20120731 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, JULY 31, 2012

A LESS INTRUSIVE TREATMENT FOR VARICOSE VEINS >PAGE 4

ON A CRUSADE FOR CHEAPER CANCER DRUGS >PAGE 9

How Hong Kong’s natural trails are being paved over >PAGE 6

Sealing beauty

2 NEWS HEALTH BITES

ASK THE DOCTORS DR JOEL TAN YEW-POH

......................................................

Jeanette Wang jeanette.wang@scmp.com

Fat used to grow blood vessels Excess fat may have a purpose after all. Adult stem cells extracted during liposuction can be used to grow healthy new blood vessels in the lab for use in heart bypass surgery and other procedures.

Current grafts – from vessels elsewhere in the body or artificially created – carry a risk of clotting, being rejected or otherwise failing to function normally, says lead study author Matthias Nollert, from the University of Oklahoma. “Our engineered blood vessels have good mechanical properties and we believe they will contract normally when exposed to hormones. They also appear to prevent the accumulation of blood platelets – a component in blood that causes arteries to narrow.” In the study, stem cells derived from fat were turned into smooth muscle cells, then “seeded” onto a collagen membrane. As the cells multiplied, they were rolled into tubes the diameter of small blood vessels. Within four weeks, they grew into usable vessels. The researchers hope to have a working prototype to test on animals within six months.

New weapon in battle of the bulge Another day, another drug for the obesity battle. This new drug aids weight loss by increasing sensitivity to the hormone leptin, a natural appetite suppressant found in the body.

Leptin supplements alone have not been effective at weight reduction because it’s believed the body has been densensitised to the hormone. It’s not entirely clear why this happens, but cannabinoid receptors, which mediate the feelings of hunger produced by marijuana and naturally occurring cannabinoids in the body, are thought to be involved. In a study published last week in the journal Cell Metabolism, scientists tested in obese mice a new compound that targets a particular cannabinoid receptor. The compound suppressed the appetite of the mice, caused weight loss and even improved metabolic health, in part by making mice sensitive to leptin again. Importantly, the mice did not show signs of anxiety or other behavioural side effects that previous anti-obesity drugs targeting the receptor had.

Versatility sets man apart from beasts A light-hearted comparison of the extraordinary athleticism of humans and animals was published in the Veterinary Record last week ahead of the London Olympics. In his study, Craig Sharp, from the Centre for Sports Medicine and Human Performance at Brunel University, notes that humans can run at a maximum speed of 37.6 km/h. Usain Bolt (pictured) runs 100 metres in 9.58 seconds, but a cheetah (maximum speed 104 km/h) does it in 5.8 seconds. An endurance horse can run a full marathon in one hour, 18 minutes and 29 seconds, compared with Patrick Makau Musyoki’s two hours, three minutes and 38 seconds record. In the long jump, a red kangaroo can leap 12.8 metres, compared to Mike Powell’s 8.95 metres. When it comes to power, the tiny hummingbird can manage 200 watts per kg; cycling world champion Mark Cavendish puts out a maximum 23 watts per kg during a sprint. But no single species matches the physical versatility of human beings, Sharp concludes, and that is what the Games are designed to display to best effect.

Yoga strikes a balance in stroke patients Yoga can improve motor function, balance, independence, confidence and quality of life for stroke survivors who no longer get rehabilitative care. The study, published in the American Heart Association journal Stroke, involved 47 participants, aged up to 90 or more, and about 75 per cent of them were male veterans. All had had a stroke at least six months earlier and had to be able to stand on their own at the study’s outset.

They were divided into three groups: twice-weekly group yoga for eight weeks; a “yoga-plus” group, which did group yoga and listened to a relaxation recording at least three times a week; and a usual medical care group that did no rehabilitation. The yoga classes, taught by a registered yoga therapist, included modified yoga postures, relaxation and meditation, and got progressively tougher.

Compared with the control group, those who completed yoga or yoga-plus significantly improved their balance. The yoga patients’ mindsets about their disability also improved.

Q: I’m 30 years old and never had any dental problems, but lately I’ve realised that my gums are receding. What could be the problem?

A: Periodontal disease is the most common cause of gum recession. This is due to plaque accumulation, especially inside the gum pockets.

The gum pockets provide a safe haven for the bacteria to flourish, leading to destruction of the alveolar bone and collapse of the gingivae.

It’s good to visit the dentist twice a year to clean out these pockets.

Excessive brushing of the gums can lead to their downward migration, exposing the roots of the tooth and leading to hypersensitivity to hot and cold sensations.

Brush with gentle strokes when cleaning the teeth close to the gums.

Sometimes our subconscious mind clenches our teeth tightly together during sleep or during high-stress activities.

This leads to increase force being applied to the gums, which can cause them to recede.

A simple remedy is to make a conscious effort not to clench. Another treatment is to wear a mouth guard to avoid stressing the teeth.

Dental treatments such as braces, crowns and bridges, laminates and bleaching can also cause gum recession.

Dental restorations have a tendency to accumulate plaque, especially if they are poorly made.

The oxidising agent used during bleaching may cause the gingiva to be inflamed and in extreme cases direct

chemical injury can lead to loss of gingiva.

I must emphasise that our society’s quest for aesthetic perfection has lead to a downgrade of the preservation of unadulterated healthy yellowed teeth.

Please brush properly around all prosthesis and use good quality treatments to avoid damage to your oral health.

Bite problems arising from not having sufficient teeth can lead to gum recession due to teeth biting directly on the gum, thereby injuring it.

If you notice you have such jaw problems, it’s advisable to consult a dental professional as they can diagnose the problem for you and recommend the relevant orthodontic treatment or orthognathic surgery.

Health issues such as diabetes, Aids, calcium metabolism problems or even pregnancy can cause gum recession.

If you have compromised immune conditions, there is a higher chance your gums will recede.

Please brush carefully and go for your scaling treatment at shorter intervals to avoid plaque accumulating under the gums.

Dr Joel Tan Yew-poh is a dental surgeon with White on Whites in Singapore.

APP OF THE WEEK

Not quite on the pulse ......................................................

Katie McGregor healthpost@scmp.com Stress Check Free Rating 5/10 Stress Check measures your stress level, the developers say, by monitoring your heart rate variability (HRV). At a small percentage of the cost of other devices that measure HRV, the free Stress Check app looks appealing.

Heart rate variability measures the miniscule variations in the interval between heartbeats.

Researchers have discovered that these variations provide an indication of heart health and nervous system activity. Other references suggest a high HRV is also associated with better physical and mental health.

The Stress Check measures the heartbeat over a short period of about two minutes, and at the end gives you a stress score based on your HRV. So that you don’t get bored while waiting, the app provides helpful tips and information such as: “We all need some eustress in our lives. Forming bonds with new friends induces a sense of stress that’s good for you, so make time to be social.”

My first score was 2 per cent, after a stressful morning of work deadlines. My next score was 7 per cent, after 20 minutes of meditation.

Besides the obvious inversion of results, I was also concerned about my physical and mental health since these results were clearly not high.

A few days later I tried again, and over the following few days scored 29 after meditation and 30 after another stressful morning, with various other erratic scores around these.

As I write this review, on holiday and sitting on a terrace with family by a lake in Ireland, my score is 34.

The app tells me my stress level is slightly elevated, that my mind is alert, but I should take a break soon and practise some deep breathing.

Perhaps this is eustress. I don’t think I need to take a break.

NEWS 3 QUIZ ......................................................

Jeanette Wang jeanette.wang@scmp.com How do we commit to memory what really matters? The secret, say experts at the Association for Psychological Science in the US, is to have a moment of quiet.

In the Association’s journal, Psychological Science, psychological scientist Michaela Dewar and her colleagues show that memory can be boosted by taking a brief wakeful rest after learning something verbally new.

“Our findings support the view that the formation of new memories is not completed within seconds,” explains Dewar.

“Our work demonstrates that activities that we are engaged in for the first few minutes after learning new information really affect how well we remember this information after a week.”

The study involved two experiments with 33 participants between ages 61 and 87.

The participants were told two short stories and told to remember as many details as possible.

They were asked to describe what happened in the story straight after they had heard it.

Next, they were assigned to either 10 minutes of wakeful resting or a computer game of “spot-thedifference”. The game was chosen because it required attention but was non-verbal.

In one study, the participants were asked to recall both stories 30 minutes later, and then a week later.

MEDICAL TECHNOLOGY Those who had wakeful resting remembered more.

Dewar explains that there is growing evidence to suggest that the point at which we experience new information is “just at a very early stage of memory formation and that further neural processes have to occur after this stage for us to be able to remember this information at a later point in time”.

Test yourself on how much you know about memory with this quiz.

1. What are the three basic types of memory that scientists differentiate by how long they are retained? a. sensory, short-term, long-term b. episodic, procedural, semantic c. temporary, average, permanent 2. Typically, how many random items can a human short-term memory store? a. 6-8 b. 9-11 c. 12-14 3. A short-term memory is likely to become long term if it is related to: a. sensory information b. current or historic events c. other personal long-term memories

Keep your eye on the ballpoint ......................................................

Jeanette Wang jeanette.wang@scmp.com A new technology that uses only the eyes to write in cursive script gives hope to people who have lost the use of their limbs.

Developed by Jean Lorenceau, of the Pierre-and-Marie-Curie University in France, it tricks the neuromuscular machinery into doing something that was thought impossible: voluntarily producing smooth eye movements in arbitrary directions. The report was published last week in Current Biology.

“It then becomes possible to generate smooth renderings of digits, letters and words, or even one’s signature,” says Lorenceau, who tested the technology on six participants.

Although learning rates differ between people, he says it typically takes three to five 30-minute sessions performed on different days to learn to make these smooth eye movements. The technology relies on changes in contrast to trick

Cursive writing could help many patients. Photo: Current Biology the eyes into the perception of motion. When viewing that changing visual display, people can learn to control their eye movements smoothly and at will. In everyday life, smooth pursuit eye

movement is used to track moving targets, Lorenceau explains.

While our eyes never cease to move, it is normally impossible to control those movements smoothly in any direction.

The new technology could be of benefit for those with motor neuron disease, and cerebral palsy and tetraplegics, says Lorenceau. He says by using cursive eye writing, people who can’t move their limbs could communicate by drawing figures or their own signature at will.

This offers many possibilities not available with current eye-writing devices, where users make fast eye movements towards predefined items displayed on a computer screen, fixate on the desired object for some time, and blink to validate their choice.

It might also help to improve eyemovement control in people with conditions like dyslexia or attention deficit hyperactivity disorder, as well as experts like surgeons, who rely heavily on eye movements.

Lorenceau is now working on a better version of his eye writer.

4. Which of the following is an indication of a serious memory problem? a. taking longer to learn new things b. getting lost in places you know well c. forgetting certain words or names

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com

Answers: 1. a; 2. a; 3. all are correct; 4. b.

Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888.

4 MEDICAL VARICOSE VEINS

A thigh of relief ......................................................

Monica Proctor healthpost@scmp.com Sebastian Guevara, 38, had his first surgery to treat varicose veins when he was 18. Though the condition affects women twice as much as men, 10 per cent to 15 per cent of males are affected by the gnarled, bulging veins typically found in the legs.

With a family history of varicose veins, Guevara watched the veins

reappear a year after the surgery along his left leg. Despite another minor operation, the condition worsened, with sick veins developing behind the knee and calf.

The Argentinean has lived with the condition for the past 20 years, but now, Guevara, a chef and athlete living in Hong Kong, hopes a relatively new non-invasive procedure will take care of his veins for good – for reasons of health rather than vanity.

“They are probably a reason for some cramping when I compete in running races.” he says. “But what worries me most is the fact that I’m a potential prospect for deep venous thrombosis. So I stay away from alcohol and try to eat healthily.”

Radiofrequency ablation (RFA) is a minimally invasive alternative to traditional vein-stripping surgery for varicose veins that promises better cosmetic results with less scarring and faster recovery times.

The outpatient procedure is

performed under ultrasound guidance and with the patient awake. After a local anaesthetic is injected into the thigh, a laser fibre is threaded into the vein through a small puncture hole.

Radiofrequency energy is released, which heats up the vein wall and causes it to collapse.

The fibre moves along the whole length of the diseased vein until the entire vein is destroyed.

Only a couple of stitches are needed to close the incision. The

Sebastian Guevara has his varicose veins examined with ultrasound by Dr Chad Tse. Photo: Nora Tam

entry site is bandaged, and patients are encouraged to walk and resume all normal activities.

“Two weeks after the procedure, I could start exercising again, versus one month with traditional surgery.

There were minimal scars, and they were less painful. With the old method, I had much bigger swelling and bruising,” says Guevara, who paid HK$54,000 for the treatment.

The body has two main systems of veins that return circulating blood to the heart, explains Dr Leo Chiu Kai-ming, a specialist in general surgery at Hong Kong Adventist Hospital. Deep veins are embedded inside muscles and superficial veins are underneath the skin.

Blood is returned to the heart through veins, which contain valves that only allow blood to flow in one direction. When vein walls are weak, these valves do not close properly, gravity pulls the blood downwards and it pools in the legs. Superficial veins puff up as varicose veins or spider veins.

The symptoms can be classified in distinct stages, says Dr Chad Tse Cheuk-wa, a specialist in general surgery at Veno Leg Vein Clinic in Hong Kong.

During stage one, small capillaries start becoming obvious.

“At this stage, it’s more of a cosmetic concern and veins in themselves are harmless.”

In stage two, veins begin to bulge and start becoming tortuous. As stage three kicks in, the patient

Western patients seek treatment early for cosmetic reasons, but Chinese wait until symptoms are painful DR CHAD TSE, VENO LEG VEIN CLINIC

begins to feel discomfort such as aching, swelling, tiredness and pain.

By stage four, the skin around the ankles becomes darkened. At stage five, there is itchiness. By stage six, wounds and ulcers may appear.

“There’s also a stage zero, where no veins are visible but the patients may still experience discomfort as the insufficiency lies in the deeper vein network,” says Tse. “We advise treatment from stage four onwards. Below that it’s optional. I find that Westerners come seek treatment earlier, during stage one to three for cosmetic reasons, but my Chinese patients wait until symptoms get really painful, usually stages four to six.”

Traditional surgery, also known as “stripping”, is usually performed under general anaesthetic and requires being in hospital for two to three days. A cut of several centimetres is made at the groin or behind the knee, over the top of one of the main varicose veins.

The vein is then tied off where it meets the deeper veins and taken out. Tse says this method is reserved

MEDICAL 5 CASE HISTORY

.................................................

Eileen Aung-Thwin healthpost@scmp.com Elaine Wong, 50, is no stranger to challenges. She was born with a congenital bone condition called osteogenesis imperfecta that made her bones fragile and twisted her spine. But thanks to a loving and supportive family and her strong character, Wong did not let the disease get in the way of her life. She completed school and went on to pursue a career.

She knew her health was not robust, so she shrugged off her daily morning headaches, breathlessness and general fatigue. But she didn’t realise that the twisting of her spine was growing more severe as she aged, thereby compressing her upper body, including her lungs. This prevented her diaphragm and chest wall from pumping air efficiently into her lungs.

Her lungs were unable to take in enough oxygen from the air she breathed and expel carbon dioxide. Her body was simultaneously starved of oxygen and poisoned by high levels of carbon dioxide, which resulted in, among other things, her morning headaches and fatigue. Wong was suffering from chronic respiratory failure and didn’t know it.

Things came to a head in 1999 when Wong was in her late 30s. Her weakened respiratory muscles were unable to help her cough up phlegm and sputum in her windpipe, and she eventually came down with pneumonia and had to be admitted to hospital for more than a month.

After recovering, she would fall ill again.

In 2000, Wong decided to seek care at the United Christian Hospital, where she met Dr Chu Chung-ming, a respiration specialist. At that time, Wong was in great discomfort – very short of breath even with minimal activity, and her heart was constantly racing.

Wong’s blood test showed she had respiratory failure. While healthy people have between 96 and 100 per cent saturation of oxygen in their blood, Wong had levels as low as a life-threatening 40 per cent.

Chu noted that Wong’s lungs

Illustration: Angela Ho

for acute and very tortuous veins, or for veins that are too close to the skin’s surface.

The newer endovenous procedures do not require groin dissection and are therefore less traumatic.

Apart from radiofrequency energy, lasers can also be fed through a catheter inserted in the vein to destroy it.

Called Endovenous Laser Therapy (EVLT), it is a safe procedure with a high success rate, according to a study by University of Hong Kong’s department of surgery doctors published in the Hong Kong Medical Journal in 2009.

But another alternative treatment, foam sclerotherapy, is over four times more cost-effective than EVLT and allows patients to resume normal activity even sooner, according to a study last year by Imperial College London researchers. The procedure involves injecting foam into the vein, which inflames the lining of the wall and seals the vessel.

Dr Siu Wing-tai, a specialist in general surgery at Hong Kong Sanatorium and Hospital, says both traditional and newer endovenous treatments have about a 1 per cent risk of nerve injury, whereby the patient may experience some numbness. There may also be a greater chance of varicose veins recurring with the newer treatments, and thick vessels may still be felt.

So for acute cases, the traditional stripping method may be better. For small cosmetic veins, foam sclerotherapy is the most commonly used method, with pigmentation as a possible side effect.

Self-care measures include exercise, weight management, a low-salt, high-fibre diet, leg elevation and compression socks.

“Excess weight, heavy lifting and pregnancy also increase the likelihood of developing varicose veins as they all put increased pressure on the body,” explains Siu. “Increasing age, menopause, genetic weaknesses in the vein walls or in the valves, and a low-fibre diet also increase the risk of developing varicose veins.”

Avoid wearing tight clothes around your waist, groin and legs.

Tse adds: “Refrain from standing for prolonged periods of time, and for women, avoid wearing high heels.”

All treatments focus on destroying versus repairing or stalling the formation of varicose veins. But research by scientists from the University of Heidelberg in Germany, published in The FASEB Journal last year, revealed proteins that control the development of varicose veins. This suggests that prevention of these proteins with drugs could stall progression of varicose veins and lessen the need for surgery and reduce related complications.

For now, Siu says surgery will remain the main treatment for varicose veins. As equipment gets cheaper, less invasive methods such as endovenous laser therapy or radiofrequency ablation are likely to become more popular.

Patient gets her second wind

Without the machine, Wong would grow progressively weaker and be unable to care for herself could perform the gas-exchange function normally, but it was the compression of her thoracic space by the crooked spine that caused her body’s pump function to fail. So, she needed an external or artificial pump to help bring enough air into her lungs. Because her condition was irreversible, Wong would need long-term care or help to breathe.

Conventionally, invasive ventilation is used. A tube is inserted into the patient’s mouth or neck to pump pressurised air into the lungs.

This requires a prolonged stay in hospital, involves much pain and discomfort, and increases the risk of contracting pneumonia.

Chained to the hospital bed, the patient is not able to speak, eat, sleep or function normally. If a patient wants to be cared for at home, the total cost is well over HK$100,000 a month, excluding trained help.

But technological advances enable non-invasive ventilation (NIV), whereby the patient only wears a special mask. The mask is attached to machines that pump pressurised or oxygen-enriched air.

Although this option has been available in Hong Kong hospitals for about 20 years, improvements in technology and training mean that patients can now undergo the treatment at home.

Chu suggested Wong consider buying or renting an NIV machine for use at home during sleep. While

sleeping, respiratory muscles tend to rest, says Chu. Sleep then becomes a highly vulnerable time as the pump function weakens further.

The machine would cost between HK$10,000 and HK$60,000 to buy, or from as little as HK$1,000 a month to rent. With a little training, the machine is easy to use as Wong needs only to put on the mask, turn on the machine and go to sleep.

The normalisation of the oxygen and carbon dioxide levels that take place during sleep will help support her body during the daytime as she goes about her life.

But Wong was not keen. She says she did not like the idea of being hooked up to a machine because it made her feel disabled. She was also afraid that it might take away her ability to work and that it would cause a great deal of inconvenience.

Chu advised her that without the NIV treatment, Wong would grow progressively weaker and become unable to care for herself. Her life was also at risk. Conversely, studies in Europe showed that patients with similar conditions who used the home NIV treatment enjoyed the same life expectancy as others.

But he knew that patients needed time to digest the idea of lifelong dependency on a machine. He asked Wong to think about it. A month later, Wong agreed.

Initially, Wong had to get used to sleeping with the mask and the machine. The machine was noisy, and it was uncomfortable having a mask strapped to the head. The first night, she hardly slept.

But she grew accustomed to it within a week. She noticed improvements to her health. The morning headaches vanished, and her energy levels picked up. She could concentrate better and no longer felt as fatigued or breathless.

Wong can also walk further distances and prepare her own meals.

Although she needed to add oxygenated air to her treatment in 2007, Wong has not had to be admitted to hospital since she started using the machine.

Wong says: “This disease has brought me limitations, but my life is now good. I can even go out for an hour or two unless the air outside is bad.”

6 COVER STORY

The

Concrete bungle

COVER STORY 7

Many trail paths are being ‘tamed’, and for some users it’s an unwanted intrusion, writes Charley Lanyon

E

very autumn, race organiser Keith Noyes heads out into Hong Kong’s country parks to determine the route for his King of the Hills trail race and is met with the same sight: “We go back out to look at the courses and discover new sections have been concreted.” Previously natural trails are paved over and uphill sections fitted with concrete steps.

In many ways, Hong Kong is an outdoor-lover’s dream. A hiker can leave his office in Central and be out on a trail in 10 minutes. Private banker Sandro Gianella, who moved to Hong Kong 11 years ago, says: “Trail running makes me feel like I’m in a different place, not in a concrete jungle.”

But the increasing concreting of trails is extremely annoying for many. “In terms of access to the outdoors, Hong Kong is the best in the world. What’s a shame is that the trails themselves are losing their natural state,” says Noyes, who has lived in Hong Kong since 1992.

“You don’t see trails in Japan or Taiwan being concreted like this.”

There’s a joke in the trail running community that the annual 100 kilometre Oxfam Trailwalker, started

more than 30 years ago as a training exercise for the Gurkhas, is increasingly being called the “Cementwalker”.

One of the most recent trails to be paved is the Sunset Peak to Pak Mong section on Lantau Island.

More than 1,500 steps have been added, according to a trail runner who declined to be named. The section is used in at least three races.

“At least 1,300 of them are completely dangerous. When rain washes away the dirt or sand, what is left are little cement walls with steel rods sticking out that are even more treacherous in the long term,” the runner says.

The other 200 steps, he says, have been built using rocks, which are “safer for the foot to land on when running, but still an eyesore and absolutely not needed in this area – there’s no potential avalanche or any danger of slopes falling”.

“From a runner’s perspective, if they really have to build stairs, do the same as Lantau Peak. Sunset Peak [Pak Kung Au side] uses big rocks, which look more natural and are much safer long term. Cement stairs just reminds us of being in the city, which is what we are trying to get out of!”

There are health benefits to running on a trail rather than the road. Runners on paved surfaces fall into a steady stride and repeat motions. This leaves them vulnerable to repetitive strain injuries. Conversely, trail runners must change their stride constantly to react to the uneven terrain and engage the body’s small stabilising muscles for balance. Science has shown that road runners are more susceptible than trail runners to nearly every manner of runningrelated injury, with the exception of twisted ankles.

Hong Kong’s country parks, and by extension most of its trails, fall nominally under the care of the Agriculture, Fisheries and Conservation Department, which is tasked with trail building and maintenance. But practically, local district councils reserve the right to modify paths that affect their districts’ villagers.

Lee Ying-ming, a country parks officer with the department, explains: “Our country parks are not like the ones in the US. There are a lot of villages inside the parks and there are trails leading to the villages, so when they want to have better access they ask the district office to improve the track.”

According to Lee, the department’s purpose is “to conserve the environment, both ecologically and visually”. To that end, it tries to maintain as much natural trail as possible and use natural stone pavers, a process

Country parks officer Lee Yingming prefers sustainable trails such as the Tai Lam bike trail (above); one trail runner says the partly paved steps on the Sunset Peak to Pak Mong trail on Lantau (facing page) are dangerous.

Photos: K.Y. Cheng

called armouring, to preserve the feel and look of the trails. Lee says the department will only interfere in cases of safety, accessibility or trail erosion.

But he concedes that the district councils do not always follow the guidelines. “A lot of the time, the district offices do concrete paving.”

Trail runner Rupert Chamberlin echoes the confusion of many natural trail aficionados: “I think the disappointing thing is that trails that are quite accessible and open to most people are still being concreted over. Hard dirt pack trails don’t need to be turned into tarmac.”

Noyes is suspicious. “They are manufacturing excuses to pave a lot of these trails. It is disconcerting, because a lot of what they are picking on now are trails that absolutely don’t need maintenance.

A lot of the things are blatantly make-work projects that make no aesthetic or safety sense.”

Although it is tempting to blame the department or district councils for the state of country paths, perhaps the real issue is the preferences of the hikers themselves.

The Hong Kong trail system is extraordinarily popular and appeals to a wide range of hikers, runners and walkers with varying degrees of experience and competence. Many

They are making excuses to pave a lot of these trails.

Many of them absolutely don’t need any maintenance KEITH NOYES, KING OF THE HILLS TRAIL RACE ORGANISER

appreciate the paved surfaces.

Housewife Lo Siu-chun, 60, says: “I hike so that I can hang out with my friends who have all retired and don’t have much to do.” She appreciates the flat, even surface of many country paths. “I prefer paved trails as they are easier to navigate for old people, who can sprain their ankle or stumble,” she says.

Chamberlin says: “It may be dangerous for some, but where do you draw the line? Not every trail has to be accessible to everybody.”

Many in the department are sympathetic to trail runners and hikers. Lee says his favourite hikes are in the upper hills of Sai Kung because “there is less concrete”.

The department has sent representatives to Australia to attend a conference on sustainable trail building and has brought in experts from the US. Recently, it built two sustainable, concrete-free mountain biking practice trails in Tai Lam. The tangle of agendas surrounding Hong Kong’s country parks complicates an issue that outdoor fans believe to be obvious.

“There is an abundance of paved roads and trails in our parks,” says mountain biker Steve Coward.

“Concrete doesn’t belong there, just as an unsurfaced trail doesn’t belong in a shopping mall.” charley.lanyon@scmp.com

8 FITNESS SPORT

Sprocket rockets ......................................................

Gregory Bishop When Mike King raced BMX bikes the sport’s elite knew nothing of dynamic warm-ups, or core cooling, or thermal regulation. They did not mix sports drinks for maximum hydration and electrolyte balance.

They were BMX riders, and they resided at the intersection of counterculture and extreme sports, and the very idea of science as a means to improvement seemed downright uncool.

This was before bicycle motocross became an Olympic discipline, before King became an Olympic coach, before his sport and its outdated training methods underwent a scientific revolution after its debut in the 2008 Games in Beijing.

At a recent practice session, King looks less like an employee of USA Cycling and more like the BMX pioneer he once was in what now seems like another life. He’s wearing a mesh hat cocked sideways and low-hanging shorts, his face covered in stubble, eyes hidden behind sunglasses.

BMX has evolved a lot since the Beijing Games, transformed from rebellious adolescent into, King says, “something more grown-up”. As he speaks, the team’s video coordinator records practice runs from a nearby roof, beaming the images and data to the iPads of coaches on the course.

One of those coaches, James Herrera, started in BMX in 1977. As he gravitated towards coaching, he focused on less-developed training methods, returning to school and obtaining master’s degrees in psychology and exercise physiology.

Such methods sounded, at first, like a foreign language to his charges.

When King raced, advancements in strategy came mostly from watching competitors or reading textbooks. The basics: climb on small bike, pedal furiously, turn left, repeat. The riders travelled together, ate together and sometimes bunked together, a mix of French and British and Australian, with as much camaraderie as competition.

Some of the more serious athletes moved into other cycling disciplines. The British track cyclist Chris Hoy, winner of three gold medals in Beijing, started in BMX. So did his teammate Jamie Staff, a gold medallist for Britain who became a track cycling coach for the United States. He used to watch Christophe Leveque, the Flying Frenchman who dominated BMX throughout the 1990s with support from French sports federations. Staff and others were devoted, riding for six to eight hours a day. But that training, Staff says, was “misguided” and “uneducated”.

When the sport made the

Olympic stage, other nations followed the Leveque model. BMX training became more like track cycling training, which had become more like road cycling training.

“It’s getting really scientific, which is not really BMX,” Staff says.

“I know they’re trying to keep BMX cool and hip and trendy. At the same time, they’re changing the mentality. At this point, you buy into it, or you don’t bother.”

When the 2008 Olympics rolled around, King concentrated on keeping his athletes relaxed.

He knew the pressure and the magnitude would be higher than ever.

He says it felt like a culmination: BMX, at the highest level of sport, on prime-time international television; BMXers in the opening ceremony, clad in red, white and blue. This meant more money, more exposure, more legitimacy as a sport. One future Olympian watched the event on television. His name is Connor Fields and he’s a favourite in the London Games. “The impact couldn’t have been bigger,” King says. “The Olympics justified and solidified everything we do.”

The minute the races in Beijing ended, another race began, and the US programme was caught flatfooted. The American men and women had seized half the Olympic BMX medals because they possessed the deepest talent pool, because the sport was created and incubated in southern California.

That would no longer be enough.

Not when Australia and France and other countries put their considerable resources – more private financing and sports institutes – behind BMX in late 2008.

The US, Herrera says, fell “maybe a year behind”.

At the same time, King and company shifted their junior development strategy. They went for youth, replacing veterans with prospects, save for Mike Day, the elder statesman and a silver medallist in Beijing.

The US retained the sport’s largest talent pool but needed to take a more scientific approach to training. Herrera was mindful of the pattern in another cycling discipline.

Mountain biking, he says, was also created in the US, and yet an American last won an Olympic medal in that sport in 1996, its first year in the Games.

The US BMX programme underwent a training overhaul.

Herrera came onboard. Simple dietary changes were instituted: no dessert or sugary energy drinks; more fruits and vegetables and nutritional supplements. Jerseys were designed to be tighter and more wind-resistant.

Coaches studied different exercises in the gym and measured their effects on the bike. They added

power meters, as in the other cycling disciplines, and, based on the data they accrued, they adjusted the volume of on-course training and its frequency, determined whether riders needed more practice on uphill or downhill sections and selected gear.

They hired a videographer who used the computer programme Dartfish to show riders the best lines to take on a given turn. Video of individual riders could be placed side by side on a screen, as if they were racing, to compare which one took the most direct route.

“In my era, we’d probably roll our eyes,” King says. “But at this level, with the money we spend, 1 per cent of improvement based on sports technology could be onethousandth of a second, which could be the difference between a gold and silver medal.”

The New York Times The Olympic BMX competition will take place from August 8-10 at the BMX Track in the Olympic Park in east London.

It’s getting really scientific, which is not really BMX … you buy into it. Or you don’t bother JAMIE STAFF, A GOLD MEDALLIST FOR BRITAIN

James Herrera checks practise run data at the training centre

HEALTH 9 BMX riders take off as coach James Herrera (far left) monitors their performance with his smartphone at the US Olympic Training Centre.

Photos: NYT

INDIA

Cost a bitter pill to swallow ......................................................

Amrit Dhillon healthpost@scmp.com

SHIFT INTO HIGH GEAR Hong Kong Jockey Club International BMX Park Kwai Hei Street 91, Gin Drinkers Bay, Kwai Chung www.bmxpark.org.hk, tel: 2419 9613 Admission charges are HK$60 for weekdays and HK$80 for weekends. Bike and protective gear rental at HK$40. Packages and season passes available.

The Hong Kong Cycling Association (HKCA) organises BMX training courses yearround at the park. Prices range from HK$580 for a six-hour elementary course to HK$980 for an eight-hour advanced course. Prerequisite: ability to control a two-wheeled bike.

Po Kong Village Road Park BMX area Po Kong Village Road, Diamond Hill, Wong Tai Sin tel: 2320 6140 Rather than a dirt track, this is a concrete park with three vertical ramps of different levels of difficulty. The park can be used free of charge but cyclists first have to pass an assessment organised by the Leisure and Cultural Services Department and HKCA. The highest ramp is only for training under a qualified instructor.

BMX Evolution www.bmxevolution.com.hk, tel: 6807 9863 This BMX shop in Cheung Sha Wan, Kowloon, offers training sessions starting from HK$150 an hour (excluding BMX Park entrance fee) for training in a group of three to five riders, to HK$300 an hour for one-on-one sessions.

A few months ago, Arun Bharati, 18, walked into the state-run All India Institute of Medical Sciences in New Delhi with his father, a farm labourer in eastern Bihar state.

The doctor diagnosed Hodgkin’s lymphoma and said the drugs would cost 300,000 rupees (HK$42,000) a month. Bharati’s father earns just a few dollars a month.

That night, father and son caught the overnight train home to their village where they broke the news to the family. A week later, unable to cope with not being able to afford the drugs, the father committed suicide by swallowing pesticide.

Harmala Gupta, a cancer survivor and head of the voluntary group CanSupport, comes across many such cases every month – not necessarily of suicide but of families devastated by the cost of cancer drugs. According to World Health Organisation figures, 2.5 million Indians are diagnosed with cancer every year.

“The first question patients ask doctors is how much the treatment will cost,” says Gupta. “The middle class run around borrowing from relatives, selling their property and jewellery and bankrupting themselves. The poor walk out of the hospital and you never see them again.”

This mental agony, exacerbating the physical pain, is something Dr Yusuf Khwaja Hamied, chairman of Indian generic drugs giant Cipla, saw in Aids patients in India and Africa. Knowing that people were dying despite the existence of drugs that could help them was, to him, devastating.

In 2001, the Cambridge-educated multimillionaire sent tremors through the boardrooms of every multinational drug maker when he offered an affordable Aids treatment option. Hamied slashed the price of life-saving triple therapy Aids drug cocktails from US$10,000 per person per year to US$150. He could do this because making the drug at his Goa plant – which is approved by the US Food and Drug Administration – is cheaper than making it elsewhere.

An estimated seven million Africans have been treated with Cipla Aids drugs (now even cheaper at US$80 a year), making the Cipla name a legend in Africa.

“Reducing the price of Aids drugs gave me so much satisfaction that I’ve been thinking of what else I can do,” Hamied says.

His next target: cancer. In May, Cipla cut the price of its generic drugs for lung, brain and kidney cancer by 75 per cent.

“This decision by Cipla is a great gift to cancer patients,” says New Delhi oncologist Bhavna Sirohi.

Manufacturers of generic drugs such as Cipla have given India the name “pharmacy of the developing world” for making low cost, high-quality generic drugs that have saved or prolonged millions of lives. International aid organisations buy these drugs and supply them to Africa and other countries.

The Indian generic drugs revolution began in 1972 when India passed a law allowing medicines to

A man waits outside a cancer hospital in Calcutta. Many cancer drugs are prohibitively expensive for most Indians. Photo: AFP

With a population of 1.3 billion, India can’t afford a monopoly in health care DR YUSUF KHWAJA HAMIED

be copied even if under patent, provided the process was not the same. It led to the creation of hundreds companies making generic drugs.

But in 2005, in a move that Hamied calls “disastrous”, India signed the intellectual property agreement Trips (Trade Related Intellectual Property), which requires every nation to protect patents on new drugs for 20 years.

“With a population of 1.3 billion, India can’t afford a monopoly in health care. Monopolies lead to higher prices and we can’t allow them in a country with so much poverty and misery,” says Hamied, who runs a free cancer hospital in Pune, western India.

The only redeeming feature of TRIPS is that it allows governments the option of “compulsory licensing” – granting a licence to a domestic drug company, without the consent of the patent owner, permitting it to produce a generic version if it is in “the public interest”.

The drawback is that applying for this licence is a cumbersome process. Hamied has been pushing the government to allow the widespread use of licences for the production of life-saving patented drugs for the benefit of the poor.

5.4b

$

From November, India’s state institutions will be providing free generic drugs to all patients in a programme costing this many US dollars

In March, New Delhi granted its first compulsory licence, allowing domestic drug company Natco Pharma to make Nexavar available to cancer patients for a fraction of the price of Bayer’s version.

In keeping with Trips rules, Natco Pharma will pay Bayer 6 per cent in royalties. There were howls of protest from Western drug giants.

“If compulsory licences are misused, the research and innovation being done to save future lives will be in danger and will harm patients,” says Ranjit Shahani, head of the Organisation of Pharmaceutical Producers of India, which represents foreign drug makers.

Indian Commerce Minister Anand Sharma defended the move, saying millions of Indians were dying because they could not afford the branded Nexavar. Bayer is suing India’s patent office.

While the drugs giants condemn Hamied for being a “pirate”, he is unperturbed. “Western multinationals do not understand what it means to be poor in a developing country and unable to afford drugs,” he says.

He says India should have a “permanent compulsory licensing” system for drugs. “We can follow Canada’s example. From 1969 to 1992, Canada copied any drug or product it liked, provided it paid a 4 per cent royalty to the patent holder.

No multinational protested. If this system was good enough for Canada, it should be good enough for us,” he says.

Hamied has a family history to live up to. His father, Khwaja Abdul Hamied, set up Cipla in 1935. During the second world war, as demand for medicines from the Indian army surged and supplies from Europe’s drug makers collapsed, Cipla provided quinine to treat malaria and injections for dysentery.

The government seems to be listening. The Planning Commission has called for more compulsory licences to be issued for patented and expensive drugs so that India can build up its “drug security”.

The government has instigated a US$5.4 billion plan to provide free generic medicine. From November, state institutions will be able to prescribe them to all patients. Those who prescribe branded drugs will face punishment.

10 DIET THE TASTE TEST COUSCOUS ......................................................

PERSONAL BEST Tipiak Couscous HK$24.50 for 500 grams, Taste This French product is plain and hence takes on flavours well, so pair it with anything you fancy, from raisins and chickpeas to feta and peppers. The package notes that this is mediumgrained, but it takes a keen eye to notice it’s a bit bigger than Casbah’s.

Verdict: a great alternative to rice. Perfectly al dente when cooked according to package instructions; a pat of butter makes it especially tasty.

Jeanette Wang jeanette.wang@scmp.com

Casbah CousCous HK$35.50 for 340 grams, ThreeSixty Originating from North Africa, couscous is not a grain but itsy bitsy pasta. Like pasta, it’s made from durum semolina wheat flour. Because of its size, it’s super quick to cook: boil water, pour over couscous, let stand for five minutes, and voila! This particular brand is a Canadian favourite.

Verdict: plain but therefore versatile. Goes well with vegetables, meats and sauces.

Higher purpose

Al’Fez Moroccan Spiced Couscous HK$25 for 200 grams, City’super This is British couscous for the lazy; it’s infused with spices, sultanas and pine nuts so it’s flavourful right out the box. Add broccoli, halloumi, sugar snap peas, cherry tomatoes, and a drizzle of lemon juice and olive oil, and you have a good meal.

Verdict: tasty, but watch the sodium: it’s got 1,060mg per 100 grams.

HEALTHY GOURMET

The joyous benefits of indulgence ......................................................

Andrea Oschetti healthpost@scmp.com While constant indulgence overloads our system and stifles our digestion, occasional positive indulgences are equally important to our well-being. We should ultimately enjoy our food, visually and orally.

Our bodies metabolise food

differently, depending on how we react to indulgence. A sense of guilt, rather than celebration, will generate a different assimilation process in your body. Indulge positively, in moderation and as a celebration.

Most “diets” and detoxes take enjoyment away from eating and make it an antisocial activity.

This approach goes against our well-being and is also unsustainable.

Eating is a social activity that should be enjoyed. I want to counter the approach that indulgence comes with a sense of guilt and the perception of “indulgent” food as the “enemy”.

Eating well can and should satisfy. Let me share with you a delicious and simple dessert recipe that has no added sugar or dairy. It beats many other desserts out there.

Mango coulis with truffle of chocolate and cranberries Serves 4 4 ripe mangoes, deseeded 100 grams almond milk 110 grams dark chocolate 100 grams dried cranberries zest of one orange • Purée mangoes in a mixer until smooth.

Set aside.

• In a small pot, bring almond milk to a simmer and remove from heat.

• Cut chocolate into small pieces. Add it to the almond milk and stir until it melts.

• Put mixture in a metal pan and let cool in the fridge. When chilled, wet your fingers and create four balls.

• Chop cranberries and mix them with orange zest. Coat the chocolate balls with this mixture.

• Pour some mango coulis onto a plate, place one chocolate ball on top. Serve.

Buon appetito!

Healthy Gourmet is a recipe column by private chef Andrea Oschetti that runs in Health Post each week. He can be reached at andrea@fioreblu.com

......................................................

Jeanette Wang jeanette.wang@scmp.com In 2006, still smarting from a bad break-up, I agreed on a whim to an invitation to do Ironman Korea – which consists of a 3.8 kilometre swim, 180.2 kilometre ride and 42.2 kilometre run. I had seven weeks to train for a triathlon that was double the distance of any I had done before.

There’s something about throwing oneself into a new challenge to overcome heartache.

Some people lie in the fetal position on the floor for days, others get a beauty makeover. I’d rather convert my emotional energy into power for propulsion in the pool, on the bike or on the run.

Maybe it’s because for that few hours a day spent training, the body feels pain greater than that in the heart. Maybe it’s because postexercise fatigue clouds the mind, fogging up hurtful memories. Or

perhaps because swimming, cycling and running, quite literally, mean moving forward.

After a four-year relationship ended last October – I had moved to Hong Kong for him – I decided it was time again for what I’ve termed sweat therapy. This time, bitten by the trail bug caught when introduced to the wonders of offroad running in this city, I signed up for the Trail Verbier-St Bernard, held this month in the southwestern Swiss canton of Valais.

After doing multiple Ironmans since that first in South Korea in 2006 and a few ultramarathons of up to 84 kilometres, I needed a race that would push me to a new limit. At 110 kilometres and with a 7,000-metre elevation gain, the Trail Verbier-St Bernard was perfect – just enough challenge to hurt but not kill me.

I’d chanced upon the race while researching the Ultra Trail du Mont Blanc, a 166-kilometre race with 9,400-metre elevation gain that’s one of the international trail-

WELL-BEING 11

An exuberant Jeanette Wang on the path of perfection during the Trail Verbier-St-Bernard challenge. Photo: Cyril Bussat

running marquee events. It’s another world of pain for next year – but to qualify, runners need to chalk up seven points by participating in other races. Trail Verbier-St Bernard would give me four precious points.

The YouTube videos of the Verbier race were the real clincher: runners carving their way up and down lush mountainsides and along ridges shadowed by snow-capped peaks that reach towards a clear blue sky. The sound of cowbells, waterfalls and crunching dirt with each stride. I could almost smell the crisp air and feel the warmth of the Swiss summer sun. Goosebumps.

With my race registration confirmed, I threw myself into training. For hours week after week I’d lose myself in Hong Kong’s amazing network of hundreds of kilometres of trails. I signed up for nearly every local trail race, competing almost every other weekend as practice for the big day.

By February, my heart was almost as good as new. It was a

If the YouTube videos were awesome, the race itself was magnificent beyond description JEANETTE WANG

surprise – I had taken a year to get over the 2006 break-up of an 18month relationship. I thought I’d take forever to get over this recent split, especially because I thought we’d be forever.

But the trails were the perfect antidote. It wasn’t about running away from past demons but running towards happiness. In the peace and serenity of the trails, on the cusp of bustling Hong Kong yet seemingly miles away from the madness, my mind was free. It wasn’t uncommon to see barely a handful of people on a three-hour run.

Without distractions on the trails, I was able to think clearly and reflect.

I was able to listen more sharply to the Big Man up in heaven. He said: “It’s all part of the plan. I’m lining up someone much better for you.”

There’s something about bounding over a natural obstacle course and getting mud-stained legs that make you feel like a child again.

It’s simple, primal, soulful. Standing on a mountain peak with the world

at your feet, it’s impossible not to feel humbled by God’s amazing creations. Faced with such scenery, I know there is so much more to life than dwelling on the past.

“The life we receive is not short but we make it so,” writes Lucius Annaeus Seneca, a Roman philosopher, in his essay On the Shortness of Life. “We are not ill provided but use what we have wastefully.”

Six months flew by quickly; it was time to race the Trail Verbier-St Bernard on July 7. If the YouTube videos were awesome, the race itself was magnificent beyond description.

It started and finished in the popular ski resort of Verbier at an altitude of 1,490 metres. The undulating course over dirt, rock and snow went by many peaks, including Pierre Avoi (2,473 metres), Col de Fenetre (2,698 metres), Col du Grand Saint Bernard (2,469 metres), Col des Chevaux (2,714 metres) and Col de Mille (2,480

metres). For a memorable finish, the race’s hardest climb was right at the end, a steep and technical ascent through the Arbaray Forest up La Chaux (2,200 metres). In contrast, Tai Mo Shan, at 957 metres, is Hong Kong’s highest peak.

The race started at 5am on a Saturday with the faintest hint of a rising sun against the craggy silhouette of the Alps, and I finished under a magical starlit sky just past 3am the next day. My goal had only been completing within the race cut-off time of 32 hours, but at the finish line I was handed a bonus: I’d won the women’s senior category (23-39 years) and finished fifth woman overall.

I won a bunch of prizes, but it’s the journey that I cherish the most. A smile never left my face throughout those enjoyable but painful 22 hours, for I knew that suffering produces perseverance; perseverance, character; and character, hope. And hope does not disappoint.