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The Doctor's Consultation

Agony Column

Camera Class by Snapshot

Money Matters

Life in Chiang Mai

Let's Go To The Movies

Life in the laugh lane

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 getting better.
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 readings too.
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  with Hillary

Dear Hillary,
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!
Dear Mistersingha,
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
Dear Hillary:
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 less passionately.
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 well-spoken.
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.
Tumworth Mugglethump
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 Harry Flashman

Camera – Analyze – Action!

Take 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 focus!
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 and Utilities.
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 trend.
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 in November.
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: Mark Gernpy

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 thriller.
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.

“No. 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 Hampshire.
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 never come.