The 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.

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.

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.

Congrats, Yasmin!

Topped the PSLE. Loving mixed-ethnicity family. Muslim. Neighbourhood school. What else can I say?

We are all superly happy and proud of you, Yasmin! And if this represents what Singapore is about, I can say I am damn proud to be a Singaporean!

But there is a flip side to this story.... we should ask ourselves (and the MoE), why it should be this way? Why should a Primary 6 examination, which is supposed to be nothing more than a competency exam to enter Secondary school, be an exam where we identify top students? It is about time we put a stop to this madness.

Traditional medicine and all that Andy Ho stuff......

Andy Ho did us all some service when he wrote that pretty accurate piece about the placebo-ness of traditional chinese medicine (TCM). Pity, but expectedly I suppose, he caught a lot of flak over the articulation of those truths.

What disappointed me most in the whole episode was the realization that the Singapore Medical Association was all for the legitimization of TCM, because by their response, they are signalling rather publicly their intent to maintain their role as a trade guild rather than a professional association. It's all about earning those few extra bucks peddling snake oil if necessary, since the patients seem to want it. Shame, shame.

So what is traditional medicine? Really nothing more than a primitive form of rationalized medicine based on empirical observations. No mystery. Nothing more, nothing less. The Chinese are not the only people who engaged in such practices. Our good old friend Hippocrates, whom many of us would regard as the father of modern medicine, was famous for his practice of observational medicine. Not that his theories were correct, or that his cures are still being applied today, but he based his practice on rather astute but emprical observations of the world around him at that time. So did many physicians over the years, until modern scientific theories caught up with practice of medicine.

TCM is the Chinese form of that empirical practice. It has maintained its mystique today to a large extent because in the isolation of the cultural revolution, TCM was pretty much all that was available in rural China. Now that mystique is carried by the sentimentalities of the very (very) large Chinese diaspora.

One can predict, very legitimately, that traditional or TCM when brought to its logical conclusion will very much resemble modern medicine. Useful herbs are of limited utility until the active ingredient is identified, purified and proved in clinical trials. Until that happens, TCM will remain a fairly emirical practice. Placebo effects? Perhaps.

So let's be very clear about it. TCM is a stunted version of rationalized medicine. There may be some limited utility to the herbs being used, but it will remain stunted because of the empirical environment it remains locked within. Much research is required, and much willingness to move out of the box of traditional sensitivities.

The SMA needs to get back to basics and hold on to the truths and defence of science and professionalism.

Mammograms? Much ado about not much, apparently...

A new study published in the New England Journal of Medicine once again has debunked the exaggerated benefits that mammograms produce. Not much, apparently. Have to screen 2500 women over 10 years just to avoid one death. This is not even considering the numbers of unnecessary screening, false positives and needless surgeries.

But I am not surprised.

When mammograms were first introduced, it was really difficult for anyone to refute the arguments that more screenings mean more lives saved. Of course in the process, more sales of mammography machines, more money to screening clinics and more money to breast surgeons. All happy, of course.... except the women who had to undergo needless breast surgeries. They were a small price to pay for the peace of minds of everyone else, apparently.

So now we know.

An act of God?......sez who?

It is pretty much of in our human nature to claim credit for the good things that happen and blame God for all the bad stuff. Take the recent flood for example. The flood mitigation efforts are all credits and kudos to PUB, but when floods occur, it's an "act of God", no less.

It kinda made me wonder where this expression came from. Actus Dei. Not much help from my fav source of knowledge, Wikipedia. Phrase Finder tells us that it originated from religious texts dating back to the 13thC CE. Not a particularly enlightened period of european history. It apparently began to appear in legal documents in the 19thC.

I would actually prefer the other phase "vis majeur" refering to a "superior force of such a degree that no effective resistance can be made to it". No need to blame God. Our own stupidity, ignorance, incompetence or negligence can also be that superior force.

On another note, I was also wondering what that term meant to atheists, who clearly do not believe in God. Actus Dei? Or actus non-humanus....., or simply, 'whatever it is, don't blame me'.

Ineffective screening for breast cancer?

A new study published in the British Medical Journal has raised new questions about the effectiveness of large scale breast screening programmes.

The report in Times Live can be found here. The abstract of original paper in the BMJ here.

The Danish study reports that they were "unable to find an effect of the Danish screening programme on breast cancer mortality. The reductions in breast cancer mortality (they) observed in screening regions were similar or less than those in non-screened areas and in age groups too young to benefit from screening, and are more likely explained by changes in risk factors and improved treatment than by screening mammography."

Late last year the U.S. Preventive Services Task Force (USPSTF) revised the recommendations for screening mammograms in women between 40-50 years of age.

Methinks it's about time our breast oncologists did some serious and honest review of the situation, though I seriously doubt they will say anything other than to defend the need to do lots more screening.

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

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

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

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

How about that?

Climategate - the festering sore

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

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

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

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

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

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

Race and ethnicity in Singapore - the confusion continues

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Procrustes and the climate

In Greek mythology, Procrustes was a not so nice guy who prey on tourist passing through his territory. He had an iron bed (actually 2...) where he made his 'guests' lie in. He would essentially work on each guest to make them fit the bed. If the legs were too long, he would just amputate them...etc...

In science, this is called committing a Procrustean crime. Wikipedia explains a Procrustean solution as being:
"the undesirable practice of tailoring data to fit its container or some other preconceived stricture. A common example from the business world is embodied in the notion that no résumé should exceed one page in length.

In statistics, instead of finding the best fit line to a scatter plot of data, first choose the line you want, then select only the data that fits it, disregarding data that does not, so to "prove" some point you are making. Its a form of deception that rhetoricians make so to forward their own interests at the expense of others. The unique goal of the Procrustean solution is not win-win, but rather that Procrustes wins AND the other loses. In this case, the defeat of the opponent justifies the deceptive means."

Sound familiar? Seems to me that this was what the climate scientists were doing. They had a model of global that they knew had to be right. Just too bad that some of the data didn't quite fit in with the model. So they just did what Procrustes did.

Interestingly there is actually a Procrustes analysis of climate data. Even though the context is a little different. :)

There is a nice simple write up about theoretical thinking here.... something even I can understand; even though the climate scientists seem to have difficulty with these concepts.

"The second reason you can't prove a theory true is that there is never just one theory that fits the facts. A theory is really just a narrative. A tale that explains. But stories can be told very differently. In a sense, there are always an infinite number of theories that fit the facts."

But for climate science, we are told repeatedly that the science is settled. Theory proven.

Procrustes would have been proud.

AWARE? Quo Vadis?

Paul Jacobs, Dy Political Editor of Straits Times, wrote a pretty balanced editorial on the issue. I can't reproduce it here, so I suggest you go read for yourself. It's on pg A2 of today's issue.

from My Sketchbook

Blogs' reach limited: Study

The recent study and comments by the Institute of Policy Studies is another one of these pointless meaningless exercises. I mean what's the point of comparing apples and oranges. The mainstream media is a mass media, heavily resourced and professional outfits whose mission is to generate revenue out of news as a commodity. Blogs are very different entities. Admittedly some blogs do deceive themselves into believing they are news outfits, but they seldom get close to competing with the traditional mass media on that platform

The innate strength of blogs is their nimbleness and cost effectiveness in maintaining a cyberspace community through which news and views can circulate in an unrestricted fashion. They cannot be evaluated as if they are a single business unit, not can they be benchmarked in terms of parameters more suitable for newsprint and other mass media. There is no comparison to the power of the blog, when you consider that it allows a single, otherwise powerless voice, to communicate ideas to the world and/or to the powers that be. Free and freely. Does it work? Depends on the ideas being floated. Many will die as soon as it is articulated. Some will reach the intended ears...and maybe effect a small change. Some ideas will assume a power beyond expectations, and perhaps even change the world.

All this for the cost of a computer, and an internet subscription.

Keep the faith!

Ho Ching's departure - timing is everything

There is a dearth of political humour, so a site like My Sketchbook, showcasing political cartoons can be quite appealing.

The above one about Ho Ching's departure from Temasek Holdings play on a commonly held view. But I think it is probably wrong, and quite unfair. I can nonetheless see how that perception can be perpetuated given the 'disasterous' investments Temasek has made in recent times.

The truth is probably much more mundane, in that Ho Ching's position in Temasek has been quite an embarassment for Temasek as it goes about on its business as a sovereign wealth fund. I think it has become increasingly difficult for her in Temasek, so something had to give. It was probably only a matter of time before she had to distance herself from Temasek. Unfortunately she had to depart in the depths of an extreme economic depression.

Timing is everything.

Dengue and Chikungunya in Singapore - endemicity and ecdemicity #2

Chikungunya virus particles

An interesting thing happened to me on the way to the toilet. Someone I knew, and who knew of my posts on this matter whispered to me (hushed tone with a wicked grin) an interesting exchange between the Ministry of Health (MOH) and the Ministry of the Environment and Water Resources (MEWR) / National Environmental Agency (NEA) about the chikungunya problem.

Apparently the MOH is somewhat sensitive about acknowledging that chikungunya has become endemic in Singapore ( a bit of misplaced pride here), while the NEA is somewhat keen to declare it endemic. Apparently if it is endemic, NEA's vector control people no need to work so hard to stem the spread of the disease (which is inevitably happening anyway...).

I don't know how much of this is true, but since I have no reason to doubt my source, there may be some truth lurking in there somewhere. Kinda amusing thinking of these serious policy makers approaching this issue with that kind of childish parochial mindset.

Kinda misplaced priorities if you ask me...

Compassion (and ethics) in clinical studies?

This morning's Straits Times carried a pretty insightful letter from Ms Sim Seng Ann. I reproduce it below for your reference.

Clinical scientific research tries to close the gap between the lab and the patient. The gap has always been there. This takes time to close. However commercial pressures have been driving very hard towards expediting the process. Ostensibly this is to benefit patients earlier, but we all know the pressures are mostly revenue related. Every day of delay in getting a new drug into the market costs the company developing it, millions of dollars.

Ms Sim is correct in pointing out that instead of taking "'discoveries from the laboratory to the patient'. It seems it is expanding the walls of the laboratory and taking the patient into the laboratory". The patient is very quickly becoming the guinea pig that serves the commercial interests of big pharma.

But surely new drugs benefit patients? Yeah...well, we can't deny that. But in reality, newer drugs benefit fewer and fewer patients, and become more and more costly to develop. Even where good drugs are developed, the incremental benefits are small. For example, it is not as if we do not have good anti-cancer drugs, we just want better ones. There are very good anti-diabetic drugs...though, apparently not good enough. In practice, most newer drugs often only produce marginal benefits.... and then often get hastily withdrawn from the market because of previously unrecognized toxicity.

The people pushing biomedical research in Singapore are usually those in support of trade and industry. Ministry of Health seems often to be dragged reluctantly into this as such activities tend to drive up health care costs with only marginal health benefits for the patients.

I have always been chary abut the ethics of many clinical studies. Most appear to benefit the investigators (fame, glory, and lots of money) much more than producing any real benefits for the patients (present or future).

'But aren't all these regulated by ethics committees?' You might ask.

Yes, they are. But without casting any aspersions of my colleagues who serve on ethics committees, it has always seemed to me odd that while the ethics committees are supposedly independent, they are all appointed by institutions who benefit from the research activities. Often, they end up been advocates of the research rather than being advocates of the people being experimented on. To be fair, they do look after interests of the 'experimented upon' but often when there is a conflict between who comes first, the balance can sometimes fall on the side of the 'experimenters' rather than the 'experimented upon'.

We certainly need more scrutiny of this process. But sadly I doubt we will get it.

-----

Inject compassion into scientific studies

I REFER to the article, 'Immunity studies: From mice to men' (Jan 17).

The article is strong and logical on the need for immunity studies to shift from mouse-based research to human beings. However, it seems to be of scientific interest rather than medical or therapeutic interest.

The medical and scientific research industry has been given a lot of room and trust in internal regulation. It is not obvious to most people what the difference is between therapeutic research and scientific research, and sometimes the line is unclear, as in the case of writer Paola Castagnoli's proposition of human research in immunity studies.

A convincing hypothesis is still a hypothesis. While there are regulatory authorities and ethics review boards in place, their interest is in ensuring that the protocol and methodology comply with state laws and do not infringe on human rights.

I believe there is no one to question the necessity of the study in the first place, except the investigators themselves. Is it not possible that a patient who meets the inclusion criteria of a study, who may not need to go on a study because of the side effects it can have on the quality of his life, is recruited by the investigator anyway?

I am not too convinced when Ms Castagnoli said such research 'takes discoveries from the laboratory to the patient'. It seems it is expanding the walls of the laboratory and taking the patient into the laboratory.

It may take small sacrifices in order to find solutions for the greater good, but then, it is entirely a researcher's morals and value system that decide whether a study really comes from therapeutic interest or from scientific interest.

If people know exactly what is involved in them getting an answer to their rather innocent question, 'Is my immunity good or bad?', they may think twice about whether they want it answered. I hope that soon, scientists and researchers will be instrumental in instilling a culture of compassion and moral empathy in scientific studies.

Seng Ann Sim (Ms)

Bisphenol-A: Hysteria developing?

Bisphenol-A

In today's Straits Times Forum there is a letter written by a Ms Sai Siew Min entitled "Is the AVA Up To Date?". The letter addresses the writer's concern about the presence of bisphenol-A in baby bottles. Hmmmmm......

Bisphenol-A is a funny small molecule that has two arms, and is used in the manufacture of hard plastic bottles. The concern is that there is some data in animal studies that bisphenol-A at low levels can act as 'endocrine disruptors'. Bisphenol-A has some estrogenic properties, and can leach out from those hard plastic bottles, so mothers and mothers-to-be are legitimately concerned about the effects this may have on their babies.

There are quite a lot of reviews written recently about this that summarize the state of ignorance quite well:
Wikipedia
NIEHS-NIH
AVA

Truth be told, I have had a look at the data and I am not so convinced. It's one thing to look at endocrine changes in lab animals, and another thing to exprapolate those effects to the real world. Much of the data is kinda iffy anyway. My feeling is that AVA doesn't really have much to act upon other than a lot of emotive rants from various interest groups.

Also if you look at bisphenol-A, the effects are largely due to its estrogenic properties....and there are a lot of estrogenic substances all over the place, in our diet etc. Bisphenol-A isn't the only chemical that does this. Our diet contains naturally occuring estrogens such as bioflavonoids (fruits, veges, soya beans)...inodole-carbinols (cruciferous veges) to name some. An article here from the Texas A&M Univeristy and funded by the NIEHS estimates that the contribution of industrial estrogens probably amount to only about "0.0000025% of the daily intake of estrogenic flavonoids in the diet". The presence of these dietary estrogenic flavonoids have in fact, often been touted as being the reason for the 'health giving' properties of many fruits and vegetables.

Hysteria in the making...yeah, probably.

Tuberculosis and the IDA Schedule 6

It's very stange that the Ministry of Health reported rather proudly in 2007 that the incidence of TB is dropping.

"Over the past ten years, Singapore has seen a steady decline in the number of TB cases. There were 1,256 cases in 2006, compared to 1,712 cases in 1997. In 2006, the incidence rate of TB declined to 34.8 new cases per 100,000 resident population, from 37.0 per 100,000 in 2005 and 54.9 per 100,000 in 1997. In 2006, men accounted for 863 (69% percent) of new TB cases in Singapore, and more than half (55%) of the patients were aged 50 years and above.

The concerted efforts carried out under the Singapore Tuberculosis Elimination Programme (STEP) and by the medical community have contributed to the decline in TB cases in Singapore."

Hooray.

Then all of a sudden, they come out with a statement that the projected 2008 incidence based on the first 6 months reporting of 700 cases was 38.8/100,000 as compared to 35.1/100,000 in 2007. This sudden projected spike, suddenly precipitated the need to place TB in Schedule 6 of the Infections Disease Act.

Huh??

Add to this strange bit of reasoning, the inference that as most (86%) of the new cases were over the age of 50, it was likely that the postulated, projected increase was due to re-activation rather than new infections.

Double huh...???

If these were mostly due to reactivation, then it couldn't have been due to transmission. So why the urgent need to put in place intrusive methods to limit spread??

The only conclusion must be that this grandiose act is primarily directed towards interfacing with the international community so that we can tell other agencies and airlines who the active cases are.

Hmmmm.....Stranger and stranger.

Nature and infidelity - a venus and mars thing?

There was a report in today's My Paper (yes, yes...I read My Paper...'cos it goes well with my teh see siew dai!!), about a kinda pointless study done in the Virginia Commonwealth University about men and infidelity, and such...The New Scientist reported on it as well.

"Paul Andrews at Virginia Commonwealth University in Richmond and colleagues gave 203 young heterosexual couples confidential questionnaires asking them whether they had ever strayed, and whether they suspected or knew their partner had strayed. In this, 29 per cent of men said they had cheated, compared with 18.5 per cent of women.

The men were better than women at judging fidelity. "Eighty per cent of women's inferences about fidelity or infidelity were correct, but men were even better, accurate 94 per cent of the time," says Andrews. They were also more likely to catch out a cheating partner, detecting 75 per cent of the reported infidelities compared with 41 per cent discovered by women (Human Nature, vol 19, p 347). However, men were also more likely to suspect infidelity when there was none."

Kinda silly and pointless because you don't really need to do expensive research to tell you what you already could have figured out.

Considerations of love and such aside.... the females of our species are biologically more concerned about raising their offspring. Once they got the sperms they want, all they are interested in is to ensure that her offsprings are adequately resourced and can be raised safely. That's really all they need the males for. And if they are unfaithful, they are not likely to fess up and risk losing their source of support. They are also not very hung up on the fidelity of their male partners...as long as their family resources are not compromised.

The males of our species however, are really only interested in sowing their oats. If they are unfaithful they are not shy about advertising it...kinda like a badge of honour. What they are concerned about really is that their women are faithful...because they are concerned about whose children their women are bearing. Hence the fidelity of their partners are paramount.

Hence men are biologically more likely to confess their infidelity and also more sensitive to the spouses' infidelity. Women however, hide their infidelity and forgive their spouses' sins, as long as they are able to preserve the family integrity...and resources.

Common sense.

But we humans are complex creatures. We layer our biology with things like love and respect...and ideas of morality. We regard much of our biology as part of our animal and baser instincts....that have to be suppressed. What is sin but that deep dark biological urge that must be kept under control?

But it is love and morality that keeps order in our lives, and generally keeps us sane. 

Funny thing this thing called love.

Human organ trade - a necessary evil....NMEC???

A really funny thing happened to me just now on my way to the toilet. I heard a report over Channel NewsAsia that the National Medical Ethics Committee (NMEC) has proudly declared its acceptance of the recent Bioethics Advisory Committee's recommendations on the egg donation thingy. It's now carried on the news portal and in the Straits Times.

A very funny thing this NMEC. It was a committee set up in 1994 by the Ministry of Health "to assist the medical profession in addressing ethical issues in medical practice and to ensure a high standard of ethical practice in Singapore". But somewhere along the way, they seem have become lost. Even the Ministry of Health doesn't seem to want to know they exist. I tried Googling them and came up empty. No information. Zilch. The Ministry of Health portal has no links leading to any information about this Committee. The BAC site carried a dead link.

I don't know if they still have a mandate anymore...who they are and what they do nowadays.

What is very telling is that the MoH apparently proclaimed acceptance of the BAC recommendations without seeming to have consulted with them. Today the NMEC then kind of sheepishly accepted the recommendations....kind of after the fact. I mean, could they have said 'No', after the Ministry had accepted the recommendations?

Who is the NMEC, I wonder? Why does the Ministry of Health, who birthed them, not seem to know they exist?