Solution

Don’t be too excited. I’m not going to say there are solutions for medicine as such – but there are for those working in this field.

Oh, when it comes to survival – I do not mean the patient – we all become very creative.

One of the strategies that we have is to make use of the advance in technology.

You know what. When something new is measured – by say, a digital gadget for 5-dimension monitoring of molecular movement that we borrow from Nintendo – we can start a new round of exercise. You have a (possible) new treatment ? Good, let's do a trial for 2 weeks and measure the change with our new toy. (If there are many parameters measurable, it is even better !)

Why don't we use the traditional outcome (say, mortality) ? Simple. It needs many subjects and takes ages. Don't you know there is a group from Pluto called "Research Assessment Exercise" ? They come and visit you - to audit your publication output - every three years.

Your career succumbs before your patients.

Difficulty

VW and TL – two upcoming colleagues of my department – find my blog on academics reflect (part of) their difficulties.

On a second thought, that's not a problem of new researchers, but the one for medicine as a whole.

Why could we have good single center randomized trials thirty years ago on a few hundred subjects ? Because there were common conditions with high mortality (or morbidity). Once you have a treatment that improves the adverse outcome from, say, 40% to 10%, you don't need many patients to prove the point. (My software says we need 76.)

Very soon, that 10% further comes down to 5%. What can you prove next ? To bring it down to 2% ? You know what: we need 1304 subjects – take aside the possibility of drop out.

Are we getting at a depressing truth that there will soon come to a limit no medical “breakthrough” could practically be proved by clinical trials ?

Details

One all time favorite stock of JW - and of mine to some extend - is a particular insurance company.

My only reservation is that this company has the most complicated annual report that I have ever encountered. As Benjamin Graham said, "The primary principle is to avoid trouble." If there are so many (to me) incomprehensible details, I would simply drop it.

For more than once, those friendly people in the bank recommended to me various kinds of "products" - funds, ELI, and so forth. "After 5 years, the return is linked to the price of 30 stocks ..." "You will have a guaranteed return, the amount of which depends on the change of 20 market indexes over the globe ..." Thanks to Graham's teaching, which saved me in countless times. (Yes, dyslexia is a gift - look at the American president.)

You may say, "That's because you are demented. Young and intelligent chaps like me have no problem to read the report."

Absolutely. And that's why old people should not step into risky investment - which is defined as any thing whose detail could not be comprehended by our declining number of neurons.

Screening

One major problem of serious but amateur investor - like me - is to decide which stock to analyze.

Yes, your eyes are correct. I said "which stock to analyze", not "which stock to buy".

It is not difficult to learn how to valuate a company. There is no shortage of book in this area. The problem is, however, it takes (a short) time to gather the data for any company that you are interested in. Let's assume you need 10 minutes for a stock. How many of them can you examine, say, during a Easter holiday ?

The scenario is similar to doing study on genetic polymorphism. If you have a candidate gene (and mutation) in mind, there is no difficulty what so ever to prove whether it has any effect. But, in the sea of human genome, which one should you pick ?

We need some kind of microarray for stock analysis.

PS. In genetic study, the other difficulty is, of course, how to get the result published if it turns out to be negative. That's another story.

Gambling

C - a good friend of Vivian - had a long chat with my wife over the phone last night. One of the topics, as I could overhear (not eavesdrop, I promise !), was buying warrant.

My jaw fell onto the floor.

After the call, I asked Vivian, "When did the old girl become interested in gambling ?"

"Oh, she just wants to save a bit more money."

I can understand, but hardly agree. As Andre Kostolany said (in Die Kunst über Geld nachzudenken [一個投機者的告白]): the quality of a company is the master, and the price of the share is the dog - the latter wander around the former. Although the dog may sometimes be naughty and runs far ahead - or behind - the master, in the long run, it is the man who leads the way.

And warrant is a flea on the dog: It feeds on the dog, seems very small but can run as fast as, if not faster than, the four-legged animal. The bad thing is: it does not follow the man and, because of its short life, may fall apart from the dog any time before the naughty pet could pick up the pace of its master.

There is an old Chinese sayings: 貪字變貧

They have not told you the phrase that follows: 輪字變輸

Game

"You do not act (or live) up to the standard that you teach. Why do I have to follow your sayings ?" You would easily come to this conclusion after reading my blog yesterday.

Great. That's what I learn from Humphrey Appleby (in Yes, Prime Minister): we play the man, not the game. If there is a policy that (is good but) you do not want to materialise, go and find conduct problems of the man who makes such a proposal.

And this trick is not monopolised by English people. Wang Anshi (王安石) and Fan Zhongyan (范仲淹) of the Song (宋) empire fell for the same reason.

(Ironically, it was the old Chinese saying: do not abandon the words because of the man [勿因人廢言].)

You may think of course we should not give up a piece of good teaching simply because of the poor conduct of the teacher, but what about teachings on moral and ethics ?

Remind you: Linghu Chong (令狐沖) certainly did not give up the swordsman craft of Yue Buqan (岳不羣), but, more importantly, if Linghu gave up the humanistic character taught by his mentor, he would just be another Tian Boguang (田伯光).

We follow a teaching because we agree with it, not because of an adorable teacher.

Moral

You know what: I secretly changed the concept of "ethics" yesterday - and pulled your legs badly.

There are two areas in ethics that we wish to teach new doctors: common ethical problems and dilemma related to medical decision (similar to the ethics taught in many MBA programs, as I alluded to yesterday), and education to ensure our students practising at an acceptable moral (i.e. not only professional) standard. The former is no doubt suitable for didactic teaching and - as our educationalists prefer so much - examination by MCQ. Unfortunately, many extra-terrestrials and senior officials have the idea that the latter could be achieved by increasing the material we cover in the former.

This is similar to believing all lawyers obey to the law, and all philosophy teachers lead a living conforming to their own teaching.

"Too simple, sometimes naive," as pointed out by a certain Jimmy.

As Theodore Roosevelt once said, "A man who has never gone to school may steal from a freight car, but if he has a university education, he may steal the whole railroad."

Ethics

Our man from Pluto reminds us to put up more teaching on medical ethics in the curriculum. (Of course it is a request from other extra-terrestrials outside the solar system.)

It sounds as if ethics is another textbook and you can learn all these by reading it from cover to cover. Does anyone become more ethical after attending some of these lectures ?

You know what, "business ethics" is a major topic in many MBA courses. Don't laugh. The aim of this subject is NOT to teach the candidates what is (ethically) right and wrong; it simply explains what common ethical problems - in the field of business - are, and what ethical implications do many business decisions often bring along.

Of course doctors should have a higher standard of ethics than businessman (although many of the former are the latter in disguise, I know). But the standard could not be achieved by lectures. Decades ago there was no one in our sister medical school across the harbour teaching ethics - students just followed the practice of Professor McFadzean, Sir David Todd, and so forth. Now, judging from the demonstrations around, are we coming to the conclusion that there should not be double ethical standard across different fields, and we should just behave like businessman ?

PS. I am not against rich people, and I have all my respect to Andrew Carnegie and Warren Buffet. But my face would be all red - and many of my classmates would develop projectile vomiting - if the man who teaches us ethics later turns out to be another Spitzer.

House

There is a house in the forest.

A poor chap taps on the door; a well-dressed man comes and answers.

"It is freezing outside. Can I stay here for a night ?" "No. You are so weak - look as if you have not eat anything for 3 days. Don't die in my house and spoil it. If you want to stay here for a night, go and have a good dinner, make yourself warm, and then I shall consider."

"But, sir, if I could have some food and warmth, I would not have come and begged your mercy. I'm sure I shall die if I spend my night with the snowman around !"

"That's your problem, but I would allow no death here."

The poor man look up the door of this house. There is a piece of metal hanging on it. A few words, written in Bookman Old Style, go like this: Charity House for the Poor.

This is the first time he realizes that the one whom he is speaking to is not the owner of this house - but merely a security guard. He squeezes up all his remaining strength and speaks up, "But this is a place to help - to prevent us from dying of cold and hunger outside."

"So what. I got to keep this place clean. I am in charge of this house and if you die within this four walls, it would become my responsibility."

*******

KM taps on my shoulder and wakes me up from day-dreaming. I am standing outside the operating theatre and talking to an anesthetist.

Support

Our man from Pluto is long for an audit on the work of our department laboratory.

For those who are not familiar with the language in Pluto, "work" means research output - the synonym of indexed publication.

This is a bad sign. The laboratory is largely meant for supporting our research - technicians there are not supposed to have publication.

You know what: After the suicide of Xiang Yu (項羽), Liu Bang (劉邦) was asked to evaluate the contribution of individual subordinates. Amongst all the generals, Xiao He (蕭何) was ranked the top - and was appointed as the Prime Minister of the Han Dynasty.

Alas, Xiao never fought a battle himself. All he did was staying in the backyard, made sure all Han army in the front line were well fed, and kept sending more soldiers for the campaign.

As a case control study in history, Cao Cao (曹操) had had the same support from Xun Yu (荀彧) - that was the time when Cao won a series of successful battles in northern China. At the most difficult time of Cao (during the Battle of Guandu [官渡之戰]), the only - but also the best - support that Xun gave Cao was a psychological one (in a letter with seminal skill and passion, I must say). Being less fortunate than Xiao, Xun was forced to commit suicide by Cao many years later - because of a difference in opinion. The rest, alas, has become history.

Compare

Not long after my grumble about the seminal result of our Media of Instruction (母語教學), a report from CUHK shows that students from secondary schools that teach in English have better admission rate to the university.

Any one with an elementary training in clinical trials would spot that the control is not right and the two groups are not comparable. Why ? The 100 secondary schools that could continue to teach in English obviously were prestigious ones, and undoubtedly they had better students to start with.

This is our dilemma: when someone prove our theory with obviously erroneous methodology or logic, what are we doing to say ?

On a second thought, this is a perfect timing to announce a result of this kind: when everyone (including our government) agrees with your conclusion, they become very forgiving with your flaw.

金田一

AL was amazed to find the Japanese comics Kinda'ichi Case Files (金田一少年の事件簿) on my bookshelf.

I must say the stories of Yozaburo Kanari (金成陽三郎) and Seimaru Amagi (天樹征丸) are far from perfect, and the illustration of Fumiya Sato (佐藤文也) appears monotonous. Nonetheless, for lovers of detective story, there aren't very many choices. (Of course Detective Conan [名偵探柯南] is superior in every aspect, but you need a variety of diet.)

Many detective stories have elaborated tricks, but few authors create adorable characters. As Hercule Poirot once sighed (in The Clocks): our faithful Dr Watson was the real triumph. That's another reason why Detective Conan is memorable: it is all because of Kogoro Mori (毛利小五郎). Is he all that thick ? Or has he actually seen through all the disguise of Shinichi Kudo (工藤新一)?

PS. Kogoro is no doubt a perfect symbol of the boss - taking all the credits, the best contribution he could make is to sit there (asleep !) and do nothing, but you always have the worry that he actually knows what's going on !

Asura

If you think Naraka realm is terrible, many of the people around were caught up in Asura (阿修羅) realm - hopefully a cut higher - since 2003.

"It is the government's fault." What a convenient excuse. We attack the others. Revenge ? We fight back.

This is realm.

Have you ever cooked crabs in a wok ? When the water gradually heats up, there is no need to worry that those crabs would escape - even though they are alive and free to move.

Other crabs at the bottom of the wok will pull them back for sure.

And they fight against each other - until all of them die. Their life is a history of struggling in a wok.

(My apology for spoiling the appetite of many crab lovers. Fortunately this is not the best season for the gentlemen without a gut [無腸公子].)

Oh, I have guts - and I shall try my best not to be pulled down to the wok again.

Scar

All classes of kindergartens and primary schools are suspended for a possible outbreak of influenza.

Why, three children died. Although it is quite possible that none of them was directly related to the virus, we'd better play safe. Just five years ago, we were shocked with what had happened - we don't want it again.

And we take all the drastic actions: we isolate everyone with chest infection or diarrhea. We become skeptical with all reassurance, and believe only in bad news. We give up science and logic. "We are not in the court. We do not have to consider evidence - my eyes is evidence," declared by the best actress of the soap opera.

And everyone around think this is a doctrine of wisdom ... my god!

Yes, it was a traumatic experience. We didn't die, but we were locked up in the Naraka realm (地獄界) - forever.

It leaves a terrible scar - not on our face, but in our behaviour.

Third

You man say, "we can improve the productivity of the crop, so that both ends could be met."

Good idea. In fact, Yuan Long Ping (袁隆平) has done this kind of work in rice - successfully feeding millions of people. We can do the same for corns.

Hold on. How are you going to do this ? By introducing genes to the plant (in order to make it produce bigger fruit, and increase the resistance against insects and virus) ?

No. Genetic manipulation is the third sin.

"There is no need to manipulate the gene. We can select those strains with desirable characters and breed them specifically."

Friends, do you seriously think this is not a kind of genetic manipulation - albeit in a "low-tech" way ? (By the way, modern corns were really "selected" by such a method from its ancient predecessor - and it took more than one thousand years to make the fruit edible.)

That's why I said Vatican has moved to Pluto.

Two

"Pollution is a sin," declared the messenger.

Our automobile certainly plays an important part in air pollution. What can we do ? Use a less dirty fuel - after all, petroleum is expensive and the supply is not unlimited.

Hence alcohol (ethanol) comes to the stage: it burns without smoke, and we can make it from agricultural products (for example, corns). In short, it is environment-friendly.

We see more and more farmers turning into to this business - and give up rice and wheat. Do you know the price of flour has gone up by over 30% last year ? Rice is the same. Quite some countries are cutting down the export of rice and wheat in view of the fall in production - to save for internal consumption.

We can pay - but not those in many less than affluent countries. We create poverty - or inequality.

"Creating poverty is - again - a sin," so declared the messenger.

Seven

The new version of seven (social) sins is certainly groundbreaking - like Philo Vance (in The Benson Murder Case), I am so impressed that I lose my nerve. The door of the Castle suddenly opens, out come an official, from whom we receive a message of the Lord.

For those not familiar with Kafka, the Lord of the Castle is Count Westwest - the German of decaying matter. Has the Lord died ? Who is sending out the message ?

Maybe it comes from Kagemusha (影武者) of Akira Kurosawa (黒澤明).

I hope it doesn't matter. As K says (in The Trial), "Die Lüge ist für die Weltordnung." (The lie is made for world order.)

But, I have a feeling that Vatican is not in Italy any more - it has moved to Pluto.

Kamikaze

With the ward mistaken as war, an increasing number of medical students but limited material resource, I am more reminded of the Kamikaze (神風特攻隊) in the Second World War.

When soldiers were in abundant supply but petroleum was scarce (as a result of the disappointing conquer of North-east China and miscalculation of the Japanese army), it is easier and more effective to use human body as part of the bomb. You know what: the most expensive - in terms of petroleum consumption - bit of training an air-force pilot is landing.

PS. From a military tactics point of view, Kamikaze is a most ingenious design: the distance that one can attack from an aircraft carrier is doubled because you do not need gasoline for your way back. Generals can stay in a safe distance and enjoy bombing your enemy - without the risk of facing a revenge. No wonder the trick is so highly praised by the ancient (and current ?) inhabitants of Pluto.

Battlefield

Appreciating some emails between L and an extra-terrestrial - the ones on our bed status and duty allocation.

To my horror, both old boys use the term "battlefield" for our wards. As Philo Vance's criticism on Markham (the District Attorney of New York County, in The Benson Murder Case), "I can understand a lay person making such a comment. But to say this as a professional, it is a bad sign."

Yes, it is true that the ward is overcrowded and our life is tough. Nonetheless, "ward" is something more than "war". In 1940's, when London was under the thread of German bombers, the Royal Family and Winston Churchill did not remind English people that they were living in the battlefield - citizens were encouraged to lead as normal a life as they could. The challenge does not last merely a day or two; the best way to prepare ourselves is to have an orderly and enjoyable life. It is worrying to consider us as generals and soldiers - seemingly preparing us to become hero and sacrifice.

It reminds me of the movie Assembly (集結號).

5 days

Another method to cut the unemployment down is to reduce the number of working day per week.

This is no news. Many affluent countries have been doing this for decades - "to improve the quality of life of our people". Quite right. After all, human civilization first came from agriculture, which spared the time to obtain food for many people, so that they could develop music, literature, and science.

Of course our ingenious government has another creative use of this trick - to become a means of expanding the number civil servant. (Well, this is in itself a marvellous strategy to bring down unemployment - have more people by yourself, rather than relying on the ever declining local industry !)

The worrying bit is: creatures in Pluto want to have it for doctors and nurses - both with too many posts but no one to fill. "We can keep these people by improving their quality of life." Jove, they must have not heard of Zhuangzi's (莊子) story of teaching monkeys (朝三暮四): The amount of work remains the same, the number of people has not changed (limited by supply), this system would not reduce the workload for any one of them - the task merely becomes fragmented.

Or are they really intelligent beings and have already thought of all these ? We are seeing increasing number of medical students soon !

Empire !

PS. You may wonder why I said "teaching" monkeys. Would it not be "cheating" monkeys ? Friends, "teach" and "cheat" actually have the same alphabets. It just depends on how you see (or use) it.

Unemployment

The obvious benefit of prolonging education is to keep the unemployment rate down.

Contrary to the prediction of Thomas Malthus, in many civilized parts of the world, from James Watt to Google (I declare no conflict of interest - although I would love to have some), productivity has increased exponentially and exceeded the rate of population rise - at least for the moment.

And, we have longer life span - and therefore more time of nuisance to dispose. How ? Obviously by deferring the age of retirement.

If we have less work to do in a society, but existing workers stay in their post for a longer time, what would happen ? Young people cannot get the job - look at France. (If young people do, then more senile ones don't - that's our old friend: discrimination by age.)

What to do ? Ask the young ones to stay in school longer, of course !

And we say: "Young people should not have too much stress at school." "To improve your competitiveness, you'd better have a higher degree ..." What a good medicine with sugar coating.

Although medicine is always the synonym of poison.

Puberty

"Then, why on earth do we have a delayed 'mental puberty' nowadays ?" You may wonder.

I must say the phenomenon, albeit unexplainable by biologic evolution, does appear to be real. Most of our fresh secondary school graduates - and in fact medical students - appear green and have no grip on the real world.

Why, we had 6 years of free education since 1971. It became 9 years in 1979, and 12 years soon. To my surprise, the degree of "literacy" and other capabilities remain similar for all people who completed the free education - irrespective to the number of years. Imagine: In early 1970's, we expected a primary school graduate to be able to write reasonable Chinese, read Mark Twain or Conan Doyle, and could apply for police officer. Now, we have the same expectation for someone with a School Cert.

Are you coming to the conclusion that some invisible hand is slowing down the education / maturation process of the new generation ?

For what ?

Mature

A side kick of my hypothetical worry about senior (senile) applicants for the medical school is whether we should have more "mature" students - the very label implying that most of our students have not been through the puberty yet.

Oh, I'm not using the term puberty as a metaphor - I do mean it. This is the time after which the body, including our brain, becomes mature. From then on, we do not think any more better, although we do accumulate experience (from failure, or bad judgement - according to Oscar Wilde), social connections, and prejudice.

Look: Alexander the Great conquered Persian at the age of 27; William Pitt took up the office and became the Prime Minister of Britian at 24; Zhou Yu (周瑜) won the Battle of Red Cliffs at the age of 33, and his successor Lu Xun (陸遜) the decisive Battle of Yiling at the age of 20 - a victory against the 61-year-old Liu Bei (劉備), a symbol of age and experience.

"That's history and those were genius. The world is different today." You may argue.

Oh, I have difficulty to believe evolution of human structure takes such a hurry pace, and our process of maturation is profoundly slower than Homo sapiens a thousand years ago.

Academics

Met VW in the weekend course, and our conversation fell back to the problems faced by academic nowadays.

“It is very difficult to have high impact research now – for a young faculty member like me,” the gold medallist sighed.

I cannot agree more. Twenty years ago you could do a randomized control trial with 100 subjects and got it published in the top journal – it doesn't happen now. You probably need 5000 subjects, which means a multicenter collaborative work with much influence from the pharmaceutical industry and is not meant for new comers.

How about high niche basic science work? You need three things: man, money, and facility. I am very intrigued to see how to produce satisfactory result if you can only employ a fresh university graduate as your assistant (note that I do not use plural), the freezer space allocated is only enough to put your lunch box, and the cell culture hood is shared amongst 10 departments and you can use it once each week.

The group from Pluto says, “The resource is limited, but you can still have stunning work if you are really a genius.”

Well, there was an example that Nobel Prize was awarded to someone who used only pencil and paper. I know him well – he is Albert Einstein. Yes, it is nice to have an Einstein around, but I shall be maniac to expect most of my colleagues around are genius of that kind.

It hurts my inferiority complex.

Employment

“Education is different. We should not discriminate people for their age in employment considerations.”

Friends, where is the line between requirement and discrimination? We do not allow a fresh secondary school graduate to take up the post of Mr. Tsang either. Who are we discriminating? Nobody. We need someone with experience.

For the same reasons, we cannot accept some Mrs. Yip - one of our retired government secretaries - to play Shakespeare's Juliet (Lady Macbeth would be our pick for her, of course), or Tony Blair joining Manchester United - if you were Sir Alex Ferguson. (Oh, AC Milan may accept our ex-PM; that’s another story.) Why? The physique doesn’t fit.

Then, how vigorous a job do we accept a preference for young applicants?

You may think we are entering a grey area. Remind you, there is no such colour called grey in physics. There is only a mixture of black and white - the details of which we are unable to discern.

Age

It remains probable that there are some elementary characteristics that we should not use to discriminate people.

It sounds noble. “Why couldn’t I be admitted to the medical school?” an applicant, 50-year of age, asks. (Oh, this is not one of our retired senior professors – who are usually too busy in the political circle, making money, or both.)

But, let’s stand on the side of the society: medical schools are there to train doctors that serve the community. If the resource for training every doctor is the same, a more “senile” trainee means a shorter working life span – and therefore more costly for the society.

You may say we still should not discriminate aged applicants: that’s the price to pay for fairness in a mature civilized (i.e. affluent) society. My friend, it does not only mean money to train a doctor. Every of our medical student should have enough experience of being refused to be clerked or examined by our patients. Human resource is limited.

PS. On that aspect, young doctors are being discriminated – an aged appearance is always considered to be the sign of experience and competence. As I used to joke with JW: people around can easily tell when we are about to go for private practice – when I start keeping a moustache, and he stop dyeing his hair black !

Fair

On a superficial look my skeptical view on discrimination is over-reacting. There should be a clear line between discrimination and (market) competition: nobody should be disadvantaged in a competition because of his age, race, or social class.

"Why couldn't I have this expensive monoclonal antibody treatment ?" some poor people roar.

That's the reason our government covers many of these costly treatment for our CSSA recipients. Then why on earth should we work hard ? In reality, you are discriminating those who earn their own living. When we start, we say people should have fair competition. Now we conclude that all people should have the same share of the fruit irrespective to the result of competition.

If you are not yet convinced, followers of Karl Marx had done excellent experiments on this area. The results are published on millions of tombstones in Siberia and its south.

Discrimination

The annoying bit of this suspected candidate is the all too familiar blame on discrimination - another word that has been raped for so many times that it has become a prostitute.

"Why do I fail the final MB ? Is it because I have a history of psychiatric disease?" Jove, it doesn't mean that you can pass the examination by default because you are psychotic. Of course, our man from Pluto obediently followed Benjamin Graham's advice on buying bonds: the first principle is to be free of trouble - and avoid any possible complaint or legal process.

You consider it crazy? There are better ones: "Why can't I enter the medical school? Is it because I am blind / mentally retarded / illiterate (hopefully not all of the above) ?" The amazing bit is: some similar ones do get admitted, and those creatures outside the solar system explain, "Why shouldn't we broaden our imagination? Everything is possible."

I am not sure how many of our patients would love to be cared by doctors whose admission to medical school (and treatment) is based on imagination.

PS. Well, there are seriously many of our graduates being illiterate - in a "literal" sense. God knows whether it is because of our fair admission criteria, or that's the result of our medical education.

Requirement

"You should not discriminate someone with no university degree. Why can't we apply for the job?" What an legitimate outcry from the disadvantaged.

I am in no position to judge whether a bachelor of something is necessary for the task. It would actually be quite interesting if a dental surgeon applies; after all, RTHK has become the toothache of our government. (Oh, maybe a neurosurgeon is better. It is more a headache; and becoming neoplastic.)

Nonetheless, this Mr. Chow should simply quote the followings and say nothing more:

不知腐鼠成滋味
猜意鵷雛竟未休

李商隱<安定城樓> (典出: 莊子.秋水)

Well, any one who is able to quote this is no doubt better educated than 99% of our university graduates.

身教

Our man from Pluto asks all of us - alas, clinical and academic staff - to attend the medical grand round.

Why, this weekly exercise has degraded in the past 10 or 15 years from the pilgrimage on Saturday to a kind of supplementary lecture for medical students - with a summer holiday. To add oil on the fire the extra-terrestrial reminds us to put up questions from the materials covered for the final examination.

Nonetheless, the audience is drying up - both in their number and enthusiasm. (I can see JW works very hard to boost up questions and discussions but - as he understands very well from the stock market - you just hurt yourself when trying to catch a falling knife.) There is, seriously, only one way to improve the grand round: the man from Pluto himself be there - even for topics unrelated to the endoderm, joins the discussion, and while waiting for the lift downstairs and seeing some medical officers hurrying off work, says "Are you going to the round ?"

Good

KM is involved in screening the applicants of new medical officers next year - one of them is D who, not surprisingly, receives quite a number of less than favorable comments from the others.

I node, "D is a good person, but hardly a good physician."

"Why, a good person is the very quality of a good physician." CB, as usual, puts up an objection.

I do not say more; my mind brings me back to a scene in the classic Japanese comics - Candy Candy (小甜甜). It was around the time of World War I, when Candy was an all too enthusiastic student nurse. There was another girl in the same class who, as expected, was knowledgeable but cool, and did not get on very well with the orphan. There was a moment when the two of them argued how best to help a patient, and Candy said, "I am no good at book work, but just a kind heart - and that's the most important thing."

"No," the distinction student retorted, "What good could you do besides soothing the patient ? I know what could be done and how to do them all. If you know nothing, what you do - despite of its best intention - may actually harm the patient."

Yes, most of the disasters in human history did not come from devils, but those (who believe they were) saviours of all men.