The Doctor's Consultation: TB - is it still with us?
by Dr. Iain Corness
Let us get one thing straight. Yes, TB is still with us,
yes it is a dangerous disease, and yes, several thousand people die of the
disease in Thailand. In fact, if you look at global figures, the number is
around three million world-wide. It is also highly infectious.
When you think back that 800 people died in the world from
SARS, a disease that crippled tourism world-wide (and kept newspapers in
business with the daily reports), and 3,000,000 die each year from TB, I get
the feeling that we have our priorities a little mixed. Even the latest threat
to mankind, the mutated Bird Flu (if it happens), is unlikely to claim that
number of deaths in one year, let alone every year!
TB is caused by a bug, and we have medication that can kill
it in our bodies. The medications are not new breakthroughs, but a standard
treatment therapy that has been used for decades. So why has it not worked?
Dr. James Orbinski, a past president of the Medecins Sans
Frontieres, said a couple of years ago, “In essence, tuberculosis today is a
global public health emergency. It is a curable disease and yet two billion
people are infected with mycobacterium tuberculosis. 16 million people around
the world live with active tuberculosis, and a very significant percentage of
those 16 million people are spreading tuberculosis.
“Every year, two to three million people die of
tuberculosis and the number of new cases - or the incidence of tuberculosis -
is increasing significantly. What we see today is that the incidence in the
last year alone has gone up from 8 million new cases last year to 8.3 million
new cases this year. This is quite significant. By the year 2020, the rate of
spread may increase by up to 40 percent so that 70 million people could be
dead by then and over a billion more people infected with tuberculosis. At the
same time, we are seeing the rise and spread of multi drug resistant
tuberculosis (MDRTB). In the last few years, MDRTB has been identified in over
100 countries and this is now a major, major global public health emergency in
addition to the emergency that primary tuberculosis represents.”
He also went on to say, “Only 25 percent of people who
have tuberculosis are in active treatment programs which means that 75 percent
of people with active TB are not in active treatment programs.” With those
sort of statistics, you begin to see just why TB is getting out of hand.
Even those who have TB and are put under treatment, rarely
go through with the full course. The reason is simple. The course of treatment
is somewhere between six to nine months! Research has demonstrated that the
vast majority of people with TB will continue for two months, but after that
length of time will most likely discontinue. So we have those millions of
partially treated people who will not get better, and are capable of spreading
For a disease that has been around for years, why are we
working with such unwieldy, and outdated therapy? When you consider that a
patient with TB is expected to take four different medications three times a
day, and keep that up for nine months, the sheer logistics becomes a problem.
Now factor in the cost. Since TB is rampant in the poor of Asia and Africa,
are they likely to be able to afford the medication for nine months? Simple
It is probably high time that the researchers gave us
something new, for a very old disease.
Dear old Pater was delighted to find so many ladies in waiting as he
whirdled forth with his shooting-stick. “There they were, woggling their
grummitts,” chuckled Pater, “My splod was fairly bogled!” What Pater
needs is a decent truss shop and a handmaiden, e.g., a Nok, Lek or Britney
to “take care he.” Suggestions please Hillary.
Suggestions? It’s too late for you and your father, I’m afraid. He
should have trussed up and his dongel cut off before you were born. Then
we would not have had to put up with your outpourings of lamentable value
and lacking in any brillig thoughts. While I remember, whatever happened
to the champagne and chocolates that you assured me were on their way
three years ago, or was it even longer?
I have been told that my Thai children cannot inherit my estate if I die.
Their mother and I have been together for ten years, but we have never
been married as I have a wife and grown up children back home. What is the
situation as regards my Thai children? With what my friends are telling
me, I am worried that in the event of my dying (I am 66 at present and the
children are 8, 6 and 4) they will be left with nothing. I don’t have
much, but the UK family is all grown up and can take care of themselves.
Have you any guidance, Hillary?
Foot in the Grave
Dear Foot in the Grave,
Take it out! Not yet, Petal. Not yet! There are a few things you have to
do before you clamber in. First, have you made a will in Thailand? If you
have not, then your family in the UK could have certain rights to your
estate, which could out-rank your Thai children’s rights. There’s
nothing like a good funeral to get family members scratching each
other’s eyes out! On both sides of the world. To protect your Thai
children, see an accredited Thai lawyer who will register your will in
English and in Thai. If you really are that close to shuffling off then do
it today! For that matter, do it today anyway - you might get run over by
one of our multitudinous busses. The British embassy can advise you too. I
congratulate you on protecting the welfare and future of your new family.
This is a home decor problem, not a broken heart problem, so perhaps
it’s something different for you. We are looking at buying some
furniture for the bedroom, but when we go to the store and look at what is
there, they tell us that we cannot take the actual wardrobe that we see
there in the shop and want, as it comes in a kit form. I am hopeless at
this construction sort of thing, and my husband not much better. Have you
any answer for us? Or is it DIY lessons out here for everyone?
Barbara the Builder
Dear Barbara the Builder,
You’ve definitely got hold of the wrong end of the screwdriver, Builder
Barbara! Time you went to another furniture shop my Petal. You do not
assemble the furniture yourself, but the agreed price will include
delivery and assembly. If the shop you have been looking in doesn’t
explain this to you properly, then it is time to find one that does not
suggest you buy a full kit of screwdrivers as well. Hillary had some
furniture delivered the other day and they assembled both in under one
hour, cleaned the room afterwards and even took the packing away. I gave
the men a small tip, I was so pleased with what they had done. (Only
small, mind you, as on my salary I can’t even afford chocolates this
week, and champagne is out of the question!).
This is a fairly delicate problem and one that threatens to upset the
entire family. My younger brother is going to come over for a couple of
weeks in December and I just know it will be a disaster. First, every time
he goes anywhere for “just a couple of weeks” he is still there one
month later. He has a pension, so he doesn’t need to work, so that
doesn’t take him away. He also criticizes everything I do and I also
know he will bring women home, which is not the right thing to do in front
of my children. How can I persuade him not to come?
Dear Big Sis,
There are a couple of ways around this problem, Petal. First off, you can
threaten to go away on holidays yourself. After all December is a good
month to visit the rellies. You could always go and stay with him! You can
ask some other friends to come over so there is no room. You can decide to
redecorate and there will be no spare rooms without painters tarpaulins
and ladders. Or you could do what you should have done many years ago -
just say, No! You do say that you have children, so it’s not as if you
are 12 years old. He may be the youngest in the family, but it’s time
you just stood your ground. Do something positive. Time you took charge of
Camera Class: Looking Up, Looking Down
by Harry Flashman
is a great tendency for us all to take very ‘standard’ shots. By
‘standard’, I mean from a very standard viewpoint, so we end up with
standard pictures. For example, when was the last time you took a photo that was
not taken while you were standing and looking through the viewfinder? A long
time, I am sure.
However, when you take a photo from the standard position,
you do get something that is instantly recognizable, because the subject of the
photo is presented as we normally see that subject. We look up to see street
lights, we look down to see children. All sounds boringly obvious. But it is
that ‘normal’ viewpoint that can also make your photographs boring.
I have mentioned before that when taking photographs of
children, you should get down to be at the same level as they are. This way you
will get a much more pleasing photograph of your little bundles of joy. However,
when you are down on your knees you have also produced the situation whereby you
can get some other different shots. These are a baby’s eye viewpoint of the
Looking up at everyone and everything. It is well worth
trying to take some shots of adults, or even the environment of the house. You
will be amazed at just what your infants see! You may also be horrified when you
see the dust under the computer table!
While still in the ‘looking up’ mode, when you look
higher than the ground floor shops, you may find there are some sights well
worth blazing off a couple of frames. Even just washing hanging out can be quite
noteworthy. Just try it. Remember too, that you get a distorted shot when you
tilt the camera towards the sky. Buildings appear to lean over backwards, the
trunks of trees look much more substantial than they really are. It is a kind of
exaggerated perspective effect.
Now ‘looking down’ can probably be even more rewarding,
as this is a viewpoint that you never usually try (other than on children and
lift wells). It also will present you with a kind of ‘helicopter’ view, that
from that aspect alone, makes it very different. Look at the shot used this
week. This was a weekend market and the shot was of a hat stall. You have to
admit that the different viewpoint holds your imagination, more than a standard
shot would have done.
So since helicopters are expensive to hire, you have to start
looking up first, before you can look down, and when you do this you will find
there are many roosts for photographers who are training themselves to look at
life differently. There are over-bridges, there are observation platforms, there
are even hotels and condominiums with ledges and parapets. They are all there
for you to use, after you have looked up to find them.
What lens should you take? This is one of the rare times when
I recommend a zoom lens. From the lofty viewpoint, it is difficult to predict
what focal length you will need, and rather than taking several lenses up to the
platform with you, the zoom can do it all.
There is also the fact that if you go very high up (or even
out of the helicopter), a Skylite 1A filter does help get rid of any altitude
‘haze’, but I would expect that most photographers already have the 1A
permanently screwed on the front of the lens, just as scratch insurance.
It is important that as you develop your artistic eye, you
experiment with different viewpoints. Not all of them will be successful, but
some will be, and the new viewpoint can be the catalyst for some unique art. And
surely that is what many of us are trying to achieve.
I personally believe that by applying some different viewpoints to some
traditional Thai subjects you would produce some excellent wall art that could
even have commercial possibilities. A trip around the local Wat, looking up and
looking down, would be an interesting project for all photographers, from school
age to old age. Try it this weekend (just don’t fall!).
Dogs - Man’s best friend: Scent hounds and related breeds – Breed group #6
The scent hounds were originally bred by the nobility for
hunting large game. They would follow a track, sometimes covering long
distances. The hunters could easily follow the loud barking from the dogs.
Once the game was found they would corner it, making it easier for the
hunter to kill.
A typical scent hound is droop-eared, smooth-coated,
though some are rough-coated, and has a melodious voice. The coat color is
often white with black and brown/red patches or only white with brown/red
patches. For their task they usually need to run long-distances, resulting
in long-legged dogs with agile bodies. Scent hounds usually work in big
when people outside the nobility were also allowed to hunt and the habitat
of large game shrank, fox-hunting and other small game hunting was included,
followed by a selective breeding of smaller-types and short-legged scent
hounds, such as the Beagle and the Basset Hound.
This breed group comprises three sections: Section 1:
Beater hounds, the largest group, tasked to beat down game, until the hunter
is able to shoot it. The breeds vary in size, type of coat and color. Most
breeds are specialized in just one game species in one specific terrain.
Well-known breeds are the Beagle, Basset Hound, Foxhound and the Bloodhound.
Section 2: Tracker hounds, that will follow the blood track of a shot
animal. Examples are the Hanover Hound and Bavarian Mountain Hound. Section
3: Related breeds to which the Dalmatian and the Rhodesian Ridgeback belong.
A scent hound has a huge stamina, and thus, needs lots of
exercise. Their hunting passion and scent abilities are very strong and
there’s a great sense of independence, often resulting in some problems
with obedience (especially the recall) as it rather follows its nose once
outside. Therefore, the sooner the education of this type of dog is started
the better. Most dogs are very social towards humans and their own species.
Inside the house they usually are docile and attached. However, some breeds,
like the Dalmatian and the Rhodesian Ridgeback do sometimes show territorial
dominance - or fear-aggression towards their own people, strangers and/or
other dogs. As real pack dogs they often have trouble staying alone, with
some owners solving this problem by getting their dog a companion. And
although some breeds are favored as pet dogs, even in present times, some of
the scent hound breeds are still hardly suitable for such a life.
For more information on dog-issues, boarding, training or behavior,
please contact LuckyDogs: 09 99 78 146 or [email protected]
Money Matters: Big in Japan
MBMG International Ltd.
One position that did not unfold as we expected last year
was our preference for Japanese equities at the expense of those in the US.
In fact, our preferred Japanese fund manager, Orbis, actually achieved
better base currency returns in their global portfolio through their US
listed shares than their Japanese ones, although that relative
over-performance was somewhat offset by the benefit derived from the
associated exposure to an appreciating yen.
We believe, however, that this is more of a timing issue.
Orbis’s company-specific research continues to conclude that their
Japanese holdings offer prospective long-term returns that are no less
attractive than those in the US but with less risk of permanent loss of
capital. Thus while Japanese shares may struggle to keep pace with strongly
rising global equity markets if there is any continuation of the short term
liquidity boom (which is looking increasingly unlikely) we believe they will
help reduce vulnerability should the global environment for equities become
This is a key component in the way that investments are
evaluated at MBMG - the potential return for each unit of risk. While this
leads to some extremely complex matrices, it provides a focus on earning
superior long-term returns while minimising exposure to the risk of
permanent loss of capital.
Clearly this isn’t always straight forward - one
example that our commodities researchers have highlighted is a number of
opportunities amongst selected South African focused resource companies
(such as the gold and platinum miners) whose earnings and share prices have
been significantly impacted by the persistent strength of the South African
rand versus major international currencies. These companies effectively earn
their revenues in dollars and incur a substantial portion of their costs in
rand. As a result, the earnings of these companies are significantly
positively geared to a weaker domestic currency and several of them can be
acquired on attractive multiples assuming a more normal level of earnings.
While there is a growing consensus within South Africa that the rand is
likely to remain strong or get stronger, we do not share this view and
believe that there is risk of weakness from these levels.
With regard to Japan, two further specific examples of
this theme are detailed below:
Canon Sales, which constitutes our biggest Japanese stock
exposure, is typical of the Japanese shares we find attractive. From a macro
standpoint, shares in Canon Sales, which is the distributor in Japan for its
renowned multinational parent, Canon Inc, are favoured as Canon Sales’
earnings have been hurt by the long-depressed Japanese economy - at least
until very recently.
By contrast, Japanese multinationals have prospered for
many years from buoyant economies outside Japan. Furthermore, the
domestically focused Canon Sales is unaffected by the strengthening yen.
Fujio Mitarai’s appointment as president of Canon Inc
in 1995 subsequently transformed that company’s profitability. At Canon
Sales, we expect President Haruo Murase’s appointment in 1999 to do
likewise, but in this case we believe the improvement in profitability is
only just beginning.
Despite the share price of Canon Sales appreciating 61%
to ฅ1,531 in the 6 months since we first acquired exposure, the share
price only now approximates the underlying tangible net asset value per
share of ฅ1,533.
Canon Sales’ balance sheet is pristine with no less
than ฅ591 per share in cash and cash equivalents net of all debt,
representing 39% of shareholders’ equity. With bank deposits in Japan
yielding zero and 3-year government bonds yielding only 0.24% pa, this 39%
of assets in net cash earns nothing.
Clearly if these excess financial assets were returned to
shareholders, return on the company’s reduced equity would nearly double
in one fell swoop.
A more reasonable expectation, now that confidence is
gradually returning to management in Japan following the traumatic bursting
of the bubble that began in 1990, is a higher dividend payout, redeployment
of excess financial assets into growing operating assets both from internal
growth and through acquisitions, perhaps some buybacks, and no dilution from
new share issues.
Western companies and their shareholders have long
benefited from such soundly implemented “financial engineering”. These
benefits still lie ahead for many cash-rich Japanese companies, including
Canon Sales, with market leaders such as the Toyota Group showing the way.
Management - conservatively we believe – expects a 5%
return on equity in 2004 which translates into a 9% return on the remaining
61% of shareholders’ equity not in cash but actively employed in the
business. We expect earnings growth to exceed expectations as profit margins
are boosted by the transformation of Canon Sales’ important business
solutions division with networked printers, copiers/multifunctional printers
and the shift to colour printing.
A small loss was realized last year with a very small
position shorting Japanese Government Bond (JGB). Although JGBs were the
worst performing of any major government bonds globally in 2004, both
Japanese long-term and short-term borrowing costs have remained lower for
longer than had been expected. In order for short JGB futures position to
provide a positive return, Japanese interest rates must rise (causing a drop
in bond prices) by a greater amount than the market had expected.
Despite the lacklustre performance of this small position
last year, we continue to hold the short JGB futures position because of our
conviction that the yields on JGBs are too low in relation to prospective
economic activity and perceived future inflation.
One reason why the JGB yields have not risen in line with
stronger economic activity is the program of continued JGB repurchases by
Japan’s central bank, which pumps cash into the system and supports the
JGB prices, in the hopes of further stimulating economic activity through
increased money supply.
The current policy stance of the Bank of Japan (BOJ) is to continue
buying back JGBs until a neutral or inflationary environment prevails.
Inflation in Japan had been negative for some years, but has been running
just shy of zero for some time now. In our opinion, the BOJ’s repurchase
program in the face of continued signs of underlying economic growth only
prolongs the eventual adjustments in bond yields needed for the new higher
levels of economic growth and inflation expectations. It should also further
increase the likelihood and magnitude of an eventual interest rate move that
will ultimately benefit the short JGB position.
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
Life in the Laugh Lane: The Agony and No Ecstasy
by Scott Jones
own two big bikes. “Big” means “Been In Garage” eight months for
repairs. A riding addict, I’m now at the mercy of rental companies. They keep
my passport while I spend excessive amounts of cash and never know if the bike
will run. (Hmm. Having my own bikes is exactly the same, except I get to keep
my passport.) Before this bike trip I rent a Super Four, fill it with petrol,
go to bed at 8 p.m., rise at dawn for yoga and final preparations for an uphill
ride through northern Thai mountains. By 7:30 a.m., the day goes downhill.
A good friend needs a jumpstart for his dead bike. I arrive
at 8, but he’s in another time zone, having a sandwich and beer for
breakfast. Conversation, jumping and a couple of errands sets departure time at
the crack of 11. I’m way behind and haven’t started yet. My last task is to
fetch my scarf hanging in a tree. As I grab it, the stinging begins. I see a
red ant and brush my body with the scarf. The stinging persists and my riding
mate (who is absolutely terrified of snakes but we’ll get to that later)
searches under my shirt for more ants. None. Okay, fine, I’m hot, sweaty and
in agony. “Let’s ride. I’ll cool off and feel better.” Not.
30-some miles out of Chiang Mai in some miscellaneous
jungle, the engine stops. As I try to start the bike with every combination of
choke, throttle, tick-over, push-start and swear word I know, my partner
scratches, itches and breaks out in a painful rash, the same one that now
covers my neck, back and arms and has turned my skin into a mountain range of
burning welts. Did the ants spawn vicious babies under my skin? Did I touch
some lethal Thai poison ivy? Is last night’s Fire Curry seeping out of my
pores as poison? The sun is melting the asphalt highway and our hair. The
itching blisters are reproducing. We’re out of water. As my friend screams on
the mobile phone at the rental staff who keep repeating “Gas? You get gas?
You have gas?” and have lost the ability to understand Thai or English, we
hear a substantial ‘thunk’ next to the bike. My mind assumes “palm branch
hit the ground”, but my eyes say “five-foot snake just landed on the
road.” My friend’s screams move up one octave. Personally I’m not afraid
of a snake clumsy enough to fall out of a tree. Even if it did try to jump us,
it missed by two meters. It probably broke a few ribs, but having 300, he
slimps (contraction of slither and limp) into the ditch.
At the stroke of two, just before a sun stroke, friends
arrive and start the bike immediately, making me feel like spit (Stupidest
Person In Thailand). The Rental Nazi finally brings another bike after scouring
northern Thailand looking for the exact mileage marker on the exact road we
gave him. Original schedule scrapped, we scratch our way to Malee’s Nature
Lovers Bungalows in Chiang Dao and learn about our disease: “Caterpillar
hairs, like my son get, itch all over. Take medicine.” Great. Not only did I
contact major caterpillar hairs, I beat them into my skin with a scarf and then
infected my mate.
I trade in the bike for a chicken. It wakes me in the morning, eats
caterpillars and snakes for fuel, and I can eat it when I’m done riding. If I
ever get back to America, I’m going to sell caterpillar hairs to the