Saturday, April 3, 2010

No need for a 'uneqqee' name : Trend of using unique Westernised names reflects insecurity

The Sunday Times Mar 21, 2010

By Lee Wei Ling

Over the last 50 years, the names people choose for their children, and the names some people give themselves, have changed dramatically.

When my father was born in 1923, his family consulted a friend knowledgeable in choosing names. He suggested 'Kuan Yew', which means 'brightness' in Hokkien.

My great-grandfather was awed by the British and added 'Harry' to my father's name. Because his name appeared as 'Harry Lee Kuan Yew' on his birth certificate, when he graduated from Cambridge University and later from Middle Temple, he could not persuade either institution to drop 'Harry' from his university degree or his certificate as Barrister-at-law.

In 1950, he managed to arrange for himself to be called to the Singapore Bar as just 'Lee Kuan Yew', sans 'Harry'. 'Lee Kuan Yew' thus became his public persona. To this day, only family members and a few very close friends call him 'Harry'.

My brothers and I have no ang moh name. My parents were not literate in Chinese when we were born, so my father approached a court interpreter he knew to give him some names to choose from.

My name, 'Wei Ling', means 'the sound of tinkling jade'. My parents did not foresee that I would grow up to be a tomboy who would join the army cadets in secondary school, where my loud and resonant voice was deemed appropriate for a parade commander.

'Wei Ling' is a very common name for Chinese girls. When I try to sign up for electronic journals on the Internet, and the system prompts me for a user name, I try all possible permutations of my name, including 'Li', 'Weiling' or 'Wei-Ling'. Alas, I invariably find they have all been taken by others. Exasperated, I would sometimes try 'Lee Hsien Yang', and the system would immediately accept it.

Throughout my years in school, from kindergarten to pre-university, all my friends had only Chinese, Malay or Indian names. When I was in medical school and during my early years of postgraduate training, the only Westernised names were the Christian names of those who were actually Christian.

By the late 1980s, however, non-Christian Chinese began to have Westernised names and often did not use their Chinese names at all. The trend was initially subtle and I had assumed that those with Westernised names were all Christians. It was only when I needed to write a cheque to a friend and I was told, 'don't include my Western name, just write 'Tan Chee Beng'' or whatever, did it dawn on me that the Western names were not official.

My brothers chose not to give their children any Western names. One nephew, when he was in school, asked his parents' permission to adopt a Western name. His mother Ho Ching told him: 'In China, only waiters and waitresses use Western names.' My father also explained how 'Harry' became part of his name and how he tried to remove it.

To date, none of my nephews or niece has a Western name.

I trained in Boston from 1981 to 1984, and in Toronto in 1992. I kept my Chinese name throughout and told those who had difficulty remembering my name just to call me 'Lee'.

To my close childhood friends and my family, I am just 'Ling'. I still think 'tinkling jade' hardly reflects my nature. To those who know me, 'Wei Ling' perhaps conjures up a very different image from that of tinkling jade.

I am glad that Malays and Indians rarely give or adopt Western names - unless they are Christians, in the case of the Indians. I guess there is still a strong anti-colonial instinct in me that leads me to abhor any attempt by people in former colonies to adopt the names of their past colonial masters.

In the book The Narcissism Epidemic by Jean M. Twenge and W. Keith Campbell, there is a chapter on 'Uniqueness'. They write: 'The biggest trend in baby names recently isn't a particular name; it's that fewer children receive common names.

'The Social Security Administration has compiled a database of the names given to every American child born since 1879. Half the boys born in 1946 received one of the top 23 names. Back then, naming a child was about belonging and fitting in instead of uniqueness and standing out...

'But over the last few decades, parents, tired of common names, wanted something unique for their children. At first it was a slow progression: As late as 1987, 3 per cent of boys were named Michael and 3 per cent of girls were named Jessica, with one out of five boys and one out of six girls receiving one of the 10 most popular names.

'Then, during the 1990s, unique names caught fire and fewer and fewer children received the most popular name for their sex, and only one out of 11 boys and one out of 12 girls went by a name in the top 10...

'Now it is considered better to stand out as an individual and be 'unique'. In fact, 223 babies born in the 1990s in California were named Unique, with some parents putting teeth into it with names like Uneek, Uneque or Uneqqee...

'Unique spellings are also trendy: Why name a child Michael or Kevin when they can be Mychal or Kevyn?'

The same trend can be observed in Singapore, especially among the Chinese. An example I came across recently here of a thoroughly made-up, 'uneqqee' name was 'Evetor'.

I asked a Malay friend whether there has been a similar trend among Malay names. She replied: 'Most Malay names have either Arabic or Sanskrit roots and some are drawn from Malay literature. When I was younger, many more Malays had simpler names. Now you find a whole generation growing up with multiple names, not just a simple Fatimah or plain Aminah. Instead, it will be Fatimah Nadia Trina, or Natasha Atiqa, et cetera.

'What you will notice about these new fashionable names is that they are a blend of Western and Islamic names,' my friend told me.

I view this new trend of choosing Westernised unique names as another example of the narcissistic epidemic. I feel that if you need a name to distinguish yourself, you or your parents probably have a chip on your or their shoulder, combined with a cultural inferiority complex.


Dr Lee is the director of the National Neuroscience Institute.

A different kind of sarong party girl

The Sunday Times Mar 07, 2010

A different kind of sarong party girl

By Lee Wei Ling

Recently, there was an exchange in Parliament between NTUC secretary- general Lim Swee Say and Member of Parliament Irene Ng - on undergarments of all things.

I found the entire episode rather comical, especially Ms Ng's comment that 'women choose their clothes, including their undergarments, to look good for themselves, not only for the men'.

I choose clothes for their comfort and relatively low price. I do care a little how I look, but only insofar as my patients do not find my attire offensive.

Recently, I have resumed accompanying my father, Minister Mentor Lee Kuan Yew, on his travels abroad, after a gap of 15 years. On these occasions, I try to meet conventional codes of dress, what foreign dignitaries would expect of a member of the Minister Mentor's delegation.

My sister-in-law Ho Ching and some of my friends, believing I need help, decided to assume the duties that once belonged to my mother: Dress the reluctant dresser.

So reluctantly, I have been fitted out with blouses, skirts or long pants, sandals and handbags for overseas trips, so as to satisfy what foreign dignitaries might expect of a member of the Minister Mentor's delegation. Some among my friends, knowing my propensity to give away fancy things, have given me gifts of clothing with the firm instruction that they are for my personal use and not to be given away as presents.

I have not wholly solved the problem of formal shoes - also known as court shoes or pumps. As anyone who runs or does step aerobics for durations exceeding an hour a day will know, toe nails can turn blue and drop off as a result of such exercise, so wearing any footwear covering the toes is rather painful. My solution is to wear a pair of somewhat dressy sandals, leaving my toes exposed.

My philosophy of clothing is that there is a necessity to cover up certain areas of the body, which social conventions have decreed would be indecent to expose. Beyond that, I choose colours that are easy to mix and match like black, white and brown - as well as my favourite colour, blue.

Until my father pointed out to me recently that cotton batik skirts are not considered formal, I was unaware of that fact. My preference for cotton batik skirts is based on their comfort (cotton is cool) and convenience (batik prints hide creases).

I particularly like the wraparound batik skirts because I usually wear exercise shorts. A sarong skirt can be wrapped around relatively thin running shorts quickly and I don't even need a private area to do so. On the occasions when I need to 'change' from gym wear into work wear, all I need to do is tie the skirt over my shorts, and I am 'decent'. As one friend noted wryly, 'even Superman needs a telephone booth to change'.

As for a blouse, a black or blue short-sleeved T-shirt is, I think, acceptable for seeing patients. None of my patients or their parents has ever complained about or commented on my attire. They don't appear surprised that a senior consultant with the title of professor dresses as informally as I do. What matters to them is whether I am sincerely concerned about their welfare and try my best to solve their problems - not just medical but also social, work-related or educational.

Once upon a time, I was a little girl who dressed only in shorts and T-shirts except for Chinese New Year. Perhaps because dressing up appeared a special privilege, I looked forward to it.

I still have a portrait of myself wearing a dress, with a ribbon - of the same colour as my dress - in my hair, and earrings. The photograph has special sentimental value for it was taken by my maternal grandfather, a multi-talented man who was a very good amateur photographer, with his own dark room at his home to process his films and photographs.

Somewhere between Primary 1 and Primary 6, I decided that party dresses were uncomfortable and unnecessary. Aside from my school uniform, I would dress most of the time in shorts and T-shirts.

I have maintained that attitude towards clothing into my adulthood. Comfort and cost are my main consideration - not looking good, whether to myself or for others.

I am with Mahatma Gandhi on this score. When asked once if he felt under-dressed when he met the King of England and Emperor of India, he replied: 'The King was wearing enough clothes for both of us.'

Part of the reason I share this sentiment is that I detest the consumerism so rife in our society. I see many of my patients, especially the older adolescent and young women, dressed in clothes that must cost them at least half their monthly salaries. I also see wealthy women dressed in fabulous concoctions that must cost the equivalent of many months of a bus driver's salary.

I try to remind myself that it is their right to spend their money as they wish. My personal values are mine, and I have no right to impose them on others or judge others by my own yardstick.

Still, I would discourage my readers and friends from placing too high an emphasis on their attire, whether it be undergarments or over-garments. Like other material possessions, expensive clothes are 'red dust', giving their wearers only a transient illusion of physical beauty.

Physical beauty will eventually fade. To place too great an emphasis on it will one day cause psychological distress.

By renouncing as many items of 'red dust' as possible, we would be less tied down emotionally by material luxuries and we would become better and more charitable people.


Dr Lee is the director of the National Neuroscience Institute.

Being the Panda's daughter

The Sunday Times Feb 28, 2010

Regardless of how I'm perceived by people, I will continue to do what is right and just

By Lee Wei Ling

Recently, I have been asked to give talks, or just to meet and greet certain 'VIPs', more often than before. This is probably due to the fact that I began writing regularly for this newspaper in 2008.

I have no doubt that when my name is heard, it is almost immediately followed by the thought, 'she is LKY's daughter'. I suspect many readers first read me because they were curious about LKY's daughter, how she thought and felt, especially since some perceived me as anti-establishment.

I am Minister Mentor Lee Kuan Yew's daughter and I am proud of him. That does not mean I need to agree with every decision the Cabinet makes.

But I am not anti-establishment either. On the contrary, I would like the establishment to make decisions that are correct for Singapore. When it makes a decision that I think is unwise, I try to give feedback and hopefully persuade the authorities to reconsider their position. Why else would I, a neurologist, agree to be part of the roster for the Think-Tank column in The Straits Times or write in this space roughly every fortnight? I hope that by now people read me because they find what I write interesting and educational. (kojakbt: as you can see, it's the ST fellas who want to "sarkar" her...)

As for my family, I am aware that I am perceived by outsiders - including some members of my extended family - to be at the bottom of the totem pole among my nuclear family, including both my sisters-in-law. This does not upset me.

We all have our own roles in society. I chose a role that is relatively low-profile, but which gives me satisfaction since I am able to help and comfort my patients. The psychological rewards of being a doctor are almost immediate versus the longer timeframes for a public policy or business decision to bear fruit.

But perceptions, whether accurate or not, do affect how people react to me. Many people think I have a 'godfather'. But as my staff at the National Neuroscience Institute know, events last year proved that my family connections do not give me special protection.

Others may believe that I am powerful and have special privileges. But I am influential only if I, like any other writer, can persuade Singaporeans to a particular point of view.

As for special privileges, what are they? Well, I can use the Istana grounds, as I have since my childhood. But it has been a while since I used the Istana grounds to jog or exercise, though I do take friends there for a walk once or twice a year.

But perceptions, as I said, do matter. I know many people do not treat me the way they would treat others. I try to put them at ease by treating them as equals. In discussions, some who do not know me well may defer to me though I actually prefer robust debate. I cannot know everything, and most certainly cannot be right on every occasion.

'Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant; they too have their story,' the Desiderata urges us. I have a strong egalitarian streak, so I naturally would listen to the 'dull and ignorant'.

Just this past week, a friend of mine sent me a report from The Economist of a study of OECD countries: 'One of the reasons people try to get ahead is to boost their children's chances in life. And indeed the children of the well-off and well-educated earn more and learn more than their less fortunate peers....'

My friend commented: 'Whether you believe in nature or nurture, most apples do not fall too far from the tree. We (in Singapore) provide everyone with equal opportunities - in fact, more help is given to those from the lower end - but we cannot expect equal outcomes.'

I replied: 'Yes, we all have different weaknesses and strengths. We are all also fellow travellers in transit in this present time and country. Here and now is the only certainty you and I know. That applies as much to Singapore's billionaires as it does to the cleaning lady in my office.

'The ideal that Singaporeans should strive for is a society where all are treated equally. Being treated equally does not mean being paid the same. But in our personal interactions with one another, unless we know or strongly suspect the other person is a bad person, we should try to treat everyone with the same degree of consideration. I use the word 'consideration' rather than 'courtesy' because I find 'courtesy' a somewhat phoney thing. I may or may not do you good or harm, but I can still treat you courteously.'

In the fourth century, a great Chinese writer Tao Yuan Ming - who unlike most Chinese scholars, wanted no official position and preferred the seclusion of a farming life - was forced to take up a minor official position because he could not feed his family by farming. Less than 80 days after he took up his position, a higher ranking official visited him. Warned to be courteous to the higher official or he would get into trouble, Tao declared: 'I will not bow for five bushels of padi.'

Perhaps five bushels of padi was his annual remuneration. My close circle of friends understands when I say: 'I won't bow for five kilograms of gold.' It means I will not waver from my principles no matter what the cost.

A humorous aspect of being 'LKY's daughter' is that not infrequently, various people ask to meet me though they have nothing specific to discuss with me. My mother used to say wryly of such people: 'If they cannot see the Panda, the Panda's daughter may be an acceptable substitute.'

Perhaps wanting to meet the Panda's daughter is a reflection of the awe with which many view my father. That is a compliment to him, not a merit I won myself.

Regardless of how people perceive the 'Panda's daughter', I will continue to do what is right and just, until I'm physically unable to do so anymore.


Dr Lee is the director of the National Neuroscience Institute.

Culture: Marching to our own drumbeat

The Sunday Times Feb 14, 2010

It will take time but Singaporeans have the ability to forge an identity unique to us

By Lee Wei Ling

I circulated the draft of my article Handling The Influence Of The West, which was published in The Straits Times last Wednesday, to some friends for comments. One friend directed me to a Lianhe Zaobao Sunday article written by senior executive editor Lee Huay Leng, Why I Miss Beijing And London.

I was amused by the article. While I was struggling with my cultural identity, Ms Lee was bemoaning Singapore's cultural poverty, evidently overwhelmed by the cultural 'depth' of London and Beijing.

We are obviously on different wavelengths. I am 55, a balanced bilingual - Chinese-educated in terms of culture and English-educated in terms of my professional training. I have travelled extensively, and never felt a sense of cultural inferiority anywhere, including Britain and China, whose leaders and intellectuals I have met.

I am puzzled why an educated Singaporean woman should prefer Beijing and London to Singapore. Would she still prefer living in Beijing if she had to work there as a journalist earning PRC wages? To work for Zaobao in Beijing, as Ms Lee has, and be paid Singaporean wages, is not a true test, as she can then enjoy a standard of living much higher than that of her Chinese counterparts.

The foreign countries I know best are Canada and the United States, since I did my postgraduate training in these places. With some exceptions, their newspapers are parochial. The Straits Times is better than most American papers in terms of its sheer coverage.

The same is true of China, as a few nurses from China who are now Singapore citizens have told me. Our Chinese newspapers, they said, are comparable to those in China and their reports are more credible, which explains why Zaobao Online is read widely in China.

As for books and magazines, again Singapore is not inferior to China. Indeed, the nurses told me they can read Taiwanese publications here that are unavailable in China.

In the past decade, the Singapore Government has devoted more resources to the arts. But the fact is the majority of Singaporeans do not consider the arts to be their top priority. What bothers Ms Lee does not bother them much.

We are a pragmatic people. Most Singaporeans would place more emphasis on a good job, a comfortable home, good-quality health care and education, and a clean and safe environment. These are also the considerations that attract immigrants from China, India and other parts of Asia to Singapore.

When it comes to 'elite culture', I agree that cultural standards in Beijing and London are superior to Singapore's. But how can it be otherwise? These two countries have larger populations and richer histories than we do. Singapore is a young immigrant society.

In 1965, we had only two million people, mostly the descendants of illiterate peasants from China and labourers from India and the Indonesian archipelago. How many artistically talented people can we nurture in less than 50 years of independence?

As a multi-racial society, we never spoke or wrote in one common language. Even now, many Singaporeans write in one language but speak in two. In Britain and China, they have worked on only one language over hundreds and thousands of years, respectively.

China has had dynasties that lasted centuries, during which it became the most prosperous, productive and refined society in the world. Britain is less ancient, but over 200 years it conquered a large empire. That huge economic base provided it with considerable resources. Its elite enjoyed security and comfort and could devote themselves to the arts.

Singapore struggled to make a living from the 1960s until the early 1990s, when we became more secure and had sufficient resources to devote to the arts. We now have museums and art galleries as well as Western and Chinese orchestras, among other things. Even so, our social infrastructure is still not equal to that of the principal cities of China or Britain. It took many thousands of years in China and hundreds in Britain to develop the cultural resources they now possess.

Still, despite all those resources, it is American culture that is dominant worldwide today, including in China and Britain - a dominance that is likely to continue for a few decades. It is mostly popular American culture that is so influential, but do Americans feel culturally inferior to the Chinese and British for that reason - because they, like us, are a young people?

I was in Delhi last December. I saw scrawny, dirty children perform acrobatics in the narrow space between the cars at red lights, then gesture with their hands to indicate they were hungry.

Originally from Rajasthan, they belong to a caste that once travelled from village to village depicting in dances stories from the Indian epics the Mahabharat and the Ramayana. Now, as a result of television, they are jobless. So they have migrated to Delhi to work in construction and beg for food at traffic junctions.

Indians today prefer Bollywood to ancient, sacred dances. Does that make India less cultured? Can we not consider Bollywood India's new culture, just as rock 'n' roll and soap operas constitute America's new culture?

Ms Lee concluded her essay thus: 'Being able to go online wirelessly, and being able to watch cable television - these have nothing to do with our level of thinking. The strength of this island-state lies in its ability to connect to the world and circumvent its own weaknesses. This in fact deepened my sense of loneliness at the thought of going home (from Beijing).'

I cannot understand her logic. In Singapore, she can access culture from the entire world, including Beijing and London. Why claim a 'sense of loneliness' on coming home?

I have travelled often. Each time the plane lands at Changi airport, no matter what a wonderful time I have had overseas, I eagerly look forward to returning home.

More important than whether Beijing or London has a superior culture to ours is what keeps us rooted to Singapore. For me, home is where my emotional bonds are, where my close friends and nuclear family live. I choose Singapore as home, though there are many issues which I feel the Government has handled less than wisely. I am less enamoured of other societies, whether or not my ancestors came from them, because Singapore is the country to which I owe my loyalty.

I am confident that if we continue to thrive, we will eventually develop a uniquely Singaporean culture. That that culture will not have 5,000 years of history behind it is irrelevant. We must dare to go our own way, different from those set by our colonial master or our ancestral lands.


Dr Lee is the director of the National Neuroscience Institute.

Time to reverse 'narcissism epidemic'

The Sunday Times Jan 17, 2010

The young today are more self-centred and less driven,
possibly due to their upbringing


By Lee Wei Ling

The principal of a mission school invited me to give a talk to his teachers recently.

'The purpose of inviting guest speakers to the school is to open up my teachers' minds about new possibilities and the demands of the real world,' he told me.

I was unable to give the talk but volunteered one of my doctors, an old boy of the school and a superb and compassionate doctor. I told the principal: 'My perspective on the education of these relatively elite boys is to teach them that they owe society a duty.'

The principal agreed, but observed: 'Unfortunately, given the changes in Singapore... my teachers are increasingly pushed by larger societal forces that worship the relentless pursuit of academic excellence as a means of material gain... While there is nothing wrong with pursuing academic excellence, it cannot be an end in itself.'

I and many other senior doctors have noticed that a significant percentage of newly graduated doctors are more self-centred and less hard-working than we were.

For example, there are more house officers with each passing year, and in some departments, there seem to be too many of them. The total work has not increased much, but this is divided among more house officers. Yet house officers complain that they are stressed out and they cannot cope with the work.

When I was a house officer, there was no payment for being on call. As a medical officer, I was paid $40 for the first four calls in the month, and $100 for each subsequent call. There were no mandatory maximum or minimum number of calls for house officers or medical officers.

But some time after 1990, house officers were not allowed to do more than six calls a month and medical officers were not allowed to do more than four calls. House officers are now paid $110 a call on weekdays and $150 on weekends. Medical officers are paid $210 a call on weekdays and $300 on weekends.

We used to have to do eight to 10 calls a month, and the number of patients I saw each time I was on call was considerably more than the numbers seen by house officers and medical officers today.

But despite having to do less work, junior doctors apparently have less time for self-study today. Consequently, many training programmes now set aside 'protected time' during working days for them to study. In addition, most departments have structured teaching programmes for young doctors - a far cry from the bad (or good) old days when there was no time during working hours for structured teaching and most of us learnt from patients or senior doctors. And to reinforce our knowledge and ensure we missed no crucial information, we would read a standard textbook from cover to cover.

All of the above would appear to be exceedingly difficult for the present generation of junior doctors. For some years, I wondered whether this was the fault of our medical school or indulgent parents.

The parents often come from humble families themselves, but have made good because of our meritocratic system. Having experienced hardship, they feel that their children should have whatever they desire. Consequently, young Singaporeans are more self-centred and less driven than their parents, and have little sense of duty to society.

Perhaps this is not a problem unique to Singapore. As Jean M. Twenge and W. Keith Campbell note in The Narcissism Epidemic: Living In The Age Of Entitlement, it is a problem endemic to developed countries. They define narcissism as 'a very positive and inflated view of self'.

Narcissism is the reason five times as many Americans undergo plastic surgery and cosmetic procedures today compared to just 10 years ago. It is the inevitable result of parents teaching their children song lyrics like 'I am special. Look at me' - precisely the skill teenagers and young adults obsessively hone on Facebook and MySpace.

What is the solution to the epidemic of narcissism? We cannot artificially create hardship so that our children become resilient. In the past, it was family upbringing that determined how the child turned out. Now, the children spend most of their waking hours in school or with their peers. My view is that the school should at least share the responsibility once shouldered solely by parents.

As I was writing this article, I received an e-mail message from the principal of Methodist Girls' School (MGS), Mrs Shirleen Ong, to tell me that Ms Jacqueline Woo, a patient of mine, 'has done well for the GCE O levels with five distinctions'.

Anyone who has witnessed Jac's physical disability will know how remarkable it is for her to achieve what she has achieved. She has a rare condition called 'primary generalised dystonia', which has left her body twisted like a pretzel. Her family has been very supportive of her and both her parents give her a great deal of attention, but they have not spoilt her. And her school, MGS, has played a crucial role in nurturing her.

It has accommodated her special needs. For example, because of her dystonia, she cannot write. Even typing on a word processor is tedious. She was given double the normal time for each exam paper, which meant typing for four to five hours at a stretch.

Her mother stood outside the examination hall in case Jac needed to go to the toilet, but Jac was so determined to use every minute that she did not take a break. Her mother said to me in amusement that the invigilators had to change shifts waiting for Jac to finish.

Her determination in the face of her physical handicap has touched many hearts. Even the school cleaner asked how she did and was happy that she had done well.

Some readers may criticise me for basing my conclusion on just one instance. But I firmly believe that a nurturing school that not only teaches a child academic subjects but also builds her character, together with caring but firm parents, is the most practical way of reversing the narcissism epidemic.

We should try to cure this epidemic as soon as possible.


Dr Lee is the director of the National Neuroscience Institute.

Heavy cost of pursuing beauty

The Straits Times Jan 9, 2010

By Lee Wei Ling

HUMANS have always sought to enhance their appearance. Excavations have uncovered prehistoric skeletons buried with ornaments. Wearing gems in pierced ears and noses is still common practice in many cultures.

With improvements in medical science, more invasive methods of enhancing physical appearance have been developed. The number of such procedures has increased exponentially over the past two decades. Some pose risks to patients.

Many Singaporeans appear to be trying these methods without, sometimes, full knowledge of the risks involved. I was shocked to read in The Straits Times on Wednesday of a 44-year-old man, the chief executive of a property firm, who died after a general practitioner allegedly performed iposuction on him.

Liposuction is a surgical procedure to remove fat from different parts of the human body - ranging from the abdomen, thighs and buttocks, to the neck and arms. The more fat is removed, the higher the risk.

The procedure may be performed under either general or local anaesthesia. In a clinic setting - versus an operating theatre - the anaesthesia used is usually the local tumescent method.

It is ideal that the patient is as fit as possible before the procedure and has not smoked for several months. While almost all doctors know that general anaesthesia carries some risk, some may be unaware that local anaesthesia is also not without danger. If the injection of local anaesthesia into the fatty area gets into a blood vessel, there can be deleterious effects on both the heart and the brain.

Last year, the Ministry of Health issued guidelines for various aesthetic procedures. General practitioners are allowed to do liposuction if they have adequate training, and do not suction more than one litre of fat at any one sitting. I have often wondered how the ministry can check to ensure that only one litre is suctioned each time.

Even if liposuction is limited to one litre of fat per procedure, there is still the risk of being under anaesthesia - albeit low if the patient is in competent hands. Also, there can be other complications, such as perforation of the abdominal wall, which can be life-threatening.

Not everyone is a good candidate for liposuction. To be a good candidate, one should be over 18 years of age and in good health, have tried a diet and exercise regime, and have found that the last 10 or 15 pounds (4.5kg to 6.8kg) of excess fat persist in certain pockets on the body.

Diabetes, any infection, heart or circulation problems are contraindications for the procedure. In older people, the skin is usually less elastic, limiting its ability to readily tighten around a new shape. In this case, other procedures can be added to the liposuction, such as an abdominoplasty - or 'tummy tuck' as it is popularly known.

The irony of liposuction is that while the procedure has clear risks, it has no compensatory health benefits. The fat that is detrimental to health is the intra-abdominal fat, which can lead to Type 2 diabetes. This is the common type of diabetes associated with being overweight and not exercising. It used to affect adults mostly, but as the epidemic of obesity has extended to children, there are now children with Type 2 diabetes.

Diabetes can affect many organs. It may lead to an abnormal lipid profile, hypertension and vascular inflammation, all of which promote the development of atherosclerotic cardiovascular disease.

Liposuction can remove abdominal fat only from under the skin (subcutaneous fat). This does not reduce the risk of Type 2 diabetes or coronary heart disease. Those adverse health effects are mediated via intra-abdominal fat, which liposuction cannot reach.

Dieting and exercise are safer methods to reduce obesity. In addition, they have beneficial effects on health.

Exercise may be beneficial beyond its effect on weight loss by more selectively removing abdominal fat, at least in women. The standard exercise recommendation is a daily minimum of 30 minutes of moderate-intensity physical activity, such as a brisk walk.

The Government seems convinced, and the public has been repeatedly told, of the inadequate numbers of doctors in Singapore, given our population size. In fact, we have more than enough doctors. The problem is that not all our doctors are doing what we need them to be doing. And the way doctors are currently distributed, there are not enough doctors in certain specialities that are not lucrative.

However, there is an excess number of GPs. Often, people become GPs because they were not counselled properly on possible career paths after they had finished their one year as a house officer.

GPs who limit themselves to coughs and colds and writing medical certificates may not earn much, after having accounted for rental and the salaries of clinic assistants. Thus they dabble in aesthetic medicine, for that is more profitable than being a good family physician.

For example, a 20-minute session of intense pulsed light therapy, allegedly to beautify the skin, can bring in $400 in cash up front - and not many patients ask for a receipt. On the other hand, looking after a patient above the age of 65 with hypertension and/or diabetes and/or high cholesterol or a stroke patient for one year can earn a GP $300 - after he has submitted the necessary information via Internet to Medisave. This is a situation that can tempt many GPs to practise aesthetic medicine rather than look after the health of their patients.

Ideally, we should train our GPs to become competent family physicians, and allow them to charge a consultation fee that reflects their skill and effort. In that way, they can be good gatekeepers for the acute hospitals, and emergency departments need not be swamped with patients who don't need to be seen there. Indeed, the Ministry of Health found itself apologising just a few days ago because Tan Tock Seng Hospital could not accept more patients, and ambulances and patients had to be diverted to other hospitals.

While the financial benefits of practising aesthetic medicine are clear, I wonder how many of these doctors can live with their conscience. It seems to me that many have become inured to guilt.

The message I wish to convey is simple: Never do any unnecessary medical procedure. Any attempt to alter the body's function carries risk. Beauty - and health - is not a matter simply of surfaces.


Dr Lee is the director of the National Neuroscience Institute.

The true nature of friendship

The Sunday Times Jan 3, 2010

Genuine relationships are built on more than mutual goodwill and exchanging of favours

By Lee Wei Ling

I had gone to bed at 7pm on Dec 30 from sheer exhaustion. I woke up at 2am and responded to e-mail on my Blackberry.

I noticed that I had missed two phone calls from two very close friends. It was obviously inappropriate to return the calls at 2am, so I e-mailed to say I'd return the calls during lunch time.

I then went back to sleep and have just woken up at 6am, trying to recall what day of the week it was because that would determine my schedule for the day.

For a moment, I thought it was Friday, New Year's Day. It was only when I went outside to pick up the newspapers that I realised it was only New Year's Eve.

I do not usually place any emphasis on 'special days' - whether it be Christmas, New Year's Day, Chinese New Year or birthdays.

These days are determined by the calendar, but to me they are no different from regular days.

In fact, they often are less pleasant than regular days as I dislike the noise and crowds of special days. I solve that problem by simply staying in my room at home on such days, clearing e-mail and paperwork. This applies even to the reunion dinner on Chinese New Year's Eve.

I am by nature not a sociable person. Indeed, I had become asocial by the time I reached pre-university in school. I do have friends and I have never neglected to help any of them when they needed help.

But for most of my adult life, I have not been willing to spend more time than necessary on conversations and social interactions with my friends. I felt that would be a waste of time - time that could have been better spent reading medical journals, analysing research data, exercising and other 'more important activities'.

It was only since 2001, after repeated bouts of illness, that I learnt that friendship does not just mean mutual goodwill, but also spending time with friends talking about things other than medical research.

Staying for months in hospital makes any friend dropping in to see one a welcome relief, though I was not bored as such as I could work on my laptop. As prisoners know, solitary confinement (even in a hospital) can be terribly punishing on the spirit.

Human beings are social creatures. We are social not just in the trivial sense that we like company, and not just in the obvious sense that we depend on others. We are social in a more elemental way: Simply to exist as normal human beings requires us to interact with other people.

There is a Chinese saying, jun zi zhi jiao dan ru shui, xiao ren zhi jiao tian ru mi (君子之交淡如水, 小人之交甜如蜜). The literal translation is: 'The friendship between two honourable people is as understated as water.'

Many of my English-educated friends have difficulty grasping this concept. They would often exclaim in surprise: 'Surely you have changed the saying. The relationship between two honourable people must surely be as sweet as honey.'

No, I have not reversed the idiom. The friendship between two good honourable people is understated. Each will help the other when help is needed even before a request for help is issued. And when one offers to help, the other would accept without feeling any obligation to return the favour.

The 'friendship' between two petty people, on the other hand, is as cloying as honey. When one offers to help, the other would feel that at some point the favour would have to be returned.

The simplest analogy for this saying is as follows: Between honourable friends, there is no account of how many favours I owe that friend and vice versa. The relationship between petty people, on the other hand, requires an accurate account, since for every favour accepted, a return favour would be expected. As far as I can help it, I avoid such friendships.

I am not in the habit of making New Year resolutions. We should change our undesirable behaviour and mend our ways as soon as we discover that our behaviour is less than honourable; there is no need to wait for the New Year to resolve to do so.

2009 has given me both suffering and happiness. I expect the same of 2010. But to all readers who feel a New Year represents a new chapter in life, I wish you a Happy New Year, filled with true friendship and good deeds. And may 2010 be a better year than 2009.


Dr Lee is the director of the National Neuroscience Institute.