Old Kidneys and Young Kidneys

Recently I discussed the topic of organ trading. The ST article below raises an interesting point not previously mentioned in my old blog post nor by the readers who had commented.

ST July 17, 2008
Short queues for kidneys in Spain and Norway: Here's why
Kidneys from the elderly are accepted and more people are willing to be donors
By Salma Khalik

BEFORE considering organ trading, Singapore can increase its supply of kidneys by learning from Spain and Norway, says a top kidney specialist here.

The two European countries have short waiting lists for kidney transplants - unlike Singapore, where the average wait is nine years for the 560 people on the list.

Both countries accept kidneys from the elderly, whereas in Singapore, kidneys are taken only from people 60 years old and younger.

This immediately cuts off the supply of many kidneys every year. In Spain, a third of the cadaveric kidneys are from people over 60 years old.

Spain and Norway stand out in the world for their short list of patients waiting for kidney transplants. Their success has been cited in the current debate raging over whether Singapore should consider legalising the organ trade to meet the high demand here.

Organ trading is a criminal offence here and, in the last month, five men were charged in connection with the offence, the first such cases here.

The cases have resulted in some people calling on the Health Ministry to reconsider the ban on organ trading.

But before going down that route, Professor A. Vathsala, director of the kidney transplant programme at the National University Hospital, said Singapore should expand its organ donation programme first.

She has visited Norway and Spain and believes that some of their practices, such as removing the age restriction on cadaveric donation, could be adopted here.

Spain transplants both kidneys from an older donor - even someone in his or her 80s - into an elderly recipient.

'No organ goes 'wasted' to be buried needlessly when it can save the lives of so many others with organ failure,' she said.

The obvious question that comes to mind is whether older cadaveric kidneys and younger cadaveric kidneys yield equally good transplant results. (Strangely, the Straits Times article did not discuss this at all).

I did a quick Google search. The answer seems to be that younger cadaveric kidneys deliver better transplant results than older ones. How significant that difference is, I must leave to the experts to comment (a fair number of doctors regularly read my blog).

The next point to consider is whether the kidney patient would be better off with a transplanted old kidney, or with no kidney transplant at all. This could be a "beggars can't be choosers" situation. Your best bet might be with the old kidney, since a young kidney might never become available before you die.

Finally, back to the question of whether organ trading should be legalised. The way I see it, there are many ways to skin a cat, and they don't have to be mutually exclusive. For example, we could legalise organ trading and at the same time, accept the use of older cadaveric kidneys. At the same time, we could continue to encourage "altruistic" donations from living donors etc.

The goal is to save lives. We can simultaneously pursue different paths to that goal.

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If A Very Sick Man Was About to Die, Wouldn't You Help To Let His Mother Know?

Apparently not. Today we look at a human interest story in the Straits Times. To summarise, a man had a stroke and would soon die. His relative tried to contact the man's mother. The Immigration and Checkpoints Authority (ICA), which is also our national issuer of NRICs, knew exactly where the man's mother lived, but refused to reveal the details.

ST June 13, 2008
One last look at prodigal son
ST helps cousin of man in coma to locate his family; son dies 15 minutes after mum leaves hospital
By Teh Joo Lin

MORE than 20 years ago, Mr William Rajasingam Kasinathan became estranged from his family. He lost touch with his mother, sister and son.

... Last week, the 53-year-old prodigal son suffered a stroke and was on his deathbed. And the search was on for his kin.

On Tuesday, mother and son had a reunion of sorts - Mr Kasinathan was comatose - in the intensive care unit of Tan Tock Seng Hospital.

The frail woman gazed upon her son and looked lost as she repeatedly rose from her chair and sat down.

Fifteen minutes after the 78-year-old left the hospital, he died.

It was his cousin, Ms Prem Bir Kaur, 53, who managed to track down the old woman.

Aided by a doctor and a medical social worker, she contacted the Immigration and Checkpoints Authority (ICA), the custodian of the national registration records, in the hope of securing an address.

The hospital staff offered to furnish proof that Mr Kasinathan, a bar musician, was in a critical condition so that the ICA could try and contact his mother on Ms Kaur's behalf.

But rules forbade the ICA from revealing her whereabouts, Ms Kaur was told.

On Monday night, she called The Straits Times, which helped her locate Mr Kasinathan's mother by going down a list of possible family names in the phone directory.

When given the news that her son was gravely ill, the old woman told her daughter: 'He's still my son. Take me to see him.'

Ms Kaur is relieved mother and son got to 'meet' one last time but wonders why the ICA would not help her.

She said: 'It's not fair for him to die alone. At least I can say I've tried to fulfil his last wish.'

And why did the ICA not help to fulfil he dying man's last wish? What reason could the ICA possibly have?

An ICA spokesman told The Straits Times that the National Registration Regulations make it an offence for any public officer to disclose to anyone information from its records - on pain of jail time, a fine or both.

The exceptions are few - when it is in the public interest and with the permission of the ICA Commissioner, or for the purpose of criminal proceedings.

This was not a criminal case, so the police could not formally help either.

Dr Teo Ho Pin, who chairs the Government Parliamentary Committee for Law and Home Affairs, agreed it was important to protect the private information of people.

Recently I commented that PAP MP Teo Ho Pin is quite a clever person. After reading the above ST article, and Teo's remark as quoted in it, I feel compelled to withdraw my comment. I no longer think that Teo is very clever.

According to the law, ICA was not allowed to reveal the old lady's address to Prem Bir Kaur. However, there was a very simple solution. ICA could have contacted the old lady directly, by phone or by mail, and said:

"Dear Madam

We were informed by Tan Tock Seng Hospital that your son William Rajasingam Kasinathan is seriously ill in Ward ___. His cousin Ms Prem Bir Kaur has also contacted us about this matter. She has been trying in vain to locate you.

To safeguard your privacy, we have not given them your personal contact details. However, if you wish to know more about the matter, you can directly contact Tan Tock Seng Hospital (tel no. XXXXXXX) or Ms Prem Bir Kaur (tel no. YYYYYY) yourself."

Simple as that. As I see it, there could only have been two reasons why ICA didn't do it:

(1) ICA is just too stupid; or
(2) ICA just can't be bothered.

Either way, it just reflects very badly on the ICA.

On a separate note, isn't it really quite ironic? If you have died in hospital without signing the opt-out form, the government has the legal right to immediately cut out your organs for transplant purposes. But while you're dying in hospital, the government won't even help to let your mother know.

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Contagious Diseases On A Crowded Little Island

ST April 16, 2008
HFMD epidemic may be the worst since 2000
Over 1,000 kids fell ill last week, 13 warded; virulent EV71 virus behind 16% of cases By Salma Khalik & Sujin Thomas

SINGAPORE may be facing its most serious hand, foot and mouth disease (HFMD) outbreak since an epidemic killed seven children eight years ago.

More than 1,000 children fell ill last week - the highest number of weekly infections since the 2000-2001 period.

Of the 13 who needed hospitalisation, one girl was seriously ill, with inflammation of the brain.

..... HFMD is endemic in Singapore, with children catching the virus almost daily.

Symptoms include fever, headache, sore throat and a red rash, usually on the limbs and in the mouth, which gives the illness its name.

I just read the latest parents' newsletter from my kids' school (yes, the same one which teaches sex education to little kids). The newsletter reported that one student has just come down with HFMD.

Since HFMD is highly contagious, this means, unfortunately, that more students at the school may possibly be coming down with the illness in the next week or so. The usual incubation period is between 3 to 7 days.

I've just discussed with Mrs Wang and we decided that our little kids will get to skip school for the next few days.

Incidentally, I've often wondered whether the government has really considered the potential health implications of its ambitious population plan. I'm referring to the government's plan to increase Singapore's resident population to 6.5 million people (mainly by importing more foreigners).

There are plenty of reasons why we should be cautious about such a plan. One reason is that we live in a time where mankind seems to be constantly threatened by the likes of SARS and bird flu.

Squeeze 6.5 million people together on a little red dot. Make it the world's most densely populated country. Every day, pack a great number of citizens like sardines into the public transport system. What do you get?

Potentially, a great recipe for a massive epidemic .....

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The Elusive Nature of Medical & Other Truths - Part 1

Recently, the practice of "aesthetic medicine" in Singapore received a lot of media attention. Since I like my own face as it is, I did not really pay much attention to the specifics of the debate.

However, I did gather that some doctors in Singapore have been offering beauty treatments which are "scientifically unsubstantiated". The issue is whether these doctors should be stopped, and if so, how.

For more background, refer to these doctors' blogs - Angry Doctor; Alien Doc; and No Fear Singapore. (Notice how doctors tend to choose such unusual blogging names for themselves).

Health Minister Khaw Boon Wan has taken the position that the Ministry will step in only as far as invasive, high-risk procedures are concerned.

Thus the Ministry will not bother to intervene with non-risky beauty treatments, even if their benefits are not scientifically proven. Instead the Ministry will leave it to the medical profession to regulate itself on such matters, through organisations such as the Academy of Medicine.

In my opinion (although Angry Doctor would furiously disagree), Khaw's approach is very sensible.

I am quite confident that most, if not all, the aesthetic treatments offered by your neighbourhood HDB beautician are also "scientifically unsubstantiated". This does not mean that all these aesthetic treatments do not work.

It merely means that the treatment either does not work, or the treatment works, but has not been "scientifically" proven to work. And most of the time, the latter simply means that scientists have not bothered to do research on that particular treatment.

Which is quite alright, if the treatment does not harm or hurt you. It just means that you may have wasted some of your money on your neighbourhood HDB beautician. Your loss. Next time, try some other fruit or vegetable.

"Mr Wang is wrong. Chillis would hurt.
And durians could be downright dangerous."

Now the question then is whether we should regard doctors who provide aesthetic treatments in the same light as neighbourhood HDB beauticians.

Obviously there is some risk to the reputation of the medical profession, if many doctors go around offering beauty treatments which are non-risky but scientifically unsubstantiated to be beneficial.

The reputational risk to the medical profession would decrease, if these doctors offer beauty treatments which are non-risky and scientifically unsubstantiated, and actually work. (Happy patients don't file complaints).

But either way, the potential damage is only to (1) the medical profession's reputation, and (2) the patient's purse.

If you're not a doctor, well, frankly, who cares about Risk (1). And if you're the patient, well, Risk (2) is no different from the kind of risk you face, going to any beauty salon or parlour.

So I think Khaw is quite wise to leave it to the medical profession to regulate itself.

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A Tale of Two Drugs

Which is more dangerous – alcohol or cannabis?

This is a trick question - for Singaporeans. In many other parts of the world, the correct answer is already very well-known. Meanwhile in Singapore, many people would unhesitatingly answer, “Cannabis”.

Wrong. Alcohol is more dangerous.

For an authoritative study on the topic, you can refer to this study commissioned by the UK Science & Technology Select Committee. This study compared 20 legal and illegal stimulants commonly used in Britain. The full report is here.



Heroin is the most harmful drug. Cocaine takes 2nd spot. Alcohol is rated the fifth most harmful drug. Tobacco comes in at No. 9.

Meanwhile, cannabis is rated 11th. Ecstasy comes in at No. 18. If all you knew about drugs was Singapore's drug laws, you'd never have guessed this.

You can buy alcohol and cigarettes at any supermarket. But if you were caught selling cannabis, you could die. They'd hang you.

Why am I writing about this? Just felt like it, after reading the following article in the Straits Times:

ST March 25, 2008
Drinking binge killed China woman

By Elena Chong

A CHINA woman had so much to drink at a pub that she died of acute alcohol intoxication, a coroner's court heard on Tuesday.

Ms Zhu Shaoyun, 31, had been drinking from 5pm till about 9pm at Dong Guang Entertainment Group Pub along North Bridge Road on Nov 12 last year.

In Singapore on a social visit then, she had ordered beer and a bottle of Cordonbleu from waiter Ng Wei Guang, 25.

By about 8pm, she was heavily intoxicated.

At an inquiry into her death, Station Inspector Eugene Lim Kuan Leng from Central Police Division said in his investigation report that out of goodwill, Mr Ng accompanied Ms Zhu back to Lorong 8 Geylang in a cab. She vomited on the way.

When they arrived at Lorong 8, Mr Ng noticed her foaming in the mouth and nose. She was also pale and not breathing.

Mr Ng immediately asked the cabby to take them to Raffles Hospital where she was pronounced dead at 10.50pm.

Ms Zhu's blood-alcohol level was 547mg/100ml - more than 1 1/2 times the lethal range.

SI Lim also told the court that Mr Ng had noticed that Ms Zhu, a married woman, appeared depressed, and that when he approached her, she told him to leave her alone.

Verdict: Misadventure.

Death by alcohol overdose is relatively common. In contrast, it’s practically impossible to die from a marijuana overdose. See Point 2 of the article here.

(Naturally Mr Wang is not suggesting that you go out now and buy cannabis from your neighbourhood dealer. Mr Wang is merely suggesting that you be careful how you drink your alcohol).

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Why I Do Not Let My Heart Beat Too Fast

As a follow-up to my previous post, I thought I would blog about heart rate monitors. I use one myself, when I go trotting around the neighbourhood.

The model I use has three parts - a wrist watch, a chest strap and a little shoe pod. As you run, the chest strap device and the shoe pod will continuously capture information and transmit it to the watch.

By looking at your watch, you can find out your heart rate, your average running speed and the distance you’ve covered. Depending on the model, you can also check how many calories you’ve burned, how much running you did in the aerobic/anaerobic range, and so on.

For me, what’s the most useful function of a heart rate monitor? Well, the watch automatically starts beeping when my heart rate rises or falls below certain thresholds. If my heart rate falls below the lower threshold, it means that I’m not pushing myself hard enough and therefore not really getting any cardiovascular benefits – I should run faster. But if my heart rate rises above the upper threshold, it means that I could be pushing myself too hard and should stop or slow down.

Monitoring the upper threshold is important to me because I was born with certain heart defects. According to medical science, those heart defects are not a good reason for me to refrain from physical exercise. However, also according to medical science, those heart defects make me a better candidate for sudden cardiac arrest than a completely normal person.

Since medical science can be such a contradictory pain in the neck, I take the middle ground, by exercising, but not too hard. And my heart rate monitor helps me to do that.

(For those of you who are wondering, yes, there are ways to roughly calculate how fast or slow your heart should beat during exercise, depending on your fitness goals. Click here for more information about training heart ranges).

Just in case I gave anyone the wrong impression, the heart rate monitor is not a medical device. In other words, it wasn’t invented to help heart patients exercise safely. It was invented to help serious athletes and fitness enthusiasts to train for optimal performance.

Thus there is no scientific study (as far as I know) proving that the use of a heart rate monitor can help to reduce the risk of sudden cardiac arrest (whether in serious athletes, ordinary folks or heart patients). Nevertheless it seems logical to me that this should be the case.

This post comes too late, of course, to help the Unfortunate Major.

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The Unfortunate Major

A letter to the Straits Times Forum:

ST Jan 7, 2008
Modify 2.4km IPPT run to ease strain on heart

I REFER to the report, 'SAF officer dies after 1.2km run' (ST, Jan 3).

There has been a spate of deaths recently with the victims collapsing while running. Most national servicemen have to complete a 2.4km run in order to fulfil their annual Individual Physical Proficiency Test (IPPT), so I think it is high time the Ministry of Defence looked into revamping this segment of IPPT.

On average, in order to obtain a Gold standard in the IPPT, a national serviceman has to obtain a minimum of four points (out of a maximum of five points) for each of the four stationary fitness stations and then run 2.4km in about 10 minutes, plus or minus half a minute.

Anyone who has ever achieved a sub-10 for a 2.4km run can attest to the power of endurance needed, and the pain and fatigue undergone. Of course, the excitement and sense of achievement are what push one through.

However, it is unrealistic to expect the majority of national servicemen to reach that level of fitness. Many have unintentionally injured themselves trying to break the 10-minute barrier by overtaxing their bodies.

Hence, it is not advisable to set such a short time limit for a 2.4km run.

Fitness experts recommend that we engage in a cardiovascular exercise continuously for at least 20 minutes in order to maximise its benefits. Running a sub-10 does not seem to serve that purpose.

My suggestion is to extend the distance of the run to 4km or 5km, with a time limit of 30 to 40 minutes, thereby focusing more on the endurance and general fitness than speed. This should put less strain on the heart and body, while giving the runners some time to warm up and ready their bodies for the run in a less gruelling manner.

We cannot delude ourselves that these 'running deaths', which have led to the demise of healthy men in their 20s to 50s, are coincidences. Neither can we attribute the concerns expressed over these occurrences to 'sensationalised news' by the press.

Instead of a sudden burst of energy to complete a run in a short time, a longer run may be all it takes to prevent a cardiac arrest.

Rick Lim Say Kiong

Rick Lim was referring to the recent death of Major Tan Yit Guan. It was probably the TODAY newspaper which reported this incident most thoroughly.

TODAY tells us that Major Tan did not even manage to jog the full distance of 1.2 km. He ran only about 600 metres and then walked the rest of the distance back to the finish. This suggests that Major Tan was already unwell that day.

Rick Lim says that it is unrealistic to expect the majority of servicemen to achieve the Gold standard time. However, I don't think that the majority of servicemen are expected, or expect themselves, to achieve the Gold standard time (barring servicemen in certain elite vocations like the Commandos or the Guards).

Rick also says that the standard recommendation for cardiovascular exercise is to do it continuously for at least 20 minutes in order to maximise its benefits. Of course it is always possible to relook the way the IPPT is done. However, at the same time, I would say that the IPPT in the SAF isn't done for the sake of your cardiovascular fitness or personal health goals. It's done for the purpose of ensuring a certain level of fitness in the soldiers, for military purposes.

Also, it's not clear to me that extending the IPPT distance and increasing the time limit would help reduce incidences of sudden cardiac arrest. The real point is how hard you are pushed to exert. Is it really any safer for your heart, to complete 4 or 5 km as fast as you can, than to complete 2.4 km as fast as you can? For that matter, are people less likely to die from a 100-metre sprint, than they are from a 42-km marathon?

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The Right to Use a Condom

So the Christians spoke loudly against homosexuality, and Parliament decided to retain section 377A of the Penal Code, a law that can put homosexuals in jail.

Religion is part of society, and it is inevitable that the very existence of different religions in Singapore - whether Christianity, Islam, Hinduism, Buddhism or whatever else - will influence the way Singapore is run. However, it is interesting to consider how each religious group may seek to influence society according to its own beliefs.

We know for instance that the Catholic Church is strongly against the use of contraceptives. But we also know that the Ministry of Health provides health advice like this, on its official website:

Persons who engage in high-risk behaviour i.e. multiple sexual partners, casual sex or sex with prostitutes, are strongly advised to use condoms to reduce their risk of HIV infection. Condoms should be used consistently during every sexual encounter ..... Persons who have unprotected sex while engaging in high-risk behaviour have a higher risk of HIV and other Sexually Transmitted Infections (STI).

What if tomorrow you opened your newspaper, and found that the Catholics in Singapore are now loudly telling Parliament that the Ministry of Health should remove such advice from its website? That such health advice (to use condoms) offends their religion and is immoral like homosexuality? That Singapore is "not ready" for such health advice to be stated in a public manner?

Does this scenario sound absurd or unlikely to you? Perhaps it is. Yet the Ministry of Health's advice is against Catholic teachings - quite unmistakeably so. In Catholic thinking, the use of contraceptives is wrong, even if by a married couple. Contraceptives are regarded as part of the Culture of Death - a term coined by Pope John Paul II. Wikipedia tells us that the term:

"...... is used in contemporary political discourse in many countries, including the United States and Poland, to describe supportive positions on certain subjects, such as abortion, euthanasia, human cloning, poverty and capital punishment which adherents of opposing positions deem to be inconsistent with their concept of a "culture of life". Some commentators would add to that list homosexuality, contraception and other phenomena perceived to attack marriage and the family."

See what many Americans are worried about in the US right now - "Bush Family Planning Appointee Called Contraceptives Part Of The ‘Culture Of Death’".

What are the possible implications of the Catholic Church being against the use of contraceptives? We don't have to use our imagination here, for real-life examples are readily available. See this article from the Guardian, which provides a somewhat international perspective "across four continents":

Vatican: condoms don't stop Aids
Steve Bradshaw, The Guardian
Thursday October 9, 2003

The Catholic Church is telling people in countries stricken by Aids not to use condoms because they have tiny holes in them through which HIV can pass - potentially exposing thousands of people to risk.

The church is making the claims across four continents despite a widespread scientific consensus that condoms are impermeable to HIV.

A senior Vatican spokesman backs the claims about permeable condoms, despite assurances by the World Health Organisation that they are untrue.

.... The WHO has condemned the Vatican's views, saying: "These incorrect statements about condoms and HIV are dangerous when we are facing a global pandemic which has already killed more than 20 million people, and currently affects at least 42 million."

The organisation says "consistent and correct" condom use reduces the risk of HIV infection by 90%. There may be breakage or slippage of condoms - but not, the WHO says, holes through which the virus can pass .

Thank goodness the World Health Organisation is doing what it can to correct this misinformation. Still it is a tough battle. From the Guardian article, we get a sense of the actual, day-to-day difficulties of combating such misinformation.

For example, the article relates how the director of an Aids testing centre was prevented from distributing condoms, because of church opposition.

A video produced by the Catholic Church (presumably an "educational" video) shows a nun advising her choirmaster (who was already infected with HIV) not to use condoms with his own wife because "the virus can pass through".

According to the Guardian article, the Church has been reiterating these sorts of claims (that condoms don't help to prevent AIDS) .... across "four continents", and "as far as apart as Asia and Latin America".

I don't know if such claims are being made here in Singapore, and if they are, to what extent. But if they are being made in Singapore, then this, in my opinion, would constitute a public health hazard.

Of course, the problem is that if you spoke up publicly on this issue, some Catholics might well say that you're being religiously offensive. But think of it this way - if you spoke up publicly on this issue and raised awareness of the importance of using condoms, you would be saving lives.

As opposed to contributing to death. I mean that literally .... I'm not just referring to the "culture" of it.

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Retirement, Money and Singaporeans

A Straits Times article, about retirement, savings and Singaporeans' expectations.

ST Aug 11, 2007
Retire? Not so soon, say many
Singaporeans polled
They need to carry on working because of worries
over insufficient savings
By Lydia Lim

SINGAPOREANS are in no hurry to retire and most want to work beyond the official retirement age of 62, some even into their 70s.

It's a case of 'CPF no enough' for many of these workers.

Seven in 10 polled last month in a Straits Times Insight survey on CPF said they do not think their savings in the national pension fund will see them through old age.

Six in 10 of them said the same of their Medisave funds for hospital bills and specified treatments.

The survey of 636 Singapore residents aged 30 and above found that apart from CPF, 77 per cent expect to be able to draw from other sources of retirement income, mainly savings, investments and insurance.

But a significant minority of 23 per cent had nothing else set aside.

One cause for concern is that only one in two Singaporeans has done any financial planning for retirement.

Even fewer, three in 10, have done their sums on how much they need to squirrel away.

What may mitigate against any resulting savings shortfall is their willingness to work beyond the retirement age of 62. Some two-thirds said they plan to do so.

Of these, one-third are willing to work up to age 65, another third up to age 70 and the remaining third into their 70s.

The journalist has got her thinking hat on backwards. The truth can be stated much more simply. It doesn't really matter what the "official" retirement age is. You will go on working as long as you (a) need the money, and (b) are still able to keep working.

Unless you regard suicide as an alternative, you don't have a choice. What were you thinking - that Singapore is a welfare state?

Blue-collar and lower-income workers are the most likely to want to work longer.
Eight in 10 plan to do so, against six in 10 among professionals, managers, executives and business types, or those drawing more than $3,000 a month.

Older Singaporeans are also more likely to want to work past the retirement age than those in their 30s.

The vast majority - 83 per cent - are however against a recent suggestion by ministers to raise the age when they can draw down their CPF minimum sum. It is currently 62.

The only practical significance of the "official" retirement age is that it is also the age when you can start utilising (in tiny little monthly instalments) your CPF minimum sum. For an explanation of how this works, refer to my old post here.

The survey findings also revealed a good amount of ignorance of the workings of the CPF system. Seven in 10 do not know how much they had in their CPF accounts.
And one in two does not know the rate of return on CPF savings.

Of the half who do, most - 63 per cent - are unhappy with the interest rate, which
stands at 2.5 per cent for Ordinary Account savings and 4 per cent for Special and Medisave Account savings.

The top two changes CPF members would like to see are more flexibility in the use of their money, and a higher interest rate on their savings.

Financial experts and Members of Parliament said it is good that Singaporeans feel no false sense of security over their retirement finances.

Manpower Minister Ng Eng Hen emphasised in an e-mail interview that a critical factor in determining what is enough for retirement is how long people work in relation to how long they can expect to live. Average life expectancy has risen from 61 years when CPF was introduced in 1955, to 80 today.

I believe that in the long run, what will catch many people off-guard is how long they end up living. Life expectancies (except in very poor countries) have steadily been rising over many decades and the curves don't seem to show any sign of topping off.

In 1900, life expectancy at birth in the United States was only 47 years. By year 2000, it had climbed to 77 years (an increase of 30 years). In 1950, life expectancy in China was 35 years. By 2000, it had risen to 71 years.

If you google around to check out what the scientists and doctors have to say about new medical discoveries and research and their implications for how long people are going to live, well, you'd probably be quite startled. Anti-aging medicine has become an industry in itself.

The question is - how long can you afford it? Not the medicine. I mean - life itself. Living 10, 20 years longer than you expected means that you need money to support yourself for an additional 10, 20 years. That's a pretty long time.

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Thoughts Affect Reality. Let's Imagine Muscles

Hilariously, some readers are still missing the point. I wonder when they'll get it.

I have been using different sorts of examples to illustrate the "thoughts affect reality" concept.

But when I used Buddhism as an example, some readers said I shouldn't use Buddhism.

When I used quantum physics, some readers said I shouldn't use quantum physics.

When I used financial markets, some readers said I shouldn't use financial markets.

When I used rats and children in the Rosenthal experiment, some readers said I shouldn't use rats and children.

They miss the point. They just don't see that reality refuses to be divided up into neat slices according to our academic classifications.

Reality is not "Buddhism". Reality is not "quantum physics". Reality is not "financial markets" and reality is not "rats" or "children".

Reality is just reality. And thoughts affect reality - all of it. Whatever you think about.

And that is why you can look into ANY area of reality, including such diverse areas as Buddhism, quantum physics, finance, psychology etc, and still find evidence of the same "thoughts affect reality" phenomenon at work.

Today, what shall we talk about? Ummm, let's see. How about health and fitness? Shall we proceed to grow our muscles just by thinking about them?

"Ridiculous! Mr Wang is insane! Next he'll tell us that scientists have really discovered that you can increase your muscle size AND strength, just by thinking!"

Yawn. It's quite old news, actually:

Physical Training in Your Dreams

Scientists have come up with just about the best news that a couch potato could ever want to hear.

They say you can increase the strength of your muscles just by sitting back and imagine yourself taking exercise.

The discovery could help patients too weak to exercise to start recuperating from strokes or other injuries.

If the technique works in older people, they might use it to help maintain their strength.

Muscles move in response to impulses from nearby nerve cells called motor neurons. The firing of those neurons in turn depends on the strength of electrical impulses sent by the brain.

Dr Guang Yue, an exercise physiologist at the Cleveland Clinic Foundation in Ohio, says that this suggests you can increase muscle strength solely by sending a larger signal to motor neurons from the brain.

New Scientist magazine reports that Dr Yue and his colleagues have already found that visualising exercise was enough to increase strength in a muscle in the little finger, which it uses to move sideways.

Flexing biceps

Now his team have turned their attention to a larger, more frequently used muscle, the bicep.

They asked 10 volunteers aged 20 to 35 to imagine flexing one of their biceps as hard as possible in training sessions five times a week.

The researchers recorded the electrical brain activity during the sessions.

To ensure the volunteers weren't unintentionally tensing, they also monitored electrical impulses at the motor neurons of their arm muscles.

Every two weeks, they measured the strength of the volunteers' muscles.

The volunteers who thought about exercise showed a 13.5% increase in strength after a few weeks, and maintained that gain for three months after the training stopped.

Controls who missed out on the mental workout showed no improvement in strength.

The researchers are now repeating the experiment with people aged 65 to 80 to see if mental gymnastics also works for them .....

Boy, this sure gets repetitive. Do I have to say it again? Thoughts affect reality, yadayadayada.

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Mr Wang's Baby No. 3

Well, not exactly. This is Mr Wang's Baby No. 2, and it's an old photo - she's grown up quite a lot since then. Now she's running, climbing and talking ... a lot.

I decided to post this little baby photo, because my wife and I have recently been talking about the possibility of having another little baby. No, we have not actually decided. We're just discussing.

The discussion is important, because either way, this should be a deliberate, considered decision. I think that very often, many Singaporeans don't realise that not having a child is a decision as much as having a child.

I make this point, because I've just read Kitana's post entitled "Why Should Singaporeans Have Kids?". Kitana has heard all the usual reasons why Singaporeans don't want kids, and now she's trying to figure out the other side of the story - why Singaporeans should have kids.

In real life, I think that many Singaporeans fail to give the matter much thought, until it's too late. The matter is what Stephen Covey would call a 2nd Quadrant matter - it's important, but not urgent. All too often, human nature is to neglect tasks that are important, but not urgent.

Right now, you and your spouse are busy - with this, and that, and this. What about kids? Well, well, that's possible, but let's think about it later. Maybe next year. Next year comes around, and once again you're busy. Umm, this baby stuff is not urgent, let's think about it another time.

Well, unfortunately, Mother Nature doesn't give you forever to think about it. Wait too long, and you may never get another chance - as these Singaporeans are discovering. There's a very strong correlation between infertility and the woman's age; this is a well-known fact that non-doctors (that is, most of us) often fail to appreciate.

Note - Mr Wang isn't saying that you should rush off and have a kid now. Mr Wang is saying that there's a natural time bar for such decisions. If you want kids, then choose when. If you don't want kids, then let that be your considered decision. And be aware that there may be no turning back.

Don't just keep taking a wishy-washy, we'll-think-about-it-later attitude. Before you know, you may hit the age when the ovaries won't stick and the sperm cells start swimming funny. No, IVF does not work all the time - far from it.

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