Away on Vacation

You might have guessed that I am away on vacation, until 1^st May in fact. In the meantime, perhaps you would like to catch up with some of my past postings: 57 in total since I ventured into the Blogosphere; or even read my book: The Cockroach Catcher.


If I may, I would like to share some of the reviews and feedback I have received so far:

From the LULU.com website, where you can preview the chapter Seven Minute Cure and if you so wish, order a copy of the book (after creating your own account):

Fascinating! What a great read. Just reading the one chapter made me want to read the whole book. Thank you!

A beautiful opening! A piece written with of all that wit, intelligence and sarcasm! The author has managed to illustrate a boring NHS subject in the most interesting of ways. He has convinced me to read on. The NHS should urgently seek help and advice from this doctor!

Thank goodness for doctors like these!! If the rest of the book is as good as the preview chapter then it will be a fantastic resource for practitioners and the public.

Fascinating preview chapter. I can't wait to read more.

Horrah for the doctor. Chapter 1: The Seven Minute Cure. The doctor overcame the obstacles faced from the establishment and freed a young child from her prison. Great read.

Other reviews and feedback:

Absolutely riveting! Brings me back to working (in NHS psychiatry) when work was really interesting! The tone is quite conversational; it is like hearing you telling stories. I ordered more copies for my family and friends.

I knew it would be very special and it sure is. To us your trainees it is like going back on the rotation to have the joy of working with you again. The difference is that l can now learn at leisure from this book. Congratulations.

The book is very well written and makes very easy and interesting reading even for the laymen. You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

Fascinating account of child psychiatry cases, including some creative yet effective treatments. Anyone who is a parent or around children or really anyone at all actually will find the book surprising, entertaining, thought-provoking, funny and moving.

The book makes me realize the difficult decisions with which a doctor is so often faced, the need for him to have faith in himself and, coupled with that, the need for continued idealism and enthusiasm. These don't, of course, apply only to doctors but are particularly important for them.

Great book. I have bought one to give to my son on his birthday.

(Note: both father and son are doctors.)

I was in Special Education for many years. I just love the way you dealt with the girl who was bullied, and the boy with Behaviour Disorder. I am buying two more copies, one for my friend who is a psychologist and one for a colleague in Special Education.

I wish I had read your book when I was headmistress. I would have had so much more insight into why some of the pupils behaved the way they did.

I have been a school counsellor for 15 years and we have had regular recommendations on books to read. None of them taught us as much as your book, which would have been very useful for our weekly screening meeting discussions.

Reading the book and his blog, you cannot help admiring the author's width and depth of knowledge, the light-heartedness, the humility, the humane and the human side of people.

You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

What a book! I cried a little. I laughed a little. I know I should not.

Your stories are amazing. I really enjoy reading it.

My wife cannot put your book down and I shall not be able to get my hands on it until she has finished.

I was horrified by some of the gruesome cases and agonised at the suffering of some of your patients. But there are moments of laughter and smile at Dr Zhang's wit in handling the cases and patients.

Am Ang, thank you for a wonderful book. You know I could not put it down. My husband is now reading it and he said it is such an easy read as he thought it was all going to be heavy and clinical.

You have such a way with the little ones. What about the 12 year old pretending to be three and a half! My goodness.

Just the village life can fill a book. (Seriously an in-depth version will be much welcome!) Book two can be Life at HKU. And so on... Fascinating!

Having grown up in farming country, I love the Chapter on The Village. I know it is different but so much about village life just clicked with me. Makes me wants to go home to have a look. I would like you to write more about yourself. Just all the little details you are so good with.

I wish I had your book when I was bringing up my kids. I am giving each of my two children a copy. I decided to put down Pillars of The Earth for a while and start your book on a flight. I could not put it down to go to sleep. Wow: it makes so much sense.

I did expect the cover photo to be one of yours – after all, the creative mind needs full exposure, artistic and otherwise. I was just recommending it to some friends.

I never imagine I can have so much fun and gain so much knowledge by reading a book of this sort by, of course, an author with a sense of humour and a deep understanding of human nature. I really enjoyed reading it. Life could be so much easier if we had the chance to do what we like, to let our thoughts be shared by someone we trust, to make sugar pills of nasty encounters and so on and so forth for bearing more positive thinking. Just by a mere short conversation, which hit exactly at the 'dead pit' of the hiccup boy, the hiccup was over. Human nature is just like that. After reading the author's accounts of his cases, I wish I could also be endowed with such wit and wisdom, not so much for curing others, but to let my own body and soul remain healthy and sound always.

Love it. I read it in three days flat. Not only should parents read it; I think all those in the medical profession should read it. There is so much common sense. I am recommending it to my book club. Will you come and talk to them about it?

Wine, Media and The Mind

It is amazing how easy it is to influence modern day consumers with nothing other than a well made film. As far as wine is concerned the film Sideways has more or less changed the wine landscape of California if not elsewhere. This is because of two simple lines from the film. The wine snob character Miles tells friend Jack before a double-date dinner:

“If anyone orders Merlot, I'm leaving. I am not drinking any……Merlot.”

All of a sudden, it is no longer cool to order Merlot, and Pinot Noir becomes the new Merlot.

The fact that the same snob Miles’ most treasured wine Cheval Blanc is 45% Merlot is lost to the vast majority. In fact if Petrus had not refused permission, Miles would have drunk Petrus in the film, and that, one of the most expensive wines in the world, is 95% Merlot.

In the animated hit Ratatouille, feared critic Anton Ego visits Gusteau's, the restaurant in which the movie is set, and orders a bottle of 1947 Château Cheval Blanc to go with his meal. The '47 Cheval is probably the most celebrated wine of the 20th century. However, there has been no rush to buy cases of this as you are unlikely to find them except in top merchants and private cellars.

I have my own suspicion about some lesser known films that may have influenced wine drinking habits in the Far East.

In 1985 the film Tampopo came out of Japan. This comedy features a truck driver who helps a young widow named Tampopo improve her noodle restaurant, and draws attention to the power of food.

There is a beautiful wine tasting scene, by a group of hobos following the lead of a professor. The professor realises that life as a hobo is much freer, with no one above him telling him what he should do, no targets to meet, and no paperwork.

The wine tasting is not at a winery or a restaurant. It is in a park by the back door of a restaurant. The wine is that little bit left at the bottom of a bottle. There is not enough to go round; so the hobos allow the professor to do the tasting and are content to just listen to his analysis. (In the Cockroach Catcher, I wrote that a blind case presentation at Queen Square was a bit like wine tasting.)

It is one of the most enjoyable scenes for wine lovers and if you are not a wine lover you will become one.

The wine?

“Chateau Pichon Longueville Comtesse de Lalande,” announced the professor in perfect French.

This wine has since become a favourite of the Far East.

Chateau Pichon Lalande is not as expensive as the First Growths but is fast catching up. Fortnum and Mason of London used to have a house Pauillac made by Chateau Pichon Lalande. I was tipped off to get the last few bottles some years ago. Now the supplier of their house Pauillac is Chateau Haut Bages Averous, a vineyard next to the new rising star of Bordeaux: Chateaux Lynch-Bages.

The best year in recent vintages has to be 1989, a great year for most of Bordeaux and rumour has it that it will become drinkable in 2009. Hurrah. The 2000 is superb too but recent vintages have all been great and if you can store them buy them now.

The biggest wine influence worldwide came from a documentary. In 1991, after the airing of 60 Minutes on CBS, wine sales went up 44% in the next four weeks in the U.S. It was about the French Paradox: the incidence of coronary heart disease in France being 40% percent lower than in the U.S.

Health sells.

Once upon a time in Hong Kong, when people made money they drank the most expensive Cognac and Scotch, with Hennesy XO and Dimple being the “Gold Standards”, partly because of their highly recognisable bottles. To have such a bottle on your dining table was a sure sign that you had arrived. Now, the status symbol is the most expensive red wine, and it is often taken with just about any dish that is served.

But then the French perhaps always knew; including its own most famous psychoanalyst Jean Laplanche (born 1924). His book The Language of Psychoanalysis was first published in 1967 and translated into English in 1973. All of us training at the Tavistock had a copy and it is to this day one of the best reference books on the subject. He has co-authored a number of other books in psychoanalysis.

What is not so widely known is that Laplanche was for many years the owner of Chateau de Pommard, a Burgundy vineyard, and actively involved with the wine-making processes. He sold the vineyard in 2003 but continues to live on the estate with his wife and to act in the capacity of a consultant to the new owners on wine making matters.

Free Drugs For All!

On C.N.N. today:

Prescription drugs found in drinking water across U.S.

“(AP) – A vast array of pharmaceuticals – including antibiotics, anti-convulsants, mood stabilizers and sex hormones – have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows.

In the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas -- from Southern California to Northern New Jersey, from Detroit, Michigan, to Louisville, Kentucky….

The situation is undoubtedly worse than suggested by the positive test results in the major population centers documented by the AP.”

Here are some of the key test results obtained by the AP:

• Philadelphia, Pennsylvania – 56 pharmaceuticals in treated drinking water (63 in watersheds), including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems.

• Southern California (18.5 million people) – anti-epileptic and anti-anxiety medications in a portion of the treated drinking water.

• Northern New Jersey (850,000 people ) – metabolized angina medicine and the mood-stabilizing carbamazepine in drinking water.

• San Francisco, California – a sex hormone was detected in the drinking water

• Washington, D.C., and surrounding areas – drinking water tested positive for six pharmaceuticals.

The Washington Post headline reads:

Drugs in Water Hurt Fish and Wildlife:

According to the report, the affected species include: fish, prawns, oysters, mussels, vultures, snails, antelope etc.

“Pharmaceuticals in the water are being blamed for severe reproductive problems in many types of fish: The endangered razorback sucker and male fathead minnow have been found with lower sperm counts and damaged sperm; some walleyes and male carp have become what are called feminized fish, producing egg yolk proteins typically made only by females.

Meanwhile, female fish have developed male genital organs. Also, there are skewed sex ratios in some aquatic populations, and sexually abnormal bass that produce cells for both sperm and eggs.

There are problems with other wildlife as well: kidney failure in vultures, impaired reproduction in mussels, inhibited growth in algae.”

Victoria Falls—not tested!

Are we just looking at the excesses of the Americans? Apparently not. The same article reports:

“Elsewhere in the world: from the icy streams of England to the wild game reserves of South Africa; snails, fish, even antelope, are showing signs of possible pharmaceutical contamination. For example, fish and prawn in China exposed to treated wastewater had shortened life spans, Pacific oysters off the coast of Singapore had inhibited growth, and in Norway, Atlantic salmon exposed to levels of estrogen similar to those found in the North Sea had severe reproductive problems.

… Freshwater mussels exposed to tiny amounts of an antidepressant's active ingredient released premature larvae, giving the next generation lower odds of survival; in a separate lab study, the antidepressant also stunted reproduction in tiny fresh water mud snails….

In Pakistan, the entire population of a common vulture virtually disappeared after the birds began eating carcasses of cows that had been treated with an anti-inflammatory drug.”

Have the locals in Barbados been right all along? They have always claimed to have the best coral filtered drinking water! Was that one of the reasons why they have the second highest number of centenarians per capita in the world?

You may ask: What about bottled water? Antimony, a chemical used in the making of polyethylene terephthalate (PET) bottles, used by most mineral-water sellers, can be detected in bottled water, according to Prof. Shotyk at the University of Heidelberg:

“Bottled water had an average 160 ppt of antimony when opened immediately after bottling. But ground water stored in a PET plastic bottle had 630 ppt of antimony when opened six months later.

Prof. Shotyk no longer drinks water from PET bottles.”

Volvic was in trouble in 2006: two bottles had naphthalene in it. So was Evian: in 2007, China seized 118 tons of Evian water because of excessive amounts of bacteria.

Also, don’t forget that some bottlers simply repackage tap water. According to the industry's main trade group, they do not typically treat or test for pharmaceuticals.

I think I will start my own distillation plant for water, like they do in Aruba.

Or else just drink wine.

Passion and Easter

Passiflora alata

In the early 1600s, a Jesuit priest came across a Passion flower in South America and was taken by its complexity and beauty. That night he had a vision, so the story went, that the flower's trio of stigma resembled the three nails used in the crucifixion; the stamens represented the wounds; the spiky purple crown above the petals, the crown of thorns; and the tendrils of the plant were the scourges. The name was a direct reference to the Passion of Christ. I find it peculiar that the plant has been found in the wild in every continent except Europe and Antarctica.

In England the Victorians loved it and then fell out of love with it. Now it is making a comeback possibly due to the fruits’ popularity in modern gourmet cooking.

There are many varieties and some are edible. Of the edible kind there are two big groups, the one with the dark skin one and the one with the yellow skin.

The plant itself, from the stem to the leaves and the flowers, have been used by South American natives for various medicinal purposes, none currently approved by the F.D.A.

The fruit has some of the most concentrated fragrance of any fruit species. The charm is in its acidity which enhances the intense flavour and natural sweetness. With fine vanilla ice-cream it is a delight. It can be used as a topping for many desserts and famously for Pavlova. It is made into soft drinks and is often used in tropical cocktails. The golden variety is best eaten fresh and the dark skin ones can be left to mature as the flavour intensifies further.

With the golden to near blood red seeds, the fruit qualifies as a colourful non-green fruit, with all the necessary anti-oxidants. To me it is just flavoursome.

The other passion of course is Bach’s St Matthew’s Passion, appropriate for this time of the year. The biologist Lewis Thomas when asked what message he would send to aliens famously said: “……Bach, all of Bach……”. Richard Dawkins picked it as one of his eight desert island discs. Now you know.

On the Easter music note, it is perhaps appropriate to mention Mahler’s Second Symphony: The Resurrection. The text of the music made no biblical reference and it was Mahler’s very personal view of life and his life was full of tragedies and suffering, with the premature deaths of his siblings and daughter, and his own heart disease. There has not been a greater composer to emerge since his death.

Alaska, Good Friday Earthquake and Zyprexa

On March 27, 1964 at 5:36 p.m. an earthquake of the magnitude of 9.2 was recorded in Alaska with an epicenter 80 mile east of Anchorage. Of the 131 deaths recorded, 119 were caused by the tsunami triggered by the quake that devastated Valdez and severely damaged the coastal towns of Seward and Kodiak. It is still the most powerful earthquake recorded in U.S. history. On the first day alone, eleven aftershocks were recorded with magnitudes greater than 6.0.

Alaska is the largest state of the whole of U.S. It was bought from the Russians on March 30^th, 1867, and represented one of the all time best buys given the discovery of gold in 1872 and later oil. One should never sell the family silver.

The most important gold town of Juneau was named after one of the miners.

The most impressive modern day engineering achievement has to be the Oil Pipeline:

“The 800-mile-long Trans Alaska Pipeline System (TAPS) is one of the largest pipeline systems in the world. It stretches from Prudhoe Bay ……to Valdez, the northernmost ice-free port in North America. Since pipeline startup in 1977, Alyeska Pipeline Service Company, the operator of TAPS, has successfully transported over 15 billion barrels of oil.”

On March 24, 1989 the Exxon Valdez got into trouble in Prince William Sound when it hit Bligh Reef, splitting its side open and releasing oil and leaving an eight-mile (1.61km) slick. It is one of the worst environmental disasters of modern times and 19 years on the U.S. Supreme Court is still deliberating whether to uphold the $2.5 billion punitive-damages award levied against Exxon Mobil for the spill.

Alaska recovering after Exxon Valdez

In the meantime there is a different kind of earthquake in Anchorage.

March 6, 2008, Anchorage Daily News:

State claims drug maker hid data

“Drug maker Eli Lilly knew from the start that its schizophrenia drug Zyprexa was linked to health problems in patients but hid that information because it wanted a big moneymaker, a lawyer for the state told jurors in Anchorage Superior Court on Wednesday.”

Zyprexa is the trade name of Olanzapine.

In The Cockroach Catcher, Dr Am Ang Zhang inherited a patient who had been put on Olanzapine:

“ The biggest girl was asking for her third helping. She could not help it. It was the Olanzapine she was on. Now she looked nothing like the slim girl she once was, having put on as much as her original body weight.

But her symptoms had disappeared.

She needed three helpings of cereals and six slices of toast complete with thick layers of jam and butter – butter that was from the EEC and only for hospital use by patients, all part of the huge mountain that even the might of the Vatican could not consume.”

Seroxat and Ribena

In The Cockroach Catcher, Dr Am Ang Zhang had an interesting discussion with his Junior who had just transferred from one of the top London teaching hospitals:

“Do you agree that Leroy has Social Phobia ? Everything fitted in with the criteria in DSM IV.” My junior plucked up courage to ask me during supervision.

It was good to keep oneself on one’s toes with juniors who had just arrived from London and who read up on everything.

“What’s wrong with shyness?” I joked, “Do you want me to put him on SSRI (Selective serotonin reuptake inhibitors)?”

“It is supposed to work.”

“If he starts taking SSRI at thirteen, what is he going to do for the rest of his life?!”

“The newer short acting ones are supposed to be better.”

“Take one advice from me; think the opposite, the opposite to what the big Pharmas tell you. In pharmacology, shorter acting drugs are more addictive. That was what I learned in Medical School and is still true if you think carefully about it.”

Today’s Times headline: No prosecution on suicide-risk drug.

“A report suggested that GlaxoSmithKline (GSK) knew about safety risks but failed to report them to the medicines safety watchdog for five years.”

The drug concerned is Paroxetine and in the UK marketed as Seroxat and in the US as Paxil.

“GSK submitted data from clinical trials to the MHRA in May 2003 showing that patients under 18 had a six or sevenfold increased risk of suicidal behaviour if they were treated with Seroxat than if they received a placebo. Data also showed that the drug was not effective for treating depression in children and adolescents. Leaked documents suggested that GSK had known about these results as early as 1998.”

Keen eyed bloggers would have noticed Paxil CR in a previous posting of mine about how GlaxoSmithKline had all their Paxil CR and Avandamet seized in the U.S.

Now the story of Ribena has to be one of those sweet (sorry) stories one remembers for a long, long time.

Anna Devathasan (left) and Jenny Suo, New Zealand

Photo by Martin Sykes

In 2004 a science experiment by two 14-year-old high school girls in New Zealand brought embarrassment to the world's second-largest food and pharmaceutical company, GlaxoSmithKline, whose Ribena sale is around $8 million a year.

"We thought we were doing it wrong, we thought we must have made a mistake," Anna said when they found negligible vitamin C level in the Ribena they tested. The company had promoted the product by claiming that blackcurrants had four times the vitamin C of oranges.

The girls got short shrift when they telephoned GlaxoSmithKline.

"They didn't even really answer our questions. They just said it's the blackcurrants that have it, then they hung up," Jenny said.

Well, that was very clever. Blackcurrants have it, but not Ribena. So, nobody is misleading the public. You can guess the “concentration” of blackcurrant in Ribena. Have you tried the Syrop de cassis from France? The flavour of blackcurrant just bursts in your mouth.

The question must be asked of the second largest pharmaceutical company in the world. If they did not know how to check for vitamin C level, what business did they have in producing drugs that are used by millions? If they knew about it then ……wow!

The 2007 New Zealand Commerce Commission Report did not mince their words:

"Health claims are big business in today’s market, and the Commission has targeted bogus health claims in recent years. It is very disappointing to see a major pharmaceutical and health products company like GlaxoSmithKline mislead the public in this way……….a massive breach of trust with the New Zealand public."

GSK pleaded guilty to 15 representative charges of breaching the Fair Trading Act by making misleading claims about the Vitamin C content of Ribena, was fined $227,500, and ordered to undertake a nationwide campaign of corrective advertising in newspapers to explain that some forms of Ribena contain no detectable level of vitamin C.

GSK were lucky that they did not get fined over Ribena in any other country including Australia. In Australia, they avoided the fine by undertaking to explain the true nutritional makeup of Ribena on its packaging, its website and in future advertising.

Knowledge is power and it is good to know that there are young Cockroach Catchers as far away as New Zealand.

The two girls must have the last words:

Every time I see the new Ribena ad, the one where they don't mention any vitamin C, I'm just like, "Oh, yeah".

Cats Going Insane

In the mid-1950s in Minamata, “cats appeared to be going insane, and were falling into the sea. The people thought the cats were committing suicide.” The same happened in 1976, when an outbreak of pneumonia occurred among ex-service personnel attending a convention of the American Legion in Philadelphia.

In The Cockroach Catcher I wrote:

“… Take Legionnaire. It was first declared a form of ‘mass hysteria’. ‘Mass hysteria’ leading to deaths! One of the psychologists proclaiming such was carried out horizontally three days later with the same ‘hysteria’. Then a little germ was found.”

Have we learned not to jump on the psychological bandwagon? I fear not.

What happened in Minamata was in fact the start of the worst story of environmental pollution of the 20th Century and it did not happen in some backwater of a third world country – Minamata was in Japan.

The Japanese have had a long love affair with tuna and it is this love affair that caused such a major disaster. However the methyl mercury that was the main culprit was in all the seafood collected by the fishermen of Minamata Bay.

But tuna is long living and high up in the food chain, which means it accumulates the mercury gobbled up by those creatures further down the line. After the war Japan needed all the help industry could give to recover and it is well worth reading the full history of the disease development and the denial by the corporation concerned and by the government despite clear scientific evidence. In Japan, country came before people:

“……In spite of the fact that Dr. Tamiya of the Medical Department of Tokyo University - Japan's supposed authority on the subject, who was supported by the Chisso Chemical Company and other mercury-handling industries - was named convenor, the Japan Medical Association group was disbanded in 1962, also without reaching any conclusions. In this manner the issue was neutralized without the problems really being confronted.

Governmental funding for the Minamata disease research group at Kumamoto University was cut off, but the university continued its efforts to discover the causal mechanisms involved in the disease……

……The industry-related government departments evolved their own theories to counter that of the university research group, pressured the research group to hold back on publicity, and cut down on research funds……”

Now this may sound familiar:

“……Scholars receiving trust funds from industry sources would produce differing opinions that resulted in support for industry…

……Minamata disease came into being as a result of one chemical complex that was, at a certain point in time, positioned at the heart of a new and rapidly growing industry. Because of the company's pride in its own technological prowess, it was blinded to the dangers of the waste effluents that it allowed to enter the human environment. The industry and various governmental organizations understood pollution problems only in terms of economic viability, and these same sectors of society tried to evade and cover up these problems through an initially successful series of oppressive measures.”

Yet such problems are not just limited to Japan. Remember Camelford:

“……In July 1988, 20 tonnes of aluminium sulphate were accidentally dumped into the wrong tanks at the Lowermoor treatment works near the Cornish town of Camelford. As a result aluminium entered the water supply……

……A leading authority on the harmful effects of aluminium has criticised the latest conclusions of the independent team of scientists commissioned by the government to investigate the Camelford incident……

……Barbara Clayton, professor of metabolism at the University of Southampton and chairman of the committee, says the report takes into account evidence from 80 scientists, 130 other sources and the world literature on aluminium. She says the conclusions 'represent a consensus view'……”

This appeared in the Guardian in 2006:

“……The requirement to examine the DoH's handling of the incident was removed from the terms of reference. No independent expert on aluminium toxicology was included in the working group. An attempt was made to include Waring as medical adviser to the group, even though he was the author of the original letter stating that no lasting ill effects would result……”

Barbara Clayton became Dame Commander of the Order of the British Empire in 1988.

What a pity Dr. Crippen was not blogging then!

Next time your pet goes a bit funny, do not take it to the pet psychoanalyst, check the pet food.

In the meantime, Pompano is a much safer fish than Tuna and other predatorial fish. Pregnant mothers and those planning on having children should avoid Tuna, Sword fish and even King Mackerel.

We may in fact be staring at the reason for the exponential rise in the numbers of diagnosed Autistic Spectrum Disorder and not know it. Tuna, long perceived as the low fat high protein good food that is in tins and in many “healthy” salads has a high mercury content by nature of the reasons I described above.. Sushi and Sashimi are gaining widespread international fame as lean and healthy. The truth though is that the mercury content is also high and mercury is a serious neuro-toxin. One mother knew though, she was having tuna every day and both her sons developed autism.

I will stick with Pompano for now.

Also: Mercury in High Fructose Corn Syrup ---Autism: What If!

Buy the book: The Cockroach Catcher

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The Cockroach Catcher and Pompano

In about a week’s time, fish will start migrating from the warmer waters of the tropics to more temperate waters in search of food. So will the Pompanos.

I wrote in The Cockroach Catcher:

“……Mother always bought fresh fish from the market, often a Pompano which when fresh has tender flesh with a delicate flavour and makes a popular Teochiu dish. It is perhaps very apt that the first fish I caught... some forty-five years later was none other than a Pompano……”

Pompano caught 45 years later.

Pompano is a favourite fish for the average fisherman as it can be caught on a light tackle and it gives a good fight for the weight of the fish. It is a quick maturing fish and as such do not tend to pick up mercury. In the US it is one of the highest priced gourmet marine fish on the market and for a good reason. It is a delicate fish in terms of texture and flavour.

The classic Teochiu way of cooking Pompano is to simply steam it in with sliced ginger and spring onion. What makes it special is the addition of Teochiu urn preserved mustard green. This ingredient imparts a distinctive delicate flavour that my parents loved. I suppose it reminded them of the home village they left behind.

Another great way to prepare the Pompano is to wok-sear it. This is very similar to pan-searing that is now fashionable. The best fat for searing this fish is Goose Fat, but if it is not available then chicken fat is a good enough substitute. It has to be from good quality free range chicken though. We usually finish the searing with ginger, spring onion and soy sauce.

I can nearly taste it now.

Artistic rendition of Pompano - (Trachinotus carolinus) in Aruba

The best wine to go with Pompano is Pinot-gris from Alsace and my favourite vignerons are Hugel & Fils and Dopff and Irion in the quaint Alsace village of Riquewihr. As Pompano is delicate in flavour you need a wine with a nice firm flavour and a balanced acidity to go with it. There is no need to pick a very acidic wine. I particularly like Dopff and Irion's Sporen Tokay Pinot-gris. It fits the bill perfectly. It is subtle yet complex in flavour and will not over-power the fish like some heavily oaked chardonnays will.

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More Expensive Placebos Bring More Relief

There is an eye catching headline in today’s New York Times:

More Expensive Placebos Bring More Relief.

“In marketing as in medicine, perception can be everything: a higher price can create the impression of higher value, just as a placebo pill can reduce pain.

Now, researchers have combined the two effects. A $2.50 placebo, they have found, works better than one that costs 10 cents.

The finding may explain the popularity of some high-cost drugs over cheaper alternatives, the authors conclude; it may also help account for patient reports that generic drugs are less effective than brand-name ones, though their active ingredients are identical. The research is being published Wednesday in The Journal of the American Medical Association…..”

In The Cockroach Catcher, Dr Am Ang Zhang mentioned one of his consultants who was nicknamed the “Chief”:

“…….There were two lady consultants and the “Chief”. The “Chief” was an Austrian émigré, six foot six and a very formidable figure that most people were scared of. He was a highly intelligent man with a French wife and two highly intelligent children. Fortunately we hit it off from the very start……”

I had my own Chief and he had his eccentric ways. He famously created three “drugs” for use with his patients: Maplac Blanc, Maplac Verde, and Maplac Rubra. These could not be found in the British National Formulary (BNF), but were only available from our hospital pharmacy, white, green and red capsules, dispensed in bottles complete with proper Hospital labels.

For those who could not swallow capsules there was only one Maplac Rubra Syrup.

“Plac” is the short for placebo. In those days there was no rule against placebos and for a long time various vitamin preparations, including Vitamin B12 injections, were used for such effect.

Some prescribed drugs may have only worked as a result of the placebo effect. In any case, some drug tablets have been found not to contain the specified dosage of the active ingredient, as with GlaxoSmithKleine’s ever popular antidepressant Paxil CR and Avandamet (used for Type II diabetes).

“FDA inspections revealed that some lots of Avandamet tablets are not always manufactured uniformly and that these tablets may not have an accurate dose of rosiglitazone (one of the two active ingredients in Avandamet). FDA also found that some lots of Paxil CR tablets are not manufactured properly and can split apart, so that patients may receive a portion of the tablets that lack any active ingredient or a portion that contains the active ingredient and does not have the intended controlled-release effect.”

Wow. A lot of drug trials would be like triple blind control trials. You would need to analyse hair samples to decipher which patients have been administered the active ingredient in the end. It could be the reason why some drugs were shown to be not more effective than placebos.

Paxil is of course one of those Antidepressants implicated in the Hull report, which is causing a lot of frenzy. As far as I can tell, the story continues.

I remember attending one of these huge American Psychiatric Association (APA) conferences shortly after Olanzapine was launched. I had some first hand experience of the voracious appetite induced by this drug. I thought I should ask a question about their supposedly double blind control trial. Written questions had to be submitted in advance. So I wrote and asked how it could be a true double blind trial if within a short time relatives reported ravenous appetite in the active drug group. “It would have been so obvious!” I wrote.

Guess what happened? They just ignored my question! I was young then.

According to the “Chief”, the white tablets were good for bed wetting and green for “naughty” children. Red was great for sleep problems.

“Taste this.” He once poured me some of the red stuff.

“It’s bitter!” How clever the “Chief” was!

Then I thought: I knew the flavour.

Angostura Bitter! It is safer than anything we can think of and we would only need to add a small amount.

“Is it legal?” No, I did not ask him.

“Now, I have this mother. Her two kids won’t sleep and I gave her two bottles of Maplac Rubra, one for each kid. She took them all herself and was unconscious for 48 hours.” The Chief told me.

As far as I know, “The Chief” never lied.

I once went to a lunch time talk by someone from a well known London hospital. It was a presentation of his findings on the effectiveness of the newer SSRIs compared to that of placebos. In his final slide he showed a cartoon of two Pharma executives during the lunch break of a big launch of one of their SSRIs, one asking the other, “How can we move into Placebo?” I could not get my hands on that slide, but did find some good Placebo cartoons on the Net. I like the one about placebo rehab!