Psychology

You may argue although frequent ward round does not affect the biological process of a disease, doing round twice a day would hasten discharge and reduce unnecessary hospital stay if a substantial proportion of the patients are around for various social or administrative reasons.

Well, yes, I agree many of our patients are in the ward for non-medical reasons. (In fact, I always say that the majority of the problems that we have to solve during ward round and routine patient care are administrative problems and require merely a tiny dose of common sense rather than any medical knowledge.) Nonetheless, it remains a naive idea to believe that doing the round more frequently would facilitate the resolution of non-medical problems - unless you also hold the belief that holding meetings more frequently does help the business.

And we all know it won't. Doctrine of basic human psychology states that if one has more frequent opportunities to make a decision, he would be more tempted to procrastinate. The standard excuse is Let's wait until the time is ripe. For the same logic, we usually treasure the time we spend with someone whom we seldom have a chance to meet, but would turn a blind eye to the one whom we dine with every night.

PS. You may wonder if we have someone with the extraordinary character of not to procrastinate, would doing round more frequently help ?

Of course not. He would merely find more problems in his patients.

Round

You may think my concern about the trading hour of HKSE rather irrelevant to practising doctors.

On that, you are wrong.

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

Around the same time when HKSE announced the news, it has been proposed that all of us should do ward round twice daily - in order to hasten the discharge of our patients and shorten their hospital stay.

I consider that an ingenuous (oh, sounds like ingenious, but in reality not) idea. To say the least, I don't think doing ward round more frequently would enhance diuresis for patients with heart failure, or hasten resolution of bronchospasm for those with asthma, or shorten the course of antibiotics or heparin.

Well, maybe our extraterrestrial friends wish to manage the hospital as a poultry farm. You know what. If you keep hens for laying eggs and bring them up under ordinary sunlight, they will give you an egg each day. However, if you try altering their biological clock and keep them under artificial light of gradually shortening diurnal cycle, they would eventually lay an egg every 12 hours - although the products would be somewhat smaller and with a thinner shell.

No wonder our doctors of the younger generation keep running around like chickens with no head.

Length

For those who are familiar with the local financial market, it is no news to learn that the Hong Kong Stock Exchange (HKSE) is going to shorten the lunch break in order to extend the trading hours.

A similar proposal was put up in 2003 but failed as a result of opposition from brokers. Nonetheless, the argument for extension is simple: The two-hour lunch break between the morning and afternoon sessions in Hong Kong is the longest among the world's 20 major stock exchanges. Extending the trading hours is generally believed to enhance the competitiveness of the local financial market.

But, I beg to disagree.

A simple and earthly reason is a long trading hour would attract speculators and aggravate market fluctuation. (Yes, true, a high volume of speculating trade increase the profit of HKSE - that's why the Venetian and Sands and others are opened 24 hours a day, 7 days a week.)

On the other hand, serious investors do not need frequent trading. As pointed out by Warren Buffett, a good investor needs to trade once a year (for updating his portfolio) and enjoy his life the rest of the time.

PS. A side-track but inevitable consequence of this very suggestion of our giant in investment is related to how we choose a trust fund - another important topic that we can discuss later.

Or I should ask my friend Warren to discuss later.

Risk

(My dream continues.)

Although Company Z really does nothing to promote their Zyximab for the off-label use on nephrologist's dementia, some practising clinicians do spot the opportunity and dilute the drug themselves. A few with an academic mind actually proposed randomized control trials to compare the two medicines.

The sales manager of Company X is horrified. In fact, the sales of their Xyzimab is not as good as they expect - obviously because many suitable cases use that cheap cheap diluted version from Company Z.

An urgent meeting is hold.

"Look. We've got to stop all this." The CEO roared.

"But how ? Zyximab is obviously as effective as our product - and way less expensive." The scientific officer said, rather naively.

"Let me see. Oh, yes. Let's focus on the other side of the coin and talk about the potential risk."

"Risk of what ?"

"Risk of - let me see - causing memory loss." The CEO concluded.

"But, nephrologist's dementia causes memory loss !" The scientist could not believe his ears.

"Exactly. We can put up a few cases who are treated with Zyximab and the memory gets worse - we then blame it to the drug. Since there's no control trial as yet, no one could prove a similar risk of deterioration when treated with our product."

"Jove, that sounds courageous. Who is going to believe us ?" The marketing manager asks.

"No, the public need not to believe in us," the CEO smiled, "We shall pass the cases to those patient support groups and possibly some of our alliance in private practice - they will voice out to the media."

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

My dream broke off. I was dumbfounded and soaked with sweat. All of a sudden I realized Zhuangzi (莊子) was wrong - both him and the butterfly may represent reality.

Market

(The meeting in the drug company continues.)

"Why doesn't Company Z advocate to use Zyximab to treat nephrologist's dementia? From a pharmacological point of view, it is essentially the same as our Xyzimab, and they could just dilute the drug by 100 times and give it to the patient - I'm quite sure it works." The scientific officer asks.

"Yes, in theory they could. In reality they wouldn't - and never," the CEO said with confidence, "They are making a good profit of selling their product for Szeto's syndrome already."

"But, they can fund clinical trials to see the effect. It seems doing no harm to explore a new indication ?" The marketing manager added.

"On that, you are wrong," the CEO put up a wicked smile, "Our friends in Company Z know just too well they shouldn't step in our market - otherwise we shall fund projects to see the benefit of using our Xyzimab to treat their Szeto's syndrome - and I'm sure that will show the same benefit. At the end of the day, we set up a vicious cycle of cutting the price for both products in both diseases - not desirable for either of us."

"But ... isn't it Market Division - which is outlawed under the anti-trust regulations?" The scientific officer hesitates to point out.

"I would not comment on this question," the CEO gives the others a cold stare, "Who would know the two diseases belong to the same market ?"

Everyone around the table are forced to agree.

Dream

I must be not sleeping very well recently and keep having funny dreams.

Here is another one I had just last night.

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

(During a senior official meeting in the headquarters of a famous drug company X.)

"How much should we sell our new medicine Xyzimab ?" The marketing manager begins.

"What's the cost of making it ?" The scientific officer asks.

"The manufacturing cost is trivial - but that's quite irrelevant," the man sitting at the end of the long table said, "We need to cover the money we poured in for its development, and we need a good profit. Since the standard dose for the treatment of nephrologist's dementia - our licenced indication - is 0.1 mg, let's make it the vial size and sell it at $10000 per vial. After all, we are the only one to make this drug."

"Not exactly," the naive scientist interjects again, "I know company Z is making Zyximab, a similar product; they are selling it for the treatment of Szeto's syndrome - an entirely different disease."

"Really ...?" the rest of the table all gasped.

"Yes. In fact, the dosage to treat Szeto's syndrome is actually 10 mg, and therefore that drug comes in vials of that amount. Company Z will soon know that Xyzimab and Zyximab are almost identical, and they would advocate to give a tiny dose of their product to treat nephrologist's dementia!"

"Don't worry. That won't happen." The chairman said with confidence.

(To be continued.)

Document

(The story of our young medical officer continues.)

It must be a miracle; Dr. C could start his round an hour later.

His first patient is an old man with chronic bronchitis. The young doctor flips through the temperature chart, greets the patients, asks how's everything getting on, listens to the chest of the patient, and, then, he is forced to stop. He notices the problem.

"Em... Sister, excuse me," he finds himself a trouble maker, "Where're the X-rays of my patient?"

"Jove, we're running the film-less system. Go and look at the X-rays from the computer." The nursing officer said.

"Quite right. But, how about the blood test results?" The doctor goes on.

"Same. We no longer keep the print-out of laboratory result. Go check from the computer." There seems a tinge of proudness in the answer.

"And progress sheets ?" Dr. C pursues.

"Yes, and progress sheets." The senior nurse is not moved.

"In that case, may I ask why's this patient still having such a thick pile of paper in the hospital record?" The young doctor is incredulous.

"Jove, we don't need to keep the patient's clinical notes and result, but we need to keep the documents that all the things are done properly. Look, for each blood taking and X-ray, we have a check list on the procedures; we've got to fill in and file. Similarly, we don't need to put down the patient's temperature - they're in the computer. The temperature you found in the case notes is actually yours - as I said, we need to document that you are not febrile when seeing the patient !"

The young doctor collapses and has a seizure.

Fit

Date: 2 July 201x

Time: 9 AM

Place: Medical ward of a public hospital

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

A formally dressed young man enters the ward. He looks around and soon he find his target.

He heads to the middle-age woman in a white uniform standing in the middle of the ward.

He murmurs politely, "Good morning, Sister. I am Dr. C, the new medical officer here. Would you be kind enough to tell me where my patients are so that I can start the morning round ?"

The woman replies in a monotonous manner, "Good day to you. Have you reported the duty and done with the morning routine?"

"Yes, I've reported my duty to the department office and get my pager. In fact, the secretary there sent me to this ward," the young doctor paused for a moment to choose his words, "What's the morning routine?"

The senior nurse seems startled, "Jove, don't tell me you haven't heard of that - we are in the N-th round of this accreditation exercise. To ensure patient safety and free of any legal consequence, each day, every doctor has to prove that they and their instrument are fit for doing the round before they are allowed to see the patient."

"Which means ...?" The medical graduate suddenly suspects he has receptive aphasia, or the other side is speaking the dialect of an alien.

"In short, you have to go to the personnel department and have your ID card checked - so as to prove you are the doctor who you claim to be. Then you have to go to the staff clinic and get a body check to prove that you do not have an infectious disease to spread around. You also need to visit the EMSD (author's note: Electrical and Mechanical Services Department) and get the certificate stating that your stethoscope and other instruments are functioning properly ..."

"Is that all?" Dr. C finds that he is really having a vertigo and may not be fit for the work.

"Ah, just that you remind me. You've also got to see a psychiatrist to get the proof that you are not having pre-senile dementia or paranoid disorder against the others." The ward manager finished triumphantly.

"I suppose there's no need for the last bit," the young doctor sighed, "I'm sure I have."

Leader

When I come to think of Rafael Benítez, the story of Xiang Yu (項羽) keeps flashing across my mind.

Well, I don't think I need to elaborate the campaign between Xiang and Liu Bang (劉邦). The very point is, not only was Xiang's side much stronger at the beginning, many of the Liu's crucial helper came from Xiang. Notably,

• Han Xin (韓信) was originally a junior soldier of Xiang's side. (The classical record was Han used to hold the halberd for Xiang Yu; so called "執戟郎".) He turned out to be, in my opinion, the best military leader in the history of China.
• Chen Ping (陳平) began as the political advisor of Xiang; his excellent planning saved Liu's life no fewer than five times.
• Ing Bu (英布), Zhou Yin (周殷), Lu Ma Tung (呂馬童), and Shusun Tong (叔孫通) all started as subordinates of Xiang, but they left for Liu's side one after another.

And, worst of all, being loyal was to little avail. Fan Zang (范增) was a life-long friend of Xiang's family, and, in modern terms, the chief military advisor of the King of Western Chu (西楚霸王). Suspected of bribery (based on a rumor ingeniously spread by Chen Ping), Fan was fired and sent home with no pension - he died soon afterwards at his home town because of, in modern medical terms, carbuncle.

Alas, Chinese has a long history of voting by their legs.

Milan

While my friend VW was having some special feeling with what happened recently in (the football club) Manchester United (see http://vwswong.blogspot.com/2010/11/manchester.html), I could not help to think of F.C. Internazionale Milano.

Or, more specifically, its head coach, Rafael Benítez, when he took over from José Mourinho, who led the team to win incredibly The Treble earlier this year.

It is always difficult to follow the footsteps of a giant.

And, it really depends on your point of view. To the supporters of Benítez, the team that he inherited was defective in many ways. (Just a bit of technical details, for example, Eto'o always insists to play forward; the midfield depends too much on Sneijder, Samuel and captain Zenetti are getting old, and, as defenders, Lucio and Maicon do not stay in their responsible position as often as they should.)

But, the problems were already there when the team won The Treble ! It was Mourinho who kept Eto'o as a supporting player quietly, maintained an excellent physique of Sneijder and Zenetti, and got the best use of Maicon's ambition to score. In the right hands, crisis becomes opportunities.

PS. The very motto of Mourinho, which I entirely agree, is there exists no undefeatable team - not even FC Bacelona. The job of a coach is to conceal the problem of your side and find out those of your adversary.

We should all hold the same view in the game of our life.

遷葬記

余父仙遊倏已廿載，骨灰素供奉於某道觀內。其始，家母以年事漸長，唯恐百年後杯土之地難求，便於別處覓得靈位兩個，禆作長久之計。後立約刻碑，歷時數月。而今點撥停當，便擇於季秋吉日，舉家赴會，遷舊龕至新處，以償慈願。

此地也，佛道兼容。百殿千廈，依山而建，頗有巍峨勝貌。而背倚峯巒之勢，譬如承先，前佔城門之濶，當澤後人。危欄遠眺，儼仗夸父之肩而能極目，追嚴顏之教而思今日。及念至此，能不悚然乎？

或曰，觀者三九之地，豈不落俗？噫，其事也必。然潌滯之處，不外紅紙一張，自足疏濬。此身外之物，常可通神。其祀也，無非鮮花水果，素雞芋魚，方士一通，誦經數遍。木魚嫋嫋，徙滌心神，檀香裊裊，彌足垂涕。可稱虛應故事，以慰慈顏，亦是浮生半日，自求心安。俄而禮成，便皆歡喜讚歎而去。從此春秋二節，當有所歸。鶼鰈百世，復相廝守。此後嗣報劬勞之義，愧不稱德也。

《庚寅亥月太宰此誌》

Admirer

Maybe I shouldn't blame that naive student too much.

As the old Chinese saying, Since there are people up there like it, for sure the subordinates would overdo the thing. (上有好者，下必有甚焉。)

But, the problem remains: How do we tell a genuine admirer from another who tries to kiss your ass?

I don't know. In fact I am not sure if there exist a qualitative difference. For example, a small pinch of sugar would light up your palate, but a large dose of saccharin inevitably brings you bitterness. Nonetheless, it is not because of a difference in the chemical structure of the two - too much sucrose could give the same unpleasant taste (although you could argue one really needs an industrial dose for such an effect).

And, if there is a qualitative difference, human nature would always favour the malevolent version. The more candies you have, the less sensitive your taste buds become. With time, one would do away with all sugar because he could only sense the sweetness of saccharin.

Maybe that's how many great people die.

Mistake

Received a remarkable email - obviously mistaking me as the man from Pluto.

Here you go:

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

尊敬的沈教授：

您好！

首先衷心感谢您前两次对我的慷慨帮助（我曾向您求助过三篇宝贵的文献），其次，我刚刚从网上得知您是香港中文大学的校长,更佩服您的人格魅力，您是医学方面的专家，对肾病方面的研究也独树一帜，不知道以后还能否聆听您的教诲？我是XXX医院的一名学生，目前正从事肾病方面的研究！

最后祝您身体健康！家庭幸福！

学生XX

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

I seriously believe we need very much a course to teach our students the proper method to polish others' shoes.

Names

(Our dinner discussion continued.)

"I am also disappointed with that two-and-a-half year of sentence." Vivian said.

"Quite true." I was forced to agree.

"Sometimes I just hope I could have a volume of Death Note and do the justice myself." My wife went on.

"That's silly. Don't try that even if you really have a notebook of that kind!" I smiled.

"Why !? You think I would overuse the power and become a dictator?"

"That may be true, but there is a more simple reason."

"Eh ...?"

"Whose name do you want to put down ?" I asked.

"Well ..." my wife became hesitated.

"Were you a naughty child in primary school?" I went on.

"What do you mean ?" Vivian was at a lost.

"I presume you do not have the experience of writing tens of thousands of names?"

We both laughed - albeit in an atmosphere of sorrow.

PS. For those who are not familiar with Japanese comics, Death Note is the masterpiece written by Tsugumi Ohba (大場鶇). In short, the Death Note grants its user the ability to kill anyone whose name they know. It lends an opportunity to its owner to create a perfect world by removing everything (that he considers) evil.

Rooster

During a casual dinner discussion, my mother wondered who should go to Norway and accept the prize.

"There are two, I think, representatives from Hong Kong, and I'm sure a few key persons who took part in the 35th May matter would go," Vivian said.

"That's exactly the problem. Who should go up to the stage and take the medal from the king of Norway? There must be a hot debate - you know what Chinese people are!" I smiled.

"What would you suggest?" My wife asked - knowing perfectly well that I always have an opinion.

"They could all go to the ceremony, but none should march up to the stage. Since the recipient is not available, they should follow the traditional Chinese culture." I said.

"Which means ...?"

"Which means they should send a rooster to the stage and get the medal - just like what Chinese do for a wedding ceremony when the bridegroom is found absent. It's definitely dramatic enough to catch the attention of all media, and it saves everyone from the undeserved honour of delivering the thank-you speech, as well as stirring up any internal conflict." I explained with a wicked twist on my lips.

PS. There is yet another reason of sending a rooster that I did not tell Vivian - the bird could later be used for another purpose.

Do you know the traditional procedure of getting entrance to the Triad Society?

Options

My friend TW mentioned to me recently that we can do trading of stocks listed on the New York Stock Exchange by a local bank.

It sounds a good idea. To say the least it provides an alternative option of investment (which is very much needed when the interest rate is hell low). I have an account there for a long time. Naturally I visited their web site and downloaded some of the details.

But, on a second thought, I decided not to sign up.

Maybe I could explain by citing a scene in the Demi-Gods and Semi-Devils (天龍八部), when Jiu Mozhi (鳩摩智) offered an exchange in the archives of martial arts with monks in the Tenryu Temple (天龍寺):

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

本因道：“師叔，明王遠來，其意甚誠。咱們該當如何應接，請師叔見示。”

枯榮大師道：“本因，咱們練功習藝，所為何來？”本因沒料到師叔竟會如此詢問，微微一愕，答道：“為的是弘法護國。”枯榮大師道：“外魔來時，若是吾等道淺，難用佛法點化，非得出手降魔不可，該用何種功夫？ ”本因道：“若不得已而出手，當用一陽指。 ”枯榮大師部道：“你在一陽指上的修為，已到了第幾品境界？ ”本因額頭出汗，答道：“弟子根鈍，又兼未能精進，只修得到第四品。 ”枯榮大師再問：“以你所見，大理段氏的一陽指與少林拈花指、多羅葉指、無相劫指三項指法相較，孰優孰劣？ ”本因道：“指法無優劣，功力有高下。 ”枯榮大師道：“不錯。咱們的一陽指若能練到第一品，那便如何？”本因道：“淵深難測，弟子不敢妄說。”枯榮道：“倘若你再活一百歲，能練到第幾品？”本因額上汗水涔涔而下，顫聲道：“弟子不知。”枯榮道：“能修到第一品麼？”本因道：“決計不能。”

Capability

After you come to realize the evolution of human brain, there remains an important question that may skip your eyes:

If the human brain was evolved long before a written language, what's the point of having such a large capacity of semantic memory (for those ancient Homo sapiens) ?

I must say I don't know - at least it appears quite useless to me.

The remotely possible reason is that the memory capacity was not meant for semantic information; modern men merely squeeze some of our hard disk for episodic memory and use it for a different purpose. One supporting evidence is that the two memory systems share the same site in the brain. It also explains why we remember stories better than textbooks.

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

I'm not the only one to note all these. As pointed out by Jared Diamond (in Collapse), human beings living in an entirely primitive environment and have no opportunity of education are as smart as modernized men like us (if not more smart; otherwise they should have succumbed to the adverse condition).

But, they do not use their intelligence to read textbook or memorize Powerpoint slides; the hard disk is used for observing, reflecting, reasoning, and trying.

Skills that we have long forgotten.

Or, as pointed out by Bertrand Russell, men are born ignorant, not stupid; they are made stupid by education.

Capacity

Although I believe our students could have make a better use of their memory, the problem is not entirely theirs.

They have too much to be remembered.

And that's not a problem for medical students only; all modern man face the same difficulty. (Yes, I agree the problem is exaggerated in our circle because of the breadth and depth of the subject.)

The very fact is, the structure of human brain remains essentially the same as the one we found 200,000 years ago when Homo sapiens sapiens first appeared. (The speed of natural evolution by random mutation is very slow.) However, the amount of knowledge that a modern man needs to master is probably 100 times than that of his ancestor. Notably, with the invention of writing (and paper and printing), human knowledge could accumulate - meaning that more material are there to be learned by a student.

With computer and Internet, the accumulation of knowledge became exponential.

And that amount of information is not supposed to be handle by our good old brain.

Just imagine you are using a computer with Intel 8086 processor to play an on-line game.

PS. A minor feature may skip your eyes: human brain completed its evolution before the invention of words and writing, and is therefore not meant for semantic memory. That's why we are so much more comfortable in remembering a story.

Story

(Continue from yesterday.)

The more important and practical implication of the classification of our memory system is: Although the total capacity of our memory is huge, we have a very different capacity of each category.

And, to most of us, we are somewhat like an iPhone.

Do you see the point? Semantic memory is the files and documents and e-books that we put in that tiny piece of gadget from Steve Jobs, while episodic memory is the songs. Yes, in theory, you can squeeze a whole lot of books and files into an iPhone, but that's not what Apple designed it for, and, when you use the software, there's always a sense of inconvenience.

iPhone is best for storing and playing songs.

Therefore, the system works better when we convert documents to songs, and facts to stories.

As for the latter, there are two ways in general:

1. clinical exposure and experience
2. understanding the theory

(Many commercial classes that boast about a super-memory actually use the technique of converting a chain of unrelated objects into a story.)

PS. You may wonder why I put so much effort to study the physiology of memory. (In fact, I began my interest soon after I entered the university.)

Jove, you read the instruction of your lap-top computer or iPhone before using it, don't you ?

Memory

After my blog on that characteristic adverse effect of a certain drug (see http://ccszeto.blogspot.com/2010/11/placebo.html), some students point out - quite rightly I must say - that our current system of examination tests too much on memorizing factual knowledge.

(That's why I always support open-book examination. See http://ccszeto.blogspot.com/2010/01/open.html)

But, I am still convinced that our students are not making the best use of their memory.

Why? Let's start with a bit of basic neuroscience.

Rather than classifying into short- and long-term, there are four basic types of memory:

1. semantic memory, i.e. remembering a fact (e.g. What is the adverse effect of this drug?)
2. episodic memory, i.e. remembering a short story (e.g. What happened to that patient I saw yesterday who took this drug?)
3. procedural memory, e.g. remember how to drive a car
4. working memory, e.g. keeping a phone number “in your head” or following a route in your mind

That sounds simple, eh? Several interesting facts of these four categories of memory may skip your eyes.

First, working memory is only meant for short term use. In other words, you cannot keep rehearsing a book paragraph in your mind for several months - probably not even a few days, and burning the midnight oil before examination does not improve your knowledge in the long run.

More to come tomorrow.

Meaning

The question that remains for the triplet is, therefore, what would they feel when they grow up and come to be aware of the fact that they were "created" for a somewhat pragmatic reason.

(I shall not discuss the problem of having no mother - orphans do not.)

But, before laughing at them, maybe we should ask ourselves: Why were we "created" ?

Yes, a good many of us were here because our parents were in love and we were very much wanted. (I won't go that far and ask the meaning of wanted - be it an imprinted desire from evolution or, simply, a wish to get a bigger piece of pork in the village.)

Nonetheless, another substantial proportion of the ordinary population are around because of accident or other nondescript reasons. Should they have anything to be ashamed of? (In fact, if you believe in Steven Levitt, getting rid of unwanted baby by legalizing abortion played a major role in reducing crime. See Freakonomics.)

Of course not. We look for the meaning of ourselves from ourselves, not the couple (or the one) who created us, nor any external factor.

Otherwise we wound end up like K in The Castle, who found out that Count Westwest, who summoned K to measure the land around the castle, was actually long dead.

Ethical

What's there for us to have evil?

I believe many of you may answer to provide contrast and demonstrate the love and greatness of the god.

I beg to disagree.

If someone need to set up an evil enemy in order to show off his greatness, he is not that great after all. (There are countless examples in our history. I don't think it needs any elaboration.)

The problem is: Does evil exist?

Yes, we're back to square one.

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

But, let's think of it. To a mouse, cats are evil - but not to the farmer who keeps cats at home. In fact, mouse is probably the evil to the farmer. (How about eliminating all mice? Jove, that would put an end to the cat as a domestic animal, and is the last thing that a cat wants. In fact, all human cats must remember this principle.)

Similarly, to the 19-year-old university student who wished to buy an apartment for his girlfriend, the superman is evil. However, a 70-year-old widow whose living depends on the dividend of stock #0001 would think otherwise.

The very question in philosophy and theology is, in fact, Is there anything that is absolutely good or evil, right or wrong, ethical or not?

I don't know, and I shall not pretend to be able to distinguish.

PS. The same topic is, in fact, rather hot amongst biologist: Is there any species on earth that we could eliminate without any inadvertent adverse effect?

Go read the article by Fern Wickson, and other related ones, in Nature on 25 August 2010.

Evil

Little Einstein's story sounds great, eh?

The problem is, why doesn't heat, light, and god be present everywhere, so that there is no cold, darkness, and evil.

In other words, winter is winter because the sun is not working to its full capability. (I discussed this consideration some time ago in this blog under a slightly different context. See http://ccszeto.blogspot.com/2009/11/blog-post.html)

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

No, I'm not blaming anything.

We need cold to, for example, store our food, and we need darkness to get a good sleep and refresh ourselves.

How about evil ?

PS. This little story of little Albert Einstein is nothing more or less than fictitious. There is no evidence that it did happen. In fact, by all we know, the Nobel laureate in physics was rather autistic as a child and was unlikely to challenge his teacher.

Triplet

Many of us are amazed with that billionaire who had a triplet of grandchildren. Some said that it is not ethical to use an artificial means to create new life; other are more concerned with the psychological problems to be encountered by the three brothers who do not have a mother.

I have a simple opinion, but I shall give it in a slightly convoluted and very indirect manner.

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To begin with, many of you may have seen a clip on YouTube that described how the young Albert Einstein challenged his teacher on the existence of cold and darkness. (See http://www.youtube.com/watch?v=2JgpARGvBnc)

If you prefer the written version, here it goes:

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The teacher challenged his students with this question: Does God create everything that exists?

A student bravely replied, "Yes, he did!"

The teacher answered, "If God created everything, then God created evil since evil exists, and according to the principle that our works define who we are, then God is evil."

The student became quiet.

Another student raised his hand and said, "Can I ask you a question?"

"Of course", replied the teacher.

The student stood up and asked, "Sir, does cold exist?"

"What kind of question is this? Of course it exists. Have you never been cold?"

The child replied, "In fact, sir, cold does not exist. According to the laws of physics, what we consider cold is in reality the absence of heat. Cold does not exist. We have created this word to describe how we feel if we have too little heat." The student continued. "Sir, does darkness exist?"

The teacher responded, "Of course it does."

The student replied, "Once again you are wrong, sir. Darkness does not exist either. Darkness is in reality the absence of light. Darkness is a term used by man to describe what happens when there is no light present." Finally the child asked the teacher, "Sir, does evil exist?"

Now uncertain, the teacher responded, "Of course, as I have already said. We see it every day. It is in the daily example of man's inhumanity to man. It is in the multitude of crime and violence everywhere in the world. These manifestations are nothing else but evil."

To this the student replied, "Evil does not exist sir, or at least it does not exist on its own. Evil is simply the absence of God. It is just like darkness and cold, a word that man has created to describe the absence of God. God did not create evil. Evil is not like faith, or love, that exist just as does light and heat. Evil is the result of what happens when man does not have God's love present in his heart. It's like the cold that comes when there is no heat or the darkness that comes when there is no light."

The professor was speechless.

And the child was later known as Albert Einstein.

Approval

(Communication between a university professor and the secretary of a grant administration office.)

Dear Professor X,

Thanks for the application on the above grant ... Please prepare a letter addressing to the Fund Secretariat advising them that ethics approval / proof of exemption are being sought from the relative ethics committees and will sent them a copy once they are available.

Regards, et cetera.

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Madam,

Thanks for your mail ... As to the "letter addressing to the Fund Secretariat advising them that ethics approval", since clinical research ethics approval is available and enclosed in the grant application, do I still need a separate letter as such ? (And, if yes, what am I expected to put down in the letter ?)

Professor X

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Dear Professor X,

For the ethics issue, it is referring to those you declare not required in the form. As stated in the requirement, proof of exemption is required to be obtained from the relative ethics committees. At this stage, you can just prepare a letter advising them that these are being sought and will let them have a copy once available.

Regards, et cetera.

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Madam,

Since my application is related to patients' clinical record and does not involve any laboratory work or animal, do I still have to seek exemption from laboratory safety office and animal research ethics ?

Professor X

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Dear Professor X,

Yes ...

Regards, et cetera.

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(The final mail that this humble university academic decided to keep to himself.)

Dear Madam,

For sure I shall apply for exemption of animal research ethics - I shall not study your clinical record in this project.

X

Clinic

Many of my colleagues are still trying to adapt their life in the new hospital block. There are, no doubt, many problems - some are silly, some more serious. I shall not join and point finger to our extra-terrestrial friends. Nonetheless, a casual chat with my friend C was illuminating.

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"I shall move later when I have a new chair. You know, many of us do not even have a chair in our new office," my friend sighed.

"Why don't we buy some ?" I was curious.

"Jove, who's going to pay for them ?"

"Of course the department ! Many of us are seeing private cases, and part of the income goes to the department central fund. The money is meant to be used for the welfare of our colleagues," I said.

"Oh, don't you know that we have used the fund to cover up our budget deficit last year?" C was slightly excited.

"But that's not the original purpose of having such a fund!" I was surprised, "and, if that's the case, who would have the incentive to see private case?"

"None and never," my friend continued, "That's why we find it unbelievable to set up - in the near future - a semi-private clinic for government servant."

"Alas, I suppose the clinic is named after Pandora," I said to myself.

Right

I must say when I wrote the blog that described my discussion with TW (see http://ccszeto.blogspot.com/2010/10/property.html), I was not aware of the fact that JW - the Warren Buffett of my friends - appeared in the morning paper and talked about the same subject.

And the two had rather different an opinion.

More so, they are the two, and only two, distinction students from the same class. I suddenly find it difficult to work out which one to follow.

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This little incident brings my memory back to the days as a first year medical student.

On one occasion, our class undertook a particularly difficult histology slide test (during which each of us had to see 40 slides and answer some questions). In the evening after the test, two of the smartest students of my class met in the canteen and checked the answers with each other.

To their horror, in only one out of that 40 questions, they gave the same answer.

Neither of them slept very well in the following days.

But, their panic attack did not last long. A few days later, the result was announced. The annoying bit was, the two of them scored the highest within our class. (And, as to that question of which the answer they agreed with each other, they were both wrong.)

Alas, when every one keeps making the wrong decision, a few correct ones would bring you to the top already.

PS. Seriously the opinion of TW and JW are not all that different - they were referring to slightly different contexts. Go read http://hk.myblog.yahoo.com/cal-culator/article?mid=468

Guess

You may wonder why I was so sure the students had mistaken the slide and there was no specific syndrome called placebo-like effect.

In fact I was not.

But, to begin with, I merely applied a rule that I used since my days as medical student.

It says: If I have not heard of it, it does not exist.

I could hear you gasp, as well as your unspoken comment: How arrogant and histrionic!

Yes, I am - but not that far.

The fact is, this rule was designed for MCQ examination. You don't need to be encyclopedic and be absolutely certain that something does not exist if you have not heard of it - you only have to be knowledgeable to the extend that if you have not heard of a particular thing, the probability that this subject at hand does not exist is higher than that you are being ignorant on this particular matter.

In other words, if I put my money on the former and keep betting, I would expect a positive return.

I call it a calculated arrogance.

PS. Of course, I was not answering MCQ this time, and I had to go back to the reference and looked up the subject before I could be certain.

Placebo

That day proved to be exceptionally busy. After meeting two friends of mine, I received a whole pile of written paper from the panel examination of our third-year students.

I was responsible for scoring one of the essays.

It was a question on lipid-lowering medicine, their clinical use, and adverse effects.

The task was tedious. To my surprise, when I went through the answer for the adverse effect of a particular drug, nearly half of the class wrote the following:

Placebo-like effect.

I must say I have never heard of a distinct syndrome with such a name, nor did I encountered problems remotely related to this seemingly characteristic phenomenon.

And then I had a hunch.

I went back to the Powerpoint file of that lecture, which was made by another professor. On the slide that described the adverse effect of that drug, there was just one line: placebo-like.

It means the drug has no specific side effect and the profile of adverse reaction was similar to the placebo group in randomized trials.

For sure many of our students have intact visual cortex, temporal lobe (for semantic memory), and motor area - they could recite exactly what's written on the teaching slide without knowing what it means.

A icy cold feeling sudden went through my back.

PS. The most dramatic answer sheet, however, belongs to a remarkable candidate who wrote an entire page in an attempt to answer the question last year (which was pretty much the same as the present one, except that we were asking a different class of drug).

Articles

In that afternoon I met WG - my previous PhD student who happened to be in Hong Kong. (For our relation, see http://ccszeto.blogspot.com/2008/06/wg.html)

"How are you recently ?" I feel really warm to see my student becoming my trusted friend and collaborator.

"So so," he was cautious, "Well, have you read the recent paper in Nature ?"

"You mean the one by Daniel Chitwood and Marja Timmermans on microRNA ? Yes, that's interesting." I said, referring to the review article Small RNAs are on the move, which discussed a topic that WG and I had long for doing some research together. (See Nature 23 September 2010, p 415.)

"No. I mean the story of Fang Shimin." WG said.

"Oh, I see what you mean ..." I was sympathetic, reflecting the problem now faced by my friend, "The title is Brawl in Beijing, written by David Cyranoski." (See Nature 30 September 2010, p 511.)

"You know, it is often difficult for people like me to do serious scientific work." He sighed.

"And, even if you did, it is unlikely to convince other people. In fact, you should also read Strong medicine for China’s journals by the same author." I said grimly. (See Nature 16 September 2010, p 261.)