Wala lang, perpective pics kunwari, using a digicam, the legatoscope, and CT plates of a guy with hydroceph…

Just received my first paycheck as a “Medical Officer III,” employed by the Republic of the Philippines-University of the Philippines-Philippine General Hospital. And now that the customary treat for the more senior residents and the required contribution for bills at home are already done/paid, it’s time to contemplate what to do with the rest of what the government has decided to compensate for my (rather amateur) services as a physician. Do I:

 [  ] buy a laptop I can use to make the 7 mortality presentations I need to finish by the end of the month? (correction, 7 and running, since Feb is not yet over)… I’m eyeing the white ultraportable eeePC:

[  ] buy a dual-SIM phone I can use to call my family and friends (Globe) and co-residents (Sun), without the hassle of having 2 bulky phones in my blazer pocket? The stylish myPhone Slyder is at the top of my list:

[  ] buy the latest edition of Adams’ Principles of Neurology? So that I won’t fail the next exam? (or else, Sunday duty ang katapat).

[  ] buy a new Littman branded stethoscope? I lost mine in the Pay wards last month, and I’m now using a cheap imitation (works great, by the way, so this item is at the bottom of my things-to-buy).

Or, I could be really childish and buy something totally unrelated to work… like my own Playstation!

It’s shopping time!!!

Starting today, I’ll be posting interesting stuff related to my chosen specialty (Neurosciences) that I find on the net in a series I’ll call neuroyloy in aloyloy. This serves two purposes: 1. to promote Neuro as an alternative to boring old residency programs (calling all medical interns out there still deciding where to go after the Boards… join us in Neuro na lang!); and 2. to prevent this blog from CODING (ie, flat-line) while I am in first year (ie, while I am the slave of all slaves in the department, at the bottom of the totem pole, jingle lang ang pahinga). So, even when I’m too busy with hospital work or too tired to post, you, dear loyal readers (yes, the 3 or 4 of you) will have something to aloyloy about.

The first of this series is a very interesting article from The Guardian about what I think is one of the most complex diseases known to man, epilepsy. I remember that there were many instances in the past when, while I was in Church, or at a dine-in, or even while I was lounging at the beach (yes! true story!), a PWE (Person-with-Epilepsy) near me suddenly seized. All these events I took to mean that I really belong to Neuro. Here’s the article, pasted without permission from The Guardian’s website (I cite Fair Use):

Earthquakes may hold clues for treatment of epilepsy
Alok Jha, science correspondent
The Guardian, Thursday January 10 2008

Earthquake-prediction techniques could help develop a way to forecast epileptic seizures, according to research which found striking similarities between the electrical activity in the brain before and during seizures and seismological data around earthquakes.

Both are usually preceded by small, barely detectable tremors and, as with an earthquake, the longer it has been since a seizure, the longer it will be until the next one. According to scientists, these shared features mean that the patterns are not random and could even be governed by similar mathematical rules.

Epilepsy comprises a set of conditions which disrupt the electrical activity in the brain and the main symptoms are recurrent, unprovoked seizures. It is one of the most common long-term neurological disorders, affecting 456,000 people in the UK and around 50 million worldwide.

The condition can often be controlled by drugs that damp down the brain’s electrical activity, although surgery to remove the affected part of the brain is sometimes used in the most hard-to-treat cases.

Seizures often start suddenly in a region of the brain and can then spread to engulf the organ. An earthquake also appears as a sudden, potentially damaging vibration focused around a relatively well-defined point. The researchers said both seizures and earthquakes could be thought of as “relaxation events”, in which accumulated energy is suddenly dissipated.

In their study researchers led by neurologist Ivan Osorio from the University of Kansas showed the frequency of both earthquakes and epileptic seizures could be described by “power laws”, which can often explain the frequency of events that, on the surface, seem random. In earthquake prediction power laws link the size of an individual quake with the time that passes between quakes of that size.

Osorio suggested that the similarities between electrical activity in the brain and seismic activity could bring prediction and prevention of seizures a step closer. “This suggests a novel research direction for the prediction of seizures based on the notion that seizures beget seizures,” he wrote in a paper uploaded to the Arxiv website, where scientists swap research findings before they undergo peer-review.

Matthew Walker of the experimental epilepsy group at University College London told New Scientist magazine that the research was an “attractive concept”, adding that “a good predictive method could revolutionise people’s lives”. But he cautioned that the Kansas team had yet to show that its method worked in practice.

Aloysius Domingo, MD
A> Neuro first-year resident
Chronic fatigue syndrome

Admitting Orders
January 1, 2008

> Admit to Ward 5 under PGH Adult Neurology service
> Secure consent for admission and for 4 whole years (and possibly more) of toxicity
> Diet: diet as tolerated but mostly PGH canteen food or fastfood
> IVF: none for now, will insert once with dengue secondary to callroom mosquito bites
> Monitor NeuroVSq3days (ie, everytime mag-postduty), WOF decrease in sensorium
> Monitor I&O qshift and record, refer if already urinating coffee
> Diagnostics: [ ] CXR-PA upright — baseline, in case mag-pulmo eff 2dary to PTB
                      [ ] plain cranial CT Scan STAT – R/O first-duty stroke
> Therapeutics: start ChartRounds 25mg tab 1 tab PO bid x forever
                               ServiceRounds 100mg cap 1 cap PO q3days x forever
                               ConsultantRounds 1 amp IV qweekly, WOF hypersensitivity rxn
                               OPD neb 1 neb twice a week
> May give diazepam 1 amp IV PRN for frank seizures during rounds
> Self to ensure meds are given, else will be kicked out of program
> Limit social life
> Refer to Psych for evaluation and co-management
> WOF hypertension (when in Charity Svc), WOF pedal edema (when in Pay Svc)
> Close watch please, for standby intubation
> Inform family and friends once admitted, because they might think he disappeared
> Refer PRN

RIZAL, MD
Lic No 000001

Yesterday was Rizal Day; today is new year’s eve; and tomorrow is my first day as a resident physician at the Philippine General Hospital.

So many have inquired about this choice of mine, to stay in the Philippines, and to undergo residency training here.

There is no doubt that there are more financially-rewarding opportunities abroad. There is also no doubt that the programs in first-world countries are more modern, and represent best practice. All in all, there is no question that career-wise, migration and specialization in a hospital in the developed world is the more logical choice. No wonder there is the phenomenon of health professional migration: currently, the push and pull factors balance out logically in the direction of travel and training abroad.

The caveat here is, what is logical is not always what is most rational, especially under very dire circumstances. The dictum after all is Omnia Supra Ratio, “Reason Above All,” not “Logic Supersedes Everything.”

I refuse to pass judgement on those who choose to go; to each his own. I am sure they have very important reasons why they are opting out of the Philippine health system. I have no right to judge, because I myself am not sure that I will be staying until the very end. Right now though, considering all the considerations there are, I just can’t leave this country behind… even if it means a less comfortable life, even if it means slower professional progress, even if it means refusing the logical choice of going abroad to train.

I bet Rizal also faced a similar dilemma in his time. As a wealthy ilustrado, he had the capacity to study and to work abroad (he actually did). As a citizen of the world, he also had the opportunity to forever leave the country and be comfortable and safe. But he always came back. He wrote about life in the Philippines (dire then, dire now) and he emphatized with those he left behind. He went back to share to his countrymen the things he learned abroad. He eventually got killed for his patriotism (slash hard-headedness).

If there was one thing that stuck from the address given by Rizal historian Ambeth Ocampo when he spoke to our graduating class last April, it’s this: Rizal was not a very good doctor during his time; he actually mismanaged and even killed a lot of his patients… yet we call him Hero.

(Photo above: Notebooks I will use for residency! Standard Best Buy record books bought from National Bookstore, with the labels replaced by stickers from Team Manila… The Sunday Inquirer Metro headline was very apt: “… looking for a few good men”)

This afternoon I was convinced by my mother to allow a manicurist to work on my ugly toenails. And since these toenails of mine have not been seen by a professional in a year or so, the ill-fated manicurist had to contend against what was probably the largest, deepest, and ugliest ingrown cuticle she had to remove in her entire career (judging from the old woman’s routine, she’s been at it for a long time). Her experience and agility was unfortunately not enough against this monster of an ingrown that I had been allowing to thrive in the corner my right big toe: I was injured as she was trying to extract it (the monster of course was resisting death). We both gasped at the sight of blood, but what happened next was very interesting.

First she comforted me and told me that everything was fine, that sometimes these things happen, and that everything was under control (hmmm… familiar lines of medical interns missing IV insertions). Then she wiped away the blood with a cotton ball, which she followed with antisepsis using alcohol (OK so far). From her kit she then took a packet of what I later found out to be ground penicillin tablets; this preparation was carefully topically applied onto the side of the nail (where presumably the wound was). Her home instructions were to not allow the toe to get wet, as it would wash away “the medicine.”

It wasn’t my first time to encounter this strange belief that topical penicillin works on wounds. In Batangas, where I had my Community Medicine immersion, there was a man who, prior to consulting with us at the Barangay Health Center, already made budbod ground penicillin over a puncture wound (he accidentally stepped on a nail). It was my first time though to experience being the subject of the practice. The manicurist on the other hand tells me that this has been her routine ever since she started cutting nails (or more appropriately, ever since she started injuring people?); she swears by its effectivity.

Pharmacology teaches us that tablet preparations have to be activated by enzymes and juices in the stomach for them to take effect. There are topically-applied antibiotics (like mupirocin or tobramycin), but these are special preparations (gel, cream) and I doubt that they are produced simply by grinding the tablet forms of these drugs and then mixing them with water and starch to make a gel equivalent.

Knowing however that in the crazy world of medicine anything can happen, I launched a Pubmed search using the search terms “penicillin” AND “topical application.” The query yielded around a hundred citations. Sorry to EBM OCs, but my ADHD prevented me both from browsing through all the pages and from refining my search. Instead, I settled with the following abstracts which I felt were somehow relevant to my question.

1: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Dec;96(6):685-94.

The efficacy and safety of 50 mg penicillin G potassium troches for recurrent aphthous ulcers.

Kerr AR, Drexel CA, Spielman AI.

Bluestone Center for Clinical Research, New York University, New York, USA.

PURPOSE: To determine both the efficacy and safety of the topical application of 50 mg penicillin G potassium troches (Cankercillin) in the treatment of minor recurrent aphthous stomatitis (RAS). STUDY DESIGN: The investigation used a phase 2 double-blind, randomized placebo-controlled trial with a no-treatment arm. Subjects with minor aphthous ulcers of duration <48 hours were followed for 1 week. The primary endpoint for efficacy was time (days) to complete ulcer resolution, and the secondary endpoint was time (days) to complete pain relief. RESULTS: Thirty-one, 33, and 36 subjects were randomized to the active treatment, placebo, and no-treatment arms, respectively. Baseline findings were heterogeneous across arms. Subjects who received penicillin G treatment had complete ulcer healing and pain relief significantly earlier than those in the placebo and no-treatment arms. No allergic reactions were observed. CONCLUSIONS: Topical penicillin G, by mechanisms which remain unclear, reduces the time of healing and pain relief of minor aphthous ulcers with minimal safety concerns. Larger phase 3 studies are necessary to confirm these findings.

2: J Infect. 2003 Oct;47(3):203-9.

When should old therapies be abandoned? A modern look at old studies on topical ampicillin.

Charalambous C, Tryfonidis M, Swindell R, Lipsett AP.

Department of Surgery, Manchester Royal Infirmary, Manchester, M13 9WL, UK.

OBJECTIVE: We sought to determine whether topical ampicillin can reduce the rate of wound infections in clean contaminated surgical wounds (appendectomy, colorectal surgery). METHOD: All randomized controlled trials examining the use of topical ampicillin in appendectomy and colorectal surgery published in English were identified via a Medline, Advanced Medline, and Cochraine Controlled Trials Register search and a meta-analysis performed.Results. Topical ampicillin vs. no antibiotic prophylaxis in clean contaminated wounds significantly reduced surgical wound infection rates (Odds Ratio (OR)=0.084, 95% CI, 0.04-0.16, P<0.0001). Topical ampicillin vs. no antibiotic prophylaxis in contaminated wounds also reduced surgical wound infection (OR=0.262, 95% CI, 0.14-0.51, P<0.0001). Topical ampicillin combined with systemic antibiotics vs. systemic antibiotics alone did not reduce surgical wound infection rate (OR=0.927, 95% CI, 0.27-1.72, P=0.90). CONCLUSION: Topical ampicillin significantly reduces the rate of surgical wound infections in clean contaminated surgery. A significant but smaller effect is seen in appendectomies where the appendix is gangrenous or perforated. Topical ampicillin did not confer any additional benefit when systemic antibiotics are used. While ampicillin may no longer be an effective agent, topical application of antibiotics is effective.Summary. A meta-analysis of studies using topical ampicillin for the prevention of infection in clean contaminated wound suggests that topical ampicillin is effective, but no incremental benefit is seen with systemic antibiotics.

Needless to say, the journal search was quite disappointing (Should I be surprised? Don’t harass me, I’m so tamad today to really look for relevant journals… plus, I’m injured). There have been many studies recently that look into the antiseptic and wound healing properties of some herbs and plants (like Takip Kuhol, for example, I should know, I’m sort of doing a paper and a presentation on this for Dr Jimmy Galvez-Tan). Maybe someone should look into the efficacy of ground tablets for topical application as well. Reminder: when that paper is finally written, don’t forget to credit manicurists for the discovery.

(This post also doubles as my announcement that I want a Robosapien for Christmas )

The medical school where I graduated from leans to the application of the humanistic approach to the practice of medicine. When I was a student, we were always encouraged to develop rapport with our patients; we were always instructed to get not just a detailed history of the course of illness and the reason for consult, but to also derive the thoughts, feelings, and emotions of the patients we were assigned to. Emphasis was given to finding out the context of the patient: his family situation, economic capacity, educational attainment, social standing, etc. All these were postulated to have significance and relevance to the nature of the patient’s illness, and were taught as important in the treatment of the disease and eventually in the patient’s healing. “Your patient is a living person, and not just a defective machine” were frequently spoken words of wisdom from our teachers.

DeMyer, however, in his textbook Technique of the Neurologic Examination (my favorite med school book of all time) teaches us something else. He makes a compelling case for the treatment of patients like robots:

“The purpose of reducing behavior to its stark biological elements is not to deny the Pt’s humanity and sentiency. The conception of the Pt as an organism consisting of a set of levers, apertures, tubes and glands operated by neural circuits emphasizes that our elemental needs and natures are all alike. We all arrive, live, and die by the same biological processes, and we all exult and suffer alike… Appreciation of our common biological bonds supersedes liking or disliking the Pt and obviates any pejorative ruminations about the Pt’s personality, life style, or perceived transgressions. Undistracted and unimpeded by such judgemental intrusions, the physician accepts all Pts with equal humility and grace. Because of your carefully fostered accessibility, each particular nervous system before you, operating its levers, apertures, tubes and glands, can disclose itself and its sentiency as a whole person, whether saint or sinner, without fear of retribution, reprisal or condemnation. Only when Pts can disclose themselves freely can the physician discover and effectively respond to the Pt’s real medical needs.”

Oha. I really want that Robosapien now.

Sometimes the problem with med school is that you get so busy with duties and with studying, that it becomes difficult to find time to attend to other interests, especially those that are not relatable to work inside the four walls of the hospital. So many episodes, movies, games, plays, books, events, news, issues etc etc were lost this way during my 5-year stay at the PGH. Survival sometimes meant having to block out all other competing interests in an effort to understand and commit to heart (yes, not just to memory) the fronto-ponto-cerebello-dentato-rubro-thalamo-cortico-spinal pathway; and for this, the feeling that one is detached from the real world is an all too common experience for the average med student.

Good thing there are reruns.

Today I watched five documentaries in a docufest sponsored by my sister’s org in UP Diliman. All were from the award-winning GMA show I-Witness, and all I missed when they were originally shown on TV. The first, Howie Severino’s Brod Is Thicker Than Water, discussed the death of UP stude and Sigma Rho neophyte Cris Mendez from hazing. When news broke out of Cris’s death, I was on duty at PGH for pre-residency qualification; I found out about it from my sister, Cris’s classmate at the NCPAG. We usually talk about updates on this issue (or the lack thereof) during dinner.

In the documentary, Howie explored the possibility of achieving justice in fraternity-related deaths. The spin in the story showed how in the case of another student who died by the hands of his brods, UP student Alex Icasiano, closure was attained because the fraternity chose to cooperate with the criminal justice system by admitting their error and surrendering the involved brods (something that Sigma Rho has yet to even start doing). Howie was present in person during the screening this afternoon; he described how he had to ambush Sigma Rho law students just to be able to move around the fraternity’s gag order on the issue.

The second documentary was Howie’s Lucayo: Hindi Ito Bastos. The documentary tackled the erotophobia (thanks to Nicolo for the term) involving a custom in Kalayaan, Laguna, where, when a couple would wed, old women in the barangay would welcome them into the married world with dances involving phallic symbols as props (wooden penises and sometimes, eggplants). The docu apparently was found offensive by the MTRCB (validating the erotophobia aspect), and I-Witness was slapped a 2-week suspension. I guess they took literally what anthropologist Ramon Obusan said: “baliktarin mo ang titi, titi pa rin… kiki is kiki pa rin.“

Sandra Aguinaldo’s Doctor Nurse (no videos available, sorry) is about Filipino doctors who take nursing courses just to be able to work in the US. Her docu tells the story of the 2004 Med Boards topnotcher working in the States as a nurse for a hospital; and of other doctors who left their profession to migrate and work in US nursing homes. Sandra exposed how while these MD-RNs miss their parents or children at home, they feel content and satisfied with the economic benefits of their career choice. Unfortunately, the sob story was not balanced with a discussion on the impact of their migration to the local health scenario. For this, I am consulting a study done by Dr Galvez-Tan; I’ll write about it soon.

The 36-Peso Challenge (I couldn’t find videos) is Jay Taruc’s response to the national statistic that says that one needs only 36 pesos to survive a day in the Philippines. He challenges a housewife, a jeepney driver, and a businessman working in Makati to spend only 36 pesos the entire day for both food and non-food expenses (he tried but was unable to challenge President GMA also). After the screenings, I tried The 36-Peso Challenge myself; with the alloted budget, I was able to buy 20 pcs of fishballs (P10), 3 pcs of chicken balls (P10), a cup of buko juice (P7), and a ride home (Ikot jeep for P6.50; for a total of P33.50). I still have P2.50 in savings — assuming that what’s listed would be all that I’ll eat today.

The most provocative of the five documentaries in my opinion was Kara David’s Sa Mata Ni Ekang. The docu tells the story of a family with a drug dealer for a mother, a criminal (holdaper) for a father, and a pimp for a grandmother. The 3-year old kid Ekang is forced to witness shabu sessions at home, and is taught to buy cigarettes from the nearby store for her parents. The documentary ends with a family reunion of sorts as Ekang’s 3-month old sister is baptized in a church. Hopeless and hopeful clash each other all throughout.

DVDs of these and other docus would be highly appreciated gifts this Christmas.

It was around two Sundays ago when the parish priest in our church first invited mass attendees to read the circular issued by QC bishop Ongtioco opposing the proposed reproductive health bill for Quezon City sponsored by Councilor Joseph Juico. The ordinance “Establishing a Quezon City Population and Reproductive Health Management Policy” was attacked in that it supposedly ”kills unborn children, causes deadly cancers, (and) destroys the Catholic educational formation of our youth.” A leaflet with the letterhead of the Our Lady of the Miraculous Medal Parish (in QC) says the ordinance would bring “sexual promiscuity to intermediate and high school students in their class lessons.” In the next few days, the proponent has apparently been villified by pro-life advocates and has come under intense pressure and condemnation from the Church (see related news items: ABS-CBN, Inquirer).

The objection of the Catholic Church to the progressive concept of Reproductive Health is not new (“progressive,” to distinguish from the Church’s archaic view that the natural method is a safe, effective and acceptable method of reproductive control). In 2005, the Church and its pro-life minions successfully buried House Bill 3773 or the Integrated Reproductive Health and Population Reduction Bill. As a result, there are still no comprehensive government strategies to combat the continually exploding population size of the country and family planning efforts nationwide are still underfunded and lacking; the situation is expected to get worse as the USAID fund for contraceptives (the largest source of free contraceptives for the Filipino poor for the past 30 years) runs out by the end of 2008.

The response of the Church to the cited need for a strategy to address the population problem is denial. In raising issues of morality, promiscuity, and even cancers (?), the Church chooses to ignore the primary rationale for the ordinance: population control and poverty alleviation.

Rotating in Ob-Gyn in PGH during med school, I was able to observe the following among mothers coming in for complications of induced abortions (Philippine Law bans abortions, but allows MDs to treat complications arising from illegally-done procedures to end unwanted pregnancies): most patients were poor; most were in their 20s-30s; most of these patients were married, or had long-time partners; and most already had children, the present pregnancy would usually be the 4th or 5th. Some are consulting for their 2nd or 3rd abortion. It is undeniable that the sector most affected by the paucity of governmental support for family planning are not curious, promiscuous teenagers, but poor families who cannot afford to support another child. These women suffer near-death experiences secondary to bleeding and infection, situations that could have easily been avoided with the availability of family planning services for the underprivileged.

And in the aspect of reproductive health education, it is but right that the targets are high school students through school lessons. A progressive perspective about population and poverty is best inculcated during formative years, after all. These “children” would soon graduate into a country of 100 million people; there are only too much resources to serve the rich, or the wise.

The Catholic Church is in a very special position in Philippine society. As one of the most prominent and respected institutions in the country, it has a responsibility to contribute to nation-building, development, and poverty alleviation. In Latin America, progressive Roman Catholic priests have started to accept the use of condoms and other artificial methods as viable alternatives in an effort to make the Church more responsive to the social and economic needs of the common people. I’d like to see my Church to have the courage to do the same. The challenge is for the Philippine Church to lift the masses both spiritually and physically out of suffering.

One of the major trends in modern medicine is its respect for the intrinsic power of numbers and their study. In the movement known as Evidence Based Medicine (or EBM), the teachings of tired old doctors passed on from generation to generation are not taken as absolute truths, but as principles that are less convincing than those supported by hard evidence. The NHS classification of medical literature uses Level A to apply to theses supported by strong studies such as consistent Randomised Control Trials (or RCTs), and Level E to refer to expert opinion or theoretical results (find out what Level B, C, and D mean in Wikipedia). The whole idea is to determine best practices in the medical field by testing them against objective observations and to do away with extraneous variables such as bias in making important medical decisions.

Indeed numbers have a very strong power to convince. When used properly (ie, in presentations that can sustain the interest number-haters like myself), they can strongly influence opinion, affect stances, and forward certain advocacies  (who can forget that three-storey projection in The Inconvenient Truth? 3:15 on this YouTube video). I am sharing below my favorite number-play sites (ie, sites I go to when I suddenly get that nerdy urge to know more about the world):

Gapminder (www.gapminder.org) was introduced to me by my Med Informatics advocate friend Pam, MD. This tool can compare different countries based on three variables at the same time (using the X and Y axes, and the size of the dot that represents the intersection). In addition, the interpretation can be made relative to the country’s geographic location by looking at the color of the marker. Time as a variable can also be injected by pressing the play button (toggles the markers to “move through time”), or by adjusting the time bar. In this example, the graph is able to convey that the Philippines in 2004 had a life expectancy and income per capita almost similar to that of smaller nations Jordan, Paraguay, and El Salvador (in the screenshot below, the Philippine dot is marked, and the smaller green and yellow circles nearest to it represent the three countries mentioned… it’s really better to see the dynamic graph; click the link above):

The limitation of Gapminder is that there are very few indicators (life expectancy, income per capita, urban population, internet users, contraceptive use… only 17 in all). And while these are spread among differing categories of study, the data set still is very much limited… On the other hand, there’s NationMaster (www.nationmaster.com), which has probably the largest data sets comparing different nations online. The information on this site is compiled from the CIA factbook (aha! data from US spies!), the United Nations, and the OECD (Organization for Economic Cooperation and Development). The data set is huge, with 30 categories (covering agriculture, lifestyle, terrorism, etc) and around 300 indicators per category. NationMaster however loses to Gapminder’s strength, which is the dynamic presentation… most comparisons are made via conventional graphs or charts (ADHD people like me like their charts moving).

Enough of the toxic. Let’s go to Swivel (www.swivel.com). The banner of this site reads: “tasty data goodies.” I think of the site as sort of a Wikipedia/YouTube for number-players… in this site, users get to upload their data sets for sharing. On the other hand, there are data sets marked as ”from official sources” (like the OECD, WHO, UNESCO) to indicate that the comparison came directly from trusted organizations. The Sexual Experiences comparison among countries noted that the global percentage of extramarital affairs is 22% and that of a threesome experience is 15%. Australia is also apparently the world leader in homosexual experiences, while Norway leads the race in one night stands. Unfortunately, there was no data available for the Philippines (note: there have been concerns about the credibility of the data set as mentioned on the site… it still is fun though). There are other weird and zany data sets like one comparing MySpace friends of the different zodiac signs (with politician Leo surprisingly getting last place and Sagittarius getting the top spot).

Finally, in a world that is rightly concerned about carbon emissions, sites for carbon monitoring are a must. The website of CARMA (Carbon Monitoring for Action, www.carma.org) lists the carbon emissions of major power plants in the world, as well as the power generating capabilities of different countries. This is where I learned that the Philippines still uses fossil fuels for 57% of its energy needs (hydroelectric energy generates 14% and other renewable sources account for around 28%). We have about the same carbon emission load as Romania (but Romania generates much more output, possibly because they have a nuclear plant); conversely, our energy output is almost similar to that of Pakistan, but Pakistan has lower CO2 emissions (again probably due to a nuclear power plant). As I mentioned, numbers should guide policies, and I think this makes the case for the reactivation of the Philippine effort to go nuclear.

I have never been a fan of numbers. As a kid, I hated math. Count Dracula’s antics never really appealed to me. My choice of vocation was probably even a subconsciously driven strategy to avoid mathematics in adult life. With the popularity of EBM, however, data and statistics are unavoidable even for MDs. Resources like those above make life easier for number-haters like me.