Monday, August 29, 2011

The great Islamic physician Muhammad ibn Zakariya al-Razi

Modern medicine owes a great debt of gratitude to the great physicians who populated the medical world during the Islamic golden age. For while Europe languished in darkness, it was the Islamic physicians who systematically collected, archived, translated, studied and innovated upon the classical medical texts from the Greeks and Romans before them. It was this vast corpus of knowledge that eventually fueled the developments during the European renaissance.

One of the great physicians of this period was the Persian physician, Muhammad ibn Zakariya al-Razi, also known by the Latin form of his name Rhazes. Al-Razi was not just a physician, but also a great thinker, philosopher and rationalist. That he not only survived, but flourished during this period was a testament to how open minded and tolerant the Islamic society of those days were to non-conformist ideas.

He was known for a great many innovations and discoveries in medical practice. He identified for example, allergic asthma, and was the first to distinguish smallpox from measles (a great achievement considering the state of ignorance at that time of the microbial world). He was also the guy who pioneered the distillation of alcohol.

After his death, a compilation of his writings became a widely regarded classic of medical science and philosophy, The Virtuous Life (Kitab al-Hawi الحاوي).

Widely remembered as arguably one of the greatest physicians of that period, and possibly the Father of Paediatrics (having written the first ever treatise on Paediatrics,The Diseases of Children), he was not only a great mind, but also an ethical and compassionate physician.

"The doctor's aim is to do good, even to our enemies, so much more to our friends, and my profession forbids us to do harm to our kindred, as it is instituted for the benefit and welfare of the human race, and God imposed on physicians the oath not to compose mortiferous remedies."

Selamat Hari Raya Aidilfitri!

To my Muslim friends everywhere, "Selamat Hari Raya Aidilfitri"! Please forgive me if I have wronged you in any way.

Friday, August 26, 2011

The elected President will have considerable moral authority but should not aspire to be our moral authority.

So we will have our Presidential Elections today. Very exciting because it is a very significant milestone in our political development. I like the political awakening I see yet I remain somewhat concerned that this new political energy has been too enthusiastically injected into this presidential contest. Wasn't it supposed to have been a non-partisan affair? But then, I suppose, any kind of election will inevitably be 'political'. By this logic then, the very act of creating the elected presidency had already begun politicization the highest office in our country. Even though it was not intended to be, it has become the new reality.

Instead of being a purely ceremonial position, the Presidency has now become a lightning rod for all kinds of things. Because of the political energy that has been vested into electing the President, regardless of what the Constitution tries to curtail, the elected President will receive a considerable moral authority to do and say things. This authority must come with responsibility. The elected President must realize that notwithstanding the electioneering and promises made in the heat of the moment, the Presidency is a position that must chiefly unify and inspire. He must try and embody all the noble values that will bring us together as a united citizenry.

But should he speak up for all kinds of perceived wrongs and champion pet causes? Though we may wish it to be, I believe he should not. This is not to say he cannot support community based projects and causes. But that he should be careful not be a social activist for causes which may be controversial and divide the society. Can the President be the standard bearer for justice and morality in our society? To be the heart....or voice ....of the people? I don't think so. Because, how is he to decide what is just and unjust,what is moral and what not? The election does not confer upon him the supernatural ability to make those judgements for the rest of us. So inevitably, to place himself on a pedestal to champion a particular position in such causes will cause him to elevate some ... and in the process, decrease some. And make the position open to all kinds of political lobbying. He should therefore ask himself if such activities serve to unite or to divide.

When we elect the President, we willingly confer upon him the moral authority to assume the highest position in our land, but this does not make him eligible to be the authority for our morals.

Wednesday, August 24, 2011

Why I find it difficult to support Tan Jee Say for President

He would seem to be the ideal candidate for President.... scholar, humble origins, family man, and very personable. Someone who can comfortably be at the wet market, engage academics in scholarly discussions and also hobnob with world leaders.

But I have reservations.

There is something in his past that I have not been able to understand. Here is a guy who worked his way up the admin service for 11 years and then served for 5 years as the PPS for the then DPM Goh Chok Tong. Now, I know some out there will deny this vehemently, but to my reckoning, nobody goes through this kind of career trajectory without first conforming and then succumbing to a certain degree of political and admin group think. But somewhere along this trajectory TJS appears to have experienced an epiphany of sorts to suddenly become a highly political animal of the opposition sort. But not only an opposition figure but a key figure of the most vehemently anti-PAP and anti-government opposition parties out there.

Now I may be way off course here, but common sense tells me that something happened in TJS's life. Something which we do not know about. He is not saying. And obviously neither is the government. This is important gap in our understanding of the man, because it will give us a better idea of his true drives in seeking out the presidency.

The other reservation is linked to the first. TJS has come across as a bit to combative, and rather too willing to confront the government on too many populist issues. I think this goes beyond just electioneering. I think these are pet opposition issues that an opposition party should confront the PAP government about. But these should not be issues taken up by the President. By all means debate these in Parliament but these should not form the contentious bickering backdrop for the relationship between the President and the government. I certainly do not want an opposition party to usurp the post of President. And although TJS has stepped down as a member of the SDP, it is clear from the rabid and almost exclusive support given him by Temasek Review Emeritus that he remains very much their man. To what extent he can maintain a position free of SDP influence if he does become President remains to be seen. But I am doubtful.

To this latter ends, I would like to suggest the the criteria for eligibility for President must be non-association with any political party for a period of at least 5 years. Otherwise the criteria of not belonging to a political party is meaningless.

So TJS, sorry, no support from me. I suppose this would only leave two options for me on Saturday.

Thursday, August 18, 2011

Why I find it hard to support Tony Tan for President.

Much has been made of his dead fish handshake. Sadly, I have been at the wrong end of that dreaded handshake with presidential hopeful Tony Tan, so I can vouch for the veracity of those allegations. For me it had been a significant turn-off.

But a limp and damp handshake is too frivolous a reason for rejecting a presidential candidate.

In 1991 when the elected presidency was introduced, its purpose was to act as a check against a profligate government. The custodial powers of the elected president would include powers to check governmental abuse of power as well as to have custodial powers against governmental raiding of our national reserves. It seems clear that the PAP introduced this scheme not to check itself but to protect against a freak election result which allowed an opposition group to take over government, and therefore be in a position to 'raid' the reserves.

Increasingly though, the people are now coming round to the idea that the national reserves as well as public service appointments are actually assets belonging to the nation and should be managed in a non-partisan way. The elected president should therefore have custodial powers over the reserves and public service appointments, regardless of which political party is in power. Previous President Ong Teng Cheong had tried unsuccessfully to exercise these powers. But the shabby way he was treated as the people's President because he had the audacity to do his job remains deeply etched many people's minds. I have to confess I still harbour deep resentment for his being denied a state funeral when he passed away.

So never again.

Logically therefore, the uber establishment Tony Tan should automatically be disqualified from the job as he is just too deeply enmeshed with the PAP leadership and the GIC management of our national reserves. How can he be the second key for the reserves when he has been such an integral part of the first key? The increasing litany of endorsements from leaders of unions and establishment groups just continue to flag him out as being so ultra-establishment and so pro-status quo that I find it harder and harder to consider his legitimacy for the elected presidency position. In fact I find it increasingly difficult not to see him as a desperate attempt by the government to stem the growing movement towards greater expectation of a higher level of transparency of government and of the management of our reserves.

It does not help also that he has not 'come clean' about the allegations of preferential NS deferment for his son Dr Patrick Tan. From what I have read of the incident and of his early rebuttals, the whole thing seemed somewhat irregular. And if he as a very senior political leader, cannot see that it was irregular and should not have happened, then I am more than concerned. So be it if it was a lapse in judgement. I can accept that. But if it remains unaddressed, it sets an awful precedence for all our subsequent generations of leaders that such 'white horse' decisions are acceptable and defensible. That's not the road I want our country to go down.

I have actually tried very hard to avoid commenting on the presidential election, but I find it very difficult because it continues to grate upon my conscience. I want my President to represent my country and to function correctly as the custodian of the reserves and a guard against a profligate government. And I am not sure Tony Tan is the man for the job. Sadly though, he may still end up getting the job because of the continued silliness of the other candiates in not wanting to coordinate their efforts for Singapore's sake.

Which of the other three candiates would I vote for? I am not telling you. But two of the three appear to be too driven by their egos for my liking.

Monday, August 8, 2011

Happy National Day !! Majulah Singapura!

Assoc Professor Paul Ananth Tambyah's speech

Ladies and Gentlemen,

My name is Paul Ananth Tambyah, I am an academic infectious diseases physician working at a major teaching hospital. I would like to state from the outset that I am speaking entirely in my personal capacity.

Historically, Singaporeans, especially those in public sector jobs have been very reluctant to speak at major political events except for those organized by the ruling party for fear that it would adversely affect their careers. I am pleased to share that after speaking at the SDP rallies at Boat Quay and Sembawang, my career has not taken a dive, I am not in exile on some island feeding seagulls off Pedra Branca and I am not walking the corridors of Mt Elizabeth Hospital looking for a job.

Since the SDP rallies at Sembawang and Boat Quay, I have received countless messages from all ends of the healthcare spectrum. Allow me to share a few of these actual quotes:

“I am a current Houseman. I just wanted to thank you for speaking out for our state of healthcare in Singapore. Many of us echo your sentiments, but are too timid or too selfish to speak out for our patients. As Singaporeans, we have often been taught to take the pragmatic approach and very often that means to be silent and let the underprivileged fend for themselves, I pray that the day will come when the sole aim of our healthcare system is to serve our people and not fill the coffers.“

From a cancer specialist, “I saw your impassioned speech on the internet and I would like to thank you for voicing the concerns of thousands of doctors in the public sector. I often see patients making treatment decisions based on whether or not they can afford them. This one patient I am looking after decided to stop cancer treatment the moment his medisave account ran dry. He did not want to burden his children. He knew that he was not eligible for additional funding as he had dependents. The only way for him to continue treatment was to tap on his daughter’s medisave accounts. I ask myself if there is indeed fairness in the world. I worry for my 11 month old child’s future. I need to think hard this elections, not for myself, my career but for his future”

From a SPH journalist, “I read your rally speech online, agree with you on many points. Healthcare and education are two major areas that need seriously to be re-looked if we want to build a truly inclusive society. Also, our social safety net…”

These are just a sample of the heartfelt feedback that I have received after the SDP rally speech. It has been very heart warming and encouraging to me to recognize that not all Singaporeans care only about making money.

On the other hand, there have been rumors going around that I was sacked or demoted or reprimanded. I would like to state categorically that this is NOT true. In fact, in the last few weeks, I have received nominations for awards and important administrative appointments.

More importantly from a pragmatic Singaporean point of view, I received my bonus letter last week telling me that I got a thousand dollars more than last year. I also received a letter from NS PC telling me that I was now eligible for a responsibility allowance and I received an award from MINDEF for my service as a volunteer.

Although I have enjoyed working with the SAF in research, education and clinical care in my field of Infectious Diseases, I am also still serving with an infantry brigade as a BMO. In fact, last week, I broke my elbow walking out of the cookhouse to a bus en route to a training visit!

Many in authority in Singapore are trapped in a system which says “Do not rock the boat”. Like the SPH journalists who privately support alternative points of view while publicly producing official spin, many in public sector institutions set aside their own personal beliefs and convictions to “toe the party line”, make minor tweaks to official policies without really addressing the fundamental flaws or unintended consequences of policies which come from above.

I believe that the fundamental flaw in our current system lies in the corporatization of our country and society. In healthcare, we have seen how restructured hospitals are expected to recover costs as far as possible.

I have tried to explain to many in authority that I do not believe that anyone chooses to get sick. There is always the fear of abuse when subsidies are provided liberally. I once asked a panel of senior parliamentarians, which individual would say “Aha, the government is providing free healthcare for children with leukemia – let my child get leukemia so I can enjoy that benefit”.

Healthcare, like education, public transport and defence and security are public goods. Singapore has an outstanding record in maternal and child mortality. That is the result of a massive investment in maternal and child care from the 1950s onwards.

My generation are beneficiaries of that investment, today’s parents are often afraid to have children in case the medical costs bankrupt them especially since the state health insurance policy specifically excludes congenital illnesses.

A corporation is concerned about the bottom line, about maximizing shareholder value while on the other hand, a country or a society is concerned primarily about the wellbeing of the people. The key indicator should not be GDP growth, it should be whether all people – young and old, rich or poor, able bodied or disabled are allowed to reach their fullest potential. There are corporations like Google which believe in “Doing No Evil” and perhaps we can start by being less of a Microsoft and more of a Google!

Investments are based on trust. Singaporeans do have a high degree of trust in the government although recently there have been many questions raised about policies and practices. It is time for the government to trust the people. Philip Yeo who is one of the most outspoken voices of the establishment has said “My greatest fear now is that the Government is terrified of the people.”

That is a fantastic position to be in. The ministers need to recognize that the only reason that they are in their jobs is because we the people put them there. We can dismiss them if we think that they are not performing. Singaporeans are an educated people, a first world society who are savvy enough to know what we want rather than being told what is best for us.

The fundamentals of a society can be changed from the ground up and the online social activism that has demonstrated its vibrancy during the elections is a good start. My rally speech was ignored by the mainstream English media and rebutted partially in the Zaobao but it was widely circulated online among the medical and healthcare community.

The internet has provided an unprecedented level of accountability with ministers being forced to justify to their employers – that is us – the citizens why they have implemented various policies. This is good for Singapore. But change can also come from above.

The highest office in the land is the Presidency of Singapore. The President and his wife look down on us from every school and government office. That is an extraordinary position for someone with moral courage and leadership like Mr Tan Jee Say or someone with guts and an independent mind like Mr Tan Kin Lian. Jee Say sees himself as the conscience of the nation. Kin Lian is someone who will speak for the people. Both, like the SDP, have a clear stand on the issues that matter – on how our money should be spent and how our citizens should be valued.

One person who speaks up can be safely ignored. I think that perhaps is what many hope will happen to me. Ten thousand people speaking up at many different fora, at different times and in different places cannot be ignored.

This is the new era in Singapore politics when more and more citizens start asking questions about justice and equality, about our reserves and about our jobs, about our healthcare and our education. We cannot “sit down and shut up”. We will be heard. Start by choosing a President who puts the people first. Vote for either of them.

Happy National Day. Majulah Singapore!