Feedback: complaint about a clinic
Ms. W sent in feedback to the MMR complaining about vaccination she received from a clinic. She wants to know how to voice her grieviances.
Well, MS W. the proper authorities to channel your complaints to are the Malaysian Medical Council and the Malaysian Medical Association's ethics committee. Complaints are taken seriously and will require you to put it in writing - please contact these bodies directly.
Malaysian Medical Resources
Monday, May 31, 2004
And we thought condoms were safe.....
Sometimes I really wonder if all this is worth the fuss. It just puzzles me why the Chemical and Veterinary Institute in Stuttgart decided on this study.Are animals using condoms too? And why on earth do we need our condoms to be more elastic?? Or perhaps I am missing something here!! ;)
So looks like now condom manufacturers will need to put a label on those condoms. And when you shop for one do not buy condoms without labels!! Of course, then you will end up with no condoms!
As N-nitrosamine is a known carcinogen, how can a local government official say that it poses no immediate health danger? Perhaps he is right, but of course, the danger of cancer may develop many years down the road. More studies need to be done. However, I would support just simply removing the substance from condoms!
We are now only waiting for condom manufacturers to rebuff these new, possibly damaging claims! Would you use a condom tonight?
| Study Finds Condoms Contain Cancer-Causing Substance BERLIN (Reuters) May 28 - Most condoms contain a cancer-causing chemical and their manufacture should be subject to greater quality control, a German scientific research institute said Friday. The Chemical and Veterinary Investigation Institute in Stuttgart, Germany, said it found the carcinogen N-nitrosamine present in 29 of 32 types of condoms it tested in simulated conditions. "N-nitrosamine is one of the most carcinogenic substances," the study's authors said. "There is a pressing need for manufacturers to tackle this problem." The carcinogen is thought to be present in a substance used to improve condom elasticity. When the rubber material comes in contact with human bodily fluids, it can release traces of N-nitrosamine, the study said. Local government officials said condom users should not stop using rubber contraceptives based on results of the study because N-nitrosamine does not present an immediate health danger. But Germany's Federal Institute for Risk Assessment said that daily condom use exposed users to N-nitrosamine levels up to three times higher than levels naturally present in food. |
Sometimes I really wonder if all this is worth the fuss. It just puzzles me why the Chemical and Veterinary Institute in Stuttgart decided on this study.Are animals using condoms too? And why on earth do we need our condoms to be more elastic?? Or perhaps I am missing something here!! ;)
So looks like now condom manufacturers will need to put a label on those condoms. And when you shop for one do not buy condoms without labels!! Of course, then you will end up with no condoms!
As N-nitrosamine is a known carcinogen, how can a local government official say that it poses no immediate health danger? Perhaps he is right, but of course, the danger of cancer may develop many years down the road. More studies need to be done. However, I would support just simply removing the substance from condoms!
We are now only waiting for condom manufacturers to rebuff these new, possibly damaging claims! Would you use a condom tonight?
Sunday, May 30, 2004
World No-Tobacco Day
Tomorrow, May 31st is World No-Tobacco Day.
The WHO says:
The tobacco lobby in this country is quite strong. Dzulkifli Abdul Razak writes in the NST:
So if you are still smoking - what are you waiting for? Kick that habit now.
Tomorrow, May 31st is World No-Tobacco Day.
The WHO says:
 Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year). If current smoking patterns continue, it will cause some 10 million deaths each year by 2025. Half the people that smoke today -that is about 650 million people- will eventually be killed by tobacco. |
The tobacco lobby in this country is quite strong. Dzulkifli Abdul Razak writes in the NST:
| TOBACCO companies have always insisted that their products contribute to the economic well-being of tobacco-growing countries. This is not the case. In fact, the opposite is true, for tobacco increases poverty. This will be among the facts and figures that will be released tomorrow, World No-Tobacco Day. Aptly, the theme this year is "Tobacco and Poverty: A vicious circle." According to the World Health Organisation (WHO), tobacco is the fourth most common risk factor in diseases worldwide. It is a leading cause of death in Malaysia, incurring high public health costs in treating tobacco-related diseases. It deprives families of breadwinners and nations of a healthy workforce. |
So if you are still smoking - what are you waiting for? Kick that habit now.
Saturday, May 29, 2004
More than meets the eye
I would not be surprised at all. Even the white coats are filthy and germ-carrying. Imagine doctors wearing the same overalls day in and day out without washing. Even ties as mentioned are rarely washed. What else? Jewellery? Stethoscope? etc?
Hand washing remains an important practise. But is that enough? Looks like we have to look closer at other things as well. Doctors appear to be the biggest culprit in hospital acquired infections!
Now that this article is published, it appears doctors will have an escalating laundry bill!!!
| Study: Patients risk getting infection from doctors’ ties LONDON: Beware of well-dressed doctors. Their ties might present a health risk. A study in New York suggests that doctors’ sartorial habits make them carriers of potentially dangerous infections. Researchers found that 47% of ties worn by medical staff at one hospital harboured bacteria and that clinicians were eight times more likely to have bugs in their ties than security staff. “Studies such as this remind us about what we may bring to our patients’ bedside,” said Steven Nurkin, of the New York Hospital Medical Centre in Queen’s, who presented the findings to the American Society for Microbiology in New Orleans. The findings called into question whether wearing a tie was in the best interests of patients. “While there is no direct evidence to implicate neckties in the transmission of infection to patients, the link between contaminated necktie and the potential for transmission must be considered,” said Nurkin. – The Guardian |
I would not be surprised at all. Even the white coats are filthy and germ-carrying. Imagine doctors wearing the same overalls day in and day out without washing. Even ties as mentioned are rarely washed. What else? Jewellery? Stethoscope? etc?
Hand washing remains an important practise. But is that enough? Looks like we have to look closer at other things as well. Doctors appear to be the biggest culprit in hospital acquired infections!
Now that this article is published, it appears doctors will have an escalating laundry bill!!!
Why do doctors resign from Public service?
Utusan Malaysia brought up this issue
Promotion prospect is an important issue. One of the most archaic aspects of the JPA (PSD) is that promotions are tied to "posts" and not given to the individual where they are working (hence the contant need to get transferred, uprooting the fmaily and what not). The JPA also has its own promotion criteria (yes, the mandatory courses and civil service exams) for the public service as a whole whereas it does not give much consideration to professional qualification and expertise as criteria.
I always thought the salary scheme and promotions of healthcare professionals should be divorced from the JPA.
One thing the article failed to mention is a more touchy issue - how many women doctors resign because of "family matters"? I don't know the statistics and I don't want to sound sexist. However this is a pertinent issue because the female:male ratio amongst medical school intake is now increasing and if I am not mistaken there are now more female medical school undergraduates than males - please tell me if this is the case in your medical school: I would be interested to know.
Utusan Malaysia brought up this issue
| Every year, about 300 doctors who have completed their housemanship resign from public service because they find themselves not cut out for a medical career, Deputy Health Minister Datuk Dr Abdul Latiff Ahmad said Friday. He said students' interest, comprehension and exposure to the duties of a doctor should be considered before they are allowed to pursue medical courses at public institutions of higher learning to prevent them from making wrong career choices. "This profession differs from others because it is based on skill and the ability to combine both the arts and sciences," he told reporters after opening the sixth Malaysian Islamic Medical Association's (PPIM) scientific meeting here. Therefore, Dr Abdul Latiff said, public universities should re-examine the method of student selection into medical courses because not all students with excellent academic results would make dedicated doctors. He said another factor encouraging doctors to leave the public service was the salary, which was much lower than that paid by the private sector. However, he said, the trend was getting less popular because the quality of the public service had improved and private practices no longer promised the high returns it once did a decade ago. "There are also those (doctors) who resign from the public sector because of the difficulty in getting promotion. Consequently, the government has suggested setting up a Medical Services Commission so that the promotion process for doctors in the public service differs from other civil servants'," he said. He said the government needed to prepare a long term plan to encourage doctors and specialists to continue serving in the public sector by providing them various facilities. For the long run, he said, the government must set up many more medical faculties, including in public institutions for higher learning which previously did not offer medical courses, to cater for a ratio of one doctor to every 800 patients (1:800) by the year 2020. The current ratio is 1:1,400. Dr Abdul Latiff said the number of Malay doctors had also increased and according to the year 2002 statistics, there were now 5,346 Malay doctors or 40 percent compared to 4,151 Chinese doctors or 31 percent and 3,546 Indian doctors or 29 percent. |
Promotion prospect is an important issue. One of the most archaic aspects of the JPA (PSD) is that promotions are tied to "posts" and not given to the individual where they are working (hence the contant need to get transferred, uprooting the fmaily and what not). The JPA also has its own promotion criteria (yes, the mandatory courses and civil service exams) for the public service as a whole whereas it does not give much consideration to professional qualification and expertise as criteria.
I always thought the salary scheme and promotions of healthcare professionals should be divorced from the JPA.
One thing the article failed to mention is a more touchy issue - how many women doctors resign because of "family matters"? I don't know the statistics and I don't want to sound sexist. However this is a pertinent issue because the female:male ratio amongst medical school intake is now increasing and if I am not mistaken there are now more female medical school undergraduates than males - please tell me if this is the case in your medical school: I would be interested to know.
Friday, May 28, 2004
Getting into Medical School
So what does it take to get into Medical school in Malaysia these days? It's certainly very competitive now that we know 128 top scorers fail to get into medical school
During my time it was quite hard to score 5 As in the STPM (or HSC as it was called back then). Are exams getting easier or are students getting smarter?
How many of the students really know what they are getting into? What's their perception of medicine as a career?
So what does it take to get into Medical school in Malaysia these days? It's certainly very competitive now that we know 128 top scorers fail to get into medical school
| This year, an amazing number of students – 1,774 – obtained the maximum CGPA, and more than half of them applied to do medicine |
During my time it was quite hard to score 5 As in the STPM (or HSC as it was called back then). Are exams getting easier or are students getting smarter?
How many of the students really know what they are getting into? What's their perception of medicine as a career?
EV71 resurfaces
Enterovirus 71 has resurfaced in HongKong:
Perhaps it's time Dr. Vadivale updates his EV71 Outbreak page. Nevertheless this link has numerous links to EV71 if you are interested.
And some info from Dr. Jane Cardosa's post in Promed:
Enterovirus 71 has resurfaced in HongKong:
| HONG KONG - A third Hong Kong toddler has been confirmed with the potentially deadly enterovirus 71 in a recent outbreak at a local nursery, the Health Department said Thursday. Enterovirus 71 killed 50 children in Taiwan in 1998, and 30 in Malaysia 1997. It is one of several viruses that causes hand, foot and mouth disease — whose symptoms include sores or rashes on those body parts, as well as fever. The latest Hong Kong enterovirus 71 case is a 2-year-old girl, Hong Kong's Health Department said in a statement. She attends the same nursery as two other toddlers who came down with the virus and went on to develop hand, foot and mouth disease, the statement said, adding those two children have since recovered. |
Perhaps it's time Dr. Vadivale updates his EV71 Outbreak page. Nevertheless this link has numerous links to EV71 if you are interested.
And some info from Dr. Jane Cardosa's post in Promed:
| HUMAN ENTEROVIRUS 71 - MALAYSIA (SARAWAK) ***************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Wed 2 Apr 2003 From: Jane Cardosa Human Enterovirus 71 Outbreak in Sarawak; Emerging New Sub- genogroup -------------------------------------------------- Sarawak is currently experiencing a large outbreak of human enterovirus 71 (HEV71) that began in February 2003. Most cases have uncomplicated hand, foot and mouth disease (HFMD), but a small number include neurologic disease. More than 70 strains isolated this year have been sequenced in the VP4 gene region. The results show that 80 percent of the strains belong to genogroup C1 (which has been seen sporadically in the Asia-Pacific region since 1997) and suggest that the next big outbreak of HEV71 in the region will likely be due to strains from this genogroup. The remaining strains belong to a distinct cluster within the B genogroup and may represent an emerging new sub-genogroup. -- Jane Cardosa University of Malaysia, Sarawak [Human enterovirus 71 (HEV71) was first isolated in 1969 and is most often associated with outbreaks of the mild childhood exanthem, hand, foot and mouth disease (HFMD). HEV71 is closely related to Coxsackie virus A16, the other major causative agent of HFMD, but unlike Coxsackie virus A16, HEV71 is also associated with cases of acute neurologic disease including poliomyelitis-like paralysis, encephalitis, and aseptic meningitis. Although HEV71 outbreaks associated with small numbers of cases of severe neurologic disease were reported in the 1980s in Australia, Asia, and the United States, mortality associated with such outbreaks was low, unlike earlier outbreaks in Bulgaria in 1975 and Hungary in 1978. 20 years later in 1997, deaths associated with epidemics of HEV71-associated HFMD in Sarawak, Malaysia, followed closely by outbreaks with high mortality in Taiwan in 1998 and 2000, raised considerable public concern about the virulence of this virus and the disease syndromes most recently attributed to it. Now a comprehensive overview of the molecular epidemiology of HEV71 in the Asia-Pacific region from 1997 through 2002 has been published by Cardosa et al., in the journal Emerging Infectious Diseases, Vol. 9, No. 4, April 2003. Phylogenetic analysis of the VP4 and VP1 genes of recent HEV71 strains indicates that several genogroups of the virus have been circulating in the Asia-Pacific region since 1997. The first of these recent outbreaks, described in Sarawak in 1997, was caused by genogroup B3. This outbreak was followed by large outbreaks in Taiwan in 1998, caused by genogroup C2, and in Perth (Western Australia) in 1999, where viruses belonging to genogroups B3 and C2 co-circulated. Singapore, Taiwan, and Sarawak had HEV71 epidemics in 2000, caused predominantly by viruses belonging to genogroup B4; however, large numbers of fatalities were observed only in Taiwan. HEV71 was identified during an epidemic of hand, foot and mouth disease in Korea; that epidemic was found to be due to viruses constituting a new genogroup, C3. - Mod.CP] |
Tuesday, May 25, 2004
Site update
I have decided to remove the Tagboard - it looked kinda ugly. Does anyone want a Forum for the Malaysian Medical Resources? Please put up your hands..... :)
I have decided to remove the Tagboard - it looked kinda ugly. Does anyone want a Forum for the Malaysian Medical Resources? Please put up your hands..... :)
More criticism for the Private wings in Public hospitals plan
This news item from IPS is interesting:
Yup. This is a real danger.
What about the existing "private wings"?
Exactly what I think too....
And what the Health Minister or anyone from th Government failed to mention:
How true. And how sad.....
This news item from IPS is interesting:
| The reaction to the plan was swift. ''It is clear that our under-financed government health care will become even less available to the poor,'' said Dr Chan Chee Khoon, coordinator of the Citizens' Health Initiative. He warned that private wings in state hospitals would lead to human and material resources being reallocated to serve the dictates of the health care market - including ''health tourism'' - rather than the needs of the poor |
Yup. This is a real danger.
What about the existing "private wings"?
| The public-private mix has already been introduced in a few hospitals such as the University Hospital (UH) and the National Heart Institute (IJN) to plug the brain drain to the private sector. ''It has been a disaster so far,'' said Dr T Jayabalan, advisor on health care issues to the Consumers Association of Penang. Drug, procedure, and laboratory charges at the UH has soared, he said. What's more, ''the IJN is probably the costliest place for heart surgery'', he noted. ''The waiting time for heart patients who are unable to afford surgery could be two years or more.'' |
Exactly what I think too....
And what the Health Minister or anyone from th Government failed to mention:
| The key issue is underfunding of public health care, a subject rarely discussed openly in Malaysia. Expenditure on public health care as a percentage of Gross Domestic Product has traditionally hovered at around 3 percent - well short of the five to six percent proposed by the World Health Organisation. Underfunding is responsible for inadequate facilities, long waiting lists and low salaries. In the Penang General Hospital, for example, the waiting time for patients needing a Magnetic Resonance Imaging (MRI) brain scan can be up to five months. Underfunding also means that government doctors remain underpaid -- despite their heavy workload. Medical officers routinely see some 150 outpatients a day, when the ideal should be not more than 50. |
How true. And how sad.....
Breast Cancer ......... in Men
From CNN Health,
Not many are aware of the possible occurence of breast cancer in men. After all, men do not have breasts. And so they thought..!
Breast cancer in men is still comparatively rare as compared with the incidence in women. However, the worry is that both the incidences of breast cancer in men and women is increasing. The exact cause of such an increase is still not known.
The situation in Malaysia, I presume, will be similar. I am not sure if we have data on breast cancer in men. Even doctors are sometimes not aware of the fact that men do get breast cancer.
Even other cancers are on the rise. I believe that there is a strong environmental component in the pathogenesis of cancer. From pollution in the air, our water supply to carcinogens in our food and smoking, we are being increasingly exposed to cancer causing agents. But because it is sometimes difficult to pinpoint the culprit, prevention can be a difficult task but possible.
Cervical cancer, for example can be avoided by regular PAP smear screenings. Similarly, breast cancer can be detected early by breast self examinations. In men, prostate cancer can also be detected earlier by simple blood investigations.
Cigarrettes are a proven source of carcinogens and should be aggresively tackled. Current measures appear sheepish.
The list goes on and on. Genetics cannot be denied in the causation of cancer and requires more research.
In the meantime, we may just have to educate our men on breast self examinations as well!!! The irony of life!
From CNN Health,
| Breast cancer on rise in U.S. men, study finds Monday, May 24, 2004 Posted: 9:56 AM EDT (1356 GMT) WASHINGTON (Reuters) -- Male breast cancer is on the rise in the United States -- bad news for men and their doctors, who do not even know to look for it, researchers reported Monday. Although the disease remains extremely rare -- just 1,600 cases are predicted for 2004 -- the 25 percent increase in 25 years is worrying, said Dr. Sharon Giordano of the University of Texas M. D. Anderson Cancer Center in Houston, who led the study............... |
Not many are aware of the possible occurence of breast cancer in men. After all, men do not have breasts. And so they thought..!
Breast cancer in men is still comparatively rare as compared with the incidence in women. However, the worry is that both the incidences of breast cancer in men and women is increasing. The exact cause of such an increase is still not known.
The situation in Malaysia, I presume, will be similar. I am not sure if we have data on breast cancer in men. Even doctors are sometimes not aware of the fact that men do get breast cancer.
Even other cancers are on the rise. I believe that there is a strong environmental component in the pathogenesis of cancer. From pollution in the air, our water supply to carcinogens in our food and smoking, we are being increasingly exposed to cancer causing agents. But because it is sometimes difficult to pinpoint the culprit, prevention can be a difficult task but possible.
Cervical cancer, for example can be avoided by regular PAP smear screenings. Similarly, breast cancer can be detected early by breast self examinations. In men, prostate cancer can also be detected earlier by simple blood investigations.
Cigarrettes are a proven source of carcinogens and should be aggresively tackled. Current measures appear sheepish.
The list goes on and on. Genetics cannot be denied in the causation of cancer and requires more research.
In the meantime, we may just have to educate our men on breast self examinations as well!!! The irony of life!
Sunday, May 23, 2004
Malaysian AIDS Foundation Circle of Hope Fund Campaign
From the Malaysian AIDS Foundation website:
How can you help?
I think collecting donations by SMS is fine but I wish organisers would be more transparent about how much actually goes to the charity and how much the Telcos make out of each SMS (if any).
Links :
Malaysian Aids Foundation (website now added to the MMR's list of Public Societies and Associations)
Malaysian Aids Council - website has at last come out of hibernation. But alot of the pages here are still "under construction"
From the Malaysian AIDS Foundation website:
 KUALA LUMPUR, May 14, 2004 – The Malaysian AIDS Foundation (MAF) today announced the launch of the Circle of Hope Fund Campaign, held in conjunction with International AIDS Memorial Day (IAMD) 2004 which will be officially observed on Sunday, 16 May.The launch was officiated by MAF Chairman Datin Paduka Marina Mahathir at 3.30p.m. on Friday, May 14 2004 at the Malaysian AIDS Council Headquarters. MAF Board of Trustees, MAF private sector partners and members of the media were invited to attend the launch of the campaign. Each year, the MAF commits close to RM 800, 000 to these three Schemes in the hope that it will help : - prevent AIDS from destroying families by ensuring that HIV+ adults remain healthy; - save the children of PLWHAs from orphanhood; - ensure that the basic and daily needs of children of PLWHAs are met in view of reduced household income levels due to HIV/AIDS - improve financial independence of households struck by HIV/AIDS. |
How can you help?
| To kick-start the Circle of Hope Fund Campaign is a Short Message Service (SMS) drive where public are given the option of making a one-off donation by typing ‘MAF’ or a monthly donation by typing ‘MAF ON’ via SMS to telephone number 36886. Each SMS costs RM2.50. |
I think collecting donations by SMS is fine but I wish organisers would be more transparent about how much actually goes to the charity and how much the Telcos make out of each SMS (if any).
Links :
Malaysian Aids Foundation (website now added to the MMR's list of Public Societies and Associations)
Malaysian Aids Council - website has at last come out of hibernation. But alot of the pages here are still "under construction"
Site Update
The MMR's Professional website listing has been updated with the following new entries:
- MMA Selangor branch
- Malaysian Society of Haematology
The MMR's Professional website listing has been updated with the following new entries:
- MMA Selangor branch
- Malaysian Society of Haematology
Saturday, May 22, 2004
Self medication : The way forward?
In Medscape,
Self medication is becoming an increasingly worrisome trend. Patients thus would attempt to buy medications without having to see a doctor. This arises due to the fact that information is now readily available especially on the internet. Even medical advice can sometimes be sought online.
The article above illustrates that current trend. Statins have been proven to be effective in decreasing cardiovascular morbidity and mortality. Unfortunately, it is not free of serious side effects and may not be appropriate for everyone. The decision by the British Government to allow the sale of statins over the counter is puzzling. Who will then monitor such patients? The pharmacist? What the British Government has done contradicts all basic ethics and teachings in clinical medicine. The rationale for such a decision is a mystery. The comdemnation by Lancet is appropriate and should be supported. Which drug is next?
It is sincerely hoped that Malaysia do not follow Britain in this regard. It is my personal belief that self diagnosis and medication should be discouraged with the exception of minor ailments like headaches. However, recurrence of a problem should warrant a visit to a doctor.
Just as the Internet has revolutionised medicine, it has also changed how patients perceive their healthcare providers. Patients are now "on par" with their doctors in terms of access to information. Although it is commendable, there has to be a certain amount of caution when reading online materials. Not all that you read is necessarily true, thus similar to the mainstream media. It is the ability to critically assess these articles is what that matters. Doctors can thus no longer "fool" their patients with incorrect or obsolete information.
I strongly believe that patients and doctors should strengthen their relationships rather than severing it in the name of reducing costs. It is this collaborative effort that ensures an optimal management of a patient. Afterall, the doctor always has the patient's best interest at heart! :)
In Medscape,
| Lancet Slams UK Approval of OTC Cholesterol Drug LONDON (Reuters) May 21 - The British government is using the public as human guinea pigs by allowing the sale of cholesterol-lowering medicines without a prescription, a top medical journal said on Friday. The Lancet said in an editorial there was insufficient clinical data to justify self-medication with the drugs, which are widely used to reduce the risk of heart attack and stroke. Last week's move makes Britain the first country in the world to allow over-the-counter sales of so-called statin drugs. Merck & Co Inc's Zocor, or simvastatin, will be the first statin to go over-the-counter this summer. It will be sold in a low dose of 10 milligrams and cost between 10 and 15 pounds per 28-day pack. In the absence of evidence that the change will actually save lives The Lancet said it appears the real reason is to save money. |
Self medication is becoming an increasingly worrisome trend. Patients thus would attempt to buy medications without having to see a doctor. This arises due to the fact that information is now readily available especially on the internet. Even medical advice can sometimes be sought online.
The article above illustrates that current trend. Statins have been proven to be effective in decreasing cardiovascular morbidity and mortality. Unfortunately, it is not free of serious side effects and may not be appropriate for everyone. The decision by the British Government to allow the sale of statins over the counter is puzzling. Who will then monitor such patients? The pharmacist? What the British Government has done contradicts all basic ethics and teachings in clinical medicine. The rationale for such a decision is a mystery. The comdemnation by Lancet is appropriate and should be supported. Which drug is next?
It is sincerely hoped that Malaysia do not follow Britain in this regard. It is my personal belief that self diagnosis and medication should be discouraged with the exception of minor ailments like headaches. However, recurrence of a problem should warrant a visit to a doctor.
Just as the Internet has revolutionised medicine, it has also changed how patients perceive their healthcare providers. Patients are now "on par" with their doctors in terms of access to information. Although it is commendable, there has to be a certain amount of caution when reading online materials. Not all that you read is necessarily true, thus similar to the mainstream media. It is the ability to critically assess these articles is what that matters. Doctors can thus no longer "fool" their patients with incorrect or obsolete information.
I strongly believe that patients and doctors should strengthen their relationships rather than severing it in the name of reducing costs. It is this collaborative effort that ensures an optimal management of a patient. Afterall, the doctor always has the patient's best interest at heart! :)
Thursday, May 20, 2004
For those Coffee Lovers
From Medscape,
Good news for Coffee Lovers! Another reason to rush to Starbucks and get that astronomically priced but absolutely delicious Caramel Macchiato! Yes, coffee drinking is inching its way into the fabric of Malaysian lifestyle. It is becoming an increasingly popular and trendy pastime! Cost, it appears, is no longer a factor to our increasingly extravagant young generation.
The impact of the above study is not known. Similarly, the exact mechanism of action of caffeine on the liver is still mysterious. Have we then stumbled on an incidental miracle?
Nevertheless, it will prove sufficient to justify those long hours at a coffee joint for those coffee lovers! Sipping coffee in a WIFI enabled location seems to be like heaven on earth! Well, it still probably cannot surpass the thrill of thunderous sounds of a shoddy discotheque while binging on destructive substances! Or can it?
From Medscape,
| Coffee, Caffeine Consumption Associated With Reduced Liver Disease Karla Harby May 18, 2004 (New Orleans) — A U.S. population study of 5,944 adults conducted by researchers at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has found a strong association between coffee drinking and caffeine consumption and a lower risk of liver injury in persons at high risk for liver disease. The researchers defined the high-risk population as those who reported being heavy drinkers of alcohol, or who had hepatitis B or C, iron overload, were obese, or had impaired glucose metabolism. Liver injury was defined as a serum alanine aminotransferase (ALT) activity level in excess of 43 U/L. |
Good news for Coffee Lovers! Another reason to rush to Starbucks and get that astronomically priced but absolutely delicious Caramel Macchiato! Yes, coffee drinking is inching its way into the fabric of Malaysian lifestyle. It is becoming an increasingly popular and trendy pastime! Cost, it appears, is no longer a factor to our increasingly extravagant young generation.
The impact of the above study is not known. Similarly, the exact mechanism of action of caffeine on the liver is still mysterious. Have we then stumbled on an incidental miracle?
Nevertheless, it will prove sufficient to justify those long hours at a coffee joint for those coffee lovers! Sipping coffee in a WIFI enabled location seems to be like heaven on earth! Well, it still probably cannot surpass the thrill of thunderous sounds of a shoddy discotheque while binging on destructive substances! Or can it?
Wednesday, May 19, 2004
Protecting Your Future
AIA is spending 5 million on an Ad Campaign called Protecting Your Future. Wow, great I thought. At last, an Insurance company which places emphasis on preventative medicine and perhaps now at last encouraging people to go for screening, well men/women clinics, promoting healthy lifestyles etc etc.
But wait... no, AIA is going to blow it all on...:
Insurance companies should realise that if they want to cut down on reimbursements for "Critical Illnesses" then it is imperative that the message goes out that prevention is better than cure or in this case insurance protection which is useful only when you are struck down with the disease. Isn't it better to go for regular BP checks, cholesterol measurement etc than insure yourself but neglect the more important aspects of prevention? How many Malaysian Insurance companies will reimburse "routine" screening tests and well men/women clinic visits?
AIA is spending 5 million on an Ad Campaign called Protecting Your Future. Wow, great I thought. At last, an Insurance company which places emphasis on preventative medicine and perhaps now at last encouraging people to go for screening, well men/women clinics, promoting healthy lifestyles etc etc.
But wait... no, AIA is going to blow it all on...:
| The campaign is aimed at reminding customers of the real-life costs and implications of inadequate insurance protection. |
Insurance companies should realise that if they want to cut down on reimbursements for "Critical Illnesses" then it is imperative that the message goes out that prevention is better than cure or in this case insurance protection which is useful only when you are struck down with the disease. Isn't it better to go for regular BP checks, cholesterol measurement etc than insure yourself but neglect the more important aspects of prevention? How many Malaysian Insurance companies will reimburse "routine" screening tests and well men/women clinic visits?
Tuesday, May 18, 2004
Update: more Northern hospital sites
David Ting has sent in these links:
Kedah Medical Centre
Metro Specialist Hospital
Putra Medical Centre
I have updated the MMR listing of Private Hospital websites with these items. Thanks David.
I note that there are TWO Putra Medical Centres now - one in Sungei Buloh and one in Kedah. I wonder if there should be a body to coordinate the Names of Private hospitals lest there is confusion. Perhaps the Association of Private Hospitals should do something
David Ting has sent in these links:
Kedah Medical Centre
Metro Specialist Hospital
Putra Medical Centre
I have updated the MMR listing of Private Hospital websites with these items. Thanks David.
I note that there are TWO Putra Medical Centres now - one in Sungei Buloh and one in Kedah. I wonder if there should be a body to coordinate the Names of Private hospitals lest there is confusion. Perhaps the Association of Private Hospitals should do something
Monday, May 17, 2004
Its not about the Private...
There's been a mini-battle of words in the Press between the honorable Minister of Health and the Association of Private Hospitals. Dr Chua fired the first salvo in Private Hospitals Fear Competition (MMM Permalink):
Then Dr. Ridzwan Bakar, the APHM president replied in Private wings do not mean cheaper fees (MMM Permalink):
I think the point here is the efficiency of the people (administrators and support staff, nursing, labs, radiology etc.) who will run the private wings in the public hospitals. I can't imagine a system which is already overburdened with a large patient load also take on the additional burden of a private wing. This will almost certainly drain resources from the Public side - in terms of manpower, lab and radiology services, OT time etc etc. The Government will then have to hire additional staff to run the private wing as there won't be enough nurses and other staff from the Public sector. In the end, it will become a small exercise in privatisation of the Public medical services. I think too there is a real danger in deterioration of the standard of care in the Public services. I doubt too that the reason for this - retaining doctors in service - will work. Doctors from UMMC and HUKM which have private wings are still resigning!
At the end of the day, the Government MUST separate the salary scheme of Health professionals from the archaic Public Services Department which only knows how to lump all the Public servants together with minial differentiation of salary schemes which are hardly realistic in todays job market. There MUST be a comprehensive and compulsory not-for-profit National Health Insurance which will cover all Malaysians of all ages so as to take the burden off the Public health services. Unless the latter is in place, the Government must not consider any form of privatisation.
There's been a mini-battle of words in the Press between the honorable Minister of Health and the Association of Private Hospitals. Dr Chua fired the first salvo in Private Hospitals Fear Competition (MMM Permalink):
| Private hospitals fear the competition that may arise from the proposed setting up of private wings in government hospitals, said Health Minister Datuk Dr Chua Soi Lek. He said some people were worried the move would affect the quality of service in government hospitals. “We have to strike a balance between the profit-oriented private sector and the Government’s responsibility of providing services at minimal rates. |
Then Dr. Ridzwan Bakar, the APHM president replied in Private wings do not mean cheaper fees (MMM Permalink):
| The setting up of private wings in government hospitals will not mean that medical fees would be cheaper compared to private hospitals, said Association of Private Hospitals of Malaysia president Datuk Dr Ridzwan Bakar. He said fees charged would depend on the tests needed by the patients. He said private wing charges would be different from those at private hospitals due to the cost of machines and efficiency of usage. |
I think the point here is the efficiency of the people (administrators and support staff, nursing, labs, radiology etc.) who will run the private wings in the public hospitals. I can't imagine a system which is already overburdened with a large patient load also take on the additional burden of a private wing. This will almost certainly drain resources from the Public side - in terms of manpower, lab and radiology services, OT time etc etc. The Government will then have to hire additional staff to run the private wing as there won't be enough nurses and other staff from the Public sector. In the end, it will become a small exercise in privatisation of the Public medical services. I think too there is a real danger in deterioration of the standard of care in the Public services. I doubt too that the reason for this - retaining doctors in service - will work. Doctors from UMMC and HUKM which have private wings are still resigning!
At the end of the day, the Government MUST separate the salary scheme of Health professionals from the archaic Public Services Department which only knows how to lump all the Public servants together with minial differentiation of salary schemes which are hardly realistic in todays job market. There MUST be a comprehensive and compulsory not-for-profit National Health Insurance which will cover all Malaysians of all ages so as to take the burden off the Public health services. Unless the latter is in place, the Government must not consider any form of privatisation.
Sunday, May 16, 2004
To Russia with...
Back in April, ES asked about studying in a Russian medical school.
Interestingly, there is an article in The Star's Education section (MMM permalink)on studying Medicine in Russia.
The article states:
To my mind, this is not the same as saying these degrees are recognised by the Malaysian Medical Council as the MMC is the proper body to accord recognition and not the PSD. These schools are not listed in the MMC's Schedule II list of recognised Medical schools or the list of Unscheduled Medical Schools from which graduates may sit for a qualifying exam. It may be that the website lists are out of date (no surprise) and hence potential students would be wise to check with the MMC and not rely on the newspaper report.
It must be very tough studying medicine in Russia mainly because of the need to learn Russian particularly in the clinical years. The same could be said of going to Japan or Korea to study medicine. I am not clear what the entrance requirements are but I hope standards are not compromised for the sake of $$$. Did I not read a report somewhere that a student from the Arts stream somehow got accepted into a Russian medical school?
Back in April, ES asked about studying in a Russian medical school.
Interestingly, there is an article in The Star's Education section (MMM permalink)on studying Medicine in Russia.
The article states:
| The Public Services Department in Malaysia recognises medical degrees from the Moscow Medical Academy, Russian State Medical University, Nizhny Novgorod State Medical University, Volgograd State Medical University and Kursk State Medical University. The six-year medical degree in Russia includes clinical experience. |
To my mind, this is not the same as saying these degrees are recognised by the Malaysian Medical Council as the MMC is the proper body to accord recognition and not the PSD. These schools are not listed in the MMC's Schedule II list of recognised Medical schools or the list of Unscheduled Medical Schools from which graduates may sit for a qualifying exam. It may be that the website lists are out of date (no surprise) and hence potential students would be wise to check with the MMC and not rely on the newspaper report.
It must be very tough studying medicine in Russia mainly because of the need to learn Russian particularly in the clinical years. The same could be said of going to Japan or Korea to study medicine. I am not clear what the entrance requirements are but I hope standards are not compromised for the sake of $$$. Did I not read a report somewhere that a student from the Arts stream somehow got accepted into a Russian medical school?
Saturday, May 15, 2004
Hyperlipidemia: Focus on Ezetimibe
Hyperlipidemia has long been known to be a risk factor for cardiovascular morbidity and mortality. The focus now is on Low Density Lipoprotein(LDL) cholesterol or widely known as the bad cholesterol. Achieving targets for LDL-c is now the priority in any anti-lipid management. Target levels for LDL-c has been continually revised in line with new evidences. Of course, the lower the better!
Statins(HMG Co-A reductase inhibitors) have been at the forefront of anti-lipid management. Many studies have substantiated its effectiveness in reducing mortality (CARE, LIPID, HPS etc) . However, with the acceptance of more aggressive targets, statins alone is usually not sufficient! Most patients will require combination therapy. However, other classes of drugs are associated with side effects that can be quite uncomfortable. Fibrates have been a good partner for statins but this combination increases the risk of rhabdomyolysis! Moreover, fibrates are quite ineffective in lowering LDL. Niacin and cholestyramine have its own share of side effects as well!
In comes Ezitimibe, a selective cholesterol absortion inhibitor marketed as Ezetrol. It inhibits absorption of cholesterol from dietary and biliary sources by inhibiting transport of cholesterol through the intestinal wall. If given alone, it can lower LDL by 16-20% from the baseline. However, combining it with a statin enable up to 50% reduction of LDL! No combinations have yet to provide such dramatic decrease in LDL! It also displayed a good safety and tolerability profile. How this will translate into reducing mortality is still unknown and trials are ongoing!
Cardiologist and diabetologist are now beginning to advocate the combination of statins and ezetmibe for a more effective control of LDL. Ezetimibe has only been approved in Malaysia this year and not many have caught on to this new concept.
Combination pill containing statins and ezetimibe is already in the market but has yet to be approved in Malaysia. Nevertheless such advances in lipid management is welcomed in our daily struggle in achieving treatment targets for our patients!
Hyperlipidemia has long been known to be a risk factor for cardiovascular morbidity and mortality. The focus now is on Low Density Lipoprotein(LDL) cholesterol or widely known as the bad cholesterol. Achieving targets for LDL-c is now the priority in any anti-lipid management. Target levels for LDL-c has been continually revised in line with new evidences. Of course, the lower the better!
Statins(HMG Co-A reductase inhibitors) have been at the forefront of anti-lipid management. Many studies have substantiated its effectiveness in reducing mortality (CARE, LIPID, HPS etc) . However, with the acceptance of more aggressive targets, statins alone is usually not sufficient! Most patients will require combination therapy. However, other classes of drugs are associated with side effects that can be quite uncomfortable. Fibrates have been a good partner for statins but this combination increases the risk of rhabdomyolysis! Moreover, fibrates are quite ineffective in lowering LDL. Niacin and cholestyramine have its own share of side effects as well!
In comes Ezitimibe, a selective cholesterol absortion inhibitor marketed as Ezetrol. It inhibits absorption of cholesterol from dietary and biliary sources by inhibiting transport of cholesterol through the intestinal wall. If given alone, it can lower LDL by 16-20% from the baseline. However, combining it with a statin enable up to 50% reduction of LDL! No combinations have yet to provide such dramatic decrease in LDL! It also displayed a good safety and tolerability profile. How this will translate into reducing mortality is still unknown and trials are ongoing!
Cardiologist and diabetologist are now beginning to advocate the combination of statins and ezetmibe for a more effective control of LDL. Ezetimibe has only been approved in Malaysia this year and not many have caught on to this new concept.
Combination pill containing statins and ezetimibe is already in the market but has yet to be approved in Malaysia. Nevertheless such advances in lipid management is welcomed in our daily struggle in achieving treatment targets for our patients!
Friday, May 14, 2004
Nurses Day
International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale's birth. The theme for 2004 is: NURSES: Working with the Poor; Against Poverty.
Is nursing still a popular profession amongst Malaysians?
Utusan carried this story:
Is it all about attitude? I think it's more than that. There is great importance in a sense of professionalism and gratification in seeing through patients under one's care. It's also equally important to be acknowledged by patients, doctors and indeed employers (Goevernment, hospitals) and not to be taken for granted.
And it's also about pay. If the nurses pay in Malaysia falls below that of office and factory workers, is it no surprise Nursing is less popular nowadays? Countries like in the Middle East, Brunei, UK, USA and Australia pay their nurses well - so much so that they attract our nurses - a nursing drain which our good Health Minister forgot to mention. The salary of nurses in these countries can be something like RM8000-10000 per month, exceeding even the salary of Malaysian Government doctors.
Well if anyone is interested in Nursing as a profession, the MMR has links to the various nursing schools with websites in the Schools page.
2004 - Nurses Working with the Poor; Against Poverty
International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale's birth. The theme for 2004 is: NURSES: Working with the Poor; Against Poverty.
Is nursing still a popular profession amongst Malaysians?
Utusan carried this story:
| Nursing is no longer an attractive profession among girls as the noble values of Malaysian society have changed with priority given to materialism, Health Minister Datuk Dr Chua Soi Lek said Thursday. In the past there was stiff competition to become nurses but not so now, he said after opening a Hemodialysis Centre here. "Thirty years ago Malaysian girls in large numbers went as far as England for nurses training. Now there is no such enthusiasm." "Nursing is no longer the profession of the first choice. It is not easy to look after and care for patients, they say and look for work instead in factories and offices." Dr Chua said the shortage of nurses was acute. "The shortage will remain a permanent feature as long as Malaysian women and men do not change their attitude towards nursing as a profession," he said. |
Is it all about attitude? I think it's more than that. There is great importance in a sense of professionalism and gratification in seeing through patients under one's care. It's also equally important to be acknowledged by patients, doctors and indeed employers (Goevernment, hospitals) and not to be taken for granted.
And it's also about pay. If the nurses pay in Malaysia falls below that of office and factory workers, is it no surprise Nursing is less popular nowadays? Countries like in the Middle East, Brunei, UK, USA and Australia pay their nurses well - so much so that they attract our nurses - a nursing drain which our good Health Minister forgot to mention. The salary of nurses in these countries can be something like RM8000-10000 per month, exceeding even the salary of Malaysian Government doctors.
| IN KOTA BHARU, Deputy Minister Datuk Dr Abdul Latif Ahmad said the Health Ministry has set up a special committee to review qualifications and allowances for government doctors, nurses and medical workers in efforts to ensure they received commensurate renumeration based on their qualifications and duties. He said the committee, formed last week, was headed by the ministry's newly appointed Secretary-General Datuk Ismail Adam. The committee will conduct a study on the matter and recommend proposals to the Public Service Department (JPA). "We support more allowances for medical personnel but they depend on the agreement and approval of the JPA," he told reporters after launching the national-level TB Day at the Universiti Sains Malaysia campus, here. He said this when asked to comment on the reluctance of the younger generation to choose nursing as their career as the ministry did not have a salary grade for nurses with degrees and they were lumped together with diploma holders. On Wednesday, the Malaysian Nursing Association president, Dayang Annie Abang Narudin said there was now a shortage of 20,000 specialised nurses and the situation became more acute with at least 1,000 nurses either leaving the profession or going on retirement each year. |
Well if anyone is interested in Nursing as a profession, the MMR has links to the various nursing schools with websites in the Schools page.
Thursday, May 13, 2004
Hope for Thalassaemics
In the NST,
This is a heartening advance. Thalassaemics especially those of the beta-type, usually require repeated blood transfusions. This will increase their iron level in their body over time leading to a condition termed haemasiderosis. This can affect the heart, nerves and endocrine tissues. Most thalassaemics had a short life span due to this unwanted accumulation of iron.
Then iron chelation with desferoxamine was found. Iron chelation means binding to excess iron for excretion from the body. However, the patients were inconvenienced by the fact that this drug could only be given by a intramuscular route. Thus the quest for an oral drug began.
There is currently another oral agent, desferiprone. It however is far less effective than desferoxamine and had potential suppressive effects on white blood cells. This latest oral drug of ICL 670 is so far been promising. In actual fact at a dose of 20mg/kg/day, it surpasses the chelating effects of desferoxamine. It is also a daily dosing drug thus it can be taken with ease. There has so far been no reported adverse side effects.
Despite still in Phase III trials, such promise augurs well for the thalassaamic community. Malaysia has a high number of thalassaemia patients and those with traits. One way to fight thalassaemia is effective family counselling. Partners who both have thalassaemia traits should be advised to not get married. Thus we can hopefully decrease the prevalence of this faulty gene.
We are still waiting for the day that gene therapy can cure all genetic diseases. We are still a long way from it but current research is on-going. Due to a high number of thalassaemic patients here, it would be wise for the government to invest more money in research. Pharmaceutical companies can also play a role in establishing a research center here in Malaysia!
Docguide article
E-Thal
In the NST,
| Hope for thalassaemic patients Ranjeetha Pakiam and Farish Shahrir KUALA LUMPUR, May 12: The painful injection that thalassaemic patient Mohd Zanel Ibrahim, 18, endures daily will become a thing of the past soon. Advances in the medical field have brought substitute medication in the form of pills and syrup which can be taken orally. A new drug called ICL670 removes excess iron from the thalassaemic patient's body caused by frequent blood transfusions. The transfusions are needed since those suffering from the genetic disease experience rapid break-up of red blood cells, leading to anaemia (low haemoglobin levels). This drug, so far, is said to have no side-effects. ................ |
This is a heartening advance. Thalassaemics especially those of the beta-type, usually require repeated blood transfusions. This will increase their iron level in their body over time leading to a condition termed haemasiderosis. This can affect the heart, nerves and endocrine tissues. Most thalassaemics had a short life span due to this unwanted accumulation of iron.
Then iron chelation with desferoxamine was found. Iron chelation means binding to excess iron for excretion from the body. However, the patients were inconvenienced by the fact that this drug could only be given by a intramuscular route. Thus the quest for an oral drug began.
There is currently another oral agent, desferiprone. It however is far less effective than desferoxamine and had potential suppressive effects on white blood cells. This latest oral drug of ICL 670 is so far been promising. In actual fact at a dose of 20mg/kg/day, it surpasses the chelating effects of desferoxamine. It is also a daily dosing drug thus it can be taken with ease. There has so far been no reported adverse side effects.
Despite still in Phase III trials, such promise augurs well for the thalassaamic community. Malaysia has a high number of thalassaemia patients and those with traits. One way to fight thalassaemia is effective family counselling. Partners who both have thalassaemia traits should be advised to not get married. Thus we can hopefully decrease the prevalence of this faulty gene.
We are still waiting for the day that gene therapy can cure all genetic diseases. We are still a long way from it but current research is on-going. Due to a high number of thalassaemic patients here, it would be wise for the government to invest more money in research. Pharmaceutical companies can also play a role in establishing a research center here in Malaysia!
Docguide article
E-Thal
Wednesday, May 12, 2004
Do it for your country
Take the Durex Global Sex Survey 2004 and stand a chance to win an iPod!
In 2003, 5645 Malaysians took part in the Durex survey. Let's do better this year :)
The results showed:
76% Malaysian are happy with their sex life
Malaysians ranked at the bottom (just beating Singapore which reported 96) with sex an average of 100 times a year - may be this explains why Viagra, Cialis and now Levitra sell well here 8-)
Take the Durex Global Sex Survey 2004 and stand a chance to win an iPod!
In 2003, 5645 Malaysians took part in the Durex survey. Let's do better this year :)
The results showed:
76% Malaysian are happy with their sex life
Malaysians ranked at the bottom (just beating Singapore which reported 96) with sex an average of 100 times a year - may be this explains why Viagra, Cialis and now Levitra sell well here 8-)
Tuesday, May 11, 2004
The CHI Speaks
At last someone from the Citizen's Health Initiative has responded to the Government's plans to setup Private wings in Government Hospitals. Dr Chan Chee Khoon is the coordinator of the CHI and he wrote this letter to Malaysiakini:
I think these are good points. Time and time again we hear that the Government cannot "match" the income of doctors' in the private sector. The point is that salaries of Government doctors have fallen so far behind the times that the moot point is that even the drug companies sales representative can earn more than the medical specialists, let alone comparing with incomes of doctors in private practice. As for the latter the situation is basically what they earn is proportational to how hard they work. SingHealth on the other hand looks far more proactive and their public hospital positions are much better paid than Malaysian ones. They are able to retain senior medical staff better than in Malaysia. Why can't the Malaysian Government fo the same? It boils down to the very archaic mentality of the civil service (JPA) which ties down the professionals to the rest of the civil service. It's high time this is separated and professionals get due recognition for their services.
The CHI has a website, the last time I checked it was hosted on one of the USM servers but it's down at this point in time. If there is another link, I would appreciate it if someone could point it out.
At last someone from the Citizen's Health Initiative has responded to the Government's plans to setup Private wings in Government Hospitals. Dr Chan Chee Khoon is the coordinator of the CHI and he wrote this letter to Malaysiakini:
| Some years back, as part of the government's corporatisation policy, government hospitals were directed to increase the rate of their cost recovery (at the time, patient charges at government hospitals contributed in toto to about 5-10 percent of the hospitals' actual operational costs, i.e. government medical services were being subsidised to the extent of 90-95 percent). In preparation for corporatisation, government hospitals were instructed to increase their cost recovery, so that the government could reduce its health outlays which would be preferentially allocated to the low-income, while ‘those who could afford to pay more should become less dependent on government subsidies’, or better yet, look to the private sector for their healthcare needs. (This is the World Bank's favoured ‘targeted approach’ for a rump public sector in healthcare, as privatisation proceeds to create markets for healthcare entrepreneurs, and more generally, a generic template for the privatisation of social services). Well, in June 2002, the janitor responsible for my building at the Universiti Sains Malaysia in Penang underwent colorectal cancer surgery at the Penang General Hospital. She earns RM500 monthly (no overtime) and receives no hospitalisation benefits from her private concessionaire employer (outpatient treatment expenses are split 50:50 between her and her employer). When she was discharged from her third-class ward, she was presented with a bill for RM1,662 (for a stapler device to re-join her colon after surgery), and RM141 in ward charges. Some months later, I brought this up with the hospital director, who in turn replied that this was in line with a government directive to increase cost recovery to about 20 percent of the operational costs of the Health Ministry's hospitals. It is clear that our underfinanced government healthcare will become even less available to the poor when private wings are set up in government hospitals as human and material resources are reallocated to serve the dictates of the healthcare market rather than the needs of the poor. Any expectations that private wings will generate revenue for government hospitals for cross subsidies to poorer patients, have been disabused by the same article: "On MMA's complaints of ‘fee splitting’ (where doctors pass on part of their fees to the hospitals they serve), (Health Minister) Dr Chua asked doctors attached to private hospitals to lodge reports with the ministry if this happened. "It is regarded as unethical," he said. Would it also be unethical for government hospitals to retain a substantial portion of the professional fees earned in private wings? It is furthermore predictable that private wings will soon be encouraged to service the regional health tourism market as well. Indeed, this is already the case. At a management conference organised by the Health Ministry in 2002 in Penang, Chow Sang Hoe, a consultant with Ernst & Young, reported on a survey of health tourism prospects commissioned by a group of private hospitals in conjunction with the ministry. One of the salient points in his talk was that cardiological and cardiothoracic services constituted the largest clinical category (38 percent) of inpatient procedures performed for foreign nationals at the 28 hospitals surveyed (five public, 23 private), and that the Institut Jantung Negara (a corporatised government referral heart hospital) figured prominently in this. The Citizens' Health Initiative has repeatedly voiced its concern over such developments. We are not against foreign nationals benefitting from our national healthcare capabilities, indeed we can take pride in this. But we are much concerned when more and more of our local health resources are diverted to serving regional (and national) healthcare priorities as dictated by economic (market) demand, rather than on the basis of need. The proposal to introduce private wings in government hospitals is an unworthy idea which should be definitively scrapped. |
I think these are good points. Time and time again we hear that the Government cannot "match" the income of doctors' in the private sector. The point is that salaries of Government doctors have fallen so far behind the times that the moot point is that even the drug companies sales representative can earn more than the medical specialists, let alone comparing with incomes of doctors in private practice. As for the latter the situation is basically what they earn is proportational to how hard they work. SingHealth on the other hand looks far more proactive and their public hospital positions are much better paid than Malaysian ones. They are able to retain senior medical staff better than in Malaysia. Why can't the Malaysian Government fo the same? It boils down to the very archaic mentality of the civil service (JPA) which ties down the professionals to the rest of the civil service. It's high time this is separated and professionals get due recognition for their services.
The CHI has a website, the last time I checked it was hosted on one of the USM servers but it's down at this point in time. If there is another link, I would appreciate it if someone could point it out.
Monday, May 10, 2004
An Aging Population : Focus on Men's Health
Malaysia has an aging population. Soon we will join the ranks of developed countries in terms of its demographic characteristics. This was pointed out by Dato Dr Tan Hui Ming, a consultant urologist with SJMC, during the launch of Levitra(ED drug) recently. Interestingly, it is the men that is not coping well with aging, that is they are not aging healthily. Several contributors include the consumption of alcohol, smoking and their reluctance to seek early medical attention. This increases the incidences of cardiovascular morbidity, cancer, diabetes and hyperlipidemic states. All this contributes to the higher rate of mortality in a younger age group among men leading to their declining numbers as the age increases.
Even erectile dysfunction it appears is prevalent among our aging men. Nevertheless, not many seek medical attention and even less are taking treatments for erectile dysfunction(ED). The treatment of ED has revolutionised since the introduction of oral medications that is the PDE-5 inhibitors. Sildenafil(viagra) was the first of its kind. Levitra (vardenafil) can be considered as a second generation PDE-5 inhibitor.
Among the advantages of Levitra over Viagra is its specificity for the PDE-5 enzyme. This specificity reduces side effects associated with viagra especially blue-green color vision associated with inhibition of PDE-6 enzyme in the eye. Although Levitra also inhibits the PDE-11 enzyme, the function of this enzyme is unknown. Side effects from trials include benign conditions eg headaches , flushes, nasal congestion and an upset stomach. The onset of action(ie the time to achieving an erection) for Levitra could also be as early as 10-15 minutes with variations among patients.
According to the PROVEN study, Levitra was effective in about 46% of the men who were previously unsuccessful with Viagra. However, note that there are no head to head comparison studies to date.
Below is an article I wrote on MMR previously
With new information on Levitra, it probably holds an edge over Viagra in terms of its onset of action and its safety profile. Cialis is less enticing due to its long duration of action. However, all 3 drugs do work and it boils down to patient preferences. As pointed out, a good sexual life is not all just about achieving an erection!
Lastly, healthy aging involves a healthy and fulfilling sexual life! Levitra is certainly a welcomed addition to the armamentarium of ED treatment.
http://www.levitra.com
Menshealth (Malaysian site)
Malaysia has an aging population. Soon we will join the ranks of developed countries in terms of its demographic characteristics. This was pointed out by Dato Dr Tan Hui Ming, a consultant urologist with SJMC, during the launch of Levitra(ED drug) recently. Interestingly, it is the men that is not coping well with aging, that is they are not aging healthily. Several contributors include the consumption of alcohol, smoking and their reluctance to seek early medical attention. This increases the incidences of cardiovascular morbidity, cancer, diabetes and hyperlipidemic states. All this contributes to the higher rate of mortality in a younger age group among men leading to their declining numbers as the age increases.
Even erectile dysfunction it appears is prevalent among our aging men. Nevertheless, not many seek medical attention and even less are taking treatments for erectile dysfunction(ED). The treatment of ED has revolutionised since the introduction of oral medications that is the PDE-5 inhibitors. Sildenafil(viagra) was the first of its kind. Levitra (vardenafil) can be considered as a second generation PDE-5 inhibitor.
Among the advantages of Levitra over Viagra is its specificity for the PDE-5 enzyme. This specificity reduces side effects associated with viagra especially blue-green color vision associated with inhibition of PDE-6 enzyme in the eye. Although Levitra also inhibits the PDE-11 enzyme, the function of this enzyme is unknown. Side effects from trials include benign conditions eg headaches , flushes, nasal congestion and an upset stomach. The onset of action(ie the time to achieving an erection) for Levitra could also be as early as 10-15 minutes with variations among patients.According to the PROVEN study, Levitra was effective in about 46% of the men who were previously unsuccessful with Viagra. However, note that there are no head to head comparison studies to date.
Below is an article I wrote on MMR previously
| Erectile Dysfunction(ED) : Sildenafil vs tadalafil vs vardenafil ED is an under-discussed problem between patients and their doctors. Unfortunately most doctors themselves are uncomfortable discussing about sexual problems with their patients. The prevalence of ED in Malaysia is not known but I would suspect little difference with other countries. In the United States, up to 26% of males are said to be suffering from moderate to severe forms of ED. The aetiology of ED is numerous from organic (eg vascular compromise due to smoking or diabetes) to psychogenic problems. Some have mixed aetiologies. The treatment of ED has revolutionised over the past decade with the introduction of Sildenafil (Viagra). Since its advent, second generation ED drugs have surfaced namely talalafil (Cialis) and Vardenafil(levitra). These are drugs that competitively inhibit the enzyme Phosphodiesterase (PDE), specifically PDE-5 which is mainly found in smooth muscle and vascular tissues. For the benefit of all, here is some physiology about erection. Upon sexual stimulation, the parasympathetic nerves release nitric oxide which then diffuses into smooth muscle cells before binding to enzyme guanylate cyclase there. Guanylate cyclase converts GTP to cGMP. cGMP then binds to Protein Kinase G which then causes smooth muscle cells to relax allowing blood to flow through the sinosoids of the corpus cavernosum producing an erection. PDE-5 causes the breakdown of cGMP. Therefore by inhibiting PDE-5, cGMP could produce its effects for a longer period of time. With the recent introduction of tadalafil(Cialis) in Malaysia, which would be a better choice? Viagra or Cialis? There are at this moment no comparator studies between the two. So no one can say one is better than the other. But doubleblind placebo controlled studies have shown both to be efficacious. Viagra has a shorter half life (4-6 hours) and its onset of action is approximately 30 minutes. Studies have shown and proven its safety , even in heart patients. But side effects are dose dependant ie the higher the prescribed dose, the greater its side effects. Because Viagra inhibits PDE-6(present in the eye) at high doses, it could produce colour visual disturbances. Other side effects, headaches, diarrhoea and flushing are similar with other groups of PDE inhibitors as well. It is contraindicated in patients using nitrates (also a vasodilator) and caution in patients with heart disease. Although data from some studies actually show a cardioprotective effect from Viagra! Vardenafil(Levitra) has a similar profile to sildenafil due to its slosely similar chemical structure. Cialis on the other hand,which has a slightly different chemical structure, has a longer half life, up to 24 hours. It is said to be more specific for PDE-5 although it is known to also inhibit PDE-11 which is found in the testes and heart. The effect of this is unknown pending post marketing studies. Due to its long half life, the chances of side effects from it is much higher. However the benefit of tadalafil is said to be that, it is not significantly affected by renal or liver impairment. The onset is also claimed to be as fast as 15 minutes in responsive patients!! The verdict? Personally, i would prefer a more well tested drug ie Viagra. The shorter half life is more comforting as compared to a longer one. Until further studies show a superior safety profile of Cialis, Viagra would be the preferred choice. Perhaps a head to head comparator study needs to be done, pitching Pfizer, Bayer and Lilly! That would certainly be the next big thing ... after Lord of the Rings! |
With new information on Levitra, it probably holds an edge over Viagra in terms of its onset of action and its safety profile. Cialis is less enticing due to its long duration of action. However, all 3 drugs do work and it boils down to patient preferences. As pointed out, a good sexual life is not all just about achieving an erection!
Lastly, healthy aging involves a healthy and fulfilling sexual life! Levitra is certainly a welcomed addition to the armamentarium of ED treatment.
http://www.levitra.com
Menshealth (Malaysian site)
Sunday, May 09, 2004
Site Update
The Persatuan SLE Malaysia (Malaysian SLE Association) has an official website. I have added this to the list of Public Societies and Association websites of the MMR.
SLE or Lupus is quite a common autoimmune disorder affecting mainly women in Malaysia. I find that few people are aware of this disease and understanding even amongst local patients is poor. The concept of "autoimmune disease" is an alien one and difficult for them to grasp. I think the SLE association should come up with websites in English and Mandarin as well.
Some brief info from the site:
The SLE association can be contacted at:
934,Tingkat 1, Jalan 17/38
46400 Petaling Jaya
Selangor Darul Ehsan
No. Tel: 03-7957 7672
Fax: 03-7957 0407
Email: pslemm@pd.jaring.my
The Persatuan SLE Malaysia (Malaysian SLE Association) has an official website. I have added this to the list of Public Societies and Association websites of the MMR.
SLE or Lupus is quite a common autoimmune disorder affecting mainly women in Malaysia. I find that few people are aware of this disease and understanding even amongst local patients is poor. The concept of "autoimmune disease" is an alien one and difficult for them to grasp. I think the SLE association should come up with websites in English and Mandarin as well.
Some brief info from the site:
| SISTEMIK LUPUS ERITEMATOSUS atau lupus merupakan penyakit kronik yang berlaku akibat kecelaruan sistem pertahanan tubuh (auto immune disease). Sistem pertahanan tubuh merangkumi rangkaian sel dan organ yang melindungi tubuh daripada serangan benda asing. Sistem pertahanan tubuh akan menghasilkan antibodi aabila ia mengesan organisma yang masuk ke dalam tubuh. Antibodi ini bertindak mempertahankan tubuh daripada serangan jangkitan organisme berkenaan. Bagi pesakit SLE, antibodi yang terhasil (auto antibodi) menyerang sel-sel tubuh akan mengakibatkan gejala-gejala yang berbeza |
The SLE association can be contacted at:
934,Tingkat 1, Jalan 17/38
46400 Petaling Jaya
Selangor Darul Ehsan
No. Tel: 03-7957 7672
Fax: 03-7957 0407
Email: pslemm@pd.jaring.my
Friday, May 07, 2004
Private Wings in Public Hospitals
Good or bad idea? The aim is to stem the flow of doctors from the public to the private sector.
From the Straits Times:
So now the MoH wants to emulate what the MoE has done with UMMC and HUKM. The 6 million dollar question is it enough to stem the flow? I know that people are still resigning from UMMC so something's not right.
Good or bad idea? The aim is to stem the flow of doctors from the public to the private sector.
From the Straits Times:
| KUALA LUMPUR - The Health Ministry is looking into the feasibility of setting up 'private wings' in government hospitals, to halt the brain drain of specialists and doctors to the private sector. Health Minister Chua Soi Lek said a committee headed by his deputy, Dr Abdul Latiff Ahmad, had been formed to look into all aspects of the proposal, such as legislation, use of human resources and fees, as well as feasibility. Advertisement 'I expect a working module to be ready within two months,' he told reporters after a dialogue with the Malaysian Medical Association yesterday. The government had last year proposed the setting up of private wings in public hospitals to attract more medical specialists and enable serving doctors to enjoy better remuneration while providing treatment at reasonable charges. The wings would offer facilities such as private rooms with attached bathrooms and television. A private wing is already available at the University Malaya Medical Centre and Hospital Universiti Kebangsaan Malaysia, both under the Education Ministry. |
So now the MoH wants to emulate what the MoE has done with UMMC and HUKM. The 6 million dollar question is it enough to stem the flow? I know that people are still resigning from UMMC so something's not right.
HRT, PAP smears and Bedside Manners
In the NST letter section,| Our hospitals need doctors with better bedside manners May 07: I AM a pensioner and I am under the care of a gynaecologist at a government-run hospital. For quite a while, I have been on hormone replacement therapy (HRT). With the recent controversy over HRT, I am apprehensive about its long-term effects especially when told that all hormone tablets are a form of synthetic steroids. So I voiced my concerns to the gynaecologist. I was appalled when she replied in no uncertain terms that if I wished to be taken off HRT, I would not qualify to seek treatment for my menopausal symptoms. Are we not given any other choice? Have the health authorities done enough research to warrant that all women of a certain age be put on HRT in government hospitals? I was also told that women over 60 years of age do not qualify for a pap test. She said that statistics show that only three per cent of women over 60 get cervical cancer. What if I am among the three per cent? How uncaring and high-handed can doctors be in government hospitals? Minister of Health Datuk Dr Chua Soi Lek said he was working towards cutting short the waiting time in government hospitals. That is commendable. What we government pensioners would like to see are specialists with better bedside manners. JANE WONG Subang Jaya |
Hormonal Replacement Therapy remains a controversy ever since the Women's Health Initiative Study results were published. It used to be the wonder drug for post menopausal women. Despite its effectiveness in alleviating menopausal symptoms like hot flushes, new data have cautioned physicians especially gynecologists on potential side effects. The WHI study suggested a link between HRT and Coronary Heart Disease. It also suggests a possible link with breast and ovarian cancers. So doctors are now more apprehensive when treating for menopausal symptoms. It is no longer a knee jerk reflex in giving HRT to all menopausal symptoms.
Below is an article i wrote earlier on MMR:
| Hormonal Replacement Therapy(HRT) : A continuing dilemma HRT which contains estrogen and progesterone in combination, has been widely prescribed to peri and post menopausal women until several years ago when fresh data (in particular the Women's Health Initiative study) suggests an increase in cardiovascular and stroke risk. HRT has been useful in alleviating disturbing menopausal symptoms, eg hot flushes and irritability. The increased risk of breast and endometrial cancer(if estrogen given alone) has also been noted. Thus it appears that the recent revelation has been the final nail in HRT's coffin. The recently concluded 11th World Congress of Gynecological Endocrinology held in Florence, Italy, discussed HRT at length. THe controversies surrounding the recently published studies remain. However, there is a trend to look for alternatives that are superior to conventional HRT. One alternative drug is the Selective Estrogen Receptor Modulators (SERMs) namely Raloxifene. It is a synthetic compound that binds to estrogen receptors at different sites and can be both pro or anti estrogen depending on the target tissue. In the bones, it prevents bone resorption, increases bone mineral density and decreases the incidence of spinal fractures as shown by the MORE study (Multiple Outcomes of Raloxifene trial). Most importantly, it has little effect on the endometrium or the breast. However , the effects on the cardiovascular system needs further evaluation. As SERMs do not alleviate menopausal symptoms, the drug may not be well received by patients. Perhaps for long term protection, SERMs may have its best advantage. Tibolone(livial) has long been available in Malaysia. Tibolone is a synthetic steroid that can display estrogenic, androgenic, or progesterone-like effects, depending on the target tissue. It alleviates vasomotor symptoms, improves BMD, and has no significant endometrial and breast effects. Its cardiovascular safety has not been established in large trials. Experiences of family members on Tibolone has been marred by elevated liver enzymes on routine investigations , thus discontinuation of this drug adn the return of liver enzymes to normal values. The combination of estradiol and drospirenone, a synthetic progestin, was also mentioned and is associated with favorable vasomotor, cardiovascular, skeletal, and quality-of-life effects.It is available in Malaysia as Yasmin tablet. Remifemin, a CIMICIFUGAE RHIZOMA EXTRACT is a traditional compound that has positive effects on menopausal symptoms.(see table below) Nevertheless it has no protective effects on the bone and heart and probably neutral effects on the breast and endometrium. However, experiences of my patients on Remifemin was not as dramatic as those on conventional hormonal replacement therapy. However, conventional HRT cannot be totally ignored. It will still serve its purpose and remains the best agent in alleviating menopausal symptoms. Its other previously stated benefits remain under the microscope. The best strategy may be to start early , even in the peri menopausal period and not exceed 10 years of therapy or discontinuation earlier if menopausal symptoms do not recur. There is no right or wrong in this scenario and only time will tell if we have been doing the right things for our patients. "God guide us!", we pray. |
With regards to a PAP smear, there should be no age limit. Any woman with sexual exposure is at risk. Although some studies suggest a lower incidence of progression to dysplasia in menopausal women, these are just figures and each population will vary. So when the gynecologist in the above case mentioned that PAP smears are not for women above 60, it is utter rubbish.
It is important that doctors explain certain issues carefully to ensure that patients understand what they are being told. Perhaps there was a misunderstanding in the case above leading to more confusion and thus dissatisfaction and anger. I have to agree with Jane that some doctors will need some brushing up on bedside manners.
Womens Health Initiative
Thursday, May 06, 2004
The Threat Of Diabetes
From Medscape| World Faces a "Devastating" Diabetes Epidemic--WHO By Richard Waddington GENEVA (Reuters) May 05 - The world faces a devastating diabetes epidemic, with the annual death toll already exceeding the three million killed by AIDS and set to rise, the World Health Organisation warned on Wednesday. Issuing a cry of alarm about the disease, the WHO and the International Diabetes Foundation said the number of diabetics worldwide would more than double to 366 million by 2030, from some 171 million at present. Although often thought a rich country risk, it is in poorer countries that diabetes is growing fastest, with cases seen rising 150% over the next 25 years. In India, for example, the number would leap from 32 million to 80 million. Furthermore, while in rich states diabetes affects mainly older people, in poorer countries incidence is surging among those still economically active, the two organisations said. "The number is increasing dramatically and has the potential to overwhelm countries' health systems," WHO director for chronic disease Dr Robert Beaglehole told a news conference. WHO and the Foundation said they were launching a campaign to raise awareness, because, unlike some other health threats, type 2 diabetes could be prevented by improved eating and exercise habits. "It is determined environmentally and therefore it can be reversed," Beaglehole said. LARGELY UNRECOGNIZED Some 3.2 million people died in 2000, the latest year for which figures were available, of ailments brought on by diabetes such as cardiovascular disease and kidney failure. This compares with three million deaths from AIDS. "The burden of premature death from diabetes is similar to that of HIV/AIDS, yet the problem is largely unrecognised," the two organisations said in a statement. Although it was not possible to predict accurately the future death rate, WHO officials said it would probably mirror the increase in overall cases. The per capita death toll was highest in the Middle East and parts of the Pacific, with more than one in four deaths in the 35-64 age range attributed to diabetes. |
Diabetes mellitus is indeed on the rise. In Malaysia, we are not spared. Registration figures at diabetic clinics are rising and the age at the time of diagnosis is decreasing. Exact figures will probably not be availabe until the next Health and Morbidity Survey in 2006. The question is why is it increasing at such an alarming rate and why is it affecting a younger age group?
Genetics have been shouldering the blame. Although genetics do have a role in the pathogenesis of diabetes, there are environmental factors as well. Among them are a poor diet and a sedentary lifestyle. Diets high in sugar and carbohydrates appear unfriendly to cells producing insulin. Look around us, from "santans" and curries to Coffee Beans and Secret Recipes. The tantalizing view of delicious looking dishes tempts all. This puts stress on insulin-producing cells and studies have shown that such high sugar content in the bloodstream is toxic to these cells.
Lack of exercise and increasing waistlines are also culprits in this scourge of diabetes. Obesity rates are on the rise even among children. The habit of exercising needs to be inculcated in the young. More facilities are also needed for the public. Exclusive clubs and expensive membership fees to gymnasiums, especially in urban areas, are a move in the wrong direction.
There is increasing evidence that smoking is an independant risk factor for diabetes. Smoking is certainly on the rise despite the valiant efforts of the Government in stemming it. More young souls are delving into this practice of self destruction.
So the fight against diabetes has to be on several fronts. We need to treat the community even before diabetes strikes. For when diabetes strikes, there is no turning back. Diabetes can be prevented but we have to change the lifestyle that many others in the developed world are abandoning.
Are you at risk for diabetes? Perhaps you could take the Diabetes Risk Test
Smoking and Diabetes
National Diabetes Institute,Malaysia
Diabetes dan Anda
American Diabetes Association
Wednesday, May 05, 2004
Stroke Awareness Week
The Star ran a story today on Preventing Stroke:
Why the need? Here's some alarming statistics:
I tried to locate Nasam's website but apparently there isn't any. The physical contact is:
Nasam House,12 Jalan 7/2, 46050 Petaling Jaya, Selangor (03-79564840 / fax: 03-79542275 / e-mail: nasam@po.jaring.my)
Some Neurology websites:
Malaysian Society of Neurosciences
Asean Neurological Association
The Star ran a story today on Preventing Stroke:
| The National Stroke Association of Malaysia (Nasam) will embark on a nationwide Stroke Awareness Week campaign from this Sunday till May 16. This year’s theme is Let’s Get Physical, because the association hopes to encourage more people to adopt a healthy and active lifestyle to reduce the risks of getting stroke. |
Why the need? Here's some alarming statistics:
| Malaysia with a population of 20 million, is estimated to record 40,000 new stroke cases annually. Yeo expresses concern over the possibility of rising stroke cases in Malaysia with the spread of Western lifestyles, particularly the fast-food culture. |
I tried to locate Nasam's website but apparently there isn't any. The physical contact is:
Nasam House,12 Jalan 7/2, 46050 Petaling Jaya, Selangor (03-79564840 / fax: 03-79542275 / e-mail: nasam@po.jaring.my)
Some Neurology websites:
Malaysian Society of Neurosciences
Asean Neurological Association
Pharmacist : Should they prescribe?
There is a current air of haziness as to the role of a pharmacist. Can they prescribe or should they just dispense? From a doctor's viewpoint, pharmacists are not trained to prescribe, as their training do not encompass making a proper diagnosis of a patient through their history, physical examination and investigation.
Let me illustrate. A hypertensive patient once told me that he could walk up to a pharmacist and request for loose tablets of hypertensive medication with no questions asked. No blood pressure readings were even taken. This is an unacceptable and unethical practice.
Pharmacist have an important role to play in healthcare. However, they are not ready to prescribe yet. Their history taking and physical examination skills need some brushing up if they are to take over the role of general practitioners. Even the prescription of simple medications may be tricky if proper procedures are not adhered to.
It is my opinion that the pharmacists should stick with dispensing for now. The regulation of the practices of pharmacists needs improvement as well. Perhaps if a pharmacist would like to prescribe, he/she should undergo 6 years of gruelling training that a medical student has to undergo. Even their examination formats will have to be revamped to accomodate such a change in responsibilities.
The bottomline is that a patient's healthcare should not be compromised.
There is a current air of haziness as to the role of a pharmacist. Can they prescribe or should they just dispense? From a doctor's viewpoint, pharmacists are not trained to prescribe, as their training do not encompass making a proper diagnosis of a patient through their history, physical examination and investigation.
Let me illustrate. A hypertensive patient once told me that he could walk up to a pharmacist and request for loose tablets of hypertensive medication with no questions asked. No blood pressure readings were even taken. This is an unacceptable and unethical practice.
Pharmacist have an important role to play in healthcare. However, they are not ready to prescribe yet. Their history taking and physical examination skills need some brushing up if they are to take over the role of general practitioners. Even the prescription of simple medications may be tricky if proper procedures are not adhered to.
It is my opinion that the pharmacists should stick with dispensing for now. The regulation of the practices of pharmacists needs improvement as well. Perhaps if a pharmacist would like to prescribe, he/she should undergo 6 years of gruelling training that a medical student has to undergo. Even their examination formats will have to be revamped to accomodate such a change in responsibilities.
The bottomline is that a patient's healthcare should not be compromised.
Tuesday, May 04, 2004
World Asthma Day
Did you know today., May 4th, is World Asthma Day?
The Star today has a feature on Breathing easily again.
World Asthma Day is sponsored by the Global Initiative for Asthma (GINA) – an organisation made up of chest specialists who act together to promote better care of asthma and to create awareness of asthma care
Did you know today., May 4th, is World Asthma Day?
The Star today has a feature on Breathing easily again.
World Asthma Day is sponsored by the Global Initiative for Asthma (GINA) – an organisation made up of chest specialists who act together to promote better care of asthma and to create awareness of asthma care
| If you have been conscientiously taking your medications to manage your condition, you might want to give the World Asthma Day Jogathon a go. Scheduled for May 16 at Padang Merbok in Kuala Lumpur, this event is a great way to let asthma patients realise that they can enjoy a normal life if they take an active approach to managing their asthma symptoms. As organising chairperson Dr Norzila Mohamed Zainudin asserted: “A patient suffering from asthma should not view it as a mere inconvenience. It is a serious disease that requires treatment.” The World Asthma Day Jogathon in Kuala Lumpur is organised by the Malaysian Thoracic Society in partnership with pharmaceutical giant GlaxoSmithKline. It is aptly themed On Your Mark, Get Set, Breathe! Those interested can collect the registration forms from Bukit Bintang Plaza, Sungei Wang Plaza, Starhill Shopping Centre, KL Plaza, Lot 10 Shopping Centre, Berjaya Times Square, Sogo, Mid Valley Megamall, One Utama Shopping Centre and Amcorp Mall. Registration ends on May 8 |
Anti-aging medicine : a continuing debate
The recent focus on anti-aging medications have been hyped. The articles in the press were also non-specific on what constitutes anti-aging medications and this will pose a threat to vulnerable and gullible individuals. Unscrupulous profit minded organisations are sure to exploit the unending need for youthful looks among our population, to make a fast buck.
Growth hormones have been the focus of anti-aging research. However most studies do not show the desired anti-aging effect. Its side effects especially in stimulating the uncontrolled growth of certain cells is quite uncertain. Could it lead to an increase in the incidence of cancer? Moreover, growth hormones are now widely available as oral preparations. With a growth hormone being a peptide hormone, it is degraded by gastric acid and enzymes and thus useless to the body. What is the pharmacokinetics of this drug? Can companies producing these medications produce scientific evidence of a good bioavailability from oral preparations? Or are these just SCAMS?
From Medscape,
The Government should stop making confusing remarks in support of anti-aging medications. Even Dr Ng Yen Yen questioned if anti-aging treatments are readily available in this country. Is there a real need or urgency for anti-aging medications for cosmetic purposes?
The bottomline is there is still no proof as of yet. The New England Journal published this article with this final conclusion:
"Studies that have followed the 1990 report by Rudman et al. confirm the effects of growth hormone on body composition but do not show improvement in function. In contrast, resistance training improves muscle strength and function, indicating that real effort is beneficial. There is no current "magic-bullet" medication that retards or reverses aging. It remains to be determined whether growth hormone secretagogues that consistently increase endogenous production of growth hormone are beneficial in the elderly. Antiaging therapy with growth hormone has not yet been proved effective according to objective outcome criteria."
So there you have it. I agree with Palmdoc that we can pretty much forget about growth hormone. There are no shortcuts to a good and healthy aging process.
The recent focus on anti-aging medications have been hyped. The articles in the press were also non-specific on what constitutes anti-aging medications and this will pose a threat to vulnerable and gullible individuals. Unscrupulous profit minded organisations are sure to exploit the unending need for youthful looks among our population, to make a fast buck.
Growth hormones have been the focus of anti-aging research. However most studies do not show the desired anti-aging effect. Its side effects especially in stimulating the uncontrolled growth of certain cells is quite uncertain. Could it lead to an increase in the incidence of cancer? Moreover, growth hormones are now widely available as oral preparations. With a growth hormone being a peptide hormone, it is degraded by gastric acid and enzymes and thus useless to the body. What is the pharmacokinetics of this drug? Can companies producing these medications produce scientific evidence of a good bioavailability from oral preparations? Or are these just SCAMS?
From Medscape,
| Fresh Warning Against 'Anti-Aging' Medicine Issued by Expert Panel NEW YORK (MedscapeWire) Mar 04 — A fresh warning against the growing "hype" of so-called "anti-aging" medicine is being sounded by a blue-ribbon panel of experts on gerontology and medicine, after one of the most comprehensive reviews to date of the scientific evidence. Although, the panel finds "much promise" in recent basic research on aging, it says the "anti-aging" movement threatens to discredit such serious "longevity" research and discourage investment in it by philanthropists, pharmaceutical companies, and government funders. Longevity research is vital as populations age, the panel says, because at the very least it could further reduce the diseases associated with aging. "The cost savings and health-related benefits to individuals and to our society in the near future would be tremendous." The panel's review was organized by the International Longevity Center-USA (ILC-USA), a not-for-profit, nonpartisan policy research organization in New York City, with co-sponsorship by the Columbia University College of Physicians and Surgeons Center for the Study of Society and Medicine, the Kronos Longevity Research Institute, and the Canyon Ranch Health Resort. The co-chairs were the gerontologist Robert N. Butler, M.D., president of the ILC, and the bioethicist and historian David Rothman, Ph.D., of the Columbia College of Physicians and Surgeons. The panel's report is part of a growing effort by scientists to oppose "anti-aging" medicine and support more significant research. The panel flatly states, "There is as yet no convincing evidence that administration of any specific compound, natural or artificial, can globally slow aging in people, or even in mice or rats." It links the "anti-aging" movement to a "long chain of quacks, snake-oil salesmen and charlatans." Yet "anti-aging" medicine is a "multi-billion dollar industry in the U.S.," the ILC-USA report says. The industry "is under the control of non-scientists who use terms like 'virtual immortality' and 'an ageless society' to attract customers to untested remedies that have not withstood the rigors of serious clinical trials" and that often have dangerous adverse effects. A further danger of "anti-aging" medicine, the panel says, is that it "promotes and reinforces ageism," putting a "profoundly negative connotation on the very occurrence of aging, emphasizing its negative and depleting aspects" and denying "all that is enriching and positive about aging in the psychosocial sphere." Even without scientific breakthroughs, the panel estimates that people in industrialized countries could achieve "at least a ten-year increase" in average life expectancy by eating less and exercising more: "Half the [US] population is overweight, 20 percent is obese, and only 15 percent of people over the age of 65 regularly exercise. Our diets are overwhelmingly conducive to the development of coronary artery disease, and far too many of us still use tobacco products." For the future, the report summarizes the encouraging but so-far equivocal results from work in restricted-calorie diets, genetic and chromosomal manipulation, and treatments with antioxidants, hormones like estrogen and growth hormone, and stem cells. It praises the National Institute on Aging's consideration of a comprehensive program for testing such possibilities. The report -- "Is There An Anti-Aging Medicine?" - is available for free from the ILC-USA Web site at http://www.ilcusa.org. The scientific workshop it summarizes was the sixth in a series the ILC-USA has convened on critical and often unexplored issues in aging. |
The Government should stop making confusing remarks in support of anti-aging medications. Even Dr Ng Yen Yen questioned if anti-aging treatments are readily available in this country. Is there a real need or urgency for anti-aging medications for cosmetic purposes?
The bottomline is there is still no proof as of yet. The New England Journal published this article with this final conclusion:
"Studies that have followed the 1990 report by Rudman et al. confirm the effects of growth hormone on body composition but do not show improvement in function. In contrast, resistance training improves muscle strength and function, indicating that real effort is beneficial. There is no current "magic-bullet" medication that retards or reverses aging. It remains to be determined whether growth hormone secretagogues that consistently increase endogenous production of growth hormone are beneficial in the elderly. Antiaging therapy with growth hormone has not yet been proved effective according to objective outcome criteria."
So there you have it. I agree with Palmdoc that we can pretty much forget about growth hormone. There are no shortcuts to a good and healthy aging process.
Whither Medic Alert Malaysia? part II
Follow up to Part I
I was informed, the current contact for Medic Alert Foundation Malaysia is:
MedicAlert Foundation Malaysia c/o University Malaya Medical Centre, Jln Universiti, 59100 KL. Tel 03-7957 5111.
Well I just called up 03-7957 5111 at 0800 on 4 May. It is a Public Holiday today and I wanted to test the system (and find out if this is the correct 24hr phone number and if there is indeed a new email contact and website). The phone call was automatically diverted to someone in UH Emergency who told me it's a PH and Medic Alert's office is closed! I then asked what if this were an emergency and I wanted to find out patient information? The first time, I was put on hold, then after a minute or so the line went dead. I called again. This time I spoke to a man and I asked what the Medic Alert Hotline is since this is UH Emergency and not the correct place? Would you believe it I was told this number: 03 79575111 !! Back to square one.
So folks, it looks like Medic Alert Foundation, whose website does not work, also does not have a working 24 hr hotline service. What's the point?
Follow up to Part I
I was informed, the current contact for Medic Alert Foundation Malaysia is:
MedicAlert Foundation Malaysia c/o University Malaya Medical Centre, Jln Universiti, 59100 KL. Tel 03-7957 5111.
Well I just called up 03-7957 5111 at 0800 on 4 May. It is a Public Holiday today and I wanted to test the system (and find out if this is the correct 24hr phone number and if there is indeed a new email contact and website). The phone call was automatically diverted to someone in UH Emergency who told me it's a PH and Medic Alert's office is closed! I then asked what if this were an emergency and I wanted to find out patient information? The first time, I was put on hold, then after a minute or so the line went dead. I called again. This time I spoke to a man and I asked what the Medic Alert Hotline is since this is UH Emergency and not the correct place? Would you believe it I was told this number: 03 79575111 !! Back to square one.
So folks, it looks like Medic Alert Foundation, whose website does not work, also does not have a working 24 hr hotline service. What's the point?
Anti-ageing medicine - a cautionary note
Recently there has been publicity on the introduction of anti-ageing medicine in Malaysian hospitals. There was a report in The Star ( MMM Permalink ):
There was no specific mention of what medicines in particular. What concerns me is that we might see a sudden mushrooming of "Growth Hormone clinics" in this country. From what I understand, there are some doctors in this country administering Human Growth Hormone (HGH) for "anti-ageing" purposes. Does it work? Is it safe?
You would be well advised to read this article by Stephen Barret MD: Growth Hormone Scams
Some extracts from the article:
What is even worse is the current marketing scam going round whereby products claim to "release HGH" if ingested! From Dr Barret's article:
Doctors and interested persons are also advised to read this 2003 article Can Growth Hormone Prevent Aging? (free full text from the New England Journal of Medicine)
How to help yourself? Forget about HGH. Live a healthy lifestyle. Eat a balanced diet. Take lots of fruits and veg. Don't smoke. Excercise.
Recently there has been publicity on the introduction of anti-ageing medicine in Malaysian hospitals. There was a report in The Star ( MMM Permalink ):
| KUALA LUMPUR: The Government will introduce anti-ageing medicine in hospitals if it is proven to be effective in treating or reversing ageing-related diseases. Health Ministry Family Health Development director Datuk Dr Narimah Awin said such medicine presented a new perspective and a paradigm shift in the population's healthcare. “The Government will incorporate it (in the healthcare system) if there is evidence that anti-ageing medicine is good for the Malaysian population,” she said at the First Malaysian Conference on Anti-Ageing Medicine yesterday. |
There was no specific mention of what medicines in particular. What concerns me is that we might see a sudden mushrooming of "Growth Hormone clinics" in this country. From what I understand, there are some doctors in this country administering Human Growth Hormone (HGH) for "anti-ageing" purposes. Does it work? Is it safe?
You would be well advised to read this article by Stephen Barret MD: Growth Hormone Scams
Some extracts from the article:
| Caution Needed HGH is useful for treating growth hormone deficiency in children and adults and has several other proven (FDA-approved) uses [11]. But the the American Association of Clinical Endocrinologists has warned that the clinical use of growth hormone as an anti-aging treatment or for patients with ordinary obesity is not recommended |
What is even worse is the current marketing scam going round whereby products claim to "release HGH" if ingested! From Dr Barret's article:
| ...many amino acid products were claimed to cause overnight weight loss by increasing the release of growth hormone. So called "growth-hormone releasers" were also marketed to bodybuilders with claims that they would help build muscle. Such claims are unfounded because amino acids taken by mouth do not stimulate growth hormone release. These formulations are based mainly on misinterpreted studies of intravenous arginine, which can increase HGH blood levels for an hour or so. Taking it by mouth has no such effect. |
Doctors and interested persons are also advised to read this 2003 article Can Growth Hormone Prevent Aging? (free full text from the New England Journal of Medicine)
How to help yourself? Forget about HGH. Live a healthy lifestyle. Eat a balanced diet. Take lots of fruits and veg. Don't smoke. Excercise.
Monday, May 03, 2004
Feedback: SAM
melisa munir writes:
I did not get credits for my science subjects in my spm examination. I am now pursuing South Australian Matriculation majoring in Bio-science in Taylors College with the governments minimum requirements of 5 credits including maths and english.I would like to know wheather it is compulsory for me to repeat my science papers(SPM) or getting good grades in S.A.M programme would be sufficient to pursue a medical degree.Thank you very much.
Well, Melisa, I suppose that would depend on the entrance requirements of the University Concerned. I doubt if the SPM will be relevant to the entrance requirement of an Australian Medical Degree course. Perhaps the easiest way to find out is to ask your career counsellor in Taylor's College. I doubt it will be grades alone but also what subjects you are taking in the SAM programme e.g. chemistry, physics and what not.
There is some information you can glean from the web. One useful link I found is Which course? Which University?.
For example, I found from the above website, the University of New South Wales requires;
Another website you can visit is Study In Australia
Well, I hope this helps, Melisa. Medicine is a tough and long course.
melisa munir writes:
I did not get credits for my science subjects in my spm examination. I am now pursuing South Australian Matriculation majoring in Bio-science in Taylors College with the governments minimum requirements of 5 credits including maths and english.I would like to know wheather it is compulsory for me to repeat my science papers(SPM) or getting good grades in S.A.M programme would be sufficient to pursue a medical degree.Thank you very much.
Well, Melisa, I suppose that would depend on the entrance requirements of the University Concerned. I doubt if the SPM will be relevant to the entrance requirement of an Australian Medical Degree course. Perhaps the easiest way to find out is to ask your career counsellor in Taylor's College. I doubt it will be grades alone but also what subjects you are taking in the SAM programme e.g. chemistry, physics and what not.
There is some information you can glean from the web. One useful link I found is Which course? Which University?.
For example, I found from the above website, the University of New South Wales requires;
| Assumed Knowledge: HSC Mathematics, English and Chemistry. Other: Prospective students are advised that while it is not a requirement, they should include Physics, as well as Chemistry, in their high school program as knowledge of these disciplines is useful in the first years of the medical course. Students who have not included Physics in their high school program are strongly advised to undertake the short Physics Bridging Course at the University. Information on the Bridging Courses offered at UNSW can be found on the UNSW website at http://www.unsw.edu.au. There is also an assumed knowledge of basic organic chemistry. A knowledge of Biology is also desirable. |
Another website you can visit is Study In Australia
Well, I hope this helps, Melisa. Medicine is a tough and long course.
Sunday, May 02, 2004
Whither Medic Alert Malaysia?
M.P. Emmanuel writes:
I need to get in touch with medic alert urgently. Can u pls give me their e- mail address? The one I have medicale@medicalert.com.my doesn't work. Thank you.
Well, M.P. Emmanuel, as far as I know the Medic Alert Foundation Malaysia's website has been down for AGES. I presume the same for their email. Someone should alert them!!
If you need to contact them urgently, I have this phone number in my database which I hope is still applicable:
+60 (3) 79502816
Post feedback and let us know if you are successful in contacting them.
The link to Malaysia from the International MedicAlert 's webpage also does not work. This link takes one to the UMMC website. Disgraceful.....
M.P. Emmanuel writes:
I need to get in touch with medic alert urgently. Can u pls give me their e- mail address? The one I have medicale@medicalert.com.my doesn't work. Thank you.
Well, M.P. Emmanuel, as far as I know the Medic Alert Foundation Malaysia's website has been down for AGES. I presume the same for their email. Someone should alert them!!
If you need to contact them urgently, I have this phone number in my database which I hope is still applicable:
+60 (3) 79502816
Post feedback and let us know if you are successful in contacting them.
The link to Malaysia from the International MedicAlert 's webpage also does not work. This link takes one to the UMMC website. Disgraceful.....
Feedback and Site Update
heekheen sent in this email:
This is the site of the newly established medical school in UMS. I hope it would be useful for those who wants to know more about the school.
Universiti Malaysia Sabah School of Medical Sciences
Thanks for the Headsup heekheen. I have duly added the Universiti Malaysia Sabah School of Medical Sciences to the Schools section of the MMR.
The Webpage is in Bahasa Malaysia only and there is no English section. The Dean is Prof.Dr.Osman Ali. Amazingly, the Faculty has only 8 academic staff (4 orang Profesor, 2 orang Profesor Madya dan 2 orang Pensyarah). The first batch of 34 students commenced their course in June 2003.
So if anyone out there is looking for an academic job, the UMS needs you.
heekheen sent in this email:
This is the site of the newly established medical school in UMS. I hope it would be useful for those who wants to know more about the school.
Universiti Malaysia Sabah School of Medical Sciences
Thanks for the Headsup heekheen. I have duly added the Universiti Malaysia Sabah School of Medical Sciences to the Schools section of the MMR.
The Webpage is in Bahasa Malaysia only and there is no English section. The Dean is Prof.Dr.Osman Ali. Amazingly, the Faculty has only 8 academic staff (4 orang Profesor, 2 orang Profesor Madya dan 2 orang Pensyarah). The first batch of 34 students commenced their course in June 2003.
| Sekolah pada masa ini dalam rangka mengambil kakitangan dalam bidang berikut;Fisilogi perubatan,imunologi perubatan,atologi perubatan,,mikrobiologi perubatan,radiologi perubatan,psikiatri,Perubatan dalaman,Perubatan keluarga dan patologi kimia. |
So if anyone out there is looking for an academic job, the UMS needs you.
Saturday, May 01, 2004
Too late again
We failed Norishzyani Amylia Ahmad. Just two years old, the innocent child died apparently of severe child abuse. The child was allegedly turned away from the University of Malaya Medical Centre two months ago .
Toddler Kicked To Death?
What monsters can do these things to children?
UMMC Probes Claims Victim Turned Away (MMM Permalink) :
Report: Two-year-old subjected to vicious abuse
............if only.......
Some links on child abuse:
Action against incest and child sexual abuse
Counterpoint
Leaflets: Child sexual abuse
We failed Norishzyani Amylia Ahmad. Just two years old, the innocent child died apparently of severe child abuse. The child was allegedly turned away from the University of Malaya Medical Centre two months ago .
Toddler Kicked To Death?
| Petaling Jaya deputy OCPD Assistant Commissioner Hassan Abdul Rahman said the post mortem stated that the cause of her death was due to internal bleeding from a punctured liver and injuries to her intestine. Norishzyani is believed to have gone into a coma a few minutes after the incident and died on arrival at the hospital. "If they had brought her earlier to the hospital, she could have been saved by the removal of the clogged blood from the punctured liver," said Hassan. The post mortem also showed abuse marks all over her body, including her private parts. A University Malaya Medical Centre spokesman from the pathology and forensic unit said there are old and new marks on her body, some could have been inflicted as long as three months ago. There were also tear marks on her anus, believed to have been caused by a hard object. The marks and bruises could have been due to pinching, bite marks and scars from scalding by hot water. |
What monsters can do these things to children?
UMMC Probes Claims Victim Turned Away (MMM Permalink) :
| KUALA LUMPUR: The University Malaya Medical Centre (UMMC) yesterday started investigations into claims that Norishzyani Amylia Ahmad, a two-year-old child abuse victim who died on Monday, was turned away by the hospital two months ago. It was reported that the girl was sent to UMMC at 10am on Feb 25 after she was slapped hard by a woman (not a child-minder) at a childcare centre in Petaling Jaya. The incident left her bleeding from her ears and lips. The child was then rushed to UMMC's accident and emergency unit at 10am by the minders that day. They had hoped she would be given treatment and that the hospital would report the matter to the police. Instead, sources had told The Malay Mail that the UMMC registration department had refused to accept her because those who brought her there were not her guardians. UMMC staff had also claimed they could not register the girl as there were no Welfare Department officers, who under the law, become guardians for children suspected to be abuse victims. The child was handed back to her parents the same day. The matter was also not reported to the police. The Malay Mail learnt that the meeting, headed by its director Datuk Dr Mohd Amin Jalaludin yesterday, was also to identify and reprimand the staff who had acted irresponsibly. |
Report: Two-year-old subjected to vicious abuse
| The injuries were reported to the department as mandated under the Child Act 2001 by a childcare centre in Petaling Jaya and the relevant authorities took action, including visiting the child and her parents. “Despite all the mechanisms in place to protect a child, it is obvious that they aren’t enough,” said Wong. Citing Noriszyani case, she said the first failure in the system was when the childcare centre could not get her admitted at the University Malaysia Medical Centre after the third incident. “They were asked for evidence of legal guardianship, without which the child could not be admitted despite the obvious injuries.” The second area of failure, Wong said, was in the role played by the designated child protectors, in this case, the department's officers, who must respond immediately to any child abuse report. While the officers did monitor the case, including visiting the family, they did not pick up any warning signs that the child was in danger, she said. It is understood that the department was still waiting for a full report from the Petaling district officer in charge of the case. |
............if only.......
Some links on child abuse:
Action against incest and child sexual abuse
Counterpoint
Leaflets: Child sexual abuse