Friday, February 26, 2010

What has the 3rd medical school got to do with GSK and the H1N1 pandemic?

A strange nexus seems to have developed between the much anticipated 3rd medical school and happenings with respect to GSK and the H1N1 story.

As we all have been told the planned for 3rd medical school was supposed to be a tie up between Tan Tock Seng Hospital, NTU and Imperial College. One of the champions of the proposed tie up was apparently the past rector of the Imperial College, Professor Sir Roy Anderson. Sir Roy is a pretty influential person and has been listed as a VIP on the Board of GSK. But he apparently has a bit of checquered past. In July last year he was in the middle of a controversy about his role in the British SAGE (Strategic Scientific Advisory Group for Emergencies), a 20-strong task force drawing up the action plan for the H1N1 virus, while holding a highly paid position with the drug and vaccine manufacturer, GSK. Earlier he had been in another series of controversies which led to his resigning from Oxford University. You can read the details here.

In November last year, he abruptly stepped down as Rector for Imperial College. The reasons for his departure is unclear and there have been a number of speculations. His departure has however created a bit of a hiatus in leadership for Imperial College. Sir Keith O’Nions, the Director of Imperial’s Institute for Security Science and Technology, took over as Acting Rector. It is also not clear if the new leadership is as enamoured with the tie up with NTU/TTSH for the 3rd medical school. I hear in the grapevine that the vibes are not that positive. Which means the 3rd medical school is now left in a bit of a lurch and scrambling to find a suitor.

So ....a right royal mess......

Friday, February 12, 2010

What they don't tell you about stents

Former US president Bill Clinton's recent procedure to implant 2 stents prompted me to rethink this particular issue.

Few people know that stents, small little thingies stuffed into your coronary arteries to keep them open, are poorly regulated medical devices. Currently in Singapore, medical devices such as stents are not regulated at all. In other words, apart from satisfying some generic compliance to manufacturing standards, there is no need for a supplier to show evidence of safety or efficacy. Odd isn't it for something that you want to stick into a patient's coronary arteries?

In fact, as this paper indicates there is an immense problem in trying to decipher what data is objective with regards to establishing whether stenting procedures are really effective. This is a multibillion dollar industry.

Furthermore, doctors are not regulated at all, with regards to their application of stenting procedures to patients, so there is a lot of off-label use of stents. As far as I know, hospitals also do not track the revision rates of stent procedures, i.e. how many such procedures are due to operator/clinic errors rather.

Shouldn't it be time that we start to systematize this whole area of medicine?

Singapore Medical Council's case against Dr Devathasan overruled!

The decision taken by the Court of Appeal to overrule The Singapore Medical Council Disciplinary Committee's punitive judgement on Dr Devathasan is a timely slap in the face for the SMC, and is a timely reminder to the SMC of how badly her procedures and logic lack either system or clarity. The SMC should do a study of the Court of appeal's reasons for overruling.

See my previous post on this.

Monday, February 8, 2010

Is Mother Earth running a fever?

Just wondering how those climate scientists figure out what the temperature of the earth is, or ought to be? Seems like if we want to talk about global warming, we should at least have an idea of what the baseline is.

If we want to know whether the patient is running a fever, we kinda know what to do. Assuming the nurse does it correctly, that thermometer under the tongue gives a reasonable approximation of what we think the core body temperature ought to be. Sticking the thermometer into the other orifice isn't particularly pleasant, and the axilla doesn't give very reliable readings.

But how do these climate scientists determine what the temperature of the earth really is, or ought to be? You would imagine that they can get an aggregate of the temperature across various locations on the earth, and if they have lots of thermometers everywhere, the aggregate value can be tracked across time to see if there is warming, or cooling. The choice of locations for the thermometer then becomes important because while one part of the earth's surface is warming, another may actually be cooling. Seems to me that if you want to track the temperature changes, these locations must be fixed over the period of tracking. Furthermore, they must be free of confounding effects such as urbanization etc.

I wonder how one can be confident about global temperature trends if the locations of the thermometers change with time. Country sources change. Locations change to more or less urbanized areas, or to regions of different altitudes. One can imagine that selectively picking your thermometer locations will allow you to tell whatever story you choose - whether warming.....or cooling.

Worse, how can anyone be confident of a temperature change across epochs before we had thermometers to the present day? It's a bit like saying we can tell increasing body temperatures because we charted toe nail growth rates, combined it with tactile estimates over the forehead, did axillary measurements, then spliced them onto sub-lingual ones. We don't really have this problem because for the patient, we have a very short time-line to be concerned about. But when we are trying to diagnose Mother Earth's fever, truth is it just doesn't seem like we have very good data to make those conclusions with.

It worries me that these people are so confident about the interpretation of the data, and that they try and tell us 'the science is settled'. Not only that, but that this temperature change must be all due to man-made CO2...

Hmmmm....... call me a skeptic. But then what do I know? I'm just a small furry animal in a burrow.

Wednesday, February 3, 2010

Conjunctions, and the medical school

In astronomy, when heavenly bodies align in space, it is thought that there might be exceptional physical forces that produce changes here on earth. In astrology, such conjunctions are thought to produce various metaphysical changes in energy which have effects on our destinies, etc.

Come February 14 this year there will be an extraordinary conjunction of events.

Other than an obvious fortuitous conjunction of Valentine's Day and Chinese New Year, there are a number of other much lesser known events that we might want to take some time to remember.

In 1942, during the fall of Singapore to the Japanese, a 4th year medical student Yoong Tat Sin, was killed by shrapnel on February 14. This happened at the Tan Tock Seng Hospital. He later died in SGH. That same evening, a group of his friends decided to give him a proper burial on the grounds of the SGH. During the occasion they were attacked by Japanese gunners and 11 students (5 Chinese, 4 Indians, 1 Malay and 1 Eurasian) perished. They were buried in the SGH grounds, after the British surrender on 16 February. An account of this war time tragedy can be found here.

On February 14, 1942, the Japanese had also over-run Alexandra Hospital (then the British Military Hospital) and massacred, bayoneting 250 patients, doctors and nurses. The next day additional groups were taken out and shot. Apparently, Gen Yamashita, upon hearing of this massacre apologised profusely, but it was too late.

The British surrendered on 15 February, 1942. It was also Chinese New Year, then.

February 15 also marks the 83rd anniversary of the College of Medicine Building. It was declared open by the Governor Sir Laurence Nunns Guillemard in 1926. Incidentally the architect of the building PH Keys was also the same chappie who designed Fullerton Building. An account of this, found here.

It is somewhat sad that few remember this history, and the heritage of the medical school and profession has been all but lost. Ironically, in times of deprivation and struggle, the school and profession seem to have had risen to greater heights of glory, than the glass and steel artifices that have been created more recently in times of great wealth.

Any proof of H1N1 vaccine safety and efficacy?

Here's something really interesting...... This is a 'no-duff' notice.

$10,000 reward offered for scientific proof of H1N1 vaccine safety and effectiveness

(NaturalNews) In conjunction with NaturalNews, the non-profit Consumer Wellness Center ( has publicly offered a $10,000 reward for any person, company or institution who can provide trusted, scientific evidence proving that any of the FDA-approved H1N1 vaccines being offered to Americans right now are both safe and effective.

Vaccine promoters keep citing their "science" in claiming that H1N1 vaccines are safe and effective. NaturalNews and the CWC ask one simple question: Where is this science?

For more details of this challenge, read here.

Any takers? Any scientific proof of efficacy or safety?

Tuesday, February 2, 2010

Monday, February 1, 2010

Canada investigates Gullain-Barre Syndrome from H1N1 vaccines

The Toronto Sun has reported that 17 cases had fallen seriously ill after the H1N1 vaccines. Four of these cases came down with the dreaded but rare Guillain-Barre Syndrome.It is not clear what the relationship is between these vaccines and the earlier GSK batch that had been yanked off the shelves.

The Canadian form of the vaccine appears to be slightly different from that which has been supplied to Singapore. It is called Arepanrix, and manufactured in Alberta, Canada. The one supplied to Singapore is called Pandemrix. They are essentially the same formulation but manufactured in different locations. Apparently Arepanrix has more turbidity even though the manufacturing process is same as Pandemrix.

The painless piles fix squabble

Yesterday's ST carried a curious report about a squabble about painless piles surgery.

Dr Peter Goh had apparently made claims through an advertisement about the Transanal Haemorrhoidal Dearterialization (THD) being a 'painless' procedure. This claim brought forth a response from the Presidents of the Society of Colorectal Surgeons (Singapore) and the ASEAN Society of Colorectal Surgeons, as well as a past President for the Singapore Society. It wasn't very clear in the report, but it appeared that these latter surgeons had countered Dr Goh's advertisement by writing a letter, apparently to the newspapers.

It just seemed strange that the surgeons had chosen the newspapers as a means to settle a professional difference of opinion. If Dr Goh was making a false claim in the advertisement, shouldn't the Societies make their complaint to the Singapore Medical Council?