Sussing out the Susan Lim saga...

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 COE values.

Even so, Gigamole has to confess to not even coming close to understanding the charges brought against her.

Singapore has no accepted fee structure for medical consultations. A previous non-binding guidelines published by the Singapore Medical Association was unilaterally and mysteriously scrapped in 2007. 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.

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.

The Singapore Medical Council owes us an explanation here.

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.