Thai Medical Council Urges Drug Rethink, Defends Hospitals

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MEDICAL COUNCIL

Council urges drug rethink, defends hospitals

By The Nation

The Medical Council will today attempt to reverse the exclusion of glucosamine, which is used to treat osteoarthritis of the knee, from the civil service medical plan.

"An official letter will be sent to the ComptrollerGeneral's Department next week explaining the pros and cons of its announcement [on reimbursement for glucosamine], including details on the damage and benefits to patients," Dr Samphan Komrit, secretarygeneral of the Medical Council, said yesterday.

The council also disagreed with the finding by the Department of Special Investigation of irregular spending on medicine at two state hospitals, saying the DSI's probe was exaggerated.

The council had held a meeting among its members, including representatives from several royal medical colleges, to discuss the appropriate approach for prescriptions. The meeting resolved to ask the ComptrollerGeneral's Department to revise its announcement that prohibited civil servants from receiving glucosamine under their medical benefit scheme.

Dr Saranet Vaikakul, president of the Royal College of Orthopaedic Surgeons of Thailand, said the report that the department had used to decide to control the budget of the civil service medical plan, especially for glucosamine and three other drugs, was out of date, as it was based on a study made in 2002.

"The researcher who conducted this study was not a specialist. It should not be used as a reference for decisionmaking," he said.

Regarding the DSI's probe into the soaring cost of medicine under the plan, Dr Somsak Lohlekha of the Medical Council said the DSI's inquiry did not come up with a clear conclusion that these two hospitals were involved in suspicious activities.

"The DSI's investigation has already ruined the reputation of these two hospitals and this is unfair," he said.

-- The Nation 2011-05-06

[jfchandler]

This issue really hits home for a lot of Thai bureaucrats/civil servants...

My wife works in the orthopedic department of one of the private hospitals in BKK, and (completely apart from this news issue) has long been telling me that Thais as a group seem to have far more problems with their knees than others, including Americans and Europeans... Not sure why...

The orthopedic docs in her department say farangs tend to have hip problems, while Thais tend to have knee problems... and they have a lot of them....

So the bid to exclude glucoasmine is one that hits a lot of Thai civil servants where they walk.

[WarpSpeed]

They squat and kneel all day long, not surprising really..

[Tywais]

has long been telling me that Thais as a group seem to have far more problems with their knees than others, including Americans and Europeans... Not sure why...

The first thing I thought of regarding this was 1. squating 2. prayer (sitting on their feet puts a strain on the knees). Did a little research and found this:

The effect of religious practice on the prevalence of knee osteoarthritis

Abstract The aim of this study is to evaluate the effect of religious practice on the prevalence, severity, and patterns of knee osteoarthritis (OA) in a Thai elderly population with the same ethnicity and culture but different religions. A houseto- house survey was conducted in two subdistricts of Phranakhon Sri Ayutthaya province where inhabitants are a mixture of Buddhists and Muslims. One hundred fifty-three Buddhists and 150 Muslims aged ≥ 50 years were evaluated demographically, physically, and radiographically.

Those suffering knee pains were questioned about severity using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and examined for their range of knee motion. Radiographic knee OA (ROA) was defined as Kellgren–Lawrence radiographic grade ≥2 while symptomatic knee OA (SOA) was defined as knee symptoms of at least 1 month in a knee with ROA. Muslims had on average a higher number of daily religious practices than their Buddhist neighbors (p<0.001). The prevalence of knee pain and ROA was significantly higher in Buddhists than in

Muslims ...

Source

[jfchandler]

Sorry Tywais... I'm not following this one...

The Muslims are down on their hands and knees paying more... but the Buddhists have worse knee problems?

And what we're to conclude from that is???

[Tywais]

Sorry Tywais... I'm not following this one...

The Muslims are down on their hands and knees paying more... but the Buddhists have worse knee problems?

And what we're to conclude from that is???

You have to read the pdf file I linked to above. It shows the different prayer positions and their effect. BTW, that link is to a Thai research publication.

[jfchandler]

And so they say...

The Muslim way of praying since childhood, forcing the knees into deep flexion, may stretch the soft tissue surrounding the knee and decrease stiffness and contact pressure of the articular cartilage.

Muslims are required to pray five times a day (kneel 17 times a day) while Buddhists pray by kneeling and bowing their heads only once a day. The type of toilet used also differed significantly. More Muslims than Buddhists were accustomed to squatting over Eastern-style toilets.

These differences might be a benefit from the strict faithfulness in religious devotion of Namaz (worship of the Allah's kindness) by Muslims. These monastic vows involve kneeling down 17 times a day from the age of 7. Regular practice since childhood may result in more strength and flexibility of soft tissue of the knee as well as juxta-articular bone remodeling to prevent microtrauma from repetitive kneeling. The Namaz may also cause moderate loading, leading to thickening of articular cartilage which prevents knee OA [10, 11]. On the contrary, Buddhists religious ritual involves prolonged knee-bending floor activities only once a day (Fig. 1). As they do not regularly practice until they grew older, their muscle and tendon around the knee might be too stiff resulting in more mechanical strain on degenerative meniscus and articular cartilage leading to impact injury and thus an increased risk of joint degeneration

Thus, we concluded that the strict faithfulness in religious devotion of Namaz, starting at the right time since childhood, led to stronger knee infrastructure. Moreover, Namaz might lead to regular muscle and tendon training that improves the strength of quadriceps [17, 18]. These factors may explain the lower prevalence of knee OA in Muslims than in Buddhists with the same ethnicity and daily activities.

I guess the takeaway from this study is.... if you're going to use a squat toilet, start early and go often for optimum knee health.....

Of course, westerners typically don't get down on their knees to pray every day nor do they typically use squat toilets.... But that's another story for another day...

Edited May 6, 2011 by jfchandler

[zzaa09]

Sorry Tywais... I'm not following this one...

The Muslims are down on their hands and knees paying more... but the Buddhists have worse knee problems?

And what we're to conclude from that is???

More than likely a genetic trait, is all.

The issue is not health comparatives, but the ever-increasing role that politics plays in our well-being.

[WhizBang]

 Interesting, because there was a study published recently (not sure US or European), that showed that the use of Glucosamine had no benificial effect.

[jfchandler]

Ya, I had wondered about that too... In the U.S., it's sold over the counter, not as a prescribed drug... same like vitamins...

There's a pretty broad sense among people that it's supposed to be good for joint care... But, I've never been clear that that's been established through any kind of reputable medical research.

[TheyCallmeScooter]

But, I've never been clear that that's been established through any kind of reputable medical research.

I'm sorry.

What? Are there drugs that have been?

Subjected to reputable medical research, I mean.

The last drug I'd heard that was, was found to be effectively a placebo. This was published in the journal of the AMA. Scandalous news, as the drug just so happened to be the Number 1 best-selling drug of ALL TIME. I said, ALL TIME!

And...it remains, the Number 1 best-selling drug of ALL TIME. So in addition to my question above, one might ask the question, what's. the. freaking. point. anyway. lol?