Expert: More sex is good for you PETALING JAYA: An active sex life improves health, reduces mortality rate and strengthens a couple’s bond, said a prominent Australian sex therapist. Dr Rosie King, a renowned expert on men and women’s sexual health, said a 10-year study found that those who had sex twice a week had a mortality rate that was half of those who had sex once a month. “Sex is good for you and marriage is good for your health,” she said when revealing the findings of the Caerphilly Cohort Study on men aged 45 to 59. ...................... The Star

Looks like you can never have enough of sex. 918 men were selected in this study between 1979 and 1983. WOW! it has been more than 20 years.... and those men who were in the high orgasmic frequency group were having sex at least twice per week. I really wonder how they kept that up... They were 46-59 at the time of recruitment .... so now they should be around 66-80.... I find it hard to believe!!.... I guess in a small place like Caerphilly in the south of Wales, they have nothing else to do!!!

Also note that the test for trend between all cause mortality and frequency of orgasm were just marginally statistically significant with p values close to 0.05. In simple terms, it could be by chance that such a result is achieved.

There are more questions than answers. But it is a wonder how the media makes fallacies into facts. It is juicy for sure. Of course sex therapists will promote this.... you know even a dog does not have sex 2 or more times a week!!( I think lah.. just to stress a point for those vets who may be reading)... how many actually achieve this????? not many for sure.... business opportunity for sex therapists,perhaps....

and by the way, not many will say that marriage will be good for health.. ;-)

Our new Health Minister started his job with the utterance of his first agenda. The waiting time. It has long been infamously known that waiting times in hospitals and clinics nationwide are way too long ranging from an hour till 4 hours at some places. His predecessor has worked to alleviate this problem to no avail. The increasing patient load does not commensurate with the workforce in healthcare. Increasing patient expectations does not go in tandem with progress in the healthcare sector. Mind you, the long waiting time is not confined to Government centers but private ones as well although the problem is more acute in public hospitals and clinics.Why? How can our Health Minister tackle this problem?

There are no easy answers but one glaring problem is manpower management. The management of human resource especially in the healthcare sector is appaling. Doctors remain overworked, underpaid and under- appreciated. Top management personnel are not in touch with the ground staff. The different categories of healthcare staff remain fragmented and totally unsynchronised. The bottomline, lack of corporate culture, profesionalism and disiplin of the top management themselves. The very thing that they propagate, they themselves lack.

We need a good management team. We should not harbour those that have proven to be fruitless. We need a total revamp of the system. One example of a poor system is that of hiring foreign doctors. These doctors are paid higher than their Malaysian counterparts. They get to choose where they wish to serve. This despite having similar qualifications and on top of that, poor command of Bahasa Melayu and even English!!! Where on earth are foreigners treated better than locals themselves. We have been suckers all this while to accept such behaviour.

The system in Malaysia is like a funnel... Pour all that water and it comes out through one hole.. Yes... top managers will individually come up with a bright idea of a programme and implementation will be by only a few groundstaff. Top managers do not familiarise themselves with the actual environment that layworkers have to endure. Their occasional meteoric rise is questionable and riddled with suspicion.

What has all this got to do with waiting time? Well , that is the least of our problems. If we want to increase productivity, we need to motivate our healthcare staff. We need a good management that can allocate human resource in needed areas and can identify problematic areas effectively. Then will waiting time decrease accordingly. We can no longer sweep dust under the carpet and assume everything is all and well. Wake up!!!

Along Came Polly (eng)

Classification: 18SX
Genre:
Romantic comedy
Running Time:
1 Hour 30 Minutes
General Release:
25 March 2004
Distributed by:
United International Pictures
Starring:
Ben Stiller
Jennifer Aniston
Philip Seymour Hoffman
Debra Messing
Alec Baldwin
Hank Azaria
Bryan Brown
Director:
John Hamburg
Synopsis:
A man who's afraid of risks (Stiller), but makes a living analysing risks, ends up getting involved in a risky romance (Aniston), cheating on his new wife (Messing), which turns his stable life upside-down.

cinemaonline

Overall a mediocre show. Ben Stiller portrays an all too familiar and monotonous character. The comedy is unimpressive and storyline uninteresting. I would give this show a 5 out of 10! Are there any good shows out there anymore??

Added ICQ functionality to this website for a more instant and interactive experience!

Actually just for the fun of it!!!! :)

FDA Approves Rapid Oral HIV Test By Todd Zwillich WASHINGTON (Reuters Health) Mar 26 - Federal officials on Friday announced the approval of the first rapid oral test for HIV, which can give a result in as fast as 20 minutes. Officials said that the product could help to expand AIDS screening in the US and overseas, where hurdles to testing are thought to severely hinder intervention efforts............... Medscape

This oral Kit tests for antibodies to HIV-1 by scraping the insides of one's mouth. It is said to be 99.3%sensitive and 99.8% specific. This new test will omit the need for pricking one's finger for a blood sample. It may make the test more acceptable as a screening tool. Nevertheless if the test is positive, other blood tests need to be performed to comfirm one's HIV status.

It may be awhile before Malaysia gets its hands on this new kit. The Ministry of Health has an on going anonymous HIV screening programme aimed at encouraging the public, with risk factors, to test themselves. Unfortunately, this programme is still not well received. One possible cause is the reluctance of individuals to have contact with healthcare staff and their distrust with the system at hand. It is often seen especially by intravenous drug addicts as a "trap" set up by the Government. There also appears to be confusion among healthcare workers as to the procedure in the event one has a reactive test.

Indeed , anonymous means anonymous. One can come and go without the need to identify oneself whatever the result may be. It is hoped that by doing this, we can ascertain the severity of this HIV outbreak which is noticebly under-reported. There will be controversial opinions and conflicting ideas in this regard.

But to battle a formidable enemy, we need to size up its strengths in order to execute a successful assault. At this juncture, we appear to have lost some battles but the war is still ongoing and there is little choice but to fight till none is left standing.

At last, to our relief, Datuk Chua Jui Meng is out. We have new faces in the Health Ministry.

Minister: Datuk Dr Chua Soi Lek
Deputy Minister: Datuk Dr Abdul Latiff Ahmad
Parliamentary Secretary: Lee Kah Choon

This is good news. As posted in the MMR, Datuk Dr Chua Soi Lek is a medical doctor. I think this will augur well for healthcare workers. Datuk Chua Jui Meng was thinking too much as a lawyer when he was Health Minister. He even advocated the public to sue their doctors. I think this was unforgivable for a Health Minister. Datuk Chua Jui Meng's latest obsession with traditional medicines was also mysterious and irrational.

As a doctor with the Ministry of Health, I welcome Datuk Dr Chua Soi Lek. Hopefully there will be much progress under your tenureship as Health Minister. It is time that the healthcare workers work hand in hand with the Health Minister after a difficult relationship with your predecessor.

Update : Datuk Dr Chua Soi Lek is a psychiatrist by training!!... That is good isn't it? I think we all need him badly!!

Recently, a family member who is hypertensive went for a follow up visit in a private hospital in Petaling Jaya. At this visit, she was suddenly informed that she is Hepatitis B positive. She was shocked and quite speechless. The doctor then decided on a repeat test. Despite immunisation and the presence of sufficient antibodies, she was infected. She has no known risk factors. When another family member called the doctor, this doctor mentioned that it is quite unlikely to be a mistake.

This caused a lot of mental distress and sleepless nights wondering what went wrong and how to take things from here. Then the repeat result was announced today and the verdict.... a lab mixup! When the doctor was asked how such mix ups could occur? The doctor replied " It happens!!!".

I am very annoyed and angry. I can accept false positive results which do happen from time to time. But i cannot accept a laboratory mixup. It should not have occured. Who says such things only happen in a government hospital? The attitude of the staff in the hospital was that of complacency. It is like "what is the big deal?" kind of attitude.

An apology would suffice. But no, there was none offered. As a doctor myself, i am flabbergasted as to how a doctor could be so inhumane. Does the conferment of a specialist degree equate to an elevated status and thus the ensuing snobbish behavior? This specialist was even unhappy when I provided the same hypertensive medication to this family member for cost-saving purposes. Her attitude was, "if you think you are so smart then go see another doctor" attitude.

Nevertheless, I am relieved that the repeat HbsAg result was favorable.

In the star today,

EC chief takes blame for Selangor confusion BY SIM LEOI LEOI PUTRAJAYA: Election Commission chairman Tan Sri Abdul Rashid Abdul Rahman has accepted responsibility for the fiasco in Selangor on polling day which prevented many from casting their votes. However, he refused to accede to demands by opposition parties, particularly the DAP, Parti Keadilan Nasional and Parti Rakyat Malaysia, that he resign. Abdul Rashid said the confusion came about because changes were made to the format of the electoral roll in Selangor and more than one polling station was set up in 56 polling districts in 16 parliamentary constituencies. ........................

An internal investigation has been ordered by Tan Sri Rashid. Does this equate to "taking the blame"? "Taking the blame" means that something was wrong be it the SPR's fault or otherwise. Tan Sri Rashid has mentioned that he will take responsibility for the fiasco but his subsequent actions do not reflect one that has "taken the blame". An internal investigation as we know it, will hardly be transparent and I can bet you that it will turn out to be nothing. The proper response to " taking the blame " is resigning!. He made a grave error and that deprived many voters of their rights to vote. I agree with the Opposition that due to Tan Sri Rashid's confession at this own accord, he should resign. If not many other politicians will use the term "take the blame" loosely.

For example, Kerk Kim Hock "took the blame" for losing at DAP's stronghold in Kota Melaka. He resigned. This is taking the blame! What if the SPR's investigations proved nothing wrong on the part of SPR?? What is the point of taking the blame?? Something obviously went wrong! What will happen then? Who will then be accountable and ensure that this will not recur!?

The SPR officials are too much like our politicians. All talk and no action. I am deeply disappointed at the conduct of SPR in this fiasco. They are ultimately responsible to ensure the voting process goes on smoothly and should not divert blame to local municipalities. They should have cleared it up before the elections began. Rather I saw Tan Sri Rashid busy with interviews in the media as if he himself was running in the election.

Read this letter sent in by a polling agent published in Malaysiakini which describes disturbing truths about the entire election process!

Looks like a landslide victory for Barisan Nasional. Taking back Kelantan and Terengganu must be a welcomed bonus. This sends a clear message to PAS that its Islamist policies do not go down well with voters. Both its leaders have lost including its president. Proud statements by PAS leaders that DAP is obsolete is laughable. Even "troublesome" areas eg in Perlis and Kedah, was a stroll in the park.

Nevertheless, DAP has performed extremely well as compared to the elections in 1999. They look set to be the main opposition party. All its top leaders have won except for its secretary general Kerk Kim Hock, who was surprisingly beaten in Kota Melaka. But the emergence of Lim Kit Siang and Karpal Singh unscathed is probably the gem for DAP.

A holiday perhaps???

ps... BN failed to recapture Kelantan after the recount. But by a slim margin. Perhaps in the next election!

Like Penang Food? I tried Penang Village in Taman Tun Dr Ismail. Had their Nasi Lemak. Nothing great although the effort of decorating the food was evident. There was also good ambience as well. Probably worth a try!

Penang Village
No 1, Ground Floor, Jalan Rahim Kajai 13 , 60000 Taman Tun Dr. Ismail, Federal Territory
Phone: 03-7722 4288 / 03-7726 0118
Fax: 03-7725 6223 / 03-7726 0119
Email: connie@penangvillage.com.my
Opening Hours: 11.30am to 10.30am
Lunch: 11.30am to 3.00pm
Dinner: 6.00pm to 10.30pm
House Specialties:
1.Ju-Hu Caar, 2.Crispy Tofu, 3.Otak-Otak
4.Kerabu Mango,5.Nyonya Fish, 6.Curry Chicken Kapitan
7.Char Koay Teow, 8.Assam Laksa, 9.Rainbow Ice Kacang
10.Durian Chendol

Halal
Cards Accepted: • Visa • MasterCard

Being a movie buff, watched another movie. Oh man! another long movie.

Synopsis:
In Ron Howard's latest offering, set during classic 1880s Western, Samuel Jones (Tommy Lee Jones) returns to his family after adopting a Native American identity. His daughter Maggie Gilkeson (Cate Blanchett) sends him away but is forced to seek his help when her eldest daughter is kidnapped by a group of Apache warriors.

It starred Tommy Lee Jones ( i still cannot shake the Men In Black image of him!!) and Cate Blanchett. I would not classify it Drama/Western but Suspence/Horror. There were some gory scenes here and some were "snipped off" to my relief!! The story developed slowly thus the 2 over hours long movie!!. I would rate this 6 out of 10.

Have you seen the latest Malaysian-made Ah Lok's Cafe? There is nothing spectacular about this movie where Reggie Lee's cartoon character is brought to life. It is about Ah Lok, played by Leonard Tan (who is by the way quite a good impersonator) who is an avid Elvis fan who owns a cafe. What intrigues me is the twist in the story where his younger daughter , Ai Ling, was diagnosed with a heart condition and could not foot the medical bill.

So Ah Lok had to find ways of paying for the medical fees which requires expensive surgery. Ultimately, he decided to sell his cherished Cafe. This rings an all too familiar tune. How many families out there who had to fork out tonnes of money to pay exorbitant medical fees? Even insurance policies do not cover for recurring medical conditions, eg for cancer relapse. You are pretty much on your own. Even government medical fees, although subsidised, would still be too costly for some. And mind you, the waiting list in Government hospitals will be extremely long. Most heart patients die while on the waiting list!

So, we need some sort of "Medicare-like" programme for Malaysians. Even in a Government subsidised hospital, things are never completely "free". For example, the artificial lens for cataract surgery costs approximately RM$500 which the patient has to pay him/herself. Some segment of society still cannot afford this.

Back to the movie, I found it "draggy" and the sound effects were poor. If it was not a Malaysian movie, I would certainly not recommend it but I think we have to support our local film industry. There are talents, for example Shawn Lee playing Fatt Chye in the movie, is certainly a young talent! Go see it!

It was late evening when i got a call from the clinic that a body has been brought in dead due to an apparent snake bite. Initial findings by the medical assistant is that there were 3 puncture marks on his cheek. Otherwise no other injuries were noted. This was a 56 year old gentleman with no prior history of medical illnesses. The event occured approximately at 6 pm and he was brought in at 9 pm. There was no information regarding the type of snake that it was.

Due to the sudden nature of the death, a post mortem report is requested. Unfortunately the family members refused. The Police officer in attendance, urged me to write the cause of death and settle the issue. I refused as i insisted on a proper post mortem examination in hospital.

This was not the only case. In another, a lady in his 50s was brought in dead due to alleged electrocution. She was previously healthy. I wrote a letter informing the police regarding the circumstances of her death as relayed by her family members. There were no external injuries noted. A burial permit was issued. Later in the afternoon, the police requested for a post mortem report. The body had been released and i could only mention "alleged electrocution" as the cause of death.

The point is, the system in Malaysia leaves much to be desired. There is no flow and even the police can sometimes appear lost. Asking them about procedures will only get a reply that "you are the doctor. you tell me". Knowing such incompetencies and inconsistencies in procedures of determining death, murder could easily be missed.

Even though i am a doctor at a clinic, without clear causes of death, i can only rely on information provided in the history. In an ideal situation, a post mortem (eg a simple blood sample) should be performed by qualified personnel. Even doctors may not be experienced enough to detect foul play.

Calls that post mortem is unIslamic and thus family members refusal for one should not be entertained. If not , it leaves the system vulnerable to abuses. A murderer could easily escape.

Take this scenario. Poison someone with cyanide. He dies. You bring him to a clinic. You say he suddenly died afer complaining of chest pains. Doctor requests post mortem. You refuse. Police request doctor to issue a report so a burial permit can be given. Doctor agrees to write a cause of death (eg acute coronary syndrome). Police issues burial permit. You bring body home and bury. You get good chunk of insurance money. Everybody is happy!

Trust me ... it could probably already have happened with our current system.

links..
how about reading a log of a medical examiner intern. Interesting stuff.

I am quite surprised as to the blogging boom that has been happening among Malaysians and in particular medical students. Every corner you turn is a site just waiting to be explored. These blogs are diverse in topics and some are just downright hilarious. They are all fun to read with scenarios that in normal circumstances would not have been shared with another person. In the masquerade of a pseudonym, many find the courage to share their innermost thoughts unreservingly.

There are many professions that indulge in this habit of blogging, from teachers to lawyers. Some display impeccable English while others resort to our infamous Manglish. But the aim is ultimately to get readers to read your masterpieces. It is this growing reader base that inspires a writer or blogger to continue writing.

Making new friends and entering new and unfamiliar boundaries of cyberspace is inevitable in blogging. It is a growing community in this world that recognises no borders. Scepticism still remains high, though, to the lingering hostility and evil that anonymity attracts.

i can forsee a great future for blogging. It presents many , including myself, with an avenue to speak one's mind without fear of censorship and retribution. Just like the blogging boom in Iran, blogging in Malaysia acts as a release-valve for many and is thus here to stay.

Happy blogging.

ps. Now blogging in the MMR website as well

This year the postal war appears more subdued. You get a sense that most parties are facing financial constraints. The opposition seems to be more affected as compared to Barisan Nasional. The posters by the opposition appears old and worn out. And in areas where their flags come up, a wave of BN flags and posters would overwhelm and engulf them in return. There is less excitement when public "ceramahs" are not allowed. There is no more voice for the opposition. They appear defeated. They appear lost. The battle seems over before it has even begun. There is little hope.

As the local media publishes Barisan's fool-proof manifesto, the opposition's manifesto is fragmented and hazy. There is no direction. Even DAP is lost. Heavyweights like Karpal Singh is uncertain as to where to pick his fights. He is desperate and lacks confidence to spar with even Chew Mei Fun, a comparative novice, in PJ Utara. Lim Kit Siang, lost in political wilderness, decides on a new battleground. Can he prevail? There is little hope with DAP.

Pas the only opposition that could realistically challenge. Kelantan belongs to them. Terengganu is almost their. Kedah could fall. They appear to be a formidable foe. But they do not offer much to non-Muslims. They shift ground way too often and are clueless as to what constitutes a multiracial society. Despite a relative calm in Kelantan all this while, the Chinese population there is small and unthreatening. How would they deal with a larger non-muslim population. Would their brand of Islamic state be acceptable? The clear answer is NO. Pas would be a difficult option for non-Muslims.

Keadilan is no better. Its president has problems voicing her opinions and appear amatuerish in politics. Tian Chua appears more interesting in picking fights than proposing a solid agenda. Their beacon of light, Anwar, is still languishing in prison. They appear to be mere PAS puppets. No Keadilan would ruin this country if their leaders were allowed to rule.

BN is still a corrupt conglomerate. They lack transparency and are often hypocritical. Its leader, AAB, still appears inept at handling corruption. The judiciary remains subtlely under its control despite their vehement denials. They have much to answer but chooses to remain silent. They are autocratic rulers in disguise.

So which party should one choose? A difficult choice indeed. Perhaps it boils down to choosing the lesser of two evils!

Seeing our badminton doubles players, Choong Tan Fook and Lee Wan Wah, crashing to the ground from pole position was heart breaking. All it took was a bad call from the umpire to allow a service when Wan Wah was signalling his unreadiness to receive. It was indeed part and parcel of a game. After all the experience they have had and millions spent on their training, I would have expected more composure. This was an amateurish reaction that does not depict a world class athlete.

Perhaps what is lacking is proper training in Sports Psychology. Western sporting bodies invest lots of money on strengthening mental toughness and puts equal emphasis on it. Techniques are further employed to frustrate an opponent effectively negating whatever technical superiority the opponent may (or may not) possess. This is an important element in achieving sporting excellence.

We have seen time and time again how feeble minded our Malaysian athletes are. They succumb too easily to mental pressure and frustration. They appear not to handle the pressure well in the most dire of circumstances. They may have the skill and physical advantage but their lack in mental superiority makes them weak and vulnerable. I still remember Kwan Yoke Meng playing 3rd singles in the Thomas CUp final in KL against Ardy Wiranata of Indonesia. He had the Indonesian at his mercy but sly and psychological play broke Kwan and he eventually lost. We know the Indonesian badminton players are famous for that.

So it appears what we need is a more structured and effective training in Psychology. I think this has been our Archilles tendon in sports, leading to failure after failure to excel.

Mind Tools : Sports Psychology
Athletic Insight
Sports Psychology Resources

Violence in Teen-Rated Video Games Conclusions: Content analysis suggests a significant amount of violence, injury, and death in T-rated video games. Given the large amount of violence involving guns and knives, the relative lack of blood suggests that many T-rated video games do not realistically portray the consequences of violence. Physicians and parents should appreciate that T-rated video games may be a source of exposure to violence and some unexpected content for children and adolescents, and that the majority of T-rated video games provide incentives to the players to commit simulated acts of violence.

This was an interesting study posted by Medscape. T-rated video games are games for Teens. And violence was certainly prevalent with rewards for number of "kills" made. But the question is " Does violence in games actually lead to increased violence in the real world?"

In the same vein, the accessibility of pornography through the internet and pirated VCDs have certainly been blamed on the rising sexual crimes in Malaysia. We cannot win the war on pornography through the internet, but we can safeguard our children through screening viewing materials before allowing our children to go online. Cybercafes should also be monitored closely by the relevant authorities. Internet service providers can also do their bid by barring access to known pornographic sites or at least have an age verification process before entering these sites.

So the war on internet thugs (including spammers) has begun. It still appears that the dark forces are gaining momentum. Is Malaysia well equipped for this war? What would be the most ideal strategy? The internet is a great tool but like all great tools they are always vulnerable to exploitation by unscrupulous, self serving and unconscientiousness individuals! "God help us all"

Journeyed to One Utama. Was wise enough to start early and beat the crowd. This place can be jam packed with people.

Decided to dine at Fish & co, with their theme "Seafood in a Pan". Chose their "Fish & Chips", purportedly the best in town. Service was good. Decoration was mediocre. Indeed they served their food in a pan!. But their fish & chips was certainly not the best that i have tasted. Pricing was satisfactory with their fish & chips about $15. In actual fact, I prefered the fish & chips served by The Fish Shop. To date, the best fish and chips ever served is at Backofen Bakery in Sri Hartamas. They do not have it all the time but the fish is just brilliantly tasteful!


Then decided on a movie "Hidalgo". It was a surprisingly long, loong, loooong movie. It is based on a true story about a long distance race horse named "Hidalgo" who decided to enter a race of survival, Ocean of Fire somewhere in Arabia. Its rider Frank Hopkins was a dispatch rider for the army and he had Sioux blood. It was boring and melancholic. Its storyline was predictable and shallow. The horse stole the show actually, a mustang! I would not recommend it and give it a 5 out of 10

Smoking for health

We know that there is an active campaign against smoking. Millions of ringgit has been and will be spent to fight this widespread addiction. This is where the irony begins.

I was going for my breakfast when I approached a stall with a group of people wearing 'KESIHATAN' jackets. They were having breakfast. As i was digging into my nasi lemak, I smelt pungent cigarette smoke. Guess who? All the guys wearing the 'KESIHATAN' jackets were smoking away!! What kind of message will this send? Are they not ashamed to wear the jacket?

This typifies the lackadaisical attitude of health staff in partcular those from the Ministry of Health! This is also probably the reason why implementation of health programmes are less than satisfactory. Ideas from the Director General of Health is not translated into action by the ground staff!

So it appears that the money spent on the 'Tak Nak' campaign is probably going down the drain. Another misadventure for the Government, unfortunately.

SALT LAKE CITY, Utah (AP) -- A pregnant woman who allegedly ignored medical warnings to have a Caesarean section to save her twins was charged Thursday with murder after one of the babies was stillborn. Prosecutors said Melissa Ann Rowland, 28, didn't want the scars that accompany the surgery.

This should serve as a lesson to those that ignore medical advice. I have had many antenatal mothers that refuse intervention at the baby's peril. Most are influenced by their ignorant fathers as well. There has to be a law in Malaysia that allows doctors to intervene against the wishes of the parents. Even religion may sometimes have to take a back seat when it comes to saving a life. I am sure there are many doctors out there with experiences with stubborn parents, even some blogs have elaborated on ridiculous beliefs and superstitions.

Ezetimibe has been touted as a new cholesterol drug in a recent article in The Star. It acts by inhibiting specifically the absorption of cholesterol from the gut and is of particular benefit to patients with familial hypercholesterolemia, a condition that results from the lack of LDL (bad cholesterol) receptors in the body. Its efficacy is said to be better if combined with a statin drug (statins inhibit the production of cholesterol in the body). It can also be useful in patients that are unable to take statin drugs.

Statin drugs has been linked to drug induced hepatitis and rhabdomyolysis (breakdown of muscle tissue). Despite the fact that these side effects are said to be rare, I actually to see a considerable number of cases with rhabdomyolysis. The drug will then have to be stopped. The alternative at this moment will be fibrates which is less effective for cholesterol lowering, and bile acid sequestrants which is associated with considerable gastrointestinal side effects.

SO the arrival of Ezetimibe may offer patients intolerable to statins, an alternative. Perhaps we could lower the dose of statins when Ezetimibe is given. Preliminary studies have shown a good safety profile with no side effects or drug interactions. There has been no reported increase in incidence of rhabdomyolysis and hepatitis when used with a statin drug. HOwever, patients with liver disease should not take this drug.

Tried looking up the drug on the BPFK(Badan Pengawalan Farmaseutikal Kebangsaan) website but it appears their server is down.. Will try again later and update this information.

UPDATE : Ezcetimibe is registered under the name Ezetrol by Merck, Sharpe, Dohme and so is available in Malaysia.

British Heart Foundation
DiabeteSuffolk
Lipids Online

The internet has been growing at a very rapid rate. The information that can be obtained from it is enormous. Its arrival has made libraries obsolete and unnecessary. The internet has grown from just simple static webpages to interactive and service providing sites. In certain countries, you can get even your groceries online!

Legal services have now jumped onto the bandwagon. From a recent article in The Star, foreign law firms are forming internet sites to provide legal services to the public including Malaysians. This provides competition to our local law firms. Globalisation is the term where borders no longer offer protection against foreign forces. Could medicine be heading in the same direction?

Probably yes, and we Malaysians must progress fast enough. The utilisation of the internet among Malaysians even doctors is still comparatively low. Our education system is not going with the times and lack foresight in planning. Even the boasting of paperless hospitals in Malaysia is a mere illusion. Are we promoting the use of the internet among our medical students? Are we encouraging the use of technology in hospital wards? Most hospitals and government institutions cannot even maintain a decent website! As even countries like India are moving towards tele-consultations, Malaysia lags humiliatingly behind. Most in Malaysia still do not yet see the potential benefits of the internet.

Medicine is definitely becoming increasingly technology dependant. From information gathering to communication, the internet is becoming the main tool. In the future, wars could be fought and won in cyberspace. We must prepare and equip our future generations including doctors for this eventuality. We should progress further, not just setting up of webpages and online forums. We need more interactive, service providing sites. We need innovation and ideas. We need commitment in computerisation from online medical records to patient management. We need better cyberlaws.

There is much work to do. We need to spark a revolution. A revolution that brings Silicon Valley (forget about MSC) to our doorsteps. It is a dream requiring a collective mindset and determination. It entails exploration and experimentation. It involves more failures than successes. But this is how the future is created.

Teaching anatomy has seen some changes in many medical schools since this past decade. It used to be sessions spent with cadavers and medical students having to slice them up. Now anatomy is much cleaner. Models take the place of cadavers where structures are beautifully outlined. Conservative anatomy lecturers would scorn at this new concept mentioning that plastic models looks anything but the real thing. "New Age" lecturers will say that teaching only the essentials will suffice for doctors. With an ever expanding syllabus, "new age" lecturers may have a valid point. Cadavers are the real thing but looks(and feels) nothing like a living body! Many medical schools are now teaching clinical anatomy, ie anatomy that relates to everyday clinical practice (living bodies that is!). The old days of learning every nook and crany of the human body is becoming obsolete. Most would forget them after the 3rd year anyway. But would this make new medical graduates weaker in the field of anatomy?

Cadavers are also becoming a scarce resource. Not many people are willing to donate their bodies for science these days. More so with increasing cases of cadaver mismanagement like the recent case in UCLA. Are these bodies eventually going to be given a respectable burial? What happens to them? No one really knows. This problem appears more acute in Malaysia, where most families will even refuse a post mortem, let alone manipulation by medical students. The emergence of unknown viruses has also indirectly given cadavers less appeal.

However, models are surprising extremely expensive unlike their cadaveric counterparts. It is also less exciting. Some medical students thrive on scalpels and raw flesh! THis leaves no room for the faint hearted and those who are compulsively clean. Models are like still photographs while cadavers resemble moving pictures. Or perhaps Netter's Atlas of Anatomy will suffice!

There is little doubt that cadaver-based teaching is losing support. But are we going in the right direction? Perhaps in this computerised era, there is little need for a cadaver or a plastic model. Virtual reality could fill future classrooms where medical students can perform surgeries on live patients! Anatomy would be so much fun then, seeing beating hearts as we learn the layers that surround this ticker. hmmm..

Perhaps being an anatomy lecturer would be more fun and appealing in future. But in the meantime, plastic models rule as cadavers relinquish their throne.

Mona Lisa Smile: Another Julia Roberts masterpiece

This is a must see movie. It is set in the 1950's where a teacher, played by Julia Roberts took a challenging position as an Arts History teacher in an all-girls Wellesley College! Here she attempts to change a very conservative mindset of the students and faculty regarding the role of women. At the same time, she struggles with her own relationships. The message ; women can have a successful career in tandem with a good family life!

This movie touches on a lot of central issues pertinent in today's world! i would give this movie an 8 out of 10.

Cancer has always been a dreaded word. It strikes fear in the hearts of many and reminding us of our own mortality. People believe incorrectly that they will never get it. This perpetual denial often leads to a delay in seeking treatment. This often has catastrophic results.

Having a close family member or friend with cancer can be a very trying time. Conversations can be eerily jovial with fearful undertones. Seeing a drastic change in appearance due to chemotherapy can also be just too much for some. This is a time that families close ranks giving strength to the afflicted.

Personal experiences has thought me much. Being a doctor has no added advantage when we ourselves are on the other end of the conversation. Even if the message is for your family member, the fear and uncertainty of receiving the bad news is evidently felt. Thoughts of losing someone that has been such a towering figure is ... just unthinkable. The dreaded word 'chemo' surfaced and i could still remember the fear. But humankind has been blessed with hidden mysterious inner strengths. Guardian angels some say. Perhaps.

It has now been 2 years after chemo. Gratefully, our dear family member is still with us and in remission. We laugh and joke as we try to forget that dark chapter. But deep down, we live in fear that an active volcano will one day erupt. We can only pray.

National Cancer Society of Malaysia
Hospis Malaysia

My delve into opthalmology resulted as I lay on the couch watching one of my favourite shows, Call for Help. During one of the intermissions, "Medical Minutes" popped up where they featured a patient who lost his eyesight when he was 3 due to some chemical accident. His eyesight was partially restored by stem cell transplantation. I jumped up and started doing some research on the internet.

The technique is limbal stem cell transplant. The limbus is the area where your cornea meets with the sclera (the white part of your eye). It is in this area that stem cells reside and eventually grow into mature corneal cells. In many corneal conditions, these stem cells are destroyed thus distorting the anatomy and physiology of the cornea resulting in a hazy cornea and the resulting blindness. Among such conditions are ocular surface malignancy, chemical burns and ocular surface destruction eg by autoimmune conditions (SJS and ocular cicatricial pemphigoid).

By replacing these limbal stem cells, the surface of the cornea will eventually be repopulated by normal corneal cells. This improves vision. Unlike corneal transplant, homologous limbal stem cell transplant require life long immunosuppression with cyclosporin. However, if the other eye is intact, an autologous transplant can be performed negating the need for immunosuppressive therapy. Corneal transplant can also be performed after a limbal transplant but initial studies show that it is inferior to limbal transplant alone.

Limbal stem cell transplant has also been shown superior as compared to conventional treatment for recurrent pterygium. The recurrence rate is much lower (2.9% vs 19.4%) in favour of limbal stem cell transplant.

EyeNet
HealthLink : The University Hospital
Medscape (The Cornea : New Biologic Research)

Making sense of it all

Election time is here at last. Went around PJ but still found no evidence of postal wars. Maybe the next day perhaps. We are left with 2 weeks to decide the future of our country. This is a short time indeed. Worse still, public rallies are disallowed. There are so many issues at stake and time is needed to hear out the candidates and thus decide accordingly.

Why, i asked, has the government not allowed a longer period of campaigning? Fear of unrest was one factor that i frequently hear. Unrest? Is this nation so fragile? The fear now is more towards religious fanatism rather than racial differences.

PAS has become a real threat to UMNO's supremacy. PAS has employed a formidable tactic to woo its supporters. The use of religion has always been successful in drawing support. How can we turn our backs on God? Does anyone dare challenge our clergymen? Perhaps we need a rule that separates state from religion like some states in US. As no one should challenge a religion, fanatism and extremism needs strong condemnation. But is PAS a fanatical extremist party? UMNO would certainly like us to believe so. However, my visits to Kelantan has been quite the contrary. My chinese friends have no problems with their daily lives and i was even brought to a pork selling market right in the middle of Kota Baru. Even i had not known as well that it is in kelantan that lies the biggest sleeping Buddha in South East Asia! Church services are never obstructed as well! Religious tolerance is evident and a pleasant surprise.

Politics has never been my forte and my arguments that PAS may not be all that bad has drawn criticism even from my family! Does arguing in PAS' favour equate suppoting this Islamist party? I say NO. We just need to be a little open minded to arguments and look things in a broader perspective. We need to weigh the pros and cons not just gobble up the pros of the ruling goverment that has been consistently fed to us through undeniably tight media control. News portal like Malaysiakini has been a welcomed addition to our daily news digest.

March 21 is the day of polling. Let us make good informed decisions. Hear both sides of the story, then decide.

Ultrasound has become a common investigative tool for doctors. One of the main uses of an ultrasound is in the field of obstetrics. Ultrasound has in some cases become a routine practise in antenatal clinics. And doctors, including myself, believe that ultrasound remains safe for use in antenatal care. But its safety has now come under scrutiny with many groups calling for more research into long term effects on the fetus. What seemed perfectly safe many years ago is now deemed potentially hazardous. So the recommendation now is to avoid unnecessary exposure and performed only when clinically indicated.

Ultrasound uses high-pitched sound waves inaudible to humans. These sound waves are then reflected back to the transducer which then produces a digital image. Some believe that the frequency of these sound waves can damage certain organs in the fetus. Some studies suggest possible intrauterine growth retardation while others suggest a possible link with impaired or delayed speech development. The radiologymalaysia.org website also suggested possible thermal and local mechanical effects attributable to ultrasound use.

No doubt the advent of the ultrasound has not improved the rates of maternal and perinatal mortality. But its clinical usefulness has never been in doubt. From dating a baby to assessing fetal growth, ultrasound has proved tremendously useful. As antenatal care moves toward prenatal diagnosis of illnesses, the role of ultrasound could possibly expand.

But the central question is "Is ultrasound safe?" After more than 25 years of clinical use, ultrasound has not been concretely linked to any abnormalities to date. Majority undergo this investigation without much fuss both to the mother and the baby. However, due to the growing concern on its safety and the paucity of research on its long term safety profile , the recommendation is to perform an ultrasound only when indicated and to minimise the duration of exposure to the fetus. Common GP practise of determining the sex of the baby has been deemed inappropriate and unethical!

Dangers of prenatal ultrasound
Radiology Malaysia : Routine ultrasound scan during pregnancy?

Recycling has always been advocated by the Government and many non governmental organisations. It is a good way to preserve the Earth's resourses. Almost all things can be recycled in one way or the other. Despite calls to recycle, the response has been mute. Costly advertisements on recycling had not achieved its desired effect and thus our garbage dumps are nearing its capacity. Why has this awareness failed to take root in Malaysian society? Do we not love our environment?

The path to recycling awareness has been hampered by all levels of society from the average citizen to top government agencies. Take the Election Commision for example. Now they are using disposable booths when its metal counterparts could still be used. They should have mentioned or used recyclable booths! More trees need to be felled and we are not even sure if these booths can or are going to be recycled.

Even average citizens are not doing their part. They can't even keep the cleanliness of their environment. How then do you expect them to recycle?

Recycling bins are also inadequate and not strategically located. They are hard to find. It would be ideal if each household could separate their garbage into separate containers for recycling purposes before collection. Perhaps our garbage disposal companies can take the lead.

Some countries provide cash incentives for the return of recyclable goods. For example, the old newspaper collector that gives cash in return. It has been the only purple patch of our recycling endeavours. Perhaps we could extend this concept to other recyclable goods as well.

We need to protect the environment and recycling is important. Just like what was recently being said in TV advertisements, we need to put to practise what we preach!

Kitar Semula

17 new lines of human embryonic stem cell lines were discovered recently. Embryonic stem cells are precursor cells found in human embryos and they have the ability to become any type of cell in a human body. In this new field of regenerative medicine, there is great hope that these stem cells will one day cure diseases like diabetes and Parkinsons Disease. Nevertheless , research in embryonic stem cells are fraught with ethical dilemmas.

For one, stem cells can only be derived from human embryos. Researchers now use embryos from abortion clinics. Their argument is that it is going to be discarded anyway. Anti abortion activists are of course against it ,so are most religious groups. So we are left with a decision of whether to support science or religion. Personally, i see stem cells as a probable solution to many illnesses that plaque mankind. It is only my hope that one day these stem cells could be reproduced synthetically without the sacrifises of human embryos. Hmm.. by cloning perhaps? Another area of quicksand!

Would you support embryonic stem cell research?

Stem Cell News
Stem Cell Basics - basic information on stem cells! Good read!

Today was indeed one of those days.

I was seeing a patient when the lenses detached from the spectacle frame. It appears a screw popped loose and was nowhere to be found. I am pretty close to useless without the glasses on. There was no spare glasses. Miraculously though after a brief episode of hysteria, the screw miraculously showed up on the table and i was able to fix it right in front of the now bemused patient.

Then when i was driving out to get some lunch, a loud pop and some mysterious hiss sound decided to appear. I pulled over only to note that i had a rear flat tyre. As i struggled to get the tyre fixed, i was thinking as my sweat dripped profusely from my face, it is times like this that i wished i was a woman. Just look pretty and i bet you someone will stop and help. As my tender hands finally finished the job, i was suddenly filled with a sense of pride. Sure i had changed tyres before, but this was different. I did it in record time!

No offence to women but it is just that i feel really grumpy. Amazingly, there was no utterance of vulgarity. But it was certainly "one of those days"!

After 7 years of follow up, the estrogen alone arm of the WHI study was stopped. The preliminary conclusion is that estrogen only replacement offers no additional benefits to women in terms of cardiovascular protection, increases the risk of stroke, decreases hip fractures and no increase in breast cancer. This follows the halting of the estrogen plus progestin replacement arm in 2002, when the risk of stroke , heart disease and breast cancer was increased in patients taking the estrogen plus progestin pills.

So the current recomendations to physicians are that Hormonal replacement should not be given to women for cardiovascular protection.

Current Labeling: Indications and Usage

1. Treatment of moderate to severe vasomotor symptoms associated with the menopause.

2. Treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with the menopause. When prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered.

3. Prevention of postmenopausal osteoporosis. When prescribing solely for the prevention of postmenopausal osteoporosis, therapy should only be considered for women at significant risk of osteoporosis and non-estrogen medications should be carefully considered.

So the era of glory for hormonal replacement therapy has really ended. It was once widely prescribed to postmenopausal women and touted as a wonder drug for menopausal women. Now it appears that less and less physicians will be using it. What's next?

Women's Health Initiative
National Heart Lung and Blood Institute -WHI

Children with special needs covers a variety of disabilties from severe intellectual and physical impairments to delayed developmental milestones. These children need special attention and care. Parents plays the pivotal role in their care. Nevertheless most parents are ill-equipped and require the guidance and emotional support. Some may even require financial assistance to care for these children.

It came to my attention recently that the current educational system in Malaysia do not accomodate students with special needs. A parent came with complaints that her child was asked to go home as the teachers in the school had enough students and cannot cope with this child. There was no offer of any assistance or providing an alternative. Teachers remain ignorant and at times aloof when it comes to such cases.

I find it unacceptable that a government funded school is unable to handle such a case appropriately. Even if the school is not equipped to handle children with special needs, there should have been an alternative option provided. As our nation builds more and more schools, it has unfortunately left a bunch of special children in its wake. Current centres are inadequate and working on maximum cylinders. Most depend on voluntary services as well.

The Ministry of Education has a special unit , Jabatan Pendidikan Khas to handle such issues. A check on their website showed an out of date telephone number but beautifully written objectives and functions. It appears to be one of the few portions of the website that was not updated. Is our Ministry of Education putting enough emphasis on educating our children with special needs? Sadly it appears that this group has been long forgotten.

Jabatan Pendidikan Khas,Ministry of Education

Incestual rape and incest offenders are becoming more common. It is currently hoped that stricter laws can be imposed on such criminals. An amendment to the Criminal Procedure Code allow punishment from a minimum of 15 to 30 years jail and a minimum of 10 strokes of the rotan. Criminals above 50 previously spared under this Code are now eligible to be whipped after a medical approval from a medical officer. However, if there is an element of consent, then the sentence is usually reduced.

We live in a male-dominated society in Malaysia. Many offenders do get away scot free due to intimidation and feelings of guilt of the victim. Many family members especially wives protect their husbands, even if they knew such offences have been commited on their own children. Some even fault their children. As many women still fear their man in this society, many cases go unreported.

We need to remove these barriers. We need to educate women and children alike. We need to educate our chauvinistic males as well. All these to protect our children from sexual predators. We need to empower our women. We need a ready and easily available place to report such crimes. We need good counsellors. In short, we need change.

A change in current mindset on sexual dominance, a change in the laws of the land, a change in the attitude of the public, a change to the health support system and its staff and a change in mentality of our women.

Information is still scarce. Hotline numbers are not prominently displayed. Cases are still fraught with bureaucratic processes and a police force that is poorly trained and ill-equiped to handle such cases with delicate care.

Prosecuting offenders is essential but so is the continuing support of the victims. Damage continues even after the case has long been closed. Such victims usually suffer silently and are prone to mental disorders for example clinical depression, post traumatic stress disorder, sexual disorders etc. Do we provide such support to victims?

My search of the internet did not result in any find for malaysian websites. None in bahasa malaysia for sure. Newspapers are not much use either as information is scarce and more politically motivated. Why? We are suppose to be at the forefront of information technology with the MSC. Unfortunately , it remains an illusion.

Rape, abuse and incest national network
Survivors of Incest Anonymous, World Service Office Inc.
VOICES (Victims of Incest Can Emerge Survivors)
Domestic violence and incest resource center
Abuse/Incest Support (about.com)