The front page news of The Straits Times of Singapore (28/06/2008) was about two Indonesian men arrested for offering their kidneys in exchange for money in a private hospital. In both cases, the man pretended to be a relative of the recipient and offered to ‘donate’ it to a loved one. When the donor returns home, an agreed sum of money is deposited into the bank account. The first man ‘donated’ his kidney in return for S$29,390. The second man was to get S$20,000 but the operation was stopped by the Ministry of Health one day before it was due. Both cases were reviewed by the ethics committee of the private hospital and were cleared to proceed. In the second case, the alleged relationship was that the donor’s aunt was married to the recipient’s niece’s brother-in-law. Were these the first 2 cases of organ trading in Singapore? I do not know. Is organ trading only limited to Singapore? Definitely not.

It can be difficult to make a decision on whether an organ donor is truly related to a recipient based on testimonies only. Precisely for this reason, in the United Kingdom as part of the workup, all living related transplantation cannot go ahead unless both donor and recipient have had a genetic test in UK to prove their relationship. This is an objective test and unlike an interview, cannot be ‘coached’. Having a genetic test to establish kinship before allowing an organ transplant operation to go ahead will certainly help to reduce the number of organ ‘donation’ for money.

The issue of organ trading has plagued the medical community for many years. Society has a responsibility to protect the weak and poor from exploitation. As doctors we too have a responsibility to protect the potential donor from exploitation. We have to be convinced ourselves that the donor is genuinely giving his organ out of love and not out of monetary consideration. If we are not convinced, we must desist from being involved. That is our job too.

The organs in our body do not normally fail for no reasons. In the case of diabetic kidney failure we know that diabetic patients who have poor glucose control will have a much higher risk of developing kidney failure. Therefore it is important that diabetic patients are taught to strive for near perfect sugar control. By having long-term tight glucose control, this will either prevent a patient from developing or delay the onset of kidney failure. Remember, prevention is better than cure.

Breast cancer is the most common cancer in women. While there are specific genes for breast cancer, the majority of women who developed breast cancer do not have a family history of breast cancer or have inherited the genes for breast cancer – BRCA1 and BRCA2. One of the methods used to detect breast cancer is to perform a mammogram. Mammographic examination is part of the breast cancer screening process. Should mammogram be done yearly or should it be every two or three years? That depends on which country you are in and what your doctor’s preference would be. In USA it is yearly. In United Kingdom it is 3 yearly. One would have thought yearly mammogram would detect the cancer earlier and thus lead to better survival, right?

In the 6th European Breast Cancer Conference recently held in Berlin, UK researchers presented the data from the UK breast cancer screening programme set up in 1988. This programme screened women with a mammogram every 3 years from the age of 50 to 65. Between 1989 and 1996, about 100,000 women enrolled in the UK Breast Cancer Screening Frequency trial. The women were randomized into a control group (n = 50,162 women) and a study group (n = 49,173 women). In the control group women had one incidence screen at three-yearly intervals after the initial prevalence screen. The study group received an interval screen every year after the prevalence screen. After an average follow-up period of 13 years, there were 373 deaths in the study group and 374 deaths in the control group. There was no statistical difference in the number of breast cancer deaths between the 2 groups. Putting it in another way, there were approximately 1.4 deaths per 1000 women in the control group who attended the 3-yearly screen versus 1.3 deaths per 1000 in the study group (yearly screen). This study showed that there was statistically insignificant reduction in the relative risk of dying from breast cancer by performing yearly mammogram.

Despite the findings of this study, the controversy between yearly and 3 yearly mammographic examination for women will continue. No doubt there will be critics for the yearly approach and there will be ardent supporters of the 3 yearly programme. What is of crucial importance is that women must realize that they themselves play a significant part in the whole breast screening process. Reliance on the yearly mammogram alone is insufficient. There is a need for each woman to faithfully perform a self breast examination every month. It does not matter when each month – at the beginning of the period, 5 days after the end of the period or mid-way through the cycle - as long as it is at the same time of the month.

Self breast examination is simple and takes a moment of your time each month. Remember to do it or you might regret it.

I am sure you have come across friends who take glucosamine for arthritis or as a supplement to prevent the onset of arthritis affecting the knees or hips. The commonly sold forms of glucosamine are glucosamine sulphate or glucosamine hydrochloride. It is commonly sold in combination with chondroitin sulphate and methylsulfonylmethane as a supplement for treating arthritis.

Glucosamine exist normally in the body as D-glucosamine. It is made naturally in the form of glucosamine-6-phosphate. Glucosamine-6-phosphate is made from fructose-6-phosphate and glutamine as the first step of the hexosamine biosynthesis pathway. The end-product of this pathway is UDP-N-acetylglucosamine (UDP-GlcNAc). UDP-GlcNAc is then used to make glycosaminoglycans, proteoglycans and glycolipids. Glycosaminoglycans are a major component of joint cartilage and glucosamine is a precursor for glycosaminoglycans; hence, the logic behind taking glucosamine as a supplement for treating or warding off arthritis.

Researchers from Erasmus Medical Center in Rotterdam carried out a randomized study to assess whether glucosamine sulphate has an effect on the symptoms and structural progression of hip osteoarthritis (Ann Intern Med 2008; 148: 268 – 277). Two hundred and twenty two patients with hip osteoarthritis were treated with either 1500 mg of oral glucosamine sulphate or placebo (a pill that looked and tasted like the glucosamine pill) daily for two years. Outcome measures were Western Ontario and McMaster Universities (WOMAC) pain and function subscales and joint space narrowing over 24 months. After 24 months, there was no difference in terms of pain, ability to do normal activities and joint space narrowing between those who received glucosamine sulphate and those who had placebo.

In USA glucosamine is classified as a health supplement. Therefore, it does not require FDA approval and a prescription is not required. In Europe, glucosamine is listed as a drug and thus it is prescribed. At the prescribed dosage, glucosamine has a good safety profile. Despite the findings of the above study, the jury is still out on whether glucosamine is beneficial or not. Under such circumstances, it is the subjective feeling of the individual that will determine his / her habit of consuming glucosamine or not. If one feels better after taking glucosamine then one will continue. If it does not seem to make a difference, one will stop. In these situations, study outcomes do not mean much to the lay public. This is alright as long as the product has a good safety profile and does not cause harm to the consumers.