Overcrowded wards
This posting in
Jeff Ooi's Screenshots Mailbag: Wards 23 & 24, KLGH reminded me of my days working in Penang and Alor Setar General Hospital.
I quote nurulchan:
Horror of horrors. the ward was so overcrowded, you have to see it to believe number of patients in the ward. normally there is only 4 beds in a corneredd section of the ward, this time the number was 15, along the partitioning, the number of beds is usually 6, another 2 was added as there was a bit of space. in between..... where there is spacesfor walking. another 3 pallet beds was added. this ward was packed like sardines in a sardine can.
after observing the ward for the ward for the next 3 hours i decide ENOUGH ,,, time for me to scram. if i had stayed the night there, my blood pressure will go up, due to the toing and froing of the patients.
the question is... how much money has been alloted by the government of today towards expanding and upgrading of hospital facilities AS a tax-payer I would be very happy to know how my income tax money has been put to use. Please do not let the health minister know about my request to you to see for urself the terrible condition in ward 24 in this so-called GH, KL. i feel disgusted at the standard of health- care given to patients in this ward. |
Time travelling back to 1983-86. In Penang GH and Alor Setar GH, it was not uncommon to see a sudden surge in admissions (sometimes like 40 admissions a night resulting in very exhausted House Officers who sometimes can't even finish clerking all the admissions by 0800) on busy days. There weren't enough normal beds and what happened was the staff had to put up canvas beds on the floors to accommodate the patients. I felt sorry for these patients who looked mighty uncomfortable but these were patients from the poorer sections of the community who had no other choice but to seek care in Government hospitals. The next days ward round would be one of frantic discharges to try to achieve a sense of normalcy in the much overcrowded wards.
So it looks like things have not changed much in 20 years.....
The St. Elsewhere Syndrome
Dr J Veight
wrote in Malaysiakini pertaining to the current debate on Overseas treatment for a prominent political figure and mentioned this in his/her letter.
Part of it is the syndrome that ‘St Elsewhere’ provides better medical care, a situation certainly not unique to Malaysia. Call it by any name, it boils down to lack of final trust in the local scene.
If a person wants to retain the services of a specific specialist for treatment and has the resources to support his faith in that person, it is very difficult to change his mind. Think about how health decisions are made in one’s own family.
It is a well-known fact that many Malaysian dignitaries and business tycoons very rarely receive their medical treatment locally. They may seek medical care from Malaysians practising in Singapore and somehow that is acceptable! |
How true. I think a significant proportion of people still have this mind set that health care south of the Causeway is streets better than the healthcare found in Malaysia. I think the issue is one of perception rather than reality especially when we don't have objective measures or hard data to go by. If you have heard of stories of treatment failure in this country followed by apparent success when transferred south of the Causeway, I can also tell you tales of the reverse scenario. Such stories are only anectdotal and by no means are measures of quality of care on either side of the causeway. Tell me what you think. Do you subscribe to the St. Elsewhere theory?
Mobile phones in hospitals
I always thought hospitals have been excessively cautious when it comes to mobile phones - notice all those "no handphone" signs in the corridors of many Malaysian hospitals? Not that these were adhered to anyway - patients, visitors and staff often ignore those signs. Are you one of them?
Not to worry, in
New advice issued on the use of mobile phones in hospitals UK29 Jul 2004
Updated guidance on the use of mobile phones was today issued to hospitals by the Medicines and Healthcare products Regulatory Agency (MHRA). The new advice is necessary to take account of developments in mobile technology and the growing communication needs of patients, visitors and hospital staff.
The advice reinforces existing MHRA guidance that a total ban on mobile phones in hospitals is not necessary. It recommends measures that hospitals should introduce to balance the risks of mobile phones interfering with critical devices and the desire for better communication in hospitals.
Prof. Kent Woods, Chief Executive of the MHRA said:
“Mobile communication technology is particularly fast moving, resulting in a wider range of communication equipment becoming available. We have recognised that hospitals need to be updated and advised as to what action to take in light of these advances. Some mobile devices can cause interference with critical medical equipment and it is important these are turned off where a risk exists. However, there is no reason why mobile technology can’t be used in designated areas of hospitals where there is little or no risk of interference with critical medical equipment.
“Mobile technology can be an easy and quick way for staff to communicate and help them to deliver the best possible care to patients. Overly restrictive policies can act as obstacles to this beneficial technology so this updated advice will help ensure that hospitals reap the benefits of mobile technology without compromising patient safety.”
The new guidance recommends that:
-- Hospitals should identify staff to manage how mobile technology is used within the hospital and to identify interference risks.
-- Hospitals should consider designating areas where staff and visitors can use mobile phones safely.
-- Particular mobile wireless systems which have a low interference risk with medical equipment (such as wireless network technology) could be issued to doctors and other hospital staff and comprehensively managed.
-- Interference problems are reported to MHRA
|
At least the UK authorities show some flexibility in being able to change with the times. What about here? I wonder how long they'll take to change the rules (not that they were being followed anyway!)?
Trying out a voting booth in the MMR - please vote!:
Generic Drugs Asian Summit 2004
IBC sent in this blurb:
| IBC's Generic Drugs Asian Summit 2004 is happening soon! Seats are filling up fast! Have you sign up already? Grab this opportunity to gain the latest insights and network with major players in the industry including Pfizer, GSK, Mayne, Stada, Micro Labs and many more! |
When and where: 29-30 July 2004, New World Renaissance Hotel, Kuala Lumpur, Malaysia
Website:
http://www.ibc-asia.com/Generics2004.htm
Cancer Screening II
The American Cancer Society has these
Guidelines for Cancer ScreeningBreast Cancer
* Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
* Clinical breast exams (CBE) should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women 40 and over.
* Women should report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
* Women at increased risk (e.g., family history, genetic tendency, past breast cancer ) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (e.g., breast ultrasound or MRI), or having more frequent exams.
Colon and Rectal Cancer
Beginning at age 50, both men and women should follow one of these five testing schedules:
* yearly fecal occult blood test (FOBT)*
* flexible sigmoidoscopy every 5 years
* yearly fecal occult blood test* plus flexible sigmoidoscopy every 5 years**
* double-contrast barium enema every 5 years
* colonoscopy every 10 years
*For FOBT, the take-home multiple sample method should be used.
**The combination of FOBT and flexible sigmoidoscopy is preferred over either of these two tests alone.
All positive tests should be followed up with colonoscopy.
People should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors.
* a personal history of colorectal cancer or adenomatous polyps
* a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative younger than 60 or in two first-degree relatives of any age) Note: a first degree relative is defined as a parent, sibling, or child.
* a personal history of chronic inflammatory bowel disease
* a family history of an hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon cancer)
Cervical Cancer
The American Cancer Society recommends:
* All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
* Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years with either the conventional (regular) or liquid-based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection,or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.
* Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test.
* Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
* Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.
Endometrial (Uterine) Cancer
The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary nonpolyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35.
Prostate Cancer
Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk (African-American men and men with a strong family of one or more first-degree relatives (father, brothers) diagnosed at an early age) should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.
Information should be provided to all men about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.
Men who ask their doctor to make the decision on their behalf should be tested. Discouraging testing is not appropriate. Also, not offering testing is not appropriate. |
Cancer prevention and screening
In
Doctor or Mechanic?, YP likened doctors to motorcar mechanics. If you think about it, if you liken your body to a motorcar, I dare say some of you maintain your cars better than your bodies. I mean, how many of you service your car (preventive maintenance, early detection and pre-emptive repairs) regularly instead of taking your car to the mechanic only when it breaks down?
Two of the leading causes of death in Malaysia are Cancer and Heart disease.
I thought I'd just focus on Cancer prevention today.
It's kinda shocking to hear the Health Minister
say that:
“When we conducted a survey, it came as a surprise to us that 76 per cent of Malaysians were concerned about their health but did not know how to maintain their health.
“They did not know much about healthy eating and living, stress management and, most of all, where to get health-related information,” he added.
|
Some frightening statistics from the
National Cancer Registry 2002 report:
A total of 26,089 cancers were diagnosed among all residents in Peninsular Malaysia
in the year 2002, comprising 11,815 in males and 14,274 in females.
The cumulative risk of cancer in Peninsular Malaysia was 18%. That means 1 in 5.5
Malaysians can be expected to get cancer in their lifetime. Taking into account cancers not registered by the NCR, the risk would be higher with 1 in 4 Malaysians getting cancer in their lifetime. |
The top cancers recorded in the registry:
It seems to me the statistics for the leading cancers are pretty similar to the "West" except that nasopharyngeal cancer stands out.
Well, cancer prevention is a lot about "healthy eating and living". Don't forget too we mentioned the need to
Declare war on cigarettes.
If you want detailed information, the NCI is a good place to go for info on
Cancer PreventionAnother aspect is early detection and appropriate screening. Don't waste your time with blood tests for "cancer markers" - I already
mentioned that the vast majority are useless for early detection of cancers in general.
Again, the NCI has good information on
Cancer screening. Cancerhelp UK also has information on
screening for cancer. The AFP has a
good article reviewing the evidence in screening tests: a good read if you want to know about false positives, lead times etc.
So the bottomline is arm yourself with knowledge. Discuss screening tests with your family doctor who can guide you better. Prevention is better than cure so they say and never more true when it comes to cancer....
Site update: Google search
I have added a Google-powered search of the MMR (and Materia Medica Malaysiana's archive of Malaysian Medical News) at the top of the page. I am still keeping the FreeFind search box (at the right hand column of this page) for the time being, so you can use either search facility to look thru the MMR's and MMM's large archives. If you can't find what you are looking for, please do send me
feedback. I'd also appreciate feedback on which you find the better search engine for the MMR
Kursus Kejururawatan
Hashimah menulis:
| Jika ada kursus kejururawatan,sila hubungi saya |
Saudari Hashimah, ada beberapa kursus diploma kejururawatan di hospital kerajaan serta di hospital swasta. Untuk maklumat Hashimah, sila lihat laman web MMR tentang
Sekolah-sekolah perubatan (ada maklumat disini tentang sekolah kejururawatan yang mempunyai laman web).
Hashimah boleh menghubungi sekolah-sekolah kejururawatan ini untuk mendapati maklumat lanjutan. Sebagai contoh,
Laman web Sekolah Kejururawatan PPUM ada maklumat tentang kursus kejururawatan di Pusat Perubatan Universiti Malaya, termasuk maklumat tentang program diploma, kurikulum, dll.
Lecturer in Medical Informatics
Ben Kanagaratnam wrote in to inform the MMR that there is a Job vacancy in Ireland for a
Senior Lecturer in Medical Informatics & Medical EducationThanks for the feedback Ben. I have posted the Job details in the
MMR's Locum jobs available page.
I note the annual salary quoted is €83,230 for the Senior Lecturer's post. This converts to
RM386,030 per annum in Malaysian currency which is a princely sum indeed by local standards. How does Malaysia hope to attract any well qualified professionals to stay on in the country with the pittance the Government is paying in our local Universities?
Regaining brains
There's a medical brain drain going on, so much so I wonder what's the IQ left in our teaching hospitals. Experienced senior staff are resigning for the private sector. Come to think of it even experienced private sector professionals are leaving. Recently two of my colleagues have emigrated - one to Canada and another to Australia.
In
Perks to woo our overseas-trained graduates, Pak Lah says
Better financial perks, favourable retirement age and terms of contract will be provided to lure back the estimated 30,000 Malaysian graduates working overseas.
Datuk Seri Abdullah Ahmad Badawi said opportunities and facilities for research and development, areas which these Malaysians said were lacking, would be made conducive to entice them under the nation’s “brain gain” campaign.
The Prime Minister said that looking at the issue objectively, there was an urgent need for Malaysia to improve the working environment and facilities to encourage them to return.
“We must also show them that we have equal and quality opportunities for them to continue what they are doing,” he told Malaysian journalists on the final day of his three-day official visit to Britain. |
I would really like to see the day when there are "equal and quality opportunities" in the Universities and larger public hospitals, the very place where undergraduate and postgraduate doctors are being trained.
Will the "financial perks, favourable retirement age and terms of contract" be offered only to these professionals currently located overseas, neglecting deserving serving locals? If so, this will disillusion even more people.
Going back to June 20th, there was an article in the NST on
Rigidity Kills the Medical ServiceIndeed, why work in a system which, in TJ's case, adamantly places seniority above experience? Why succumb to a pay structure where even the most highly-skilled Malaysian contract doctor must begin at the bottom rung? And, why put up with small-minded bureaucrats when you know your expertise is needed elsewhere? Unhappiness, it turns out, is not limited to Malaysian contract doctors. Medical professionals who have served in government hospitals for decades are equally distressed by the treatment they receive.
Last week, a professor of medicine, unable to contain her frustrations, sent an open letter to the Prime Minister, parts of which were carried by the NST.
"My husband and I are fair dinkum Malaysian doctors who returned as medical specialists back in 1982 after our medical training and after working abroad for some 13 years," she wrote. "He served as a lecturer and later professor in medicine, planned and administered the Hospital UKM whilst I first served in the Ministry of Health as a kidney specialist before joining the department of medicine in UKM. "We have each contributed much of our private time to serve in our respective professional societies and in setting up or strengthening national patients' associations. We are among pioneers of both the undergraduate and postgraduate medical training programmes in our local universities as well as in paramedical training programmes." More than all this, said the professor who is about to retire, is the satisfaction she has gained from research and her interaction with trainees, housemen and colleagues. Seeing her patients get better by the day also keeps her going.
But all this, she said, has been soured by the way the Public Service Department treats government doctors, nurses, paramedics and other health professionals.
"To them, we exist as mere statistics within a group much like the unskilled and semi-skilled staff in the civil service who work office hours, 8am to 4.30pm, with all the public holidays and alternate weekends off." "Although some minor improvements have occurred in recent years, inflation, long working hours, the near-absence of career advancement and further training opportunities, the time-consuming and morale-deflating examinations (all of which are totally unrelated to patient care) have pushed doctors into a corner.
"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.
Which is not to say that money is the motivating factor for all doctors, but they certainly "cannot live on chicken feed and self-gratification" today.
The solutions she offered were: Keep the doctors we have by giving them equitable remuneration and training opportunities rather than enticing a few to return at exorbitant salaries or recruiting expatriate doctors and paying them higher salaries.
Facilitate promotion of government doctors based on professional merits and qualifications as this would help maintain and enhance professional standards to provide the best care possible for patients.
Remove red tape and stumbling blocks e.g. SSM-PTK examinations — these take away critical staff for two weeks at a time.
She ended her letter with a plea to the Prime Minister to "intervene before we lose most of our young medium-rank specialists and medical lecturers to Singapore and the private sector". |
It is obvious to me who this Professor of Medicine is. I have always been impressed by her clinical skills, dedication and service to the Malaysian medical education system. I can imagine the frustration which drove her to write the "open letter". So Pak Lah, I hope you can be true to what you were quoted as saying in London. Do not make the mistake of "enticing a few to return at exorbitant salaries or recruiting expatriate doctors and paying them higher salaries". Think of one's own backyard too. The backyard is in a serious mess and needs overhauling badly.
Declaring War on Cigarette Smoking
In the BMJ,
Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement
Peter H Whincup, professor of cardiovascular epidemiology1, Julie A Gilg, research statistician1, Jonathan R Emberson, BHF junior research fellow2, Martin J Jarvis, professor of health psychology3, Colin Feyerabend, principal biochemist4, Andrew Bryant, senior analyst4, Mary Walker, research administrator2, Derek G Cook, professor of epidemiology1
1 Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE, 2 Department of Primary Care and Population Sciences, Royal Free Campus, Royal Free and University College Medical School, London NW3 2PF, 3 Cancer Research UK Health Behaviour Research Unit, Department of Epidemiology and Public Health, Royal Free and University College Medical School, London WC1E 6BT, 4 Medical Toxicology Unit, New Cross Hospital, London SE14 5ER
Objective
To examine the associations between a biomarker of overall passive exposure to tobacco smoke (serum cotinine concentration) and risk of coronary heart disease and stroke.
Design
Prospective population based study in general practice (the British regional heart study).
Participants
4729 men in 18 towns who provided baseline blood samples (for cotinine assay) and a detailed smoking history in 1978-80.
Main outcome measure
Major coronary heart disease and stroke events (fatal and non-fatal) during 20 years of follow up.
Results
2105 men who said they did not smoke and who had cotinine concentrations < 14.1 ng/ml were divided into four equal sized groups on the basis of cotinine concentrations. Relative hazards (95% confidence intervals) for coronary heart disease in the second (0.8-1.4 ng/ml), third (1.5-2.7 ng/ml), and fourth (2.8-14.0 ng/ml) quarters of cotinine concentration compared with the first ( 0.7 ng/ml) were 1.45 (1.01 to 2.08), 1.49 (1.03 to 2.14), and 1.57 (1.08 to 2.28), respectively, after adjustment for established risk factors for coronary heart disease. Hazard ratios (for cotinine 0.8-14.0 0.7 ng/ml) were particularly increased during the first (3.73, 1.32 to 10.58) and second five year follow up periods (1.95, 1.09 to 3.48) compared with later periods. There was no consistent association between cotinine concentration and risk of stroke.
Conclusion
Studies based on reports of smoking in a partner alone seem to underestimate the risks of exposure to passive smoking. Further prospective studies relating biomarkers of passive smoking to risk of coronary heart disease are needed.
Read here for the full article
|
Mounting evidence suggests the risk of cardiovascular disease in passive smokers. As this study suggests, the absence of a partner that smokes does not mean that one is not a passive smoker or at a lower risk.
Fig Proportion of men with major CHD by years of follow up in each smoking group. "Light passive" refers to lowest quarter of cotinine concentration among non-smokers (0-0.7 ng/ml), "heavy passive" to upper three quarters of cotinine concentration combined (0.8 to 14.0 ng/ml), "light active" to men smoking 1-9 cigarettes a dayAs the graph suggests, the risk of heavy passive smokers of developing major coronary heart disease is similar to light smokers.
The point is that we are being exposed to passive cigarette smoke everywhere from shopping complexes to the hustle bustle of a coffeeshop. There is no escape as smokers continue to huff and puff at public places. There is little enforcement of our "No Smoking" zones. It appears to be trendier to challenge the "No Smoking" rule. It is becoming a dangerous fashion statement of the younger generation. Even top politicians are known heavy smokers not to mention those in the health profession including doctors. We are a nation at its mercy. There is litte wonder as to why tobacco companies are flushed with cash despite aggressive and expensive campaigning against smoking.
There is sufficient evidence to show that smoking, both the active and passive variety, kills. It is a fact beyond doubt. Yet many prefer to ignore this issue. Now it no longer is an issue confined to smokers but everyone else as well. Our health is at stake. Should we just then sit back or tackle the bull by its horns? It is my opinion that the time for soft talk is over. We need strict enforcement of existing laws regarding smoking. The millions spent on useless campaigning should be chanelled to enforcement activities. We need tough penalties for those flouting this law. Even politicians that smoke should not be allowed to run for public office. Even medical students that smoke should be expelled. We need to show people the seriousness of the issue by taking tough and real actions. We need to declare a war on cigarette smoking.
Useful sites
Campaign for Tobacco-free KidsThe Truth- an interactive site. Great and fun site. Good for children and young adults.
Anti-Tobacco SitesThe Brian Curtis Story- must read
Even More Reasons to Quit at
Why Quit?
Comment
In a letter to
The Star,
Give docs from unrecognised varsities a chance
ACCORDING to a recent newspaper report, the Government plans to take legal action on the guarantors or family members of 570 sponsored medical students who have refused to come back to serve in government hospitals.
It is a pity that government-sponsored medical students prefer to serve outside their own country and it is sad that they leave the Government with no choice but to take legal action against them.
But what is worse is that the Government is closing its eyes on the 200 qualified medical doctors from universities all over the world, unrecognised by the Malaysian Medical Council.
These doctors have shown their commitment to the nation by coming back to Malaysia. They want to serve their people, and yet the Government is not giving them a chance.
They have borrowed the required funds from banks, relatives, parents and loan sharks to realise their dreams of becoming doctors.
K. POONAM,
Klang. |
Indeed it is sad that government sponsored medical students are refusing to return to Malaysia to serve. This not only does little justice to the Government but the people of Malaysia in general. Afterall, it is the taxpayer's money that was spent on their education. I feel that court action itself is insufficient as these unscrupulous students remain in countries beyond the jurisdiction of our laws. The Government should take sterner action and work closely with the Medical Councils or the Governments of these countries to "repatriate" them to Malaysia. This may be necessary to safeguard our future interests and "investments".
Shortage of doctors and healthcare workers remain a problem in Malaysia especially in government-run establishments. Current measures of recruiting foreign doctors into the service remains short term and does little to solve this shortage. The mushrooming of medical schools has been allowed with the hope of easing this shortage in the future. However, the continuing worry is the dilution of standards of our future doctors. Medicine is a field where there should be no compromise on standards. Thus, however unfortunate it may be, medical graduates from unrecognised universities should accept the laws in this country or the terms that are currently being offered. The acceptance of these medical graduates from unrecognised centers will only set an unhealthy precedent and a possible of influx of graduates from unrecognised centers and a resulting compromise of standards.
Aspiring doctors should do some research on centers where they hope to pursue their education. They can check with the Malaysian Medical Council to determine if these centers are indeed recognised in Malaysia. This should be the responsibility of these respective students. The Government should not be pressured into accepting students that have failed to do their "homework". It is unfortunate that many students still opt to further their studies in unrecognised centers due to the ease of entry into these centers rather than meeting the standards of recognised ones.
Birth Control Patch
JA writes
| I've been reading about this patch website, ORTHO EVRA.... i really need more info about this patch by women of Malaysia. do please send it to me ASAP! want to know if there's any pros & cons about this |
Well JA, I don't think this is available in Malaysia yet. I presume by website you mean
www.orthoevra.com.
The
Planned Parenthood Federation of America has some information on it, including Advantages and Disadvantages.
Medlineplus has some drug information on
transdermal contraceptive systemsFinally (I am not suggesting you are contemplating this, it's just that the link came out in my search), the FDA has issued a
warning about purchasing contraceptive patches from foreign websites - there are counterfeit ones being sold apparently. Generally it is inadvisable to purchase drugs from websites and please seek professional advice fom your own doctor especially when it comes to contraceptives.
Feedback: Alzheimer's Disease Foundation
Cyril wrote to inform that he was unable to connect to the
Alzheimers' Disease Foundation of Malaysia's website (located in the MMR's
Public Societies and Associations section) because of a "bad gateway" error.
Thanks for the info Cyril. Yes, I do believe their website has been down for sometime - if it remains down for another month or so, I'll be putting up the cobweb
sign next to their site.
From the MMR's
searchable support group database, the Foundation's contact is listed as:
Address: 14 Lorong Utara A 46700 Petaling Jaya Selangor
Phone: +60 (3) 79581522
Fax: +60 (3) 79581507
Email: alzheimers@pd.jaring.my
However when I Googled for it, it is listed in an International Alzheimer's
Association listing as:
9a, Lorong Bukit Raja
Taman Seputeh
58000 Kuala Lumpur
Malaysia
Tel: +603 2260 3158/ 2274 9060
Fax: +603 2273 8493
Email: alzheimers@pd.jaring.my
I don't know which one is applicable so you could call up both or email them (will they respond to email I wonder - many Malaysian organisations have email addresses but they are pretty useless!!)
If anyone know's of a new website for the AFM and the correct address, please post feedback or a comment here, thanks.
AddendumThanks to
Chet, here's a bit more information:
The Taman Seputeh address is the right one. The contact person is Long Heng Kow, Honorary Executive Secretary.
Their web site is down at the moment, but they've identified two volunteers to work on it.
Apart from housing the office, the Taman Seputeh address is also a day care centre. It operates 5 days a week (Mon - Fri), from 8:00 a.m. to 5:00 p.m., at RM30/- per day offering lunch and two breaks, one morning and the other afternoon.
The numbers vary between 6 and 9, with more females than males. The racial mix is an almost equal mix of Chinese and Indian. No Malays so far, altho they've had Malay visitors come check out the centre.
Bird flu again
There's a suspected
human case of bird flu in Thailand Jul 20, 2004 (CIDRAP News) – A woman in Thailand, where avian influenza has resurfaced in the past month, may have the first human case of the illness since the outbreaks earlier in the year, a Bangkok newspaper reported today.
An online report by The Nation said a 53-year-old woman in the central province of Lop Buri was hospitalized Jul 14 with symptoms of suspected avian flu, including a heavy cough, high fever, and breathing difficulty. The woman subsequently improved and was out of danger today, the story said.
The woman, identified as Jamras Pumthongdee, was among 29 villagers who touched a dead chicken in an area affected by avian flu, the provincial chief public health officer was quoted as saying. |
The "avian flu" link from the
MOH webpage takes one to the
Dept. of Public Health but I can't find any info on avian flu there!
For the latest news, you can visit Dr. Vadivale's
Avian Flu page
Flick, don't swat
Researchers from Bronx,NY apparently report on a case of "Fatal Myositis Due to the Microsporidian Brachiola algerae, a Mosquito Pathogen" (Coyle, Christina M.; Weiss, Louis M et al. New England Journal of Medicine. 351(1):42-47, July 1, 2004.)
This was picked up in the news (
CNN):
Flicking away pesky mosquitoes may be better than swatting the bloodsucking insects, which can risk infections if their body parts are smashed into human skin, researchers say.
The issue is reviewed in an article published this month in the New England Journal of Medicine that focuses on a 57-year-old Pennsylvania woman who died in 2002 of a fungal infection in her muscles called Brachiola algerae.
Doctors were puzzled because the fungus was thought to be found only in mosquitoes and other insects. But it's not found in mosquito saliva like West Nile virus and malaria, so a simple mosquito bite could not have caused the infection.
The article's authors concluded that the woman must have smashed a mosquito on her skin, smearing its body parts into the bite. |
Interesting though I think what the researchers reported would be quite rare - don't think flicking will be better for the vast majority of people (the mosquito gets away!). I recently visited the Forestry Reserve in Kepong and was bitten like anything. FRIM was selling Citronella based mosquito repellants so I was curious to see how effective this is (compared to the regular DEET based ones). It seems Citronella didn't perform too well (see
Mosquito Repellents )
Doctor or Mechanic?
YP, a medical student, has produced an
insightful blog on her experiences during her stint in the Outpatients Department.
| Having sat in the clinic for a whole day, watching patients come and go, watching the MO at work, all I can say is that the relationship between a doctor and his patient is synonymous to that of a mechanic and a car. The simplest way I can put this is, problem come, attempt to solve problem, send out of workshop. Each patient was treated as a problem and no more than that. Some of them wanted to say more, wanted to talk and all we see if a Dr nodding away while scribbling something on the patient’s card. The Dr’s pretense at “listening” can only be called a vain attempt. Is it his fault? Is he uncaring? Looking at the crowd in the waiting area, as some patients knock impatiently at the door, complaining about the long wait, one can only say that it doesn’t matter whether he cares, he has no choice. Is this only found in the government sector? Do we blame the system? Do we blame the patients’ impatience? Do we blame the Drs? Do we blame the medical schools? I don’t know and am not in a position to judge. |
Actually YP, I blame the system. There has to be a political will on the part of the administration and the MOH to accept the fact that there can only be so many patients a doctor can see in a day otherwise the time spent with the patient will be ridiculously short. If a doctor sees 50 patients in a 3 hour span, that would average 3.6 minutes per patient. Can you imagine what sort of history taking and physical examination can happen in 3.6 minutes not to mention trying to listen to all the patients problems or even appear sympathetic?
We need hospital administrators with the
guts to enforce a reasonable fixed number of patients in the OPD per day to ensure a minimal standard of care. Right now the outpatient burden is unacceptably high in many Government OPDs. The problem will not go away unless there either the Government builds more OPDs and hire more staff to cope with the load (I doubt that will happen as they will always be playing "catch up"). Getting private doctors to do "national service" in the Government clinics won't help unless there are more clinics and more clinic staff.
I think many patients would be happy to see their local GPs for outpatient care if only there were a mechanism for drug cost subsidy or reimbursement particularly if they are government servants or pensioners. If there were a national health insurance coverage for all which takes care of the basic drug bills that would go a long way to solve this problem too. When if ever will this take place?
Media Watchdog
The media has certainly positioned itself as the main provider of information regarding health to the general public. An increasing number of health related articles are filling the pages of our local dailies to quench the thirst for health information of Malaysians. The question is how accurate is the information provided by journalists who do not have any medical qualifications. How trustworthy is the local media? Are the articles really promoting health or is it all driven by market forces?
The BMJ highlighted the resolve of a group of doctors from Newcastle Institute of Public Health in New South Wales, in tackling the problem of accuracy.
Website gives media the tough treatment
Many doctors and scientists have long been concerned about the quality of medical reporting. Now, in a direct response to what they see as spin and distortion, a group of academics and clinicians in Australia has launched a website that evaluates media coverage of new medical treatments. Their particular goal is to counter the public relations blitz that often accompanies product launches.
The website (www.mediadoctor.org.au), which went live two weeks ago, evaluates press articles using a three-star rating system and criteria that include how benefits, harms, and costs are reported, as well as the independence of information sources, and whether there is any disease mongering. .....
BMJ 2004;329:178 (17 July), doi:10.1136/bmj.329.7458.178 |
The website is certainly worth a visit and should be emulated in Malaysia. Each article in the press is given a rating based on the following :
1. Whether the treatment is genuinely new
2. The availability of the treatment in Australia
3. Whether alternative treatment options are mentioned
4. If there is evidence of disease mongering in the story
5. If there is objective evidence to support the treatment
6. How the benefits of the treatment are was framed (in relative or absolute terms)
7. Whether harms of the treatment are mentioned in the story
8. Whether costs of the treatment are mentioned in the story
9. Whether sources of information and any known conflicts of interests of informants are disclosed in the article.
Indeed there are inaccuracies in media reporting at times. This could potentially mislead the public. This includes those involving traditional cures that on most occasions are vague and unsupported by evidence. Some are even mind-boggling.
Perhaps, MMR could be the answer in this regard for Malaysians. :)
Will the real TCM practitioner stand up?
So now the Government has
stopped recognising five traditional medicine groups (
MMM Permalink). These are the Federation of Chinese Physicians and Medicine Dealers’ Association of Malaysia, Federation of Traditional Malay Medicine of Malaysia, Society of Traditional Indian Medicine, Malaysian Council for Homeopathic Medicine and Malaysian Society for Complementary Therapies.
“We have received many complaints, especially against the Federation of Chinese Physicians and Medicine Dealers’ Association of Malaysia.
“There were claims that some of these organisations had used the Health Ministry’s logo in official letters and certificates without our approval, besides conducting courses without proper accreditation.
“Some have used the terms ‘doctor’ and ‘clinic’ and solicited funds for unreasonable earnings,” Dr Chua told reporters during an official visit to the Penang Hospital yesterday.
He noted that the ministry had received several complaints against traditional medicine practitioners and consultants, claiming to have academic certificates from China that were recognised by the ministry.
“While the ministry drafts the Traditional and Complementary Medicine Act, which we hope to implement by 2006, we will soon form a Traditional Complementary Medicine Council to protect the interests of traditional medicine practitioners. |
2006. That's two years away. In the meantime who's to say which TCM practioner is real or bogus? Who's to protect the interest of the consumer? Caveat emptor again.
Cervical cancer screening saves lives
Reuters Health Information (2004-07-16): Cervical cancer screening really does save lives has this info:
That annual Pap smear may be a chore, but it pays off. Britain's cervical cancer screening programme averted an "epidemic" that would have killed about one in 65 women born after 1950, according to a new report.
The national screening system, implemented in 1988, has saved 100,000 women born between 1951 and 1970 from premature death due to cervical cancer, at a cost per life saved of roughly £36,000, Professor Julian Peto from Cancer Research UK and colleagues write in The Lancet medical journal.
Cervical cancer mortality projections "suggest that the introduction of effective national screening prevented an epidemic that would--without any screening--have culminated in British rates being among the highest in the world at all ages, with about 11,000 invasive cancers and 5,500 deaths per year in England and Wales by 2030," the researchers say.
"Eighty percent or more of these deaths are likely to be prevented by screening."
The results of the analysis refute recent reports that have suggested the benefits of cervical cancer screening do not justify the costs, Dr. Peto told Reuters Health.
"The fundamental point is that the (cervical cancer) death rate went up 3-fold among British women under 35 from the mid 1960s to the mid 1980s," he said. "The second thing is that...it's pretty obvious that screening has a long term effect, it is a lifetime enormous reduction in risk."
There's little chance that the analysis has overestimated the benefits of screening, he said. "In fact, there's a pretty strong case for saying we've underestimated it." |
A couple of points here. It's a sad fact that many cancers in Malaysia are detected only at a late stage. Early detection is important for the best chances of cure. Several factors may delay this - including fear of hospitals, ignorance, denial, seeking quack medical cures and going for the wrong type of screening. As for the latter I cannot emphasise enough that it is a fallacy that there are "comprehensive blood tests" to screen for cancer. Most blood cancer markers are not sensitive enough to be used as screening tests and are not reliable. Cervical cancer is is classic example so if you are a woman aged 18 and above who is sexually active, you should be seeing your GP or Gynaecologist for a PAP smear on a regular basis. Blood tests are not a substitute for this. There are other modern methods employed now including thin preps and HPV testing - discuss this with your doctor.
Links:
New Tests for Cervical Cancer ScreeningPapmeister (info for PDAs)
Bizzare: Surgeon goes crazy
Surgeon goes crazy and cuts off patient's penis and slices it into three pieces is one of the most bizzare piece of news I've come across. But don't worry, it didn't happen in Malaysia, it happened in Romania.
A surgeon in Romania suddenly went crazy and cut off a patient’s penis and sliced it into three pieces. He was supposed to have operated on the man’s testicles.
The doctor, Naum Ciomu, was a senior doctor and also worked at the University teaching anatomy.
Head of Bucharest’s emergency hospital, Sorin Oprescu, said "We are shocked by what has happened. It is the first time we have had such a case."
The patient had a testicular malformation and was being operated on by Dr. Ciomu. The patient was rushed for emergency reconstructive surgery. The plastic surgeon who is trying to restore the patient’s organ said he may be able to restore his urinary function, but doubts whether the man’s penis will ever be able to perform sexually. |
Ouch!
Feedback: Studying medicine in India
drlts writes:
| I have a son who has just completed his A level studies. He is thinking of going to India to study medicine. I understand that nowadays it is quite difficult to get a place to study medicine in India unlike the good old days. I would most appreciate it if you can tell me how to go about applying for the course. Which universities are more establised and recognised by the govt / internationally. I hope you can provide me some guideline as I am do not know anything about studies in India. |
Thanks for the feedback DrL. The Malaysian Medical Resources does not have much information on studying in India but have you considered the private colleges here? For instance there is now the
Melaka-Manipal Medical College which is listed in the
Schools section of the MMR. India has many medical schools and like all countries there are good medical schools and there are the not so good ones. The
MMC is the body to contact for which ones are recognised. In the
Professional Associations section of the MMR, the
Manipal Alumni Association website is also listed.
If you wish to get feedback from other docvtor colleagues, do consider joining
Dobbs, the free forum for Malaysian doctors - you'll likely get some response there as well.
Government's Bulldozing Tactics
As reported in The Star,
Ministry directs four colleges to admit STPM top scorers
KUALA LUMPUR: The Higher Education Ministry has directed four local private colleges to immediately register the 33 STPM top scorers who have been offered places to do medicine even if they do not have the money to make initial payments.
Its deputy minister Datuk Fu Ah Kiow said the directive was issued last week and it involved 17 students in the International Medical University (IMU), 10 in the Royal Perak Medical College, four in the Allianz College and two in the Asian Institute of Medicine, Science and Technology.
“The students must be accepted and the Government is still working out details on the convertible loan for them,” he said in an interview here yesterday but did not reveal details of the loan. |
The Government has made a mess of its education system but requires others to bear the brunt of its mistakes. The above is a clear example of high handed tactics employed by the Government to solve its self-inflicted woes. If the Government and public universities did not bungle the initial selection process, it would not have to resolve to such deplorable actions to right the wrong. Directing private ventures into accepting students, in my opinion, should not be the prerogative of the Government but solely that of the stakeholders in such private ventures. Sadly,it has become a culture in Malaysia to seek political intervention in order to get things done. Moreover, such actions are rarely condemned due to the obvious and most politicians become individuals "larger than themselves".
No doubt medicine is a competitive field and should remain as such in order to prevent pretenders from ever pursuing this field. It entails hard work, commitment and sacrifice. Admitting students solely on grades can be an error of judgement. Are these top students ready to pursue medicine? Perhaps the proper way is for these students to seek temporary employment or perhaps be involved in attachments related to medicine and reapplying during the next intake when their financial terms are more solid. This would make students more appreciative of their place in medical schools.
These private institutions should reject the Government's directive and stand firm on principles that the later obviously lacks. Or perhaps it is the public institutions that should absorb these students into their medical programmes. Students as well should not be pampered into believing that entering university is their birthright but instead work towards it. Conversely, the Government should be more transparent and fair in its selection process. Little does it know that their decisions can make huge impacts on one's course in life.
Cord Stem Cell Banks : An investment for the future?
Stem cells are gaining prominence in the medical field. It has now branched away from hematological diseases to enrich treatments in Cardiology, rheumatology and neurology. It will probably not be surprising if this research will one day redefine treatments in all field of medicine. It is indeed exciting that diseases previously incurable are now showing favourable response to this stem cell therapy. Diseases like Alzheimers, SLE, Heart diseases, hematological malignancies and many more will be among the beneficiaries of this stem cell therapy.
With this exciting trend, the question is should we invest in storing cord stem cells even from our children in stem cell banks for possible future use? Is it going to be the ultimate life insurance? There are certainly stem cell banks available in malaysia where it will be frozen in time, only to be used for unforseen diseases occuring in the future. It could perhaps be the answer to many diseases.
In Malaysia, a National Cord blood bank was established in July 2002. As of June 2003, Malaysia is also served by three banks for private storage. The interest in stem cell therapy is undeniable. It is beyond doubt the next advancement in medical therapy. Will you then pay to store your children's cord blood in such banks?
Addendum (Palmdoc)Previous postings about Cord Blood in the MMR:
Feedback: Query on Cord BloodCord Blood IICord Blood I
Obesity
Recently, the problem of obesity in Malaysian soldiers has been highlighted. In this
news item:
More than 20 per cent of soldiers in Malaysia's armed forces are suffering from chronic lifestyle illnesses like heart disease and obesity, a study revealed Tuesday.
Out of the 1,488 soldiers who have died in the past 10 years, more than 20 per cent died from heart disease, high blood pressure or other forms of chronic diseases, the study by the armed forces' health services division revealed.
The results, which have sparked concerns that the health of security personnel is increasingly declining, have prompted the government to introduce incentives for soldiers to stay healthy.
"This is a worrying trend," Defence Forces chief Mohamed Zahidi Zainuddin was quoted as saying by the official Bernama news agency.
One of the new incentives put in place would be to reward obese soldiers who are successful in losing 10 kilogrammes of their weight in a six-month period, Zahidi said.
He said a proposal to ban smoking at all army training camps was also in the pipeline, adding that a whopping 55 per cent of army personnel are smokers. |
Well, at least the army is now sitting up and taking note of the problem. What about you? Are you overweight?
Some of the things you should be aware of:
Ideal Body WeightBody Mass IndexBody Fat ContentDaily Calorie RequirementsIs there a short-cut to weight loss? No. It's all about maintaining a sensible diet and exercising regularly.
Nutriweb Malaysia has some useful information on these aspects. If you are looking for some detailed information on the caloric and other content of Asian food, you can check out
Nutrition.com.sgThe links above are some of the many free tools available to you on the web to help you achieve your wegiht-loss goals.
I am a PDA enthusiaist (see
The Palmdoc Chronicles) and I believe one of the great ways to help you maintain a healthy body weight is to carry the tols with you wherever you go and what better way to do this than on a PDA!
I actually wrote
Fatcalc as a tool which combines all the calculators I mentioned above in a portable format for PalmOS PDAs:
 Estimates your Body Fat according to BMI, Ideal Body weight and Fat content. Also calculates your BMR, Daily Calorie requirements and has a guide to how many Calories you'll burn according to type of physical activity/exercise.
You can Load/Save your data so that you don't have to re-enter measurements. This will also allow you to keep track of your weight and other measurements by Date. |
Another tool I came up with is a way to carry with you a database of Asian Food content information - I
blogged it here. It's great to be able to see how much calories, fat, fibre, carbohydrate etc that plate of Char Kway Teow contains!
You need a database program on your PDA such as Handbase or MobileDB. I thought of converting the database to a stand-alone version but I haven't got round to doing it yet as it will take some time - if there are enough requests I might just do it ;)
You could view the data on a spreadsheet like Excel but unless you carry a PDA I don't see you lugging a notebook along to every restaurant or coffeeshop you patronise!
Feedback: Chinese Physicians
Noor Hamah asks:
| I would like to know whether The Association Of Chinese Physicians In Malaysia is registered as recognize Medical Practioner in Malaysian Medical Council |
No the MMC does not keep a register of practitioners of Chinese Traditional Medicine but only practitioners of "Western" or allopathic medicine. There is a Chinese Physician Association of Malaysia and a Federation of Chinese Physicians and Medicine Dealers Association of Malaysia but I do not have the contacts/address so perhaps if comeone knows, please post a comment here.
Tragedy and the Emergency Number
Another senseless death... what a tragedy. In
Student murder: 10 Thais among 11 held, the NST reports that:
A fight ensued and someone in the group allegedly used an irod rod to hit Kang, causing him to fall to the ground.
Others in the group allegedly reached for chairs and started hitting the victim.
At this point, Goh tried to call the 999 number using her mobile phone but was unable to get through
|
I don't know if the NST reporter got his/her facts right, but just a reminder for everybody - the
proper Emergency Number to call from a mobile phone is 112 and not 999. In fact
Dr. Liew did blog about this sometime back.
FDA issues tattoo ink warning.
If you are into Tatoos and "Permanent Makeup Inks", then take heed. the
FDA has issued a warning.
The U.S. Food and Drug Administration is alerting the public about adverse events associated with certain micropigmentation procedures, a form of tattooing, used to apply "permanent makeup" for lip liner, eyeliner, or eyebrow color. The adverse events are associated with certain ink shades of the Premier Pigment brand of permanent makeup inks manufactured by the American Institute of Intradermal Cosmetics, doing business as Premier Products. So far, the FDA knows of more than 50 adverse events and is investigating additional reports sent to the manufacturer. The reported reactions include swelling, cracking, peeling, blistering, and scarring as well as formation of granulomas (chronically inflamed tissue mass associated with an infection) in the areas of the eyes and lips. In some cases, the effects reported caused serious disfigurement, resulting in difficulty in eating and talking. In July 2003, the manufacturer notified the FDA that it would stop marketing five shades of ink five for which problems had been reported. However, reports have
implicated shades that were not included in the firm's removal effort. [FDA alerts consumers about adverse events associated with "permanent makeup." FDA Talk Paper, July 2, 2004] |
Links:
FDA alerts about permanent makeup inksAdditional information about tattoos and permanent makeup
Bird flu resurfaces
A deadly form of bird flu, fatal for humans, has appeared again in Thailand, China and Vietnam. The strain is called H5N1. Thailand's Deputy Agriculture Minister Newin Chitchob has confirmed that the strain has infected birds in the Thai province of Ayuthaya and Prathumthani, near Bangkok.
The Thai government has ordered a mass cull of chickens in a five-kilometre radius around the affected area. |
Source Scary in a sense yet reassuring that Governments are keeping a close eye on the situation and taking prompt action instead of covering up. For the lates on H5N1, you can visit
Vads Corner's section on H5N1
Diabetes Expedition
In what is possibly the first of it's kind activity in the world, the Malaysian Diabetes Association together with the UK-based youth charity Raleigh International and Diabetes UK will mount an unprecedented 16-day expedition to Kampung Terian in the Crocker Range. The
Sabah Daily Express has the news but unfortunately doesn't mention the date of the expedition.
It would involve 11 diabetics from the UK, in addition to a doctor, a nurse and a couple of Raleigh staff. But Drew Boswell, Raleigh Country Director for Malaysia, lamented that much as they tried, there were no takers from the Malaysian diabetic side.
Diabetes afflicts a staggering 9 to 15 per cent of the Malaysian population, 95 per cent of which were Type 2, according to consultant physician Dr Heather Yong, who is also Vice Chairman of the Malaysian Diabetic Association.
Although such statistics were mainly findings in Peninsular Malaysia, “I am sure Sabah is not much different. There is nothing to suggest this is a different population,” said Dr Heather Yong.
The major reasons for such rising trend are change towards a sedentary life style where kids sit down a lot more in front of the TV, computer, eating more fast foods and less fruits and vegetables.
UK’s diabetics constitute about 3 to 4 per cent of its total population, 80 per cent of whom are Type 2, according to accompanying nurse, Claire Bushnell. “Even that we consider quite high,” she said.
As such, Dr Tong said she attached great “significance” to the diabetic expedition, which is to draw attention to these unfounded fears and help change the mindset of a rising diabetic population. |
Such typical Malaysian apathy - "no takers from the Malaysian diabetic side". Are we (or at least Sabahans) such a pathetic lot?
Links:
Persatuan Diabetis Malaysia (Malaysian Diabetes Association)(more links to the other Medically related Societies with webpages in the
MMR Societies section : if your Society is not listed, please send me
feedback with the URL)
Gene therapy for cancer
The Star picked up this news item from China Daily:
Ray of hope for cancer patients
CHINA has developed a gene therapy for cancer, the world's first officially licensed “gene therapy.”
Terminally ill cancer patients from Europe and America are travelling to China for treatment with a revolutionary anti-tumour drug.
The drug works by inserting a gene, called p53, into a virus, which is then injected into patients.
The gene is naturally present in healthy cells but is “switched off” or mutated in many cancer patients.
When reinserted into tumour cells by the virus, it triggers their self-destruction, and programmes cancer cells to commit suicide.
The Chinese government approved the manufacture and use of the drug at the end of last year after clinical trials found that it markedly improved the survival rate for patients with cancer of the head and neck.
Doctors are now extending the treatment, named Gendicine, to patients with lung and stomach cancer. – China Daily |
I'll bet there will be now tons of cancer patients or their relatives now asking their doctors for more information. I am not an expert in the field of gene therapy so I cannot comment further but as with good clinical practice we need to see the results of the phase III clinical trials and see these duplicated in reputable centres. I Googled
this link and I quote:
'Gendicine' or 'Gendi..china', What's going on ?...
The use of recombinant adenoviruses carrying a 'healthy' version of the tumor suppressor gene p53 for the treatment of human cancers has been widely investigated (several hundred papers in the official publication database)
Clinical trials with this kind of approach have reached phase II and are just entering phase III, at least according to available registries (example: Wiley database). The official documentation about the results obtained in phase I and Phase II is partly encouraging and partly disappointing.
Given the controversial results, it is very surprising to hear that a product based on this principle has been allegedly approved for commercialisation in China. More surprisingly the available news talk about the largest clinical trial having involved 120 patients. this number is suspiciously small for the traditional criteria of a rigorous phase III trial.
At this very moment, many western specialists are rather suprised by this move. It remains to be established whether this prospected drug fulfils the standards of efficacy and safety that are usually required by good clinical practice. My preliminary feeling is that at the basis of this claim there are more financial interests than genuine medical-scientific progresses. |
So is someone jumping the gun? Time (and more trials) will tell..
1st Class Honors and Housemanship
Tucked away in the comments on this MMR post on the
WHO warning on alternative medicine is this Comment which I almost missed had I not checked my Haloscan comment database:
Dear reader,I'm a fourth year medical student at the moment with many questions which needs answers.I'm from Nizhny Novgorad state medical academy,an institute which is recognised by mmc.i'm planning to do my postgraduation right after my degree.i'll be most probably getting a first class honest.So rumours say that a first class degree holder is not requested to do her housemenship before futuring her education.just want to know how far it is true.I'm planning to do my postgraduation in the same academy.Will that be recognise by MMC.Please do reply me soon.
Netia d/o Jeganathan |
I replied:
That is absolutely not true. Housemanship is compulsory for all.
Ginseng 'hampers blood clot drug'
I have already mentioned that Ginseng and some other herbs may interfere with clotting and promote bleeding in susceptible individuals when I highlighted WHO's
Warning on alternative medicineSeems to be herbal warning season now - the BBC has another reminder that
Ginseng 'hampers blood clot drug'The herbal remedy ginseng interferes with the action of a drug often given to heart patients, warn US scientists.
The University of Chicago team found ginseng reduced the blood level and anti-clotting effect of warfarin, which they say makes this combination unsafe.
The UK Medicines and Healthcare products Regulatory Authority said it would investigate the concerns.
The report on 20 patients, after a four-week trial, appears in Annals of Internal Medicine. |
So
if you are on Warfarin - do not take GinsengI wonder if we'll see cautionary statements from our own regulatory authorities??
Herbs fail to treat hepatitis
In Asia, herbs are often prescribed to treat viral hepatitis. Unfortunately, this sort of treatment is given without any sound evidence of clinical benefit. Studies must be properly conducted and there should be controlled clinical trials (that is comparing a treatment with other established treatments or placebo) before one can say for sure it works or does not work. Herbalists are unable and unwilling to perform such clinical trials so it is up to modern day doctors once again to test these out.
Reuters Health reports that a herbal combination used in Asia failed to be of any benefit in Hepatitis C:
NEW YORK (Reuters Health) - A Chinese herbal treatment often used to treat hepatitis in Asia does not appear to reduce liver inflammation or improve quality of life in people with hepatitis C, new research reports.
Moreover, after 3 months of treatment, herb-takers who participated in the study did not show any change in the amount of virus in their bodies.
"Unfortunately, our results suggested that the herbal compound was no different than placebo," study author Dr. Jeffrey H. Albrecht told Reuters Health.
"At this point in time, I am aware of no conclusive data that these herbs provide any meaningful benefit in" hepatitis C, added the researcher, who is based at the University of Minnesota in Minneapolis.
SOURCE: Archives of Internal Medicine, June 28, 2004. |
Alternative medicine in this country continues to be inadequately regulated. People continue to consume herbal treatment with the belief that herbs are "good for them" and will benefit their illness. There is an urgent need for proper scientific research and more trials like these to show once and for all whether or not various herbal remedies truly work. I am aware of a handful of studies which show benefit in herbal remedies - one of them being Chinese TCM in the treatment of atopic dermatitis/eczema published in the BMJ a long time ago. But the majority of herbalists continue to peddle herbs without scientific proof of efficacy to a gullible public.
Smokefree workplaces save lives
Is your workplace a smoke-free zone? Do you have inconsiderate colleagues who light up their cigarettes at work or in the office disregarding their non-smoking colleagues?
Medical News Today has this article on
Passive smoking kills, Smokefree workplaces save lives On Monday 5 July at 9am, Deputy Chairman of the BMA (British Medical Association), Dr Sam Everington and Deputy Chairman of the Board of Science, Dr Peter Maguire, delivered 4,500 doctors' letters to the Prime Minister.
The letters were delivered to Downing Street in a giant cigarette packet. At the beginning of June 2004 the BMA had urged 1000 doctors to write a letter to the Prime Minister on this issue to represent the 1000 people who die every year from second-hand tobacco smoke. By the end of the month 4,500 letters were received.
In the UK approximately three million workers are regularly exposed to second-hand smoke and around 1.3 million workers are exposed to second-hand smoke at least 75% of the time. Workers in lower socio-economic groups run the greatest risk of exposure.
Last week's Annual Meeting of the BMA congratulated the government of the Irish Republic for the leadership it has shown by banning smoking in enclosed workplaces by legislation and called on the BMA to lobby government for the immediate introduction of equivalent legislation throughout the United Kingdom |
If you are a victim of indiscriminate cigarette smoke in your office, show this article to your boss. Too bad if your boss is one of the guilty party!
More herbal warnings
Consumers should be cautious as ever. This item comes from
Medical News TodayEven with the recent banning of ephedra, consumers should remain cautious about trying other herbal supplements.
According to doctors at UT Southwestern Medical Center at Dallas, substances such as bitter orange, germander, jin bu huan and usnic acid – ingredients in weight-loss products – have been associated with kidney and liver problems.
“A number of herbal preparations have been implicated in causing liver damage, some even leading to the need for a liver transplant or to death,” says Dr. William Lee, professor of internal medicine and an expert in digestive and liver diseases. “Herbal products are not under any specific supervision by the Food and Drug Administration, so there is no quality control, no proof of efficacy and no tests of safety.”
The ban on ephedra, which had been linked to more than 150 deaths and dozens of heart attacks and strokes, was the government’s first for a dietary supplement. New manufacturing and labeling regulations for dietary supplements are expected later this year, according to the FDA.
“The herbal industry is largely satisfying a need for self-remedies for patients who are unwilling to seek conventional medical attention or are wary of doctors,” says Dr. Lee. “Most supplements are indeed harmless and only injure the pocketbook. Many people, however, take these compounds in any amount, never limiting themselves to what is advised regarding dosing.” |
My personal opinion is that there are herbs which may have some therapeutic benefit but unfortunately the documentation of these possible benefits are scanty in terms of controlled clinical trials. What is more worrying is that adverse effects go unreported but of late more and more adverse events are highlighted as modern medicine is forced to monitor these events since your regular herbalist will seldom do this!
More links:
The
Herbal Minefield
Site update: Allergies & MSAI
Browsing the web my current favorite way (using SharpReader and multiple RSS feeds), I came across an article in Medical News Today on
Containing the allergy epidemic. This is a summary and recommendations of a new report from the Royal College of Physicians, UK.
There has been a dramatic increase in allergy in recent years, including severe life-threatening and multi-system allergies. There is, however, a growing gulf between the need for effective advice and treatment and the availability of professional services.
In particular, there is an urgent need (a) for specialist-led allergy centres where the more complex cases can be treated and which can provide the necessary training for other specialties dealing with allergy patients (many of whom are children), and (b) for GPs to acquire the necessary knowledge and training so that they can provide an effective primary care led allergy service in which patients can have confidence.
The recommendations of the report have been designed to form the basis for the development of a coordinated service. |
If the UK has a "growing gulf between the need for effective advice and treatment and the availability of professional services" you can imagine how much more severe the situation here is in Malaysia. There is a dearth of trained clinical allergists indeed.
I managed to locate the
Malaysian Society of Allergy and Immunology wesbite (and duly added this link to the MMR's list of
Professional Societies and Associations websites). I am glad there is such a society and hopefully it will inspire more Malaysians to take up this field. The IMR's
Allergy and Immunology Research centre also deserves a mention. I note the old link for the IMR in the
Govt Medical Department websites listing (it was http://imr.gov.my) did not work and I duly changed it to the current
IMR website. Usually most hosting configurations will be able to handle links to the website without the "www" but not this one.
Feedback : Odessa State Medical University
yee asks:
i wonder to know if The odessa State
Medical University ,Ukraine is recorgized by Malaysian Medical Council or not. Thank a lot. |
Firstly Yee, you need to improve your English and your spelling ;)
The MMR has a previous post on
Russian Medical Schools. The gist of this is that only the
Malaysian Medical Council can answer your question so I suggest you contact them. The only Russian medical school listed in the MMC's website (this may be out-of-date) is the Crimea Medical Institute - moreover this is in the
Unscheduled Universities list meaning it is not fully recognised by the MMC and graduates still have to sit for a qualifying examination in Malaysia prior to being able to start Housemanship. I don't know the answer to your question but would be interested to know once you find out from the MMC. Good luck.
Storing your medicines
Have you looked at your medication packaging to see what the recommended storage temperature range is? Mind you, our room temperatures can soar to 34 degrees Celsius in these sweltering months.
Many of them warn not to store the medication past temperatures like 25 or 30 degrees C. Some even require you to refrigerate the item.
If you have the original packaging, you can find out. If your doctor has given you medications in separate packaging (hopefully with a label and the name of the medicine!!) , it is wise to check with him or your pharmacist.
This article applies to medicines in the UK but imagine how much colder the room temperatures are there compared to Malaysia where I suspect the problem is more seriuos and under-appreciated.
Medicine storage temperatures are too high
The recommended maximum storage and transit temperatures for most medications is 25°C and are set by the pharmaceutical manufacturers.
Are healthcare providers following these guidelines? In the July issue of the Journal of the Royal Society of Medicine, Dr Brian Crichton, of Hobs Moat Medical Centre in Solihull, investigates how Britain’s local pharmacies are storing medications during hot weather spells.
Typical storage of medicines
Doctors who run family practices in the UK store medicines either on practice premises or in ‘bags for emergency use on home visits.’ Most drugs are licensed for storage at a temperature up to 25°C because, at higher temperatures, there is a ‘risk that their efficacy will be adversely affected,’ the author says. He argues, ‘The quality of drugs carried by family doctors for emergency use needs to be above suspicion.’ This study investigated the storage conditions of medicines in a suburban primary care setting in England during a heatwave.
Temperatures are ‘too high’
Thermometers were placed on the shelf in the drugs cupboard at the practice location and in typical doctors’ bags. The bags were then placed in the boots of two different coloured cars - one silver and the other dark blue - parked in similar places in the car park. The medicines ‘at every storage site exceeded 25°C’ throughout the entire study, Dr Crichton writes. Medicines on the drug cupboard shelf reached a high temperature of 37°C; in the silver and blue cars, temperatures reached 43°C and 49.5°C respectively.
Storage conditions and efficacy
The author believes these conditions are consistent across the UK. A telephone survey of the ten closest dispensing pharmacies found that not one used air conditioning or temperature logs for drug storage. ‘Do these deviations from the recommended storage temperatures matter in practice?’ Dr Crichton asks. A previous study revealed that some drugs show ‘no significant alterations’ by exposure to high ambient temperatures. Others, however, ‘do seem temperature sensitive.’ Many drugs, including cefalexin, ampicillin and erythromycin have shown a reduction in efficacy when exposed to high temperatures. Aspirin, for example, degrades under increased temperature conditions.
‘A need for more work’
Although this study does not investigate the responses of specific drugs to high temperatures, the author stresses the need for this issue to be further investigated. ‘We must react to the implications of this study to ensure the safety of the medications patients receive in the primary care setting,’ he says. ‘The issue of drug efficacy and stability needs to be studied more closely, before a problem occurs. If pharmacies are air conditioned in other parts of the world, why don’t we set the same standard in the UK?’
http://www.rsm.ac.uk |
Source
1,000 illegal practitioners
In Malaysia, all doctors must possess a valid Annual Practicing Certificate (issued by the
Malaysian Medical Council) in order to practice medicine. Failure to do so is a serious offence.
What about practitioners of "alternative medicine"? It appears to me that the situation is "free for all" and if there is any regulation, it's poorly enforced. There were murmurings about legislature on Traditional and Alternative medicine - i.e. to determine who is qualifed and what not - but I am not sure what's happening to this now. It seems to me any Tom, Dick or Harry can setup shop in this country and declare himself or herself a "Natural/Alternative/Herbal/__fill in the blank__" practitioner. God help the consumer - if you choose to see an Alternative medical practitioner, then its truly a case of
Caveat Emptor.
One of the oldest schools of Traditional Medicine are the practitioners of Chinese Traditional Medicine. Now
The Star reports:
IT IS estimated that there are over 1,000 unregistered Chinese physicians in the country, Nanyang Siang Pau reported.
According to the Federation of Chinese Physicians and Medicine Dealers Association of Malaysia secretary Thong Choong Khat, this figure was derived based on a study conducted three years ago.
He told the paper he believed that the number would have been reduced now that the Government was looking into the issue.
He said the federation could only make recommendations but it was the Health Department that grant permits to foreign Chinese physicians to practise here.
He said the Immigration Department would issue a working permit to a foreign physician once it has obtained a clearance letter from the Health Department, he said.
“Foreign physicians without professional training and certification will not be able to practise in the country,” said Thong.
He said those physicians whom the federation recommended would display their permits in their clinics.
Thong advised the public to look for such permits to avoid going to unregistered practitioners.
Deputy Home Minister Datuk Tan Chai Ho said physicians who work without a permit in the country would be blacklisted and barred from entering Malaysia again.
He urged the public to alert the authorities if they know of any unregistered physician. |
What I am curious about is what criteria the Immigration and Health Department use when they issue such permits? What "professional training and certification" is recognised and not recognised?
Hey it seems it doesn't matter since over 1000 can practice without such certificates!
It's a clear day...
At least the rains have washed away most of the haze. But for how long?
Doc Vadivale maintains a great page on the
Haze in Malaysia - go there for the latest news and links. Too bad our local DOE's website isn't much help. Certainly no where near Singapore's
Haze Monitoring website. Better to be forthcoming with facts - there's no point hiding the data. I agree with Doc Vadivale -
A.P.I : Time to put it out the data!!
NIOSH's COSH
The
National Institute of Occupational Safety and Health (NIOSH) will organise a Conference of Occupational Safety and Health (COSH) on July 20-21 2004.
More information from the
NIOSH website
