Give the gift of knowledge

The other day I saw a greeting card displayed on the check out counter at Waynesburg University Eberly Library saying “Give the gift of knowledge”; the most precious gift, after the gift of life.

And this is the gift I received today; I received two books sent from Amazon.  One is Churchill by Himself edited by Richard Langworth; the other is Farnsworth’s Classical English Rhetoric.  I checked out these two books October from the two local libraries and I've been allowed to renew repeatedly since no one requested for them.  I told Janice I began to feel guilty in keeping the renewal.

The two books come with two gift notes from Janice (see photo).  Daughter knows father the best.  In the first 10 years of my coming to America, all I read was medicine or science, and then I began to read scientists who can write, the likes of E.O. Wilson, James Watson, and Richard Hawkins.  It was Lincoln and Churchill that led me to discover the beauty of English language.  I have been reading these two literary giants for almost 30 years and am still reading; reading them or about them.  Churchill is a Nobel laureate in literature, Lincoln would deserve it had he lived after 1900, the year the Nobel Prize began.

In the book (inside) cover of Farnsworth’s rhetoric, one read “Masters of language can turn unassuming words into phrases that are convincing, effective, and memorably beautiful.  Lincoln and Churchill had this power; . . .” I immediately know this is my type of book.

I am reading “366 Days in Abraham Lincoln’s Presidency”—a free online eBook (published in 2010) loaned from Amazon through my Prime membership.  I have read “tons” of books by Lincoln and about Lincoln, and I still discover something new every month, if not ever day.  When Lincoln made the unprepared farewell address at Springfield railroad depot that began his 12-day inaugural train journey to D.C.  Mary Lincoln was not there.  She did join Lincoln at Indianapolis.   I never knew why.  I even read one book saying Mary threw a tantrum and refused to go with Abe that morning.  I read “Mary was shopping in St. Louis and joined him at Indianapolis.” in this “366 days” book  This shows how Mary was treated unfairly in history.  Mary also went to NY City with Robert (eldest son, the future Harvard man) for a shopping spree for two weeks to make sure she had the First Lady dress and accessories and returned to Springfield two days late.  The poor Abe went to the train station and came home alone two days in a row.

Steelers are playing for pride, revenge and control, not for the playoff berth, tonight

Yesterday was a good day, a victorious day for the Steelers, and they didn’t even play.  All the teams that are supposed to lose lost.  Steelers clinched the AFC playoff berth because Oakland, Tennessee, Denver and New York Jets all lost.  And better yet, with the Baltimore Ravens lost at San Diego last night, Steelers were propelled to the AFC North Division champ.

Taking advantage of this situation, the ankle-sprained Roethlisberger may play tonight to ensure a win, as Pouncey was out and Harrison is being suspended for one game.  This is not a Must Win game, but it is a game for pride, revenge and control.  Two of the three losses the Steelers suffered this season were at the hands of John Harbaugh’s Ravins.  And Steelers are to play Jim Harbaugh’s (John Harbaugh’s younger brother) San Francesco 49ers tonight.  If you cannot beat that Harbaugh (John), you got to beat this one (Jim).

The Big Ben should play or not tonight; to play or not to play, that is the question.  Mike Tomlin got paid to make this kind of tough decision.

PSA prostate cancer screening controversy: to do it or not to do it, that is the question

FDA approved PSA to be used to screen for prostate cancer in 1994, although it has been so used for many years prior (probably around 1986).  But, to screen or not to screen, that is the question (with no definite answer!)  To illustrate the complexity of the controversy I’ll first mention the most vocal opponent against using PSA to screen for prostate cancer is Dr. Richard Ablin (see photo, left), who discovered PSA in 1970.  He wrote an op-ed at NY Times (3/9/2010) “The Great Prostate Mistake”, in which he chastised the American Urological Association (AUA) for still recommending PSA screening ‘shamefully’.  He also wrote, “If the biopsy showed any signs of cancer, the patient was almost always pushed into surgery, intensive radiation or other damaging treatments”.

Patients are “pushed into surgery” for the “damaging treatments”, that is to say “shame on you, you urologists!”  Drug companies are not spared, he wrote, “Drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened.”  To say ‘peddling’ is equivalent to “咱們的跑江湖賣膏藥的「王樂阿仙」”

Dr. Ablin concluded by saying “I never dreamt that my discovery 4 decades ago would lead to such a profit-driven public health disaster.”

Current U.S. Preventive Services Task Force does not recommend PSA screening for patients of any age.  What’s wrong with PSA screening?  I used it as one of the examples of “sensitivity and specificity” concept in interpreting the Lab tests during my talk at the Taiwanese Bible Study last month.

PSA (prostate specific antigen) is produced by the epithelial cells (上皮細胞) of prostate and is released to the blood stream.  PSA increases in the presence of prostate cancer as its production increases, as does the leakage into the blood stream.  And better yet 90% of prostate cancer detected by PSA screening show the cancers are confined to prostate or regional spread (no distant metastasis); the 5-year survival is almost 100%.  Prostate cancer diagnosed after patients become symptomatic (i.e. without PSA screening) are almost always too late.

This makes PSA screening much desirable and medically advisable.  No wonder 90% of US men (50 yr-old or older) have at least one PSA test.  However, the advantages stop here.

Vicious attack on AUA and drug companies notwithstanding, Dr. Ablin also made many sensible and legitimate comments, such as “American men have a 16% lifetime chance of receiving a diagnosis of prostate cancer, but only a 3% [2.9% to be exact] chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.”

An autopsy study shows two thirds of  men (of 80 years of age or older) died of any illness other than prostate cancer have prostate cancer; these people “die with prostate cancer than to die of it.”

If you read the Lab report you would see PSA of 4 is the upper normal limit.  But, in realty no one knows what is the normal upper limit of it.

In a 7-year study of 18,882 patients, 9,459 patients have annual PSA and digital rectal examination (DRE), 2,950 patients have prostate biopsy at the end of 7 years and 449 (ages 62-91) turn out to have prostate cancer.

  

The number of PSA among these prostate cancer patients spread all over from below 0.5 to way above 4.

            PSA                 0 - 5                             6.6%

                                    0.6 – 1.0                      10.1%

                                    1.1 – 2.0                      17.0%

                                    2.1 – 3.0                      23.9%

                                    3.1 – 4.0                      26.9%

                                    ---------------------------------------------

                                                                        74.5% (with PSA less than 4.0)

                                    greater than 4.0           25.5%

If 100 patients known to have prostate cancer and do PSA test, only about 25 (1 in 4) have PSA ≥ 4.0, that is to say that PSA test has 25% sensitivity.

A high sensitivity test is good to rule out disease.  For example, D-dimer test (elevated in cases of deep venous thrombosis or DVT) has nearly 100% sensitivity, that is to say if one has normal D-dimer, one doesn’t have DVT.  But PSA has such a low sensitivity (about 25% in this study), one has ‘normal’ (i.e. <4.0) PSA still doesn’t guarantee no prostate cancer.

Setting PSA 4.0 as a cutoff value, sensitivity is about 21-25%, setting PSA 3.0 as a cutoff value, sensitivity is 32%, so lower the number, increases sensitivity, but what about specificity?

A high specificity test is good to rule in disease.  If PSA test has a specificity of 100%, then if one has a PSA>4.0, then one has prostate cancer.  However, using PSA 4.0 as a cutoff value, its specificity is 91%, i.e. 9% of patients with a PSA>4.0 will turn out not to have prostate cancer.  Using PSA 3.0 as a cutoff value, the specificity is down to 85%.

I mention this dry statistical stuff to make a point that there is no such a thing as to what is “normal” PSA; setting PSA 4.0 as a cutoff is a “compromised” trade off between sensitivity and specificity. 

                       

Why is it so? the answer lies in the fact that there are many other conditions that will raise PSA, most commonly benign prostate hyperplasia; the list is as long as your arm, like Dr. Albin wrote, “Infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate a man’s P.S.A. levels.”

Not all prostate cancer behave the same way; most are slow growing, but some can be aggressive.  One wrote in a letter-to-the-editor in NY Times claimed “roughly 30-40% of all prostate cancers are aggressive.” (see photo below).  I am not sure all urologists would agree with the number of 30-40%, though.  Unfortunately, PSA screening cannot differentiate between indolent and lethal [aggressive] prostate cancer.” 

The urologists have many tools at their disposal in predicting which will be more aggressive and treated accordingly; these evaluations are helpful, but by no means perfect.

^  Gleason score (after prostate biopsy)

^  PSA velocity (rate of increase)

^  ratio of free over bound PSA

^  PSA density (PSA divided by volume of prostate)

^  age

^  comorbidity

^  life expectancy

There are two major trials study the impact of treatment outcome of PSA screening.  One is from Europe: ERSPC (European Randomized Study of Screening for Prostate Cancer), the other from the U.S.: PLCO (prostate, lung, colo-rectal & ovary trial).  The ERSPC involves 182,000 patients in 7 European countries over 9 years period, whereas the PLCO involves 76,693 patients at 10 U.S. centers over 7-10 years period.  Both studies were published in the same issue (3/26/2009) of New England Journal of Medicine (NEJM).

The result is not favorable in pursuing PSA screening.  The ERSPC shows small absolute survival benefit after 9 years follow up.  Although there is 20% decrease in prostate cancer mortality in the group of ages 55-69, the absolute survival benefit is very small (a decrease in 0.7 death per 1,000 patients after 9 years follow up), and 1,410 patients have to be screened and 48 patients have to be diagnosed to have prostate cancer to prevent one death.

The “over diagnosed” issue comes into play.  If one’s prostate cancer never would have caused any problem during his life time, and it is picked up because of doing PSA tests and is therefore subject to surgery (radical prostatectomy) or radiation therapy, resulting in complication or undesirable consequence, such as erectile disorder (20-70%) or urine incontinence (15-50%), then this is “over diagnosed”.  Over diagnosed may lead to unnecessary treatment and the potential complications.

The PLCO study shows no mortality benefit from annual PSA screening in 7-10 years of follow up.

This is what led the U.S. Preventive Services Task Force to recommend no PSA screening.  However, American Cancer Society still recommends the PSA screening begins at age of 50, while AUA at age of 40 (see photo below). 

PSA is very good in monitoring the progress of prostate cancer treatment or recurrence; there is no controversy about it.

The way Dr. Ablin criticizes the AUA is not fair.  The urologists are the ones seeing all the troubles, complications and suffering of prostate cancer patients.  This is not 飯碗的問題 (not a matter of making a living); in fact, the urologists end up making more money in taking care of complicated prostate cancer patients.

Keep in mind that Dr. Ablin is a Ph.D., not an M.D., let alone an urologist.  A super scientist though he may be, he may lack the knowledge and understanding of the relevant clinical problems and idiosyncrasy of individual patient.

USPSTF is supposed to be a government (federal) agency; one may wonder their stand and recommendation put more weight on the cost than the benefit of individual patient.  They caused an uproar two years ago when they announced the mammogram can be done every two years, instead of every year, and begins at age of 50, instead of 40.  Is this the Obama Care to come?

One thing for sure is that a PSA test shouldn’t be requested (by patients) or ordered (by doctors) without a through counseling, which will be a daunting task.  The photo is the cover of the British Medical Journal illustrating the importance of physician patient partnership.  It is not as graceful as the image implies.

上醫醫未病之病

中醫醫將病之病

下醫醫已病之病

This is from 黃帝內經.   Prevention is not as easy as it seems.  It is not easy to be a 上醫.  The issue of PSA screening also demonstrates the wisdom of 黃帝內經.

This writing is to help you understand the complexity and dilemma of a medical controversy.  Is a PSA test right for you?  Only you and your doctor can make the decision.  The last slide of my talk quoted what Enrico Fermi said in 1938,

 “Before I came here I was confused about this subject, but now having heard your lecture I am still confused, but at a higher level.”

After reading this, if you’re still confused, hopefully at a higher level, then the purpose of this writing is served.

Speaking of PSA, I have to mention a very popular book in Taiwan (Family Medicine series) “攝護腺肥大: 小 Case” (see photo) written by an urologist Dr. Chung Cheng Wang (王炯珵).  It is a well written, comprehensive and informative book, every thing you need to know about prostate gland; a must read book by men as well as by women for their loved ones.   

Dr. Wang (王炯珵) was a research fellow at UPMC about six years ago.  When he came to attend the annual American Urology Association meeting at Washington, D.C. this past May, he made a side trip to Mount Vernon with us—a fond memory.  The photo shows Dr. Wang and Katy at the back yard of George Washington’s House at Mt. Vernon, overlooking the majestic Potomac River in Northern Virginia.
 

Katy’s report to 日報: National Taiwan University Alumni Luncheon at Pittsburgh

Katy’s dispatch to the World Journal (世界日報) reporting the National Taiwan University (NTU) Alumni Holiday Luncheon was published today (Dec. 15).  It was held at Monroeville City Buffet on December 11.  The initially scheduled speaker was 許倬雲, the faculty member (院士) of Academia Sinica (中央研究院), who was unfortunately not at his best health and unable to attend the luncheon that day.  The arrangement was made to obtain a new speaker, Charlie Chian (簡豐源), who is a NTU alumnus with a Bachelor of Arts in Law degree.

(You may read directly online)

http://www.worldjournal.com/view/wjnjpanews/16789888/article-%E5%8C%B9%E8%8C%B2%E5%A0%A1%E5%8F%B0%E5%A4%A7%E6%A0%A1%E5%8F%8B%E6%9C%83%E8%81%9A%E9%A4%90?instance=nj2

 

Chen’s topic is about the Long Term Care Insurance.  He pointed out many things worthy of attention and emphasized that the insurance company selected has to be state-approved.  He jokingly said that thing would be simple and easy if one is poor; the state will take care of the poor as long as one’s asset or bank deposit is less than $2,000, otherwise one would have to pay all the expenses.

He reminds every one of the importance of designating beneficiaries for the pension and life insurance.  It has to be clear and exact, such as writing the specific names, instead of “children”.  He suggested asking for POD (payable-on-death) for bank accounts and TOD (transfer-on-death) for stocks and brokerage accounts as well as joint tenancy with right of survivorship.

Living trust is more complicated.  Each individual can give $13,000 to each of his or her children or even relatives or friends.  It is not advisable to give away the money too soon.  Chen mentioned an example.  Mr. so and so gave money to his married daughter who died in a car accident; the money went to the surviving son-in-law, who remarried and also met his accidental death.  The money went to his widow; the result is none of the grand children of Mr. so and so will get any money.  Setting trust would be the solution, the more trustees the better.

NTU is a national university, its tuition is traditionally lower than that of private universities.  In order to fund the scholarship and keep the world class teaching faculty, the university has been fund raising asking each alumnus to donate $100 every year to 「台大永續基金」。「百元美金，台大躍進。三千細水，台大長流」is the fund raising slogan.  This effort will propel NTU into the World Top 100 Universities.

In order to promote and strengthen the contact between the university and alumni, the university encourages the alumni to apply for Alumni Card (台大校友證), with which the alumni can enjoy the resource and various benefits of the university.  For further information, please visit http://www.ntu.edu.tw . (Katy Tsai, 張瓊月)

(the following is Katy’s dispatch)

匹茲堡台大校友會聚餐

【賓州匹茲堡訊】 世界新聞網 北美華文新聞、華商資訊

December 15, 2011 06:00 AM 

匹茲堡台灣大學校友會日前在夢諾維爾的市區饗廳（Monroville City Buffet）聚餐。原計畫邀請中央研究院院士許倬雲演講「國際風雲」，由於高齡80的許倬雲身體違和，不克出席，臨時改由台灣大學法律系校友簡豐源演講。

簡豐源演講主題是「購買美國老人的長期照顧保險注意事項」。他指出，最主要的是不管買那一家的保險，都必須注意是向該州有認證旳保險公司購買。如果沒有錢，反而簡單，如果銀行存款只有2000元，政府將補助長期照顧。如果有錢就只要自己付費。

他 提醒大家注意退休金、人壽保險的受益人，要清楚註明，避免日後被清算付稅。他建議可到銀行把存款帳號免費做 POD（payable-on-death），還有股票帳號做 TOD（transfer-on-death）。兩人聯名的帳戶，如果一方死亡，就直接全部歸屬另一人。

簡 豐源說生存信託（living trust）就比較複雜。每人每年可以給子女或親友1萬3000元，但必須報所得稅時有紀錄才行。不要太早把錢分給子女。他舉例，某人把錢分給女兒，女兒 意外死亡變成女婿的錢，女婿再婚後又出意外，錢財落到遺孀手上，親外孫反而拿不到錢。所以他提議最好為可能喪偶的家人或小孩預先設立信託基金，多找幾位信 託人。

目前因為台大是公立大學，向學生收取學費比其他私立大學低廉很多。為確保能多發獎學金及保持世界一流教學品質，希望校友響應每人每年「百元美金，台大躍進。三千細水，台大長流」，支持台大進入世界百大，捐款贊助「台大永續基金」。

另外為了加強學校與畢業校友之間的連絡，方便校友共享學校資源，台大歡迎辦理台大校友證，憑證可享受各種優惠。詳情可上網查詢 http://www.ntu.edu.tw。（張瓊月)

Fredericksburg, VA was a slaughter-pen today (Dec. 13) in 1862

Lincoln in 1862

Union army suffered a major defeat in Fredericksburg, VA (George Washington’s boyhood home) today, December 13, 1862.  Union casualties were 12,650 and Confederate losses 5,300.  Watching the carnage, Robert Lee said, “it is well that war is so terrible, or we should grow too fond of it.”  Andrew Curtin, Pennsylvania Governor, returned from Fredericksburg battlefield and visited Lincoln around midnight.  Lincoln asked, “Well, Governor, so you have been down to the battlefield?”, to which the Governor responded, “Battlefield? Slaughter-pen!  It was a terrible slaughter, Mr. President”

The above is from “366 Days in Abraham Lincoln’s Presidency” by Stephen Wynalda (published in 2010).  I am reading it online free, thanks to my Amazon Prime membership through my purchase of Kindle Fire.

In Carl Sandburg’s Lincoln, we read the PA Governor said, “Mr. President, it was not a battle, it was a butchery.”

General Burnside

Lincoln’s general was Burnside (photo credit: “A. Lincoln: A Biography” by Ronald White, Jr.), who was charismatic and honest, but lacked intelligence and confidence to be a great general.  It was said he possessed “ten times as much heart as he has head.”  The political ramification following this defeat and disaster really depressed Lincoln more than any event of his life.

No wonder Linclon aged in his four-year Presidency.  This picture of Lincoln was taken by Mathew Brady in 1862 (credit to “Team of Rivals: The Political Genius of Abraham Lincoln” by Doris Kearns Goodwin).

士林夜市小吃 (Shih-Lin Night Market snacks) and tones of Chinese language

Mae Hwang sent us this YouTube of士林夜市小吃.  This may make some of you home sick.  This also reminds me of a story that happened in 1993 when Janice was sent to a summer camp at Taipei by the Overseas Chinese Affairs (僑委會).  One day she called saying she went to a Shih-Lin “Yes” market (士林夜市); it took me a long while before figuring out she was not talking about Yes or No, it is Yes (夜市, night market)—both has 4^th tone, not “Yes” that has 3^rd and 1^st tone.

 

The four pitched tones of Mandarin Chinese make the learning of it by Americans all the more difficult and confusing.  Someone told me there are nine tones or more in Taiwanese; I am not aware of it.  If one has to learn the tones of a language then that language is not his or her native tongue.

http://www.youtube.com/watch?v=5O7_0rTX-WQ&feature=youtube_gdata_player 

Yamamoto: the man behind the Pearl Harbor Attack on December 7, 1941—A date of infamy

Seventy years ago today (Dec. 7), which as FDR said, has lived in infamy.  Admiral Isoroku Yamamoto (山本 五十六) masterminded the sneaky Pearl Harbor attack.  Ironically if Yamamoto had his way, this wouldn’t have happened.  Not only was he against the Tripartite pack (Rome-Berlin-Tokyo), he was also opposed fighting with America.  Not that he was pro-America; he knew very well that Japan couldn’t win the war with America in the long run.  He said, “I shall run wild considerably for the first six months or a year but I have utterly no confidence for the second and third year.”  He was prophetically correct as the Battle of Midway (June 4-7, 1942) proved the turning point of the war in favor of America.

I always wonder what would have happened to Yamamoto on the post-war war criminal trial had he survived the war.  His aeroplane was shot down over Solomon Islands on April 18, 1943 after a Japanese message was decrypted by the American Pacific Fleet’s Radio Unit.  America couldn’t rejoice and celebrate in public, lest Japan would suspect their secret code was broken.  This is the ultimate revenge for the Pearl Harbor attack.

Yamamoto spent two years studying at Harvard (1919-1921), exactly the same time when Lin Yutang (林語堂) was at Harvard (Lin entered Harvard in 1919 and left for France then University of Leipzig in Germany in 1921, where he obtained his Ph.D.) I wonder whether Yamamoto and Lin met during their stay at Harvard.  It was said that Yamamoto read all books about modern naval warfare in Harvard libraries.  Lin Yutang also said it was at Harvard Widener Library where he “first found himself and first came alive.”  I visited Widener many times, but never had time to stay long enough to experience exhilarating feeling as Lin did. 

Let’s hope Green Bay Packers will win every battle except the last

Steelers (9-3) had an easy win against Cincinnati Bengals today, and as Observer-Reporter’s E. Dale Lolley wrote, is now a contender, not a pretender, for the playoff.  New York Giants gave Green Bay Packers a run for their money today; the successful 31 feet field goal kick with 3 seconds left for the game kept the Packers as the only NFL undefeated team (12-0).  When Green Bay Packers and Pittsburgh Steelers meet in the Super Bowl, let’s hope the Packers will be like Will Durant said of Thomas Cromwell (Henry VIII’s counselor), “won every battle except the last.” (Cromwell eventually went to the Tower of London.)

Broken Heart Syndrome: 哀慟欲絕 = 碎心症

I gave a talk in the Taiwanese Bible Study (in Pittsburgh) on Nov. 26 and Katy wrote a report sending to the World Journal (世界日報).  I’ll continue to post what I talked.  Here is the Broken Heart Syndrome.

Broken heart syndrome mimics acute myocardial infarction (heart attack); it was first reported in Japan in 1991. Over the years I had my doubt.  Patients had acute heart attack following acute emotional distress in most of the cases, such as upon hearing an unexpected death of a loved one, encountering an armed robbery or death threat, or a car accident, etc.  I thought these patients must have had significant or critical underlying coronary artery disease (CAD) before encountering these events, which just simply push him or her off the cliff.  Now I am convinced I was wrong.

 

The classic heart attack occurs following the total occlusion of a coronary artery, but the coronary arteries prove normal and patent in the coronary angiography (done thru a cardiac catheterization) The above photo was from New England Journal of Medicine (NEJM) reporting a 93-year-old lady with heart attack.  No acute emotional stress prior to the onset of heart attack.  But she had another heart attack 4 years earlier that followed a colon surgery.

It is also called Apical Ballooning Syndrome as all the cases have apical diskinesia (the apex of the heart—left ventricle—fails to contract during the systolic/contraction phase that leads to a characteristic finding seen in cardiac catheterization.  It looks like tako- (octopus) tsubo (pot), the octopus catching pot used in Japan, hence the name of Tako-tusbo cardiomyopathy.  

The left lower panel of the above photo shows the heart (left ventricle) in the diastolic/relaxing phase, and the right lower panel systolic/contracting phase.  One will see the apex of the left ventricle fails to contract (akinesia—kinesia means motion, thus akinesia means no motion, no contraction), yielding a takotsubo shape. 

The presentation of the Broken Heart Syndrome is very similar to classic acute heart attack (chest pain, shortness of breath, characteristic EKG changes, etc.), except troponin (an enzyme released from the damaged heart muscles) may be normal or only mildly elevated.  The temporary heart (left ventricle) dysfunction often improved within days and complete recovery in 6 weeks in majority of the cases, whereas the classic heart attack often leads to a more permanent damage and more lasting dysfunction.

The suspected theory is too much catecholamine (adrenaline and noradrenaline) that “stun” the heart leading to temporary heart muscle dysfunction.  The detailed mechanisms remain elusive.  This theory gives another name of this disease (Stress-induced cardiomyopathy).  

This disease has been recognized as a distinct disease entity in the States as well as in the Europe.  It must have been around for ages, it was just never recognized until 1991, thanks to the Japanese doctor, whoever (s)he is (I haven’t got time to do the search yet).  The ICD-9-CM code is 429.83.  The frequency of which is unknown, some estimate it may comprise of up to 1-2% of all heart attacks.  Theoretically it can be fatal, although the mortality is also unknown.  驚死 (scared to death) is real!  So for the sake of your heart, don’t worry, be happy. 

Broken heart has been around in literature for ages, medicine lags behind and finally catches up; medicine imitates literature/art.  柔腸寸斷 (tender bowel broken into pieces) is another Chinese literary term to describe the one stricken with extreme despair, sorrow, grief and despondency (哀慟欲絕).  I am afraid that it may be a long while for medicine to come up with a disease entity to fit “柔腸寸斷”, if it ever can be.  It may sound condescending, but it also tells the more imaginative and abstract nature of Chinese literature.  

The followings are reports of Broken Heart Syndrome from various prestigious medical journals or institutions in the US and Europe.

  

How Shakespeare (莎士比亞) wrote 秀色可餐 & 藍田種玉

In my post of “Love at first smell”, I used “so perfumèd, that the winds were lovesick with them;” to describe how Cleopatra used perfume to seduce Antony (in Shakespeare’s Antony and Cleopatra).  This is right after they met:

Upon her landing, Antony sent to her,

Invited her to Supper.  She replied

It should be better he became her Guest,

Which she entreated.  Our courteous Antony,

Whom never the word of ‘No’ Woman heard speak,

Being barbered ten times over, goes to the Feast,

And for his Ordinary pays his Heart

For what his Eyes eat only. (Cleopatra is 秀色可餐)

It basically says Antony accepted Cleopatra’s invitation as Antony never said ‘No’ to any woman.  “Being barbered ten times over” means Antony had the barber groom him excessively before meeting Cleopatra.  “For what his Eyes eat only” says Cleopatra is 秀色可餐, Antony went to the feast but ate nothing although his eyes did eat.  Antony was satiated and satisfied by looking at (eating, 可餐) the sensual beauty (秀色) of Cleopatra.

Then we read,

She made great Caesar lay his Sword to Bed;

He ploughed her (藍田種玉), and she cropped.

Before Antony came, Cleopatra has had a child (prince) with Caesar.  Plough is 耕種 or 播種, crop is 收成 or 收割, thus “He ploughed her, and she cropped” means Caesar 耕種 (藍田種玉) and Cleopatra 收割 (produced a child/prince).

 This is my way of doing comparative literature.

The Red Shoes: 引人無限遐思

My niece, WenChen posted this photo in her Facebook page, invoking many interesting comments.  One said, “那雙紅鞋引人無限遐思”; one said, “真有意思,每個人看到的都不一樣”.  I said “Mark Twain once said a literary classic is “a book which people praise and don’t read”; if this is the cover of Hans Christian Andersen’s The Red Shoes, I bet the readership will increase.”  I shared (borrowed) it in an attempt to attract the traffic to my blog.

Medicine imitates literature: Cancer by any other name would not be as terrifying

This is from a New York Times article reporting Dr. Donald Gleason (a pathologist who invented the Gleason score for prostate cancer) wants to rename prostate cancer to make it sound less terrifying.  Carcinoma (a type of cancer) in situ (早期子宮頸癌) has been renamed as cervical intraepithelial (上皮細胞) neoplasia, taking the dreaded “carcinoma” away.

The title (Cancer by any other name would not be as terrifying) of this article is obviously taken from Shakespeare’s Romeo and Juliet.  Juliet said “What’s in a name? that which we call a rose / By any other name would smell as sweet;” after she learned that Romeo belongs to Montague—a rival family that she grew up to hate.

'Tis but thy name that is my enemy;

Thou art thyself, though not a Montague.

What's Montague? it is nor hand, nor foot,

Nor arm, nor face, nor any other part

Belonging to a man. O, be some other name!

What's in a name? that which we call a rose
By any other name would smell as sweet;

So Romeo would, were he not Romeo call'd,

Retain that dear perfection which he owes

Without that title. Romeo, doff thy name,

And for that name which is no part of thee

Take all myself. 

             Romeo and Juliet  Act 2 Scene  2 

This is another example of how medical writing strives to have a literary title/headline.

Medicine imitates literature: Love at first smell (2004 Nobel Prize in Medicine)

I gave a talk in the Taiwanese Bible Study (in Pittsburgh) on Nov. 26 and Katy wrote a report sending to the World Journal (世界日報) that was published today (Dec. 1)

Life imitates art or art imitates life?  According to Oscar Wilde, it is “Life imitates art more than art imitates life”.  And I say medicine imitates literature.  “Broken heart” has been used in art/literature for ages; we sing Elvis Presley’s Heartbreak Hotel, we read Bernard Shaw’s Heartbreak House.  Medicine doesn’t want to be left behind, so we manage to come up with a Broken Heart Syndrome.

I also show a few examples of New England Journal of Medicine (NEJM) Perspectives with literary titles.

One is “Love at First Smell”, which is a Perspective in 2004 when the Nobel Prize was awarded to honor the discovery of the molecular mechanism of smell.

Love at first sight (一見鍾情)

Love at first smell (一嗅[聞]得芳心)—我用“芳心”因為芬芳有香味.  Aromatic (fragrant; sweet-smelling) leads to romantic mood.

Smell is associated with love is no less than sight is to love.  If you read how Shakespeare describes how Cleopatra presented herself to Antony, you know Antony has no choice but surrender. “so perfumèd, that
The winds were lovesick with them;”  They (the barge and all) were perfumed so heavily that they made the air seem dizzy with love.  Love at first smell, indeed.

And you wonder how Elizabeth Taylor (who played Cleopatra in the movie Cleopatra) made a fortune in her perfumes series.  Who can resist her Passion?

The barge she sat in, like a burnished throne,
Burned on the water: the poop was beaten gold;
Purple the sails, and so perfumèd, that
The winds were lovesick with them; the oars were silver,
Which to the tune of flutes kept stroke, and made
The water which they beat to follow faster,
As amorous of their strokes. For her own person,
It beggared all description: she did lie
In her pavilion, cloth-of-gold of tissue,
O’erpicturing that Venus where we see
The fancy outwork nature. On each side her
Stood pretty dimpled boys, like smiling Cupids,
With divers-coloured fans, whose wind did seem
To glow the delicate cheeks which they did cool,
And what they undid did. 

             Antony and Cleopatra,  Act 2 Scene2

I presume you do not want to read the molecular mechanism of smell, which is the editorial all about.