tag:blogger.com,1999:blog-61258573141656459512024-03-13T09:35:19.712-07:00The Gigamole Diaries...a small critter's view of biology, medicine and life in Singaporegigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.comBlogger522125tag:blogger.com,1999:blog-6125857314165645951.post-53783752204500738022013-06-28T18:47:00.000-07:002013-06-28T18:48:44.890-07:00The N95 mask - why liddat also must try and make money?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA5x0v3QfOuMB6lAqlISfN9s_gULP5ppg6fNhy0OHk4t3q8jpCkJrzsHo1aQ_IX2DSid8GwN0WHABA3yLO2PzIUpb5BAUt-JueoxLI6aSYQ1xvp2goMUFgCrTwf_t1Sdpv1a3GmJ-7VBo/s599/mask.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA5x0v3QfOuMB6lAqlISfN9s_gULP5ppg6fNhy0OHk4t3q8jpCkJrzsHo1aQ_IX2DSid8GwN0WHABA3yLO2PzIUpb5BAUt-JueoxLI6aSYQ1xvp2goMUFgCrTwf_t1Sdpv1a3GmJ-7VBo/s400/mask.jpg" width="300" /></a></div>
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.<br />
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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.<br />
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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.<br />
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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 href="http://www.amazon.com/gp/offer-listing/B002AUVWSC/ref=dp_olp_new?ie=UTF8&condition=new">a pack of 20 (N95 3M 8210) for US$14.95</a> (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!<br />
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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.<br />
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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?<br />
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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.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com4tag:blogger.com,1999:blog-6125857314165645951.post-52159293965355855852013-06-26T02:49:00.001-07:002013-06-26T02:52:32.182-07:00So you think you are safe from the haze indoors? Think again.<div class="separator" style="clear: both; text-align: center;">
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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.<br />
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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.<br />
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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 <a href="http://www.epa.gov/iaq/largebldgs/i-beam/text/hvac.html">US EPA current requirements</a> 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.<br />
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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.<br />
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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.<br />
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This level of contamination by outside air is indexed as the infiltration efficiency. A <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385439/#ehp-1104447-s001">recent study</a> 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.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-27367688373840907002013-06-21T19:28:00.000-07:002013-06-21T19:28:04.324-07:00Ng Eng Hen and Grace Fu, you are both sooo wrong!!!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghNUsWF2h7t87AURvpDPc_U0eXs24FzecuD6UyLgV5dbMVWkgKUhz6Il3XoDOD2HfJRAX8d8oh_fN5xMl5avKsx62WOm-DLBfbTTmIeWI86QslrSMO0iTqSGCA78OPYwRgIhzL1aL48ng/s1600/suma18d.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghNUsWF2h7t87AURvpDPc_U0eXs24FzecuD6UyLgV5dbMVWkgKUhz6Il3XoDOD2HfJRAX8d8oh_fN5xMl5avKsx62WOm-DLBfbTTmIeWI86QslrSMO0iTqSGCA78OPYwRgIhzL1aL48ng/s400/suma18d.jpg" width="343" /></a></div>
First Second Minister of EWR <a href="http://www.todayonline.com/singapore/24-hour-psi-reading-betterreflection-haze-impact-health">Grace Fu said</a>, "The health impact of the air pollutants is determined by both the concentration and the duration of exposure."<br />
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Not wrong.<br />
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Then she says, "the 24-hour measurement is a better reflection of the total exposure of the individual to particulate matter."<br />
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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.<br />
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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??<br />
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Minister of Defence Dr Ng Eng Hen, lagi best, <a href="http://www.channelnewsasia.com/news/singapore/refer-to-24-hour-psi-not/720046.html">further glossed over the issue</a> 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..."<br />
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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.<br />
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So Gigamole's plea to these two smart politicians is.....to STOP TRYING TO DUMB DOWN THE DATA!<br />
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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 <u><i>real</i></u> 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.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-80847083601300780372013-06-17T01:34:00.000-07:002013-06-17T01:34:37.882-07:00Who 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?<br />
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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.<br />
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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.<br />
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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?<br />
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How come no one is asking?<br />
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But again, this may also be just the tip of yet another iceberg. Peter Ludlow recently wrote <a href="http://opinionator.blogs.nytimes.com/2013/06/14/the-real-war-on-reality/">a great opinion piece</a> 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.<br />
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Yes, gahmens do set the agenda. And they do this not only by controlling the main stream media.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-3658225580280878782013-06-04T08:44:00.001-07:002013-06-04T08:45:56.653-07:00FREE MY INTERNET!!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxXrPIfiP-OA1kYyTrHK8l62Zq4VLnllOM5ViQlHAXY9ZPFLp4E0s2lh3EZLubZAS1EJPEsiYI-u91PM-bxFG43rBrAcap_vc3vL-nazpucomWFw4S6aWHe2YbXixPKs2vaVGd8QXEMUM/s1600/FREEMYINTERNET.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxXrPIfiP-OA1kYyTrHK8l62Zq4VLnllOM5ViQlHAXY9ZPFLp4E0s2lh3EZLubZAS1EJPEsiYI-u91PM-bxFG43rBrAcap_vc3vL-nazpucomWFw4S6aWHe2YbXixPKs2vaVGd8QXEMUM/s400/FREEMYINTERNET.jpg" width="400" /></a></div>
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-47420499281374174252013-03-04T00:10:00.000-08:002013-03-04T00:10:41.133-08:00Investigations into Johnson & Johnson's marketing practice - the ongoing saga of unregulated medical devicesOne 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. <a href="http://gigomole.blogspot.com.au/search/label/DePuy">Gigamole has blogged about this before</a>.<br />
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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, <a href="http://www.reuters.com/article/2011/04/08/us-jj-bribery-idUSTRE7374ZB20110408">J&J was forced to pay off US$78 million</a> for having paid bribes and kickbacks. Apparently bribing orthopaedic surgeons is a common practice among device manufacturers. In <a href="http://www.ncbi.nlm.nih.gov/pubmed/22025434">a report in the Archives of Medicine in 2011</a>, 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.<br />
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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.<br />
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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.<br />
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Gigamole wonders when HSA is going to do the right thing?<br />
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com1tag:blogger.com,1999:blog-6125857314165645951.post-71365070530600181532013-02-21T19:30:00.000-08:002013-02-21T19:32:41.006-08:00Hearing but not listening. Beyond the population white paper.<div class="separator" style="clear: both; text-align: center;">
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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.. "<i> .....but you are not listening</i>!! *sigh*<br />
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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?<br />
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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.<br />
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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.<br />
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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.<br />
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Sadly, with potentially tragic outcomes.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-21797006048929377252013-02-09T18:51:00.000-08:002013-02-09T18:51:20.387-08:00恭喜发财!万事如意!<div class="separator" style="clear: both; text-align: center;">
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Happy Lunar New Year all! Here's wishing the black water snake will bring us better news than the white paper did!<br /><br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-8140784827910355652012-12-20T21:38:00.001-08:002012-12-20T21:38:26.623-08:00Our hospitals' creative definitions of charity.....<a href="http://leongszehian.com/?p=2174">Leong Sze Hian's expose</a> on the NUH (Patient Care Charity Fund) and TTSH Community and Charity Funds' use of collected money provided another jaw dropping moment for Gigamole.<br />
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What's going on here?<br />
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How can you use funds collected under the guise of charity to pay for education and training of staff, and the building of hospital infrastructure? For the NUH Fund, only 52% of expenditure apparently went to needy patients, while 48% went to medical education, training and research. For the TTSH Fund, apparently only 47% went to real charity-worthy needs. The rest of the expenditure apparently went to finance the building of infrastructure in the form of a new Emergency Diagnosis and Therapy Centre.<br />
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If these revelations are true, Gigamole is extremely offended. Clearly these are abusing donor's and patient's trust, not to mention demeaning to the idea of charity.<br />
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The Commissioner of Charities should have something to say about these.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-85266956778085016932012-12-20T20:57:00.000-08:002012-12-21T10:33:41.257-08:00The Alirio Melendez research misconduct issue finds resolution.... well, at least some kind of resolution ...! After one and a half years of dingdonging, the Melendez research misconduct investigations finally <a href="http://blogs.nature.com/news/2012/12/immunologist-accused-of-misconduct-in-21-papers.html">get an NUS report</a>. Twenty one papers were associated with plagiarism, fabrication and falsification. Strangely, the NUS refuses to say which papers. But the NUS apparently exonerated all the co-authors. Whoohoo......! Nobody else were responsible!<br />
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Incredible news, I must say. The lead authors of the papers not responsible? I am sure Melendez was not the lead author for all 21 papers. How can this be?<br />
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In the NUS, I am told, there is a scheme of apportioning glory and credit for scientific publications. This is for the purpose of chalking up points for promotions and other 'rewards'. The lead and the corresponding authors get 50% of the credit<i><u> each</u></i>. All the other co-authors stuck in between get 10% each. On this model, one published paper with a mass grave of 10 co-authors can chalk up a total of 180% credit.<br />
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Contrast this with research misconduct, where suddenly everyone in the mass grave is invisible and not involved, and only one person takes the blame for everything.<br />
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You go figure the logic!gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com5tag:blogger.com,1999:blog-6125857314165645951.post-14670045724573905382012-12-07T00:54:00.000-08:002012-12-07T00:56:43.995-08:00Depuy hits the headlines in Singapore - finally!<div class="separator" style="clear: both; text-align: center;">
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Straits Times Health Correspondent Salma Khalik finally decided the Depuy hip implant problem was important enough to highlight. A half-page spread today.... whoohoo....! Gigamole had been <a href="http://gigomole.blogspot.com.au/search/label/DePuy">beating this gong</a> for the last 6 months and wondering if anyone was listening. So....thank you Ms Khalik!<br />
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Truth is HSA has floundering somewhat with respect to medical devices regulation. With all good intention, it started to do something about it but mismanaged the implementation. After an hysterical outcry from suppliers and practitioners, it pulled back from doing the right thing. Kinda like 3 steps forward and 2.9 steps back.<br />
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The Depuy hip implant failure is now subject of a <a href="http://www.prweb.com/releases/2012/11/prweb10129835.htm">national class action lawsuit in the USA</a>. Just a few days ago, Johnson & Johnson <a href="http://www.bloomberg.com/news/2012-12-03/j-j-knee-implant-settlement-approved-by-australian-judge.html">agreed to settle in Australia</a> for A$30,000 per patient. In Singapore however, the situation is far from clear.<br />
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There are many problems.<br />
a] Lack of patient awareness. A dear doctor letter was sent out, but there has been no follow up by any responsible party.<br />
b] No one has any idea who received the implant. There is no registry of such implant use.<br />
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c] HSA has no idea who is affected, and what to do about it. Gigamole thinks they have just been hoping the problem will fade away in time.<br />
d] There is no service laboratory in Singapore that will measure chromium and cobalt for toxicity.<br />
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There is no equivalent of a lemon law for medical devices in Singapore, and no patient consumer movement to look into the interests of the patient-consumer. Like it or not, the only authority who can do this is the HSA, but they seem clueless and toothless.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-76129549954034036782012-11-08T12:22:00.002-08:002012-11-08T12:26:35.712-08:00Silence is golden, NUS? I am disappointed.Sometimes I wonder if the National University of Singapore (NUS) values good press above doing the right thing. I understand that managing the corporate profile is important, and that for a school such as the NUS that relentlessly chases the rankings, avoiding bad press is important. But there are other ways of managing your reputation than just avoiding difficult issues.<br />
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Here the imposed silence on<a href="http://www.asiaone.com/News/Latest%2BNews/Edvantage/Story/A1Story20121108-382312.html"> student blogger Alvin Tan's punishment</a> says a lot about NUS character and maturity. I am not interested in the sordid details about what the blogger did, but the consequences of what he did especially while he was a scholarship holder. Whatever NUS's disciplinary decision was, there are important lessons for everyone. Transparency in dealing with such a difficult issue will show to the world the heart and soul of the university. We need to know what value systems, the NUS stands for. If the disciplinary action was fair and honest, why is there a reluctance to make it known? There are lessons for everyone. As a world class university aspirant, the NUS should not fear engaging in public discussions and debate, even about its own corporate decisions.<br />
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But I am disappointed. Because it seems clear that the NUS has opted to hide behind zipped lips and walls of silence rather than bravely engaging the public. This has been how the NUS has chosen to manage previous incidents - from <a href="http://gigomole.blogspot.com/2012/04/research-misconduct-continuing-concerns.html">research malpractices</a> to <a href="http://gigomole.blogspot.com.au/search/label/labaccident">spectacular lab accidents</a>. To date, the public remains in the dark about what mistakes were made and what actions taken. Valuable opportunities to learn from these incidences have been lost. This over-reliance on the strategy of retreating behind walls of silence is very damning, and I believe in the longer term, will stunt the intellectual growth of the university. Perhaps some timely advice from the managing editor of the SPH who sits on the NUS Board of Trustees is appropriate here.<br />
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It's time the NUS grew up.<br />
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-2248767416634403722012-11-08T00:40:00.000-08:002012-11-08T00:40:43.840-08:00The patient-doctor relationship - a relationship between unequals<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQz5-skIF94U3rDECdQkRC2wkHta8hUmv6YfUOKM47rvOnz8EShXgDRxtTC91aaCwJHX2zy1_Zw41JqqKbjNxF0oRgpu4cdg3n596f6aghOsjafsGZdwLL31VCuWdVEErIL7lqSzhiGjM/s1600/ST.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQz5-skIF94U3rDECdQkRC2wkHta8hUmv6YfUOKM47rvOnz8EShXgDRxtTC91aaCwJHX2zy1_Zw41JqqKbjNxF0oRgpu4cdg3n596f6aghOsjafsGZdwLL31VCuWdVEErIL7lqSzhiGjM/s400/ST.jpg" width="400" /></a></div>
Today's Straits Times carried an interesting report of contest in a coroner's court between a mother who is a nurse, and a surgeon. The mother, who had lost her daughter in a liver transplant contended the surgeon provided sub-standard care because she had a spat with the surgeon earlier.<br />
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She did not convince the coroner. However, the case highlighted the inherently unequal relationship that exists between a patient (and relatives) and the doctor. Here, every patient is in essentially a subordinated position, and generally hesitant to offend the attending physician/surgeon. This is generally the case, unless the relationship is based on a completely elective and unnecessary procedure, when a more commercial/contractual relationship may apply.<br />
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This is why I am concerned about how the physician/surgeon goes about taking consent for procedures. Often the consent is taken by the care giver. In this case, the patient is often afraid of offending the doctor. This unequal relationship very clearly does not create the circumstance when a truly voluntary consent can be obtained. This ethical lapse, also applies to the situation when consent is being sought for participation in a experimental procedure or clinical trial when the researcher or care giver is himself/herself the one administering the informed consent. <br />
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The more academic hospitals compound the problem further by expecting patients on admission to consent to giving up rights to tissues and genetic material for research purposes. This consent is often taken at most inappropriate times when the patient and his/her relatives are most dependent and submissive.<br />
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The hospital ethics committees applying their very utilitarian logic, obviously do not disapprove of these ethical lapses.<br />
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-84684341628408621742012-09-29T17:42:00.001-07:002012-09-29T19:00:52.803-07:00Sex and corruption in medicine<div class="separator" style="clear: both; text-align: center;">
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<img align="BOTTOM" height="400" src="http://rense.com/general89/BigPharma_Comic_med.jpg" width="385" /> </div>
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The recent <a href="http://www.asiaone.com/News/Latest+News/Singapore/Story/A1Story20120125-323860.html">sex and corruption case</a> at the Central Narcotics Bureau has certainly woken many people up. But there is really nothing new here other than the titillating stories of trysts and late night sexting between two very gatal (itchy) people. Sex sells. And all through history women have used their wiles to charm their way into position, power and wealth. So was this corruption, or just two very gatal people acting out their fantasies? We won't know for some time, and Gigamole will not speculate.<br />
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Nonetheless, Gigamole is reminded that the medical and health industry is not immune to such sex and corruption issues. Just that many do not get flagged out.<br />
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The WHO has estimated that the about US$4.1 trillion is spent globally on health services and of this, US$750 billion was on pharmaceuticals. It is a massive industry. The pharma companies aggressively compete for this market, and many (if not all) resort to unsavoury methods to market their wares.<br />
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Recently <a href="http://usatoday30.usatoday.com/money/industries/health/drugs/story/2012-07-02/glaxosmithkline-pleads-guilty-3B-fine-illicit-promotion-prescription-drugs/55979616/1">GSK was fined US3 billion</a> for illegal marketing of its products. Part of these charges relate to providing junkets for doctors and various other kickbacks. <a href="http://www.reuters.com/article/2011/04/08/us-jj-bribery-idUSTRE7374ZB20110408">J&J also had to pay up US78 million</a> to settle charges of bribery and kickbacks it had provided.<br />
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Does this happen in Singapore? For sure. But perhaps not so obvious, because of our CPIB. But bribery and kickbacks in some form definitely occurs. Our doctors (especially) go on junkets all the time. Not to mention kickbacks of various sorts. These are supposed to be regulated and notified to senior management, but nobody really scrutinizes anything, and consultants regard these as the perks of their practices. <a href="http://www.theaustralian.com.au/news/nation/doctors-on-the-spot-to-reveal-pharma-junkets/story-e6frg6nf-1226449605658">Medicines Australia reported</a> that the annual spending by Pharma companies in wining and dining doctors and healthcare workers amounted to about A$24 million. How much "hospitality" spending in Singapore? Gigamole doesn't know. In fact the authorities don't really want to know.The public should insist that this be reported and made known publicly.<br />
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Any sex involved? Gigamole cannot prove anything. But suffice to point out that the industry is much bigger than selling the odd IT systems. Anybody stopping to point out that the sales reps for pharma companies are invariably attractive young ladies in short skirts?<br />
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This is not a problem that affects just pharmaceuticals. Medical devices suffer the same corruptibility. The susceptibility also extends up all levels of the health care chain....all the way from the prescriber, procurer and possibly even the regulator. Can we trust that we have only the best medical information, drugs and devices? Possibly not.<br />
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We need to look at this more carefully. The trouble is that the medical industry is seems rather "protected" and few want to stir the pot to root out these problems within the industry.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com1tag:blogger.com,1999:blog-6125857314165645951.post-50387442271466059832012-09-29T16:55:00.001-07:002012-09-29T16:55:33.456-07:00The PSLE should merely be a competency exam!In case the point had been lost before, Gigamole is saying it again. The PSLE should remain, but only as a competency exam. We have compulsory primary school education in Singapore, and a competency exam is required at Primary Six so that we can be assured that all children have achieved a minimum level of education when they leave Primary Six to go to secondary school. There is really no necessity to grade this exam.<br />
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Gigamole cannot understand why secondary schools should be allowed to select students based on grades. If you are a good secondary school, prove it by the product that leaves the school, not by the students admitted to the school. All this talk of de-banding the secondary schools is hogwash, and a red herring to the discussion. The schools' reputation will become known in time, with or without banding. What credit is there to the school if it is enrolling only the best performers at PSLE? The Ministry of Education in retaining the graded PSLE seems to only be interested in protecting the positions of established elite secondary schools.<br />
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Please protect our your children by removing this unnecessarily competitive exams from their educational experience. There is more than ample opportunity to compete after they have left primary school. Shifting the competitiveness in education later will also be fairer to students who are naturally late bloomers.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com1tag:blogger.com,1999:blog-6125857314165645951.post-42206400428021149142012-09-28T02:19:00.000-07:002012-09-29T17:43:29.644-07:00"You ignore me, how, how, how?"Sounds like the plaintive cry of <a href="http://news.asiaone.com/News/Latest%2BNews/Singapore/Story/A1Story20120927-374144.html">a woman scorned</a>. And we all know enough to beware that woman scorned.<br />
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Yet, often we Singaporeans are made to feel like the woman scorned. By the gahmen (and their extensions) we love. Gigamole feels that way sometimes. Important issues brought up often meet that deadly wall of silence. The icy stare. The cold shoulder.<br />
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Issues that continue to bounce off the wall of silence::<br />
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a] <a href="http://gigomole.blogspot.com.au/search/label/streetrace">Illegal street racing</a>. All we hear are the Ferrari engines that continue to roar down our city streets in the dead of night.<br />
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b] <a href="http://gigomole.blogspot.com.au/search/label/workerssafety">Lab explosions in the NUS</a>. A lab accident after another, yet the Ministry of Manpower, for all their new empowerment through the WSH Act, and the NUS, continue to maintain their walls of silence.<br />
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c] <a href="http://gigomole.blogspot.com.au/2012/04/research-misconduct-continuing-concerns.html">Research misconduct.</a> The Alirio Melendez story came and went. Yet for all Singapore's vaunted push for research integrity, the Melendez related dirt seems to have been conveniently swept under the carpet.<br />
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d] <a href="http://gigomole.blogspot.com.au/search/label/medicaldevices">Unregulated wacko medical devices.</a> The HSA sweeps some more dust under the carpet as they maintain their wall of silence of some pretty disturbing information about medical devices let loose in Singapore.<br />
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e] <a href="http://gigomole.blogspot.com.au/search/label/JayLu">Disbarred doctors who can practice in Singapore</a>. The latest question mark that needs to be unmarked by the Singapore Medical Council. Don't hold your breath waiting for an ans They'll intubate you!<br />
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You ignore me, how, how, how?<br />
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-61514682213359433402012-09-18T02:35:00.000-07:002012-09-18T02:35:33.594-07:00The PSLE - Is it so difficult to see what the problem really is?Gigamole is glad to see <a href="http://www.channelnewsasia.com/stories/singaporelocalnews/view/1226598/1/.html">the discussions about childhood education shift</a> towards the Primary School Leaving Examinations (PSLE). To scrap or not to scrap, seems to be the focus of the debate. To Gigamole, it seems they are missing the point. An exam is necessary at the end of Primary Six. There is no doubt about this. But people are (deliberately, perhaps) forgetting that <a href="http://www.moe.gov.sg/initiatives/compulsory-education/">Singapore has compulsory education up to Primary Six</a>. The PSLE is appropriately named the Primary School Leaving Examinations. The PSLE should not be anything other than a competency exam. Somewhere along the way, the Ministry of Education allowed the PSLE to morph and mutate to become the grotesque thing it now is. Currently the PSLE is an uber-competitive exam to identify top students who can be streamed into elitist schools to fuel an even more uber-elitist agenda. The banding of schools serve no other function that to feed this elitist mindset. To disband the schools is however, only a symptomatic response to the real problem, which is that as long as the PSLE remains a competitive exam, parents will relentlessly drive their children into excelling so that they will have a chance to enter elitist secondary schools.<br />
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Gigamole says that if you really want our children to have a proper educational experience and a wholesome childhood you need to remake the PSLE into just a competency exam. That's really what is only required at Primary Six. Is this so difficult to see?<br />
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-71871692469093825252012-09-18T02:12:00.000-07:002012-09-18T02:12:59.404-07:00Has our traffic police fallen asleep at the wheel....again?It seems like the <a href="http://www.sammyboy.com/showthread.php?127369-Illegal-street-racing-in-spotlight-again">illegal street racing</a> problem highlighted<a href="http://gigomole.blogspot.com.au/search/label/streetrace"> elsewhere before</a> has not been curbed at all. One wonders what the traffic police have been doing all this while. One of Gigamole's blog readers <a href="http://gigomole.blogspot.com.au/2012/05/ferrari-accident-and-illegal-street.html">had pointed out</a> that was this going on along Orchard Boulevard. Surely the Traffic Police cannot be aware? Surely it cannot be so difficult to clamp down on this? All it takes a a couple of discretely placed CCTV cameras, or speed cameras. Or even a strategically placed patrol car.<br />
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It really boils down to whether they want to act or not. All this talk about providing a racing track is pure hot air. For once and for all, just go ahead and clamp down on it.<br />
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-83051256584316303312012-09-11T01:01:00.002-07:002012-09-11T01:01:19.223-07:00The jaw dropping revelation about NUH's Dr Jay Jiade Lu<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8AVvUZ1XE1ssyFyLS5GCdyzwgJZzvdWI8eNx5JxI-OY8ULDV1KxBQgRSgB5z7gUpu2mPPxiXooQT8uJusunxOGMhq0nO0fILbJMorGaegX8zQeaKLU3dln0PLkdnflUfSVirg_N04LGM/s1600/jaylu.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8AVvUZ1XE1ssyFyLS5GCdyzwgJZzvdWI8eNx5JxI-OY8ULDV1KxBQgRSgB5z7gUpu2mPPxiXooQT8uJusunxOGMhq0nO0fILbJMorGaegX8zQeaKLU3dln0PLkdnflUfSVirg_N04LGM/s200/jaylu.jpg" width="162" /></a></div>
Gigamole was not the only one taken aback by <a href="http://www.tremeritus.com/2012/09/08/foreign-doc-revoked-in-u-s-for-illegally-selling-viagra-online-now-employed-by-nuh-in-spore/">the revelations about Dr Jay Lu's past history</a> of being stricken off from the medical register in Florida. The relative silence from the medical community cannot be taken as a general lack of concern. Rather it reflects the discomfort many doctors have about pointing fingers at one of their colleagues. At least publicly.<br />
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The issue however should not be lightly dismissed and swept under the carpet.<br />
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The <a href="http://www.healthprofessionals.gov.sg/content/hprof/smc/en/leftnav/becoming_a_registereddoctor/documentation_requirements_processing_time.html">Singapore Medical Council has made it very clear</a> that all applicants for registration must have a certificate of good standing and must not be under complaints, pending investigations or any disciplinary actions. That Dr Lu was actually under investigation at the time he applied for registration seems evident. Furthermore, there is no doubt that he failed to 'fess up when he was struck off the register in Florida. He had a free run for 11 years.<br />
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NUHS and NCISs' big heartedness in publicly forgiving Dr Lu is laudable but grossly misplaced. But this is not a <a href="http://en.wikipedia.org/wiki/Jean_Valjean">Jean Valjean story</a>. The Singapore Medical Council cannot prevaricate in this instance and must act decisively.The damage done institutionally and nationally cannot be easily undone.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com2tag:blogger.com,1999:blog-6125857314165645951.post-75605792328713335692012-09-01T00:23:00.000-07:002012-09-01T00:36:59.853-07:00How about a Lemon Law for medical devices?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5itLJUHIPotWICpRAYUJVX6F5KFgCr5pnIsWHfAqDcWlW-kVed4MqIf_6yFIcX-PcA99UxHSUKzRQveXcZxuIFi7_VA3Po099DkmXuPVB6vMwdLf0NAZ-d37Q3d2wuxrQCu8d_e12XFs/s1600/lemon.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="395" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5itLJUHIPotWICpRAYUJVX6F5KFgCr5pnIsWHfAqDcWlW-kVed4MqIf_6yFIcX-PcA99UxHSUKzRQveXcZxuIFi7_VA3Po099DkmXuPVB6vMwdLf0NAZ-d37Q3d2wuxrQCu8d_e12XFs/s400/lemon.jpg" width="400" /></a></div>
Gigamole was delighted to read about the Lemon Law for Singapore. Kicks in today! Gigamole wonders why it had taken so long to want to protect consumers, but ne'er mind, better later than never.<br />
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Gigamole also wonders how the Lemon Law might protect the patient consumers from faulty medical devices such as heart stents, and other prostheses. It would seem that that the prostheses itself should be covered under the current Lemon Law, since the patient did "purchase" a device. The surgery to implant the device is not covered, as it would be a "service". On the other hand, the surgeon would actually be the retailer of the device, so should be responsible for the replacement of the device if it were faulty within 6 months.<br />
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The problem with medical devices is that defects often do not reveal themselves within 6 months. So the patient often has to shoulder the burden of proving that the defect did not live up to expectations of quality. <br />
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This raises a further question of who actually provides assurance of quality of the product and who protects the patient consumer from exploitation by manufacturers. One may expect that the HSA, as the government regulator to provide assurances that any device entering the market has an acceptable level of quality and safety. But this is not the case at the moment. The nascent attempts to regulate medical devices ran into bad publicity, and the HSA has since appeared to shrink from doing the right thing.<br />
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So now no one knows if the medical devices that are stuck into a patient's body is of acceptable quality and safety. No one knows who is actually protecting the patient consumer. Recently Gigamole has flagged up issues with metal on metal hip implants, transvaginal meshes, cardiac stimulators, heart valves, which have increasingly been cited in various regulatory withdrawals and law suits overseas. But locally, there has only been a deathly silence from the HSA. So no one apparently wants to inform the patient consumer the bad news. No one wants to point the finger at surgeons for retailing faulty devices. Seems to be that the patient's only recourse is through litigation. Even so, there should be adequate awareness among patient-consumers that there is a problem. Sadly, there is so little local information available for the patient-consumer to use. HSA's silence is certainly not helpful.<br />
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Gigamole believes we need a Lemon Law for medical devices. But not just a law, we need a healthy consumer protection movement for drugs and medical devices.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com1tag:blogger.com,1999:blog-6125857314165645951.post-89200626033873004562012-08-25T00:07:00.000-07:002012-08-25T00:07:27.653-07:00Returning Singapore to Singaporeans? Dare we wish?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTC4DYfkuSQkyQsXB7Npnpsxi1oLw66GRioHZx52LnP999iAkpNAre1XLnyz5aSPx8Ksji1VHH7I9Pzc86C_QGtvhfi4EnM54zSWnK61RzxRBhBgjkpM_2AWJRSCqvwUlr2PJTpxo2-TQ/s1600/Giga.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="326" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTC4DYfkuSQkyQsXB7Npnpsxi1oLw66GRioHZx52LnP999iAkpNAre1XLnyz5aSPx8Ksji1VHH7I9Pzc86C_QGtvhfi4EnM54zSWnK61RzxRBhBgjkpM_2AWJRSCqvwUlr2PJTpxo2-TQ/s400/Giga.jpg" width="400" /></a></div>
It is hard to feel betrayed. Gigamole says 'feel' because that is what it is, only a feeling. Gigamole can understand the logic of our political leaders, and I don't think they had any real malice in the decisions they took. But Gigamole thinks they were misguided, and Gigamole, like many others, feel betrayed. <br />
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Mind you, Gigamole was one of those who stood in the rain for the first National Day parade. And Gigamole was one of those who dug into pocket money to give to the Singapore National Defence Fund.<br />
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Whether it is about birth rates, education or academic achievements, where we are now, and who we are is a result of policies in place during the early years of nationhood. Until the 1980s, the thinking about university education was that we were training too many graduates. University education was seen to be an 'evil' contributing to frustrations and social discontent. The university was deliberately kept small. We were producing too many doctors. Not good, because doctors were woolly headed and bleeding hearted.<br />
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Gigamole remembers that medical research was regarded as a 'luxury'. Research funding was only available to allow medical scientists to 'tickle' their minds and keep them interested in their science. Gigamole remembers how we all had to troop, hat in hand, to the Singapore Turf Club to ask for a small sum of money to do some research.<br />
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What a turn around in the 1980s when the university began to expand, and research became a much sought after activity. In the years that followed, Gigamole has seen hard working colleagues given the boot because they did not have the research track record that was comparable to academics from developed countries who had spent a lifetime doing research. Foreign talent they were called.<br />
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Since then or universities and research establishments have turned into <a href="http://gigomole.blogspot.com.au/search/label/whales">wonderful performing whale-ariums</a> populated by non- Singaporeans. Mind you, Gigamole is not against foreign talent. Just that it has become too easy a solution to rent (not buy, mind you) performing whales in order to vicariously capture research glory. It is really no different from buying Olympic gold medals on Ebay. Now almost every department in the Universities and Research Institutes are headed and staffed by non-Singaporeans. It looks fantastic on paper, but only on paper. The reality is that the local content has been severely hollowed out. To make matters worse, the current crop of 'foreign talent' mostly do not want to teach, and do not engage in any technology transfer. The Nanyang Technological University, for example, under their Swedish President, is fast becoming a totally foreign university, desperately trying to catch up with the NUS in glbal ranking. The Lee Kong Chian Medical School with their Deanery imported from Imperial College, London, seems engaged in political struggle with the more indigenous Tan Tock Seng Hospital for pre-eminence. No prizes for guessing who is backed by higher forces, and who will eventually win.<br />
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Even the student population appears to have been done in. Gigamole has often wondered about the logic of building so many elitist universities, that our own Singaporean children have no choice but to venture overseas if they want a university education.<br />
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So Gigamole is not happy. Gigamole can't help feeling betrayed.<br />
<br />gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com5tag:blogger.com,1999:blog-6125857314165645951.post-86537956784507277652012-08-24T23:20:00.000-07:002012-08-24T23:23:56.576-07:00Sussing out the Susan Lim saga...<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFdM9K8POX8Aj12G142EVmAsbvDwOvsF-T0w_98Drscfb23344nefK_KCgr4arqjoieuHk8aM8O-KFCJ_r2mk8EyemQPWvKsb3DPoLh4quXOCMLbWUpGfnc1OZGwBKc-3uCLxrkw8xvIg/s1600/overcharge.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="329" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFdM9K8POX8Aj12G142EVmAsbvDwOvsF-T0w_98Drscfb23344nefK_KCgr4arqjoieuHk8aM8O-KFCJ_r2mk8EyemQPWvKsb3DPoLh4quXOCMLbWUpGfnc1OZGwBKc-3uCLxrkw8xvIg/s400/overcharge.jpg" width="400" /></a></div>
Gigamole is deadset against Dr Susan Lim's grotesque charges for her services... especially as Gigamole has to seriously contemplate a car-less future, in view of the even more grotesque <a href="http://en.wikipedia.org/wiki/Certificate_of_Entitlement">COE values</a>.<br />
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Even so, Gigamole has to confess to not even coming close to understanding the charges brought against her.<br />
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Singapore has no accepted fee structure for medical consultations. A previous non-binding guidelines published by the Singapore Medical Association was unilaterally and <a href="http://www.hpm.org/de/Surveys/University_of_Singapore_-_Singapur/09/Deregulation_of_doctor_fees.html">mysteriously scrapped in 2007</a>. Apparently this was to make SMA compliant with the Singapore Competition Act of 2004. Methinks however, it was in response to pressure to free up the fee structure to market forces so that the competition will drive down health care costs. What the policy makers didn't reckon with however, was that this would work only if it is a perfectly free market. But it never was a buyer's market, and fees were not significantly driven down. Instead, the deregulation allowed the high flyers such as Dr Susan Lim to escalate their costs. She is not the only medical consultant in private practice to exploit the deregulation, just the most obvious and noteworthy one. It might never have surfaced if not for the fact that some rich royalty called the Ministry of Health. <br />
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One might argue that the 'over-charging' occurred prior to the deregulation in 2007. But for the 20 years before 2007, even with the guidelines in place, there was never anything binding to the extent that anyone could be penalized for over-charging. Therefore, Gigamole is totally mystified as to how the Singapore Medical Council can determine that Dr Susan Lim over-charged anyone.<br />
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The Singapore Medical Council owes us an explanation here.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-48746960132841404882012-08-19T18:14:00.000-07:002012-08-19T18:15:26.045-07:00The cyclist-motorist conflict - It's time the LTA did something<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj774GIwCHfsUUholOLkZ7HJzu29LSA3YlFfaCMUgWShM-PyPhZ_OISTx21RPgnIWLSccz0VXAExN8778aTPdPQIZO45NAz6ziLOIl28j7bQ6v0a3xGsmV1xLkEU2HMRWjeYnUsRAzRZ-8/s1600/Indecision-250x250.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj774GIwCHfsUUholOLkZ7HJzu29LSA3YlFfaCMUgWShM-PyPhZ_OISTx21RPgnIWLSccz0VXAExN8778aTPdPQIZO45NAz6ziLOIl28j7bQ6v0a3xGsmV1xLkEU2HMRWjeYnUsRAzRZ-8/s1600/Indecision-250x250.jpg" /></a></div>
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A paralysis of indecision happens when someone cannot decide between two or more courses of action that will independently lead to conflicting outcomes. We have seen how this can affect regulatory agencies such as the HSA, when trying to decide between pleasing the biomedical industry and protecting public interests A proper balance between conflicting outcomes may be difficult to strike. The indecisive will often just sit on their hands, and hope the problem will blow away, or at the very least stay away until the decision maker can escape to another, usually higher appointment.</div>
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The problems between cyclists and motorists have been brewing for a very long time. It's not as if the LTA has not been aware of it. Gigamole had <a href="http://gigomole.blogspot.com.au/2010/08/cyclist-vs-motorist-debate-why-is-lta.html">posted before on this conflict almost exactly 2 years ago</a>. Yet no action had been taken since then. Recently, this has blown up again because of some <a href="http://smallwheelsbigsmile.blogspot.com.au/2012/08/letter-to-mr-lui-by-stephen-choy-friend.html">tragic and unnecessary accidents</a> between cyclists and motorists. </div>
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An increasing cyclist lobby are rightfully clamouring for more space, more consideration and more safety. On the other hand motorists say cyclists are often irresponsible on the roads, that motorists feel they have more rights to, as they pay road taxes while cyclists do not. Truth be told, both parties do engage in risky, irresponsible behaviour. Who is right?<br />
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It is during times like this that the LTA need to step in and openly declare the appropriate boundaries, physical as well as behavioural. It is in this situation that the LTA has been neglectful, and in my mind irresponsibly indecisive. I can appreciate their dilemma. On one hand they do not want to restrict the behaviour and recreational choices of the growing cycling population. Yet the road system is far from adequate to accommodate both cyclist and motorist needs. Motoring traffic is congested enough as it is already. S what does LTA do....? It appears they just want to sit on their hands and hope the problem will be delayed to the next cohort of managers.<br />
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So here is Gigamole pleading again with the LTA.... please do something about this. Before more unnecessary deaths occur. Make the rules clear to both the cycling and motoring populations, and be committed to enforce them until such time as behavioural norms can be established.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-71583949835960673832012-08-18T09:10:00.001-07:002012-08-18T09:10:58.231-07:00Selamat Hari Raya Aidilfitri!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihb_EhWRIqg7S6O-69cC87NFxVPuQ1SJmSzNorJTSoi5_wg8tdfU1nZHtRALv4WnXoUYk4YBkaLIWoPVzavo90pSmcx4Kl7tT0261qWeJKivPQjl71OAW3aVj3raO8OHuP3nE-wKOs4Rg/s1600/hariraya.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihb_EhWRIqg7S6O-69cC87NFxVPuQ1SJmSzNorJTSoi5_wg8tdfU1nZHtRALv4WnXoUYk4YBkaLIWoPVzavo90pSmcx4Kl7tT0261qWeJKivPQjl71OAW3aVj3raO8OHuP3nE-wKOs4Rg/s400/hariraya.jpg" width="400" /></a></div>
I love the Malay greeting for Hari Raya. Asking for forgiveness is just so much more meaningful then wishing for prosperity and wealth.<br />
Maybe we should all go round first thing in the morning and wish everyone, particularly our muslim friends, "Maaf zahir & batin".<br />
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Selamat Hari Raya Aidilfitri all!gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com0tag:blogger.com,1999:blog-6125857314165645951.post-25219238873707087002012-08-16T03:29:00.002-07:002012-08-18T09:04:26.068-07:00Workplace Safety and Health Act - a case of "I see nutting,I know nutting"?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvUbGRH12ri6FRQ0PkoEf_sy6vqzJMpRMpxu8430cMM2e_Jt7Vnwu_vjaz4hpHUUZtPTFwiL_7SvT1q-AtiZeVJpbBo_SOEUtByWMKwDt-bYSeauh0Q1kWMS4Bp1a8YLO9kIrDqiUqEig/s1600/tve917-19660415-156.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvUbGRH12ri6FRQ0PkoEf_sy6vqzJMpRMpxu8430cMM2e_Jt7Vnwu_vjaz4hpHUUZtPTFwiL_7SvT1q-AtiZeVJpbBo_SOEUtByWMKwDt-bYSeauh0Q1kWMS4Bp1a8YLO9kIrDqiUqEig/s200/tve917-19660415-156.gif" width="200" /></a></div>
Gigamole remembers somewhat fondly, an old TV comedy series called Hogan's Heroes, where one of the most colourful characters was a German POW prison seargent, Sgt Schultz, who regularly articulates his famous line, "I see nutting, I know nutting...". Sometimes, I get the feeling that our Ministry of Manpower indulges a bit in this.<br />
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The Ministry of Manpower had taken a fresh and refreshing new position with respect to workplace safety in 2005. This was followed up by the enactment of the Workplace Safety and Health Act in 2006. Many of us involved in research labs, were encouraged by this new commitment to workplace safety, and despite the increased administrative, operational and logistic demands, faced up seriously to the challenges. Indeed, there was a flurry of activity on the ground to get procedures and guidelines up and going. Of all the research labs I know of, the <a href="http://www.nus.edu.sg/osh/">National University of Singapore</a>, I think, has been the most systematic and fervently active in pursuing this mission. That's why it's somewhat ironic that they have been the facility in Singapore whose labs have been most frequently blowing themselves up. (see <a href="http://madscilab.wordpress.com/2008/09/04/serious-accident-at-nus-lab-not-mine/">1</a>, <a href="http://www.timesdirectories.com/specialtychemicals/news/two%20injured%20by%20exploding%20chemical%20in%20cargo%20lift/751230">2</a>, <a href="http://singaporeseen.stomp.com.sg/stomp/sgseen/editorpick/894854/fire_breaks_out_inside_nus_lab.html">3</a>, <a href="http://gigomole.blogspot.com.au/2012/08/the-amazing-exploding-nus-solar-cell.html">4</a>)<br />
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But despite all these incidents, there is no evidence that the Ministry of Manpower is noticing or doing anything about it. They seem to be content merely in <a href="http://news.asiaone.com/News/Latest%2BNews/Singapore/Story/A1Story20120815-365634.html">inspecting construction sites</a>. If there had been any action taken about the lab accidents cited above, it's all shrouded in secrecy. Gigamole maintains this is counterproductive. All accidents are learning opportunities. It is only through the systematic revelations of mistakes made at all levels that the infrastructure, management and operators can improve. This is the best way forward to better workplace safety.<br />
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Gigamole is really puzzled by the MOM's reluctance to discuss lab accident investigations publicly. Gigamole is reluctant to believe that this is because, unlike construction sites where the subcontractors are relatively lowly placed on the foodchain, the most liable person in the research lab is usually a high value researcher, or a high value institutional leader.gigamolehttp://www.blogger.com/profile/18328852130774608540noreply@blogger.com1