What We Should Know About Vaping?

Smoking is a known health issue. Evidence has shown that besides the nicotine which is responsible for the addiction to smoking, each cigarette stick contains over 4000 chemicals which are toxicants and carcinogen (can cause cancer). Smoking has been related with many diseases like COPD, ischaemic heart disease cancer of the lungs, prostate, breast and in asthmatics it worsens the condition. All these effects are also seen amongst the second hand smoke ii the people who breathes in the smokes produced by the people smoking around them.
Smoking evolves from burning tobacco which is wrapped with a leaf (rokok daun) to what is available now. Similarly interventions and activities to quit smoking evolve. From counselling and behaviour therapy to NRT (Nicotine replacement therapy) and pharmacotherapy (eg: varenicline). Along the way E cigarettes has been produced and it too evolves from appearing exactly like a cigarette stick to the present e cigarette which is better known as Vape.
Why E cigarette or Vape?
Majority uses E cigarettes because they:
1. Want to stop or quit smoking
2. Feel Vaping or e cigarette is safer
3. Believe Less addictive
4. Want to flow with the currents trend
5. Have more freedom to use in public places
6. Think it has Less effect to people around them (second hand vapers)
7. Believe it is Cheaper,
And for various other reasons like for fun, it’s the technology and youngsters used it out of curiosity!
Facts on vaping.

A. Is it true that Vaping or smoking e cigarette is safe
  1. Vaping is still not safe, even though it contains lesser harmful chemicals (toxicants & carcinogens) compared to conventional cigarettes. The prophylene glycol which is responsible in producing the vapours, will be converted to acetaldehyde (ex: formaldehyde which is used to preserve dead body) when burnt. There are studies on industrial use of propylene glycol and exposure to theatre fog (produced from prophylene glycol) that show negative health effects. These effects include throat and eye irritation, cough, mild airway obstruction, headache, and dizziness. So, inhalation of this humectant is not as safe as most people think.
  2. The problems with the labs studies that examined the presence of toxicants & carcinogens in e-cigarettes only tested for known toxicants and carcinogens of conventional cigarettes. Other impurities or by-products of heating e-juices are not known.
  3. You can become a drug addict by vaping! There has been a recent news about the juices has drugs added to it to increase its effects when used. You may start vaping to quit smoking or out of curiosity but end up a drug addict.
B. People can get addicted to vaping

As mentioned earlier the chemical responsible for addiction is nicotine. It has been found that even the e juice labelled as nicotine free contain certain amount of nicotine. Studies have shown that people do not use vape forever. Majority quit vape. They end up smoking conventional cigarettes.

C. Are people around the e cigarette vaping affected?

There are studies which show that vaping changed the air quality around them. The concentration of PAH (polycyclic aromatic hydrocarbon) increases. Another study also found an increase in serum cotinine in the ‘second hand’ vaping. Unfortunately there are no studies to confirm the long term impact of vaping to the people around them. Let’s make sure our children and spouses are not the ‘guinea pigs’ for this study.

D. What is the issue with our children and adolescents?

Adults may vape to quit smoking. However adolescents do it out of curiosity, to fit in with the peer group and to follow the trends. This will not be for long until they become dependent on nicotine and later become chain smoker although they might not have planned to smoke in the first place. This is actually another public health concern. Vaping can cause gateway to nicotine addiction/ smoking conventional cigarettes especially among adolescents’.

E. Can E cigarette be used to quit smoking?
  1. There are evidences that demonstrate ‘vaping can help smoking abstinence or cessation’. It showed that vapers had 2.2 times the chance to stop smoking conventional cigarettes for at least 6 months compared to smokers who do not vape.
  2. However, vaping still allows maintenance of nicotine addiction. Vapers still receive nicotine from e-cigarettes. Studies that examine its effectiveness as a treatment of smoking cessation (comparing with NRTs and Champix) are also lacking.
  3. So, it’s effectiveness as a treatment for smoking cessation (like nicotine replacement therapy) is still not proven. One of the possible reasons because the amount of nicotine that the vapers get from inhaling the vapours are varied, and it is quite difficult to titre down the concentration of nicotine. Even though they use the lowest concentration labelled on the bottles of e-juices, it is not guaranteed that they inhale nicotine of the stated concentration.
  4. The concentrations of nicotine are different from puff-to-puff, and across the brands and models of e-cigarettes.
  5. Furthermore, this smoking abstinence may not be sustainable as studies have shown that substantial number of vapers does relapse to smoking conventional cigarettes due to many reasons.
F. Vaping can be hazardous

The latest news on the hazards caused by vaping is the fire in a flight which developed from a vape kept in the pocket in one of the passenger. It has been reported that the device explodes while using causing injuries to the users hand and face

Ingestion of the ejuice can be fatal. It can cause nicotine toxicity. The initial symptoms are mainly due to stimulatory effects and include nausea and vomiting, excessive salivation, abdominal pain, sweating, low blood pressure, increased heart rate, tremors, headache, dizziness, muscle fasciculation and seizures. Later the depressor effect will take place where it causes low blood pressure, low hear rate, muscle weakness/paralysis, difficulty in breathing, central nervous system depression and coma
To really combat problems with nicotine addiction, it must involve all bodies, organisations, employers, and even all Malaysians to create a norm that ‘smoking or vaping is unacceptable’. For those who have chosen a wrong step in the past and already addicted to nicotine, their struggle to free themselves from this addiction should not be undermined. We have to help them to treat their nicotine addiction by ensuring that they can appreciate their risks of smoking, helping them to overcome their barriers, providing them necessary skills to change their habits and psychological dependence, and prescribing the proven effective pharmacotherapy. As majority of the smokers are in pre-contemplation stage, doctors should be trained to provide counselling for these smokers so that they want to stop smoking. Doctors should be trained to provide effective interventions for smoking cessation. Doctors should also be provided with adequate medication and non-pharmacological assistance for treating nicotine addiction. Smokers need to be assisted adequately to quit and their difficulties in the battle must be taken care and intervened as best as possible. The most important thing is we should aim for no smoking and no vaping. Smokers need to come forward to seek help and get rid of their addiction problem.
As vaping device can also be used to inhale illicit drugs openly without being notice by narcotic enforcement team and our country Malaysia is well known to have strict drug law hence any possibility of facilitating illicit drug use must be taken action seriously. In fact it was recently discovered by the ESERI, Universiti Sultan Zainal Abidin Terengganu that vape liquid studied in the laboratory also contain cannabis precursor (both synthetic and natural).

In conclusion smoking conventional cigarette and vaping are both addictive and harmful. Although the cigarette and vape industries may create great wealth to some, we must always remember, our greatest wealth is health.

SAY NO TO NICOTINE. SAY NO TO TOBACCO

By,
Dr Salmah Nordin & Dr Hizlinda Tohid
Family Medicine Specialists Association Malaysia (FMSA)

An open letter to the Members of Parliament of Malaysia

13 November 2015

An open letter to the Members of Parliament of Malaysia

We, the undersigned medical professional bodies and non-governmental organisations, would like to register our concern regarding the increasing presence of electronic cigarettes and vaping in our society. We note with dismay the Cabinet’s rejection of the Ministry of Health’s proposal to ban the sales and use of electronic cigarettes.

1. Malaysia proudly signed and ratified the World Health Organisation’s Framework Convention on Tobacco Control (FCTC). This is a reflection of the nation’s commitment to protect present and future generations from the devastating effects of tobacco, a product that kills 6 million users annually. In Malaysia alone, eight individuals are killed daily due to tobacco and many more are affected by the significant health, social, economic and environmental costs.

2. It is a commonly held but misleading view that electronic cigarettes and vaping are safe. However, due to the lack of any form of quality control, equipment malfunction (include explosions leading to death) have been reported. The content of electronic cigarette ‘juice’ also varies depending on the manufacturer, with studies demonstrating a huge variability in toxin content and nicotine delivery. Even claims that the colourings used are safe are misleading as most consist of industry-certified food dyes, which can be safely swallowed but not necessarily safely inhaled.

3. The increasing use of electronic cigarettes, ostensibly as a smoking cessation tool, is not backed by current scientific evidence. Although the potential for harm reduction is an opportunity not to be missed, we must be careful that we are not substituting one form of addiction for another. At present, scientific evidence indicates that most individuals end up being dual users – i.e. using electronic cigarettes and tobacco at the same time. We are cognisant of the harmful effects of nicotine dependence, which is why it is a Group C Poison under the Poisons Act 1952.

4. The use of electronic cigarettes does not solve the problem of nicotine addiction. This problem is compounded by the fact that electronic cigarettes are gaining popularity amongst youth. Studies from the United States have demonstrated that children are increasingly using electronic cigarettes and that these same children are more likely to eventually smoke tobacco. In other words, the use of electronic cigarettes is a gateway to lifelong nicotine addiction.

5. It is clear that many products are targeted at younger sections of society despite claims to the contrary. Electronic cigarettes are sold with attractive colours and flavours, with marketing very similar to that employed by the tobacco industry in decades gone by. The sexualisation of the product with advertisements consisting of scantily-clad women and flavours such as ‘the taste of a virgin’ and ‘nenen’ (breast milk) also points to a worrying trend that is against the cultural norms of our beloved nation.

6. It is because of these factors that we welcome the statement by the Health Minister, Datuk Seri S Subramaniam, regarding the Ministry of Health’s long-term aim to ban electronic cigarettes. We truly believe that this move is for the benefit of our rakyat’s health. It is also in keeping with similar moves by our neighbours in the region, namely Singapore, Thailand and Brunei.

We are aware of allegations that this move is a result of lobbying by the tobacco industry, but it should be pointed out that most electronic cigarettes are manufactured by tobacco companies. Furthermore, we welcome the statements by YB Khairy Jamaluddin (Minister for Youth and Sports) and Datuk Dr Lokman Hakim, Deputy Director-General for Public Health, that a ban of electronic cigarettes should be in tandem with a ban of tobacco.

We call upon Parliament, as the most august law-making body of the land, to take the above points into consideration and to take into account the following proposals:

I. restrictions be immediately put in place for the retail sales and public use of electronic cigarettes and vaping
II. a discussion in Parliament in the foreseeable future regarding the need to implement a ban for both electronic cigarettes and tobacco
III. introduction of retail licensing for tobacco products retailers
IV. ensure that restrictions and bans are enforced rigorously without fear or favour
V. ensure that a fixed proportion of taxes and excise duties raised from tobacco sales are used exclusively for tobacco control efforts
VI. continuous increase in tobacco taxes and electronic cigarettes alongside related paraphernalia
VII. support access to smoking cessation services, including subsiding the cost for treatment. We are aware that more than 50% of current smokers in Malaysia are keen to quit, and it is our duty to help them achieve abstinence

We reiterate the point that it is misleading to say that the effects of electronic cigarettes on our health and society is minimal. We must learn from the mistakes made during the public health efforts against tobacco, in which it took decades for the true costs of tobacco to society to be made public.

The health of Malaysians today and tomorrow is too precious a commodity to be gambled. We urge the Members of Parliament from across the political spectrum to set aside their differences and support the Ministry of Health’s efforts in prioritising the health of the rakyat above all else.

Issued by:
The Malaysian Thoracic Society (MTS) on behalf of the following medical
professional bodies and non-governmental organisations:
Academy of Medicine of Malaysia Addiction Medicine Association Malaysia (AMAM)
Asia Pacific Academic Consortium for Public Health Kuala Lumpur
College of Public Health Medicine
Consumer Association of Penang (CAP)
Faculty of Medicine, Universiti Mal
Faculty of Medicine, Universiti Kebangsaan Malaysia
Faculty of Medicine, Universiti Teknologi Mara
Family Medicine Specialists Association (FMSA)
Federation of Malaysian Consumers Association (FOMCA)
Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM)
Ikatan Pengamal Perubatan dan Kesihatan Muslim Malaysia (I-Medik)
Islamic Medical Association of Malaysia (IMAM)
Islamic Renaissance Front (IRF)
Lung Foundation of Malaysia (LFM)
Malaysian Academy of Pharmacy
Malaysian Adolescent Health Association (MAHA)
Malaysian Animal-Assisted Therapy for the Disabled and Elderly Association (PETPOSITIVE)
Malaysian Association for Bronchology and Interventional Pulmonology (MABIP)
Malaysian Association of Environmental Health
Malaysian College of Physicians
Malaysian Council for Tobacco Control (MCTC)
Malaysian Association of Dental Public Health (MADPH)
Malaysian Green Lung Association
Malaysian Gynaecological Cancer Society
Malaysian Medical Association (MMA)
Malaysian Paediatric Association (MPA)
Malaysian Pharmaceutical Society (MPS)
Malaysian Psychiatric Association (MPA)
Malaysian Thoracic Society (MTS)
Malaysian Women’s Action for Tobacco Control & Health (MyWATCH)
Medical Practitioners Coalition Association of Malaysia (MPCAM)
National Cancer Society Malaysia (NCSM)
Pemuda dan Wanita Ikatan Muslimin Malaysia (ISMA)
Penang Medical Practitioners’ Society
Persatuan Belia Islam Nasional
Persatuan Doktor Pakar Kesihatan Awam Malaysia
Persatuan Pakar Perubatan Islam Malaysia (PAKAR)
Persatuan Pengguna-Pengguna Pengangkutan Awam Malaysia (4PAM)
Pertubuhan Amal Perubatan Ibnu Sina Malaysia (PAPISMA)
Pertubuhan Doktor-Doktor Islam Malaysia (PERDIM)

It’s going to be family docs first, says minister

Datuk_Dr.S.SubramaniamMALACCA: The Government is set to revive the concept and role of the family physician as the “first line” of healthcare for the people.

Health Minister Datuk Seri Dr S. Subramaniam said the approach would see patients being treated and diagnosed much earlier.

“This approach is to ensure that the people keep healthy by seeing their family physicians regularly and not when they are already seriously ill,” he told reporters after a two-day conference here yesterday with stakeholders on the ministry’s future direction over the next four years.

Dr Subramaniam said the decision to revive the concept was decided at the conference.

The Government, he said, would empower health clinics nationwide to realise the practice of family physicians.

“Higher allocations would be given to existing health clinics for them to be better equipped.

“Appropriate training on family medical healthcare will also be given soon for doctors and other staff,” he added.

Dr Subramaniam said the practice of having family physicians used to be the norm in the old days, where every member of a family were seen by a family doctor who was familiar with their medical history.

The ministry, he said, was also looking into a proper bridging mechanism to utilise all facilities available in the public and private healthcare system.

Becoming a Family Medicine Specialist in Malaysia

Written by Dr Far Ari Lately a few friends have approached me with regards to becoming a Family Medicine Specialist in Malaysia. I hope the information here will be beneficial to all Although General Practitioners (GP) have been around for the longest time in Malaysia however, the recognition and training of Family Medicine Specialist (FMS) in […]

Role Empowerment For Family Doctor – Dr S Subramaniam

Datuk_Dr.S.SubramaniamMELAKA, Oct 20 (Bernama) — The role of the family doctor would be empowered within four years to correspond with the health ministry’s initiative to strengthen its frontline services.

Datuk Seri Dr S Subramaniam said with the initiative starting early next year, diseases could be detected and treated at an early stage by family doctors, thereby reducing the number of patients receiving treatment for serious illnesses in the hospitals.He said family doctors both in government and private clinics were an important component in the health frontline services as they were responsible for ensuring the success of disease prevention efforts in society.”At one time we practised the ‘favourite doctor’ concept where we have a specific doctor from whom we seek treatment whenever we fall sick, from the time we were still single until we become grandparents and then bring our grandchildren to see the same doctor.

“This is a good concept because the doctor knows the medical history of the whole family. But this has faded away over time,” he told reporters after chairing a two-day health conference which ended Sunday.

Asked whether there would be sufficient doctors to cater to the family doctor concept, he admitted there was a shortage but that the ministry was making efforts to overcome it.

“We are in the midst of enhancing our skills and training system to produce more family doctors, also discussing on expanding the scope of the doctor to increase family medical specialists…we can’t have a speedy solution because it takes time to produce a good doctor,” he said.

— BERNAMA

ACCORD: Insulin exposure not an independent risk factor for CV mortality

Published June 28, 2013 at Healio Cardiology

Elias S. Siraj, MD, FACP, FACECHICAGO — Results from a post-hoc analysis suggest that higher insulin doses were not responsible for the increased CV mortality found in the ACCORD trial, a presenter said at the ADA Scientific Sessions.

Main results from ACCORD demonstrated an association between increased all-cause and CV mortality in patients assigned to intensive treatment for diabetes, but several post-hoc analyses have been unable to pinpoint the cause, according to Elias S. Siraj, MD, FACP, FACE, associate professor of medicine, director of the diabetes program and director of clinical endocrinology at Temple University School of Medicine.

Elias S. Siraj

“This presented the diabetes community with a huge puzzle that challenged us to figure out why we are seeing these results,” Siraj, who presented the data, said during a presentation.

Researchers have, however, identified a link between increased mortality and higher HbA1c in the intensive treatment arm, prompting Siraj and colleagues to hypothesize that higher doses of insulin in these patients may have contributed to increased CV mortality.

The researchers examined insulin exposure data in units/kg of body weight from 10,163 patients with a mean follow-up of 5 years. Data from an unadjusted univariate analysis implicated insulin exposure in the increased risk for CV mortality. HRs for all insulin, basal insulin and bolus insulin were 1.83 (95% CI, 1.45-2.31), 2.29 (95% CI, 1.62-3.23) and 3.36 (95% CI, 2.00-5.66), respectively. However, after adjustment for 14 baseline characteristics, including age, history of CVD, complications of diabetes and baseline HbA1c, these associations were no longer statistically significant. HRs declined to 1.21 (95% CI, 0.92-1.6) for all insulin, 1.3 (95% CI, 0.87-1.94) for basal insulin and 1.65 (95% CI, 0.88-3.11) for bolus insulin, according to the study abstract.

Siraj reported that, consistent with prior analyses of all-cause mortality, higher HbA1c remained associated with higher CV mortality before (HR=1.38;. P<.0001) and after adjustment for baseline variables and insulin exposure (HR=1.49; P<.0001).

“In conclusion, after adjustment for covariates, insulin dose was not associated with increased CV morality, and these results do not support the hypothesis that higher dose of insulin is an independent risk factor for CV mortality,” Siraj said. – by Melissa Foster

For more information:

Siraj ES. #386-OR. Presented at: ADA Scientific Sessions; June 21-25, 2013; Chicago.

Disclosure: Siraj reports receiving honoraria for speaking or consulting from Boehringer Ingelheim, Merck and Sanofi.

Sad Story about Vaccination Programme

  1. Disember 2012, kelompok ekstrimis Muslim telah membunuh 7 orang pekerja kesihatan hanya disebabkan mereka memberi vaksin polio dalam program eradikasi polio di Pakistan. Golongan ini berpendirian bahawa pemberian vaksin adalah tidak Islami ditambah dengan sentiment anti-Amerika yang memuncak. Barat dan Amerika dituduh berselindung disebalik program eradikasi ini sebagai program risikan. http://www.aljazeera.com/news/asia/2012/12/2012121962433106974.html
  2. FIMA (Federation of Islamic Medical Association), gabungan persatuan doktor-doktor perubatan Muslim sedunia, sebagai respon mengeluarkan Deklarasi Kaherah berkaitan program eradikasi polio pada persidangannya Februari 2013 yang menggesa alim-ulama’, pemimpin masyarakat dan lainnya menyokong program ini serta membantah pembunuhan tersebut sebagai suatu tindakan diluar batas. Bersalahan dengan prinsip Islami malah manusiawi. http://fimaweb.net/cms/index.php?option=com_content&view=article&id=349%3Acairo-declaration-for-polio-eradication-&catid=37%3Afima-news&Itemid=196
  3. Bulan yang sama (Februari 2013) juga berlaku kes pembunuhan petugas kesihatan yang menjalankan program eradikasi polio di Nigeria. Sekumpulan ulama’ membantah keras program tersebut dan mengaitkan pemberian vaksin polio boleh menyebabkan kemandulan. Sekali lagi asas penentangan adalah anti-perubatan moden serta rasa sangsi keterlaluan terhadap Barat. http://www.aljazeera.com/news/africa/2013/02/201328103718172375.html
  4. Keganasan terhadap petugas dan sukarelawan program eradikasi polio terus berlaku. May 2013 yang lepas, seorang lagi dibunuh. Pekerja-pekerjakesihatan ini secara simplistik dituduh sebagai pro-Barat atau tali barut Amerika. http://www.nytimes.com/2013/05/29/world/asia/anti-polio-campaign-worker-shot-dead-in-pakistan.html
  5. Kelompok yang memainkan sentimen anti-vaksin sudah cuci tangan. Kesannya bakal dihadapi bersama.

Leading Clinicians and Clinicians Leading

Richard M.J. Bohmer, M.B., Ch.B., M.P.H.

N Engl J Med 2013; 368:1468-1470 April 18, 2013DOI: 10.1056/NEJMp1301814

Stubbornly high costs and the expected care needs of aging baby boomers make more effective models of care delivery a pressing need. Unfortunately, new models often perform below their potential. Their designs — usually comprising some combination of alternative sites of care or caregivers, new care processes, and enabling technologies — promise global improvements in quality or cost. But successful implementation depends on two local factors: effective care teams and good management of local operations (“clinical microsystems”). Clinicians influence both.

The prospects for care redesign and performance improvement depend on clinician leadership in units, wards, clinics, and practices. Models such as accountable care organizations and patient-centered medical homes presume capable leadership and management. Better organizational performance improves health outcomes, and clinical leadership affects performance. Calls for leadership are common, but the specifics of which clinicians need to do what remain unclear.

Although heads of medical and nursing departments have obvious leadership roles, the need for leadership by clinicians deeper in the organization — usually without any formal title, authority, or leadership job description — is increasingly recognized. Clinical microsystems are composed of and controlled by front-line clinicians whose primary work is patient care. Although many have little interest in leading, the success of health care reform depends on them.

Most definitions of leadership include a focus on a shared goal, dependence on others’ actions to reach that goal, and a lack of direct control over others. Leaders create conditions that enable and encourage others to achieve a shared goal through collective action — a challenge in health care, since most clinicians were schooled as individualists, don’t necessarily view the goal as shared, and generally feel more accountable to professional bodies than local hierarchies.

Front-line clinicians leading local systems have four key tasks. The most important is to establish the group’s purpose by emphasizing that the goal is shared and the action needed is collective. Many clinicians presume their organization’s purpose is to provide patients with services, and them with clinical resources. Transactional performance measures such as clinic volumes or procedures per operating-room day have reinforced an individualistic perspective. However, recent policy shifts toward population accountability, global budgets, value-based purchasing, and outcome measurement have put a premium on teamwork.

In this environment, defining the purpose isn’t the exclusive domain of chief executive officers (CEOs). Local leaders must help identify care goals that unify diverse multidisciplinary teams and align these with the patient’s health goals, the local environment’s financial demands, and the wider organization’s mission.

The second task is ensuring that clinical microsystems can execute to achieve these goals. Local care systems must address two perceived tensions — one between evidence-based medicine and patient-centered care, which requires the flexibility to deliver standard care where the evidence is strong and customized care where it isn’t, or when standard care conflicts with the patient’s preferences; and one between medical and human needs, by ensuring caring and compassion as well as clinical precision.

These requirements may suggest that creating an effective microsystem is a technical design challenge: recruiting, staffing, task allocation, information technology selection, and process design. But since a microsystem’s performance is as influenced by its culture as by its processes,1 the challenge is one of leadership. The team’s culture guides decision making where protocols fail to provide appropriate variation and encourages compassion in technical settings. And the way local clinical leaders speak and act to model the balance between standard and custom, technical and human, helps define local team culture.

The clinical leader’s third task is monitoring system performance. Complex systems demand day-to-day control to ensure that inappropriate variation is minimized, quality and efficiency remain high, improvement opportunities are identified and seized, and microsystems meet patients’ needs.

For most clinicians, control at a distance — reviewing aggregate process and outcome data and influencing others’ behavior — is challenging. They may be unfamiliar with financial statements or quality-measurement science. Historically, professional etiquette has discouraged explicit judging of peers. Yet recent experience suggests that detailed population-specific data and unblinded peer comparisons discussed in small groups can help reduce inappropriate variation and improve quality and efficiency. Applying this insight can require explicitly setting expectations and calling close colleagues to account. Yet to be effective, a clinical leader must do exactly that.

The final task is improving performance. Neither financial pressure nor the push of new technology will abate soon. The productivity enhancement required to meet future demands with existing resources necessitates innovation and improvement in the execution of health care. Clinical leaders must model the combination of humility, self-doubt, restless curiosity, and courage to explore beyond accepted boundaries that drives organizations to relentless improvement despite colleagues’ preferences for stability and familiarity.

Faced with these challenging tasks, how can a leader lead? Clinicians might take on the role more easily if they were in charge or were the acknowledged experts. But few clinicians have access to such tools of authority as budget control or hiring-and-firing ability, and often medical expertise is only one of the elements required to meet patients’ needs and achieve shared goals. Typically, other team members have greater expertise in their fields — including such disciplines as operations management — than the leader.

Clinical leadership of expert peers involves inviting the team to define its purpose and design the most effective way of achieving it. Leaders create an appropriate environment, guide the conversation, and occasionally choose among competing options. Clinical leaders are simultaneously part of the team and apart from it.

Without formal authority, the only tool that clinical leaders have is their behavior: what they say, how they say it, and how they model good practice. The choice of language2 — expressing the team’s purpose in terms of creating value, curing disease, preventing harm, and caring for patients — and even tone of voice are essential leadership tools. Above all, leading peers in the four key tasks requires asking questions: “What are we trying to achieve?” “What is the best way to achieve it?” “Are we getting the desired results?” “What can we do to get even better results?” And “are our systems keeping patients safe?”

This model of clinical leadership runs counter to much current practice. A focus on promoting collective action, ceding control to the team, and showing the way by asking others how to get there are contrary to mainstream medical training and culture and the current tort environment. In many places, accepting a clinical leadership role brings a loss of status and income as well as disdain from peers. Although leadership is making its way into clinical training, the workforce of the near future is already practicing. How can senior leaders enable and encourage front-line leadership among today’s clinicians?

Surveys suggest that clinicians want a greater leadership role but feel unprepared3 or disempowered.4 Institutional leaders can encourage and support unit-level and front-line clinical leadership by framing the organizational purpose as value creation, giving local leaders the authority to make microsystem changes, tolerating the failure of some new delivery ideas, and creating professional pathways for clinicians who want to make leadership a career option. But data remain the single most important motivator and tool for a clinical leader. High-quality, comparative, unit-level and individual-level clinical and financial data5 can both create the need for clinician leadership and be the starting point for the four tasks. Other critical resources include protected time, training and mentorship (provided by many academic centers either in house or through collaboration with professional societies and business schools), and clear organizational expectations of clinician performance.

CEOs may resist investing in developing clinical leadership and decentralizing control or may believe the process will be too slow to address current pressures. But the need is evident, the tasks are clear, and the skills are at hand — data orientation, the relentless pursuit of excellence, and a habit of inquiry are all second nature to clinicians. Ultimately, investment in such leaders will be essential to achieving the goals of health care reform.

Message from FMSA President

From the moment I took office as the FMSA President, I have made a promise to deliver the best that I can. Alhamdullilah, many of the activities have been running well. All this is important. But even as we’ve made progress, we know that the road to prosperity remains long and it remains difficult. And we also know that essential step on our journey is to control the spiraling cost of health care in Malaysia and to ensure quality service delivery to all citizens.
When it comes to the cost of our health care, then, the status quo is unsustainable. So reform is not a luxury; it is a necessity. When I hear people say, well, why we need the reform, our health care system is okay? Many of us with MOH are not bothered about this issue and too complacent. I like to remind people that it would be lovely to be able to defer these issues, but we can’t. I know there’s been much discussion about what reform would cost, and rightly so. This is a test of whether we — Malaysians — are serious about holding the line on new spending and restoring financial regulation.
But let there be no doubt — the cost of inaction is greater. If we fail to act and you know this because you see it in happening in our practices and the private GP practices. If we fail to act, the insurance premiums will climb higher, benefits will erode further, the rolls of the uninsured will swell to include millions more Malaysians — all of which will affect our practice.
And if we fail to act, government (MOH) spending will grow over the coming decades. It will, in fact, eventually grow larger than what our government spends on anything else today. It’s a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, or overwhelming deficits, or drastic cuts in our federal and state budgets.
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Malaysia – Achieving the Millennium Development Goals Successes and Challenges

At the United Nations Millennium Summit held in New York in September 2000, world leaders committed to strengthening global efforts for peace, democracy, good governance, and poverty eradication, while continuing to promote the principles of human rights and human dignity. The Millennium Declaration, building on the outcomes of the international conferences of the 1990s, made a strong commitment to the right to development, to gender equality, to the eradication of the many dimensions of poverty, and to sustainable human development.

This report traces in detail Malaysia’s performance over the period since 1970, adopted as the benchmark year for this report, in accomplishing a number of key national developmental goals, many of which were later adopted under the banner of the MDGs. The publication makes use of illustrative and helpful charts and diagrams while mapping each goal to policies and programmes that have been put in place to support the achievement of these targets. It  further explores Malaysia’s position relative to its regional neighbours and highlights challenges moving forward which need to be addressed in order to ensure that the MDGs are achieved in all communities in the country.

more http://www.un.org.my/0912010200%C2%BBMDG_Reports.aspx