01 Jun 2008

Berita Akademi - Jun 2008

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Message from the Master
Professor Dato' Dr Khalid Abdul Kadir

Last June, I was invited to the Annual Congress of the American College of Physicians in Washington DC. It has been a tradition that the Master is invited to attend such auspicious Congresses of sister Colleges overseas, and we have always had representations by previous Masters or our representatives. This however, was the first time I had attended the Annual Congress of the American College. I took one afternoon off to visit Abraham Lincoln's Memorial and then walked along the Reflection Pool towards the Washington Monument. As I walked along the Reflection Pool, I felt tired and sat down quietly to gaze at the shimmering waters, and reflect on the Congress and what it meant and what do we in Malaysia have as a comparison. At the same time, my mind wondered off to the recent past and recounted on the events that have shaped our Academy and specialist medical practice in Malaysia. On reflection, I realised that I had attended an Endocrine Conference here as a young physician from Australia training to be an endocrinologist in 1979, and as a Speaker at the International Diabetes Federation Meeting in 1990, and here I am again as a guest of the College in 2008, and that I have been in the Council of the Academy for 21 years. It is time I give the younger more agile minds with strong bodies to carry on with the Academy and the direction in which we will practise specialty medicine in the future and the standards that we wish to set our medical practice in Malaysia.

The Annual Congress of the College of Physicians was very well attended by more than 10,000 participants ranging from elderly physicians who could hardly walk up the many stairs of The Washington Convention Center, to many bright young doctors aspiring to be Physicians. There was no lack of enthusiasm. All the halls were full, we had to book ahead to attend seminars and workshops. The Exhibition Hall which was more than 3 acres in size was full of exhibitors. I was told the same goes for the Annual American College of Surgeons Meetings.

This is of course not the case for us in Malaysia. We had problems getting exhibitors for our Malaysia-Singapore Congress of Medicine and College of Physicians Meetings, whereas we had no problems getting exhibitors for the Meetings of the Specialist Congresses and Meetings. We have always had better attendances for the Specialist Societies Congresses and Meetings compared to the College of Physicians and the Malaysia-Singapore Congress. This was not the picture when I first came back and attended the Malaysia-Singapore Congress in 1979, nor in the eighties. What has happened and what does it reflect? In contrast why is it not so in the States, Canada, Australia, etc?

In my opinion, it reflects the trend towards specialisation away from being a general physician or general surgeon or gynaecologist or paediatrician or radiologist, rather towards being a hepatobiliary surgeon or a cardiologist or a paediatric neurologist, or interventional radiologist or gynaeoncologist, medical statistician, medical virologist and others. The generalist seems to be accorded a distinct secondary preference by the trainees. Why has this happened? Perhaps because up to the eighties, we did not have many subspecialists such as cardiologists or neurosurgeons or neonatologists or medical statisticians and the Government was encouraging the development of subspecialty practice to cater for the Ministry's needs. It came to such an extent that promotions were based on acquiring a subspecialty in medicine. This is also being carried out in the Universities and University medical services. I was also a party to that policy. I ensured that all our lecturers are specialised in a subspecialty of medicine or surgery, etc. Somehow I forgot the need of having a general physician or internists. The public is also to be blamed now. Patients are seeking medical advice and treatment directly from subspecialists without even going through a general practitioner at times with self-diagnosed ailments, etc. To certain extent, it has become more acute now that the Universities are now offering subspecialty training in certain fields without going through the initial general training, for example, in Medical Oncology, Neurosurgery, etc. Thus, if the person is trained only in a subspecialty, he / she will not be able to look after patients as a generalist, compared to his counterparts who were trained, say, as a general physician first before being trained as an oncologist.

Is this an issue? What are the issues apart from poor attendances at the College Meetings or Academy Congress? We should be happy that we now have many more specialists in various subspecialties. We now have cardiac centres and cardiologists in Ministry of Health Hospitals in Penang, Johor Bahru and Kuching, not just in Kuala Lumpur. Similarly, we now have neurosurgical services in Johor Bahru, etc. It is in fact, a two-edged sword to the Medical Profession. We need general physicians, general surgeons, obstetricians and gynaecologists, paediatricians, pathologists, public health specialists, etc, in the Ministry of Health hospitals. It is only in the largest hospitals that we need subspecialists for the various Subspecialty Centres that have been set up. The majority of the services are provided by the generalists in general hospitals and district hospitals. Thus, by right, promotions in the Ministry should not be tied to the acquisition of subspecialty qualifications if we were to nurture the concept of general physician or general surgeon.

In the private hospitals, the reverse seems to be true. Most if not all, the larger private hospitals cater for the subspecialties. On reflection, this is what I am doing now as I recruit specialists for the new Medical Centre that I am involved in. These subspecialists then also provide general medical or surgical care. Very few subspecialists can survive on pure subspecialty medicine alone except, perhaps for cardiac surgeons, ophthalmologists, ENT surgeons and neurosurgeons. There are however, very few who profess to be a general physician or general surgeon in private hospitals. Thus, arise the problem of whether a subspecialist physician can provide adequate medical care in general medicine? Can a practitioner profess to be a subspecialist if a significant proportion of his time is spent doing general medicine or surgery? On the other hand, is the general physician adequately trained to look after a cardiac patient or a general surgeon look after a vascular problem? What are the medicolegal implications if, say, an untoward event happens to a patient with a general medical problem who is looked after by a subspecialist? What are the implications if an untoward event happens to a patient looked after by a general physician if a subspecialist is available at the hospital? Are we practicing defensive medicine when we refer patients? Or, are patients at times, being “dissected” by various subspecialists and no one looks at the patient as a whole? Should subspecialists only be looking after patients when they are referred to by generalists as is the case in America, Canada etc? Why should a diabetic specialist, say, be looking after a simple diabetic? The College of Surgeons of Malaysia has decided that, to solve all these complex issues, it is recommending that most surgeons register as general surgeons if they are so trained with a subspecialty after general training. They can still practise subspecialty surgery. Others in the Council were of the opinion that it complicates matters of trying to determine or locate a subspecialty surgeon when the need arises from the specialist register, and so on.

All these questions will have answers both ways. As I look at the Reflection Pool in Washington, I am not sure which is correct proper practice and what is practical practice at times, as I have gone through practice at the General Hospital Kuala Lumpur, at Hospital UKM, and now in both private practice in Pantai Medical Centre and public service in Hospital Sultanah Aminah Johor. I am glad to see general medicine, surgery, paediatrics, O & G, radiology, etc, are still practised at Hospital Sultanah Aminah Johor with full gusto. However, I am also indulged with pleas for help from younger colleagues who are seeking places for advanced training in Malaysia, Singapore, Australia, United States, etc. One of my former students is now an endocrinologist in Texas after passing the Internal Medicine Board and after two years, the Endocrine Board. I am very proud of her but I thought she would have become a very good internist too! None of the young ones in Johor were interested in general internal medicine as a specialty, which is not the case in the States or Australia or Singapore. The need to have general medicine internists is an acute problem in these countries such that, many more internist positions are being offered. In fact, I was informed that the American College is offering positions to overseas doctors including Malaysia who are interested in general internal medicine. I hope my successor will follow this up to enable more Malaysians to be trained in Internal Medicine. I hope the younger doctors in the Colleges, Universities and Ministry should consider via the various committees that are in place, the direction we should take for the future of specialty practice in Malaysia.

I hope they would also consider the problem of getting adequate training positions and trainers for both general and subspecialty medicine, surgery, etc, and consider the fact that, sooner or later, we will face with the World Trade Organization agreement which will open our doors to others from other countries. We should look at the fact that, highly specialised high quality medicine is developing rapidly, if not over taking even Singapore, India and Thailand. Patients from Malaysia now have other alternatives for specialty treatment apart from Malaysia and Singapore. We cannot prevent them, or the Government, from obtaining medical services from these countries. We can however, combat the trend by having high standards of medical practice such that, patients and the public will continue to seek our services rather than those from other countries or in other countries. In reflection, as I sat by the Reflection Pool, I bemused the fact that, in the 80’s we were offering better standards of medical care in comparison to others except Singapore, in the region. I was going to Thailand, Indonesia, Brunei, Vietnam to lecture and helping to conduct workshops. Now Thailand has over taken us. When will Vietnam overtake us? Hopefully not within my lifetime!




From the President's desk...
College of Radiology, Academy of Medicine of Malaysia

Reflections on Being Re-elected as President for Another Term...

“Ask not what your country can do for you – ask what you can do for your country” – John F Kennedy, 35th President of the United States of America.

The above quote from John F Kennedy’s Inaugural Speech came to mind when reflecting on my past two years as President. How does one galvanise our College of Radiology (CoR) members to actively participate in determining the future of their allied professions in Malaysia? How can we encourage more to join their professional body? Just how do we (collectively as the newly elected council) motivate, cajole or plainly jolt ourselves out of our placid and idyllic comfort zones?

In my many years in various roles on the CoR council, I have not ceased to hear new radiologists, oncologists and allied professionals question “what’s in it for me to join the CoR?” Can a handful of people in the council promote and advance the allied professions?

Much as I would like to think we can, in reality, our spectators who are expecting the miraculous transformations, the subsidised academic programmes, training, lobbying the government, providing solutions to turf issues will not materialise overnight. Human, financial resources and time factors play heavily as does commitment and contributions from every single member of the profession. The members themselves determine how strong and relevant the CoR is – not just a handful of members.

So with these in mind, our focus in this new term would be to follow through on our various projects – Practice guidelines / Quality Assurance Programmes / Safe Practice in Mammography (to include digital mammography), Ultrasound, Magnetic Resonance Imaging, Interventional Radiology as well as updating our CoR Position Statement on Whole Body CT Screening. Then, we probably need to market the value of belonging to a professional body. If members of the profession join the professional body, then the CoR can truly represent the various allied professions. We need to grow the membership!

Our financial health requires nurturing as our venture to purchase office space within the Academy of Medicine Building has set us back significantly. We do not have our own office space to house the Secretariat but have relied on the goodwill of University Malaya Medical Centre for the past 31 years! For that, we are very grateful. Back to financial health, should we follow the model of sister organisations in established countries – actually encourage donations from members to run the Secretariat as well as programmes which are beneficial to us? A serious contemplation indeed.

Challenges – and we must embrace, face and overcome them one way or the other. The National Specialist Register, the transition of Nuclear Medicine as it evolves into a separate specialty, Continuing Professional Development being linked to a licence to practice or to be listed on the specialist register, organising scientific meetings and to top it off, our social and community efforts will definitely keep the council busy. We are co-opting more from amongst the members to form committees and subcommittees to oversee their own areas of development and sincerely hope they will be enthusiastic about their roles. Cumulatively, this will advanced the profession as a whole – thereby benefitting the patients / public.

We shall aim for “MISSION POSSIBLE” as the motto for the newly elected council. So, let us all get going, the council, the membership drive, the members and more!

Dr Evelyn Ho
President 2008 – 2010
College of Radiology, Academy of Medicine of Malaysia




Featured Article (28th May 2008)
Addiction Medicine News
Drug Addiction - A Relook at the Genetics
(Proceedings from the 1st International Conference of Addiction Medicine
15th – 17th November 2007; Kuala Lumpur, Malaysia)
by Dr Steven Chow

Addiction is often hailed as a product of nurture rather than nature. But new scientific studies have revitalised the debate to indicate that genes play a bigger role in the disease.

Addiction, a recurring compulsion by an individual to engage repeatedly in a specific activity despite its harmful consequences, has long been regarded by many as a social problem.

The moralist school consider addiction to be product of the environment that we grow up in e.g. abusive or absent parents, bad neighbourhoods or even cultural oppression resulting in the conditioned behavioural response to physically or mentally dependency on certain substances.

However, there is now conclusive evidence that have revealed that the oft-blamed nurture is not as clear-cut as it was long thought to be.

Molecular geneticists have now identified specific genetic component that points to why some individuals are more likely to be addicted to substances compared to others.

This debate of environmental factors over genetic factors has been revitalised once again with recent research that reveals a bigger role of genes in inducing a problem drug use, more so than environmental factors.

Research by the Yale School of Medicine, the University of Connecticut Health Centre, Boston’s McLean Hospital, the Medical University of South Carolina and Boston University in 2000, have confirmed that a person’s environment do play a significant role but more importantly that, there was a significant gene influence for drug abuse. The research was carried out across 393 small families with at least two family members with drug dependence.1

More recently, in 2007, studies conducted at Cardiff University Department of Psychological Medicine, Virginia Commonwealth University’s Department of Psychiatry and Human Genetics and the Oxfordshire Community Mental Healthcare Trust, showed that genetic influences played a bigger role towards a “progression to heavy substance use” and that, family or community experiences merely contributed to teenagers experimenting substance abuse.2

“These findings are significant, especially for the treatment community as it can lead to breakthroughs in the way medical treatment is delivered to address addiction,” said Dr Noor Zurani Md Haris Robson, Addiction Medicine Specialist and Senior Lecturer at University Malaya Medical Centre, Kuala Lumpur.

“It really shows that, addiction is not just a product of environmental factors alone but also a combination of historical and biological elements.”

It has now been shown that, a natural single nucleotide polymorphism can occur in the human gene that encodes the principal endocannabinoid-inactivating enzyme, fatty acid amide hydrolase (FAAH). In its homozygous form, it is strongly associated with both street drug use and problem drug/alcohol use.3 The long-termed therapeutic implication is that, treatment for addiction can be delivered using appropriate medications just like other chronic diseases.

Dr Noor Zurani went on to say that, in the case of many chronic illnesses e.g. Type II diabetes, certain cancers and cardiovascular disease, the genetic link suggests that, if one family member has the disease; other members are more predisposed to the condition compared to those in families who do not have the disease at all.

“Taking cardiovascular diseases as an example, we have learnt that the risks for the disease can be lowered by adhering to the health precautions as well as taking appropriate medications,” Dr Noor Zurani added.

“This is also the case for addiction, where individuals who are genetically predisposed to drug dependency should be cautious of trigger factors or seek medical treatment early if they have the problem.”

According to Dr Noor Zurani, chronic unrelenting stress is reported to be one of the main triggers for addiction and those more susceptible to this condition, should learn to manage it better through positive coping strategies.

Role Of The Medical Community

Adopting the approach that addiction is a disease; it also goes to say that, addiction can be addressed medically instead of incarceration approach that has been the mainstay measure in this country for more than three decades.

In Malaysia, the private medical community have made positive steps in this direction recently by adopting drug substitution therapy as its pivotal strategy, which has shown positive results in a short space of time.

Drug substitution therapy in Malaysia is administered through the recent public-funded methadone maintenance treatment program (MMT) or via the private-funded community based treatment program (CBT), mainly to address addiction to opiates such as heroin, opium and morphine.

What Is Community-Based Treatment?

“The CBT program is a service by the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) in close cooperation with the Ministry of Health Malaysia. It offers addicts patient-centred medical treatment in settings such as private clinics, specialist centres or at home” said Dr Steven Chow, founding Chairman of the “DrsWhoCare” of the FPMPAM, the medical NGO that was responsible for developing and promoting community-based treatment.

The key element of the drug substitution therapy is a structured treatment program that replaces the addiction to illegal opiates with an approved medications such as methadone, buprenorphine mono therapy or buprenorphine/naloxone combination therapy which is prescribed under strict protocols and guidelines.

By undergoing treatment with these medications, patients can avoid the vice-like grip on their psyche caused by addiction and many can resume quality and productive life again.

Built on a specially-trained network of doctors, Malaysia’s CBT treatment has achieved success in four critical areas namely, increased training of treatment providers in primary care, better access to addiction treatment, increased capacity of treatment services and an improved rate of patients who have stopped using heroin, morphine or opium in a short space of four years.

Some Early Statistics

“According to Ministry of Health Malaysia and statistics by the National Drug Substitution Therapy (NDST) register (the electronic system that monitors the program), the 1 year treatment retention rate of patients who received treatment from the methadone program and CBT was 75 per cent, which is above the WHO benchmark of 55 to 60 per cent” said Dr Steven Chow.

“Feedback and available statistics also indicate that the program has been well accepted by patients, doctors and the community where the number of patients seeking addiction treatment more than doubled from 6,184 in March to 13,174 in August in the year 2007. However, it is indeed prudent to be cautious in making any early claims as treatment of addiction is a long-drawn process. Time and political will will see if the initial treatment rates can indeed be sustained and relapse rates must remain within acceptable levels. The time is now appropriate for a National Policy for Addiction Substitution Therapy which will legally allow addicts to be treated as patients by the medical community and help minimise the stigma of this debilitating disease” said Dr Steven Chow.

Dr Noor Zurani added that, this treatment offered by private doctors is a relatively new field in Malaysia called addiction medicine and encompasses the fields of public health, psychiatry and primary care medicine.

“It also involves the process of detoxification, rehabilitation, individual and group therapies, halfway houses, treatment of withdrawal-related symptoms, acute intervention, and long-term maintenance therapies.”

“All this, is aimed to lessen the chance of a relapse and prevent return to using heroin or other opiate addictions.”

To strengthen knowledge on these areas and improve the results of addiction medicine, Dr Noor Zurani said that, more research must be conducted on genetics of the disease.

“Further development in this area can help detect individuals that are prone to become addicted to substances and save a lot of lives from becoming enslaved to drugs.”


  1. The American Journal of Human Genetics: (Published online March 16, 2006. DOI 10.1086/503631
  2. Journal of Addiction. 102(6):894-903, June 2007
  3. Jack C. Sipe,et. Al.; Proc Natl Acad Sci U S A. 2002 June 11; 99(12): 8394–8399. doi:10.1073/pnas.082235799.

About The ICAM

This article is courtesy of the 1st International Conference of Addiction Medicine 2007 which was organised in conjunction with 4th National Conference on Addiction Medicine by the Federation Of Private Medical Practitioners’ Associations, Malaysia and Addiction Medicine Association, Malaysia.


AMM & MoH National Ethics Seminar 2008
"The Ethical and Professional Doctor: The Role of Medical Education"

Date: 6th December 2008 (Saturday)
Venue: Auditorium, Institute of Health Management, Bangsar, Kuala Lumpur
Theme: “The Ethical and Professional Doctor: The Role of Medical Education”


Time Details Speaker/Panelist To Be Invited
1330-1400 Registration  
1400-1440 Opening of Seminar and Keynote Address
“The Ethical and Professional Doctor: The Role of Medical Education”
Tan Sri Datuk Dr Mohd Ismail Merican,
Director-General of Health Malaysia
1440-1500 Can Medical Students Appreciate Ethics? Prof Christina Tan (UM)
1500-1520 Are Ethical Issues Escalating? - The Malaysian Medical Council's Perspective Dato’ Dr Abdul Hamid Abdul Kadir
1520-1540 Ethics as Part of Continuing Professional Development (To be confirmed)
1540-1600 The Public Perception of a Doctor (To be confirmed)
1600-1700 Panel Discussion
“The Ethical and Professional Doctor: The Role of Medical Education”
Moderator: Tan Sri Datuk Dr Mohd Ismail Merican, Chairman, Malaysian Medical Council
1. Prof Dato Sharifah Hapsah (VC, UKM)
2. Prof Victor Lim (IMU)
3. Dato' Dr Abdul Hamid Abdul Kadir (MMC)
4. Dr David Quek
5. Prof Zabidi Azahar Hussin
6. Prof Looi Lai Meng (UM)
1700-1730 High Tea  


Category Before 1st November 2008 After 1st November 2008
Doctors RM 75.00 RM 100.00
Medical Students RM 50.00 RM 75.00

For enquiries, please contact


National Ethics Seminar 2008

19 Jalan Folly Barat, 50480 Kuala Lumpur, Malaysia
Tel: (603) 2093 0100, 2093 0200 Fax: (603) 2093 0900
Email: secretariat@acadmed.my

Calendar of Events


31st July – 3rd August 2008
Thursday – Sunday
Shangri-La Hotel
Kuala Lumpur
Academy of Medicine
of Malaysia
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: secretariat@acadmed.my
URL: http://www.acadmed.org.my
31st July – 3rd August 2008
Thursday – Sunday
Melaka, Malaysia Malaysian Paediatric
3rd Floor (Annexe Block)
National Cancer Society Building
66 Jalan Raja Muda Abdul Aziz
50300 Kuala Lumpur
Tel: +603 2691 5379
Fax: +603 2691 3446
Email: mpaeds@po.jaring.my
URL: http://www.mpaeds.org.my
15th – 16th August 2008
Friday – Saturday
Hyatt Regency Hotel
Resort & Spa
Pahang, Malaysia
Malaysian Society of
Colorectal Surgeons
Email: ecss3_iium@yahoo.com
URL: http://www.colorectalmy.org
15th – 17th August 2008
Friday – Sunday
PJ Hilton Hotel
Petaling Jaya
Selangor, Malaysia
Malaysian Society of
Rheumatology &
Singapore Society of
Email: msr-ssr2008@pfizer.com
21st – 24th August 2008
Thursday – Sunday
Shangri-La Hotel
Kuala Lumpur
Malaysian Society of
Gastroenterology &
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: secretariat@acadmed.my
URL: http://www.msgh.org.my
22nd – 25th October 2008
Wednesday – Saturday
The Magellan Sutera
Harbour Resort
Kota Kinabalu
Sabah, Malaysia
Malaysian Orthopaedic
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: apas2008@apas-home.org
URL: http://www.apas-home.org
31st October –
1st November 2008

Friday – Saturday
Renaissance Kota
Bharu Hotel
Kota Bharu
Kelantan, Malaysia
Malaysian Association
for Thoracic and
Cardiovascular Surgery
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: secretariat@acadmed.my
URL: http://www.acadmed.org.my
5th – 7th March 2009
Thursday – Saturday
(To be confirmed) Malaysian Society of
Colorectal Surgeons
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: secretariat@acadmed.my
27th – 29th March 2009
Friday – Sunday
Impiana Casuarina
Hotel, Ipoh
Perak, Malaysia
Perak Medical
Practitioners' Society
Email: pmps@tm.net.my
14th – 16th May 2009
Thursday – Saturday
Shangri-La Hotel,
Kuala Lumpur
Malaysian Society of
Otorhinolaryngologists -
Head & Neck Surgeons
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: secretariat@acadmed.my
URL: http://www.acadmed.org.my
21st – 23rd May 2009
Thursday – Saturday
Sutera Harbour Resort
Kota Kinabalu
Sabah, Malaysia
Malaysian Orthopaedic
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: secretariat@acadmed.my
URL: http://www.wenmiss.com
29th – 31st May 2009
Friday – Sunday
Awana Porto Malai
Pulau Langkawi
Kedah, Malaysia
College of Surgeons,
19 Jalan Folly Barat
50480 Kuala Lumpur
Tel: +603 2093 0100, 2093 0200
Fax: +603 2093 0900
Email: secretariat@acadmed.my
URL: http://www.acadmed.org.my



Hong Kong Academy of Medicine 15th Anniversary Congress

Please feel free to contact the Congress Secretariat for further details.

HKAM15 Congress Secretariat
Hong Kong Academy of Medicine
10/F, HKAM Jockey Club Building, 99 Wong Chuk Hang Road, Aberdeen, HONG KONG.
Tel: (852) 2871 8896 / 2871 8815
Fax: (852) 2871 8898
Email: hkam15@hkam.org.hk
Website: www.hkam.org.hk/hkam15