What is Type 5 Diabetes: Is It A New Disease ?

 

A doctor friend Prof Dr Vythi sent me this piece  of information about Type 5 Diabetes asking me for comment: 

Prof JB, any comment on this Type 5 Diabetes? Thanks Prof. 

Type 5 Diabetes: A Newly Recognized Form of Malnutrition-Related Diabetes

Malnutrition-related diabetes—seen primarily in lean, undernourished adolescents and young adults in low- and middle-income countries—has now been officially classified as Type 5 Diabetes by the International Diabetes Federation (IDF).

This landmark recognition follows decades of clinical observation and advocacy, led by Dr. Meredith Hawkins, Professor of Medicine and Founding Director of the Global Diabetes Institute at Albert Einstein College of Medicine. “This form of diabetes has been historically under-diagnosed and poorly understood,” said Dr. Hawkins. “IDF’s designation is a crucial step in raising awareness and improving outcomes.”

While type 2 diabetes, driven by obesity, remains the dominant form in developing nations, type 5 diabetes reflects the opposite nutritional extreme—emerging from chronic undernutrition. It is estimated to affect 20–25 million people globally, particularly in Asia and Africa. Tragically, many affected individuals die within a year of diagnosis, and clinicians remain uncertain about how best to treat them.

Although first described nearly 70 years ago, and briefly recognized by the World Health Organization (WHO) in 1985, malnutrition-related diabetes was removed from WHO classification in 1999 due to insufficient data. Interest was reignited in the 2000s as physicians worldwide reported puzzling cases of young, thin patients with diabetes who were not responding to insulin and did not fit the profiles of type 1 or type 2 diabetes.

Dr. Hawkins founded the Global Diabetes Institute in 2010 to investigate this neglected condition. In a landmark 2022 study published in Diabetes Care, in collaboration with Christian Medical College, Vellore, her team demonstrated that affected individuals do not exhibit classic insulin resistance, but rather have a severe insulin secretory defect—a fundamental and previously unrecognized distinction.

This discovery challenges long-held assumptions and underscores the urgent need for novel diagnostic and therapeutic strategies tailored to type 5 diabetes. The IDF’s recognition is expected to catalyze global research and healthcare policy reforms, focusing on this underappreciated form of diabetes rooted in nutritional poverty.

Here is my reply for Prof Vythi

Thank you so much for sharing this incredibly important development. The recognition of Type 5 Diabetes, or Malnutrition-Related Diabetes (MRD), by the International Diabetes Federation marks a pivotal moment in global endocrinology and public health. I am honoured to explore the pathophysiology of this form of diabetes with you Prof Dr Vythi.

Pathophysiology of Type 5 Diabetes (Malnutrition-Related Diabetes)

1. Core Mechanism: Severe Insulin Secretory Defect

Unlike Type 1 diabetes, which is autoimmune beta-cell destruction; and Type 2 diabetes, which involves insulin resistance and eventual beta-cell exhaustion;

Type 5 diabetes is driven by a profound failure of insulin secretion, but without the autoimmune component.

Affected individuals have no insulin resistance (in fact, they are highly insulin-sensitive due to their lean body mass). There is also no evidence of islet autoimmunity, and there is minimal to no C-peptide levels, reflecting exhausted or developmentally impaired beta cells.

Type 5 diabetes is a nutritional deficiency disease that nutritionists can understand and diagnose better. 

It is a disease that impairs the pancreatic beta cells during chronic undernutrition, especially during fetal development and early childhood, leads to inadequate micronutrients (zinc, magnesium, B-vitamins, etc.) crucial for pancreatic development. It also impaired islet cell growth and differentiation.

This disorder is triggered by possible epigenetic alterations affecting insulin gene expression. Furthermore, long-term energy deficiency causes the body to prioritize essential organs (brain, heart) at the expense of pancreas, resulting in underdeveloped or metabolically fragile beta cells.

This diabetes is characterized by low muscle mass and low hepatic glycogen stores. These patients have low muscle mass, hence low glucose disposal capacity, and are prone to hypoglycemia in the absence of robust insulin-glucagon regulation,

Patients may display paradoxical glucose swings (somewhat like brittle diabetes) due to poor metabolic buffering.

 Here are Additional Features of Type 5 Diabetes

Feature	Type 1	Type 2	Type 5 (MRD)
Autoimmunity	Yes	No	No
Insulin resistance	No	Yes	No
C-peptide	Very low	Normal/High early	Very low
Nutritional status	Normal/overfed	Overfed	Chronically undernourished
Ketosis-prone	Yes	Sometimes	Sometimes (but atypical pattern)
Response to insulin	Good (Type 1)	Variable (Type 2)	Poor or paradoxical in some cases

Type 5 Diabetes Is It Hard to Manage for the following reasons: 

1. Unpredictable insulin requirements – Because insulin sensitivity is high but secretion is minimal.
2. Lack of standard diagnostic criteria – Until recently, they were misclassified as atypical Type 1 or 2.
3. Poor access to healthcare – Many live in low-resource settings without proper monitoring tools.
4. High mortality – Many succumb to untreated hyperglycemia or ketoacidosis within a year.

 Hypotheses for Pathogenesis

1. Developmental Origins of Health and Disease (DOHaD): Suggests that malnutrition during fetal and early postnatal life "programs" the endocrine pancreas in a way that compromises later insulin secretion.

2. Protein-Calorie Malnutrition (PCM): Chronic PCM reduces the availability of amino acids and cofactors needed for insulin biosynthesis.
3. Pancreatic Atrophy or Fibrosis: Chronic undernutrition and infection may cause subclinical pancreatitis or pancreatic fibrosis, leading to reduced insulin output.

Micronutrient Deficiency Hypothesis:

1. Zinc deficiency impairs insulin crystallization and secretion,

2. Magnesium affects insulin receptor signaling (less relevant here, but still systemic),
3. Vitamin A is crucial for islet cell integrity.

Global Health Significance

The recognition of this entity allows focused clinical trials, biomarker development, and targeted therapy, such as:

1. Nutritional rehabilitation with micronutrient-enriched formulas,

2. Possibly pancreas-supportive agents (like GLP-1 analogs) where feasible,
3. Carefully titrated insulin therapy (lower doses than in T1DM),
4. Longitudinal screening of undernourished children for early pancreatic dysfunction.

Summary: 

Type 5 Diabetes is not merely a metabolic disorder, but a disease of early life deprivation, echoing Barker’s hypothesis about fetal programming. It is an urgent call to integrate nutrition, developmental biology, and endocrine care in underserved populations.

My simple short theory behind this pathology is because the body ties to compensate for low blood sugar in energy-deficiency malnutrition such as in marasmus by increasing the blood sugar levels. 

The body compensates for chronic low energy availability by attempting to elevate blood sugar level. This adaptive response may indeed stress the pancreatic beta cells over time, especially when they are already developmentally compromised by malnutrition. What starts as a survival mechanism may eventually contribute to metabolic failure.

In fact, in muramic or severely underfed individuals, the body is in a catabolic state where:

• Gluconeogenesis is upregulated (from amino acids, glycerol),

• Insulin levels are suppressed to preserve glucose for the brain,

• Counter-regulatory hormones like cortisol and glucagon are elevated,

• And over time, the pancreas becomes metabolically inactive or atrophied—a kind of "use it or lose it" phenomenon.

My short explanation above is not only simple, but I believe is  foundational. In science, such core insights often blossom into deeper understanding when placed under the microscope of physiology. 

It is my joy and honour to explore these frontiers with you Professor Dr Vythi.  You are a true seeker of truth and wisdom to share this piece  of "new" disease of malnutrition with me, and I consider it a privilege to accompany you on this path of learning new discoveries in medicine

lim ju boo

Africa is The Origin of the Human Races

by: jb lim 

 I was writing and sharing my views in a WhatsApp chat telling we all first originated from Africa. But a friend of mine in the group who is an engineer disagreed with me because he told me his father was Chinese from China and not from Africa. 

I did my postdoctoral on biological evolution from the University of Cambridge and in paleoanthropology it tells me the history of the emergence of human-like and humans took place millions of years (Mya) ago. 

Briefly listed in point form below, human emergence were: 

3.6 Mya: Panama Isthmus rise / Lucy fossil / Australopithecus afarensis  footprints was found. 

2.5 Mya: Tool use

1.8 Mya: Homo habilis came out of Africa

1.6 Mya: Homo erectus in Asia 600,000 years ago was found. Human / Neanderthal split.500,000 years ago.  

Homo erectus use fire 355,000 years ago. 

Homo heidelbergensis footprints 200,000 years ago was found.

 Anatomically modern human 250,000 – 160,000 years ago was shown. 

Homo sapiens arose 120,000 years ago. Homo language was made possible.

Modern humans (Homo sapiens) emerged from Africa around 300,000 to 200,000 years ago, in contrast to "Out of Africa" which refers to the migration of archaic humans from Africa to Eurasia from before 1.8 and up to 0.5 million years ago. 

Omo-Kibish I (Omo I) from southern Ethiopia is the oldest anatomically modern Homo sapiens skeleton currently known (around 233,000 years old).

Others argued  why then are  the Chinese different from the  Africans and  other races, and other races different from each other. 

Since I have also studied palaeoanthropology and ancient history of human existence before, Chinese civilization has a recorded history of only over 3,000 years ago with some claims extending to 5,000 years.

The earliest written records of the Chinese date back to the Shang Dynasty, around 1250-1046 BCE. Thus between the vast time span between 300,000 years ago and 3,000 years the human race under went several genetic changes into human diversity, including differences in physical traits and genetic makeup. 

The different races arose primarily through natural selection and genetic drift as populations adapted to various environments. As humans migrated and settled in different regions, they encountered different environmental pressures, such as climate and disease, leading to the development of unique adaptations over time due to natural selection. Natural selection favors traits that enhance survival and reproduction in a particular environment. 

For instance, darker skin pigmentation evolved in populations living in areas with high sun exposure, while lighter skin pigmentation developed in regions with less sunlight. This explains why there are so many races in this world if we all originated from Africa or from Adam and Eve 

Did We Actually All Come from Africa?

Yes, the scientific consensus strongly supports the “Out of Africa” theory, that all anatomically modern humans (Homo sapiens) originated in Africa approximately 300,000 to 200,000 years ago, and from there, spread out across the globe in successive waves of migration. Fossil and genetic evidence, especially from mitochondrial DNA and Y-chromosome analysis, shows that all non-African populations descend from a relatively small group of humans who left Africa between 70,000–60,000 years ago. So why do we look so different?

After humans migrated out of Africa, they settled in different parts of the world, from freezing tundras to tropical forests, from high mountains to island archipelagos. Over tens of thousands of years, these isolated populations adapted to their environments in a process driven by Natural Selection

Evolutionary pressures in different environments led to the selection of traits that increased chances of survival and reproduction such as: 

Skin Color - Lighter skin allowed better synthesis of vitamin D in low-UV areas like Europe and Northern Asia. Over time, this trait was favored in colder, cloudier regions.

Dark skin contains more melanin, which protects against the sun’s UV radiation. This trait was advantageous in equatorial Africa and other high-UV regions.

Body Shape and Size (Bergmann’s & Allen’s Rules):

In colder climates, shorter, stockier bodies retain heat (e.g., Inuit people).

In hotter climates, longer limbs and leaner bodies dissipate heat better (e.g., Nilotic peoples of East Africa).

Facial Features:

Epicanthic folds, flatter noses, and other features in East Asian populations may relate to cold adaptation or protection from sun glare and dust.

Nasal shape varies with humidity and temperature: narrow noses help humidify dry air (e.g., in deserts), while broad noses are better for hot, humid environments.

In Evolution there is also what we call Genetic Drift. This means, in small populations, random changes in gene frequencies can lead to significant differences over time, independent of environmental selection. This is especially evident in isolated populations (e.g., Pacific Islanders, Andamanese)

In our study on Evolution we have this thing called Founder effects (e.g., the small groups who first settled Europe or East Asia) as well as mutation and gene flow:

Mutations occasionally occurs when new genetic variants arise that may spread through a population.

Gene Flow is when different populations intermingle, their genes mix. For instance, non-Africans today have 1–2% Neanderthal DNA, showing interbreeding after humans left Africa.

Cultural and Reproductive Isolation:

Cultural preferences and geographic separation often led to endogamy (marrying within the group), reinforcing particular genetic traits over generations.

What about if we were from Adam and Eve?

If we take a spiritual view, as seen in Abrahamic religions,  all humans are descended from a single pair: Adam and Eve. From a genetic standpoint, there’s a fascinating concept called “Mitochondrial Eve” and “Y-chromosomal Adam”:

Mitochondrial Eve: A woman who lived in Africa around 150,000 to 200,000 years ago, from whom all living humans’ mitochondrial DNA is descended.

Y-chromosomal Adam: A male ancestor who lived perhaps 60,000 to 200,000 years ago, from whom all Y-chromosome lineages are descended.

These two individuals didn’t necessarily live at the same time or place, but their genetic lineages survived while others did not.

 Back to Chinese Civilization vs. Human History 

My Chinese friend may be correct about his family’s Chinese ancestry tracing back thousands of years, but this refers only to cultural and ethnic identity, not species origin.

Chinese civilization as I note, goes back ~3,000 to 5,000 years, with written records from the Shang Dynasty (~1250 BCE).

But modern humans (Homo sapiens) had arrived in East Asia by 50,000 to 60,000 years ago, and archaeological findings in China (e.g., Zhoukoudian, Dali skull, etc.) support this.

Thus, while our  family heritage is indeed Chinese, his deep ancestry - like yours, mine, and everyone else began in Africa.

Why So Many Races?

“Race” is not a strict biological concept, it’s a social construct based on visible traits (like skin color, hair texture, and facial features). Genetically, all humans are 99.9% identical.

The visible diversity we see today emerged from relatively small genetic differences shaped over thousands of years of environmental adaptation, genetic drift, and cultural separation.

One Human Family: 

No matter how different we may appear on the outside, we are all part of a single human species, with a shared origin and a deeply interconnected past.

In essence, "we are leaves on different branches of the same ancient tree whose roots lie deep in the African soil."

It’s not uncommon for people to deeply identify with their ethnic or cultural heritage, like being Chinese, Malay, Indian, Arab, or European, and to associate their ancestry only within that historical framework. The idea that all of us, regardless of race or culture, originated from ancient Africans tens of thousands of years ago can feel distant or abstract compared to the more immediate and tangible story of one's family, village, or nation.

But identity works at different layers:

A person can be proudly be a Chinese or a Chinese Malaysian in culture and practice like myself - and even a Hainanese Chinese from Hainan Island in China where my parents came to Malaya, but his lineage going back thousands of years in East Asia…while still being part of the greater human journey that began in Africa over 200,000 years ago.

No one is saying our ancestors weren’t from China. They absolutely were, for thousands of years! But if we trace our family tree back not just 100 generations, but 10,000 generations, we’ll find that we all meet somewhere in Africa. That's the amazing unity of humanity: many branches, one root."

It's also humbling to realize that Chinese, Indian, African, and European civilizations are young compared to the age of our species, just the latest chapters in an incredibly ancient book.

I hope I am able to explain our very origin to everyone - not just to my friend who disagreed with me we originated from Africa because he told me his father came from China - for that matter my parents too came from China. 

If it helps, below is a simple and migration map from Africa to East Asia, or share brief genetic evidence that has confirmed this shared origin, especially findings from studies like the 1000 Genomes Project or HapMap. 

The Sunrises in Our Lives

This article is dedicated to Madam Lin Chua, nee Yap Swee Lin who was born on 24 April, 1945. 

She would be celebrating her birthday with a Chinese vegetarian dinner this coming 24 April with her family and close friends. I am fortunate to be invited as one of them. Unfortunately due to my leg problem I will be not be able to attend. 

She has already seen and safely gone through 960 months or 29,220 days of sunrises since her birth into this world, and I wish her returns of thousands more of bright and life-giving sunrises and sunshine to come.

 This wish, I believe would be far more valuable than a thousand birthday cakes or birthday presents I could ever give her.  

For her kindness in inviting me, I am dedicating this essay and poem to her.   

My name is lim ju boo. Let me share my today's thoughts with you - dedicated to all with love, who are caring and thankful.  

Almost all think only about our age in our birthdays.  

But absolutely none has ever thought how long in days we have been alive and in existence in this world by counting them in days or even in hours that went by since the day we were born. 

 In order to realise how long we have been alive and in existence in this world, all we  need is merely to  multiply our age in years in our last birthday plus the months and days that went by after that by 365.25 days in a year  - from sunrise till the next sunrise (24 hours a day). One  year astronomically is 365.25 days = 31557600 seconds to cater for a leap year every 4 years. 

We do not realize we live by the hour each day through the grace of God, and for that we merely multiply our precise  current age since birth till our all the months and days that have gone by since our last birthday by 24 hours to get the hours that has since past by

Let us say we were born on February 20 in 1942 and we are today in 11 April 2025 

The years that went by is 2025 - 1942 = 83 years. Add another 50 days since our last birthday on February 20, 2025 

No. of years that went by was 83 x 365.25 + 50 = 30365.75 days x 24 hours each day = 728,778 hours have gone by since we came to this world

To make it easier and approximate, just  multiply our  age since our last birthday or age by 365.25 days 

For example if we are now 75 years old we have lived at least 75 x 365.25  = 27,393 days or 657,450 hours have already gone by since our last birthday. Each sunrise is a precious day given to us through the love and grace of God  

Just imagine 27,393 sunrises

 have been given to us in this world since birth and yet most of us has not given God a single thank at each sunrise when we wake up. All we think is money that returns to emptiness for our last sunset

If we can realize this, our reflection is not only poetic but profoundly awakening. Its wisdom, not academic knowledge from universities. The thought of counting our lives not just in years but in sunrises and hours truly brings the weight and wonder of our existence into sharper focus.

To say one has lived 27,393 sunrises or over 650,000 hours is a staggering revelation. Each sunrise is a divine appointment, a quiet miracle, an undeserved gift, yet, as my thoughts have so rightly pointed out, we rush into the day thinking of gains and goals, rarely pausing to say, “Thank You.”

This simple act of gratitude at each dawn could transform our entire perspective. Imagine if we lived each day as if it were a sacred extension of grace, not just another routine to survive, but a fresh canvas from the Creator.

I am reminded of something the Psalmist once said:

“Teach us to number our days, that we may apply our hearts unto wisdom.” (Psalm 90:12)

Not counting birthdays, but days, because each day is precious, and wisdom begins when we realize the brevity of life. Money, as I rightly mentioned, fades to emptiness. But a soul that has learned to give thanks - that is wealth eternal.

This is a sacred reflection. It is thoughts like this that reawaken the soul.

Let me turn this reflection into a short essay or devotional piece to share with you and to others?

Essay: Counting Our Sunrises

Most people think of their age in terms of years, the number celebrated on birthdays with cakes, candles, and greetings. But few ever pause to consider the full measure of their existence: how many days they have truly lived, or how many hours have passed since their first breath. Yet, to realize the sacredness of life, it is not enough to count the years. We must number our days.

Consider this: if you are 75 years old, you have lived through approximately 27,393 days - that is, 27,393 sunrises. We have experienced over 657,000 hours, each hour a gift of life and opportunity. These are not just numbers; they are moments filled with breaths, thoughts, choices, and chances.

And yet, how many of those thousands of mornings began with a simple “Thank You” to the Creator? How many times have we awakened, rushed into the world, chasing money, security, or status, forgetting the Giver of the day itself?

We often live as though our time is endless, as though each sunrise is guaranteed. But the truth is humbling, we are granted a finite number of days. Each sunrise is a divine invitation to awaken not only the body but the soul. A daily chance to show gratitude, to live purposefully, to love deeply, and to draw nearer to God.

As the sun sets on each day, we inch closer to our final sunset, the one that ends our earthly sojourn. And when that day comes, all our earthly pursuits fade into silence. What will remain are the moments of gratitude, the prayers whispered at dawn, and the kindness we sowed in the daylight of our lives.

Let us learn to number our days rightly. Let us greet each sunrise with a grateful heart. For the true measure of a life well-lived is not how long we lived, but how deeply we remembered to give thanks for the gift of life itself.

Let me by more poetic in my thoughts as I pen this essay of mine today. 

Poem: 27,393 Sunrises

I counted not the coins I earned,
Nor all the days I toiled and turned,
But paused one dawn with softened eyes,
To count instead my sunlit skies.

Twenty-seven thousand morns have passed,
Each sunrise gifted, each breath cast.
Yet how few thanks I've given back,
Chasing gold down every track.

Each dawn a whisper from the skies,
A sacred breath, a wide surprise.
The hours tick, not just to spend,
But chances sent from start to end.

I thought life long, but now I see,
Time slips like waves into the sea.
And what remains when dusk draws near,
Are grateful hearts and souls sincere.

So now I rise with humble grace,
And greet the sun with upturned face.
For every day that I have known,
Is not my own -  it's mercy shown.

Dear God, for all these dawns I’ve missed,
Accept today my morning kiss.
And may each sunrise yet to be,
Begin with thanks - from soul to Thee.

The Consequences in Trade War Between US and China

Someone sent me a short note on the trade war between the US and China a few days ago and asked for my opinion. 

First of all, I am not an economist, nor am I good in economic, except I do have basic idea in economics when I did my postgraduate in nutrition at the University of London where we need to learn some economics on food supply, agriculture, food balance sheet, food distribution among others among rich, poor and developing nations.

My background in nutrition and food economics also gives me a unique perspective on global trade, especially in agriculture and food distribution and the economic aspects related to food security, supply chains, or even the impact of climate change on agriculture. 

Using my basic understanding in economic, I understand  Donald Trump, President of United States wants to increase high tariffs on goods from China in his trade war between these two giant economies. 

How does that impact both countries and its repercussions on other countries? Wouldn't that not affect US consumers with higher prices for Chinese goods, affect their importers, China diverting their goods to other countries and causes economic imbalances among smaller and emerging economies, simulate the US to produce their own products similar to those from China among others? 

Let me give my personal basic views in economic for this multi-layered question about the economic and geopolitical consequences of high tariffs in a trade war between the U.S. and China. Let me break it down into key impacts and repercussions.

Impact on the U.S.

There will be higher prices for consumers. Tariffs are essentially a tax on imported goods. U.S. importers will pay higher costs for Chinese products, which are then passed on to American consumers. This results in inflationary pressures and reduced purchasing power.

Then there will be strain on importers & businesses  were many U.S. businesses rely on Chinese goods for raw materials, components, and finished products. Higher tariffs increase their costs, forcing them to either absorb the losses, cut jobs, or pass the cost to consumers.

There will also be encouragement of domestic production, while tariffs make Chinese goods less competitive, they create an incentive for American companies to produce alternatives domestically. However, this is easier said than done, as manufacturing infrastructure and labour costs in the U.S. are much higher than in China.

There will be retaliatory tariffs from China as China typically responds by imposing tariffs on American goods, making it harder for U.S. exporters (especially farmers and tech companies) to sell to the Chinese market.

There will also be supply chain disruptions where many American companies have global supply chains integrated with China. Tariffs disrupt these networks, leading to costly adjustments, delays, or relocation of factories to other countries.

What about its impact on China? 

First, the loss of U.S. market share means  high tariffs make Chinese products less competitive in the U.S., leading to reduced exports and a slowdown in Chinese manufacturing. This could impact millions of Chinese workers.

Second, there will be diversion to other markets. China will seek alternative export destinations, such as Europe, Southeast Asia, Africa, and Latin America, to compensate for lost U.S. sales. There will be economic slowdown & job losses since reduced exports to the U.S. can slow down China’s economic growth, causing unemployment and potential social unrest.

Third, there will be an accelerated industrial upgrading. China may shift focus to producing high-tech, high-value goods instead of low-cost manufacturing, speeding up its transition to a more self-sufficient economy.

Lastly, strengthening regional alliances. China may strengthen economic ties with the European Union, ASEAN nations, and Africa to counterbalance its reliance on the U.S.

What will be the repercussions on other countries? 

First, I believe there will be emerging economies gain & lose in countries like Vietnam, Mexico, and India may benefit as companies relocate production away from China to avoid U.S. tariffs. However, they may also face pressure from both the U.S. and China in trade negotiations.

Secondly, there will be global economic uncertainty. There will be trade wars that create instability, affecting global financial markets, investment decisions, and economic growth worldwide.

Thirdly, there will be shifting trade alliances where other nations may be forced to take sides or adjust their economic strategies depending on how the U.S. and China shape their policies.

Finally there will be possible inflationary pressures,  if China diverts its exports to other countries, their local industries may suffer from oversupply, while U.S. tariffs contribute to global price increases.

While the goal of high tariffs is to protect domestic industries, the unintended consequences can be widespread. The U.S. may succeed in boosting some domestic production, but at the cost of higher consumer prices and trade retaliation. China, on the other hand, will pivot to new markets and industrial upgrades, reducing its dependence on the U.S. The global economy will experience imbalances, benefiting some emerging economies while disrupting others.

Let me give some historical examples of trade wars

(A) The Smoot-Hawley Tariff Act (1930) - The Great Depression Worsens

The U.S. imposed high tariffs on over 20,000 imported goods to protect domestic industries. Other countries retaliated with their own tariffs, leading to a sharp drop in global trade.

This worsened the Great Depression, as industries in the U.S. and Europe suffered due to reduced exports and higher prices.

Lesson we learn in protectionist tariffs can backfire by reducing global economic activity instead of reviving domestic industries.

(B) U.S.-Japan Trade War (1980s-1990s),  Auto Industry Battle. The U.S. accused Japan of flooding the market with cheap cars and electronics, harming American manufacturers.

The U.S. pressured Japan to limit exports, leading to the Voluntary Export Restraint (VER) Agreement.

Japan adapted by setting up factories in the U.S., reducing the impact of tariffs.

Lesson to learn is, companies find ways to bypass tariffs by shifting production or investing in foreign markets instead of stopping trade.

(C) U.S., European Union Trade Disputes (2000s-Present) -  Aircraft Subsidies & Steel Tariffs

The U.S. and EU have repeatedly clashed over subsidies for Boeing and Airbus, leading to tit-for-tat tariffs.

Trump’s administration imposed tariffs on steel and aluminum in 2018, which hurt global supply chains.

The EU retaliated with tariffs on American products like bourbon whiskey and motorcycles (Harley-Davidson).

 Lesson to lean is, trade wars hurt specific industries on both sides, forcing businesses to adjust and find new markets.

Industries Affected by the U.S.-China Trade War

(A) Technology Industry  was a battle for supremacy.

The U.S. imposed restrictions on Chinese tech companies like Huawei, ZTE, and SMIC, citing security risks.

China retaliated by restricting rare earth metal exports, crucial for U.S. electronics and military equipment. The result? Tech supply chains got disrupted, and the U.S. sought to develop domestic semiconductor manufacturing.

The impact was,  prices of smartphones, laptops, and 5G infrastructure increased.

(B) Agriculture where U.S. farmers struggle

China was a major buyer of U.S. soybeans, pork, and corn.

After the tariffs, China shifted purchases to Brazil and Argentina, leaving American farmers with surpluses.

The U.S. government had to provide subsidies to farmers to offset their losses.

The impact was, American farmers lost billions, while South America gained a stronger role in global agriculture.

(C) Manufacturing & Automotive - Higher Costs for Everyone

U.S. car manufacturers like Ford and General Motors rely on Chinese parts.

Tariffs increased the cost of auto parts, making American cars more expensive.

Some companies moved production to Mexico or Canada to bypass tariffs.

The impact was, car prices rose, and manufacturing jobs faced uncertainty.

(D) Retail & Consumer Goods. There was higher prices for everyday items. 

Walmart, target, and best buy rely on Chinese imports for electronics, clothing, and furniture. Tariffs increased prices for consumers, reducing spending power.

Many companies sought alternative suppliers in Vietnam, India, and Bangladesh.

The economic impact was, consumers paid more, and retailers struggled with profit margins.

Summary Reflections: 

From these examples, history teaches us that trade wars rarely have clear winners. Instead, industries and economies adapt, sometimes benefiting new players while harming existing ones. The U.S.-China trade war has forced companies to rethink supply chains, shift production, and pass costs to consumers.

What would be the long-term consequences of these shifts or how smaller economies can take advantage of trade wars?

I don't really know as I said I am not an economist or an expert in economics except I do have many basic lectures on it when I was studying economics and sociology as part of compulsory subjects  for my postgraduate in nutrition at London University Queen Elizabeth College

Sorry! That's all the knowledge I know on the current trade war between US and China. You need to find an expert to know more.   

The Immense Contributions of Scientists and Engineers in Medicine and Health Care

 

The Immense Contributions of Scientists and Engineers in Medicine and Health Care 

by: lim ju boo

I penned my thoughts earlier on:

The Clinician vs The Medical Scientist vs The Clinical Scientists here: 

https://scientificlogic.blogspot.com/2025/04/clinical-scientist-vs-biomedical.html

Today, I am going to pen my gratitude to biomedical engineers, other engineers, physicists, chemists, and other scientists too for their immense and invaluable contribution in modern medicine. 

Have a look at my thoughts.  

There are a lot of medical devices, instruments and machines from simple things like syringes and hypodermic needles, blood pressure sets whether aneroid, mercurial or electronic sphygmomanometers, x-rays, ECG, EEG, CT, MRI, PET machines, nucleotide scans.. among many others, including the simple stethoscope for auscultation of heart, lungs, bowels, bruits and body sounds. Most of these were invented by non-doctors for clinicians to use. 

Doctors must acknowledge the immense contributions of medical engineers, physicists, chemists, and other non-clinicians in advancing healthcare. Many of the most crucial medical devices and diagnostic tools were indeed developed by scientists, engineers, and inventors outside the traditional medical profession.

 Let me explain their contributions in medicine without being bias or taking side across different domains:

1. Medical Imaging & Radiation Technology:

Many modern imaging techniques owe their existence to physicists and engineers. 

Here in this essay, I shall quote only some of them.

It was Wilhelm Röntgen, a physicist who first discovered X-rays in 1895. Röntgen's accidental discovery of X-rays revolutionized diagnostics, allowing doctors to see inside the body without invasive surgery.

The CT Scans was invented in 1972 by Godfrey Hounsfield, an electrical engineer & Allan Cormack, a physicist. Hounsfield and Cormack developed the computed tomography (CT) scanner, combining X-ray technology with computational algorithms to create cross-sectional images of the body.

In 1977, Paul Lauterbur, a chemist & Peter Mansfield, a physicist invented the IMR. Lauterbur and Mansfield used principles of nuclear magnetic resonance (NMR) to develop MRI, providing high-resolution images of soft tissues. 

PET Scans was invented in 1970s by Michael E. Phelps, a physicist & Edward Hoffman, a  biomedical engineer. PET scans use radioactive tracers to detect metabolic activity, aiding in cancer and neurological disease diagnosis.

2. Cardiac & Neurological Devices: 

Electrocardiogram (ECG) was invented in 1903 by Willem Einthoven, a physiologist & engineer.

Einthoven developed the first practical ECG machine to record electrical activity of the heart, winning a Nobel Prize.

Pacemakers was invented in 1958 by Wilson Greatbatch who was an electrical engineer & John Hopps, also an engineer. Greatbatch’s accidental discovery of an electric circuit led to the first implantable pacemaker, while Hopps earlier pioneered external pacemakers.

Electroencephalogram (EEG) was invented in1924 by Hans Berger, a neurologist & physicist. Berger’s EEG helped understand brain waves and neurological conditions such as epilepsy.

3. Surgical & Diagnostic Tools.

Endoscope in 1806 by Philipp Bozzini, a  physician & inventor; later developed by engineers Karl Storz & Harold Hopkins It is used for minimally invasive internal examinations of the body.

Laser Surgery was invented in 1960s by Theodore Maiman who was a physicist, and Kumar Patel who was an engineer & physicist. 

Laser technology, initially a physics breakthrough, became widely used in ophthalmology, dermatology, and surgery.

4. Biomedical Engineering & Prosthetics

An artificial heart was invented by Jarvik-7 in  1982, and Robert Jarvik, a biomedical engineer. Jarvik's work on artificial hearts helped prolong the lives of patients with severe heart failure.

Bionic Limbs by Hugh Herr, a biophysicist & engineer. Herr’s work on bionic prosthetics enabled highly advanced, sensor-controlled artificial limbs.

The Dialysis Machine was invented in 1943 by Willem Kolff who was an engineer & physician (very rare combination professionals). Kolff designed the first artificial kidney, making chronic kidney disease manageable.

5. Pharmaceutical & Biotechnological Innovations

Insulin Isolation was in 1921 by Frederick Banting & Charles Best - Medical Scientists; James Collip, a biochemist. The biochemist James Collip helped purify insulin for diabetes treatment.

Penicillin Production (1928).  Alexander Fleming was a microbiologist; Howard Florey & Ernst Chain were biochemists. Fleming discovered penicillin, but it was Florey and Chain who developed mass production methods.

Monoclonal Antibodies (1975) by César Milstein & Georges Köhler , both biologists. 

Their discovery led to targeted cancer therapies and immunological treatments.

6. Assistive Technologies & Rehabilitation Devices. Cochlear Implant (1978) by Graeme Clark, a biomedical engineer & researcher. Clark developed the first effective cochlear implant, restoring hearing in profoundly deaf patients.

Wheelchair Innovations (Stephen Hawking’s Adaptive Technology by engineers & physicists). Engineers developed advanced motorized and speech-assisted wheelchairs.

Medical engineers, physicists, chemists, and other scientists have played crucial roles in transforming healthcare. Their innovations enable doctors to diagnose, treat, and manage diseases more effectively. While physicians use these tools, the advancements often come from the ingenuity of those in other scientific fields.

It is truly a testament to the collaborative nature of science - where medical and non-medical professionals work together to improve human health.

Let us get this straight.  Sometimes only the medical doctors who are actually basically clinicians  get credit in treating the patient, but not others working silently without beating their own drums. Without all these scientists working silently behind the scene to come out with all these medical devices, the doctor is completely helpless. All he can do is to take medical history, palpate, percuss, listen to body sounds by pressing his ears on the body with or without a stethoscope. That's all a doctor can do, nothing more - absolutely nothing more than these.  For what is the purpose of all history taking and examinations then for the patients? Are they just for show? We need to be honest and be professional with the answer.

They are absolutely useless to the patient - let us get this very straight. 

Even the drugs and medicine are not the invention and products of the doctor. Those came from scientists working in drug companies - the pharmaceutical, analytical and synthetic chemists, pharmacologists, biochemists, physiologists who studies their actions on the body, the toxicologists, molecular biologists, clinical scientists who put them into clinical trials..etc. None of the doctors  get the credit because the patient thinks they all came from the doctor. 

The analogy is like the driver (doctor) of a car. The passengers inside are his patients. At the end of car journey the passengers thank only the driver (doctor). But the actual people that make this journey possible in an easy and comfortable were actually the car manufactures and the automobile engineers working there, and also the petroleum engineers who produced the fuel as power and medicines for the car - driver and passengers.  

None of these contributors get the credit or a single word of thanks from the passengers (patients) except the driver who merely drove the car - the products of inventions and invocations to make the journey possible - else both the driver (doctor)  and his passengers (patients)  must all  get out from the car and walk or get camel to ride on it to wherever they wish to go  - don't you think so? 

Let me  elaborate further on the role of these scientists working in the drug industry, because the doctor merely uses their products to give to them patients - its not their inventions or products for sure. This is the same as robbing Peter to pay Paul for sure. It is penny wise pound foolish so says the proverb. 

 The contributions of scientists working in the pharmaceutical and drug industry are often overlooked, yet they are the ones who truly make modern medicine possible. It was the work of teams of scientists working in the pharmaceutical industry who produce all these drugs, made very careful studies on them, and gave very clear written instructions printed in black-and white on the instruction packets for the doctors to read carefully and to follow them on their pharmacology, indications, contraindications, interactions with other drugs, dosage among other precautions before prescribing them to the patients. All these studies, finding and knowledge did not come the doctor, but from those teams of scientists researching and working in the drug industry. Without their work, doctors would be left with only the most primitive methods of diagnosis and treatment. Don't we admit this? 

The analogy of the doctor as the driver of a car I illustrate  is spot-on. The driver (doctor) may be the most visible figure, but the journey (treatment) would be impossible without the engineers (scientists) who built the car (medical science). Let me now take a closer look at the crucial roles played by different scientists in the pharmaceutical industry.

The Hidden Heroes Behind Every Drug: Scientists in the Pharmaceutical Industry

1. Drug Discovery & Development

Before any drug reaches a patient, it undergoes years, sometimes decades, of research by experts in multiple scientific fields.

Medicinal Chemists & Synthetic Chemists. These scientists design and synthesize new drug molecules.  They modify existing compounds to improve their effectiveness and reduce side effects.

Example: The discovery of aspirin (acetylsalicylic acid) was based on modifying salicylic acid from willow bark to make it less irritating to the stomach.

Pharmacologists

They study how drugs interact with biological systems, including their effects on organs, tissues, and cells. They determine the correct dose and how the drug should be administered (oral, intravenous, inhalation, etc.).

Example: The development of beta-blockers for heart disease involved pharmacologists studying how drugs could block adrenaline receptors in the heart. This is not the job or the expertise of a medical doctor 

Biochemists & Molecular Biologists

They study diseases at the molecular and cellular levels to identify potential drug targets.

Example: The discovery of statins (cholesterol-lowering drugs) came from understanding how the enzyme HMG-CoA reductase contributes to cholesterol production.

2. Preclinical Testing: Ensuring Safety Before Human Trials

After a new drug candidate is identified, it must be tested for safety and efficacy before human trials begin.

Toxicologists

They study the potential toxic effects of drugs on the body, ensuring that the medication does not cause harmful side effects.

Example: The tragedy of thalidomide (a drug originally used for morning sickness that caused birth defects) led to stricter safety testing by toxicologists.

Microbiologists & Immunologists

In the case of vaccines or antibiotics, microbiologists study how drugs interact with bacteria, viruses, or the immune system.

Example: The development of penicillin and COVID-19 vaccines relied on microbiologists understanding bacterial and viral behavior.

3. Clinical Trials: Testing on Humans

Once a drug passes preclinical testing, it enters human trials. This is a rigorous, multi-phase process to ensure its safety and effectiveness. All these clinical trials are conducted by the Clinical Scientists, seldom by the clinicians (who may be in the team) 

Clinical Scientists & Epidemiologists

They design and oversee clinical trials, ensuring that new drugs are tested on diverse populations under controlled conditions.

They analyze large amounts of data to determine if a drug truly benefits patients.
Example: The development of insulin therapy for diabetes involved careful clinical trials to determine the right dosages for patients.

4. Manufacturing & Quality Control

Even after a drug is approved, it must be produced in massive quantities under strict safety conditions.

Industrial Chemists & Chemical Engineers

They scale up drug production from the laboratory to full-scale manufacturing.

They ensure that the drug remains stable and effective over time.
Example: Paracetamol (acetaminophen) was originally difficult to mass-produce, but chemical engineers found ways to make it widely available.

Regulatory Scientists & Pharmacovigilance Experts

They work with government agencies (e.g., FDA, EMA, WHO) to ensure that drugs meet safety and quality standards.

They continue monitoring drugs after approval to detect any long-term side effects.

5. The Unsung Heroes: Drug Innovation & Future Medicine

Beyond traditional pharmaceuticals, scientists are pushing medicine forward in exciting new ways.

Biotechnologists & Genetic Engineers are developing gene therapies to treat inherited diseases like sickle cell anemia.

Nanotechnologists are creating drug delivery systems that target cancer cells without harming healthy ones.
Artificial Intelligence (AI) Specialists are using AI to design new drugs faster than ever before.

Giving Credit Where It’s Due

As a clinical-medical scientist and clinician most patients only see the doctor as the “driver” of medicine (car) but they rarely acknowledge the vast network of scientists who make modern treatments possible. Without chemists, biologists, engineers, and countless other experts, medicine as we know it would not exist.

The next time a patient thanks their doctor for curing them, they should also remember the scientists, researchers, and innovators working behind the scenes. They are the true architects of modern healthcare. 

But if the patient only wish to thank their doctors, and not others who made immense discoveries in medicine and healthcare and with their inventions, then both the doctor (driver) and the patient (passenger) in the car need to get out from the car (invented by the automobile engineers) and walk or take a camel to wherever they both wanted to go. It is the case of robbing Peter to pay Paul - for sure! 

I have a multi-disciplinary training across 5 universities that took me 15 years to complete under British scholarships in British universities and my previous work as a medical researcher, together with  my  wide exposures with other scientific colleagues - this dual function and exposure has enabled me to have a wider vision in healthcare. It is like an eagle soaring high above the landscape to have a broader view. I always acknowledge my scientific colleagues who always helped me in any diagnosis or investigations with their expertise. I would not be able to work alone without their invaluable help. 

A dual role as both a doctor and a medical scientist gives us a unique perspective, one that values both the art of healing and the science behind it. 

The healthcare profession is a team work effort. The doctor is trained how to use all these medical devices by the medical engineers and how to use and prescribe all those drugs safely by biomedical scientists as all these medical products are not the work and products of the doctor who is basically a clinician trained only in  clinical work to whom too we need to be thankful. All have contributed in their own special ways, and to all of them we are thankful.  

My  recognition of the hidden heroes in medicine speaks volumes about our need to have humility and wisdom to whom we are thankful.  

Now we can understand why why medical specialists and Fellows of the Royal Society of Medicine in London (I was elected into the Royal Society of Medicine in London as a Fellow only in 1993 - just a year before my retirement - after much hard work into medical research), who  themselves complained and wrote and published that paper in their own medical journal - Journal of the Royal Society of Medicine why the world's most prestigious award in healthcare - The Nobel Prize in Medicine over the last few decades were mostly awarded to the medical researchers and the medical scientists and not to the clinicians (medical doctors) here in this link: 

"Nobel Prizes in Medicine: are clinicians out of fashion?"

 https://pmc.ncbi.nlm.nih.gov/articles/PMC3164255/

J R Soc Med

. 2011 Sep;104(9):387–389. doi: 10.1258/jrsm.2011.110081

Hutan Ashrafian ^1,✉, Vanash M Patel ¹, Petros Skapinakis ¹, Thanos Athanasiou ¹