XTRA Health+ Newspaper February 2016 Issue 03

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

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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

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

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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.”

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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

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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.

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

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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

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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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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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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

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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

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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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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.

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

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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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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

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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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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

C

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

T

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

C

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

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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

I

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

SHUTTERSTOCK

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

T

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

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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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2016 | february

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

M

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

L

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

CREATIVE COMMONS

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.

• 19

2016 | february

Unshackling HIV stereotypes

CREATIVE COMMONS

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

T

B y N or m an 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.

20 •

february | 2016

Advance in quest for HIV cure

CREATIVE COMMONS

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

A

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

CREATIVE COMMONS

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.