Who's your daddy?

Depending on your intonation and inflection, the phrase above could be either:

a) an innocent inquiry, or
b) an invitation to violence, or
c) taunting someone after pwning to the nth degree.

In the common parlance, (c) is commonly the favoured answer. But option (a) can be quite the booby trap, snapping steel-trap jaws on the unwary.

Sperm donation has made possible many infertile couples to have children. It has also allowed single women to have biological children as well. Once upon a time, sperm donations were relatively anonymous: all a donor had to do is fill up a questionnaire regarding his health and education and off he goes produce the desired fluid in privacy (with the help of a handy visual aid or two). Most fertility centre pay these men for their time (and specimen!), making it particularly an attractive way for college-age men to afford the weekend beer.

As more awareness of the ethical considerations of this issue surface, more stringent regulations are put into place to control assisted reproduction technology. Many countries, particularly in Europe and United States are no longer allowing anonymous donation, driving down the number of sperm donors. Lack of anonymity renders them vulnerable to unwanted contact with their offspring and even potential financial assistance demand. There are a number of donors who are categorised as open donors; i.e. they are alright to being approached by their offspring after they reached 18. However, their numbers are relatively small.

So what is your obligation to your gamete? Your donation has made a child, a person of his/her own right. Someone who is genetically linked to you. Whether or not you have any kind of relationship with the mother, or even know who she is, the child is half yours; 50% of the child's chromosomes come from you. That in itself means that you have a moral obligation to play a role in the child's life.

Women who get pregnant (either planned pregnancy or otherwise) are expected to want their children and to take care of them until they mature. Therefore women are expected to bear the burden of their fecundity by default. So why is it women who opted to terminate their pregnancy (without it being a health risk) are pilloried? Why are men exempted from this?

Many religions frown upon gamete donation. In muddies the relationship and lineage of inheritance. A number of people conceived via gamete donation has decided to look for their biological parent, hoping to fulfill some kind of emptiness from the lack of knowledge of their familial history. And as more women donate their eggs, there is the possibility that one day we will hear of people looking for their donor mothers.

By the way, if you think that sperm donation is only for the heathenish West, think again. We also have them in Malaysia. *snicker*

Of veiling kathoeys and bearded bois

What comes to mind when one says, Iran?

Nuclear warheads pointing westward? Bare-chested bearded men flagellating themselves down the avenue a la the best Folsom Street tradition? Xerxes and his funky curls?

I was privileged to experience first hand the beauty of the country and marvel at their historical monuments. The food is marvellous and travelling there can be pretty cheap. You get the pleasures of the four season and easy food (for Muslims).

But do many people realise that Iran is actually transsexual friendly? Apparently they lag second behind Thailand for the number of sex-change operation conducted annually. Yup, that means chopping off the family jewels and constructing a new plumbing system. Or creating new package where there wasn't any. If you want the gory details, go google it yourself.

Now, you may think ... nah ...

But seriously, the Shiite clerics are pretty enlightened about a number of things. The late Ayatollah Khomeini issued a fatwa to allow a trans-woman to undergo surgery, after asking his physicians to explain to him the difference between a hermaphrodite and a transgendered person. He believed that a good Muslim need to have a proper gender identity in order to fulfill his/her spiritual obligations and if that means going under the knife ... then so be it. Once they are the gender of preference, they are obligated to adhere to the conventions pertaining to their gender; e.g. veiling for women and beards for men.

This however, does not mean homosexuality is legal. They adhere to the strict interpretation of the Shariah law whereby men who have same-sex relations (the biblical knowing, okay?) can be sentenced to death. But a woman can marry a man who was born a woman (and vice versa).

The Government also issues a new set of documents to people who had undergone gender reassignment surgery for their new identity. So no getting flagged at the airport because the passport picture doesn't match. Isn't that wonderful?

So Fatine, hie yourself to Tehran, pronto!

Salting the wound

It is quite common to hear stories about men, who, after divorcing their wives (and marrying another), skedaddles without paying the ex-wife child support. This is worse if the ex-wife hasn't got the means to support the family; either through lack of education or disability. These men are scums of the earth what ought to have their names printed in the newspapers in font 100 (at least) declaring their irresponsibility (apart from the tarring and feathering and proper enforcement of court-ordered paycheque deduction).

But what about men who have been faithfully supporting the wife and child and then discovering said child is not his? What if after the divorce, the ex-wife marries the man who is the biological father of the child and still HE has to pay for child support of a child who carries none of his DNA strands?

Would love trumps the biological imperative for continuing one's genetic inheritance? In the case of Mike L., this appears to be so; proving that not all men who left their wives are scums and that women's cheating have a long and just as terrible a consequence as when a man cheats.

DNA testing: opening Pandora's box in more ways than one.

:p

Thanks a lot ...

You are a mathematical genius who was instrumental in breaking the codes used by your government's enemy to help win the second world war. Your brilliance helped pave the way of the modern theory of computation. How does your government repay you for your loyalty and service?

By chemically castrating you.

You can't get it up no more, humiliated by the witch hunt trial that ended your career by taking away the security clearance required to do your job and kill yourself at the age of 41.

Fifty five years later, the Government apologised. Gee, thanks, Mr Brown.

R.I.P. Alan Turing.

How to live with a hole in your soul (or torso)

Ganked in its entirety from Medscape. But it is sooooo fun and gruesome and the not-so-little geek in me just wanted to have a show and tell.

From Medscape General Surgery > Historical Perspectives in Surgery

The Case of the Wounded Woodsman and His Dedicated Physician

Albert B. Lowenfels, MD

Published: 09/02/2009

The Case

The patient was a 28-year-old, healthy itinerant laborer who was accidentally shot at close range by a companion. The shell entered the left anterolateral side of his body a few inches below the left nipple. The patient fell to the ground but remained conscious. A physician who examined the patient shortly after the accident noted a large wound of entry about the size of a man's hand, but no wound of exit. The left lung protruded through the opening along with a portion of the stomach, with an opening caused by the bullet. Several adjacent ribs had been fractured. Food from a recent meal was present in the wound.

In describing the patient's injury, his physician wrote: "I considered any attempt to save his life entirely useless." Nevertheless, his physician debrided the wound, replaced the protruding stomach and lung, and applied a protective dressing. On the following day, the patient developed fever, a cough, and had evidence of pneumonia. For the next week, the patient continued to be febrile; the wound became infected; and the patient was fed rectally.

To the physician's surprise, over the next several weeks the patient's condition gradually improved, although the gastric wound never completely closed. Nevertheless, he could tolerate oral feedings if the gastric opening was occluded with a compressive dressing. Over the next year, the patient's strength gradually returned to normal, but the gastric wound refused to close. The physician made an arrangement with the patient to follow him more closely and to study his gastric physiology; these studies continued intermittently over the course of many years.

Who was the patient?

Daniel Boone

Kit Carson

Alexis St. Martin

Paul Bunyon

Who was the physician?

William Osler

William Beaumont

Harvey Cushing

William Wells

Brief History of the Physician and His Patient

William Beaumont (1785-1853) was born into a farming family and grew up in Connecticut, where he remained until his early 20s when he joined his brother in Upstate New York.^[1] There, he taught school for several years, before deciding at the age of 25 to study medicine. Although it was possible in the early 19th century to practice medicine without any formal training, Beaumont became an apprentice to Dr. Benjamin Chandler, a prominent Vermont physician. This apprenticeship lasted for 1 year, covered both medicine and surgery, and led to certification by the Vermont Medical Society. His training never included any formal background in physiology, and it is unlikely that Beaumont was aware of the available rudimentary knowledge of gastrointestinal physiology.

Figure 1. Portrait of William Beaumont, frontier doctor and scientist.
From Gillett MC. Early campaigns in the North, 1812 to 1813. In: Matloff M, ed. The Army Medical Department 1775-1818. Army Historical Series. Available at: http://history.amedd.army.mil/booksdocs/rev/gillett1 Accessed August 26, 2009

In 1812, a few months after receiving his certification, Beaumont enlisted in the US Army, and then actively engaged in war with the British Empire. Eventually, after the conclusion of the War of 1812, Beaumont was posted to Fort Mackinac, an important trading post located on a small, remote island between Lake Huron and Lake Michigan.

By good fortune, Beaumont was at the Fort on June 6, 1822, when Alexis St. Martin, a French-Canadian employee of the American Fur Company, was accidentally shot in the left chest. Beaumont had received some surgical training during his apprenticeship and additional experience while caring for injured soldiers during the War of 1812. Without Beaumont's presence, it is unlikely that St. Martin would have survived such a serious injury.

St. Martin came from a background that was very different from Beaumont's. According to his birth certificate, St. Martin was born in 1794, in the small Canadian village of Berthier. His family, who originated from Bayonne, France, was poor, and St. Martin grew up to be an illiterate trapper. He earned his living as a fur trader and voyageur (a porter and large cargo canoe man) in the region between what is now Michigan and Canada. When he was wounded, St. Martin was 28 years old and unmarried.

When St. Martin was sufficiently recovered, he signed a contract with Beaumont, who offered him employment as a handyman in return for a stipend, food, and permission to carry out experiments on St. Martin's stomach. To facilitate the research, and to ease the financial burden on the physician, the US Army made St. Martin a sergeant, paying him a small salary.

About a year after St. Martin's injury, when Beaumont realized that the gastric wound was unlikely to close, he began detailed studies of the process of digestion within St. Martin's stomach. These experiments, conducted with the often reluctant St. Martin, continued intermittently over the course of about a decade. St. Martin agreed to travel to Europe to be examined and studied by leading physicians, including Claude Bernard, but he changed his mind before embarking on the voyage. He never did go to Europe, but he did exhibit his fistula at several American medical schools.

Despite Beaumont's efforts, the wound never completely healed; nevertheless, St. Martin was able to resume a nearly normal life if he plugged up the gastric opening with a piece of cloth. Eventually St. Martin married and had several children. He was always poor, however, and frequently drunk. His health, despite the fistula, was sufficiently robust so that he could support his family by hard labor, such as chopping wood.

Regardless of his persistent gastric fistula and his heavy consumption of alcohol, St. Martin lived to be 86 years old; even now this is well above the normal life span for white men in North America. As for Beaumont, after completing his army service, he settled in St. Louis, Missouri, where he practiced medicine until he died in 1853 from a head injury after falling on an icy path. St. Martin outlived his physician by several decades.

Prior to St. Martin's death, prominent physicians, including William Osler, had tried without success to persuade the family and the patient to agree to an autopsy.^[2] Osler was particularly anxious to examine St. Martin's famous stomach and to have it preserved in the US Army Museum. However, the family was vehemently opposed to any further contacts with the medical profession. To ensure that his body would not be disturbed, the family buried St. Martin in an unmarked deep grave. Only in 1962, more than 80 years after his death, did the Canadian Physiological Society place a marker at the approximate grave site.

What Beaumont Added to the Knowledge of Gastric Physiology

Before Beaumont's long-term observation of St. Martin's progress, other patients had sustained gastric wounds and lived with a gastric fistula, but none had been studied in a scientific fashion.^[3] Toward the end of the 18th century, the Italian Lazaro Spallanzini conducted a series of experiments and concluded that the stomach contained an active principle and that digestion was more than a simple mechanical process. In 1803, Jacob Helm, a Viennese physician, studied a middle-aged woman with a gastric fistula, noting the ability of the gastric juice to act upon stomach content. Just prior to Beaumont's first publication, an English chemist, William Prout, noted that the stomach secreted hydrochloric acid.^[4] It is unlikely that Beaumont knew about any of this work on the stomach: His observations are unique.

Without any formal training in physiology, gastroenterology, or any branch of science, Beaumont recognized a unique opportunity, and over the course of several years he performed numerous experiments that led to a solid foundation for gastric physiology. The astonishing aspect of Beaumont's research is that under difficult circumstances he took advantage of a rare chance to study digestion by visualizing the interior of the stomach and obtaining samples of gastric juice from a living subject under various circumstances. Moreover, he took careful, detailed notes.

Beaumont performed a series of 3 experiments on St. Martin at geographic locations separated by thousands of miles.

Figure 2. Map listing locations and dates for major events in the lives of St. Martin and Beaumont.

The experiments were carried out under less than ideal circumstances on a patient who was not always cooperative. Today, it would be difficult to obtain approval to perform a similar series of experiments. Beaumont describes his first experiment as follows^[5]:

EXPERIMENT 1. August 1. 1825 -- At 12 o'clock, A.M., I introduced through the perforation, into the stomach, the following articles of diet, suspended by a silk string, and fastened at proper distances, so as to pass in without pain -- viz.: -- a piece of high seasoned la mode beef, a piece of raw salted fat pork, a piece of raw salted lean beef, a piece of boiled salted beef, a piece of [unclear] bread, and a bunch of raw sliced cabbage; each piece weighing about two drachms, the lad continuing his usual employment about the house. At 1 o'clock, PM, withdrew and examined them -- found the cabbage and bread about half digested; the pieces of meat unchanged. Returned them into the stomach. At 2 o'clock, PM withdrew them again -- found the cabbage, bread, pork, and boiled beef, all cleanly digested,* and gone from the string...The lad complaining of considerable distress and uneasiness at the stomach, general debility and lassitude, with some pain in his head, I withdrew the string, and found the remaining portions of aliment nearly in the same condition as when last examined; the fluid more rancid and sharp...I did not return them any more.

*These experiments are inserted here, as they were originally taken down in my note-book....

Beaumont published his early results in January 1825, after his first series of experiments and about 3.5 years after St. Martin's injury.

His major contributions to our knowledge of the digestive process included:

• Studies of gastric motility;
• Studies of gastric acidity (recognition of the importance of hydrochloric acid);
• An important role for neurogenic influences on digestion, which eventually led to vagotomy as a treatment for peptic ulcer disease; and
• A suspicion that something other than acid accounted for the stomach's ability to digest food.

Of note, this last substance turned out to be pepsin, which was eventually identified by Theodore Schwan in 1836, shortly after Beaumont concluded his third series of experiments.

How Would the Patient's Wound Be Treated Today?

St. Martin sustained the full force of a shotgun blast fired accidentally at close range, resulting in a complex wound involving the left lung, the stomach, and the diaphragm. Beaumont describes a "fist-sized" hole (approximately 9 x 9 cm) in the left lateral chest wall. St. Martin apparently remained hemodynamically stable after his injury, although the sphygmomanometer wasn't invented for several more decades -- so there were no blood pressure measurements.

Figure 3. Beaumont's sketch of St. Martin's wound about 4-6 weeks after the injury.
From Beaumont W.⁵

Even today, this injury would present a significant challenge to a surgeon.^[6,7] However, long-term results following current surgical repair of severe chest wall injuries are excellent, with patient status being similar to the general population.^[8] Current management would include the following:

• Careful physical examination supplemented by imaging studies to determine the extent of injury.
• If there were a pneumothorax or respiratory compromise following this chest wound, ventilatory support would be provided via an endotracheal tube until the patient was ready for surgery. (Note: there was no mention of shortness of breath from a pneumothorax in St. Martin's case.)
• Exploration via a left thoracoabdominal incision.
• Careful exploration to ensure that no other organs, such as the pancreas or the spleen, had been injured.
• Debridement and cleansing of the original wound to remove shattered rib fragments, necrotic lung tissue, imbedded clothing, fragments of the shell, and food particles.
• Blood transfusion, rather than bloodletting, as was done for St. Martin.
• Closure of the gastric wound and the diaphragmatic tear.
• Repair of the chest wall defect. This would probably require application of a synthetic mesh covered by a muscle flap. If necessary, the repair in the chest wall could be closed with a split-thickness skin graft.

Summary

By a fortunate coincidence, William Beaumont -- a young, resourceful, relatively inexperienced US Army surgeon -- happened to be stationed in a remote fort on the western frontier of the United States when Alexis St. Martin, a French-Canadian voyager, received a near-fatal gunshot wound of the chest. St. Martin survived, but was left with a permanent gastric fistula, permitting Beaumont to perform a series of unique experiments that greatly expanded our knowledge of gastric physiology.

Traditionally, St. Martin's physician has received full recognition for the brilliant series of experiments carried out under primitive conditions. However, St. Martin also should be credited for participating in tedious, repetitive experiments that must have been disagreeable and sometimes painful.^[9] Although not always cooperative, he should be remembered as being perhaps the first of that special group of human "guinea pigs" who have done so much to advance the progress of medicine. Two centuries later, physicians and patients remain indebted to Beaumont and Alexis St. Martin -- Beaumont's often reluctant patient.

Additional Reading

• Green AH. The Market Cultures of William Beaumont: Ethics, Science and Medicine in Antebellum America, 1820-1865 [doctoral thesis]. Baltimore: The Johns Hopkins University; 2007. AAT 3262421.

Internet Sources

• Helms R. Alexis St. Martin (1794-1880): the intrepid guinea pig of the Great Lakes. Available at: http://www.guineapigzero.com/AlexisStMartin.html Accessed August 20, 2009.
• Life of Dr. William Beaumont. Available at: http://www.james.com/beaumont/dr_life.htm Accessed August 20, 2009.

Museums

• American Fur Company Store and Dr. Beaumont Museum. Available at: http://www.mackinacparks.com/ Accessed August 26, 2009.
• Prairie du Chien Museum at Fort Crawford. Available at: www.fortcrawfordmuseum.com Accessed August 26, 2009.
• William Beaumont Birthplace. Available at: http://www.james.com/beaumont/dr_birthplace.htm Accessed August 26, 2009.

References

1. Horsman KR. Frontier Doctor. William Beaumont, America's First Great Medical Scientist. Columbia, Mo: University of Missouri Press; 1996.
2. Sarr MG, Bass P, Woodward E. The famous gastrocutaneous fistula of Alexis St. Martin. Dig Dis Sci. 1991;36:1345-1347. Abstract
3. Modlin IM. From Prout to the proton pump -- a history of the science of gastric acid secretion and the surgery of peptic ulcer. Surg Gynecol Obstet. 1990;170:81-96. Abstract
4. Rosenfeld L. William Prout: early 19th century physician-chemist. Clin Chem. 2003;49:699-705. Abstract
5. Beaumont W. Experiments and Observations on the Gastric Juice and the Physiology of Digestion. Mineola, New York: Dover Publications, Inc.; 1959. Available at: http://books.google.com/books?id=H6F4_9joRkgC&pg=PA8&dq Accessed August 20, 2009.
6. Koch H, Tomaselli F, Pierer G, et al. Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy. Eur J Cardiothoracic Surg. 2002;21:874-878.
7. Weyant MJ, Bains MS, Venkatraman E, et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg. 2006;81:279-285. Abstract
8. Mayberry JC, Kroeker AD, Ham B, Mullins RJ, Trunkey DD. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg. 2009;75:389-394. Abstract
9. Myers NA, Durham-Smith E. A debt to Alexis: the Beaumont-St Martin story. Aust N Z J Surg. 1997;67:534-539. Abstract

Authors and Disclosures

Author(s)

Albert B. Lowenfels, MD

Professor of Surgery, Professor of Community Preventive Medicine, New York Medical Center, Valhalla, New York; Emeritus Surgeon, Department of Surgery, Westchester Medical Center, Valhalla, New York

Disclosure: Albert B. Lowenfels, MD, has disclosed that he has served on an advisor to Solvay Pharmaceuticals Inc.

Medscape General Surgery © 2009 Medscape, LLC

Lunacy in sanity?

I am a firm believer in self determination. If someone is ill, that person has the right to dictate the kind of treatment he/she wishes to receive and whether or not to continue with the regime. This is fairly straight forward when one is dealing with a functional adult of sound mind.

But what if that person is a minor?

The bioethics involved in treating a minor is still in a murky zone. Status quo indicates that the decision regarding the welfare of a minor rests in the hand of the child's guardian. Hence, the guardian has a a right to push or even reject a treatment for a minor. This is easy enough if a child has no bigger complains than the usual coughs and colds and playground injuries. However, it has come to fore of parents (and guardians) who are refusing treatment or seeking harmful or even allowing the minor to remain untreated for reasons of faith or even non-spiritual belief.

In the case of Colleen Hauser and her son, Daniel, who fled their home in Minnesota to escape court-ordered chemotherapy, who is in the right? The mother, who believes that her child should not have toxic materials injected in him because she favors the natural healing methods of an American Indian religious group known as the Nemenhah Band? Or is it the court who determines that Daniel would benefit from conventional treatment that has been proven to cure Hodgkin's lymphoma?

Many cultures imbue the right of parents to determine the decisions affecting their children. It is not uncommon in Asia for neighbours to look the other way while a child is being disciplined; of course in some cases, such discilinary measures not only verge but enter the realm of abuse and still people will accept that it is the right of the parents to act in such a manner. In the West, this feature has changed with the adoption of bills that prohibit parents from using corporal discipline on their children. It got to such that a mother cannot smack her toddler's bottom for being mischeavous in public.

But in the case of Colleen and Daniel, who have the right to determine what is best for him? It would seem to many that his mother is jeopardising his life by refusing him treatment and influencing him to reject it as well. In the case of Madeline Kara Neumann, who died from untreated diabetes complication, her mother rejected conventional medicine and instead, chose to have her healed via faith healing. Whether it is laying of hands or dependence on supplements and sweat boxes, these are parents who chose other treatment options for their children out of their own particular belief system (regardless of what faith they hold to). One of the extreme cases involved very young children who had the devil tormented out of them by a rabbi with consent from their mother. One of the child now suffers permanent brain damage.

As a person of faith, I am appalled at how belief system can be perverted in such a way as to inadvertently harm vulnerable children. But then again, people have used faith to justify harming other people with purely malicious intent. One would think that with the brain that The Almighty has gifted them, they could reason better than that.

But apparently, not.

*shakes head*

Learning Sans Ego

It was reported at a meeting of the Society for Healthcare Epidemiology of America in San Diego on Saturday that something as simple as balling up your paper gown and stuffing it in your gloves prior to disposal has a 26 - 62% rate of success at reducing hospital acquired infections. This measure has been included as one of three "Positive Deviance approaches that the CDC has found reduced infection rates at hospitals. PD is based on the premise that in any group there are natural problem-solvers".

The innovator: a humble patient escort named Jasper Palmer.

I'm glad to hear that august surgeons, clinicians as well as other hospital staff are willing to learn from Mr Palmer. Many a time people are not willing to learn from those they deem to be beneath them, no matter how egalitarian the society. It is nice to hear that people are serious about the problem of nosocomial infections that they are willing to listen to sensible solutions proposed by someone without a PhD.

Lovely.

Robbing Peter to Pay Paul ... The Good Version

The economic crunch is hurting pretty much everyone. You can't help but feel your blood boil when you read about how the AIG execs are still getting their bonuses (after screwing up other people's life savings, thank you very much) and the President of the Royal Bank of Scotland keeping his USD 1 million pension (also after screwing up other people's life savings).

And then you read how the doctors at the Beth Israel Deaconess Medical Centre in Boston is giving up part of their pay to help support their departments and stave off lay-offs. It appears that each of the heads of department are willing to contribute $27,000 of their annual salary to the cause. I have no idea whether this would suffice to bolster the financial woes of the hospital, but I think a contribution of $350,000 would make a dent to reduce potential redundancy.

Your faith in human nature is restored.

Paging Dr No ...

Huh. Apparently in Sweden even convicted murderers can be accepted into medical school. I guess the 6 and a half years in prison gave him plenty of time to study and get awesome enough grades to get in.

But seriously, wouldn't you worry if your physician is a convicted felon? So he's smart, brilliant etc etc, but if he has race issues and you are definitely too coloured for his taste? A bit iffy, no? Vetting for entrance into medical school has always been a hotly debated issue, ranging from scholastic performance to extra curricular activities and even mental and psychological aptitude for the work. I guess now the Swedes will have to include query of legal issues in the application forms. In Malaysia, if you were ever in trouble with the law (say, you used to boost cars in your misspent youth or was busted during a nightclub raid), you can kiss your university entrance goodbye, much less the august medical schools.

So what makes good doctors? How do we make sure that the ones with the right stuff to become good doctors are given the chance to get into medical school? Should we allow a brilliant Nazi sympathiser (and every other colour of this sort) to get in because of his/her scholastic excellence?

*rubs chin thoughtfully*

Unwitting Participants of a Ponzi Scheme?

Man, I'll bet three months ago you would not know what is a Ponzi scheme. But thanks to Bernard Madoff, we understand that a Ponzi scheme is a "fraudulent investment operation that pays returns to investors from their own money or money paid by subsequent investors rather than from any actual profit earned." (per Wikipedia).

It seems that with the economic downturn afflicting the global economy, a great deal of attention has been placed on issues that previously are never really caught the limelight. One of them is the health insurance issues plaguing the United States. Physicians on the Medscape's Physician Connect have alleged that "commercial, for-profit health insurance is one of the greatest Ponzi schemes ever foisted on the public". As I understand it, patients do not pay directly to the doctors for treatments and prescription, but the insurance will handle it. Dubbed to be consumer driven health care, the American health insurance is a billion dollar industry. What this means? Read here.

I would like to believe that good health care should be the rights of all, especially in the self-dubbed greatest country on Earth. But it does look like the basic economic principle of "those who can afford, gets it; those who can't afford, forget it" is still at play here. Many have hung their hopes that the Obama administration will do their utmost to resolve this issue. I sympathise with the Americans who skimped on drugs that their insurance companies balked to cover or those who can't afford it, as they are the ones who are the greatest hit by the economic downturn and hope that Mr Obama and his crew will manage a miracle on this.

Malaysians should be grateful that they can get decent health care at Government hospitals with minimal payments for treatment and prescription. Even those who work in the private sector is still partially subsidised by the Government even though they pay more than civil servants. Those with diabetes and hypertension who needs long-term medication to control their condition, should they know the true price of the drugs they consume, would be a little more appreciative of the efforts of the Goverment.

Granted there is room for improvement, especially in terms of service delivery and time turnovers, but at the very least, you do get treated. Unless of course, if you decide to trust the medium/bomoh/tok dukun who promised you the cures of all ailments from cancer to baldness. Then, by all means, go to them. Let other people benefit from the Government hospitals.

Eggs for Sale?

Women are oftentimes the first and hardest hit during economic downturns. They can act as the barometer of financial weather: look for numbers of women getting the pink slip and pay cuts. Believe it or not, there are still employers who do so with the draconian idea that women always have a man to look after them; hence, it is okay to lay off the female workers first.

However, for many single parent households, it is the women who are the sole breadwinners. Married women contribute to the financial health of their family. Often times, you hear daughters setting aside money for their parents, but quite often you hear that sons do not do the same: they have their own nuclear family to support and cannot afford to do so.

There are reports that in this time of economic crisis, women are resorting to selling parts of their body. No, not the oldest profession (although motherhood is the oldest job, and to this day, still no hazard pay, pension or days off), but selling their eggs. Egg harvesting is risky, painful and financially rewarding. A sperm donation is worth only USD 60 at fertility clinics, but eggs can fetch up to USD 10,000. Many young college women have been lured with the promise of paying back student loans with something that their body discard monthly anyway. They put not just their future fertility on the table, but also their health and life. Stimulating ovulation puts undue stress on the body and the long term effect is not known, as the practice of egg donation started as recent as 14 years ago.

But seriously, what a tempting offer.

Can We Afford to be Moral?

In times of painful economy, it appears that ethics is about to take a flying leap out the window. In New Zealand, at least.

Oh, boy.

A Nail that Sticks Out, Gets Hammered

I remembered that quote from Tokyo Drift, the 3rd of the Fast & Furious franchise that launched Vin Diesel into the stratosphere of stardom. The father of the protagonist quoted the Japanese saying in hopes of getting his son to keep his head down, nose clean and no getting into trouble.

But what if keeping to ourselves means smothering our conscience to the expense of our health; physical, mental and emotional? I posted earlier on how nurses have one of the most stressful and dangerous job; it seems here that it does appear as though there is no way for a nurse to win.

A job should be one that not only helps pay your bills, but also fulfills something inside so that it becomes an ibadah (i.e. a way to serve God). But when you have to decide between your professional health and voicing out your concerns, it is really tough indeed. How often do you find yourself swallowing your view points that is for the benefit of your clients/patients/students/etc because you are afraid that the upper echelons will fall on you like the proverbial tonne of bricks?

Perhaps it is better to balik kampung dan tanam jagung*.

*return to the hometown/village and plant maize

Living with a Lab Rat

As I dip my toes into looking at human subjects, it became clearer to me how hard it is to recruit subjects who not only fits the criteria you wish, but also those who would agree to be poked/prodded/electrocuted etc.

I got the link to this article in NYTimes from The Scientist' Community and when I started reading, I thought, "Hey, why not?" My cousin who was working on juvenile immune response recruited her nieces and nephews for her study. She bribed them to agreeing to come with her to the hospital to have their blood drawn. To date, there don't seem to be any kind of negative effect from their participation in her Master's project.

In general, children have an innate desire to please the adults in their life; be it a parental figure or any other caretaker. Is their consent for the study something taken for granted or is easily waived away because their parent(s) signed the parental consent form? What happens when they grew up and decided that they were not happy with having participated in the study and wishes for the data to be withdrawn? That is something that have been seen in adult participants who withdrew from studies.

I wonder if any of the children who participated in their parent(s)' studies have ever said something along the lines of, "Hey, my data helped you get that professorship. How about springing a car/Playstation/new dress etc for me?"

*ponders*

Doping your way to higher grades/pay scale

When looking at a student's grade, do we ever think about the effort it takes to achieve it? Swotting, sure. Some all-nighter perhaps. So what if the kid knocks back a couple of Red Bull to keep his/her red rimmed eyes open to cram as much as possible for tomorrow's paper. No biggie. But taking and (most likely) abusing a controlled drug? Would that be considered extreme?

This commentary in Nature deserves some examination. According to some, as human beings, we owe it to ourselves to go further than ever with the aid of such enhancement. For others, it is "unnatural" and therefore abhorrent.

Whatever your take on this, you can betcha if I could line me some Ritalin, I would not hesitate to take it for my all-nighters, warranted or not.

Does that make me a bad person?

*ponders*

Don't go gently into the good night ...

Or something like that. Yeah, quote abuse abounds in this blog.

Anyway, to my point. Euthanasia is something that is hotly debated the world over. Some countries legislate it and allow people; commonly the terminally ill or massively disabled, to end their lives. Belgium allows assisted suicide, so does Switzerland and some states in the USA, notably Oregon.

Why do these group in the population request for assisted suicide? Well, primarily because they can't do it themselves. They are seriously ill with limited physical ability or was injured severely that they can no longer perform daily tasks such as feeding themselves, walking etc. Why do they want to die? Is their physical condition or deterioration reason enough to snuff out their life? Well, judge not lest ye be judged, is all I can say.

I do not want to judge people who opt for this decision. No one wants to live out the rest of their life infirm and dependent on others for their physical needs. The loss of dignity and being a burden is something that is feared by many, with good cause. To lose control over one's body, to not be able to care for oneself the way one has always done so, whether due to physical or mental deterioration, is something that no one wants to contemplate. But millions of people the world over have to live (and slowly die) with this reality.

It is easy to say, when you are whole and hearty, that you'd rather die than become paralysed. But if that is your reality, can you actually make a firm decision to choose to die? Or for someone whose physical condition slowly diminishes, taking away their dignity and quality of life, does it take more strength to die or to live? I think that no one who have to live with such reality, or have someone they love live with that reality, should make any kind of judgment.

Most religion forbids the taking of life, with suicide one of the greatest insult of all. If you are a person of faith, it is perhaps, not so difficult a decision to make. But for many without the comfort of faith and devotion to The Divine Being, the lines can be as blurred as the tidelines come monsoon.

But to broadcast this choice in the name of education, documentary, what-have-you, is that acceptable? I wonder if the station actually warns viewers of possible disturbing content that they may see from the film. But even if they do so, it is human nature to gawk at horrid circumstances.

Just ask any faithful rubberneckers at the highway accident.