Monday, January 31, 2011

"Her best friend's name is Zoloft"

My world currently revolves around a company that markets drugs for mental disorders in general, anti-psychotics and major depressive disorders in particular. It has been the reason why I have learned more about depression than I could have ever learned in medical school or in my psychiatry rotations during clerkship or internship.

Depression is not the same as sadness. There are days when we are down and out and perhaps from time to time feel sad. This is not unusual. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than just sadness.

Depression is more than just sadness. It engulfs your daily life. People who suffer from clinical depression are hampered with interference of normal activities of daily living. Feelings of helplessness and hopelessness dominate most of their daily lives. While clinical depression varies from patient to patient, common signs and symptoms include the following:

1. Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
2. Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
3. Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
4. Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
5. Irritability or restlessness. Feeling agitated, restless, or on edge. Your tolerance level is low; everything and everyone gets on your nerves.
6. Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
7. Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
8. Concentration problems. Trouble focusing, making decisions, or remembering things.
9. Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Depression has many faces. Younger patients have a different clinical presentation from the elderly. Men compared to women have a different presentation as well. Though women are at higher risk for depression, men who present with depression have a higher risk of suicide. Depression also takes various forms - major depressive disorder, atypical depression, dysthymia (recurrent, mild depression), and seasonal affective disorder. Then again, depression may be part of a bipolar disorder, presenting as only one side of the coin.

There are many causes to triggering clinical depression - loneliness, lack of social support, traumatic life experience, financial problems, relationship disagreements, early childhood trauma or abuse, health problems, unemployment - to name a few. Finding the key trigger is vital in the treatment of depression. Unfortunately, identifying the exact cause is difficult as many of them stem from complex factors and the contributing factors are like going through the spider's web.

Acceptance plays a key role in recognition of depression.

When my mom was diagnosed to have clinical depression, I knew that aside from having to take the daily pills to control her hypertension and blood sugar problems and dealing with life in the elderly, there would be a need to provide stronger family support. And while the latter is given to her on a silver platter, her dysthymia is something we need to live with.

There are various treatment options - which include psychotherapy, changes in life style, emotional building skills and drugs.

While I know that there are those who rely on self-help and googling the internet for answers to questions they don't know, studies have shown that the internet is not a reliable source for finding answers to questions that even science has no answers to. The internet will provide a whole conundrum of pros and cons on drugs and self-help aides to combatting depression.

The key here is identifying the cause and using appropriate resources including drugs in helping treat the problem.

Like all drugs and diseases, life style changes are mandatory. Hypertensive patients need to watch their diet and stress factors. Diabetic patients need to change their eating habits. I tell my mom that we are all patients eventually. Drugs may not be the solution to the problems of our lives and they will not change the underlying condition to why we eventually become afflicted with the illness - whether it is hypertension, cancer, diabetes or mental disorder. If you're in such a rut because you have a dead end job or that you're stuck in the worst kind or relationship or that you fear dying because you're aging, one needs to get out of this rut by exploring other options in treatment aside from the drugs.

For those that are already on antidepressants, it is a known fact that only 30% of patients who are already on anti-depressants go into full remission after therapy. The greater majority will need to: continue their medications sometimes for life, change their medications, combine other drugs to the current one they are taking or increase the dosage of their current medicines. While I fully understand those who refuse to continue taking the pill, we need to face the reality that we are all not born perfect. Eventually, some of these physical and psychological frailties take a toll on us and expose our illnesses - whether it is mental or physiological.

Like all drugs, there is no drug that does not have a side effect. Side effects of most newer antidepressants are generally mild, but can be bothersome in some people. They include stomach upset, sexual problems, fatigue, dizziness, insomnia, weight change, and headaches. One must remember, however, that taking drugs is a risk:benefit decision. If the benefits outweigh the risk of complications of the disease process, then the drug is worth the risk of the side effects which are mostly minor and inconsequential.

Depression recovery begins with positive daily lifestyle choices. If you cultivate supportive relationships, challenge negative thoughts, and nurture your physical health, you can help yourself, slowly but surely, overcome your depression.

I guess it is easier to discuss about depression than be in the same shoe as the patient who experiences it. Like all disease states were are in, we need to challenge ourselves on the road to recovery. I blog from an outsider's perspective and I guess all the self-help guides are onlookers as well. We encourage people to seek help and to help themselves. We serve as the cheering squad for those whom we care for and love.

At the end of the day, my mom will always have a best friend with her even when I am not around 24/7 to watch over her. Her best friend is with her in both good and bad times. Sticks to her and listens to her when she feels deep down shitty. And when fears overcome her, sometimes creeping into her skin in the middle of the night, her best friend allows her to forget some of the pain and anxiety so that she can continue her normal activities of daily living. Like many other people in this world, she shares her best friend with them.

Her name best friend's name is Zoloft.

[For more information on depression -;
Help information for lay -]

Friday, January 28, 2011

Over dimsum, peking duck and friends

I scrambled to erase all existing appointments for my friends. You see, I've not seen many of them in gazillion years. They were my co-residents during residency training in Pediatrics at the UST Hospital and they have come home to celebrate their silver jubilee.

And while they were preparing and excited to see their former classmates and enjoy some bonding time, they found some time to squeeze me in their hectic schedule.

Excited and giddy as I was, I was able to meet most of them during their short stay in Manila (as majority of them are now based in the US).

It was lunch at the Shang Palace at the Makati Shangri-La. Over dimsum, Peking duck and some delectable soup, we shared stories and reminisced those days when we were still young, carefree and yup...crazy.

Stories on life during residency training, admitting conferences with Dr. Eus Rigor, our consultants whom we feared and whom we loved, the loves and tragedies during the training years, the co-residents whom we despised, the scandals, the breakfasts we all shared each day after the admitting conferences when I was chief resident.

Stories on where they are today. Some had married while some, true to being a pediatrician remained - all the single ladies.

The 2 1/2 hours of tete-a-tete wasn't enough but we closed the restaurant and had to part ways and while it was the last I saw of them during their stay in Manila, they will remain one of the best part of my life.

They say that the people you meet along the journey of life completes your life story.

They complete mine.

Saturday, January 22, 2011

Violence, violated and why I believe in the death penalty

So we don't live in a perfect world. Is there anything wrong with wanting to?

Have you ever felt being violated because of a crime committed against you?

I have. I've had a gun poked in front of my face by some drunk bodyguards of a ConCon delegate (during the Marcos era) after they bumped my car from the back. They told me to say it was my fault or that I would be found among the salt mines. I pissed in my pants out of fear. When the cop arrived he asked what happened and then took me to the precint but not the burly idiots. He let me go after I told him what happened. I was so shaken up when I arrived home and when I told my parents about it, they were infuriated. I couldn't sleep and kept thinking - what if? I never took the same route again. It took me a few months to shake off the feeling, but I could never forget at staring a gun in my face.

When I was fresh out of medical school, I served in one of the government rural centers as part of the Marcos' program where where it was mandated that doctors serve in a rural community for 6 months after their internship. One day, after seeing all the patients in the health clinic, one of the patients had requested for some free medicines. I stood up to go to the medicine cabinet and left my bag for a few seconds, got the meds she requested, gave it to her. I saw a few more patients then left the center to meet up with my mom. When I got to where my mom was, I couldn't find my wallet. Gone! Money. License. Cards. Everything!

I was angry and I felt violated. It was an unforgettable feeling. I had sleepless nights thinking about it. Like a bad movie, it just kept playing over and over and over again in my head.

A few weeks passed and life was back to normal. Or so I thought.

Living in the Philippines is like putting a gun to your head. It's a Russian roulette with life.

During my residency training, I had felt the violation again. While doing a bone marrow aspiration for a charity patient, I left my bag by the door. It took less than 5 minutes to finish the procedure...and my bag - wallet and all - had disappeared. A few weeks later, all my cards and license were strewn in front of the house of someone who contacted me after seeing the address on my license. But they were useless already by the time they were discovered. I had felt so much anger and so much pain. It was reliving a nightmare over and over again.

And the cops could not do anything. Report it. Blotter it. And then that's it. No response or feedback again.

A year after we moved to our house, two thieves had broken into our home and beat up our maid. It was good that they were caught in the middle of the robbery. But we were shaken. Even in an exclusive village like ours, no one was spared from crime.

The recent spate of killings over carnapping incidents which occurred in a 2-3 days span sent shivers up my spine. Evangelista and Lozano were found burned and shot with bullets through their heads in some deserted place in Central Luzon. Both were used car salesmen. Both ended up dead in the most henious way.

When I read the news about these grizzly killings, I recalled what one of my patient's mother told me. A few years ago, they bought a new Pajero. It was only a few days old when it was carjacked right in front of their garage. Some men came in, pointed a gun at the head of their daughter, pointed a gun at the husband and the SUV was gone in 30 seconds. When they reported it to the police, the cop just replied - "since your car is insured, the insurance company will pay you the full cost of a brand new car. Just forget about this one. You wouldn't want the thieves to come after you and your family."


And I am sure that the cops are in cahoots with the hoodlooms. While I cannot say that all cops are bad, I firmly believe the bad cops outnumber the good ones. I base it on experience. You get death threats each time you expose a rogue cop. They know who you are and where you live. With reasoning like this and no follow-up on crimes, you get the feeling of helplessness. Worst is how they reason out. That the current scenario is that the number of cars that are stolen are much lower this year compared to the same time last year! Did I get it right? My God!!!! With this kind of reasoning, it was tantamount to saying that "it's okay to be poor and hungry, there were more starving last year!" This typical answer from government officials and cops and military personnel is moronic!

While the church and the sorry asses have their hearts bleeding out against the death penalty, saying that it is anti-poor and that there are a lot of innocent people who are sentenced to die because they were wrongly accused, I can only reply that it's not the punishment that's the wrong solution. It's the judicial system! There is something very wrong in our judicial system and it makes me want to puke that even PNoy with all his want-to-do-good and be-good attitude has got his brain all warped up in order to please the church and the faith.

I know that I may strike a few sensitive chords here, especially among those who would die for the faith and for religion, but this is a personal opinion. While imposing the death penalty may not be a deterrent to crime in the Philippines, it is because we do not impose the punishment to the full extent.

I remember that Marcos sent a strong message when he had a drug pusher publicly executed by firing squad. For awhile, drug pushing was at it's all time low. Today we are the drug mule mecca of the world!

One can debate the pros and cons of the death penalty. I am sure though, that until you've stared the end of the barrel of a gun in your face and watch your life go quickly by, you don't have the right to any opinion on this matter at all. The feeling of being violated because of violence can only be solved with "an eye for an eye, a tooth for a tooth".

[photo from ABS-CBN]

Monday, January 17, 2011


He says, she says.

And that's the way the story goes between Alliance of Volunteer for Education party list Congressman Eulogio Magsaysay when he allegedly called Philippine Airlines Customer Service Agent Sara Bonnin Ocampo a menopausal bitch at the Mabuhay Lounge when Rep. Magsaysay was waiting for his flight to Los Angeles with his family.

The Philippine Daily Inquirer had reported this altercation in the January 12, 2011 issue of the newspaper. One side of the story is that the congressman wanted to sit beside his son and asked to be transferred. According to him, Ms Ocampo had declined saying that it was a full flight and was not in any capacity to make any changes. Then there was an exchange of words with Ms Ocampo claiming that Magsaysay had called her "menopausal bitch" and Magsaysay saying that she had it coming because she was raising her voice at him.

So now we have perturbed the crowd - half want the head of Magsaysay on a silver platter, calling him unbecoming of a person of government stature; the remaining half want the head of Ocampo because as a customer service agent they MUST please customers no matter how much they berate them. I was reading the ABS-CBN news thread regarding this, with readers providing feedback to the news article with Magsaysay apologizing saying "Sorry, but my son needed me on the flight".

Additional details are scant but perhaps in the best interest of all, there are many fill in the blanks in this story (and I hope this is where the news reporters are more detailed in getting it right):

1. Magsaysay now claims that his son had stomach pains already while still in Manila. He thought it was just gaseous pain. I am sure they waited for almost 3 hours (not including the travel time from their house to the airport) prior to boarding the flight from Manila to LA. Then include the 12-13 hr flight and the arrival into LA and through immigration. According to Magsaysay, his son was diagnosed to have Acute Appendicitis when they got to LA and was operated there. Which shows you how irresponsible the action of Magsaysay was. Acute Appendicitis is a medical emergency. But the sorry-ass congressman didn't seem to have any choice but make sure that his family (or son) boarded that plane because they already had tickets to go to LA. It would seem to me that he was stressed that he was traveling with his son who was already complaining of an illness. Because of this, he was stressed enough to throw fits and tantrums at a non-accommodating customer service representative. Did the boy have fever? Was the boy in severe pain? How old was the boy? Did the crew members on the flight notice that the boy was in severe pain? Why did he opt to travel with the boy as the appendix could have ruptured during the flight and he would have posed more risk for both passengers and crew had the boy died on the plane? If these were so, I guess Magsaysay should not only be charged for the cusses he blurted out on that fateful day, but for child abuse and negligence and endangering a minor as well.

2. Some nincompoop-no brainer called yourmoneyiwant replied to the thread of the congressman's "excuse" that in customer service there are two rules - rule #1 is that the customer is always right., rule # 2 is when the customer is wrong, refer always to rule # 1. Let me be frank. That rule and whoever made that rule is a loser. A great big loser!! Loser big time most especially for the fck*dup dimwits who believe in this rule!!! No one, and I reiterate, NO ONE has the right to call even a customer service person names. You may disagree with the customer service person but you can also say it nicely. For the record, no matter how stressed Magsaysay was, he had no right to call Ocampo a bitch, no matter how wrong she was. He could have asked for the supervisor and talked to her nicely and tried to explain the situation. But he should have thought about that as the reason and not brandished his son-with-an-appendectomy-story AFTER the initial report of the Inquirer.

3. Of course PAL officials had sent a letter of apology for the untoward incident. Tsk tsk tsk...I always say that when one is right, there is nothing to apologize for or apologize to. (Maybe they also sent another set of round trip business class tickets to appease the congressman? Just asking.) Management must learn to be a little pro-labor force. Not all the employees in its basket are bad. Many of the officials are worst. They get fat paychecks, kowtow and rub elbows with the government officials and sadly, some of them that sit in the board are as arrogant as the government officials of this country.

For the record:

1. When I was on one of the PAL flights from Manila to Davao, there was this guy who was seated right beside me with the whole seat in the declined position. Like I was staring at him and even when the plane was taxiing on the runway, he was still in the same position. The flight attendants were not even calling his attention. I found out later that he works for PAL as one of its biggies. My goodness! Talk about consistency in what you teach!

2. On another flight I was with one of the senators and his henchmen. When the doors of the plane was closed they asked me to turn off my iPod but the senator who was seated beside me was still yakkity yakkity yakking on his mobile phone even when we were taxiing already. Ganun? May exception to the rule?!?! Pwe!

3. When I fly on Mabuhay Class I always prefer to sit in front especially if it's an A319 or A320 configuration. Every time I check in and request for this, more often than not, they will tell me that it is reserved. That's fine. So who's the personality in seat 1A or C? - taddahhhh~~ congressman or senator or cabinet undersecretary or cabinet secretary or mayor or vice-mayor or governor~~~basta nasa gobierno! Nampucha naman! Eh pareho naman bayad namin noh. At least ako, pera ko. Eh sila pera ng bayan. Dapat nga sa economy-flight-go-lite-book-and-buy fare ang mga ito!!! So what's the reason why they have preferential treatment again?

As one of the thread followers would say, let's all put this story into the hands of the court, out of the media circus, and move on with our lives. Next story please, BITCH!!!

[Photos from]

Thursday, January 13, 2011

For the love of drugs

At Kinokinuya in Singapore and chanced upon the paperback "Hard Sell: The Evolution of a Viagra Salesman" by Jamie Reidy.

This is a true story in the life of Reidy, a former medical representative from Pfizer who tells the whole world boldly of the realities of the pharmaceutical industry and the dealings and relationship of the industry with doctors. Reidy is a story teller, while albeit, at times the story drags on and on (and we may not be able to relate to the story in some segments as Indiana and Fresno are particularly not within the radar of even the most rural Filipino), the humor in his storytelling is somehow still sustained.

It's actually a good read and while some of the doctors (and med reps) in the Philippines may be alluded to in many of his escapades, the shocking revelation of the pharmaceutical business is a wake up call to the paradigm shift that the industry must take on this day and age where "dealing" with the industry and "conflicts on interest" can pose ethical problems in clinical decision making of the physician.

And if you're the kind of skeptic who clearly has doubts on his doctor to whatever he/she prescribes or how much he/she charges for his/her professional fee, well this book has clearly affirmed that doubt - that there are doctors who collude with the medical representative, anywhere from getting free samples, free trips or even free meals.

Reidy expounds on his having to detail Zithromax, Zoloft, Zyrtec and Diflucan as a prelude to his becoming top salesman for Viagra. He does this with candor and compares the extensive "brainwashing-our-product-is-the-best-supergood-do-it-all-cure-it-all-drug" training programs of Pfizer reps. How difficult it was to convince doctors to shift from Biaxin (Klaricid in the Philippines) to Zithromax, how doctors talked about sweet deals before shifting from Prozac to Zoloft, how ironically the staff of Dr A would be hungry 24/7 waiting for the med rep to bring a pizza or some doughnuts so that he can get to cover the doctor that day, and so on...

Then comes vitamin V. A drug that was supposed to resurrect the dead - penis, that is! After extensive training on "when, why, how, who and what" to use Sildenafil citrate (Viagra) for, he tells us how strange it is that doctors become suddenly become accommodating. "Where is that med rep that details Viagra?", "Where is the Viagra boy?", "Where are the samples?"...never was he been more astounded with a drug that required a lot of detailing on safety on us was so much demand that people were just craving for it, without having the need to listen to the dosage and indication - from the doctor to the 98 year old across the street! Even the guy that had strict "no bathroom privileges" were begging to get a pop to pump that pathetic useless piece of appendage that would not stand anymore! Even the women wanted to use it and the young men started experimenting with it to get stiffer boners, hard as a beer bootle when you flick your fingers against the bottle! And so the discovery of the century - getting those dead boners - suddenly had a life!

Reidy resigned from Pfizer in 2000 and joined several other pharmaceutical companies before his book became popular and before it became a movie. While the first 30 minutes of the movie is related to the book (and lambasts the shennanigans of the pharmaceutical company and the doctors), the remaining 60 minutes is fairy tale and not based on even the life of one Jamie Reidy. Starring Jake Gyllenhaal and Anne Hathaway, "Love and Other Drugs" debuted in the US in November 2010 and will show in the Philippines on January 26, 2011.

As to how the public will perceive the relation between the doctor and the pharmaceutical industry, we can only wait and see. As to how the public will perceive Pfizer as a company, that's something the company will need to be ready for.

I don't think the movie will really create a massive impact (hopefully not), and the movie does not do justice to the paperback story. But I think this was intentional so that there would be minimal impact on Pfizer and the pharmaceutical industry and the backlash against the physicians would be awfully small.

Then again, it's stories like these that tell you how it is and what it is that make people believe that a collusion between pharma companies and physicians actually exist and that there is change of hands in terms of favors rendered for favors received...

Love and other drugs Trailer 2
Uploaded by teasertrailer. - Full seasons and entire episodes online.

Sunday, January 9, 2011

Fraud in medicine

I received a text message the other day from the mom of a concerned patient asking me if I had been following CNN's Anderson Cooper's show regarding the relationship between MMR and Autism. And if I did, what was my opinion?

How did this controversy ever start? Who is Dr. Andrew Wakefield? What was the study all about?

Dr. Wakefield is (or was until he was stripped off his license to practice for fraud and conflict of interest) a British surgeon and researcher who published a paper in February 1998 linking autism and vaccines in the prestigious journal the Lancet. The study was done in 12 children who had bowel problems and diagnosed to have autism. Of the 12 children, 8 were supposedly received MMR vaccine while 1 developed measles infection prior to the onset of the autism symptoms. After the publication, many parents became indignant to the pharmaceutical companies that they opted to defer or delay MMR (measles, mumps, rubella) immunization for their children. Subsequent decline in vaccine coverage led to outbreaks and deaths among afflicted children.

Let me answer some queries of parents.

1. "If there was not enough proof on the findings of Wakefield, why did a prestigious journal like Lancet publish his study?"

I served as Editor-in-Chief for 15 years with the Santo Tomas Journal of Medicine (Official Publication of the Faculty of Medicine and Surgery of the University of Santo Tomas) and Editor-in-Chief for 8 years with the Philippine Journal of Pediatrics (Official Publication of the Philippine Pediatric Society). These, aside from various positions in the editorial boards and reviewer of several manuscripts published locally and internationally, form the basis for my right to critique the publication of Wakefield and how the public and media wrongfully perceived ONE article.

Let me remind everyone that the journal is an avenue for sharing data and findings of various researchers. Unlike the newspapers or mainstream media, each scientific article is unique in the sense that it is a complex structure based on the design of the study and the statistical treatment on the given data. Studies can be anywhere from case reports to complex cohort studies and the interpretation of said studies may be thwarted unnecessarily by those NOT trained to interpret results and findings from the published literature.

All studies are peer-reviewed. Which means that those who reviewed the article agree that the paper is worthwhile publishing. It does NOT imply that we agree with the findings. For a simple case-series (12 cases do not make a formidable study and is the one of the weakest of all types of studies) like Wakefield's, many other researchers worldwide attempted to duplicate his study by either doing larger case-series or case-control studies BUT were NOT able to duplicate his findings. It is up to the astute physician or reader to critique and interpret the published studies well. Unfortunately, misinterpretations by media men who are not even trained to discern a good study from a fraudulent one ends up as sensationalized journalism.

Simple studies like Wakefield's are published to trigger the medical and research community to do larger and extensive studies in order to demonstrate positive findings in favor of the his data. Which is the core of research. One study DOES NOT make the rule. One study should be able to trigger prospective studies on a larger scale basis in order to demonstrate either reproducibility and fact OR fraud.

2. Why was the article published initially then called fraudulent later on?

With so many researches in whatever field of endeavor (business, IT, medicine, science, pharmacy, engineering, etc.) it is difficult to make 3 or 4 people conclude that what he or she is reviewing is fraudulent or not.

Anne Hudson and Faith McLellan published a book "Ethical Issues in Biomedical Publication" [The Johns Hopkins University Press, 2000] that tackles ethical dilemmas in scientific publication. And misconduct in research (like misconduct in various forms of business and media) can range anywhere from misuse and manipulation of data to conflict of interest to publication bias.

Plagiarism and fabricated data has been the most clear example of publication scandals. Even our Supreme Court was not spared from such moronic acts. The most well known cases of scientific misconduct on publications are the Darsee and Slutsky cases.

John R. Darsee was a Harvard student and was only 31 years old when he joined the Cardiac Research Laboratory of world renowned cardiologist and editor of cardiology textbooks of medicine, Dr. Eugene Braunwald. The mentors of Darsee at Emory University tagged him as a brilliant and outstanding physician.

"...Until May 1981, when he was observed faking lab results of experiments on dogs on two separate occasions, Darsee seemed to be living up to the promise of his recommendations. He worked hard, published extensively, and gained Braunwald's deep trust and respect. Indeed, when accusations of misconduct were brought against Darsee, Braunwald at first suspected his accusers of being motivated by jealousy. And when Darsee confessed to falsifying data but insisted that he had done so on only one occasion, Braunwald believed him, accepting a "single, bizarre act" as an explanation for Darsee's behavior. It was months before Braunwald was persuaded that Darsee had engaged in widespread pattern of misconduct, which had begun when he was an undergraduate biology major at Notre Dame and continued during his years as a cardiology resident and fellow at Emory. It took years to investigate Darsee's research thoroughly and to determine how many of his publications were based on fabricated data....When the dust settled, investigators had revealed that Darsee's nine Harvard papers, co-authored by Braunwald and Braunwald's research deputy Robert A. Kloner, were all based on fabricated data and had to be retracted. These papers had been published in prestigious journals, such as the American Journal of Cardiology and Proceedings of the National Academy of Sciences. In addition, most of the 10 papers and 45 abstracts that Darsee co-authored with researchers at Emory could not be validated had had to be retracted..."

Robert A. Slutsky was a mirror reflection of Darsee. Slutsky started as a radiology resident and unsalaried associate clinical professor at the University of California San Diego. It was startling that Slutsky was producing 1 paper every 10 days for several years. Even if you were not seeing patients and were just reviewing procedures in radiological science, it would be practically impossible to get that many researches in a span of days.

"...Despite this extraordinary output, which should at least have attracted critical attention to his work, Slutsky's fabrications went undetected until early 1985, when he was being considered for appointment as an associate professor of radiology at UCSD. Then, a member of the departmental committee evaluating Slutsky's work noticed duplicate data in two of Slutsky's articles. Questioned about the duplication, Slutsky abruptly resigned his appointments at UCSD...In the investigation that followed, a ten-membered UCSD faculty committee determined that, of Slutsky's 137 publications, 77 were valid, 48 were questionable, and 12 were fraudulent...."

These are not isolated cases and perhaps there is more in the published medical literature. Which is why we teach medical students to be able to discern the quality of the published literature. Not everything you read is the golden rule.

3. Are you absolutely sure there is no link between vaccines and autism?

No I am not. And there is no such a thing as a drug being absolute free of side effects. Even if John Lloyd winks back at you on an advertisement on Biogesic being safe, it is moronic AND ironic that the public and media are willing to believe some lackey actor endorsing a drug to be devoid of side effects when in fact, Paracetamol (the generic name of Biogesic) is the number one drug worldwide that causes drug-induced hepatitis.

Which means that we must remain vigilant about drugs and vaccines in the market. Vaccines remain to be the major discovery of the 20th century. Without vaccines, more people would have died. Every drug or vaccine that comes out in the market are not fool proof or should I say, without side effects. During the initial phases of the studies, we only use a few thousand patients. So if the drug or vaccine, say, causes a side effect of autism in 1 out of every 100,000 patients that receive it, you will not be able to detect that in the initial clinical trials.

Add to that the benefit:risk ratio. Which means that without the vaccine 1 in every 100 children afflicted with measles will die. 1 in every 10 child afflicted with measles will require hospitalization. 1 in every 10,000 children afflicted with measles will have neurologic sequelae. Therefore on a public health scale, the implementation of a vaccination program is more cost effective and will have greater impact on health benefit for the majority rather than the few who MAY purportedly develop autism.

After reviewing the case of Wakefield, the following conclusions were arrived at:

1. He received money from lawyers of parents (to the tune of close to 500,000 pounds) for his work on the paper. Parents of the 12 children in the study of Wakefield were recruited through a lawyer in the UK to prepare a lawsuit on the manufacturers of MMR.

2. No other study was able to duplicate the study of Wakefield. In addition, Wakefield was not a pediatrician nor a developmental specialist. All he did was take the word of the parents that their child was autistic and had received MMR and concluded that they developed problems after the vaccine was administered. On thorough review of the data of the 12 patients in Wakefield's study, many of them had developmental problems even BEFORE they received the vaccine. In addition, what explains the fact that there were 4 patients that never received the vaccine and YET were diagnosed to have "autism"? One was said to have developed measles infection. If this line of thinking were true then that should put all patients who develop measles infection at risk of developing autism as well.

3. I have patients diagnosed to have autism and have never received any form of vaccine (let alone MMR) whatsoever. What explains their autism?

The cause of autism remains unknown today. There are several theories, but no one knows the exact cause. But with the evolution of science in leaps and bounds, we may eventually be able to unfold the mystery regarding autism.

The increasing cases in autism is currently not related to MMR vaccine. In spite of the precipitous drop in MMR vaccination in the UK and the US after the Wakefield publication, evidence shows that the number of autism cases had still increased. Are we seeing an epidemic? Is it environmentally related? Or is it genetic? Or perhaps it is because we have greater awareness of the diagnosis of autism that we are able to label patients as autistic earlier on.

I pity actually the parents of autistic children who are dying to defend the stand of Wakefield. And while I commiserate with them I cannot condone their line of thinking on what they believe. An open mind and understanding on the spectrum of autism should be their focus so that they can begin to care for their children afflicted with this disorder. They need to focus on providing care and helping out in the dissemination campaign on appropriate education and understanding on how we can help families with autistic children. I am not asking them to embrace the disease and walk away. I am simply asking them to look beyond one man's fraudulent publication and belief and focus on their children who need their care and attention more than defending Wakefield's ludicrous claims.

Media should also desist from providing biased reporting. If they do not understand the published literature, they should ask someone with knowledge and expertise to interpret it for them at a fair airtime and not blab blab blab on their one sided interpretation! A little knowledge is deadlier than having no knowledge at all.

In the history of pharmacology, it is best to remember that all drugs are double bladed swords. One man's medicine may be another one's poison. After all, science is fallible.

Jones, AH: "Changing traditions of authorship" in Ethical Issues in Biomedical Publication, Ed: Anne Hudson Jones and Faith McLellan. The Johns Hopkins University Press, Baltimore USA, 2000: 7-12

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Thursday, January 6, 2011

Forward...and backward...

Before BPOs even became the number one industry in the Philippines, we were tagged as the TEXTING capital of the world.

Note that this phenomenon was BEFORE the Americans and Europeans even learned how to send SMS!

We are so text crazy (I don't know if this is correct grammar) that the average Filipino most likely owns a minimum of TWO mobile phones.

Which goes to the meat of this blog.

Have you ever received a text message that goes something like this:


Forward this to 10 other people - including me if you consider me a friend - and a miracle will happen in 3 days.
If you don't do this now, something bad will happen to you. A friend of mine did not believe and is now sick and lost his job.
Pass this on if you love God.

Watdf**k is the matter with this message? It's nothing but a chain text (remember those chain letters when we were kids?)! And if there is something really awful in these chain text messages - it's the fact that it's not FREE!!!!!! Darn!

I am sure that even God rolls over on His belly and scorns upon the Pinoys who seem to be wanton and dazed at the stupidity and mediocrity of believing in chain texts. I recall sometime ago, the Church took a stand on chain letters and told the faith not to believe in them. So why isn't anyone from the cloak saying something about this? In cahoots? Geez!!!!

First of all, yes you are my friend. But I don't need to keep sending you this message back and forth so that we can ink our friendship! Second, God surely loves us - after all, He sent His only son to be born and then die for us! He did not text us nor did any message miraculously appear on your celfone from GOD. Thirdly, 70% of the Pinoys live below the poverty line. They can't even make heads or tails with the food that they will serve on the table - and they turn to texting each other back some thwarted message like this! OMG!!! Finally, if you know how to count, and your phone is able to do that - remember that the mobile phone companies charge anywhere from P0.50-P1.00 for every 160 characters (inclusive of spaces) you type!!!!! [Of course I guess that's why there are so many Sun Cellular subscribers - therefore accounting for the TWO PHONES per Filipino, because of the text and call all you can as long as you're within their network.]

And here's the rub - there's a difference in believing and fanaticism. Whoever invented this chain text is pulling in the big bucks (and I have a strange feeling that one of the idiots from the celphone company started this darn trend). And the average Pinoy is in starvation mode. [Tapos mag rereklamo na wala na silang load o ang mahal ng kanilang bill na babayaran - sanamagan talaga!]

We keep forwarding these text messages, which are already mindless and robotic! [And when it pops up, I simply press - DELETE message.]

Like the stand of the Church regarding chain letters decades ago, where they called it a SIN, it is SINFUL as well to deprive ordinary people of honestly earned meager livelihood only for the benefit of the mobile phone companies.

Responsible texting is something that we need to educate the Pinoys on. It should help temper the indescribably silly use of SMS as an appropriate means of communication.

When will we ever learn? We keep forwarding mediocrity by moving backwards in our more pathetic can we get?


Sunday, January 2, 2011

Of gifts, happiness and walking away...our Singapore New Year

I spent the New Year with my family and partner in Singapore. It was a fitting cap to 2010. Perched on the roof top of the luxury boutique hotel - Naumi Hotel, we counted down to the fireworks amidst the splendor of Marina Bay, with champagne on one hand and canapes on the other.

The trip was a bonding of sorts - Universal Studios, shopping on Orchard, dining out, shopping on Bugis and Chinatown, eating out, shopping on Raffles, gastronomic experience. Of course, everyone who still had some cash left, shopped all the way to Changi Airport and onboard duty free on Singapore Airlines.

Naumi Hotel is a charming personal luxury hotel on Seah Street, right at the back (or side) of Raffles Hotel. The cab drivers definitely had a hard time looking for the hotel. It was a virtual unknown hotel to the locals. As a member of, I had the opportunity to find a good hotel - swanky, personal and yes, fabulous location - at the heart of Singapore. I highly recommend it to everyone who wants to stay in a great hotel in Singapore. The personal touch, Molton Brown toiletries, the free minibar (sodas and water till you drop) and healthy breakfast is icing on the cake of the sprawling suites where the flat screen supersized TV sets are divided from the bedroom and living room and the bathroom shower has a rainshower head and a steam bath. Where the bedroom and living room has a divider controlled from your bedside panel. Where there beds have 7 layers and a menu of pillows to choose from. Where the lighting system can be controlled from romantic mood to study mood. Where wifi is free all over the hotel. But the selling point of Naumi is its great location and wonderful staff!

Universal Studios Singapore is a let down. For everyone that plans to go to Universal, may I suggest that you simply defer this until the whole place is finished (which I doubt will even be comparable to the US Universal Studios versions). It is tinier than HongKong Disneyland and quite expensive. For $65 per person per admission, the queue is so long that it would take you forever to enjoy a 50 second ride. I got the express land pass which meant an additional $48 per person. Of course, we didn't have to queue anymore so Universal was done in 2 hrs - rides, shows and shopping. Located at Resorts World Sentosa, unless you plan to play and stay at the Sentosa area for 2 days, then Universal should be in your wish list. But if you're just visiting Universal Studios and would not want to have anything to do with the casino and other sites at Sentosa island, skip Universal Studios.

As Singapore is at the equator, there is NO DAY that it does not rain in Singapore. Be ready with an umbrella or get ready to get really wet in Universal (not only from the rain but from the rides) or get wet while you're out shopping.

Marina Bay Sands is chic, but all hype. You need to be a guest at their hotel in order to have access to the pool at Skysands. Then again, if you're the spending kind and wouldn't want to stay at the casino cum hotel cum shopping mall, there's always the Skysands entrance at $20 per head. We had a sumptuous buffet lunch at $45++ per head at the Rise restaurant in Marina Bay Sands upon our arrival in Singapore. Unfortunately the restaurant was located in the lobby so access to Skysands restaurants was not allowed. The booking is a mile long and they have preferential booking for hotel guests.

Singapore is a revelation in itself. Sparklingly clean and safe, you could actually feel that it tries to achieve Nirvanah or Shangri-La where everything turns out to be perfect. I hate saying it, but too perfect to even be thrilled at anything. It's a country where business is business and where politics and graft and corruption is frowned upon. Where crime is deterred through severe punishment. Where drug trafficking is punishable by death (ironically, the Europeans don't even deter the death penalty in Singapore and even when they do, the Singaporeans tell them to just shut up and these die hard goodies just roll over shut up). Where laws are laws and rules are rules and no one, not even government officials are exempted from them. It's a country so ideal that it makes us cringe at the thought that we live in a third world country that is like a roller coaster ride with life and death.

Whatever I spent during this holiday spree (which was my gift to my family) cannot be measured in terms of seeing us all laugh, play, rest, and eat together. As the slogan goes - happiness is priceless, everything else there's Mastercard.

Which leads me to the end of this short blog.

The presents we give should be one out of love and from within our hearts. When we give presents, we must fade away quietly. We do not make a big fuss over these gifts and how generous we are. The real challenge in life is how to do something good and then exit or fade away quietly, how to live life and let go, how to play our role and do our part and then take a bow. That is how people will "notice our star when it has faded into the night."

And as we all start the new year, it is time to get back to work and save enough for the next gift for the coming year for my family. Again...