Wednesday, October 29, 2003

Hospitals set fees for health tourism

PENANG: The Association of Private Hospitals Malaysia (APHM) has finalised the recommended fees for the common health tourism packages, Health Minister Datuk Chua Jui Meng said.

He said a sub-committee on fee packaging, chaired by the APHM recently, had finalised the recommended fees to ensure that tourists coming to Malaysia for medical reasons get value for their money.

He said yesterday that the fees were highly affordable and competitive internationally.

“Basically, there are three health screening packages – the Basic Health Screening package, the Well Woman package and the Well Man package with fees ranging from RM450 to RM1,150 depending on the number and complexity of tests performed,'' he said when opening the Penang Adventist Hospital's Clinical Pathology Laboratory services and launch of the Architect ci 8200 Analyser.

He added that the packages would also include minimum and maximum recommended fees for 18 procedures commonly performed in cardiology, ophthalmology, orthopaedics, plastic surgery and diagnostics such as endoscopy, MRI and CT-scan.

Chua said the Government was making efforts to expand the health tourism industry in a big way and had identified health tourism as one of the potential growth areas in the country's tourism industry.

“A survey commissioned by the Government last year estimated that our foreign patient market was worth close to RM90mil and admission of foreign patients into our healthcare facilities have grown at an annual rate of about 30% over the past three years,'' he said.

Chua added that 35 private hospitals were identified and currently being promoted as providers of health tourism services.

“Although none of our Health Ministry hospitals has yet to be promoted as a provider of health tourism services, the setting up of many new, sophisticated and ultra-modern hospitals under the ministry have been identified as prime movers of health tourism in the future.

“Our public hospitals have the potential of raking in at least RM2bil a year in health tourism earnings by the year 2010,'' he said.

Also present at the opening were Adventist Hospital's president and Chief Executive Officer Teddric Jon Mohr, Abbott Diagnostics South Asia's regional director Ian Martin, Penang Chinese Chamber of Commerce executive advisor Tan Sri Tan Kok Ping and state director of health Dr Azmie Shapie.

Monday, October 27, 2003

Scanning through 3D medical images

AS FAR as software engineering is concerned, 3D medical imaging systems for displaying MRI or CT scan data have become the thing to do, it seems. Apart from the tremendous commercial possibilities, such systems are also proving to be extremely useful to radiologists and surgeons who need to take a peek into a patient without cutting him or her up into little pieces.

Barely a month after we ran a story on such a system (see In.Tech, Sept 9), we’ve stumbled across yet another group of individuals eager to display their very own 3D medical imaging system, called Uppercut3D.

Graphic Imaging Solutions Sdn Bhd, the local marketing agent for Uppercut3D, recently held a demonstration to promote the system to the public (mostly people in the medical field). The press kit and posters littering the exhibition hall showed some rather nice looking computer-rendered images of someone’s spinal cord, flanked by two kidneys. Obviously, the system was capable of producing very high-quality 3D graphics, something which its designers were keen to point out.

Before the presentation, I spoke to Dr Khoo Ee Win, a senior registrar with the Radiology Department at the Queen Elizabeth Hospital, South Australia. He had a big badge with the words “Uppercut3D” in bright colours, which meant that he probably had something to do with the event. After a bit of small talk on the current state of medical imaging and various other things, I asked Dr Khoo if Graphic Imaging Solutions was going to demonstrate the software.

“Sure, I’ll be giving you a demonstration of the software ... from my laptop,” he said.

“You mean you’re going to show me some videoclips and screenshots of Uppercut3D from your laptop, right?” I said, attempting to correct him.

“No, I’ll be running the actual program from my laptop,” he asserted, with a deadpan look.

This was a surprise. Normally, if you want to get your hands on a 3D medical imaging system you’d have to either purchase some exotic, specialised computer hardware or establish links with certain government-funded organisations so that they can buy the system for you, in the likely event that you can’t afford it. And that’s before you even buy the equally pricey imaging software to run on the system.

Now, here I was, standing in front of a very humble looking laptop, watching as Dr Khoo flipped, cropped, sliced and rotated a very highly detailed 3D representation of somebody’s skull in real-time, on his laptop’s monitor.

“This person was involved in a motor accident and smashed his face into a steering wheel. You can clearly see the extent of the fracture and make accurate measurements here and here,” said Dr Khoo, pointing at two gaps on the person’s badly broken jaw. Not only was the image frighteningly realistic, it looked really painful too.

“So, who wrote this software, then?” I asked.

“I did ...” he replied, with a slight grin.

It turns out that whenever night falls, the mild mannered radiologist reveals his true identity; he’s actually a computer programmer. In fact, he’s the founder of Pty Ltd in Australia, the company which handles the R&D for Uppercut3D.

Dr Khoo first saw the need for a 3D imaging tool during his undergraduate training, when he saw the difficulty doctors had in manipulating images obtained from CT and MRI scans.

“I took on the challenge of creating a 3D visualisation system, something which the big companies and vendors did not offer at the time. As an undergraduate medical student, I formed a team of programmers with friends to develop 3D volume rendering software. Within a couple of weeks everyone dropped out. Undaunted, I persevered on my own, but slowed down the development to complete my medical studies,” explained Dr Khoo.

“On completion of my medical course, I invited three people to form a team to speed up the programming. Ensuring the product was bug free was a major challenge, as was getting compatible hardware configuration.

“I spent almost all my free time after work and on weekends on the project, very often till the wee hours of the morning. I sacrificed a lot of my social life to singularly focus on the success of this program,” said Dr Khoo.

Like all 3D medical imaging systems, Uppercut3D relies on volume rendering with voxels (individual coloured pixels), rather than surface rendering with polygons. Voxels require far more processing power to render than polygons. A good analogy to explain this is trying to build a house out of sawdust (voxels) rather than with wooden planks (polygons).

The most impressive technical aspect of Uppercut3D is that, even in the absence of specific volume rendering hardware, it is able to render complex 3D volumes rather quickly. Dr Khoo used a progressive rendering technique which displays low-resolution versions of the 3D model while you’re manipulating it on screen (rotation, zoom, cropping, etc), only rendering the final full-detailed version within a couple of seconds after you’ve completed your manipulations.

Dr Khoo pointed out that while other competing 3D medical images are hardware-based, the rendering engine in Uppercut3D is 100% software based, which also drastically reduces development and production costs. It will run on most Pentium 4-equipped PCs.

“Much of the rendering engine uses proprietary algorithms. However, the basic strategy for fast rendering is through optimisation at the lowest level of programming. The general principles of volume rendering have been well known for several decades now,” explained Dr Khoo.

Although it currently runs only on Windows, the software can be ported to other platforms such as Linux and Macintosh, should the need arise. Dr Khoo added that the code can be optimised to take advantage of the new 64-bit processors for Windows-based PCs.

Improving the quality of treatment
Technological accomplishments aside, one thing that Dr Khoo highlighted repeatedly is that Uppercut3D was designed by doctors, for doctors and is therefore very relevant since it is tailored towards the workflow of a radiologist.

“The current workflow of a radiologist is plagued by many inefficiencies,” he said.

“When a patient is scanned, the radiographer is responsible for developing the hard copy films for the radiologist to view. He or she is relying on experience to know what the best standard views are for the radiologist to report on. If the optimal angle and contrast was not achieved, the radiologist would have to request more prints from the radiographer. This is very time consuming.

“In addition, today’s CT scanners can routinely generate hundreds of slices of data (typically 500 slices) and more. The current method of printing the hard copy films of the enormous amount of data is not time effective or cost effective. The workaround at the moment is to not print all the thin slices but to print the thick slices. However, much of the extra information is not looked at. This is dangerous since small lesions and details may be missed,” said Dr Khoo.

He then explained how his software fits into the picture: “Uppercut3D fits perfectly into the workflow because the radiologist can now generate the viewing angles all by himself in real-time, allowing the radiographer to work more efficiently. Alternate contrast and brightness settings can be quickly applied to the images in real-time as well. More importantly, the radiologist has at his/her fingertips, all the thin slices instead of having to report from the thick slices only.

“In addition, 3D volume rendered views of the pathology such as a complex fracture can be generated in real-time as well by the radiologist. These can then be printed and sent to the referring clinician. The endpoint of the workflow is the successful communication of the findings and the diagnosis to the referring clinician,” explained Dr Khoo.

According to him, another advantage of having photo-realistic 3D rendered representations is that it helps both doctors and patients to understand the problems at hand. After all, it’s much simpler to convince somebody if he’s okay or not by showing him what his innards look like.

“This should ultimately improve doctor-patient relationships enormously; they’re less likely to argue if they can see the problem,” quipped Dr Khoo.

The market
Dr Khoo believes that the quality of healthcare for a patient should not be determined by cost. Since Uppercut3D runs on readily available and affordable PC hardware, it can be sold to hospitals at a much lower price than most of its competitors.

Uppercut3D is already available in the market, having undergone extensive and rigorous clinical testings for two years. Dr Khoo claimed that in all trials, no problems had been identified. Indeed, it’s already being used in actual clinical work.

“Two medical institutions are currently using Uppercut3D on a daily basis. They are the Queen Elizabeth Hospital (a large public hospital) and Jones and Partners (a large private national radiology service provider), both in Adelaide, Australia,” he revealed.

Although he currently lives in Australia, Dr Khoo was born in Malaysia and spent his childhood here. His family and relatives set up Graphic Imaging Solutions with the sole purpose of marketing Uppercut3D in Asia.

They plan to sell Uppercut3D for less than RM100,000, as a complete solution offering support, upgrade patches, hardware, warranty and training. They have already spoken to a few hospitals in Malaysia and will be setting up demo units so that the hospitals can evaluate their system. This may seem pricey but, according to Dr Khoo, it is more affordable than any other competing system in the market which typically costs between RM160,000 and RM480,000.

Dr Khoo has also identified medical schools as another possible market. Graphic Imaging Solutions is considering releasing a special edition at a reduced cost, for lecturers and students.

“The ability to view scans from a live patient’s anatomy is very important in the study of diseases. Hopefully, there will be a transition where students can study anatomy from 3D images. Dissections are somewhat artificial in that they do not depict live tissue,” explained Dr Khoo.

Whether or not it achieves the commercial success that its designers and distributors are hoping for, Uppercut3D is a rather impressive piece of software. When asked if there are any improvements planned for Uppercut3D, Dr Khoo said: “Well, we could include an animated 3D fly-by through a patient’s innards ....”

Wednesday, October 22, 2003

Modernise traditional medicine, services’l

KUALA LUMPUR, Oct 20: Traditional medicine products and services should be integrated into mod-
ern healthcare as their usage has been found to be beneficial, Deputy
Prime Minister Datuk Seri Abdullah Ahmad Badawi said today.

"Traditional and complementary medicine is long-term in nature, with a philosophy that advocates consistent life-long care rather than once-off remedies," he said.

Abdullah was speaking at the launch of the Fifth International Conference on Traditional and Complementary Medicine today.

Departing briefly from the text of his speech, he said his wife Datuk Seri Endon Mahmood was happy and doing well as a result of her cancer treatment which applied a mix of modern and alternative medicine.

"My wife receives her treatment in Los Angeles where she is treated by both an oncologist and traditional medicine practitioners.

"They combine their expertise and come up with a holistic approach in treatment.

"Whenever a herbal remedy is prescribed, the oncologist will first be consulted. My wife seems to be doing very well under the treatment," he said.

Most doctors of modern medicine, however, remained sceptical over traditional or alternative medicines, which have been widely accepted by lay people.

Abdullah said in order for traditional medicine to gain acceptance, products and services ought to be subjected to standards.

"This involves testing, user acceptance and high-quality production processes," he said.

He said Malaysia should also offer itself as a "test bed" for the integration of traditional medicine into modern medicine.

At a Press conference later, Abdullah said makers of traditional medicines should not make general claims that their products could cure any disease.

"A lot of products make general claims that they are good for overall health and well-being, or claim that they can cure a thousand and one ailments.

"They should be more specific and also have guidelines on consumption so that people don't take too little or more than they should," he said.

Abdullah added that Malaysia's investments in biotechnology, such as in the BioValley project, would complement the development of the traditional medicine industry.

"Using biotechnology and science, traditional medicine can be accepted as a part of modern medicine and receive acknowledgement as an industry that is scientifically-based." He also praised the Health Ministry for its move to set up a Traditional and Complementary Medicine division, to be operational in January.

The move is to co-ordinate all aspects of traditional medicine, such as research, practice and product regulation, which were currently under the ambit of different departments.

Earlier, Abdullah launched the ministry's global information hub on traditional and complementary medicine, available at The on-line hub is to eventually become a worldwide database on alternative medicines and treatments. Currently, information is limited to Malaysian content, obtained from local universities.

The Health Ministry is also working on a mechanism to protect information in the database from abuse and to protect the intellectual property rights of those who contribute to the database.

Abdullah, with Health Minister Datuk Chua Jui Meng, also witnessed the signing of letters of intent by the National Institute of Natural Products and Vaccinology (under the ministry), Pharmaniaga Bhd and Quintiles Ltd. Quintiles is a USbased pharmaceutical contract research and development company providing clinical expertise.

Thursday, October 16, 2003

Keeping up with medical advances: "WITH tremendous advances in technology, many things that doctors and nurses learnt from traditional text books have become obsolete.
Increasingly all over the world, people have begun to ask themselves whether they are doing the right things or doing things the right way,� said Tan Sri Dr Mohamad Taha Ariff, director general of health in his speech Evidence Based Practice: The Way Forward at the recent Asian Regional Conference on Evidence-based Nursing held in Kuala Lumpur recently. Even patients have begun to ask questions like, �Are you sure this is the best way to do this dressing?�
Evidence health care, the process of systematically finding, appraising and using current research findings as the basis for decisions in health care is the basis of medical practice today and it has recently included medical practitioners� tacit knowledge drawn from experience as well as patient�s perspective, he said.
However, the issue with the evidence-based approach is that finding and evaluating evidence is costly in terms of time and money and not everyone is skilled in locating the information and using computers, said Mohamad Taha.
The most common complaint is that it demands knowledge of statistics that few have mastered. Poor indexing too may lead to frustration in literature searches.
The evidence-based approach is also a rigorous and rigid system. It uses the results of studies applied to populations whilst clinicians are used to dealing with single patients on an individual basis. It may also be viewed suspiciously as a form of rationing which could be used to prevent clinicians from using treatments of unproven efficacy even where their clinical acumen suggests it may benefit the patient, said Mohamad Taha.

On the other hand, since evidence-based practice is about improving the quality of patient care, it is likely to show that there are also effective interventions that are underused, he said.

It makes medical and nursing curriculum more problem-centred and less about memorising a static body of knowledge. The practice provides some rules and rationale for group-based problem-solving and teaching, he said.

It also functions as a tool to keep up to date with research and to understand research techniques and encourages health care professionals to be more focussed and productive in their reading habits and data handling. This helps to improve the confidence of health care professionals in decision-making.

Evidence-based practice ensures that good research findings are applied more quickly to clinical practice. For instance, it took 10-15 years for people to adopt thrombolysis after a myocardial infarction despite evidence that this was effective, said Mohamad Taha.

Dr S. Sivalal, the head of the Health Technology Assessment Unit at the Health Ministry, said the practice of evidence-based health enhances knowledge-based components of clinical practice and does not invalidate clinical judgment.

In his paper, Developments in Evidence-Based Medicine, he said medical staff face the frustration of not being able to find the evidence they want for making many clinical decisions.

“There have been a lot of advances from purely research papers to secondary sources of evidence which people appraise and compile into systematic reviews. So rather than going through the original papers, readers can look at these reviews,” he said.

In coping with new findings and overload of new information, medical staff should target readings to specific patient problems, he said.

Evidence-based practice in nursing

“Florence Nightingale believed – and in all the actions of her life acted on that belief – that the administrator could only be successful if he (she) was guided by statistical knowledge. The legislator – to say nothing of the politician – too often failed for want of this knowledge. Nay, she went further: she held that the universe – including human communities – was evolved in accordance with a divine plan. But to understand God’s thoughts, she held we must study statistics, for these are the measures of His purpose. Thus the study of statistics was for her a religious duty.”

Quoting this statement made by well-known applied mathematician and statistician, Karl Pearson (1857-1936), Dr Sivalal pointed out that even the Italian-born Nightingale (1820-1910) stressed on the importance of statistics in nursing. What is less well known about this amazing woman is her love of mathematics, especially statistics, and how this love played an important part in her life’s work.

In Malaysia evidence-based practice in nursing is still limited. Dr Nafsiah Shamsudin, head of the nursing school at University College Sedaya International, said evidence-based nursing is practised here but not uniformly practised throughout the country.

“It’s happening in terms of medicine, and the nursing sector is about to catch up,” she said.

Speakers at the conference pointed out that nurses shy away from research because they lack confidence and research skills and appraisal.

“Nurses are not able to analyse critically articles or journals that are published,” said Dayang Annie Abang Narudin, principal matron at the Health Ministry in her presentation Strategies to introduce evidence-based practice in nursing.

Although evidence-based nursing is today’s password, many nurses tend to remain in the comfort zone and do things the usual way because they do not want to change, however, but change is inevitable for success and improving nursing care services, she said.

Currently, in Malaysia, there are fewer than 500 nurses with degrees and only a handful of nurses have Masters, she said.

Nafsiah is possibly the first to receive a doctorate in nursing.

During a question and answer session the day before, a member of the floor asked how nurses could be mobilised to practise research-based nursing when there is a lack of resources and a limited number of nurses with degrees or Masters.

In response, Dr Linda Johnston, associate professor on nursing practice research from the University of Melbourne, Australia, said: “I don’t believe that every nurse should conduct research or even like research but every nurse should use research.”

“You have to be able to show that the practices are based on evidence. That requires Internet access, some funding to assist in journal clubs being set up,” she said.

In her paper Nursing Research Activities in Malaysia, Lim Pek Hong, a lecturer from the Faculty of Medicine, Universiti Malaya, said that nurses could either be indirectly involved in research as a consumer or directly involved as a research producer.

Few participate in research activities, she said. Even if there were any projects that had been conducted, there is a lack of information dissemination.

Someone from the audience also pointed out that although nurses have been carrying out research work, their work is are not widely known.

Jaye Devi Coomarasamy, a senior nursing officer at the Health Ministry, said a newly-formed Nursing Foundation would be able to fund and publish research carried out by nurses while Sivalal said a lot of research have been done by nurses under the Quality Assurance Programme organised by the Health Ministry.

Nurses rarely have time to be away from the hospital as staffing is tight (especially in public hospitals) and they are busy with work. As a result, hospitals often have difficulty in releasing nurses to go for training, said Christopher Maggs, a professor of clinical practice and development at the Mid Staffordshire General Hospitals in Britain.

In his presentation Nursing research: Can we do it? Maggs said if nurses explore what they do intuitively and with more thought, nursing research can be done.

It takes a team to implement evidence-based nursing and there must be collaboration and interest in it. “If nurses want to implement it, hospital management and doctors must support the effort,” she said.

“Nurses need to identify areas of practice that are questionable. Why are we doing this and why are we doing it this way, for example in injection and dressing,” said Nafsiah in her paper Patient centred nursing: A Paradigm Shift.

“In Hong Kong and China, they use acupressure as part of medical practice. Can urut (massage) lessen the pain of the patient? I hear a ‘yes’ but do we have evidence? How do we get that evidence? If it’s not invasive, why can’t we use it? We have to be brave enough to bring out the evidence,” she said.

One of the things to do in practising evidence-based medicine is to adopt Clinical Practice Guidelines, which are adopted from research results. The guidelines work as a basis for doctors and nurses to draw up clinical pathways, which are standard procedures that medical staffs adhere to in their hospital, said Sivalal.

“That way you get the whole team involved,” he said.

Daily Express, Sabah, Malaysia -- News Headlines: "Kuala Lumpur: Bank Negara Malaysia Governor Tan Sri Dr Zeti Akhtar Aziz said that private medical and health insurance have an important role in complementing and supplementing the national healthcare system.
“Indeed, more and more Malaysians are turning to the insurance and takaful industries for insurance protection to finance their healthcare requirements,” she said in her opening remarks at a seminar on Medical and Health Insurance for Insurers and Takaful Operators, here Tuesday.
She said that this has led to substantial expansion in medical and health insurance business in the last five years, with premiums increasing at an average annual rate of 16 per cent to nearly RM1 billion in 2002.
Medical and health insurance currently accounts for more than five per cent of total premiums in the insurance industry.
“Going forward, we can expect more Malaysians to allocate an increasingly larger proportion of their income for healthcare provisions,” Dr Zeti said. She said that although Malaysia has a relatively young population, demographic changes point to an expanding ageing population with improvement in living standards and advances in medical science and healthcare facilities.
At the same time, any changes in the extended family structure would increase pressures on individual responsibility for medical care, she added. “These developments pose significant social policy challenges for the national healthcare system to ensure access to fundamental medical facilities for all Malaysians in the most efficient and cost effective manner,” Dr Zeti said.
She said that in this regard, private healthcare financing will become increasingly important in complementing and supplementing the healthcare facilities in the public sector.
The Governor said that the public sector healthcare financing has already been on an upward trend in recent years.

She said that the Government healthcare expenditure is expected to approach RM9 billion by 2004 from about RM2.8 billion in 1995 while healthcare expenditure as a proportion of the overall Government budget is projected to increase to eight per cent from five per cent over the same period. - Bernama

Tuesday, October 14, 2003

The major healthcare players:

THE drug maker is expected to be a beneficiary of the recent budget measures.

Government initiatives to upgrade healthcare facilities and build more hospitals nationwide are expected to create more concessionaires for the supply of pharmaceuticals to the public hospitals.

Pharmaniaga, a member of the Renong group, is well positioned to win a lion's share of those contracts with concession business accounting for about 70% of the group's sales. The remaining 30% to 35% of earnings comprise sales from manufactured over-the-counter (OTC) and prescribed medicines.

The group has been awarded the rights to supply and distribute pharmaceutical and medical products to hospitals and medical institutions under the Ministry of Health (MOH) via a concession in 1994 that runs for 16 years.

Pharmaniaga is working towards reducing its dependency on the concession business and focusing on the private sector so that this business segment would contribute 40% of its turnover in the next few years.

The group's half-year to June sales rose 3.9% year-on-year to RM309.79mil due to higher concessions and exports, with sales to the Health Ministry accounting for 76.6% of the total.

Its six-month pre-tax profit also grew by about 3% to RM31.26mil. Second-quarter sales, however, fell slightly by 1.4% year-on-year to RM155.26mil, mainly due to the absence of medical equipment contract revenues.

Stock watch on Pharmaniaga

KPJ, a subsidiary of Kumpulan Perubatan (Johor) Sdn Bhd, is expected to continue benefiting from Malaysian’s rising affluence and health awareness, as well as increased population of older age groups and tax rebates for health-related expenses.

KPJ Healthcare Bhd’s principal activities comprise owning and managing specialist hospitals and providing medical and healthcare services.

It is now operating 11 hospitals and building another two – Kuching Specialist and Seremban Specialist, which are expected to open at the end of 2003 and early 2004, respectively.

Currently KPJ has 1,371 licensed beds, 360 specialists and 3,674 staff members, making KPJ the second biggest healthcare employer after the Ministry of Health.

Primary catalysts of growth for the group would be its new hospitals, which would make KPJ’s coverage nearly nationwide.

In addition to its ongoing efforts in aggressively growing its hospital chain and expanding the hospitals, KPJ is set to build a new nursing college to facilitate its expansion and mitigate the risk of nurse shortage.

Revenue for the first half of the year ending Dec 31, 2003, jumped to RM240.4mil from RM79mil last year. Pre-tax profit increased from RM8.4mil to RM12.7mil.

Stock watch on KPJ

The increase in government expenditure to upgrade existing healthcare facilities and to build more hospitals would generate demand for medical gases and gas pipeline installation for the industrial gas solutions provider.

MOX acquired rival Nissan-Industrial Oxygen Inc Bhd, now renamed MOX Gases Bhd, last year and analysts said the merger of the companies would drive growth this year as the acquisition provides MOX with a near monopoly in Malaysia.

Its market share would increase to 70% and the group would be better able to manage its efficiency and costs, as the acquisition would allow the company to achieve higher growth rates.

MOX posted a net profit of RM82.2mil for the nine months ended June 30, up 32% from the previous corresponding period, while turnover rose 19% to RM413.3mil.

The improvement was due to the contribution from MOX Gases, and the completion of non-recurring large projects.

Notwithstanding the merger, the company has maintained that it needs foreign direct investment and a healthy economy to drive revenues and profit up.

Stock watch on MOX

Kotra's share price has been hovering around RM1.30 to RM1.50 in the past one year since making its debut in the Mesdaq market in October 2000 with an IPO price of 87.5 sen.

However, the group seems positive about its future revenue growth targeted to be above 20% a year.

Kotra is also deemed to be in a very resilient and recession-proof industry as it is producing something that is a necessity for consumers.

Manufacturing both prescribed drugs and non-prescribed products (OTC products), the group has its own product/market niche in children's health supplements under the brand name Appeton, which has achieved market recognition.

Its prescribed range of products is marketed under the brand name Axcel. In addition, the group also produces Booster, an energy-enhancing beverage.

Kotra's pre-tax profit dropped by 50% to RM3.5mil for the year ended June 30, 2003. Revenue, however, increased from RM31.8mil to RM38.8mil.

The drop in profit was attributed to an estimated loss of RM1mil in respect of the nationwide voluntary product recall exercise, additional advertising and promotional activities of RM2.6mil, and increased production overheads and manufacturing costs.

Increased sales of generic products had also reduced the group's gross profit margin despite higher sales.

Stock watch on Kotra

The company's strong fundamentals and its clear lead in the injectables market have made it an interesting stock for investors.

Duopharma is enjoying healthy demand for its small volume injectables (SVIs) and its new four-storey plant, scheduled to be ready by the end of this year, will increase capacity by 50%.

It is purportedly the largest supplier of locally made injectables in the country. It has a market share of more than 85%. Currently, it relies on Pharmaniaga Bhd for some 40% of its sales. Another 40% comes from its sales to the private sector, 10% from tender sales and the remaining 10% from exports.

Pharmaniaga is said to have recently confirmed that it would be renewing a contract worth an estimated RM30mil with Duopharma for the supply of injectables. The contract expires in December.

It is also reported to be making a concerted effort to diversify its earnings by xpanding into new markets like the Middle-East and competing for more government tender exercises.

Expectations are that Duopharma's proposed one-for-five bonus issue, which has obtained all the necessary approvals, will spur interest in the stock.

The exercise is to facilitate its transfer to the main board. It reported a net profit of RM8.9mil for the first six months of its financial year ending December 2003, compared with RM2.4mil in the last corresponding period. Revenue rose to RM39.8mil from RM11.8mil.

Stock watch on Duopharma

APEX Apex Healthcare Bhd, which graduated to the KLSE main board in August, is confident of maintaining steady growth. For its first half-year ended June 30, the company's revenue and pre-tax profit grew 11.8% and 11.3% respectively to RM89.6mil and RM7.2mil against the corresponding six months of 2002.

EPS during the period increased 9.7% to 11.75 sen from 10.71 sen previously. Manufacturing is the main income earner for the company and contributes 60% to earnings, while marketing, distribution and retail make up the balance.

Apex's manufacturing arm, Xepa-Soul Pattinson (M) Sdn Bhd, plans to launch three to six new drugs a year.

Currently, the group supplies mostly to pharmacies and clinics in the private sector with the government sector accounting for only 10% of group sales.

This mix is said to have worked well for Apex over the years.

Analysts reckon the market is big enough for Apex to concentrate mainly on the private sector as that is where the group's strength lies.

Abroad, the group's aim is to set up more offices in the company's major markets. This has been achieved in Singapore where Apex has its own sales and marketing team.

Stress driving teenagers to suicide - OCT 14, 2003: "KOTA BARU - About 130,000 out of one million children and teenagers in Malaysia are suffering so much mental stress that some commit suicide.
'Suicide is the third contributing factor to death among youths in this country,' the Health Ministry's director-general, Tan Sri Dr Mohamad Taha, said in a speech marking World Mental Day.

He said emotional and behavioural problems among young people include depression, stress, restlessness, suicidal tendencies, drug abuse, educational issues, hyperactivity and autism.
'The Health Ministry wants to give serious attention to overcome the problems. If they are treated at an early stage, 75 per cent of them can be cured,' he said yesterday.
He urged parents to monitor their children's behaviour. If there were signs of mental stress, they should immediately take their children to a hospital paediatrician.
Deputy Health Minister Suleiman Mohamed said there was an acute shortage of paediatricians, especially those specialising in counselling, in all government hospitals. -- Bernama"

Thursday, October 09, 2003

Govt officer presents working paper on post-mortem in M'sia: "The approach towards carrying out post-mortem on dead bodies must be changed to fulfil Islamic religious needs so it can be practised by the Muslim nations.
According to Japar Maidin, an officer at the Brunei Darussalam's State Mufti's Department, the need to slice open dead bodies is permitted in Islam only within the context of disease research or when investigating the cause of death.
Japar said that during earlier times, such treatment on dead bodies was adjudged to be haram (forbidden) in Islam, because corpses had to be treated with respect.
'Cutting open dead bodies was not a strange thing in Islam. In the 17th century, post-mortems conducted on dead bodies were considered normal, whether for the purpose of research or for investigating the cause of death towards finding the truth,' said Japar while delivering a working paper entitled 'Bedah Siasat Mayat: Satu Tinjauan Menurut Perspektif Syarak' at the Fiqh National Seminar in Bangi, Selangor, Malaysia recently.
The seminar was organised by the Syariah Department, Islamic Education Faculty, Universiti Kebangsaan Malaysia and Kolej Islam Darul Ehsan.
Japar added that in Islam, sick people must receive medication or services towards improving their health, and that it is also a must for able Muslims to study towards becoming doctors or nurses so they can treat patients.
'A specialist doctor needs to acquire knowledge towards performing post-mortem on dead bodies for the purpose of education and medical knowledge,' said Japar.
'Slicing open a dead body for such purposes is permissible in Islam as it is considered as an emergency approach towards finding medical solutions to cure sick patients and towards improving the health status of people who are still alive.

"The question is that we must find humane ways to cut open dead bodies so ethics towards such post-mortem can be produced based upon the need to perform the operation in order to find the truth."

"There are many verses of Al-Quran where an accused person is entitled to a fair trial. The question is in how such a person can receive a fair trial in the case of non-availability of witnesses or whether the victim had succumbed to his or her injury.

"This is where post-mortem on a dead body is allowable to determine the cause of death or how the victim died," he said.
Utusan Malaysia Online - Home News: " In KUCHING, Sarawak's demand for paramedics will be fulfilled with the completion of the Kolej Sains Kesihatan Bersekutu here in the middle of next year, Deputy Chief Minister Tan Sri Dr George Chan said.
He said the RM78 million college, in Jalan Penrissen, would have a capacity to train 1,500 students undergoing diploma-level courses.
'It is important to have sufficient health personnel with calibre to ensure that all levels of society, especially rural folks, can enjoy quality health care,' he said during the Kolej Kesihatan Bersekutu convocation here Wednesday.
Dr Chan said under the Eighth Malaysia Plan a sum of RM316 million had been allocated to improve Sarawak's health facilities, including the construction of two new hospitals in Dalat and Sarikei, five city and 11 rural health clinics and two training colleges, one here and the other in Sibu.
The implication of these improvements was that the Ministry needed more health personnel who were innovative and dedicated, he said. "

Tuesday, October 07, 2003

Health facilities in rural Sabah on par : "Kuala Lumpur: The Health Ministry plans to build more clinics and upgrade the existing equipment at health clinics and rural clinics throughout the country under the 9th Malaysia Plan.
Health Minister Datuk Chua Jui Meng said the move aimed to raise the quality of service at the clinics, particularly for rural dwellers.
He said currently the ministry has 855 Health Clinics (now known as Community Clinics), 101 Child and Maternity Clinics and 1,940 Rural Clinics throughout the country.
On the deployment of medical experts, he said 110 experts on family health had been assigned to health clinics throughout the country and the number was being increased yearly.
He said this in a written reply to Ronald Kiandee (BN-Beluran) who wanted to know the rural health situation in the country, particularly in Sabah.
Chua said rural health facilities in Sabah were on par with that of rural clinics in the peninsula, except for the number of manpower due to the shortage of doctors.
He said that for Sabah, five experts on family medicine had been deployed to the main health clinics, that is, in Kota Kinabalu, Sandakan, Penampang, Menggatal and Tuaran.
He said as of December 2001, Sabah had nine Area Health Offices, 23 District Health Offices, 90 Health Clinics, 195 Rural Clinics, 19 Child and Maternity Clinics and nine Mobile Clinics.
On the maintenance and repairs of equipment and facilities at the health clinics nation-wide, he said the ministry had allocated RM60.5 million annually for the purpose.- Bernama "

Sunday, October 05, 2003

Utusan Malaysia Online - Home News: "MELBOURNE Oct 3 - A group of Australia's leading and internationally renowned medical specialists will visit Sarawak next week as part of a trade delegation from South Australia (SA) to Kuching and Kuala Lumpur.
Led by SA Industry and Trade Minister Rory McEwen, this is the first time that such a group of top medical specialists will visit Sarawak.
A seminar on 'Medicine in the 21st Century' will be conducted at the Kuching Hilton Hotel on Tuesday, Oct 7, at 6.30 pm when the specialists will outline some of the latest advances in medicine.
Leading the specialists is Professor Tan Hock Lim, who is the Inaugural Professor of Paediatric Surgery at the University of Adelaide and Head of the Department of Paediatric Surgery at the Women's & Children's Hospital.
Acknowledged as a world pioneer and an international expert in keyhole surgery in children, Malaysian-born Professor Tan will explain how it is now possible to perform complex surgical procedures in young children without needing to make an open cut, using some of the techniques and equipment which he designed.
According to Professor Tan, these new techniques will completely revolutionise how surgical conditions in children are treated.
He will also visit the Sarawak General Hospital where he will conduct a series of lectures to surgeons and will perform keyhole surgery on several Sarawakian Children with Dr Anne John, Head of the Department of Surgery, who is also an Australian-trained paediatric surgeon.
Another member of the visiting medical team will be Dr John Chen, a Sarawakian now living in Adelaide. He is the deputy director of the Liver Transplantation Department at Flinders University and is an expert on liver cancers.
Dr Chen will give a talk on the latest treatment for liver cancers and liver transplantation.

Dr Suren Krishnan, an ex-Singaporean and expert on reconstructive head and neck surgery, will talk on surgery for head and neck cancers, while Dr Martin Borg, an expert on radiotherapy from the Royal Adelaide Hospital Cancer Centre, will discuss the latest treatment for cancer of the nose, a common cancer among Asians. Dr Borg will be making his fourth trip to Kuching and will give a separate talk on breast cancer on Monday night.

Professor Alan Crockett, an expert on chest diseases, will give an update on asthma and other common chest conditions.

"We are keen to share our expertise with Malaysian specialists and to develop links with Sarawakian specialists and to help Malaysia train more specialists," Professor Tan said.

"A new telehealth system, about to be launched in Australia, will make it easy for Sarawak specialists to link up with their Australian counterparts for real time virtual consultation."

Dr Chris Hughes, an authority in telehealth, will tell the Sarawak medical seminar how this can be done.

Dr Krishnan, the Royal Australasian College of Surgeons chairman for South Australia and Northern Territories, says that "coming from this part of the world, many of us would like to give something back" - a sentiment shared by Dr Chen and Professor Tan.

The seminar, to be opened by McEwen, is free and is inclusive of a networking dinner. It is open to the public.

It is jointly sponsored by the Australia-Malaysia Business Council (SA) Inc and the South Australia Government and has the support of the Malaysian Medical Association (Sarawak Chapter), the Sarawak Alumni of the University of Adelaide (SAUA) and the Australia Business Centre, Sarawak.

The free admission is on a first come first served basis via registration. Those interested to attend the seminar can register by contacting Dr. Kiu, of the Malaysian Medical Association (Sarawak Chapter) on 082-874037, or contact Rodger Chan, of the Australia Business Centre in Sarawak, on 082-48388, 483999 or 012-8840033 or email

The Sarawak Alumni of the University of Adelaide can be contacted via Fong on 082-346712 or 016-8592411 or Dr Sim Swee Liang on 082-247693.
Health: Hold on to those pearly whites: "A BIG, bright smile can cheer up a dull day and make anyone feel good. But, says periodontist (gum specialist) Datin Dr Rosnah Abdul Jalil, in order to have a nice smile, you need good teeth and to keep your good teeth, you need healthy gums.

So for the past 24 years Dr Rosnah has been educating people about the importance of looking after their teeth and creating awareness that caring for the gums is just as important.

“Our gums are very, very important. If the gums are weak, the teeth can loosen and eventually fall out,” she says with concern.

Her worry is well-placed. If Dr Rosnah’s observations over more than two decades in the Government dental service can be used as a yardstick, the condition of Malaysian teeth is a cause for worry.

“When I was teaching at the Faculty of Dentistry at Universiti Malaya (UM), I saw that in so many cases people would come in for treatment only when their teeth were starting to loosen. They had no idea that they had a gum disease which was at a critical stage. And once you’ve had gum disease, you will always be susceptible to re-infection because there is a chance that a small percentage of the bacteria that caused it will remain in your mouth,” she explains.

A loose tooth is an indication that a person has gum disease. If it is extracted, it is usually because there is a cavity, not because the tooth is loose. Unlike the shattering pain of a tooth ache, gum disease starts slowly and silently.

“It is a silent disease, happening inside the gum. All of us have bacteria in our mouth and it is normal. Known as the grand positive healthy bacteria, it gets dangerous when the number of bacteria increases, or the bacteria moves into the crown of the tooth if a person d"

Friday, October 03, 2003

Daily Express, Sabah, Malaysia -- News Headlines: "Kuala Lumpur: Malaysian researchers will work with global partners to achieve the worldwide target of eliminating cancer by 2015, Health Minister Datuk Chua Jui Meng said Thursday.
He said the seven institutes under the National Health Institute of Malaysia would be linked to renowned health research institutes such as the National Health Institute (NIH) at Bethesda, USA and the Swedish Karolynska Health Institute.
�We are looking at various fields of co-operation as well as research grants for Malaysians to do research at NIH USA,� he told reporters after a cheque presentation by Marie France Bodyline Sdn Bhd for SMI Women Entrepreneur Award here.
The SMI Women Entrepreneur Award would be presented during the SMI Recognition Award Series 2003 at Sunway Pyramid Convention Centre tonight (Friday).
Chua said during his recent visit to the US, he visited Bethesda and was impressed with the research conducted at the 21 institutes under the NIH there.
�Malaysians are particularly keen to collaborate with the US National Cancer Institute, the forerunners for the cancer research worldwide as well as in the field of bio-science.�
�We are concerned over the cancer cases in the country and NIH Malaysia is hopeful that it will be part of the international collaboration to eliminate cancer by 2015,� he said.
�We will start the international network this month, and the Institute of Traditional Medicine, under NIH Malaysia will establish the link. Already, the China National Academy of Traditional Medicine has agreed to work with us,� he said.
At the same news conference, Chua also said all agencies under his ministry had been directed to enforce the law against the sale of unregistered medicine including imitation viagra pills.- Bernama "
Malaysia to link up with Swedish centre for bioscience research: "KUALA LUMPUR: Malaysia will link up with the world’s largest research centre in Sweden to expand its research in biosciences and biotechnology, Health Minister Datuk Chua Jui Meng said.
He said collaboration between the Institute of Medical Research and Karolynska Institute in Sweden would begin next year.
He also said the country’s national institutes of health (NIHs) would also collaborate with their US counterparts in Bethesda, Maryland.
Chua said the decision on collaboration was made by the Cabinet following Prime Minister Datuk Seri Dr Mahathir Mohamad's trip to Sweden and his own visit to the US.
Research grants, worth about RM150,000 each per year, would be offered by the NIHs in the US to local researchers and scientists to conduct their PhDs, he said, adding that several candidates would be selected by next year for these grants.
Chua told reporters this after receiving a cheque worth RM100,000 from Marie-France Bodyline Sdn Bhd for exclusive naming rights in the upcoming SMI Recognition Award Series 2003.
He also said China’s National Academy of Traditional Medicine has also agreed to work with Malaysia on research and development after the recent visit to Beijing by Deputy Prime Minister Datuk Seri Abdullah Ahmad Badawi. "