Head in the game: While players get treatment for injuries, there has been little or no protection against brain damage

The thrills and spills, rough and tumble of elite competitive sports are all part of the attraction for those who pursue them professionally, as well as for spectators who cheer on from the sidelines or the couch. But what is becoming increasingly clear is that the very competitive nature of high-level contact sports can exact a severe price on players through the onset of debilitating brain damage.

This health issue, which is now more widely recognised, has hit home particularly in the likes of football, rugby, American football, ice hockey, boxing and wrestling, where repeated blows to the head and concussions may occur. Constant, crunching tackles are also a concern due to the whiplash-like effect of this impact reverberating through the body to the head. Many parents are discouraging their offspring from participating in sports where head injuries are likely.

Injury blows

Respected BBC rugby commentator Chris Jones has suggested that this effect on brain health is an existential crisis for his sport. More than 300 retired rugby union players in England and Wales are pursuing legal proceedings over brain damage they say was sustained during their years in the game. They accuse the rugby authorities of being negligent and failing to protect them from permanent injury.

The number of claimants has risen rapidly since England World Cup winner Steve Thompson and other former players initiated the lawsuit in December 2020. They say part of their motivation in taking legal action is to save the game for future generations by securing new protective measures.

Failures levelled at rugby union’s world and national governing bodies include taking inadequate steps to inform, educate or warn players about the risks of permanent brain damage; conducting insufficient research into the effects of multiple concussive and subconcussive impacts on the brain and the prevention of permanent brain injury; and not reducing the amount of contact allowed in training or the number of matches per season.

Brain damage hits

This ongoing litigation in the UK has been compared with a successful American football class-action lawsuit brought against the National Football League (NFL). In this case, more than 4,500 former players and their families sued the NFL for misleading them over the long-term dangers of concussions and head injuries. It ended in a 2013 settlement worth about US$765 million (HK$5.9 billion).

This lawsuit highlighted the prevalence in American football of chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by repeated blows to the head. Brain-related injury had been detected in boxers as early as 1928 when US doctor Harrison Martland linked signs of being ‘punch drunk’ – mild mental confusion and a staggering gait – with serial head punches. The condition was given the name dementia pugilistica.

More than 75 years later, in 2005, NFL hero Mike Webster became the first in his sport to be diagnosed with CTE; after retiring from the game, he suffered from dementia, cognitive impairment and mood changes, and brain damage was identified following his sudden death.

Post-mortem revelations

Sadly, a number of American footballers have committed suicide in recent years, most likely triggered by the neurological effects of playing their sport. One of them, Dave Duerson, who took his own life in 2011, had asked for his brain to be donated to the Boston University School of Medicine; subsequent tests found CTE. The autopsy of Australian Rules footballer Heather Anderson, who struggled with depression and killed herself in 2022, also detected this incurable disease of the brain.

England’s Thompson, who suffers from early onset dementia, has talked of being put on suicide watch as a result of his illness – as have other former rugby players involved in the ongoing legal action.

Carrying on with concussion

Ex-Wales international Alix Popham, who was diagnosed with probable CTE and early onset dementia in 2020 at the age of 40, shares in a BBC podcast some of his experiences of playing professional rugby and the lack of concern at the time about head injuries.

“Concussion was a bit of a joke; if somebody got knocked out or had ‘Bambi legs’ … players would have a laugh,” he says, explaining that teammates did not want to show any sign of weakness. “You were expected to chuck some water in your face and sniff some salts and just carry on. That was the way we did it.”

Popham believes most of his brain damage was inflicted during training because of the amount and length of contact required. He says these sessions might last as long as two hours and physios or doctors were not in attendance.

“My neurologists described subconcussive hits like a dripping tap on a piece of mud. [If it drips] once or twice, there will be no mark at the end of the day. But if it dripped for 14 years, there will be a big hole, and that is what is happening with every hit that a player is taking, not just to the head but to the body as well.”

Popham adds that some current players he has spoken to remain hesitant to quit the sport despite being advised that brain scans they have had are not “great”. It was perhaps this lack of clarity surrounding the issue that prompted him – along with his wife, Melanie Bramwell-Popham, and Sally Tucker, an NHS surgeon with a special interest in medical ethics and law – to set up Head for Change. Dedicated to pioneering positive change for brain health in sport, the charitable foundation provides a supportive space for sportspeople with neurodegenerative disease.

Heading for disaster

These laudable goals cannot come a moment too soon. Tucker’s father is a former professional footballer who has been diagnosed with dementia, probably caused by repetitive head injury from heading the ball during his career. Research published in 2019 found that footballers were three and a half times more likely than the general population to die from a neurodegenerative disease.

Just last month two former Premier League football players shared their health concerns after years of heading a ball for a living. Former England defender Gary Pallister talked of how sickening migraines would blur his vision, affect his speech and leave him unable to train for two days. Along with many ex-players, he harbours fears for his future wellbeing.

As for Pallister’s ex-England colleague Steve Howey – who at 53 sometimes struggles to express himself and suffers from short-term memory loss – scans have revealed that his brain is in cognitive decline. The British charity Head Safe Football is campaigning for heading to be declared a national health issue, and the harmful skill is now being phased out at grassroots youth level.

Howey is one of a number of ex-professional players in England who are taking legal action against football’s governing bodies. The group includes the family of former 1966 World Cup winner Nobby Stiles, who had advanced dementia in later life; he was diagnosed with CTE after his death in 2020.

More severe for women?

Sportswomen are feared to be at greater risk from concussion than their male counterparts. Research conducted by SidelinesDr in Australia and others suggest that women are not only more likely to sustain concussion in any given sport, but their symptoms tend to be more severe and their recovery time longer. Some medics have speculated that this is down to weaker neck muscles.

Other research in Australia found that 79 percent of jockeys have had at least one concussion during their horseracing career, and a quarter have suffered four or more.

Last year, World Rugby launched a call for applications to fund player welfare research projects into concussion, injury surveillance and prevention at all levels of the game. It also established a steering group to examine player welfare in the women’s sport. 

Technology is playing a part to help limit head injuries. For instance, researchers at the University of Wisconsin-Madison in the US are working on a new protective foam that could revolutionise helmets in contact sports. Many sports governing bodies are also finally supplying guidelines, education and awareness about the long-term hazards of concussion and repeated blows to the head.

Medical Code: Enabling early diagnosis and cutting costs, AI technology is seen as a saviour in healthcare

The transformative effects of machine learning and the onset of AI in healthcare systems around the world have huge implications for the improvement of our wellbeing. From better and faster diagnosis to understanding and managing symptoms to drug development, as well as the more efficient management of the systems themselves, the potential is almost endless.

AI has already woven itself into our lives through recommendations on social media as to what content we should click on and which adverts we see. AI systems utilise a user’s profile and demographic to make these decisions. Now, as its tools become increasingly applied to support healthcare, it may offer humanity more meaningful and lasting benefits.

Predictive power

Artificial Intelligence is a statistical software using algorithms that can find patterns in large amounts of data, whether words, images, video, audio, code, or even DNA, and then make predictions based upon these. This is different from the early days of computers, which were essentially based on a list of instructions similar to how calculators operate. Modern AI or machine-learning systems – ML being a subset of AI – predict what is the most likely outcome for something. As such, there is no definitive answer, but the technology considers what should come next based upon what it has seen in the past.

This formula is the building block for ChatGPT, which has the ability to find relationships between different words to predict which one should come next in a sentence, and ultimately compose advanced academic reports. The implication of this skill in making sense of big data from disparate sources is now becoming increasingly apparent in the provision of healthcare as medical research increasingly moves from code to clinic.

Success in sight

In ophthalmology, for example, AI is being used to prevent blindness. Pearse Keane, a Consultant Ophthalmologist at Moorfields Eye Hospital in the UK who specialises in the treatment of retinal disease and age-related macular degeneration, first considered the potential of artificial intelligence because patients were experiencing delays in getting an appointment with a doctor. Some, in critical cases, went blind as a result. He thought applying an AI system to data gleaned from retinal scans would help identify those whose sight was most under threat and enable them to receive attention within a few days rather than weeks or months.

He approached the co-founders of AI research laboratory DeepMind. “I told them we were doing 1,000 retinal scans per day at Moorfields and can we work together to develop an AI system to prevent blindness,” he relates in a BBC podcast. “The rest is history.”

Researchers at Moorfields shared about one million anonymised, historical scans with DeepMind and, essentially, trained AI algorithms to recognise eye disease. The performance of this powerful AI technology was “on par with world-leading experts from Moorfields for more than 50 different retinal diseases,” says Keane.

Window to the body

Interestingly, the retinal scans are also being considered for a new field called oculomics. The idea of using the eye as a window to the rest of the body to detect health conditions has been postulated for over a century. However, the ability to crunch and analyse vast amounts of data at speed has spawned a potential breakthrough. Keane enthuses: “What has been really exciting in the last four or five years is this idea that if you combine advanced retinal imaging with big data, with the latest advances in AI, it turns out that you can actually potentially predict Parkinson’s disease or dementia, or predict the risk of heart attack or stroke.”

Although Keane is hopeful this technology will be widely available on an open-source basis within two or three years, he cautions: “But the caveat to that is we are still at the proof of concept; we are still pushing research-paper stage.”

Cancer detection tools

The life-saving potential of software trained to analyse millions and millions of scans was recently highlighted by an AI system called Mia used by the NHS in Scotland to detect signs of breast cancer that may be indiscernible to the human eye. Mia analysed the mammograms of more than 10,000 women and was able to flag all those with cancer, as well as an extra 11 the doctors did not identify. This ability to detect cancer at a much earlier stage could make the difference between survival and a potential early death, given that tumours can grow and spread very quickly.

Here in Hong Kong, researchers at the Hong Kong University of Science and Technology (HKUST) recently developed AI-based tools to detect 30 types of cancers and diseases. The university has developed four models which they believe are poised to transform the medical and healthcare fields, surpassing existing models due to their foundation on extensive data sets and novel machine-training strategies. Their breast-cancer diagnostic tool is said to achieve accuracy levels comparable to radiologists with five or more years of experience.

Another tool is poised to act like a “medical GPT”, with the ability to answer questions, generate medical reports, and provide initial diagnoses based on medical images. A further tool called XAIM (Explainable AI) is designed to enhance healthcare professionals’ confidence in adopting AI by explaining how medical AI models reach their decisions. Researchers at the university suggest that while many AI models offer high accuracy, they often lack transparency, and this leads to scepticism about their adoption.

“XAIM addresses this by providing visual and textual explanations of the models,” says a spokesperson for HKUST, which has previously developed an AI model predicting the prognosis of brain-tumour patients and a highly accurate blood test for early detection of Alzheimer’s disease.

Big data doubts

For sceptics, one of the issues with using AI in healthcare is that it relies on a vast data set and its output will necessarily reflect that data set and also any errors or specific biases it contains. For instance, marginalised populations who do not access healthcare will not be reflected in the data and the results will not therefore serve the population as a whole. Another concern is that models are perceived as having a “non-deterministic” nature, meaning they will not always respond in the same way and make the same predictions to the same stimuli. Privacy of personal data has also been flagged as an issue.

There is also the question of accountability. For instance, if an AI model is used to determine which patient receives a heart transplant and which does not, then who would be accountable if that judgment is subsequently proved to be wrong?

Dr Jessica Morley, a Postdoctoral Researcher at Yale University’s Digital Ethics Centre, believes current AI modelling lacks transparency, especially given the complexity of its development. She tells the BBC podcast this is the crux of the AI conundrum: “If we have come to the point where something the algorithm is making a “wrong” decision – where did the wrongness start? Is it who collected the data? Is it who curated it? So how did you decide what was cleaned and what was not? Is it who designed the model or who evaluated the model? Is it who interpreted the model?”

AI concerns and hopes

These sorts of ethical considerations are behind recent calls in Hong Kong for guardrails and protection to be put in place before the widespread rollout of AI in healthcare and other sectors, such as finance.

However, many in healthcare have high hopes that AI can also reap efficiency savings and increase productivity. Tools such as AI-backed voice transcriptions, for instance, could save a huge amount of time and cost for a health system. In 2022, a McKinsey report suggested using AI to predict diagnostics outcomes and support clinical decisions could create US$5 billion in economic value in China. Many poorer nations across Africa could also derive immense benefits from AI in healthcare.

Days in the dark: For migraine sufferers, recent drug research could afford bearable light at the end of the tunnel

Migraine is ranked by the World Health Organization (WHO) as the seventh most disabling disease and the leading cause of disability among all neurological disorders.

Such is the severity of migraine in its harshest manifestation that the august body considers it to be as debilitating as quadriplegia, according to Dr Mark Weatherall, Consultant Neurologist at the Buckinghamshire Healthcare NHS Trust in the UK.

“Now that sounds ridiculous on one level, but it is not really,” he says in a BBC podcast. “Because if you think about someone in the throes of a severe migraine attack, they are bedbound, they are vomiting, they can’t move, they can’t bear the light, they can’t bear the noise. They cannot do anything.”

Widespread suffering

Up to one billion people in the world are believed to suffer from migraine. The onset and causes of the disorder are thought to vary from person to person and the symptoms, likewise, differ considerably. A migraine may last for just a few minutes or as long as a few days, though several hours is often cited as common. Major symptoms include a throbbing head, nausea, dizziness and disturbed vision, yet any of the human senses can be affected, from phantom smells to tingling skin.

Though conceding it is not a permanent disability, the headache specialist notes that the lives of people who have migraine daily or almost every day will be severely impacted. Carrying out normal routine activities or holding down a job may not be possible. Ultimately, acute migraine can wreck lives. Some sufferers have said they become emotionally withdrawn from family and friends.

Until relatively recently, the condition has been little understood. It was not widely studied in the medical community, resulting in misdiagnosis. For instance, those struggling to find the right words for things during a migraine attack have been rushed to hospital with doctors suspecting stroke or a brain tumour.

Hallucinatory hell

Visual disturbance comes under a range of symptoms called the migraine aura, which occurs in about 20-30% of sufferers. Relating to the focal area of dysfunction in the brain, auras can be flashing lights, wavy lines or a much more complex hallucinatory experience. The latter can be terrifying for the migraineur in the first unknowing instances – that is, before the extent and intensity of the sensations have been fully explained to the sufferer.

During an aura, some people feel an overwhelming sense of fatigue and have reported seeing hexagonal shapes as if they were looking through the eye of a fly. A simpler visual disturbance is photopsia, which consists of circles, triangles, squares and other geometric patterns, usually white or multicoloured.

Although these can be seen in any part of the migraineur’s visual field, it is actually a trick of the perceptual imagination; the patterns and shapes are not there in reality. Their occurrence is most likely unrelated to the eye itself and caused by irritation of the vision centre of the brain. More complex and symmetrical patterns can sometimes be seen, and even the blind have been known to experience this disturbing phenomenon.

Distorted perception

Some disturbances are so bizarre that patients delay seeing a doctor for fear of being thought mentally ill. Objects can appear distorted and contorted in some types of visual aura, as if being visualised through a funhouse mirror; body proportions seem out of shape, necks become larger and legs look abnormally small. This is aptly called Alice in Wonderland syndrome since author Lewis Carroll was afflicted by migraine and used his bizarre hallucinatory attacks as inspiration to create Alice and her magical world.

Changes in distance perceptions are also a feature of visual aura – how close or far away objects seem to the beholder could be totally unrelated to reality.

Distortions of sensation or movement are characteristics of classic aura. Tingles or numbness on one side of the face and in the hands and arms can become alarming very quickly. Weakness and clumsiness can occur, while dizziness or abnormal sensations of motion or auditory misperceptions such as a ringing or crackling noise in the ears have been reported. For some sufferers, irritation in the part of the brain that handles memory also results in amnesia.

Pulsating headaches

Migraine headaches are divided into two subtypes – classic migraine which has the aforementioned aura, and common migraine which appears with no aura. They usually affect the frontal forehead region as well as the eyes – an initial pressing, gripping pain that later progresses to a throbbing, banging, pounding headache.

While headaches can be absent altogether (silent migraine), in some cases they are agonisingly painful, affecting the person’s entire skull; their ferocious intensity can entice suicidal thoughts. The scalp can become very tender during a severe migraine attack and sneezing, coughing and vomiting can become extremely painful.

People with a prolonged history of migraine headaches should seek professional support if their headaches do not fit a recognisable pattern, or when abnormal physical symptoms are apparent.

Triggers of attack

The exact cause of migraine is not clear, although spinal disorders, hormonal fluctuations, stress, fatigue, sleepless nights, certain odours, allergic reactions, glaring sunlight, diet, caffeine, exercise, levels of hydration, cigarette smoke and smoking itself have all been cited as contributory factors. Some people have even reported experiencing migraine headaches during sexual activity, especially at the moment of orgasm. For others, barometric pressure or altitude changes are believed to have triggered attacks. Avoidance of triggers may help, but attacks will usually still occur.

Constriction of blood vessels was once theorised as a cause, but it is now thought that nerves in the body drive migraines. Weatherall notes that normal processes in the body dealing with sensory input go awry during a migraine attack. “You start to get signals sent out to the blood vessels around the head and the neck, and various neurochemicals are released. The lynchpin molecule, calcitonin gene-related peptide, is picked up by receptors around the blood vessels, which starts to generate pain. As that process continues, other networks start to become engaged that may make us feel nauseous or sensitive to light or noise,” he explains.

Effective drugs

Medical research conducted into ways to block or ease the transmission of overactive pain nerves has highlighted a relationship between serotonin, a chemical messenger in the brain, and migraine. The triptan family of drugs has demonstrated efficacy in halting migraine attacks by affecting serotonin receptors. These drugs are often prescribed to patients when other preventative medications, such as painkillers or beta blockers, fail to provide relief. By imitating the actions of serotonin, these drugs ease overactive pain nerves

A major new study led by the University of Oxford and involving more than 89,000 people has found that triptans are the most effective medicine for adults experiencing acute migraine. It compared the effectiveness of 17 different oral medications often used to treat the condition. The results were published in The British Medical Journal this summer.

Fit for Purpose? Physical’s sudden demise spotlights a saturated gym sector in need of a work-over

The collapse of Physical Fitness, one of the stalwarts of Hong Kong’s gym industry, was a shock to many of its loyal customers and those unfamiliar with the dynamics of the industry. It has left some wondering whether there are simply too many gyms in Hong Kong and if they provide value for money.

Physical, which had operated in Hong Kong for 38 years and once boasted 23 branches, ceased trading this September after the Mandatory Provident Fund Schemes Authority demanded it settle unpaid contributions to more than 700 employees amounting to millions of dollars. The decision by the gym chain owners to close shop left staff jobless and triggered thousands of complaints to the Consumer Council over loss of membership fees. Some customers were on decade-long membership packages. There were also reports of lengthy packages sold just prior to its closure.

Given the recent upsurge in investment in the sector, Physical’s failure did not come as a shock to many gym insiders. “I can’t say that Physical going under felt like a massive surprise,” says Ed Haynes, founder and CEO of boutique gym Coastal Fitness, who also made reference to some of the “amazing” deals the chain offered just before its ignominious collapse, perhaps in a desperate bid to cut its losses.

Fall of the mighty

Haynes notes this is the fourth big commercial gym operation to shut down during the 16-year lifespan of Coastal Fitness – on the heels of California Fitness in 2016, Goji Fitness and the Hong Kong branches of international chain Fitness First. The latter two faltered amid the pandemic, which interrupted business and made the recruitment of new members almost impossible.

Certainly, many consumer discretionary sector businesses, including cafés, restaurants and cinemas as well as fitness centres, suffered financially during the Covid years. But the pandemic also had a benign influence on the fitness industry – people became worried about their health.

“In the minds of the Hong Kong public, the idea of health and exercise came to the forefront a lot more,” says Haynes. “In the pandemic, when everything closed and people were confined to their homes in their small and immediate environments, a lot of people actually started exercising.”

Gym crazy

Since then, he has witnessed a huge upswing in many forms of physical activity practised in the community, which in turn has prompted a proliferation of investment in the industry. “Because the fitness industry saw this big boom in exercise participation, low-cost 24-hour gyms started popping up everywhere. And I think that’s almost saturated that market,” he states.

From the less than 10 24-hour gyms believed to be operating in 2018, the number had ballooned to more than 110 by last year. Haynes believes too many gyms have opened up too quickly, causing supply to outpace demand. He also maintains that many of the newer gyms are soulless and lacking in a community feeling. “The way these gyms are set up is just you go in and do your hour; you’re isolated in many of them,” he opines.

The pandemic not only sparked an increase in physical activity but also a desire for community-based fitness where people can connect with each other, according to Haynes: “If you go out to any of the waterfronts right now, every morning, every night, they are packed with groups of people in running clubs, sweating, moving, having a good time.”

Cash flow precautions

He also outlines a key learning curve in the gym business from the pandemic years: the importance of maintaining cash flow through offering membership packages. More than two-thirds of the Coastal Fitness membership sign up for six or 12 months in advance, providing money in the bank. The pay-when-you-use model adopted by some of the newer gyms, by contrast, does not give owners this security.

Haynes has witnessed a rise since the pandemic in the purchase of long-term packages by clients willing to commit to regular exercise. He does caution against lengthy prepayment deals though; at Coastal Fitness 12 months is the maximum term offered.

The majority of his clients come through referrals or word of mouth, and they include people from all walks of life. Most use the North Point gym’s services at least three times a week, and all receive some type of coaching, whether through attending a group class led by a coach, having a personal training session, or by following a tailored fitness programme designed by a coach.

Operational stress

During the post-pandemic investment splurge in the gym business, John Bower took on the managerial responsibilities of a new fitness start-up in Hong Kong. As an entrepreneur who had created and sold a human resources business earlier in his career, he seemed an ideal fit to launch the venture. However, the market glut in gyms soon exacerbated the stresses of running a fledgling operation, and breaking even took longer than planned. Exhausted, he quit after two years and now freelances as a personal trainer and executive coach.

Bower believes the gym sector has been flooded with entrants and the next two years will favour the consumer. He says managers of gyms should be crystal clear what market they are going to dominate. “In the longer term, the harsh truth is that many gyms are on borrowed time and need to figure out their strategy – being number one in the local market and number 10 in Hong Kong might be fine,” he says.

Far happier working as a freelance coach, he often conducts sessions for clients at the city’s many boutique gyms. He loves the interpersonal interaction with clients and can advise on all aspects of life aside from physical training. “The value of personal training is that it enables the client to physically challenge themselves,” he says.

Market jitters

Some gym-goers may be tempted to turn to personal instruction rather than sign up for memberships as fears over the stability of the wider fitness sector mount. Recent disputes over unpaid rent at branches of Pure Fitness, an upmarket chain of fitness and yoga studios, caused jitters in the market, although the issues were quickly resolved.

Hong Kong-based lawyer and writer Sanjeev Aaron Williams chose not to join a well-known commercial gym after their sales pitch left him unclear about what the fees would cover. He now attends gyms run by the Leisure and Cultural Services Department. While available at a fraction of the price of many private gyms, these government fitness rooms have their drawbacks, says Williams, such as blackout periods restricting use and irregular availability of equipment.

Essential regulation

Williams sees a future for commercial gym operators, but calls for urgent government regulation. “Gyms in Hong Kong need to be regulated by legislation and monitoring. We are behind other countries in regulating consumer protection and gym operations,” he says. “Commercial gyms in Hong Kong have been the subject of failures and scams since the 1980s when the fitness trend began. We’ve gone over 40 years without regulated protection.”

He believes any legislation should cover the entire fitness sector including large commercial gyms, 24-hour gyms, personal training studios, personal trainers, pilates and yoga studios, boxing and martial arts gyms, as well as the classes offered at these venues.

The lawyer urges a limitation on the length of prepayments, saying they should not exceed more than two years, and calls for the implementation of a legal “cooling-off period [that] should be prominently advertised on the premises and to each customer”. He adds: “Consideration should be given to increasing criminal penalties for misleading advertising and sales tactics or carrying on business when [the operator] knew they couldn’t meet their debts.”

Viral Load: For millions weighed down by covid symptoms, there has been no relief

As American athlete Noah Lyles was wheeled off the track after securing bronze in the 200 metres at the Paris Olympics, the sheer exhaustion on his face said it all. Just moments later he revealed his Covid-19 diagnosis – he had kept it quiet beforehand so his competitors wouldn’t have the edge.

This is a supreme athlete who only days previously had secured a fantastic gold medal in the 100 metres. Now, though, he was light-headed, short of breath and suffering from chest pains. Covid symptoms that more than likely would last a relatively short period of time.

But what if they were to persist for months, if not years? Then Lyles would join the estimated 65 million people around the globe – including many formerly super-fit athletes – who have long covid. For these sufferers, whose symptoms can severely impact the quality of their daily life, the Covid-19 pandemic has never ended. Despite the amount of research invested in long covid, medical science appears far from finding a cure or pinpointing the cause of the debilitating condition.

Lingering symptoms

According to New Scientist, the term ‘long covid’ was used in medical circles as early as May 2020 to describe people whose covid symptoms lingered on. There are a multitude of continuing symptoms, but shortness of breath, brain fog and fatigue are most commonly cited, as well as post-exertional malaise – a feeling of exhaustion after just a short spurt of activity.

The loose consensus among the medical community is that about 10% of people infected with the SARS-CoV-2 coronavirus suffer from long covid, says David Putrino, Director of Rehabilitation Innovation at the Mount Sinai Health System in New York and an expert in the condition. The figure is the subject of continued speculation, though, and the risk of long covid appears to depend upon the viral variant. Nevertheless, some studies have predicted that up to 200 million people will develop the condition over the next decade.

The clinical definition of long covid is a persistence of Covid-19 signs and symptoms beyond four weeks; having persistent symptoms after 12 weeks that are not explained by an alternative diagnosis is deemed to be post Covid-19 syndrome – though, in practice, the two terms are often used interchangeably.

Gut action

There is no unifying theory of its cause, but rather a number of pervading theories that perhaps overlap. “One that is getting most traction is that the virus itself is hanging around in the body away from the immune system, most likely in the gut,” said David Strain, an Associate Professor at the University of Exeter Medical School, in a BBC podcast. “The virus is not getting into the blood on a regular basis, and when it does, it doesn’t get high enough to trigger any tests – [so] you aren’t going to show positive on a lateral flow test or a PCR test.”

In this situation, when sufficient virus leaks intermittently into the blood, the person re-experiences a flu-like illness and becomes exhausted for no apparent reason.

Another theory is that the infection causes a degree of permanent damage to the cell mitochondria. “The mitochondria are the powerhouse of every single cell, generating the energy you need to do any sort of activity,” says Strain. “When the virus gets into the cells, it uses the pathway that stimulates the production of mitochondria, [and doctors] are suggesting that the virus itself makes those mitochondria go dormant, which is why we run out of energy much quicker [resulting in] fatigue and brain fog.”

Capillary blockage

Micro-clotting is also being considered as a cause of long covid. As Dr Strain relates: “We know that covid causes small blood clots to form within the capillaries, the very, very small blood vessels within our body. If those small blood clots are blocking those capillaries, the body can’t get nutrients to the tissues that need them, and probably more importantly, it can’t get rid of waste products.

This would explain why some people with long covid feel fine at the start of the day, when the body has had time to replenish itself, but become exhausted very quickly soon after. “It also accounts for why people who do some exercise will take two or three days to recover – post-exertion malaise – because those toxins build up and they aren’t clearing at the normal rate,” he reveals.

Immune disruption

As reported recently in New Scientist, there is a growing body of evidence pointing to disruption in the immune system of long covid sufferers. Studies have suggested some parts of their body develop an overactive immune system, while in other parts the immune system remains underactive. Other research indicates the existence of an autoimmune disorder in which the immune system attacks the body.

Strain, however, is not so sure, since people with long covid appear to improve after receiving Covid-19 vaccinations. “If it was an autoimmune disease, the immune system ramps up [and] you may expect that vaccination to make it worse rather than better,” he notes.

Evidence that the virus persists in many parts of the body – tissues and organs, gut lining, skin and lungs – has highlighted the similarities between this and other chronic conditions such as myalgic encephalomyelitis (ME), or chronic fatigue syndrome. Strain believes it is likely that ME and long covid belong to the same family of conditions but have different underlying triggers.

Brain energy drain


Brain fog is one of the symptoms reported by sufferers of long covid. This is where people have difficulty concentrating, perhaps even struggling to get to the end of a sentence. Strain says this brain fog could stem from a lack of energy reaching the brain, though some studies suggest the virus may have caused significant brain injury.

A 2022 study in the UK involving 800,000 people explored the cognitive effects of Covid-19. On average, people who had covid for more than 12 weeks or had required hospital treatment performed worse in the cognitive tests. Even those who had symptoms for less than 12 weeks did worse than the no-confirmed-infection group. People infected early in the pandemic were shown to be among the poorest performers. This could be attributed to the effects of vaccinations and other variants coming into play.

Ultimately, many questions about the long-term consequences of Covid-19 infection on the brain remain unanswered. Separate research has suggested low levels of serotonin, a neurotransmitter, could explain cognitive symptoms that occur in long covid.

Treatment conundrum

Long covid is undoubtedly a nightmare to treat because of the huge degree of uncertainty surrounding the condition and the large number of different presentations. There is no test for long covid and it could be years of clinical trials before practitioners know how best to treat it.

Existing treatment methods include recurrent boosts of vaccines and laboratory-made antibodies to top up the immune system. Long-covid specialists advise those affected to seek a thorough assessment supplemented by a range of treatment options from psychological support to medication.

Olympic Gold: Rewarded by cash incentives and sponsorship deals, today’s champions can run straight to the bank 

Standing highest on the podium to receive an Olympic gold medal is the achievement of a lifetime, stirring up feelings of supreme pride and fulfilment. It can also bring immense financial rewards, as well as personal and social benefits that are beyond monetary calculation. But just how financially enriching is Olympic glory?

As the joyous celebrations of the Paris Olympics fade into memory, it is worth considering that in many places around the world, especially Asian cities like Hong Kong, building a career based on unconventional activities like sports in the headlong pursuit of Olympic triumph was once frowned upon. But Hong Kong’s success in the last two Games, in 2021 in Tokyo and now Paris, especially in fencing, has meant many parents now question this dogma and encourage offspring who want to pursue dreams of sporting glory.

Those that do so received a tremendous boost when the Hong Kong Jockey Club announced just prior to the Paris Olympics that it had increased its cash rewards to high-performing athletes representing Hong Kong, China. Payments from the Jockey Club Athlete Incentive Awards Scheme rose by 20% for both teams and individuals compared to the Tokyo Games. This meant that Hong Kong’s two gold medallists, Edgar Cheung Ka-long and Vivian Kong Man-wai, each received HKS6 million. Handouts were scaled down successively according to finishing position, with those placed from fifth to eighth receiving the lowest amount of HK$375,000.

Gifts for glory

Hong Kong athletes were in the enviable position of being some of the best earners at the Olympics. Indeed, foil champion Cheung reportedly received an additional HK$3 million through the Outstanding Athletes Incentive Awards Scheme of his alma mater, Lam Tai Fai College, after defending the title he had won in Tokyo.

Rewards offered by countries to incentivise their athletes participating in the greatest athletic show on earth varied considerably. Singapore badminton star Loh Kean Yew’s exit at the quarter-final stage cost him a possible golden payout of SG$1 million (about HK$5.8 million), a sum just shy of Hong Kong’s top reward. Serbia and Malaysia offered considerable cash incentives to reach the centre podium as well as the carrot of a lifelong pension. Thus, Serbia’s Zorana Arunović and Damir Mikec, following their success in the 10m air-pistol mixed team event, will be the lucky recipients of their national pension when they reach the venerable age of 40.

Lifetime of ice cream

All those years of unending training and physical exertion will certainly be worthwhile for gymnast Carlos Yulo of the Philippines, who won two gold medals in Paris. His list of rewards seems almost endless: a generous cash prize mandated by law; the Senate Medal of Excellence; gifts of condos and houses from big business and property agents; free flights with Philippine Air; shopping perks; a lifetime of free pizza from Pizza Hut and ice cream by Dairy Queen; a Land Cruiser Prado from Toyota; and even three personalised gold bars gifted by a pawn shop. Filipino band Moonstar88 have also promised to play at his wedding.

To put these rewards into context, sporting nations like Great Britain, Sweden and Norway do not offer their athletes any financial incentives for winning gold at the Olympics. It is expected, though, that such success will lead to other opportunities for making money through brand sponsorships and partnerships.

Increased marketability

According to Tom Potter, CEO of Rush Sport & Entertainment, the marketability of sports stars depends on a combination of their association with a popular sport, their individual qualities, excellence in performance, and sometimes personal aesthetics. “The dynamics of these relationships can change based on the athlete’s performance, public image and the evolving landscape of sports and marketing,” he says.

Though not referring specifically to Olympic triumph, Potter believes sporting success is bound to inflate the marketability of an athlete. “The individual qualities of a sports star, including their sporting excellence and fair play, may contribute significantly to their marketability. Fans admire and respect athletes who excel in their respective sports, and these qualities can enhance the positive image of a brand associated with them,” he says, adding: “While it’s not a strict requirement, reaching a high level of excellence often increases a sports star’s appeal to brands.”

China’s teenage diving sensation, Quan Hongchan, already has an estimated net worth of between US$1.5 million and US$2 million. This year’s successful defence of her Olympic crown added to her wealth – including a reported 450,000 yuan (US$63,700) from the sale of the car she was awarded. Her rise to stardom has been meteoric, and her earning potential will surely rocket as leading brands seek to tap into her reflected glory.

Generally speaking, athletes who consistently perform well, break records or achieve remarkable feats tend to attract more lucrative sponsorship deals. Interestingly, those who do not win but have other qualities can also strike valuable brand-association deals. They may be loveable underdogs with big personalities or possess real character, and despite not being great champions, add entertainment value to the sport and have a strong fanbase.

Endorsement queen

Some stars have struck short-term deals with major brands to capitalise on this festival of sport, such as US gymnast Simone Biles who joined hands with Uber Eats for the Tokyo Olympics. “This allowed Uber Eats to capitalise on Biles’ popularity and relevance during key moments, without committing to a long-term arrangement,” says Potter.

This is on top of her slew of multi-year endorsement deals with major brands like Athleta, the Gap-owned athletic apparel line she jumped to from previous sponsor Nike in 2021. These are companies that are keen to forge a deeper connection with a sportsperson, thereby fostering authenticity. Such endorsements far exceeded the estimated US$100,000 Biles pocketed directly from gymnastics last year; according to Forbes, she landed US$7.1 million in total earnings in 2023.

While financial success is no doubt welcomed, the gymnastic idol has subjected herself to mental anguish and sacrifices in the pursuit of glory. In Tokyo on a vault routine, she could not sense up from down and withdrew from her remaining apparatus events. She has since been candid about her mental health, revealing that she sees a therapist once a week. In Paris, she won a further three gold medals to add to her collection.

Other stars, such as US sprinter Noah Lyles, have talked about the pressures of being a top-tier athlete. Lyles said he suffered from depression during the pandemic. But after a disappointing performance in Tokyo, he recovered sufficiently to achieve gold in the 100 metres in Paris.

Athletic presence

In a Forbes’ list of the highest-paid athletes at the Paris Olympics, it was those in mainstream sports such as basketball, tennis and golf that dominated the rankings. The richest is billionaire LeBron James, whose annual endorsements top even his hefty NBA salary of some US$50 million a year.

Athletics, which gains such prominence during the Olympics, perhaps lacks visibility outside this elite occasion. The Financial Times revealed moves are afoot to raise its profile beyond the Games and increase the number of high-paying meets. If there is not a path to a good living, some sports will struggle to attract the best athletes, indicated one insider.

Two-time Olympic badminton champion Viktor Axelsen echoed these sentiments at the Hong Kong Open last month. The Dane said he would be the cheerleader to give the sport greater global attention outside the glare of the Olympics.

Riches & rewards

Another issue is funding of athletes to train and be ready to compete at the highest level. In Hong Kong, there has been much debate about increasing the financial support offered and improving the governance of sports associations. Local badminton star Lee Cheuk-yiu has called for more attractive annual remuneration packages to help aspiring Olympians make ends meet.

Ultimately, to become an Olympic champion, and achieve the riches this accrues, requires an impressive mental and physical toolbox. Aside from the lottery of life determining which nation you represent, the amount an athlete can earn depends on a whole range of factors. Endorsements and personal brand development are the real goldmine, but gaining recognition through sport can also deliver education and employment opportunities.

Some athletes like to give back, such as épée gold-medallist Kong, who aims to set up a charity with her winnings to promote sports development in Hong Kong. She is someone who undoubtedly knows the sacrifices and tough mentality needed to make it to the top of the sporting money tree.

Ill Feeling: Hypochondria is a living hell for those whose profound fears about their health cannot be relieved 

Anxiety, an increasing concern in recent years particularly among young people, is detrimental to health, but what if it is excessive worry about your health that troubles you? Exaggerated feelings of unease about having or developing a serious undiagnosed medical condition are nothing new. The Greek physician Hippocrates first used the word hypochondria in the fifth century BCE, and it has been the subject of discussion and study through every era since, with a vast and bewildering literature dedicated to the subject.

Around the 17th century, hypochondria had come to denote a mysterious and melancholy condition thought to result in an imbalance in the organs of the abdomen; then gradually, it was used to refer to any illness without a detectable cause. It is generally considered shorthand for an illness that is all in your head.

Hypochondriasis is a psychiatric disorder with very specific diagnostic criteria. Health anxiety is a much broader term used today to describe such conditions, which can encompass depression, various anxiety disorders, chronic illness and pain, among other problems.

A diagnosis of hypochondriasis or illness anxiety disorder usually entails the following: a preoccupation with a fear of having a serious disease based on misinterpreting the meaning of physical symptoms, which persists despite medical tests showing nothing is wrong and reassurance from doctors, is present for at least six months, and is not focused exclusively on a concern about physical appearance; and an awareness on some level that this fear may not be 100% accurate.

Personal battle

British writer Caroline Crampton lives in constant fear that there is something seriously wrong with her. In a moving and heartrending story of a hypochondriac in the throes of despair, she details her personal battle with the debilitating condition.

It all began when she was 17 and developed blood cancer, which was only discovered after a tumour had appeared on her neck. Following several gruelling rounds of chemotherapy, she was given the all-clear, but even though she was cured, she became ever-alert to potential new symptoms, constantly worrying that the cancer may have returned. “The fear that there is something wrong with me, that I am sick, is always with me,” she says in a BBC podcast of her memoirs called A Body Made of Glass.

She tells of a bus journey “half listening to somebody else’s phone call, when I suddenly went deaf”. Her heart beat faster and faster as the fear grew stronger, and her vision blurred into “a sparkling circle of refracted rays”. This sudden loss of hearing and sight happened three more times that week. “There was no pattern to it. I saw a nutritionist, a neurologist, a urologist, a cardiologist, a psychiatrist and an endocrinologist,” she shares.

Contradictory fears

None of her tests showed anything unusual, so she had an MRI. As she lay motionless in the machine, she oscillated between two contradictory hopes: “I really wanted the scan to find something, so that I would have a name to put to my symptoms, and I was terrified that it would deliver the devastating news that I had some life-altering illness.”

Another disturbing thought niggled at her, could she even be satisfied with the results, or would her impulse toward hypochondria convince her that there was something else lurking unseen just out of reach?

The scan revealed nothing of concern, and this was the end of the road diagnostically. The answer to the baffling question of her hearing and vision problems was never discovered. She was given a small daily dose of a medication for low blood pressure, which reduced the number of episodes from several a week to just a few a year. “I still take this pill every day, dutifully refilling the prescription every month, despite having no idea why I am doing so or what malfunction of my body it is treating,” she says.

Nothing is wrong

Crampton has lost count of the number of times that she has been to the doctor only to be told the best thing to do is nothing at all. “This is hard advice to receive; the human craving for satisfying narrative demands an explanation for our suffering. Do something it screams – make an appointment, swallow a pill, take a test.”

It took her a long time to entertain the idea that she might be a hypochondriac. It was much easier for her to see in hindsight. She had been encouraged by doctors to pay close attention to how she was feeling, in case she could pick up on an early warning sign of recurrence of her cancer.

Following her all-clear, she gradually came to realise that her level of interest in her fluctuating state of wellness was far from the norm. The sheer variety of procedures she had undergone had given her a level of comfort with the rarer elements of medicine that was unusual.

Good at being unwell

“More than that though, the awareness crept up on me that I spent much more time and effort on this aspect of life than anyone else I knew, even though I supposedly had no active conditions requiring treatment. At some point, my responsible cancer survivor behaviour had morphed into something else. Rather than worrying about actual developments with my illness, the worry itself had become the problem,” she reveals.

“And it feels at times like having cancer for real was the training I went through so I could have a dozen other illnesses in my imagination. I am now very good at being unwell. I have had a lot of practice.”

She believes most people have some legitimate concern about at least one aspect of their health, whether it is a prior condition, a family history or an environmental factor. “Hypochondria creeps in when this justifiable anxiety expands well beyond the boundaries of the verifiable health concern. For example, when someone with a chronic back injury becomes convinced that they have mouth cancer.”

Safety and avoidance

People with elevated levels of health anxiety are known to rely on safety behaviours or often avoid feared situations. Safety behaviours may include seeking reassurance from family and friends, doctors, medical books or the Internet; requesting frequent unnecessary medical tests; and monitoring physical symptoms, such as pain, racing heart, dizziness or blurred vision.

Alternatively, some people with a form of health anxiety avoid feared stimuli, which keeps their fear alive over the longer term. They may put off medical tests or seeing a doctor, or talking to others about health, illness or a feared disease. Experts suggest these strategies are counterproductive and advise confronting feared situations directly, and accepting feelings of anxiety and fear rather than trying to control them.

Symptom management

There are no straightforward answers to this chronic mental illness. Cognitive behavioural therapy, stress management and mindfulness techniques, such as meditation, may help manage symptoms.

The impact of the Covid pandemic has lifted already rising rates of hypochondria, and a study in Norway has shown that high levels of anxiety about one’s own health can increase the risk of heart disease by up to 70%. As Crampton observes: “It would seem that worrying about being ill can, in fact, make you ill.”

Gut Reaction: Nourishing your immune system with plant fibre and fermented foods fights inflammation and ill health

Food plays a powerful role in developing a strong and resilient immune system. This simple fact means we can boost our immune system through what we eat.

This is vital as the immune system plays a powerful role in the maintenance of our health. It helps protect us from infections caused by viruses and other harmful microbes. If a person has weak or compromised immunity, it can have severe consequences. A healthy immune system, for instance, can identify tumours as foreign and may be able to contain or destroy cancerous cells.

Thus, aside from doing regular exercise and avoiding alcohol, drugs and a stressful lifestyle, for optimum health we should succour our immunity with foods that are known to play a vital role in upping our ability to combat disease and infection.

Scientists are developing a clearer picture of the role food plays, and doctors are even prescribing certain foods as medicine – clinics and health organisations in various countries offer low-income groups produce prescription programmes so they can boost their intake of fruit and vegetables. Some nutritionists are now selling so-called immunity cubes – small ice cubes packed with immune-boosting ingredients – and advocating them as part of the daily diet.

Healthy defence

A basic understanding of the immune system is valuable to health. According to New Scientist, our innate immune system is the body’s first line of defence against pathogens. It responds rapidly to general threats and can distinguish between different classes of pathogens to recruit the most effective form of adaptive immune response to eliminate them. Providing an immunological memory of the threats we have faced, it enhances our future immune responses and builds a specialised defence system.

T-cells, which attack invading pathogens and infected cells, form part of the adaptive immune response. These lymphocytes can act as ‘helper cells’ by supporting B-cells to produce antibodies. B-cells are involved in both the innate and adaptive immune system and are responsible for mediating the production of antibodies against specific threats. Antibodies recognise specific antigens – a molecule from foreign material such as a virus or pollen grain that adheres to a specific antibody or T-cell – and bind to them as a way of tagging the unwanted object for attack by the rest of the immune system.

Alternatively, antibodies can neutralise foreign material directly. Natural killer (NK) cells – white blood cells that form part of the innate immune system and provide a rapid response to viruses and other pathogens – are important players here.

Balanced immunity

A key aspect of a healthy immune system is to strike a balance between reactivity – such as warding off infection by detecting and killing bacteria, viruses, fungi and parasites – and restraint. The latter is required as the immune system can overreact when internal checks are compromised, causing it to attack the body’s own cells and proteins.

This is often the case with people who have allergies; their immune system overreacts to harmless foreign substances like pollen and peanuts and these overreactions can lead to chronic low-level inflammation and cause debilitating conditions and accelerate the ageing process.

Microbe management

Scientists now know that the digestive tract is at the heart of the immune system. The largest immune organ in the body, the gastrointestinal tract has to sift through and cope with oodles of foreign bodies and microbes on a daily basis, sorting out the helpful from the harmful. Some microbes make us ill, while many more are crucial for our health. The immune system is in regular contact with trillions of microbes living in the gut, and from this communication, signals are sent to instruct the ramping up or down of gut activity.

The vast microbiome inside our gut is the all-important bacterial community for stimulating the immune system. This vital link between gut microbiota and immunity became clear in a 2020 study by the Memorial Sloan Kettering Cancer Centre in New York, which showed for the first time that the concentration of different types of immune cells in the blood changes in relation to the presence of different bacterial strains in the gut.

Powerful foods

Furthermore, research has revealed that food plays a vital role in our gut ecology. Given the important function this organ plays in our health, it is heartening to know that scientists believe the delicate balance of the immune system can be modified naturally through diet. As the composition of our microbiome can redress chronic inflammation, any dietary intervention could be critical.

Numerous studies have highlighted the correlation between diverse, immune-healthy gut microbiota and a high-fibre diet containing vegetables, whole grains and lettuce. The likes of leeks, onion, artichokes, soybeans and cabbage are particularly rich in a variety of fibre that provides nourishment for beneficial bacteria. Other prebiotic foods with special plant fibres that help healthy bacteria grow in the gut include garlic, asparagus, chicory and bananas. It is also possible to take prebiotic supplements.

Foods such as green, leafy vegetables that dampen any inflammation after meals are thought to be vital in boosting the immune system. A team at King’s College London discovered people who regularly eat a lot of vegetables had lower levels of circulating white blood cells, resulting in fewer bouts of chronic inflammation and lower risk of chronic disease.

Fermentation focus

Consuming fermented foods such as kimchi, miso or yoghurt that contain helpful probiotics also plays a role in developing microbiome diversity and decreased inflammation markers. Probiotics are live cultures of the good bacteria normally found in your intestine. They can benefit your health by improving the balance of your gut bacteria and alleviating the harmful effects on the gut of poor diet, stress, ageing, infection or antibiotic use. A popular form is kefir, a fermented milk drink that can contain a billion bacteria. Probiotics are also available as tablets, capsules or sachets which can be added to a range of foods.

A note of caution regarding prebiotic and probiotic supplements comes from Justin Sonnenburg of Stanford University in California, who has said “very few things are solved just by popping a pill”. The professor of microbiology and immunology believes the most important factor in keeping your natural defences in good shape and maintaining a healthy gut is the overall composition of your diet.

Ultimately, foods containing essential vitamins and minerals such as vitamins A, C, D and E, as well as some of the B vitamins, plus zinc, copper, selenium, magnesium and iron will help provide micronutrients to support the immune system. Fresh raw fruit and vegetable are the best sources of vitamin C, and pulses, shellfish and unrefined cereal provide zinc. In essence, immune-boosting foods are thought to be gut-friendly foods that help microbes do a more effective job in safeguarding the immune system.

Healing Heritage: With TCM wards and Western diagnostics, Hong Kong can break through borders as a Chinese medicine frontier 

The age-old traditions of Chinese medicine have continued to thrive in Hong Kong, standing as a testament to the enduring wisdom of holistic healing practices. Traditional Chinese Medicine (TCM) in Hong Kong has long been regarded as a reliable and effective approach to maintaining overall health and treating a wide range of ailments. 

Practitioners of this ancient art often take a comprehensive view of the body, focusing on the delicate balance of yin and yang, as well as the flow of vital energy, known as qi. Through the use of herbal remedies, acupuncture and other traditional techniques, Chinese medicine aims to address the root causes of health issues, rather than just treating the symptoms – a common criticism of routine Western medical practice.

One of the key advantages of Chinese medicine is its emphasis on preventive care and the promotion of overall well-being. Practices like acupuncture, tai chi and herbal therapy seek to strengthen the body’s natural defences and increase resilience to disease. This stands in contrast to the Western medical model, which often relies on reactive measures and the use of prescription drugs to manage symptoms.

Herbal Hospital

The opening of the Chinese Medicine Hospital, Hong Kong’s first TCM hospital, in Pak Shing Kok, Tseung Kwan O, in late 2025 is slated to serve as a showcase for international attempts to integrate Western and traditional practices. “This is a Chinese medicine hospital, but there will be a number of Western medicine examination facilities,” says its CEO, Professor Bian Zhaoxiang, a renowned authority in traditional Chinese medicine. 

The government-funded hospital will have a total of 400 beds – including 250 in inpatient wards, 90 in day wards, 40 in paediatric wards, and 20 in the clinical trial and research centre. The highly anticipated opening of its Chinese medicine inpatient wards will mark “the first time in Hong Kong’s history that there will be such services,” notes Bian. Some 65 per cent of the new hospital’s services will be subsidised by the government, with the remainder provided by the private sector. Currently, private practitioners provide 95 per cent of TCM services in the city.

“Hong Kong’s Chinese medicine sector should seize the opportunity to capitalise on our characteristics and strengths … to demonstrate the value of traditional Chinese medicine and the collaboration between Chinese and Western medicine to the world,” says Lo Chung-mau, Hong Kong’s Secretary for Health.

A cooperation agreement between the upcoming facility and the Guangdong Provincial Hospital of Traditional Chinese Medicine has been also inked, covering areas like talent exchange, database setup and the creation of a network for scientific research. Lo declares that Chinese medicine in Hong Kong will reach “new heights” as a result of the partnership with the state-run Guangdong hospital. “With the rich experience and technology sharing from the [Guangdong hospital], I believe that the Chinese Medicine Hospital of Hong Kong will be able to launch its services smoothly,” he noted at the signing ceremony in January. 

Holistic Endeavour

While Western medicine has made remarkable advancements in the fields of diagnostics, surgical procedures and pharmaceutical interventions, it is often criticised for its narrow focus on treating specific symptoms or conditions. In contrast, Chinese medicine takes a more holistic approach, viewing the body as an interconnected system and seeking to restore balance and harmony.

Dr Arthur Lau Chun-wing, the Chinese Medicine Hospital’s Deputy Chief Executive in Western Medicine, anticipates that the new facility will capitalise on the advantages of the two types of treatment. “I hope we can formulate standards that can serve as the blueprint for the world to follow and reference,” he says.

China’s main medical practices have historically been acupuncturing and herbal therapy. Acupuncture is regarded as a yang therapy, and for more persistent problems, yin herbal medicine is used in addition. Arguably the most advanced in the world, the Chinese herbal system encompasses thousands of recipes and plants. The majority of herbs are used in combinations, with eight or more different plants often combined to provide a synergistic cure. Additionally, animal parts are frequently included in medicinal formulae. Two examples to treat asthma are dried caterpillar fungus and gecko tails. A highly sought-after and costly tonic in Hong Kong is created from the saliva of the swiftlet bird.

Chinese vs Western

Studies have demonstrated the efficacy of certain Chinese medicine practices in treating conditions such as chronic pain, digestive disorders and even certain types of cancer. However, the reliability and scientific evidence behind Chinese medicine remains a subject of ongoing discussion, with some Western medical professionals expressing scepticism about the lack of standardised clinical trials and the potential for inconsistent quality control.

Dr Leung Ting-hung, the former Director of the Centre for Health Protection in Hong Kong, has said: “Chinese medicine can complement conventional Western treatments, but patients should be cautious of unsubstantiated claims. The safety and quality of Chinese medicine products require more regulation and oversight.”

The pros of TCM in Hong Kong include its long-standing tradition, its holistic approach to health, and its potential effectiveness in treating certain conditions. Many patients appreciate the natural and non-invasive nature of Chinese medicine treatments, as well as the emphasis on maintaining balance and harmony within the body. On the downside, doubters cite the lack of standardised quality control, and the potential for inconsistent or unreliable results and adverse reactions with Western medications. Additionally, some Chinese medicine practices, such as the use of endangered animal parts, have raised ethical concerns.

Future Tradition

Cheung Wai-lun, the Hong Kong Health Bureau’s Project Director for the Chinese Medicine Hospital, says officials want to coordinate and promote the quality development of Chinese medicine. “Besides local development of the sector, we hope to cooperate with the motherland’s development plans in this area. That is to use Hong Kong as a platform – like a display window – to showcase to the world how Chinese medicine can be applied.”

Ko Shing Street in Sheung Wan has been the heart of the wholesale trade in Chinese herbal medicine in Hong Kong for 100 years. It’s nirvana for herbal or health geeks, and a must-visit to witness a unique insight into the past. While shopkeepers in this iconic street find it challenging to keep their stores operational due to Hong Kong’s expensive rent and living expenses, preserving these customs and ensuring that they continue to influence modern holistic treatment in the future are essential.

As the city continues to navigate the dynamic landscape of healthcare, the role of traditional Chinese medicine remains an integral part of the city’s medical landscape. While the debate over its reliability and effectiveness compared to Western medicine continues, the enduring legacy of this ancient practice serves as a reminder of the importance of preserving and exploring diverse approaches to healing and well-being.

The Elixir of Life: In the modern quest for eternal youth, the path is more medical science than myth

The desire to keep one’s youth and vitality by defying the natural ageing process is not a recent phenomenon. While it may not be as old as the hills, it probably spans the existence of humankind. This Peter Pan-like urge to stop the march of time has long been the subject of popular culture. In the 1959 horror film The Man Who Could Cheat Death, a centenarian artist and scientist in 1890 Paris maintains his youth and health by transplanting parathyroid glands from the necks of the living. Another film, Orlando (1992), based on the Virginia Woolf novel, depicts a nobleman’s struggles to find his place in the world after being ordered not to grow old by Queen Elizabeth I.

Cognitive concerns

The subject of age has dominated the US presidential election campaign, with both Joe Biden, 81, and Donald Trump, 77, accused of being too old for the job. Critics point to the inevitability of age-related mental decline and forgetfulness, and attribute their gaffes, such as getting names mixed up, to their advanced years. Some analysts have suggested this is unfair, given the enormous pressure they are under and the constant scrutiny they are subjected to. In these circumstances, occasional misspeaking is to be expected.

Furthermore, the science of ageing is uncertain. Research in cognitive function by Joshua Hartshorne of Boston College and Laura Germine from the McLean Institute for Technology in Psychiatry suggests it is no myth that wisdom increases with age. Older people tend to have the ability to see the big picture better than their youthful counterparts, though not necessarily the capability to recall specific facts instantly. The former skill is essential for a politician – a greater grasp of the wider historical context of world events would enable more informed decision-making. On the flip side, some studies have shown that tasks involving short-term memory decline from as early as 20 years old. To add to the complicated picture, arithmetic and comprehension skills, plus vocabulary, are thought to keep improving until 50, then decline thereafter.

Jay Olshansky of the University of Illinois believes the two main contenders’ well-to-do backgrounds and family history of longevity work in their favour in terms of the ageing process and their expected lifespan.

An article published in The Hill in January states that both Biden and Trump have higher than average expected chances for men of their age of surviving another presidential term. Olshansky also opines that some of Biden’s gaffes have been blown out of proportion. For instance, when he was captured falling off his bike in June 2022, many deemed it a sign of his physical decline and poor balance. However, a closer examination of the circumstances indicated that he had caught his foot in the pedal strap, something anyone could do. The pertinent point here is that Biden, then aged 79, was comfortably able to ride a bike in the first place – not that he got his foot caught.

Survival of the fittest

Some people are chasing the anti-ageing dream far beyond the normal advice to reduce their weight, exercise and sleep more, quit smoking and limit alcohol intake. American entrepreneur Bryan Johnson, who made a fortune selling his electronics payments company Braintree to PayPal, reportedly spends US$2 million a year attempting to stop the biological clock.

An all-over skin laser treatment is said to have reduced the 46-year-old’s skin age by 22 years, and he is known to observe a vigorous daily exercise routine and a strict plant-based diet including eating a kilogram of vegetables before 11 am, his usual dinnertime. He also consumes some 100 tablets a day, including the diabetes drug metformin and the immunosuppressant rapamycin, both hailed by longevity enthusiasts as ‘miracle’ anti-ageing pills.

Described as the most measured man in the world, Johnson’s biological and chronological age are continually tracked and monitored. His aim is to reverse his measured biological age by more than one year for every one year that passes – the first stage of longevity escape velocity in which life expectancy increases faster than time passes.

Confident his tortuous routine is paying dividends, he describes how he has near undetectable levels of inflammation, perfect blood pressure for his demographic, the ideal range of vitamin C, vitamin K, coenzyme Q10, 1GF-1 (insulin-like growth factor 1) and LDL (low-density lipoprotein) cholesterol, and a DHEA-S hormone level of someone aged 27. Just as impressively, in a series of physical tests, he scored equivalent to the top 10% to 25% of 18-year-olds.

Supplement strides

Johnson is now selling a basic version of his Blueprint protocol – described on his website as ‘The Most Nutritious Program in History’ – to those interested in adopting what he considers to be the perfect diet for the body. The idea that caloric restriction can significantly extend lifespan as long as all the necessary nutrients are ingested via minerals and vitamins is not new. It was advocated by the late Roy Walford, a professor of pathology at the University of California, among others, and their findings helped spawn the plethora of mineral supplements on the market.

Though their life-extending capacity for humans is open to question, some supplements are generating considerable interest. Taurine, an amino acid, was recently found to extend the lifespan of mice by 10%, as well as boosting a whole range of functions in the middle-aged rodents including muscle strength, endurance, coordination and insulin sensitivity. A major study in the journal Science published last year linked lower taurine levels to age-related problems, noting that blood levels of taurine in elderly humans are 80% lower than they were when they were younger. The attention such revelations generated has made taurine a popular dietary supplement among the legion of alternatives.

Counter evolutionary?

Extreme do-it-yourself lifespan extension, however, goes against the grain of evolution, which is more interested in reproduction rather than longevity. It is thought that increased lifespan comes at the cost of reduced fertility. Our bodies contain trillions of cells that will ultimately need rejuvenation or renewal – something which is incredibly difficult to overcome as evolution has little interest in keeping the repair system going.

So perhaps we should turn to the original Star Trek actor, William Shatner, who is now in his early 90s, for advice on staying young. He told Newsmax: “Say yes to the opportunity life is offering. Say yes to life, yes to dinner, yes to going out, and yes to something new.”