The Right To Know

It upsets me to learn that some fellow doctors do not bother revealing the origin of low molecular weight heparin (LMWH) to their patients. It upsets me even more that they think that those who do, shouldn't!

On what grounds? Look, I know most of us have the genuine intention to treat our patients to the best of our abilities. Therefore, my opponents think that withholding a minor detail such as that above is done in the patient's best interest - a so-called therapeutic advantage. They argue that most Muslim patients who were told of LMWH's porcine origin ended up declining its use. They are after all offering the best treatment there is (in the case of acute coronary syndrome - ACS).

But still I ask, on what grounds? If you're a Muslim, don't you want to know if your treatment is halal? If there is no better alternative, the origin or religious legitimacy of a particular therapy does not preclude its use. I usually make it a point to counsel a Muslim patient before I administer LMWH. Yes, it's porcine in origin. Yes, it's the best treatment available (for ACS). Yes, there is an alternative, albeit an inferior one. Yes, in my professional opinion, you should receive this form of heparin. And yes, the final decision is yours.

In the end, if you are mentally competent, able to comprehend and retain this information, the final decision is yours. It's your right, the right to self-determination. In my limited experience, most of my Muslim patients have no objection to using LMWH, since it is undoubtedly the one thing that can save their lives when they present with ACS.



We'd like to think that doctors know best (and want the best for their patients), but let's not also forget that ultimately it is the patient's right to decide what they really want. Autonomy still rules.

My Cup Of Tea

An old love affair has been rekindled.

Ah, the joys of drinking tea...rediscovered.



Growing up in a household virtually devoid of caffeine (bar the occasional root beer, cola or Sarsi during festivities), I didn't begin to drink tea regularly till I was much older. Tea quickly became my new favourite beverage. I love both its taste and after taste; I like it thick and black, slightly bitter, and hot. Of course, I also like what it does to my spirits - one cup and I'm living up to my potential. I could do a million things, I write better, I articulate better. That, as we very well know, is caffeine-driven!

I have tried a variety of tea brands, and so far Tazo has been a sentimental favourite. I remember my first days in Sarawak General Hospital, when my husband and I were housed temporarily in one of the empty rooms in the specialist clinic complex while waiting for the actual quarters to be vacated. Those were such cold days in every sense of the word. The air-conditioning was on 24-7, and I would be reduced to a cyanosed, shivering mess trying to get an express shower at midnight after returning from my "tagging" duty. My only material comfort was my Tazo tea. For that I think I have Wyeth to thank. To promote their antibiotic Tazocin, they gave away Tazo tea bags with their drug papers. What a clever marketing gimmick! My darling hubby had collected an impressive 6-8 sachets from his colleagues because he knew I loved tea. I was wary and slightly confused at first ("you sure this tea doesn't contain any Tazobactam?"), but Tazo had me at first sip.


Over the years I had come into contact with some mediocre tea; you know, those shamelessly watered down, diluted imposters. And the lure of coffee was strong. Even if coffee proved too strong for me initially - giving me palpitations, headaches, and insomnias - I soon crossed over to the dark side. Pretty soon I was downing something like 3 cups a day (which is to be considered massive given my small frame), and I realised I was more dehydrated, edgy, and thoroughly exhausted at the end of the day. One of my resolutions for the year had been to cut down on my coffee intake. First quarter review : partially successful. Will work harder on that.

So how did I rediscover tea? I was at a conference recently and expecting to be fed the usual inferior quality brown beverages passing off as tea/coffee during the multiple tea breaks. But this particular hotel of the many many 5-star hotels I know had this charming little booth where tea bags were displayed and we could have our own pick. Fine tea all, measured in bag per cup, not in parts tea per million. My cup of tea, precisely. So there I was, one tea break after another, trying a different flavour each time, quietly but rapturously sipping my tea in the corner. Ah, the simple pleasures.

For now, I'm sticking with tea. The perfect cuppa? Tazo Awake, an English Breakfast blend, of course.

*Tazo says it best : Before the advent of Tazo Awake, most of humanity lived in a kind of dazed, dreamlike state where nothing much got accomplished on a regular basis. This made organising things like the Internet pretty much unthinkable.
Tazo is available at Starbucks.

Steve Versus Bill

Poser of the century : PPC or Palm? Canon or Nikon? Mac or PC?

While I have sworn allegiance to Canon, and would switch to a Mac in my next upgrade, I still don't own a PDA because I cannot decide which to get.

Anyway, here's a hilarious Steve VS Bill cartoon I found in You Tube. (Note : Bill has the green lightsaber, but why is he the good guy?)

Drug Wars

It's war between the drug cartels (small fry need not apply). Drug pushers are sent out to the streets to ply their trade, and we're caught in the cross-fire. No, I've not migrated to some drug-lord infested South American nation. I simply work in a hospital.

The hospital, or for the matter any health institution is fertile ground for drug-pushing. I don't mean that in a bad way. Pharmaceuticals is a multi-million dollar industry, and understandably it's break-neck competitive. The prescribing policy of a hospital could mean a windfall for a particular company and bust for another. New drugs and old ones given new indications are pushed into our faces all the time. So how does one choose?

Life just keeps getting more and more complicated. Choices, choices, choices! From skin care to hair care to brand of cereal or fresh milk, I am swamped with choices. Consumer products are petty matters. With drugs, my choices can have a huge impact on patients' lives and health economics. So how do I choose?

All drugs being more or less equal in terms of efficacy, tolerability and cost, do I choose based on

• the strength of evidence of drug trials
  
• my consultant's prescribing preference
• the likeability of the pharma rep
• the agreeable appearance of the pharma rep
  
• the support from pharma company (i.e. sponsorship for CMEs, conferences, department, research grants)?

All of the above for me, to a certain extent, with the exception of the physical attributes of the salesperson (there are more comely young lasses than lads in the pharma industry anyway, so not very interested). Our prescribing practice usually mirrors that of our specialists and consultants in the early years, with some fine tuning along the way as we mature into experienced practitioners. Ultimately, most of us prescribe within the confines of consensus guidelines where they exist, and where cost is not prohibitive.

In the meantime, we enjoy the attention. Sales blitz is the latest marketing ploy, where reps sometimes dress and give out lunch packs or snacks according to theme. My favourite so far? Sushi packs, as sushi=fish and fish="mascot" for one 3rd generation cephalosporin. The most desperate? Secret Recipe cakes for energy to last you 24 hours, to remind us of a certain ARB's "24-hour protection".

We are not complaining.

*CME : continuous medical education; ARB : angiotensin receptor blocker

Disclaimer : Opinions expressed are entirely the author's and may not reflect the truth of the situation, and certainly do not represent the views of the doctors practising medicine in Malaysia.

Roma Fan

This is old news, I know. That Manchester United trashed Roma 7-1 like ages ago. Yawn.

Anyway, just thought I'd share this because I find it amusing.

Spotted in my ward the day after the breathtaking match :


The caption should read : Roma fan keeps flag (towel) flying. Poor thing. I bet she didn't even know her team had lost!