Monthly Archives: January, 2009

A Healthy Dose of News

Visitors to Washington DC now have an added attraction to look forward to – the Newseum.  Located on historic Pennsylvania Avenue, the newly-opened (April 2008)  news museum offers an experience that blends five centuries of news history with up-to-the-second technology and hands-on exhibits.

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The Facade of Newseum, featuring a 74-foot high marble engraving of the US First Amendment( partly seen on the left)

Among favorite exhibits are:

  • The Pulitzer Prize Photographs Gallery, a comprehensive collection of prize-winning photographs,
  • The News Corp. News History Gallery, where 500 years of newspaper front pages create a timeline in history,
  • The Berlin Wall Gallery, where visitors can stand beneath eight 12-foot-tall concrete sections of the original wall and a three-story guard tower.
  • The museum has the mission of providing a forum where the media and the public can gain a better understanding of each other.Maybe, the dose of the same medicine can be prescribed to other countries as well?

    The Worst Food in America – Healthwise

    Passing through some of the bigger cities in the US, one cannot help noticing the number of grossly obese urbanites, so it was quite interesting watching what they consume in restaurants and eateries.

    Most of the food-chains are recognised worldwide and the items similar except the portions larger with liberal amounts of fats,oil and creams added on, thus ballooning up the calories consumed. It seems that the US fast-food industry has declared war on expanding the waistlines – the weapons of mass inflation!

    My vote for the most lethal weapon goes to:

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    Outback Steakhouse - Aussie Cheese Fries with Ranch Dressing

    Take a look at what it contains, according to Men’s Health :

    2,900 calories
    182 g fat
    240 g carbs

    Assuming you’re an adult male that requires 2,500 calories daily, having this dish alone would have given you your daily calorie requirements already, not to mention loads of cholesterol!

    Another Battle At Our Doorsteps..Literally

    Now that there’s a temporary reprieve  in Gaza, our attention should shift to a series of attacks by various viruses  in the Far East. In China, a potential outbreak (again!) of bird-flu is in the making with the death of a 27 year-old woman in China. Caused by the H5N1 virus, the last outbreak was in Asia in 2003 where  247 died. Find out more about the avian influenza virus( the proper name).

    A little-known virus, Chikungunya (pronounced chikoon-goon-nya) has already made its entrance with Malaysia reporting 100 cases per week instead of the usual 100 cases per year. This disease is usually confused with dengue as they have similar presentations, although it follows a more benign course. Read more about it in my recent posting “This Thing called Chikungunya”.

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    Of immediate concern is the recent outbreak of dengue fever(pronounced den-gie), where the incidence has doubled in recent months in tropical and subtropical areas. In Malaysia, 8 deaths have been reported this month alone. Here’s a good write-up about dengue but I would like to highlight a few pointers:

    1. While the typical symptoms are high fever with chills, rashes, headaches and severe bodyaches in the absence of a runny nose, the latest outbreak has produced unusual symptoms like fits, yellowing of the eyes (jaundice) and kidney failure, all of which require treatment in hospital.
    2. Both Chikungunya and Dengue viruses are carried by the same mosquitoes called Aedes Aegypti. They are the ones with black-and-white stripes on their bodies.  Don’t ask me why, but the females are the culprits and they have adapted themselves so that they don’t fly in your face or make a loud humming sound, preferring to come in low and bite in the ankles. These mosquitoes are attracted to perfume and dark clothing, so party animals, beware!

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      Aedes aegypti: only the females bite

    3. Because the Aedes mosquito cannot travel far, it is generally accepted that the breeding ground is within the same compound or area, so one should get rid of pools of stagnant water which can collect in empty bottles, cans and plastic wrapping.
    4. You can confirm whether a fever is due to dengue via blood tests although they are not always accurate. Sometimes it is necessary to repeat the tests several times before they become positive. Nevertheless, diminishing numbers of a component of blood cells called platelets is suggestive of dengue.
    5. There is no treatment that can cure dengue. Like in most viruses, its up to one’s body resistance; and this can be enhanced by rest, adequate fluids and measures to reduce the fever.

    At the end of the day, prevention is the mainstay. The way not to get dengue is to eliminate the Aedes mosquito if thats at all possible; failing which, to prevent the insect from biting you and passing you the virus..

    Health Questions Too Embarrassing To Ask

    This morning I had to see a male patient who had been put on cholesterol-lowering medications. After the mandatory checks were over, he seemed reluctant to leave and appeared to have a question over his head. After some coaxing, he admitted to having impotence after commencing the medications.

    This problem was easily sorted out, but it got me thinking …were there other ailments that people wanted to ask their doctors but were too shy to ask?  A look on  AOL Search yielded the answers:

    Top Searched Embarrassing Health Concerns on AOL Search:
    1. Herpes
    2. Irritable Bowel Syndrome (IBS)
    3. Yeast Infection
    4. Psoriasis
    5. Urinary Tract Infection
    6. Genital Warts
    7. Hemorrhoids
    8. Impotence
    9. Hyperhidrosis
    10. Incontinence

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    Herpes Simplex Tops the List of Embarrassing Ailments -To Ask or Not to Ask?

    Why, impotence wasn’t even in the top 5! I guess its hard bringing up health issues which are deemed private with a relative stranger on issues that make one blush just thinking of them. But the doctor is a trained professional and if you’re comfortable with yours, by all means bring it up. They’ve probably seen scores of patients with similar problems as yours anyway!


    One Brain, Two Hands, Three Choices

    You are driving down the highway and the mobile handset rings. There’s one of three things you can do..ignore the call (the safest bet), answer the phone with one hand (thereby committing an offence) or put the phone on hands-free (the legally correct way).

    But the problem is, even on hands-free, there’s only one brain processing the information; and for the brain to multitask two active actions simultaneously is very much like clapping with one hand – impossible. Its not that your hands are not on the wheel, its that your mind is not on the road.

    There are several factors why cell-phone use is risky.A study by the  Applied Cognition Laboratory at the University of Utah showed that phone conversations appear to take a significant toll on attention and visual processing skills of the brain, very like using most of a computer’s CPU power, leaving very little resources left for other tasks, causing  a slowdown in the processing of images seen by the eyes and delayed reaction times.

    It may  also be that talking on the phone generates mental images that conflict with the spatial processing needed for safe driving. Eye-tracking studies show that while drivers continually look side to side, cellphone users tend to stare straight ahead.

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    The End of Hands-Free Calls Soon?

    Whatever it is, the National Safety Council in the USA are convinced that drivers talking on a cellphone are four times as likely to have an accident as drivers who are not – they have now  called for an all-out ban on using cellphones while driving, including hands-free. And if  you think their chances are slim, its worth remembering that they were the prime movers behind the seat-belt laws and drink driving awareness, both of which are now standard rules of the road.

    If their recommendations are adopted, there’s a real possibility that the rest of the world will follow and you can then stop wondering why the car in front is moving too slow despite a clear road ahead.

    Health Alert(7) : This Thing Called Chikungunya

    This is not a take-off from Abba or the name of a Japanese fruit(!), but is the latest in a series of diseases caused by a virus and spread by mosquitoes. While most of us were distracted by events of the world, this disease has steadily made its impact, not only in tropical regions but also in far-flung countries like Italy. In Malaysia alone, in 2008, more than 3700 cases have occurred. It used to have an incidence of 100 cases per year but this has now risen to 100  cases per week. Strangely enough, mainstream media has been deafeningly quiet and the health authorities have not done enough to educate the public on this relatively unknown condition.

    Chikungunya (pronounced chi-koon-goo-nya) is but the latest in a long line of diseases carried by mosquitoes, which include Malaria, Dengue Fever, Yellow Fever, Japanese Encephalitis, and the West Nile Encephalitis and causing 1 million deaths worldwide.

    chikungunya

    The disease  causes an illness with symptoms similar to dengue fever. CHIKV manifests itself initially with fever, rashes, bodyaches,headaches and lethargy which lasts only two to five days, followed by a prolonged period of joint pains. The pain associated with Chikungunya infection of the joints persists for weeks or months and can be confused for severe forms of arthritis.

    Morbidity is high but mortality low…in other words, while people can get sick for weeks, they will invariably recover; and death is very rare. The latter could very well be the cause of why there appears to be some complacency in promoting health prevention. One needs to note, however, that with the mobility of people nowadays, this disease is no longer confined to the tropics but has been known to occur in Italy,UK and the USA.

    Read more about this disease here and here.

    Hospitals – Hazardous to Your Health?

    For most, hospitals are seen as a refuge where the sick may get well. At least, that is the intention of all parties. But there may be more to it, despite the best intentions of everyone to achieve a good end-result. I highlighted earlier in a post on “Highlighting Hospital Hazards for Patients” that complications can occur even in the best medical centres.

    Such complications include infection by super-bugs, bleeding (particularly in those taking certain herbal supplements, see here) and perhaps the most dreaded of all, medical errors.

    While human causes of errors are being actively addressed by management of most hospitals by adopting various quality assurance programs like the ISO standards and ISQUA,  the high reliance on machines and technology by themselves  create a new set of problems.

    The ECRI Institute, the body that researches on patient safety issues and came to the forefront with the Y2K issue at the turn of the century, recently issued the top ten hazards due to technology and devices which occur in hospitals.

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    New on the list are air embolisms (bubbles of trapped air which travel to the lungs) from the contrast-media injectors used to inject dye into patients for X-ray imaging of blood vessels. Though there are safety features on the injectors to reduce the risk, they aren’t foolproof, and errors can be fatal.

    Also new on the list is retained surgical devices — such as a sponge or clamp left in a patient — and “unretrieved fragments,” like a piece of a surgical tool that breaks off and either isn’t noticed by the surgical team or is lodged in a part of the anatomy too risky to attempt retrieval.

    Though burns during electrosurgery dropped off the list from 2007, burns from another source made the top 10: the fiber-optic lights used on endoscopes and headlamps to illuminate treatment sites.

    Also new on the list: serious problems with anesthesia equipment just before it is to be used on a patient (or after it is too late), including misconnected breathing circuits and ventilator leaks.

    Finally, misleading displays on medical devices — such as infusion pumps with confusing displays — can mislead clinicians into making serious errors, like misprogramming medication doses.

    For The Health of All..Watch the New Media

    So sanity has prevailed. I’m referring to the previous blog entry on the Malaysian blooper of the year award. News just received has indicated that the public company concerned had dropped its plans ” based on public sentiment and feedback it received”.

    The public will welcome this news, especially after the mainstream media had remained unerringly silent and the expression of public opinion being almost totally left to blogs, online news portals and emails…the New Media.

    Indeed, the leaders and governments of today worldwide, for their own health, need to listen hard to the New Media as it appears to wield a heavy hand in influencing public opinion . Why, the term New Media has only a few days ago gained recognition in 2009’s new terms you need to know when Wikipedia meant it to encompass the emergence of digital, computerized, or networked information and communication technologies in disseminating information and views. Read more of it here.

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    The New Media...a force to be reckoned with

    Healthcare Blooper of the Year – Malaysian edition

    This blog was meant to be for an international audience, but by request from one of the blog’s avid followers, I am presenting the Malaysian equivalent of ‘blooper of the year’. Several candidates came to mind…the ex-Health Minister episode, the conviction and jail sentence of a doctor for noncompliance to the PHFS Act and the gaffe by the Deputy Minister in stating that doctors have a licence to kill.

    But the winner is….the proposal to privatise the National Heart Institute by a Malaysian public-listed company.

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    The National Heart Institute of Malaysia - a model of corporatisation as a prelude for all public hospitals?

    For international readers, a quick 101 : Malaysia has a unique healthcare system – public and private. The two entities are separate and distinct so that  staff cannot work in both sectors. The public hospitals are  almost totally subsidised by tax-payers and is accessible by all citizens at practically no charge. The private sector is profit-orientated with  approximately two-thirds of its patients funded by third-party payors while the rest pay out-of-pocket.

    So what makes this deal unique? After all, this sounds similar to the extensive NHS privatisation exercise carried out since 2006 in the UK which drew much fanfare. Well, the National Heart Institute in Malaysia (NHIM) started life in 1992 as a corporatised entity. In essence, the government retained the physical assets (the balance sheet) and parceled out the operations (P&L- profit & loss accounts) to a state-owned entity, MOF Inc. The P&L has remained healthy and it is believed to have over USD 70 million in cash assets. In short, the Institute seems profitable.

    So what’s wrong with the deal? Plenty..

    1. When the NHIM started in 1992, its vision and mission was to be a centre of excellence with equal time devoted towards training and research & development(R&D) as towards service to patients. As it is, due to the busy patient service workload, NHIM has strayed away from its original objectives. Today, R&D is almost non-existent. Can privatisation remedy this? It is doubtful, as R&D is hardly profitable in the near-term.

    2. Transferring a corporatised entity to a privatised entity means, amongst other things, looking for an alternative source of funding for the 85% of its patients who are now almost completely subsidised by tax-payers. This will cut into the P&L like a hot knife into butter and melt away the profits, especially in the absence of a comprehensive national health insurance scheme. Who is going to finance these group of patients under privatisation? Surely not the tax-payers! Otherwise,why privatise at all?

    3. Unknown to many, NHIM is already classified as a  private hospital under the 1998 Private Hospital Facilities and Services Act. This adds to the confusion as, in many ways, it works and runs like a public hospital despite its categorisation as a private hospital.

    4. Despite the above misgivings, NHIM has been operationally viable and relatively successful. The privatisation proposers have not given solid reasons as to how the Institute will benefit should it be privatised.

    5. It is clear that the views of all stakeholders were not obtained prior to the somewhat premature announcement of the takeover. I am given to understand that even top management were left in the dark.

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    The privatisation team

    The decision-makers in government  have since sidelined the proposal; but there are many other ways that a public-listed company can work together with the Institute. One is to form a strategic partnership instead of a takeover. For instance, by  establishing heart units country-wide funded by the public-listed company and using IJN technical expertise and training, the service workload can be minimised and the company  hopefully achieve a decent profit in the medium term.

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