Prominent oncologist suspended for professional misconduct

Dear Dr. Chris,
How are you and Mdm. Beng Im? Hope everything is okay.
I’ve just got this information from my friend in Singapore a couple minutes ago.
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Prominent cancer doctor Ang Peng Tiam given 8-month suspension by Supreme Court

Dr Ang Peng Tiam of Parkway Cancer Centre has been given an eight month suspension in lieu of a $25,000 fine.

SINGAPORE – Prominent cancer specialist Ang Peng Tiam of Parkway Cancer Centre, who had appealed to the Supreme Court against a Singapore Medical Council (SMC) fine of $25,000, has been given an eight-month suspension instead of the fine.

It would have been a 16-month suspension had the SMC acted on the complaint more expeditiously, said Chief Justice Sundaresh Menon, who delivered the Court of Three Judges’ decision on Tuesday.

Two daughters of a former patient made a complaint against Dr Ang in 2010. The patient died in October that year. But the SMC served the notice of enquiry on Dr Ang in April 2015.

The SMC’s disciplinary tribunal had found Dr Ang, 59, guilty of two of the charges: That he made false representation to the patient who was suffering from lung cancer that there was a “70 per cent” chance of responding to the treatment he suggested and that he failed to offer her surgery as an option.

The disciplinary tribunal found that Dr Ang “had no reasonable basis” for saying there was a 70 per cent chance of response and felt that he had “wrongly held out false hope” to the patient and her family.

It also found him guilty of not offering surgery when that was “the preferred initial treatment option”.

A statement from the SMC on Wednesday (June 28) said the disciplinary tribunal found that there was an “intentional, deliberate departure from standards observed or approved by members of the profession of good repute and competency”.

Dr Ang had claimed that he has seen about 16,000 new patients over the past 16 years, of whom 10 to 15 per cent suffered from lung cancer.

It felt that his actions “merit severe penalty” but given testimonials in favour of Dr Ang as well as his community work, it decided against a suspension.

Instead, it imposed a fine of $25,000, a censure, an undertaking not to repeat the offence and for him to pay 60 per cent of the cost of the proceedings.

Dr Ang appealed against the tribunal’s decision to the Court of Three Judges which on Tuesday (June 27) upped his sentence from a fine to an eight-month suspension.

The SMC had also filed an appeal against what it considered was a light penalty from its disciplinary tribunal and had urged the court to impose a six-month suspension for each of the two offences for which Dr Ang had been found guilty.

Instead of taking his “eminence and seniority” as a mitigating factor, the court saw it as an “aggravating” factor and his “unblemished record” of more than 30 years had limited relevance in mitigation.

However, the court took into account the 41/2 years it took the SMC to serve notice of enquiry on Dr Ang after receiving the complaint. This “inordinate delay” caused suffering to Dr Ang.

Justice Menon said the appropriate sentence in the light of the seriousness of the offence would have been a suspension of 16 months for the two charges. But given the long delay by the SMC, it halved the sentence to an aggregate of eight months.

Source: http://www.straitstimes.com/singapore/health/prominent-cancer-doctor-ang-peng-tiam-given-8-month-suspension-by-supreme-court?xtor=CS11-88

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Well-known cancer surgeon gets 8-month suspension for professional misconduct

PUBLISHED: 5:23 PM, JUNE 28, 2017     UPDATED: 7:05 AM, JUNE 29, 2017

SINGAPORE — Prominent cancer surgeon Ang Peng Tiam’s punishment for giving a former patient suffering from Stage 2B lung cancer false hope about her disease has been upped to an eight-month suspension.

The suspension for his “aggravated” professional misconduct would have been double that, said the Court of Three Judges which heard his appeal, if not for the 4½-year delay in the disciplinary proceedings by the Singapore Medical Council (SMC).

In its grounds of decision released on Wednesday (June 28), the court made clear that the penalty it is imposing had nothing to with whether Dr Ang — a 35-year veteran and medical director of Parkway Cancer Centre — was correct in his treatment plan for the 55-year-old, who died about six months after seeing him.

Rather, Dr Ang had no basis to tell the patient there was a 70 per cent chance of her tumour shrinking with the treatment plan he had. He also should not have taken away her right to choose surgery, even if he assessed it to be an unsuitable course of action.

“A doctor might believe that a particular treatment option is in his patient’s best interests, but ultimately, it is the patient who must make the decision on her treatment,” said Chief Justice Sundaresh Menon, delivering the judgment on behalf of the court on Tuesday.

Dr Ang first saw the patient in late-March 2010. She had a 8cm, fast-growing and aggressive tumour, as well as a few smaller growths, in her right lung.

He recommended combining chemotherapy with a drug called gefitinib, telling her, in Mandarin, this treatment would give her “at least a 70 per cent chance that the tumour will shrink”.

Dr Ang also explained to the patient, her husband, and their two daughters that his assessment of her chances was based on her being Chinese, female, someone who had never smoked, and a tumour diagnosed with adenocarcinoma.

But he had no justification for his claim because this rate of success was only applicable to patients with these characteristics who had also tested positive for epidermal growth factor receptor mutation. Dr Ang did not send the patient for a test to determine her status.

He also did not tell her that surgery was an alternative way to treat the cancer.

The patient went with his plan but did not respond well to treatment, dying a little over six months later. Her daughters lodged a complaint with the SMC later.

After a 13-day hearing, a disciplinary tribunal fined him S$25,000 for two counts of professional misconduct, relating to his unjustified claim about the patient’s chances and his failure to provide surgery as a treatment option. Dr Ang appealed against his convictions.

The Court of Three Judges, which included Judges of Appeal Andrew Phang and Judith Prakash, upheld the tribunal’s decisions on both counts.

This was not a case where Dr Ang had made a mistake, misjudged or misinterpreted medical papers on the effectiveness of his treatment plan for the patient, it said. Instead, he made the claims intentionally even though he knew or ought to have known there was no basis for him to do so.

On not giving the patient the option to go for surgery, which was the preferred option with similar conditions as this patient under the National Comprehensive Cancer Network guidelines, Dr Ang argued that as a doctor, he was obliged to exercise his clinical judgment instead of blindly and rigidly following the guidelines.

While they agreed that doctors should not suspend their clinical judgment and slavishly adhere to the guidelines, the judges said doctors were obliged to present the range of viable options and what the pros and cons of each of these were. Patients must get to decide for themselves what treatment they want, the judges added.

“It was not Dr Ang’s role to decide, but to inform,” the judges said.

In deciding on the sentence, CJ Menon said the priority in this case was in general deterrence, rather than preventing reoffending.

Noting Dr Ang’s senior position — he has been president of the Singapore Society of Oncology and Singapore Cancer Society, among others — he is “expected to set an exemplary standard and to serve as a role model for fellow practitioners”, he added.

“Seniority and eminence are characteristics that attract a heightened sense of trust and confidence, so that when a senior and eminent member of the profession is convicted of professional misconduct, the negative impact on public confidence in the integrity of the profession is correspondingly amplified,” CJ Menon said.

Dr Ang’s unblemished record and past contributions to society were also of little relevance. “The law must also not be misconstrued as providing those with an established good track record a free pass for misconduct on the basis that it is out of character,” said CJ Menon.

Source: http://www.todayonline.com/singapore/well-known-cancer-surgeon-gets-8-month-suspension-professional-misconduct

Air travel comes at a price: Slightly elevated risk of cancer

Radiation doses from body scanners and baggage X-ray machines at airport security checks are minimal, compared to actual radiation exposure from the flight itself.

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In April, Mr Tom Stuker, 63, became the world’s most frequent flier, logging 18 million miles of air travel over the last 14 years.

If his travelling behaviour is typical of business fliers, he may have eaten 6,500 inflight meals, drunk 5,250 alcoholic beverages, watched thousands of inflight movies and made around 10,000 visits to airplane toilets.

He would also have accumulated a radiation dose equivalent to that of about 1,000 chest X-rays.

COSMIC RAYS COMING AT YOU

You might think the radiation dose comes from the body scanners and baggage X-ray machines.

But radiation doses from airport security checks are trivial.

The major source of radiation exposure is from the flight itself.

This is because at high altitude, the air gets thinner. The farther you go from the earth’s surface, the fewer molecules of gas there are per volume of space.

Thinner air means fewer molecules to deflect incoming cosmic rays – radiation from outer space.

In fact, it is the accumulation of radiation dose that is the limiting factor for the maximum length of manned space flights. Too long in space and astronauts risk cata- racts, cancer and potential heart ailments when they return home.

So, what would Mr Stuker’s cumulative radiation dose be and what are his health risks?

It depends entirely on how much time he has spent in the air.

Assuming an average flight speed of 550mph, his 18 million miles would translate into 32,727 hours or 3.7 years of flight time.

The radiation dose rate at typical commercial airline flight altitude of 35,000 feet is about 0.003 millisieverts per hour.

By multiplying the dose rate by the hours of flight time, we can see that Mr Stuker has accumulated about 100mSv dose of radiation.

The primary health threat at this dose level is an increased risk of some types of cancer later in life.

Studies of atomic bomb victims, nuclear workers and medical radiation patients have allowed scientists to estimate the cancer risk for any particular radiation dose.

Assuming that low doses have risk levels proportionate to high doses, then an overall cancer risk rate of 0.005 per cent per mSv is a reasonable estimate.

Thus, Mr Stuker’s 100mSv dose would increase his lifetime risk of contracting a potentially fatal cancer by about 0.5 per cent.

The question is whether that is a high level of risk.

Most people underestimate their risk of dying from cancer. Although the exact number is debatable, about 25 per cent of men ultimately contract a potentially fatal cancer.

Mr Stuker’s 0.5 per cent cancer risk from radiation should be added to his baseline risk – from 25 per cent to 25.5 per cent.

A cancer risk increase of that size is too small to measure in a scientific way, so it must remain a theoretical increase in risk.

If you want to know your cancer risk from flying, estimate your airline miles over the years.

If you have clocked 370,000 miles, you would have a 0.01 per cent increase in the risk of contracting cancer.

However, most people do not fly 370,000 miles, which is equal to 150 flights from Los Angeles to New York, within their lifetimes.

So, for the average flier, the increased risk is far less than 0.01 per cent.

List all the benefits that you have derived from your air travel, such as job opportunities, vacation travel and family visits, and look at your increased risk again.

If you think your benefits have been meagre compared to the elevated cancer risk, maybe it is time to rethink flying.

But for many people, flying is a necessity of life and the small elevated cancer risk is worth the price.

Source: http://www.straitstimes.com/singapore/air-travel-comes-at-a-price-slightly-elevated-risk-of-cancer

The surprising number of American adults who think chocolate milk comes from brown cows

Seven percent of all American adults believe that chocolate milk comes from brown cows, according to a nationally representative online survey commissioned by the Innovation Center of U.S. Dairy.

If you do the math, that works out to 16.4 million misinformed, milk-drinking people. The equivalent of the population of Pennsylvania (and then some!) does not know that chocolate milk is milk, cocoa and sugar.

 

For decades, observers in agriculture, nutrition and education have griped that many Americans are basically agriculturally illiterate. They don’t know where food is grown, how it gets to stores — or even, in the case of chocolate milk, what’s in it.

Source: https://www.washingtonpost.com/news/wonk/wp/2017/06/15/seven-percent-of-americans-think-chocolate-milk-comes-from-brown-cows-and-thats-not-even-the-scary-part/?utm_term=.f7e1c9540535&wpisrc=nl_az_most&wpmk=1

 

Evidence grows linking grilled meat and cancer, but you can lower the risk

By Emily Sohn June 3 at 8:30 AM

When cooked at high temperatures or over open flames, according to accumulating evidence, compounds in red and processed meats undergo biochemical reactions that produce carcinogenic compounds capable of altering the eater’s DNA.

Grilled vegetables don’t harbor the same risks.

The case for meat as a cancer risk has been building for decades, with plenty of studies showing that people who report eating diets heavy in red and processed meats have higher risks of certain types of cancer, as well as heart disease and other chronic illnesses. Enough of those studies — together with lab work — have built up to make a convincing case that meat carries risks, according to a 2015 analysis by the World Health Organization’s International Agency for Research on Cancer, which considered more than 800 studies conducted around the world.

Overall, the IARC review found that the strongest evidence linked processed meats (such as hot dogs, beef jerky, bacon and ham) to colorectal cancer — with each hot-dog-size serving of processed meat eaten daily raising the risk by 18 percent over a lifetime.

More than 34,000 cancer deaths are caused around the world each year by diets high in processed meat, according to data referenced in the IARC report. By comparison, tobacco causes about a million cancer deaths annually. Alcohol consumption causes 600,000. And air pollution is responsible for 200,000.

The IARC review also found evidence for an association between unprocessed red meat (such as beef or pork) and colorectal cancer, along with some evidence that red meat might contribute to pancreatic and prostate cancers, too.

Cooking methods make a difference, according to studies that have zeroed in on two groups of chemicals that appear in particularly large quantities when meat, fish or poultry is cooked under high heat by grilling, barbecuing, boiling or even pan-frying. One group, called HAAs (heterocyclic aromatic amines), form during high-temperature reactions between substances in muscle tissue.

PAHs (polycyclic aromatic hydrocarbons), which form when meat is smoked, charred or cooked over an open flame, are also found in tobacco smoke.

Turesky is beginning to turn up evidence that it might. In a study published last year, he and colleagues studied biopsies of prostate tumors and found that DNA in the cancer cells had been damaged by HAAs.

“This is the first unequivocal proof that, once you eat the cooked meat mutagens, some of them find their way to the prostate and damage the prostate,” Turesky says. The study doesn’t prove that meat caused the cancer, he adds. “It could just be an association. Now we have to show that the mutations are attributed to the chemicals in cooked meat.”

Source: https://www.washingtonpost.com/national/health-science/evidence-grows-linking-grilled-meat-and-cancer-but-you-can-lower-the-risk/2017/06/02/f946078c-4549-11e7-a196-a1bb629f64cb_story.html?utm_term=.65bccab06061&wpisrc=nl_az_most&wpmk=1