Sunday, March 29, 2015

THIS IS A SAD WEEKEND. POST KUAN YEW, POST #KitaLawan, POST WEEKEND SEMINAR.



This weekend we bad farewell to a legend the late Mr Lee Kuan Yew. He was indeed a great Hakka. He was totally committed to his vision for Singapore. He live, eat, breath and sleep Singapore. God gave him a special vision. But perfect he was not, as many who did not agree with him found out.
Rest in Peace LKY.


Besides the passing of legend LKY, this weekend is also black, because the PDRM is arresting opposition politicians at will and humiliating them Why is there a need to handcuff YB Rafizi? He is not a criminal. He had been fully co-operative and had a track record of co-operating with the Police. Why? Why? Why the need to handcuff and parade him? Do not worry PDRM, these kinds of attitude will back fire. We are waiting for GE 14. This will spur us to work harder. And they have to abduct Hishamudin Rais in full view of the public, on Saturday, just to fetch him to Dang Wangi? What kind of country have we become? He has never resisted arrest. You know where he is? Just ask him to follow you, that's all! We are a failed state where we abduct people and make them disappear. It could happen to me, or to you. This country is now rule by law and some are persecuted. There is no longer rule of law. This is very sat. As John F Keneddy said " when you make peaceful protest impossible, you will make violent protest inevitable."

The black box is also for a very humiliating weekend for me as I oversaw the "Weekend Seminar in Cardiology and Diabetes for GPs 2015". I am very upset. I did put in my usual effort, but it sure was not good enough. We saw an attendance of about 250-300 on Saturday afternoon and evening. This morning, we saw about 150-200 in the main hall. This is just not good enough. We are used to  registering 800-900 and attendance of 500-600 on Saturday and 300-400 on Sundays. I spend the whole weekend trying to analyse what went wrong in an event which we have successfully held for 13 years running, this being our 14th Year. Of course, the well wishers who wanted to console me said that it was the timing, "ching ming", many meeting all over the city and country, many doctors and family were preparing for GST next week. I am sure that there is some truth in all those reasons. But as I analyse the run up and what happened this weekend, it is obvious that the organising committee ( for which I am responsible ) made some strategic mistakes. We had appointed a secretariat that failed to fulfill their responsibilities, but yet was prepared to tell me that they had. I was very angry that I was lied to. Recruitment and registration too was not our usual, and not enough was done to recruit doctors. I have learned my lessons and must be more careful next time. Maybe I assumed too much. I should have been more meticulous in checking and double checking the details myself.. This time, I invited Edaran Tan Chong Motors to be one of our sponsors to ry and raise non-Pharma money. I hope that the doctors can accept that.

So I had a tough time trying to right the many surprises that appeared. It was not a nice weekend for me. I was fire fighting, something which I never like to do.

On the surface, the meeting went well. Besides a low turn out, the lectures were ok and the breakout sessions were OK. Pullman food this time was below par and yet the cost was high. I also wasted a lot of food.

Well I learned my lesson. I must exercise greater care in choosing the secretariat, as I do not have the time now to check all the details, myself. I trusted my helpers and this time, I was badly let down.
I accept responsibility and I have learned my lesson.
I am glad the weekend is over.

Now, we move on to plan for the next FPMPAM Sarawak Medical Camp scheduled for end May. There is much work to be done.

Thursday, March 26, 2015

CHINA INTERVENTIONAL THERAPEUTICS 2015

I just received this very nice letter from the organisers of CIT 2015.
It makes me feel good. I must confess that I did not think I did anything to deserve those kind words.
In a way I feel sad that my own country have never written some nice words about me after what I have contributed. 


Dear Dr. Ng,

It is truly a great honor for us to have your participation as faculty for CIT2015 in partnership with TCT. On behalf of the CIT Board of Directors, we would like to thank you, from the deep of our hearts, for the personal support and commitment you’ve given to us during the whole last week at CIT2015 meeting.

CIT 2015 this year back in Beijing was, again, a big success with 6,478 attendees from 30 countries and regions, and 32 provinces and municipal cities of China. During the three and a half days, CIT2015 had more than 1200 lectures presented, over 40 hours live case demonstrated, and 14 late breaking trials / first report investigations released. In the past 13 years, there were ups and downs though, CIT has become more than just a conference. It is a platform to meet new friends and to renew friendship with old acquaintances. With all your help and contribution, we are able to make CIT become an internationally remarkable teaching course in interventional cardiology. Our gratitude is beyond words. The long-term friendship and supports we got from you was an invaluable asset for CIT!

CIT2016 in partnership with TCT will take place on Thursday, March 17 through Sunday, March 20, 2016 in Beijing. We look forward to working with you again next year.


Sincerely, 
Run-Lin Gao, MD
Chairman of CIT

Bo Xu, MBBS
Secretary General of CIT



Monday, March 23, 2015

CHINA INTERVENTIONAL THERAPEUTICS 2015

I spend the last 4 days in Beijing as a guest faculty at the China Interventional Therapeutics 2015 ( CIT 2015 ).
One thing was very obvious as I sit there at the main hall. They have grown by leaps and bounds. I could see the tremendous growth from the days of 4th June 1993 ( when I first went to visit and help them at Fu Wai Hospital, Beijing till today.


This meeting now has an attendance of about 10,000 attendees, of foreign doctors, local doctors, nurses, technicians and industry personnels. We saw 40+ live cases and there were so many concurrent sessions that I really cannot count. There was the local section and the international sessions.
I did learn a few lessons, as usual.
1. The organisation is always fantastic. Everything is taken care of, and executed well. The sessions ran smoothly, even with all the live demo sessions.
2. You could do cases well, in a simple manner with good results, as shown by Dr Jean Fajadet on Saturday morning.
3. TAVI has grown in USA and they are now advocating TAVI for minor risk patients with AS. BUT they have actively promoted the formation of a heart team to safeguard abuse.
4. You also could have live demo and also cine case discussion to get the best of both worlds.
5. My good friend Prof Gao RuLin is actively grooming a young set of interventionist to take over the meetings. I can see that many of the symposium chairpersons and also presenters are young interventionist ( before my time ). They are grooming new leaders.

           Beijing also has grown. The Beijing Capital International airport has grown. It has 3 runways and to parl the plane after landing takes 15-20 mins ( looks like forever turning.  The water cube, Bird Nest stadium, the Olympic Park, all  across the road from my hotel, was all spruced up as they await the IOC inspection team arriving on 22nd March.  Beijing subway fare rate has increased from 2 yuan to 5 yuan to Tian Ann Men square. I bought myself an IC ( their name for a subway pass
The weather was great. Day temperature was about 18-20oC and evening was 7-9oC. That was great.
The security around Tian Ann Men was very strict.

They were doing body searches and so the queues at the entrance to the square was about 100 feet long, at 5 abreast till one lane just before the body search.

Tian Ann Men itself still looks grand as ever. With a beautiful sky ( that day, air polution was minimal ), and the people were out ( it was Saturday 21st March ), so it was carnival like with great crowds. Eating at the side streets of WangFuJing is always an experience. Everything boiled and cooked of course.
The only upset in Beijing was the Facebook, Googles, and Gmail blankout in Beijing. I could not contact anyone by gmail, so I had to aplogise and literally reply hundreds of mail on Sunday night. Usually, FB is blank-out. This time, Gmail and Googles as well.
I flew out with about 5 other interventionists ( unplanned of course ) on flight MH 360 ( the successor of MH 370 ) which landed in Beijing Capital International airport st about 12.30am on 19th March. My pick-up had actually come to pick me up at 1am on 18th March ( the problem of flight leaving one one day and landing on next day ), so I had to email for them to send the pick-up again. Anyway, the flight was pleasant and I must say, the cabin crew service was good this time. The return flight was MH 361, leaving Beijing at 1.30am and arriving KLIA at about 7.35 am on 22nd March.
All in all, it was a good trip, and I met many old friends.


LEE KUAN YEW IS DEAD. RIP

My Condolence.


The man who build Singapore from a small fishing village to the 1st world nation in our neighbourhood, is dead. Mr Harry Lee died this morning after a short illness with pneumonia. He was 91 years old.
The fact that he build Singapore is not in doubt. The controversy is the way he did it.
Harry, rest in peace.
My sincere condolences to your family and all your loved ones too. And to all Singaporean who is feeling the lost of this Singapore giant.

Monday, March 16, 2015

NEWS FROM ACC. CTA NOT BETTER THAN FUNCTIONAL STRESS TESTING FOR EVENT PREDICTION.

The American College of Cardiology is holding their Annual Scientific Meeting in San Diego, California now ( 14-16th March 2015 ). One of the papers presented on Day 1 was an interesting study of the use of CTA in the evaluation of new onset  Chest Pains. Dr Pamela Douglas of Dukes Clinical Research Unit, Durham, N Carolina led the study. This study ( importantly ) was NHLBI funded. Is was also simultaneously published in the latest issue of the New England Journal of Medicine.Dr Douglas and colleagues studied 10,003 patients with new onset chest pains, and divided them into two arms. One arm ( 4,996 pts ) received a CTA for evaluation and the other arm ( 5007 pts ) received functional stress testing including nuclear imaging and stress ECG. The primary end point was composite of death, MI, hospitalisation for Unstable angina, and risk of major procedural complications. This study was called PROMISE ( Prospective Multi-center Imaging Study for the Evaluation of Chest Pains.
After 2 years follow-up, they found that overall, the event rates were small, 3.3% in the CTA arm and 3.0 % in the functional stress testing arm. This difference were not statistically significant.
This shows that in the evaluation of new onset chest pains, more costly CTA with the additional risk of radiation did not do any better than the conventional stress testing in prediction clinically important events. There was one exception however. The use of CTA in the emergency unit, did expidite discharge from hospital, avoiding unnecessary admission. This was the first indication for CTA in the early years, if you remember.

In an unrelated piece of not so nice news from the local scene,
I heard news ( have to confirm with other sources ) that a certain politician is serious mis-using the CTA in Kuching Heart Center to do cardiac screening for assymptomatic patients as a political favour for his " constituents " without even explaining to them the serious radiation risk. It is alleged that the Hospital Director knows about it but is unable to, or doing nothing about it. These screening CTAs have no registration number, although they are using Public Hospital facilities. Some of those screened were as young as 17 years old. I do hope that the Ministry of Health will look into this. Political campaigning using public hospital facilities, using a tool which has risks to the patients is opens  a new and dangerous chapter in Malaysian politics. I do hope that the news is wrong, but investigation by the relevant authorities would certainly help to clarify the exact situation. What is more important, that this unhealthy practice be stopped. Patients must know the risk of procedures, their indications and and usefulness. Using of public facilities by politicians would mean that those patients who need those facilities, will have a longer waiting list. This is not fair. It is not lost on us, that the Sarawak State Election is coming, and so there may be a element of truth in the "rumour".

Saturday, March 14, 2015

WHY ARE DOCTORS SUING CUSTOMS?

This letter was send for publication. Lets see if it appears.

Doctors threaten to sue Customs on GST.
It is all over the social media,  that poorly advised private doctors are mulling taking legal action against the government.  Having participated in meetings with the MOH on Regulations of the PHCFS Regulations and having participated in discussions with Custom’s on healthcare GST, please allow me to help clarify on this issue of GST on Healthcare with particular reference on Private Hospital Consultant. I believe that I am in the know, and would like the facts to be known.
 Perhaps the only wrong doing of the government, in this case the Prime Minister,  is to promise that the coming GST will see no increase in private healthcare cost as healthcare will be GST exempt. Besides that, the government ( in my opinion ) is not to blame for the controversy of private hospital doctors charges when GST is imposed on the 1st April 2015.
When we met with the Director of GST, Datuk Dr Sobramaniam in late Nov 2014, he made it very clear to us that all private doctors, who are registered with the Ministry of Health under the PHCFS Act is GST exempt. That was clearly spelt out. In November 2006, when the PHCFS Regulations were being enforced, private doctors were asked to register. GPs and solo practitioners paid their dues and registered. They subjected themselves to inspection by Ministry of Health Officials and were okayed.  Private Hospital Specialists were advised by their hospitals not to register individually but that the hospital will register them under their  healthcare facility. This was obviously because the private hospitals wanted to control the doctors. Doctors were labeled “independent contractors” by the hospitals and treated as such, which included the right to hire and fire, like other contractors are subjected to, with little regard to their medical duties and responsibilities. This independent contractor status had been accepted from the very beginning by all the private doctors for the last 30 years. When private hospitals labeled doctors as contractors, they had no qualms that this was a noble  profession dealing with patients health.
The “Goods and Services Tax ( GST ) is a tax on goods and services. Since the doctors are providing a service to the hospital, the hospital should duly pay them the 6% GST.  The private medical consultants  should therefore have no issue with the Custom’s Department. Their duty then is to remit this 6% to the Custom’s Department.  The issue is the private hospital is unhappy as this may affect their profit margin. So they are using the doctors to fight their battle. And the doctors, without understanding the issue have fallen into the trap and allow themselves to be used. I have tried my best to explain to the doctors, but to no avail.
So the doctors are wrong to argue that Custom’s Department are wrong. This issue has nothing to do with private practice doctors. They are being made used off by private hospitals. Of course, what is not said is that should private doctors not “play ball” with private hospitals, they face the possibility of disciplinary action, not excluding termination.
What then is the solution?
Well, on the doctors end, do nothing. Let the hospital solve the 6% issue through creative accounting, and price manipulation. Obviously the private hospital will increase cost of care, to allow for the 6% increase to be passed on to doctors. I hear that they will probably round of to at least 10% or maybe even 15%, to include their annual fees increase. I hear that some private hospitals have also asked doctors to raise their charges by 6 % and share the 6% with  the hospital. This is called “fees splitting” which is against the PHCFS Act. The private hospitals may also allow doctors to be fully independent, amend their contract and make doctors medical service providers with rented premises in the private hospitals. This will allow doctors to collect their own fees. Then doctors will register with the MOH under the PHCFS Act.Then their services will be GST exempt. The hospital is unlikely to allow that as that would mean that they cannot hire and fire the doctor at will..
So there are solutions. But the private hospitals do not like these solutions as it would mean less profit, or less control over their doctors.
Basically, private hospitals want their cake and eat it. In the meantime, get the doctors to do their dirty work and sue Customs.

 Doctors, wake up please.

Monday, March 09, 2015

#KitaLawan 307

I spend yesterday afternoon from 2.30pm till 6.15 pm at town center with the #KitaLawan 307 rally.
I arived at Masjid Jamek LRT exit ( near OCBC bank ) at about 2.30pm. My medic team there comprise Dr Tan GM, Dr Steve Wong and nurse Katerine. This was the scene that greeted me as I exit the LRT station. The whole Jln Tun Perak was partially blocked till one lane on each side.

The VIPs for us to look after was YB Nurul Izzah, YB Nik Nazmi and YB Teo. I must say that throughout the rally, I only saw YB Nurul speaking at Sogo. Obviously the arrangements were rather loose. Anyway, as I was hunting high and low for them, the sky began to turn dark. ( As I left Sunway after a meeting at 2pm the sky was bright and hot ). A about 4 pm the instructions came for us to move and walk towards Sogo. So we walked and the group from Pasar Seni joined us. As we came near Sogo, another group join us, probably the group from PAS HQ. I estimated the crowd at about 7,000 although my colleague felt that it was nearer 10,000. What was obvious was the absence of the PAS fraction.  I thought I saw a few Amal Unit. There was a very healthy number of Chinese ) more than usual for demos, in my experience ). There was a significant number of Indians and of course the majority were Malays.I am so sorry to have to think in terms of race, but that appeared almost as a matter of fact.

At Sogo, there were speeches. I stationed one team at the south end and I went to the north end near the KFC traffic lights. While at the Sogo supermarket, the thunder came and the firecrackers came. I could make out Nurul giving a speech and I thought I heard Kak Wan as well. I could not see and the crowd was thick at my end. Then the drizzle began and we started to walk towards KLCC. We walked and sang until we reached the junction where the traffic lights are. There Dr KB Ng joined us, having just returned from Indonesia. Then some speeches and then we moved into the KLCC compound for more sounds and singing. Then they sang terima kaseh and slowly the crowd dispersed. When the crowd was thin, I dismiss the team and allow them to go home. We were all tired.

We went into KLCC for a rest and a drink. Then we took the LRT back to Taman Jaya to collect my car and gave Dr KB Ng a ride home.
I would like to say that I could identify DAP ADUN Rajiv at the rally. I also saw YB Ong KM, ADUN Ng SL. I notice the DAPDSY and some of my friends from Impian Sarawak and some were carrying the DAP flag. We were remarking that the flags were not high enough. Yes, the DAP was represented.
I was heartened to see the decent size crowd. In fact as I was at the Sunway meeting before going to Masjid Jamek, I received pics ( thru whats app) of FRU trucks heading to KL from Putrajaya. On the whole, the Police were there directing traffic and helping us. They were pleasant and not abusive. We chatted and got along well.
The spirit and mood for change is still there very much so. The songs they sang and the voice and toen. There are some very angry Malaysian youths out there. Although we say that the rally is for DSAI's release and also calling for PM to step down, I believe that the rally was just as much a ventilation of their severe frustration with what is happening in the country, All the scandals and corruption. Anyway, we will leave that for another day.
I have been warned that more rallies are planned in KL.  I suppose there is a price to pay, for fighting injustice. DSAI in prison for us, and we out here fighting for his freedom and also to bring down a corrupt regime.

Saturday, March 07, 2015

#Kita Lawan. 7th March 2015.



 The event for today.
Looks like an international event, the base is here. I must say that I wish that they have chosen a better name like #Keadilan.

DAPSY is lending our full support to this Saturday's #KitaLawan rally at Sogo, KL and we hope that you'll be joining us. 

These are the details:
1) Come in BLACK!
2) Gather at Masjid Jamek in Kuala Lumpur at 3pm on 7 March 2015;
3) Follow instructions of our security team (Unit Amal dan Skuad AMK) who will be at the scene to guide and protect all participants;
4) Do not in any way confront the authority - let the security team deal with them;
5) Bring as many friends as possible, follow Democratic Action party's Facebook or #KitaLawan FB (https://www.facebook.com/KitaLawanOfficial) or Twitter @KitaLawan_my for updates & spread the words.

STATIN RELATED RISK OF DIABETES WITHIN 6 YEARS. 46% INCREASE RISK.

This debate has been raging for a while. While BIG PHARMA has obviously denied the relationship, studies by many independent bodies seem to suggest that there is a very real risk.
The latest to join this list is a smallish study by the doctors in Finland. Dr Henna Cederberg of the University of East Finland and Kuopio University and colleagues studied 8,744 non diabetics aged 45-73 years. 2,412 were started on statins for whatever reasons, and the were followed up for 6 years with regular assessment of fasting blood sugars, HbA1c estimation and also if they have been started on oral hypoglycemic agents during follow up. This study is call METSIM or Metabolic Syndrome in Men, published in the Journal Diabetologia, 4th March 2015.
They found that in the 6 years, they found that the ingestion of statins was associated with a 46% increase in the risk of Diabetes, when compared to the normal Finnish population risk of 10-20 %, meaning that the regular ingestion was associated with a more than 2 fold increase with the risk of diabetes. What's more, the risk of diabetes seemed to be dose dependent. The higher the dose, the more likely. The most common statins taken in Finland seems to be simvastatin and atorvastatin. They found that females and obesity seem to make the patient more prone ( obviously ).
The researcher also study the reason why? They found that the ingestion of chronic statins reduces the secretion of insulin by about 12% and also increases insulin resistance by about 24%.
I think this study sets a firm foundation that there is a risk of T2DM in patients who are taking statins.
I suppose, as always, we should weight the risk against the benefits. If you are taking statins for secondary prevention, then clearly the benefit ot weighs the risk, and you should take statins. If you are taking statins for primary prevention ( where the benefit is less obvious ), then you should have to re-consider. And certainly, if you are taking high dose statins, you must reconsider.

Wow, it feels good to write a cardio blog, instead of all the social issues. It feels different, and shows that I can still do it.

Thursday, March 05, 2015

#KitaLawan 307. 7th March 2015


I am looking for medical volunteers for the above event. The organisers have asked for my help. My station is Masjid Jermak LRT station. I am to provide medical aid to all who need ( including PDRM personnel ).
If you are a medical personnel, and who wish to help, please do let me know.
You will need to have a first aid kit, walking shoes and dress lightly.
We must fight to uphold the rule of Law and justice.
Say NO to political persecution and rule by Law.