The Blue Vanguard Vol.18

Yonsei Student Pharmacist

THE

BLUE

VANGUARD

MAIN ARTICLES Interviews

Joung Min Seo, CEO of Pharmacist

International Issues

Racial and Ethic Disparities in Health Care Battling the 'Corona Blues'

Before Covid-19 After Covid-19

2020 December

Vol.18

Editor's note Park Seo Woo Tempora mutantur, nos et mutamur in illis. This is a Latin adage meaning, “Times are changed; we, too, are changed with them.” With COVID-19 changing every aspect of our lives, 2020 was a year full of ambiguity. Despite the hardships, we have made sustained effort to adjust to the pandemic. In this light, Yonsei Pharmacy’s Blue Vanguard focused on covering changes in our daily lives, health technology, and innovations, specifically in response to the COVID-19 pandemic.

The main article in this issue is an interview with Pharmacist & Health, which introduces the development of health functional foods that are crucial for managing a healthy state.

Furthermore, racial and ethnic disparities in health care alongside the Black Lives Matter movement will also be covered. Finally, various articles dealing with COVID-19, with topics ranging from ‘Corona Blues’ to diagnostic techniques and treatments are included in this issue.

I would like to thank my fellow Blue Vanguardians for their immense effort and contribution towards improving and maintaining the one and only English pharmaceutical magazine among the 37 colleges of pharmacy. It was a challenging year, publishing amid the difficulties this epidemic has presented. Despite the adversities, Blue Vanguardians, as student pharmacists, consistently give our best effort to provide informative and enjoyable articles every semester.

We hope you enjoy our 18th issue.

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CONTENTS 1) Interview - Joung Min Seo, CEO of Pharmacist & Health : 4-5p

2) Pharmaceuticals - The Usage of Bacteria from Insects : 6-7p - Current Status on the Treatment of COVID-19 with Repurposed Drugs: 8-9p - Medical Application of CRISPER-based Genome Editing : 10-11p - Evolving Diagnostic Techniques for COVID-19 : 12-13p

3) Column - Are Animal Experiments and Drugs Incompatible? : 14-15p - Connection between COVID19 and Hair Loss : Telogen Effluvium : 16-17p

4) National Issues - Ongoing Conflict between Government and Doctors : 18-19p - Nonproprietary Names Prescription - Truth and Falsehood : 20-21p

5) International Issues - Racial and Ethnic Disparities in Health care : 22-23p - International Overdose Awareness Day : 24-25p - Battling the 'Corona Blues' : 26-27p

6) Life issues - Sleepless Nights - Getting Over Insomnia : 28-29p - Appropriate Usage of Aerobic and Anaerobic Exercise : 30-31p - Zero-waste: A Small Step to Save Our Pale Blue Dot : 32-33p

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INTERVIEW

Joung Min Seo, CEO of Pharmacist & Health

I

Seo Woo Park

pinkwoo97@naver.com

n 2014, a group of pharmacists established the company “Pharmacy & Heath” with the objective of bringing pride to local pharmacists who recommend the company’s products and improved health to consumers who purchase the products. The company distributes, sells, and exports health functional foods and cosmetics not only domestically, with over 3500 pharmacies nationwide, but also abroad. In September of 2020, the BlueVanguards of Yonsei Pharmacy interviewed Joung Min Seo, CEO of Pharmacist & Health. Amid the COVID-19 outbreak, the interview was conducted virtually using ZOOM. During the Zoom interview, Mr. Seo offered honest and sincere advice to our pharmacy students.

Q: Please tell me about yourself and your career.

After graduating from Kangwon National University, I received a doctorate degree and joined Kwangdong Pharmaceutical. While working for 7 years, I learned the process of drug development, marketing, production quality control (QC), and health supplements manufacturing. These became the foundation of what I am doing now. Also, I have been running Gwang Hye Dang as a chief pharmacist for 20 years. For the first 10 years, I managed the pharmacy with a specialization in medication counseling, especially in herbal medicines. Afterwards, I have been providing health care advice to patients using nutritional counseling, which is my strength. While managing the pharmacy, I established “Pharmacists & Health,” a company that can contribute and volunteer to the society, in 2014.

Q: What are the main reasons for starting a business?

While working for a pharmaceutical company, the reality of a company’s motive to solely pursue profit drove me away. Because pharmacists study to treat patients as health care practitioners, it felt ironic for me to work for a drug manufacturing company. Moreover, around 2013, Lactobacillus products called probiotics became a huge hit in Korea.

However, there were problems with insufficient logistics in the manufacturing process of health functional food. The packaging and theory sounded plausible, but the raw ingredients were poor and thus less effective. This motivated me to start my entrepreneurship journey because I felt it was an opportunity to provide properly made probiotics to consumers.

So, I set up a small company with one probiotic product that was made based on my in-depth knowledge of natural products and herbal medicine. The company’s first product was successful, and with the opinions of nearby pharmacists asking for other health functional foods, we gradually started making a variety of products. With the commitment to make the world’s best products, I traveled around the world searching for great raw materials and created products with them.

Through this process, we have grown into the current “Pharmacist & Health.”

Q: What drove “Pharmacists & Health” to focus on cosmetic products on top of health functional foods?

Many cosmetic products from overseas were imported into domestic pharmacies, but it did not reach the customers’ expectations. This sequence occurred because Caucasians and Asians have different skin properties. With the idea of making suitable products for Asians, we partnered with world-class cosmetic companies to supply the best raw materials

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INTERVIEW

and develop them into products. Pharmacists and Health first coined the term cosmeceutical, a compound word of cosmetics and pharmaceutical, and enables pharmacies to provide therapeutic-based products that are safe and effective.

Since product quality is our top priority, we invested 90% in the material and 10% in the packaging when we first started developing cosmetics.

Q: Recently, many health functional foods have been sold through SNS and home shopping, etcfalse advertisements are becoming indiscriminate. What do you think about this?

Health functional foods must be handled with conscience and accurate knowledge, but unfortunately, many cases are not. For example, some health functional foods are mixed with unknown chemicals, while other products contain less amount of the active ingredients than advertised. Products made with low-grade raw materials are cheaply distributed, and they are excessively advertised through the media because they are highly profitable. The current health functional food market is a bubble that will continue to grow in the future; products made by pharmacists must be differentiated from the low-grade products and follow a strict guideline that prevents ordinary companies from creating the low-grade products. Also, I believe the turbid market is an opportunity for pharmacists. If all people can make health functional foods like pharmacists, pharmacist will lose their ground. However, they must reduce margins and invest heavily in research and development to do so. In the future, relevant laws will be made, and when the market is purified, customers’ perceptions will also change, and more people will look for high-quality products. Furthermore, products handled by pharmacists will receive more attention.

Q: Can you give some advice for pharmacy students who want to start a startup in the future?

Starting a business can be a life-changing experience. However, the magical daydream of you as a successful CEO is not enough to start a business. A founder must be experienced and have the confidence that he/she will be able to succeed in his/her field. Also, accumulated references, which refer to a lot of experience in patient care are crucial. In particular, to start a business after graduating from a college of pharmacy, you need to go beyond the basic knowledge first, then gain health and treatment knowledge derived from experience. You will become an expert in a specific field while working in a pharmacy or hospital, and based on this expertise, you can start a business when you are able to add value to the society in your own way.

In addition, you should consider your role as a founder. With a straightforward philosophy and entrepreneurial spirit, start in a field where others have not been able to do. It was possible for me because I pioneered a new therapeutic field using natural products. In other words, small changes or improvements to business items are not differentiated and competitive. Keep your passion deep in your heart, and at some point, you will overcome difficult processes. Keep up with the thought of ‘I will do this,’ and prepare until the day of the new start comes. B

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PHARMACEUTICALS

The Usage of Bacteria from Insects

W

Donghwan Lee

donglee1009@naver.com

e often think that bacteria are dirty and contagious. However, we should notice that bacteria are omnipresent and mostly not infectious; only few of them are harmful to other living creatures. All animals and plants get help from bacteria. For example, bacteria in animals’ guts make nutrition that hosts cannot make or control hosts’ immunity system. It is not an exception to insects. Insects also get help from bacteria, and sometimes vice versa.

Some bacteria make enzymes that insects cannot make, protect their host from other contagious bacteria or viruses, and control the insects to select specific individual when trying to mate. Then can we get benefits from these unfamiliar bacteria? The answer is Yes!

Leefcutter Ants If you are interested in animals and watched several documentaries, especially about tropical animals, you might have seen ants that cut the green leaves with their large jaws and carry them to their house. These ants are called leafcutter ants. Leafcutter ants include several species that belong to two genera, Acromyrmex and Atta. Both have common features, living only in tropical weather and growing fungi. Yes, they harvest fungi like we harvest mushroom!

Also, the leaves they collect are not for their own diet but for the fungi. When the queen ants settle down in their nests, they start to make fungi farm with mycelium in their oral cavity. When the queendom is well-founded, mediae worker ants go out and get leaves for fungi harvesting, and minims worker ants take care of broods and fungi.

Here is one more interesting thing. The ants not only supply fresh leaves for their fungi but also protect fungi from bacteria or other parasitic fungi. For example, Acromyrmex leafcutter ants grow Leucoagaricus gongylophorus, and these fungi are vulnerable to parasitic Escovopsis fungi. Then how can ants protect their fungi from the infection?

Ants working in fungi farms have colonies of bacteria belonging to the genus Pseudonocardia on their cuticle, and these bacteria produce antibiotics. It is expected that these bacteria make various types of polyene antifungal nystatin.

Also, substances produced by Pseudonocardia help ants to fight against other pathogens. The most interesting fact is that although the ants have had symbiosis with these bacteria for more than a thousand years, they still can use antibiotics efficiently. It is thought that as Escovopsis develop resistance to antibiotics, Pseudonocardia also develops their antibiotics to kill their enemies. Also, in 2014, scientists found out that some species of Pseudonocarida have antibacterial activity against Staphylococcus aureus. Although there should be more research on how to develop it into medicine, it seems hopeful.

Beewolves Beewolves are not mammal wolves. They are wasps with a bright yellow tail, black stripes on it. They do not look like a wolf at all. However, their name came after what they prey on. They hunt bees solitarily. When a honeybee is distracted by a flower and honey, the beewolf approaches its prey. Then it injects venom into the honeybee. The prey gets paralyzed, and the feast begins.

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Unlike the other well-known bees, beewolves do not make their hive. Instead, when they are ready to make offspring, the female beewolves make nests on the sand. Although they usually live solitarily, they make nests nearby each other. When the nesting is over, female beewolves prey on bees and keep them in their nest. These bees are not for their feasts, but for their larva. The female beewolves lay only one egg in the chamber with some poor bees’ dead bodies. When the larva hatches out, it starts to devour the bees that its mother had caught for weaning food. After that, the larva makes a cocoon to hibernate through the winter and becomes a ferocious predator.

You might think ‘Oh, they have quite an interesting life cycle but not so special’. However, they have interesting skills; they somehow use antibiotics for their eggs! Female beewolves have bacteria belonging to the genus Streptomyces in their antennae. When they finish preparing for their baby, the female beewolves start to paste Streptomyces on the chamber, and these bacteria make antibiotics to protect the baby larvae. Especially when the larva starts to become a cocoon, it weaves some bacteria together, and these bacteria protect the cocoon with a cocktail of antibiotics. Yes, Streptomyces make various types of antibiotics. One more interesting fact is that the beewolves have sustained the symbiosis with Streptomyces for more than 68 million years, and it kept working to protect their babies without antibiotic resistant pathogens. The scientist found that the symbiotic Streptomyces use less selective enzyme than free-living Streptomyces when synthesizing antibiotics. This might be a reason why there is no antibioticsresistant microorganisms. Also, the adaptation of the Streptomyces, and one-time-usage of antibiotics on a one-timestay spot might be the other reasons. We might be able to find a way to use these antibiotics cocktails to fight against resistant microorganisms if we study more about the beewolves’ resistant-free antibiotics.

Mosquitoes Mosquitoes are one of the most annoying animals in the world. They bite us and make those spots itchy and scratchy. However, more severe problems are mosquito-borne diseases. Mosquitoes can carry several viruses such as Zika virus, West Nile virus, dengue virus, and malaria. According to World Health Organization (WHO), malaria alone took 438,000 lives in 2015, and about 390 million dengue virus infections occur per year. It seems quite infectious and you might think ‘We might be able to stop these infections by killing mosquitoes with insecticides.’ However, it seems like quite an impossible solution. First, there are too many mosquitoes. Second, some mosquitoes will gain resistance to insecticides. Then is there no way to save ourselves from this hell of mosquitoes? Fortunately, we might be able to find the answer from bacteria.

Wolbachia is one of the most common parasitic microbes in the world. This genus of bacteria was first discovered in 1924, in the Culex pipiens, a common house mosquito. After that, it was found that many insects have these bacteria.

Now it is estimated that 25~70% of all insect species are potential hosts. Living as a parasite, Wolbachia sometimes negatively affects its host. Some hosts die earlier than non-infected ones, and some insects cannot freely mate; infected individuals should meet infected ones to make their offspring. However, some of the other insects need Wolbachia to be alive. Bees named Asobara tabida need Wolbachia, and bedbugs need Wolbachia to make vitamin B. Also, most importantly, Wolbachia can protect mosquitoes from infection by some viruses.

Scott O’Neill, the scientist and the founder of the ‘World Mosquito Program’, tried to eliminate dengue fever since 1980, and he found that Wolbachia can be the solution. However, Wolbachia does not choose Aedes aegypti mosquitoes, the main culprit of dengue fever, as their hosts. Scott knew that Wolbachia not only prevent mosquitoes from infection of viruses but also can be transferred to offspring, so he could not give up the hope. At last he found a Wolbachia strain named ‘popcorn’ and succeeded to transfer this strain to Aedes aegypti mosquitoes. The ‘popcorn’-infected mosquitoes did not transfer dengue viruses and could not mate with uninfected mosquitoes. That means his study was successful.

He released Wolbachia carrying mosquitoes in Cairns region and achieved another success; nobody got dengue after that.

Although there should be more research on how to effectively transfer Wolbachia to specific mosquitoes, we do find a hope to fight against mosquitoes-borne diseases with bacteria that were first discovered in mosquitoes. B 2020 VOL.18

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PHARMACEUTICALS

Current Status on the Treatment of COVID-19 with Repurposed Drugs

S

Gayoung Lee dlrkdud724@naver.com

ince its first outbreak in Wuhan in December 2019, COVID-19 has spread throughout China and around the world. It has continued on for quite a long time, penetrating deeply into our daily lives. Many scientists around the world are developing drugs against COVID-19, but still have no significant results. The development of a drug from initial discovery to the marketplace takes more than a decade. That is why many potential treatments for COVID-19 are drugs that already exist. This is called “drug repositioning” which is a strategy used to identify the new uses for approved or investigational drugs that are outside the scope of the original medical indication. Here is where we are at with treatments for COVID-19.

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Remdesivir : A Promising Antiviral Drug Against COVID-19

Dexamethasone : A Steroid For Treating Severe Patients

Antivirals are medications that reduce the ability of flu viruses by restraining their multiplication.

Remdesivir is a drug that failed in clinical trials against Ebola in 2014. Research on MERS, a disease caused by a different type of coronavirus, showed that the drug blocked the virus from replicating. Remdesivir is being tested in many COVID-19 clinical trials around the world. In late April this year, the drug’s manufacturer, Gilead Sciences, announced that Remdisivir reduced the time for the patient to recover.

The trial reported that people taking the drug recovered from COVID-19 in 11 days compared with the 15 days for people who did not take Remdesivir. At the same time, another study published in The Lancet reported that the participants in a clinical trial who took Remdesivir showed no benefits compared to people who took a placebo. Despite the conflicting results, the FDA issued an order on May 1 for the emergency use of Remdesivir. From early July, it has also been available to hospitalized patients in Korea as the Korean Ministry of Food and Drug Safety has ordered special import permits for Remdesivir.

Dexamethasone is a corticosteroid used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects. The University of Oxford is running the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial which is a large-scale, randomized controlled trial of possible treatments for people in the UK admitted to hospital with severe COVID-19 infection. In mid-June, U.K. researchers announced that Dexamethasone reduced mortality by about a third in patients on ventilators, and by a fifth in those who needed oxygen support. The RECOVERY trial involved the use of Dexamethasone 6mg daily oral or intravenous for ten days. Higher daily doses of Dexamethasone have been used for other indications for a long time and are known to be safe.

In September, Korean researchers from KAIST revealed that the number of neutrophils and glucocorticoids are one of the factors that decide the severity of COVID-19 symptoms. Glucocorticoid produced from adrenal glands represses expression of the gene CXCL8.

The gene expression of excessive CXCL8 leads to the increase of

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neutrophils in organs and the uncontrolled secretion of cytokine, otherwise known as the ‘cytokine storm’. The team from KAIST found that people with severe COVID-19 illnesses have low glucocorticoid, causing excessive expression of CXCL8. They expect that using glucocorticoid medications such as Dexamethasone may be effective in treating severe patients of COVID-19.

Ibuprofen : A Controversial AntiInflammatory Drug Anti-inflammatory drugs are medications that reduce inflammation or swelling. In early June 2020, scientists started a clinical trial to see whether the pain medication could be used for people hospitalized with COVID-19. Among many anti-inflammatory drugs, Ibuprofen has recently aroused controversy.

Ibuprofen has been used to reduce Acute Respiratory Distress Syndrome (ARDS) caused by cytokine storm. A current theory states that Ibuprofen’s antiinflammatory qualities could help ease breathing difficulties associated with the illness.

However, there are some clinical observations suggested that Ibuprofen could slow down recovery from bacterial pneumonias or further make viral infections like chickenpox. Other lab experiments also show that Ibuprofen may boost the amount of ACE2 receptors that novel coronavirus uses to infect cells, spreading the virus at a faster rate. However, this is purely a theory that is not backed up by clinical evidence in patients. Many experts assert that there is not enough evidence that Ibuprofen aggravates COVID-19. The increase in the number of ACE2 receptors by Ibuprofen may be insignificant if the increase itself is small or if the person already has a large number of those receptors. The World Health Organization (WHO) has triggered much confusion when it revoked its claim that people infected by COVID-19 should not take Ibuprofen to treat pain and fever.

Niclosamide : A Parasiticide With Successful Results In vitro Experiment In April, Institut Pasteur Korea announced that they are preparing clinical trial of Niclosamide with Daewoong holdings to treat COVID-19. According to the results of the drug-repositioning research perused by Institut Pasteur Korea, the antiviral efficacy of Niclosamide against COVID-19 in cell experiments was superior to the drugs under clinical trials at home and abroad. It has high antiviral activity against COVID-19, being 40 times higher than that of Remdesivir and 26 times higher than that of Chloroquine. Despite its excellent antiviral effect on COVID-19, Niclosamide has a problem of maintaining blood drug concentrations in the human body when taken orally, because the drug is a parasiticide.

Researchers are now proceeding to find a formulation that best maintains the blood drug concentration. The actual effect of Niclosamide on COVID-19 is to be examined in clinal trials.

Chloroquine/ Hydroxychloroquine : Failure In Clinical Trial Chloroquine and Hydroxychloroquine are antimalaria drugs. The FDA issued an emergency use authorization (EUA) at the end of March for these drugs, but later revoked it in June after studies showed that they are unlikely to be effective in treating COVID-19. Studies published in May in the New England Journal of Medicine and Journal of the American Medical Association also showed that the drugs did not significantly help people with COVID-19.

These drugs have shown high antiviral activity in vitro, but not in clinical trials. This shows why it often takes a long time to successfully develop a drug; test results are often far from what is expected. B

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Medical Application of Crispr-based Genome Editing SangHee Lee

idshannon@yonsei.ac.kr

C

RISPR , which stands for ‘Clustered Regularly Interspaced Short Palindromic Repeat’, is a system that targets and modifies certain DNA sequences with Cas protein. This innovative system is actually from the immune system of bacteria against the virus. The bacterial genome contains the genes of viruses that frequently invade. When a virus invades, this inherited gene helps Cas protein to recognize the viral geneand cut them off. Unlike conventional geneediting technology, this system has high specificity and easy application, drawing much attention in biotechnology.

How does the CRISPR/Cas9 system work in an animal cell?

The best known CRISPR/Cas system is the CRISPR/ Cas 9 system, which consists of guide RNA and Cas9 protein. When guide RNA and Cas9 protein is transfected, guide RNA recognizes and combines to endogenous DNA which has the same sequence with guide RNA. The combined part is cut by Cas9protein, creating a double-strand break. This damaged DNA is recovered through its repair system - Non Homologous End Joining (NHEJ)orhomology directed repair (HDR). NHEJ repairs the sequence by random insertion or deletion (indel). This is usually used for gene knockout. HDR, on the other hand, is a process that repairs the sequence based on the injected template. This is usually used for gene knock-in.

As such, CRISPR/Cas9 is used as a system that targets and edits specific DNA sequences when transfected in the animal cell.

Medical application of CRISPR/Cas system CRISPR/Cas system is a gene-editing technology that can be used in various aspects. As a therapeutic application, researchers are conducted to knock-out the important gene of cancer using the CRISPR/Cas9 system. Studies are also being conducted to modify genetic mutations that cause birth blindness and give proper treatment to the patients before they completely lose sight. The CRISPR/Cas system is also being studied for diagnostic purposes. SHERLOCK diagnostic system using Cas13and CRISPR-chip technology using Dcas9 are being developed for diagnostic purposes.

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Therapeutic application CRISPR/Cas system is studied for clinical purposes.

For example, there is a research about EGFRknockout to control cancer. Epithelial Growth Factor Receptor(EGFR), is one of the frequently mutating genes found in lung cancer, breast cancer and thyroid cancer patients. As a member of the tyrosine kinase family, activation of EGFR leads to phosphorylation of the cytoplasmic region and subsequently increases phosphorylation of proteins in downstream signal cascade which leads to increased cell proliferation. Through the gene mutation, this normal signaling cascade is manipulated, making the EGFR protein to be continuously active. In this way, downstream signals of EGFR increase greatly, thus causing the cell to have an uncontrollable proliferative ability– which is the character of the cancer cell.

As CRISPR/Cas9 system can create a double strand break at a specific site, researchers assessed the possibility of the CRISPR/Cas9 system as a cure for thyroid cancer patients with abnormal expression of EGFR. The research team of Li-Chi Huang transfected CRISPR/Cas9 system into the SW579 cell line which is a thyroid carcinoma cell line.

Three days after the transfection, the protein level of EGFR and cellular growth related protein (AKT)were decreased.

The cell viabilityof the cancer cell line was also suppressed. This result showed that targeting the EGFR gene using the CRISPR/Cas9 system might be an effective therapeutic approach for cancer treatment.

Diagnostic application CRISPR/Cas system is also being studied for diagnostic purposes. SHERLOCK diagnostic system, which stands for ‘Specific High Sensitivity Enzymatic Reporter UnLOCKing’, is a highly sensitive tool to detect infectious diseases.

The Cas protein used in SHERLOCK is a Cas13 protein. As the Cas9 protein cuts the target DNA, the Cas13 protein cuts nearby RNAs when activated. SHERLOCK diagnostic system was developed using these properties.

Here is how the SHERLOCK works. First, reporter RNAs are added to an amplified RNA sample from a patient with a possible viral infection. Then, Cas13 protein and engineered sgRNA which finds and combines to virus RNA are added to the sample. If the patient is infected, thissgRNA binds to the viral RNA. When this happens, the cleaving region of Cas13 is activated, beginning to cut nearby RNA including reporter RNA. Reporter RNA is the RNA that emits fluorescent light when cleaved. This means, fluorescence is detected if the patient of the sample is infected, and no fluorescence is detected if not infected.

The SHERLOCKdiagnostic system has the advantage of being fast, intuitive, and highly sensitive. Recently, there are many kinds of research to detect SARS-CoV-2 which causes COVID-19. The research team of Feng Zhang showed that SHERLOCK diagnostic system has higher sensitivity compared to RT-qPCR. Furthermore,the SHERLOCK systemdetected the virus in 15 to 45 minutes, which is way shorter compared to RT-qPCR which takes 24 hours to a few days. Currently, HUDSON detection technology and HOLMES detection technology, which arethe improved versions ofthe SHERLOCK system, are being widely developed. Although the therapeutic/diagnostic use of the CRISPR/Cas system is still in the research stage, it is a technology with a great potential for clinical use in the near future. B

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Evolving Diagnostic Techniques for COVID-19

T

Aran Kim

dreamct717@naver.com

hese days, the world is completely paralyzed because of the novel coronavirus. Covid-19 is truly a ‘disaster’ for the mankind. The fight between humanity and covid-19 has not yet ended, and many people are continuing a lonely fight to protect their neighbors and themselves from the virus. As the fight against the disease is prolonged, the diagnostic technology that can quickly and accurately determine whether one is infected is becoming more important. Sorting out those that are infected quickly is important for it can save lives by treating patients in time, but also because we can isolate the infected patients from society so that no further infection occurs. In this article, we will examine how the diagnosis of covid-19 is made, what diagnostic technology is currently commercially available, and what is being studied to improve it.

How is COVID-19 Diagnosed?

For the diagnosis of COVID-19, it is important to collect a sample first. Usually, samples are taken from the upper respiratory tract (nose, mouth, airways, etc.). While wearing personal protective equipment, medical staff insert a long, flexible cotton swab into the nasal cavity to collect secretions such as snot. Collected specimens are immediately refrigerated and transported to the laboratory as soon as possible. Afterwards, the sample is tested, and the types of tests include cell culture, antigen/antibody testing, and molecular testing. The cell culture test method has a long test time and is not well used for diagnosis because it is inappropriate for large-scale tests. The cell culture method is mainly used for producing vaccine antigens by infecting cells with COVID-19 to amplify the virus and then to eliminate its infectivity through purification processes. The antigen-antibody test is a method of testing whether an antigen is present in the body or identifying whether antibodies formed after the infection. This is not a diagnostic method mainly used in screening clinics because it is difficult to make a diagnosis in the early stages of infection.

However, it can be used to check whether antibodies are produced in patients who have been cured. In addition, it is used as an auxiliary means mainly for diagnostic tests. Because of its accuracy and speed, molecular testing is mainly used at present. The molecular test method is a way of examining the gene base sequence. How will the Molecular Test proceed? First, very small amount of DNA in the sample is amplified using PCR(polymerase chain reaction) technology. By comparing the specific nucleotide sequence of the coronavirus and the DNA nucleotide sequence amplified from the patient’s sample, we can find whether the coronavirus is present in the sample. Base sequence analysis is performed twice. The first Pan-corona test cannot specify the novel corona 19 virus. It targets the detection of novel coronaviruses along with six existing viruses (HCoV 229E, HCoV NL63, HCoV OC43, HCoV HKU1, SARS-CoV, MERS-CoV).

Therefore, if it is negative in the first corona test, it means that it is not a coronavirus infection. If it is positive in the first test, the base sequence of the sample with the six existing coronaviruses is individually compared in the second test. If none of them match, the owner of the specimen will be diagnosed as a patient infected by the novel coronavirus.

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Real-Time Reverse Transcription PCR For coronavirus testing, real time reverse transcription PCR technology is also used. Through this, it is possible to check the DNA amplified by the PCR reaction in real time, and to analyze the presence and quantity of the target DNA without additional electrophoresis. In real time reverse transcription PCR technology, primers or probes are attached to two base sequences which exist only in the novel coronavirus. Since DNA replication can occur only in the presence of primers, if the sample is amplified to a certain value, it is judged as positive. If not amplified, it can be judged as negative. In other words, the inspection method is simpler than the pan-corona inspection, and the inspection time is also very short. This method is being used in China, the United States, Germany, Thailand, Hong Kong. Korea has started to use this test method since January 31st.

Current COVID-19 Diagnosis Technology Problems and Solutions Currently, COVID-19 is mainly diagnosed through RT-PCR. As described above, this has the advantage of high accuracy because it can make a positive or negative determination within a short time and is based on the specific nucleotide sequence of the novel coronavirus. However, despite the use of this method, there is one problem with the COVID-19 diagnosis technology. It is that the reference value for each diagnosis kit is different. Because of the supply and demand problem of diagnostic kits, diagnostic kits from several companies are used for testing. But each product has a different reference value for determining whether the test result is positive, thus causing confusion. Due to this problem, there has been an ongoing argument that a ‘standard material containing accurate information about the COVID-19 virus gene’ should be used for the corona diagnosis. Therefore, research about viral gene standard substances is being actively conducted all over the world. For example, the Korea Research Institute of Standards and Science (KRISS) and the new virus research group succeeded in developing the virus gene standard substance for the first time. The use of a viral gene standard is expected to contribute to minimizing the uncertainty of diagnosis.

Then what kind of diagnostic kits are developed and distributed to use this method? One of the products currently being exported after receiving an overseas export license in Korea is ‘GeneFinder COVID-19 Plus RealAmp’ developed by Ohsang Healthcare. This diagnostic kit diagnoses COVID-19 infection using real time reverse transcription PCR technology and is being exported to about 30 countries with approval from mid-March 2020.

To escape the disaster of coronavirus, we must prevent, diagnose, and treat it effectively. Diagnostic techniques are very important to isolate the infected from society, and to clearly identify the progress of treatment in the confirmed cases. Diagnosing diseases cost-effectively and accurately will play a very important role for us to gain full freedom from the coronavirus. B

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COLUMN

Are Animal Experiments and Drugs Incompatible?

A

Jiyoun Son

kikijenny1203@gmail.com

nimal testing is a crucial part of pharmaceutical research. Legal and regulatory agencies around the world currently require drug testings in animals prior to clinical trials involving humans. As a result, more than 100 million animals - including mice, rats, frogs, dogs, cats, rabbits, hamsters, guinea pigs, monkeys, fish, and birds - are killed in U.S. laboratories each year for biology lessons, medical training, curiosity-driven experimentation, and chemical, food, cosmetics, and drug testing.

Animals are used for drug testing for many reasons. The main reason is to determine whether the drug is toxic to humans. This is done by studying how the lead compound is metabolized into other metabolites in the liver. Some metabolites accumulate over time and often cause serious problems. Therefore, it is very dangerous to give new untested drugs to people, especially considering that drug users are patients, already suffering from sickness. Other than toxicity, animals are used to see if the drugs work in a biological system. Before the actual “drug development phase”, scientists go through the “discovery phase.” During the discovery phase, scientists select a target and develop a lead compound, which is a compound that is expected to show high efficacy as a drug candidate. But most of the discovery phase is performed in vitro, which refers to a study or experiment which is done in the laboratory within the confines of a test tube or laboratory dish. However, experimental results from test tubes differ a lot from in vivo experiments and in vivo results are also far away from actual clinical results. As a result, in order to save the tremendous cost during the clinical development phase, animal experiments are essential to test whether the drug candidate works in living organisms.

The truth is, there is still not enough scientific evidence to prove whether animal experiments are useful for human drug development. In reality, over 90% of drugs that received positive results in preclinical animal tests fail during the remaining clinical trials. Most of these drugs fail due to their toxicity and weak efficacy on humans.

On the contrary, substances that are safe and effective for humans can be rejected by showing negative results in animal testings. Either way, the low correlation between animal testing and actual usage on humans could delay the development of effective treatments for humans. It is important to realize that animal models do not completely reflect what will happen in human systems. However, there is currently no better way to get information about how certain drugs interact with the human body.

As the voice of animal rights grows and technology develops, people insist on finding an alternative for animal testing and scientists are working hard to find one. As a result, a group of scientists believes they may have found viable alternatives. Examples of the alternatives that have been developed include in vitro methods, such as 3D printed human cell and tissue models, organ-on-a-chip, revolutionary computer, and mathematical models. Studies have repeatedly proved that these methodologies are more effective in modeling human disease and predicting how drugs work than current animal experiments. The following are two representative examples that could replace animal testing in the future.

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Miniature organs In recent years, scientists have begun growing human cells cultured on scaffolds embedded in plastic chips to form tiny structures that mimic human organs. These are known as organs-on-a-chip (OoCs) which can provide new ways to test the effects of new compounds or drugs on human cells. Using these simplified and miniaturized versions of human physiology can provide more human-related results than animal experiments. Moreover, this test may even replace the entire use of animals in the early stages of research where scientists do not need to test the entire biological system.

Currently, conventional cell lines are commonly used in labs. Conventional cell culture uses a homogeneous population of cells cultured in a monolayer under static conditions. However, the development of OoCs will enable the creation of more sophisticated systems that mimic organs, tissues, or whole organisms. But generalizing OoCs is definitely an expensive and tricky technique. To reproduce physiological conditions, it is necessary to consider and contain the entire environmental parameters when maintaining cells in culture. Temperature, acidity, air composition (O2, CO2) should be taken into account and all parameters have to be controlled in a smart well or microchip.

OoC technology is increasingly used in laboratories around the world. Various chip designs allow scientists to develop almost any tissue in the human body, including the heart, lungs, kidneys, bones, and intestines. Moreover, combining various organ models on-chip provides a better understanding of the drug’s action in a precisely controlled physiological environment. Ultimately, a human-like system is created on the chip, allowing one to see drug metabolism and its effects on other organs.

Computer (in silico) models Another approach is to replace animal testing with computer algorithms. Researchers have developed computational models that use vast amounts of existing data to predict the impact of a new compound on an organism. This is a very applicable approach given the cost-effectiveness and logical validity. In fact, computer models are already being used in drug development. Fast algorithms are used in labs during screening processes and when searching for lead compounds. They extract information from online databases to identify and compare structural similarities between thousands of tested and new, untested compounds. Furthermore, similar programs are also used to test the toxicity of untested compounds. Quantitative Structure-Activity Relationships (QSARs) are computer-based techniques that can replace animal testing by making elaborate estimates of a substance’s potential of being hazardous, based on its similarity to existing substances and knowledge of human biology.

Computational predictions like this can help reduce the amount of animal research needed. However, most computer models and AI that are used during drug development processes are slower and more ineffective than experienced scientists yet. Thus, to completely replace animal testing, technology still has a long way to go.

This paradigm shift is encouraging but it does not mean that animal experiments will be replaced by these technologies overnight. Some governments still require drug toxicity testing on animals which is the biggest obstacle for the elimination of animal testing in drug development. But the pharmaceutical industry is moving rapidly towards a direction to where animals are no longer suffered for R&D. By investing more in innovative nonanimal methods and bold policy initiatives, more promising human treatments can be developed. Ultimately, the transition from animal testing to more effective methods will benefit both humans and animals. B

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CONNECTION BETWEEN COVID19 AND HAIR LOSS: TELOGEN EFFLUVIUM Sung Hyungkyu

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tjdgudrb@naver.com

Corona Virus and Hair Loss Phenomenon

OVID19 is a respiratory infection disease that first broke out in Wuhan, China in December 2019, and spread throughout China and all around the world. While much effort is being made to develop treatments and vaccines for about10 months after the outbreak, viruses are using their superior propagation power to produce a large number of infections worldwide. Thus, COVID19 has not yet faded out, showing people the potential for the virus. Recently, long term effects or aftereffects of COVID19 have been reported at homeland and abroad by some of those who were diagnosed with the complete cure. These range from common expectations such as headaches, difficulty breathing to total body systemic aftereffects such as diarrhea, insomnia, drowsiness, miscarriages, nausea, and vomiting. Surprisingly, among them, there are hair loss symptoms.

The hair loss phenomenon has recently become a hot topic by Alisa Milano, who has recovered from the coronavirus. She posted on her social media that she is suffering from hair loss due to the aftereffects of COVID19, and it has been reported that more and more people are suffering from it. Some studies even suggested that one in four COVID patients suffer from hair loss. This growing number of cases has raised the need to investigate the causal relationship between COVID19 and hair loss symptoms.

However, many experts estimate that the COVID19 virus is unlikely to cause hair loss directly and that the symptom is ‘telogen effluvium’.

What Is “Telogen Effluvium”?

“Telogen effluvium” is a scalp disorder which is common after a disease, an accident, or stressful condition, with symptoms such as temporary loss of hair and thinning of hair. As a result, people can see a pile of hair falling off when they brush their hair, look at the drain after a shower, or wake up and look at the pillow on the bed. As telogen effluvium appears after a psychologically stressful event, it can be seen after many different types of illnesses,

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including malaria and tuberculosis. It can also occur if there is a serious stressor or loss of loved ones, if not after a disease.

After experiencing various psychological stress factors, there is a period when the hair cycle is disturbed. During this time, the hair becomes thinner or hair loss increases. The telogen effluvium typically manifests about three months after the stressful event, and both men and women can be affected. To understand telogen effluvium, it helps to understand the hair growth cycle.

The hair cycle consists of three stages, anagen (Growth) phase, catagen (Transitional) phase, and telogen (Resting) phase. The anagen phase is the time when cell division is active, causing hair growth. After this period is called the transitional phase. Hair growth is slowed down as maternal and pigmented cells stop working. In the telogen phase, the hair is attached by the force of the connective tissue of the hair follicle, and slowly old hair changes to the new one. In other words, as new hair grows, it pushes out the hair that existed before, and falls out. Hair shows periodic changes through these three stages.

At any given time, 85 to 90 percent of healthy human hair is in the anagen phase, and only 1 to 2 percent is in the catagen phase. And about 10 percent is in the telogen phase, the time when hair is removed, and is associated with telogen effluvium. In telogen effluvium, a larger than normal portion of our hair moves into the telogen phase and is shed. With this condition, around 30 percent of the hair follicles move into the Telogen phase, and that is why hair shedding occurs.

At this point, you may wonder what these symptoms have to do with COVID19.

Many people with COVID-19 become severely ill with high fever and signs like respiratory symptoms. Besides physical stress, COVID19 has left us with many problems. The craze for COVID19 has dealt a heavy blow to the global economy, putting some individuals in economic trouble. In addition, some people lost their loved ones or friends, and parents are greatly concerned about their children. As such, COVID19 has changed all aspects of society, economy, and education, which may have caused stress for individuals, raising the possibility of leading to ‘telogen effluvium’. But hair loss should not be too much of a worry. This concern only accelerates your hair loss, because many experts say” telogen effluvium” is a temporary hair loss caused by stress, and if the stress source is removed, you will recover normal hair within three to six months. Thus, desirable behavior is to pay attention to your body, try to recover, and be calm-minded.

To Conclude..

Although there have been many recent cases of hair loss, the prevailing opinion is that the COVID19 virus is unlikely to directly cause hair loss symptoms. The main cause of the current assumption is “telogen effluvium,” but there is plenty of other possibilities. For example, there is an opinion that hair loss can occur naturally during our body’s response to the COVID 19 virus.

When our bodies are infected, it is judged to be an emergency and can be dealt with by creating antibodies against the virus.

Therefore, the human body will stop producing fingernails and toenails that are not urgent and focus only on healing to overcome the war against viruses. So, hair loss may occur temporarily at this time. There are numerous assumptions, but none of them are definite.

Because we lack the knowledge of COVID19, we will have to take a little more care and look at the future situation and deal with it. B

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NATIONAL ISSUES

ONGOING CONFLICT BETWEEN GOVERNMENT AND DOCTORS Jihye Seo sjihye@yonsei.ac.kr

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outh Korea was once praised for its diagnostic capabilities and effective response over COVID-19. The country showed a sign of recovering from the pandemic ahead of many other nations. However, South Korea lately faced another obstacle: Doctors went on strike against the government last August. The controversy was escalated into nationwide boycotts amid the pandemic. So, what exactly happened?

July 23rd

August 4th ~ August 18th

A Backlash against the new medical policy

Medical students refuse to attend training and take the medical license exam

The government announced a plan called ‘Medical Reform Scheme’ to establish new medical schools starting in 2022 and increase the number of medical students by 4000 over the next 10 years. According to the OECD report, South Korea has 2.3 clinicians per 1000 population while the OECD average is 3.4. The plan is meant to solve the deficiency of health care specialists in rural areas by giving incentives to doctors who volunteer to work.

Also, the government is willing to increase the number of epidemiology investigators and bio-pharmaceutical experts who play a key role in the COVID-19 pandemic.

Soon the controversy was engendered since the government’s plan was not discussed with doctors and medical students in advance. Korean Medical Association(KMA) argued that South Korea has great health care access and there is a sufficient number of doctors in the country already. “Adding more doctors cannot be an effective solution to the current problem. One solution to meet the health care needs is to provide better medical charges to support unpopular medical specialties” said Kim Sol, resident physician of Seoul St. Mary’s Hospital, during the protest. In addition, doctors are worried about fairness issues since the recommendation letter from the governor is essential for public medical school admission.

The Korean Medical Student Association (KMSA) says it is inevitable to take collective action and reject to attend sessions and training. According to KMSA’s speech, 85% of medical schools (34 out of 40) nationwide will partake in the action. The association strongly insisted that it will prolong the strike unless the government withdraws the plan. Moreover, KMSA stated that the members decided to boycott the medical license exam and take a collective leave of absence to oppose the government’s policy on August 18th.

Young doctors kick off mass rallies and seniors closed their clinics

The Korean Intern Resident Association(KIRA) held a protest in Yeouido, Seoul on August 7th. According to the association’s speech, about 16,000 interns and resident doctors joined the 24-hour walkout. “The government should deal with the issues through dialogue,” a representative of KIRA said. Meanwhile, 33,000 hospitals and clinics nationwide had closed their doors.

The government urges the doctors to come back The Ministry of Health and Welfare threatened to imprison doctors who denied the return-to-work order.

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The government toughened its response to the medical community’s walk-out. Vice Health Minister Kim Gang-lip said the government extended the executive order on interns, residents, and fellow doctors to resume work.

“The public will distrust the medical community if doctors continue the collective action,” he said. He also said that the government would take strong action if necessary, to prevent possible gaps in healthcare services and to save lives. Meanwhile, Choi Dae-zip, president of KMA, said doctors would continue the strike as the government ramps up legal penalties.

August 31st ~ September 4th The Medical license exam has been postponed to September 8th

As the protest intensified, 90% of the students up for the medical license exam canceled their registration. Vice Health Minister Kim Gang-lip said in an online press briefing that the absence of young doctors can cause critical medical supply shortage. The government postponed the exam a week later than its original date, September 1st, on the day before the exam.

The KMA and the government come up with a truce

The KMA and the ruling Democratic party eventually reached an agreement to suspend the government’s plans laid out in July until the COVID-19 pandemic subsides.

They also agreed to build a consultative body to deal with ‘four evil medical policies’, including 1) increasing the number of medical students 2) establishing new public medical schools 3) health insurance benefit for herb medicine 4) non- face-to-face treatment, later. As the negotiation was achieved, the head of KMA asked doctors to get back to their clinics instantly.

September 6th ~ September 24th Med-students refuse to take the license exam

However, the KMSA emergency committee claimed that medical students will continue to refuse taking the medical license exam due to the haste deal between the KMA and the government. On the other hand, the Health

and Welfare Ministry announced that applicants can only re-apply during the renewed period. As a result, only 446 medical students applied and 2,726 missed the chance to take the exam. On the first day of the exam, only six applicants took the place. Still, the government makes it clear that there is no additional exam since the students spontaneously refused to take the opportunity. Students who missed the exam will have to wait until next year.

Professors ask for a bailout

The KMSA claims to end the collective action and 14,090 students will go back to school on September 14th. Lately, medical students also stated their intention to take the medical license exam. Professors and the Korea Association of Medical Colleges(KAMC) emphasized that the absence of future interns will cause plenty of problems, hence it is necessary to discuss additional opportunities. “Despite the public’s disappointment with the present situation, it is inevitable to allow med-students to take additional exams to the protect public health care system” Han Hee-chul, chief director of KAMC, said.

In the meantime, more than half a million people agreed on the petition against giving a second chance to the left-out medical students who canceled the application. Now is the time to discuss whether or not to give med-students a chance and how to deal with the shortage of doctors in 2021.

To conclude..

It seems the boycotts diminished as soon as the agreement was declared, and most of the doctors immediately came back to work. Medical students also came back to their school, yet 86% of senior students cannot take the license exam this year.

A majority of the public criticizes that the doctors’ strikes were irresponsible behavior because many patients who needed urgent treatment were neglected during the walk-out. Besides doctors, who play key roles in the current COVID-19 pandemic, left their workplace causing chaos in society. Nonetheless, some support doctors and medical students since they believe public medical schools will ruin the quality of medical services. Anyway, it is obvious that public health should be prior to anything else. B

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NATIONAL ISSUES

Nonproprietary Names Prescriptions - Truth and Falsehood Sang Soo Na

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sangsoo66@yonsei.ac.kr

ecently, the following image from an unknown source went viral among the health and medical community. This image seemed to sarcastically depict the ‘nonproprietary name prescription’ issue. What is it, and why is it such a hot potato?

Although both are legal, doctors generally make prescriptions based on proprietary names.

When prescriptions are made with proprietary names, pharmacists may provide generic substitutions only when both the prescribing doctor and the patient agree (Pharmaceutical Affairs Law Section 27). These two interest groups have been debating over this policy ever since the separation of drug prescription and dispense in July 2000, but why?

Pro and Cons

What is it?

To begin with, we need to know how medicine prescriptions are made. In the Republic of Korea, there are two options in giving medicine prescriptions: proprietary names and nonproprietary names. In the former, a medical professional assigns a specific proprietary name of a drug from a certain pharmaceutical company. In the latter, medications are prescribed under the name of therapeutic ingredients for patients’ medical condition.

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Generally, doctors make prescriptions with proprietary names. Doctors claim that they know the patients the best, and thus the doctors’ prescriptions are the best for patients. Doctors seem to be skeptical of how trustworthy bioequivalence experiments are. The Korean Medical Association executed an experiment in 2006 to see whether different brands of the same nonproprietary chemicals were truly bioequivalent. The result suggested that some generic drugs for Itraconazole, Simvastatin, and Felodipine were not bioequivalent to original drugs or even had no valid remedial effect at all. Therefore, the doctors advise that health and medical personnel take conservative actions towards patients’ health.

On the other hand, pharmacists insist that nonproprietary names prescription must be promoted.

Otherwise, it only will give a great burden to the health and medical field. Drug companies offer rebate to doctors every year so that their brand gets prescribed. This leads

NATIONAL ISSUES

to a rise in retail prices, only to burden the consumers without any substantial benefit. Indeed, some generic drugs fail to meet the bioequivalence requirements, and it is demanding for the government to thoroughly monitor all the quality control process. However, pharmacists rebut that this is not the problem of nonproprietary names prescription policy, and it can be resolved by putting forward more stringent standards for generic drugs. In fact, inexpensiveness of different brands does not mean differences in medicinal effects. Rather, the reduction of such expenses can be invested in other medical welfare services.

Nonproprietary names prescription can also protect patients’ right of choice. In a survey done by Health Insurance Review and Assessment Service in 2012, 64.7% of the respondents answered that they prefer a lower price substitute if they have other options. This implies that the patients are unaware of the options they have, and medical professionals have the responsibility to provide the necessary information. Additionally, proprietary names subscriptions coerce pharmacies to hoard different proprietary drugs from numerous brands for the same diagnosis, resulting in a waste of resources.

Efforts to Institute The Korean government once attempted to commence nonproprietary names prescription. Prior to operating the policy, it launched an about a year-long pilot project in September 2007 for 20 ingredients and 32 items at the National Medical Center. The average rate of nonproprietary names prescription resulted to be 31.76% followed by 4.6% reduction in the total drug fee. The project hinted that there is a long way to go before the policy takes its roots down. The first task in hand is to cut down the prices of generic drugs. Indeed, 31.76% of nonproprietary prescriptions does not mean that all those prescriptions were prepared with substitutes. However, 4.6% reduction in drug fee is nevertheless nowhere near expectations. Both pharmaceutical companies and the government ought to endeavor to reduce the prices of generic drugs.

Another assignment is to secure reliability in bioequivalence tests. The items that were unqualified in the previously mentioned experiment in 2006 were in fact tested by private institutions under the companies that developed the generic drugs. Permissions for 203 cases were revoked immediately, but the credibility of bioequivalence test was tarnished (Supreme Court Lawsuit 2013. 12. 26 sentenced 2011다96550 Adjudication). Doctors and patients will put their trust only when the quality issues are redeemed with the efforts of pharmaceutical companies. Furthremore, the nonproprietary names prescription policy will be enforced only when everyone’s awareness changes.

Conclusion The debate on how prescriptions are made may seem to be relevant to only healthcare and medical professions, but it actually applies to every single one of us and affects the entire medical service system. Clinging to the conservative state and making original drug-centered prescriptions can be one way of minimizing risk factors such as unexpected adverse reactions. However, it becomes a different story if sufficient verifications are made for alternative choices. Cutting down drug price will benefit all the parties in the long run. It will encourage domestic pharmaceutical companies to develop reliable and reasonable alternatives to expensive medications. The change will also unload doctors’ burdens of responsibility in prescriptions. Consequently, patients will be the main beneficiary of the policy. After all, it all boils down to providing the ideal therapy to patients, and there is no doubt that both pharmacists’ and doctors’ number one priority in common is to better patients’ health. B

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INTERNATIONAL ISSUES

Racial and ethnic disparities in health care Chae Hyun Lee

chaehyun.lee96@gmail.com

“#BlackLivesMatter”.

T

he unjust death of a black man, George Floyd, by a white policeman, Derek Chauvin, revealed the racial disparities in the criminal justice system. This hashtag went viral amid the COVID-19 chaos and acted as a reminder to the world that even in 2020, racism still exists. Racism is present everywhere; our daily lives, the law, the media… and the list goes on. Amongst these, one of the sectors in which racism can lead to a very serious problem is the health care system. The racial and ethnic disparities in health care have become official when the Institute of Medicine (IOM) has released a report addressing these issues. So, what’s the real deal?

Race, ethnicity and health care Health care disparities refer to inequality in health care experienced by less advantaged social groups. Health disparities can occur due to various factors, and amongst them, race and ethnicity trigger many interests in the current situation. America is a good example to study as it is one of the countries which has the most diverse ethnicities.

The ethnic minorities in USA include Asian Americans, African Americans, Hispanics or Latinos, Native Hawaiians and other Pacific Islanders, American Indians, and Alaska Natives. These ethnic minorities often experience the inequities of health care services.

Many research and statistics evidently show that ethnic minorities in USA have poor health conditions, receive inadequate health care services, and have low health insurance coverage. Statistics show that 10.6% of African Americans and 16.1% of Hispanic Americans were uninsured whereas 5.9% of the Caucasians were uninsured in 2017. Moreover, higher cases of chronic health conditions were observed in ethnic minorities.

Sources of racial/ethnic disparities in health care Lack of health care insurance: In USA, government-sponsored health insurances such as Medicare and Medicaid are provided only to specific groups of people who meet the requirements. Medicare is available for people who are over 65 years of age, people with disabilities and people with end stage renal diseases or Lou Gehrig’s disease. US citizens who do not meet the criteria and want to be insured must pay personally for private health insurance. In many cases, the company pays for this private health insurance. However, many of the ethnic minorities work at lowpaying jobs which do not include health insurance payment. This means that an individual is more likely to receive preventative and screening services, as well as learn more about self-management of health problems. Therefore, the having health insurance lowers the chances of acquiring a disease and increases the overall quality of life.

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Language barriers: One of the most important factors in health care services is the communication between the health care provider and the patient. However, each ethnic group speaks different languages and may not be fluent enough in English to communicate at an advanced level. Even more so, medical terms are not easy even for the people who are fluent. On top of that, there are not enough language interpreting services which aid the nonEnglish speaking patients. This clearly decreases the quality of health care services these patients will receive for the following two reasons. First, they will not fully understand what the health care provider is saying, hence may misinterpret the diagnosis or medication instructions. Second, it is difficult for them to explain their symptoms precisely. As a result, there is an increased chance of misdiagnosis along with decreased medical adherence.

Poverty: Socioeconomic inequality issues are inevitable when it comes to race and ethnicity. In 2018, 17.6% of Hispanics, 20.8% of African Americans, 23.7% of Native Americans were in the poverty range while 8.1% of Caucasians fell below the poverty line. Having a lower socioeconomic background is closely related to geographical disparities. Poor people tend to live in areas where there are not enough health care facilities nearby and transportation is highly inconvenient. This acts as a barrier for many ethnic minorities to receive health care when needed. On the same note, low-income neighbourhoods usually do not have large supermarkets, so it is hard for the residents to buy fresh fruits and vegetables. Even if a large market does exist, junk foods are usually cheaper than fresh foods, hence financially difficult people tend to opt for junk food. As a result, ethnic minorities who live in these areas have a higher incidence of nutrition-related diseases.

Prejudice/biasedness: Prejudice is a subjective, negative opinion towards a particular subject without experience or evidence. Prejudice still exists against certain races and this branches out into the health care sector. Although health care providers try to be as unbiased as possible, their underlying prejudice may be displayed without realizing.

For example, for diagnosis or decision-making processes which rely greatly on the patients’ reports, physicians tend to trust the reports told by ethnic minorities less than the reports told by Caucasians. Another study showed that doctors thought of African American patients as less intelligent, less likely to comply with medical advice and more likely to do drugs and alcohol. It is important to realize that these biases exist and may affect the health care services in which the ethnic minorities receive.

Efforts to reduce disparities One representative effort to reduce racial disparities in health care was by expanding health insurance. An attempt by the US government was to enforce the Affordable Care Act (ACA) which expanded the coverage of health insurance. This policy has remarkably reduced the racial disparities in health insurance by 30-40%. Another solution was to collect primary language information about the people in each community. This information is collected so that patients and health care providers which speak the same language can be connected. Furthermore, to improve cultural and linguistic competence, L.A. Care provides health education materials in various languages and free telephone interpretation services which enhance communication between patients and health care providers. Apart from these efforts, many policies are constantly being amended to reduce health disparities. However, these problems have not been completely eradicated, therefore we should consistently work towards solving this inequality. B

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INTERNATIONAL ISSUES

International Overdose Awareness Day YoonZoo Gee

yzgee@yonsei.ac.kr

F

or many years, organizations have worked ceaselessly to deliver overdose prevention education by helping people recognize the symptoms of overdose. The International Overdose Awareness Day (IOAD), in particular, has been a very successful event for these organizations to not only spread information on detecting signs of overdose to raise awareness of drug abuse, but also host memorial services, ceremonies, and open mic nights to reduce the stigma of overdose deaths.

What is International Overdose Awareness Day? Held on August 31st each year, the International Overdose Awareness Day is a global event that raises awareness of overdose and reduces the stigma of drug-related deaths. The day was established by two Australians Sally J. Finn and Peter Streker in Melbourne, Australia in 2001. It was a commemoration of those who have lost lives to overdose and support to the loved ones who have been affected by drug abuse. Since 2012, Pennington Institute, an Australian non-profit health organization, has taken the responsibility to coordinate the event.

What are Current Statistics on Overdose?

Overdose is an increasing global problem. The ‘World Drug Report 2019’ by the United Nations Office on Drugs and Crime (UNODC) estimates that a total of 585,000 people worldwide have died from drug use in 2017. North America has the highest drug-related mortality rate, accounting for one-fourth of the drug-related deaths globally.

Around 35% of the total drug-related deaths come from the Asian sub-region. In addition, more than 70,000 deaths from drug overdose have occurred in the first decade of the 21st Century among European Union countries.

Why Do Overdose Deaths Occur?

Among the many causes of overdose deaths, most of them occur due to opioid abuse. Opioids are often used as medicine to relax the body and relieve pain. They bind to and activate the opioid receptors on cells in the brain, spinal cord, and various organs in the body where pain and pleasure are involved. As a result, opioids block the pain signals sent from the brain to the body, releasing large amounts of dopamine.

Opioids can be categorized into natural, semi-synthetic, and synthetic opioid analgesics. Natural opioid analgesics include morphine and codeine. Semi-synthetic opioid analgesics include hydrocodone, hydromorphone, oxycodone, and oxymorphone. Synthetic opioid analgesics involve methadone, tramadol, and fentanyl.

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What Has Opioid Misuse Brought Upon Us? The opioid overdose epidemic has been a serious issue in the United States since the 20th century as seen in three distinct waves. The first wave began when prescriptions of natural opioids, semi-synthetic opioids, and one particular synthetic opioid, methadone, increase in the 1990s. The second wave emerged as overdose deaths involving heroin rapidly increased in 2010. The third wave then came with significant increases in opioid overdose deaths since 2013.

These deaths particularly involved synthetic opioids (excluding methadone), most of which were illicitly manufactured fentanyl mixed with heroin and/or cocaine for enhanced euphoric effects.

What Has the IOAD Achieved So Far? Reducing the impacts of synthetic opioids has thus been a major concern for IOAD in recent years. In particular, the IOAD has made a lot of progress in tackling synthetic opioids by raising awareness and distributing naloxone.

Naloxone is an opioid antagonist that is designed to rapidly reverse an opioid overdose. It allows the overdose victim to breathe normally by counteracting the depression of the central nervous and respiratory system. As a result, the Victorian Minister for Mental Health has announced to fund $2.2 million on increasing access to naloxone and Needle Syringe Programs (NSPs) across Victoria, Australia. Additionally, the European Network of People who Use Drugs (EuroNPUD) has produced a video campaign and ‘Naloxone Saves Lives’ resources in 10 different languages.

IOAD continues to grow and achieve real change. In 2019, a total of 874 events have been held in 39 countries, surpassing the 747 events that had been held in the previous year. More people are expressing interest as well as seen in the increasing number of followers on social media. The IOAD’s Facebook page now has more than 400,000 and the Twitter page has more than 4,000 followers. In addition, last year’s campaign had 237,000 people visit the IOAD website and download online resources such as fact sheets, posters, and support kits more than 20,000 times.

The next big step for IOAD would be to follow-up on the relationship between the number of events held and the number of drug-related deaths. This way, the IOAD will be able to see how effective its events are on reducing the number of people dying from drugs.

What are Future Plans for IOAD? The IOAD is setting ambitious targets this year such as reaching 1,000 registered events in 50 countries. It is also aiming to achieve a greater number of real-policy outcomes and see continued growth in target areas specifically in South-East Asia, South America and Africa, and the United Kingdom. There are many ways to participate in IOAD throughout the year. Holding activities, posting tributes, purchasing merchandise, donating, and even just engaging in social media can all make a big difference. Be a part of it! B

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Battling the ‘Corona Blues’

T

Okyoon Kim

okyoonkim@gmail.com

he COVID-19 has been in our lives for quite a long time now. With this virus becoming a pandemic, people have adjusted to care for their health by social distancing and maintaining personal hygiene. During this time when there is so much focus on our physical health, it is also important not to forget about our mental health.

What is the ‘Corona Blues?’

Since the outbreak, we are living in a different world. Restriction on meeting other people itself have changed our lives. Most students are taking online classes. Places where people interact, like cafes and bars, are closed. Any activity that brings many people together, like concerts and festivals, is canceled. With all the big and small changes that are happening in our daily lives, it is easy to feel depressed, overwhelmed, and stressed. Experts refer to this phenomenon as the ‘Corona blues.’ This term is coined from the words Coronavirus and having the blues, which refers to feeling depressed. Any psychological concerns due to COVID-19 are included in the term ‘Corona blues.’

What are the Causes?

There are two leading causes of the Corona blues: one is the anxiety and fear about the novel disease, and the other is the changes that the disease has brought to our lives. Since the virus is highly contagious and no appropriate medications are yet provided, people can feel anxious and scared just by thinking, “what if I got the virus?” This insecurity may go on to worrying about spreading the virus to one’s families, friends, and colleagues. Further concerns may arise from the public gaze that comes with the infection.

Even though people are participating in social distancing, there may be inevitable activities which may bring upon the anxiety of getting the virus. Activities like going to work, shopping for groceries, or visiting the doctor are necessary to sustain our lives. These activities may cause anxiety just by the fear of being exposed to any chance of obtaining the virus.

The media is also a source of the problem. Indeed, social media is a useful way to communicate and socialize, especially during the pandemic where it is important to keep physical distancing from others. However, it also brings unexpected negative consequences. Social media may provoke anxiety due to the exposure of misinformation. This spread of dubious facts is not limited to social media. News outlets may face difficulties following up the rapidly evolving circumstances. This causes the spread of false news, circulation of rumors, and the propagation of confusion and stress.

Apart from the fear of infection, there may be additional stress due to the changes in society. The restrictions that come from social distancing is frustrating. Moreover, since social distancing is necessary to reduce the spread of COVID-19, at the end of the day, it only leaves people feeling helpless about the situation.

The virus has been a big blow to certain businesses and the economy in general. Travel agencies, cinemas, restaurants, karaoke, fitness centers, and any other businesses that bring many people together are facing economic difficulties. The increasing number of businesses in crisis and job losses leave people distressed. More burden adds on due to the uncertainty of when this pandemic will end.

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However, even without experiencing the economic crisis, people can still get the Corona blues. Living in a restricted world itself makes people feel suffocated. Before the COVID-19, we met physically to enjoy food and drinks together. We traveled overseas. We went to various concerts and festivals. We enjoyed outdoor activities and working out at fitness centers. However, today, all these little bits of happiness in our daily lives are limited due to the virus. The restrictions leave us depressed as those activities were a means of stress relief. Furthermore, long-term restrictions may build and accumulate additional stress. Moreover, the lack of interaction with others may bring fear about social relationships as we spend most of our time alone.

What are the Symptoms?

The main symptoms of the Corona blues include feeling afraid, stressed, and anxious. The strong emotions and stress during this pandemic may cause: • Sleeping or eating disorders • Difficulties in concentrating • Worsening of mental health conditions • Worsening of chronic diseases • Increased reliance on alcohol and cigarettes

What Can We Do to Overcome?

Since the Corona blues is mostly due to the changes in our daily routines, many may think that we should just hang on helplessly until the crisis ends. Fortunately, however, there are things we can do to protect our mental health during this tough time. To begin with, the most important fact that everyone should remember is that feeling stressed and anxious is normal during a pandemic. Everyone is going through this situation together, which means that you’re not the only one falling behind. Hence, the first step towards handling the blues is to accept that it is natural to feel stressed and that everyone is in this together. Here are some tips that you can apply in your lives: 1. Find ways to relieve stress: There are stress-relieving activities that can be done at home. Playing instruments, listening to music, or working on artwork can distract you from worrying. Exercising at home can also boost up your mood.

2. Connect with others: Call or video-call your loved ones and chat about each other’s daily lives. Have online meetings with a group of friends. This will help relieve the fear of the lack of physical socialization.

3. Be smart in checking the news: Refer to trustworthy sources such as your local health authorities or the CDC. Do not trust the unsure rumors in social media. If you feel overwhelmed, step away from COVID-19 related news for a while.

4. Maintain regular living patterns: The changes in one’s daily lives - like online classes or job losses - may distract sleeping and eating patterns. Sleep disruption may lead to amplification of stress and cause health issues, especially in the immune system. Sticking to a rhythmic schedule will be helpful for both physical and mental health.

5. Seek professional help when depression is prolonged: Talking with a counselor and taking proper medications will help. Korean citizens may contact the Korean Psychological Association (02-5067-2619) or Mental Health Welfare Center (1577-0199) for professional help.

You may think these suggestions are obvious. But like it or not, the old clichés can never go wrong. So now, it’s up to you. Will you leave yourself helpless or jump into action? Trust me. Your mood is in your hands. B 2020 VOL.18

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LIFE ISSUES

Sleepless Nights Getting over Insomnia

JungWon Kim

A

wjddnjs521@naver.com

ccording to the Centers for Disease Control and Prevention (CDC), adults need at least 7-9 hours of sleep in every 24 hours. Sleeping is not a state of doing nothing, but a time of hard preparation to effectively carry out daily life. Therefore, if the quality of sleep is not secured, our bodies cannot perform normally at daytime.

While this is a fact that nobody doubts, not many people are obeying this rule in their lives. It is common in modern society that people often ignore their sleep deprive because they are too focused on their daytime life. Insomnia is sometimes considered insignificant.

Insomnia is a concept that includes sleep disorders, such as having hard time getting asleep or maintaining sleeping state throughout the night. Thirty to forty percent of total population is suffering from temporary insomnia. Chronic insomnia, in which these symptoms last more than three months, occurs in about 10 percent of the population. People with insomnia suffer from nervousness, fatigue, lack of concentration, anxiety, and mood disorders during the day which makes them unable to live a normal day. Causes of insomnia vary widely, so if you have insomnia, you should accurately recognize the cause in your case and find a proper solution to it.

How do we fall asleep?

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1) Sleep homeostasis controls until you fall asleep.

2) In vivo timer controls while you are asleep.

Homeostasis is the ability to maintain a stable internal state of the body. Homeostasis here means keeping the quantity and quality of sleep in an ideal state. Sleep homeostasis is a concept that the required sleeping time is determined by the amount of time previously slept last night and the degree of fatigue gained today. Thus, if the sleep time is insufficient, the body would be in a sleepfriendly lethargy state because it needs more sleep to lead a smooth daily life. Sleep homeostasis directs the overall sleeping time to make sure that condition of our bodies does not break down.

There is the light of day and the darkness of night in everyone’s day, and the timing to sleep for effective daily life varies slightly from person to person. The battery that regulates the biological clock, known as the in vivo timer, is a sleep hormone called melatonin. At night, melatonin is released from the pineal gland, which makes the body lethargic and sleep-friendly. On the other hand, less melatonin is secreted during the day so that we can be mentally and physically awake. During winter, upregulation of melatonin due to shortened daytime and cold temperature both make people feel sleepier than usual. Moreover, people in northern European countries with long winters who suffer from seasonal emotional disorders are found to be melatonin over-secreted, making them emotionally lethargic and constantly feeling tired.

In a normal body, melatonin is essential for high quality of sleep, and deep sleep is impossible unless enough melatonin is secreted during sleep.

THE BLUE VANGUARD

LIFE ISSUES

Causes of Insomnia 1. Biological Factors People with insomnia usually have heightened levels of cortisol, which plays a crucial role when waking up every morning. Thus, cortisol makes people wake several times throughout the night, obstructing the way to deep sleep.

Also, people of insomnia are typically more sensitive to the effect of cortisol, waking up in much lower levels of cortisol compared to the general population. In addition, insomnia is found to be associated with the reduced levels of estrogen and progesterone. This usually happens at menopause, disturbing women from having normal condition. Some food or drink can also affect the sleep.

Caffeine is the prominent example. It disturbs the role of adenosine in the brain, which leads to an arousal reaction.

This encourages people to focus on their works, but also becomes a huge obstacle for people with insomnia. This is a vicious caffeine cycle a lot of people with insomnia are in.

2. Psychological Factors In psychological factors, insomnia is usually a symptom of other diseases or conditions. Insomnia is known as the first and clear symptom of one’s stressful state. This is usual when a person is in an unfamiliar environment such as getting a new job, having a newborn baby, or having trouble with friends. Temporary insomnia due to these factors can be diminished easily when people adapt to their situation. However, some psychiatric conditions lead people to chronic insomnia. For example, anxiety disorders from a relationship that would never change in a short time are typically followed by chronic insomnia. A more serious problem is that insomnia itself again makes people anxious, and it is hardly possible for them to get out of this problematic cycle on their own. In addition, nightmares also can lead to chronic insomnia due to increasing levels of anxiety and fatigue.

3. Physical Factors People without much stress can also have insomnia sometimes. This can be due to their physical condition which disturbs their sleeping state. Specifically, people who have a cramp every night would be impossible to get into the deep sleep state. Also, people with pulmonary diseases usually have a hard time getting asleep since they cannot continue comfortable breathing for a long time.

COVID insomnia is a new term. It is from lack of exercise due to ‘staying home’ policy all over the world. As mentioned, the sleep homeostasis calculates the requiring sleep time from the sleep at last night and fatigue gained.

During the staying at home period, there are no such physical fatigue gained, which hinders body from being sleep-friendly. Studies have found that people suffering from insomnia have clearly increased in 2020, and the number of prescriptions of sleep pill has also swelled.

Treatments Commonly, people of insomnia self-medicate their state with alcohol or benzodiazepines. Both could be extremely dangerous. Alcohol abuse can lead to physical and psychological changes and increase dependency on alcohol. Similarly benzodiazepines, especially shortacting, can lead to dependence and have high abuse potential. It is much more important to get proper treatment and help the body to be in a sleep-friendly state.

1. Psychological Treatment For people with insomnia, giving an autosuggestion is the most important method. Anxiety from life issues should not disturb our mind at night. An effective way to do is to read a book or listen to a calm music. Stimulus control is another method in which oneself does not force sleep to happen, and get out of bed if one cannot get sleep in 20 minutes. The point is that bedtime without sleeping such as watching TV should be removed.

2. Behavioral Treatment People without psychological problem should focus on their everyday routine. Good sleep hygiene, going to sleep and waking up at the same time every day, is the first step one should try. This can be performed by exercising but not right before bed, reducing alcohol intake, avoiding daytime naps, also caffeine and smoking in the evening.

3. Pharmaceutical Treatment If one is suffering from insomnia and cannot overcome, some medications can help. Melatonin agonists, and nonbenzodiazepine sedatives can be options, occasionally benzodiazepines less than 2 month. To get over insomnia, it is essential that medications are used as combination with psychological and behavioral therapy. B 2020 VOL.18

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LIFE ISSUES

Appropriate Usage Of Aerobic And Anaerobic Exercise Donghyeon Kim kdhbbr@naver.com

A

s of 2016, the number of gyms nationwide reached 2,500. If you go out in the downtown area, there are a number of gyms in just one neighborhood. This shows that today, more people exercise and their demand for sports facilities has increased. The purpose of exercising varies from people to people. Some may exercise for health while others may exercise for fitness, beauty, or as a job. The methods of exercise may also differ as they depend on one’s purpose and situation. Furthermore, due to the busy schedule, it is difficult for people to manage extra-time for exercise.

As a result, people tend to exercise selectively depending on their purpose, not knowing the side effects of it. Therefore, this articl will introduce the necessity and effect of exercising diversely.

Correlation of Weight Loss and Anaerobic Exercise In general, people with the purpose of weight loss tend to focus only on aerobic exercise while leaving out anaerobic exercise. This is probably because people overlook the benefits of anaerobic exercise. Anaerobic exercise can help lose weight too. Moreover, it brings better results when combined with aerobic exercise. Factors that anaerobic exercise help to lose weight are the followings.

First, under the same conditions, moderate-intensity anaerobic exercise consumes as much or more calories as aerobic exercise during the same time. However, for weight loss, many people think that only aerobic exercise can directly burn fat. Therefore, they think it is more effective to use aerobic exercise instead of anaerobic exercise that uses glycogen from the liver and muscles. Half of this is true. Indeed, anaerobic exercises does not burn calories efficiently. However, it is as effective as aerobic exercise for weight loss. This is because the change in total fat depend only on total caloric intake and consumption. To be more specific, if glycogen from the liver and muscles is used through anaerobic exercise, the excess carbohydrates ingested will fill in the space where glycogen used to be. Therefore, excess carbohydrates will not be converted into fat. Hence, by blocking the conversion of carbohydrates to fat, people can prevent additional body fat gains.

Secondly, anaerobic exercise can reduce body fat while maintaining or even increasing muscle mass depending on the body muscle-fat composition ratio. By preventing the loss of muscle mass, it reduces the loss of exercise performance.

Moreover, when you exercise with strong intensity, you can burn more calories in the same amount of time, leading to a faster loss of body fat. In addition, when increasing muscle mass, the basal metabolism itself increases too. After reaching the target weight, even if you take in a general diet or even relatively more calories than before, increased muscle can easily digest them and prevent the conversion of excess calories into fat. This prevents the yo-yo phenomenon. On the other hand, if you only perform aerobic exercise without any anaerobic exercise, even though fats burn quickly, muscles will also break down at the same time since they are not stimulated by anaerobic exercise. This is because our body works very efficiently. Muscles consume huge amount of energy itself. So, when muscles are unused, the body will judge that it is wasting energy and thus break them down. Hence, since muscle loss occurs together with fat loss, it results in the body gaining fat easily.

In summary, for efficient fat loss, anaerobic exercise should be done together with aerobic exercise since the absolute reduction in fat mass is important. Moreover, anaerobic exercise helps reduce body fat by increasing basal metabolism.

Therefore, it is much more effective to perform both aerobic and anaerobic exercises for weight loss.

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Effects of Aerobic Exercise in Increasing Muscle Mass People focus on anaerobic exercise to increase muscle size. This is truly natural. However, for a faster and more efficient muscle gain, it is more effective to perform both aerobic and anaerobic exercise. Factors that affect the increase of muscle mass by aerobic exercise are as follows.

First, by performing aerobic exercise, capillaries are developed in the muscles for the smooth supply of oxygen and nutrients, and cardiopulmonary endurance is improved. On the other hand, many people interested in exercise know that excessive aerobic exercise impairs muscle growth by causing an imbalance in muscle recovery after anaerobic exercise.

For this reason, people who want to increase muscle mass tend to avoid aerobic exercise because they fear muscle growth inhibition. Of course, this is also correct. However, in the long run, it is overlooked that there are even greater benefits of aerobic exercise. Due to the development of capillaries, there is more blood circulation, which leads to the rapid removal of lactic acid and resupply of glucose during anaerobic exercise. Also, the development of cardiopulmonary endurance enables more oxygen to be supplied. Therefore, this allows better performance during anaerobic exercise for a long time which will eventually promote muscle growth. Second, since aerobic exercise mainly uses type 1 muscle and the anaerobic exercise mainly uses type 2 muscle, performing two types of exercise at the same time will help muscle growth.

Even though the type 1 muscle lacks in power production and growth rate compared to the type 2 muscle, it is still well stimulated by aerobic exercise leading to muscle growth. So if anaerobic exercise is proceeded with aerobic exercise, the type 1 muscle also can be sufficiently stimulated, and muscle hypertrophy occurs accordingly. Type 1 muscles have characteristics that are suitable for extended exercise with low intensity. When the amount of type 1 muscles increases, the muscle strength itself is also elevated, and by a principle similar to that explained in the first reason, it will allow people to perform the anaerobic exercise for a longer time which will create a virtuous cycle in muscle growth.

In conclusion, even for muscle hypertrophy, aerobic exercise can promote muscle growth by enhancing the efficiency of anaerobic exercise. Therefore, simultaneous anaerobic exercise and aerobic exercise would be superior to a single type of exercise for increasing muscle mass.

Conclusion In this article, the importance of performing both aerobic and anaerobic exercise was emphasized. When the purpose of an exercise is to lose body fat, anaerobic exercise not only reduces body fat but also helps maintain body weight by increasing the basal metabolism to accelerate body fat loss. Additionally, if the purpose of the exercise is to increase muscle mass, by performing aerobic exercise, it can enhance exercise performance by increased blood vessels in muscles, and type1 muscle itself. There is no one answer to exercise as it depends on the individual’s body conditions, life patterns, and exercise purposes. Thus, it is appropriate to find a method that suits you, not focusing on one thing, but by proceeding at a necessary rate according to your needs. B

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LIFE ISSUES

Zero-waste: A Small Step To Save Our Pale Blue Dot Heeyoun Yang

hyyang11@yonsei.ac.kr

T

oday, we are living in the Plastic Age. Moving from the Bronze and Iron Age, plastic has become the representative material of the current era. Since the first plastics were invented in the 1920s, more than six billion tons of plastics have been made and are now everywhere. The problem is that plastics don’t degrade easily and the rate of plastic recycling is low. These facts mean that most of them end up in the mother nature without any countermeasures. What should we do so that we don’t wake up in a place full of plastic wastes?

“Zero-waste: The conservation of all resources by means of responsible production, consumption, reuse, and recovery of products, packaging, and materials without burning and with no discharges to land, water, or air that threaten the environment or human health.”

This is the latest updated definition of Zero-waste adopted by the ZWIA, the Zero Waste International Alliance in December 2018. The ZWIA was organized in 2002 to establish standards to guide the development of Zero-waste in the world. Zero-waste simply means “waste prevention” which focuses not only on the follow-up processing of wastes ever made like recycling or reusing, but also on making total changes of production and distribution systems, from packaging design to manufacturing processes, in order to make NO waste discharge.

From now on, here are some items that can help you practice Zero-waste.

Natural Loofah Loofah, also spelled luffa, is a gourd which belongs to cucumber family. It grows in tropical and subtropical climates.

After its flower grows and falls off, a long, zucchini-like gourd grows. It can be used as a sponge instead of a synthetic plastic sponge. With Loofah, you can clean and exfoliate your skin and keep your household neat by washing dishes and scrubbing dirty surfaces. Loofah has been used as a sponge for a long historical time. To be used, loofah get dried for 6 months, soaked in water and then its peel gets removed. Their seeds are also removed. Afterwards, they get sliced into form looks like an ordinary sponge. However, here are some things you should take care while using them for cleaning your body. It can be a carrier of bacteria, for example E. coli, as it can keep your dead skin pieces at a moist bathroom. It can also cause some damages on your skins if you use it with too much pressure and frequency. You need to take care of loofah and your skin to keep your body and house clean while saving the Earth.

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LIFE ISSUES

Bamboo Toothbrush Bamboo toothbrush refers to a toothbrush made of bamboo instead of a plastic handle. Its bristle is usually made of nylon.

The fact that bamboo is 100% degradable is the most attractive part of the bamboo toothbrush. Sometimes the nylon bristle of bamboo toothbrush is covered with charcoal to improve its role to brush the teeth. Charcoal will absorb and bind bacteria and finally remove them from your mouth. Charcoal is also good for whitening your teeth as their main ability to absorb makes any stain-inducing things like tea, coffee, wine go away. If you want a 100% eco-friendly toothbrush you can use one with boar’s hair. It will make you feel better while brushing your teeth to put the boar bamboo toothbrush into hot water before you use it.

You can use one bamboo toothbrush for 3 months, which is the same as that of a plastic one. The big difference between the plastic and the bamboo is that you can separate the nylon part and throw the bamboo part into the manure of the grass when you want to start using next one. If yours is made with a help from a boar, you can even skip the step of separation. The price of bamboo toothbrush is also not that burdensome. It costs just near ₩1,000. If you take a healthy walk instead of a bus, you can get one bamboo toothbrush. Save your Earth and your health at once. How reasonable it is.

Soapnut The soapnut, also called ‘Sapindus Mukorossi’, is the berry of a plant that is part of the lychee family. It takes 9 years for the plant to fruit but once it starts to fruit, it continues to do so for the next 90 years. It can be harvested from September to February, which is a period of half a year. Soapnut can be an answer to water pollution induced by chemicals like laundry detergent and plastic pollution induced by plastic shampoo bottles.

How to use: put them in a fabric bag and tie it tight. Then put the bag with your pile of laundry when you do the laundry. Done! The saponin contained in the berry works as a surfactant and it can make your laundry clean just as a soap does. Moreover, the soapnut can be reused for several times. The soapnut is also better for your health. It’s from the nature and also non-toxic. One unfortunate point is that the soapnut works only with hot water because the temperature plays an important role in turning the soapnut soapy. Furthermore, the soapnut is not as effective as synthetic chemicals.

However, there is a way to improve it. You can use vinegar, lemon juice, sodium percarbonate with the soapnut to improve their ability, and they are also from the nature!

Even without these Zero-waste items, you can also start Zero-waste in the familiar ways in your daily life. You can use tumblers instead of disposable plastic cups when you get coffee from a cafe. You can take shopping baskets and eco bags instead of disposable plastic bags when you go grocery shopping. Bringing your own multi-use packaging containers to the restaurants is another since a lot of disposable garbage comes out when you order delivery food. It is also helpful to use soap without plastic containers and a handkerchief instead of a paper tissue. These things can be troublesome because it is not easy to change our old familiar habit. Finding information on practices of Zero-waste is also very time consuming. But remember. Step by step. That is the way you can save your pale blue dot, the Earth, so that it can be with you a little longer. Precisely, that is the way you can save yourself so that you can be with the earth a little longer. B

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MEMBERS Editor In Chief Seo Woo Park

Vice Editor In Chief Ji Hye Seo

Copy manager Sang Soo Na

#Journalist

Jung Won Kim

Aran Kim

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Dong Hwan Lee

Ga Yeong Lee

Ji Youn Son

Dong Hyeon Kim

Ok Yoon Kim

Hyung Kyu Sung Hee Youn Yang

Sang Hee Lee

Chae Hyun Lee

Yoon Zoo Gee

#Designer

Design Manager Beom Ju Cho

Ji Hyun Kim

Hyo Jeong Kim

Hee Do Yang

Min Gi Lee

Dae Hyun Kim 2020 VOL.18 Cover designed by katemangostar / Freepik

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