Y O U R D A I L Y D O S E
If I can ever be so blunt and bold, strictly speaking, 2020 is a year where we find ourselves rotting and decaying, withering away with the loss of our youth and vibrance. Due to safety concerns and for the betterment of society, we find ourselves standing in a circle. If that circle is where we have “protection” from the nasty coronavirus, with masks and gloves and goggles and everything else that will make you look like a humanized bubble wrap. And one must never possibly leave the circle. Fear and paranoia for both our own health and others are only too common.
While there’s not much that we can physically do to help strengthen your immunity (since that would be illegal and can get us into a pickle), we found a better way to improve your mental “immunity”! Of course, you can sit there and waste your life as you succumb to the horrors of brain-rotting entertainment, but once quarantine is over and life is back on track, you may find yourself slacking even more than you are to begin with, in appearances and in knowledge. A weakling, if I daresay.
Maybe you have already been seeing some side effects in the mirror every morning, as you gasp in horror with the disbelief of your shrivelled reflection (yes, it’s your reflection). But fear not! Your daily dose of self-enrichment has arrived and it is now unfolding in front of you. To combat your diminishing immunity against stupidity, we have prescribed to you this lovely article formula. What better way to improve your “immunity” than engaging yourself into the world of immunology?
Because of the pandemic, we can’t really get much travelling done. But that shouldn’t excuse us from exploring the wondrous world of immunology, in fact, it’s an even better reason to explore! Our tour guide for today will be Dr Philip Li, (obviously) an immunologist, and he will guide you through everything.
Buckle up, everyone. We got this.
T H A T ‘ S R O U G H B U D D Y
Immunology is a profession dedicated to studying the complex immune system. Working as an immunologist, Philip illustrates the immune system as a ‘yin and yang’. If you happen to have an overly-active immune system, it can cause rare diseases like lupus or rheumatoid arthritis; or it can be against things that are not deadly, such as food allergies.
But as a ‘fresh’ speciality, there is poor and limited understanding of immunology. “All the focus is on rheumatology and allergy,” Philip laments, “ Very little interest and resource is actually put into immunodeficiency. Heck, I never even heard of immunodeficiency before I became an immunologist or finished my medical degree. In addition, there are a scarce number of immunologists in Hong Kong. There are over 350 immunodeficiency diseases but none of them are being properly diagnosed.” As he carries on explaining, immunodeficiency is where the immune system usually has poor functioning, either you are born with it or it is secondary (for example: you suffered from cancer and you received immunotherapy for curing, but the side effect renders self harm of your own immune system).
“I have seen a patient who has hereditary angioedema,” Philip discloses, “No one has ever heard in HK until 3-4 years ago, but in the UK, where there is a very good immunologist network, this disease is quite common, with the affected rate being of 1 in 10000. It’s a disease that you are born with, and as you reach your childhood to early, or late adulthood, you will get these life-threatening attacks of angioedema. Your mouth or hands will have random swelling, even your neck is not safe from it, and you can die from it or go into ICU.” But these patients cannot receive a proper diagnosis until they receive an official test.
“My oldest patient in Hong Kong with this condition is seventy years old,” He reveals, “ And she spent her entire life being hospitalized over hundreds of times. She is constantly having these deadly attacks but no one has ever diagnosed her. Her father had the same condition as her and he died from it. It was until lately in Queen Mary Hospital, where we set up an immunologist service could she finally receive her well-deserved care.”
Philip expresses sadness in seeing such a well-known disease in other parts of the world to be overlooked in Hong Kong. “These patients are very under-priviledged. All their lives, they have been deprived of education, jobs, even normal daily life routines can be bothersome to them since they suffer from these constant attacks of swelling! Not to mention, most of them live in poverty and they don’t know how to complain or fight for their rights. It is a very sad phenomenon. These immunodeficiency patients lack the treatment and diagnosis that they deserve.”
Have you ever heard of the term ‘bubble boy’? Much like the name itself, you will have to live in a bubble to survive. This is the most obvious disease in immunology that has received the most attention, care and investment. “These babies, born after a few months, will constantly get infected by different diseases that can render them dead , with no immune system to defend themselves.” Philip says, “The most tragic part is that the majority of immunodeficiency diseases are not that fatal and they are not easily discovered in early parts of life. They may not necessarily die, but their prolonged suffering may be even worse than a death sentence, having to live their entire lives with such burden.”
SCID (Severe Combined Immunodeficiency) would be an example of a successful case in immunology, in which everyone has put in a tremendous amount of effort, labour and intensive care to find out the problem, finally discovering bone marrow transplant as a solution and the possibility of gene therapy by supplementing the missing enzyme. “While this is an immunology breakthrough, it being the most classical and most famous disease,” Philip voices, “Other diseases may not undergo such experience. We are only left with experimenting different options on patients as there is no factory or company that is willing to invest in less-well known immunodeficiency diseases to find a diagnosis or treatment for the patient. In western countries, it’s all money talk. If you do not have enough patients with such disease, the profit you can earn from the discovery cannot override the costly investment you put in.” The reason for SCID in Hong Kong to be pretty successful is because a large amount of funding goes to pediatrics, “Oppositely speaking, we can have an adult in their forties getting hospitalized but people generally don’t care as much as they do when it comes to a few months old baby getting hospitalized.”
Without a doubt, diseases that receive the most attention, investment and money are namely cancer, cardiovascular disease, stroke and diabetes. The reason for this is because many people have these diseases and yearly, new medicines for such diseases are invented which involve extravagant work, yet medical factories can earn far more profit from them. “As a medical doctor, ethically speaking,” Philip conveys, “We should not devote all our resources to these diseases. Of course, we should prioritize them with the majority going to common diseases, but you should give some to the under-priviledged diseases that no one has ever conducted research upon. I think that part of my responsibility is about advocating for the rights of these under-priviledged diseases and fighting for their needed resources.”
P E N N Y F O R Y O U R T H O U G H T S
When asked why would he choose immunology, Philip describes it as a ‘serendipity’. Growing up, he did not have a particular interest in certain aspects of medicine, which was why he often admired people who had directions. When he was studying in high school, he went from dreaming of becoming a pilot to wanting to enroll himself into the military army, however this was quickly shot down due to his parent’s objection.
“I had no idea what to do,” Philip admits, “Luckily, I received grades with flying colors and after some interviews, I went to medicine. Earlier on, I found myself interested in becoming a surgeon, but then after some time, I discovered that I actually favoured studying molecular or abstract things, I found that line of thought was quite interesting. And immunology perfectly fits it.”
“As long as your theory makes sense, there’s a potential for its validity,” He states, “ Not to mention, Hong Kong has no clinical immunologists, thus I had a sense of heroicness. I can feel closer to patients and I can believe that I am making an impact on the world. So, I flew to the UK to study and took examinations, and even though it was difficult, it was worthwhile.”
Hence, Philip strongly emphasizes on personal interest, and advises students to cast aside influences from the media or entertainment industry, as often, their portrayal of occupations can be misleading. It is of utmost importance that you need to know every aspect of a certain job and acknowledge your own limitations, such as whether or not you can handle hecticness. Having interest and passion for a certain profession holds significant priority and stands as a motivation for you to persevere and not give up after a short period of time. “I have many classmates that dropped out after studying or refused to become doctors even after finishing their medical degree,” Philip mentions, “But I am so happy for them. It’s not about a matter of ability, it’s simply about the lack of interest. Please do look into things broadly and experience everything before consolidating and make a final choice. It;s similar to dating, you can find a perfect match for yourself but you need to have a connection to become successful in the relationship!”
Photo: Dr. Philip Li - HKU Department of Medicine: Clinical Assistant Professor