Cancer: More needs to be done



At the  the World Cancer Congress 2018, Kuala Lumpur.

Cancer is the fourth most common cause of death in Malaysia with approximately 37,000 cases reported every year. This is estimated to rise to more than 55,000 newly-diagnosed cases by 2030.

Cancer is responsible for 12.6% of all deaths in government hospitals and 26.7% in private hospitals.

The data and findings from the Health Ministry’s Malaysian Study on Cancer Survival (MySCan), which was released at the conference, make for grim reading.

The first population-based cancer survival report in the country aimed to help guide the development of cancer control strategies, it describes poor survival rates of patients who presented late for treatment, specifically at Stage 3 and 4.

Despite existing screening facilities and programmes, those with breast, cervical and colorectal cancers were coming forward late at 41.3%, 38.5% and 63.8% respectively.

Within the period of the report, around 43% of women diagnosed with breast cancer died; for individuals with cervical cancer, it was 56% and 52% for those with ovarian cancer. Nine out of 10 lung cancer patients did not make it.

Gastrointestinal cancers have an average survival rate of less than 40%. Those of the nasopharynx, which badminton ace Datuk Lee Chong Wei is currently battling, also had a similar number.

With such data, it is not surprising that Malaysia has one of the highest mortality to incidence ratio for breast cancer in South-East Asia.

Besides late presentation of disease, insufficient facilities and specialists (particularly outside urban areas), lack of access to innovative surgical, radiotherapeutic and oncological treatments contributed towards this sad state of affairs.

Compounding these factors are complications caused by financial catastrophe and the lack of allied health professional networks.

It is in this spirit that during the pre-Congress event, “Advancing an agenda of hope and action on cancer in Malaysia”, jointly organised by Galen Centre for Health & Social Policy and the National Cancer Society Malaysia, a series of concrete, short-term and long-term policy recommendations for members of parliament and policy makers was launched.

Developed by Malaysian cancer patients, these recommendations are intended to make policymakers take heed and seriously respond to specific challenges which affect cancer treatment and care in the country.
Five short-term recommendations, which can be achieved with minimal effort, were highlighted as low-hanging fruit for the new government to implement in order to demonstrate its ability to deliver on the promises of increasing the quality and depth of existing healthcare services.

These include removal of dual referral charges at public hospitals, standardisation of treatment fees across public healthcare, improving the quality and availability of national cancer data, and providing support to lower-income patients through integration of cancer screening and diagnosis as part of the Skim Peduli Sihat initiative.

There were eight long-term recommendations which require greater institutional reforms to policies, strategies and services on cancer care.

These included ensuring stronger and improved government accountability of the national cancer strategy, establishing multi-sectoral consultative and partnership mechanisms, adopting sustainable healthcare financing strategies, reforming the Social Security Organi­sation (Socso) legislation and regulations relating to cancer, improving public drug procurement policies to respond better to advances in cancer treatment, and establishment of cancer survivorship services as part of care.

To help realise these recommendations, The Cancer Care Working Group was launched as a new cancer advocacy initiative comprising patients, cancer specialists, health professionals and cancer advocates. They currently work in a number of related areas including health service delivery, research, prevention, information and support, care and treatment, and patient involvement.

The Cancer Care Working Group aims to help influence public policies to improve outcomes, treatment and care of cancer in Malaysia.

It will work towards enhancing and adding value to the government’s implementation of the National Strategic Plan for Cancer Control Programme (2016 – 2020), and campaign for action, improvements and change in cancer policy.

Most importantly, it aims to promote the voices of patients and their empowerment and meaningful participation in public policy consultations and discussions. Patients must continue to be at the centre of policy-making which directly affects them.

Perhaps with the strength of their voices, the current situation can change for the better so that more people with cancer can move from always hoping to living.

/theSTAR 05-10-2018


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Pharmacist's Role: More than Dispensing



THE role of pharmacists is beyond procurement and supply of medicine, says Deputy Health Minister Dr Lee Boon Chye.

Dr Lee said pharmacists are now involved in the production of medicine in the pharmaceutical industry in the country, as well as in the logistics and distribution of local and imported medicinal products.

He said dispensing of medicine is also evolving, and thus dispensing of drugs in government facilities, private hospitals and community pharmacies are carried out by a pharmacist together with drug treatment services, medical safety screening and monitoring of adverse effects of drugs.

“Pharmacists are also involved in clinical activities such as the management of infectious and non-infectious disease drugs.

“They help monitor drug therapy for HIV and tuberculosis patients, the use of antibiotics and monitor drugs prescribed for diabetes, hypertension, heart disease, stroke, rheumatoid arthritis, haematology and asthma.

“Pharmacists are also involved in smoking cessation and weight loss programmes,” Dr Lee said in his speech before launching the Perak state-level World Pharmacists Day 2018 at Ipoh Parade.

The history of pharmacy services in the country, he said, started in 1951 with 20 registered pharmacists, adding that in 1957 there were only 23 registered pharmacists in the public sector.

Dr Lee however said with the rapid development in the profession, the number of registered pharmacists increased yearly. “Until March this year, there are 16,210 registered pharmacists, and out of this, 7,577 work under several divisions of the Health Ministry,” he added.

State Health deputy director (pharmacy division) Leong Weng Choy, who is also Perak Malaysian Pharmaceutical Society chairman, said pharmacists play an important role in determining the success of medication treatment received as an effort to improve a patient’s quality of life.

He said a pharmacist is involved in every aspect of managing the medication, right from the drug formulation until the dispensing of the medication to patients.

As part of the healthcare team, he said pharmacists are required to be in the forefront of all issues involving medicine, health and safety of patients.

Leong said the ultimate goal of pharmacists is to ensure optimum and rational drug therapy.

“This is done through the involvement of pharmacists in the processes associated with the use of such drugs, like providing, distributing, controlling information to those who prescribe, like doctors, and to the end users."

“The responsibility of a pharmacist is becoming increasingly important with the development of new drugs by research scientists and the current challenges faced in relation to medication,” he added.

Leong said every year, thousands of drugs are prescribed to patients and almost all of the dosage are checked first by a pharmacist whether in a hospital, health clinic or community pharmacies.

He said in a mission to empower users and to increase trust among patients, users and pharmacists, several initiatives were taken by the government and the private sector.

Among the initiatives are “Recognise Your Medication” by the Health Ministry which focuses on enhancing awareness of the use of drugs rationally.

Besides that, Leong said the society has also produced posters, videos and pamphlets on the prescription rights, which could be used by pharmacists as a guide in educating patients.

/theSTAR  09-10-2018

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1% Malaysians signed up as organ donors



The number of Malaysians who have registered to become organ donors is still low, with only less than 1% having made the pledge out of 32 million Malaysians.

National Transplant Resource Centre organ and tissues procurement coordinator head Dr Omar Sulaiman said currently, a total of 25,000 kidney patients throughout the country were still waiting for compatible donors.

“Only an average of 40 patients are able to replace their damaged kidney in a year; the figure is small because we record about 1,000 kidney patients a year in Malaysia,” he added.

Dr Omar said this during the Organ Donors Week 2018 launch at Sultanah Aminah Hospital (HSA) here.

He pointed out that besides kidney patients, a total of 18 critical liver patients and six heart patients were also waiting for the right donors.

Dr Omar added that his side was doubling their effort to get more people to become donors through their “Let’s Talk” campaign.

“Many are still unaware that despite having already registered to become a donor, it does not necessarily mean that this person will have his or her organ donated when a death happens. This is because the hospital will still need to get approval from their family members or next of kin, and check on the condition of the organ before starting the process,” he added.

Dr Omar advised those who have already made the pledge to donate their organs to inform their family first to ensure their loved ones were not shocked at their decision and able to carry out their intention.

/theSTAR 11-10-2018

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Ministry of Health: "No hanky-panky in drug procurement"



The Health Ministry says allegations of drug supplies monopoly and corruption levelled against it are baseless.

However, the whistleblower who first made the allegation in June, expressed disappointment and  has given an update to The Star detailing the rising tender contracts value of drug supplies by the top six tendering agents.

A tendering agent, however, begged to differ, explaining that the procurement procedures were transparent and the use of agents was common even in other countries.

The real issue was whether tendering agents should be bumiputra agents only, he said.


On Friday (Oct 19), Health secretary-general Datuk Seri Dr Chen Chaw Min said  that the ministry had investigated the drug supply procurement procedures for hospitals and found they were carried out according to the  guidelines set by the Finance Ministry.

On the issue of the appointment of agents, involvement of politicians or senior government servants in procurement, as well as the monopoly claims, he said the matter had been referred to the Malaysian Anti-Corruption Agency (MACC) and the Malaysia Competition Commission (MyCC).

"So far, nothing out of ordinary has been reported against the ministry."

"With this statement, we hope that no parties will make any assumption or create confusion about the management of the procurement at the Health Ministry," Dr Chen said in a statement on Friday (Oct 19) in response to a Free Malaysia Today report.

The portal had reported that the whistleblower was disappointed with the lack of action after his revelation.

On June 13, The Star carried a report on the allegations in which the whistleblower provided details on high-ranking officials and companies linked to politicians said to have control over billions of  ringgit worth of medical supply to the Health Ministry.

A 12-page document was emailed to Health Minister Dr Dzulkefly Ahmad and forwarded to a few parties including The Star.

It said there were bid-rigging of open tender process, thus enabling the monopoly of medical supply.

In response to the ministry's statement on the matter, the whistleblower provided updates, saying that the top six tendering agents had, to-date, been awarded approximately RM5,934,877,317 or 92.21% of the approximate RM6,435,975,589 total tender contracts value.

The whistleblower said with the latest information, the amount was now approximately RM6.44bil for the period of 2010 to 2018 (and ongoing).

"Collectively the top six tendering agents were awarded approximately RM5,934,877,317 or 92.21% of the approximate RM6,435,975,589 total tender contracts value," he said.

The tendering agent, who disagrees with the accusations, said this was not evidence of wrong-doing, explaining that the procurement procedures were transparent and the use of an agents was common even in other countries.

The agent, who is not one of the top six, said he was surprised a pharmaceutical company would make such allegations because the procedures were transparent.

In fact, he said drug patent was the actual monopoly that is causing drug prices to be high - a legal monopoly according to the World Trade Organisation's agreement, of which Malaysia is a signatory.

Moreover, for some drugs, he said, direct negotiations were required because they were patented with no other companies producing them.

"Why would the government call for a tender if a product is patented? So, it would have to be direct negotiations," he said.

He said multinational companies might say they did not want a middle man, but a lot of countries had some sort of an agency arrangement.

Some companies were big enough to step up operations in Malaysia, some were not and would use the service of a tendering agent, he said.

"So, this requirement is actually global. Now, whether it needs to be a bumi agent or not is the bigger question.

"That is why I tell the MNCs to be clear of what they are against," he added.

He said because the six tendering companies had been around for a long time and pharmaceutical companies were happy with their services, they continue to use the tendering agents.

"If you are number 50 to 75, and you expect the licence to bring in money, then sorry, because none of the principals would want to deal with you," he said.

He said that the pharmaceutical company he represents once "got burnt" as the tendering agent did not pay up for some of the products it supplied.

"That's why I understand why MNCs are comfortable dealing with only certain agents," he said. 

/theSTAR 20-10-2018

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Malaysia: First in region to eliminate mother-to-child HIV/Syphilis transmission



Malaysia is the first country in the World Health Organization (WHO) Western Pacif­ic Region to be certified as having eliminated mother-to-child transmission of HIV and syphilis (eMTCT).


Health Minister Dr Dzulkefly Ahmad was presented with a validation certificate by WHO director-general Dr Tedros Adhanom Ghebreyesus during the WHO Regional Committee for the Western Pacific session in Manila.

With the success, Malaysia is the 12th country in the world to receive the certificate. “Malaysia has achieved a level of health it can be proud of, where the mother-to-child transmission of HIV and syphilis are no longer a key public health threat,” Dr Dzulkefly said in a statement.

He said HIV transmission from mother-to-child was the main cause of HIV infection among children.

Without intervention, between 30% and 45% of children born from HIV positive mothers would get the infection while in the womb, during delivery or through breast-feeding.

To overcome the problem, the ministry launched an infection prevention and treatment programme for the two infections.

To prevent babies from being infected with HIV through breast­feeding, the government had also given free formula milk as a replacement for two years.

For mothers infected with syphilis, 50% of babies born would suffer from congenital syphilis and low birth weight while some mothers suffer from miscarriage, premature delivery, stillbirth and complications from infections.

While the programmes reduced the rate of HIV infection from mother-to-child to less than 2% in 2016, which met the elimination status indicators, the transmission of syphilis had always been low with 50 cases per 100,000 life births, which also indicates elimination.

Dr Dzulkefly hopes that with WHO’s continuous support, Malay­sia would be able to achieve similar success for Hepatitis B.
/theSTAR 09-10-2018 

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