Any Stuff related to the MOH :: MiNIstry of Health and Health Issues. Issues which would result in the MOH becoming a better health provider for us all.
Free treatment at public hospitals to end next year Annie Freeda Cruez
KUALA LUMPUR, Apr 25: There isn't going to be any more free treatment at government hospitals! From next year, some eight million Malaysians will have to pay for their medical treatment.
This is when the National Health Financing Scheme comes into force.
Those exempted will be the one million civil servants, some 200,000 disabled people, about 435,000 pensioners, around 250,000 hardcore poor and the unemployed.
Health Minister Datuk Dr Chua Soi Lek said public sector healthcare financing had been spiralling upward in the past two decades. Since it first breached the RM1 billion mark in 1983, he said, government healthcare allocations had increased to RM9 billion last year.
He said the demand for health care was projected to increase further.
Last year, there were 1.7 million admissions in government hospitals nationwide. The outpatient departments had 47 million visits.
"The Government subsidised 98 per cent of their treatment. This cannot go on as there has been a significant escalation of health care costs in recent years. Medical inflation in Malaysia is ever increasing," he said after the launch of The Pacific Insurance Berhad's Gold-Cross Medi-Preferred Insurance and Gold-Cross Home Healthcare Insurance here.
At present, Dr Chua added, the general scheme of things under the National Health Financing mechanism had been decided upon and they were in the process of appointing a consultant to look into details, such as the quantum, criteria and ceiling of contributions, the collection mechanism, the basic health packages and the provider payment mechanism (how the ministry will pay the clinics and hospitals).
Dr Chua said the National Health Financing Scheme was a payment scheme and not a privatised or insurance scheme.
The study connected with the National Health Financing Scheme has been going on for years and it has yet to see the light of day. The medical fraternity and the public have not been allowed to know what it is all about. We have been just fed with a morsel here and there. Why the secrecy when joe public is the ultimate consumer of the Scheme. Still nothing concrete has been told. It appears that another consultant will be hired to look into its finer details. Probably the unprecedentedly appointed new DG of Health will be around to see it through. Datuk Dr Ismail Merican has been long involved in the formulation of the scheme. Once again the NST has got things wrong, what's going on, anyway free treatment is not going away just yet. See this BERNAMA report, excerpts ::
On another matter, Dr Chua described as inaccurate a report in an English daily today stating that there would be no more free treatment at government hospitals from next year when the National Health Financing Scheme comes into force. He said it would take a consultant about a year to study the details of the scheme. "If the consultant is appointed this year and finishes the task in a year, it does not necessarily mean that after it is completed, the current payment practices are stopped. It's a bit misleading," he said. Dr Chua gave the assurance that the government would continue to look after the needs of civil servants, the poor, the disabled, pensioners and the unemployed.
By Patricia B. Gatbonton, MD Posted on Monday, February 09, 2004
The exodus of doctors from the Philippines has been continuing. But this is hardly news anymore.
Over the past few years, however, the exodus has taken a new twist: Filipino doctors are moving abroad to look for jobs not as physicians but as nurses. And the country’s health care system may collapse if society does nothing to stop the hemorrhage.
Aging baby boomers are straining the healthcare system in developed countries, causing an acute shortage of nurses. In the US, the shortage is estimated to be 600,000 by 2010; in Japan, the nurse deficit will be 1.2 million. A BBC report says that over 17,000 Filipino nurses—the largest minority group—migrated last year to work in Britain.
The Philippine Nurses Association estimates that some 2,000 doctors have enrolled in nursing schools throughout the country. The National Institute of Health Policy Development pegs the number closer to 3,000—double the number of licensed medical practitioners produced each year. One hundred physicians took the nursing boards in June 2002.
Nearly every physician I know speaks of at least one colleague who has taken up nursing. There are as many reasons as there are profession shifters.
Disenchantment with the medical profession itself: The paltry HMO-driven consultation fees, the long wait for checks, the looming threat of compulsory malpractice insurance, the persecution and paper chase by the Bureau of Internal Revenue. As self-employed professionals, doctors pay income tax quarterly, have 10 percent of any income automatically withheld, and pay an additional 2-percent monthly tax. On top of this, any physician who grosses over P500,000 a year in professional fees has to register as VAT and pay the additional 10 percent. Do the math.
To practice in a hospital, on top of needing certification credentials, the applying physician may need to buy stocks, rights to practice, and clinic and parking space, ranging from P800,000 to P1.5 million. In addition, if the doctor is lucky enough to beg, inherit, or borrow the money, there is no guarantee he will get a return on his investment. Patients balk at having to pay an outpatient consultation fee of P350 to P500 in a medical center. Socialized fee for service is the general practice. For most in-patients, physicians charge depending on the room rate. But admissions and out-patient consults are seasonal, and go up and down, depending on whether it is tuition fee time or summer vacation, Christmas is another lean season. Most doctors earn between US$300 to $1,000 a month. Although doctors figure in the BIR’s top 100 taxpayers, these are long established specialists in their field.
The unkindest cut of all is when patients and their relatives automatically assume a doctor is overcharging. Do we ask the person who cuts and colors our hair for a discount? The patient may leave the hospital as long as he has paid his bill, but there is no holding him back even if he does not pay his doctor a single centavo.
That is not to say physicians are not capable of charity. Doctors are charitable with both time and knowledge in the medical school wards with doctors in training and their patients. Professional ethics extends the no-charge policy to fellow physicians and their immediate families. Many doctor friends, by choice, do not charge the religious, employees of the hospital, a family friend and sometimes extend this courtesy to a friend of a friend of a friend. (Otherwise know as an extension in UP-PGH lingo. Extentionitis is a patient you do not expect to charge). Of 10 patients in the waiting room, half would be card-paying, two would be religious and only three will pay the consultation fee. Not much to show for a hard morning’s work.
Charity should be a personal choice—although frankly, sometimes there is no choice. How many times have my clinic mates and I lamented, “Mayaman ako sa promissory notes.” We tell ourselves: we’re not in this for the money. But the reality is, we cannot eat promissory notes for dinner, nor will it put gas in my car or pay for our children’s education. By experience, only 1 in 10 will come back and settle the balance. The rest we chalk up to heaven, experience and good karma, trusting that what goes around, comes around.
Other push-me-pull-me-away-from-my-homeland factors include the state of the nation’s peace and order, the current and future political climate, “If FPJ wins, I’m out of here,” is a phrase I hear nearly every day, the free-floating anxiety triggered by the free-falling peso, the escalating cost of living, the enticement of the almighty dollar, the greener (currently snow-white) pastures in the US, London, Canada and Ireland. Filipino doctor-nurses are among the top human resources the Philippines currently exports.
At an October meeting of the Philippine College of Physicians internal medicine residency training institutions, participants wryly acknowledged that fielding a full plantilla of trainees, even in medical university affiliated teaching hospitals, was more difficult than usual. The palpable reduction in the number and quality of applicants is a shared experience. In years past, competition was fierce for a limited number of slots. The inevitable conclusion: Everyone’s taking up nursing.
A byproduct of hard times
The doctor who is also a nurse is a rapidly growing phenomenon, an evolutionary byproduct of hard times. The game of life is all about survival of the fittest—those that survive are the most ready and willing to double-task and start over. Evidently many of my colleagues are. Anesthesiologists, general and specialist surgeons, obstetricians, general and subspecialist internists, general and subspecialist pediatricians, dermatologists, radiologists—you name it—there is no exception, physicians are jumping on the nursing bandwagon.
As with any trend, there are positive and negative repercussions. Nursing schools are sprouting everywhere. The latest tally at the Commission on Higher Education (CHED) of the Department of Education, Culture and Sports (DECS) is there are 233 nursing schools throughout the country; CHED accredited 32 new schools in 2002. On the other hand, enrolments in medical school have dropped.
The initial special curriculum for doctors and other allied medical professionals required a licensed doctor to undergo one year of classroom and practical training before receiving a nursing diploma. The premise being, after four years of medical school, one year of internship, plus an additional three to five years of residency and an optional two to three years of fellowship, the physician needs only one year to acquire additional nursing skills. Contrast this with a regular four-year college-nursing course.
This is the mind-boggling paradigm shift: medicine is now a pre-nursing course. Is nursing an upgrade or downgrade of medicine? Talk about evolution in reverse (or vice-versa).
Beginning in 2004, the course will now take two years and is a heavier investment in both time and money. This has got the goat of both the doctor nurses-in-training and nursing students.
Reality bites
Doctors complain about the additional time requirement (How long will it take to learn how to mix intravenous fluids and drugs?) And even if the clinical instructor (CI) addresses you as “doctor” in the classroom, going on duty as a nurse in the wards is a tough reality check. You might frontline patient care, but have to strait jacket every impulse to do more. Like order laboratories or medicine in the chart. Talk to the family about the patient’s diagnosis. Make decisions that affect life and death. Something a doctor does all the time. Something that is second nature. How does one turn “being a doctor” off?
A friend (whom is migrating because his licensed-dentist wife is an American citizen practicing in California) tells me of the day a group of doctor-students sheepishly stood around a hospital bed, learning how to change the bedding layers, rubber sheet and linen, with a patient still in bed (Easy-peasy you say? Its a lot harder than you think.) A competent and compassionate internist, the patient’s condition set off his clinical radar and he automatically went into doctor-mode, interviewing the patient’s relative. His CI gently chided him, “Doctor, your assignment is to change the bed sheets. That’s all.” Reality bit him hard that day.
Unfair competition?
Nursing students, on the other hand, claim the nursing board exam degree of difficulty has gone up—because doctors are topping the exam. (Although another friend says its not as easy as she thought, she would often answer the question on the mock boards and find she got it wrong, because she was thinking like a doctor, and not like a nurse.)
A nursing student I know (whose sister is a nurse in Michigan, and will help him apply to a position at the same institution) says that doctor/nurses are bad news. Obviously, a doctor/nurse is formidable competition, with years of clinical experience and the medical degree behind him. Hospital recruiters would prefer the doctor/nurse to the wet-behind-the-ears new nursing graduate like him. He is counting on the family connection to help him land a job.
The nursing board results in December this year, just released, had a 43-percent-passing rate. Three thousand three hundred and eleven new nurses will shortly receive their licenses. Scanning the pass list quickly, I recognize many familiar names, and am frankly shocked and saddened, at seeing one or two. Many physicians will not openly admit to having enrolled in nursing, and rumors abound in the medical community grapevine.
The reality is that nurses can make an average of US$50 an hour. Working eight hours a shift three times a week, a doctor can make in one month five times what he will make in the Philippines if he is lucky. Hospital recruiters understandably hire doctor-nurses in the Emergency Room and Intensive Care Unit settings—where they command up to US$80 per hour.
One anecdote making the rounds is a story of a long practicing anesthesiologist, now a licensed nurse in California. On ICU duty one night, with a second-year medical resident, he came upon a patient needing to have a breathing tube put down his throat. The inexperienced resident found it difficult, the patient was in bad shape, and there was no one else to help. The doctor-nurse suggested that he insert the tube himself, and both the patient and the resident benefited from his skill. Had that got out though, legally, the doctor-nurse could have been liable. His license to practice in California is as a nurse, not as a doctor.
Honor in our calling
Many doctors who are sticking it out in the country are looking at other alternative sources of income. Teaching pays peanuts, even in the best medical schools, so those full time academicians teach for sheer love of the job. I know, I taught for three years before I wised up. Many doctors sell nutriceuticals and other supplements, real estate and insurance. Many go into business on the side. One neurosurgeon friend supplies bangus from his fishpond to hotels in Manila.
That we have to go into business to subsidize our profession saddens me. As much as I kid around that I will quit my “day job” and work as editor of HealthNews full time, the reality is that being a doctor is 24/7. I can’t give it up. Once a doctor, always a doctor, licensed to practice or not. Doctoring is in our blood, a part of who we are. Away from the hospital, when people find out you are a doctor, they will come up to you for the opinion, the prescription, the ambush consult. It goes with the territory.
So we do what we need to do to stay as doctors. I empathize with my friends and colleagues who feel the only way to improve their lots is to leave the country. I don’t question their reasons, idealism or nationalism, because I can’t be a hundred percent sure that I won’t go down that road myself one day.
As a very low maintenance singleton with no family pressure and indulgent parents, I can’t really identify with the mortgage, the tuition, the car payments, the bleak future.
Not too many people can wake up and say they love the work they do. That a doctor’s life and work rewards with a sense of purpose and fulfillment may be unique to the health care profession. It is something other people don’t or can’t have. Although money is necessary to sustain a comfortable life, we mustn’t let it stain our hearts, morals and principles. Nor must it entirely drive our career decisions.
It is not hard to explain or reconcile the doctor-nurse phenomenon, for if you cannot, by force of circumstances, stay a doctor, nursing is the next best thing. Nursing is as much about caring for a patient’s well being, lessening pain or suffering, and bringing comfort as doctoring is. And if it happens to pay well, there is nothing wrong with that. There is honor and calling in both professions, at home or abroad.
Google "doctors leaving phillippines" and you will get 162,000 links within 0.11 seconds!
All Donated Blood Tested Before Being Issued To Recipeints
KUALA TERENGGANU, April 18 (Bernama) -- The Health Ministry, Monday gave an assurance that all blood issued to patients had gone through various test and were free of infectious diseases.
Health Minister Datuk Dr Chua Soi Lek said that among the tests carried out on donated blood before being issued to patients who needed them were for HIV, Syphilis and also Hepatitis.
"We don't issue blood to recipients directly from donors. As such patients need not worry," he told reporters after a visit to the Specialist Clinc at the Kuala Terengganu Hospital, here Monday.
Newspapers today reported that more than 200 people who had been infected by transmittable diseases including HIV, continued to donate blood in different locations, something that has got the National Blood Bank worried.
Chua also said that testing procedures in the country were among the best and most stringent in the world.
However, according to him, the ministry was surprised by the actions of the people concerned as to why they would still want to donate blood knowing fully well they had been infected.
In another development, Chua said all operation theatres in the Kuala Terengganu Hospital which had been delayed almost three years could be used form next June.
He said the operating theatres would be completed by the end of this month and another month would be needed for cleaning works and installing of equipment.
"We believe the backlogs in surgeries will be overcome once the theatres are operational," he said commenting on reports that patients had to wait some times sup to eight months as only five of the 16 surgery rooms were in operation.
This was due to the appointed contractors not being able to get the operating theatres and post-surgical care rooms costing RM7 million ready on time.
Methadone Can Reduce Cravings But Not Cure Addiction
KUALA LUMPUR, April 18 (Bernama) -- The use of the synthetic drug methadone is a method to reduce the cravings experienced by drug addicts but is not a cure for addiction, director-general of the National Drugs Agency Datuk Hamzah Abdullah said.
He said that the use of methadone was not new and had been used by private clinics and private drug rehabilitation centres in the country.
"Methadone helps to reduce the addict's cravings for several hours and during this time he can carry out work or any activity normally," he told Bernama, here Monday.
He was asked to comment on the statement by Deputy Prime Minister Datuk Seri Najib Tun Razak on the use of methadone to tackle drug addiction in the country.
He said that if an addict took methadone, it has to be continuously taken as a replacement for heroin, morphine or the like.
"However, the amount will depend on the level of addiction and will gradually reduce," he said.
Hamzah said taking of methadone would also give a choice to the addict of continuing to stay at home instead of going op a rehab centre.
"They just need to go to a private clinic to get their supply of methadone when they have cravings," he said.
He said this way they might not face society's stigma of drug addicts.
At rehab centres, the psycho-social or "cold turkey" approach was used to rid them of the problem, said Hamazah.
Meanwhile, when contacted Monday, the chairman of the Former Drug Rehabilitation Centre Inmates Association (Prokim), Aminudin Ismail supported the proposal by Najib to use methadone to overcome the problem of drug addiction.
PUTRAJAYA, 17 April (Bernama) -- The government is now in the final stage of a study on the use of "Methadone" to treat drug addicts, said Deputy Prime Minister Datuk Seri Najib Tun Razak.
The government, through the National Anti-Drugs Action Committee, was now carrying out a pioneer project in treating drug addicts by giving them the synthetic drug.
The outcome of the study conducted by the committee, whose members included medical and pharmaceutical experts, revealed that Methadone was capable of preventing addicts from craving for the drug, he said.
"The National Anti-Drugs Action Committee is now carrying out a pioneer project using the Methadone drugs as a way of overcoming the addicts' withdrawal symptom," he told reporters after participating in the Bowling Fest 2005, organised by the Sports and Welfare Club of the Deputy Prime Minister's Office.
He said the outcome of laboratory tests on the effectiveness of Methadone in treating drug addiction had so far shown positive results.
Najib said the government had to look for new methods in the form of clinical treatment which were more suitable in treating drug addicts as the present treatment under the "Pusat Serenti" or One-Stop Rehabilitation Centre had not been very effective.
"This is because the briefings given by the National Anti-Drugs Agency so far showed that the success rate of rehabilitation at the Pusat Serenti is only 15 per cent," he said.
According to the report by the United States National Drug Control Policy, Methadone is a type of drug that can overcome cravings for drugs especially heroin, which had been tested repeatedly and proven effective for treating hardcore addicts in that country.
Methadone has already been tested extensively in many countries for use in drug addiction programmes. Why are we still running tests? Methadone is probably the "free drug" the Parliamenatry Sec of the Internal Security Ministry was talking about the other day
Be Self-sufficient In Vaccine Production, OIC Countries Told
KUALA LUMPUR, April 15 (Bernama) -- Datuk Seri Abdullah Ahmad Badawi Friday stressed the need for the Organisation of the Islamic Conference (OIC) member countries to be self-sufficient in vaccine production to ensure adequate supply and better development of halal vaccines for the ummah.
The prime minister said there was a risk of vaccine production becoming marginalised as more and more pharmaceutical companies chased higher profits in manufacturing other products such as "blockbuster drugs."
"Given the decline of the vaccine production in the western countries, it is vital that we in the developing world build our self-sufficiency in this area.
"In this way, we can ensure not only adequate supplies but also better development of halal vaccines. We can also ensure that vaccine development for diseases prevalent in our respective regions, such as malaria, will receive the attention that it deserves," he said when opening a four-day international convention on self-reliance on vaccine production in the Islamic world.
The convention was jointly organised by the Health Ministry and Islamic Development Bank.
Abdullah said the Malaysian government was currently embarking on a project for national self-sufficiency in vaccine production to ensure an adequate supply of safe and effective vaccines for the population.
As part of the project, the Malaysian National Institute for Natural Products, Vaccines and Biologicals was being established to act as the focal point for research and development in vaccine productions for the country.
"It is our aspiration that Malaysia will be self-reliant in vaccine production in the very near future and in doing so, be able to share our knowledge and expertise in halal vaccines with the Muslim world," he said.
He said the OIC members must recognise the urgent need to enhance cooperation among themselves, especially to bridge the deficit of global vaccine supply for use within OIC countries.
Abdullah said it was a fact that infants and children who live in Islamic nations faced a higher risk of catching epidemic and endemic infectious diseases, one of the leading causes of high mortality rate.
He said that according to the United Nation's Population Record 2004, seven of the 10 nations with the highest infant mortality rates were OIC members.
Some African and central Asian nations showed infant mortality rates exceeding 100 per 1,000 life births, he added.
"It is a tragedy to allow millions of our member nations' infants and children to die of such preventable causes. There are many reasons that contribute to this state of affairs, but perhaps the most important is the deprivation of childhood vaccination," he said.
Abdullah said that while it was important to promote the economic development of OIC member nations, it was just as important, if not more, to attend to the most basic of concerns, such as health and sanitation.
Indeed, to make economic and political change sustainable, measures to enhance livelihood must be accompanied by measures to sustain life, he said.
M'sia to produce 'halal' vaccines for Muslim world Malaysiakini Apr 15, 05 12:06pm
Malaysia plans to begin manufacturing "halal" vaccines for the Muslim world in the next two to three years to help bridge a serious supply deficit and mitigate possible effects of bioterrorism, ministers said today.
Health Minister Chua Soi Lek said a National Institute for Natural Products, Vaccines and Biologicals had been established to ensure adequate supply of basic childhood vaccines, and conduct research and development on vaccines for diseases prevalent in Southeast Asia such as dengue and Japanese encephalitis.
He said the institute would also play a key role to "mitigate effects of bioterrorism by having capability to scale up any seed vaccine from other sources in terms of emergencies such as smallpox or anthrax vaccines."
"It is our aspiration that Malaysia will be self reliant in vaccine production in the near future and in doing so, also be the halal hub for vaccine production for the Muslim world," he said in a statement at a conference here on vaccine production in the Islamic world.
There are no vaccines currently forbidden for Muslims on religious grounds but officials say there are concerns that some vaccines could be made from parts of the pig, which is considered unclean in Islam.
Chua said Malaysia previously produced its own vaccines but halted it in 1990 after 24 years. He said the government hoped to revive manufacturing within "two to three years" after conducting a feasibility study.
Serious deficiency
Prime Minister Abdullah Ahmad Badawi told the conference that there was a serious deficiency of basic childhood vaccines in the 57-member Organisation of Islamic Conference (OIC) nations due to a funding gap for immunisation and weak access to global supply.
He said according to the United Nations, seven of the top 10 nations in the world with the highest infant mortality rates were OIC members, with some African and central Asian nations recording more than 100 deaths for every 1,000 births.
He said the pharmaceutical industry's focus on profits had also led to a global major shortage of vaccines for ailments prevalent in Islamic nations such as measles, malaria and respiratory infections.
Abdullah, who is currently OIC chairman, called for deeper collaboration among OIC countries to work towards self-reliance in vaccine production.
"Given the decline of vaccine production in the Western countries, it is vital that we in the developing world build our self sufficiency in this area. In this way, we can ensure not only adequate supply but also better development of halal vaccines," he added.
THis is new to me, that we were producing vaccine till 1990! According to an NST report, Malaysia has had 24 years experience in vaccine production. Excerpts from that report ::
Malaysia has 24 years of experience in producing several types of vaccines through the Vaccine Producing Unit (VPU) of the Health Ministry. Among the vaccines produced by VPU were for Smallpox, Rabies, Cholera, Typhoid/Parathphoid, Tuberculin injections and Antivenoms against the Malaysian pit viper. However, the VPU was closed in October 1990 following a recommendation from a foreign consultant. Vaccine supplies for Malaysia have come entirely from foreign manufacturers since then.
Now after an absence of 15 years, can the MOH get back into action to reactivate its vaccine production abilities? Another question that needs an answer, why did we shut down the VPU in the first instance?
F.D.A. Panel Backs Breast Implants From One Maker By GARDINER HARRIS The New York Time Published: April 14, 2005
AITHERSBURG, Md., April 13 - Silicone breast implants made by a California company should be available to women who undergo cosmetic breast surgery, a federal advisory panel voted on Wednesday, rejecting arguments about serious health problems.
The panel chairman called the 7-to-2 vote to approve an application by the company, the Mentor Corporation, unexpected.
On Tuesday, the panel voted, 5 to 4, to reject a similar application from the Inamed Corporation.
Before the vote on Wednesday, Mentor was widely seen as having the weaker of the two applications because it had followed patients in its principal breast-implant study for a year less than Inamed.
Most panel members said they were comfortable with the long-term safety of Mentor devices, and most dismissed concerns that ruptured implants caused the kind of serious diseases that some women's groups have listed.
The diverging votes sent a mixed message to the drug agency, making predictions about what it would decide all but impossible. In 2003, the panel, with some different members, voted, 6 to 3, to approve an Inamed application. The drug agency rejected it in January 2004, saying more information was needed.
Many experts say they believed that the agency had toughened oversight of device and drug manufacturers in recent months. Yet, the agency generally follows the advice of its advisory panels.
The three-day hearing on implants began on Monday and included more than 160 witnesses who gave impassioned pleas to approve or reject silicone implants.
Dozens of women said implants had sickened them severely, and some gave gruesome testimony about silicone from ruptured implants squeezing out of their eyes and ears.
Dozens of other women pronounced silicone implants a safe boost to their self-esteem. Nearly all studies have found no link between silicone implants and serious disease.
The potential market for silicone implants could approach several hundred million dollars a year in the United States. About 250,000 breast augmentation operations are performed annually, and if the stigma and uncertainty attacked to silicone implants are removed, more women may choose the procedure.
At the moment, just saline implants are allowed for purely cosmetic operations, even though many patients and doctors say silicone implants feel more natural and look better. Several panel members said they had voted to approved the implants because Mentor made a more convincing presentation than Inamed.
"I want to explain to myself and everyone else why I could vote yes on one application and no on another," Dr. Stephen Li, a panel member who is president of Medical Device Testing and Innovations in Sarasota, Fla., said after the vote.
Mentor silicone implants "had an extremely low rupture rate," Dr. Li said.
"And we didn't have nearly the questions on this application that we did on the last application," he added.
The president of Mentor, Joshua H. Levine, said it was "very grateful that the panel looked at the science" and decided that "these products are not all created equal." Mr. Levine said he hoped that the F.D.A. would follow the guidance from the panel.
Inamed and women's groups complained about the votes.
"I'm stunned and amazed by a bizarre and strange decision by a few panel members who yesterday demanded longer-term safety data and today accepted shorter-term data," a vice president of Inamed, Dan Cohen, said.
Dr. Diana Zuckerman, president of the National Research Center for Women and Families, called the conflicting votes illogical and predicted that the drug agency would reject both applications.
Bitter rivals and crosstown neighbors in Santa Barbara, Calif., Mentor and Inamed each has 50 percent of the silicone implant market in the United States and together control 75 percent worldwide.
Silicone implants are mostly available just for patients undergoing breast reconstruction after cancer.
With the companies evenly matched, the differing votes represent a public relations coup for Mentor. Mentor shares, which rose 77 cents, to $35.33, in trading during the day, before the vote was announced, shot as high as $39.66 in after-hours trading.
Inamed shares, by contrast, plunged $2.90, or 4.37 percent, to close regular trading at $63.51. The stock fell even more rapidly after hours, after the vote was announced, dropping as low as $60.
Saline implants sell for about $400 and silicone implants for $800. Insurance almost never covers cosmetic procedures but does cover reconstructions.
As with the Inamed presentation on Tuesday, much of the panel's discussion on Wednesday revolved around how often Mentor implants ruptured and what happened to women with ruptured implants. The two questions have plagued silicone implants for more than 20 years.
Mentor described a study in which it is closely following 420 patients. The study has 3 of an expected 10 years of figures, and the women in the study have had just two screenings with magnetic resonance imaging. Screening is important because physical examinations by patients and their doctors rarely spot ruptured silicone implants.
After two years, six patients, or 1.4 percent, had ruptures. All were "silent," meaning patients and doctors were unaware of the problem until the screening showed it.
With two years of data from its own study, Mentor relied on studies by others to predict the long-term viability of its implants. Those studies showed that Mentor implants had a lifetime of 25 to 47 years, the company said. After 12 years, it estimated, 9 to 15 percent of the recipients could experience ruptures.
Given such limited data, the drug agency did not even try to estimate the long-term rupture risks for the Mentor implants as it had for Inamed. Staff members of the agency pointed out that Mentor had dropped women from its study when they had their implants removed and not replaced.
The outside study that Mentor relied on for many of its long-term estimates had myriad problems with the selection of women used, the agency said.
Dr. Sahar Dawisha of the office of device evaluation in the drug agency told the panel that even if the Mentor rupture estimates were correct, the widespread use of its implants would lead 22,500 Americans to suffer ruptures every year.
The panel placed nine conditions on a Mentor approval, including requiring that surgeons receive hands-on training with silicone implants before using them and that Mentor continue to study ruptures. The F.D.A. has little power to enforce such conditions after it renders an approval.
Mentor promised to abide by the conditions. Most panel members said the company gave them confidence.
"We don't have exhaustive knowledge about these devices," said Dr. Michael Miller, a panel member and a professor of plastic surgery at the University of Texas. "We have sufficient knowledge to justify their use."
Dr. Barbara R. Manno, a panel member and professor of psychiatry at Louisiana State University, said the panel wanted to give women a choice of implants.
"And it isn't to have a choice," Dr. Manno said. "It is to make a choice. And tough luck if it doesn't work out."
The American Society of Plastic Surgeons offered extraordinary support throughout the hearing to the manufacturers. Dr. Scott Speer, president of the society, is an Inamed consultant and delivered much of its presentation.
Barnaby J. Feder contributed reporting for this article
Breast implant is big business as more and more ladies are clamouring for breast enhancement operations. But the latest FDA panel voting on the 2 manufacturers can be confusing. Breast implants obviously have a rupture rate and a lifespan and these are things those chosing breast implants have to accept. And they will have to make an informed choice as to what is best and acceptable to them. It is unlikely that the FDA will approve either of the implants with the "bizzare and strange" voting pattern of the advisory panel members. The best choice for the patients who are considering breast jobs, is obviously accepting what nature has provided them with.
Gomen considering supply free drugs to addicts? The report by BERNAMA began like so ::
The government supplying drugs to addicts for free? It may sound nonsensical, but the Internal Security Ministry is prepared to look at the proposal as part of the measures to tackle the drug addiction problem in the country.
Is this for real? This suggestion of free drugs was made by Baharum Mohamed (BN MP-Sekijang). He further suggested that those addicts given free drugs would then be placed on a remote island to facilitate monitoring. We certainly do have MPs who can think out of the box! As to why he made the suggestion, the BERNAMA report quoted him as saying this ::
"We notice that the mandatory death sentence on drug traffickers has not been effective in curtailing drug trafficking. This is because drug traffickers want to get rich quickly while the addicts want to die quickly."
i am sure the YB's suggestion is not because he wants to help fulfill the death wish of some of the addicts who want to die quickly and hence the free drugs. Surprise number 2 came when the Internal Security MINIstry, Parliamentary Secretary, Datuk Wira Abu Seman Yusop, stated that the gomen is willing to consider the proposal. Surprise number 3 came when he further declared that a study could be carried out based on history where opium shops were licensed in the past to supply opium legally to addicts. Ain't our parliamentarians full of surprises. Has it got to do with their recent salary hike and the need to do something to show that they are worthy of it? To my simple mind the "free drugs" referred to meant methadone or other similar opiate substitutes which are used in some harm reduction programmes for drug addicts. As far as i am aware, the gomen is not too keen on these methods where free substitute drugs and free needles for exchange are given out under close monitoring. The Parliamentary Sec appeared very serious when he mentioned the following ::
"Supplying drugs to addicts for free needs to be studied in terms of its pros and cons although there were licensed opium dens in the past. "This could be used as a guide in making the study. We will submit (the proposal) to the Health Ministry."
i certainly hope the MINIstry of Health does not take him too seriously or else we will be back to the era of opium dens like those of the early 20th century.
MELBOURNE, April 11 (Bernama) -- Malaysian-born surgeon, Prof Tan Hock Lim, has been appointed to the executive committee of the newly-established high-powered Australia-Malaysia Institute.
He joins a select group of distinguished Australians in a committee that will help further strengthen and promote relations between Australia and Malaysia.
The chairman of the institute is barrister Michael Abbott QC, who has long-standing and active interest in Malaysia through his involvement with the Australia-Malaysia Cultural Foundation.
The other committee members are Paul McClintock, former secretary to the Australian cabinet; Prof Anthony Milner, of the Australian National University; Bob Cotton, former Australian High Commissioner to Malaysia; Dr Wendy Smith, from Monash University; Greg Sheridan, foreign editor of `The Australian'; and Kerry Adby, managing director of Copernican Securities Pty Ltd.
The institute will hold its inaugural meeting next month.
Australian Foreign Minister Alexander Downer, who announced the formation of the institute during Prime Minister Datuk Seri Abdullah Ahmad Badawi's visit to Australia, said that it reflected Australia's long-standing links with Malaysia in business, education and culture.
It would focus on exchanges of young politicians, intellectuals and media representatives, as well as cultural exchanges.
Prof Tan, a former student of St John's Institution in Kuala Lumpur, is Professor of Paediatric Surgery at the University of Adelaide and director of the Department of Paediatric Surgery at the Women's and Children's Hospital in Adelaide.
Downer had said that the institute would make a significant contribution in deepening mutual understanding and cooperation.
During a lunch meeting in Sydney on Friday, Prof Tan drew the attention of Abdullah to the fact that there were more than 100,000 Malaysian-born living in Australia, and many were in senior academic and professional positions.
Prof tan said he believed many like himself were willing to contribute their skills and knowledge to Malaysia, but there was no forum existing for those willing to explore this.
He hopes that the Australia-Malaysia Institute would be instrumental in developing the framework for this to occur.
Prof Tan's appointment is a recognition of work he has been undertaking the past few years, especially in developing a memorandum of understanding between the Malaysian Government and the Adelaide Women's and Children's Hospital.
Health Minister Dr Chua Soi Lek, who witnessed the signing of a letter of intent between Malaysia and Prof Tan's hospital, stated that the Government was building a women's and children's hospital within the Kuala Lumpur Hospital, and the Adelaide Women's and Children's Hospital was "a well-known paediatric centre, which could offer proper training to our doctors."
Prof Tan is a world authority on keyhole surgery and has developed many new methods to perform major operations through tiny puncture holes instead of making a large surgical cut.
He has also visited Kuching on several occasions in the past two years after he was approached by the Sarawak Government to help develop a centre for keyhole surgery.
He has also saved the lives of several young Malaysians in the past few years.
-- BERNAMA
Once again we are hearing of another Malaysian-born doing great work and getting recognised for it. Once gaain another loss to Malaysia and a gain to another nation. i wonder whether this came as a surprise to Pak Lah, Prof Tan of keyhole surgery fame told Pak Lah that there were more than 100,000 Malaysian-born living in Australia, and many were in senior academic and professional positions. Prof Tan also said that he believed many like himself were willing to contribute their skills and knowledge to Malaysia, but there was no forum existing for those willing to explore this. So do not be surprised when we next hear of "another Malaysian-born gets recognition" in some far away land.
There isn't going to be any more free treatment at government hospitals! From next year, some eight million Malaysians will have to pay for their medical treatment. 
