Angry Doctor

Wednesday, November 28, 2007

TCM finally catches up with western medicine

angry doc and Dr Oz bloke have often wondered aloud on this blog why it is that patients never seem to complain about adverse outcomes when they are under the care of TCM physicians, the way they do when under the care of western medicine. In the comments section of an earlier post, angry doc speculated that "with 'mainstream' hospitals now housing TCM practices on the premises, expectations will change and I think it will be a matter of time before it happens".

It seems like angry doc's prediction is coming true:

Physician's needle joke ends in pain for patient

ON SATURDAY, I visited the new Bao Zhong Tang TCM Centre at Singapore General Hospital for the second time. For pain in my lower back and hip, a senior physician administered about 15 acupuncture needles to my back, waist, hip and thighs.

As soon as the last needle was inserted, the physician left the room to attend to other patients. About 20 minutes later, another physician came to remove the needles.

As he was not the one who administered the needles, I asked whether he had removed all of them. He said jokingly that if there was any he missed removing, I could keep it as a souvenir.

When I turned around and sat up on the bed, I felt a sharp pain in my right thigh. The physician simply pulled out the needle, as if nothing serious had happened.

Should a physician who administered acupuncture needles on a patient let another remove them?

What if a missed needle gets thrust deeper into a patient's acupressure point when he rolls over to get up?

Would it cause great injury?

I hope what I had experienced was just a sharp pain. I did not take the souvenir.

Lim Chye Hin

Such, perhaps, is the price of being 'mainstream'.

TCM has finally 'arrived'.

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Tuesday, November 27, 2007

SMA Medical Students' Assistance Fund

angry doc still hasn't got anything to blog about, so he will just draw his readers' attention to this article from The New Paper on the Singapore Medical Association's newly-launched SMA Medical Students' Assistance Fund.

What angry doc found interesting was this little story about Prof Goh, which he has never heard before:

"SMA president Wong Chiang Yin shared the story of his predecessor, Associate Professor Goh Lee Gan and his struggle to become a doctor.

Associate Prof Goh came from a poor and large family, and couldn't even afford the first term fees, said Dr Wong. So he tried his luck with three friends and bought a lottery ticket.

The 4-D number struck first prize and the four of them shared the prize money of $4,000, then a princely sum.

With his share of $1,000, Associate Prof Goh was able to enrol in medical school. That was back in 1966.

Associate Prof Goh is now the president of the College of Family Physicians Singapore. He is also a former president of the SMA.

Said the Dr Wong of his colleague: 'Prof Goh is the de facto 'father' of academic family medicine. Imagine our medical profession and family medicine today without him.'

Associate Prof Goh, 62, told The New Paper: 'Without the money, I would probably have gone to teacher's training college and become a teacher.'

The lottery money saw him through his first year of medical school. He paid $600 for his fees and spent the rest on a skeleton and some second hand books. Government bursaries saw him through the rest of his medical education."

angry doc didn't know they had 4-D back then.

If you wish to help, or learn more about the Fund, you can do so at the SMA's webpage here.


Monday, November 19, 2007

Science and how we know we are right

Ben Goldacre, who blogs at Bad Science, has an excellent article on homeopathy which appeared in The Guardian last week.

While homeopathy is not a subject angry doc discusses often, the topics addressed in the article - why a form of unproven therapy nevertheless has its believers, the common fallcies used by its proponents to defend it against criticism, why science remains our best method of knowing whether a mode of therapy works, and what kinds of harm can result when we ignore science and promote an unproven therapy - may apply to many other types of alternative medicine.

It's a pretty long article, but if you read all of it, you will "understand evidence-based medicine to degree level".

Do have a read.

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Thursday, November 15, 2007

"Complementary and Alternative Medicine Month"

Well, everybody's talking about it, so angry doc thought he might as well plug it here too...

Panda Bear, MD., has decided to make November "Complementary and Alternative Medicine Month" on his blog. Do drop by and learn "Everything you need to know about Complementary and Alternative Medicine".


Tuesday, November 13, 2007

Goldilocks and the Three Chairs

(image from

Goldilocks survived her encounter with the three bears and lived to a ripe old age, when she became plagued with rheumatism of her left knee.

Unable to bear the pain, she decided to see a healer.

She walked into the woods with the aid of her cane, and pretty soon she came upon a house of healers.

The first healer, a shaman, invited her to sit on a yellow chair, its back carved in the shape of a totem bird, saying to her:

"Your pain is due to a demon which is living in your knee, and I shall rid you of the pain by sticking these needles into your leg, piercing the demon and driving it away."

The second healer, an acupuncturist, invited her to sit on a red chair, its back carved in the form of the element Fire, saying to her:

"Your pain is due to qi stagnation caused by excessive dampness, and I shall rid you of the pain by sticking these needles into your leg, unblocking the qi."

The third healer, an anaesthetist, invited her to sit on a black chair, its back carved in a geometric, sterile shape, saying to her:

"Your pain is due to chemicals released during inflammation, and I shall rid you of the pain by sticking these needles into your leg, which will stimulate the release of chemicals which will relieve the pain."

Which chair, O gentle reader! should Goldilocks choose?


Sunday, November 11, 2007

Cow Dung 6

Fellow-Clearthought blogger i must be stupid spotted this interesting news article, and gives his take on it here.

angry doc reproduces the article here:

(emphasis mine)

No cane, no gain?
Many flocked to Jurong West last week for an offbeat treatment for aches and pains: caning
By Debbie Yong

THEY sat on red plastic stools in a loose circle at an HDB void deck in Jurong West, waiting for their turn to be caned.

They pointed, whispered to one another and occasionally cringed as they watched an elderly man in the middle use a slim wooden rod to repeatedly strike at a bare-bodied man until his flesh turned red and raw.

Some passers-by stopped to stare before continuing on their way with a shudder. Mostly middle-aged and complaining of backaches and muscle soreness, the crowd of about 25 who had gathered at Block 987C in Jurong West Street 93 on Thursday afternoon believed caning to be a form of physiotherapy.

'My shoulders used to be very stiff but after my first caning session four days ago, I feel much better,' said bus driver Chua Cheng Hui, 55, who was on his third visit.

'I want to catch Master Goh one last time before he leaves,' he added, referring to physiotherapist Goh Seng Guan, 72.

Mr Goh, a Malaysian, was on a one-week trip to visit friends in Singapore from last Saturday to Friday.

But he ended up working throughout his holiday after a Shin Min Daily News report on Monday on his unusual form of therapy sent readers knocking on the door of his Singaporean hosts, Mr Png Peng Siah, 60, and Madam Qui Em, 56.

He promptly set up a makeshift shop outside their ground- floor flat, with Mr Png and Madam Qui taking turns to record customers' names and issue queue numbers.

Over the next three days, he whipped a steady stream of about 50 to 70 customers a day, working from 10am to 10pm with short breaks in between for meals.

He charged about $20 per person. The cash was discreetly pocketed at the end of each five-minute caning session.

Mr Goh, who runs two orthopaedic centres in Betong, southern Thailand, and Penang, Malaysia, with his wife, said he learnt the skill from a Tibetan lama when he was 20 and has been doing it for the last 50 years.

He claimed to be a certified Chinese physician in Thailand, but did not have his certificate with him.

His work tools: home-brewed medicated oil with his portrait on the label and 11 wooden rods of varying lengths and thickness laid out on a small wooden table.

The caning helps to loosen up muscles and improve blood circulation, he explained, as he pointed out black bruises that had appeared on clients' skins, indicating 'toxins that were being purged from the blood circulation system'.

Madam Qui, a cleaner, first met him in 1996, when she sought treatment for a pain in her shoulder at his Thailand centre, on a friend's recommendation.

His first visit here was with his wife last December, when Madam Qui invited them for a holiday.

Many of his customers, an equal mix of men and women, said they were trying it out of curiosity.

One resident of the same block, painter Ramdan Sardon, 45, who complained of a chronic backache, said: 'I see so many people here queueing from morning to night, maybe it works.'

Maintenance officer Vincent Loh, 35, said the pain was bearable, but acknowledged that he would have to wait a few days to know if the caning was effective, by which time Mr Goh would have left.

Insurance agent Raymond Goh, 53, said he came because the acupuncture treatment he had received for his sore calf in the past year was not working.

'It's more painful than death - this is the first and last time I'm doing it,' he said as he hobbled away with a swollen calf.

Traditional Chinese medicine (TCM) practitioners interviewed were sceptical about the effectiveness of this treatment.

Physiotherapist Simon Toh, 55, said there used to be a shop specialising in caning therapy at People's Park Complex run by a Taiwanese woman, but it shut after less than a year.

He said: 'Singaporeans prefer to play safe with conventional methods of treatment. People might try it only as a last resort, after taking Western medicine or seeing TCM physicians.'

Retired TCM practitioner Liang Ming Na, 60, said it was a 'very ancient practice' which originated from rural villages and is not orthodox.

Thye Shan Medical Hall's Madam Tang Eng Hua said: 'It does not have any scientific basis. The bruises could be a result of repeated hitting and anyone can rub a sore muscle to make it loosen up and feel better.

'Furthermore, it must be done with skill and care. If not, you could end up hurting someone, especially when it's the elderly.'

One passer-by at the scene, interior designer Wendy Goh, 41, saw the queue and quipped: 'Why should I pay someone to beat me?'

Why indeed, when we can buy a Healing Broom and beat ourselves with it at home?

Of course, there are some reasons to believe that a good caning can relieve pain, but like imbs, angry doc is nevertheless amused to read that a TCM practitioner has criticised the caning therapy as "a 'very ancient practice' which originated from rural villages" that is "not orthodox" and "does not have any scientific basis".

That's just priceless.

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Friday, November 09, 2007

Science and how we know we are wrong

A reader has questioned angry doc's self-imposed quest to "fight against alternative medicine when there are far more dangerous issues within their own western medicine to fight for", citing the specific example of the topic covered in this news article, and advising that "western doctors solve their own problems first before talking about alternative medicine practitioners":

Super-bugs lurk outside S'pore hospitals

It's an alarming discovery.

A study by the Communicable Disease Centre (CDC) suggests that drug-resistant bacteria may already be prevalent in the community at large. Based on skin swabs of 1,000 patients at the Accident and Emergency Department in Tan Tock Seng Hospital, more than 1 in 4 were found to carry the "ESBL and MRSA super-bugs" even before they were hospitalised. Some 25 per cent of the patients were found with ESBL, while 1.8 per cent were found with MRSA.

Experts had thought that these super-bugs were confined only to hospitals. Doctors say one reason for the presence of these super-bugs outside a hospital setting could be the misuse of antibiotics.

Associate Professor Leo Yee Sin, clinical director at the CDC, said: "In situations where we need to use antibiotics, we use them. But in situations like common cough and cold, where we know that it's likely caused by virus, the antibiotics are not going to be useful."

From next year, the CDC will work with grassroots organisations to collect more samples to determine the prevalence of these super-bugs in the population. — Channel NewsAsia

The cause of this problem, as pointed out in the article, is "the misuse of antibiotics".

Our reader elaborates:

"My GP often tells me that he knows about this problem but most patients want antibiotics and if he doesn't give it to them, they don't like it and he loses business. He also complained that MOH and HPB do nothing to support good doctors like him. On the other hand another clinic where the GP gives out antibiotics for every cold and flu that clinic's business is overflowing!

So much so my GP says he has started pandering to the crowd to survive.

Two wrongs don't make a right. But if the majority are doing wrong, while the minority does right....the wrong becomes the "right" to some people."

Fellow-Clearthought blogger i must be stupid points out that "[t]he problem of alternative medicine and the indiscriminant antibiotic use are 2 different types of problems... [o]ne is a regulation problem while the other is more of a problem with intellectual honesty".

angry doc agrees with him.

To angry doc the failure of western medicine shown in this article does not represent the failure of science, but the failure of the market. Actual practices sometimes fall short of evidence-based standards due to market factors, and that is an issue angry doc has blogged on many times.

In fact, this article illustrates one of the strengths of western medicine and science: that a system is in place to collect and review data, and that we are willing to change our practices based on the findings. The very fact that we recognise and acknowledge the problem of antibiotic resistance is an achievement in itself, because that is the first step towards finding a solution.

When was the last time alternative medicine looked at evidence and decided they needed to change their age-old traditional practices?

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Wednesday, November 07, 2007

Alternative Medicine and the Ultraman Mystery

As a child, angry doc used to enjoy watching 'Ultraman'.

Maybe it was the monsters, maybe it was the fact that the internet hadn't been invented yet, or maybe it was the sight of a masked man in a tight, shiny bodysuit...

For readers who are unfamiliar with 'Ultraman', here's a
succint summary of the TV series:

The show seemed to follow a formula that was set in stone. The Science Patrol is summoned to investigate strange occurrences and encounters a monster. They battle the creature for a while with their rocket plane or hand weapons, but find that they cannot stop the giant menace. At that point Hayata figures out a way to separate himself from the group and transforms into Ultraman. The rubber monster's lifespan can be measured in minutes once Ultraman appears.

What typically happened was that Ultraman would fight the monster-of-the-week using karate until a warning light on his chest beeped - indicating to him that he was low on energy - whereupon he would decide to sod all that martial art stuff and utilise his Death Ray instead. This powerful mode of attack (officially known as the
Specium Ray, it seems) would instantly vapourise the opposition, after which our hero would fly off into the sunset.

Even at that age, however, angry doc could not fathom why, seeing as how effective the attack was, Ultraman did not choose to use his Death Ray at the first instance but risked dangerous hand-to-hand combat instead.

Time after time.

Episode after episode.


So what has 'Ultraman' got to do with alternative medicine, other than the fact that they both involve mysterious men from the east with strange powers to save us that science cannot yet understand?

Well, one of the justifications from proponents of alternative medicine on their use is that if western medicine has done all that it could and the patient is still not cured, why not try alternative medicine since is harmless and may in fact provide a miraculous cure?

It kinda makes sense in a 'what does he stand to lose anyway, right?' sort of way, until you realise that if alternative medicine therapies were indeed harmless and may provide a miraculous cure, it would be more logical to use them as the first line of therapy instead, wouldn't it

Or is there some mysterious reason that eludes angry doc as to why we should 'save the best for last', as Ultraman always did?


Monday, November 05, 2007

"Teach both theories..."

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