Monday, August 03, 2009


I would like to ask leave of my readers, to deal with two issues of public interest that I am very concerned about.

1. The H1N1 issue : When this global infection first started to affect the world and our country in early 2009, almost 6-7 months ago, I must say that I thought that it was just another " flu " but with the potential of mutating ( H1N1 from humans, infecting animals including birds / swines, and then returning to infect humans ) thereby causing a deadly form. One of the problems in this present " Pandermic " is the politicising of the health issue. One sometimes find it difficult to separate the real health issues with statements by politicians and also pharma companies, who have an obvious conflict of interest. Say what you like, this infection is spreading, but not " rapid ". With globalisation and a global transport, a rapidly spreading infection would have involved millions by now. It has not. In a country of 27 millions in Malaysia, after 6 months, we have 1,400 cases. Yes, it is still spreading, but no, it is not spreading rapidly.
But what I am very concerned about are the two latest deaths, last week and yesterday, which involved two kids, who have no previous illness. Of course, we need more details, but the sudden rapid onset of the infection resulting rapidly in death in someone not predisposed, does not sound like " flu" anymore. It makes me wonder whether the H1N1 has mutated already into the more virulent forms like " swine " flu or " bird " flu. Of course, the other possibility is that the anti-virals, used indiscriminately, may have caused side-effects and further damaged the host immunity. After-all, anti-virals are anti-RNA like-products, and do have known side-effects. In fact many experts have advised that in patients with H1N1, complicated by pneumonia, antibiotics to treat the super-imposed infection, maybe better than using expensive anti-virals. Heavy doses of anti-virals, and vaccines, are of very limited value ( although pharmas are cashing in, giving rise to many conspiracy theories.
I would have thought that the best thing wthat we can all do is to maintain a healthy body ( a body with strong immunity to infections ) and also to observe good hygiene. The Ministry of Health must help us to trace all cases, especially fatalities , study the pattern of spread and devise stategies to contain and control. Blaming doctors every now and then, is not a good strategy. It is time to work together, to fight this infection. And even more important, to tell us what kind of virus, we are dealing with, H1N1, or H5N1, or others, if possible, without causing panic.

2. Generic Drugs : Last week, I was also involved in a three day Ministry of Health ( MOH )meeting on the Malaysian National Medicine Policy ( MNMP ). Apparently, in 2006, the MOH had written a drug policy, and we are now task with doing a workshop to see how to update the Policy. Our comments at the meeting, was that, although doctors are one of three important stake-holders of the MNMP, there were only two doctor organisations invited to participate, and only three non-government doctors present. This would not be a good forum to formulate a MNMP. There were of course, multitudes of pharmacist, and ministry officials.
A quick look at the agenda, will reveal that the MOH is very keen to push generic ( copycat of drugs whose patency has expired ) drugs. What is even more important to note, is that the MOH seem to be pushing for " generic drug substitution ", meaning that the pharmacist can substitute a drug that the doctor has prescribe, with a copycat copy, whose stock, he/she is holding. Now this is very dangerous and against the pharmacy code of ethics. For awhile, from expediency ( read profit ), this ethical code is forgotten. Well after some "hooha" the ethical code book is refered to and now, pharmacist will have to seek the permission of the prescriber, before substituting. There is also an obvious trend in the discussion and agenda, to separate prescibing from dispensing. We also managed to suggest to MOH that there should be a list of drugs ( drawn up by the doctors ) that cannot and must not be substituted.
It does look like pharmacist is pushing very hard to take over the doctors role to dispense. There are pros and cons in this debate. I feel that, whatever policy we make, the patient must have a choice. In the free market society that we profess to be, the consumer must have a choice. We should not legislate a system, where the consumer have no choice.

There are many other pressing health issues, but I should not take up cardiac space, too much.

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