The Ministry of Health (MOH) and Academy Medicine of Malaysia (AMM) recently held its 12th Scientific Meeting at the Putra World Trade Centre (PWTC), Kuala Lumpur, from 30 October – 1 November. Incorporating the 20th NIH Scientific Seminar and the 5th International Clinical Conference in Emergency Medicine (ICCEM), it welcomed 800 healthcare professionals – to an intensive and detailed programme, echoing a timely theme “Battling NCD – New Strategies”.

With a back-to-back programme lined-up with ten plenary sessions and more than 70 mini-sessions in dedicated symposia – delivered by more than 80 local and international experts – the event is all geared up to empower healthcare professionals through the exploration of new strategies and preventive measures in tackling NCDs.

This year, the event has incorporated AMM’s closed-door Annual General Meeting, in addition to the admission of 102 medical specialists to the AAM and the conferment of 25 scholarships on senior members of the academy. The annual ICCEM poster competition, which saw a submission of 119 posters, witnessed its the top three winners for each category who walked away with certificates and tokens of recognition.

119 posters were submitted for the annual ICCEM poster competition. All are displayed either in print or digitally, at the lobby of the reception.
119 posters were submitted for the annual ICCEM poster competition. All are displayed either in print or digitally, at the lobby of the reception.

The top three winners of the ICCEM and NIH poster competitions for each category are awarded with certificates and tokens of recognition during the closing ceremony.
The top three winners of the ICCEM and NIH poster competitions for each category are awarded with certificates and tokens of recognition during the closing ceremony.

“Malaysia is not alone in facing the impact of NCDs with its complications in a growing ageing population. We are fortunate to have with us distinguished international and local speakers who will share with us their knowledge and wisdom in tackling this economically burden disease,” remarked Professor Dato’ Sri Dr Abu Hassan Asaari, Chair of the Organising Committee in his welcoming speech. “In this era of digitalisation, tackling this challenge will require innovations and new strategies,” he added.

In his welcoming speech, Professor Dato’ Sri Dr Abu Hassan Asaari, Chair of the Organising Committee also mentions that it is tough battle against NCDs as it needs to address a change in lifestyle and human behaviour, and affects the economic status of a country.
In his welcoming speech, Professor Dato’ Sri Dr Abu Hassan Asaari, Chair of the Organising Committee also mentions that it is tough battle against NCDs as it needs to address a change in lifestyle and human behaviour, and affects the economic status of a country.

“Prevention is better than cure”: Addressing NCDs as a nation

Kicking off the event was a series of pre-conference events, featuring workshops on prolific intervention for emergency medicine; i.e. courses on damage control resuscitation, non-invasive ventilation and an introduction to motorcycle paramedics as universal responders.

The official opening ceremony was graced by the presence of Deputy Health Minister, Datuk Seri Dr Hilmi bin Yahaya. In his opening speech, Dr Hilmi alerted the audience that the prevalence of NCD risk factors continues to rise among Malaysians – a worrying trend for the country.

“For Malaysia, it has been estimated that 73% of total deaths are due to NCD and that half of these are due to cardiovascular diseases,” he highlighted.

Based on the National Health and Morbidity Survey (NHMS), the prevalence of NCD risk factors will continue to rise, a worrying trend for the country.

“This message is vital because NCDs can be prevented by practising a healthy lifestyle,” echoed Dr Hilmi, emphasising that ““prevention is better than cure”.

He called for a whole-of-society and whole-of-government approach to battle the increasing prevalence of NCDs.

The opening ceremony graced by Deputy Health Minister Datuk Dr Hilmi bin Yahaya, on behalf of Health Minister Dr S. Subramaniam, highlights that Malaysia could adopt strategies from other countries such as Australia and Hong Kong in tackling the rise in prevalence of NCDs.
The opening ceremony graced by Deputy Health Minister Datuk Dr Hilmi bin Yahaya, on behalf of Health Minister Dr S. Subramaniam, highlights that Malaysia could adopt strategies from other countries such as Australia and Hong Kong in tackling the rise in prevalence of NCDs.

Dr Hilmi further stated that the nation has launched an initiative goal for the community, “Perkasa Negara, or KOSPEN, which means healthy communities building in the nation”. The initiative is hoped to bring down NCD risk factors through the introduction and facilitation of living practices among the respective communities. This can then ensure “involvement among the rakyat in prevention and awareness programmes to control NCDs in Malaysia.”

Commenting on the government’s involvement, he assured that the MOH will be realigning “the primary healthcare system in Malaysia to be NCD-sensitive” – instead of the current system that is geared towards acute care. Achieved through the Enhanced Primary Healthcare (EnPHC) initiative, it will focus on diabetes, hypertension and exacerbating heart disease in the following year.

Dr Hilmi highlighted that the newly aligned system “needs to address the entire spectrum of promotion, prevention, screening and early diagnosis, optimal treatment, and irrigation on preventive care for NCDs.”
Dr Hilmi highlighted that the newly aligned system “needs to address the entire spectrum of promotion, prevention, screening and early diagnosis, optimal treatment, and irrigation on preventive care for NCDs.”

Highlighting the fact that the determinants of NCDs largely fall outside the health domain, Dr Hilmi assured that the MOH has “adopted the whole-of-government approach to effectively prevent NCDs, to be strong and proactive, with the involvement of many other ministries as stakeholders.”

“While there is still much to be done to tackle NCD – with a long and challenging journey ahead – “we already know our goal – a 25% reduction in premature NCD death by the year 2025. If we share our resources, expenses and expertise, I’m confident that they will all reach that destination together safely,” asserted Dr Hilmi.

(left – right) Professor Abu Hassan, Chair of the 12th MOH-AMM organising committee and Professor Dato’ Dr P Kandasami, Master of AMM presents a token of appreciation to Dr Hilmi Yahaya for attending the meeting.
(left – right) Professor Abu Hassan, Chair of the 12th MOH-AMM organising committee and Professor Dato’ Dr P Kandasami, Master of AMM presents a token of appreciation to Dr Hilmi Yahaya for attending the meeting.

Unexpected effects of climate change and nuclear threats

With the vision of reducing the burden of NCDs, this year’s theme hopes to encourage delegates to develop and advocate for effective and sustainable NCD interventions by treating it as a public health emergency.

Reiterating the theme, Datuk Dr Ronald McCoy, Past Co-President of international Physicians for the Prevention of Nuclear War (IPPNW), shared his expertise for delegates to contemplate the effect of climate change on NCDs and the strategies required to tackle the problem.

As Dr McCoy pointed out, climate change has evidently increased the incidence of natural disasters – leading to a terrain of public health issues. Providing a general solution, he elaborated, would require “unprecedented multilateral cooperation” and sustainable development. However, sustainable development “remains an ill-defined set of descriptions for international governance and national implementations.”

Datuk Dr Ronald McCoy delivers an eloquent speech on how climate change and nuclear threats represent newer challenges in NCDs. He also reminds that “solutions lie within reach and should be based on a redefinition of prosperity.”
Datuk Dr Ronald McCoy delivers an eloquent speech on how climate change and nuclear threats represent newer challenges in NCDs. He also reminds that “solutions lie within reach and should be based on a redefinition of prosperity.”

Addressing nuclear threats, he urged Malaysians to be educated about nuclear power as in June 2009, the government declared that the country will have its first nuclear power plant 2021 to reduce carbon emissions. Yet, there is no strong community support, genuine dialogue amongst the public or evidence that nuclear energy is cheap, clean and safe.

“Most critically, how are we going to carry out the safe and permanent disposal of lethal, invisible, odourless nuclear waste which will remain radioactive for hundreds of thousands of years?” he questioned.

Dr McCoy then called for the medical profession to “exert its considerable influence on governments, politicians and the business sector, particularly the arms industry – and by advocating equally ecological sustainable developments in response to climate change, the phasing out of nuclear power and the elimination of nuclear weapons.”

Attacking NCDs on a molecular level: A genetic perspective

The session on precision medicine in NCDs provoked much thought among delegates. Chaired by Senior Professor Dato’ Dr Khalid Yusoff, Vice-Chancellor of UCSI University, the joint symposium featured Professor Dr Gordon Williams, Harvard University’s School of Medicine and Mr Leonard Ariff, Chemical Company of Malaysia Bhd.

“Precision medicine is a medical model that proposes the customisation of healthcare with medical precision practices in our products being tailored to individual patient,” explained Professor Williams.

Expanding on the concept of precision medicine, he suggested approaching the fight against NCDs through genetics. Citing hypertension as an example, Professor Williams likened the treatment of hypertension to fever, 50 years ago. He explained that the medical profession treats high blood pressure as a disease, making the reduction of blood pressure – a sign – as the primary goal of therapy. The treatment is also population-based.

“But, we don’t treat fever as a disease anymore. Fever is a sign. Yet, we still use an elevated blood pressure as a disease, or an elevated glucose level as a disease, or obesity as a disease; when in reality, they are probably not diseases at all,” he elaborated.

The problem with this algorithm of practice is that it does not account for environmental factors – which have huge interactions with genes, in producing syndromes. “But it does not distinguish between disease and syndrome? What is the disease? What is the phenotype? Is hypertension a disease? Is obesity a disease? Is diabetes a disease?” Professor Williams pondered.

Professor Dr Gordon Williams, Harvard University’s School of Medicine gives insight onto how genes may play a bigger role than thought on NCDs. He reminds that it is a doctor’s job to “treat the patient, not the symptom.”
Professor Dr Gordon Williams, Harvard University’s School of Medicine gives insight onto how genes may play a bigger role than thought on NCDs. He reminds that it is a doctor’s job to “treat the patient, not the symptom.”

Returning to the problem of hypertension, he stated that patients with hypertension often have problems with salt sensitivity – too sensitive or not sensitive at all. Using big data, the genetic culprits were narrowed down, and further specified through deep phenotyping.

“Nine different proximate phenotypes, each with one link to a different variation in the gene were identified,” Professor Williams states. The nine genes define the mechanisms behind the different salt-sensitivities of patients with hypertension, therefore this warrant “different proposed treatment strategies that would be precise and specific with them.”

However, there are barriers for the adoption of such precision medicine – such as legal and regulatory frameworks, said Mr Leonard Ariff.

(left – right) Mr Ariff and Professor Williams sit down to answer questions from the floor during their session. Both agree that Malaysia is a strategic location to advance scientific research through clinical studies.
(left – right) Mr Ariff and Professor Williams sit down to answer questions from the floor during their session. Both agree that Malaysia is a strategic location to advance scientific research through clinical studies.

Among other factors, Mr Ariff put forward the access of data for development of drugs, limited ability to integrate data sources and the limited number of collaboration partners, as some of the key barriers.

He urged for a central laboratory to be built in Malaysia for the growth of the concept of precision medicine – as equipment to carry out trials are available but spread out across six universities in Malaysia. Echoing in agreement, Professor Williams stated that it would be useful step – as the multicultural background of Malaysia provides an advantage of carrying out studies in Malaysia.

Reframing NCDs as a nation development issue

Another thought-provoking session, featuring a panel of three speakers – Professor Dr Lekhraj Rampal, Vice President at College of Public Health Medicine, AMM; Dr Feisul Idzwan Mustapha, Head of the NCD Sector in MOH; and Dr Azlan Darus, manager of Prevention & Promotion of Occupational Health at SOCSO – resonated with Dr Hilmi’s suggestion for NCDs to be a nation development issue, instead of a health issue.

“It is not the role of the NCD unit in the MOH. It is the role of the healthcare providers and the rakyat to solve this problem,” Professor Rampal said exasperatedly. He urged healthcare professionals to support the MOH in making policies, and foster innovation in thinking of ways to tackle NCDs.

Citing the event as an example, Professor Rampal shared with the crowd that it was “the first time in MOH-AMM history, that we are talking about NCDs and move forward to tackle it as a whole” – further echoing the importance for continuous engagement and involvement of the community at all levels.

Professor Dr Lekhraj Rampal, Vice President at College of Public Health Medicine, AMM urges the current cohort of doctors to advocate for policies that the MOH introduces for the benefit of public health. This includes the change in age restriction for the sale of tobacco, as well as alcohol advertisements.
Professor Dr Lekhraj Rampal, Vice President at College of Public Health Medicine, AMM urges the current cohort of doctors to advocate for policies that the MOH introduces for the benefit of public health. This includes the change in age restriction for the sale of tobacco, as well as alcohol advertisements.

Dr Feisul agreed, but mentioned that behaviour of individuals cannot be easily changed as it depended on many drivers – or determinants. “If we talk about behaviour patterns, you have your environmental – the living environment that shapes it. Just changing the environment is challenging. This does require policy interventions,” he noted.

“If we still look at NCDs as a health issue, then it is very difficult to make any change. We have to reframe it into a nation and development issue,” he suggested, “It can only be addressed effectively through addressing the social determinants of health.” These factors include epidemiological transition, urban transitions, responsible consumption and production, as well as the environment – all factors outside the health sector.

Dr Feisul Idzwan Mustapha, Head of the NCD Sector in MOH suggests the reframing of the NCDs issue into a nation and development issue rather than a public issue. On the National Strategic Plan for NCDs 2016-2025, he says that the secondary objective is not about education, but rather, creating a health-promoting environment.
Dr Feisul Idzwan Mustapha, Head of the NCD Sector in MOH suggests the reframing of the NCDs issue into a nation and development issue rather than a public issue. On the National Strategic Plan for NCDs 2016-2025, he says that the secondary objective is not about education, but rather, creating a health-promoting environment.

Tobacco control in Malaysia

(left – right) Speaking on Tobacco Control in Malaysia, En Mohammed Shaani, ex-comissioner of SUHAKAM; Mr Veeramohan Supramaniam, ex-Vice President of the Malaysian Association of Environmental Health; and Dr Molly Cheah, President of the Malaysian Council for Tobacco Control, urges healthcare professionals to play a role in curbing the rising prevalence of smokers.
(left – right) Speaking on Tobacco Control in Malaysia, En Mohammed Shaani, ex-comissioner of SUHAKAM; Mr Veeramohan Supramaniam, ex-Vice President of the Malaysian Association of Environmental Health; and Dr Molly Cheah, President of the Malaysian Council for Tobacco Control, urges healthcare professionals to play a role in curbing the rising prevalence of smokers.

Perhaps the most anticipated session of the meeting was the round table discussion on tobacco control in Malaysia. Moderated by Dr Milton Lum Siew Wah, council member of AMM, it gathered three panel speakers – Dr Molly Cheah, President of the Malaysian Council for Tobacco Control; En Mohammed Shaani, ex-comissioner of SUHAKAM; and Mr Veeramohan Supramaniam, ex-Vice President of the Malaysian Association of Environmental Health.

“I don’t see more than 50 people in the audience. I hope this doesn’t reflect the enthusiasm in which, the medical community is supposed to have, in regard to getting some information about the biggest culprit of all our problems,” expressed Dr Milton.

As delegates trickled into the hall, Dr Cheah shared her expertise, prompting healthcare professionals to pay attention to trade issues of tobacco in Malaysia. “The globalisation of the tobacco epidemic only occurred in the past two decades when there was liberalisation of the global trade. Somehow, the medical profession missed addressing this issue,” she said, stating that “it was not too late” to do so.

Dr Molly Cheah highlights the importance of trade issues, claiming that tobacco is the biggest culprit in the NCDs. She shares that understanding trade issues will provide insight into why the prevalence of smoking in Malaysia is still high despite spending millions and possibly billions on tobacco control measures.
Dr Molly Cheah highlights the importance of trade issues, claiming that tobacco is the biggest culprit in the NCDs. She shares that understanding trade issues will provide insight into why the prevalence of smoking in Malaysia is still high despite spending millions and possibly billions on tobacco control measures.

Detailing regional and global trade agreements, she mentioned that tobacco trade liberalisation has only worked in favour of the translational tobacco trade industry. “Ethically, is it correct to allow the producers to do something so dangerous and addictive to be given so much privilege?” she questioned.

She cited a recent report on the US government taking USD280 billion worth of legal action against prominent tobacco companies for racketeering.

“How is it then, that this same industry deserves the right and liberty to propagate the deadly product to our people and our children – in the name of free market – when it endures intense restriction in its country of origin?” she asked rhetorically.

Dr Cheah also cited studies that provided evidence that the impact of trade liberalisation is associated with increased tobacco consumption, especially in low and middle-income countries with market penetration. “Tobacco should not be treated as a normal product. It should not be given incentives, and it should not be protected,” she emphasised.

En Mohammed Shaani cites several scientific bodies, stating that second-hand smoke is carcinogenic and equally harmful as first-hand smoke, therefore making tobacco control a human right.
En Mohammed Shaani cites several scientific bodies, stating that second-hand smoke is carcinogenic and equally harmful as first-hand smoke, therefore making tobacco control a human right.

En Mohammed Shaani agreed, stating that cigarettes should be totally banned, especially when “second-hand smoke is one of the hindrances to achieving out targeted prevalence.” Elaborating further, he said that smoking affects all individuals, through smoke particulates that are invisible in the air or on surfaces where the smoke lands.

“I think the medical profession has a bigger role to educate smokers who come into clinic – to be a responsible smoker,” he suggested, “if you want to smoke, you know the risks, go ahead. But, please do not visually influence a child to start smoking. This should be the critical control point.”

Dr Cheah also called for healthcare professionals to put pressure on fellow colleagues who smoke, to stop smoking, as well as ensure that anyone working in the healthcare sector do not smoke.

“Everybody who has the responsibility to treat, should prevent,” En Mohammed Shaani said. MIMS

Read more:
Malaysia updates guideline: Primary and Secondary Prevention of CVD 2017
Why trade matters: How are trade policies impacting the surge of NCDs in Malaysia
Budget 2018: An extensive overview on the possibility of improving Malaysia’s healthcare system