Problem of Delinquents, a transcient problem?

The article 'Girls behaving badly' published by The Straits Times on March 22 is indeed enlightening. It highlights one of the social ills that is taking in our society today. I am sure it did not come as a surprise for many of us. Possible reasons had been postulated for this phenomenon: bad influences from media and internet, increasing materialism, just want to have fun, weaking of family bond, etc. But what is the real underlying factor?

Previously, such badly behaved children were usually associated with broken families. Broken family is defined as those family where the parents are divorced or separated. In the old days where the mother is usually the home-maker, it follows that once divorced, the mother will have to work leaving the children to fend for themselves with minimum guidance. But reading the article clearly debunk this myth. Nowadays intact families are equally inflicted by this social ills.

To me, this is hardly surprising. Intact family nowadays is only intact as far as the marriage goes. What is not intact is the time spent between the parents and children. With the rise in cost of living, the better standard of living and the rising (unrealistic) expectations, a single income is no longer feasible in most households. Coupled with the fact that women are now better educated, with changes in mindsets and aspirations, being a home-maker is no longer expected. Hence, all these give rise to the double income family, where both the parents work, leaving the children to fend for themselves.

Therefore, on the surface a family is intact but in actuality, the family unit is as broken as that of a broken family. There is practically nobody to mind the children. I choose the word mind and not look for a reason. When one look after the children, one merely make sure that the children are fed and safe. They are not taught about what is right or what is proper. As a result the children do not know how to behave. How does a child know what a proper behaviour should be when he does not even know what is right or wrong?

Some parents tried to amend the situations by 'spending' time with them during the weekend and holidays. This is all well and good until the way how these parents 'spend' their time is examined. During weekends, this usually means going to shopping centres. The father will look at electronic stuff, the mother will look at clothings and the children, depending on the age, toys, stationery or handphones. The point is that the time spent is not fruitful. Each has his own agenda. This is no different as each going out to different shopping centres! How much minding can there be?

Then there are those parents who are indulgent. I have witness a 7-year old child who actually opened the wrapping of a toy to play with it. When he was politely told not to play with it, the father actually told the boy to leave the toy since 'people don't want you to play.' How would the boy learn from his mistakes? Would the boy even know that he was wrong?

The problem of delinquent children will get worse. The cost of living will not be any cheaper. Both parents will have to work. Children of such parents will grow up with no parenting skills. They will not know how to mind their own children even if they want to. The future certainly looks bleak.

I am not pointing fingers at those parents who working. How many of us have a choice? How are we going to solve this problem if the root cause is not tackled? I feel that the only way to tackle this is to do it as a society. Let the society set the standards. This means that if a child is seen to behave badly, let the society reprimand the child. And society means people like you and me. If our children misbehaved, we should not shield them. And if we cannot handle our children, then let the society do so.

Doctors unfairly targetted?

The Singapore Health Ministry has decided to ban the practice of unsubstantiated aesthetic procedures carried out by doctors here. The official reason given was that "As professionals bound by ethical codes, they should know they are not doing the right thing if they are practising unsubstantiated procedures that have no scientific basis in terms of efficacy or safety." In addition, it was feared that "doctors who sell snake oil pose greater danger to the public than lay persons selling snake oil because the public tursts doctors more" because patients rarely question such procedure when carried out by doctors.

I agree with the Ministry that unsubstantiated procedure should not be carried out by doctors just as unsubstantiated medical treatment should not be practiced. This is because nowadays, the practice of medicine is evidence-based. This means that all treatments must be backed up by studies as to the efficacies. This is the accepted mode of practice and is used as the yardstick in the courts of law. Therefore to practice unproven procedures should strongly be discouraged.

However, is targetting the practice of these unproven methods on doctors logical? Are they being unfairly targetted? After all, many of such practices had been carried out by beauticians, and doctors are only jumping into this lucrative bandwagon. Are they being discriminated just because they have "Dr" in front of their names?

Although I agree with the Ministry, I feel that the ban is too drastic and too sudden. This is because by banning such practices among doctors, it created a vacuum which will be filled up by beauticians instead. And if the main aim of the Ministry is to prevent the practice of such questionable methods, then this problem had not been solved. It merely just shift the focus from one of ethics to one of safety. This is because if any untowards happen to the 'patient' in the course of the 'treatment', at least a doctor is better equiped to handle the complications. Furthermore, a doctor has a heavier responsibility towards his patient, merely because of licensing requirements. This is not so with beauticians.

What the Ministry should do is to regulate the whole aesthetic industry; for it does not matter whether the procedures were carried out by doctors or beauticians. Currently, doctors and beauticians have been using all manner of aesthetic treatments, ranging from the non-invasive methods of skin peelings, to the minimally-invasive methods of skin laser to the overtly-invasive method of mesotherapy and colonic washouts. There is no regulation as to who can do what. In the interest of "patient's" safety, guidelines should be drawn up with clear definition as to what procedures a beautician can do, what a general practitioner doctor can do and what a specialist can do with a breakdown of specialty. Just because one is a specialist does not mean that one can claim specialist right to do aesthetic medicine, because he can only be a specialist in his own specialty. His skill level in aesthetic medicine should only be expected to be on par with that of a general practitioner. In the same vein, the differentiation in criteria for beautician and doctors should not be based on medical background but should be based on the risk involved and the ability of managing any potential emergency complications by the practitioner. This will ensure that everyone is given a level playing field.

One of the defence often cited by doctors is that procedure such as mesotherapy had been widely practiced in France and South America. While mesotherapy had been practiced since it was first pioneered by French physician, Dr Michel Pistor in 1952, its use in aesthetic medicine had a shorter history. And the few studies on the effect of mesotherapy on fat cells had not been conclusive. If this method is so effective, I find it strange that drug companies do not fall over themselves to come up with studies that will prove conclusively once and for all the efficacy of this method and get the treatment mainstream. More likely, most of the studies funded did not show statistically significant positive results.

With the banning of doctors from practicing such unproven procedures, I wonder what will happen if doctors choose to close their clinics and convert it into a beauty saloon instead and do away with their official title; effectively be a beautician. After all, the practice of aesthetic medicine is so lucrative that I am sure these doctors do not need the run-of-the-mill practice of seeing cough and cold. Technically they are doctors but they do not run a clinic; in other words, a medically-trained beautician, just like a medically-trained Minister. What will be the Ministry's stand in such cases? Hence, instead of pushing such doctors 'underground', a full regulation of the industry seemed a better option.

I purposely steer clear from any ethical issues. If a patient finds that his doctor seemed to be more preoccupied with aesthetic medicine, then change your doctor. There are so many doctors in Singapore, and I am sure some of them will actually be appreciative for the chance to see you. However, if your choice is limited by the Managed Health Care scheme, then I can only sympathise with you. And that issue belongs to another blog!


Updates on 24 March 2008

The Health Minister yesterday reiterated that the Ministry will leave the professional bodies - College of Family Medicine and Academy of Medicine - to look into various mode of treatment. However the Ministry will draft guidelines on high-risk procedures. This seemed to be a change in stand by the Ministry and is in-line with what happened in the US where although the cocktail of medication for mesotherapy is not approved by the FDA, mesotherapy itself is not deemed illegal by the medical professional body.

P.S.: I am a practicing doctor not involved with aesthetic medicine.



Links:
College Pharmacy - Mesotherapy treatment
Caring Medical - Mesotherapy
Consumer Guide to Plastic Surgery - Lipo-Dissolve under Investigations
DermNet - Mesotherapy Suture for a Living - Mesotherapy/Lipodissolve
WebMD - Fat-busting Injections under Scrutiny

Malaysia's 12th GE - the aftermath 2

Barely one week post election, Malaysians are thrown into a number of uncertainties.


In Penang, there was the UMNO-led street demonstration against DAP plan to stop the NEP. It was reported that there was about 500 UMNO members including the ex-Deputy Chief Minister of Penang. Strangely this comes barely 2 months after PM Badawi said that street demonstration was not in the Malaysian culture. He was commenting on the Hindraf demonstration then. What was more intriguing is the fact that nobody was arrested despite the fact that no permit was issued for the demonstration. Of course it can be said that it was a peaceful demonstration, and hence no reason to arrest anyone. But then again, the Hindraf demonstration was also peaceful until the police moved in to disperse them.

Another intriguing phenomenon is that even though PKR's Tan Sri Khalid, the newly-appointed Selangor MB also plan to scrap the NEP, the response from the BN was different. PM Badawi did not chastise him for stoking the racial sentiments. But similar proclaimation by DAP had stirred up entirely different response. Now I wonder who is stoking whose sentiments?

The role and power of the Sultan in forming state's government cannot be any clearer. Now we know that the Sultan has the ultimate power to choose the MB. The question now is since he has the authority to appoint MB, does he has the authority to fire him as well? This is pertinent especially in Perak, where the ruling DAP-PKR-PAS coalition seemed very fragile at the moment. It state progress had been stagnant either from the disruptive squabble of the coalition or from the witholding of funds from the federal government, does the Sultan have the power to replace the MB, even if this candidate is from the minority party? If this is so, what implication will it bring regarding the Sultan's status as being above politics? Will it change the whole equation of the party with the majority seats forming the government of the day? Already the Raja of Perlis had scuttled the BN's plan for a MB.

I am sure Malaysians are anxiously waiting to see how PM will name his Cabinet. How will the minority be represented in Cabinet? Will he 'punish' the Chinese and Indians for abandoning MCA and MIC? Or will he try to win back these minorities and behave as a national leader for all Malaysians? His actions will have great implications on how Malaysians will vote in five years' time.

The Great Malaysian Experiment

Now that all the election dust had settled, one thing is clear - that the just concluded election outcome was a freak. This is because if the government, the people and even the opposition were caught unaware, then the result can only be described as freakish. From press reports, interviews and analysis, it is clear that this was more the results of protest votes against the ruling BN and not so much the support for the untested Opposition. Is this a bad omen for Malaysia? On the contrary, I think this is a golden opportunity and I call it the Great Malaysian Experiment.

This is because if such freakish outcome had not resulted, then the status quo of poor governance, non-accountability, corruption, nepotism, cronyism and wastage will continue. All this because nobody was willing to test the unknown. Until now every Malaysian is willing to tolerate the abuses and excesses of the government of the day; all this because of the lack of a credible and untested hodgepodge Opposition. All this changed unexpectedly after the last general election; and this presented Malaysia with an opportunity that may never happen again.

It will be interesting to see how the federal government deal with the state government held by the opposition. From previous experience, when Terengganu was under the control of PAS, the Federal government withhold the oil royalty to the state Government and was able to get away with it. This was partly because of the very poor representations of the Opposition in the Parliament. But this has changed since last Saturday. Not only are there now more Opposition MPs in Parliament, they now control five states. On top of that, the states government are under the control of different parties making up the Opposition. Hence, it will not be so easy nor practical now to just withhold state funds that are due to the states under Opposition control. Then there are other issues like foreign investments, and the megaprojects spanning across state lines. How the BN will handle these situations may be the precedents for future governments' dealings with states under the Opposition control. Because of the two-tier election where a voter gets to vote for the state and federal government, there may arise the possibility of the federal government and all or most of the state governments being governed by the opposing camps. This was unthinkable until last Saturday.

Then there is the problem of how the states relate to each other. Previously, because all the states were controlled by the same party which also made up the federal government, states relation was not much an issue. However now the states are essentially controlled by different parties. How are states controlled by the different party making up the loose coalition of Opposition going to deal with each other? Friendly and tolerant or mercenary and non-forgiving? This again will be something new to explore.

Previously, change of government was very smooth. The Sultan was merely mentioned in passing. Whoever was appointed the Mentri Besar by the respective party will just be sworn in. This also changed after last Saturday. The swearing-in of the Menteri Besar for Perlis, Terengganu, Perak and Selangor was delayed; apparently because the Sultan has not endorsed the appointee. What will happen if the compromised appointee of the loose Opposition grouping is not endorsed and further disagreement of the candidates cannot be resolved? What will be the role of the Sultan then? Never before has the role of the Sultan been scrutinised so closely. As of yesterday, we now know the Sultan has the ultimate authority to choose a Menteri Besar when the candidate from PAS was choosen as the Menteri Besar for Perak even though he was from the smallest victorious party and had the objection of the largest party making up the Opposition governing the state. How will this affect the working relationships of the parties making up the coalition of Opposition?

This also brings in the question the state constitution which stipulates that the Menteri Besar should be a Malay Muslim; and only the Sultan has the power to waive it. This is pertinent because of the situation in Perak where the DAP won 18 seats compared to PKR's 7 and PAS's 6. Under normal circumstances, the party with the largest assemblymen will be made the Menteri Besar or Chief Minister. But in this case, clearly it is not possible. Therefore question arise as to under what circumstances will the Sultan exempt the requirement, if at all?

Now that the Perak MB has been appointed, it will be interesting to see how effective a minority leader can be. Even if the two Malay-based party of PKR and PAS combined, it is still in the minority. Can the minority leader be effective in implementing policies that he may not really believe in but was 'forced' to accept due to concensus within the Opposition? Or will he just be happy to be a puppet leader whose action is being dictated by the majority party?

The Islamic party of PAS now has two states where it has the majority, that of Kelantan and Kedah. In Kelantan, PAS introduced strict Muslim laws despite the protest of the non-Muslim minority. However in Kedah, its newly appointed MB has promised that the same strict Islamic law will not be implemented in Kedah because of the differences in the ethnic demographics. This beg the question of how one can decide when to implement Muslim law and when not to; without being seen to have double standards and pretentious. And even if it is possible to have differential laws applied to different states, how can PAS justify itself as an Islamic party with Islamic ideals? A very interesting situation to see as it unfolds.

The Opposition has already declared that they will abolish the affirmative policy in the states they control. This was proclaimed in Penang and Selangor. It will be a new testing ground for such a proclamation. Firstly how will the Malays view such a move? Secondly, how will it affect race relations? It has to be remembered that the affirmative policy was introduced after the racial riot of 1969, blamed on the disparity in wealth distribution among the races. Will its abolition further threaten the already fragile and fractured race relation in Malaysia? Or will it be something positive, both for the bumis and non-bumis, alike? Only time will tell.

Because of all the above 'experiments', this last election presented itself as a golden opportunity where many unknowns exist that can be tried and tested simultaneously. And, as an added bonus, lessons learned from the situations in the states can be projected and applied to the federal level. Minority leader, role of the King, the abolition of the affirmative action and the very unlikely take over of the PAS as the ruling federal government may happen someday; although unlikely and unthinkable. But last Saturday all that changed. So whatever the outcome from this general election, it can only benefit Malaysians and not otherwise.

Malaysia is now at a crossroad. The people wanted change and change is what they get. Now it is left to the law makers to make good this change. Opportunities abound for the Opposition to make good their promise and to prove themselves. The ruling BN also has the opportunity to re-invent and to make itself relevent to current and future generations. The political landscape and mindset is given a chance to change and to adjust. This maybe the only opportunity Malaysia has to better herself and its people. Hopefully, the Great Experiment will be a success.

[Update 14 March: Since this post was published, the appointment of the Perak Menteri Besar had been postponed due to differences between DAP-PKR-PAS. There should be good lessons to be learned from this incident]

Malaysia's 12th GE - a new beginning?

The election result has been finalised. The ruling Barisan will continue in the government having won 140 seats out 0f 222. They will face, for the first time, the Opposition which is represented across the board. Where previously the Opposition was largely the Chinese-based DAP in 2004 or the Islamic-based PAS in 1999, this time round, the DAP, PAS and PKR, a largely Malay-based party, all did equally well. This outcome has presented Malaysia with a new political opportunity.

Since Independence 50 years ago, the ruling Barisan coalition had always been the only realistic choice to govern the country given its representation of the various races through its component ethnic-based parties. This is because, the politics of Malaysia had always been race-based and it is an accepted fact that a non-Malay will never be the Prime Minister, at least in the foreseeable future. This couple with the realisation that the non-Muslim minority will never support an Islamic-based party to rule the country. Because of this, there is no real chance for the Chinese-based party of DAP or the Islamic-based party of PAS to form the government.

The success of DAP, PAS and PKR this time round having won themselves a combined seats of 82 have presented a viable alternative to this largely monolithic political system. Together this three parties represented all the three major ethnic groups in Malaysia. Although the DAP is largely Chinese-based, it has a sizeable Indian parliamentarian. The Malay electorate will be represented by PAS and PKR. What is different in this election with that in 1999 when these 3 parties formed a coalition called the Alternative Front is in the presence of a de facto leader in Datuk Seri Anwar Ibrahim. Hence for the first time the Opposition has a Malay leader with parliamentarians representing the major ethnic groups; akin to the Barisan coalition.

Now that the people has made their choice, the Opposition will have to prove themselves in Parliament. They will have to show that they can work together, creative and truely able to address the major issues at hand - the issues of religious conversions, the judiciary independence, the 'perceived' marginalisation of the ethnic minority, the 'perceived' Islamisation of the country among others. And they must do this without the rhethorics which was so common previously. This election has shown that Malaysians are now more educated and discerning, able to analyse issues and no longer just support parties based on ethnic lines. If the Opposition can oppose constructively or even elect to support the government when such is warranted, then I am sure the future of the Opposition will be bright.

UMNO, the backbone of the ruling Barisan, can also 'benefit' from this result. For years, UMNO can rely on the Malays support. This has probably made UMNO too confident and arrogant, loosing their direction along the way. This can be seen by the jostling for candidancy in the days leading up to the nomination days. There do not seemed to be any clear criteria for selections. Probably, the leadership had felt that it does not matter who was standing for the election as long as they belong to UMNO. Certainly this has proven to be wrong and showing that even the Malay voters are now more discerning. Issues and the ability to solve them becomes more important than just the party banner.

The fall of Gerakan in Penang is not unexpected given the poor track record under the leadership of Tan Sri Koh. He did not even have the full support of Penang UMNO. MCA's dismal showing, to me is a surprise, given that they had made more representations to UMNO under the leadership of Ong Ka Ting.

MIC's disastrous showing should be no surprise given the unpopularity of Samy Vellu. Maybe power has gone to his head to the extend that he was still so arrogant, aloof and defiant in the face of the hostility that he had received since the Hindruf street demonstration. It is probably appropriate that he be dumped unceremoniously by the electorate on his 72nd birthday. The insult can not be any worse when at the same time the leader of Hindraf was elected with a clear margin of victory; all these even while he was in political detention. Truely, MIC will need a more practical and dynamic leader.

All these changes give Malaysia a real opportunity to set things right. For the ruling coalition, not to take thing for granted and to try to solve long-standing and sensitive issues, like the question of religious conversions, rising crime rates and the judicial independence, and not just sweep under the carpet for the next leader to solve. For the Opposition, a chance to prove themselves a viable alternative to the long-entrenched ruling party; that they can present constructive views and criticism for the betterment of the country.

Malaysia is now at a crossroad. The electorate have shouted out loud. If this 'experiment' works, then the days ahead are bright because then no ruling party can be complacent, and misdeeds can be minimised if not eradicated due to the check-and-balances. However, if this experiment fails, then things can only get worse.

Malaysia's 12th GE - the aftermath

The 12th Malaysian General Election was conducted yesterday and the results, dare I say, shocked many people. Yes, the ruling Barisan coalition was expected to lose some seats and may even stood a chance to hold on to the two-third majority in Parliament; long used as the yardstick of the people's support. However, eventually, this was not to be. Not only have Barisan failed to retain their two-third majority, but they were further slapped on the face with the lost of their major component party of MCA, Gerakan and MIC.

At the state level, things don't look any better. As expected, Kelantan remained in the hands of opposition PAS. Penang, although not expected to do as well as before, also fell to the opposition. Surprises came with the fall of Kedah, Selangor and Perak. All these loses were mainly at the expense of MCA, Gerakan and MIC.

In the run-up to the election, the Barisan coalition was not expected to do as well as in 2004 when they won 198 parliamentary seats out of 218. Many factors worked against the ruling government of Datuk Seri Abdullah Badawi.

Firstly there was the Mahathir factor. Unexplicably, after choosing Datuk Seri Abdullah Badawi as his successor, he suddenly turned against him. Dr Mahathir criticised his successor repeated and painting negative pictures of him at every turn. How Datuk Seri Abdullah can remain quiet with such personal attacks remained a mystery. To his supporters, you will say he has wisdom, respect and poise. To his critics, he is a lame duck, weak prime minister. How can a reigning prime minister fight an election when even an elder respected, still powerful stateman criticises him? Maybe Dr Mahathir is now smiling at poor showing of ruling coalition under the leadership of his chosen successor.

Then the is the Badawi factor. When Badawi ascended the premiership, he had vowed to eradicate corruption and clean up the running of the civil service. But at the end of four years, not much had changed. He was shown to be a weak leader time and again. Could this have contributed to the dismay results?

How much had the Anwar factor contributed? I think it is just a matter of timing - being at the right place at the right time. No doubt he had been the most prominent face of the Opposition. But his influence will most likely have the most effect with the Malay majority. Even then, if one listened to his speeches, there is not much difference between his and that of the Chinese-based DAP. His main groused was mainly with the previous administration of Dr Mahathir. In fact he had not criticised Badawi directly.

But the biggest issues of the day must be that of race and religion issues. Unfortunately after 50 years of independence, these issues had not been conclusively resolved. The people merely tolerated such issues and not openly discussed them publicly. However with the Badawi's administration, either through policy change or otherwise, such issues came to the open. The Hindruf street demonstration was the most telling. It seemed that the minority's fustration had reached its limit. Where previously, such unhappiness can only be inferred, with yesterday's results, it is only too clear to be seen.

With the above background, it is not difficult to predict the fall of Datuk Seri Samy Vellu, the president of MIC. However the fall of bigwick of the Chinese-based party is certainly a surprise especially that of MCA. Penang, under Gerakan had been getting from bad to worse. Even the outgoing Chief Minister Tan Sri Koh Tsu Koon did not get much support from UMNO and his political days were perhaps numbered starting with Khairy's speech and his being ignored by the Tanjong division UMNO chief during the opening of the Tanjung division headquarters back in 2006. However, at the national level, MCA had been fairly successful in fighting for its cause.

So what will this mean to the ruling coalition of Barisan? And how will it affect the government's policy towards race relations, one of the major issues in this general election. Will there be any backlash to the country's minority? What will be Anwar's next step? Will he contest in a by-election as planned? Will he keep his word on dismantling the affirmative policy? Only time will tell.