31 Jan 2013


At recent journal clubs, we discussed 2 articles from the New England Journal of Medicine. The first was a trial on rectal non-steroidal anti-inflammatory drugs to prevent pancreatitis after endoscopic retrograde cholangiopancreatogram (N Engl J Med 2012;366:1414-22). The other tested how aggressive transfusion should be given in patients with acute upper gastrointestinal bleeding (N Engl J Med 2013;368:11-21). Both were multi-center studies involving hundreds of patients.

On both occasions, our Dean remarked how brave the investigators were. “The studies will change clinical practice,” he explained. “However, if the results were negative, the authors would have a hard time publishing their work despite their huge efforts.”

I felt deeply with his remarks, not least because I was the unfortunate investigator he described who invested much resource to produce a negative study last year. We made a bold move to a human trial because of very promising results from our own animal studies. Unfortunately, since the trial results were negative and the compound was new to the field, most journal editors considered the findings irrelevant.

During a meeting in Taiwan, I chatted with WC and mentioned my experience. “Do you think it is foolish to invest one’s time and energy this way? If I used the same study design and chose another compound that other doctors had been using, the results would be important even if they were negative.”

The Singaporean professor kindly advised, “How else can breakthroughs in medicine occur? Keep working, and remember to send me your paper when it is published.”

Under the current climate, it is easy to forget that our primary aim is to contribute to science rather than to have just another big paper. It is lucky to be reminded of what we are doing.

24 Jan 2013


“I have a job for you,” the boss said.

When I went to the company, they played a CD. It was a 5-minute recording of a Disney parade song. “We have to make a demo to illustrate what we are capable of,” he explained. “The presentation is tomorrow.”

Mozart was said to be able to recite the whole symphony after listening to it only once at a concert. I was no prodigy. I had to listen to the CD for around 20 times, but yes, I could arrange the music. The computer chip was ready the next day.

The American customer was impressed. After this, I got another offer to prepare a Christmas package. The daily wage, to say the least, was double my current pay even before adjustment for inflation.

Whenever I reached this part of the story, the listener would invariably ask why I left the industry. I never really thought about this seriously. Perhaps one important factor is that I gave all my part-time earnings to my mother then, so money meant little to me. With this, I have never been financially competent, but most of my decisions could be dissociated from the money issue.

Another point is I would certainly be out of job if I kept doing the same thing over the years. The simple musical chips have been eliminated by technological advance long ago. You may argue that if I stayed, I would have learned new tricks and survived time and again. This is probably true, but learn we must. At that point, I simply decided it was time to learn something else that was closest to my heart.

17 Jan 2013

Summer Job

My first job had nothing to do with medicine.

After the certificate examination, I decided to see more of the world by finding a summer job. I thought, “If I want memorable experience anyway, why don’t I go for the extreme?” Therefore, I went to a toy manufacturing company and asked for a job as a storekeeper.

The personnel manager was shocked. “Are you aware that this post involves moving really heavy objects?” I nodded timidly, more like Piglet than Hercules. Obviously, we had different views on really heavy objects. That said, the lady was very kind and offered me a job as a junior clerk instead.

My assignment turned out to be very religious. The Korean Church wanted a music box that could play all 600 songs in their hymn book. Readers with iPods would probably find it trivial. Back then, however, computer chips were quite rudimentary. Even the hard disk of my desktop computer had a smaller memory than any USB nowadays. If we recorded everything liberally, the music box would have to be bigger than a piano, hardly something the Church would buy.

Instead, my job was to translate the songs into computer language. Each song had four parts. Apart from playing all parts together, the program could also play only one part in case a choir wished to practise. The job was fun. With some tricks, I solved the problem of playing triplets (8 and 16 could not be divided by 3) and tempo change. I also figured out that if I recorded cymbals in place of organ as the basic tone, voila, we could even have percussions.

Soon, my summer holidays ended and I went back to school as usual. To my surprise, my former boss called me a few months later.

(To be continued)

10 Jan 2013

Time Flies

As the year closed, Angela remarked how fast 2012 passed. This was hardly surprising. Many people around me said so, too.

But this is not possible. A year is a year. What has changed is our perception. While many of us cannot remember what we had for lunch 2 days ago, we can nevertheless vividly describe details of an important occasion. For example, I have no trouble recalling where we went on our first date and what we had for dessert.

Our memory clings to yard posts. We need to forget trivial matters so that we can concentrate. In the medical literature, there are reports of people who can remember almost everything they come across. Are they more successful than ordinary people? Quite the opposite. Many of them are absorbed in trivialities and are hardly functional at work.

On the other hand, if there is nothing worth remembering, a year would go by without a trace. Young kids find everything new and exciting. Their days are long. While we have passed this stage, we should not forget that life is worth living.

3 Jan 2013


I just finished reading Moonwalking with Einstein by Joshua Foer during the holidays.

No, it is not a book about physics. Instead, that was a story about a journalist who decided to take part in a memory contest after he interviewed some ‘mental athletes’ at one such event. During the preparation, he learned various methods to memorize words, numbers and cards. The book also reviewed the history of mnemonics and the value (or lack of value) of those techniques in the digital age.

At one point, Foer encountered something we all must have experienced before – his performance ceased to improve despite further practice. His advisor suggested him to look up literature on typing speed. When one learns typing, there is first a sharp learning curve. Most people, however, reach a plateau soon and the typing speed becomes constant. The same phenomenon occurs in almost all acquired skills such as playing musical instruments and sports.

That said, it is clear that the plateau (Foer called it OK plateau) is not an insurmountable barrier. In sports events, for example, records are broken year after year. The main reason for staying in the plateau is because our conscious performance has become automatic. After some training, we can type words without consciously thinking about it. However, it is possible to type even faster by getting feedbacks and targeting potential weaknesses, such as a few keys that are particularly slow. After that, this may turn automatic again and become our new plateau. The trick, therefore, is to have the heart and skills to improve.

Does it mean that we must fight against plateaus? Certainly not. We need to do most things automatically so that our mind is free to focus on more important areas that merit improvement. As the New Year starts, however, it is time to examine if we have allowed too many important parts of our lives stuck at the OK plateau.