Who runs the Ministry of Health?

Letters
by EJB

I refer to the newspaper report “Doctors to be disallowed from dispensing Medicine” NST 29th March where the DG of Health has apparently agreed to a pilot proposal where doctors seeing patients at their clinics only prescribe and patients will then have to locate a pharmacy where they will have to purchase their medications separately. Don’t ask when these negotiations started and who were at the discussions who finally agreed to this proposal. In all likelihood doctors’ representatives were either kept away or presumably threatened with the OSA (Official Secrets Act)

It seems the ruling party has learnt nothing from the last elections. More pertinently one must ask. Is this a dying priority for the Ministry of Health now especially when it reported only these last 48 hours about the lethal outcomes of the dengue scourge which it has repeatedly shown it is unable to control and the rising incidence of resurgent tuberculosis? We will not even discuss about waiting time for patients who queue up to see doctors at 4 am in the morning or of parents begging in the media for financial help to save their sick children.

The DG of Health, one would have thought, would have his hands full trying to pool his resources without digging further holes he cannot cover. But there you are. He appears to have caved in to the pharmacy lobby. This debate is not new. It is ancient in terms of healthcare provisions in Malaysia. The basic contention. Why should General Practitioners or other doctors prescribe when there are pharmacists around? Answer, for the convenience of the patient especially in the rural areas or in locations where pharmaceutical chains open ten stores to show a 30 million ringgit turnover so that they can get into the second board while employing only 5 pharmacists to cut costs. These pharmacists will only be in during shift hours and usually not available after 9pm where the rigors of a 24 hour practice will call upon the dedication and commitment of a medical doctor where treatment and prescription come hand in hand.

Was this proposal also the result of a pow wow discussed quietly and clandestinely in a remote backroom of the Ministry? Or could the flashing of this sudden pilot proposal headlined in the NST’s frontpages an attempt to improve Merican’s rather sagging image recently. However, if Merican and co have proposed this truly in the belief that it is for the benefit of patients, then they cannot even possibly fathom the inconvenience they will now inflict on patients who will have to hop off two different locations for medical treatment especially if they are a distance apart.

It appears that Prime Minister Abdullah Badawi is essentially saying it’s business as usual and may have indeed missed a point what the electorate was trying to point out to him in the last elections. Cost of living has boomeranged out of control for much of the middle and lower income groups in this country. The idea is to reduce costs and keep them down if you can, not increase it. This maneuver by pharmacists with the tacit approval of the DG of Health doesn’t point in that direction. This pilot project appears to be directed to enhance or further secure the business interests of pharmacists rather then a genuine calling to help patients. The Malaysian Pharmaceutical Society president John Chang Chiew Pheng’s statement that this move will not necessarily cost patients more is decidedly less then assuring. Hopefully the new Health Minister, Liow Tiong Lai, doesn’t have a hand in this considering the fact that he denied the statement later the same evening. If he has, then clearly lessons of the past have not been learnt.

The Ministry and Malaysian healthcare in general face some serious problems, especially the lack of doctors, accessibility to specialists, waiting time and rising incidences of some serious illnesses both infective and degenerative. The Minister and his DG with their limited resources must focus on this rather then pander to businesses such as the pharmaceutical and medical equipment industries. It was bad enough during Chua Soi Lek’s time when for some mysterious reasons best known to him; he appeared focused on traditional medicine when the nation was having problems even running its conventional medical services properly. Shouldn’t the MOH be trying to make services more convenient for patients instead of fragmenting them and making patients run all over the place for consultations, tests and now prescriptions? Who runs this Ministry anyway?

EJB

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231 Replies to “Who runs the Ministry of Health?”

  1. This one is the Malaysian Pharmaceutical Society’s proposal for pharmacists to dispense medication to patients. Many doctors not happy. It is the age old question of who encroaches on whose traditional turf and who gets to make the money from dispensing medicine and pharmaceuticals – all of course in the name of the public’s convenience and good.

    The Health Ministry has however not yet decided to disallow doctors from dispensing medicines. Health Minister Datuk Liow Tiong Lai said yesterday he would like to meet the Malaysian Medical Council, doctors and pharmacists to discuss the matter.

    “At the moment, we are still looking at the proposal. We have not made any decision yet,” he said after his first official visit to the Kuala Lumpur Hospital yesterday.

    Se link – http://www.nst.com.my/Current_News/NST/Sunday/Frontpage/2199368/Article/index_html

  2. Some bozos have come out with e-Kesihatan and with such ruling not surprising some UmnoPutras will come out with a scheme called the e-pharmacy so that they can reap off the Rakyat.

  3. In the first place, have we really looked into the ridiculous prices of medicine being charge at various dispensaries? Why is that so? Oh yes, some middlemen made some huge profit out of us taxpayers.

  4. Dear Datuk Liow,

    Congratulations on your appointment as the new Minister for Health. I got your email from the NST today and decided to write to you the thoughts of some of the young GPs in this country.

    I am a doctor practicing in a clinic in the out skirts. I was totally taken aback when I read the headlines yesterday in the NST, wherein the DG of Health was reported to have said that doctors will eventually be relieved from their right to dispense medication at their clinic, another unpopular move by the DG of Health.[ who also happens to be the President of MMC ]

    Indeed there was a lot of rumbling and grumbling on the ground almost immediately and many were not pleased by this statement by the DG. I think sooner or later the DG aims that doctors should be out of jobs.

    There will come a day when medical laboratory technologists will say that they can run blood and urinary tests and are capable of infering results so no need for the doctors to infer results. Then the radiographers will say they can do X Rays and scans and therefore patients who need a X Ray or scan may just walk in to their ” clinics”. As it is the Ministry is trying to face out doctors from the hospital administration. Now we have paramedics who have reached the stage of Deputy Directors of Hospitals. Soon computers may be able to diagnose diseases and there you go………… the mission and vision of the Ministry will be achieved.

    The right to dispense is the right of the doctors and thats why we read Pharmacology in medical school and journals/CMEs now. No one can say that a doctor doesnt know much about drug interactions, drug reactions and adverse reactions. Only fools will believe this. If a patient is supposed to get a priscription from a doctor and go to the nearby pharmacy, what guarantee is it that the medicine is being dispensed by a qualified pharmacist and not a helper in the pharmacy. We all know that you only get to see the pharmacist in any pharmacy if you request to see one and all other transactions are done by helpers with no medical back ground what so ever at the counters. You mean to say these helpers are better than a doctor in a clinic who gives personalised treatment to his patients ?

    I also found the write up about how doctors in Taiwan, Korea went on a strike for 3 days despite government warnings , distasteful. It appeared to me and others that the Government was giving the doctors in Malaysia a warning pre emtively should we also consider doing the same. When there were demonstartions held recently the Government was quick to belittle the organisers by saying that ” this is not our culture “. Well Dato Liow, the dispensing of medicines at clinics in Malaysia has been Malaysian culture ever since time can remember and this system has worked very well in the Malaysian scenario. Kindly do NOT change this well worked, time tested Malaysian culture.

    The guardians of Health in this country are the doctors and not with the Minister,the DG, the pharmacists, the MLTs, the radiographers or anyone else. The body that represents us is the Malaysian Medical Association and NOT the Malaysian Medical Council . Any change in policy should be done in consultation with the doctors and not by free hand forcefully by the Minister or the DG as in the case of the Private Health Act which was bulldozed past us.

    Kindly read this mail with a sense of urgency

    Thank You and Kind regards,

    Once again wish you all the best in your tenure as the Minister of Health , Malaysia

  5. THE FACTS remain that the Ministry has got its priority mixed up.

    of course in most countries like in Australia, the doctors prescribed, and the pharmacists dispensed, BUT like anything else in Malaysia, we “bolehed” the agenda without serious thoughts about the logistics.

    liken to the lrt and monorail and skyrail or whatsoever to improve public transport, BUT, conduit to the ends are not in place to facilitate a smooth flow.

    money is to be made out medicines – THATS A FACT. we are not naive that the profit margins on medicines are high. but, until there are a supporting pharmacy in every medical doctor’s clinic, it is doom to fail. we dont plan.

    imagine, you have a high fever, or vomitting and you need to wait and see a doctor,than drives around and look for a pharmacy. this is not too bad, because some medicines can be bought over the counter. many like guardians and watsons have inhouse pharmacists to dispense controlled medicine. what happened if the pharmacist is not around after normal business hours ?

    like most decisions, its knee jerk reaction to appease but NO thorough thoughts have been done.

    IT IS ONLY GOOD WHEN ALL FACTORS THAT ARE REQUIRED TO MAKE A SICK PERSON WITH IMMEDIATE ACCESS TO MEDICATION IS POSSIBLE, THAN THE IMPLEMENTATION IS FEASIBLE. until than, i hope we who pays have a choice to choose.

  6. typo error
    money is to be made out of the medicines.

    the cost of the antibiotic augmentin is x and is sold for rm 10.00 each at some pharmacy.

    and there are generic and non generic medicine of similar kind.

    the rich gets richer, the poor gets so much poorer.

  7. Let’s be practical, what’s the benefits of disallowing the doctors from dispensing medication to the population at large ?

    None !!! Let me explain why:

    1) The patient would need to travel to 2 different locations just to get the necessary medication. Imagine the hardship inflicted on someone who is either sick or elderly in addition to the extra costs for travel. And the “Malaysian Pharmaceutical Society president John Chang Chiew Pheng’s statement that this move will not necessarily cost patients more” is not less than assuring but downright fraudulent.

    2) Are the pharmacies going to dispense these medications at lower prices? Unlikely, as most pharmacies would not dispense generic drug which are cheaper. By the way, most doctors do not make a major profit from the drugs they dispense anyway and has anyone made a proper study of the differences in prices between the medication drugs available for sale in pharmacies and the price of medications dispensed from medical clinic ? You will be very surprised by the results.

    3) The claim that doctors are less knowledgeable than pharmacists when it comes to knowledge of medicine and modern drug is ridiculous. The prescription would still need to be provided by the doctors and the pharmacists do not have any power to override the prescriptions. This move would relegate pharmacists to the role of “medicine dispensing machine” which is a rather big waste of their talents.

    The current system works well. The doctors would provide the prescriptions and the medications as well. Meanwhile, long term prescriptions for diseases like diabetes and high blood pressure, the patient is of course free to get medication from pharmacies and other approved sources according to the prescriptions provided by medical doctors.

    Is the DG of the Health Ministry so selfish that he sacrifice the well-being of others just to line his pocket ? What goes around comes around ? There will be one day that these rogues regret their actions.

  8. Many countries in Asia allow doctors to dispense medicines: Singapore, Taiwan, Hong Kong, Japan. There is nothing to suggest that their medical care is any worse than that in Europe or the US.

  9. For doctors in Malaysia to have a fair shake, we need a Walk-for-Justice kind of march.
    We have seen that only radical movements and something extraordinary can strike fear into the Barisan Nasional government and knock some sense into their head.
    But such radicalism be seen among Malaysian doctors?

  10. Hey Ministry of Hell,

    What’s the problem with the existing arrangement? On one hand you want to improve on your services to make it convenient for the people to get treatment and on the hand some smart alec is trying to do away with it for whom?

    Don’t force us Rakyat to create a second tsunami okay?

  11. It is normal, now UMNO putras must crack their head to tap the Malaysian. Don’t forget they call themselves “Kerdil” or Dwarf when YB LGE proposed the “open tender policy” they are reluctant to change, they are like childrens crying and jumping to make their parents (Federal Govt.) buy them toys to satisfy their desire. They have become arrogant, and start thinking of how to cheat the rakyat by exploiting all angle. I hope the opposition state don’t obey to it.

  12. it is totally reasonable for pharmacies to dispense based on prescriptions by doctors. but truthfully, pharmacies are already prescribing medicines off the shelf without doctors’ prescription and how is the ministry of health going to curb such malpractices?

    i think there are much more things the ministry should be worried about esp like HIV infection, tuberculosis, dengue which is literally KILLING ppl, rather than be busy with whose rights it is to prescribe!

  13. Like i have been saying all this while UMNO is not fighting for the rights of the Malays …But the right of UMNOPUTRAS.This UMNO guys know only how to take and take and take.

    This UMNOPUTRAS are a shame to the MALAY race..Without the help of the goverment they can never survive on their own.Its sad really sad

  14. YEARS AGO….
    Nori brought her fiancé KayJay home to meet her parents. After dinner, her mother told her father to find out about the young man.

    The father invited the fiancé to his study for a talk.

    “So what are your plans?” the father asked the young man.

    “I am a politician,” kayJay replied.

    “A politician. Hmmm,” the father said. “Admirable, but what will you do to provide a nice house for my daughter to live in?”

    “I will play racial politics,” the young man replied, “and God will provide for us.”

    “And how will you buy her a beautiful engagement ring, such as she deserves?” asked the father.

    “I will play more racial politics,” the young man replied, “God will provide for us.”

    “And children?” asked the father. “How will you support children?”

    “Don’t worry, sir, God will provide,” replied the fiancé.

    The conversation proceeded like this, and each time the father questioned, the young idealist insisted that God would provide.

    Later, the mother asked, “How did it go, dear?”

    The father answered, “He has no job and no plans, and he thinks I’m God!”

  15. Being a mdical doctor myself I prefer to prescribe mdications for my patients and charge RM30.00 as consultation(MMA recommended). Then my patients go to pharmacy to get their medications and pay another RM30.00 i.e total of RM60/=. Whereas I would have charged only RM30/= to RM40/= (cunsultation+medication). So who suffers, the RAKYAT again. Then comes the second tsunami. Is it what you want my dear YB Health Minister!

  16. oedipus, the move is to stimulate the pocket of certain members of the BN coalition at the expense of Rakyat inconvenience. This guy will give all the permits like giving AP to benefit from it. You know lah after election the pocket is getting lighter.

    Ministry of Trade – AP Queen (AP – Approved Permit)
    Minisitry of Health – PP King (PP – Pharmacy Permit)

    Why not we have a chinese PP King if there is no more AP Queen legacy?

  17. Greetings,
    Why the change? Currently this system is working very well. If we think the drugs sell at clinics are more expensive, we can go to pharmacies to purchase them. As mentioned by many people, why make the patients who are already sick and weak to travel through traffic jams and hunting for parking spaces, just to seek cure and then for medication? What works for other developed countries may not work well here. Just like they allow total freedom of speech and demonstration on the streets are irked at by you, the wakil rakyat. So, don’t again think you know best.

  18. Will this prediction turn out to be true?
    http://asiasentinel.com/index.php?option=com_content&task=view&id=1123&Itemid=31

    When parliament assembles in late April, the opposition tables a no-confidence vote against Badawi. Enough UMNO or other Barisan Nasional members stay away for the vote which is carried, forcing the prime minister to resign. Up steps Najib, or Razaleigh, to claim the crown. The BR rapidly comes to regret this move as the new UMNO administration decides to put an end to Badawi’s tolerant ways, blaming him for giving space for the opposition to develop. It cracks down on new found freedoms and threatens or even imposes a state of emergency.

  19. Aiya,lakilompat, how to have a Chinese PPKing when Um…No is still there? Um…No’s policy is still the same. After they have the scoop the cream than they pass to a others to squeeze us further. Oh yes, the Pharmacy Permit looks very very likely to be implemented soon. They already have the company. Times’ running out. They know they have got only 5 years the most. Guess their cronies may have already achieved their objectives to supply almost everything the Govt. Hospital Needs. Now, Guess this must be Phase 2. Sick RAKYATS must buy Medicine from them so that they can make a fortune out of it. Probably, like the tolls. Every year they might increase 10%…My imagination has so far been coming true under BN like the tolls, AP’s, bridges, water, electricity……. Please, please….. Not medicine please. Anwar, LKS please help me to stop my imagination from coming true.

  20. There is nothing wrong with change if change is for the better; as there is nothing wrong with check and balance between physicians and pharmacists (since being skeptics of human nature we’re always talking about check and balance in everything to avoid abuse) but the questions are whether the change is really for the better and whether there is really check and balance, ie who is checking and balancing who, the pharmacist checking the doctor or the other way around???

    The main problem is that pharmacists intend to take away a traditional and pre-existing preserve of physicians (who are also trained in pharmacy) to dispense medicine and make money from it. However if pharmacists do not try to do so, what is the rationale and justification for their training and existence? So let the public and consumer good be the arbiter on this question on whether to separate dispensation of medicine from physician’s work to diagnose and treat – and leave that to pharmacists.

    Pharmaceutical Society immediate past president John Chang argued that, left alone, doctors may prescribe brand names of drugs that are expensive or that they stock. Doctors ought to prescribe “generic names instead of brand names” so that patients will have a choice as advised by pharmacists to meet their budget and needs. “This allows the patients to play an active part in the healthcare system. The average person may never question prescriptions given by doctors. Present system allows doctors to abuse the system without the participation of the patients in decision-making”. There is no check and balance against abuse.
    The argument that patients should be allowed to play an active part in the healthcare system is no big argument and may cut both ways: Pharmaceutical stores too – and not just doctors – can also stock and push their favourite brand names, stocked can’t they?

    At heart of dispute is the question whether pharmacists are better trained than GPs to dispense. Now it is also true that a good GP familiar with drugs can do just as well. So where is the data to support either position??? Also on question of costs : is there any data to support argument that if functions of dispensing medicine are severed from GPs and given exclusively to pharmacists, the cost of medicine without sacrifice to medical needs is lowered vis-à-vis consumers???

    Doctors argue for patient’s convenience. Dispensing doctors, who know about their patients’ health needs and have a full set of medical records, provide a highly valued, convenient, cost effective “one stop” – and immediate – provision of medicines. Rural areas have no pharmaceutical access.

    John Chang however argued that that was only administrative. It was a matter of time, and that with demand pharmaceutical stores would open everywhere including rural areas. John’s arguments of course do not take into consideration whether it is cost efficient for pharmaceuticals to open in rural and sparsely populated areas. Whereas a clinic dispensing medical treatment and medicine and drugs could survive, a pharmaceutical store dispensing drugs alone may not, therefore inconveniencing the patient.

  21. The bottom line is that if implemented – this will increase the cost of healthcare. Pay once at the doctors and another time at the pharmacy? At the moment, if i want to save a bit, I can go straight to the pharmacies bypassing the docs, BUT i would like to have the option to consult them without incurring additional costs.

  22. Oops….sorry to deviate a bit….

    Just read in Malaysiakini that your DAP State assemblyman for Buntong has resigned from DAP purportely in protest of DPP Perak appointing just 1 Indian Exco member in the new govt.

    My my my…..is this the start of something bad for DPP? Why DAP has to pick someone as a candidate who is actually a katak?

    BN must be gleeing with saliva dropping out on the prospect of having a remote chance of grabbing the state govt…..

    LKS pls do something about this….we don’t wan to see BN back in Perak Govt.

  23. Presently, many doctors charge RM30-RM40 in bigger towns/cities for a “consultation-plus-medication” package. In smaller towns/cities, the charges might be RM20-RM30 because of lower overheads.
    Not many people know this, but the doctors’ consultation fees, as prescribed by the Ministry of Health in the Fees Schedule of the Regulations 2006 (which was signed by the Minister of Health Chua Soi Lek in March 2006), allows for consultation fees alone, WITHOUT MEDICATION, to be RM10-RM35.
    If we were to take an average, this would be something like RM25 for consultation fee alone.

    If at present, a consultation-plus-medication package costs RM35-RM40, that would only leave RM10-RM15 for a patient to purchase medication from a pharmacy, under the new separation of consultation and dispensing.
    Would a patient be able to buy all the medication which he presently gets from doctors, for RM10-RM15 at a pharmacy?
    A bottle of cough mixture costs about RM10.
    A strip of 10tablets of Panadol costs RM2-3, and most doctors prescribe 20tablets.
    These two medications alone would cost RM10+RM5 = RM15.
    What about other medications like nasal decongestants and antibiotics?

    In summary, it would cost the patients more, to pay the doctor a pure consultation charge, and also have to pay for medication separately from a pharmacy.
    Not many people understand that doctors are already giving a discount to patients off their consultation fees, simply because they are already making a margin off the medications.

    Would doctors be still expected to give a discount off the consultation fees, if the margins off sales of medication are removed from them? Surely not!

    Then there is also the inconvenience of patients having to go to a different location after seeing a doctor, to buy medication.
    Imagine the extra effort and time taken – traffic jams, looking for parking lots and paying parking charges, or for those who take taxis and buses – the extra fare cost and time involved.
    Can you imagine a patient who is not feeling well, and is alone, having vomiting or diarrhoea, or even a sprain or limp, having to look for a pharmacist after he has consulted the doctor?!

    Perhaps, to overcome the problem, we should legislate that new pharmacies must NOT be allowed to be set up just anywhere! They MUST ONLY allowed to be set up right next to any existing clinics!

  24. what happens to this AN Sivasubramaniam?
    Wanna quit DAP…

    Come on DAP people… we voted you people
    not to see how the infighting of power, but
    we want you people to be the representative
    for rakyat!

    Please always remember that your MAIN
    purpose in joining politic is to SERVE rakyat!

    I am really upset when I saw that news!

  25. Off topic

    breaking news.

    Perak: DAP assemblyman quits

    In a major blow to DAP, newly-elected Buntong state assemblyperson A Sivasubramaniam has quit the party because only a single Indian was appointed to Perak’s state cabinet.

    In a letter to DAP secretary-general Lim Guan Eng, Sivasubramaniam claimed that DAP Perak chief Ngeh Khoo Ham had reneged on his promise to appoint two Indian Malaysians in the state executive council.

    “This is a major blow and a lie to the Perak Indian community,” stated the disgruntled DAP leader in his letter, a copy of which was made available to Malaysiakini. (from malaysiakini).

    What is going on in Perak? Anyone aware about his before it becomes ‘major blow’? Previously DAP Perak has been ‘blamed’ for Po Kuan’s not to stand for GE 2008 and now this.

    Any comment?

  26. hey u guys,

    can some of your please go write on Datuk Sharir Samad’s blog, he doesnt have a single comment yet.

    He may begin to cry and tomorrow in the MSM he may say bloggers have not been fair to him at all.

    Please la, have a heart for the man

  27. By paying RM40-50 for a visit that c/w medicine you guys say its mahal????

    Whats the huha abt the pricing for consultations? I am presently working in Vietnam and do you know how much we have to pay for 1 consultation visit?…Its from USD 50.00 onwards.

    1 of my colleagues had flu and have to pay USD 60.00 for treatment wit medicine.

    Another had to pay USD 150.00 for consultaion with medicine in another clinic which calls itself International Clinic.

    How’s that?

  28. to better understand this situation,u all should watch Michael Moore’s “sicko”,it tells alot about healthcare in the u.s. and all those profit making stuff. having said that however,let me warn u all that not *all* that he said is true,as he’s kind of a biased dude. i think u all know where to get it right ?
    ;-) ;-).

    to really solve this issue as the citizen,it is really important for us to gather the facts straight and then present our case,by posting it in blogs,webpages,youtubes and such, instead of just shouting and bemoaning empty comments like most of the poster here are doing;seriously, do u ppl really thinks crying stuff like story of sleepy man and his cronies-lah,churning rumor and hear-say-lah,kerdil-lah,sugesting rally-lah is going to propel us forward ? lol !

    change and revolution never came from empty bitc-hing alone…..

    every time i was browsing this site i expect to be enlightened,by smart rational p.o.v,reasonable accusation,intelligent arguements with links to solid evidence,facts,pdfs,or at lease some plausible webpages that can back up thier claim,……….

    but nope,it’s all just empty ramblings, like smeagroo’s claim of drug price difference between pharmacy and clinics,where’s the price list ? will ppl who are not living in malaysia take ur claim seriously ?even i who lives in malaysia didnt felt convinced by ur allegations,i kno there’s a slight difference,by how much ?

    to force change,we must strike them where it hurts “them” most,which happens to be thier facial-dermis(been-poy),and the feeling of shame can only be inflicted by world community. as long as we fail to convince the world on what we claim,as long as we fail to expose thier shame to world community,change,if any,will come and pass surely,but sllllllllloooooowwwwwwwlllllllyyyyyyy.
    it’s unfortunate that our goverment have to be shamed into action, question is,will world community put weight on what u think about ur goverment ?

    however adressing megaman’s opinon that all doctors is equally knowledgeable as a pharmacist is not true. there’s some shabby “doctors” that are hired to run those 24hours franchise clinics(penang is full of them) who know alot,and i mean really alot *less* about newer or hi-quality/alternatives medications other that those that they had prescribed day in and day out for the past few years. conditions in some of these clinics are horrible,which i was “forced” to go due to the fact it was my company’s designated panel-doctor.damm……which is what health ministry should focus on in the 1st place.

  29. Perak Chief Ngeh made 2 mistakes:-

    1) Put 3 names when YB LKS proposed the name should be from winning coalition party
    2) Now with this promise, 2 Indians, is this consulted and agreed by YB LKS? Sammy Vellu Sg. Siput is coming back (Ayam Kambing Bag).

    Well it should be resolved as soon as possible, not for individuals (Sammy fight) but for the people who voted them.

  30. From feedbacks and friends in Perak…especially DAP members, Ngeh is not the leader type and he is always promoting camps in Perak.

    If you follow things in Perak DAP you will be able to see the truth in Ngeh. Wonder why in all your years in politics, LKS, you always seems to have this very big weakness in getting or selecting someone who is a good leader and can work for the rakyat and stick with you no matter what….I can think of one ie. Teng in Selangor…though he was sidelined as EXCO…he still stays back and cont to work for DAP and us rakyat. Syabas Teng. Siva should learn from Teng.

  31. chanjoe i agreed with u, u sees, sometime YB LKS can’t do much becos perhaps of different view. U see, YB LKS would like to have candidates selected from PKR – DAP as MB, somehow a name from PAS was been submitted unaware by him, he’s angry too but nothing much can be done except to seek royal pardon. Anyhow, they said it has been resolved. And now with this event coming, (Sammy Vellu is gonna be the happiest man and granted some bullets now to shoot DAP) who allowed this to happen? don’t blame on YB LKS, is nothing to do with him. Is there a black and white promise or just verbal promise to the Indian assembly man that 2 will be taken as EXCO. I hope Ngar Kor Ming can help resolve this, as he’s pretty good and savvy in talking, he should be able to convince the Indians.

  32. As a consequences that YB LKS have foreseen, now there are not enough places for the EXCO seats. Sure something must be fixed as a consequences, now PKR & PAS are happy as the expense of DAP. Quitting the party post is an act of protest against the DAP state leader, i hope Karpal Singh can calm down this man, so that he can continue to serve like Teng.

  33. i think it is important for elected MPs esp those from the opposition to understand they are elected to represent the ppl, and to undo all the wrong that has accumulated in decades of wrongdoing IT TAKES TIME.

    if this chap thinks that by having more indian reps (just like that of the Barisan Nasional) will help… he should re-think his decision. its better to have 10 ppl (of all races) wanting to change the plight of the needy indians, than to have 2 indians wanting to change the plight of the needy indians!

  34. It is a big shock to see this piece of news:
    Buntong assemblyman quits DAP

    PETALING JAYA: Buntong assemblyman A.Sivasubramaniam has quit DAP, leaving the DAP-PKR-PAS coalition government in Perak teetering on the brink of collapse.
    Sivasubramaniam: ‘I cannot accept the decision made by the Perak DAP’

    In a letter to DAP secretary-general Lim Guan Eng dated March 31, Sivasubramaniam said he had had lost confidence in the Perak DAP as it failed to fulfill its promise to appoint two Indian state executive council members.

    He added the decision was a “big slap” in the face of Perak Indians and tantamount to deceiving the community.

    “My victory in Buntong was a mandate given by the Indian community in the area, and therefore I cannot accept the decision made by the Perak DAP,” he added.

    Sivasubramanian could not be reached for further comment.

    Of the 10 exco members sworn in on March 29, six were from DAP, including one Indian representative, Sungkai assemblyman A. Sivanesan.

    In the March 8 general election, the Opposition coalition won 31 state seats in Perak – 18 seats went to DAP, seven to PKR, and six to PAS – while Barisan bagged 28 seats.

    With Sivasubramaniam’s resignation from DAP, the coalition is left with 30 assemblymen.

    Maybe one of the Chinese exco can give way to him. I see merit in the Indians asking for more exco seats otherwise you will be doing what BN was doing all this while.

  35. Teng handle it more professionally, Siva got pumped and Mr. Sammy Vellu is behind giving him a good pump. So now Mr. Sammy Vellu can talk big again for his MIC, come on Siva join MIC, it’s not too late another 5 yrs.

  36. All of us were looking at BN ADUNs or MPs becoming kataks…and even PKR ADUNS & MPs were thought to be more easier to be being kataks….how wrong we are……DAP who everyone thought is solid and strong has started the ball rolling and I foresee more to come….

    Whtas the big deal about 1 or 2 Indians as EXCOs? If thats the case, all Indians should leave Kelantan or Terengganu because there are no Indian EXCOs there at all.

    Sivasubramaniam…you are voted by all races in Buntong…Indians, Chinese and Malays….If you say you are voted in by the Indians, then you are very wrong. If not for DAP you will not be elected too.

    We challenge you to resign as ADUN and then see if Indians will vote for you if you are to stand as an Independent. Shame on you.

    Everyone knows why you resign….be a man and resign right now as ADUN. let the people of Buntong reelect another person to represent them!!!!!

  37. Everything comes so ngam for Samy. Ask for release of 5 Hindraf, then come this Sivasubramaniam quits.

    Oi Samy, up will all your dirty tricks? I am pretty sure this Siva was bought over…

    Money is the root of all evil!

  38. Aren’t we supposed to appoint ‘able’ candidates to the Exco? Racial composition should be good but I don’t think that’s the first criteria for appointing candidates to the State Exco.

    DAP’s Buntong State Assemblyman Sivasubramaniam should be ashamed of himself for such hasty action; that’s not the way to behave. Obviously winning the Buntong State seat has gone to his head but he forgot the people did not vote for him alone, but for “DAP”.

    Sivasubramaniam should know that Party(collective) decision should come first and he must tow the line and not be thinking of himself alone!

    A Sivasubramaniam, you have showed your impatience and true colors, time you say “goodbye” to a political career before it ever begins. It must be DAP’s greatest mistake to have appointed you a candidate for Buntong. I feel sad for the party, not you!

  39. Another shocking news came up from Johor where the Ketua Bahagian UMNO compiled a list of JKR contractors who voted or assisted Opposition parties during the election and the letter and list was forwarded to MB of Johor Abdul Ghani to blacklist the list.

    UMNO never learns. They still want to use the same arm twisting tactics again to instill fear into rakyat rather than using their real work and care to win over rakyat.

  40. Events
    1) YB LKS protest on MB appointment – Exco not enough to satisfy everyone
    2) Initial proposed EXCO seat allocation rejected (DAP will have to sacrifice less seat)
    3) Only 1 Indian Assemblyman elected the other was marginalized
    4) Sammy Vellu (opportunist) still able to bounce back in MIC saying “u all opposition bloody fools, only me can see Pak Lah becos he only listen to me a BN”.
    5) Siva is not bought over, jus protest against Ngee Koo Ham leadership, promised 2 Exco seats, now only get one, if I’m him, i will also resigned as I’m not serving the people I’m serving for dignity & principle.

    Now S’langor Teng issues come back, if Teng not happy he can leave, why not? becos he’s a geniune hero compare to Siva. I must admitted some ppl are emotional, but been emotional is not a sin, if a pretty girl agreed to marry u, but then rejected it, how u will fell? This also allowed Mr. Sammy Vellu mouth to move again and again. He will summon all Indian to go against DAP in Perak, creating a chaos, all he need is proof that DAP marginalize the Indian by promising 2 exco but end up one. He can easily bounced back with wealth of fortune he amassed during his tenure as Works Minister. That’s why he won’t resign from MIC, as it can benefit from cases like this.

  41. Its not even a vote for Sivasubramaniam. Its a vote for Barisan Rakyat comprised of PAS/DAP/PKR. Sivasubramaniam really sucks. He should resign and a by-election should be held to replace him.

  42. Lets consider a few things here…

    1) No doubt he was chosen by various races. He should consider all before arriving at a decision.

    2) Weren’t we supposed to be moving away from the whole ‘Malay-take-care-of-malay, Chinese…Indian…’…doesn’t matter if its a monkey, as long as he/she does the job…for all.

    3) That said, principles also matter…if indeed Ngeh promised as such, why is he reneging? Cooperation is based on trust, after all. And if that is lost, whats the point? Can Siva expect to trust him again when needed? Why should he?

    4) Fong Po Kuan before the GE also pulled a similar stunt and rumours were abound about the Ngeh-Nga leadership. After all the drama, she came back. If she can throw a tantrum and get away with it, why the double stds with Siva?

    ..and are there grounds that this Ngeh fella could be the root of some of the issues??

    We also need good and trustworthy leaders…otherwise, its BN all over again!

  43. Ngeh & Ngar must convince the Indian, else there will be another “Hindraf” the Indian felt betrayed & will turn back to Sammy Vellu. Mr. Sammy Vellu looking at this opportunity will gather his supports again, ppl will still give him a chance as he’s now helping the Hindraf victim and start to attack DAP, saying they are cheaters they don’t walk the promise.

  44. Fong Po Kuan is different. She’s most capable and able MP and that earned her the “cili-padi” nickname that she proudly acknowledges.

    This A.Sivasubramaniam is practically an unknown, nothing compared to Fong Po Kuan. So don’t expect anyone to beg him to stay. To me he’s good riddance!

  45. Again…we have big headed ADUNs who think they won their seats becuz of their own merits.

    Sivasubramaniam….you won becuz of the Rocket symbol and the voters of Buntong voted for DAP becuz they wanted Opposition to represent them in Buntong not U…damn stupid blocked head!!!

    Buntong seat went to DAP becuz its part of Opposition DPP during the GE. Its not becuz you are Sivasubramanian or for that matter you are an Indian.

    Even if DAP put a Chinese candidate, he will also win. Who are you to threaten us rakyat and be so stupid just becuz you are now a YB. I advise you to retract your resignation and work with the DPP Perak state govt to help improve the Indians plight esp in Buntong area.

    People will spit on you when they see in the streets….

  46. typical malaysians, love to shoot from the hip…

    didn’t LKS display the same level of petulance when PAS appointed MB??

    I’m not saying that what he has done is right, but, in all fairness, DAP needs to check whats going on in Perak leadership.

    And the statement that if they put a Chinese also, they would have won is a no brainer…but, it could have been a monkey as well and it would have won…not because ppl like DAP, but because they hate BN!

    I voted the opposition not so much that I believed in them, but because I didn’t trust the ruling party. There is a difference, you know.

  47. By resigning this SivaSubramaniam guy has let down the people of Buntong, be they Indians, Chinese, Malays or others. He is not that smart afterall.

    He must resign from Buntong State seat. Let him stand as Independent, I guarantee he’ll lose his deposit. I don’t think he’ll get 200 votes!

  48. Did some people hide in caves while the so-called ‘political tusnami’, swept across this nation? How else can you explain the idiocy of even someone contemplating this idea at this time?

    What is the rational for this except to generate jobs for pharmacist? Do we have a lot of unemployed pharmacist around?

  49. SivaSubramaniam sux.

    Still having BN racial politics mentality. What is so important in having to have exco same skin colour as you, if an exco can take care of the others regardless of race and religion.

    You shouldn’t have joined DAP. Better join your BN friends.

  50. optimuz : that is the point.We can put anyone and still win in Buntong becuz everyone hated BN. The smart big headed alec Siva Subra dare to counter that the Indians voted for him but what about the others?

    The voters in Buntong voted not for Siva Subra but for Barisan Rakyat.

    I read in the Sun that Semi Value (now no more value) said the spouses of Manoharan & Khenghadaran visited him to ask for his assistance to secure hthe release of their husbands.

    Is that true? Or is he there “blowing water” again? Can anyone tell us if thats true?

    Maybe Siva Subra was so moved by Semi Value’s changed of heart that he resigned from DAP and wanted to join Semi Value to fight for Indian’s rights? Hmmmm….maybe there is logic for him to resign from DAP rite? I wonder…..I wonder……

  51. Separation of prescribing and dispensing is the way forward. Of course pharmacists will face resistance from the Drs in Malaysia as dispensing is one of the things that generates a lot of money for Drs. Drs and specialists get even better cost of medicines compared to pharmacies. That’s why there are a lot of Drs ordering in bulk and wholesaling to pharmacies, although Drs ARE NOT supposed to do wholesale, but is this highlighted at all?

  52. ———————————————
    ———————————————
    achtung ! achtung !

    this post is another shining example of the malaysian mentality.

    the post started with the title :
    WHO RUNS THE MALAYSIAN HEALTH
    MINISTRY.

    some hours latter,it got hijacked,now it’s officially a “SivaSubramaniam”
    comment dump.

    this is why malaysian is always lagging behind,as soon as there are progress,or sense of progress,we got distracted,turn to something else…..inevitably forget what we had set out to do in the 1st place. lol !

    ;-) ;-) ;-) ;-) ;-) ;-) ;-) ;-) ;-)

  53. WHO RUNS THE MALAYSIAN HEALTH MINISTRY

    is not so important but why Siva quit that’s a big problem, is like participating in a joint lucky draw but only selected few get the prizes. If he did not get EXCO he quit, this shows, the DAP leader not all some of them just want power rather to serve the rakyat fair and square.

  54. I’m a registered pharmacist, working as retail pharmacist for bout 5 years. Definately, Dr will not allow this dispensing right to be given to pharmacist, the reason is very simple

    1) Dr dun want to let pharmacy to earn

    2) Dr Study a lot pharmacology? (which only study 1 or 2 semester)

    3) Dr know more drug than pharmacist?
    (pharmacist spend 4 years study pharmacology, who know more?)

    4) This is a trend if this country will like to move forward and not backward.

    If anyone of u do attend those international conference very frequent, try to communicate with those oversea DR. I’ve personally know one Prof. Dr from india. Wht he told me very amazed me ‘ Your country no good, Dr should spend more time diagnosting patient and given more care to patient, not spending more time dispensing medicine which is a pharmacist job’

  55. Ruling gov has not learnt a single thing from the 2008 GE-thats final-no need to argue about it.Health Ministry trying to copy the Indian Health Ministry kot? POhchee lah !!!

    As for Sivasubramaniam- we voted for Barisan Rakyat not DAP/PKR/PAS !!! Remember…as an Indian, I dont mind who represents me as long as he is not corrupted ! Even if there are 3 or 4 Indians reps in Perak…we will only be happy if he is honest and dedicated to serve.But if our fellow Malay or Chinese brothers are willing to sincerely do their best without prejudice…I have nothing to complain.Maybe some sort of compromise could have done b4 you jumped into ‘resignation’! Now we lost the 1 Indian rep. for good.Are you really happy now? Or are you contemplating to join PKR? However, IF Ngeh DID promise to have 2 INdian reps….I wonder why Ngeh or uncle Kit did fulfill the promise?………Tuhan sahaja yang tahu ‘kebenaran’ yang tersirat dan tersurat’ wahai makkal ku di Malaysia !

  56. My 2 cents, this arrangements of having doctors to diagnose and
    pharmacist to dispense the medication sounds familiar and maybe
    based on the winning formula of 1. Indah Water, 2. Fomema, 3.
    Puspakom. All these money making cash cows seems spoken for
    by ‘higher ups’, cornering all these ‘mesti untung’ businesses.
    Correct me if I’m wrong.

  57. I support the motion that pharmacists should dispense and drs focus on diagnosing and i’ll tell u why. Last year my father had a very bad case of cough and it lasted many months.

    We saw many drs and tried many medicines, still the cough persisted. When my father dropped by a pharmacy to buy some more cough medicine, the pharmacist asked my dad if he was taking any medications. My dad was on a high pressure pill and the pharmacist suspected that could be the reason for the cough. He referred him back to his family dr to discuss a possible change in the medication.

    When my dad went to visit the dr, the dr ask who told him that the cough could be caused by the pressure pill and when he heard it was from a pharmacist,the dr said it was rubbish and proceeded to give some more ‘stronger’ cough medicine and antibiotics.

    My dad then went to see another dr, and that dr promptly changed my father’s blood pressure pill. He confirmed that cough is an unwanted side effect of that pill.

    From my experience, pharmacists are like auditors and i will support them in getting dispensing rights. Having 2 stops is not an inconvenience if safety is at sake. Sometimes, I worry that clinic helpers themselves aren’t even qualified. Not all drs know everything and even if they don’t some are too proud to admit and seek knowledge. What a dangerous combination. drs and pharmacists should work together instead of fighting over profits.

  58. If the doctor can dispense the medicine what benefit is there for the patients to get them from the pharmacy. Yes the doctor may not physically handle the drug, but they ensure that correct drugs are provided. If the patient needs only to pay the services to one professional, the physician, why should he pay additionally for the services of a pharmacist? One cannot assume that there is a pharmacy next to every clinic, and it means that the patients not only have to visit the clinic, but to a pharmacy somewhere else most of the time. Why create unnecessary troubles for the patients?

    Is profit motives the reason?

  59. Pak Lah regime is to get things done at higher cost. RM 1 million project suddenly become RM 2 million project. A sick person go to clinic was charged RM 20 with medicine, now with the proposal, the sick person have to pay consultation fees RM 20 without getting any medicine to cure his ailments then he have to travel to town to find pharmacy by paying RM 10 for medicine (u think it is so cheap) this medicine prescription from Pharmacy will cost RM 50-100 also how abt. the cost of transportation to the Pharmacy?

  60. Don’t fall for the trap of the indian who quit DAP, he’s not qualified to be in DAP, DAP is not BN, they are not selecting who to be in the exco based on race, but on their capabilities! I’m a voter in Perak too and I hope people will not fall into the “RACIAL TRAP”, it’s time to change our mind after 50 years!

  61. In what way can the government keep drug prices low or at par with prices before the change?
    Government in developed countries are struggling to control rising drug (and healthcare) costs. Whilst, pharmacies need to keep margins in check to remain viable given drug prices are at large controlled by the government. Drugs sold are largely subsidised by the government or generics are used as alternatives.

    What is the role of the health ministry in pursuing this change?
    Do they have the intention of being the “middle man” negotiating directly with major drug companies at relatively low price by bulk buying and selling directly to pharmacies at a gain? This may force pharmacies to sell at higher prices to the public. Or, the quality of drugs sold will have to be comprised?

    How can the health ministry ensure that there won’t be a possible rise in healthcare cost given GPs especially private owned clinics will lose their income from drug sales which in part help to fund to keep consultation price low?
    Will it be viable for GPs to continue to charge low consultation price if this change is in place? How can the ministry ensure there will not be closures of private owned clinics which play a role in filling in the deficiency of health care providers in the country? This may possibly result in even longer queues in government hospitals and some may be deprived of healthcare services as treatment/ consultation will need to be prioritised.
    Or does the health ministry have the intention to replicate healthcare structure in developed countries whereby, the general public has to contribute a certain amount of their salary to support the countries’ burgeoning healthcare costs.

  62. maybe the present of pharmacy really scare the s*** out of doctors.
    Do u think it is easy for a pharmacist to open pharmacy next to the clinics?

    I myself wanted to open my pharmacy situated in the same row of 3 clinics for public convenience but being denied. The owner first agreed to rent to me, but after knowing that i am going to open a pharmacy, he rejected me… Rumours saying that the owner was afraid of offending the dr.

    Haha…So i end up open my pharmacy about 1km away from the clinics.
    But i can tell u, the doctor’s patient still come to my pharmacy..haha…

    Some answerable questions but not being answered…

    1)Why dont let the public choose who they want to get their medicine from?
    2)Why cant the doctor just write the prescriptions and give the patient a choice whether want to get it filled in the clinic or pharmacy?
    3)Why the patient is not allowed to know the name of the medicine they r taking for? What if in an acute case of child poisoning, the medicine cannot be identified?
    4)Why we cannot separate dispensing right?
    I know, pharmacist know, doctors know, and if u think the public dont know? Think again..

    U see why do pharmacies biz flourish in the first place even without doctor’s prescriptions?

    But do the public have a choice? I mean a choice of getting the prescriptions and whether to get it filled in clinic or pharmacy….hahaha…

    Last word: Just give me the d*** prescriptions…

  63. I think they made a mistake to put him up, and after he win, the true colours of him come out, there’s always some unexpected things will happen in politic.
    I’m confident that the DAP will deal with this matter properly.

  64. The discussions as to whether the doctor or the pharmacist knows more about pharmacology (and therefore which drug suits a patient more) is not appropriate here. The doctor does not write on his prescription form “cough – up to pharmacist to prescribe best medication”. The doctor writes “benadryl” and the pharmacist has to give the exact medication. Hence the issue is whether the patient should get the medication from his/her doctor or take a prescription and go to the pharmacist for his/her medicine.

    There is merit in splitting the prescription from the medication – but only if the pharmacists allow their bulk discounts to filter down to the patients. Doctors don’t get as much bulk discounts as the big pharmacies.

    Why don’t we have a true free market – and let the patient decide if he/she wants a prescription alone, or have the doctor supply the medicine ? The doctor could charge RM30 for a prescription or RM 45 with medication. This way, the patient can never complain that he/she doesn’t have a choice and the doctor is generally indifferent.

  65. AHILA,

    I think you meant :

    “However, IF Ngeh DID promise to have 2 INdian reps….I wonder why Ngeh or uncle Kit did not fulfill the promise? ….Tuhan sahaja yang tahu…”

    – No, there must be more capable guys than this A.Sivasubramaniam, simple as that, as to why he was not selected.

    I don’t think it’s fair to blame Ngeh. I am sure, much as he would like to have a more balanced racial composition in the Perak State Exco, there may be other factors he needs to consider. Furthermore, he too needs to tow the line and respect the wishes and opinion of other component party leaders in BR.

    DAP should have no regret, good riddance to bad rubbish!

  66. Godfather says:
    Doctors don’t get as much bulk discounts as the big pharmacies.

    You’re wrong. Drs will always get a better deal because they are the ones that initiate the treatment and start the patients on drugs. Companies always give Drs the best bonuses to entice them to prescribe their products.

  67. The doctor won’t write expensive drugs, it will prescribe those affordable and effective drugs so that it won’t burden the patients so much. I knew a skin cancer doctor, he’s prescribed good drugs usually cost at least RM 200, but his drugs always work well.

  68. Debacle after debacle.Remember the haste with which the Ministry of Health moved to remove the recognition of the Crimea State medical University? remember the furore that followed. Well, the Indian community never forgot and we showed our anger at the recent polls. Who was the man behind the move to remove the recognition for what were never truly strong reaons? Ismail Merican, the Director of Health. Remember the haste with which the Private Healthcare Facilities and Services Act 1998 was forced through parliament? who was the man behind it? Ismail Merican who was so forceful in defending it but quietly snuck away to a corner and left the ex- Health Minister to defend the fall out.This man was a reason for the Barisan Nasional losing badly in the general elections. Thousands have been made to suffer because of his irrational and publicity seeking decisions. A well qualified doctor is in jail on account of him! Now this controversy between doctors and pharmacists’. Just a fortnight after taking office as the new Health Minister, Datuk Liow Tiong Lai has been left embarassed by this sudden relevation that doctors would be relieved of the right to despense medication at their clinics. Chua Soi Lek was I beleive also in the same spot when the recognition was withdrawn from the CSMU. But as the Minister ,he was forced to defend the decision made solely by his DG. He was also embarassed when the doctor was sentenced to hail for a meaningless offence under the new private healthcare and facilities act. The impact of the act only hit home hard for Soi Lek when the doctor was jailed as he was all along saying the Act would not see such a thing happening. So, who is really running the Ministry of Health. Obviously it is not the Minister of Health, as he is not being effectively consulted. told or advised of matters that have far reaching implications. Clearly, Ismail Merican has usurped the powers of the Minister and has become a power unto himself in the Ministry. This arrogant civil servant uses a journalist in the NST to test all his ideas and also to defend himself. The NST must investigate this journalist and her relationship with Ismail Merican to ensure that the newspaper is not being used to advance his own crusades. Finally, I would also like to ask why ismail merican is still in service. Are there no capable offciers within the MOH to take over? If there are indeed no officers then the Government must be truly ashamed! But i seriously doubt if this is the case. Kick Ismail Merican out before he causes more damage to the MOH, the Minister and the BN Government. As fr as I am concerned, Ismail Merican, like the medicine he is used to dispensing, is past his shelf life.

  69. Hey, Siva! pls use your common sense before taking such an irresponsible action. They voted you NOT because you are Siva or someone that only representing the Indians there. They (Indians, Chinese and Malays) voted you because of the party that you represented which is part of the Barisan Rakyat. If you think that you are there just to represent a certain race, then you are right in quiting DAP and pls VACANT your seat now and stand as an independent (or probably you can join your no value friend in MIC) in the by-election. This will prove your value in the eyes of the people in Buntong on whether they wanted you because of yourself or the party that you have represented in the past, ie the DAP also a colliation member of BR. Although I am not from Buntung or a member of DAP but I strongly believe that you have disappointed thousands of people in Buntung who voted for you on 8 March. Irrespective of whatever promises made to you by your leaders in the past (I think they should have their valid reasons for appointing only 1 Indian EXCO), you should learn how to behave as a junior and toe the line with the leadership and put behind whatever SELFISHNESS. EGOISM and MATERIALISM behind the Buntung people’s trusts and wishes. Pay them back by serving them well instead of BACKSTABBING them in return. DO you think that by appointing you as an EXCO or having 2 Indians in EXCO will serve the Indians better? How about the only one Indian cabinet minister in the current government? Should he quite as well? Siva, pls be more mature, the recent political tsunami had started to change everybody mindset that race-based political is longer important. Every colliation parties in the BR had began to tranform both internally and externally to suite the current political scenarios. If there are no gives and takes, do you think the opposition-controlled states especially Penang, Selangor and Perak could able the govt? So, pls think again for the sake of people in Buntong, Perakians as well Malaysians. Retract your decision now or vacant your seat immediately and you will not be re-elected again (you can play goft with no value friend). Prove me wrong!!!

  70. I am quite perplexed by this debate. Can someone enlighten me as to the difference between Malaysia’s situation and the situation of other countries (like the UK, and saying ‘oh they are developed we are not’ not what I want to hear -_-) where medicine is dispensed at pharmacies which could justify the negative arguments regarding this matter?

    There is one thing though that I think the gov needs to do if they are serious about this proposal and that is to strengthen or even enforce the role of GPs as the first point of reference for patients. I think GPs tend to suffer nowadays because ppl think it’s better to go straight to a specialist for any problems. A clear delineation of roles, and all else being equal, would merely put things (costs and profits) where they ought to be.

    The strongest contention I see is an argument about the rise of costs to patients. I am not so sure whether this is true: my very simple knowledge of economics tell me that it can go either way depending on the particularities of our medical industry. Well, hopefully the gov sets up a regulator to regulate the prices; also, is medication provided by state hospitals subsidized? The range of medicine being subsidized must of course be increased-perhaps in this way the ‘poor’ won’t be as badly affected; I won’t presume to know much about this matter.

  71. ADUN DAP Buntong di Perak keluar parti
    31/03/2008 2:23pm

    KUALA LUMPUR 31 Mac – Krisis kerajaan campuran di Perak masih belum selesai apabila menerima tamparan terbaru ekoran pengumuman Ahli Dewan Undangan (ADUN) Buntong, A. Sivasubramaniam meletak semua jawatan dan keluar dari parti itu.

    Sivasubramaniam dalam surat kepada Setiausaha Agung DAP, Lim Guan Eng yang salinannya dihantar kepada media, beliau berkata keputusan itu dibuat kerana tidak puas hati dan hilang kepercayaan terhadap kepimpinan Pengerusi DAP Perak, Ngeh Khoo Ham.

    Katanya, Khoo Ham tidak menunaikan janji untuk mengagihkan kerusi Exco kepada dua pemimpin India yang dianggapnya sebagai tamparan dan penipuan kepada kaum itu di Perak. – Utusan.

    Im asking MB LKY to start a new thread on this! This is a total disgrace against people trust and vote. Im asking DAP to practise political maturity because since the general election, DAP had caused some problems toward Barisan Rakyat. It should stop blaming others ie PAS for their Islamic State pursuit and start thinking how to change rakyat’s view especially among malays that DAP is not a Chinese chauvinist political party. As since the general election, PAS is the only political party among the opposition that had exercised its utmost political refrain and maturity, the question lies whether DAP would learn from PAS….

  72. Voice, u say that DAP is a party put up best candidate for Exco. Funny to say this we in Selangor have our most experience and best candidate Adun (YB Teng) being sidelined and Exco seat being giving to a 29 years freshie by name of Au Ean. Now we heard that DAP Perak are thinking to put this Indian Adun as Speaker. Wow !! all DAP doing is to put their sideline candidate as Speaker.

    I personally think Indian community reserve 2 Exco in Perak. Before election we know Indian community have a lot of problems but after election all the problems seems gone. They feel being cheated.

    What a way to move forward for DAP. A party being control by Lim father and son. Teach both of them a lesson. Didnt before election both of them said that they always listen to Rakyat voices, but after election, DAP CEC have all the say in picking Exco members.

    “BN BOLEH, DAP LAGI BOLEH”

  73. To YB Subra,

    Anything should be settled in a proper manner, i mean through discussion and consultations with party leaders and by doing this you are of course being described as turning away from rakyat’s trust and vote. The reason why you won that seat is simply the rakyat NO-BN view, and not YES-SUBRA view…

    However it is understandable that the Indians were promised 2 exco seats by Ngeh but in the end of the day, he just gave uguys 1 only. As Perak DAP leadership has been plagued by various problems ever since before the election when the Batu Gajah case, it is understandable that you revolt against their injustice. So im pointing out a suggestion over here…

    1. if you still didnt think that Ngeh delivers his promises, just get out of DAP and enter PKR as a solution so as the trust and vote of NO BN given by the rakyat is respected. Plus this give another lesson for DAP to start showing to the rakyat that its not a Chinese chauvinist party.

    2. I would like to remind and warn you that any move or attempt to enter BN/MIC will see you as turning away from rakyat’s trust and vote. And this distrust will cost you a lot in a very very looooonnngggg time.

    Okay YB, make your move…

  74. kslaw70,

    I don’t think it’s fair for you to blame that the party is being controlled by Lim father and son. If it had been, I don’t think this A.Sivasubramaniam stands a chance at all to be selected to stand for Buntong State seat.

    I understand Malaysian Indian population in Buntong area are furiously looking for him for the letdown; they find his action most irresponsible and suspect he has sold his seat.

  75. He retracted his statement! :) All good again… We need heart stopping moments in our lives to make things colorful and wonderful…
    Make sure all have strong hearts, if not… end up like Zakaria

  76. Yes, the problems of indians need to be addressed as soon as possible, but we have to give in some time to our elected representatives, as the parliament is not even started yet.
    And A.Sivasubramaniam has retracted his resignation from DAP.

  77. The bottom line of the issue is SPECIALIZATION. Are we ready to bear the costs of specialization while savouring the benefits of specialization. Costs and benefits analysis must be professionally, objectively carried out before we mandatory reduce the pocket size of the doctors.

    The crux here is we do not have right kind of candidate to do such demanding job. The ideal party should be Health Ministry, but they command 0 capability and creditability. So doctors shouldn’t worry too much if they want to splash deposit for latest model of BMW, the right of dispensing medicine remaining theirs.

  78. I know this might not be an appropriate title to discuss on this Buntong stupid fellow. First of all, even if he retracted his resignation letter I still think DAP should fire him. How can a MP be so racist? How he ever know that Indian people won’t be getting help at Buntong area when the Exco don’t even start their work yet. Very sad that DAP still having this kind of person in them. I think Barisan Rakyat should really support the implementation of anti-hopping law as I heard SAUDARA Lim Kit Siang had push this issue in 1978 if I’m not wrong. Whoever jump ship no matter BN or BR they should vacate the sit and re-election should be held.

  79. ” In a dramatic turnaround, newly-elected Buntong state assemblyperson A Sivasubramaniam has retracted his resignation from DAP hours after he made the announcement today.” – Malaysiakini

    A very wrong move, so he has now decided to retract his resignation. How can we have such irresponsible ‘kids’ as our Wakil Rakyat?! What a sandiwara but will he ever be trusted anymore by the rakyat who placed their trust and voted for him, or for that matter the DAP leadership? He should look at himself in the mirror! This guy has a very big ego and he has showed how easily he was able to point
    fingers and blame the party leadership for his inability to get promoted(!!) …sigh!

  80. Malaysian healthcare through the MOH is fast becoming a farce. The minister for health sevices and his ministry’s DG have got all their priorities mixed up, whether it is the ruling about the employment of Malaysian doctors from foreign universities which after being recognised gets derecognised at the whims and fancies of the MOH.

    Doctors wishing to undergo specialist training within the country are also discriminated according to race. A certain race seems to be predominantly represented even if they do not merit to be in such a programme. World renowned specialist degrees from UK, US, Australia and other Commonwealth countries are not recognize because these specialists of Malaysian origin seem to have a different skin colour

    The middle and the lower income groups are the ones who go to government hospitals and clinics and wait the whole day for diagnosis, prescription and medicine.

    The well-to-do and affluent UMNOputras, the towkays from MCA and MIC have their 5 star hotel-like medical centres that cater for people with fat bank accounts. Just a visit to any of these centres would set you back by a few hundred ringgit for consultation and medication even for common colds!

    Why is this unholy rush to help the pharmacies? As it is pharmacies are mushrooming all over the place because it is such a lucrative business. Is it the Ministry’s intention to set up another UMNOputra company to bleed the already poor?

    Be prepared for a 2nd and more devastating tsunami if you are still blind and deaf to the plight of the rakyat.

  81. The ministry of health , among many ministries had new buildings , office furniture
    Every one is talking about buzz efficiency and effectiveness, customer satisfaction and bla bla….all becomes non sense because the ownership of all responsibility goes only to the politician’s whim and fancies as in all other ministries , a legacy trait of Bee End work and management culture and it is hard to rid them unless their policy makers get the fxxking boot and out for good.
    THick skin and arrogant , always hides below the bureaucratic red tape always yearning for a overseas visit trip.
    They can do Nothing for malaysian always on the reactive , a bunch of blood sucking idiots draining the our income taxes for the wrong usages and deployment.

    Saya yang mengikut perintah rules okay

    These Fxxxking so call policy makers eats and sleep best under pleasure.

    Dont they ever heard ” IF it AIN”T ROSAK DON”T REPAIR IT”

  82. Maybe the government should put the money into science research and produce a device call Auto-doc. Auto diagnosis and auto prescription. Problem solved.

    Sarcasm aside, the question of health and education is a tricky problem for every nation. Upon dissecting the question, the cause is always the same: poor or in this case, lousy management and power-abuse among the politician(what benefit can I gain from this…), business man(we should patent this med…). In the end, it’s always the people who are suffering.

  83. Why aren’t you blogging about A Sivasubramaniam’s resignation (and his subsequent retracting of his resignation)? Is it because it is race-sensitive?

    “Anyone who says that they fight for all Malaysians need to say (and act) that they are willing to trust in the leadership of another race, that they would be well cared for by another race, rather than bicker about racial representation.”

    DAP needs to acknowledge that it plays race-politics as well.
    Read the entire post here at:

    http://myoe.wordpress.com/2008/03/31/flaming-perakians-and-the-whole-race-thing/

  84. If anyone had tried getting any medication from any pharmacies, they will know that there are NOT a single phamacists on duty when you need one. As a matter of fact, I would say that there is a shaortage of pahamcists in Malaysia………so who may i know is the idiot who propose that we have to run all around town for some medicine knowing well that we wont be able to get hold of a pharmist in the firat place.

    An idiotic proposal that could only come from a bona fide idiot.

  85. Moving back to communal politics is a disgrace for DPP led government. Yes, the Indians have voted for a change through Makhal Sakhti. There are also calls by certain quarters to appoint Indian as Deputy MB. Why not ask for PM’s position?

    As rakyat, we are expecting DAP to lead in the formation of a Bangsa Malaysia. For goodness sake please stop all racial demands. Indian will definitely be rewarded. We need solidarity in ensuring that BN is defeated and UMNO condemned to the core.

  86. I read with interest the comments posted. Many were by person unfamiliar with the medical profession (yes, that includes, pharmacist, nurses etc). Even supposedly learned doctors have some misguided understanding of the role of pharmacist and I would like to rebuke them here:

    From the doctor:
    1. Pharmacist doing the job of doctors. The pharmacist is NOT SUPPOSED to do the job of diagnosis and treating patients. Their sole responsibility is to dispense what the doctor prescribed. So Dr. Drmaharajahrk concern is totally misplaced.

    2. While doctors spend 5 or 6 years in university, they studied many other things like anatomy to cardiology to Psychiatry to surgery to pharmacology (how drug exert its action in the body). On the other hand, pharmacist spends their entire 3 or 4 years in university studying about medicine and yes, they studied a LOT more than doctors on pharmacology. So while it’s correct to say a doctor should know his pharmacology, a pharmacist should know far better.

    3. Dr. Drmaharajahrk mentioned about non-qualified person dispensing medicine. I totally agree with him because I think all those doing the dispensing in the clinic are From 5 or 6 school leavers so don’t bother asking her about drug side effect or to take your medicine before or after meal.

    4. There are not enough pharmacists in some rural area. The same can be said of not enough doctors in some rural area as well. So does that mean that the sick should not be treated by anyone else beside the doctors? And from what I understand, this pilot project is only to be carried out in major towns with sufficient pharmacies and to even oppose that smack of preservation of self interest at the expense of the patients.

    To the layman:
    A. Safety reason. Doctors are also human so will make mistakes. If you doubt the need, just go onto Internet and google “dispensing mistake”. Therefore, we need an extra layer of checking on what’s being prescribed. And universally, the best person to do that job is the pharmacist whose entire training is focused on medicine, their actions, their interaction with various other drugs, their proper usage and dosage, their proper handling and storage. When I was in UK, I read a news report whereby a patient was given excessive dose of some migraine drugs resulting in amputation. The court ordered the doctor to pay 60% of the compensation and the pharmacist the other 40% because he failed in his duty to check the mistake of the doctor.

    B. Quality of care given. When a doctor charges you flat RM30 for consultation and medicine, there will be a huge incentive to cut corners. For example, I notice doctors in Malaysia typically give you 3 days supplies of antibiotic. That’s against doctor’s ethic because that’s insufficient leading to antibiotic resistance (go on Internet to see the huge danger this poses). Overseas, they typically give you 5 or 7 days so the cost of medicine will naturally doubled. So expect to pay RM50 instead of RM30 should he be giving you sufficient antibiotic.

    C. Quality of care given again. Pharmacist will be duty bounded to tell the patients everything he wanted to know about the medicines he is taking. It’s his duty to tell you and your right to scold him should he don’t. To tell you about the medicine’s side effects, the best time to take the medicine, the do and don’t, possible interaction with certain foods, suggest alternative formulation (tablet or liquid or suppositories) etc.. Are you getting that kind of care nowadays? In Western countries, they do. So what the West does is not all automatically bad like some suggested. Not if you think the right to know is a bad thing.

    D. Increased cost. Yes there will be an increase because I have not come across a professional engineer, architect, doctors, accountant, nurse, lawyer, banker and not even your favourite roti cani cook working for free so why should the pharmacist?

    E. Increased cost. No because for the same drug, there are many brands with different cost just like a Channel dress will definitely cost more than one you get from pasar malam even though they serve the same function. Take for example Panadol (Branded name aka Channel) and Paracetamol (same thing or Generic name aka pasar malam price). The price different is 10 folds. With doctor, you don’t get to choose whether it’s the expensive Branded or dirt cheap Generic. Heck, with some doctors, he wouldn’t even tell you the name of the medicine. With dispensing by pharmacist, doctors will be duty bounded to write the name of the medicine on the prescription. That way, not only does the pharmacist knows, you get to know what you are taking as well. The pharmacist can also give you a choice of the expensive Branded or the dirt cheap Generic and let you decide and therefore, pay accordingly.

    I am disappointed with LKS who should have listened to the views of doctors and pharmacists before opposing. Guess old habit dies hard and simply oppose everything for the sake of opposition. Shameful.

  87. LKS & Kula, what are your comments? Please keep us rakyat and loyal DAP & DPP supporters posted whats the situation status now?

    Kula was the one who strongly nominated SivaSubra as candidate for Buntong but now diam diam and kept us in suspense.

    This is not helping the just cause of DAP and DPP.

    Pls response.

  88. The foolish acts that this Sivasubramaniam has shown us that the choice to leave him out of the exco list is downright right! This is not the issue about the equal representation of Indians community (we already have Sivanesan), but rather about his personal selfish gains which he has been rightfully denied of.

  89. Even if he retract his resignation, his term is as good as terminated and he should only be allowed to serve and service his Indian voters for 1 term only. No more of such character.

    Elected not even 1 month old and already started to turn coat. Its true that its lucky he was not appointed an EXCO or else more damage would have been done.

    Well, it seems Perak DAP Perak is jinked to have outburst of stupidity as shown by 1stly, Fong Po Kuan, then 2ndly LKS and now Sivasubra.

    Please put a stop to all these nonsense and act wisely. Count to 10 before you spurt out your next outburst.

    Thank you.

  90. Is Mr. Liow Tiong Lai a qualified doctor? Is the nation really incur a severe brain drain that there are no other better talents available to be promoted as the Minister of Health? Mr OKT must be highly accountable if the health system in Malaysia deteriorates due to his promotion system based on party loyalty instead of meritocracy.

  91. This Sivasubramaniam is an opportunist, that’s all.
    Yes, he should look at his face in the mirror whether he is deserve a seat in the Exco. So easy arhh, for a jobless guy, malu the BR government lah.

    He should thank the DAP leadership for their magnanimous gesture, still talked him into retracting his earlier decision.

    If not for the BR Govt’s position hanging by a thread of 30 seats against BN’s 29 in the Perak State Assembly, as a result of his departure, I think the DAP will tell him to go fly kite! But resign first.

  92. If anything, the Ministry of Health should do is to ABOLISH DUTIES AND TAX on medication; if they really want to help the Rakyat!

    Do you know how much is the price some medication. A person with a heart condition or high cholesterol, or diabetic could expect to pay between RM20 to RM5 per dose, and most times its a least two dose a day, imagine RM5x2x30=RM300 per day minimum,

    Why is our politicians especially the ones in BN always conspiring on how to rip us off instead of fighting to reduce cost of living for those in need?

  93. I think we can tolerate a dual system.
    Doctors can still provide medicines but perhaps the patient can opt not to get from the doctor. This means the doctors’ bill should have separate charges for consulting and medication so that the patient knows the details.

    The doctor should also give a prescription for drugs that have been prescribed allowing for a 3-months supply for long-term medical conditions.

    One aspect of this problem that has not been discussed is that it is quite easy to get prescription drugs from pharmacies that know you even without prescriptions. And some pharmacists will do a quick diagnosis for common ailments to recommend medications.

  94. Which MoH approved this arrangement? Current or previous? The choice should have been left to the patients. With the doctor, it could be a little cheaper since he has also charged consultation fee; Whereas with the pharmacist, it could be higher, after all, he can charge only for the medicine sold.
    MoH, just leave it to the patients to decide, you don’t need to interfere!! F…K off !!

  95. The best way to get cheap medicine is to do away with doctors and pharmacist all together. Most drugs should be made available to anyone who wishes to buy them. If somebody wants to kill himself by self medication so be it. It is his choice. The country is better off with one less stupid idiot.

  96. Angus, i still think that doctor should allow the dispense of medicine but with a certain scale. Maybe for instance we set a scale of medicines from 1 to 10. Doctors are allowed to dispense for example medicine in the range on 1 to 5 for instance. I mean don’t expect patient to go and see doctor for fever, then have consultation have to go pharmacist and get medicine right? Troublesome.. :)

    Just my 2 cents!

  97. Doctors spend only part of his 5 or 6 years university time studying medicinal compound but pharmacist spend his entire 3 or 4 years studying medicinal compound. Therefore a pharmacist should know a LOT more than doctor on medicinal compounds. He has legal and professional responsibility should harm comes to patient.

    Doctors are human and do make mistakes. I surfed and there are far too many reports of patient being harmed by wrong medication. The job of a pharmacist is therefore, to act as a safety device to prevent those mistakes. Like every other profession, he should be paid for that service.

  98. Firstly….Malaysia Health systems have been stuffed for 50 years thanks to UMNO-BN.

    2ndly – MMA wants to control their turf, power and $$$$$ (a legacy of UMNO-BN mentality) from pharmacy dispensing.

    3rdly – Pharmacist after years of being ignored and just act as Sales people is TOO insulting to their hard earned degree. Therefore wants to maintain a global status quo….where Pharmacist make and dispense. They are specialist on medicine per say!

    A doctor SHOULD can prescribe but Never should dispense. A Pharmacist should never consult but only prescribe.

    Unfortunately in all these its the doctor who are GREEDY….they want the cake and eat it all. WHen they cannot cure you with their “sub-prime” medicine they ask you to go to chemist and get better stuff. There is no control of the Shelf life of all Doctor’s medicine…….cheaper is not necessary better.

    In the mean time should a Pharmacist with 4 years of Specialist training be confined to sales job…….is this the direction for a better Malaysia…..certainly not!!

    Malaysian Doctors have also lost their Moral high ground where they have put $$$$$$ above health. In specialist hospital…they purposely keep people alive for a period so as to make more $$$$$ as you stay there longer….Kind of False hope to burn your money…..believe me Doctors Practice too needs a Royal Commission……like the Judiciary….etc.

  99. This blog confirm full of doctors one. U see every time something on health care pops up on this blog, sure got the highest number of response one.

    Doctors can be quite bitter at times, maybe too smart kua, as the saying goes ignorance is bliss… doctors are not ignorant, maka no bliss.

    MOH must use brain and think, is Malaysia suited for this kind of system. Many Malaysian Private GPs are struggling to make a living, if you deny them even the little bit of money they earn out of selling some pain killers and antibiotics, how are they going to survive?

    Tolongla wei, doctors life bad enough la… you DG don come make things worse can or not?

  100. Three things I need to comment here. The first one is about this doctor/pharmacist issue. I am trying to put myself in a scenario like this. I am very sick. My fever has a temperature that is near 102. If this was not bad, I am also suffering from chills and body aches. I am taken to a GP to have a look over. After the check up, I am given a prescription to get my medications from a pharmacist. As soon as my car reaches the main road, there was a hugh traffic jam which is so uncommon in KL. I have to bear the suffering in the car until I manage to find one pharmacist nearby, and it took me almost 45 mins to reach the outlet. Upon arrival at the pharmacist, I still have to wait because the staff have to attend to customers buying non-medical products in the shop. I was told that today is the dispenser’s off-day and that I will be attended to by one of the ordinary (read “untrained”) staff. Incredible as it may seems, but the scenario is real.

    In fact, what I would like to know is, who is this Liow Tiong Lai? Is he qualified enough to head the Health ministry? Was he in any medical practice before entering politics? During the recent GE, these BN guys have been telling the rakyat not to vote for the opposition as they don’t have experience in administering the state. Now we have one bloke who has no medical background and running a health ministry?????? Someone must be joking ……..

    Finally, our friend Sivasubramaniam. The BR has been voted in to run the state on a multiracial platform, so for heaven’s sake, think multiracial and not Indian. Although we are glad that you have rescinded your decision to quit, but patience has its virtue. We have a long struggle ahead of us and we must stick together no matter what. Being new in managing a state, there are bound to be teething problems. I guess the best remedy is have a chat with the party leaders concerned to have your views aired. Quite frankly, being a Chinese Malaysian, I don’t care even if the state exco is made up of 10 Indians or 10 Malays or 10 Senois or 10 Negritos. So long as we have good people running our state and that we are not ripped off in the process, I can then sleep peacefully at night.

  101. Mr. Lim,

    If the outcome is unfavourable , this can impact the society at large. The middle income group will bear extra financial burden, whilst the poor and the needy will be hit worst.
    As it is, a large number of these group of people are deprived of good and affordable healthcare. There are cancer patients who are too poor to seek medical help whilst there are doctors who out of kindness are able to charge the poor lower consultation and drug prices via the gains from drug sales. What is the objective of the health ministry in pursuing this change?

  102. I don’t think we are ready to have such a system implemented. Will a pharmacy open up a dispensary in a kampung with just say 5000 people? Who (pharmacist) would like to be based there?

  103. Many people talked about conveniences but that’s often at odds with safety.

    For maximum convenience, we should allow any Tom, Dick & Harry and bomoh and sinseh next door to do the diagnosis, treatment and and dispensing of antibiotic etc. Too much trouble having to go see a doctor that could be miles away.

    For maximum safety, we should only allow qualified doctor do the diagnosis and treatment and let the qualified pharmacist do the checking of prescription for possible mistake.

  104. Talking about unqualified person doing the dispensing at the pharmacy. I thought that’s what going on in doctor clinic with the young girl doing the dispensing. Try asking her more about the medicine like what’s it for, best time to take them, what are the side effect I should look out for and likely to draw a blank. But it sure is conveniences and not having to find a pharmacist to ask those questions.

  105. When tomorrow come, we should change the Federal Govt. for burdening the Rakyat, all these Federal appointed Ministers are giving more trouble to Rakyat rather than help ease the burden especially when globalization is in the brink.

    Do u still want to vote for BN? for higher cost?

  106. some of us seem to think that doctors are some kind of super humans who can find cures for all your ailments. Wake up man! As a thinking human, your should be able to understand your own body better. I have seen too many doctors dispensing potent drugs to the ignorants for quick cure. They are not the exceptions, they are competing for sure cure!! Maybe you can find a small % of them sincerely trying to advise the truth.
    I came across an incident of a young man who woke up to find his 87 year old mother suffered a stroke. Panic, he sent her to the private hospital. Within the stay at the hospital, she was operated 4 times and the family was landed with a bill of nearly 100k!!.
    When the sister related to me the incident, I asked her what car the specialist was driving? Let me guess! Must be Porchse! Indeed he owned 2!! according to my friend.
    Would anyone in his right mind seek to put a 80 plus patient throgh 4 major operations in such condition? Trying to find cure??? B…S Nothing but $$$$ was right infront of the eyes of the doctor. I did tell her that they should bring up the case or just leave the mother with the doctor!! Talking about morality?

  107. Mr Lim,

    The Health Minitry should concentrate on Pertinent healthcare issues as follows:

    1. Resolve the issues on Pharmicists not fully utilising their expertise.

    2. The inability of girls in clinics not being able to provide info side effects (this should be directed to GPs)
    (KKK I have to borrow your statement if you don’t mind)

    3. Providing affordable and better healthcare to the poor and needy
    and overall improving the provision of healthcare to the general public,

    4. Minimising waiting time and long queues.

    5. Resolve the plight of overseas graduate Malaysian doctors being deterred from practising in Malaysia.

    Can the proposed change address health care issues which is not limited to the above?

  108. That is not fair. Like any profession, there are black sheep amongst them. I have also seen excellent doctor with high standard of morality and ethic.

    But those doctors who oppose extra safety like not wanting their prescription check does make me wonder their true motives. Or may be they think they will never make any mistake.

  109. jetainme.f, i think your idea is very relevant. Most doctors are high level in those multi level marketing programs as they dispense those products to their patients which i think is totally wrong.

    doctors are now like a money making machine. So i hope all the doctors in malaysia can change for the better of our country.

    Jom Ubah! :)

  110. I don’t trust the hospital alot, my grandpa was rushed to Malacca hospital due to diarhoe, they put all the needles into him and diagnose everything, they pump in really strong medicine till my grandpa become unconscious, then he was very weak to wake up again becos he’s 80. In the morning, he can still drive to nearby clinic becos he got severe stomache, he’s driving a vios at 80. He never got chronic disease, and still healthy just that day only all of sudden like it is fated. My uncle rushed in to Hospital becos he’s shaking badly.

    I was working in Penang when that happen, my mum told me, they put many stuff in him, the whole thing cost us RM 30-40K just for a diarhoe they sentence him dealth penalty. He was sent back to our new Bungalow in Kluang, that’s a new bungalow we build and it is his last wish to die at new home. The funeral take place at the new bungalow, i hold his hand there, and carry him to the casket. It was very sad, how d fk the hospital treat and old man, take blood sample, cucuk all the pins here and there make it like he’s in critical condition when in the morning my grandpa can still drive around his vios.

    I saw the diagnose report, they said no virus found, and he’s just too weak to wake up again (overdose) case. But what can we do, my grandpa is dead already. I still hated the Malacca hospital alot.

  111. “One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes, according to a report being released today by two nonprofit groups that are urging all hospitals in the state to install a computerized prescription ordering system” 2008.

    And this is in USA and already with pharmacist checking. Can you imagine the amount of likely errors in Malaysia with no pharmacist checking and no computerized system? As I say, for increased safety, you have to give up some convenience and increased cost. There are no free lunch in this world.

  112. Doctors are charging a relatively low total “consultation-plus-medication” package presently, simply because they are heavily subsidizing or discounting their consultation fees.

    IF doctors are NOT allowed to dispense medication anymore, they will simply STOP giving subsidies or discounts. It’s as simple as that.

    Doctors will charge what they are allowed to charge for plain consultation alone.
    And, under the law presently, they are allowed to charge up to RM35 JUST FOR CONSULTATION ALONE.

    Can you imagine paying RM35 just for consultation, and then have to pay extra to buy medication from the pharmacy?
    This extra also does not yet include the extra expense (taxifare, busfare, parking fees, petrol) plus the time and effort spent to travel to another place just to buy medication.

    imho, the BEST OPTION, is to give the option to the patient.
    Imagine, if a patient offers the patient:
    CONSULTATION ONLY: RM35/-
    TOTAL CONSULT+MEDS: RM40/-
    Which will the patient choose?

  113. KKK stop been evil, ur name said u r an evil person, Klu Klux Klan is a bunch of whiteman clan who encourage mass slaughter of Black man in US.

    “for increased safety, you have to give up some convenience and increased cost. There are no free lunch in this world.”

    At the expense of Rakyat? U shud have a petition to hear whether public prefer higher cost and more inconveniences? All the rich ppl don’t go to clinic, they normally have family doctor, the problem is the Rakyat who are poor, KKK suggestion will leave them dying at home.

  114. As I said earlier, for maximum convenience and lowest cost, we should allow any Tom, Dick & Harry and bomoh and sinseh next door to do the diagnosis, treatment and and dispensing of antibiotic etc. And not let doctor has the sole monopoly to give antibiotic. Do you agree to that, lakilompat?

    BTW, do you get paid to do your work? If yes, why shouldn’t the pharmacist?

  115. The Health Ministry should also be questioned on their role in providing healthcare to the Malaysian people?

    If they are in dire straits of funds which I believe they do (the nurses and doctors working for the government is not getting the pay they should get, poor health care services provided, poor infrastructure), the Health Ministry should be pressing the Federal Government for funds and requesting the government to stop splurging and use the RM110M on healthcare instead of spending it on the aeronautical segment. The wealth should be distributed to the area which is most needed – healthcare and education. The people does not have the means to take on extra financial burden given the overall poor salary they earn (check the per head GDP compare to other countries) and the country’s current economic structure.

  116. It is the government’s responsibility and duty to the people to ensure the funds generated by the people is redistributed back to the people in the form of good healthcare and education, etc. and to have the ability and calibre to increase the nation’s wealth through sound investments so that the people can continue to enjoy the most basic needs of life. Singapore’s tax rate is relatively low, yet the people can enjoy better basic healthcare services compare to Malaysia. Why?

  117. KKK, i agreed, anything to much monopoly is bad, what i try to defend is that, we shouldn’t trouble the Rakyat by creating too many inconveniences. In overseas, the doctor will not give medicine, they only charge consultation but will give a note or recommend where you can dispense the medicine. One of the country i lived, Mauritius, is practicising such. Well, the medicine they imported are very very effective compare to the medicine we can buy from Malaysia pharmacy, have u heard of Coldrex, it is very good flu medicine, but not sure which pharmacy have stock them. Are Malaysia ready for world class pharmacy? When I’m Canada, i got real sick of coughing, the landlord, is a German Canadian a certified pharmist from University of Toronto, he don’t give me any medicine, jus “chicken soup” very thick one, once i drink it, all the flame start to subside. Some of the knowledge is pass on, you don’t need a doctor to cure ailments. I mean not everytime have to go pharmacy to dispense medicine, it will be more convenient to get em at clinic.

    Every pharmacy license must be registered with a qualified pharmacist, if not u won’t be able to get the license that’s minimum requirment to obtain the license. I knew MOH is trying his best to voice up for Pharmacist as they study for so long ending up not getting a fair share of profit from doctor. I’ve a cousin who studied pharmist but she drop it because the mother said no future for pharmist, at first they thought it worth it then they drop it she ended up studying accounting, now working in MNC rather than opening her own pharmacy. You see, because everyone is eager earlier on, becos there are only few pharmacy, but now it’s booming and they started the pharmist started cry hungry and wanted govt. to send them some lambs to make lamb chops. That’s what MOH is doing, to fight for the rich! at the expense of Rakyat. By the way, my cousin family is pretty which they owned several traditional chinese “kedai ubat” luckily the mother advised my cousin to change course, else he will be voting for Barisan Nasional for this bill to pass.

  118. My argument was. If you wanted increase safety, you will have to pay for it. But of course, you can also reject having increased safety so don’t pass this bill.

    There are always two side to a story and many people only know about the negative part of this practice aka extra cost and inconvenience. Even our LKS. Not many know about the positive side and that what I am trying to get across.

    You also brought out another issue about why some medicine oversea are more effective. The reason is simple. If consultation alone is RM35 whereas Consultation+Medicine is only RM40, then ask yourself: How good is that a RM5 medicine?

    If you only pay for consultation, then doctor will be free to write the best & most effective & often most expensive medicine on the prescription for you because he is no longer constrained by the RM5 limit. But are you willing to pay for that? From what I read here, many aren’t so you shouldn’t complain when our Malaysia medicine is less effective than those in Western countries. As the saying goes, “You pay peanut, you get monkey.”

  119. Well, if u import good medicine at large batch without paying those cronies, u will get cheaper medicine compare to overseas.

    Problems not lies with the Rakyat, is the MOH who allowed cronies to breed freely and reap from this move.

    If I’m running the federal government i will try to control the price of good antibiotic, negotiate a good price, and check for latest drugs in the market. In overseas there are many good medicine at cheaper cost, such as Australia at the moment, Australia drugs cost RM 200 above, but is very good. The problem is, our MOH did not help the Rakyat, they don’t give a sh..t ok, they only treated ordinary folks like lambs, if wan better pay for it. It should be the govt. to negotiate and seek for better drugs, what’s the budget allocation for MOH each year? did they fight for Rakyat? the Rakyat can’t be burden or marginalize anymore. They can afford to send “good looking malay” to space but can’t afford to use the funds to ensure cheaper drugs for clinic?

    The BN cronies already filter 1 layer of cost into their pocket before it reaches the pharmacy shelf, now the Rakyat have to go get them by themselves.

    How nice! is the arrangement, anyone know why there is Perkeso when there is already several existing govt. association?

    It is not negative! it is the facts, if u deal with ppl like Sammy Vellu u will know his gangster style. “Mana ada bocor, bocor sini bocor sana, semua adalah tipu, kalau ada bocor mari jumpa saya, saya office ada buka, bila bila mereka boleh datang jumpa saya”. That happen when cases of kebocoran happen everywhere. See him also no use, he just good talk only, but what i mean is ppl. no longer trust Federal govt. they are robbers, they are just sitting there bidding their time to be replaced.

  120. The Ministry of Health has the responsibility to provide basic and safe healthcare to all. The people should not need to pay for basic “safety” needs. If there’s additional value add to the already safe and effective healthcare system, these extras will need to be borne by the people who demand for the extras (including the “extra safety” element).

    How can the Ministry ensure that this “separation” proposal/ policy does not result in economic costs outweighing the benefits to the society (including the poor).

    And if the costs is greater, wouldn’t this be the government’s responsibilities to ensure that these are provided to the public at minimal or no cost simply because this is the basic needs that every society has the right to enjoy.

    Alternatively, if this is to be passed on to the public given perhaps the Federal Government does not have the capacity to fund, why can’t the Health Ministry pressure the Human Resource Ministry to look into factoring that costs by increasing the salary of the general public or get the corporates to bear the costs?

    The poor and low income earners should not be excluded. The poor and low and medium class household income earners should not need to pay for these costs.

  121. If the Health Ministry insist that these costs is to be borne by all, the Consumer Affairs Ministry (if there’s one) should be playing its role to work on ensuring the prices of goods & services and petrol costs is depressed to the level that is affordable by the general public such that the people can be “stress free” and Chip in to pay for these costs.

  122. I would like to share some of my experience of practicing pharmacist in Australia. In Australia, Doctors are still allowed to dispense, provided with NO PROFIT make from dispensing medication. The results of this is 90% of the Doctors are not dispensing any medication. Why so?? When there isn’t any profit to gain, no one is bother to do it for the sake of convenience of the patient. 10% of the Doctors are still dispensing because there are no pharmacy around especially in the rural areas. Another issue about very sick patient seek for immediate treatment do not have time or unable to search for pharmacy. To overcome this, all Doctors in Australia have a Doctor’s Bag that have all the essential injection for emergency treatment. The patient can get a injection to relieve fever or pain before they leave the clinic to get the prescription filled. Talk about convenience, would you rather have better treatment outcome or convenience? Talk about cost, how many of you know that the doctors actually getting a better price from the pharmaceuticals company? The pharmaceutical company offer the doctors better price, perks and incentives so that the doctors use more of their products. Is this good for the patient?? If there is a separation, the doctors will make more rational prescribing instead of stick to the one that they stock. You might argue that the pharmacy will then have same problems but the patient have the right to choose where to filled their prescription and the pharmacist are not allowed to change the prescribed medicines (except substitution of generic where patient can choose from). One thing Malaysia should do before starting the separation is that No Pharmacy should be open for business if there isn’t any pharmacist present. Last but not least, do we need a 24hour pharmacy? If Sydney with a population of more then 5 million can do away with less then three 24hours pharmacy and clinics, i am sure we can survive. After all, the emergency cases should always refer to the Hospital A & E.

  123. I am in the pharmaceutical industry so know a bit more than the typical layman as to how good Western medicine became so expensive in Malaysia. And yes, it has to do with some stupid government policy. And that’s what DAP should be gunning for instead of sensationalizing this dispensing issue.

    Let me take the drug Viagra as an example. It’s made by the Western drug company Pfizer and still under patent. Once a company (ABC) registered Viagra with the Drug Control Authority of Malaysia, they will be given the SOLE right to import it. Even if you go to Pfizer USA factory to buy the exact same Viagra, you will be not be allowed to import it into Malaysia even though you own a legal pharmacy or clinic. Sensing this, ABC will price Viagra at a very high price because they now have a monopoly in Viagra. Same with many other drugs.

    Another issue is lack of alternative to patients. Taking Viagra as an example again. It is still under patent which means, beside Pfizer, no other company can produce and sell it. But in country like Canada, before Pfizer is given the approval to sell it in Canada, they must first license another company to make Sildenafil so effectively introduce competition. Therefore Canadian has the opportunity to buy Sidenafil from 2 different companies at lower price. This is something DAP can bring up in Parliament.

  124. dap-for-pj,

    may be for you, these DAP ppl are stupid …

    but if abdulllah asking these stupid DAP ppl whether he look like Britney Spear … they will say NO … However, i guess the Kak Ting will answer YES …

    sometime, stupid also good …

  125. If Khairy get hold of sole distribution right of this medicine, guess how much he want, RM 1 billion at least.

    “It was bad enough during Chua Soi Lek’s time when for some mysterious reasons best known to him; he appeared focused on traditional medicine when the nation was having problems even running its conventional medical services properly.”

    BN are known to put unqualified ppl to perform the task, Mr. CSL prefer to test “chinese viagra” rather than work on national interest.

  126. lakilompat says:
    If I’m running the federal government i will try to control the price of good antibiotic, negotiate a good price, and check for latest drugs in the market. In overseas there are many good medicine at cheaper cost, such as Australia at the moment, Australia drugs cost RM 200 above
    =====================================================
    Can I also add, Australian government subsidize quite a large number of the drugs under the Pharmaceutical Benefits Scheme especially non-generic drugs, hence the good quality drugs can (they try to) be priced at relatively affordable price. If the Australian government had not intervene to ensure drug prices is affordable be it drugs that have not fallen out of their patents and promote the use of generic drugs, whilst at the same time ensures the people can still afford to pay for consultation fees, the nation will not be able to enjoy the basic health care needs.
    Drugs that have not fallen out of patents are expensive because of the high cost of research and development and the long time frame of about 15-20 years to get the drug ready and safe for the market, hence the reason why subsidies are required.

    Drugs can be sold at very low price and distributed for free in countries like Africa by large pharmaceutical companies like Pfizer. These are drugs which are sold for the purpose of clinical and post clinical trials.

    Can the Ministry in their attempt to pursue proposed “separation” also ensures that the people (especially the low-medium income earners and the poor) not be burdened by posssible increase in consultation fees as well as the need to pay for separate higher medication costs?

  127. Well, i’m hoping the new MOH Datuk Liow Tiong Lai can do something like what the Australian govt. is doing instead of troubling the Rakyat.

    The problem is govt. will prefer “waste money policy” rather than subsidizing the rakyat to ease their burden when economy is not moving due to their bad reputation in international arena.

    Not many international leader acknowlege Pak Lah effort, i believe Pak Lah has no records whatsoever contributing to international fights.

    Govt. can help promote good & quality medicines at cheaper cost by building good relationship to these laboraties, they can also set up incentives to attract these drug laboratory to invest in Malaysia. They are not willing to come because BN govt. is corrupted and also M’sia is not safe, even daylight got robbery, the police eat rasuah rather than rice, the govt. is not thrifty they robe from rakyat rather than help them, they steal the national resources for their own (cronies) benefit.

    Foreigner drug company will start investing in Malaysia only when BN government is replace by Barisan Rakyat, more accountable, transparent, fair and just govt. lead by Datuk Seri Anwar Ibrahim.

    He will put those cronies under ISA, replaced the current Khairy-Pak Lah cabinets with more Rakyat based cabinets. A good cabinet is required to propose sound and feasible plan.

  128. I am a car enthusiast. I take good care of my cars.
    When the autogear needs an ATF (automatic transmission fluid) change, most car owners send their cars to the mechanic. He will drained the gearbox of the old ATF and filled it with a new one. A knowledgeable car enthusiast, will go to the spare parts shop, pick up the best quality and appropriate ATF for that particular gearbox (for example Peugeot AL4 gearboxes use only Esso ATF; Hyundai’s only SPIII and not others). Then only he will ask the mechanic do his job using those properly prescribed parts. Likewise if you have a faulty air cond cooling coil, don’t ask him to do it, he is no air cond specialist! Forget about ‘One-Stop’ center, I want the best for my car.

    Oh yes, I am a pharmacist too. Why do most patients want the doctor to dispense their medicine when he is not trained to do so? Unknowledgeable car owners would let any Tom, Dick and Harry to fix their cars. Unknowledgeable patients would not demand pharmacists to dispense his medication! That’s why.

  129. Responding to “pharmacist”
    I’m a registered pharmacist, working as retail pharmacist for bout 5 years. Definately, Dr will not allow this dispensing right to be given to pharmacist, the reason is very simple

    1) Dr dun want to let pharmacy to earn
    Why open a pharmacy? pharmacy sell anything else beside drugs?

    2) Dr Study a lot pharmacology? (which only study 1 or 2 semester)
    They are not pharmacist.

    3) Dr know more drug than pharmacist?
    (pharmacist spend 4 years study pharmacology, who know more?)
    So what? still the pharmacist does not acquire doctor license.

    4) This is a trend if this country will like to move forward and not backward.
    Not moving backward, but these pharmacist are the rich ppl who sent their children overseas just to come back Malaysia to get a license to open pharmacy. Then they can start prescribing drugs much profitable like clinic because of the pharmacy more stuff to sell beside drugs.

    If anyone of u do attend those international conference very frequent, try to communicate with those oversea DR. I’ve personally know one Prof. Dr from india. Wht he told me very amazed me ‘ Your country no good, Dr should spend more time diagnosting patient and given more care to patient, not spending more time dispensing medicine which is a pharmacist job’
    Yes becos tell that Indian Dr, Malaysia not many rich patients like India have, our country have rich govt. who robe Rakyat to feed the cronies, but fortunately doctor are kind enough to spend more time to dispense the right medicine. We don’t need pharmacist becos it is meant for rich person who wanted to obtain license to open pharmacy this will robe from the Doctor, those who really work hard to obtain a Doctor license.

    Why we need pharmacist, these are robbers, their main purpose to get a license from BN cronies so that they can open Pharmacy. Many rich and smart family already drop the plan to send their kids to study 4 yrs Pharmacology, becos now in Malaysia jus have to pay “Duit Kopi” to get license to open Pharmacy, then hire a pharmacist etc pay him copyright. Whether he or she is qualified also not sure becos not a doctor.

  130. The best advise I can give you, lakilompat, is this:

    When you are sick, you don’t have to spend money going to the doctor or pharmacist because there is no law in this country says you must. There is always the dirt cheap bomoh or some herbs in your garden.

    But if you do want to see a doctor or pharmacist or any other professional like accountant or lawyer or engineer, you are expect to pay. But as I say, you don’t have to engage their service if you don’t want to. So calm down.

  131. lakilompat says:
    Govt. can help promote good & quality medicines at cheaper cost by building good relationship to these laboraties, they can also set up incentives to attract these drug laboratory to invest in Malaysia.
    ==================================================
    That’s the reason why the question on the objective of the government for proposing the change is posed?
    The Ministry has to provide clarity on how the “separation benefits” flow through and can be enjoyed by the people (regardless of one’s income level).

    What will the role of the government be in this change? Will they take on a “middle man” role to earn quick bucks from the people?

    The Ministry has to also address possible issues on the viability of having a stand-alone pharmacy. Can pharmacists survive purely on selling drugs? Won’t they need to increase prices to do so? Due to competition, some pharmacists have to resort to selling other non-drug related items ie. cosmetics, consumer products.

    What about the doctors, given the high rental costs, can private owned-clinics remain viable especially in metropolitan areas? How can the Ministry ensure that there is no closures of private clinics if consultation price is not raised? How will the MInistry ensure that closures will not worsen the country’s existing healthcare services.

  132. I’m not sure whether private clinic fall under MOH jurisdiction or responsible. What the MOH sole duty shouldn’t be just to tackle how many clinic are open and how many are closed that’s beyond his control. Anyhow, he must ensure regular check, that they don’t simply charge the consultation fees. Well, i heard private clinic consultation fees varies, so what is the minimum and maximum fees, is there a cap since it is private? I knew that in Mauritius, the consultation fees is very expensive, it is 3 times more expensive than Malaysia, i think almost everything.

    I’m hoping the MOH can promote Malaysia by inviting overseas drugs laboratories to invest in setting up plant here. Problem again, the security, and corruptions level. if the leader represent the govt. is a liar, who dare to invest? The media, radio and press are biased and they use ISA without trials. With the current govt. not sure whether they interested to come. Even Volks Wagon (VW) are tendered by cronies to sell in Malaysia at exorbitant prices that’s why it cost RM 180K or 250K for a VW, it is more expensive than Benz and BMW. For that price i would better go for Benz or BMW. It is the same for medicine, if they set up lab in Malaysia, then govt. will try to form department, to collect fees or duties, these will again go to cronies pocket. They must again give contract to all the cronies contractor listed by the BN govt., 1 light bulb will cost ten times the market price.

    Many foreigner have moved out due to this, look at Seagate they are fortunate they shift their operation to Thailand, in Thailand the cost is better their govt. is rich enough, corruptions are not so rampant in Thailand. The cost of living in Thailand is not so high in certain rural areas. You can have a decent meal, and massage at very cheap, the ppl there still lived happily compare to Malaysian.

  133. The problem with Malaysia is that most people think that doctors know absolutely everything when it comes to medicine. They fail to realise that doctors only form a part of the medical processes and industry. Pharmacists do play an important part in this. It’s time that the people realise that we’ve been playing the game with the chess pieces on the wrong squares all along.

    Alot of the complaints againsts pharmacists here seem to be about their efficiency or lack of thereof. They don’t show up etc etc. But these are not substantive reasons not to change the system. My goodness, if McDonalds serve their food slow does it make their food of any less quality? These are procedural/structural problems that can be corrected!

    =====
    On a minor note: jetaime.f Says:

    Today at 09: 05.26 (9 hours ago)
    THe Health MInistry should focus on hunting down these “doctors” who have a fiduciary duty to their patients.

    I think you mean duty of care. At least in English law, doctors do not owe fiduciary duties to patients. And unfortunately, again at least in English tort law, its hard to prove breach. But I agree with all the issues you noted.

    =====
    lakilompat says:
    Govt. can help promote good & quality medicines at cheaper cost by building good relationship to these laboraties, they can also set up incentives to attract these drug laboratory to invest in Malaysia.
    >
    Unfortunately, I don’t think we have the expertise to attract them, nor are we economically attractive to them. But more importantly, it does not follow that having drug companies build and do their research in Malaysia automatically = cheap and high quality drugs. These companies usually only go to places where they can exploit the lax law and cost savings.

    Just something I quickly googled up.

    The drugs that are produced are not necessarily cheaper for us. Even if it would be, and some how our govt manages to strike a deal, I doubt that these companies would slash the prices off drugs that they have already produced before the agreement and thereby leaves us with most drugs still being expensive; and the cost we pay for that minimal gain is a high one: it probably requires a relaxing of the laws and open the public to exploitation.

    =====
    One solution is to increase govt subsidization of medicine. But look at the NHS system in the UK. It’s full of problems and there is never enough money. If the UK govt cannot adequately fund the NHS, what more to say about our Malaysian govt.

  134. Hi slashed, thanks and I do apologize for the error. Guess I’ve forgotten most of the terms and concepts I’ve learned relating the legal side of the medical world.

    I don’t think anyone of us would be stupid enough to reject “safe” healthcare. The government has to assess this diligently.

  135. QUOTE:”KKK Says:

    Today at 17: 04.33 (2 hours ago)
    The best advise I can give you, lakilompat, is this:

    When you are sick, you don’t have to spend money going to the doctor or pharmacist because there is no law in this country says you must. There is always the dirt cheap bomoh or some herbs in your garden.

    But if you do want to see a doctor or pharmacist or any other professional like accountant or lawyer or engineer, you are expect to pay. But as I say, you don’t have to engage their service if you don’t want to. So calm down.”

    I think KKK is making a very good point here. I’m sure you WILL obtain more thorough professional advice by visiting the Doctor+Pharmacist than by just visiting the doctor alone. For that better service, you will have to pay a bit more, nothing is FREE!

    REAL LIFE EXPRERIENCE:
    I have an aunt who used to visit this personal gynea for many years. Since she had her menopause, this gynea has given her hormone replacement drugs plus other types of drugs as she have high blood pressure etc. She visits the doctor about once every 2 to 3 months for a medical checkup and the drugs. This went on for over 10 years! And yes, she took those hormone replacement pills for over 10 years without being advised on the danger of taking them. And any educated doctor or pharmacist should have known that by taking hormone replacement medication, you are exposing yourself to a greater risk of cancer. And yet, the fcking doctor still give her those pills even after 10 years after her menopause just to be able to charge her more for “THE CHEAP CONSULTATION + MEDICATION FEES THAT YOU GUYS ARE SO WORRIED ABOUT”. There is really no reason for a doctor to prescribe that sort of medicine for so long. Upon realising what the doctor has done, my aunt stopped visiting the doctor and taking the hormone replacements as she was totally fine without them.

    However, my aunt ended up with breast cancer, and the amount of agony and pain that she has to go through can’t even summed in any amount of money that you can saved. Thankfully she has recovered and still alive now. Although one can never prove for certain whether the prolonged hormone replacement medication has a direct effect on this, there is certainly a very high possibility.

    I know majority of the doctors out there are probably more professional than the one my aunt encountered. But there is also a lot of doctors out there who are only concerned about the amount of profit they make! Else why so many doctors prefer to run private pratices? Why so many people want to do medicine? To save life and to help the ill? Maybe true for some, but for the majority of them is the because of the $$$$$$$$$$$.

    I’m just trying to point out there’ll be a better check and balance if the power to dispence medicine is given to the pharmacists. This will reduce the chances of what happened to my aunt occuring. As the famous saying goes, “Power tends to corrupt, absolute power corrupts absolutely!” Noone can tell if the doctors in Malaysia aren’t as corrupt (such as dispencing unnecessary medicine etc.) as those BN goons. After all, if you look at MCA, many of those corrupted leaders are actually doctors! ROFL…

  136. Sad isn’t it for Kementerian Kesihatan Malaysia. Always telling people to be sihat but sendiri not so sihat at all. Mengutamakan duit is not sihat at all. In fact, this sort of thoughts should be referred to a psychiatrist. It does look like KKM is heading the way of privatization because anything to do with medicine is actually very expensive. Then may be jobs and businesses will be created for those with pharmacology expertise. If money is the reason for everything, then there is no need for status, titles and there is no need to talk about what historical heritage . Looks like money is running the MOH. The MOH is imitating the private hospitals. In private hospitals, their pharmacy is kept aside and after seen by a doctor, you bring your prescription to the counter of the pharmacy, buy and pay for the medicine.

  137. # walkman Says:
    March 31st, 2008 (2 days ago) at 11: 37.33

    Greetings,
    Why the change? Currently this system is working very well. If we think the drugs sell at clinics are more expensive, we can go to pharmacies to purchase them. As mentioned by many people, why make the patients who are already sick and weak to travel through traffic jams and hunting for parking spaces, just to seek cure and then for medication? What works for other developed countries may not work well here. Just like they allow total freedom of speech and demonstration on the streets are irked at by you, the wakil rakyat. So, don’t again think you know best.

    ***************

    BEWARE

    The doctor usually checks the drugs packed by his nurse before issued to patients. This is good.

    In medical centres, which charge very high because of high overheads, we can opt to get he drugs ourselves at the corner and friendly drugstore. This is good.

    The doctor is not around to guide the patient at the phamarcy on the correct drug and dosage as the same drug could be 20mg or 40mg packings. He may buy a larger dosage risking overdose. This is bad.

    Some pharmacies get high commissions from certain manufacturers or local distributors such as oversea trips to push their products. Therefore, how could unsuspecting patients be able to decide to take the many alternative original makes and generic forms? This is bad.

  138. “The doctor is not around to guide the patient at the phamarcy on the correct drug and dosage as the same drug could be 20mg or 40mg packings. He may buy a larger dosage risking overdose. This is bad.”

    I think you are very confused and got it wrong the other way around. The JOB of the pharmacist is to check the correct drug and dosage prescribed by the doctor.

    BTW, did you know drug companies very often send doctors free trip overseas to attend seminars (or fun) and very seldom the pharmacist? That should give you an idea as to who is getting the fat commission. Again, your information is very wrong. As I say, I am in the pharmaceutical industries and knows a bit more than most people.

  139. If the pharmist prescribed wrong medicine, who’s fault is it? or if the doctor wrote wrongly? But if doctor wrote wrong sometimes the nurse will check again with the doctor because he or she is there to be consulted. But the pharmist wouldn’t know he or she just follow the instructions.

  140. very well said, KKK. as u and I r from the industry we understand much better than the man on the street. many comments here made me want to laugh out loud. basically most equate a pharmacist to a medicine peddlar and not a medical professional. most talked about convenience and r not willing to sacrifice that for improved safety, this is mind boggling, really!

    there are much more the pharmacist community need to do to educate the public. surely their asking for making their own choice and this should not be the ministry’s decision is very wrong. we know that decisons made under such circumstances surely can never be a good one.

    alternatively, all doctors should be made compulsory to present every patient with a prescription (and also the patient to keep a copy) whether he wants his medicine from the doctor or his choice of pharmacies. this will be able to avoid doctors forcing medication on their patients. this also will let the patient to compare prices. too many a times patients do not knowq what medicine they are taking!

  141. To KKK, u r jus jealous that a 4 years pharmacology was owned by a doctor. Don’t forgot Doctor is a profession (they have to serve the public before obtaining license to open their clinic), well having said that i don’t mean pharmist is not a qualified profession, just very rare profession in Malaysia & not widely recognized it is unlike Western country whereby consultation cost is expensive, normally u will visit pharmist to prescribe some drugs as in overseas you can find pharmacy in every major stores.

  142. lakilompat,
    there is a thing call telephone.
    even at this moment where doctors are doing dispensing, they still write out prescriptions to be filled by pharmacists (for medicine not available at their clinics), we sometimes encounter this – dr wrote wrongly/ prescribed wrong medicine, we CALL the precribing dr to clarify! and pls do not make up your own stories, NURSES (in private clinics, these are school leavers and not state registered nurses) are not trained to ask the dr!!! they are not able to identify these! even if she is a lawyer, engineer, accountant, PM (yes..badawi)… they cannot do it!!!

    i have to say too, lakilompat, u r doing a good job by exposing what the public do not know and this gives a chance for pharmacists to educate, thank you…. pls continue.

    P/s– it’s pharmacist, not pharmist!

  143. lakilompat, drs dont spend 4 yrs studying pharmacology, that’s for pharmacists. and pls know what u r saying first, chk out what pharmacology is, google it.

    pharmacists also go thru compulsory attachment with the govt hospitals (ie serving the public) before getting their license to practice!

    now u (and the others) know more and u r more informed, yes, pls continue!

  144. Firstly, let me introduce myself. My name is Lim Kah Poh. I am the Secretary of the Negeri Sembilan Area Committee, Malaysian Pharmaceutical Society. I had read the comments written in this blog and I would just like to offer my clarification on some of the matters of concern.

    Firstly, regarding comments that there is nothing wrong with our current culture/system in healthcare, I would say that it is a working system with its pros and cons. I guess the keyword here is development. Just like in the old days, we use typewriters. You can still use a typewriter if you want to. However, it is not going to be very productive compared to a computer. As ranked by the World Health Organisation, the countries with the best healthcare systems are all practicing separation of dispensing and prescribing. If it is such a bad system, why is it that there are so many countries working their way towards it?

    Secondly, I think it is disrespectful to say that the guardian of the healthcare of a country are doctors only. It is a show of bitterness to disregard other health professionals. Dentists, Dietitian, Vetenary doctors, Nurses, Medical assistants, Pharmacy assistants, among others (my apology to those that I had left out) each have different roles to play, but each are equally essential in a proper healthcare system of any country. Now, I know a lot of doctors who are very close friends and I have my utmost respect for the profession. However, to have a doctor who claim that they are in only important factor in the healthcare system if pure arrogance.

    Thirdly, regarding pateints having to travel from a clinic to a pharmacy to get their medicine, I would say those are superficial assumptions. At this moment, pharmacists who decide to start their own pharmacy or doctors who decide to start their own clinic will more often than not, decide to start in an area reasonably far away from each other as possible. This is because, in a way, we are competitors. It is just like if you want to open a grocery store. How likely is it that you will want to open your grocery store next to a Hypermarket? I think you do not have to have the business sense of the likes of Bill Gates or Donald Trump to see that it is more likely to be a suicidal business decision than not. However, when there is separation of prescribing and dispensing, pharmacists who want to start their pharmacy and doctors who want to start their own clinic will look for a place where it is relatively close to each other. This is because, we understand that if we make it convenient for the patients, then it is more likely for patients to visit our clinics and pharmacies rather than one that is situated a distance away.

    Forthly, regarding the misunderstandings on the knowledge of pharmacists and doctors. Remember this, we are different profession, trained to fill different parts of the healthcare system. As a pharmacist, I do not look down on the knowledge and capabilities of a doctor and would not condone such action from any of my peers. However, I would say that there are black sheeps among us, both pharmacists and doctors. I had never claim that I am capable of performing a doctor’s job. As such, I hope doctors do not claim that they are capable of performing our job. I don’t belittle a doctor’s contribution to the health of the nation, so please don’t belittle a pharmacist’s contribution.

    Fifth, regarding the profit and cost. Well, this is all about the share of the cake ain’t it? We don’t see doctors in the government hospital coming out and say, “Well, why should you make the patient wait for hours in the pharmacy? I can dispense my medicine straight away after I diagnose and check me patients.” How can anyone possibly say that dispensing separation will cost the patient more? If the price of medicine is the same, then there will not be any difference in the cost. However, when there is separation of dispensing, the patients will have easier access to “pharmaceutical care”. Keep in mind, that when a prescription reaches the hand of a pharmacist, he/she does not just blindly dispense the medicine as written by the doctor. Prescription screening, evaluation of drug-drug or drug-food interaction, screening for polypharmacies, evaluation of prescription vs. diagnosis, evaluating pharmacoeconomy and in selected cases, planning and coming out with alternative treatment plans which the patient can in turn reconsult the doctor and reconsider his treatment plan in order to safe money, have a more efficacious and safe treatment plan and so on.

    There is an example given by a fellow contributor regarding the cost, that a patient were to pay RM45.00 for his visit to a clinic. At this moment, doctors are earning their income from both consultation and dispensing. Say his total nett earning is RM30.00 per patient. Is it fair that he charges the same nett earning of RM30.00 per patient if he were only to consult and not dispense and as such point to a pharmacist profiteering when he/she know fully well that the medicine that he had prescribed will have a cost of RM15.00? I don’t think that it takes a Sherlock Holmes to see who the real culprit of profiteering is, right?

    Lastly, ultimately dispensing separation has one major benefit that this by itself warrants all countries which are not already practicing it, to seriously consider. Dispensing separation brings about rational prescribing. If you were to compare a country with dispensing separation and a country without and actually study their prescribing pattern, for, lets say, a simple example of a common cough. In a country where there is dispensing separation, most of them will only be given an antitussive(cough suppressant) and asked to take more fluid and rest. In a country without dispensing separation, we see these patients given an antitussive, a course of antibiotics and some vitamins. If you were to look into the WHO website or any other medical website for any guidelines to the treatment of common cough, you will see that in most cases, the cough would be caused by a viral infection and an antibiotic is not necessary. Why then is this being prescribed so often in countries without dispensing separation? Quite simply, it is because antibiotics are prescription only medicine and if patients have the perception that whenever he has a common cough, flu and fever, which make up to the majority of patients who visits a clinic, the patients will need to go to the clinic to consult the doctor as it is illegal for pharmacists to sell them without a prescription.

    It is understandable that nobody will be happy when there is a new policy that can affect their income. However, as health professionals, I believe that spreading inaccurate rumours and backstabbing is uncalled for. For my fellow pharmacists, I hope that you refrain from belittling doctors. For the MMA and the doctors, I hope you would give our profession the respect it is due. Rational opinions to the public are most welcome. To Mr. Lim Kit Siang, I am sorry if I sound authorative in your blog. However, having read what I had, I believe I have to put in a few words.

    Thank you.

    kp

  145. Are the pharmacies going to dispense these medications at lower prices? Unlikely, as most pharmacies would not dispense generic drug which are cheaper.
    ……………………………………………………………………………..
    Some pharmacies get high commissions from certain manufacturers or local distributors such as oversea trips to push their products. Therefore, how could unsuspecting patients be able to decide to take the many alternative original makes and generic forms? This is bad.
    ………………………………………………………………………………

    I am a pharmacist and I am really surprised that doctors think we pharmacists like to sell expensive drugs. These scenarios refers more to doctors rather than pharmacists. People usually go to pharmacy to save money. Do u think they are so stupid as to take up everything recommended by pharmacists? On the other hand, patient will not know what is being prescribed by doctors untill they are paying at the counter. When they are prescribed expensive drugs, they will only pay the bill and vow not to come again. In a pharmacy they can just refuse to buy or walk straight out of the pharmacies if they think that particular pharmacist is not honest.

    Regarding the good incentives (overseas trips) some pharmacists get from selling medicine, I am not at all envious or jealous because in order to get these incentives, they will have to purchase a big lot of one particular brand of medicine before hand, totalling tens of thousands. For your information, this medicine will expire in a short 2 years and if they don’t sell it in time, this will mean loss literally. Furthermore, if they are not selling it cheap, nobody is gonna buy. It’s really surprising to know that doctors think that pharmacies are making huge profit from selling proprietory medicine. We all know generics are more profitable, generics are cheaper and hence more acceptable by the public.

    I am really pissed of with my own ‘profession’. While our government recognise pharmacists as ‘professionals’, but there is nothing exclusive about being pharmacists as provided by our health policy. Our role is only a subset to doctors’. For example, what lawyers do, an engineer can’t do. They can do but there is no credibility and is not legal. You don’t see doctors issuing legal letters, or defending someone in the court. This is what I mean of the exclusive rights of one profession. However what u see in Malaysia is quite unique. Everything a pharmacist can do, doctors do them all. Some clinics even have very attractive displays of health supplements in patient waitng area.

    I for one will not choose to study pharmacy in the first place had I know that I am going to be in this awkward position. And I suspect, perhaps agreed by most of my counterparts, that our health policy is made this way just because a lot of our policy makers are in favor of doctors. And some of them hold medical degrees, e.g. our ex PM, our ex health minister etc. I hope our new government will be wise enough this time. I they really think pharmacists don’t deserve exclusive right to dispense, just abolish this profession in Malaysia. Then nobody is gonna complain.

  146. Pharmacist off course will get higher commission if they sell better drugs. In Taiwan, when you are having cold or flu, the pharmacist will ask u, give u 3 choices of 3 brands, cheaper (eat more), medium, and strong (expensive). Then it is up to the consumer to pick the one he can afford. I’m not sure in Malaysia whether pharmacist are that honest to give you choices.

    One thing good abt. US, they have varieties of choices (economic power) but Malaysia pharmacy normally have limited capital, therefore, they don’t subscribe too much else it will expired and if you order less mean the cost is higher.

    The MOH don’t care abt it, they only care to find way to robe and profit from these pharmacy. Perhaps the MOH move is try to rejuvenate profit into pharmacy so that pharmacist will have fairer share of profit at the expense of doctor.

  147. lakilompat Says:” But if doctor wrote wrong sometimes the nurse will check again with the doctor because he or she is there to be consulted. But the pharmist wouldn’t know he or she just follow the instructions.”.

    Now you are making me laugh. Are you saying the nurse know more about medicine than the doctor so able to check on the doctor?

    And this is where you are very wrong. All over Western world, the pharmacist is acknowledged to be more knowledgeable than the doctor on medicine. Therefore, the pharmacist check on the doctor on medicine and NOT the other way around.

    Good joke. I liked it.

  148. lakilompat Says: To KKK, u r jus jealous that a 4 years pharmacology was owned by a doctor. Don’t forgot Doctor is a profession.”

    Again another statement that is funny and getting it all wrong. Pharmacist studied pharmacology for 3 or 4 years, not doctor. Go ask your doctor how many months he studied pharmacology.

  149. lakilompat Says:….i don’t mean pharmist is not a qualified profession, just very rare profession in Malaysia & not widely recognized it is unlike Western country”.

    It is indeed good that you realize/acknowledge we Malaysian are still backward 3rd world country so not able to recognize the true value of pharmacist. On the other hand, by recognizing the true value of pharmacist, people of the 1st world get to enjoy 1st class treatment and safety when it comes to medicine.

    So now the question for fellow Malaysian: Do you want to remain receiving 3rd world treatment or 1st world treatment. If you wanted 1st world treatment, then you must start using the pharmacist for what they are trained for, i.e., get them to double check for possible mistake made by doctors on medicine. And it will cost you money like everything else. Sorry, no free lunch in this world.

    On the other hand, if you don’t want to spend the money, we can all reject this new bill and continue to receive 3rd world treatment on medicine. The choice is yours.

  150. For those of u who are not familiar with pharmaceutical industry, doctors are not dispensing in other countries because their government want to promote rational use of drugs. How? Let say in Malaysia, when a doctor sees one of his expensive medicine is expiring soon, to avoid loss, he can choose to prescribe that particular brand of medicine instead of giving cheaper ones which is equally good. Likewise, pharmacist can also do the same, only if the customer agrees to pay. Dispensing separation is carried out in such a way that doctors may decide which is best for the patient and pharmacists may dispense without conflict of interest on either side, which in turn will only benefit patients.

    For your information, some government linked company is already benefiting from manufacturing and supplying of medicines to governemnt hospitals (I won’t mention their name. If you go to investigate u will only find out those companies actually belong to one particular political party). I dun see how they are going to benefit from this move ( to disallow doctors to dispense) unless they can take control of all the indepedent pharmacies in this country. And for independent pharmacies like us, we can still decide to not buying from government-linked companies. But if the drugs are good and cheap, why not?

  151. KKK, let’s just ignore that clown. That ignorant fool can’t even pronounce ‘pharmacist’ correctly. If this guy thinks he is representing doctors, well, he will only humiliate them. I have nothing against doctors. I am only speaking up against a biased health policy, which discriminates my profession.

  152. I agree with you KKK.
    Consumers like you ‘lakilompat’ must be one of crowd that do not take or even buy medicine before. In addition, most of Malaysian are ignorant and this include the person who write this letter to YB LKS. Why do I say so??

    1) Most Malaysians do not even bother to know what kind of drug they are prescribed by the doctor.

    2) Do Malaysians know who are the real person dispensing the medication to you all?? I for once never doubt a doctor’s ability to know the drug. However, while the doctors are attending to another patients, someone near the dispensory (i will call someone as ‘this person’) call your name to collect your medication. Do you know that the person is qualified to dispense the medication?? My experience tell me that ‘this person’ can only tell you ‘this tablet is for flu and that for fever’. Do Malaysian ever question what kind of active ingredient(S) is(are) present in that one tablet?? I can assure you ‘this person’ dont even know what is an active ingredient. I wonder why Malaysians can bare this kind of treatment?? And I dont know why Malaysians dont want a professional to dispense this medication when pharmacist didnt even charge one cent for it.

    3) regarding cost of medication, ‘lakilompat’ and others, have you ever buy medication from a pharmacy before?? Most Clinics will only write
    (Let assume an arbitrary receipt)
    Consultation RM30
    Medication RM20
    DO YOU KNOW HOW MUCH (FOR EXAMPLE) A BLISTER OF PARACETAMOL WILL COST YOU??? The most you can read out from the receipt you received from a clinic is that the total medication cost me 20 ringgit. How sure are you now that the doctor did not overcharge you??

    4) Most of you says ‘there is lack of 24h Pharmacy’ or ‘i cant find a pharmacy’. I would like to ask you to use your brain and think. If a pharmacist doesnt has the right to dispense, how do you expect a pharmacist to open a pharmacy?? This is a demand and supply concept. Pharmacist also need to earn to survive. IF Pharmacist were given the right to dispense, i can assure you will find a pharmacy nearby a clinic with given proper time frame.

    5) Some of you even says that all self medicate and die of it. I would like to ask, to what extend is there truth about it? I for once would not self medicate if i do not know what disease i am having. Furthermore, self-medication of minor ailments is a common practice by most Malaysians. Dont even dare you tell me you didnt even self-medicate for once! If there is a pharmacist, you can ask a pharmacist’s opinion whether can you self medicate. If you has a minor cough, you wouldnt go to a doctor but to buy a bottle of ‘WOODS’ or ‘PEIPAKOO’ to self medicate 1st. And do you know what kind of active ingredient(S) is(are) present?? Can you confirm that brand ‘X’ can help you with cough or just another marketing gimmick??

    Pls think carefully first b4 you all lash out and talk bad about one profession. If Pharmacist isnt good in dispensing drug or not knowing more about drug, why would all hospital want to hire pharmacist to dispense drug to you all but not doctor or even nurse?? You can see this practice all over the world whereby doctor diagnose and pharmacist dispense. Then why would it be bad for community pharmacist to dispense medication to you all??

    regards,
    c_mon14

  153. Papayamilk, pls let lakilompat continue, so that we have a chance to let evryone knows the true picture, and also what to address. we do not know what the public needs to know. he is not the only one reading this.

    lakilompat wrote: “The MOH don’t care abt it, they only care to find way to robe and profit from these pharmacy. Perhaps the MOH move is try to rejuvenate profit into pharmacy so that pharmacist will have fairer share of profit at the expense of doctor” – this is not how things are. seriously i dont really understand your system here either!!??

  154. I agree with deja vu here. Let lakilompat continue. I suspect the majority of Malaysian general public holds his view on pharmacist, including DAP supremo. So it’s good to hear their views out aloud.

    Despite his many failing, I believe BN Prime Minister Badawi was absolutely right on one thing: We Malaysian may have 1st class infrastructure but 3rd class mentality. And typical Malaysian mentality on role of pharmacist is indeed 3rd class. Sad but true.

  155. I did a survey last nite at one of the new complex opposit Bukit Jambul, there’s a Maybank there, and some electrical shops, then I find there are so many pharmacies outlet there with various name. I went to one of them at random, managed to bought ointment “Zambuk” at one of the private pharmacy (Not a typical Guardians chain) cost RM 8.50 but is there any place i can get cheaper than this? I observe the pharmacist is not there, although they have a clear Pharmacist counter on the counter, i asked them where is the pharmacist, the owner said he’s not around. My question are we ready to trust them rather than the nurse who dispense the drugs? and will it be more expensive to get them in Pharmacy?

    There are many reason why pharmacies tend to charge higher, it can be due to rental.

    The person who might be benefiting from this move is Khairy, don’t forget Khairy registered a company name “Puncak-Pharma” with the funds he amassed, he might venture to open Pharmacy chains, doctors will have to sponsor his little projects. Those doctors who reject to dispense from his pharmacy will get their license revoke and can’t practice in Barisan state or Malaysia.

  156. Now at least it’s something that make sense here. For ur information, u dun need a pharmacist around to buy zambuk ointment. Anybody can sell zambuk. in my shop with a 20% markup it’s 9.50. is it not reasonable with this percentage? it all depends on the cost.

    if u got insider’s info regarding what evil kj is going to do, expose them. i’ll be the first one to oppose this plan if it will only benefit evil kj eventually.

  157. I didn’t know you need special license to buy Zambuk or Panadol or Axe Medicated oil or milk powder or lipstick in Malaysia?

    Any way, since the Malaysian general public do not want nor appreciate the skill of a pharmacist, why should he stick around? May be he decided to go to the canteen or have a smoke or go cry in a corner somewhere. Who knows?

  158. I don’t believe anyone should be restricted from voicing out their opinions, question or sharing their views and beliefs. Every blogger would want to use this blog site to voice their opinions and views so that the decision-makers/ government can be better informed and take into consideration the views of all re a certain topic. In this instance, the views of the people, the pharmacists, the doctors, being all parties affected by the proposed policy change.
    But I think it is impolite and I don’t believe anyone would like to be spoken to in a derogatory and contemptuous manner. This is just my belief and opinion.

  159. I recommend, the Doctor should hired a pharmacist to work for them in running the clinic. Those nurses should work in general hospitals either govt. or private. This just a suggestion to solve husband – wife conflicts.

    Rebrand Malaysia clinic become “Pharma-clinic” Doctor can invite Pharmacist to become partner like law firm.

  160. Oh yeah, while waiting for their turn in “Pharma-clinic” they can shop around for latest health supplements. I would be interested to visit such clinic not only the first world country don’t have but not even our neighbor country like Singapore.

  161. lakilompat,
    one reason why the pharmacist doesnt stay put in his pharmacy – his true function is taken over by doctors. his work load is much less vs if he is given the sole right to dispense. if the pharmacist do not own the outlet himself, chances are his boss would not want him to work through out opening hours (no doubt this should not be the case).

    u just dont get the idea. i want to see u renovate your hse. can one guy fix the roof, tiles, the plumbing work, the electricals etc. well, the subcontractor will pool all the ‘specialists’ together to get the job done. surely u wont want someone offering his services telling u he can do everything, because u know he surely will screw up! if u love your house, u wont agree to it and u know in the long run u would not need further renvation, cances are your house will be in better shape. now why dont u treat your body the same. dont tell me u rather have a sick body vs a damaged house. i am putting to u in simple language as i know u dont know much about the medical field.

  162. I recommend, the Doctor should hired a pharmacist to work for them in running the clinic.
    ==============================================
    I don’t think this is an good idea because the Check & Balance mechanism might be compromised.

    Let’s look at a very worst case scenario. Assuming you have a very unethical doctor who wanted to prescribe some unnecessary & expensive drugs and because the pharmacist is under his employment, he will not dare to speak out. So where is the Check & Balance for the benefit of the patient, the rakyat?

  163. lawyers in law firm do not take in judges to become their partners.
    no doctors will want pharmacists as partners! why pay another professional (it wont cheap) to do something they THOUGHT they can do well?

    lakilompat, u dont know how the system works, so quit making foolish suggestions. stick to raising questions regarding your concern with the separation of function here.

  164. let’s move on from lakilompat to some more serious ‘concern’.

    this is what Dr Milton Lum wrote in to NST, pls comment.

    By : DR MILTON LUM, Petaling Jaya
    I REFER to the reports on the issue of dispensing medicine (“Doctors to be disallowed from dispensing medicine” – NST, March 29 and “A need for 24-hour pharmacies” – NST, March 31) and the misrepresentations in the statements attributed to John Chang, past president of the Malaysian Pharmaceutical Society (MPS).
    Among his claims were:

    – With serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge rather than from a doctor who had none.

    – Doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more.

    – The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist.
    Pharmacology is not synonymous with pharmacy, although the two are sometimes confused in everyday usage.

    Pharmacology, which is the study of the interaction between drugs and humans to produce a change in function, is part of a medical undergraduate’s training and continues throughout the medical course.

    Pharmacology encompasses drug composition and properties, drug interactions, toxicology, therapy, and medical applications of drugs.

    On the other hand, pharmacy is the study of medicinal substances and drugs, their origin, nature, properties, formulation, production and effects, and their use in humans and animals. Depending on the university, pharmacology may or may not be part of the pharmacy course.

    There is also confusion between prescribing and dispensing.

    Depending on the illness, a doctor prescribes treatment, which may or may not include drugs, subsequent to making a diagnosis, after taking a history, doing a physical examination and/or carrying out diagnostic investigations.

    A prescription is a written instruction authorising a patient to be issued with drugs and/or other treatment.

    Dispensing refers to the preparation and supply of drugs prescribed by doctors.

    Because of the nature of their training, doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe.

    The only healthcare providers who see and treat adverse drug reactions are doctors. Nurses also see adverse drug reactions and they assist doctors in treating them. However, pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals, where they may see and assist doctors.

    Drug interactions can be minimised when there is knowledge of the patient’s medical, surgical, drug and family history. Such information is usually provided by patients to their doctors. This information is usually unavailable to pharmacists or, if available, insufficiently detailed.

    Drugs are prescribed and dispensed by doctors. Some are branded drugs while others are generics. Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown, unlike the branded drugs.

    Many doctors are already prescribing and dispensing generic drugs.

    When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.

    Patients seen in private clinics have a choice of having their prescriptions dispensed by the clinic or by a pharmacy. Doctors who dispense incur costs for providing the service, i.e. carrying cost for the drugs and staff salaries.

    The claim that doctors prescribe and dispense expensive medicines because of profit and hold patients to ransom is inflammatory.

    Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible.

    The proposed pilot study by the Health Ministry should answer a fundamental question: Who decides where patients should get their drugs from; doctors or pharmacists? Or is it the patient’s right to make his own choice? The MPS president’s advocacy that patients be deprived of his right of choice in the dispensing of his drugs, needs an answer from the people who are affected, the patients.

  165. jetaime Says:
    In this instance, the views of the people, the pharmacists, the doctors, being all parties affected by the proposed policy change.
    ————————————————————–
    That’s the question I would like to ask Lim Kit Siang when he posted all those objection.

    If we want to become an advanced developed country, its only logical that we adopt what’s been universally accepted as normal or good 1st world practice of dispensing by pharmacist.

    On the other hand, if we think we are not ready to become 1st class in patient care because of the extra cost, then don’t implement this policy.

    And it’s not wrong for MOH to do a pilot study of trying to improve patient care. To ridicule MOH for the sake of objection is wrong IMO.

    Of the many government departments, although they all have room for improvement, the Immigration and Hospital staff are the better ones and we should encourage & thank them and not put them down. My 2 sen.

  166. in responce:
    “Depending on the university, pharmacology may or may not be part of the pharmacy course”
    a ‘pharmacy’ course that do not include pharmacology cannot produce pharmacy graduates, but only pharmacy dispensers or technicians (which is not quite true since dispensers do learn about basic pharmacology as well)

    “doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe”
    this is the malaysian senario.
    and pharmacists are legally permited to PRESCRIBE medicine (these are knowned as poison C drugs) for certain minor ailments.

    “pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals”
    Almost all pharmacists have practical attachments with govt hosp before being granted their practising certs.

    “Drug interactions can be minimised when there is knowledge of the patient’s medical, surgical, drug and family history”
    drug interaction – family history??? dont try to pull a fast one, doc. i do not even want to say u yourself dont even know…. how sad! that’s your doctor, not a normal GP but a respected specialist!!!

    “Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown”
    perhaps the DCA (drug Control Centre) would like to make a police report, the good doctor suggested DCA failed to protect the public by approving ‘inferior’ products?

    “Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible”
    who said that? there is a difference between no knowledge vs limited knowledge compairing to a pharmacist.

    either Dr Milton asked someone to write this piece or he surely can come out with something much better…. SAD, yes, very SAD!

  167. A partnership of Pharmacy & Clinic “Pharma-Clinic” if both markup the price too high ultimately customer/patients will choose other.

    Pertaining to the fixed consultation fees If you have a permanent job ultimately you can ignore this as it is covered by the hiring company. Normally, company have panel clinics, where operator can visit them. The only things the panel clinics don’t cover are elder ppl, jobless ppl, and siblings.

    If we combine Clinic with Pharmacy, the elders ppl. will have varieties of choice cheap to expensive depend which type of drugs they can afford.

    In Kluang, Johor, there is a tabib china (he’s certified doctor from china) where a chinese medicine shop are combined. He will normally take your pulse then start asking abt the symptoms. Well, it is very good you will get instant herbs after visiting them. The chinese herbs cure the roots. I once have asthma, it is also cured by a chinese tabib.

    What i can see here is Pharmacist are accusing Doctors, then Doctors are accusing Pharmacist, why not shake hand and united, reinvent the business. Whether is expensive or cheap, let the market force decide “laissez-faire” theory.

  168. Dr. Milton said “pharmacology may or may not be part of the pharmacy course.”
    ————————————————————-
    It indeed sad to think that Malaysian doctor are of such low caliber. Yes, Malaysia deserve to be stuck in the 3rd world category when one of the most learned people in her society like doctor & main political figure could be so poorly informed and providing wrong information. I truly fear for the safety of our Malaysian patient.

    On pharmacology. EVERY pharmacy student learn pharmacology. Period. If not, it’s like saying a doctor never get to study anatomy in university and a lawyer never studied law. Tell this to 1st world people and they will laugh their heads off. It’s so ridiculous as to defy imagination. For the record, pharmacology is one of the most vital and main subject studied by pharmacist.

    And for this incorrect info to come from a doctor, I have to hide my my head in shame in front of people from other countries.

  169. For those who have not already read it, you can refer to my post at 12:28:13 for clarification of some of the issue stated here.

    “When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.” Quote from Dr. Milton Lum

    Since this matter is brought up, I guess I will go deeper into that so that more of you will understand why separation of dispensing and prescribing is so important.

    Yes, bonuses is indeed given to pharmacists and doctors. However, there are many pharmaceutical companies are offering doctors compared to pharmacists, a better bonus so that they prescribe that company’s medicine as oppose to those of a competitor. There are companies which give doctors unofficial bonus as well.

    Being competitors and so that clinics will have a higher capability of retaining their customers, uncrupulous (not all) doctors will choose to dispense medicine from these companies rather than those of the competitor, even though the competitor’s medicine may be the medicine of choice for that particular problem as recommended by treatment guidelines from the World Health Organisation.

    There are also doctors who dispense smuggled medicine (one commonly termed as Parallel Import) or even immitation of counterfeit medicine to patients without labelling it so that patients do not know the content of the medicine. As such they take the medicine without knowing the possible harmful effect that it may have.

    As such, we have doctors prescribing a medicine not because they think that that medicine is best suited for your condition but because they are given a trip to South Korea by the pharmaceutical company or because they can sell that medicine at their competitor’s cost price and still make a substantial amount out of it.

    Having said that, I would like to remind you that not all doctors do this.

    The above is an example of what we term as irrational prescribing.

    With dispensing separation, this can be minimised, if not stopped.

  170. I agree with you KKK.
    Consumers like you ‘lakilompat’ must be one of crowd that do not take or even buy medicine before. In addition, most of Malaysian are ignorant and this include the person who write this letter to YB LKS. Why do I say so??

    1) Most Malaysians do not even bother to know what kind of drug they are prescribed by the doctor.

    2) Do Malaysians know who are the real person dispensing the medication to you all?? I for once never doubt a doctor’s ability to know the drug. However, while the doctors are attending to another patients, someone near the dispensory (i will call someone as ‘this person’) call your name to collect your medication. Do you know that the person is qualified to dispense the medication?? My experience tell me that ‘this person’ can only tell you ‘this tablet is for flu and that for fever’. Do Malaysian ever question what kind of active ingredient(S) is(are) present in that one tablet?? I can assure you ‘this person’ dont even know what is an active ingredient. I wonder why Malaysians can bare this kind of treatment?? And I dont know why Malaysians dont want a professional to dispense this medication when pharmacist didnt even charge one cent for it.

    3) regarding cost of medication, ‘lakilompat’ and others, have you ever buy medication from a pharmacy before?? Most Clinics will only write
    (Let assume an arbitrary receipt)
    Consultation RM30
    Medication RM20
    DO YOU KNOW HOW MUCH (FOR EXAMPLE) A BLISTER OF PARACETAMOL WILL COST YOU??? The most you can read out from the receipt you received from a clinic is that the total medication cost me 20 ringgit. How sure are you now that the doctor did not overcharge you??

    4) Most of you says ‘there is lack of 24h Pharmacy’ or ‘i cant find a pharmacy’. I would like to ask you to use your brain and think. If a pharmacist doesnt has the right to dispense, how do you expect a pharmacist to open a pharmacy?? This is a demand and supply concept. Pharmacist also need to earn to survive. IF Pharmacist were given the right to dispense, i can assure you will find a pharmacy nearby a clinic with given proper time frame.

    5) Some of you even says that all self medicate and die of it. I would like to ask, to what extend is there truth about it? I for once would not self medicate if i do not know what disease i am having. Furthermore, self-medication of minor ailments is a common practice by most Malaysians. Dont even dare you tell me you didnt even self-medicate for once! If there is a pharmacist, you can ask a pharmacist’s opinion whether can you self medicate. If you has a minor cough, you wouldnt go to a doctor but to buy a bottle of ‘WOODS’ or ‘PEIPAKOO’ to self medicate 1st. And do you know what kind of active ingredient(S) is(are) present?? Can you confirm that brand ‘X’ can help you with cough or just another marketing gimmick??

    Pls think carefully first b4 you all lash out and talk bad about one profession. If Pharmacist is not good in dispensing drug or not knowing more about drug, why would all hospital want to hire pharmacist to dispense drug to you all but not doctor or even nurse?? You can see this practice all over the world whereby doctor diagnose and pharmacist dispense. Then why would it be bad for community pharmacist to dispense medication to you all?? And to say pharmacist did not study pharmacology is absurd. Please, pharmacists even went further than pharmacology; i.e. pharmacotherapy.

    regards,
    c_mon14

  171. Having reread what I had written, I believe it is important for me to note that I believe the MMA and the health ministry do not in any way condone irrational prescribing. I believe, they will take all action necessary against doctors who practice this way just the same way as the Malaysian Pharmaceutical Society or the Bahagian Farmasi will take action against unscrupulous pharmacists.

    It is just an illustration or what might happen as there are always black sheeps among us, no matter which profession we are in.

    If my illustration had in any way offend anybody especially any doctors, I offer you my sincere apology.

    Thank you

  172. Depending on the university, pharmacology may or may not be part of the pharmacy course.
    ……………………………………………………………………………..

    HAHAHAHAHA….People who came out with this claim definitely needs help. I was once told by a doctor (a specialist, mind you) , that I should not initiate any treatment on my own. If what he means include offering painkillers, flu medicine..etc.I dunno what else I can offer to my customers. I do not diagnose.
    The law provides us the right to sell Goup C medicine without prescription, I hope he knows that.

    Seriously, I think the writer of this letter (EJB) is a doctor. That may explain why he talks so much about the disadvantages of dispensing separation, and totally neglected the advantages. And he even warns that if government is to carry on this plan, the voters will exercise their rughts blah blah blah..If this is so bad why so many first world countries are still keeping this arrangement? YB Lim Kit Siang might think EJB’s letter is important because he talks about the increase of medical cost and of course, of how voters’ opinion should be respected.

    I am not putting in much hope though. See what had our ex health minister done. He had been singling out pharmacists as the culprits for illegal drug trade and abuse. When there was a doctor selling sleeping pills illegally, he simply brush aside the news saying that in every profession there are black sheeps.

    Therefore, I suggest that the government should just abolish this profession called ‘pharmacy’ in Malaysia, because it is just redundant, because we have doctors who know it all. So that no more naive young one (for my case, is being stupid and naive all together) will step into this field with high hope and being greeted with disappointment, constantly bashed by people from other profession.

  173. Lim Kit Siang. Dispensing right for pharmacist is not what you should spend your time because you don’t seem to all the pictures. But this is a letter in Malaysiakini deserve the utmost investigation and if found to be of substance, something urgent must be done. And show us what you are made of.

    Slab scheme for doctors needs review
    Product of the System | Apr 2, 08 4:15pm

    I can accept many features of the NEP, albeit swallowing them like a bitter pill. I will never be able to accept the Skim Latihan Akademik Bumiputera (Slab), however.

    For those who are unfamiliar with the Slab scam scheme, it is basically a training programme tailored for ‘outstanding’ bumiputeras with professional qualifications to embark on an academic career.

    The privileges accorded under this scam scheme are plentiful and far-reaching, available to ‘bumi’ graduates in medicine, law, sciences and IT. I shall only touch on the medical careers, drawing from my own personal experience lest I make wrong generalised statements about other fields.

    Under the Ministry of Health (MOH) ruling, all doctors are required to serve at least four years before being eligible to apply for specialty training in the Masters programme in local universities. No one is exempted from this ruling as in this noble profession of medicine; all doctors are equal in this fair nation regardless of the ethnicity.

    Some are more equal than others, nonetheless.

    These are the supposed outstanding bumiputera doctors. They only need to serve one year of government service before being offered a range of clinical disciplines in which they desire to specialise in and later on, lecture in. While the rest of their non-bumiputera colleagues serve the district folk, these privileged lot are bypassing everyone else to begin a premature training as a clinical specialist.

    On the outset, it would appear justified to reward these ‘prodigies’ with a shorter route to specialty and thereafter a career in academic medicine. If one scrutinises the Slab candidates however, the ugly faces of discrimination, cronyism and shortsightedness will become obvious.

    Despite its namesake, the Slab programme is almost exclusively reserved for Malay Muslim bumiputeras. There is a reasonable pool of qualified and talented non-Muslim bumiputera doctors in Sabah and Sarawak. They, however, are denied the chance to become academics through this supposedly noble training scheme. It’s bad enough to label Malaysians as bumi and non-bumi. To further differentiate between Malay and non-Malay bumiputeras is an act more despicable that the apartheid NEP itself. It is racial egoism.

    In principle, the by-invitation only Slab programme is open to outstanding, phenomenal Malay bumiputera doctors. In practice however, the candidates are far from it. My Malay colleagues who can hardly string a proper sentence of English together are being accepted into the programme. They can’t even present a simple case summary to the consultants during ward rounds and now they are expected to lecture medical students? Pretty preposterous isn’t it? The quality of Slab trainees ranges from those with minimal knowledge in basic pharmacology to those who cannot handle common medical emergencies without descending into a state of panic.

    Are we confident to let our children learn and train under these pseudo-lecturers? A great number of my colleagues who failed final year MBBS exams in Universiti Malaya were invited to join the Slab programme! It gives one a general idea of the quality of our future lecturers. The majority of these Slab products have either failed the external Royal Colleges exam or were never confident to attempt these exams in the first place. There were also two Slab trainees in UM who were dropouts from Australian universities. The future of medical education does not look bright indeed.

    Like most other NEP privileges, the Slab programme has been hijacked by well-connected Umno loyalists. A great number of trainees are accepted into the programme because they carry a ‘bin Datuk-something’. The truly qualified bumis are denied an opportunity while mediocre, below- average children of Umnoputras are offered a silver platter to quasi-professorship.

    More than being another Umno racist policy, the Slab programme is one that is dangerous. Clinical acumen in the profession of medicine comes from years of experience and there is no other way. A pre-university student who enters medical school without battling it out on a level playing field is already a cause for concern. Now, the same person is expected to perform the clinical duties of a lecturer-specialist after serving just one year of housemanship. In our feudalistic healthcare system, the specialist is always regarded as correct and infallible, even when he has less experience than his medical officers who are subordinates merely because they were not born with a privileged skin colour.

    The intentions of the Slab programme were never to provide a helping hand to aspiring bumiputera doctors. It was also never the intention of the Slab programme to provide our universities with a steady source of well-trained lecturers.

    The way it is carried out, the aims and purposes of the Slab programme is to mass-produce as many Malay bumiputera specialists as possible and in the shortest time, as well as to inhibit the careers of non-Malay doctors. It is already punishing enough that non-bumi students enter university one year later that their bumi counterparts (two years if one is from a national-type school).

    Now they even have to wait four years later than their Malay colleagues before being eligible to apply for specialty training. A Slab product will become a full-fledged specialist by the age of 30 with an almost guaranteed pathway to sub-specialty and professorship by 40. His non-Malay colleagues meanwhile, will only be a newbie specialist at 35, assuming the doctor was successful in his application for specialty training at the very first attempt.

  174. KKK Says:
    Today at 00: 38.55 (20 hours ago)
    The JOB of the pharmacist is to check the correct drug and dosage prescribed by the doctor.
    BTW, did you know drug companies very often send doctors free trip overseas to attend seminars (or fun) and very seldom the pharmacist? That should give you an idea as to who is getting the fat commission.
    1st Para: Not true: The pharmacist DOES NOT check the prescription. However, he dictates: “Have prescription will sell”. No prescription no sale. But how many times I have gone to a pharmacy to find the pharmacist on leave or gone to another branch. Probably there is time sharing because they have many outlets with a real shortage of qualified pharmacists.
    2nd Para: Not true: Both doctors and pharmacists have equal opportunity to travel. See below:
    Lim Kah Poh Says:
    Today at 17: 54.35 (3 hours ago)

    “When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.” Quote from Dr. Milton Lum.
    My suggestion is to continue as before that is, doctors are allowed to prescribe but willing to write prescription if the patient opts to buy medicines outside.
    In doctors are NOT allowed to “sell” drugs patients would suffer.
    1. We must have noticed that pharmacies are not only selling drugs. In fact, the pharmacies contain in volume more vitamins, supplements, toiletries, health foods and nuts. The “dispensary” is a small portion of the shop usually at the back of the shop. The list goes on. AS such, pharmacies may not keep stock of all the drugs that all the doctors in say Klang Valley prescribe.
    2. Patients would be flocking to the pharmacies in town. The problem of getting the drug required in just one pharmacy nearby becomes real since the stock would quickly diminish with greater demand.
    The pharmacies especially those with almost a hundred branches all over Malaysia with names we are getting familiar with are very rich and influencial. Hence, their voice would be heard. Whereas, the medical doctors do not have a powerful voice to be heard except for their association. As such, I believe despite all of our views, the final decision by the powers that decide is a foregone conclusion.

  175. I am all for the check and balance.

    In the justice system, the enforcement (police) cannot be the judge and executioner and neither can the judge be the enforcer nor the executioner.

    In the business accounting process, you always need an external auditor to verify the books.

    In governance, the Parliament needs the Senate to perform check and balance and vice-versa.

    In prescribing medicine don’t we need a check and balance as well?

    Doctors are after all only human and are just as capable of making mistake.

  176. my, my, my, nus… most of your arguments have already been raised and answered. the diff is u rephrased them! come out with something new…. pleeeeeeeeeeeeease!

    i wrote: we check, if doc wrote wronglly… we CALL, we telephone to clarify (to answer lakilompat saying ‘nurses’ will ask doc blah blah blah)

    if you’re the pharmaceutical company, tell me what’s the rasionale behind giving better incentives to pharmacists over docs… sorry to say u dont even have a good biz accumen! comeon, doc recomends new drugs and those pharmaceutical guys needs them more! simple as that.

    a thriving biz will stick to their main inventory, those struggling will tend to add in more to supplement, to stay afloat, to survive. pharmacy without sole rights to dispense cannot survive solely on medicine. hey, inventory control is no child’s play… overstock, expiry, pilferage, capital tie down etc. r u in biz yourself anyway?

    Guardian Pharmacy?… they r not UMNO cronies, for heaven’s sake! u r funny!

  177. Those doctor who object pharmacist dispensing right are just afraid of losing their means of getting extra income from dispensing drugs. Sounds familiar ? It is just like those UMNO conies who are afraid of losing their contracts when people say want to start open tender system. They will give various excuses like no 24 hours pharmacy, troublesome etc… which is just plain nonsense, but I do agree that some people living in rural area will have difficulty in getting medication, thus I would say it is ok for those doctor serving in rural area to dispense, but not those in urban city!

    Things like drugs can be get at a cheaper price in a clinic was due to the fact that doctors do get a better deal/discount on some drugs compared with pharmacist, reasons? Ask those pharmaceutical company. Moreover, a doctor can get earn through consultation fee, but there is no consultation fee for seeing a pharmacist, therefore pharmacist will need to earn through other way.

    Doctor do study Pharmacology, but how much do they learn compared with a Pharmacist ? I know how to drive a car and M.Schumacher also know, but the difference is the driving skill he has got is more than me…that is the main point, both Dr and RPh have different specialized skills and they work together for the benefit of patients!

    To all Malaysian, medication error can be very minor, but it can also be life-threatening. Pharmacist is your another barrier for preventing this from happening, pharmacist with dispensing right will be a win-win situation for all of us.

  178. Why should any of the $4.25 billion Australian taxpayers paid last year to subsidise the cost of prescription drugs be being spent on the free dancing girls, the free food and wine at top restaurants, and the generous free gifts and perks that the pharmaceutical industry is lavishing on our doctors?—- http://sunday.ninemsn.com.au/sunday/cover_stories/article_896.asp

    Google and you will come across many such cases being reported all over the world and the same thing is happening in Malaysia. May be there are but I hasn’t come across similar case for pharmacist. While it’s normal for commercial company to reward merchants selling large amount of their product, even my friend selling agricultural product get to go to China free trip, but for doctor to prescribe an expensive product for the sack of prescribing because he is influenced by those free dancing girl and NOT because it’s in the best interest of the patient is poor professional ethic.

    So there you have it. A few grandma may be taking some expensive heart medicine not because she needed it but because of some free dancing girl. And the saddest part is, the grandma has no choice in that decision because it’s made by the doctor and given by the doctor. She wasn’t given a second opinion or double checked by some pharmacist. Heck, she probably wouldn’t be told what she is taking anyway because the doctor don’t have time to tell her and the Form 5 girl at the dispensing counter in the clinic hasn’t a clue anyway about side effect and drug-drug interaction. But let me make it very clear…..not all doctors are unethical and the very vast majority are excellent. But like every profession, there are black sheep and there are those with questionable ethic & wisdom including those that give misleading information to mislead the general public in this very forum. And that’s why we must have a Check & Balance mechanism and giving the pharmacist (universally recognized all over the advanced Western countries to be more informed than doctor on medicinal product and anyone saying otherwise is ethically suspect) that checking right. To say pharmacist is only giving out medicine is totally misleading because should anything goes wrong with the medication he gave out; he is professionally and legally responsible. He is not supposed to act as a Form 5 girl in clinic and Malaysian shouldn’t expect pharmacist to earn a Form 5 girl salary either.

    Now you may ask, aren’t pharmacists getting to see those free dancing girls too? Yes, they are also given incentive just like my agricultural product selling friend. But there is very important different here and that’s called “CHOICE”. Having and able to exercise your choice is a fundamental human right and Lim Kit Siang know that extremely well and fighting very hard for that. Thank you, Lim Kit Siang. With pharmacy, if he wanted to sell you expensive Panadol because he wanted to see the free dancing girl, the Malaysian patient will always say…..”wow, so expensive, do you have cheaper type of Panadol?” And sure enough, you will be given a choice to either buy the expensive Panadol or the cheap generic equivalent and pay accordingly. I don’t see anything wrong with that, legally and professionally. After all, we are in a democratic country and thank god and people like Lim Kit Siang to keep that flame burning. And also to have all doubts, different opinions etc being freely expressed in this forum and get the truth out.

  179. Pharmacist are been marginalized. All the Pharmacist should go protest. If they can’t work with Doctor then lay low and enjoy the fight between Pharmacist vs Doctor. So, MOH is a hero to fight on behalf of Pharmacist at the expense of Rakyat.

    Pharmacist want that cake, Doctor deny them, Pharmacist seek help from MOH, the end result, Rakyat suffer. All pharmacist get or no get Rakyat still suffer because MOH not doing anything to improve both. To make peace merge the two, “Pharma-clinic” you can choose your drugs, and also seek consultation. A scenario whereby the elder brother is a Doctor, and the younger is a Pharmacist, both can combined the business into “Pharma-Clinic” the Rakyat can benefit. The main purpose not for profit but to serve Rakyat too. The problem is money is root of all evils. Same with the BN coalition govt. these leaders are good but when come to money, you and i know, at the expense of whom?

  180. to nus,

    you said:

    The pharmacist DOES NOT check the prescription. However, he dictates: “Have prescription will sell”. No prescription no sale. But how many times I have gone to a pharmacy to find the pharmacist on leave or gone to another branch. Probably there is time sharing because they have many outlets with a real shortage of qualified pharmacists.

    Please note that a pharmacist’s license only enables him to practice in one particular branch only. So u r saying maybe that pharmacist is taking care of other branches, that is not true. That pharmacist might be away, and if they sell poison without the pharmacist’s supervision they are bound to be punished. This is the same with clinics operating on medical assistants alone. Now this reminds me of another discrimination against pharmacy. Our license won’t allow us to practice in other outlets, which means that our health policy makers believe our knowledge is only valid when we are in the outlet where our licenses entitle us to practice. Doctors are allowed to do locum, but pharmacist are not, that’s the reason why sometimes there are no pharmacists in one outlet. Pharmacists also get sick, but they can’t find people to replace because our health policy thinks we are super humans.

    U said,

    AS such, pharmacies may not keep stock of all the drugs that all the doctors in say Klang Valley prescribe.

    If u understand how our market works. When there is a demand, there sure will emerge the supply. We don’t need to argue on issues like pharmacies don’t operate 24hr, don’t have enough staff, not enough pharmacies…Those are all the excuses used by doctors, including Dr. Chua Soi Liap. There is no doubt that he has a lot of doctor friends.

    you said,

    Not true: Both doctors and pharmacists have equal opportunity to travel.

    Can’t u see the difference there? Doctors take no risk to earn a trip, they just earn it by prescribing espensive medicines. My ex boss only earned a trip after buying one particular brand of medicine for RM30,000++, and mind u, the stock will expire in a mere 2 years. I don’t envy him. I even pity him because one box of this medicine costs RM 185, he only sells it at RM200. And it’s a Group C medicine, so there is no ‘selling without prescription’ issue here.

    U said,

    If doctors are NOT allowed to “sell” drugs patients would suffer.

    Ur assumption reminds me of MCA and UMNO. They said if u dun vote us, there will be no development, our country is going to be in dire state, nobody is going to voice up for chinese community and fight for their rights and so on. So do u see any survey in the U.S. that reveals that most Americans attribute their suffering to “dispensing separation”? I nearly suffocate myself from supressing laugh.

    YB Lim Kit Siang now you hear us please do not let people like EJB twisting your mind anymore. Pharmacists have every reason to be angry. I have no choice because I am already in this profession.

  181. lakilompat, I don’t understand your logic.

    Is it wrong to spend money building hospitals using rakyat money? Is it wrong to spend money to buy expensive but necessary X-Ray machines using rakyat money? Is it wrong to spend money to pay salaries of doctor and hospital worker using rakyat money? Likewise, is it wrong for MOH to try make things better for patient in term of drug quality and safety using Rakyat money? Personally, I don’t think those things are wrong.

    We should not question MOH motive in this issue because that’s a correct way to move forward in providing safer & better care to patient. Instead, we should debate as to whether we are ready for better care and whether we are willing to pay for it. And for people like lakilompat, your choice is you don’t want better care because you don’t want to spend more money on it. Ditto those who don’t want better care because it causes you inconveniences. Those are you people’s choice and I respect your decision.

    As I said many times before, the Rakyat can choose to remain a 3rd world country as far as safety of medicine supply & conveniences are concerned and therefore, not spending any more money and save on inconveniences. On the other hand, if the Rakyat wanted same 1st class standard as enjoyed by advanced 1st world, then the Rakyat will have to spend money and inconveniences going to the pharmacy. Which way the Rakyat decide is not important but the important thing is, the Rakyat must be given all the facts from both side that’s fair, logical and correct to base their decision on.

    And those who provided wrong and misleading facts to the Rakyat are doing this country a great disservice and should rightly be condemned by all right minded Malaysian. For example, saying Lawyer do not study Law or Engineer do not study Physic or Pharmacist do not study pharmacology or Doctor know more more about medicinal product than Pharmacist or the Sun rises from the West.

    And why am I spending my time writing all these? I believe it’s my duty to fellow Malaysian to provide as accurate as possible the true picture and to correct any deliberate or non-deliberate misinformation by some questionable doctor posting questionable info in this forum. But I am also willing to accept what I posted may be wrong if someone can give me an logical explanation that’s based on facts and figures. I believe that’s the best way for me to update my own knowledge and the way forward. And I hope other people in this forum think the same.

    As to who is eating whose cake. In advanced countries, majority of that cake belongs to the pharmacist so who is eating whose cake in Malaysia?

  182. Personally, I think pharmacist in Malaysia is having a raw deal. They are unappreciated by everyone ranging from the doctors to the general public like lakilompat thinking pharmacist are no more than a Form 5 school leaver counting tablet and collecting money at the cash till. But the true fact is, pharmacist has to spend 3 or 4 years in university studying medicinal products (far more than doctors even though they tried to claim otherwise – google and confirm that to yourself), then another year working under supervision (similar to doctor doing housemanship) before they are qualified to be a pharmacist. For all those hardwork and money spend, they can’t even have the right to do what they are specifically trained to do, i.e., dispensing and checking for possible mistake on prescription. And some like lakilompat wanted them to work for free!

    I can only pity the pharmacist to be in such a lousy profession in Malaysia. In Australia, a fresh accounting graduate earns A$30K. A fresh engineer graduate A$40K to AK50K. But the highly appreciated fresh pharmacist earn A$80K so why bother coming back to Malaysia when people think you are a nobody here? From what I read in this forum, Malaysian wanted to remain a 3rd world country when it come to drug supplies. And I can understand why some don’t stay inside their pharmacy because they are not wanted anyway. So to these pharmacists, immigrate to Australia etc is your answer. You are not wanted in Malaysia. Period. Not even for-the-Rakyat DAP.

    As for me, I would hope Malaysia can move forward toward a better and safer drug supply system and pay for the pharmacist services. It’s far better than sending some tourist into space and for what?

  183. I am beginning to understand how Mr. Lim Kit Siang and Mr. Lim Guan Eng feels each time they had their words twisted or being misquoted.

    In todays NST, a respondent says
    “IT is appalling to hear statements from the Malaysian Pharmaceutical Society past president claiming that doctors do not know about the side effects of medicines and drug interactions. Such a sweeping statement is not only misleading but highly disrespectful.”

    It made me reread each and every word that was written in all the articles on dispensing separation carefully and the closest I had come to read from a statement from Mr. John Chang was “doctors cannot claim that they are expert in this field”. I remember what Mr. Lim Guan Eng said, “If you want to hit me, don’t hit me on the groin.” Well, or something like that.

    I had written countless letters of opinion to the News Strait Times but none of them was ever published. I am not disappointed about that as I believe there must be countless letters of opinions sent either by doctors or pharmacists on this issue. However, I am, shall I say, faberghastered to see such blatant letter that twist the words to dishonour someone was chosen to be published.

    I would like to state that dispensing separation would hardly bring about much, if any at all, financial benefits to community pharmacists running our own pharmacy. It will be the big chain pharmacies that will gain the biggest. In fact, being a small business owner, it may even come as a threat rather than an opportunity. I had always told my fellow community pharmacist, “When and if dispensing separation come about, be aware of a possible storm that may come forth as we can expect to see a high increase of the number of chain pharmacy outlets.” It is blatant for anyone to accuse that pharmacists will be drooling over this and expect to laugh our ways to the bank.

    Perhaps we are going about this the wrong way. Perhaps all the pharmacists in the government hospital should hand in their letters of resignation, stating that well, why don’t you get doctors to do the job. They claim that they are better at it.

    To be very bold, I am not disappointed if the Ministry of Health suddenly make a “U” turn as say there will not be such project. It is the people who will suffer most as we continue to prefer the “typewriter over the computer”. I am just disappointed to see how low some doctors, someone who is suppose to be a respected figure, will go to mislead, accuse and dishonour another profession.

    I am a man of my words. I don’t hide behind an anonymous name. My name is Lim Kah Poh. I am a pharmacist and I am proud to be one! Yes, I am here to defend and disprove any false accusation made against my profession. If you want to make any accusation, do it like a man.

  184. I would like to share some experience about two specialist that near my area. Both are paediatrician but sure not both of them are ethical (from my point of view). Paediatrician A work in a private hospital and the hospital do have a pharmacist dispense medication to patient. This particular doctor always prescribe medication as mild as possible as he believe children should not use too much/ strong medicine to treat the ailment unless is necessary. Therefore, some parents of the patient who do not understand the reasoning of the doctor and claim paediatrician A not as good whenever compare to paediatrician B, simply because they feel his medication doesn’t do wonders immediately. Whereas paediatrician B is an owner of a private clinic and advocates use strong/powerful medication to treat the young children. Most often, parents will bring 2 bags full of medication and charges amount to a few hundred dollars. Most parents satisfy (beside the hefty charges) with the results as the symptoms disappeared rather quickly (mostly being prescribe strong/powerful antibiotics, steroid and some supplements). Paediatrician B at one point come to an extent to ask for sole right to use 1 particular brand of the steroid inhaler and the pharmaceutical company duly obliged, meaning that only paediatrician B can order and use this particular inhaler and no other people (including doctors and pharmacists). Paediatrician B also prescribe a lot of Probiotics (friendly bacteria) and guess what, no other people have access to this brand of Probiotics. Have paediatrician B done any wrong? This i let the rakyat decide. After all, many people do prefer quick fix and conveniece.

  185. Waah, we can see lots of pharmacist replying on this issue but no doctors lately.Guest Doctor dont have much time and busy at work,while pharmacist………………………………………………….Did someone suggest pharmacist are crying and go smoke??So unhealthy……….

    Guest people can be divided by so much thing even profession.”The Pharmacist are being marginalised huh?”.Guest we can do a “Pharma Sakhti” next.Although 6000 is still a dimunitive figure.

    Whatever the reason given,Its obvious that the real intention/motive is MONEY.Theres no other way around it.

  186. in NST, DR D.P. LEE, Kuala Lumpur… I fully acknowledge a pharmacist’s knowledge in the field of pharmacology, but please remember that when it comes to clinical pharmacology, doctors certainly know much, much more.
    ?????????????? if u spend a few months reading a subject, how much better can u be vs someone else spending 3-4 yrs reading in-depth the same subject!?

    DR D.P. LEE wrote: when it comes to drug usage, interactions, indications and effects on patients, a doctor is the best person to consult.
    what will he do if someone brought to him a bag full of various meds to him (this is very common in a pharmacy)? would he be spending his precious time explaining to this patient (who is not sick in the first place), can u see this ‘best person to consult’ doing what normally a pharmacist do and dont charge a cent?

  187. in NST, a govt hosp MO, D.C.H., Kajang wrote: “pharmacists face no small amount of competition from general physicians. So in order to survive, some pharmacies resort to selling controlled medication (including antibiotics) over the counter to patients regardless of whether they carry a little piece of paper stating the drug name, dosage, and frequency and duration of administration with them”.

    confession – MOST retail pharmacists do this!!! yes, i am talking the majority of us! why? yes, for survival!
    prescriptions – we dont see much of these, let alone one that is properly written (most doctors either do not bother to write a legally proper script or do not even know what a proper one should be!).
    to solve this – make it compulsory for doctors to write proper prescriptions for EVERY case, yes, every case.
    then, and only then the choice of either buying from the doctor or their preferred pharmacy is in the patients’ own hands!

  188. So long is cheap and convenient, Majority of Malaysians are willing to risk theirs life. Probably is due to our fatal education system, we seem can’t understand the underlying economics principles of SPECIALIZATION. It looks like a lot of people refuse to acknowlege what we are today; “plentiful of quality products and services” is the result of SPECIALIZATION.

    Perhaps we should make life more convenient and cheaper too by only having GPs/general surgeons to diagnose/operate whatever illnesses we have, why so troublesome travel up & down to see dentists, cardiologists, neurologists….. tak payahlah.

    lakilompat!! don’t you think is a great idea. You no need to jump anymore, so tiring, lakitidur will do, comfortable and relax.

  189. controlnation1,

    You are probably right when you say that it is all about money. Let me tell you why and give you a scenario. Take a look at this website:

    http://rationalmedicine.org/drugs/antibiotics_abuse.htm

    and

    http://rationalmedicine.org/drugs/antibiotics_abuse2.htm

    Take a look at the following situation.

    Now this may be a bit technical and you may not understand it completely, but I believe you will understand the rough picture.

    As written in the website, in most situation when you have fever, you do not need antibiotics. Like I mentioned in my previous post, in countries with dispensing separation, they do not prescribe antibiotics unless in special circumstances that they know that the patient has a bacterial infection which will not got away by itself, and I did mention that most patient that visit a clinic are people with cough, cold, flu and fever.

    Now, do you need a doctor to tell you that you are actually having fever? You don’t even need a pharmacist to tell you that. In fact, if you have a 6 year old son, ask him to put his hand on your forehead and tell you if you are having fever. He will do just as good a job.

    So, why then do you need to consult a doctor? Well, certainly it is to get the antibiotics, right?

    Now, go back to the link to the website I had given. You will see that more often than not, you do not need that antibiotics. Your fever will heal by itself just as quickly without them. So, why do you need to pay RM45.00 consulting a doctor who will give you something you do not actually need?

    Tell you a secret. In countries that have dispensing separation, research had shown that the people actually SAVE money, yes, you did not need to get your eyes checked. SAVE MONEY!

    The main reason is, the people will soon learn that most of the time, they do not actually need to consult a doctor. They only need to consult a doctor when they need a condition diagnosed of for checkups, etc. They don’t need a doctor to tell them they are having fever, cough, sold and flu.

    That is why they are trying to mislead people. For anyone who read this, who is not on either side, just take some time and evaluate things. Have I not disprove each and every arguments that was brought up? You will soon see the difference between facts and fallacy.

  190. hey, i have a better idea…. since people dont care much about who can do a proper job and deliver the best service, all they want is a ONE-stop centre, convenient, less trouble as possible, cheap (yes, u save on petrol, time as well) etc etc, so many good things… just let the pharmacist diagnose and dispense u medicine! want ah?

    the best thing is u dont have to sit and wait for your turn, like in a clinic, no one enjoy that kind of ‘waiting’, full of ‘dont-know-whats-gonna-happened-next’ kind of feeling. in a pharmacy setting, while waiting for your turn u get to browse around, look @ some interesting things as well, sometimes u can even get lipsticks too, surely can save time to pick up a dozen of french caps same time! good huh?

    now u see our point? God help these bunch of ppl, pls!

  191. hours after i posted the supposed sarcastic piece above… i got the support from BBC (but that’s regarding Uk’s healthcare system of course)!!! i paste here:

    Page last updated at 10:34 GMT, Thursday, 3 April 2008 11:34 UK
    Chemists ‘to offer GP services’

    The government wants chemists to play a greater role in providing care for those with minor ailments, potentially freeing up GPs for more serious ills.

    It believes pharmacists are a vastly under-used resource who could easily provide diagnosis for some conditions as well as dispensing treatments.

    Primary care trusts – responsible for local health services – already have the power to ask more of chemists.

    But the extent to which they do so varies greatly across England.

    This is what the government wants to address in a new White Paper, which is designed to encourage PCTs to commission more services from pharmacies by outlining exactly how they could assist.

    It is estimated the proposals could save 57 million GP consultations a year.

    Health Minister Ben Bradshaw said pharmacists were health professionals capable of dealing with minor ailments, screening for diseases and giving health advice.

    “As 99% of the population can get to a pharmacy within 20 minutes, everyone will benefit from more types of treatment available through local pharmacies who can prescribe more, advise more and deal with more.”

    Smoking and pregnancy

    The kind of services envisaged include vaccinations, help with quitting smoking, and management of long-term conditions like asthma and diabetes.

    The “health MoTs” – checks for heart disease, stroke, diabetes and kidney disease for the over-40s announced earlier this week, are also a target.

    Many chemists are also already involved in tackling teenage pregnancy, with powers to distribute the morning-after-pill.

    The British Medical Association (BMA) broadly supports the move, while the Royal Pharmaceutical Society of Great Britain (RPSGB) also welcomed the news.

    “Research has shown that the vast majority of the public has easy access to pharmacies: 99% of the population can reach a community pharmacy by car, by walking or by public transport within 20 minutes,” said Paul Bennet, RPSGB chairman.

    Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee said better use of pharmacists could save GPs an hour of consultation time a day.

    “We have a tremendous resource in community pharmacists – we’ve got 10,500 in England alone – and they see people with minor ailments every day of the week.

    “There is a real opportunity to use the community pharmacy network to take a burden off GPs.”

    But David Stout, director of the Primary Care Trust Network, said that while involving pharmacies was a good idea in practice, it was not always easy for PCTs to find the funding.

    “Unfortunately everything costs money, and when you commission services from a pharmacy to free up doctors, you’re still paying the same amount to each GP practice – so it doesn’t release any funds.”

    “PCTs are working under significant financial constraints, and have to prioritise.”

    New contract

    The Conservatives also support the idea of using chemists, but said the government had promised in 2005 to do more on this front when it introduced the new community pharmacy contract.

    This gave pharmacists the ability to operate as “supplementary prescribers” – handing out repeat prescriptions to prevent patients having to go back to their doctors.

    But according to the Tories, figures show that in England just 101 pharmacies provided supplementary prescribing services in 2006/07 out of more than 10,000 community pharmacies.

    “All the evidence shows that, three years later, the government has failed to use the contract to deliver the new services it promised,” the party said in a statement.

    The Confederation of British Industry (CBI) says involving pharmacies could in the long term save money.

    “Seeing a pharmacist costs far less than a GP appointment, and as people are generally seen when they are relatively healthy, problems can be identified before they become a significant long-term risk,” its director of public services, Dr Neil Bentley, said.

    But Professor Steve Field, chairman of the Royal College of GPs, said although he welcomed extending the role of pharmacists it may not save GP time.

    “By involving pharmacists in preventative healthcare and screening, GPs will actually be busier as we will be identifying more patients who might otherwise slip through the net.

    “We believe that there are opportunities for pharmacists to work much more closely with patients – but this needs to be done in partnership with GPs and primary healthcare teams, not instead of.”

  192. Give up lah, Deja Vu. From what I can see, these are the sad scenarios in Malaysia:

    1. the vast majority of Malaysian posses 3rd class mentality and knowledge about what’s really happening in the 1st world.

    2. they have absolutely no concept as to how country like UK became advanced 1st world. And why Malaysia is rightly called 3rd world.

    3. even when shown a well proven and documented better & safer drug supply system, 3rd class Malaysian citizen still wanted to remain 3rd class. And of course they has every right to choose that just like they have a right to choose a government. But in this case, MOH should be commented in trying to pull our drug supplies into 1st world standard. But guess what, they got bashed, even by political parties that fight to have 1st world democracy but not 1st world safety standard for patients. How ironic.

    4. frighteningly distorted information given by some of the supposedly cream of Malaysian society, the doctor themselves on pharmacist. Dr. Milton saying pharmacist do not study pharmacology aka lawyer do not studying law is the most hilarious. If deliberate, then their ethic & morality is suspect and prove even our Malaysian doctors are 3rd class. If non-deliberate, it show a frighteningly total lack of knowledge & wisdom so our Malaysian doctor are truly 3rd class.

    5. By starting this thread, it shows that our main opposition political party in Malaysia only know how to oppose. They do not know how to govern yet. Again, 3rd class standard.

    Conclusion. We are 3rd class country primarily because her people wanted to remain 3rd class and make no effort to change themselves. When you have attitude like that, how are we ever going to be 1st class in every other fields of achievement? To become 1st class, we ourselves must change or else everything else is poppycock. But are they solely to blame? I don’t think so because the pharmacist society must take the 1st step in education the general public about her role. And people in power or will be in power like the DAP must do the same. So there you have it, education is the key. Only when people become better educated and informed, will they want to change. And that include Dr. Milton.

  193. To be frank, I very much like to have people like Lakilompat and Dr. Milton speaking out in this forum. Because of people like them, we can have a better understanding of the problems facing this issue. Only by knowing the problem as to why they wanted to retain a 3rd class drug supply system, can we find solution and hopefully, becoming 1st class one day.

    Keep them coming…..

  194. controlnation1,

    If u are observant enough this thread is originally started by a doctor, and has a huge follow up from doctors echoing his claims. Why did they disappeared all of a sudden? Really makes me wonder. I assume they run out of words. Anyway if u are a doctor just reveal urself and talk like a man. Don’t be so boh hud (it means no balls literally).

    I am very free, everyday, because I got NO PRESCRIPTION to fill ever since I operate my pharmacy. Working hours wise, denifitely longer than that of doctors. I reckon I can make more than most people, but there is NO JOB SATISFACTION in it. People asking to see pharmacist to ask for discount. Every once in a while u hear arrogant and ignorant comments from doctors like chua soi liap and milton lum pa (if u know what that means in hokkien) making , my blood pressure is shooting high and I think I’m bound to die from heart attack (I prefer dying immediately rather than being admmited to any private hospital and later to come out bed ridden with expensive bills).

    Call me rude , call me sloth (for being so free), I don’t care. The only persons I need to apologise here are my counterparts, for failing to use more civilised words. If any under age students or children happen to read my comments, sorry, they are meant for adults actually. I’m gonna leave this thread anyway.

  195. Normally students who went overseas will continue their career there. If you choose to come back, then it will be very tough and impossible to chase the time.

    Malaysia is 10 or 20 yrs backward compare to those countries in term of its economy liberalization. The Malaysian pharmacist are not ready for this, trust me. Only big pharmacy chain can gain from such liberalization by the MOH. Big pharmacy have the economic power to suppress varieties of drugs, whereas small pharmacy have to stock up from them. Behind this, Khairy will gain as it has become apparent, he will divest his funds to develop pharmacy chains. Another gold mine for him.

  196. lakilompat, ” The Malaysian pharmacist are not ready for this”… no! it is not us but it is ppl like u who are not prepared for this. dont twist the fact!

    i dont know how KJ can manipulate all these. but if he has the money (tangkap dia if u can prove his money is dirty) u cant stop another person from venturing into business.

    lakilompat, we will appreciate more if u can comment on the BBC report above and also what KKK had written regarding 3rd world mentallity and how hard it is to adopt 1st world methodologies.

  197. I can understand your anger, déjà vu. A properly trained pharmacist is considering the foremost authority of drug usage amongst the entire new university graduates including doctor in all advanced 1st world countries. Unfortunately in Malaysia, you are being under-appreciated, under-utilized, under rewarded both professionally and monetarily and to rub salt into the wound, being ridiculed even by supposedly-know-better doctors. I suspect some with malicious intends with money for motivation. Unfortunately, anger does you no good and bad for your health. If I may, I hope you wouldn’t mind, give you some advice?

    Life does not have to stop at the pharmacy counter especially when the Malaysian public doesn’t want you anyway or are not ready for you. Don’t roll in your self pity if they wanted to have 3rd class health service. Look positive, change your attitude, and consider yourself too good for them. Do something else. Besides gaining a very solid foundation in science, you should be able to acquire excellent analytical skill and maturity to do many other things beside pharmacy. I have seen some pharmacist using that merely as stepping stone and was successful. But the majority does not think out of the box and suffers in silent. One common fault I found of highly educated people is there inability to lower their self esteem. If its monetary rewards you wanted most, lower your entry point by taking up a salesman job or be an insurance salesperson and with your training background, you can kick a lot of assess.

    On the other hand, should you want to have a better career in pharmaceutical industry, you should go join your professional body, to speak out (public speaking skill comes in handy and I would recommend you go check out the dirt cheap Toastmasters program), be one of its leaders and try to educate the very ignorant public of which there are many, including Dr. Milton. You should excuse their ignorant which, more than anything else, is probably a sign of the failing of our educational system. I hold belief that people are all basically good; just need better environment and motivation to reach the goodness in them.

    And the most important thing of all is to be happy doing what you are doing. You can never be good at anything if you aren’t happy. Cheer up. There more to life out there in the world waiting for you. I wish you all the best.

  198. My summary:

    1)
    Dr says “Pharmacist selling Prescription Drug without prescription”
    Pharmacist reply “But in the first place, Dr never issue any prescription at all”. Then Dr keep quiet.

    2)
    Then Dr says, there are no 24 hour pharmacy. Pharmacist reply “Give us the Dispensing Seperation and you will see 24 hr pharmacist, it is a matter of supply and demand”. Dr keep quiet again.

    3) Then Dr says, price will go up. This I say, “You want quality service, you have to pay. A pharmacist is a human being and he/she is carrying out a public duty, why shouldn’t he/she be paid a wage. Simple as that” . Furthermore, like Deja-vu said, why seek specialist (Cardiologist, Oncologist or Neuro-surgeon)… let your Cardiologist treat your tooth-ache, deliver babies, operate on your brain. After all, you want convenient, one stop centre.

  199. thanks for your kind words, KKK. i am not angry, not even a single bit.
    FYI, i am already into my twilight yrs in my community pharmacy career, contemplating what i should do next. i have actually started in retailing, then to pharma sales, and moved on to pharma biz management; back to retailing until today.

    i am writing all these more for the benefit of the younger generation pharmacists in this country. and i do not deny that it would be a nice sending off for this old man if we do see this ‘right’ returned to the rightful owner before i march out.

    i do not think dispensing separation will be very rewarding monetary to the pharmacists in the first place. but it is more for the dignity and due recognition.

    at this moment i am still waiting eagerly for lakilompat’s reply.

  200. lakilompat,

    You never failed to amuse me. Luckily you active in this blog after 8/3 tsunami election, no chance for LKS to put you as MP candidate, otherwise you will be a well known DAP bocor parlimentarian like abang Buang.

  201. In a country with dispensing separation, highly abused medicine such as antibiotics and sleeping pills are categorized under prescription only medicine in order to reduce, if not to prevent abuse.

    In this case, it is good to have a party that do not gain any financial benefit to determine whether or not that particular medicine is needed. Even so, there are doctors in these countries that actually sell prescription of sleeping pills to addicts. However, they are doing that with a risk of having the pharmacist who dispense the medicine report them to the health ministry for inethical practice. If, the pharmacist are also inethical and in turn, dispense the sleeping pills to that person, knowing fully well that it will be abused, then he also risk being sent to the board of ethics.

    Now, in the local scenario, it is not the case. Doctors often claim that pharmacists are selling antibiotics without prescription. Not only that, antibiotics are also available for sale in coffee shops and the pasar malam (night market). No doubt, these are all abuse of antibiotics. However, what else can you expect when the supposedly guardian of the abuse of antibiotics and sleeping pills are abusing it themselves? Yes, pharmacists risk the wrath of the law for illegal sales of antibiotics and sleeping pills. Vendors in the night market risk being put in jail for doing this. However, an unscrupulous doctor can freely abuse it without much fear. All this, is because they stand to gain financially.

    There is a joke saying out of 100 patients who walk into a clinic run by an unscrupulous doctor with fever, 99 of them walk out with a pack of antibiotics. The one who did not walk out of the clinic with a pack of antibiotics is so unfortunate that he visit the clinic when the clinic ran out of antibiotics.

    As was mentioned in the link that I had put earlier, not all patient with fever should be put in antibiotics and those. This is what we call rational prescribing. Without rational prescribing, there is no difference between antibiotics being made a prescription only medicine or a common medicine just like paracetamol (Panadol) can is available anywhere and so easy/convenient for a patient to buy off the shelves.

  202. Why would anyone care whether drug is being abused or not. This is after all a 3rd world country and it’s citizen wanted 3rd class drug supply system any way. Even the main opposition party wanted it that way.

    No, I am not saying if pharmacist having dispensing right will stop those abuse altogether. But it’s a step in the right direction and doctor that prescribe excessively or in irresponsible manner will know the pharmacist dispensing it will know about it. Not good for reputation, you know :)

  203. deja vu Says:
    Yesterday at 00: 56.32

    my, my, my, nus… most of your arguments have already been raised and answered. the diff is u rephrased them! come out with something new…. pleeeeeeeeeeeeease!

    Hi deja vu,

    Thanks for your comments.

    Since we are all commenting like everyone is talking at the same time, we can miss out on earlier comments. Maybe you being very knowledgeable could kindly make, for the benefit of those would log on halfway, a list of all the previously mentioned pros and cons and give an unbiased, fair, logical and reasonable summary.

  204. I was told to give some comments on the below.

    How hard it is to adopt 1st world methodologies?

    We can’t adopt 1st world methodologies, because our education level is weak too many ppls. scored ‘A’ s, too many multiple choice questions. All these intelligent ‘tikam’ students do they read English Novels and have freedom to express themselves & encourage in public debates on countries affair? Some chinese school might have political debate competition etc. which is pretty good. But the problem is our leader very seldom have a successful 1st world methodologies story to tell Rakyat. After 50 yrs of independent do we have any successful 1st world methodologies implemented?

    1) Our banking liberalization still falling behind.
    2) Our education, quota system, all chinese or indian were forced to send their childrens study overseas, or private college, as govt. University are limited, major quotas for the Malays.
    3) Proton is making loss, can you believe it, a milo tin car that sell twice higher than a typical branded sedan overseas.
    4) MAS is making loss
    5) Govt. have no money to build bridge from Johor to Singapore but prepare to pay concession for the penalty.
    6) Govt. rather buy shukoi jet & submarines to fill their pockets with big fat commissions.
    7) Our press, media, and radio are controlled by the ruling party not the general public.

    When pocket become more important, the rakyat will be deny forever the 1st class methodologies.

  205. lakilompat, what i mean is, what do u think about this report:

    The government wants chemists to play a greater role in providing care for those with minor ailments, potentially freeing up GPs for more serious ills.

    It believes pharmacists are a vastly under-used resource who could easily provide diagnosis for some conditions as well as dispensing treatments.

    Primary care trusts – responsible for local health services – already have the power to ask more of chemists.

    But the extent to which they do so varies greatly across England.

    This is what the government wants to address in a new White Paper, which is designed to encourage PCTs to commission more services from pharmacies by outlining exactly how they could assist.

    It is estimated the proposals could save 57 million GP consultations a year.

    Health Minister Ben Bradshaw said pharmacists were health professionals capable of dealing with minor ailments, screening for diseases and giving health advice.

    “As 99% of the population can get to a pharmacy within 20 minutes, everyone will benefit from more types of treatment available through local pharmacies who can prescribe more, advise more and deal with more.”

    Smoking and pregnancy

    The kind of services envisaged include vaccinations, help with quitting smoking, and management of long-term conditions like asthma and diabetes.

    The “health MoTs” – checks for heart disease, stroke, diabetes and kidney disease for the over-40s announced earlier this week, are also a target.

    Many chemists are also already involved in tackling teenage pregnancy, with powers to distribute the morning-after-pill.

    The British Medical Association (BMA) broadly supports the move, while the Royal Pharmaceutical Society of Great Britain (RPSGB) also welcomed the news.

    “Research has shown that the vast majority of the public has easy access to pharmacies: 99% of the population can reach a community pharmacy by car, by walking or by public transport within 20 minutes,” said Paul Bennet, RPSGB chairman.

    Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee said better use of pharmacists could save GPs an hour of consultation time a day.

    “We have a tremendous resource in community pharmacists – we’ve got 10,500 in England alone – and they see people with minor ailments every day of the week.

    “There is a real opportunity to use the community pharmacy network to take a burden off GPs.”

    But David Stout, director of the Primary Care Trust Network, said that while involving pharmacies was a good idea in practice, it was not always easy for PCTs to find the funding.

    “Unfortunately everything costs money, and when you commission services from a pharmacy to free up doctors, you’re still paying the same amount to each GP practice – so it doesn’t release any funds.”

    “PCTs are working under significant financial constraints, and have to prioritise.”

    New contract

    The Conservatives also support the idea of using chemists, but said the government had promised in 2005 to do more on this front when it introduced the new community pharmacy contract.

    This gave pharmacists the ability to operate as “supplementary prescribers” – handing out repeat prescriptions to prevent patients having to go back to their doctors.

    But according to the Tories, figures show that in England just 101 pharmacies provided supplementary prescribing services in 2006/07 out of more than 10,000 community pharmacies.

    “All the evidence shows that, three years later, the government has failed to use the contract to deliver the new services it promised,” the party said in a statement.

    The Confederation of British Industry (CBI) says involving pharmacies could in the long term save money.

    “Seeing a pharmacist costs far less than a GP appointment, and as people are generally seen when they are relatively healthy, problems can be identified before they become a significant long-term risk,” its director of public services, Dr Neil Bentley, said.

    But Professor Steve Field, chairman of the Royal College of GPs, said although he welcomed extending the role of pharmacists it may not save GP time.

    “By involving pharmacists in preventative healthcare and screening, GPs will actually be busier as we will be identifying more patients who might otherwise slip through the net.

    “We believe that there are opportunities for pharmacists to work much more closely with patients – but this needs to be done in partnership with GPs and primary healthcare teams, not instead of.”

    thankyou in advance lakilompat.

  206. nus,
    it’s such a waste of resources to ask another blogger to summarise what transpired here. u can always scroll to read what others have posted (u do know how, right… if not, i can always teach u).

    all written in a blog are supposed to be read by each individual, and they can put in their feedback. thats how a blog works. and it’s very unproductive to ask another to do make summaries of pros and cons etc. dont expect to be spoonfed like the corrupted UMNOputeras lah! always longing for handouts…. sigh!

  207. deja vu Says:
    Today at 17: 30.55 (1 hour ago)

    nus,
    it’s such a waste of resources to ask another blogger to summarise what transpired here. u can always scroll to read what others have posted (u do know how, right… if not, i can always teach u).

    Thanks. Please teach me.

    Imagine scrolling 228 inputs. It is blurring and teary for an old chap like me.

  208. oh, dear, why didnt u say so earlier, uncle?
    then again, i’ll like to ask: what is this blurry eye old man doing here in a young men’s playgraound!!!

    oh, oh…. dont tell me uncle’s also suffering from a weak heart too. well, the playground here is one hell of a ruthless and heartless one, no place for an old emotional old man!

    see… pls dont hijack this thread for your personal outburst, let’s get back to our discussion on dispensing rights!

  209. Dear Deja Vu, the ideas sounds good, i have doubt, just becos overseas are doing great, here in Malaysia, majority of those who have the chemist license, do you think they will follow the guidelines?

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