Forwarded by a SN and Fb friend

One for the students (BMJ doc2doc forums)

Choose medicine.

Choose nights, choose PRs and scrotal exams, choose being bleeped when you’re taking a shit, choose bare below the elbows, choose and book, choose being so hungry you enjoy hospital food, choose never seeing your friends again, choose not washing your hands for a change, choose dehydration, a f***ing big cannula, Quality Street over Roses, MRSA, choose scrubs (watching it or wearing them). Choose cyclizine the morning after the mess party, choose Adele the Australian physio, choose sitting in the mess watching mind-numbing, spirit-crushing game shows, stuffing junk food into your mouth praying that you’re bleep won’t go off. Choose MI over PE because someone’s got to make a diagnosis. Choose bd, tds, qds, those f***ing T’s with the dots on them.

Don’t choose life, choose medicine.

I thought they got it right when Malaysiakini ran an article Blood tests a big scam? but unfortunately quite a fair bit of it was about an “explanation” from an alleged Klang Valley doctor who touted Live Blood Analysis (LBA)’s “usefulness”. Unfortunate for this explanation amounts to pseudo-scientific hocus pocus.

The Malaysikini article contained the alleged doctor’s claims:

“Through LBA the activities of blood cells such as killing bacteria and fungus can be observed clearly,” said Lim, who has been conducting LBA in his center for 10 years.
He added: “To perform LBA, a single drop of blood is collected from a finger-tip for examination when the blood cells and microorganisms are still alive.
“Through LBA doctors are able to assess a patient’s immune, nutritional, circulation and toxicity (liver stress) status after the blood cells have been observed under a microscope.
“It thus gives us early signs of deterioration of our health conditions and provides vital information to formulate a nutritional or metabolic programme.”

The warning flag should be the “nutritional or metabolic programme” that someone is trying to sell you.

Unfortunately the notion that LBA can reliably detect one’s “immune, nutritional, and toxicity” status is extremely contentious to put it mildly. There are far better and more sensitive tests to detect liver function, infections and assays for specific deficiencies where these are indicated.
“Free radical test” as a follow-up to LBA? Please-lah, this is another scam test you see advertised in “natural health” websites and carried out by nutrition quacks.

I just want to quote Wikipedia which summarises it nicely, and at least this time gets it right:

Proponents believe that live blood analysis provides information “about the state of the immune system, possible vitamin deficiencies, amount of toxicity, pH and mineral imbalance, areas of concern and weaknesses, fungus and yeast.” Some even claim it can “spot cancer and other degenerative immune system diseases up to two years before they would otherwise be detectable” or say they can diagnose “lack of oxygen in the blood, low trace minerals, lack of exercise, too much alcohol or yeast, weak kidneys, bladder or spleen.” Practitioners include alternative medicine providers such as nutritionists, herbologists, naturopaths, and chiropractors.

Dark field microscopy is useful to enhance contrast in unstained samples, but live blood analysis is not proven to be useful for any of its claimed indications. Two journal articles published in the alternative medical literature found that darkfield microscopy seemed unable to detect cancer, and that live blood analysis lacked reliability, reproducibility, and sensitivity and specificity.

Edzard Ernst, professor of complementary medicine at the University of Exeter and University of Plymouth, notes: “No credible scientific studies have demonstrated the reliability of LBA for detecting any of the above conditions.” Ernst describes live blood analysis as a “fraudulent” means of convincing patients to buy dietary supplements.

Let me repeat the last line in case you didn’t get it in your heads:

Ernst describes live blood analysis as a “fraudulent” means of convincing patients to buy dietary supplements.

LBA if done by a medical doctor is not necessarily better than if done by “nutritionists, herbologists, naturopaths, and chiropractors”. The issue is not who is doing it but the scientific basis (or lack of) behind LBA and the dubious claims practitioners make about it.
I am also surprised that according to Malaysiakini, “The Health Ministry and the Malaysian Medical Association declined to comment on this issue”. Nothing to say on this? What if the alleged doctor is indeed a registered medical practitioner on the MMC register? Isn’t it worse?
Any claim that a particular “test” has a clinical application should be properly evaluated. There should be publications which independently validate the tests and if one tries to search for Live Blood Analysis in the medical literature via Pubmed or Google Scholar, the precious few there are aren’t positive (see References below)

More reading:
Guardian: Intrigued by the spectacular claims made for Live Blood Analysis? Don’t be. It doesn’t work
Quackwatch: Live Blood Cell Analysis: Another Gimmick to Sell You Something
Skeptic Zoners: Live Blood Analysis – hocus pocus?

References:
1. Clinical utility of live blood analysis. J Korean Acad Fam Med. 2001 Jan;22(1):70-77.

There was no difference between patients and controls in observing 3 abnormal finding. CONCLUSION: We conclude that Live blood analysis may have no clinical significance.

2. Complementary and alternative allergy tests : review article. Morris, Adrian 2006
This article reviews the common tests employed by complementary and alternative medical practitioners to diagnose allergies and intolerances. These tests include VEGA, applied kinesiology, hair analysis, auriculocardiac test, stool and live blood analysis, leucocytotoxic tests and IgG ELISA tests. None of these tests has proven to be as accurate as specific IgE measurement in allergy diagnosis and they cannot be recommended.

3. eMJA 2004; 180 (12): 647-648: Good medicine and bad medicine: science to promote the convergence of “alternative” and orthodox medicine
- poses a question which those in charge of ethics should ponder (MMC, MMA Ethical committee):

Should Medical Boards (and indeed similar statutory authorities monitoring the quality of care given by nurses and allied health professionals) be more vigilant in challenging the appropriateness of renewing registration of those whose diagnostic and therapeutic approaches would not be acceptable to their peers (for example, the use of “live blood analysis”, inappropriate chelation therapy,infusing massive doses of intravenous vitamin C, colonic irrigation procedures)?

Related MMR posts:
Live Cell Analysis: High-Tech Hokum
Nutritional Live Blood Analysis

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With the hype over this global pandemic intensifying, there appears to be an argument as to what this illness should be called. As the world waits intently for a vaccine to be developed, the only method of containment is isolation. With expected rise in the number of cases, it will surely become more costly and labour intensive to maintain a reasonable tab on the cases and their respective contacts. What then can we expect in the coming months?

The origins of this strain of influenza A (H1N1) is still relatively unknown although it closely resembles those found among pigs. It is clearly a mutated strain. Fortunately, the virulence of this virus is low as compared to their cousins, the bird flu or the SARS virus. Most confirmed cases are usually well and might have recovered even without the aid of Tamiflu. Why then are we concentrating our healthcare resources on a ‘mild’ virus?

My belief is that previous deadly encounters with firstly the SARS virus and then the bird flu, has made Asian countries extremely sensitive to such viral outbreaks. The consequences of inaction is no longer acceptable to the general public. Therefore, Governments have taken a cautious approach lest they be accused of being lackadaisical. I prefer to belief that this ‘real life drill’ could be paramount in our future responses to more deadly air borne viruses.

The virus is bound to spread further and the numbers of confirmed cases is expected to rise. Our actions of containment appears only to delay the inevitable. It is hoped that with increasing infections, the global community will develop a herd immunity towards this virus. Until and unless, a vaccine becomes readily available, our strategies only appear to be surmountable barriers for the virus.

Our only prayer is that this virus will not mutate into a more deadly virulent strain that could then inflict high number of casualties.

The morning got off to a bad start. The website was down as the MySQL server had caught H1N1 I guess. Then the depressing news that Michael Jackson, the King of Pop, has passed on. We don’t know the exact cause of death as a post-mortem has not yet been done.
I don’t want to say too much so I’ll just post this video of my favourite song performed by MJ

Heal The World
Make It A Better Place
For You And For Me
And The Entire Human Race
There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

So true, MJ. RIP.

There’s a bit of a running joke that the UMMC wards have “no class” which is true since unlike MOH hospitals, there is no 1st, 2nd and 3rd class wards. Yes, UMMC practices “socialist” medicine and all patients are treated equally according to their medical needs.
Usually when people write in to the media about their experiences, it’s the one who have grouses or want to find fault, and hence negative feedback far outweighs the positive ones. I wish more people would write in with the positive experiences but such is human nature I guess.
Anyway it’s nice to read Bhavani’s letter to Malaysiakini and I am sure the doctors in UMMC’s geriatric ward can pat themselves on their backs. Kudos!

(spotted in FB)

The MOH apparently now advises (?requires) that one includes the MMC registration number in rubber stamps and calling cards used by doctors
I believe this is supposedly to reduce the chances of people pretending to be doctors.
Would you throw away your hundreds of name cards just to follow this ruling?

Personally I think this is not going to help at all since all Malaysian doctors’ names and MMC registration numbers are easily obtained from the doctors’ register in the MMC website. You don’t need the MMC registration number to search. All you only need to know is the name of the doctor and you can verify if the name is a bonafide doctor or a fake. So for instance if you want to know Dr. Chua Soi Lek (our ex- Health Minister)’s details, they are available on the MMC website.
So is this new “ruling” another futile exercise?

If you really want to impersonate a doctor, all you have to do is grab the name and corresponding MMC registration number from the MMC website.

The MMC has proudly put up all the details of a doctor’s registration and place of practice on it’s website. The problem is now anyone can use this information for the purpose of identity theft. Indeed if we have clinic assistant nurses now trying to impersonate locum doctors, I wonder if there won’t be even more instances of identity theft where the impersonator will be smart enough to check the details on the MMC website and get the name right!

So what’s next - perhaps as Bushido in the Dobbs forum suggests, the Government will now require all name cards to be manufactured by a contracted/designated company, and to ensure authenticity, the cards will have a hologram? Hmm perhaps the APC should have a hologram too ?

Seriously though, it looks like all doctors who employ locums must now not only check the APC but have to check the IC or other independent identification documents (driver’s license, passport) since the APC can be forged.

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