Climate change humour - Pres Obama's State of Union address...

H1N1 scandal

As the world sits on massive stockpiles of unused and unwanted H1N1 vaccines, the WHO comes under investigation by PACE (Parliamentary Assembly of the Council of Europe) for its (mis)handling of the 2009 'pandemic'. Earlier, Dr Wolfgang Wodarg, Head of Health at the Council of Europe, accused the makers of flu drugs and vaccines of influencing the World Health Organisation's decision to declare a pandemic.

Among the accusations was the way WHO had modified the definition of a pandemic to make it easier for a pandemic to be declared. Previously (2005) the definition of a pandemic required there to be an enormous loss of lives, but with the new definition, it was only required for there to be 'worldwide epidemic'.

An influenza pandemic occurs when a new influenza virus appears against which the human population has no immunity, resulting in several, simultaneous epidemics worldwide with enormous numbers of deaths and illness. (WHO, 2005)

A disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease. An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity. (WHO, 2009)

Now, Professor Ulrich Keil, director of the WHO’s Collaborating Centre for Epidemiology, gave evidence before the inquiry, that the 'the swine flu pandemic was part of an overblown “angst campaign”, devised in conjunction with major drug companies to boost profits for vaccine manufacturers.'

Not looking very good for WHO.... but pandemic communications expert Peter Sandman has another view of the proceedings. He reportedly told CIDRAP News that 'critics at today's hearing seemed unable to distinguish between what they called a "fake pandemic" and one that has so far turned out less severe than it might have been.'

'.... WHO may have set itself up for unfair criticism by making the same mistake the Intergovernmental Panel on Climate Change made, which led to successful attacks on its credibility: failing to acknowledge the small piece of the truth their critics are getting right.

The critics' strongest arguments are: first, that the WHO should have more quickly admitted that the pandemic was milder than initial evidence suggested; and second, that the WHO routinely included severity among factors to be considered before raising pandemic phases, until its most recent pandemic guidance revision, published in April 2009......

"By failing to concede these two points, WHO gives unjustified credibility to the critics' other, much less valid claims," he said. "Good guys have a harder time than bad guys understanding the need to concede the validity of valid criticisms, even when they're packaged with invalid ones."'

More on mammograms

Singapore M.D. reminded us about the recent guidance provided by the US Preventive Services Task Force on the relative uselessness of mammograms. No doubt the post was instigated by Minister Khaw's recent blog on the use of medisave for mammograms.

I had posted on this previously. I hope rational thinking will prevail here, and that we return to a clearer practice of evidence-based medicine.

Seems like too much of recent public health utterances have been based on fear mongering rather evidences of real therapeutic benefits. "Do this, or you will get cancer, or die....and it will be all your fault" seems to be the mantra, nowadays. One wonders if the rationale is driven by altruist concern for patient's well being, or just commercial returns.

Do we believe in anything of value....?

Singaporeans have been faulted for being perhaps a bit too pragmatic. Pragmatic to a fault, and perhaps too mercenary in our approach towards many issues.

These faults have sadly been brought to the fore recently in discussions about our contribution to the Haiti effort, and then yesterday about our graciousness (or lack of)...

When responding to criticisms about how little we are monetarily contributing to the relief effort in Haiti, the gahment pretty much argued from a pragmatic point of view. And I am wondering why we need to cast everything in terms of realpolitiks, or look at potential economic returns in everything we do? Isn't doing the right thing, a good enough reason in itself? Isn't compassion a good enough reason in itself to want to reach out in a more substantive way to help a country in agony?

How about the discussion about the development of grace in our society? I couldn't believe the discussions reported in the Straits Times today, about the proceedings at the Singapore Perspectives meeting yesterday! An economic value to graciousness? Duuuhhhhhh........

Isn't being gracious important enough on its own merit, that we have to place a monetary value to it?

But these are not the exceptions in our national psyche...

We smile and try to courteous, not because these are worthy on their own merits, but because we want to improve our business rankings, and bring in the shopping $$$.

We are ethical, not because we think being ethical is important on its own merit, but because we want to be accredited and be recognized internationally, because it brings in the R&D $$$.

We try to be environmentally friendly, not because we genuinely want to save the world, but because of the economic value of being seen to be green.

So sad and tragic.

Singapore, what do we really believe in?

Between World Cup 2010 and Haiti...... the choice is clear

NoFearSingapore's blogger Dr Huang writes, in a sign of soccer addiction, that the MDA should fork out the $1 million to FIFA to bring us the World Cup 2010 telecasts. To me this is blatant profiteering by the soccer body. Why should be capitulate?

Meanwhile, ST's Chua Mui Hoong laments the paltry $50,000 Singapore government forwarded to Haiti's relief. So true. And so disgraceful.

I suggest as a national gesture, from both gahment and citizens, we vote to forgo the World Cup this year as a snub to FIFA, and instead divert that $1 million into an emergency humanitarian relief fund, with the first benefactor, the people of Haiti.

How about that?

Climategate - the festering sore

Notwithstanding the MSM's reluctance to report on this, the Climategate problems continue to fester. The key players implicated have yet to be properly investigated and cleared. The science continues to be called into question.

Most recently, the IPCC report, supposedly peer reviewed, have been caught red-handed making grandiose claims about glacial melting based on nothing than a conjecture. Increasingly, the data and most importantly, the conclusions arising appear corrupted and biased towards portraying an alarming rate of global warming attributed almost solely to CO2.

The U.S. National Oceanic and Atmospheric Administration (NOAA) has also been accused of cherry picking the data in favour of global warming.

A systematic review of the Climategate emails by the Science and Public Policy Institute, can be found here.

Sadly, the case of anthropogenic global warming has been called seriously into question. It is not even certain now how much global warming is occurring. This is not to say that there is no global warming, but just that the entire science has been called into question, and consequently the conclusions cannot be assumed to be 'settled' in any way.

It has become quite clear to this simple mind that there is not the 'scientific consensus' about AGW as has often been claimed. Go blame it on the 'climatologists' for this mess.

Race and ethnicity in Singapore - the confusion continues

The confusion between race and ethnicity continues today in the Straits Times, through 2 opinion pieces today. One is written by Shankar Vedantam, who is a Washington Post reporter, and the other by Andy Ho, Senior Writer at the Straits Times.

I don't have any difficulties with Mr Vedantam's views, as he was merely dealing with the reality of 'colorism' in life. Yes, flawed though we may be, we often do look at the colour of one's skin, and often it makes a difference. Accepting that reality helps us to deal with it, and perhaps reduce the discriminatory consequences.

Mr Ho's views (reproduced in the Malaysian Insider) however is somewhat offensive, for he appears to be advocating racial classifications according to skin colour and other physical attributes. Now I can understand if a politician makes the mistake of confusing race and ethnicity. Just put that down to being misinformed or ill-advised. But for a science correspondent to advocate classifying people into races according to skin colour, is actually quite offensive.

I wish to ask Mr Ho..... just how do you think we can divide people by skin colour? What tonality or hue can we use? What shade of brown, or darkness would be appropriate? How does one make a distinction between a dark Malay and a light Indian? Or a dark Chinese and a light Malay?

Quite clearly classification by race is nonsense. There is no biological or genetic basis to classify people into races. And certainly no anatomical bases for this. Not only that, the CMIO (Chinese, Malay, Indian, Others) categories that we use are not racial classifications. They are ethnic classifications based on personal identification with various communal groups.

For once and for all, let's stop this idiocy which advocates racial classifications, and restrict ourselves to dealing with ethnicity classifications.

Marking examinations on a curve..... major pitfalls

It is a common practice for examinations to be 'marked on a curve'. There are clear advantages to such a practice, and I am sure the recent PSLE have been 'marked on a curve'.

One of the major advantages of marking on a curve, is that the average grades become pretty stable year after year, regardless of fluctuation in examination difficulty. It is common in such a system to see examination questions get more difficult and challenging as teachers introduce novel questions, often in responseto increasing ability of students to 'game' the examination.

Looking at the annual average scores will not reveal the changing difficulty level of the examination questions.

The average rates of passes for the PSLE for example remain flat through the years. This 'flatness' is boring..... but great for the MOE Annual Report.

The inherent problem here, one which is seldom recognized, is that such statistics play tricks on sub-group analysis. Let me explain....

You can see from the figure, that the Chinese students perform admirably, in fact above national averages. This is perhaps because they are best able to 'game' the PSLE exams. Because they do so well and are numerically the biggest contributor to the national average, their results essentially 'drive' the national average. And in fact determine the difficulty of the exam. As their performance improves, the pressure for the examination board (Singapore Examinations and Assessment Board) is to increase the difficulty of the exam. But you do not see this because the national average, being determined by a normalizing curve, remains identical year after year.

But what of the other sub-groups e.g. Malays and Indians? Their numbers being numerically smaller (much smaller) than the Chinese data are essentially numbers that are relative to the major sub-group, i.e. the Chinese data.

Therefore, an apparent decline in achievement of a non-Chinese sub-group, is not necessarily a decline in standards, but merely a decline in achievement relative to the Chinese sub-group. In reality, the absolute performance of all sub-groups may actually be improving. But these improvements are not visible, and tragically, not recognized.

One can speculate about why the Chinese sub-group does so well....but my guess is that they have better access to resources which help prepare them for exams and make them better at 'gaming' the examination.

By contrast, the GCE 'O' level examination is set by the University of Cambridge Local Examination Syndicate (UCLES) do not experience the same problem. This is because, the standards are determined by the UCLES and all our ethnic groups are relatively small components of the total numbers. Here you can see overall standards improving and the pass rates for the Malay students, often regarded as poor performers, possibly improving the most rapidly of the ethnic groups.

Why is this important?

Well..... I think it is extremely important for educators to recognize that there is a critical difference between telling students they are always doing worse every year no matter how hard they try, and encouraging them by recognizing that they are actually performing better every year, though perhaps not improving as rapidly as others. The former discourages and creates and sense of despondency and helplessness, while the latter is inherently affirming and encourages the community to do better.

We should stop using racial definitions...

DPM Wong Kan Seng made some very pertinent remarks about racial harmony yesterday. While I fully agree with the points he raised, I wished that he would stop making references to race when I think he meant ethnicity. It is unfortunate because racial definitions imply we can differentiate communities based on biology and genetics. This is obviously false, so I must assume this is not what he meant.

So this is my plea to all who read this blog.....please stop referring to race when what you mean is ethnicity. Our references in Singapore to Chinese, Malay, Indians and Others (affectionately known as CMIO) are ethnicity definitions based on self perception, and not racial definitions.

Is this just semantics? I believe not.

The race and ethnicity divisions.....

The recent public discussions following upon the recent government rulings on double-barreled listings of race, have unfortunately been confused by the lack of distinction between what are generally accepted ideas about race and ethnicity.

Race (see Wikipedia), generally refers to a set of external physical characteristics which are heriditable. So we can arbitrarily think about a 'Caucasoid' race, or a 'Mongoloid' race etc. This is a notion that has become quite obsolete. Although, it is true that external physical characteristics can be largely heriditable, the limits defining racial groups are extremely fuzzy. Think for example, how impossible it is to define the limits of what the Caucasoid race is. Similarly, there are no real limits to the definition of a Chinese race. In fact, contrary to what some people may think, Chinese-ness is not a 'race'. To push the point, neither are Indian-ness and Malay-ness.

Ethnicity is however, a rather different concept (see Wikipedia). The concept of an ethnic group refers to commonly agreeable ideas of what constitutes a community, or grouping of people. This does not depend on heriditable physical characteristics, but will include characteristics related to culture, language, religion, etc. Hence to say we are ethnically Chinese, or Indian or Malay would be appropriate. In fact to be more correct globally, the identifier should be Singaporean Chinese, or Singaporean Indians etc.

We should therefore drop all reference to a 'race' identifier, and just restrict our definitions to that of ethnicity. This way we will avoid the unfortunate 'genetic' or 'biological' connotations of categorizing people according to racial groups.

It should also be clear that ethnicity is largely a social construct. It is necessary because everyone in the world defines himself or herself as part of some sort of grouping. This is an important part of how societies organize themselves and allocate resources. Our government is correct that the idea of ethnicity will never go away. We ignore it to our own peril. Every government in the world resorts to some sort of ethnicity definition (even if they deny doing so) because governments need to allocate resources according to various groupings of people. The better we are able to do this, the better we can equitably allocate resources. The trick in doing so is going to depend on how we make sure such ethnicity definitions are affirmatory and not discriminatory. This will come down to good governance and a good constitutional protection of ethnic minorities.

Dr Devathasan's run in with the Singapore Medical Council

Dr Devathasan's recent run in with the Singapore Medical Council is being watched with great interest. Although the details are scanty, and the SMC proceedings are not publicly available, you can read about the case here and here.

It is also interesting as one of the chief complainant is apparently a 'professional rival'. Dr Devathasan was supposed to have offered an unproven therapeutic option to a 77 year old woman. Remember Para 4.1.4 of the SMC ethical guideline?

Curious.

A number of questions need answers:

a] How does the SMC decide if a therapy is 'unproven'. I have pointed out in previous postings that many doctors offer unproven therapies, in the form of off-label prescribing of drugs, various untrialed medical devices etc. Why was Dr Devathasan singled out?

b] What would constitute a 'proven' therapy? How many trials and what quality of trials are needed?

c] What do we do about Tradition and Complementary Medicine practitioners who are free to make outlandish claims and offer a host of unproven therapies..... some of which may be actually 'endorsed' by the Minister of Health. So if TCM practitioners are championed because they offer unproven options which 'complement' proven western remedies, why is it wrong for Dr Devathasan to do so?

I am all in favour of a greater level of scrutiny of how doctors behave, but SMC need to show it has a rational system in place, and not just engage in random cherry picking of cases to prosecute.

The Singapore Medical Council gets new dentures......

First the 'greatest scientific scandal', which was Climategate. Then now, the greatest medical scandal of the H1N1 pandemic that never was. Hmmmm....what shall we call it? H1N1-gate? Swinegate?

In the midst of all this, the news that the Singapore Medical Council gets increased powers to act against errant doctors. Great news, I think. Unlike many of my colleagues who resent this intrusion into their professional lives, I think this empowerment has long been overdue. In the current overheated environment for commercialized medicine, more regulation is preferred over less.

The fundamental question remains - will this empowerment nudge the SMC to go down the more difficult road of acting against the big fish peddling false cures and promises, who may happen also to be influential colleagues, or will they just continue to busy themselves chasing after low lying fruits such as GPs with MC misdemeanors and those who sell anxiolytics?

H1N1 pandemic? Now we know what a sham it had been

I had never been convinced of the H1N1 pandemic. All the time there had been this dichotomy between the alarmist messages being spread and reality that nothing much was happening on the ground. People weren't really falling over and dying as much as the the alarmists were saying they were. Tamiflu was never as effective as they made it out to be. I think many people were also not convinced, but there was little bases to counter the pandemic signals being rung at every street corner.

Now that the pandemic that never was is pretty much over, we are beginning to hear of another reality.

Dr Wolfgang Wodarg, Head of Health at the Council of Europe has come out to criticize the actions of the WHO, saying that "the swine flu scare was a 'false pandemic' led by drugs companies that stood to make billions from vaccines", and that "major firms organised a 'campaign of panic' to put pressure on the World Health Organisation to declare a pandemic."

Calling for a major inquiry, he called it "one of the greatest medicine scandals of the century".

More of Dr Wodart's comments in his blog, here.

View Al Jazeera report here: http://www.youtube.com/watch?v=hoQN1to3C2U

Countries are now stuck with massive stockpiles of vaccines that their citizenry were too smart to want to be exposed to. Some are still trying to persuade people to go for the vaccination even though the anticipated threats had had passed. Germany and Spain have cut back on their orders for the vaccine, and Canada is either trying to sell off, or 'lend' their stocks to other countries such as Mexico.

Meanwhile the WHO is undergoing a review of how it handled thre so-called pandemic, amidst accusations of big pharma complicity. The Council of Europe's Health Commission has voted to investigate.

And some people are laughing all the way to the bank!

Sigh....... who can you believe nowadays?