It is also the first in a sequence of events that marks my return to the world of medical research, as I board the plane for Heathrow, London via Dubai tonight. The next few weeks will see me alternating between London, Oxford and Cambridge Universities, before I officially commence my studies in October. 

More updates to come soon!

This is going to be a short blogpost of what I’ve been up to thus far, which is definitely anything but profound! (and I’m referring to both the blogpost and the things I’ve been up to…)

From April until June, I completed my General Medical & Surgical Junior Clerkships at Southend University Hospital. The hospital was great, but the sand and sea were better!  

During one of the Bank holiday long weekends, I escaped from my hospital work and travelled up north to Scotland to visit the IMU gang in Edinburgh. Glen was there too. Visited loads of tourist attractions in the Lothian city, did lots of touristy stuff etc. etc.

Right after the clerkships, I returned to London for my end of year examination. Kudos to the Dawson Hall transfer crew for for our effort in practicing for the OSCE exam! It was good fun. Really.

I returned to Muuuutherland on 17th August. The gym junkie in me ensured that the first thing I did when I arrived back home was to join the local gym. In between burning off calories, I was piling on the carbs, and to this end, Malaysian food pretty much hit home.

I originally had quite a lot of things lined up for the summer, but somehow, ‘administrative work’ and a lot of unexpected turns in my life seemed to get the better of my time. The things I had to miss out: white water rafting in Gopeng with Amanda et al. (sorry Amanda!), and trip to Bentong and Genting Highlands with David and Nicholas (sorry guys!!) 

The things I did do:

1) Annual ‘pilgrimage’ to Penang (a.k.a. late nights out, sleepovers, and generally, bugging the hell out of Yew Ewe and co. at Penang Medical College). This year’s Penang trip proved to be much more eventful and fun compared to previous years. (*nudge* *nudge* *wink* *wink*). It felt really refreshing to reconnect with people from my past.

2) 2nd UKEC Malaysian Students Leaders Summit (MSLS)2008 in KL. I had my (not-so) little sister joining me for this event. Some of the talks/forums were compellingly engaging, while some were just downright bo-ring. I sometimes felt a bit out of place, due to the fact that an overwhelming majority of the participants were either undergraduates or pre-university students(OK la.. I’m NOT that old…). But the post-MSLS BBQ in PJ was good fun, and gave me the chance to get to know more people. Thanks to Chen Chow for letting me in on this!

(Productive) Things that I’ve trying to do:

1)Read up my pre-course notes on animal surgery and anaesthesia for my upcoming UK Home Office Animal License training course in London. 

2) New developments in the area of my research project that have taken place in the last three months. I’ve been trying to learn 3D mathematical modelling in order to understand the work of a rival group from Oxford working on a similiar topic. Not fun. It amazes me what four years of medical school can do to deteriorate one’s mathematical acumen. I swear I knew more when I was studying for A-level math, whereas now, I can’t even do simple trigonometric differentials to save my life! (There’s always the scientific calculator, no? )

3) Deutsche Sprache learnen. On my own. No classes. Just from books. And have I ever told you that German grammar is insane? No? Well, it sure is. Thus far, I cannot yet string a proper sentence beyond four words. So much for DIY language-learning.

********

(Not-so) Little Sister is coming back from KL today. I’m looking forward to see her again! Yay~

Time: Late February 2007

Place: Royal Free Hospital, Camden, London, UK

Occasion: Interview for entry into Royal Free & University College Medical School

Friend: Shen-Han, do you know what is the best way to predict whether you will be accepted into a school or not?

Me: No, I don’t. How?

Friend: Very easy, actually. Just look around you when you’re in the school. Do you feel at home there? Do you feel like you’re welcomed there? Do you get THAT feeling, just by being there?

Me: Whoa… really? Man, I don’t really feel nice in this place. And I don’t think the interviewers liked me. Must be something I said….

Friend: Whoops…..

Me: Shite.

True enough, three days later, I got a nice, succint one-page R-letter, nicely signed by the Faculty Tutor. Blergh. In hindsight, it was a good thing to happen. Instead, I got accepted by Barts & The London School of Medicine.

Scene 2

Time: February 2007

Place: Cancer Research UK Cambridge Research Institute, Li Ka-Shing Centre, Cambridge, UK

Occasion: Lunch at the Cafeteria

Me: Whoa…….. this place rocks. Sparkling new research centre.

Friend: Shen-Han, you’re so superficial.

Me: Tell me about it…..

Friend: It’s the research going on in this place that counts la…..

Me: Don’t care. It’s nice. That’s all I care. You’re lucky to be able to do your Part II project here, dude. Man, I wish Iwas doing a cancer-related Part II project at this place.

The strangest things do happen. And sometimes, you get more than what you bargained for.

Scene 3

Time: December 2007

Place: Dawson Hall, Charterhouse Square, London, UK

I had an epiphany.

A sudden realisation.

It occured to me that I was still in love with her. Science. I cannot forget her, no matter how much I try. The excitement that she stirs in me is just too intense. Passionate. Full of life and energy. We first met when I was an impressionable young student. I admired her in her many forms. Physics, Chemistry, Biology & Mathematics – each of them representing different parts of the perfection that is her.

I used to hold dearly to the motto of the University of Michigan. Artes Scientia Veritas. And yet, I held strongly to the rhetorics of the German pathologist, Rudolf Virchow who argued against ’science for the sake of science’ (Virchow believed that everything in science is applied, and there is no merit in pursuing ’science for the sake of science’. The purists might disagree…).

Yet, I was still commited to my first love. Medicine. For as far back as I could ever remember, I have always longed for her. She was the one thing that brought light to the destitute, and hope to the despaired. She was the one that everyone turned to when they were at their bleakest hours of their lives. She gave, selflessly, without discrimnating creed or color.

What if I wanted both of them? Could they co-exist in harmony? More importantly, was I able to envision myself spending the rest of my life with the both of them?

(pardon the romantic personification of science and medicine. *how nerdy can I get, huh?*)

I thought long and hard. It was a moment of existentialism.

Follow your heart.

Follow your heart.

My mind was flooded with flashes of conversations that I had earlier that day, with a few different people, one being the abovementioned friend and another medical school-mate in the same hospital. (Refer to my previous post on ‘An Epiphany’)

On one end of the spectrum:

‘A good scientist can never be a good clinician’

‘A doctor who spends too much time with his patients can never produce ‘world-changing’ scientific work’

On the other end of the spectrum:

‘The thought of finding something new everyday gives you a reason to live’

‘Some of the clinician-scientist I’ve worked with are the best clinicians in the hospital’

Fast forward to present time.

As I am typing this post today, I can  only ponder with bemusement at all these events that have transpired over the past year. Certainly a lot has happened since then. I am only glad that I’ve finally made up my mind. There is some truth in what my friend had said. The thing about that good feeling you get when you’re applying to a school for admission.

M. Judah Folkman, the legend behind the theory of angiogenesis in the development of cancer, has died. A clinician-scientist par excellence who weathered through the storm of skepticism in the early days of his career, Dr Folkman leaves behind a legacy of using anti-angiogenesis drugs to make cancer a manageable disease, very much like diabetes and ischaemic heart disease. Having read his works, publications, reflections, and memoirs during the ‘Pharmacology of Inflammation and Angiogenesis’ module of my Part II undergraduate course in Pharmacology at Cambridge, I count Dr Folkman as one of my heroes in science and medicine.

May you rest in peace, Dr Folkman. 

One thing that caught my eye was the last part of the interview, when Dr Zerhouni was asked of his views on where the future of medicine lies. He replied:

“Well, fasten your seat belt because it’s going to be fun. Medicine is going to change more than ever; firstly its knowledge content is going to improve tremendously. Also, instead of being curative and intervening when patients are sick you are going to have to intervene much before the disease actually strikes.   We will be in era of 4 P’s.  Predictive medicine, 

Personalisation regarding genetic variation,

Pre-emption, the natural consequence of knowledge, and finally

Participatory, the patients will be more involved in their own health care.” 

His words really got me very, very excited. Excited that the future holds so much promise!

Taken from the first line of Rudyard Kipling’s ‘The Ballad of the East and West’

An fMRI study on visuo-spatial tasks involving human subjects, published in this January’s issue of ‘Psychological Sciences’ from a group based at MIT, Stanford and SUNY Stony Brook further confirmed this adage of the differences between Easterners and Westerners. The paper was entitled ‘Cultural Influences on Neural Substrates of Attentional Control’. See the news report from MIT’s news office, and a copy of the research paper (if you have personal or institutional subscription to Blackwell Synergy)

In geekspeak:

ABSTRACT—Behavioral research has shown that people from Western cultural contexts perform better on tasks emphasizing independent (absolute) dimensions than on tasks emphasizing interdependent (relative) dimensions, whereas the reverse is true for people from East Asian contexts. We assessed functional magnetic resonance imaging responses during performance of simple visuospatial tasks in which participants made absolute judgments (ignoring visual context) or relative judgments (taking visual context into account). In each group, activation in frontal and parietal brain regions known to be associated with attentional control was greater during culturally nonpreferred judgments than during culturally preferred judgments. Also, within each group, activation differences in these regions correlated strongly with scores on questionnaires measuring individual differences in culture-typical identity. Thus, the cultural background of an individual and the degree to which the individual endorses cultural values moderate activation in brain networks engaged during even simple visual and attentional tasks.

(from the abstract of Hedden et al. 2008)

Or in lay-person talk:

Psychological research has established that American culture, which values the individual, emphasizes the independence of objects from their contexts, while East Asian societies emphasize the collective and the contextual interdependence of objects.

(from the MIT news office)

So, yes, our brains are wired differently, according to the prevailing culture in the environment we grew up in during the developmental plasticity phase of our brains.

I came to myself in a dark wood

For the straight way was lost.”

Translation from the first canto of the first cantica Dante Alighieri’s The Divine Comedy

Much have been going through my head lately. Apart from my work. About life. About what I really want to become in life. A doctor? A scientist? Or, perhaps, both? (and I haven’t even begun to think what field of medicine I would like to specialise in!)

Pondering aloud has begotten me a wide spectrum of response from the people around me.

On one end of the spectrum, one of my hospital colleague is of opinion that the excellence in both fields are mutually exclusive. That to achieve excellence in one requires the sacrifice of the other.

“A great scientist can never be a good clinician, while a doctor who spends much time with his patients will never produce world-changing scientific work. Are you willing to quit medicine? Are you able to imagine yourself stuck for long hours in the lab for the rest of your life?”

(I should have clarified with her what she meant by ‘world-changing scientific work’…)

On the other end of the spectrum, an old friend of mine feels the other way around.

“The thought of finding something new everyday gives you a reason to live. You don’t want to spend the rest of your life doing the same thing, do you? You only live once, you know?

In the USA, each year, about 1000 of 17000 medical students do an MD-PhD, and go on to become great scientists. And some of the clinician scientist that I have worked with are some of the best clinicians in the hospital.”

(No prize for guessing correctly whether this guy is an MD-PhD student)

A crossroad.

Two paths to follow. One filled with hurdles. The other filled with hurdles, and extra hurdles.

I think I will try my best to prove to the lady-colleague of mine that she is wrong. Even if it takes a lifetime to do that. There is truth in words of the MD-PhD friend. Yet, words from both parties have invoked a deep-rooted determination in me.

http://www.topmba.com/fileadmin/pdfs/2007_Top_200_Compact.pdf

Boy oh boy.. notable changes in the rankings:

• UCL has the largest improvement, breaking into the top ten, rising from #25 in 2006 to #9
• MIT, Stanford and UC Berkeley charted the lowest rankings in years, ranked at #10, 16 and 22 respectively. If the rankings are to be taken seriously, does this mean UCL is better than MIT, Stanford and UC Berkeley? I leave that to the wisdom of the readers.
• LSE fared the worst of the ‘elite’ universities, ranked at #59

When I heard about MIT’s position in the rankings, I almost choked and spluttered my drink. One of Imperial College’s goal is to emulate MIT and be the MIT of the UK. With its current position at #5, does this mean that it has now fared better than its role model?

MIT, my favourite unversity (though not my alma mater) used to be #3 (2004), 2 (2005) and 4 (2006). I find it hard to stomach the fact that it’s ranked #10 this year, lower than *gasp* Imperial and UCL! This is blasphemy!

Things that didn’t change from last year: Harvard is still #1 (*yawn*), followed by Cambridge, Oxford and Yale, all three tied at #2. Looks like Cambridge’s got to pull its socks up if it wants to remain second fiddle to Harvard as the world’s best university, simply because other universities are catching up!

And oh, on the local front, unfortunately, none of the Malaysian universities made it to the Top 200 list.  

 Lots and lots of it. *cough*

(In the UK, it’s called Powerade. So, it seems that USAN not only covers pharmaceuticals, but also sports drinks. ) 

Oh, also, it might be possible to drop dead from viral-induced septic shock in front of the Emergency Department of one of America’s finest teaching hospitals -which I shall not name - and nobody will attend to you if you can’t pay the co-pay fees that your medical insurance didn’t cover – something to the tune of $ 100 per emergency admission out of office hours, without an appointment. And in case you didn’t have a medical insurance, you’ve to fork out the full fees – $1500. Great. Just great.

Thank God for the NHS!

Galen (Greek: Γαληνός, Galēnos; Latin: Claudius Galenus; AD 129–ca. 200 or 216) of Pergamum was a prominent ancient Greek physician, whose now discredited theories dominated Western medical science for over a millennium. The forename “Claudius”, absent in Greek texts, was first documented in texts from the Renaissance.

Here’re some fine examples of Galen’s famous now-discredited theories:

“The heart has two chambers with numerous connections” (Galen must’ve dissected a cadaver with a serious case of congenital septal defects, and thought that it was normal)

“The brain is a large clot of phlegm, from which the psychic ‘pneuma’ is formed by a rhythmical pump” (whatever the second part of the statement meant….. but brain as a large clot of phlegm? Oh please, the brain deserves more credit than to be equated with phlegm!)

“The small intestine is long because it saves having to eat all the time” (Nice try, Galen… nice try.)

As ludicrous as these statements may sound, it is worrying that these ideas were thought of as correct for nearly a millenium. One might be tempted to wonder how our ‘medical knowledge’ of today will be viewed by our future generations in a thousand years from now…..