Death by glutathione

On Feb. 3, Shyril Gee Distor, 33, a restaurant manager, died after a “glutathione session” in a spa in Sampaloc, Manila. News reports indicate that she collapsed after having been administered a dose of Aqua Skin-Diamond Pro Ultra White and Vitarex–C, was rushed to the nearby UST hospital, and had a fatal cardiac arrest hours later.

It was an incident waiting to happen. For over a decade, the Food and Drug Administration (FDA) has been warning about the use of glutathione as a skin lightening agent. In a public advisory last year, it cited possible side effects including “toxic effects on the liver, kidneys, and nervous system.” It added that large doses of Vitamin C — which often accompany IV glutathione as in the case of Distor — “have resulted in hemodialysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency.”

The Philippine Dermatological Society (PDS) has also aired similar warnings, questioning both the efficacy and safety of IV glutathione, which is administered, off-label, either as a “drip” that takes hours or a “push” that lasts for 15 minutes. A November 2018 news article by Jovic Yee in this paper cited a PDS report that “documented at least 69 patients who suffered from complications due to IV glutathione use, ranging from dizziness, increased blood sugar and easy bruising to difficulty in breathing and gastritis.” The same article quoted Dr. Belen Dofitas, my dermatology professor in PGH, as calling on the “public to stop patronizing IV glutathione and for the government to clamp down on such practice before somebody dies.”

Hopefully, a thorough investigation will shed more light on the nature of Distor’s death. Regardless of culpability and other legal issues, however, the unfortunate incident and other cases of apparent glutathione-related complications raise a number of questions.

In the first place, why are spas and “clinics” able to offer such a procedure? As Dr. Eric Domingo, health undersecretary, said of the incident, “In the first place, IV use is not allowed in nonhospital settings and the clinic is unlicensed. So if something like that happened, they are liable and can be sued.”

Clearly, there is a failure here to regulate both the practice and the products in question, and the problem extends to the online marketplace. In Lazada, for instance, a plethora of sellers offer the same products that were allegedly used on Distor, packaged as “complete push sets” that include vials, syringes, scalp vein sets, and even sterile water. Nurses or midwives, licensed or unlicensed, offer to administer these products as a “raket” to compensate for their un- or underemployment.

More fundamentally, of course, we may also interrogate why people go to great lengths to try to whiten their skins. On top of the medical risks and effort, it is a relatively expensive procedure; even the lowest prices I see online — P600/session — are still significant sums, especially when people are told that they need several sessions to see “results.”

Beyond facile explanations of “colonial mentality” and “Western beauty standards,” I find it useful to look at these practices in terms of what the sociologist Norbert Elias terms “figurations,” or people’s ways of relating to those around them — from their peers, members of the opposite sex, their labor environments, and their aspired-for futures. Despite the clear influence of mass media and marketing in shaping people’s sense of beauty, who can blame them for desiring whiter skin when they observe that “pleasing personality” — a euphemism for attractiveness in job advertisements — can lead to better economic and social opportunities? And what philosophical or moral distinctions can we make between different forms of beautification—pills, powders, “pushes,” plastic surgery?

We may never be able to resolve the above questions. However, it is clear that we need to draw the line between safety and harm. If we cannot stop people from trying to whiten their skins, the least we can do is to ensure that all products in the market are safe, and those who administer those products are trained to do so.

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