It was during my second week working as a medical doctor that I attended to a man in his fifties who took an unsuspecting action that could have cost his life. He was annoyed with a tattoo on his forearm that he had acquired in his twenties. Conveniently, a tattoo artist owed him a favour and offered a cover-up tattoo, which he gratefully accepted. Everything seemed fine on the afternoon when he looked at this freshly-applied tattoo until he suddenly started to feel rather odd. The area around the tattoo began to swell and turned red. Both the swelling and redness then progressed to his upper arm and face. His breathing became increasingly difficult as his cheeks, lips, and tongue began to swell. The inside of his chest felt like it was burning. He had never experienced anything like this before, but he understood that he urgently needed help and called an ambulance. When he arrived in the emergency room, he was anaphylactic and could have died of suffocation if it wasn’t for the medication he received that provided prompt relief.
This is where the story begins: we were puzzled by what exactly triggered his anaphylaxis. The most obvious culprit was hiding in the tattoo ink. But maybe, I thought, this was just a coincidence and he had eaten something new? He didn’t. In fact, he had boringly regular diet. He took the same medication as always, had not gotten bitten by any bug, wore anything new or did something different. The geeks among you will think: “They should have checked for hereditary angioedema!” That’s an inheritable disease where a missing enzyme can cause swelling of, say, the hands, arms and face (etcetera) if you get minor trauma, like from a dental procedure or—perhaps—needle pricks. Well, we ran exhaustive blood tests and there was no sign of that either. So, it was just very likely that the tattoo ink was the source of evil. But when we searched the medical literature, we found only one trustworthy report of a similar case. Frankly, that’s not much when more than two million scientific articles are published each year. So I started to dig deeper and we reached out to his tattoo artist, who innocently told us that he bought only ink from established brands through official German suppliers, thinking this would guarantee their safety. He had no idea how wrong he was.
The patient was fine now but we couldn’t rest the case. We just had to know and felt like there was something else going on that could cause more harm if it remained unrecognized. So we contacted the German Federal Institute for Risk Assessment to investigate the matter further. I didn’t think they would care much, but we ended up collaborating closely on this investigation. To our surprise, tattoo inks are a major concern to them because, well beyond Germany, tattoo inks are legally treated like cosmetics, which, by definition, you put on your skin (not in it). That makes a difference: we discovered lots of formaldehyde and other allergens, stuff you mostly don’t need to worry about if they touch your skin before they eventually are washed away. But you certainly don’t want them injected into your flesh and then flushed into your system! I don’t know why more cases like ours have not been reported.
To be fair, everybody is different and perhaps most of us will cope just fine with diverse toxins and allergens among our cells. But I can imagine that many mild (yet annoying!) reactions go unreported because people don’t think about consulting a doctor and doctors don’t communicate a case to their authorities (they only have to for certain diseases because otherwise they would do nothing all day but fill out forms). However, other complications are far better described in the literature. Did you know that to one in twenty people get bacterial infections after receiving a tattoo? Some of those infections are localised and uncomplicated while others can grow to massive problem… And nobody’s quite sure about the long-term consequences of the variety of compounds (some of which are cancer-causing) that are found in tattoo inks either… By the way: a Swiss survey revealed that 37% of tattoo inks did not comply with their current regulations.
Many product safety agencies are struggling to do anything about this, because laws constrain their ability to conduct adequate studies, and finding tattooed individuals who are willing to volunteer for toxicological evaluations is difficult. Hence, my little case from the frontline is hugely important for them to promote meaningful change for the public.
What I learned from this experience, aside (of course) from insights into tattoo regulation and physiology, is the impact that anyone whose curiosity expands beyond their professions can have on society. Whatever our profession, we gain insights into the workings and challenges of our society: we hear first-hand about the worries, problems, and ideas of individuals from diverse backgrounds on a daily basis.
“The bigger your horizon, the bigger the system you can see”
In a case like mine, most doctors stop after the problem is resolved for the individual patient. And, granted, that is already a solid achievement. Some would publish a case report to raise awareness. But we should actively seek to bring a problem we uncovered in an individual case to societal discourse. It gives our daily work a greater purpose and rewards us with fulfilling insights about the very system we operate in. Plus we can win allies who support our work by complementing it with skills and resources that we wouldn’t be able to access otherwise. I would never have had the time and capabilities to solve this riddle by myself! Instead, I was invited to a tour through the agency’s high-tech labs and gave a presentation to a group of 80 highly trained staff. An exciting experience.
You might think you don’t have the time for such endeavors. And many young professionals often don’t know how to engage with these alien realms. But our generation is more connected than any other before and our voices are perhaps more listened to than we care to believe. Just search the internet for people whom your insights might be helpful and email them directly. Or find communities and conferences where the relevant people might be present. There’s no “too big to care” – many executives worry that they lose touch with the base and are happy to hear about problems, especially if they’re accompanied by pro-active ideas to overcome them. And often you don’t even need to reach to the top to get a problem solved, you can also start with lower hanging fruits like a local newspaper or a magazine with an interest in your discovery, or maybe just ask the people you work with on a daily basis for their advice. As with everything: you will become better at it with every time you try. In my case, this one patient helped (if only a little bit) to fill in a gap of evidence that previously prevented an important reflection about the regulation of tattoos as a whole. And that’s something that currently affects around 120,000 million people in North America and Europe! And I certainly learned a lot from engaging with a federal agency.
Individual stories matter. We as young professionals need to assume our societal responsibility by recognizing that there is a world beyond our professions. In an era of increasing complexity, it is becoming less acceptable for our generation to keep our heads down in the small trenches we call our professional home. We need to let the daily insights we gain at an individual level become the inspiration that enables us to expand our impact on a broader societal level. It will also widen our understanding of the very world that we are part of. Our generation is uniquely positioned to lead and grow with purpose, let’s not miss this beautiful opportunity.