Archive for the 'Health' Category

A radioactive imagination

Set against a backdrop of the current Lynas controversy, this film — which is directed by imaginative Liew Seng Tat — explores grim (and at times, comical) scenarios of a post-apocalyptic Malaysian kampung. An enjoyable and educational flick.

Rare earth in Kuantan

The spectre of rare earth has re-emerged in Malaysia. It was reported that a rare-earth refining plant has been built in Kuantan, Pahang.

Prime Minister Najib Razak assured Malaysians that this plant has the necessary safeguards that would supposedly prevent a repeat of the radioactive waste problem that was associated with a closed plant in Bukit Merah near Ipoh. 

According to a recent New York Times report, the Bukit Merah experience shows that “refining rare earth ore usually leaves thousands of tons of low-level radioactive waste behind”. This explains why this controversial project in Bukit Merah gave rise to a frenzyof protests from the local community and civil society groups of Malaysia some 20 years ago.

Given the radioactive nature of the enterprise, it behoves us concerned Malaysians, particularly the folks living around the Kuantan plant, to reflect upon this matter seriously.

GM mosquitoes meet in Bentong

The planned release of GM mosquitoes has aroused increasing interest as well as deep concern among Malaysians.

In Bentong, one of the places where these mosquitoes are scheduled to be released, a meeting will be organised by a coalition of concerned citizens on 26th December 2010 at 2.00 pm to discuss this issue. The meeting will be held at the DAP office there.

Generally mysterious (GM) mosquitoes?

Doubts have been raised by concerned Malaysian individuals and organisations about the impending release of Living Genetically Modified (GM) aedes aegypti mosquitoes in Pahang (Bentong district) and Malacca (Alor Gajah and Malacca districts). The latest expression of concern came from the Federation of Consumers’ Associations of Malaysia (Fomca).

Given the hitherto hazy background to this serious undertaking, not to mention the suspected far-reaching implications on human health, ordinary Malaysians deserve full explanation and assurance pertaining to this GM mosquito project.

Thus, the authorities concerned, particularly the National Biosafety Board and the Ministry of Health, should come forward to provide basic and necessary information.

I reproduce below a long letter of deep concern regarding this planned mosquito release from ‘Ex-vector control staff’ that was published by Malaysiakini, something that merits the attention of concerned members of the general public:

GM mosquito: Too many questions and no answers
Ex-vector control staff
Nov 18, 10
In the letter “GM Mosquito: Stringent protocols in Place” of Nov 9, 2010, Madam Yamuna Perimalu, writing on behalf of the corporate communications unit of the Ministry of Natural Resources and Environment, describes the lengthy (5-year) process that has occurred to develop the present proposal to release Living Genetically Modified (GM) aedes aegypti mosquitoes in Pahang (Bentong district) and Malacca (Alor Gajah and Malacca districts) and attempts to assure us that all issues raised have been thoroughly addressed.

genetically modified mosquito 290810 generic mosquitoIt should be pointed out that the Malaysia Biosafety Act was only approved in 2007 and only came into force in 2009. What safeguards were in place during the unregulated years?

The development of a GM mosquito is certainly a scientific and technological tour-de-force and the accomplishment needs to be appropriately recognised as such. However, what is most disturbing about the present planned release of GM aedes aegypti mosquitoes is the lack of information and further approvals associated with the proposed release as outlined below.

1. Why is the Ministry of Natural Resources and Environment spearheading this undertaking? Doesn’t mosquito and mosquito vectored disease control fall under the purview of the Ministry of Health? Why is the Ministry of Health silent in this entire matter?

2. What commercial entity is undertaking this endeavour and who are the individuals involved? There has been no disclosure of what and who is supporting the GM mosquito and its release (other than the Institute for Medical Research, IMR).

Who is going to produce the GM mosquitoes, who will release them, who will account for them and who will assume responsibility for any untoward events that occur? When it comes to larger scale release, billions of male mosquitoes will be required to be released – who will produce them and be accountable?

3. In the United States, any release of a genetically modified organism that involves humans requires an Institutional Review Board review of the proposed release and signed informed consent of all individuals exposed to the genetically modified organism.

How will informed consent be obtained from all individuals potentially exposed – not just from a few isolated individuals – or are Malaysian lives not nearly so dear to our government? And shouldn’t the review committee include Institute of Medical Research and the University that has an entomology department such as Universiti Putra Malaysia and the vector division, Ministry of Health to offer the opinions and advice?

4. The GM mosquito is designed to control wild mosquitoes that are classified as a “pest”. All materials engaged for the control of mosquitoes are consequently classified as “pesticides” and require registration and approval from the Malaysia Pesticide Board. There is no mention that such registration and approval has been requested or obtained.

5. Mdm Yamuna states that the USDA has approved the release of the GM pink bollworm and the GM fruit fly. This is true. However, these are agricultural pests and are not a threat to human health. To imply that the same level of criteria should be applied to GM mosquitoes, a known human blood feeder and human disease vector vastly oversimplifies the safeguards that need to be considered.

6. Mdm Yamuna further cites other countries, including India, as evaluating the GM mosquito. India has recently rejected the Genetically Modified eggplant – does the Ministry of Natural Resources and Environment really believe that India will then accept the GM mosquito?

7. It is stated that this is only the first step in a multi-step process of approval and is for only the proposed “limited” field trial. How long will the overall process require and how will dengue be controlled in the interim – how many Malaysians will become sick and how many deaths will occur?

8. Under Malaysian law, it is illegal to harbour, rear or propagate mosquitoes. With the GM mosquito, these activities are clearly occurring. Has the concerned business and people obtained an exemption from this law?

9. Are there other competing technologies that can also be considered, that are effective at controlling dengue-carrying mosquitoes?

The above are only specific questions regarding the release of GM aedes aegypti mosquitoes. 

Communities involved must give consent

There are further more general questions (as described in the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) publication ‘Ethical, Legal and Social Issues of Genetically Modified Disease Vectors in Public Health’ by Darrel Marcer).

psm health protest 231204 dracula and mosquito1. Before field release of transgenic organisms, researchers must assess all the scientific and social issues associated with GM vectors and develop safety precautions to address potential risks.

2. The scientific and social risks should be minimised through careful design of the vector system, relevant laboratory experience, and careful choice of site including consideration of appropriate social and cultural factors.

3. Even if there are no perceived realistic risks, a procedure for their evaluation should be set up so that new information can be gathered and interpreted. This procedure may involve establishing a specialised ethical review committee to offer advice to researchers seeking guidance on the ethics of projects.

4. There should be prior environmental, medical and social studies for site selection, and the most appropriate site should be chosen based on the data obtained.

5. Information should be openly exchanged as broadly as possible to relevant community leaders, members of the community, and mass media. This needs to be done with international collaboration.

6. Consent should be obtained from the communities involved. Specific mechanisms for this need to be developed and will be useful for other areas of public health interventions.

7. A contingency plan for aborting field trials needs to be developed. One approach is to engineer a lethal gene for the vectors that can be induced by a non-toxic chemical to ensure total elimination of those that have acquired the genetic construct.

8. Commitment to the local communities involved in field trials should be made that they will be the first beneficiaries of more permanent use of a GM vector should the results indicate that its use is appropriate.

9. Intellectual property concerns should not be barriers to implementation of public health measures using GM vectors or their symbionts and/or pathogens. Prior negotiation, including possible involvement to allow access to the latest technology, is preferable to confrontation.

10. To avoid any suspicion by the public that could result in their rejection of this approach, governments should not involve partners from military research establishments in the projects.

11. The data should be open to all in order to benefit from global expertise and develop international consensus.

12. Whatever guidelines are developed, they should be revised as experience with genetic engineering technology grows, as knowledge of ecology and communities grows, and with societal trends.

Dr Marcer further emphasises that an international approach is required since vectors do not honor national borders, nor is their behavior always predictable.

Has the Ministry of Natural Resources and Environment fully followed all of these suggested guidelines?

Simulations not sufficient

No consideration of mosquito mating behavior and dengue virus transmission is reported by Madam Yamuna or the Ministry of Natural Resources and Environment. Mosquitoes have a complex mating behaviour which requires the male and female mosquito to come within 1 inch (2.54 cm) of each other before their wing beats harmonise in their mating ritual.

dengue 120105 larve in a bottleHow will the laboratory-reared GM mosquito find its wild female partner? In the wild, the adult male mosquito emerges before the female and remains nearby so that when the females emerge, they can go and obtain a sugar (nectar) meal before host-seeking and mating. The GM mosquito has no clue where the wild females are. How will they find them – by sheer chance?

Madam Yamuna reports that simulated, contained field trials have successfully been carried out. At best, this is an artificial situation that bears no relation to the real world. When mosquitoes are contained in a closed environment, they have no choice and will eventually find each other and produce the expected result. In the wild, there is no containment and the likelihood of the GM male mosquito finding a wild female partner is dramatically reduced.

The dengue virus not only infects the salivary glands of the adult female aedes aegypti mosquito, but also the ovaries and eggs. When the eggs are laid, they are infected with dengue, which persists through the larval and pupae stages. Consequently, when the adult females emerge, they are already dengue positive and transmit the virus on their first (human) bite.

Even if they mated with the GM male Aedes aegypti mosquito, the wild female mosquitoes will still be positive for dengue and transmit the disease throughout their adult life cycle. Further, the wild male mosquitoes from the dengue infected eggs will also transmit the virus to any uninfected wild female mosquito that they mate with, thereby propagating the dengue virus to subsequent generations.

The GM adult male mosquito will soon die – usually within 3 days. How many mosquitoes, at what frequency of release and for what period of time will be necessary to control dengue with the GM mosquito?

What if it transmits HIV?

There is a famous quotation from the late Professor Andrew Spielman then at the Harvard School of Public Health:

“No animal on Earth has touched so directly and profoundly the lives of so many human beings. For all of history, and all over the globe, she has been a nuisance, a pain, and an angel of death. The mosquito has killed great leaders, decimated armies, and decided the fate of nations. All this, and she is roughly the size and weight of a grape seed” – from the Preface to Mosquito by Andrew Spielman and Michael D’Antonio (Harvard).

Since the mosquitoes are genetically modified, there is a high probability of it causing a new borne disease in the future and it is advisable not to disturb the natural eco system. Malaysia had its first dengue outbreak in Jinjang, Kuala Lumpur in 1972. Before that, it was unheard of and basically, the aedes mosquito had developed the new strain of disease.

There are many unknowns and unanswered questions concerning the GM mosquito. Science is very good at obtaining answers to posed questions. How do we know that we are asking the correct questions? In science, it is the questions that are not recognised and unasked that lead to the greatest problems.

For thousands of years, mosquitoes have been very clever at devising ways to overcome whatever mankind has thrown at them. What assurance can be provided that that is not the case with the GM mosquito? What would happen, for example, if the GM mosquito were to acquire the ability to transmit the Human Immunodeficiency Virus (HIV/AIDS)?

What assurances can the unidentified business and people provide that this will not occur? What would happen to the Malaysia tourist industry if some unanticipated consequence resulted from release of the GM mosquito – would other countries ban travel to Malaysia – would Malaysian’s be banned from traveling to other countries? What would the economic consequences be – both for tourism and industry if that scenario arose?

The mosquito is quite literally the Most Dangerous Animal on the Planet! What is being proposed is the release of mankind’s most mortal enemy. Can Malaysia afford to take that risk?

Antares hospitalised

I just got to know about Antares’ Malaria infection via Zorro’s blog.

I pray for his speedy recovery.

Antares is known for his deep concern for social justice, human rights and last but not least, the environment.

Side-effects of medical tourism

Just in case if advocates of medical tourism, and others who are excited about this concept, missed this.

The Star reports:

KUALA LUMPUR: Overall quality of healthcare in the country will suffer if medical tourism is allowed to sap medical staff in public hospitals, health experts warn.

North Carolina’s Chapel Hill University’s Maternal and Child Health associate professor Trude Bennett said the glamour and profitability of medical tourism tended to “crowd out” public health.

“Government resources such as land, financial subsidies and tax incentives tend to be diverted to start up private facilities with high technology.

“Meanwhile public health services and primary care will be left to languish,” said Bennett in her speech on medical tourism at the Health Systems in Transition workshop on Thursday.

University Malaya Medical Centre infectious disease head Prof Dr Adeeba Kamarulzaman added that the lure of medical tourism could further lead to brain drain, resulting in the lack of senior doctors and specialists to mentor younger medical staff.

“When that happens, the quality of staff produced would be low and those who leave for the private sector too would be of low quality.

“Without a check-and-balance on medical tourism, the public and the private sector would be affected as well,” said Dr Adeeba.

Why the plan to privatise IJN shouldn’t be deferred

The plan to privatise the Institut Jantung Negara (IJN, or National Heart Institute) should be halted completely as ‘it was not meant to be a commercial institute’.

Malaysia’s most renowned cardio-thoracic surgeon Dr Yahya Awang knows the reason and knows it well. Read below an extract from Sunday Star:


PETALING JAYA: The National Heart Institute (IJN) should not be privatised as it provides training to develop cardiac units in all Government hospitals by 2020, says the country’s most renowned cardio-thoracic surgeon.

Tan Sri Dr Yahya Awang said this was reason enough for the premier heart institution not to go private.

“Currently, there are four cardiac units in Penang, Johor Baru, Sarawak and Serdang hospitals. Even so, the units there are not as well-equipped and well-staffed as IJN.

“We still have a long way to go,” he added.

Dr Yahya, Malaysia’s first cardio-thoracic surgeon, wanted IJN to remain a corporatised body and controlled by the Government.

“It (IJN) was never meant to be a commercial institute. It was meant to be a centre of research, a premier academic institute,” he told The Star in an interview at his office in the Damansara Specialist Centre yesterday.

He added that, as a pioneer who was directly involved in the setting up of the hospital in 1990, he was “taken aback” by the idea of privatisation.

“I was told that even the doctors (at IJN) were not informed of the idea (to privatise),” he said.

On the Government’s deferment to conduct an in-depth study, Dr Yahya said professional opinions should be sought as they were the service providers.

“This is to ensure the academic aspects of it are not pushed aside. However, I am sure, even as you lay all the facts and figures on the table, the right decision will be not to privatise the hospital,” he said.

A change of heart?

The government reportedly decided to defer the plan to sell a substantial stake of the National Heart Institute (Institut Jantung Negara, IJN) to big corporation Sime Darby in light of strong opposition from the general public.

This sudden shift on the part of the government is certainly a relief, although possibly temporary, for many Malaysians, particularly those who have heart-related ailments and, worse, are not well-off.

If there’s a lesson to be learnt from this episode is that matters of the heart — and healthcare as a whole — should involve consultation with the Malaysian stakeholders, i.e. the general public because they are the ones who’d bear the brunt of any form of privatization of healthcare.

There’s another thing we need to be clear in our minds: big corporations are in the business to make handsome profits. They are not there to play charity.

This explains why few people are convinced by the assurance made by the government that the privatised IJN would not hike medical charges after the planned takeover.

Given this context, it is indeed heart-warming to learn that the IJN consultants had expressed their collective preference and commitment, which is ‘to serve IJN in its current form’.

Still taking a leap into yoga

The controversy surrounding yoga still rages on in Malaysia as reflected in the mainstream press. In today’s Sunday Star and New Sunday Times (NST), for example, a few pages have been allocated for the discussion of yoga and its relationship with Islam.

The NST published its interview with Dr Abdulfatah Haron Ibrahim, a professor of Theology and Philosophy from UKM regarding his take on yoga and Islam under the headline, ‘Why create the trouble?’. This is followed by another piece, also an outcome of presumably the same interview, headlined, ‘Yoga, mysticism and Islam’.

In its ‘Focus’ column, Sunday Star ran a piece headlined, ‘In a twist over fatwa ruling’. Here the writer interviewed people such as the religious adviser to the Prime Minister, Dr Abdul Hamid Othman, Syariah lawyer Saidiah Din, Jamaah Islah Malaysia president Zaid Kamaruddin, Pas research head Dr Dzulkefly Ahmad, yoga instructor Suleiha Merican, and Sisters in Islam (SIS) programme manager Masjaliza Hamzah.

While it’s commendable that these newspapers did attempt to bring to the fore the controversial subject of yoga, I feel that more needs to be done so as to enlighten the readers further. For instance, the views of other yoga experts and practitioners should be given ample space to explain in detail about yoga particularly when certain Islamic leaders and bodies claimed that the kind of yoga that is practised in Malaysia has some elements of Hinduism, and therefore can cause havoc to a Muslim’s aqidah.

That said, I thought I’d share this with you what, it seems to me, requires a mental leap after reading the last bit of the Star story. In response to SIS’s Masjaliza’s contention that the religious authorities should not ‘make it a criminal offence to go against a fatwa’, Dr Abdul Hamid snapped in disagreement.

He said: ‘Going against a fatwa is a crime because it is a crime against religion. When you believe in Islam you are bound by its laws. For example, you can’t walk around naked in public.’

It doesn’t take a nudist to tell you that going around in the altogether is a complete no-no not only to adherents of Islam but also other faiths. And I am sure practitioners of yoga are also uncomfortable with the idea of walking unclothed in the public domain.

Put another way, the controversy surrounding yoga may not be as clear cut as baring oneself in public — although it may expose one’s incoherence.

Of yoga and spiritual leap

A few Muslim opposition leaders — apart from Muslim yoga practitioners — have already voiced their concern and unhappiness over what they consider as a blanket ban on Yoga, arising from the fatwa issued today by the National Fatwa Council.

Kuala Selangor MP and also PAS research head, Dr Dzulkefly Ahmad, said that if the intention of practising yoga was for the well-being of the body, mind and spirit, then religion need not come into it.

‘There is no need for this siege mentality where everything is viewed from the perspective of encroaching on Islam and attacking us,’ he said, adding that if one wanted to stray from Islam, there were other ways besides yoga to do it.

Yes, perhaps the Council may want to consider critically examining other areas in Malaysian life where one’s faith in God might become questionable, if not shakeable. For instance, the apparent obsession among certain Muslim politicians with raw political power and their seeming insatiable desire for material wealth that might just decentre, or marginalise, the Almighty in their scheme of things on this earth.

Here’s an excerpt from The Malaysian Insider report on the yoga issue:

PAS, PKR and ordinary Muslims criticise yoga ruling

By Shannon Teoh

KUALA LUMPUR, Nov 22 – Muslim opposition leaders want the National Fatwa Council to be more specific in its edict so that Muslims can decide what forms of yoga are permissible.

PAS research chief Dr Dzulkefly Ahmad told The Malaysian Insider that the council should not make a blanket ban but “lay down what is or is not permissible about yoga.”

“This allows a Muslim to be critical of their own faith and empower them to make judgments based on convictions.”

The Kuala Selangor MP added that if the intention of taking up yoga was for the well-being of the body, mind and spirit, then religion need not come into it.

“There is no need for this siege mentality where everything is viewed from the perspective of encroaching on Islam and attacking us,” he said, adding that if one wanted to stray from Islam, there were other ways besides yoga to do it.

PKR Youth’s chief strategist Yusmadi Yusoff also said that the council needed to be more specific with what forms of yoga it found objectionable as generalising the entire art under a ban was discriminatory and denied Muslims a choice of a healthy lifestyle.

“The form of yoga practised in Malaysia is simply a healthy exercise. If the fatwa is on the basis of religious rituals or inclinations, then it must be more specific and detail what parts exactly,” he said.

The Balik Pulau MP also noted that other martial arts, including those in Malay culture, had religious inclination but were not banned outright and doing so, as with yoga, would sacrifice a lot of benefits as a physical and mental form of exercise.

August 2020

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