Monday, September 01, 2014

Help

I tried to post the PARADIGM-HF study this morning. As you can see, the middle paragraph came out gibblish. I do not understand why and I could not correct it.
Can anyone teach me how? Am I corrupted by virus? or is this manmade?

HELP

I tried this morning to re-write the article again. The same thing happened.

PROMISING BREAKTHROUGH IN HEART FAILURE THERAPY

In Barcelona over the weekend ( European Society of Cardiology, annual scientific meeting ), an important heart failure trial result was announced. The PARADIGM-HF trial. It was also simultaneous published in the New England Journal of Medicine. ( Pharmas are so powerful nowadays that they can "convince" the editor to time their publication for maximal marketing effect ). I am surprise that it did not appear in Forbes magazine too.




But lets not be distracted by marketing gimmicks. This is an important study. It is actually the followup of a smaller study, PARAGON-HF, published earlier, which essentially showed the same. The PARAGON-HF study was on Treatment of Heart failure with preserved LV systolic function, which forms about 50% of heart failures.
Now back to PARADIGM-HF. Take a look at the authors of this paper. Novartis ( the company that manufactures LCZ 696 ) has assembled together a whose who in heart failure management. Drs John McMurray, Dr Milton Packer and Dr Karl Sweberg. Wow.
They recruited about 10.521 patients with class II,III and IV heart failure with LVEF<40 -="" .1="" .="" 2009="" 2012.="" 27months.="" 47="" 8="" about="" after="" and="" both="" centers="" countries="" dec="" enrolment="" followup="" from="" in="" included="" medical="" nov="" of="" out="" patients="" period="" screening="" started="" the="" they="" usa.="" was="" were="" with=""> 4,000 patients in each arm. This was a RCT.  All the patients had LCZ or enalapril on top of their usually heart failure medications given by their physicians. 
Anyway, the trial was obviously positive, showing a 20% reduction in primary endpoint and 20% reduction in CV deaths and 16% reduction in all deaths. 
LCZ 696 is a combo pill of Valsartan ( ARB blocker ) and Neprilysin-Sacubitril ( an endopeptidase enzyme inhibitor ).

As usual such magic drugs must be thoroughly scrutinise by the FDA ( I hope that they do a good job and not be "rushed" by Novartis ).
There are obviously side effects. Not to forget that a previous drug of this almost same group ( Omapatrilat ), also a bradykinin inhibitor gave life threatening angioedema.
With Neprilysin, the side effects noted in PARADIGM-HF was symptomatic hypotension, which reach a p-value of 0.001 and a 2x raised creatinine level. These two side effects could prove troublesome as we see Heart Failure in the elderly ( the average age of PARADIGM-HF was 60 years ) who are already prone to symptomatic hypotension, and a raise creatinine.
Then of course, there is the issue of cost? How much will we have to pay for this drug? It is important to note that with PARADIGM-HF cost analysis, we have to treat 32 patients to save one CV death. It is also good to remember the good old drug called Spironolactone ( very cheap ) which in the RALES study also reduced CV death by 30%, except that spironolactone may cost painful breast enlargements.
When will LCZ696 reach us, assuming it crosses FDA, looks like 2016. By then it should have a nice sounding name.
We await more news, for better or for worse.
I must congratulate Novartis for a good piece of work. I am sure that there will be a place for LCZ 696





Monday, August 25, 2014

MEDICAL SCHOOLS IN MALAYSIA - FOR BETTER OR FOR WORSE?


Your article in the StarBizWeek on “Medical College Shakeup”, is certainly timely after  certain Medical Colleges has shamed Malaysia by recent bad publicity for allegedly not paying staff salaries and not settling their contractual dues. If the medical schools involved do not feel ashamed, we Malaysians and Malaysian doctors feel shame. It is certainly not our Malaysian Culture to be know across the world for  this. Recently there is also the irresponsible statement by the deputy minister to cut down on places in Public medical school when the problem is with private medical schools.
Private Medical Education is now a business.
I am writing to highlight this very important issue that Medical Education has now become a business, important only for the bottom line of the company owning the licence. One of the person you interviewed, unashamedly said that it was important for his company to have a medical school, because it is good for their branding, in other words to give their business a better name. There seemed to be  no concern about helping Malaysia produce better doctors for the rakyat.
The wrong reason to have medical schools
There is now 33 medical schools of various sizes and track record. The majority are privately owned. I understand that there are licences, already issued for another 7-8 more. Part of this mushrooming of medical schools is because of the often quoted statistic that we should have a doctor: patient ratio of 1:400 which is better than a 1st world country.  This data is used to justify having more medical schools. Let us not forget that doctor patient ratio is never a stand alone statistics to measure healthcare standards.
We must see the healthcare needs of each country. Just simply aping another high income economy healthcare needs is too simplistic. The specific healthcare needs of each country is different. In high-income countries this ratio is relevant to  different disease patterns and a healthcare expenditure nearer or in excess of 10% GDP. We in Malaysia spend only about 4.6% GDP on our Healthcare, with a doctor : patient ratio of 1:800 and yet have similar  healthcare outcomes . Basically we have a good healthcare system and do not need a 1:400 doctor :patient ratio. Healthcare outcomes are more important statistics than just a simple doctor:patient ratio. You get to see a doctor ( he is there ) but he is so poorly trained that he cannot help you. You maybe worse off than no doctor.
There is certainly no need for 33 medical schools, many of doubtful quality, producing more than 3,500 medical graduates, many of which are also of doubtful quality. This falling medical students standards is currently also affecting the standards of our public medical schools. What we need is 4 to 5 well-funded, well-staffed good medical schools ( preferably Public ), together producing about 1,000 medical graduates annually, forming an annual increase of 5,000 new medical graduates ( together with those returning from overseas ).
  
The state of affairs in some medical schools
Do any of you know the state of affairs in many private medical schools?
Many have few permanent full time staff. They hire contract doctors to teach. Some medical colleges time these contract medical teachers arrival to coincide with the arrival of the regular checks by the Ministry of Higher Education / MMC committee. This gives a false picture for the inspecting team. Once the inspection is over, many contract teachers are also send back.
The students that we admit into medical schools are also of much lower standard. Many of them do not have the linguistic and technical skills needed to be a doctor. Many are products of “spoon fed” teaching methods. In established medical schools around the world medical students are not  spoon-fed. They must be able to think and work out a problem. This method is important as medical students (future doctors) must be able to work out the complexities of a patient’s sickness based on varied symptoms and signs.
The problem is that these students are unable to switch overnight from one system to another. Not to mention that many of the contract teachers themselves are from countries where “think for yourselves” is also NOT a strong point. So now we have a requirement not to spoon feed and students and teachers who know nothing except the spoon feeding method. That compounds the problem. Our secondary educational system is to blame.
So how do medical schools short of teaching staff fill up their time table? Take a look at the time table of many medical schools. They have the headings “ self directed learning” and “ ward work” without any guidance and any supervisor. Some medical school time table for their final year, does not even cover 50% of the core curriculum. When queried the answer we prefer not to “spoon-feed them”. We want to  “ let them study on their own”. Guess where the students are?  Many are anywhere except the ward and the library. Then they might as well just mark everyday “self directed learning” and the students just buy a thick medical textbook and study on their own. Just turn up for the exam. It will save the parents plenty of money. Is this the kind of medical school that we want? Is this the way we want our future doctors to be taught?
Now, when medical students reach Year 3, they have to begin to learn to begin their junior clerkship. Meaning they must learn to clerk ( interview ) patients to try and work out what disease the patient is suffering from. MOST OF THE PRIVATE MEDICAL SCHOOLS DO NOT HAVE THEIR OWN HOSPITALS.  So they borrow the use of Public Hospitals.   Now there are some public hospitals in Kuala Lumpur who have medical students from 2 or 3 medical schools walking the corridors. The patients are utterly fed up and many refuse to co-operate with the medical students. So the medical students do not have enough patients to practise their interviewing techniques and medical examination. The medical students also do not get enough opportunities to observe procedures and new treatment methods.

Without your own hospital, private medical schools cannot attract good medical specialist to teach, because medical specialist wants to continue to practise their skills. So the medical specialists that teach in private medical schools are part-timers. A specialist who is no longer in practice clinically, is a theory only medical teacher devoid of clinical relevance. All the while, medicine is progressing by leaps and bounds. My colleague in your article called them “deskilled”. There are many specialist teachers in private medical schools who are de-skilled.

So now, you have a poor quality students, studying under a “no spoon feeding system” which is alien to the students. The students have to adapt overnight by hook or by crook. The students are taught b mainly “deskill” medical teachers ( except for a few ). What do you think will be the end result? 
It is important that by law, all private medical schools must have their own privately funded teaching hospitals to provide for service and teaching. This will allow for better clinical materials, better supervision of students, and better clinical teachers.
What are the implications of poorly trained medical graduates?
If the medical graduates are too many and poorly trained, it is very difficult to redress this in the housemanship years. Here too we see the problem of too many housemen and not enough supervisors and clinical material. That will mean that when they are medical officers, they are still not ready for independent clinical work. So when they go to district hospitals and rural hospitals, they cannot cope and so “safe doctors” will refer everything (short of cough and cold ) to the district hospitals and general hospitals, further clogging up the system. The daring gung-ho ones will try on their own giving rise to complications and in some cases death. Currently there is a rising number of patient complaints in Public Hospitals.
What then is the solution?
To begin with, there should be NO MORE LICENCES FOR MEDICAL SCHOOLS.  Those private medical schools that are small without adequate teaching staff should be asked to merge. Either merge or close and have your students transferred to another medical school. The cost of all this will have to be borne by the school themselves. This is an important first step.
 Laws must be passed to allow setting up of private hospitals to be used for medical education. Of course, such laws must be properly drafted so that private hospital patients are protected.  We need better trained medical students but not at the expense of compromising private medical care. Some “carrots may have to be given to these “ private medical teaching hospitals”.
The relevant monitoring and enforcement agency in the Ministry of Education must keep a close watch on staffing in private medical schools, especially their teaching staff numbers and quality.
All graduates from all medical schools will sit for a common qualifying exam. Medical schools whose graduates do poorly, will need to be closely monitored and their license reviewed.
The ministry should also hold regular meetings with student bodies and teaching staff of private medical schools to get feedback. Parents of medical students should be advised to take a more active interest in their children’s medical education. Do not just pay the school fees ( which is a lot ) and do not care what happens. Help the country. Help your child be a better trained doctor.
It should be the policy of government not to allow the commercial interest of private medical schools to override public interest. Medical schools objective must be to train doctors to take good care of our citizens, particularly our workforce to that we have a healthy good work force to drive our economy.  To close an eye to the commercialisation of medical education will be a unmitigated disaster for the future healthcare system of Malaysia.

This article was written in respond to the recent many articles in the press highlighting the problems in Medical Schools and the Deputy Minister's statement ( subsequently refuted by the DG MOH ) that the government is thinking of restricting the number of enrolment to public medical schools.
This article was send to the Editor of STAR last night.



Tuesday, August 19, 2014

MIM MEETING LAST WEEKEND, 16-17th AUGUST 2014

It has been a busy weekend. I had to tutor UTAR 5th yr medic and then run to UM, Faculty of medicine to take part in MIM ( Medicine in Malaysia ) weekend seminar. They had invited me to go take part in their seminar. To judge their poster competition and also deliver a talk on Cardiology in Malaysia.
I was very impressed with what I saw over the weekend.
Lets take a step back.
This MIM series of meeting through the country, is run by a group of undergraduates from Overseas ( mainly UK ), together with their Malaysian counterparts ( undergraduates ) from UMMC and IMU. It is funded by Talent Corp, who obviously wanted to get to this group of Malaysians studying overseas, to get them to return.
The meeting was well attended ( guestimate ), about 300 in the Dewan TJ Danaraj, UMMC. The poster competition featured some simple research ( some done overseae and some from local Us like UMMC and Hospital Pinang ). It was quite obvious that the work done overseas were better thought about and executed. I was particularly impressed by a piece of work from UK where they tried to identify markers of drug non responsiveness in patients given come chemotherapy for Glioblastoma Multiforme. I thought that that held much clinical promise.
I spoke on Cardiology in Malaysia, outlining our journey through the last 2 decades, from the time of clinical cardiology till present day PCI. I also dwell a bit of current day private practice in Malaysia and the plethora of laws governing us from Medical Act '71 to PHCFS Act, Local council laws, to  PDPA, to Medical Act 71 amendment ( NSR ) to GST, and yet we are being squeeze by MCOs where there is no law to govern them. Life as a private doctor is tough.
I sat through some of the sessions hearing big chiefs from MOH telling the young ones, how good is the Healthcare service in Malaysia. Gosh, it made me want to pewed.
Anyway, that was my weekend. Life is almost back to normal.
This weekend we start to finalise preparation for ICF 2014, at year end.

Sunday, August 10, 2014

WEEKEND SEMINAR IN CARDIOLOGY AND DIABETES FOR GPs 2014;

This event went very well. The program was smoothly carried out. All in good time. One session in the breakout room ( ECG tutorial ) started late as both tutors came late. I nearly had to take over.
We registered 900+ attendees ( preliminary ). 850 before Friday and 123 on site. On Saturday afternoon, we had about 500 in the ballroom, and on Sunday morning we had 400 in the ballroom. The Saturday lunch had no sitting seats although NovoNordisk ( sponsors for lunch ) had book 400 shares. We nearly had to send people to coffee house for lunch.
This year, we altered the program significantly. Only 2 hours of monolog lecturers for all the whole weekend and 8 hors of case discussion in 3 rooms concurrently.
Pullman Hotel catering is good. The food quality was good. BUT the management is not so well organise to cater for a large meeting. They did quite a few things wrong. I went to Pullman using the LRT. It is off the Kg Kerinchi station.
The ballroom at 3.30pm on Saturday. We had placed 400 seats and added 50 seats and some were standing.
All in all it was a good meeting. These were the comments from the attendees. They like the venue, although I do not. They love the case discussions and use of the interactive pads.
The whole ballroom ( ballroom 1 ) was crowded during tea break with hardly any place to stand or walk.
I must thank the lecturers and tutors who worked hard to complete their case discussions and learning objectives.
It was a tiring but very rewarding weekend.
Thanks to all attendees for making this event a success. Thanks to the sponsors and the secretariat ( MSD ).
See you all again next year.

Saturday, August 02, 2014

WEEKEND SEMINAR IN CARDIOLOGY AND DIABETES FOR GPs 2014

JUST A REMINDER.

This event is on next weekend. There is very experience and expert faculty to discuss clinical cases and how to manage. All sessions will be interactive with use of interactive pads to poll the audience. Lunch and dinner provided.
WEEKEND SEMINAR IN CARDIOLOGY FOR GPs 2014                                                             PROGRAM
Saturday
9th August 2014


12.45-13.50 pm
 LUNCH SYMPOSIUM
1400-1415

Opening of Weekend seminar.
1415-14.45 pm
Management of Diabetes in the Clinic – State of Art
                     Goal of therapy and how to achieve the goal    Dr Hew FL

14.50 – 15.50 pm
Case study on Diabetes – Problem solving
                               MH       :  Dr Hew FL
                               RM 1    :  Dr Vijayan    RM 2 : Dr Wong Ming
1550-1620
TEA BREAK
16.30-18.00 pm

ECG tutorial  -  Self assessment
                              MH   : Dr P Kannan
                              RM 1 :  Dr Yee KM                 RM 2  :  Dr Ed Mah
18.10  18.40 pm
Managing chest pains in the clinic – State of art
      How to recognize the problems and what to do?  Prof Wan Azman
1840
DINNER SYMPOSIUM  


Sunday
10th August 2014
0800-08.30 am
Hypertension – State of Art
             Life style modification, drugs and intervention?
             Which and When?                                  Prof Chia YC
08.40 – 10.00 am
Case study on hypertension - Problem solving
                                                     MH  :  TBC
                                                    RM 1 :  Dr Wong TW    RM 2 : Dr  CK Yeo
10.00-10.30am
TEA BREAK
10.40-12.00 noon
Case study on CCF and Dyslipidemia
                                       MH    :   Dr L Chan
                                       RM 1 :  Dr Dewi  Ramasamy      RM 2 : Dr Ernest Ng
12. 10 – 12.40 pm
Management of ambulatory Heart Failure – State of Art
                          Life style, Drugs or devices   
                                                                   Dr Tamil Selvan
12.40- 12.50 pm
                                             CLOSE            
13.00-14.00 pm
Lunch Symposium.

 It is free. We have registered 700 attendees. CME points and Certificate of Attendance will be awarded.

If you wish to join us at the seminar, please call your favourate pharma and they will register you or call 012-2122468 ( Ivan Lee ). Hurry

Wednesday, July 23, 2014

GST : POTENTIAL EFFECTS ON HEALTHCARE IN MALAYSIA.

I was asked to do some reading up and write an article on GST and its potential effects on Healthcare in Malaysia.
As we all know, GST is coming next year.

You can read this article at 
http://www.fpmpam.org/files/GST_July2014.pdf

Thanks.

Monday, July 21, 2014

STABLE ANGINA PECTORIS. SHOULD WE OR SHOULD WE NOT, REVASCULARISE? NEW DATA POST COURAGE



The interventional world was noticeably shaken in 2007 with the release of the COURAGE trial ( Dr William Bolden ) that optimal medical therapy was as good as PCI in the management of stable angina pectoris. That paper caused many interventional cardiologist to rethink their strategy. Of course the noise level came up that optimal medical therapy was very intensive an "optimal" ( more "optimal" than was practised by many institution at that time ) and PCI was done with mainly bare-metal stents ( this was 2007 ), or just plain old balloon angioplasty. Those were the days.
Of course since then stents have improved in design and also technology from bare metal to 1st generation drug eluting and now 2nd generation drug eluting, and today even 3rd generation drug eluting stents and even bioabsorbable vascular scaffolding. Things have gotten along and clinical trials are always behind the curve.

Well these advances prompted Dr Stephen Windecker and colleagues to re-visit this question with a meta-analysis of data from 1998-2013 of 100 randomised trial of medical therapy Vs PCI with second generation DES. It included all RT ( randomised trials ) with an enrolment of at least 100 patients in each arm ( medical therapy Vs PCI )  and which had a t least 6 months follow up.This paper was published in the June 23rd BMJ. There were 93, 553 patients in total, in the 100 RT analysed.

Rate Ratio (95% CI) for Outcomes by Revascularization Method vs Med-Based Strategy for Stable CAD in Meta-Analysis
Revascularization methodEnd points
All-cause mortality, 95 trials (n=93 553)MI, 92 trials (n=90 472)Revascularization, 94 trials (n=90 282)
CABG0.80 (0.70–0.91)0.79 (0.63–0.99)0.16 (0.13–0.20)
Balloon angioplasty0.85 (0.68–1.04)0.88 (0.70-1.11)0.97 (0.82–1.16)
Bare-metal stent0.92 (0.79–1.05)1.04 (0.84–1.27)0.44 (0.59–0.82)
"New-generation" DES
Everolimus0.75 (0.59–0.96)0.75 (0.55–1.01)0.27 (0.21–0.35)
Zotarolimus (Resolute)0.65 (0.42–1.00)0.82 (0.52–1.26)0.26 (0.17–0.40)
"Early-generation" DES
Paclitaxel0.92 (0.75–1.12)1.18 (0.88–1.54)0.44 (0.35–0.55)
Sirolimus0.91 (0.75–1.10)0.94 (0.71–1.22)0.29 (0.24–0.36)
Zotarolimus (Endeavor)0.88 (0.69–1.10)0.80 (0.56–1.10)0.38 (0.29–0.51)

Basically, the results showed that PCI with 2nd generation DES came out better for patients with chest pains and also asymptomatic CAD.
This paper showed me that the pendulum is still swinging and the definitive answer is still unknown. This is obviously because stents are getting better and that is the way it should be. The second lesson that I learn from this paper is that not all stents are the same. There are significant differences between the bare metal, 1st generation and 2nd generation DES. The difference between the 2nd and 3rd generation, in my opinion is minimal. When we talk about the second generation DES, we are talking about the everolimus eluting Xience V and the Zotarolimus eluting Endeavor Resolute. I suppose by extension also the Promus Element, although the data is scarce here.
I am very concern that all over town and this country, generic stents are being implanted left right and center, on unsuspecting patients who were being told that all stents are the same. This I believe is also being done in Public Hospitals where cost is a constrain, so cheap DES ( non FDA approved ) are being used in significant number on the assumption that all stents are the same and patients don't know better.This is simply not fair.

Well, maybe this blog posting will serve to further inform the public, though limited in its outreach.




Thursday, July 17, 2014

THE DENGUE VACCINE - EARLY EXPERIENCE



Yes, I am a cardiologist, but being a civil society activist, I have great interest in this dengue scourge that is upon us, in my opinion, in epidermic proportions. When tens of Malaysians  are dying every month, one has to sit up and take notice and scratch our heads to find a solution.
So when news broke last week that Sanofi has been studying a vaccine and that the first publication is out, I looked around for a copy. My friend found me a copy and so I took a look at it.

The latest issue of Lancet carries the full article.
This study was led by Dr Maria Capeding of the Research Institute for Tropical Medicine in the Philippines and funded by Sanofi. I am only glad to note that two of our paeds Institute ( the Penang Hospital Paeds institute and the HKL paeds institute took part in the study.
Dr Maria and team carried out an observer masked, randomised controlled, multicenter, phase 3 trial in 5 countries in the Asian Pacific Region between June 3 and Dec 1 of 2011. Their aim was to assess the efficacy of the CYD dengue vaccine against symptomatic, virologically confirmed dengue in otherwise healthy children.
They vaccinated 10,275 healthy children ( age 2-14 years ), assigned to receive either vaccine or placebo of which about 10,000 were included in the primary analysis. Those assigned to the treatment arm received 3 injections of recombinant, live attenuated, tetravalent dengue vaccine at 0, 6, 12 months. The cohort was followed up for 25 months.The primary endpoint was the vaccine efficacy against symptomatic virologically confirmed dengue, that took place more than 28 days after the third injection.
From the 10,000 children in the study, about 250 cases ( 2.5% ) of dengue took place 28 days or more after the third injection ( 117 cases in the treatment arm and 133 cases in the placebo arm ). The primary end point was achieved with 56.5% efficacy.
However, the side effects were significant. They recorded 647 serious adverse events ( 402 in treatment arm and 245 in the placebo arm ), some within 28 days of the vaccination. This is not minor. There was one case of acute disseminated encephalomyelitis. There were 4 deaths in the treatment arm and non in the control arm. 3 of the deaths were classify as accident? one of tracheal injury. The numbers all round were small, so may give a skewed picture. Need more numbers to have a fairer picture. Certainly the side effects are not insignificant.

All in all, although we greatly need a vaccine to combat this dengue epidermic that has befallen us, this first attempt leaves much to be desired. A small sample ( 2.5% ) infection in a region infested by the Aedes mosquito must raise a few questions. Why did we not get more cases? A 5.6% protection rate against a serious side effect rate of 6% must also raise an issue?

Looks like this first vaccine is NOT yet ready for primetime. Let us call it an early experience.
I hope that the government is smart enough to see that.


Wednesday, July 02, 2014

“NEGARA - KU” TO RECLAIM OUR NATION

A group of NGOs and NGIs led by Pak Samad and Dato Ambiga Sreenevasan has decided to launch a People’s Movement “Negara-Ku” to Reclaim Our Nation.

        “NEGARA-KU”: A PEOPLE’S MOVEMENT TO RECLAIM OUR NATION
2 July, 2014
WHY?
On a daily basis, we are confronted with serious challenges that have begun to undermine the very foundations of our Nation. The peace and harmony of our multi-ethnic, multi-faith and multicultural society are under threat.
Ethnocentric and race-based politics and communally-minded politicians continue to derail the process of inclusive nation building and the formation of a Bangsa Malaysia national identity. Importantly, religion is now increasingly used as a main marker of identity, and as a boundary maintenance mechanism to polarise the people.
There are political parties and their affiliates that are not focused on nation building, rather on building their respective power bases. These parties on both sides of the divide pursue their agenda that are transactional and short-term, not transformational and long-term.
The mobilisation and manipulation of race, ethnicity and religion have resulted in increasing intolerance, bigotry and extremism. There is also an emerging sub-culture of political violence. These are symptomatic of dangerous under-currents in our society.
The State, by default or design, has failed to address these pernicious developments. The State has also failed to play the role of an honest broker in managing conflicts in our society.
WHAT?
We believe the majority of the People want to end this brand of divisive ethno-religious politics.
We want to take ownership, fully cognisant, that Malaysia is a nation where her people are inextricably bound by a shared history, commonweal and destiny.
We have to act before our society descends into the abyss of instability.
2
The “NEGARA-KU” Coalition aspires to mobilize and empower the People: -
 To resist all forms of intolerance, bigotry, hatred, extremism, and violence;
 To oppose all forms of discrimination, oppression, persecution and injustice;
 To strive for a socially inclusive society;
 To exhort the State and its Institutions to respect, adhere and uphold the Rule of Law; and
 To demand adherence to the principles of stewardship, integrity, accountability and transparency in all aspects of governance.
We will strive to do this by returning to the basics:-
 The Federal Constitution as the Supreme Law of the Land;
 The Malaysia Agreement; and
 The Rukunegara as the guide for national objectives and values.

By this process of engagement and empowerment we endeavour to “HEAL THE NATION” and “RESTORE HOPE” in our future.


NEGARAKU-COALITION 
c/o GBM Secretariat, No. 1, Jln Maharajalela, 50150 Kuala Lumpur. 
Tel: 03- 2272 3594 / 017 3985 606 EAdd: infogpoam@gmail.com 

2 July, 2014 


Dear Friends, 

Our beloved Nation is in distress! 
Known and unknown forces are beginning to overtly and covertly shred the fabric of our society. 
The very foundations of our multi-ethnic, multi-faith, multi-cultural nation are being undermined. 
The time has come for the silent majority to stand up and reclaim ownership of our Nation. 
Silence is not an option! 
A group of NGOs and NGIs led by Pak Samad and Dato Ambiga Sreenevasan has decided to launch a 
People’s Movement “Negara-Ku” to Reclaim Our Nation. [Please see attached Charter] 
We earnestly need your whole-hearted commitment to this cause to “Heal the Nation and Restore 
Hope” for our shared common future. 
A series of road shows, forums, and dialogue sessions including multimedia presentations are being 
planned to engage and empower our People to take ownership of our Nation. 
In this regard we call upon you and your organization to:- 
1. Endorse the “Negara-Ku” Charter; 
2. Attend in solidarity the Media Conference to launch “Negara-Ku” on 10th
 July 2014 (Thursday), 
11.00 am @ KLSCAH; 
3. Participate in the Civil Society Discussion on the Way Forward for “Negara-Ku” on 17
th
 July 
(Thursday), 2014 (Wednesday), 6.00pm @ KLSCAH; 
Kindly email endorsement and confirm attendance for events (2) and (3) above by latest 8
th
 July 2014 
(Tuesday) to the Coordinating Secretariat, Gabungan Bertindak Malaysia (GBM), 
infogpoam@gmail.com. Tel: 03 2272 3594. 
We look forward to your invaluable support and contribution to this initiative to save the Nation. 

Thank You! 
For and on behalf of Negara-Ku Coalition 

Zaid Kamaruddin 


I THINK THIS CALL IS TIMELY.
THINGS ARE GETTING OUT OF CONTROL
WE NEED TO SAVE MALAYSIA.
LETS JOIN HANDS TOGETHER AND DO IT.