LAST CALL – December 2013

javier-pic22Three Disasters and a Country


The second half of 2013 may well go down in Philippine history with a record three disasters in a row. While other nations confront a calamity for several or more years, the Philippines unfortunately had to grapple with three disasters in just a few months – two natural and one man-made.

In October, a magnitude 7.2 earthquake struck the Visayas, with the epicenter in Bohol, and affecting the neighboring cities of Cebu and Davao. The quake, which was the deadliest to hit the Philippines in more than 20 years, is said to have released the energy equivalent to more than 32 Hiroshima bombs. It killed more than 200 people and displaced nearly a million people.

Less than a month later, while the dust had just begun to settle in the Visayas, a monster super typhoon – Yolanda (international code name Haiyan) hit the island province of Leyte, badly affecting Tacloban and Eastern Samar, killing more than 5,000 people and causing unimaginable and unspeakable destruction of lives, limbs and properties. Touted as a Category 5 storm and given an unprecedented Signal 4 which is the highest storm signal issued by the Philippine weather bureau, the typhoon was labeled as the strongest ever recorded and reported to make landfall. Yolanda undeniably lived up to all weather forecasters’ hype.

Just hours before the super typhoon struck, the Philippines reeled from another super storm – the man-made calamity of a national scandal woven by Janet Napoles. As she sat on the witness stand during the Senate Blue Ribbon Committee hearing on the pork barrel scandal, she unleashed powerful torrents of “I don’t know, I cannot recall and I invoke my right against self incrimination”. In the end, she wrought havoc on the collective psyche of a nation which tried to make sense of how this Basilan undergraduate was able to dupe the Filipino people of ten billion pesos allegedly.

Last Call

Napoles’s dumbfounding silence on the stand provided the eerie calm before the storm Yolanda. She essentially was the front-act for the super typhoon.

With two natural calamities and one man-made disaster, the world once again witnessed the much vaunted Filipino resilience. The entire humanity saw the indomitable Filipino spirit that goads all Filipinos – calamity survivors or not – through their daily lives.

The interaction of these three calamities cannot be lost on any intrepid observer. While the relief operations for the quake victims had yet to be completed, the super typhoon derailed all these efforts and mobilized the most massive relief operations ever to be staged for a Philippine disaster – engaging the services of governments and countries around the world.

Ironically, it takes Mother Nature to come to seemingly protect a man-made disaster whipped by Napoles as Yolanda takes the nation’s attention away from that which Nature has nothing to do about – although one wonders how much of human nature propels and fuels greed and avarice among Napoles and her accomplices. As she gets sidelined and shielded from public fury in the aftermath of Yolanda’s devastation in the Visayas, Napoles gets a break from media headlines and national attention. Yet, she and the ‘monster’ of all scams that she is involved with is an economic disaster where the alleged amount behind the large scale pillage of the national economy would certainly bring about a huge impact on the rehabilitation of the quake and typhoon-ravaged areas of the Philippines.

With massive local and international aid pouring in, the relief operations will slowly but certainly bring back the damaged cities and provinces back on their feet, and shall once again prove to all and sundry the grit and strength that Filipinos are made of. Call them imperturbable, sturdy and iron-clad. (As CNN reporters repeatedly emphasized, they do not and cannot fathom where Filipinos draw their strength from.)

One wonders – when will we, as a nation get the relief (and closure) from Napoles, her coddlers and benefactors? This country has had disasters far too many. We need the collective respite from any other disaster. Heavens spare us from typhoon “Tanda”, “Sexy” or “Pogi”.

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LAST CALL – November 2013

javier-pic22Fates and Faiths

By Saturnino P. Javier, MD, FPcP, FPcc, Facc

There is a certain unease that creeps over me in the aftermath of the 7.2 Magnitude earthquake that hit Bohol and nearby provinces and destroyed lives, limbs and properties. Something just does not seem right when there is a pervasive sense of relief and gratitude that engulfs many of those living in Metro Manila as they heave a collective sigh —“What a relief it did not happen in Manila!” Or something like—“Thank God, it spared Metro Manila!”

The remarks may seem selfish, or even un-Christian. Yet, realistically though ironically, it must be a common reaction among us in the city.

I certainly understand the reason where the sense of gratefulness is coming from. However, it does not seem right that we thank God that the quake hit Bohol and it spared us and the city. Or that it killed Boholanos and spared Metro Manilans. Or that it was all right for a quake to hit any city elsewhere, just not ours. When we thank God, it seems like God is a punitive and mer-By Saturnino P. Javier, MD, FPcP, FPcc, Faccciless Being who selectively imposes devastation and death on some places and people.

When the dust settled down after the quake, hundreds died and damage ran up to billions. In the aftermath, Bohol and nearby provinces dealt with personal losses. Many must have been traumatized and scarred – mentally, emotionally and physically.

Equally painful, if not worse, the province suffered indescribable cultural and historical losses. Many historical landmarks – especially places of worship in Loboc, Baclayon, Maribojoc, Loay, Dauis and Loon – were either levelled to the ground or destroyed beyond recognition. The full glory and magnificence of those centuries-old churches were lost. For many Boholanos and the others who had the privilege of seeing those churches up close and personal, the grandeur and stature of those places would just be etched in the collective imagination of all those blessed with seeing them before.

Countless poignant images surfaced after the quake. There was an iconic Madonna and Child statue standing tall as a mute witness amid the pile of rubble from the 180-year-old Our Lady of Light Parish Church in Loon, Bohol. Another statue of the Virgin Mary stood unscathed at the Santa Cruz Parish Church in Maribojoc, also in Bohol. On television, there was the repeated showing of the Santo Nino in the Cebu Cathedral where the bell tower collapsed.

Likewise, there were the many images of earthquake survivors leaving behind all their belongings and just holding on to their Santo Nino’s, Nazareno’s and Virgin Mary’s, clutching their crucifi xes, embracing their faiths and clinging on to what seemed like their last vestiges of hope.

Amidst the wreckage, the chaos and the devastation, the devoutly Catholic Filipino communities stood strong and unperturbed, turning (or returning) to their faith, showing all the world that the indomitable Filipino spirit will triumph and prevail – with God’s merciful assistance and divine intervention.

Alas, something seemed to have been lost in the media reporting, or downplayed in the chronicling of events even if a few have alluded to it. The fact is that what saved a lot of lives was that the day was a national holiday – where most students and employees were not in the schools or offi ces respectively.

What needs to be underscored is that quite interestingly, it was a Moslem holiday—the Eid al-Adha—that seemingly spared a number of Christian lives. In the interweaving of lives, fates and faiths, an important and significant day of the Moslem faith kept a number of Catholic lives from being lost in the powerful quake.

Last CallHow do we put all these therefore– without being sacrilegious or blasphemous? Worship for Allah spared the lives of many worshippers of Christ? A day of sacrifice in the Moslem faith ushered unspeakable sacrifices and hardships among the Catholics?

When fates and faiths intertwine, there are rich symbolisms, deep connections or undefined ironies that may be fully hard to comprehend, or even accept. It leaves us all with the singular appreciation that when all else is lost or gone, we turn to Someone to pull us through.

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Last Call – September


Between Our Taxes and Kleptocracy


(N.B. This article was  first published in Health & Lifestyle Magazine in July 2005. Today, eight years later, with the pork barrel brouhaha involving Janet Napoles and several lawmakers, it is frustrating that the insights and sentiments expressed are even more painfully relevant. Some things never change – like our hardearned taxes finding their way to Machiavellian schemes fueled by greed and corruption. With little revision, I am featuring the article once again. This, hopefully, should be the last.)

How many instances have we, as physicians, and as citizens of the Republic of the Philippines, quietly complained, deeply sighed, occasionally hissed out of exasperation and dismay, to ourselves or to our accountants when income taxes are being filed and paid for? How many times have some of us muttered “What for am I paying this government a lot?”

Is it imagined or real when there is a pervasive resistance letting go of something one has worked hard for and rightfully earned to a system that seems mired in graft and corruption? Is it immoral to have a heavy heart when we should willingly and uncomplainingly divest ourselves of income earned and productivity compensated? We pay taxes for the common good, the good of the Filipino people. Essentially, what good will our money do if it only serves the good of a few people, the depths of a few pockets, the accounts of a few Jose Velardes and Jose Pidals (and now, a few Janet Napoleses)?

Last CallIf Filipinos feel their money goes to productive endeavors, infrastructure growth and healthcare improvements – the sense of financial loss is balanced by the prospect of community gain and societal growth. For many of us, the sense of loss is compounded by the perception of absence of any foreseeable gain. Between the taxes paid and the tangible or perceivable gain for the country, the community and the society is a well-entrenched culture of corruption and greed that bestows upon us the second place on Transparency International’s (2004) list of most corrupt countries in the world, the singular notoriety of having two Philippine leaders listed as the most corrupt leaders in the world and an embarrassing rank of 40 (out of 60) in a list of countries perceived to have the most profitable business climate because of, among others, concerns aobut corruption.

Physicians, by the very nature and requirements of their educational attainment, get to where they are after years of hard work and sacrifice, late nights, mental exhaustion and considerable expense. Thus, when one embarks on a professional clinical practice, every cent is ultimately well-deserved.

When paying taxes, we derive relief and consolation from the expectation that our hard-earned money will be put to good use. In the Philippines, “good use” nearly borders on what dreams are made of. We dream of the cleanliness of Singapore’s streets and subways. We dream of the conforts and amenities of Hongkong’s Kai Tak Airport. We dream of quality free education in the United States. We dream of the quality of life in some European countries.

Back here, we do not dream big. We just hope real. We just think realistic. We just want clean toilets, efficient baggage handling and functional baggage carts in our airports. We just want to walk around safely on our side streets. We just want floods controlled. We just want garbage collected, roads repaired and traffic decongested.

The iniquity of this all is when leaders who are supposed to lead us to economic stability plunge us to near-bankruptcy. Our leaders bring us closer to fiscal crisis and we have to bail them out of it. Our leaders keep on borrowing and we have to be diligent in our paying. Between our paying and the government appropriating and earmaking, someone else is pocketing, mulcting, extorting, embezzling and plundering.

Paying taxes is both a duty and a sacrifice. Our propensity to resist is fueled by the avarice of a few. Our desire to contribute to nation-building is hampered by the mindless mind-boggling spending of others. How can we imbibe selflessness if all that we witness is senselessness? How can they preach honesty when they practice kleptocracy and large-scale pillage of the national treasury? and how can patrimony be invoked when plunder is in vogue?

For comments,

LAST CALL – August 2013

javier-pic22Why Pork – In All Forms – Is Bad


Pork distinctively represents the quintessential source of the bad cholesterol, the so-called LDL-cholesterol or low density lipoprotein-cholesterol. This is the heart specialist’s bane – the major compound responsible for build-up of plaque inside the blood vessels of the heart and the brain that can lead to a major heart attack of a stroke respectively.

Animal fat, whenever mentioned, expectedly includes pork fat – in all its diverse sumptuous expressions – namely lechon de leche, crispy pata, inihaw na liempo, lechon kawali, bagnet, fried pork rind or chicharon, among others. Yet, the taste is so deliriously delicious that it makes one wonder – how can something so good be so bad. Yet, it is common knowledge among medical professionals what such animal fat, particularly pork and beef, can do to our health and our hearts.

A typical physician’s admonition for any heart patient is a low fat or a low cholesterol diet – since it is one of the hallmark strategies for the prevention of heart and blood vessel diseases. Any advocacy on heart wellness will inevitably include dietary restrictions that will exhort the individual to stay away from this maligned animal fat.

The evil that pork can do does not seem to be confined to a person’s heart and brain. Judging by recent events in the political arena, pork – in another manifestation – is also bad for the soul of a nation. Pork has crept onto the national consciousness as it has brought to the fore the integrity and moral ascendancy of a number of senators and congressmen. It is easy to conjure how this can erode once again the foundations of trust and confidence of a nation that never seems to run out of news of corruption and scandals every day.

Senators and congressmen are both provided priority development assistance funds (PDAF) or more widely known as “pork barrel fund” as mandated by the law, where each senator gets 200 million; each congressmen, 70 million. The intricate and schematic general appropriation that ensures honest and justifiable use of such funds has never been fully appreciated by the Filipinos who continue to view such funds as a symbol of corruption. The notorious “pork” of our legislators (including seven senators and several congressmen) now appears to have been diverted into bogus projects and clandestine non-existent beneficiaries through the efforts of a company that has been able to perpetuate such a scheme for about a decade.

JLN, a company owned by a Janet Lim Napoles, is at the center of the controversy, as it has been touted to be at the heart of a scam that has skimmed 10 billion pesos (or more) from the pork barrel funds of legislators.

This scandal puts an added spin to the evil that surrounds pork. Pork thus becomes not only a source of unwanted vessel deposits, but also a harbinger of corruption and malversation. As it corrupts the blood vessel of the heart and the brain, so does it damage the moral fiber of a branch of government and the nation at large.

Pork fat is a known source of the component of cholesterol deposits inside the blood vessels leading to narrowing and obstruction of blood flow. All dietary efforts as well as drug therapy are geared to eliminate it, or prevent its accumulation. Pork barrel fund has come to be regarded a national iconic representation of what is illicit, inappropriate and unhealthy. It is thus no surprise that such pork has become an easy fodder for corruption and plunder – a mechanism that has involved even the duly elected solons of the land.

It is high time pork – in whatever form – must be avoided. Pork fund, much like pork fat, causes harm. It should be restricted. That is simply a clear national prescription for a nation’s wellness and progress.

For comments, A pin from a grateful OFW

Last Call – July 2013

javier-pic22Traveling with OFWs

By Saturnino P. Javier, MD, FPCP, FPCC, FACC

There are expectedly certain Manila-outbound international flights that teem with OFWs, particularly in those bound for Italy, Singapore, and Middle East, among others. Some of these countries are take-off points for other destinations while the others are the ultimate ones.

On those flights where i had to take the coach class, there were times when i had some of them seated next to me. I can honestly say that those occasions were at times instructive, enlightening, even uplifting (Of course, in all honesty too, there were occasionally annoying and trying times. But that is another story).

Marita, a very nice thirty-something lass from Dumaguete, was bound to work in Rome as a domestic helper. I could assume that it was her first time to travel. As i was seated on an aisle seat, I could see her repeatedly make the sign of the cross before the plane took off . This did not seem like a customary sign of the cross being made by a relaxed, devout Catholic. This was a fidgety, obviously anxiety-driven in the name of the father, etc. repeated countless times before the flight took off . Also, she kept fiddling with her bag, which I presumed contained her valuables, which was why she did not want to leave it in the overhead bin. It was a medium-sized purse that went unnoticed by the flight attendants and thus did not get stowed.

She sat frozen during the take-off and only relaxed somehow when she saw me recline my seat after the take-off . She asked me how to do that (I can be a grouch on certain trips especially when the flight is an early morning one. But in this instance, I just felt that assisting her was the natural gentlemanly thing to do). So I patiently told her how to recline her seat, how to turn on the night light, how to turn on her monitor to watch a movie or a show. I was, in fact, amazed at how patient I was. That was not my usual self, I think.

But heck, I would always tell myself that these OFWs are modern-day heroes whose collective remittances through the years have kept the Philippine economy afloat even during economically challenging times (The current dollar reserves stand at 84 billion dollars largely from the remittances of OFWs. Philippine Daily Inquirer, 5.7.13.). So I kept reminding myself: What is a little inconvenience if only for what this lass and many others do (unknowingly perhaps) for the country?

When the meals were being served, the english- speaking, accent-heavy, eyebrow-raised filipina attendant happened to be the unfriendly and condescending one. “Ma’am, would you like braised beef or the deep-fried fish?” did not at all register with Marita, as I could hear awkward momentary silence after the question. I casually just asked her what she wanted for the attendant to serve her. When asked “Something to drink, ma’am?” she looked at me as if asking for help. So I just decided to order soda for her. She smiled, which was enough “thank you” for me.

Since this was an emirates flight, that flight attendant would be considered an OFW by definition. Yet, she probably felt she was on a different level. She probably felt she was a notch higher. Some degree of schadenfreude seemingly operates on this flight attendant, who probably considers herself a more supreme race compared to this girl.

What she does not know is that Marita is the eldest of six, whose father died in a tricycle accident when she was ten, while the mother sells vegetables and fruits at a stall near their house in the province. Her journey to Dubai is courtesy of an aunt whose two other children have been able to work overseas.

I decided to play a little trick on this flight attendant on her behalf. I asked the flight attendant that the girl wanted to have a feedback or evaluation form to rate the service of the crew. Well, the attendant seemed to take notice. There was some noticeable change in her demeanor when she was back for another food service. She was all too smiling and more pleasant, and spoke to her in Tagalog that the feedback form would be given soon. We both smiled when she handed her the form.

As we touched down, I played my good self to the hilt. I was unusually nice. She was, after all, old enough to be a daughter. I can only imagine the pain of a parent allowing her to leave for a Middle eastern destination in search of greener pastures. I reminded her to work hard, to pray, to stay safe, to always keep the number of the embassy, among others.

As we touched down, I could see two gentlemen eagerly opening the overhead bins despite the announcement and reminder for the passengers to remain seated until the plane had come to a full stop. They were obviously filipinos when they mumbled filipino words as their other companions ribbed them after the female flight attendant yelled at her station:“Please sit down, sit down!” I whispered to Margie: “Don’t ever do that. That is dangerous.”

Before she left me when we stepped out of the plane, and as I proceeded to look for the gate of my connecting fl ight, she ran to me and handed me a small native pin. Was I touched…!

For comments, A pin from a grateful OFW

Last Call – May 2013

javier-pic22The Fly in My Urinal

By Saturnino P. Javier, MD, FPCP, FPCC, FACC

Warning: This article is men’s talk about urinals. My deepest apologies to women reading this piece, or to everyone who may feel queasy about such a topic.

This relates to a question that may haunt some men for quite a while. I am talking about a fly. It is the life-sized image of a fly etched on urinals inside men’s rest rooms. There has been numerous sightings of the urinal fly everywhere.

I first saw it a few years back on different occasions at the WC (water chambers) of Schiphol International Airport in Amsterdam, the JFK Airport in New York and the Changi International Airport in Singapore. Nowadays, I always see it at the men’s room of Edsa Shangri-La Hotel in Mandaluyong whenever some function or meeting is held in this venue.

It is not a real fly, but a realistic etching on the bowl, although others are stick-on decals. That housefly, Musca domestica (order Diptera), is supposed to change human behavior, or specifically men’s behavior (specifically their urinating habits). It is supposed to affect maintenance systems and costs incurred by hotels, parks and airports. Most importantly, it can impact on ecological and environmental conditions, among others. The original idea is by Dutch economist Aad Kieboom (as reported in

That fly, lifeless and perched unobtrusively on the surface of a urinal very near the drain, supposedly provides an easy target for men when they urinate. It appears there are behavioral studies that indicate men generally like to aim and instinctively direct their urine stream on a target. That fly provides something for men to get fixated on while relieving themselves. Consequently, this entomological recipient and target of urine stream supposedly brings about substantial savings in cleaning and maintenance costs.

Think of the world’s busiest airports, the most crowded stadiums and arenas or the most congested public park restrooms. Think of how many liters of urine do not find their way to urinal drains because of spillage from inattention and sheer recklessness. Think of how many manpower hours and resources are utilized to clean up and maintain toilets in those places. Then think of how much expense is spared if only men are goaded to aim better. Alas, all it takes is an insect to take men right on target. Some behavioral analysts call it process control.

Schiphol Amsterdam reported that since they introduced the fly on their bowls, the frequency of misdirected urine streams had been reduced by as much as 80 percent. Not bad, when one realizes that all it took was a little etching or a sticker of an insect plastered on urinals.

Intuitively, men look down when they urinate. Some hotels put paintings or some news clippings or announcements on the walls in front of the urinating guest. Those strategies invite unsanitary habits and ecological disasters resulting from misdirected streams and volumes of spilled urine. The image of a dirty insect, being crushed by the huge torrential downpour of warm acidic urine for several minutes, is certainly an inviting proposition for men whose eyes and minds may wander while waiting for the ultimate relief of bladder-emptying.

Whether such strategy is brought about by engineering, aesthetics, interior design or marketing genius, it is certainly novel, practical and, as has been shown, effective. What a brilliant concept to have this ubiquitous insect which has been known for ages to carry disease and sickness to be emblazoned on dirty urine basins. A book author, Richard Thaler, considers it a nudge, defined as a bit of engineering savvy that positively changes behavior without really doing much or changing a lot. Indeed.

But why a fly? Are there other logical options? A small cockroach? (No, this is bad for people with fear of cockroaches.) A locust? (No, this raises the prospect of a jumpy insect scampering away when it gets targeted by urine stream.) A butterfly? (Not good really, because it is not a vermin or despised dangerous disease-carrying creature so there is no need to annihilate them by peeing on them).

The fly, on the other hand, is ubiquitous and can always find its way to a toilet bowl or urinal which really is its preferred lair. It can always find its way to the interiors of both the priciest hotel and the dingiest public toilet. Moreover, a man urinating on a fly will never incur the ire of insect conservation groups or animal welfare organizations.

Thus, anyone who sees this insect nonchalantly stationed near the drain of a urinal, feel free to pee on it. It is ecologically friendly, environmentally responsive, behaviorally appropriate and surprisingly sanitary.

For comments,

Last Call – March 2013

javier-pic22Self-Gifting-Why Not?

Time to reward thy self, Santa (Conclusion)

By Saturnino P. Javier, MD, FPCP, FPCC, FAC

ENTITLEMENT is the underlying persuasion that lures the buyer to purchase a commodity. It is the core motivation that drives the consumer to think and feel that he deserves a particular product on sale.

This notion is behind most strategies which get repeated countless of times and in diverse ways in many department stores. Stores would prey on the inherent gullibility and weakness of the buying customer by harping on their self-reward and selfcentric inclinations. The buyer is inevitably drawn by a marketing spell that urges and pushes him to feel that he, after all, needs to think about himself, care for himself, reward, and ultimately please himself.

In an annual survey by the US National Retail Federation (NRF) in 2012, it was shown that more Americans were buying themselves gifts during the holiday season while the rates of gifting for others had dropped. The survey indicated that the percentage of people who stated in October that they intended to grab good bargains for themselves during the holidays increased to 60 percent last year (it was about 50 percent in 2004 when the same question was first raised).

For many, it appears that self-gifting starts even before and during the holidays. It is intuitive to consider that for most of us, self-gifting after the holidays, when everyone else has been remembered and made happy, is perfectly acceptable. Indeed, why not the self, after all the others, for a change?

It surely takes away the guilt. Self-centric moves after what seemed to be a long and winding selfless journey during the year is not really a tough call to make. Someone even once sang that the greatest love of all is learning to love yourself. It is not hard to justify that little acts (though expensive sometimes) of putting a premium on self-worth is not a crime, or a fodder for selfishness and narcissism.

Paco Underhill, a writer for behavioral research and shopping since the 1970s, maintains that rationalization plays a large role in the self-gifting process. When one says that by buying a shirt, he will look better for his spouse, or his partner will appreciate this fragrance on him, or this gadget will make him punctual for all his appointments in consideration of others who keep complaining about his tardiness, the purchase for oneself still translates to a kind and thoughtful consideration of others.

Many times, we have been urged by our better halves or our beloved partners, to dispose off a shirt, a pair of jeans or a watch for a newer brand, make or look. Well then, guess what, by buying something for ourselves, we actually do them a favor.

Anyone can always rebuff this notion with a sarcastic, “Yeah, right!” But who can argue that for some, the underlying motivation is indeed the thought that what we purchase will still make someone happy, overwhelmed, or grateful? In the end, one’s shopping translates to someone else’s approving. One’s buying means someone else is benefiting.

According to the NRF, the self-gifting trend, which appears to be increasing in popularity through the years, was expected to reach an all-time high last year. This is still in keeping with the bleak economic situation that has affected many countries. The NRF estimates that the average shopper (viewed as honest enough to admit) plans to splurge about USD 240 (or nearly PhP 10 thousand) on “self-gifts”. This is a jump of 27 percent in five years.

Now, do not wonder anymore why SM, Robinsons, and Ayala are paying good money to announce their mega sales, warehouse sales, inventory sales or closing out sales on the leading newspapers everyday. Consider that in the US, the retailers are targeting the nearly USD 240 that each one is earmarking for self-designation and self-gratification.

Thus, the malls announce endlessly, repeatedly, and ubiquitously in all marquees, standees, one-page advertisements: “You are special; you deserve this; treat yourself; reward yourself.” All these are potent invitations to nurture this natural human side of each one of us that makes us feel we deserve to think about ourselves sometimes. All these remind us that a pat on the back or a tap on the shoulder surely will not hurt.

Somehow, my family fell for this at the start of the year. And the best part? It might have rendered us penniless, but quite surely, it was guiltless.

For comments,

Last Call – February 2013

javier-pic22Time to Reward Thy Self, Santa

By Saturnino P. Javier, MD, FPCP, FPCC, FAC

Just a few days after New Year’s Day, my eldest son, Luigi asked me to accompany him to get some casual walking shoes in some shops in Makati. By then, many shops were offering huge discounts on their rack merchandise – by as much as 70 percent off the actual retail price. My 12-year-old daughter Sofia joined us later in the day and she exclaimed, “How could anyone let that opportunity pass?” Never mind that there was really very little need for the merchandise – whether it was a shirt, a pair of shoes or toiletries.

I guess many of us sometimes find it hard to resist the marketing wizardry and sales pitch of most department stores and malls, especially after the holidays.

Time to RewardIt is a shrewd marketing strategy when stores would slash the price of an item by half the price to entice the customer to purchase it. The unsuspecting and initially unwilling customer who bites the bait of a markedly reduced item now feels empowered financially since he has been able to save from this purchase and, thus, ready to procure another discounted item (even if frivolously at all). In the end, the same customer will probably end up spending more than what he originally intended.

For many of us, the whole holiday season must have been spent looking for presents for everyone we remember and care for, think about, and thank for the year that was – the family, the house help, drivers, secretaries, mentors, colleagues, friends, co-workers, and subordinates among others. The many days before the Yuletide season must have been devoted getting something for everyone and anyone – except thy self.

In the holiday frenzy that sent traffic to a standstill, the malls to a sea of humanity and the parking areas to chaos, the race to the cash register to obtain presents for those we care about was a tedious challenge. How much of that purchase was driven by fatigue and time constraints (“I just want to get this over and done with.”), sincerity (“She will truly appreciate this.”) and financial constraints (“I better get this for him because it is on sale.”) is subject to lengthy dissertation, which the recipient will probably never ever know.

Come Christmas time, many of us watched at the sides as others excitedly opened the presents we had painstakingly obtained for them. We smiled at the thought that someone liked our gifts, we were elated at the sight of the driver eagerly trying on his new shirt, and we gloated at the compliments thrown our way for the best paella we sent (ordered for) them.

In the gift-giving melee of the season, many of us appropriately took the back seat. The syndrome of “I, me and myself” was relegated to the background. As the cliché goes, it is infinitely better to give than to receive. Playing Santa Claus to others surely brought out the true Christian in some of us.

But pray tell! Who does not want to be at the receiving end, too? Who does not want to open a handsomely wrapped package adorned with multi-hued glittering ribbons, bearing a personalized gift card embodying the heartfelt greetings of the Christmas season?

I always get ribbed no end by the children when my concept of wrapping gifts is requesting the secretary or the house help to buy those ubiquitous ready-to-use Christmas bags – or the “instant” package – that just requires a little tape to fasten and seal the contents from immediate scrutiny. Someone once expressed disdain for such Christmas bags saying it is the laziest and most impersonal way to gift someone you care about. I apologize that I have yet to abandon this practice totally.

When the Christmas dust has settled (or the drizzle has stopped), the holiday frenzy has ebbed, the alcohol has waned off and the lechon stains on the shirt have been washed off, what now, Santa Claus? Should this now be a time for Santa to reward thy self? A time for self-gifting – since after all, he has been good during the season?

Alas! Self-gifting is now an increasing trend in the world. As some consumer studies have documented, there has been an increase in the incidence of people who feel they ought to reward themselves by self-gifting. Retail experts and economists have reasoned out that tougher economic times have somehow driven consumers to justify buying presents for themselves by availing of the generally steeper discounts during the holidays.

(To be concluded in the next issue)

Last Call – January 2013


How the Holidays Can Be Bad for the Heart

By Saturnino P. Javier, MD, FPCP, FPCC, FAC

The Philippines has the distinction of having the longest Christmas season (and, thus, the longest holiday) in the world. It is customary to see malls and shops putting up Christmas decorations and hear Christmas carols being played as early as September. Morning programs immediately start a countdown to Christmas day as early as October.

Holidays are expectedly associated with conditions and situations that pose threats to wellness and health. They are synonymous with partying, excessive drinking and overeating. Ironically, the supposedly ‘holy’ days bring about an abundance of health ‘sins’ – alcohol, salt, sweets, smoking, stress, sleeplessness, even ‘shabu’ and other drugs.

In another column, I wrote about the benefits one may get from wine and alcohol when taken in moderation. The American Heart Association (AHA) maintains that moderate alcohol consumption, which is one to two drinks per day, is associated with a reduction in the risk of death from cardiovascular disease.

Drinking excessive alcohol can raise the level of some fat molecules in the blood, particularly the triglycerides. Alcohol products also have calories which can lead to obesity and thus a greater predisposition to diabetes. Furthermore, some binges of excessive drinking can lead to undue increase in blood pressure and stroke.

In fact, there are conditions that are specifically related to holidays. Holiday heart syndrome is the occurrence of irregular heartbeats brought about by a binge of alcohol consumption during a holiday drinking spree. It can occur in individuals with or without known heart disease. Stress, dehydration and undue excitement can all contribute to a heightened predisposition to having an episode of this holiday phenomenon.

While generally not serious, the palpitations that an individual experiences can lead to an emergency room visit. The most common irregularity is called atrial fibrillation where the heart rate can go up to as high as 600 beats/min (the normal is 60-100).

The irregular rhythm or “arrhythmias” usually resolves in less than 24 hours, especially in those whose hearts basically have no structural abnormalities. It generally does not require maintenance therapy, but one must keep in mind that a similar alcohol exposure can trigger the same bout.

There are some studies which indicate that these “ber” months of the Christmas season are, in fact, associated with deadlier heart attacks compared to other months of the year. In other countries, where the cold winters take its toll on the people during the holidays, the cold season is another factor thought to contribute to the increased incidence of heart attacks and strokes aside from fatty foods, alcohol, depression and emotional stress. Additionally, reduced hospital staffing and absence of medical professionals could be considered as aggravating factors.

A study by Kroner, published in Circulation 2008, indicated that deaths from heart attacks increased by 33 percent during the months of November to January – with its peak on Christmas and New Year’s eve. The authors explained that the increased incidence of heart attacks was brought about by the well known effect of stress on the release of chemicals (catecholamines) in the body. These can increase the blood pressure and heart rate which have deleterious effects on the heart and blood vessels.

A related 2004 study in the Tufts University School of Medicine that examined 53 million death certificates from 1973 to 2001 at the University of California in San Diego indicated a five percent increase in deaths involving heart conditions during the holiday season. Christmas alone was associated with a 12 percent increase in deaths and illness, with heart disease as the main cause.

This is further validated by a 2004 Harris Interactive survey, which established that about 80 percent of adults suffering from high blood pressure in the United States engaged in unhealthy behavior during the holiday season, which expectedly placed them at risk of a heart attack. The survey showed that these people ate about 60 percent more than usual while their levels of stress mounted by about 50 percent.

This should not really come as a surprise, given how holidays and celebrations have a way of making everyone, with or without a heart condition, throw caution to the wind. When complacency and stubbornness set in, many things are bound to happen. Physicians’ visits are cancelled or postponed for later dates. Prescription refills are missed. Regularity of drug intake goes haywire.

In congested cities like Metro Manila, the situation is worsened by the perennial holiday rush that creates the deadly mix of overcrowding, heavy traffic, frayed nerves and temper outbursts.

Furthermore, the extremely clannish Filipino culture brings about depression and added stress for those whose relatives and loved ones are gone, or are working and living in another country. All these are key elements for developing acute heart conditions.

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Last Call – December 2012


The No-Charge Policy Among Physicians

By Saturnino P. Javier, MD, FPCP, FPCC, FACC

One of the essential aspects of medical practice in the Philippines is the “no charge” policy – the rendition of medical services with no expectation of monetary or material compensation. Here, the provision of healthcare service carries no price tag or service fee. Such policy can be an encompassing privilege given to a wide number of patients for a wide variety of reasons.

The delivery of free service can be borne out of cultural peculiarities, partly the ‘bayanihan’ spirit, partly an offshoot of our extremely clannish societal structures and extended family systems. It is also driven by the dictates of the Hippocratic profession itself, socioeconomic realities, personal favours and indebtedness (the ‘utang na loob’ mentality), among others.

The Hippocratic Oath stipulates that a physician should not exact any payment from a fellow physician and his colleague’s immediate relatives. This has never really been a contentious issue among physicians – when one talks about simple consultations, house calls, phone follow-ups, outpatient visits, etc.

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But some questions arise when the physician-patient (or essentially physician – physician) relationship involves a surgery or procedure, where the attending physician does not just render or give simple opinions, prescriptions or instructions, but performs a procedure whereby he himself incurs radiation exposure, drug exposure, undue stress, among other things.

Giving free consultations to colleagues should essentially be viewed as a privilege. Being sought out by a fellow physician is fundamentally a badge of honor that indicates a colleague has recognized one’s expertise and skills. While charging a colleague is against the tenets of the Hippocratic Oath, one may argue if such tenets cover complicated and life-threatening surgeries, prolonged or protracted life-saving procedures, or time-intensive long-term hospital managements.

Certainly, there are situations when doctors willingly render services for free – during medical missions, in times of natural calamities, or similar urgent situations requiring the services of medical professionals. These are clearly defined and perceived at the outset to be charity projects – and the participation of medical professionals are borne out of volunteerism and humanitarian considerations.

It should be borne in mind that charity can also potentially deliver ill results.

One of the ‘mistakes’ I had committed early on in my practice was not to pass a bill when a patient died under my care. Every physician gets a mortality in his practice as a medical professional. Deaths are as real and expected as the smiles of relief and the comforts of healing. A mortality is inevitable as the consequence of human limitations, and occasional imperfections.

However, for budding medical professionals embarking on a new career, the natural feeling that surfaces is “what have I done wrong, where have I failed, what did I miss?” Confronted with those questions and driven by the penchant for fostering goodwill and for assuaging the pain of loss and suffering of the grieving family and relatives, one is sometimes tempted to just ward off any professional charges. This is not always right. In fact, it can be a legal blooper. As legal opinion indicates, waiving off one’s fees may be misconstrued as subtle admission of wrongdoing or guilt for professional misconduct. Thus, an act of goodwill can lit the fuse of a potential malpractice suit.

I once had the unsavoury experience of performing a procedure on a patient who managed to be accepted to the charity ward where the entire hospital expenses (minus doctors’ fees) were paid for by the city government. The patient was a celebrity whose media persona clearly portrayed him as one with the full capacity to pay all kinds of fees. But by some shrewd maneuverings, he got himself admitted as a charity patient and was able to undergo nearly a million-peso cardiac procedure at zero cost to his fat pocket.

All I can mumble to myself is “I’ve been had!” To make matters worse, the celebrity patient even had the audacity to call up a month later to ask whether or not it would be safe for him to travel to Europe for a family vacation. Call it double whammy for abuse.

Rendering service free of charge can also be a burden for patients. Many patients admit to not being comfortable coming back or following up without spending a centavo for the many visits made. The charitable act can thus become a fodder for clinical disasters. I remember a long-time patient who nearly succumbed to kidney malfunction after years of reluctance to follow up because, well, he was embarrassed to keep coming back (The reverse is also real and very true – there are non-paying patients who derive the ultimate thrill following up weekly for the slightest of symptom, the faintest of pain, the unlikeliest of the possibility of a real clinical disease.)

The practice of not charging for services rendered does not in any way mean that no “revenue” will be made. In fact, the “return” can come in diverse ways.

In general, Filipinos put a lot of premium on indebtedness. When a debt has been incurred, the gratitude is endless and boundless. Some patients whom never get charged a cent end up paying a lot more through gifts they insist on sending on Christmas and other occasions. There are patients who genuinely make you feel like they cannot thank you enough. Heart-warming cards, genuine heartfelt gestures and words of eternal gratitude, testimonials of your care and expertise given to circles of relatives and friends, among others , are but priceless ‘revenues’ of this profession. (Of course, the contrary is true, as there are a good number of patients who seem to have forgotten everything a physician has done the moment they leave the hospital. But that is another story.)

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