A friend sent me a CD recently and asked me to have a look at the booklet.
The CD was a remix of Paula Tsui’s songs. In the booklet, Chet Lam described Paula as a respectable singer who insisted to do her own music with little regard to the trend.
The analogy I immediately recalled was Franz Schubert. A prolific composer who wrote almost a thousand pieces before he died at 32, Schubert was unfortunately not very much treasured during his days. The audience then favored ‘grand’ pieces, and his romantic style was too soft for their taste. Several decades after his death, his works became increasingly popular. Of course, similar stories are just all too common among artists. When people become history, we can finally filter out the influence of trend and see their true worth.
To sidetrack a bit, Schubert’s works were also mentioned in Kafka On The Shore by Haruki Murakami. In one scene, Oshima talked about Schubert’s Piano Sonata in D.
“It’s a tough piece to master. Some pianists can play one or maybe two of the movements perfectly, but if you listen to all four movements as a unified whole, no one has ever nailed it. A lot of famous pianists have tried to rise to the challenge, but it’s like there’s always something missing. There’s never one where you can say, ‘Yes! He’s got it!’ Do you know why?”
“No,” I reply.
“Because the sonata itself is imperfect. Robert Schumann understood Schubert’s sonatas well, and he labeled this one ‘Heavenly Tedious’.”
“If the composition’s imperfect, why would so many pianists try to master it?”
“Good question,” Oshima says, and pauses as music fills in the silence. “I have no great explanation for it, but one thing I can say. Works that have a certain imperfection to them have an appeal for that very reason – or at least they appeal to certain types of people. Just like you’re attracted to Soseki’s The Miner. There’s something in it that draws you in, more than more fully realized novels like Kokoro or Sanshiro. You discover something about that work that tugs at your heart – or maybe we should say the work discovers you. Schubert’s Sonata in D Major is sort of the same thing.”
I knew Schubert’s sonata was not popular but did not know it was imperfect. I knew what I was doing was imperfect but did not know it was not popular. In any case, I will continue to do what I think is right. And thanks for the CD.
18 Oct 2012
11 Oct 2012
Trick or Treat
Last week, some Dr Chau demonstrated a novel way of tackling medicolegal issues. “The aim of the procedure is to enhance health. So it is not a medical procedure. All our clients have signed documents and agreed that this is not a medical procedure.” According to his definition, anything from hernia repair to kidney transplantation can be regarded as not a medical procedure.
Doctors can be the worst kind of cheaters. Other cheaters only want money. When doctors cheat for money, they do unindicated and potentially harmful procedures. I can just pray that would not happen to my students.
Doctors can be the worst kind of cheaters. Other cheaters only want money. When doctors cheat for money, they do unindicated and potentially harmful procedures. I can just pray that would not happen to my students.
4 Oct 2012
Protocol
I learned almost everything about clinical trials from KL during my trainee days.
On average, he spent half a year to write a study protocol. The protocols were down to the finest details. For example, he would obsessively describe where the randomization codes would be kept and who could read the codes. It always amazes me that we are still in the middle of the NSAID No. 8 Study (KL had already been promoted to Chairprofessor after No. 7). To him, a clinical trial is a symphony, not a piece of homework to the Research Grant Council.
Completion of a protocol is just the beginning. Every day, he stayed at the Endoscopy Centre to see trial patients and perform endoscopies. In addition, he would find out every case that should be entered into his trial and remind us not to miss it next time. Remind is a soft word.
At one time, I became his roommate during an American meeting. The No. 7 study had just been completed, and KL was preparing the manuscript. For three days, he sat in front of his laptop without typing a word. I asked what was going on and he said he was thinking how to write the first paragraph of the discussion section. Interested readers may find the final version of this paragraph at Lancet 2007;369:1612-6.
On average, he spent half a year to write a study protocol. The protocols were down to the finest details. For example, he would obsessively describe where the randomization codes would be kept and who could read the codes. It always amazes me that we are still in the middle of the NSAID No. 8 Study (KL had already been promoted to Chairprofessor after No. 7). To him, a clinical trial is a symphony, not a piece of homework to the Research Grant Council.
Completion of a protocol is just the beginning. Every day, he stayed at the Endoscopy Centre to see trial patients and perform endoscopies. In addition, he would find out every case that should be entered into his trial and remind us not to miss it next time. Remind is a soft word.
At one time, I became his roommate during an American meeting. The No. 7 study had just been completed, and KL was preparing the manuscript. For three days, he sat in front of his laptop without typing a word. I asked what was going on and he said he was thinking how to write the first paragraph of the discussion section. Interested readers may find the final version of this paragraph at Lancet 2007;369:1612-6.
27 Sept 2012
Change
When I was a house officer, the department implemented a new policy – All intravenous catheters were to be replaced every 3 days to prevent phlebitis and bloodstream infections. Our group read aghast the memo. That meant a lot of extra work.
That evening, I wrote an e-mail to Angela (I was trying to date her back then), explaining why the new policy was not evidence-based and detailing the study design required to answer this question.
Imagine how I felt when I read Lancet last Saturday. Claire Rickard and colleagues from 3 Australian hospitals randomly assigned 3283 patients who required intravenous catheters for several days to change catheters every 3 days or only when clinically indicated (Lancet 2012;380:1066-74). Phlebitis occurred in 7% of patients in both groups. Nine patients in the routine replacement group and 4 in the clinically indicated group developed bloodstream infection. The authors concluded that both groups were equivalent and the practice of routine catheter replacement should be abandoned.
The study was strikingly simple and could be designed by a house officer like me. Why then, you may ask, was the study not published by me 10 years ago instead?
During a casual discussion on study planning, I mentioned a friend with my Mentor and remarked that he had loads of brilliant ideas but surprisingly few publications. He agreed with my observation and thought for a while. Then he said, “We do not know how he does things. I suspect he lacks the ability to complete a project. You can have a wonderful idea every day, but nothing will happen if you do not do anything.”
P.S. The dating request in the same e-mail was, as you can guess, successful. The intravenous catheter policy, on the other hand, was surprisingly short-lived.
That evening, I wrote an e-mail to Angela (I was trying to date her back then), explaining why the new policy was not evidence-based and detailing the study design required to answer this question.
Imagine how I felt when I read Lancet last Saturday. Claire Rickard and colleagues from 3 Australian hospitals randomly assigned 3283 patients who required intravenous catheters for several days to change catheters every 3 days or only when clinically indicated (Lancet 2012;380:1066-74). Phlebitis occurred in 7% of patients in both groups. Nine patients in the routine replacement group and 4 in the clinically indicated group developed bloodstream infection. The authors concluded that both groups were equivalent and the practice of routine catheter replacement should be abandoned.
The study was strikingly simple and could be designed by a house officer like me. Why then, you may ask, was the study not published by me 10 years ago instead?
During a casual discussion on study planning, I mentioned a friend with my Mentor and remarked that he had loads of brilliant ideas but surprisingly few publications. He agreed with my observation and thought for a while. Then he said, “We do not know how he does things. I suspect he lacks the ability to complete a project. You can have a wonderful idea every day, but nothing will happen if you do not do anything.”
P.S. The dating request in the same e-mail was, as you can guess, successful. The intravenous catheter policy, on the other hand, was surprisingly short-lived.
20 Sept 2012
Fight
Last weekend, we watched a powerful demonstration of national education by our countrymen in the news. We could not help but wonder if our country would be dragged into war again.
At the turn of the last century, the prevailing view among academics was that large-scale warfare would not happen in Europe anymore because of the high level of economic development. The cost of war would be too great for any country. Unfortunately, shortly after the proclamation, two biggest wars in history broke out one after another.
If economic reasons are not strong enough to stop people from making stupid decisions, can globalization help? For two groups of people to kill each other, the distinction between ‘them’ and ‘us’ has to be clear cut. Soldiers are even trained to see enemies as animals. To do so, however, one has to be sufficiently unfamiliar to people in the opposing party. Even during relatively modern combats such as the Gulf War, the average soldier knew close to nothing about the culture, religion and life of his enemies. Now, we know our neighbors so well. We visit their cities, watch their movies and eat their noodles. Some of them are nasty, but so are we and the rest are good people. Is this knowledge good enough? I am not sure.
That said, a country should be defined by its people but not the number of uninhabited islands it claims. Sacrificing precious lives for sacred and oil-soaked soil? My answer is no.
At the turn of the last century, the prevailing view among academics was that large-scale warfare would not happen in Europe anymore because of the high level of economic development. The cost of war would be too great for any country. Unfortunately, shortly after the proclamation, two biggest wars in history broke out one after another.
If economic reasons are not strong enough to stop people from making stupid decisions, can globalization help? For two groups of people to kill each other, the distinction between ‘them’ and ‘us’ has to be clear cut. Soldiers are even trained to see enemies as animals. To do so, however, one has to be sufficiently unfamiliar to people in the opposing party. Even during relatively modern combats such as the Gulf War, the average soldier knew close to nothing about the culture, religion and life of his enemies. Now, we know our neighbors so well. We visit their cities, watch their movies and eat their noodles. Some of them are nasty, but so are we and the rest are good people. Is this knowledge good enough? I am not sure.
That said, a country should be defined by its people but not the number of uninhabited islands it claims. Sacrificing precious lives for sacred and oil-soaked soil? My answer is no.
13 Sept 2012
Hugga Wugga
Jonathan’s favorite video clip on Youtube is Hugga Wugga. It features an alien chanting ‘Hugga Wugga’. When it encountered another creature singing another song, the alien bullied it by blowing steam at it. Frightened, the poor creature followed the alien and sang ‘Hugga Wugga’.
Then came a new yellow creature that sang ‘You are my sunshine’. Hugga Wugga tried to silence it by blowing steam again. This time, however, the yellow creature outwitted Hugga, blew steam in its face and subdued it.
Yes, if hunger strike is radical, the yellow creature must be a terrorist.
Then came a new yellow creature that sang ‘You are my sunshine’. Hugga Wugga tried to silence it by blowing steam again. This time, however, the yellow creature outwitted Hugga, blew steam in its face and subdued it.
Yes, if hunger strike is radical, the yellow creature must be a terrorist.
6 Sept 2012
Brainwash
During a case presentation at the grand round, a student kept saying Drug N was the treatment of choice for peptic ulcer. After he had mentioned the drug the fourth time, I could not help but interrupt, “N is a brand name. There are also similar drugs in the same class. You have been brainwashed by the drug company!”
People say that art and humor are the best defense against brainwashing.
At the time of Soviet rule, a government official invited a famous artist to draw a painting to celebrate Soviet-Polish friendship. Seeing his reluctance, the official promised that he would have the freedom of expression, so far if he used the title ‘Lenin in Poland’.
When the painting was unveiled a few months later, the official almost fainted. It showed an ugly peasant woman in the arms of a man in front of Kremlin.
“Who is this ugly woman?” he asked.
“She is Nadezhda Krupskaya (Lenin’s wife).”
“And the man?”
“He is Leon Trotsky.”
Catching his breath, the official asked the final question, “Then where on earth is Lenin?”
“Lenin is in Poland.”
People say that art and humor are the best defense against brainwashing.
At the time of Soviet rule, a government official invited a famous artist to draw a painting to celebrate Soviet-Polish friendship. Seeing his reluctance, the official promised that he would have the freedom of expression, so far if he used the title ‘Lenin in Poland’.
When the painting was unveiled a few months later, the official almost fainted. It showed an ugly peasant woman in the arms of a man in front of Kremlin.
“Who is this ugly woman?” he asked.
“She is Nadezhda Krupskaya (Lenin’s wife).”
“And the man?”
“He is Leon Trotsky.”
Catching his breath, the official asked the final question, “Then where on earth is Lenin?”
“Lenin is in Poland.”
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