Malaysian Medical Resources

Tsunami Disaster Funds II

Those of you who have Maybank2U accounts can electronically transfer donations directly to :

Mercy Malaysia
or
The Star/Maybank Tsunami Relief Fund

posted by Palmdoc @ 10:25 AM

Feedback: More statistics

wisatawati writes:

Hi, I want to know some basic information on heart disease, kidney disease and cancer in Malaysia, ie the epidemiology and the cost of the treatment.

The MMR has links to several Government and quasi-Govt bodies where you can find some data in the Government Departments page of links. Do try searching those web pages and see what you can find. I do know the MOH has the 2003 Health Facts I blogged about here. As for Cancer, the CRC National Cancer Registry report is available for download. While CRC is listed with the Govt Depts page but it is actually a research initiative by the Govt but funded also by private means.

posted by Palmdoc @ 4:46 PM

Transfer of doctors

In The Star,

Docs ‘avoiding transfers’ PONTIAN: Some government doctors are using their political connections to avoid being transferred to rural areas and this has annoyed the Health Ministry. Minister Datuk Dr Chua Soi Lek said the doctors, both seniors and juniors, would write to the politicians asking them to use their position to have transfer orders withdrawn. “They would give all sorts of excuses like their parents are aging or that their family won’t be able to join them at the new place. “The politicians, afraid of being labelled as powerless, would pressure the directors to cancel the order,” he said at the Benut Health Centre near here yesterday. Dr Chua said this would disrupt the health department’s planning, especially in matters related to services in rural areas. “That is why in most places, we have one doctor who is responsible for five health centres. “With that ratio, the doctor will only be able to serve one centre each day,” he said. Dr Chua hoped that health department staff would give their cooperation regarding transfers.

The transfer of doctors is a very contentious issue. It has long been noted that this system is flawed and riddled with bureaucratic hurdles.The criterias for postings is not clearly delineated and there is way too much room for corrupt maneuvering. Adding to this misery is the fact that the Ministry lacks the skill to an effective 2-way communication between the doctors and themselves. They have erected a barricade which silences genuine pleas for compassion. On the other hand, there are priviledged doctors who will use all means at their disposal to manipulate the system in their favour. It is a wonder how the MOH can be autocratic on one hand and kow-towing to interfering politicians on the other regarding the placement of doctors.

Genuine interest in post graduate studies in a particular area can be stifled by an unreasonable posting. There are concerns that a rural posting will thwart a doctor's ambitions in gaining valuable experience in a particular field of choice. These are realistic and understandable concerns that should be addressed by the MInistry of Health. Allaying such concerns is the responsibility of the MOH. In doing so, they will be able to gain the trust of doctors and assure them that the MOH also has their interests at heart. Or do they?

posted by TE Cheah @ 9:02 PM

Tsunami Disaster Funds

I am sure there are many of you out there who want to help out the unfortunate many thousands of victims of this natural disaster.

The NST Tsunami Fund:

The New Straits Times and Berita Harian newspapers, joined by TV3 and 8TV have launched a Malaysian Tsunami Disaster Fund to assist Government efforts in rehabilitating and helping the thousands of victims affected by this tragedy. All contributions will be handed over to the Federal Government Disaster Fund. Contributions can be sent to the New Straits Times or Berita Harian at Balai Berita, 31, Jalan Riong, 59100 Kuala Lumpur and cheques should be made out to New Straits Times Press Berhad. On the reverse side of the cheque, please write "NST-BH Malaysian Tsunami Disaster Fund."

The Star Earthquake/Tsunami Relief Fund:

WE ARE launching The Star Earthquake/Tsunami Relief Fund in association with the Malaysian Red Crescent Society (MRCS) and Mercy Malaysia. The public can send their cheques to our headquarters at Menara Star, 15 Jalan 16/11, Section 16, 46350 Petaling Jaya, Malaysia, or to our Penang office at The Star Northern Hub in Penang at 202 Jalan Sultan Azlan Shah, 11900 Bayan Lepas, Penang. If you want to donate to MRCS, please write your cheque to Malaysian Red Crescent Society and mark “Tidal Waves Victims” at the back of the cheque. If you want to donate to Mercy Malaysia, please make your cheque to Mercy Humanitarian Fund with “South-East Asia Earthquake Appeal” written on the back of the cheque. The Star will hand over the cheques to the respective organisations at the end of the appeal campaign.

In the meantime, the UN warns of impending epidemics within days unless health systems were put in place to cope with the tsunami disaster.

posted by Palmdoc @ 9:08 AM

Vocational Driving - Medical Guidelines

In response to the Driving and Heart Ailments post by Dr. Cheah, Dr. Aini writes in:

Thanks for your highlight on the above topic and the news of the death of one gentleman due to heart attack. I just want to add to your comment that actually we have a Medical Examination Guideline for Vocational Licence (PSV &GDL) prepared by MMA & JPJ. You can get the guideline at Primary care Doctor of Malaysia (PCDOM) website In this guideline, it is clearly state about permanent refusal or revocation of licence to those who has angina with symptom while on medication and to heart failure. Other heart condition also mentioned under Cardiovascular disorders. While this guideline is mainly for Vocational Licencee but I think private car driver also could be included. May be MOH or MMA need to sit again with JPJ to discuss this matter.

Thanks for the tip, Dr. Aini.

posted by Palmdoc @ 7:38 AM

MRCS Appeal

From Bernama: MRCS Appeals For Assistance

The Malaysian Red Crescent Society (MRCS) has appealed to the public to extend all possible assistance to victims of the tidal waves in Penang, Kedah, Perlis and other affected areas in the country. The tidal waves were set off by a powerful earthquake in northern Sumatra Sunday morning. "Together with the National Press Club (NPC), the MRCS welcomes all forms of assistance, in cash or kind, to help victims during this difficult time," MRCS Media Committee chairman Datuk Ahmad A.Talib told Bernama Sunday evening. Cheques can be made out to the Malaysian Red Crescent Society and marked Tidal Waves Victims at the back of the cheques to be forwarded to the NPC or to any of the MRCS offices. Ahmad said that any inquiries can be directed to 03-42578122.

Links:
The MRCS is listed together with other websites in the MMR's Public Societies and Associations webpage.

posted by Palmdoc @ 6:58 AM

Feedback: Qualifying exam

Geetha writes:

hi,i hope u can help me. i am a final year medical student studying in cluj napoca romania.i have sent all required info to the malaysian medical council.however i still have difficulties gaining info about the qualifying exam that i have to sit for to be able to practice in malaysia.i donºt even know what the exam is called and how it works and what kind of questions are coming out. pls i reqally do need your help, i am really desperate. pls advice. thank you, geetha

Hi Geetha. As far as I know, the qualifying exam for medical students from unscheduled Universities is basically like the final MBBS for Malaysian medical students so there are the usual theory and clinical long/short cases covering the breadth of medicine/surgery/o&g/paediatrics etc. If anyone reading this can share his/her personal experience, please use the Commenting system.
I didn't know there were Malaysians studying in Romania, Geetha. Are there many others? I am sure adapting to the language and culture must have been difficult.

posted by Palmdoc @ 6:25 AM

Earthquake precautions

By now you would have been aware of the earthquake which took place north of Sumatra and causing tidal waves and tsunamis affecting countries across Asia including Malaysia. The 8.9 Richter scale earthquake was strong enough to cause tremors in major towns in Malaysia.
Unlike Indonesia, we are not sitting on an Earthquake belt but I am sure it must have been scarey for those staying in high-rise buildings.
I felt the tremors this morning too.
So what precautions should one take if one should be unfortunate to be caught in an earthquake?
Here are some links:

What to do in an Earthquake - from the Americal Red Cross
National Earthquake Hazards Reduction Program - some information on Disaster Planning

Condolences to the families affected in Penang and Kedah.

posted by Palmdoc @ 9:06 PM

Feedback: Mineway

ckleong writes :

I bought a pack of medicine from MINEWAY (M) SDN BHD inside the booklet show the website is www.mineway.com.my Well, I hav tried few times but it doesnt exist.. I would to get the link to this company to check abt the product

CK, for a moment there I thought you were mentioning a new generic pharma company I have not heard of. But I managed to get into the Mineway and they are not what I would consider a company manufacturing medicines (not if you consider "Kacip Fatimah" a medicine!) but one which manufactures "nutrional/health" products.
Their contact is listed on their webpage. Perhaps their website was temporarily down when you tried to access it.

posted by Palmdoc @ 6:43 PM

Email problems

The Feedback form doesn't seem to be working in the sense that the email does not seem to be reaching me. I am not sure for how long this has been going on but it did happen before until the hosting provider fixed it. So if you did send in feeback but did not hear from me, please feel free to email me again.
Sorry for the inconvenience.

posted by Palmdoc @ 9:27 AM

Mention

I'm on vacation at the moment and sorely missing broadband. The dial-up connection here in Alor Setar is so pathetic :(
The Malaysian Medical Resources did get a mention in Jeff Ooi's blog but yours truly made a mistake with the Trackback Ping and called the MMR the Palmdoc Chronicles which is really my other main Blog on Palm medical stuff. Sorry Jeff.

Wishing all Christian Malaysians a Merry Christmas!

posted by Palmdoc @ 9:07 AM

Driving and Heart Ailments

From The Star,

Driver dies of heart attack at the wheel STORY AND PHOTO BY ELAN PERUMAL KLANG: A 42-year-old man died of a heart attack while driving to work and his car skidded off the road, felled some small trees and landed in the bushes near Tesco Hypermarket at Bandar Bukit Tinggi here yesterday. Police found Abdul Rahman Mohd Salleh’s body with no injuries in his green Proton Iswara at 9am following a tip-off from the public. A manual worker at a factory in Teluk Panglima Garang near Banting, Abdul Rahman had left home at 7am from Kampung Sungai Putus in Batu Belah here. OCPD Asst Comm Jamil Ayub said Abdul Rahman’s car was heading towards Banting before the incident occurred just after it crossed the Bandar Bukit Tinggi traffic light at 8.30am. As the vehicle was coming down the slope, he said, it went off the road and knocked down several shade trees, jumped the divider and crossed the opposite lane before landing in the bushes with its back facing the lane heading towards Klang. The car had a small dent. “Our investigations confirmed that he had had a heart attack. “He was said to have been suffering from a heart ailment,” he added.

Educating heart patients regarding their fitness to drive is mandatory to avoid untoward incidents similar to that highlighted above. Unfortunately,there has been little enforcement as to the eligibility to drive following a heart ailment. Perhaps the doctors are to be faulted here for their inactions. Or should it be the responsibility of the patients to inform the Road Transport Department? Should it be a crime for heart patients ,that are ineligible to drive, if found driving?

First and foremost, there are no clear guidelines for the public to digest. A search of the RTD website posed no answers. Even the guidelines on Unstable Angina /NSTEMI published in 2002 by the Academy of Medicine, put little emphasis on driving and no clear guidelines were offered. It only mentioned that specific instructions be given regarding driving.

The British Heart Foundation advises that driving be disallowed for a month after a heart attack or bypass surgery and a week after angioplasty. All unstable angina patients cannot drive till their symptoms actually resolve as they are at high risk for developing an acute myocardial infarction. Even patients with dizziness and faintness secondary to a heart condition should be advised not to drive.

Malaysia should come up with its own set of guidelines based on local conditions and protocols. Perhaps our roads are dangerously filled with silent time bombs. Who will be responsible then if innocent lives are lost just because the doctor failed to advise or perhaps because it was not a mandatory rule?

posted by TE Cheah @ 10:08 AM

Vitamin C - the facts

This is a follow-up to the Medical Misinformation post on Jeff Ooi's blog.
The person featured on 8tv's Eve's diary programme allegedly claims endometriosis is due to "lack of vitamin C". User comments on the blog allege that the person is promoting vitamin C for lots of conditions. Quoting one of the comments (spelling mistakes and all! ;) ):

Yeah, the Dr. Wxxx. I was lucky that my friend who went to his talk shown me his business card. His is card it is stated he is a Medical Doctor (MD) with a few more professional medical title. But at his back of his card, he is a hemopathy practitioner as well. But I do recall of seeing the website of www.xxxxxrath.foundation.xxx In his presentation, he claimed everything including cancer and heart attack are caused by lack of Vitamin C. If you are tired, it is Vit. C that you are lacking. He even claimed that all doctors were bought by pharmaceuticals so that they do not let you the secret of Vit. C and so that doctors too can make profits out of many sufferers. So take more Vitamin C and buy from him.

So what is the truth about vitamin C? You do need vitamin C for health. It does not necessarily mean that taking much higher doses of vitamin C is better.
The Mayo Clinic has useful information on Vitamin C
The best sources of vitamins are still the truly natural sources - fruits and vegetables. I tell my patients anything which comes processed in a bottle or pill/capsule form and claims to be natural is in fact no longer natural.
So what about the hype about vitamin C? There is enough randomised clinical trial evidence that vitamin C has NO benefit in preventing the common cold (though it may alleviate the symptoms a little) and there is NO benefit in preventing or treating cancer.
Do read these articles from Quackwatch:
The Dark Side of Linus Pauling's Legacy
High Doses of Vitamin C Are Not Effective as a Cancer Treatment

posted by Palmdoc @ 6:33 AM

Medical misinformation on TV

If you think we see enough medical misinformation in our newspapers, you can get extra doses on TV now.
Jeff Ooi has a blogpost on Medical facts: 8tv should be more careful

An Obstetrics & Gynaecology Specialist happened to watch the EVE'S DIARY programme on 8tv at 4pm yesterday, and came across what he calls an "unethical distribution of false health information on a public TV station". He had sent an e-mail, reproduced verbatim below, to 8TV at eves_diary@8tv.com.my but wasn't sure if the e-mail would reach the TV station. He wants Screesnhots to highlight this issue so that the Malaysian public would not be misled.

Do read the entire blogpost which posts the email from Dr Ng, an O&G Specialist, to Jeff Ooi.
There are quacks out there who use the title "Dr" when they are not medically trained and do not possess a basic MBBS qualification. I think the authorities must come down hard on these people who are hoodwinking the public. You can smell a scam when at the end of the day the aim of the fraudster is to promote and sell some "health supplement". Do be careful.

Reliable links to Endometriosis

Mayo Clinic
Endometriosis.org

posted by Palmdoc @ 7:27 PM

Feedback: Dengue statistics

Yusmi writes:

Saya pelajar dari jabatan Geografi Universiti Malaya ingin bertanya tentang bagaimana cara saya untuk memperolehi data mengenai denggi di kawasan Tampin dengan segera.

Yusmi wishes to know the statistics on dengue in the Tampin district urgently (I guess the assignment is due soon eh?)
Well Yusmi, the fastest way is to get in contact with the Department of Public Health - they have a Disease Control Division. I am afraid they do not provide any dengue statistics online, and certainly not for specific areas like Tampin. In fact clicking on their Section of Vector Borne Diseases Control gives a "404 error". Yeah, that means webmaster not found!! Malaysia boleh!!
So you have to actually do some work and go to the DPH personally (I'll bet phoning won't work either) to dig up the statistics.
Another possible solution is to go over to the Faculty of Medicine, UM and perhaps some kind academics at the Social and Preventive Medicine Department might know or could point you to some resources perhaps in the UM Medical library. Good luck!

Speaking of statistics, the MOH has preliminary Health Facts for 2003 - according to this page, the incidence rate (per 100,000 population) of Dengue Fever is 58.9 with a mortality rate of 0.04. For Dengue Haemorrhagic Fever the incidence rate is 2.7 with a mortality rate of 0.27.

posted by Palmdoc @ 5:35 AM

Feedback: Doctors refusing treatment

Spinosum writes in about whether a Govt. Doctor can actually refuse to treat patients who are abusive towards the doctor e.g. who "yell and scream" at the doctor?
Interesting problem, Spinosum.
I believe a doctor can actually refuse to treat a patient under certain circumstances.
From Healthcare Management

Rright to decline treatment? Does a doctor has the right to decline treatment to patients. If yes, then under what conditions: a) If the doctor himself is not well or free. b) Doctor may refuse to give fresh treatment to a patient if he has had a bad experience in the past. c) He cannot be compelled to treat a patient in odd hours. That is at hours other than those ear-marked by him for his profession. d) There is no legal obligation to answer a call to visit the patient at his or her place of residence. e) Doctor treats a patient in emergency on ethical grounds.. It does not mean that he has accepted the patient. He may advise that patient to go to some hospital or a specialist for further treatment. f) If a patient does not agree with the method of treatment or fee asked, doctor may refuse to treat the patient. g) In his honest opinion, if a doctor feels that he is not in a position to treat a patient because of non availability of certain facilities, instruments, medicines, staff etc. he may refer the patient to a suitable place.

Honestly if a patient is abusive towards a doctor, then it would put the doctor in a difficult position and certainly in that situation I would feel that I am no longer in the position to treat such a patient. The duty of care then is to pass on the patient to another colleague either in the same hospital or another hospital.
I am not a lawyer but I believe that there has to be a mutual agreement before the doctor undertakes the care of a patient (emergency situations not withstanding). Patients often forget that while they have their rights, they also have their responsibilties which I mentioned earlier about the long-forgotten Patients Charter. I think though they missed out:
13. The patient shall behave in a civilised manner and not yell and scream at the doctor.

Well that's only my humble viewpoint. You may get better responses from other doctors in Dobbs.

posted by Palmdoc @ 4:29 PM

Mobile Phone Radiation

It's still a controversial topic but Yahoo/Reuters reports:

Mobile Phone Radiation Harms DNA, New Study Finds

Radio waves from mobile phones harm body cells and damage DNA in laboratory conditions, according to a new study majority-funded by the European Union (news - web sites), researchers said on Monday. The so-called Reflex study, conducted by 12 research groups in seven European countries, did not prove that mobile phones are a risk to health but concluded that more research is needed to see if effects can also be found outside a lab. The $100 billion a year mobile phone industry asserts that there is no conclusive evidence of harmful effects as a result of electromagnetic radiation. About 650 million mobile phones are expected to be sold to consumers this year, and over 1.5 billion people around the world use one. The research project, which took four years and which was coordinated by the German research group Verum, studied the effect of radiation on human and animal cells in a laboratory. After being exposed to electromagnetic fields that are typical for mobile phones, the cells showed a significant increase in single and double-strand DNA breaks. The damage could not always be repaired by the cell. DNA carries the genetic material of an organism and its different cells. "There was remaining damage for future generation of cells," said project leader Franz Adlkofer. This means the change had procreated. Mutated cells are seen as a possible cause of cancer. The radiation used in the study was at levels between a Specific Absorption Rate (SAR) of between 0.3 and 2 watts per kilogram. Most phones emit radio signals at SAR levels of between 0.5 and 1 W/kg. SAR is a measure of the rate of radio energy absorption in body tissue, and the SAR limit recommended by the International Commission of Non-Ionizing Radiation Protection is 2 W/kg. The study also measured other harmful effects on cells. Because of the lab set-up, the researchers said the study did not prove any health risks. But they added that "the genotoxic and phenotypic effects clearly require further studies ... on animals and human volunteers." Adlkofer advised against the use of a mobile phone when an alternative fixed line phone was available, and recommended the use of a headset connected to a cellphone whenever possible. "We don't want to create a panic, but it is good to take precautions," he said, adding that additional research could take another four or five years.

I think too its a good precaution not to talk longer than necessary on the cellular phone. I think some people out there seem to have mobile phones permanently stuck on their ears!!
Back in 2000, the BMJ had an editorial on The health hazards of mobile phones where the conclusion was "the only established risk is of using one while driving".
On a related point, there was an article last year in the BMJ that Mobile phones in hospitals are not as hazardous as one would think. Perhaps the MOH could direct Pengarahs of hospitals to be more lenient and do away with the No mobile phone signs in hospitals. Most of the public (and staff) do not seem to follow the signs anyway!!

posted by Palmdoc @ 10:39 AM

Get your billing right

The Government laments the fact that it is Losing RM8 Mil In Medical Fees From Immigrants.

The government is unable to collect medical fees of more than RM8 million annually from immigrants who seek treatment at government hospitals nationwide. Health Minister Datuk Dr Chua Soi Lek said Monday it was difficult to trace the immigrants and collect payment as many of them did not have a permanent address. He said many government hospitals had also reported cases of women immigrants who disappear with their new-borns after giving birth to evade setting medical charges. "There are also cases of immigrants using fake identity cards when registering as patients and instances where hospitals treat immigrants without any personal documents based on humanitarian grounds," he told reporters after opening the RM5.1 million Sitiawan Health Clinic here. Dr Chua said the immigrants sought various treatments from government hospitals, including child delivery, surgery and outpatient treatment. "I hope hospitals can be stricter when admitting immigrant patients. They need to verify the authenticity of personal documents to ensure that the vast allocation provided by the government for medical facilities benefits Malaysians," he said.

This is basically an admission that due to billing and collection inefficiency, RM8 million annually is lost by the MOH hospitals. I can tell you that its not a friendly system. Even in a large teaching hospital, you might end up having to line up 3-5 times in a day just to see a doctor, get a number, queue up again to get future appointments, and then queue up perhaps another 2 times to get medication at different counters. The billing too is very inefficient as there are "cash only" counters and cheques and credit cards are not accepted. For some strange reason, "guarantee letters" by large corporations like Tenaga Nasional are not accepted. This leads to problems faced by the corporate employees. The private hospital where I work accepts G/Ls from TNB. If I were to send blood samples for Tissue Typing tests to this teaching hospital, they will not accept G/Ls from the private hospitals or even TNB. This puts the patients ina quandry and great inconvenience. Sometimes the tests or drugs cost in the thousands of ringgit and the poor TNB employee has to get that amount of CASH to pay the teaching hospital upfront.

posted by Palmdoc @ 10:08 AM

What happened to Telehealth?

From Bernama

The Health Ministry will restructure its Telehealth programme as the initial project has failed to produce satisfactory results due to several problems, said Health Minister Datuk Dr Chua Soi Lek. He said Telehealth had several advantages in providing good medical services particularly for consultation and education as Malaysia was facing a shortage of doctors especially specialists. "The initial project was too ambitious as it planned to link all the hospitals and polyclinics in the country. Now, the government has agreed for the project to be in stages and has approved RM60 million for that," he told reporters after visiting the Teluk Intan Hospital, here Sunday. He said to ensure the project's effectiveness, it would be implemented at selected hospitals or polyclinics which had the needed facilities and they would also identify suitable disciplines for the project. "Not all disciplines are suitable for Telehealth. We have identified four important components namely teleconsultation, continuous professional development, mass health educational programmes and personalized health record. We scaled it down only to these four components," he said.

What happened to the grand plans? What happened to all the money spent?
Telehealth, or Integrated Telemedicine was to be one of the flagships of Malaysia's Multimedia Super Corridor project. It was supposed to have 4 components:
1. Lifetime Health Plan (LHP)
2. Mass Customised/Personalised Health Information and Education (MCPHIE)
3. Continuing Medical Education (CME)
4. Teleconsultation

So what are the "several problems" that the Health Minister alludes to? He doesn't mention at all the company given the contract and the money for the project.
From The Edge

The R&D factor aside, the flagging flagship projects are a major disappointment. Bureaucracy, poor implementation and poor leadership have been blamed for the lack of progress. Take the Telemedicine project. The Ministry of Health, fed up with the delays, finally took away the project from Medical Online for its failure to deliver.

Is this Vision 2020? Take the links to Medical-online and the Telehealth project, and you'll know what I mean. Millions of dollars gone down the drain? Millions of dollars of tax-payers money. Your money. My money. I wonder which Company now will take over the "revamping" of Telehealth Malaysia?

Let's hope they do the job properly this time. I am worried though. You know what diseases are rampant in this country? They're called GREED and DISHONESTY. It results in situations like "A" being given a lucrative contract but "A" really cannot do the job, so "A" subcontracts it to "B" who subcontracts it to "C" and finally the job gets done (and sometimes shoddily too) for 1/5th initial sum and along the way $$$$ gets skimmed off.

The year 2005 approaches. The Malaysian Medical Resources will be 9 years old then. I first started this project in 1996 and have been single-handedly maintaining this website (primarily as a resource for links to Malaysian Medical sites) since then until 2004 when I got Dr Cheah in as a co-blogger. In 1997 I started Dobbs, which is today a thriving online community for Malaysian doctors. Sorry if I do seem like blowing my own trumpet but the point I wish to make is that things can be done without multi-millions of dollars in funding (though I wouldn't mind if a million or two came my way!) - it just takes the interest and the perseverance. In my own little way if I have made some contribution to "grass-roots telemedicine" and some people have benefited from it, then I'm glad and that makes it all worthwhile.

posted by Palmdoc @ 5:36 AM

Traditional poisons

The catch words are "herbal", "natural", "wholistic". Think that all these means "safe"? Think again.

'Natural' is not always the best

A new report published by the Journal of the American Medical Association shows that many imported herbal medicines, including supplements associated with India's ayurvedic healing movement, contain heavy metals at potentially toxic levels. The researchers were first put on to the problem by a Boston, MA patient admitted to hospital with severe lead poisoning that turned out to have been caused by a lead-laced ayurvedic arthritis treatment. Lab tests showed the patient's remedy contained 10,000 times more lead than is recommended as an acceptable maximum. Once they investigated further, the researchers found more lead, as well as mercury, in a number of traditional remedies from China, Africa, Mexico, the Middle East and Malaysia.

I have personally seen a patient with severe lead poisoning after ingestion of Chinese medicine. She presented with anaemia and recurrent abdominal pains. Given the lax enforcement in Malaysia, one should be wary of what one consumes. "Traditional medicines" or "traditional poisons"?

posted by Palmdoc @ 5:14 AM

Celebrex and Bextra too

After the Vioxx withdrawal, there's now some indication that Celebrex and Bextra (both products by Pfizer)may have an impact on cardiovascular risk:

Yahoo news

NEW YORK (Reuters) - Pfizer Inc. on Friday said its popular Celebrex arthritis drug more than doubled the risk of heart attack in a large cancer-prevention trial, a setback that comes just weeks after Merck & Co. recalled its similar Vioxx drug due to heart safety risks. Shortly after the Celebrex news, the New England Journal of Medicine carried a letter in which Vanderbilt University cardiologists questioned the safety of Pfizer's newer arthritis drug, Bextra, and recommended doctors not prescribe it. Shares of Pfizer, a component of the Dow Jones industrial average, fell 11.1 percent following the double blast of bad news

Soon after the Vioxx withdrawal, Pfizer Malaysia went on a local publicity blitz with letters and circulars to imply that it was not a class effect. Looks like that may have been premature.

Links:

Cardiovascular Toxicity of Valdecoxib (early release from the NEJM)
FDA: Consider 'alternative' to Celebrex

posted by Palmdoc @ 1:58 PM

Oncologists

The nation is apparently short of oncologists

Deputy Health Minister Datuk Dr Abdul Latiff Ahmad said there were only 39 oncologists in the country, including 16 in government hospitals, when it should have at least 100 specialists in the field. "The recommended ratio is one oncologist for 250,000 people, so based on our population of 24 million, we should have at least 100 oncologists," he said at the launch of the Second Cancer Incidence in Malaysia Report 2003 at Kuala Lumpur Hospital. Dr Latiff said the ministry encouraged more doctors to be trained as oncologists, adding that more cancer treatment centres would be set up. He said Malaysia had 21 centres for radiotherapy and oncology in public and private hospitals. The ministry operates two centres in hospitals and three in universities. A national cancer institute is also being planned for cancer research and treatment. This is in addition to the Oncological Unit at Putrajaya Hospital, which is the centre for cancer treatment in the country.

At least there is now more credible data on the cancer incidence and burden in this country. Good to acknowledge we are short staffed in this area of healthcare. Hopefully the Government doesn't just pay "lip-service" encouragement and actively sends doctors for training, provide scholarships etc.
One thing we are not short of is the plethora of quack practitioners in this country who claim to be able to treat cancer. The public are being fleeced by various people including botanists and what-not (some of these people also use titles like "Professor" and "Doctor" even though they are not MBBS or Medical doctors) who employ unproven therapies on cancer patients. There are unfortunately also those real doctors who choose to practice quack medicine like "ozone therapy".

Where is the regulation, MOH?

I say again that a real danger these people pose is that they deny cancer patients a chance at cure by delaying proper treatment. Cancer is not one disease, but a variety of diseases with different treatments. But in general, if they are detected earlier, they stand a better chance of being cured.

One popular "herbal treatment" for cancer being advocated by some groups in Malaysia is rodent tuber (Typhonium flagelliforme). There are no published clinical trials on rodent tuber showing any anti-cancer effect. I tried to look up independent laboratory studies on rodent tuber and came up with this paper on The cytotoxicity and chemical constituents of the hexane fraction of Typhonium flagelliforme (Araceace) (J Ethnopharmacol. 2001 Sep;77(1):129-31.
Choo CY, Chan KL, Sam TW, Hitotsuyanagi Y, Takeya K. Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia) :

The plant, Typhonium flagelliforme (Araceae), commonly known as the "rodent tuber" in Malaysia, is often used as an essential ingredient of herbal remedies for alternative cancer therapies. The hexane extract of this plant was evaluated for cytotoxic activity against in vitro culture on P388 murine leukaemia cells and showed weak IC(50) of 15 microg/ml. The partial chemical constituents were identified as methyl esters of hexadecanoic acid, octadecanoic acid, 9-octadecenoic acid and 9,12-octadecadienoic acid. In addition, several common aliphatics were identified as dodecane, tridecane, tetradecane, pentadecane, hexadecane, heptadecane, octadecane, nonadecane and eicosane. The unique methyl ester of 13-phenyltridecanoic acid was isolated and positively identified using spectroscopic methods. None of the identified compounds showed or are known to have cytotoxic behaviour.

I think the MOH must get its act together and protect the public. They must regulate all types of people to prevent them from falsely claiming to be able treat cancers when there is no evidence to back their claims. Its pure fraud.

posted by Palmdoc @ 7:20 AM

At last, the NHIS cometh

Finally we have news that the National Health Insurance Scheme may be launched soon according to a Bernama news report:

PETALING JAYA, Dec 15 (Bernama) -- After two years of study, the government has agreed to implement the proposed National Health Insurance Scheme (NHIS) soon to reduce the healthcare burden on the government and help ease the long waiting time in public healthcare facilities. Health Minister Datuk Dr Chua Soi Lek said it would be based on a community-rated model. "This means it would be based on cost and risk-sharing across the population, with the rich subsidising the poor, the young for the elderly, the healthy for the sick and the employed for the unemployed," Chua said the community-rated model would encourage cost-sharing among stakeholders and consumers of healthcare while optimising the government's contribution and commitment and improving the quality of life of the people. "The mechanism will be affordable, viable and sustainable, provide universal and comprehensive coverage and achieve greater equity and accessibility to quality health are for all Malaysians," he added. Chua said the present system would be retained and be improved with greater integration between the public and private sectors while the mechanism would help to ensure better access to healthcare, either in the public or private sector. "To govern and run the national health financing mechanism, there is also a need to set up a National Health Financing Authority under the Ministry of Health and to be wholly owned by the government," he said. The National Health Financing Authority would function as a single payer for the healthcare of all citizens and eligible non-citizens.

This is long overdue. We need a system which will be equitable and will ensure that the medical needs of the elderly and those already with pre-existing illnesses are also taken care of. The latter two groups of people would find it difficult to get health insurance cover with private insurance companies who are only profit orientated.
Lets hope to see that the system is implemented smoothly and that there will be a lack of red tape and bureaucratic delays. Wishful thinking?
I await details of the NHIS with bated breath......

posted by Palmdoc @ 4:59 AM

Mystery illness

Spotted in Bernama

Ten-year-old boy Sugan and his sister Devarani, six, have grown little since their birth and weigh 3 kg and 2.5 kg respectively. Their parents, P. Moorthy, 44, and A. Thanthy, 31, who have three other children, have tried everything to cure them of the affliction but to no avail. The mysterious illness struck the second and fifth of their children when they were two-month old infants. Despite their ages, both Sugan and Devarani only consume milk and cereals like babies. "They have to be cared for very carefully. I have taken them to many doctors, including at Ipoh Hospital, but all of them tell me my children don't have any problem," Moorthy told reporters Tuesday at his home, here. He said that going by their ages, his children should be attending school but they can hardly walk or even move. "They live the life of newborn babies and have to be helped in every way. This worries me when I think about their future," he added. Moorthy said the family received aid of RM50 a month from the Welfare Department to reduce the family's burden in looking after the two unfortunate children.

My (unqualified, since this is not within my specialty!) guess is that this is some in-born disorder of metabolism, possibly Mitochondrial Disease. As the parents are apparently normal, and both sexes are affected, it is quite possibly an inherited autosomal recessive genetic disease too.
I am surprised that the parents have gone to Ipoh Hospital and yet claim that "all of them tell me my children don't have any problem". I would indeed like to hear Ipoh Hospital's side of the story. What I do know is that Ipoh Hospital has fine Paediatricians and in fact they do run post-graduate training courses in Paediatrics.
I would comment too that the support services in this country for families and children in need are sorely lacking. Something is wrong if all that can be offered is RM50 from the Welfare Department. These children need special medical care and have special needs. We are far away from vision 2020.....

posted by Palmdoc @ 5:57 AM

Learning from the Movies

In Can medical students learn empathy at the movies?, the BMJ strikes a chord.
I recall during pretty stressful times, my late colleague Dr. John Bosco used to say "go see a movie". How true. I have found medical movies at times quite inspiring and insightful and in case anyone (medical students and doctors alike) think they have lost their way, go see a movie. Some of my favorites:

1. Lorenzo's Oil (the Director is actually an Australian, George Miller, who did Medicine initially but later on made movies instead - so you see, Medicine is relaly a stepping stone to greater things in life!)
2. The Doctor
3. Patch Adams
4. Awakenings

One of my heroes too was 'Hawkeye' Pierce of the TV Series M*A*S*H - what an inspiring character Alan Alda was! One of his most inspiring moments I recall was a speech he gave to the graduating class of 1979, Columbia University. I can't quite find the full transcript now but if I do, I'll place the link here. It was really great inspiring stuff for young doctors. Here's an excerpt:

“You’re entering a special place in our society. People will be awed by your expertise. You’ll be placed in a position of privilege. You’ll live well, people will defer to you, call you by your title — and it may be hard to remember that the word doctor is not actually your first name. It’s easy to think that because our society grants us privilege that we’re entitled to it. Privilege feels good, but it can be intoxicating. As good doctors, I hope you’ll be able to keep yourselves free of toxins.”

Alan Alda also reminds us of this point in anatomy which I am sure you were not taught: that the Head bone is connected to the Heart bone.

So what's your favorite medical movie?

posted by Palmdoc @ 7:05 AM

Smoke and mirrors

First the Deputy Health Minister takes a cheap shot at Government Doctors claiming they are over-prescribing, and at the same time hinting that the Government cannot afford to subsidise the ever increasing drug bill.
Now the true agenda becomes apparent as the real aim is the privatisation of the Government hospital pharmacies beginning with Putrajaya and Selayang hospitals.
Now comes the "smoke and mirrors" to try to placate the public with the Health Minister Denying Govt To Stop Giving Free Medicine To The Poor

The Health Ministry does not intend to stop prescribing free medicine to patients, especially the poor, seeking treatment at government hospitals, Minister Datuk Dr Chua Soi Lek said Monday. Instead, the government only planned to set up private pharmacies at selected government hospitals to facilitate patients who could afford to get their medicine supply. "As a trial, the ministry has identified the Putrajaya and Selayang hospitals to launch the concept before it is expanded to other hospitals," he told reporters after performing the ground-breaking for the Labis branch of the Muhibbah Haemodialysis Centre here. He said the statement by his deputy Datuk Dr Abdul Latiff Ahmad that the ministry planned to stop giving free medicine to patients was inaccurate. On Saturday, Dr Abdul Latiff was reported to have said the Health Ministry proposed to stop giving free medicine to patients seeking treatment at government hospitals.

So who is telling the truth now?
I would like to ask the Health Minister who decides who is too poor to afford subsidised medicine? Social workers? Assessment officers? I can tell you it's no easy task. Moreover, a considerable proportion of those seeking treatment at Government hospitals belong to the economically less privileged anyway. What about the Senior Civil servants who do not belong to the "poor" category. Are you going to expect them to pay for drugs too?
I can imagine one possible scenario. These "private pharmacies" will be stocked with certain items "not available" in the normal pharmacies within the Government hospitals. The public will be told "sorry, but you have to purchase this item from the private pharmacy". With one stroke, the Government lowers the drug burden on themselves and transfers this to the paying public!
I sure hope the apathetic public will wake up before they find that the piece-meal privatisation of the health services going on today becomes complete. It seems to me like the Government is trying to find little excuses to try to privatise bits and pieces of the health services. We already have the medical waste disposal privatised as an example. There was also the suggestion that ambulance services would be privatised. And now even the pharmacies may be at least partially privatised. What next?
And to top it off, still no sign of a National Health Insurance/Financing Scheme....

posted by Palmdoc @ 5:30 AM

Feedback: Anyone from Kapit?

Melanie writes in:

My name is Melanie. I was adopted from the Kapit Goverment Hospital on December 17, 1970. Michael and Judith Heath were the people who adopted me at the hospital. I am trying to email the hospital to see if they can help me find my mother. The email will not go through. If you can help me find someone who can help I would appreaciate it. I live in Denver, Colorado. Any information on the hospital, records depatments etc. I am having health problems and need to find her. Thank you

Well, if anyone from Kapit, Sarawak is reading this, perhaps you could help Melanie.
The Kapit District Hospital Contact that I have is:

Hospital Kapit
96800 Kapit
Sarawak
Malaysia
Tel: +60 (84) 796333
Fax: +60 (84) 798333
Email: hd.kapit@cmis.com.my

Bloggers and anyone from the Press: please spread the word and if anyone has contacts in Kapit, Sarawak with possible info, you can send email to me..

posted by Palmdoc @ 7:32 AM

Government doctors not over-prescribing

The MMA has come out in defence of Government doctors who have been accused by the Deputy Health Minister of over-prescribing:

KUALA LUMPUR: Government doctors are not over-prescribing medicine. The high government spending for medicine is because the drugs to treat chronic illnesses such as heart diseases, diabetes, high blood pressure are generally expensive, said the Malaysian Medical Association (MMA). MMA president Datuk Dr N. Arumugam said if government hospitals stopped giving chronic illness medicine free or cheap to patients, this might discourage some patients from taking the medication without them realising this would cause them serious medical complications.

If you look at Dr. Cheah's post on the alleged "Overprescribing" and the comments in support of his post, you'll see that Government doctors, already hard-pressed, over-worked and under-paid could do less with these "sweeping statements" from politicians. Does the Deputy Health Minister have the facts to back up his accusation implying that a large part of the RM 800million a year (really a paltry sum and more can be spent - will elaborate later) is due to over-prescribing? He must mean so since he is implying that by cutting down on over-prescribing, a substantial sum of this 800 million can be saved.
The MMA rightly points out that a large part of drug budget goes to paying for heavily subsidised medication for chronic illnesses like ischaemic heart disease, diabetes mellitus and hypertension. I would like to add too that there is a huge cost of subsidising expensive drugs in the treatment of cancers in general. I recall one retired teacher, a pensioner, who never got the approval from the Government (she was given the run-around from the Ministry of Education to the Pensions Department) for Glivec to treat her Chronic Myeloid Leukaemia. Not suprising when you realise that Glivec costs RM8000+ per month! Let me tell you that the Government is not subsidising Glivec even though it is the best medical treatment for CML. As for expensive drugs like monoclonal antibodies and growth factors there is a limited budget even in the large referral Public and University hospitals. The poorer patients end up having to pay for some of it or dependent on charity funds to help with the cost or worse still, not even getting the best treatment possible.
So if the Deputy Health Minister is trying to give the impression that there is "wastage" in prescribing in the Public sector, I would beg to differ - there is actually under-spending. Due to budgetary constraints, many patients may not be getting the best treatment available and have to make do with less appropriate cheaper choices.
The same article in the Star has various bodies and respected persons like Lee Lam Thye asking the Government to "ensure the poor will continue to get free medication". They all miss the mark. The problem is that the Government cannot afford to continue subsidising and even with a drug budget of 3 times the current one, it will still fall short. The real solution comes only with a National Healthcare Financing Scheme. This has been long overdue and this is what our society really needs.

See:

MMA Lauds Need for National Health Insurance Scheme
MMA Letter to the Editor on the NHFS

posted by Palmdoc @ 8:49 AM

Asian execs highly stressed

So reports the Star:

PERC recently published a report that shows stress levels among executives in Asia are escalating. “In Asia, it’s when people don’t have the ability to manage a problem that stress escalates,” says Broadfoort.

I personally see alot of stress related symptoms in out-patient practice. A lot of physical symptoms may be stress related including headaches, neck ache, back ache, indigestion, insomnia etc. These often lead to people going on their own accord for alot of unnecessary "comprehensive" blood tests in private labs thinking their symptoms are of physical origin. And you know what happens when you do all these tests? Yup, there's bound to be some minor abnormalities which gets them even more worried and that's when they come running for help.
I think in part one problem we face is that there is lack of a "social net" in Asia and indeed Malaysia where if you are out of a job, physically disabled or very poor, you are in trouble because the "welfare aid" here is a pittance in comparison with the social support services in the developed western nations. There is then this drive to accumulate wealth to support yourself for the present and the future.
How does one cope? Tablets are not the answer but improving your fitness and physically chanelling your frustrations by regularly exercise goes a long way, as does paying attention to your diet and spending enough "quiet time" by yourself as well as quality time with your family.

Here are some links to Stress Management:

Stress Management I
Stress Management II

posted by Palmdoc @ 8:26 PM

Overprescribing or overreaction?

In the Star,

Prevent wastage of medicine, doctors advised BY K. PARKARAN KUALA LUMPUR: Some doctors in public hospitals overprescribe medicine or give a longer course of treatment which results in wastage, Deputy Health Minister Datuk Dr Abdul Latiff Ahmad said. He said there must be a serious commitment on the part of government doctors and hospital administrators to check this trend as a substantial amount of money could be saved. Dr Latiff said his statement on the matter should not be misconstrued as “disturbing the clinical liberty of doctors in public hospitals.” “Instead of giving 10 tablets, they would give 20. There is a lot of wastage. What I am saying is that if a patient comes with a simple respiratory tract infection and suffers from fever, cough and running nose, most doctors prescribe a two-day treatment with no antibiotics. “However, some of them prescribe five days of treatment with antibiotics even for a viral infection. There is normally no need for antibiotics here. Only in exceptional cases do you give antibiotics,” he said in an interview yesterday. Dr Latiff said that three days of medicine were wasted in such cases, adding that the Government spent some RM800mil a year to subsidise the cost of drugs for patients, who pay only RM1 for all drugs prescribed by doctors at government hospitals or clinics. “For instance, patients with hypertension or diabetes need a three-month supply of medicine for which they only pay RM1. They will not appreciate it,” he said, adding that some patients would ask for the medicine again when they lose it. Citing another example, he said patients suffering from hypertension were sometimes given three types of drugs even when it was not necessary. He said one was to relax the muscles of the vessels, another for the kidney and the third for the brain, adding that only certain cases needed all three drugs. Dr Latiff said that for a patient suffering from diabetes and high blood pressure, medication for two months could easily cost about RM2,000 if medicines were overprescribed. “Doctors could save the Government RM1,000 if they put in some effort in prescribing the appropriate medicine,” he said. He said that during the recession in 1997, the Government had to reduce funds for drugs and hospitals “tailored” their needs according to the money available by cutting down on overprescription. “I am sure this can be done now. We need to educate our doctors on this,” he said. Dr Latiff emphasised that whatever is done to save costs would not be at the expense of quality treatment for the people, especially because most of those seeking treatment at public hospitals were from the lower-income group.

Reading this article left me flabbergasted. The Deputy MInister of Health, despite carrying a Dr in front of his name, obviously does not know what he is talking about. The reason of the above press conference was to sound government doctors on irresponsible prescribing. However, what he achieved to portray was only an ignorant and disjointed Deputy Minister. Perhaps it was because he has long left the dicipline of medicine to pursue the lust of politics. Or perhaps he was not too bright in the first place.

Before vilifying doctors on front page news, he should have at least thoroughly investigated the entire issue and presented it in a fair and balanced manner. But it appears that politics superceded the reality of medicine. Firstly, "a 2-day rule" of treatment even for viral infections is unheard of. It remains subjective and the duration of treatment should be the sole prerogative of the treating doctor. Secondly, he mentioned that giving hypertensive patients a multiple drug regimen is often not necessary. The reality, most hypertensives will require more than one type of drug before achieving blood pressure control. In some cases, incontrovertible evidence has resulted in the preventive style in drug prescription. For example, prescribing Angiotensin Converting Enzyme Inhibitors, a hypertensive drug, for diabetic patients in the absence of hypertension.

"Dr Latiff emphasised that whatever is done to save costs would not be at the expense of quality treatment for the people, especially because most of those seeking treatment at public hospitals were from the lower-income group" This statement puzzles me. Does it mean that lower income groups deserve a lesser budget on healthcare?

The managerial style of the Ministry of Health is confrontational and illogical. They appear distant from the realities on the ground. They remain authoritarian in many issues. This reflects a lack of leadership skills and pure inaptitude. This nasty combination will continue to drive talent away from public service. Doctors are a professional group and therefore they expect to be treated as such. It is the Deputy Minister that requires education that not all can be measured with $$$!

posted by TE Cheah @ 3:57 PM

Down centre needs playthings

If you are from Kedah, then do take note of this plea from the Kedah Down Syndrome Association Day Care Centre:

The Kedah Down Syndrome Association has about 100 members, with some coming from as far as the Baling district. As part of the When You Wish Upon The Star festive wish campaign, the centre wants more outdoor playthings, including a picnic table and musical instruments. The centre also wishes for an Airex Atlas exercise mat. The Kedah Down Syndrome Association is located at 414, Lorong Teratai Putih 1, Taman Berjaya, 05050 Alor Star, Kedah. Azimah can be contacted at 012-4529549 or 04-7724019.

Links:
Persatuan Sindrom Down Malaysia

posted by Palmdoc @ 6:02 AM

Site update: Doctors' personal pages

The MMR's Doctors' Personal Websites page of links has been updated.
I have removed Dr Aini Murni's homepage at his request since it is no longer operational.
A new addition is Life (and death) which is the blog of a young Malaysian doctor training in Internal medicine in the USA. This is an interesting blog if you want some insight into the tough life of a medical doctor, and also a peek into life in an American hospital and America in general. Very interesting reading and thanks for the tip, YP.

If you know of any other doctors' homepages, please send me feedback

posted by Palmdoc @ 5:42 AM

Yet another call for help

Girl needs help for surgery KUALA LUMPUR, Wed Seven-year-old Norhidaya Mohd Nafir, born with a deformed lower left leg, is appealing for public donations to enable her to straighten her leg.

We have recently been inundated with news of patients seeking funds for medical expenses. No doubt medical treatment is expensive and not everyone is fortunate enough to foot these astronomical bills. However, what is concerning is the fact that there is hardly any regulation that governs such an activity. It is worrisome that such publicity for medical funds can degenerate into a fracas if left unregulated with no clear rules or guidelines.

Often such medical cases are not clearly defined by the press. Even the necessity of certain medical procedures can come into question. Some cases are, in my opinion, clearly unjustifiable especially when cheaper available options can be chosen. Instead, they prefer to raise public funds to enable the patient to perform a medical procedure overseas at a private medical center.

If such "fund raising" is to be allowed, the medical details of such an individual has to be published. This is to enable potential donors to scrutinise each case before chipping in. I have little confidence in the media and doubt that they would be able to make sound medical judgements to enable them to sieve the cases that are worthy to be published.

The press should also be held accountable for the disbursement of such funds. This information should be made public for scrutiny.

I am of the opinion that the press should only be a tool for publicity and should not be managers of public funds. There should be an independant body to manage such funds and determine the worthiness of each medical case. The press should only be called upon in the eventuality that publicity is needed to raise funds. There should be more charitable organisations or foundations to oversee this need. The paucity of these noble ventures have led to the media taking up this role. Here we have to call upon entrepreneurs or celebrities or even the Government to fulfill their silent obligation to society. The Welfare Department that currently exists is ineffective and burdened with corruption, bureaucracy, bankruptcy and only used as a political tool. I have personally witnessed in a smaller town that certain individuals can call upon the Welfare Department just to fix a leaking roof despite parading a Honda Civic car in the front porch.

The Government should wake up and correct the situation lest it deteriorates into a free for all scramble for funds for an unnecessary medical procedure.

posted by TE Cheah @ 9:13 PM

What's a little sweat?

Are we getting too spoilt by technology nowadays that we can't sweat a little now and then? In Lack of Ventilators Dr Cheah highlights the incident where the newborn had to be sent 180km away for ventilation. In Shortage of ventilators is relative the Malaysian Paediatric Association's President says this is nothing new:

"There will always be a demand for ventilators. This is relative," said Dr Zulkifli. The paediatrician said that sourcing for ventilators in other hospitals was not new. "It's just that those occasions did not make the headlines

Let me tell you a little story about Dr KB Chua (the discoverer of the Nipah virus) when he was a Paediatric Medical Officer in UHKL years ago. I was then a medical student and there was this newborn who required ventilation one night and there were no spare ventilators available that time. What Dr. Chua did to my astonishment and admiration was to single handedly manually ventilate the baby the whole night until a ventilator became available! I recall too that we medical students had to help with manual ventilation in rotation during times of emergency. Perhaps people are too soft nowadays?

posted by Palmdoc @ 1:57 PM

Another privatisation attempt

In what should read "bid to privatise ambulance service" The Star reports:

The Health Ministry is again considering the possibility of privatising the ambulance service of government hospitals and clinics to provide a more efficient service. Deputy Health Minister Datuk Dr Latiff Ahmad said a similar study had previously been carried out but no decision had been made. The ministry is re-looking into privatisation following a directive from the Economic Planning Unit. Dr Latiff, however, did not say how long it would take to complete the study but added that something had to be done. “We've been told that the poor service has caused a lot of inconvenience to the public. So, it's timely to reconsider privatising the ambulance service so that it can be managed in a more professional and efficient manner,” Dr Latiff said to reporters after attending a Hari Raya gathering jointly organised by Pantai Medivest Sdn Bhd at the Batu Pahat hospital yesterday.

Surely there can be some other means to improve the ambulance service or is the Health Ministry so incompetent they have to resort to contracting it out to the private sector and hence incur more costs to the public (and conveniently less cost to the Government).
I think if privatisation is the means to solve the inefficiency of any aspect of the civil service, then perhaps the ENTIRE civil service should be privatised!

posted by Palmdoc @ 1:49 PM

Antioxidants Might Reduce Mortality Risk

Despite the publicity you see in our drug stores and newspaper advertisements, published results of randomized, placebo-controlled trials of supplements containing antioxidant nutrients have not provided clear evidence of a beneficial effect in the prevention of coronary artery disease or cancer. In fact a recent meta-analysis showed that high doses of vitamin E are not beneficial (and may be detrimental) in patients with coronary artery disease. There is however now a recent a double-blind trial from French investigators with some positive news - well at least in men only and probably because this group was deficient in these nutrients (particularly beta-carotene).

The researchers randomized 13,017 adults (5141 men: mean age, 51; 7876 women: mean age, 47) to receive daily capsules containing placebo or a combination of ascorbic acid (120 mg), vitamin E (30 mg; equal to 30 IU), ß-carotene (6 mg), selenium (100 µg), and zinc (20 mg). Overall, no reduction was noted in risk for cancer, cardiovascular disease, or all-cause mortality among supplement recipients compared with placebo recipients during an average follow-up of 7.5 years. However, among men, significant reductions were found in cancer incidence (relative risk, 0.69) and all-cause mortality (RR, 0.63). Among men in the placebo group, cancer risk was correlated with baseline ß-carotene levels (RR for the highest quintile compared with the lowest quintile, 0.55).

The best thing is still to take lots of fruits and veggies if you want to reduce your cancer risk - as well as practice other aspects of healthy living, especially avoiding tobacco. The French data suggests that anti-oxidant supplementation benefit might apply to those with baseline deficiencies.
The moral of the story: more is not better..

Ref: Hercberg S et al. The SU.VI.MAX study: A randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 2004 Nov 22; 164:2335-42

Background and rationale behind the SU.VI.MAX Study

posted by Palmdoc @ 5:34 AM

UCSI Medical Programme

The University College Sedaya International (UCSI) has announced a "soft launch" of it's Medical School programme which is due for first intake in April 2005 with the first batch of 60 students.
The first two years of pre-clinical training will be taught at the UCSI Connaught Campus in Kuala Lumpur. The remaining three clinical year traininig will be at the UCSI clinical school, Kuala Terengganu attached to the General Hospital, Kuala Terengganu and District Hospitals and Health Centres within the state of Terengganu.
You can view details of the curriculum.
I cannot find any details on their academic staffing though. What I worry is that with medical schools sprouting everywhere in Malaysia, there is bound to be a shortage of teachers in medical schools and I wonder what the staff:student ratio is and also importantly who the teachers are - their experience and qualification etc.

Addendum
I won't be adding this to the Medical Schools listing of the MMR until the actual start next year, since this is only a "soft launch". If there are any other new medical schools/colleges coming up please let me know. I am not sure if I should continue to include "twinning" programmes like the Monash one in the listing. Perhpas I should since I have already included those like the Melaka-Manipal College and Penang Medical College. Any thoughts?

posted by Palmdoc @ 10:03 AM

Ozone fraud

I have encountered patients who allegedly were receiving "Ozone therapy" for lymphoma (a type of blood cancer). The treatment was administered allegedly by a local doctor. None of these patients exhibited any response to the "Ozone therapy" which is not surprising. In fact I would say that the fraudulent "treatment", by delaying proper treatment of their lymphomas, has adversely affected their chances of cure.

I would like to sound a warning to the public that Ozone therapy is Quack Medicine. It belongs to the pseudo-science category of Oxygenation therapy which is totally useless in the treatment of AIDS and Cancer.
In the United States, disciplinary proceedings and license revocation have been instituted against doctors who use Ozone therapy

If you know of any local medical doctor practicing Ozone therapy you should report him/her to the Malaysian Medical Council.

posted by Palmdoc @ 6:50 AM

Lack of incubators

As highlighter in The Malay Mail

NO INCUBATOR AT HOSPITAL IN PUTRAJAYA, SEREMBAN, SELAYANG, MALACCA.. 180km RUSH TO SAVE BABY' Azlan Ramliand Pauline Almeida Dec 6: PUTRAJAYA: A first-time daddy had a fright when he was told his newborn had to be sent 180km away for a life-saving incubator. The Putrajaya Hospital, where his wife had delivered, did not have a spare incubator for his son. The baby boy, weighing 3.9kg, was delivered at 3.30am on Dec 1 and had to be treated at the hospital’s Intensive Care Unit (ICU) following a complication during birth.

The problem of lack of incubators and ventilators has long been a problem at government hospitals. In this scenario, I would guess that it is the ventilators that were in short supply rather than incubators. The accuracy of this report is questionable.

Ventilators are expensive medical equipments. It was indeed unfortunate that on this occasion, all were being utilised, leaving an unfortunate baby with no option but to be tranferred out to another hospital.

It is sad that in an area like Klang Valley, a ventilator could not be found. Sending a baby to a far away hospital in a small town does not reflect well on our health system. Other than government hospitals like Hospital KL, Hospital Selayang, Hospital Klang, UMMC and HUKM, there are endless private options like Assunta, SJMC, Sunway, Damansara Specialist etc. There should have been no reasons why ventilators could not be found for this baby. Risking the life of this baby by transferring him for 2 hours through bumpy roads in less than ideal conditions, is in my opinion an unsound decision.

Having said that, the above report is inaccurate in its information and does not paint a balanced picture. It reflects an amatuerish reporting style. Then again, why should I be surprised? The Malay Mail has been infamous for its gossips and sensational news. In this instance, they could not help jumping into the bandwagon of hospital-bashing without first discovering the underlying circumstances of this scenario. The blanket statement of "could not be reached for comment" is pure inaptitude.

posted by TE Cheah @ 11:24 PM

Seminar Pendedahan Kursus Perubatan

Eida writes to inform that Kolej Tun Dr Ismail aka Fakulti Perubatan UKM is doing a 3 day seminar geared for those who want to apply for a local medical or health-related course (STP holders, matriculation students, form 4 and 5 students) from 10-13 December 2004 in HUKM. It'll be officiated by the Timbalan Health Minister. Among the programmes are briefings of the medical courses and applied health sciences courses, forums on medical doctors responsibilities etc.
You lament the fact that you can't find much promotion material on this event. I guess that is the fault of the organizers. They really should have gone out to the media to publicise this. I am surprised (well, not really!) that the event is not even in the "berita" section of the HUKM Website - in fact the Berita link gives a 404 error. I give the HUKM webmaster a "D-"!

posted by Palmdoc @ 1:41 PM

Bras and Breast Cancer Myth

Unfortunately there is an article in The Star on Bras and Breast cancer by a medical doctor which quotes unnamed studies claiming that there is a relationship between breast cancer and wearing tight bras.
I would lump this in the category of other famous Breast cancer myths floating around the Internet such as "antiperspirants cause breast cancer".

Here's a statement from the Canadian Cancer Society:

There have been reports, e-mails and websites that say wearing a bra might cause breast cancer. At this time, there is no reliable, scientific evidence that shows a link between wearing a bra and developing breast cancer. If well-designed, peer-reviewed studies are carried out on this subject, the Canadian Cancer Society will review the research and the results. The Canadian Cancer Society understands that Canadians are concerned about breast cancer, but recommends that caution be exercised in evaluating any medical information or claims obtained from the unmonitored Internet – the Internet can be an empowering source of information but personal health concerns should always be discussed with a qualified health professional.

One needs to be critical when appraising evidence. One needs to be even more critical when obtaining medical information from the Internet. Even medical professionals may be fooled.
Looks like you have to be extra critical when it comes to medical information from our local newspapers as well.

Links:

National Cancer Society of Malaysia
Malaysian Oncological Society

posted by Palmdoc @ 1:25 PM

Chasing the targets

Hot off the press from ASH (the American Society of Hematology) 2004, comes news of yet another new "targeted therapy" agent, this time for treating Chronic Myeloid Leukemia patients who no longer respond well to Glivec (Gleevec) due to the leukaemia cells developing resistance to Glivec.

A team of prominent researchers led by Charles Sawyers, M.D. and Moshe Talpaz, M.D., presented compelling clinical findings today showing that a new drug, BMS-354825, can successfully treat patients who have become resistant to Gleevec (the frontline therapy for chronic myelogenous leukemia, CML). Dr. Sawyers and Dr. Talpaz presented results of a phase I clinical trial at the annual meeting of the American Society of Hematology in San Diego. The trial showed that 86 percent of the patients treated with BMS-354825 achieved a complete hematologic response (complete remission). A Specialized Center of Research (SCOR) grant from The Leukemia & Lymphoma Society financed the discovery of the major mechanism of resistance to Gleevec, and identified the compound that circumvents resistance.

This demonstrates the way forward in research in cancer treatment. It's about identifying mechanisms of cancer cell growth and development and targeting these for treatment. Glivec is already achieving impressive results for CML and now we have new agents coming to the rescue should Glivec fail. Perhaps combinations of these drugs will prove to be even more effective but only clinical trials will tell.
Too bad all this research is happening in the "Western" world. What about here? We are still so obsessed with herbal therapy and traditional "cures" that we'll be left far far behind. And we'll be beholden to importing these drugs for decades to come.....

posted by Palmdoc @ 7:14 AM

The Patients Charter

The Star reports that many are unaware of the Patients Charter. Are you one of them?

NINE years after the Patients Charter was accepted, many people, even those in the medical service, are not aware of it. Datuk Dr S. Sothi Rachagan, the Consumer Rights columnist in Berita Harian, said the concept of a charter was not new. He said a similar charter was drafted in South Korea by its consumer association and accepted by the government in 1985. Malaysia, however, drafted its Patients Charter after lengthy discussions among consumers and medical service providers. These discussions, involving parties like the Federation of Consumer Associations (Fomca), Malaysian Medical Association and the Malaysian Pharmaceutical Society, took six years before the charter was finally drafted in 1993 and accepted with minor amendments, in 1995. The country’s Patients Charter was widely acclaimed and received positive comments from the British medical journal, The Lancet, in 1994.

Well it has been 9 years. I guess it is time to re-visit the Charter and it is fortunate that the MMA's website has details on the charter.
There are basically the Patient's Rights and the Patient's Responsibilities

Point 2: "The patient shall keep appointments and shall inform the health professional if unable to do so"
So it's a two-edged sword people. You can't have it both ways. You can't complain about the waiting time unless you ensure that the patients keep to their appointments and don't fail to inform the doctor if they need to! Too many Malaysian patients expect to just walk in at anytime and expect the doctor to see them instantly without an appointment.

Point 9: "Every individual has a responsibility to maintain his or her own health and that of society by refraining from indulging in :-
* unhealthy food consumption;
* addiction forming substances such as dadah, tobacco and alcohol;
* lifestyles that have an adverse impact on health such as sexual promiscuity, reckless activities, and physical inactivity; and,
* contamination of the environment".
Gosh I think alot of patients (and even some doctors) will flop over this point!

What about the Patient's Rights? So many points there and indeed I think in many instances, we fall short.....

Just food for thought.

posted by Palmdoc @ 6:25 AM

Declining post-mortem rates

In Declining Post-Mortems: A Cause for Concern, Drs. Pathmananthan and Chandrasekharan succinctly write on the importance and usefulness of post-mortems, especially in instances when the cause of death is not known.

Almost invariably additional diagnoses come to light during a post-mortem (PM) examination. In a significant proportion of cases (25%), the PM alters the diagnoses completely. In a prospective survey of 1000 necropsies, Cameron et al, found that the main clinical diagnosis was not confirmed in 39% of cases. The autopsy also serves as a check on the appropriateness of therapy and is a valuable lesson against similar mistakes being made in future. It provides data on both old and new diseases; this may follow from single case reports or of compiled data from several cases. Not only may the natural history of a disease be studied to advantage but the effects of investigative/diagnostic procedures, drug therapy and surgical intervention may also be observed.

They also lamant the declining rates of post-mortems in this country and also speculate on the possible reasons.
Post-mortems should be done whenever the cause of death is not known and certainly if there is the remote possibility of foul play. Yet there is pressure on hospital authorities and doctors by relatives NOT to have any post-mortems despite clear-cut "coroners cases" like death within 24 hours of admission or someone brought in dead to hospital where no cause of death is apparent. Imagine how easy it is to "bump off" people in the rural areas when you can report to the police station that so-and-so died of "sakit tua" at the age of 60 years!
In Cases where police exhumed bodies to investigate possible murders one wonders how people can obtain burial permits so easily like this case:

The family of Mokhtar, 47, had told villagers he died of a heart attack while hunting deer, but a neighbour preparing the body for funeral noticed blood from a head wound and reported it to the police after the victim was buried. Police exhumed Mokhtar's body and an autopsy revealed gunshot wounds to his chest and a bullet in his head

Post-mortems need to be conducted by properly trained Forensic pathologists and not inexperienced Medical officers. Already there is a hint that there is a Critical shortage of Forensic pathologists in this country.

CSI standard we are not.

posted by Palmdoc @ 5:17 AM

Aptitude test

It has been reported that 6,000 students will be required to undergo a pilot Malaysian Medical School Admission Test (MSSAT) next year to assess their suitability to do medicine in public universities.
I do not think there is a perfect screening system - whether purely on academic grades, aptitude tests or even interviews. The field of medicine is so wide now and I believe if the student can make it through medical school, that itself is a screening process. Following medical school, he or she can then pursue various clinical and non-clinical fields.
What I think is intersting is that there are already two methods to gain entrance into medical school - one via the STPM and another via the matriculation scheme. So do both these groups of students now sit for a common admission test? True meritocracy at last?

posted by Palmdoc @ 6:16 AM

Regulating private hospital charges

From Bernama

The Health Ministry is drafting regulations to control treatment and medical fees charged by private hospitals in the country, the Dewan Rakyat was told Wednesday. Its parliamentary secretary, Lee Kah Choon, said the ministry was aware of the problem of high fees charged by the private hospitals on the people, including the not so rich. "With these regulations, we hope to resolve the problem," he said in reply to a supplementary question from Datuk Raja Ahmad Zainudin Raja Omar (BN-Larut) who wanted to know whether the government was formulating laws to control the private hospital fees.

The MMA Schedule of Fees is now in it's 4th Edition. A couple of pertinent points here though:
As the MMA points out:

It must be very clear to the public that the MMA Schedule of Fees only deals with consultation and procedure fees of doctors. It does not deal with cost of drugs, bed charges, etc., which are determined by the respective hospital administration, except for a few hospitals, who do not receive any subsidies from the government.

I think too it is important to differentiate professional (the doctor's) fees from the overall hospital bill. From my own experience the professional fees are usually less than 10% of the overall hospital bill so it is hospital charges which make up the bulk of the fees. At least with the MMA Schedule of fees, there is a basis for comparison if there is an allegation that the doctor is overcharging. How is anyone to know though if the MMA schedule of fees is not available freely for public access? I can't find a copy of the MMA schedule of fees on the MMA's website! It should be open and transparent IMHO. Some private hospitals also have their own fixed professional schedule of fees but I suppose it is in the interest of the public that there should be nationwide standards.
Still, as the bulk of the hospital bill are hospital charges and not doctors' charges, it is timely that there should be MOH guidelines on this aspect. However, medicine is expensive business and no matter how much you regulate, the costs will still be high. One can't compare with the Government hospitals where the costs are much subsidised.
The Government must stop dilly-dallying and come out with the National Healh Financing Scheme or a National Health Insurance Scheme which enables equitable healthcare for all. When is this ever to be put in place?

posted by Palmdoc @ 5:32 AM

Waiting game

The DG has been reported to claim that Long Waiting Time Not At All Hospitals

KOTA BAHARU, Nov 30 (Bernama) -- The problem of patients waiting a long time for treatment is not happening at all government hospitals, Health Director-General Tan Sri Dr Mohamad Taha Arif said Tuesday. He said the problem occurred only at certain hospitals in big cities and did not have anything to do with the shortage of doctors but with society's belief that better treatment could be obtained at bigger hospitals. This caused congestion at hospitals and "we can shorten the waiting time but would we be satisfied being checked by a doctor for just a minute or two?" he said after the MS ISO 9001:2000 ceremony for the Kelantan Health Department here. Dr Mohamad Taha said congestion also occurred at hospital emergency units after the operation hours for the outpatient treatment units ended. He said the Health Ministry also found that there were sufficient doctors to provide complete care for patients at hospital emergency units.

I am reminded of the British television comedy series "Yes Minister" - there was an episode where a news crew was investigating an NHS hospital which reportedly had a wonderful record of keeping to budget, zero complaints, zero waiting time etc. The reason was because the hospital had NO patients :) When the crew visited the hospital there was ONE patient in a wheelchair sent there accidentally by ambulance.
I am sure one can claim there is little waiting time in unpopular hospitals but one must investigate why the hospital is unpopular. Is it because it is under-equipped and under-staffed?
Why is it the major hospitals are congested? That's because the public knows that's where you can find the expertise and facilities. The public are not fools.
I suspect too that there are already Government OPDs where patients are "checked by a doctor for just a minute or two" and yet the clinics are congested. So if the DG thinks this is not acceptable perhaps he should do something about it.
I don't know why there is this obsession with ISO standards. They merely reflect the ability to keep standard operating procedures and sticking with these SOPs. It doesn't mean the hospital is better off with ISO if the SOPs are cumbersome and inefficient in the first place. I know of a teaching hospital which is ISO certified but is still an inefficient place where clinic notes still go missing, lab results are delayed or go missing, radiology appointments take weeks, patients still wait hours for the doctors etc......

posted by Palmdoc @ 6:26 AM