Monday, February 25, 2008

Our Home

I have been captivated, engrossed, enthralled by the BBC series "planet earth", a documentary about, well, our planet.

It gives a fascinating overview of our home, an audio-visual history, if you will, covering almost every single landscape one can find on Earth. From the frigid poles, to the arid deserts; from the highest summits to the unlit ocean depths, the producers have used the latest in film making technology to give us never-before-seen images of sometimes alien-looking environments.

The cameramen went through extremes in weather & environmental conditions just to get shots of rare animal breeds & behavior. Accompanied by elegant orchestral compositions, we see waddling penguins, leapin' lizards, galloping gazelles, graceful dolphins, hunting predatorial cats, many of which has never been seen by the human eye before. Haunting whalesong, the unforgiving cruelty of nature, & the rarely seen dances of mating birds of paradise are just a few examples of the amazing scenes captured by the seemingly omnipotent BBC cameramen. The miracle of nature has never been so apparent - the wonders of how animals & plants have adapted over the thousands & millions of years are seen up close & personal.

Narrated by the guru of documentary narrators David Attenborough, this series also highlights how fast our climate is changing, resulting in the destruction & shrinking of much of the natural habitat of our fellow earthlings.

The icing on the cake are the short segments at the end of each episode called "Diaries" which gives viewers insights into how certain scenes were captured. This was fascinating, especially for a wannabe film maker like moi.

This should be mandatory viewing for all...especially for those who are still not convinced that global warming is, in fact, affecting everyone of us on this precious blue planet of ours.

Tuesday, February 19, 2008


Straits Times Feb 18, 2008
GPs quizzed on shoddy cosmetic treatments

Health Ministry is also looking at regulating aesthetic medicine
By Judith Tan

AT LEAST 20 doctors have been questioned by the Health Ministry in the last five months on their shoddy aesthetic practices.

This is part of a ministry clamp down to ensure general practitioners offering treatments such as Botox and collagen injections are appropriately trained.

A ministry spokesman told The Straits Times it is studying the regulation of aesthetic medicine - something the plastic surgery fraternity has been fighting for.

'Doctors who performed aesthetic or other health-related procedures need to substantiate them with scientific evidence on safety and efficacy,' she said.

GPs using unsafe practices will be referred to the Singapore Medical Council (SMC) for disciplinary review.

The medical watchdog told The Straits Times it received six complaints last year on aesthetic procedures performed by GPs.

Its spokesman declined to comment on complaints against specific doctors as investigations are on-going.

The MOH surveillance is a move away from its previous hands-off policy which favoured self-regulation by the medical profession.

Plastic surgeons, however, are up in arms over the leeway given to GPs to dabble in aesthetic medicine. They fear the public would be misled into thinking non-plastic surgeons are trained in surgery.

With a rise in the number of people wanting cosmetic treatments, some GPs have moved beyond coughs, colds and flus to performing cosmetic services.

Some have even become hugely successful in this field. Typically, a patient pays between $300 and $1,200 for Botox treatment to get rid of wrinkles. Treatments may be once every three months.

There are more than 1,400 registered GPs in Singapore. Although the number of GPs offering aesthetic treatments is growing, there is no official figure on how many of them are doing so, said the Singapore Medical Association.

The Straits Times understands that some GPs pay anything between $2,500 and $8,000 to attend online courses for which they receive the diploma a week later; or attend day-long seminars on procedures to be qualified.

Doctors say patients with botched treatments are unwilling to press charges because the procedures are private matters.

Another reason: GPs provide corrective surgery for botched treatment and patients are afraid payments would stop should they complain.

One patient, a 28-year-old woman who did not want to be named, had gone to a GP for fuller lips.

But she was injected with too much of the wrong type of lip filler and collagen, and ended up looking like a 'duck'.

Alarmed by the results, the GP - who the patient declined to name - brought her to a plastic surgeon who performed surgery to drain the filler. The GP is still paying for her follow-up treatments.

Dr Ivor Lim, consultant plastic surgeon with The Plastic & Hand Surgery, said aesthetic GPs are only trained in administering procedures like injecting Botox or collagen. 'But when things go wrong, they don't know how to correct the mistake or how to manage the complications. That is where the problem lies.'

MOH feels regulation would help ensure quality of treatment, its spokesman said.

Dr Chai Chin Yoong, a GP and medical director who started a clinic offering aesthetics and weight-management programmes at the Parkway Shenton medical group, thinks there are pros and cons to regulation.

'On the one hand, regulation will not only ensure quality of the work done, but also allows insurance companies to define a premium to cover the doctors,' he said.

But it would also mean that doctors will have to attend courses at approved institutions. 'This would mean higher fees, which would probably get passed on to patients,' he added.

It's about time for this to happen. It would only make sense that there be some kind of control over aesthetic procedures performed by GP's. I had never quite understood the Ministry's previous stand of self-regulation where aesthetic medicine was concerned.

I had been quite appalled to see "aesthetic practitioners" sprout up right, left & center all over Singapore, whether it be in the HDB heartland, or in the midst of the bustling CBD district or the residential enclaves of districts 9, 10 & 11. I wondered when the bubble would burst, and when the Ministry would realise that the ignorant public did not have the know-how nor the common sense to double check if the doctor he/she went to for their various aesthetic procedures had the training & the experience of doing a proper job, and more importantly, to do some research into what the possible complications of a botched job could be.

In the land of people willing to pay thousands of dollars for an aesthetic procedure & yet balk at coughing up $30 for a GP consult + medication to treat an URTI, I do not blame GP's for trying to make a living with aesthetic procedures. Some probably have gone for training. But a one-week course does not an aesthetic physician make.

As a doctor, I would be ethically bound to ensure that I have the appropriate training & experience in whatever invasive procedure I would perform on a patient. (And yes, chemical peels & Botox/collagen injections ARE invasive). In a prior job, I had been asked before by my boss if I would be willing to perform chemical peels on patients as this was a very profitable endeavour. I had always declined because I never felt that I had the qualifications nor the know-how to do it.

I am glad that MOH is starting to feel the same way too.

Saturday, February 16, 2008

War of the Worlds

This & this does not augur well.

Signs of the coming of the feared pandemic? Maybe not quite yet. But this is just a small example of what could happen when vaccines don't work as well as they should.

And the ever-changing, ever adaptable influenza virus looks to be developing resistance against Tamiflu, which so far had seemed to be the last stalwart against it.

Not quite a "War of the Worlds" scenario, but just goes to show that no matter how technologically advanced or mighty the human race may be, the fight against these tiny microbes, who have existed much longer than the homo sapiens species, continues...and we may not turn out to be the victor.

Wednesday, February 13, 2008

Docs Outraged....

...and well they should. My initial reaction was also that of outrage. An insurance company wants US to squeal on our patients???

I'll be the first to admit that among my patients in one of my past jobs included those sent by insurance companies for checkups before they buy insurance. These were patients who KNEW why they were going for the checkups & signed declaration forms saying that they were basically telling the truth & allowing the examining physician to reveal whatever medical condition they had to the insurance company. This is very different from the case mentioned in the above article, where the insurance company in question wants physicians to tell on patients who are already insured, hoping to catch them in a lie. This goes against the very grain of doctor-patient confidentiality. And all in the name of profits (for the insurance companies & their shareholders).

The issue of health care costs & the uninsured is one that is & has been in the news, whether in the US or Singapore.

FACT: EVERYONE will need health care sooner or later.
FACT: Health care IS expensive
FACT: Not everyone can afford the best quality care
FACT: There are grey zones as far as what is considered "best" quality care is concerned, & we can argue till the cows come home over what constitutes good, better or best care.

Bottom line is: how do we address these problems? The Singapore government is promoting means testing, which, if you think about it, makes a lot of sense. If you can afford it, why not pay for it? The problem then arises with how one gauges whether one can afford it or not.

I am no economist; but I can understand the concerns of the middle class who may fall into the cracks of means testing because they make just a bit too much income to pass whatever test they need to pass to get 'x' amount of subsidy. I'd like to see the means by which MOH will do the means testing (pardon the pun).

I don't think health insurance is a bad thing. But when the $$$ sign becomes more important than patient care, the alarm bells start to go off.

Tuesday, February 12, 2008

Holiday in HK

Hong Kong sure is crowded. We spent the Chinese New Year holidays there. Talk about 人山人海 (literal meaning: people mountain people sea; actual meaning: kazillions of people around).

It was a bit strange meeting Chinese salespeople & waiters who spoke English! Not used to that as most Beijingers can't.

The Police concert at the Macau Venetian Arena was amazing.

Sting's bass guitar looked really worn out - but that's ok.
And Stewart Copeland looked winded during most of the concert while he was energetically banging on the percussion insturments - but that's ok.
And Andy Summers looked rather pathetic (and rather arthritic)when he tried to jump off an amp like rockers are supposed to do - but that's ok too.

Because despite appearances, they still sound frikkin' fantastic! Sting was trim & toned & still looks pretty sexy!


Surprisingly, my 14 year old son really enjoyed the concert too, probably in part due to the fantastic performance of the percussionist, who not only played on the traditional drum set, but also made brilliant music on a variety of cymbals, & bells & timpani. He was not impressed by the guitarist though, aficionado that he is, of all things pertaining to the guitar & the playing of. :)

Stewart Copeland in action! Believe it or not, this image was taken off the HD screen on stage.

My 16 year old, on the other hand, found it too loud, didn't really like their music & looked at me in astounded disbelief when I sang along (rather enthusiastically) & knew the words to the classics like Every Little Thing She Does is Magic, Message in a Bottle & Every Breath You Take...:) He actually enjoyed the support band, Fictionplane, more - not surprised as they have a more modern rock sound.

The rest of our holiday was spent shopping, eating & meeting family we otherwise would seldom get to meet. A good time was had, in all.

Happy Year of the Rat!

Sunday, February 03, 2008

Impressions from China - Winter Fun

It's been snowing & snowing & snowing in the central, eastern & southern parts of China. And up here in Beijing, where it is notoriously cold in the winter? Nada - Zero - Zilch. Not a single snowflake. Apart from that one snowfall we had in the beginning of Dec, we haven't seen a sprinkling of H2o in any form since. Dry as a doorknob.

Lots of ice though. On the lakes, that is.

Above: This is Qianhai Lake, frozen over. The building on the left is the Gulou (Drum Tower) which has been around since the days of Kublai Khan.

You can bike-skate.

You can ice skate.

And you can chair-skate. Yes, you heard me, chair-skate. One thing about the Chinese is: they are innovative. Strap some flat blades on the bottom of some chairs, add a couple of poles that act as ski poles & there you have it - a nifty little contraption you can use to slide on the ice with.

And, if you really feel up to it, how about an invigorating dip in the icy cold waters in minus 2 degrees weather? This Polar Bear Club member did it. I don't know which was a bigger turn off: the frigid cold, or the filthy polluted water. To each his own...