Thursday, June 30, 2011

Conflicts of interest

Almost the same time last year, I had talked at the postgraduate course of the Department of Pediatrics, University of the Philippines-Philippine General Hospital on the continuing saga of the doctor and the pharmaceutical industry.

I had mixed feelings giving the lecture. After all, the audience were doctors. They are all my colleagues and many are my friends. Choosing the right words to say was going to be a challenging task. My talk was eventually published in the Philippine Journal of Pediatrics last year.

The issue of conflicts of interest has touched raw nerves in the medical-pharmaceutical community in the Philippines.

Over a decade ago, the Philippine Daily Inquirer ran an article entitled "The Med Rep is OUT - with the Doctor". The article highlighted the extraneous relationships between the physician and the pharmaceutical industry through the medical representative. With the increasing scandals involving various forms of gift giving of the industry to physicians, many pharmaceutical companies and medical organizations are dissuading physicians from getting entangled in situations that may question their credibility due to conflicts of interests.

The other day, I overheard in a meeting that a bunch of doctors had decided to boycott a pharmaceutical company because the company did not accept their request to go to a convention somewhere in Europe! The doctors arrived at the conclusion that since the company had not supported them to conventions in the last 2 years, the accumulated 2 years was equivalent to a convention in Europe. Now that took a lot of gall, if not KAPAL NG MUKHA on their part and I felt ashamed that there are doctors that stoop this low just to attend a convention.

Let me call a spade a spade. You may want to un-friend me in your Facebook account after reading this blog. It is my final blog for the month and while I have been quiet, I also thought deeply about writing this entry.

First of all, the fact that doctors are wined, dined and given gifts is NOT an obligation by the company. WE DO NOT HAVE RIGHTS or ENTITLEMENTS to what the company gives as dole outs. If we accept these gifts, so be it. If we don't, then so be it as well. No one coerces us to prescribe a drug. It's not like they put a gun in our heads and then threaten to annihilate our families if we don't provide them the number of prescriptions they ask for. If we prescribe a drug in exchange for a gift, it is a form of indirect bribery. As doctors, we are already paid by patients our professional fee. That is payment in itself. Prescribing a treatment for our patient entails due ethical and medical consideration of the whole clinical spectrum or condition of the patient, before we write down what medicines they need to buy. If the drug is not needed, we should desist from writing down a prescription only to pay back or please the last pharmaceutical company that sent us to some out-of-town lecture or pleasure trip to never-never-land. If the patient does not need a prescription, tell the patient that. Our prescriptions should not be clouded by the incentives or perks that come along with the "field trips" or "excursions" or "lunch baskets" provided the industry. I will go direct to the point - there is no gift that is given without an exchange awaiting. The bigger the gift, the larger the investment of the industry, the larger the expectation.

These conflicts of interest have begun to be scrutinized lately by several ethical, academic and governmental institutions both abroad and locally. Ironically, while it is the industry that now calls on the moratorium to the excessive spending and lavish wining and dining to doctors, it is also the industry that started this marketing ploy that has now caught them in between the devil and the deep blue sea. Like rearing children, the industry has spoiled the kids rotten. The phrase "spare the rod and spoil the child" aptly describes the old disciplinary method of not punishing children when they are caught doing something wrong. As a matter of fact you will hear tales from the industry that doctors literally ASK for anything under the sun - from cars to trips to furniture to laptops to mobile phones to sponsoring their annual dues or convention fees to driving them to and from the airport or picking up their children to school or asking med reps for personal "favors" in exchange for keeping a "close relationship" with the rep in particular and the pharmaceutical company in general. But that's because they allow it and that's because the industry is so deeply mired in this traditional exchange "gift" that the marketing people have not changed the old "tactics" of selling a product.

I tell my students that a good drug, sells itself. A bad drug, needs a gift to go with the bag.

Some of my friends who practice in the United States once asked me how some of my colleagues here are in several conventions in the U.S. or Europe or Asia in a year. When I asked them how they know, they tell me that they read it as "shoutouts" with matching pictures of various tourist destinations from some of our colleagues almost every other month! Some of them even post the pictures on Facebook with the signage of the drug product they were asked to pose and promote.

One of the biggest contributors to sponsorship as an indirect form of bribery are the various organizational societies themselves. Touted as pillars of the medical circle, some of them violate ethical boundaries by demanding from pharmaceutical companies sponsorships in conventions which they collect convention fees and some threaten companies of boycott if they do not "contribute" to the success of said conventions. When the pharmaceutical company agrees to sponsor an event like a convention, the society must maintain its unbiased position by ensuring that the sponsors do not in any form pose bias in the promotion of its company's products by unduly providing more exposure than the other sponsors with lesser financial means. If the society cannot police itself at the get go, how will it expect its members to follow suit?

The National Pediatric Infectious Diseases Seminar (NPIDS) sponsored by the Baylor College of Medicine in Houston spearheaded by Infectious Disease pillars Drs. George McCracken and John Nelson had discontinued their program after almost a quarter of a century of providing unbiased CME programs because they decided to adhere to more ethical standards in the conduct of the seminar. Because industry did not want to sponsor events where there would be less exposure to their products, the pharmaceutical companies threatened to pull out sponsorships if the organizers refused to give them more exposure. Because the cost of running the program without the aid of the industry was a tall order and prohibitive, the organizers decided that it was time to end the program rather than give in to the coercion of the industry. I used to attend this seminar for over 10 years until it closed down several years ago. It was a great loss but I admired the organizers for taking a stand.

The issue on conflicts of interest are not solely the problem of doctors. Each professional field is mired in its own conflict, but the medical field is the only one wherein a second person or more persons are affected by the decision made by the primary person whom that conflict is borne upon - a decision that can affect life, cost/benefit outcome in limited or scarce resources scenario, and burden of treatment or diagnostic procedure when the latter is not required.

During a meeting with one of the pharmaceutical companies, they had expressed exasperation at the attitude of some doctors whom they could not provide "gifts" to. Some of the doctors were either angry or in denial or were bargaining (agreeing to sponsorships for local conventions instead of foreign ones) and I was shocked that some even had the temerity to reply, "paano na ngayon?"

Truth be told, the doctors are one of the highest paid professionals - locally or abroad. Let's face it, our patients know that. They see how grandiose some can be - toting a Hermes or LV or Prada, driving an Audi or Porsche or Pajero, living in posh villages, wearing signature clothes with matching shoes, belts and bags and bling, dining in 5-star hotels or expensive restaurants. The mere fact that we flash around all these largesse and yet ask pharmaceutical companies for "gifts" in any form leaves a bad taste in the mouth.

I am not saying that we don't accept a gift. When a gift is given, it should not expect anything in return. After all, if it is a sincere gesture, it should not expect payback. If the gift provided is part of an exchange deal, then it should not be accepted. It is unethical to demand anything from a company. What the industry provides or gives us is a privilege and not a RIGHT!

Today's changing landscape in the pharmaceutical industry should be a reason why there needs to be a paradigm change on the Filipino physician's role with the industry. There needs to be a concerted effort at preserving the dignity of each of us in spite of the pressure of some sectors of the industry putting a carrot in front of the rabbit to make the rabbit hop!

After 10-15 years of studying to be the most distinguished profession in the world, we cannot let conflicts of interest destroy our integrity. At the end of the day, our patients should benefit from our judgement. They pay our professional fees, put food on our table, a house over our heads, send our children to good schools. They deserve nothing less than the best standard of care without undue influence from the pharmaceutical industry.

Sunday, June 26, 2011

The circus came to town

It was a rainy weekend, with tropical storm "Falcon" pouring torrents of water in Manila (and the neighboring provinces). The streets of the metro was flooded and I had to cancel clinic on a Saturday.

Saturday was also the day that my family and I had bought tickets to see the circus that came to town. Le Cirque du Soleil had flown in over P700M worth of equipment, stage, acrobats and clowns for the first ever performance of Cirque in the Philippines. That Saturday afternoon, the weather had cleared and it was a childhood fantasy relived all over again.

Varekai was the Cirque version that performed in Manila. I had bought the tickets way back in February and had gotten good seats. Varekai had premiered in Montreal, Canada in 2002 and the plot is basically a take off from the Greek mythology of Icarus, the fallen angel whose wings had melted after flying close to the sun. Instead of drowning into the sea, he falls into a lush forest and the creatures and plants in the forest teach him how to fly again.

I have seen some of the other Cirque shows in Las Vegas and while Varekai falls short of the much more fantasmagoric shows of Cirque, its setting in Manila at a specially built Grand Chapiteau (circus tent) that was fully airconditioned, provided a good atmosphere to enjoy a circus. The show started right on the dot and the rules on no cameras, mobile phone conversations and other gadgets were fully implemented. On a negative note, I guess the full episode of Varekai was not shown because of the limitations of space, so the show simply lasted 1 hr 30 mins with a 25 mins intermission number.

The highlights of the show were the child performers, the clown acts and the grand finale that got ooos and ahhhs from the audience.

While I guess for those like me who had seen other performances of Cirque, Varekai had provided the entertainment to the locals. And I am hoping that this will not be the last performance of Cirque in Manila.

Varekai runs until July 24 at the Luneta Grandstand. And for those who may still want to catch it, get the tickets at the farther end at the upper rows so you can see the stage in full. We were watching from the very front row and had torticollis after the show.

Until the next circus comes to town...enjoy the fantastic spectacle that only Cirque can provide. It's worth the weekend.

Wednesday, June 22, 2011

Death by kindness

So you hate someone or you probably are angry at the world. You've been wronged and you want revenge. Who doesn't? In a culture where being "mean" can mean being "in", we've probably gotten a taste of the sore end of being bullied.

There's a story that goes like this:

"A newly married woman was to live with her mother-in-law. On the outset she noticed that her mother-in-law was a little devil. The mother-in-law saw nothing right about her whatever she did in the house. Disturbed and devastated, the young wife went to a chemist-friend and asked for some poison to kill her mother-in-law slowly. The friend gave her a potion that she would drop little by little into the coffee of the mother-in-law who would drop dead in a month. But the friend strictly advised the young wife to be very patient and kind to her mother-in-law so as not to attract attention to her evil design.

So while slowly poisoning the mother-in-law, the young wife treated her very sweetly and kindly. Soon after, the mother-in-law changed and started treating her daughter-in-law very sweetly and kindly, too. This made the young wife guilty and ashamed of what she was doing. She went back to her friend, crying and begging for an antidote to the poison she had been giving her mother-in-law.

Her friend just smiled and said, "that was no poison I gave you, but just some baking powder. What killed her was our kindness. Go home and continue to treat her as you would want to be treated."

The message is clear and simple. We get treated the way we want people to treat us or the way we treat people in return. Sure, there are mean people and sure, we lose our tempers from time to time. No one is born perfect. But in each and every act of kindness we give, we get kindness back in return. Maybe not from the same person...but from other peoples.

A bit of compassion, understanding and love. A piece of our heaven, our purgatory and hell in our journeys in life.

[Photo from John Sokol: AIM ABOVE THE MARK]

Thursday, June 16, 2011

Botoxed at 53

What do you get yourself as a gift for your birthday?

Been there, done that mode.

During our younger years, we couldn't hurry up to be more "mature" looking so that we could pass as adults for our age. Then when we're at the prime of our lives, one day we look at the mirror and start counting the lines across our foreheads, the crow's feet along our eyes, the laugh lines that have deepened, the greying (if not balding) hair, the paunch on our midsection and then we heave a heavy sigh.

It's not of discontent. It's reality sinking in. Yes dear, we're counting down to our senior citizen card.

But why do we want to look like 70 when the wonders of science have changed the landscape of remaining beautiful or younger or sexier even in our prime?

A month ago, I woke up one morning and looked in the mirror at the lines across my forehead and made a frown. Reality check - no Shu Uemura foundation or Triaktiline firming cream or Lancome anti-aging could reverse the process.

The truth of the matter is, I fell for the old trick in the book. I went to Marie-France to enroll in the facial Refirme program. Paid almost P43,000 ($1000) for 4 sessions (3-4 weeks apart) where they staple your face 1000 shots of heat emanating from a gadget. It was like I was getting jolted on the face for an hour. When the session was over, the skin felt smooth and firmed. But that didn't last. After a week, the lines were visible once again. And it went on and on until I decided that all these advertisements were such a scam (I told you they don't work. These endorses just get the programs for free so like Dawn Zulueta or Ping Lacson, they're all photoshopped to sell a spiel.)!!!

A week ago, I decided to take the final plunge. I researched on onabotulinum toxin A (Botox Cosmetics) and called my dear friend Ida (she's my dermatologist at Asian Hospital) and told her about getting a Botox. Yesterday, I finally had 52 units of Botox injected into my face (on the forehead, across the crows feet, on the laugh lines, and along the chin area).

Was it painful? Well, let's put it this way, I had EMLA all over so the pain was tolerable. You can't look down for 1 hour. You can't lie down for 4 hours. You feel like gazillion bees had stung your face and it's red all over. The headache was minimal. And now as I write this blog, my face feels stretched. But the lines, oooohhhh, they're disappearing slowly. You can see the improvement in just 24 hours but the maximum effect is supposedly noticeable in 2 weeks.

So if you bump into me and see the change, it's not because of the cosmetics or the facials I get, it's Botox.

I will not post before and after pictures because it's horrifying (this is supposed to be a general public reading blogspot). When you bump into me one of these days, you'll see the difference. It's aging beautifully that matters now.

And for those that want to know how a Botox is done, watch this video from youtube...

Sunday, June 12, 2011

Burying Marcos

I was a Martial Law child. In 1986, the Filipinos ousted a dictator through People Power.

The world was focused on history in the making. Through a peaceful protest, I distinctly remember the events that led to the dramatic expulsion and eventual exile of a dictator. When the Filipinos had broken into Malacanan Palace, Marcos and his family were gone. With the help of the Americans, his family went into exile in Hawaii. And the rest is history.

Twenty five years and five presidents later, the Philippines has still to get back on track compared to the other Asian countries in terms of economic growth. Ironically, however, every time we seem to falter, we keep pointing back to the same problem - Marcos. While I relatively agree that Ferdinand Edralin Marcos may have been the primary reason why the economy of this country collapsed, I disagree that he is solely to blame. Unfortunately, this is the pathetic reason provided by some lackeys who do not know how to run the country (and are obsessed only with joining government to steal from its coffers).

In one of the lunch conversations on the topic of where, when and how we should bury Marcos, I expressed my ten cents worth of opinion - we just need to bury him with dignity. We need to close the chapter on this history of ours and as Filipinos, stop living in the past, recalling on the crimes and atrocities his 21 years of rule had impacted on individual Filipinos. The problem with some Filipinos and the politicians (not to mention some feeble minded media men) is that they keep resurrecting the ghost of Marcos past as a "scare tactic" or feeble excuse on why current government programs fail.

Indonesia, like the Philippines, was ruled by a dictator under an authoritarian regime. President Suharto was it's second president holding office for 32 years up to his resignation in 1998 due to pressure from the people and the army. His children, friends and relatives were able to set up business conglomerates under a nepotistic rule.

The Vietnam War, a cold war era military conflict occurred in Vietnam, Laos, and Cambodia from November 1, 1955 to April 30, 1975. This costly 20 year war had torn down the very fiber of economy and livelihood in these countries. The devastation in a cold war era was practically insurmountable. It's Asian neighbors and the world had opined that it would take these countries 40-60 years to even begin rebuilding itself.

During World War II, the Japanese and British had fought fiercely for a small island country called Singapore. The history of Singapore is a rich and proud one. On Sentosa Island, you can literally take a tour to find out how proud Singaporeans are of their heritage and roots. It was not until 1963 that Singapore had gained independence from Britain and in 1965, it became a republic. Lee Kwan Yew was its first prime minister in 1959 up to 1990.

Today, many of these countries have left the Philippines almost at the end of the tail in terms of GDP (gross domestic product) and PPP (purchasing power parity) per capita. According to the IMF 2010 data, Singapore ranks 3rd, Indonesia 122, the Philippines 125, and Vietnam 130 in terms of GDP. GDP growth was at 26.3% (rank 34) for Vietnam, 18.45% (rank 81) for Indonesia, and 17.02% (rank 92) for the Philippines. PPP is more useful when comparing generalized differences in living standards as a whole because it takes into account the relative cost of living and the inflation rates of the country (rather than exchange rates which can distort the figures). GDP (PPP) IMF 2010 data showed Indonesia at number 15 (Million$1,029,884), Philippines at number 33 (Million$350,279), and Vietnam at number 40 (Million$275,639). In terms of data of countries by income equality the ratio of the richest 10% to the poorest 10% and richest 20% to the poorest 20% in terms of inequality metrics for income data for the United Nations shows: Indonesia (7.8, 5.2), Philippines (15.5, 9.3), Singapore (17.7, 9.7), and Vietnam (6.9, 4.9). Clearly a disparity among the rich versus the poor, which means that the increasing economic growth reported are only benefiting a few. Finally, based on IMF data of 2010 on real growth rate taking into consideration inflation Singapore ranks 3rd at 14.47%, Philippines ranks 26th at 7.6%, Vietnam is close to us at 39th at 6.784% and Indonesia ranking at 49 at 6.109%.

Clearly, over the past 2-3 decades the driving force of the economy in the Philippines are the BPOs and the OFWs. With the ongoing war in the Middle East, the decline in demand for nursing graduates in the US and Europe - the Philippines stands to lose some ground when it comes to sending funds back home.

Which brings the story back home. 25 years after we have overthrown a despot from political office, the various presidents that have replaced him have seem to be either in disarray or not in luck at transforming the country into one of the more competitive Asian nations, again. Cory was mired in coup after coup with a disgruntled military that was the spill over of the corruption of the Marcos regime. When FVR took over as president in 1992, the former military general seemed to have punched the right buttons when the Asian Crisis had hit home. While the Philippines may not have been gravely affected by this, it was not because of overexposure, but rather underexposure. There was nothing to eat us up during the crisis because the country was basically poor from the get go. In 1998, we elected another president. But votes by popularity in a country where 70% of its population live below the poverty line ended with us having an ex-movie star in Erap as president. After only 3 years in office, People Power II had taken over and installed GMA in 2001 as its president. In the post-Marcos era, only Gloria had occupied the longest position as president. She would go on to steal the next election in 2004 when her inherited term lapsed and go on to becoming president again for 6 years, a total of 9 years under her rule. But alas, the Filipinos tired of People Power revolts. And GMA knew that. Instead of marching back to the streets, the best way to get out of the corrupt system was to migrate. Last year, a reluctant candidate in the form of PNoy ran for president. On the platform of "Kung Walang Corrupt, Walang Mahirap" [without corruption, there will be no poverty] battle cry, the son of Ninoy became our 15th President of the republic. But the reluctant president seemed to show his true colors after one year in office. With basically a political background a tad better than his mother Cory, he depends on friends and acquaintances for advice on what next to do.

25 years after Marcos, the Filipinos had the chance to rebuild its lost glory. Back home, the jeepneys, buses and tricycles still load and unload passengers anywhere it wants on the streets. Back home, the traffic enforcer on the busy streets is busy catching number coded cars rather than paying attention to the traffic on the road. Back home, the men are still using every wall and post along the streets as their public urinal, pissing on the walls as their bladders beckon. Back home, the poor quality of infrastructure still shows after every rainshower when the roads are full of potholes and the government still collects road taxes from every vehicle owner. Back home, the greedy people in the political arena are still jockeying for even the most menial position in politics only to propagate their wealth. Back home, it's quite obvious that even in jail, the rich are able to live a better life than the poor. Back home, as if amnesia or Alzheimer has struck the Filipinos, they still elected Bongbong as senator, his mother Imelda as congressman, his sister Imee as governor.

Bury Marcos.

We are where we are today not only because of Marcos. We have no political will. As a people, we have no love of country. Until we change our paradigm and outlook on self sacrifice, we can never be a great nation ever.

We need to bury Marcos and all the lessons of corruption from this despot. It's time we move on. Many of us may not see the tangible changes in our lifetime, but for the sake of our next generation, our children and our children's children, we need to bury Marcos and whatever he stood for. Only then can we move on as a nation, truly dedicated to serving the Filipino people.

Tuesday, June 7, 2011

Of truths, propaganda and the "weather weather lang" phenomenon

We get confusing reports from politicians, which is bad. Of course, every politician will say that half truths and half lies are within the realm of "strictly politics". Whichever administration you're looking at, it's either you're looking at the glass half empty or half full.

So here's the beef. The lack of transparency in any government is hurtful to the people as trust is the hallmark of any political system.

Rep. Anthony Weiner a Democrat congressman in New York was recently in such an imbroglio. There was a lot of flip-flop on the statements the camp of Weiner gave regarding his sending a lewd photo of him to a woman on Twitter. His initial excuse was that his account had been hacked. Then when Andrew Breitbart had exposed more stories, the congressman hurriedly came up with a press conference apologizing for this pervert act, shed a few crocodile tears and refused to resign.

The same thing is observed on a grander political scale. The war and uprising in Libya, Yemen and Syria have baffled the world as to the true picture of what's going on there. Their heads of state refuse to step down saying that insurrection on the part of the people needs to be taken cared of by the government as it is the government's obligation to make sure that it's sovereignty and citizens are protected. But the inconsistencies in the stories coming out of Libya, Yemen and Syria (not to mention Bahrain) have left the kibitzers wondering who's telling the truth and whether NATO allies have the right to invade and meddle in the political affairs of other countries. CNN and BBC show footages of what the governments claim to be insurrection of a few. On the contrary, rebels have shown footages of human rights violations of the government as well. The scenario has NATO excusing themselves for the collateral damage on innocent lives and providing an excuse to the ongoing turmoil. But US and European media have clearly stated that the footages from the governments are merely propaganda from these heads of states in what is explained a justification of violence on its people.

Back home, Edwin Lacierda had initially claimed that the rift at the Department of Transportation and Communication by resigned Ping de Jesus from the Aquino administration was regrettable but the spokespeople in the palace were mum on the real problem of frustration after frustration in the search for decent cabinet members that were not part of the "friends, Inc." of PNoy. It is, after all said, that what PNoy wants PNoy gets. Almost a year in office and the country is till desperately scrambling to fit into the picture of moving forward. While we have to hand over the fact that there's a bit more transparency in the government today, majority of those who had an earnest desire for a great change at the slogan "Kung Walang Corrupt, Walang Mahirap" from the people in the palace. It is said that whoever you put in with the crocodiles will swim like a crocodile eventually. And while the trapos were put aside in the current administration, it is still lacking in complete transparency and defends the wrong of friends very close to home.

Without doubt, the Filipino saying (as echoed repetitively by Kim Atienza on ABS-CBN) that life is "weather-weather lang", fits the kind of government we all have. Corruption creeps to us in various forms. Whether it is "kamag-anak, Inc." (where you have all your relatives in every little nook and cranny of government) to "kaibigan, Inc." (where you have all your buddies in the choicest governmental positions, not necessarily out of talent, but out of friendship) - the ethical and moral dilemma seems to be elusive to people in politics.

Accountability, transparency and trust. Three defining words of a good government official. Sorely lacking. Only when we find someone who will not get swallowed by the system can we truly be a better nation. I have my doubts that we will see a significant change in the Filipino way of life in our lifetime. At the moment, it's every man for himself. Our future, after all, is based on "weather weather lang".

Sunday, June 5, 2011

Winning and losing


Who could imagine that these 6 numbers could change the life of a 60 year old carpenter who lives in a squatters area in Las Pinas City in the Philippines? He only made one P20 ($0.40) bet on these numbers. According to the seller of the ticket, the carpenter was one of the last few bettors of the night in that crowded squatters area. A few hours after closing, he heard screams from the neighborhood, but simply thought it was an ongoing nightly brawl.

The following day, when the newspapers had printed the winning numbers, he knew that the winner bought the ticket from his place. The old carpenter won Php 356,552,917.20 ($8.3M) tax free. He never went back to the shanty he resided in. His whole family would go back to the province to start a new leaf on life.

There are many stories on Lotto winners not only in the Philippines but worldwide. The sudden surge of cash will definitely change the lives of many people. But while there are those whose lives are changed because of winning events like these, there are more who struggle with making ends meet each day - from having a decent meal to struggling with health issues and problems. Everybody loves a winner. The cheers and accolades add hope to the many that have to contend with the routine motto of "I owe, I owe, so off to work I go."

It's a fair reminder that happiness does not come in a silver platter.

The art of being happy lies in the power of finding joy in ordinary things. Life does not force us to be the best. To be the happiest. To be the luckiest. It only asks that we try.

The Italian wish "vive bene, spesso l'amore, di risata molto" should serve as our daily reminder to LIVE WELL, LOVE MUCH, LAUGH OFTEN.

After all, at the end of our lives, it's the journey that mattered to the winner.

Thursday, June 2, 2011


In this day and age of technology at our fingertips, finding an answer to any question is a GOOGLE away.

Which is actually not bad, considering that the trip to the library eons ago took up a lot of wasteful time in search for the answers to our questions.

But does GOOGLING a query provide the accurate answer?

Let me zero in on the perfect example.

A few days ago, a friend on Facebook had "shouted out" that her family would be traveling soon and that they would need to bring their 1 year old child. The mother was apprehensive about the travel ahead and that the child may become eventually "fuzzy" during the long haul. As in any FB "shout-outs", a comment thread follows.

And so the "friends" began providing comments: "enjoy the trip", "put a pacifier", "let her drink milk", and so on and so forth and I provided my ten cents worth of consult over FB as well - "give her 5ml of Diphenhydramine (Benadryl) since that's over the counter 30 minutes prior to the trip."

Walanghiya!!! You should read the comment thread that came after my comment from the do-gooders: "don't give benadryl and then there's suddenly a link from on the cons of giving benadryl!". The trail doesn't end there. The next suggestion you read is "give ibuprofen instead. Then another link to another website about what to give your kids if you're traveling by air". Then another suggestion crops up "give acetaminophen (paracetamol) during the trip. it's not advisable to give drugs to kids as they are harmful." Then you see another link somewhere from another God-forsaken site. Finally, there's a comment that "consult your pediatrician about the Benadryl. It's not good."

I felt tempted to agitate the comment thread, but decided against it for fear of harming the ignorant few.

I believe that while technology has changed the landscape in the search for answers to queries on the information highway, it has also been abused by people who "google" and pass on the "found" answers to others as the "definite remedy to the malady". This is most commonly seen in the medical field, but encompasses all - from entertainment to fashion to gossip to politics to science. What I cannot stand actually are people who are not in any capacity authorized to provide unsolicited advise to others. For example, when someone asks you what is atopic dermatitis, if you're not a doctor, do not attempt to google atopic dermatitis and then pass on the information link and say voila - there's the answer to the question and then pat yourself on the back. You have no idea how seriously dangerous information is in the wrong hands. Unless you are licensed to give a professional opinion on something as ginormous as the life of someone, you should not be Miss Do-Good-Know-it-All answering other people's concerns. You have no business here and should try to get a life! You can experiment on your children or next of kin for all I care (and I seriously pity your whole family with having to live up with your inanities).

And for discussion sake, I will not give the pros and cons of dosing a kid with diphenhydramine on the flight, but would prefer that the 15 hour trip be a restful one for both the parents and the child. After all, it's not their friend that will be carrying the "fuzzy baby" on the lap during the whole flight!

I have a lot of patients parents that come up to me and ask me if the information that is passed on to them as a link is true or not, or that she heard a colleague telling her that my prescription may be harmful to her child, or that she read somewhere that a certain vaccine purportedly has a link to Autism, and so on and so forth. I discuss with them all the issues in a very professional manner. And no, I really do not mind discussing the concerns with them because they have the right to know. Full disclosure and a healthy professional discussion after seeing the patient (even if they have a whole folder or downloaded information) is the right of every patient to quality health care. It is the patients' rights to search and read up on their diseases and the treatment options to it. These rights should extend to the clinic office where the parents discuss these with their health care provider, with the latter providing treatment options where the benefits outweigh the risks. If you have a good doctor, he/she should be capable of answering the questions you post spontaneously at the clinic!

It is inappropriate that the discussion includes a third party who happens to have no professional training nor experience on treating patients or any other credentials to a well informed discussion except the fact that that person is keen in the art of googling. A second opinion means seeking the advice of another professional adept in that field of expertise of concern. It does not mean that you ask your hair stylist on why, for heavens sake, you should not put a steroid cream on the atopic patch of your child. Wala akong pakialam sa payo o kuro-kuro ng manicurista mo!

With that said, let me remind everyone that googling information is an FYI. It does not provide the absolute solution to the problem, especially when it comes to diagnosing or treating patients. It is infuriating that there are so many wannabes that need to realize that while they are probably techie experts in this age of information technology, they are not cerebrally fit to provide opinions that should be left alone to professional providers. And while you can pass on some information, you need to be trained to discern what is correct and what is misinformation. After all, not everything googled is correct!

If you feel you're alluded to in this blogpost and don't get the point, I think you should just roll over and die. The world would be a better place if we googled you had passed away.