Medical Madness: A Product of American Capitalism and Chinese Moral Corruption
 
About two years ago we noticed that our son’s foreskin didn’t retract properly and sometimes got infected. Nothing serious, but I wanted it to be checked and therefore took him then to United Family Hospital Puxi, where he was also born in 2012. The physician told us, that we should wait for another two years for the foreskin to open up on its own. A few weeks ago I consulted the same physician, Dr. Hatti Wang, again, and she said that a surgery is inevitable.
 
There was no further diagnosis neither an explanation of the surgical procedure, but both a pre-OP check date and a surgery date was arranged. I was then of the opinion that we would receive a complete diagnosis and an explanation of the surgery procedure during the pre-OP check, but realized yesterday during the pre-OP appointment, that a nurse waited for us to get a blood sample only. No physician, no surgeon, nothing of additional information.
 
I explained to the nurse, that I am still missing important information, e.g. a proper diagnosis or which kind of anesthetics will be applied. The nurse understood my concerns and called the head of the surgical department Dr. Zhang Zhuo. It is mainly this consultation which not only disappointed me, but actually confirmed my lost trust in a system of profit driven clinics. You simply can’t run a health institution on a capitalist foundation and employ morally corrupted staff.
 
Dr. Zhang told me that

1. The medical condition my son suffers from is called phimosis.
2. The probability, that our son’s foreskin opens up on its own, is at age 4 close to zero.
3. A surgery is therefore inevitable.
4. Delaying the surgery will lead to painful infections.
5. Full anesthesia is mandatory for the safety of the child.

 
We arrived at these conclusions only because I insisted to get a complete consultation and I told Dr. Zhang that a parent does not want to perform surgery on his child if there is no imminent reason to do so. He said that he understood my concerns. But I couldn’t help to observe a sly salesperson’s smile throughout our conversation. And I have to give Dr. Zhang and Dr. Wang their credits: as medical doctors they have way more knowledge than the average patient. But, I told myself, didn’t they swear the Hippocratic Oath, i.e. aren’t they obliged to help their patients and must not do harm.
 
Well, lets not get into an ethical discussion here. Let’s stick to the facts:

1. Our son does not suffer from acute pain nor were the infections serious or lasting. We therefore do not see an imminent reason to perform surgery.
2. Wikipedia writes that physiologic phimosis, common in males 10 years of age and younger, is normal, and does not require intervention. Non-retractile foreskin usually becomes retractable during the course of puberty.
3. A local anesthesia costs only a fraction of a full anesthesia.  

I therefore conclude, that both Dr. Zhang and Dr. Wang intentionally provided false medical information. They acted rather as sales persons than as physicians. No harm done, yet, but the risk of full anesthesia and the risk of performing an unnecessary surgery was accepted in order to generate additional turnover for their employer and surely some bonus for themselves.
 
It is not my intention to blame these individuals, although they, too, have a responsibility to take a step back and inquire into what they do and why. I rather ask here, why we develop such systems of greed and fraud. On several different occasions, and in different industries I have heard people say, that the worst features of humanity are produced when American capitalism merges with Chinese corrupted morals, i.e. when refined greed meets refined fraud.
 
Dr. Zhang told me during our discussion on the necessity of full anesthesia, that he worked in a local Shanghai hospital before joining United Family. There, only a local anesthesia is implemented on children, and he is convinced that from a medical point of view, a full anesthesia is safer. Well, I am not a physician, and there will be pro and con arguments for full anesthesia, but I know that United Family had a long negotiation with our insurance provider to explain the necessity of a 30k CNY surgery; a third of which for anesthesia.
 
This is also the time and place to do some self criticism. We are in the lucky situation that we have an international health insurance, which covers globally pretty everything apart from dental care. That’s luxury, considering that a substantial fraction of humanity must survive without any insurance at all. We have come to cherish this luxury, but we have also been trapped in the system. If high-end medical care is free of charge, one is inclined to stop reflecting about the necessity of services provided. I made that mistake, when I consulted United Family for our son’s condition.
 
We will therefore change this habit; and even though our insurance might cover some services, we will check ourselves if we really need them. I was already inclined to return to Vienna for the birth of our son, when I learned that United Family charges about 120k CNY, but it would have been too complicated. Our daughter was born in a lovely Viennese hospital and the public insurance covered the costs of 1500 EUR, a 10th of what United Family charged our international insurance provider in the end. Can medical service be really so much better? No. And it actually wasn’t.
 
Again. I am not bashing individuals. I ask what we can change about the medical system, which has clearly gone awry in both the US, which has the highest per capita expenditure of all OECD countries, and China, where medicine has turned into one of the least sought after careers. Even safe havens like Austria will have to change their health systems, which are essentially low productivity government extensions, with overlapping markets of municipal, provincial and national hospitals.
 
One path into the future was explained this June during a TEDx Caohejing event by Mr. Zheng Jie, CEO of Sulan Health Group.  Mr. Zheng explored the future of medicine and referred substantially to the American physician Eric Topol (check out his TED talk), author of The Patient Will See You and The Creative Destruction of Medicine.  According to him, we will see a deconstruction of the “Gods in White”, and an increasing number of intelligent patients empowered by digital medicine, who will use physicians only to execute a decision they have made themselves. Massive Open Online Medicine (MOOM), the Internet of Medical Things (IoMT) and an unprecedented amount of personal medical data will provide the patient the required information to wield the power of decision, whereas the physician can increase the amount time spent to interact with his clients.
 
Such a utopian scenario does not take the economic factor into consideration, but its at least a plausible way forward. Authors like Martin Ford in Rise of the Robots are pessimistic about how economic dynamics will actually hamper the positive development of our increasingly digitalized health systems. In any case its high time to increase our self-awareness and self-responsibility.
 
Further reading:
https://en.wikipedia.org/wiki/Hippocratic_Oath
https://en.wikipedia.org/wiki/Phimosis
http://shanghai.ufh.com.cn/
https://en.wikipedia.org/wiki/Health_insurance
https://upload.wikimedia.org/wikipedia/commons/8/8c/Health_Expenditure_per_capita_OECD_2013.png
http://www.shulanhealth.com/
https://en.wikipedia.org/wiki/Eric_Topol
http://www.ted.com/talks/eric_topol_the_wireless_future_of_medicine
http://www.mingong.org/blog/book-review-rise-of-robots-technology-and-the-threat-of-a-jobless-future
 

What is original? A review of a TED radiohour and some implications on how the Western world should change its perspective on the “Chinese technology threat”: give up your technology and trust in the invisible hand.

During the last decade I have been involved with technology transfer and intellectual property issues related to China. I have come to recognize some basic patterns in this field, which are nothing new but are somehow my main take away from working in the technology law industry in an emerging market:

-       Since the mid 80ies China has opened up its economy and in the course of the following 20 years it has established a well drafted intellectual property framework based on international laws promulgated by bodies like WTO or WIPO and modeled after foreign innovation system like Singapore or Germany.

-       This national legal framework – in spite of poor execution measures - was sold to the Western world as China’s acceptance of international law and was one of the entrance tickets to the Western dominated world economy.

-       In the tradition of the Chinese proverb 指鹿为马 [pointing at a deer and calling it a horse] China reiterated for years that it had fulfilled all requirements and obligations but actually undermined the IPR framework by industrial policies which force foreign investments to gradually give up technology and know how. James McGregor described these policies in an APCO paper “China’s Drive for Indigenous Innovation”.  The German author Frank Sieren calls one of the main elements of these industrial policies pointedly “Concubine Economy”.

-       This reality caused foreign businesses to develop their own protection strategies, which try to circumvent a seemingly not navigable system, i.e. protecting know how without resorting to the legal system. A Swiss research team on technology management analyzed these measures in a paper titled “How Managers Protect IPRs Using de facto Strategies”.

-       I have the impression that such de facto strategies can delay know how loss, but in the long run a technocrat government will succeed in absorbing what it wants; and more importantly it is the peculiar economic development stage at which China finds itself that creates know how spill over and thus intense domestic innovation. 

-       I moreover believe that all the obstacles that humanity faces can only be resolved if East and West collaborate. That’s not a call for world peace, but a pretty rationalistic understanding of which problems we face and what it takes to resolve them – just think of environmental pollution on a global scale. It might as well be that some required inventions for humanities progress are only triggered by great turmoil, disastrous warfare and close to end of the world scenarios. In other words: all is good, even though it might look dim and dark, because there is an invisible hand guiding all of us, all that is.

-       Retiring from metaphysical and religious deliberations and resorting to mundane explanations, I would like to summarize a National Public Radio podcast called “TED Radiohour” which aired a program at the end of June under the title “What is Original?”

DJ and producer Mark Ronson: “You know, in music, we take something that we love, and we build on it. That’s just how it goes. Pablo Picasso is quoted: Good artists borrow, great artists steal.”

T.S. Elliot built on this quotation: One of the surest tests [of the superiority or inferiority of a poet] is the way in which a poet borrows. Immature poets imitate; mature poets steal; bad poets deface what they take, and good poets make it into something better, or at least something different. The good poet welds his theft into a whole of feeling which is unique, utterly different than that from which it is torn; the bad poet throws it into something which has no cohesion. Ronson continues: “Subconsciously we are influenced whether we like it our not.”

Filmmaker Kirby Ferguson claims that only the big bang is original, everything else is derivative. He describes Bob Dylan as a folk musician whose music was 2/3 copied from others, but acknowledges that in what he did, he followed the routine of all artists of that genre: folk musicians contributed to the body of folk music.

He dismantles George Lucas Star Wars movies as a copy of the Japanese director Akira Kurosawa, and shows with the iphone that American copyright and patent laws run counter to this notion that we build on a common body by considering creations a private property although the common body of inventions is a public good.

Where is the line between copying and building something new? Steve Jobs showed that it’s more a question of perspective that anything else:  in 1996 he quotes Picasso and confirms that Apple has always been shameless about stealing from others. In 2010, when Google’s Android mobile phone is launched, he says “great artist steal, but not from me”.

Ferguson suggests to be transparent in using contents from others – what people want is credit for their contribution to the common body of inventions. I think that’s a reasonable approach.

Johanna Blakely tells us that the fashion genius is really in curating from the past and reviving it in the present; and since copyright law barely touches fashion, the  industry benefits in innovation and sales. Why not extend this best practice to other industries?

Earlier this year, Tesla Motors CEO Elon Musk decided to give away his company's patents for free. It might seem like a strange business move, but Musk said he wanted to inspire creativity and accelerate innovation. Writer Steven Johnson says this is the way great ideas have been born throughout history. Therefore it’s maybe time to rethink how we try to control our know-how. SO why continue to spend a fortune on patent registration, IPR maintenance and enforcement, in particular in China, where as we have read earlier, it’s all in vain?

Ideas and innovation thrive in environments where ideas are free to flow from mind to mind and to be reused and repurposed and remixed in interesting and surprising ways. And a lot of the technology we're dependent on has come out of that kind of collaborative network.

Johnson continues to explain that these collaborative networks and a change in diet [from alcohol to coffee] were the reason for many inventions made during the age of enlightenment. Visionary people would come together in coffeehouses in Boston, Philadelphia, London, Paris and Vienna to discuss visionary ideas. 

I ask myself where these places happen to be nowadays. Where do visionary people meet to discuss visionary ideas? Silicon Valley or Shanghai Zhangjiang Hitech Park? Steven Johnson wrote a book about “What is the space of creativity?” but I am not sure if he only wrote about traditional Western spaces or new Chinese realms of creativity.

I see innovation not only happening in China because companies absorb foreign technology and the central government coerces hitech enterprises to jump into JV with SOEs. I see bursts of innovation because technicians, engineers and executives from all continents and industry backgrounds meet on a regular basis in technology parks like in Shanghai’s Pudong district Zhangjiang Gaoke. They might not meet in fin de siècle Viennese coffee houses, but they equally exchange ideas and spill over know how. I see intense innovation happen, because Chinese entrepreneurs who have spent a few years abroad return to China with ideas which they adapt and improve. I see innovation happen, because humanity faces in densely populated regions like Eastern China new challenges, which do not exist anywhere else. Think of mass transportation within urban centers and between them. Think of food provision for million of people, but a scarcity of arable land. I have seen pork farms and green houses in Yunnan entirely shaded with photovoltaic roofs to use land twice: for agriculture and power generation. And there is one thing I couldn’t agree more with Johnson: diet. Chinese are more innovative than they have been 10 years ago, because they slowly turn into a coffee drinking society. Starbucks already calls China it’s second home market.

Western innovation reports tend to emphasize the importance of formal basic research & development, but usually undervalue incremental research and development. Comparing European and Chinese businesses over the last years, I have the impression that the West sometimes innovates for the sake of innovation whereas China builds on top of existing inventions to commercialize.

Even the cold war created great inventions: Steven Johnson tells us that the launch of the first Soviet satellite caused the US to develop the global positioning system GPS. Insofar, even war and the build up of arms can do some good for humanity in the long run. Trust in the invisible hand and to throw in some Eastern philosophy, some Taoist thought and some Buddhist concepts: trust that all knowledge that is has only one source and worldly barriers and differences are nothing but avidya: a delusion. Abandon (intellectual) property law because it is the vehicle for division between yours and mine. In reality nothing belongs to us, but everything to all that is.

The Tibetan Buddhist master Ringu Tulku explains the nature of avidya (ignorance) as follows:
In the Buddhist sense, ignorance is equivalent to the identification of a self as being separate from everything else. It consists of the belief that there is an "I" that is not part of anything else. On this basis we think, "I am one and unique. Everything else is not me. It is something different."... From this identification stems the dualistic view, since once there is an "I," there are also "others." Up to here is "me." The rest is "they." As soon as this split is made, it creates two opposite ways of reaction: "This is nice, I want it!" and "This is not nice, I do not want it!"

1.    its good to travel once in a while without children to rejuvenate a couple’s relationship. What was scary in the beginning (what would we be talking about, if our kids were not around?) turned indeed out to be closing the ever increasing gap between us that was actually only bridged by our offspring lately. Time spent together. Some fighting, but more caressing and getting closer to each other again. Daily obligations when caught up in the routine of work and family life can at times turn into an inescapable treadmill. Thus, our new mid year plan: travel once a year as a couple without children.

2.     Spain, in particular Andalusia, is a great place to spend your holidays: fiesta, flamenco, siesta, sangria, tapas, tinto, playa, prado, etc. We will come again. Spain is a difficult place to live: wealth concentration in the hands of a few, abundant cronyism, vast inequalities of access to health care, education and in particular to the labor market. We don’t plan to move to Spain.

3.    We were lucky to witness an ecstatic football victory celebration, a Corpus Christi parade in Cordoba, and La Saca de las Yuegas (the take out of the mares) in Huelva without having planned any of it. But such festivals contribute a great deal to an enjoyable and memorable holiday. Therefore we will plan all future holidays around local festivities. Pamplona next July might be a good reason to come again.  

4.     The Spanish railway network is great, although it is recommended to always choose AVE trains over all other train classes. Only AVE trains are new or kept in good shape. Moreover, book RENFE tickets in advance online, if you don’t want to pay twice as much at the counter.

5.     Accommodation appeared to be really affordable and mostly great value. Preciously decorated double-rooms including a hearty breakfast for EUR 60 are not easy to find in other countries we have been traveling to.

6.     Spaniards are probably the best-dressed people on Earth. Climate, a beautiful mixture of natural colors wherever you turn your head to and the Islamic-Roman heritages explain this easily. No surprise that many successful fashion brands like Mango, Zara, Massimo Dutti, etc. have their HQ in Spain. In an aesthetic crisis it is recommended to spend some time on the Iberian Peninsula, even more so if the decoration of your new home is on your mind.  Students of architecture, design and other creative industries might well spend a semester or two at Sevilla’s university of bellas artes.

7.    Whether in Madrid or in Sevilla, it’s quite obvious that all that splendor and grandeur is proof of a nation that once ruled the world as an empire. An empire that has been in decline since some time. Quite on the contrary to the Germanic nations, Spain has turned into an entry economy for Asian manufacturers. Tata and Mahindra, never ever seen on Germanic roads, seem to fulfill on Spanish roads EU exhaust and safety standards.  Tata Hispanic produces passenger buses in Spain that are used e.g. by Madrid’s public transport provider. Spain will be most likely also the entry market for Chinese automobiles to Western Europe.

8.    I was told before this journey to Spain that almost all of Madrid’s convenience stores are now operated and mostly also owned by Chinese. Even many traditional Spanish restaurants have been taken over by Chinese without the customer taking notice of it. Behold! this does either not speak for the Spanish gourmet or it speaks for the culinary competences of Chinese restaurateurs. After stops in Madrid, Valencia, Cordoba and Sevilla I can now confirm that at least in regard to convenience stores this is true. The amount of Chinese immigrants is considerable and the EU is advised to enact similar regulations on immigration as China does. Whereas China grants residence only to highly skilled foreigners, the most unskilled Chinese are washed upon the shores of Europe.

9.     What has started in France with Chinese investors buying up Merlot and Bordeaux and Burgundy wineries, will continue in other parts of Europe. I already see my beloved Rioja being sold out to Asian entrepreneurs only to export the produce to Asia where profits for average grape juice are multiple of those in the Western world. The EU states are advised to enact legislation that thoroughly screens the funds of investors and limits real estate purchase to non EU citizens to JVs, in which the majority of stakes remains with a local owner.

10. Culture and history combined with nature and great food is so much better than lazy beach holidays. The excavations of Italica close to Sevilla confirmed my intention to propagandize the thousand-year-old cultural tradition of Europe. I am so sick of Chinese media and brainwashed individuals telling me of their [non-existent] continuous 5000 year history. What is continuous? What is culture? What is history? Its high time for Europe maybe even for the entire Western world (compare Samuel Huntington’s Clash of Civilizations) to develop a unanimous understanding of our common roots. China is great and I love many of its cultural aspects, but lately Confucianist propaganda is just giving me the creeps. And I mean it: Europeans have a grand Greek, Roman and Islamic heritage; the latter by some of our politicians purposely forgotten. Another plan thus: travel to places that tell important history like Rome, Sicily, Athens, Jerusalem, etc.

11.  When we bought our tickets to Italica, a top notch archeological site at the same level as Xian’s terracotta army (tickets sell there for EUR 25), we were about to be charged EUR 1.50 for the entry ticket, but since we both have a EU residence permit, we got in for free. There are many other such examples where it just feels like Europe gives away its treasures for free whereas China rips tourists (domestic and international ones) off.  The Madrid based world tourism agency reported that Chinese tourists ranked #1 in international tourism spending in 2013. Considering the size of the Chinese population this is rather not surprising. There will be an increase of 7 million Chinese tourists to the EU in 2014 compared to 2013. The EU member states are well advised to cash in on this trend. An eye for an eye a tooth for a tooth.

12. But how do ideal holidays – putting aside my ruminations on orient and occident  - really look like? There are a few aspects that seem to be key ingredients for a memorable and enjoyable vacation.

a.     Share your travel experience: never travel alone unless you need to work out something very personal. Only a shared experience remains a good experience.

b.     Chose a destination in which food you are interested. The value of great food is much too underrated. I don’t understand why Germans and Chinese continue to eat their home cuisine when abroad.

c.      Chose a regional festival for your travel date. Festivals and holidays are windows in the lives of people where they let themselves go or open up some other insight into their lives. This makes a stay in their world much more interesting than any other time of the year.

d.     Travel to fill your intellectual well with something new or forgotten about God’s creation, e.g. how the Roman Empire extended its reaches to the Iberian Peninsula or how the Islamic world influenced Europe for several hundred’s of years.

e.     Combine language training with something applied, in particular for your children who suck up language certainly faster than you, but even more so, if they are immersed into some three-dimensional, captivating activity e.g. four weeks horse back riding camp in Huelva or two week sailing course in Valencia.

f.      Make a clear plan of how many days to spend where, but then allow for some spontaneity and divine guidance to have a smooth experience. Otherwise you are either completely without any clue [only works if you have infinite time available] or you miss the great moments which even a great planner can not foresee. Listen to Arthur Eisenhower: Every time that I prepared for a battle I have found plans are useless; but planning is indispensable.

Pictures of this journey are posted under TRAVELS.

The Living Buddha business, he said, was a political or diplomatic system and always worked out for the good of the rich an influential. The local Buddha was very rich; so was his steward; and when "reincarnations" occurred, it seemed to him that this "miracle" always happened just as it might have been desired by the chief Buddha. For example, when the daughter of a powerful chief died, she was soon afterward incarnated in the person of a small boy, a nephew of the Buddha's steward - a business and political arrangement agreeable to all concerned! When one of the minor Buddhas of Radja died he, too, was happily, conveniently, and quickly reincarnated, this time in the person of the steward's brother!
I smiled and asked the water-carrier how it happened that none of his children was the reincarnation of some departed Buddha. With a twinkle in his eye, he remarked that it was because the sum of all his worldly goods was two goats.
---
Joseph Rock, Austrian-American botanist and explorer traveled for this expedition in Southwestern Gansu province of nowadays China, between 1924 and 1927.

status: nervous. about becoming dad. again. and having to - at least for the time being - bring up two kids in China, which is more and more at the point of war with its neighbors. today's papers in China have only one cover story: control over the Diaoyu Islands, a piece of rock that not only China but also Japan and Taiwan claim sovereignty over. small rocks roughly 200 km north of Taiwan with massive natural resources underneath. China had similar conflicts this year with Vietnam, Philippines and Korea. But the Japanese are the favorite-hated nation to the Chinese. Like the Germans to the Dutch.

I ignore most reporting about these conflicts, like I did ignore reporting on the Balkans war in the 90ies or the continuous conflict in Israel and Lebanon. Bad vibes and no way to change anything for an individual outside of the combat zone. this time my family might be inside though. and I feel the fault lines open up during rare political discussions at work, where people you have thought to be on the same side with, are suddenly brainwashed nationalists, who don't seem to realize that their government plays an old trick on them: turn attention on enemies to cover up for own deficiencies.