Ban Smoking : The only way forward
Effect of Passive Smoking on Heart Risk Double Earlier Estimates
By Patricia Reaney
LONDON (Reuters) Jun 30 - Passive smoking may be much more dangerous than had been thought, researchers report in the British Medical Journal Online First edition for June 30.
Researchers in Britain studied exposure to passive smoke, measured by serum cotinine levels, in 2105 non-smokers in 18 towns between 1978 and 1980. The men were followed for all-cause and cardiovascular mortality, and information on coronary heart disease events was obtained from GP reports and patients' records, through December 2000.
"People who were non-smokers but had relatively high levels of cotinine had a heart disease risk of about 50% higher than those people who were exposed to low levels," Professor Peter Whincup, of St. George's Hospital Medical School in London, told Reuters.
Whincup said the research provides further evidence that passive smoking has adverse effects that may have been underestimated in the past.
Previous studies had estimated the increased risk of heart disease from passive smoking in non-smokers at 25% to 30%. Earlier research into the effects of second-hand smoke had focused on non-smokers living with smokers.
Supporters of a ban on smoking in the workplace, bars and restaurants described the findings as further evidence for new smoking legislation.
"The need for a ban on smoking in public places in the UK has never been better illustrated than by this potentially pivotal study. We have known for some time that passive smoking was strongly associated with increased risk of coronary heart disease (CHD), but this study strengthens the evidence considerably," Dr Tim Bowker, of the British Heart Foundation, which partly funded the research, said in a statement.
"The evidence is now compelling. The government should not delay any further in introducing legislation to protect non-smokers from this unnecessary risk," he added.
Ireland recently became the first country to introduce a national ban on smoking in public places. New York and parts of Australia have taken similar measures.
BMJ Online First 2004. |
The smoking habit still appears to be picking up steam despite the on going "tak Nak" campaign. It appears that Malaysians are getting immune to this message that health authorities are trying hard to relay. Perhaps the time to talk has ended. It has come to take stern action.
Smoking laws currently in place have to be strictly enforced. All non-smoking zones should be closely monitored. Stiffer fines and penalties are much needed. Community service, perhaps could be a good deterrent to would-be offenders.
Malaysia should also look seriously into banning smoking all together. Put it this way, if we do not take drastic actions, this tobacco addiction will definitely not go away. This is wishful thinking. Countries like Ireland, has probably gone through all the process of talking and campaigning. It is simply just not working.
We should forget about financial gain from tobacco companies. Lives are at stake. There is incontrovertible evidence that smoking damages health for smokers and non-smokers alike. It debilitates and kills patients. Even the medical costs of treating smoking related illnesses are escalating. What else do we need to prove before decisive action is finally taken?
Insuring tests
Before you buy that health insurance plan, do scrutinise the fine print and be aware of what you in for. Claims are getting harder and harder as some insurance companies are getting more wiley in trying to deny as many claims as possible. One recent grouse I have with insurance companies is that now they are denying claims for investigations even though these investigations are not "routine" and play an important part of the patient's management. Doctors often need to carry out tests to establish the diagnosis, stage the disease or exclude other disorders and complications. Yet some insurance companies will deny claims to these on the basis that they will not entertain "tests" and only cover "treatment". In the eyes of these insurance companies, "treatment" only covers things like medication and surgery. This is pretty stupid as early intervention and diagnosis (which often require "tests") is equally if not more important than "drugs and surgery". So do check if your insurance company falls under this category. If so, be warned that your claims for investigative procedures like scans, endoscopy and bone marrow biopsies may be rejected.
I think insurance companies will come out with anything nowadays to protect their own interests first. If they can help it, they will insure only the healthy who won't fall sick. In
Medical insurers drop plan for policy-holders to bear part cost health consumers are lucky they escaped having to pay for health care despite paying for insurance as well.
MEDICAL insurers has dropped a proposal requiring medical policy-holders to bear part of the cost incurred in a medical treatment due to the improving claims ratio.
ÂWe have decided not to purse with the proposal and it is now up to each company to pursue the plan on their own , said Sonny Tan, chairman of a joint committee on medical insurance. |
To each his own it seems. Such is the terrible fragmented state of healthcare insurance in this country today. There are good ones and there are bad ones. Unfortunately not everyone will read the fine print and many are often caught in the bad ones.
A National Healthcare Insurance Plan which covers everyone including the elderly, those with pre-existing disorders etc is
long overdue. The pressure must continue from consumer groups and from the public. Petition your local MP, write in to the Hon Health Minister, write in to the papers. Do something before it is too late. What's going to happen to you for instance if you were unfortunate enough to fall ill with a serious illness like leukaemia and require expensive chemotherapy and perhaps require a bone marrow transplant?
On herbs and patents
Its good to read of some action taken to protect some natural resources in this article on
Tongkat Ali and Pegaga.
Research on Tongkat Ali and another common herb, pegaga, has resulted in three international patents for Malaysia, including one that could eventually see extracts of these herbs in pharmaceutical preparations abroad. The three inventions by the Malaysia-Massachusetts Institute of Technology (MIT) team have been patented in the United States, Europe, Japan and Malaysia since research on the herbs began in 1999, said Forest Research Institute of Malaysia (Frim) director-general Datuk Dr Abdul Razak Mohd Ali.
The patents are jointly held by the Malaysian Government and MIT. All benefits arising from the royalties will be shared by the Government and the MIT-Malaysia team.
Frim hopes to complete all its basic research and development work by 2006, after which efforts to commercialise discoveries will begin. |
We don't want others to take advantage of any potential pharmaceutical application of our natural resources, as depicted in the article
Bio-piracy and law of jungle. On the other hand, I hope the "basic research and development work" will include proper clinical trials to evaluate the true efficacy and safety of these herbs. Clinical trials are important as we need to weed out any apparent improvement from what can be attributed to the
Placebo Effect or even natural recovery. Want to know more about Clinical Trials? The US National Library of Medicine has an excellent
Primer on Clinical Trials (requires Flash plug-in installed)
Incidentally I did a
PubMed search for Eurycoma longifolia (Tongkat Ali) and there were absolutely ZERO controlled clinical trials in humans.
Tap running dry?
Antibiotics have always been hailed as the miracle of modern medicine. Since the discovery of penicillin, many treatments in particular of bacterial infections have been revolutionised. Mortality rates from these bacterial infections were drastically cut. Over the years, more and more antibiotics were being prescribed by doctors. Even more patients are demanding antibiotics from their doctors. The battle has been won, so it was assumed. Unfortunately this is far from the truth.
As these antibiotics were prescribed at will, it was noted to be losing its effectiveness over years than months. From cultures, it was discovered that these previously vulnerable bacterias have mutated and developed resistance to these antibiotics. To counter this trend, newer antibiotics were prescribed in our quest to outwit these microorganisms. Unfortunately, these minute "creatures" continue to show increasing resistance even to the newest of antibiotics.
At this juncture, humans are losing this race. Moreover the micro-world does not have to deal with the pressures of financial constraints.
Trends in Antimicrobial Drug Development: Implications for the Future
[Spellberg B et al. Clin Infect Dis 2004;38:1279]:
The authors address the issue of new antibiotic development in the face of emerging resistance with emphasis of antibacterial drugs. Their analysis is based on a review of FDA approvals with emphasis on historical trends and data from 15 major pharmaceutical companies and seven major biotechnology companies that make relevant information available on their web pages. |
Pharmaceutical companies are now more reluctant to risk their resources on antibiotic development. The profits are much less as compared to other drugs.
Pharmaceutical Research and Development Expenditures: A review of financial data was performed using expenditures disclosed for FY02 and FY98 annual reports of 10 major pharmaceutical companies. This analysis showed a 31% increase in expenditures for research and development during the five year interval, but this was accompanied by a decrease in expenditures for antibacterial drug development.
Biotechnology Developmental Programs: The seven largest biotechnology companies show a total of 88 drugs in development including 81 NMEs, but only one (1.1%) of the NMEs is an antibacterial agent.
Rationale for this Shift: The authors note several reasons for this decrease in R&D for new antibacterial agents including the following:
1.It is estimated to cost $400-$800 million dollars and require an average of eight years for the development of an approved agent (DiMasi JA J Health Econ 2003;22:151).
2.The economic incentive for new drug development is agents for chronic medical conditions that require prolonged courses such as hypercholesterolemia, hypertension, dementia, mood disorders and arthritis. The obvious problem with antibacterials is that they are usually given for short courses.
3.Current emphasis in public health is to reduce the use of broad spectrum antimicrobials, thus minimizing both sales and resistance. |
To put it simply, the tap is running dry. The resistance to antibiotics is occuring at a much faster rate than our ability to cough up newer antibacterial agents. We now have resistant strains of bacteria even to the "strongest" of antibiotics to date. We are simply losing the battle. Our enemies are growing but our ammunition is depleting. We can only now hope that our frontlines are using these ammunitions more prudently.
You can't hide the facts
Suaramalaysia.com makes a point in
Haven't we learnt from China?. There's a link to the
IHT news item:
Air pollution figures will remain a state secret because of fears that the economy would be hurt by disclosing how much smog from neighboring Indonesia had blanketed parts of the country, Malaysia reported Thursday.
Malaysia now refers to air quality generally as "good, moderate, unhealthy or hazardous." It has banned the release of specific air pollution figures for fear that the information might drive away tourists. Deputy Prime Minister Najib Razak said pollution figures were "distorted by the international media" and gave "a grim picture of Malaysia." |
I think it is more grim to think that we will benefit by hiding the facts. People need to be informed and in this day and age of IT the news that we are hiding the facts will be reported far and wide and it won't go down well.
The haze of 1997 was very bad and hopefully it won't be repeated. But that time I recall the
Department of Environment's website kept us informed of the Air pollution index until someone pulled the plug and deemed the information "too sensitive". One brilliant Health Minister once also advised the public not to "breathe too deeply".
If the air we breathe being threatened with pollution is not problematic enough, we now have to brace ourselves for possible
water cuts.
Site Update
Sara wrote in to inform us of the
Medical Directory Malaysia.
This website has quite an extensive list of links to dental, medical, hospital and laboratory equipment suppliers in Malaysia.
I have added this website to the MMR's links in the
Labs & Pharma section. Incidentally I am sure there are more pharmacy websites out there - please let me know if you come across any.
The worsening air quality
A patient of mine, studying in the US, is just back on holiday. He says "Doc, ever since coming back to Malaysia, my Asthma's been acting up".
Well no wonder. The haze is back folks. From
Utusan KUALA LUMPUR June 22 - The air quality over the whole of the west coast of Peninsular Malaysia is showing signs of deteriorating in the wake of the current hot and dry weather coupled with increased cross-border pollution.
Department of Environment (DOE) Director-General Rosnani Ibarahim said in a statement on Tuesday the greater pollution load is borne by south-westerly monsoon winds from Sumatra, where she said the number of hotspots had increased to 254 on Tuesday from 84 on Sunday.
The air quality in five areas of the peninsula is unhealthy, while it is moderate in 43 areas and good in two places, according to Rosnani, with four spots in the Klang Valley - Gombak, Klang, Shah Alam and Petaling Jaya - showing a deterioration. |
I find it very disappointing that the Malaysian authorities are still in denial and covering up mode. From
Malaysiakini:
| The government says media fears about the haze conditions must be put to rest as the air quality is not as bad as other countries. However, it has no plans to release the air pollution index figures |
Afraid the figures would affect tourism? Hey, how about the health of your citizens? Isn't that your concern too?
The Rand Corporation has an article on
The Dangers of Smoke Haze: Mortality in Malaysia from Indonesian Forest Fires
Warning on alternative medicine
"There are a lot of examples of people who not only suffer but die because of drug interaction or non-proper use of traditional medicine"
Vladimir Lephakin, World Health Organization While the local health authorities are busy promoting alternative and herbal medicine - perhaps blinded by financial motives and peddling this to a public equally blinded by the false belief that "natural = safe and free from side effects", there comes a timely
warning by the World Health OrganisationWHO warns on alternative medicine
The World Health Organization warns the unregulated use of alternative medicines can cause unpleasant or potentially dangerous reactions.
It has issued new guidelines advising consumers on therapies ranging from acupuncture to herbal medicines and food supplements.
They are aimed at helping those who buy complementary medicines over-the-counter and do not tell doctors.
The WHO said such medicines were not "good for everybody all of the time".
As increasing numbers of people in industrialised and developing countries use alternative medicines, there are increasing reports of adverse and even fatal reactions.
The WHO said that, although there were no global statistics on reactions to the medicines, individual countries were reporting problems.
It said that in China, there were 9,854 cases of adverse reactions were reported in 2002 alone, more than double the number registered during all of the 1990s.
Xiaorui Zhang, WHO's coordinator for traditional medicines, said that consumers often assumed that "natural means safe", but lacked knowledge about using such products properly.
She added: "Most countries have no regulations to control herbal products. More than 90 countries sell them over-the-counter."
Some countries are taking steps to limit the risk to consumers. In December, the US Food and Drug Administration issued a warning about dietary supplements containing ephedra, also called Ma huang, a natural substance used in China to treat people for coughs.
Sales of ephedra are already restricted in the UK.
'Lack of knowledge'
Vladimir Lephakin, WHO assistant director-general for health technologies and pharmaceuticals, said: "It is not true that good, traditional medicines are good for everybody, every time in big quantities. This is a big mistake"
He added: "There are a lot of examples of people who not only suffer but die because of drug interaction or non-proper use of traditional medicine."
He said food supplements, which are not often regulated as medicinal products, also lacked quality controls.
Mr Lephakin added some studies had found that some products in different countries contained toxic heavy metals and in extreme cases there were traces of narcotics to make the products addictive.
He said: "There is a need for strengthening control of food supplements in all countries."
An EU directive, due to come into force on 1 August 2005, will harmonise the rules on vitamins and food supplements across the European Union.
It includes a list of vitamins and minerals which can be used in food supplements. It also includes upper limits on certain vitamins. |
I think everything quoted here rings true. I have personally seen (and also reported) adverse reactions to alternative medicines. Amongst these include two cases of Thrombotic Thrombocytopenic Purpura after traditional medicine for high cholesterol, a case of ITP after ingestion of an Indian medicine for Diabetes Mellitius, severe and fatal bleeding in a leukaemic patient after ingestion of Ling Zhi. By the way, it is not widely known that a number of herbal supplements can promote bleeding in susceptible individuals. Apart from Ling Zhi (Reishi mushroom), Ginseng products, Gingko and Garlic may trigger off bleeding in those with low platelet counts and on anticoagulants (blood thinners). In fact patients going for surgery should be (but are often not due to lack of awareness) told NOT to take these products for at least a week prior to surgery.
The contaminant issue is also very real. I have now seen 4 patients who developed severe hepatitis after ingestion of blue-green algae (these are found in Spirulina and similar products). A colleague who is a gastroenterologist also has seen similar cases. This is not peculiar to Malaysia: in
Algae: False Claims and Hype you can read about this:
On May 5, 1999, the Canadian Health Protection Branch warned that products containing blue-green algae may contain toxins harmful to the liver and some species of blue-green algae naturally produce toxins known as microcystins.....
In May 2000, the Oregon Department of Health released data from a survey which found that 63 out of 87 samples contained microcystin levels above its regulatory limit of 1 microgram/gram.... |
The Canadians found that certain branded Spirulina were less likely to contain the contaminants than other brands of blue-green algae. This highlights the problem of poor quality control in the "food supplement" industry.
Apart from quality control, there is also very lax enforcement by the Malaysian regulatory authorities. There are blatant advertisements on the radio and TV with products making all sorts of fantastic claims. "Food supplements" are licensed to be sold only as such. The manufacturers should not be selling these on the value of any (almost entirely untrue) claims of therapeutic value in various disorders.
Recommended site:
QuackwatchAddendumYou can
view the WHO press statement and
Download the guidelines (PDF format, 3.1MB)
Rural Health
In
Taking Care of Rural Health (
MMM Permalink), it seems to me the MOH has got it's priorities right.
The Government has taken numerous steps to ensure that the population in rural and remote areas, including Sabah and Sarawak, are not neglected in terms of health care and facilities.
Initially there were only seven maternal and child health clinics in the late ‘50s but now we have over 4,000 health clinics, of which almost 80 per cent are located in the rural areas.
These clinics provide maternal and child health and dental services which cover a comprehensive range of promotive, preventive, curative and rehabilitative services. |
Apart from "re-employment of retired doctors and employing private doctors" I think there should be additional incentives for "rural health service" to encourage more doctors to practice in the rural areas. What I think the younger doctors are afraid of is that they would get "stuck" in a rural health post with no prospects of career advancement. Surely there could be an organised scheme to rotate doctors to the rural health where doctors who serve there get "points" towards promotion and post-graduate training opportunities.
"Concerned with the shortage of doctors in rural areas, efforts are being made to make rural health postings more attractive." The measures taken include providing quarters and allowing career development with the creation of family medicine speciality. Those posted to Sabah and Sarawak will be given a regional allowance — 12.5 to 17.5 per cent of their basic pay.
The use of friendly information communication technology is also being explored to allow doctors in rural areas establish continuous and reliable connections both in follow-up of cases as well as educational and professional contacts. |
The latter would be an interesting point. With the advent of Telemedicine, doctors serving in the rural areas would not feel isolated if they had a chance to interact with their colleagues in the referral centres and teaching hospitals. This is one area I feel where technology could be put to real good use. Of course broadband in this country must improve first in order to make this feasible (at the moment broadband here is a sub-standard effort by the local monopolistic telecomms monolith compared to countries like Singapore and Korea. If you are a rural doctor practicing in a private clinic or health centre and have just dial-up to contend with, fear not - at least you can register (for free) with
Dobbs, an information and discussion site for Malaysian doctors. There are over 1500 doctors registere with Dobbs today. Dobbs is a private not-for-profit initiative affiliated with the MMR and we are proud to say we have been around since 1997 and survived the dot-com crash and still growing everyday without any government support.
Skinheads in Russia
Got this as an IM
My friend just got back from Russia after 2 years into her medicine course there. What she told me about the reason of her returning is very shocking. Apparently there's a huge anti-foreigner movement going on by Russian skinheads, who go around beating up anybody that isn't Russian.
Apparently the situation is so bad that my friend and her Malaysian friends have to stay in the hostel and uni at all times. People who were stupid enough to go out ber-dating and walk to grocery store alone sure 100% kena beaten the shit out fo them. Apparently this other girl I know got her hands stepped on till her fingers broke, and the back of her head banged with a brick. And apparently the Malaysian guys studying medicine there are all wussified losers, from one of my friend's accounts:
"We were walking to a bakery, and across the street were a gang of skinheads. They are mostly kids. The 3 guys with us were so scared they tried to squeeze and run through the bakery door, leaving the girls behind, looking in disbelief"
No more maruah. Anyway they got into the bakery , called the police and them Ruskie police are brutally efficient and huge mofos. They grab the gangster by their necks, slam them against the floor and arrest them.
My friend had to discontinue her course....and she can't credit transfer due to complications involving getting a transcript from the university. (apparently its impossible to get anything mailed or something like that) 2 years wasted. Clearly this should be make public so unsuspecting students won't waste time there or get hurt for nothing. |
Hmmm... I was also informed of this news article
Moscow skinheads attack foreign students from The Age.
Scary stuff. But I guess Malaysian students seeking to study Medicine abroad have to also be aware of this and other issues apart from degree recognition, language and cultural differences. I would be happy to hear feedback from any Malaysian students studying in Russia if indeed such problems with Skinheads are so prevalent.
A passion for medicine
In The Star,
Passion a factor to practise medicine
I AM writing in response to the letter 'Pleas have fallen on deaf ears' (The Star, June 18). I could not agree more with the facts and figures in the letter.
As I observed the resolution of the issue of insufficient places for our top students to study medicine, I am overwhelmed with mixed feelings. Of course I feel happy for wishes being granted eventually; but I could not help worry about our public’s misconception of the practice of medicine in government service.
Do all our 17- and 18-year-old top scorers who applied for medicine have a crystal-clear perspective of what practising medicine is about?
I have been serving the government hospitals for almost four years now. The appalling working conditions of public doctors are a fact. I am not trying to discourage people from becoming doctors. My point is that medicine is for those who have passion for it.
More importantly, it is not a profession with lucrative income.
I cannot agree more with Sir William Osler in that “Medicine is a calling, not a business”. No amount of money can replace a life saved. The immense satisfaction from improving someone’s health and saving lives are the only reasons that keep us in government health service.
However, it’s a great pity that government doctors are barely surviving with their pay.
I hope somebody is listening.
A BARELY SURVIVING GOVERNMENT DOCTOR,
Kuching. |
I could not have agreed more. Having a passion for medicine is the key to surviving the tough working conditions of a government doctor, a phase every doctor has to endure.
There has been increasing speculation of the reasons behind the sudden increase in the demand for medical seats. Are our aspiring doctors going into medicine for all the right reasons? Are our young medical enthusiasts aware of the actual commitments needed to practice medicine? Does our system ensure that only committed students are accepted to study medicine?
Malaysia has been fraught with economic uncertainties of late especially after the turmoil of 1997. Since then, professions deemed secure before the crises looked extremely vulnerable. Millionaires went bankrupt overnight and jobs were lost in a flash. However, one profession escaped relatively unscathed. Doctors.
Doctors have always been viewed as being economically secure. Losing one's job is unheard of in medicine. Job security therefore,appears to be an advantage for medical doctors. Could this be the reason for this increase in medical applications? Possibly.
Medicine is a lifelong commitment. It involves hard work and a never ending hunger to improve oneself. It revolves around learning which will span one's career in medicine. It involves the ability to communicate and express one self effectively. It involves teamwork. But most importantly, a sincerity to practice medicine.
The flaws in the current selection of students to study medicine will evidently be expressed in the quality of graduates that follow. Many candidates who are disinterested in medicine are offered places to do medicine in view of higher scores. I happen to talk to a mother of a medical student who expressed surprise that her daughter is being offered medicine despite not requesting for it. This trend if true, is a cause for concern.
Genuine students with a passion for medicine are on most occasions left out due to "inferior" scores. Good grades do not make a good doctor. This has to be emphasised to our policy makers. This is a very common misconception that only top scorers could have the means of completing a medical course successfully. This is far from the truth. Medical practice is not about the ability to regurgitate facts. It is about the ability to tackle a medical problem maturely and in the most rationale manner, based on current practices. No amount of reading can prepare one for real life drama and situations in daily medical practice.
Lastly, medicine is not about making money. Having said that, there is little justification for low pay in government service. Having a reasonable pay for doctors can help alleviate financial constraints and help them concentrate more on their tasks in medicine. Doctors are humans and the luxury of having some extra cash is welcomed. Saying that doctors are unpatriotic due to their reluctance to do national service is unfair and unjustified. If it is so, than even the Prime Minister should be on minimal pay without the perks, as it should be a form of national service.
The point ultimately is that despite all these drawbacks, the only thing that can keep a doctor going is his/her passion to practice medicine, the passion to help and improve the life of others, the passion to increase one's knowledge and skill and the passion to uphold the sanctity of life.
Social class, race and a rotting system
In case you are not aware, social class and race have a major impact on one's chances of getting into medical school. A study now confirms this and no, I am not talking about Malaysia, but this study was done by the
British Medical Association| In a new report, 'The Demography of Medical Schools', the BMA reveals marked differences in medical school acceptance rates between ethnic groups and social classes, and calls for action to ensure that no discrimination is taking place. It also says that the proportion of mature students at medical school is rapidly increasing, and that women doctors could outnumber men by 2012. |
From
MedicalNewsToday:
Key findings of 'The Demography of Medical Schools':
-- Six in ten (59%) medical school applicants come from the highest social classes (families where the main source of income is a professional or managerial job such as law or accountancy)
-- In recent years applicants from these groups were twice as likely to be accepted as those from working class backgrounds
-- Medicine attracts a higher proportion of ethnic minority students than other courses, but acceptance rates vary between ethnic groups
-- 73% of medical school applications from white and Asian students are successful, compared to 39% for students from black African backgrounds
-- In 2003, more than one in five students (21%) accepted into medical school were over 21, compared to fewer than one in ten (9%) in 1996
-- In 2003, more than three out of every five (61%) entrants to U.K. medical school were female, compared to 29% in 1963
|
Food for thought indeed. So what about this country? Perhaps we should look beyond just ethnicity and consider other issues. It's certainly no easy task selecting candidates for medical school but clearly examination grades alone are not a good criteria though I dare say there is no perfect system to gauge this difficult area.
On a related note you may be interested (thanks to Sian for pointing this out) to read a letter to Malaysiakini. LF Ng pontificates in
What’s new in learning medicine? - one may not entirely agree with him but there is some truth to what he says, and I agree that "Medicine is a journey of life-long learning and humility". There are quite a few who lack the latter quality. They may be brilliant academically but what's the point if they can't get along with colleagues, are so highly opinionated that they won't listen to others, are arrogant and so on. These undesirable qualities won't be picked up in a simple entrance exam.
Another important thing is we need good role models in our teaching hospitals. Its not just about numbers but quality. Students need to look up to someone and at the alarming rate that local Universities are haemorrhaging experienced teaching staff its a wonder who their role models are. Frankly I see little hope unless the entire system is revamped. Some pertinent issues were brought up in
Rigidity that kills medical service (
MMM Permalink). This article highlights an Open Letter by a local Consultant in a teaching hospital to the Prime Minister.
| "Is it a wonder there are fewer and fewer of us left? Is it a wonder that waiting lines are getting longer at government clinics and outpatient departments?" The professor said if no one fights for the medical profession, good doctors and nurses will move on to greener pastures. |
The article goes on to say:
Interestingly, there are individuals in the Ministry of Health who recognise the problems.
"The rot set in a long time ago," said one anonymously.
"We have a bloated bureaucracy but any attempts to remove the deadwood will be met with resistance," he said. "At the bottom, we have clerks and junior officers suffering from power denial psychosis (where a little power gets to the head) and, at the top, we have senior people who cannot see eye to eye." As a consequence, he said, the people who matter most — the medical professionals — are trapped in between. Of course, not all medical personnel behave like hapless sheep; those who see the benefit of playing politics will jump into the fray.
But those who cannot stomach the nonsense and neglect, leave. |
After 16 years, I could not stomach it myself and I left.
Site update: housekeeping/RSS
I have added some minor changes to the main page:
- each post now has a Title
- this enables me to keep a list of Recent Posts (located in the right hand side panel) for your ease of navigation
I have also re-done the Syndication links. The links are available from the
images at the right hand side. I have maintained the Atom.xml feeds but re-done the RSS 1.0 feeds since the previous one was not working. If you have no idea what I am talking about, you might be interested to read the
Voidstar RSS FAQ. RSS is the future of Web publishing and if you were to get an RSS reader, you can "pull" many useful informative websites into one "News aggregator". If you use Windows, I highly recommend
Sharpreader which is a great free RSS newsreader. Saves alot of time and it's much faster than surfing/browsing thru multiple sites.
Feedback: Crimea State Medical University
ghtatt wrote in to ask:
| I wish to enrol myself at Crimea State Medical University in Ukraine. But firstly I need to know if this particular university is recognised by the Malaysia Medical Association. |
I firstly replied to ask him to read this post on
Recognition of Medical Degrees.
Another point I want to bring out is that I often find people confused about the MMA, which is the Malaysian Medical Association and the MMC, the Malaysian Medical Council.
The
MMA is a professional body which functions like a "union" protecting the interests of doctors and the medical profession. It has nothing to do directly with recognition of medical degrees. This function comes under the MMC, a governmental organisation.
From the
MMC website:
FUNCTIONS OF THE COUNCIL
The functions and powers of the Council are set out in the Act, amongst which are:
* To maintain a register of medical practitioners in Malaysia.
* To promote and maintain standards of practise of medical practitioners.
* To investigate complaints made against practitioners, and administration of disciplinary provisions of the Act.
Hope this clears up the confusion.....
The piggy bank's empty
Where has all the ringgit gone?
Long time passing
Where has all the ringgit gone?
Long time ago
Where has all the ringgit gone?
Some people have wasted every one
When will they ever learn?
When will they ever learn?
(with apologies to Peter Seeger)Sadly, in the Star we read of the
Tengku Ampuan Afzan Hospital being
Hurt by Low Cash.
The Tengku Ampuan Afzan Hospital here has not been able to carry out blood tests for diabetes and several types of cancers in the past few months.
It was learnt that the reagents needed to carry out such tests had not been available due to “lack of budget”.
Patients are unaware, for instance, that the HBA1C, a test done to check the control of diabetes over a period of three months, is unavailable.
“The test is a routine one for all diabetic patients and such tests have been conveniently omitted without the knowledge of the patients each time they turn up for their check-ups,” according to a source.
This has disrupted the management of patient care in the public hospital. |
There are a couple of disturbing things here - firstly if there is a shortfall of funds, surely there must be an urgent mechanism to rectify this: an emergency fund so to speak. There is I am sure, but as is typical of Government machinery, things work slowly. Secondly it is disturbing to me that if the test is important for the well being of patients, how can one "
conveniently omit it without the knowledge of patients"?
If the public hospital cannot for instance provide adequate service (a very long waiting time to a CT Scan for instance may be disastrous for the patient with lymphoma undergoing staging) then the patient should be given an option to have the test done elsewhere.
Is this just the tip of the proverbial iceberg? How many other instances of shortfall in drug supply, equipment and what-not occurs in Government hospitals because of budget mismanagement and misallocation? I am sure some of you know and perhaps can provide examples and feedback here.
Site update: ColumbiaAsia
Dr Ramnan Jeyasingam wrote in to inform me of
ColumbiaAsia's website.
ColumbiaAsia has three medical centres in Malaysia - in Miri, Seremban and a Nursing/Rehab centre in Shah Alam.
I have duly updated the MMR list of
Private Medical Centres.
Rural service
How do you get more doctors to serve in the Rural areas? Thats tough.
The younger ones who wish to specialise certainly wouldn't want to languish in the peripheries when they hope to quickly get into the training/Masters programmes.
The MOH has a
plan to attract retired Docs to the rural areas.
THE Health Ministry is banking on the desire of many senior doctors to continue working past the mandatory retirement age to provide partial relief to the doctor shortage which has hit rural Malaysia the hardest.
Indeed, many are in their prime and are not broken-down old horses ready to be put out to pasture. The Health Minister says 34 retired doctors have already accepted re-employment in rural health centres and hopes to persuade even more to follow in their footsteps. However, unless country life rather than city living is their old-age idyll, and they have established roots in rustic communities, it remains a moot point whether the pastoral charms of rural medicine will prevail over the pragmatic enticements of urban private practice. In the Malaysian medical scene, when doctors decide to move, it has always been in the direction of the private sector and to towns and cities. There has been a steady and continuous exodus at the rate of one doctor per day for the past 10 years.
What this means is that while there has been no shortage of stop-gap measures — hiring retired doctors and foreign doctors, getting private practitioners to put in a number of hours in government clinics, etc — these will be insufficient to mitigate the losses, let alone replenish the stock. It is not because we are not training enough, although, of course, we need to increase the number of medical students. |
Another plan by the MOH doomed to fail. Why? The article concludes correctly....
| The fact is we don’t pay government doctors enough. The antidote to the haemorrhage lies in a pay-and-perks package potent enough to immunise them against the allure of the private sector and strong enough to attract and retain them in public service. |
There's also an interesting letter in Malaysiakini,
"Enough doctors, just distribution". The writer, a specialist in a teaching hospital, mentions:
| To address the urban-rural imbalance, I can only hope they come up with a financial lure not unlike one EU country I know where working as a specialist/consultant in designated rural area can earn one a significant bonus. |
I think the MOH has to face up to this. The truly wholly altruistic are the minority. The rest of us have to deal with the realities of life like funding a roof over our heads, planning for the children's education and what not.
Docs rebuff idea of refusing care to lawyers
Unbelievable but it's true. There was actually a
proposal brought to the American Medical Associaton House of Delegates meeting to this effect. Fortunately the American Medical Association will not approve this controversial proposal suggesting that doctors could ethically deny non-emergency medical care to trial lawyers or their spouses (even though there is no love lost amongst doctors for lawyers in general!)
The resolution, which was brought to the AMA House of Delegates meeting here by Dr. J. Chris Hawk, III, a Charleston, South Carolina surgeon, gained notoriety when it was circulated over the last two weeks.
The first clause in the resolution, which had the innocuous title, "Reform of the Civil Justice System", stated that "except in emergencies and except as otherwise required by law or other professional regulation, it is not unethical to refuse care to plaintiff's attorneys and their spouses."
In testimony before an AMA reference committee considering the resolution, Hawk asked that the first resolve be deleted. Hawk, who said the resolution grew out of his own frustration with the medical liability system, said, "it has accomplished its intention as a wake-up call."
He asked his fellow delegates to forgive him for any trouble caused by the resolution.
Two other clauses in his motion ask the AMA to organize a national task force to reform the civil justice system and to continue efforts to reform the U.S. health care system. Dr. Hawks asked that those clauses be adopted by the AMA." |
We are fortunate that in Malaysia, we don't see as much frivolous law suits as in the USA. I sure hope we don't go down this path with the cost of medical care driven up by adopting defensive medical practices and very high malpractice insurance rates.
On a lighter side, I would like to share this joke with you:
It had to happen sooner or later. Lawyer Dobbins was wheeled into the emergency room on a stretcher, rolling his head in agony. Doctor Green came over to see him.
"Dobbins," he said, "What an honor. The last time I saw you was in court when you accused me of malpractice."
"Doc. Doc. My side is on fire. The pain is right here. What could it be?"
"How would I know? You told the jury I wasn't fit to be a doctor."
"I was only kidding, Doc. When you represent a client you don't know what you're saying. Could I be passing a kidney stone?"
"Your diagnosis is as good as mine."
"What are you talking about?"
"When you questioned me on the stand you indicated you knew everything there was to know about the practice of medicine."
"Doc, I'm climbing the wall. Give me something."
"Let's say I give you something for a kidney stone and it turns out to be a gallstone. Who is going to pay for my court costs?"
"I'll sign a paper that I won't sue."
"Can I read to you from the transcript of the trial?
Lawyer Dobbins: 'Why were you so sure that my client had tennis elbow?' Dr. Green: 'I've treated hundreds of people with tennis elbow and I know it when I see it.' Dobbins: 'It never occurred to you my client could have an Excedrin headache?' Green: 'No, there were no signs of an Excedrin headache.' Dobbins: 'You and your ilk make me sick.' "
"Why are you reading that to me?"
"Because, Dobbins, since the trial I've lost confidence in making a diagnosis.
A lady cane in the other day limping..."
"Please, Doc, I don't want to hear it now. Give me some Demerol."
"You said during the suit that I dispensed drugs like a drunken sailor. I've changed my ways, Dobbins. I don't prescribe drugs anymore."
"Then get me another doctor."
"There are no other doctors on duty. The reason I'm here is that after the malpractice suit the sheriff seized everything in my office. This is the only place that I can practice."
"If you give me something to relieve the pain I will personally appeal your case to a higher court."
"You know, Dobbins, I was sure that you were a prime candidate for a kidney stone."
"You can't tell a man is a candidate for a kidney stone just by looking at him."
"That's what you think, Dobbins. You had so much acid in you when you addressed the jury I knew some of it eventually had to crystallize into stones. Remember on the third day day when you called me the 'Butcher of Operating Room 6'? That afternoon I said to my wife, "That man is going to be in a lot of pain.' "
"Okay, Doc, you've had your ounce of flesh. Can I now have my ounce of Demerol?"
"I better check you out first."
"Don't check me out, just give the dope."
"But in court the first question you asked me was if I had examined the patient completely. It would be negligent of me if I didn't do it now. Do you mind getting up on the scale?"
"What for?"
"To find out your height. I have to be prepared in case I get sued and the lawyer asks me if I knew how tall you were."
"I'm not going to sue you."
"You say that now. But how can I be sure you won't file a writ after you pass the kidney stone?" |
Disclaimer: the above joke does not refer to any particular person in real life of course.
MAYC says Nak
Rationalising makes it right, so it seems
| The Malaysian Association of Youth Clubs' decision to tie-up with tobacco companies for a youth anti-smoking campaign while 'paradoxical' would nonetheless allow the companies to make a 'positive contribution', its chairperson Syed Hamid Albar said today. |
Do you agree? I find it hard to believe that tobacco companies will part with money for anti-smoking campaigns. I would be more inclined to believe that there may undercurrents which will "water down" such campaigns.
More from Malaysiakini.
Sometime ago, I recall there was alot of hue and cry when it was revealed that the British Medical Association had investments in tobacco firms. I believe since then the BMA has dissociated itself from such investments.
What about
principles? Sounds like it's more a case of
money talks louder than principles.....
Previous blogs:
Holy Smoke IIHoly Smoke I
The reality of medicine
From an article titled "
A time to live or a time to die?" in the BMJ,
My worst forebodings, expressed to his original consultant, have been fulfilled. Michael is everything he least wished to be. PEG feeding must be about adding life to years, not years to life. The whole person must be considered. Seeing a patient make a small physiological improvement may cause the medical team elation, but it does not give quality of life. The profession must recognise that it does not have a monopoly of either wisdom or knowledge. A patient must be permitted to die and not be condemned to live just because life can be prolonged. Some might say that Michael's human rights have been violated. He has to live with the consequences of this decision; those who made it do not. A year on I wonder what more he has to endure.
It should be mandatory for aspiring doctors to work in a nursing home, to remind them of the possible long term consequences of their lifesaving actions. We, the public, need to remember that hospital dramas on television, with their nubile nurses and minimal number of suffering senior citizens, are not reality. Doctors need to be protected from litigious patients and their families, but equally they must be open, honest, and realistic, avoiding cosy paternalistic terms such as "popping in a tube" or "blip." There must be a frank, honest dialogue with the public at large, so that society as a whole learns to have realistic expectations and to accept that death is part of life. The use of living wills must be fully debated and encouraged.
A very sick child once said to me, "The trouble with the health service is that it means people spend a longer time dying." Perhaps she was right. There is a time to live and a time to die. |
Medicine is more than just treatment of diseases. As the article states, interventions should add life to years rather than years to life. Studies to date measure success mainly by how they decrease mortality and morbidity rates. Few would focus on the quality of life achieved. Are the medical interventions made improving the quality of life or just "prolonging the time of death"? The above article sums up the inhumane aspect of modern medicine. Perhaps the morale of the story should be that the healthcare professionals should listen more to their patients and not elevate themselves on a pedestal.
Doctors, as correctly pointed out in the article, often think of themselves as superior beings. Unfortunately in this era, the longer the initials are after your name, the more superior one gets. Many patients do not get enough access to specialists , whom ultimately are the ones making the decisions. On most occasions, the medical or house officers are left with the job of explaining the rationale of treatment and whom have little authority to overrule decisions made by consultants. The reality is that consultants spend the least time with their patients and most of their decisions are based on results of studies which on many occasions fail to address issues at multiple platforms.
Ultimately, we must keep in mind that we are treating fellow human beings. Respecting their decisions and rights is important. After all, we are all mortals.
The MMA says No to Dr Chua's Proposal
The Hon Health Minister had announced a proposal for
National Service for Doctors and confidently stated that the " compulsory service was well-received at yesterday’s dialogue ". Judging from the feedback from doctors in
Dobbs, the vast majority are against it, particularly the way it is being shoved down people's throats. The initial press announcement stated that the MMA President had no comment then. The MMA has now
come out strongly against this proposal.
| Its president Datuk Dr N Arumugam said this arrangement of part-time work in government hospitals should be on voluntary basis with appropriate remuneration and it should not be mandatory or linked to the renewal of APC. |
If you think about it, getting private doctors to work in Government OPDs for instance is not going to solve the problem of overcrowding at the OPDs. The Government simply still does not have enough clinics and supporting manpower e.g. clinic assistants, nurses to cope. What I think is a more sensible solution, at least at the Outpatient level, is to "outsource" and send patients (including civil servants) to private clinics for follow-up and ambulatory care of chronic illnesses like diabetes and hypertension. These patients could still get the free/subsidised drugs at Government pharmacies with prescriptions from the private clinics. Another alternative of course is to set up the long-awaited National Health Insurance scheme where the drug cost can be reimbursed at any pharmacy. Such a system will be a win-win situation : reduce the overcrowding at Government clinics and also get GPs to participate in "National Service" without disrupting their practice.
Recognition of Medical Degrees
For students intending to study overseas, I repeat once again, the proper body to check with if a particular medical school is recognised or not is the
Malaysian Medical Council. The MMC's website lists some recognised degrees but bear in mind this site may not be up-to-date (the MMR has nothing to do with maintaining this site, we only link to it) so it is best that potential medical students check with the MMC.
Time and time again, we also see advertisements in the newspapers by representatives of overseas medical schools that so-and-so's degree is "recognised by the JPA (Public Services Department)". This is misleading as the JPA is NOT the proper body to confer recognition of medical degrees.
This
report from the Daily Express, if true, shows how bungling the JPA can be to even sponsor a student to an unrecognised medical school.
The Health Ministry will look into claims by a Malaysian graduate from Akita University in Japan that his medical degree is unrecognised locally.
Deputy Health Minister Datuk Dr Abdul Latif Ahmad said he was waiting for full reports on the issue, including that from the Malaysian Medical Council (MMC).
“I cannot comment further as the claims will be studied in detail after obtaining feedback and full reports from various parties, including MMC,” he said when contacted here Friday.
He said this when asked to comment on a Bernama report Thursday which said a 27-year-old graduate was frustrated after finding out that the MMC did not recognise his degree even though his medical course in Japan was fully funded by the Public Service Department (JPA).
JPA Deputy Director-General Datuk Zakaria Mohd Taib, when contacted, said the department would issue a statement over this issue soon. |
NST duped?
The revelation of a Malaysian pharmacist securing a nomination for a Nobel Prize in Natural Medicine has created an air of confusion. Is it too good to be true?
I read the article in the NST and found that it has been irresponsibly written with evidences that the reporter clearly did not do his homework.
For example,
| The results were astounding. Diabetes, hypertension, gastric problems, hormonal imbalances and allergies were some of the many health problems successfully treated. |
I would like to query how successful was Prof Ananthan in treating his hypertensive and diabetic patients. What is the meaning of successfully treated? Cured? Controlled? Even as modern medicine struggles with treatments of hypertension and diabetes, natural medicine has claimed that it can successfully treat these chronic diseases. It smells fishy and such claims will only give patients false hopes and in many instances, affect compliance to modern medicines that have a proven track record in reducing morbidity and mortality.
I would also be very interested in reading Prof Ananthan's doctoral dissertation titled "The use of spices, beans and cereals in the Prevention and Management of Human Health Problems". It would be interesting to read his research methodology and his findings. The title itself is vague. Human Health Problems is such a wide field and it only baffles me that spices, beans and cereals can cure the human ills. I would challenge Prof Ananthan to publish or at least furnish the medical community with a copy of his dissertation for a more thorough evaluation and analysis.
Most alternative practitioners would claim that the modern medicine practitioners would never understand their approach and thus warrants no explanation. Unless they are God, I think they owe people some proof before claiming such grandiose cures.
A Nobel Prize is an honour bestowed on people that have conferred benefit to mankind through their works. I can only hope that standards are not diluted to include deviant and irresponsible individuals.
Malaysian "Nobel Prize candidate"
The NST has this item about a Malaysian
Researcher nominated for Nobel Prize Professor Ananthan Krishnan, 53, a pharmacist, conducted six years of research into the benefits of alternative medicine, resulting in breakthrough medicinal formulae. This prompted three institutions from Canada and the US to nominate him for the Nobel Prize in Natural Medicine.
The Alternative Medicine Research Institution (AMRI), Weston Reserve University (WRU) in Canada and the American College of Integrated Medicine in the US will jointly nominate Prof Ananthan for the prize, which honours outstanding individuals in different fields for their contributions to the world.
Natural medicine is a new category, introduced only last year, so the nomination is all the more meaningful for Prof Ananthan, whose main aim is to promote a healthier alternative to allopathic ("normal" or "Western") medicine. |
I haven't heard of a Nobel prize category called "Natural Medicine" - this is news indeed. I checked the
Nobel website and I can't find it listed there. Can anyone help? A Google search for "Nobel prize in Natural Medicine" also comes up with naught.
Blackmailling doctors
Move to make private doctors do government service
News update by FOONG PEK YEE of The Star
KUALA LUMPUR: The Health Ministry is planning to make it compulsory for the 8,000 private doctors and specialists to do certain hours of compulsory service in government hospitals each year before the ministry renew their annual practising certificate.
Minister Datuk Dr Chua Soi Lek said this would see a form of social responsibility from the doctors and specialists to help ease the workload of those from government hospitals.
He said some 8,000 government doctors and specialists were looking after 1.7 million in-patients and 48 million outpatients nationwide a year.
Dr Chua said a joint committee comprising his ministry and the private sectors, including the Association of Private Hospitals of Malaysia (APHM), would work out the details for the compulsory service, like the number of hours and the location of hospitals the doctors would be serving.
Dr Chua earlier held a meeting with APHM here this morning. |
Where is the purpose in this new adventurous move? How can the Government use such high handed tactics to solve problems that it has created in the first place? Have they ever consulted the individuals involved? How do they propose to do that?
In Malaysia, the trend of politicians, including now Dato Dr Chua Soi Lek, is to talk first and think later. The Association of Private Hospitals of Malaysia certainly do not represent doctors in general. To work out and decide on such a huge and controversial move without first consulting and determining the opinions of the doctors themselves suggest the Government's utter disrespect to the profession.
Many doctors, who have been ill treated by the Government before, have sacrifised so much in their move into private practices only now to be forced back into government service. I feel that it is highly unfair to these doctors. Now they have to abandon their clinics for a period of hours to serve an institution that hardly appreciates hard work. Now they are thinking of withholding the Annual Practicing Certificates of doctors that do not comply! I smell blackmail!
Doctors should be offered to serve the government sectors rather than be forced into it. We may be citizens of Malaysia but doctors have rights as well. The right to choose their future paths and careers. Some may lament that doctors lack patriotism and are too profit orientated. Well, why pick on doctors? Look at your own backyard, I will reply.
This will certainly have a negative impact and will drive doctors away from this country. Who knows what the Government can come up with next? There is usually neither any explanations nor compassion from the Government in its implentation of directives.
I disagree with the current move of forcing private practitioners or specialists into Government service. I suggest the Government look more carefully at its management of human resourses and its tumultuous relationship with doctors. Try not to settle one problem by creating another!
Site update: More Blogrolling
YP has provided a few more medical blogs:
Elena's AirlineLee Chong AikXiao_zhaiall Med Students of course.
Thanks YP.
Site update: Blogrolling
Rajinder wrote in to request that the Medical Blogroll links (on the Right Hand side of this page in case you didn't notice) to his actual
Blog rather than his Moblog.
Blogrolled as requested, Rajinder.
Many of the Medical Bloggers are Medical Students. I find that browsing through them gives one an interesting peak at the lives, thought, frustrations etc. of Medical Students. Then again some of the blogs are er.. trivia to put it mildly. But overall, an interesting read.
Any others?
Pharmaceutical reps and their place in medicine
In the BMJ,
German prosecutors probe again into bribes by drug companies
Jane Burgermeister
Vienna
German prosecutors are investigating whether pharmaceutical companies gave bribes to hospital doctors to boost the use of their drugs.
Munich state prosecutors confirmed that they have searched the offices of a pharmaceutical company in the city, seizing files.
And according to a report in the regional daily newspaper Westfalen-Blatt (19 May), state prosecutors are investigating seven to nine pharmaceutical companies in Germany. |
Most doctors would have encountered sales representatives of pharmaceutical companies during their practice. Sales representatives are people hired to "educate" doctors and other healthcare personnel about their products and convince them on using them more often. Their targets are ultimately to improve sales of their respective drugs. In a recent study, doctors were found to use certain drugs more often when the drug representatives visited more frequently. I guess they are constantly being reminded of the "superior efficacy" of these drugs , as at times grandiously proclaimed by drug reps.
I do admit that on many occasions, we do get benefits from talks by drug representatives and their array of "educational" materials and multimedia presentations. Doctors will also get additional supply of stationary and odd paraphernalias, not forgetting as well free meals. There are occasions as well when doctors are sponsored by these companies to attend conferences organised by these respective companies. There is little doubt that doctors benefit greatly from these pharmaceutical companies. It almost seems like a symbiotic relationship and they just seem to know what a doctor usually craves for.{free meals ;)}. But how far is too far? Monetary tokens? Or the selling of sample drugs?
It is almost impossible to answer at times. Doctors have been tuned to accept these as perks in the medical business. Some even expect it from their sales representatives. Even as medical students, attendance at drug talks and exposure to the sales pitch of reps, is a norm and part of the experience. Would it be a crime, for example, if a company rewards a doctor for the sale of a certain drug, even if the doctor had not requested or agreed to such?
I was even surprised that drug reps would approach doctors in the wards of hospitals trying to grab the attention of doctors that pass by. They almost seem out of place. Most drug reps have very pleasant characters, as expected, and sometimes their task seems almost futile.
No doubt, doctors still need the services of these reps. From providing the necessary continuing medical education to the unending supply of stationaries, their functions are undeniable. But as with any sales reps, doctors may have to take what they say with a grain of salt.
Private Healthcare Facilities and Services Act
Utusan urges the "government to speed up enforcement of the Private Healthcare Facilities and Services Act 1998 which was passed four years ago."
Its Public Complaints Bureau Chief Datuk Subahan Kamal said the act would enable the government to monitor and reduce medical fees charged by the private hospitals.
"By enforcing the Act, private hospitals cannot charge their patients to their whims to the extent of taxing those who really need treatment but face financial constraints. |
Wishful thinking and quite misguided too. No amount of regulation can reduce the cost of medical care in private hospitals by any significant amount - not unless you want all private hospitals here to be charitable organisations. People don't realise how expensive medical care really is. What Utusan should be urging is the Government to implement a Comprehensive National Health Insurance plan to cover all Malaysians of all ages. Utusan should also be querying why the Government's Healthcare Expenditure is so low in proportion to the GDP. Malaysiakini has an article on
Experts say Malaysia spending too little on healthcare.
However I do agree healthcare practices in the Private (and for that matter in Public) hospitals must be monitored. Cost is an important issue and charges should be reasonable (there are already guidelines in place). But even more important is that there should be consistent and defined minimum standards of care in place. The Act covers Private healthcare facilties but who or what is to protect the public if any Government healthcare facility falls short by the same standards?
The cost of HIV treatmentAt least the cost of the drugs will be cheaper now, so reports
The Star.
The cost of the three-in-one combination drug treatment for HIV-infected patients will be reduced to between RM200 and RM220 from this month compared to the current RM1,200.
Health Minister Datuk Dr Chua Soi Lek said the cost reduction came after his ministry amended the Patent Act to enable the patented drugs to be imported from India. |
That's a drastic drop.
Still...
| “To ensure commitment on the part of patients, they are required to buy one of the three drugs,” he said in an interview here. |
I think that's a good move. If the MOH were to provide completely free drugs, it won't be appreciated. I sure hope patients appreciate how much subsidy they are getting. Malaysians sometimes take too many things for granted. I know of patients chucking away "free" (actually expensive original drugs) medicines from Goverment run clinics thinking that they are "cheap stuff" and the ones they pay more for (actually cheaper generics) from the private clinics are better.
Links:
Malaysian AIDS Council Malaysian AIDS Foundation
Calling a spade a spade
Pertinent issues in the qualifying system for entrance into Malaysian Medical schools were highlighted in this NST article, entitled
The angst of having a perfect score Their story sadly shows how the same scenes of anger and anguish are replayed year after year, and how problems identified in the analyses that follows never get fixed. In arguments throughout the week, columnists and commentators showed how unhappy everyone was with the meritocracy system.
Malays claimed their representation in critical courses was falling, the Chinese were suspicious of the formula used to make matriculation and STPM results comparable and Indians were concerned about their poor overall representation in public universities.
The core problem is the two-track system. |
Call it meritocracy or what you will, it's still a two-track system.
Matriculation is essentially a one-year, semester style pre-university course, where examinations are held immediately after the subject is taught. Questions are set and marked internally.
In STPM, exams are held after almost two years of comprehensive studies and exam papers are set and marked externally, on a national level. "An A in one system cannot be equated with an A in the other as the systems differ greatly in teaching methods, content and how the exams are set and marked," says Yayasan Strategik Sosial executive director Dr Denison Jayasooria.
To introduce a merit-based system with two very different exams creates doubts that will polarise children for a long time to come. |
Therein lies a danger to this two-tiered system.
At least there are people who are honest about it:
"Instead of skirting around the issue, let's call a spade a spade," says UKM's Prof Datuk Dr Shamsul Amri Baharuddin. "The dual system is seen as a problem in Malaysia because one system caters for a hand-picked Malay majority whereas a large majority of the non-Malays take the STPM," adds the social anthropologist.
The problem lies not just with the education system but society, where almost every aspect of life is seen from the ethnic point of view, he says. |
I thought this article in the NST was very well written and does discuss socio-economic issues on why just grades alone may not be such a good method in order to select candidates for medical school. I personally know of colleagues (bumi & non-bumi) who did not "score well" or did brilliantly in medical school, yet turned out to be fine doctors. On the other hand, there have been brilliant students who didn't make very good doctors. Clearly, there are other qualities besides academic brilliance which are important in the making of a good doctor.
An overhaul of the present university entrance system is urgently needed to ensure that the demands of meritocracy as well as social justice are met. There have also been suggestions that candidates undergo aptitude tests or an additional entrance exam set by the university they have applied to. There is also a call to increase opportunities for tertiary education across the board.
Education is a right, says Denison, and governments worldwide are moving towards allowing as many people as possible, at whatever age and under all sorts of circumstances, to pursue tertiary education.
When this is done, admission will no longer be a sensitive issue. "It's really about providing every child who has done well, a place to study in this country," says Siva Subramaniam.
This is the thought to hold on to as the country works its way to a permanent solution to the problem. |
Amen to that.
Engineered Skin Grafts
It's nice to read reports of Malaysian Medicine being in the forefront of research as in this article in the NST
Giving back patient his own skin At Universiti Kebangsaan Malaysia's medical school, Dr Ruszymah Idrus, an associate professor of physiology, has moved five years of research in engineered skin tissue to a new reality.
In a limited trial over the last six months, four patients with hopeless foot ulcers have had those ulcers surgically removed and the area covered with skin engineered from their own skin cells. The four — three diabetics, one with end-stage renal failure — had been living with severe ulcers that refused to heal. Their next option was amputation of the foot. They had had skin grafts but that procedure had failed on them. All had refused to try skin grafts again because of the pain.
Since their surgery, the areas covered with their engineered skin have healed completely. No scars have formed yet and the borders of engineered skin have set seamlessly with the patient's own skin. The little patch of engineered skin doesn't have skin pores or sweat glands. But, because engineered skin is a living thing, blood vessels and capillaries in the vicinity of the wound are already inching their way in.
"It's been so encouraging," says Dr Ruszymah, who began working on tissue engineering in 1999. "We hope to start a large-scale clinical trial soon." HUKM clinicians continue to monitor this small group. Already, the medical community is buzzing. Malaysian plastic surgeons are asking for engineered skin tissue, so are doctors and scientists overseas willing to work with a Malaysian team.
|
Such techniques will be a great boon to patients with ulcers, large wounds, burns and such. R&D takes a lot out of the busy academician. You have to have persistence, often face obstacles (funding, busy schedules, clinical commmittments). In the understaffed Medical Faculties in Malaysia, we need to see more of this. Lets see less spending on "glamour" activities like building the biggest, talles, climbing the highest... etc and go back to basics.
Some links:
The Miracle Of Tissue EngineeringSkin grafting
Amazing Advancements In Skin Technology
The Human Touch
In the BMJ,
Medicine and man's fall
If medicine were simply a matter of prescribing drugs and wielding scalpels then monkeys—or at least robots—might make adequate doctors. It's the human bit, as in most enterprises, that makes medicine tricky, fascinating, and difficult. Medical journals might be accused of ignoring much of that complexity with their diet of drug trials and systematic reviews. Increasingly, however, we are publishing qualitative research that probes the interactions between doctors and patients. ......cont..... |
This article in the BMJ points to the important role of effective communication between doctors and their patients. On many occasions, doctors become engrossed with medical facts that they forget all about the patient's need for information. This lack of information can lead to misunderstandings, that if left unchecked, can flourish into a public relation nightmare. In this era of medical litigations, there appears to be less and less room for error.
Such misunderstandings can lead to confusion and anger. Therefore medical schools should learn how to teach young medical students, he proper ettiquette in medicine. Such good habits require earlier interventions which is remediable at a younger age.
What's the true ratio?
The
NST (
MMM Permalink) reported:
The six public medical faculties cannot accept more than the 779 students allocated places this year as their resources have been stretched to the limit.
Council of Medical Deans chairman Professor Dr Zabidi Azhar Hussin said some had vastly exceeded their capacity, with a 1:8 medical lecturer-student ratio when 1:6 was the accepted ceiling. |
It's puzzling to read a
report in the NST (
MMM Permalink)two days later, about the Higher Education Minister Datuk Dr Shafie Salleh stating:
| We are looking at the overall picture meaning these students will be at both public and private universities for six years, which includes two years of pre-clinical. At one time, University of Malaya had one lecturer to 10 students and the Malaysian Medical Council did not recognise the degrees. Therefore, I have discussed with MMC yesterday, and it has agreed to expand the lecturer and student ratio from 1:4 to 1:6 during clinical years. This translates to one hospital bed having six students, three on each side of the bed with one lecturer supervising. If there are eight or 10 students, those standing behind will have their views obstructed. Now, they allow the 1:6 ratio and anything more is not allowed. If we disregard the ratio, MMC will not recognise the degrees. |
I hope the Hon Higher Education Minister will realise that the Council of Medical Deans chairman Professor Dr Zabidi Azhar Hussin has already admitted that
some medical faculties already have a 1:8 ratio so by right, the MMC should not recognise these degrees. What does the Education Ministry have to say?
The
MMR Listing of Medical Schools in Malaysia
Farewell Hospital Kinrara
The Malay Mail had a feature on
"What Ails Hospital Kinrara"| Millions spent on highly-trained medical specialists and equipment are going to waste at the 54-year-old 95 Kinrara Armed Forces Hospital in Puchong in view of its impending closure.The Malay Mail learnt that several of the specialist clinics in the nation’s oldest military hospitalare almost non-functional due to the premature ‘phasing out’ of their services.It is also learnt that the hospital will be closed and replaced by a new hospital under construction in Genting Klang which is scheduled to be completed in June 2006.Sources said that with the phasing out of services which began a year ago, patients seeking treatment at the hospital are now referred to thealready congested University MalayaMedical Centre (UMMC), Hospital Universiti Kebangsaan Malaysia (HUKM) or Kuala Lumpur Hospital should they require more specialised treatment.As a result, the skills of the specialists at Kinrara hospital, who were trained at a cost of between RM6million and RM8 million per person by the Armed Forces, are practically under-utilised |
Why the big rush? And before even any adequate replacement has been set in place?
| The move to close down the Kinrara hospital is believed to facilitate the sale of the land to a private developer to the tune of about RM200 million.It is also learnt that under the deal,the proceeds from the land sale was to be pumped into the new Genting Klang Hospital. However, it is learnt that work on the Genting Klang hospital stopped on May 1 due to funding problems.“Why the hurry? Is it because the property has already been sold to the private company?” asked a source.“Why do they want to close it down so fast, especially after spending several million ringgit a couple of years ago to refurbish the hospital?” |
The Deputy Prime Minister came out with a
statement after that :
| Deputy Prime Minister Datuk Seri Najib Tun Razak said the 95 Kinrara Armed Forces Hospital in Puchong, would be relocated as it is too far from the Ministry of Defence (Mindef) in Jalan Padang Tembak in the city centre. |
And I suppose Genting Klang (in Gombak?)is much closer....
He also confirmed that work on the new military hospital, costing about RM200 million, near Taman Melati, Gombak, had been put on hold although land clearing work on the project had begun.
"The project was approved under the 8th Malaysia Plan but we have to put it on hold as no allocation was given," he said.
On claims that the land on which the Kinrara Hospital sits had been sold to a private developer, the official said there had been several proposals to develop the land.
"However, nothing has been approved or decided." |
Wonder who's telling the truth now...
Whatever, a chapter in Malaysian Military Hospital history comes to a close.
95 HOSPITAL ANGKATAN TENTERA KINRARA
Middlemen
There's a little storm brewing in the teacup with
Bumi firms risking bankruptcyMANY bumiputra medical supply companies are losing millions of ringgit and risk bankruptcy due to Pharmaniaga Bhd’s failure to meet medical products supply contracts worth RM190mil with the Health Ministry, Utusan Malaysia reported yesterday.
It said the failure could have been caused by lack of transparency in contract distribution at ministerial level, especially involving the bumiputra quota to suppliers registered with Pharmaniaga.
Pharmaniaga, a government-linked corporation and a subsidiary of United Engineers (M) Bhd, was given a RM336mil concession for distribution purposes to bumiputra and non-bumiputra supply companies for the period between 2004 and 2006. |
However, the
Health Ministry denies it failed to meet contractsThe Health Ministry has denied allegations that it failed to meet medical products supply contracts worth some RM190mil with Pharmaniaga Bhd, causing many bumiputra medical supply companies to lose millions of ringgit and risk bankruptcy.
Its Minister, Datuk Dr Chua Soi Lek, who said that a report on the issue in Utusan Malaysia was untrue, pointed out that under a 15-year contract concerning the supply of medicines and medical products signed in 1994, both the ministry and Pharmaniaga were required to review the prices of all products supplied by the company every three years.
“The current review period, which started in August last year, is ongoing and we have until September this year to conclude this evaluation together with Pharmaniaga,” said Dr Chua at his ministry yesterday. |
So what's the problem? Pharmaniaga makes the drugs. Somebody is contracted out to distribute the drugs. The latter are the middlemen and some of these are the ones complaining that they aren't getting the contracts. Perhaps a case of too many people after easy money? Maybe companies should look beyond government contracts and learn how to compete in the business world.
Pharmaniaga's website
Feedback: NHI
Winston writes:
Whatever happened to the above plan? I understand that it has been years in the making by the MMA and it was
presented to the health ministry many months ago. It's supposed to be an affordable
medical health insurance plan, so what has happened to it? Perhaps we are in dire need of men of action in our government instead of lethargic ones! |
I agree Winston - it's long overdue. I am equally in the dark over when it will be put in place.
Some interesting links on why we need this ASAP:
The Continuing Crisis in Malaysian Health CareHealthcare in MalaysiaWHO: Malaysia Core health Indicators
Foreign specialists
| TEN per cent of foreign medical specialists employed by the Health Ministry are incompetent. |
The
NST reports thus. There were "flaws in the selection process" so admits the MOH. Apart from these flaws has anyone stopped to consider the likelihood of "high caliber" foreign doctors coming to work in Malaysia given the salaries they are offered? Malaysia's salaries (mind you these expat specialists are paid more than local doctors) are hardly competitive compared to Singapore's Singhealth which is able to attract doctors even from the USA and Australia. The world is shrinking. We have to open up and be realistic to the true global marketforces.
My contention is, if you pay peanuts then you'll only be hiring monkeys.
Health Ministry strikes back .... lamely!In parliament today, the Deputy Health Minister Dr Abdul Latif rebuffed claims by malaysiakini that the Ministry's budget will be cut. Here is his excuse :
He claimed that the issue had been blown out of proportion by ‘quarters who are jealous (of us).’
Abdul Latiff then explained that under the Eighth Malaysia Plan, the Health Ministry had allocated RM5.5 billion for development expenditure and the allocation went up to RM9.5 billion after the plan’s mid-term review.
"This (report) is definitely, and clearly, untrue. If we have money to build hospitals, surely we have money to pay our staffs. There is no problem with my (salary) payment too," he said. |
As the Deputy Health Minister denied any existence of monetary constraints, his boss Dato Dr Chua Soi Lek admitted to budgetary limitations. Here is an excerp from the malaysiakini report:
However, Health Minister Chua Soi Lek, who had earlier responded to the malaysiakini report, was quoted by Chinese newspaper Oriental Daily today saying that the cost-cutting directive was to ensure all departments in the ministry used their allocations wisely and prudently.
In order to meet the massive salary shortfall, then Health Ministry secretary-general Alias Ali had informed all section and unit heads to take certain measures such as holding off the creation or filling of any new positions, unless critical and necessary, and to review overtime salary payments.
"In general, it was found that the ministry will face a shortage in the salary payments by as much as RM210.24 million for 2004," Alias said in a March 19 letter.
"Seeing that there will no additional allocation for 2004, this shortage will have to be supported by savings from the ‘general objectives' area under the 2004 estimated administrative budget."
Other items identified for cutbacks under the ‘general objectives’ area are vehicles and utilities. |
Looks like Dr Abdul Latif is not up to date with his facts. Today when the MOH parliamentary secretary was sent to mop up Dr Abdul Latif's mess, he made this statement :
The parliamentary debate today was wrapped up by Health Ministry’s parliamentary secretary Lee as Abdul Latiff was not present in the afternoon.
Lee said the ministry’s cutbacks were to ensure it would have a balanced budget next year.
"We have to balance our budget so that we do not run a deficit," he explained
He stressed that the ministry would ensure that staff salaries would not be affected by the cutbacks, and the review of its allocations for hospitals and other departments are specifically aimed at saving costs. |
Clearly this issue lack transparency and fraught with irregularities. This unwillingness to be transparent suggests an attempt to conceal facts that might be damning. The reasons suggested by Abdul Latif in rebuffing claims appear strikingly familiar with its amateurish and childish undertones, something local politicians have a habit of doing.
I only hope that this is not "the tip of an iceberg" type of problem. Perhaps the Deputy Minister should be the first to take a pay cut in an attempt at cost cutting!
Health Expenditure SlashedMalaysiakini has a feature on this item.
| The Health Ministry has ordered significant cutbacks in its expenditure after receiving a Treasury directive that there will be no increase in its financial allocation for 2004. |
For more details, see also
Dr. Cheah's blog.
I find it strange that a system which is also
short of staff can now be so terribly
underfunded. Very perplexing. Something is rotten in the state of Denmark....
Feedback: Clinic listingsWinston writes:
| I wanted to do a search for Drs Young & Newton & Rakan-rakan and find it impossible using just this detail. Even the Telekoms yellow pages are no help.Perhaps something should be done about this. |
Winston, as far as I know, there is no comprehensive online listing of clinics in Malaysia. The Telekoms yellow pages - I presume you mean the online version - doesn't list them all either. I guess you have do let your fingers do the walking and actually use a proper paper telephone directory.
The straw that breaks the camels backDo you agree with the Hon. Health Minister's comment that the current medical schools should absorb the 128 students who didn't make the grade?
I don't.
1) Standards have to be maintained
2) You can't please everyone
3) The current medical faculties have their limit on the number of students they can handle - or is this not important?
In
Faculties’ resources stretched to limit :
The six public medical faculties cannot accept more than the 779 students allocated places this year as their resources have been stretched to the limit.
Council of Medical Deans chairman Professor Dr Zabidi Azhar Hussin said some had vastly exceeded their capacity, with a 1:8 medical lecturer-student ratio when 1:6 was the accepted ceiling. |
If the government is serious about increasnig the medical student intake, then perhaps they should consider giving more scholarships to deserving students who otherwise can't afford oversease medical education.
Another thing, its a pretty stupid policy to "stop the drain" by increasing the intake. Just plug the leak!! Look at the reasons why people are resigning and rectify the problems.
Site updateProf Ikram wrote in to inform of a new permanent address for the
Malaysian Malaysian Endocrine Society. The site has been updated accordingly in the MMR list of
Professional webpages.
Another related link is the
Persatuan Diabetes Malaysia which is listed in the MMR list of
Public Societies and Associations page.
There is a broken link in this site (the links to other sites does not work!) so the webmaster has some work to do. The website and patient information is only in English but is otherwise quite comprehensive.
For those seeking patient information on Diabetes in Bahasa Malaysia, you can visit Dr. Cheah's
Diabetes dan Anda website.
