Bait and Switch

That about sums up this year, doesn't it?

House started with grouchy a doctor solving cases beyond the average physician, and ends up with hurt-and-in-need-of-love doctor only making the diagnosis only after realising that (once again) the patient was lying, or finally ordering that test that he should have ordered a long time ago given the patient's presentation.

NKF showed you clips of suffering patients, but not of the decor of the offices your donation money actually went towards funding.

This blog started with 'what your doctor doesn't want you to hear', and ends up now mostly with 'what you don't want to hear from your doctor'.

Well, angry doc doesn't believe that just because a ball of dirt made a circuit around a ball of fire that things are going to become better, but try and have a good new year anyway.

Thanks for reading.

Fumbling towards Angry 2

OK, it gets weirder...

"hairy groins"

"how to fool a doctor"

"louis ng car dealer"

"voluptuous aunty story"

"doctors die young"

"doc test not pregnant singapore"

"amitabha sutra mp3"

"disability pregnant proof back pain doctor certify"

"stomach bloats rolling bubbles from stomach"


And I swear I didn't make any of those up.

When I grow up, I want to become a...

... doctor.

But what kind of doctor?

Thanks to Dr RW, who provided the link to this test, I now know that my top ten choices should be:

Rank
1. dermatology
2. colon & rectal surgery
3. radiation oncology
4. gastroenterology
5. urology
6. radiology
7. pathology
8. general surgery
9. rheumatology
10. pulmonology

Send angry doc a Christmas Present!

Well, not really.

But if you are in the generous mood after your year-end bonus, do consider donating to the School Pocket Money Fund.


(click here to donate)

Thank you.

(Yes, I pre-dated this entry to keep it on the top of the page.)

Abusement Park

An interesting letter on the ST Forum today:


Dec 22, 2005
Put a stop to drug merry-go-round

There is a vicious circle of a sizeable number of repeat drug offenders going in and out of rehabilitation and jail. Once out, they are back with their own kind, scouring the island for clinics willing to supply them with sleeping pills, Subutex, codeine cough mixtures and painkillers, and tranquillisers.

Addiction recognises no social or professional barriers. For obvious reasons, there will always be someone willing to supply addicts with drugs if you refuse to. Then the doctors who prescribe 'too freely' get hauled up by the Singapore Medical Council. The addicts then go on an islandwide merry-go-round looking for other drug sources, and the cycle repeats itself without the root cause of the problem being addressed.

Yes, we have the Community Addictions Management Programme (Camp), but how many people know the hotline number or where the so-called 'We Care' centre is? These clinic junkies will not seek help voluntarily and the problem will never be solved unless Camp is more proactive in its efforts.

You get stressed-out executives hooked on Dormicum or Nitrazepam, or hear of people telling you they have accidentally spilled their cough mixtures and need some more. Some even go to the extent of looking after other people's babies, and claiming they cannot sleep because of the crying at night.

The authorities or Central Narcotics Bureau should suggest where doctors can send these hopelessly hooked codeine junkies and stop their perennial merry-go-round game with clinics. Otherwise doctors will get hauled up regularly for prescribing sleeping pills or codeine-based cough mixtures too freely, and the problem never gets solved.

Dr Lim Boon Hee


Dr Lim seems to have identified the problems, but I don’t think the solution he proposes will work.

The primary problem is: “junkies will not seek help voluntarily”. Add to that the fact that “there will always be someone willing to supply addicts with drugs”, what you have is a perfect working relationship that neither party has reasons to break. Those who refuse to prescribe to known or suspected junkies (bearing in mind that ‘under Regulation 19 of the Misuse of Drugs Regulations, a doctor who attends to a person who he considers or has reasonable grounds to suspect is a drug addict shall, within 7 days of the attendance, furnish details of the person to the Director of Medical Services (DMS) and the Director of the Central Narcotics Bureau (CNB).’) will not “get hauled up by the Singapore Medical Council”.

Those who do prescribe ‘too freely’? Well, under the Misuse of Drugs Act, ‘(a)ny person who abets the commission of or who attempts to commit or does any act preparatory to, or in furtherance of, the commission of any offence under this Act shall be guilty of that offence and shall be liable on conviction to the punishment provided for that offence.’

Fact is, doctors know it is wrong to prescribe to addicts, that it is wrong to not inform the authorities (there is even a clause in the Act to protect the informant’s identity), and they know whom to notify.

So I don’t think doctors are innocent victims in this relationship who get hauled up to the Medical Council for no good reason at all. If the addicts are the ones going on a merry-go-round ride, the doctors are the ones collecting admission into the Abusement Park.

Here's 2 cents that won't be going to any charity...

I don't suppose there's anything to be said about the NKF saga that hasn't already been said or written about.

What bugs me is not how easily we can all become victims to fraud, but how easily we can become the perpetrators.

Are they really worse than the young men who entered medical school because they wanted to heal the sick and comfort the afflicted, but now charge exorbitant rates for mis-used steroids and Subutex? Or are the delinquent doctos worse, because they not only steal your money, but also your health?

I hope I never lose my ability to feel angry.

Revisiting...

1. The other angry doctor has updated his blog!

2. K tells me that 'conscientious objection' is protected by the law:

Conscientious objection to participate in treatment to terminate pregnancy.6. —(1) Subject to subsection (3), no person shall be under any duty whether by contract or by any statutory or legal requirement to participate in any treatment to terminate pregnancy authorised by this Act to which he has a conscientious objection.

- Termination of Pregnancy Act

Normoglycaemic in New York

If you think some of the bogus stories I come up with are ridiculous, you should read this real-life story…

(excerpt)

Keeping track of diabetics in NY

NEW YORK — New York has adopted a health code regulation that will make it the first American city to keep track of people with diabetes in much the same way it does with patients infected with HIV or tuberculosis.

The city will occasionally use its database to prod diabetics to take better care of themselves.

The policy breaks new ground because it involves the collection of information about people who have a disease that is neither contagious nor caused by an environmental toxin.

New York's health commissioner, Dr Thomas R Frieden, said on Wednesday that the programme's potential to save thousands of lives outweighs what it gives up in medical privacy. "We will ensure that the utmost care will be taken to keep people's privacy and information protected," he said.


I don't think I could have come up with a better bogus story.

Can die but cannot fall sick?

You know how people always say: "In Singapore, you can die, but you cannot afford to fall sick."?

Maybe we can take a leaf from this town in Brazil?

Bonus Bogus Story

Singapore -

Parliament is debating a new bill to impose a fine on Singaporeans for preventable deaths.

If passed, the new law will exact a fine of S$10,000 from the family of a person who dies from a preventable cause, such as suicide, self-inflicted injury, or a poorly-controlled chronic illness.

The bill is mooted after a review of the principle causes of death by the Ministry of Health. The review found that death from cardiovascular diseases such as heart attack and stroke account for 28.6% of all deaths.

"As cardiovascular deaths are the result of poorly-controlled chronic illnesses like hypertension and diabetes, we hope that this law will encourage Singaporeans to take their health more seriously," said the Minister for Health.

"If Singaporeans can be made to be personally accountable for their health, this law would have served its purpose."

The leader of opposition in the house expressed his disagreement to the proposed law.

"Even the most well-controlled diabetes patient must die some day. How can we hope to distinguish between people who died from neglecting their health, and those who died despite their best efforts?" asked the angry doctor.

The minister assured parliament that his ministry will come up with detailed instructions and guidelines for classifying preventable deaths.

Parliament will continue the debate today.

"Where patients come first"

That's the slogan Merck, the manufacturer of Vioxx uses.

The company's Values read:

"Our business is preserving and improving human life. All of our actions must be measured by our success in achieving this goal."

"We are committed to the highest standards of ethics and integrity. We are responsible to our customers, to Merck employees and their families..."

"In discharging our responsibilities, we do not take professional or ethical shortcuts."


Google or Blog-search up 'Vioxx trial' and you will find many sites on the latest information on how the Vioxx saga is playing out.

While I am not sure whether it is possible to prove conclusively if a person died from Vioxx use (and Vioxx use alone), I think it speaks volumes about people's perception of the big pharmas from the way Merck is treated in the media.

When all the trials are completed, and all the compensation paid up, will anyone really be a winner?

Health Economics

There is no such thing as health economics – only socio-politico health economics.

- Hobbit’s Nonsensical Guide to Health Economics

I don't actually know who Hobbit is, but I suspect I may have worked with him before...

Anyway, I was searching for stuff on health economics because of this question raised by Dr Oz Bloke:


Why doesn't the government give these tests free to the public anyway?


There are actually several un-asked questions there.

What would be the objective of such free tests?

To reduce healthcare burden by early detection and treatment? To win votes?

If the first, is universal screening of asymptomatic individuals is a cost-effective way to reduce healthcare burden in Singapore? What disease should be screened for?

If the second, why hasn't it been done yet?

I'm sure you have your own your answers to the questions above, and can come up with more questions too...

In any case, here's a rather technical site on health screening that you might find useful. Enjoy.

Now repeat after me...

... there's no such thing as a free lunch.


Surprise request makes senior citizens' blood boil
FREE checkup, but there's a BLOOD 'FEE'?
By Maureen Koh
December 13, 2005

THEY had fasted for 10 hours - no food, only water - to prepare for a health-screening the following morning.

Three of them, all aged above 55, woke up as early as 7.30am to make their way from their Bedok homes to the community club at Joo Chiat where the screening would start at 9am.

All for what the publicity banners had promised: Free health-screening.

It was to be a public service to senior citizens above 55 years old.

But to their surprise, they claimed they soon learnt that this 'free' service came with a condition:
Some elderly participants said they were told they had to sign a consent form to agree to take part in a study.

For this, they each had to give 20ml of their blood, of which 5ml would be for the health-screening and 10ml to be used for research purposes.

The remaining 5ml would be stored up to five years for future related studies.

'TURNED AWAY'

It might not have been much, but it was enough to turn some people away.

One of them was Madam J Wan, 63.

The housewife, a diabetic and former stroke patient, said in English: 'I explained that even I had difficulty drawing blood for my own home-tests, and that I was not prepared to donate my blood.'

She claimed she was then told by one of the nurses who had attended to her: No signature on the approval form, no free health-screening.

Said Madam Wan: 'How can they say this? In the first place, it was not stated anywhere (on the banner) nor was it properly told to us that there were conditions attached.'

The Department of Psychological Medicine of the National University of Singapore, which is conducting the research, however, said it was a miscommunication.

But another participant, who wanted to be known only as Mr Tang, 59, agreed with Madam Wan.

NOT CLEAR

He said in Mandarin: 'I think they should make it very clear. I mean, it is quite ridiculous to expect us to fast, make our way there and then be turned away because we do not agree to them taking 'extra' blood.'

Those who refused were allegedly given back their identity cards and told that they could go home.

Mr Tang signed the form. He said: 'What do you expect me to do? Go home? I don't have a job, so if I can save some money, why not?

'People will probably call us 'cheapskates', but when you are poor, every cent saved means something.

Anyway, you can see it this way - I did not get it for free. I paid for it with my blood,' he said.

For cleaner Leong A J, 65, it was more a matter of principle.

She said in Mandarin: 'To me, they are not different from sales people who claim they are giving away free things, then later tell you that you have to spend a certain sum of money first.'

The episode did not end there for her.

According to her, someone called her later in the day and wanted to find out why she had not agreed and if she minded going back again.

Said an annoyed Madam Leong: 'After I had wasted four hours of my time, I still had to put up with this.

'It was not even because they just wanted feedback - but they were more concerned that they had lost a potential 'donor'!'

Mrs Lim, 64, a nanny, also claimed she received such a call.

Some of the elderly citizens also alleged that none of the personnel there could tell them what the research was for.

Delivery man Ishak, 58, said in a mix of Malay and English: 'I asked the woman what's the name of the research, and she was unable to answer. She just muttered, 'Some research, lah.'

'That is really so strange. How do you expect us to trust them if the answers were not forthcoming?' he said.

Madam Wan said that the way she was 'dismissed' was a case of adding insult to injury.

She alleged: 'One of the women who returned my identity card commented, 'Anyway, you are not from Joo Chiat!' '

HUMILIATION

According to the Patient Information Sheet and Informed Consent Form that the participants received, residents living in all areas covered by the South East Community Development Council (which comprises Geylang Eunos, Aljunied, MacPherson, Bedok and Marine Parade) are eligible.

Madam Wan said: 'We may have gone for something free, but that does not mean that we should be treated this way.'

Madam Winnie Foo, 56, a school administrative assistant, said the publicity materials should have clearly stated the conditions.

She said: 'When they do that, we can make our own decisions.

'To the healthy, an extra 5ml of blood may mean nothing, but some elderly folk may have reservations.

'I guess, as the saying goes: There's no free lunch.'

Misunderstanding, says don

IT was impossible to list all the details of the free health-screening on banners displayed in the neighbourhood.

So said Associate Professor Ng Tze Pin, director of the Gerontology Research Programme, from the Department of Psychological Medicine at NUS.

'There was no way anyone can put all that information on the banners,' he told The New Paper.

'It was just a case of miscommunication.'

The health-screening was part of the Singapore Longitudinal Aging Study, a medical research aimed at increasing the understanding of ageing and health among elderly Singaporeans.

POPULAR

Prof Ng confirmed that 20ml of blood was to be taken from all participants, of which 15ml would be used initially for the health-screening and the study.

Another 5ml would be kept for future related research.

But Prof Ng insisted that it was not his team's intention to turn away people even if they declined to donate blood.

He said: 'These allegations are not true.

'Our programme is very popular with many people and we have many subjects who sign up.

'Of course, there are those who would refuse and they cite health reasons like they are anaemic, have low blood pressure or that they may feel faint.

'We will still accept them.

'There may be unique cases where the subjects decide against participating altogether.'

Figures given to The New Paper showed that since the programme started in September 2003, there have been 2,728 participants.

Of these, 17 were enrolled into the programme even though they declined to donate their blood.

TROUBLESOME

At the Joo Chiat Community Club, where the team has been operating since 19 Sep this year, 585 participants have signed up for the study.

Prof Ng stressed that staff members have been reminded to explain the details fully.

'They have been told to handle the subjects carefully and patiently.

'We always tell our staff that these are old people.

'They are not educated and can be troublesome, which is expected because of their age.'

However, he added: 'While we do our best to explain the details, can they understand them fully?

'Even if you tried to do so, can you guarantee that they can understand you? We can only do our best.'


Well, not enough information for me to tell who's wrong or right, but certainly proves once again that there is no such thing as a free lunch... or 'free' health screening.

The Doctor is on MC

Sorry for the absence, but angry doc was on MC.

Interesting how efficient a consultation between two doctors can be…


Friend: Hey, what’s wrong with you, man?

Me: I got [diagnosis] lah. [Symptoms] x [duration].

Friend: No need to examine right?

Me: No need lah.

Friend: OK. You want medicine?

Me: No need; I still got stock.

Friend: Two days' MC enough?

Me: Enough.

Friend: OK, have a good rest.

Me: Thanks.

And the funny-word of the day is...

... Viopril.

A 'new' ACE-inhibitor that is featured in today's episode of House. According to House, '(a)ll they’ve done is added antacid' .

"You know how I know the new ACE-inhibitor is good? Because the old one was good. The new one is really the same, it’s just more expensive. A lot more expensive. See, that’s another example of Ed’s brilliance. Whenever one of his drugs is about to lose its patent he has his boys and girls alter it just a tiny bit and patent it all over again. Making not just a pointless new pill, but millions and millions of dollars. Which is good for everbody, right? The patients? Pish! Who cares? They’re just so damn sick! God obviously never liked them anyway."

OK, House is just being House, but the name 'Viopril' really tickles me.

Then Jacob gave Esau bread and pottage of lentils;

I’ve been wanting to blog about this issue for a while now; this news article gives me the excuse:


SINGAPORE :

The drug Subutex, which is used to treat heroin addition, may be listed as a controlled substance.

The Health Ministry is discussing with the Health Sciences Authority and Central Narcotics Bureau to make it a criminal offence for anyone to possess the drug without a prescription.

Subutex is fast becoming a drug of choice among former heroin addicts as they regard it as a 'legal fix'.

The pills are often dissolved in water and mixed with sleeping tablets to create a potentially lethal injection.

Demand for the drug on the black market is high, with one pill costing up to $35.

The Health Ministry has conducted an audit on nine private clinics to see if they prescribe the drug too freely, and is currently reviewing the results.

Strict guidelines on the prescription of Subutex were released last month.

These include supervising patients to ensure they take the tablet properly by placing it under their tongue for the first month of treatment.

Doctors found guilty of prescribing the drugs too freely can be fined up to $10,000 and struck off the medical register.

(source)


The problem is not new, and the Ministry had recently issued guidelines on the prescription and use of Subutex.

You have to wonder: who first decided it would be a good idea to pound a tablet, dissolve it in water, and then inject it into his vein?

But the subtext here is this: doctors are prescribing Subutex to people who abuse the drug.

Don’t they know?

Can they really miss the bruised and hardened veins on the arms of the addicts? Or don't they check?

Doesn’t the drug company know that its product is being abused in a manner that harms its abusers?

Why was a drug that has potential for abuse approved for use to treat addiction?

And people ask me why I am angry...


… and he did eat and drink, and rose up, and went his way: thus Esau despised his birthright.

Fumbling towards Angry

I decided to post some of the more interesting search words that led innocent internet users onto my blog over the past week...


"angry client in hairdressing"

"lemon with matchsticks"

"who is the angry professor"

"when is the financial fiscal year period for singhealth?"

"angry relatives and doctors"

"dr. boothe"

"angry dentist"

"sifu"

"angry pharmacist"

"heaty eating"

"angry and health"

"nurse treat poor patients differently"

"angry nightmares"

"curses using lemons"

"being a doctor sucks"

"dr chai china cancer cures"

"angry patients "leave them alone" "


I think I see a pattern here...

Guns don’t kill people…

… bullets going through body cavities at three times the speed of sound do.

Still, I usually hold the guy pointing the gun at the target to begin with accountable.

But that’s not the point of this post. The point was made by Anonymous in his/her comment on the post on Numbers Needed to Treat.

"I am just making a point that while statistics is a useful tool it cannot be used without human discretion. … I am also sure that you are aware that although evidence based medicine relies heavily on stats, people can manipulate it to look acceptable."

There’s the rub.

I believe in statistics, which is why the only gambling game I will play in a casino is poker.

Medicine, it has often been said, is both a science and an art.

Of the two, I account science the first and greater component.

Without science, all the art in the world will not make you different from a quack – someone who professes an ability to heal which he does not in truth possess.

With science but no art, you can still be a cold, efficient doctor, with patients who are alive, healthy, but none too grateful. You may not have made them happy, but at least they are alive and free to find happiness.

Now I’ve always believed that God is kind to doctors, in that he made the science of medicine possible. Certain conditions give certain sets of signs and symptoms, which allow doctors to make diagnoses. And certain diagnoses respond well to certain treatments. Although nothing, of course, is 100% certain.

Still, the largely consistent trends allows us to study diseases and their treatment, and for us to compare them and see which of the treatment we apply produce the best outcome.

That has always been the foundation of medicine, although it is only relatively recent that the term ‘Evidence-based Medicine’ had been widely used and codified.

It is now the new religion.

But the problem with evidence, and indeed all sorts of information including what you read in this blog, is that everything that you are presented with is there because someone wants you to know it.

With modern technology, the amount of sheer information a doctor has available is huge, and it becomes a real problem trying to know everything and to separate the wheat from the chaff. We end up relying on summary papers and weekend lunch-talks by experts.

Most doctors know that the information they get is not what they want, but what 'related interests' want them to know and base their practices on.

I always feel a little angry when I read about the latest 'head-to-head' trial between two drugs. I mean, when you watch a commercial on how this new detergent 'makes your clothes 20% whiter than Brand X detergent', do you really think the people at the detergent company just wants you to look your best? It seems a terrible waste to spend so much time, money, and brains trying to get a bigger market share on an established (and profitable) 'market' when there are still so many (less lucrative) diseases to be cured.

We seem to have painted ourselves in a corner now, having decided and proclaimed that we will henceforth base almost all our judgements on 'evidence' alone, but not having secured a say over the source and type of information we want.

I don't think it a very satisfactory state of affairs, although I must say I don't know how we can rectify it.

All I know is: Happiness is a Warm Gun.

Parkinson’s

No, not the talk show host, not the disease, nor even the dirty joke about how old men in the old-folk’s home prefer old women with that disease, but this letter from the ST Forum today:


Dec 7, 2005
Review doctors' working hours, for safety's sake

I refer to the article, 'Checks in place to manage stress, fatigue' (ST, Dec 2), which stated that pilots are not allowed to fly more than 100 hours in any 28 consecutive days. This is to ensure that they fly with full concentration and deliver passengers safely to their destinations.

I wish to relate this to the plight of doctors here. Not long ago, an article in Time magazine reported that in the United States, around 98,000 deaths each year are the result of medical errors. Could some of these errors be due to fatigue or poor concentration?

I have friends who are junior doctors. They tell me their workday typically starts at around 7am, when they prepare to do ward rounds, after which the rest of the day is spent mostly in the wards carrying out instructions given by senior doctors. Their day theoretically ends at 5pm, but they do not usually leave before 6pm.

And when they have night duty, they work continuously from 5pm till the next morning. Thereafter, they continue the morning's duties like in any other day. They are allowed to leave only when they have completed the tasks for that morning. Many a time, it can be as late as mid-afternoon. That means they would have worked non-stop for close to 24 hours. And these night duties can occur up to six times a month.

These junior doctors are always stationed in the hospital wards and if their concentration and competence are affected by fatigue, are we not placing patients at risk?

Are we so short of doctors? Or are the hospitals swamped with too many patients? As with passenger safety, when there are patients' lives at stake, it makes sense for doctors' working hours to be reviewed.

Chris Tan


The opening analogy is interesting, not least because junior airline pilots earn more than junior doctors, and few patients are worth as much as aeroplanes. But the bit I would like to rant on is the last paragraph.

I believe that Parkinson’s First Law, which states that:

Work expands to fill the time available for its completion

also applies to subsidised healthcare.

The cost of unsubsidised healthcare is so high and hence the subsidy so attractive, that people will continue to seek subsidised healthcare and stretch it to its capacity unless one or both of two things happens:

1. It becomes so dangerous or unpalatable that people would rather spend the extra money than to receive it.

2. A system is in place to deny people of subsidised healthcare, based on whatever criteria as the case may be (e.g. means testing).

It seems that the author of the letter is arguing that we should do something about doctors’ work hours before 1. becomes a reality (some would argue that it already is a reality), without implying that 2. is the solution.

I don’t think anyone is actually perpetuating the current system of night-calls which really means six or more 36-hour shifts per month just to torture junior doctors. A simple calculation will tell you that to have separate night-shift doctors will mean a doubling of manpower requirement if after-hours are to be fully-staffed, or a 50% increase if it is on half-staff.

The current manpower shortage simply does not allow that, even if we had the money to employ the staff. Or is it a distribution problem? Can we increase the manpower pool by luring GPs in the private sector to work as junior doctors for a five-figure salary?

It might work, but that will drive healthcare costs up to an amount we are not willing to bear. Plus from Parkinson's Law, one can predict that people will continue to consume as much healthcare we can provide.

Something has to give.

I don't really wish to see 1. happen, so I guess I have to root for 2.

I'm not a fan of means testing as it stands though - it allows for a situation where a poor person may over-consume healthcare he does not need with impunity, while a rich person who needs it for a major illness can quickly become no-longer-rich from having to pay for it.

Even though this is theorectically a question of economics, as doctors we see this being played out so often you wonder if there is a fairer way of doing it.

The Doctor is Out

angry doc will be taking a short break from blogging.

















We hope to return to our regular ranting soon.

"Quantity Has a Quality All Its Own"

This post from my mentor complaining about the assembly-line workload doctors face got me thinking about a term I learnt from one of those Evidence-based Medicine workshops: Numbers Needed to Treat (NNT).

I failed biostatistics back in medical school, but I believe NNT means the number of patients you need to treat before one of them benefits from the treatment. Applying this to say stroke prevention, it means that a treatment with NNT of 10 means that for every 10 patients you treat, you would have prevented one stroke (which would have occurred if they were not given the treatment).

A more thorough explanation can be found at this site.

Let's say we take the figure from this article:

"Two studies of antihypertensive treatment in hypertensive people over 60 years have NNTs of about 40 to prevent one stroke over 4 years compared with placebo. This means that 40 people have to be treated for four years to prevent a stroke in one of them, who would have had a stroke if they had been given a placebo."

So say aliendoc sees 8 patients an hour, for 44 hours a week, and she works 46 week (14 gazetted holidays, 3 weeks leave, one week MC...) a year.

That makes 16,192 consultations.

Let's say half of those are acute cases like cough-and-cold, and that the rest are repeat visits for chronic illnesses like diabetes and hypertension, on 3-monthly visits.

That makes 2024 unique chronic patients.

Given that the prevalance of hypertension in Singapore is about 25%, and given a NNT of 40, that makes 12 strokes prevented.

That's one person saved from a stroke each month.

The numbers may not be exact, but I suspect the order of magnitude should be correct. And we haven't even counted the other complications like heart attacks, or the other chronic diseases like diabetes and high cholesterol.

So how many strokes have you prevented today?

And the nominees are...

The list of nominees for the 2005 Medical Weblog Awards is out.

I have so far been unsucessful in getting Dr BL Og to revive his blog to contest, but I have nominated a blog I like.

Also I suspect many of you would want to root for Dr Oz Bloke.

Nothing really matters

Is this the real life?
Is this just fantasy?
Caught in a landslide
No escape from reality
Open your eyes
Look up to the skies and see
I'm just a poor boy, I need no sympathy
Because I'm easy come, easy go
A little high, little low
Anyway the wind blows, doesn't really matter to me, to me

Mama, just killed a man
Put a gun against his head
Pulled my trigger, now he's dead
Mama, life had just begun
But now I've gone and thrown it all away
Mama, ooo
Didn't mean to make you cry
If I'm not back again this time tomorrow
Carry on, carry on, as if nothing really matters

Too late, my time has come
Sends shivers down my spine
Body's aching all the time
Goodbye everybody - I've got to go
Gotta leave you all behind and face the truth
Mama, ooo - (anyway the wind blows)
I don't want to die
I sometimes wish I'd never been born at all

I see a little silhouetto of a man
Scaramouch, scaramouch will you do the fandango
Thunderbolt and lightning - very very frightening me
Gallileo, Gallileo,
Gallileo, Gallileo,
Gallileo Figaro - magnifico

But I'm just a poor boy and nobody loves me
He's just a poor boy from a poor family
Spare him his life from this monstrosity
Easy come easy go - will you let me go
Bismillah! No - we will not let you go - let him go
Bismillah! We will not let you go - let him go
Bismillah! We will not let you go - let me go
Will not let you go - let me go (never)
Never let you go - let me go
Never let me go - ooo
No, no, no, no, no, no, no -
Oh mama mia, mama mia, mama mia let me go
Beelzebub has a devil put aside for me
for me
for me

So you think you can stone me and spit in my eye
So you think you can love me and leave me to die
Oh baby - can't do this to me baby
Just gotta get out - just gotta get right outta here

Ooh yeah, ooh yeah
Nothing really matters
Anyone can see
Nothing really matters - nothing really matters to me

Anyway the wind blows...

- Bohemian Rhapsody