CC Szeto

Haunted

2012-02-12T06:30:00.000+08:00

(Morning round in the intensive care unit.)

“Madam, you look very much better now,” the consultant says to a young female patient, “We shall send you back to the general ward later this afternoon.”

“That would be great, doctor,” the woman replies, “Em… but, can I make a small request?”

“Yes…?” The consultant raise his eyebrow. From all he knows, this patient is not particularly demanding.

“Can you send me to an ordinary third-class bed? For god’s sake, I don’t want to be isolated or stay in a single-bed room.” The patient sounds serious.

“Well, we can arrange that. After all, you don’t really need isolation. But, why on earth?” The consultant is confused, “I remember you were actually staying in a single room before being transferred here, and I suppose you know the whereabouts of this hospital. You could only have a descend environment in a single room – staying with another seven or eight patients in a third class cubicle is no fun.”

The patient is speechless. Her eyes seem to say that there is a good and obvious reason.

But, however good that reason is, the consultant certain has no idea. Standing by his side, a junior doctor suddenly steps forward and pull aside the consultant.

“Sir, you know, the isolation room that this patient used to stay is haunted.” The trainee whispered.

“What!?” The consultant could not believe his ears.

(To be continued.)

選美

2012-02-11T06:30:00.000+08:00

Met FK and a few other colleagues of mine during lunch.

“You know, I’m about to attend the beauty contest,” the respiratory physician said while she was gobbling up some suspicious semisolid mysteriously labeled by the canteen as lunch.

“Well?” I knew my friend was about to say something.

“Oh, I mean the interview for new medical officers.” She said with a sigh.

“Of course, of course,” I knew how difficult the task was, “Since there is an obvious road to success, do we have enough applicants?” (If you have no idea which road I am talking about, go read http://ccszeto.blogspot.com/2010/05/road.html)

“Actually, quite many.” FK went on to explain, “The problem is most of them also apply for every other post in the city, and a good candidate could easily get five or six offers. Our task is, in reality, to make sure our target ones would pick us!”

“Alas, in other words, you are attending the beauty contest – not as a judge, but the one on the stage, waiting for being chosen!” I could not help smiling.

My friend was not amused.

小甜甜

2012-02-10T06:30:00.000+08:00

While talking about Daddy Long-Legs, I cannot help to think of Candy Candy (小甜甜) – the classic Japanese comics written by Yumiko Igarashi (五十嵐優美子).

My déjà vu feeling is easily explained, for the two stories are eighty percent similar. (Despite the advances in artificial intelligence, too bad there’s no simple computer software that could test the plagiarism of idea.)

Of course, to be fair to the Japanese author, the plot of Candy Candy is more elaborated and, at least in 1970s when the story was first published, at the forefront of the society. Although Mr. Audrey was almost certainly an adopted version of Mr. Smith, Anthony and Terry are superb additions.

PS. For obvious reasons, I watched its TV series but never the original comics, and my memory of Candy is rather fragmented - perhaps except her argument with one of her aggressive classmates on what makes a good nurse.

Go read http://ccszeto.blogspot.com/2008/03/good.html.

Letter

2012-02-09T06:30:00.000+08:00

For those who are familiar with (sensational) English literature, you may realize Love Letter is not the first story told in a series of letters.

On this aspect, The Sorrows of Young Werther (少年維特的煩惱) of Johann von Goethe was probably the most famous. But, the first one, as far as I know, was Julie, or the New Heloise of Jean Rousseau, published in 1761. (The romantic story of Werther was first published some 12 years later - I have no idea whether von Goethe could read French, or if there was a German translation of Julie.)

The first one that I read, however, was Daddy Long-Legs of Jean Webster.

PS. I must say I agree with that so-called Mr. John Smith in Webster's novel. In return for his paying of the tuition fee, he asked Jerusha Abbott to write him a letter each month because he strongly believed that letter writing is an important training of a competent person.

Looking at many of the referral letters and consultation notes, we may have to do the same for our medical students.

情書

2012-02-08T06:30:00.000+08:00

I must say I was first attracted by Oufuku Shokan because of nothing but its very layout: The stories were told in by a series of letters.

It reminds me of Miho Nakayama (中山美穗) and her Love Letter (情書).

I shall not elaborate further. For the audience who had watched this film, sufficient was said; for the others, you missed one of the best romantic movies.

By the way, the actual love letter that Itsuki Fujii (藤井樹) received from her secret admirer was hidden in the library card of À la recherche du temps perdu (追憶逝水年華) of Marcel Proust - a real romantic story that I never had a chance to read.

PS. Of course it is slightly outdated to talk about letters. Just ask yourself: When was the last time you picked up a pen and wrote a personal letter? (No, not the ones you write to the Council for the application of a certificate, or to the Faculty for a revision of your examination score.) In fact, email is now considered by some youngsters to be outdated - at least if you write in complete sentence with no spelling mistake or grammatical error.

Shokan

2012-02-07T06:30:00.000+08:00

My recent bedtime reading is Oufuku Shokan (往復書簡) of Kanae Minato (湊佳苗).

Yes, the author of Confession (告白).

Seriously, this tiny paperback is the only detective fiction that I feel an impulse to buy in the past ten years. (But I didn’t; I borrowed it from AL, who happened to have ordered it on-line from Taiwan some weeks ago.)

I am not saying this book is great – quite the opposite actually. It is not a story, but a collection of three short ones – and the first and last are slightly dull and disappointing.

However, the second one, with the subtitle Homework After Twenty Years, is stunning. When Atsushi Ohba (大場敦史) – the school teacher – wrote the letters and described his interviews with that six students, I expected the story was going to unfold like Hercule Poirot talking to one passenger after another on the orient express, or the evidence would appear like Rashomon (羅生門) of Akira Kurosawa (黑澤明).

But, no. Minato did give me a surprise (albeit a slight one) – in an entirely logical way.

PS. I am particularly impressed by the second story for another reason: If you remember Cao Cao (曹操) wrote that famous Essay on My Original Objective (自明本志令), I find the letter of Ikuta Yoshitaka (生田良隆) – yes, the boy who was drowned and nearly dead fifteen years ago – a very suitable one for me.

M-shaped

2012-02-06T06:30:00.000+08:00

An inevitable consequence of achieving a fully developed economic system, again as predicted by Adam Smith, is the progression to an M-shaped society.

The idea is simple: When a society has fully developed and the economy is not expanding rapidly, there's very little competition of labour and employment - because there won't be many new factories or jobs. As a result, salary of the middle and lower class comes down, and wealth of the society concentrates in the few from the upper class.

(The situation becomes more obvious with the advance in technology and reduction in the need of labour job - a problem that I briefly discussed some time ago.)

How's that related to medical or scientific research?

You may say the rich should shoulder more responsibility in supporting research. Alas, that's why every university is so eager for philanthropic donation. The situation was fully discussed in three Nature articles, by Jim Giles, Heidi Ledford, and Patrick Aebischer respectively, on 19 January 2012.

And my opinion? I have a déjà vu feeling of seeing the First Emperor of Qin (秦始皇) craving for the immortal medicine!

Stagnant

2012-02-05T06:30:00.000+08:00

You may argue there may still be ground-breaking advances from new research and, even when we confine our discussion to medical science, new problems continue to come up and there are always fertile fields to explore.

(The favorite examples quoted by many are the epidemic – of medical literature, I mean – about heart attack in the past two hundred years, and about AIDS in the recent two decades. In the latter case it actually saved an entire subspecialty – well, yes, saved by half; another half by influenza – oh, I should shut up.)

I could not agree more.

Nonetheless, how much resource, once again, in terms of money and manpower, could the human society afford to advance our knowledge? If the global GDP becomes stagnant, the amount of money available for research would follow, and the actual advance in our knowledge – I’m not talking about the number of scientific publications – would continue at best in a slow steady speed. (In reality it will become slower and slower, because with the increasing number of areas of interest and a fixed amount of resource, the material advance in each of the area will be less.)

And it is not a fancy idea – the scenario that we are seeing in every developed country is not a transient hiccup of a continual and exponentially growing global economy. As long been predicted by Adam Smith, in a fully developed economic system, both the interest rate and the growth of GDP will become very low.

Go read The Wealth of Nations.

PS. In his Facebook, my friend JW recently put up a summary about the increase in GDP of Hong Kong and other countries. I am less depressed but more pessimistic (if you know what I mean) and consider that just another example of the problem faced by all developed and declining societies - we see the same thing in America and Europe.

Afford

2012-02-04T06:30:00.000+08:00

In my discussion yesterday, I deliberately omit the macroscopic problem on the amount of medical knowledge that a human society could afford to acquire.

The consideration is simple: Imagine there's no countries (oh, John Lennon!) and we count the GDP of the whole world. It is entirely cost-effective to spend money and develop a compound called 2-(acetyloxy)-benzoate, which could reduce the risk of heart attack and stroke by about one-third in selected patients. (Yes, we now call this very chemical aspirin.)

But, how about a new one that reduces the relative risk of a nondescript composite end point by 10% (and the absolute risk by 1%), and, for its development, being hundreds of thousands of times more expensive than your good old aspirin? How does it compare to spending the money (and human resource) on education or elderly care?

After all, you can't reduce the risk indefinitely. By the law of nature the risk could not be reduced to zero, and zero is the sun - where Icarus of science are trying to get by wings of feathers and wax.

Limits

2012-02-03T06:30:00.000+08:00

When I said there is a limit for us to expand our medical knowledge, I was actually considering two distinct problems – and each has two subtly different aspects.

The first one is the amount of medical knowledge per se, for which you can consider either the actual volume of information that is possible (a taboo question that should not be asked by a religious scientist) or the amount of material that could be handled by the brain of Homo sapiens (a philosophical question which, when analyzed by the method of Ludwig Wittgenstein, could never be answered).

I shall therefore leave these considerations aside.

The second problem is the amount of medical knowledge that a human society could afford to acquire – both in terms of human and financial resources.

Once again, there are two layers of this problem. In a microscopic scale, you have to consider whether manpower and money should be better spent on a few potentially fruitful areas of research – leaving out other interesting but probably less practical topics.

This is why many granting bodies now heavily rely on track record, favour the approach of Area of Excellence, and prefer giving a few big grants to elaborated groups of collaborators than tiny bits of money to a whole range of researchers with no overall theme. To a certain extend, this is a winner-takes-all approach and, in the long run, makes the environment hostile to new comers.

Interested visitors may like to go on and read More time for research: Fund people not projects by John Ioannidis, in the 29 September 2011 issue of Nature.

Expand

2012-02-02T06:30:00.000+08:00

On a casual glance, it seems obvious that nothing could expand forever, and putting money on a company that had already enjoyed excellent growth in the past five or ten years is nothing more or less than absurd.

(One easy example at hand is, if Facebook expands by 50% each year, everyone on earth would be a citizen of King Zuckerberg five years later – and, what next?)

But, as pointed out by Arthur Schopenhauer, all truth passes through three stages: first, it is ridiculed; second, it is violently opposed; third, it is accepted as being self-evident. Many of us are still taken in by the rosy future of growth stocks – or, even worse, mutual funds – by their past performance. The dream only comes to an end when the bubble bursts.

(Another simple example: If the profit and asset of Apple continues to grow by 40% each year, it will conquer all wealth on earth before 2046. And, once again, what next? Explore new markets on Mars?)

Everything sounds very simple, eh?

What about our medical knowledge?

PS. If your response is This time the scenario is different, there is no need to discuss the problem any further – everyone I know who buy pseudo-growth stocks gives the same answer.

Double

2012-02-01T06:30:00.000+08:00

As a school child, a remarkable story that I learnt from A Hundred Thousands of Why was this:

*********************

A warlock invented a kind of chess game for the king. The latter decided to give any reward that the former asked.

The warlock said, "My request is very simple. There are 64 squares on the chess board. Please put one grain of rice in the first square, then two grains in the second, and, to fill up each square, please put twice as many rice as the previous square. I shall be satisfied if you could fill up all the 64 squares with rice."

Surprisingly, the king could not reward the warlock. Why?

*********************

Of course we now know why. As Albert Einstein said: The most powerful force in the universe is compound interest.

But, many people only come to realize this very principle after putting all their savings on some growth stocks.

PS. For the calculation of the number of rice grain, there is a short cut and you don't really need an electronic calculator. The idea is simple: 2^10 equals 1024. In other words, for 10 squares, the number rises by around 1000-fold; for 20 squares, one-million-fold; and so forth.

Why

2012-01-31T06:30:00.000+08:00

While thinking of interesting books to boost up the general knowledge of our school children, a series that I read as a primary school student flashes through my mind.

It is A Hundred Thousands of Why (十萬個為什麼).

The origin of this book is in itself remarkable. The first book of the same title was actually written in Russian (Сто тысяч почему) by a Soviet author M. Ilyin (Ильин) in 1929; the idea of this title apparently rooted from Rudyard Kipling's poem Six Honest Serving Men.

Ilyin himself had very little ambition. All he wished to do was to put up a little book for Russian children to raise their interest in art and science by asking simple questions on common daily observations. When the book arrived the communism China, its exceptional potential was foreseen. The Children's Publishing House (少年兒童出版社) expand the tiny volume of Ilyin, which only had no more than 100 entries, to a series of 8 volumes and 1484 entries. It was first published in 1962.

And the rest is history. The entire series was huge success - there are nowadays versions for kids and even toddlers, not to say another several dozens of clumsy mimics.

PS. The series that I used was the second edition, published in 1965, with 15 volumes and around 3000 entries.

PPS. An excellent lesson I learnt from this very series was to be critical and paranoid with your source of information. There were no short of slogans and advertisement of communism throughout the volumes, and a considerable amount of information described was obviously wrong - as long as you open your eyes (and your mind) to look around, and exercise a tiny bit of common sense.

Textbooks

2012-01-30T06:30:00.000+08:00

There is, of course, no serious need to put up an elaborated curriculum on general knowledge for our school children. In fact, rather than wasting effort of making our own textbooks, there are no short of excellent books that we often use for leisure reading but are very suitable for our children.

For example:

novels of Jin Yong (金庸), for Chinese literature and a bit of history
Romance of the Three Kingdoms, for Chinese literature and a bit of history
novels of Harry Potter, for English literature
The Complete Sherlock Holmes, for English literature
A Brief History of Time, for natural science
A Short History of Nearly Everything, for natural and biological science
How to Win Friends and Influence People, for psychologyand inter-personal relationship
Sophie's World, for philosophy
Freakonomics, for economics
The World Is Flat, for globalization
Collapse, for history and environment protection

And, as to the teaching of arithmetic, investment, and possibly inter-personal relationship, I believe it would more fruitful by playing Monopoly - or, simply, mahjong!

General

2012-01-29T06:30:00.000+08:00

I shall not discuss the possible (but not definite) decline in the general knowledge of our younger generation, or the curious decision of our government to take away important subjects - history, economy, geography, general science, and so forth - in our secondary schools, and make up a new one with a suspicious title general knowledge (通識).

Or, rather, the official translation got to be Liberal Study.

Once again, when I came to realize what areas are included in this subject, I was so impressed that I lost my nerve. In short, there are six aspects - or what they call modules:

Personal Development and Interpersonal Relationships
Hong Kong Today
Modern China
Globalization
Public Health
Energy Technology and the Environment

Just for comparison, the top five recommended topics to be covered by the Ivy League are:

art
medicine and health science
natural science
economics and business
engineering

Alas, aren't they the ones we used to have in our secondary schools?

Questions

2012-01-28T06:30:00.000+08:00

On a recent occasion, Vivian showed me a copy of the examination questions used for the subject General Knowledge in the graduation examination of a primary school in 1953. I believe the questions, which I translated to English here would be interesting to visitors of this site.

(The original document in Chinese is apparently being displayed in a small local museum.)

Part 1: Answer two of the following four questions.

Compare and contrast Spata and Athens.
Describe the cause of the French Revolution.
(i) What are the areas of the monsoon zone? What is their climate and rainfall? (ii) What is the cause of desert?
Compare and contrast the agricultural practice of China and United States.

Part 2: Answer three of the following four questions.

Describe the structure and responsibility of the legislature, judiciary, and executive organization s of the Hong Kong government.
Why does the Hong Kong government set up the Secretariat for Chinese Affairs? What is its duty?
Why should a government tax its people? What could be done if a citizen does not agree with the amount to be taxed?
When was the United Nations established? What should it do to achieve its highest ideal One World?

Part 3: Answer two of the following three questions.

Explain the cause of tides by text and figures.
How many kinds of vitamin are there? What is the use of each of them? What are their contents in common kinds of food ?
What is the difference between an ordinary mosquito and the Anopheles mosquito? How is malaria being spread by mosquito?

PS. I must say my face turned slightly red when I recollect, rather recently, I asked the following question on so-called general knowledge to a new-generation doctor:

Have you heard of A Brief History of Time?

Intention

2012-01-27T06:30:00.001+08:00

While talking about my experience as a teacher of medical ethics, I must say I am often confused with its aim.

By and large, I agree with Steven Silbiger, as he described in The 10-Day MBA:

"The purpose of ethics in the MBA curriculum is not to make students model corporate citizens. Rather, the intention is to make students aware of the ethical implications of business decisions. Through casework and role playing, students confront ethical dilemmas similar to those they will face in the workplace. The top business schools train their future champions of industry to deal with any challenge."

Unfortunately, that's not the idea of many of the other teachers - nor that of the faculty board, the medical council, the bureau, the university grants committee, or most of the lay public.

As it was once said: If you think the whole world is crooked, you would just have a twisted neck.

Decision

2012-01-26T06:30:00.000+08:00

(The tutorial continued.)

I paused for a moment, and then began my story.

"Let's say you are the emergency call medical officer. A nurse in the ward tells you there is a middle age man just admitted for acute chest pain. Heart attack is possible, but, more likely than not, it's nothing really serious. At the same time, another ward calls you and says that they just admitted an old woman with severe chest infection. Well, she also has many other problems, say, some form of cancer, and, even without this infection, she is not expected to live for anything more than a few months. The dilemma is: Which patient should you see first?"

My students had their mouths wide open.

"Oh, we can do away with all details of medical science, as well as any discussion about the principles of triage and resource allocation," I became more serious, "I just wish to show you a general principle: The scenarios you guys presented always involve one patient, and there's almost always no dilemma in this situation - because there's something called patient autonomy, or, we can ask individual patients to be their own god and make the decision. The real problem actually comes when a decision involves two or more patients with conflicting interest - in which case you have to play god and make the decision."

PS. My argument was obviously simplistic. For example, for a single patient, there may be more than one party, and their interest may not agree with each other.

Dilemma

2012-01-25T06:30:00.000+08:00

Shortly after I had my family dinner, I was asked to lead a tutorial on medical ethics for our final year students.

This was not the first time I did it, and, honestly, most of the sessions were rather boring. The arrangement was simple. There were four students in my group, and, in the hour allocated, they were asked to present two cases of ethical dilemma that they recently encountered in their own patients, with an aim to stir up the discussion.

This time was no different. I must say the presentation in itself was reasonable, but the cases were hardly interesting. We probably finished in no more than 20 minutes, and then I made the conclusion, half yawning, "Your scenarios are actually very straightforward. There was hardly any dilemma in your first case. And, as to the second one, any difficulty was created by the doctor himself!"

Alas, I shouldn't be too harsh on my students. "How could they easily spot the ethical dilemma in the case that they encounter in the ward?" I said to myself.

"Professor, you may be right. But, can you outline a scenario that you consider a real ethical dilemma?" One of the student asked.

I was taken aback.

糯米

2012-01-24T06:30:00.000+08:00

正躊躇店家是否漏單之際，葷菜便上。先係葱爆牛肉，看來無甚特別。此碟實為席上兩位印傭而設，自己也未細嚐。

之後是豬肉兩味。先為蓮香一字骨，即肋條混和糯米，再裹以蓮葉蒸之。廚子手重，米夠味而肉軟糯，只是蓮香甚淡，未能儘善儘美。另一味是清燉獅子頭。肉物質輕鬆化，湯亦鮮甜，大抵店家無視健康，不吝肥肉，才有如此珍味。

再來是香酥八寶鴨。此物亦為手工菜，係以全鴨去骨，腔中釀入糯米，兼有冬菇、蝦米等作料，先蒸再炸。究其原理，與陸羽茶室的古法糯米雞相彷，然鴨架較大，去骨後仍甚足觀。且吃來外皮極酥脆，而鴨肉耐火，混和糯米及其他餡料，滋味複雜而有層次。較之廣府製作，似乎更勝一籌。

單尾醬炒年糕，無甚特別，較之杭州酒家，自不能同曰而語。

此時各人亦十二分飽。甜品奉上，驚見是煎八寶飯。至此方才想起已吃過一字骨和香酥鴨，一餐三味糯米，實為區區失策。然事已至此，唯有姑且下箸。相比老飯店等之薄身版，此店較小而厚，賣相是有所不及。然而，正因形貌厚實，可以煎得外焦脆而內綿軟，甜味似無還有，倒是出乎意料的精采。

總的來說，此店服務殷切，這餐也是漸入佳境，尤其糯米三味，俱為不可多得的珍饈。回程時細思之，這次上菜次序顛倒，大概是店家歲暮客忙，掌廚者一時不察。然而，先素而後葷，由淡入濃，以健康、嚐味而論，都是王道，也可說是歪打正着矣。

綠楊村

2012-01-23T06:30:00.000+08:00

歲暮，舉家於綠楊村飯店團年。一如既往，地點為內人所選，菜單則是區區所定。

前菜三味，計為宮廷富貴花，丁香雞，和煎素鵝。富貴花即漬蘿蔔切片，砌成花形上碟。外貌嫻雅，脆嫩而酸味適中，確為開胃良品。

丁香雞亦為店內名物。量其作法，應是雞隻浸熟放涼後切件，再配以丁香醬進食。肉嫩皮爽，口味近乎粵式沙姜雞，倒也無甚特別。

素鵝乃滬式煎法。此店有趣之處是腐皮餡內除草菇外，竟有些日式金菇。這個恐怕是將貨就價再加上掌㕑者不知素鵝原理的蛇足之舉矣。

湯品是文思豆腐。此乃江浙手工菜，以豆腐切成髮絲細條，和入火膧湯內。以外觀而論，無可置喙，然食味則與一般食肆高湯無異。一試無妨，倒也不是非吃不可。

出乎意料，再上是蔬菜兩碟，計為炒雜菇及腐衣津白。前者平平無奇，且琉璃獻略厚，非余所喜。後者倒清甜不膩，奶油濃淡，恰到好處，值得推薦。

席行至此，已略感納罕。這時樓面傳上的，竟是單尾蔥油薄餅。平心而論，此處蔥油下得夠多，餅亦煎得香脆。只是誠如蔡瀾所言，蔥多難熟，成餅便稍有草腥之氣，是嫌美中不足。

(待續。)

Streetlamp

2012-01-22T06:30:00.000+08:00

(The conversation continued.)

The daughter was silent for a moment. Her father decided to change a bit of the topic, “My dear, do you have any favorite star?”

“Em… yes, dad,” the girl hesitated for a moment, “I like the one over the other corner of the street.”

Her father laughed, “Don't be silly, sweetheart. That’s not a star – it’s a streetlamp!”

"Is it? To me, they are quite the same," the girl explained, "The lamppost was high up, and its light showed me the way when it is dark. Dad, there's a trap round that corner and people often got stuck when they pass there at night. But, when I see the lamppost, I feel warm and safe with the humble light. It is a gorgeous star to me all the same."

"Well, you may have a point. But, don't you think the star is more important? The Polaris leads the way of thousands of sailors for hundreds of years!" The father said.

"Dad, I am not a sailor, and I don't quite have a plan to travel far. All I want is to wander around the village every night, and, for that purpose, the streetlamp is the best guiding star - the Polaris is too high up and a little dim for me."

The father was speechless. All of a sudden he found his daughter had already grown up.

Have a nice lunar new year eve.

Star

2012-01-21T06:30:00.000+08:00

(Conversation between the little girl and her father again.)

“Look at that star, dad. It’s so bright.” The girl was pointing at the sky.

“Yes, my dear,” her daddy said in a soothing voice, “You know, tonight our village is celebrating the star festival.”

“Oh, that’s why the atmosphere is so enchanting,” the girl seemed cheered up, “Em… dad, why do we worship stars?”

“Because stars are high up, they are bright, and, above all, they show us the way when it is dark.” The father explained.

“You mean the Polaris? Oh, and there are the 12 Signs of Zodiac. Stars actually give clues to our fate, don’t they?” the daughter said, half-jokingly.

“You know, my dear, each of these tiny spots of light actually has its own remarkable story.” Her father sounded slightly more serious, “When we look up the starry sky, we should always be grateful for having so many great people who have set us examples and lead our way.”

(To be continued.)

Result

2012-01-20T06:30:00.000+08:00

While Friedrich von Hayek wisely deduced that communism would inevitably lead to dictatorship, the reverse is obviously not true.

For example, look at Philippines at the time of Ferdinand Marcos, or Taiwan under the reign of Chiang Kai-Shek (蔣介石) and his son.

The real question is, therefore, although we agree communism in itself would lead to poverty, and the process is aggravated with dictatorship, would dictatorship per se - without a communism system - always result in the collapse of economy?

I don't know. But, it does not seem to be the case - just consider what Rhee Syngman (李承晚) achieved south to the 38th parallel.

PS. As a scenario more close to North Korea nowadays, I should actually cite the Shu (蜀) Kingdom with Zhuge Liang (諸葛亮) as the prime minister - but that would probably hurt the feeling of many of my audience.

Dictator

2012-01-19T06:30:00.000+08:00

The first question that came through my mind when I read this book of Barbara Demick was: Which component of the system caused the tragedy?

Specifically, was it communism, or was it dictatorship?

My initial naïve idea was: It got to be communism.

The arugment is simple: When every farm and factory is owned by the country, who would have the interest to work hard?

But, in no time I realized I might be wrong. Communism will always end up with dictatorship. (If you find the causal relationship not immediately obvious, go read The Road to Serfdom of F.A. Hayek. Or, just consider this: The two only species that follow truly communisum are ant and bee; both of them need a superior queen as the head of their society.)

And, it seems needless to explain why dictatorship commonly results in tragedy: Although a democratic leader and a Nazi tyrant are equally like to make a wrong decision, only the latter would have a chance to make bad ones repeatedly.

Alas, but, what would happen if a communist country has such a good luck and find a brilliant dictator?

Well, in that case, I’m sure this very leader would bring an end to Karl Marx’s theory.

Don’t you remember Mikhail Gorbachev and Deng Xiao-Ping?

Envy

2012-01-18T06:30:00.000+08:00

While talking about different shades of gray, my recent bedtime reading is Nothing to Envy – Ordinary Lives in North Korea by Barbara Demick.

Yes, a place without black and white.

I must say this paperback is the best book I read in the past twelve months. But, ironically, it is also amazingly simple. The entire content could be summarized into one sentence: Everything George Orwell described in Nineteen Eighty-Four does happen in real life.

*******************
A usual excuse people use to explain the tragedy of North Korea in the past ten or fifteen years is the country locates in a much more deserted area than its brother in the south.

But, that argument hardly holds water. The rotten empire of capitalism harbors twice as many people as his communism brother. Yes, as compared to Pyongyang and its surrounding, there is more land suitable for agricultural use south to the 38th parallel – but not quite twice as much. The two countries share roughly the same sea area for fishing, and the land under the feet of Kim Yong-Un has arguably more mines and ores of heavy and precious metals.

It got to be a problem of the system.

Gray

2012-01-17T06:30:00.000+08:00

While I was thinking about the problem of black and white, a little story that I heard some time ago flashed through my mind.

Here you go:

***************************

The headmaster of a primary school in a small village put up a new rule: All teachers must dress in no more than two colors – socks and ties and mittens and everything included.

On the next morning, a young teacher was stopped by the headmaster as soon as the former appeared at the entrance of the school. Her blouse was white, her skirt was black, and she was wearing a red scarf.

“Hey there! Are you aware of our new dressing code?” The headmaster was obviously not happy.

“Yes, sir. What’s wrong?” The young woman sounded innocent.

“In that case, why do you dress in three colors?”

“Oh, no, sir. There are only two colors,” the teacher explained, “I have a red scarf; my blouse and my skirt are actually in one colour – they are just different shades of gray.”

I don’t think I have to explain in which country this incident happened.

B&W

2012-01-16T06:30:00.000+08:00

After a few weeks of practice, I am now quite accustomed to use my Kindle to read most of the journals.

(Rather than the slightly complicated method I described earlier, I find a Send to Kindle apps in the Google Chrome Web Store, and everything becomes very easy.)

But, I come to realize hardly anyone around use this gadget of Amazon - most of the people I observe in bus or underground use iPad or Samsung. When I show my pseudo-tablet to the others, the invariable first response is, "Oh, there's no touch screen!"

(Of course. I do not want to connect to the Internet. In fact I am only interested in reading text.)

Then, the next comment would be, "Alas, it has no color!"

Well, if we cannot tell black and white, why do we need so many colors?

Finning

2012-01-15T06:30:00.000+08:00

Another recent episode of this TV series was about shark finning.

The story is simple and should be familiar to many of us. In short, shark finning refers to the removal and retention of shark fins and the discarding of the rest of the fish; it takes place at sea so the fishers only have to transport the fins – and therefore more sharks could be killed.

I must say I am no fan of shark fin soup and am eager to preserve all resources on our planet. Nonetheless, I am always skeptical with those environment protection groups. (The analogy is one could deeply believe in the god but is paranoid with the church, or we can love our country but have a different feeling with the party.)

Just a few facts I gather from the Internet:

Around 100 millions of sharks are caught each year, one-third by the method of shark finning, while one-half are actually bycatch (that is, the unintentional capture of species by other fisheries).
Sharks are common seafood in many countries, notably Japan, Australia (as fish-and-chips), India (deep-fried as sora puttu), Iceland (fermented as hákarl), and many other European countries (as fish fillet).
A number of American States (for example, Hawaii, California, and Washington) ban the possession, sale and distribution of shark fins. Whole sharks could still be legally fished, but the fins could no longer be sold – and are therefore discarded.

No, I’m not saying we should allow shark finning – it is cruelty, as simple as that. From the point of view of environment protection, however, I am sure there are more important areas to focus our attention.

Island

2012-01-14T06:30:00.000+08:00

One of the favorite TV programs that Euterpe enjoyed every weekend is a documentary series about the South Pacific Ocean.

I must say Vivian also like it very much – and so do I, but for a slightly different reason.

************************

A recent episode was about unique species of birds and reptiles on those islands.

There were no fewer than a dozen of similar stories. Take moa on the New Zealand as the example. Before Homo sapiens came to the island, this gigantic bird was probably the largest animal on the island. Since food was everywhere and there was absolutely no predator (except a few Haast's Eagle), it soon evolved to suite the heaven: it became slow, timid, pleasant, and, the most important of all, it lost the ability to fly. (In fact, moa has no wings.)

The consequence was dramatic. When Māori arrived in the thirteenth century, moa was in no way comparable to the newcomers; it had no means to protect itself, and soon became extinct.

PS. A critical bit of detail was not touched in the program: The time that took for many of these wingless birds to evolve and became incompetent was very much quicker than you expect from the traditional Darwin’s type of evolution. (Many species of wingless bird on these south Pacific islands arrived no more than 30000 years ago – obviously when they could still fly.) The reason was obvious: It always takes a long time for a random evolution to come up with a desirable trait, but it is very easy (and in a lightening speed) to lose a valuable character – because the maintenance of which involves effort and flesh and blood and competition.

Twin

2012-01-13T06:30:00.000+08:00

You may argue the Tree of Justice in Eden and the other that Satan showed Adam were all but one plant.

On that, you are wrong.

“Aren’t justice and fairness the same virtue?” You may ask.

No, no, no. For fans of Jin Yong (金庸), justice is Qiu Qianren (裘千仞) in The Legend of Condor Heroes (射鵰英雄傳), while fairness is Qiu Qianzhang (裘千丈) – the younger twin brother who was good at nothing but pretending to be his more successful sibling.

“What’s the difference?”

Simple. Justice means all people have to obey to the same set of rules. Fairness, as it now turns out, has become the pursuit of everyone having the same treatment and benefit. The passing mark of all medical students in the final examination is identical; this is justice. All students should, irrespective to their performance, get the same grade – this is fairness. (Don’t laugh. It really happens. Many courses in the university give only pass-or-fail grading nowadays.)

To go one step further, fairness is not an advanced or modified form of justice. To make sure everyone gets an identical outcome or benefit – irrespective to their effort and performance – inevitably we have to twist the rule applied to individual person, or, in other words, we have to give up justice.

Fairness is, therefore, not only not a virtue – it is a sin.

It is the predecessor of sloth.

Fifth

2012-01-12T06:30:00.000+08:00

Some of you may remember the story I told some months ago about the four trees in the Eden. (See http://ccszeto.blogspot.com/2011/07/trees.html) The story that followed was equally interesting but, once again, not mentioned in the Genesis.

Here you go:

****************************

Contrary to the common belief and what’s described in the Genesis, Adam actually did not realize he didn’t quite swallow the apple of wisdom, and was convinced that he saw things differently after acquiring the fourth virtue.

And he left the Eden, content and full of confidence.

In no time Adam met the snake again. The poisonous reptile greeted him enthusiastically, “Hullo, my friend. Let me show you something great.”

The avatar of Satan led the first man to a new corner, where they saw an enormous tree. Long branches were stretching in all directions from the trunk, along those there were numerous fruits – red, juicy, and seductive.

The snake said, half smiling, “Look, this is the Tree of Fairness. Yes, the fifth virtue – and the most important one too. Come. Try its fruit. It’s good for your heart.”

I shall not elaborate what happened afterwards. Suffice to say, if the first apple dragged Adam out from Eden, this second one sent him to hell that and there and forever.

Discrimination

2012-01-11T06:30:00.000+08:00

You may think giving up the opportunity of appreciating our hard-working staff is an inevitable consequence from the pursuit of a fair society.

On that, I beg to disagree.

My argument is simple. If we follow the same logic of not discriminating against those who fall sick, we should also not award any scholarship to outstanding students. In fact, we should not fail a medical student in final examination because he knows nothing – we are discriminating the incapable people.

Great. I would suggest all supporters of this kind of equal opportunity – and their families – should be cared by doctors whose performance is outstanding in the other side of the spectrum.

PS. To consider the problem philosophically, the law of evolution states that we should appreciate excellence and beauty and all other admirable characters of human being. If we reverse this very principle of Darwin, oppress the good, but appreciate the evil, our species will be dying, you know?

Go read Thermodynamics. (See http://ccszeto.blogspot.com/2008/07/thermodynamics.html)

Recognition

2012-01-10T06:30:00.000+08:00

During another casual discussion, my friend CB asked, "Do you know why our nurses - and doctors actually - no longer get the perfect attendance award (勤工獎) nowadays?"

For those who are not familiar with our system, the award used to be given regularly to a staff who takes no sick leave during a defined period of time (usually one year). This award used to be very common amongst private companies.

"No idea," I said.

"Is that because the Hospital Authority tries to prevent staff with acute febrile illnesses coming back to work?" KM suggested.

"No, not that brilliant a reason," our consultant smiled, "Just that we are forbidden by the Equal Opportunities Commission to give such an award, because it is considered as a discrimination against those who fell sick."

"How ingenious," KM sounded grim, "But for that we lost a nice way to give some recognition to our hardworking colleagues."

"I believe we should follow the advice of that extraterrestrial commission and not to discriminate," I pursed my lips, "We should give two kinds of award: one for those who do not take any sick leave, and the other for the, say, top three, who take the highest number of sick leaves. Well, we should thank the latter for trying to come back and work occasionally. After all, they need to be recognized!"

Incapable

2012-01-09T06:30:00.000+08:00

(During a lunch time casual chat.)

"Do you know where is T up to?" One of us asked.

T is a medical graduate from the other side of the harbour. He just finished with his surgical training and is the son of a supposedly very important person.

"Oh, he was recently promoted to be the associate consultant." The answer came from the other side of the table.

"Alas, which hospital - or which team does he join?" I asked.

"Professor L's team, of course."

"I think Professor L doesn't like him very much - and for good reasons?" I was incredulous.

"Yes, but the professor conceded. In fact, L comes to the conclusion that it is not necessary for everyone in his team to be able to do surgery!"

"Well, there's some truth in it," I was forced to agree, "In fact, if a medical student tells me in the final examination that his ignorance is absolutely acceptable because not every doctor needs to treat patient, I shall be quite willing to pass him!"

Nihilism

2012-01-08T06:30:00.000+08:00

You may think my recent discussion is nothing but grumble from a (not very successful) investor.

But no. The same problem appears in many other aspects of our life.

Say, for example, we often consider randomized control trial as the gold standard of assessing the benefit of a drug (or other forms of treatment). Yes, we can prove a drug being useful or not. But, we can never prove that the placebo group (that is, doing nothing, or sticking to the available treatment at hand) represents the optimal therapy - there is always something possible to make things even better. Just that we don't know what.

Isn't that the principal reason people do medical research?

For that reason, it really needs wisdom for a researcher to conclude major advance is unlikely in a particular field of study and effort could be better spent in another area.

I don't think I should say any more.

PS. In fact, it is difficult enough for a patient to feel content with the natural course of illness or the limited options of available treatment - or, in other words, be satisfied while knowing that he is in the placebo group.

Nothing

2012-01-07T06:30:00.000+08:00

You may realize the method I described yesterday was roughly what I did for assessing my own performance of investigation: first, compare to a benchmark index; next, compare to doing nothing.

But, if you come to think of it, my suggestion is only good for reviewing the performance (or, in the jargon of extra-terrestrials, for auditing). It could never be used for prospective decision on what to do.

In other words, with this approach, you can occasionally prove what you did was entirely useless or had even led to a worse investment return, but there is no situation where you could justify doing nothing - because, with hindsight, there are always better ways of investing.

Bearing that in mind, you may come to realize it needs both exceptional wisdom and extraordinary self confidence to accept the portfolio at hand is satisfactory and decide one should sit and do nothing.

Compare

2012-01-06T06:30:00.000+08:00

I must say I have a different opinion on the madman analogy of the stock market. Nonetheless, on a second thought, my recent review of my investment portfolio actually has a more profound implication.

Let me explain in a slightly convoluted manner.

First, how do we access how well we manage our portfolio - or, actually, the performance of a fund manager? The conventional method is to compare it with a benchmark. For example, for a mutual trust fund that focus on the local stock market, we can compare its performance to the Hang Seng Index. (The alternative method is to determine the investment return and rank it amongst all other similar funds. This is usually what's reported for our MPF, and a similar method is used for the examination result of our medical students.)

But, that doesn't really solve the problem - or prove that your fund manager worth his salt.

For example, would the fund perform even better if the manager did nothing in the past one year?

Mad

2012-01-05T06:30:00.000+08:00

While I was reviewing my investment portfolio, my friend JW recommends in his Facebook a nice book on financial analysis by a local author.

It was 《一名經人》 by Law Ka Chung (羅家聰)

In no time, a friend of us made the following comment: Don't you think trying to analyse the stock market is like trying to guess whether a mad man wandering in a psyche hospital will take a left turn or right turn with his next move?

For this, a little talk of Hercule Poirot (in The ABC Murders) flashed through my mind:

It is no answer to say that the man was mentally unhinged... A madman is as logical and reasoned in his actions as a sane man - given his peculiar biased point of view. For example, if a man insist on going out and squatting about in nothing but a loin cloth his conduct seems eccentric in the extreme. But once you know that the man himself is firmly convinced that he is Mahatma Gandhi, then his conduct becomes perfectly reasonable and logical.

Napoleon

2012-01-04T06:30:00.000+08:00

It doesn’t need a expert of detective fiction to tell the Professor Moriarty under Guy Ritchie is a laughable idiot.

First, a real Napoleon is always an expert in psychology and, if he prefers to do away with the Duke of Wellington, he could certainly identify a suitable person and infuse that idea into that whoever’s brain. (This idea is long in the tooth, from Agatha Christie’s Curtain to Anthony Hopkins in The Silence of Lambs.) To be a master of crime, one does not have to – and, in fact, should not – soil his own hands.

But, there is a more fatal flaw: Would any sane person believe he could make big money by becoming a firearm supplier and then induces wars? Seriously, it may not only not making big money, it may not make any money at all – the government may nationalize your business.

Then, what’s the best way of making big money?

Go ask Lü Buwei (呂不韋).

Moriarty

2012-01-03T06:30:00.000+08:00

To me, the biggest disappointment came from Professor Moriarty.

No, it has nothing to do with Jared Harris, who did strike a fine balance between presenting as the original professor of mathematics under Conan Dolye and playing the role of an ambitious Napoleon of crime under Guy Ritchie.

But, it was all wrong. The personal history was not correct. (See the original description in The Final Problem: He is a man of good birth and excellent education, endowed by nature with a phenomenal mathematical faculty. At the age of twenty-one he wrote a treatise upon the binomial theorem which has had a European vogue. On the strength of it, he won the mathematical chair at one of our smaller universities, and had, to all appearances, a most brilliant career before him. But the man had hereditary tendencies of the most diabolical kind. A criminal strain ran in his blood, which, instead of being modified, was increased and rendered infinitely more dangerous by his extraordinary mental powers. Dark rumours gathered round him in the University town, and eventually he was compelled to resign his chair and come down to London.)

And, even worse, the personality of this friend of the Prime Minister in the movie does not only differ from the original resigned professor, his plots are so ingenuous that he could hardly be a real harm to the world - Robert Downey just over-reacted.

PS. In contrast, Jude Law made such beautiful deductions and decisions in the Switzerland Summit that he could not have been the real Dr. Watson.

Guy Ritchie should put Mycroft Holmes to find out whom Rene was disguising.

Holmes

2012-01-02T06:30:00.000+08:00

Watched Sherlock Holmes: A Game of Shadows.

An excellent piece for entertainment I must say. Nonetheless, there remains a slight dissatisfaction to a fan of the great detective - and a real disappointment to a loyal reader of Arthur Conan Doyle. In the first movie two years ago, personality and personal history of all original characters - Irene Adler, Dr. Watson, Mary Morstan - were preserved; we saw one of their untold tales. Now, the Game has changed; we see Professor Moriarty, Mycroft Holmes, and Colonel Moran, but they are not the same persons whom we know from Sir Arthur.

For example, Mycroft is no longer an inconspicuous civil servant hidden in the London city; he becomes an important figure of the English government and needs to attend the Peace Summit in Switzerland. (I am sure the real Mycroft would never agree to leave England - even if ordered by the Queen.) In fact, the scene that a naked Stephen Fry, playing Mycroft Holmes, was looking for his breakfast, reading letters, and talking to Kelly Reilly, did not remind me of the great detective's elder brother; that copious volume of fat moving around in his house looked more like Winston Churchill.

PS. Vivian and Euterpe watched the film with me. My daughter was obviously bored. To her, the only story of Sherlock Holmes that I ever told is this one:

Sherlock Holmes and Dr Watson went on a camping trip. After a good meal and a bottle of red, they lay down for the night and went to sleep.

Some hours later Holmes woke up, nudged his faithful friend and said, "Watson, I want you to look up at the sky and tell me what you see." Watson said, "I see millions and millions of stars." Sherlock said, "And what does that tell you?"

After a minute or so of pondering Watson said, "Astronomically, it tells me that there are millions of galaxies and potentially billions of planets. Astrologically, I observe that Saturn is in Leo. Horologically, I deduce that the time is approximately a quarter past three in the morning. Theologically, I can see that God is all powerful and that we are small and insignificant. Metereologically, I suspect that we will have a beautiful day today. What does it tell you?"

Holmes was silent for about 30 seconds and said, "Watson, you idiot! Someone has stolen our tent!"

Now

2012-01-01T06:30:00.000+08:00

What happen after one year?

The Hang Seng Index closed in 2011 at 18434, dropped by 20% (19.97% to be exact) over 12 months.

And, if I did not do anything with my portfolio, it would drop by 16.6% - dividend included.

But, certainly, I sold some of the issues, at least to cut down the number of stock I hold. By now, it becomes something like this:

The whole thing fell by 11.1% this year, and I'm still having around 20% as free cash.

Review

2011-12-31T06:30:00.000+08:00

It comes to the end of 2011 - a good time to review my portfolio.

Here is mine on 31 December 2010:

Yes, it was very much diworsified. (Quite against my personality I must say.) On that day, the Heng Sang Index closed at 23035. I had around 21% of my portfolio as cash.

What happened to it after one year? Let me tell you tomorrow.

Rebuttal

2011-12-30T06:30:00.000+08:00

In a peaceful afternoon, my friend WY came to my office, rather unexpectedly.

She was obviously not very happy.

“Em… Szeto, does the specialty that you are talking about begin with X?” She asked.

In no time I realized she was referring to my recent blog on specialty board examination. (See http://ccszeto.blogspot.com/2011/12/question.html)

“Oh, yes. What’s wrong?” I felt like a primary school student being caught red-handed by his class mistress after doing something naughty.

“Nothing. Just that the questions you mentioned is not the truth – or, at least, not the whole truth.” The consultant said.

“You mean…?”

“Well, we did ask for specific guidelines and FDA recommendations, but, the discussion began with clincical scenarios related to the routine management of common problems, and what information the candidate would provide to his or her patients in real life.” My friend gave her version of the story – which was the examiner’s account, “But, since some candidates seemed having very little idea how some common drugs are used as well as their important contraindications, we had no choice but needed to probe at specific angles – so as to make sure the candidate really did not know what’s going on.”

I nodded. As always, the same event is described in entirely different manner by two different persons. This little incidence of Rashomon also serves as an excellent illustration of a general principle: Students (or candidates in professional examinations) never fail because they do not know the answer of difficult questions; they fail because they trigger the examiners to ask those questions. As a rule, a student has already failed when his examiner decides to ask some difficult stuff.

PS. The opposite is also true: A distinction candidate is not someone who could answer difficult questions, but the one who could answer simple questions in a confident and seamless manner.

Gen'ya

2011-12-29T06:30:00.000+08:00

My recent bedtime reading is Gen'ya (幻夜) of Keigo Higashino (東野圭吾).

This novel is widely regarded as the sister work of Byakuyakō (白夜行), another story written by Keigo. But, it appears to me not the case. Byakuyakō is, in its heart, a story of romance; Ryoji Kirihara (桐原亮司) and Yukiho Karasawa (唐沢雪穂) were, in the jargon of Agatha Christie, partners in crime, and, although they never met formally in the novel, were in a genuine and legitimate relationship.

In contrast, Masaya Suwon (水原雅也) was a tool of Mifuyu Shinkai (新海美冬) all along. Did Shinkai ever think of having a permanent relationship with Suwon? Obviously not. The plot is not a a variant of Byakuyakō, but really resembles Human Metamorphosis (Ningen Konchuki, 人間昆蟲記) of Osamu Tezuka (手塚治虫), and Shinkai is no doubt a modified (and malicious) version of Toshiko Tomura (十村十枝子).

PS. In fact, before the final combat between Suwon and Inspector Kato (加藤亘), the unfortunate engineer should have rung up Shinkai and asked, "Why do you hide everything from me? Aren't we a duet of crime - just like Byakuyakō ?"

"You read too much Keigo Higashino." A voice with no emotion appeared from the other side.

Antidote

2011-12-28T06:30:00.001+08:00

Another rumor about MSG is that one could treat (or prevent) the Chinese restaurant syndrome by drinking Coca-Cola.

On the face of it, that's entirely reasonable. Coke contains caffeine, which would effectively combat the headache induced by MSG; the sheer amount of water obviously relieves the thirst sensation. In fact, a cup of light coffee should do the same.

But, you know what, if you search MSG and Coca-Cola together in Google, the most widely advocated effect is, the combination becomes an aphrodisiac.

Of course that's not true. Neither MSG nor Coke has that effect, and the two certainly do not have a chemical reaction when mixed together. (Otherwise Pfizer could not have make so much money from Viagra.) But, the plot is ingenious - once again, what could make a better advertisement and induce people having that sweet brown beverage when they go to a Chinese restaurant?

Maybe that's the rare occasion when an antidote is the same as an aphrodisiac.

Thirst

2011-12-27T06:30:00.000+08:00

You may wonder there might have been a lot of MSG in my food - just that I did not notice.

Well, I consider that quite impossible, because I am actually very sensitive to MSG.

No, I do not have flushing or headache or whatever with it - except an intolerable sense of thirst. In fact, as a traditional Chinese, I am quite accustomed to, and do enjoy, salty food. (Not a nice declaration by a nephrologist, I know.) I could finish with a good serve of salted fish (鹹魚) or pickled tofu (腐乳) without drinking any water.

But, when it comes to MSG, the need of something to drink is irresistible. In fact, I used to tell a distinguished English professor of nephrology that we have glutamate receptors in the thirst center of our brain, and it explains everything.

That's a hoax, of course.

PS. Human brain does have glutamate receptors, but they are found in the learning and memory centers.

MSG

2011-12-26T06:30:00.001+08:00

One slight surprise for the several meals that I had during my little trip to the other universe was there was very little MSG in the food.

Yes, I do mean monosodium glutamate, which add to the taste of umami (鮮味) in our food.

Oh, I'm not against the use of MSG - quite the contrary indeed. As Chinese, most of us would expect some scientific additives in the food serve in any restaurant. If it does enhance the flavor, why should we worry about an amino acid?

Many gourmets and food critics are, however, against artificial substance, not because it may be unsafe, but for the very phenomenon that MSG would mask the flavor of other natural ingredients in the dish. Well, scientifically, that's entirely sound. To begin with, it is now known that, in addition to the four primary tastes (salty, sour, sweet, and bitter) and umami, there are other non-traditional tastes - notably for purines and long chain fatty acids. An excessive stimulation of the glutamate receptor would obviously make one be less aware of signals from other pathways. Orthodox neurology teaching actually states that a substantial part of taste does not come from the tongue, but, rather, the nose. It is therefore silly to stimulate just one kind of taste bud and forget about the more important part.

PS. When you swallow, a negative pressure is generated in the nasopharynx, so that volatile ingredients of the food could fill up those tiny air chambers and stimulate the olfactory nerve. That's why we could tell so many kinds of taste despite there are only limited types of taste receptors on our tongue - we have about 400 types of smell receptors.

Sprout

2011-12-25T06:30:00.000+08:00

While choy sum is probably the most common kind of vegetable I have in Hong Kong, my personal favorite is Brussels sprout.

I first encountered this tiny variant of cabbage when I was doing my overseas training in Bristol. It appeared two or three times each week as the side dish in the hospital canteen, and, I must say, the taste was horrible. British people have absolutely no idea how to cook the veg and these little green spheres are always put into boiling water - which invariably results in overcooking.

(Specific for Brussels sprout, overcooking does not only mean making the veg gray and way too soft; it releases glucosinolate sinigrin, a special chemical you find in this tiny green balls, resulting in a repelling sulphurous smell.)

Fortunate for my taste bud, I was not put off by the clumsy chef of the hospital canteen. Soon after I settled, I find this lovely spheres in a local supermarket, selling in discount. I bought some, tried stir-frying them that evening with a bit of soya sauce - and, hooray! There's no pungent smell, and, yes, the center was slightly bitter. But if you like the taste of bitter melon (苦瓜), the little green balls are certainly more chewy, and, because their taste is less sharp, you do not need to mop up the bitterness (and therefore the freshness of veg) by douchi (豆豉) or other strong seasoning.

PS. Oyster sauce was even better than soya sauce for enhancing the flavor, as I subsequently found out.

菜心

2011-12-24T06:30:00.000+08:00

A few days after I cast my vote, I went to the other universe to teach a course for some postgraduate students.

I shall not elaborate on what happened, or my view on our alternative universe. But the dinner was remarkable. In the evening after the first day of the course, the host brought the three overseas speakers - me included - to a local restaurant somewhere 10-minute walk away from their hospital campus.

The place looked like an ordinary Cantonese restaurant you find in any public housing estate of Hong Kong. The menu was also a humble one - no shark fin or abalone. Oh, there was a good dish of pan-fried foie gras, but it seemed the residual material from a place famous for roast goose.

The climax came towards the end, when the green was served. (For those not familiar with the custom of a Canton banquet, a dish of green is usually served towards the end of the menu, generally before some carbohydrate - rice or noodles - and then the dessert.)

It was a large bowel of choy sum (菜心) in a clear broth.

I shall not describe how good it was - words fail me. Supposedly it was a delicate mixture of freshness, crispness, and sweetness - or the pleasure of stimulating the taste buds paradoxically by the absence of any stimuli.

"This is gorgeous. What's the secret in it?" One of the overseas speakers asked.

"Oh, nothing. It's just fresh from the garden of our consultant." The host said, blushing a little.

Study

2011-12-23T06:30:00.001+08:00

By coincidence, my friend VW also talked about our recent election in his blog yesterday. (See http://vwswong.blogspot.com/2011/12/election.html) He rightly pointed out that candidates were not hiding their choice from us, but from the future winner.

I read VW's blog on my way to the hospital. During that 20-minute bus trip, when I came to think of it, the problem is more complicated than I suspect.

To begin with, the risk of offending the future CE, if you happen to support the wrong side, was actually minimal - and, to balance out, there is always the potential benefit of supporting the correct one early. (It brings the problem to another level of discussion: What is the purpose of running for the Election Subcommittee? Is choosing the future CE an end, or is it for future personal benefit?)

Alas, let's better focus on science. Say, amongst that 80 candidates, if one comes out and declare which side he supports, would that give him an edge to win? I presume yes, if there are sufficient number of people who have make up their mind already. In that case, by the game theory, declaring support to the obviously favorable side (be it the pig or the wolf) would become the dominant strategy, and you would expect every candidate to come out and declare the same. By then, the few candidates who refuse to declare their intention would not survive; it doesn't really matter to whom we cast our vote, and there is actually very little glory to become elected.

This is true democracy.

PS. When the bus came out from the Tate's Cairn Tunnel, I came to the conclusion that it might be a good idea to test my hypothesis and run for the election next time with the dominant strategy.

But, alas, no, thank you. I am not that devoted to science.

30

2011-12-22T06:30:00.000+08:00

While I was impressed by H's strategy of advertising himself, in the following afternoon, I voted in the Chief Executive Selection Election Subcommittee election.

As an ordinary doctor with dyslexia, it was in fact a trying task to vote this time. There were some 80 candidates running and we have to pick 30 from the list. Although there are a few obvious name lists, candidates of those did not appear in consecutive numbers, and I am sure no medical practitioner could remember a list of 30 names or numbers - people with such an extraordinary memory and intelligence should have found a better job in the financial market.

Therefore, at the end of the day, I picked only seven or eight - there were overwhelmingly so many that I certainly did not want to be elected.

But, as soon as I walked out from the voting center, I regretted.

Mine was the worst strategy to achieve my own purpose. By the law of game theory, I should pick a full list of 30 - not for the purpose of fully executing my right, but to increase the chance of winning of those who I was not particularly against, so that they could have an edge over H and those who rose to the top but were not the cream.

I shall do better next time.

PS. On the contrary, picking 7 or 8 (when you could pick 30) is the appropriate strategy when there are a few candidates who you definitely want to win, and you do not really care who else on the list come out.

Advertise

2011-12-21T06:30:00.000+08:00

Met WC in the wedding banquet of MT.

I did not meet our previous consultant cardiologist for quite some months – and he certainly had not changed.

“You know, it is really eye-opening to see H running for the Chief Executive Election Subcommittee election.” He said. (H used to be an academic staff over the other side of the harbour, but resigned and joined the private market a few years ago. He is a specialist of treating celebrities and wealthy women – or, as it later turns out, so we used to think.)

“To be honest, I could not make head or tail of his move.” I remarked, “I suppose he is not so naïve to believe he has enough friends to vote for him?”

“Lack of insight is a necessary criteria of personality disorder,” WC murmured, “But that’s beyond the point. I’m sure he has achieved his primary aim.”

“Which is…?” I was curious.

“He has gained legal permission to put up posters and banners in almost everywhere in the city,” my friend went on to explain, “I could even find his picture and summary of qualifications in the lobby of some public housing estates! Although hardly anyone living in those places are eligible to vote for him, what could make a better advertisement?”

I finally saw what my friend was getting at. Just like many items in our stock market over the past one year, cheap things could always become even cheaper.

Lunch

2011-12-20T06:30:00.000+08:00

That very Saturday proved to be an exceptionally busy one. By noon, once I finished with my presentation in the advisory board meeting and answered a few questions, I had to rush back to the Chung Chi Chapel and joined my wife. It was the wedding ceremony of my little friend MT, who, for reasons that I never understood, asked Euterpe to be one of her flower girls.

Everything in the ceremony went as planned, and Euterpe was overjoyed to make acquaintance of some new friends. The only set back was my daughter and I had to leave before we could take some photo with the bride – It was the music class examination of Euterpe that afternoon.

And, by the time I found myself in a local fast-food store and had the chance of examining a bowel of suspicious semi-solid labelled with much imagination as wonton noodle, it was nearly sunset.

All of a sudden, the famous teaching of Zhu Bo Lu (朱柏廬):

一粥一飯，當思來之不易；半絲半縷，恆念物力維艱。

Temptation

2011-12-19T06:30:00.000+08:00

To be fair to my new friend, he finally took my advice and I could use my own slides – certainly with some new additions suggested by him. The meeting on Saturday went smoothly, and it served as an excellent example of Humphrey Appleby’s teaching:

As in all public performances, the real work is done in rehearsal, behind closed doors.

*************************

Nonetheless, a minor incident in the morning was worth mentioning.

It went like this: I arrived slightly early for the meeting, which took place in the function room of a local hotel. Naturally, I turned on my computer and did some work of my own. A few minutes before the meeting was formally started, a secretary approached me with a little card, "Sir, you need a password for the wireless Internet connection. Here it is."

"Oh, that's very kind of you." I smiled, stretching my arm to take that tiny piece of paper.

But, in no time, I stopped - before I actually reached the card. All of a sudden I saw light and withdrew my hand, "Thank you, I think I don't need this."

"Wouldn't you like to check your email and go on-line?" The secretary looked puzzled.

"Exactly, I would not like to. That's the only way I could do away with all temptation and focus on some serious work." For a moment I was serious.

Advice

2011-12-18T06:30:00.000+08:00

(My remarkable evening continued.)

Time flied. I regained consciousness one-and-a-half hour later.

“So, what do you think?” The verbose man finished – at last.

“I suppose I am supposed not to think?” I said to myself. But, instead, I put up a friendly smile and said, “I could not agree with point one of your conclusion…”

“Oh, how could that be?” My new acquaintance was obviously surprised, “Don’t you agree with the animal data that I showed – which are all very convincing?”

“Em… What you showed was your new drug is not toxic to the kidney. It really doesn’t prove that the drug protects the kidney.” I pointed out.

He paused for a moment before saying, “Doesn’t our human experiment also show the same result?” I refrained to comment any further, but, instead, gave him my favorite response of Dr. James Sheppard (in The Murder of Roger Ackroyd), “I must be off home. Thank you for a most interesting and instructive evening.”

“Oh, no. Not yet. Just a moment more,” my Hercule Poirot said, “We have to go through your slides as well.”

I began to wonder why Dr. Sheppard did not try to silence the great detective once and for all.

“Eh… I suppose I know them very well?” I hesitated to suggest.

“No, not now. I made some new slides for you.” He said.

I must say the remarkable director was right – I could not recognize my own slides when they were shown to me. He had not only added a few new slides (if 20 slides for a 30-minute talk are a few), he also changed the sequence of my old slides, choose a new slide layout, and used a different font for the text.

And, as you expect, he certainly showed me how he expected me to present – or what I should say in the presentation.

I believe my memory was very bad and he had probably told me when we greeted each other two hours ago that he came from Russia and he was a former KGB officer.

“Don’t put words into my mouth – not to say idea into my head,” I left by playing Mary Debenham of The Murder on the Orient Express.

My Hercule Poirot was stunned.

PS. I encountered this little incident before my friend VW described in his blog AL's story (see http://vwswong.blogspot.com/2011/12/invitation.html). It is really an honor to be compared to the Queen of Hepatitis.

Rehearsal

2011-12-17T06:30:00.000+08:00

(I must have a flight of idea and the story I recalled keep moving back and forth. Let’s go back to that lovely afternoon of our own board examination, which passed quickly and smoothly.)

In the same evening, I was scheduled to have a meeting with two representatives of a drug company in the café of a hotel nearby.

Oh, no. They’re not going to sell any drug to me. On the contrary, they were asking me to join the advisory board for the development of a new product of theirs. They actually made that request a few weeks ago, and we were supposed to have a formal meeting that Saturday – where I would give a brief talk and summarize my suggestions. I gave them the slides a week prior to the meeting, and, to my surprise, the contact person of their local office called me and told me that the director of product development of their headquarters wished to see me in person two days before the formal meeting.

“We just want to go through the slides.” I was told.

I arrived on time, and was met by the director – a verbose middle-age man from some southern state of America, and a nondescript assistant of his.

“Let me first show you the slides that the first speaker is going to use,” he said. (By the way, I was going to be the third speaker, and the second on the timetable was this sales director.)

It turned out that he did more than what he said – he gave the talk, from head to toe literally.

I tried my best not to snore – at least not loud enough to disturb people sitting at the next table.

When I woke up thirty minutes later, he had, apparently, just finished.

“Now, let me show you my slides,” he went on.

I decided I could have a longer nap, and was suddenly thankful for the years of training in medical school – so that I could sleep when I am sitting upright, sometimes even with my eyes open.

(To be continued.)

Question

2011-12-16T06:30:00.000+08:00

I am sure many of our HPTs of other specialties would not agree with me and our local board examination is not always easy - at least for a few highly celebrated specialties.

************************

Just a few days ago, I met L outside the ward. He caught me in my arm and said, "You know, quite a few candidates failed in the XXX board examination last week."

"That's not news. This is one of the most difficult specialty - at least in terms of board examination," I smiled.

"Have you heard of the questions?" My friend asked.

"Of course not. What's so interesting?"

"They asked details of specific clinical studies, and the latest FDA precautions of several medications..."

"As usual, I would say the problem is in the examiners rather than candidates." I remarked, "There is no point to recite all those specific figures from clinical trials, and even less value to remember word-by-word the FDA documents - they keep changing everyday!"

Alas, there must be pearls that can stand time hiding under the sea of information. The painful truth is neither could wisdom be taught nor examined.

Focus

2011-12-15T06:30:00.000+08:00

I might not have to worry too much about the prospect of general medicine. In a warm winter afternoon (actually a few days before I put up my recent blog entries and received the email comments from VW and JW), I participated in the examination of my own specialty board.

It is my strong belief that doctors of a similar personality go to the same specialty, and nephrologists are generally pragmatic and time-conscious. The seven of us lunched together, went through the questions, and, we finished (roughly) on time. Most of the questions are set in a way that it is difficult to fail even if the candidate does not happen to know the specific detail – as long as he or she has been actively practising and knows what’s happening on earth.

My friend JW certainly holds a similar opinion, and he always advises students and trainees against an examination-oriented study. His argument is simple: Examinations are generally easy (we are serious) but the scope is inevitably narrow; it is much more difficult to know enough and be a competent doctor – which, unfortunately, is our ultimate aim.

PS. You may find it difficult to believe examinations are easy – they are, in fact, difficult, but, only for the examiner. Since the voice of asking for a fair examination was becoming ever louder in the past twenty years, questions and scenarios need to be standardized, and there left less and less suitable material for examination of a large class of students (or trainees). The situation is somewhat similar to the steamed fish of a Chinese wedding banquet – it is always cultivated grouper and no one would ever think of wild ones, not because the couple wishes to cut the cost or help the environment, but you could never find twenty or forty wild groupers of a similar size on that very day.

JW's

2011-12-14T06:30:00.000+08:00

(The comment of JW followed two hours later.)

Dear VW,

The lack of interest among youngsters is multi-factorial. In my student days, the academic staff is really more negligent to clinical and teaching duties but we are not deterred from doing research. Amongst various causes, the most important one is lack of peer-group interest / pressure. When I was a MO, we have numerous HPT role models. (Szeto's note: HPT stands for higher physician trainee.) Can you name any now?

Of course, this loss of peer-group force is again multi-factorial.

JW

***********************

PS. I must say the three of us have very different worries: VW was hot about the behaviour of young academic staff (a stage which I suddenly realize my friend has long passed), JW focused on the foreseeable shortage of clinical researchers,while I put my attention on the widening gap between clinical and laboratory medicine.

And, there's no absolute right or wrong.

Comment

2011-12-13T06:30:00.000+08:00

In general all comments to this blog go to an obscure place. Nonetheless, for my recent humble opinion, my friend VW sent me a personal email as comment - which I believe deserves a better attention.

Here you go.

**************************

Dear Szeto,

Thank you for your sharing, my friend. I have no problem with RAPs, who are dutifully focusing on the job they were assigned.

What saddens me, however, is how clinical staff reacts to the paradigm shift - concentrating on research, flying around to give talks, evading clinical and teaching duties, you name it. In the past I was annoyed that young people were no longer interested in clinical research; now I see things differently. If we look like selfish people who care about nothing but our career advancement, how would youngsters want to become one of us?

Yours,
VW

Split

2011-12-12T06:30:00.000+08:00

What's wrong with all these?

First, there actually remains a square one problem to be solved: How to decide which teaching staff to be promoted, especially if they do not do much research?

No, there's none as far as I could see. At the end of the day, clinical teaching staff probably have little prospect of promotion (unless they could lead a team supported by RAPs), and many would take the post as a step stone before entering private practice.

(I shall not comment on their quality or enthusiasm of teaching.)

But, this is, to me, the smaller problem.To me, the more important problem of having research associate professor to work on basic science and clinical teaching staff to take care of students is we are taking the soul away from the body.

I shall leave it to your imagination which side is soul or body.

And, have you heard of the dinosaur with two brains?

Go read http://ccszeto.blogspot.com/2009/10/stegosaurus.html

Research

2011-12-11T06:30:00.000+08:00

I have no idea who first invented the term research associate professor (RAP) for a clinical department. He must be the same genius who discovered opium and gave an apple to Adam in Eden. It follows the logic of Adam (what a name) Smith and is a nice division of labour. Clinical staff could direct their effort back to teaching and patient care, and research output of the medical school is guaranteed.

To go one step further, RAP in a clinical department is a positive-feedback system. Since most of them do basic science research, their papers have more citations. As a result, basic science journals generally have a high impact factor. Since only true scientists know what they themselves are talking about, they are the only one to publish papers in these high impact journals. In reality, they form a elite group that any chairman of a clinical department would like to employ when their research output is going to be audited.

So far, so good.

But, there are two problems that may skip your eyes.

Yardstick

2011-12-10T06:30:00.000+08:00

What yardstick should we use?

Or, the very question is: Can we use the performance of teaching as the criteria of promoting an academic staff?

For obvious reasons, no. To put it simply, the quality of teaching (or clinical care) could hardly be quantified. (Alas, by definition, quality could not be quantified.) Peer review and examination result are biased, and, if you wish to follow students’ opinion, let me ask you one question: What’s the difference between the Most Popular Actor Award and the Best Actor Award?

And, therefore, medical schools resolved to assessing the performance in research.

No, I'm not going to discuss the problem of impact factor or h-index. My friend VW discussed that not too long ago (see http://vwswong.blogspot.com/2011/09/citations.html). I shall also not discuss the problem of our new generation academic staff, who try to avoid teaching and clinical duty and spend their time on research. (Yes, these are serious problems, but we shall leave them aside for the moment.)

But, once research becomes the yardstick for promotion, funding agencies soon follow and use it as the criteria for resource allocation. At the end, research per se becomes a specialty.

And we enter the era of research professor.

Evolution

2011-12-09T06:30:00.000+08:00

While we are seeing the fragmentation of general medicine into various specialties, division of labour in a different domain is secretly taking place.

Let me give you a slightly convoluted account:

Fifty years ago, the department of medicine of a typical medical school had one professor and around a dozen of lecturers. They saw patients and taught medical students, the latter largely by setting examples via their own clinical practice. For the small amount of spare time they had, they did research, be it clinical or laboratory based.

In the following decades, things gradually changed. Our life expectancy lengthened, and the whole health care system expanded. We needed more doctors and therefore had more medical students. The number of academic staff rose.

The inevitable result of having a whole lot of lecturers is they all need a prospect of their career, which, when summarized in one word, is promotion. But, which lecturer should be promoted?

Our extra-terrestrial friends taught us that much: To be fair, we needed to think of an objective yardstick.

That opened a Pandora box.

Division

2011-12-08T06:30:00.000+08:00

You may argue specialization, although does make the rich in knowledge eat at very separate tables, is the inevitable result of medical advance in the past twenty or thirty years.

That may be true. In fact, it is quite impossible nowadays to master all aspects of internal medicine by one person. And, seriously, it is actually rather difficult now to stay tuned in every aspects of a single medical specialty – for example, cardiology or nephrology.

(I made a similar comment last year. See http://ccszeto.blogspot.com/2010/10/divison.html)

Or, as Adam Smith put it, the greatest improvement in the productive powers (in the history of human) have been the effects of the division of labour.

But, hold on. Don’t follow our giant of economy blindly. In fact, the author of The Wealth of Nations did not imply that all kinds of division of labour would always lead to an increase in productivity, and, in modern medical practice, division of labour is very often not meant to increase the productivity or efficiency of medical care, but to achieve skill monopoly, or to evade responsibility.

I shouldn't say any more.

Feudal

2011-12-07T06:30:00.000+08:00

You may think my little story in the past four days was exaggerating the fact.

I beg to disagree.

The sobering fact is, the evolution of general medicine in the past 30 years was a close analogy to the history of the Zhou (周) empire 2500 years ago.

When King Wen (文王) first began his campaign, it was meant to be a central government. Nonetheless, it was quite impractical to rule an area of over 1.5 million square kilometer and a population of 30 million; inevitably, it had to resolve to a feudal system (封建制度).

(The same problem remains real nowadays. As I alluded to some months ago, despite the advance of Internet and information technology, you cannot kick the ass of someone on the other side of the Pacific Ocean.)

And, with time, the duke or marquis or count or baron or whoever became the lord of his own land and actual leader of his people. The Zhou emperor became on paper the leader of the country but had little land or people left to himself. He had not much respect from and even less control on his vassals.

Instead, the order of the empire is maintained by the most powerful duke amongst all feudal states.

General

2011-12-06T06:30:00.000+08:00

(The young doctor is obviously surprised to hear the idea of a general physician.)

"Don't you know the category of general medicine has been removed from the list of medical specialty?" He asks.

"How could that be? I think you are a physician trainee?" The woman could not believe her ears.

"Yes, I am, but I have my own specialty training." The young doctor says solemnly.

"What is your specialty?" The woman asks reflectively.

"I am a trainee of consultative medicine - a specialty devoted to consult the others... I mean we are the experts who know which specialty to consult." The doctor replies - and his face does not turn red.

Instead, the woman's turns white.

PS. Don't laugh at the young doctor. For us working in a public hospital, we are often surprised to see the complicated medication list prescribed by private physicians (our jargon is polypharmacy). For example, they give a syrup for someone who has a cough, another tablet if the patient also complains of backache, and another capsule if there is also a toe swelling. Many of us are certainly more sophisticated; we consult a respiratory physician, an orthopedic surgeon, and a rheumatologist for the same three problems.

Experts

2011-12-05T06:30:00.000+08:00

(The conversation has not ended - yet.)

“Not that bad. We can have everything before sunset, I hope.” The doctor tries to be reassuring.

"And you can finally do something by then?" The woman asks.

"Well, yes and no. It looks as if your father needs some medicine to prevent the blood from clotting. But, as I emphasized, we should be cautious to protect... eh, whoever." The doctor replies.

"What do you mean?"

"I mean, we need to consult a drug specialist and make sure there is no inadvertent interaction between the drug that we want to give and the others than your father used to be taking," the doctor goes on, "We need the assessment of a swallowing specialist to check if your father could safely swallow the tablet - so that you won't sue us if your father chokes and aspirates. By the way, it doesn't mean that your father could have his dinner if he could swallow; we will have to wait for the report of our diet specialist to determine what dinner your father should have..."

The woman interrupts, "My god, couldn't all these be done by a properly trained general physician - or actually anyone with a common sense?"

Report

2011-12-04T06:30:00.000+08:00

(The discussion continued.)

“How long does it take for the rad… specialist, whoever he is, to give the report?” The daughter pushes further.

“Don’t worry, our Chief Executive has promised on behalf of their Chief-of-Service on behalf of the front line radiologists that it would be available within one hour,” the doctor explains, “But, before that, we need to wait for our virtual technology specialist to go through the films and confirm their quality to be suitable for reading and reporting…”

After another moment of dead silence, the young woman says again, “Well, once we get hold of the report, can you start some treatment ?”

“No, not that fast… I mean, don’t jump to the conclusion that quickly. We need to see all the other results.”

“Yes, of course. I suppose ECG and blood tests are simple matters?”

“Alas, simple as they seem, we need to be very cautious to protect ourselves - I mean, our administrators - oh, I actually want to say, our patients.” The young doctor hurries to explain, betraying himself subconsciously that he is not sure which party his is trying to protect primarily, “After several recent incidents of missing an abnormal ECG or blood test result - all labelled as our malpractice and negligence - recently, our CE decides to have all the ECG read by a heart specialist, and blood tests interpreted by an expert of laboratory chemistry.”

“!” The woman is dumbfounded.

The exclamation mark represents what she looks like, not what she says.

Film

2011-12-03T06:30:00.000+08:00

(Medical ward of a regional hospital, some time in 2012.)

“Doctor, what’s wrong with my father?” An anxious young woman asks the on-call medical officer.

“Madam, I suppose you know what’s happened,” the young doctor says monotonously, “Your father was jogging in the playground this morning when he sudden collapsed.”

“Is he having a stroke?” The daughter asks.

“Yes, very likely,” the doctor nod.

“Does he need a CT brain?” The daughter goes on.

“We had one a moment ago. In fact, we also have arranged an ECG and some blood tests for him.” The doctor replies.

“What’s the result of the CT brain? Does my father have bleeding in his brain?”

“We need a bit of time – I mean we need to wait for the radiologist to go through the film and give a formal report…” The doctor hesitates. Since the CT films are going to be read by a specialist and what a physician trainee finds does not count, he has not actually seen the films himself.

And, since he knows from his very first day of training that he does not hold responsibility of reading a film, he doesn't know how.

2011-12-02T06:30:00.000+08:00

(Overheard the conversation between two persons.)

"The new arrangement is insane. It is the worst kind of communism!" A hook-nosed middle age man began.

"I haven't read the news. What's that all about?" His friend, who had a childish face but a lot of grey hair, asked.

"Just think of this analogy," the hook-nosed explained, "In the past, you have your own purse and I have mine. Every now and then you may overspend a bit, and you can borrow from me in order to get through the difficult time. The new arrangement states that, since you are in debt most of the time and I have a decent saving, we should share the same purse - so that you can caste away as much as you like and there's no need to worry!"

"Yes, that may be true," his grey-hair friend said slowly, "But, since we two are living under the same roof, shouldn't we be less selfish and try out best to help each other?"

"There is more than a fine line between asking for help and evading one's own responsibility," the hook-nosed said, "After all, we should help people who put up their very best effort to help their own self. For example, it is absurd to ask Angela Merkel to foot the bill of Silvio Berlusconi for his visits to brothels!"

I was confused. Were they talking about the European PIGS, or some local ones?

Equal

2011-12-01T06:30:00.002+08:00

(I remained silent for a while in order to digest what my friend just said.)

"You look puzzled." L said.

"Eh... I mean, your discussion seems to be leading to somewhere. But, what are you trying to get at?" I asked.

"Alas, you see that finally," my friend smiled again, "Very simple, contrary to what those so-called pioneers of democracy declare, the system of our CE election could actually be entirely satisfactory without much modification of the present system. All we need to do are to minimize the time between the Election Committee Subsector Election and the actual CE election, and to have all candidates running for the Election Committee declaring which side they are going to vote for."

"Em... Isn't it how the Americans choose their president?" I asked.

"Exactly," my friend nodded.

"But, that's not entirely democratic; it is not one man, one vote!" I exclaimed.

"No, but, you know me well enough. I am a fan of George Orwell. All animals are equal!"

I could not help nodding.

Who

2011-11-30T06:30:00.000+08:00

Met L on my way home. He seemed absorbed in his own thoughts.

“Hey, man. What’s up?” I tapped on his shoulder.

“Oh, nothing. I was just going through the advertising pamphlets of our coming CE Election Committee Subsector Election," my friend said, "Boring as they seem, there is an amazing thing between the lines - or should I say between the pictures?"

"Eh...?" I made an inviting grunt.

"Since you are so fond of psychology, look, there is something which should be there but is not." L smiled.

“What’s missing?” I scratched my head literally.

“None of the candidate says which side they’re going to vote!” My friend explained, “Very simply, is it the pig or the wolf?"

"Isn't it the whole purpose of democracy to elect some wise people so that they could make the decision for us in important matters?" I asked.

"Unfortunately, this time is the rare exception." L explained, "The only job of this Election Committee is to vote for the new CE. In other words, it is quite useless to advocate how good looking they are, or what policy they are for or against. Most of us have our own preference for the new CE, and we want our representatives to vote for the one we like – as simple as that. If someone come out and say it openly he stands for the side that I prefer, I shall vote for him; it doesn’t really matter if he was the root cause of the SARS outbreak or being literate only in four-letter words!”

Conscience

2011-11-29T06:30:00.000+08:00

(The doctor continued with his explanation.)

"There are many subtle hints of declining well in advance. For example, the CEO of this #9413 sold his Porsche last week, the floor of its reception lobby is covered with an inch thick of dust, and its web page is still showing the information three years ago. Aren't all these sinister signs?"

"Well, ah ... yes," the stock broker was forced to agree, "But they are only proved indicative with hindsight. The problem is usually not we have insufficient information, but we have too much and could not distinguish genuine signal from environmental noise in a jungle of information."

"All the same," the doctor was not a trace more forgiving, "You are the professional. You are supposed to be the expert to extract valuable information and make the decision. What you are telling me is you do not only lower your standard of practice to the adherence of practice guidelines and standard procedures, but you also bring down your level of conscience so that you won't feel guilty as long as you have followed all those amulets written by extra-terrestrials!"

The stock broker was speechless. In a sense his client was right, but, on the other hand, he had no idea how he could pass his days if he were not to lower his level of conscience.

Maloccurrence

2011-11-28T06:30:00.000+08:00

(The discussion between stock broker and his client continued.)

"I still believe it's your fault. You've not done everything that could prevent my losing money," the doctor insisted.

"No, we've done everything we should do from our side - and we are entirely satisfied with our performance," the stock broker remained calm and content, "True, you did lost money all the same. As you always say, this is a known complication of investment."

"I know what you mean," the doctor replied, "You've followed all practice guidelines and standard procedures. Every move was documented, conversation recorded, and consent signed. Yes, you have satisfied the administrator or whatever regulatory body there is, but, it is quite a different question to satisfy your own conscience - if you have any."

"What do you mean?"

"I mean, have you been staying alert to all trivial information and hints that would indicate the risk was going to materialize?" The doctor said.

(To be continued.)

Investment

2011-11-27T06:30:00.002+08:00

(Discussion between a stock broker and his client.)

“Gentleman, I must say the situation is grim,” the broker began, “You've put your money on Neptune Opportunity, and, my goodness, the price crashed by 95% this morning.”

The client, a middle age physician, remained expressionless. Contrary to the common belief, he was barely literate, and could not comprehend any logical argument of more than twenty words. He had no idea what's the difference between, say, PE and PB ratios, or what kind of company Neptune Opportunity actually was – all he remembered was he was advised by the man sitting opposite to him to buy a stock with the code #9413.

Oh, there’s one thing he knew: He had lost money. Big money he earned by sweat and blood.

After another five minutes of dead silence, the doctor said, “It must be something you’ve done wrong, or information you've hide from me. It's a negligence or your side, or I should call it malpractice.”

"No," the stock broker remained calm and content, "This is not malpractice. This is maloccurrence."

Age

2011-11-26T06:30:00.001+08:00

(A real story in my private patient clinic recently.)

"Doctor, you look really young. I never imagine a professor of medicine has no grey hair." The wife of my patient said before she left the consultation room.

"Oh, thanks for your compliment," I smiled, "But there are actually so many young professors of my medical school nowadays ..."

(I was about to say the title professor deflated a lot in the recent years, but I refrained to say so in front of my patient.)

"You are too humble," she went on, "Let me see, you must be far from 60-year of age. Are you 53 or 54?"

I made a loud hiccup - the inevitable response when one tries to laugh and vomit at the same time.

Delay

2011-11-25T06:30:00.000+08:00

(The discussion in the resuscitation room continued. Oh, yes, the blood pressure of the unfortunate young man continued to drop.)

"Damn, we are not against transfusion, but how could you be sure the blood is safe?" The grey hair man took over. He obviously was in the habit of using a colorful language.

"We always perform some necessary testings. Nothing is perfect, I agree. But the situation is urgent." The doctor explained.

"Stop that kind of bull shit. You ain't know anything of this testing business." The grey wolf roared, "In the old days, the standard way is to have the potential donor passing through six stages and fifteen tests before the blood is accepted. Now, you just check hepatitis and AIDS. That's not enough."

"That's picking bones from eggs," the doctor said to himself.

But, he did not say it aloud. He hesitated for a while, and then he continued, "All I could say is: Delay no more."

"What!?" Both the monkey-face and the grey wolf jumped.

"Alas, don't be paranoid. I am speaking English." The doctor was forced to say.

Bleeding

2011-11-24T06:30:00.000+08:00

(The story in the resuscitation room continued.)

"Gentlemen, let's make it straight. The situation of your brother is critical. If he does not have some new blood in the coming hour or so, the chance is he would not make it." The doctor was grave.

"I don't think he needs any blood," the monkey-face said, half smiling, "I see that you are no short of water. Just give him more fluid to support the blood pressure."

"Let's face it. What he needs is new blood; the old blood won't do much better with more water." The doctor insisted.

"No, I don't think he is short of blood. All he needs is a better distribution of blood flow to each organ, so that some organs would not be deprived of blood while another gets too much." It now became clear that the smiling face was taking charge of the discussion.

"Alas, I agree there may be some organs better perfused than the others, but it does not mean that your brother has enough blood!"

"Well, even if he is hypovolemic, transfusion does not solve the root of the problem. You need to find ways to stop the bleeding." The monkey-face changed the topic.

"No, but transfusion is an important supportive treatment. If we do not give blood quickly, your brother may soon pass the point of no return, and he could not be revived even if we do stop the bleeding."

Shock

2011-11-23T06:30:00.000+08:00

(In the resuscitation room of the Emergency Department.)

"Oh, this is horrible. He must have bled a lot. What is his blood pressure?" The doctor was examining an unconscious young patient just arrived and was obviously soaked in blood.

"Eighty over forty; pulse one-thirty." The nurse replied.

"Thank god we have a drip running. Let's give him some blood." The doctor ordered while looking for the site of bleeding.

"Hang on. We do not agree." An unexpected voice emerged behind the curtain. The doctor looked up. Two middle age man appeared besides the bed. One of them had a face like a monkey, and the other was full of grey hair.

"Who are you?" The doctor asked.

"We are his brothers." The monkey-face man said, pointing to the patient.

The doctor somehow hallucinated this man was smiling.

"Oh, my god - I mean oh, I see," the doctor tried to conceal his surprise, "Your younger brother has bleeding from somewhere. He must have lost one third, if not more, of all his blood. We need to give him transfusion, or he may die."

"Fxxk, we know - we are doctors ourselves," the man with much grey hair spoke with the voice of a wolf, "We've given him a shot of erythropoietin injection - his hemoglobin will increase a few months later."

(To be continued.)

Memory

2011-11-22T06:30:00.000+08:00

While reading this horrifying story of George Orwell, as a middle-age man brought up by the colonial education, I could understand the worry and confusion faced by Winston Smith.

To begin with, there is always a vague memory of the old days and old system that we used to live with. Alas, now, we are not having a better system. In contrast, we are repeatedly being reassured that the things we are seeing are the same as the one we used to have, say, twenty or thirty years ago. (It is in its own a curious objective when a people refuse to improve, which always involve some difference, but insist to remain unchanged.) Each time, when a regulation is breached or a rule is modified, we are told that the rule is not new but has always been the same - although rather often we need to seek someone higher up to clarify the interpretation.

And, our memory is failing us. History study is ridiculed. Like the Department of Truth, our government is actively wiping off everything that triggers the memory of the colonial days. The portrait of the queen vanished and becomes the logo of bauhinia. Royal turned into People's. Nothing seemed to have happened in this fishing village for 100 years, and, according to the textbook of our children, the place suddenly became a metropolis and returned to its mother country in 1997. That's why by 2046, nothing would have changed, because no one would actually remember what this place was like fifty years ago.

As to the few who happen to believe they remember, their memory must be wrong.

They would be taken care of at room 101.

Orwell

2011-11-21T06:30:00.005+08:00

My recent bedtime reading was Nineteen Eighty Four.

I bought the book last Christmas as a present for the winner of the grand round quiz. Nonetheless, I did not give it away and, as a general principle, I would not leave a book on my shelf unread. (See http://ccszeto.blogspot.com/2010/12/1984.html)

You may be surprised to find I did not go through this classic of George Orwell before, while I have read Animal Farm for at least three times - first as a secondary school student.

But, in retrospect, I find it an excellent arrangement. Big Brother is probably too much to be understood for someone below the age of 40.

Alas, maybe that's why Winston Smith had so much problem.

************************

You may think this horrifying story of Big Brother is outdated after the fall of the iron curtain. But, I find it more real now than ever. Orwell had the wisdom of seeing the world ends up with three super-powers. You may call it USA, EU, and China.

Or, more likely, Google, Apple, and Microsoft.

Ross

2011-11-20T06:30:00.000+08:00

Let me tell you a slightly irrelevant story.

In 1932, Barnaby Ross, whose name was never heard of before, wrote a book titled The Tragedy of X. It was a fiction about Drury Lane, a Shakespearean actor who had retired from the stage due to deafness and was consulted as an amateur detective.

The book proved a best seller, and, shortly afterwards, when his second novel, The Tragedy of Y, was published, Ross became the superstar of detective fiction. To add oil to the fire, Ross's novels were openly criticized by Ellery Queen, another famous crime novelist at the time. The two of them subsequently staged a series of public debates, pointing fingers at each other.

In order not to be recognized by the others, both of them wore masks when they appeared in front of the public.

The problem is, however, no one had ever seen Barnaby Ross - not even his publisher. Since his skill and plots appeared too sophisticated to be a new comer, it was suspected from the very first day that Barnaby Ross was the pseudonym of someone well known.

Alas, you could guess that much: Barnaby Ross and Ellery Queen were one and the same. I did not say one person because the two pseudonyms were used by two cousins, Frederic Dannay and Manford Lepofsky, who wrote novels in a combined effort. During the public debates, one took the role of Ross and the other Queen.

Lancashire

2011-11-19T06:30:00.000+08:00

A recent hot topic amongst the cultural circle is a famous local author put up her own photo in her blog.

If you do not know who I am talking about, just visit the Lancashire Road. I must say I am quite far away from being cultural, but Vivian is a fan of this young lawyer. In fact, my wife was rather excited when she saw the picture of her favorite author.

"Oh, she really looks like a movie star!"

"Alas, that may be true, everything just sounds slightly unreal," I said.

"What do you mean?" As usual, my wife did not know where I was getting at.

"Oh, I don't mean that her face is a product of some plastic surgeon," I smiled, "But I have a gut feeling that the girl in the picture may not be her, or be the complete her."

"But, she said in her Facebook that many of her friends and aunties recognize her and ask why she suddenly comes out." My wife said.

"That's exactly the curious bit," I explained, "Nowadays the internet is so far reaching. If you put up the picture or video of anyone on to the web, in no time the face would be recognized. People appear from every corner and declare being the neighbour or classmate or friend. But, this time, they just write to her - or so it was said. We see nobody come out and say Hey, I know this woman; we belonged to the same hostel in the university."

PS. You may still be puzzled what I meant by the complete her. I shall explain tomorrow.

Match

2011-11-18T06:07:00.002+08:00

You may think my worry was far-fetched because genuine bribery in election remains uncommon, and not all policies involve long term benefit.

But, unfortunately, the general idea remains - and is happening more often then you could imagine. There are innumerable topics of a society that people concerned are unable to grasp the whole picture to make a wise decision, while a small group who hold some critical information also have their own agenda.

The best example at hand is the public health policy, or, specifically, the recruitment of overseas medical graduates.

****************************

I shall not elaborate my opinion on that very last topic any further. Frequent visitors of this site would know just too well. Nonetheless, it really touched my nerve when Vivian told me our noble council representative said that manpower allocation was not even across all government hospitals and every department.

"That may be true, but I would be most enlightened if you could give me five examples that a department in a government hospital has a surplus of manpower. I can only name one - the headquarters."

"But, for the same specialty clinic, the waiting list is one week in a hospital, but 15 months in another," my wife tried to defend the surgeon.

"Does it mean that the hospital with a one-week waiting list has an over-supply of doctors, or their chief-of-service is an expert of torturing his staff?"

Mismatch

2011-11-17T06:36:00.003+08:00

You may argue, based on the previous example of a benefit twenty years later, it is logical to ask only those who are potentially affected (i.e. those below 60-year of age) to vote.

But, I'm sure you see it plainly that's quite impossible, for obvious reasons:

Most importantly, the group most benefited (that is, those below the age of 20), is often quite incapable of making a logical and appropriate judgement.
It would be seen as a discrimination of age - a taboo that we don't want to get near to.
In real life, it is often difficult to tell how long it needs to wait for the benefit.
And, in reality, we do not vote for policies one by one (and we don't want to anyway - otherwise we would not need a representative in the council), we vote for persons, or, a choice of different bundles of policies.

Specific for point #1, you may now come to realize it is an inherent problem of democracy: There is often a mismatch between those eligible to vote and those who actually get the benefit, and the temptation is more than real for the former group to choose a policy (or, a candidate or political party) than would benefit themselves rather than the entire society. To put it simply, they balloon up their own purse by taking money from those who do not vote, or vote for the opposition.

Remarks

2011-11-16T06:19:00.005+08:00

There are some remarks I have to make after the recent discussion.

First, genuine support to democracy does not mean voting for Party D. A well informed and calculated voter should vote whatever he prefers.

And, don't be too serious with my example of bribing voters by cash money - all elections are bribery of one form or another.

In most cases, however, the transaction is more subtle than the famous Four Great Inventions (蛇齋餅糉). Sometimes they fight for a better social welfare, rising our salary, cutting working hours, limiting competition from new immigrants - be they Filipino maid or British doctors. Yes, between statesmen or parties, politics is negotiation. But, between backbenchers and their constituents, politics is always benefit or bribery - depending on how you call it. For each candidate running for an election, they represent a mixture of policies and proposals sold in a bundle; even a wise voter could only choose a better candidate by balancing the gain and payoff.

It is, in short, the rule of the game.

Oligopoly

2011-11-15T06:16:00.003+08:00

The problem is: Why should bribery of the election be so profitable?

Because the cost is very low for a selected group. (In our previous example, those over 60-year of age.)

But, if this group of voters do come to realize their true value, they would ask for a higher price. In reality, if there exists another malicious Party C2 and is willing to pay twice as high (i.e. $2), both Parties D and C would lose the election to the new comer. In a free market, by the law of economy, the final price to bribe these people would eventually be much higher - or, to put it in a more palatable language, the underprivileged group would enjoy more benefit.

However, politics does not often operate in the setting of a free market. In the jargon of business, the admission threshold (入場門檻) to form a Party is high, and, for us, since there is another invisible hand behind the scene, the choice is limited. In other words, it is a form of oligopoly (寡頭壟斷) - with the inevitable implication that the bargaining power of an ordinary citizen is very low.

Profit

2011-11-14T06:34:00.004+08:00

I might be going too fast yesterday and the profitability of bribing an election may skip your eyes.

Let's suppose there are 6000 citizens in a country with a smooth distribution of age; voting for Party D would generate a total benefit of $600,000 to the society twenty years later. Equally shared by each and everyone, it means $100 per head. For simplicity, we assume the life expectancy is 80-year, and citizens could vote after the age of 20.

Now come the critical moment: A malicious Party C would try to take all the benefit for their own ($0.6M twenty years later, or around $128,700 immediately - assuming a discount rate of 8%). To bribe a sufficient number of vote, and suppose everyone could be reliably bribed, the cost would be:

First, we need to get all 2000 votes from citizens over the age of 60. We can pay $1 for each, and the cost is $2000.
The present value of $100 in 20 years is $21.5. Since we need another 1000 votes to win the election, the cost is $21500.
Therefore, the total cost to win is $22500, and the net profit, if cashed immediately, is $106,200.
(In fact, if we take it as a present investment of $22500 and a return of $600,000 twenty years later, the yearly return is 17.8% - as good as the performance of Warren Buffett.)

In reality, the cost would actually be lower, because the turn up rate of voting is never 100%. A detailed mathematical model predicts that the money Party C needs to bribe a sufficient number of voter actually falls rapidly if the turn up rate comes down to 50%. Readers with an obsessive personality disorder can try to work out the numeric details yourself.

Here, a determining factor of this profitable business may not be immediately obvious. Let me tell you tomorrow.

Expectancy

2011-11-13T06:16:00.005+08:00

You may disagree with my attempt to understand the phenomenon of bribery in election; I myself is slightly suspicious. To say the least, the traditional discounted cash flow method does not take into the account of the interaction between time and life expectancy.

It goes like this:

Let's suppose voting for Party D would generate a benefit of $100 twenty years later. Assuming a discount rate of 8% (the standard rate of return for a business with an average risk, as suggested by Benjamin Graham), the present value is $21.5. In other words, a calculated voter could be bribed by paying him $22.

But, in reality, you can do away with paying that much for many of the people in the community.

Why? If the expected life span of this country is 80 years, the future value of voting for Party D would be zero for anyone above the age of 60. In layman's term, they would not live that long to see the benefit - and, therefore, they could be bribed by an amazingly small sum.

Say, $1.

What's the conclusion? Alas, it means that bribery in election is a highly profitable business!

PS. In real life, many senior citizens do vote for the benefit of their children and grandchildren, and one could always join the dinner (or take whatever benefit that is offered) and vote for the other side. If you could think of all these, you would hardly be fooled by any politician. Unfortunately, most people are honest and do keep their promise.

Discount

2011-11-12T06:07:00.003+08:00

You may think I am short-sighted and do not appreciate the long term benefit of supporting democracy. Well, let's analyze the problem from a business point of view:

First, please accept all long term gain could be converted for immediate cost-benefit analysis by the discounted cash flow (折讓現金流) method. The principle is simple. For example, in 1990, if Alan Greenspan promised to give you $100 ten years later. Given his creditability, we take 4% as the annual discount rate. It would imply the effect would be the same if our previous Chairman of the Federal Reserve gave you $67.6 in 1990 that and there. (Try it with your own calculator.)

But, if Ben Bernanke made the same promise to you in 2010, the financial environment (and, I am forced to say, the person) changed. The future is more risky, and the discount rate needs to be higher - let's say, 8%. In that case, you may prefer cashing away $46.3 from the chairman now, rather than having to wait until 2020.

The idea is, therefore, simple: The more uncertain and risky the future, the higher the discount rate, and, as a result, the lower the present value one would take as being equivalent. And, as pointed out by Albert Einstein, compound interest is the most powerful force in the universe. If we have to wait long for a huge wealth, we may as well get a tiny sum immediately. (For example, for 30 years and a discount rate of 12%, $100 becomes $3.3 only.)

Therefore, don't blame people who vote for the candidate that brings them to dinner; they have very little idea when democracy would bear fruit, and, since pursuing such an exceptional virtue has a very high risk, the discount rate should be huge.

Now

2011-11-11T06:29:00.004+08:00

(The conversation between the old man and the pioneer of democracy continued.)

The politician then asked, "Why didn't you use your vote to support democracy?"

The old man said, "Why on earth?"

The politician scoffed, "Democracy is so important! With it, you can really reflect your opinion and affect government policy."

The old man asked, "But, how long will this all take?"

The politician replied, "Oh, 15 to 20 years - maybe slightly longer."

"But, even if we achieve eventually this ultimate aim of real democracy, what then?" asked the old man.

The politician laughed and said, "That's the best part. Old people like you can ask for more social welfare - for example, free flu vaccine or even free dinner party!"

"What do you think I am having in my hand?"

*******************

Do you think this old man is short-sighted and does not appreciate something more important in the long run? I would not go that far. After all, democracy should not be the goal - it is a means leading to a better life.

As Hercule Poirot emphasized (in Murder on the Links): If you do not see this point, you could not see anything.

PS. Exactly for this very reason, if democracy leads to a foreseeable adverse outcome, I would not support democracy.

Election

2011-11-10T06:19:00.004+08:00

While I was considering to whom I put my vote in the medical council election, we have another one for the district council.

Like many others, I live in a place where there are two persons running this time: The original council member, who has done a lot of work on local affairs but has a suspicious party background, and a young man who, to keep my wordings modest, is more vigorous in pursuing democracy.

I shall not mention which side I support. In fact, an entirely different story of a fisherman came through my mind (see http://ccszeto.blogspot.com/2009/11/rich.html).

Let me modify it a bit:

****************************

A pioneer of democracy passed by the garden of a public housing estate, where he found an old man sitting there, with tickets to some dinner banquet and free influenza vaccine in one hand, and a voting paper in the other.

The politician complimented the old man on his support to the election, and asked which side he would vote for.

The old man replied, "The ally of Napoleon, of course."

(To be continued.)

Vote

2011-11-09T06:04:00.001+08:00

During a casual chat, I suddenly realized many of our junior colleagues did not vote in our recent election of the medical council.

"Why! Rather hopeless for us to change anything," AC, my own registrar, said, "It's just a game for the insiders."

I was forced to agree. A sound economic principle actually lies here: If we consider our own personal benefit, we should never vote: There is no benefit because a single vote of us would not affect the result, but it does cost a trace amount of time.

Nonetheless I did vote. I took it as part of the duty of a doctor, and, if everyone believes we couldn't do anything, nothing would eventually be done.

Seriously, I have no favorite candidate.

I am just against one.

Modify

2011-11-08T06:14:00.003+08:00

On a second thought, chopstick is a lingua franca of the Chinese culture.

Like everything else in life, it got modified slightly wherever it goes:

In Korea, chopsticks are generally made of metal (iron or silver); using wood or bamboo ones are considered as a sign of poverty.

In Japan, chopsticks have pointed tips (as compared to the blunted end of traditional Chinese chopsticks, which remains the standard design of disposable ones in Japan). For that seemingly trivial modification, there is, in fact, a substantial difference in the proper way of holding them.

On that last point, I shall not elaborate on the actual techniques. Suffice to say, a skilled user of the Chinese chopsticks could easily use his instrument to cut out a piece of flesh from, say, a whole fish – a task that is not meant to be done by the Japanese equivalent, however dexterous the user is. Of course, the explanation is obvious: We serve whole fish or other cuisine in big dishes, and there is often a need to dissect the object for sharing; in Japan, meals are generally served individually.

(Another contributing cause is that Japanese rice is slightly more sticky – or, in scientific terms, has a higher content of gelatin – for which it is less messy to use chopsticks with small pointed ends. Just try it yourself.)

PS. It is a common belief (and in fact quite scientifically proved) that chopsticks take part in the spreading of infections that could be transmitted via salive (notably Helicobacter, the cause of peptic ulcer). However, the blame is not entirely legitimate. A noble Chinese with an appropriate upbringing should finish with his dinner without soiling his chopsticks – each piece of food is diligently put into the mouth by a non-touch technique.

Chopstick

2011-11-07T06:04:00.004+08:00

It was a Wednesday morning. When I received my lunch box after half way through our unit meeting, I found something important missing.

And I grumbled, "Gosh. I am a traditional Chinese, and I definitely need a pair of chopsticks for my lunch."

"So, did you bring your own pair when you went to England for study?" Someone asked.

I smiled, "That's really a story - I did not, or, I should say I forgot to do so. To make things worse I was in Bristol, not London, and I had no idea where to buy a new pair." (During that time, to be honest, I had either to dine in the hospital canteen - it is perfectly OK to eat fish-and-chips with knife and fork - or to use a spoon for everything if I decided to prepare my own dinner.)

"How did you get around the problem?"

"Alas, I rang up WY, who happened to need to be in London later that month for a meeting, and I asked her to bring me a new pair!" I smiled.

By the way, I am still keeping this very pair in my office - to remind me of the good old days.

Conversion

2011-11-06T06:35:00.005+08:00

You may ask: How do I find my Kindle?

Not bad. To say the least, the screen is soothing and there's no flash light. (Good for someone with migraine, like me.) I tried the Wifi connection and bought a novel from the Amazon site. Everything was plain sailing. Nonetheless, to save the battery power, I turn off the wireless most of the time, and, if I need to buy new books, I could do it on my desktop computer and move it to the device via a USB cable.

The major difficulty, however, came when I tried to read journal articles. To begin with, it could only open HTML or DOC files after conversion - not convenient. If you download a paper in PDF and pass it to the device, the file could be opened, but, since the paper size is usually A4 or standard letter, you need to zoom in and it is rather complicated to move around a page. The next thing I tried was to open a paper as full text and then print it to PDF after adjusting the paper size to A5. Alas, it comes up perfectly well on the Kindle screen - just that the files are amazingly big (often 15 to 20 MB for each article).

PS. You can also open a full text, save it as HTML only file (rather than a full web page), and then print that file to PDF as A5 pages. The file size becomes much more manageable (generally 300 to 500K). But the process is slightly complicated.

PPS. Which book did I buy to test my new toy?

Why! For sure it was The Murder of Roger Ackroyd.

Kindle

2011-11-05T06:17:00.002+08:00

My recent new toy is Kindle.

I bought it on-line as a bargain item. Although I am slightly uneasy with virtual bookstore and a paperless system (for example, see http://ccszeto.blogspot.com/2011/10/choice.html), there is an objective need for me to have an electronic reader. It goes like this:

Since our wards moved to the new hospital block last year, it becomes quite a nuisance to people like me who have our office staying in the old block. (The root of the problem is, of course, when the new block was designed by some extra-terrestrials, no office space was planned for academic staff.) Although it takes no more than 5 or 7 minutes to walk from our own office to the ward, it becomes neither here nor there when we have, say, 15 minutes of spare time in the ward (for example, after the morning round but before a bedside teaching).

For that reason, many of us bought iPad in the past one year. Well, after reading Tim Ferriss, I am not fond of checking emails all the time, but it seems a good idea to have some documents or journal articles at hand.

PS. Another brilliant design of the new hospital block is that the largest blind spot for mobile phone connection is the lift lobby - exactly the place where you need a mobile.

CC Szeto

Haunted

選美

小甜甜

Letter

情書

Shokan

M-shaped

Stagnant

Afford

Limits

Expand

Double

Why

Textbooks

General

Questions

Intention

Decision

Dilemma

糯米

綠楊村

Streetlamp

Star

Result

Dictator

Envy

Gray

B&W

Finning

Island

Twin

Fifth

Discrimination

Recognition

Incapable

Nihilism

Nothing

Compare

Mad

Napoleon

Moriarty

Holmes

Now

Review

Rebuttal

Gen'ya

Antidote

Thirst

MSG

Sprout

菜心

Study

30

Advertise

Lunch

Temptation

Advice

Rehearsal

Question

Focus

JW's

Comment

Split

Research

Yardstick

Evolution

Division

Feudal

General

Experts

Report

Film

Share

Equal

Who

Conscience

Maloccurrence

Investment

Age