Opportunistic

"What do you mean by opportunistic cause ?" I asked.

"Two folds actually," L became more calm and patient than ever, "The simple one is a microscopic personal individual consideration. Let's take heart attack as the example. By the time the patient goes home, he should be taking aspirin, a beta blocker, and an ACE inhibitor. Right?"

"Yes, they have their benefits proved beyond doubt."

"Now, if we have a mega-trial and prove that, say, adding a second anti-platelet has some additional benefit, are you going to give it to your heart attack patient?"

"Of course."

"How about another trial on, say, a new aldosterone antagonist?" L smiled.

"Em ..." I began to hesitate.

"And yet another trial on- what about a direct thrombin inhibitor ?"

"In that case ..." I began to see what he was getting at.

"In that case your patient would be taking an increasing number of medicine, which means a higher risk of unexpected drug interaction, or, simply, a higher risk of non-adherence to the treatment ! Although your new gadget may achieve some marginal benefit under experimental setting, in real life it would deter the patient from taking the more important medicine - for example, aspirin in our above discussion."

"Or, to put it simply, there is a limit of how complicated one could put up a practical treatment regimen," I was forced to finish for him.

Size

(I would not let L go that easily after a - to me - lighthearted comment.)

"Are you implying all mega-trials are useless ?" I pursued on the topic.

"No, but quite so I must say," my friend smiled, "If a new treatment is cheap and harmless, it really doesn't matter if it helps only marginally for an uncommon condition. The problem is, hardly any new treatment falls into that category."

I was forced to agree, "Quite so, except perhaps some public health measures that, say, you find in The Lancet. But I would argue human life and suffering are priceless - and medical researchers should do everything and test every possible measures to treat our patients."

"No, there is a price for everything - including human life and suffering," L murmured in a voice that I could hardly hear. After a moment of silence, he continued, "Even if we do away with the monetary cost, there are good reasons against mega-trials."

"Yes ...?"

"First, it involves exposing a large number of subjects to a new medicine with relatively unknown risk. After all, if we are so concerned about rare adverse events that we have to recall propoxyphene, how could we ever be sure the drug under testing is safer than the good old Dologesics ?"

"True, but that remains a balance of probability, or between risk and benefit," I retorted.

"Quite right. But my major concern is the opportunistic cause and damage to the fourth party."

"What !?"

Power

(My conversation with L continued.)

"I think it is quite correct to say that if they could have a bigger trial, they may find a benefit for the new drug. Where's the catch ?" I was puzzled.

"You are caught by doing correct mathematics," my friend twisted his lips, "Look, the study that we are talking about has over 1600 subjects. What benefit could it not detect ?"

"Why, it depends on both the magnitude of the benefit and the prevalence of the problem." I still remembered the basic principles of sample size estimation.

"Of course, of course. As I said, you are obsessed with numbers and details," L was not moved, "Say, if the outcome would develop in half of the untreated subjects, what benefit of a new treatment could be reliably detected by a clinical trial of 1600 patients ?"

"You are pulling my legs. I do not bring along with me the software." I complained.

"Don't worry. Let me show you this," and then he gave me a tiny sheet of note, on which was full of his scribbles.

Here it goes:

• assume 80% power and a P value of 0.05 being statistically significant
• two-arm study; 800 subjects each side
• if the risk of developing an event in the control arm is 50%, the study has sufficient power to discern it from a treatment arm with an event rate of 43%
• in other words, it can detect an absolute risk reduction of 7%, or relative risk reduction of around 14%
• if the treatment has the benefit of a relative risk reduction by 50%, a sample size of 1600 would have sufficient power to detect the difference when the risk of event is 6% (i.e. the treatment reduce the prevalence to 3%)

I considered for a moment this piece of paper, and remained somewhat puzzled, "Yes, I understand all these. But, what's the point ?"

"The point is, if you need an astronomical sample size to detect a difference, either the risk of event is very low, or the benefit is really marginal, or, more likely, both," my friend sighed, "And the concern is not only relevant to this fortunately harmless medicine - it applies to all mega-trials !"

Better

Met my friend L on my way home and caught him by surprise - he was absorbed in reading journal and did not notice my approaching until I tapped on his shoulder.

"Hullo! What's up in the New England?" I asked while pointing at the tiny volume that he was holding.

"Ground-breaking research. Let me read the conclusion to you: Treatment with X had robust effects on this risk factor of heart problem, had an acceptable side-effect profile, and, within the limits of the power of this study, did not result in the adverse cardiovascular effects observed with the drug." My friend finished triumphantly.

"Do you mean ... oh, do they mean the drug has a benefit ?" I was confused.

"No, it means the drug makes the numbers better, and, more importantly, is not making the patient any worse !" He said, with a twist at the angle of his lip.

"But, who cares about the numbers? I know drug Y - another drug of the same mechanism - improves the numbers, but patients who take this drug end up having more heart attack."

"Exactly," my friend reassured me, "That's why this time they have to emphasize patients taking X apparently do not die more easily as compared to placebo."

"Gosh. Why making such a big fuss for finding a drug that does not kill ?" I smiled, "But, they may have a point. If they could conduct a study with more patients, they may be able to detect a benefit."

"Mathematically you are correct," the face of my friend somehow turned grave, "But I cannot say I agree with you. The matter actually involves a much deeper water than that comes to your eyes."

(To be continued.)

Protect

You may argue the procedure of risk assessment may be considered cumbersome, but that's necessary for the protection of small investors.

On that, I beg to disagree.

The complicated procedure is meant for the protection of the bank or stock broker, not small investors. After all, who do you think has a better comprehension of that thickness of document? (The same argument also hold for a complicated consent procedure, or the time-out policy that our friends from extra-terrestrials are recently so fond of.)

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

On a second thought, I begin to suspect the entire business does not protect the bank very much better either.

The problem goes like this: In the middle of this risk assessment exercise, I was asked how long an experience I had been involved in a list of investment products (e.g. fix deposit, stock, ELI, warrant, and so forth). Since I never touched any ELI, I chose none for that item.

A moment later, another question asked what investment products I was holding at the moment. The list was, in fact, the same as the previous question mentioned above. However, I had not took my morning coffee at that time and was in a confusion state - I said that I was holding some ELI.

Alas, that was, of course, self-contradicting and logically impossible. Nonetheless, the serious-looking woman did not notice it when she checked my answers, and neither of us noted that when we went through the answer again the third time.

I am sure if anything disastrous happens, I could still sue the bank and declare that I was in an abnormal mental state when doing the risk assessment.

OSCE

You may wonder why I felt like going through an OSCE.

Alas, I had five stations in 90 minutes:

1. The friendly woman I mentioned yesterday, who checked my documents and started the procedure.
2. I was then led to another room to meet a young lady, who had the words financial sales clearly written on her face. Her purpose was obvious - and so was my response.
3. I was next brought to see an apparently more senior woman, who did the risk assessment for me before I could set up an investment account.
4. Then I saw yet another young lady who activated the investment account.
5. And, finally, I was brought back to the first friendly woman, who arranged the transfer of a small sum to Adler's new account as the seeding money.

To me, the unexpected bit was obviously that risk assessment business.

Well, that's required by the Securities and Futures Commission after the financial tsunami. As you know, the whole process was recorded. It was not a passive process of recording what the bank explained to me; I had to gave verbal response (saying "yes" or "agree") at appropriate points - so much so the woman and I needed a brief rehearsal before the formal recording began. In addition, I had to sign several times on the document, and was actually given a copy of the signed document after the whole process.

How did I feel during the process ?

I felt great ! Thank goodness our extra-terrestrials have no experience on this, otherwise they would ask for the same when we are obtaining a consent for any medical procedure.

That is really disastrous.

Account

After finished telling a story in Euterpe's kindergarten, I went to the bank to open an account for Adler.

(My younger daughter is almost 6-month-old now; Vivian and I believe it is a good idea to have a bank account for her to save up the red-pocket money. Euterpe has the same arrangement, with the account tagged to Vivian. Therefore I plan to have Adler's one tagged to me in order to avoid confusion.)

To begin with, I thought the process was easy. (After all, it took no more than 20 minutes when we set up the account for Euterpe in 2007.)

And I arrived at the bank at 9 AM sharp. I am a (so-called) "prestigious" customer, the first to arrived at the counter, and was served immediately.

"What could we do for you ?" A friendly woman sat at the other side of the desk asked.

"I want to set up an account for my daughter, and here are the relevant documents," I replied and showed her a pile of paper that I prepared in advance.

"OK, do you just want a saving account, or are you also going to do some investment - mutual fund or stock or whatever - for your daughter?" She asked again.

"Everything," I said, "We had the same for our elder daughter."

In retrospect, her face appeared funny in response to my answer - it was a mixture of sympathy and helplessness.

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

I left the bank at 10:30 AM.

Yes, it took 90 minutes to set up the account. My feeling was no better than our medical student going through a OSCE.

Let me tell you what happened tomorrow.

Discipline

Went to Euterpe's kindergarten and told a story.

Frequent visitors of this blog would know I did the same thing last year. (See http://ccszeto.blogspot.com/2010/05/story.html) This year, my daughter moved to a new school and I faced a group of different students.

Similar to last year, I brought a picture story book and did some rehearsal in advance to make sure of the time-keeping. To begin with, I expected I would met some lovely girls sitting there and I would showed them the pictures in the book while going through the story.

But I was wrong.

Yes, there were around 20 kids (mostly girls). They were led into the playroom (where I was going to do my deed) by two teachers - both of them disappeared as soon as the children said good morning to me and settled in their chairs. (By the way, although I am literally a teacher for nearly 12 years, this is the first time the students in my class said good morning to me.)

And, as soon as there was no teacher and I was alone telling the story, almost everyone of them stood up and tried to say something to attract my attention:

"Oh, I cannot see the picture !"

"Can I come closer? I want to see what's there on the rabbit's hand."

"Can I touch this and that ?"

(Alas, the list is endless.)

I must say I began to worry how well disciplined these children - and my daughter - could be.

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

The 20 minutes of story-telling session passed quickly without my notice. A funny sound suddenly appeared in the air, and, before I could realize it was the school-bell, all the excited kids turned silent. In no time they formed a line, waved goodbye to me, and went off the room one by one - heading to their own classrooms.

My mouth was wide open.

After a brief moment, I pulled myself together again, picked my belongings, and left the playroom, only to find the headmaster smiling outside the corridor.

Well, she had more than good enough reasons to be proud of.

Diary

Since 1st January this year, I changed to a new diary book.

Frequent visitors of this site would know I am still writing my hard copy diary almost everyday. The habit began in 1987 (see http://ccszeto.blogspot.com/2010/04/beginning.html) and, seriously, it is usually no more than some brief notes so that when I read it years later, it would help to bring back my memory.

And, exactly for that reason, although it is nearly 25 years, I keep just a few diary books:

• 1987 to 1992 (life as a medical student and house officer)
• 1992 to 1997 (trainee days)
• 1997 to 1998 (Bristol experience)
• 1998 to 2003 (life as a young academic)
• 2003 to 2010

Alas, I am not implying I am starting a new chapter of my life - just so happen I have a new Moleskine notebook to dispose.

EverNote

After some slightly disappointing experience with Connotea and Microsoft OneNote, I started using EverNote recently to manage journal articles.

In short, it is a program as well as an on-line service. You can use it as a free service (with limited capacity), or sign up and pay for a much higher storage.

To begin with, it was designed for notes taking, and one could record things as text, image, or voice record. Similar to OneNote, each notes is one page, and one could add tags and group several note pages into a notebook.

The very edge of this program - to me at least - is when you open a web page of journal article, be it a full one or just the abstract, you could click a single button on the browser and add it as a separate note, with the title of the article and the journal automatically detected and hyperlink saved. Furthermore, if you select a paragraph of that journal page (for example, the conclusion of the abstract) and then click that button, the selected part would become the text in that notes - still with the article title and everything in the right place.

But, things are never flawless: If you want to type your own notes, the list of font for your choice is horrible, and the bullet function does not work properly. I am also yet to see how efficient the search engine is when the collection of notes gets fat. Nonetheless, like every other problem on earth, we do not want a perfect solution in the unknown future - we need a reasonable remedy here and now.

PS. Although my usage is not that much, I sign up for the premier account and pay a small sum of money (around HK$360) each year - there is no free lunch in the world, and I prefer to know what I am giving away to get the service.

Electronic

As to the Pandora Box of electronic filing, it actually began a few years ago - before I had the problem with my system of keeping hard copies.

To begin with, the Nature Publishing Group created Connotea - a free online reference management service - since late 2004. I was, in fact, one of the first few who signed up for this service. Papers and their corresponding hyperlinks were saved; tags could be added for easy searching. I used it for a few months but was forced to give up - the information to fill in for each paper was slightly complicated (for someone with dyslexia like me), the server was not very stable and often slow.

(I still try the system once or twice each year - just to see if the system has improved - but to no avail as yet.)

In 2006, I bought a new laptop computer. In it there was a pre-installed software: Microsoft OneNote - a program that was designed for notes taking and information management.

I must say the program is easy to use; text and images could be conveniently pasted and organized (and with the very useful screen capture function) - just that I do not have it installed in the desktop computer of my office, where most of the work is done.

How about buying a new copy?

It's not all that expensive. The problem is, for the new versions (2007 and 2010), that is sold in bundle with the entire Microsoft Office.

And, everyone who tried to use this product of Bill Gates would agree the new Office is really a modern one - full of bureaucracy and procrastination; you can never find what you need or do what you want in a convenient way.

Therefore I decide to keep my old Office and forget about a new OneNote.

Filing

But my problem did not end there. I used the method of filing useful journal pages since 2001, and it worked well until recently.

There is more than one problem. To begin with, I did not receive several issues of some of my subscriptions last year - only to discover when my friend KM tried to discuss with me the recent literature.

And, as my collection files grow fatter after ten years, it is increasing more difficult to extract useful information when I need them.

Of course, since the birth of Euterpe and Adler, I also paid inevitably less attention to maintain the system.

What should I do?

The obvious answer is: go electronic.

That opens the Pandora Box.

PS. For those who are interested to keep yourself update on medical literature, there are actually two problems to solve. First, one needs a secure system to receive and read the list of journals that you select. Second, we need a filing system so that we could trace back the information when required (often when we have only a vague memory on what the topic is).

That's whey we do not be too ambitious with our list. As Sherlock Holmes said in A Study in Scarlet: A fool takes in all the lumber of every sort that he comes across, so that the knowledge which might be useful to him gets crowded out, or at best is jumbled up with a lot of other things, so that he has a difficulty in laying his hands upon it.

Reading

As a matter of fact, I tried no fewer than a dozen of methods over the years to keep up with the literature and prevent my desk being flooded with unread journals. (All visitors to my office know just too well I am an obsessive follower of the clear desk policy.)

To begin with, I was young and had a better memory, I read the journal and then threw it away. On rare occasions I made some notes - written or electronic - in case I need some further reference. In general, I read through every review article but only the abstract of original ones. (I also read the Case Record of the Massachusetts General Hospital and the correspondence column of the NEJM, as well as the Obituary of The Lancet.) Alas, that only work when my reading list was short; that was also the only possible strategy when there was no sophisticated information technology.

(I claim no credit of this strategy; I learnt it from RJ Epstein, as described in the previous edition of Medicine for Examination.)

When my reading list grew longer, I almost always read only the summary of the review articles, and then study the tables, figures, and the first sentence (sometimes the last, depending on the writing style of the author) of each paragraph. As to original articles, I usually read only the conclusion of the abstract. (That's why I hate the Nature Publishing Group; their journals use an unstructured style for their abstracts, so that it is sometimes difficult to find what the main point is.)

What do I do with the journal after reading?

I tear out the useful pages (mostly the figures and tables of those review articles, sometimes with text highlighted), and file them in folders according to the subject. I also keep the table of content - sometimes with a few notes scribbled - for further reference. I usually use half an hour or so every Saturday morning to file the pages that I kept from the previous week.

I did not invent this method either; my previous colleague GK taught me that much.

Journal

A few days ago, my friend VW put up a list of journals and compared the change in their impact factors over the past 10 years. (See http://vwswong.blogspot.com/2011/01/time-capsule.html)

The list is illuminating to say the least. I shall not elaborate on the problem of impact factor and other measures to compare journal performance. (On this, interested visitors of this site should read Citation bubble about to burst? by Jürgen Schmidhuber published on 6th January 2011 in Nature.) But, I just want to show this - the list of journals that I subscribe and read:

• New England Journal of Medicine
• The Lancet
• Journal Watch
• Nature Medicine
• Nature
• Journal of the American Society of Nephrology
• Clinical Journal of the American Society of Nephrology
• Kidney International
• Nature Reviews Nephrology
• American Journal of Kidney Disease
• Peritoneal Dialysis International

There are a few others that I receive the free copy and would thumb through regularly. In fact, the list grows with years. When I was a trainee in 1993, NEJM was the only one I subscribed.

One of the eternal puzzle that I wish to resolve, in fact, is how to tackle the information overload.

PS. When I received the first subscribed copy of Kidney International in 1995 (shortly after I began my training in nephrology), I found it written in a language of the aliens. I told my feeling to the man who still had a moustache, and his response was remarkable:

"If you could understand 80% of all the titles, you could be called fully trained."

I was slightly taken aback.

After a moment of silence, he added, "By the way, I do not read journal articles - I write them."

Reminder

In clinical practice (and many other sector of business and industry), when we come to realize it is a common trap to fail to recognize what should be there is not there, it is the time to put up check lists and protocols.

And, that's the main purpose of these inevitable evils. Guidelines and protocols should not be there to govern what clinicians do; they are reminders to physicians - after all the work and do the things that we feel important and appropriate, they give the safe-guard and make sure no major area has not been taken care of, and, as the old English sayings, no stone left unturned.

Unfortunately, this very principle is not appreciated by most extra-terrestrials who put up guidelines and protocols.

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

This discussion, however, applies only to clinical practice - and probably business and industry. We want every details to be correct or conform to a desirable standard. In daily life - as in the example of promoting the bidding of Asian Game that I put up yesterday - the situation is quite the opposite.

What I mean is, it is in fact very unlikely to have everything that should be there is there.

As Philo Vance said (in The Canary Murder Case): Nothing flawless is natural or genuine.

And, as compare to asking what should be there is not there, it takes a even harder work of the brain to be able to ask: This appears flawless, who's making it up ?

I have paranoid personality disorder, I know.

Trap

While talking about psychological trap, another one that commonly pulls our legs is the thing missing.

To put it simply, it is the situation where we see a list of items forming a scenario, and then the ability to ask the question: What should also be here but is missing ?

Similar to noticing the difference between different things, seeing what is present needs nothing but a reasonable (not necessarily normal) visual acuity, but it calls for active brain function to remember to ask the very question of what is not there.

For example, in a neurology short case, when we see a patient with paraplegia and hyper-reflexia and bilateral up-going plantar response and a sensory level, we ask: Why does the patient have no urinary catheter?

Or, in the recent incident of government officials trying to promotion the bidding for the 2023 Asian Games, we find Mr. Fok and several Mr. Tsang going everywhere to solicit support, and we ask: Where is Henry the Chief Secretary?

And one often learns a lot by spotting what should be there is not there.

Similar

You may find it slightly out of the way to compare a magic wand to a sword.

No, that's not only a metaphor but something more fundamental. You know, it is a classic psychological trap. For example, in a formal cognitive function assessment, we do not ask what the difference is between an orange and an apple (or between an orange and a ball), but, rather, one ask what is the similarity.

To go one step forward, seeing the difference between two different things is a matter of passive recognition and comprehension; seeing the similarity requires active neuronal activity.

Or, wisdom, if you prefer to call it that way.

And, by seeing the similarity, human being could classify things and formulate scientific hypothesis. More importantly, when faced with an unfamiliar situation, we make use of the similarity with some seemingly unrelated matter as the analogy for illumination and a guide for our decision.

PS. That's also why Aristotle was such a gigantic figure in the history of philosophy and science - he saw the similarity between various objects and made a classification.

Potter

Watched Harry Potter and the Deathly Hallows Part 1 with Vivian.

I must say I am no fan of the boy with glasses and lightning birthmark. Yes, it is a pleasure to see Hermione Granger, and, I dare say, Luna Lovegood.

But the film is slightly dull this time. I have not read the original fiction by JK Rowling, but I suppose David Yates leaves all interesting bit to the second part, and it seems an inevitable result if you split a book into two movies. (No, that's hardly an excuse. Peter Jackson did it much better for JRR Tolkien's masterpiece.)

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

On my way home, I suddenly realized there's actually very little difference between Harry Potter and martial arts fictions - just that the characters fight with each other by curses and spells and wands rather than qigong (氣功) and sword.

Well, if you find no analogy between the story in Hogwarts and those described by Jin Yong (金庸) or Liang Yusheng (梁羽生), go read The Biography of Shushan Swordsman (蜀山劍俠傳) by Huan Zhu Lou Zhu (還珠樓主).

The difference lies in their marketing.

Alas, you may say The Biography was never finished - the story broke off around the time of changover in China.

Right. That's the main difference.

Patients

I left FL's office with NT. He obviously saw that I was startled with the idea of pathology clinic.

"Don't worry," my friend tried to reassure me, "The discussion is hot in America, but our friends here are hardly serious - they are sane !"

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

My friend explained, "You know, when we were medical students, the King of the Round Table used to say if you like to work, become a surgeon; if you prefer thinking than working, go become a physician; if you like talking to others but neither working nor thinking, go become a psychiatrist; if you like to think and work, but do not want to talk to the others, you should become a pathologist. That's the main reason why some medical graduates end up in this department - they do not want to talk to patients !"

I pursed my lips, "Well, yes, very true. But I must say I see the need of having a pathologist to see the patient on some occasions. Say, I could understand why you set up a clinic - because you are the rare expert in metabolic disease and certainly the best one to explain what genetic test to choose and how to interpret the result. Similarly, PC, our consultant skin pathologist, want to go to the clinic because he does not want to see histology slides only; he likes gross pathology and prefer to see the entire specimen - which is the patient himself !"

My friend returned an understanding smile.

PS. My friend's citation is certainly not applicable nowadays. Pathologists do not have to see patients, but they may have to see relatives when receiving a coroner referral.

Quite a disappointment for both parties.

Clinic

Paid a visit to FL, our emeritus professor of pathology, for some trivial matter. In his office, I found a large crowd of pathologists and there was an excited discussion.

"What's up?" I ask NT, one of my classmates who happened to be there.

"They are discussing the possibility of setting up a pathology clinic," the professor of clinical chemistry made a grin.

"Eh ...?" I could not hide my surprise.

"It is a hot topic," one of them said, "You know what. Pathologist is a vanishing species because no one - no patient, I mean - know of our existence. It is recently advocated by many renowned pathologist over the world that we should come out and set up our own clinic and see patients, so that we could have some interaction with them."

"But, what are you guys going to do in the clinic?" I remained incredulous.

"We could give a detailed explanation of the investigation result," replied by another.

"Then, how about the discussion of treatment option ?"

"Oh, of course we leave it to the clinicians."

Thank goodness my friends didn't say the discussion on the choice of medication would be left to some pharmacologists who also set up their own clinic.

James

While thinking about the delinquent royal ladies in ancient China, I met a few of my colleagues and had a brief conversation on a topic that my friend VW recently discussed in his blog.

(See http://vwswong.blogspot.com/2010/11/manchester.html)

I shall not elaborate on the details of what we talked about. But, rather than Wayne Rooney, I kept thinking of LeBron James - the star basketball player of America.

For those who are not familiar with NBA, James was selected in 2003, at the age of 18, as the number one pick of NBA Draft by the Cleveland Cavaliers, and soon became the brightest jewel in the crown of the Cavaliers. In the summer of 2010, however, he left Cleveland and joined the Miami Heat - (apparently) in order to have a better chance of winning the championship from the NBA Playoffs.

But, did the Cavaliers try to keep the star player? Of course. Certainly. Beyond doubt. What a question. James was treated as the King in Cleveland; his decision override that of the head coach repeatedly; and his salary rose from US$4M in 2003 to nearly $16M by 2009. From a strategic point of view, the Cavaliers put too much focus on keeping their small forward, and did not have a plan B in case he left - so much so the team's performance was abysmal in 2010.

PS. That's in fact a biological principle: Most animal needs at least two legs to support their body and walk. It is all right to have none - just that you must learn to crawl, like a snake. However, it is distinctly dangerous to support the whole structure by one leg.

Allow

You may say, "Oh, you mean one should put up disciplinary action in order to set an example. That's a truth from the Sunday School."

(I shall not retort by saying that Sunday School is place of teaching the, supposedly, eternal truth. As Guan Lu [管輅] said: 老生者見不生，常談者見不談。)

No. My point is this: The problem does not lie (entirely) on the delinquent royal ladies.

Why did King Helü of Wu (吳王闔閭) allow - or tolerate - the women to behave in that way ?

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

To go one step forward, the very thing that Sun Tzu did was taking over the decision from King Helü and set up an example of maintaining rules and orders, irrespective to the preference of his actual boss.

Or, to put it in another way, while seeing the delinquent women laughing at his order, he did not rush to the field and perform the orders himself.

Otherwise he would become an accomplice of the King.

As Francis Bacon said: If we do not maintain justice, justice will not maintain us.

寵姬

Another story from ancient China:

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孫子武者，齊人也。以兵法見於吳王闔閭。闔閭曰：「子之十三篇，吾盡觀之矣，可以小試勒兵乎？」對曰：「可。」闔閭曰：「可試以婦人乎？」曰：「可。」於是許之，出宮中美女，得百八十人。孫子分為二隊，以王之寵姬二人各為隊長，皆令持戟。令之曰：「汝知而心與左右手背乎？」婦人曰：「知之。」孫子曰：「前，則視心；左，視左手；右，視右手；後，即視背。」婦人曰：「諾。」約束既布，乃設鈇鉞，即三令五申之。於是鼓之右，婦人大笑。孫子曰：「約束不明，申令不熟，將之罪也。」複三令五申而鼓之左，婦人複大笑。孫子曰：「約束不明，申令不熟，將之罪也；既已明而不如法者，吏士之罪也。」乃欲斬左右隊長。吳王從臺上觀，見且斬愛姬，大駭。趣使使下令曰：「寡人已知將軍能用兵矣。寡人非此二姬，食不甘味，願勿斬也。」孫子曰：「臣既已受命為將，將在軍，君命有所不受。」遂斬隊長二人以徇。用其次為隊長，於是複鼓之。婦人左右前後跪起皆中規矩繩墨，無敢出聲。

《史記列傳第五：孫子吳起列傳》

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For those who could not understand Chinese, here is the English translation I adapted from Wikipedia:

The King of Wu (吳) tried to test the skill of Sun Tzu (孫子) by commanding him to train a harem of 180 concubines into soldiers. Sun divided the mistress into two groups, appointing the two most favoured ladies of the king as the leaders. When Sun first gave order to the women, they giggled. He reiterated the command, and the delinquent females continued to laugh.

Sun immediately ordered the execution of the two team heads, that is, the king's two favoured concubines. Sun explained that once a general was appointed, it was their duty to carry out their mission - even if the king protested. He also made it clear that if the soldiers understood their commands but did not obey, it was the fault of the officers. After both concubines were killed, new officers were chosen. In no time, all female soldiers performed flawlessly.

PS. As Alan Greenspan said, if you think you know what I'm saying, you've definitely misunderstood me.

And, as one of my favourite pop star once said: The hall is full of audience, but I am singing to only one.

Arrietty

Watched The Borrower Arrietty (借東西的小矮人) with Euterpe.

My wife made the suggestion. The story was adapted from the novel The Borrowers by Mary Norton. The director was Hiromasa Yonebayashi (米林宏昌), supposedly under the supervision of Hayao Miyazaki (宮崎駿).

The plot was simple, and I considered there could be many areas better explored in the story. For example, how about using a tiny jar - from that miniature kitchen - of honey rather than a sugar cube as the parting gift ? (I suppose I cannot blame Hiromasa or Hayao; they just followed the original story of Mary Norton.)

Nonetheless, the film was entirely enjoyable. There was no explosion or extra-terrestrial alien. Nothing was exciting - just a somewhat plain story slowly unfolds itself. All emotions were contained. There was also not much hidden meaning or great lesson to learn. In that 90 minutes, we had a sick boy making friend with the little Arrietty. That's all.

And, simple is beauty.

Learn

But, having a satisfactory investment return is not my conclusion.

After all, I did not hold any of these items after 2002.

The real point is: How did I pick this list ?

It was some 10 years ago, when I first started some investment in the local stock market. As you know, I had no formal training in finance or business, and most of the items were chosen by intuition, or by simple layman parameters (for example, a low P/E ratio or high dividend rate).

Soon afterwards, I recognized my insufficiency. I began by reading The Ten-Day MBA of Steven Stilbiger, trying to learn how to read a balance sheet and financial statement. In the next two years or so, I had extra private study and went through another half dozens of books in this area (notably, Security Analysis by Graham and Dodd, and One Up On Wall Street by Peter Lynch).

But, am I making better investment decisions now ?

I doubt very much.

(Well, yes, it is gratifying and rewarding to read and learn an entirely unrelated subject. The pleasure is beyond the financial return.)

PS. I began reading the financial page of our morning paper since secondary school, but neither did I have the time nor some seeding money to start a trade. In fact, buying and selling stock in those days was, to me, a complicated task. It was not until the availability of internet and electronic banking when I could stay at home and make investment decision at the most inconvenient time. From then, a large population of people who used to have no easy access to stock trading could join the market, contributing to the bubble in late 1990s. The whole story is an excellent example to illustrate The World Is Flat as outlined by Thomas Friedman.

Draw

You may ask what could I make out of the list.

Alas, it really depends on your point of view.

You may ask, like Hercule Poirot, "We saw the same thing, shouldn't we make the same conclusion?"

Then, let's go through the facts:

• 6 of the 18 issues on the list did horribly (#55, 274, 643, 1071, 1163, and 8056)
• 6 prospered well (#87, 177, 345, 347, 984, 1052)
• the remaining 6 just followed the market trend (#125, 682, 711, 900, 991, 1038)

Just looking at the numbers, you may say that's a draw.

However, only one of the issues had its value fell to zero (#8056); all other 5 that decreased in price had some residual value (average 37%). In contrast, the 6 whose price rose dramatically made an average of 6-fold return - far much more to compensate for the loss. In fact, if you made a portfolio with equal weight of the 18 items in 2001, the value increased by 2.7 fold after 10 years, or a 70% extra return as compared to putting your money on Hong Kong Tracker Fund.

List

During the new year holiday, I went through an electronic time capsule.

It is, alas, a list of previous stocks that I hold transiently between 2001 and 2002.

Here you go:

It should be noted that Heng Sang Index was around 10000 during that year, but 23000 now.

PS. Stock #0055 changed its name to 中星集團 (in 2005, I think), while #1163 is now known as 德金資源.

PPS. The list is, of course, incomplete. I did not include those items that I hold beyond 2002.

輓詩

淡泊平生志，奈何作莒人。

伯夷鄙周栗，田橫恥漢臣。

燭光傳薪火，丹心誌汗青。

忝哭寢門外，杯酒奠斯文。

《庚寅歲次太宰敬輓，並傷同籍之誼》

Done

(... cont'd)

But, the problem had not ended. The courtier didn't even know how to boil water.

Alas, we shouldn't worry for him. After all the ingredients were ready, the courtier turned himself to the Royal Kitchen in the palace, where he found the head chef.

"His Highness asks me to prepare some soup. I know you are engaged in another matter and are about to go. Would you mind me doing it here ?"

"Oh, of course not. You have all the stoves, ovens and other utensils at your service," and off the busy chef went.

A moment later, the senior assistant chef came and found the courtier in the Royal Kitchen.

"Sir, can I help you ?" He asked.

"Yes, of course, you have to," the courtier said, "I'm preparing a soup for our King, and your boss agreed to have the Royal Kitchen to take part. Please figure out how we are going to make it."

"Oh, what kind of soup do you need ?"

"I have no idea. Here are the ingredients that I have. Go work it out."

A few junior staff of the kitchen were summoned to join.

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In the next hour or two, the courtier just sat there and appeared to observe with interest how everyone busy around for his soup.

Eventually, it was done.

The courtier briefly thanked everyone and asked them to retire to bed. Carefully he took the the pot out from the stove, and filtered the tasty solution through a sieve to remove all remaining vegetable and meat.

Now, he had a clear soup ready for His Highness.

Of course, he did not forget to put the stone in his pocket into the pot before he actually met the King.

Soup

An old story that is familiar to most of us (and I add a little spice):

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A courtier told the King, "Sir, I could make the most delicious soup with a piece of stone - just that you have to allow me to do so."

The master cheered up, "Why! I cannot believe it. Well, go ahead and have a try by all means."

With that order, the courtier picked up a piece of stone and put it in his pocket. Then he got a large pot of water and went to the royal garden in the palace, where he found a junior staff.

He showed the staff that pot of water, "The King asks me to make a good soup from this. Give me some potatoes."

Not accustomed to asking any question, the latter duly complied.

The courtier then bring the pot of potato water to the head gardener

"Look. The King asks me to prepare some soup. Give me the potatoes, tomatoes, onions, and mushrooms."

Seeing that the courtier was taking an imperial order and the project had already started, the head gardener didn't think she was in the position to refuse. The list of vegetable was ready in no time.

Now, you could imagine the rest: The courtier got some meat from the butcher, and all the herbs he needed from the pharmacist. Seeing that he had got many of the ingredients and the project was on-going, none of the persons he encountered doubted why and how it was started.

(To be continued.)

Gingerbread

Vivian was on-call on the Christmas day; I stayed home and made gingerbread man with Euterpe.

This was, maybe to your surprise, the first time I ever made this type of traditional cookie.

How did we find the experience ? It seems easier to explain by a picture:

Happy new year !

PS. Although gingerbread seems very British, it was actually brought to Europe shortly before 1000 AD by an Armenian monk, and ginger originates from South Asia. I suppose in a cold weather, adding a tiny amount of this spice to the dough gives a sensation of warmth, which explains why this bread is so well received.