24 Dec 2007

Berita Akademi - Dec 2007

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Message from the Master
Professor Dato’ Dr Khalid Abdul Kadir

The Academy Of Medicine Of Malaysia As We Approach 2008

As we leave 2007 behind and enter 2008, it is appropriate for us to reflect and ponder on our progress, successes and failures as we plan for the new year. The year 2007 has been a special year for the Academy. The Registrar of Societies approved our amendment to the constitution to admit as ordinary members, specialists who have accredited post-graduate training, good standing and are recommended by two other members or Fellows, without having to fulfill the old additional criteria of having published papers in refereed journals. Thus associate members who previously did not qualify for full membership are now conve r ted to full members. It also means that we can now admit within our folds all the other specialists who previously were not qualified because of the deleted clause. We should now encourage all our colleagues, young and old, to become members of the various Colleges in the Academy, or should there be no Colleges , be direct member s of the Academy. By so doing, we will be able to represent most if not all of the specialists in the country and thus be a stronger association in the country. I urge all of you to please encourage your friends and your juniors to join the Academy.

In 2007, we were also able to see rapid progress in the construction of the Academy Building. If all goes to plan, the Building will be ready latest by May of this year. However building costs have increased tremendously and the Academy will need to raise at leas t another RM 2 million by May. We will be organizing a Fund Raising Dinner on 5t h April 2008 and will need the support of every member to raise the funds. If every member were to donate RM 1000, we will be able to achieve the target. Please give generously so that we will have a permanent "home" and a Center for post-graduate and continuing professional development.

The Ministry of Health has been a strong supporter of the Academy, and has entrusted us with the National Specialist Register. It is very reassuring to see many members applying to be in the NSR, and even more assuring to note that members of the fraternity have been contributing their time and efforts to vet through the hundreds of applications to the NSR. We had teething problems, as expected, and a number of applicants may not have been satisfied with the "slow" progress. Please understand that the vetting process of the hundreds of applications by the volunteer members of the various specialist subcommittees will take time. We have been able to now catch up with the back-log and most of the applications will have been vetted in the next few months. We must thank the members of the various specialist subcommittees for their untiring efforts. We need to be ready for the amendment to the Medical Act which will make it compulsory for all specialists to be registered with the National Specialist Register.

With the Specialist Registration comes the requirement that we keep ourselves updated professionally... the need for Continuing Profess ional Development or CPD. Recently the Ministry of Health has spearheaded the implementation of CPD within its Ministry, with the consent of the JPA to recognize the CPD points for the doctors’ yearly assessments. This is indeed a giant step forward and we should congratulate the team led by Puan Sri Dr Suraiya H Hussein which was able to achieve this. In the Minisry, the CPD will be implemented from 2008 onwards. It remains incumbent on the rest of the profession to follow suit. The Academy had organized a Briefing Session with the team led by Puan Sri Suraiya recently. The specialist bodies need to now work fast and decide on their CPD needs and the amount and types of "core" CPD activities so that we can soon implement CPD for every member of the Academy and every Specialist. We need to ensure we are professionally competent and also maintain that competency, as well as develop ourselves professionally to remain within the Specialist Register.

Talking about professionalism and standards of being registered as a specialist, an issue may arise about the role of the Specialis t Subcommittees vis-a-vis the Ministry of Education’s Higher Education Joint Committee and the recognition of new specialties . Some members are concerned about the standards of the various new specialist training programs started in the public Unive rsities, the type of training and trainers etc. The issue is that these new specialties are awarded an academic degree with a Master of a specialty. The Master degree is under the jurisdiction of the University and the Ministry of Higher Education, usually then being automatically recognized by the JPA and Ministry of Health. These courses are started because of the national need of the Ministry e.g. in Blood Banking etc. The concern of the profession is perhaps akin to the concern faced by the Universities when the Master of Medicine or Surge ry or Ophthalmology, etc, was started by the Universities years ago. Perhaps with the standard setting by the MQA of the Ministry of Education, these concerns of standards can be addressed and assessed. The professional bodies may and should help to ensure that these standards are adhered to. We all need to contribute to the national needs. At the same time, the Academy still feels that the subcommittees should vet these qualifications the same way as it has vetted the other specialties and specialists to ensure standards of specialist care is upheld.

The Malaysian Medical Council is the custodian of the standard of medical practice in general, and with the new Medical Act coming soon, it will be responsible also for the standard of specialist care. The Academy has been entrusted to run and maintain the National Specialist Register on behalf of the Minstry and later the Malaysian Medical Council. It is therefore important that the specialist subcommittees find a way to ensure that these new training programs meet with the criteria of training needed as a specialist, and work with the awarding bodies to find an amicable solution.

In 2007, we received news that our institutes of higher education had not performed so well compared to institutions of higher education in other countries including those in our neighboring countries. It is of concern to all of us, including the Academy, as most of our specialists are being trained locally in local universities. Academic standards are closely linked with professional standards. Perhaps, looking at it objectively, the main concern about so-called declining standards is the deficiency of international class research resulting in publications in high standard journals with good citation index, etc. I am assured that the Universities are taking stock of this deficiency and are emphasizing the need to have active high standards of research and publications. In medical schools, the emphasis in active research need to be further enhanced. Having been in Academia for more than a quarter century, I can reiterate the need for support for research in our medical schools. Perhaps one trend that is discerning is the increase in pharmaceutical drug trials at the expense of actual research in basic and clinical medicine. Our masters programs have research as an important element of post-graduate training, but unfortunately even with this exposure, many of the young specialists and young upcoming academicians are not able to do productive and meaningful research resulting in publications in international journals. The Universities, the Ministry of Health and the Ministry of Science have all provided funds and facilities for research, but the output is not encouraging. Perhaps the old excuse of too much service load, too much teaching load with undergraduates and post-graduates is still valid. Perhaps the needs of private practice and extra income from private practice is taking a precedence over research, but then not all academics are engaged in private practice...

Whatever it is, the reputation of medical schools and research institutions reflect on the standards of medical care including specialist care in this country. We should now find ways and means of supporting those few specialists and academics who are dedicating their lives to research. Not everyone is good in or is interested in research. Those who do effective research should be duly rewarded in lieu of less income from private practice, etc. We hope in 2008, those institutions identified as research unive rsities will be able to turn the standard of research around and in the same instance enhance the credibility of medical and specialist practice in this country.

Have a Happy New Year and to our Chinese friends, Gong Xi Fa Cai.





The Master and Council Members of the Academy of Medicine of Malaysia would like to extend their deepest condolences to the families of the following members who passed away recently:

  • Dato’ Dr S C E Abraham
  • Dato’ Dr Lim Nyok Ling
  • Datuk Dr Nik Zainal Abidin




"Is Medical Ethics and Professionalism at the Crossroads?"
Keynote Address by Tan Sri Datuk Dr Mohd Ismail Merican
Director-General of Health Malaysia
presented at the National Ethics Seminar on 1st December 2007

Firstly, I would like to thank the Organizing Committee for inviting me yet again, to participate in the National Ethics Seminar 2007, organised jointly by the Academy of Medicine and the Ministry of Health, Malaysia. This event has evolved into an annual event that is keenly anticipated by the profession. I must congratulate the organising committee for the efforts in bringing this seminar to fruition.

There are those amongst us who regard such seminars as only attracting the converted as an audience. Doctors to whom some of the issues should be addressed may not find it palatable to attend such conferences and seminars. While I view this with concern, the rest of us must continue to deliberate on issues pertaining to ethics and the profession and we hope that those who stay away will soon find it to their benefit to also play a role in evolving the opinion of the profession towards some of the topical issues that will be discussed. We must be reminded that all registered medical practitioners must abide by guidelines of the regulatory bodies such as the Malaysian Medical Counci l when these are released.

The Malaysian Medical Council has issued a set of nine guidelines on various professional issues of concern. The profession must be seen by the public to move rapidly to regulate itself when issues that worry the public emerge i.e issues that may suggest that the profession is deviating from the high standards it has set for itself. The theme of the conference "Commercialisation and Professionals" is apt as the question has often been asked as to whether Medicine and Commerce are compatible with each other. While one has the aim of curing sometimes but comforting always, the other has other considerations. Let me attempt to answer some of the questions by looking at some areas of concerns that are emerging and how the profession should respond.

New and innovative therapies

A recent newspaper article in the New Sunday Times informed us that an organisation is shifting its biotechnology manufacturing plant from Slovakia to Malaysia. The cost incurred would be RM 280 million over three years. The article also informed us that 100 cases involving stem cells have been treated in Malaysia at a cost each of RM 26,000 onwards. It was claimed that the therapy could cure diabetes, hormone deficiency disorders, early menopause, male and female infertility, immune deficiency disorders such as AIDS, cancer and autoimmune diseases, aging diseases including menopause, impotence and depression, cirrhosis of the liver and chronic hepatitis as well as regeneration of damaged cells and tissues.

This company would be sourcing the stem cells from rabbit fetuses which would be inbred with claimed mi nimal exposure to vectors of infectious disease. Recently, there are even more outrageous claims of cure using stem cell therapy. What should be the response of our profession to such news items? The MOH’s response is clear. Those who have advertised their services will have to explain to the MAB. Those who have introduced new services they have not declared to us will be deemed to have flouted the PHCFS Act. The MMC will seek clarification on the practice of non-evidence based therapies practice outside the context of clinical trials.

But, what about the response from our profession? We appreciate that Medi cine is continuously evolving. It is the characteristic of medical practice that current knowledge is often outdated by the end of a practitioner’s professional lifetime. Hence, the need to conduct proper research. The aim of medical research is to produce new knowledge. Research is an attempt to drive new knowledge by addressing clearly defined questions using systematic and rigorous methods.

There are in existence well defined research guidelines that govern the conduct of clinical research. The experience of unethical research has resulted in stringent guidelines for human research. The MOH has made it mandatory for all its clinicians intending to conduct research to have approved GCP training so that they fully understand the importance of di s cipline and accountability when conducting clinical trials and that the safety of human subjects and data integrity are paramount. Human subjects must know their rights and be fully informed of all issues pertaining to research and all the relevant information about the product or procedure in question. Consent forms used in research make this clear to the research participants. When innovative or emerging therapies are translated into clinical practice, such advice on risks and benefits may not be given to patients.

Innovation is a standard feature of care. It is generally unacceptable for new remedies or techniques to be applied without ethical overview or independent assessment. In 2001, the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984-1995 (the Bristol Report) stated that in any case of a new, untried invasive clinical procedure, permission should be sought from the local research ethics committee thereby indicating that innovative treatments should be treated as a form of research, especially when they involve an unknown or increased risk for the patient. Patients must be informed of why the proposed treatment differs from the usual measures and have an opportunity to consider the risks involved. Patients are also entitled to know the experience of the physician or surgeon involved in any procedure.

It is not acceptable to recall patients for what is assumed to be health monitoring for their own benefit when the actual intention was to carry out research. The classic case quoted to illustrate this principle is Moore v Regents of the University of California 1990. Mr Moore was under the impression that blood taking was solely for the purpose of monitoring his health after his treatment for hairy cell leukaemia. Unknown to him, a cell line had been developed from his extracted cells which was commercially very valuable to the researchers.

Patients involved in innovative therapies need to know:

  • Why the therapy is proposed in their case
  • The evidence to support its use and the areas of uncertainty about it
  • Whether it has had any form of ethical review
  • The clinician’s experience with it
  • The alternatives, if any
  • How it differs from standard treatment
  • The likely risks and benefits for themselves
  • The measures for safety monitoring and support if things go wrong
  • The likely future use of the therapy, if successful

Is this the norm or the exception in Malaysia?

Public confidence in the profession can be eroded if innovative therapy is perceived to be carried out in a clandestine manner.

Informed consent is at the very heart of research and innovative treatment. The patients need to have access to detailed information. There should be no pressure or undue additional risks involved to any patient involved in innovative treatment. The level of financial incentives involved should be monitored. The patients should be able to withdraw without prejudice to future treatment.

Malaysia has attracted a lot of investors and businessmen to enhance or purportedly to jumpstart our biotechnology industry. While I have no problems with that, I want to caution our Malaysian counterparts to be critical of all proposals put forward. Lest they be taken for a ride. I always tell the relevant authorities or agencies that the best way to deal with the situation is to refer such proposals to the MOH as we are the largest healthcare provider and the main regulatory authority dealing with matters pertaining to health and healthcare. We know how to differentiate between glass and diamond and between a gem and a fraud. Even some of our own doctors are indulging in the practice of so-called new and innovative therapies that are not backed by sound scientific evidence.

Let us briefly consider the whole area of stem cell therapy. No doubt stem cells are fascinating stuff since they have the ability to differentiate into various specialized tissues. There are two types, the embryonic stem cell and the adult stem cell present in umbilical cord blood, blood/marrow or amniotic fluid. While the embryonic stem cell is pluripotent, the adult stem cells are multipotent. We must appreciate that to date, no formal trials using ESC have been conducted mainly because of safety issues related to fear of tumor formation. The MOH does not allow ESC research at present. Embryos are divine creations. This is in line with our national philosophy, the Rukun Negara. This is a theistic view in line with our multi-religious society. Embryos are not ours to neither destroy nor create.

Adult stem cells, being multipotent rather than pluripotent, have only the potential to become certain cell types. Harvesting adult stem cells does not involve the destruction of embryos. Tissues grown from adult stem cells will also be immunologically compatible with an individual. Potentially a tissue bank can be created for various stem cells and therapeutic cloning is widely accepted in many countries. There are no emotional issues as with embryonic stem cells.

I hold the view that adult stem cell research can be allowed using a strict research protocol and GCP guidelines. Fully informed consent should be obtained. The patient must be informed in no uncertain terms that the research may not benefit him.

Doctors should not be too anxious to recommend new and innovative therapies until such evidence appears in peerreviewed scientific journals. Otherwise research protocols and guidelines should apply. I am not sure whether our doctors practicing stem cell therapy, other than haematopoietic stem cell transplant or bone marrow transplant, are doing so in the setting of a clinical trials to enable their practice or results to be closely monitored. Hardly any one of them, as far as I can recall, have written in to the MOH to get clearance before undertaking such therapies. So the responsibility is all theirs and the institution they work in. Patients need to know whether such therapies are endorsed by MOH or otherwise before agreeing to such therapies. There are claims that stem cell therapy can cure spinal injury, Parkinson’s disease, Alzheimer’s disease and diabetes. To me these claims must be backed by sound scientific evidence and reliable and peer-reviewed data. If there are none, such therapies must be done in the context of a properly-conducted clinical trial, with prior approval of a credible ethics committee. Otherwise, I will maintain that such claims remain baseless claims and should things go wrong, we will know what to do. Recent example of a patient with breast cancer subjected to vitamin therapy and who subsequently died, much to the frustration and anguish of concerned parents.

Doctors should be cautious and make a considered professional decision and not a commercial one about using innovative and experimental therapies.

The implicit agreement between medi cine and society entailing reciprocal rights and obligations has been called a social contract. In return for a physician’s commitment to altruistic service, a guarantee of professional competence, the demonstration of morality and integrity in their activities and their agreement to address issues of social concern, society grants to both individual doctors and their profession considerable autonomy in practice, status in the community, financial rewards and the privilege of self regulation.

Having been granted this power, the profession established the means of setting and maintaining standards of education and training, entry into practice and the practice itself. Integral to effective self regulation is the responsibility and obligation to ensure that these standards are met and to discipline unethical, immoral or incompetent practices. These powers have been ascribed to the Malaysian Medical Council.

Recently there has been a perception that the profession has abused its privileged status and public trust, and that its regulatory procedures were seriously flawed. Standards were considered to be weak, variable and inconsistently applied. Physicians were accused of protecting their own kind. The profession was criticized for its lack of openness and transparency in regulatory procedures and for their absence of public involvement in them. But the MMC is doing all it can, within the constraints of the present Medical Act 1971. The revised Medical Act will address some of the perceived weaknesses of the present Act.

The majority of our doctors abide to the code of professional conduct. Some gets too adventurous and indulge in professional misconduct. If they are found guilty, we have to expose them so that others will not do the same. At the same time, we take cognizant of the fact that the public is now very knowledgeable and demanding and expects a lot from the profession. We have to be aware of these at all times in our dealings with the public. A seemingly friendly patient whom we have known over the years may turn out to be our greatest critique who may report you to the MMC, simply because you do not accord him or her enough time.

The members of the self governing profession have a pride in their profession that acts in the public interest, in that standards are set high and lapses in the conduct or performance are not taken lightly. Public members of regulatory authorities in other countries are known to comment that medical members are harsher in their judgment of physicians than they are. The doctor answers to a higher standard than that of the market place namely the authoritative judgment of fellow physicians.

Modern medi cine is extremely complex. A non-medical person would have greater difficulty in developing the appropriate expertise and knowledge to operate efficiently and effectively.

Rapid changes in practice brought on by advances in medical science may render the knowledge and skills we acquire and practise as a young medical doctor, obsolete and irrelevant. Throughout the developed world, countries have moved or are moving towards instituting some form of recertification. Nevertheless, public demands for assured competence are both present and growing, virtually guaranteeing a future for the processes of relicensure and recertification. The MMC will introduce measures for recertification of doctors and specialists in the near future and this will include CPD activities. It is better for us to be the ones introducing this rather than be compelled to do so by the public in keeping with practices around the world.

Conflict is inherent in a profession in which individuals are expected to be altruistic while as human beings, still pursue their own interests. As long as the profession remains in high esteem outside observers presume that altruism would prevail and that the patient’s needs would come first. Negative events have overtaken those relatively simple days and the situation medicine now faces are different. Trust must be continuously earned from a skeptical public who are very aware of the opportunities for its abuse in a highly competitive market orientated health care system that encourages and rewards entrepreneurial behaviour. Doctors are exposed to a plethora of potential and real conflicts.

Not all these conflicts originate from outside the profession. Self referral to doctor-owned laboratories, surgery centres or pharmacies and getting non-medical personnel to screen patients in a centre and sending those found positive, whatever that means, to selected specialists and centres, can cause a conflict of interest and thus far the profession’s attempts to regulate conflicts have met with only limited success.

The very high profile problem of unethical or incompetent doctors can tarnish the reputation of the entire medical profession. This small number of doctors will need to be dealt with. While the methods must be consistent with the principles of due process and natural justice, the main objective must be to protect the public. While there certainly have been attempts to improve di s ciplinary procedures, both the Institutes of Medicine Reports from the United States have not satiated the public concern as to whether the profession is meeting its obligation to adhere to the highest standards.

The concept of self-regulation is strongest in the medical profession. Self-regulation implies a voluntary and internal regulatory mechanism within the profession, irrespective of whether such controls are demanded by law or others outside the profession. Self-regulatory mechanisms must have sufficient transparency before they can gain credibility in the public eye.

The medical profession cannot escape being inextricably linked with the pharmaceutical industry. A large number of patientdoctor encounters are completed with the prescription of a drug.

There is therefore competition between pharmaceutical firms to get doctors to prescribe their drugs as compared to that of their competitors. A general ethical principle is that a doctor should not associate himself with commerce in such a way as to let it influence or appear to influence his attitude towards the treatment of his patients. It is improper for an individual practitioner to accept from a pharmaceutical firm monetary gifts or loans or expensive items of equipment for his personal use.

The pharmaceutical sector is highly profitable and companies depend on expanding product sales in order to maintain their competitive edge. The proportion of total sales revenues allocated to marketing has been rising continually. A 1997 article by Devlin and Hemsley in Scrip Magazine estimated that pharmaceutical companies spend approximately 35% of sales revenues on marketing, around double the proportion spent on research and development. An argument often heard is that drug companies need to recoup their expenditure spent on R&D. We now know that is not true. The patient pays more because of the expenditure of pharmaceutical industry on marketing their drugs to doctors.

WHO defines drug promotion as: "all information and persuasive activities by manufacturers and distributors, the effect which is to induce the prescription, supply, purchase and/or use of medical drugs." By definition the aim of promotion is to stimulate product sales.

Ultimately it is the public who will be faced with the predicament due to unscrupulous advertising. Dr H Mahler the then director general of WHO in 1986 said that much of the polemic surrounding the use of drugs have arisen around the ethical principle of telling the truth, the whole truth and nothing but the truth and all too often, unethical principle of not doing that. The US Consumer Report found that one third of direct to consumer advertisements contained factual inaccuracies or assertions that were not scientifically supported and nearly 40% were considered more harmful than helpful by at least one reviewer of the expert panel.

Physicians may invest in the pharmaceutical industry. Already, a growing number of doctors have become shareholders in the health care facilities and hospitals in which they practice or of enterprises to which they refer their patients. Surgeons invest in ambulatory surgery facilities that are owned and managed by businesses or hospitals, and which they perform surgery on their patients. Thus they are not only paid for their professional services but they also share in the profits resulting from the referrals of their patients to a particular facility. Malaysian law neither prohibits such conduct nor even requires a declaration by the doctor to the patient of the doctor’s potential conflict of interest. Ethical standards dictate that a practitioner has a duty to declare an interest before participating in a discussion which could lead to the purchase by a public authority of goods or services in which he, or a member of his immediate family, has a direct or indirect pecuniary interest. Non-disclosure of such information may under certain circumstances, amount to infamous conduct in a professional respect. Where the practitioner has a financial interest in any facility or service to which he refers patients for diagnostic tests, for procedures or for inpatient care, it is ethically necessary for him to disclose his interest in the institution to the patient.

Medical practitioners have begun making deals with wholesalers of prescription drugs and selling those drugs to their patients at a profit, or buying prosthesis from manufacturers at reduced rates and selling them at a profit in addition to the fees they receive for implanting the prosthesis.

Doctors, including academic clini cians, are frequently hired by drug firms to give lectures or write articles about the manufacturer’s new products and many doctor’s clinics have posters promoting particular brands of products.

Drug manufacturers offer inducements to practicing physicians to attend seminars at which their products are promoted, and even to institute treatment with a particular drug.

The salaries of sales representatives remain the largest single marketing expenditure of pharmaceutical companies. Sales and marketing expenditure for a typical brand based company represents an estimated 35% of sales, roughly 20% in sales force and advertising promotion and other expenses. It would be interesting to find out what sort of information sales representatives supply to doctors.

Lexchin reviewed English language studies carried out between 1966 and 1996. There were only four studies from France, Finland, US and Australia that looked at this area. The results were consistent over time and in all four countries. Sales representatives almost always stated the indications, and the drug’s brand and generic names, but usually failed to include safety information such as side effects and contraindications and many statements contained inaccuracies. These studies are limited but are supported by research from Belgium, the UK and the US, which has shown a consistent association between doctor’s reliance on the information provided by detailers and inappropriate prescribing.

At a teaching hospital in Beirut, drug representatives are not allowed to visit doctors in their clinics. A table has been set away from the clinics where reps can meet doctors during their free time. A poster at the clinics’ entrance prominently displays the rules governing interactions between reps and doctors.

In the Netherlands, a community-based hospital decided to ban all visits by sales representatives. Instead, they invite sales reps to present new drugs and the results of trials at once monthly meetings of the entire staff. Often a company’s medical adviser, rather than a rep, will make the presentation and the quality of the information provided has greatly improved.

Health care providers, patients and payers need independent comparative information on pros and cons of all available treatment options in order to ensure that both potential health and monetary costs do not outweigh potential benefits and to able to choose the least costly among equivalent alternatives. Public financing of the development, regular updating and wide dissemination of treatment guidelines could provide this.

In conclusion, L & G,

Health care is and should remain a public responsibility. We, as doctors, should continue to develop standards and guidelines for the profession and even, sometimes, for society.

We also value the autonomy of our profession in controlling major aspects of their work and we do not wish to be dictated by a third party. But to play this game, we must also be fair and not steer away from our professional responsibilities for monetary gains. Eg the story of anaesthetist charging RM 200 / visit in the ICU.

We also must be obsessed with enhancing our competence to ensure excellence in medical practice and professional activities.

Hard work and long hours as well as life long education are still characteristics of the profession although perhaps not as highly valued as previously.

Whatever the circumstances and whichever role we may play in our dealings with ourselves, our families, our friends, colleagues, the commu nity and society at large, we must not allow ethics to take a back seat, especially as we are doctors. Those in the profession must use their scientific reasoning, which is inherent in their training as a doctor to distinguish between the truth and sales gimmicks of the industry.

Medical ethics and professionalism are at the cross roads. Not too long ago, a senior lecturer in the UK was credited with implanting an ectopic pregnancy via the cervix into the uterus and carrying the pregnancy to term. The co-author of the paper was the then President of the Royal College of O&G who was also the then editor of the British Journal of O&G. The same journal published another article by the senior lecturer of a three year double blind study on miscarriage using either human chorionic gonadotrophin or placebo. Both reports were subsequently found to be fraudulent with fictitious patients.

Other examples include doctors who sell drugs inappropriately for rehabilitation of drug addicts at a profit and doctors who tout for patients akin to the soliciting carried out by the world’s oldest profession.

Are we then in a crisis I think not... I mean not yet. I believe the profession will prevail because the majority of us are trained to behave ethically. It is the grounding in ethics that will carry us forward past the cross-roads on to the road ahead where we look forward to seeing well trained doctors behaving professionally and ethically while the medical profession is still held in high esteem by the public. We owe this to ourselves, our profession, our patients and the society at large.

I end my speech with a quote

"Professionalism is not an inherent right but is granted by society and as long as society considers them trustworthy, it will be maintained".




1st National Paediatric Research Conference
organized by the College of Paediatrics, Academy of Medicine of Malaysia
University Malaya Medical Centre, Kuala Lumpur
11th August 2007

Panel of experts answering questions from the audience.



The 4th Congress of Asian Society for Paediatric Research




Journal of Neonatal-Perinatal Medicine
Editor-in-Chief: Hany Aly, MD, FAAP

The New
Journal Of Neonatal-Perinatal Medicine 2008


We are delighted to announce the launch of a new journal, the Journal of Neonatal-Perinatal Medicine beginning in 2008. This journal will be published in both print and online forms.

  • The mission of the Journal of Neonatal-Perinatal Medicine is to strengthen research and education of the neonatal community on the optimal physical, mental, social health, and well-being of infants through highest quality publications on neonatal-perinatal medicine and to provide examples of best practices in order to improve the quality, safety and effectiveness of infant’s healthcare worldwide.
  • This journal will also accommodate research and experiences in the field of global health relating to neonatal-perinatal medicine. Examples of acceptable articles for the journal are:
    • Clinical trials on infants at neonatal age
    • Basic science research related to neonates
    • Meta-analyses on best practices and outcomes
    • Neuro-developmental and long-term outcomes of at-risk infants
    • International practice improvements
    • Evidence on current practices in neonatal care
    • Practice Statements that include new recommendations for best practices
    • Review articles related to and impacting current practices in neonatal care
    • Case reports will also be accepted if they are novel and significant to current care
  • We know it is critical to get your work published in a timely manner. Therefore, we plan to respond with a preliminary decision within 72 hours. In addition, our journal offers a simplified submission process by emailing articles to jnpm@gwu.edu.

Please display the attached flyer for the Journal of Neonatal-Perinatal Medicine in your department and encourage colleagues to submit research papers to jnpm@gwu.edu. For more information, you can also visit www.iospress.nl.

Hany Z Aly, MD, FAAP
The George Washington University Hospital

Continuing Professional Development

Datin Dr Rusnah Hussin giving her input.

Datuk Dr Abdul Hamid stressing a point.

The Council of the Academy of Medicine of Malaysia organised a briefing on Continuing Professional Development Points on 15th December 2007 at the Pantai Medical Centre, Bangsar, Kuala Lumpur. The briefing was attended by Academy Councillors and Councillors / Representatives of the Colleges.

The Briefing started off with an address by Prof Dato’ Khalid Kadir, Master of the Academy, and this was followed by an introduction of CPD Credit Points by Puan Sri Datin Dr Suraiya H Hussein. Puan Sri stressed that what was presented was the outcome of a series of discussions and a workshops organized by the Ministry and involving representatives from MOH and the Academy and Colleges. The presentation was followed by an active discussion. A major point that was raised was the balance between core and non core subjects and what constitute a core subject. The Colleges have been requested to put up proposals and to actively involve the professional specialist societies in this matter.

Puan Sri Datin Dr Suraiya H Hussein briefed
on the CPD Credit Points of MOH.

Participants at the Workshop.



4th Academy of Medicine Tun Dr Mahathir Merit Award (2008)

Fellows and Members of the Academy of Medicine of Malaysia are invited to submit nominations for the above award.

The Criterion

The award shall be given to an Academy member as an honor and acknowledgement of his / her contribution to the advancement of the objectives of the Academy.

Nomination And Selection Process

The potential recipient shall be nominated by any member of the Academy. The final decision of the choice of the recipient will be made by the Council of the Academy.

The proposer should submit a written background of the nominee to support his/her proposal.

The Award

It will consist of a certificate and a crystal vase with the name of the award and recipient engraved on it.

Please submit the nominations to the Academy Secretariat by 30 April 2008.



Calendar of Event




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