The Doctor's Consultation:
by Dr. Iain Corness
We’ll just run a few tests...
One of the common questions
that doctors get asked, after a patient has had a blood test, is “What was
my blood group?” or even, “How was my AIDS test?” It may come as a surprise,
but neither blood groups or HIV testing are really ‘routine’ examinations
(though there several good reasons why they should be).
The tests we order are designed to assist the treating doctor work out the
“Definitive” diagnosis from the initial or “provisional” diagnosis.
Unhappily for the doctor and the patient, this can sometimes be a complex
and expensive net-throwing detective story.
Take someone who presents with unexplained bleeding. Haemophilia? Sure, it
might be - Factor VIII, Factor XI, Factor XII or even Factor XIII.
Unfortunately the cause might also be from metastatic carcinoma, drug
ingestion, poisons, kidney failure, systemic lupus erythematosis, von
Willebrand’s disease or even something called the Bernard Soulier Syndrome,
about which I could write all I know on the back of a matchbox and still
leave room for the national anthem (long version and hand written).
Tests are ‘tailored’ to identify, or exclude, the diseases that the doctor
feels are ‘possibles’ after the initial clinical impression. If the ‘most
likely’ causes turn up negative in the initial batch of tests, then the
doctor has to rack his or her brains a little more and start going into the
‘less likely’ ailments and testing for those. This is why you may need more
than one round of tests to come up with the definitive diagnosis. And then
after that you will need repeats of the tests to see if you are in fact
Another poorly understood concept is that of the “Normal Range”. Just how or
from where do we get this “Normal Range”? Actually it is relatively simple.
We examine the blood of 1,000 people, take off the bottom 25 low results and
the top 25 high results, and we keep the 95 percent in the middle. That now
gives you the Normal Range, but this does not mean that it is the “healthy”
range, as we could be sampling 1,000 people with high levels of something!
Take Cholesterol as an example. If you live in a Western community that has
a diet high in Cholesterol, the majority (the 95 percent in the middle) will
have higher levels than a similar community living in the East that has a
diet low in saturated fats. So the “Normal Range” can be different between
communities (and even between laboratories). So what may be considered
within the guidelines for one group may be outside the 95 percentile limits
for another. So if you just “scraped in” under the top level for the Normal
range, I wouldn’t be too complacent about it!
The “recommended” levels may also not follow the “normal range”. Cholesterol
is a classic example. The cardiologists have been progressively lowering the
“recommended” range over the past 30 years, and to keep your cardiologist
happy, you should aim for the low end of the so-called “normal range”!
However blood testing has even more traps for young players. If the
tourniquet is left on too long while taking the blood, the Cholesterol can
be falsely raised by up to 20 percent! If the sample is too small, the
Potassium will appear to be elevated when it is not. Samples kept too long
in the fridge can also be inaccurate as far as blood sugar is concerned.
Some medications, including the (so-called) health store ‘natural’
medications can also affect the tests, giving false positive or negative
No, interpretation of tests is a veritable minefield out there - that’s why
we have specialist Pathologists to lead us through that minefield! Now
getting back to your blood group - if you want to know you will have to ask
the doctor to add it in - or even better, go and donate blood and they will
tell you what you are.
Heart to Heart
I can but quote Ensign Bluebottle after your most recent outburst!
“Arrggghhhh!!! You dirty rotten swine!!! You have deaded me!!!” Never
mind, I shall enter the next life as an Egyptian embalmer and get stuck
in to winding up Mummies and Aunties for a living!
So you want to be an Egyptian embalmer. You do have some rather strange
tastes, Mistersingha. Or persuasions. I don’t believe they mummify
corpses any more, Petal. I think you might have left your run a little
late. And if I have indeed “deaded” you, there is a legion of people
applauding and wondering why I didn’t “deaded” you years ago. However,
like so many others, I am sure, I was too gullible and believed your
utterances. The promised chocolates and champagne which never
eventuated. Empty promises. Please don’t tell me your obituary is
another one of them! Goodbye Mistersingha
Thailand is the Land of Smiles; to travel agents. In Thailand it is the
Land of the Fish and Snake. I was amused by your marriage proposal and
it raised once again the question. Are you a man or a woman? Thai or
farang? One of more entertaining aspects of your column.
My guess (it is a guess mind you) is you are a post-middle-age Western
guy. Your English is waaaaay to good for you to be Thai. I know many
Western-educated Thai people, some Harvard PhDs, and they don’t come
close. Any Thai person who could quote Tom Lehrer the likes of wouldn’t
be writing a lonely-hearts column in the Chiangmai Mail. Its (sic) also
pretty rare that I meet a Thai person who likes chocolate very much…much
So you are a Western man or woman. mmmm..? Its unlikely that a Western
woman would be as familiar with the whiles (sic) and ways of Thai
bar-girls, and their intimate goings-ons as much as you seem to be. Only
someone with such experience among them, and a lot of conversation with
others similarly experienced, would be. Men would be unlikely to share
such experiences with a farang woman. But at the bar “bending an elbow”,
playing golf…they might, with a guy.
You have the sense of humor of a man and some of the slang you use I
never hear from the mouth of a well-spoken Western woman…and you are
In addition, no farang woman I know would want to save lecherous farang
men (am I being too kind?) from being robbed and/or destroyed by young
beautiful ladies of night whom they pay in betrayal of their native
women. Most farang woman I know, who don’t ignore it, are at least
dubious (if not downright resentful) about the whole Thai-girl thing.
I’d be really surprised if you are woman.
You are however not old enough to be “retired”, at least in your mind.
So its unlikely you are in your 60s or older. You could be much younger
but you’ve revealed fragments of “your time” now and again. I’d say you
are late 40s early 50s, probably UK/Dominion.
My question is. How do I get a job like yours?
Please protect my anonymity as I, like you, value it highly.
Dear Tumworth Mugglethump,
Aren’t you a right little Hercule Poirot, then. (Does that mean I’m
French, I wonder?) But no, you have decided I must be from the
UK/Dominion. The Dominion? How long is it since that existed, my Petal?
How old are you? You also seem to lose your thread a bit where one
minute I am accused of using slang that no well-spoken woman would use,
yet the next minute you say I am well spoken. Make up your mind,
Tuggworth (sorry, Tumworth)!
Of course I am equally as interested in you, wishing to protect your
anonymity, which you value so highly. Why, Molesworth (sorry
Mugglethump)? What have you got to hide? After all, you have already
admitted that you want my job, but haven’t got one. Do you have some
dark and secret criminal background? On the run from Interpol perhaps?
Or even worse, are you here on overstays?
So where do you come from? Your English isn’t bad, but you do tend to
leave off apostrophes when you shouldn’t, and mix up “wiles” and
“whiles”. This would make me think that you do not write as much as you
speak. Perhaps you’re the elbow bender at the local bar? Am I getting
close, Petunia? So that would make you English, rather than Dominion
(that fair cracks me up), and probably well into the 60 plus bracket.
But you could also be American. The word “guys” I do not hear much from
British respondents. And you are very wrong when you say that men would
not share their experiences with farang women, but they do with other
guys at the bar. The people who write in are sharing their experiences
with the world, not just Auntie Hillary.
By the way, it was not “my” marriage proposal. It was that dear man’s
proposal to me! Please try to be more correct in future. And also
present your findings in a more appropriate manner (attached to a bottle
of bubbly would be better).
Camera Class: by
Camera – Analyze – Action!
a look at the photo with this week’s column. It is one of the
best “action” shots I have seen for some time. This is a very
professional shot, but one that you could take yourself. But
first you must develop the critical eye.
Look critically at the photo – the blurred background, slight
blurring of the cyclist’s legs to show movement there, crisp
sharp subject with everything else out of focus and lighting to
show the mountain bike to best advantage. You can practically
“hear” the whoosh as the cyclist whizzes past you on the dirt
trail. So how did this photographer manage to do all this?
Again it helps if you look critically and analyze the shot.
Let’s take the background first. You produce this by moving the
camera as you take the shot. This is called “panning” and has
been covered in this column before. Between 1/15th and 1/30th of
a second was probably the exposure time used as the photographer
swung the camera at the same speed as the cyclist. This slow
shutter speed will also allow the slight movement to be seen in
the cyclist’s legs.
Now look at the focus. Sharp, sharp, sharp! This is not the kind
of focus you can get “on the run” so to speak. This is achieved
by pre-focussing. The photographer would have had the cyclist do
the runs several times so that there was a track to follow, then
focussed on the position on the track and, Hey Presto! Correct
Now the lighting for this photograph. Look carefully and you
will see that there are two sources of lighting for this shot.
Yes, two. One is the great lighting technician in the sky,
directly overhead and the other is side on about 45 degrees to
the front. Look at the flare on the front brake and you’ll see
what I mean.
That second source of lighting is from a flash mounted off
camera to the left. It would have been mounted on a tripod and
its output would have been matched to the ambient lighting from
the celestial sunlight. Probably about one stop less than
ambient would be a good guess. You can also say that with the
light overhead, the shot was taken around the middle of the day.
But there is even more that you can deduce from critically
looking at this photograph. Note that the front wheel looks much
larger than the rear. If this were taken by a long lens, the
further away wheel would begin to look larger. With the slight
exaggeration and bias towards the front, this was taken with a
wide angle lens. Probably only about 35 mm, though a 28 mm one
could also fit. Since nothing other than the bike is in focus,
the photographer would have used a short depth of field. This is
produced by using a large aperture and being very close to the
subject. Here the photographer probably chose an f stop around
5.6 to 4.
So by critically looking at one photograph we have deduced the
likely shutter speed, aperture, source of light, lens used and
even time of day. So what does that do for us? A lot! It means
that you can use all these tricks of the trade when you want to
produce a similar “action” packed shot. Just remember that the
photographer did not just take one exposure and went and drank
beer for the rest of the day to congratulate himself on being
such a fine photographer. That photographer would have spent at
least two hours in just setting up that shot and then another
hours worth of shooting. Probably around 100 shots were taken
and the best shot selected using a magnifying glass.
Good shots don’t happen – they are made! Go and make some
yourself this weekend.
Money Matters: Graham
Macdonald MBMG International Ltd.
Portfolio Construction - Part 4
In addition to the intelligent scepticism of Stephen
Roach, JP Morgan seems rather more open-minded than many other US investment
houses right now. They think it is too soon to call the end of the recent
correction. It bothers them that the volumes are higher on down days then
they are on up days. Moreover, volatility levels have moved back towards
previous lows. Technically, global equities are at critical turning points
and it is possible there could be further moves down.
This is in direct comparison to the folks at BlackRock Merrill Lynch who
recently published “The case for investing in equities”. Their view of
economic history in this document dates all the way back to ... 1982. Try to
imagine a view of world history that begins with Reagan and Thatcher and
fails to recognise anything at all prior to that. Our first inclination is
to feel sorry for them and our second is to feel sorry for their clients.
This myopic attitude continues when they then move to discuss asset classes.
For them it would appear that asset allocation is entirely driven by
deciding which S&P sector to allocate to. They consider the following:
Consumer Discretionary, Consumer Staples, Energy, Financials, Healthcare,
Industrials, Information Technology, Materials, Telecommunication Services
In fact they discuss the relative merits of all investable asset classes and
their understanding of these is limited to: International Equities and then
US Fixed Income, US Equities Large Cap Core, US Equities Large Cap Growth,
US Equities Large Cap Value, US Equities Mid Cap Core, US Equities Mid Cap
Growth, US Equities Mid Cap Value, US Equities Small Cap Core, US Equities
Small Cap Growth, US Equities Small Cap Value.
So, according to BlackRock Merrill Lynch there are 11 asset classes but 9 of
these comprise different kinds of US equities, only one (International
Equities) has any global exposure and only one (US Fixed Income) has any
non-equity exposure. Now, we know that BlackRock Merrill Lynch is better
than this but it does make you wonder about how biased their reporting is.
What conclusions can you draw from this? Your portfolio allocation needs to
be done by someone who understands the full range of asset classes - we’re
happy to take advantage of BlackRock Merrill Lynch’s speciality in managing
specific sectors from time to time because we recognise that this is a very
different job to portfolio allocation. Horses for courses! If you want to
restrict your asset allocation to less than 10% of available global
investable assets don’t be surprised if the results are very volatile and
the performance is poor. Choose an active multi-asset allocation specialist
or face the consequences! There can be clear and specific dangers of what we
tend to view as the complacency of the equity-infatuated, especially with
their ability to attempt to justify the unjustifiable. Construct a
sufficiently contrived way of looking at data and you can argue that black
is white or rather that expensive is cheap.
An interesting article in the FT recently looked to challenge the virtually
consensus view that you have to buy equities right now because they’re
considered to be cheap. The basis of what it said is that markets look
expensive when using trend earnings. They also went on to say that earnings
have been above trend for so long now that they have to start to go below
London-based Smithers & Co have analysed the actual and the cyclically
adjusted price-earnings ratio of the Standard & Poor’s composite index since
1881. The cyclically adjusted measure follows the method of Professor Robert
Shiller of Yale University: it is the ratio of stock prices to the moving
average of the previous 10 years’ earnings, deflated by the consumer price
index. This shows that the actual P/E ratio is now very close to its
long-run mean of just over 15.
The most recent cyclically adjusted P/E ratio, however, is 26.5, or about
two-thirds above its long-run average. It is not quite as astronomically
high as in 2000, but it is very high, by historical standards. The US and,
indeed, most of the world, has experienced a massive upswing in corporate
earnings. What emerges from this research is the undoubted cyclicality of
earnings. What can also be seen is the scale of the recent surge: in real
terms earnings rose by 192 percent between March 2002 and December 2006
(real earnings also rose by 170 percent between December 1991 and September
2000, before collapsing in the ensuing months: in March 2002 real earnings
of the companies in the index were only 19 percent higher than at the
previous trough, over a decade before).
The bottom line is that it is always a mistake to confuse a cycle with a
trend. In the case of corporate earnings, it is worse than a mistake, it is
a huge blunder. The intense cyclicality of corporate earnings is the most
important reason why the unadjusted P/E ratio is a worthless indicator of
value. The question one has to ask is whether somehow this time will be
different and they will be sustained or fall back again, as they have done
in the past.
To be continued…
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]
Life in Chiang Mai:
by Mark Whitman
Don’t you just hate people who say, “I told you so.” Just
this once, the reviews and the scalpels have been out for la Streisand, who
filled the vast new 02 arena in London last week and managed to give what
was generally regarded as less than value for the seat prices that ranged
from 75 to over 500 pounds each. The Guardian newspaper critic went so far
as to use the term fleeced (of the audience that is) and commented that if
she ‘had laid on the schmaltz any thicker she’d be using a trowel’.
The main commentary was because of short shrift, a few songs, masses of chat
and then a departure in favor of a quartet of male tenors, only to be
followed by a question and answer session during what was announced as her
last tour. Who said every cloud has a silver lining?
The program for the current Bangkok Film Festival looks a bit thin,
certainly in respect of movies from the west, although there are a couple of
great works from the past such as Bunuel’s Diary of a Chambermaid (which was
also filmed by Jean Renoir) and Tristana, also by Bunuel and more typical of
his output. The program is much heavier on films from Thailand, Malaysia,
the Philippines and other points east, all of which are easier to come by
and less expensive to import – an important aspect for festivals which are
often strapped for cash.
How nice it would be if a few of the films on until the end of the month
could find their way up to Chiang Mai, especially those with Thai and
English subtitles. There are few French films which the Alliance Francaise
might be able to screen and a couple of British works, including the
controversial “This is England” (not very good admittedly but welcome up in
film starved Chiang Mai). No chance of the British Council arranging
screenings, I suppose, no I thought not. I guess we’ll just have to wait for
the EU film festival, which travels from the capital to the north, usually
All quiet on the Manchester City football front as Mr. Thaksin seems to have
parted with a reputed 70 million pounds for that English football team. A
question that occurs to me in the unlikely event of ever having that amount
of money or even a great deal more… Why would one choose to spend it on a
football team? It is a little odd that we do not hear more about Thailand in
Britain’s newspapers, even in such papers as The Independent and The
Guardian. There was a scurry of attention last week when the baht reached a
ten year high against the dollar but little notice paid to current politics.
Only football and a possible scandal seem to warrant attention.
Let's Go To The Movies:
Ratatouille: US Animation – From all indications this is
amazing creation about a chef rat that pleases just about everybody. Don’t
miss it. Word is it’s a nearly flawless piece of popular art, providing the
kind of deep, transporting pleasure, at once simple and sophisticated, that
movies at their best have always promised. Reviews: Universal acclaim.
Harry Potter and the Order of the Phoenix: US Adventure/Fantasy – A sleek
and exciting movie. Each film in the series seems to get darker – this one
begins like a horror movie, and proceeds as a tense and twisty political
There are many wonderful performances, effects, and details in the film –
marvels for the eye and ear. Nevertheless, I find the actions and themes in
this series to be about as understandable as the Book of Revelation. And it
is not helped by the youngsters’ poor enunciation and their tendency to
blurt out whole paragraphs in a single unclear utterance. But that’s only
the surface of the mysterious and confusing incomprehensibility of the
Potter world. Really, do these books and their film adaptations require
life-long study, like the Bible or Proust?
Grind House: Death Proof: US Horror/Thriller. From directors Quentin
Tarantino and Robert Rodriguez comes a double-bill of thrillers that will
recall both filmmakers’ previous exploitation films. “Grind House” will be
presented as one full-length feature comprised of two individual films
created separately by each director. Tarantino’s film, Death Proof, is a
slasher flick where the killer pursues his victims with a car rather than a
knife, while Rodriguez’s film explores an alien world eerily familiar to
ours in Planet Terror. If you’re the sort that likes Tarantino and
Rodriguez, then I guess these are just right for you.
Transformers: US Action/Sci-Fi – A gigantic, spectacular, and funny summer
blockbuster, with truly exceptional and unprecedented visual effects.
It’s interesting to me how similar in some ways this movie is to Die Hard.
Both of them show off the incompetence of the government (any government, I
guess). It seems government agencies simply can’t do anything right, and one
is perfectly justified in being very suspicious of anything they say or do.
It’s a fun movie, but quite noisy.
Die Hard 4.0: US Action/Adventure/Thriller – A fascinating story of a
conspiracy to take down the entire computer network that holds the US
together. It’s very frightening stuff.
Still one of the most entertaining movies around, all in all. Very exciting,
good dialogue, good action and provocative themes. Bruce Willis was born to
play the role of police detective John McClane, now in his fourth outing,
and he seems to be enjoying himself more than he has in years. He’s just the
man for this movie.
The old school approach to stunt work relied on in this film seems to me
very much worth the trouble, because you can really see the difference
between an actor actually making a death-defying leap and one just faking it
in front of a blue screen. Reality is simply a lot better. If you have any
interest in this kind of movie, see this one. It is slick, well-written, and
well-acted. You’re in the hands of professionals here.
VDO Clip: Thai Horror/Thriller (English subtitles). Another run-of-the-mill
generic Thai horror film, with nothing particular to recommend.
In Country Melody: Thai Comedy/Romance. From the previews, I would have to
say this is the most disgusting Thai comedy that has come along for some
time. The preview has been shown before every film screened at the Bangkok
International Film Festival last week (where I have been seeing about 40
films), and I am embarrassed that this preview was shown for visitors from
all over the world. As if passing wind jokes weren’t enough, this goes the
logical next step further: actual crap. Three men in a sauna tub and pieces
of excrement surfacing and the men blow the stuff away from themselves and
towards the others. I am sorry to report that many of the Thais in the
audience laughed uproariously. Please don’t see it! This sort of thing
shouldn’t be encouraged.
Kung Fu Tootsie: Thai Comedy – A very low class Thai comedy with a lot of
popular Thai television stars. I have to say that at the screening I was at,
Thais laughed a lot; I was shaking my head in disbelief. It’s supposed to be
a parody of the movie Kung Fu Hustle (2004), itself a parody of the Kung Fu
style (wuxia genre), this one as disgusting with plenty of cross-dressing
and obnoxious gay slurs.
Life in the laugh lane:
by Scott Jones
The House Rules
Three months in America, 15 states, 20 homes…and only 4 motel rooms. I’m
lucky to have friends and family scattered over the landscape that will put
me up or… put up with me. Some folks have lived in the same home for 40
years, so even though they’ve tried to escape me with new emails, bogus
phone numbers and PO boxes, I can still catch them, often lurking the dark
with the lights off.
Whatever you’re thinking of, you can’t do it here. No.”
When you stay in people’s homes, common hospitality says anything goes until
the second day when you must learn the house rules. Sometimes they are
unspoken and must be determined by close observation, unlike motels that
list them on the door. “Check-out time: 11 a.m.” (Unless you can convince
counter help you’re waiting for a call from your grandmother who just died.)
“No motorcycles in the room.” (Unless you can distract the staff by setting
off car alarms in the parking lot while riding the Harley into the
elevator.) “No sex in the hallways, with someone, or alone.”
At my first home stay on the left coast in San Francisco, one unwritten rule
was very puzzling while in the elegantly decorated home/work-of-art by my
cousin, a major graphic designer. Though the fixtures were high-tech modern
or fashionably antique, the bathroom door was always kept ajar by a plain
ol’ plastic bottle. Once you do your business, you put the bottle back. I
don’t know why, nor did I ask, it must be art, I just did it.
At my second stay in a three-story mansion on the right coast in New Jersey,
though locks and security codes existed, none were not required, probably
because of the three large vocal dogs, two of them psychotically friendly
Old Yeller labs, who, if you dared climb over the fence, would cavort around
merrily, fetching balls and animals for you to throw while barking madly in
Dogspeak: “Oh goodie, oh boy, a wonderful friend has arrived! We have a new
buddy, who will throw the ball into the pool forever, unlike our masters who
are totally sick of it! Yay, bark, yay!” After a long history of six kids
with hundreds of friends coming, staying and hardly ever going, the only
rule I remember hearing was “This is the neighborhood’s refrigerator.”
Gentle guidelines were posted on the walls: “If you’re pushing fifty, that’s
exercise enough” and “No outfit is complete without dog hair.” Attempting to
find more peace, my friends purchased another home in Vermont. They’ve given
me the address, although I suspect the real address is somewhere in New
House Number Three in Nashville had a rule requiring men to sit down while
doing Number One, which is a good thing, because every once in awhile,
without warning, two streams begin and you quickly adjust for one while
soaking the toilet paper, then swing to adjust for the other and hose the
hand towel, unwilling to experience the pain of stream stoppage. They shared
the location of their hidden key even though they wanted to exterminate
someone in another state who knew. This other “friend” disclosed its
location to random people, and, without notifying my friends, actually told
them: “You can stay there. They won’t mind.” And the people actually came!
(They’ve got to get some new friends.)
As I left House Number Four in North Carolina, I carefully locked all the
doors and, of course, forgot my shaving kit inside. When I asked my friend
at her office to send it to me, her jaw dropped: “You locked the doors? We
don’t lock the doors. I wonder if Ed has a key?” I know they got in because
a few days later I received my kit, its contents coated in drying goop. I’m
pretty sure the slit in my toothpaste tube was intentional.
My friend’s rules in Wisconsin were simple: Drink as much beer as possible
and pass out in the hot tub.
I have four rules for my bungalow:
1) In Thai style, remove your shoes before entering.
2) Do not leave the light on at night or you’ll have to sweep up the
million, give or take a million, termite bodies that may invade.
3) Do not disturb the fifty geckos that live on the ceiling; they eat
mosquitoes. Consider gecko poop on your shoulder a free souvenir.
4) I haven’t seen one yet, so if you witness a cobra slinking through the
neighborhood, tell me as soon as possible, by tapping me on the shoulder,
screaming quietly or cell phoning me from the top of the nearest building. I
never tell friends about these rules before they visit, otherwise they’d