June 23, 2017

Tags Posts tagged with "health"


YOU may be up to date with the latest famiLEE news, but are you up to speed on what else is happening in Singapore? The past few days also had news on the arrest of two Singaporean auxiliary police officers under the ISA, a report that long-term unemployment rates have increased, a Singaporean teenager setting a world powerlifting record, report that obesity rates have increased and the G said that new laws to battle fake news will be out next year.

We’ve summarised these developments in bite-sized form:

1. Terrorism: Two more Singaporeans arrested under ISA; radical publications banned

Two Aetos auxiliary police officers were arrested under the Internal Security Act (ISA) in May, the Ministry of Home Affairs (MHA) revealed yesterday (Jun 20). Muhammad Khairul Mohamed, 24, has been detained for planning to fight against Shi’ites alongside the Free Syrian Army (FSA) militia in Syria. His colleague Mohamad Rizal Wahid, 36, has been issued a Restriction Order (RO) for failing to report Khairul and suggesting ways to get to Syria.

Separately, the G has banned nine publications by extremist Singaporean preacher Rasul Dahri under the Undesirable Publishing Act, the Ministry for Communications and Information announced yesterday. In some of his works, the preacher called for Muslims to reject secularism and establish an Islamic state. The Islamic Religious Council of Singapore (Muis) called Rasul Dahri “exclusivist” and “hardline”, advising Muslims to “avoid such teachings”.

2. Economy: 2017 growth forecast raised, exports shrunk, no improvement in long-term unemployment

There’s mixed news in the economic sphere. The job market remains tough as long-term unemployment is at an eight-year high of 0.8 per cent in March, up by 0.1 percentage point from a year ago. The majority of those retrenched are professionals, managers, executives and technicians, who are also finding it difficult to re-enter the workforce.

There are some silver linings though. Unemployment in the first quarter was lower than projected by the Ministry of Manpower. Some 4,000 workers were laid off between January and March, down by nearly 1,500 from a year ago. And projections for economic growth are up, with private sector economists predicting 2.5 per cent growth, up from their forecast of 2.3 per cent in March.

3. Sports: Singapore Athletics feud; SG teen sets powerlifting record

Disputes between Singapore Athletics (SA) and track and field coach Ms Margaret Oh over the schedule for Ms Shanti Pereira’s training sessions and participation in events have been resolved. Ms Margaret Oh is the coach of 200m champion Ms Pereira, who won gold at the 2015 SEA games. Ms Pereira told The Straits Times on Monday (Jun 19) that “they had a good, positive discussion.” Both Ms Oh and Ms Pereira have agreed to join the pre-SEA Games centralised training camp next month. Ms Pereira will be competing in the Women’s 100m and 200m at this year’s SEA Games.

On a happier note, 17-year-old Mr Matthew Yap set a new world squat record at the World Classic Powerlifting Championships in Minsek, Belarus on Sunday. He lifted 208kg in his third attempt, overtaking Kazakhstan’s Mr Dmitriy Chebanov on the leaderboard to win a Gold medal. In addition to the win, Mr Yap has also won a bronze medal in the bench press and a silver medal for the overall standing in the competition.

4. Health: Obesity and STIs

Singapore is a makan paradise for the foodies. But overeating can take a toll on the health of the average Singaporean. Findings from the Health Promotion Board (HPB) showed that while Singaporeans are exercising more, they are also eating more. Six in 10 are exceeding the recommended food intake.

What’s worrying is that obesity rates could reach 15 per cent in seven years. ST reported that on average, the median body mass index (BMI) score for adults last year was 23.15 – outside of the healthy range.

In other health news, the Department of Sexually Transmitted Infections Control (DSC) Clinic recently released figures that showed an increase in adolescents getting diagnosed with sexually transmitted infections (STI). In 2015, 421 boys and girls aged 10 to 19 contracted STIs. The year before there were 391 cases. This is an increase of 8 per cent from the year before, reported The Straits Times. The highest number of cases occurred in 2007 with 820 adolescents contracting STIs. Since then, the figure had been on a steady decline. Experts suggest that while adolescents here are generally aware that condoms are used as protection against STI, many simply choose to forgo using condoms.

5. Law: Fake news laws likely out next year

The G has decided to come up with new laws to battle fake news, Minister for Law and Home Affairs K. Shanmugam said on Monday at the opening of a two-day conference on fake news. Mr Shanmugam cited a poll by the G which showed the need for such laws. He said:“Around two-thirds [of Singaporeans] could not recognise fake news when they first saw it. And only around half are confident of their own ability to recognise fake news.”
In an ideal case, “most misinformation will be dealt with through a resilient society, responsible and effective media, and the innovation of Internet companies”. But in reality, the Minister said: “We cannot always rely on the content standards of the Internet giants… The Government will also need to update our toolbox.”

To achieve this, Minister Shanmugam said the G had surveyed the positions of three other jurisdictions: the European Union, Germany, and Israel. These jurisdictions are considering laws to compel social networks to take down illicit content.


Text by Sharanya Pillai, Danielle Goh, and Johannes Tjendro.

Featured image by Sean Chong.

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by Abraham Lee

ARE you stressed at work? You’re not alone. Roffey Park‘s 2016 study and Willis Towers Watson’s 2014 survey findings have shown that at least half of Singaporean workers face workplace stress. It comes from various sources, anything from heavy workloads and organisational politics to a poor working environment, and can lead to both physical and mental health problems, such as heart disease, stroke and depression.

Dr Lim Boon Leng, psychiatrist from Gleneagles Hospital, said that “the main sources of stress come from overwhelming workload and long hours of work leading to insufficient rest and poor work life balance” while others included “difficult and overly demanding superiors” and “interpersonal conflicts at the workplace“.

Poor or unsupportive relationships can put pressure on workers and office politics can complicate even the easiest tasks, making them tedious and drawn-out, wearing workers out. Workers who feel that they are unfairly treated can also feel isolated, putting undue pressure and stress on them.

Other common sources of stress come from employees feeling a lack of control at work or are faced with job insecurity. They can feel stressed because they are unable to take charge of their lives and made to feel unimportant and dispensable. Weak management can impress upon workers a sense of directionlessness and hopelessness while over-management can cause employees to feel discouraged, distrusted and undervalued, hurting their self-esteem.

Stress isn’t inherently a bad thing because it can motivate us to meet challenges. Said Dr Lim: “Stress is not always bad… As stress increases, our ability to function increases.” But if we become more stressed than we are able to handle, our ability to function plateaus and eventually falls sharply. “When we start to notice that the stress is getting the better of us… it is time to take stock of things and to slow down, rest and find means to de-stress,” said Dr Lim.

Stress takes a toll on the immune system and stressed out workers “are more prone to infections”. Long term stress is associated with a variety of physical health problems like diabetes, heart problems and stroke. Often overlooked is the risk stress poses to workers’ mental health. Dr Lim said that stress “can trigger mental illnesses such as insomnia, anxiety disorders and depression”.

Mental health problems can be “be extremely disruptive to people’s personal and professional lives”. “In mild cases, it may be that one takes a few days of sick leave from work and is slightly more irritable… In severe cases, one may be incapacitated and unable to work long term and may even be suicidal,” said Dr Lim. When asked how long it usually takes people to recover fully from mental health problems, he said that “people take different periods of time to recover”, that “some may take a few weeks to feel better and get back to their usual routine” while for others “the conditions can become chronic and permanently disabling”.

The first thing you can do is to find out if you are stressed and under too much pressure by checking yourself against the list of common symptoms or more accurately, take a free assessment online. If you’re an existing AIA customer, you’re in luck. Just sign up for AIA Vitality and take its Mental Wellbeing Assessment for a short spot-check.

After all, prevention is better than cure and it’s essential for your longterm health to develop a game plan that can help you manage stress in the workplace.

Breaking bad habits like worrying about the uncontrollable and flogging yourself over the need to be absolutely perfect can also help to reduce stress. Dr Lim said that “we have to start by understanding our own ability to handle stress” and our own limits. “Those who may be perfectionistic and harsh to themselves have to learn to change their mindset and be gentle to themselves,” he said.

It’s also important to develop supportive relationships, be it co-workers you can turn to or family and friends you can depend on. Instead of turning to your handheld devices during breaks, try engaging a colleague. A strong network of friends you can lean on can counteract the negative influence of work stress and ensure you’re not left feeling isolated and vulnerable.

“Asians tend to define themselves by their work, but it is imperative to also have adequate focus on family, exercise and hobbies,” said Dr Lim. “Only with a balanced life can we be more effective at work and sustain a high level of productivity and also maintain good physical and mental wellness.”

Exercise should be made a regular habit as it not only helps you to sleep better but boosts your mood, energy and ability to focus, while providing an avenue for relaxation. Form a running or cycling club with your friends and family, or challenge yourself in the AIA Vitality Weekly Challenge with your co-workers if you need that extra motivation.

How well you do at work lies in how well you maintain your body at home, when you’re not at work. Make sure to eat healthily, drinking alcohol in moderation, avoiding nicotine and caffeine, which can all dampen your mood.

Another tip is to get enough rest both at work and at home. Dr Lim said that “rest is not being away from work” or “not being productive but that it is part and parcel of work to allow rejuvenation and hence better productivity after rest”. Prioritise tasks and create a balanced schedule that won’t overwhelm you. Getting enough rest includes getting enough sleep. It affects how well your body recovers from the past day and how prepared it is for the following day.

Last but not least, if workplace stress persists, address the source of the pressure. Communicate with your boss, clarify expectations and ask changes that can help you manage your work better. Or ask for a few days off, for that long overdue holiday.


This story is part of a series with AIA Singapore.

AIA Singapore is invested in the health and wellness of Singaporeans and has launched AIA Vitality, a comprehensive wellness programme that rewards members for taking small, everyday steps to improve their health.


Featured image by Sean Chong.

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by Daniel Yap

THE focus of insurers has traditionally been on offering customers financial protection against unexpected life events such as illnesses. With good risk management and underwriting processes in place, it is generally sustainable for insurers to continue offering compelling insurance products that meet their customers’ protection needs.

But in this age of great convenience enabled by technology and with the ever-expanding food choices, it is becoming increasingly challenging for insurers to support the growing financial needs of their customers as a result of their unhealthy, sedentary lifestyle.

An insurer ultimately has a stake in its customers’ health, and they need to find a way to influence their customers’ lifestyle choices in order to stay ahead of the spiralling healthcare costs and ensure their long term sustainability.

How then can an insurer encourage healthy behaviours?

The human mind is wired to miscalculate decisions about long- and short-term gains (we explained it all here), like eating healthy or driving safely, are stymied by hyperbolic discounting and other types of short-term thinking. No Claim Discount for motor insurance, for example, don’t always account for the risks that others take since you only lose your discount after an accident occurs.

Discount programmes that some companies offer for healthy lifestyle choices are common, but these compete with other discount programmes from retailers or dining clubs that are designed to tempt you in the opposite direction.

But what if there was a more effective way to motivate healthy behaviours? AIA Vitality, for example, is one such attempt to help each party get the most out of their insurance – customers who upkeep a healthy lifestyle receive a variety of rewards as well as premium discounts, while those who have been less healthy would be motivated to move towards the same direction. The insurance company, on the other hand, can continue to offer customers adequate protection at affordable premiums.

The key is how AIA Vitality leverages science and technology to drive positive behavioural change by employing comprehensive tools to assess each member’s health and make tailored recommendations to help them become healthier. It also makes use of the principles of behavioural science and rewards members who are on track to becoming healthier.

The problem of hyperbolic discounting is also addressed more effectively – people tempted to veg on the sofa are given a very realistic weekly activity challenge (such as clocking 7,500 steps a day or checking in at the gym) to meet for a reward of a $5 voucher, which alone more than offsets the $3-a-month cost of being on the programme. The company partners with supermarket chain Cold Storage to offer cash back rewards worth up to $160 each month for healthy food items. Add to that a range of discounts and tie-ups with healthy partners and you have a much more holistic approach for tackling unhealthy living.

But why would an insurer give you $5 a week and more for something that you only pay $3 a month for? That’s because this method has proven to be a win-win for all – a study on Vitality members found that those who engaged in the programme were less likely to fall sick or be hospitalised for prolonged illnesses, resulting in an overall 14 per cent lower cost per hospitalised patient.

Those who ranked higher in the Vitality programme which divides members into Bronze, Silver and Gold statuses, saw a lower mortality rate in practically every age group. It’s a data-driven system that has been fine-tuned to benefit all participants.

Everyone gets what they want – customers enjoy rewards when they meet their health goals and pay less for their insurance as they become healthier. AIA Singapore, on the other hand, gains from healthier customers who will help to ensure that insurance remains affordable for all.

The end result is a more effective model than simply offering financial protection- by driving behavioural and lifestyle change, insurers like AIA Singapore are now able to keep their customers healthier, lower premium costs and stay sustainable in the long run: what the company calls “shared value for health”.


Featured image from TMG file.

This story is part of a series with AIA Singapore.

AIA Singapore is invested in the health and wellness of Singaporeans and has launched AIA Vitality, a comprehensive wellness programme that rewards members for taking small, everyday steps to improve their health.

Featured image by Flickr user Ray_LAC CC BY 2.0

by Abraham Lee

DIABETES isn’t a disease you “catch”, and that means that nobody can “give” it to you. But it’s not far-fetched to say that your job could put you at risk. Lifestyle factors form many of the risk factors for developing diabetes, and since we spend about a third of our day working (and for some of us another third of our day thinking about work), your job, work environment and the people around you become key factors in the war against diabetes.

Singaporeans work among the longest hours in the world. In 2015, we worked “an average of 2,371.2 paid hours” – longer hours than those in reputedly ‘workaholic’ nations like South Korea and Japan. Work habits and culture have a great deal of influence over our lives simply because we spend so much of our time at work.

While great habits at work can promote positivity, bad ones can debilitate other areas of our lives, especially our health. Singapore ranks second among developed nations for diabetics as a proportion of the population, with 11.3 per cent of Singapore residents suffering from diabetes in 2010. That number is projected to rise dramatically to 20 per cent by 2050.

None of us wants the lifetime burden that diabetes promises. The incurable disease is also the gateway to heart disease, stroke, blindness and other complications. The most common strain, Type 2 diabetes, is largely due to lifestyle factors and is usually seen “in people aged 40 and above who are overweight and physically inactive”.

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So what are the riskiest things about our job, diabetes-wise?

Working late can disrupt your mealtimes, sleep patterns, and heighten stress levels. Irregular meal times from skipped meals or late lunches or working late “are linked to a higher risk of metabolic syndrome”, a group of factors that increase the risk of heart disease and problems like diabetes.

Stress from work also messes up your hormone levels, including cortisol which increases appetite and can lead to overeating when its levels remain elevated due to continued stress.

Entertaining clients over drinks, or going out drinking with colleagues, if done too frequently, can also become a hazardous habit as alcohol intake is linked to Type 2 diabetes.

Your work posture can cause tension in your muscles which in turn changes our hormone levels. Sedentary, desk-bound work also lowers our activity levels, which puts us at risk of weight gain, which can lead to diabetes.

Fatigue from work often discourages us from spending time in the evening exercising – it’s much more tempting to veg out in front of the computer or TV, and then go to sleep.

While workers should take responsibility for their own choices, companies are also key stakeholders in promoting healthy lifestyles for employees through healthier work culture. Promoting work life balance, encouraging workers to exercise more and reminding them to practise self-care will result in healthier and more productive employees.

It’s not all that difficult to do either. The Health Promotion Board (HPB) has led the way with healthy eating campaigns and the National Steps Challenge which encourages walking 10,000 steps per day with in-kind rewards. In its second season, it introduced the Corporate Challenge pitting companies against each other with cash prizes at stake and setting up a platform for intra-company challenges.

Complementing HPB’s National Step Challenge is AIA Vitality, a comprehensive wellness programme, launched by AIA Singapore to help users make real change to their health. The programme offers weekly rewards to members when they meet their weekly physical activity targets, cashback, discounts on gym memberships, airfares and more to incentivise them in making healthy choices. This wellness programme is also made available to companies who wish to have it as part of a comprehensive health and wellness benefit for its employees.

It’s going to be a tough fight to live a healthy lifestyle at the workplace, but with the commitment from both the public and private sectors to create a healthier workforce, we can win the fight against diabetes. In the end everyone stands to gain – us, the G, employers and our children.


This story is part of a series with AIA Singapore.

AIA Singapore is invested in the health and wellness of Singaporeans and has launched AIA Vitality, a comprehensive wellness programme that rewards members for taking small, everyday steps to improve their health.


Featured image by Flickr user Ray_LAC. (CC BY 2.0)

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For breaking news, you can talk to us via email.



by Daniel Yap

SINGAPORE is engaging in a long-term war, with high stakes. It’s the war for our health and overall well-being, and for disease prevention which has long-run payoffs – better quality of life, reduced costs, lower risks. The details of NurtureSG, a Ministry of Health plan to instill healthy habits in our children, will be announced later this year, but any plan needs to consider potential obstacles.

The first thing standing in the way of healthier children is unhealthy adults. We need no reminding that children are most influenced not by what they are told by their parents and teachers to do, but by what they see their parents and teachers doing. Thus, any aim to change the health-wise behaviour of the next generation must take into account the behaviour of this generation.

It may be straightforward enough to try to drill healthy habits into our children, but how then can we incentivise adults, whose habits have already been formed and practiced for decades, to change? We would not want to train our children up a certain way only to have them slip back into an unhealthy adult lifestyle because they were following their parents’ footsteps.

Adults need to replace old habits by forming new ones, and new habits are formed by repetitive behaviour. Without long-term goals, such sustained change would be difficult.

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For starters, we need to address the psychology that defeats long-term goals: affective bias, risk discounting, and hyperbolic discounting.

Affective bias, that is, bias that is rooted in our emotions, causes us to hear only what we want to hear. For example, the strong emotion associated with comfort eating can cause us to put too much stock in a “reduced fat” label on an unhealthy snack…and there goes the diet.

Uncertainty about the goals we set is what leads to risk discounting, where we downplay the risky effects of our behaviour. If you didn’t know how much you needed to eat to lose weight, would you have chicken nasi briyani for dinner, and a large bag of potato chips at the movie afterwards? Probably. But if you knew you had to eat under 1700 calories a day to lose weight, then it would be immediately clear to you that the 900 calorie nasi bryani and the 1000 calorie bag of chips would completely wreck your goals, especially if you already had a typical 500 calorie breakfast and “diet” 400 calorie lunch.

Hyperbolic discounting is the cognitive bias that favours short-term gains – why someone would choose to get $50 now than $1,000 a year later. It is why diet plans fail, why savings plans fall through, why we won’t cut our carbon footprint even though we know we put the future in peril.

How can children and adults get past these roadblocks to a healthier life? First, the emotional appeal of a long-term healthy lifestyle needs to stay strong. We need constant reminders that this is good for our family, good for our children and good for our silver years. Strong campaigns and culture-building are key to achieving this.

Then, we need instant gratification for our efforts. This is the short-term counter to short-term temptations, and this has so far been the hardest to achieve on a national scale.

This is why people post their workouts and gym bods on social media – to soak up the likes and encouragement as fuel for the next workout. This is why wearables are effective, because they are a constant reminder on your wrist of whether you’ve covered your 20,000 steps today, or gotten enough sleep, or pushed your heart rate frequently enough this week.

Instant gratification is why we need incentive programmes like the national steps challenge, in-house corporate fitness or weight-loss competitions, or programmes for individuals like AIA Vitality to reward workouts with vouchers, send encouragement, form support groups, set reminders, and do anything necessary to keep our eyes on the short-term goal for as long as it takes to reach the long-term one.

We are all, in one way or another, attracted by short-term gain. And if healthy living isn’t attractive in the short-term, then unhealthy living will win out. And what happens in the short term determines who wins the long-term war for our well-being. If we lose the war for our own well-being, we’ll be putting unnecessary obstacles in the way of the G’s push to make our children healthier.


This story is part of a series with AIA Singapore.

AIA Singapore is invested in the health and wellness of Singaporeans and has launched AIA Vitality, a comprehensive wellness programme that rewards members for taking small, everyday steps to improve their health.


Featured image by Sean Chong.

If you like this article, Like The Middle Ground‘s Facebook Page as well!

For breaking news, you can talk to us via email.



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Bertha in coffee shop

by Bertha Henson

WHEN my mother was in her 60s, she had both her knees replaced. Last year, when she was 71, she had surgery to her spine. She made a swift recovery but age is telling on her. She laments that she isn’t able to walk as quickly or as far as she could. She laments that she is unable to carry the bags of groceries and has to ask the Sheng Siong staffers to lug it for her to her car boot. Yes, she still drives and I’m thinking of taking away her keys because she has a greater tendency now to confuse her routes.

How does one come to terms with getting old(er)?

Everywhere you see material that caters to the younger set, whether on looking good or dressing well. If there is material on the old, it’s about how some elders are ageing gracefully, like doing the triathlon or something. Or it is the rather more depressing stuff, like end-of-life issues and hospital or hospice care. Or it’s about maintaining enough funds for retirement.

The truth is, ageing is not graceful.

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I see increasing signs of an ageing population everywhere everyday. Like hawkers and stallholders in my neighbourhood who are now wheelchair bound. Like having to make my way through sidewalks crowded with personal mobility devices – and I don’t mean skateboards and wheels for the young. Like seeing an increasing number of foreign helpers who go out marketing with their older charges.

There is a couple I’ve known half my life who walk bent and at a snail’s pace around the neighbourhood. They used to be perky and sprightly. At least, I thought, they have each other and they still hold hands. I tell my mother to straighten her posture when she’s walking or she’ll end up looking like them.

How does one come to terms with growing old(er)? My mother fights age with every ounce of her decreasing energy. She colours the tuft of grey on her head with hair mascara. She dons track shoes for her increasingly shorter walks. She maintains herself well, never neglecting the face powder, lip-stick and earrings when she gets out of the house, even if she’s bound for the wet market. She makes sure her spectacles are youngish – she just bought a red-framed one which she worries would be too flashy for her age.

She knows, however, that she is losing her battle with age. She complains about being “useless’’ because she can’t bake as many cookies as before or cook the big family spreads she used to.

Nothing really prepares you for the slow and steady drip of energy and strength. It doesn’t help when friends you’ve known half your life suddenly succumb to illness. A friend of my mother’s who is one of the most out-going and social beings in her set, collapsed at a mall a few weeks ago and died in hospital a few days later. It’s depressing when people your age suddenly pass on, as it was for my mother.

It’s one aspect of ageing that is seldom talked about: the psychological acceptance that you are not as young as you used to be. We can mend our body parts and even replace them, or slow down the ageing process. We can ensure we have enough funds to live until death, but what is the point when you can’t live life to the fullest in the meantime? You hear it, don’t you? Older folk saying they want to holiday overseas before they become incapable of walking. That they want to enjoy their life with their CPF savings while they are still healthy and sprightly. Yet we tell them to see the big picture: that without funds, society would end up caring for them. It’s a message for the young, who can yet envisage being old.

I feel age creeping on too. Creaky knees, reading glasses and a bad wrist that appears to be the result of too much time on the keyboard. Like my mother, who considers herself young, I look at older folk and wonder about the day I become one of them.

Singapore has to get used to the presence of older folk. I can declare that I have never heard any driver honk at an old person who is taking his time to cross the road. And I have never seen anyone not responding to an older person who asks for help. But I also know that statistics show that the elderly are vulnerable on the roads and die in accidents, and that they are susceptible to scams, especially if the trick involves their children’s well-being.

I read on Friday about an old lady who has kept herself in her own home because she is afraid of falling down when she ventures outside. I smile because my mother is afraid of falling too, not just because of broken bones, but that she would look like a foolish sight in public, sprawled on the ground in an unsightly manner.

Maybe that’s why she always dresses well when she ventures out of the house. You really want to look your best when you are at your worst.

May age be kind to all of us.


Featured image by Sean Chong.

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Featured image by Flickr user Vaping360. (CC BY 2.0)

by Daniel Yap

SENIOR Minister of State for Health Amy Khor’s answer to WP Non-constituency Member of Parliament (NCMP) Leon Perera’s question about heated tobacco products exposed a weakness in the Ministry of Health’s policy on alternative tobacco products, and its approach to science. Smoking is a big risk for our healthcare system, and if alternative products can lower that risk, then perhaps we need to consider them more carefully.

Heat-not-burn tobacco may be strange to Singaporeans because it is banned here, but it accounts for more than five per cent of the tobacco market in Japan after being on the market for just two years, and is catching on in many major markets worldwide. Its popularity is due to rising fears of the effects of second-hand smoke and also smokers’ desire to quit or reduce harm to themselves and their families.

But since Singapore plays host to research and development facilities of tobacco companies, it’s odd to think that we know so little.

How Philip Morris International's iQOS system works
At least we know how Philip Morris International’s heat-not-burn iQOS system works

Plus, since we are at war with diabetes (of which smoking is a major risk factor), it behooves us to be interested in even preliminary studies of products that claim to reduce risks, including e-cigarettes and heat-not-burn products.

I have family and friends who smoke and I would like to know whether this product (or any other, like vaping) could reduce the harm they are doing to their bodies (and to mine). I would think every smoker’s family does.

It takes time, of course, but Dr Khor did not say that studies were underway. Are they? I know the budget is tight, but this is a budget for the future, isn’t it? Why not spend a few million now to potentially reduce future healthcare costs by billions of dollars?

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1. Don’t know means don’t know, not “no”

Dr Khor’s reply sounds like a defence of the G’s policy of banning heat-not-burn products, along with e-cigarettes and non-smoking tobacco. If a lack of information exists for an issue as important as smoking, then it is the duty of the G’s scientists to go and find out more.

If we don’t know, we should be open to trying. I’m not saying we should completely legalise alternative products to all and sundry. Even Mr Perera’s suggestion to start with giving these products to smokers trying to quit will be a start.

2. Citing nicotine levels as a reason why heat-not-burn is bad

Mr Perera was asking about the overall risk of heat-not-burn products. Dr Khor answered with how nicotine levels were comparable to regular cigarettes. This answer is strangely off-track.

Smokers are addicted to nicotine but killed by tar and other chemicals. Shouldn’t the answer be about tar and carbon monoxide instead? Or at least one of the many other chemicals in cigarettes that could harm your body?

And if lower levels of other chemicals are detected in heat-not-burn products, then the same level of nicotine would be a good thing because it would be easier for addicts to switch products because they get the same high while causing less harm to themselves and others.

We practise “reduced harm” policies for other vices. If heat-not-burn products and e-cigarettes reduce harm, we should allow them, and the health authorities should commit to this and then go research it.

3. Criticise the research, not (just) the researcher.

Dr Khor is a little too dismissive of the research done by tobacco companies when she says “while there have been claims that such tobacco products are less harmful…these claims are made by the tobacco industry”. It is one thing to know that a person or organisation is an interested party in a study or has lied in the past, but that isn’t what makes a study true or untrue.

Research done by tobacco companies on heat-not-burn stretches back to 2008. And it is extensive, with publicly available methodology. Philip Morris, for example, has submitted a two million-page dossier to the US Food and Drug Administration on the effects of heat-not-burn. If heat-not-burn is as harmful as cigarettes, as Dr Khor presumes, then we need to dive into the research, not ignore it.

Since there is currently no research to disprove the tobacco companies, why not peer review their studies? Why not attempt to replicate them? Why not conduct independent studies? That is how one refutes (or proves) another’s research, not by a mere claim that the other party is an interested party. That’s what we do with big pharma, so apply it across the board.

Good science was responsible for linking cancer, diabetes, heart disease and a host of other ailments with smoking. We need to drop the lazy rhetoric and do the hard work of science.

4. “There is no safe level of tobacco use”

This was the answer Dr Khor gave to Mr Perera’s query about trialing reduced-risk products to help smokers who have registered for smoking cessation programmes quit.

Not only does it fail to answer Mr Perera’s question, the answer hides behind a truism. Of course there is no safe level of tobacco use. There is also no “safe level” of particulate pollution. There is no safe level of red meat consumption. But we know that a PSI below 50 is considered “healthy”. We know that one can eat a moderate amount of red meat and not be considered “at risk” by doctors or insurers.

We want to know whether heat-not-burn is safer than cigarettes, not whether tobacco is bad for you. Big tobacco is claiming that heat-not-burn is safer. There are no claims that it is safe.

5. The “gateway effect” and other “evidence from other countries”

Dr Khor says that “evidence from other countries” shows that heat-not-burn products have emissions that are not too different from cigarettes. However, a November 2016 Ontario Tobacco Research Unit report on heat-not-burn products comes to this conclusion:

“To date, we have not found new independent science that has assessed the harm reduction potential or the acceptability of the current generation of heat-not-burn products… If independent science finds that the new heat-not-burn products do indeed considerably reduce harm and are widely acceptable to smokers, an opportunity would arise for eliminating the sale of the higher risk combustibles.”

So other “evidence from other countries” so far is a well-documented seven-year-long and counting study by UK health authorities disproving Dr Khor’s “gateway effect” fears, and showing the exact opposite.  Dr Khor mentioned the study but didn’t have the time to explain why she didn’t accept its findings.

Instead, her evidence backing up the “gateway effect” is only half a story – that adolescent e-cigarette use in the US is growing quickly (ten-fold since 2011). The other side of the story, which she left out, is that there was a sharp decline in conventional cigarette use over the same period. I’ll not be one to confuse cause and correlation, but telling only one side of the story robs us of the facts.

Add to that the fact that the UK government has concluded that e-cigarettes are definitely less harmful than regular cigarettes and you’ve got to ask: Could the Ministry of Health, in their over-zeal to protect Singaporeans from “potential harm”, also be holding us back from potential benefits? All I know is that we can’t justify our policy positions with bad, bad science.


Featured image by Flickr user Vaping360. (CC BY 2.0)

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ASIA is home to thousands of cultures, yet the one ingredient that unites us all is having rice as part of our daily meals. From India in the west to Japan in the far east, down to furthest southern reaches of the Indonesian islands, rice has been a staple for billions of people for thousands of years.

Yet the humble grain, or at least the processed white version of it, has been at the crosshairs of health authorities in recent years for its role in diabetes.

Harvard researchers studying over 350,000 participants way back in 2012 for instance, noted that an additional serving of white rice raises the risk of Type 2 diabetes by 10 per cent. This is explained in part by its high glycemic index (GI) score which causes spikes in blood sugar.

But these same researchers note that modern sedentary lifestyles have a large part to play as rice has been in the Asian diet for millennia and health issues are cropping up only now. One solution: reduce the amount you eat, but do it without starving.

This is easily done by adding seeds, nuts and grains. While the purity of a simple bowl of white rice is certainly hard to beat, these small modifications not only add interest in flavour and texture but ramps up the amount of nutrition you’d get in one sitting. Here’s 7 you can add for a healthier bowl of rice.

01 Barley
Barley incorporated into short grained rice yields a nutty taste with the chewy texture of al-dente pasta while providing more manganese, phosphorus and proteins. The grain cooks at the same rate as rice so it can be mixed and cooked at the same time. To get this right, combine 1 cup barley with 1 cup rice with 2 ½ cups of water and cook as per normal in your rice cooker.

02 Quinoa
For those looking to increase the amount of protein in your diet, quinoa is your go-to grain. The cereal which is native to South America takes just 15 minutes to cook so add it into your rice towards the end if you prefer it still crunchy. While white rice and quinoa is an easier combination, consider cooking with brown rice to include more fibre.

Amaranth, the ancient Aztec grain.
Amaranth, the ancient Aztec grain.

03 Sesame Seeds
There’s more to sesame seeds than just having it as an oil or to sprinkle on top of burger buns. They’re packed with nutrients like proteins, fat and fibre, and tastes best when roasted and crunchy. To get the best out of this flavour and texture, dry roast the sesame seeds on a hot saucepan until slightly browned, and mix it in with cooked rice.

04 Amaranth
This ancient grain was a staple of the Aztecs and is as protein packed as quinoa. Unlike quinoa though, amaranth turns mushy when cooked, so go by your preference when cooking it with rice. Generally, more amaranth leads to a soft pudding-like texture. But a good way to start and gauge your preference would be to use 1/4 cup of amaranth to 3/4 cups of other grains.

05 Soy Beans
Soybeans have long been cooked with glutinous rice in Asia as part of leaf-wrapped dumplings and often come seasoned with savoury additions. The beans are also so protein-packed that it’s recommended as a replacement for those on meat-free diets. To cook it, soak the soy beans overnight so they soften up, dehull them and then add your desired amount into the rice to cook simultaneously.

A bowl of garbanzo beans
A bowl of garbanzo beans

06 Mung Beans
Healthy ingredients can be difficult to find but thankfully, mung beans or green beans as they’re commonly known are found everywhere. They’re packed with nutrients like magnesium, manganese, potassium, copper, folate, zinc and vitamin B6. Like soy beans, soak the green beans overnight before cooking. Recipe-wise, the Iranians have a dish named Mash M’tubuq which calls for ½ cup of mung beans to 1 cup of rice. It also calls for other ingredients like yoghurt, onions, molasses and dill but there’s no reason why you can’t try it out plain.

07 Garbanzo Beans
Garbanzo beans are often seen more as the main ingredient in hummus than with rice but it’s a combo that’s also seen in Mediterranean and Indian dishes. Save yourself some time and go for the canned version rather than the dried version as getting the buttery texture it’s so loved for requires more than just soaking, but also simmering for 1 ½ hours. As canned versions are already cooked, simply add your desired amount towards the end of the rice cooking cycle and give it a good stir.


This article first appeared on Michelin Guide Singapore. Visit Michelin Guide Singapore on Facebook.

Featured image mixed rice by Flickr user theilr. (CC BY 2.0)

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Photo By Shawn Danker
Singapore Parliament.

by Wan Ting Koh

IS ZIKA here to stay, and is it even possible to eradicate it fully? What about fogging – is it useful in the long term?

These were questions asked in Parliament yesterday (Sept 13) after two ministerial statements concerning the mosquito-borne disease were read out.

The first statement was by Health Minister Gan Kim Yong, who spoke about the current local situation of Zika and outlined strategies concerning the disease moving forward. He was followed by Minister for Environment and Water Resources Masagos Zulkifli who spoke about efforts to control the disease in terms of eradicating mosquito breeding grounds.

Both ministers responded to questions from eight Members of Parliament (MP), including the MP for MacPherson SMC Tin Pei Ling. MacPherson SMC is currently one of the seven Zika clusters in Singapore.

And it was Ms Tin who asked if Zika could be considered endemic and if it was possible to rid Singapore of the disease. The answer? In short, don’t know.

Mr Gan replied that it was “too early to tell” if it was endemic. He said that to focus on the terminology at this point in time is “not productive” and that the focus should be on the “immediate task”, which is vector control. Basically, to eradicate the source of the mosquitoes to prevent the transmission of the disease.

(Endemic diseases regularly occur among a certain region or place. The term is different from “epidemic” which describes an infectious disease that spreads rapidly to many people. Think SARS.)Why delay in detection?

Speaking of endemic, non-constituency MP Daniel Goh brought the house back to when Zika first started and asked why the 36 foreign workers, whose Zika infections the Ministry of Health (MOH) announced on Aug 28, were not detected earlier. Mr Gan said the symptoms were mild and that the infection is difficult to identify; the workers had also tested negative for dengue and chikungunya.

On Aug 23, a general practitioner at Sims Drive Medical Clinic, informed the MOH of an unusual increase in cases with fever, rash and joint pains. The cases were classified as mild as the initial hypothesis was a cluster of mild viral illness transmitted from person to person. MOH then made arrangements for the clinic to refer new cases to the Communicable Diseases Centre (CDC) for further testing and to start tracing past cases for review and testing if appropriate.

The ministry also communicated with nearby clinics and construction sites to be more vigilant and report cases to the ministry. Patient A, a 47-year-old Malaysian woman whose case was reported on Saturday (Aug 27), is considered the first case of locally transmitted Zika infection here. Patient A visited the same clinic as the construction workers on Aug 25 as she had developed fever, rash, and conjunctivitis. She was referred to the CDC at Tan Tock Seng Hospital, where she was tested positive for Zika.

The infections of the 36 foreign workers were identified via back-tracing.

As for its current Zika control measures, the G is now extending Zika testing beyond the clusters and providing a subsidy to all Singaporeans with Zika-like symptoms at public healthcare institutions, Mr Gan said. In addition, it is keeping doctors, especially GPs, which Mr Gan describes as the “key gatekeeper”, up to date with Zika developments. Zika was made a notifiable disease under the Infectious Diseases Act from January 5 this year, which means that MOH would immediately be alerted if any doctor or laboratory in Singapore detected a case of Zika.

Fog more often?

As for the Ministry of Environment and Water Resources, Mr Masagos said that the ministry will continue to employ more “boots on the ground” in terms of inspectors who check both household and construction sites for mosquito breeding grounds.

What about fogging? He said that routine and indiscriminate fogging was “not wise”. It is not a sustainable measure or effective against the local mosquito population, he added.

Fogging is only effective if the chemical has direct contact with the Aedes aegypti mosquito and it will have to be applied frequently as there would always be new batches of mosquitoes from breeding grounds that are not removed, said Mr Masagos.

Said Mr Masagos: “Fogging should only be used when there are Zika or dengue clusters or when the adult population [of Aedes mosquitoes] is observed to be high.”

In fact, fogging may cause a “build up of resistance in mosquitoes” which may then become immune to the insecticide. A more effective solution would be the “detection and removal of mosquito larvae”, he said.

Featured image from TMG file. 

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ZIKA is here. We’d rather not say “finally”, since we’ve been warned about it so many times that it seemed like a bad mantra. That exotic word by the way, refers to a disease spread by that dratted Aedes mosquito, the type which also spreads dengue.

We’ve been warned that we’re vulnerable because we have so many people going through Singapore. In May, Singapore reported its first imported case, a 48-year-old who travelled to Sao Paulo. It had seemed like something so far away, in Brazil, where pregnant women could pass the infection to the foetus who would be born with birth defects.

But Singapore’s latest Zika patient, a 47-year-old female Malaysian who resides at Block 102 Aljunied Crescent and works in Singapore, hasn’t travelled to Zika-affected areas recently. This means she was probably infected in Singapore which makes her the first case of local transmission.

MOH is also screening others living and working in the area who have symptoms of fever and rash. At this point, two members in a family who live in the Aljunied Crescent area and an individual who works there, had preliminarily tested positive based on their urine samples.

Don’t start panicking.

According to MOH: “Zika is generally a mild disease. It may cause a viral fever similar to dengue or chikungunya, with fever, skin rashes, body aches, and headache. But many people infected with the Zika virus infection do not even develop symptoms.” But pregnant women who live or work in the vicinity and who have a fever or rash should see a doctor.

The Malaysian, who developed fever, rash and conjunctivitis on August 25, is recovering well.

As for precautions, we should just do what we’ve always known we should do – wipe out the mosquito population. That might just rid us of the dengue fever scourge as well. Dengue has claimed seven lives so far. By the way, the Malaysian isn’t living in an active dengue cluster but there are two other clusters nearby.


Featured image from TMG file.

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