Issue No. 69 - March - April 2012 - DOH

contents17255335 Melody for Health7 Our Own Journey to Good Health9 Molar Pregnancy12 Colorectal Cancer: 'Di Malayo sa Bituka15 Additional Benefit of Bilateral Tubal Ligation16 NAPC's New Sectoral Representatives17 Outstanding Healthy Lifestyle Advocacy Awards22 Bloomberg Awards for Global Tobacco Control25 Tobacco-Free Metro Manila Film Festival33 The Abaya Sin Tax Bill37 Why Nicotine is So Addictive39 The Air Pollution That We Breathe42 Healthy Lifestyle: Banat ni Lolo, Hirit ni Lola45 Trigger Finger48 The "Crack" Epidemicjokesn'yostress RELIEF 24laughter HEALS 32FACEbeat 44SAbeat 5048March - April 2012 I HEALTHbeat 3

HEALTHbeatDEPARTMENTOF HEALTH - National Center for Health Promotion2F Bldg. 18, San Lazaro Compound, Sta. Cruz, Manila 1003, PhilippinesTel. No. (63-2) 743-8438 Email: healthbeat@ymail.comLegislators, Please...Legislators. They are the politicians elected by the people to write and pass laws thatwould commit to the common good. In a political system that recognizes the theory of theseparation of powers, legislators are different individuals from the members of the executiveand the judiciary.We are currently witnessing how the members of the House of Representatives file animpeachment suit against Chief Justice Renato Corona and how the members of the Senateserve as judges in the trial. If this political exercise has become a media spectacular whichhas turned into a soap opera or even a comedy of manners, we cannot put the blame onour legislators. Let us not forget that we live in a society with a culture that everything,including the impeachment trial, is “more fun in the Philippines!”Last February, Congressman Aurelio Gonzales Jr. has filed a House Resolution formalizing theappeal that seeks to put an end to the negative image of congressmen as seen in movies andtelevision shows. He said the bad portrayals have been unfair and have only tainted the names ofHouse members. Following this line, we can hope that legislators too would put a stop in showingtobacco use in all forms of media that would entice the youth to smoking.Legislations can reverse the tobacco epidemic. Aside from the ban on advertising, promotion andsponsorship of tobacco products, laws are also needed to effect smokefree public places to protectthe public from exposure to secondhand smoke; putting graphic health warnings on cigarettepacks to encourage smokers to quit; and taxation to increase the price of tobacco products.Taxation is the single most effective way to reduce tobacco consumption, that is why theDepartment of Health needs our legislators to pass House Bill No. 5727, penned by CaviteRepresentative Joseph Emilio Abaya. This is the most fitting among the 12 pending measures inCongress seeking to restructure the excise tax on alcohol and tobacco products. It moves from amulti-tiered tax structure to a unitary tax system, indexes taxes to inflation and dedicates taxesto alternative livelihood for tobacco farmers and universal health coverage in PhilHealth and toenhance the nation’s health care system by upgrading government health facilities to providebetter health services.Honorable Legislators, please pass the necessary tobacco control laws that would protect thehealth of the youth and the majority of the population who are non-smokers. This common goodis in your hands!– The EditorsEditors-in ChiefManaging EditorStaff WritersCover DesignGraphics DesignPhotographerContributors(Words)CirculationEditorial BoardIvanhoe C. Escartin, MDRosemarie G. AguirreAnthony R. RodaMay Elenor R. de GuzmanDonato Dennis B. MagatElizabeth G. MascareňasAbigail Corpuz-QuetulioGlen S. RamosDiosdado G. Angeles, Jr.Joerem P. CeriaJacquelyn F. FelipePaquito P. RepelenteElizabeth Sumama, MDTato M. Usman, MDDOH-NCHPProduction, Disseminationand Collection SectionFOR EDUCATIONAL PURPOSE ONLY. NOT FOR SALE.Opinions expressed in this publication do not necessarily represent those of the DOH. The mention of specific companies or of certain manufacturer’s products does not imply that they areendorsed or recommended by the DOH in preference to others of similar nature. Articles may be reproduced in full or in part without prior permission, provided credit is given to the DOH fororiginal pieces. A copy of the reprinted or adapted version will be appreciated. Articles, artworks, photographs, caricatures, letters and other contributions are most welcome. Materials willbe edited for clarity and space. Unsolicited manuscripts will not be returned. Contributors must indicate their names and addresses.4 HEALTHbeat I March - April 2012

COVER storyPop Diva Kuh Ledesma (right) and daughter Isabella (right) sing the DOH safe motherhood jingle, "Sa Health Center, Suportado Ka. Punta Na!" (Photo byPaking Repelente)Melody for HealthThe Department of Health isintensifying its effort to reduce maternal andchild mortality as part of its commitment toachieve Millennium Development Goals 4and 5 and Kalusugan Pangkalahatan(Universal Health Care). Together withthe Local Government Units (LGUs) ofEastern Visayas and the Japan InternationalCooperation Agency (JICA), the DOH isstepping up the Strengthening Maternaland Child Health Services Project whichseeks to enhance the capacities of healthcenters in the Eastern Visayas in deliveringmaternal and child health (MCH) services.JICA, a governmental agencyof Japan, administers Japan’s OfficialDevelopment Assistance (ODA) programs inthe form of technical cooperation, grant aidand loan. There are about 100 JICA overseasoffices (including the Philippines). Today, it isadvancing its activities around the pillars of afield-oriented approach and human security,with emphasis on effectiveness, efficiency,and speed. JICA’s vision of "inclusivedevelopment" represents an approach todevelopment that encourages all peopleto recognize the development issues theythemselves face, participate in addressingthem, and enjoy the fruits of such endeavors.In particular, the JICA-supportedMCH Project aims to provide assistancethrough provision of essential medicalequipment, capacity building of healthservice providers, institutionalization ofthe Community Health Teams (CHTs), andstrengthening of partnerships among localstakeholders for increased support forimproved MCH services.Now on its second year, the Projecthas been received well. A gradual increase inuse of MCH services at these health facilitieshas been observed and this contributedlargely in making pregnancy and childbirthin Eastern Visayas safer. With the NationalSafe Motherhood Program now in fullMarch - April 2012 I HEALTHbeat 5

“Sa Health Center, Suportado Ka.Punta Na!”ChorusKuh:Isabella:Kuh:Isabella:Kuh:Isabella:Verse 1Kuh:Isabella:Repeat ChorusVerse 2Kuh:Isabella:Repeat ChorusTogether:Sa Health CenterPunta na...Panganganak mo’y siguradoSa Health CenterPunta na...Ika’y ligtas at protektado.Pagmalaman mong ika’ybuntis magpa-check upkaagad sa Health CenterNang apat na beses bagomagsilang para kumplikasyonay maiwasan.Pagkatapos mong manganakpunta na uli sa health centerPara makasiguro at mapanatiliang kalusugan mo at ni baby.Kaya laging tandaanSa Health Center,Suportado ka!Punta Na!implementation, the DOH is just like theexcited “expecting parents” waiting for theirbaby project to be fully delivered.“Sa Health Center, SuportadoKa” is the key message of the DOH's newradio jingle to promote its national safemotherhood program. Originally producedin Eastern Visayas, the song encouragespregnant women to visit health centers toavail of pre-natal care consultations, worryfreedelivery and postpartum care with thesupport of the CHTs.Pre-natal visits have been shownto reduce the risk of maternal deaths and toimprove over-all maternal and child health.Now that health centers are equipped withthe proper equipment and are manned bycompetent health workers, Filipino mothersand their babies will be provided qualityhealth in these facilities, true to the promiseof the jingle, “Sa Health Center, Suportado Ka.Punta Na!”Pop Diva Kuh Ledesma and herdaughter Isabella lent their talents to givethe soul to the DOH Maternal and ChildHealth radio jingle – a song that delivers amessage of passion and love.Kuh, known for her rendition of“Ako ay Pilipino” among others, is not just asinger but is a person with a golden heart.Unknown to many, she is an advocatein uplifting the lives of underprivilegedchildren. She is currently raising funds toset-up libraries and church buildings whichwill benefit several communities in Cavite.Isabella, meanwhile is a younglady with a lot of promise. Not only did sheget her mother’s looks, she also got hermother’s musical talent and her compassion.She uses her talents in singing and actingto share messages of life and love to manypeople.It is just fitting that the motherand daughter tandem of Kuh and Isabellasing this song which encourages mothersto seek proper health care in health centersso they can be assured of the support theyneed for their health and the health of theirfamilies.- o O o -The "Pomelo Squad" of the DOH National Center for Health Promotion poses with Kuh and Isabella during the media launch of the jingle.6 HEALTHbeat I March - April 2012

HEALTH promotionGovernor Esmael Toto Mangudadatu (right) gives vitamin A drops to a child. Assisting him are DOH ARMM Secretary Kadil Sinolinding (left) and ProvincialHealth Officer I Dr. Elizabeth Samama. (©USAID/HealthPRO/Nancy Pizarro/2011)First Person Account:Our Own Journey to Good HealthbyDR. ELIZABETH SUMAMAMaguindanao Provincial Health OfficeLittle did I know that the beadsof sweat on our foreheads would formripples of change in our beloved province ofMaguindanao.When we first heard about theDepartment of Health’s Lakbay BuhayKalusugan, we really got nervous. It was anundertaking that we thought we could notdo in Maguindanao.I thought that it was a tall order.Bring a mobile bus to a disadvantagedcommunity and deliver health services andinformation to as many mothers, fathers,and children as possible. Impossible! I firstsaid to myself.Dr. Kadil Sinolinding Jr, our DOHARMM secretary, and Dr. Tahir B. Sulaik,Maguindanao Provincial Health Officer II,guided us and convinced us that LBK can bedone in Maguindanao. We presented LBK toour Governor Toto Mangudadatu. He quicklyapproved it saying that health is a big priorityfor his administration.Thus began our own LBK journey.It was difficult at first. We had to meet withdifferent partners to get their support. Wewent to the town of Buluan, spoke to MayorDatu Ibrahim Mangudadatu, and got hisapproval to host LBK.On October 10, 2011, the colorfulMarch - April 2012 I HEALTHbeat 7

us came and our own health fiestastarted. It was tiring but we did not mindthe hardship because we saw so manymothers, fathers, and their children enjoyingand participating. We never imagined thatwe would be able to serve 3,740 people,including 361 pregnant women and 722children in just two days.Through the collective effortsand participative support of all majorstakeholders, we have made an impossibilityinto a very wonderful and promising healthpromotion caravan.But I did not expect that our LBKjourney would continue. Our local leaders,mindful of the lack of adequate informationand education as one of the one major factorsthat prevent access to available healthservices, appreciated LBK so much that theydecided to launch our local version of LBK.We called it the SLAM Mobile Health Festival.SLAM stands for the Southern LiguasanAlliance of Municipalities. The alliance iscomposed of other towns like Datu Paglas,Paglat, General Salipada K. Pendatun, Sultansa Barongis, and Pagalungan. The honorablemayors of these towns joined hands andagreed to bring the LBK health caravan todifferent communities.On February 23, we made our firststop in Datu Paglas where more than 1,000fathers, mothers, and children participatedin fun activities and health classes. Otherhealth services like dental care, circumcisionand minor surgery, handwashing program,reflexology and even free haircuts wereadded to the roster of activities.The SLAM mayors also agreed tocustomize a mobile vehicle that would serveas the SLAM LBK vehicle.For a health professional like me,it was very heart-warming to hear localleaders pledge their support to our healthprograms. Mayor Mohammad Paglas said itso fittingly, “We could not achieve optimalhealth for our people without the heroicefforts of our unsung heroes – our healthworkers.”To my team: Municipal HealthOfficers Dr. Renalyn Masukat and Dr.Tina Almirante, our public health nurses,midwives, and barangay health workers, Isay it was a job well done.To the DOH and developmentpartners like the US Agency for InternationalDevelopment (USAID), thank you for puttingyour trust in us.Yes, we were in the midst of allthe action of LBK. But we also could notdo it if not for the generous support of ourother partners. Together, we made ripplesof change because we all wanted the samething – provide universal access to qualityhealth care to all people of Maguindanao.Our journey has just started. It’sstill a long way to go for us. But it’s a trip wewill gladly take and remember.And LBK’s message is heard soclearly in Maguindanao. “Walang iwanan sabiyaheng kalusugan!”- o O o -TOP: “Beads of sweat form ripples of change.” Dr. Elizabeth Samama (left) presents the MaguindanaoLBK experience at a lessons learned meeting in December 2011. BOTTOM: Pregnant women line up fortheir pre-natal check up at the LBK bus. (©USAID/HealthPRO/Nancy Pizarro/2011)8 HEALTHbeat I March - April 2012

maternal HEALTHMOLAR PREGNANCY where a fertilized egg does not develop into a pregnancy but instead grows and forms into a bunch of grape-like shapes. Photo grabbedfrom and inset illustration grabbed from < www.mdguidelines.com>.Molar PregnancybyGLEN S. RAMOSHEALTHbeat StaffPregnancy is almost always ahappy event in a woman’s life, but it is notwithout risks. One of the uncommon andvery frightening complication of pregnancyis molar pregnancy or in its formal medicalterm, hydatidiform mole. This happenswhen a fertilized egg does not develop intoa pregnancy, instead, it grows and forms intoa bunch of grape-like shapes.Molar pregnancy is one of a groupof conditions called gestational trophoblastictumors. Even though they are called tumors,they are usually not cancerous. They mayspread through the womb, but can be cured.Only 1 out of 1,000 develops into cancer.Dr. Abigail Baret, an Obstetrician-Gynecologist and a resident physician atTalon General Hospital (TGH), one of thepremier 50-bed tertiary level referralhospital based in the City of Tarlac,describes molar pregnancy as a defect ofthe fertilization process. She said the eggreleased by the ovary is entirely devoid ofDNA, or what is also called as “empty egg.”The chromosomes in a normal pregnancyis 46. A fertilized egg has 23 chromosomesfrom the mother and 23 from the father. InMarch - April 2012 I HEALTHbeat 9

a molar pregnancy, the wrong number of xand y chromosomes come together whichresults in abnormalities in cells that grow toform the placenta. The two chromosomes inthe fertilized egg (i.e. molar chromosomes)directly come from the male only. Thesignificant abnormality of this clinicalcondition is that the molar chromosomes areentirely derived from the father. Its cause isstill unknown.Baret identified two distincttypes of molar pregnancy – complete andpartial. In a complete molar pregnancy, thefertilized egg has no chromosomes fromthe mother and the chromosomes from thefather's sperm are duplicated (meaning,there are two copies of chromosomes fromthe father). In this condition, it is not possiblefor an embryo, amniotic sac and normalplacenta to develop but instead the placentaforms a mass of cysts that looks like a clusterDr. Abigail Baret, an Obstetrician-Gynecologist and aresident physician at Talon General Hospital in the City ofTarlac explains that although molar pregnancy belongsto a group of conditions called gestational trophoblastictumors, it is usually not cancerous.of grapes that can be seen through anultrasound scan. In partial molar pregnancy,the fertilized egg has 23 chromosomes fromthe mother but a duplicated set from thefather (there are a total of 69 chromosomesinstead of the normal 46 and this canhappen when chromosomes from the spermare copied or when two sperm fertilize thesame egg).A complete molar pregnancy canbe detected by using an ultrasound scanduring the early stage of pregnancy. Thelevels of the hormone, human chorionicgonadotrophin (hCG) and also known as the“pregnancy hormone,” will be much higherthan normal. Measuring the hCG level witha blood test is one way of finding out if thewoman has a complete molar pregnancy.Levels can first be detected by a blood testabout 11 days after conception and about12 - 14 days after conception by a urine test.In general the hCG levels will doubleevery 72 hours. The level will reachits peak in the first 8 - 11 weeks ofpregnancy and then will decline andlevel off for the remainder of thepregnancy.Partial molar pregnancy is moredifficult to detect, especially ifit has not been seen on a scan.If the pregnancy ends naturallybefore a scan, i.e. miscarriage, thewoman may opt to have a testto verify whether it was a partialmolar pregnancy. Samples of themiscarried tissues will be analyzedto make sure the right treatment willbe provided.Baret explained that in a caseof a molar pregnancy, all theusual pregnancy symptoms willbe experienced. The woman willfeel severe nausea and vomiting(hyperemesis), her belly may swellup due to the growing placenta,making the uterus to expand. The developingplacenta pushes up the levels of the hCG,which makes her so nauseous.“But actually, it is not the embryothat is growing but the neoplasm whichis replacing the true embryo. This willeventually turn into a tumor and whichshould immediately be removed,” sheconfirmed.Bleeding during a molar pregnancymay also occur and it may vary. It could bebright red or dark brown, continuous orpatchy, and light or heavy and it could startas early as six weeks into the pregnancy oras late as 16 weeks. Although bleeding iscommon in the early stage of pregnancy, it isessential to visit the doctor to ascertain thecause of the bleeding.The occurrence of molar pregnancyis highest in teenage pregnancies, amongwomen over 40 years old, those with historyof molar pregnancies (especially two ormore), those with history of miscarriage andthose with vitamin A deficiency (especiallybetacarotene).In the United States, molarpregnancy occurs in one out 1,500pregnancies while the United Kingdomregisters one in every 1,000. But in Asianwomen, they are twice as common and thereason is yet to be discovered. In one of herresearches, Baret found that two out of 80pregnancies in the Philippines are molarpregnancies, which is the highest rate ofoccurrence worldwide. The distinct markedgeographical and ethnic variations in theprevalence of this condition are also verycommon in in China, Indonesia, Japan, IndiaAfrica and Latin America. There is no definitereason behind molar pregnancy but somemedical experts attribute this condition togenetic factors, diet, and environment asprobable influences.At the Jecson’s Medical Hospital,another hospital in Tarlac, an incident of10 HEALTHbeat I March - April 2012

molar preganancy was recorded in Februaryalone. The patient suffered from profusebleeding and complained of pains in thepelvic region.Symptoms Diagnosis & TreatmentThe symptoms of a molarpregnancy are the same with that of a normalpregnancy, like a missed period or morningsickness. But it also causes other symptomsthat may include bleeding from the vagina,an enlarged uterus, severe nausea andvomiting, signs of hyperthyroidism.Other symptoms are feelingnervous or tired, having a fast or irregularheartbeat, profuse sweating, a painfulfeeling in the pelvic region, vaginaldischarge of grape-shaped tissues (this isusually a sign of molar pregnancy). Most ofthese indications can also happen during anormal pregnancy, a multiple pregnancy, ora miscarriage.Molar pregnancy can be diagnosedby a pelvic exam, an ultrasound and a bloodtest. A pelvic exam may reveal whether thewoman has large or small uterus or enlargedovaries. A sonogram will show a “cluster ofgrapes” appearance, signifying an abnormalplacenta. And a blood test will indicate anabnormally high amounts of the pregnancyhormone hCG.A woman suffering from amolar pregnancy may need a dilatationand curettage (D&C) or a minor operationcommonly known as “raspa.” A surgeonwill carry out the D&C while asleep undergeneral anesthesia.“Most molar pregnanciesnaturally end and the grape-like tissues willeventually be expelled by the body. In somecases, it is removed by suction curettage(D&C) or sometimes through medication,”Baret explained.It is important that all the molarcells be removed from the uterus wallbecause the cells can spread through theblood and may affect other organs, includingthe lungs, liver and brain. Further testingmay be done to ensure that it hasn't spreadbeyond your uterus. Even though molar cellscan spread, they are not cancerous and thiscondition has a cure rate of nearly 100 percent.Gestational Trophoblastic DiseaseApproximately 90% of womenwho undergo this procedure require nofurther treatment. A regular blood test willbe done over a period of 6 to 12 months tomonitor the hCG levels and to look for signsof gestational trophoblastic disease (GDT)and to ensure that it will not develop afterthe operation.According to Baret, “these bloodtests will make sure that the hCG levelsare dropping, indicating that the patientis getting better. Once the hCG levels arenormal, then it is a sign that no molar tissueis left. A follow-up is also done to ensurethat the mole has been completely removedfrom the walls of the uterus. Traces of themole can begin to grow again and this maypossess a cancerous-type threat to the body.”GTD is a term used for a group of pregnancyrelatedtumors. These tumors are rare andappear when cells in the womb start to growout of control. The cells that form gestationaltrophoblastic tumors are called trophoblastsand come from tissue that grows to form theplacenta during a molar pregnancy.In case a GDT may develop, there isa minimal chance that it will turn into cancer.And if this happens, chemotherapy is usuallyrecommended so that it will not spread toother parts of the body, or it will sometimesbe combined with radiation treatment.In very few cases, however,persistent GTD can lead to an extremelyrare form of cancer called “choriocarcinoma.”It is a quick-growing form of cancer thatoccurs in a woman's uterus (womb). Theabnormal cells start in the tissue that wouldnormally become the placenta, the organthat develops during pregnancy to feed thefetus. Choriocarcinoma is an uncommon, butvery often curable cancer associated withpregnancy. A baby may or may not developin these types of pregnancy.) A chest X-ray,bloodwork, and other radiological examsare done prior to D&C to determine if amolar pregnancy has metastasized (spreadto other parts of the body). This can alsobe successfully treated with chemotherapy.The condition occurs in one in 30,000 of allpregnancies, including normal pregnanciesand miscarriages.Baret assures women who havehad a molar pregnancy that they will stillhave a chance of having a normal pregnancynext time. However, it is important to followyour physician’s advice before trying to startagain. “For those who have undergonechemotherapy, they will need to wait upto six months or even a year. They need tohave their hCG level back to normal becauseif they become pregnant before all of theseconditions are set to normal, they will havea greater chance of having another molarpregnancy,” she reiterated.Pregnancy should be avoided forthe period of one year. She recommendsthe use of birth control methods with theexception of an intrauterine device (IUD)until it is safe to try for another pregnancy.“Condoms can be used and pills, although Ido not recommend using pills especially ifthe hCG levels are still high,” she cautioned.“The chances of having anothermolar pregnancy are very minimal, aboutone or two per cent. When the womanis pregnant again, be sure to have anultrasound scan in your first trimester tomake sure all is well”, Dr. Baret concluded.March - April 2012 I HEALTHbeat 11

CANCER awarenessCOLORECTAL CANCER'Di Malayo sa BitukaFilipino's Most Vital Organ?Think about this. For Filipinos, themost vital part of the human body is not theheart but the intestine.Many of the rich, vivid and colorfulFilipino idiomatic expressions zero in theintestine – “magkakabit ang bituka” refersto a strong relationship bond; “halangang bituka” refers to very bad person;and “huwag kang mag-alala, malayoyan sa bituka” usually refers to a non-lifethreatening wound or condition.Even the folk belief concerning theaswang has its interest on the intestines; andthe life of a manananggal ends when salt isplaced on its exposed intestines in the lowerhalf of the body that is left behind while theupper half is in flight looking for its victim.And notice the modern Filipino psychichealers who concentrate their treatment onthe abdominal area.Life, so it seems, is focused on theintestines, and most parts of the abdominalregion. And why not, the continuance andsustenance of life is food. The availability offood, or lack of it, becomes crucial to survival.And that Filipinos associate food with healthis seen in rituals which always have foodofferings.Alas, the food we eat, the alcoholwe drink, and the lifestyle we have mayput this vital organ of the body at risk ofdeveloping a serious disease – cancer ofthe colon (large intestine) and rectum orbyELIZABETH G. MASCAREÑASHEALTHbeat StaffThe large intestine. Photo grabbed from theInternet.collectively known as colorectal cancer. Badnews, its cases are on the rise!The American Cancer Society (ACS),in its Global Facts and Figures, reported thatan estimated 1.2 million cases of colorectalcancer worldwide occurred in 2008, whereinthe highest incidence rates were found inNorth America, Australia, New Zealand,Europe, and Japan. However, rates were lowin Africa and South Central Asia. It was notedthat rates were significantly higher in menthan in women.In 2008, there were about 608,700deaths from colorectal cancer worldwide,which accounts for 8% of all cancer deaths.The incidence of colorectal cancer globallyis increasing in certain countries, where riskwas historically low, like in Japan.Meanwhile, in high-risk/highincomecountries, trends are either graduallyincreasing (Finland, Norway), stabilizing(France, Australia), or declining (UnitedStates) with time. The greatest increases inthe incidence of colorectal cancer are in Asia(Japan, Kuwait, Israel) and Eastern Europe(Czech Republic, Slovakia, Slovenia).The ACS also stated that thedecrease in colorectal cancer incidence in theUnited States partially reflects the increasein detection and removal of precancerouslesions, while the increase in several Asianand Eastern European countries may reflectchanges in risk factors for colorectal cancerthat are associated with westernization,such as elevated obesity and smokingprevalence.In contrast to incidence trends,decreasing colorectal cancer mortality rateshave been observed in a large number ofcountries worldwide and are most likelyattributed to colorectal cancer screeningand/or improved treatments. However,increases in mortality rates are still occurringin countries that have more limitedresources, including Mexico and Brazil inSouth America and Romania and Russia inEastern Europe, ACS stated.Health Secretary Enrique T. Ona,who led the observance of Colorectal CancerAwareness Month in March, announced that12 HEALTHbeat I March - April 2012

the disease is more common in developingcountries and in people aged 50 years andabove. In the Philippines, approximately5,787 Filipinos were affected by the diseasein 2010 alone.According to the Philippine CancerFacts and Estimates 2010, colorectal canceris the third most common cancer in men(3,208cases or 8% of all cancer sites) andfourth among women (2,579 cases or 6%). Itwas noted that the incidence rates begin tosuddenly rise at age 50 years in both malesand females.These figures were gathered fromtwo population-based cancer registries,namely the Philippine Cancer Society -Manila Cancer Registry and the Departmentof Health – Rizal Cancer Registry, whichgenerated age-standardized incidence ratesof cancer during the period 1980-2002 whereit showed rising trends in colorectal andprostate cancers and became more commonthan liver cancer with stable incidence overtime.The highest incidence rates ofcolon cancer among males was in 1998-2002 and were monitored in the cities ofMandaluyong, Parañaque, Manila andQuezon City, while the rest of Metro Manilaand Rizal province had lower incidence rates.Among females, the highest incidence rateswere in Parañaque, Quezon City and Manila,and also decreasing incidence rates eastwardto Rizal province.Meanwhile, the highest incidencerates of rectum cancer among males in1998-2002 were in Manila, Quezon City,and Parañaque, and in females the highestincidence rates were in Manila, Pasig andQuezon City.According to the two registries,one (1.2) out of 100 men and one (0.8) outof 100 women had a likelihood of gettingcolorectal cancer before age 75. There were3,060 deaths in both sexes, 1,690 in malesand 1,370 among females, in 2010. In2008, the estimated national standardizedmortality rates were 4.7 per 100,000 in bothsexes, 5.5 among males, and 3.9 amongfemales.Understanding Colorectal CancerWith statistical figures oncolorectal cancer continuing to increase,understanding the disease could be the firststep to winning the battle against this typeof cancer.Colorectal cancer refers to theuncontrolled growth of abnormal cells inthe colon or rectum, which are part of thedigestive system. Colorectal cancer is usuallycurable when it is detected in the earlystages. Increased screening could furtherreduce the incidence and mortality rate ofcolorectal cancer.This cancer usually begins aspolyps, which are abnormal growths in theinner lining of the colon or rectum. Polypsare not cancerous but can become so overthe years. More than 95 percent of colorectalcancer is adenocarcinoma, a cancer of thegland cells that line the inside wall of thelarge intestine.No one knows for sure what causescolorectal cancer. But there are certainrisk factors that can increase a person'schances of getting and dying from this typeof cancer. Some risk factors for colorectalcancer cannot be controlled, such as havinga family history of this cancer type, age andethnicity. A person with a history of chronicinflammatory bowel disease also has ahigher risk for developing colorectal cancer.However, some lifestyle habits that increasethe risks may be managed, such as avoidinga diet high in animal fat and low in fiber,inactive lifestyle with no exercise, drinkingalcohol, obesity and smoking.Colorectal cancer sometimes ariseswithout any symptoms. When symptoms dooccur, they usually consist of the following:rectal bleeding or blood in the stool;change in bowel habits (such as diarrhea,constipation) that lasts for more than a fewdays; abdominal pain; a continuous feelingof need to have a bowel movement and bodyweakness.Screening examinations forHealth Secretary Enrique T. Ona leads this year’s observance of Colorectal Cancer Awareness Monthin March dubbed as “Kapit-Bisig Sa Paglaban Sa Colorectal Cancer.” This is in collaboration with thePhilippine Society of Medical Oncology and Merck Serono.March - April 2012 I HEALTHbeat 13

colorectal cancer should start at age 50 yearsfor average risk individuals who have notyet shown symptoms. Persons at higher riskshould begin screening at a younger age andmay need to be tested more frequently.One of the most commondiagnostic tests is annual fecal occult bloodtesting, which can detect minute amounts ofblood in the stool, even without noticeablegross blood. Other tests for colorectal cancerinclude rectal digital examination; andproctoscopy or proctosigmoidoscopy, whichrefers to the examination of the lower end ofthe colon and rectum.On the other hand, flexiblesigmoidoscopy is an examination of themucosal lining of the distal left colon andrectum. Colonoscopy or the examination ofthe entire colon may also be performed. Itdoes not only let doctors see the interior ofthe colon and rectum, but also allows themto remove any polyps that may be growing.Polyps can develop into cancer, thus, theremoval of these polyps can prevent canceraltogether. Ultrasound, blood tests, x-raysand magnetic resonance imaging or MRIspiritual HEALTHcan also be considered for asymptomaticindividuals.Possible indicators of the diseasemay include changes in bowel habits,abdominal pain and bleeding from therectum. However, screening for colorectalcancer is still an urgent step for individualsbecause symptoms may be absent or may becaused by other conditions.A person with these symptoms orconsider him/herself at risk even without thesymptoms, may want to talk with a doctorwho would be able to suggest ways toreduce the chance of developing colorectalcancer and plan an appropriate schedule forcheckups.Public information and educationis important, as well as physicianeducation. Delayed diagnosis of colorectalcancer is often attributed to the mistakenconcentration of Filipino physicians withamoebiasis, other forms of infectiousbowel diseases, and hemorrhoids. The wideavailability of antidiarrheals, antibiotics, andamoebicides also results in their prolongedand sometimes dangerous use. Moreover,many physicians still insist on prescribingvitamin preparations and hematinics forchronic unexplained weight loss and anemiawithout endeavoring to look for the cause.Dr Felycette Gay Lapus of thePhilippine Society of Medical Oncology,explained that the outlook for recoverydepends on the stage of cancer, meaningthe higher the stage, the more serious thedisease. The five-year survival rate refers tothe percentage of patients who live at leastfive years after being diagnosed. Stage Ihas a 74% five-year survival rate whileStage IV has a five-year survival rate of only6%. Recent advances and multi-modalitytreatment has led to a greater potential forcure rates for advanced disease, some withgreater than 40% five-year survival rates.Anyone can suffer from colorectalcancer regardless of socio-economic status,education or culture. In the list of famouspeople diagnosed with the disease are: PopeJohn Paul II, US President Ronald Regan,Milton Berle - American comedian, AudreyHepburn – actress, Charles Schulz - creator of“Peanuts,” and President Corazon C. Aquino.Hindi Kumplikado Ang BuhayIsang guro ng Pilosopiya ang nagbigay ng iisang tanong sa kanyang mga estudyante para sa kanilang FinalExam. Ang tanong ay,"Paano mo ako mapapaniwala na ang silya sa harap ninyo ay invisible?"Isang oras ang ginugol ng klase para sagutin ang tanong, maliban sa isang tamad na estudyante na tinaposang pagsusulit sa loob lamang ng limang segundo. Kinabukasan, ipinaskil ng guro ang resulta ng FinalExam. Ang tamad na estudyanteng ito ang nakakuha ng pinakamataas na grado. Alam ba ninyo kung anoang kanyang isinagot?"Anong silya?"ARAL: Huwag gawing kumplikado ang mga simpleng bagay.14 HEALTHbeat I March - April 2012

RESEARCH briefNavigating through the maze of information from medical research can be difficult and confusing. This brief aims to provide concise and evidence-basedinformation on state-of-the-art medical practice.Additional Benefit of Bilateral Tubal Ligation:Prevention of Ovarian CancerOvarian cancer is the seventh leading cause of cancer deaths amongwomen in the Philippines. In 2010, an estimated 2,165 new cases ofovarian cancer were diagnosed, and over 1,000 women died from thisdisease nationwide. 1As in most cancers, the cause of ovarian cancer is unknown, but riskfactors, including age over 40 years, nulliparity (state of not bearing anoffspring), and family history of breast and uterine (endometrial) cancers,have already been identified. 2Part of the reason why many regard ovarian cancer as a “silent killer”is because it does not usually show symptoms at the outset. 3 If it does,these are nonspecific, minimal and often ambiguous. Lower back pain,pain during intercourse, abnormal vaginal bleeding, irregular menstrualperiods, and other symptoms such as abdominal pain, bloating, lossof appetite, constipation, flatulence and frequent need to urinate, aresometimes confused with symptoms of other less severe diseases suchas gastrointestinal complaints. Late diagnosis is common because ovariesare difficult to access and examine. Tests to diagnose the disease, suchas pelvic ultrasound, laparoscopy, colonoscopy, blood test and biopsy,are still too costly to be part of a routine check-up for the general public.Treatment options include surgery for patients with early stage ovariancancer, and chemotherapy for those in advanced stage.Existing evidence shows, however, that the risk of ovarian cancer isgreatly reduced through bilateral tubal ligation (BTL). In this surgicalprocedure, a woman’s fallopian tubes are cut to prevent the egg frommeeting the sperm. This method of contraception is a safe and effectivefamily planning option for women who do not want any more children.Research confirms that women with BTL had reduced the risk of ovariancancer by 34% with the protective effect lasting 10-14 years followingthe procedure. 4Several theories have been proposed to explain BTL’s protective effectagainst ovarian cancer:• Diminished ovarian circulation after TBL contributes to thesuppression of ovarian hormone production;• Reduced utero-ovarian circulation by BTL leads to the decreasedamount of uterine growth factors reaching the ovaries;• BTL may prevent the entry of carcinogens or talc into thefallopian tubes and contact with the ovaries as well. 5BTL is one of many family planning options available in the Philippines.While knowledge among all women in the country about ligation iswidespread, only 9% of married women of reproductive age rely on BTLas their method of choice. 6 BTL costs 1,400 - 10,000 Php, depending onwhether it was done in the public or private sector. 7 PhilHealth membersand dependents are entitled to a PhP4,000 reimbursement per case,subject to the provisions of the benefit package. 8In addition to BTL’s contraceptive benefits, information on how it protectsagainst ovarian cancer should be shared by health service providers withwomen who have completed their family size and have signified theirinterest in long-acting and permanent methods of contraception.(Photo: USAID/HealthPRO/Ignacio)1http://www.scribd.com/doc/80871630/11/REFERENCES. pp. 11, 13.2http://www.doh.gov.ph/node/3143Ibid.4D. Cibula, M. Widschwendter, O. Májek and L. Dusek. Tubal ligation and the risk of ovariancancer: review and meta-analysis Hum. Reprod. Update (2011) 17(1): 55-67 first publishedonline July 15, 2010 doi: 10.1093/humupd/dmq0305http://www.medinewsdirect.com/?p=9966National Statistics Office Philippines and ICF Macro. 2009. National Demographic and HealthSurvey (NDHS) 2008. Calverton, Maryland: National Statistics Office and ICF Macro, pp. 51, 52,54, 63, 66.7Ibid, p. 62.8http://www.philhealth.gov.ph/circulars/2008/circ16_2008.pdfMarch - April 2012 I HEALTHbeat 15

HEALTH partnersNAPC's New Sectoral RepresentativesThe National Anti-PovertyCommission (NAPC) is the governmentagency that coordinates poverty reductionprograms of national and local governmentsand ensures that marginalized sectorsparticipate in government decision-makingprocesses.NAPC was created by virtue ofRepublic Act (RA) 8425, otherwise known asthe "Social Reform and Poverty AlleviationAct," which took effect on 30 June 1998.Its specific mandates include: acting as thecoordinating and advisory body that exercisesoversight functions in implementing thesocial reform agenda (SRA) and ensure thatit is incorporated into the formulation ofnational, regional, sub-regional and localdevelopment plans; institutionalizing basicsector and non-government participationin managing the SRA cycle; developingmicrofinance programs and strengtheningthe People's Credit and Finance Corporationas the forerunners for microfinance services;and strengthening local government unitsso they can incorporate the SRA in their localdevelopment efforts.President Benigno S. Aquino IIIchairs NAPC and is assisted by the Vice-Chairperson for the Government Sector(with 25 national government agenciesand presidents of the four leagues of localgovernments as members) and anotherVice-Chairperson for the Basic Sectors(with representatives from the 14 basicsectors as members). NAPC is supported bya Secretariat, which is currently headed byLead Convenor Joel M. Rocamora.During the National SectoralAssemblies held on October 17-19 2011,Aquino has imposed a new set of criteria forsectoral representatives who can participatein the assemblies of the NAPC. He issuedAdministrative Order No. 21 that returns tothe basic sectors the power to nominate theirrepresentatives. He said that during the pastyears, many civil society organizations havebeen disenfranchised from joining the NAPCprocess. AO 21 amended the implementingrules and regulations of RA 8425 to push fora more meaningful representation from thebasic sectors.On January 22, the Palace releasedAquino's latest appointments and namedthe new NAPC sectoral representatives,including Engr. Emerito "Emer" Rojas(staunch anti-tobacco advocate and thecover of Healthbeat's September-October2011 issue) for persons with disabilities.He is a tobacco victim who lost his voice tolaryngeal cancer.(See photo for the complete list ofthe sectoral representatives.)- o O o -LEFT: NAPC SECTORAL REPRESENTATIVES. Front row from left to right: Gloria Madayag (workers in the informal sector); Marilou Tapia (farmers and landlessrural workers); Teresa Fernandez (women); Maria Cagay (victims of disasters and calamities); Maria Linda Paracuelles (urban poor); Norisa Saberin (children);and Delfa Talaid (artisanal fisherfolk). Back row from left to right: Gibby Gorres (youth and students); Marlon Manuel (NGOs); Emmanuel Villafuerte (seniorcitizens); Secretary Jose Eliseo Rocamora (NAPC lead convenor); Emer Rojas (persons with disability); Ponyong Kadlos (indigenous cultural communities/peoples); and Daniel Ang (cooperatives). RIGHT: Engr. Emer Rojas (staunch anti-tobacco advocate and the cover of Healthbeat's September-October 2011issue) during his oathtaking as sectoral representative for persons with disabilities.16 HEALTHbeat I March - April 2012

The Poor Dies EarlyOHLAAOutstanding Healthy Lifestyle Advocacy Awards"Only the good dieyoung," says a Billy Joel song in1977. But maybe not anymore.International media reported inFebruary the results of a longevitystudy in United Kingdom thatshowed that the wealthiest peoplelive longer than the poor. This is nota pioneering study, but many of thiskind of study in other countries hadthe same results. The World HealthOrganization (WHO) has stated that"people further down the socialladder usually run at least twice therisk of serious illness and prematuredeath of those near the top."The reason why poorerpeople die earlier is because theyhave less access to health services and theirhealth literacy or the knowledge abouthealth-related issues are very limited.The poor also tends to lead less healthylifestyles like drinking, smoking and eatingunhealthy food. The lower the social statusalso translates to more insecurity, stress andanxiety, all of which increase susceptibilityto disease. And the level of work, degreeof social isolation and sense of control overlife could very much affect the likelihood ofdeveloping and dying from chronic diseasessuch as diabetes and cardiovascular disease.And sadly, as WHO Director GeneralHealthy Lifestyle is about getting the right proportions. (Photo grabbedfrom the Internet)Margaret Chan stressed, non-communicablediseases (NCDs) are “the diseases that breakthe bank”. This is a reality that is experiencednot only at the personal level but alsoat the country level. For many low- andmiddle-income countries, scaling up a coreintervention package to prevent and treatNCDs is very difficult.In the Philippines, two (2) of the10 leading causes of morbidity and seven(7) of the leading causes of mortality in thecountry today are NCDs or chronic diseases.The major causes affecting the lives ofthe people are linked by the common andHEALTH lifestylepreventable biological risk factors– high blood pressure, high bloodcholesterol, overweight; and byrelated major behavioral risk factors– unhealthy diet and nutrition,physical inactivity, tobacco, alcoholand drug use.Advocating Healthy LifestyleOver at the Department ofHealth, officials are trying very hardto reduce risk factors and createhealth-promoting environments aswell as strengthen national policiesand health systems. That is whythe prevention and control of NCDsnow becomes an important partof Kalusugan Pangkalahatan.With the current initiatives ofgovernment, the DOH is now improvingaccess of the poor to quality healthcare, providing them with financial riskprotection through the expanded coverageand enhanced benefits of PhilHealth, andimproving the quality of health servicesparticularly in the public sector throughhealth facilities enhancement. Manyinterventions are also directed at makingthe society and environment conducive tohealthy lifestyle. After all, healthy lifestyle isabout getting the right proportions.Health Secretary Enrique T. Onasaid, “I don’t think we have been remiss inMarch - April 2012 I HEALTHbeat 17

advocating for a health lifestyle. We havetime and again urged everyone to stopsmoking, to engage in regular exercise, andto eat a healthy and well-balanced diet.We have had several activities to remindeveryone about this. Nagiging makulit nakami pero hinding hindi kami magsasawa sapag-papaalala at pangungulit sa publiko angpagpo-promote ng healthy lifestyle.” He,however, stressed that “advocating healthylifestyles does not only mean badgering andorganizing public relations activities, it alsoentails putting in place policies that will beconducive for the pursuit of healthy lifestylesamong our countrymen.”The DOH wants to cascade itsefforts on the promotion of healthy lifestyleto all sectors of society. It is through concretepolicies, programs and partnerships that thecountry and its people can better achievehealthy lifestyle.Thus, the DOH holds theOutstanding Healthy Lifestyle AdvocacyAwards (OHLAA) every two years torecognize the work of local governments,other government agencies, and nongovernmentorganizations, professionalsocieties, the private sector, and businessand commercial establishments that havedemonstrated exemplary efforts in theformulation of policies and programs thatpromote healthy lifestyle and caused itseffective implementation. The scope of theAwards includes: 1) promotion of physicalactivity; 2) promotion of healthy diet andnutrition; 3) tobacco control; and 4) controlof harmful use of alcohol.The DOH staunch partner inthis endeavor is the Philippine Coalitionfor the Prevention and Control of Non-Communicable Diseases (PCPCNCD orcommonly known as the NCD Coalition).It is a group of 40 organizations workingon NCD prevention and control formed onApril 14, 2004 by virtue of a Memorandumof Understanding with the DOH. Amongits objectives are to: promote policy andlegislative environment supportive to thepractice of healthy lifestyle; enhance people’sawareness and practice of healthy lifestyle;and enhance surveillance mechanisms forNCDs. The current chair of the NCD Coalitionis the Philippine Association of DiabetesEducators.On February 29 at the LandbankPlaza, the second OHLAA was held. Out ofthe 28 nominees that were screened basedon the documents they submitted, eight (8)finalists were shortlisted for the next roundwhich consisted of site visit and observation,PRACTICE WHAT YOU PREACH. At the start of the 2nd Outstanding Healthy Lifestyle Advocacy Awards Night, Health Secretary Enrique T. Ona (center) and somemembers of his Executive Committee join the performers and lead the crowd to an aerobic exercise routine. In the photo are Undersecretary David Lozada,Assistant Secretary and National Nutrition Council Executive Director Maria-Bernardita Flores (extreme left and second from left), Undersecretary TeodoroHerbosa and then Assistant Secretary and now Undersecretary Nemesio T. Gako (second from right and extreme right). (Photo by Paking Repelente)18 HEALTHbeat I March - April 2012

Carmona Mayor Roy Loyola leads the Balik-Padyak program. Today, more residents ar using bicycle asa means of transportation and exercise regimen especially in the early morning and late afternoon.As a DOH Red Orchid awardee for smokefree municipality in 2011, Veruela is serious in implementingits anti-smoking campaign.interview of key players, and interview ofbeneficiaries. The finalists were furthertrimmed down to the five (5) winners whoreceived a cash prize of Php 100,000 anda plaque of recognition each. Meanwhile,the three (3) remaining finalists receiveda cash prize of Php 25,000 and a plaque ofrecognition each.The finalists are: Municipality ofSan Jacinto in Masbate; Taft District HealthCenter in Surigao City; and Heaven on EarthVegetarian Wellness Center in Baguio City.And The Winners Are...Local Government Unit CategoryTwo municipalities tied in thiscategory with only 0.12 percentage pointsdifference.Municipality of Carmona,Cavite. This is its second OHLAA. Its programknown as DAHLIA or Direct Access to HealthyLifestyle Intervention and Advocacy includeshealthy lifestyle exercises, regular medicalcheck-up, lectures on lifestyle-relateddiseases, creation of social awarenessthrough health promotion messages andmaterials, supportive facilities like wellnesscenters, and integration of the program to allsectors of the community. Community-basedorganizations and workplaces have adoptedthe DAHLIA program. The program has alsobeen included in the annual investmentplan of the municipality, thus, assured of itssustainability in terms of financial support. Asystem of monitoring, the DAHLIA card, wasdeveloped to ensure regular participationand utilize the same as a tool for evaluationand analysis. The commitment of localofficials is expressed through policiesand laws to include executive orders,memoranda, resolutions and ordinances.Likewise, continuous capability buildingprograms are being implemented toenhance the effectiveness of health workersas implementers. As of now, there are morethan 3,000 active participants of DAHLIAwho benefit from the program and acceptthe responsibility of taking care of theirhealth.Municipality of Varuela,Agusan del Sur. The municipality deeplyfelt the effect of NCDs. Smoking, alcoholdrinking, poor eating habits and the lackof concern for physical fitness were evidentin the rising incidence of hypertension andchronic obstructive pulmonary diseases(COPD) as the top causes of morbidity,while stroke, cardiovascular diseases, COPD,cancer and liver cirrhosis as the top causes ofmortality. The rural health unit was taskedto do healthy lifestyle advocacy down to thecommunity level, but the burden of doingand not being heard by the majority of theMarch - April 2012 I HEALTHbeat 19

Making importance of its numerous recognitions, no less than Davao City Mayor Inday Sara Duterte (fourth from left) is present to receive the OHLAAGovernment Office Category.constituents was discouraging. This situationwas elevated to the local officials during alocal health board meeting and they decidedto issue an ordinance in March 2011 for anintensive and comprehensive program.Although self-change to break a bad habitis difficult and would take a very long timeto do, with the ordinance in effect somehowforced people to abide with the law in orderto avoid penalties. A multi-sectoral taskforce was also organized and a battlecry wascoined to bring home the message – “MagHL Tayo, Tayo’y Aasenso Kapag May Sipag,Tiyaga at Malasakit (STM).” The proponentsof this advocacy program are Mayor SalimarT. Mondejar and Municipal Health Officer, Dr.Lumira M. Lagapa.Government Office CategoryDavao City Health Office. Thecity’s healthy lifestyle program is a uniquemix of a wide range of initiatives for theprevention and control of NCD risk factors20 HEALTHbeat I March - April 2012that span at least five years in combinedimplementation. The program includes themulti-awarded anti-smoking program. Itwould later become the standard emulatedby other LGUs in the country. The programalso integrated the nutrition programsthat include food fortification, Gulayan saBarangay and community-based feedingprograms, among others. Mental Healthprogram is being implemented down tothe barangay level with strengthenedlinkage with the Philippine Mental HealthAssociation to further advance its technicalcapacity. Davao City has also establishedcenters and institutions for mental health,for women and children in crisis, andrehabilitation centers for drug dependentsand people suffering from alcohol abuse.Physical activity is also included in theProgram where government agencies,private institutions and malls are initiatingactivities to promote healthy lifestyleamong individuals in the city. Central tothese initiatives is the Integrated NCDManagement Program, popularly known asthe Cardiovascular Disease (CVD) Program,which started in 2007. The CVD Programprovides concrete interventions usingpopulation-wide strategies for physicalactivity, tobacco cessation, diet and nutrition,promotion of stress-free environment, andNCD risk factors education.Non-GovernmentOrganization CategoryEpiscopal Diocese of NorthernPhilippines – Bontoc, MountainProvince. True to its mission of nurturingcongregations as good stewards of creation,the diocese implements its comprehensivehealthy lifestyle program: 1) HealthyLifestyle Advocacy through Health Sundaycelebration and other occasions; 2) NoSmoking Campaign; 3) Liquor Ban; 4)Junking Junk Foods; 5) Health AssistancePlan; 6) Organic Food Production (herbaland vegetable gardening in mission schools;

tobacco CONTROLThe Philippines gets one of fiveBloomberg Awardsfor Global Tobacco ControlHealthJustice Philippines WinsMichael R. Bloomberg, philanthropistand Mayor of New York City,conferred one of the five BloombergAwards for Tobacco Control to HealthJusticePhilippines for providing tobacco industrymonitoring information to government thatled to the issuance and implemention of theCivil Service Commission and Departmentof Health Joint Memorandum Circular (CSC-DOH JMC) in order to protect the bureaucracyfrom tobacco industry interference – a firstof its kind in the world.The Bloomberg Awards recognizegovernments or non-governmental organizationsin low- and middle-income countriesthat demonstrate excellent progress orachievement in implementation of MPOWERpolicies. The MPOWER strategy, establishedby the World Health Organization (WHO),are the six most effective – and proven –tobacco control interventions: Monitoringthe epidemic and prevention policies,Protecting people from secondhand smoke,Offering help to people who want to quit,Warning about the dangers of tobacco,Enforcing bans on advertising, promotionand sponsorship and Raising tobacco taxesand prices. The awards ceremony took placeon March 22 in Singapore at the 15th WorldConference on Tobacco or Health.Bloomberg honored the fairlyyoung non-government organization formonitoring the tobacco industry's attemptsto undermine laws and government policiesDr. Daniel Tan, president of HealthJustice Philippines, receives one of five Bloomberg Awards for GlobalTobacco Control from New York City Mayor Michael Bloomberg. Photo grabbed from .that will reduce tobacco consumption inthe Philippines. It was formed in 2008 bydoctors, lawyers, and economists, providesgovernment agencies and advocates withlegal information and advice on how tocounter these attempts.The CSC-DOH JMC aims to promotetransparency and accountability, which arebasic governance values and in line withthe core value to promote integrity in publicservice. The tobacco industry has consistentlyused political and economic power toprevent effective regulation and underminetobacco control measures. Through the jointmemorandum, the government is able tofurther control the meddling of the tobaccoindustry in the way it acts or decides, as wellas show that the government is sincere in itsefforts to be transparent and accountable inall its dealings.The CSC-DOH JMC covers allgovernment officials and employees underthe jurisdiction of the CSC. It prohibitsunnecessary interaction with the tobaccoindustry. If the interaction is necessary forits effective regulation, transparency mustbe observed and the interaction shouldbe carried out in such a way to avoid thecreation of any perception of real or potentialpartnership or cooperation. The jointmemorandum also prohibits preferentialtreatment to the tobacco industry and itprohibits acceptance of gifts, donations and22 HEALTHbeat I March - April 2012

sponsorship from the tobacco industry.Dr. Daniel Tan, who received theaward on behalf of HealthJustice, said,"We have seen this policy systematicallydenormalize the tobacco industry andredefine as 'interference' any tobaccoindustry actions and reactions to varioustobacco control measures, including legalchallenges in court and personal attacks onadvocates."Tan said that the tobacco industryinterference is the single biggest threatto tobacco control and WHO FrameworkConvention on Tobacco Control (FCTC)implementation. This first internationalhealth treaty – which the Philippinessigned along with 173 countries – requiressignatory countries to pass laws that willreduce, and eventually eliminate, tobaccouse. These laws include those banningsmoking, banning advertisements andpromotions of tobacco products, requiringtobacco companies to put graphic healthwarnings on their products, and preventinggovernment collaboration with the tobaccoindustry."That's why we helped developa government-wide policy that will shieldagencies in the Philippines from tobaccoindustry influence or threats," Tan added.HealthJustice has also helpedthe Metropolitan Manila DevelopmentAuthority, Land Transportation RegulatoryBoard and a number of local governmentunits across the Philippines in theirvarious tobacco control efforts. Its latestfeat is in assisting the Department ofEducation (DepEd) in issuing DepEd OrderNo. 6 series of 2012 on the adoption andimplementation of public health policieson tobacco control and protection againsttobacco industry interference based on theCSC-DOH JMC. It must be noted that many ofthe tobacco industry's so-called "corporatesocial responsibility" activities are directedin schools, like building classrooms or stage,painting buildings and holding youth events.HealthJustice also advises othergovernment agencies in the cases filed bytobacco companies in different courts toskirt the advertising ban, prevent graphichealth warnings on packs, and relax onno-smoking spots. It also regularly sendsadvisories to media organizations whentobacco companies are trying to get aroundthe rules, or when government officialsand agencies may be getting cozy with theindustry, such as when then Senator RichardGordon, as chair of the Red Cross, wasphotographed accepting a donation fromPhilip Morris (PM), and when the Bureau ofInternal Revenue publicized PM as one of thetop corporate taxpayers.Former Health Undersecretary andnow PhilHealth's Chief Operating OfficerAlexander Padilla said, "HealthJustice keepsgovernment people from sliding back,makes people honest. If some sectors thinkHealthJustice is stretching things too far, thegroup will always get back to you with theWHO FCTC."Other AwardeesHealthJustice Philippines wonin the Monitoring category. The otherawardees were: “Protecting” Category –Turkish National Coalition on Tobacco orHealth (Turkish acronym: SSUK) for ensuringthat the Turkish national tobacco controllaw passed was strong and comprehensive;“Warning” Category – Uruguay Ministryof Health for being a world leader inimplementing pack warnings, which iscurrently the largest pack warnings inthe world (80% of pack on both front andback); “Enforcing” Category - CorporateAccountability International Colombia(CAI) and Fundaciónpara la Educación yel Desarrollo Social (FES) for their jointeffort to strengthen implementation andenforcement of Colombia’s newly passedtobacco advertising and sponsorship ban;and “Raising tobacco taxes” Category –Egypt’s Ministry of Finance for includinga 100% tax on shisha (a tobacco smokedin a water pipe) and cigarette taxes whichnow represent over 70% of the pack pricefor the most popular brand in Egypt andhave generated over 2.2 billion USD ingovernment revenue annually.As no country is currentlyperforming at a level of excellence in the“Offering help to smokers to quit” category,there was no award given in this area.Bloomberg said, “Tobacco killsevery day but we are fighting back. Ourawardees represent the thousands ofheroes who are taking on the fight againsttobacco in their countries, regions and citiesevery day. We are honoring those who haveshown exemplary progress since our effortscommenced in 2007, and we hope theirwork will inspire others to achieve similarsuccess.”Bloomberg Philanthropies worksprimarily to advance five areas globally:arts, education, environment, governmentinnovation and public health. The BloombergInitiative to Reduce Tobacco Use is focusedon reducing the public health impact oftobacco use globally by implementingproven tobacco control policies in low- andmiddle-income countries where 80% oftobacco-related deaths occur.- o O o -Catch HEALTHbeat Online: March - April 2012 I HEALTHbeat 23

stress RELIEFRated SPGStriktong Patnubay at Gabayng Magulang ang KailanganJASPER: Kuya, lahat nalang ng palabasay kailangan ng PATNUBAY atGABAY ng MAGULANG...DENNIS: Oo nga eh...JASPER: May matapos pa kayang gawainsi Nanay?UlanLITA:JEFF:Anak, tingnan mo nga kungumuulan sa labas?'Nay naman. Sa tanda n'yong 'yankailan ba umulan sa loob?Chocolate SundaeSa Fastfood Chain...ABBY: Isang chocolate sundae nga.CREW: Ma'am 25 pesos po.ABBY: (Nagbigay ng 100 pesos)CREW: Ma'am, meron po ba kayong 5pesos?ABBY: Para kang ex-bf ko, binigay kona nga ang lahat ng meron ako...tapos, nagkulang pa din ako?CREW: Ma'am hindi ko naman posinabing nagkulang ka, minsanhumihingi lang kami ng kontinghalaga para masuklian ka naminng buo.Ito ang TamaREMY: Hoy! Umuwi ka na nga! Inom kana naman ng inom d'yan!JOEREM: 'Nay naman. Nakakahiya sa tropa!Wala pa kaming tama. Kontinalang 'to!REMY: Aan'hin mo pa ang alak, kung saakin palang ay tatamaan ka na!Uweeeeh!Walang MangyayariLUZ: Tigilan mo nga yang pagboboyfriendna yan... walangmangyayari sa inyo!HANNAH: 'Nay naman... Ba't po kagabimeron?!?HagisTITSER:PAULO:TITSER:PAULO:BagsakAng unang makasagot ng tanongko ay makakauwi agad.(Hinagis ang bag sa labas ngbintana.)Kaninong bag 'yun?Sa'kin po Ma'am! Bye classmates!NELSON: Bakit bagsak grades mo?JERRY: How can I pass if my teacher hatesme? Parang love lang yan, kahitgaano ka man kaseryoso, kungayaw sayo, hindi ka papasa.NELSON: Naks! At nagdrama pa ang bobo.Hot CakeDENPOT: 'Nay penge pera, bibili ako ngHigh Cake...BETH: Engot ka talaga! Kanino ka banagmana? Hot Cake 'yun!DENPOT: Ganun ba, 'Nay? Oh, penge nang pera...BETH: Sige, kunin mo dun sa kwartoyung Soldier Bag ko!SwitzerlandNICOLO: Ma, saan nga yung Switzerland?ALEGRIA: Ayan kasi. Kung saan-saan langinilalagay ang mga gamit! Taposkapag nawala, sa akin hahanapin!24 HEALTHbeat I March - April 2012

Tobacco-FreeMetro Manila Film FestivalWeeeeh... Hindi Nga?!?Metro Manila Film FestivalIn a decade that was regardedas the second golden age of Philippinecinema after the 1950s’, the Metro ManilaFilm Festival began in 1974. It showcasedquality films besting each other out foracting and technical awards as well as boxoffice success. The Festival was organizedmainly to help promote and enhance thepreservation, growth and development ofthe local film industry.According to Dr. Romulo A.Virola, secretary-general of the NationalStatistical Coordination Board, posted in“Statistically Speaking” on February 13,2012 at , over theyears, the production of local films saw adecline, from the average of 140 films peryear from 1960 to 1999 to only 73 filmsper year during the past decade. Television(TV), telenovela or soap opera, and theInternet and intellectual copyright piracymay have caused the problems faced by thefilm industry at present. The film industryhas also been producing films far from thequality of those made during the goldenyears of Philippine cinema, and the numberof local box-office hits also dipped. In fact,byANTHONY R. RODA, MaHeSoS*National Center for Health PromotionThis film is adjudged as quality and best film in the 37thMetro Manila Film Festival but is looks like one big andlong tobacco advertisement and promotion.among the frontrunners of the box-officehits for the year were Festival entries.The MMFF, which happens fromChristmas Day to the Feast of the Three Kings,now becomes the biggest and most excitingevent for the Philippine film industry. ItHEALTH researchstarts off with a parade of stars aboardextravagant floats on December 24, 2011,to the opening day on Christmas, to theglittering awards night two days later,and onto the last day on January 7, 2012.During this period, no foreign movies areshown in all cinemas.Most producers gamble theirmulti-million peso budgets in the hopesof drawing moviegoers eager to splurgesome of their holiday cash. The MMFF hasalso become one of the more prestigiousaward-giving institutions in the country,offering huge cash prizes to the winners.The Best Picture receives P800,000, whilethe Second Best Picture and Third BestPicture gets P550,000 and P300,000,respectively. On the other hand, thewinner of the Gatpuno Antonio VillegasAward brings home P550,000. Meanwhile,the Best Actor, Actress, Director andScreenplay each get P100,000, while theBest Supporting Actor, Supporting Actress,Child Performer and technical winners winP50,000. Moreover, the earnings acquiredduring the 14-day Festival are dividedamong institutions/organizations involvedin film development, welfare of movieworkers and anti-film piracy.- - -*This article is based on a study entitled “Tobacco-Free Movies: Is It Possible in the Metro Manila Film Festival?” by Anthony R. Roda, Acting Division Chief ofthe National Center for Health Promotion and one of the Editors-in-Chief of HEALTHbeat. He is also one of the ASEAN focal points on tobacco control. The studywas first presented as a poster in the 15th World Conference on Tobacco or Health in Singapore on March 20-24, 2012.March - April 2012 I HEALTHbeat 25

Call for Tobacco-Free MoviesThe 37th Annual MMFF isspearheaded by the Metropolitan ManilaDevelopment Authority (MMDA) – theoverseer of Metro Manila, the Philippines’premiere region, which hosts 14 millionresidents and consists of 16 cities and amunicipality. MMDA is led by ChairmanFrancis N. Tolentino, whose current“Enforcement of Smoke Free Policy” programregulated the use and consumption oftobacco products in confined public places.In retaliation to his exemplary advocacy, thetobacco industry challenged the authority ofhis office, criticized him harshly in the media,and filed administrative suits against him.Tolentino did not waver in his cause and hecontinued his advocacy even in the holdingof the MMFF.On June 2, 2011 when Tolentinoannounced the extension of the submissionof scripts in order to qualify as MMFF entries,he also called on participating movieproducers to exclude scenes that show actorssmoking cigarettes. He said such scenes infilms entice people to crave for a cigaretteand that young viewers alike are enticed tosmoke as they are indirectly being told thatsmoking is cool when they see a popularactor puffing a cigarette. He said, “We don’twant to send the wrong message to ourchildren. We want to inculcate positive,health-conscious values and awareness.”The Philippines Global YouthTobacco Survey (2007), a school-basedsurvey of students 13-15 years old, showedthat 27.4 per cent of youth (34.7% males,19.6% females) currently smoke cigarettes.And despite the ban on tobacco advertisingin Philippine mass media, as high as 88%saw pro-cigarette ads on billboards and84.7% saw pro-cigarette ads in newspapersand magazines.Movie folk expressed alarm andcommented that Tolentino’s appeal ordirective is an encroachment on artisticfreedom. In general, they say that filmmakingis built on the nuances of characterizationand if smoking will project the nature ofa role or enhance cinematography, it isjustified. If the actor’s character is smoking,it does not mean he is setting a bad exampleto the youth. Even in animé, there arecharacters who are smoking. Children watchthis and they know how to distinguish reeland real life.Counting Smoking in MMFF MoviesThe result of Tolentino’s appealfor tobacco-free movies seemed to betried, ridiculed and rejected by more thanhalf of the producers participating in the37th MMFF. A Department of Health studyentitled “Tobacco-Free Movies: Is It Possiblein the Metro Manila Film Festival?” countedthe scenes, shots and seconds smoking thatwere shown in each of the seven (7) officialMMFF entries, analyzed the context inwhich smoking was used, and determined iftobacco brands were identified in the movie.The latter would constitute a violation underRepublic Act 9211 (Tobacco Regulation Actof 2003) that prohibits tobacco advertisingin mass media.The monitoring of movies wasdone in cinemas during the Film Festivalperiod. At first viewing, the total number ofrunning time, scenes and smoking sceneswere counted. When smoking scenes werepresent in a film, a second or third viewingwas necessary to count the total numberof shots and seconds. The actual countingof scenes, shots and seconds was donemanually and this becomes the limitation ofthe study. Accuracy was estimated at plus orminus 10 scenes, shots and seconds.A scene is one of the basic structuralunits of the film taken at one basic time andplace. A scene is composed of several shots.A shot is a photographic view or exposureand in the study tried to differentiate thesmoking exposure into: long shot (full viewof object or human figure some relation toits surroundings); medium shot (a shot ofthe person from the knees up or the waistup); and close-up (a shot of a person fromthe shoulders up). This was done to analyzehow the film showed detail, character, andintricate emotion to the act of smoking. Themore medium and close-up shots used, themore importance is given to the message ofsmoking.Although there are severalstudies of this kind in other countries, thisis a pioneering study in the Philippines, atobacco-growing country that has bannedtobacco advertising in mass media but stillhas strong tobacco industry influence inpolitics, governance, culture and the arts.The results provide a brief snapshot to helpunderstand how smoking is portrayed inPhilippine movies.Smoking-Filled Movie LeadsSeven entries were included in theroster of films to the 37th MMFF. Originally,11 films submitted the required scripts tothe Festival. Only eight films were chosenas official entries. However, due to someproduction issues, two films pulled out ofthe competition. One spot was filled in bythe ninth movie that was earlier not includedin the official list.This movie is the “ManilaKingpin: The Untold Story of AsiongSalonga,” a black-and-white, biography,gangster, action flick starring Jorge Estregan(a.k.a. ER Ejercito) and produced by VIVACommunications Inc. and Scenema ConceptInternational. It was originally directed byTikoy Aguiluz, but he secured a court orderto have his name removed from the credits26 HEALTHbeat I March - April 2012

Counting the Smoking Scenes, Shots and Secondsin the 37th METRO MANILA FILM FESTIVAL EntriesFILM ENTRY/GENRE/RATINGRUNNING TIME(minus Closing Credits)NUMBEROF SCENESNUMBER OFSMOKING SCENESNUMBER OFSMOKING SHOTSTIME OF SMOKINGEXPOSUREManila Kingpin:The Untold Storyof Asiong SalongaAction/Gangster/DramaR-13112 mins 00 sec 914418162 close-up shots60 medium shots59 long shots11 mins 57 secs163 secs242 secs302 secsShake Rattleand Roll 13HorrorPG-13142 mins 03 secs102121 long shot1 close-up shot0 min 14 secs13 secs1 secSegunda ManoHorror/SuspensePG-13100 mins 00 sec84121 long shot1 medium shot0 min 8 secs4 secs4 secYesterday, Today,TomorrowDramaPG-13113 mins 20 secs1150**but in one scenesmoking wasincorporated in thedialogue of one of themain female characters00Ang Panday 2Action/FantasyGP105 mins 09 secs79000Enteng ng Ina MoComedy/FantasyGP101 mins 24 secs77000My Househusband(Ikaw Na!)Comedy/RomancePG-13106 mins 16 secs90000Note that the actual counting was done manually inside the movie theater, and accuracy is pegged at + or - 10 scenes, shots and seconds.March - April 2012 I HEALTHbeat 27

of the film due to re-shooting and editing ofthe film without his permission. Darryl delaCruz was eventually named as director.The movie earned a “Grade A”from the Cinema Evaluation Board becauseit was said to be a “fine example of a periodfilm” and because its director was “able toestablish believable characters throughmasterfully conceived and executed actionscenes.” The Board is mandated under thelaw to review and grade the quality of filmsbefore being released for public viewing. Italso awards tax incentives to films graded“A” and “B” as a way of encouraging Filipinofilmmakers to produce more quality filmsand increase the international marketabilityof Philippine cinema. This Board is totallyindependent and not at all connected to theMMFF."Manila Kingpin" also dominatedthe 37th MMFF Awards Night by winninga total of 11 awards, including BestPicture, Best Director, Best Screenplay, BestSupporting Actor, almost all of the technicalawards, and the special award – GatpunoAntonio Villegas Cultural Award.Ironically, this adjudged qualityand best film is filled with tobacco andsmoking scenes from the first four minutesof the movie up to the last few minutestowards the end. Smoking is also veryobvious in the movie’s trailer, music video,print advertisement and poster. However, inthe posters displayed inside the malls wherethe movie was being shown, the cigaretteswere omitted.The lead actor and his cohortssmoked cigarettes, while the main villainsmoked cigar. The jail warden and somepolicemen were portrayed as smokers. Andin one sex scene, the lead actor and hismistress use smoking as foreplay. Althoughthere were no noticeable brands of cigarettesand cigars, the movie seems like one big andlong tobacco advertisement.Forty-four (44) out of the total91 (48.4%) scenes depicted smoking onscreen, with a computed running time of717 seconds (11 minutes, 57 seconds).There were a total of 181 shots that showedsmoking and this is divided into: 62 closeupshots (163 seconds); 60 medium shots(242 seconds), and 59 long shots (302)seconds. The whole movie, minus the closingproduction credits, runs 112 minutes (1 hour,52 minutes).Other MMFF EntriesThe other MMFF entries thatshowed smoking scenes are “Shake, Rattleand Roll 13” and “Segunda Mano.”“Shake, Rattle and Roll 13” isthe 13th instalment of the Filipino horrorfilm dating back to 1984. This is a trilogy(three episodes) film produced by RegalEntertainment Inc. and Regal MultimediaInc. under the matriarch of Filipino films,“Mother” Lily Monteverde. Incidentally,Monteverde has been very vocal againstMMDA Chiairman Tolentino's call to make thefilm entries tobacco-free. She was quoted inmedia as saying, “Hindi pupwede (It cannotbe). Actors have to bring life to any role and iftheir character is smoking, it does not meanthat they are setting a bad example to theyouth.”In the first episode entitled“Tamawo,” an Ilonggo word for a mysteriouscreature, the rich provincial ranch owneris shown smoking in one scene and twoshots lasting for 14 seconds (a long shot for13 seconds and a brief close-up shot for 1second). The film was judged MMFF thirdbest picture.“Segunda Mano” is a horror/suspense movie produced by Star Cinemaand starring Kris Aquino, the Presidentialsister, and matinee idol and MMFF BestActor, Dingdong Dantes. In one scene, aglamorous woman vacationing from abroadand whose role flirts with the lead actoris shown smoking in one scene and twoshots lasting for 8 seconds (a long shot for 4seconds and a medium shot for 4 seconds).“Yesterday, Today, Tomorrow”is a drama movie billed with a powerhousecast and riveting performances led byMaricel Soriano (MMFF Best Actress)and produced by Monteverde’s RegalEntertainment Inc. and Studio 5. Althoughthere was no smoking scene in this movie,smoking was implied in a dialogue by oneof the main female casts, Carla Abellana. Inthe middle of a supposed stressful meetingin the boardroom, she ended the meeting bysaying to her colleagues, “Why don’t we takea break, I’m sure yosing-yosi na kayo (you’reraring to smoke).”If this was a deliberate inclusion inthe script to defy Tolentino’s call for tobaccofreemovies, only the producers wouldknow. Incidentally, the MMFF executivecommittee unanimously disqualified thefilm from competing in the Best Picture,Director, Screenplay and Gatpuno AntonioVillegas Cultural Award because the moviewas different from the script that waspresented to the committee from which itbased its approval and this was consideredas a violation of the rules. Tolentino saidthat after the script was approved, what wasshown was different and even the cast wasdifferent. Only the title was the same.Fortunately, the three familyentertainment MMFF entries did not showsmoking scenes.“Enteng ng Ina Mo” was therunaway box-office champion, grossingover P183 million in eight days of showingin the MMFF. This action, fantasy, adventurecomedy movie also won the second bestpicture. It is produced by Star Cinema andM-Zet Films and the concept came from afusion of blockbuster hit movies "Enteng28 HEALTHbeat I March - April 2012

Smoking starts in the first four minutes of the black-and-white film, "Manila Kingpin: The Untold Story of Asiong Salonga," starring Laguna Governor EREjercito (a.k.a. Jorge Estregan, forefront). Photo from the Internet.Kabisote" of Vic Sotto and "Ang Tanging InaMo" of Ai Ai delas Alas.“Ang Panday 2” is an action,fantasy and adventure movie that is also thesequel to the 2009 reincarnation of one ofFernando Poe, Jr.'s most beloved cinematicalter-egos based on Carlo J. Caparas' comicscreations. It stars Senator Bong Revilla andproduced by Imus Productions and GMAFilms.“My House Husband Ikaw Na”is a comedy, romance movie produced byOctoArts Films starring reel- and real-lifecouple, Ryan Agoncillo and Judy Ann Santos,their first movie together since tying theknot. The movie essays a reversal of roleswhere the husband found himself out ofwork and taking care of the house andthe two kids, while the wife goes to fulltimework and becomes successful in hernewfound career.Tobacco Imagery Viewers GetFor the tobacco industry, filmsprovide an opportunity to convert a deadlyproduct into a status symbol or token ofindependence. According to the WorldHealth Organization in the second editionof “Smoke-free Movies: From Evidence toAction,” published in September 2011,“because smoking on screen is uniquelyvivid and because young people see somany films so often, its promotional effecton smoking initiation is striking.”In “Manila Kingpin: The UntoldStory of Asiong Salonga,” cigarettesmoking is for the main character who isa notorious gang leader but a caring, alaRobin Hood, toughie during his time, andcigar chomping is for the villain who gunneddown the main character. The said villain hasa scene where he spits cigar remnants in theface of a poor, helpless man. Research showsthat the villain who smokes can be evenmore influential on adolescents than thehero.The movie is set in the 1950s whensmoking was all the rage in real and reellife. Although smoking may be necessaryto represent the smoking of real historicalfigures in which the film is based, smokingis overused and over emphasized in this film.And while many movies usesmoking as a form of relaxation after sex,this movie showed a reversal of imagery. Inan interesting and innovative way, smokingbecame a prelude to sex. The lead actor’smistress, who is also a sex worker, seduceshim by lighting two cigarettes and givingone for him to smoke. The sexiness of theacting as well as the effect of cigarettesmoke in a black-and-white film completedthe imagery that smoking is sex foreplay.In “Shake, Rattle and Roll 13,”smoking is associated with the rich ranchowner, while in “Segunda Mano,” smokingis associated with a glamorous womanvacationing from abroad and who flirts withthe lead actor after his wife supposedly lefthim.Smoking actors are rich, tough andrebellious while smoking actresses are sexy,attractive and sophisticated. These are themessages delivered by the three movies thatMarch - April 2012 I HEALTHbeat 29

show smoking scenes. For decades, these arethe images the tobacco industry use in theirmarketing in the hope that young peoplewill take part in the exciting lifestyles of therich and the glamorous, that they will adoptthe behaviors they see in these charactersdepicted in the movies.In “Yesterday, Today,Tomorrow,” the message the lady bossblurts out to her colleagues in a tiring officemeeting that it is time to smoke showedsmoking is a way to relax and relieve thosepent-up stress. But the idea that smokingrelieves stress is a myth; rather than helpsmokers relax, nicotine actually increasesanxiety and tension, says PsychologistAndy Parrott, whose findings have beenpublished in the medical journal AmericanPsychologist. He explained, “Regular smokersneed nicotine to maintain normal moods asthey suffer tension between cigarettes.”Meanwhile, in the presentationof tobacco in the MMFF entries that havesmoking scenes or dialogues, there is nomessage that reflects the dangers andconsequences of tobacco use.The Tobacco Atlas (2009) publishedby the American Cancer Society and theWorld Lung Foundation noted that tobaccomarketing increases cigarette consumptionand seduces new smokers into addiction,negating public health efforts to controltobacco. The World Health OrganizationFramework Convention on Tobacco Control(WHO FCTC), the first global public healthtreaty, recommends that “Parties (orcountries) recognize that a comprehensiveban on advertising, promotion andsponsorship would reduce the consumptionof tobacco products.”In the Philippines, the TobaccoRegulation Act of 2003 (Republic Act 9211)prohibits only mass media advertisingon television, radio, print and outdoorbillboards. Advertising and promotions areallowed at points of sale. Limited sponsorshipis also allowed. Partial restrictions, like inthe Philippines, are proven to be ineffectivein reducing smoking because tobaccocompanies redirect their marketing effortsto available venues, like the movies.In the December 2006 issueof Archives of Pediatrics and AdolescentMedicine, a study “The Extent to WhichTobacco Marketing and Tobacco Use in FilmsContribute to Children’s Use of Tobacco,”found that depictions of smoking in moviesare more psychologically powerful thancigarette advertisements and have a greaterimpact on children’s attitudes and behaviorsregarding smoking. The research looked at51 studies and found that media exposureto tobacco use increases the odds of youthtaking up smoking almost threefold.Alas, even with severalscientifically-proven evidences all over theworld, many in the Philippine entertainmentindustry do not realize nor believe the impactthat smoking in media has on influencingbehaviors among children and adolescents.Even the self-professed non-smoker andnon-drinker since birth, Cesar Montano, apopular action star who led an anti-smokingfun run in Manila on November 26, 2011,would not tuck in a smoking scene in anyof his movies if the scene or the role callsfor it. He said in one published news report,“I believe that if a scene requires that acharacter has to smoke, the act should beallowed. People should be able to draw theline between being oneself and playing arole.”What Can be DoneAlas, no movie in the Film Festival depicts true images and messages of the health hazards of smoking,like oral cancer as seen in a patient above.Internationally, there is noconsensus yet on what should be doneabout smoking on TV and in films. Often,the issues being raised are those of artisticfreedom and being truthful/factual (becauseordinary people do smoke), especially whendealing with historical films wherein famouspeople known to have smoked are portrayedor many people of that time/place smoked.Critics of censorship will also ask why alcoholor violence should not be treated in the sameway.In Thailand, the act of smokingand any lit cigarette is prohibited on screen,such that any TV shows or movies (includingimported movies) that have smoking scenes30 HEALTHbeat I March - April 2012

are required to block out the hand or mouthwith the cigarette. This is rather ugly andquite distracting (but great for raisingawareness that smoking is bad), so that localproducers have made conscious efforts tonot have any smoking scenes in their films/shows.In China, the State Administrationof Radio, Film and Television released anorder in February 2011 directing producersto minimize plot lines and scenes involvingtobacco and show smoking only whennecessary for artistic purposes or characterdevelopment. Minors under age 18 cannotbe shown smoking or buying cigarettes, andcharacters may not smoke in public buildingsor other places where smoking is banned.In the US, Stan Glantz, professorof the Department of Medicine and directorof the Center for Tobacco Control Researchand Education at the University of CaliforniaSan Francisco (UCSF) and his group madethe following five reasonable, responsiblesteps to protect young audiences from onscreensmoking which were endorsed by theUS Centers for Disease Control on July 15,2011: 1) assigning R ratings to movies thatdepict onscreen smoking; 2) requiring antitobaccoads in movies that depict smoking;3) prohibiting on-screen display of tobaccobrands; 4) requiring producers to certify thatno one associated with a movie depictingtobacco use received compensation for it,and; 5) harmonizing the State movie subsidyprograms with the tobacco control programsby limiting eligibility for subsidies only totobacco-free movies.In India, the Ministry of Healthand Family Welfare has issued a notificationdated October 27, 2011 that mandates aU/A certification (universal/adult rating)shall be given for a film in which an actor/actors are shown smoking or using tobacco.A disclaimer of 20 seconds duration shall berequired in the beginning and middle of thefilm in the voice of the actor shown smokingor chewing tobacco. There shall also be ahealth warning scroll in legible and readablefont going across the scene as a ticker sayingsmoking causes cancer; smoking kills,tobacco causes cancer. As of this writing,this notification is being contested byfilmmakers.Tobacco-Free Movies?!?Tobacco-free movies may not bepossible in the Metro Manila Film Festivalat this time, but the pioneering effort tocall on filmmakers not to depict smokingin their films may be the start of somethingbig because it has already elicited healthypublic discussion and debate. Although thetobacco industry remains silent on the issuein media, the move has drawn flak fromthe movie industry but wide support fromtobacco control advocates and non-smokingpublic. This now gives an opportunity notonly to push for government action but alsoto encourage self-regulation.MMDA Chairman Tolentino hintedthat it is time for the movie industry torun the film festival by itself and withoutthe support of MMDA and the localgovernment units. This may be a good ideaconsidering that subsidies are provided bythe government, even for movies that depictsmoking scenes. It is about time to considersuch films as indirect tobacco advertisingand promotion vehicle, which is a violationof an existing law, and therefore should notbe eligible for any government subsidies ortax incentives.During Tolentino’s call, theDepartment of Health was also reportedto have consulted Grace Poe Llamanzares,chair of the Movie and Television Review andClassification Board (MTRCB), regarding theguidelines in the possible implementationof a No Smoking directive in films andtelevision programs. This would have beena good measure to prevent producers forincorporating smoking scenes. An R-18 or“For Adults Only” rating would not only limitviewership of minors, but would also meanlimited showing in cinemas because theleading chain of malls in the country whichcarry the most number of moviehousesnationwide, ban R-18 movies in theirefforts to make their malls family-friendly.However, the MTRCB has still to decide themerits of issuing tobacco-free guidelines.Let this be the time to educatethe filmmakers. Tobacco control advocatesshould exert efforts in educating filmmakerson the harmful effects of tobacco use andthe evidences that smoking scenes have onsmoking initiation and craving to smoke.This strategy may encourage them not toshow smoking scenes or depict the truepicture of diseases and deaths broughtabout by smoking in their movies.And finally, in a country wherepolitics and showbiz are inter-related asmany politicians crossover to the otherfield almost instantly, actor-politicians, likeGovernor ER Ejercito, should be encouragedto push forward public health and welfare bynot being seen in movies as characters whouse and promote a product that is not only ahealth hazard but also deadly.Last February, CongressmanAurelio Gonzales Jr. filed a House Resolutionformalizing the appeal that seeks to put anend to the negative image of congressmenas seen in movies and television shows. Heexplained that the bad portrayals have beenunfair to legislators and have only taintedthe names of House members who workhard for their constituents. Well maybe, justmaybe, legislators and other political leadersshould also be thinking and working hardto put a stop in showing tobacco use in allforms of media for the sake of all Filipinos!Weeeeh... Hindi nga?!?March - April 2012 I HEALTHbeat 31

laughter HEALSPAG-IBIGsa Septic TankFeelingsPutikWARNING: This page is full of toilet humor.Tunay na LalakiJOJIE:DANNY:JOJIE:DANNY:JOJIE:DANNY:Ayos!FLOR:ERIC:FLOR:ImburnalOSCAR:DELIA:OSCAR:DELIA:OSCAR:Alam mo para kang inidorokapag na-jejebs ako.Hahaha. Ang sama. Bakit naman?Kasi it’s that feeling... I’m fallingfor you.Ako naman when I’m with youparang lagi akong naiihi.Ha?Kinikilig pagkatapos.Ayusin mo nga kama mo, hindi'yang puro Facebook anginaatupag mo.Magugulo lang naman ulit. Bakitko pa aayusin? Para lang akongnagmahal tapos masasaktan langmuli.Ayun! At nagdrama ang batugan!'Wag ka na ring kumain, kasiidudumi mo lang din.Miss, imburnal ka ba?(Kinikilig) Bakit naman?Tanga lang kasi ang mahuhulogsa 'yo!Ah, ganun ba? Hmmp!At isa na ko sa tangang 'yun.32 HEALTHbeat I March - April 2012GLADYS: Noon, ang akala ko, ang tao aygaling sa alikabok at gawa saPUTiK..JACKIE: Bakit, Mare? Walangkatotohanan ba iyon?!?GLADYS: Kasi ikaw, gawa sa PLASTIK?!?!LabiGANI:EDNA:GANI:KadiriMalamig siguro ang labi mo.(Kinilig) Hindi ah, bakit?Nagyeyelo(w) kasi ang ngipinmo 'eh.Nagkita ang kulangot at tinga...KULANGOT: Oy! Pare kamusta ka na?TINGA: You're here?!? Anongginagawa mo dito 'pre?DumiMIKE:DIANE:MIKE:DIANE:MIKE:DIANE:MIKE:Ipapasok ko na, ha?Dahan-dahan lang ha?Ako ang bahala.Aaahhh... Ang sarap!Ididiin ko pa!Oo sige, ikut-ikutin mo pa!Ayan, malinis na. Sa kabilangtenga naman.DINKY:TERE:Ang babae ay parang Barbie.Pwede mong paglaruan, at 'pagnaluma na ay pwedeng ipamigaypero tandaan mo, ang tunay nalalaki ay hindi naglalaro ngBarbie.Kaya wag n'yo kaming paglaruankung tunay kayong lalaki!Tunay na BabaePHILIP: Ang laki ng problema ko sa syotako, 'Pre.IBARRA: Pare, tandaan mo ito... Ang tunayna babae ay marunong maglutotulad ng nanay n'ya. Hindi 'yungkasing-lakas uminom tulad ngtatay nya.PayabanganPAKING: Pare yung brief ko hindi T-back...no back! Hahaha.ROMY: Wala 'yan sa brief ko... 'Sakenparang lumang plaka. PwedengSide A at Side B! Hahaha.ARIEL: Yuck...grabe naman 'yan. Pareyung brief ko parang blockbusterna pelikula...PAKING: Bakit?!?ARIEL: NOW ON ITS SECOND WEEK!

HEALTH policyHealth Secretary Enrique T. Ona, during the hearing on excise tax reform on alcohol and tobacco products, explaining that the main intention of House Bill5727. (Photo by Paking Repelente)Honorable Legislators, Please PassThe Abaya Sin Tax BillbyDONATO DENNIS B. MAGATand ANTHONY R. RODA, MAHeSoSHEALTHbeat StaffCongress Delayed is Health DeniedThere is a tug-of-war in the Houseof Representatives in reforming the excisetax structure of the so-called “sin” products,particularly tobacco and alcohol, and it maystill take a while or even the next Congressto do so even if it has been classified urgentby President Benigno S. Aquino III and withpressures from the World Trade Organizationfor the government to enact a new excise taxlaw that would be compliant with the globalstandards.The country’s cigarettes andalcoholic drinks are among the cheapestin the world! Cigarettes, for example,have become cheaper relative to basiccommodities such as food, education, andMarch - April 2012 I HEALTHbeat 33

health in the past 10 years. The currentmulti-tiered tax system puts the youth andthe poor in a trap by the ills of smoking anddrinking as it encourages them to shift fromhigher-priced to lower-priced brands.Increasing the tax and price ofcigarettes and alcohol will effectively helpprotect the young and the poor from theharmful effects of smoking and drinking.Addiction to smoking and drinking usuallyhappens when individuals start these vicesat a very young age. Studies have alsoshown that the health effects of smokingand drinking are worst for those who beginsmoking and drinking in their youth. Hence,the young population needs the mostprotection from picking up these vices.On the other hand, the poorsmokes and drinks more than the rich. Thepoor also have the least capacity to get theneeded health care when they get sick dueto smoking- and alcohol-related diseases,and are the most vulnerable to chronicpoverty when they experience health shocksdue to these vices. Moreover, the pooresthouseholds spend more on tobacco andalcohol more than education or health care.Hence, the poor also needs to be protectedfrom the harm caused by smoking anddrinking.Local studies and reports showthat many Filipinos are dying and thePhilippines is in a health crisis. Some 515 to827 Filipinos contract smoking-related lungcancer and lung and heart diseases DAILY!About 240 Filipinos die daily because ofsmoking-related diseases. Of the 10 leadingcauses of mortality, seven (7) are smokingrelated.Although government revenue fromtobacco taxes is about P23 billion annually,the economic burden of health costs andproductivity losses of only four smokingrelateddiseases – cancer, heart diseases,stroke and chronic pulmonary diseases –add up to P148 to P314 billion yearly in thecountry.The government is in a financialcrisis and it badly needs more revenues.Increasing sin taxes will be the most effectiveand efficient tool to raise a significantamount of revenues in the short to mediumterm. Even with improved tax administrationunder the Aquino administration, tax efforthas remained low at 12% of gross domesticproducts (GDP). Moreover, GDP growth ratewas only 3.7% in 2011. While the budgetdeficit was reduced to P96 billion in 2011,the government was not able to spend foressential public services, which is the mainreason for the close-to-stagnant status ofthe economy in 2011.Why the Abaya BillThere are 12 pending measures inCongress seeking to restructure the excisetax on alcohol and tobacco products, butthe one being supported by the Aquinoadministration is House Bill (HB) No. 5727,penned by Cavite Representative JosephEmilio Abaya, the chair of the Housecommittee on appropriations.The following are the salientfeatures of the Abaya bill:• IT MOVES FROM A MULTI-TIEREDTO A UNITARY TAX SYSTEM: It will simplifythe current multi-tiered tax structure. Onlyone tax rate for all cigarettes and one tax ratefor distilled spirits;• IT INDEXES TAXES TO INFLATION:After reaching the unitary tax system, taxeswill be automatically increased yearly, tofollow inflation; and• IT DEDICATES TAXES TOUNIVERSAL HEALTH CARE AND ALTERNATIVELIVELIHOOD FOR TOBACCO FARMERS: Part ofthe taxes will be used for the Aquino HealthAgenda of providing universal health care forall Filipinos. Another portion will be used toaid tobacco farmers in shifting to alternativeand more lucrative livelihoods.This sin tax reform would have theeffect of raising an additional P400 billion inrevenues for the government during the lastfour years of Aquino’s term.Meanwhile, the Department ofHealth projected that an increase in sintaxes would generate at least P60.7 billionin additional government income annually.Of this amount, P45 billion will be allocatedto tobacco farmers while the remainingwill be used to fund the government’suniversal health care agenda or KalusuganPangkalahatan.Here Comes The OppositionThe move to raise sin taxes is beingopposed by lawmakers from the Solid North– the traditional tobacco-growing regionsof Ilocos, Cagayan Valley and Central Luzon– claiming it would kill the tobacco industryand threaten the livelihood of 2.9 milliontobacco farmers and workers and theirdependents.Ryan Singson, Ilocos Sur 1stDistrict Representative, warned that ifthe government proceeds with its plan ofadopting a unitary tax system for alcoholand tobacco products, tobacco-producingfarmers of his province would have a difficulttime finding buyers for their products.The unitary tax system would makecigarette brands currently taxed at P5 perpack pay P40-P45 per pack in three years.Meanwhile, local distillers led by the giantSan Miguel Corporation, also warned thatthe 1,000-percent hike in taxes being soughtby the sin tax measure would drive localplayers out of business and leave hundredsof thousands of workers jobless as domesticbrands would lose their price advantage overforeign brands.Singson filed a substitute versionof the sin tax bill that supposedly intends to34 HEALTHbeat I March - April 2012

alance competing interests, but a carefulscrutiny of the bill shows that it does notserve the public interest.According to the Action forEconomic Reforms, an independent,reform-oriented policy group that conductsanalysis and advocacy on key economicissues, the Singson bill does not reformthe existing weak and backward law. Itintroduces a new classfication system thatwill merely perpetuate the weaknesses inthe law. It does not introduce indexationto inflation. Its tax rates are very low, andcannot even correct the losses from inflationin the previous years. This defeats the twinobjectives of significantly yielding revenuesfor government and stemming the rise ofboth communicable and non-communicablediseases arising from tobacco and alcoholconsumption.Pro-Abaya Bill in Full Forceproducts, he had come to the conclusionthat only manufacturers prospered at theexpense of the farmers.Chavit said that he was alarmedwhen two giant tobacco companies mergedbecause they would monopolize theindustry to the detriment of farmers andsmall companies. He vowed to explain thebenefits of supporting and passing of theAbaya bill to other congressmen and tobaccofarmers in his area.Meanwhile, Umali who leadsthe LPP, the organization of all provincialgovernors in the country, said, “The LPPsupports this landmark legislative measure(HB 5727) which will generate revenues tofinance public-private partnership projects,prevent smoking related expenditures, andsave young and poor countrymen fromlifestyle diseases.”Former Finance SecretaryMargarito Teves also expressed the urgencyon the enactment of the Abaya bill, whichhe said is an “improved” version of theDepartment of Finance’s (DOF's) proposalunder the Arroyo administration. “I wantit to be like the Conditional Cash Transfer.The funding for tobacco farmers was notincluded on our proposed bill during mytime. But with HB 5727, farmers are assuredof income in the event that they would shiftto other crops,” he said.The bill provides a safety net forthe tobacco farmers. The history of tobaccofarming in the Philippines showed that it isdeclining and a lot of farmers have shiftedto other crops. In the 1990s, 69,000 hectaresin the country were used for tobacco, but itis now down to 30,000 hectares. In studiesmade by the Department of Agriculture, thepossible alternatives for tobacco would besweet corn, tomatoes, sweet pepper andbitter gourd.Aside from Teves, 12 formerThe League of Provinces of thePhilippines (LPP) through its NationalPresident, Oriental Mindoro GovernorAlfonso “Boy” Umali and its NationalChairman, Ilocos Sur Governor Luis “Chavit”Singson recently joined mounting calls forthe passage of the Abaya bill. With Chavitin this corner of the arena going againsthis son’s bill, the sin tax debates becomesmore intriguing.“It’s high time that we raise thetaxes for tobacco products as this will notonly raise funds for the health sector butbenefit the tobacco farmers,” proclaimedChavit whose province is the among theleading producers of tobacco products inthe country. “I am calling our honorablelegislators to approve the Abaya Billand pave the way for the realization ofthe Universal Health Care,” added theGovernor. He said that after years ofopposing increased taxes on tobaccoIN FULL FORCE PUSHING FOR THE ABAYA BILL. From left to right: Oriental Mindoro Governor Alfonso “Boy”Umali, Health Secretary Enrique T. Ona, Ilocos Sur Governor Chavit Singson, and BIR Commissioner KimHenares. (Photo by Paking Repelente)March - April 2012 I HEALTHbeat 35

government officials expressed their supportfor the Abaya bill through a position papersigned during a press briefing. They areformer DOF secretaries Ernest Leung, Robertode Ocampo, Jesus Estanislao and Ramon delRosario; former DOF undersecretaries RomeoBernardo and Milwida Guevara; former DOHsecretaries Alberto Romualdez, EsperanzaCabral, Jaime Galvez Tan, Juan Flavier andAlfredo Bengzon; and former NationalTreasurer Leonor Briones.For her part, Bureau of InternalRevenue Commissioner Kim Henaresemphasized that the Abaya bill is beingpushed for its benefits for the health ofFilipinos as it seeks to prevent smokers andpotential smokers from indulging in thisaddictive and harmful behavior. She saidthat the bill would tax all tobacco companiessimilarly, and added that it is unfair for nonsmokersto pay for the health bills of smokers.With the proposed bill, the governmentthrough its Kalusugan Pangkalahatanagenda, it will have enough money toshoulder expenses of smoking-relateddiseases.Dr. Shin Young-soo, World HealthOrganization (WHO) Regional Director forthe Western Pacific Region, also throws inhis support the use of a percentage of theproposed tobacco tax increase for health."For a half century, the scientificcommunity has generated solid androbust evidence to show how smoking andexposure to secondhand smoke directlyharms health," Shin said. "We know thatHEALTH tipsecondhand smoke contains not justnicotine and tar but more than 7,000 otherchemicals, including hundreds that are toxicand about 70 that can cause cancer. WHO hasa very clear stance on tobacco control and isdetermined to help governments protect thehealth of their people."We realize that developingstrong tobacco control policies is notsimple. Nevertheless, we know that therestructuring of tobacco prices and taxesin the Philippines would significantlyreduce tobacco consumption and preventunnecessary suffering and death fromcancer, heart disease, stroke, and suchchronic respiratory diseases as emphysema,which, with diabetes, are now the leadingcauses of illness and death in the country,”The National Youth Commission(NYC) is also in the bandwagon appealingto Congress for higher taxes on cigarettesto discourage Filipino youth from acquiringthe deadly habit. NYC Commissioner PercivalCendana said, “We have one of the cheapestprices of cigarettes, not only in SoutheastAsia but also in the Asian region. At present,a local cigarette stick costs P2.”The most popular brands ofcigarettes sold in the Philippines cost anaverage of less than 50 cents per pack. Bycontrast, in the Lao People's DemocraticRepublic cigarette prices recently doubledto about one US dollar per pack. In Malaysia,cigarettes cost three US dollars per pack. Theaverage cost of a pack of cigarettes in HongKong (China) is six US dollars and nine inSingapore.The NYC reiterated a recent studyby the University of the Philippines-DilimanCommunication Research Society thatrevealed 60 percent of its respondents willquit smoking if cigarettes were priced at P5per stick.The NYC said that based on its“conservative estimation,” two out fiveFilipino teens aged 13 to 15 years smokedin 2011. This computation was based onthe Philippines Global Youth Tobacco Surveywhich showed that 19.6 per cent of the agegroup smoked in 2003. This figure increasedto 27.3 per cent in 2007. The NYC estimatedthat youth smokers increased by 40 percentlast year.Health Secretary Enrique T.Ona expressed great satisfaction at thisdevelopment which bodes well for theAbaya bill.“We appreciate the support ofour partners who fully understand how thismeasure will boost our fight against themenace of non-communicable diseases aswell as our efforts to achieve KalusuganPangkalahatan, he said. Ona also revealedthat the bulk of the projected revenue fromthe measure will be channeled to financeof the administration’s effort to achieveuniversal health coverage in PhilHealth andto enhance the nation’s health care systemby upgrading government health facilities toprovide better health services.“We again urge legislators to passthe sin tax reform bill,” Ona concluded.Coffee With Dinner? Try Decaf...That after-dinner cup could be interfering with your sleep. To get a good night's rest, avoid caffeine for eight hours before bedtime.While your body doesn't store caffeine, it takes many hours to eliminate the stimulant from your system. (Lifted from Mayo Clinic website.)36 HEALTHbeat I March - April 2012

Muslim HEALTHWhy Nicotine is So AddictivebyTATO M. USMAN, MD, MPAIMDOH Center for Health Development - Autonomous Region in Muslim MindanaoAddiction is defined as compulsiveuse despite damage to the individual orsociety and drug-seeking behavior cantake precedence over important priorities.It persists despite a desire to quit or evenrepeated attempts to quit.Nicotine is an alkaloid found in thenightshade family of plants that constitutesapproximately 0.6%-3.0% of the dry weightof tobacco, with biosynthesis taking place inthe roots and accumulation occurring in theleaves.Nicotine is the tobacco plant'snatural protection from being eaten byinsects. Its widespread use as a farm cropinsecticide is now being blamed for killinghoney bees. A super toxin, drop for drop it ismore lethal than strychnine or diamondbackrattlesnake venom and three times deadlierthan arsenic.One cigarette may have approximately1-1.5 mg nicotine (depending on thebrand) and it is only one of more than 7,000chemicals such as carcinogens (cancercausingagents), toxic metals and poisongases) found when tobacco is lighted up.Nicotine is a tertiary amine thatresults in addiction. According to John R.Polito, author of Freedom from Nicotine -The Journey Home, it is hard to understandnicotine addiction, or any form of drugaddiction for that matter, without a basicunderstanding of the brain's primarymotivation neurotransmitter, dopamine.The brain's dopamine pathways serve as abuilt-in teacher. It uses a desire, yearningNicotine: C 10H 14N 2. Photo grabbed from the or wanting sensation to get our attentionwhen it wants to pound home a survivallesson necessary to keep us humans aliveand thriving.When we feel hunger ourdopamine pathways are being stimulated,teasing us with anticipation "wanting"for food. If kept waiting, the anticipationmay build into urges or even full-blowncraves. Each bite we eat further stimulatesdopamine flow until stomach peptides atlast tell the brain we're full and wantingbecomes satisfied.But our brain does not stop withsimply creating and satisfying wantingassociated with species survival eventssuch as eating, drinking liquids, bonding,nurturing, accomplishment and sex. Itmakes sure that we don't forget them, thatin the future we pay close attention to theseactivities.The brain associates and recordshow each particular wanting was satisfied inthe most durable, high-definition memorythe mind may be capable of generating. Itdoes so by hard-wiring dopamine pathwayneuro-transmissions into our consciousmemory banks (in the prefrontal cortex ofthe brain), where each is linked to the eventthat satisfied dopamine pathway wanting,March - April 2012 I HEALTHbeat 37

hunger and yearning.On one hand, smoking a singlecigarette may provide enough nicotine toinitiate the addictive process, a recent studyfound. That is because a small quantity ofnicotine, roughly equivalent to what is foundin one cigarette, can produce long-lastingchanges in the dopaminergic reward centersof the midbrain. By studying rat brain tissue,University of Chicago researchers found thatthe nicotine in cigarettes not only directlystimulates nicotinic acetylcholine receptorsin the ventral tegmental area (VTA), oneof the dopaminergic reward centers of themidbrain, but also alters synaptic function inthe VTA.In the study by Huibert Mansvelder,PhD and Dr. McGehee, the direct stimulatoryeffect on the nicotinic acetylcholine receptorsin the midbrain was short-lived becausethese receptors desensitized in a matter ofseconds. However, nicotine also induced along-term potentiation of excitatory input tothe dopamine neurons.This phenomenon, said Dr.McGehee, probably explains the sustainedrise in dopamine release that followsnicotine exposure; the root cause appearsto be activation of presynaptic alpha 7subunit containing nicotinic acetylcholinereceptors on glutamatergic terminals. Thisactivation results in an ongoing increase inthe excitatory input to the VTA.Recently, the National Institute onDrug Abuse-funded researchers have shownin animals that acetaldehyde, anotherchemical constituent of tobacco smoke,dramatically increases the reinforcingproperties of nicotine and may alsocontribute to tobacco addiction14.The investigators further reportthat this effect is age-related, with adolescentanimals displaying far more sensitivity tothis reinforcing effect 14, suggesting thatthe brains of adolescents may be morevulnerable to tobacco addiction.Likewise, ammonia added tocommercially made cigarettes can boostthe availability of nicotine up to 100 times,says a new study by the Oregon GraduateInstitute of Science and Technology inPortland. The study supports the claim ofmany critics of the tobacco industry thatammonia enhances the effect of nicotine, aclaim that tobacco companies have denied.The process of increasing theimpact of nicotine by adding ammonia iscalled "free-basing" to heighten the effectsof nicotine.Nicotine exists in two forms,namely: acid and base. When ammonia isadded, the nicotine converts from acid tobase form. The base form can vaporize moreeasily from the smoke particles into thegas phase, enabling it to deposit directlyon the lung tissue and immediately diffusethroughout the body.Although the research has shownthat ammonia makes nicotine more availablefrom cigarette smoke, James F. Pankow, oneof the authors of the study, warns that moreresearch needs to be done to determinewhether "the increased chemical availabilitytranslates into a more rapid uptake ofnicotine by the smoker."Similarly, the Action Smoking onHealth and the Imperial Cancer ResearchFund say that they have evidence uncoveredby a review of tobacco industry documentsthat:• Additives are used to makecigarettes that provide high levelsof 'free' nicotine which increases theaddictive kick of the product;• Additives are used to enhance thetaste of tobacco smoke;• Sweeteners and chocolate are usedto make cigarettes more palatable tochildren;• Eugenol and menthol are addedto numb the throat to mask theaggravating effects of tobaccosmoke;• Additives such as cocoa are usedto dilate the airways allowing thesmoke an easier and deeper passageinto the lungs; and• Additives are used to mask thesmell and visibility of smoke that isnot breathed in by the smoker.The Islamic Stanceon Tobacco AddictionEminent Muslim scholar SheikhYusuf Al-Qaradawi, states: “There is harmfuleffect of smoking that is disregarded by thosewho have tackled the issue of smoking likethe negative psychological effect. Gettingaccustomed to smoking enslaves one'swill and makes it a prisoner of that foolishhabit that one can hardly give up even ifone decides to do so one day for a certainreason, such as noticing its obvious negativeeffect on one's health or concerns aboutupbringing one's children, or discoveringone's need to spend one's money on usefuland beneficial matters, or for any othersimilar reason. Due to such psychologicalenslavement, most often than not, smokerneglects to meet the needs of one’s familybecause one is addicted to smoking, fromwhich one has become unable to freeoneself. In addition, if a smoker cannotafford it for a single day, due to an internal orexternal reason, one becomes afflicted witha state of disorder, imbalance, irritation andanger for the slightest reason.”In gist, there is a clear link amongacetaldehyde, additives (like ammonia),nicotinic receptors (including alteration ofsynaptic function in the VTA) and dopaminethat makes nicotine more addictive.Allah Almighty knows best.- o O o -38 HEALTHbeat I March - April 2012

environmental HEALTHPhoto floats online.TheAIR POLLUTIONthat we breathebyABIGAIL CORPUZ-QUETULIOHEALTHbeat StaffBreathing can be dangerous inMetro Manila.A few years back, I was confined atthe Lung Center of the Philippines for a lungsurgery that was caused by a congenitalanomaly. After the operation, I was given acopy of my medical records and there I sawthe condition of my lungs and how theylooked like. I noticed there were tiny spots/stains in my lungs and when I asked thesurgeon about it, he said those stains werejust caused by the air pollution in MetroManila. I realized that this happened to mylungs after only five years' stay in MetroManila. I dreaded the thought of the extentof damage the air pollution would bring tomy health in the next coming years.Metro Manila has the worst airpollution in the country today. According tothe Department of Environment and NaturalResources (DENR), around 80% of MetroManila’s air pollution comes from vehicleswhile around 20% comes from factories,waste burning, and dust.Poor air quality affects healthand daily exposure to polluted air can beassociated with worsening lung problemsand increased cardiovascular events such asstroke and heart attacks. The Departmentof Health records show that three of thetop 10 causes of deaths (chronic lowerrespiratory diseases, diseases of the heart,and pneumonia) and four of the top 10causes of illness (acute lower respiratorytract infection and pneumonia, bronchitis/bronchiolitis, diseases of the heart, andacute respiratory infection) are related to airpollution.Air pollution, as defined bythe World Health Organization, is thecontamination of indoor or outdoorenvironment by any chemical, physical orbiological agent that modifies the naturalcharacteristics of the atmosphere. Accordingto a World Bank study, around 18 millionFilipinos are exposed to air pollution,resulting in an annual national economic lossof P7.6 billion due to human productivityloss.DENR Secretary Ramon J. P. Pajestressed, “We need to reverse this trend, orat least put a stop to it not only for the sakeof the economy, but more importantly, toimprove our quality of life.”Air Pollutants and HealthThe following are the common airpollutants and their health effects:Particulate Matter (PM) or tinyMarch - April 2012 I HEALTHbeat 39

airborne particles or aerosols of two sizes:10 micrometers or less and 2.5 micrometersor less. These are collectively referred to astotal suspended particles (TSP), a regulatorymeasure of the mass concentration of PM incommunity air. These particles constantlyenter the atmosphere from human sourceslike motor vehicle use, combustion productsfrom space heating, industrial processes,power generation, and smoking tobacco. Thehealth effects include reduced lung function,inflammation of the lungs, increasedsusceptibility to respiratory infections,aggravation of heart and lung diseases,and may cause chronic bronchitis and lungcancer.Sulfur Dioxide (SO2), a poisonousgas with a pungent, irritating smell releasedfrom vehicular emissions, combustion offossil fuel (coal and heavy oils) and industrialemissions. Its health effects are breathingdifficulties, eye irritation, chest tightness,especially among asthma sufferers, andaggravation of heart and lung diseases.Nitrogen Oxide (NO 2) is a binarycompound of oxygen and nitrogen or amixture of such compounds found in vehicleexhaust, tobacco smoke and smog. Itshealth effects are irritation of the respiratorytract, increased susceptibility to respiratoryinfection, and impaired lung function.Carbon Monoxide (CO) is acolorless, odorless, and tasteless gas that isslightly lighter than air. It is found in vehicularemissions resulting from incompletecombustion. It can cause headaches,dizziness, chest pains among those sufferingfrom cardiovascular disease, and deathwhen exposed in high concentration.Volatile Organic Compounds(VOCs) are organic chemicals that havea high vapor pressure at ordinary, roomtemperatureconditions. Their high vaporpressure results from a low boiling point,which causes large numbers of moleculesMan-made outdoor and indoor air pollution affects the lungs and other vital organs of the body. Photograbbed from .to evaporate or sublimate from the liquid orsolid form of the compound and enter thesurrounding air. VOCs are numerous, varied,and ubiquitous. They include both naturallyoccurring chemical compounds and manmadelike in vehicular emissions andbiomass burning. VOCs can cause irritationof the eyes, nose and throat, headaches,nausea and loss of coordination.Ground Level Ozone (03) or“bad” ozone is not emitted directly into theatmosphere. It results from photochemicalreactions between NO 2and VOCs in thepresence of sunlight. It can cause itchinessand burning of the eyes, irritation andinflammation of the lungs, breathingdifficulty, and increased susceptibility torespiratory infections.Poly-Aromatic Hydrocarbons(PAH) are chemical compounds that containmore than one fused benzene ring. Theyare commonly found in petroleum fuels,coal products, and tar; e.g. Naphthalene,Anthracene and Phenanthrene. Theyare produced by combustion processes,including solid fuel use in households;tobacco smoke; vehicular and industrialemissions. Long-term exposure to PAH canlead to cancer, and affects the reproductivesystem, liver, lungs and skin.Usok Mo, Buhay KoOn February 29, the DENR and itspartners conducted a Clean Air Summit forMetro Manila dubbed as “Usok Mo, BuhayKo” which was participated in by close to400 participants coming from nationalgovernment agencies, local governmentunits (LGUs) and civil society.The Summit was organized by theDENR’s Environmental Management Bureau(EMB), along with the Department of Interiorand Local Government, the Department of40 HEALTHbeat I March - April 2012

Transportation and Communication (DOTC),the Metro Manila Development Authority(MMDA), the Kapisanan ng mga Brodkasterng Pilipinas (KBP) and the Philippine MedicalAssociation (PMA). Late last year, the DENR,PMA and KBP signed a Memorandum ofAgreement that sought to strengthen theanti-smoke belching program in MetroManila in an effort to maintain reducedparticulates in Metro Manila. PMA and KBPcommitted to help raise public awarenesson the urgency of addressing the country’sworsening air pollution problem.The Summit drew attention to theunhealthy effects of constant exposure toair pollution especially in Metro Manila, andenjoined commitments from various sectorsto address the problem. It was agreed uponduring the summit that there was need for a“no nonsense crackdown plus a readjustmenton policies involving the implementation” ofthe Clean Air Act.Under the Clean Air Act, theDENR has a major role as it serves as theenvironmental pollution regulatory agencyparticularly for air quality by settingstandards, enforcement and monitoring.The DOH, on the other hand, has therole of participating in the developmentof air quality policies, guidelines andstandards. The DOH also provides healthinformation relative to diseases related toair pollution. The Department of Energysets specifications for all fuel types andfuel-related products. Meanwhile, the DOTCthrough the Land Transportation Office(LTO) conducts roadside inspection andemission tests for approval and renewal ofvehicle registrations. The LGUs includingMMDA and as deputized by the LTO alsoconduct roadside inspections and emissiontest for smoke belching vehicles. They arealso mandated to implement the banningof smoking in public places and burning ofwastes.Dr. Mike Aragon, PMA media affairschairman, said laws and policies governingair pollution need amendments to makethem attuned to the times. “Enforcementis the problem. Unsustained enforcementof the law coupled with graft is a majorstumbling block in eliminating air pollutionin the National Capital Region,“ he said.Dr. Mardave Martinez, PMA vicepresident, said air pollution “kills” and itshould not be tolerated. Before death comes,an affected family will first suffer from hugehospital expenses and loss of income due tosickness related to air pollutants, he said.Meanwhile, Health SecretaryEnrique T. Ona said that having a systematicand strict implementation on programs andinitiatives to reduce air pollution would havedirect health significance. As the presentadministration seeks towards achievingKalusugan Pangkalahatan (UniversalHealth Care), strengthening the promotionand monitoring for air quality is indeed animportant health issue to address. As everyFilipino deserves access to quality healthcare services, everyone also deserves a goodfresh air to breathe in especially here inMetro Manila.Measuring Air QualityA month after the Summit, theDENR reported that it has started puttingair quality monitoring stations capableof gathering PM 10and PM 2.5. The TSP willstill be monitored, but Sec. Paje said, “Wedo recognize the importance of shiftingto measuring PM 10PM 2.5as the moreappropriate indicators of the adverseimpacts of air pollution on human health.”He stressed that with the levels ofTSP going down, the DENR can now focusmore in coming up with concrete measuresto address PM 10and PM 2.5pollution. Based onthe DENR National Air Quality Status Report2005-2007, the TSPs were on a decreasingtrend – from 144 to 97 microgram perNormal cubic meter (ug/Ncm) but theconcentrations are still above the annualmean for TSP guideline value for one year of90 ug/Ncm.The DENR has already set upPM 10monitoring stations in Metro Manila.There are nine stations monitoring PM 10,6 of which are manual and are situated inCaloocan, DOH Manila, MRT Pasay-Taft,Marikina, National Printing Office (NPO)-EDSA and MMDA Guadalupe. There are threeautomatic stations and these are located atRadyo ng Bayan in Valenzuela City, AteneoUniversity and National Mapping andResource Information Authority (NAMRIA)which also measures PM 2.5.Based on EMB records, moststations showed readings that exceed thePM 10annual guideline value of 60 microgramper normal cubic meter as provided for inthe Clean Air Act. These are the stations atNPO-EDSA (74 ug/Ncm), Marikina (66 ug/Ncm), Pasay-Taft (130 ug/Ncm), Valenzuela-Radyo ng Bayan (64 ug/Ncm) and Caloocan-Partisol (168 ug/Ncm).Paje added that the installation ofadditional monitoring stations on PM 10andPM 2.5is now underway. For 2012, the DENRwill put seven more PM 10and PM 2.5stations,and eventually work towards setting upstations in all cities and municipality ofMetro Manila in 2013.Paje stressed the need for moreintervention to achieve healthy air quality.This includes the enhancement of antismokebelching operations in Metro Manila;the adoption of more stringent emissionstandards for all types of motor vehicles;and stricter monitoring of private emissiontesting centers and motor vehicle inspectionstations with the use of closed-circuittelevision or CCTV cameras.- o O o -March - April 2012 I HEALTHbeat 41

physical ACTIVITYHEALTHY LIFESTYLEBanat ni Lolo, Hirit ni LolaOld Age Doesn't Mean Poor Health“Banat ni Lolo, Hirit ni Lola” maysound vulgar, but it’s not!It is the way the Department ofHealth is encouraging the older populationto live a healthy lifestyle and participatefully in society by making importantcontributions as family members, volunteersand as active participants in the workforce.Old age should no longer be equated withpoor health.Dr. Margaret Chan, directorgeneralof the World Health Organization(WHO), said, “When a 100-year-old manfinishes a marathon, as happened last year,we have to rethink conventional definitionsof what it means to be ‘old’. Stereotypesdeveloped in past centuries no longer hold.”Life expectancy is going up in mostcountries, meaning more and more peoplelive longer and enter an age when they mayneed health care. Meanwhile birth ratesare generally falling. Countries and healthcare systems will need to find innovativeand sustainable ways to cope with thedemographic shift.In the next few years, for thefirst time, there will be more people in theworld aged over 60 than children agedless than five. By 2050, 80% of the world’solder people will be living in low- andmiddle-income countries. The main healthchallenges for older people everywhere arenoncommunicable diseases (NCDs), such asheart disease, stroke, cancer, diabetes, andchronic lung disease.With the rapid ageing ofpopulations, finding the right model forlong-term care becomes more and moreurgent. “People in low- and middle-incomecountries currently face up to four times the42 HEALTHbeat I March - April 2012

isk of death and disability from NCDs thanpeople in high-income countries, yet most ofthese conditions are largely preventable orinexpensive to treat,” says Chan.This year, on the occasion of theWorld Health Day (April 7), the WHO iscalling for urgent action to ensure that, at atime when the world's population is ageingrapidly, people reach old age in the bestpossible health.The risk of developing all NCDs canbe significantly reduced by adopting healthybehaviors, such as being physically active,eating a healthy diet, avoiding the harmfuluse of alcohol and not smoking or usingtobacco products. The earlier people adoptthese behaviours, the better their chance ofenjoying a healthy old age. Healthy lifestylefrom the very beginning of life is key to ahealthy and active old age.The WHO highlights the needfor countries to take steps to prevent NCDsand to ensure that systems and servicesare in place to provide treatment and carewhen it is required. Many of these servicesare highly cost-effective. For example, highblood pressure – a key risk factor for bothheart disease and stroke – can be effectivelytreated for just a few dollars a year. Today,less than 15% of older people in low- andmiddle-income countries in need arereceiving treatment for high blood pressure.The WHO has outlined four keyactions that governments and societies cantake now to strengthen healthy and activeageing.• Promote good health and healthybehaviours at all ages to prevent ordelay the development of chronicdiseases.• Minimize the consequences ofchronic disease through earlydetection and quality care (primary,long-term and palliative care).• Create physical and socialenvironments that foster the healthand participation of older people.• "Reinvent ageing" - changing socialattitudes to build a society in whicholder people are respected andvalued.Ageing Population in the PhilippinesIn the Philippines, the populationof 60 years or older was 3.7 million in 1995or 5.4% of the total population. In the 2000census, according to the National StatisticalCoordination Board, this increased to about4.8 million or almost 6%. At present, thereare 7 million senior citizens (6.9% of thetotal population), 1.3 million of which areindigents.With the rise of the ageingpopulation is also the increase in thedemand for health services by the elderly.According to a study on the share of healthexpenditure of Filipino elderly on thenational health account (Racelis et al, 2003),the elderly are "relatively heavy consumersof personal health care (22%) and relativelylight consumers of public health care (5%)."From out-of-pocket costs, the aged are heavyusers of care provided by medical centers,hospitals, non-hospital health facilities andtraditional care facilities.Fortunately in the Philippines,like in most Asian countries, it is customaryfor the family elder to be cared for by hischildren or other relatives. There is a senseof respect and reverence of Filipinos to theelderly. Adult children care for their parentsout of respect and gratitude for raisingthem. The government is also making surethat Filipino elderly are assisted in old age.An Office for Senior Citizens Affairs in citiesand municipalities attends to their needs,while the senior citizens' ward in everygovernment hospital provides better healthcare.Moreover, the DOH is currentlylining up appropriate and quality health careservices for the elderly, especially those whobelong to the marginalized sector.Last year, 197,000 pneumococcaland 173,000 influenza vaccines weredelivered to all Centers for HealthDevelopment (DOH regional offices) andprovided for indigent senior citizens. HealthSecretary Enrique T. Ona also revealed thatthe DOH is targeting to give out 1,043,745 ofthe said vaccines this year for indigent seniorcitizens aged 60 years old and above usingthe National Household Targeting Systemof the Department of Social Welfare andDevelopment.The DOH also conducts a "SummerCamp ni Lolo at Lola" every May andsupports the Walk for Life" for the elderlyevery October.Good Health Adds Life to YearsWorld Health Day is celebratedon April 7 to mark the anniversary of thefounding of the WHO in 1948. The day fell onBlack Saturday this year and the DOH and itspartners moved the celebration to April 11 atthe Quezon Memorial Circle in Quezon City.The worldwide theme "Good Health AddsLife to Years" was transformed into a morefun way of doing things in the Philippinesand became "Healthy Lifestyle: Banat ni Lolo,Hirit ni Lola.” In the event, a dance-exercisevideo for senior citizens was launched toprovide them with opportunities in adoptinga healthy lifestyle. The exercise video wasdeveloped by the Strength and Conditioning,Inc. in collaboration with the DOH and WHOPhilippines Office.The Philippine Physical ActivityGuidelines generally prescribes 30 minutesto one hour of physical activity and exerciseper day which can be done in accumulated 10minute bouts throughout the day or in oneMarch - April 2012 I HEALTHbeat 43

continuous session. For older population,60 years old and above, at least 30 minutesof light to moderate physical activity,accumulated or in one session, is needed formost days of the week, if not daily.Older adults need their balance,strength and flexibility to ensure appropriatefunctionality and a good quality of life.Researches reiterate over and over thechallenges brought about by ageing, suchas balance deficiencies, loss of strength, andsoft tissue stiffness. All these are alleviatedby appropriate physical activity and exercise.The dance-exercise video forolder persons adopts movements that aresimple and easy to follow. While it is onlyFACEbeat12 minutes in length, it may be repeated ifmore exercise is desired. However, it mustbe emphasized that physical activity is bestdone with variety to effect balance andmoderation. As such, other forms of physicalactivity should be done to complete the 30minutes to one hour requirement. Examplesare household chores, physically activecommute, physically active recreationalactivities, social and other forms of dancing,and other forms of exercise such as yoga, taichiand the like.For most people, physical activityand exercise promote health and wellnessbenefits. However, it must also be recognizedthat for a small minority of population, itcan cause potentially dangerous outcomessuch as injury and illness. To reduce therisks associated with physical activity andexercise, a clearance from a physician isneeded and adherence to the limitationsprescribed by the results of the evaluation.And a final reminder, adopting ahealthy lifestyle requires consistency andgood habit formation. For people doing thedance exercise-video, it is important to startslow and adopt modest objectives. Makeprogress only when the exercise becomescomfortable and easy. And at any pointduring the exercise, do not hesitate to stopif dizziness, nausea, shortness of breath orchest pains manifest.IbangTeknolohiya(Photo floating online)44 HEALTHbeat I March - April 2012

one HEALTHTrigger FingerbyDONATO DENNIS B. MAGATHEALTHbeat StaffDENNIS: Bakit pag umaga di ko maunatang middle finger ko? Sobrangsakit!GLEN: Rayuma yan, pare.PAKING: Sumpa yan, pare. Tingnan moaffected yung bad finger mo.DENNIS: Mga loko! Bakit ba kinausap kopa kayo. Wala naman pala akomapapala sa inyo.It isn’t the usual Healthbeat joke,so don’t be dismayed if you did not find itfunny. In fact, the pain I had with my middlefinger was so excruciating, especially in themorning.One of the most common handproblems/injuries encountered today inorthopedic practice is trigger finger, alsoknown as trigger digit. Trigger finger ismedically termed Stenosing Tenosynovitis.Itis a "snapping" condition of any of the digitsof the hand when opened or closed.One of the fingers gets stuck ina bent position and then straightens witha snap — like a trigger being pulled andreleased. If trigger finger is severe, the fingermay become locked in a bent position. Thecondition is called trigger finger becausewhen the finger unlocks, it pops backsuddenly, as if releasing a trigger on a gun. Itis a common disorder, usually among adults,characterized by catching, snapping orlocking of the involved finger flexor tendon,associated with dysfunction and pain.Often painful, trigger finger causesthe fingers or thumb to catch or lock in aMarch - April 2012 I HEALTHbeat 45

Dr Jonathan Sabadao (second year hand resident, left) and Dr. Ryan Ruiz (chief resident, center) ofthe Jose R. Reyes Memorial Medical Center Orthopedic Department treat Dennis Magat (Healthbeat'smanaging editor, right) who is suffering from trigger finger. (Photo by Paking Repelente)bent position. The problems often stemfrom inflammation of tendons that arelocated within a protective covering calledthe tendon sheath. People whose work orhobbies require repetitive gripping actionsare more susceptible. It is also more commonin women and in anyone with diabetes.Dr. Melito Antonio Ramos, formerVice Chair of the Jose R. Reyes MemorialMedical Center (JRRMMC) OrthopedicDepartment, explains that trigger finger is acondition that usually affects older persons.He added that it occurs becausethere is a disparity in size between the flexortendon and the surrounding retinacularpulley system, commonly known as the A1pulley, resulting to difficulty in flexing orextending the finger and the “triggering”phenomenon.Basically, the cause of triggerfinger is a narrowing of the sheath thatsurrounds the tendon in the affected finger.Tendons are fibrous cords that attach muscleto bone. Each tendon is surrounded by aprotective sheath — which, in turn, is linedwith a substance called tenosynovium. Thetenosynovium releases lubricating fluid thatallows the tendon to glide smoothly withinits protective sheath as the finger bends orstraightens like a cord through a lubricatedpipe.If the tenosynovium becomesinflamed frequently or for long periods,the space within the tendon sheath canbecome narrow and constricting. The tendoncan't glide through the sheath easily, attimes catching the finger in a bent positionbefore popping straight. With each catch,the tendon itself becomes more irritatedand inflamed, worsening the problem.With prolonged inflammation, scarring andthickening (fibrosis) can occur and bumps(nodules) can form in the affected finger/s.Diagnosis is made almostexclusively by history and physicalexamination alone. More than one fingermay be affected at a time, though it usuallyaffects the thumb, middle, or ring finger. Thetriggering is usually more pronounced in themorning, or while gripping an object firmly.Data presented at the 2005American College of Rheumatology NationalMeeting suggests that a majority of patientswith rheumatoid arthritis have inflammationaround the tendons of the palm of thehand that could develop into trigger finger.Also, prolonged, strenuous grasping mayaggravate the condition.In the Philippines, there is no exactdata on the number of affected Filipinos butDr. Ryan Ruiz, chief resident of the JRRMMCOrthopedic Department, approximates thatabout 25-30 patients every month are seenat the JRRMMC. If left untreated, this mayresult/progress to pain or restrictive fingermovement.He further explained that peoplewhose occupation requires mostly the useof their hands are prone to develop triggerfinger. Farmers, industrial workers, andmusicians are frequently affected by triggerfinger since they rely on their fingers orthumbs for multiple repetitive movements.The condition is more common in womenthan in men with a frequency of 2-6 timesand tends to occur most frequently in peoplewho are between 40 and 60 years of age. Thepeak incidence of trigger finger is observedamong individuals aged 55-60 years. Agedistribution has not changed significantlydespite repetitive tasks.Increased incidence of triggerfinger is observed in the dominant hand.The involvement of several fingers is notunusual. Triggering seems to occur morefrequently in patients with rheumatoidarthritis or diabetes mellitus. These patientsalso seem to be more resistant to injectiontreatment.One of the first symptoms oftrigger finger is soreness at the base ofthe finger or thumb. The most commonsymptom is a painful clicking or snappingwhen attempting to flex or extend theaffected finger. This catching sensation46 HEALTHbeat I March - April 2012

tends to worsen after periods of inactivityand loosen up due to continuous movement.The signs and symptoms mayprogress from mild to severe. These include:finger stiffness, particularly in the morning,popping or clicking sensation as the finger/sis move, tenderness or a bump (nodule)at the base of the affected finger, fingercatching or locking in a bent position, whichsuddenly pops straight, finger locked in abent position, which becomes unable tostraighten.Dr. Jonathan Sabadao, secondyearhand resident also of JRRMMCOrthopedic Department, explained thatthe key to prevention is education, properbiomechanics, and common knowledge.The common mistake of trying to workthrough the pain over use of the finger mustbe avoided. When dealt with trigger fingersymptoms, address it conservatively by shortexercises during stressful work at home,massage, resting and soaking finger in tepidwater is effective and are good preventivemeasures. When symptoms persist, see yourphysician.No x-rays or lab tests are usedto diagnose trigger finger. It is generallydiagnosed following a physical exam of thehand and fingers. In some cases, the affectedfinger may be swollen and there may be anodule, or bump, over the joint in the palmof the hand. The finger may also be locked ina flexed (bent) position, or it may be stiff andpainful.“Treatment of trigger fingervaries depending on the severity. The firststep to recovery is to limit activities thataggravate trigger finger, Sabadao explained.Occasionally, a doctor may put a splint on theaffected hand to restrict the joint movement.If symptoms continue, anti-inflammatorymedications may be prescribed.An injection of steroid medicationmay also be recommended into the tendonsheath. If the condition does not respond toconservative measures or consistently recurs,surgery may be recommended to releasethe tendon sheath and restore movement.Stretching, ice, and anti-inflammationtreatments can be helpful.The most rapidly effectivetreatment is a local cortisone injectionaround the affected tendon and mostpatients responds to this type of treatment.However, if the condition persists after twoinjections, surgical procedure to ultimatelyremove the inflamed or scarred tissue isconsidered.The recovery time differs fromevery individual and depends on the severityof the condition. The choice of treatmentalso impacts recovery time. However, mostpatients with trigger finger recover withina few weeks by resting and limiting the useof the affected finger and/or using antiinflammatorymedications.Injection of the tendon sheathwith a corticosteroid is effective over weeksto months in more than half of patientstreated. When corticosteroid injection fails,the problem is predictably resolved by arelatively simple surgical procedure (usuallyoutpatient, under local anesthesia). Aregimen of physical therapy is generallyprescribed after the procedure, which mayextend for two to six months.One recent study in the Journalof Hand Surgery suggests that the mostcost-effective treatment is two trials ofcorticosteroid injection, followed by openrelease of the first annular pulley. Choosingsurgery immediately is often not necessaryfor resolution of symptoms.More recently, a randomizedcontrolled trial comparing corticosteroidinjection with needle release and openrelease of the A1 pulley reported that only57% of patients responded to corticosteroidinjection (defined as being free of triggeringsymptoms for greater than 6 months). This iscompared to a percutaneous needle release(100% success rate) and open release(100% success rate). There is a theoreticalgreater risk of nerve damage associatedwith the percutaneous needle release as thetechnique is performed without seeing theA1 pulley.Other investigative treatmentoptions with limited scientific supportinclude non-steroidal anti-inflammatorydrugs, occupational or physical therapy,steroid treatment, splinting, therapeuticultrasound with anti-inflammatory creamand acupuncture.Sabadao also suggests that peoplewith trigger finger should immediatelyconsult a health professional as this maylimit one’s performance of daily tasks oreven productivity at the workplace.- o O o -Oki, Dok!ED:RAUL:Pare, alam mo ba kung bakit nagsusuot ng gloves ang mga duktor at nars bago mag-opera?'Pre, kasi kung mamatay ang pasyente, walang makukuhang fingerprints!March - April 2012 I HEALTHbeat 47

fashion DOCTORThe"Crack Epidemic"“Exposure”A fit and healthy body exudesconfidence in carrying any type of clothing,from the relaxed jeans and t-shirt to themost formal barong or coat and tie for menand dinner dress or gown for women. And sothe old fashion maxim goes, “if you have it,flaunt it.”But what if you don’t have thatkind of body, and what you got is a beerbelly or a coca cola body (coke in can, thatis) instead of a six-pack abs or a curvaceousbody. Would you still wear the trendiestfashion?On the street, on television, in themall and even in the office, women (andmen too) of all ages and sizes are wearingtight, low-slung, butt-hugging jeans andpants that hit at, or often far below, the hip.Low-rise jeans are worn to display more skinat the waist, torso, and hips. Accordingly,they are sometimes worn in combinationwith shorter crop tops, giving a glimpseof skin between the jeans and the top, orshowing their entire midriff including thebelly button.This fashion statement escalatesto the “crack epidemic” where low-risejeans partially reveal the buttocks whenthe wearer sits down or bends over. In manycases, butt cleavage becomes visible.In some cases, it is the designer orbranded underwear that is flaunted. Whena thong is exposed above a pair of low-risejeans on the back, it is commonly referred toas a "whale tail," due to its somewhat similarshape. When boxer shorts become visiblethis is known as "sagging" or "sagg".A Facebook post posing as a "publicservice announcement" that is recentlycirculating, discourages people from wearinglow-rise jeans. It says that this fashion trendwas born in the United States' jails whereprisoners who were willing to have sex withother prisoners needed to invent a signal bypartially showing their butts and that theywere available to be penetrated. (See imagenext page.)In the US, low-rise jeans are said tofall out of favor in 2008 and have become lesscommon since, although they still remainsomewhat popular. In the Philippines, itis still very much in fashion especially foryoung people. However, paraphrasing thetourism campaign, wearing low-rise jeansis “more funny in the Philippines” especiallyfor the modest Filipinos. Instead of flauntingtheir butt crack, they keep on pulling theirshirts or blouses down or cover their backwith their hands when they sit or bend over.Wearing these jeans is like putting their hipsand buttocks in some humiliating way.“Etiology”Low-rise jeans are not new fashion.The style dates back to the late 1960s withthe ascendance of the hippie countercultureand rock 'n' roll, and was referred to as hiphuggers.Rock icons like Jimi Hendrix, JanisJoplin and Jim Morrison popularized it. Later,hip-huggers became a staple of popularculture and were incorporated into the discoscene of the 1970s. However, waistlines48 HEALTHbeat I March - April 2012

moved higher in the 1980s and 1990s,as more women entered the corporateworkforce.The revival of low-rise jeans canbe credited to British designer AlexanderMcQueen, who first showed his famous lowrise"bumster" trousers in his 1996 "Dante"collection show. And the style becamepopular again in the US, particularly amongthe youth, when Britney Spears startedwearing it in 2000.In 2004 and 2005, at least two USlegislators tried to outlaw low-rise jeans,particularly the display of underwear underthe pants, claiming it to be disrespectful andobscene. Their bills were eventually rejected.Now, low-rise jeans are wornby both men and women. The jeans areintended to sit low on, or below, the hips.Usually they sit at least 8 centimetres (3inches) lower than the belly button.But in several styles, the rise hasdipped as low as 3 or 4 inches.The "rise" of any jeansis determined by the distancebetween the crotch and thewaist and is usually around 30centimeters or cm (12 inches) onregular pants. In comparison, theaverage measurement of low-risejeans is roughly 20 cm (8 inches).But in several styles, the rise hasdipped as low as 7-10 cm (3-4inches).“Emergency”The real problem withextremely low-rise jeans is thatthey are impractical. Sitting isdifficult: If you cannot find a chairwith a closed back, you may haveto tie a shirt around the waist orrisk scandalizing the room. If youdrop something, or need to tie ashoelace, abandon all hope because bendingover with dignity is next to impossible.You must perfect the art of squatting, backstraight and head up. These jeans also tendto slide down, requiring the wearer to hitchthem up repeatedly.You may look nice with those lowrisejeans or any other skinny outfits for a daybut in a long run, you have no idea about theeffects of wearing skin tight clothes. Takea look to know how tight clothes impactshealth.In 2003, the Canadian MedicalAssociation Journal published a report byDr.Malvinder S. Parmar stating that lowrisejeans can cause a condition calledmeralgiaparesthetica. It is characterizedby numbness or tingling in the thighs, bypinching a nerve located at the hip. Leftuntreated, the numbness can become(A Facebook post discouraging people to wear low-rise jeans. )permanent. This condition was diagnosedin three mildly obese women who had wornlow-rise jeans for 6–8 months. It resolveditself after they avoided wearing low-risejeans for 4–6 weeks.Likewise, back pain may also occur.Wearing too tight low-rise jeans compressesthe back muscles causing pain. You will knowif your pants squeeze your waist badly whentaking a seat. Again, tingling in the area mayoccur. To prevent this, when choosing a pairof jeans, try it and see to it that it does notshrink your body when you squat.Then, there is the possibility ofyeast infection. When women’s pubic areasare kept tightly under wraps, the areabecomes very warm and moist. This makesit a breeding ground for bacteria and, asa result, can cause yeast infections. Thevaginal area becomes very itchy, irritatingand painful. To avoid this, especiallyin hot weather, avoid wearing tightpants. Instead, wear sundresses,loose fitting and breezy pants.Finally, there is heartburn,abdominal pain and evenconstipation. The tight pressureon the stomach and the abdomenleads to pain. It may cause an acidreflux resulting in severe burningsensation. Tight pants can alsoslow down the digestive process.The symptoms may include bittertaste in the mouth, pain below thewaist, pain in the abdomen for twoto three hours after eating a meal.It is important to eat smaller mealsand make sure the belt and pantsare not too tight. Or better yet,unbutton your pants and change itimmediately. Drink water and weara loose outfit.In the final analysis, clothesshould be made for comfort.- o O o -March - April 2012 I HEALTHbeat 49

SAbeatGusto Mong Away?Away BFFNagkasulutan ng boyfriend ang dalawangBFF (Best Friends Forever)...LIBBY: Anong pangarap mo?WENA: Bakit friendship?!?LIBBY: Sisirain ko!Away BekiNEIL:BRYAN:Sana mamatay na lahat ngmalalandi sa mundo!Bakit may pera ka na bangpampalibing mo?Away Mag-asawaJUDGE: Ano ang dahilan para kayomagpa-annul?JOAN: (Nagsalita habang nakayuko) Yourhonor, katawan lang ang gustoniya sa akin.JUDGE: At ano naman ang prueba mo?JOAN: (Nakayuko pa rin) Tuwingnagsisiping po kami, tinatakpanniya ng towel ang mukha ko.JUDGE: Ikaw Mister bakit mo ginawa yun?MARIO: No comment, your honor. Just seefor yourself.JOAN: (Nagalit at ihinarap ang mukha saJudge) Bastos po talaga ang 'yan!JUDGE : (Habang nakatingin kay Misis)Annulment petition granted. Ikawnaman lalaki, bakit ngayon kalang nag-file ng annulment? Angtiyaga mo rin!Away Mag-amaJOJO:Joshua! Kinuha mo ang pera sabulsa ng pantalon ko 'no?JOSHUA: Anong sabi mo 'Tay?!?JOJO:Ang sabi ko, kinuha mo 'yungpera sa bulsa ng pantalon ko!JOSHUA: 'Di ko talaga marinig 'Tay.Kung gusto mo palit tayo ngpwesto. Dito ka at ako namanang magtatanong d'yan.JOJO: Sige, subukan natin.JOSHUA: Sinong babae 'yung kasama mokanina?JOJO: Ay, oo nga! 'Di nga marinig.Away DambuhalaPRESCY: Taba, taba, magkano baboyngayon?!?BAMBI: Hoy! Ayusin mo yangpananalita mo ha!PRESCY: Baboy, baboy, magkano tabangayon?!? Hahaha.Away MatandaLYNDON: Dok! Dok! Nawala angmemorya ko!DOK: Huminahon po kayo, lolo.Kailan po nangyari ito?LYNDON: (Nagtataka) Kailan nangyariang ano?Away BansaMANNY: Tayong dalawa, para tayongPilipinas at Spratlys.MARIVIC: Bakit naman?MANNY: Kasi kahit gaano kalapit natin saisa't isa, hindi ko pa rin masabingikaw ay akin.Away MahirapERNIE:FRANK:ERNIE:FRANK:Pahingi naman ng pinya...Pahingi? Nasaan ka noongnagbubungkal ako ng lupasa ilalim ng init ng araw? Nasaanka nung binabantayan ko angmga pananim habangkumukulog, kumikidlat atbumubuhos ang malakas na ulan?Nasaan ka nung nag-aani ako nanagkalat ang mga ahas sa daananko? Nasan ka nung naghihirap akosa pagpasan ng pinya? Nasaan ka?Nakakulong kasi ako noon!Nakapatay ako ng madamot!Ganun ba? Kuha ka na, kahit ilan!May langka pa doon!50 HEALTHbeat I March - April 2012