Science begets knowledge; opinion begets ignorance.

Working as a family doctor for more than twenty years, I feel sorry to say that quite a significant portion of patients are so ignorant.  It is not that they are ignorant about medical knowledge or advance in medicine (as I consider this natural, just like I am totally ignorant about car repair), but they are so ignorant about simple logic and scientific methods, not to say evidence-based medicine.  It is only through an open mind equipped with logic and ability to appraise scientific evidence that the patient can learn new knowledge and take part in the management of his medical problem.  Walter Isaacson (the author of Steve Jobs) even writes in his book Einstein that “an appreciation for the methods of science is a useful asset for a responsible citizenry.”  Over 2000 years ago, Hippocrates stated that: “There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.”  He insightfully explained why patients became and remained ignorant.

It is not uncommon to encounter patients arguing with you about treatments they learn from their friends, who in turn learn about such treatments out of nowhere traceable.  When you try to explain to them, their query is usually a reverse burden of proof.  Yes, they ask you to prove why such treatments will not work!  Some knowledgeable patients rely on opinions from authorities.  However, how they look upon authorities may depend on how frequent the subjects appear on commercials and how confident they are when communicating the treatments they advocate.

Have we doctors done enough to help our patients?  Evidence-based medicine was elected by BMJ in 2007 to be one of the 15 greatest medical advances since 1840.  However, we still encounter too many advertisements, books, seminars, products and “expert opinions” on miracles and alternative treatments.  Too frequently, patients come to us (or more sadly, leave us) because there are better but never proven methods in treating their diabetes, alopecia, erectile dysfunction and even cancers.  Advocates of such alternative treatments not only make unsupported claims on the miraculous effects (and at the same time, with no side-effects at all) of their products, but too often, they launch attacks on traditional medicine.  Have we discharged our responsibilities to our patients and the public in taking time and effort to address these scams?   

Recently, I have read a book about alternative medicine: Trick or Treatment by Simon Singh and Edzard Ernst.  In this book, the writers dissect various alternative treatments by adopting the evidence-based method and the appraisal of existing evidence.  They skillfully introduce the importance of clinical trials to laymen by telling the story of bloodletting and the first American President.  Bloodletting had been a recognized method of treatment for various diseases since ancient Greece.  At that time diseases were thought to be caused by an imbalance of four bodily fluids known as the four humours.  They were: blood, yellow bile, black bile and phlegm.  By removing some stagnant blood from different parts of the body, different diseases could be treated. (This reminds me of the “lymph plumbing” (通淋巴), which I hear from patients and watch in the media everyday.)  The former US president, George Washington, at the age of 67, caught a cold on a Black Friday (13 December 1799).  It turned out to be epiglottitis.  Within 24 hours, several bloodlettings were performed as treatment and about 3 liters of blood were drained from him.  Obviously, he died the following day.

At that time, bloodletting was the norm.  There was a lawsuit in 1797 between a renowned English journalist William Cobbett and the “Pennsylvania Hippocrates” Dr. Benjamin Rush.  Dr. Rush was the only doctor who had a statue erected in his honour in Washington DC.  He was an advocate of bloodletting.  Cobbett examined the local bills of mortality and concluded that Ruth’s bloodletting had “contributed to the depopulation of the Earth”.  Rush sued him for defamation.  The verdict returned on the day Washington died of blood loss (and/or epiglottitis). Cobbett was ordered to pay Rush a fine of $5000, which was then the largest compensation paid in Pennsylvania.  Apparently, scientists and doctors were not scared by the fine.  In 1809, a Scottish military surgeon called Alexander Hamilton designed a clinical trial to study bloodletting.  His study was valued because there were elements of randomization and control.  He found out that among 366 soldiers of various diseases, the death rate of those treated with bloodletting was ten times to those treated otherwise.  Various studies were then carried out.  And nowadays our common sense that bloodletting means to kill rather than to cure has been firmly established.

Other interesting stories in the book include evidence-based tea (tea, or milk first?), the story of James Lind on scurvy, the study of Florence Nightingale on the importance of hygiene, Dolls & Hill on smoking, Bill Silverman on refuting his discovery of treating retinopathy of prematurity with ACTH, and many others.  The authors also expose plainly and cruelly the origin of some alternative treatments.  Histories review the absurd theories some alternative treatments are built upon.  Among them is the story of Chiropractor.  Chiropractic therapy was founded by Daniel David Palmer, who was born near Toronto in 1845.  He moved to Iowa at the age of twenty.  In 1895, as he himself wrote, he cured a deaf man by repositioning a displaced vertebra (as interpreted by him).  The man could hear soon after his manipulation.  Another man with heart trouble was also cured immediately after he adjusted, again, a displaced vertebra (of course, as interpreted by him) which “pressed on nerves that innervated the heart”.  He then regarded himself as the founder of a miracle treatment and developed a philosophical (if not religious) theory behind it.  He believed that “ninety-five per cent of all diseases were caused by displaced vertebrae”.  Diseases were caused by subluxation in the spine resulting in blockage of the body’s “innate intelligence”.  So replacement of the different displaced vertebrae could allow the rectification of the flow of “innate intelligence” and nearly all illnesses from measles, to sexual dysfunction, to asthma, etc. could be treated.  In two years time, he opened the Palmer School of Chiropractic in Davenport, Iowa.  And his son, Bartlett Joshua Palmer, was his successor.  In 1924, B.J. Palmer started a lucrative sideline in selling “neurocalometer” invented by him for detecting subluxations.  It helped the practitioners a lot since afterall the so-called subluxations were (with due respect) in the minds of the chiropractors.  It was sold at a price of $2200, which at that time was enough to buy a house in Iowa.  However, the apparatus was then found to contain nothing but a thermocouple (you know what it is!).

Too bad?  Not until you read about homeopathy!

(Source: HKMA News March 2012)

Quirkology

I spent the festive holidays quietly, except for a short trip to Po Lam Monastery for a yearly gathering in Lantau on the coldest day.  I walked uphill in freezing rain without an umbrella, appreciating the advance in technology of clothing to keep me warm and dry.  I was also lucky enough to barely miss the risk of being hung in a 360 cable car, which apparently prepared every passenger ready for frozen section.

I finished two books on similar topics by the same author: Richard WISEMAN.  WISEMAN (what a name!) is a Professor of the Public Understanding of Psychology at the University of Hertfordshire.  He was a magician before he graduated in Psychology and then obtained his Ph.D. in Psychology.  He was fascinated by the quirky side of human behaviour such as lying, decision-making, superstition and fortune telling.  In his two books: “Paranormality” and “Quirkology”, I learn about a quick test to distinguish good and bad liars by drawing a “Q” on your own forehead with your index finger of your dominant hand.  I also learn about a script for fortune telling which most people would find it an accurate description of them.  There are also experiments elucidating mysteries of Ouija boards, out of body experiences, subliminal perception etc.  However, what enlightens me most is that his studies go beyond reviewing how such paranormal phenomena come about.  They further look into why people tend to behave in these ways and cling to such phenomena.

After reading the two books, I come to an idea of my own study.  One day I found that there were so many people crowded in Cafe de Coral (a fast food chain store, in case you don’t know) during lunch hours.  I asked myself: why didn’t they go to other restaurants for lunch?  In fact they could make a reservation at Lobster Bar or Cova (and also had the chance of meeting Eve Lai there).  So my study involves distributing out lunch coupons to working people to see if their meal-seeking behaviour can be modified.  They will be given $250 each in one year.  However, my study cannot be carried out because there is no one willing to sponsor it.

Don’t judge me silly or stupid for being blind to the obvious reason of price differential governing the meal-seeking behaviour of workers.  In fact we have been paying for such study since 2009.  It is the Elderly Health Care Voucher Pilot Scheme.  This scheme is more “mission-impossible” than my study.  This is because the subjects of the scheme are all over 70 years old.  They are thus more difficult to change.  They also take it more seriously on matter concerning their health than food.  Moreover, the price differential is even greater between public and private sectors.

Well, people can do all kinds of studies they like.  It is even acceptable to spend public money in a not-well-planned or not-so-worth manner (because it is very common).  But it is a sin to spend public money on unsound theories, and at the same time drawing biased conclusions, which affect the elderly and the medical profession.  Apart from the two books, I have also gone through (again) the 136 – page Interim Review of the Elderly Health Care Voucher Pilot Scheme.  It is stated clearly that “it is expected that the Scheme could help promote key ingredients of good primary care among the elderly and healthcare service providers…”  And that they “expect that more elderly people would be able to choose private primary healthcare services close to their homes.”

My conclusion is that within the 2-year study period, most of the elderly remain sane.  So as expected, they do not suddenly change their health-seeking behaviour because of the given $250 per year.  And that they retain their choice for the public services.  Of course some of them make good use of this minimal subsidy for one or two consultations for minor ailments.  However, the review shows disappointment about the findings and tries to put the blame on the co-payment charged by doctors on each consultation.  The poor quality of the study itself and the review is exemplified by the following:

1026 elderly were recruited for a survey.  Among them, only 35% of them had actually used the healthcare vouchers.  However, “In the survey, the elderly were asked whether, from a perception point of view, the consultation fees in general had increased subsequent to the launch of the Scheme.  45% did not perceive any increase in consultation fees.  42% reported that they did not know whether the Scheme had led to any increase in consultation fees.  14% perceived that the consultation fees increased as a result of the Scheme.”  One cannot expect a vague question than this.  First of all, this question was answered by most of the elderly who had not used the voucher at all.  There was also never any intention to clarify the so-called perceived increase in fees.  What was done was to conclude that: “The sampling survey suggests no significant degree of perceived increase in service fees, though a small but not insignificant (no significant, but not insignificant!) proportion of elderly people did report perceived increase in service fees due to the use of vouchers.”  Based on such data, follow-up actions were taken seriously.  Officials formally invited the media to report on this.  Starting from 2012, doctors have to put down the co-payment before they can register the vouchers for the elderly.  It is stated that it is the co-payment amount that might hinder the behavioural change of the elderly.

The damage has been done.  What I can think of is to formally call for sponsors for the following studies:

• To invite WISEMAN to design a study to see why the good intention of the Chief Executive to subsidize the elderly would be twisted in such a way.
• There had been a willingness-to-pay study in the pilot scheme.  However, the wrong question had been asked.  A study should be done again with the correct question: “What is the amount you are willing to pay or co-pay when there is perceived (yes, perceived, again) free lunch?”
• A follow-up study on those elderly who did show irrational behavioural changes to see whether there is any underlying pathology such as cerebral insufficiency, dementia or frontal lobe lesions.
• To introduce healthcare vouchers to young adults as they are the group who have real potential for behavioural changes and they will exert greater burden on the healthcare system now and later.

 

(Source: HKMA News February 2012) 
 

新年進步

(Source: HKMA News January 2012)

Finally, investigation fee is not "rebate in disguise".

I would like to draw members’ attention to the recently issued Newsletter of the Medical Council (Issue No. 18, October 2011).  (We received it by mail.  If you have lost it, you can go to http://www.mchk.org.hk/newsletter18.pdf and have a look.)  On page 6, under the section of “Advice/Information for All Registered Medical Practitioners”, you would find an article entitled “Guidelines on Charging Fees for Laboratory Tests”.  It started by stating that: “On 27 April 2010, the Chairman of the Medical Council issued a letter to all registered medical practitioners drawing their attention to a disciplinary case of a doctor charging a patient excessive fees for tests performed by laboratories…  The Medical Council considers it appropriate to provide further guidance to doctors on charging of fees for laboratory tests.”

My first impression was that: “What’s the matter with the Medical Council?  Why does it take one and a half year to clarify a letter issued by the Chairman?  Who can remember a case nearly two years ago?”  However, upon reading the article, I realized that many of us, especially doctors in private practice, would remember this confusing, if not wrong, judgment concerning “rebate in disguise”.  And, in fact this low-profile, half-hidden article was our long-awaiting rebuttal of the again confusing, if not wrong, message from the Chairman of the Medical Council.

Maybe let me dig up the relevant documents so that facts speak for themselves.  In August 2009, a doctor was found guilty of misconduct for charging his patient excessively for laboratory tests.  However, the judgment indicated that a comparison was made between what the doctor charged the patient and what the laboratory charged the doctor.  It then concluded at para 17 that “A doctor shall not receive any rebate from diagnostic laboratories or similar organizations to whom he refers patients.  A doctor must be honest and clear in setting out the charges to patients.  The differences in charges indicate that the Defendant Doctor has a financial gain from referring the Patient for laboratory tests.  This is a rebate in disguise.”  (http://www.mchk.org.hk/docs/STW_20090828.pdf)

Many doctors found the judgment against normal practice.  It ignored the fact that doctors had actually provided service in performing laboratory tests and they were entitled to charge their patients.  The Editorial of the September 2009 issue of the HKMA News made a thorough analysis of the case (No More “Laboratory Tests”!  (http://cm-mc-articles.blogspot.hk/2009/09/no-more-laboratory-tests.html). It pointed out that the inquiry panel should try to prove that the doctor actually did overcharge the patient.  It should not jump to such artificial and wrong invention of “rebate in disguise” principle.  It also urged the Medical Council to look into the case and to clarify queries from practicing doctors who were then at risk from the judgment.

Astonishingly, the response was given by the Chairman herself.  She did not put up any discussion in the Council.  Instead, in April 2010, she sent a personal letter to all doctors expressing her personal views (http://www.mchk.org.hk/letter_from_chairman.pdf).  Among others, the letter stated that “Arising from this case, the Medical Council wishes to impress upon members of the profession that the doctor’s own fees for professional services should be clearly separated from the fees collected on behave of laboratories for investigations.  If the doctor charges fees for his own services in connection with the investigations to be performed by the laboratories, the charges should be clearly set out and explained to the patient.”  Unfortunately, this letter served to complicate matter.  What the Medical Council said to impress upon doctors (but in fact was only the personal opinion of the Chairman; and it was later clarified by the Medical Council) was exactly what the profession disagreed.

In response to this confusing letter, the Editorial of the May 2010 issue of the News entitled “Dangerous Precedents” clarified this matter. (http://cm-mc-articles.blogspot.hk/2010/06/dangerous-precedents.html)  It pointed out that the letter posted a strict liability on doctors to explain charges to patients irrespective whether patients asked for it or not.  This was more than that of the judgment of the case.  This was also more than that stated in the Code.

No action was taken by the Medical Council or the Chairman of the Medical Council.  So private doctors had to work under fear and under uncertainty.  To avoid being caught by the ambiguity of the judgment, we had to add disclaimers explaining that every charge on the receipt should be interpreted as including, and not limited to, consultation, handling, professional judgment and advice, rental..., and virtually everything in the world.

It was only after one and a half year that came this piece of Guidelines.  Among them, the following three points were most relevant:

• 2. The Code does not require a doctor to itemize his own professional charges in invoices/receipts….

• 3. Section 12.1 of the Code stipulates that “Consultation fees should be made known to patients on request.  In the course of investigation and treatment, all charges, to the doctors’ best knowledge, should be made known to patients on request before the provision of services…”

• 8. A doctor may charge fees for all professional services rendered by him…  For an investigation, the whole package of services rendered by a doctor to a patient should be described in the invoice/receipt as “investigation fee ( 檢驗費 )”, in order to avoid any misunderstanding that the fee is collected on behalf of the third party.

From the interpretation of an average doctor (that’s me) on the plain and natural meanings of the Guidelines, the following points arise:

• The article points out that the previous letter from the Chairman contains information that needs to be clarified.
• Interestingly, the letter from the Chairman can still be found in the website of the Medical Council.
• There is no strict requirement to set out the items of charges and to explain them to patients unless patients ask for them.
• A doctor can charge more than what the laboratory charges him for tests.  He just needs to write down the term “investigation fees” in the receipt (and only if he chooses to do or as requested by his patient) so as not to cause any confusion.  In fact doctors rarely collect fees on behalf of a third party, such a laboratory.  Rather it is a common practice of the legal profession only.

(Source: HKMA News December 2011)

「這些年，我這個醫委會委員 ……」

Readers must have come across many (and in fact too many) reports and comments on the “coming soon” applications by the Hospital Authority for limited registration for some “overseas doctors without full registration” to fill some service resident positions.  However, readers must remember the fact that there has not yet been any application received by the Medical Council on this subject matter.  As a member of the Medical Council, I have the duty to decide on whether allowing applications for limited registration according to the provisions in the Medical Registration Ordinance (MRO).  I have to judge carefully and clearly whether the details described in the application forms are true and whether the candidates fulfill the requirements spelt out in the MRO.

However, before the applications reach me, the applications seem to be discussed openly.  Apart from reasoning and logical arguments, there have been comments, criticisms, and even threats to the Medical Council.  Alarmingly, some of these comments, criticisms and threats came from the applicant!  More alarmingly, some of these comments, criticisms and threats came from high-ranked government officials!  I considered all these undesirable.  I waited and waited for any action or announcement from the Medical Council or some judicial bodies to call a halt to all these undue influences.  There seemed to be none.  I therefore analyzed the situation: I must realize that I was facing certain pressure and influences.  It was only upon realization of such pressure that I could assess its effect on my judgment.  After careful consideration, I reassured myself that I was still perfectly OK.  And then I wrote the following, and read it aloud to the Chief Executive and some officials of the Hospital Authority in a meeting:

一個醫委會委員在壓力下的獨白：

近日就醫管局招聘海外醫生，申請「有限度註冊」一事，城中鬧得沸沸揚揚，各位各抒己見。其實，「有限度註冊」的審批，早有法定程序，就是由獨立法定組織「香港醫務委員會」，按《醫生註冊條例》，就每一申請個案作詳細討論及審批。

作為醫委員會委員，應該廣聽及廣納各方面意見，再理性分析，並依法審理。不過，在這次事件中，面對近日各界人仕，包括高官及位高權重人仕的指導性、指示性、甚至指令性及指責性言論，我感受到頗大的壓力。所以我覺得有責任向業界及公眾交待事件。

首先，我要指出這次事件的一些特點：

1. 我是醫委會委員，對海外醫生循「有限度註冊」途徑來港執業持開放態度。而且，審批這些申請根本是每個月的例行工作之一。
2. 我並不是「聯席香港醫療水平關注組」成員。
3. 根據醫管局對外言論，局方並不是要求重新立法，亦不是提出特別情況作任何特別處理的要求。而是準備以現存法例，主要是 「醫生註冊條例」中第十四條條文，為準備僱用的海外醫生申請「有限度註冊」。
4. 正因為是按現存法例，循正常途徑申請，醫委會便是唯一法定組織，有權力亦有責任，根據法例條文，審理申請個案的細節，決定通過與否。
5. 醫管局根本未有作任何申請，但卻就事件展開宣傳攻勢，而且愈演愈烈，發展至有聲音指示醫委會應該怎樣處理這些還未作出的申請，亦有指責醫生及醫委會的言論，甚至是威嚇要廢除法例賦予醫委會的權力與功能。 
6. 作為醫委會委員，面對這些言論，我感受到頗大壓力。而我亦意會到，這是一個頗嚴重的情況。因為審批申請並不簡單，須要不受任何影響下，根據法例中細節，判決申請機構、部門、海外醫生履歷、條件、僱用合約等等，是否符合法例要求。
7. 法定組織能在不受影響下依法處理申請很重要。例如之前有官員以個人名片代替填寫申請外傭入境申請表，便引起公眾嘩然。近日律政司司長亦叫停外界就外傭申請居港權官司的評論，以免影響法庭判定的獨立性。
8. 我仔細感受這些壓力，我仔細了解，仔細分析，清楚知道我在這些壓力下，仍然可以不偏不倚，按法例去審批每一項申請。這可能和我是私人執業及曾受法律學士及碩士訓練有關。
9. 不過我不知道，亦不能評估其他委員有否感受到壓力，知否自己正在壓力影響中，及會否受壓力的影響。 

以上是我的獨白，我相信是我的責任向大家說明。雖然，引用＜這些年，我們一起追的女孩＞ 語錄：「人生有很多事本來就是徒勞無功的。」～～ 沈佳宜

「左手申請只是輔助，因為右手要搞宣傳。」(「櫻木花道說的好，左手只是輔助，因為右手要拿滑鼠。」～～ 柯景騰在電影中『打手槍』時的對白。)

(Source: HKMA News November 2011)

Azalea and Election

In the old days, when I was a medical student, I was told during my Students’ Union Orientation Camp that there were many azaleas (杜鵑) around the Main Campus.  These azaleas were also known as “panic flowers”.  (“Panic flowers” is my translation; actually they were called 騰雞花.  The term 騰雞 was quite popular at that time.)  This was because azaleas bloomed around March and April, and they served as a signal for the rush to study for the final exams.  However, I was then told in the Medical Orientation Camp that this signal did not apply for medical students.  The unique saying for medical students was that we needed to study and to prepare for the exams when there was grass around Sassoon Road.  Literally, this meant that we had to work hard around the year.

These stories suddenly came to my mind when I saw a young lady wearing a ribbon wave to me while I was driving down Old Peak Road from the Canossa Hospital.  She was standing in the middle of a pedestrian refuge, waving vigorously to every driver that passed by.  The next day, early in the morning, there was another young man standing in the same site waving to me and other drivers alike.  So these waving candidates and the banners reminded me that it was time for elections.  They were the azaleas in the Main Campus.

Actually those are the candidates for the coming District Council Election.  The polling will be held on 6 November 2011 (Sunday).  Hong Kong is divided into 412 District Council Constituency Areas under 18 Districts.  Together with the 102 appointed members and 27 ex-officio members, there will be a total of 541 members in all 18 District Councils.  The District Council Election 2011 has been regarded as a “super election”, as it is significantly related to the Legislative Council Election 2012 and also the selection of members of the Election Committee for electing the Chief Executive in 2012.  

The Hong Kong Chief Executive Election 2012 will be held on 25 March 2012.  The Chief Executive will be elected by a 1200-member Election Committee.  For the medical functional constituency, there are 30 seats out of the total 1200.  And these 30 representatives will be elected by doctors and dentists.  The date for voting for the Chief Executive is not of so much concern to most of us.  However, if you would like to be one of the lucky 30, you need to remember that the nomination period for the non-District Councils subsectors of the 2011 Election Committee Subsector Elections will run from November 8 until November 15.  For most of us, all we need to remember is the polling date, which is December 11. 

Another more important date to remember is December 1.  This is the deadline for returning the ballot paper for the yearly Medical Council Election.  We need to cast our vote to elect three Members to fill the three vacancies in 2012.  Information of the candidates and the ballot papers will be sent out to all registered doctors on October 28 (a few days after you receive the News).  We need to return the ballot papers by post before December 1.

Distracted by the “waving azaleas” on the pedestrian refuge and all those thoughts about elections, I still needed to concentrate on driving.  I doubted very much the use and the meaning of such waving exercise.  Where were the candidates before the blooming of the azaleas?  Had they ever been active in district affairs?  Where would they be if they were elected?  Could I stop the car and try to discuss the election platform with the candidates?  Would their actions endanger drivers and pedestrians?  Would people just vote for the candidates because they saw them waving hands on one fine day?

I am not sure whether such waving practices will help, since they seem to be routines in elections.  However, as doctors, we have been trained to look for the grass against the azaleas.

(Source: HKMA News October 2011) 

Judgment

Congratulations to the HKMA Badminton Team.  HKMA was the first runner-up in this year's Joint Professional Badminton Competition.  While watching the games, I thought of the old days when we needed to be linesmen in the inter-school badminton competitions.  In fact due to the constraints and resources, members from opposing teams had to take turns to be umpires and linesmen.  Arguments sometimes arose.  It was the transient recall of such moments that made my mind drift to think about judgments.

In fact this month was also characterized by arguments arising from different judgments.  On August 18, the HKU Centenary Ceremony turned out to be the focus of heated debate and protest.  There was even a chapter found in Wikipedia captioned "Hong Kong 818 incident".  It wrote: "The Hong Kong 818 incident was a case of alleged civil rights violations that occurred on 18 August, 2011 at Hong Kong University during a visit by Li Keqiang, the Vice Premier of the People's Republic of China.  His arrival at the school led to a lock-down and complete takeover of the school by the Hong Kong Police force.  Controversy arose as a result of claims by the media and students that their rights had been violated."  The argument and judgment were between security and human rights.  Then another minor argument arose from the "complete rubbish" judgment of Mr. Henry TANG on the argument of whether the government violated people's rights in the above incident.

On September 2, the league of Social Democrats activists were acquitted of disorderly conduct charges over protest in which Mr. Donald TSANG said he was struck on the chest.  This happened during a protest outside the Hong Kong Museum of History on March 1.  On the same day, September 2, the second of the two Legco by-election public consultation forums was gatecrashed by protesters.  Mr. Stephen LAM and others had to flee backstage.  Some claimed injured in the event.

On August 22, a High Court judge started hearing arguments in the landmark case filed by a Filipino domestic worker, who had challenged a legal provision denying permanent residency to hundreds of thousands of foreign maids in Hong Kong.  On June 8, in a split decision, the Court of Final Appeal of Hong Kong determined that a sovereign nation could not be sued in the Hong Kong courts.  The matter was then referred to the China's National People's Congress Standing Committee in Beijing.  On August 26, the NPC Standing Committee unanimously affirmed the decision and declared that companies could not sue sovereign states to recover assets.  On September 2, Mr. Steven CHAN, TVB General Manager, was found not guilty of all charges against him on wrongfully concealing from TVB payment he received and on cheating five TVB artists.

Don't think that making judgment is easy.  Even professionals like judges would be biased.  Concerning the domestic helpers case mentioned above, the Secretary for Justice had to issue a statement to urge the public that: "when they are minded to express any view, to show the greatest respect to our Court and our legal system, and to avoid as far as possible making any comments which might prejudice or affect the Court's adjudication of the case.  This would enable our Court to make its decision fairly and independently, in accordance with the law and admissible evidence, and thereby safeguard judicial independence and the rule of law in Hong Kong."

All these complicated judgments contrasted the judgments made by a linesman.  However, going back to the old days and the simple job of a linesman, the simple judgment is not as simple as it appears upon analysis.  First of all, the rules governing the judgment of "in" and "out" need to be clear.  For example, a shuttlecock falling partially on the line is regarded an "in".  Second, environmental factors count.  For example, is the line drawn properly?  Is it solid and equal without getting blurred or peeling off from wear and tear?  Third come the basic functions of the observer, i.e., the linesman.  He needs to have reasonably good eye-sight.  He needs to be able to concentrate on the lines while he may wish to watch the magnificent match.  He also needs to capture the split-second when the shuttlecock falls on the ground and to relay this signal to his brain to make the judgment.  Last come the higher functions of the judge, i.e., the linesman.  Human is distinguished from machine in that human can think and can be biased by emotion and over-riding thoughts.  The linesman can be eager to see his home team winning.  He may thus either intentionally or unintentionally call a wrong judgment.  It may be so corrupted that someone else is "buying" the linesman to make biased judgments.  In some cases, which might be much more common than we can think of, the lineman himself is running his higher functions to the extreme of human ability.  He second-guesses and analyses what others, especially those powerful ones, would like to see the results to be.  He is ready to make bogus calls either to avoid the slightest possibility of upsetting the powerful, or to wait for the rare chance to let the powerful know that he is doing whatever to appease them.

It is this higher function of the judgment maker, when applies inappropriately, that causes many of the problems in judgment.

(Source: HKMA News September 2011)