My bedtime reading at the moment is a pictorial book called "German Millennium".
It is essentially a collection of paintings and photos that outline the history of German in the past 1000 years - and I have just started with the World War I. Koch, Plank, Mozart, Beethoven, Kant, Schopenhauer, Nietzsche; this people had such a huge number of genius in science, music, and philosophy. No wonder some of them came to the belief that they should rule the world.
Those with some idea of Europe would remember very well the history of German as a united country is rather short. When a nation is divided, people become cohesive and they work for the same goal - see also the Jews. When a kingdom has been united for 2000 years since the First Emperor, genius become bureaucrats and start having plots against each other.
Thursday, January 31, 2008
Wednesday, January 30, 2008
Funeral
Went to the funeral of KY's father. On the way Vivian was discussing with her classmates for a gathering - it had been 10 years after their graduation.
"Our class has not met since houseman !" She sighed.
A flash back appeared: the first gathering of my university classmate was towards the end of our houseman - it was the funeral of Rita.
I did not know Rita very well. She was a cheerful girl but, in a class of 120, we probably had no more than 10 seconds of conversation in that 6 years. All I heard was she broke up with her boyfriend, had some reactive depression, and jump out of the window - just outside the ward that she was working at.
It was all 16 years ago. If there were reincarnation, she might now be in her (or his ?) secondary school, studying for public examination, and applying for university. Would she choose medicine again ?
Now I realize why mengposhang (孟婆湯) is the holy grail of all sorrow.
"Our class has not met since houseman !" She sighed.
A flash back appeared: the first gathering of my university classmate was towards the end of our houseman - it was the funeral of Rita.
I did not know Rita very well. She was a cheerful girl but, in a class of 120, we probably had no more than 10 seconds of conversation in that 6 years. All I heard was she broke up with her boyfriend, had some reactive depression, and jump out of the window - just outside the ward that she was working at.
It was all 16 years ago. If there were reincarnation, she might now be in her (or his ?) secondary school, studying for public examination, and applying for university. Would she choose medicine again ?
Now I realize why mengposhang (孟婆湯) is the holy grail of all sorrow.
Tuesday, January 29, 2008
Inflation
One of the reasons that JW - and most of us - are so interested in investment (or speculation) is that we plan for retirement.
How much money do we need ?
Of course that depends on what type of living you wish. Because of inflation, a reasonable sum of money today may be good for nothing ten or twenty years later. (As Bill Gates says, we often over-estimate the change in one or two years, but under-estimate that in ten years.)
To many of us, it is confusing - if not hypnotizing - to hear the inflation rate reported by the government: 2 or 3% each year (although the price of pork or beef went up for 50% in the last year, and crude petroleum by even higher a figure).
I am no economist and would not argue with experts. But there is one thing I am certain: inflation rate, as it is reported, does not consider the change in technology and life style. For example, 20 years ago, none of us would consider mobile phone a necessity, and its cost for a reasonable life was nothing. Now we cannot imagine how one can survive without the phone. Although its unit price (and its service) actually decreased in these 2 decades, the cost for a reasonable life rose from non-existent to a substantial sum.
How much money do we need ?
Of course that depends on what type of living you wish. Because of inflation, a reasonable sum of money today may be good for nothing ten or twenty years later. (As Bill Gates says, we often over-estimate the change in one or two years, but under-estimate that in ten years.)
To many of us, it is confusing - if not hypnotizing - to hear the inflation rate reported by the government: 2 or 3% each year (although the price of pork or beef went up for 50% in the last year, and crude petroleum by even higher a figure).
I am no economist and would not argue with experts. But there is one thing I am certain: inflation rate, as it is reported, does not consider the change in technology and life style. For example, 20 years ago, none of us would consider mobile phone a necessity, and its cost for a reasonable life was nothing. Now we cannot imagine how one can survive without the phone. Although its unit price (and its service) actually decreased in these 2 decades, the cost for a reasonable life rose from non-existent to a substantial sum.
Monday, January 28, 2008
Speculation
LS showed me some email communication between JW and KL. In short, the two old boys talked about the stock market - and of course had very different opinion.
JW is the kind of man who buys stock with great long term potential and holds for years; he is always proud of being an investor (according to the definition of Benjamin Graham in his classic Security Analysis).
KL, on the other hand, is a head-to-toe speculator. I take it as a good sign - at least he has the insight. Most people speculate and (often when the result is not agreeable) believe they are doing investment.
Graham is often taken as a pioneer of value investment and a great investor. The first half is no doubt true. Nonetheless he was a real speculator by his own definition - he bought reasonable company at a bargain and sold when its intrinsic value is reflected in the price. He hardly ever regarded himself as the owner of that company - the very character of an investor. "Value investment" is - alas, a specific, albeit highly educated - form of speculation.
JW is the kind of man who buys stock with great long term potential and holds for years; he is always proud of being an investor (according to the definition of Benjamin Graham in his classic Security Analysis).
KL, on the other hand, is a head-to-toe speculator. I take it as a good sign - at least he has the insight. Most people speculate and (often when the result is not agreeable) believe they are doing investment.
Graham is often taken as a pioneer of value investment and a great investor. The first half is no doubt true. Nonetheless he was a real speculator by his own definition - he bought reasonable company at a bargain and sold when its intrinsic value is reflected in the price. He hardly ever regarded himself as the owner of that company - the very character of an investor. "Value investment" is - alas, a specific, albeit highly educated - form of speculation.
Sunday, January 27, 2008
Eight
When I think twice, it becomes clear that my worry about advertising by Imagine is fully justified. Some genius did use the song for marketing - with a seminal success.
For most Hong Kong people and all those with hand-on experience with our stock market, it is obvious that I am referring to the Hong Kong Telecom - alas, PCCW nowadays, or the all too famous "number 8".
There was this hypnotizing song of John Lennon on the TV ... the screen of which showing the astronaut, making his giant leap for mankind on the moon. We saw great potential in communication and Internet. The world was becoming one. What an ideal company to invest !
Oh, we wake up after much pain (and bleeding). The world does not become one - at most it becomes flat as Thomas Friedman says. Worst of all, the market becomes many, and our number 8 lost its monopoly. At last I understand why they used so much money on the marketing - it was not meant for the customers, but potential shareholders !
(Well, with all these, I still put Imagine as the favorite song of mine - it is always good to have a sweet dream.)
For most Hong Kong people and all those with hand-on experience with our stock market, it is obvious that I am referring to the Hong Kong Telecom - alas, PCCW nowadays, or the all too famous "number 8".
There was this hypnotizing song of John Lennon on the TV ... the screen of which showing the astronaut, making his giant leap for mankind on the moon. We saw great potential in communication and Internet. The world was becoming one. What an ideal company to invest !
Oh, we wake up after much pain (and bleeding). The world does not become one - at most it becomes flat as Thomas Friedman says. Worst of all, the market becomes many, and our number 8 lost its monopoly. At last I understand why they used so much money on the marketing - it was not meant for the customers, but potential shareholders !
(Well, with all these, I still put Imagine as the favorite song of mine - it is always good to have a sweet dream.)
Saturday, January 26, 2008
Imagine
Being brought up and educated in a grass root district, my first encounter of John Lennon's Imagine was in the early 1990's, when the Hong Kong Telecom - alas, PCCW, the famous stock #8 nowadays - used it as the theme song in its TV advertisement.
I said to myself: this is, no doubt, the song of the (last) millennium; and I still think so.
One world, and everyone live on today - what a beautiful dream. The US government (or CIA ?) was right: If the communist Russia did use it as their national song, the States - and Europe - would have been quickly conquered. It was fortunate for the civilized world that Stalin and his successors did not have the wisdom to make such a drastic move. Otherwise the history textbook of our children would be describing Russian tank entering not only Prague but also Washington, and the statue of Socrates in addition to Confucius (孔夫子) being pulled down - that's really catastrophe.
Of course you may argue if the communist leader did have the wisdom - and courage - to advertise by Imagine, he could well have been the real Moses of all men and lead us through the red sea of cold war and terrorism. I am - as a rule - skeptical with anyone good at marketing.
I said to myself: this is, no doubt, the song of the (last) millennium; and I still think so.
One world, and everyone live on today - what a beautiful dream. The US government (or CIA ?) was right: If the communist Russia did use it as their national song, the States - and Europe - would have been quickly conquered. It was fortunate for the civilized world that Stalin and his successors did not have the wisdom to make such a drastic move. Otherwise the history textbook of our children would be describing Russian tank entering not only Prague but also Washington, and the statue of Socrates in addition to Confucius (孔夫子) being pulled down - that's really catastrophe.
Of course you may argue if the communist leader did have the wisdom - and courage - to advertise by Imagine, he could well have been the real Moses of all men and lead us through the red sea of cold war and terrorism. I am - as a rule - skeptical with anyone good at marketing.
Friday, January 25, 2008
Butterfly
To many senior officials, human resource is paper work. If we want to increase the number of medical students, ask for more money from the government - and that's done.
Predictably these would be the same officials whom when promoted to the WHO and being asked about how to solve the famine in Africa, the answer would be: ask them to grow more crops.
Why, the amount of wheat or rice from each farm is limited physically, and the number of people suitable of becoming a doctor is no different. Not only because people of sufficient intelligence to survive medical school education is limited (which I believe may not be the major factor), but people of suitable personality is wanting. Education can give one knowledge, but it doesn't change the character. You may know 99 causes of shortness of breathe after passing through a medical school, but many unsuitable graduates just cannot make up their mind which cause does a particular patient at hand have.
The result of this soap opera over the past four days is: the quality of doctor would gradually decline, and so would their social and professional status. By promoting an important health care topic, we end up damaging both parties - patients and doctors. Are we seeing a butterfly effect ?
Predictably these would be the same officials whom when promoted to the WHO and being asked about how to solve the famine in Africa, the answer would be: ask them to grow more crops.
Why, the amount of wheat or rice from each farm is limited physically, and the number of people suitable of becoming a doctor is no different. Not only because people of sufficient intelligence to survive medical school education is limited (which I believe may not be the major factor), but people of suitable personality is wanting. Education can give one knowledge, but it doesn't change the character. You may know 99 causes of shortness of breathe after passing through a medical school, but many unsuitable graduates just cannot make up their mind which cause does a particular patient at hand have.
The result of this soap opera over the past four days is: the quality of doctor would gradually decline, and so would their social and professional status. By promoting an important health care topic, we end up damaging both parties - patients and doctors. Are we seeing a butterfly effect ?
Thursday, January 24, 2008
Competition
Anyone who believe in my prediction yesterday of fewer ophthalmologists or cardiologists must be intensely thick - all emperors would fight for their (own) kingdom. We need to screen for cataract or macular degeneration, set up facilities for primary angioplasty for myocardial infarction, or look out for chronic kidney diseases !
You see, each kingdom would try to expand. Even if any one of them doesn't intend to do so from the beginning, they need to join the competition once they see other empires are thriving. This is a matter of live-or-death (not of the patient) !
The quick answer to this situation – obviously by our honorable council members – is to increase the quota of medical student (and pupil nurse).
This is really a perfect illustration of the old Cantonese wisdom: 一闊三大
You see, each kingdom would try to expand. Even if any one of them doesn't intend to do so from the beginning, they need to join the competition once they see other empires are thriving. This is a matter of live-or-death (not of the patient) !
The quick answer to this situation – obviously by our honorable council members – is to increase the quota of medical student (and pupil nurse).
This is really a perfect illustration of the old Cantonese wisdom: 一闊三大
Wednesday, January 23, 2008
Resource
The story that I put up yesterday has further repercussions (I borrow this word from Sir Humphrey Appleby in Yes Prime Minister): where are those gastroenterologists coming from ?
From medical school, of course.
If we assume a gastroenterologist becomes independent at the age of 32 (graduates at 24, one year of houseman, seven years of specialty training) and retires at 60, the “working life expectancy” is 28 years. Since we need 56 extra gastroenterologists, there has to be 2 medical school graduates each year joining this program.
On a first glance, this is not a problem: we have 250 to 300 graduates each year.
(It would be a problem, however, if we follow what recently mentioned by the media: to screen everyone over 50-year of age yearly. In that case we need 1.5 million colonoscopy yearly, or around 420 gastroenterologists, which means 14 new gastroenterologists each year fresh from medical school.)
Nonetheless, there is a problem: how to persuade two highly intelligent young doctors each year to use (waste ?) their life and join this program ? Remind you, this is a monotonous life that work on nothing else. From our understanding of human nature, this is of course impossible. Even if they make a promise when they join, we know just too well how good a man (or woman, no sexual discrimination) can keep his promise. The result is – they either leave the system early, or they yet create another system of bureaucracy. Alas, even more people are needed !
Of course the more likely happening is these "screening gastroenterologists" will share their work load with the equal number of existing "general" gastroenterologists. Will their life be less boring ? No, just that all specialists of this field need to take half of their time to work on this program - with the same sequel.
There is an even deeper implication. If the number of medical student remains the same, our deduction means that each year two (hopefully not more) graduates would then be diverted from other important specialties. By promoting this program, we have a trivial fewer – say – ophthalmologist, surgeon, or cardiologist. Do you mean these people are now often at a leisure and enjoying extra pair of hands ?
From medical school, of course.
If we assume a gastroenterologist becomes independent at the age of 32 (graduates at 24, one year of houseman, seven years of specialty training) and retires at 60, the “working life expectancy” is 28 years. Since we need 56 extra gastroenterologists, there has to be 2 medical school graduates each year joining this program.
On a first glance, this is not a problem: we have 250 to 300 graduates each year.
(It would be a problem, however, if we follow what recently mentioned by the media: to screen everyone over 50-year of age yearly. In that case we need 1.5 million colonoscopy yearly, or around 420 gastroenterologists, which means 14 new gastroenterologists each year fresh from medical school.)
Nonetheless, there is a problem: how to persuade two highly intelligent young doctors each year to use (waste ?) their life and join this program ? Remind you, this is a monotonous life that work on nothing else. From our understanding of human nature, this is of course impossible. Even if they make a promise when they join, we know just too well how good a man (or woman, no sexual discrimination) can keep his promise. The result is – they either leave the system early, or they yet create another system of bureaucracy. Alas, even more people are needed !
Of course the more likely happening is these "screening gastroenterologists" will share their work load with the equal number of existing "general" gastroenterologists. Will their life be less boring ? No, just that all specialists of this field need to take half of their time to work on this program - with the same sequel.
There is an even deeper implication. If the number of medical student remains the same, our deduction means that each year two (hopefully not more) graduates would then be diverted from other important specialties. By promoting this program, we have a trivial fewer – say – ophthalmologist, surgeon, or cardiologist. Do you mean these people are now often at a leisure and enjoying extra pair of hands ?
Tuesday, January 22, 2008
Empire
There is an ever-increasing urge, mostly from the press and our honorable council members, for the government to put more resource on health care. “Money is not a problem.”
(Of course. Money is always not a problem; no money is the problem.)
OK, money is not a problem now. Can we do whatever we want ? Let’s take screening of colon cancer by endoscopy as the example. The unit price is merely HK$5000. If we do it for everyone over 60 year of age in Hong Kong every 5 years– assuming there are around one million eligible subjects – it costs HK$1000M each year. (If you know the expense of our Monetary Authority and what it doses, you would fully agree with me that HK$1000M is a negligible addition - to waste.) Maybe we can find some Mr. Li to donate !
But the story doesn’t end here. Who is going to do the endoscopy ? Gastroenterologist of course. How many of them do we need ? Let’s assume one fully trained gastroenterologist can do 10 colonoscopies each half-day session (an all too optimistic estimation), it will be 80 per week (5-day-week as ordered by some Mr. Tsang, one working day needed for clerical work, education, and breathing) and 3600 per year (45 weeks per year, allowing for leave and public holiday). Since we need 200,000 endoscopy each year, we need 56 gastroenterologists dedicated for a program of this kind – essentially doubling the number of existing manpower under government hospital.
(This is, no doubt, a highly unprofessional demonstration of health economics calculation. We have not considered the need for additional investigations for any abnormality detected, nor the manpower for pathologist and the all too important nurses.)
I am sure those aiming to build big empire would argue – more than ever - for a program of this kind after looking at this estimation. Or they may have think of it well ahead of us.
(PS. Don’t be mistaken and I have nothing against infra-diaphragmatic colleagues. If we do virtual colonoscopy for screening, we end up with the same numbers, but all those budding gastroenterologists become radiologists.)
(Of course. Money is always not a problem; no money is the problem.)
OK, money is not a problem now. Can we do whatever we want ? Let’s take screening of colon cancer by endoscopy as the example. The unit price is merely HK$5000. If we do it for everyone over 60 year of age in Hong Kong every 5 years– assuming there are around one million eligible subjects – it costs HK$1000M each year. (If you know the expense of our Monetary Authority and what it doses, you would fully agree with me that HK$1000M is a negligible addition - to waste.) Maybe we can find some Mr. Li to donate !
But the story doesn’t end here. Who is going to do the endoscopy ? Gastroenterologist of course. How many of them do we need ? Let’s assume one fully trained gastroenterologist can do 10 colonoscopies each half-day session (an all too optimistic estimation), it will be 80 per week (5-day-week as ordered by some Mr. Tsang, one working day needed for clerical work, education, and breathing) and 3600 per year (45 weeks per year, allowing for leave and public holiday). Since we need 200,000 endoscopy each year, we need 56 gastroenterologists dedicated for a program of this kind – essentially doubling the number of existing manpower under government hospital.
(This is, no doubt, a highly unprofessional demonstration of health economics calculation. We have not considered the need for additional investigations for any abnormality detected, nor the manpower for pathologist and the all too important nurses.)
I am sure those aiming to build big empire would argue – more than ever - for a program of this kind after looking at this estimation. Or they may have think of it well ahead of us.
(PS. Don’t be mistaken and I have nothing against infra-diaphragmatic colleagues. If we do virtual colonoscopy for screening, we end up with the same numbers, but all those budding gastroenterologists become radiologists.)
Monday, January 21, 2008
Clinical job
A few of our colleagues leave for non-clinical job in the recent years, and it looks as if there are a few more to come. In fact, the little girl who joined us for a week or so is considering resign - the stress is just too much.
I consider it as a failure of the system - of the medical school (or the education system as a whole). Although medical career has a broad sense and encompasses many "non-clinical" jobs - pathologists, microbiologists, radiologists, and anesthetists - the majority of our graduates should end up doing clinical ones. (In fact, many non-clinical doctors would have an edge if they have clinical experience.) If we assume personality, including the capability of handling stress, cannot be altered, we must have recruited inappropriate students to the medical school, and we should do some kind of personality test for the applicants - not just look at their high school examination result.
KM and so forth laugh at this idea; I cannot agree either. True, personality cannot be changed; but capability of handling stress can. Alas, at least people can be desensitized. Nowadays our educationalists are so kind to the students - not only in medical school, but from the very kids onwards - that they have never walked on their own feet until they first see a hungry tiger. No wonder they are quickly torn into pieces.
I consider it as a failure of the system - of the medical school (or the education system as a whole). Although medical career has a broad sense and encompasses many "non-clinical" jobs - pathologists, microbiologists, radiologists, and anesthetists - the majority of our graduates should end up doing clinical ones. (In fact, many non-clinical doctors would have an edge if they have clinical experience.) If we assume personality, including the capability of handling stress, cannot be altered, we must have recruited inappropriate students to the medical school, and we should do some kind of personality test for the applicants - not just look at their high school examination result.
KM and so forth laugh at this idea; I cannot agree either. True, personality cannot be changed; but capability of handling stress can. Alas, at least people can be desensitized. Nowadays our educationalists are so kind to the students - not only in medical school, but from the very kids onwards - that they have never walked on their own feet until they first see a hungry tiger. No wonder they are quickly torn into pieces.
Sunday, January 20, 2008
Useless
After reading my previous notes Anatomy, you may ask: even if time is not a limiting factor, why should we teach so much anatomy ? (Now, it is equivalent to: can we do away with bare bone and just leave the marrow ?)
This question bring my memory back to the old traditional examination system in China, when all candidates were tested on one - and one highly artificial - style of writing: the eight-legged assay (八股文). It was obvious that this writing style had no practical value what so ever, and was quickly dropped (after being used for over 300 years as the method for the selection of government officials) once the Qing Empire (清朝) collapse.
What happened ? Nothing, except the new officials were a shade less compliant to rules and less capable of juggling with words (alas, government documents). Of course ! The eight-legged assay, if it serves no other purpose, is an excellent personality test on compliance to regulation and a superb quiz on words. Anatomy, if it does not help us to learn clinical medicine, at least it could train our memory - for terms that we cannot understand ! - and a vigorous anatomy examination is no doubt the best training for our ability to handle stress.
Perhaps this is what Zhuangzi (莊子) means: the use of useless (無用之用).
This question bring my memory back to the old traditional examination system in China, when all candidates were tested on one - and one highly artificial - style of writing: the eight-legged assay (八股文). It was obvious that this writing style had no practical value what so ever, and was quickly dropped (after being used for over 300 years as the method for the selection of government officials) once the Qing Empire (清朝) collapse.
What happened ? Nothing, except the new officials were a shade less compliant to rules and less capable of juggling with words (alas, government documents). Of course ! The eight-legged assay, if it serves no other purpose, is an excellent personality test on compliance to regulation and a superb quiz on words. Anatomy, if it does not help us to learn clinical medicine, at least it could train our memory - for terms that we cannot understand ! - and a vigorous anatomy examination is no doubt the best training for our ability to handle stress.
Perhaps this is what Zhuangzi (莊子) means: the use of useless (無用之用).
Saturday, January 19, 2008
Discussion
The man from Pluto sends out a mass email, commenting on the poor quality of the "Life long learning skill" assay submitted by our students. Materials are unedited copies from textbooks without considering the case being discussed (worst scenario I have ever seen: pregnancy as a possible underlying risk factor of pulmonary embolism in a 70-year-old man), and few students could cite relevant literature.
This is, alas, one of the uncommon incidents that I agree with an extra-terrestrial.
A collection of senior educationalists who used to live (I believe) in Pluto, but recently move out of the solar system, make several reply emails as a response - an eye-opening experience for me and a vivid demonstration of creative use of English:
"This project is not under my supervision ... but I would like to share my concern on their teaching about this project." (Boring ? Let's see what comes next.)
"I fully agree. In fact I have even more concern on the use of manikins for the teaching of this project ..."
"Yes, the use of manikins has a lot of problem in general ..."
"Maybe we should discuss how to use more real subjects for teaching ..."
"Clinical teaching is such a big area. I would like to share my concern on ..."
(Alas, what was we discussing originally ? Who cares !?)
When I was a child, I enjoyed very much playing the megaphones game (傳聲筒遊戲) - it is really fun to see how meanings of a conversation could be distorted when passed from one to another. I am so thick and could only realize now that many poker-face officials are in fact superb players of this game - in written language - and such sneak thieves in distracting our attention to the problem at hand.
This is, alas, one of the uncommon incidents that I agree with an extra-terrestrial.
A collection of senior educationalists who used to live (I believe) in Pluto, but recently move out of the solar system, make several reply emails as a response - an eye-opening experience for me and a vivid demonstration of creative use of English:
"This project is not under my supervision ... but I would like to share my concern on their teaching about this project." (Boring ? Let's see what comes next.)
"I fully agree. In fact I have even more concern on the use of manikins for the teaching of this project ..."
"Yes, the use of manikins has a lot of problem in general ..."
"Maybe we should discuss how to use more real subjects for teaching ..."
"Clinical teaching is such a big area. I would like to share my concern on ..."
(Alas, what was we discussing originally ? Who cares !?)
When I was a child, I enjoyed very much playing the megaphones game (傳聲筒遊戲) - it is really fun to see how meanings of a conversation could be distorted when passed from one to another. I am so thick and could only realize now that many poker-face officials are in fact superb players of this game - in written language - and such sneak thieves in distracting our attention to the problem at hand.
Friday, January 18, 2008
Granuloma
Don't be mistaken. I have no prejudice against B cells.
Although cellular immunity (administration) is important, the most common form of overactivity is a whole mass of T cells call a meeting and sit together - usually because of something not digestible. The result is, alas, granuloma - not an effective way of self defence (or administration).
For those with some knowledge on histology would know: granuloma do not only have T cells, and meetings do not only involve administrators. Lymphocytes invite (force) a collection of macrophage to sit around - which are working hands and not meant for the talking. No wonder when we sit there, our faces transform and change in colour - we become histiocytes !
Although cellular immunity (administration) is important, the most common form of overactivity is a whole mass of T cells call a meeting and sit together - usually because of something not digestible. The result is, alas, granuloma - not an effective way of self defence (or administration).
For those with some knowledge on histology would know: granuloma do not only have T cells, and meetings do not only involve administrators. Lymphocytes invite (force) a collection of macrophage to sit around - which are working hands and not meant for the talking. No wonder when we sit there, our faces transform and change in colour - we become histiocytes !
Thursday, January 17, 2008
Lymphocytes
Received a few verbose emails on various new policies and their justification (excuse ?). This kind of mail - and memo - is all too common nowadays; a few of the senior officials are well known to be keen on polishing their English and training front-line staff on cursory reading.
Is it an effective way of administration ? Many believe so. To someone with immunology background, they are walking (writing ?) examples of B lymphocytes that hide themselves in the marrow (i.e. their office) and keep producing immunoglobulin - and try to make things happen in a distance.
The more important way of body defence - alas, communication - is, as we all know, T lymphocytes that talk to each other and their targets face-to-face.
Well, B cells without helper T cells are rather useless - they just produce the same email (antibody) without class switch. Unchecked B cell activity without T cell control either produces too much immunoglobulin and attacking their own self (autoimmune disease), or it being a malignancy.
Is it an effective way of administration ? Many believe so. To someone with immunology background, they are walking (writing ?) examples of B lymphocytes that hide themselves in the marrow (i.e. their office) and keep producing immunoglobulin - and try to make things happen in a distance.
The more important way of body defence - alas, communication - is, as we all know, T lymphocytes that talk to each other and their targets face-to-face.
Well, B cells without helper T cells are rather useless - they just produce the same email (antibody) without class switch. Unchecked B cell activity without T cell control either produces too much immunoglobulin and attacking their own self (autoimmune disease), or it being a malignancy.
Wednesday, January 16, 2008
Anatomy
Had an interesting discussion with Vivian on the anatomy of the autonomic nervous supply to the rectum. As usual, I ended up with the question, "How did you pass the FRCS exit examination ?"
"That's not a problem. I can always check the textbook whenever I am not sure." She is quite true. In fact it is safe practice to look up the reference rather than rely on our rusty memory, and to many of us (non-surgeons), a large body of knowledge on anatomy seems rather useless - except when I argue with my surgeon wife ! (By the way, Vivian knows very well that one of my wildest dreams is to be invited as the external examiner of surgery, be it final MB or FRCS.)
The question therefore becomes why do we teach so much anatomy in pre-clinical years ? The "problem" was in fact well taken by our educationalists and teaching on anatomy has been very much trim down - to allow time for important topics. Great.
Nonetheless, we apply anatomy knowledge every now and then in our learning and practising of clinical medicine, and it is often difficult to predict which bit of the knowledge becomes useful in the future. (Who can predict one has a surgeon wife ?) Medical school should not only teach bare bone basic knowledge, it should give some exposure to the breadth and depth of all field of medicine. To teach less anatomy is, seriously, an unwilling compromise after consideration on its opportunistic cost.
"That's not a problem. I can always check the textbook whenever I am not sure." She is quite true. In fact it is safe practice to look up the reference rather than rely on our rusty memory, and to many of us (non-surgeons), a large body of knowledge on anatomy seems rather useless - except when I argue with my surgeon wife ! (By the way, Vivian knows very well that one of my wildest dreams is to be invited as the external examiner of surgery, be it final MB or FRCS.)
The question therefore becomes why do we teach so much anatomy in pre-clinical years ? The "problem" was in fact well taken by our educationalists and teaching on anatomy has been very much trim down - to allow time for important topics. Great.
Nonetheless, we apply anatomy knowledge every now and then in our learning and practising of clinical medicine, and it is often difficult to predict which bit of the knowledge becomes useful in the future. (Who can predict one has a surgeon wife ?) Medical school should not only teach bare bone basic knowledge, it should give some exposure to the breadth and depth of all field of medicine. To teach less anatomy is, seriously, an unwilling compromise after consideration on its opportunistic cost.
Tuesday, January 15, 2008
Memory
Amazed to hear questions like "In trial X, what is the percentage of subjects having this complication ?" in some diploma examination. Oh, I should not be amazed - some specialists ask similar questions on numeric details in MB examination.
Those who have read A Study in Scarlet would remember very well the analogy that Sherlock Holmes put up when he was asked on questions about the solar system: our memory is a (small) room with limited capacity. We should not put in too much irrelevant things, otherwise there would be not place for useful information.
What our great detective didn't say was that the room in Baker Street 221B has a very high roof - so as most of the rooms of our memory. We put numeric details on the floor (where they deserve !), occupying very much of our room. What one should aim for is really to see the relation between items and appreciate the underlying principles - so that we can pile up the items without taking up much space.
Those who have read A Study in Scarlet would remember very well the analogy that Sherlock Holmes put up when he was asked on questions about the solar system: our memory is a (small) room with limited capacity. We should not put in too much irrelevant things, otherwise there would be not place for useful information.
What our great detective didn't say was that the room in Baker Street 221B has a very high roof - so as most of the rooms of our memory. We put numeric details on the floor (where they deserve !), occupying very much of our room. What one should aim for is really to see the relation between items and appreciate the underlying principles - so that we can pile up the items without taking up much space.
Monday, January 14, 2008
Mutation
Attending a course on computer training at the moment. (I really mean at the moment. The others are doing the on-line exercise but as a naughty student I surf around with my browser !)
There are in fact quite a number of mistakes in the exercise: the handout was prepared for a previous course but the on-line program for another one. Many of the research nurses around, who are typically meticulous with details, therefore find the thing confusing. The situation is just like cells with high fidelity DNA polymerase would not be able to replicate when there is a lot of damage in the DNA. Being a bacterium with error-prone enzyme, it is of course not a problem of mine !
There are in fact quite a number of mistakes in the exercise: the handout was prepared for a previous course but the on-line program for another one. Many of the research nurses around, who are typically meticulous with details, therefore find the thing confusing. The situation is just like cells with high fidelity DNA polymerase would not be able to replicate when there is a lot of damage in the DNA. Being a bacterium with error-prone enzyme, it is of course not a problem of mine !
Sunday, January 13, 2008
Detective story
Read The Honjin Murder (本陣殺人事件) by Seishi Yokomizo (横溝正史) on my way to Singapore. It is in fact a very short story and I probably finished with it before my plane passed Vietnam.
Is it good ? My eternal answer is: I have seen better ones.
The first time I read any detective story was in the summer holiday before advancing to the final year of my medical school, under extreme fatigue following a whole week of assistant intern in general surgery. (At that time AI had to present in grand round, and the team head was AL - our previous VC !) The first one I read was The Murder of Roger Ackroyd by Agatha Christie.
For any one who has read this story, you could probably understand why I said I have seen better ones. Of course there are many other brilliant authors and fascinating stories, I could hardly find one substantially better - hampering very much on my interest in reading more detective story. Highly educated taste buds make a good gourmet - but at the same time one also loses the chance to enjoy everyday food.
Is it good ? My eternal answer is: I have seen better ones.
The first time I read any detective story was in the summer holiday before advancing to the final year of my medical school, under extreme fatigue following a whole week of assistant intern in general surgery. (At that time AI had to present in grand round, and the team head was AL - our previous VC !) The first one I read was The Murder of Roger Ackroyd by Agatha Christie.
For any one who has read this story, you could probably understand why I said I have seen better ones. Of course there are many other brilliant authors and fascinating stories, I could hardly find one substantially better - hampering very much on my interest in reading more detective story. Highly educated taste buds make a good gourmet - but at the same time one also loses the chance to enjoy everyday food.
Saturday, January 12, 2008
Communcation problem
Thirty years ago, the rubbish-bin explanation of all life's questions was: it is the fault of the society.
Now, the answer is: it is a problem of communication.
When there is a medical incident, it is a communication problem. When someone hangs himself after his CSSA is discontinued, it is a communication problem. What communication are we talking about ? The proper procedure is described in the textbook but is not read. The practice is in the guideline but is forgotten. (Alas, there are so many guidelines.) It is remembered but so difficult to follow - and therefore shortcuts. There was a way to help but nobody told the victim. Someone did tell the victim but no one made sure the victim seek help. He did seek help but was turned away - because he did not convey his problem clearly ...
I am sure an extra-terrestrial student on human language would come to the conclusion that "communication problem" means Satan - or merely the long form of space bar ?
Now, the answer is: it is a problem of communication.
When there is a medical incident, it is a communication problem. When someone hangs himself after his CSSA is discontinued, it is a communication problem. What communication are we talking about ? The proper procedure is described in the textbook but is not read. The practice is in the guideline but is forgotten. (Alas, there are so many guidelines.) It is remembered but so difficult to follow - and therefore shortcuts. There was a way to help but nobody told the victim. Someone did tell the victim but no one made sure the victim seek help. He did seek help but was turned away - because he did not convey his problem clearly ...
I am sure an extra-terrestrial student on human language would come to the conclusion that "communication problem" means Satan - or merely the long form of space bar ?
Friday, January 11, 2008
Herbs
"What is the cause of XXX ?" asked in the grand round. The XXX could stand for kidney problem, liver problem, confusion, or any nondescript symptom.
"It is herb-induced."
Alas, the crowd march to next bed. What a convenient answer ! Herb has become a rubbish bin: any problem that we cannot explain - or do not have time to explain - we take it as herbs. How often is it proved ?
We know very well that there is not much firm scientific evidence - randomized control trial - on the efficacy of herbs on any medical condition. (This simple fact seems not being recognized by our government and local granting agencies - another excellent example that planned economy always fails.) Nonetheless, there is equally limited amount of evidence on clinical problems caused by herbs - except a few highly characteristic ones.
You may not like herbalists, but it is exactly for that reason you should not attack them by their (lack of) logic and argument.
"It is herb-induced."
Alas, the crowd march to next bed. What a convenient answer ! Herb has become a rubbish bin: any problem that we cannot explain - or do not have time to explain - we take it as herbs. How often is it proved ?
We know very well that there is not much firm scientific evidence - randomized control trial - on the efficacy of herbs on any medical condition. (This simple fact seems not being recognized by our government and local granting agencies - another excellent example that planned economy always fails.) Nonetheless, there is equally limited amount of evidence on clinical problems caused by herbs - except a few highly characteristic ones.
You may not like herbalists, but it is exactly for that reason you should not attack them by their (lack of) logic and argument.
Thursday, January 10, 2008
Tuna
It's all on the headline a few days ago: a man from Hong Kong successfully bid the biggest wild blue-fin tuna from the fish market of Tokyo on the first day of this year.
Take aside the potential consequence of provoking unpredictable reaction by local Japanese, and that the quality of nationalism of our local paper remained stagnant for a century, I know very well that wild blue-fin tuna is a much endangered species. My spinal cord with a sense of environment protection tells me that this kind of catching and bidding for big tuna does harm to the ocean. I feel satisfied with the small fishes for my dinner. Should I be happy ?
I ask my mum, "Where do these fishes come from ?"
"Fresh catch from sea, of course." she has an obsession for fresh food.
I know just too well: fresh catch by fine-eye nets, and hopefully not explosives. Whatever the method, it got to be an exhaustive one: small fishes could not get through - before they become big enough to have offspring.
An ice-cold feeling appears on my back. When Europeans (Vikings) spread from Scandinavia to Iceland and then settled in Greenland, the already limited natural resources there - wood, grass, pure water - were gradually depleted. Those unfortunate Greenlanders ran into desperate famine, and gradually ate up their goat (or sheep) - so that they had no more milk - and then baby goats - so that there was no further breeding. The goats became extinct, and then the men. Oh, my god !
I am speechless - not knowing what to do. But I am sure I will finish with my dish and shall not in the future order one that I cannot complete - be it big tuna or small sardines. Maybe Snowball of George Orwell is right when it comes to the end: all animals are equal.
Take aside the potential consequence of provoking unpredictable reaction by local Japanese, and that the quality of nationalism of our local paper remained stagnant for a century, I know very well that wild blue-fin tuna is a much endangered species. My spinal cord with a sense of environment protection tells me that this kind of catching and bidding for big tuna does harm to the ocean. I feel satisfied with the small fishes for my dinner. Should I be happy ?
I ask my mum, "Where do these fishes come from ?"
"Fresh catch from sea, of course." she has an obsession for fresh food.
I know just too well: fresh catch by fine-eye nets, and hopefully not explosives. Whatever the method, it got to be an exhaustive one: small fishes could not get through - before they become big enough to have offspring.
An ice-cold feeling appears on my back. When Europeans (Vikings) spread from Scandinavia to Iceland and then settled in Greenland, the already limited natural resources there - wood, grass, pure water - were gradually depleted. Those unfortunate Greenlanders ran into desperate famine, and gradually ate up their goat (or sheep) - so that they had no more milk - and then baby goats - so that there was no further breeding. The goats became extinct, and then the men. Oh, my god !
I am speechless - not knowing what to do. But I am sure I will finish with my dish and shall not in the future order one that I cannot complete - be it big tuna or small sardines. Maybe Snowball of George Orwell is right when it comes to the end: all animals are equal.
Wednesday, January 9, 2008
Tie
There is a hot debate on whether we should wear tie, long sleeves and watches in workplace. (Those interested please read the editorial of Lancet on 29 September 2007, and the explosion of correspondence afterwards.)
The story started from the release of the UK Department of Health's uniform and workwear guidance. People for this idea believed that these measures could reduce the risk of nosocomial infection, especially by MRSA. The others argued that the (published) evidence was weak, and we should not blindly follow political bodies. There is also evidence that ties, white coats and long-sleeves do facilitate trust on the doctor.
What should we expect from our students ? In the old days we insisted males ones to wear ties and formal (long sleeve) white coat when they came to the ward, and have a watch - with a second arm to count the pulse rate - when they came for exam. It seems that the old dictum is correct again: half of what we teach our student is wrong, but we don't know which half.
I try to convince myself that that doesn't matter. If they have considered the pros and cons and make a judgement, that's good enough. But the problem is: how could I tell ? A student appears in the ward without a tie: Has he considered both sides of the argument and decided that tie is risky ? Or is he just back from the tennis court ?
(Alas, that's probably why this student think that I look blank and keep talking to plants.)
The story started from the release of the UK Department of Health's uniform and workwear guidance. People for this idea believed that these measures could reduce the risk of nosocomial infection, especially by MRSA. The others argued that the (published) evidence was weak, and we should not blindly follow political bodies. There is also evidence that ties, white coats and long-sleeves do facilitate trust on the doctor.
What should we expect from our students ? In the old days we insisted males ones to wear ties and formal (long sleeve) white coat when they came to the ward, and have a watch - with a second arm to count the pulse rate - when they came for exam. It seems that the old dictum is correct again: half of what we teach our student is wrong, but we don't know which half.
I try to convince myself that that doesn't matter. If they have considered the pros and cons and make a judgement, that's good enough. But the problem is: how could I tell ? A student appears in the ward without a tie: Has he considered both sides of the argument and decided that tie is risky ? Or is he just back from the tennis court ?
(Alas, that's probably why this student think that I look blank and keep talking to plants.)
Tuesday, January 8, 2008
Two heads
Our sister team recently recruited two seniors (accidentally, I hope). To avoid the obvious conflict, one is designated as the division head, and the other the director of service within the cluster - of 3 hospitals.
Then, who is the man with the final say ?
I have a deja vu feeling. Some years ago when Chelsea won the League Champion of England while Liverpool got the European Champions Cup, fans and managers of the two sides broke into fierce arguement - which team was better ?
Alas, as Hercule Poirot pointed out (in the Murder on the Oriental Express): this must be not by chance, but design - Oh, don't be paranoid; I am not talking about football.
(PS. My father was a fans of Liverpool and I inherited the same alleles. That's not good for making judgement, I know.)
Then, who is the man with the final say ?
I have a deja vu feeling. Some years ago when Chelsea won the League Champion of England while Liverpool got the European Champions Cup, fans and managers of the two sides broke into fierce arguement - which team was better ?
Alas, as Hercule Poirot pointed out (in the Murder on the Oriental Express): this must be not by chance, but design - Oh, don't be paranoid; I am not talking about football.
(PS. My father was a fans of Liverpool and I inherited the same alleles. That's not good for making judgement, I know.)
Monday, January 7, 2008
Supervision
An old story: Two men were caught up in a fire, one was blind and the other paraplegic. The former put the latter on his back, whose good vision guided both of them out of the trouble.
A small side-kick not told with this tale is: a third man on the scene, with good vision and no weak leg, could not escape. No, this is not an IQ test to pull your legs. This man just saw the fire around the door and thought that it was too dangerous to go - alas, too painful for his feet to step on the red hot floor. (This was of course not a problem for our paraplegic hero - the pain was not on his feet. We can imagine he put as much encouragement as he could to sooth the blind man's feet, just to make sure they could get out of the fire !)
I gradually learn that this paraplegic hero is often called supervisor, and the blind trainee. Some heroes of course have no weak legs and can theoretically get out of the fire by themselves. Nonetheless it seems better to sit on the back of some blind one - not (only) to save the latter, but it is more difficult to guide your own legs without any consideration of the feeling.
A small side-kick not told with this tale is: a third man on the scene, with good vision and no weak leg, could not escape. No, this is not an IQ test to pull your legs. This man just saw the fire around the door and thought that it was too dangerous to go - alas, too painful for his feet to step on the red hot floor. (This was of course not a problem for our paraplegic hero - the pain was not on his feet. We can imagine he put as much encouragement as he could to sooth the blind man's feet, just to make sure they could get out of the fire !)
I gradually learn that this paraplegic hero is often called supervisor, and the blind trainee. Some heroes of course have no weak legs and can theoretically get out of the fire by themselves. Nonetheless it seems better to sit on the back of some blind one - not (only) to save the latter, but it is more difficult to guide your own legs without any consideration of the feeling.
Sunday, January 6, 2008
Cost
On thinking twice, I begin to doubt whether we really know the cost.
One example at hand is organic farming, which many of us are so fond of nowadays. Of course there is no chemical and therefore not much pollution. The crops are a little more expensive, but we can afford - so what ?
The very fact behind the stage is that organic farming needs, on average, eight times more land. (Or, from another angle, the yield per field is one-eighth.) When farmers in developed countries put excessive crops to ash we scream like hell for their neglecting those hungry children in Africa. But to whom we should yell when we use fertile lands for organic farming - while we can use the land to feed more people ? (You can take this arithmetic analogy: we eat eight times more food because we can afford; just close one of your eyes to the famine outside the door.)
You may say the land is ours, and we have the money. Well, the money is yours, but the natural resource belongs to every man on earth (if you believe all men are equal). One should not waste natural resource because they have the money - and put the others in jeopardy.
(Alas, I am not sure all men are equal. But it just irritates my eyes because most of the supporters of organic farming don't agree with George Orwell and think that even all animals are equal.)
One example at hand is organic farming, which many of us are so fond of nowadays. Of course there is no chemical and therefore not much pollution. The crops are a little more expensive, but we can afford - so what ?
The very fact behind the stage is that organic farming needs, on average, eight times more land. (Or, from another angle, the yield per field is one-eighth.) When farmers in developed countries put excessive crops to ash we scream like hell for their neglecting those hungry children in Africa. But to whom we should yell when we use fertile lands for organic farming - while we can use the land to feed more people ? (You can take this arithmetic analogy: we eat eight times more food because we can afford; just close one of your eyes to the famine outside the door.)
You may say the land is ours, and we have the money. Well, the money is yours, but the natural resource belongs to every man on earth (if you believe all men are equal). One should not waste natural resource because they have the money - and put the others in jeopardy.
(Alas, I am not sure all men are equal. But it just irritates my eyes because most of the supporters of organic farming don't agree with George Orwell and think that even all animals are equal.)
Saturday, January 5, 2008
Diary
I am recently struggling whether I should continue to write diary - after I start writing the blog. On a first glance, it seems a waste of effort.
Nonetheless, I realize I do not write the same thing on the two. As KM says, our blog is a wardrobe to display the best clothes - to friends and, if you like, peepers; diary is for our secret self. It is always an enjoyable experience to read our own diary - not really for the pleasure of reading but for the very catalyst to bring back old memory, usually with boring details turned fast-forward and bitter stories sweetened. After all, what can we really earn from this world besides memory ?
Ayako Miura (三浦綾子) once said: a person who has continued to write diary for 5 years - because of his persistence and determination - would be successful in some aspect of his life. Alas, I don't need to be successful in four aspects (or more); some flash-back when I become demented is a treasure on its own.
Nonetheless, I realize I do not write the same thing on the two. As KM says, our blog is a wardrobe to display the best clothes - to friends and, if you like, peepers; diary is for our secret self. It is always an enjoyable experience to read our own diary - not really for the pleasure of reading but for the very catalyst to bring back old memory, usually with boring details turned fast-forward and bitter stories sweetened. After all, what can we really earn from this world besides memory ?
Ayako Miura (三浦綾子) once said: a person who has continued to write diary for 5 years - because of his persistence and determination - would be successful in some aspect of his life. Alas, I don't need to be successful in four aspects (or more); some flash-back when I become demented is a treasure on its own.
Friday, January 4, 2008
Learning objective
A group from Pluto has set off to define "Learning Objectives" for our students.
Don't be mistaken. This is not a one-line motto, but 500-page (if not more) arm-breaking Bible, listing things - in all "dimensions" - that the faculty expect a student to master, down to the detail of each month (or each week).
I fainted with the idea. (Eye-witness told my doctor that I had a seizure.) Didn't we give up something called "syllabus" not so long ago ?
"This is different," so was I told by this group from Pluto. Yes. It is more comprehensive. It is so comprehensive that an ordinary student would take five years to read the objective per se.
Why can't we just adopt, say, the table of content of Harrison (or Kumar & Clark if you like) as the syllabus - sorry, "Learning Objectives" - of internal medicine ? Are we implying that Harrison deliberately omits important areas on the practice of internal medicine ? (Even if it does, one can add a short appendix to fix it up.)
No, we should not do that. The learning objective - I get it right at last - should be one simple sentence: to learn the practice and relevant scientific background of anything and everything that is related to clinical medicine, with the target of being able to be safe junior medical officer.
"But what are the things that is related to the practice ?" Go to the ward and clinic and find out yourself !
"But the GMC people are doing it in Britian !"
Good lord. We are not on the Titanic. You jump - I do not have to follow.
Don't be mistaken. This is not a one-line motto, but 500-page (if not more) arm-breaking Bible, listing things - in all "dimensions" - that the faculty expect a student to master, down to the detail of each month (or each week).
I fainted with the idea. (Eye-witness told my doctor that I had a seizure.) Didn't we give up something called "syllabus" not so long ago ?
"This is different," so was I told by this group from Pluto. Yes. It is more comprehensive. It is so comprehensive that an ordinary student would take five years to read the objective per se.
Why can't we just adopt, say, the table of content of Harrison (or Kumar & Clark if you like) as the syllabus - sorry, "Learning Objectives" - of internal medicine ? Are we implying that Harrison deliberately omits important areas on the practice of internal medicine ? (Even if it does, one can add a short appendix to fix it up.)
No, we should not do that. The learning objective - I get it right at last - should be one simple sentence: to learn the practice and relevant scientific background of anything and everything that is related to clinical medicine, with the target of being able to be safe junior medical officer.
"But what are the things that is related to the practice ?" Go to the ward and clinic and find out yourself !
"But the GMC people are doing it in Britian !"
Good lord. We are not on the Titanic. You jump - I do not have to follow.
Thursday, January 3, 2008
陳公博
My knowing of Chen Gongbo (陳公博) largely comes from a novel on Wang Jingwei (汪精衛) and Wang's wife (陳璧君). Chen was the right-hand man of Wang. Yes, that's around the time of the movie "Lust-Caution".
Chen's story that attracts me was plain simple. When Wang died at the convenient time before the - by then foreseeable and unavoidable - collapse of Japanese army, Wang's wife urged Chen to take charge of the (pseudo) Chinese government at Nanjing. Chen knew all too well that that would cost his life, but he accepted without a second word - Wang was his mentor; the show must go on until the music ended (be it a horrible tragedy).
That is, of course, in a novel. The annoying bit is, when I first read the story, I was told that it was genuine history. (It is always difficult to change once you form an opinion.)
We Chinese used to be proud of our 3000 years of written history. Nonetheless we have lost that era: there has been no objective account during that time and it is impossible to have one in the future. People with first-hand experience have vanished and important documents destroyed. It is a people who were drunk and drugged - for a century ! - and, when they woke up, there was no recollection of what had happened.
(They have some fragmented memory - some real, some hallucinations from their drugged mind. Stories are written as novel but treated as history. My god !)
Alas, maybe you are right. If there were a good account of what had happened, I may not wish to dine with Chen at all. The dark side is, in that case, I have no one in the history of my home country - no political character at least - whom I would like to dine with.
Chen's story that attracts me was plain simple. When Wang died at the convenient time before the - by then foreseeable and unavoidable - collapse of Japanese army, Wang's wife urged Chen to take charge of the (pseudo) Chinese government at Nanjing. Chen knew all too well that that would cost his life, but he accepted without a second word - Wang was his mentor; the show must go on until the music ended (be it a horrible tragedy).
That is, of course, in a novel. The annoying bit is, when I first read the story, I was told that it was genuine history. (It is always difficult to change once you form an opinion.)
We Chinese used to be proud of our 3000 years of written history. Nonetheless we have lost that era: there has been no objective account during that time and it is impossible to have one in the future. People with first-hand experience have vanished and important documents destroyed. It is a people who were drunk and drugged - for a century ! - and, when they woke up, there was no recollection of what had happened.
(They have some fragmented memory - some real, some hallucinations from their drugged mind. Stories are written as novel but treated as history. My god !)
Alas, maybe you are right. If there were a good account of what had happened, I may not wish to dine with Chen at all. The dark side is, in that case, I have no one in the history of my home country - no political character at least - whom I would like to dine with.
Wednesday, January 2, 2008
Hawking
I used to believe Stephen Hawking doesn't need much introduction. With an all too disabled physique but probably the best brain of the world (possibly of the history of mankind), who can be more legendary ?
Nevertheless, this view is not shared by everyone, and some universities (at least one) refuse to pay for his visit. (Some rumour says for merely US$100,000.) Economist asks: is it cost-effective ? Who would pay for US$500 in order to dine with him ?
I will.
And many people who wish to salute to good science would.
We know the cost very well, but who knows the effect ? If we need all measurable effects there should be no research in pure science. (There should, in fact, be no industry. All one care is speculation in stock market - alas, Hong Kong people !) When Albert Einstein first arrived at the States, neither he nor Princeton knew what the effect of the Theory of Relativity would be - not until August 6, 1945 at Hiroshima.
As Einstein himself once said: not everything that can be counted counts, and not everything that counts can be counted.
Nevertheless, this view is not shared by everyone, and some universities (at least one) refuse to pay for his visit. (Some rumour says for merely US$100,000.) Economist asks: is it cost-effective ? Who would pay for US$500 in order to dine with him ?
I will.
And many people who wish to salute to good science would.
We know the cost very well, but who knows the effect ? If we need all measurable effects there should be no research in pure science. (There should, in fact, be no industry. All one care is speculation in stock market - alas, Hong Kong people !) When Albert Einstein first arrived at the States, neither he nor Princeton knew what the effect of the Theory of Relativity would be - not until August 6, 1945 at Hiroshima.
As Einstein himself once said: not everything that can be counted counts, and not everything that counts can be counted.
Tuesday, January 1, 2008
Kassirer
I first read New England Journal of Medicine in 1990 when I was a final year medical student. At that moment Jerome Kassirer was the editor-in-chief.
That was a time when all Case Records of the Massachusetts General Hospital were diagnostic problems, and almost all presentations ended with the mysterious sentence: a diagnostic procedure was performed. I was soon attracted by this weekly intellectual exercise - and to internal medicine.
Some years later I entered the field of renal medicine, and Kidney International became the regular reading. There was a (now obsolete) section called Nephrology Forum, in which experts were invited to discuss special cases and topics. The coordinators of this project, as stated on the journal, were Cohen, Harrington, and Madias. It took me some years to find out that Kassirer was a nephrologist by profession and indeed one of the founder of this Forum.
To me, the most glaring contribution of Kassirer was, however, not to nephrology or his editorship of the New England Journal, but the editorials that he actually wrote. In an era of being "neutral", Kassirer was never shy of giving his point of view - on important issues related to public and health care in general. Yes, as the in-charge of a leading medical journal, silence on important issue does not mean neutral - it is negligence. In a world flooded with information, we need someone to show us the way to the shore.
That was a time when all Case Records of the Massachusetts General Hospital were diagnostic problems, and almost all presentations ended with the mysterious sentence: a diagnostic procedure was performed. I was soon attracted by this weekly intellectual exercise - and to internal medicine.
Some years later I entered the field of renal medicine, and Kidney International became the regular reading. There was a (now obsolete) section called Nephrology Forum, in which experts were invited to discuss special cases and topics. The coordinators of this project, as stated on the journal, were Cohen, Harrington, and Madias. It took me some years to find out that Kassirer was a nephrologist by profession and indeed one of the founder of this Forum.
To me, the most glaring contribution of Kassirer was, however, not to nephrology or his editorship of the New England Journal, but the editorials that he actually wrote. In an era of being "neutral", Kassirer was never shy of giving his point of view - on important issues related to public and health care in general. Yes, as the in-charge of a leading medical journal, silence on important issue does not mean neutral - it is negligence. In a world flooded with information, we need someone to show us the way to the shore.
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