Learning from mistakes 

This article first appeared on Medicine Malaysia

The recent ‘victory’ for vapers may be the start of a long journey against its ill effects. Cigarette smoking had an eerily similar start with its perceived safety and the false promotion of ‘the’ lifestyle. That has since been debunked in 1964 after the announcement of the Dr Luther Terry, the Surgeon General’s report on the ill effects of smoking. [link]

Vaping has had a relatively short history. We attempt to look at the evidence thus far.

Marini S1, Buonanno G2, Stabile L3, Ficco G3., Short-term effects of electronic and tobacco cigarettes on exhaled nitric oxide, Toxicol Appl Pharmacol. 2014 Jul 1;278(1):9-15. doi: 10.1016/j.taap.2014.04.004. Epub 2014 Apr 13

This article looked at the short term respiratory effects of e-cigarettes versus conventional cigarettes. They measured exhaled nitric oxide (eNO) as a representation of the average particle deposited in the alveolar and transbronchial region of the lungs. Vaping and conventional cigarettes had similar effects and was, as expected, higher than controls. So vaping certainly does not do less harm to the deeper regions of the lungs.

Tierney PA1, Karpinski CD2, Brown JE1, Luo W2, Pankow JF3., Flavour chemicals in electronic cigarette fluids, Tob Control. 2015 Apr 15. pii:tobaccocontrol-2014-052175. doi: 10.1136/tobaccocontrol-2014-052175. [Epub ahead of print]

This looked at the content of e-cigarette fluids. Many had aldehydes, known lung irritants and other formulations/chemicals which are of toxicological concern. The concern is the poor regulations surrounding the production of these fluids and many of them are unlabelled. Many are also self-produced by those trading with these fluids.

There are still many unknowns with vaping. The long term effects will likely be better known in many years to come, especially when more people pick this habit up. It is unfortunate that we are likely to repeat the past and the errors of judgement and deceit prevalent during the heydays of cigarette smoking. Pro vapers have used the notoreity of cigarette smoking to justify their existence, without truly understanding the safety surrounding vaping.

Giroud, de Cesare, Berthet, Varlet, Concha-Lozano, Favrat, E-Cigarettes: A Review of New Trends in Cannabis Use, Int J Environ Res Public Health. 2015 Aug 21;12(8):9988-10008. doi: 10.3390/ijerph120809988.

Vaping apparatus opens up a new method of ‘smoking’ illicit drugs. It brings a dark parallel to the days of opium smoking. There is nothing dissimilar in this episode. Malaysia’s fight against drugs could take an unfortunate turn with the acceptance of vaping. It will create a new environment where the battle against drugs could get complicated and more widespread.

We should not succumb to a still small numbers of pro-vapers, and sacrifice the future of generations to come, just to score a few brownie points. There is no harm stopping it in its tracks while a more detailed study is done.

Let history be our guide and let’s not make the same mistake twice!

Let us not forget

This post appeared on Medicine Malaysia.


Like war memorials, eradicated diseases like small pox and poliomyelitis must be enshrined in museums so that the public will not forget what devastation these diseases brought to Mankind. Lest we forget and the silliness takes over, dragging us back into the dark ages before immunisation was discovered.

Anti vaccination movements are based on crooked facts, contorted to paint a picture of evil intent, even to the despicable action of dragging in racialism, religion and politics. There is no science or proof to their claims but the rhetoric and the art of instilling fear often courts potential converts to their egregious cause.

Fortunately, their numbers are small and the element of herd immunity continues to offer protection. However, we cannot be lackadaisical in our efforts to remind everyone that immunisation has had an excellent safety record and has had a track record of keeping deadly diseases at bay. We need to constantly remind everyone of the danger that lurks when this invisible armour is stripped and the human body lays at the mercy of a minute, unseen enemy.

Let us not forget!

Brace for Impact

Brace, brace, brace!

These are often the most feared words when on an airline. The impending doom is undeniable.

Is fighting against corruption a sin? Are the ruling politicians so blinded by power and wealth? Do we actually care about Malaysia?

One gets a sense that those who don the yellow T shirts this weekend are marching into danger, putting possibly their lives on the line. That’s love for your country. It neither mean they are less religious, nor does it make them bigots. It’s the final resort to save our country from apparent lawlessness. The inanity of words spewing from our politicians are just too hard to swallow for many. These words are clearly to cause division while claiming the strategic racial and religious high ground. Their fitness to lead a country that prides itself with diversity, is now suspect.

The surreal sense of doom this weekend may either be prophetic or just a false sense of alarm. One would pray that the authorities will show maximum restraint. Let history judge this weekend as the defining moment of triumph for Malaysia, and not plunge us into the dark world of anarchy.

Brace, Brace, Brace!

#bersih4 #saveMalaysia

Playground danger

Malaysia has lots of shopping malls. Within these malls, children’s playgrounds are also springing up. They can certainly be a place to keep your children occupied while you shop. However, within these playground areas lurk an unseen danger.

Microbes transmitting diseases often lurk in abundance, clinging to the paraphernalia associated with these places. The swings, the carousel, the slides, the ball pool and the list is endless. The chances of picking up a nasty infection from these places is rather high.

Playgrounds are not monitored by the authorities for cleanliness. Eateries and even kindergartens are often under scrutiny, but these public play areas has escaped strict surveillance. Many do not even have basic precautions, for example hand scrubs. No one even knows how often these places are disinfected and cleaned.

Many parents can attest to the fact that children often can fall ill after a visit to a public playground. However, establishing a relationship between the two is almost impossible, unless an epidemic arises in a particular area.

So my advice to parents are the following.

1. Ensure that proper sanitizing facilities, e.g. hand scrubs are available at the entrance with a strict rule that all must perform a hand scrub upon entry.
2. Cleaning maintenance schedules must be publicly displayed.
3. Compulsory checks on body temperature
4. Limiting the number of children at any one time

Without these four compulsory criteria, I feel that playgrounds are flouting rules in ensuring the safety of our children from infectious diseases.