Interesting read at Wired

The difference between what drug companies tell the government and doctors suggests that they’re cooking the books, which could mislead doctors making prescriptions.
Of 33 new drugs approved by the Food and Drug Administration in 2001 and 2002, one-fifth of supporting clinical trials were not published in medical journals, according to a new study. And those results that were published were often more positive than what companies presented to the FDA in their applications. As a result, potentially unreliable data is being used to promote drugs on which billions of dollars and thousands of lives may ride.

Trust no one!

Ref:
Reporting Bias in Drug Trials Submitted to the Food and Drug Administration: Review of Publication and Presentation [PLoS Medicine]

More than 33 million people around the world are currently living with HIV and AIDS. Strikingly, many adults with HIV or AIDS don’t know that they are carrying the virus. US doctors now propose expanding the use of HIV tests to slow the spread of infection.

read more | digg story

An old school buddy sent me this one. Enjoy!!

At 85 years of age, Roger married Jenny, a lovely 25 year old. Since her new husband is so old, Jenny decides that after their wedding she and Roger should have separate bedrooms because she is concerned that her new but aged husband may overexert himself if they spend the entire night together.

After the wedding festivities, Jenny prepares herself for bed and the expected knock on the door. Sure enough the knock comes, the door opens and there is Roger, her 85 year old groom, ready for action. They unite as one. All goes well, Roger takes leave of his bride and she prepares to go to sleep.

After a few minutes, Jenny hears another knock on her bedroom door and it’s Roger, again he is ready for more action. Somewhat surprised, Jenny consents for more coupling. When the newly weds are done, Roger kisses his bride, bids her a fond good night and leaves.

She is set to go to sleep again but, aha you guessed it - Roger is back again, rapping on the door and is as fresh as a 25-year-old, ready for more action. And once more, they enjoy each other.

But as Roger gets set to leave again, his young bride says to him, ‘I am thoroughly impressed that at your age you can perform so well and so often. I have been with guys less than a third of your age who were only good once. You are truly a great lover, Roger.’

Roger, somewhat embarrassed, turns to Jenny and says: ‘You mean I was here already?’.

The moral of the story:

Don’t be afraid of getting old, Alzheimer’s has its advantages.

While we are on the topic of depression and psychiatric illnesses amongst medical staff, you might be interested to know that there is a recent Finnish study which shows a correlation between overcrowding in wards and antidepressant use - by medical staff.
The investigators correlated bed occupancy with the number of new antidepressant prescriptions filled by staff . Overcrowding was considered to have occurred when the ratio between inpatient days and available beds within a 6-month period exceeded 85%. The degree of overcrowding showed a linear relation to the risk for new antidepressant prescription among staff. An overcrowding level greater than 10% in a 6-month period was associated with a 1.7 times greater risk for new antidepressant prescriptions.

As junior doctors are working in busy government hospitals where overcrowding is the norm, perhaps data like this should prompt the MOH to wake up to the fact that the intolerable working conditions are indeed a occupational hazard and it impacts on the mental well-being of their employees?

Ref:
Overcrowding in hospital wards as a predictor of antidepressant treatment among hospital staff. Am J Psychiatry. 2008 Nov;165(11):1482-6.

How would you feel if your doctor told you that you have such and such a disease and there is treatment but the medicines alone will cost you something like RM 15,000 a month? Think that is shocking? There are also medications nowadays which cost like RM30,000 a month!!
The pharmaceutical industry and the way drugs are being developed and marketed could be regarded as being in dire need of revamping. Too many medicines these days are becoming so expensive they are out of reach of the ordinary working folk. Governments, and that includes Malaysia, are increasingly balking at the high drug costs and are reluctant to foot the entire drug bill.
The WHO is already sounding out a warning that Essential medicines out of reach for most people

An alarming lack of availability of essential medicines in the public sector drives patients to pay higher prices in the private sector or go without, according to a WHO study reported in today’s online edition of The Lancet. The results confirm that governments must do more to improve access to essential medicines as part of their efforts to make national health systems more efficient and equitable.

The study analysed data from surveys in 36 countries from all WHO geographical regions and World Bank income groups. Results show an average public-sector availability of only 38% across surveys. This forces patients to buy medicines from the private sector where treatments are more expensive and frequently unaffordable. In Africa, for example, the lowest-paid government worker needs to spend two days’ salary each month to purchase diabetes treatment using the lowest-priced generic medicine. When the originator brand is used, costs escalate to over eight days’ wages.

We can save costs by using effective generics. But for some disorders, the original medicines are still covered by patent rights and they are costly. The mark-up can be zero to minimal for these expensive medicines and yet they will be out of reach for the average worker unless some other form of funding can be found.
I still think this is one of the important reasons why a National health insurance or financing system needs to be urgently implemented. If the Health Minister really wants to make an impact during his tenure, kick-starting the NHIS would be a great achievement.

(image from Michelle Au’s Twelve Types of Medical Students)

Doctors were once medical students and the Physicians for Peace and Social Responsibility (PPSR) claims that those who studied abroad in a foreign language are particularly prone to depression when they return to Malaysia, facing a “cultural shock”.

Physicians for Peace and Social Responsibility (PPSR) vice-president Datuk Dr Abdul Hamid Abdul Kadir said that large numbers of young Malaysians were being trained in foreign medical schools in Indonesia, Russia, India, Poland, Britain and the Republic of Ireland.
At a forum on Saturday organised by the PPSR, it was highlighted that at least five such houseman are found to suffer from mental illnesses every month.
“These countries have varied systems of medical training and different types of patient care, based on the emphasis of the country. As a result, many of the students who go there undergo a culture shock,” said Dr Abdul Ha­­mid.
“Coming from different universities, backgrounds and experiences, they have difficulty relating and working, especially the weaker students,” he said, adding that there had been a sudden sprouting of many public and private medical schools.

I am not sure whether it is the “culture shock” or whether it is the quality of the students and the quality of their undergraduate training which determines how prepared they are to face up to and cope with the stresses of housemanship and working life. Their attitude towards and aptitude for medicine will be particularly significant. Those who did medicine out of “parental pressure” or just for the “Dr.” title would perhaps be confronted with the stark realities of the hard life of a scut monkey.
So do you think the inherent characteristic of the medical student or his or her training determines the ability to cope with mental pressures of working life as a doctor?

December 1st is World AIDS Day. The ongoing theme carried forward from the previous year is “Leadership” and this years campaign slogan is “Stop AIDS. Keep the Promise.””

Meet the Rotarix bear!

According to this report from The Star At least five doctors to suffer from mental woes every month

Every month, at least five doctors are found to be suffering from mental illnesses, director-general of health Tan Sri Dr Mohd Ismail Merican said.
He said these doctors were either psychotic or neurotic but still managed to get into medical schools because these schools were not screening students meticulously enough.
“When the doctors complete their two-year housemanship and their applications are submitted for registration with the Malaysian Medical Council (MMC), they fail to get registered.
“Their supervisors do not certify them as fit to be registered because of indiscipline and poor attitude arising from mental health problems.
“The mental cases range from psychotic to neurotic. Psychotic cases include delusions and hallucinations, and neurotic behaviour includes anxiety, fear and anger due to the competitive environment,” said Dr Ismail.

I think there is no perfect screening system. Medical school itself is stressful and students have been known to break down and give up half way to do other courses. There are those who have had “nervous breakdowns” and psychotic illnesses triggered by the rigors of medical school life.
I also wonder how many have been discovered in the Ministry of Health?
Many would agree that clinical work is more stressful than non-clinical. Perhaps those more susceptible to stress end up doing administrative work and hence the MOH