26 Mar 2009


Our department held the research day last Saturday. Sadly, none of our trainees attended the meeting. I hope they were just skeptical about the quality of the meeting instead of having no interest in research at all.

This is not to say that research must be of prime importance. In fact, I am afraid some people put too much emphasis on research output in judging one’s worth. I am all too happy to see youngsters striving to become responsible and competent doctors. However, in the era of evidence-based medicine, even doctors not doing research should know how research is done and if the conclusion of a report does justice.

The event led me to reflect why I am doing research.

Hopefully, it is not for fame, prize and money. If I choose those, the temptations to do wrong are too great.

It is the sheer joy of finding things out. Not only do I want to learn the truth, I am also eager to see how people get the answer. Our nephrologists were probably fed up during my attachment when I asked silly questions like ‘Why does proteinuria lead to frothy urine? When is frothy urine pathological (I often see bubbles in urine)? Does the size or number of bubbles matter?’

Recently, I brought our youngest and talented trainee to a laboratory meeting. After the presentation, she summarized the whole work in one question – ‘What is the use?’ At that time, I nodded politely. (Friends familiar with both of us would understand that I had no other choice.) Deep in my heart, however, my answer was, ‘You never know.’

When Osamu Shimomura applied for a research post to investigate why jellyfish glowed in the early 1960s, many might also question the significance of his work. Who would have imagined that the discovery of the green fluorescent protein would transform biomedical research and earn him a Nobel Prize in Chemistry 40 years later?

19 Mar 2009

Coca Cola Classic

Have you noticed the word “Classic” beside the Coca Cola logo in some of its products? What is so classical about a can of coke?

In 1980s, Pepsi launched an aggressive advertising campaign to boost sales. People at my age would probably remember television advertisements featuring a boy or girl trying two cups of unlabelled coke and being asked to choose the better one. After he/she had made the decision, the better coke always turned out to be Pepsi. You may think this is rubbish. We can always hire an actor to do this, right?

The Coca Cola Company certainly did not trust it either. However, being a big company, it decided to be cautious and secretly performed similar tests on volunteers. Much to their distress, Pepsi really seemed to be winning. Over 60% of testers thought Pepsi tasted better. The company saw this as a potential disaster, and quickly changed the formula of the drink with “New Coke” on 23 April 1985.

The result? The company converted a potential disaster to a real one. Customers just hated the new products and protested. Sales dropped. The company quickly returned back to the original formula in less than 3 months. To be absolutely sure that the customers were pleased, it added the word “Classic” next to the logo.

What went wrong? In a sip test, a tester only takes a mouthful of soft drink. The sweeter product is more likely to win. In real life, people drink the whole can of coke, not a sip. In such settings, it may taste too sweet.

Therefore, you must understand what an investigation is measuring before you can use it. Misusing an investigation is not useless. It is worse than useless. It is misleading.

Some weeks ago, I noticed a young doctor checking blood for carcinoembryonic antigen in a patient with anemia. “This is not supposed to be a screening or diagnostic test,” I said.

“A positive test increases our suspicion of colorectal cancer,” the doctor protested. “Taking some blood causes no harm anyway.”

“No,” I disagreed, “you can still harm the patient. Imagine what would happen if you decide not to perform endoscopy to rule out cancer if the blood test is negative.”

12 Mar 2009

Air Pollution Index

Last month, a group of medical students from our sister university took to the streets in protest and urged the government to update the Air Pollution Index (API). Do I support the act? Of course. Do I support the proposition? I am afraid not.

The protest was an excellent piece of civil education. I hope our students would join some of these activities, too. The real question is – does updating the API do any good?

Currently, the Environmental Protection Department provides the API based on the level of 6 atmospheric pollutants, including sulfur dioxide, nitrogen dioxide, suspended particulates, carbon monoxide, ozone and lead. The index and air quality objectives were set in 1987. Actually, the medical students were not the first to criticize that the index was not update. In October 2005, Task Force on Air Pollution has already stated that the current API is ‘meaningless’. First, some harmful components are not measured. Second, our cutoffs fall short of the World Health Organization Air Quality Guidelines.

I do not doubt that the experts know a lot more about the relationship between air pollution and disease. But what if we update the API? Can we shut down a few factories in Guangdong on bad days? Can we ask our drivers not to drive? Don’t be silly. You may argue – at least we can warn patients with lung diseases not to go outdoors, right?

People working in hospitals in Hong Kong may recall that we have an alert system for avian influenza. It is funny to use the word ‘recall’ for something in the present. The trouble is we are always on yellow alert. When you are always on alert, you have no choice but to ignore it. According to Prof Anthony Hedley of the Task Force, the air pollution of Hong Kong should be stated as ‘absolutely sky high’ most of the year. Can we ask the poor men to stay at home most of the year?

At the end of my hematology rotation as a medical student, I gathered my guts and asked. “Professor GC, our patients come in every few weeks for blood transfusion, but most of them do not have a diagnosis. Wouldn’t it be nice if we perform bone marrow exam and know what we are dealing with?”

“Investigations should only be done when they change the management,” the hematologist answered. “If these people suffer from myelodysplastic syndrome, I will provide supportive transfusion. If they turn out to have leukemia, I will still provide supportive transfusion.”

So forget about more investigations. The government certainly knows that the air pollution is bad. What we should push for is the means to combat pollution, not how to measure it.

5 Mar 2009


(The original version of ‘Sixteen Things About Vincent’ appeared in Facebook on 31 January 2009. Thanks to my friends’ feedback, the arrogant phrases were modified.)

My mentor tagged me. I guess I just have to follow suit.

1. I studied in three primary schools. My mother thought that was like Mengzi’s mother, who moved house three times to pave the way for the great scholar. Through the process, I did learn how to adjust to new environment. In essence, you have to make friends quickly, and respect that others may do things differently in different places.

2. I entered primary school at the age of 5 and have been the youngest in class ever since. While I was OK with language and mathematics, I could never manage craftworks.

3. Contrary to what child educationists may suggest, my mother constantly emphasized that I was not smart at all when I was in primary school. She believed this would make me more hard-working. Some of my friends would probably agree with her – that I am hard-working and not smart.

4. I am a Wah Yan boy. Although the Wah Yan spirit has never been formally defined, most Wah Yan boys think they get it. It is very much like the Dragon Scroll in Kungfu Panda.

5. I thought I was good at physics. I am humbler now. I am glad that Stephen Hawking deleted most mathematical formulas in A Brief History of Time.

6. I was made the producer of a joint-school musical play when I was in Form 6. While all my classmates were busy dating girls, I was worried sick about how to settle the budget everyday. This was meant to be a fund-raising project for the Hong Kong Cancer Fund, but the stage staff and actors spent almost every penny in the end. During the last rehearsal, the stage curtain was torn in half by a handrail at the edge of the set, costing another $5000 (I know. Similar things happened when Jesus died on the cross.). This was the only time when an opera moved me to tears. After the event, I was rather depressed and ashamed for letting the Cancer Fund down. In retrospect, this was no big deal, and we learned a lot through the project. But it took me years to forgive myself.

7. I can play piano, violin and pipa. If you only want ‘Twinkle, Twinkle, Little Star’, I can almost play any instruments.

8. I learned handball in the university. Two other medical students attended handball class with me, but I was the only one who had scored at all (only 3 goals in 10 games).

9. Prof Jean Woo was my Physician on my first day as a resident. I later learned that she did not want a first-year trainee, but Dr Michael Fu convinced her that I would be good enough. Of course I can never be good enough. I only strived to become better everyday.

10. After my MRCP exam, Prof Sung told me that I failed. I was glad he got it wrong this time.

11. I presented an abstract in a European meeting right after the MRCP exam. After I stepped down from the stage, Prof Anna Lok praised me. This was very important for my development. Before that, I had quite severe stage flight. Now I try to praise young doctors and students whenever I could. If you have read Henry’s notes, you will know that Prof Sung and Prof Lok are the grandparents of my career.

12. I wrote my first paper with Dr Nancy Leung and Henry. I could not find ‘chi-square test’ in the pull-down menu of SPSS, and Prof CC Szeto taught me right away. I did not mention his help in the acknowledgement section because it was quite embarrassing to thank people for teaching me chi-square test in a scientific paper. I would like to thank him now.

13. My wife and I prepared a presentation on osteoporosis in my final year. The presentation went badly, but I got my wife.

14. My favorite movie is The Pianist by Roman Polanski. My wife thought I was crazy when I repeatedly played Chopin’s Ballade No. 1 in the movie. Now that my daughter is 3 years old, we can only watch Strawberry Shortcake at home.

15. I tell my daughter bedtime stories every night. Since I am bored with her story books, I have started making up stories. The latest hits included Strawberry Shortcake meets Spiderman and Strawberry Shortcake meets Mr Incredible.

16. I know I seldom attend social gatherings now. But on the first day I went to work after the New Year holidays, my daughter complained to my wife. “My Daddy doesn’t miss me.” What else can I do?

Want to read the arrogant version in Facebook? Don’t be silly. I have already modified it.