticizing voices toward the Nutt’s research that it was not based on empirical data and was not a clinical trial targeted for human. So, what’s the truth? Electronic cigarettes, are they really safe?

What are E-cigarettes?

To accurately discuss about the safety of E-cigarettes, it is a fundamental step to know what E-cigarettes are. Electronic cigarettes are types of cigarettes which form steam by heating up the liquid nicotine with battery. They were first designed

by Herbert A. Gilbert in 1963 and cigarette companies started to be interested in E-cigarettes to make ‘safer cigarette’ in 1980s. The most familiar form of E-cigarettes we easily encounter nowadays was developed by Chinese pharmacist Hon Lik in 2000 and started to spread across the world.

E-cigarettes consist of liquid nicotine, absorbent, cartridge, vaporizing system which converts liquid nicotine to steam and charger. The liquid form of E-cigarettes includes water, alcohol, propylene glycol and other components for flavor.

The second and third generation of E-cigarettes let smokers adjust the amount they inhale depending on their preference, therefore also called ‘personal vaporizer’. With the individualized adjusting system, they also have larger capacity of cartridge compared to the first generation.

E-cigarettes spread out rapidly through smokers and according to the U.S. CDC, the total sales of E-cigarettes were 6.5 billion dollars. In 2014, the ratio of E-cigarettes smokers has already exceeded the ratio of conventional cigarettes smokers among teenagers in U.S. Similarly, in Korea since E-cigarettes were first introduced in 2008, the number of E-cigarettes smokers has increased exponentially. This proves that E-cigarettes are something really influential to be reckoned with between smokers. One of the reasons they could be so popular is their marketing methods which emphasized their safety. As mentioned before, since they heat up liquid nicotine and convert it into innocuous steam, E-cigarettes companies stressed the fact that E-cigarettes do not include harmful materials except nicotine which make them much safer than the conventional cigarettes. In addition, those companies argue that E-cigarettes can avoid secondhand smoking. However, the safety of E-cigarettes has constantly been a hot potato in our society. So what makes E-cigarettes so controversial?

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INTERNATIONAL ISSUES

The dark side of E-cigarettes Despite the effort that E-cigarettes companies made to improve E-cigarettes’ image, people’s fear toward E-cigarettes is growing bigger and bigger. This is because of the numerous researches done throughout the world which prove the danger of E-cigarettes. According to the researches, unlike the companies’ claim, the liquid phase of E-cigarettes contains numberless class 1 carcinogens such as formaldehyde, acetaldehyde, and tobacco-specific nitrosamine. Moreover, the “steam” from E-cigarettes which was advertised as safe gas, turned out to be an aerosol that also includes class 1 carcinogens from the liquid phase. Therefore, it has a possibility that E-cigarettes “might be” safer than the conventional cigarettes, however it definitely stretches the imagination to regard E-cigarettes as totally safe cigarette. There are some researches which prove the short-term influence on our health, however it is still difficult to guarantee the safety since we lack of long-term tracking studies on the major diseases such as cancer, cardiovascular disease, and lung disease.

Another reason which makes it difficult to compare E-cigarettes and conventional one is that there are too many variables to compare those two in equal condition. For example, there are various types of inhaling system for E-cigarettes and numerous combinations of components. Unlike people regarding E-cigarettes as a single product, they cannot be simply defined since they are composed of diverse combinations of materials, therefore we must consider in various perspectives to determine whether they are safe or not.

Recently, a number of direct evidences which prove the danger of E-cigarettes have unveiled. One of those was relevant to lipid-soluble components, especially Vitamin E acetate. Vitamin E acetate, which has similar viscosity and characteristic to hemp but cheaper, was mixed instead into the components. Moreover, E-cigarettes also includes nicotine as well as conventional cigarettes. Therefore nicotine-dependence cannot be overlooked. These facts made E-cigarettes riskier and teenagers are now more easily exposed to cigarettes than before.

What should be considered?

Unlike the public image that E-cigarettes are safer than conventional cigarettes, the controversy around their safety and regulation are getting bigger and bigger. Since both sides do not have enough evidences to prove each argument, it is more important to set proper guidelines for E-cigarettes’ upright direction. Above all, since safety is the most controversial problem, safety guidelines regarding chemical compounds included in E-cigarettes should be prepared. There is still no guideline regulating E-cigarettes, therefore further researches related to the usage and safety of E-cigarettes and management plans are required. Furthermore, there are researches showing that flavoring materials increase the risk of inflammation, so even if Vitamin E acetate is pointed to as a cause of death, we should not overlook other many options which affects the risk of death. Thus, it is crucial to set regulation about the combination of components and ratio of flavoring materials. Researches focusing on the effect of long-term exposure by E-cigarettes and the amount of hazardous components released depending on the way of smoking might be essential for establishing regulations. Since nothing has proven yet, we should always be aware of the dark side of E-cigarettes to guard our health. B

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COLUMN

Vegan & Cruelty Free : new Ethical Beauty Trends

Ji Hye Seo sjh0216ann@gmail.com

I

n recent years, Millennials and Generation Z are highly concerning about environmental problems than any other generations before. This phenomenon is now driving shifts in beauty markets indeed. As acknowledging consumers’ new demands, plenty of cosmetic companies are now making vegan and cruelty-free products. Also, there are some cosmetic brands that have substituted plant-based ingredients for animal-based ones.

What Caused the Shift in Beuaty Industry?

Younger generations, also called Millennials (born 1981-1996) and Gen Z (born 1997-2012), are embracing veganism in their lives for the sake of ethical values. They choose plant-forward options for diets, fashion retailers, and even for beauty products. On the other hand, a growing number of consumers are fighting against animal testing which includes brutal process in order to test toxicological issues. As mainstream consumers are being aware of the ethical problem of using animal-derived ingredients and testing on animals, they are leading the change. The beauty market is now making an effort to provide vegan and cruelty-free certified products. Moreover, there are some mobile applications, like Logical Harmony, that give lists of those kinds of brands.

There was 300% increase in the sales of vegan products since 2015 meanwhile Boots.com(a British health and beauty retailer) reports a 56% increase in vegan related searches in 2019. It does not only belongs to a UK trend though, as the global vegan beauty industry is expected to register a CAGR(Compounded Annual Growth Rate) of 7.1% between 2018 and 2023. Meanwhile, the global cruelty-free cosmetics market size is estimated to reach USD 10 billion by 2024, and the market is expected to register a growth rate of 6.0% during the forecast period of 2019 to 2024. Due to the increasing awareness of consumers regarding the harmful effects of animal testing on the environment, the demand for cruelty-free cosmetics is increasing.

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Vegan Beauty & Cruelty Free < Vegan beauty >

Animal-derived ingredients including honey, beeswax, lanolin (wool grease), squalene (shark liver oil), carmine (crushed-up beetles), gelatin (cow or pig bones, tendons or ligaments), allantoin (cow urine), ambergris (whale vomit) and placenta (sheep organs) are commonly found in beauty products. Vegan beauty products, however, are free from these animal or animal-derived ingredients and made of plant-based ingredients or alternatives.

The Body Shop is one of the leading key players in the vegan beauty market. The business sold over three million vegetarian products in 2018, with around half of its product are classified as 100% vegan. Some products from The Body Shop are labelled as â&#x20AC;&#x2DC;vegetarian beauty productsâ&#x20AC;&#x2122;, which means they are free of any animal-derived ingredients obtained by killing animals. For instance, honey, beeswax, or lanolin are animal-derived substances that do not need to slaughter animals. The company tries to get the resources for Vegetarian-friendly beauty products in sustainable and organic way.

Products of Elf Cosmetics are also produced without any animal derived ingredients, which means they are 100% vegan. Their lip glosses and skin care serum have coconut oil that help nourish lips and skin. Also, brushes and false eyelashes are made with synthetic materials instead of animal hair. Elf cosmetics uses inexpensive packaging for its products and provides its products via a direct-to-consumer in order to keep price low. By doing so, elf became one of the most beloved cosmetics companies maintaining long-time relationships with customers.

COLUMN

< Cruelty free >

Cosmetic testing on animals is conducted to ensure the safety and hypoallergenic properties of products for use by humans. Terrified rabbits, rats, guinea pigs and mice have substances rubbed frequently on their bare shaved skin, dripped into their eyes and have gone through repeated force-feeding studies lasting weeks or months for checking symptoms and signs of side effects. Thought it was a think of the past? But it’s still happening somewhere well hidden!

Cruelty-free means that the products have not been physically tested on non-human animals. PETA(People for the Ethical Treatment of Animals) is now providing a Beauty Without Bunnies program, which shares information about cruelty-free companies and products with consumers. Companies which have gained PETA’s certification guarantee that they do not harm any animals for tests on ingredients, formulations, or finished products and vow not to do so in the future.

Lush is also widely recognized as a cruelty free brand.

It has not conducted animal testing since 2007, and confirmed that they will not buy any ingredient tested on animals. Instead, they use acceptable in-vitro alternatives to ensure safety. Moreover, it doesn’t sell its products where animal testing is required by law, like China. Not only complying with their cruelty free policies, they also launch various campaigns to raise awareness of inhumanity of animal testing. On International Kissing Day, 6th July 2013, Lush shops across the globe participated in ‘Are Your Kisses Cruelty Free Campaign’ to highlight the fact that animal testings for cosmetics are still being conducted

Due to the harm done to the animal subjects, animal testing is opposed by animal rights activists and others.

Cosmetic animal testing is banned in the European Union, United Kingdom, India, Israel, and Norway. Unfortunately, there is no regulations on testing non-medicated cosmetics or household products on animals in the U.S. and Japanese law, so companies that make and sell their products here can choose to conduct tests on animals. Though Japanese Brands such as Shiseido and Mandom have ended most of their animal testing, other leading cosmetics companies in Japan are still conducting animal tests. Each year, more than half a million of rabbits are blinded, poisoned and killed around the world.

Conclusion Animal-friendly beauty industry was considered as a niche category several years ago. Now, the public became more aware of the environmental ethics as well as making better choices for our planet. Why don’t you give it a try to be a part of the movement? Finding either vegan or crueltyfree cosmetics can be difficult at first, since the products are barely labelled to say ‘made of pig tendons’ or ‘tested on bunnies’. However, you can take the first step forward by being conscious about those issues and supporting socially responsible brands. B

Confronting Challenges Vegan doesn’t always mean the product is 100% safe.

Misunderstanding of the concept often leads companies to greenwash. Many vegan beauty brands may not contain animal derived materials, but they’re often full of seriously toxic ingredients that can harm your health. This is common for color cosmetics often containing heavy metals like aluminum, lead, chromium and cadmium, which are bio-accumulative. In addition, there might be some quality issues if the products only contain pure organic ingredients.

Without proper additives, they can easily go contaminated, spoiled, and lose their original efficacy.

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6. LIFE ISSUES

Eating Disorder

Cycle of overeating and fasting JungWon Kim

P

wjddnjs9628@gmail.com

Are you a perfectionist?

erfectionism is a personality trait characterized by “a person’s striving for flawlessness and setting excessively high performance standards, accompanied by overly critical self-evaluations and concerns regarding others’ evaluations.” Every person has some perfectionistic personalities. When a daily plan goes unexpectedly, many people just let all the remaining works go away, and the schedule set at the start of the vacation disappears with a single oversleep. Perfectionism is also a huge obstacle for people on a diet. At the beginning of the year, dieting, eating healthy foods and exercising are the biggest concerns. But at the end of the year, most look forward to next year again and again. Keeping a strict diet in a modern society is almost ‘mission impossible’. Even some success on eating only chicken breasts salad for a while, hanging out with friends or just watching one eating show, widely known as Mukbang, can break all the resolutions and people never go back to green diets again. Do all of these happen simply due to the lack of will? This thought leads people to eating disorders. Since the survival system of our body is much more delicate and firm than annual resolutions for diet, it should be understood thoroughly so that our body and mind can move forward to same direction.

Case1. Eating Disorder from Physical Stress When a person goes on a protein-based diet, the body detects many changes. Since the diet is composed of foods with less spice, the absolute amount of nutrition consumed decreases because we stop eating after feeling full. It makes the body working in peace turn into a state of alert.

Moreover, low-calorie and protein-based diets affect the proportion of carbohydrates, which are the main source of energy. Lack of immediate energy source available lets the body feel like something is missing, ending up eating something more. This can also be explained using the relationship between blood sugar level and insulin. Because blood sugar does not rise enough, the body continues to order something to eat, especially carbohydrates-intensive foods.

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If we obey to this order and start to eat carbohydratesintensive foods, would it be possible to finish eating within a single dish since the absolute amount of nutrients and proportion of carbohydrates are evenly balanced? This is impossible for two main reasons. First, our body considers it as emergency procurement and try to bargain as much as possible. Hormones for satisfaction will be suppressed and a continuous warfare will be going on for full provision of nutrients, even after filling every space of stomach. This idea also occurs in our brain, as the more people strictly abide with their diet, the more they accumulate hunger for non-diet foods. Reminding tomorrow’s healthy diet makes it harder to be satisfied with today’s pizza.

LIFE ISSUES

It often ends up with inhaling pizza as much as possible as if it is the last chance in life. This series of vicious circle eventually leads to a devastating rationalization for overeating, that finishing current hunger will lead to tomorrow’s healthy diet. This situation is often depicted as a ‘sudden cheating day’. ‘Cheating day’ originally means to cheat our own body by getting away with a strict diet for once every set period of proper diet, so that the low carbohydrate and thirst for specific foods can be satisfied.

However, rationalization with ‘sudden cheating day’ would lead to irregular intakes of carbohydrates-intensive foods and amplify thirst for food because every day seems like the last day.

With already expanded stomach and thirst for carbohydrates, salad after burger tastes even worse.

Overeating never ends with a single day. In this stage, unfortunately most people choose to go on a self-starvation or even vomiting after overeating. Not to mention vomiting puts a serious threat to our body, misinforming our body to require more nutrients. Then what about fasting? Sometimes fasting can be beneficial for our body. In fact, there are a lot of people who actually balance their diet with intermittent fasting or 3-day fasting. But a sudden determination is always a high risk choice. Fasting for physical condition inevitably confuses our body and makes harder to keep on proper diet. In often cases, fasting is followed by another overeating, putting oneself in a never-ending circulation of overeating and fasting.

Case2. Eating Disorder from Mental Stress Are people without any strict diet forever free from eating disorders? Unfortunately, anyone can face the eating disorder when food comes as the only joy in their struggling life. Eating favorite carbohydrate-intensive foods temporarily releases stress-relieving hormone such as dopamine, which helps to forget the stress caused by other issues. The joy from foods is certain and effective, so that people under harsh stress tend to start overeating to

run away from the problems in reality for a while. Unlike overeating caused by physical stress, eating disorder caused by mental issues progresses over a long period of time.

Repeated binge and lack of self-affection consequently bring bipolar disorder with a hysterical personality. In fact, a research suggests that a person gets improvements on diet when getting through a successful treatment for mental collapse.

We need to…

Stress, as the main route to eating disorder, can be both expressed mentally or physically. Standards made by comparing with others can never make a person happy enough. Reactions and threshold for stress can be different among people and also among organs. Comparing with others should be stopped and we should listen to the whispers our own body makes. B

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life issues

DIY Mask & hand sanitizer

C

Sang Hee Lee

idshannon@yonsei.ac.kr

OVID-19 pandemic is changing the way we live. It is common to see people wearing masks. Hand sanitizers are placed in front of building lobbies and subway platforms. People are avoiding public places such as restaurants, schools are closing, and workers are working from home. As Korea Centers for Disease Control and Prevention (KCDC) strongly recommended using face masks and cleaning hands often, face masks and hand sanitizers are flying off shelves. So, this brings us to the question: how do we choose the right product and how do we make our own face mask and hand sanitizer?

Which mask should we use?

There are several types depending on the purpose, such as a cloth face covering or an industrial mask. Masks used for preventing COVID-19 are ‘respiratory masks’. A respiratory mask is one that is used in everyday life to protect respiratory system against harmful substances or infectious agents by its particle blocking capability. According to the

by Ministry of Food and Drug Safety(MFDS), it is treated as ‘quasi-drugs’. The respiratory mask denotes the particle blocking performance by marking the number after the letter KF, which stands for ‘Korea Filter.’ In specific, KF80 means the mask blocks 80 percent of fine particles (average particle size of 0.6μm). KF94, 99 blocks higher percent; 94 percent and 99 percent of the fine particles (average particle size of 0.4 μm). They all protect the respiratory system from hazardous particles such as yellow dust and fine dust. Additionally, KF94 and 99 protects respiratory system from infectious agents.

On January 29, 2019, the Ministry of Food and Drugs recommended the use of KF94 and KF99 respiratory masks in the community setting to prevent coronavirus infection. Wearing these masks is especially important because they protect people from those who are infected but asymptomatic. However, masks are out of stock on most days. Also, they are not good for the environment when disposed. Here is a way to make a DIY reusable KF94 mask.

DIY respiratory mask Preparation: handkerchief, paper wires(or bread strings), rubber bands, cloth tape (about 10 mm wide), iron or a hair iron, KF94 respiratory filters, sewing tools.

1. Cut the handkerchief 25 centimeters wide, 34cm long. Also, cut the cloth a) b) tape 34cm long to fit the length of the handkerchief.

2. Place the cloth tape on the long end. Same with the other end.

3. Fold the end of the handkerchief to cover the cloth tape, and press it using an iron.

4. Fold the short ends using a cloth tape and iron, in the same way.

5. Fold the handkerchief in half and unfold it. c) d) A’ line 6. Fold the end of the fabric (A-line) toward the middle line. Fold the other end of the fabric (A’-line) toward the middle line.

7. Unfold one side, place the cloth tape and wire in the middle of the folded line.

8. Fold it back. Press the area where the wire and the tape are located.

A line 9. Same for the other side, attach the wire.

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life issues

e)

f)

B line C line

g)

h)

i)

j)

10. Fold into three equal parts and unfold it.

11. Pinch line B and C together. Same with the other side. Use a clip to fasten it.

12. Make two knot with the rubber bands and place them on both end of the folded handkerchief. Fold the fabric 1cm to hide the knot. Fasten it with a clip.

13. Sew the folded part to attach the rubber bands.

14. Open the middle of the handkerchief. You can see that there is a pouch in the middle. Put the filter (KF 94 filter 13 by 16.5 cm) in this pocket.

Now, you have a nice KF 94 filter respiratory mask. This method does not require specialized props such as sewing machines. Also it is reusable simply replace the filter.

Which hand sanitizer should we use?

One of the essential ways to avoid infection is to wash your hands frequently. When you can’t afford to wash hands, use alcohol based hand sanitizer instead.

Alcohol eliminates microbes in two ways – dissolving microbe membrane and denaturing proteins. Since alcohol is amphipathic, it binds with microbe’s membrane which becomes soluble in water as a result. This causes the membrane to weaken its structure and fall apart. By weakening of the membrane, alcohol spreads into the microbe. Because hydroxyl group of alcohol easily makes hydrogen bonds, it breaks secondary and tertiary structures of proteins in the microbe. As a result, proteins lose their functions, causing the microbes to die quickly. Therefore, alcohol-type hand sanitizers are effective in eliminating germs, fungi and epidermal viruses.

Because of the fear of COVID-19 infection, hand sanitizers are also out of stock. Therefore, let’s make our own hand sanitizer and stay safe from infection. In fact, ethanol that we can buy at a pharmacy is already highly effective for disinfection. Concentration of this ethanol is between 76 and 80 percent – okay to use without dilution. However, this ethanol can dry your hands if you use it often, so we will mix it with moisturizers.

The U.S. Centers for Disease Control and Prevention (CDC) announced that hand sanitizer containing more than 60 percent ethanol should be used. Most hand sanitizers sold in the market are 62 percent alcohol, so let’s make hand sanitizer with 62 percent ethanol.

DIY hand sanitizer Preparation: Ethanol, glycerin, purified water, empty bottles, paper cups.

1. Disinfect paper cups and empty bottles with ethanol.

2. Place 10 cups of ethanol in an empty bottle.

3. Pour 1 cup of glycerin in the bottle.

4. Pour 0.5 cups of purified water in the bottle. Depending on your preference, purified water may be omitted or replaced with glycerin.

5. Shake hard.

a)

b)

c)

d)

Now, making your own hand sanitizer is done. If you want to make a gel-type hand sanitizer, you can add aloe gel instead of glycerin. Apply the sanitizer on your hands and rub the hands together. Use hand sanitizer frequently to prevent the infection.

To stop the spread of COVID-19, protect the respiratory system with your own sanitary mask and maintain good hygiene with easily made hand sanitizer. Hopefully, everyone’s participation will end the pandemic! B

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zoom.farewell

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Edit

Eun Chan Lee

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Kyung Eun Lee

Help

Ye Ji Jeon

The Blue Vanguard

Jun Seo Oh

Ja Yeon Heo

From Eun Chan Lee to Everyone: Through the Blue Vanguard, I had a great opportunity to interview great people and expand my knowledge regarding many issues. The various experiences and good connections gained through the Blue Vanguard will be a great asset to me. Additionally, I'm so proud of all my peers because they did their best to publish the magazine in their places. Thank you to all and cheer to the next Blue Vanguard members!

From Kyung Eun Lee to Everyone: Finally, it's time to say goodbye. The last couple of years with the Blue Vanguard were somewhat challenging yet delightful. I learned that what makes a magazine valuable is not the printed paper itself, but the hours of work by dozens of people who are dedicated to creating the best issue. I would like to thank each and every one!

From Ye Ji Jeon to Everyone: Last two and half years with Blue Vanguard were one of my most valuable experiences I've ever had.

Although the first start was somehow challenging, the progress I made here was much more meaningful and irreplaceable. I really appreciate everything I received from Blue Vanguard, and I hope rest of the members could also enjoy this club. Thank you!

From Jun Seo Oh to Everyone: The Blue Vanguard activity can be a pleasure to build up knowledge as you look for stories on a variety of topics to write your own articles. However, the reason why the Blue Vanguard activity is so much better is that you can share the thoughts of each other by reading the articles of other members. I think it's a great activity in that it is a place for discussion to share thoughts that could not be shared deeply through general conversation. My Blue Vanguard activity ends at the end of this issue, but I will continue to support it in my mind as I read articles written by juniors. I'm hoping for the ever-evolving Blue Vanguard!

From Ja Yeon Heo to Everyone: Blue Vanguard is the only club that I have joined since I enrolled in Yonsei Pharmacy. It was much better than the high expectations I had; I learned and grew a lot from the club experiences. I would like to thank the members of BV, whom had offered me plenty of help. I believe that BV, along with Yonsei Pharmacy, will grow and be loved for many years to come.

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Ji Eun Ryoo

Seo Kyong Kim

So Yeon Choi

Joo Yon Lee

Su Min Yoon

Jae Min Cha

From Ji Eun Ryoo to Everyone: How time flies!! BV not only helped me delve into pharmaceutical issues but also helped me learn how to express my thoughts through an article. I will definitely cherish the past two years I have had in BV :) From So Yeon Choi to Everyone: I felt a great sense of achievement in writing also designing my own article every semester during quite a busy pharmacy college school life. Blue Vanguard offers a beneficial time to be constantly exposed to English for me who has had not enough opportunity to use English. I hope I can keep a close relationship with good Blue Vanguarders, also would like to take this opportunity to say ‘Thank You’.

From Su Min Yoon to Everyone: From homecomings and peer edits, Blue Vanguard is a community where seniors offer advice and peers provide feedback. I’m grateful to have joined such a warm family and have made valuable memories throughout the semesters. Working collectively on a magazine every term built a sense of teamwork and bond, which I will treasure as part of my pharmacy school life. Hope the next members also will get a wonderful experience out of Blue Vanguard and hope to see you at the next homecoming!

From Seo Kyong Kim to Everyone: It has been pleasure working with you all. I would like to sincerely thank each of you for every experience shared, friendship made, opportunity offered and good times had during this time. Good luck in all your venture.

From Joo Yon Lee to Everyone: I was happy to be with Blue Vanguards for 2 years. As a designer, I enjoyed the time and effort put in covers and articles and it will remain as a good memory. It is so sad that I graduate from Blue Vanguards, but I believe that juniors will make more useful and wonderful magazines. BV Fighting!

From Jae Min Cha to Everyone: Being part of the Blue Vanguard as a designer was a unique and precious experience. Thank you to all the Blue Vanguard members who have been together. I hope to continue to see some of Blue Vanguard's cool and original articles and designs.

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#Thanks to the Medical Staff #Thank you #We Respect You

#MEMBERS

#Journalist Editor In Chief: Seo Woo Park Copy Manager: Sang Soo Na Ye Ji Jeon Kyung Eun Lee Jung Won Kim Hee Youn Yang Ji Eun Ryoo Dong Hwan Lee Jun Seo Oh Dong Hyeon Kim Ok Yoon Kim Yoon Zoo Gee

Vice Editor In Chief: Ji Hye Seo Ja Yeon Heo Sang Hee Lee Su Min Yoon Ga Young Lee Hyung Kyu Sung

Eun Chan Lee So Yeon Choi Ji Youn Son A Ran Kim

Dae Hyun Kim

Hee Do Yang

#Designer Design Manager: Beom Ju Cho Hyo Jeong Kim Min Gi Lee Ji Hyun Kim Address Collge of Pharmacy, Yonsei Univ. 85 Songdogwahak-ro, Yeonsu-gu, Incheon 20983, Korea

Online Site http://issuu.com/bluevanguard