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The Doctor's Consultation

Agony Column

Camera Class by Snapshot

Money Matters

Your Health & Happiness

The Doctor's Consultation:  by Dr. Iain Corness

A bloody pain in the bottom

Do you have rectal pain and bleeding? That’s what I meant when I wrote “a bloody pain in the bottom”. Embarrassing yes, but it’s usually a minor problem known as “piles”.
Piles are one of the most common ailments around. Embarrassing and very often a pain in the bottom, to use the very apt phrase! The medical term for piles is hemorrhoids (hemorrhoids if you come from the left hand side of the Atlantic), which shows why we don’t commonly use that name - too long and too hard to spell! I have often said that the reason that the medical course is six years is that it takes five years to learn how to spell the long words, but then, I’m joking of course.
So just what are piles and do you get them from sitting on wet grass, as the old wives will tell you? Let’s deal with the grass first. You do not get piles from sitting on anything, be it grass, newly mown or otherwise. End of the grass story. Piles are simply ‘varicose veins’ of the anus. You see, around the edge of the anus there is a very rich plexus of arteries and veins and it is possible for the veins to become distended and eventually form a grape-like structure that can even protrude from the anus itself. This is what is known as a classical “pile”.
The biggest problem with hemorrhoids is acute bleeding. Embarrassing as mentioned before, but can actually be such as to run you out of iron and you end up anemic. Other symptoms include local soiling and discomfort. You can also get a thrombosis in one of these protruding piles that can be very painful indeed. Ask anyone who has ever had one (or two).
There are lots of theories as to why we get hemorrhoids. Many women feel that they are the result of pregnancy or straining during childbirth, but since men get them as well that would appear to shoot that theory down in flames. Both sexes can get piles. A lack of dietary fiber has also been given the nod as a cause, but personally I am not convinced, as many people with great fiber diets still get piles. Constipation and straining at toilet does appear to have a bearing (bearing down?), but I honestly feel that the real reason relates very simply to our stage of development in the history of mankind.
My theory (Darwinian, I admit) is as follows - we used to walk on all fours, like all the other quadrupeds. Look at our first cousins, the monkeys, and they are still wandering around with knuckles in the dirt (and I have met some people that still do this), but many moons ago after seeing our reflections, we decided we looked better standing on our hind legs, so we learned to walk erect. This was fine, other than the fact that the valves in the veins in our legs and ano-rectal region were not up to the additional pressure the column of blood was exerting from the heart, now a meter or so higher than the valves. Straight out hydrodynamics.
Fortunately piles are relatively easy to fix, and the common rubber-banding technique will be successful for most. The only real danger in this condition is in ignoring the bleeding, thinking “It’s only piles.” As mentioned before, this bleeding can lead to anemia, but the biggest problem can be the fact that rectal bleeding might just be a symptom of something more sinister, such as cancer, and not hemorrhoids, and it is possible to have both complaints at the same time.
The answer is to never ignore bleeding (from any cause) and get your doctor to check. It may be embarrassing - but it could save your life.


Heart to Heart  with Hillary

Dear Hillary,
Could all this fat belly dancers gentlemen understand one day, how love between young and beautiful girl work? First try to figure out you 60 years old falling in love with a 90 years old woman, is it possible? It’s the same for a 20 years girl to fall in love with you. For the girl you are only a sponsor. You put money on the girl and you got back something, sometimes there is more than one sponsor and every one get a part of the lady and maybe she might find a richer sponsor and let you down that’s the way is life.
‘Ercule Poirot
‘Ercule!
How lucky am I? Getting a famous French detective to come and unravel the great mysteries of life in Thailand. Unbelievable! But ‘Ercule, mon ami, you just might ‘ave made ze little supposition that may not be zo correct, Cher Petal! Zere are men who ‘ave loved women much older zan zey are. Zere are women who ‘ave loved men much older zan zey are too. Ze big difference iz ze magic ingredient called “love”. Love overcomes all barriers, but zere is a difference between “love” and ze financial arrangements. By ze way, ‘Ercule, I seem to have lost my gold pen. Did ze maid take it?
Dear Hillary,
Everybody must know by now if they read your column that there is a difference between the girls who work in the bar and the girls who work in regular jobs. What you say is for us to look for female company from the regular job girls. What you don’t say is that the regular jobby ones can’t speak English, are difficult to meet or get to know, while the ones who work from the bars can speak English and are easy to meet and are easy to get to know. For my money, give me the bar girl every time.
Francis
Dear Francis,
How astute of you, my Petal! Yes, there are great differences, and even more than the ones you mention, even such things as educational level. If all you are looking for is some female company, then the bar is the right place, but the problem comes when the customer (guys like you) then falls in love with their English speaking, easy to meet and know girl. Thai girls do not choose to work out of a bar unless they are looking for quick money, without having any necessary qualifications to put them in high salary jobs. They are using their looks, their (presumed) sexuality and their ability to get money from their customers. ‘Ercule in the letter above yours calls it ‘sponsorship’, and he is really quite correct. You are paying for a commodity by meeting the sponsorship fees demanded. When you fall in love with someone who is used to being fully sponsored, the relationship is not really on the emotional plane, but in the financial one. And like all business deals, you can get burned. And many like you do. As you wrote “For my money, give me the bar girl every time.” And that’s what it is, Petal, your money and you are entitled to spend it any way you please, but don’t complain if you find it has all gone, and the girl’s “affections” with it.
Dear Hillary,
I have a somewhat delicate problem, so you will forgive me if I do not sign this fax to you. I am a single man, working in the Sand Box and I come here regularly for many weeks at a time. On these trips here I generally find that there will be a young lady who indicates that she would like to take care of me, and a suitable arrangement can be entered into. This is great for a bachelor like me, but I also want to play the field a bit too. One young lady has really begun to sink the hooks into me, and I can see a problem coming up, because I own my own condo here. How do I get her to understand that this is not a lifetime relationship, and when I go back to work I will want her to leave the condo? I have four weeks left, Hillary, so a quick fix will be appreciated.
Sand Box Sam
Dear Sand Box Sam,
I think you have just found out that you can’t have your cake and eat it too! The way around this problem is to bring it out into view and it will cease to be such a worry for you. Since Hillary doesn’t know how good your Thai is, it may be better for you to have an interpreter, as it is important the young lady understands the situation. And understands it right now, not two days before you leave. She has been taking care of you, so now you must take a little care of her and her feelings. Now is the time to spell it all out, my Petal. Your problem is one that Francis (see above) will also have to face if he continues in his current way of life.


Camera Class:  by Harry Flashman

Break the portrait rules

This week it is back to people photography - the kind of snaps that most people take most of the time. There is really no secret in taking good portraits and this column has been over the “rules” many times. Here we go again, try to ensure that your lighting is coming from above and slightly off to the side, use a long lens (around 135 mm is ideal) and look out for distracting backgrounds (see all my previous columns on backgrounds). If you can, use a wide f stop (around f 4 is good) and get the subject to turn his or her head slightly, while you move around them, snapping away as the facial expression changes. You will get a good shot doing just that. But it will be a ‘good’ shot, not a ‘brilliant’ shot.
Here’s how. Sometimes you can get a brilliant shot, just by breaking the “rules”. Take a look at this week’s photographs. Portraits with plenty of punch, plenty of personality and a sense of immediacy. Long lens? No! Lighting off to the side and from above? No! Attention to the background? No! Yet these are good portraits and all the rules have been broken. So what or who do you believe?
Well, the first thing is to look again at the photographs. These shots get their immediacy from the activity in the shot. One man is half way through a large baguette, and has obviously been interrupted during eating. In fact, in mid munch. The second shot has violinist looking directly at the photographer, while obviously in the middle of a number. Neither of these being great “portraits” but both have that immediacy and action, making the shot come alive.
Now you could get these shots with the long lens, but by using one, you would stop the interaction between the subject and the photographer, being so far away while you take the shot. By using a wide angle lens, in this case a 24 mm, the subject was surprised by the photographer with the closeness. The subjects could not escape. They were caught by the photographer, like rabbits in front of the headlights of a car. It is not stretching your credulity to say that both photographs show that startled look of, “Where did you just bob up from?”
Now the lighting. While the “ideal” is the light coming from above at 45 degrees and slightly from the side, both these shots were taken with a flash mounted on the camera. Nothing fancy in any way. To have tried to set up the “ideal” lighting would have meant that the subject became a knowing part of the photograph. Immediacy? None! Surprise? Gone!
The moral of all this is simple. If you want “dynamic action” portraits, break all the rules of classical portraiture. You are really now in the realms of photo-journalism. This is the walk up close, “in-your-face”, paparazzi style of photography. You may, of course, get an earful of abuse from some subjects, but you have to be brave and brazen it all out. After all, look at the shot you may get.
Please note, however, that there is one rule that was not broken - and that was to make the subject the “hero” and the dominant part of the photograph. The subjects in these photographs fill the frame, and with the wide angle lens that did mean walking in close. Real close! Try getting in close this weekend. With the camera!


Money Matters:  Graham Macdonald MBMG International Ltd.

Art for art’s sake or your wallet?

An interesting study of alternative investments in the second issue of Opalesque A Squared looked at a couple of investments that, even with our open-mindedness, we haven’t yet taken any exposure to - Fine Art and antique violins.
The claim is that “good quality art work” that comes from good or great artists and can often be acquired at a price that lends itself to an appreciation at times of as much as 40% in a year or 100% within three years. In general, in the art market, there does seem to be a correlation to economics in that in boom times art prices increase and at others they can fall. There now exist art indices - these serve as a good guide and provide an overview of the market, but these, per se, do not imply a compelling case for art as an investment class. Whether, at a micro level, asset selection can generate significant out performance is the key question here - i.e., is the art market so inefficient in its pricing that a smart art investor can consistently outsmart the market and accumulate consistent gains through well considered trades rather than just relying on an asset class that is ultimately correlated to economic fundamentals?
One potential source of alpha is the ability to source art through distressed sales. The correlations also vary from one art category to another - contemporary art exhibits the closest correlation to boom & bust cycles. There are 70 different categories - investing in “The Old Masters” has the least correlation to equities as it tends to be driven by collectors and museums that are willing to pick up the price tag even during economic downturns.
Similarities between the art and the specialist antique market are obvious. Antique stringed instruments are every bit as unique and irreplaceable items. The potential returns offered are virtually uncorrelated with any other asset class, hold steady over as great works of art. The proponents of investing in antique violins assert that the risks of doing so are low and inexpensive to hedge. Correlations exist amongst the various makers, age and condition of string instruments. As with old masters, the “antique value” of a rare collectable is partially quantifiable - even at times when demand falls there are never enough old Italian high end instruments around. Similarly a speculative value, like that with contemporary art, surrounds less known makers from this century - instruments dating back to the 1920s have already experienced this - some investors believe that there is a compelling case to “buy and hold” less familiar makers from the 1930s to 1960s until they also start to appreciate.
There are certain principles and factors used by professional art and antique instrument investors - invest in a great work by a second rate artist than a poor work by one of the greatest artists.
Have the means to acquire a diversified portfolio of high quality art (ideally private investors should have at least USD 5-10,000,000 available for allocation into their fine art holdings within their overall investment portfolios). Smaller sums such as USD 100,000 could finance the acquisition of one good painting but commensurately rolls up the risk as there is no diversification. Specialist art funds generally require minima of at least USD 250,000. For lower budgets, a minimum of USD 30,000 could be sufficient to start to invest into antique string instruments, which can also be acquired through syndicates or participation in an investment trust. Specialists can structure syndicates as investment vehicles to support and fund the acquisition of music instruments.
Targeted returns from art tend to be stated as between 10-15% annually compounded over a span of 3 - 7 years. With investments in contemporary art - returns can be between 20% and 100% in a year. Since launch in 2004, the Fine Art Fund has achieved an annual return of 58%. Over the past 50 years, investment into string instruments is claimed to have returned an average of 8-15% annually.
Investors in art should be prepared to ride out the vicissitudes of fashion as well as economics, and the minimum holding period should be at least 3 to 10 years.
For private investors the spread between buy & sell price can be as high as 30% per transaction, making it extremely difficult to generate net returns in the short to medium term - for institutional investors this can be reduced to 5% or less.
Many art funds have failed to assemble and maintain a team of good and independent experts. One fund claims that, “There are 50 sought after experts, of which we have 8. It is rather difficult to get more than a few of them to work together.” Adequate critical mass is, for want of a better word, critical. According to one leading art fund manager, the art market is not going through a bubble. Although he states that, “some of the top 200 artists have peaked ... there are thousands of artists out there.” Gerhard Richter, Sigmar Polke and Georg Baselitz are all popular at the moment at a good price.
There is an element of self-fulfilling investment due to the relatively small size of the art market - with an estimated amount of USD30bn invested in art, institutional investors making allocations of USD 1.5bn have the capacity to directly influence the market. The market for fine instruments is similar - presently valued at approximately USD22 billion, but, surprisingly perhaps, growing as instruments made by newer makers have become more prominent.
Art critiques can affect prices to some extent - therefore it’s vital to be in tune with the more influential museum curators and art dealers. The market is certainly open to anyone with an interest in diversifying their portfolio. All of which is very interesting but hasn’t yet appeared on the MBMG ‘buy’ radar.

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 Graham Macdonald on [email protected]


Your Health & Happiness:

Thailand saves 1 billion Baht annually in low-cost medications

Thai Public Health Ministry’s decision to issue compulsory licenses for two HIV-AIDS pharmaceutical treatments and a heart disease drug is able to help low-income patients to gain access to quality drugs, while the national economy is able to benefit by more than Bt1 billion yearly in savings from imports, a senior ministry official said.
Dr. Sanguan Nitayarumphong, secretary general of the National Health Security Office (NHSO), said compulsory licenses for the heart disease drug Plavix, made by Bristol-Myers Squibb and Sanofi-Aventis, and Abbott Laboratories’ Kaletra to treat HIV/AIDS, both issued by the ministry in January, and another drug for treating HIV-AIDS, Efavirenz, manufactured by Merck and which was given a mandatory license in Thailand last November, could help save Thailand in foreign exchange of not less than Bt1 billion annually.
Most importantly, it allows poor people suffering from these diseases to have access to the medicines as they are now becoming less expensive and hence have a better quality of life, said Dr. Sanguan.
For example, the price of Efavirenz is cheaper by about half the cost of the imported pharmaceutical, while Kaletra is about 40 per cent cheaper and could as a result now treat some 12,000 patients this year, up from 8,000 patients estimated earlier, he said.
In addition, the price of Plavix is about six times cheaper than the imported, patented drug.
The compulsory licenses which Thai health officials said earlier would spare the country from significant foreign exchange costs drew praise from AIDS activists but flak from the United States government and the drug industry, which are urging the ministry to rescind them.
The three foreign pharmaceutical companies complained they were caught by surprise as the government overruled their patent rights without prior consultation or negotiation – a point strongly denied by public health officials who claimed they have held repeated talks with the patent holders over pricing, but without real progress.
In contrast, the compulsory licensing in November has allowed the state-owned Government Pharmaceutical Organization to build up stocks of imported generic versions of AIDS medication Efavirenz – about 16,000 bottles so far. (TNA)