Milk powder issue - A medcial or marketing issue

Milk product is essential in every part of human life.  There is no doubt that the best choice for infant feeding being breast milk.  For practicality, in every modern society, milk formula is popular as alternative.

From 2010, there is widely known fact or news that milk formula is the target of every Mainland visitors.  Especially in northern district, the dispensary retail outlets run out of infant milk formular in days and weeks.  Actually, it also occurs from time to time in urban Kowloon. The situation in Hong Kong island may be better.  But the cost of inflation, salary and shop rental push the price of milk product to sky high. Therefore the search for cheap milk products in some selected retail is much keener.  In big retail chains, they transfer all cost of high rental to customer. The price of milk formula is higher in such chains. But in individual shop, the demand of milk formula is much more intense if they do not raise price tremenduouly.

So the problem is there for 2008, 2009 , 2010 then 2011 - 13.  Local birth rises and climaxes at year of 2012.  Therefore the voice of milk powder control is higher and stronger.  For same reason, the privilege of choice exists for mainland mother too. If not all Hong Kong mothers give breast milk to their kids, why can't mainland mothers give better quality milk formula to their off springs.  So there is no wrong or right for them to search milk formula in Hong Kong or through their agents.. Even if mainlanders buy milk formula in Hong Kong and resell for profit. They are not morally right or wrong.

To curb the high competition for milk formula in local stores, immigration control of milk formula is instituted.
This is drastic measure. Back in 2008 or 2009, the competition of milk products is left to the market force that the place where demand is high push up the price. When the price is high the customers drift to other region. Then the supply is back and price is adjusted down and the customer flog back and push up the price once again.
The market control is successful but slow.

Urgency for securing supply of milk formula is there.  So rules set in.
Some scholars advise the baby to switch to whatever brand the mother can get hold of. Theorectically it is sound. But we can do better by sticking to one brand.
Actually, on can observe the same strategy exist for mainland visitors too. They are not just buying on brand only. They prefer one brand. Then if it is out of stock, they don't mind and purchase other brands and transfer up to mainland.


Milk formula are no different from one and other. The only difference is the confidence in the brand.
So that lies on the marketing strategy of each brand.
For milk formula sold solely in HK without distributors in mainland, they can obviously attract more customer.
But of course, no firm or company will look down on the vastness of mainland market.
For some reason, they cannot enter to mainland market directly, then they promote itself more intense in HK so that mainland customers prefer to ship large amout ot it to China.

For local mothers, I would suggest that most infants are capable of tolerating adult milk formula once they reach the age of 8 to 9 months. There body system develop stronger adaptability. In fact the difference between adult and infant milk formula is only minute. As in dfference of different brand, the adult milk may contain more sodium or other substance. So long as trial of milk by infant is successful, they can tolerate adult formula. Then the competition for infant formula can be left to neonate under age of 8 months.

Lastly, I wound point out that milk powder demand fluctuate widely. Maybe in next 5 or 10 years, no one would buy infant formula from Hong Kong. They may buy it direct from supplier. Then, for Hong Kong government, they will limit their own business by insituting so called proctecting local mother rules.

Pneumothorax - a life threatening disease

 

Recently I came across a news peculiar to pneumothorax.  An adolescent aged 18 of a single parent family committed suicide becasue of health trouble of recurrent pneumothorax.  Even working in the field specialising for pneumothorax surgery, I am not aware of similar case.





Although there is high chance that this patient may have psychiatric illness, it is shocking such a treatable disease lead to this tragedy.  The adolescent with pneumothorax must be dissatisfied with the treatment. The recurrence must be frequent causing disruption of school and social life.  With the introduction of minimally invasive thoracic surgery (also named VATS for Video assisted Thoracic Surgery), pleural disease like pneumothorax is easily treated.  However, the popularity of using VATS do induce non -expert surgeons to operate more.  Recurrent pneumothorax (if recur after the first attempt of surgery) do need referral to specialised experienced thoracic surgeons with keen interest in VATS.

Operations maneuvers for treating recurrence must include:

1. Proper identification of lung bleb (weakness of lung causing air leak)

2. Consideration of additional procedure like: pleurectomy, limited deocortication and adhesiolysis esp for lung adhering to medial part of diaphragm
and pleural tenting or transient phrenic nerve paralysis

3. Adding chemical agents like talc insufflation and chemical agents silver nitrate, fibrin glue and oxytetracycline , concentrated glucose

4. Position of suitable drain or drains (2 drains)

5. If patient allow and prefer early discharge, use of ambulatory draiange device or drainage bag with valve.

Proper procedure can reduce the recurrence to less than 3 %.

With patient aging beyond 35, the possiblity is low by nature. But with good surgery, if there is no recurrence in the post operative 3 - 4 years, the chance of recurremce is much less though not unheard of.

Sometime, pneumothorax cause problem of immobilisation. In old days, a young patient has open pleurodesis operation and subsequent deep vein thrombosis. He was put on anticoagulant but unfortunately develop hemothorax in recent operated chest. A redo thoracotomy is needed and patient has prolonged hospital stay.

In patient with Marfan's syndrome, recurrent hemopneumothorax may be troublesome.


By Dr Chung Shiu Shek