You only need the English Proficient for international operations as it's an ICAO thing. Some countries, like France, check; others may not. Similar on the RRTO -- some countries, like Canada and the Bahamas don't require it, but others, like Turks & Caicos, do require it and do check it.
Apoptosis, or programmed cell death, is a naturally occurring process in the body. It involves a controlled sequence of steps in which cells signal self termination. Apoptosis works to keep the body's natural cell division process of mitosis in check.
Moreover, they don't do it only when things go wrong! The apoptosis mechanism is a normal and creative aspect of multicellular life. Orchestrated apoptosis helps the growing embryo to sculpt many aspects of its final form. Every year the average human loses half of his/her body weight in cells via apoptosis!