Lecturer Shortage : No surprise
Highligted in
The StarVarsities to face shortage of lecturers
KUALA LUMPUR: Local universities will face a shortage of medical lecturers when the terms of service of some 40 doctors seconded from the Health Ministry expires over the next few months.
Higher Education Minister Datuk Dr Shafie Salleh said seven government doctors lecturing at the Universiti Sains Malaysia would be the first batch to leave at the end of the month and return to their duties.
“We are still negotiating with Health Minister Datuk Dr Chua Soi Lek to extend the secondment period but Dr Chua said his ministry is also facing shortages.
“If an extension is not possible, then, we will have to fall back on Plan B, which is to employ foreign lecturers,” he said at a buka puasa function with public universities' student council representative last night.
Dr Shafie said the leaving of these Government doctors would have a great impact on the quality of medical courses in eight local universities. |
All public varsities are losing much needed experience to their private counterparts. There is little surprise to this fact when factors like unfavourable policies and working conditions continue to thrive in government-run institutions. Managers entrusted with running a facility often fall short in all departments. They lack leadership and sometimes basic common sense and are totally incompetent. This makes working under such environments frustrating. Even the fundamentals of human resource management is sorely lacking leading to unhappiness within the ranks. There is little effort made in effecting proper communication between faculty, management and staff. Inconsistencies in policy implementation further destroys all credibility of institutions that supposedly pride themselves as centers of learning and excellence.
The solution. Meritocracy and transparency. There is little hope when favouritism persists which corrupts even the most formidable of systems. There are some areas that should not kowtow to biased practices. Education is one field that should never be subjected to unjust policies. Meritocracy has only one meaning and should not be manipulated and distorted to suit the likings of select individuals. Disguising it will only sow the seeds of mistrust.
Selecting only the best will guarantee success. However, in a system that lacks transparency in selection processes from the undergraduate level to faculty positions, there is little wonder why premier instititions like University Malaya is slipping down the ranks. It is amazing how rules are flouted blatantly to suit the fancies of certain individuals. It is my belief that so long as meritocracy and transparency is not properly respected, there is little hope at all for a country that supposedly aspires to become a fully developed nation in 16 years time.
Feedback: CPGs
eida writes:
| As you know that there are recent updates to Malaysia's CPG (if I am not mistaken on DM and HPT) but I can't find it online (though my senior doctor mentioned there was a site that host all of it). Could you help me with this? Thank you |
Thanks for writing in eida. The
Academy of Medicine has a page on
Clinical Practice Guidelines. These appear to be quite updated and should be what you are looking for.
Psoriasis
Tomorrow, October 29, is the
1st World Psoriasis Day.
Globally, there are millions of people with this skin disorder and Malaysia is no exception.
You might be interested to know that there is a
Malaysian Psoriasis Association though the website needs to be updated with the latest info as they have only the year 2000 list of office bearers.
It can be quite a disfiguring disease if the skin and nail lesions are extensive and the ignorant or unaware might be concerned if the disease is contagious - which it isn't. Some patients also have joint involvement - Psoriatic arthritis.
Modern treatment encompasses topical preparations (i.e. applied to the skin), phototherapy and for the more severe cases, oral/systemic drugs. There are also new "biologic" agents being tested such as alefacept, efalizumab, etanercept, infliximab and adalimumab which work on specific targets.
Links:
Dermatological Society of Malaysia Questions & Answers on PsoriasisWhat is Psoriasis?
Feedback: Peptik ulser
Jasri Selamat menulis:
| saya mahukan informasi dalam bahasa melayu. kerjasama tuan/puan amat saya hargai. |
Jasri,
Carian Google menghasilkan beberapa laman web tentang perkara ini.
Gastrik dan Ulser merupakan laman web dari USM yang mengandungi maklumat tentang ulser gastrik. Kebanyakan ulser peptik disebabkan oleh kuman
Helicobacter pylori . Doktor anda boleh menasihat anda tentang cara-cara untuk merawat ulser peptik dan jangkitan Helicobacter pylori.
Feedback: recognition questions
I am still getting feedback asking about the recognition status of various medical schools abroad. I am afraid you have to check with the
Malaysian Medical Council (MMC) which is the proper body which accords recognition of the basic MBBS degree. The MMC's website has a
list of recognisable qualifications and a
list of Unscheduled Universities. The latter are Universities from which graduates can register only after sitting for and passing a qualifying exam in Malaysia. Please note that these lists belong to the MMC and
not the MMR. It is quite possible that the lists are not up-to-date (it all depends on the MMC's webmaster and you know
Malaysia has plummeted to 83rd in the e-Govt rankings) so you have to enquire directly from the MMC.
The MMR is not connected at all to the MMC - we serve as a link to all important Malaysian Medical websites. The MMC and other Government bodies and departments are listed in the
MMR's Government section. In case you haven't noticed, the Navigation bar at the top of the page will take you to other sections and a large repository of links.
Repaying loyalty
How do you repay your long serving and long suffering staff and retirees? Apparently, UH shows how
not to do it.
In
Nurses feel cheated by University Hospital board, a group of retiree Nurses who served at the University Hospital wrote in to The Star :
WE are a group of retired nurses of University Hospital writing to appeal to the Board of Management of the University Malaya Medical Centre to reconsider its decision to terminate our free medical benefits.
We were the pioneer batch of nurses of the hospital since its inception in 1967 and have dedicated our lives to caring for the sick despite the acute shortage of professional nurses and frequent night duties.
Our pay was relatively low with no overtime, critical allowances or bonuses.
In 1986, the staff morale was at its lowest as large numbers of experienced nurses and paramedics were leaving for higher pay overseas and in the private sector.
As an incentive to retain the nurses and healthcare personnel, the board promised to reward the long-serving employees on EPF scheme free medical benefits only at University Hospital.
We have fulfilled our part by staying on until retirement and as promised were given a pension card, Kad Pesara KWSP, which entitled us to free medical treatment at the hospital upon retirement.
However, a circular dated April 7, last year, was given to the counter staff in the polyclinics to invalidate our Kad Pesara KWSP.
We, the retirees, were never informed of this personally or via any public announcement.
The present board has the moral obligation to honour a promise that was made 17 years ago.
It is a most cruel act to deprive a handful of elderly nurses in their twilight years of the free medical benefits that they rightly deserved. |
What prompted the UH management to deprive the "Victims of Injustice" of their free medical benefits? Is the monetary gain worth more than what you lose in moral ground and standing in the eyes of your ex-employees and the community?
What's in a name? (part 2)
You probably are aware that every drug has a
generic (scientific name) and according to the manufacturer, may have one or more
brand names.
The antifungal drug fluconazole is marketed by the company Pfizer under the brand name
Diflucan (PDF file). However there are now other manufacturers (I guess the patent has expired?) of fluconazole. A local company,
YSP, manufactures fluconazole 150mg under what a
Dobber has called the "Mother of all names" :
FukoleHmmm. I guess I won't be enquiring over the phone to my hospital pharmacy (often manned by SYTs!) if they stocked "Fukole"
Seeking funds
The Star reports that a
Cancer patient seeks fundsHousewife Hoong Hai Poh, 58, from Batu Gajah, who is suffering from cancer of the rectum is in need of RM15,000 for six cycles of chemotherapy treatment.
Hoong said her husband, a former carpenter, had spent his life savings of RM11,000 to send her for radiation therapy and to have her uterus removed when she suffered from cancer of the cervix in 1994.
“Now, we have no choice but to seek public donations for the chemotherapy treatment.
..
She said the chemotherapy would be carried out in a private hospital where the rectal growth was removed in August.
Doctors there had advised her to continue her treatment at the same hospital instead of going to a government hospital at this stage. |
In the absence of a National Health Insurance Scheme (when if ever will this be put in place??) there will continue to be an endless stream of needy patients like this.
Another issue is I thought is such appeals for charity are frequent but it seems like it is up to the newspapers to decide whether or not the appeal is deserving or not. For instance, could not patients be referred to Government hospitals for chemotherapy? Why is there a need for a particular patient to continue treatment in a private hospital if there is a clear financial need?
It was just not long ago there was all this hype about a National Health Welfare Fund - the one the previous Health Minister was
Under Fire in the press and there were "accusations of delay and tardiness at the Health Ministry". So will the NHWF help in cases like this too? The same report mentioned it is assisting in another patient with cochlear deafness.
First Aid
The Star has a feature on "
What to do in an emergency".
Well and good, but I doubt many people are going to keep a copy of this and the subsequent sections handy when they actually encounter an emergency. Reading this through is OK but people are bound to forget Even if you have undergone a basic first aid course, it would be nice to carry information with you all the time. As a long time Palm PDA user, I have a suggestion - if you use a PDA, perhaps you should consider carrying first aid information in your PDA. It might save a life!
Here's a freebie:
 1st AID v1.4 is freeware. It "offers useful information to help you deal with common urgent and emergency care situations, ranging from a nosebleed or sunburn to a life-threatening heart attack or stroke". |
So have you encountered any real-life emergencies yourself? I would be interested to hear your experiences and would gladly post them here on the MMR if you care to share.
Site update: profizham.org/my mom's best
Dr cheahwc wrote in to inform that www.profizham.org listed in the MMR's
Doctors' Personal Home Pages listing is defunct as the man has moved to Australia (?permanently). I have accordingly placed a cobweb (
) sign on the site. Well sites do come down and new sites come up. Lets see more academics come up with something for the post-grad docs.
I have also added
My Mom's Best posted by Dr TE Cheah below to the
General Information links section of the MMR. Just my opinion but the title seems a little truncated to me as "My Mom's Best.." seems begging for something to be appended to it. You know, like Best Friend, Best Effort, Best ....
If you know of any other links - new or broken - please send me
feedback.
What's in a name?
What's in a name? That which we call a rose
By any other name would smell as sweet.
~William Shakespeare, Romeo and Juliet
I think the press is using the title "Doctor" too loosely and inaccurately. The term Doctor is applied to a medical doctor (holder of an MBBS or equivalent qualification) or a phD doctor. Practitioners of "alternative medicine" be they chiropractors, sinsehs, bomohs, auyervedics and what-not should not use the title "Doctor" as this would mislead the public into thinking they have undergone mainstream medical training and have an MBBS qualification.
The Star has this dramatic story called
Doctor put boy in torture chamber A 14-year-old boy, who was used as a guinea pig by a doctor in his experiments to discover new cures, was forced to drink his own urine.
“I was in a torture chamber, forced to drink my own urine, abused and turned into a guinea pig,” he said.
The boy also described his 30-day ordeal with the doctor, who practises traditional medicine, as “hell in the cell.”
The boy, who escaped from the bizarre experiments, said the doctor used him to discover new traditional cures.
The 52-year-old doctor and four of his accomplices were arrested at a house in Taman Desa Rasah here on Saturday after the boy managed to escape his tormentors on Oct 4. |
So is this "doctor" a real MBBS holder? If the allegations are true, I cannot imagine an MBBS doctor would be responsible for the despicable acts. But then the clue is the reference to the "doctor who practices traditional medicine" - in all likelihood this is not a real doctor but a traditional medicine practitioner. I think the MMC and the MMA must act and come out in defence of the medical profession. They should confront the press who should stop using the term "doctor" to decribe practitioners of traditional or alternative medicine. A Headline such as "Doctor put boy in torture chamber" really puts the medical profession in a bad light and makes one think we are going back to the bad old days of Nazi medical experiments.
This is not to say the medical profession is not without it's bad sheep. Which profession doesn't? But then please call a spade a spade.
Website focus : MyMomsBest
"Malaysia's breastfeeding and Parenting Website with a heart". It started as a support group on Yahoo. A group of enthusiastic mothers have ventured out of their way to create a website that disseminates the wonders and advantages of breastfeeding your own child. It also encompasses common health related topics concerning babies and its day to day care. It also has a recipe section. It is definitely worth a visit even if you are not a mum or dad!! ;)
Lessons to be learnt
In The Star,
Elderly man dies after ambulance crashes
BY NIK NAIZI HUSIN
 KUANTAN: An 82-year-old man, who was being sent to hospital, died after the ambulance he was in crashed at the East Coast Expressway near Sri Jaya, Maran.
Kidin Mohamad was being ferried from the Maran district health centre to Tengku Ampuan Afzan Hospital here when the incident occurred at the 189th kilometre of the expressway at 12.50pm yesterday.
The accident occurred in front of his son Daud Kidin, 55, who was tailing the ambulance about one kilometre away on the highway.
This ambulance which was ferrying two patients from Maran to the Tengku Ampuan Afzan Hospital in Kuantan turned turtle after the driver is believed to have lost control of the vehicle at the 189th km of the East Coast Expressway near Sri Jaya in Maran. One patient, aged 82, died in the 12.50pm incident yesterday while the other escaped unhurt.
“I saw the ambulance suddenly going out of control and overturning. When I stopped my car, I saw my father lying in a drain. He had been thrown out from the ambulance during the impact,” he said.
Shortly after the impact, the ambulance caught fire.
Daud said he took a fire extinguisher from a lorry driver who stopped by and put out the fire inside the ambulance.
He said he managed to carry his father into his car, and broke the glass window of the ambulance to rescue nurse Yah Mohammad, 41, and driver Redzuan Abd Ghani, 36. Yah and Redzuan suffered burns and wounds.
The ambulance was also carrying another patient, Mahadzir Mohamad, 26, and his father Mohamad Ghapur, 61. They were unhurt and were taken to Kuantan in another ambulance.
Daud drove his car carrying Yah, Redzuan and his father to Kuantan.
“However, my father passed away on the nurse’s lap during the journey,” Daud said at the hospital mortuary.
Daud said his father had earlier refused to be taken to the hospital when he complained of pains on his leg following a fall.
He added that medical staff at the clinic near Kidin’s house in Luit found that he had swelling on his leg and advised him to go to Kuantan to undergo an x-ray. |
There are lessons to be learnt from this incident.
Firstly, ambulance drivers ought to be more careful and should abandon their daredevil driving stunts even in the face of an emergency situation. They should be taught not to put the lives of their patients and that of their colleagues at risk.
Secondly, an ambulance should never carry more than one patient at a time. The ambulance was never equipped and designed for the carriage of more than one patient. The spaces are limited inside the ambulance and would make long journeys a torment for the patients and healthcare staff alike.
Thirdly, the design of our current ambulance vehicles is flawed. In the eventuality of a resuscitation, the dimensions of the current ambulance would render that impossible. These are just vans with beds rather than an ambulance. The design is obsolete and requires an overhaul.
Lastly, travelling more than 60 kilometers from Maran to Kuantan for an X-ray is a good indication of the disparity in healthcare facilities in Malaysia.
Malaysia Boleh!
Government-run private hospitals
In The Star,
Private hospitals to be available in government hospitals soon
JOHOR BARU: Services equivalent to those in private hospitals will soon be available in government hospitals with the introduction of the full payment service, aimed at improving efficiency, services and increase competition in the health industry.
Health Minister Datuk Dr Chua Soi Lek, in making the announcement, said under the proposed service, patients would be warded in first-class wards and could choose the doctors and specialists to treat them, similar to the option available when seeking treatment in private hospitals.
Speaking to reporters after attending the MMA (Johor branch) annual dinner on Saturday night, he said this would be implemented instead of the earlier proposal for a private wing at government hospitals, which would incur a high cost in setting up.
He said instead of paying the subsidised fees, these patients would be required to pay the full amount and the fees would be compatible to that charged by private practices, according to schedule drawn by the Malaysian Medical Association (MMA).
Dr Chua said the Cabinet had made the decision last Wednesday and Putrajaya and Selayang hospitals had been selected to start the service next year. |
I sometimes fail to see the logic in certain decisions by our political administrators. It smacks of indecision and paucity in research. Having a private wing in government hospitals itself is fraught with controversies as specialists subtlely devote a greater amount of time in expanding their wallets. Some would even cunningly utilise the non-private entity in fulfilling the appetites of private patients. This further strains the already stretched services at the non-private sector. There are no clear delineations in certain aspects. Now the idea of having private patients in government hospitals is a tragedy in itself.
I do not forsee a better service. In actual fact, forecasting a worsening quality of service may not be too farfetched. How would the demarcating lines be drawn in such situations? Should private patients be given the priority over non-private ones especially when it comes to waiting lines in the clinics or even for radiological procedures? This would create a "caste" system that encourages discrimination based on economic grounds. As the situation stands, more consultants are already choosing to neglect non-private patients in centers with private wings.
Why must we have private patients in government hospitals? Why can't the Government entertain and correct issues that are contributory to a poor service? There are enough beds in private centers. And there are more than enough patients in government run hospitals. There is little need to increase competition.
The Government should channel its brainpower to solving the deteriorating conditions at government hospitals. It should no longer turn a blind eye to the welfare of its employees. I can certainly tell you that accepting private patients will not improve efficiency and the services rendered. Conversely , it may even cause a further deterioration of services to non-paying customers when additional resources are channeled to financially priviledged ones.
This move lacks foresight in planning and displays great immaturity in management. It would only replace one problem with another and can potentially create a further rift between the rich and the poor.
Geriatric Care: Where are we?
Malaysia has an aging population. It has been projected that by the year 2025, 13% of Malaysia's population will be above 65 years of age. It is this fact that warrants a review of geriatric care in our healthcare system. Unfortunatly,one fact that sticks out like a sore thumb is the lack of care for our debilitated elderly by family members and at healthcare institutions.
The state of our current hospitals certainly needs to be improved to facilitate its use by elderly folks. It would be disastrous for hospital administrators to ignore the fact that the elderly are currently being sidelined. They are expected to queue with more abled individuals for hours just to get medical advice for 5 minutes. Hospitals at the moment certainly do not provide comfortable logistics for our elderly.
Caring for the elderly requires perseverence, commitment and dicipline. It will certainly take its toll on the caregivers of debilitated old folks. Thus,unfortunately, many turn to hospitals for respite care. This would certainly end up overwhelming the resources of our hospitals. The lack of facilities that provide respite care for the elderly has resulted in such misuse of hospital facilities. Nursing homes are abundant. But good nursing homes are a rarity. The standard of care at nursing homes in general, leaves much to be desired. From the lack of funds to the lack of manpower, excuses are expressed when an elderly presents with avoidable complications at our local hospitals. To top it up, exorbitant fees are charged for substandard services and care.
Ultimately, the care of our elderly should be the responsibility of his or her immediate family members. It frustrates me to learn that on many occasions, family members especially the siblings refuse to accept the responsibility of caring for their old folks. Some would offer reasons like financial constraints and work commitments as excuses not to assume the caregivers role. It may appear that the presence of dementia in many elderly folks is a protective mechanism against such ingratitude.
The Government should invest seriously in healthcare for the elderly. In addition,regulation of old folk homes needs to be improved. Respect for senior citizens by our younger population requires stricter enforcement. At the moment, the future of healthcare for our elderly remain seriously out of focus.
Link
Gerontological Association of Malaysia
Vitamin E: it's all hype
Vitamin E as a supplement and supposed benefits as an antioxidant which may help in cardiovascular disease, cancer prevention etc. has been debunked.
News-Medical.Net reports:
When researchers at the Cleveland Clinic Foundation reviewed seven vitamin E studies involving more than 80,000 participants who took between 50 and 800 International Units of vitamin E daily and were followed for up to six years, no dose of vitamin E was proven to be beneficial for reducing death from cardiovascular disease. Further, a Canadian study that tracked approximately 2,500 women and 7,000 men aged 50 years or older who were given either a vitamin E supplement or a placebo found that, after five years, those taking the vitamin were no better off than those taking a placebo. In fact, supplement-takers suffered as many heart attacks, strokes and deaths from cardiovascular disease as did placebo-takers.
Vitamin E supplements also recently failed to demonstrate that they could boost immunity in older people. Researchers in the Netherlands randomly assigned 652 healthy people aged 60 or older to take a vitamin E supplement, a placebo or a multi-vitamin for 15 months. Interestingly, when people receiving the vitamin E supplement got a cold or the flu, it lasted an average of five days longer and they suffered more symptoms than the placebo-takers. In addition, a 2002 Australian study of 1,000 healthy volunteers found that those who took vitamin E supplements were no less likely to be diagnosed with macular degeneration than those who took a placebo. |
Some early studies showed slightly positive beneifts of vitamin E - I recall one British study on patients with ischaemic heart disease. But it looks like more recent and larger studies show it's a failure.
My advice is to take lots of fruits and veg. Forget about the vitamin supplements.
Malaysian sex habits
Well folks,
back in May I mentioned the Durex Global Sex Survey 2004. Did you take the survey?
In 2003, 5645 Malaysians took part, and this year there were 8,202 Malaysian respondents to the online survey.
You can view/download the
GSS2004 results from the Durex website.
The Star summarises some highlights:
- average age Malaysians lose their virginity: 19.3 years
- Malaysians are among the oldest to receive sex education at 14.5 years
- 30% of Malaysian respondents even claimed that they have never had any formal sex education
- 69% of Malaysian respondents were concerned about HIV/AIDS and another 22% about unplanned pregnancy, more than a third (35%) of them, as well as those in the rest of the world, admitted to having had unprotected sex without knowing their partner's sexual history.
- Most Malaysian respondents felt that parents and guardians (49%) and schools (30%) should be responsible for teaching sex education
- According to the survey, the French are having the most sex (137 times a year) while the Japanese are the least sexually active (46 times a year). In this respect, Malaysians are not doing too badly at 86 times a year compared with the global average of 103 times.
So did you take part? I did and I won a prize ;)
Muslim diabetics and Ramadan
The month of Ramadan starts this week, commencing a month long fasting for Muslims.
Muslim diabetics and their care-givers may face a dilemma on what to do during this month. You might be interested to know that there is a "Diabetes and Ramadan Advisory Board" and they have published new guidelines in the paper "International Recommendations for for Muslim subjects with Diabetes Mellitus who fast during the month of Ramadan" (Clinical Diabetes, Middle East Edition, Vol 3 No 3 2004)
The following excerpts are tables taken from the paper:
It is an interesting paper and the guidelines were in part based on the large EPIDIAR study which was an epidemiological study on Muslim diabetics and the experts have updated the first guidelines formulated in Casablanca in 1995.
Feedback: Mobic
W wrote about an experience his son had with a doctor who prescribed Mobic.
Well W., Mobic is the tradename for
Meloxicam which is a Non-Steroidal Anti-inflammatory drug. You are mistaken in inferring it is prescribed only for osteoarthritis as it can be used for a variety of inflammatory and painful conditions. It is not a muscle relaxant either but can reduce swelling and stiffness due to inflammation.
The link to Meloxicam above comes from the excellent
Medlineplus Drug Information database which I think all health consumers should use so that they are aware and more knowledgeable about the medication they are taking.
No, and I don't know why the calcium tablets were precribed either - for that you have to ask the doctor concerned.
The true cost of blood?
The Health Ministry parliamentary secretary has made a
statement which claims to the effect that private hospitals are over-charging for blood transfusion.
He said some private hospitals asked for blood supply from government hospitals that either charged RM80 a unit or did not charge, depending on the cases.
The RM80, he said, was the cost of screening blood donated by volunteers.
He said private hospitals should only charge the amount paid to the government hospitals upon obtaining the blood supply. |
The private hospital where I work does not get it's blood supply from the government (which in any case is often in short supply themselves) and has to rely on it's own blood bank. The cost of cross-matching and screening (for hepatitis viruses, HIV, VDRL etc) is not trivial. However cost is not an issue here as the patient's safety is more important and we need to ensure the blood supply is indeed safe. If I am not mistaken the cost will actually come to about RM200-300 per unit of blood. Is this expensive taking into account all the tests done to ensure the blood is safe? How does this compare to overseas?
In the US, the
Cost of outpatient blood transfusion in cancer patients comes to a whopping US$469 for adults and $568 for pediatric cancer patients per RBC unit.
I really wonder what sort of screening can be done for RM80?
The Vioxx Debate
Merck & Co recently made a decision to withdraw Vioxx from the market worldwide. This drug is said to cause an increased number of cardiovascular events following a prospective, randomized, double-blind, placebo controlled trial, APPROVe(Adenomatous Polyp Prevention on VIOXX). Since this announcement, there has been anger misdirected at the company. Some allege negligence and financial greed.
A letter to the NST illustrates this fact.
DRUGS: Patients must always come before profits
By Dr A. Soorian, Seremban
Oct 8:
THE withdrawal of the arthritic drug Vioxx by its manufacturer, Merck, is a classic case of greed. The withdrawal came three years too late, unfortunately.
It is a case of putting the cart before the horse. Merck put the drug on the market first and, after three years, it was found to cause heart attacks and strokes as potent side-effects in patients.
The consumer has every right to ask the manufacturer why the drug was not effectively tested first prior to distribution. Had they done so, many lives would have been saved, and the company would have averted the huge financial loss and embarrassment. Pharmaceutical companies seem to be overzealous in rushing a "wonder drug" onto the shelves of pharmacies only to be dismayed subsequently by the lethal side-effects. They should not be obsessed with profit alone, disregarding the dangers posed to the public. |
The question is what has a Adenomatous Polyp Prevention on Vioxx(APPROVe) trial got anything to do with cardiovascular events? The APPROVe trial was designed to determine if Vioxx 25mg could prevent the recurrences of colorectal polyps. Incidentally, the trial showed an increased relative risk of confirmed cardiovascular events
after 18 months of treatment in patients taking Vioxx as compared to placebo. It has to be highlighted that this trial DID NOT show an increase in cardiovascular events in the first 18 months of treatment and was consistent with earlier trials that led to its approval. Nevertheless the company has decided to withdraw this drug based on this new finding.
With this story in mind, allegations against the company is misguided and misinformed. I feel that this pharmaceutical company should be commended for its action in putting customers health first rather than profit. It could have easily continued marketing with a slight adjustment of the labels eg "not for use more than 18 months" . In addition, on most occasions , Vioxx, being a painkiller, will not be used for more than a few months at a time. I believe that this drug has not been oversold as alleged by the Consumer's Association of Penang's president in his
letter to the NST. The COX-2 inhibitor class has demonstrated a safer gastrointestinal side effect profile as compared to conventional NSAIDS. This is indisputable.
Undeniably, there has been many more patients whom have benefited from the prescription of Vioxx. It is unfortunate that new data could not support its long term use especially in chronic diseases like rheumatoid arthritis. The withdrawal was bold and responsible. It deserves praise and salute not otherwise.
note: the author has no association with Merck (just in case you were wondering!)
The Pride of Seremban
Highlighted in The Star,
Seremban Hospital bags top award
PETALING JAYA: Seremban Hospital gained international recognition when it was named the winner of the “Governance or Social Responsibility” category of the 2004 Asian Hospital Management Awards held in Bangkok, Thailand yesterday.
The award was one of eight that went up for grabs, which included categories like customer service, human resource and development, quality medical care, patient safety, information technology and e-commerce, technical services and marketing and brand management.
Asian Hospital Federation (AHF) president Datuk Dr Ridzwan Bakar said in a statement that the award won by Seremban Hospital was for an undertaking that made a difference in the improvement of corporate governance or in responsible leadership, including that of healthcare in the community.
He said Seremban Hospital’s “Volunteer Service Programme” received praises from the panel of judges as it had illustrated that it was possible to present such an initiative at minimal expenditure in today’s landscape of ever increasing costs, utilising a comprehensive pool of volunteers.
A total of 165 entries from 11 countries had been received for the eight categories.Dr Ridzwan said the panel of judges comprised hospital management “gurus” from the United States, Europe and Asia.
Seremban Hospital director Datin Dr Zailan Adnan represented the hospital in accepting the award.
The award ceremony was held in conjunction with the Hospital Management Asia Conference held by the AHF, which was attended by delegates from 72 hospitals from 25 countries. |
Congratulations Hospital Seremban. Your achievements is well worth taking note of. It is hoped that such a deserved recognition will provide the impetus for a continued excellence in healthcare.
Unfortunately, Hospital Seremban does not have an official website. An
unofficial website exists nevertheless. A picture of Hospital Seremban in 1967 caught my attention.
Amazing transformation to its current state.
Aspartame
Malaysians in general have a sweet tooth no doubt if you look at our national consumption of sugar. Too bad if you are a diabetic but many consume artificial sweeteners such as Aspartame (e.g. NutraSweet).
If you do a Google search for aspartame,you'll come across lots of websites expounding the dangers of aspartame including linking it to dementia, hair loss, cancer and what not. Are these warnings true?
The British Medical Journal published a timely
Editorial on Aspartame. The bottom line:
| The Food Standards Agency takes public concerns very seriously and thus pressed the European Scientific Committee on Food to conduct a further review, encompassing over 500 reports, in 2002. It concluded from biochemical, clinical, and behavioural research that the acceptable daily intake of 40 mg/kg/day of aspartame remained entirely safe—except for people with phenylketonuria |
Unless you drink something like 10 cans a day of drinks sweetened with Aspartame it is unlikely you will exceed 40mg/kg/day.
There are a lot of misleading websites out there so be careful. But as always, moderation in the things you eat and drink is a good thing.
Compliance and OnTimeRx
One of the problems faced by patients taking long-term medication is remembering their doses. I recently saw a patient with Essential Thrombocythemia, a blood condition where excessive platelets are produced, with poorly controlled platelet counts. She admitted to being "forgetful". How common is this? Very, I can tell you.
There are however very simple devices which can help remind you to take your medicines. The cheapest are simple plastic pill organisers which you can find in your local pharmacy. These allow you to place your pills in the compartments labelled by the day of the week so that you know if you have taken your medicines for the day.
Some of the more elaborate ones come with electronic alarms.
As a PDA user, I personally use a software called
OnTimeRx 
This little program works as an electronic reminder when it is time for your medicines and keeps track of your compliance rate. It is full featured and has:
- Reminders for all medication doses - Routine or PRN
- Reminders for remaining Days Supply
- Reminders for To Do events
- All Reminders have auto-snooze alarms
- Activity response log for Drugs and To Do events
- Personal medical history and 911 data
- List manager for healthcare supplies
Highly recommended if you are a Palm PDA user.
Feedback: Hepatitis B
dina writes
| i just want information on hepatitis b especially about vaccines, curing or other treatment that required for. where can i found such a suitable vaccines for hepatitis b in malaysia. |
Well Dina, a couple of good sites to start reading on Hepatitis B are:
Hepatitis B Foundation - this site is in English and also has pages in Chinese, Korean, Spanish and Vietnamese.
What I need to know about Hepatitis B - very simple, clear and concise page.
Hepatitis B vaccination is commonly available in Malaysia. Please consult your own doctor who can advise you on availability and whether or not you need it.
Vioxx withdrawal hotline
The Star reports that Merck Malaysia has set up a toll-free service line at 1-800-38-1202 so that those with questions on could call between 9am and 6pm until Oct 8 or else one could visit
vioxx.com for more info.
Malaysian Society of Rheumatology president Dr Yeap Swan Sim said Vioxx was a popular drug for people suffering from various kinds of arthritis.
However, she said it was almost impossible to determine the number of patients in Malaysia who were using it.
“I don’t think there should be a problem arising from it being withdrawn as it is the kind of drug which a patient can stop taking immediately,” she said.
Dr Yeap also said there were alternatives in the market and urged patients to see their doctors to get proper advice on this.
She added that Vioxx was not only used for arthritis but also migraine and menstrual pains.
On the risks which brought about the drug’s withdrawal, she said she was not aware of any incidents of heart attack or stroke in Malaysia resulting from taking the drug. |
Health On Net certification
It's been a long review process - three months! But I am pleased to report that at last, the Health On Net foundation has certified that the Malaysian Medical Resources is in
compliance with the HONCode.
Feedback: Vioxx
Eddie writes:
| hey i dont know if vioxx is available in malaysia for osteoarthritis, but it is being withdrawn due to increased risk of heart attack and strokes |
Thanks Eddie. It's all over the news and radio too.
Here's the FDA
Public Health AdvisoryAn excerpt:
The Food and Drug Administration (FDA) today acknowledged the voluntary withdrawal from the market of Vioxx (chemical name rofecoxib), a non-steroidal anti-inflammatory drug (NSAID) manufactured by Merck & Co. FDA today also issued a Public Health Advisory to inform patients of this action and to advise them to consult with a physician about alternative medications.
Merck is withdrawing Vioxx from the market after the data safety monitoring board overseeing a long-term study of the drug recommended that the study be halted because of an increased risk of serious cardiovascular events, including heart attacks and strokes, among study patients taking Vioxx compared to patients receiving placebo. The study was being done in patients at risk of developing recurrent colon polyps. |
Well, I think Merck did the right and responsible thing. This illustrates the important point that drugs need to be continually monitored as certain adverse events may not be evident in earlier clinical trials and emerge only in later studies.
If you think about it, what about all herbal and alternative products which lack post-marketing surveillance and safety monitoring? You really think there are no serious side effects? Apparent lack of side effects reflect lack of studies and lack of monitoring. Only when there are tragic deaths from very serious adverse events like
Herbal slimming pills and sudden death that people sit up and take notice.
Update: MSO and IKU
Updated the
Professional societies page of the MMR to inclued the
Malaysian Society of Oncology's new webpage.
Also included the
IKU's webpage link in the
Govt departments page but this website is down at the moment.
Feedback: Australian degrees
Neha asks,
| Is australian post graduate medical degree recognized in malaysia? |
Well Neha, the MMC recognises eligibility for registration to practice on the Undergraduate degree and not the Postgraduate degree. But generally Australian post-graduate training is well accepted in Malaysia.
