Monday, October 29, 2012

On the CUHK student

There are quite a bit of noise in the society as to whether this gentlemen should be punished. And there is an interesting standpoint that I would like to comment on...

"Freedom of Speech"

It has been said that the best way to test one's support to the freedom of X is when X is used against the person.

When your social group is called "ugly", "with speech bypassing the brain", or perhaps attributed as a species like C. familiaris, by a certain person that your very social group is supporting, it is rather difficult not to be at least angry.

It is true that such hateful speech, no matter how bad it is, is probably not illegal in Hong Kong. And there shouldn't be legal punishment for that.

However, given that he is receiving scholarship from taxpayer's money, a privilege, removing such privilege may not be exactly wrong -- you can't take the money from us and slap us on our face at the same time, right? Remember - we are only suggesting that we take away his privilege that we granted him in the first place for his scholarly results and personality. when we find out that we're wrong, it's time to act!

Monday, June 4, 2012

My stand on Inclusive Education

What's inclusive education?

Quoting Wikipedia, Inclusive education is "an approach to educating students with special educational needs. Under the inclusion model, students with special needs spend most or all of their time with non-disabled students."

The notion is that, by allowing students with special educational needs to participate in classroom with other students who are not disabled, these students with SEN will fare better.

What is the issue?

There exists quite a number of premises that must be fulfilled before inclusive education would be beneficial.

(1) Teachers must be educated such that they know how to handle students with special education needs.

We are talking about a really wide range of knowledge that a teacher needed before they can conduct a lesson with these students with SEN. There are a thousand and one disabilities out there and these requires knowledge and input from speech, occupational and physio-therapists. And we are talking about three-to-five years of tertiary education here.

And then, the ability to deal with difficult case adequately is strongly correlated with center experience (in almost all sort of fields). Do you know why liver transplant in Hong Kong is only done in QMH? Do you know why we need to segregate hospitals into different levels of "trauma center" in the US? It has all to do with the center experience and center volume.

The more you do, the better you can do it. There's a reason why people are called "specialists".

(2) The classroom (i.e. teachers AND other fellow students) must extend to adapt to the need of the students who may be unable to receive traditional instruction without interrupting the class.

In the past, special education schools opened because people find that the traditional classroom was too rigid to adapt to the need of the students with SEN, and for the matter, there has been little change in the classroom situation.

and so on, and so forth.

Without these premises fulfilled, the situation of "inclusive education" in Hong Kong is more like dumping all those special students into schools of poorer academic performance, whether you like it or not...

Sunday, June 3, 2012

On the June 4th Incident...

It is almost time, and many colleague of mine had discussed with me on the possibility of exchanging a day of compensatory leave on the June 4th. They were trying to attend the June-4th memorial held in the Victoria Park (or something).

I have talked briefly on the trouble of democracy earlier on in this blog. 

Whereas I do have my admiration towards those who protested in the Tiananmen square in 1989, for their bravery and pursuit of their dream (of a democratic China), these memorials have been transformed into more of a political tool of the pan-democratic band than a memorial of the martyrs.

What I had even more trouble with is the churches that organized memorials for the June-4th event. If anything, they should hold memorials for the mass killings of:

(1) Egyptians firstborn sons (Exodus 11-12),
(2) Canaanites (Numbers 21; Deuteronomy 20), and perhaps also
(3) Amalekites (1 Samuel 15)

And then perhaps, for the Catholics, they could also consider holding memorials for

(1) People who died in the Crusade,
(2) Those who are butchered by the Canon laws because of holding a religious belief rather than Catholic, and
(3) The slaughtering of the Ancient Pagans, the Saxons who refused to convert, those who refused Church taxes all across europe in the middle ages, the so-called Heretics, Witches and so on...

I mean, these churchman holding memorials for the June-4th incident is just.. hilarious.

Sunday, May 13, 2012

Placebo’s guide – getting into medical school

There are no grades that I’ll talk about (you can see for yourselves in the JUPAS website I suppose); there are few examples of what would bring a person into medical school (there are enough medical doctors around you and it’s easy to ask); what this piece deals with is how you get there after you have got all the requisites – good academic results, reference letters and the much needed luck. Accept this, and read on.

Medical schools in Hong Kong are basically a place for really bright students[1]. For those who are less able to get good grades at public examinations, alternatives include entrance to medical schools in Taiwan, the United Kingdom and Australia.

Medical school isn’t exactly something one should consider if you are asking for money. Yes – really good surgeons do make a million a week – but how many of those are there? You are much better off doing MT jobs and hope for the best. You will work less hours, have better quality of life earlier and hopefully retire earlier. There are certainly jobs in the medical sectors that would provide you with decent hours, but those would usually require either a period of damnation which may be quite long (some 8 years perhaps for physicians to rise to the level where you need not be on-site during on-call period) or an unreasonable curriculum that you will need to finish (e.g. anatomic and cytopathology).

Who do they want as medical students?
It all stems from one thing – a medical school wants to train safe doctors. The idea is, you could at least expect a safe doctor taking care of you when you’re in the hospital – thus, we need doctors (thus medical students) who understand their limits, work as a team and listen to others.

Accept it – medical school is all about vocational training. There is no ‘university’ part involved unless you are part of the academic staff in the university – and even then, not until you receive your fellowship.

You are going to get interviews, and you are going to be asked on why you want to be a medical doctor (once you’re in you will graduate unless you quit) and why you should be offered a place in the medical school.

So why do you want to be a doctor?
It is very natural to ask this question, am I not correct, monsieur? Let’s look at some sample answers:

1.      My mother told me to do so.
2.      I am living in a public housing estate and all I want to do is to get some decent salary to raise my four younger brothers.
3.      It is my dream to become a doctor.
4.      My father is a doctor, and I am to inherit his practice.

And so on, and so forth. These may as well be the real underlying reasons for many doctors out there, but of course, as a reasonably good student you know that there are many ways of presenting the same idea. I am not trying to give standard answers here, but the idea is that you want to help other people out, and medicine is one direct way of helping these folks.

[1] No, the luminance is not required for passing the examinations after you get into the medical school.

Friday, May 11, 2012

Childhood education - our future?

Irrelevant introduction

There are a total of four pillars in the Trafalgar square. Alongside Lord Nelson, are four pillars with the statues of King George IV, Sir Charles Napier and Sir Henry Havelock. Yes- we are missing one of them. At the current moment, it showcases a sculpture called "Powerless Structures, Fig. 101".

Powerless Structures, Fig.101 by Loz Flowers
An excerpt of the caption thus reads:
"... the work references the traditional monuments in the square, but, with its golden shine, it celebrates generations to come... We wanted to create a public sculpture which, rather than dealing with topics of victory or defeat, honours the every battles of growing up."
This shows how these Englishman see the importance of our future generations - they raise the depiction of our future generations to the status of historical heroes.

Childhood educators

Childhood education is important[1]. The thing is, whether you believe in the critical period hypothesis or not, the golden rule in language acquisition is still the earlier the better. The problem[2] with childhood education in Hong Kong is the utter neglect of it by the government.

Face it, the average parent in Hong Kong is not that sort of well-educated parent we are seeing in the advertisements (e.g. of HSBC) - look at the statistics - the average boy in Hong Kong doing HKCEE (although it is now historical, this represents what we have in the society for at least a decade-worth of men) would not pass all the three core subjects (Chinese, English and Mathematics).

And then we need kindergarten[3], and some of us may believe in the supposition that these quasi-educators in the kindergartens are better qualified than these apparently academically not-so-competent dads and moms. And perhaps we are wrong - at least for our generation. The minimum qualification, back in the years when the now-working generation were kindergarten pupils, for kindergarten teachers is that of finishing Form 3. The requirement has since changed to five passes in HKCEE (and still not requiring a pass in mathematics).

I suppose our children deserve better education. It is time we actually examine what is going on in the kindergartens rather than trying the best of our luck in applying for the best kindergartens judged by their associations with the international primary schools...


In the form of replying a specialty consultation, may I suggest:

(1) Raising the salary for all education posts such as kindergarten, primary and secondary teachers to improve the competitiveness in the job market.
(2) Mandatory language assessment for all childhood educators (to the likings of LPAT in primary and secondary teachers) - our children are looking at them for INPUTS during their critical (or early if you insist) years.

I am not asking for much - a pass in CAE or CPE would be quite sufficient - and mind you, we had that passed in our matriculation years.

[1] If you believe that a citation here would be useful, go here. I believe in the contrary.
[2] If there were no problems then I wouldn't have written this.
[3] To be honest, this is probably not the reason for the existence of kindergartens, and even with the universal tertiary education in taiwan, things are much better looking either.

Thursday, May 3, 2012

English as medium of instruction - II

In the classroom

It is no secret that the English competence of an average HK secondary school student is inadequate to learn the curriculum in English. However, to satisfy parental demands of using English as the medium of instruction, schools has been silently allowing teachers who were supposed to teach in English, to use Cantonese to supplement teaching - this supplementation could sometimes be a whole session conducted in Cantonese.

In fact, this (using Cantonese to conduct a lesson teaching material in a textbook written in English) certainly improved the understanding of students despite being rather unsound pedagogically. The problem with it though, is that, should we still label these as "EMI" schools? "EMI" subjects?

The situation of the pseudo-EMI teaching in secondary school has not been studied thoroughly, the obvious reason being that teachers will usually revert to teaching in English when being observed. What comes to rescue, though, is studies conducted among university students in Hong Kong.

Braine and McNaught had a fairly well-written literature review of the pseudo-EMI teaching in Hong Kong in their paper entitled "Adaptation of the ‘Writing Across Curriculum’ Model to the Hong Kong Context" [1]. In essence, in the university, students pressure the lecturers to use Cantonese by simply not responding to lecturers who still teach with English.

We can see that the outcome associated with teaching in English in these students whose competence do not enable them or facilitate them to learn in English is that - they will simply NOT learn the subject, and the outcome associated with teaching in Cantonese in these students would be that their English couldn't improve. The issue lies on:

(1) Are we doing an adequate job in placing students into correct MOI group?
  ... are we trying to put too many students in EMI schools?
  ... could this be due to parental demands?
(2) Is it possible to setup a category so that English textbooks are taught in lessons conducted in Cantonese?
(3) What is wrong with the current English education in HK?


Wednesday, May 2, 2012

English as medium of instruction - I

There is a recent posting on the medium of instruction in matter surrounding the discussion was that whether Chinese should be employed during teaching of a subject (other than English) in a school where the "medium of instruction" is English.

a short history of MOI in Hong Kong

a large proportion of this historical account was derived from [1].

It all started in 1978 - when universal education in Hong Kong was in its first year of life. It was the year that all Hong Kong children, regardless of their socioeconomic background, were granted 9 years of free education.

The curriculum then, was terribly difficult even for students nowadays. The 1953 Joint primary 6 examination was famous and it was well-circulated on the internet. A copy was donated by a retired teacher to a museum in Hong Kong (三棟屋博物館).

The questions were as follows:






This is terribly difficult even for junior secondary school students nowadays. Given such examination paper, one can imagine how elitist the education then was. The less prestigious schools were then harbouring a lot of students from lower socio-economic status who basically had completely inadequate English competency to study the curriculum in English.

And expectedly, the Education Commission sought help from UK. The panel of experts then recommended that: for the Government to impose Cantonese as the medium of instruction in FI-III of all secondary schools...
and also leave alone the small number of school which have been genuinely successful in using English as a medium of instruction...
The idea then was to introduce English progressively throughout junior secondary education. Then, a policy called "positive discrimination" evolved. It was a policy such that schools teaching in Chinese could brand themselves as such. The problem that follow was of course - very few school followed this recommendation. The reason was simple - you need good input to make good output, and better students tends to go to schools that teach in English.

With failure of the policy, a mandatory scheme was then introduced to categorize STUDENTS, first, into Group I-III (Ability to learn in I - both EMI and CMI schools, II - CMI schools only, III - EMI schools only) and then those school that couldn't get enough of EMI-capable students are forced to use Chinese as the medium of instruction.


Tuesday, May 1, 2012

Moral, Civic and National Education

There is certainly a lot of complaints surrounding this subject in Hong Kong.

According to the EDB,

Moral, Civic and National Education is an essential element of whole-person education which aims at fostering students' positive values and attitudes through the school curriculum and the provision of diversified learning experiences. It also develops students' ability to analyse and judge issues relating to personal, family, social, national and global issues at different developmental stages, and enhances their willingness to make commitment and contribution.

My personal belief is that whereas this MNE may as well be a rather political scheme of introducing the ruling government in a more pleasant manner to students in Hong Kong, this is actually a "good thing". 

The past decade of Hong Kong has been in a media-guided turmoil - citizens had generally been led into a exercise of voicing out all sorts of negative emotions. Children these days learn from the media that anything they have the freedom of speech - they can voice out anything that is unfair (or they so opined). What is wrong with this, one may ask?

The problem is that they don't quite understand the situation before they even speak.

If somebody go on to ask the secondary and university students of Hong Kong on whether they support democracy, chances are they are going to get quite a majority support. What is missing in this question is whether they KNOW what is democracy. You hear Raymond saying Aristotle in the morning, Immanuel Kant in the nighttime in a day, and Confucius in another day. How many of their books have these  secondary and tertiary students read to form their opinion of supporting democracy? My experience with secondary and tertiary students has been extremely poorly informed in political ideologies - not to mention the philosophical background of them.

If anything, this MNE will likely stimulate the learning of students on this subject and our society will benefit from it. Knowledge is power!

Monday, April 23, 2012

The authority of teachers

Apple daily had a recent commentry written by Chip Tsao(陶傑). 

For those who can't read Chinese, it was about a secondary school teacher having problem with child who doesn't give a damn about the subject she was teaching - home economics. The child thought that if the button goes off from the cloth she'll just buy another piece of clothing[1]. Tsao believe that it is important for the teacher to hold up their dignity and perhaps traditional values in school and that she should not be afraid of complaints.

To be honest though this is totally NOT applicable for secondary teachers these days -- the principals in schools are more apologetic than ever and to be honest do they even have the dignity of an academic?

The value of his comment aside, this is a very vivid illustration of teachers losing their authority over students and parents.

I personally hold a belief that teachers should:

(1) Be very knowledgeable in their field, and
(2) Be respected.

The thing is, if you would like the teachers to deliver their teaching effectively, they have to be able to manage the classroom well - and to manage the classroom well, one has to confer them of adequate power to discipline the children in the class (fairly).

These days, the typical teacher had more fear than power inside the classroom. Children are more fragile than ever - they are prone to harm themselves, taking drugs, joining gangs and so on - if you ever punish them, and they retaliate by abandoning themselves. And then if they go such way after your punishment, you are going to be the "killer teacher" who will be fired and not be hired by any other school. And even if a child cries at home after being scold/punished in school, parents these days often complain to the school without even knowing why their child was punished.

If a teacher had more fear than power inside a classroom, how can they teach effectively?

Thus, the way to go is:

(1) For the management of school - you should stand by the very teachers you have hired, and treat students as students, parents as parents and school as a professional agent delivering teaching. If they run the school like a service industry, the only that can come is failing the delivery of teaching (and thus they fail professionally).
(2) For the teachers - they should uphold their professional standards and not be put into fear by these students and parents who would only complain.

In my humble opinion, though, teachers in Hong Kong had more problems with knowledge in their fields than complaints...

[1] well, true - and perhaps it even isn't economical to put it back in if the one doing it is earning quite a bit per hour

Friday, April 20, 2012

Tetris & Friends

Came across this piece recently. The technique may not be perfect but his interpretation of the tetris song (Korobeiniki) is excellent. For the original, see below:


Examinations for doctors

Examinations for the medical doctor (as in achieving a specialist status) are usually divided into two parts:

1. Membership examination
2. Fellowship examination (also called the "Exit" examination)

The membership examination is often itself comprised of several parts, with the first examination focusing on the basic sciences of medicine (e.g. Anatomy, Physiology, Biochemistry, etc.) - the so-called "part 1 examination". The remaining parts of the membership examination then focuses on patient management - usually those skills and knowledge that are required to run a department rather independently.

The fellowship examination are designed to examine candidates to see if they deserves the specialist status - advanced knowledge on the subject, latest development, and increasingly, management skills are examined, often in a face-to-face manner, known as the 'viva' examination.

Tuesday, April 17, 2012

Bride wannabes :: Florence

Warning: Spoilers ahead

She, in fact, is the most truthful women out of the five contestants.

Not that she is particularly pleasant or that her personality is particularly amiable, but she is speaking the truth, deep in her mind - and I guess this mind-set is sort-of engraved onto the mind of fellow female citizens of Hong Kong.

Your look matters, you age matters

She mentioned in episode three that Mei-ling has introduced to her an old man - CK Tsang in the show - who purportedly is a community college lecturer[1]. She obviously judged CK in his look and that his age is old - without thinking that she is already approaching 40. Looking at it on the another scale, she is only a few years approaching menopause, which, otherwise could be termed as "physiological infertility".

It is the nature of men to date young women. Though feminists may disagree on this, the nature of men to date young women is likely an evolution-derived characteristic.

The simple reason behind dating a young woman is for her fertility. Women ovulate every month, and often till the age of 50. It is very important to know that all the ova inside a woman's ovary are already made by the time that she was born, and these ova, unsurprisingly would be worse off when used 40 years after it was made, than, for example, some 20 years after it was made. This is demonstrated by the vast increase in genetic defects such as Down syndrome for women past the age of 35.

As to giving birth to a child, the answer is: 20 years old physiologically, 30 years old psychologically and 40 years old economically.

And then if you loved me, you should accept me "as-is"

Not that it is any wrong - but one has to get others to love him/her before one can say this. And as Mei-ling pointed out aptly, in terms of matchmaking, no matter how good you are, there ought to be somebody out there who are as good as you, yet prettier than you - and if you don't care about your outlook, you won't even get the chance in the first place.

Love is a bilateral business[2]. Anything bilateral involves compromises - that is, unsurprisingly, changes that one has to make in order to keep the relationship going. I am not a christian, but the biblical teaching on love is really on the point:
Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrongdoing, but rejoices with the truth. Love bears all things, believes all things, hopes all things, endures all things[3].
There is probably no such somebody out there who do not need to change to behave as described above... Not me, after all[4].

More to come.

[1] And according to some facebook members who confirmed his teaching career
[2] Readers who can read chinese is directed to RC's blog here
[3] Emphasis mine.
[4] I love my girlfriend dearly, and not that I haven't changed. I think I changed for the better of our relationship.

Monday, April 16, 2012

First degree

Recently came across a few books in the commercial press on the topic of "what i wish i knew when i was 20".. Surely these books do have some content to sell and if a 20-year-old man would really follow the advice i can see it working...

I also have something to offer to the secondary school students (though i think none of them are likely audience of this blog). it's about one's own education.

what comprises a degree

depends on who you ask - this is going to mean very different things for different people. most would see a degree in terms of:

(1) the granting institution
(2) the faculty / major
(3) the honor (as in, first, second upper/lower and third)

for those who dig deeper, these are also interesting to the employer:

(4) whether it is acquired in distant learning (esp Lond degrees)
(5) supervisor for final year project
(6) courses taken

For the items 4-6 they would need your transcript to know it.

and getting a good first degree is important

the reason why a good first degree is important is that a second degree (or taught master for the matter) is never going to cover up the blemishes introduced by the first degree - unless the second one is really a spectacular one. studying for a second degree mean that you will need to dedicate time which you could spent to polish your career path. these also raises question in the job interviews on why you do not get into your target school in the first place (hint: this prompts the interviewer that you may be a lazy person)

what is a good first degree? it's simple:

(1) the best local schools - nobody is going to blame you for not going overseas
(2) oxbridge, icl, lse, st andrew, durham, ucl
(3) ivy league, pacific-12

for the purpose of hong kong students - (1) meant hku, cuhk and hkust. it is not that the other schools do not have good degrees[1] - it's that people look at the degree name, then the bracket, then the rest.

and then not that japan universities are not good - in fact, u of tokyo is very good in most aspects and are great rivals with hku in terms of ranking - note that hku's ranking is more of a research thing than a teaching thing and many of us would consider u of tokyo having better teaching and better students than hku.

why not a good second degree/master degree?

the simple reason is that it is less recognized - most boss understand what taught master meant - it's just exchanging money for degree - and often one do not learn much because of (1) its part-time basis, and (2) because of daytime work. if you do fulltime on these taught master then it raises question on how much your time is really worth - to be honest, to a productive man, a year off just for a master degree is way too much.

for the (overseas) research master, it may as well be better, but then the career choice would then be much more limited - mostly to companies with R&D, as well as in the academic/teaching field. it is also a more difficult business - professors detaining research students just to complete projects are not something that is unheard of.

[1] for example, polyu BA in design is of course best in the field, but we are talking about general degrees. general ones.

Mechanical watches

Watches, watches...

These days wearing a mechanical watch seems to be more of a lifestyle choice than a necessity – clocks are everywhere – the little clock sitting at the right-lower[1] corner of the screen is the ubiquitous example. To make the watches even more redundant – a clock which synchronizes to a network clock is almost always available at your pocket – your smartphone.

So yes – your watch is likely to be a mere ornamental instrument.

Why do people wear watches then?

In some professions, doctors included – recording the time of an incident is of extreme importance and good documentation can often spare one from a legal suit that may cost millions of dollars. A handy reference at your left hand, be it 5 minutes late or 4 minutes ahead, is still better than having to take the phone out from the pocket (often with a dirty hand).

In other professions, the watch is a symbol of wealth and sometimes a fashion statement. Granted, some watches are very good looking – just look at the latest Omega watches – they are definitely gorgeous (look at the Ladymatic line!) However, in my humble opinion, the beauty of old-school Swiss watches e.g. Patek Philippe and Vacheron Constantin are not really that easily appreciated, especially for those who do not have a great interest in it... Do the watches really look THAT good with the black leather strips? Wearing it is probably more for the brand than for the look (and movement) of the watch.

It is the mechanism that matters

Many of us men have an innate love to great engineering – and mechanical watch is exactly one of those things that belong to the 'wonderfully complex, yet incredibly small' category. If you own one of those watches that had a 'open-heart' configuration, or one of those with a transparent back – looking at the movement (the term for the mechanism of the watch) is quite an enjoyable thing.

In the beginning, most watches are hand-wound and the power derives from the tension build upon the mainspring. The mainspring provides the force necessary to drive the watch. The force is then used to drive a series of gears which moves the balance wheel – which is made to rotate in a simple harmonic motion – it oscillates to and fro at a constant rate.

The periodic movement of the balance wheel is then converted into stepwise, single-direction, rotatory movement by a structure called the escapement. This stepwise, single-direction, rotatory movement then drives a series of gears which eventually tells the time.

Below are a few video that is quite interesting and a good introduction to the working of mechanical movements:

What do I wear?

I wear a rather uninteresting mechanical watch with a power reserve indicator. The mechanical watch allows me to know the time easily, the mechanical nature pleases me because I know it is harvesting the otherwise wasted energy from the movement of my hand, and the power reserve indicator soothes my soul because it allows me to know the mechanical energy remaining in the mainspring (and thus I can have a good sleep without winding all these watches before I sleep in the fear of losing time)

[1] For those mac users, right-upper corner.

Sunday, April 15, 2012

What? Winnie Leung as a life coach? Coaching whom?

What is with choosing Miss Winnie Leung as a life coach? Is it that she is so successful in life that we would need her to coach other women who are unable to find a man who would stay with her for life?

Just examine the labels at her blog:

"bling bling, BMW, Chanel, Clinique, Facebook, Grand Hyatt, Hermes[1], HRT, il colpo, iphone, Kenji Ng, L'Oreal Paris, Lane Crawford, Louis Vuitton, LV, M.A.C. Porsche, Purpleland, Sassou Cosmo, Sex and the City, Tod's, TVB, Ultima II, Winnie Leung, Younger by Design, YSL" (There are another 19 Chinese tags) [2]

If these are representatives of what she is most interested in, I do have my reservation for her to be anybody's life coach...

Not that I am skeptical to the discipline of aesthetic medicine - but if she has nothing more than makeup, facials and aesthetic medicine to offer to her clients, one would really need to think if she is really some target goals that these five ladies in the show should really be after... (not that she's married, anyways... did I say the show is called "bride wannabes"?)

To some, the show means good entertainments for 10 weekdays.
To some, the show means an often undesired reminder for those who are still not in a relationship.

To some, the show means the day of judgement for ladies who are still not in a relationship by the age of 30.
To some, it is a joke.

[1] I really do not see the need to type the letter e with a grave accent - does that make it look nicer? Perhaps. To be honest, typing the letter with the accent is quite an undertaking for somebody with a keyboard manufactured in Hong Kong - but then who knows - maybe she got a Hermes branded keyboard...
[2] Taken from her blog on 15/4/2012 5:30

Saturday, April 14, 2012

Bride wannabes, and Supersize vs Superskinny II

The UK television program probably wins in terms of actually making people happier.

Getting the much needed love - for the lady

It is really not that difficult to get love - especially for the ladies, given the correct mentality. It is never the face or body shape that is precluding a woman from a successful relationship[1]. It might as well hinder a bit in terms of establishing a relationship in the beginning, but past the first few months, the face is not going to mean much.

The face ages, the body shape sags, but the mind evolves.

In Bride Wannabes, they are giving the ladies chances in changing themselves - mostly aesthetic, sometimes behavioral, but almost never mental - You see them having their hair dyed, face covered with makeups, eyelashes lengthened to exponential scales and different clothes to package them into nice-looking ladies. You also see courses given to them in terms of how to seduce people, and how to begin a relationship.

But then this is not the point - what they need is to change their mind[2]. The most important thing that they can learn is to extend their social circle. It is really not that hard - know the friends of your friends, and you are already exponentially enlarging your social circle.

Contrasting it with the UK program, in which the chief reason for their problem (eating habit) is being treated - which program is doing good for the ladies?
[1] The same is true for the gentleman. 
[2] There are quite some discussions on how these girls are paid actress, but anyways, it doesn't matter - what we're discussing on is the mindset / philosophy behind the show.

Friday, April 13, 2012

Bride wannabes, and Supersize vs Superskinny

For the uninitiated...

Miss Winnie Leung is an avid blogger, and author of various books including 男人争氣手冊, 美肌瘦身祕笈 etc. Her blog can be accessed here: She has become quite famous recently because of her participation in the TVB reality programme "Bride Wannabes"[1] (盛女愛作戰).

Dr Christian Jessen is an English doctor and a TV personality. He is best known for his presentation in "Supersize vs Superskinny" which was broadcasted in BBC Channel 4. He is a regular columnist of The Daily Mail, The Evening Standard as well as the FHM. He has written an accompanying book for the TV show entitled Supersize vs Superskinny: Take Control of Your Weight. His personal website can be accessed here:

The television shows

Supersize vs Superskinny is a television show, presented by Dr Jessen, describing a pair of clients in each issue - one supersized (overweight) and one superskinny (underweight). In each episode the pair is invited to a house for a week of weight treatment - they are presented of what their eating habits were, how their eating habit came, and how they damage their body, and what change do they have to make in order to become healthier. They are released home, and at the end of the episode they have a debriefing showing their progress.

Bride Wannabes is a television show showing five middle-aged[2] ladies and their progress on finding love. In the process, their "life-coach", Miss Winnie Leung, together with others such as the matchmaking specialist Mei-Ling[3], provides the five ladies with various improvement programs on their outlook, the way they communicate, among other things - and they are offered chances to meet men in various activities. They are given time to express themselves, and more often than not, put into cut-scenes showing a contrasting picture on how others viewed them.


To boot, the UK television show is much better received than the Hong Kong show although the Hong Kong show is only beginning with the fourth episode being aired as of the day of writing. Where's the difference?

Readers are suggested to have a look on the episodes of each show. The TVB show can be viewed in mytv:

The UK television show, although not supposed to be viewable online for non-UK citizens, the following youtube search can probably yield dozens of episode available... (Warning: very addictive)

To be continued...

[1] I didn't invent the name - it's TVB's official translation.
[2] Not in the medical sense, this middle-aged refers to women in their late twenties to late thirties.
[3] Whose comment was critical, dead-on and very interesting...

Wednesday, April 11, 2012

TCM practitioners and Laboratory medicine (and other investigations)

To be honest I really do not understand why these TCM practitioners/herbalists are increasingly utilizing laboratory medicine to extend their patient care...

What is the trouble?

The trouble is not of the fact that they could order tests - any layman can order tests themselves and submit their blood sample to the laboratory - some laboratories even offer to take your blood and test it right away provided that you give up your almighty buck to them.

It is also not the fact that they are not (western-) medically trained that matters to me. To be honest I have little problem with bonesetters requesting radiographs - it is in fact helping the patient very much as these radiographs often come with accompanying reports (that are, indeed, easy to read - e.g. "avulsion fracture of the proximal end of the left 5th metatarsal" would be unmistakably understood, and referred to the orthopaedic surgeon)

The trouble is with interpretation. It is perhaps a convention that the common requests for the clinical chemistry laboratory are reported but not interpreted (e.g. blood gas, liver and renal function test panels, etc. see note 1.) and in fact interpreting the liver and renal function tests has not been an easy task even for some specialists... I have recently come across a patient with significant hyponatremia. He was diagnosed to have the syndrome of inappropriate ADH secretion "SIADH", even (1) in a dry clinical picture and  (2) he has been on a thiazide diuretic before admission.

The truth is that interpreting tests takes time and training to learn - and it is important to learn in a supervised manner, that you get the feedback from your senior that your interpretation is wrong.

It is not the first time for us to see people with chronic hepatitis B managed by certain herbalists missed their chance of curative treatment for hepatocellular carcinoma (liver cancer) even though their biochemical picture is strongly suggestive of space-occupying lesions in the liver.

If they are not trained to do the interpretations correctly perhaps they shouldn't order it at all. It's just like calling a medical doctor to look at all the gauges and meters in the nuclear facility.

[1] Of course there exists tests that are interpreted, e.g. Serum electrophoresis, etc. but the majority of tests are not interpreted.

Sunday, April 8, 2012

Friday, April 6, 2012

The 80s generation - education

This is definitely a complex socioeconomic phenomenon that one must write about these days.

They are born in the years of prosperity that last through their young childhood. Then they see the recessions. Not once. Not twice. Not thrice. Perhaps there has been too many recessions for them, occurring too frequently for them to adapt to even one. 


To be honest, education is one thing that has been in turmoils for people born in the 1980s. It is not that they have not enough options. It is that they have too many options - and mind you, that is not so much of a good thing.

For those born in the 70s, when they have finished their school certificate examination, they can study up to matriculation (which, they can apply for universities/higher education afterwards), or they can come out and work. There are the vocational schools e.g. Haking Wong Technical Institute[1], which allows youngsters to be trained into somebody who can do their job really well in a certain sector.

For those born in the 80s, though, as the number of universities grew, higher education became a necessity rather than a privilege, a basic need rather than a luxury. And then the government gave them something called "associate degree" which (1) cost an arm and a leg, (2) teaches little that is practical, and (3) had extremely lax graduation requirements -- to some, it is almost like selling the diploma rather than doing education[2] - of course it is just an example... but if you can let these people graduate...

It looks really bad -- to the previous generation -- these people born in the 80s are not learning for the sake of learning, they are learning for the sake of not working.

Readers, what do you think?

[1] I can still remember the free soup that was available in the canteen in Haking Wong back in the days. The meals there was affordable, and most importantly, one can be sure that he is well fed there with just $20...
[2] My experience with these associate degree people is that.. I once came across a biological science major - I asked him if he could tell me the features of various phyla of the animal kingdom - he couldn't. I asked the same for the plant kingdom - he couldn't. I asked for the most important cycle in the body - Kreb's cycle - he can't even remember the intermediates (and I was only asking for citrate, alpha-ketoglutarate and oxaloacetate - i wasn't asking for the details). So what kind of biological science major is he....

Thursday, April 5, 2012

Malachite green, melamine, plasticizer and pink bug drink in Starbucks - 4 of 4

Pink bugs in starbucks

IT was quite a sight - I went back to work in the hospital just to find that the nurses are all there chattering about Starbucks drinks made from insect fragments. My first reaction to it was like...

Okay. Topic to write on.


Cochineal is a type of insect that feeds on cactus. It contains a compound known as carmine (wiki) which is usually used as its salt in product as a kind of red colouring. Historically it is produced in Spain and is extremely valuable. The value of cochineal fell much following the discovery of artificial red dyes in the previous century.

So why are we using cochineal?

In fact, this is likely to be the only reasonable red colouring for use in food. The other legal food red colouring these days is Red 40 (wiki) which is under attack[1]. The cochineal red coloring can be obtained in two forms, carmine, and cochineal extract.

Cochineal extract is prepared from a water-alcohol extraction of powdered, dried cochineal.Carmine on the other hand are further filtered and is more chemically pure.

Comments like "Are we eating insect fragments? - Oh I still remember there are quiet a few red fragments there when I had my strawberry frappucino - That must be the insect fragments" are everywhere[2]. These comments are of course factually wrong - if a industrial pulverizer can leave insects fragments alone then it wouldn't be called a pulverizer at all. And we are talking about powdery food additive which are freely soluble in water (and they cannot have insoluble components of more than 1% by weight (by UN standards).

Food standards with regard to insect fragments

To understand the ubiquity of insects in our common food, one must understand what standards are set there - FDA (of america) has set some ground rules for food in america (and those approved in america are usually allowed in Hong Kong - go figure). These are a few examples of "action level" of FDA[3] (i.e. they will accept the product if the count is below these...):

(1) Cinnamon, ground - 400 or more insect fragments per 50 gram
(2) Chocolate -  60 or more insect fragments per 100 grams
(3) Canned orange juice - 5 or more fly eggs per 250 ml

Can you imagine you accepted a can of orange juice with 4 fly eggs? I guess if these are acceptable, cochineal extract is just a mere mental inconvenience... Plus it is healthier than those artificial substitutes... 

[2] "...不免令人聯想到,可能是被攪碎的蟲子翅膀、身體...", "...現在想想,難道這就是尚未被碾碎的蟲子翅膀或其他身體部分..." etc. Obtained from a google search on "胭脂蟲 翅膀 starbucks"

Tuesday, April 3, 2012

Malachite green, melamine, plasticizer and pink bug drink in Starbucks - 3 of 4


There has been quite a fuss surrounding taiwanese drinks back then in 2011 - you hear all those 'completely artificial' drinks from taiwan and many of us stopped buying drinks from these taiwanese outlets. Whereas it is true that these drinks are artificial, the health impact they had in human is debatable.

The case was that a supplier of clouding agent added a plasticizer called Bis(2-ethylhexyl)phthalate also known as DEHP into its product.

Clouding agent

Clouding agent is a type of food additive which causes the drink to become cloudy.

This cloudy lemonade is an example of what a drink would
look like if a clouding agent is added to it[1]

Typical clouding agent contains gum arabic, palm oil as well as citrus extracts. By nature of its palm oil, it is easy to spoil and gives a rancid taste when spoiled. There, they noted that DEHP, when added to it instead of palm oil, will produce a very nice clouding effect with little chance of spoiling. All these contribute to a better product, except... that DEHP is an antiandrogen (That is, it interferes with male sex hormone production and/or the effect of male sex hormone).

And then, as usual, with the ultra-sensitive investigations available, suddenly we are worried about the presence of DEHP everywhere - taiwanese drinks included. But when it comes to a drug...

There are also other plasticizers similar to DEHP and their toxicity are also similar. 


Augmentin is a very common penicillin-type antibiotics. Arguably, it is the most commonly prescribed antibiotic both in in-patient and out-patient settings - mostly because of its broad spectrum (the ability to kill many different kinds of bacteria).

The tablet of it contained 2.7 ppm of DIDP, 1.1ppm of DEHP and 3.5ppm of DINP.

The powder for syrup reconstitution contained 88ppm of DIDP and 1.4ppm of DINP.

The maximum allowable intake level of DIDP is 2200 microgram per day[2]. 2.7ppm is 2.7mg/kg = 2.7microgram/g. An augmentin 375mg tablet is about 500mg in weight. by proportion, it contains about 1.35 microgram of DIDP. A full course of augmentin thus contain 28.35 micrograms of DIDP (1.35 x 3 times per day x 7 days). The daily dose is about 0.18% of the maximum allowable intake level. One has to take a 500x overdose of augmentin tablet in order to see a reproductive effect of DIDP. To be honest, if one takes a 500x overdose augmentin I would worry about the brain of the patient more than the antiandrogen effect of DIDP/DEHP/DINP...

For the powder, it has a vastly higher amount of DIDP at 88ppm. 88ppm is 88mg/kg = 88 microgram per gram. The 457mg/5ml syrup contain around 1g of powder for 5ml of syrup. Thus, there is 88 microgram of DIDP in 5ml of syrup. A full course thus contain 1232 microgram of DIDP. The daily dosage, which is 176 micrograms, represents 8% of the maximum allowable intake level.

And then they take away all the oral augmentin available from the clinics and hospitals. Compare the risk of patient requiring the use of second line antibiotics (which are more expensive / had more side effects / had narrower spectrum / less suitable) with these small risks of anti-androgenic effect from plasticizers... well, not that the ban is incorrect, but the negative impact is so much worse than the woes it caused.

For the matter, the maximum allowable dose level of DEHP is 418ug/day for adults, 58ug/day for children and 20ug/day for neonates; and none was defined for DINP. One can try to do the mathematics, but it is exceedingly unlikely for anybody to become affected by the dose level available in the syrup or the tablet.

You get the idea.

[1] The picture taken was from a natural cloudy lemonade, which is a mixture of water, sugar and lemon juice. The clouding effect is natural and is not due to a clouding agent. This photo is (C) 2009 JJ Harrison, used per CC-BY-SA 2.5 license. (Further information available from Wikipedia)

Monday, April 2, 2012

Malachite green, melamine, plasticizer and pink bug drink in Starbucks - 2 of 4


Melamine is a trimer of cyanoamide (H2NCN). The industrial use of melamine is basically as a polymer: (after mixing with other chemicals)

(1) Thermoset plastic - melamine resin is very durable. The only problem with it though is that it heats up in microwave, thus it cannot be used in a microwave.
(2) Melamine foam - it can be used as a soundproof/insulation, as well as an abrasive cleaning agent (quite well known by now in Hong Kong and perhaps Japan as 激落君)

On the other hand, since melamine contain more than 60% nitrogen by weight, it has been considered for use as a (rather unsuccessful) nitrogen source in the feed for livestocks[1]. In the melamine-tainted milk incident, it was used to increase the apparent nitrogen content of the milk because some assays measure protein content in milk by measuring the nitrogen content.

The acute toxicity of melamine is very low. the LD50 (lethal dose-50, i.e. the dosage of the medication to kill 50% of a population, usually of laboratory animals, e.g. mice, rats) is around the same as salt, at >3000mg/kg. Chronic toxicity is another problem - melamine by itself requires consumption of large amount of pure melamine without good water intake. This is almost impossible for adults.

Melamine has been implicated in several incidents, including one involving pet food in the past. Together with the 2008 melamine tainted milk incident, it was noted that melamine primarily cause complications due to two mechanisms:

(1) the hydrolysis product of melamine (co-contaminants due to the use of low quality of melamine) inhibits a liver enzyme called uric acid oxidase which decomposes uric acid - this leads to a high blood, and thus urine level of uric acid and cause kidney problems.
(2) melamine is also excreted unchanged in the kidneys, causing stone formation.

Again - the addition of melamine is one act of pure fraud. It is definitely not something acceptable in any society. but then as talked the day before, the dose defines the poison. In the Sanlu milk that caused this whole scandal, the dose detected was up to 2,500mg/kg (=part per million, and later up to >6197mg/kg), which is very high - and this dose is only causing the disease in infants because they almost do not drink anything else - the lack of water intake increases the precipitation.

The story in Hong Kong

According to the Centre for Food Safety, melamine-tainted food that has been seen in Hong Kong had concentration up to 68ppm (in chocolate bars).This level, together with the target population, is unlikely to cause any damage even in the worst case scenario (child eating it as the only food - in which case the parents should be prosecuted for child abuse I think).

And then we see a boycott of milk products from China, as well as all other diary products in Hong Kong because of a detection of concentration averaging around 3 part per million.

And then we saw the hospital authority opening special clinics for those children who "supposingly" had taken melamine-tainted milk. To be honest, if anything, if we have a look at the balance between:

(1) Loss of work hours of parents and study hours for children
(2) Risk of contracting disease from clinic attendence
(3) Delay of other patients in same / different department (e.g. ultrasound appointment)
(4) Pressure of work to our paediatric colleagues


(1) The remote risk of having renal disorders from locally bought milk powder/other products

I think most of us could judge.If the child had Sanlu, Mengniu or Yili infant milk powder from China I think it is very acceptable for doctors to consider a streamlined investigation protocol for them. For others, I think the readers can now decide.

[1] The use of non-protein nitrogen sources in animals has been a practice in farming for quite some time - compounds such as ammonia, urea and biuret can be feed to the ruminants and would eventually be incorporated into protein for the animal because of bacterial action in the ruminant stomach.

Sunday, April 1, 2012

Malachite green, melamine, plasticizer and pink bug drink in Starbucks - 1 of 4

It is not news that people are easily manipulated[1].

The collective stupidity of people never fails me... Looking at the list of feared substance that occur in Hong Kong, I can only say, good luck, my friend. Below lists a handful of substance that has been publicized in Hong Kong for being added to food (legally or illegally) and are of utmost hazard to your health:

(1) Malachite green
(2) Melamine
(3) DEHP (Bis(2-ethylhexyl) phthalate and other similar plasticizer)
(4) Cochinea colouring

This is the first installment of a four-article series on the public reaction to chemical substances identified in food.

Malachite green

Malachite green is an aniline dye which is commonly used in production of green articles made of e.g. silk, leather or even toilet paper. Another use of it is in eradicating protozoan disease, notably Ichthyophthirius multifiliis which is better known as white spot disease (白點病), a prevalent parasite of freshwater fish. 

Malachite green has been implied in causing cancer, change in genetic material, abnormal babies as well as toxicity to lung[2]. Together with its metabolite in fish, leukomalachite green, these produces an increase of liver DNA adduct in rats (a measurement of genotoxicity), in a dose-related manner in concentrations above 91ppm[3]. There is also an increase in lung adenoma (a benign tumor) in the tested rats.

There is, however, in this 2-year tumorigenesis study, no increase in the occurence of liver tumor.

According to the press release by CFS, HKSAR[4], the samples concerned contained  16ppm and 0.0025ppm respectively (by LC-MS/MS among other methods[5,6]), well below the concentration that has been observed to cause significant genotoxicity.

In fact, most of the samples acquired in Hong Kong afterwards contained up to 5ppb (part per billion) only - which is, higher than the EU directive (<2ppb) but lower than the Japanese directive (<10ppb).

The ban is correct

I for one am surprised that samples would contain as much as 16ppm, far above the possibility of contamination, and this points much more to (illegal) usage of malachite green in that particular case. The ban means that future products would be tested for it with sensitive assays and the fisheries will have an incentive NOT to use malachite green in their fish-farming practice.

But the reactions are stupid

The dose makes the poison - Paracelsus

The trouble though, with these incident is that most of those who wrote about these had little idea that toxicity is related to the dose - even something as innocent as pure water or pure oxygen could be a poison if given in large enough a dose and/or long enough a time period, but even cyanide could be nontoxic if given in small enough a dose.

What people says about these malachite green-tainted eels?

"致癌鰻魚驚世大發現"[7] - Written by a chemistry teacher.

What's the deal? The dosage isn't even remotely near the carcinogenic levels. To make it worse, he further wrote "孔雀石綠經已被証實為可以致癌的物質" - when has it been classified to be a known carcinogen? The WHO publishes a list of known carcinogen - one can check here. There are some borderline evidence of carcinogenesis - e.g. a significant increase in "pooled liver adenoma and carcinoma"[8]. Yes, one can say that it is a potential carcinogen (with all the indirect evidence) but proven to be carcinogenic?

And then the worst in the article: "右圖為被過量孔雀石綠浸過的甲魚,魚身已被染成綠色" - what's remaining in the malachite green tainted fish is mostly leukomalachite green which had longer half-life (of 10 days) than malachite green - which is not coloured at all. To add to it, the observed amount (even the wow-factor 16ppm detected) will unlikely add any colour to the specimen.

Please, for god's sake - learn before you teach.

[1] Do you really expect a source on this? It's April Fool's day!
[2] Srivastava S, Sinha R, Roy D. Toxicological effects of malachite green. Aquat Toxico. 2004 Feb 25; 66(3): 319-29.
[3] Culp SJ, Beland FA, Heflich RH et al. Mutagenicity and carcinogenicity in relation to DNA adduct formation in rats fed leucomalachite green. Mutat Res. 2002 Sep 30;506-507:55-63.
[5] Tang HPO, Choi JYY, Analysis of Malachite Green in Fish Samples. Downloaded from:,
[6] Tang HPO, Choi JYY, Analysis of Malachite Green in Fish. Downloade from:
[8] Culp SJ, Mellick PW, Trotter RW et al. Carcinogenicity of malachite green chloride and leucomalachite green in B6C3F1 mice and F344 rats. Food Chem. Toxicol., 44 (2006), pp. 1204–1212.


Democracy has been promoted by so many proponents of it that it is almost impossible to criticize democracy in front of people without triggering a flamewar instead of a fruitful discussion. In fact democracy has been popularized to the point that those speaking about it often have no idea what is being represented by the term.

The term democracy comes from the Greek word demokratia, which is the combination of the term demos (people) and kratos (power). Essentially, the aim of any democratic system would be to grant the power back to the people.

In my humble opinion there is really not a need to talk about the benefits of a democratic society - though, to be honest, most of the quoted benefits of the democratic society are actually the prerequisite of a democratic society, not an effect of it (and these includes freedom of speech, freedom of political expression, freedom of press, etc.)

One major problem of democracy is that of a mob rule. The treatment by Plato on this subject is at least interesting (if not practical enough) to read. Mob rule refers to the situation in which the majority utilizes its power via democracy to intimidate, or even harm minority groups. Another situation that could also be referred to mob rule is when the majority in the society elects (or intimidates the government) for a certain action to be passed, when the action itself may not be for the better in the long run.

Look at the $6,000 scheme by the Government of Hong Kong last year.

In my opinion, the government has been doing a disservice to the society by changing its decision from investing six grands into people's MPF account to dispensing cash. The problem is that many of us are not being protected adequately by our retirement scheme and the approval of such decision is only making the government more liable in terms of social security spending because these people who do not save it up and spend the money right away are likely to be the people who would rely on the social security policy for their "retirement plan" in the long run.

Saturday, March 31, 2012

Two other kinds of personalities

Coming from the previous post on borderline and paranoid personality, maybe today we could talk about two other personality disorders - these two are very common in daily parlance, though those speaking of it quite often have little idea what's under the words...

Histrionic personality disorder

People with histrionic personality tend to be self-centered and attention-seeking. They have a shallow, labile affect which they display in a dramatic manner. They are often flirtatious and inappropriately seductive – however, their sexual feelings, like their emotions, are often shallow and they often fail to achieve orgasm despite elaborate displays of passion.

They are overconcerned with physical attractiveness. They often repeat themselves, often to achieve self-deception (as in believing in one's own lies)

Narcissistic personality disorder

People with this disorder have a grandiose sense of self-importance and are boastful and pretentious. They are preoccupied with fantasies of unlimited success, power, beauty and intellectual brilliance. They think that they are special and entitled to special services and favors.

The phenotypic feature is thus the tendency to exploit others, as well as being envious of other's success.

Placebo: Ahh it is really difficult to write an article a day.

Thursday, March 29, 2012

Personality problems

People with personality problems are commonly seen in clinics[1]. It is in fact a cluster of problems which is even more troublesome than most other psychiatric problems. Some of these problems affects the person (patient) more than others, others affect the people surrounding the person having the problem.

"Psychosis, you can treat, but personality disorders, not really." - said my friend who is now a psychiatrist.

This in fact reflects both the resistance to treatment, as well as the general resentment that such disorder actually occurs in our population, and in our clinics.

Some personality disorders are very traumatic to others (not that these are not traumatic to oneself):

Paranoid personality disorder

People with this kind of personality are suspicious and sensitive. One can see a marked sense of self-importance but you can always feel a hint of shame, and humiliation, in their eyes, even after minor setbacks.

They are keen observers, as observant as the best scientists, they search not for scientific hypotheses, but attempts by others to deceive them.

They are very sensitive to rebuff, they are prickly and argumentative and they often read between the lines to see non-existent threatening meaning in obviously innocent remarks. They never forgive others for real or imagined threats, and they often seek revenge in this modern society by hiring lawyers and proceeding to litigations (often unnecessarily).

Borderline personality disorder

You see extreme efforts by them to avoid abandonment - they manipulate others by acts such as recurrent suicidal behavior to relieve themselves of their chronic feeling of emptiness. They are impulsive, they can't control their anger.

People often quote these borderline people to have intense, but brief, and unstable relationships, and this is true, and in addition, approaching the end of their relationship, you see paranoia in their behavioral pattern, and they become suspicious when they are stressed.

What's the personality problem described here?

[1] Not that I don't have one. I am a dependent person. Dependent on my girlfriend.

Test concepts

To be honest, these days, many patients come to the hospital for tests rather than for consultations, and for (self-prescribed) treatment rather than diagnosis.It seems to us that when we offer a test (instead of history taking and physical examination), the patients are more satisfied and many of them still hold the belief that the tests are invariably correct.

And this is not a small mistake to make.

When we look at tests, we look at the test result (e.g. a blood test), compared to the actual result (whether the patient actually have that particular condition).

positivetrue positivefalse positiveTP/(TP+FP) = PPV
negativefalse negativetrue negativeTN/(TN+FN) = NPV

TP/(TP+FN)=Sn  TN/(FP+TN)=Sp

PPV = Positive predictive value
NPV = Negative predictive value
Sn = Sensitivity
Sp = Specificity

Sensitivity and Specificity are inherent to the test itself - it depends on the test itself, and the cutoff value chosen only. When different values are chosen as the cutoff for a test, the sensitivity varies with specificity, and we can plot a graph that is known as the "Receiver operating characteristic curve" (Wiki on ROC curves)

Sensitivity measures how good the test is at detecting the condition when the condition is present. Specificity measures how good the test is at ruling out the condition when the condition is absent.

The detail for the ROC curve isn't that important - but it is important to know that if you pick a value that makes the test more sensitive, the specificity will go down, and if you pick a value that makes the test more specific, the sensitivity will go down. The clinical implication that, if you want doctors to have very few misses in diagnosing a condition, doctors are going to do a lot more tests on everybody, and most of these tests will turn out negative.

Take the sample ROC curve above as an example, if you want the sensitivity to go as much as 90% (i.e. 90% of patients who have the disease the test will be tested positive) then the specificity will fall to 40% (i.e. only 40% of those who do not have the disease will test negative - or, put it the other way round, 60% of those who do not have the disease will test positive). These patients who are so unfortunate to have a false-positive result will be subjected to confirmatory tests, which are often more invasive and incur morbidity and mortality - for example, a 0.25-0.5% risk of death following a diagnostic coronary angiogram.

And then we come to the positive and negative predictive value. We talked about the sensitivity and specificity being inherent to the test and being related to the cutoff value chosen - the positive predictive value and negative predictive value depend very much on the prevalence of the condition (i.e. the number of people having the condition in the population)

For example, let's say we have a population of 1000 (e.g. in a secondary school) that we are going to test for drug use. There are, let's say, 20 students abusing the drug. And our tests are 95% sensitive while 95% specific.

present     absent
positive1949 PPV = 27.9%
negative1931NPV = 99.9%

We can see that the tests is inappropriate for this application - We are going to have 49 false positive among these 1000 students. Imagine the psychological trauma and the effect of labelling in these students while confirmatory tests are being done.

Imagine the same test being done in another school where drug problem is very severe - 200 students are abusing the drug:

present     absent
positive19040 PPV = 82.6%
negative10860NPV = 98.8%

The result looks much nicer compared with the previous one - with the same test, same cutoff (and thus same sensitivity and specificity). We can see that this test is much more suited to the application in this particular school.

What does all these mean to the readers, then?

Looking at it, human decision making is also a test (even if no laboratory resources are used), It means that, the higher the quality (i.e. the lower the miss-rate) you require from the doctor, the more tests will be done on you, and many of them will eventually going to be negative, and worse still, some of them are going to be false positives.

Wednesday, March 28, 2012

Liberal education - Looking back


There has been quite a body of discussion on the establishment of liberal studies. Various published articles, most prominently on Hong Kong Teachers' Centre Journal, have already listed out the difficulties of establishing such a subject in Hong Kong, citing reasons such as (1) Lack of a clear scope for liberal studies, (2) Necessity of an adequate prerequisite base of knowledge before the appreciation of the intrinsic value of liberal studies,(3) Lack of established teaching protocols, (4) Lack of applicable teaching materials, and the detrimental effect of establishing a standard one, (5) Lack of staff development on the subject, (6) Lack of substantial guidelines, etc. [1]

Whereas some of these concerns have been addressed by the issuance of formal guidelines on the development of liberal studies, vacuum still exists (despite how the nature abhors it) even though the academic exploration of it started some 5 years ago.

Liberal studies and general education

Originally, the term to the academia was that of general education, and it is perhaps a response to the increasing specialization of undergraduate courses that spurred in the 1970s (especially in the US of A). There, it was noted that although these new graduates are extremely knowledgeable in their own field, they are often ill-informed in most other fields.

To quote, the question at the end of the 1970s was that of whether the universities and colleges could continue their strengths in specialization, and at the same time offer something more, like, a liberal, general education[2].


While the difficulty of establishing a general education system at a university level is to get the departments to provide manpower to the courses and to design the courses such that it is understandable to the uninitiated, the difficulty in establishing a general education (or liberal studies) system at the secondary level is the lack of scholars who are able to teach.

While the level of knowledge that would eventually be tested would not be excessively difficult, it is to the interest of students, that each element of general education (as in science, social sciences and humanities) be taught by somebody who is well informed in each of those subjects.

It is perhaps to the advantage of students that the curriculum development of liberal studies in Hong Kong has always been ignoring the scientific part of it – such that,at the very least, a student won’t be taught on, for example, the scientific method (which, unsurprisingly, is an integral part of liberal studies curriculum elsewhere) by a teacher who has not even been instructed formally for it in a tertiary setting.

The good ol’ days of liberal studies

In the olden days, students are formally required to take almost all subjects while in junior forms, including literature, history, geography, integrated science and so on. This, perhaps, is actually the ideal picture of general education, and liberal studies at work. Each subject was taught by a relatively specialized teacher, relatively knowledgeable in their own field, and was ready to answer the question in an unambiguous manner.

It is perhaps to the best interest of students that we actually divide it back into pieces, and allow each piece of knowledge to be delivered by those in the know.

[1] see H K Kwok. The implementation of Liberal Studies in Hong Kong and its strategies, published in 2007, in Hong Kong Teachers' Centre Journal (pp1-6), for further discussions.
[2] see J Scott Lee. Liberal studies and general education in the undergraduate curricula in the 21th century: their role, development and the challenges.(Presentation available from google search)

This article is an edited version of my original post in an education forum.

Completing the family, for researchers

Completing the family (i.e. having children) is a rather controversial topic especially for female researchers. It is not only the time off that comes from the planning, child-bearing, delivery and child-rearing, but also the change in family status which mattered.
Getting a child is perhaps going to take a big toll on the research and teaching that one is currently doing but this is important for at least two reasons:-

1. The birth of the child to one, or occasionally a pair of academics would mean that they will be raised in a better environment than an average person. The environment will likely foster a child of good, if not great intellectual capacity.
2. A completed family is a continuing family. Living alone at an old age is lethargic at best - and believe it or not, academics are destined to be long-living. A family, especially one with children, will continue to supply the elder member of the family with vitality that is fading out with age.

This article is an edited version of my original post in an education forum.

Nursing - is it really THAT attractive?

A whole lot of people are asking about the working condition/hours/undergraduate curriculum (and so on and so forth) of nursing in the forums. I have always wondered - why is there so much interest in the society in becoming a nurse? Granted, salaries for nurses are among the highest if you look at the admission grades, but then is it really such an attractive package? If so, are those who aimed at pursuing the nursing profession suitable to do it?

I personally think that being a nurse, or for that matter a doctor, is a job that is in fact not really well paid for the necessary work. The price-performance ratio might as well be better for nurses but basically there is too much risk to bear for that particular salary. If I were for the salary, the medical industry would be down on the bottom of the list in applying for jobs.

For that mere 20k/month salary, one has to deal with infectious blood, urine, faeces, cerebrospinal fluid or even semen -- and then, as much as I hate to say it, unreasonable patients represent a significant portion of daily work in a hospital environment, be it in public or in private sector -- if you are lucky, you get scolded, if you are unlucky, you could be (unreasonably) complained, harassed or even beaten. Contracting HIV during procedures such as suction and blood taking is not something unheard of in the industry.

And here goes the shift work. Most nurses need to work shifts - be it in the operating theatre or wards - some may be exempted from shift work because of work location (outpatient department, day ward, etc.) but these places are often staffed by nurses with morbidities such as psychiatric illness or autoimmune diseases. Shift work imposes a lot of stress on the physical, psychological and social well-being of an individual.

If I were them, I probably wouldn't choose this subject as a career - there are a lot of career choices in which, if one is willing to work in such hazardous environment, in such irregular hours I think they are going to success and excel wherever they work.

Tuesday, March 27, 2012

New immigrants from China

Talked with a few other fellow doctors in the recent week and we kind of summarized what we saw in terms of the epidemiology of diseases in these new immigrants. These represent of course, anecdotal evidence and are not backed up by statistical tests[1].

Demographics of these new immigrants

There are basically four groups of immigrants. The first of them would be the ladies aged around 30-40 by now, which corresponds to the time when the vast interest in searching for wife in mainland began. The second, would be the kids that were first raised in mainland and brought to Hong Kong in the past 10 years. The third, would be working people holding the one-way permit, and the last group is the rather old people that were brought to Hong Kong to be cared after. I will focus on the first two groups.

First group of new immigrants: Ladies around 30-40

The major illness that comes in this group is anxiety-depression and female genital tract diseases. It is of no surprises that the prevalence of VDRL positivity and HPV positivity is much higher in this group of people and we are seeing a lot of really young patients with cervical cancer.

For the psychiatric part though, are really the fault of the Hong Kong people - their husband by the time now is already some 60, 70, or 80, and more often than not their husband are of the lower social class, and their health is poorly managed. You see them crippled by illness such as cerebrovascular accident, chronic obstructive airway diseases et cetera and it is really an ever-lasting difficulty for these ladies to care for their husband.

As to the female genital tract aspect however, it is more of a selection bias which I do not attempt to discuss here.

Second group of new immigrants: Kids raised in China

The problem with these kids is mostly psychiatric, and sometimes learning. It is not a surprising thing that students in Hong Kong in the past (during the British rule) has been shown to be superior in terms of their mental capability compared with peers in the western countries.

And our education system, unsurprisingly, is extremely high stress -- our top students (whom, are selected from a population of a mere 7 million) are able to get into the top universities, more often than our mainland counterparts (whom are selected from a country of 1.2 billion). After all, when we say that our medical examination is having so high a standard that it fails half the candidate, do we remember that our HKCEE fails (as in making the student not acceptable to matriculation courses) up to 80% of candidates in the past[2]?

The problem with these kids (or young gentlemen/ladies) is that they find it very difficult to position themselves in Hong Kong, where even local professionals have difficulty in living a reasonably cozy life.They often end up in two routes - one is early psychosis, and another substance abuse. They often do not have enough money and as a result, they will buy what they can afford - ketamine. The street price of ketamine, according to the police who presented in the HA toxicology conference this year, is around HKD$120 per bag, and each bag, could be used by first-time abuser for 5-6 times, thus it is just around HKD$20 per trip. Comparing the experience of two ketamine trips to a so-so lunch in [insert fast food chain here] which would cost you about the same amount of HKD, and without the knowledge of the consequences, I am sure we can understand why these kids would choose ketamine over the lunch.

I guess we can talk about the other two groups in the next few days...

[1] We do, however, have a firm belief that if statistical tests are being done then it has a real high change of being significant although an analysis like this has almost zero chance of passing through the ethics committee...
[2] Of course we understand that the medical doctors are a selected group compared with the relatively unselected group of HKCEE sitters...but anyways, there are three kinds of lies - lies, damn lies, and statistics.

Monday, March 26, 2012

Are we really helping the society to get more talents?

Are we really helping the society to get more talents?
A rather long rant

The education system in Hong Kong has undergone dramatic change which accumulated into the establishment of a new examination system, HKDSE, starting in 2012.The aim of an education system is of course to foster the development of talented person for the society, but then is our system really doing this? Are we really changing for the better?

A social worker has pointed out, during an episode of Hong Kong Connection (鏗鏘集), on how the bourgeois had cast their vote of no confidence by walking away from the government-sponsored education system in Hong Kong to the international schools, which, according to some, foster learning by providing an environment that is more dynamic and less examination-oriented. This behavior is of course not without its consequences, with eventually more local Chinese occupying positions in international schools and increasingly fierce competition for the places in it. Some foreigners who worked in Hong Kong could no longer find a place for their children to study in because they simply do not learn enough Chinese to allow education in the local system, nor could they secure a place in these international schools because of the fierce competition[1].

The problem with the change is that the education system has been modified in such a way that it promotes grade inflation, disproportionate amount of resources spent on particular groups of students, and increasingly, education for those who don't really want it.

Grade inflation

We are admitting an increasing number of students into our higher education system every year - be it in the statutory universities, in the statutory institutions, approved post-secondary colleges, VTC or other institutes which are accredited by the Hong Kong Council for Accreditation of Academic and Vocational Qualifications (What a long name!).

In the past, most of these students would have failed (and for the matter, some of them still failed) in the certificate examination (or eventually, for some, in the advanced level examination) and they do not have a chance of receiving tertiary education - their situation was perhaps not as bad as one would be in, these days, without a tertiary qualification, because a degree was not perceived as a must back then.

The grade inflation comes from three sides - the first side is that a reasonable curriculum has to be defined for a degree or other qualifications that is to be conferred; the second side is the institutional need of passing a reasonable number of students per year; the third side is the admission quality. One has to understand, that, despite the increase in overall intelligence in the general population, the number of those who could actually demonstrate good understanding in an undergraduate-level curriculum is definitely limited. I for one could not, really, achieve good understanding of a mathematics degree, for example, despite that I have finished my medical degree - it's not only a matter of intelligence, but also a matter of specific talent.

And then, now that an instructor, or a lecturer is now in charge of teaching students who failed their A-level physics AND applied mathematics, in an associate degree or perhaps a higher diploma program in the discipline of Engineering, what do you do? Do you change the curriculum? (not possible) Fail most of them? (not acceptable to the institution) or do you just inflate the grades? (the easy way out).

I am not saying that this is a specific problem of the education system in Hong Kong - in fact,  this is happening in a global scale even in the best universities - but the fact that this problem is global doesn't mean that it could immediately be passed as normal -- we still need to do something about it.

Disproportionate amount of resources spent in groups of students

In the past, there were the special education program, and there were the gifted education program (basically organized by the Faculty of Education, CUHK - The Program for the Gifted and Talented). Nowadays, we do not see as much emphasis in these and in fact, we are seeing a lot of money (and man-hour) being spent on remedial programs.

Remedial programs are definitely not news - we have remedial program, especially for language education since really long ago and it is everywhere - even in century-old establishments. The concept of remedial education is also not wrong - in a way, it is there to help those who could not learn effectively in the original classroom environment and provides a place in which the upper bar of student performance is lower, and the teacher-student ratio higher - this allows a teacher to teach a group of students in which the variance of ability is lower, and unsurprisingly this will lead to better received teaching.

The problem with remedial programs nowadays is that it is never-ending, and that it does not allow for additional time (as in academic year, not in lesson-hour) for the students to learn. A more terrible version of it has recently been developed by some band-2 schools which targeted a group of students who have trouble, but also 'hope' for a pass in the public examination - there, the students are divided into three groups:

(1) Those who are likely to fail despite remedial measures
(2) Those who are likely to benefit from remedial measures
(3) Those who are likely to pass the examination irrespective of remedial measures

And to make it further extremist, they are precluding the students categorized in (1) from coming to the remedial classes. Not that this is not utilitarian-correct,  but imagine the psychological health of the students so-categorized!

Then we look at the higher education. Higher education is an extremely expensive business, and I think most of us understood this.

The notion that the newer generation ought to have some sort of higher education has  been engraved onto the mind of parents in Hong Kong. The issue with these, though, is that they have to understand that the university is supposed to be a place for the advancement of science and arts, and we are looking for potential researchers in university education -- University education is NOT vocational training, and NOT a continuation of secondary school studies. To further the advancement of science and arts, however, is definitely not something that everybody is suited to do.

Education for those who don't really want it (and it is really parents' problem)

Most of us would understand that motivated students are some of the best students one would have in any education establishment. And the one of the worst problem we are having in the 21st century is that most of our students aren't motivated enough.

The best students often study because the subject matter itself is interesting to them - there is little else that is contributing as to why the student study. This is what people refer to as intrinsic motivation.

The lack of intrinsic motivation could be due to the vast array of distractions available these days, like computer games, TV programs, magazines, etc, but it could also be the diminished exposure of certain subjects to students which makes it increasingly difficult for students to actually find their true love -- a subject that is of their interest. For one, if you have never introduced to a subject like, bioinformatics for example, how does one get to like it?

This is not yet the worst enemy. Now that we have a wave of parents who are completely clueless as to how to rear a child, for example - we have parents who feed their newborn 3 times per day, essentially starving them to a near-fatal state, it is not surprising that they will foster learning in their child the wrong way. Some of them would provide a lot of extrinsic motivators without understanding the effect of it and the correct way of using it. And then when they find that the rewards don't work any more because of tachyphylaxis, they blame it on the teacher (you can't expect them to have learnt education psychology, could you?)

By now we can see that the causes of the motivation problem can be summarized below:

(1) They don't even get to develop the interest in a subject because they are not even exposed to it adequately.
(2) There are too much distraction these days
(3) Parents are often giving rewards the wrong way


With all these problems it is difficult to see how the new generation could actually learn - perhaps the education system would act as a sieve that allows only the best students to pass through, but this is currently at the cost of educating so many people who are really unwilling to learn (in "band 2 and 3 secondary schools" and in non-university tertiary education).

Could we have done better?

[1] Not that the government is obliged to provide them with it though, but this will surely hamper professionals from coming over.
[2] Formerly, there was also an examination for primary school graduation, but this is perhaps too old for me to comment on. Comments from readers with experience in the former system is encouraged. I refer the change to the changes imposed on the academic year 1996-1997. 
[3] Well, if they tried to foster their children's learning, it is already better than a 'so-what attitude' that is quite common these days... 

Edited 27.3.2012 - Mostly English usage (Too many complaints from my girlfriend)