Happy Valentine's Day

Picture credit: http://www.toilette-humor.com

Don't get the joke? Click HERE, but be forewarned, it is rated PG!

Heart Disease May Be a Risk Factor for Prostate Cancer

Picture credit: http://timesofindia.indiatimes.com

In a large analysis of men participating in a prostate drug trial, researchers at the Duke Cancer Institute found a significant correlation between coronary artery disease and prostate cancer, suggesting the two conditions may have shared causes.

If confirmed that heart disease is a risk factor for prostate cancer, the malignancy might be combated in part by lifestyle changes such as weight loss, exercise and a healthy diet, which are known to prevent heart disease.

"What's good for the heart may be good for the prostate," said Jean-Alfred Thomas II, MD, a post-doctoral fellow in the Division of Urology at Duke and lead author of the study, which appears online this month in the journal Cancer Epidemiology, Biomarkers & Prevention.

Coronary artery disease kills more adults in the United States than any other cause, accounting for one in four deaths. Risk factors include inactivity, obesity, high blood pressure and cholesterol, cigarette smoking, and diabetes.

Similarly, prostate cancer is a common killer. It's the second-most lethal cancer for U.S. men, behind lung cancer, with about 240,000 new cases diagnosed a year, and 34,000 deaths. Previous studies exploring the relationship between coronary artery disease and prostate cancer risk have found conflicting results, making it difficult to determine whether the malignancy is fueled by poor lifestyle choices.

In the current study, the Duke team used data from 6,390 men enrolled in a large study called REDUCE, a four-year, randomized trial to test the prostate cancer risk reduction benefits of a drug called dutasteride. All the study participants had a prostate biopsy at the two- and four-year marks, regardless of their PSA levels. They also provided a detailed medical history that included their weight, incidence of heart disease, alcohol intake, medication use, and other factors.

Among the men in the study, 547 reported a pre-enrollment history of coronary artery disease. This group of men tended to be older, heavier and less healthy, with higher baseline PSA levels, plus more diabetes, hypertension, and high cholesterol. The men were also much more likely to develop prostate cancer, even after accounting for all the baseline differences.

Having coronary artery disease increased the men's risk of prostate cancer by 35 percent, with the risk rising over time. The group was 24 percent more likely to be diagnosed with prostate cancer within the first two years of the study than men who reported no heart disease, and by four years into the study, this group's prostate cancer risk was 74 percent higher.

"We controlled for a number of risk factors, including hypertension, taking statins, or aspirin," Thomas said. "We don't have a good grasp on what's causing the link, but we are observing this association."

Stephen Freedland, MD, associate professor of surgery and pathology in the Division of Urology at Duke and senior author of the paper, said the study had some shortcomings. Notably, it relied on data from a previous trial that didn't account for factors such as diet, physical activity and severity of heart disease that may have influenced the results.

But Freedland said the study eliminated a screening bias common in previous findings that correlated prostate cancer and heart disease using men with high PSA levels.

"This is giving us a lot of good ideas for what to look at next," Freedland said, noting that the overlap between prostate cancer and other diseases associated with poor health habits is a focus of his research group.

<<< * >>>

The above story is reprinted, with editorial adaptations, by The Zestzfulness Team from materials provided by the Duke University Medical Center.

The article is appears online in January 2012 in the journal Cancer Epidemiology, Biomarkers & Prevention: Jean-Alfred Thomas, Leah Gerber, Lionel L. Banez, Daniel M. Moreira, Roger S. Rittmaster, Gerald L. Andriole, and Stephen J. Freedland. Prostate Cancer Risk in Men with Baseline History of Coronary Artery Disease: Results from the REDUCE study. Cancer Epidemiol Biomarkers Prev, 2012 DOI: 10.1158/1055-9965.EPI-11-1017

Short Term Memory Loss

Picture credit: http://www.mybrainx.com

A popular motivational speaker was entertaining his audience.

He said : "The best years of my life were spent in the arms of a woman

who wasn't my wife!"

The audience was in silence and shock.

The speaker added: "And that woman was my mother!"

Laughter and applause!!

A week later, a top manager trained by the speaker tried to crack

this good joke at home.

But he was already a bit foggy after a drink.

He said loudly to his wife who was preparing dinner:

"The greatest years of my life were spent in the arms of a woman

who was not my wife!"

The wife went: "Huh??!" with shock and rage.

Standing there for 20 seconds trying to recall the second half of the joke,

the man finally blurted out: "....and I can't remember who she was!"

By the time he regained consciousness, he was on a hospital bed

nursing burns from boiling water.

Forwarded by John Ng, we suspect, in a moment of empathy.

Possible Early Dementia

Memory loss follows a specific pattern in Alzheimer's disease. The losses are mainly in short-term memory. This means that the person has problems remembering recent events.

The person cannot remember what he did last week or instructions the doctor gave this morning for taking a new medicine.

This often contrasts sharply with the person’s strong ability to remember minor details and events from many years ago.

The memory loss is followed by many other cognitive and behavioral symptoms. Eventually, over many years, the person loses many mental and physical abilities and requires around-the-clock care.

Further information HERE.

Fish Oil May Help Prevent Psychiatric Disorders

Picture credit: http://www.naturalhomeandgarden.com

Researchers at Zucker Hillside Hospital’s Recognition and Prevention (RAP) Program who have worked with teenagers at risk for serious mental illness for the past decade are now studying the effectiveness of Omega 3 fatty acids (fish oil) for treating psychiatric symptoms. This new study is a National Institute of Mental Health-funded randomized double-blind trial that was designed to test whether Omega-3 fatty acids improve clinical symptoms, and help adolescents and young adults (ages 12 to 25) who are at elevated risk for severe psychiatric disorders function better in school, work and other social environments.

“Of the 300 adolescents who have participated in the RAP Program, most have shown substantial improvement,” noted Barbara Cornblatt, Ph.D., director of the Recognition and Prevention (RAP) Program and investigator at The Feinstein Institute for Medical Research. “If this study continues to show success, Omega 3 could offer a natural alternative to the range of medications and therapies now offered to RAP participants. Ultimately, the goal of the RAP Program is to intervene and prevent illness before symptoms get worse.”

Omega 3 fatty acids are critical for normal brain function and they have been increasingly studied as potential treatments for medical and psychiatric disorders. The RAP Program study will randomly assign participants to either Omega 3 supplementation or to a placebo, and will compare the groups on key measures of symptoms and functioning after six months. Participants in both groups will be monitored closely on a monthly basis and compensation will be provided. All supplements are offered free of charge.

<<< * >>>

The above story is reprinted, with editorial adaptations, by The Zestzfulness Team from materials obtained from the news room of the The Feinstein Institute for Medical Research. http://www.feinsteininstitute.org/Feinstein/News+Releases

Read related articles in Zestzfulness:

Omega-3 Reduces Anxiety and Inflammation in Healthy Students

Aug 20, 2011

A new study gauging the impact of consuming more fish oil showed a marked reduction both in inflammation and, surprisingly, in anxiety among a cohort of healthy young people. The findings suggest that if young participants ... Earlier research suggested that the compounds might play a role in reducing the level of cytokines in the body, compounds that promote inflammation, and perhaps even reduce depression. Psychological stress has repeatedly been shown to ...

CLICK HERE for details.

Mental Health and Omega-3

Jan 02, 2010

Using this scale Bountziouka et al explored the association between fish intake and depressive symptoms, in 1190 men and women (>65 years) free living in various Greek islands and in Cyprus. They found that participants reporting higher fish intake have less depressive symptoms. Almost 70% of ... GoldLife's Bio-Omega Natural Fish Oil 1000mg is made in Australia. This and a selected range of Omega-3 are available at out pharmacies in Klang, Pandamaran and ...

CLICK HERE for details.

Fish Oil's Impact on Cognition and Brain Structure

Aug 27, 2011

Researchers at Rhode Island Hospital's Alzheimer's Disease and Memory Disorders Center have found positive associations between fish oil supplements and cognitive functioning as well as differences in brain structure ...

CLICK HERE for details.

This is Cute!

Recommended by Yee Hing. Get more 'wackywits' funnies HERE

I Care Mandatory? 10% Deduction?

10% deduction from your monthly salary for health insurance just a proposal?

When you read between the lines, it tells you that there is indeed a proposal to make it mandatory for employees to contribute 10% of their monthly salary to the 1 Care scheme.

Wow, 10% of salary is a lot of money for practically all of us. And it is non-refundable!

Contrast this with SOCSO or Social Security Organization programme that only requires a contribution of 1.75% from the employer and 0.5% of wages from the employee for the Employment Injury Insurance Scheme and the Invalidity Pension Scheme.

The 10% proposal may well be a simple salesman’s pitch, a planned presentation for the expected bargaining to reach a predetermined figure which the sales prospect, the Rakyat, will unwittingly take credit for.

A 20% discount from this 10% will still make a painful 8% damage on your hard-earned income but you will be feeling smug and singing praise to the authorities for their “people-friendly response”.

Why Are We Telling This?

We am telling you this lest you might think doctors and pharmacist are going to gain unfairly from this 1Care scheme!

Our feeble minds tell us that your money is not going into a provident fund where you can withdraw with interest upon termination.

It tell us that the money, a phenomenal RM45 billion a year according to one writer in the free press, will go to a main player complete with the usual layers of rent-seekers who will make minimum payouts to ensure maximum profit for their "effort".

For pharmacy, it will mean having to register (on top of the mandatory registration with the Pharmacy Board and licensing by the Ministry of Health and local council) with each insurance provider, purchase their computer software and pay them for the privilege to dispense prescriptions issued by their registered doctors.

The “re-registered” pharmacies will then be constrained to accept the very minimum of compensation for professional involvement in dispensing from a restricted list of medications and professional involvement in medication research to prevent adverse drug interactions, side effect and ensure correct dosage and schedule of dosing, patient counseling and maintenance of medication and insurance records.

And you may required to fork out extra Ringgit, over and above your health insurance premium, to pay for medications not included in the restricted 1 Care list. These may include superior dosage forms of the same 1 Care mandated medication like sustained-release antiasthmatics, combination antihypertensive/antidiuretics, a spray form of antianginal, a higher strength cholesterol lowering tablet, an innovator brand instead of a generic form the third world.

The above is mere speculation. Like you, the Rakyat, we community pharmacists have been told little about 1 Care.

Dr David KL Quek, Immediate Part-President of the Malaysian Medical Association has written on the health reform socio-economics, CLICK HERE and HERE. The Federation of Private Medical Practitioners' Associations Malaysia has started a Tak Nak 1Care facebook campaign.

But we find “1-Care: More Transparency Needed” by Black Cactus succinct and have reproduced below this January 8, 2012 article from the Malaysian Insider (without permission) for your convenience.

The 1 ‘S’Care scheme — The Black Cactus

January 8, 2012 - In the last few weeks, there has been immense debate on the proposed national health scheme dubbed 1 Care in both the internet and the mainstream media. A collective conclusion shared by both the public and the very professionals alike (who play a major role in the system) is the uncanny ability to fully comprehend the confusing entity which remains an uncertainty till today.

This commentary was written to achieve the following objectives

1. To help the public understand why this system was proposed and what led to the genesis of

this scheme;

2. If possible, to pressure the government to be more transparent in providing information on

the 1 Care scheme to allay fears among the general public; and

3. To help the layperson understand the unaddressed policy issues but highly crucial

perspectives surrounding the 1 Care scheme

First, it would be wise to have a quick update on the prevailing Malaysian health care system so that it would help shine some light as to why there is a sudden accelerated interest to bring the 1 Care scheme into an imminent reality.

The Malaysian health care scenario

The Malaysian health care system has often been hailed globally for its ability to endorse a sustainable health policy that reflects an outstanding and equitable health status at a relatively low economic burden.

By allocating just three per cent of its GDP to health care (majority of industrialised countries invest rough about six per cent, with the exception of the United States, which devotes 16 per cent), data compiled by World Health Organization shows that the performance of the Malaysian health system is, in fact, highly efficient.

This is evidenced by the “Health Adjusted Life Expectancy (HALE)” at birth indicator, which categorises Malaysia as equal to most industrialised countries, at 63 years.

However, the complexity of the system has also brought in much uncertainty that has not only slowed down service delivery, but has been closely related to the gradual increase in economic burden.

In an effort to make health care accessible (and most importantly equal) to all fabrics of the society, the concept of Universal Health Care was formulated and adopted by most countries around the world including Malaysia.

The system attempts to finance the health benefits for all by a balance of tax revenues and medical insurance (mostly recommended by private health caregiver in Malaysia currently). This is imposed on employed, working class population. In Malaysia, much of the public medical fees are subsidised to a great extent from the much gained tax revenues.

It is important to note that the Malaysian Ministry Of Health only manages to recover three per cent of its total operating cost through fees collected at health care premises. The amount is strikingly lower than most payments made in most European health system (which employs the co-payment system where funds are partly subsidized by the government and the insurance premium paid by the patient). The average consultation at a token rate of RM1 at any primary care centre barely covers 1 per cent of the economic cost per visit.

The resulting non sustainable system calls for fiscal limitations and will eventually cause much financial loss due to:

1. The spur of an unrealistic and unachievable demand for public health care;

2. The operational costs to cover universal health care will surpass the government’s current

fiscal capacity.

By understanding this, it comes as no surprise that the proposed 1 Care scheme is a platform designed to re-coup the wastages from a bleeding pre-existing ( but noble and functional if properly handled) health care system that is sub-optimally managed.

Like any other subsidised policies, the current health care system is resilient to any structural reform partly due to the lack of political will (where it is vital to appease voters by holding on to the unsustainable RM1 token fee and RM15-20 token fee paid at primary and specialist health clinics respectively) and the society itself whom have become so accustomed to enjoying cheap but scarce medical resources that has been perpetually vulnerable to potential abuse all these years.

The single most important question: Where is the information?

Unlike most countries that have proposed and implemented such a scheme, information on the mechanics and the policies enshrined in the health care scheme is widely available for public scrutiny. One could easily access any updates and knowledge on the health care scheme through the Ministry Of Health website of the respective countries.

The same cannot be said for the 1 Care system. The public, at large, have very patchy ideas on the health scheme without corroborative evidence from the Ministry Of Health. It would have been prudent, with all the disparate views available from all avenues of the mass media, to allay all concerns by allowing the public to peer into the workings of the proposed scheme or at least highlight the salient points that matters most to the average Malaysian. Efforts to make it an intellectual discourse by taking in question from the public would have been highly commendable.

Strangely, the documents or information regarding its modus operandi has remained elusive and is not available on the Ministry Of Health website (which is mandatory in most civil nations). The reason as to why this has been enshrouded in secrecy remains anyone’s best guess.

However, one could only speculate that perhaps the precise knowledge of the system is within the confines of a privileged few elites who are still, themselves, grappling reach a consensus on how to implement a scheme that is totally not viable given the current economic climate.

Hypothesized 1 Care scheme model

Care scheme as the utility towards managed care

With the escalating medical expenditure of the country, a cost containment approach has to be put in place to eradicate or replace an ailing healthcare system that burdens the economy. One such option would be the 1 Care scheme. Given the very sketchy information on how this would be implemented, one could only draw inferences from other similar healthcare systems.

Bearing that in mind, it would suffice to say that the scheme would promote the technique of “managed care” (by managed care organisations or MCOs) where the autonomy of patients is sacrificed and replaced by a predetermined set of rules.

These rules govern patient’s rights to which doctor, the type of care and the kind of medications he/she receives. Many of us are aware of this has been given much focus in the previous attempts to describe the proposed health system in the media.

This has, in the past, led to reprisals from the public dissatisfaction due to denial of care stemming from government legislation to tight labour rules that restricts the access one has to healthcare options. Employers would then offer private health care plans (which are private insurance plans) to fill in this vacuum so that employees could afford all available treatments. Ultimately (and to the contrary of cost containment), this incident would give rise to the ballooning of medical expenditure in the country.

Free treatment for all, really?

Unless the full blueprint is made public, one could only hypothesize the magnitude or the process of financing involved in the 1 Care scheme, which is the crux of understanding how the whole system functions.

The population might be divided up to two broad classes namely:

1. The general public;

2. Concessional patients (the ageing public, citizens below the poverty line,

disabled/handicapped).

It will be compulsory for all working citizens of the general public, who have wages within the taxable bracket, to pay 10 per cent of their earnings as contribution necessary for the funding of the scheme.

Remember that this 10 per cent tax does not mean that one is entitled to the type of care, it is just a contribution that is used to pay the wages of the physicians and other miscellaneous expenses (purchase of new equipments or subsidising the concessional patients etc.). This will be collected as federal taxes.

Secondly, to be amenable to treatments within the system, the general public will have to take up an insurance policy (social health insurance). Treatments within this system will be closely regulated by MCOs which could mean that a patient might not be covered for a wide range of interventions (eg. optical surgeries, prosthesis, aesthetics, etc.).

One burning question: Is the scheme really free so that it provides universal healthcare in a similar vein to the current system? Will drugs be free now that payments have been made by contributing to taxes and insurance schemes? Read on carefully.

So much focus has been given to the taxable amount that we need to contribute but the society has become oblivious about other aspects of the mandatory payments that one has to make in order to get the full package of services available. In summary, this would be the likely formula for the 1 Care scheme:

Social health insurance (SHI) + General taxation + minimal Co-payments for a defined Benefits Package

The fundamentals of SHIs and general taxation have been explained in detail earlier. What are copayments and benefit packages that are also an inherent part of the formula though?

Of copayments, benefit packages and additional private health insurances

Copayments are payments that have to be made by patients when their treatment has exceeded the threshold tolerated by the health scheme. Thus, a patient has to fork out a certain amount of money once the treatment requires more financial assistance due to the nature of their illness.

Benefit packages seem define the type of insurance from which special group within the population will be stratified according to deserve exemption from payments or will have their treatments partially subsidised.

Extrapolating from the statement above, even the casual layperson would demand an explanation by posing several questions below:

1. It was said that free treatment will be given to all. But what are these copayments, then?

2. Will there be copayments for drugs? Is there a minimum pricing policy?

3. Which class of society will be eligible to total subsidy and exempted from all payments?

4. How will the general public gain access to other treatments that the SHI does not cover?

To minimise copayments, steps will be taken to provide cheap but “equally” good quality drugs or services determined by the MCOs. This is called the minimum pricing policy, a key policy issue that has been very much in the shadows since the planning of 1 Care policy.

MCOs will only allow more patient autonomy if they are willing to endure an additional cost by purchasing an additional private insurance. The results would be:

1. Patients will now be provided with the added benefits which are not covered by the SHI

policy;

2. Patients will be able to then choose doctors and types of procedures

(dental/optical/physiotherapy that was previously not available in the SHI scheme).

Rise in public health care burden secondary to rise in market demand

The trend of an increase in purchase of additional private health insurance will influence the increase in demand of services as a whole. With the access to an affordable yearly insurance premium, the growing population will have a lowered out-of-the pocket price to pay when seeking medical treatment. This will directly lead to the increase in market demand for health care services for the medical needy and indirectly cause the sudden surge of prices for medical services.

With the increase in slow increase in inflation rates in Malaysia (upward trend towards the level of 3.3 per cent in December 2011), larger spectrum of the working population would be pushed into the higher marginal tax brackets. This would often leave citizens with lesser disposal income for their utilization.

In line with this scenario, many tax payers would prefer out-of pocket medical expenses be paid before-tax ringgit than after-tax ringgit (which is subject to tax imposition) by purchasing health insurance. Thus, this will inexorably increase market demand and simultaneously increase prices of medical services, especially if it is poorly regulated and unprepared.

Reeling from the aftermath

Repercussions

Faced with rising medical expenditure, the federal government will be dogged by limited and painful options.

1. Raise the 1 Care payroll tax and incomes taxes on the non age to sustain the failing 1 Care

scheme;

2. Necessitate higher premiums for 1 Care among the aged and increase their deductibles and

copayments;

3. Reduce payments to hospitals and physicians

The full brunt of the burden will be directed towards the public if the system goes awry. Physicians will opt out of the 1 Care scheme as their fees will be slashed to lower levels. Patients will then need to pay higher out of the pocket settlements to their doctors who are no longer under the 1 Care scheme.

The aged and the non-working class, who have little or minimum wage, will have to face a less forgiving reality that their benefits to subsidy will be greatly reduced.

The working population, with already rapidly diminishing disposal income will find it extremely difficult to come to terms with a scheme that requires them to be taxed higher and receive very little benefit from such health policy.

Recommendations

It is time that the government stepped up to the plate and educates the nation on their intentions behind the 1 Care Scheme. Let it not be a half baked policy reminiscent of the recent SBPA debacle (that still remains unresolved till this date) as the stakes are much greater and bigger calamity looms if the scheme is not reviewed with due diligence.

It would be pertinent, for the time being (while 1 Care scheme is being mulled upon), that the following recommendations be considered:

1. Assess the agent status of the majority of practitioners (whether they are they are perfect or

imperfect agents for the proposed health care system)?

2. Take all steps possible, and in a transparent manner, to convince the nation regarding the

relevance of the 1 Care Scheme.

Meanwhile and until it is acceptable to the public, minor tweaks or reforms could be made to the pre-existing healthcare system to make its function far superior than at present:

1. The symbiotic relationship between health care provider and patients is strongly encouraged

in the hopes that patients themselves could be an active participant (and agents of cost reduction) in the system;

2. The reduction in over-reliance of services provided by the privatization of healthcare, thus

curbing progressive increase in market prices by decreasing the percentage of the population who seek inexpensive medical treatment (due to insurance premiums and lower out-of-pocket payments), which could be prove to be economic vicious cycle;

3. Corporatisation of health care services (rather than a full change in the health care system)

permits better operations management and greater accountability of a highly complex organization such as the primary health care system;

4. Careful and gradual integration of new information technology advancements to the pre

existing service delivery system (e-mail consultation for example) which could ultimately reduce cost and lead times.

* This is the personal opinion of the writer or publication. Like The Malaysian Insider, The Zestzfulness Team does not endorse the view unless specified.

We list below the official sites where we hope you will be able to obtain clarifications to the points raised by The Black Cactus:

Official portal of the Malaysian Ministry of Health

Official blogspot of the Malaysian Ministry of Health

And when you do, would you please share the information with our readers and us. Thank you.