In Vitro versus In Vivo

What works in theory does not necessarily work in practice.  It is common knowledge that a drug that works in vitro (literally meaning “in glass”, which is in experiment settings) might not work in vivo (literally meaning “in life, or in human”).  Among other factors, the absorption, distribution, metabolism and elimination of the drug affect the concentration of it at its target site.  You might never reach the effective in vivo concentration in vivo without causing toxic effects to other organs.  However, another hard-to-believe but disturbingly true explanation for a drug not working in vivo is that, for one reason or another, the patient does not take the drug.

That also happened to my suggestion made to the Medical Council about not to criminalize doctors who had forgotten to renew their Annual Practicing Certificates.  In the Editorial of the September issue, I identified a situation where an apparently harmless mistake (forgotten to renew the Annual Practicing Certificate) might end in criminal conviction of the doctor and inability to practice for a long period of time.  This was because the doctor’s honest declaration that he had been practicing during that “window period” was taken to the strictest sense.  He was reported to the police for practicing while his name was not on the General Register.  I pointed out that in a similar case (Fong Ngai Chiu), the judge dismissed the criminal charge because he accepted the defense that the doctor believed for good and sufficient reason, although erroneously, that his name were on the General Register.  I pleaded the Medical Council Members to consider adopting the reasoning of such defense to exempt the absent-minded doctors from police investigations and criminal charges.

The suggestion was not going to work because Members did not take it.  There was legal advice stating that judgment from a district court had no binding effect on others.  Also, it was difficult for a doctor to say that he reasonably believed (erroneously) his name to be on the General Register because the Medical Council had sent out repeatedly registered letters to remind him.  That in itself was a reckless act.

Obviously this was not true.  It was hard to believe hundreds of doctors behaved recklessly every year.  The defense was not from the point of view of the Medical Council.  It should be from the point of view of the doctor.  A simple reason to explain how an absent-minded doctor could believe his name to be on the General Register was just that he had forgotten to update his address.  He was wrong to do so.  He had made a careless mistake.  But this should not be criminal.

Some members had different opinions.  Some insisted that such act was criminal and the Secretariat should report to the police whenever she encountered such declarations.  Some believed that the Medical Council was not in a position to give legal advice to doctors, especially those who had erred.  Some shared no sympathy with the absent-minded doctors and believed that harsh punishment was deserved.  Some found no problem with the current situation.

In conclusion, my suggestion did not work in vivo.  What I can do is to remind readers here to check whether you have renewed your Annual Practicing Certificate.  And I shall remind you later repeatedly.  However, I hope such act would not make the absent-minded doctors deemed more reckless.

Another sad outcome was from the Student Movement.  It was the situation where what worked in vivo did not work in vitro.  All along, scientists have been making various observations on things that happen in certain patterns, or something that work in certain ways.  The real challenges are how to elucidate the reasons behind such observations.  Why and how do things work?  Without knowing the true reasons behind, it would be difficult to reproduce the effects in artificial conditions with certainty.

For the Student Movement, it was planned to be the Occupy Central action which involved an estimated 1000 people to occupy Central for a day or so during a public holiday.  The aim was to arouse attention of Hong Kong citizens and international media on the issue of Chief Executive Election.  As you all know, it turned out to be near 10,000 people occupying different sites including major roads for more than 70 days.  No one knew exactly how these were sparked off.

In late November, while the Movement seemed to be caught in a dead end, student leaders tried to reproduce what happened in September 28.  Occupiers were asked to march against thousands of pre-informed police.  Sadly, what worked in vivo before did not work in such artificial conditions.  Many occupiers were injured, and so was the image of the Movement.

But I am not blaming any of the students.  Right from the start, no one would have expected them to achieve a political reform overnight.  Neither does Hong Kong need any revolution.  No matter how the Movement ends, their aim of sending a clear message to Hong Kong people has been achieved.  All of us will remember the yellow umbrella, the giant banner at Lion Rock, and various art works.

The Student Movement reminds me of Buddhist teachings.  The Buddha is not bringing you to the moon.  His teachings serve as a finger that points the way to the moon.  The right direction has been shown.  Everyone of us should work hard accordingly towards that direction.

(Source: HKMA News December 2014)