Whistleblower Dr Li We Liang has died. He was among the 8 who were arrested on New Year’s Day and warned not to “spread rumours” about a SARS-like outbreak. We now know that Dr Li and his colleague were not spreading rumours. They had stumbled on a the spark of a raging global pandemic. The Wuhan coronavirus, renamed Covid-19, has brought China’s public health system on its knees. Interestingly (for want of a polite word) the authorities are still warning people not to spread rumours.
In the wake of Dr Li’s demise, two courageous influencers, who had been reporting live from Wuhan, Chen Qiu Shi and Fang Bin have disappeared – warning that Dr Li’s death notwithstanding, whistleblowers are still not welcome. Being his hometown, Fang Bin was especially emotional in his revelation of the dire situation in Wuhan. Sadly, we are unlikely to hear from both of them ever again.
The current epidemic appears to be much bigger than SARS. It has definitely infected and killed more people, so perhaps it can be considered something new to China. What can we learn from history? How was the Spanish Flu managed in the US in 1918?
The US had its own whistleblowers back then. The authorities back then, led by President Woodrow Wilson, also acted pretty much in the same way that the Chinese authorities had acted.
Dr Loring Miner of Haskell, Kansas first wrote in Public Health Reports in March 2018 that he was shocked to see dozens of his patients become very sick with what seemed to be “influenza of a severe type” and die. And they weren’t even frail and elderly patients with other health issues. Most of those who died were between the ages of 25-29. He reported his findings to the US Public Health Service which did not take the outbreak seriously.
The mortality rate for the common flu looks something like the dotted U-shaped curve below. The virus kills the most people at extremes of the age scale. Other than infants, the majority of fatalities come from those who have reached the end of their lifespans. For this reason, the common flu is not taken that seriously.
A novel virus like the Spanish Flu virus, however, kills far more infants and hundreds of times more people in their prime. That is why it needs to be taken far more seriously. Why did America not take it seriously? That’s because a law passed in the US in 1917 stated that anyone who would “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the government of the United States” could be jailed up to 20 years. Something like that would be considered unconstitutional in the US today, but Americans would learn it the hard way.
The virus quickly spread in army camps. Some infected soldiers died in 24 hours. One newspaper published the headline: “Vicious Rumours of Influenza Epidemic Will Be Combatted”. 40,000 American soldiers would die from illness caused by this novel virus.
The state of Philadelphia would be determined to deny the epidemic. The Liberty Loan Parade on September 28 would go ahead. Dr Howard Anders begged reporters to write about the dangers posed by the parade. The health of the entire population of Philadelphia would be in peril. None of them wanted to risk a 20-year jail term. The Philadelphia Inquirer gave the following advice:
Live a clean life. Do not even discuss influenza. Worry is useless. Talk of cheerful things instead of the disease.
The parade went on as planned. Just as Dr Anders had feared, the epidemic spread to the civilian population. Less than 2 weeks later, 759 (uncensored) people in Philadelphia had died. Still the Inquirer reported that “Scientific Nursing Halting Epidemic … Officials Say Entire Situation Is Well in Hand”.
Meanwhile, horse-drawn carriages started collecting dead bodies rotting on the sidewalks, projecting images from the plague in the 14th century. The city quickly ran out of coffins and all kind of chests and boxes were improvised. Trucks driven by priests went round to collect bodies as public services became overwhelmed. By the end of October, a little less than one month after the parade, 11,000 (uncensored) people in Philadelphia had died. Death rate for the infected was about 40%. The total death toll in the US was already 195,000 (uncensored) and growing.
In Chicago, the health commissioner claimed that “fear kills more than disease”. As more and more public places were shut down and limits were set on passenger loads on public transport, the public stopped trusting the government and put matters into their own hands. They started wearing masks. Sales of quinine rocketed. Desperate doctors actually prescribed whiskey. People who didn’t ear masks got beaten up. The police arrested those caught spitting. Some became deranged, killing their own family members to stop them from getting the disease.
Then, the virus seemed to get less deadly by 1919 and by 1920, the epidemic was in its last legs. The final tally, 675,000 (uncensored) Americans had died and about 50 million worldwide. It’s called the Spanish Flu because Spain did not suppress or censor reports and thus appeared to have the most cases in their official reports. Deaths reported in Spain over 3 years indicated how the epidemic was tapering off: 147,114 in 1918, 21,235 in 1919, and 17,825 in 1920.
Interestingly, Spain had never asked for the epidemic to renamed Covid-18. It is unimaginable that America will manage things the same way it did in 1918. Can we expect that from other countries?
A very comprehensive update and analysis. Are The Lancet and Vox blocked in China? One important thing to note is that there are three levels of confirmation in determining whether an individual is infected. The procedure is as follows:
Medical team at the first line make a provisional diagnosis.
A team of specialists confirm the diagnosis.
The findings are sent to Beijing for “final confirmation”.
Only then can a case be announced as confirmed. As long as Beijing does not confirm the case, it cannot be announced as a confirmed case. There is thus a very significant delay in the release of latest updates.
The epidemic actually started in October 2019 and not January 2020. The infection is not just lethal to the elderly. Even the young are killed by it. The information was published in The Lancet and Vox by Chinese experts on the ground. Ironically, their findings are not available to the general public in China.
Friends in masks have been showing up on Facebook these couple of days. Yes, it’s the Wuhan virus and so far the Hubei city of 11 million is the only Chinese city that has been locked down. Apparently, it’s a case of closing the stable door after the horse has bolted. The worst blunder from the Wuhan authorities was probably announcing the lockdown of the city some 8 hours before it was to be implemented, causing a massive exodus of Wuhan residents in the wee hours of the morning on 23/01/20. Check out the following video. You can ignore his call to end CCP rule towards the end of the video if you’re not interested in politics.
Meanwhile, our very own MOH sent me an “situation update” via SMS along with a embarrassing dead link. This should not and ought not happen but it did happen, so we’re very sorry that it happened (but it’s not our fault?) I guess it doesn’t matter. There are numerous sources of timely updates out there. A subsequent link I got from TCM Board worked.
Meanwhile, from the Daily Mail 25/01/20:
Leading US health experts predicted a coronavirus could kill tens of millions of people in a chilling warning three months before the deadly outbreak in China.
Scientists at the prestigious Johns Hopkins Center for Health Security modeled a hypothetical pandemic on a computer as part of research last October.
The simulation predicted 65million people from every corner of the world would be wiped out in just 18 months.
So far the highly contagious disease currently ravaging China has killed 26 people and infected more than 900 – but experts predict the true number to be thousands.
Coronaviruses are infections of the respiratory tract that can lead to illnesses like pneumonia or the common cold.
One was also responsible for the outbreak of severe acute respiratory syndrome (SARS) in China, which affected 8,000 people and killed 774 in the early 2000s.
Dr Toner’s computer simulation suggested that after six months, nearly every country in the world would have cases of coronavirus.
Within 18 months, 65million people could die. The outbreak in Wuhan isn’t considered a pandemic, but the virus has been reported in 10 different nations.
The US, Thailand, Japan, South Korea, Taiwan, Vietnam, Singapore, Hong Kong, Macau and Nepal have all confirmed cases.
Dr Toner’s simulation imagined a fictional virus called CAPS – a pandemic that originated in Brazil’s pig farms in the hypothetical scenario.
The virus in Toner’s simulation would be resistant to any modern vaccine. It would be deadlier than SARS, but about as easy to catch as the flu.
His computer modelled outbreak started small, with farmers coming down with fevers or pneumonia-like symptoms. You can read the rest of the article here.
We’ve been told not to panic, but if Dr Toner’s computer-generated model pans out, then the situation is decidedly grave. Panic is of course useless, but how concerned should we be? I’ll be going to China (Nanning, Guangxi) on a business trip at the end of February. How worried am I? On a scale of 1 to 10, maybe 6-7. There are folks out there who say that we should put matters in “perspective”.
Mr Michael Fumento, the American author who wrote the now infamous (thankfully out of print) book The Myth of Heterosexual AIDS (in which he claimed that the only heterosexual people at risk of AIDS are Black women who have sex regularly with drug addicts) wrote a piece in which he seriously downplayed the virulence and potential damage that the Wuhan virus could cause.
In an article published in the New York Post (please note that the New York Post is a tabloid that has nothing to do with the more reputable New York Times), Fumento urged us not to buy into the media hype over the new China virus.
Fumento wrote in the New York Post:
The media are correct in saying the closest comparison here is SARS. It also was first reported in China and was what’s called a coronavirus. But while they want you to remember SARS as akin to the Black Death with cries of “Bring out your dead!,” fact is, there was a grand total of only 8,098 cases, of whom 774 died. Then the disease simply disappeared. More than 7,000 of those cases and about 650 of the deaths occurred just in mainland China and Hong Kong. The United States had just 75 cases and zero deaths.
By contrast, the CDC estimates about 80,000 Americans died of flu two seasons ago.
To be fair to Fumento, the virus may not be as deadly as it is feared and I agree that the seriousness of this crisis could have been exaggerated by experts like Dr Toner. However, complacency has no place in a situation like this. True, evolution selects strains that are less deadly to the host, but while evolution is not random, mutations are. The fact that the virus has evolved to spread from human to human has been a move in the “wrong” direction.
Next, are Fumento’s comparisons of the Wuhan virus with SARS and influenza fair? Consider the late Dr Alexandre Chao who was only 37 when he contracted SARS and died. Had Dr Chao not survived at least a couple of bouts of influenza throughout his 37-year lifespan? Of course he must have. Most young and healthy individuals are only given 2 days’ MC (grossly inadequate, but nobody cares) for flu. With SARS, they could end up in ICU. If SARS killed someone like Dr Chao, then it must be something quite different from influenza – something that we should all be very concerned about and make sure that it does not spread like flu.
Mr Fumento might also want to know that on 25/01/20, a doctor at a hospital in China’s Hubei province, the centre of the coronavirus outbreak, has died from the virus. Liang Wudong, a doctor at Hubei Xinhua Hospital who had been at the front line of the coronavirus outbreak in Wuhan city, died from the virus aged 62. Do any doctors die while treating influenza patients?
The fact that influenza appears to kill so many is because nobody bothers to contain it and the vast majority of otherwise healthy people who are infected recover after two weeks. Only the medically compromised succumb to it. In contrast, desperate attempts have been made to contain SARS. Victims were all ill enough to mandate hospitalisation and robust management of their condition. What if we had treated SARS in the same way that we had treated influenza? For sure, the death toll would not have been just 774.
For the sake of argument, what might have happened if no attempts were made to contain SARS back in 2003? In 1918, the Spanish Flu killed 100 million people or 3-5% of the human population back then. It’s called the Spanish Flu because Spain seemed to have the largest number of cases. It has been found that that’s because Spain was the only country that did not cover up or under-report the numbers. Make no mistake, this was no ordinary flu virus. The deadly thing about this virus is that it could trigger a cytokine storm (overproduction of immune cells and inflammatory factors) which ravages the stronger immune system of young adults. Apparently, that’s how SARS killed so many otherwise healthy adults.
The fatality rate for the Wuhan virus, based on available data, is
only about 2%, but 20% of the those infected require ventilation.
Without timely and adequate treatment, it will certainly not be a 2%
fatality rate. Without robust management and containment, the final
death toll could be closer to that of the Spanish Flu – 50 million.
The medical community is not stupid, paranoid or buying into media
hype. They know the common flu has killed more people this season. But
this is something far more sinister. If
SARS had not been dealt with aggressively, the death toll would greatly
exceeded that of the common flu in any season, any year.
It’s extremely irresponsible for the ignorant denialists to make light
of the situation and point at the “insignificant” death toll without
recognising the herculean effort of medical staff all over the world.
If the Wuhan virus were really as “harmless” as folks like Mr Fumento would like to believe, then we shouldn’t be too worried about letting it run its course without taking any action to contain it. But if it turns out to be another version of SARS or the Spanish Flu in terms of virulence, then we’re in for a catastrophe. I can assure him that the vast majority of planet earth’s population is not prepared to take the risk. This is what our local academics and intellectuals said.
And this is what a true authority on epidemiology said.
Without analysing his claims, it’s easy to find Mr Fumento’s perspective sexy. Not surprisingly, even some of our university professors (thankfully not medical) agree with him. Let’s hope this sort of complacency isn’t too contagious. The image below is sure to provoke some thoughts, but the I blog about socio-political issues in another blog.
A friend of mine who has remained a cloistered academic most of his working life buys into the narrative that economic growth is imperative regardless of what is needed to sustain it. He was trying to mock those who highlight the devastation that follows unchecked growth.
Like all kinds of growth, economic growth can be healthy and it can also be toxic – like cancers. As Singapore heads towards a recession (after many years of impressive GDP), many asset-rich folks will worry and hope that those at the helm can do something about it. A few mavericks who have their feet on the ground may see this downturn as something positive. Yes, it’s time to hit the reset button.
But in the meantime, quite a number of my friends who have been trained as engineers or who are in IT are now doing a whole variety of unrelated jobs from driving Grab to directing funerals. Growth has brought about a massive influx of cheap foreign professionals to replace our expensive technicians and engineers. Yes, the industries have been growing, but at whose expense? The effect of foreign talent on the medical or dental profession may be a little less pronounced (we’re not driving Grab yet), but new onerous regulations are also forcing some clinicians to “moonlight”. One of the most popular jobs out there is selling MLM products. You’ll be surprised by the number of doctors and dentists quietly doing it.
While most MLM products are harmless or even pretty good (albeit overpriced), there are products and treatments which are not only ineffective but even harmful. I’ve written about clinicians who have gone over “the other side” to condemn and turn against everything they have been trained to do (and make a fortune out of it). COC or no COC, it’s the money that talks. Let me bring up an interesting item which has been abused and exploited for monetary gains for decades. Repeated actions from the US courts and the FDA have failed to kill it. What is this tenacious substance?
Google search for the word Laetrile yields descriptions like “clinically ineffective,” “dangerously toxic” and “quackery”. What is Laetrile? Well, simply put, it’s a synthetic form of the compound amygdalin found naturally in apricot seeds, bitter almonds, peaches and plums.
And that’s the shocking thing (not truth) about Laetrile. I thought it’s dead and buried after countless lawsuits and aggressive actions from the FDA, until it reared its ugly head in the form of a relatively new book by Ralph Moss PhD I found at the library. It’s entitled Doctored Results and it supposedly reveals how mainstream medicine suppresses valuable research data on the efficacy of Laetrile against cancer. Like other conspiracy theorists, Moss believes that mainstream medicine is colluding with big pharma and government to protect the chemotherapeutic industry by hiding the “truth” about Laeterile. Note that Doctored Results was published in 2014. Note also that Dr Moss’ PhD is in the Classics (like Greek literature).
Before we go further, there’s an important piece of history that we need to look at to appreciate how absurd that such a dangerous substance can still be believed.
In 1977, a little boy by the name of Joey Hofbauer was diagnosed with Hodgkin’s disease. He was warded in hospital, scheduled for radiation and chemotherapy. The oncologist who presided over the case was Dr Arthur Cohn. Cohn was optimistic, giving Joey a 95% chance of survival.
Before any treatment was done, the Hofbauers got frightened due to the invasive and destructive nature of radiation and chemotherapy. They checked him out of the hospital and flew Joey to Jamaica where Laetrile was touted as the latest cure for cancer. Their family doctor threatened to report them to the Children’s Protection Agency. When they returned, the police had to be called in to get Joey back into hospital. His father was so convinced that the hospital was killing him and Laetrile could save him that he secretly smuggled the substance into Joey’s ward and gave him a few doses.
The matter was heard in court. The judge allowed the Hofbauers to try Laetrile for 6 months under Dr Michael Schachter from New York. Michael Schachter’s “treatment” was a witch doctor’s recipe which included not just Laetrile but also raw liver juice, megadoses of vitamin A, pancreatic enzymes and coffee enemas. The patient was also given an injection of bacteria obtained from his own urine. Six months later, the patient’s swollen lymph nodes grew from one to 17! He also showed signs of liver damage due to megadoses of vitamin A and suffered from abdominal cramps and nausea. Laetrile gives off cyanide in the gut and apricot seeds have long been recognised in TCM as toxic.
Miraculously, Dr Schachter was able to convince the judge that his treatment was working. Meanwhile, court cases in several states challenged the FDA’s authority to restrict access to what they claimed are potentially lifesaving drugs. More than twenty states passed laws making the use of Laetrile legal. Joey’s Laetrile treatment was allowed to go on. When actor Steve McQueen checked into a clinic in Mexico run by one Dr William D. Kelly to have alternative treatment for his stomach cancer and the actor went on TV to promote Laetrile, judges were even more convinced that this could be the Holy Grail for cancer. That pretty much sealed Joey Hofbauer’s fate.
Thanks to all the hype and celebrity endorsement, Laetrile developed a significant following due to its wide promotion as a “pain-free”, “non-invasive” treatment of cancer. More audaciously, the previously obscure substance was even deemed an alternative to surgery and chemotherapy which were already known have significant and unpleasant side effects.
Two years later in 1980, Steve McQueen died a very painful death, followed by poor Joey Hofbauer. Dr Michael Schachter was never held accountable even though Joey’s body was riddled with metastatic tumours, contrary to Schachter’s claim that he was improving. For the record, Schachter was a psychiatrist who had neither training nor expertise in treating cancer. His methods were “discovered”. Even more unbelievably, he is still in practice.
Steve McQueen had also died under Dr William D. Kelly. Just a little more surprisingly, Kelly was actually a dentist or orthodontist to be exact. From straightening people’s teeth, Dr Kelly went on to diagnose cancer from blood samples and treat them with supplements. After he was struck off, he moved to Mexico to continue practising his “alternative cancer cures”. Because there is nothing to stop these doctors from practising alternative medicine, they could pretty much go wherever they wanted. Incidentally, Dr Kelly also suffered from cancer and died in 2005, not long after he wrote a book on his victory over cancer.
In spite of the number of deaths and failures, Laetrile continues to be popular. The US Food and Drug Administration went out on a limb to seek jail sentences for vendors marketing Laetrile for cancer treatment, calling it a “highly toxic product that has not shown any effect on treating cancer.” However, the FDA and AMA (American Medical Association) crackdown which begun as early as the 1970s, only managed to push prices up on the black market. Some vendors tried to pass Laetrile off as “vitamin B7”. Many desperate cancer patients bought the conspiracy narrative and had ironically enabled scammers and unscrupulous profiteers to foster multimillion-dollar smuggling empires; not to mention Mexico’s lucrative medical tourism for treatments and procedures banned in the US.
Yes, it’s hard to believe, but Laetrile is still alive and well. Just look at Ralph Moss’ 2014 book. It has an average review of 5 stars on Amazon and the book is available in our libraries. However, there is obvious copping out in the introductory disclaimer. The author bears no responsibility and cancer patients are advised to consult a board-certified cancer specialist. Moss must be hoping that readers will miss this part of the book – which is enough for it to lose all credibility.
Moss’ book The Cancer Industry (published 1996) has been negatively reviewed by Quackwatch, which noted that “the book is dangerous because it may induce desperate cancer patients to abandon sound, scientifically based medical care for a bizarre, ineffective “alternatives”.
Interestingly, many recent advocates of Laetrile have changed the rationale for its use. It was originally an alternative treatment of cancer. Later, some alternative medicine practitioners claim that it’s only a vitamin (which it isn’t). And most recently, most of these practitioners have taken a step back and use the substance only as part of a “holistic” nutritional regimen and pain management in cancer. In other words, they are no longer fighting to replace conventional medicine but trying to play a supportive role.
I’m not sure what Quakwatch will say about Moss’ 2014 book Doctored Results, but going back to doctors and dentists who are struggling to make ends meet, some of my jaded colleagues out there may get some funny ideas of cooking up conspiracy theories and starting a crusade against the “conspiracy”. While this may be a little far-fetched in Singapore, insane competition, financial stress and the availability of claimable treatments are the ingredients for undesirable outcomes – not the lack of competence.
According to Singapore Dental Association (SDA) members who had attended recent meetings, COC is not compulsory and there will be no restrictions. All this sounds like backtracking and too good to be true. It’s also pretty much hearsay, with no firm assurance from officialdom. As such, it shouldn’t stop me from thinking about Plan B.
Consider writing. This is my favourite, my life. But gone are days when I could earn almost $2000 a month from book sales and from freelancing for magazines. Back then, I had to run around interviewing celebrities and news-makers. It required a lot more energy than dentistry, but it was also a lot more rewarding when I saw my work in print, my name next to a celebrity’s and a cheque in the mail. During those days, my side income paid for my frequent side trips to Thailand. Nowadays, writing pays pittance and income from it pays only for candy and ice cream – both of which I don’t particularly like.
But as always, I try to keep my persona as a writer separate from my persona as a dentist. Why? This is something that many of my fans and followers cannot understand. Allow me to go back to one of the happiest moments in my life – when my works were first published in the Straits Times and Singa magazine in 1989/1990. When they asked me for my occupation, I filled “unemployed” without a second thought.
You see, back then, the Dental Board had strict rules against dentists advertising. Though publishing poems and short stories could hardly be considered “advertising”, I still entertained the possibility that someone might not like it. After being a regular contributor to the Life section of the Straits Times, the folks there didn’t believe that I was unemployed. My decision to reveal my profession was purely based on the answer to the question: “Are you ashamed of your profession?”. The answer was a definite no. I finally revealed my profession and instantly became someone newsworthy. Why?
The late Dr Goh Poh Seng (GP) is the grandfather of Singapore literature. The late Dr Gopal Baratam (neurosurgeon) was also a prominent writer. But in an arena dominated by lawyers, teachers and journalists, the “errant” dentist became an instant talking point. An interview was requested. From unemployed to writer/dentist. Should I do it? Would a backlash come faster than you can say amalgam? My decision was made based on the answer to the question: “Will your profession feel proud of you?”. I accepted the interview and perhaps because I was too much of a chatterbox, the result was a full page feature in the Straits Times. That mystery person behind the poems and short stories, a novel, the magazine articles, that “unemployed” dude was finally revealed. Sure, I received some fan mail, calls from editors who offered me jobs, but certainly not more patients as most of them don’t even read English. A couple of weeks later, I received a letter from SDA. It was not a congratulatory letter. It was a stern letter asking me to “explain” the article after a member of the fraternity thought that I was advertising my dental services.
I was flummoxed. Could these guys even read? That article had absolutely nothing to do with dentistry even though it carried a photo of me sitting next to a dental chair. What was there to explain? Being young and overly honest, I spoke my mind and pissed the SDA council off. I received a call and the council member said that he simply wanted me to assure them that it was the journalist’s own idea to feature me and not me who shamelessly asked to be interviewed! Yao mo gao chor ah? The complainant might have been anonymous, but this episode really said a lot about him/her. The answer to the question “are you ashamed of the profession?” was no longer obvious. I have not been an SDA member since then.
This website (name of my former clinic) and my former Facebook page on aesthetics used to be very prominent. At the height of its popularity, it drew some 30,000 hits every month, thanks to the beautiful faces, smiles and my dabble in portrait photography. I also wrote many entertaining articles on dentistry; very different from the boring stuff that you read on official sites. I caught some practices copying and printing my articles for patient education. I decided to be generous and not claim copyright. This went on for almost 7 years until some dentist complained that the contents on my website and social media were “unbecoming of the dental profession in Singapore”.
The tribe has spoken. Pretty faces, creative poses and playful captions are not allowed in dentistry. I had to take them all down and direct my creative energies elsewhere. And presumably the same standards also apply in medicine. While chatting with a model in a park, I discovered that she is a medical colleague. Let’s call her Dr L. To me, she’s not some exhibitionist all out to corrupt young minds or seduce someone’s bored husband. She’s simply passionate about modelling. While doing shoots with her, I warned her about the dangers of revealing her profession to the public. It’s worse for models than for photographers as there is always the assumption of immorality in our pseudo-conservative society.
Dr L went on to take part in a beauty pageant. I watched her competing on YouTube and she had wisely lied about her employment. She got into the finals but didn’t win. I wondered how many who knew she is a doctor recognised her. I guess it’s OK when your haters are unlikely to watch. It might be just as well that she didn’t win. There is no way she could have continued to lie about her profession when journalists start following her.
Anyway, Dr L is now married and she still models once in a while with the full knowledge and approval of her husband who is also a doctor. The moralists should just shut the … (words unbecoming of the dental profession), but this is Singapore and you don’t always decide what is good for yourself. Burmese doctor Dr Nang Mwe San is not so lucky. I can’t read Burmese, so I can’t tell whether she had identified herself as a doctor in her “edgy” photos. If not, then, she must have been sabotaged by members of her fraternity who recognised her and ogled privately while publicly denouncing her.
BANGKOK: A Myanmar model and doctor said she would appeal against a medical council decision to revoke her licence for posting photos of herself on Facebook in revealing outfits and bikinis.
On her Facebook page, the 28-year-old often posts photos of herself wearing tight dresses, lingerie, swimwear and even traditional Burmese clothing in sexy poses.
Dr NangMwe San has been a general physician for four years, but stopped practicing two years ago to pursue a modelling career. The move to revoke her licence bans her from medical practice.
According to the letter posted on her Facebook page, the council said Mwe San had continued to post photos of herself in outfits that did “not fit with Burmese tradition”.
No, I’m not writing whimsical dental articles or taking pictures related to dentistry anymore. Dr Nang Mwe San has the international community behind her, a few disgusted Singaporean women notwithstanding. Artistic expression requires space. An officer from the Dental Council once told me to keep dentistry “clean” (and boring). For once, all my English lessons failed me as the opposite of “clean” is “dirty” and it all made no sense. Anyway, message received, point taken. I will just have to channel my creative energies elsewhere. I will need to separate the two and remain a low profile, boring dentist – until COC kicks in. What then?
As an adventurer and survivor, the most painless way to resolve this problem (while still practising) is to simply relocate and bring all my surgical kits over. I can live on Nepalese dhal baat like few Singaporeans can. I have lived cheaply in many parts of Thailand and Indonesia like few Singaporeans can. I can cook complete meals for the family like few Singaporeans can. I can even make my own wine unlike most Singaporeans.
Given my background, Thailand seems the natural choice, but given the current political situation and the rather unhealthy social order as a result of it, Thailand may have to wait. Furthermore, Thailand is also saturated with dentists (in towns and cities where people can afford them), but still not as bad as in Singapore. If I ever relocate to Thailand, I would be running a spa/clinic based on TCM principles. Yes, the website will be full of pretty faces and athletic bodies. Disgusted folks can ask for it to be blocked in Singapore.
A little more seriously, I’m considering Bali or some other part of Indonesia as the only possible location if I choose to remain a dentist. If that doesn’t work out, I can consider turning another thing which I enjoy doing into a business. Cooking.
So if for some reason I can’t practise in Bali, what do I do? How about cooking? The food business? It’s not a shot in the dark. I have a Singaporean friend whose son moved to Bali and set up a restaurant there. Can I move Dr Chan’s Kitchen from the virtual world into the real world? This is worth considering even though I know how tough the food business is. I’ve been cooking, preparing all kinds of meals for the family for decades. I’ve even appeared on a cooking show on TV (luckily nobody complained; my haters probably wouldn’t watch something so unglam). Cooking for customers is very different and I dread the stress, the learning curve and the bottom line considerations when sourcing ingredients. I probably need an environment that is kinder to the newbie; perhaps in Thailand (when things get better), Indonesia or Malaysia. Setting up in Singapore is not even worth considering as I foresee more onerous regulations hitting this business as well.
Some folks who read my previous post remarked that I am too negative and pessimistic. Of course I welcome a backtrack from the original concept of the COC, but even then, a major shakeup of the industry is imminent. The bubble must and will burst. Meanwhile, I’ll continue writing. The ultimate happy ending is to have several books that sell millions of copies. I shall write and dream on.
A short while ago, I posted something on Facebook that sparked the curiosity of many of my closer friends.
Yes, I’ve been in the profession for 30 years and boredom set in since the very start! Believe it or not, I was already talking about retirement (from the profession) and migrating (voting with my feet) 15 years ago. While I’ve gone back to pursue my passion in the arts, dentistry is still bringing home the bacon. If I ever have to quit any time soon, it would most likely be because it fails to bring home the bacon.
The cataclysmic changes I was talking about was reported by the Online Citizen a month later. It has to do with a new policy which restricts the practice of dental GPs. They would not be allowed to carry out complex dental procedures without first acquiring a Certificate of Competency (COC)
I’ll come back to COC later. First, some background and history of dentistry in Singapore that I have managed to live through.
In my book Dental Phobia, I painted the alamak patient as one who would refer to the neighbourhood dentist as Pull Teeth One. Indeed, to most heartlanders born in the 1950s or earlier, dentistry is little more than filling teeth, pulling out teeth and making plastic teeth. In spite of the lack of glamour and prestige, many retired dentists who once had lines as long as Toto queues managed to make their fortunes just providing these relatively simple services. If they had wanted their children to follow in their footsteps, the younger generation will need to swim against some very hostile currents engulfing the profession today. Suffice to say that unless they somehow have the same Toto-like queues that their predecessors once had (extremely unlikely in today’s competitive environment), they may not even survive, let alone thrive and make their fortunes.
When I first graduated in 1988, dentistry was decidedly a sunset profession. Crowns and bridges were considered extremely high end procedures and root canals occurred as frequently as condemned criminals getting a presidential pardon. My starting pay was not as “upper middle class” as I had wanted it to be, but the cost of living was low then and I managed to get by.
Into the 1990s, many patients started asking for tooth-cloured fillings – which were invented in 1962. These materials evolved rapidly and by the 1990s, had become a lot more reliable since my student days. But Singapore tends to be a little behind time due to the low priority placed on good dentition. Full ceramic Dicor crowns (which were more aesthetic than porcelain fused to metal crowns) were already around since the 1950s and Empress crowns were already available since 1980. They did not become popular in Singapore until the turn of the century circa 2000.
But as millennials grew into image-conscious, blogging teens, orthodontics turned into a virtual necessity for kids with malocclusion. More and more dentists started doing it. Even as the tussle between Taiwanese serials and Korean dramas was still ongoing and K-pop was still in its infancy, costly European implants with limited user support became drowned under the tide of cheap and good Korean products with excellent after sales service provided by smiling, bowing Korean staff.
On top of that, Medisave could be used to make partial payment for some surgical procedures. Tooth replacement with implants, root canal surgery, wisdom tooth surgery became a bit more affordable for all. Extractions were feared, not for the pain, but the loss. Endodontics (root canal) became commonplace – with that came crowns, metal-free restorations, cosmetic gum surgery, flexible dentures. More and more people wanted to save their teeth. More and more asked for implants to replace their missing teeth. More and more did ceramic crowns and veneers for their front teeth. More and more whitened and straightened their teeth, or even go through extreme makeovers for that winning smile. The scope of practice for the dental GP swelled and so did our population. Dentistry in Singapore was no longer behind time.
The Sun Rises
New technology and innovations always excite Singaporeans and rising from the ashes, dentistry became a sunrise profession. All of a sudden, dentists started attending continuing education courses, not just to earn continuing education points (they need 70 points in a 2-year period) by sleeping through irrelevant lectures but actually acquiring new skills and adopting new technologies. I have personally witnessed many young and even not so young dentists getting energised into bringing their practices to the next level. Many who are not specialists have trained themselves to provide complex, high value cases for considerably lower fees. Consequently, demand for sophisticated dentistry went up. In my opinion, that was the golden decade (2000-2010) for the profession in Singapore. Never mind the alamak patients. The internet provided an almost endless stream of curious and interested inquirers. Dentistry regained its status as a promising career and a glamorous one at that. Straight A students started pounding the doors to be enrolled in the Faculty. The barrier to entry was raised accordingly. GPs who had upgraded themselves became decidedly upper middle class.
But it ought to be noted that the concept of the super GP is not new. Quite a number of dental GPs currently in their 70s were already doing braces, wisdom tooth surgeries, precision dentures and even implants during their heydays. It was during this golden decade, with the increase in opportunities to learn, share and advertise skills that super GPs flourished.
With so much potential within the profession, it’s difficult for venture capitalists not to take notice. As money started pouring in and a few blue eyed boys were identified as potential CEOs, some dental clinics started to transform, branching out into every nook and cranny of our tiny little island. An Indian professor once gave a talk at one of our continuing education lectures. He said that the ratio of dentist to population was still not ideal. He felt that we didn’t have enough dentists and ought to produce more until we attained a healthy ratio like that in Australia.
Our professor seemed to have forgotten that our geography here is very different from that in Australia. If you don’t want to see Dentist A in Australia, Dentists B could be 2-hours’ drive away. In Singapore, there are scores of dental clinics between 2 MRT stations. How difficult is it to obtain treatment if one really needs it? Then, he also talked about our aging population and why we need more dentists. I wish he had attended a conference on geriatric dentistry here. The room was barely 25% full whereas at a conference on aesthetic dentistry, there’s only standing room available. It’s obviously not simple arithmetic at work here.
After one company went public, a dozen or so wannabes started rooting for a ride on the IPO bandwagon. On a street with only two blocks of flats with two rows of shops on the ground floor, there were 3 dental clinics and only 2 medical clinics. Things have gone totally irrational. A patient recently remarked to me that he sees more dental clinics than coffee shops and that’s not an exaggeration. At one of the clinics where I work, there are two other dental clinics within 20m and another 4 within 300m, another 2 within 500m.
The CEOs of these rapidly multiplying practices were not only desperate for dentists to man their new branches but they lose sleep while closely monitoring “sales figures”. The problem of manpower is not too difficult to overcome. Foreign dentists or dentists who graduated from certain foreign universities are allowed to work in Singapore. Meanwhile the Faculty of Dentistry at NUS has almost doubled its intake of dental students since my time. Only about 30+ of us graduated back then. Today, almost 80 are expected to graduate every year!
The arithmetic is simple. If you set up 100 clinics, you “need” 100 dentists. The manpower issue is by no means an insurmountable issue. As in any other industry, you could either employ foreign graduates or wait for NUS to churn them out or do both. The problem of sales target is a lot trickier and it’s not difficult to figure out why. Are there enough patients and indications to feed these high maintenance clinics equipped with high tech equipment on hefty leases? Can the trees keep branching out without looking back on whether there’s enough earth to support it? What happens when there are too many dentists and too few patients? Will dental treatment become cheaper as dentists undercut one another? Will dentistry still be practised as ethically as before?
In 2013, the Chinese authorities decided to introduce a cooling measure for their overheating property market. Couples who sold a second property had to pay hefty taxes for the sale. What did the Chinese couples in Shanghai do? The selling couples teamed up with the buying couples and both couples got divorced. The ex-husband in the selling couple would keep the property. Money from the buying couple was given to the ex-wife in the selling couple so it didn’t look like a sales transaction. The ex-wife from the buying couple then married the ex-husband from the selling couple! They then got divorced with the ex-wife from the original buying couple keeping the property. When everything was back in place and the property transferred, the two couples got together again. No taxes paid. Shanghai saw 30 divorces a day when this game was ongoing.
While Singaporeans are way less crafty and unscrupulous, dentists are pretty smart people – until they get caught. Be prepared for lots of juicy scandals. The golden decade is pretty much over.
Dentistry depends a lot on skill and skills take time to develop. Nobody is skillful when he first graduates. I would have gone crazy if my boss set a quota for me when I first started private practice. In a way, many young graduates today are not so lucky. And the character of the whole industry has also been totally transformed. This is the age of dental empires. Your friendly neighbourhood dentist is fast going extinct. With cookie cutters on steroids, new clinics are sprouting up everywhere with emphasis placed almost entirely on branding and not the practitioner. They don’t even put the practitioner(s)’ names out there anymore. As a result, practitioners no longer have any sense of belonging to the practices. The practices milk them and they in turn milk patients and get out, either to another practice or another country. The only real winner here is the dental empire. I will come to the aftermath of this carnage in a moment.
I’ve heard about the COC way back in early April and I’d wanted to refrain from commenting until the thing goes public. And would you believe it, some commercial entity has already prepared itself for it long before the rest of us have any inkling of this shocking development. TOC reported that “The Singapore dental fraternity is up in arms over the possibility of a conflict of interest in relation to the introduction of certificate of competencies (COC) and restriction framework for dentists who are general practitioners.”
The latest development involves a complaint being made to the CPIB and I shall not comment on whether the complainants have a case until investigations have concluded. Suffice to say that there are too many coincidences. It’s sad that some of my colleagues had to resort to reporting criminal activity to get this problem solved, but then again, is there any other way?
Now, what is the COC and why do the authorities think that it should be implemented? The COC is a scheme that follows a recent proposal by the Ministry of Health (MOH) and the Singapore Dental Council (SDC) — which is the profession’s self-regulatory body — that could require dentists in general practice to undergo more training for procedures such as wisdom teeth surgery and implants before they are certified “competent”.
For the record, there is already a COC in force for facial aesthetics (Botox and filler injections). Of course, we’ve never learned that in dental school, so it’s only fair that we must attend a course (with a written test at the end) and pass it before we can perform the procedure. However, I remember I only had to take a one-day course to obtain my COC for that. Even though the 1-day course is officially recognised, I felt it was really inadequate. I learned much more from a voluntary programme with a lot of hands-on practice on volunteers in Taiwan.
The obvious irrationality here is, you can be a total newbie in the field of facial aesthetics and you just need one day’s course to get a COC. You can have decades of experiences removing wisdom teeth and sinking implants. You still need a COC to certify your competence.
Explaining the purpose of the COC, the Ministry of Health (MOH) and the Singapore Dental Council (SDC) said in a joint statement that the moves are meant to allow “dentists to be further trained in these specific dental procedures and to be able to practice safely and competently without having to undergo specialist training. Both the MOH and SDC added that the decision on certification is backed by international benchmarks, patient concerns and complaints.
Let’s say you want to “further train” a dentist to do a complex root canal. Will this “further training” exceed the length of training that the dentist had in dental school? If not, then is this just a formality? If not, does it then mean that the curriculum for the procedure of root canal in NUS is somehow inadequate? Does it mean that foreign degrees that are recognised by the ministry are inadequate and they are just beginning to realise that?
There are some very senior super GPs out there who have done literally thousands of wisdom tooth surgeries and implants. That is competency. Do they need to attend courses to be certified for basic competency in procedures which they have been doing expertly for decades?
Coincidentally (or so it seemed), local dental group Q&M dental group stated in an interview with ST on 2 May that it was setting up a private dental college in Singapore by the middle of this year. The college wouldn’t provide degrees but would provide “courses” for graduate students. How superior are these “courses” (days?weeks?months?) compared to those which our GPs have been attending? What value do they add to their decades of experience?
The company running the college, Q & M College of Dentistry Pte Ltd, has already been incorporated in December last year (long before we knew anything about the COC). Coincidentally again, the Aoxin Q&M dental group limited, a subsidiary company which is also registered in Singapore lists Professor Chew Chong Lin as an independent director. My colleagues who made the complaint to CPIB has an issue with this arrangement as Professor Chew Chong Lin is also the President of the Singapore Dental Council since 2009. SDC is the self-regulatory body for the dental professions constituted under the Dental Registration Act (Chapter 76).
This is an important milestone. For the longest time, the regulatory body for dentists has been throwing rules, guidelines and regulations at us. The so called “self-regulation” is quite a misnomer. In spite of the elected members of the council, the cue always appears to come from the Ministry and not from the general body of dentists. Besides that, the council in both SDA and SDC are dominated by Q&M dentists. For the first time in our history, dentists who have been under the thumb of the council are calling out on a possible major transgression.
Other colleagues talked about a “slippery slope”. What are we slipping into? Certification for dental assistants before they are allowed to assist? Which company is going to manage this certification process? Your guess is probably the same as mine. It of course does not mean that inhouse, informally trained assistants are less competent. It’s going to be a question of who is approved and what is recognised.
When news of the COC first emerged, the response from the public was quite predictable. Folks who had bad experiences with treatment outcomes flooded Facebook with comments supporting it. If these comments were to be taken seriously, then there should be no argument as to whether there ought to be a COC. The impulsive commenters may not be aware that with the COC in place, they may have to go to a specialist to get their wisdom tooth removed or their implant placed. They may not think twice about supporting it until they need to pay for it. By then, it’s already too late.
So do the specialists have any cause for celebration? Maybe, maybe not. The biggest losers are the super GPs whose numbers have grown steadily throughout the golden decade. If there are hundreds of disciplines and procedures they need to obtain COCs for, it could take years before they are certified “competent” in all these procedures.
What about the public? Why do people complain? Many dentists who have been practising successfully for 40 years had all the complaints they ever received made within the last 10 years. Why no complaints before that? Because they suddenly became lousy dentists in the last 10 years? Or is it because patients have become more knowledgeable and demanding? Has it also become a lot easier to complain? Just a click of the mouse. Assuming that these complaints are justified and treatment outcomes could have been better, why did such problems arise? Why are so many inexperienced dentists attempting risky procedures which are beyond them? Why are they cutting costs with incompatible third party implant components? Could it be because they have committed themselves to a massive implant package and suppliers are chasing them for payment? Could it be because the staff are not paid, the leasing company is hounding them and the landlord sends another reminder? Could it be because they have a “sales target” and the CEO of their dental empire is breathing down their necks?
If I were a patient and I need to have my wisdom teeth removed, would I go to a dentist with a good track record or would I go to a newbie with a COC. It’s a no-brainer for me, but the scheme should make sense as long as there are enough unthinking people around.
Treating these problems with COC is like treating cancer with antibiotics. The root of the problem is that we have too many dentists and dental clinics. Way too many. Only some of us are doing well. The rest are struggling and forced to do things they shouldn’t do. The numbers are unreal and should not have been allowed to build up in the first place. And the biggest irony is that in spite of the numbers, the public is not going to be served any faster or better because so many super GPs are going to get their hands tied. And that’s after beefing up the supply of dentists to a “healthier” level. It’s a joke, except that it’s not funny. The bubble is set to burst and the empires are striking out at the small fries who have been minding their own business. Make no mistake, we are at (or perhaps even gone past) the peak of a dental bull run and the only way to go is down. It ain’t going to be a pretty picture down there.
Nobody can be sure what the outcome is. One part of me wants things to go back to the status quo, let me practise the way I’m used to for another 10 years or so before I quit for good. Another part of me is hoping that a tsunami would sweep through the dental landscape, flattening out all the cookie cutter practices and restore the old school of solo and small group practices (not more than 6 branches) where patients identify with their friendly neighbourhood dentists and not some brand.
Unfortunately, neither of these outcomes are likely, given the interests of corporations and the numbers they show. Couple that with a ministry that knows better than the rest of us and you have a perfect recipe for a humble pie that we will all be forced to eat. To endure the humiliation/inconvenience and settle for much less than what I deserve? Or to quit and move on to something else?
For a country that fiercely defends its independence when criticised about press freedom and human rights, we are virtually led by the nose when it comes to following cool innovations from Western countries. Just like in Singapore, the folks who implement these policies over in the US have little idea of the challenges on the ground.
The usual narrative is that this is something that will help us keep up, failing which we would fall behind the rest of the world. Sometimes, it’s better to fall behind than to march along with the other children as they follow the pied piper of Hamelin.
Toni Bark is a forceful promoter of ice-cold dips in lakes and other dubious “alternative cures” like homeopathy. On her website, she claims to practise “Disease Reversal, Holistic, and Functional Medicine”. A bestselling author, popular speaker and a powerful crusader on social media, she has also made a vocation out of speaking against vaccines and how they harm our children. You would think that she must be some self-taught guru with no substance beyond her gift of the gab. Except that Dr Toni Bark is a qualified paediatrician.
Yes, she sees (or appears to see) little or no threat from measles and other illnesses that had killed many children in the past. At the same time, she makes many parents think that there are safe “natural cures” for these conditions. Instead of managing common paediatric conditions in a clinical practice, she focuses on “illnesses” caused by vaccines and insists that vaccines are the cause for autism in the face of overwhelming evidence to the contrary. As a layman, she could have been dismissed as some snake oil salesman, by Dr Bark testifies in courts as an expert witness!
There is always a supply of conspiracy theorists ready to lap up whatever sensational cover ups that the activists have exposed. Dr Spark claims that 70% of the reports on the safety of vaccines in mainstream media are paid for by the big pharmaceutical companies (Big Pharma). Followers and believers of the anti-vaccination movement come in all shapes and sizes. From Jews to Muslims, school dropouts to university professors, homeless folks to those who live in mansions – there is no typical profile for the average “anti-vaxxer”, as they are commonly referred to. Throw in a few celebrity “influencers” and you’ll have an unstoppable anti-vaxxer movement.
However, if you were to study these anti-vaxxer websites, a predictable pattern is observed. There is usually very little scientific data or statistics – just moving, even tear-jerking stories. While most rational people will not accept these stories as representative of the mean, some people just fall for it. Knowingly or otherwise, the cult leaders capitalise on the people’s mistrust in the government (and who can blame them after the fake news about WMD in Iraq that cost Americans thousands of lives and $2.4 trillion) and manipulate that mistrust so that they can even make the most far-fetched conspiracy theory believable. Sadly, the writing is on the wall. Truth is losing ground. The more the authorities try to beat them down with statistics, the more the cult would try to rebel against the system and recruit new members.
All cults come with leaders and for someone as intelligent and well-trained as Dr Toni Bark, it’s hard to see her as a follower even though the anti-vaxxer movement may not have started with her. Whatever her motives, it is likely that she became much better known after she spoke out so vehemently against vaccines, especially when she travels the country to give fiery speeches and riveting talks against the establishment in contrast with the usual stuff that most unassuming paediatricians talk about. She wouldn’t have generated any buzz. She wouldn’t have become famous if she had worked as a regular doctor. By going against all that and practising quakery, her patient load increased rather than decreased.
“The anti-vaccine lobby has grown from a fringe movement in the late ’90s, early 2000s to this massive media empire that has now hundreds of websites, amplified on social media. They have political action committees now, it’s become politicized,” said Peter Jay Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and the director of the Texas Children’s Center for Vaccine Development. “This was never a problem up until a few years ago, but now it’s become this huge issue.”
Yes, it’s now so huge that it has become political. It is believed that Donald Trump scored quite a number of points by pointing out that vaccines could be a cause for autism. Like Dr Bark, Senator Rand Paul is also a doctor and an ophthalmologist to boot. He too seemed to have gained quite a few supporters by suggesting that vaccination should not be compulsory. A 2015 Pew Research Poll concluded that 68 percent of U.S. adults say childhood vaccinations should be required, but 30 percent say parents should be able to decide.
The movement is bearing a toxic fruit. In 2018, 349 individual cases of measles were confirmed in 26 states and the District of Columbia. This is second to 667 cases reported in 2014. Measles was supposed to have been eliminated in the US in 2000 but most recently from January 1 to April 4, 2019, 465 individual cases of measles have been confirmed in 19 states! Will it hit a new high?
Meanwhile, the anti-vaxxers continue their crusade to leave more children unprotected. Are they simply ignorant, misled, or do they have a more devious motive – like some vegan guru who doesn’t practise what she preaches?
We all know that politicians are in a breed of their own and their stand can shift with the movement of public sentiment. But It would not just be an irony but an utter insult to the medical profession if doctors who are not doing well practising medicine somehow manage to earn a fortune by going against it.
True story. Tim was gym owner who was all stressed out even though he was doing a booming business. After numerous ranting sessions with friends and family, he began to rationalise his position. He realised that over 90% of his customers were satisfied with the service and amenities he provided. Less than 10% were habitually complaining, threatening and making all sorts of demands.
Tim had been reading books by business gurus who said that he must hold his customers as a bucket would hold water. Once there’s a leak, his business will bleed. It all sounds very nice and logical, but the reality is something that the guru had not grasped. Tim decided that he would just refund the membership fee to that measly 10% and focus on that 90%.
The guru was wrong. He did earn a little less money, but his business did not bleed. Most importantly, Tim’s sleep and appetite improved. His regained his health and he was even beginning to enjoy his work.