Tuesday, July 31, 2012

So how often do Professors have romantic relationships with their students? More common than we want to admit.

The university campus experience is a very exciting one, for a variety of reasons. For many a young adult, it is an escape from parental/family control and the first tastes of being an independent individual. For many it is their first experience of being free to think, as well as to make independent lifestyle choices. The interactions with charismatic professors who seem to know everything can also be quite intoxicating and .... seductive. Especially when hormones are raging.

On the other side of the corridor are the professors who, being married to their science, often live lonely dysfunctional lives .... and by the time they achieve some seniority invariably suffer from some undiagnosed mid-life crises.

Under these circumstances, it is not difficult to understand why a professor may fall for the charms of a young nubile female student. Or why a young female student may develop an infatuation with the middle aged academic demi-god / authority figure. This relationship is obviously inappropriate. But it takes a clear head and strong principles to be able to step away, and do the right thing. Unfortunately, university eggheads are not necessarily clear headed people.

Of course, there are also those with more sociopathic inclinations who will exploit the situation. Female students who try to sleep their way to better grades, for example. Or predatorial professors who take advantage of susceptible young female students. Worst, the senior academic who engages in habitual sexual harassment for cheap gratification.

How often does this occur in our campuses? No one has done a survey to find out. I don't think the universities really want to find out, so don't hold your breath in expectation of some expose to be published. The only survey I have come across was one conducted in a major US university campus. There, from 235 male faculty respondents, 26% reported sexual involvement with female students. This was a survey done in 1988 in a major US campus (Fitzgerald et al, 1988). I leave it to you to figure if the situation in a Singaporean campus, in 2012, is likely to be better .... or worse.

I personally think the situation is more prevalent than we care to admit. There is a tendency on campuses to look the other way unless there is frank criminal intent. Honest though inappropriate relationships just make for interesting gossip. Just think of how many senior 'respected' academics marry their graduate students. In these situations don't imagine that their relationships began after graduation.

Monday, July 30, 2012

The NParks wayang - Problems with GeBIZ that everyone knows about but the auditors turn a blind eye to.

When the NParks Brompton bicycle story first broke, I daresay many had already guessed at what lay behind the procurement/tender fiasco. I am not referring here to the allegations of corruption, or the buddy-buddy relationships between procurer-approver-supplier. Simply, the GeBIZ system is kinda screwed up and pretty much every procurement officer is well aware of these problems and knows exactly how to navigate (read 'cheat') the system to get what they want. It is not as if the auditors don't know. They generally pretend not to know and are pretty 'satisfied' so long as the documentations are in order. Minister Khaw's mistake was his over-eager endorsement of the purchase of the bikes on the assurance of procedural and documentary 'correctness'.

All tenders need to go through the GeBIZ system, yet many of the small suppliers are not registered on GeBIZ. Therefore if the product depends on small suppliers, how do you open a tender on GeBIZ, and expect a reasonable response from suppliers? In the NParks case, what is the likelihood that bicycle shops will be registered on GeBIZ, and will be aware of the tender? Ultimately this will depend on some non-GeBIZ way of disseminating the tender information and hoping the suppliers will go into GeBIZ and tender. This non-GeBIZ way of information dissemination is already subjective and selective to only a limited number of suppliers. And therefore open to abuse.

Secondly, very often procurement offices already have a specific product in mind. This is not necessarily dishonest, but operational centres often have a preference for a specific product. Sometimes this is logical, but often they are not.This is not necessarily the cheapest, but is often perceived to be the most 'desired' product. What makes this product most desirable depends on many factors, most of which are not codifiable. In the laboratory for example, many researchers have preferences for certain branded products, names which they associate with reproducibility or reliability. If they open the tender for the equipment, they run the likelihood of being swamped with cheaper but less desirable products. And endless needs to justify awarding the tender to the non-cheapest tenderer. So what do they do? They word the tender in such a specific way that only one brand name matches the tender specifications. In the NParks case, the wording of the tender was so obviously directed towards a very specific product.

The above are without doubt 'bad practices' but superficially may be viewed as being procedurally 'correct'. I challenge any auditor to say that he/she is unaware of these practices but has not looked the other way in performing the audits.

Another problem contributing to this fiasco is the familiar end-of-financial year monkeying with the accounts. How many of us are unfamiliar with the regular message that comes down from senior management that there is left over money that needs to be spent? Rather than to return the money and risking a reduction of next year's budget, the instruction that comes down from senior (or very senior) management is to spend the money. It is under these circumstances that the most wasteful expenditure of public funds occur. It is under these circumstances that you see the sudden purchase of weird, expensive and poorly justifiable items. Perhaps 26 expensive Brompton foldable bikes?

Thursday, July 5, 2012

Regulatory conflicts of interest - lessons for the HSA from SMRT/LTA COI

The recently released findings of the Committee of Inquiry for the SMRT breakdowns has some important lessons for the HSA. Apart from pointing out the lapses in SMRT, it also fingered the failure of the regulator, LTA, in managing the intrinsic conflicts of interest inherent within the workings of the regulator. But the LTA is not alone is this regard. Many, if not all of Singapore's regulatory agencies are stacked full of these conflicts.

The HSA is similarly affected. Gigamole has pointed out these conflicts of interests before. How can a regulator do its job when it has also been tasked with befriending and facilitating growth of the very industry it is supposed to regulate? In some cases, the HSA is itself, also the service provider in the areas where it is supposed to regulate.

 In the recent brouhaha about medical device regulation, the HSA came across looking almost afraid of the industry it is supposed to regulate. Note how very quickly it capitulated to the demands of industrial players. To Gigamole, "regulate with a light touch" really means "I will look the other way while you do your thing. Just don't get into trouble".

In the hurriedly convened "closed" town hall meeting, HSA met up with 370 of the industry players to anxiously reassure them of this "light touch". Conspicuously absent was any representation from any consumer groups. Do patient-consumers not have a voice, and do they not need to be protected? It used to be that we can depend of the Ministry of Health, or its proxy, in the form of a governmental regulatory agency, to have the interests of the public first. But nowadays, this cannot be assumed, because regulators have to be industry friendly, and promote the development of these very industries. And the biomedical industry has become significantly more powerful and insistent of late. The need to "perform" with respect to the Pro-Enterprise Index, speaks volumes.

The LTA had been found wonting because it did not adequately firewall its regulatory functions from the need to also promote. Likewise, Gigamole predicts that it is only a matter of time before the HSA runs into serious problems with major consequences for the patient-consumer if it doesn't make a serious attempt to deconflict these functions.

Monday, July 2, 2012

Selling off our heritage: How our medical school disappeared. Happy birthday, our grand old Alma Mater!

Few will, or will care to remember that our present Medical School and indeed, the National University of Singapore was born July 3rd, 1905. So sad.

Towards the end of the 19th Century, Singapore was still training "doctors" by sending qualified students off to Madras. In 1904 a tin trader, Tan Jiak Kim collected the necessary funds and spearheaded a move that would eventually lead to the establishment of our own true-blue Singaporean medical school. This was initially called the Straits Settlements and Federated Malay States Government Medical School.

The building it operated in was actually an old women's asylum, located somewhere behind the current grand looking College of Medicine Building at Sepoy Lines (Ministry of Health). The precious heritage building is no more there because in the early 80s, after the medical school relocated from her birthplace to Kent Ridge, the huffy Ministry of Health decided that such useless heritage was not worth preserving and promptly flattened the historical building - replacing it with of all things, a car park!

Ever forward looking, the National University of Singapore seemed also little interested in heritage issues. When in 2005, the Yong Loo Lin Trust donated a "transformational gift" of $100 million to the medical school, the school threw heritage out the window and gratefully renamed itself the Yong Loo Lin Scool of Medicine. It simply didn't matter that no one actually knew who Yong Loo Lin was.

A hundred million dollars was apparently the biggest gift the University had ever received. But it was in truth, a relatively small sum compared to the operating budget of the university. One wonders what would happen now if Gigamole donates $105 million to the University. Can I get the medical school named after me?

It is so easy to sell off our heritage. Sad, and tragic, because it is our heritage that ties us together, and makes us who we are.

But Gigamole remembers. So here's wishing you a happy happy birthday, our dear Alma Mater. Though I am not sure where you are now. Sadly, I don't think the NUS or YLLSOM will remember your birthday today. Last I checked, nothing on their websites.

Sunday, July 1, 2012

Smith & Nephew R3 recall - MHRA advisory

Here's a follow up of the Smith & Nephew R3 acetabular system that Gigamole had highlighted a while back. The UK regulators, MHRA (Medicines and Healthcare products Regulatory Agency) has now issued an advisory about the recall. Their advice is pretty similar to the FDA advisory for the DePuy ASR implant recall.

All patients, symptomatic or not, should undergo MRI or ultrasound scanning. They should be followed for the lifetime of the implant in the body. Blood levels should be checked for cobalt and chromium levels. If either scans are abnormal, or metal levels are rising, surgical revision should be considered.

HSA meanwhile is maintaining their wall of silence.