Wednesday, March 02, 2011


These few days, the minister and DG have been rather busy making press statements and declaring open healthcare facilities. I think there is more to come as we head towards GE 13. Lets examine what they have said, and see if they make sense.

1. Yesterday, the YB, minister of Health announced that MOH have had discussion with the Association of Private Hospitals of Malaysia ( APHM ), to ask them to declare their private hospitals fees in their website.
A quick check yesterday and today showed that his statement has not been adhered to. It is possible that their fees schedule is hidden in some remote corner of their website, but it certainly is not easily accessible. This is something that we have fought for and hope that it will come about. A fees schedule for private hospital charges. The reason is simple. If you feel it important to have a doctors fees schedule ( doctors fees is roughly 15% of overall bill ), then it only make sense to also have a fees schedule for the 85% portion. Otherwise controlling the 15% makes no sense when the 85% is not controlled. Lets give it sometime. Obviously, this declaration of fees in their private hospital website is the first step, towards fees regulation in the private sector. This will come about, not because of us ( in case we get swollen headed ), but because the government is working towards a social health insurance scheme, for which reason, they must know how much each cost. Whatever their reason, if you wish to control doctors professional fees, it is only fair that the private hospital portion also be controlled. Our advice have always been that there should be no fees structure. It should be free market, as in Singapore, and promote healthy competition. Whatever insurance coverage should always be capped. The insurance pay so much ( declared before hand ), and the patient pay the rest. If you choose to go to a budget hospital, the extra portion will be small. If you go to a luxury private hospital ( for face-cy ), then you have to folk out more. That seems fair to us for all.

2. Yesterday too, the DG announced that they are looking for regulations towards " stem cell " research and therapy.
This is way overdue. I have heard of cardiologist, injecting bone marrow aspirates into coronary arteries post infarct angioplasty, charging patients and telling them that it will help heart muscle grow. There is a fool born every minute. And some people believe them. Actually, that idea is copied from a clinical trial being carried out overseas ( REPAIR-AMI trial ), and the 5 years follow-up results looks encouraging. Our Malaysian boys have simplified it, and hope for the best. What many do not realise is that stem cell therapy can cause harm. In the area of the heart and myocardium, patients have died in the early experiments, when the stem cells initiated wrong cells to grow, at the targetted sites. We had examples of bone cartilage growing in the heart muscle, causing the heart to stop. Doctors must always remember, first do no harm. The DG is correct. It is about time. This new and exciting field is promising, but can be severely miss-used. Then there is also the ethical issue of donors and recipients. I know of a group that is going around, harvesting fat tissue ( adipose tissue ), from their liposuction ( a procedure to suck away fat from the tummy ), selling the fat tissue to a third party, who treats it chemically and then use it as stem cells into joints to grow cartilages. There is some research being done, that shows that adipose fat cells can when triggered correctly, form targetted tissues at targetted sites. But it now begs the question, what is the law of selling ones tissue ( organ donation ) to another ( organ recipient )? I know that that is not allowed, under MMC code of conduct. But what about adipose tissue for stem cells?? So the DG is correct, this issue must be studied and proper regulations drawn up, to protect the medical fraternity and also the patient.

3. The YB minister announced today that the Medical Devices Act is coming and companies are asked to register their medical device with the MOH.
This Act has been in the pipeline for a long time. When we first started angioplasty, I remember, I just literally took in the rotablator, and later the stent, for use in my patients, after being trained in them. It is proper that these devices, which can potentially harm, be registered ( which is a form of licencing ). Just the other day, I saw a patient who was treated in another medical center, and he had received a " optimiser " stent. In my many years of interventional cardiological practice, I have no knowledge of the "optimiser" stent. I can onlky concclude that it is a generic stent produced by some small company, with little research and documentation. It is obviously not FDA approved. I suppose it comes cheap. What I would like to say, is that, it may cause harm. Is it a safe stent?. Stents are permanent implants that once sited in, cannot be removed ( short of cardiac surgery ), and so safety both short and long term, is very important. The government must act, to make sure that patients are protected. First cause no harm.
Besides stents, there are many machines and devices out there that can cause harm and are being used without proper documentation. We always wait for something to go wrong, and for patient to sue. That is too late. The damage has already been done to that victim, and to many others who are unaware.

All in all, looks like GE is coming and politicians are working very hard, making announcements and handing out goodies. I can only encourage all eligible to register as voters and to vote, when the time comes, FOR THE GOOD OF OUR NATION, Malaysia.

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