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The Doctor's Consultation

Agony Column

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Money Matters

The Doctor's Consultation  by Dr. Iain Corness

Copy drugs and the internet

I am sure that you are like me. Every day I receive at least four internet email offers of cut-price drugs that will keep me in a state of perpetual priapism. For those unsure of this condition, it is a state of continuing (and painful) male erection and the term was coined after the Greek god Priapus who is shown in paintings to have a central member that puts the (in)famous John Holmes of porn movies to shame.
However, this is actually a serious situation. If most drugs are only available through pharmacies world-wide, on the prescription of a doctor, is it safe to just buy over the internet, without any doctor’s advice?
I believe it is not safe. As the American Food and Drug Administration (FDA) reports in its website, “Patients who buy prescription drugs from websites operating outside the law are at increased risk of suffering life-threatening adverse events, such as side effects from inappropriately prescribed medications, dangerous drug interactions, contaminated drugs, and impure or unknown ingredients found in unapproved drugs.”
The FDA goes on to warn “… certain drugs be dispensed only with a valid prescription because they are not safe for use without the supervision of a licensed health care practitioner. Generally, before the practitioner issues a prescription for a drug the patient has never taken before, he or she must first examine the patient to determine the appropriate treatment. Subsequently, the patient receives the drug from a registered pharmacist working in a licensed pharmacy that meets state practice standards.” That situation is certainly not the case when you look at buying blue diamonds over the ‘net, is it?
The incidence of internet pseudo-pharmacies is also very high. In the US, according to the American Medical Association, there are at least 400 web sites that both dispense and offer a prescribing service - half of these sites are located in foreign countries. Some have estimated that the number of websites selling prescription drugs may now be closer to 1,000.
As far as I can see it, one of the big problems is the lack of regulation that these “net pharmacies” work under. Are the blue diamonds ‘real’ Viagra?
According to the World Health Organization (WHO), it has been fighting drug counterfeiting since it became a major threat in the 1980s. The problem was first noticed by the pharmaceutical industry. They saw that their own products were being copied, and it went on from there.
In fact, the WHO estimates that 25 percent of medications bought in street markets in developing countries are fake. My own experience in some of the poorer SE Asian countries has been that another 50 percent are real but out of date, leaving around 25 percent genuine manufacturer’s stock.
Some authors say that the figures are even worse than that. An international study published in Tropical Medicine and International Health in 2004 found that 53 percent of Artesunate tablet packs sold in the region did not contain Artesunate. And Artesunate is a vital antimalarial drug. You can see the danger.
The reports come in from all over the world. The WHO cited the case of a counterfeit iron preparation that has killed pregnant women in Argentina in the last two years. Hundreds of children in Bangladesh suffered kidney failure and many died due to a fake paracetamol syrup diluted with diethylene glycol, according to a study published in the BMJ in 1995.
The FDA in the US estimates that worldwide sales of fake drugs exceed USD 3.5 billion per year, according to a paper published in April 2005. The Center for Medicines in the Public Interest in the US predicts that counterfeit drug sales could reach USD 75 billion globally in 2010 if action is not taken to curb the trade.
According to WHO, drugs commonly counterfeited include antibiotics, antimalarials, hormones and steroids. Increasingly, anticancer and antiviral drugs are also faked. And you can add to that the ‘blue diamonds’. Never forget the phrase “Caveat emptor” (Let the buyer beware).
You have been warned. Get your medications on prescription from a pharmacy you can trust.

Heart to Heart  with Hillary

Dear Hillary,
This is an authentic letter sent to Dear Deirdre of the Sun Newspaper. “I am a sailor in the merchant navy. My parents live in Torry, Aberdeen and one of my sisters is married to a guy from England. My Father and Mother have recently been arrested for dealing crack cocaine and are currently dependent on my two sisters, who are prostitutes. I have two brothers, one is currently serving a non-parole life sentence in Peterhead Prison for the rape and murder of a teenage boy in 1994, the other currently being held in Craig inches remand centre on charges of incest with his three children. I have recently become engaged to marry a former Thai prostitute who indeed is still a part time working girl in a brothel; however, her time there is limited as she has recently been infected with an STD. We intend to marry as soon as possible and are currently looking into the possibility of opening our own brothel with my fiancée utilizing her knowledge of the industry working as the manager. I am hoping my two sisters would be interested in joining our team. Although I would prefer them not to prostitute it would at least get them off the streets and hopefully the heroin.
My problem is this: I love my fiancée and look forward to bringing her into the family and of course I want to be totally honest with her. Should I tell her about my brother-in-law being English?”
I find it impossible to comprehend that anyone would have such a low mentality to write the following, yet it’s supposed to be a true story! How would Hillary respond?
Dear Tim,
Hillary must be more astute than her fellow comrade in pens, Deirdre of the Sun. This is obviously not a genuine letter as it claims he is going to marry a former Thai prostitute, who is actually still working. This is obviously not correct, as prostitution as we all know is against the law in Thailand, so it must have been made up!
Actually, Tim my Petal, this is an old one (it’s even older than Hillary) and you fill in your favorite country to ridicule for the brother-in-law. Thank you for thinking of Hillary, and bowing to my superior wisdom in these matters.
Dear Hillary,
How did you spend the festive season? Are you several kilos heavier from all the chocolates and champagne? Or did you have to spend the time in rehab? With the constant cries for champers and chocolates, you must be about 20 stones by now!
Dear Misterheineken,
You have obviously been reading the letters I have received over the years from that awful Mistersingha wretched person. I certainly wouldn’t be going over the limit with his offerings, which never materialize, despite all his protestations that it is on its way. So is Xmas 2007. Nor, for that matter, did I get anything from you, so I don’t really know why you are asking such things. However, for those of my readers who did send me the goodies, I thank you very much. All the champagne went to a good cause (loosening tongues) and the chockies sweetened me up for 2007. You also gave away your nationality when you wrote “20 stones” as avoirdupois measure is only still used in the UK. In the US it would be 280 pounds (14 pounds to the stone at last count), or in Thailand which is metric, that would be around 126 kg.
Dear Hillary,

At the end of last year, someone called “Hughie” suggested you were like Oprah in the States and should get more money. How stupid was that? Everybody knows that Oprah is a big star and sindicated (sic) all over the place, while you are just an old aunty writing for the idiots in Pattaya. Why anyone even bothers to read your advice I don’t know either. If you get payed (sic) anything you should think yourself lucky.
Dear Spewie,
What an interesting name you have, my Petal. Did your parents give that to you or was it a nickname that you earned? I note with interest that you wonder why anyone would read my advice in the column, but what amazes me is that you do. Don’t you, Spewie! Mind you, it is obvious that spelling lessons were also something that you did not bother to do either. The words you were striving (unsuccessfully) for were ‘syndicated’ and ‘paid’. After you have passed third grade, please do write again.
Dear Hillary,
Can you assist me about dowries. I am close to marrying my Thai girlfriend and I am curious, how much should be paid? I have never seen a concrete amount assigned. Is it something like America where the engagement ring is two months salary? I have been led to understand that the amount should reflect how much I love the girl; however, I can not give her family the world.
Dear Wondering,
You will usually be advised by an “Uncle” of the amount deemed satisfactory. There is no two months salary equation here, my Petal. It’s an “Open your wallet and say after me - Help Yourself” equation I’m afraid. Generally it is in the range of 30,000 to 100,000 baht for the farang suitors. Make sure she’s worth it. The dowry is non-returnable!

Camera Class  by Harry Flashman

It’s as easy as One-Two-Three

As we go through the festive season, everyone seems to have a small digital camera in a purse, pocket or handbag, which is brandished triumphantly as everyone attempts to record the “good times”.
This is an admirable use of the digital camera, but unfortunately the “good times” are often spoiled by “bad pictures”. And unfortunately, one of the reasons is the One-Two-Three. That is the “One-Two-Three” that every social photographer seems to think has to be said before popping the shutter, which is accompanied by the photographer holding up One-Two-Three fingers, leaving the camera held in one hand only.
Now I am aware of the fact that the new mini, compact digitals will easily fit in one hand, but just as in conventional (old) film photography, to get a sharp picture, you have to make sure the camera is still while the shutter is tripped. One handed picture taking just doesn’t keep the camera still enough. Especially when as the happy festive photographer is waving the free hand in the air, the camera is also waving around!
Coincidentally, I had just written the introduction to this week’s column, when in came my photographic friend Ernie Kuehnelt with an article written by Don Sambandaraksa about image stabilization with digital cameras. Now I have been in touch with Don previously, and this chap knows more about pixels than certain politicians know about tax evasion. In the article he mentions the various ways the different manufacturers do this stabilization, but basically it is either the lens or the sensor that is programmed to move to counteract unsteadiness in the camera, caused by the photographer not holding the camera firmly - or perhaps suffering from Parkinson’s disease.
However, it is not the be all and end all. You only need a slight movement in the camera to produce ‘soft’ photographs. You will not realize this when you look at the postage stamp sized LCD screen on the back of your camera, but when you go for larger prints it all becomes too obvious.
With the larger cameras, SLR’s and the like, it becomes even more important to avoid camera shake. After all, why spend thousands of baht to buy super sharp lenses and get soft “blurry” photographs. You might as well have stuck with a cheap disposable “camera in a film box” and saved your money for booze - which will also give you the shakes just as easily but possibly more enjoyably!
The simple fact of the matter is that to get sharp photographs, the camera must be held still while the shutter is held open, despite all the electronic froofrah. Now, in most daylight situations if the camera is set on “auto” it will select a shutter speed of around 1/125th of a second, and while that sounds “fast” it really isn’t. You will still get noticeable “softness” in the final print if the hand holding the camera has allowed any movement.
The secret really is in the grip. And it is a two handed one. You will not see any professional photographer taking shots with one hand free. I also recommend that you take a short breath in and then hold it while gently squeezing off the shutter. Another good practice is to keep the elbows in by your sides, and even lean against a solid object, like a telephone pole! In overcast weather when the camera will select slower shutter speeds, this is even more important. Your camera will also most likely have two “hand/finger” impressions on either side of the camera body. They are not there for decoration. Use them!
No, if you really must let your subjects know that they are about to be recorded for posterity, a simple verbal One-Two-Three (while hanging on to the camera with two hands) is all that is necessary. I guarantee you will get pictures more sharp than you used to get before.

Money Matters  Graham Macdonald MBMG International Ltd.

“Hard-a-starboard! Full speed astern ... hard to port!” Part 1

There are a number of theories as to the cause of one of the most earth-shattering disasters of the last century - the sinking of the Titanic (does everyone remember the plans to bring the movie version of the ship to Pattaya??).
Many people subscribe to the easy view that it was Captain Edward J. Smith’s fault. Having proclaimed less than 5 years earlier that “I cannot imagine any condition which would cause a ship to founder. Modern shipbuilding has gone beyond that,” it’s believed that complacency caused Captain Smith to ignore seven iceberg warnings from his crew and other ships choosing not to slow down and potentially avoid the ultimate disaster.
A more recent theory is that the standard of steel used in shipbuilding at that time was so inferior to what would be acceptable at the present time for any construction purposes and particularly not for ship construction. However, that doesn’t alter the fact that if the Titanic had not collided with the iceberg, it could have had a career of more than 20 years just like its sister ship, the Olympic, which was built of similar steel, in the same shipyard, and from the same design, but which never encountered a giant iceberg.
Another popular theory points the finger of blame at Bruce Ismay, the managing director of the White Star Line who, it is believed, may have put pressure on Captain Smith to maintain the speed of the ship.
Others prefer to blame the fact that the ship’s architect, Thomas Andrews, the managing director of Harland and Wolff had designed a ship with sixteen watertight compartments but hadn’t made these as high as, in hindsight, they should have been (the White Star Line only wanted these to go as far as E Deck in order to maximise living space in first class).
The commissions of enquiry into the disaster in both America and Britain placed most blame for the deaths at the hands of Walter Lord who captained the Californian, which had stopped for the night about 19 miles north of Titanic. At around 11.15, Californian’s radio operator turned off the radio and went to bed. Sometime after midnight the crew on watch reported seeing rockets being fired into the sky from a big liner. Captain Lord was informed but it was concluded that the ship was having a party. No action was taken by the Californian. If the Californian had turned on the radio she would have heard the distress messages from Titanic and would have been able to reach the ship in time to save all passengers. However, that relates more to the rescue operation than the sinking.
Far less people point the finger at First Officer William McMaster Murdoch. First Officer Murdoch was at the bridge at the time of the collision and immediately prior to the collision issued the order “Hard-a-starboard! Full speed astern ... hard to port!” Had Murdoch reversed the port engine, and reduced speed while maintaining the forward motion of the other two propellers (as recommended in the training procedures for this type of ship), some experts believe that the Titanic might have been able to navigate around the iceberg without a collision. Other experts believe that if the Titanic hadn’t altered its course at all and had run head-on into the iceberg, the damage would only have affected the first or, at most, the first two compartments and the ship would have survived.
All very interesting, but not what you’d normally find in an article from MBMG. Why are we devoting so much space to a maritime tragedy from almost a century ago? In many ways this is the best parallel for the recent events in Thailand. A minor economic disaster happened last month but who’s to blame. Like with the Titanic, everyone has a theory about who’s to blame and like with the Titanic, the easy view might not actually be the most perceptive.
Initially, Tarisa Watanagase, governor of the Bank of Thailand, announced that foreign investors bringing in cash worth US$20,000 or more (approximately Bt700,000) would need to park 30 percent of the amount in financial institutions (who, in turn, would remit the funds to the BoT on the 7th of every month - analogous to withholding tax - allowing the BoT to generate returns on the withheld amount) with the withholding being fully returned if the cash wasn’t taken out of the country within 12 months. Tarisa is the first female governor of the Bank of Thailand, who was appointed as the BoT’s 21st governor by the interim government to replace MR Pridiyathorn Devakula, who became deputy prime minister and finance minister of the new government. Tarisa, 57, is a civil servant who has worked as an economist for the central bank since 1975 and has been deputy governor since 1992.
Tarisa said, “We think this measure will help slow down the short-term inflows as it would increase costs for speculators.” The measure was introduced to counter offshore baht speculators and followed inflows of billions of dollars in recent months which had pushed the baht to a level disadvantageous to Thailand’s exports. In November, inflows amounted to US$300 million per week, increasing to $950 million per week in the first few weeks of December, according to Tarisa. As a result the baht shot up to a nine-year high - Bt35.06 - a 16 percent increase year to date.
The measure, as initially introduced, did not apply to foreign direct investment (FDI) or to exporters or to Thai individuals or corporations repatriating foreign earnings. Governor Tarisa believed that the new measure would effectively discourage speculative inflows and reduce baht volatility, but, in recognition of what a step into the dark this was, she advised that the central bank would closely monitor baht performance adding that the BoT might cancel the measure, change the reserve amount, or change the time limit depending on the situation and that it was unclear how long the measure would last. The reserve measure was the preferred solution to the problem because taxation legislation would be too cumbersome, taking too much time to introduce and being inherently less flexible than the BoT’s solution. At the time of implementation, Tarisa recognised that the move could also adversely affect the debt market but the BoT were also keen to prevent speculative inflows into the debt markets.
Tarisa was at pains to point out that several countries had previously successfully implemented similar measures to curb currency speculation - Chile had used the 30% reserve arrangement for less than six months before being able to cancel the measure.
Deputy Prime Minister and Finance Minister MR Pridiyathorn Devakula supported the BoT’s arrangements as being positive news for investors and exporters (whose price competitiveness in US$-aligned economies had declined as the baht had strengthened - currently, the export sector accounts for 62 percent of the country’s GDP - up from 38% in 1997 - and any damage to this sector and to tourism which also suffers from a strong baht could be cataclysmic for the country’s economic prosperity as a whole) and he welcomed a weakening of the baht.
The immediate reaction of the markets was panic - foreign investors interpreted this as backdoor “capital control” and prior to a meeting scheduled to explain the new programme to securities dealers drove the SET down alarmingly causing the Stock Exchange of Thailand to order a stock trading halt for 30 minutes at 11.30am. In a single trading day, the Thai stock market lost Bt800 billion as the SET index plunged by a record 14.84 percent - the worst since Black Monday in 1987.
The news caused a ripple around the regions with Jakarta down 2.85 percent; Kuala Lumpur, down 2 percent and Singapore, down 2.23 percent. However, the effect on the baht was as intended with the currency depreciating by almost two percentage points to about Bt36 per dollar.
Deputy Premier and Finance Minister Pridiyathorn Devakula said the Bank of Thailand had acted in the interests of the private sector, especially exporters who were suffering from the strong baht. Some commentators interpreted this as the interim government acting in the interests of the Thai economy over the interests of foreign speculators (which is surely their job and to us it’s indicative of the mindset of many of the programme’s most vocal critics that they should see this as being a negative). To us the criticism of the measures fell into 2 camps:
1) The hysterical self-interests damaged by these measures (those who in many cases were meant to be the intended victims)
2) Constructive criticism such as Teerana Bhongmakapat, an economist at Chulalongkorn University, who accepted the rationale behind the policy but queried the details saying that the reserve requirement on Thailand’s capital inflows should be cut to five percent from the current 30 percent so that negative impacts are lessened (this would effectively cut the capital inflow tax to 2.53 percent instead of the 10 percent that has been introduced).
Fund managers (and ex-fund managers) invariably squealed the loudest - Nasu Chansom, head equity fund manager of Ayuddhya Fund Management, complained, “Our good performance so far this year collapsed in one day. Our portfolio value was depreciated by billions of baht.”
At least Chatri Sophonpanich, chairman of Bangkok Bank Ltd (BBL), admitted that the BoT has no better alternative to protect against baht speculation and that failure to do so could lead to a situation reminiscent of the financial dislocation and crisis in 1997 - “The BoT’s measure is necessary. If they don’t do it, it will lead to a problem. Though the measure will intercept foreign capital inflow, we need inflow of money for long-term investment not for speculation.”
Jeremy Warner in The Independent viewed the programme as being farce. However, we tend to think that any commentators who feel the need to point out that Thailand is run by a military government and that a “popular democratically elected prime minister was overthrown by force” are journalists with little or no understanding of Thailand but who feel compelled to file a story on the subject.
Warner felt compelled to write, “The size of the capital inflows, strongly suggestive of another bubble in the making, seem to indicate that investors have yet to learn their lesson. Perhaps so, yet many of these economies today give cause for genuine confidence in the future, even if the actions of their governments do not.”
Alongside Warner we dismissed many similar commentaries with equal contempt (the idea that regional commentators based in KL who’d been silent about the ringgit policy in 1997 but now felt able to vent spleen that was almost a decade old raised our eyebrows).

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]