Thailand, Week 3

So we are obviously back from Thailand, and I have to tell you, the trip was fantastic. We had the time of our lives, except that hopefully we will get to do many more things like this in the future. Anyway, the third week of the trip, spent mostly in Phuket, was just as great as the first two. We spent our time on, in and under the water, with breaks mostly for eating and sleeping.

On Sunday, after the spectacular meal in the pool on Friday night and a similarly wonderful and romantic meal at Azur, the fabulous Mediterranean place at the hotel (amazing giant seafood platter), on Saturday, we were picked up at the hotel, and along with the 4 generations of a Malaysian family we picked up on the way, headed up Phang-Nga Bay (pronounced Pang-Ga) for a tour. We rode in a longtail boat out to Koh Tabu (on the right), the island from the James Bond film Man with the Golden Gun, then sea kayaked through a series of Karst caves in another part of the bay before stopping for lunch at Koh Panyee, a muslim fishing village built on stilts over the water in the shadow a large, karst cliff. Lunch was great, and the place was really interesting, and we lingered for a while before heading back to land to visit the monkey cave before heading back to the hotel. The whole tour was a bit touristy, but the bay and the national park it contained were truly beautiful, with islands of giant limestone karst looming over the water, scattered throughout the bay like they had been sprayed there by a giant blunderbus. Back at the hotel, we had time for a quick dip in the sea side pool before dinner, which was a surprisingly mediocre chinese new years banquet at the hotel, highlighted by the made to order duck rolls. The food was okay, but I think we are spoiled by the incredible chinese food in New York and had hoped it would be better.

Monday was both good and bad, as we tried to go scuba diving around Raya Island, but on the 1 and 1/2 hour boat ride out there, Aviva got so seasick that she was unable to dive. I had two fabulous dives of about 10 and 20 meters, and saw a number of remarkable sea slugs, beautiful schools of fish, a really cool black lionfish and a fairly large (maybe 4 feet long) grouper. Aviva did recover while we were out there and she got in some good snorkeling. For dinner we ate at a little resturant down by the Panwa Bay promenade, I had yellow seafood curry and Aviva had an amazing whole fish (we think it was sea bass) spiced with peppers, plums and lemongrass. Mine was okay but hers was fantastic and we demolished it.

Since Monday was kind of rough on the water, Tuesday we took it easy, spending the morning at the hotel, in and out of the pool, before catching a speedboat over to coral island in the afternoon for some snorkeling, lounging and general relaxation. The beach was beautiful and not so crowded (no small thing in Phuket), and although the snorkeling was not fantastic, because most of the corals we fairly badly damaged, it was still nice to be snorkeling and looking at fish together. After returning to our hotel, Aviva took a dip in the pool and we headed out for the night, renting a car and driver to take us over to a wonderful seafood place on Karon beach, one of the more lively parts of the island. The resturant, Mali seafood, did not disappoint, as we had a variety of excellent ocean fare, and seeing the crowded, Englishized, ridiculous party that was Karon beach made us incredibly happy that we had ended up staying in the remote, quiet, romantic corner of Phuket that was Panwa Bay.

Wednesday, we woke up late and flew back to Bangkok, getting to our hotel in the early afternoon. I was exhausted and crashed while Aviva toured the neighborhood, which was far outside the city center and a much more authentic (we were guessing) slice of bangkok life than we had seen the first time we were in the city. The evening was occupied by a self-guided tour of the local markets, an internet cafe where we arranged spa treatments for the next day, followed by pad thai from a street cart, fantastic as always. On thursday we awoke and took a cab to the spa, where we were pampered and rubbed for several hours. My body and head massage for shorter than Avivas seaweed wrap, body massage and facial, so I also got my hair cut (what little there is of it) and wandered about. We ate lunch and elaborate, ridiculous ice cream cones in the office tower where the spa was before wandering around a bit and then heading over to the Erawan museum and sculpture garden for our last taste of Thailand. After some small confusion getting back in a taxi, we again had dinner at a nearby street cart restaurant, this time dumplings and soup, which was also delicious. Then to bed and when we awoke too early at 5 am, we headed over the the airport and began the long, long, long (15 hours in the air) flight home ... stopping briefly in Tokyo, to eat udon and buy some whiskey.

And now we are back, have been here a few days and are finally beginning to realize that this is not just another hotel (the bed is way too nice). Over a fantastic trip ... can't wait for our next one.

Thailand, Week 2

I intended to post this about four days ago, but was completely seduced by the Radisson resort we have been staying at on Phuket and have come to understand why people got to resorts to do nothing ... but comes later and I still haven't told you what we did last week. Again, no pictures, we have had a small camera malfunction and the small camera that is easy to upload images from is no longer working ... but if it were working, you would have seen some amazing stuff ...

When I last wrote, we were wandering around Chiang Mai, and the day after that post we spent all day at a fantastic cooking class where we learned to make a large number of Thai dishes ... the hands down winner was chicken with cashew nuts, which is secretly the most popular dish in Thailand. A close second was the curry with noodles, Khao Soi. Spectacular!

The day after the cooking class we slept in and then took the bus up to Chiang Dao, a small town about an hour north of Chiang Mai, up in the mountains. We stayed at a resort called the Nest ... which is really a small portal into some kind of paradise we can somehow access here on earth. It is a series of gorgeous wooden bungalows spread out across a series of edenesque gardens on the edge of a National Park full of soaring 2,000 meter mountains. Fantastic. While we we there we walked the 500 steps up to an incredible monastery, took a guided trek through the park, exploring a cave, a gorgeous waterfall and 2 Lisu villages and ate at the incredible European style restaurant at the Nest. Best dish was probably the duck in passion-fruit reduction with new potatoes and leeks, followed by an incredible vanilla bean creme brulee. Awesome. After two glorious days at the Nest (and we both wished we had booked longer), we went back to Chiang Mai, picked up our tailored shirts and Aviva's suit, and we to a Thai cultural dance performance that was half-tourist trap, half-fantastic ... the dance where the young men danced while playing veritcal drums was awesome.

Then, Friday, we headed down to Phuket. We were originally going to Samui, but it turns out that Chinese New Years is a bigger deal here than we expected and every flight to Samui was full. So Phuket (pronounced poo-get) it was ... and even though our hotel choices were limited, we ended up with an incredible deal at the Radisson Plaza Resort Panwa Bay, in a deluxe suite with a private balcony including an outdoor bathtub overlooking Panwa Bay. It was unreal. We spent much of Friday and Saturday just lounging around in the seaside pool, having drinks at the swim-up bar, checking out the aquarium and walking in the tidepools just off shore during low tide.

Friday night we ate at a an insanely pretentious beach club, Sri Panwa, down the cape, where we sat at a table that was recessed into a huge cliffside swimming pool over looking the ocean (its really tough to describe so I grabbed this image from their website - we sat at the far left table). The way to the restaurant was a half a mile walk, and we were asked no fewer than eight times if we needed a taxi to get there from the entrance (proving, again, that as we were told, Thais do not walk anywere). The table was only accessible by a series of stone steps through the pool, and as the waiters we walking over to you it looked like they were swimming. The food (giant tiger prawns and sweet/spicy grouper) was great, but the ambience was ridiculous.

Saturday afternoon we headed into Phuket city, made plans for some tours in the next few days, ate an incredible lunch at Siam Indigo (I think Aviva's loster ravioli just edged my braised young duck fillets over hokken noodle clusters) and spent another romatic night on our balcony, before waking up on Sunday to start our tours .... which I will tell you more about in the last update ....

Thailand, Week 1

I wish I could get the pictures off my camera to show ... this last week has been unreal. You would be seeing pictures of incredible ruined Wats and Chedis (temples) from the Ayuthaya period, a wild bull elephant, Aviva feeding long-tailed macaques, me feeding semi-domesticated catfish, sampan deer, gibbons and pig-tail macaques, our completely tatooed tour guide in wildman pose, an amazing 25 meter plunge fall in the middle of the rainforest, the fascinating back-canals of bangkok, fried shrimp head cakes, elaborate, gorgeous vegetable stands, the insanity of Bangkok traffic, the incredible, rainforest-like spa in Bangkok where we got two hour massages, and of course, lots and lots of Buddhas, black and white and emerald and gold, sitting and standing, old and young.

The people here are incredibly friendly and happy, and almost everyone goes far out of their way to help and to try to make you happy or comfortable whether you are eating at a street stall or a restuarant, looking for directions or buying fish food. Except for the tourist traps around major sites and the agressive tuk-tuk and taxi drivers, everyone here has been amazing.

We just arrived in Chiang Mai last night, and are staying with Daniel and Amanda, one of my best friends brother and his wife, who are basically amazing. They are doing research on the Thai highland tribes and are basically working to improve the lives of hundred of thousands of natives who are being pushed out of their heritage by modernity (and the aggressively racistish laws of the Thai government). Even though we were all exhausted we spent the first night here just talking for about 3 hours about their and our research. It was great.

So today we wandered Chiang Mai, which is a delightful city, and tomorrow we will be taking an all day cooking class before we head up into the mountains near Chiang Dao to relax, hike and enjoy nature a bit more before flying down to spend a week in on Koh Samui and Koh Tao. I cannot believe we still have two weeks to go, and that I am as excited about each of them as I was about the last week.

Thailand!!!!!

Today Aviva and I are finally starting our long delayed honeymoon, so we are heading off to Thailand until February 19th. It should be an absolute blast and we are incredibly excited about it. I will try to blog a little while we are there so if you want to know what we are up to, come here and check it out. Otherwise I will talk to you all again in about 3 weeks.

Thailand HIV Vaccine Trial

So about 2 weeks ago, in the New York times, there is an article discussing the results of an HIV vaccine trial in Thailand. This trial, conducted over three years by a combined group made up of the United States Army, the Thai Ministry of Public Health, Dr. Fauci’s institute, and the patent-holders in the two parts of the vaccine, Sanofi-Pasteur and Global Solutions for Infectious Diseases.

This trial, known as the RV 144 trial was performed on a group of 16,402 adult volunteers, began in 2003 and concluded in 2009. Although discussed as a phase III vaccine trial, the trial was actually a Phase IIb test-of-concept trial. It was the largest HIV vaccine trial ever conducted. The participants in the trail received a total of six immunizations over six-months: four immunizations with ALVAC-HIV and two with AIDSVAX B/E given at the same time as the last two ALVAC-HIV injections. Half of the participants received placebo vaccinations and the other half received the actual vaccinations.

The information I have found about the study does not specify the type of volunteers and this is important, because people with risky behavior such as prostitutes and IV drug users provide a much more robust test of vaccine efficacy, as these individuals are much more likely contract HIV. That said, HIV infection is relatively prevalent in Thailand due to a combination of drug abuse (HIV spreads through dirty needles and risky behavior brought on by drug-altered behaviors) and the prominent sex trade. US Army researchers have had a long-standing relationship with the Royal Thai Army, Thai Ministry of Public Health and other Thai vaccine experts, and together they developed a plan to test this candidate vaccine in Thailand.

The results from the trial, which came out two weeks ago, stating,

"Results of the trial show that the vaccine regimen is safe and 31.2 % effective at
preventing HIV infection. While this is a modest level of efficacy, it represents a major
step forward for HIV vaccines, providing the first evidence that development of a safe
and effective preventive HIV vaccine is possible."

More specifically, 74 out of 8,198 volunteers who received placebo immunizations became infected with HIV compared to 51 out of 8,197 volunteers who received a combination of two vaccines, ALVAC vCP1521 and AIDSVAX B/E. There was no difference in the viral load between the infected individuals receiving the placebo and those receiving the vaccine. Viral load is the amount of virus in an individuals blood, so if the vaccines were even partially working one would expect to see a reduction in the viral load in individuals who have received the vaccines. The fact that we do not see any difference in viral load is unexpected, although there are several reasonable explanations.

Overall, there have been a variety of opinions and a bit of skepticism at the impact of the trial. While some news outlets are trumpeting this as a major breakthrough, there are other articles, including those here and here, are less clear on the impact. The very small differences in the number of people infected make the statistics, while completely valid and accurate, less robust than one would like.

My own view agrees with this,that while the statistics show that the numbers are significant, they are still quite small and I would like to see a more robust effect ... mostly because a few people in either direction could alter the significance of the statistics. Still, I believe that the use of the prime-boost methodology and particular types of vaccines used gives us valuable information going forward, this is a small step in the right direction rather than a major breakthrough. Having said that, this is the first time that an HIV vaccine trial has shown any efficacy in terms of reducing HIV transmission, so it is wonderful to see in terms of hope that a successful vaccine is getting closer.