Cellar

(Open letter of a certain Mr. Teng.)

Dear all,

I write this to tell you the true story about that gigantic "cellar" of my house.

As a matter of fact, I am the victim.

I bought the place ten years ago from a Mr. Li, and, before I moved in, I was not aware that it is a house - as I always imagined I bought an apartment. The brochure that I got said that I was buying the platform floor (or, Mr. Li called that the fourth floor) of that building, and, part of the deal was I had to buy also the level below that platform, which I suppose is the ground floor.

And, so, in other words, the "cellar" that you all call is the ground floor in my understanding.

Well, maybe there was a subsidence - perhaps by the landmine of CY?

Sincerely, et cetera.

PS. You may ask: In that case, why did I put up my wife as the excuse?

Of course. How could I offend Mr. Li?

AIRS

During another casual lunch time conversation, our discussion came again to the selection of new medical officers.

"X, our previous house officer, wishes to do internal medicine very much, but I think she has given up and has applied for something else," one of the selection committee member said.

"Why?" We all asked.

"It's all because of that mishap. Well, we all know she was trying to help the patient, but, at the end of the day, it was her slip. And, you know, the incident was reported to AIRS, and it doesn't look good in her personnel record." (For those not familiar with our system, AIRS in the Hospital Authority stands for adverse incidents reporting system. I deliberately omitted the medical details of what actually happened.)

"Alas, I agree AIRS is a very important point for consideration when we choose our medical officers." I smiled.

"You can't be serious, do you?" LS said.

"Of course I am," I replied, "Only house officers who are really trying to do something would get caught by this very gadget. For example, have you ever heard of that lovely pizza-hair being reported by AIRS?"

"Quite right. In that case, we should only recruit house officers who have a track record of medical incident!" LS chuckled.

PS. Pizza-hair was, until very recently, a house officer of our department. Her special capability is being unbelievably slow. I suspect she is so dense that light bends around her.

Jokes

Trainee: The patient's daughter asked when would the patient die.

Trainer: How did you reply?

Trainee: I just muddled and said it depends.

Trainer: Quite true. It depends on when we need the bed.

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

(After Lunar New Year holiday.)

Student: I am sorry we did not fix up with the tutorial scheduled before Christmas. Can you do it now?

Teacher: Of course that's not possible. You've passed the time and I consider you guys have given up that session.

Student: But we really miss your lesson.

Teacher: No problem. You have now learnt a lesson.

Blessed

(Backbench discussion during grand round.)

Nursing officer: Ah.... (snoring)

Nephrologist: Are you alright?

Nursing officer: Fine. I'm just bored.

Nephrologist: That's what I always pray for.

Nursing officer: Ah... (confused)

Nephrologist: My humble wish everyday when I wake up is I would like an absolutely boring day, and nothing exciting is going to happen. By the time when I'm off work, if I could say the day was boring and I was doing dull paper work in front of my computer from eight to six, I would feel I am blessed.

Alas, Utopia is a place with nothing for historians to record.

PS. Of course, the Utopia of absolute zero could achieve this very aim by silencing all historians.

Benefit

(To those students who were urgently called to attend the tutorial by our honorary professor.)

Dear all,

I must say I was absolutely disappointed when I realized there were only three students (from a group of 30?) attending the tutorial.

Yes, I appreciate from your perspective the session may not be informative or beneficial or examination oriented or even comprehensible. I’ve said more than once to my colleagues it is easier to give a tutorial by myself than to orchestrate the nitty-gritty.

Nonetheless, teaching session of this kind is essential and beneficial in the long run – and not only by training you all to endure all those endless meetings in the public hospital system.

The actual reason is somewhat convoluted for explanation. Well, to put it simply, medical schools do not survive on their own, and they don’t even survive by government subsidy alone. There are councils, academy, colleges, donors, and a whole lot of other important people. I suppose delinquent behaviour of yours would not make a friendly lymphocyte produce autoantibodies, but may merely damp down the activity of an important regulatory T cell – and that’s sufficient to trigger damage later.

It is, of course, difficult to understand immunology – and political immunology is the most difficult subject of all. As a result, I integrate the information for you, and put down in the notice “all students must attend”. I mean what I say.

Sincerely,

Your malicious nephrologist
(with some immunology background)

Successor

(Our conversation continued.)

“Dirty British politics,” L sighed.

“Alas, don’t blame the Iron Lady – our good old Mr. Tung certainly learnt from her.” I smiled.

“Did he? What? When? Who?” My friend suddenly summoned three honest servants of his.

“Don’t you remember? When that Mr. Tung was in charge of our city, he wished to do away with a certain Mr. Tsang. But, since Donald was a senior official and could not be fired, he was promoted to the most senior position of the civil servant.”

“Ah… I see what you mean. Our unfortunate Donald became, on paper, the right-hand man of Mr. Tung – who was left-handed.” L chuckled, “Every project and all decisions were directly reported to Mr. Tung, and the right hand was a dummy.”

“Exactly. By some positive thinking – pioneered by Lu Xun (魯迅) or Ah Q – you can call it extended paid leave. The very point is Mr. Tung certainly had someone else in his mind to be his successor as CE, and, by putting Donald idle, he could avoid inadvertent competition and secure the passage of power.”


“Very true … but, hold on. Didn’t we start with discussing what happened in a gangsters’ meeting?” My friend suddenly jumped back to square one.

I did not make further comments.

Vice

Met L shortly after I attended another gangsters’ meeting.

My friend was obviously aware of the happenings.

“Philo, what do you make out of this business?” He asked.

“My dear Sherlock, in my humble opinion, there is only one key message of this meeting,” I smiled, “It is clearly stated in that tiny sheet of paper which describes the allocation of duty amongst the senior staff.”

“Really? What’s that all about?”

“Em… That very duty list actually reminded me of an old story about Margaret Thatcher.” I tried to be evasive.

“What do you mean?” L insisted for an explanation.

“Let me ask you this: Do you know why Geoffrey Howe took up the post Deputy Prime Minister of United Kingdom?”

(To be continued.)

Width

(My wife and I continued to talk about calligraphy.)

“My dear, you are repeating yourself indirectly: You prefer Chu Suiliang.” Vivian smiled.

“Quite true. As I always say, handwriting is a very good reflection of one’s personality,” I said, “Although calligraphy is not a subject suitable for quantitative analysis, I can give you a non-scientific one of Zhao and Chu.”

“Yes…”

“When you look at the writings of Zhao Mengfu and his famous great grandfather, the Emperor Huizong of Song (宋徽宗), their words all appear slightly flat – I mean they are wide but not as tall – and their transverse strikes are almost always more narrow than perpendicular ones. In contrast, if you come to take a look on Chu Suiliang’s writings, they are taller but less wide – in fact you could feel a sense of strength behind the words.”

“Well, I agree that’s the impression I have, but what’s the science behind all these?” my wife insisted for an explanation.


“Simple. You know, the anatomical lever system of our arm has an intrinsic property: It takes less effort to make a horizontal strike than a verticle one when we write. The habbit of scribbling Chinese words wide and short, therefore, reflects the tendency of giving up virtue and value for the exchange of pleasure and comfort.”

PS. Of course there is always a price to pay for the preservation of virtue and value, and occasionally the price is unbelievably high – if you remember what happened to Chu Suiliang when Wu Zhao (武曌) seized the crown.

PPS. I shall no elaborate on the analogy between Zhao’s weak but obsessive handwriting and the modern protocol-based medical practice, and would leave this topic to your own imagination and interpretation.

Persistent

(My discussion with Vivian continued.)

“What are you talking about?” My wife was obviously at a lost.

“Alas, let’s begin with a simple observation,” I explained, “It is plain obvious that Zhao Mengfu had obsessive personality disorder. What I mean is, when you thumb through the pages of this Sutra, the construction of each word appears exactly the same each time when it is written. For example, the first tick of the word Si (師) was missing under Zhao’s hand, and, every time when he wrote this word, there’s no such a tick. It was, therefore, not by accident, but a deliberate move after careful planning – I suppose that’s because Zhao found that the word Si appeared more artistic when the tick is not there. More importantly, in the aggregate, all these bits of slight modifications and unique handling of individual words become what we know as Zhao’s characteristic font!”

“Well, I can understand your argument,” Vivian remained puzzled, “But what’s that got to do with medical practice?”

“It goes like this: A modern doctor should treat his patients exactly the same as how Zhao did for his writing, with every management protocol being a word in a book. It is necessary not only to carefully conceive well ahead what should be done under a specific scenario – that’s what a protocol is all about. But, more importantly, just like each word would appear exactly the same every time under Zhao’s hand, a modern doctor should – or, I would rather say, is expected to – handle a clinical scenario in exactly the same manner no matter how many time he encounters it.”

PS. You may wonder: Wouldn’t that mean giving up all flexibility?

Very true. That’s why I am never very fond of Zhao’s calligraphy.

Mengfu

While I was considering how to encourage Euterpe and Adler to learn more Chinese, Vivian found a bargain item in a local bookstore.

It was Zhao Mengfu's (趙孟頫) handwritten version of the Lotus Sutra (妙法蓮華經).

Without a second thought, my wife bought it right the way. It was supposed to be a gift for my mother - who has some experience in both calligraphy and Buddhism. Of course, at the end of the day, as you may expect, I was the one who studied the entire volume with deep interest.

When I finished with my perusal with satisfaction - like a cat finished with a plate of milk, my eyes were apparently beaming. Vivian asked, half jokingly, "Well, what do you make out of this?"

"Oh! It's entirely enjoyable. As I always say, if you wishes to learn calligraphy, you should go for Zhao Mengfu!" I said.

"Yes, you've said that before," my wife said, referring to another discussion between us some time ago (see http://ccszeto.blogspot.com/2009/08/calligraphy.html), and then she went on, "But I think you have something more to say."

"Em... yes," I hesitated a bit, "While I was reading this, I actually came to realize Zhao Mengfu's handwriting is an excellent illustration of what good medical practice means nowadays."

Names

I must say it's not only the seven deadly sins; the name of almost character in the Fullmetal Alchemist was carefully conceived.

For example, Colonel Roy Mustang is the name of that famous P-51 American fighter in the World War II. As his main supporters, Riza Hawkeye is the eternal early warning aircraft (first introduced in 1964, and is still in service with its turboprop engine!), Jean Havoc is the Russian Mi-28 attack helicopter, and, Maes Hughes is the H-4 Hercules heavy transport aircraft.

And, Dr. von Hohenheim - the father of the Elric brothers - is the German physician during the Renaissance  period (who is usually known as Paracelsus nowadays), who first proposed that many diseases are caused by disturbance of body mineral content.

Alas, of course, there is Madam Dante - the root of all evil.

PS. To me, Maes Hughes is the most adorable character of the entire series, and I can always remember what Colonel Mustang said in the funeral of his faithful friend:

"Killed in Action, and promoted two ranks for it. Brigadier General Hughes. You're the guy who was going to work below me and push me to the top. Then you get yourself killed and pass me in the ranks. I don't know what's more absurd - you or the State."

Alchemist

While talking about Chinese and Japanese comics, I was amazed to find Euterpe beginning to watch the anime series of Fullmetal Alchemist (鋼之鍊金術師).

For sure a four-year-old girl could never comprehend the whole meaning of this masterpiece of Hiromu Arakawa (荒川弘). Nonetheless the story is attractive enough, so that I could take the chance and introduce the gang of Lust, Gluttony, Envy, Sloth, Wrath, Greed, and Pride.

Yes, the seven deadly sins.

Oh, and I also want to infuse into my daughter the very principle of exchange of equal value (等價交換): You have to pay - or give up - something in exchange for what you want.

PS. That rule of exchange is, unfortunately, Arakawa's romantic extrapolation of a basic chemistry principle. The original doctrine states that you can exchange an ion for another with the same electric charge.

Yes, in medicine, that's the drug known to us as resonium.

Traditional

(Our luncheon discussion went on.)

“I also think comics is a good start of learning Chinese.” NT said, “You know, exactly for that purpose, I bought the whole series of Choi Chi Chung (蔡志忠) – Mencius (孟子), Zhuangzi (莊子), and everything!”

“God, where did you buy them? I wish to buy some for my own leisure reading actually but couldn’t find it anywhere. This lovely series simply disappeared ever since the Publication Limited (博益出版) bankrupted some years back!” I said.

“Oh, someone else from the mainland got the copyright and print it all over again – rather recently.” Our professor of chemical pathology explained.

“The only bad thing is,” WY interjected, “they are now printed in simplified Chinese.”

“Well, although mainland is a strong country, I would prefer my children to learn a bit more about traditional Chinese.” LS sighed, “So, is there any good comics written in the traditional version?”

“Em… I’m afraid in that case you would need to resolve to those Japanese comics translated by Taiwanese.” I murmured, “The choice is broad and the standard is generally good. Authors like Osamu Tezuka (手塚治虫) did have publications suitable for general education.”

Isn’t it learning a lost tradition from the barbarians (禮失求諸野)?

Comics

While wondering about good books for general education, I found myself engaged in another casual luncheon discussion on nitty gritty of bringing up our children.

“We really should boost up their capability of Chinese,” LS said, “I don’t mean only the spoken Putonghua, but the Chinese language – reading, writing, and all these.”

All of us could not agree more.

“The real problem is, children nowadays don’t like to read books!” FK signed, “As soon as they see a page full of words, they just turn away. Chinese is particularly difficult because you really need to recognize the characters. Otherwise, no reading as such is possible. For English, even if you don’t know the words, as long as you have some basic skill of phonics, you could well pronounce the words and read along.”

“I end up giving my children Chinese comics as supplementary readings,” NT – our professor of chemical pathology – added, “You know, there are excellent comics adaptations of many classical Chinese novels, for example, The Romance of the Three Kingdoms and The Return of the Condor Heroes – many of them were done by Li Chi Ching (李志清).”

“I do the same actually,” WY remarked, “A small problem is the stories are often a little too bloody for a primary school student.”

“How could that be? I think the stories are all very modest!” I was naïve enough to say.

“That’s because you read the original text,” NT was smiling, “When the descriptions are turned into drawings, you take away the imagination but ... you know what would happen!"

Friends

(My conversation with L continued.)

“I believe I could understand the bitter feeling,” I said quietly.

“No, you don’t – and you couldn’t,” L interrupted, “H was slightly upset for not being invited, but he was totally disappointed for an entirely different reason.”

“Well…?”

“His mother invited her ex-husband.”

“That’s not too bad, I think?”

“Maybe not, I agree. But, how about asking the old man to sit next to the washroom in the banquet?”

“Oh…ah… how could that happen?” I could not believe my ears.

“Well, more than that.” My friend continued, “You must remember the old woman is, as we all believe, very rich. In reality all her money comes from those men whom she makes friend with – you know what I mean. And, while she did not ask her children to come to her birthday party, she invited all her – em – important friends – to come and, as she said, to thank for their contribution over the years.”

“Em… that’s…” I paused for a moment to choose the right word, “pragmatic. But, I suppose that’s the little price to pay if you need to survive and prosper?”

“My friend, as you always say, I don’t think I need to have an opinion on this matter.” L went on, “Nonetheless, the old sayings of a previous American president – I cannot remember who – keeps echoing in my mind: If we do not stand for something, why do we want to be elected? In this case, I must say, for any living soul on earth, if you are not prospering for something, why do you want to prosper at all?”

“Well, yes, you have a point there. I suspect you may make your point better if you used the word survive instead of prosper.” I was suddenly calm, “Nonetheless, we may have to mind our own business, and make sure our alma mater is not going to do the same!”

Step-father

Met my friend L while I was about to off work. Apparently he had just finished with a conversation over his mobile phone.

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

“Nothing really serious. You know, I was just listening to H re-telling his story.”

“What’s that all about?” I knew who H was – an old classmate of us. A pleasant boy. Well, all I could remember was he had a rich mother.

“As an outsider, it’s quite a funny story,” my friend explained, “You know, H’s mother was celebrating her 100th birthday last month, and there was a gorgeous party for it in a 6-star hotel.”

“Our friend must be very happy,” I made an unfortunately careless remark.

“Alas, he was not invited.” L pursed his lips.

“How could that be?”

“It’s a long story. To begin with, you know, H does not get along very well with his mother’s husband…” My friend murmured.

“Oh…you mean… his step-father?” My mouth was wide open.

“I suspect the term I used to describe their relationship is more close to the fact.”

Somehow I hallucinated my friend giggled.

Manager

(… cont’d)

The consultant and his trainee quickly finish with the rest of the round. When they are walking to the clinic, the senior doctor determines to resume the discussion.

“A haunted room? That can’t be true. After all, we moved to this new hospital block just last year, and I cannot remember a single patient died in that room!”

“Sir, the problem is, they did see vivid things at night – it’s not only this patient, but a few others who did stay in that room.” The young doctor explained.

“What did they see?”

“A woman in white dress.”

“Well, OK. What did this woman in white do? Did she take off her head or show a tongue two-feet long?” The consultant is obviously annoyed.

“None what-so-ever, sir,” the trainee goes on, “This woman-in-white always stands next to the door for a while, and then comes forward to the patient and tells the patient not to occupy the bed for too long – because the bed is hers!”

The consultant is startled. But, in no time, he turns into a laughter, “Alas, there may be a very simple explanation of the entire story.”

“Yes…?” The young doctor could not imagine what.

“They may have just seen our ward manager, who is crazy for making up some empty beds for the winter surge!” The consultant purses his lips.

Haunted

(Morning round in the intensive care unit.)

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

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

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

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

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

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

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

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

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

(To be continued.)

選美

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

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

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

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

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

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

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

My friend was not amused.

小甜甜

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

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

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

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

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

Letter

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

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

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

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

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

情書

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

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

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

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

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

Shokan

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


Yes, the author of Confession (告白).

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

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

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

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

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

M-shaped

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

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

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

How's that related to medical or scientific research?

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

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

Stagnant

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

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

I could not agree more.

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

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

Go read The Wealth of Nations.

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

Afford

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

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

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

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

Limits

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

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

I shall therefore leave these considerations aside.

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

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

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

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

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

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

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

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

Everything sounds very simple, eh?

What about our medical knowledge?

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

Double

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


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

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

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

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

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

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