HEADLINES [click on headline to view story]:

Psychological Perspectives

The Doctor's Consultation 

Agony Column

Camera Class by Snapshot

Dogs - Man’s best friend

Money Matters

Life in the Laugh Lane

Psychological Perspectives: Research program in Northern provinces aims to save lives by changing behavior

by Michael Catalanello, Ph.D.

When Somchai’s health began to deteriorate in March of 2004, both he and his family suspected that HIV might be the culprit. He experienced fever, diarrhea, and a significant weight loss. His wife and mother had already begun to distance themselves from him, avoiding even casual contact, refusing even to share the same eating utensils for fear of contracting the dreaded AIDS virus.

A 38-year-old woodcarver in Hang Dong District near Chiang Mai, Somchai had already made up his mind. If his blood test came back positive for HIV, he would end his own life. The reputation of HIV/AIDS as a killer is firmly established within this rural community, and the high cost of medical treatment beyond the reach of Somchai’s 4,000 to 5,000 baht per month income.

When he went for his results, however, Somchai was met by a nurse counselor who provided not only the unfortunate news of his positive test results, but also reassuring information about the free availability of an HIV treatment regimen known as highly active antiretroviral therapy (HAART), capable of controlling what was once a routinely fatal progression of the disease.

This was followed by a counseling session directed towards his family, aimed at providing accurate and up-to-date information concerning the prognosis and care of people living with HIV/AIDS. Arrangements were also made for Somchai to meet with others in his community who are successfully living with the virus, a process known as “peer counseling.”

Somchai no longer contemplates suicide. His mother has developed into a community activist of sorts, educating the people of the village to the facts about HIV, a serious and life-threatening illness, but one that is capable of effective management. His family no longer fears infection by casual contact.

The main challenge facing Somchai now is to maintain very strict adherence to the treatment regimen. This requires him to take his antiretroviral (ARV) medications every 12 hours, with minimal variation or missed dosages.

Patients like Somchai, however, typically find the required level of adherence a major challenge. Less than 95% adherence to ARV treatment allows the virus to develop drug resistant strains. Unchecked by the antiretroviral treatment, the virus can once again begin to replicate, attacking and destroying the body’s protective immune system. A weakened immune system allows opportunistic infections to occur, placing the patient’s life at risk, and requiring treatment with other expensive drugs.

Adherence to a treatment regimen is, by its nature, a psychological issue, since it requires changing patients’ attitudes and behavior. For this reason, Dr. Sombat Tapanya, a psychologist with previous research experience on issues of treatment adherence, provided a valuable psychological perspective. The outcome of this research is expected to demonstrate that both medical and psychological components are necessary in order to achieve maximal treatment effectiveness.

To assist him with strict adherence, Somchai was provided with an alarm watch, which signals him each time he must take his medications. He meets monthly with his assigned counselor who monitors his adherence to treatment, and tries to address social and economic issues that could adversely affect him and his family. He also participates regularly in peer counseling, in which he and other patients provide mutual support and encouragement to maintain adherence to ARV treatment and avoid infecting others.

Somchai is one of about 700 participants in a research project aimed at increasing treatment adherence among people living with HIV/AIDS. The project, jointly funded by the Population Council, an international nonprofit NGO, and the Thai Ministry of Public Health, is being carried out in 45 hospitals in Chiang Mai, Chiang Rai, Lampang and Lampoon provinces. The project utilizes four teams of workers; a clinical team, led by Tasana Leusaree, M.D., a counseling team, led by psychologist Sombat Tapanya, Ph.D. and Sangworn Sombatmai, peer intervention, led by Sureerat Treemakara, and an evaluation team, led by Suwat Chariyalertsak, M.D., Ph.D.

Armed with life saving medications, knowledge, and psychosocial support, Somchai and others living with HIV/AIDS in Northern Thailand are empowered to resume their lives, after receiving a diagnosis that formerly would have meant a death sentence.

This innovative program to increase adherence to ARV treatment is the first of its kind in Southeast Asia. Plans are now underway to make similar programs available in other areas of Thailand, as well as other countries in the region.

Dr. Catalanello is a licensed psychologist in Louisiana, USA, and a member of the Faculty of Liberal Arts at Asian University, Chonburi. You may address questions and comments to him at mscat @asianust.ac.th, or post on his web log at http://asianupsych.blogspot.com

The Doctor's Consultation: The Good News and Bad News - Good and Bad Cholesterol

by Dr. Iain Corness

“Cholesterol” rose its (ugly) head as a ‘baddie’ more than 20 years ago. However, to complicate the issue, the news that Cholesterol was not all bad also filtered out into the public domain around ten years ago. And so the terrible twins of Good and Bad Cholesterol were born.

Cholesterol is actually a type of fat (that we medico’s call a ‘lipid’) that the body uses to help build cells and produce certain hormones. However, we had found that too much Cholesterol in the blood increased the risk of heart disease, stroke, and coronary artery disease.

The basis for this was described in a scientific body of work called the Framingham study, to which a Prof. Kannel was associated. I was lucky enough to attend a lecture given by him in the early 60’s, and I left the lecture theatre convinced. What happens when there is an excess of circulating Cholesterol, this blood fat leads to a deposition of chemicals on the inside of the arteries, which we call ‘plaque’ (which is nothing to do with the smelly stuff on your teeth that the dentists scrape off). When the plaque deposits get large, they can block off the artery, or clots can form on the surface of the plaque, which then get carried into the circulation and produce the strokes and nasty cardiac events.

So where does the ‘good’ stuff come in? Well, Cholesterol travels through the blood attached to a protein. This Cholesterol-protein package is called a lipoprotein and these come in two forms. High density or low density, depending on how much protein they have in relation to fat. Lipoproteins with more protein than fat are called High-density lipoproteins (HDL), while lipoproteins with more fat than protein are called Low-density lipoproteins (LDL). High-density lipoprotein cholesterol is the so-called “good” cholesterol and the LDL is the black sheep of the family. It is the LDL that gets deposited in the arteries, not HDL.

The way HDL works is by removing LDL from the circulation. It does this by binding with the LDL in the bloodstream and carrying it back to the liver to be broken down. Consequently, a high level of HDL cholesterol appears to lower your risk of developing heart disease and stroke.

Now to complicate matters, there is another blood ‘fat’ called Triglycerides, which the body uses to store energy. A high triglyceride level along with high LDL may be more of a risk for heart disease than only having a high LDL on its own.

So how do we measure all these different factors? A total Cholesterol test measures the total amount of Cholesterol in the blood. Lipoprotein analysis, or a lipoprotein profile, on the other hand, measures blood levels of total Cholesterol, and then the fractions of LDL Cholesterol, HDL cholesterol, and finally Triglycerides.

The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (now there’s a mouthful!) which is known as the Adult Treatment Panel III, or ATP III, recommends fasting lipoprotein analysis every 5 years for all adults age 20 and older. Also, if the total cholesterol level from a (random) non-fasting sample exceeds 200 mg/dL, or HDL cholesterol is less than 40 mg/dL, the ATP III recommends repeat testing with a fasting blood sample.

So what should you do? If there are any risk factors for heart disease, including poor family history, obesity and diabetes, then begin checking annually. The cost of testing is cheap insurance if you can avoid coronary artery disease and strokes, surely!

Agony Column

Camera Class: Pro photography - a case of supply and demand

by Harry Flashman

At least once a month I get asked if I know of any professional photographers in the area that would like to photograph XXX. For “XXX” you can insert, “shots of my restaurant”, “some fashions we are producing”, “shots of my girlfriend”, “underwear we want to sell overseas” and the like.

At least once a month I reply that I don’t know of any in the area, but if I do stumble across one I will let them know. Starving people with cameras, who would like to be professionals, are probably weeping by now, but I’m sorry folks, there’s a reason I don’t pass on all these great opportunities.

The first reason is that the initial request is usually trying to get me to do it. I always reply that I haven’t got the time. Why do I do this? Simply because the average “client” has no idea of the difficulties associated with professional photography, no idea of the costs involved, absolutely zero idea of the time it takes, and would be staggered by the costs of doing it professionally (and properly). In other words, from my point of view, it isn’t worth the hassle.

The second reason is that I haven’t really got the time to ‘educate’ these would-be clients as to what professional photography is really all about, and why 15 years ago, my going rate was 30,000 baht a day, plus film and expenses. It is the old concept of billing for professional services “For taking the photographs - 3,000 baht. For knowing how to (produce what you want) - 27,000 baht.”

Pro photography is a hard business, believe me. You have to spend (almost) as much time trying to work out what the client has in his (or her) mind, as you do to produce the shot. It is no good producing a stunning jewellery shot on a blue shiny satin background, when the client has the idea that all his jewellery looks best on red. Even when you have finally discussed everything with the client, and you (think) you’ve got the handle on the needs, wants and desires, you can still be disappointed when you come up with the final transparency. One client rejected a cover shot for his electronics business catalogue because by the time I had arranged all his little electronic bits and pieces the way he had previously told me he wanted (this took two days, by the way), he had changed his mind and decided that he wanted his 12 month old daughter sitting in the middle of electronic parts chaos instead. And always remembering, at all times, that all professional photographs are ‘made’ by the photographer. They don’t just ‘happen’.

There are so many other variables in any shot that many pro shooters employ a junior whose main function is (other than shifting furniture) to look over the photographer’s shoulder and see all the minor details that the pro might have overlooked in his desire to get the lighting correct for the shot. This includes models who are wearing clothes with the price tag showing, or food on a plate that has a slight smear around one side, or a gold watch with a small piece of lint from a polishing cloth on it.

Even shooting people is fraught with dangers, and I don’t mean the 9 mm handgun style of shooting. Every person has a preconceived idea of what they actually look like. Someone with ears that look like handles on a beer stein does not even see them - until they see the photograph! Women clients all expect to look glamorous, and never dare show some ‘crow’s feet’ - even though the client might have a face like a ploughed field. Animals are worse, as you have probably a 10 second window of opportunity to get the right shot. Children are even worse, if that’s possible. The window is 10 nanoseconds!

No, pro photography is demanding and difficult, and like me, you should refuse all offers of “popping down to the shop and banging off a couple of shots for a brochure”. It isn’t worth the hassle.

Dogs - Man’s best friend: Spitz - and primitive types – Breed group nr.5

Nienke Parma

One of this group’s main characteristics is its natural look: erect ears, a high-set curled tail and a robust and strong build body. Their original tasks were multiple, like herding, guarding, draught sleds or carts, and hunting. Some breeds were even used as food source and for their fur. These breeds are known for their great need for exercise. In general, they’re stable independent and placid, and often very attached to the family. Due to their hunting passion, many members of this group show problems with the recall.

A Dalmatian which is fabulously beautiful for its breed, but he’s clearly not interested in that.

This breed group consists of two main types: the Spitz and the primitive. The Spitz-types comprises mainly the pole-dog breeds, distinguished in the sled-dogs Scandinavian hunting dogs and the Scandinavian guard and hunting dogs, and the Keeshond, distinguished in the European Keeshond and the Asiatic Keeshond.

Sled-dogs (e.g. Siberian Husky and Alaskan Malamute) are real pack animals, resulting in a tolerance towards their own species and a strong sensitivity for a correct hierarchical structure. Although most are friendly dogs, usually they’ll keep a certain distance from strangers as well as their own family. They can’t cope well with being alone, often expressing this in howling. Scandinavian hunting dogs (e.g. Finnish Spitz, Norwegian and Swedish Elkhound) are brave, quite tough on themselves and often very self-willed. They are fast learners, which does not necessarily mean that it’s always what the owner wants. Although good as watch dogs, they bark only when necessary. The Scandinavian guard and shepherd dogs (e.g. Norwegian Buhund) are social and cheerful animals and characterize themselves through their big receptivity to training. These breeds also need a lot of exercise and challenge. Their hunting passion is generally slightly less then the other two groups.

The Keeshond (consisting of four size varieties) was originally bred as companions on Dutch barges, making it an excellent watchdog, though wary of strangers. It’s a real family dog: strongly attached, cheerful, curious, meddlesome, full of temperament, that eagerly learns. Towards their own species they tend to be not too tolerant. The smaller varieties can be a little reckless and fearless, which does sometimes end up in accidents during encounters with larger dogs. Also this dog has a hunting passion, due to their original secondary task as vermin-controller. The Keeshond’s thick coat need extra skin and coat care. The Asiatic Keeshond (e.g. Chow Chow, Japanese Akita) are less likely to obey their owners, than their European counterpart.

The Primitive types consist of ancient breeds some of which have existed for thousands of years. Examples are the Pharao Hound and the Basenji. The Dingo and the New Guinea Singing dog are primitive breeds, but they have not been affected too much by human intervention. They are self-willed and independent, and have stamina. They won’t be friends with everybody, but normally will act neutral towards strangers. And although, they are capable of obeying, they won’t find much pleasure in doing so. In Thailand a well-known primitive dog is the Thai Ridgeback, however nowadays it’s placed under the hound dog group. Another Thai dog that would fall under this breed group is the Ban Keaw. Unfortunately, it is not yet a recognized breed by the world’s major kennel clubs. To be continued …

For more information on general dog issues, boarding, training or behavior modification, please contact LuckyDogs: 09 99 78 146 or lucky4paws@yahoo.com

Money Matters: The Big Picture

Alan Hall
MBMG International Ltd.

In the global asset allocation game it is easy to get carried away with all the short-term noise. Those familiar with MBMG International’s philosophy will be aware of our 3 level approach to core asset allocation. The second two, business/economic cycles and technical analysis, are vital to long-term successful asset allocation and investment returns but getting the first, “big picture”, correct is what allows certain investment professionals to survive over numerous market cycles. Investors such as Warren Buffet, George Soros, Richard Russell and Jim Rogers are good examples and we should listen to their free advice.

Jim Rogers is regularly on CNBC and has just written a new book titled “Hot Commodities”. There is no secret where he has his vast fortune invested at present and he had these recent snippets. “Buy low and sell high are the only rules. CNBC has no commodity commentators, which proves that there must be value. There are not enough bright 29 year olds for 10,000 hedge funds. Copper is dumb and never heard of Alan Greenspan, but commodity stocks have management, gearing, regulations, etc., which can distort value.”

Soros and Buffet make no secret of their dislike for the USD and “The sage of Omaha” reiterated his view that he finds common stocks expensive at current levels and is not buying any. We concur that the big picture remains one where the western hemisphere equity bear market has not finished, all paper currencies have problems and that trendy hedge fund, whilst a core in any portfolio, warrants caution at present.

Richard Russell has been publishing his views for many decades and whilst his short calls can be wayward, there’s a lot in his current big picture view for everyone.

After the bubble — When the stock market bubble burst in the year 2000, Greenspan (having watched the bursting of the Japanese bubble and the deflation in Japan that followed) realized that the US too could sink into deflation. With the sky-high levels of US debt, Greenspan realized that deflation in the US would be an unmitigated disaster. Greenspan decided that the strongest possible measures must be taken to ward off potential deflation in the US. Thus, the Fed drove short rates down to generational lows while flooding the system with liquidity.

The Fed’s frantic anti-deflation policy succeeded in driving both stocks and real estate prices up to “bubble” valuations (which is where they are today).

Now we’re facing the next chapter in this zany series. The latest is that the Fed is now openly worried about inflation. Short rates have been below the inflation rate for months on end (and they still are), meaning that the money can be borrowed literally on a “no cost” basis — money is still literally being “given away.” Realizing that rates must be brought back to something approaching “normal,” the Fed has been raising short rates at a “measured” pace.

Amazingly, although short rates have been rising, long rates have actually been coming down. The rate on the bellwether 10-year note is now below where it was last September. Thus, the bond market is clearly unworried by the Fed’s action in boosting short rates. This has caused bond experts to ask, “Is this the bond market’s way of saying that we’re heading for recession? What is the bond market ‘thinking’ when bond yields actually decline in the face of a Fed tightening?”

The markets now appear to be at a crossroad. If the Fed holds off on boosting rates, inflation could heat up, and the twin bubbles of stocks and real estate could become even more dangerous.

On the other hand, if the Fed raises short rates to the point of pain (which is what they’ve always done in the past), the US economy could sink into unmanageable deflation.

In the meantime, an increasing number of “unknowns” are creeping into the picture. The Iraq war is not turning out the way Bush and Rumsfeld thought it would. The debts and deficits continue to build, and the Iraq war is simply making the situation worse. It seems clear that the war will add at least $100 billion in annual expenses to the budget, assuming war expenses are even included in the “regular” budget.

The consumer has become a deepening mystery. Up to now, US consumer spending (much of it based on rising real estate values) has gone a long way toward keeping the US economy afloat. But now we hear that consumer credit in November took its biggest drop since the statistics were first made available in 1943. Are America’s debt-laden consumers finally ready to turn stingy? It doesn’t seem likely, but then again — every excess has its limits.

Staying the course is the most difficult, especially with short-term pressure, but the most rewarding.

The above data and research was compiled from sources believed to be reliable. However, neither MBMG International Ltd nor its officers can accept any liability for any errors or omissions in the above article nor bear any responsibility for any losses achieved as a result of any actions taken or not taken as a consequence of reading the above article. For more information please contact Alan Hall on alan@mbmg-international.com

Life in the Laugh Lane: Airy Orgy

by Scott Jones

Do not show this column to my daughter or she’ll never visit me in Thailand. I visited a friend in Chiangmai. As we prepared dinner, a few bugs flew around the kitchen - very big bugs that seemed drunk and barely able to fly. As we began to eat, an official swarm of 5,000 formed. Outside a dense fog of several billion bugs staggered through the air and smashed against the windows. Poisoning the house and food with pesticide seemed fruitless so we turned on a light in the living room and ate in the shadows. An hour later, the bugs were gone, but 10,000 wings covered the carpet. With no bodies. Not one. Anywhere. I was glad I didn’t have to sleep there with 5,000 new creatures lurking in the darkness.

Another night I came home late to insect mayhem in my country bungalow. The light in my outdoor kitchen was on. An infinite number of these same bugs, half with wings, half without, were writhing in every cupboard, crevasse and oven mitt. Squirming masses of stained-white bodies were piled 6 inches high against the counter top stove, fridge and every wall. I grabbed a broom and tried in vain to sweep them off the deck as they came semi-alive into a meter high mass of flapping and crawling hysteria. You can’t sweep the air. At this point, if my daughter didn’t die of fright, she would commit suicide.

After this dramatic and traumatic experience, desiring sympathy and comfort, I excitedly told a couple friends. A farang neighbor with 12 years in Thailand said flatly, “Don’t leave your light on.” My Thai friend said, “Yes, we eat them.” Hmmm. As my kitchen swarmed with UFOs, I didn’t consider firing up the wok. In Thailand, they do eat anything that flies (except airplanes) which explains why bikers ride with their mouths open.

I’ve learned these are termites and there are lots of them. With perhaps a million in each colony and an average of 14 colonies per acre, the zeros in their global population number would fill this entire column. They’ve got queens, kings, soldiers, workers and the flying reproductive caste, or “alate,” which means “Give me a latte before I run away from home, learn to fly and find a wife.” For one day in their lives, they leave their black holes, head for the bright lights, party hearty for a few hours, meet their mate, fall to the ground, rip off their wing wear and crawl into the nearest cavity to copulate, similar to what happens in Spicy’s nightclub every night. Each pair becomes the new royal couple living in an inner chamber called the “copularium.” They may live up to 50 years, re-mating to maintain the queen’s prodigious output of up to 1,000 eggs a day. The queen’s body swells up with eggs until she becomes a monstrous white caterpillar-like thing, totally helpless, a bloated machine endlessly pumping out her family. This is why I’m not married. The husband brings cases of Kentucky Fried Chicken to his 250 kg, ever-expanding, bed-ridden wife and leaves with a few more kids until he runs out of sperm.

There’s good and bad news here. Bad: At 1,000 eggs per day per gazillion queens, the world could be over-run with house-eating bugs by the end of the week. Good: There are an equal infinite amount of other creatures that eat them. More good news: The mating habits of water buffalo are not the same as termites.

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