Beyond sunburn: How extreme heat strains public health systems and endangers lives
NEW YORK, June 26 — As tens of thousands of people braced for more extreme heat yesterday, authorities and public health experts in the United States issued heat warnings to help keep people safe. Cities of the US Midwest and East Coast were seeing temperatures in the 90s Fahrenheit (32-38 degrees Celsius) this week, as was much of southern Europe.
What are the health risks from extreme heat?
Heat can affect health in various ways.
With heat exhaustion, a person can feel dizzy, shaky, thirsty or develop a headache. It is not usually serious unless the person is unable to cool down within 30 minutes.
When people are unable to cool down, they can develop heatstroke — a medical emergency defined as the body's core temperature, usually close to 36.8 Celsius, going above 40.6 Celsius.
A person with heatstroke may have symptoms including rapid breathing, confusion, seizures, or nausea. Without medical attention, heatstroke can lead to long-term organ damage and death. High temperatures are especially dangerous when combined with high humidity, which makes it harder for people to cool down by sweating. Both are expected to rise with climate change, as warmer air can hold more moisture.
Workers with the Times Square Alliance wear cool towels as they empty trash cans during an extreme heat warning in New York City June 24, 2025. — Reuters pic
Who is at risk?
Extreme heat can be harmful to anyone, but some populations are more vulnerable than others.
Experts are most concerned about older people, young babies, and people who are socially isolated. They also worry about outdoor labourers and people struggling economically.
People with pre-existing health conditions, such as lung disease, heart problems or diabetes, should also be extra cautious.
Experts say more deaths occur earlier in the summer when people's bodies have not had a chance to acclimatise.
Statistics on heat-related deaths are often considered to underestimate the impact of extreme heat because many countries do not record heat as a specific cause of death.
A view of a signage warning visitors of extreme heat conditions as messages are posted around visitors centers and trail heads in Big Bend National Park, Texas June 21, 2025. — Reuters pic
Less obvious risks of extreme heat
Apart from testing a body's ability to regulate its own temperature, extreme heat can pose a host of secondary risks.
Warmer temperatures encourage the growth of bacteria and algae. So heatwaves can raise the risk of water being contaminated with diseases such as cholera, or of lakes and rivers becoming choked with toxic algae.
Heat can also damage crops or buckle roads and disrupt transport systems.
Wildfires fuelled by dried-out trees or shrubs can lead to dangerous levels of air pollution.
Heat stress, including the sleep disruption caused by heat, can also contribute to poorer mental health.
Medical experts expect that certain diseases will expand their ranges as climate change enables disease-carrying insects to move into new areas.
For example, we could see more of the deadly, tick-borne Powassan virus, while scientists also have mapped the expanding habitat of Aedes mosquitoes, which carry dengue, Zika virus and chikungunya.
In California's Central Valley, desert-loving fungal spores that cause Valley fever could do well as temperatures climb.
A couple in sun hats and with an umbrella cross the street as an extreme heat warning is in effect in Queens, New York City June 23, 2025. — Reuters pic
What you can do
Public health advisories across the United States urge people to stay cool, stay hydrated, and avoid over-exertion.
Many cities have set up public cooling centres or are providing free access to air-conditioned public transport.
Employers should ensure workers have adequate breaks and hydration, and that they are not working outdoors when the heat is dangerous. — Reuters
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Malay Mail
an hour ago
- Malay Mail
Cheap and risky: Stung by high prices, Americans turn to DIY weight-loss drugs from the grey market
Grey market grows for cheap weight-loss drugs imported from China Some users try small doses of substances not yet approved by FDA Drugmakers call trend dangerous and illicit Online community says it's filling gaps in broken system SAN FRANCISCO, June 29 — In what she calls the 'wild west' of obesity medicines, Missouri-based Amy Spencer is a pioneer. Each week the mother of two injects herself with weight-loss drugs, two of which are in clinical trials and not yet approved for sale by the US Food and Drug Administration. One comes mixed with tirzepatide, the active ingredient in Eli Lilly's Zepbound. Spencer, 50, is not part of any drug trial but mixes the cocktails herself, using tiny doses that she believes are safe. The total cost is about US$50 (RM211) monthly, as little as one-tenth of what she would expect to pay their makers for full treatment. The drugs — glucagon-like peptide-1 (GLP-1) weight-loss medicines — are manufactured and shipped from China, according to the packaging. She orders them through online vendors. Spencer belongs to a fast-growing group of Americans turning to what many call the 'grey market' for obesity medicines, bringing cheap active ingredients from China often labelled as for research purposes, according to import data and social media postings. It's a trend that drugmakers Lilly and Novo Nordisk, which makes Wegovy, say is dangerous as well as illicit. Reuters tracked online forums and interviewed seven people who said they bought obesity medicines through this market, including an attorney in Arizona who works for a state insurance agency, a retired nurse in Illinois and a Type 1 diabetic in Louisiana, who said the medicine helped cut her insulin intake by more than half. For more than a year there has been demand for cheap Chinese-made powders, exacerbated by limited health insurance coverage in the US Buyers told Reuters the grey market received a boost from an FDA ruling last year that US compounding pharmacies — outsourcing facilities that create drugs in shortage — must stop selling obesity medicines more cheaply than the companies that developed them. Shipments of such active ingredients from Chinese entities not registered with the FDA jumped by 44 per cent in January from the previous month, according to research by the Partnership for Safe Medicines, a public health group focused on the safety of prescription drugs. It said its findings are likely an undercount, because unregistered vendors may not disclose that their parcels contain medicines. Packages valued at less than US$800 that enter the US under the de minimis rule are not included in the data. Amy Spencer holds a number of vials containing components of obesity drugs, which were purchased through the grey market, a new market for obesity drugs that allows consumers to purchase medication materials from China and reconstitute them into injectable drugs, at her home in southern Missouri April 24, 2025. — Reuters pic Nearly three-quarters of US adults are overweight or obese, according to government estimates, but a survey by nonprofit health policy research organisation KFF found only about 8 per cent say they have taken medicine for weight loss. Most of the grey market buyers Reuters interviewed had told their medical providers they were taking GLP-1 medicines but not where or how they bought them. Insurance coverage for weight-loss drugs has recently increased, but typically only covers branded versions, according to consulting firm Mercer. Many Americans have paid out of pocket for cheaper compounded drugs. Interest in taking small doses of the drugs has also spurred the online marketplace, buyers said. Taking to platforms including Reddit and Telegram for guidance, buyers import small quantities, often described as research materials to sidestep regulatory scrutiny. They swap advice for navigating the market, exchanging information on vendors, shipping and dosage, and sometimes clubbing together to cover the cost of testing the powders. One forum is called StairwayToGray. It has more than 21,000 members on Telegram and recently was gaining nearly 1,000 members weekly. It did not respond to Reuters' inquiries, and blocked access to the forum after receiving them. It has a website where it says it does not facilitate group purchases. 'This community is filling the gaps and being our own regulators, ensuring testing and access for everyone who needs it. Because you shouldn't have to choose between your health or your wallet,' it says. Spencer stores her stocks in her fridge and makes them up in the kitchen — carefully measuring sterile water, rolling the vial between her fingers until the powder dissolves, and drawing the liquid into a syringe before injecting it into her thigh or belly. She has lost 24 pounds. 'This is working so well for me. It's so easy. It's cheap,' said Spencer, who assumes her health plan wouldn't cover the drugs. 'I don't know what I would do without this medicine.' Amy Spencer poses for a portrait in a beveled bathroom mirror while holding a syringe and a vial that contained the components of obesity drugs, which she purchased through the grey market, a new market that allows consumers to purchase obesity medication materials from China and reconstitute them into injectable drugs, at her home in southern Missouri April 24, 2025. — Reuters pic 'Very dangerous' In February, 38 US state and territory attorney generals wrote the FDA seeking action against illegally sold weight-loss medicines, including 'research purposes only' ingredients from China. 'Much like with counterfeit versions, these active ingredients come from unregulated, undisclosed sources... and pose risks of contamination and inclusion of foreign substances,' they said. Shabbir Safdar, executive director of the Partnership for Safe Medicines, said unapproved drugs can have problems with sterility, purity and consistency. 'It can be very dangerous. You're playing the role of your own doctor, pharmacist, and FDA inspector,' he said. Of those interviewed, only Spencer reported any problems: She once got her math wrong and overdosed, resulting in several days of severe flu-like symptoms. Lilly said it had taken many steps to address patient safety risks posed by the proliferation of unsafe or untested tirzepatide. The company said it is filing lawsuits, educating consumers and working with social media companies to identify and remove posts that promote unsafe products, including those described as 'research use only.' 'We will continue to take action to stop those who threaten patient safety and urgently call on regulators and law enforcement to do the same,' a Lilly spokesperson told Reuters. Novo Nordisk also said it continues to take action against entities that violate laws and regulations and put patient safety at risk. America's Poison Control agency, which maintains the nation's poison data surveillance system and monitors GLP-1 exposures, said it could not reliably track cases involving unregulated 'research chemical powders' because they are sold under various names and formulations. The FDA's goal is to stop illegal sales of pharmaceutical medicines at the border, said George Karavetsos, former director of the FDA's Office of Criminal Investigations and co-author of the imports study. But understanding the true nature and intended use of small parcels arriving from China can be difficult, and the FDA rarely seeks charges against consumers for personal use, he said. The FDA said it urges consumers to buy from licensed pharmacies and 'avoid products of unknown quality,' adding it was actively protecting consumers by intercepting illegal products at ports, and warning companies that market unapproved weight-loss medicines, including those mislabelled as 'for research purposes.' Although the forums show suppliers purportedly in China, Reuters was not able to verify where the drugs originate. None of the vendors responded to requests for comment. A Reddit spokesperson said the site prohibits facilitating transactions involving drugs and it had shut down a group found to be doing this. Telegram said it removes 'more than a million' instances of harmful content each day, but did not comment directly. Amy Spencer injects herself with obesity medication, which she purchased through the grey market, a new market for obesity drugs that allows consumers to purchase medication materials from China and reconstitute them into injectable drugs, at her home in southern Missouri April 24, 2025. — Reuters pic Microdose mistake Spencer has polycystic ovary syndrome and for years struggled with weight gain and hypertension. She decided to try obesity medicines after seeing claims on social media that microdosing them could give fewer side effects, and bought semaglutide, the active ingredient in Wegovy, from a compounding pharmacy for about US$200 per month. She started on one-fifth of the lowest dose. Within days, intermittent joint pain she often suffered had dissipated: 'I didn't realise how badly I hurt until the pain was gone.' The cost would reach about US$500 a month if she bought the drug from Novo, which recently introduced one-off discounts. After a week, Spencer said, her blood pressure dropped so low she thought she might pass out, so she stopped taking hypertension medicine. Her pressure stabilised and she lost three pounds. She wanted to understand more about microdosing, and turned to the grey market last summer. On Reddit, users told how another Novo drug in development, called CagriSema, had helped reduce inflammation and hunger pangs better than semaglutide. CagriSema is Novo's next-generation obesity drug candidate, still in clinical trials so not available to the public. It combines semaglutide with another molecule, called cagrilintide, which intensifies the hormone-mimicking effects to regulate blood sugar and reduce hunger. Spencer was intrigued. She found a US reseller saying they tested Chinese-made CagriSema through a third-party lab before selling it to Americans. On microdoses of CagriSema, Spencer could enjoy food in small quantities. 'I could say 'yes' because I knew I was only going to eat four bites.' In October, Spencer saw on Reddit that tirzepatide might also reduce inflammation. She placed a new order for vials that contained cagrilintide and tirzepatide combined, dubbed 'cagri-tirz.' Now each Monday, Spencer injects herself with tiny amounts of cagri-tirz. On Thursdays, she uses retatrutide, a new obesity medicine by Lilly, also in trials. As she was switching to cagri-tirz, Spencer made a dangerous mistake. She calculated her new dosage without realising the concentration of cagrilintide in the combined vials was 10 times higher than she had taken previously. 'I was an idiot. I didn't do my math. Or rather, I did the math for the tirzepatide but not for the cagri,' she said. Almost immediately, she began vomiting. The reaction was so severe she had trouble moving. She forced herself to drink water but couldn't eat. After four days, when symptoms lifted, she had lost seven pounds. Despite the blunder, Spencer didn't consider returning to compounded versions of the drugs or abandoning them altogether. She is not regularly monitored by a healthcare provider, but says her treatment has led to a 'life-changing' reduction in weight, joint pain and blood pressure. Marie, who asked to be identified by her middle name, filters reconstituted obesity medication, which was purchased through the grey market, a new market that allows consumers to purchase obesity medication materials from China and reconstitute them into injectable drugs, in the US Midwest April 28, 2025. — Reuters pic 'Honour system' Grey-market buyer Marie, 41, shows how do-it-yourself drugmakers are organising. She describes herself as a 'football mom' from the Midwest and asked to be identified by her middle name to protect her privacy. Last year she bought a compounding pharmacy's version of tirzepatide, paying about US$470 monthly, and had lost more than 20 pounds when the FDA announced the ban on compounded weight-loss drugs. She began to worry about her supply. Browsing on Reddit, she discovered links to Telegram and a trove of detailed instructions from experienced users for buying weight-loss drug ingredients from China. Customers said they often paid with Bitcoin or through mobile payment service Venmo. After a month closely following the forums, Marie made a purchase in January. The package that arrived contained 20 small glass vials of white powder with red caps. There were no instructions. The vendor who advertised the package on Telegram said it came from China. Marie returned to the forums and joined a group of 52 other customers who paid a total of US$1,020 to a Tennessee-based company called Peptide Test. Six members mailed in a vial each and the others chipped in their share of the fee. The lab found the samples were pure. Peptide Test declined to comment. 'It's an honour system,' said Marie. 'These groups are very supportive in a way I haven't seen on the internet before.' Marie, who asked to be identified by her middle name, stores obesity medication, which was purchased through the grey market, a new market that allows consumers to purchase obesity medication materials from China and reconstitute them into injectable drugs, in a deep freezer, in the US Midwest April 28, 2025. — Reuters pic Before her first injection, Marie gave her husband details of what she had done. They agreed that if needed, he would disclose everything to the emergency medics. But she was fine. In March, Marie volunteered to organise testing a new order of tirzepatide. The group formed on Telegram after users received vials from the same vendor which they judged to be from the same batch based on the colour of the caps. In all, 38 buyers agreed to chip in for the US$1,300 bill, and decided by poll that five vials would be enough. Five people sent drugs to the lab, Janoshik Analytical in the Czech Republic, which found the vials contained tirzepatide, as purported, with purity between 99.78 per cent and 99.85 per cent. Janoshik's CEO, Peter Magic, is a former amateur weight-lifter. He said his company started out more than a decade ago testing performance-enhancing drugs for online buyers. Last year, it tested 3,050 samples of obesity drugs, up from just over 650 samples in 2023. 'We're testing hundreds of these every week,' said Magic, whose company helps customers navigate customs requirements for shipping chemicals. — Reuters
Malay Mail
12 hours ago
- Malay Mail
Pakistan flash floods and heavy rains kill 24
Pakistan flash floods and heavy rains kill 24 PESHAWAR, June 28 — Heavy rains and flash flooding across Pakistan have killed 24 people including 12 children since the start of the monsoon season this week, disaster management officials said. At least 13 people have been killed in the eastern province of Punjab since Wednesday, the area's disaster management authority said Saturday. Eight of the fatalities were children, who died when walls and roofs collapsed during heavy rains. The latest toll came after officials in Khyber Pakhtunkhwa said 11 people were killed in flash floods and landslides over 24 hours. Those victims included 'four children and three women—while six others have been injured', the province's disaster management agency said late Friday. The agency said 10 of those killed were in the northwestern Swat Valley where, according to local media, a flash flood swept away families on a riverbank. Flooding in Khyber Pakhtunkhwa has also damaged 56 houses, six of which were destroyed, the disaster agency said. The national meteorological service warned that the risk of heavy rain and possible flash floods will remain high until at least Tuesday. Last month, at least 32 people were killed in severe storms in the South Asian nation, which experienced several extreme weather events in the spring, including strong hailstorms. Pakistan is one of the world's most vulnerable countries to the effects of climate change, and its 240 million inhabitants are facing extreme weather events with increasing frequency. — AFP
Malay Mail
15 hours ago
- Malay Mail
France bans smoking on beaches, parks and near schools to protect kids from passive smoke; excludes cafe terraces
PARIS, June 2 — France will ban smoking on beaches and in parks, public gardens and bus shelters from Sunday, the government said. The decree, published in the official government gazette on Saturday, will also ban smoking outside libraries, swimming pools and schools, and is aimed at protecting children from passive smoking. The decree did not mention electronic cigarettes. Violaters of the ban will face a fine of 135 euros (RM668). 'Tobacco must disappear from places where there are children,' Health and Family Minister Catherine Vautrin had said in May, underscoring 'the right of children to breathe pure air'. Cafe terraces are excluded from the ban. Some 75,000 people are estimated to die from tobacco-related complications each year in France. According to a recent opinion survey, six out of 10 French people (62 percent) favour a smoking ban in public places. — AFP
