Interview with Dr. W C Cheng, founder of Singapore's Thomson Medical Centre (transcript)

David Williams: This is David Williams, CEO of MedTripInfo.com. I visited the Thomson Medical Centre in Singapore recently and had the pleasure of meeting Dr. W.C. Cheng, who founded Thomson in 1979 and has seen it become Singapore's leading private health care provider for women and children.

At 76 years of age, Dr. Cheng is still physically and mentally fit and continues to practice medicine. In this interview, he shares his views on health care delivery and health aging. He's an advocate for hormone replacement therapy and for the importance of sex in a woman's life.

Can you tell me, Dr. Cheng, what was your vision when you started Thomson Medical Centre, and how well has it translated into reality?

Dr. W.C. Cheng: I wanted to build a hospital, which is not a hospital in looks and in its actual management of patients. The conventional hospital has got too much white, too much terror, too much fear, too much pain.

So, I then conceived of the idea to design this hospital with a completely different ambiance; basically, to transplant the hotel type of ambiance, home type of bedroom as patient rooms, with the hospital facilities hidden away, and with emphasis on personalized, very intimate, very warm, very friendly type of nursing care.

My brother helped me with the building. He was an architect, designed hotels, so we got together and sat down. And that's how this thing came about. At that time, 1979, when we first opened, this was the first of its kind, so everybody was quite shocked when they would walk in and say, "Is it a hospital? Is it a hotel?"

So, we continue to maintain that impression, to the extent that all the nurses are dressed differently, devoid of white. White, as you know, is a common trait. Somehow, that's the color for hospitals and staff. So, there is such a thing as the white syndrome--you will see white and your blood pressure goes up.

[laughter]

And children, when they see white, they cry. So, we took that away, so, for the first time, all our girls are dressed in floral uniforms. That immediately changed the image. So, all the time we are working on this theme and continue to work on this theme. For example, our hospital is the first one with room service. So, apart from making hospital food something they look forward too and not hospital taste, yucky.

We didn't borrow this idea from Singapore International Airlines, but we thought that the patient, unlike a patron in a hotel, spends most of her time in the room in bed. So, she thinks about food a lot when she's getting well--especially a maternity patient: she's hungry all the time.

So, the natural thing to do is that you have to provide them with good food, palatable food, nutritious food. And also, the trappings of so many visitors coming in, so if they can order room service, tea, coffee, that would be wonderful. So we did that. This vision, over the last 28 years now, has been realized, and all the time, we are still trying to improve on it.

David: I want to ask you about one of the newer services, which is in the area of anti-aging. And I wanted to ask you, how did you come up with that as a concept, and what does it mean for your patients?

Dr. Cheng: Well, this came up as a natural extension of my work. I started off as a young gynecologist. When I first came out in private practice, I was 32 years old. So, I got a whole cohort of young women, coming to have babies, trying to have babies. And now, 40 years down the road, I am still looking out for the same cohorts, so they are growing old with me. I am catering for their needs as they go along.

When they reach mid-life, 40, the first thing that hits them with great horror is menopause. And menopause, for them, means suddenly growing old, suddenly, the whole world's turned upside down. So, is there anything I can do to help? I tried and used the basic knowledge, basic behaviors.

We all know that growing old is a natural process. You can't stop it. But you can slow it down. You can, in fact, reverse it, to some extent. Because most of us have a lifestyle that is self-destructive, that accelerates aging.

For example, putting on weight is the surest way of accelerating aging. You look older when you're fat. You look slim, you're younger. You don't have enough sleep, straight-away, you look older and tired. If you are not fit physically, you look tired. So, go to the basics. Eat properly, bring your weight down, exercise, and be happy.

And also, in women, sex life is very important. Most people take it for granted, that it is not important for them; but in fact, it is very important. It is not realized until now. More and more research has been done, and now women are more open in what they need. So, all this added together gives you a happy, youthful appearance.

You'll have all this satisfied--and just based on basically nothing; you're not using anything at all. So, just on a change of your lifestyle, controlling your basic activities: sleep, exercise, eat correctly, your excretory functions correctly, enough movements, activities--physical, mental, and sexual. Basic. We all do these every day, so get it right. And that's anti-aging.

Then, of course, there are women who need to undergo operations, because they have got a huge growth of fibroid or other things, which mess up life a little bit. So, surgically, you have to remove it, thereby creating a problem of premature menopause, if you have to remove the ovaries when they are not yet in menopause. Because of disease, you have to do it.

Then, the question of replacement. See, the standard textbooks, when I was a medical student, when you are 40 and above, you need to go for a hysterectomy. The ovaries comes out with it, so you castrate a woman too early, so she will be suffering for the next 20 years. And nobody bothered. Everybody believed that you have rid her of an organ that is potentially capable of becoming cancerous.

That assumption is valid in the old days; not any more, now. For any one patient you prevent cancer, you've got to operate something like three to four thousand cases. That's too big a sacrifice.

So, in those days, we had no way to diagnosis ovarian cancer early. By the time they become manifest, it's already too late. But with the introduction of ultrasound, we are able to look at the ovaries very easily. We just stick an ultrasound probe into the vagina, and we can see the ovaries within a few minutes and we can tell them whether it's abnormal or not. So, with that, we are very safe, so now, we do not remove ovaries unnecessarily.

The other aspect is those who have had to be removed for various reasons or became menopaused prematurely, naturally, they age earlier, then they have a gap, from 45 to 70. This is still a very useful life stretch. They can still look fabulous. What they lack of is the sudden drop in estrogen and testosterone.

So, we have it replaced, replaced with a level commensurate with their age, maybe a little bit higher. Estrogen level drops with age. It's a straight line drop. So, if she's at 60, the estrogen, let's say, is 40. We'll bring it back to the estrogen level of a 40-year old. Then she looks totally different. She feels well. Her skin looks beautiful. Her eyes have got sparkle in them. The vagina is totally changed: moist, succulent, and the sensations are restored, and sex life is possible again.

Otherwise, how is the marriage going to continue, when she's 45, ovaries removed, the vagina is dry as paper, and she has a healthy husband who needs sex? And the marriage needs sex to strengthen its bond from time to time, from day to day, so if this is suddenly removed, it puts the marriage under very, very great stress. Families are broken up. Various things happen.

So, here we have something that could change all of that. But somehow the fear of cancer has been so exaggerated that everybody hears the word "hormones," they all get terrified. And all this came out of WHI study in 2003. Just that one study. And within a year of their study, it was proven wrong, 2004.

2003, when the first story hit the papers, it's a five column spread. The next year, exactly 12 months later, WHI study was reviewed and re-studied by medical doctors, and it was found to be completely inaccurate. The study was flawed.

The sample they chose were women between 55 and 75. So in this group, naturally, even if we do nothing, the cancer rate is higher, the bones will be more brittle, the heart will be worse. So, how can you prevent the worsening of these conditions, which they ascribed to the use of hormones to be able to prevent, start them so late and hope to reverse it? Of course not.

You should start them at 40, 45, then you see the results at 60, and not starting at 55 to 75 and see the results at 80. So, this is the major flaw. It's pointed out by various medical critics published in various medical journals, but the newspapers just won't pick it up. Bad news for them. Good news, they put it in two columns; bad news, five column spread.

David: Dr. Cheng, are there services that it would make sense for patients to travel long distances for, to come to your center from as far away as, for example, Europe or the United States?

Dr. Cheng: Definitely. I know, in the United States, HRT is taboo. The main reason is not because the doctors don't believe in it, it's because the doctors down there cannot stand the risk of litigation, because the whole media is anti-hormone replacement and link hormone replacement with breast cancer. It's linked in everybody's brain, so which doctor would dare to use it, because the media is against them? Everybody's brain, everybody's mind, is already biased.

Nobody ever mentioned that the Japanese breast cancer rate is one of the lowest. The Chinese cancer rate is one of the lowest. The Indians' cancer rate is one of the lowest, compared to America. Why? Because of food and lifestyle.

Westerners smoked, the women smoke early. Their food, almost 90%, after birth, contained lots of animal fat, which is beef, mutton, etcetera. In contrast, Japanese food is uniform and consistent throughout the country. Their breast cancer rate is nowhere near American levels.

China, only now they're getting affluent. 10 years ago, they have never seen beef. Even milk, now, is only something just started. They have got a milk farm, maybe not more than 10 years old. So, milk and animal fat eating is not yet deep down. But it will show up first in big cities, as the diets change. India, their breast cancer rate is low, because Indian women don't smoke, Indian women don't eat beef, and their diet, mainly vegetarian. They have a totally different pattern.

But all of these are not mentioned, for a simple reason. When the news comes out, from Reuters, from whatever source, it's always USA. See, for example, this WHI study is USA. So, the first flash of the news came out in California. The second flash of the news came out in New York.

So, when these two main news agencies flash this news out, all the papers pick it up and all out at the same time the next day, so everybody thinks that that information is universal. Nobody ever pointed out that it has got an ethnic difference, it has got a difference with food, difference in lifestyle.

So, in that American environment, many women who need HRT, who need some replacement, some of them at least, will find it hard to find someone that can do this for them. HRT in women is not only estrogen; testosterone as well. When a woman goes into menopause or has her ovaries removed, her testosterone level drops quickly.

And testosterone is a very important hormone for her. It gives her three very important things. A, it gives her mental sharpness. Secondly, it gives her physical strength. And most importantly, it gives her sex drive. So if you take this sex drive away, she suddenly feels useless.

And very few doctors in America dare to use testosterone, although it's been documented in "New England Journal" that use of testosterone in women is normal, because she has testosterone. Now she's dropped. You just put it back. You have done nothing new, you just put it back to where her normal age would require that level. And yet, they dare not do it.

Only recently, there was one big study from Australia, from Monash University. Professor Susan Davis, she's the first one to put in testosterone implants for women as well, and found and reported her good results. But nobody else dared to do it. Just this fear arising from education. A lot of things in the States, the doctors are willing to do, but, because of the media, because of the general perception of the people, their hands are tied.

David: Dr. Cheng, thank you very much.

Dr. Cheng: Thank you.