Friday, June 28, 2013

The N95 mask - why liddat also must try and make money?

Gigamole remains incredulous that people continue to profit from selling what is essentially an emergency resource to protect the public from an environment health hazard.

The N95 mask, arguably the gold standard protective breathing mask during the current Sumatran haze, continue to be sold at prices way above their unit costs.At one stage Tan Tock Seng Hospital was selling the masks at S$60 per pack of 20. After public protests, the hospital meekly lowered their costs to be in line with what other public hospitals were selling, S$50 per pack or 20. Some other private outlets were selling at even more outrageous prices.

But prices have since come down. Fairprice and NTUC Unity were reportedly selling at the lowest price per mask, S$2.25. Even so the price per mask is still way above their actual unit costs.

A quick check on the internet gives a reasonable idea what the actual retail unit costs per mask might be. At Amazon, you can buy a pack of 20 (N95 3M 8210) for US$14.95 (S$18.94), which makes the unit cost approximately $0.95. At ebay, you can buy same pack of 20 for US13.99 (S$17.72) with free shipping to Singapore. Only S$0.86 per mask!

So why are we still having to purchase these masks in Singapore for more that S$2 per mask? And why not enough masks? These are emergency supplies.In times of need they should be distributed free to the public, or at the very least supplied at cost.

The unresolved problem of the haze has somehow made the N95 mask into an icon that represents what the public views as gahmen insensitivity and incompetence. And Gigamole remains baffled as to why the gahmen continues to behave as if it is locked in a mode of operation that daily widens the gulf between it and the public. Why, for example, continue to report an outdated and useless PSI unless it is true that these reports are meant to lull the public into accepting the severity hazard? Why the lack of readiness to supply personal protective wear? Are we to believe that the gahmen is really ready and prepared for a repeat of SARS? Could it be that they never really learned from the last epidemic?

Gigamole is disheartened. Perhaps our leaders have been too protected by mega salaries, and too cocooned in their cosy madarinates to become responsive and effective.

Wednesday, June 26, 2013

So you think you are safe from the haze indoors? Think again.

During the current haze many people assume they are safe indoors. Many who do not have air-conditioning at home have preferred to stay in their offices thinking that they are safer there.

To some extent, it may be true, in that they are less exposed to the full brunt of the haze and noxious chemicals. But they may be less protected than they think.

The design of building ventilation systems tend to concentrate more on the replacement of stale air than the exclusion on environmental pollutants. For example, the US EPA current requirements for ventilation systems in offices and schools are air exchange rates of at least 15-20 cubic feet per minute (Cfm) per person. This ensures that the building is not "sick" and will have adequate freshness of air. There is on the other hand much less in terms of expectation to provide a barrier to environmental pollutants.

In an enclosed building, air influx from external sources occurs primarily through ventilators. One assumes that some filtration occurs, but this is not mandated. Even if filters are present these cannot be those with too small pores as they will reduce the mechanical efficiency of the ventilators. Usually I believe, contractors just suck in air from the outside. This explains why many people complain of feeling the effect of the haze and smelling the smoke even in their offices.

How much contamination of office air occurs? This is hard to predict and measure. The smaller the particle, they less likely they will be excluded from the internal air. PM2.5 therefore tends to get everywhere, even though the contamination is less visible.

This level of contamination by outside air is indexed as the infiltration efficiency. A recent study in the US reported that across many areas, the infiltration efficiency of PM2.5 may be as much as 80%.  If this is true, there is not much benefit in hiding in your offices. Ironically, it may be that sicker buildings with poorer air exchange may actually be safer.

Friday, June 21, 2013

Ng Eng Hen and Grace Fu, you are both sooo wrong!!!

First Second Minister of EWR Grace Fu said, "The health impact of the air pollutants is determined by both the concentration and the duration of exposure."

Not wrong.

Then she says, "the 24-hour measurement is a better reflection of the total exposure of the individual to particulate matter."

Again by itself not wrong. From an epidemiological perspective. Which goes to show how little insight she has into the everyday common people's perspective.

As an ordinary person, Gigamole does not know what to do with the average PSI over the last 24 hours. Gigamole is not publishing a paper about the haze. Gigamole like everyone else away from the posh offices of the EWR Ministry, is really most concerned about what is happening now. Gigamole needs to know when to stay indoors and when it has become safe to venture outside. If Gigamole has workers, Giamole will need to know when to issue that missing (from the gahmen!) order to stop work. Can this be done using a 24 hour PSI average??

Minister of Defence Dr Ng Eng Hen, lagi best, further glossed over the issue by promising to simplify the data. He pointed out that, "most studies on the exposure to pollutants are based on 24-hour measurements. That is why the government's guidelines are also based on those measurements..."

Yes, of course. All well and good if you are an epidemiologist. Nobody studies hourly peak exposures, because it is so much easier to collect averages over longer periods. But the absence of data does not mean it is unimportant. Duh....... common sense will tell you short term exposures to known toxic materials should be avoided.

So Gigamole's plea to these two smart politicians STOP TRYING TO DUMB DOWN THE DATA!

In situations such as this, more information is preferred to less. The public needs to know the real time data so that they know how to organize their daily activities to minimize discomfort and health risks. This is especially since the gahmen is reluctant to issue real advisories. No point issuing advice based on yesterday's news. We need to respond to real time events based on real time information. So please report on hourly readings of the PSI, both PM10 and 2.5. And I mean real hourly recordings and not rolling averages over last 3 hours! Please also report on the geographic information, i.e. at least North, South, East or West quadrants.

Monday, June 17, 2013

Who sets the agenda in Singapore?

This is, of course, a rhetorical question. Is there any doubt that the gahmen is the one who sets the agenda in Singapore?

The main stream gahmen controlled media is just one of the tools by which the gahmen achieves this objective. The relatively free-wheeling websites that regularly report and comment on Singapore issues via the internet are increasingly brought to heel under new media licensing regulations. Gigamole thinks the gahmen correctly anticipated that all the blustery protestations would eventually be dissipated and come to naught. And indeed it has. Will these new regulations change things? Or strengthen the gahmen's hand in setting the agenda? Only time will tell. But Gigamole thinks it will merely buy some time for the gahmen. Maybe that's all that's required. In time the websites will some way to stay beyond the reach of gahmen's control. In fact, it may in time become much more antagonistic and difficult for the gahmen to control. For the moment, perhaps that's enough.

But this is only part of the story. The bluster over the new media regulations was in fact a distraction from the more important issues that Singaporeans must face up to.

Until recently, we had only kinda guessed at big gahmens spying on the public. Mostly these were nice stories for telling in Hollywood movies. But the recent revelation by the American whistleblower Edward Snowden, about how extensive and intrusive the US gahmen had actually implemented this spying has brutally forced the issue into the public consciousness. Is this something that only affects Americans? Gigamole does not think so. The lack of any substantive response from other gahmens to these revelations is quite telling. In particular, note the absolute silence from the Singapore Gahmen. What has also been disappointing has been the absolute silence from our local activists. Maybe they have already been cowed by the new media regulations. But surely they must be concerned? Or maybe they are just concerned about their own websites? Surely our opposition party MPs must stand up and ask that million dollar question of our gahmen.... do they request information from Google, Twitter and Facebook, and our ISPs? Have they ever requested? Don't we want a categorical statement from the gahmen that they do not spy on us? And if they do conduct surveillance, what and who regulates the extent to which they can intrude into our internet lives?

How come no one is asking?

But again, this may also be just the tip of yet another iceberg. Peter Ludlow recently wrote a great opinion piece in the New York Times titled "The Real War on Reality" where he refers to an ongoing "epistemic warfare". Gigamole would really recommend you read this commentary.

Yes, gahmens do set the agenda. And they do this not only by controlling the main stream media.

Monday, March 4, 2013

Investigations into Johnson & Johnson's marketing practice - the ongoing saga of unregulated medical devices

One thing has led to another as the US Department of Justice launched an investigation into the marketing practices of the large medical device manufacturer Johnson & Johnson. At the heart of it is the number of recalled hip replacement products since 2010. Gigamole has blogged about this before.

Do not for one moment believe this will put a dent into J&J's marketing strategies. The company is no stranger to these financial penalties. It, like many other companies, have considerable sums of money set aside to cater for these penalties. After all these, Gigamole is sure the company will still be in the black. Two years ago, J&J was forced to pay off US$78 million for having paid bribes and kickbacks. Apparently bribing orthopaedic surgeons is a common practice among device manufacturers. In a report in the Archives of Medicine in 2011, the authors reported on 5 device manufacturers (Zimmer, DePuy Orthopaedics, Biomet, Smith & Nephew and Stryker) who had paid out, in 2007 alone, US$198 million to 939 orthopaedic surgeons.

Which is why medical devices need to be regulated. HSA is being very unwise in leaving medical devices unregulated, because in so doing, they are leaving the patient-consumer at the mercy of the device manufacturers. It is foolish and naive to believe that industry have anything else on their agenda than to generate profit for their shareholders.

To date however, the problems of the recalled De Puy hip replacement devices in Singapore remain unresolved. The HSA appears unwilling to take a strong public position about this. And patient-consumers remain unprotected.

Gigamole wonders when HSA is going to do the right thing?

Thursday, February 21, 2013

Hearing but not listening. Beyond the population white paper.

We all know the expression 'to hear but not listen'. How many times have we screamed' in exasperation at our kids, and for that matter - our kids screamed at us..   " .....but you are not listening!! *sigh*

Our present gahment seems a bit like that, isn't it. Minister Ng Eng Hen, said in no uncertain terms "We heard  Singaporeans clearly". PM Lee in his post election speech said it too..." We hear all your voices.". Hear, hear. The question is...have they listened?

In Medicine, hearing is a function of the auditory organ, the ear and all its connections. If you can't hear, it is a malfunction of the organ. Something is damaged, or there's just a big cockroach stuffed into your ear. But if you can't understand despite hearing.... something is wrong higher up. Some people call this an auditory Perception Difficulty, and link it with the more recognizable group of dyslexic conditions.

But it is not necessary that the gahment has something so crippling. More likely, they are just locked into an ideological frame of mind, that they cannot see anything worth considering beyond the ideology. Talk about needing to think out of the box. Here is a bunch of smart (very smart, I believe), high salaried technocrats, who believe that all they have is in that box, and cannot conceive of any possibilities outside of that box.

So when they hear, they actually cannot understand. So when they say they hear, what they mean is that they  have heard the noise and clamour, and believe that their failing is merely that they have not worked hard enough to make us come round to their way of thinking. So they will try harder, to make us understand.

Sadly, with potentially tragic outcomes.