Health+ Newspaper February 2016 Issue 03 by Health+ Newspaper

www.healthplus.com.my

february 2016

Will TPPA impact public health?

business+ No, says Healthy Ministry, but economist claims medicine prices will remain high as long as pharmaceutical firms delay generics

... page 13

Over and incorrect use of antibiotics is a growing problem everywhere. The grave danger – which is itself an irony – is antibiotic misuse has resulted in superbugs that are resistant to antibiotics. What’s even more alarming is these scary bacteria are probably present in meats too.

RM5.00(+GST) issue 03 KDN: PP18743/05/2015 (034197)

The Pulse of the Nation

Hooked on antibiotics Xtra

Local news+

Zika virus scare spreads ... page 06 3 UK travellers infected as Malaysians told to take preventive measures when visiting affected countries

... pages 02- 09

Men +

Potency for the 21st century man ... page 17

Stop your own experiments but make use of the knowledge and experts available

02 •

FOREIGNNEWS+

february | 2016

Editor’s Note

Antibiotic resistance – the silent tsunami

ealth+ wishes all our Chinese readers Gong Xi Fa Chai, and may the year bring peace, happiness, good fortune and health to everyone. In this issue, we examine antibiotic misuse, a dangerous trend that is causing widespread antibiotic resistance everywhere. The internet and social media have radically altered the way people respond to illnesses, resulting in over and incorrect use of antibiotics. And Malaysia is not spared either. Although official statistics are not available, lives are greatly affected by it. Antibiotic misuse or abuse has given rise to superbugs which are bacteria resistant to every type of antibiotics, and this spells D-A-N-G-E-R. Recognising the gravity and urgency of this problem, the Malaysian Medical Association (MMA) wants to preserve antibiotics and advocate their use only when necessary as misuse can lead to serious problems. And the Health Ministry is taking the issue by the horns when it launched the Antibiotic Awareness Week and the Antibiotic Awareness campaign last year, to raise awareness and educate the public about the growing problem and to promote the correct use of antibiotics. Are patients getting antibiotics too easily from doctors, pharmacies, and sometimes unauthorised vendors? Yes, says MMA president Dr Ashok Zachariah Phillip, who sees this as a key cause of antibiotic misuse. “Theoretically, pharmacies do not have the authority to sell you antibiotics,” he explains.

“Dispensing of antibiotics in pharmacies is only done when there is a prescription from a doctor. Although there have been cases where certain pharmacies are willing to sell antibiotics over the counter without a doctor’s prescription, by no means should pharmacy do it.” The habit of sharing is another key contributing factor. Patients sometimes feel well enough after taking their antibiotics for three days and then decide to keep them for later use or to give them to family members, just in case they fall ill. However, the most worrisome contributing factor is sales of antibiotics by unauthorised vendors, as we don’t know where they obtain their supply of antibiotics or where these antibiotics are manufactured, how long and the conditions they have been in storage, or whether they are actually antibiotics at all. Antibiotic abuse is not only confined to humans; livestock are also overdosed with antibiotics too. And so that begs the questions: Are meats still safe to eat? Consumers are on edge as a new superbug has been detected in animals in 17 countries, including Malaysia. The MCR-1 resistance gene is resistant to most, if not all, antibiotics. The superbug was reportedly found in a pig in China in November, and since then, similar resistant bacteria have also been discovered in countries like Denmark, Netherlands, France and Thailand. Experts say stopping the superbug from spreading will be difficult. In Malaysia, a veterinarian says antibiotics should be used only to

|SYED ZAID SYED OSMAN| zaid@hashplus.com.my

Junior Writers| PRASAD CHANDRA SEGARAN | prasad.chandra@hashplus.com.my

treat sick livestock, and farmers must adhere to the withdrawal period before sending them to slaughter houses. Consumer Association Penang has been calling for a complete ban of antibiotics in animal feeds. It wants the agriculture and health ministries to set up a national system to monitor antibiotic use in food for animals, including refining data collection on the use of antibiotics. In conjunction with World Cancer Day on February 4, we also examine the state of cancer in Malaysia and globally, and whether we are prevailing over this dreaded disease which has snuffed out millions of lives over the years. As the saying goes, prevention is better than cure. Leading a healthy lifestyle can help prevent up to two-thirds of cancers. Let’s start today by making changes such as eating a healthy diet and getting regular screenings. We also have many other interesting and informative articles for everybody such as the deadly Zika virus disease which has sparked many travel alerts and grave concern everywhere, particularly for women who are pregnant or thinking about getting pregnant in coming months. We also look at stevia – the healthier alternative to sugar, which is even safe for diabetics as it won’t raise blood sugar level. Amid the ongoing festivities, remember to eat and drink healthy, and have sufficient rest and exercise. And as they say, health is wealth!

Will TPPA impact public health?

www.healthplus.com.my

BUSINESS+ No, says Healthy Ministry, but economist claims medicine prices will remain high as long as pharmaceutical firms delay generics

... page 13

FEBRUARY 2016

RM5.00(+GST) ISSUE 03 KDN: PP18743/05/2015 (034197)

THE PULSE OF THE NATION

Hooked on antibiotics XTRA

... pages 02- 09

LOCAL NEWS+

MEN +

Potency for the 21st century man ... page 17

Zika virus scare spreads ... page 06

Stop your own experiments but make use of the knowledge and experts available

3 UK travellers infected as Malaysians told to take preventive measures when visiting affected countries

Antibiotic abuse endangers lives... pages 04-05 UMMC Antibiotic Stewardship Committee warns of dangers of over and incorrect use of antibiotics

www.healthplus.com.my

THE PULSE OF THE NATION

FEBRUARY | 2016

Prevailing over cancer

As we celebrate World Cancer Day on February 4, Health+ joins people, organisations, government agencies and other stakeholders around the world in taking a proactive approach to fight against cancer, highlighting solutions that are within our reach. The fight against cancer is not beyond us. We’ll eventually prevail. ... pages 10-15

Prevention is better than cure

Leading a healthy lifestyle can help prevent up to two-thirds of cancers

... page 12

In pursuit of happiness

Inspiring story of how brave mother of three triumphs over HIV and raises family at the same time

... page 18

Huang Ruifu Editor

Published by: Hash Plus Communication Sdn Bhd (1110279-M)

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Lot 2063A, Jalan Kusta Sg. Buloh, Kawasan Industri Taman Jaya, 47000 Sg. Buloh, Selangor, Malaysia. Tel: +603-6145 8163 (100 lines) Fax: +603 6141 2345 http://www.superiorpress.com.my/ Disclaimer: The content of this publication aims to inform and educate the public on health issues, developments and news, both locally and globally. In addition to our editorial team, we also invite distinguished medical practitioners and other experts to contribute articles on their respective fields of expertise. The information contained in this publication is for general information only, and readers should always seek independent, professional advice and consultation where appropriate. Whilst every care has been taken to ensure that the content is correct, the publisher and editors of Health+ will not be held liable for any loss or damage resulting from reliance upon any information in this publication, including products and services advertised. Unauthorised reproduction of this publication, in whole or in part, is strictly prohibited without the written consent by the publisher. Statements and opinions expressed by writers, contributors and advertisers are not necessarily those of the editors or publisher.

february | 2016

â&#x20AC;˘ 03

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localNEWS+

february | 2016

LEFT ON ON ON: From left: Jeff Lau, Jamie Mead, Hisham Hussein, Dr Nasir Abdul Aziz and Andrew Tebbutt. BELOW HE’S READY: Ralph Dixon with Jeff Lau.

AFIQ NOR / Health+

Running to raise AIDS awareness Red Ribbon Youth icon Jeff Lau reselected to participate in Marathon des Sables Challenge 2016

By ALI-AZMIN HASSAN

UA L A L U M P U R : Recognising the critical role of young people in combating the HIV and AIDS epidemic, the Malaysian AIDS Foundation (MAF) with the Health Ministry’s support has reselected Red Ribbon Youth icon Jeff Lau to participate in the 31st Marathon des Sables Edition 2016 this April, to raise HIV and AIDS awareness. The Marathon des Sables, which the Discovery Channel describes as “the toughest foot race on earth,” is a biennial event over 251km across the harsh terrain of the Moroccan desert. It takes at least six days to complete. Announcing Lau’s reappointment recently, MAF says this would be his second participation in the gruelling marathon, although he had repeatedly said previously he “would never again put himself through the most excruciating experience in his life”.

At only 24, Lau was the youngest participant in the 2014 edition of the marathon. Lau ran with MAF trustee Ralph Dixon in the previous challenge to raise over RM80,000. MAF hopes to double the amount this year through the generosity of concerned corporates and individuals. In 2014, young people in the 20-29 age group accounted for more than one-third of new HIV infections in Malaysia. With a

ON POINT: MAF’s Hisham Hussein (left) and Dr Nasir Abdul Aziz representing the Health Ministry share about the importance of spreading awareness on HIV and how the marathon helps with the foundation’s efforts.

In 2014, young people in the 20-29 age group accounted for more than one-third of new HIV infections in Malaysia. With a 78% jump in new infections, the epidemic is affecting the young generation more than ever before, giving rise to growing sexual transmission.

78% jump in new infections, the epidemic is affecting the young generation more than ever before, giving rise to growing sexual transmission. Apart from increasing HIV and AIDS awareness, MAF Marathon des Sables 2016 Challenge chairman Andrew Tebbutt is looking to raise funds to support high-impact HIV and AIDS health programmes for underprivileged women and children, as well as HIV education, empowerment, advocacy and leadership programme for young people through the foundation’s Red Ribbon Youth Club. Tebbutt says AIDS response in Malaysia has progressed remarkably in the past decade, resulting in

a 50% drop in new HIV infections. He is confident the second round of fervent advocate of HIV youth issues will reinvigorate the interest of donors and the public in the MAF’s cause. Yayasan Sime Darby, one of the MAF’s major sponsors this year, spoke of five elements for the event – education, environment, community and health, youth and sports, and arts and culture – which form the foundation of its philanthropic efforts to carry out impactful work and community service. The event was sponsored by Hilton Kuala Lumpur, a key supporter of AIDS prevention in the country.

localNEWS+

2016 | february

• 05

Double joy for Gintell

AFIQ NOR / Health+

UCHONG: It was double joy for Gintell when it was appointed the official health care product for Miss Tourism Queen of the Year International 2015 beauty pageant, and certified by the Malaysia Book of Records as the country’s largest health care product chain store. The Gintell grand roadshow at IOI Mall on December 27 was the stage to commemorate its double achievements and also to celebrate the 57 contestants competing in the beauty pageant. Chandni Sharma of India won Gintell’s subsidiary title Miss Gintell Wellness. She received the most votes from fans on social media and won a Gintell G-Relax Plus Handheld Massager and RM1,500 cash. Malaysia Book of Records president and founder Tan Sri Danny Ooi presented Gintell with the certification. Also present were Gintell group managing director Datuk Goh Cheh Yak and general manager CK Foo. In a separate event on January 2, Gintell brand ambassadors Datuk Jalaludin Hassan and Amber Chia shared their experiences using the De’Wise Care massage chair and CyberAIR EZ joint

GIFT FOR BEAUTY: Chandni receiving a Gintell product from Goh as Ooi looks on.

SIMPLY BEAUTIFUL: Miss India Chandni Sharma won the Miss Gintell Wellness award. protection treadmill, which were officially launched that day. The leading brand won several awards last year, including the Malaysian Business of the Year Award under the Star Business Awards, the Excellence Eagle Award and the SME Brand Excellence Award under the Golden Eagle Awards, as well as three

THUMBS UP: Goh (centre) accompanied by Jalaluddin and Chia at the launch of the company’s two new products.

awards under the Top-of-theClass Awards – the Gold Award in Marketing, Gold Award for Best

Mental health test for Uber drivers in Malaysia Kuala Lumpur: In an effort to continually improve its services, Uber head of global trust Bhavdeep Basin said in a report that the company is considering enforcing a mental health screening for its Malaysian drivers, following its successful implementation in Mexico recently. Basin said traditional methods are not adequate to determine the suitability of drivers. The safety of its passengers always comes first and a credit or crime check is never good enough to get its drivers’ key data. Driving is an extremely skilled and complex act that involves high concentration. Without mental health checks for drivers, their

judgement, concentration, and reaction time can sometimes be compromised. Driving as a job can take a toll on drivers and a mental health test is needed to prove their ability to handle stress. Driving all day in tough traffic conditions can cause mental strain, possibly leading to unwanted accidents To improve its services and passengers’ safety, Uber’s mandatory mental health screening is indeed a good judgement call. The move was welcomed by many Uber users although the taxi service is deemed illegal in the eyes of the Land Public Transport Commission. That aside, mental health checks can also make

MENTAL DRIVING: Drivers’ mental health greatly affects their judgement, concentration and reaction time.

Brand and Silver Award for Best Innovation. - Norman Hussaini

CREATIVE COMMONS

Uber services more appealing to potential users. Uber is synonymous with taxis. The difference is that it allows anyone with a valid driving licence and his or her own car to work as an Uber driver. The Android, iOS and Windows phone app connects riders with drivers using their phones’ GPS. Through the app, both parties know each other’s location, removing the question of when the ride will actually arrive. Uber makes finding public transport

easy compared with waiting and hailing for taxis on the side of the road. Even when calls are made, it’s hard to estimate the time of the taxi’s arrival. Uber has gained the trust of users and is seen as credible and even possibly better than public taxis. With an excellent social media marketing, it has managed to capture its share of the market, all just through an app, rapidly expanding its global presence. - Ali-Azmin Hassan

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localNEWS+

february | 2016

BUZZ ALERT: Aedes aegypti, the principal mosquito vector of dengue viruses, can also spread the Zika virus.

Zika virus scare spreads 3 UK travellers infected as Malaysians told to take preventive measures when visiting affected countries

ou may not have heard of it until very recently, but new cases of the Zika virus continue to pop up around the world. Spreading mostly in Latin America and the Caribbean, the virus has since been confirmed in three travellers from the UK. Public Health England said on its website that as of January, three cases associated with travel to Colombia, Suriname and Guyana had been diagnosed in UK travellers. The government agency did not provide further details about the cases but added that the virus does not occur naturally in the UK. The announcement came on the heels of alert from the US Centers for Disease Control and Prevention (CDC) recommending pregnant women postpone travel to Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela and Puerto Rico. The CDC also expanded its travel warning to include Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde and Samoa. The recommendations also call for women who have travelled to these places during their pregnancy be screened and monitored

for the virus if their visits took place while the virus was present in the country they visited. The virus is suspected of causing birth defects, prompting Salvadoran vice minister of health Eduardo Espinoza to tell women there not to get pregnant for two years, echoing similar warnings in Colombia and Jamaica. Women’s rights groups have called on the government to lift El Salvador’s total abortion ban in light of the news. El Salvador has since 1998 banned all abortions, even in cases of rape, incest, foetal deformation or where the mother’s life is at stake. In Malaysia, while no Zika virus cases have been detected so far, the Ministry of Health (MOH) has advised the public to take the same preventive measures to avoid dengue if they are visiting any country infected by the Zika virus. Health director-general Datuk Dr Noor Hisham Abdullah says WHO America Region (Pan American Health Organisation) reported that up to mid-January, countries in Latin America had Zika virus infection cases. They were Brazil, Barbados, Colombia, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Suriname

SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION

RISK TO INFANTS: The Zika virus is said to cause a rare congenital condition called microcephaly which results in babies born with abnormally small heads, although there is still no conclusive evidence.

and Venezuela. “MOH also wishes to refer to the report by Brazil’s Health Ministry dated Dec 30, 2015, which says there is an increase in children born with microcephaly syndrome of the cerebellum and the real cause of the incident is yet to be known at the moment. “Brazil’s Health Ministry is conducting further investigations to identify the real cause of microcephaly incidents which include the possibility of their connection to Zika virus infections,” he says. Dr Noor Hisham says MOH would continue to monitor events in Malaysia related to Zika virus infections. “Starting mid-2015 until the first week of 2016, a total of 247

samples were tested for Zika virus and all the results were reported to be negative. “For the purpose of strengthening the surveillance, on December 3, 2015, an order was issued for the surveillance of flavivirus (including Zika virus) conducted in 15 sentinels consisting of government hospitals and health clinics in Malacca, Negeri Sembilan, Selangor, Federal Ter r i tor y and Pahang,” he says. Dr Noor Hisham says the number of sentinels were designed to be extended nationwide in mid-2016 and every sentinel would send samples periodically to the National Public Health Laboratory for the testing of flavivirus (including Zika virus).

localNEWS+

2016 | february

• 07

Toddler hears the world Sunway Medical Centre sponsors little Ziyad’s cochlear implants and holistic rehabilitation

B y N orman Hussaini

E T A L I N G J AY A : Muhammad Ziyad Iman Mohd Shahid was diagnosed with meningitis very early in life. The one-year-old wonder was born with normal hearing but lost it in both ears following a bacterial infection. To recover Ziyad’s hearing, a surgery had to be done quickly for best results. As his family was facing some challenges to raise funds for his cochlear implants, the Sunway Medical Centre (SunMed) stepped in to sponsor the cost of the implants to give him a better future. The sponsorship was also a gesture of support for Ziyad’s grandmother who is a nurse at SunMed. While the sponsorship for Ziyad is SunMed’s first CSR initiative for cochlear implants, other eligible cases will be considered in future. Cochlear implants are a common treatment and have become popular in the last 25 years. The implants

have minimal risks as they are not considered major operations, says SunMed’s ear, nose and throat consultant and surgeon Dr Koay Cheng Boon. Cochlear implants differ from wearing hearing aids as the former provide sound signals to the brain instead of amplifying sounds with hearing aids. After the implantation surgery, Ziyad will undergo an extended

HAPPY FAMILY: Ziyad’s mother Nurul Habibah sharing her experience and how she detected his deafness early.

AUDIO SPECIALIST: Audiologist Ellin Fariza Selamat explains that the cochlear implant has two main components – an internal one that connects with the damaged cochlea and an external one to power the system.

rehabilitation programme managed by a team of clinicians from SunMed’s Speech and Hearing Centre, including an audiologist and a speech-language therapist. SunMed has the longest continuously running cochlear implant programme in a private setting since 2004. It is also the only implant centre to hold a unique switch-on party for every cochlear implant patient. The recent event commemorated the success of Ziyad’s surgery and activation of the cochlear implant. It was also to celebrate his journey and the positive impact of the treatment. SunMed has performed 50 cochlear implants since 2004, of which 10 were in both ears. The treatment is usually performed on infants and children between the ages of one and 13, although SunMed had four 18-year-old patients in the past. Dr Koay explains that cochlear implants should be done quickly because after some time, the cochlea could degenerate through calcification and could render treatment useless. EXPERT SURGEON: Dr Koay giving a presentation on cochlear implants and how some types of deafness caused by damaged cochleas can be treated.

by DATUK DR MOHD NOOR AWANG

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localNEWS+

february | 2016

CREATIVE COMMONS

Dengue vaccine hits efficacy snag Unhappy medical practitioners still waiting for Health Ministry to approve Dengvaxia for public use

engue is by far the most prevalent communicable disease in Malaysia, and the need for a vaccine to protect the people against the potentially deadly infection is pretty obvious and urgent. Still, the Health Ministry has yet to decide whether a vaccine will be made available. It was reported in December that French pharmaceutical giant Sanofi had finally made a vaccine for dengue available in Mexico. Its vaccine division head Olivier Charmeil said the first-ever dengue vaccine, Dengvaxia, was the innovation of the decade. Sanofi Pasteur, the vaccine division of Sanofi, subsequently announced that the Philippines had also granted marketing approval to Dengvaxia, making it the first vaccine to be licensed for the prevention of dengue in Asia. On July 11, 2014, Sanofi announced that the vaccine had passed phase 3 clinical trials in Southeast Asia, one of the last stages of tests before a drug can be put on the market. It said clinical trials carried out on 10,275 healthy children aged 2-14 years old in Malaysia, Indonesia, the Philippines, Thailand and Vietnam showed the

vaccine reduced dengue by 56.5% in the vaccinated group compared with the control placebo group, as observed during 25 months of active surveillance. The data also showed good serotype specific protection, with better protection shown against DEN3 and 4 (75%). However, as with the Latin American trials, the vaccine showed less protection against DEN1 (50%) and least to DEN2 (35%). Despite that, the vaccine was found to be 88% effective against dengue haemorrhagic fever. Mexico has already given the green light to use Dengvaxia, and so has the Philippines. So when will it be Malaysia’s turn? Maybe not so soon, as Health Minister Datuk Dr S Subramaniam said previous clinical trials on the vaccine had resulted in only 47% efficacy, quite a low figure compared to results in other neighbouring countries. He reportedly said early this year that the effectiveness was among several matters raised by the Technical and Scientific Committee on dengue vaccines. The ministry’s stand has unsurprisingly ruffled a few feathers, especially among medical practitioners. One of them, Prof Datuk Dr Lam Sai Kit, is strongly

FOGGY SOLUTION: Without a vaccine in sight, fogging is still a popular mosquito control method in Malaysia.

against the delay in approving the vaccine for use in Malaysia. He says a 47% efficacy is good enough for the vaccine to be made available to the public. As an expert who has been researching the disease for over 40 years, he says the percentage of efficacy is not a true reflection of the vaccine’s benefits. Maybe there’s some light at the end of the tunnel after all.

Health Ministry director-general Datuk Dr Noor Hisham Abdullah reportedly said the outcome of the ministry’s review will be ready to make a conclusion on its registration by the middle of this year. The ministry’s Drug Control Authority had organised several meetings to review the data submitted from the aspects of safety, efficacy, and quality of the vaccine.

Other news in brief

Diphtheria immunisation was included in a series of five vaccines namely diphtheria, pertussis, tetanus, polio and haemophilus influenza type B.” As he urged immunisation against diphtheria,an infection which leads to difficulty in breathing, paralysis and inflammation of the heart Datuk Dr Noor Hisham Abdullah Director-General of Health

We will use the tobacco control rules for vape by putting a new word in the rules, that is ‘vapour’, and that vapour includes vape. With the new word, vapers will be barred from smoking in 21 non-smoking areas.”

Vape users may outnumber cigarette smokers in the future. We don’t want to wait and see what the long-term effects of vaping are.” Commenting on whether vapes should be banned in Malaysia or not

Commenting on the Health Ministry’s ban on vaping in designated public areas Datuk Seri Dr Hilmi Yahaya Deputy Minister of Health

Professor Datuk Dr Abdul Razak Muttalif Respiratory consultant at the Institute of Respiratory Medicine

foreignNEWS+

2016 | february

Clinical trial goes awry, one brain dead

• 09

How does drug approval work? SHUTTERSTOCK

Five others hospitalised after having negative reactions to medication in north-western France

ne person was medically brain dead and five others hospitalised after having negative reactions to a medication they were taking as part of a medical trial in northwestern France. Press reports quoted the country’s health ministry as saying the drug was being tested on healthy volunteers by French company Biotrial in Rennes as part of an early phase trial for an unnamed client. Neither the ministry nor Biotrial had indicated what the drug was, other than saying it was an oral medication. Biotrial said in a statement that “serious adverse effects” had occurred during the study but it had complied with all safety regulations. Drug manufacturers often contract independent clinical trial companies to conduct tests. The company, based in Rennes, also has offices in London and in New Jersey, US. Volunteers who agree to participate in trials in France can earn between €100 and €4,500 (RM473 and US$21,530), Biotrial said. French Health Minister Marisol Touraine was quoted as saying the test was a “serious accident”. A report said the last major drug trial disaster in the pharmaceutical industry was in 2006,

when German company TeGenero had a drug tested against multiple sclerosis in Britain. Within moments of having the drug administered, six volunteers in the study began showing severe reactions, and a few hours later

doctors noted organ failure. One participant remained in a coma for three weeks. TeGenero declared bankruptcy a few months later, and dosages allowances for testing were lowered. – AFPRelaxnews

The process of vetting experimental drugs is designed with safety in mind and to be cautiously meticulous. Still, things sometimes go wrong, as in France where the authorities announced recently that tests with a candidate painkiller left one person brain dead and five in hospital. After preliminary tests on animals and human cells in petri dishes, a laboratory must obtain permission from health authorities for clinical trials on humans to assess a drug’s safety and effectiveness. This testing usually consists of three phases: Phase 1 is generally carried out with a sample of fewer than 100 healthy volunteers to assess drug tolerance and check for side effects. The French trial that went awry was in this phase. Normally, this phase involves young adults who have passed medical examinations declaring them in tip-top shape. After safety has been established, Phase 2 evaluates the effectiveness of the drug and the optimal dosage, usually on a sample of several hundred people. Phase 3 compares the treatment to a dummy drug (placebo) or a medicine already in use – usually testing it on several thousand people. The aim is to confirm the drug’s effectiveness. Some trials take place in hospitals, others at licensed private institutions. After clinical trials, which can last between five and 10 years, the laboratory applies to a medicine watchdog to bring the drug to market. In Europe, this is the European Medicines Agency, and in the United States it is the Food and Drug Administration. For approval, a new treatment must demonstrate a benefit/risk ratio that is equivalent to, or better than, any existing drug. According to the French National Agency for Medicines and Health Products Safety, it can take 10 to 15 years from the time a drug is first tested in a laboratory to it reaching the market. Once it becomes commercially available, the new drug remains under surveillance and ongoing assessment of any side effects. If there are any health risks, it can be taken off the shelves anytime. – AFPRelaxnews

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foreignNEWS+

Dating apps may contribute to HIV increase Rise in infections coincides with the rise in dating apps and risky sexual behaviour, warns UN study

he United Nations recently announced the results of a twoyear study that cites dating apps as a major factor in the growing number of HIV cases among young gay men in Asia. According to the report by the Asia-Pacific Inter-Agency Task Team on Young Key Populations, which includes Unicef, Unaids and others, teenagers aged 15-19 make up 15% of new HIV infections in Asia, with most of the new infections found among young gay men. The report warns that this rise in infections coincides with the rise in dating apps and risky sexual behaviour, and supports growing international concern from doctors and public health agencies on the role of mobile dating apps in the spread of sexually transmitted diseases. A leading sexual health doctor with the British Association for Sexual Health and HIV also spoke via the BBC of his concern

that apps could be a factor in the increasing rates of STDs, including a 19% increase in gonorrhoea and a 33% rise in new syphilis infections in the UK in 2014. And according to a 2014 study, gay men who meet on locationbased dating apps, for example Grindr, are at greater risk for gonorrhoea and chlamydia than those who meet in person or on the internet. Rhode Island Department of Health, USA, has also expressed its opinion that “using social media to arrange casual and often anonymous sexual encounters, having sex without a condom, having multiple sex partners, and having sex while under the influence of drugs or alcohol” has become more common in recent years, leading to the recent sharp rise of syphilis, gonorrhoea and HIV between 2013 and 2014. Commenting on the rise in dating apps, Whitney EngeranCordova, senior director, public health division for AIDS Healthcare Foundation (AHF) says: “The

february | 2016

developers of these dating apps are creating technology that is connecting people around the world in more ways than one – with one of the most significant ways being the risk for contracting and rapidly spreading sexually transmitted diseases,” he says. “Yet instead of taking ownership of their contributions to a worldwide STD epidemic and taking swift action to launch public awareness campaigns to inform their users about the inherent risks of STDs associated with having more sexual partners, we’ve largely seen the developers respond with an apathetic shoulder shrug at best – or a complete denial of the problem at worst.” To combat the rise in STDs, the

report recommends governments develop better strategies for HIV prevention, adolescent-specific laws, and using sex education in schools and through social media to better inform teenagers on the risks and how to protect themselves. The AHF, in its attempt to remind app users of the potential sexual health risks, launched a billboard campaign in September. The organisation plans to build on this initial campaign, rolling it out to further locations across the US, and again including the website FreeSTDCheck.org, to inform people where they can go for further information and to find locations offering free HIV and STD testing. – AFPRelaxnews

Teenagers aged 15-19 make up 15% of new HIV infections in Asia, with most of the new infections found among young gay men.” SHUTTERSTOCK

2016 | february

A step closer to cancer cure TRAIL protein hitchhiking in bloodstream kills tumour cells

esearchers from Cornell University in New York made a breakthrough recently in the search for a cure for cancer. According to media reports, the King’s laboratory in Cornell had created nano-sized liposomes with a protein called TRAIL – tumour necrosis factor related apoptosis-inducing ligand – which attaches to white blood cells. The liposomes are about 1/100 the size of white blood cells. The hitchhiking TRAIL protein kills the tumour cells as the white blood cells travel through the bloodstream. The use of white blood cells to ferry potent cancerkilling proteins through the bloodstream was reported to be successful during the trials with mice. The therapy seeks, attacks and destroys cancer cells circulating in the bloodstream, and concurrently prevents the spontaneous formation and growth of metastatic tumours. Professor Michael King who led the research explained that metastasis is the spread of cancer cells from one tumour to other organs such as the lungs, liver spleen and kidneys. While surgery and radiation treat primary tumours, detecting and reaching metastatic cancer cells remains difficult. In the study, prostate cancer cells were implanted into the prostate of male mice to let the tumours grow. The researchers found that the tumour had substantially shrunk in size with the secondary tumour completely prevented. “While the treated mice showed no metastases, the circulating tumour cell count remained greatly reduced but not completely zero, which leads scientists to believe you don’t have to be perfect in completely eliminating circulating tumour cells to observe a very good outcome,” King was quoted as saying. The research had also found a single dose of the therapy can substantially reduce the number of tumour cells even when delivered very late in the course of the disease. “This suggests that it may never be too late to help,” King said. – AFPRelaxnews

Use sunscreen, urges actor after cancer removed Australian movie star Hugh Jackman has again undergone treatment for skin cancer, urging people recently to wear sunscreen and have regular check-ups. The 47-year-old first had a basal cell carcinoma removed in 2013 after his wife Deborra-Lee Furness told him to get a mark on his nose checked. He has been treated several times since. “An example of what happens when you don’t wear sunscreen,” he tweeted, alongside a photo of himself with a plaster over his nose. “Basal Cell. Mildest form of cancer. USE SUNSCREEN PLEASE!!” Basal cell carcinoma is the most common form of skin cancer and often develops on parts of the body which have received high sun exposure such as the face, neck and shoulders. Jackman, known for his roles in the “X-Men” blockbusters, grew up in Australia which has one of the highest incidences of skin cancer in the world. – AFPRelaxnews

foreignNEWS+

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foreignNEWS+

february | 2016

Malaria on the way out

CREATIVE COMMONS

New WHO report signals progress in fight against deadly disease

ew estimates from the World Health Organisation (WHO) show a significant increase in the number of countries moving towards malaria elimination, with prevention efforts saving millions of dollars in healthcare costs over the past 14 years in many African countries. According to the World Malaria Report 2015 released end of last year, 57 of the 106 countries with malaria in 2000 had achieved reductions in new malaria cases of at least 75% by last year. In the same period, 18 countries reduced their malaria cases by 50-75%. Across sub-Saharan Africa, the prevention of new cases of malaria has resulted in major cost savings for endemic countries. New estimates presented in the WHO report show that reductions in malaria cases attributable to malaria control activities saved an estimated US$900 million in case management costs in the region between 2001 and 2014. Insecticide-treated mosquito nets contributed the largest savings, followed by artemisinin-based combination therapies and indoor residual spraying. Regional progress According to WHO directorgeneral Dr Margaret Chan, since the start of this century, investments in malaria prevention and treatment have averted over six million deaths. “We know what works. The challenge now is to do even more,” she says. For the first time since WHO

began keeping score, the European region is reporting zero indigenous cases of malaria. This achievement was made possible through strong country-level leadership, technical support from WHO and financial assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since 2000, the malaria mortality rate has declined by 85% in Southeast Asia, 72% in the Americas, 65% in the Western Pacific region, and 64% in the Eastern Mediterranean region. While the African region continues to carry the highest malaria burden, it too made impressive gains: over the last 15 years, malaria mortality rates fell by 66% among all age groups, and by 71% among children under five, a population particularly susceptible to the disease.

Since 2000, the malaria mortality rate has declined by 85% in Southeast Asia, 72% in the Americas, 65% in the Western Pacific region, and 64% in the Eastern Mediterranean region.

Progress towards global targets Country-level and regional progress in malaria control is reflected in global disease trends. Since 2000, malaria incidence and death rates have fallen by 37% and 60%, respectively, around the world. Among children under five, malaria death rates have declined by 65%. An estimated 6.2 million deaths have been averted since 2000. According to the report, Target 6C of the Millennium Development Goals – which aimed to halt and reverse the global incidence of malaria between 2000 and 2015 – has been achieved. Substantial progress has also been made towards the 2005 World Health Assembly target of a 75%

Miss Universe to push HIV awareness after crowning blunder The new Miss Universe, back in the Philippines after an epic televised blunder surrounding her crowning, said she would use the attention the incident attracted to campaign for HIV awareness, especially in her home country. In front of an estimated one billion television viewers

worldwide last December, pageant host Steve Harvey mistakenly announced Miss Colombia, Ariadna Gutierrez, as Miss Universe before correcting himself minutes later. The diamond and sapphire crown was removed from the head of a sobbing and humiliated

reduction in the global burden of malaria by last year. Scale-up in malaria control Progress has resulted, in large part, from the massive deployment of effective and low-cost malaria control interventions. Since 2000, nearly 1 billion insecticide-treated mosquito nets have been distributed in sub-Saharan Africa. By last year, about 55% of the population in this region was sleeping under mosquito nets, up from less than 2% coverage in 2000. An estimated 663 million cases of malaria have been averted in sub-Saharan Africa since 2001 as a direct result of the scale-up of three key malaria control interventions: insecticide-treated mosquito nets, indoor residual spraying and artemisinin-based combination therapy. Mosquito nets have had the greatest impact, accounting for about 68% of cases prevented through these interventions.

Fifteen countries, mainly in Africa, accounted for 80% of global malaria cases and 78% of deaths. According to the report, these high burden countries have achieved slower-than-average declines in malaria incidence (32%) compared with other countries globally (53%). In many of these countries, weak health systems continue to impede progress in malaria control. Millions of people are still not receiving the services they need to prevent and treat malaria. In 2014, about one third of people at risk of malaria in sub-Saharan Africa lived in households that lacked protection from mosquito nets or indoor residual spraying.

Still a long way Despite progress, significant challenges remain. Globally, about 3.2 billion people, or nearly half the world’s population, are at risk of malaria. Last year, there were estimated 214 million new cases of malaria, and about 438 000 deaths.

Closing gaps In May last year, the World Health Assembly adopted the WHO “Global Technical Strategy for Malaria 2016-2030”, a new 15-year framework for malaria control in all endemic countries. The strategy sets ambitious but achievable targets for 2030, including a reduction in global malaria incidence and mortality of at least 90%; the elimination of malaria in at least 35 countries; and the prevention of a resurgence of malaria in all countries that are malaria free.

Gutierrez and transferred to Pia Alonzo Wurtzbach of the Philippines. Wurtzbach, speaking to reporters about her plans, said she would undergo a “public testing” for HIV when she returns to the United States where the Miss Universe Organisation is based, to erase the stigma surrounding the disease. “It’s about time someone like me should step up and hopefully others would follow suit as well,” Wurtzbach, 26, said.

“I think in the Philippines, there’s a bit of a stigma because we’re a conservative country.” The Philippines reported a 22% increase in HIV infections year-on-year in September last year. Four in ten of the new cases were reported in the capital Manila. The nation of 100 million people, on whom 80% are Catholic, is heavily influenced by the church which frowns on contraceptive use. Testing for HIV is also considered taboo. – AFPRelaxnews

business+

2016 | february

Will TPPA impact public health? No, says Healthy Ministry, but economist claims medicine prices will remain high as long as pharmaceutical firms delay generics

By Zurinna Raja Adam

he Trans-Pacific Partnership Agreement (TPPA) will not prohibit Malaysia from taking measures to protect its public health, including making available cheaper generic drugs. According to the Healthy Ministry, Malaysia has a transitional period of four to five years after the agreement has been enforced before the period of implementation of intellectual property rights relating to pharmaceuticals will take place. However, an economist points out that prices of medicine will not rise because of the TPPA, but will remain high as long as pharmaceutical companies delay generics. “The pharmaceutical industry has been raising prices for a long time. The TPP just gives the

industry more leeway to extend time for pharmaceutical companies to increase prices,” he says. The Malaysian Medical Association (MMA) has also voiced its concern on the TPPA’s negative impact on the medical profession and public health. Among its concerns is that the TPPA would reduce access to cheap generic medicine due to stricter implementation of the provisions for intellectual property rights (IPR). Secondly, TPPA proposals to undertake liberalisation of the healthcare sector in signatory countries would mandate that foreign corporations be given the same access to the domestic market as local firms. This will lead to the proliferation of, for example, private hospitals and managed care organisations from the United States and other TPPA countries. “We wish to know specifically how the potentially negative repercussions of tighter IPR and healthcare sector liberalisation

LOBBYING: AntiTPPA groups have been speaking out against the agreement as it will inheritably see the prices of a number of drugs increase.

• 13

are going to be ameliorated,” the MMA says. Another economist, who declined to be quoted, said Malaysia has carefully drafted a safety net to ensure risks are mitigated when the needs arise. “Public healthcare is heavily subsidised and this includes medicine. Yes, there will be adjustments (to prices of medicine) but they will not be disruptive. We can also look at this positively. When we improve IPR protection, it will encourage more local manufacturers to be content creators,” he says. Malaysia produces only generic drugs which the healthcare system relies on heavily. He says local pharmaceutical players should pressure the government to provide long-term funds or grants for research and development in the field of pharmaceuticals so that new drugs can be developed in Malaysia. “In this way, we will be able to create a clear path for research and development for medicine in Malaysia.” The TPPA is a free trade agreement between 12-member states comprising developed and

The pharmaceutical industry has been raising prices for a long time. The TPP just gives the industry more leeway to extend time for pharmaceutical companies to increase prices.”

developing countries. Among the countries of interest to Malaysia are the United States, Australia, New Zealand, Canada, Chile and Singapore. The goal of the agreement is to facilitate trade and investments, in addition to liberalising the economies of the participating countries. Over the past months, antiTPPA groups have been vocal in opposing the TPPA as they believed prices of drugs will skyrocket and Malaysia will have less access to generic drugs. But a pro-TPPA report argues that the TPPA will increase the number of brand drugs in Malaysia as many developed countries that produce brand drugs are part of the TPPA which will have no impact on the availability of generic drugs in the country. “MOH (Ministry of Health) consulted stakeholders involved to ensure domestic interests are in place. The IPR provisions negotiated in the TPPA are applicable to only new medicines. When the patent protection is in effect for newer medicines, they will be expensive whether or not there is a free trade agreement,” the report says. The patent protection term for all branded pharmaceutical products is 20 years. This means that once an innovator drug has reached its 20th year of patent protection, generic drugs are allowed to enter the market and the price will be halved or even lower than the original price. In the long run, this environment will create healthy competition between branded and generic drugs which will eventually lower the prices of the branded drugs.

14 •

business+

february | 2016

Paint that combats HFMD, H1N1 AFIQ NOR / Health+

Nippon VirusGuard claims to inhibit growth of viruses and bacteria on coated surfaces

COLOUR SHIELD: The VirusGuard acts as protection from harmful viruses while brightening the home.

UALA LUMPUR: Walls are often overlooked as a medium that can spread dangerous viruses and bacteria, so they are usually neglected during cleaning. In a survey conducted by an independent marketing research consultancy, 80% of respondents agreed their children would always touch the walls of their homes while playing, crawling or walking. The findings inspired total coating solution provider Nippon Paint Malaysia to launch Nippon VirusGuard, the country’s first anti-viral paint that claims to combat hand, food and mouth disease (HFMD) and H1N1. The revolutionary water-based hygiene paint is developed using silver Ion technology which can persistently inhibit growth of viruses and bacteria on coated surfaces. It can also prevent growth of micro-organisms using

of contagious diseases and also inhibits growth of viruses such as coxsackievirus A16 (CV-A16) that causes HFMD, and H1N1 virus which causes influenza A. It also eradicates bacterial organisms such as E. coli and methicillinresistant staphylococcus aureus. The initial test on anti-viral efficacy which was performed by ATS Labs, an independent accredited US laboratory, showed a reduction of over 90% of HFMD and H1N1 influenza viruses over a 24-hour exposure period compared with conventional paints. To further educate parents and caregivers on the dangers of HFMD infections, Yoong says Nippon collaborated with REAL Education Group to repaint its REAL Kids centre in Bukit Jelutong, Shah Alam with Nippon VirusGuard to create a child-friendly haven to further safeguard its students from HFMD and other forms of viral

and bacterial infections. “We will continue to engage with developers and our partners to educate customers on all Nippon revolutionary products. We have been busy building up our portfolio the last eight years, and in the last two years, Nippon set the milestone with our product offerings,” says Yoong . “Products like Nippon VirusGuard change perception for walls into a functional feature at home, and a healthy one too,” he says, adding that the paint works as long as it still covers the surfaces. However, he recommends repainting at least once every five years. In April last year, Health Ministry director-general Datuk Dr Noor Hisham Abdullah indicated that HFMD infections peaked once every three years, with the last large peak in 2012 with 34,519 cases. Another large peak is thus expected this year. - Zurinna Raja Adam

by Prime Minister Datuk Seri Najib Razak, and to implement the new Siemens Artis Q Catheterisation Laboratory system in Malaysia and Southeast Asia. PMC offers complete inpatient and outpatient medical and surgical services, advanced diagnostics and 24-hour emergency services. Services and facilities provided also include pre-employment, executive health screening and dedicated specialist outpatient clinics of multidisciplinary specialties. Its high-tech facilities include Cathlab, imaging and diagnostic

unit, rehabilitation unit with snoozelen and multisensory room, haemodialysis unit, chemotherapy unit, delivery suites, operating theatres, medical and surgical daycare and critical care unit. PMC poises to deliver a hasslefree experience with pleasant environment complete with a courtyard and landscaped gardens. It won, under the RSDH umbrella, the Frost & Sullivan Award 2013 in “Excellence in EMR (Electric Medical Record) Implementation” for its implementation of HMIS.

a controlled ion-release system. Silver ion, which forms the base of Nippon VirusGuard, comes from one of the world’s oldest and natural anti-microbial which can ward off growth of viruses and bacteria. This technology uses a three-step approach – it destroys the function of viruses and bacteria, stops them from reproducing and multiplying, and deactivates growth of bacteria by slowing down their metabolism. “As the demand for healthy lifestyle gets more mainstream these days, our customers recognise that walls can play an active role as a health solution too. The Nippon VirusGuard is an innovative solution that helps to mitigate one of the factors contributing to the spreading of contagious diseases,” the company’s assistant general manager group marketing Alex Yoong tells Health+. He says Nippon VirusGuard increases defence against outbreak

HEALTHY WALLS: Yoong says walls play an active role as a health solution as many people, especially children, spend a lot of time at home.

ParkCity Medical Centre making great strides Since its opening on December 12, 2012, ParkCity Medical Centre (PMC) has been serving the communities in Kepong, Sungai Buloh, Sierramas, Valencia, Bandar Sri Damansara, Desa ParkCity, Mutiara Damansara, Kota Damansara and other areas within a 10km radius. This year, the hospital will launch various new services, including a child developmental centre, chemotherapy unit, medical day services, endoscopy and geriatric services. An expansion to the wards is also slated for this year. As it turns three this year, PMC has pledged to deliver the best for its patients in line with its tagline “people caring for people”. Striving to become a leading centre of specialist for children, women and elderly health, the hospital is going

the extra mile to make a difference in delivering care and services to patients. PMC also strives to be the pioneer in different areas. During its opening, it was the first among Ramsay Sime Darby Healthcare (RSDH) Group hospitals to pilot and launch the new Hospital Management System (HMIS). It is also the first hospital under the group to be launched

senior+

2016 | february

Physical therapy no help for Parkinson’s patients

• 15 SHUTTERSTOCK

Study suggests current standard of care for early-stage sufferers may be a waste of time and money

outinely assigning people with mild to moderate Parkinson’s disease to physical or occupational therapy offers no improvement to their quality of life, says a recent British study. The findings, published in the Journal of the American Medical Association (JAMA) Neurology, suggest that the current standard of care for early-stage patients may be a waste of time and money. Parkinson’s disease attacks the central nervous system, and affects about seven million people across the world, including about 4% of those over 80. The randomised trial involved 762 patients with mild to moderate Parkinson’s disease, recruited from 38 sites in Britain. All the patients were experiencing some difficulties with daily activities such as buttoning shirts or brushing teeth. Half were assigned to physical therapy and the other half to occupational therapy – both practised in hour-long sessions that took place several times over the course of the study. Physical therapy tends to focus on diagnosing and treating injuries, while occupational therapy aims to help patients adapt to injury and improve life skills. After three months, researchers at the University of Birmingham found “no difference between the groups” in their ability to perform daily tasks or in their answers on a health-related quality of life questionnaire. Furthermore, there were “no clinically meaningful short- or medium-term benefits” from either therapy for those in the study, the researchers add. Therefore, more time should be spent on exploring “the development and testing of more

structured and intensive physical therapy programs in patients with all stages of Parkinson’s disease,” the study says. An accompanying editorial by J Eric Ahlskog, a doctor at the Mayo Clinic in Rochester, Minnesota, points out that doctors for all the patients in the study had already decided they were unlikely to benefit from such therapies. “Thus, one may conclude from this investigation that blanket referrals of all patients with earlierstage PD for routine physical or occupation therapy appears to be cost-ineffective,” he says. But more targeted physical therapies to help exercise immobilised limbs or improve balance can benefit patients, and these were not the focus of this particular study, Ahlskog says. Currently in Britain, all patients with Parkinson’s are allowed access to both types of therapy. “This shows that there is an urgent requirement to review current guidelines for patients with Parkinson’s disease,” says lead author Carl Clarke, a professor at the University of Birmingham. “The resource that is committed towards these therapies that do not appear to be effective, could be better used in patients with more severe problems with their Parkinson’s disease.” – AFPRelaxnews

randomised trial: All the patients were experiencing some difficulties with daily activities.

Parkinson’s disease attacks the central nervous system, and affects about seven million people across the world, including about 4% of those over 80.

OLDEST DIES: The Japanese supercentenarian recognised by the Guinness World Records as the world’s oldest living man has died at 112. Yasutaro Koide, born in March 1903, died just five months after Guinness presented him with a certificate of his title in Nagoya. – AFPRelaxnews

16 •

senior+

february | 2016

Championing palliative care

CREATIVE COMMONS

Hospis Malaysia committed to spreading awareness and educating the public, including medical practitioners, on palliative care approach in healthcare

By Norman Hussaini

eceiving news that you or your family member is diagnosed with lifelimiting illness such as cancer, organ failure or a progressive neurological condition is never easy. You may undergo treatment for your disease. Your family may understand that treatments such as chemotherapy, dialysis or radiotherapy would not cure you, but they have hope that perhaps they could keep your disease at bay, or to simply buy you more time. But what about other aspects of your wellbeing? You may wonder how you would manage this condition at home. How will your family cope with all this? You may be in pain, depressed and fatigued. Symptoms from your treatments may cause you discomfort and suffering. Do you have enough information to enable you to make informed decisions about how and where you want to be treated and cared for? Healthcare system not equipped Addressing the complexity of our psychosocial wellbeing is not something our current healthcare system is equipped to cater to. Palliative care, a medical sub-speciality which focuses on relieving much of the discomfort and distress of a life-limiting illness, can help. “Medicine should be a profession that cares for people. However, in this post-modern era, the emphasis has shifted to that of pharmaceutical and technological advancements, sometimes to the detriment of the concept of care. At the heart of palliative care is the notion of addressing suffering and how it affects patients and their families,” Hospis Malaysia CEO Dr Ednin Hamzah tells Health+. Hospis Malaysia has been championing the practice of palliative care since its humble

beginnings in 1991. “Just like how Malaysia promotes itself as being diverse in its culture, healthcare should similarly be viewed in that way. There are so many different ways of looking at healthcare issues, not solely focusing on diseases and treatments,” says Dr Ednin. A major aspect of healthcare, he adds, is about understanding the people affected and how their entire lives are being impacted by diseases. Issues in palliative care Cancer pain is vastly untreated because most doctors are not trained on how to manage pain. “We have the drugs; it is simple and cheap to produce, yet we just do not know how to use them appropriately,” Dr Ednin points out. He says healthcare in Malaysia is essentially a hospital-based system. Most people want to be cared for at home rather than in hospitals. Ideally, the healthcare practitioner should be willing to explain your condition, treatment options and relate your options clearly and thoroughly. When you have a complicated condition, there may be multiple approaches to care. “Many patients complain about healthcare not because they do not feel cared for either by their doctor, nurse or hospital,” says Dr Ednin. Listening to patient’s concerns On average, doctors spend 15 minutes per patient – is this an adequate amount of time to truly listen to a patient’s concerns? This feeling of not trusting your doctor entirely has led many patients to seek alternative help such as seeing a bomoh and other traditional healers. “Although these individuals may not necessarily dispense the right advice, what they do get right is that they listen” he adds. The lack of an effective governmental support system on a national level also makes it difficult to instil the importance of palliative care among the public. “Another issue we face is since charities and NGOs are the ones taking the initiative to spread

awareness; there is no national blueprint on the minimum standards of care provision. This means any organisation can offer palliative care, even without the necessary qualifications,” laments Dr Ednin. Providing palliative care services and spreading awareness about it has generally been shouldered by NGOs, with Hospis Malaysia taking the national lead role. Despite all the hard work put in, there is only limited success in terms of spreading public awareness to the public.

CARING PASSION: The Hospis Malaysia logo is the first of its kind and Dr Ednin hopes it can be used globally to signify palliative care.

Lack of awareness Awareness on the importance and role of palliative care is still sorely lacking, even among medical practitioners. A doctor studying palliative care at Hospis Malaysia tells Health+ that some of her colleagues have even asked her what exactly she does. Her experience somewhat reflects how poorly the practice of palliative care is understood. Hospis Malaysia hopes to raise further awareness and educate the

people, as well as to rope in more doctors and nurses to be involved in providing palliative care. Hospis Malaysia runs numerous programmes to strengthen and expand the practice of palliative care, including workshops and lectures for doctors and nurses. “In more developed countries, palliative care is part and parcel of the healthcare system. Hence, rather than a mystery to both doctor and patients, its nature and benefits are known to most,” says Dr Ednin. “In these countries, policymakers and governmental bodies spearhead the initiative; collaborative efforts are forged with specialists in the field to execute the services.” For palliative care to be better recognised and implemented, medical practitioners and the public must have a better understanding of its benefits. With such collective efforts, perhaps palliative care can further develop to help those who need effective support while undergoing medical hardship.

opinion+ men+

2016 | february

• 17 men+

By Dr Selvalingam Sothilingam

ore and more ageing men wake up each morning fearing the worst – the loss of that early morning hardness. Men often reassure themselves that all is well when they have the usual night tumescence – often associated with dreams – and early morning hardness which indicates their organs are still working. However, this fear – that all may one day be lost – is not a new phenomenon as impotency has been plaguing men from time immemorial. The ancient Chinese believed in the balance between yin and yang, and had long used potions and acupuncture to find the balance. The Egyptians believed impotency was a natural disorder caused by an evil spell, most likely cast by women, and some still believe it. The Greeks believed in Aphrodite, the goddess of love, from which the word “aphrodisiac” originated. In 300 BC, Aristotle extracted aphrodisiacs of dried bodies of beetles known as Spanish flies. In the 4th century, Theodorus and Priscianus felt that men only needed to surround themselves with beautiful girls to stimulate lust. Roman men wore a talisman of the right molar tooth of a

crocodile to guarantee erections. They also prayed to the god Priapus with the mantra “bless me, make me hard”. In France, men were encouraged to pass urine through their wedding rings to keep their erections strong. Emotions like anxiety were recognised as a problem in impotency and Helen Singer Kaplan boasted that she could cure men by just telling them to abandon their over concern for their partners and be selfish in the act of love. POTIONS AND REMEDIES Over the centuries, men had ingested all sorts of potions and remedies to cure impotency. In Greece and Rome, cures included animals associated with potency such as snakes, genitals of roosters, goats, wolf penises roasted in oven, sparrow meat and starfish. The Mayans believed in the lotus flower to restore potency. In the 18th century, Dr Brodum offered nervous cordial and botanical syrup which became very popular. Patients were also asked to bathe their testicles in vinegar, alcohol and cold water. In the 19th century, Frederick Hollick recommended cannabis and the French encouraged ginseng. Between the 6th and 19th centuries, Muslim physicians introduced drugs given via the urethra – a treatment still being used today. Impotent men also used all sorts of devices and other inventions to restore potency. In the 18th century, electricity and magnetism were used to cure penile flaccidity. Dr James Graham introduced the electric bed as it was believed that electricity could stimulate a nervous force in patients. In 1920, French physician Vincent Marie Mondat invented the power vacuum massager which worked on the principle of creating a vacuum around the penis and therefore causing blood to rush into it. In 1960, Geddings Osbon invented a similar device called the youth equivalent device which worked on the same principle as the modern-day penile vacuum pump. TESTICLES AND SEXUAL HEALTH Man had for a long time believed in the role of the testicles in promoting sexual health. They started experimenting with testicular

Straight talk

Potency for the 21st century man

implants and injections. In the 1800s sheep testis extract was injected into men’s testes, and this was the standard care until the 1940s. In 1914, Dr J Frank Lydston implanted a suicide victim’s testis into his own scrotum. In 1922, physician LL Stanley injected convicts with testes of goats, rams, boars and deer. It was only in 1935 when researchers in Netherlands discovered the male hormone testosterone that its role in male libido and potency was understood. The effect of injecting drugs into the penis happened by accident when a French surgeon unintentionally injected a drug called papaverine into the male penis. However, it was after 1983 when doctors and scientist became interested in penile injections. Surgical options for the penis were also explored around this time for patients with impotency. In the early 20th century, Loewenstein came up with the coitus training apparatus which consisted of two rings for each end of the penis and rubber-covered wires in between, covered by a condom before penetration. In the 1970s, it was probably the idea of a church minister who had a tyre repair side business on penile inflatable implants that sparked interest in penile implants. Silicon rods were also implanted into penises, but it was only in the 80s that companies

The ancient Chinese believed in the balance between yin and yang, and had long used potions and acupuncture to find the balance. The Egyptians believed impotency was a natural disorder caused by an evil spell, most likely cast by women, and some still believe it.”

such as American Medical Systems pioneered the development of the modern-day inflatable penile implants. VIAGRA A major breakthrough came in 1989 when Peter Dunn and Albert Wood, based on the work by Dr Nicholas Terrett, invented the drug Sildenafil, which we fondly call Viagra. Initially meant to be a heart medicine, it was noted that erection was one of its side effects. Penile injection using prostaglandin-based drugs were also approved for use. Testosterone supplement are now available in the form of injection and patches so there is no need for testicular implants from animals. Patients can also use modern-day penile vacuum pumps and, when all else fails, there is the inflatable threepiece penile implants. As our understanding of impotency and physiology of erection improves, we can expect new drugs and treatments to be developed in future, and some of these may just be discovered by accident. So stop your own experiments but make use of the knowledge and experts available, and be thankful that you are a 21st century man! Brigadier-General Datuk Dr Selvalingam Sothilingam is a consultant urologist at University of Malaya Medical Centre.

18 •

men+

february | 2016

Could testosterone link lead to therapy for psychopathy?

SHUTTERSTOCK

Male hormone influences regulation of emotions in psychopath’s brain, says Dutch study

rain research has demonstrated that psychopaths exhibit reduced control over their emotional actions. Researchers from the Donders Institute at Radboud University discovered that the quantity of testosterone a person produces influences the parts of the brain responsible for

regulating emotions. The findings provide starting points for the treatment of psychopaths. The results were published in the online journal eNeuro. Professor of Psychopathology Karin Roelofs and her colleagues at the Donders Institute for Brain, Cognition and Behaviour investigated a group of 15 psychopathic criminal offenders in

PSYCHOPATHIC LINK: The quantity of testosterone a person produces influences the parts of his brain responsible for regulating emotions.

However in people with psychopathy, and especially in patients with high endogenous testosterone levels, significantly less activity in the prefrontal brain regions and less communication between the prefrontal brain and the amygdala was observe.” a joint research project with the Pompe Foundation for forensic psychiatry. The researchers were particularly interested in how the supply of testosterone influenced the regulation of emotions. Cold-blooded and impulsive Roelofs says among the general public, psychopaths are mainly known for their planned and targeted form of criminality. She says they are generally classed as calculating and set to work with a high degree of apparent coldbloodedness. Less well known – but no less disturbing – is that psychopaths exhibit impulsive behaviour and experience problems in regulating their emotions. These problems, she adds, often lead to difficulty in social contacts and to police arrest because at vital moments they lose their cool. Healthy persons and criminal offenders During Roelofs’ research, criminal offenders and healthy study subjects carried out a task in an MRI scanner that measured the response time of the automatic tendency to move the joystick towards oneself upon seeing images of “friendly” faces or to push it away upon seeing “angry” faces.

In the healthy control persons, the researchers saw a normal pattern of communication between the prefrontal cortex and the emotion centre, the so-called amygdala, if they had to control their reflexes by making the opposite movement with a joystick – “angry” towards themselves and “friendly” away from themselves. Such counter-intuitive joystick movements require control and that was very clearly observable in the brain activity. Explanation and treatment “However in people with psychopathy, and especially in patients with high endogenous testosterone levels, significantly less activity in the prefrontal brain regions and less communication between the prefrontal brain and the amygdala was observed. Thus there was less communication between emotion control regions. The research results provide a neuro-hormonal explanation for emotional regulation problems in psychopathic patients,” says Roelofs. Furthermore, the results provide starting points for the treatment of psychopaths by influencing the amount of testosterone in their bodies.

men+

2016 | february

• 19

Weight may affect quality of sperm

man’s weight may affect his sperm’s genetic makeup and could lead to a predisposition to obesity in his children, says a Danish study published in the journal Cell Metabolism, A five-year study undertaken by Dr Romain Barres of the University of Copenhagen has revealed that the sperm of thin and obese men have different genetic markers, which could change gene behaviour in the body. Dr Romain Barres believes it is wrong for health advice – not to drink alcohol, stay away from pollutants and eat a balanced diet, etc – to be exclusively targeted at women during pregnancy. He asserts it is also important for men to adopt a healthy lifestyle before a child is conceived. To come to this conclusion, the researchers tested the sperm of six obese men who were undergoing bariatric surgery to reduce the volume of their stomachs. Sperm samples were taken before the procedure, one week after it, and for a third time a year later. The findings showed that the men’s sperm had undergone significant changes a week after the operation and a year later. Different genetic markers were observed, which could change the way genes express themselves in the body. Their findings were the same when they compared 13 slender men who had a body mass index of less than 30 with 10 moderately obese men. No scientific study has explained how these changes occur. However, the researchers found a link between these genetic changes and the genes which control the appetite and the brain. In other words, a man’s weight can influence the health of his children, in particular whether they have a predisposition to obesity. “Until we know more, would-be parents should just aim to be as healthy as possible at the time of conception and not be drawn to faddy diets or other activities in order to try and influence the health of their children in ways we don’t properly understand,” says Dr Barres. To undertake further research into this change in the sperm’s

genetic makeup, Dr Barres’ lab is working with a fertility clinic to study the genetic differences in embryos (that must be discarded and can be used in research after

SHUTTERSTOCK

weight matters: Sperm of thin and obese men have different genetic markers.

five years, under Danish law) resulting from the sperm of men of different weight. Once the researchers have accumulated a large number of

participants, they will be able to issue new comparative data after studying the cord blood of the children that each of the men fathered. – AFPRelaxnews

20 •

women+

february | 2016

Have more kids and age slower CREATIVE COMMONS

Study suggests women with more children have a slower rate of biological ageing

ew research suggests that the number of children a woman has given birth to could affect the rate at which her body ages, with more children leading to a slower rate of biological ageing. A team of researchers from Simon Fraser University, Canada, looked at 75 indigenous Guatemalan women from two neighbouring rural communities and collected data on the number of children the women had given birth to. To find a link between number of children and the rate of biological ageing, the team also looked at the length of each woman’s telomeres, the protective tips found at the end of each DNA strand that indicate how cells are ageing. The longer the cells, the better it is for ageing and longevity. To assess the length of the women’s telomeres the team took saliva samples and DNA swabs from the inside of the cheek. A second set of samples was collected 13 years later. In the first study to look at a direct link between the length of telomeres and the number of children, the results showed that the women who gave birth to more surviving children had longer telomeres, going against the theory that producing a larger number of offspring speeds up biological ageing. The researchers believe that these results could be explained by two factors. As the women were from communities where mothers receive a large amount of social support from friends and family, this could enable the body to devote more of its energy to looking after and maintaining body tissue, therefore slowing down the biological ageing process. However, although this level of support is a social norm for communities where the study took place, it may not be seen across all cultures or societies. In addition, the results could be explained by the primary female sex hormone estrogen, which has a strong antioxidant effect on the body. Levels of estrogen rise significantly during pregnancy, leading the researchers to believe that due to its antioxidant effect, estrogen may protect the mother’s cells against telomere shortening. – AFPRelaxnews

women+

2016 | february

• 21 CREATIVE COMMONS

Orthorexia – a growing eating disorder Healthy eating is good, but being obsessed with it can be fatal

By Norman Hussaini

norexia nervosa is one of the most prevalent eating disorders, especially in the US and UK, affecting tens of thousands of lives over the years. People with anorexia restrict the amount of food they eat, make themselves vomit and exercise excessively. This dangerous condition often develops out of anxiety about body shape and weight originating from a fear of being fat or a desire to be thin. However, with the current trend of healthy food and clean eating, a new kind of obsession called orthorexia nervosa is getting increasingly popular. People with orthorexia are sometimes so obsessed with always eating healthy and clean to the point of jeopardising their health. According to a dietitian from the Children’s Hospital of Philadelphia Kerri Heckert, the condition stems from an obsession to eat healthy rather than being overweight or having ugly body shape. People with orthorexia have very

rigid eating habits and struggle with an all-consuming need to control the type and quality of food they eat. The term “orthorexia nervosa” was introduced by Dr Steve Bratman in 1996 to describe his patients who were found to be “health-obsessed”. It was never meant to be a diagnosis, but rather to help his patients understand that extreme healthy eating may not be as beneficial as presumed. Like anorexia, orthorexia nervosa affects largely women, but men may also suffer from it. Symptoms Although the condition is not considered a clinical diagnosis, a set of criteria was drawn up to identify whether a person is struggling with it. These criteria include: Compulsive behaviour and/ or mental preoccupation with affirmative and restrictive dietary practices. Violation of self-imposed dietary rules causes exaggerated fear, anxiety and shame. Escalation in dietary restrictions over time to the extent of eliminating entire food groups. Dangers As with any type of restrictive diet, orthorexia increases the risk of

CLEAN OBSESSION: Clean eating usually refers to eating only unprocessed and sometimes even raw food.

developing both energy and nutrient deficiencies. Due to the rising popularity of fat-free or gluten-free food, many people with orthorexia completely cut out fat and gluten from their diet. Cutting out fat can lead to deficiency in essential fatty acid which in turn cause dry skin, hair loss, vitamin deficiency and a weakened immune system. Cutting out gluten in food will also limit intake of B vitamins for energy metabolism and fibre for bowel regularity. People on vegan diets end up being deficient in iron, zinc and vitamin B12, which may cause anaemia, excessive fatigue, poor immunity, depression and anxiety. The mental health of people with orthorexia may also be compromised because of their obsession with eating healthy and clean food. It can affect their daily lives as they sometimes spend most of their waking time thinking about their diet. Their social interactions may also be greatly affected because of their restrictive eating habit. How to recover Although not an established eating disorder like anorexia, orthorexia can greatly affect the physical and mental health of an affected person. The first step to recovery is for the person to admit he or she has a problem, followed by finding the root cause of that obsession. The person must be more flexible and less restrictive about eating. Although not a diagnosed condition, professional help can be beneficial. A practitioner skilled at treating eating disorders is the best choice. A recovering orthorexic – a person with orthorexia – must understand that food will not make him or her a better person, and that it’s irrational to link selfesteem to diet quality. A healthy and wholesome meal consisting of all the established food groups is proven to be a better diet overall.

France taking big hits from anorexia As the leading fashion capital of the world, Paris is home to many supermodels. However, a darker side of the profession comes from the supermodels’ excessive obsession to maintain a thin body. The French government recently passed a bill requiring models to present medical certifications from their doctors to prove they are healthy. Photographs of models in magazines which had been photoshopped – altered using computer software – are required to be tagged accordingly. The bill stipulates that models must obtain a medical certificate stating that their health, “assessed in particular in terms of body mass index, is compatible with the practice of the (modelling) profession”. An earlier draft of the bill had caused howls of protest in the fashion industry as it proposed a minimum body mass index be imposed on models. Parliamentarians eventually agreed to let doctors make the call on whether a model is too thin, taking into account a range of criteria, including age, gender and body shape. The ban on ultra-thin models was put in place following growing concern over the welfare of women in the country where some 30,000 to 40,000 people – almost all of them adolescents –suffer from anorexia nervosa, an eating disorder with a high mortality rate.

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junior+ opinion+

february | 2016

Junior+

By Dr Ling Shih Gang

Parenting: You’re boss, not your baby

1. Acknowledge Acknowledge you’re the baby’s parents. And as parents, you take charge. You’re the boss, not your baby. You’re the one making decisions. You cannot be passive and let

CREATIVE COMMONS

your baby decide when to do this or that. You must be proactive in making decisions that will benefit your baby and also your family. 2. Set goals Have the outcome in mind. Ask yourself: What should an older child be able to do? For example, an older child should be able to sleep through the night without waking up for feeds. He should also be sleeping in his own bed, not with his parents. He should also have three square meals a day with snacks in between, and not fed milk every two to three hours. 3. Strategise Sleeping patterns Do not allow your baby to sleep too long in the day. If he’s still asleep after two hours, gently wake him up. If he sleeps too long in the day, he may not want to sleep at night. His bedtime must be the same as yours, not the other way round. Coax him to feed more milk at bedtime so he can last through the night without waking up to feed. If you plan to go out and your baby falls asleep just before you leave, just bring him along. Babies won’t die or get traumatised just because they miss one or two hours of sleep. Train your baby to get used to sleeping on the go. That way, when he is older, he can sleep anytime, anywhere. Never get your baby into bad sleeping habits, like sleeping with you on the same bed or sleeping in a spring cradle. Once you start him on bad habits, it’ll be hassle weaning him off later. From day one, get him to sleep in his own cot in your bedroom. When he is older, you can let him sleep in his room, with a small light on.

The Young Ones

t is an exhilarating feeling cuddling your newborn baby in your arms for the first time. Congratulations and welcome to the world of parenthood! However, what happens the next few weeks is nothing short of mindboggling. When your baby cries, you dash to cuddle him. When he fusses for milk, there you are breast-feeding him diligently. And when he sleeps, your plans for a family outing fly out the window. After all, your baby needs to sleep, right? Our world starts revolving around this little tiny being. But can you imagine your baby dictating terms in your household? Your baby is the boss while you’re reduced to a mere servant or slave to this new “cruel boss”. However, it doesn’t have to be this way. We as parents must take steps to regain control of the situation. To let your baby dictate terms is unfair – not just to you as parents but also to your baby as well. Your baby wouldn’t know any better what to do. He merely cries when he feels like it. To let him make “adult” decisions is simply unfair to him. There are four steps to take control and parent your newborn baby wisely and more effectively.

Feeding issues Some people recommend demand feeding whereby parents feed their babies only when they cry for feeds.

Initially, the feeding interval can be every two hours and later stretched to three or even four hours. Also try not to feed your baby when he’s asleep at night. Widen the interval as long apossible while increasing the amount for each feed.

However, when this happens, feeding time is no longer your call but your baby’s. Instead of demand feeding, it’s better to take proactive steps to feed your baby at regular intervals, regardless of whether he cries for milk or not. Once a routine is set, it’ll be easier for you to plan your activities. It’ll also be better for your baby as he does not have to wonder when the next feed is coming, as a pattern is already in place. Your baby will be more at peace and less jittery. Initially, the feeding interval can be every two hours and later stretched to three or even four hours. Also try not to feed your baby when he’s asleep at night. Widen the interval as long as possible while increasing the amount for each feed. If you want to exclusively breastfeed your baby, start expressing breast milk and bottlefeed him after two weeks. That way he’ll get used to sucking from both breasts and the bottle. This is particularly helpful for mothers who need to work or travel and cannot breastfeed. 4. Recognise baby’s developmental limitations While you can train your baby to sleep or feed, you must set realistic expectations. Your baby can achieve only a given milestone when he is developmentally ready.

In the first week or so, your baby may sleep as much as 20 hours a day. After that his sleeping hours will gradually reduce to 10 to 14 hours per day. In the first month or two, your baby is very unlikely to sleep through the night. Most babies can do so at only three months. In the first four days, your baby does not need to drink much milk. So you need not worry if you don’t produce much milk. By the fifth or sixth day, if you’ve been diligently putting your baby to your breasts, the milk will start to flow. Your baby will also want much more milk by then. In the first one or two months, the feeding pattern can be very erratic, and it may not be easy to set feeding at regular intervals. Your baby should start feeding more regularly by three months. Training and discipline are love Of course, parents love their babies, but love is more than cuddling, hugging, kissing, providing and giving in to their babies’ demands. Love is also about training, teaching, moulding and disciplining. When these elements are combined, stability and calm will reign in the household. And all these must start from the day your baby is born. Dr Ling Shih Gang is a consultant paediatrician at Tropicana Medical Centre.

junior+ JUNIOR+

2016 | february

• 23 Creative Commons

No need for blanket autism screening Inadequate direct evidence on benefits for toddlers and preschool-age children

he US Preventive Services Task Force (USPSTF) – an independent group of experts – says there is no need to screen all children aged 18 to 30 months for autism, a disorder that has become more common in recent years. The experts say more research is needed to determine if the benefits of universal screening might outweigh any harms. The USPSTF found inadequate direct evidence on the benefits of screening for ASD in toddlers and preschool-age children for whom no concerns of ASD have been raised by family members, other caregivers, or healthcare professionals. Inadequate evidence It says there are no studies that focus on the clinical outcomes of children identified with ASD through screening. Although some studies suggest treatment benefit older children identified through family, clinician, or teacher concerns, the USPSTF found inadequate evidence on the efficacy of treatment of cases of ASD detected through screening

or among very young children. Treatment studies, it adds, were generally very small, few were randomised trials, most included children who were older than would be identified through screening, and all were in clinically referred rather than screen-detected patients. The USPSTF says ASD is a developmental disorder characterised by persistent and significant impairments in social interaction and communication and restrictive and repetitive behaviours and activities, when these symptoms cannot be accounted for by another condition. The experts say in 2010, the prevalence of ASD in the United States was estimated at 14.7 cases per 1,000 children, or 1 in 68 children, with substantial variability in estimates by region, sex, and race/ethnicity. The USPSTF found that the harms of screening for ASD and subsequent interventions are likely to be small based on evidence about the prevalence, accuracy of screening, and likelihood of minimal harms from behavioural interventions. It says evidence is lacking, of

Hope for the autistic Autism spectrum disorder (ASD), or commonly known as autism, can be characterised by multiple factors such as: Persistent deficits in social communication and social interaction across multiple contexts. Restricted, repetitive patterns of behaviour, interests or activities. Symptoms present in the early developmental period (typically recognised in the first two years of life). Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. The term “spectrum” refers to the wide range of symptoms, skills and impairment or disability that children with ASD can have. Some children are mildly impaired

CHALLENGING BEHAVIOUR: More research needed to determine if the benefits of universal screening might outweigh any harms.

poor quality, or conflicting, and the balance of benefits and harms cannot be determined. SUGGESTIONS FOR PRACTICE The USPSTF says autism spectrum disorder can cause significant social, communication, and behavioural challenges for affected children and place substantial strain on family members and other caregivers. Treatment and maturation may reduce the effects of the core symptoms of ASD for some children, but others may experience long-term effects on education, employment, and ability to live independently. The USPSTF says it is important that clinicians listen carefully to parents when concerns are raised by the parents or during an examination and make prompt use of validated tools to assess the need for further diagnostic testing and services. It adds disparities have been observed in the frequency and age at which ASD is diagnosed among children by race/ethnicity, socioeconomic status, and language of origin, creating concern

that certain groups of children with ASD may be systematically underdiagnosed. The USPSTF cautions its statement is not a recommendation for or against screening. In the absence of evidence about the balance of benefits and harms, clinicians should use their clinical judgment to decide if screening in children without overt signs and symptoms is appropriate for the population in their care. POTENTIAL HARMS The USPSTF says although there is limited evidence about the harms of screening for ASD in children, reported potential harms include misdiagnosis and the anxiety associated with further testing after a positive screening result, particularly if confirmatory testing is delayed because of resource limitations. It says behavioural treatments are not generally thought to be associated with significant harms but can place a large time and financial burden on the family. Other treatments are less well studied and were not included in its review.

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by their symptoms, while others are severely disabled. TREATING ASD Although ASD can affect a child’s quality of life until adulthood, it is treatable. Treatments include behavioural, medical, educational, speech, language, and occupational therapy with complementary and alternative medicine approaches. Treatments for young children within the target age group for routine screening of ASD are primarily behavioural interventions, particularly early intensive behavioural and developmental interventions, which may include approaches incorporating applied behaviour analysis principles, parent training components, and play- or interaction-based interventions. Among the behavioural interventions, those based on applied behaviour analysis have the highest quality data supporting their effects on cognitive and

strain on family members and other caregivers. Treatment and maturation may reduce the effects of the core symptoms of ASD for some children, but others may experience long-term effects on education, employment, and ability to live independently.

language outcomes. These interventions can be delivered in homes or schools and are often time-intensive, with some programmes taking up to 40 hours a week. PREVENTABLE BURDEN ASD can cause significant social, communication and behavioural challenges for affected children and place substantial

WORLD AUTISM AWARENESS DAY World Autism Awareness Day, celebrated globally on April 2, aims to increase public awareness about people, especially children, with autism. It has been commemorated since 2007. Malaysia also participates in the celebration. This year, the Early Autism Project leads the initiative by organising a campaign to help people better understand autism and to bring forth positive conception about the condition. Portions of the above information are sourced from the US Preventive Services Task Force (USPSTF) report and the National Institute of Mental Health.

24 •

junior+

february | 2016

New app to predict premature birth risk

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QUiPP, available for free download from Apple store, helps doctors identify at-risk pregnant women

new app developed by researchers at King’s College London (UK) can help doctors identify women at risk of giving birth prematurely. The application, called QUiPP, was tested in two studies of pregnant women considered at high risk of preterm birth. Doctors usually consider patient histories of preterm birth when establishing the risk of premature birth in pregnant women. Additional factors include the length of the cervix and levels of a biomarker found in vaginal fluid known as foetal fibronectin. Fibronectin level is usually tested at 23 weeks’ gestation, and can signal an anomaly in embryonic

development if too low at the beginning of pregnancy. The new app uses an algorithm to combine information about the gestation times of previous pregnancies, the length of the cervix and the level of foetal fibronectin. This data is crossreferenced by the app to provide a more accurate evaluation of the risk of preterm birth (birth before 37 weeks). Researchers tested the reliability of the app in two separate studies, published in the Ultrasound in Obstetrics & Gynaecology journal. The first study looked at 1,249 pregnant women considered at high risk of premature birth due to previous preterm births, but with no

symptoms. The second studied 382 high-risk pregnant women and evaluated the probability of delivery before the 30th, 34th or 37th week of gestation in relation to their levels of fibronectin. The results showed that the study’s authors were able to estimate premature delivery more effectively with the app than when considering each factor alone. Professor Andrew Shennan, the study’s lead author and Professor of Obstetrics at King’s College, says: “The more accurately we can predict her risk, the better we can manage a woman’s pregnancy to ensure the safest possible birth for her and her baby, only intervening when necessary to admit these

Eggs are best for filling kids’ breakfast

Vaccine for virus common in children Researchers in Chile have developed the first vaccine against a virus that commonly causes lung and respiratory tract infections in children. The team says after clinical trials are conducted, it hopes to market the vaccine against socalled respiratory syncytial virus (RSV) in four or five years. RSV kills or forces the hospitalisation of thousands of babies around the world each year. According to the Mayo Clinic in the United States, the virus is so common that most children have been infected with it by age two. In temperate climates like that of Chile, there are annual epidemics of the virus in winter. The vaccine was developed after 10 years of work by a team led by Dr Alexis Kalergis at the Millennium Institute on Immunology and Immunotherapy. “This virus is very harmful and costly for Chilean society and the

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vast majority of countries,” says Kalergis. He says the vaccine has been successful in tests with animals and the team is ready for clinical trials on people. “Assuming we have financing and the results are favourable, we could have a vaccine in four or five years,” he says. – AFPRelaxNews

‘higher risk’ women to hospital, prescribe steroids or offer other treatments to try to prevent an early birth.” The study’s authors hope to carry out further work to evaluate the app clinically and determine whether inter ventions can improve pregnancy outcomes for women flagged up as high risk by the app. The QUiPP app is available to download free of charge from the Apple store. Worldwide, 15 million babies are born prematurely each year (before 37 weeks’ gestation), and over a million of these die from complications linked to preterm birth. – AFPRelaxnews

If you’re not sure which is the most filling breakfast to give your kids on a morning, a team of US researchers might have found the answer, finding that eggs are a more filling way to start the day than a breakfast of cereal or oatmeal. The study, by the University of Pennsylvania School of Nursing and published in the journal Eating Behaviors, looked at which breakfast kept children fuller for longer – protein-rich eggs or a grain-based breakfast such as cereal or oatmeal. They recruited 40 children aged 8-10, and asked them to eat one of three 350-calorie breakfasts – eggs, cereal, or oatmeal – once a week over a three-week period. The children were asked to eat all of the breakfast, and after finishing were also asked to play games with the researchers, before eating lunch, of which they

junior+

2016 | february

• 25

Oral contraceptives not linked to birth defects

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Women who use the pill before pregnancy are no more likely to have deformed babies than mothers who never use it

ral contraceptives taken just before or during pregnancy do not increase the risk of birth defects, according to a large-scale study published recently. Examining records for nearly 900,000 live births in Denmark, researchers found that even women who used the pill after becoming pregnant were no more likely to have babies with serious defects than mothers who had never used it. “We confirmed that there

decades old, had found a link between use of the hormone-based contraceptives and defects, even if most did not. “We were able to leverage prescription registries and thus eliminate any bias from women inaccurately recalling their use of the pill,” Charlton says. Drawing from Danish national health records from 1997 to 2011, Charlton and colleagues divided the women into four groups. A fifth comprising 176,000 women had never used the pill, while more than two-thirds stopped at least three months before becoming pregnant.

wasn’t any association between oral contraceptives and major birth defects,” lead author Brittany Charlton, a scientist at the Harvard TH Chan School of Public Health, tells AFP by phone. “Our findings were especially reassuring given that we were able to use a different approach.” Most previous research, she explains, is based on “case controlled” studies, which begin with a fairly rare outcome – a birth defect – and then work backwards, looking for a cause. Several of these studies, some

Eight percent discontinued use within three months of conceiving, while 1% – well above a statistically significant 10,000 women – used oral contraceptives after becoming pregnant. For all categories, the ratio of normal birth to those with major defects was exactly the same – 25 per 1,000 live births. This ratio remained consistent across all groups even with the inclusion of pregnancies that ended in stillbirths or induced abortions. The study was published in the medical journal BMJ. – AFPRelaxnews

I’m not surprised that the egg breakfast was the most satiating breakfast. What does surprise me is the fact that, according to the children’s reports, eating the egg breakfast didn’t make them feel fuller than cereal or oatmeal, even though they ate less for lunch.” – Kral

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could eat as much or as little as they wanted. During the morning the children were also asked questions such as “How hungry are you?” and “How much food do you think you could eat right now?” During the rest of the day, the children’s food consumption was recorded in a food journal by parents. At the end of three weeks,

the researchers found that children who ate the eggs breakfast (scrambled eggs, whole wheat toast, diced peaches, and 1% milk), ate less at lunch time, reducing their energy intake by 70 calories, roughly equal to a small chocolatechip cookie, and 4% of a child’s daily caloric needs. Eating more than the caloric needs regularly, even by a small amount, can cause

weight gain and possibly obesity. However although the team found that the protein-rich eggs breakfast left children feeling fuller for longer, and therefore eating less at lunchtime, this protein-rich meal only affected what the children consumed at mid-day, and not later on in the day. And despite eating less at lunch, the children did not report less hunger, surprising lead author Tanja Kral, “I’m not surprised that

the egg breakfast was the most satiating breakfast,” says Kral. “What does surprise me is the fact that, according to the children’s reports, eating the egg breakfast didn’t make them feel fuller than cereal or oatmeal, even though they ate less for lunch. “We expected that the reduced lunch intake would be accompanied by lower levels of hunger and greater fullness after eating the high protein breakfast, but this wasn’t the case.” – AFPRelaxnews

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beauty+

february | 2016

More Iranians going under the knife Nose bandages symbolise Iran’s cosmetic surgery craze

ying on an operating table in northern Tehran, Nazanine says she wants it all: a third nose job, her eyebrows tattooed and liposuction on her thighs to “fix” her figure. The patient in her 40s “had two nose jobs with another doctor, but wasn’t happy and asked us to do it again,” says her doctor Javad Amirizad, the latest surgeon to take her under the knife. In a conservative society where all women in public must wear at least a scarf over their hair and neck, such operations have boomed, with a nose job seen as a way to perfect their most visible asset. But the quest to look better goes much further: in two nearby rooms at Amirizad’s private clinic, women were having their breasts enlarged. Liposuction is another procedure on the rise and Iranian women – not just the wealthy in the capital – are also paying for less invasive cosmetic changes. Botox injections in cheeks or foreheads to conceal wrinkles, collagen in lips to make them fuller, or eyebrow tattoos to replace painful plucking or threading – removing eyebrow hairs with a piece of string – are becoming common. According to official figures, up to 40,000 cosmetic surgeries

take place in Iran each year, says Amirizad, a member of the Iranian Association of Cosmetic and Plastic Surgeons. More than 60% are nose jobs. But he says the actual number is much higher as official statistics do not include operations by non-specialist surgeons who are cashing in on people’s desire to improve their looks. In Iran’s largest cities it is easy to spot women – but also men – with bandages on their noses, flaunting the fact they recently went under the knife. The trend has seen the Islamic Republic jump into the world’s top 10 countries performing plastic surgery. In 2013 it ranked fourth worldwide – after Brazil, Mexico and the United States – for nose jobs, the International Society of Aesthetic Plastic Surgery reported.

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BEAUTY CRAZE: Amirizad (C) operates on a nose job at his private clinic.

Not just for women The cost of a nose operation starts at about US$1,500 – more than five times the minimum Iranian monthly salary of US$270. Mehrnaz Mehri, a 27-yearold manager at a food trading company in Tehran, says she paid closer to US$1,800 but considered it good value. “I know some famous surgeons ask for up to US$6,000 for a simple nose job,” she says.

“I never thought I’d have an operation, but when my mother and sister got their noses done, it was contagious.” Television is playing a part in the cosmetic surgery craze. Hugely popular South American and Turkish soap operas, beamed into homes via banned satellite dishes, show actresses looking beautiful after plastic surgery. Such channels, watched by more than half the population, broadcast round-the-clock advertisements for nose jobs, slimming creams and stomach-sucking corsets. Patients also fly in for cosmetic procedures, Amirizad says. “We get them from Iraq and Azerbaijan, but we mostly get Iranian women from abroad who know an operation is much cheaper in Iran than in the United States or other European countries.” Nose ‘like a doll’ And these days, plastic surgery is not just for women. “Twenty years ago, about 5% of men wanted nose jobs,” says the surgeon. “Today it’s 35%.” Mostafa Kashani, in his early

30s, is one of them. “I broke my nose in an accident, and after I got married my wife insisted I get it fixed,” he says. “I refused, but then my sister had it done and it motivated me.” Amirizad sees this as a sign of progress: “It shows our society is modernising.” But some Iranians are saddened by what they see as a Western cultural trend that may be going too far. Earlier this year a Facebook page called “Iranian Women Up Close” asked followers to post pictures of their noses to push back against beauty being defined as a surgically enhanced concept. Several hundred women did so under the heading “Pictures of My Natural Nose”. Some women who have had surgery understand the debate. Slomaz, 27, had wanted her nose redone since being a teenager and was just 20 the first time she went under the knife, but now says she wouldn’t do so again. “Girls now all have the same type of nose – a very thin one with an upturned end like a doll!” – AFPRelaxnews

Acne in women may be linked to hormonal imbalance If you’re a woman with adult acne, you will likely know all too well how difficult it is to treat the problem. However, if you’re among the 80% of women who see no benefit from the commonly prescribed antibiotic treatments, this could be a sign of a hormonal imbalance. Dr Kanade Shinkai, a dermatologist at the University of California San Francisco School of Medicine, advises women with irregular periods or other signs of

hormonal disorder and who have acne to discuss their symptoms with their dermatologists. Shinkai told MyHealthNewsDaily recently that women with acne may also have elevated levels of testosterone, which could be detected by hair growth on the face, deepening of voice, or increased muscle mass. A simple blood test could detect any imbalance. She adds that the most

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common cause of such a hormonal change is polycystic ovarian syndrome, or PCOS, which can be detected with an ultrasound of the ovaries. Treatment often involves taking birth control pills, which can also work well against acne even in women with no hormonal disorder, she adds. Other common treatments for

acne include retinoids, gels containing dapsone, cleansing creams containing benzoyl peroxide, and a blood pressure medication called spironolactone, notes WebMD. A study presented earlier last year at the American Academy of Dermatology annual meeting reports that more adult women are getting acne than ever before. – AFPRelaxnews

opinion+ beauty+

2016 | february

• 27 beauty+

By Dr Liow Tiong Sin

a ser facials have generated a lot of media attention of late, particularly after popular actress Jennifer Aniston publicly announced they are the reason she looks closer to 25 than her real age of 43. Other celebrities like Kim Kardashian and Courteney Cox have also been quoted in the media talking about procedures such as Fraxel as part of their beauty maintenance regimes. Much as the regular visit to beauty salons for a facial rejuvenating mask and steam session was the norm in previous years, the trend today is for doctors to offer lower-powered, no-downtime laser sessions that can deliver on all of those spa treatments’ promises of anti-ageing, skin beautifying and rejuvenation. These laser facials are designed to fill the gap in your skincare regime, when you don’t necessarily need or want a full laser resurfacing, but would like improvement on the limited results you get from skincare, spa and salon treatments. Medical answer to spa treatments A laser facial is any treatment involving a laser machine that is designed to rejuvenate the facial area. Each session is designed to reduce pigmentation, fine wrinkles and dull, rough skin, as well as improve skin elasticity and tone. Most of these treatments are designed as lunchtime sessions, so patients can leave the clinic and resume their normal activities immediately. The basic principle of any laser treatment is controlled wounding to stimulate healing and cell

renewal. Many of these techniques were developed to address the problems of acne scarring, pigmentation and rough skin, which required deeper laser penetration for effectiveness. Gentler laser treatments developed from these techniques are safer, less painful and employ the power of laser stimulation to prevent and reverse the effects of ageing. Clear+Brilliant and Q-Switch ND:YAG Laser Toning are examples of gentle and nonevasive facial treatments. Broad Band Light, or BBL, which treats a wide range of problems such as melasma, freckles, enlarged pores, fine lines, acne, pigmented scars, broken capillaries, birthmarks and unwanted hair, is a scientifically-proven treatment that can arrest and reverse cell ageing. Each BBL session involves the use of a cooling wand through which a filtered light is “pulsed” to stimulate specific skin responses. Clinical researchers found that BBL light treatments were able to actually activate skin cells that affect collagen production and immune response, helping skin to appear

Looking Good

Laser facials – the future of skincare

NO BANDAGES: Gentler laser treatments proves to be a better solution as it less painful.

visibly younger by an average of two years per session. Long-term studies have shown patients who underwent the treatment just once every six to 12 months looked years younger, even after many years after their initial treatments. Why you should consider laser facials Let’s face it – laser treatments are not cheap, and neither are they to be taken lightly as there are always risks and drawbacks to any kind of treatment. A laser treatment, whose modality of action is to cause controlled damage of the skin to encourage healing, is especially scary because you have so many factors to consider – the reliability of the machine being used, the expertise of the operator, the condition of your own skin and whether the settings on the machine correspond to your needs, for example, are vital to ensure the treatment is not only safe, but also effective. Many people find that the costs of laser treatments can be very high, so they patronise only beauty salons where treatments are more financially accessible. However, is it cost effective if, instead of two to three laser facials, you need to go to the beautician six to eight times for any improvement? Often the beautician will also insist you add additional treatments or products to “boost” the effectiveness of the treatment. Safety is also not guaranteed as the spa and salon market is highly competitive, and there is always a push for different, radical treatments that may or may not be clinically tested for efficacy and safety.

A more conservative group may rely on beauty counter lotions and potions, but this route, not even necessarily cheaper, offers very limited improvements that may only be noticeable after an extended period of use. As consumers get more sophisticated, the market also develops to address their changing needs. I believe the growing popularity of laser facial treatments is an answer to the need for truly efficacious treatments that lead the way into the future of skin care as we know it. DR LIOW TIONG SIN is head of aesthetic medicine at Beverly Wilshire Medical Centre.

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beauty+

february | 2016

SHUTTERSTOCK

PRIZED SEEDS: Alexandre stoops to pick handfuls of light brown seeds about an inch long from the tropical undergrowth.

From jungle to beauty parlour Brazil’s murumuru seeds are used in shampoo and lipsticks by beauty companies like Garnier, L’Oreal and Natura

n the heart of the Amazon jungle, Alexandre Amaral da Silva stoops and picks handfuls of light brown seeds about an inch long from the tropical undergrowth. From one of the remotest parts of Brazil, these murumuru seeds will journey hundreds of miles to bathrooms and beauty parlours where their oil will shine and soften consumers’ hair and lips. The seeds will put precious cash in the pockets of people like Alexandre, while providing a prized ingredient for cosmetics companies. Murumuru seeds, which are gathered at various spots in Brazil, are used in shampoo and lipsticks by beauty companies such as Garnier in the United States as well as L’Oreal and the Brazilian beauty giant Natura. Alexandre founded the

seed-gathering outpost of Providencia with his family 20 years ago. A few wooden huts in the middle of the jungle, it lies a three-hour boat ride up the Jurua river from the town of Carauari, some 700km from the nearest city, Manaus. Crowds of children flock to the sandy shore to meet arriving boats. “When I came here, there was nothing,” says Alexandre, a lean, tanned man in his 50s.

The murumuru gatherers are part of a traditional production chain that would struggle to survive without a powerful ally such as Natura.

Nevertheless he came in search of the seeds, knowing that people wanted to buy them. “In the beginning, we didn’t even know what they were used for. I just knew that my feet hurt if they stepped on the seeds in their spiky shells,” he says. Precious hair oil The murumuru seeds grow on palm trees up to 15m high. Alexandre waits until the seeds ripen and fall to the ground to harvest them. Then his wife Maria Terezinha gets to work, crushing them one by one with a hammer, removing the shells and keeping the hearts in a sack. A family like theirs can make up to US$460 a year to boost the income they gain from gathering other products. Official statistics show average per capita income is about US$660 a year in Carauari. Without big businesses, “there are many production chains in the Amazon that would disappear”, says Carlos Koury, director of the Amazon Conservation and Sustainable Development Institute, a non-government organisation. The murumuru gatherers are part of a traditional production chain that would struggle to survive without a powerful ally such as Natura. The gatherers sell the seeds to a local cooperative. At a factory in the jungle, the cooperative processes them into the palm oil prized by beauty companies, which say it melts into damaged hair to repair and make it silky.

Brazil’s growing beauty industry Brazil’s beauty industry is expanding despite the recession. The cosmetics market grew by 11% last year and was the third biggest in the world after the United States and China. Natura, one of the main users of murumuru seeds, reported sales worth nearly US$2 billion in 2014. It works with some 400 families in the Medio Jurua reserve, the area where Alexandre gathers seeds, where only about half the people know how to read and write, according to research by Natura. The company provides training and investment for processing murumuru and other seed oil products such as andiroba and ucuuba The region was once a major rubber producer but that industry declined and locals turned mostly to gathering cassava and fishing. In 1991, communities around the Jurua river united to form a rural producers’ association to resist powerful traders who they say paid them an unfair price for their goods. The association established a system that allows locals to trade their produce in return for necessities brought from the city. That too boosted their income and changed their lives. “Today they can call themselves a freed people,” says Rosi Batista, leader of a governmental extractors’ association. – AFPRelaxnews

opinion+ eye+

2016 | february

• 29 eye+

By Dr Yen Siew Siang

How to cope when eye cancer strikes your child is warranted so that the cause can be found and treated if required. Remember, presence of white pupillary reflex in a child’s eye needs to be examined as soon as possible! CAUSE Retinoblastoma occurs when retinal nerve cells in the eye undergo genetic mutations. The mutations cause the cells to grow and multiply in an abnormal rate giving rise to a tumour. Like any cancerous cells, retinoblastoma can invade further into the eye and nearby structures and also spread (metastasize) to other parts of body, including the brain and spine. What causes the genetic mutations that lead to retinoblastoma is still unclear in most cases. However, it is possible for children to inherit a genetic mutation from their parents which is called hereditary retinoblastoma. It is passed in an autosomal dominant pattern. In this case, only one parent needs a single copy of the mutated gene to pass the increased risk of retinoblastoma to an offspring. If one parent carries a mutated gene, each child has a 50% chance of inheriting that gene. Hereditary retinoblastoma tends to occur at an earlier age and in both eyes, as opposed to just one eye in nonhereditary type. Once clinical diagnosis of retinoblastoma is made, the child will undergo thorough eye examination using anaesthetics followed by imaging tests. Imaging tests can help the doctor to determine whether retinoblastoma has grown to affect other structures around the eye or has metastasized outside the eye. Imaging tests may include ultrasound, computerised tomography (CT) scan and magnetic resonance imaging (MRI), among others. Your child will be co-managed with other doctors such as oncologist, geneticist or a surgeon. Treatment of retinoblastoma depends on the size and location of the tumour and whether the tumour has spread to areas other than the eye. Your child’s doctor will try to preserve your child’s vision as much as possible. Treatment modalities included chemotherapy (systemic or local injection) to reduce the tumour size so that another treatment such as radiotherapy, cryotherapy

Look and See

etinoblastoma is rare form of eye cancer which nearly always affects young children, usually under five years of age, but rarely occurs in adults. It may occur in one or both eyes. Hospital Kuala Lumpur, the main tertiary centre for retinoblastoma, sees an average of 14.5 new cases per year. As retinoblastoma affects mostly infants and young children, symptoms are rare. White pupillary reflex is the most common early sign. When a light is shone into the eye, the pupil – the dark spot in the centre – appears red because of blood vessels in the retina. In an eye with retinoblastoma, the pupil often looks white or pink instead, which is known as white pupillary reflex, or leukocoria. The child may develop squint too. Less common signs are vision problems, eye pain, redness of the white part of the eye and bleeding in the eye. In advanced cases, the eye will be bulging out of the socket. Many of these signs and symptoms are more likely to be caused by something other than retinoblastoma. For example, congenital cataract can cause white pupillary reflex too and squint is commonly cause by weakness in the muscles controlling the eye movement. Still, if your child has any of these, a visit to your child’s doctor

or laser therapy may be used to treat the remaining cancer cells. All these are directed to kill the cancer cell further. This may improve the chances of avoiding a surgery (enucleation). Whatever the form of treatment, the most important part is the ability of child’s parents to maintain regular follow up particularly if a complete cycle of chemotherapy is needed. COPING WITH EMOTIONS When your child is diagnosed with cancer, it’s common to feel a range of emotions — from shock and disbelief to guilt and anger. Everyone finds his or her own way of coping with stressful situations. Your child can’t understand what’s happening to him as he undergoes investigations and cancer treatment. He goes through tremendous stress and may cry seeing doctors who are strangers to him. Crying is a sign of fear. The fear increases when faced with unfamiliar looking machines, repeated blood tests – which mean pain when blood is drawn from his vein – and repeated chemotherapy. Even though the child can’t understand, he feels the fear. The caretaker, usually the mother, has to remain calm to handle these very difficult moments. If the mother has guilt, anger, sad, fear, worry and feeling of total loss –which are very common emotions of those facing cancer diagnosis – she won’t be able to give her best to her child. Hence, a doctor should also provide emotional support to the parents, besides providing routine medical diagnosis and treatment.

This can be done by giving them space to air out their emotions. However, if it is beyond the doctor’s capability and time, knowing that the parents need further support, they may need to be referred for counselling. This will help the parents to cope better. Retinoblastoma Registry Report on Hospital Kuala Lumpur experience showed some patients are lost in the middle of treatment partly because their parents are unable to cope with the intensive treatment and follow-up frequency. The study concluded that most of the time, the issues are more of parental motivations rather than financial constraints as treatment of retinoblastoma in Malaysia is highly subsidised by the government and the National Cancer Council (MAKNA). Besides motivation issue, parents are also affected by negative emotions that may affect their relationships. Lack of support from either spouse, relatives, friends and organisations also contribute to poor follow-up. My take-home message to readers is no matter what the diagnosis you receive from your doctor, give time and attention to your emotional feelings. Face your emotional issue before taking the next best step for your child. With a better coping ability, you as a parent will be stronger to face the challenges and have less chance of defaulting your child’s follow-up. Dr Yen Siew Siang is a senior ophthalmologist at Optimax Eye Specialist.

30 •

eye+

february | 2016

AFIQ NOR / Health+

Getting rid of floating nuisance Dr Pall Singh shares enthusiastically about laser vitreolysis treatment and how it enhances patients’ quality of vision

ye conditions such as cataract, glaucoma and diabetic retinopathy greatly affect people’s vision and can sometimes result in blindness. People affected by eye conditions should not delay but promptly seek treatment from eye specialists. However, there is another eye condition called muscae volitantes, commonly known as floaters, which has largely been ignored because of its somewhat mild effect compared to other more serious conditions. Floaters are small spots moving in your field of vision, especially when you close your eyes. They occur as part of the natural ageing process and are particularly common among people above 50. The condition is generally harmless and does not affect your vision greatly. Because of this, the general consensus among ophthalmologists is that nothing can be done about it, which means you must learn to live with those troublesome floaters. However, if you are indeed bothered by those floaters, you can actually get rid of them using a modern treatment known as vitreolysis which has been available in countries like the US, UK, Australia and Taiwan for quite some time. According to Tun Hussein Onn National Eye Hospital (THONEH) senior consultant ophthalmologist Dr Pall Singh, in the past whenever patients came to him complaining about floaters, his standard answers were “hopefully they will go away”, “you will learn to live with them”, and “I wish there is something I

could do”. He was somewhat bothered by those standard answers he gave to his patients and that soon fuelled his desire to search for a solution to his patients’ floating problem. And while attending a conference he was told that the YAG laser vitreolysis machine was already available in Malaysia. “I was learning to use the machine at the conference when the product manager told me that an agent in Malaysia actually had one. So I contacted that agent and he told me no one in Malaysia was interested in using it because people lacked the ability to operate it properly,” says Dr Pall. On returning to his clinic, Dr Pall arranged for that person to bring the machine to THONEH for a product demonstration. He knew right then that he must have the machine available because so many of his patients had floaters. “I once had a patient who flew all the way to Taiwan to get treatment for her floaters,” says Dr Pall. And that patient didn’t have to make a return visit to Taiwan for her second treatment as Dr Pall was already trying out the equipment for treatment then. However, it took some time for Dr Pall to convince THONEH to provide vitreolysis treatment using the laser machine, and that eventually became a reality late last year when the hospital brought in the YAG laser vitreolysis machine. And with that, Dr Pall started using the state-of-the-art machine to treat patients living with floaters. As with other medical

Dry eye: More than meets the eye Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly. According to the US National Eye Institute (NEI), inflammation of the surface of the eye may also occur along with

LEADING THE PACK: Dr Pall is currently the only ophthalmologist in the country certified to perform vitreolysis using the YAG laser machine.

I was learning to use the machine at the conference when the product manager told me that an agent in Malaysia actually had one. So I contacted that agent and he told me no one in Malaysia was interested in using it because people lacked the ability to operate it properly,” – Dr Pall

dry eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon. Dry eye can make it more difficult to perform some activities, such as using a computer or reading for an extended period of time, and it can decrease tolerance for dry environments, such as the air inside an airplane. Dry eye can be associated with: inflammation of the surface of the eye, the lacrimal gland, or the conjunctiva; any disease process that alters the

treatments, vitreolysis does come with some risks. However, Dr Pall points out the risks depend largely on the user of the machine, not so much the treatment itself. “If it is not performed properly, the laser can accidentally hit the lens or retina which can cause bleeding. So it really is up to the doctor to master the technique before performing any treatment,” he says. The treatment has yet to be perfected, and Dr Pall frankly admits the only other “risk” in the treatment is it might not work in just one session. “Patients usually have to go through a few sessions for best results.” With multiple sessions, people with floater problem will obviously be concerned about the high treatment cost. Recognising this nagging concern, THONEH is working out something to keep the cost at a minimum level. “It will definitely be not as expensive as, say, treatment for cataract,” he says.

components of the tears; an increase in the surface of the eye, as in thyroid disease when the eye protrudes forward; cosmetic surgery, if the eyelids are opened too widely. Dry eye symptoms may include any of the following: stinging or burning of the eye; a sandy or gritty feeling as if something is in the eye; episodes of excess tears following very dry eye periods; a stringy discharge from the eye; pain and redness of the eye;

Dr Pall plans to train other doctors to use the machine successfully, and is already busy advocating the treatment at conferences and educating other doctors. “I have several doctors in THONEH who are working to become qualified experts.” THONEH uses conferences to promote the treatment to other medical centres in Malaysia so that they can also improve the quality of their patients’ vision. Dr Pall advises people who have troublesome floaters, but are unaware of this latest procedure, to seek prompt treatment as it is readily available. Ophthalmologists should also educate their patients about vitreolysis treatment. “There are still many doctors giving the same advice which I gave to my patients in the past when they complained about their floaters. We should not be bothered by this nuisance anymore,” he says.

episodes of blurred vision; heavy eyelids; inability to cry when emotionally stressed; uncomfortable contact lenses; decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention; eye fatigue. If symptoms of dry eye persist, consult an eyecare professional to get an accurate diagnosis of the condition and begin treatment to avoid permanent damage.

opinion+

2016 | february

• 31 dental+

By Dr Yoganjali Dorairaj

Debunking dental veneer myths

re you unhappy with your smile? Are your teeth chipped, discoloured, stained or crooked? Each time you look at the mirror, have you ever wished you had that dazzling white Hollywood smile? Thanks to rapid technological advancements, you can improve the look of your teeth with veneers. Veneers were created in the 1930s for Hollywood stars to temporarily change the appearance of their teeth. Veneers are beautifully crafted, thin porcelain “shells” that are artistically placed over natural teeth. Unlike braces or other orthodontic treatments, veneers are placed within two short visits, creating instant results for a gorgeous smile. Veneers have become one of the most popular procedures to great-looking teeth. With their increasing popularity, many myths have been spread about this procedure. I will debunk some of these myths, giving you the necessary facts to help you make an informed decision to achieve the smile you have always wanted.

FACT: Your teeth should not be more sensitive once the permanent veneers are placed. Unfortunately, there may be a short period of time when your teeth might experience slight sensitivity, and this usually lasts a week. The sensitive feeling will disappear once the permanent veneers are placed.

MYTH #1: My teeth will be more sensitive.

MYTH #4: My teeth shade looks unnatural. Everyone loves to have whiter teeth. However, others don’t want their teeth to be so white that they appear unnatural, especially if they are only placing veneers on a few teeth and would like their veneers to match the colour of their original teeth. Therefore, your dentist will be happy to ensure your veneers are up to your shade choice. The final decision is yours and your dentist is there to facilitate in achieving your smile as natural looking and beautiful as possible.

MYTH #2: People will know I have veneers and it is not my natural smile. FACT: Technology has greatly improved veneers. A properlyfabricated veneer will look entirely natural and should be virtually indistinguishable from the rest of your teeth. Patients tell me no one knew they had veneers until they informed others. MYTH #3: My entire tooth has to be cut down. FACT: Only a tiny amount of your tooth enamel, typically 0.5mm or less, needs to be removed from the first layer of the tooth enamel. It’s just enough to ensure the veneer won’t appear too bulky and it fits seamlessly when bonded onto your tooth.

MYTH #5: Veneering my teeth is a painful procedure. FACT: Treatment shouldn’t be painful at all. You will be given local anaesthetic before preparing your teeth, even though this might not be necessary as preparation is minimal but this is done to maximum your comfort. The next step is to have an impression taken of your teeth which is used to make the veneers. The final appointment is for the veneers to be bonded onto your teeth. It’s possible you may experience slight sensitivity

Veneers has been a common practice for people wanting to improve the appearance of their teeth.

Veneers have become one of the most popular procedures to great-looking teeth. With their increasing popularity, many myths have been spread about this procedure. to hot and cold in the first few days after receiving your veneers. This sensation should disappear as your teeth settle down after a few days. MYTH #6: Treatment is expensive and only the rich can afford veneers. FACT: Depending on someone’s income, this may be true. And unfortunately, most insurance policies do not cover cosmetic procedures such as veneers. Typically, veneers cost RM1,000-1,800 per tooth; therefore, the cost will depend on the number of teeth you wish to have veneered. Most dentists also offer additional options to pay for this procedure, like care credit or additional discounts, when the amount is settled in full. Be sure to ask your dentist about his financing options. You may be surprised having veneers is more affordable and easier that you think.

veneers are just as strong as your tooth enamel, and sometimes even stronger. Think of it like a glass table that can withstand any normal stress level, but it will break if a tennis ball is thrown at it! Any abnormal abuse on veneers will cause chipping and cracking and the veneer will be damaged. Like regular teeth, extra abuse will also cause problems like chipping too. Veneers are incredible. They look just like your real teeth and, more importantly, greatly enhance the appearance, colour and shape of your teeth. Ultimately, the choice of whether or not to get veneers is completely up to you. With your dentist’s help, you will be able to make a wise decision on the right veneers for your teeth. Ask your dentist the tough questions to help you make the decision that is right for your smile.

MYTH #7: The porcelain is fragile. FACT: In most cases porcelain

Dr Yoganjali Dorairaj is attached with Beverly Wilshire Medical Centre, Kuala Lumpur.

32 •

opinion+

february | 2016

dental+

By Dr Khairil Aznan M Khan

Braces boost self-confidence, social interactions

hat is beautiful? Standards of beauty vary from culture to culture, but most people place a premium on well-balanced facial features, especially in the region of the mouth. Generally, the mouth is a focus of attention because we consistently communicate and express our feelings through it. Having braces has a number of health and social benefits. A key reason cited by patients is braces boost their overall confidence, which in turn can lead to improvement in their social and personal lives. Braces can also improve health, especially when teeth issues lead to difficulties in maintaining proper dental hygiene. Experts and specialists assert that the benefits of braces far outweigh the disadvantages, such as cost and potential stigmas. Dental health benefits The primary health benefit of braces is potential improvement in dental hygiene, which can ultimately result in reduced risk of oral disease. Misaligned teeth, crooked teeth and bite issues can often cause increase in food build-up between teeth. As a result, individuals may experience increase in plaque or the soft film of bacteria that forms on tooth surfaces. Poorly-aligned teeth reduce the potential for natural tooth cleansing and increase the risk of tooth decay. Plaque is also a significant contributor to periodontal and gum disease. Straight teeth may be easier to clean than crooked ones. Having straighter teeth may help moderate tooth brushers to be more efficient with their oral care. By creating a more ideal environment for proper dental hygiene, braces can essentially improve a patient’s overall dental health. Protection of the teeth is another significant benefit of braces. Patients with irregular bite patterns often experience uneven stress and impact on certain teeth. Patients with protruding front teeth may be more susceptible to tooth damage, especially when playing sports. A protruding upper tooth will also make it difficult for patients to get their lips together and hence increases the susceptibility of the upper incisors fracturing during facial injuries.

Braces provide proper alignment, which can reduce the likelihood of damage. A straight upper front teeth tooth can reduce the risk of sustaining traumatic dental injuries due to the support of the lower front teeth and the lips in taking the impact. A cross-bite or reversed bite – lower teeth in front of upper teeth – can result in complications associated with lower jaw displacement. A lower jaw displacement is a condition where the jaw is not in its ideal position during chewing or biting which can result in muscle soreness and jaw clicking. In severe cases, patients can suffer from a condition called temporomandibular joint disorders where movement of the jaw will result in pain, limited mouth opening and jaw locking. The reversed bite associated with a lower jaw displacement can exacerbate tooth wear of the incisal edges and compromise the gum health of lower incisors. Over time, the patients’ teeth may wear more rapidly and this can lead to premature dental problems, such as a need to repair or replace damaged teeth. Braces can essentially improve the position of these teeth and prevent further dental problems. An increased overbite (deep bite) may cause trauma to the palatal gums and can potentiate tooth wear when incisors shear past each other. This condition is best treated during childhood as simple braces can utilise the patient’s growth in correcting the problem. In some cases, a tooth can be impacted due to lack of space to erupt in a severe crowding mouth. The impacted tooth may damage the roots of adjacent teeth. The impacted tooth may undergo cystic change and resulted in more complications. This condition will be diagnosed during orthodontic examination and will be dealt with before having braces. Functional benefits A person’s ability to incise and chew food can be compromised by having an open bite, a condition where the upper and lower teeth fail to contact during mastication. A patient may find it embarrassing to eat in public if he finds it difficult to incise food normally. When teeth don’t fit together properly (malocclusion), the muscles must compensate for

this poor fit. This added muscle tension can cause pain and various symptoms of temporomandibular joint disorders. An open bite at the front teeth can also affect a person’s speech. This is because the position of the upper front teeth together with the lips and tongue is important to ensure correct pronunciation of certain consonants or vowels. If a patient cannot attain contact between his front teeth, this may cause speech lisp. Having properlyaligned teeth can restore the teeth and jaws to their proper positions, offering benefits in terms of mastication and pronunciation. Psychological benefits A pleasant smile is always an important component of an attractive facial appearance. A person’s dental appearance can have a signiﬁcant effect on how he or she feels. The need for acceptance is something we never outgrow. An adult or child who feels unattractive because of crooked teeth or misaligned jaws may become self-conscious and preoccupied with his or her appearance. Having jotted or crooked teeth may affect self-esteem

Before and after treatment

and social interaction, and can be a focus of teasing, especially among children. They may cover their mouths when speaking or laughing, or even hesitate to smile, and this may cause them to be socially handicapped. Having braces not only improves a person’s looks, it also boosts self-esteem. Evidence suggests that orthodontic treatment can lead to improvement in self-esteem and psychological health in people with poor teeth alignment. Studies in the UK have shown that patients with an earlier need for orthodontic treatment and had treatment completed as a child, demonstrated better teeth alignment, better self-esteem and “satisfaction with life” scores. Orthodontic treatment gives a person a sense of control because it provides an opportunity to participate in the improvement of his or her appearance. An improved appearance through orthodontic treatment can greatly enhance one’s self-esteem which in turn improves his or her quality of life. Increased self-confidence is often observed even before treatment is completed. Dr Khairil Aznan M Khan is a visiting consultant in orthodontics at Beverly Wilshire Dental.

Fitness+

2016 | february

• 33

Is weightlifting safe for youngsters? Sports injury expert Dr William Chan weighs in on whether it’s okay for youngsters to lift weights

ith the burgeoning popularity of keeping fit and g yms mushrooming all over the country, particularly in the Klang Valley, we also see a growing number of young people going to gyms to lift weights. There has been much talk about why weightlifting is dangerous for youngsters and how it can stunt their growth. So is it really dangerous for young people to lift weights? Yes, says sports injury expert Dr William Chan, but only if it is not done properly. “We see many young people starting to go to gyms to lift weights. Some may do it to look good while others want to be healthier,” he tells Health+. He says weightlifting, like futsal, badminton or golf, is just another form of sport. “There has not been any conclusive proof that strength training or weightlifting stunts physical growth, particularly in youth,” says Dr Chan, who had wide experience as a lecturer and head of sports medicine at the University of Malaya Medical Centre. “I can safely say it is safe to start weightlifting when your body starts developing muscles. There is not much muscle development when you are not yet mature, so weightlifting is pointless then.” The American College of Sports Medicine contend that strength training by lifting weights can be a safe and effective activity for youth, provided the programmes

are properly designed and competently supervised. Dr Chan, widely recognised as among the pioneers of sports medicine in Malaysia, says proper practice is very important. He says the general weightlifting guideline for beginners is for them to know their limits beforehand, and start by lifting 50-60% of that weight. “Let’s say your limit is 50kg, which means you should train with weights that are only 25kg or below,” he adds. His advice to beginners is to identify the right techniques and proper ways to lift weights. “There is an array of gyms available nowadays, from the expensive ones to the more economical. Find a good personal trainer and prevent injuries as best as you can.” As a sports physician, Dr Chan has had many patients with sports injuries over the years. He says most people who came to his clinic with injuries are young beginners. “Most high school, university, or college students get hurt because they don’t get the right people to show them the proper way.” But can you blame the young ones for starting weightlifting on their own without proper guidance, particularly from personal trainers. As personal trainers at most gyms don’t come cheap, many beginners resort to looking things up on the Internet and asking friends with basic knowledge on weightlifting to help them. Dr Chan says this is why weightlifting is regarded as dangerous for young beginners. - Norman Hussaini

PIONEER: Dr William, who runs his clinic in Subang Jaya, is one of the few local sports medicine experts.

I can safely say it is safe to start weightlifting when your body starts developing muscles. There is not much muscle development when you are not yet mature, so weightlifting is pointless then.” – Dr William

Common mistakes among beginners Using too much weight, to soon

Injuries becomes prevalent when beginners start to lift weights over their supposed ability. It is better to start lower than your expected ability and work your way up gradually.

Not using enough weight

On the opposite side of the spectrum, beginners who are too comfortable lifting the same weight without gradually increasing it can make for an ineffective strength training.

Going too fast

Lifting weights fast does not equal faster muscle development; it may instead result in unwanted injuries. Lifting weights in a slow and controlled manner produces better muscle tension and less tissue trauma.

Resting too little or too much

The recommended resting time between sets is between 30 to 90 seconds. Strength training guideline from the American College of Sports Medicine and BodyBuildingcom

34 •

Fitness+

february | 2016

Tracking steps could take fun out of fitness

SHUTTERSTOCK

Using wearable tech and fitness apps tracks could decrease amount of exercise we do and how much we enjoy it

earable tech and fitness apps tracks are not only supposed to help us track progress, but also motivate us to get moving, run faster, and walk further. However, according to a new US study, tracking our activities could have the opposite effect, and decrease not only the amount of exercise we do, but also how much we enjoy it. A study by Duke’s University’s Fuqua School of Business found that although measuring our activities can initially motivate us to do more, it can take the enjoyment out of the activity, and actually causes us to do less, even once we have stopped tracking the activities. Professor Jordan Etkin carried out six experiments where participants had to colour, read or walk to measure the effects that tracking had on various activities. He looked at not only how much of each activity was completed,

but also how much participants enjoyed it. In the walking test, a group of 95 participants were asked to record their thoughts for a day while walking. Another group of participants were offered a pedometer for the day to track their own steps, which all but four accepted. They were also asked to check regularly how many steps they had taken. Participants in the other group were also given a pedometer, but were unable to see how many steps they had taken due to the display cover being taped over. They were told the reason for the pedometer was only to test how comfortable it was to wear it. The researchers, however, could record the number of steps. The results showed that from the two groups, the participants who were able to track their own steps walked further than the other group, but reported enjoying it less, even though they had chosen to wear the pedometer.

In a similar version of this test, rather than ask the 100 participants to check their pedometers regularly, the team asked them only to check if they wanted to, with the majority (71%) later reporting that they had checked their steps regularly throughout

SHUTTERSTOCK

Exercise hormone irisin is real A recently-discovered hormone called irisin that’s produced during exercise is not just a myth, according to a new study that traced circulation in the blood at nanogram levels. Not only is it present, it increases during exercise, says a research team from Harvard Medical School in response to two recent studies that questioned the methods the team had used to identify the hormone in 2012. Since its discovery, irisin has been linked with boosting metabolism, reprogramming the body’s white fat cells in to the “good” brown kind that burns energy rather than hoarding it, and promoting healthy ageing. The confusion is about how the hormone is produced by the skeletal muscle cells and to prove their point, the researchers employed

state-of-the-art quantitative mass spectrometry techniques to demonstrate the process from start to finish. With this equipment the research team developed a technique for measuring post-exercise increases in irisin that does not rely on antibodies, says the study. The team’s experiments on humans indicate that the hormone is similar both in composition and in circulation levels to irisin in mice. The team admits to one caveat in its method, which is that some of the hormone is lost during the laboratory preparation process – yet this means there is actually more irisin produced than what the team has accounted for. “Spiegelman and colleagues have unequivocally shown that the ‘mythical’ irisin peptide is produced as a result of exercise,” says

the study. The results again showed that those who checked their steps walked further, but also enjoyed it less, reporting that it felt like work and they were less happy and satisfied at the end of the day. Commenting on the results Professor Etkin says: “In general, tracking activity can increase how much people do. But at the same time, measurement has these pernicious effects. Enjoyable activities can become almost like a job, by focusing on the outcomes of things that used to be fun.” “This doesn’t mean we should stop measuring our daily activity,” Etkin adds, “but we need to balance that increased productivity against our underlying enjoyment. For activities people do for fun, it may be better not to know.” – AFPRelaxnews

FOR REAL: The hormone is not only present, it increases during exercise, says the research.

chemical physiologist John Yates of The Scripps Research Institute, who was not involved in the study. “This data should settle the controversy surrounding the existence of irisin and its increase in blood as a function of exercise.” The team’s 2012 discovery of irisin was exciting because it pointed to the health benefits

of exercise. Exactly what kind of exercise produces more irisin isn’t clear yet, although existing data points to high intensity training protocols as being particularly effective in producing the hormone. The study was published in the journal Cell Metabolism. – AFPRelaxnews

2016 | february

WELLNESS+

Massage in the dark awakens senses Physical complexes are easily overcome and the more prudish have nothing to fear or to hide anymore, as only touch matters

he concept of dining in the dark has taken off in restaurants in cities like London, San Francisco and Paris, and now a similar approach to spas and massages looks ready to win an increasing number of fans in

France. At Spa dans le noir (Spa in the Dark), which opened in Paris and Bordeaux in 2010, exfoliations, massages, baths and other treatments are offered in the dark by blind or partially sighted professionals. Stimulating other senses Inspired by the ancient South Asian tradition of the so-called blind massages, Spa dans le noir invites clients to focus on touch and smell in an environment that compels a complete detachment from all things visual. The French spas were conceived and developed by Didier Roche, who is blind. Darkness facilitates and even improves the process of relaxation: it enhances the other senses and allows for total body and spiritual release, while also protecting from unwanted attention. Physical complexes are more easily overcome and the more prudish have nothing to fear or to hide anymore. In the dark, only touch matters. The concept has proven popular and inspired others. State-certified masseurs, partially sighted for the most part, whether practising for organisations or private entities, have brought blind massage to clients who have been won over by the cocoon-like comfort. Even those who start off hesitant or panicked end up being seduced by the atmosphere. Practice originated FROM China In Beijing, China, the Beijing Massage Hospital began training blind masseurs in therapeutic practices in 1956.

• 35

Forty years later, the practice was legitimised with the creation of the Chinese Massage Association of Blind Practitioners. Since a 2006 government initiative, the number of practitioners has been steadily increasing, and have surpassed 100,000 certified blind therapists. A 2014 movie by Chinese director Lou Ye titled Blind Massage, based on a novel by Bi Feiyu, centres around the

lives of a group of sight-impaired practitioners. Though the treatments to ease pain or tension are the same when performed by a blind or sight professional, the difference often comes through in the hands. A good massage depends on tactile sensibility, and blind people have a considerable advantage in this, which is why the therapeutic massage sector is a primary recruiter. In France, in 2006, of the 55,000 practitioners in the business, between 1,500 and 2,000 state-certified masseur-physiotherapists were blind or partially sighted, according to the National Union of Blind and Partially Sighted Masseurs. – AFPRelaxnews

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WELLNESS+

february | 2016

SHUTTERSTOCK

Pre-marriage weddingmoons for stressed-out couples Whether it’s a wellness programme or meditative-yoga retreat, more and more couples are taking pre-wedding honeymoons

unt Patricia has just separated from Uncle John, meaning you have to rearrange the seating chart. The caterer has just made local news because dozens of guests are with

food poisoning. And you just can’t seem to get rid of those last five pounds for the big day. Enter the weddingmoon – or the me-moon – a pre-wedding vacation trend that more and more couples are taking to

STRESSED OUT: For overworked brides, a holiday wellness company has even coined the marketing term “me-moon”.

break away from wedding-related stress. It’s the latest trend after babymoons and minimoons, in which couples set off on their last hoorah before the birth of their babies, or newlyweds eschew the big Hawaii honeymoon for a weekend getaway or staycation. To reconnect with their future spouses after months of weddingrelated squabbling, some couples are booking weddingmoons, final vacations as untitled boyfriend,

girlfriend before exchanging “I do’s”. Earlier this year, photos of British celebrities Mark Wright (TV presenter) and Michelle Keegan (Coronation Street) showed the good-looking couple cavorting in the Caribbean ahead of their big wedding. Likewise, celebrities Nikki Reed (model) and Ian Somerhalder (The Vampire Diaries) took a pre-wedding honeymoon to Aruba before their big day. Pre-wedding health retreats for losing those last 10 pounds or recharging from a year-long ordeal is also becoming increasingly popular, not just for stressed-out brides, but couples together. Think Canyon Ranch-branded wellness programmes or meditative-yoga retreats. And for over-worked brides, a holiday wellness company has coined the marketing term “memoon,” a getaway that allows the primary wedding planner to take a break with a mini-break either by themselves or with close family and friends. And unlike major, aroundthe-world holidays, because the point of a weddingmoon is simply to reconnect with partners or disengage from the wedding planning, couples are opting for smaller, weekend getaways or staycations that don’t break the bank but remind each other w hy t h e y ’ l l b e w a l k i n g down the aisle in the first place. – AFPRelaxnews

SHUTTERSTOCK

Yoga for kids, surfing spas for women Interesting spa and wellness trends to shake up industry this year

his year is poised to see the growth of spa and wellness trends that will chart new territory for the industry and consumers. That’s according to Spafinder’s 13th edition of the Global Spa and Wellness Trends report, which looks at how wellness travel is evolving around the world. Here are some of the interesting trends predicted to shake up the industry and offer consumers more choice this year: Surfing spas There’s nothing new about surf tourism. But experts have noted an “explosion” of all-female surf retreats that offer surf classes as

well as spa services. When the waves aren’t breaking, for instance, guests can partake in oceanfront yoga, or relieve sore muscles with a massage. Likewise, hotels are recognising surfing as a particularly effective form of fitness, introducing surf-simulating classes into their fitness programmes. Bali’s Hotel Komune is cited as a shining example of a surf resort, with yoga, paddle boarding and qi gong classes, as well as yoga pavilions and a full-blown spa. Spas for kids Adults may think they have the monopoly on stress, but today’s kids can likewise experience fierce pressure with excessive screen time, bad diets, inactivity and

SURFING BOOM: Experts have noted an explosion of all-female surf retreats that offer surf classes as well as spa services.

hectic schedules. Enter yoga classes for kiddies, massage classes for toddlers and child-friendly wellness programs for families. At the Six Senses’ children’s club in the Maldives, for instance, kids can participate in music meditation classes, yoga, tai chi and gardening.

New York saw the opening of its first yoga studio Karma Kids Yoga, dedicated exclusively to kids and families. And at the monastery Plum Village in southern France, kids are taught about mindfulness, and how to meditate. – AFPRelaxnews

WELLNESS+ opinion+

2016 | february

• 37 wellness+

By Urmilah Dass

Healthy Mind

Resilience through grief t was in the early part of January 2015 when I noticed that my mother was becoming more and more forgetful. I remember a conversation we had where she told me she would cook our favourite chicken curry, a family favourite. I looked forward to dinner time but when we sat down to eat, she suddenly said, “Oh I forgot to cook the chicken curry. I don’t know how I forgot.” There were other worrying tell-tale signs too like burnt pots, misplacing things and forgetting conversations. It alarmed me as my mother had always been very sharp, who always said what she meant and did what she said. Worried about her memory deficit, I consulted a neurologist who administered some verbal tests to check on her memory and then ordered an MRI. The MRI showed that my mum had probably suffered many silent strokes which had left scarring in her brain. This caused blood flow to slow down, hence her loss of short-term memory. The diagnosis is vascular dementia. Her memory would get progressively worse. There is no cure but with the correct medication and intervention, it could be slowed down. The first thing I knew I had to do was to make plan for the best way to care for my mum. She needed medication, individual care and social support. So we had all her medication sorted out, we hired a stay-in helper who would make sure mum took her meds on time, to keep her company and, most importantly, keep her safe. She needs to continue her activities as much as she can even when she is demotivated and confused. These are the steps that have kept us all sane and which have helped mum immensely. It has been over a year now and although it weighs heavily on our minds, my mum seems to be doing okay. Her memory is slowly going and her personality has changed. The plus point here about losing her memory is that she does not hold on to emotional issues from the past simply because she can’t remember. It seems like a blessing and I sometimes think if all of us could be like that, wouldn’t it be a marvellous world! But then I ground myself when I remember this is a progressive disease, and she will get worse. I learnt there are many things that can help mum delay the disease which I try to do on a daily basis. Human interactions, especially with her family, make her happy. Simple phone calls, having dinner together, and going out for social functions help. Activities that can help mum with her memory like word search, colouring pictures, reading, watching television and talking to people, are important. Thirdly, mum needs to keep physically active. She needs to try to do light exercise like walking to improve blood circulation. I also realise that illness of loved ones takes a toll on my family and me. I’m devastated that I’m losing my mum. Like for most carers, self-care is key. Since I am now an official carer I can empathise even more with people who go through this. I’ve a grief support group at my practice Valley Psychological Services which is run by a drama therapist. It is therapeutic to talk to other people who are grieving and to get feedback from the therapist. In this process, I’ve realised it’s imperative to have “me time”. It is when I spend time talking to someone I trust, or go out for dinners and movies. Massages and other relaxing activities like pedicures or manicures are important stress busters. It’s doubly satisfying when I can invite

mum to join me as it makes us both happy. As a daughter, a carer and a psychologist, this situation is very difficult. I strive everyday to make it all worthwhile for my mum, our family and myself. I’ve

taken control of sadness and used the stress to my advantage. I will never give up. Urmilah Dass is a clinical psychiatrist at Valley Psych Human Development Centre.

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GENERAL+

february | 2016

Probiotics promote healthy guts

AFIQ NOR / Health+

Intestinal conditions like bloating may develop after surgeries

B y N or m an Hussaini

robiotics can help support healthy intestines in certain cases of intestinal conditions, such as bloating and constipation, may develop after surgeries, says a consultant paediatric surgeon. Dr Syariz Izry Sehat of Prince Court Medical Centre shared this recently at Yakult’s “The Secret of Healthy Intestines” workshop

to educate the public on the importance of eating healthy and maintaining healthy intestines. He says some new-born babies have congenital intestinal conditions and other intestinal complications which require surgery at a very young age. For example, he says bowel atresia which can be detected when a baby is born is a treatable condition. The young doctor, with his sense of humour, says we need to take care of our digestive system as we cannot live without it. He explains the importance of taking care of people with congenital

DELICIOUSLY WITTY: Chef Zubir delights the crowd with his delicious cooking and witty talk.

DOUBLE SUPPORT: Dr Syariz and his former patient Madelaine showing their support for intestinal health.

intestine conditions and how Yakult can help in the recovery process. Dr Syariz’s former patient, Madelaine Tan, was present at the event. She was born premature and contracted an intestinal condition called necrotising enterocolitis. She underwent several surgeries and has fully recovered. Shaleen Rajasegaram, a dietitian from KPJ Specialist Hospital, shared on why people need to maintain a healthy and balanced diet, and the importance of prebiotics and probiotics. “A well-balanced diet consisting of fibre (vegetables and fruits), protein (meat and fish), carbohydrates (rice and grains), and water embodies a healthy digestive system, which in turn ensures a healthy life overall,” she says. She highlights the various food sources of prebiotics and probiotics. “Prebiotics are what fuel the good bacteria in our intestines, while probiotics are to encourage the growth of good bacteria.” Celebrity chef Chef Zubir was also there to share his culinary skills and did a great job entertaining and providing practical tips. He prepared some delicious meals for the audience and even incorporated Yakult drink in his dessert dish. The audience was also entertained by D’Phoenix Band and Azman Ismail, former drummer of Flop Poppy. Yakult senior manager of public relations and science Mazlyn Mena says although Yakult probiotics

drink is sometimes given to patients with intestinal disorders, it is generally consumed by healthy people of all ages. “The Shirota strain of bacteria in Yakult helps support a healthy balance of intestinal bacteria which is associated with strong immune and digestive system.” T his intestinal health awareness campaign is in line with Yakult’s philosophy that prevention is better than cure, a healthy gut leads to long life and to deliver good health to as many people as possible as advocated by its founder, the late Dr Shirota.

DRINK TO HEALTH: Shaleen talks about healthy diets and the benefits of prebiotics and probiotics.

SUPPORTIVE TRIO: Chef Zubir, Shaleen and Dr Syariz supporting Yakult in its journey to help people and promote healthier lifestyle.

GENERAL+

2016 | february

• 39 AFIQ NOR / Health+

Lending a hand to the needy Yakult helps needy single mothers via its programme called Yakult Ladies

zman Ismail, former drummer of a oncepopular local band Flop Poppy, and his wife Azi Fitrah Ahmad were overjoyed when she conceived their third child. However, their joy turned to despair after Putra Azrullah was born on Oct 15 – he was diagnosed with a congenital intestinal condition. “My first thought when the doctors told me of Putra’s condition was of total shock and panic. We never had any problem with our first two children so we had no idea what to do,” says Azi. She and Azman, who has been busking the past four years after the band split up, turned to the public for help to pay for Putra’s surgery. Putra Azrullah needs multiple surgeries to treat his condition, and Yakult (M) Sdn Bhd has started the ball rolling with a generous donation to help pay for Putra’s operation scheduled in March. Yakult senior manager of public relations and science Mazlyn Mena says in addition to the company’s financial assistance, donations will also be collected from its staff and independent home delivery agents known as Yakult Ladies. Azi thanked Yakult for the assistance. “I am forever thankful for their help – it is truly a blessing. I do hope this will not be a one-off

thing for Yakult. They can help a lot of people with what they are doing for my family and me.” Azman and Azi were present at the “The Secret of Healthy Intestines” workshop organised by Yakult to spread love to the community and help the needy. The workshop was organised in collaboration with the National Single Mothers Organisation of Negeri Sembilan and the Mas Merah Single Mothers Association of Kuala Lumpur and Selangor. Yakult has been helping needy single mothers via its programme called Yakult Ladies whose goal is to help the women get back on their feet by selling Yakult products door-to-door in their neighbourhood. Aslina Pooa Abdullah, representing the associations, says: “What we do essentially is to provide welfare to less fortunate single mothers. We help them in many ways, including finding jobs for them, providing clothing, helping to build houses, and assisting them to get accreditation for their small businesses.” “We are grateful that Yakult had lent a hand to make the lives of some of the single mothers a little better,” she adds. Madelaine Tan, who has fully recovered from a congenital intestinal condition similar to Putra, was present with her family to give

GRATEFUL HEARTS: Azi and Azman are thankful to Yakult for helping out in Putra’s upcoming surgery.

COMMON BOND: Caroline with Madelaine showing support for Azi and Azman during the event.

moral support to Azman and his family. Her mother, Caroline Jaba, shared her experience journeying with her daughter after she was diagnosed with the condition when she was born. “My experience was full of fear, anguish, relief and finally happiness. Madelaine went through so much when she was very young and it had brought our family together,” she says. She says Madelaine was born

premature and was diagnosed with the intestinal condition. “She went through multiple surgeries and endured multiple high fevers and side effects as a new-born baby.” Although Madelaine has fully recovered, she is still under observation. “I am very happy. Madelaine is very energetic and playful. She also eats well and has good appetite,” says Caroline. Madelaine, now 7, is already in school. - Norman Hussaini

HELPING HAND: Yakult has been helping the single mothers association by providing members with work selling its probiotic drinks door-to-door.

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GENERAL+ opinion+

february | 2016

GENERAL+

By Dr Sham Kumar Sadanand

Acute pain services improve quality of patient care SHUTTERSTOCK

Basis for acute pain services Perioperative pain starts from the time of hospital admission to the first 72 hours after surgery, which varies in intensity due to subjective variations. A good perioperative pain management provides good postoperative analgesia and is associated with less morbidity and mortality. On the other hand, unrelieved postoperative pain may not only delay the recovery and discharge process, but also potentially lead to chronic pain conditions. The solution to this problem lies in setting up an acute pain services (APS) based on evidence-based approaches within available resources with accountability. A good regional anaesthesia service can be crucial to any APS as it provides timely application of appropriate pain relieving methods, which improve overall postoperative pain management and a patient’s hospital experience. Unfortunately, regional anaesthesia services are not well recognised, defined or structured and their function varies from hospital to hospital in Malaysia. Nowadays, we are witnessing an upsurge in APS, especially in developing countries. Anaesthesiologists are usually the lead physicians who work closely with paramedical staff and decide on the analgesic modality while managing side effects and assuring patient safety. Ideally, the APS pathway should include patient assessment, pain management delivery, documentation, patient’s awareness programmes, audits and defined performance criteria for evaluation.

APS components The important components of APS are: Multidisciplinary team comprising anaesthesiologists, surgeons, nurses and pharmacists. The team should define the needs and suggest the equipment and infrastructure besides providing guidance to develop and manage the APS. Acute pain management protocols and modalities of the APS. Regular pain assessment methods and guidelines to control pain within a defined time scale. Continuous professional development and teaching programmes. Regular meetings, cooperation and networking among members of the committee. Patient education and information regarding pain, treatment options and their side effects. Safe and secure central data keeping for regular follow-up. Audits on methods, patient satisfaction and cost-effectiveness. Myth on side effects and complications On many occasions well-planned protocols are abandoned due to side effects which develop from the onset or as the APS protocols go along. It has often been a knee-jerk reaction to abandon the technique in progress. As a result, the patient is left in pain and has an unpleasant post-operative period with the development of substantial psychological trauma. In selected cases there have been recognised and documented chronic pain syndromes as a result of this inadequately treated pain. Classical situations are seen in post-mastectomy, open cholecystectomy and thoracotomy patients. All the team members at Manipal Hospitals Klang (MHK) are trained to understand the concept of pre-emptive control of these issues by utilising techniques which can decrease these side effects. The aim is not to stop the APS protocol but to institute measures to control side effects. Continuous development of services In line with current trends to improve the quality of patient care and satisfaction, MHK embarked

on a pilot programme to develop a formalised APS. The programme was started by our Anaesthetic Department in June 2015 with a more formalised post-operative analgesia protocols and a bedside education programme for nurses with training in proper pain scoring methodology. Clinical audits are the backbone of good governance. Good recordkeeping and data management are crucial. Records help in follow-up and evaluation of key outcome measures. Regular audits show whether the goals of the APS are

Anaesthesiologists are usually the lead physicians who work closely with paramedical staff and decide on the analgesic modality while managing side effects and assuring patient safety.

achieved. Towards this we aim to utilise all data generated during the course of our development to further streamline and enhance our services for the best outcome. Painfree hospital stay Gone are the days when perioperative pain and discomfort used to be the most fearsome experience for any patient. The introduction of APS – including regional anaesthesia services – has increased awareness among patients and medical professionals that proper pain management in perioperative period is important to enhance a patient’s wellbeing. Our dedicated team aspires for excellence and good clinical governance, and appropriate organisational structure with the goal of achieving a painfree hospital stay, especially for surgical patients. Dr Sham Kumar Sadanand is a consultant at the Anaesthesia and Intensive Care Department of Manipal Hospitals Klang.

GENERAL+

2016 | february

• 41

Health care in your palm

SHUTTERSTOCK

Consumer Electronics Show showcases new applications for ‘virtual checkups’ and ways to treat pain, manage stress and monitor conditions

anaging your health care is moving increasingly to the palm of your hand – with new smartphone-enabled technology and wearable sensors that examine, diagnose and even treat many conditions and ailments. The recent Consumer Electronics Show (CES) in Las Vegas saw the debut of new applications for “virtual checkups” and ways to treat pain, manage stress and monitor conditions such as diabetes. French-based health group VisioMed introduced its Bewell Connect health management suite, which includes a smartphone app that communicates with its connected blood pressure and glucose monitor, thermometer and blood oxygen sensor. “If I have all these indicators I can get a pretty good assessment of your health,” says Benjamin Pennequin, research director for the group. “This is like a personal virtual checkup.” Sharing data with physician But the app goes further: If you have symptoms such as chest pain or shortness of breath, it poses a series of questions and delivers potential diagnoses, and allows the user to share the data with a physician. And a simple button on the app can connect you to a doctor:

In France the app locates nearby providers in the national medical service, and Bewell is working to establish a network of connected physicians in the United States. A hand-held connected device unveiled by Las Vegas-based startup MedWand allows consumers to measure temperature, heart rate, oxygen levels and includes a camera to examine the throat and inner ear to enable doctors to perform an examination online. Lead engineer Terry MacNeish says the data from the US$250 gadget allows for a more thorough examination than most other kinds of telemedicine. “If you’re just skyping your doctor, it’s just medical chat,” MacNeish says. “With this we can get a picture of your tonsils, we can take your temperature. It’s much more precise.” MedWand is in the preapproval phase for clearance by the US Food and Drug Administration, and is expected to complete the process this year, says inventor and CEO Samir Qamar. MedWand is working with existing telemedicine doctors and hopes to start selling the device in June in the United States and globally. MacNeish says insurance companies are generally positive towards the product because a telemedicine exam costs less than one in a doctor’s office. “The patient saves a lot of time and so does the doctor.”

104-year-old twins say closeness is their secret When they were born premature in 1912, doctors gave Paulette (pic, right) and Simone the slimmest chance of survival. But 104 years later, the French twins say there’s a simple secret to their longevity: sticking together. With their long white hair tied back in ponytails and gold spectacles perched on their noses, Paulette Olivier and Simone Thiot

are happy to pose for the camera at their retirement home in Onzain, central France. “This will be fun!” they say in chorus. There is no official confirmation that Paulette and Simone are the oldest twins in France, but they appear to be the likely holders of the title. “We’re being very spoiled,” one of them says as they show off the

BRAINY STUFF: BrainCo CEO Bicheng Han wearing the BrainCo Focus 1.

Continuous monitoring Putting more health data in consumers’ hands is a big theme at CES. US-based medical device maker Omron unveiled its wristworn blood pressure sensor which delivers information to a smartphone. “Most people only get their blood pressure checked at the doctor’s office once or twice a year,” says chief operating officer Ranndy Kellogg. “This is continuous monitoring. If there is something wrong with your heart, you really want to listen.” Tech-savvy startups and others are introducing new ways to treat pain, in some cases taking techniques which have been around for decades and adapting them for smartphones and connected wearables. NeuroMetrix debuted its Quell leg band, which blocks pain signals to the brain, and is an alternative to drugs for people suffering from debilitating pain related to diabetes or other ailments. It recently received approval from the Food and Drug Administration. NeuroMetrix founder Shai Gozani, a medical doctor who also has a PhD in neurobiology, says the device “triggers your brain to upgrade its pain modulation” by acting on the opioid receptors in the same manner as opiates – but without drugs. While Quell is a device which

treats pain anywhere in the body from a single band, iTens offers a smartphone-controlled patch which attaches to specific muscles to treat pain, using technology known as TENS, or transcutaneous electrical neuromuscular stimulation.

flowers given by the local council and fellow retirement home residents to mark their 104th birthday. Paulette and Simone were born in the central village of Limeray on January 30, 1912 to Marie Lamolie, a dressmaker, and her husband Joseph, a carpenter. Their entry to the world did not bode well. “We were premature,” says Simone, who can still get around these days without the help of a Zimmer frame. “We were due in March but we were born in January. They gave us

a very small chance of surviving. I didn’t even weigh a kilo. And you, just three pounds,” she says to her sister. “They had to keep us wrapped up for four months.” Paulette, widowed at 36, worked as a hairdresser for 15 years in Algeria, then in Paris. Simone, a dressmaker like her mother, lost her husband when she was 64. Neither had any children. The twins, whose only brother died in accident at the age of 99, insist it’s their lasting friendship that has kept them going all this time. – AFPRelaxnews

Hacking pain The technology has been around for decades in hospital settings but is only now hitting the consumer market with smartphone technology and sensor-embedded devices. “ The electrical impulse intercepts the pain signal before it reaches the brain,” says iTens spokesman Scott Overton, showing the device on the CES floor. Tech innovators have found other paths to effectively hack into the body’s neural pathways for therapy. Biotrak Health showcased a headband to help users control muscle tension that often leads to migraines and other kinds of pain. The Halo headband “alerts you when you are tense and allows you to control your own tension,” says spokesman Adam Kirell. A wrist-worn device meanwhile from ReliefBand technologies takes aim at nausea associated with motion and morning sickness. The device, which looks like a wristwatch, acts on the P6 or median nerve – the same technique used in centuries-old treatment from acupuncture. – AFPRelaxNews

42 •

GENERAL+

Why diets don’t work? Healthy foods vary by individual and one-size-fits-all approach to dieting is fundamentally wrong

h e a lt h y f o o d for one person may lead another to gain weight, according to a new study that suggests a one-size-fits-all approach to dieting is fundamentally wrong. For instance, one woman in the study repeatedly experienced a spike in blood sugar after eating tomatoes, which would generally be considered a low-fat, nutritious food. The findings are based a study of 800 people in Israel, and are published in the journal Cell Press. “The first very big surprise and striking finding that we had was the very vast variability we saw in people’s response to identical meals,” says researcher Eran Segal of the Weizmann Institute of Science in Israel. Participants wore blood sugar monitors that took measurements every five minutes for an entire week. They also provided stool samples so that their gut microbiome could be analysed, and kept

a careful log of everything they consumed. None of the participants had diabetes, but some were obese and had a condition known as pre-diabetes. Researchers were stunned to see the difference in people’s metabolic responses to the exact same foods. For instance, some people’s blood sugar rose higher after eating sushi than it did after eating ice cream. And for one middle-aged woman, the act of eating tomatoes – which she thought were part of a healthy diet – actually caused her blood sugar to rise significantly. “There are profound differences between individuals – in some cases, individuals have opposite responses to one another – and this is really a big hole in the literature,” says Segal. What we eat High blood sugar is dangerous because it can lead to diabetes, obesity, heart problems and other complications, including eye,

february | 2016

WRONG FIT: One-size-fitsall approach to dieting is fundamentally wrong.

kidney and nerve disease. Many diets aim to keep blood sugar low by incorporating fruits, vegetables and complex carbohydrates like brown rice and whole grains, while avoiding refined sugars and goods made with white flour. But those recommendations don’t work for everyone, and often, overweight people are blamed for eating too much or not sticking to a healthy lifestyle. Co-author Eran Elinav says the study “really enlightened us on how inaccurate we all were about one of the most basic concepts of our existence, which is what we eat and how we integrate nutrition into our daily life.” Instead of urging people to eat low-fat diets, a more personalised approach – one that puts an individual at the centre of the plan, rather than the diet – could be useful to help people control high blood sugar and improve their health, he says. The researchers also used their findings to forge an algorithm that could predict how different people would react to certain foods, based on a host of personal characteristics and their gut microbes. Segal says he and his colleagues are working on a system that could bring better nutritional analysis to the individual consumer. The process would involve mailing stool samples for analysis of the bacteria in the digestive system, because researchers found that specific microbes correlated with blood sugar levels after eating. Community of microbes The microbiome is the community of trillions of bacteria living inside the human body, wielding

a powerful but poorly understood effect on human health. Late last year, a group of 48 scientists from 50 US institutions called for more ambitious research into these tiny microorganisms, as part of a 10-year effort known as the Unified Microbiome Initiative Consortium that would uncover the role of individual microbes – which include fungi, bacteria, viruses, algae and more – and how they communicate with each other, their hosts, and their environment. According to Minisha Sood, director of inpatient diabetes at Lenox Hill Hospital in New York City, the Israeli study highlights the importance of individualised nutrition dietary advice should vary from person to person and should be tailored to meet the needs of a given individual based on their reactions to different foods. “What remains to be deciphered is exactly how to tailor personalized nutrition therapy,” says Sood, who was not involved in the study. “Should it be based, at least in part, on an individual’s microbiome or gut flora?” Rebecca Blake, senior director of Clinical Nutrition at Mount Sinai Beth Israel, says the role of the gut microflora contributing to obesity and metabolism is certainly an evolving discipline within the field of nutrition science. “However, we need to consider whether this is the chicken or the egg – does our diet affect our gut microbiota and our obesity, or is the microbiota somehow causal when it comes to weight status?” adds Blake, who was not involved in the study either. “We still need a lot more research to figure out the nature of these connections.” – AFPRelaxnews

GENERAL+

2016 | february

• 43

Stevia – the healthier alternative Its extracts are 200 to 300 times sweeter than sugar, and what’s more appealing is that it doesn’t raise blood insulin level

By ALI-AZMIN HASSAN

ugar is probably one of the most harmful ingredients around. It is added to almost every processed food. It is addictive and will make you overweight, depressed and sick if you eat too much. Thanks to nature, we now have an alternative sweetener called stevia. For those of you who are hearing about stevia for the first time, you might be wondering, what is this stevia which more and more consumers, particularly the health conscious, are raving about? Stevia is a plant that is typically grown in South America. It is an herb in the chrysanthemum family which grows wild in parts of Paraguay and Brazil. Stevia has been reportedly sold in Japan for about 40 years, but was only approved as a food

additive in the US in 2008, and in Europe in 2011. And it is slowly but surely gaining popularity in Malaysia. You might be wondering whether consuming stevia instead of sugar is just another passing fad. It’ll die out like every new thing, as you simply can’t replace sugar, can you? Well, that’s partly true. Consumers are naturally conservative. To most people, the idea of change can be hard, but not impossible. Nevertheless, with time and more public awareness, stevia might just make its way into the lives of the masses and become a common household item. Stevia is an effective substitute to sugar and its extracts are 200 to 300 times sweeter than the latter. What is even more appealing is that it does not raise blood insulin level, has virtually no calories, no sugar or carbohydrates and its glycemic index is zero. It also contains 10.77% fibre which helps to cure constipation and promote proper digestion. Stevia was initially sold as a

NATURALLY SWEET: Tan says stevia is a natural substitute to sugar and has proven to be safe for consumption.

Men face higher risk of cancers linked to oral sex Men are twice as likely as women to get cancer of the mouth and throat linked to the human papillomavirus, or HPV, one of the most common sexually transmitted infections, researchers say. For men, the risk of HPVdriven cancers of the head and neck rise along with the number of oral sex partners, researchers say at the American Association for the Advancement of Science (AAAS) annual meeting in the US capital. Nearly two out of three of these oral cancers in the United States and most western nations are caused by infection with the

HPV 16 strain of the virus, and incidence of cancer is on the rise in recent years, says Gypsyamber D’Souza, who teaches epidemiology at Johns Hopkins University in Baltimore, Maryland. Middle aged white men are at particularly high risk compared to other races. She says her research shows that youths are engaging in oral sex at increasingly young ages, compared to past generations. “Our research shows that for men, the number of oral sex partners – as that number increases, the risk of an oral HPV infection

ground-up powder of the plant leaves. The powder had a bitter aftertaste which limited its acceptability as a sugar substitute. But manufacturers have figured out a way to retain its sweetness and all its benefits without the aftertaste. The extraction process

increases,” she says. But with women, the number of sexual partners does not appear to raise the risk. “Comparing men and women with the same number of sexual partners, a man is much more likely to become infected with oral HPV than a woman.” Furthermore, women who have a greater number of vaginal sex partners appear to face a lower risk of oral HPV infection, she says. The reason may be that when women are first exposed to HPV vaginally, they mount an immune response that prevents them from getting an oral HPV infection, she adds. But men do not seem to have equally robust immune responses. “Men are not only more likely to be infected with oral HPV infection than women, but our research shows that once you become

involves steeping the dried leaves of the plant, then separating or purifying the best tasting sweet compounds. According to Tropicana Medical Centre clinical dietician Tan Yen Sing, stevia is safe to use and no major contraindications, warnings or side effects have been documented. Diabetics can safely use it as it will not raise blood sugar level. In terms of dental effects, she says in Germany, dentists from a local dental association have warned against the assumption that stevia is less harmful to teeth than granulated sugar. Tan tells Health+ that stevia’s claim of tooth friendliness has not been proven sufficiently by scientific studies. “Therefore, proper oral hygiene is still important with or without using stevia for one’s dental health.” Tan says stevia is highly recommended as a natural sweetener to replace artificial sweeteners. “Stevia is highly nutritious and contains vitamins and minerals such as magnesium, niacin, zinc, calcium, phosphorus, chromium, potassium, vitamins A and C, and many more in its unprocessed form. Stevia leaves also contain fibre, protein and good amount of phytonutrients. Phytonutrients are found in certain plants and are believed to be beneficial to human health and help prevent various diseases.” Furthermore, Tan says stevia is also safe for diabetic pregnant mothers and also those who want to lose weight by avoiding sugar. Stevia can be found in most local pharmacies in powdered form and drops. You can even grow your own stevia plant by buying and planting the seeds. It works just as well and you actually know where the leaves come from.

infected, men are less likely to clear this infection than women, further contributing for the cancer risk.” HPV infection is quite common, and most people clear the virus within a year or two, she says. In some cases, however, HPV does not go away and can lead to cellular changes in the mouth and throat, which eventually become cancerous. Oral sex may raise the risk of head and neck cancer by 22%, according to a study published January in the Journal of the American Medical Association. This type of cancer has risen 225% in the last two decades. The US Centers for Disease Control and Prevention (CDC) urges HPV vaccination for all pre-teen boys and girls so they can be protected against the infection before they become sexually active. – AFPRelaxnews

44 •

GENERAL+

february | 2016

How to delay disabilities linked to old age Drink less, eat healthy, quit smoking and maintain healthy weight after 40

o you want to delay or limit disabilities linked to old age? The advice by the National Institute for Health and Care Excellence (NICE) is simple: drink less, eat healthy, quit smoking and maintain a healthy weight after 40 years of age. In essence, adopting a healthy lifestyle helps reduce the risk of senile dementia and other disabilities linked with age. NICE, a health institute dependent on the National Health

Service, focuses on a pivotal age period – mid-life, or the period between 40 and 64 years of age. It explains that starting from this period, maintaining a healthy and active lifestyle is essential to prevent or delay risks of senile dementia and other disabilities or frailty linked with ageing. To avoid such risks, a few good habits should be adopted, explains Robin Ireland, lead author of the report. The recommendations call for individuals to quit smoking, lose

HEALTH IS WEALTH: Adopting a healthy lifestyle helps reduce the risk of senile dementia and other disabilities linked with age.

weight and take part in regular exercise, as well as limiting alcohol intake to between three and four units per day for men and from two to three for women. The report also incites British public authorities to take measures to make alcohol less accessible. The authors of the recommended guidelines have also asked the country’s authorities to extend non-smoking zones in public spaces including parks, open-air markets and outdoor sports installations. Efforts also need to be made in the food sector through a number of targeted measures. The report suggests, for example, encouraging the promotion of fruits and vegetables in supermarkets and

inciting stores to limit unhealthy snacking and eating by displaying information and recipe ideas using fresh and healthy produce. According to the report, healthy behaviours are more likely to be maintained if they are built into everyday life, and mid-life can be the period in which change is finally sustained. Physical and mental decline linked to age can begin as early as age 30, notes the report. Restricted mobility was observed in 18% of men and 19% of women between the ages of 50 and 64 in the United Kingdom. In this age range, 11% of men and 10% of women admitted having difficulties in doing one to two daily chores. – AFPRelaxnews

Keep your bones strong with exercise Strong bones are very important at any age, even more so when you start to hit that 40-year-old mark. According to the National Institute of Arthritis, Musculoskeletal and Skin Diseases, bone mass reaches its peak condition in 18-year-olds for women and 20-year-olds for men. Therefore, bone maintenance is very important. Exercise can be more strenuous when you have reached a certain age, yet it doesn’t mean you should not exercise. It is found that keeping a good exercising regime – strength training in particular, is a good way to maintain stronger bones. There are two types of exercises that are important for building and maintaining bone density: weightbearing and muscle-strengthening exercises. These exercises include activities that make you move against gravity while staying upright. Weight-bearing exercises can be high-impact or low-impact.

High-impact weight-bearing exercises include dancing, doing high-impact aerobics, jogging/ running, jumping rope and stair climbing Low-impact weight-bearing exercises can also help keep bones strong and are a safe alternative if you cannot do high-impact exercises. Low-impact weightbearing exercises include using elliptical training machines, doing low-impact aerobics, using stairstep machines and fast walking on a treadmill or outside. Muscle-strengthening exercises include activities where you move your body, a weight or some other resistance against gravity. They are also known as resistance exercises and include lifting weights, using elastic exercise bands and weight machines. Yoga and Pilates can also improve strength, balance and flexibility. However, certain positions may not be safe for people with osteoporosis.

GENERAL+

2016 | february

• 45

Colouring the lives of children Nippon Paint holds inaugural Colourful Dreams Camp in Kota Belud, Sabah

otal coating solution provider Nippon Paint Malaysia Group rolled out its first Colourful Dreams Camp 2015 in Sabah. A total of 100 Orang Asal children from rural villages participated in the two-day programme to explore their creative minds and develop the joy of learning through different kinds of art exposure. An extension of Nippon Paint’s flagship social corporate responsibility (CSR) programme Colourful Dreams, the camp was organised in collaboration with Yayasan Generasi Gemilang (YGG) to nurture and develop children’s desire to learn through arts and crafts. The camp was held at Kg Nahaba in Kota Belud with children from different villages such as Kampung Nahaba, Talongan, Piasau, Gandukut, Lahanas, Tengkurus and Tegudon. “We have come a long way since Nippon Paint began its flagship CSR initiative called Colourful Dreams in 2013. Throughout this journey, I am humbled to know we have impacted countless children’s lives in various meaningful

ways. We are building on this CSR initiative and extending Colourful Dreams to East Malaysia, beginning with Sabah. We will continue to nurture young children as they will be the agents of transformation for our future society,” says the company’s group general manager Gladys Goh. The children were exposed to impactful learning modules developed by YGG through engaging and interesting activities. They had opportunities to develop their confidence and explore their creativity

Goh giving her opening remarks.

Orang asal children engrossed in their artwork.

through various art tools such as water colours, crayons and craft works. They were also taught how to differentiate textures, patterns, colours and tones. There were also story-telling and sing-a-long sessions to engage the children in an interactive and fun manner. “Every child holds great potential. They deserve opportunities to learn and to grow. It is inspiring to see the children displaying their individuality, styles and interpretation of the story using colours, recycled art materials and tools. Every object lesson is intentional to stimulate creative thinking,

helping the children in all areas of development, ie. physical, social, cognitive, emotional, imagination and experiential. The children’s broad smiles and laughter are truly heart-warming,” says YGG head of strategic alliance Teri Choong. Colourful Dreams is Nippon Paint Malaysia’ CSR arm which aims to “Create Joy for Today, Hope for Tomorrow” through sustainable programmes and activities. The efforts incorporate art and creativity as one of the programme’s main tools to address both physical environment and self-developmental needs of children in shelter homes. To date, it has impacted more than 500 children from seven homes in Peninsular Malaysia and seven schools in East Malaysia. “CSR has and will always been in our DNA. We seek to inspire and empower not only our staff at Nippon Paint, but also to create positive impact to the society by nurturing young children. We can foresee that there will be many more initiatives under Colourful Dreams as we seek to commit long-term resources to positively contribute to the children and society in Malaysia,” says Goh.

ADVERTORIAL

Heart-friendly oat beta-glucan, omega 3 fatty acids Diet plays an important role in guarding you against heart disease. While Chinese New Year is synonymous with family gatherings, the abundance of festive foods can be too tempting to miss. It is still possible to savour these once-a-year indulgences without overexerting your heart. A highly recommended tip includes incorporating soluble fibre such as oat beta-glucan into your diet to reduce your risk of this debilitating disease. Oat beta-glucan is a powerful ingredient that is backed by the USFDA (Food and Drug Administration) in 1997, then the Swedish Nutrition Foundation in 2004, followed by the Swiss Federal Office of Public Health in 2006, and finally the French AFSSA (The French Food Safety Agency) in 2008. Additionally, according to the Health Ministry Malaysia, a daily

intake of 3g of oat beta-glucan reduces the risk of high cholesterol. Another important ingredient for a healthy heart is omega 3 fatty acids. Backed by credible science, it is supported by the US FDA and EFSA (European Food Safety Authority) years ago. Specifically, the FDA approved qualified health claims on conventional foods containing omega 3 fatty acids, such as EPA and DHA, reducing the risk of coronary heart disease in September 2004. In 2010, the EFSA approved statements stating omega 3 fatty acids (DHA) help contribute to the maintenance of normal blood triglyceride levels. Triglycerides are a type of fat in the blood which, if levels are high enough, can cause heart disease. Science shows us that these health claims

aren’t full of fluff – the combination of oat beta-glucan and omega 3 fatty acids is a formidable duo that can help you fight cholesterol. But how do you go about fulfilling your necessary intake of these mighty ingredients, more so during the festive season? Thankfully, preventing your cholesterol levels from spiking is a lot easier than you may think! The answer lies in a drink – a daily serving of BLM Oat Bran with Omega 3 equips you with the necessary nutrients to keep your heart running smoothly.

Three-fold action formula for robust heart

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single serving. This wholesome drink is made from 100% organic oat bran powder imported from Australia, omega 3 powder extracted from algae and puffed black bean powder. The addition of puffed black bean powder enhances the drink’s taste to ensure that you will look forward to drinking it each day! Rest assured that each serving of BLM Oat Bran with Omega 3 is made of supreme quality. The latest technology is used to produce the organic oat bran powder, resulting in a highly-refined powder that facilitates the release of the beta-glucan into the body which optimises its cholesterol-lowering and blood glucose-stabilising effects. In a nutshell, the powerful trio of beta-glucan, omega 3 powder and puffed black bean powder triples the effectiveness of reducing cholesterol and provides triple heart protection in a convenient drink.

46 •

NUTRITION+

february | 2016

DELIGHTFUL STUFF: The grilled chicken with the restaurant’s signature homemade sauce makes for a wholesome and healthy meal.

All our ingredients are fresh and made from scratch. We only cut our vegetables when the order comes in. We don’t store our ingredients long and we get our ingredients delivered daily. “ – Lai

Healthy comfort food at your doorsteps Epic Fit Meals Co is a nice change for those who want to start eating healthier

By Norman Hussaini

elivery services aren’t new in Malaysia. With our hectic working lifestyles, especially in urban centres like Kuala Lumpur and Selangor, food delivery is something of a godsend. And Lai Wick Kee was also part of the whitecollar crowd who found it easier to eat out or having food delivered to them at their workplaces. Seeing the huge potential in food delivery service, Lai and his partner Chung Wen Chuan decided to launch out into the business by setting up Epic Fit Meals Co more than a year ago. The restaurant’s location at Metropolitan Square in Damansara Perdana, Petaling Jaya is strategic as there is a ready catchment of regular customers. The food delivery service offers fresh, wholesome and healthy food. “The problem was that when I was working in a consultancy firm, the only restaurants available were either mamak stalls or fast-food outlets. Good healthy food is still quite rare and expensive in Malaysia,” Lai tells Health+. The concept Lai’s idea for Epic Fit Meals came about while he was studying in Melbourne. “I was studying finance for six years in Melbourne and I found the food there to be very fresh and

wholesome. Most of our favourite food in Malaysia is prepared using unhealthy processed ingredients.” He is right as I have fallen victim to unhealthy food a number of times, with fast food being the norm. And with pizza delivery promising you a 30-minute delivery guarantee, it is quite hard to break the habit. This is what Epic Fit Meals wants to change. “We offer fresh food made to order. Our food is made from scratch, from the sauces to stocks to the pizza doughs,” says Lai. The idea, he adds, is freshlymade food trumps processed food any day of the week. Epic Fit Meals’ delivery service offers quite an expansive, yet inexpensive menu. Lai emphasises that if Epic Fit Meals wants to offer food delivery service, it

EPIC DUO: Lai (left) and Chung keep their workplace fun and smooth to deliver the freshest food.

SPREADING OUT: The small restaurant operates from 11am to 11pm with plans for expansion to other parts of the city soon.

must have a wide variety of food for customers to choose from – and at reasonable prices. The duo seems to take their food seriously but in a fun way. With names like Sam’s Hawaiian Luau, Shrimpy Affair, and the Beefy Buffy, you know they are having their ways with them. There is still this misconception among many Malaysians that healthy food is nothing but green vegetables and green juices, with bland-tasting meals and bittertasting beverages. What Lai and his gang are doing at Epic Fit Meals is to change that perception and send a clear message to the misinformed that you don’t have to eat salads every day to stay healthy. “All our ingredients are fresh and made from scratch. We only cut our vegetables when the order comes in. We don’t store our ingredients long and we get our ingredients delivered daily. Fresh ingredients without preservatives make for the healthiest food there is,” says Lai. What Lai says is true as many people living in Malaysia know a lot more about living a healthier lifestyle than, say, 10 years ago. However, to only talk about the food without tasting it may

lead to an inaccurate discussion. So Lai was gracious enough to let me taste some of the restaurant’s best dishes, and it was certainly an interesting experience. The food I tried the restaurant’s signature Epic Grilled Chicken with homemade “country gravy”. The chicken breast was marinated with herbs and spices and doused generously with homemade sauce. I was pleasantly surprised with the portion size, which is definitely someone like me who is accustomed to unhealthy fast food is not used to. Yet, this is what a person who wants to eat healthier should also get used to. The chicken was moist and flavourful. The gravy had good consistency as it was not too thick or too runny. To be honest, it was nothing ground-breaking, but it was a delicious meal nonetheless. I next tried the 3A pizza, which stands for apple, ayam and api. The whimsical name aside, it was far more interesting than the grilled chicken. Sliced grilled chicken, sliced chilli and cheese provided the topping, along with a healthy sprinkle of herbs. But the most interesting part was the caramelised apples decorating the pizza, which added a distinct sweetness to the overall dish. It had spiciness, earthiness, cheesiness, and sweetness, riding along with the savoury-grilled chicken topping. The dough was also very soft despite its thinness. Epic Fit Meals certainly delivered in both getting the food to your doorstep as well as getting the taste right. Lai has a deep passion for sustainable eating. He believes using local fresh ingredients is better than imported ones. “There is no need for us to use imported ingredients as we already have very good quality ingredients in Malaysia.” The restaurant is certainly a nice change and addition for those who want start eat healthier, and with its plans to expand to other places, it will likely be delivering to your area soon.

OPINION+

2016 | february

• 47 NUTRITION+

By Shaleen Rajasegaram

CREATIVE COMMONS

Debunking diabetes diet myths

s we move towards self-learning, we are very fortunate to have a wealth of information available at our finger tips. However, how do we verify whether the information we receive is true, credible or up to date?

As a practising dietitian, I have met patients and even health care providers practising diets that should have been phased out 15 years ago. Due to such misconception, dietitians are very relevant as we are equipped to ferret out the hoaxes and present information which is easy to understand and apply. We should never play a guessing game with our health. There are myths and facts, and nothing in between. Let’s look at some common misconceptions relating to diabetes and high cholesterol levels.

Myth #2: Brown rice has less carbohydrate than white rice. Fact: The difference in the amount of carbohydrate between brown rice and white rice is minimal. Brown rice is more suitable due to its higher fibre content. White rice contains 0.8gm fibre per 200gm serving, parboiled rice 4.4gm, brown rice 6.48gm, and multigrain rice topping it off with 8.61gm. High-fibre meals help regulate blood sugar levels.

Myth #1: People with diabetes cannot eat rice. Fact: Rice is not the enemy of people with diabetes. Rice is a carbohydrate source, and overconsumption of carbohydrate food – such as cereals, grains, flour, nuts, legumes, milk, dairy products, fruits, honey and simple sugars – may lead to high blood sugar levels.

Myth 3: I can eat as much fruits as I want. Fact: Fruits are a type of carbohydrate food. Too much fruit in one serving can lead to high blood sugar levels. The way fruit is eaten can also impact a person’s blood sugar levels. For example, removing the peel of an apple or juicing it significantly reduces the amount of fibre.

Myth 4: Green apples are better than red ones for someone with diabetes. Fact: The amount of carbohydrate in both types is the same – the only difference is in the type, taste and colour. Two servings of fruits a day are recommended, but not always at the same time. Myth 5: People with diabetes cannot eat many types of food. Fact: A person with diabetes can eat or drink whatever he or she wants. The important thing is to control portion size of meals, how to mix and match different types of carbohydrate, limit sugary food and drink to one or two exchanges a day (10-20% of sucrose), have adequate fibre and always eat a balanced meal. Shaleen Rajasegaram is a dietitian with KPJ Selangor Specialist Hospital.

ADVERTORIAL

Kick-start your day with Vita BG35 Plus Heart disease remains the number one killer among Malaysians with an estimated 4.52 cases reported every hour. A major controllable risk factor for coronary heart disease is high blood cholesterol. The National Health and Morbidity Survey (NHMS) reported that one out of every three Malaysian adults aged 18 years and above suffered from hypercholesterolemia. The prevalence had increased from 20.7% in 2006 to 35.1% in 2011.

Eating right for healthy heart

Adopting lifestyle changes and following a heart-healthy diet can help lower your cholesterol levels and reduce the risk for cardiovascular diseases. Cut down on food with high saturated fat and cholesterol, while incorporating fibre-rich food and a variety of fruits and vegetables. Oats, rich in beta-glucan, is

particularly effective in lowering cholesterol levels. As stated and approved by the Ministry of Health, Malaysia and the US Food and Drug Administration, European Food Safety Authority and Health Canada, the daily intake of 3g of beta-glucan from oats and barley helps to lower blood cholesterol. Heart-healthy beta-glucan at daily doses of at least 3g is associated with 5% and 7% reduction in total and LDL cholesterol levels respectively. Why does this matter? Every 1% reduction in LDL cholesterol can reduce coronary artery disease risk by 1-2%. Beta-glucan is a soluble fibre that transforms into a thick gel during digestion. It forms a highly viscous solution in the small intestines and binds the cholesterol and fats from

your diet and thus, reduces their absorption in the blood stream. It also binds the bile acids and removes them from the body. The body will in turn synthesise new bile acids using the cholesterol from the blood stream. This will eventually reduce the concentration of cholesterol circulating in the blood stream.

Why Vita BG35 Plus?

To obtain 3g of beta-glucan, you need to consume about three bowls of regular oatmeal. The hassle of preparing three bowls of oatmeal is not an easy routine to follow, especially for those leading busy lifestyles. VitaHealth Vita BG35 Plus comes in serving-specificsachet packaging which is more hygienic and convenient to make on-the-go. Two sachets of VitaHealth Vita BG35 Plus provide 3g of beta-glucan which helps achieve the cholesterol-lowering

effects. It is made from the best non-genetically-modified Swedish oat bran powder and Canadian hull-less barley powder with 35% and 25% beta-glucan respectively. Not only does it taste good, it also dissolves more rapidly in water and forms a smooth and pleasant texture, making it more appealing to the taste buds. Vita BG35 Plus does more than a regular oat formula. It is enriched with Aquamin® F and vitamin D which supply the nutrients to promote bone and joint health, thereby reducing the risk of osteoporosis. Aquamin® F is derived from red marine algae that are power-packed with measurable levels of natural calcium, magnesium and 72 other nutrients. Two sachets of Vita BG35 Plus provide the equivalent calcium content found in a glass of milk. Vitamin D ensures better absorption and utilisation of calcium and phosphorus.

48 •

Opinion+

february | 2016

ALTERNATIVE+

By Dr Vijaendreh Subramaniam

What drives the Big C Cancer is probably one of the worst things on this planet, striking people of all ages. In the first part of this article featured in our previous issue, Dr Vijaendreh provided a clearer picture on cancer by highlighting the differences between normal and cancer cells, and how cancer develops in the human body. In this final part, he will talk about the key “drivers’ of this much-dreaded disease

he genetic changes that contribute to cancer tend to affect three main types of genes – proto-oncogenes, tumour suppressor genes and DNA repair genes. These changes are sometimes called “drivers” of cancer. Proto-oncogenes are involved in normal cell growth and division. However, when these genes are altered in certain ways or are more active than normal, they may become cancer-causing genes – or oncogenes – allowing cells to grow and survive when

they should not. Tumour suppressor genes are also involved in controlling cell growth and division. Cells with certain alterations in tumour suppressor genes may divide in an uncontrolled manner. DNA repair genes are involved in fixing damaged DNA. Cells with mutations in these genes tend to develop additional mutations in other genes. Together, these mutations may cause the cells to become cancerous. As scientists have learned more about the molecular changes that lead to cancer, they have found certain mutations that commonly occur in many types of cancer. Because of this, cancers are sometimes characterised by the types of genetic alterations that are believed to be driving them, not just by where they develop in the body and how the cancer cells look under the microscope. The bigger picture While I agree with many of the observations and descriptions of cancer, I believe in only half the story. The problem with the emphasis on gene defects is only around 5% of cancers are caused by purely hereditary gene mutations. The stunning implication of this is, most cancers are not caused by an uncontrollable, pre-determined (propensity/ tendency) decided by the genetic lottery, but by other factors, that necessitate us to look away from just the genetic model of cancer to the bigger picture. There is a cursory mention of environmental factors that directly damage DNA and induce mutations – like ultraviolet rays, tobacco smoke and carcinogenic chemicals – but it is not given due emphasis or followed up with answers towards reversing the causative factors. I believe a proper understanding of

cancer development includes the role of environment, epigenetics and chemical injury. The genetic model is too simplistic to explain the varied behaviour of cancer, and there are many deficiencies in the approach to the subsequent treatment, when emphasis is on finding drugs to correct each mutated gene. Ninety years ago, Otto Warburg published a body of work linking metabolism and cancer through enhanced aerobic glycolysis (also known as the Warburg effect) that distinguishes cancer from normal tissues. The conversion of glucose to lactate, which can occur in hypoxic normal cells, persists in cancer tissues despite the presence of oxygen that would normally inhibit glycolysis through a process termed the Pasteur effect. We now know that sustained aerobic glycolysis (diminished Pasteur effect) in certain cancer cells is linked to activation of oncogenes or loss of tumour suppressors. Metabolism generates oxygen radicals, which contribute to oncogenic mutations. Activated oncogenes and loss of tumour suppressors in turn alter metabolism and induce aerobic glycolysis. Aerobic glycolysis or the Warburg effect links the high rate of glucose fermentation to cancer. Together with glutamine, glucose via glycolysis provides the carbon skeletons, NADPH, and ATP to build new cancer cells, which persist in hypoxia that in turn rewires metabolic pathways for cell growth and survival. Excessive caloric intake is associated with an increased risk for cancers, while caloric restriction is protective. Hence, the links between metabolism and cancer are multifaceted.

…only around 5% of cancers are caused by purely hereditary gene mutations. The stunning implication of this is, most cancers are not caused by an uncontrollable, pre-determined (propensity/ tendency)decided by the genetic lottery, but by other factors, that necessitate us to look away from just the genetic model of cancer to the bigger picture.”

The long-term solution to cancer does not rest in an array of drugs for every single genetic “abnormality”. Genes are NOT the primary cause of cancer. They are a blueprint for protein synthesis and the cell makes proteins that the cell determines are necessary. Cancer cells can be “reprogrammed” to become specialised cells or undergo apoptosis (cell death). This too offers some interesting therapeutic opportunities. Due to their markedly altered or unstable state, cancer cells have weaknesses and susceptibilities that can b e exploited, like the energy metabolism of cancer cells which are vastly different from normal cells. Takeaway points Cancer is the end result of many factors which collectively conspire to induce cell damage. This causes secondary genetic alterations or mutations, and altered expression of the genes (adaptive mechanism that literally wakes up the oncogenes). Some people inherit genes that make them more susceptible to damage, which I think can be avoided through lifestyle modifications and nutritional and metabolic approaches. Understanding the roots and development of cancer will help to expand the range of therapeutic approaches dealing with cancer, especially non-toxic healing therapies. A holistic approach involving removal of certain drivers and stimulus of this uncontrolled growth aggravating environmental factors, and the provision of optimal nutrition, the cancer can reverse itself and reform into normal tissue. The cell dysfunction is mediated by genetic malfunction and mitochondrial dysfunction, leading to loss of aerobic metabolism in cancer cells in low oxygen environments, allowing cancer to be manipulated metabolically so that we can switch off cancer gene expression and switch on cell differentiation and programmed cell death. We need to expand our understanding of cancer cell behaviour and intensified research into healing strategies that can “rehabilitate” cancer cells. We need an open mind to view cancer from a holistic outlook and recognise cancer is a metabolic disorder. The therapeutic windows for targeting cancer cell metabolism reside in differences between normal and mutant oncogenic enzymes and addiction of cancer cells to nutrients to support deregulated cell growth programs enforced by cancer genes. Dr Vijaendreh Subramaniam is a consultant gynaecologist at Mahkota Medical Centre Melaka.

Opinion+

2016 | february

• 49 ALTERNATIVE+

By Adi Satria

When we think of fasting, the first thing that usually comes to mind is religious or holiday fasting. In actuality, this age-old practice is the most ancient and successful form of treatment for all sorts of diseases, physical or mental. This first of a two-part article focuses on water fasting in which the practitioner consumes only water

asting as a therapy is certainly an age-old ritual basically related to faith and religion. Muslims, for instance, are required to fast for 30 days during the month of Ramadhan Health-wise, it makes a lot of sense as it is a time when the stomach is given rest from digesting all kinds of food, and to detox the body of harmful toxins. After all, roughly 67% of our energy is devoted to digesting food. However, the commercialisation of the Ramadhan ritual encourages Muslim consumers to use the breaking of fast as a celebration of feasting and gluttony. Corporations use the occasion to entertain Muslim clients to buka puasa feasts, often at ridiculously high costs. The eating goes on through the night, and often forgoing the obligatory terawih prayers. All these defeat one of the key purposes of fasting – to detox the body and to appreciate the blessings of God via prayers. Muslims are also encouraged to continue the ritual with fasting on Mondays and Thursdays, thereby maintaining a healthy body and mind until the next Ramadhan. I have observed that those who adhere to this routine usually live longer and healthier. Water fasting This is something new that I discovered early this year. Mubarak Ghany, my 64-year-old classmate from Penang Free School, dropped a bombshell within our pfsnet email circle of the class of 64-70 when he announced that he had started a 30-day water fasting ritual since January 1. It was Day 7 of his water-only fasting odyssey with 23 more days to go. He claimed he had been consuming water only since January 1. Yet, he wrote, he was “feeling great, hunger totally gone, clarity in sight and brain functioning. Yet this divine-created self is able to

cope. Still doing light resistance 30-minute workouts.” Mubarak added: “Although my glucose and glycogen reserves are completely depleted, yet my brain is smart enough to convert fat (roughly three-month reserves) to ketones and to glucose to cope. It’s also smart enough not to burn, and easier to convert muscle tissue which is much needed for mobility.” In fact, his glucose level was slightly up at 4.2 compared with 3.8 the day before. He felt it was amazing how his body increased its sugar level to meet the demands of physical exertions like house cleaning and car washing. Blood pressure was 112/62 mmHg and resting pulse 45bpm. Now for a 64-year-old dude, that is quite an amazing condition. Water only eh? Mike Cheah, another classmate living in Perth and who recently retired as a lecturer, was initially shocked to hear of Mubarak’s water fast, having misunderstood that he was abstaining totally from water and food. With a sigh of relief, he decided to follow the odyssey himself while reserving his comments. On Day 10, our Amigo Mubarak revealed that he “felt like a freshlyminted coin”. In all probability, he thought he was in full ketosis for his daily metabolic needs. Fatty tissues were happily gobbled up and the lifelong accumulation of toxins within the fat tissues would hopefully follow suit. He doubted whether his tissues were compromised in any way. His weight and cardiovascular routines on a lighter scale were unaffected while blood sugar and blood pressure were “enviable”. And he is 7kg lighter with no more joint issues. At this stage, he explained that he took this challenge not to prove anything. The fasting practice has been in existent since biblical times – Jesus, David, Elijah and Joseph all fasted 40 days before Prophet Mohammed did.

Different Strokes

Water fasting for better health

Muslims are also encouraged to continue the ritual with fasting on Mondays and Thursdays, thereby maintaining a healthy body and mind until the next Ramadhan. I have observed that those who adhere to this routine usually live longer and healthier.” Mubarak said the muchmaligned immune system is playing second fiddle to mainstream pharmacology. Given half the chance, like in fasting, it is capable of taking any disease or debilitating ailment. “Just give the digestive system a rest, stay out of the body’s way and let the good guys within carry on their task,” he said. For efficacious results, a fast of not less than seven days is recommended. However, if it’s longer than a week – of course with far better results – requires medical supervision. If you’re new to this, he recommends you start with juice-only fast for as long as you can. Then proceed to water fast for a day and work your way from there. Juice fast may be a little tricky for a pre-diabetic, so consult a qualified person, preferably a naturopath Type 2 diabetes, if not on insulin, is a breeze to turn around and cure permanently. Depending on how long you have been on insulin – your pancreas may have taken a permanent holiday – a reversal can be achieved. Interesting ly, my personal acupuncturist, Professor Shamsudeen, a renowned and experienced practitioner in Langkawi, concurs. He says diabetes is not a disease but a lifestyle – simply change your lifestyle and it will be gone. Mubarak admits he is still on

a learning curve and cannot claim to be an expert on the matter. If you want to try it, he suggests a common-sense approach, and listening to the body is about the best you can do. There are many websites and forums on all manner of cures for diseases, and one just have to use common sense to pick the wheat from the chaff. Adi Satria has been in the marketing communications industry for 30 years. After retiring from corporate life, he has embarked on an active physical and mental journey of discovering the elixir of long life via alternative and time-tested therapies from various cultures.

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HEALTH TECH+

february | 2016

Bye bye floaters! Tun Hussein Onn National Eye Hospital first to bring in specialised equipment to vaporise vitreous opacities and sever vitreous strands

earning to live with floaters can be frustrating, especially when your ophthalmologist keeps reminding you they’re

nothing more than a natural ageing change in the eye. It looks like there’s brighter light at the end of the tunnel. A specially-designed equipment that can get rid of

Dr Pall Singh heads a qualified team to operate the device .

floaters is finally in Malaysia. The Tun Hussein Onn National Eye Hospital (THONEH) is the first local medical centre to own the specialised equipment – Ultra Q YAG Laser – that uses nanosecond pulses of laser light to vaporise vitreous opacities and sever vitreous strands – or floaters – by converting these molecules into gas in a noninvasive manner. THONEH, partnering with an Australianbased company committed to pioneering integrated medical technology, is the first in the country to offer the service. Floaters are symptoms of degenerative vitreous syndrome. This can happen as the vitreous humour, which is normally perfectly transparent, degenerates over time, losing its form. Sometimes, collagen fibres bind together, forming opaque clumps and knots, which cast shadows on the retina, leading to vision troubled by what looks like spots, strings and cobwebs – hence they are known as floaters. While they are bothersome, floaters typically resolve within a few months of appearance, but they can persist for much longer. The condition is very common in adults, with nearly everyone having floaters by the age of 70. Only 20% of floaters are abnormal or harmful and more likely to occur in those with diabetic retinopathy, who suffer from retinal tears or retinal detachment, or are extremely nearsighted. In the past, only severe cases of floaters were treated as they require a special surgery known as vitrectomy. As an invasive surgery, vitrectomy carries risk such as retinal detachment and macular edema, which may negatively affect vision, and is thus used only as a last resort. The Ultra Q YAG Laser has specifications that make it suitable to treat vitreous floaters by delivering short bursts of energy into the eye. The procedure is quicker and less invasive than conventional vitrectomies, and if necessary, retreatment is possible. With the use of this laser, ophthalmologists

WHAT’S NEW+

2016 | february

AFIQ NOR / Health+

THONEH vice-chairman Datuk S Kulasegaran. at THONEH can now manage floaters which are impeding their patients’ quality of life, managing a condition that was once rarely treated, and providing hope to those with long-term floaters that do not resolve on their own over time. This device is operated by a qualified team led by senior consultant ophthalmologist Dr Pall Singh. “The Ultra Q multi-modality YAG Laser we acquired offers greater accuracy and control than traditional YAG Lasers, allowing us to perform better treatment,” says Dr Pall Singh. “Additionally, with this new equipment, we can finally bring relief to many of our patients who have troublesome floaters.” THONEH, which is actively advocating better eye treatments, held a press conference recently to promote the new equipment as a way for government hospitals to get into the action by offering the same service to the public. - Norman Hussaini

• 51

Samsung debuts revolutionary wearable chip Samsung Bio-Processor is the world’s first system on a chip designed for health and wellbeingfocused wearables and as such could take everything from activity trackers to smartwatches to new levels. Samsung Electronics announced recently it is addressing the growing trend of quantified health with the all-in-one advanced system logic chip for the healthoriented wearables market. The Bio-Processor to allow accelerated development of innovative wearable products for consumers who are increasingly monitoring their health and fitness on a daily basis. “With improvements in smart, fitness devices and an increase in consumer health consciousness, more and more people are looking for ways to monitor various personal biodata, or fitness data, to constantly manage their health,” says Ben K Hur, vice-president of marketing, System LSI business at Samsung Electronics. “Samsung’s Bio-Processor, which can process five different biometric signals, is the most versatile health and fitness monitoring chip available on the market today and is expected to open up

many new health-based service options for our customers.” The Bio-Processor is the industry’s first all-in-one health solution chip. By integrating not only analogue front ends (AFE), but also microcontroller unit (MCU), power management integrated circuit (PMIC), digital signal processor (DSP), and eFlash memory, it can process the bio-signals it measures without the need of external processing parts. Even with its integrated design, it is particularly innovative thanks to its incredibly small size. When compared to the total area of the discrete parts, the Bio-Processor is only about one fourth of the total combined size, which is ideal for small wearable devices, offering a bounty of options when designing new devices. While heart rate monitoring alone may have been compelling in the past, the ability to measure a variety of fitness data is expected in today’s wearable products. To meet such demands, Samsung has designed its Bio-Processor to integrate five AFEs including bioelectrical impedance analysis (BIA), photoplethysmogram (PPG), electrocardiogram (ECG), skin

temperature, and galvanic skin response (GSR) into a single chip solution that measures body fat, and skeletal muscle mass, heart rate, heart rhythm, skin temperature and stress level, respectively. In addition, combinations of these fitness inputs can be considered for a variety of new use cases. To speed product development and better understand Samsung’s new Bio-Processor, several wearable reference platforms are now available to demonstrate various uses cases. For example, wrist band, board and patch type reference devices exhibit the Bio-Processor’s potential by demonstrating its ability to measure multiple fitness variables on an extremely small device. Samsung Bio-Processor is now in mass production and will be available in fitness/health devices within the first half of this year.

Rehydrate with Murad Hydro-Dynamic® Quenching Essence Having dry, flushed-out and dull skin? Do you feel the need to have plump, smooth, silky and supple skin texture? With Murad, you can! As a pioneer in skincare solutions since 1989, Murad has launched its Hydro-Dynamic® Quenching Essence to help rehydrate dry skin and retain water for a plumper, smoother skin. The cleanser uses extract of the Mexican blue agave leaf as it restores the skin’s ability to attract and retain water. Glycolic acid gently and evenly exfoliates to promote skin’s natural renewal, while

a botanical blend of watermelon, apple, and lentil helps reduce dryness, flakiness, and rough patches by providing the building blocks of skin’s own natural moisturising factor. Using the liquid cleanser is a breeze. Simply massage evenly over your face and neck. It is optimal to use it in the morning and evening before bed. The cleanser, at a promotional price of RM438 per 30ml, is available at any Murad product distributor, selected pharmacies and online at www.murad.com.my.

Betadine cleanser protects skin from germs

Ellex Ultra Q Reflex designed for the treatment of floaters.

TOP RANGE: The health and fitness monitoring chip can take everything from activity trackers to smartwatches to new levels.

Germs are almost everywhere – whatever you touch, see or smell is ridden with germs. This is a fact of life which many people take for granted and throw caution to the wind. It’s not something you can run away from, but learn to live with. There are a number of products to help us keep our skin clean, the latest being Betadine antiseptic skin cleanser. It contains povidoneiodine which is proven to kill a wide

range of germs, infectious bacteria and viruses. The recommendation is to use the cleanser daily, especially during high-risk periods like the flu seasons. Betadine has been tested effectively against disease outbreaks such as the avian flu and swine flu viruses. It is easy to use – just apply on your skin and rinse well after 15 to 30 seconds. Priced at RM18, the skin cleanser is available at local pharmaceutical stores.

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february | 2016

Antibiotic abuse endangers lives... pages 04-05 UMMC Antibiotic Stewardship Committee warns of dangers of over and incorrect use of antibiotics

www.healthplus.com.my

THE PULSE OF THE NATION

FEBRUARY | 2016

Prevailing over cancer

Prevention is better than cure

Leading a healthy lifestyle can help prevent up to two-thirds of cancers

... page 12

In pursuit of happiness

Inspiring story of how brave mother of three triumphs over HIV and raises family at the same time

... page 18

02 •

FEBRUARY | 2016

Hooked on antibiotics MMA advocates using these medications only when necessary as misuse can cause serious problems

BY NORMAN HUSSAINI

N alarming number of people globally are getting hooked on antibiotics. The internet and social media have radically altered the way people respond to illnesses, resulting in over and incorrect use of antibiotics. In the United Kingdom, the number of antibiotics prescribed has risen by 40% over 12 years. And in France, the national health agency has sounded alarm bells over the number of antibiotics being popped by the French – a whopping 30% more than the European average. Here in Malaysia, misuse of antibiotics is also a growing problem too, although official statistics are not available, people’s lives are greatly affected by it. Antibiotic misuse or abuse has given rise to superbugs which are bacteria resistant to every type of antibiotics. Recognising the gravity and urgency of the problem, the Malaysian Medical Association (MMA) wants to preserve antibiotics and advocate their use only when necessary as general misuse can lead to serious problems later on. And the Health Ministry is also taking the issue by the horns when it launched the Antibiotic Awareness Week and the Antibiotic Awareness campaign last year,

to raise awareness and educate the public about the growing problem and to promote correct use of antibiotics. MMA president Dr Ashok Zachariah Phillip tells Health+ the association is working with the ministry to tackle the problem at its root. “Our campaign is currently focused on the general practitioner’s (GP) clinic level. The GP is the first one we will usually go to when we fall ill, so it makes sense to start there.” For a start, the ministry has produced flip charts on proper usage of antibiotics which will be distributed to GPs. Dr Ashok says flip charts placed on doctors’ tables may seem simple and plain, but they are quite effective as patients can read them at

Some non-pharmacy or nondoctor places are found to sell antibiotics. We don’t know how they procure them. This is a really bad problem because we don’t know where the antibiotics are manufactured, how long and the conditions they have been in storage, or whether they are actually antibiotics at all.” – Dr Ashok

ROOT CAUSE: Dr Ashok says the MMA is working with the ministry to tackle the problem at its root.

the clinics. One side has information which patients can read, and the other side has important facts for doctors to explain to their patients. KEY CONTRIBUTING FACTORS Are patients getting antibiotics too easily from doctors, pharmacies, and sometimes unauthorised vendors? Dr Ashok says this is one of the main causes of antibiotic misuse in Malaysia. “Theoretically, pharmacies do not have the authority to sell you antibiotics,” he explains. “Dispensing of antibiotics in pharmacies is only done when there is a prescription from a doctor. Although there have been cases where certain pharmacies are willing to sell antibiotics over the counter without a doctor’s prescription, by no means should pharmacy do it.” The habit of sharing among Malaysians is another key contributing factor. Patients sometimes feel well enough after taking their antibiotics for three days and then decide to keep them for later use or to give them to family members, just in case they fall ill. However, the most worrisome contributing factor is sales of antibiotics by unauthorised vendors. “Some non-pharmacy

or non-doctor places are found to sell antibiotics. We don’t know how they procure them. This is a really bad problem because we don’t know where the antibiotics are manufactured, how long and the conditions they have been in storage, or whether they are actually antibiotics at all. We found a few cases where patients bought antibiotics from drawers of some shops,” laments Dr Ashok. All these factors are aggravating the problem of antibiotic abuse in the country, and certainly something must be done fast to curb the growing problem. NO UNIVERSAL GUIDELINE Proper usage of antibiotics depends on the patients’ surroundings. Dr Ashok says there is no universal guideline for doctors and patients to follow. “Different parts of the world have different kinds of bacteria, but essentially the guideline for people is to use them only when indicated.” He explains a viral infection which causes fever, cold or cough will last only three to four days, and if it persists, that will probably be a bacterial infection. A simple blood test, he says, can confirm the causes of your fever so it would be wise to opt for it. “When you do need antibiotics, take the right one at the right dosage for the right duration as prescribed by your doctor.” Dr A shok stresses the importance of communication between patients and their doctors. “Patients should always ask questions when they feel the need to. Don’t rely heavily on the internet to look for solutions. The doctors are trained professionals and it is their job to answer your questions.” To doctors, his advice is: “Practise what you already know. Do not give out antibiotics easily and always encourage your patients to ask questions.” Dr Ashok says the MMA will continue to work closely with the Health Ministry to spread the awareness on the proper usage of antibiotics throughout the country. “This cannot be just a one-week or one-year thing. It has to be continually reinforced, especially among the public.”

• 03

2016 | FEBRUARY

Basically, our bodies are colonised by bacteria which actually help protect us from various infections and also help with normal metabolism. However, when we take antibiotics unnecessarily, we change the ecology in our bodies. And some of the more sensitive bacteria are now resistant. So we start carrying resistant bacteria in our bodies and when we get an infection, we are infected by these resistant bacteria.” – Dr Sasheela

Spike in antibioticresistant organisms Stereotyped thinking that antibiotics are always the answer prevalent among many Malaysians

ANY of us are all too familiar with this scenario. We catch a cold or fever and decide to see the doctor at our local clinic. We get there and after a brief examination by the doctor, he prescribes some medication. We will almost instinctively ask whether antibiotics are part of the prescribed medication. Antibiotics are very effective medicine right? So why not take them so that we can get better quickly? That seems logical, at least to many of us! This stereotyped thinking is alarmingly common among many Malaysians, as with most other people around the world. We have this idea that antibiotics are treatment to cure fever and cold. This is why there has been a recorded spike in antibiotic-resistant organisms worldwide, and sadly, such over or incorrect use of antibiotics has contributed to this dangerous situation. University of Malaya Medical Centre (UMMC) Antibiotic

Stewardship Committee chairperson Dr Sasheela Ponnampalavanar explains this to Health+. “Basically, our bodies are colonised by bacteria which actually help protect us from various infections and also help with normal metabolism. “However, when we take antibiotics unnecessarily, we change the ecology in our bodies. And some of the more sensitive bacteria are now resistant. So we start carrying resistant bacteria in our bodies and when we get an infection, we are infected by these resistant bacteria.” Getting infected by antibioticresistant bacteria means the antibiotics we usually get from the clinics may not work at all. That’s where the misconception is ironic. By consuming antibiotics when we don’t need them, may result in them not working when we do need them. Severe bacterial infections in which the bacteria are resistant to common antibiotics will usually be treated with stronger ones which are administered intravenously to patients at hospitals.

ECOLOGICAL CHANGE: When we take antibiotics unnecessarily, we change the ecology in our bodies, explains Dr Sasheela.

The process will heighten the risk of getting another infection because of exposure to needle over an extended period of time. It is also a very costly treatment. WHO TO BLAME FOR ANTIBIOTIC-RESISTANT ORGANISMS? So who are responsible for the spike in antibiotic-resistant organisms? Malaysian Medical Association (MMA) president Dr Ashok Zachariah Phillip believes the problem started 50 to 60 years ago. He says in the 1950s and 60s, bacterial infections were more common among the public. “Back then, to go to the doctor because of a slight fever was considered troublesome and expensive. So people waited until their illnesses got worse before seeing a doctor.” At that point, the use of antibiotics to treat the illnesses was justified by the severity of the infections. “So in those days, it was quite sensible to use antibiotics quickly. CREATIVE COMMONS

This was when patients thought taking antibiotics meant getting well and not taking them meant not getting well. That habit has persisted through the years,” he explains. This misconception, he says, has been passed down to their children, and their children’s children. “Hence there is a need to raise awareness on the proper use of antibiotics.” Dr Ashok believes doctors are partly to blame too. “Because there are certain doctors who cannot say no to their patients, even when the patients are demanding medication they might not need.” “Essentially doctors only want their patients to be satisfied, so sometimes they give in and provide them what they want despite them not actually needing them,” he says. RAISING AWARENESS Recognising the seriousness of the problem, the Health Ministry recently launched the Antibiotic Awareness Week to raise awareness on this issue. As part of the campaign, the MMA is working with the ministry to better regulate doctors in private practice. UMMC also has a committee to raise public awareness on the issue. Only time will tell if their efforts come to fruition. The efficacy of antibiotics must be preserved which means such medication should not be misused. The issue is still prevalent, particularly in developing countries where regulation on usage of antibiotics is lacking. What’s important is we must do our best to spread the right information and maintain a healthy lifestyle. – By Norman Hussaini

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FEBRUARY | 2016

Antibiotic abuse endangers lives UMMC Antibiotic Stewardship Committee warns of dangers of over and incorrect use of antibiotics

BY NORMAN HUSSAINI

VER and incorrect use of antibiotics end angers your health and life, warns a medical expert as concern mounts over the exponential increase in antibioticresistant organisms infecting the masses. These organisms are bacteria living in the human body that have somehow evolved to resist medication usually used to kill them. University of Malaya Medical Centre (UMMC) Antibiotic Stewardship Committee chairperson Dr Sasheela Ponnampalavanar says the over and incorrect use of antibiotics has led to a surge in infections caused by antibioticresistant organisms. “The growing rates of antibiotic-resistant organisms are due to inappropriate use of antibiotics,” she tells Health+. Dr Sasheela, whose committee is committed to raise awareness on the proper usage of antibiotics in the country, says many people have the misconception that antibiotics are the go-to medicine whenever they catch a fever or cold. This is why many patients with fever or cold demand

antibiotics from their doctors even when they don’t actually need them. As a result, it leads to over or unnecessary use of such medication, she says. Dr Sasheela advises the public to use antibiotics with caution. “We must understand they treat only bacterial infections and are useless for illnesses from other causes.” She says the public should feel empowered to ask their doctors about the type of medication prescribed to them. “As a physician, I always believe prevention is better than cure. It is always better to prevent yourself from getting i n fe c t i o n s by washing your hands p r o p e r l y, using sanitisers after going to the toilet and, most importantly, keeping our surroundings clean.” On whether Malaysians generally consume more antibiotics than people in other parts of the world, Dr Sasheela says: “I don’t think that is true. We consume just as much antibiotics as any country as the problem is a global one, not just in this country.” She explains that the situation depends on the types of

As a physician, I always believe prevention is better than cure. It is always better to prevent yourself from getting infections by washing your hands properly, using sanitisers after going to the toilet and, most importantly, keeping our surroundings clean.” – Dr Sasheela

Finish full course prescribed by doctor IF you had ever been prescribed with antibiotics by your doctor before, you would have learned that you must always finish the entire course, which simply means FINISH EVERYTHING. That advice should never be taken lightly. Here’s why: Antibiotics are medicines used to treat infections caused by bacterial infection. To clear the infections completely, it is important to continue taking the antibiotics even when you feel better after a few days. By doing so, the risk of the infections returning will be far lower. Doctors will prescribe the dosage and duration depending on

CREATIVE COMMONS

the severity of each infection, so it is important to finish your dosage as intended. WHAT IF I MISS A DOSE? One of the other common questions on antibiotics usage is what happens when you forgot to take the antibiotic at the right time of the day. If such a thing happens, take that dose as soon as you remember and then continue to take your course of antibiotics as prescribed by the doctor. However, if it is time for the

TAKE EVERYTHING: Continue even when you feel better after a few days.

next dose, it is safe to skip the forgotten dose and continue your regular dosage. It is important that you don’t double your dosage if you have forgotten to take the previous one. Doubling dosages will unlikely cause you any serious harm. However, it increases the risk of side effects such as feeling more sick, bloating, indigestion and diarrhoea. TAKING OTHER PEOPLE’S OLD PRESCRIPTION This does happen quite often unfortunately as sharing medication is a common practice among people. You should never begin any medication until you are evaluated by a

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2016 | FEBRUARY

They all started with penicillin

LIFECHANGING DISCOVERY: Fleming discovered lysozyme in 1921 and penicillin in 1928.

INFECTIONS are very common and responsible for a large number diseases adversely affecting human health. Most of the infectious diseases are caused by bacteria. Infections caused by bacteria can be prevented, managed and treated through anti-bacterial group of compounds known as antibiotics. Antibiotics can be loosely defined as the variety of substances derived from bacterial sources or microorganisms that control the growth of, or kill other bacteria. However, synthetic antibiotics, usually chemically related to natural antibiotics, have since CREATIVE COMMONS

AFIQ NOR/Health+

antibiotics consumed. “In some countries, they have more control over certain types of antibiotics that are found to be more prone to cause resistance. “We, on the other hand, do not have that kind of control over them (such antibiotics). So the risk of us getting more of these antibiotic-resistant bacteria is higher than in some countries.” The goal of the Antibiotic Stewardship Committee is to optimise

doctor. Antibiotics prescribed for other people may not be appropriate for your current problem. Besides, very old antibiotics may cause serious harm as medicines generally expire, especially when not kept properly. There is also a risk of an allergic reaction as the antibiotics are not prescribed for you specifically. IN CASE OF SIDE EFFECTS As with any medication, antibiotics can cause side effects. Most antibiotics will not cause problems for people who take them properly. As mentioned earlier, side effects include feeling more sick, bloating, indigestion, and diarrhoea.

You should always notify your doctor as soon as possible if the medication prescribed makes you ill or if you feel you want to stop taking it for some reason. OTHER PRECAUTIONS Consumption of alcohol is found to increase risks of undesirable effects during drug treatment. It is highly recommended to avoid combining alcohol with any type of medication. Other drug treatments may also interrupt with the effectiveness. Therefore, consult your doctor about your current medication before accepting any antibiotics.

RESPONSIBLE USAGE: Dr Sasheela says over and incorrect use of antibiotics has led to a surge in infections caused by antibiotic-resistant organisms.

been produced that accomplish comparable tasks. Sir Alexander Fleming, a Scottish biologist, defined new horizons for modern antibiotics with his discoveries of enzyme lysozyme in 1921 and the antibiotic substance penicillin in 1928. The discovery of penicillin – the first antibiotic discovered – was a happy accident. Fleming was working on a culture of disease-causing bacteria when he noticed spores of little green mould in one of his culture plates. He observed that the presence of the mould had killed or prevented the growth of the bacteria. The discovery of penicillin from the fungus penicillium notatum perfected the treatment of bacterial infections such as syphilis, gangrene and tuberculosis. Fleming also contributed immensely towards medical sciences with his writings on bacteriology, immunology and chemotherapy. Since then, penicillin has been used to treat bacterial infections and was the base for the development of other antibiotics to tackle various bacteria.

patient care and outcome safety with appropriate antibiotic use. It aims to protect patients from adverse effects of inappropriate antibiotics use. The committee also plays an advisory role on antibioticprescribing policies in UMMC based on the Health Ministry’s guideline. Dr Sasheela says its core members are infectious disease control physicians, pharmacists, medical microbiologists and the infection control nurses and doctors. It also has representatives from other UMMC departments. “The issue is something that needs to be tackled at all levels so everyone needs to be on board,” she adds. Efforts to raise awareness on proper usage of antibiotics were initiated by the World Health Organisation through the World Antibiotic Awareness Week on November 16 to 22. UMMC launched the awareness campaign on November 19 with a two-day event filled with informative facts on antibiotics and their proper usage. Events such as lectures which were open to the public, doctors and medical students, games, hand hygiene demo and a host of other activities targeted at the public. About a thousand people attended the events. Prior to the antibiotic awareness campaign, UMMC had in April 2014 launched the Combating Antimicrobial Resistance campaign among medical practitioners within UMMC.

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FEBRUARY | 2016

CREATIVE COMMONS

Are meats still safe to eat? Consumers on edge as new superbug detected in animals in 17 countries, including Malaysia

Deadly bacteria kill 75% of victims

BY ZURINNA RAJA ADAM

newly-identified MCR-1 resistance gene, a new superbug that is resistant to most, if not all, antibiotics, has been detected in 17 countries, including Malaysia. According to recent reports, the superbug was first found in a pig in China in November. Since then, similar resistant bacteria

have also been discovered in countries like Denmark, Netherlands, France and Thailand. Experts say stopping the superbug from spreading will be difficult. “In the absence of new drugs it will be a case of better surveillance and reporting, being more creative with the drugs we have and controlling colistin use to minimise selection,” a report says. LINKED TO MAJOR HEALTH RISKS Rising concern on the effects of animal antibiotics, which scientist believe are linked to major health risks like creating superbugs and human resistance to antibiotic treatment, has led the US Food and Drug Administration (FDA) to impose stricter regulation for their usage by the end of this year. Known as the Veterinary Feed Directive, the amended rule requires veterinary antibiotics to be prescribed by veterinarians instead of allowing them to be bought just over the counter. Big companies like McDonald’s, Subway and Chipotle Mexican Grill Inc have also pledged their support and will serve antibiotic-free chicken at all their outlets in the US by the same deadline. By 2018, Subway expects to shift all its chicken and turkey supplies over to antibiotic-free meats. Within six years, it plans to sell beef and pork raised without any antibiotics. BANNING ANTIBIOTICS IN ANIMAL FEEDS On the local front, Consumer Association Penang has been calling for a complete ban of antibiotics in

Melioidosis, severely under-reported in 45 countries and unreported in 34, responds to only a handful of antibiotics

which it is known to be endemic and that melioidosis is probably endemic in a further 34 countries that have never reported the disease,” researchers led by Oxford University, the Mahidol Oxford Tropical Medicine Research Unit (MORU) in Bangkok and the University of Washington in Seattle wrote in a report published in Nature Microbiology. It is the first time scientists have attempted to map the disease’s global spread using computer modelling based on data from known outbreaks dating back to 1910.

as many as 89,000 people out of the 165,000 people who caught melioidosis last year died from the disease. They noted that annual global deaths from the disease were nearly as high as measles (95,000) and greater than deaths from leptospirosis (50,000) and dengue (12,500) – two current health priorities for many international health organisations. “It kills many people and kills silently,” Direk Limmathurotsakul, head of microbiology at MORU and a co-author of the report, tells AFP.

N often deadly and difficult to treat bacterial disease is much more prevalent than previously thought and kills tens of thousands of people worldwide each year, say researchers. Melioidosis, also known as Whitmore’s disease, has long been known to be endemic in parts of South and East Asia, the Pacific

DIFFICULT TO DIAGNOSE The disease, which often affects the rural poor working in fields, is notoriously difficult to diagnose because it mimics many other bacterial infections but responds to only a handful of antibiotics. As a result, misdiagnosis is common. The mortality rate of about 70% is shockingly high, greater even than the H5N1 bird flu. Researchers estimated that

ENTER BODY THROUGH CUTS The disease is caused by the bacteria burkholderia pseudomallei, which is present in soil and can enter the body through cuts in the skin as well as through inhalation. In Thailand it is often caught by rice farmers who toil for hours in paddy fields. Direk says skilled lab work is needed to diagnose a melioidosis infection, something Thailand was

and northern Australia. But a new analysis by a team of international researchers suggests the disease is also present across swathes of South America and sub-Saharan Africa and likely present in parts of Central America, southern Africa and the Middle East. “Our estimates suggest that melioidosis is severely underreported in the 45 countries in

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2016 | FEBRUARY

animal feeds. It has also urged the Agriculture and Health Ministry to set up a national system to monitor antibiotic use in food for animals, including refining data collection on the use of antibiotics. “Antibiotics should be used only to treat animals that are sick,” says a local veterinarian who did not want to be named. “We usually give antibiotics to cattle, goat and sheep only when needed. Farmers are supposed to adhere to the withdrawal period before sending the animals to slaughter houses,” she tells Health+. WITHDRAWAL PERIOD She says every antibiotic has a different withdrawal period. For example, Norodine needs 21 days to get the antibiotic completely out of the system. Every slaughter house will have a veterinary public health officer who is responsible to check the meat. Depending on the disease identified, some

carcasses might be totally rejected, while some meat will just have the affected area cut off and disposed. It all comes with a specific guideline. Much has been written and spoken about the scary effects of drugs in animals and mishandling of meat that can cause diseases and food poisoning. So, can we still consume meat from industrialised farms? “Yes, I do consume them. I trust my colleagues who are veterinary public health officers working at slaughter houses. At the same time, public concern is also good. It pushes farmers to produce healthier produce and be wary with what they put in the animal feeds,” says the veterinarian. She points out that industrialised chicken farmers need to adhere to several guidelines and protocols. However, small farm operators, who often claim their products are drug free, sometimes overlook certain criteria

USE WISELY: Antibiotics should be used only to treat animals that are sick, says a local veterinarian.

like cleanliness, which are highly encouraged in animal breeding to ensure general health and to control disease outbreak. “Product handling in the market is also important. It has to be at certain temperature to prevent it from becoming a bacteria-breeding ground. How the meat is handled at home is important too. It cannot be thawed for too long,” she says. ANTIBIOTICS IN FARMING From a medical point of view, antibiotics are used to treat sick animals to control parasites. Maintaining healthy guts in farm animals is important as they help them grow better and healthier. Antibiotics are also used as growth promotant, which was somewhat a major breakthrough in 1940, to help chickens grow at least 3% bigger. Chicks seem to grow faster when fed with bacterial shells called streptomyces aureofaciens, from which

antibiotics were extracted. Since the amount of antibiotics used to promote growth enhancement was very small, the effects were then regarded as nutritional. However, in recent years, the emergence of antibiotic-resistant bacteria has become a major concern and increasing risk, with the World Health Organisation labelling the situation a “global health crisis”. In the United States, the Centers for Disease Control and Prevention reports at least two million people being infected with antibiotic-resistant bacteria and at least 23,000 dying each year as a direct result of these infections. “The number of antibiotics that are going to be effective in the future keeps getting smaller as we see [higher] antibiotic resistance,” says a local medical officer. She says some initial studies show certain drugs used in animal feeds contribute to hormonal growth in boys who tend to become effeminate.

SHUTTERSTOCK

This is an under-appreciated and under-reported disease, the bacteria is difficult to diagnose, difficult to treat and resistant to many antibiotics. We need more awareness and diagnostic tools.” – Direk

SUPER DEADLY: Melioidosis, which often affects the rural poor working in fields, is notoriously difficult to diagnose because it mimics many other bacterial infections.

better equipped to do than many of its less wealthy neighbours like Vietnam, Myanmar and Cambodia. But even with Thailand’s more advanced hospitals and labs, the government’s own figures only noted seven deaths from the disease last year, likely a major

underestimate, he says. “This is an under-appreciated and under-reported disease,” Direk says. “The bacteria is difficult to diagnose, difficult to treat and resistant to many antibiotics. We need more awareness and diagnostic tools.” – AFPRelaxnews

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FEBRUARY | 2016

Reining in antibiotic use in animal feeds Consumer body wants stricter surveillance and national system to monitor usage

OME consignments of shrimps from Malaysia were banned from entering the United States in the second quarter of last year as they were found to be contaminated with banned antibiotics. The US Food and Drug Administration (FDA) said the ban was related to nitrofuran or other veterinary drug residues found in the shrimps. The US ban has once again highlighted the growing concern over the problem of antibiotic use in Malaysia. Local regulators do allow antibiotics to be used in the livestock industry, but the Food Regulations 1985 prohibits the presence of antibiotics in meats, meat products and milk. According to a local veterinarian who did not want to be named, although there are no restrictions on the usage of antibiotics in animal farming, there are guidelines that farmers must adhere to before their animals are sent to slaughterhouses. She says these include ensuring the livestock has undergone the required timeframe for drugs to be excreted so that the meat is free from contamination. Beside antibiotics, other drugs used in livestock also include hormones to promote growth, steroids to build up bulk and tranquillisers for anti-stress. The risk of these drugs to humans is continuously being study and reported. Consumer Association Penang (CAP) has repeatedly called for a complete ban of antibiotic use in animal farming, as far back as 2014. In its statement on January 10, 2014, it says a study carried out by the Department of Veterinary Services in 2012 found that half of domestic chickens were resistant to ampicillin, sulphonamide and tetracycline. The situation was worse with imported chickens where 87% was found to be ampicillin-resistant, 75% nalidixis acid-resistant, and 50% streptomycin- and sulphonamide-resistant. In another study of live chickens sold at wet markets in Selangor, of the 90 chickens examined, 68 were positive for campylobacter, a type of bacteria that spreads from animals to

In Malaysia, there are 97 antibiotic drugs registered for use. Most of these registered drugs are used in poultry and pig farms, less in cattle and goat farms. More than half of the antibiotics registered with the Health Ministry for food animals are not recommended for veterinary use by the WHO.”

people through contaminated food, especially raw or undercooked chicken. It causes diarrhoea which is often bloody, fever and abdominal cramps, and sometimes causes serious complications such as temporary paralysis, and even death. “Resistant salmonella, campylobacter and E. coli infections have spread worldwide through travel and food trade,” CAP says. “In Malaysia, there are 97 antibiotic drugs registered for use. Most of these registered drugs are used in poultry and pig farms, less in cattle and goat farms. More than half of the antibiotics (active ingredients) registered with the Health Ministry for food animals are not recommended for veterinary use by the WHO,” the report says. In light of the EU ban and stricter regulation imposed by FDA on the usage of antibiotics in animal feeds, CAP has proposed the following to the health and agriculture ministries: Ban antibiotic use in animal feeds; Create a national system to

monitor antibiotic use in food animals. This includes actions to improve and refine collection of data on antibiotic use in the country. Quantities and classes of antibiotics used in food animals according to animal species need to be documented. This is necessary for risk analysis, interpreting resistance surveillance data and to assess the impact of interventions to promote prudent use; Monitor resistance and track changes in antibiotic resistance through ongoing surveillance at local, state and national levels. This will identify emerging health problems so that timely corrective action to protect human health is taken; The containment of antibiotic resistance must be made a national priority. There is a need to create a national intersectoral body or task force comprising healthcare professionals, veterinarians, academics, agricultural scientists, consumers, the media, to raise awareness about antimicrobial resistance (AMR), prioritise research, collect data, recommend policy measures to contain AMR, like formulating principles for a new Animal Health Law; Develop guidelines for veterinarians to reduce the overuse and misuse of antibiotics in food animals; Provide education and training for livestock farmers on the responsible use of antibiotics; Encourage good farming and best practices in disease control, like appropriate housing design for animals, good disinfection procedures, isolation of sick animals, use of vaccines and disease eradication programmes; Monitor imported meat products for antibiotic-resistant contamination and stringent enforcement of rules; Identify food, both locally produced and imported, responsible for outbreaks of salmonella infections a n d o t h e r fo o d - b o r n e contamination; Monitor the spread of salmonella among animals in farms to prevent it from spreading.

SOURCE BY CENTERS FOR DISEASE CONTROL AND PREVENTION

Educate consumers and food workers on safe foodhandling practices and how to avoid salmonella infections. - Zurinna Raja Adam

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2016 | FEBRUARY

SHUTTERSTOCK

THUMBS UP: Chipotle received top marks for restricting the use of drugs like hormones and beta agonists in its meat supply.

Top fast-food chains fail antibiotic test Most major food brands get failing grades for policies for meat and poultry

URGER King, KFC, Starbucks and Subway are among dozens of restaurant chains that received failing grades in a new report that scored major

food brands on their antibiotics policies for meat and poultry. In the wide-sweeping report, written jointly by a group of consumer, health and environmental groups for Friends of the Earth,

Restaurants billing themselves as a ‘healthier’ option, like Subway, have a particular responsibility to live up to that image by reducing antibiotics.” only Chipotle and Panera Bread received top marks for restricting the use of drugs like hormones and beta agonists in their meat supply. Chick-fil-A received a B grade for limiting antibiotic meats, while

McDonald’s to reduce chicken fed antibiotics FAST-FOOD giant McDonald’s has in March last year announced it would stop serving chicken raised with antibiotics that are important to human health, as worries grow over resistance to crucial drugs. McDonald’s, primarily a hamburger chain but which also sells a number of chicken-based meals, said it has been working closely with poultry farmers to cut back the use of antibiotics. The move will help prod changes by the large industrial chicken suppliers which have fostered widespread use of human antibiotics among growers. McDonald’s said that it hoped

to implement the new restrictions at its 14,000 US restaurants over the next two years. “While McDonald’s will only source chicken raised without antibiotics important to human medicine, the farmers who supply chicken for its menu will continue to responsibly use ionophores, a type of antibiotic not used for humans that helps keep chickens healthy,” the company said. The company has earlier released a new policy statement saying it would follow the World Health Organisation’s guidelines on not using antimicrobials in livestock, including important antibiotics, that are considered

Dunkin’ Donuts and McDonald’s managed to eke out a passing C grade. In total, 20 chains failed to pass muster on the scorecard, either for having no disclosed policy on antibiotic use or having policies that fail to phase out its use, including Subway, a shortcoming that is particularly disappointing, says Natural Resources Defense Council senior health officer David Wallinga. “Restaurants billing themselves as a ‘healthier’ option, like Subway, have a particular responsibility to live up to that image by reducing antibiotics,” he says in a statement. According to the report, the overuse of antibiotics in meat production contributes to the rise in antibiotic-resistant infections that kill 23,000 people in the US every year. And animal welfare groups point out that the use of antibiotics reflect larger problems of poor animal welfare and farm management practices in US meat production. With Americans spending nearly half of their food budget on meals outside the home, the results of the report are aimed at helping consumers make better dining choices, the group says. Here are the results of the fast food chain report card: A: Chipotle, Panera Bread B: Chick-fil-A C: McDonald’s, Dunkin’ Donuts F: Applebee’s, Arby’s, Burger King, Chili’s, Dairy Queen, Denny’s, Domino’s, IHOP, Jack in the Box, KFC, Little Caesars, Olive Garden, Outback Steakhouse Grill and Bar, Papa John’s Pizza, Pizza Hut, Sonic, Starbucks, Subway, Taco Bell, and Wendy’s – AFPRelaxnews

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critically important in human medicine. The antimicrobials it accepts from poultry suppliers, it said, will

be limited to use for treatment and prevention of animal disease, and not for growth enhancement. – AFPRelaxnews

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FEBRUARY | 2016

We shall prevail, eventually!

AFIQ NOR/Health+

If everyone works towards a common goal of eradicating cancer, then anything is possible, says National Cancer Society Malaysia

BY NORMAN HUSSAINI

ANCER is something almost everyone knows about. It is no mystery that it has snuffed out so many lives over the decades, and is still a growing concern for people around the world. We are living in a hi-tech world where information is readily available at the flick of a finger, yet it is ironic that it’s so difficult to find out for sure where we stand in our fight against cancer. In conjunction with World Cancer Day on February 4, Health+ spoke to National Cancer Society Malaysia (NCSM) president Dr Saunthari Somasundaram to get a clearer picture of where we are in our fight against this deadly disease. Dr Saunthari readily admits that with so many derivatives to take into account, it is difficult to accurately assess the state of cancer in Malaysia. “As the National Cancer Registry’s last publication was in 2008, it is difficult to know how cancer is growing statistically in Malaysia,” she says. However, Dr Saunthari says based on estimates provided by the World Health Organisation (WHO), the number of cancer cases has definitely been increasing since 2003. “These figures are more of rough estimates than anything.” MORE PEOPLE WITH CANCER She says if we were to extrapolate data based on the country’s growing population and changing lifestyle, the number of people living with cancer has obviously increased over the years. So in that sense, the number of cancer patients is rising, although not at an alarming rate. This begs the question on whether any research on cancer is being carried out in the country. “In terms of local research, there is definitely some. The

Cancer Research Malaysia (CRM), for instance, has been specifically set up to perform research. (The question) is what type of research is being done in the country,” says Dr Saunthari. She explains that in terms of the more experimental research to find new drugs for cancer, the country still lacks the capability and resources, but there is some research to find better ways to prevent or identify cancer. T here are many other organisations doing research. She however, admits not all the research is done in accordance to international standards. Is NCSM involved in any cancer research? “NCSM is not a research body, but we have collaborated with other entities connected to cancer research. As for direct research, we do it through the programmes that we organise. Our programmes are used to collect data of cancer patients for use in other future research,” says Dr Saunthari.

SMOKY RISK: Tobacco is still the number one risk factor of cancer in Malaysia, says Saunthari.

FOCUS ON SMOKING “The NCSM is essentially an organisation dedicated to provide services to the general public and to create greater awareness of cancer in Malaysia. It is commemorating World Cancer Day with the opening of its smoking cessation clinic with the theme “We Can, I Can”. But why focus on smoking? Has there been an increase in smoking-related cancer in Malaysia?

As the National Cancer Registry has yet to publish any findings over a decade, it is difficult to know how cancer is growing statistically in Malaysia.” – Dr Saunthari

Clinic to help smokers quit NCSM service aims to reduce tobacco-related deaths in Malaysia

HE National Cancer Society of Malaysia (NCSM) is the first not-for-profit cancer organisation in the country to launch a quit smoking clinic. The clinic, to be launched on February 18, is part of the society’s initiative to reduce the impact of tobacco use and tobacco-related deaths. As part of the clinic’s outreach, NCSM will conduct smoking cessation awareness programmes to raise public awareness of the dangers of smoking and encourage

smokers to quit. The programme will include a one-day workshop on February 27 at NCSM’s Resource and Wellness Centre in Kuala Lumpur. The workshop will be a platform for participants to have ongoing sessions with NCSM’s smoking cessation specialist at its Quit Smoking Clinic. The new clinic demonstrates NCSM’s commitment to provide more facilities to boost its portfolio of cancer screening and diagnostic services for the community. The society encourages smokers to use its smoking

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2016 | FEBRUARY

“We Can, I Can”.

World Cancer Day

I will have to say yes; I believe we are winning, but the win is a gradual one. We still need a lot of effort. I think collaboration is the most integral part in our advocacy against cancer. With many working to accomplish one goal, then anything is possible.”

– Dr Saunthari

Dr Saunthari says tobacco is still the number one risk factor of cancer in Malaysia, like in so many countries. “That is why we feel the need to make a difference. We want to be able to influence people.” She says NCSM uses a twopronged approach. The first is advocating the need for a stronger policy against cancer, and also on the dangers of tobacco through public programmes. The second approach, she adds, is providing ample services to smokers who want to quit

smoking. “Because at the end of the day, advocacy can only go so far if there is no place to seek help,” she says. So are we as a community winning our fight against cancer? Dr Saunthari thinks we are moving gradually in that direction. “I will have to say yes; I believe we are winning, but the win is a gradual one. We still need a lot of effort. I think collaboration is the most integral part in our advocacy against cancer. With many working to accomplish one goal, then anything is possible.”

cessation service and try out techniques which are proven to be effective such as counselling and medical treatment. “Smoking is a major worldwide public health issue. A b out one in every 10 smokers will develop lung cancer, and more than 90% of lung cancers are attributed to smoking. Tobacco is the single biggest avoidable cause of cancer in the world, causing nearly 100 million deaths worldwide,” says NCSM president and medical director Dr Saunthari Somasundaram. “The theme for World Cancer Day is ‘We Can, I Can’. As NCSM turns 50 this year, it is imperative for us to continue our efforts in cancer prevention and focus on the dangers of smoking. Smoking cessation is something we can all encourage and NCSM will provide that support to the public.

“Malaysia is witnessing an i n c re a s e i n people developing cancer; therefore it remains our mission to drive public education and cancer screening. We encourage the government, local communities and the industry to all play an active role in smoking cessation to enable healthier outcomes and reduce the burden of tobacco use in Malaysia,” she adds. Incidence of cancer in Malaysia has increased from 32,000 new cases in 2008 to 37,000 cases in 2012, and is expected to increase to 56,830 cases by 2025, if no action is taken. According to GLOBOCAN 2012, lung cancer was the third highest cancer in Malaysia, with 4,403 cases representing 11.8% of all cancers.

WORLD Cancer Day, which takes place every year on February 4, is the one singular initiative under which the entire world can unite together in the fight against the global cancer epidemic. It aims to save millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease. The Union for International Cancer Control (UICC), based in Geneva, Switzerland, continues to expand on the success and impact of the day and is committed to ensuring that year-on-year the event is seen and heard by more people around the world. It does this through working directly with members to develop a campaign that serves its differing organisational priorities; this is

achieved through a two-pronged strategic approach: UICC provides support through the development of tools and guidance to encourage member organisations to run local cancer awareness campaigns that are aligned and adapted to the global World Cancer Day message. On an above-country level, it works to secure and support digital, traditional and social media opportunities to raise public awareness of the day. Through the continued support of its membership and key partners, World Cancer Day is beginning to firmly cement itself in calendars across the world.

QUITTING CHAMPIONS: The NCSM smoking cessation clinic has been helping people wanting to quit smoking since late last year.

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FEBRUARY | 2016

CREATIVE COMMONS

SNUFF IT OUT: Stop smoking to significantly reduce your risk for many types of cancer.

Prevention is better than cure Leading a healthy lifestyle can help prevent up to two-thirds of cancers

ANCER is probably the most feared disease. We fear cancer, and yet, fear may make us susceptible to cancer. It’s a deadly catch-22 situation. Fear of cancer or cancer phobia has led to remarkable strides in modern medicine, fuelling research that has led some cancers to be almost completely curable. As the saying goes, prevention is better than cure. Many types of cancer can be prevented by making changes such as eating a healthy diet and getting regular screenings. While what is known about cancer prevention is still evolving, it’s well accepted that your chances of developing cancer are affected by the lifestyle choices you make. PREVENTION Making slight changes to daily habits will reduce the risk of developing cancer, says the National Cancer Society Malaysia. Some recommended steps are: Stop smoking to significantly reduce your risk for many

cancers. Be active and exercise at least three times a week, 30 minutes each session. Keep to a healthy weight. Eat plenty of vegetables, fruits and dietary fibre (like oats, brown rice and cereals). Eat food low in fat, sugar and salt. Keep your alcohol intake low. Drink at least eight glasses of plain water daily. Be sun aware. EARLY DETECTION Certain cancers can be detected early and there is an 80% chance of surviving a cancer found early. There are eight warning signs of cancer to look out for: Any change in bowel or bladder habit. Unusual bleeding or discharge from any part of the body, like vaginal bleeding between menstruations or after menopause. An unexplained lump that does not go away, like in the breast or neck. A sore that does not heal.

Changes to a skin spot, wart or mole. Hoarseness of voice or nagging cough lasting more than two weeks. Unusual nose bleed, deafness or ringing sound in the ears. Indigestion or difficulty in swallowing. SCREENING Screening is a test done on a healthy individual to find the cancer at an early stage. The screening guidelines recommended by the National Cancer Society Malaysia are for early detection of cancer for people without any symptoms. Some people are at higher risks for certain cancers and may need to have the tests more frequently. Talk with your health care professional to find out how these guidelines relate to you. NUTRITION & CANCER RISK Many studies recognise the power of nutrients in fruits and vegetables in preventing diseases and cancer. Phytochemicals such as beta-carotene, lycopene and isoflavones found in fruits, vegetables and grains have been identified as disease fighters. Studies have shown that the risk of prostate cancer drops for men who eat tomatoes and tomato products as they are high in lycopene. It has been shown that colon cancer declines among those who drink green tea and regularly eat soy products and foods rich in selenium. It may not be clear how

phytochemicals in fruits and vegetables work to prevent cancer but many researches have proven that this compound is effective in lowering risks of certain cancers and disease in general. HERBS, VITAMINS, MINERALS, SUPPLEMENT & ANTIOXIDANTS While many dietary supplements may be said to cure cancer, there is still no evidence they are effective treatments Tell your health care team about any herbal products and supplements that you are using or considering using. Bring the bottle(s) of the supplement to your doctor for approval of the dose and to ensure that the ingredients do not interfere with your health or cancer treatments. Ask your doctor or dietician for reliable information on dietary supplements. Check the product labels for both the quantity and concentration of active ingredients contained in each product and the expiry date. Stop taking the product immediately and call your doctor if you experience side effects such as wheezing, itching, numbness or tingling in limbs. Avoid products that claim to be “miracle cures,” ‘breakthroughs” or “new discoveries”. These claims are almost always completely untrue. Avoid products that claim to be effective treatment for a wide variety of unrelated illnesses.

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2016 | FEBRUARY

Faulty gene’s role in ovary cancer risk Those with inherited fault in BRIP1 gene are three times more likely to develop ovarian cancer than others

OMEN who carry an inherited fault in the BRIP1 gene are three times more likely to develop ovarian cancer than those without it, say researchers. The gene variant had already been linked to cancer of the ovaries, but the size of the additional risk has now been quantified in a study in the Journal of the US National Cancer Institute. “Around 18 women in every 1,000 develop ovarian cancer, but this risk increases to around 58 women in every 1,000 for women with a fault in the BRIP1 gene,” says a statement from Cancer Research UK, whose researchers led the research. The fault inhibited tissue cells from properly repairing their own DNA, causing genetic damage to build up over time, and leading to cancer, says the team. The rare but deadly disease, with few early symptoms, is often diagnosed at a very advanced stage, hence its reputation as a silent killer. About 60% of patients die within five years. AGGRESSIVE FORM OF CANCER There is no standard or routine test for early detection of ovarian cancer – a process known as “screening” to boost survival chances by allowing for treatment to begin as soon as possible after disease onset. The study compared the genes

of over 8,000 European women, including a group diagnosed with ovarian cancer, a healthy group, and a third with a family history of the disease. They found that women who carried the BRIP1 mutation were more likely to be diagnosed with an aggressive form of cancer, at a later stage and at an older age.

“Our work has found a valuable piece of the puzzle behind ovarian cancer and we hope that our work could eventually form the basis of a genetic test to identify women at greatest risk,” says Paul Pharaoh, a cancer epidemiology professor at the Cancer Research UK Cambridge Institute. “Finding these women will help us prevent more cancers and save lives. This would be important in a disease like ovarian cancer, which tends to be diagnosed at a later stage when the chances of survival are worse.” Women with a mutation on the BRCA1 gene, for example, carry a very high risk of developing breast and ovarian cancer. Those diagnosed with the variant can opt to surgically remove their breasts and ovaries to lower their risk. Ovarian cancer is the seventh most common cancer in women worldwide, with 239,000 new cases diagnosed in 2012, according to the World Cancer Research Fund International. – AFPRelaxnews

Our work has found a valuable piece of the puzzle behind ovarian cancer and we hope that our work could eventually form the basis of a genetic test to identify women at greatest risk.” – Paul Pharaoh SHUTTERSTOCK

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FEBRUARY | 2016

Still ignorant of alcohol-breast cancer link

CREATIVE COMMONS

The public should be alerted on the potential danger, say women drinkers

T looks like Malaysian women are either unaware of, or unperturbed by, research findings linking alcohol intake and breast cancer, and that the risk increases with each additional daily drink. This was at least what Health+ surmised after speaking to three young women who seemingly enjoy life to the fullest, at least in their spare time. They enjoy travelling, good food and drinking good wine – or champagne, occasionally. Priscilla, a vibrant 25-year-old casting manager, enjoys travelling abroad and, in every country visited, she had attended the coolest parties. Such parties usually served alcoholic drinks, and

Priscilla is not ashamed to admit she had indulged in one of life’s simple pleasures. So, is she aware consuming alcohol could increase her risk of getting breast cancer? No, she answered almost instantaneously. Priscilla, who had just returned from Boracay in the Philippines, jokingly admitted she was glad the interview took place after her return, or else it would have dampened her partying mood there. She, together with friends, Jessica and Nicol, had no idea about the link between alcohol consumption and breast cancer. Nicol, a 27 year-old marketing manager, admitted knowing that drinking high amount of alcohol could lead to health problems

SPREAD THE WORD: The women say such research findings and vital information should be constantly in the news to remind the public of any possible danger.

such as liver and kidney diseases, as well as heart problems. Jessica , a 21- year-old university student, nodded in agreement. Despite her shy personality, she says there is so little, if none at all, of such awareness campaign. And if there was any, probably it was never hyped up or went viral on social media, as it should have been for such an important issue. After being made aware, the three women strongly felt that such research findings and vital information should be constantly in the news to remind the public of any possible danger as consuming alcoholic beverages is considered a social norm in our society. For cigarettes, there are ample warnings for smokers and

would-be smokers, such as on cigarette box labels and billboards that smoking is hazardous. But what about warnings on the dangers of drinking alcohol? Except for warning signs that the underage are not allowed to buy or drink alcoholic products, there is no billboard nor TV and radio advertisement, as well as product label to warn people of the dangers of drinking alcohol, aside from drinking and driving, of course. Priscilla, Nicol and Jessica may be modern and successdriven women, but they believe everybody should be educated on the importance of health, and that people can enjoy life, while also being made aware of the risks and dangers of life’s simple pleasures.

Alcohol increases risk of breast cancer A MAJOR new study involving more than 300,000 female volunteers confirms a link between alcohol intake and breast cancer, and that the risk increases with each additional daily drink. Five Spanish universities and 334,850 women between the ages of 35 and 70 from 10 European countries were involved in the research, which confirms previous evidence of a link between alcohol intake and breast cancer. Over the course of the 11-year monitoring study, 11,576 participants were diagnosed with breast cancer. The team found that a woman’s average risk of being diagnosed with breast cancer increases by 4% with each additional 10gm of alcohol intake per day, says Spanish

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scientist María Dolores Chirlaque. The team also found that the longer a woman had been exposed to alcohol consumption, the greater a risk she had, especially if her alcohol intake had begun prior to her first pregnancy. – AFPRelaxnews

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2016 | FEBRUARY

Whitening cream banned over mercury content Health Ministry says heavy metal not allowed to be used in cosmetic products

HE Health Ministry recently banned a product from popular cosmetics line Qu Puteh as it has been found to contain harmful substances. In announcing the ban on Qu Puteh Kosmetik Whitening Pro 9 cream, Health Ministry directorgeneral Datuk Dr Noor Hisham Abdullah says the product contains mercury, which isn’t allowed to be used in cosmetic products. He says the ministry’s National Pharmaceutical Control Bureau (NPCB) has found that the product contain a “high level” of mercury, based on a sampling it did on the product. The bureau, he adds, had received reports of adverse effects from users, such as ringing in the ears (tinnitus) and hair loss after using the Qu Puteh Whitening UV Pro 9 and Qu Puteh Whitening UV Block for less than three months. The users, he says, have recovered after they stopped using the products. Dr Noor Hisham explains that cosmetic products which are mixed with mercury were generally meant for skin whitening and antiageing purposes. “Cosmetic products which contain mercury are not permissible as they are hazardous to one’s health as it could damage the kidneys and the nerve system. It could also disrupt the brain development of children or even unborn babies,”

he says. Companies selling the products have been asked to cease all sale and stock activities and withdraw them from the market within 72 hours. Those who fail to abide by the ruling can face punishment of a fine not exceeding RM25,000 or three years’ jail, or both. Over the years, the ministry has banned a number of cosmetic products containing mercury and other harmful ingredients. Early last year, it banned three products manufactured by Herca PT of Indonesia. According to the NPCB, the cosmetic products had been tested and found to contain the scheduled poison hydroquinone and heavy metal mercury which are prohibited in cosmetic products. Products containing hydroquinone are classified as pharmaceutical products that require registration with the Drug Control Authority and can only be used under the advice of a healthcare professional. Hydroquinone is commonly used to treat hyperpigmentation of skin. Unsupervised use of preparations containing hydroquinone may cause unwanted side effects. NPCB says cosmetic products adulterated with hydroquinone are typically marketed for skin lightening and to treat blemishes and uneven skin tone. Hydroquinone can cause skin

CREATIVE COMMONS

HIDDEN DANGER: Hydroquinone is commonly used to treat hyperpigmentation of skin.

redness, discomfort, skin discoloration, hypersensitivity and a gradual blue-black darkening of the skin. Hydroquinone inhibits the pigmentation process (depigmentation) which reduces the skin’s ability to be protected from harmful UV rays, thus, increasing the risk of skin cancer. NPCB says exposure to mercury not only causes damage to the kidneys and the nervous system, but may also interfere with the development of the brain in unborn children and very young

children. Furthermore, exposure to mercury is not only limited to those using the skin cream containing mercury but also to others, especially children as mercury can get into their bodies from breathing in the mercury vapours. Infants and children can ingest mercury when they touch cosmetic products containing mercury or their parents who have used these products. Using products containing mercury can also cause skin rashes, irritation, and other changes to the skin.

Binge drinking more dangerous than originally thought A STUDY by the University of Missouri School of Medicine suggests that chronic alcohol use combined with repeated binge drinking is even more harmful for the liver than previously thought. Knowing that heavy binge drinking by those who habitually consume alcohol is the most common cause of liver damage, the team wanted to research further the cause and extent of this damage by looking at the effects of different forms of alcohol abuse on a group of mice over a four-week period. The researchers studied the effects of chronic alcohol use, repeated episodes of binge drinking, and a combination of both, and compared them to a control group. The results, published in the journal Biomolecules, showed that chronic alcohol use and repeated binge drinking caused moderate liver damage in comparison to the control group. However the mice that were exposed to both chronic alcohol use and repeated binge drinking showed significantly higher levels of liver damage than the other groups. Alcohol damages the liver

by causing large fatty deposits in the organ which affect its ability to function properly. In the mice that were exposed to both chronic alcohol use and binge drinking these levels of large fatty deposits were around 13 times higher than the levels in the control group. The fatty deposits were also caused in in part by metabolic changes within the liver, which in addition to increasing the number of fatty liver deposits, also increased stress on the liver, and decreased the liver’s ability to fight this stress. Shivendra Shukla, lead author of the study, also warned that chronic alcohol use does not only affect the liver. “Drinking alcohol excessively can create an inflammatory response to the liver and other organ systems in the body,” he says. “If those organs work at a lower level of function, then a whole host of physiological processes can be affected. It is important for us to understand the extent of damage caused by alcohol abuse, which also can lead to other health issues such as diabetes, cardiovascular disease and some forms of cancer.” – AFPRelaxnews

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FEBRUARY | 2016

Does your skin cream contain mercury?

CREATIVE COMMONS

Prolonged exposure can have serious health consequences, including damage to kidneys and nervous system

H AT m a k e s mercury poisoning from beauty products so scary? Many of the symptoms are non-specific and difficult to identify. They can include irritability, depression, difficulty in concentrating, insomnia, numbness and tingling in the extremities, and tremors. According to the United States Food and Drug Administration (FDA), exposure to mercury can have serious health consequences, including damage to the kidneys and nervous system, and can impact brain development of young children. Even worse, if these products

CREAMY TOUCH: The FDA says exposure to mercury can have serious health consequences.

are used over time, the mercury in them can be slowly released as airborne mercury vapour, which can contaminate entire households and affect children and family members – even if they’ve never used the contaminated products themselves. Some of the babies affected were exposed to mercury during breastfeeding. According to the World Health Organisation (WHO), mercury is a common ingredient found in skin lightening soaps and creams. It is also found in other cosmetics such as eye makeup, cleansing products and mascara. The world body says skin lightening soaps and creams are

Dangers of mercury poisoning ARE you in danger of mercury poisoning? You may be – and you don’t even know it, says Dr Joseph Mercola, a world-renowned physician and multiple New York Times bestselling author. Dr Mercola, who has treated over 20,000 patients in the United States, says mercury has been mankind’s preferred poison for decades. He explains that the phrase “mad as a hatter” originated from the radical personality changes “hatters” in the 1900s experienced the longer they worked with a mercury compound they applied on hats. He says despite this early discovery of the dangers of mercury, it is still present in the modern world. Its qualities make it very useful for everyday life, making it easier for people to ignore its more toxic properties.

DANGERS OF MERCURY

It’s staring you right in the face – mercury is a poison, says Dr Mercola who claims the belief it is a harmless, little substance is a lie! In his 24-page report Exposing the Dangers of Mercury, he reveals the sources and risks that place you in the most danger of mercury contamination, including: Mercury contamination via the fish on your tables (how does mercury trickle down from

industries to waterways until it finds you?) Silver fillings (what’s a slow release poison doing in your mouth?) Childhood vaccines (how can something that’s supposed to protect your children be so deadly?) The air you breathe and the water you drink By absorbing mercury, you are exposing yourself to terrible health risks: Nervous disorders Growing evidence it causes cancer Kidney damage Respiratory failure Even death!

MERCURY CLOSELY LINKED TO AUTISM

Dr Mercola says the worst are: Outrageous amounts of mercury are being injected into our children and parents are unwittingly agreeing to it! The dramatic increase of autism in young children coincides with rising vaccination rates! His report explains why parents are unknowingly putting their children at high risk of developing autism – a tragically debilitating condition that affects the whole family.

HEAVY METAL: Dr Mercola says despite this early discovery of the dangers of mercury, it is still present in the modern world.

commonly used in some Asian and African countries. They are also used among dark-skinned populations in Europe and North America. Mercury salts inhibit the formation of melanin, resulting in a lighter skin tone. Mercury in cosmetics exists in two forms: inorganic and organic. Inorganic mercury like ammoniated mercury is used in skin lightening soaps and creams. Organic mercury compounds like thiomersal (ethyl mercury) and phenyl mercuric salts are used as cosmetic preservatives in eye makeup cleansing products and mascara. USE, PRODUCTION AND AVAILABILITY According to a WHO report published in 2011, 77% of women in Nigeria, 25% in Mali, 27% in Senegal, 35% in South Africa and 59% in Togo were reported to use skin lightening products on a regular basis. In 2004, nearly 40% of women surveyed in China (Province of Taiwan and Hong Kong Special Administrative Region), Malaysia, the Philippines and South Korea reported using skin lighteners. In India, 61% of the dermatological market consists of skin-lightening products. PRODUCTS AND INGREDIENTS Skin lightening products come in different forms, including soaps and creams; the soap is often sold as “antiseptic soap”. These products are supposed to be applied to the skin to dry overnight. WHO says women use the soap to wash their hair, arms or face or their entire body. It is reported that some women use these products for as long as 20 years. The soaps contain about 1–3% mercury iodide, and the creams are composed of 1–10% mercury ammonium. Some soap products tested contained mercury at concentrations up to 31 mg/kg,

whereas cream products had mercury concentrations as high as 33 000 mg/kg. Products with very high levels of mercury contamination look grey or cream coloured. The amount or concentration of mercury in a product may be labelled on the packaging or in the ingredient list. Names to look for include mercury, Hg, mercuric iodide, mercurous chloride, ammoniated mercury, amide chloride of mercury, quicksilver, cinnabaris (mercury sulfide), hydrargyri oxydum rubrum (mercury oxide), mercury iodide or “poison”; directions to avoid contact with silver, gold, rubber, aluminium and jewellery may also indicate the presence of mercury. However, companies selling products that contain mercury, do not always list it as an ingredient. HEALTH EFFECTS AND HOW TO MEASURE EXPOSURE The main adverse effect of the inorganic mercury contained in skin lightening soaps and creams is kidney damage. Mercury in skin lightening products may also cause skin rashes, skin discoloration and scarring, as well as a reduction in the skin’s resistance to bacterial and fungal infections. Other effects include anxiety, depression or psychosis and peripheral neuropathy. Mercury in soaps, creams and other cosmetic products is eventually discharged into wastewater. The mercury then enters the environment, where it becomes methylated and enters the food chain as highly toxic methylmercury in fish. Pregnant women who consume fish containing methylmercury transfer the mercury to their foetuses, which can result in neurodevelopmental deficits in their children. Exposure to inorganic mercury can be quantified through measurements in blood and urine.

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TIMELINE TO ACT: The treaty sets a phase-out target of 2020 for a long list of products, including mercury thermometers.

Reducing mercury pollution and negative impacts Minamata Convention on Mercury regulates use and environmental releases of toxic liquid metal, including in mercury-added products

ERCURY is a chemical element that is harmful to human health and the environment. Many types of human activities have the potential to cause mercury pollution. The United Nations Environment Programme (UNEP), the voice for the environment in the world body, is working with governments and other stakeholders to reduce mercury pollution and its negative impacts. One of UNEP’s key activities on mercury is the Minamata Convention on Mercury, a legally-binding multilateral environmental agreement that was adopted by governments in 2013. It regulates the use and environmental releases of mercury from sectors such as artisanal mining, coal combustion, and mercury-added products. By ratifying and implementing the convention, governments can protect citizens’ health and the environment. Delegates from some 140 countries and territories signed the UN treaty on mercury, in Minamata, Japan. The location was highly symbolic as Minamata was the

scene of a mercury scandal exposed in the 1950s. Tens of thousands of people were poisoned – some 2,000 of whom had since died – by eating fish and shellfish taken from waters polluted by discharge from a local factory. The Minamata Convention on Mercury, which is the world’s first legally binding treaty on the highly toxic metal, will take effect once ratified by 50 countries, something the UN expects will take three to four years. The treaty sets a phase-out target of 2020 for a long list of products – including mercury thermometers – and gives governments 15 years to end all mercury mining. But it stipulates that countries can continue to use mercury in medical measuring devices until 2030 under certain special circumstances. According to the WHO, the negative consequences of mercury use are such that all countries should hold to the 2020 target. It said mercury and its various compounds are of global public health concern and have a range of serious health impacts including

Mercury is one of the top ten chemicals of major public health concern and is a substance which disperses into and remains in ecosystems for generations, causing severe ill health and intellectual impairment to exposed populations.” – Margaret Chan

brain and neurological damage especially among the young. The WHO said its campaign would also tackle mercury antiseptics and skin-lightening cosmetics, seek to phase out its use in dentistry, and help deal with the health impact of its use in small-scale gold mining. The latter area is a major concern for environmental groups, which say the Minamata Convention stops short of addressing the issue even though mercury threatens the health of miners, including child labourers, in developing countries. A day after nations signed the UN treaty to control the toxic liquid metal, WHO and campaigners launched a drive to try to wipe out mercury in medical thermometers,

“Mercury is one of the top ten chemicals of major public health concern and is a substance which disperses into and remains in ecosystems for generations, causing severe ill health and intellectual impairment to exposed populations,” WHO head Margaret Chan had said in a statement. Working with the campaign group Health Care Without Harm, the UN agency said it aims by 2020 to eliminate mercury from fever thermometers, as well as blood pressure devices which use it. It explained that the goal would be achieved if the manufacture, import and export of such devices was halted, and accurate, affordable, and safer non-mercury alternatives were deployed.

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In pursuit of happiness Inspiring story of how brave mother of three triumphs over HIV and raises family at the same time

IFE dealt multiple cruel blows to Sara (not her real name) when she, her husband and their less-than-a-year-old toddler were diagnosed with HIV in 2003. Despite eventually losing her husband to tuberculosis (TB) and being scorned by others, Sara has courageously risen above her

dire circumstances to be a strong, determined and positive person. She has since remarried someone who lovingly supports and journeys with her all the way. Would her life be different had she not contacted HIV? “Of course it would, but I think it would not be for the better. I am thankful for the life I have now – HIV and everything that comes with it. This condition has made my life the way it is, and I don’t feel even an inch of regret,” Sara tells Health+. CRUSHING DIAGNOSES Sara was just starting her life as a wife and mother when her then-husband had a bad bout of coughing. After a series of clinic visits which ended to no avail, she accompanied her husband to the Hospital Besar Tunku Ampuan Afzan in Kuantan for a check-up. After being referred to a specialist, her husband was diagnosed with TB. Their world almost caved in that fateful day when Sara, her husband and their baby boy were all tested HIV-positive. “The feeling I had was indescribable. I was in total shock. I felt my life had ended and that I

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LIVING CORPSE: After receiving the multiple bad news, Sara was reduced to a living corpse, spending days on end locked up in her room unable to care for herself and others.

would never have a future,” says Sara. After receiving the multiple bad news, she was reduced to a living corpse, spending days on end locked up in her room unable to care for herself and others. By then, her husband had lost his will to live, refusing treatment for both TB and HIV, and eventually passed away. And that caused Sara to sink even deeper into depression. FAMILY’S REACTION Sara initially didn’t tell anyone about their conditions. “The only ones who knew then were my inlaws as we moved into their home. When my husband died, I moved back to stay with my parents and only then they knew about it (my condition).” Her family was very supportive. However, it was the reaction of a relative who came to visit her one day that had left an indelible mark in her life, for the better in retrospect. “The relative learned about my condition from my parents. She blamed my parents for not raising me properly. She called my condition a ‘foul disease’ and that I was damned by God for having it,” says Sara. RISING ABOVE HER DIRE CIRCUMSTANCES It has been a painful journey and memory for Sara. Yet, despite it all, she succeeded in breaking out from her depressed state and found the strength to keep living. She wanted

to prove to others that she could be strong and live a normal life, so she sought treatment and looked hard to get a job to take care of herself and her young child. It was indeed tough going for Sara as her determination was met with many challenges. She says because of her treatment and regular check-ups, it was hard for her to stay at a job for more than a few months. “I never told any of my employers that I had HIV. And because I had to go to the doctor frequently for myself and my boy, I failed to keep a steady job,” she says. Her life took a turn for the better when she found a partnering group of the Malaysian AIDS Council (MAC) in Kuantan providing support services for people living with HIV. Not only has she received strong support from the group, she has even started working for the MAC in Kuala Lumpur. MANAGING AND LIVING HAPPILY Sara manages her condition with a few simple medications in tablet form. “I am taking two types of medicine while my son takes three. We take them once in the morning and once in the afternoon.” She is obviously happier these days, and her two other children from her second marriage are negative for HIV. “One of the things that is important we are trying to convey is that with treatment, you can pretty much live a normal life,” says Sara.

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Unshackling HIV stereotypes

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Malaysian AIDS Council is spearheading efforts to remove stigma and spread awareness on the condition

BY NORMAN HUSSAINI

HE act of stigmatising a group of people just because they are different is nothing new. It is a human trait that has divided us for centuries. For people living with HIV and AIDS, the public perception of them is no different. People living with HIV and AIDS are generally viewed as “bad people” and have been discriminated against for a long time. Due to the way the condition spreads, it is perhaps understandable why people living with HIV and AIDS are usually viewed so negatively by the public. However, it is definitely unacceptable for us to blindly discriminate against them. Malaysian AIDS Council (MAC) president Datuk Dr Raj Karim has been campaigning to change the stereotypes on HIV and AIDS, and the people affected by them. “HIV and AIDS are riddled with stigma and discrimination. Fighting the stigma is always a challenge,” she tells Health+. “That is why the MAC’s primary role is to remove the stigma and spread the awareness to the right people. We are focusing on what drives the epidemic.” KEY TARGET GROUP The MAC focuses on high-risk population like drug users and sex workers by educating and

informing them on the dangers of HIV and AIDS. “These people are exposed to the risk daily, so they need to know about HIV and AIDS to protect themselves,” explains Dr Raj. She says low risk groups of people are also affected by the condition. For instance, housewives and children are not exempted from the risk of HIV transmission, and this aspect should never be overlooked. STATE OF AWARENESS Dr Raj says the awareness on HIV and AIDS among Malaysians is quite high. “The public knows about it, maybe not in detail, but they do have a general idea. They know the method of transmission and how to prevent it.” The problem facing us as a society, however, is in the practice. Dr Raj says like cancer, the practice just isn’t there for the masses. “Like prevention of cancer, people’s ability to quit smoking has always been a challenge, even when they know that smoking can cause lung cancer.” Similarly, in HIV and AIDS, although people know how to prevent it, they are not necessarily taking steps to do it, she laments.

TARGET GROUPS: The MAC focuses on high-risk individuals like drug users and sex workers by educating and informing them on the dangers of HIV and AIDS.

HIV and AIDS are riddled with stigma and discrimination. Fighting the stigma is always a challenge.” That is why the MAC’s primary role is to remove the stigma and spread the awareness to the right people. We are focusing on what drives the epidemic.” – Dr Raj

MAC’S APPROACH Dr Raj says because HIV is transmitted mostly via sexual relations, the approach taken by governments in other countries to spread the awareness may differ from Malaysia’s. Sex, she points out, is a very sensitive issue to talk about in

UPHILL TASK: It was – and still is – a very controversial issue to talk about the condition, says Dr Raj.

Malaysia, and thus any campaign involving promoting safe sex and free condom distribution could possibly stir controversy. “Obviously our approach is subtler than in other countries. It was – and still is – a very controversial issue to talk about the condition. However, the public has learned to accept it.” Hence, the MAC’s efforts to spread the awareness on HIV and AIDS are done through other methods such as via conferences and festivals targeted at the public. “We have done a few conferences among professionals to talk about reinforcing the knowledge on HIV. We have also done several campaigns to help spread the word such as the Red Ribbon film competition and national World AIDS Day in Penang alongside the Health Ministry,” says Dr Raj. The campaigns, she explains, were to get a larger audience to engage on the risks of HIV and AIDS, and how to prevent them.

“The MAC is also reaching out to target groups and supplying them with preventative knowledge.” MAC shapes its activities around the established national strategic plan for HIV and AIDS introduced by the Health Ministry. “This year, the ministry aims to upgrade the national plan to fit the current trends. Therefore, we will be coming out with new strategic plan based on the new one. Once we have done that, we can move on to continue our advocacy, capacity building, training, awareness, and to focus on the target groups,” says Dr Raj. The MAC hopes to destigmatise HIV and AIDS and spread hope to people that there is a treatment. Everyone should know what the dangers are and know what prevention methods to take. The MAC also encourages people to get tested and know their state of health to ensure their safety as well as that of others.

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Advance in quest for HIV cure

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Norwegian firm says drug combination seeks to force virus out of its hiding place and kill it

Norwegian drug firm has announced an advance in its quest for an HIV cure with a drug combination which seeks to force the virus out of its hiding place and kill it. A trial with 17 HIV-positive patients yielded a “statistically significant decrease” in the virus, biotech firm Bionor announced. “This is a major achievement on the path to a functional cure for HIV,” Bionor spokesman Jorgen Fischer Ravn tells AFP. There is no cure for the disease AIDS, caused by HIV, but antiretroviral treatments help people live longer, healthier lives by delaying and subduing symptoms. In some patients who undergo treatment, however, the virus

takes cover in cells and hides away, only to reemerge once therapy is stopped. This latency has been one of the biggest hurdles in developing a cure. “Waking up” the virus and then destroying it – the so-called “kickand-kill” approach – is a promising strategy for ridding patients of HIV. Bionor’s approach involves an anti-cancer drug called romidepsin to wake up the dormant HIV, and a vaccine called Vacc-4x to prime the body’s own immune T-cells to recognise and destroy the virus. “After an activation of the virus, which would normally lead to detectable virus in the blood, Vacc-4x ensured killing of the virus-producing cells to maintain

non-detectable or very low levels of virus in the blood in 15 out of 17 patients,” says Fischer Ravn. No one has yet been cured of AIDS. Thirty-nine million people

have died of AIDS, according to UN estimates, and about 35 million are living with the immune system-destroying virus today, overwhelmingly in poor countries. – AFPRelaxnews

HIV differs from AIDS HIV, or human immunodeficiency virus, is a virus that infects the human body with the ability to affect the immune system. A weak immune system will lead to a person being highly susceptible to other diseases and infections. AIDS, on the other hand, is an acquired immune deficiency syndrome. It is the most progressive stage of an HIV infection where the body’s immune system has been completely weakened. At this stage, even the common cold can be fatal. One can be infected with HIV without ever contracting AIDS, if sufficient treatment is followed. The epidemic spreads mainly through sexual activities and sharing of needles among drug users, hence the stereotype and discrimination against people with HIV. The condition can also be passed down from mother or father to child. In Malaysia, as of

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OPEN TO ATTACK: One can be infected with HIV without ever contracting AIDS, if sufficient treatment is followed.

2014, there were 105,189 reported cases of children with HIV with 21,384 of them contracting AIDS. Although the figure is relatively small, it could soon increase

if parents don’t take preventative measures by getting their children tested and following treatment if the virus is present. Living with HIV or AIDS is

not a death sentence. With the advancement in medical technology, treatments to manage the condition have improved tremendously over the years. With proper treatment and management, a person with HIV/AIDS can live a normal life with very few complications. Treatment may also lower viral activity and prevent the virus from further multiplying, lowering the risks of passing it down to children. The costs of drugs used for treatments are not cheap. However, as part of the Health Ministry’s efforts, government hospitals offer free treatment to anyone seeking help.