This morning, I notice that I couldn’t access the MMR Forums using Streamyx. In fact Streamyx the past one week has been pretty flaky and access to various sites has been either slow or impossible. I think Streamyx once again has messed up something on their end and cannot route http requests correctly.
One quick fix is to use a proxy, i.e. you surf to the website you want via another gateway. There are various open proxies available but the easiest is to use portals like HideMyAss. Just enter forum.malaysianmedicine.com in the box and click on the HideMyAss button and you should be able to surf to the MMR forums. After you login, you should quickly click on the MMR banner or else you will have to re-enter the forum URL in HideMyAss as the re-direction takes you back to HideMyAss. But the login cookie is stored on your PC so you should remain logged in until you close your browser.
Some people use proxies when ISPs purposely block sites. In certain countries, restrictive Governments will block access to news sites which are deemed politically “undesirable”. Thanks goodness in Malaysia, we are committed to open access policies and ISPs do not (as far as I know) block “undesirable” websites.
The MMR Forums may be a little rowdy at times, and perhaps sometimes we are a little critical about almost everything, but it’s generally a friendly medical community with over 2000 registrants now and more than a third of these are medical doctors. We are mostly harmless Therefore I don’t think we are being purposely blocked by Streamyx, and I am sure this is only a technical glitch which hopefully will be resolved in due course.
In the meantime, our tip of the day is to use HideMyAss. A great site for times like this and whenever you are feeling paranoid
HideMyAss is something Politicians perhaps should learn to use. With all these “statutory declarations” flying about, it seems to me the common denominator is some obsession with the posterior aspect of one’s anatomy!

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The Universiti Tunku Abdul Rahman through its Centre for Extension Education (CEE) in collaboration with MCA Lifelong Reading Club is organising a talk by Dr. Milton Lum based on the book entitled “New Guide to Medicine & Drugs”.
Dr Milton Lum is a Consultant Obstetrician & Gynaecologist, Councillor of Malaysian Council of Healthcare Standards and Member of National Patient Safety Council. He is also the Chairman of the Commonwealth Medical Trust and a former President of Malaysian Medical Association.

Date : 26 July 2008 (Saturday)
Time : 9.45 am to 12.00 noon (including Q&A)
Venue :
Centre for Extension Education
Universiti Tunku Abdul Rahman
11 Jalan 13/6
46200 Petaling Jaya

For further enquiries, please contact Rajes / Nitthia at 016 2233 563 / 03-79555181 / 79572818. Fax: 79573818. Email: cee@mail.utar.edu.my
Limited seats available and pre-registration is required

See also the UTAR Website

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Short-Term HIV Mortality Rates, Newborns Undergo Painful Procedures, Intensive Treatment Strategies for Heart Attack

From London - In industrialized countries, those infected with HIV now experience mortality rates similar to those of the general population in the first 5 years after infection. In a study of over 16,000 people, the excess mortality rate of those infected with HIV sexually dropped from 40.8 before 1996, to 6.1 in 2006. However, excess mortality was still evident in the long-term.

From Paris - Newborns undergo several procedures that can result in pain and stress, with many performed without medication or therapy. In a study of nearly 61,000 first-attempt procedures on newborns, nearly 70% were associated with pain, and 30% were associated with stress. The researchers state that the prevention of pain in newborns is both an ethical obligation, and a way to avert immediate and long-term adverse consequences.

And finally from Boston - An intensive treatment strategy in men and high-risk women with ST-segment elevation myocardial infarction or angina may reduce the risk of heart attack or death, but may increase the likelihood of these events in low-risk women given the same treatment. In a study of over 10,000 patients, men receiving the intensive strategy had a 27% lower risk of heart attack or death, high-risk women had a 19% lower risk, while low-risk women had a 35% higher risk.

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In the 41 Secrets Your Doctor Would Never Share article in the Readers Digest, Dr. Doug Farrago, Editor of the humour site Placebo Journal, was quoted several times. Evidently some people did not take too kindly to his wit and sarcasm. Well, Doug now responds in his trademark sardonic way, and really, he says is so true. Watch:

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A lot has been happening in this nation of ours recently. Take as an example, the policemen accused of killing an unfortunate Mongolian girl. There are those who find it very hard to believe that they did what they allegedly did on instruction from some “political analyst”. What were if it were true that the heinous crime was indeed on instruction from someone higher up as alleged by someone’s statutory declaration?
Well this post is not about what is true or what not is true, but it is about what should one do if instructed to do something which is wrong - morally, ethically and even legally wrong. This applies to all of us - policemen, accountants, lawyers, doctors, nurses.

Indeed, it can be very hard sometimes being a minion.

So what do you do if your boss or superior or someone in “power” asks you to do something you know is wrong or unethical?

Those of you who work in ERs may have been pressured by “politicians” not to proceed with post-mortems in cases which clearly belong to the Coroner. You may even have had pressure from “people in power” to “omit things” from medical reports.
I can imagine the pressure must have been very high on those doctors involved in the medical examination and medical reports of a very high profile political case.
You can only report the truth and nothing but the truth. Yet, if a doctor were to be coerced by those in authority to come up with a medical report which is not the truth can the doctor be disciplined by the MMC? The allegations of a doctor making “false and incredible conclusions” as per paragraph 10 of the alleged police report is indeed disturbing.

I think there can only be one answer to the “what should you do?” question. You do what is right. Short of that you have to live with your conscience the rest of your life.

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Smoke-Free Policies Having Positive Effect on Health, Not Decreasing Business Activity (Interview with John Pierce, MA, MSc, PhD)

Another reason to make your business, be it a restaurant or office, a smoke-free environment!

Researchers out of the University of California at San Diego and International Agency for Cancer Research assessed 11 reports relating to the effects of smoke-free policies. They categorized findings having sufficient, strong, or insufficient evidence to support a causal link between the smoke-free policy and the outcome.
They found sufficient evidence that smoke-free policies substantially decrease second-hand smoke exposure and cigarette consumption in those who continue to smoke, and they do not decrease business activity in restaurants and bars but do decrease respiratory problems in workers. There was also strong evidence indicating that smoke-free legislation has helped to decrease heart disease morbidity.
Today’s research demonstrates that smoke-free policies are working. There is good evidence that they decrease smoking, smoke exposure, and heart disease morbidity. A longer follow-up period is needed to determine whether they also decrease lung cancer rates.

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In case you are not aware, we have a presence on a Facebook group: Malaysian Medic. I believe Facebook is one of the fastest growing social networking sites on the Internet today. It has just overtaken Myspace and my guess it will be a market leader for some time. If you are a Malaysian medical doctor or medical student who is a Facebook user, why not just join the Malaysian Medic Facebook Group and network with the rest of us?

There’s also a small discussion board there where you can post questions, such as Poh Ban Chung’s Rant against Muzammal syringes!. Personally I haven’t come across these syringes so I can’t comment on their quality. My encounters have been with Terumo, B Braun and BD syringes. These Muzammal syringes are apparently made by a local company. Anyone else encountered these before? What’s your feedback? If you have any, perhaps let Poh Ban Chung know. Perhaps he was unfortunate enough just to encounter a bad batch.

Just to let you know also, we have a Facebook plugin for MMR posts. If you like any of the posts you see here, you can easily add it to your Facebook mini-feed by clicking on the Facebook icon you see at the end of the post.

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Doctors Should Promote Behavior to Combat Climate Change

As doctors, we should always set good examples. Like not smoking, exercising and keeping fit. An overweight doctor who smokes is hardly a good example for his patients! What about taking care of our environment?

The video suggests ways to reduce our “carbon footprint” :

• Whenever possible, walk or bicycle instead of driving.
• Change all the incandescent light bulbs in your home to compact fluorescents.
• Be sure your home is maximally insulated. (I guess for us it means well ventilated homes and and roofs insulated from heat - to lessen air-con usage!)

OK I am now feeling even more guilty about driving my SUV 6km to work. I should cycle but that would leave me sweaty when I arrive at work. If the workplace had a convenient place to shower and change, then that would be a different matter. Actually I do have a small folding bicycle which I use whenever I want to go out for short errands like buying bread. However where I live, the roads are not conducive to cyclists and therein lies the problem. Local councils if they are serious about promoting cycling as a means of encouraging a healthy lifestyle and reduce wasteful energy expenditure, should have Cycling lanes. Maybe I should suggest this to Hannah Yeoh Frankly another deterrent for me is those slopes. I’m no Lance Armstrong and even on the low low gears, it is tough climbing those hilly slopes. On a tech note, electric assisted bicycles like this one would be a great boon in climbing hilly slopes. I only wish they sold them here.
Anyway enough about excuses. So should doctors cycle to work as a good example? Now this is an idea for the Health Minister to promote a “healthy lifestyle”. Have a campaign for all hospital staff including Pengarahs and Specialists to cycle to work!!

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General Anesthetic Increases Post-Surgical Pain, Turmeric a Potential Diabetes Treatment, C-Sections Performed in Record Numbers

From Washington - Most general anesthetics used during surgery can increase the likelihood of discomfort when the patient wakes up. Researchers discovered that most general anesthetics stimulate sensory nerves throughout the body, which causes irritation and contributes to the pain felt by patients upon awakening, as well as to a lingering over-sensitization of pain pathways in the nervous system.

From New York - Turmeric, a spice that can be found in many curries, is showing promise in the prevention of diabetes. Researchers have found that mice that were fed turmeric were less susceptible to developing type 2 diabetes, and also showed reduced inflammation in fat tissue and liver compared to untreated mice. Turmeric is also being studied as a potential treatment for pancreatic cancer, colorectal cancer and Alzheimer’s.

And finally, from Calgary - The rate of caesarean section in Canada has reached a record high, with one in four babies being delivered in this way. Key factors driving this increase include the growing proportion of overweight mothers and older first-time mothers, as well as the emerging trend of elective C-sections. While C-sections are relatively safe, they do carry a higher risk of complications than normal childbirth and should only be sought in cases of medical necessity.

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More quackery encountered in the NST, with an article by a pharmacist promoting Coffee Enemas. The author makes statements like “Coffee enemas detoxify the body” and quotes practitioners of dubious therapy like Max Gerson and Nicolas Gonzalez. I think before anyone falls into the hands of these Coffee Enema proponents, do take some time to read the following articles:

Gastrointestinal Quackery: Colonics, Laxatives, and More

Colonic irrigation, which also can be expensive, has considerable potential for harm. The process can be very uncomfortable, since the presence of the tube can induce severe cramps and pain. If the equipment is not adequately sterilized between treatments, disease germs from one person’s large intestine can be transmitted to others. Several outbreaks of serious infections have been reported, including one in which contaminated equipment caused amebiasis in 36 people, 6 of whom died following bowel perforation [7-9]. Cases of heart failure (from excessive fluid absorption into the bloodstream) and electrolyte imbalance have also been reported [10]. Direct rectal perforation has also been reported [11]. Yet no license or training is required to operate a colonic-irrigation device. In 1985, a California judge ruled that colonic irrigation is an invasive medical procedure that may not be performed by chiropractors and the California Health Department’s Infectious Disease Branch stated: “The practice of colonic irrigation by chiropractors, physical therapists, or physicians should cease. Colonic irrigation can do no good, only harm.” The National Council Against Health Fraud agrees

Nicholas Gonzalez Treatment for Cancer: Gland Extracts, Coffee Enemas, Vitamin Megadoses, and Diets

Conclusions

* Neither Kelley nor Gonzalez has identified proposed toxins in processed food.
* Neither has evidence that abnormal protein molecules from necrosing tumors are toxins or that they poison organs.
* Neither has evidence that the toxins poison oxidative metabolism.
* Neither has evidence that cancers thrive in an anaerobic environment.
* Neither has shown that coffee enemas, megavitamin doses, and their special diets inhibit the progress of cancer.
* Neither has produced evidence that a deficiency of pancreatic digestive enzymes is related to the onset of cancer.
* Neither has produced evidence that enzymes from animal or vegetable sources can replace enzymes in human organs.
* There is no evidence that ingested pancreatic enzymes seek out and kill cancer cells.
* Neither has produced evidence that their regimens are more effective than a placebo for cancer.

Dr. Chan has also written a letter to the NST on Coffee Enemas being A misleading proposition, at best. He says:

I know a woman who developed rheumatoid joint pains and a young girl who developer allergies to various foods after coffee enemas. I also know of people who had cancer and were treated with coffee enemas and died.
Many victims of this procedure do not complain as they are embarrassed. There is no justification for such a procedure as we have excellent and safe oral medication to enhance liver detoxification.

Though I am not sure what he means by “safe oral medication to enhance liver detoxification”.

So enjoy your daily dose of Caffeine folks, but make sure it goes in the right end of your alimentary tract!

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This is my PDA collection over the last 11 years. PDAs are indispensable tools for doctors. If you are a doctor, and you don’t have one, I believe you are missing out on a lot. I have maintained a PDA blog for over 5 years now preaching the PDA philosophy, The Palmdoc Chronicles, and I do feel a little nostalgic taking the picture and thinking back over the years of using Palm PDAs (and now the Treos and Centro).
I have been invited to speak to Dermatology colleagues on PDAs and Medicine in August . Once again, it will be nice to talk about something other than one’s specialty. But come to think of it, PDAs are my specialty!

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Yes, so it seems the NHIS means there is No Hope In Store for it ever to be implemented in the near future. Malaysiakini reports that the Government is in No rush to implement the health financing scheme

There is no deadline for the government to implement the national scheme to finance public healthcare and it could take “years” to implement, revealed Health Minister Liow Tiong Lai.
The scheme, known by several names but dubbed by Liow as the National Health Insurance Scheme (NHIS), was supposed to be implemented last year but little is heard about it since.
Speaking to Malaysiakini at his Kuala Lumpur office on Tuesday, Liow said the scheme was mooted about a decade ago as a means of offsetting soaring medical costs at government-funded hospitals.
However, after studying several proposals, including studies of several models overseas, a satisfactory system had yet to be found, he explained.
“Many reports were received. Recently, a consultant we engaged came back with (the latest) report. We found that (the proposals) were not applicable in Malaysia. We couldn’t go ahead with it.
“In fact, I have initiated another local group by asking the director-general (of health) to set up another committee consisting of locals to study (the feasibility of such a scheme),” said Liow.

NHIS or no NHIS, the Government cannot run away from its responsibility for the health of its citizens. At least some means of Universally accessible decent healthcare is important and that would mean boosting the beleaguered public healthcare services.

Related MMR posts on the NHIS

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