20121023 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, OCTOBER 23, 2012

HEALTH POST

Science friction When a beauty treatment becomes a medical procedure >PAGE 6

TCM: WAGING FUNGAL WARFARE ON CANCER

WALL OR NOTHING: PIONEERING RUN REMEMBERED

>PAGE 5

>PAGE 11

2 NEWS APP OF THE WEEK

HEALTH BITES

Taking the strain out of pain

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Jeanette Wang jeanette.wang@scmp.com

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Sasha Gonzales healthpost@scmp.com

Funk and disorderly Children with mental health disorders are three times more likely to be bullies, according to new research, highlighting the importance of providing psychological support not only to victims but the bullies as well. The study, presented at an American Academy of Pediatrics conference, involved nearly 64,000 children in the US aged six to 17. Using data provided by the parents and guardians on the mental health and bullying of the children, 15.2 per cent of them were identified as bullies. A sub-analysis by type of mental health disorders found that children diagnosed as depressed were three times more likely to bully, while a diagnosis of Oppositional Defiant Disorder was associated with a six-fold increase in the odds of being identified as a bully.

My Pain Diary: Chronic Pain Management US$3.99 Rating 9/10 When I saw my doctor for a sore lower back in April, she wanted to know how long it had been painful.

I didn’t know for sure, but said that some days were worse than others, and sometimes even standing was agonising. She asked me what I’d been doing to cause this pain, but I didn’t have an answer. It could have been because I wear heels, I carry a heavy backpack when I go hiking and I sleep in awkward positions. Unable to diagnose my problem, my GP gave me painkillers and told me to take things easy.

I was doing some research about back pain when I came across My Pain Diary. I’m the sort who monitors everything, from my food intake to my expenses, so I thought it might be helpful to keep track of my lower back pain, too.

From a broken ankle and arthritis to period cramps and even depression, My Pain Diary is designed to make pain management easier (no more notebooks and bits of paper to deal with) – and the app is such a pleasure to use. It lets you record the location of the pain, its category (throbbing, stabbing, dull, etc.), and intensity (on a scale of one to 10), and its triggers and remedies.

You can even upload photos of any

bruising, swelling or redness, and there is a handy notes section to record other important details.

The intuitive app then uses your input to help you identify trends, patterns and co-relations.

You can then print these records for your doctor, who can use this information to help you handle your pain.

After a few weeks of using My Pain Diary, I visited my GP again.

Looking through my log, she suspected my back pain was due to a trapped nerve and suggested that my poor posture, coupled with carrying heavy loads, was to blame.

Two physiotherapy sessions later, my back was healed. With this app, I realised that taking charge of your pain can be easy and fun.

ASK THE DOCTORS DR ANTHONY LUKE Q: I’m a physical education teacher.

How can I protect my high school students from sudden cardiac death?

A: The death of several high-profile athletes from heart conditions has raised awareness of sudden cardiac death.

Some athletes have warning symptoms, including chest pain, palpitations or lightheadedness when they exercise, but some don’t.

The risk of sudden death from all causes among high school and college athletes is one in 200,000. In the US, the most common cause of sudden cardiac death is hypertrophic cardiomyopathy, which leads to enlargement of the muscle between the two large chambers of the heart. In the wrong situation, this can lead to a fatal arrhythmia.

If your student expresses any of the above signs, they should be taken to see a doctor. Preventive measures involve checking the student’s medical history

Italian soccer player Piermario Morosini who died of cardiac arrest during a Serie B match in April.

Photo: EPA and an annual check up, including checking for heart murmurs and taking blood pressure.

Dr Anthony Luke is a professor of clinical orthopaedic surgery at the University of California, San Francisco. Reprinted with permission of the American College of Sports Medicine’s ACSM Fit Society Page

> 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 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

No smoke without fire Just 20 minutes of exposure to heavy concentrations of second-hand smoke causes near immediate harm to the airways, a study by the University of Athens and the Hellenic Cancer Society in Greece and the Harvard School of Public Health has found. Fifteen healthy participants were exposed to heavily concentrated smoke particulates in an exposure chamber – simulating a bar or moving car – for 20 minutes.

During this time, measurements were taken of the participants’ respiratory movements. There was a significant and immediate impact on airways, including increased airway impedance and resistance. Participants showed no clinical signs or feelings of discomfort. Lead researcher Dr Panagiotis Behrakis, of the University of Athens, believes secondhand smoking is the “most widespread form of violence exerted on children and workers on a global level” and “needs to be recognised as a “human rights violation”.

Milk it for all it’s worth Increasing calcium intake may reduce a woman’s risk of developing a hormone condition that leads to weak bones, fractures and kidney stones, according to researchers at Brigham and Women’s Hospital in Boston. Primary hyperparathyroidism (PHPT), which is caused by overactive parathyroid glands, affects one in 800 people. It is most common in postmenopausal women between 50 and 60. In the study, more than 58,000 women aged 39 to 66 in 1986 with no history of PHPT were tracked; their calcium intake (from both dietary sources and supplements) was assessed every four years using questionnaires over a 22-year period. After adjusting for factors including age, body mass index and ethnicity, women with the highest intake of dietary calcium had a 44 per cent reduced risk of developing PHPT compared with those with the lowest intake. Even for women taking a modest 500 milligrams a day of calcium supplements, the risk of developing PHPT was 59 per cent lower than those taking no calcium supplements.

Minor health benefits Are organic products better for your children? The American Academy of Pediatrics has conducted an extensive analysis of scientific evidence regarding organic produce, dairy products and meat – and has no straight answer. In a report in next month’s Pediatrics, the researchers say while organic foods have the same nutrients as conventional foods, they have lower pesticide levels, which may be significant for children. Organically raised animals are also less likely to be contaminated with drug-resistant bacteria. But in the long term there is no direct evidence that following an organic diet leads to improved health or lower risk of disease.

“What’s most important is that children eat a healthy diet rich in fruits, vegetables, whole grains and low-fat or fat-free dairy products, whether those are conventional or organic foods. This … has proven health benefits,” says Dr Janet Silverstein, one of the authors.

MEDICAL 3 RESEARCH BREAST CANCER

Gene mutation study offers hope to Chinese carriers ......................................................

Elaine Yau elaine.yau@scmp.com Chinese breast and ovarian cancer patients have been found to have the same pattern of gene mutations in a study done by a local medical researcher, raising hopes that a tailor-made genetic test can be developed to help Chinese fend off cancer.

The study by Hong Kong Hereditary Breast Cancer Family Registry analysed 535 Chinese breast and ovarian cancer patients for hereditary mutations in the genes known as BRCA, which increase the risk for both cancers.

These gene mutations have mainly been reported in Caucasians and Ashkenazi Jews (who have mainly central and eastern Europe an ancestry) and its prevalence is less known among Chinese and other Asians.

Ten per cent of the study subjects were found to carry the BRCA mutations. Of these, about one in four carry mutations in the four same spots in DNA genetic sequencing. The results of the study were published last month in PLOS ONE, an open-access peer-reviewed scientific journal published by the US-based Public Library of Science.

Dr Ava Kwong Hoi-wai, chairwoman of the registry and chief

If patterns [are similar] it could lead to a complete overhaul of testing methods DR AVA KWONG

of Queen Mary Hospital’s breast surgery division at University of Hong Kong, says the findings are significant in that they might prove that Chinese cancer sufferers carry a unique pattern of gene mutations.

Everyone has BRCA genes.

BRCA1 and BRCA2 are known as tumour suppressors because they help repair damaged DNA in cells that have divided improperly. But when either of those genes mutate, the repair process can go awry.

According to the US National Cancer Institute, the risk of breast cancer in the general population is 12 per cent, but those who are BRCA-positive carry a 60 per cent risk. The risk for ovarian cancer goes up from 1.4 per cent to between 15 per cent and 40 per cent.

Kwong says BRCA-positive males are 60 per cent more like to suffer from breast cancer and are four times more at risk of prostate cancer than men without the mutations.

“Most Jewish breast cancer sufferers are found to carry mutations in three spots in the BRCA. When those Jewish people predisposed to develop cancer [because family members have been struck by it] come for genetic screening tests, doctors can prescribe genetic tests aimed at the three spots, sparing the high financial and time cost in mapping out the entire gene for an initial first screen,” she says.

“Every ethic race carries different genetic mutations.

[Non-Chinese] carry more BRCA1 mutations, while Chinese carry more BRCA2 mutations. Forty-two per cent of the mutations found in our study have never been reported in other ethnicities.”

BRCA mutations have been known for a decade, but until recently there have been no studies of the Asian or Chinese population.

Kwong says more studies are

Dr Ava Kwong enjoys Pink Desserts for a Cause at The Peninsula. Photo: David Wong needed to prove the mutation patterns found in this study are unique to Chinese. To that end, the registry is collaborating with organisations and universities in Canada, Britain and the mainland to study pockets of the Chinese population. The study is expected to take one to two years.

“If the patterns found in Chinese who live in America or Britain are like those in Hong Kong, it can lead to a complete overhaul of testing methods,” says Kwong. “For future test subjects, we can do tests on the Chinese-specific four spots first before we do a comprehensive test.”

The registry has tested 903 patients and 214 family members since being set up five years ago.

Tests are also available at the cancer genetics clinic at the Hong Kong Sanatorium and Hospital.

Kwong says those who have family members suffering from breast or ovarian cancer should check their clinical status for the genetic tests.

“Not everyone needs to undergo genetic tests. Those who were struck by breast cancer before they reached 45 and those with more than three family members suffering from breast cancer, or with family

members with breast and ovarian cancers, have greater chance of carrying mutations.”

Testing the first family member, usually the cancer patient, costs HK$18,000 to HK$25,000 as the entire gene must first be mapped out. Tests on other family members cost about HK$3,000.

This month, the registry has collaborated with restaurants on Pink Desserts for a Cause. Part or all of the proceeds from the sale of special pink desserts go to the registry for patient support, research and education. For more details, go to asiabreastregistry.com

QUIZ

The inside running on Lance Armstrong’s little helper ......................................................

Jeanette Wang jeanette.wang@scmp.com It seems the French were right after all. After years of accusing American cyclist Lance Armstrong of taking performance-enhancing drugs, it now appears certain that Armstrong’s record seven straight Tour de France titles were won through an intricately planned doping conspiracy.

According to the US Anti-Doping Agency, which has stripped the

cyclist of his Tour titles, the Texan used banned substances throughout his cycling career. And he forced teammates to dope under the threat of dismissal from his squad.

Armstrong, 41, retired last year.

The banned blood booster erythropoietin, or EPO, was one of the key drugs taken by Armstrong and provided to teammates, the agency says. Testosterone and blood transfusions were other performance enhancers used.

Armstrong is certainly not the first to be done for taking EPO –

many other top pro cyclists and American sprinter Marion Jones are among the high-profile offenders.

EPO is a peptide hormone that is produced naturally by the body to stimulate red blood cell production.

An increase in red blood cells improves the amount of oxygen that the blood can carry to the muscles.

EPO can also be synthetically manufactured and injected into the skin or directly into the blood stream. In medicine, the drug is used to treat anaemia caused by specific chronic diseases or by

chemotherapy medications that suppress bone marrow activity.

Find out more about the drug by taking this quiz.

1. EPO is naturally produced in the … a. Kidneys b. Thyroid gland c. Brain 2. The main benefit of EPO is an increase in … a. Speed b. Concentration c. Endurance

3. For EPO to be effective, the athlete would need to take it within how many days of competition? a. One to three b. Three to five c. Five to seven 4. The inappropriate use of EPO can lead to … a. Heart disease b. Stroke c. Cerebral or pulmonary embolism Answers: 1. A; 2. C; 3. C; 4. All are correct

Illustration: Angela Ho

4 MEDICAL

CASE HISTORY

A ticking time bomb ......................................................

Eileen Aung-Thwin healthpost@scmp.com Roland Lee was an energetic man who travelled between Hong Kong, Shenzhen and New York running his business. So when 61-year-old Lee (whose name has been changed for reasons of patient confidentiality) started to feel increasingly fatigued, he was not sure what to make of it.

The bouts of fatigue grew worse, sapping not only his energy but his appetite, leaving him feeling constantly weak. He then developed a low-grade fever as his symptoms dragged on for two months.

During one of his business trips to Shenzhen, he sought treatment at a hospital, but doctors were baffled by his symptoms and could not pin down a diagnosis. He was given antibiotics, but little more was done.

He was feeling extremely unwell while in Hong Kong in June, so he checked himself into the North District Hospital. Immediately after admission, his temperature rose to 39 degrees Celsius, his blood pressure plunged, and Lee went into shock. He was taken to intensive care where doctors fought to stabilise him while trying to figure out his ailment.

Tests showed that Lee’s liver function was impaired. He was also severely anaemic – there were not enough red blood cells circulating in his body – and his haemoglobin levels were extremely low.

Where a healthy male should have 12 to 13 grams per decilitre of haemoglobin, Lee only had six grams per decilitre.

As haemoglobin carries oxygen, this meant that Lee’s body was being starved of oxygen, which explained his severe fatigue and weakness.

Lee’s symptoms were strongly suggestive of malaria. Doctors sent his blood to be tested for this and found that many of his red blood cells were infected by parasites – these red blood cells are thus called parasitised blood cells.

They appear to have ring forms inside, which is a typical presentation of a strain of malaria parasite called Plasmodium falciparum. It is the most dangerous form of malaria, and can cause high rates of complications and fatality.

When 5 per cent of red blood cells are invaded by parasites, doctors already consider it to be a severe case of malaria. But Lee had a whopping 15 per cent of parasitised red blood cells.

The affected red blood cells also become deformed – in the case of

P. falciparum infection, they tend to be larger or smaller than normal.

When these cells pass through the spleen, the organ will destroy them.

When a large number of red blood cells are being destroyed, it results in haemolytic anaemia.

The likely diagnosis of malaria prompted doctors to transfer Lee to the Infectious Disease Centre in Princess Margaret Hospital, where specialist Dr Jacky Chan Man-chun was called in.

Lee was given blood transfusions and antibiotics to help support his embattled body. Chan also started Lee on two types of first-line malaria medication while other tests were performed to confirm the diagnosis.

Although malaria was the likely culprit of Lee’s condition, several factors did not add up. Chan says while the blood smear showed that the parasitised red blood cells were deformed, there were more varied deformations than in typical P. falciparum infection.

Moreover, given Lee’s travel history, none of the places he visited were known for malaria infections.

But as Chan had spent time in New York City, another parasite became a suspect. Babesia is a type of parasite that can cause very similar symptoms to malaria but is transmitted by ticks.

It also infects the blood, causing haemolysis, anaemia, weakness and fever. Once it invades red blood cells, the parasite will ingest all the nutrients in the cell and cause its deformation and subsequent destruction by the spleen.

But babesia is extremely rare in Hong Kong. If Lee was infected, he would only have been the second case ever reported in the territory.

However, babesia infections are not uncommon in the US. Although there are more than 100 species of babesia, only a few are known to have an effect on humans, the most common being Babesia microti and Babesia divergens.

Because of the similarities in symptoms between malaria and babesiosis (illness caused by the babesia parasite), babesiosis is

The dog picked up a carrier tick, and the tick infected Lee while he snuggled in his bed

frequently misdiagnosed as malaria.

Chan needed to confirm if Lee truly suffered from malaria, so the laboratories used a rapid diagnostic test to check for malaria antigens.

But two different tests came back negative. Next, tests were used to check for malaria DNA and babesia DNA. Only the babesia DNA test came back positive.

With a confirmed babesiosis diagnosis, Chan switched to firstline medication to treat it. Although Lee was stable enough to be moved out of the ICU to the general isolation ward after two days, he had to remain in hospital for another three weeks while his body took time to restore his levels of red blood cells and haemoglobin.

Lee later mentioned that he had a pampered pet dog in New York.

Chan suspects that the dog picked up a carrier tick in the basement, and the tick infected Lee while the dog snuggled in his bed.

Lee has since recovered fully. He has also engaged a professional cleaning crew to thoroughly clean his New York apartment.

Chan says babesia is a common parasite found in the US and in Europe. He advises the public to be on guard for any unusual symptoms following insect bites while travelling.

HEALTH 5 TRADITIONAL CHINESE MEDICINE

Mushroom for conjecture ......................................................

Elizabeth Snouffer healthpost@scmp.com Earlier this year two US veterinary doctors conducted a study to assess the anti-tumour and survival effects of yunzhi, a mushroom used in traditional Chinese medicine for more than 2,000 years for its apparent immune-boosting properties.

The doctors tested it on a small group of cancerous dogs, and achieved results similar, if not better, than results obtained with standard chemotherapy.

Dorothy Cimino Brown and Jennifer Reetz, both from the Department of Clinical Studies at the University of Pennsylvania, believe their work may provide enough evidence to provoke a potential shift from reliance on cytotoxic [toxic to cells] therapies to a focus on complementary compounds. This implies potential advances for cancer curative therapies in human and animal health.

In the Ming dynasty (1368-1644), the yunzhi mushroom, Coriolus versicolor also known as “turkey tail” for its uncanny resemblance to one, was boiled to release its restorative qi properties. Past studies have already indicated, but not given clear evidence, that polysaccharopeptide (PSP), a bioactive agent produced from the mushroom, inhibits the growth of induced tumours in animals.

PSP has been widely used in clinical trials in Japan, the mainland and Hong Kong as an alternative method to boost immune status. It has also been used to alleviate chemotherapy symptoms in patients with small-cell lung, oesophageal, breast and gastric cancers. But to date, trials have lacked clear evidence of anti-tumour effects in humans.

The UPenn study randomly divided 15 dogs with splenic haemangiosarcoma – an aggressive, invasive cancer that affects the spleen and commonly strikes golden retrievers and German shepherds – into three yunzhi treatment groups: those on 25 milligrams, 50mg or 100mg per kilogram of body weight per day. The two highest dose groups had median survival times longer than the longest median survival time reported in literature to date.

Dogs that received the highest dose had a significantly slower cancer progression and lived longer than those dogs receiving chemotherapeutic protocols.

Brown, the lead researcher and director of UPenn’s Veterinary Clinical Investigation Centre, feels

that more rigorous scientific investigation is needed to support the many traditional Chinese or complementary alternative medicines (CAM) used with anecdotal success. “[Dogs and pets] develop many of the same diseases that people do, and study results not only inform the veterinary community about potential new treatments, but also provide proof-of-concept information for moving to efficacy studies in people,” she says.

According to Brown, the cost of the yunzhi product used in the study, called I’m-Yunity, is about US$500 for a three-month course.

That would be a lower-priced alternative to the burden of cytotoxic therapy. That is, if yunzhi’s safety profile is credible.

Dogs develop cancer about twice as frequently as humans, and one out of every three dogs is affected by canine cancer, according to the US National Canine Cancer Foundation. Advances in veterinary medicine, nutrition and pet-owner education may be helping cherished pets live longer, but there is one possible drawback.

“As a consequence, veterinarians are diagnosing more and more cancers in pets,” says Dr Lloyd Kenda, Director of the Valley

PSP should be used with chemotherapy and radiotherapy to relieve patient side effects PROFESSOR CHUN KWOK-WONG

Yunzhi, or turkey tail mushrooms were used in the Ming dynasty for their medicinal properties. Photo: Corbis

Veterinary Centre in Happy Valley.

Kenda sees many middle-aged and elderly dogs in Hong Kong with splenic haemangiosarcoma, a “dogonly disease” which usually requires total surgical removal of the spleen and related tumours.

“Chemotherapy after surgery has shown to increase the median survival rate, but not to significantly increase the 12-month survival rate.

It is a nasty cancer, and even with the best treatment, prognosis is very grave,” Kenda explains.

Despite this, Kenda believes his ability to treat these patients has improved because techniques, pharmacology and regimens are constantly being updated. He believes that chemotherapy for several types of animal cancers is “viable, humane and successful”.

Professor Chun Kwok-wong, from the department of clinical pathology at Chinese University of Hong Kong, believes Cimino’s small pilot study requires further evidence in a larger-scale animal study to confirm the anti-cancer activity of PSP. In 2005, Chun investigated the effect of yunzhi, combined with another herbal compound, on the immune response in post-treatment breast cancer patients. He concluded that the combination could be beneficial for promoting immunological function. Wong believes that studies on the benefits of PSP on tumours are inconclusive, but thinks it can enhance the immune status of cancer patients.

Chun believes PSP is best utilised as an adjuvant therapy: “PSP should be used in combination with chemotherapy and radiotherapy to relieve patient side effects and improve quality of life.”

Cimino will soon conduct another study on dogs with haemangiosarcoma – an aggressive, malignant tumour of blood vessel cells – and treated with PSP, and their morbidity and mortality compared to dogs treated with conventional chemotherapy.

“The cost of performing welldesigned, long-term clinical trials in people is very high, but if the next definitive canine study corroborates the data we have to date, it could be well worth the investment to do such studies in people,” she says.

The University of Pennsylvania canine study was supported in part from a grant

by Integrated Chinese Medicine (ICM) Holdings (Hong Kong), makers of I’mYunity, a brand of yunzhi. I’m-Yunity is sold and regulated as a health food supplement in the US. It is not available as a supplement in Hong Kong for people, but will be available to the pet population shortly as a food supplement.

6 COVER STORY

Fatal The recent death of a woman after a beauty treatment raises questions about the safety and efficacy of such procedures.

Jeanette Wang investigates

C

ancer treatments are associated more often with diminishing beauty than its enhancement. Hair loss and raw, peeling skin immediately spring to mind as common side effects of radio- and chemotherapy.

But lately, another regimen has come under the spotlight – DC-CIK injections – being used to achieve more youthful looks. Beauty salons have offered the procedure claiming it would give clients whiter, younger-looking skin with finer pores, while strengthening their immune system. But four women, who each reportedly paid about HK$50,000 for the treatment at DR Beauty chain, wound up in hospital suffering from septic shock. One eventually died from the onset, induced by a bacterial infection.

So what is DC-CIK? Short for dendritic cells and cytokine-induced killer cells, it is a form of immunotherapy that has been in existence for about 10 years, although it has never been used in Hong Kong as a cancer therapy, says Dr Raymond Liang Hin-suen, president of the Hong Kong Academy of Medicine. While some clinical trials show that it has some effect in prolonging survival, particularly in patients with kidney cancer and melanoma, DC-CIK remains an experimental treatment, even for fighting cancer, he says.

“There’s no evidence that this type of treatment works for other purposes such as improving your health, skin condition or preventing cancers,” says Liang, who is also director of the Comprehensive Oncology Centre at Hong Kong Sanatorium and Hospital. Indeed, several experts in immunotherapy and cosmetic surgery were unaware of the DC-CIK cocktail, or its application in aesthetic regimens.

Dendritic cells and killer cells are types of immune cells. Dendritic cells are present in most tissues of the body, particularly stationed at “outposts” such as the skin.

Dendritic cells act like sentries of the immune system and deliver key information about invading

COVER STORY 7

attraction There’s no evidence that this treatment works for purposes like improving your skin condition RAYMOND LIANG (BELOW), HK ACADEMY OF MEDICINE

A woman died after beauty treatment at a DR beauty centre (above); Dr Andrew Burd (below) questions the efficacy of such treatments; the human dendritic cell (right). Photos: May Tse, Corbis pathogens, which in turn helps activate killer cells – a type of white blood cell – to fend off the infectious agents. In DC-CIK immunotherapy, blood extracted from the body is cultured with a mix of proteins called cytokines, which stimulate the production of killer and dendritic cells.

The idea is that injecting this activated cocktail back into the body will boost the ability of the immune system to fight cancer cells, Liang explains.

But such a combination is largely unknown in Europe, says Laurence Chaperot, a researcher at the Albert Bonniot Institute in France. “DC, yes, CIK, yes, but not their association,” says Chaperot, who has been studying the use of dendritic cells in immunotherapy for more than a decade. “In Europe, these two kinds of cells are usually not used together, but it seems to be the case in China, as you can see on clinicaltrials.gov.”

Run by the US National Institutes of Health, this website lists eight clinical trials in progress, one in Thailand and the rest in China, in Beijing, Qingdao and Fuzhou.

Dr Ren Jun, director of Beijing Cancer Hospital’s Medical Oncology Department and also director of the city’s Capital Medical University Cancer Centre, is principal investigator for four of the seven studies. Asked about the link between DC-CIK and better looks, Ren says he has “no idea of such

beauty issues”. Neither does Chaperot. He has not found any argument that could suggest that such cell therapies would have an effect on the skin, he says. “[It’s] very intriguing.”

Indeed, Dr Walter King Wingkeung, president of the Hong Kong Association of Cosmetic Surgery, says he had not heard of DC-CIK being used for cosmetic reasons until reports emerged of the four women being admitted to hospital after receiving treatment.

“In theory, it may be a way of stimulating the immune system to mop up dying, ageing cells,” King says. But he has not come across any Western literature that explains the process or proves its efficacy.

“There’s good rationale behind the whole concept of stem-cell treatments making people feel healthier and look younger, and, hypothetically, it makes a convincing story,” says Dr Andrew Burd, professor of plastic, reconstructive and aesthetic surgery

at Chinese University of Hong Kong.

Without evidence of efficacy, however, “it’s just not appropriate” to provide the procedure, Burd says.

“That sort of treatment needs to be given in a research environment.”

Efficacy of the treatment aside, initial reports raise suspicions that the superbug Mycobacterium abscessus that infected the women may have been introduced during handling. Cell culture, which is conducted at DR Beauty’s lab at the > CONTINUED ON PAGE 8

8 COVER STORY

The good, the bad, the ugly ......................................................

Jeanette Wang jeanette.wang@scmp.com A good doctor will always assess a patient’s health for any conditions that might put the patient at a higher risk during an aesthetic procedure, says Dr Walter King Wing-keung.

For example, patients taking blood thinners may be at higher risk for any injection therapy or laser treatment and may have more bruising and swelling.

Diabetics may be more likely to get infections. People with lupus should not try laser or light treatments as this may stir up underlying conditions.

“Experience and special training is necessary [for doctors administering aesthetic procedures] to minimise and lower the complications and side effects,” says King.

Here’s a look at the trendy treatments in Hong Kong and their possible side effects. > CONTINUED FROM PAGE 7

Hong Kong Science Park in Sha Tin, is a vulnerable phase. The killer cells are incubated at 37 degrees Celsius, or body temperature. “At that temperature, if there is any bacterial contamination, then you’re growing the bacteria as well,” Liang explains.

So is the procedure cosmetic, medical, or both? The DC-CIK procedure was reportedly carried out by a doctor not employed by DR Beauty, and this has raised questions about regulating the kind of services beauty salons can perform. A task force led by Health Department director Constance Chan Hon-yee has been formed to review the operations.

Liang, who is part of the task force, says the first step is to define what constitutes a medical procedure. By extension, any medical procedure that is not performed by a doctor would be deemed illegal. But other physicians doubt the feasibility of making such delineations.

“It would be very hard to have a definition that will work well. For example, if we define anything that draws blood or breaks skin as ‘medical’, how about extractions or ear piercings?” asks dermatology specialist Dr Tinny Ho Tin-yee.

“Another example is machines like lasers and radiofrequency devices [for skin or hair]. There are now home-use versions, so one can’t say those machines can’t be used in beauty salons.”

The distinction between cosmetic and medical treatments is still “very foggy”, Burd says, citing as an example a person with acne who gets prescribed medication by their doctor. “People say it’s medical, but one of the consequences is they’ll look more beautiful. So there are medical treatments designed to make people look better.”

Singapore seems to have succeeded in making the distinction. In 2008, the Singapore Medical Council (SMC) drew up guidelines on aesthetic practices which are jointly implemented with

the Academy of Medicine and College of Family Physicians.

They require all procedures to be conducted by registered doctors.

The guidelines sort treatments into two lists, based on the scientific evidence to support their use.

List A comprises treatments with a moderate to high level of evidence, or with local medical expert consensus that the procedure is well established. The treatments are further grouped into noninvasive, minimally invasive and invasive. List-A treatments include chemical peels, microdermabrasion, lasers, botox and filler injections, breast enhancement, brow lifts and liposuction, among others.

The guidelines also demand a minimum level of competence for each treatment, appropriate

If you are not comfortable about a procedure or treatment, don’t do it. These are all elective procedures DR TINNY HO, DERMATOLOGIST

premises where the procedure can be carried out, and a requisite number of procedures that have been performed by the doctor.

Doctors who don’t have sufficient experience must get SMC approval before carrying out the procedures.

List B covers treatments for which there is little evidence and/or consensus they are well established or acceptable. These include mesotherapy, carboxytherapy, microneedling dermaroller, skin whitening injections, stem-cell activator protein for skin rejuvenation, negative pressure procedures (such as Vacustyler) and mechanised massage (such as

“slidestyler” or “endermologie”, for cellulite treatment).

Doctors who wish to perform any list-B procedures must show the circumstantial evidence for its use, and administer it using protocol similar to a research study. They are not allowed to advertise their services for these procedures.

In Hong Kong, medical opinion is divided on which procedures require a doctor’s expertise. Burd argues that professionals such as nurses or trained beauticians should be allowed to administer certain invasive treatments, such as Botox.

“If they’re giving it routinely every day, they would be better at it than a doctor giving it once a month.”

But King advises that invasive procedures such as those involving needles and knives, as well as those using lasers, intense pulse light, high energy radiofrequency and ultrasound therapies, should be performed by experienced and registered doctors.

With a range of views, and guidelines yet to be established in Hong Kong, perhaps the best protection is for consumers to make well-informed choices.

Ho advises consumers seeking cosmetic treatments to go to a clinic run by a doctor who has the expertise to assess the risks and benefits of a treatment.

Those requiring a dermatologist or plastic surgeon could check the list of registered specialists on the Medical Council’s website (mchk.org.hk). Apart from that, Ho says, there is no official certification for doctors trained in cosmetic treatments.

“Most importantly, you should find someone who is experienced, knowledgeable about what they do, and who can give you a good and fair discussion of the pros and cons and possible side effects of a treatment,” says Ho. “If you are not absolutely comfortable about a procedure or treatment, don’t do it.

These are all elective procedures. It’s not like treating a heart attack. You won’t suffer not having them.” jeanette.wang@scmp.com

BOTOX What it does Injections of this substance block muscular nerve signals, which weakens the muscle so that it can’t contract and diminishes your unwanted facial wrinkles. Can also reduce sweaty armpits or palms.

Be warned The side effects, such as drooping brows or eyelids when too much is injected, usually last no more than two months, says King.

According to the American Society of Plastic Surgeons, the toxin can spread beyond the treatment area, causing signs and symptoms such as breathing problems, trouble swallowing, muscle weakness and slurred speech. But this is very rare.

HYALURONIC ACID What it does A natural substance found in the body, when this gel is injected, it acts like an inflated cushion to support facial structures and tissues that may have lost volume or elasticity due to ageing.

It also brings water to the surface of the skin, to keep it looking fresh and supple.

Be warned “If not carefully administered, the filler can go into the blood vessel and cause tissue

damage,” King says. There may be allergic reactions.

POLYLACTIC ACID What it does A non-toxic and biodegradable synthetic filler that is injected into the face, causing the body’s own production of collagen.

It’s known to work particularly well filling the lines caused by laughing, augmenting thin lips and filling out deep nasolabial folds. The only brand approved by the US Food and Drug Administration is Sculptra Aesthetic.

Be warned Risks can include haematoma, or blood pooling beneath the skin. Although rare, infection and necrosis, or skin loss, is possible. There’s also a risk of the particles forming lumps that can be felt or seen beneath the skin, which can occur months later.

STEM CELLS AND GROWTH FACTOR BEAUTY TREATMENTS What it does Claims the injection of stem cells or application of “miracle” creams can erase wrinkles and produce younger, fresher skin.

Be warned Possible consequences include anaphylactic shock, especially for those who have hypersensitive reactions.

Stem cells cannot be used as a cream, lotion or serum because they will die and the product, which consists mainly of growth factors, has an extremely low amount of stem cells anyway.

“Our body is a very complicated machine. Even for just for the skin, we are still discovering new functions of cells and new signal pathways between cells all the time, which means we still do not have the complete picture – and may never have – of how everything works together,” says Dr Tinny Ho. HORMONE REJUVENATION THERAPY What it does Claims to bring hormone levels back to the level of the patient’s early 20s, and therefore reverse ageing.

Be warned “We don’t know enough about how these may have an impact on the different body systems in the long run,” says Ho. The therapy is typically used only for people medically diagnosed with endocrine disease.

Walter King says doctors should minimise the side effects. Photo: Ricky Chung

DIET 9 THE TASTE TEST YOGURT WITH TOPPINGS ......................................................

Jeanette Wang jeanette.wang@scmp.com

HEALTHY GOURMET

Simplicity is the shape of things to come ..............................................

Andrea Oschetti healthpost@scmp.com Forget dieting: it slows your metabolism, reduces your lean mass and accumulates toxins.

Soon enough, you will put back what have you lost.

Forget counting calories: quality calories are full of nutrients, while poor calories increase our appetite. Cooking techniques are much more important than the calorie count; a chef can heal or poison by the way he cooks. Cook your food simply and quickly.

Forget the complexity of the commercially driven diet industry.

The key principles for healthiness are few and simple. The goal of losing weight is already misplaced; you want to lose body fat, not just weight. Don’t relay on scales, look at the mirror. In terms of body aesthetic, toned is beautiful, skinny is not.

There are three simple rules if you aim to lose excess body fat or maintain your ideal weight: eat well, keep the metabolism active and exercise.

On eating well, Michel Pollan, author of Food Rules: An Eater’s Manual, puts it simply: “Don’t eat anything your great-grandmother wouldn’t recognise as food.”

Avoid industrial and deep-fried food and you are 80 per cent on the right track.

Keeping the metabolism active is the key factor to sustainable weight loss. The problem with diets is they disregard the role of the metabolism and simply limit calories: our body reacts by adapting, slowing down its consumption to conserve energy, thereby making the body more prone to weight gain.

You should lose weight by eating healthy food and spreading out your intake throughout the day. Eat what you need, don’t starve yourself.

Have a rich breakfast, a balanced lunch and a light dinner. Eat within 30 minutes of when you wake up or your metabolism will slow down.

Don’t eat a lot in the evening or you will fuel the body’s night anabolic phase, which promotes the accumulation of fats.

Physical exercise does not mean competing in ironman races. It means doing regular activities that you regard as fun. Start gradually and make sure your workout is intense enough to burn energy.

My dream of ideal weight and healthiness became real in the

Don’t eat anything your great-grandmother wouldn’t recognise as food MICHEL POLLAN, AUTHOR

summer of 2008 at Kamalaya, a wellness retreat in Koh Samui. The programme there restarted my internal engine.

Rather than working on restricting caloric intake, it focuses on making the body work again. It offers a menu that is nutritious and satisfying, complemented with daily herbal and antioxidant supplements.

Karina Stewart, Kamalaya co-founder, explains that the retreat’s cuisine philosophy is to “favour fad-free over fat-free; a sensible approach to dining that aims to educate and inspire guests to develop a more thoughtful and enriching relationship with food”.

She adds: “Purists may be

alarmed to find some richer dishes on the menu such as chocolate soufflé, but we recognise that human nature sometimes seeks indulgence. When it comes to healthy eating, the quest for perfection can be our greatest downfall because it often leads to an all-or-nothing mentality where one chocolate seems little different to the entire box.”

Here are Kamalaya’s key principles for optimising weight loss: Eat dinner early: before 7pm; ideally start the meal at 6pm.

Time your carbs: it is best to eat complex carbohydrates in the daytime when you are awake and moving, which is when you are most metabolically active.

Try a small serving of complex carbohydrates at either breakfast or lunch – for example, muesli at breakfast or glass noodles at lunch.

Complex carbohydrates are not recommended in your evening meal or more than once a day. A light dinner with an emphasis on lean protein and vegetables is more energy efficient.

Have protein with every meal: to maintain a stable blood-sugar level throughout the day. This will help sustain your energy levels and prevent you from getting ravenously hungry and overeating.

Bulk up on fibre: increase your intake

through cooked and raw vegetables, low glycaemic grains, legumes and fruits.

This will minimise overeating, help with constipation, release trapped toxins, decrease absorption of fat and lower cholesterol. It will also speed up the transit time for food through your digestive system.

Chew thoroughly: this slows down your eating and will enhance your digestion and give your body time to signal when you’ve had enough. Chew each mouthful 30 times until this becomes a habit.

Go the soup and salad route: eating more water-based vegetables and soups will provide the hydration necessary for cellular metabolic reactions to happen and prevent over eating.

Drink more green tea: it is a potent antioxidant, it boosts energy and strengthens the heart. Research shows that the combination of green tea and exercise targets tummy fat.

Turn eating into a ritual: blessing your food, giving thanks or even just taking a few deep breaths before starting your meal will calm the nervous system to work optimally.

This week’s recipe features wakame, a seaweed and one of the richest sources of vegetable proteins, vitamins and minerals. The high iodine content supports function of the thyroid, which produces hormones that stimulate diverse metabolic activities in most tissues.

Wakame salad 240 grams wakame 120 grams spring onions 320 grams cucumber ½ tsp sesame seeds Extra virgin olive oil Apple cider vinegar Salt and pepper • Cut wakame, spring onions and cucumber into thin strips.

• Mix together in a bowl, season with oil, vinegar, salt and pepper.

• Arrange the salad in the middle of your serving plates and sprinkle with some extra sesame seeds.

Healthy Gourmet is a weekly column by private chef Andrea Oschetti. andrea@fioreblu.com

Muller Corner Cookies and Cream HK$13 for 135 grams, Marketplace by Jasons Cream is full of fat, so replacing it with yogurt in this case makes the combination with cookies a bit less naughty. The button-sized cookie bits, though few, provide a good crunch and make this seem more like dessert than breakfast.

Verdict: the yogurt is light, creamy and smooth; pleasant natural flavour. More cookie bits, please.

Fage Total with Honey HK$35 for 170 grams, City’super This authentic Greek yogurt is strained to remove much of its water content, the result being a richer and creamier yogurt than regular varieties. A small pot of thick, gooey honey accompanies it.

Verdict: has strong sour, dairy taste that may not appeal to some, but the addition of honey is genius – though if you emptied the whole pot it would be a bit too sweet.

Marks & Spencer Activehealth Low Fat Natural Yogurt HK$32 for 205 grams, Marks & Spencer Bramley apple, sultana and cinnamon compote and three-seed granola combine in this luxurious pot of British-made yogurt. It has added vitamin D (6.6 micrograms, or 132 per cent of the recommended daily allowance), which is essential for healthy bones.

Verdict: sweet, tart, chewy, crunchy – a fantastic combination of textures, and very filling.

10 FITNESS ADVENTURE

Whim and a prayer ......................................................

Jeanette Wang jeanette.wang@scmp.com When Mark Wright calls himself an impulsive character he’s not joking.

Impulsiveness to many of us may mean that regrettable shopping purchase. For Wright, a 27-year-old Englishman, it meant deciding in a day earlier this year to do a selfsupported solo bike ride from his London home to Hong Kong to raise funds for breast cancer patients.

The idea popped into his head during one of his daily 10-kilometre bicycle commutes to work, the time of the day when he says he thinks clearest. “I really enjoy my rides to work and I wanted to do something longer,” he recalls.

Hong Kong was chosen as the end point because he didn’t want to fly and because his job – as a senior Southeast Asia specialist with a London-based travel agency – revolves around this region. And finally, he says, because “Hong Kong is a city that everyone knows of, even a six-year-old in Iran”.

Inspired by his mother, Siggi, a 57-year-old housewife diagnosed with stage-one breast cancer last year, he dedicated the adventure to raising funds for the British charity Breast Cancer Care, which played a key role in her recovery.

On April 14, Wright and his 55-kilogram travelling partner – a pannier-laden bike called Knodel (German for “dumpling”) – set off from Buckingham Palace. True to his spontaneous nature, Wright carried only a compass and no maps. Most nights he camped on any open ground he could find; on rare nights he had the luxury of a roof over his head.

Exactly 180 days later, on October 11, his father Philip’s 59th birthday, he arrived at The Peak in Hong Kong. Vital stats: 16,531 kilometres cycled, £14,441 (HK$180,500) raised, 19 countries visited, 14 kilograms lost and one elated, bearded man.

Wright breasted the finishing tape set up on The Peak Sky Terrace by his parents, brother Nick, and five friends, who had flown in to celebrate his amazing feat.

“I haven’t been as excited and proud since my teenage years,” says Philip, the vice-chairman of Bart’s Hospital in London. “When he first mentioned it to me over the phone I laughed for a full minute. His mother said, ‘He can’t be serious?’

But when you’ve got sons, you live vicariously through them. I’ve never done anything like that in my life, so I’m a bit jealous.”

An emotional Siggi adds: “When he called home there were times I would’ve liked to tell him to just quit and come home, but I knew it was

never an option. It’s lovely to see him well and safe.”

Over the past six months, Wright has collected enough memorable moments to pen an epic; some highlights are in his blog thewrightwayeast.wordpress.com.

He has lost count of the number of times he had to explain his journey to people he met along the way.

“Breast cancer is a worldwide issue, so everyone could always relate to it,” he says. “It was amazing when the first person who donated to my Just Giving website [justgiving.com/thewrightwayeast] was someone I didn’t know, because it was reaching a wider audience than I ever thought possible.”

Wright made it a point to interact with the breast cancer community during his journey. In Holland, for example, a family friend who is a doctor connected Wright and his hospital’s breast cancer care unit.

“If I cycled past a hospital, I’d pop in and just see the breast cancer unit, talk with the doctors and meet with some of the patients as well,” Wright says. “All of that was very special.”

Wright was always sure he was going to complete the adventure – Mark Wright on The Peak Tower after cycling from London to raise money for Breast Cancer Care.

He started his journey in April and rode through 19 countries.

except in Chengdu, China, late last month, when he was diagnosed with chemical conjunctivitis and couldn’t see for four days.

Thankfully, at that point he had more company than just Knodel.

Early in his adventure in Istanbul Wright met Zac Clayton, 23, from London, who is riding around the world to raise money for WaterAid. The pair decided to meet up again in China and cycle together to Hong Kong. Clayton was Wright’s eyes for those few days of partial blindness.

Such kindness from strangers recurred throughout Wright’s journey. In the middle of nowhere en route to Munich, Germany, he knocked on a farmer’s door and asked to camp on the land; the farmer instead invited him into the house and fed him. In Izbista, Greece, tired and hungry, Wright approached a couple selling apples and asked for one for free; they gave him that and more – coffee, biscuits, juice and fruit.

“The world is full of nice people who help you along the way,” says Wright. “If you’re ever in trouble, people will help you.

People are nice, whichever country you go to.”

If you’re ever in trouble, people will help you. People are nice, whichever country you go to MARK WRIGHT

The trip opened his eyes to different countries and cultures, and dispelled myths and stereotypes.

“For example, Iran: the Western news media drip feed you all the bad things happening there. But Iran is hands down the most hospitable country I’ve been to. I barely spent any money in Iran; the people just wouldn’t let you. I’d go into a shop to buy an ice cream and someone would jump the queue and insist on buying it for me.”

He also learned a lot about himself and what he is capable of.

“When you’re alone in the desert and got to keep going forward or perish, you learn that your limits are a lot higher than you first thought.

With problems, you are always going to hit a low, but you know there’s a high around the corner. As long as you keep that in your mind, anything can be overcome.”

Wright’s adventure has inspired those around him. His former housemate, Sophie Bentley, says she bought a bike and now cycles to work every day. Steve Daly, a friend from university, adds: “We no longer have an excuse not to do something now that Mark has raised the bar.”

FITNESS 11 William Lindesay on his epic Great Wall journey 25 years ago.

PERSONAL BEST

Where there’s a wall, there’s a way ......................................................

Mark Graham healthpost@scmp.com Long before ultra-running became popular, William Lindesay embarked on a wacky solo mission to run the length of the Great Wall – an adventure that saw him endure fiercely painful blisters, live in constant fear of arrest, and risk the possibility of a lonely and painful death in the wilderness.

The Briton ran the entire 2,500-kilometre distance without a support crew, often in intense heat on sections that were far from the nearest settlement. This year marks the 25th anniversary of that epic journey, one that saw Lindesay detained nine times by local police, and, at one point, suffer the ignominy of deportation.

The run was split into two parts, during the spring and autumn of 1987, to avoid the more extreme heat of mid-summer. Lindesay had been to the Great Wall the previous year with the intention of running its length, but realised he had massively underestimated the difficulty of the challenge, particularly the searing temperatures of July and August.

He set out nonetheless, and was quickly laid low by amoebic dysentery and a stress fracture.

But there was one positive discovery during that shortened expedition: Lindesay was surprised to find that peasant farmers living by the wall were hospitable people, willing to provide a bed and sustenance once they overcame their initial shock at seeing a gangly European stranger jog into the village.

Lindesay returned home to England and plotted another assault for the following year – this time with better preparation. The keen club runner already had the athletic credentials for an ultra-endurance mission – he had a marathon time of two hours, 39 minutes and a nippy 10-kilometre personal best of 31 minutes, 30 seconds.

What’s more, Lindesay had a passionate desire to become the first person to run the length of the Great Wall, even though it meant risking life and limb.

Says Lindesay: “People ask me if I ever got lost, and I say I was always lost. It is only when I got to bigger places that I knew where I was. I knew this was my last chance, and this time I was prepared. But there were risks – journalist friends told me that I could find myself in serious trouble.

“One time it was really hot weather, and I ran 40 to 50 kilometres in one day. My feet

started to blister, but I kept going. In fact the blisters burst and the skin welded to the socks. It was like running on knives. When I stopped, it was like having knives rammed into my feet. When I got to a town, the doctor lanced the blisters and put iodine on. It was nasty.

“At one point during the run, I was deported from China. I simply got new passport and visa in Hong Kong, and came back. The system was not so sophisticated in those days, so the different provinces could not correlate all the different ‘offences’ I had committed.

“Ordinary people were very helpful. They would think nothing of letting a stranger into their home – and a Western one at that. At one place, they gave me a room and the whole village came to see me, to look at this person from another planet.

“They were amazed that there were other kinds of people in the world who could speak another language. I showed them a picture of the queen I had picked up at Heathrow, and told them that this was the leader of my country. They thought she was my mother.”

The epic adventure started in farwestern Gansu province, where the wall is actually ramped earth, rather than the 16th-century stone structure near Beijing that most

people are familiar with. Lindesay ran on the wall wherever he could, or alongside in the parts where it had crumbled. The expedition ended at the evocatively named Old Dragon’s Head, where the wall meets the sea.

As a schoolboy, Lindesay had announced plans to visit the Great Wall, producing chuckles from his teachers and classmates.

But the ambition stayed with him into adult life.

He says: “I had my heart and mind set on it, and although I realised there were real risks, I believed I might just be lucky. It was a major adventure to a place that was little known. In fact, the moon was more familiar – I could name more places there than in China.”

I showed them a picture of the queen, and said it was the leader of my country.

They thought she was my mother WILLIAM LINDESAY

Lindesay ended up spending most of his adult life in China. He wrote the best-selling book, Alone on the Wall, about the expedition and began making a living from wallrelated activities such as writing books, giving lectures, and conducting weekend walking tours from his farmhouse home, close to an isolated part of the Great Wall some two hours from Beijing.

Lindesay and his wife Wu Qi have two sons, Jimmy and Tommy. He estimates he has spent 1,600 days of his life on – or close to – the wall.

The Briton’s indefatigable work to help preserve this wonder of the world has brought him honours from the Chinese government, an OBE from Queen Elizabeth, and universal admiration as an explorer par excellence. “The Great Wall is an outdoor museum that collides with modern China and the developers head on,” says Lindesay. “It is a unique conservation challenge.”

Lindesay, now 55, stays in shape with regular strenuous hikes along the wall. He has even started some gentle jogging, perhaps inspired by thoughts of his groundbreaking run a quarter of a century ago.

His feelings about the wall have not changed he says: “At the end of the run, I thought it was an amazing wall. I still think the same way.”

12

OCTOBER 23, 2012 SOUTH CHINA MORNING POST