Requeim for a fellow blogger 2

I remember when we used to sit
In a government yard in Trenchtown
Observing the hypocrites
Mingle with the good people we meet
Good friends we have,
Oh, good friends we have lost
Along the way
In this great future,
You can't forget your past
So dry your tears, I seh
No woman no cry
No woman no cry

- Bob Marley

Halloween Party

Spoke with Dick over the phone last night…

angry doc: So how, you went for the Halloween party?

Dick: Ya. Great party, man.

angry doc: What costume did you go in?

Dick: Oh, I just wore my scrubs and my stethoscope.

angry doc: … Er… weren’t you suppose to be pretending to be some sort of character other than yourself?

Dick: I told the people there I was an engineer pretending to be a doctor.

angry doc: …

Dick: Wanna know what I used as a pick-up line?

angry doc: No.

Dick: “You can never have too many outfits. Or too many breast checks.”

angry doc: Remind me not to invite you to my funeral; I don’t want to be remembered as ever having been associated with you.

Angry Professor - Part 3

There have been many letters following Prof Lee's on the ST Forum, but I haven't had time to comment on all of them. I would like however to respond to Anonymous at 8:25pm, who commented on my post.

Dear Anonymous,

If you are who I think you are, we have met. I welcome you to the blog, but I shall remain behind my cowardly anonymity for reasons stated previously.

No doubt 'happy endings' and 'success stories' involving individuals with disabilities exist. But that fact that such 'against the odds' stories receive publicity underlies the fact that for many, life remains a constant struggle and a strain on the emotions, time, and finances of themselves and their families.

How many unhapy stories are there to one happy story?

How many unhappy stories is one happy story worth?

And I don't just mean that in terms of money, but also in terms of the pain and anguish felt by those concerned.

Anecdotal stories may inspire, but doctors have a responsibility to temper hope with reality. We cannot just tell the patient how someone else struck the jackpot, we must also tell them what the odds are are how high the stakes are.

Specific to the issue of genetic counseling, my personal belief is that it is one thing to have an unplanned pregnancy or a child with an unexpected abnormality, but another altogether when parents attempt to 'beat the odds' and try for a 'normal' child when significant risks of an inherited disorder is already known.

And that is not to say that individuals who suffer from disabilities and their families do not deserve our help and support.

I wish you the best.

Thank you.

Profits before Patients

I was planning to resume blogging only in November, but I thought I just had to draw my readers' attention to this news snippet.

Serono admits Aids drug charges

Swiss drugs maker Serono has admitted it was guilty of illegally promoting its Aids drug, Serostim, and has agreed to pay a $704m (£398m) settlement.

The payout relates to allegations that it offered kickbacks to doctors to write prescriptions for the drug to boost sagging sales.

The settlement was agreed with the US Justice Department.

Serostim is a US approved growth hormone used to treat muscle wasting in Aids patients.

Serostim was backed by the Food and Drug Administration (FDA) regulators in 1996 at about the same time the FDA approved protease inhibitor drugs.

Out of date

Protease inhibitors revolutionised treatment for HIV and Aids and made patients less prone to muscle wasting, and therefore less in need of drugs such as Serostim.

Four former Serono executives were indicted in April on charges of offering illegal payments to doctors for prescribing the drug. The company made more than $90m profit during the period of illegal promotion, the Justice Department said.

"Serono abused the system of testing and approval, and put its desire to sell more drugs above the interest of patients," said US Attorney General Alberto Gonzales.

Serono Labs will be excluded from all federal health care programs for at least five years.

Similar cases

The Serono settlement is the latest in a series of 'whistleblower' claims that have cost major drug firms more than $3bn in recent years.

Last month, UK giant GlaxoSmithKline announced it would payout $150m to settle allegations that it overcharged the US government for two anti-nausea drugs.

Meanwhile, US federal and state officials are said to be probing 150 price and marketing fraud cases involving more than 500 drugs.


They bribed doctors to prescribe an unnecessary drug, and got away with a fine.

I bet they are now planning on how to recoup that 'loss' from patients.

It bothers me that they can destroy the trust between healthcare providers and patients and get away with a 'settlement'; they're not even guilty underthe law. But perhaps the judge knew that money was the only kind of pain they could feel. Even if you jailed a few executives, they were probably more easily replaced than a few hundred million dollars.

I hope you will remember this story the next time you see an advertisement featuring happy-looking people with a message telling you how much this drug or another had made life better for them, and how the company really cares for you.

Or, if you are a doctor, think about how the money that bought that 'free' pen or your sponsored lunch came from.

First Kill Meme

OK, one last entry before I go; something to keep my colleagues occupied while I am gone...

I thought since I've been around for nearly two months I am old enough to start me own meme. So here goes:

1. What's your 'first kill' story?

If you are unable to disclose your first kill story due to a hospital/insurance company contract or a court order, please provide the next most memorable kill story.

With the understanding, of course, that's it's all fictional.

Operator, please page for the following doctors:

1. Dr BL Og
2. Dr spacefan
3. aliendoc
4. Dr Barbados Butterfly

Let the guilt trip begin.

The Doctor is Out

angry doc will be taking a break from blogging for the next two weeks.

We hope to return to our regular ranting in November.

In the meantime, please visit the selection of fine mediblogs on the link list to the right.

To prevent spamming during my absence, I have turned on word verification. I hope to disable it again when I am back.

Thank you.

Overheard…

... in the operating theatre tea-room.

Medical Officer: … so I referred the patient to Medical, and it turns out the registrar on-call was my ex-houseman! I feel so old.

Registrar: You think that’s old? The student-nurse that I met during my housemanship is now a Nursing Officer!

Senior Registrar: You think that’s old? My ex-houseman is now my consultant!

All three: *sigh!*

Angry Professor – Part 2

As expected Prof Lee’s letter generated a few replies on the ST Forum yesterday and today.

I counted five letters, all criticising her point of view, some denying that Singaporeans who donated to the patients’ families were gullible, and all citing that heart and hope were more important that science in these cases.

They all seem to have missed Prof Lee’s points.

The truth of the matter is, from the onset Singaporeans were duped into donating money without being given all the facts.

Ask yourselves: how did they find out about the cases?

Answer: The press.

How much did they know about the clinical facts behind the cases?

Answer: As much as the press told them.

Would they have continued to donate so generously if they had known that these "were cases who would not benefit from surgery"?

I think many still would, but I also believe almost all of them donated out of the hope and belief that the poor children will benefit from the operations, and that many now ask themselves why the low chances of a good outcome were not explained to them by the press.

At the end of the day, the press had what they wanted - sensational stories, heart-warming tales of generosity, tales of the miracle of modern medicine, and a sense of the journalist’s duty well-done.

But that there were no miraculous recoveries that lasted. And worse still, there might not have been any miraculous recovery to hope for to begin with.

So yes, I agree that they were gullible, even if it was due to the goodness of their hearts.

The second, less explicit point that Prof Lee wanted to make, I believe, was the point about full disclosure, which was countered by the issue of ‘hope’.

As doctors, we often have to inform patients and their families about their diagnoses and the treatment options available to them. Most of the time it’s pretty straightforward, but in cases of cancer or neurosurgery, things can get more complicated.

It’s hard for patients and their families to accept that sometimes, no matter what we do, the outcome will not be what they hope for: a full and complete recovery.

Sometimes the treatment prolong life a bit more, but leave the patient in an uncommunicative state.

We understand how difficult it can be for the patient’s family to cope with having a relative in a vegetative state long-term. OK, we don’t fully understand, but we can see their pain.

One patient’s mother told my senior in neurosurgery, after seeing her son a vegetable for weeks, that he “tried too hard”.

But we had offered the operation to evacuate the blood clot from his head and explained the risks and likely poor outcome even if he lived, and she had given her consent for it. Now she thinks we “tried too hard”.

Offers of hope must be tempered with a healthy dose of reality. Sometimes all the heart and hope in the world is not going to produce a good clinical outcome.


Sure, at the end of the day it’s still your money and yours to throw away as you see fit. But try to have a better understanding of the medical facts in question before you decide, and if you choose not to, at least have the courage to admit that you were duped when you are.

Afterall, nobody seemed to be embarrassed by the fact that they felt duped by NKF.

Singapore Idol Runner-up to be Cancer Screening Ambassador

The comment by my disciple on the Breast Cancer Awareness post inspired this…

Bonus Bogus Story

Singapore -

Sylvester Sim, runner-up in the Singapore idol contest, will be the ambassador for Prostate Cancer Awareness month this year.

This was revealed at a press conference at the Health Promotion Board yesterday.

Mr Dee Arh Yee, spokesman for the HPB, explained that Sylvester, or Sly as he is known by his fans, has the wide appeal and recognition that will make him an effective icon to spread the message for early screening of prostate cancer.

The tagline for this year’s campaign is "You can never have too many tattoos. Or too many prostate checks."

Sylvester had this to say about his new role, "I think it is important to educate men that prostate cancer screening is a simple procedure that is cheaper, faster, than less painful than getting a tattoo. So if you have got a tattoo or are thinking of getting one, think about getting a prostate examination as well!"

The campaign will run from 1 to 28 November.

Sylvester is the second Singapore Idol contestant to become a Health Ambassador. Taufik Batisah, Singapore Idol winner, was made the anti-smoking Ambassador in August this year.


Sly demonstrates how a prostate examination is done.

Memo to a GP

Dear colleague,

I am writing to you regarding the abovenamed patient, who was seen at your clinic and had a test done there last month. She claims that you have told her that the test results were abnormal and suggested malignancy, and that she had to be referred to your gynaecologist-colleague for urgent surgery.

However, instead of following your professional advice like a good patient should, she foolishly decided to doctor-hop and had come to our subsidised clinic through a referral from the polyclinic, claiming financial difficulties.

She was a poor historian (as she was in a state of distress and crying through much of the consultation) and I could not get sufficient information about the test which you have done for her, so I wrote you a memo requesting for more details on the test and asked her to bring it to yourself.

The patient returned to our clinic today, making the preposterous claim that you had refused to provide any information regarding her case even after she had passed you the memo. I am sure she must have lost the memo but refused to admit it, or had neglected to tell you she is seeking a second opinion here, as I am certain we are both aware that the SMC Ethical Code states that “Where a doctor-patient relationship is terminated by a patient, a doctor should not withhold medical information from a patient or another doctor to whom the patient subsequently goes, if requested by the patient.”.

Your misguided clinic assistant had however complicated matters when she decided to disregard patient confidentiality by providing a copy of the patient’s Pap smear results to her without your knowledge, no doubt due to her tearful pestering. I am sure the Pap smear was not the test which you based your assessment of her need for urgent surgery on, as the results showed no malignancy and according to the guidelines required only a repeat smear to be performed. The patient also claims that she has only had one test done at your clinic, but I am sure she is mistaken.

I am therefore writing to you again to request a summary of her medical condition; hopefully the clumsy patient will not lose this memo too.

I hope that I will receive a written reply this time as the history the patient has made up makes you look like an unhelpful doctor who had sought to send her for an expensive and unnecessary surgery by your specialist colleague, either because you didn’t know how to interpret a Pap smear result, or because you stood to gain from the referral. Nothing, I am sure, is further from the truth.

Sincerely,
angry doc

Introducing a new mediblog

Chanced upon a new blog by a fake doctor about a banana republic. Looks interesting.

I'm no Sherlock Holmes

angry doc: … and you should stop smoking too.

Patient: But I don’t smoke!

angry doc: (annoyed) Then what’s that in your shirt pocket?

(Points at cigarette packet in patient’s shirt pocket.)

Patient: This? I only use it to hold my keys. See?

(Produces keys from otherwise empty cigarette packet.)

angry doc: … OK, let’s talk about your diet now…

Angry Professor

Another Forum letter from Prof Lee:

Oct 8, 2005
Nepalese twins: A tale of misplaced sympathy

I AM writing in response to the report on the Nepalese twins ('Wrangle over Nepalese twins' hospital bill'; ST, Oct 6).

I had previously written to ST Forum stating that their technically successful operation was a medical mistake. But having made a mistake, the Singapore General Hospital (SGH) did not abandon them and, in fact, tried its best to help, given the circumstances.

When the twins returned to Kathmandu after their surgery in November 2001, SGH continued their follow-up treatment, jointly with local doctors. In 2002, the SGH doctors went there to plan their follow-up management in Nepal with the local neurosurgeon.

Between 2002 and this year, SGH's team of Dr Chumpon Chan (neurosurgeon), Dr Vincent Yeow (reconstructive plastic surgeon) and physiotherapists made a few trips, at SGH's own expense, to assess and plan further treatment.

The consensus with the local neurosurgeon, Dr Devkota, was that a shunt was required for Ganga, and this straightforward operation could be done safely in Kathmandu. SGH offered to fly its surgeons to assist in the operation, and to fund the cost of treatment in Kathmandu from the balance of the funds raised in Singapore. At a later stage, both twins would be brought to SGH for skull reconstruction, a complex procedure requiring a team of neurosurgeons and plastic surgeons. This was explained clearly and repeatedly to the family.

However, the mother and grandfather insisted on coming to Singapore. They refused to let the local surgeon treat the twins. The mother then approached Dr Keith Goh, who agreed to bring Ganga to Singapore for treatment at East Shore Hospital.

After my previous letter to ST Forum, I received a letter from Ms Angella Cheng, who is very close to the twins' family and was their guardian when they were in Singapore. She wrote, and I just confirmed again over the telephone with her, that the twins' parents' motive for coming to Singapore is to get more sympathy money, which they have actually got while in East Shore Hospital this visit.

The parents even approached the Gurkha contingent in Singapore again but were turned down this time because the contingent had already donated to the twins on the first occasion.

SGH was subsequently approached by East Shore Hospital for funding from the balance of the funds when the twins arrived here. In consultation with the Nepalese Consul-General here, Mr Swami (who is also a member of the trustees of the fund), SGH informed East Shore Hospital that it would reimburse it based on the cost if the twins had been treated at SGH.

When East Shore Hospital submitted its claim for reimbursement following their treatment, the trustees (with the Nepalese Consul-General present) went through the bill. Only a shunt operation was done for Ganga. SGH then reverted to East Shore Hospital with SGH's estimated bill size and reimbursed it accordingly.

As for claims of Botox and intensive physiotherapy for Jamuna, I have no confirmation as to whether it was indeed carried out, but, even if it was, for any improvement to be possible it has to be a long-term treatment that needs to be continued in Kathmandu.

Obviously, this short-term intensive and expensive therapy will have little permanent effect on her leg deformity or ability to walk and is not justified.

As a bystander and a Singaporean, I watch this saga unfold with sadness and disappointment. I feel very sorry for the twins who will never have a normal life - perhaps less sorry for Ganga, who is a vegetable with no awareness of her own suffering, and more so for Jamuna, who has enough comprehension to know what suffering is.

I am disappointed with my fellow Singaporeans' gullibility. Some of you may remember the Indonesian baby with grossly swollen head who landed on our shores not long after the technically successful separation of the Nepalese twins.

Public sympathy again produced enough funds for a palliative operation to be done. Last seen at age 2 1/2 years, the baby was severely disabled, mentally and physically.

Then there was the saga of the Yishun siblings who had an operation for deep-brain stimulation done in Taiwan at tremendous cost, again paid for by the Singapore public. They could have been treated in SGH or the National Neuroscience Institute at a fraction of the cost.

The operation was claimed in the press to be a miraculous success, and the siblings were shown walking with assistance. Now they are no longer able to walk, not even with assistance.

I cannot resist one last story which illustrates both the propensity of the press to sensationalise and the gullibility of Singaporeans.

When the story of Huang Na's murder hit the papers, many people donated money to the girl's mother, with the total sum enough to cover many subsidised patients' hospital bills or provide bursaries for many, many poor students.

But what good is that money to Huang Na who has died?

Assoc Prof Lee Wei Ling
Director and Senior Consultant
National Neuroscience Institute

(source)

Just some thoughts on the matter:

1. While doctors may not always know best (what's best often being subjective), we probably have more background knowledge on which to base a decision on. If the donors knew that the outcome for the interventions were likely to be poor, would they have channeled their moneys elsewhere?

2. You can go all the way up in the medical hierarchy and still be angry. And you have a right to be. Perhaps most (all?) doctors have a social conscience which makes them mad when they perceive a medico-social wrong.

3. I am reminded of the time I saw these two brothers with a hereditary, progressive form of muscular dystrophy. The elder one was in his mid-teens. He was wheelchair-bound, severly wasted, and his spine twisted because his muscles could not hold his back straight. He was being admitted for a chest infection which was a complication of his condition. His intellect was normal but he had difficulty speaking.

His younger brother was in his early teens and wheelchair bound too, but still able to sit upright and speak. He looked cheerful.

But deep down inside I wonder how he viewed the fate that would befall him too unfolding in his brother before his eyes.

I wonder how he felt towards his parents, who knew that the condition was hereditary but decided to have another child anyway.

You can never have too many corny taglines?

I know breast cancer is a serious issue, but the tagline on the poster for this year's Breast Cancer Awareness Month just seemed a little too sexist to me.



For those who wish to find out more about breast cancer, do visit the Breast Cancer Foundation site.

Life's a Gamble 2

Spoke with K over the phone last night.

Bonus Real Life Story (see Disclaimer)

K: Eh, I think I met one of your readers today.

angry doc: Har? Sure or not? How you know? Don’t tell me must shut my blog down already…

K: I think so lah… Remember last time you posted about 4D?

angry doc: Er… so?

K: Today one of my patients came back after the consultation and asked me for his queue number again, so I told him he didn’t need the number to collect his medicine. You know what he said?

angry doc: Er... no.

K: He said he just wanted it so he can buy 4D with the number.

angry doc: …

K: So just to be safe I also went to buy the same number after work…

I made a nurse cry today...

Well, not really.

JD did make Carla cry in today's episode of Scrubs though.

And that reminded me of the times I did make nurses cry during the course of my career.

Score: 4 work-related, 1 personal

I'm ashamed to admit that for the 4 work-related episodes, the real problem was not really with them but with my subconscious (and erroneous) belief that it's a doctor's right to be rude to a nurse when she makes a mistake.

(Let's face it: I would never have lost it with a nursing officer or a senior doctor, so don't tell me 'rank' wasn't an issue.)

I've apologised to each of them (well, not the one in the 'personal' episode...) and they have accepted my apology in each case, but deep inside I never forget that I let my anger get the better of me when dealing with my colleagues, that I saw people as uniforms rather than people.

And that still haunts me.

So let that be a warning to you young hotheads out there.

Yes, I mean you.

Doctors of the World Unite!

Neurologists join Oncologists to call for tobacco ban in Singapore.

Oct 6, 2005
No reason to wait 10 years to ban smoking

IT WAS with great interest that we read about cancer specialists from a group of Asian countries calling for a ban on tobacco within the next 10 years ('Singapore cancer specialists to push for tobacco ban'; ST, Sept 22).

Among the many diseases causally linked with cigarette smoking is stroke. Stroke is Singapore's fourth leading cause of death, and the leading cause of adult neurologic disability. Up to 25 per cent of all strokes are directly attributable to cigarette smoking. Data from Singapore hospitals shows that 25 per cent of patients admitted to hospital admitted to being smokers.

Current research shows that the risk of stroke among smokers compared to non-smokers is increased by 1.5 times for stroke due to blockage of brain blood vessels (atherothrombotic stroke), two times for stroke due to bleeding into the brain (intraparenchymal haemorrhage), and three times for stroke due to bursting of a bubble on a brain vessel (aneurysmal subarachnoid haemorrhage), to even four times among female heavy smokers.

Environmental tobacco smoke - that is, passive smoking - puts additional, innocent lives at risk of major diseases.

Stroke is an expensive disease to treat. Hospital bills for stroke in Singapore average $7,500 a patient, rising to $29,000 for subarachnoid haemorrhage.

Additional costs for the lifetime of the patients, especially for the more disabled survivors, include outpatient medication and rehabilitation, loss of income, home help (e.g., maid), disability aids (e.g., wheelchairs, bedside commodes) and medical supplies (e.g., diapers, milk feeds).

Societal costs include absence from work and workforce attrition from premature death and disability of previously able-bodied Singaporeans.

With approximately 10,000 admissions to Singapore hospitals for stroke and related disorders every year, the total cost of this disease to Singapore would run into the millions.

While a part of the cost may be offset by duties on cigarette imports, it is largely borne by the stroke patient, the family, and the taxpayer.

Stopping smoking reduces the risk of stroke significantly within five years. The risk of a light smoker returns to that of a non-smoker, while that of a heavy smoker (more than 20 cigarettes a day) is certainly reduced, but does remain above that of a non-smoker.

Without any clear evidence of benefit from cigarette smoking that would outweigh its many risks, there is little to support its continuance. We, too, support the call for its total ban in Singapore, to run concurrent with further support for programmes to help smokers quit.

If chewing gum, which neither kills nor disables, can be banned practically overnight, we see little reason to wait 10 years to ban cigarette smoking in Singapore.

Dr N. V. Ramani
Senior Consultant Neurologist
Clinical Coordinator (Stroke Programme)
National Neuroscience Institute

A/Prof Lee Wei Ling
Director and Senior Consultant Neurologist
National Neuroscience Institute

(source)

How long before the cardiologists and respiratory physicians join in?

Imagine all the reductions in cancer, stroke, heart attack, and COPD cases...

Doctors of the World, Unite! We have nothing to lose but our jobs!

Microbes - the Gathering

Sometimes truth is stranger than Bonus Bogus Stories.

Beats micro-bee lectures, I guess...

Students learn about diseases through card game



SINGAPORE : Secondary school students may in the near future learn about diseases through a card game.

Players say this game tests their wit and knowledge of diseases.

Called Battle Cells Game Cards, it consists of two decks of cards - the pathogens or diseases, and the immune system.

It is modelled after how the body battles with deadly infectious diseases.

Players will have to reduce the health marks of the other players.

The player with the most marks wins. Initially developed by life sciences educational services and kit provider Genecet Biotechnologies, the task of modifying the cards was given to four Secondary 3 students from Raffles Institution as part of a research project.

"We wanted to create a card game that can cater to all types of learners. We want to get rid of outdated teaching methods such as textbooks which are no longer suited for children these days. We need more creative methods," said Tan Ee Kuan, a student at Raffles Institution.

Genecet says the card game is a suitable tool for students to learn about immunology and microbiology, and plans to market it.

It is hoped that with the element of fun and play, students will be motivated to learn more about diseases. "It will work well as a supplementary tool in the classroom. We feel that it serves the slogan "teach less, learn more" and bring fun to the classroom," said Jeffrey Lee at Genecet Biotechnologies.

So far about 10 schools have shown interest in buying the product.

Genecet says it plans to sell the cards at $20 each.

There are two decks of cards for each game but discounts will be given to students.

Raffles Institution will get a cut from the sale of the cards which will be ploughed back into the school fund.

There are also plans to develop a teacher's guide to facilitate teaching through the cards and expand these cards to include modules like ecology and even traditional Chinese medicine.

(source)

Now where's my SARS card?

Ci Bei Hospital to study effect of sutras on patients

The post on the clinical effect of prayer got me thinking: what if the concept was carried over to the local scene and to its ridiculous conclusion?

Bonus Bogus Story

Singapore -

Ci Bei Hospital, the largest chronic-sick hospital in Singapore, will be conducting clinical trials on the effects of recordings of sutras-chanting on patients.

This was announced by the Head of Clinical Trial Division, Venerable Chen-tao, at a press conference today.

‘We noticed that the families of many of our patients have placed audio-players that played recordings of the sutras being chanted by monks in loop by their bedside as a means of praying for the good health and comfort for the patients. This led us to wonder if the positive effects of such recordings can be proven or measured clinically.’

Several studies in the west have shown that prayer has a positive effect on clinical outcomes in patients. (See related story.)

Ci Bei Hospital has tied up with local IT company Derivative in this study. Derivative will develop and donate MP3 players in the shape of a statuette of the Avalokiteshvara Bodhisattva. Nick-named the i-Bodh, the MP3 player will be made to play a recording of the Amitabha Sutra chanted by the monks at the Ci Bei Temple for a total of eight hours a day.

‘We are very optimistic about this study, as it marks a few ‘firsts’. It is the first of its kind to be conducted in Asia, and the first one done on Buddhist sutras, and the first one done using recording rather than ‘live’ prayers,’ said Venerable Chen-tao.

Patients will be randomly assigned to two groups, and one of the groups will be provided with the i-Bodh. The progress of each group will be monitored.

‘If there is any significant improvement in the group for which the sutra is being chanted, it will mean that Ci Bei should look into providing this service for all our patients. But even if there are no objective clinical improvements, I believe that the comfort provided by the sutras will be welcomed by the patients.’

Preliminary results of the trial are expected in the middle of next year.

Additonal Disclaimer

angry doc has the utmost respect for Buddhism and any religious and/or charitable organisation which may be construed to be alluded to in this story - but let's face it: even a totally fictional story needs a context.

Ministry of Health rejects tobacco ban, considers registration of smokers

Bonus Bogus Story

Singapore –

The Ministry of Health announced today that it does not support the recent call by National Cancer Centre to ban tobacco use, but is considering registration of all smokers as a means to reduce the healthcare cost from smoking-related diseases.

Mr See Ker Lett, spokesman for the ministry, told Straight Times this at a press conference today.

‘It is unrealistic and impractical for Singapore to ban smoking in this era of globalisation. The government’s anti-smoking strategy has always been one of health education and protecting non-smokers from second-hand smoke. However, the decision to take up or to stop smoking must remain a personal choice. As such, the ministry is now considering making smokers take personal responsibility for the harmful effects of smoking. We are now looking at withdrawing the medical subsidy for smokers when they are treated or admitted for conditions known to be associated with tobacco use.’

Smoking is known to cause heart disease, stroke, and lung cancer.

‘Under this scheme, smokers will be required to show their identity cards and have their personal particulars recorded when purchasing cigarettes and tobacco. This information will be stored in a central registry that may be accessed by all restructured hospitals and government polyclinics.’

Mr See assured Singaporeans that the information will not prejudice smokers in terms of their medical treatment, but only have a bearing on the medical subsidy.

When asked if this scheme discriminates against and penalises smokers, Mr See replied:

‘Certainly it discriminates, but it does not penalise; rather, I think we should see this scheme as rectifying a situation where non-smoking tax-payers are forced to subsidise the lifestyle choice of smokers.’

The Power of Prayer

This letter to the Straits Times Forum made me laugh.

Oct 4, 2005
Doc asked patient to pray

THE letter, 'Should teachers seek to convert pupils?' (ST, Oct 1), reminded me of an incident at a specialists' clinic in a hospital some years ago.

I was consulting an oncologist on the outcome of a CT scan. Grim-faced, he told me the bad news: my cancer had returned.

Fully aware that I was not a Christian, the doctor asked me to kneel with him and pray. This made me even more distraught because the conclusion was that conventional medicine had run its course and divine intervention was needed.

At that critical moment, I felt that faith and medicine should not have been dispensed in the same prescription.

Alvin Choo Weng Kee


What I found amusing was:

1. Perhaps the oncologist knew that prayer has actually been 'proven' to be effective.

2. Mr Choo obviously survived to write the letter.

I wish Mr Choo the best.

Overheard...

… in the ICU.

O&G Consultant: The incidence is about one in three to four thousand births, and of course it occurs within the six weeks after delivery. The mortality can be up to 50%.

O&G MO: Wow. Have you seen this kind of case before?

O&G Consultant: Yes, many years ago when I was a registrar. I saw this woman who didn’t want to keep her pregnancy. I counseled her and she decided to keep the baby. When she delivered we found the baby had multiple congenital abnormalities, and the mother died of this condition within a month.

O&G MO: …

O&G Consultant: Yes… paved with good intentions…

Man arrested for protesting against call for tobacco ban

Bonus Bogus Story

Singapore –

A man was arrested yesterday for staging a protest outside National Cancer Centre.

The man, who claimed to be a doctor but declined to give his name, told Straight Times that he was protesting against National Cancer Centre’s campaign to ban tobacco products in Singapore.

Straight Times managed to speak with the man before he was taken away by police.

‘As doctors, our role in primary prevention should be patient education and persuasion. To try to abdicate our responsibilities as doctors in convincing our patients to stop an unhealthy habit by seeking legislation against it is betraying the patient-doctor relationship and an affront to the idea of patient autonomy,’ said the angry doctor.

‘Besides, it’s an insult to our policy-makers to think that they will not ban tobacco imports when the cost for treating tobacco-related diseases and running anti-smoking campaigns has exceeded the revenues from tobacco tariffs.’

‘Smoking also causes heart disease and strokes, but the cardiologists and neurologists have not sought to ban tobacco use. On the other hand, an unhealthy diet and sexual promiscuity are the respective causes of colorectal cancer and cervical cancer, but we do not see NCC trying to get the government to ban these. If we reduce the deaths from heart disease and strokes, Singaporeans will live longer, and of course we all know that the older you get, the higher your chances for getting cancers!’

‘We all have to die someday. The choice is usually between a quick and sudden death from a heart attack or a stroke, or a slow, painful death from cancer. I believe the choice should lie with the individual and not the state.’

‘I am aware that cancer is the leading cause of death in Singapore, but as doctors, we should concern ourselves not with trying to ‘cure’ the statistics of the principal causes of death and life expectancy, but with educating patients on the impact their lifestyle choices have on their own health, and leaving the ultimate responsibility to them.’

The man is now under police custody. It is understood that he will be transferred to the Institute of Mental Health for psychiatric assessment. It is not known if the man is himself a smoker.

Night shift in the A&E

I've been swimming in a sea of anarchy
I've been living on coffee and nicotine
I've been wondering if all the things I've seen
Were ever real, were ever really happening

Everyday is a winding road
I get a little bit closer
Everyday is a faded sign
I get a little bit closer to feeling fine

- Every day is a winding road

Requiem for a fellow blogger

The eyes are not here
There are no eyes here
In this valley of dying stars
In this hollow valley
This broken jaw of our lost kingdoms

In this last of meeting places
We grope together and avoid speech
Gathered on this beach of the tumid river

Sightless, unless
The eyes reappear
As the perpetual star
Multifoliate rose
Of death's twilight kingdom
The hope only
Of empty men.

The Hollow Men
T.S. Elliot

Which EBM you talking about?

K and I went out for drinks last night, and after the fourth drink I started bitching about my job again.

angry doc: Aiya, all this talk about EBM (Evidence-based Medicine) is bollocks lah.

K: No what. We are still practicing EBM what. Just not the same EBM you talking about.

angry doc: Huh? What do you mean. Experience-based Medicine issit? Professor say means must be correct. Or Emotional-based Medicine? Patient want you give.

K: No. Evidence-based Medicine right? What is the evidence based on?

angry doc: Er… trials lah. Clinical trials lah.

K: Ya. So who sponsor the clinical trials?

angry doc: Er… drug companies lor.

K: Ya. So when the drug companies sponsor a trial, they will sponsor one where their medicine is used right? Even when a trial includes an arm on diet or exercise as a means to control the medical condition, there will be an arm with their drug to compare, right?

angry doc: Er… ya lor.

K: So it’s Medicine-based Evidence, right?

angry doc: Ya… but that’s MBE what?

K: Wait. So when the drug company want to choose a drug to use in a trial, which drug, which medicine they choose? Of course the one that will make the most money right?

Why you think they go and make drugs for erectile dysfunction instead of new antibiotics to fight drug-resistant TB? Because poor people who get TB got no money to buy new drugs, and the rich got money to spend on better sex!

Why you think nowadays all the trials basically compare the company's own product against their competitor's product? All fighting for market share only.

angry doc: Huh?

K: So it’s Economics-based Medicine lah! EBM!

angry doc: Economic-based Medicine... Medicine-based Evidence... Evidence-based Medicine…

K: Correct!

angry doc: You full of Ethanol-based Mumbo-jumbo lah…

Luke... I am your friend!

It's nice to have friends on the blogosphere.

Thanks to aliendoc for trying to save me from the Dark Side,

and thanks to my disciple and Barbados Butterfly for providing you with your usual dose of ranting while I was away.