Impian Malaysia

My friend Tony Pua has again ask us to re-start the medical camps in the interior of Sarawak, both as a health project to help the people who lack healthcare facilities in the interior of Sarawak, as well as to show that DAP cares for Sarawak.

Tonight I have arranged for a dinner with Kit Siang and a strong DAP delegation, including Tony and also members of my medical and dental team to seek their opinion.

Age is catching up on me and the energy level is lower. So need to pass on to younger doctors and dentists so as to keep the dream going.

We shall be meeting, over dinner,  at the Restaurant Minitanker where we first met in 2012 to plan the first series of Impian Malaysia medical camps. We return there tonight to seek consensus for the launching of the second series.

One of our team members, Dr Carol, film this short video at one of our last Camps in Kapit. I like the video, but found the going tough because of the need to climb on and off the "perahu" whenever we reach shallow river beds. My left hip replacement always made me worried, should I fall.

Overall it was service and fun too. The younger doctors and students, had a good time too.

Please do join us. You can contact me? 

 Understanding Hypertension and how to manage hypertension.

Introduction

The understanding of hypertension has changed tremendously over the last 50 years. When I was in medical school, The change in understanding is so severe as if we were all cheated 50 years ago. All to support the pharma industry.

The old paradigm

For a century,  our understanding of essential hypertension was guided by that important paper by Dr Allbutt on " Hyperpiesis". He called that essential hypertension ( or hypertension with unknown causes ) as contrasted with secondary hypertension ( hypertension with known causes ). The understanding that essential hypertension formed about 80% of the hypertension population and secondary hypertension formed about 20% of the population.

New paradigm.

Closer inspection of the evidence seem to suggest that most of so called essential hypertension, occurring in mid-life could in fact be due to a nervous stresses and strains of everyday living causing wide fluctuations in blood pressure as we run the "rat race". And it is no wonder that this "nervous hypertension" does run in families. Nervous dad and mum breeds a nervous family, always living on the edge. White coat hypertension is another example of this. How can a patient coming to see me, for an appointment after battling through traffic jams and no parking bays, have a normal blood pressure? What should be the normal blood pressure in a busy government outpatient ( waiting time 2 hours ), full of noise and hot and sweaty. I am sure by now you get my drift. That means that for years, we are over treating labile, nervous, stress provoked " hypertension"? The only benefactor from this strategy are the pharmas who find an easy accomplice in doctors and physicians who are "pharma friendly" in many ways.due to many reasons? 

On the other hand, we also do not wish to miss those patients who are really hypertensives, who may end up in life-changing strokes. These patients must be identified early and treated early. There are almost 20% of hypertensives out there who may have secondary causes like renal disease, endocrine diseases, pheochromocytomas, coarctations, primary arteritis, renal disease, etc etc. who do need early treatment.

Management.

I would like to introduce the strategy of  " Home BP Monitoring " for all above 40-50 whether symptomatic or not. A digital BP monitor costs about RM 100 - RM 150. Teach all patients to check their BP regularly on a scheduled basis ( Sunday, Tuesday, Friday ) at 7.30 am in the morning and 10pm at night and keep a chart for the next GP/consult visit. Let them show to their practitioner and identify what is the real BP situation?. 

The digital monitors are good enough for wide spread use. The only safe guard is to make sure that the energy level in those meters are adequate and stable. There are 2 types of those digital monitors. There is one type that only uses battery power. When the battery level weakens, it will take longer to read and may give rise to errors. The second type uses dual power source, a battery source usually for travelling and a AC plug in source for home use. This type is slightly more expensive but probably more reliable.

Nowadays, in our effort to "empower our patients", there are many heart watches that we can wear on our wrist. Not very accurate, but adequate to give us a trend. It is very convenient. Make sure that the watch energy level is always charged up and once a week or two weeks, calibrate it against the digital monitors, because these health watches uses a laser pulse beam to sense the skin capillaries, so a smaller blood vessel, less sensitive but does allow you to see the trend, which is what we are interested in. NOT INDIVIDUAL READINGS.

Use these simple gadgets to monitor your BP profile daily or weekly. 120/80 mmHg is ideal. 130/80 mmHg is the upper limit of normal and any reading persistently above this, show be lowered. However, lowering it does not mean drug therapy. There is much that can be done to help without drugs.

The first step should be to exclude secondary cause. A good physical examination with basic lab test would be a good first step, together with an ECG and if possible a CXR. Remember Obstructive sleep apnea is also associated with hypertension, and relieving OSA can "cure" the hypertension.

Sit down and chat with the patient for a while to be what kind of psychological profile he/she is? Do he/she have a type A personality, OCD, work stress, family stress, financial stress etc etc. Try and help him/her understand the role of stress to the BP and these counselling session may also serve as therapy. If the patient is obese or overweight, weight reduction is also good BP lowering therapy. Regular exercise, green vegetables and fruits, no added salt, also lowers blood pressure.

Try these initial  non pharmaco steps first.

Sometimes patients' anxiety cannot be relieve without the use of a drug ( for their placebo effects ). Please choose a drug that you are familiar with, mild with a very safe drug profile. Use it but do tell the patient to continue home BP monitoring and should the Home BP profile improve, there is a possibility of gradual withdrawal of the drug, while using non-Pharmaco  therapy and home BP monitoring. I do not like drugs for evermore, except when there is no choice.

I will stop here. Getting too long.

Let us comment and ask the questions.

 Pathogenesis of the atherosclerotic plaque and atherothrombosis

Coronary artery disease, the most frequent killer of middle aged males and lately rising numbers of females, has been a bane on mankind as it kills many unsuspecting important members of our workforce, many at the prime of their lives, leaving behind many families without their most important breadwinner.

It is therefore obvious that much work has been done to understand this disease and hopefully lead to better therapy and more importantly, to better prevention so that hopefully we can wipe out this deadly disease ( surely not in my lifetime, maybe in the next decade or two.

1. What is atherosclerosis, arteriosclerosis or arteriolosclerosis?

Arteriosclerosis is derived from the Greek word arteria, meaning artery, and sclerosis meaning hardening. -osis in Greek means a disease condition.

All the 3 terms may be used interchangeably, depending on the context. They mean the same.

When I teach, I usually like to draw my students' attention to how medical terms are derived from, so that they can better understand the context and thus remember the meaning better ( hopefully ).

So we are talking about hardening of arteries. Arteries of the body, the heart, the brain, the kidneys, the liver, the arms, the legs and even the small arterioles of the eye.

All these arteries when they age, they harden. They harden as they allow lipids, particularly cholesterol, to accumulate below the inner lining ( sub-intimal ) lining of the wall of the artery (the artery wall have 3 layers, viz intima, media, adventitia ).  Besides age, some disease conditions can also cause arteries to harden. Diseases like hypertension ( constant elevated blood pressure or tension, pounding the artery wall ), cigarette smoking, diabetes mellitus, and some genetic diseases can cause premature arteriosclerosis. 

2. How does arteriosclerosis form?

In this disease, the medical community put the cart before the horse. I suspect that there was this problem of people dying from heart attacks in the 50's and some saw the opportunity to make some money. Dr Ancel Keys, published the "Seven Countries Study", which basically showed the correlation between lifestyle, diet and heart attack rates and strokes in seven countries. Surely we all know now that CORRELATION IS NOT CAUSATION. Nonetheless "Fats. Cholesterol, Diets" Stigma has stuck since then, making some Pharma billions of dollars since the 60s till today. Cholesterol is bad, cholesterol kills, and bad cholesterol is the mantra for selling cholesterol-lowering pills for all and sundry regardless of of their benefits and harmful side effects.

What then are the facts?

We have to thank Dr Peter Libby and his team at Mass Gen Hosp. ( Boston ) for much of our current understanding. 

It is obvious that God gave us Cholesterol to help us, not to harm us. Cholesterol form the basis for all our tissues, cell membranes, sex hormones and our "stress hormones". Without a healthy level of cholesterol humans cannot survive and be "human". 

However, it is true that in some people, cholesterol ( particularly oxidized LDL-Cholesterol ) can accumulate just below the inner lining of our arteries, causing the artery lumen to be narrowed and so limiting blood flow, and be severely consequential, if this should occur, in arteries to vital organs. 

Besides risk factors that promote the adhesion of LDL-Cholesterol in the arterial intimal wall of patients at risk, to promote the initial phase of arteriosclerosis, there is also the important element of inflammation and inflammatory molecules and their important role in promoting arteriosclerosis as well as muting or damping down arteriosclerosis.

What is more important to emphasize is that artery blockages do not kill. They only cause warning chest pains which make us seek medical attention and so treatment. What kills is the inflammatory process that causes a vulnerable plaque and subsequent plaque rupture. which causes atherothrombosis and a heart attack. That can kill. Dr Ancel Keys and Pharma, had no inkling about this for 30 years while they promoted the "Cholesterol scare" and profited. 

Diseased arteries and blockages per se, do not kill. A blood clot on the blockage may kill.

IT IS ATHEROTHROMBOSIS ( a blood clot on the arteriosclerotic plaque ) THAT KILLS, NOT ATHEROSCLEROSIS.

And of course, medical science has never evaluated the importance of happiness as a means of lessening inflammation, and thereby lessening the risk of athero-thromosis?  

Be happy always is a good philosophy

Next blog coming soon. The Management of hypertension. What we got wrong for 3 centuries

 The return of this old cardiologist

I am about to retire and am thinking of starting a second cardiac opinion blog site. Being not very good at mass media and social media. I will begin by doing what I know.

Please be patient with me as I learn the ropes and develop this blog slowly.

However, I hope to be honest and share a very clinical view of cardiology, the anatomy, physiology and clinical condition and try and explain to all of you how your disease condition is caused and will evolve. 

Why this? Why now?

Medicine as a whole has become very profit-oriented for financial gain and I being old-fashioned, find it hard to accept that. My old professor taught me that medicine is to help people, make them well, relieve their pain and suffering, and ultimately return them back to society, their families, their jobs so that the world can benefit from their work, in big ways and small.

I also believe that while a doctor can care, check and treat a patient, for the few minutes that the patient is at the clinic, the patient has to understand his condition and take care of himself 24/7 and 365 days a year. So that empowering the patient is VITAL for all your long term health needs.

The other important reason why now? is because of severe commercialization in medicine and that there is as much "fake" news as there is "true" news. Clinical trials are also severely flawed because companies and even institutions, that fund research, after spending USD X million on a trial just cannot allow a trial to have negative results. They have to have some return on investment ( ROI ), even if that product is potentially harmful. The best example is the deadly covid vaccine. I should not elaborate too much here, as I may be de-platformed again.

So I will start writing and share thoughts with you all out there.

Maybe you can help me with your comments ( good or bad welcomed ). I sometimes learn more from critical comments than from praises.

I will try and start with the first return blog on 'The pathogenesis of the atheromatous plaque"

Let us talk about the sick Malaysian Healthcare. The sickness is the system? – Facts and figures

 

Recently there has been many write ups on what ails the Malaysian Healthcare system. There was much focus on the problems of junior house officers  and the toxic eco-system that junior doctors are working under. Politicians and NGOs were also concern about the “brain drain” of bright young Malaysian doctors who have migrated overseas, or some just over the causeway.

I have been watching the Malaysian Healthcare scene for the last 40 years, having work in the public sector, then the private sector, having taught in the public sector then the private sector and also having contributed to the some of the treatment methods currently in use in hospitals ( both public and private ). I would like to highlight the issues that I see as an outsider ( not in the Putrajaya eco-system ), and hopefully suggest some remedy.

“ Is the present Malaysian Healthcare sick”?

The answer is a big YES.

In the 90’s the Malaysian healthcare system was greatly admired by our peers. We were spending about 3.6% GDP on our healthcare and were achieving good healthcare outcome. We first started with one medical school ( UM 1962 ), then two medical school ( UKM 1972 ), then three medical school ( USM 1979 ).  3 medical schools in 17 years. Many of the junior doctors then were from local universities and the teachers were either expats from overseas or graduates from University of Malaya In Singapore.  Toxic culture among the juniors were unheard off and they were keen to learn with good attitude. The seniors were keen to teach. Hos/Mos and specialist got along well.

However since the 1990s, many radical changes took place. Under the PM 4 ( Prime Minister 4 ) administration, the sickness began, slowly but surely. I mean the deterioration of our healthcare system both in delivery of healthcare and also the outcome of healthcare delivery.

Since the beginning of 1990 till 2014 ( moratorium on medical schools ) we had an additional 33 medical schools of various sizes, most without their own teaching  hospitals ( sharing hospital patients with public hospitals ).

PM 4, having started the production of our national car, and decided that Malaysia was now an industrialised nation and should have the health standard of an industrialised nation. Political leaders began talking about having a national patient to doctor ratio of 1:600. Looks like this triggered the tsunami of medical schools and medical graduates. There was no concern about medical standards and quality. Only great concern about medical quantity. Not to forget that it was also a lucrative business to start medical schools ( remember PTPTN loans for students ). Ex-DGs of MOH upon retirement became Pro-Chancellor of medical school, one almost the next day after retirement as DG.

Sooner or later the poor quality was bound to show, and symptoms showed. When the symptoms became serious, there was public outcry and the first knee jerk response was a moratorium on medical schools effective 2014 telling us that they then realise there was a problem.

Symptoms of this ailing system.

The symptoms first began to show itself at the turn of the millennium when reports began to appear of poor standard of care in public hospitals. These were initially treated as isolated instances and dismissed.

Then things got worse and too serious to cover up.

Malpractice suits began to appear. We all the baby who ( born at Selayang Hospital ) suffered brain damage in 2005. The parents filed a law suit and won. Then there was the case of baby Yok Shan ( 2007 )  who lost her arm, when a doctor in Klang Hospital inserted an intravenous cannula into her arm muscle instead of her arm vein, causing her to lose her arm. The parents again went to court and won. These cases are mentioned as examples.  The Deputy Minister MOH told the press ( 2017 )  that annually, MOH received about 7,000 complaints annually and paid out about RM 20 million. The MOH 2020 annual report showed that in 2019 MOH paid out about RM 23 million in legal suits against MOH. ( Remember only those with money can afford to sue ).

The other troubling symptom is of course housemen bullying ( toxic work environment for junior doctors ). Absenteeism from work, downing tools at 5pm sharp became common. Junior doctors clocking out without reviewing their patients and without passing over ill patients to the on-call to care. Housemen  ( and even specialists ) bought clock-in  machines from on-line shops and were clocking in and out at will at home. There was even a case report of a housemen who was suppose to take blood from ward patients for investigation, who decided that he will take 20 cc blood from one patient and put them into multiple bottles labeled for other patients. And as a result of that houseman who committed suicide in Penang, and measures were taken by MOH to chastise medical officers and specialist who then became defensive. The pendulum swung the other way. Housemen have now become the “untouchables”, beyond discipline, even when they are clearly not doing their job, as the MOH has now given the right for housemen to complaint against their seniors. How then can the housemen learn and get trained when an advice and correction can be taken as “scolding”? Yes, there is a lot of training and corrections going on in the ward. Some seniors do abuse their position, but not the majority. Taking action that stops training and correction of junior doctors is counter productive and will show itself in badly trained junior doctors, which will translate to poorly trained medical officers and specialist and consultants. It takes time, but will eventually spoil the whole system. When you have poorly trained, incapable MO’s in peripheral hospitals, more cases get referred back to overcrowded district hospitals and state hospitals.

Of course the other symptom is the “brain drain”. Seeing the poor state of affairs in the public hospitals many young doctors seeing a poor career prospect, have chosen to vote with their feet, mostly to the English speaking countries and across the causeway. Many rose to prominent position  receiving outstanding awards and peer recognition. Their new country benefitted from our loss. There is shortage of data on medical brain drain. The Sun Daily reported recently that about 0.5 million skilled Malaysian ( all categories ) leave the country yearly for jobs overseas. Professor of Medicine of University of Malaya, tweeted recently that UM loses about 30 doctors yearly to Singapore. In fact Malaysians fill many of the top medical jobs in Singapore. This is also true for other professions and disciplines as well. 

Signs of this ailing system

I will use hard facts as the signs of an ailing healthcare system. These are hard facts on record, and not a personal opinion. I am talking about national clinical outcomes of our system, comparing our outcomes in 1990 and what they in 2019 ( before the onset of the pandemic ).The source of the data is also provided for all to check.

This is how we compare with our peers in the region. How they have improved compared to how we have improved. For Infant Mortality, our ASEAN  neighbours improve by double digits, we improve by low single digits. For life expectancy we improve at halve their rate. I could also use other indices which will show the same trend.

Then there is the index of medical litigation which reflects medical management standards not in keeping with community standards.  The Malaysian Medical Council ( medical professional governing body ) receives complaints and only investigate those complaints that have an ethical element, or an element of professional misconduct. They ask all who feel aggrieved by medical malpractice to seek redress through the civil court process. This cost money and the average B40 after losing their bread winner surely cannot get justice. How does the DG separate professional misconduct and professional negligence is surely a mood point? Anyway, I tried to get figures of professional misconduct, but such figures are not available. The MMC takes a long time to investigate a complaint ( may take years ) and very few doctors are found guilty by MMC, resulting in one reporter calling the MMC a protector of doctors, not of the people.  

Anyway, I did manage to find some statistics from the Annual MOH report 2020. ( shown below ). I was unable to find any record of litigation in the 90’s for comparison.

As we can see, we are paying out RM18 to RM 20 million annually for malpractice suits. Another sign of an ailing Healthcare?

Conclusion.

As can be seen from the symptoms and signs shown by our healthcare system, the system is sick and needs radical treatment, the sooner the better before it becomes malignant.

 The sickness is the system.  

Happy New Year 2023. A new beginning.

 

 21st Century Paradigm shift in medical education.

I spend Friday and Saturday, examining final year medical students in their final professional exam. It went well, but the mark sheet presented to me to assess them ( give them marks ) really surprised me. 

They still insist on how they do the "heel shin test", how they, stroke the toes, how they feel for thrills and listen to murmurs, in this era of ubiquitous use of imaging techniques. The mark sheet does not give enough marks for the students ability to synthesize facts and arrive at a diagnosis and work out what could be wrong. I have mention this to the "bosses" repeatedly, but apparently this is what thw examination board wants?

I am sure, that anyone who hears a murmur ( be it diastolic or systolic ) will instantly order an cardiac ultrasound and doppler and they can see the valves the dysfunctional blood flow and arrive at the diagnosis. It is much more important, to have them know the pathology, how to integrate the gross clinical signs pick up ( enough to know which system is disordered ) and investigate accordingly and probably more actually and spend time discussing management. 

Investigations, especially imaging techniques are so common and so good nowadays, that it has become an vital tool for good management. I suppose if I am stuck in the deep jungles of Sabah and Sarawak, I may have to rely solely on percussion, auscultation and scratching the toes and rubbing the shins. But then my misdiagnosis rates will be higher and clinical outcome poorer.

Previously, a 5 year program for medical education will be sufficient, but in the 21st century is 5 years sufficient? We are seeing more types of diseases, with more complications, more treatment modalities with more treatment side effects and complications, even organs have been found to have new functions we never realise before. 

We have open up a whole new field of gene therapy and immunology. Is 5 years sufficient? Even if the answer for some is yes, should those 5 years be spend on teaching detail techniques of examination at the risk of losing out in anatomy of imaging modalities and how to better understand human organ function and inter system interaction to better treat the patient.

Medical education must make a paradigm shift and not do the same thing the same way, since the time of Sir William Harvey. It is nice to know the Wallenburg Syndrome, but an MRI of the brain will surely give me a more accurate assessment and aid my management better.

In the next posting  we shall address the Paradigm shift on "What is the truth?"

 THE PARADIGM SHIFT IN THE 21ST CENTURY -The end of American exceptionalism.

Introduction, 

When I was a kid going to school, I thought so highly of the USA. After the 2 world wars, the USA became the dominant force and country in this world. They really know how to convince the whole world that they are a force for good and will save the world from all catastrophes.  Their marketing and promotion of their country was superb. Whenever cowboys appear to kill the red Indians, we cheer almost as if good has overcome evil. Little did I realise that the Red Indians were the original people who own the land and the Americans from England were the transgressors who were the Imperialist who came to take over by force, the land of the Red Indians. It sure looks like the Americans were a very aggressive race, who likes to fight, conquer and take by force whatever they wish.

This trait was quite obvious in the 21st century as every American President since the 21st century has started a war against often innocent nations, just because they wanted, their oil, their minerals, or who did not agree with them. 

The problem of American Exceptionalism

American exceptionalism is the problem. The Americans seem to think that they are God's special chosen people. They think of themselves as the light upon the hill. A nation called by God to police and save the world. In the 20th century, they use their soft power to try and win over the world. They had their "Peace Corp", they established good educational Universities with seductive names like "Ivy Leagues' and use their military budget to make inventions like the internet and digital world. Once they have the whole world "hooked" on them, they show their true colours in the 21st century. They became very arrogant. Because of their military might, their Naval fleets sail the oceans exerting their will. If you are not with me, you are against me and I have God's given right to punish you, either by way of sanctions, or even worse attack and bomb you to smithereens. You can see all the evidence around you. And if they do not like your government they send in their dirty tricks department ( usually that CIA band under the NGO of the National Endowment for Democracy ) to cause trouble, instigate the local opposition always waiting for the chance to stage a coup and regime change. They have done that all over the world. The best example maybe Ukraine.  They have also change the government of Imran Khan in Pakistan, and they are working hard to change the government in Thailand.  And they are continuing to do so in Taiwan, of which President Tsai looks like a CIA agent acting on behalf of USA. We can now easily see the ugly side of USA by :

1. Fake NEWS: BUT lately, we have seen their ugly side. The Covid pandemic showed us that their control of the mass media and spread of fake news has caused the world to have vaccine mandates, using injections which they falsely call vaccine ( when in fact it is gene therapy ), with almost no data of effectiveness or safety. Now after 18 months it is so clear that those gene shots did not prevent the spread of covid, did not prevent those getting those gene shots from getting covid. They claim that it made covid milder, but virology 101 will tell you that when viruses pass from human host to human host, it either kills them ( those lethal viruses ) or the virus loses its virulence and survive by getting attenuated  losing some virulence ( milder ) so that it spreads more. They do this by mutating and so we now see more and more variants and sub-variants.

2. De-platform those who tell the truth. Although USA confesses to freedom of information, and transparency, in the 21st century, they have become dictatorial. They silence people who tell the truth ( remember Chelsea Manning and Julian Assange ) , they deplatform ( remove from alternative media and main media, those who try to speak the truth. Even small fry me, was deplatform 3x by facebook, and twice by MKini and oncc by Star, because I wrote things that did not conform with the official narrative.  Looks like George Orwell 1984 is here. 

3. They have lost all their values and sense of fairness and fair play. They kill Red Indians to steal their land, in the 18th century. Now they give arms by the billions to Ukraine so that Ukrainians can fight Russia to weaken Russia, using the lives of Ukrainians. When the whole world is asking for negotiations to end the war and save lives, the US is sending billions of sophisticated weapons to fight a war and get Ukrainians killed, till the last drop of Ukrainian blood. How wicked can you get.

And sadly, the Taiwanese cannot see it. They are instigating to fight till the last drop of Taiwanese blood, promising arms BUT not American lives. These actions are evil.

USA is a country with a 300 year history and they are trying to teach China ( a country with a 3,000 year history civilisation ) "rules based order"? How arrogant can you get? I really hope that China will teach them a big lesson.

4. Can we trust medical journals ( even reputable ones ) after how they have published lies, remove articles of well studied work, in this covid pandemic. It is so obvious that big Pharma did not tell the whole truth with their gene shots and drugs, yet they faithfully publish their half baked findings and refuse to publish good scientific studies tell tell an alternative narrative.

Looking back, they also tricked us about understanding and treatment of hypertension, and understanding and treatment of hypercholesterolemia. Can we trust evidence based medicine as a whole, knowing that the world capitalist world is corrupted by the greed for money.

4. It is all about money.

   How do you trust a country when their system of election is based on raising money from the Military Industrial Congress Complex MICC ). To get elected cost millions of dollars. The industry, especially the the MICC and the big pharmas donate millions towards their election funds. After they win, of course those who have donated millions to them will come calling to ask for favours, to get back their return on investment. This is CORRUPTION, straight and simple, but it is all legal. This results in USA becoming a plutocracy. The ordinary man in the street gets to put a ballot into the box, once every 4 years. BUT the people have no say. The rich donors ( MICC and Pharmas ) control congress and the president. When war becomes profit making, you can only expect more wars and more lives lost, because it is a business.  As long as lives lost is not in your country. That surely cannot be right. Kill more Ukrainians, I make more money. Kill more Taiwanese, as long as I make more money. How does that sound to you? 

This paradigm shift will surely destroy the world. It is so sad. Yet, we in small Malaysia cannot do anything about it. I suppose except pray for divine intervention.  With so much high tech very powerful missiles flying around, it does take just a small miscalculation, to destroy the whole world.

That is the world that we find ourselves in, in the 21sst century. Sad but true.

I was born in the 20th century and this 21st century is surely a severe and deadly paradigm shift bringing the whole world to the edge of destruction. 

WE MUST END AMERICAN EXCEPTIONALISM, OTHERWISE CALLED AMERICAN BULLYING, AS SOON AS POSSIBLE.

After 

THE PARADIGM SHIFT IN THE 21st CENTURY.

1. How doctors failed the world.

Ever since the start the start of the covid pandemic, I have been very ashame of being a doctor, although I wrote and got myself de-platformed by our local mass media, and also facebook.

How did good doctors allow 1. The repeated lockdowns which severely damaged the economy of all countries in an attempt to eradicate and control a single stranded RNA virus ( which after 30 months ) we know will give us a mild cough and will kill <1% of those infected. In fact if you follow the projection of one expert epidemiologist, the ultimate mortality rate from covid 19 will be 0.2%. 

Even if we accept that covid 19 ultimate mortality is somewhere between 0.2-1%, the damage that we did to the economies  of all countries with our lockdowns  is incalculable. The poor have become much much poorer while the superrich has become super superrich. In fact those countries with minimal lockdowns had their economies minimally affected. Why did not doctors speak out louder against lockdowns? Yes, I signed the GBD ( Great Barrington Declaration ) but we also have another group of doctors who wrote against GBD.

How did we allow 2. The world to embark on a mass MANDATORY gene therapy against covid 19, with  novel gene shorts, with very very minimal safety data, not proven effective, did not control the spread of the infection, did not stop you getting the infection, and yet we allowed them to called those novel gene shots "vaccines"? If those gene shorts only make the infections milder, we all know from virology 101, that all viruses through passage across human host will either kill ( thereby stopping further spread ) or get milder. It was just a matter of time. GBD seeks rightly to promote focal protection ( which I believe is correct ) and the Swedes seek to allow minimal intervention and allow the virus to run its natural course. Well after 30 months, it sure looks like Sweden is correct.

Now we are hearing more and more reports of the harms from those gene shots. In fact there were reports that in some countries, those gene shots were killing more, than Omicron BA.5? We now also have to worry where those gene shit nanoparticles may end up? Will we be seeing a surge in Malignancies in the next 5-10 years ( in fact there seemed to be an increase in malignancies recently. What about kids 5 yr old now with those nano particles in the blood stream, bone marrow, testicles, ovaries, livr, cardiac sarcomeres, brain cells, and God knows where else. What evil have we done to them, and we had Malaysian doctors arguing with me over the safety of those gene shots. I supposed, they are sincerely ignorant or just medically naïve because they did get their own child get those harmful gene shots. Now that we have seen the Pfizer records released by FDA, we know that those gene shots are harmful, AND PFIZER KNEW IT. Some doctors appear on TV and talk shows actively promoting a harmful therapy. I am ashamed, even if these colleagues of mine were sincerely wrong. 

How did doctors allow 3. Them to ban the use of Ivermectin to prevent and treat covid 19?

Of course, those big pharmas want to make big bucks from patented drugs and want to ban cheap generics, when cheap generics were safer and  more effective in the prevention and early treatment of covid. I have been on it for 15 months now ( 2 tabs weekly ) and thank God, so far I am covid 19 naive. I can only guess how many thousands of lives Ivermectin would have saved. That cheap and effective drug that was so good against Loa Loa in Sub-Saharan Africa is also so good and so safe against SARS COV 2. 

How did doctors allow 4. Reputable medical journals to print articles written by pharmas using pseudo-doctors?  Through out this pandemic, we have seen the death of evidence based medicine. Clinical studies were manipulated to show whatever the "pharmas" want to show, using "Pharmas friendly" doctors. As the saying goes, there are always doctors who can be bought. It is a matter of the price, so doctors are no better than prostitutes, just a different trade. The medical world will never trust medical evidence again knowing that many are fake. That raises a new problem of fact checking to see which is true and which is fake.

Throughout this pandemic, I had a very hard time trying to reconcile data with basic medical science, to try and arrive at the truth. It was tough analysing data and basic medical science. But that is the oath that I have chosen. 

Drs Anthony Fauci and Francis Collins are no world renown virologist to tell the world how to treat and control Covid 19. They are probably the two most hated medical doctors who let the world down. They betray their calling.  They are traitors to our fraternity. But alas, they are very rich for doing that.

In subsequent articles I will try and see the next 21st Century paradigm shift. THE FALL OF THE GREAT USA. AMERICAN EXCEPTIONALISM IS OVER. 

 I AM BACK.

I was working hard doing, professional and social work, so did not find time to blog. I replaced this blog with daily posting on Covid in Malaysia through the medical doctors' facebook. 

Now that I am semi-retired, I thought that I will again blog and share my experience in medical and also social issues.

I hope that I will have enough energy ( by the grace of God ), to continue till my last breathe,