Feedback: commercially driven healthcare screening in Malaysia

Dr. Lum writes in

Hi,

I am a Malaysian who is currently practicing in US. I like the MMR website but I am not a blogger. I would like to hear some feedback from you (or your fellows) regarding the unethical and commercial driven healthcare screening in Malaysia. I have enclosed some links.

1. Bias and misleading:

“As a medical practitioner, I was taught in medical school that only few tumour markers are really useful i.e PSA, AFP and CEA, and most of the tumour markers are used for monitoring of disease status rather than screening. I am sure a lot of doctors also share this belief.
However, after a few years working with BP Healthcare Group, I now realize that tumour markers are not as useless as most doctors think they are. Let me share with you two case scenarios which happen to my patients and, hopefully with that, you can decide for yourself whether checking tumour markers are really necessary in health screening” source

2. Commercial driven healthcare screening – ridiculous screening tests, it seems that the Malaysian Health Department is supporting these types of screening.
source a
source b (look at page 2)
source c (support from Malaysian Health Department?)

3. From Singapore Health Promotion Board (HPB) Feb 2011
source

4. From Journal of Clinical Oncology Feb 2012 (electronic) May 2012 (paper)
“Professional society guidelines and the US Preventive Services Task Force (USPSTF) review and integrate clinical study data to determine whether various tests have evidence-based utility in various situations.7,8 Low specificity of testing leads to high false-positive rates, which then promotes dangerous and unwarranted follow-up testing, treatment, patient labeling, and patient anxiety. Conversely, low sensitivity of testing leads to high false-negative rates, which then results in missed diagnosis and delayed care. Under these circumstances, evidence-based guidelines usually recommend against test use for general population screening. When applied to online DTC cancer screening, as outlined in Table 2, evidence-based guidelines either recommend against general population screening or make no recommendation for every DTC tumor marker identified in this study.

……
Legally, because these online advertisements for DTC cancer screening tests are potentially false and misleading, the FDA is empowered with the Department of Justice to file for temporary restraining orders in abbreviated ex parte hearings (ie, hearings with only one side present) to have Web sites stop these potential violations of the Food, Drug, and Cosmetic Act.19
Journal of Clinical Oncology (Feb 2012)

I hope the MMA and Malaysian Health Department will start regulating
these types of healthcare screening. Hope to hear from you (and your
fellows soon).

Best regards,

Wen Sun Lum, MD
Internal Medicine/Hospitalist
Memorial Hospital South Bend, IN and
Volunteer Clinical Assistant Professor
Indiana University, School of Medicine (South Bend)

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Malaysian physician, haematologist, blogger, web and tech enthusiast

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9 comments on “Feedback: commercially driven healthcare screening in Malaysia
  1. Palmdoc says:

    Thanks for pointing out the situation in Malaysia where indeed healthcare screening is commercially driven. Anecdotal incidences of positive blood “tumour markers” do not currently justify the use of these tests as mass screening tools for cancer. Even the use of PSA is contentious at this point in time.
    In the Malaysian doctors forum (Dr. Lum, you are most welcome to join as well even if you are based in US), someone has brought up an example where health screening test are being promoted in Groupon!!
    http://forum.mydobbs.net/groups/dobbs-general/forum/topic/groupon-for-pap-smear

  2. Vagus says:

    I agree, everything has its place. No test is infallible but the very definition of a screen is the application of a test to a general population and in that I think most agree that causes more harm. Even the PSA very recently came into fire when the USPSTF changed their stance on its use. Evidence based medicine should guide treatment, not anecdotes. After all who amongst us have not seen a patient who got ‘better’ after taking some herb?
    PS Wen Sum, good to see you’re doing well!

  3. andre das says:

    The economical spinoff also goes to radiologist and endoscopist.I have to shoulder the end results of some of these unscrupulous investigations as the interpretation is washed off the hands of the labs. Patients don’t understand sensitivity and specificity and i feel it is not appropriate to order whole body ct especially when there is a possibility of lead time which begs the question of how often do we need to continue repeating negative investigations. I think it is unethical of me to just order some investigations and if they are negative , to wash patients of my hands.

  4. Shan says:

    Dr Lum,
    Please also complain at this link below:

    http://medicalprac.moh.gov.my/v2/modules/xforms/?form_id=2

    I do not mind “cpoy & paste” your complaint, but there is no email address/contact number for the enforecement agency to contact your good self
    Cheers.

  5. WS says:

    Thanks to Dr Teh for posting it and I appreciated all your replies and feedback. I have sent it to MOH malpractice as directed by Shan, hope it will work.

    PS: Vagus (TK), you are here too… Congrats for the 2nd baby to come. Wish you well too!

  6. dr yang says:

    I just called up BP lab and gave them a piece of my mind as a Gynaecologist

    Blanket head 2 toe test not only misleads..
    They scan patients, uses diagnostic tools as screening tool. An unexperienced Medical Officer sees the customer, a lab tech does the test and a radiographer or ultrasonographer does the scan… none of these are tied down to clincal sign and symptom…Endometriosis could be merely asymptomatic gives a highish CA 125 And FINALLY you have all the ingredients to frighten a young single girl to have a cyst or cancer…where is the pre screening counseling and then you leave the post screening couseling to us….

    They also give cervical vaccine irrespective of age with improper counseling and leave us to do the rest…

    The presence of a half cooked Medical officer is no qualification to use any test and not able to explain or counsel their patients…this is not the only lab…there is another lab in KL ?? MJ Diagnostic centre…

    People may say prevention is better than cure…but when you are not sure what you need to cure and you start preventing by methods that are convienient to fill the pockets of BP Diagnostic centre and the likes…. I think some regulation needs to come in…. I WONDER WHAT MMC/MOH will think about or do ??

    yang

  7. WS says:

    Youtube links…

    http://www.youtube.com/watch?v=yybZDIQsyKo&feature=youtu.be

    http://www.youtube.com/watch?v=1_FP2ajVuFw&feature=relmfu

    http://www.youtube.com/watch?v=36MWkdFaws0&feature=relmfu

    This kind of unethical screening by BP Healthcare goes on public TV shows, expands to other countries such as Thailand and Indonesia, not to mention Malaysian government strongly supports healthcare screening without proper guidelines and regulation. It will only promote “bad name” to Malaysian doctors and further deviate us from the standard of care, especially to our future doctors.

    Why am I obsessive about it? I am a MALAYSIAN! I first noticed it when one of my patients in US brought me a BP Healthcare leaflet from Malaysia and asked me to order the tests for him, so his insurance will pay. It took me sometime to convince him not to do the tests! Subsequently, two of my friends consulted me for their abnormal tests from BP healthcare screening.

  8. foragecap says:

    i am amused by the quote “…it is better to check since it is inexpensive and besides, there is no harm in doing it.” from Dr Quah

    http://www.lovypharmacy.com/newBEP/TM.asp

    having slightly elevated tumour markers will cause :
    a. unnecessary angst/anxiety in patients
    b. further invasive tests which can cause dire effects/life threatening risks e.g. biopsy on a smallish lymph node which looks benign on CT a diagnostic laparoscopy.

    sigh…

  9. huajern says:

    This Quah fella, I hope he is merely misguided, rather than having sold his soul.