Angry Doctor

Wednesday, January 31, 2007

Alien Doctors

No, not this one, but this post by Dr Huang.

angry doc has worked with and still works with doctors from other countries. Other than the feeling that we might be 'exporting our healthcare problem' by poaching doctors from countries which may already be suffering from a shortage of doctors, angry doc doesn't really have a problem with 'importing' foreign doctors, in general or with regards to which medical school they graduated from, or what qualifications they held.

To use a cliche, there are good and bad doctors everywhere.

In fact, angry doc can't remember when the last time it was he asked a foreign doctor which medical school he graduated from (he is more likely to ask that question of a Singaporean doctor who has graduated overseas...). His opinion of his colleagues (foreign and local) depends not on which school they came from, or if they were on the Dean's List or Honour Roll, but how they performed as doctors, and functioned as colleagues.

Graduating from a top medical school does not automatically make one a good doctor, nor does graduating from a low-ranking medical school mean one will not become a good doctor.

Just as there is no guarantee that a graduate from our local medical school will not turn out to be disgrace to the profession, there can be no guarantee that limiting recruitment to a few top medical schools will bring in only doctors who will be an asset to our healthcare system. It takes time to find out if someone can function and perform in our local healthcare system with its unique set of rules and regulations (written or otherwise) and its unique patient and disease profiles, and angry doc supposes that's where the period of supervision and assessment come in.

What is important perhaps, even as we open our doors, is that we have a system to 'uninvite' the doctors who may for one reason or another be found not suitable for our healthcare system.


Monday, January 29, 2007

How NOT to argue for Alternative Medicine 7

Half-a-billion Chinese mothers can't be wrong?

Allow health product vendors to plug benefits

THE Straits Times reported that the Government will introduce new controls for health products ('New controls for health products'; ST, Jan 23). This is surely welcomed by consumers as the new law will extend better protection. On the other hand, I hope the new law will give health product vendors a clear direction in allowing them to state health benefits on product labels and in advertisements.

In the Chinese diet, medicine-powered food is often used in treatment or as a booster for overall well-being. In Chinese families that have the custom of drinking soup, gouqi (wolfberries or Lycium chinense) is often used to enhance the soup's tonic effects. Chinese medicine has long used it to improve the immune system, improve eyesight, protect the liver and boost male reproductive ability.

With the current food control regulations, you break the law if you sell gouqi and make any such claims on your product label or in an advertisement. Yet the claims are the very reason mothers use gouqi in their cooking.

In the United States, the Food and Drug Administration allows certain health claims for food high in nutrients proven to support health. For example, it allows food high in potassium to claim that 'diets containing foods that are good sources of potassium and low in sodium may reduce the risk of high blood pressure and stroke'. Such permission is given based on sufficient medical evidence and strong authoritative recommendation.

In China, the health authorities publish a list of herbs which are both food and medicine, as well as herbs prohibited in food.

Most legal systems today are designed to regulate on a 'treatment-centric' basis. One is not allowed to make claims about nutrition and food, even when everyone knows their medicinal effects. Hence, the healing power of nutrition and food is not given enough weight in the health-care system. This paradigm does not match reality, especially in Asian societies.

The authorities will prosecute anyone who sells tongkat ali labelled as 'enhancing sexuality' even though this is widely recognised in South-east Asia. Once in Melbourne, I saw an advertisement that said, 'Stronga; Longa; Tongka', a humorous way to bypass restrictions. But most health promoting foods are not as lucky as tongkat ali.

Devising a health products law in Singapore is probably more challenging than in the West as we have a long history of using food as medicine. However, I am confident the Government will come up with a practical and forward-looking law that not only protects consumer interests but also nurtures the local health food business for the global market.

Chen Bin

'This paradigm does not match reality, especially in Asian societies.'

How ironic.

Anyway, while Mr Chen is arguing for vendors of traditional herbal medicine to be exempted from having to prove their claims, scientific studies are already being conducted on herbal medicines to test these claims.

In fact, compounds extracted from the fruits and root bark of Lycium chinense have been shown to have antimicrobial and hepato-protective properties in animal studies. However, that is not to say that it does 'improve the immune system, improve eyesight, protect the liver and boost male reproductive ability' in humans, or that the effective (and safe) dosage and method of preparation had been established in human subjects.

Certainly if Lycium chinense is proven to confer all the health benefits stated by Mr Chen, vendors would be allowed to state so when selling it. Until then, angry doc doesn't see what's wrong with not allowing health products with unproven efficacy to claim otherwise just because of its customary use.

After all, one wouldn't allow cow dung to be touted as a healthy product to be used on umbilical stumps just because people in Africa have been using it for centuries.

While an absence of evidence is not evidence of absence, an absence of evidence is still an absence of evidence.

Added: the reply from AVA

Food products: Health claims not permitted

I REFER to the letter by Mr Chen Bin, 'Allow health product vendors to plug benefits' (ST, Jan 29).
The use of claims for food, including food containing approved herbal ingredients, is regulated under the Sale of Food Act and the Food Regulations administered by the Agri-Food & Veterinary Authority (AVA). A list of Chinese medicinal ingredients commonly used in food can be downloaded from AVA's website at

In Singapore, food products may carry nutrition claims as long as they comply with the nutrient-claim guidelines established by the Health Promotion Board and have an acceptable nutrition information panel incorporated in their labels. The nutrition information panel should declare the amounts of calories, protein, carbohydrate, fat and the nutrients claimed.

Claims that describe the role of a nutrient in growth, development and normal functions of the body may be allowed if they are supported by well-established scientific evidence.

However, the use of health-improvement claims on food products is not permitted as there is currently no scientific evidence to prove that consumption of any food alone, with or without the addition of approved herbal ingredients, can bring about health improvement. At present, there are also no international guidelines on the use of health-improvement claims or claims relating to the efficacy of traditional herbs when used in food.

Nevertheless, AVA would like to assure the public that it will closely monitor international developments on the use of health claims, to ensure that Singapore's regulatory requirements continue to be in line with international guidelines.

We thank Mr Chen for sharing his views on this subject.

Goh Shih Yong
Assistant Director
Corporate Communications
for Chief Executive Officer
Agri-Food & Veterinary Authority
Ministry of National Development

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Saturday, January 27, 2007

One billion Chinese can't be wrong

Once again, Saturday is 'funny letter' day at angrydr.blogspot...

Undignified to place a price on body organs

I refer to the recent debate on organ trading.

I am against such a trade. I am also against the medical directive which states that I have to opt out of the situation whereby other people are automatically entitled to my kidneys upon my death.

My heart is the seat of my deepest emotions. It experiences the intense joys and sorrows of my life. When I am disappointed or disillusioned with love, it goes through heartache and pain. The Chinese have a saying, xin gan bao bei, which implies that the liver is also associated with affection or emotion.

I don't see how or why human beings should be trading in such body parts which are closely tied to our personalities, and perhaps our soul.

Perhaps it sounds cruel to be against organ transplants, but the illegal trades being spurned off which involve kidnapping and coersion are infinitely more cruel.

It is a different matter if I am donating to a loved one. If I can give my heart to or die for my loved one, metaphorically speaking, then I feel it is not much different if I were to give the physical organ to them.

In our quest for life, why should we rob others of their dignity by placing a price on their organs?

Organ failure simply means it is time for you to go. We should accept death and suffering graciously. Our lives do not end with the passing of our physical bodies, but is extended in the lives of our sons and daughters, and in the good deeds we are remembered for.

Jennifer Wee Siew Cheng (Ms)

angry doc finds it hard to argue with that kind of logic.

Like Ms Wee, angry doc is no fan of organ transplant. In fact, angry doc is not too keen on any procedure that involves putting knife on healthy persons.

He would have posted his opinion on this blog, but he didn't have the guts. He was worried that the more progressive and sanguine members of the medical profession and society might baulk at his gall, and that their blood might boil after reading his entry. The thought of offending so many people chilled his bones, and he decided to hold his tongue.

But along comes a letter that angry doc just couldn't resist commenting on.

Well, perhaps angry doc should discuss the issue of organ transplant and trading. Who knows? He might have a change of heart after all.

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Friday, January 26, 2007

Alternotopia News 5

Bonus Bogus Story

Reflexology Council Denounces Minireflexology Claims

The Alternotopia Reflexology Council (ARC) has voiced its objections to a bid by the Alternotopia Minireflexology Association (AMA) to have minireflexology incorporated into the national healthcare system.

In a letter to the Ministry of Health, the ARC stated that 'currently there is no scientific evidence for the claims by minireflexology practitioners that pressure to different areas in the heels of the feet (which represent the anotomical areas of the feet in foot reflexology) in turn stimulate the different anatomical areas of the body, or that pressure and massage to these areas in the heels yield similar therapeutic responses to pressure and massage of the feet themselves.'

A spokesman from the ARC told Alternotopia Times that the letter was submitted to the Health Minister yesterday, and said that it is 'patently ridiculous to speculate that one small part of the foot can represent the anatomy and reflexologic function of the whole foot'.

"Imagine what the AMA would say, if some other organisation claimed that pressure to the part of the heel representing the heel in minireflexology achieved the same effect as massaging the heel in minireflexology, and hence had the same effect as mainstream reflexology," he added.

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Tuesday, January 23, 2007

Quackbuster: Singapore 2

The proposed "Health Products Bill" got a mention in the news today.

Pills to undergo health check
Law proposed to regulate health supplements here

In a move that should ensure the Slim 10 episode never happens again, Parliament has tabled a Bill to tighten the regulations for health products.

The Bill proposes that all health products be evaluated and entered into a central registry, under categories determined by the Health Sciences Authority (HSA).

If enacted, the law will also require manufacturers to list the active ingredients used in the manufacture of health products, so that banned substances such as Fenfluramine — the banned appetite suppressant in Slim 10 pills that, in 2002, caused actress Andrea de Cruz's liver to fail and killed logistics executive Ms Selvarani Raja — does not slip into the market.

The move is a long-anticipated one, with calls over the years for tighter screening of nutritional supplements flooding the Singapore market.

Currently, such supplements can be imported and sold without a licence, and they are not subject to pre-market approval. Dealers are held fully responsible for ensuring the safety and quality of their products.

While the HSA has said it does random sampling of products in the market to screen for harmful contaminants, the system is basically caveat emptor — buyer beware — with consumers urged to exercise "caution and discretion" in their consumption of health products and with potentially misleading advertisements.

But if the law now being proposed is enacted, advertising will come under greater scrutiny, with restrictions on false and misleading advertising.

The Bill also requires all manufacturers, importers and wholesalers of health products to be licensed and accountable for the import or sale of health products that have been adulterated, counterfeit, unwholesome or tampered with.

The HSA had sought public feedback on the proposed Bill back in June 2005, acknowledging that the current regulatory controls were "fragmented", "confusing" and "difficult to understand".

"The overlapping of controls in some areas sometimes made compliance with the legal requirements unnecessarily complicated," said the authority.

The Health Products Bill proposes bringing the Medicines Act, the Poisons Act, the Sale of Drugs Act and the Medicines (Advertisement and Sale) Act under one framework.

There will also be scope to include additional regulations for medical devices. In addition, current penalties for non-compliance, which the HSA described as "outdated" and not reflective of "current economic realities" in many cases, will be reviewed.

The second mention of the Bill is scheduled for the middle of next month.

You can read the proposed bill (all 91 pages of it) in its entirety here.

It will take angry doc a while to go through all of that, but it does look good on first pass. However, angry doc suspects that the very people the Bill is meant to protect may not appreciate it at all.

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Saturday, January 20, 2007

And the winners are...

The results of the 2006 Medical Weblog Awards are released.

angry doc would like to congratulate Dr Crippen on his spectacular win in three categories.

Saturday, January 13, 2007

Alternotopia News 4

Bonus Bogus Story

HSA Smashes Homeopathic Remedy Piracy Ring

The Homeopathic Sciences Authority (HSA) raided an underground factory producing bootleg homeopathic remedies and arrested more than 20 men yesterday.

According to the HSA spokesman, the piracy ring obtained legitimate homeopathic remedies from pharmacies, and then diluted them by a factor of 1000 and divided the solution into a thousand bottles similar to the ones used by the legitimate manufacturers. To ensure that the potency of the remedies is not increased a thousand-fold by the dilution, they would allow the solution to evaporate to a thousandth of its volume, before making it up to full volume again before bottling the solutions for sale.

The HSA reminds the public that homeopathic remedies should be obtained only from legitimate sources, and after a consultation with a registered homeopath.

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Saturday, January 06, 2007

Subsidy and other Preoccupations 3

No One is to Blame

You can look at the menu but you just can't eat
You can feel the cushions but you can't have a seat
You can dip your foot in the pool but you can't have a swim
You can feel the punishment but you can't commit the sin
And you want her and she wants you
We want everyone
And you want her and she wants you
No one, no one, no one ever is to blame

You can build a mansion but you just can't live in it
Youre the fastest runner but you're not allowed to win
Some break the rules
And live to count the cost
The insecurity is the thing that won't get lost
And you want her and she wants you
We want everyone
And you want her and she wants you
No one, no one, no one ever is to blame

You can see the summit but you can't reach it
It's the last piece of the puzzle but you just can't make it fit
Doctor says you're cured but you still feel the pain
Aspirations in the clouds but your hopes go down the drain
And you want her and she wants you
We want everyone
And you want her and she wants you
No one, no one, no one ever is to blame
No one ever is to blame
No one ever is to blame

- Howard Jones

Thursday, January 04, 2007

The Polls are Open

Polls for the 2006 Medical Blog Awards are open.

You can see the list of nominees and cast your vote here.

angry doc is not nominated this year, but he is glad to see that his favourite bloggers are doing well in the polls.

Wednesday, January 03, 2007

Argument Clinic

It's still too early in the year to write anything intelligent, so here goes...

angry doc: You're in denial.

Patient: No, I'm not!

angry doc: Yes, you are.

Patient: No, I'm not!

angry doc: Yes, you are.

Patient: No, I'm not!

angry doc: Sure you are! You're denying that you're in denial, right?

Patient: Er... yes.

angry doc: That means you're in denial!

Patient: Does it?

angry doc: Yes.

Patient: OK, maybe I am.

angry doc: Maybe?

Patient: OK, I'm in denial.

angry doc: No, you're not.

Patient: What?

angry doc: Well, you're not denying that you're in denial anymore.

Patient: Are you having me on?

angry doc: You have irony deficiency. May I suggest some humourtinics?

Patient: Isn't this against your Hypocritcal Oath?

angry doc: Maybe, but my therapist tells me I should learn to be less judgemental.

Monday, January 01, 2007

Have a good one yourself too

There is probably no evidence that shows that being wished a 'happy new year' significantly increases the level of joy one will experience in the subsequent 365 days, but angry doc is currently experiencing a warm fuzzy feeling inside from the well-wishes he has recevied from his friends (both in 'real-life' and via his blog or theirs).

So for what it's worth, angry doc wishes all his readers and fellow-bloggers a good year ahead.