More pics from China

My family and our adopted kids!

The bridge in Crouching Tiger Hidden Dragon near Huangshan

Saya and Jiang Zemin, the former president of China, can you see the resemblance?

Those were BIG mushrooms!

Huangshan

Its no wonder that Chinese poets, painters and philosophers have obsessed about this place. The views were breathtaking. As we climbed and hiked along the mountains, we saw cliffs and trees amidst the clouds. Each mountain took on a different quality depending on your viewing angle, the temperature and humidity level, the light. Unfortunately, it rained while we were there and on the last day, it was like walking inside a cloud with rain beating down constantly.

I highly recommend checking the weather before making this trip.

Sakura and Saya

Nice eh? This is taken at Zenkoji in Nagano. I went with Saya to her Rotary interview in Nagano and we hung out afterwards (notice she is a little better dressed than I am). Besides the temple, had some really good ice cream and snacks, ate some udon at the train station and even brought home some curry. I might have just figured out why I am getting fat.

and yes, I also have helmet hair . . .

Who is Dabao?

I was born in New York, the son of Shanghainese/Taiwanese immigrants to the US. I grew up in a middle class neighborhood in Arcadia, CA and attended public school until the age of 12 when my family and I moved to Taipei, Taiwan where I attended middle and high school. I moved back to the US for college and went on to study Literature and Economics. After college graduation, I started an internet education company and moved to Japan. After that bubble burst, I moved to the SF Bay area, worked as a venture capitalist investing in biotech and IT companies. I left SF to attend medical school in New Hampshire where I completed an MD/MBA. I will be returning to SF after a detour in Honolulu, HI, Baltimore, MD, and Portland, OR. In 2011 I met the woman of my dreams to whom I am happily married.

Among my favorite things to do are traveling, learning new languages and EATING.

So sit back, kick your feet up and enjoy my blog!

Return of Cold-war Geopolitics?

Saya has been pretty spooked about taking a trip to Shanghai with me lately. Because of her worries, the anti-Japan, anti-Chinese sentiment on both sides, I would like to try to make sense of what is happening geopolitically.

There are several players involved here. Japan, China, North Korea, Taiwan and of course the United States. Lets start with the root of all of this – money.

As a little background, The US is still kicking itself for backing the wrong horse. If only Chiang Kai Shek hadn`t been such an ego-maniacal asshole and not lost the war in 1949 to the communists, everything would be all gravy. The red-white-blue KMT flag would be flying over Beijing, the Chinese blue army would be flying F16s and the suits at the Pentagon would be high-fiving each other as new purchase orders for engines, naval systems, avionics, radars, sonars and command and control systems came in from their new and getting richer ally in the east.

Instead, Mao and the CCP won the civil war in China and now the US sells arms to a the Taiwan military to the tune of $15 billion a year, a number that is starting to look less attractive compared to China`s $51 billion annual defense budget (as a reference the US itself spent $420 billion on arms in 2003). The China market has been dominated by Russian and increasingly European technology which is naturally very different from the infrastructure (training, communication systems) that the US military systems run on. The additional political and economic capital that would be required to sell arms to China does not justify switching at the moment　(a small piece of a $50 billion dollar pie is not as attractive having the whole $15 billion pie in Taiwan to yourself). Hence the status quo. The US sells arms to Taiwan but poo-poo`s the Euros and Russians who sell to the Chinese. In the meantime, the US is trying to use its political influence in Taiwan and Japan to further its influence in the region.

America is dangling the idea of a permanent seat on the UN security council to Japan for a couple of reasons 1) The US wants to buy Japan`s allegiance and use it as a bulwark against growing Chinese influence in the region 2) The US doesn`t really care as much these days about sharing its sovereignty in multi-lateral forums like the UN anyway – as Bush repeatedly shows us, the US can act with or without the consent of everyone else on the planet

The Chinese see through this and are letting its people rough up some Japanese businesspeople and students to the extent that it does not harm its economic interests (ie limit the protests to small businesses like restaurants). Meanwhile, I`ll bet the security around those spanking new Toyota factories in Tianjin is very tight (Toyota announced a half billion investment in China in 2004).

Meanwhile, the war on terrorism is starting to shift its focus from Iraq to soon-to-be nuclear rogues Iran and North Korea. Here the Chinese have, or so the Americans think, the upper hand because North Korea won`t bite the hand that feeds it (ie their nukes are not aimed at China). The US wants China to help in the multi-lateral talks to stop the North Korean nuclear program. China is trying to leverage this position to gain concessions from the US regarding Taiwan. For instance, we did not really hear much official US response regarding last month`s declaration of the anti-secession law in China (despite massive protests in Taiwan). Despite all this, it is probably not realistic that a simple exchange (China stabilizes North Korea, US allows Taiwan to be taken) will happen in the near term. The status quo will be that China pretends to help the US in getting North Korea to talk while it waits for the opportune moment take Taiwan with the least political and economic cost. In the meantime, China probably doesn`t mind if a few terrorists get their hands on some North Korean nukes and make an attempt on a major US city. If anything, this will make the US more desperate for Chinese help in North Korea.

There is a good article by Columbia professor on China and North Korea
http://www.asianresearch.org/articles/2404.html

Meanwhile, China still wants Taiwan because the current CCP leadership has staked its legitimacy on taking back Taiwan (something Mao could never achieve but longed for until his last days) and because not doing so (ie allowing Taiwanese independence to happen) would not only go against 50 years of brainwashing the Chinese people, but would cause instability in other border regions Xinjiang, Tibet. China currently enjoys huge direct investments from Taiwan whose competitive advantage in electronics manufacturing is being coopted by the Chinese (a recent Economist studies shows that economically 68% of Chinese and Taiwanese exports overlap). With a million or so Taiwanese making money in China, an increasingly reluctant and distracted US, it is becoming a near political impossiblity for Chen Shui Bian to declare independence and risk war.

In this entire picture, the biggest loser will be Taiwan whose existence is currently on the chopping block. While China`s influence continues to expand economically and politically, Taiwan`s bargaining position shrinks. The tipping point in this equation will really be when the US can no longer afford NOT to sell arms to China and decides to trade in Taiwan for whatever concessions it can get from China. Hopefully, my family will be living in Shanghai by then.

Health care in America

Read today`s piece by Paul Krugman in the NYTimes called The Best Places to Get Sick which is a commentary on rising US health care costs. He analyzes the so-called privatized healthcare system in the US which he argues is increasingly expensive relative to other rich country`s health systems while not yielding desirable results in health indicators like overall life expectancy and infant mortality. He cites some interesting stats:

In 2002, the United States spent $5,267 on health care for each
person ($2,364 – 45% by the government on Medicare and Medicaid) while Canada spent $2,931 per person ($2,048 from the government) and France spent $2,736 per person ($2,080 was government spending).

His main argument is that Americans spend more on healthcare than their counterparts but do not receive more care. He attributes this difference to higher doctor`s wages, American health care system overpays for the same drugs, and too much is wasted in admin costs (31 cents per dollar compared to 17 cents in canada).

Not bad but I wish he went more in depth about things like legal system and practice (we are much more litigous in this country than France or Canada) which contributes to admin costs (ie HIPA), or compares the health care quality of the top 10% of income earners (more and better tertiary care in the US) and also that American consumers subsidize research and development cost of new drugs for the world while french and canadian consumers have the benefit of buying the cheap generics that are made possible by the American pharmaceutical market. And what about consumption? Doesn`t the average american lead a much unhealthier lifestyle than their counterparts (longer working hours, more stationary, higher caloric intake, less fiber, etc etc)

I can`t say I am a big fan of the increase in doctors salaries (driven by the increase in salaries of specialists that are getting paid more for treating a smaller and more focused patient base than before while primary docs salaries have stayed relatively constant) but I do believe there are other factors at work which complicate the problem. The solution may be a combination of many behavioural changes over a long period of time: work-life balance, diet, exercise, doctors that value what they do rather than how much they are paid.

The only problem with such a long term solution is that the American consumer increasingly values short term solutions. We think that with all the breakthroughs in medical science, there are (or will soon be) fast acting magic pills that will fix all our problems and allow us to get back to running the rat race ASAP.

Even so, how does one ultimately counteract capitalism which incentivizes doctors to specialize and make more money, consumers to extract more and more services they don`t need from insurers, and already unhealthy people to eat, drink and smoke more?

Pain Management

ROAD to life
(Radiology, Opthamology, Anesthesia, Dermatology)

I shadowed an attending at the UCSF pain management center today. Learned several useful things. First, that personality match really determines what kind of residency a person ends up in. In addition, a balance of what kind of impact you want with the economics of how to make enough money to support a family seems to play heavily into this (I guess considerations when you are in your 30s with a family is very different from the 20s). And specialties like Dermatology are not just important for their money making potential and lifestyle but also seem to offer a wide range of options for practice anywhere from myeloma to private cosmetics clinic.

Research is important in getting into such competitive residencies because most people want folks that will advance the field. Note to self: shadow and participate in research early in med school so I can know if I want or don’t want to go into these fields early on.

In addition, I was not that happy about a few things I saw today in the treatment of patients. First of all, an outpatient clinic may be a great place for seeing VIPs (CEOs, presidents of companies and institutions, professors, etc) but the doctor I worked with didn’t seem to like poor people much and used words like “crazy”, “draining”, “waste of time” when it came to describing the Medi-Cal patients she HAD to see. I also did not like the general trend of very specialized tertiary care in which you really stick to what you know and although you “Communicate” with psychiatrists, neurologists, etc you don’t really know enough to form a unifying diagnosis about the underlying cause of some pain and can only treat the symptoms. Seeing the patients also allowed me to better understand some of the problems of western medicine. For instance, many chronic pain patients will live with pain the rest of their lives and the drugs can only help control and “manage” the pain, not cure it. Meanwhile, many do not respond to certain drugs, most have to take a combined regimen and will experience varying degrees of side effects. Dosing is very much an idiosyncratic art form (based on experience and trial and error) rather than a science since it varies patient to patient.

Also the very existence and marketing of “miracle” drugs creates a dependence mentality whereby some “treatment or diagnosis seekers” just go around trying everything because they think there MUST be ONE single scientific diagnosis or magic pill they can take to make the pain all go away.

Some excellent independent artists in SF, SD

http://gohnakamura.com/
– My friend Aya’s bro

http://www.jturtlemusic.com/

memorias de viaje

Its so easy to get caught up in the “doing” that we forget sometimes about just “being”. Tonight I watched a couple of guys in their element, playing music simply because they love it. There is something special about that.

As I was driving home, I thought of a moment from my own life where I felt a brief respite from DOING and just WAS.

I was in Ecuador, on a bus with some friends bound for Banos (a little town in La Sierra where tourists go to take mineral baths, drink and dance). We were excited, it was our first weekend in Ecuador and everyone felt adventurous. Upon leaving the bus station in Quito, the bus made several stops to fill up with passengers. By the time we left the city limits, people were standing in the aisles. About halfway to our destination, we picked up an old indigena couple. They silently made their way to the back of the bus and not having anywhere to stand, the two of them squeezed into a small luggage compartment at the very back of the bus, adjacent to where I was sitting.

I had brought my dinner onboard, a chicken sandwich from KFC of all places. The meal cost about $1.50. A few minutes after the couple situated themselves next to me, I felt a pang of hunger and took out my sandwich to eat it. As I was about to take the first bite, I saw out of the corner of my eye the old indigena looking at the sandwich. I turned towards her and asked her if she was hungry. She nodded without speaking. I asked if she wanted half of my sandwich. Another nod. Without hesitation, I tore my sandwich in two and gave the larger half to her. She then split her half with her husband (pressed in the corner next to her). I ate slowly, taking notice of how quickly the indigenas wolfed down what little I had to offer. They really were hungry.

About an hour later (some rural area north of Banos), the indigenas got up to leave. As they began making their way forward, the old woman put her hand on my shoulder and smiled at me.

I felt . . . I WAS great.

Happy Bday to Me!