Saturday, September 29, 2012

Sex and corruption in medicine


The recent sex and corruption case at the Central Narcotics Bureau has certainly woken many people up. But there is really nothing new here other than the titillating stories of trysts  and late night sexting between two very gatal (itchy) people. Sex sells. And all through history women have used their wiles to charm their way into position, power and wealth. So was this corruption, or just two very gatal people acting out their fantasies? We won't know for some time, and Gigamole will not speculate.

Nonetheless, Gigamole is reminded that the medical and health industry is not immune to such sex and corruption issues. Just that many do not get flagged out.

The WHO has estimated that the about US$4.1 trillion is spent globally on health services and of this, US$750 billion was on pharmaceuticals. It is a massive industry. The pharma companies aggressively compete for this market, and many (if not all) resort to unsavoury methods to market their wares.

Recently GSK was fined US3 billion for illegal marketing of its products. Part of these charges relate to providing junkets for doctors and various other kickbacks. J&J also had to pay up US78 million to settle charges of bribery and kickbacks it had provided.

Does this happen in Singapore? For sure. But perhaps not so obvious, because of our CPIB. But bribery and kickbacks in some form definitely occurs. Our doctors (especially)  go on junkets all the time. Not to mention kickbacks of various sorts. These are supposed to be regulated and notified to senior management, but nobody really scrutinizes anything, and consultants regard these as the perks of their practices. Medicines Australia reported that the annual spending by Pharma companies in wining and dining doctors and healthcare workers amounted to about A$24 million. How much "hospitality" spending in Singapore? Gigamole doesn't know. In fact the authorities don't really want to know.The public should insist that this be reported and made known publicly.

Any sex involved? Gigamole cannot prove anything. But suffice to point out that the industry is much bigger than selling the odd IT systems. Anybody stopping to point out that the sales reps for pharma companies are invariably attractive young ladies in short skirts?

This is not a problem that affects just pharmaceuticals. Medical devices suffer the same corruptibility. The susceptibility also extends up all levels of the health care chain....all the way from the prescriber, procurer and possibly even the regulator. Can we trust that we have only the best medical information, drugs and devices? Possibly not.

We need to look at this more carefully. The trouble is that the medical industry is seems rather "protected" and few want to stir the pot to root out these problems within the industry.

The PSLE should merely be a competency exam!

In case the point had been lost before, Gigamole is saying it again. The PSLE should remain, but only as a competency exam. We have compulsory primary school education in Singapore, and a competency exam is required at Primary Six so that we can be assured that all children have achieved a minimum level of education when they leave Primary Six to go to secondary school. There is really no necessity to grade this exam.

Gigamole cannot understand why secondary schools should be allowed to select students based on grades. If you are a good secondary school, prove it by the product that leaves the school, not by the students admitted to the school. All this talk of de-banding the secondary schools is hogwash, and a red herring to the discussion. The schools' reputation will become known in time, with or without banding. What credit is there to the school if it is enrolling only the best performers at PSLE? The Ministry of Education in retaining the graded PSLE seems to only be interested in protecting the positions of established elite secondary schools.

Please protect our your children by removing this unnecessarily competitive exams from their educational experience. There is more than ample opportunity to compete after they have left primary school. Shifting the competitiveness in education later will also be fairer to students who are naturally late bloomers.

Friday, September 28, 2012

"You ignore me, how, how, how?"

Sounds like the plaintive cry of a woman scorned. And we all know enough to beware that woman scorned.

Yet, often we Singaporeans are made to feel like the woman scorned. By the gahmen (and their extensions) we love. Gigamole feels that way sometimes. Important issues brought up often meet that deadly wall of silence. The icy stare. The cold shoulder.

Issues that continue to bounce off the wall of silence::

a] Illegal street racing. All we hear are the Ferrari engines that continue to roar down our city streets in the dead of night.

b] Lab explosions in the NUS. A lab accident after another, yet the Ministry of Manpower, for all their new empowerment through the WSH Act, and the NUS, continue to maintain their walls of silence.
c] Research misconduct. The Alirio Melendez story came and went. Yet for all Singapore's vaunted push for research integrity, the Melendez related dirt seems to have been conveniently swept under the carpet.

d] Unregulated wacko medical devices. The HSA sweeps some more dust under the carpet as they maintain their wall of silence of some pretty disturbing information about medical devices let loose in Singapore.

e] Disbarred doctors who can practice in Singapore. The latest question mark that needs to be unmarked by the Singapore Medical Council. Don't hold your breath waiting for an ans They'll intubate you!

You ignore me, how, how, how?

Tuesday, September 18, 2012

The PSLE - Is it so difficult to see what the problem really is?

Gigamole is glad to see the discussions about childhood education shift towards the Primary School Leaving Examinations (PSLE). To scrap or not to scrap, seems to be the focus of the debate. To Gigamole, it seems they are missing the point. An exam is necessary at the end of Primary Six. There is no doubt about this. But people are (deliberately, perhaps) forgetting that Singapore has compulsory education up to Primary Six. The PSLE is appropriately named the Primary School Leaving Examinations. The PSLE should not be anything other than a competency exam. Somewhere along the way, the Ministry of Education allowed the PSLE to morph and mutate to become the grotesque thing it now is. Currently the PSLE is an uber-competitive exam to identify top students who can be streamed into elitist schools to fuel an even more uber-elitist agenda. The banding of schools serve no other function that to feed this elitist mindset. To disband the schools is however, only a symptomatic response to the real problem, which is that as long as the PSLE remains a competitive exam, parents will relentlessly drive their children into excelling so that they will have a chance to enter elitist secondary schools.

Gigamole says that if you really want our children to have a proper educational experience and a wholesome childhood you need to remake the PSLE into just a competency exam. That's really what is only required at Primary Six. Is this so difficult to see?

Has our traffic police fallen asleep at the wheel....again?

It seems like the illegal street racing problem highlighted elsewhere before has not been curbed at all. One wonders what the traffic police have been doing all this while. One of Gigamole's blog readers had pointed out that was this going on along Orchard Boulevard. Surely the Traffic Police cannot be aware? Surely it cannot be so difficult to clamp down on this? All it takes a a couple of discretely placed CCTV cameras, or speed cameras. Or even a strategically placed patrol car.

It really boils down to whether they want to act or not. All this talk about providing a racing track is pure hot air.  For once and for all, just go ahead and clamp down on it.

Tuesday, September 11, 2012

The jaw dropping revelation about NUH's Dr Jay Jiade Lu

Gigamole was not the only one taken aback by the revelations about Dr Jay Lu's past history of being stricken off from the medical register in Florida. The relative silence from the medical community cannot be taken as a general lack of concern. Rather it reflects the discomfort many doctors have about pointing fingers at one of their colleagues. At least publicly.

The issue however should not be lightly dismissed and swept under the carpet.

The Singapore Medical Council has made it very clear that all applicants for registration must have a certificate of good standing and must not be under complaints, pending investigations or any disciplinary actions. That Dr Lu was actually under investigation at the time he applied for registration seems evident. Furthermore, there is no doubt that he failed to 'fess up when he was struck off the register in Florida.  He had a free run for 11 years.

NUHS and NCISs' big heartedness in publicly forgiving Dr Lu is laudable but grossly misplaced. But this is not a Jean Valjean story. The Singapore Medical Council cannot prevaricate in this instance and must act decisively.The damage done institutionally and nationally cannot be easily undone.

Saturday, September 1, 2012

How about a Lemon Law for medical devices?

Gigamole was delighted to read about the Lemon Law for Singapore. Kicks in today! Gigamole wonders why it had taken so long to want to protect consumers, but ne'er mind, better later than never.

Gigamole also wonders how the Lemon Law might protect the patient consumers from faulty medical devices such as heart stents, and other prostheses. It would seem that that the prostheses itself should be covered under the current Lemon Law, since the patient did "purchase" a device. The surgery to implant the device is not covered, as it would be a "service". On the other hand, the surgeon would actually be the retailer of the device, so should be responsible for the replacement of the device if it were faulty within 6 months.

The problem with medical devices is that defects often do not reveal themselves within 6 months. So the patient often has to shoulder the burden of proving that the defect did not live up to expectations of quality.

This raises a further question of who actually provides assurance of quality of the product and who protects the patient consumer from exploitation by manufacturers. One may expect that the HSA, as the government regulator to provide assurances that any device entering the market has an acceptable level of quality and safety. But this is not the case at the moment. The nascent attempts to regulate medical devices ran into bad publicity, and the HSA has since appeared to shrink from doing the right thing.

So now no one knows if the medical devices that are stuck into a patient's body is of acceptable quality and safety. No one knows who is actually protecting the patient consumer. Recently Gigamole has flagged up issues with metal on metal hip implants, transvaginal meshes, cardiac stimulators, heart valves, which have increasingly been cited in various regulatory withdrawals and law suits overseas. But locally, there has only been a deathly silence from the HSA. So no one apparently wants to inform the patient consumer the bad news. No one wants to point the finger at surgeons for retailing faulty devices. Seems to be that the patient's only recourse is through litigation. Even so,  there should be adequate awareness among patient-consumers that there is a problem. Sadly, there is so little local information available for the patient-consumer to use. HSA's silence is certainly not helpful.

Gigamole believes we need a Lemon Law for medical devices. But not just a law,  we need a healthy consumer protection movement for drugs and medical devices.