Wednesday, June 25, 2008


Mention ACCORD, ADOPT, DREAM, VADT and RECORD to anyone and chances are many would respond in the negative. These are acronyms for medical trials pertaining to diabetes. For example, ADOPT is actually short for A Diabetes Outcome Progression Trial and ACCORD is Action to Control Cardiovascular Risk in Diabetes Study Group.

Last weekend I was in a medical workshop discussing the updates in Diabetes treatment and for two days I was overwhelmed with the above jargons. To ease us of the burden of absorbing all these packed and meticulous information, the drug company responsible was kind enough to hold it in Westin Langkawi, a beautiful spa resort perched on a hill, facing a small bay not far from Kuah Jetty.

Our room

Avandia or Rosiglitazone (or Rosi, as used by some presenters, implying how comfortable they are with the drug now despite the recent controversy that shrouds it) is a fairly recent oral hypoglycemic agent, used to treat Diabetes. Its usage was on the rise and was getting global acceptance, despite its steep pricing, as it is a diabetic drug in a class of its own with a coveted ability of preserving the pancreatic beta cells and it is thus beneficial especially to young type 2 diabetic patients.

At Temurun Waterfalls on the way to Datai Bay

However, last year, someone called Steve Nissen (who has a fitting resemblance to Salman Rushdie), came out with a meta-analysis that gave a shocking conclusion that Avandia gives an increased risk of cardiovascular events. The finding nearly caused Avandia to be taken off the shelf! After rigorous effort, GSK (the drug company that produces Avandia) managed to retain it in the market albeit a caution tag that comes with the label i.e. Avandia is not to be given to patients with a known heart disease.

Essentially the workshop was to impress upon us that the study done by Steve Nissen was seriously flawed and that Avandia is still a safe drug and should be given to especially the young type 2 diabetics as it gives good glycemic control, bringing down the HbA1c to below 7%, besides preserving the beta cells function in the pancreas as well as giving kidney protection in the long run.

Firstly, to begin with, the study was actually a meta-analysis, meaning that it was a retro review of other trials done before and thus to make a major conclusion out of such a study is rather uncalled for. Scrutinizing Steve Nissen’s meta-analysis, we would find numerous flaws. He had looked into 42 trials and out of it, only 2 were big trials i.e. ADOPT and DREAM which consisted of more than a thousand patients. The rest were small trials with more or less 100 patients. Nissen had made ADOPT, DREAM and all the small trials as the 3 arms of the study and for many of his analysis, the p was never significant in the first 2 arms but was compounded when averaged with the 3rd arm which was the collection of the small trials. To add salt to injury, some of the small trials were not even trials to prove CV events with Avandia but was included nonetheless.

All these prove to show that researchers would go all out to produce journals to attain good resume. However, many a time, these studies are bogged down with many mistakes and weaknesses and if they get published, imagine the impact it will have on us. KKL told me that there was even a published clinical study which was only done on one single rat! Btw, you might be interested to read this published paper. Someone we know is one of the researchers!

One of the available villas.

Nevertheless, it was a very insightful workshop that has enlightened me on many issues. Besides, staying in Westin was a splendid retreat for both iKelah and I, not to mention the endless array of food provided in all the meals. Heavenly experience indeed!

Thursday, June 05, 2008


Have you noticed the sudden mushrooming of massage spas everywhere? In a mall over here, they charge RM 10 for a ten minutes shoulder rub, RM 50 for 45mins of foot reflexology/massage up to calf area, RM 130 for a full body massage and RM 150 for a body massage plus an extra reflexology of the foot. No, I haven’t tried them though my mom says the foot reflexology is good. The masseurs are all young females imported from Bali. The ambience is typical of a spa salon, dimly lit cubicles with massage beds, aromatic incense burning and subdued soothing music playing in the background, a sure recipe to make anyone doze off in a jiffy. The music? Javanese gamelan of course!

Ask any adult Malaysians and I am sure many will say that they have had at least once being massaged by someone, professional or not. Asian women are renowned for being meticulous in post partum body care especially indulging them selves in daily body massage, several days after giving birth. Their masseurs are typically elderly ladies who incidentally have a common trait amongst them, i.e. the ability to gabble on any topic they deemed fit to sustain a person’s attention as many customers would prefer to lull themselves off to sleep whilst the masseur knead their knotted muscles. Of course, no masseurs would like the idea of working in balmy silence, lest they themselves would nod off too!

Masseurs employ certain style/pattern of kneading the body, slathering their customer with either a traditional minyak urut or for the more affluent ones, aromatic oil or creamy lotion. How do they acquire the skills? Many would typically say that it was simply passed down through the generation in the family but the flamboyant ones would offer intriguing tales of receiving the explicit art of massaging via a dream. Often I’d wonder whether the lesson was gotten all in a single dream or perhaps staggered in a series of dreams that probably stretched in a span of time. Non the less, I’d keep the query to myself, not wanting more barrage of hocus pocus being fed into my ears, as I prefer to relax without engaging in idle conversation.

Once, I was unfortunate to experience a weird kind of massage given by a kampong lady in Sg Bakap. Introduced by a friend and hoping for a good body massage, I was at her disposal. Horrors of all horrors, I had to withstand an hour of pinching actions and being a meek and polite person I am, I endured with great patience! Apparently, her pinching style of massage is good for the tired body. Needless to say, I ended with black and blue pinch marks all over! I did feel better but vowed to never use her service again.

Many traditional malay masseurs who specializes in the female reproductive organs would tell their customers that their pregnant wombs have ‘dropped’ and would do a maneuver to ‘push’ it up again. And each time I have to explain to these patients that their pregnant uterus has got no where to go except to stay put in the pelvis!

Others love to tell their customers that he/she has lots of ‘angin’ in their body and to prove that, they would belch rudely each time they knead your ‘angin’ laden body! Once, I had to accompany hubby to this pakcik masseur who belches incessantly the instant he touches your body. Hubby said that his massage was so mild/ gentle that he hardly felt a thing, almost like a faint rub. Like a dog whose bark is worse than its bite, for this pakcik, his belch was worse than his massage!

Of course there are good and effective masseurs around who would throw an advice or two as they do their work. However none can beat the young chap at Bukit Tinggi, Padang. Hubby gave him a ten and told me that none in Malaysia came as close as giving 10% effort when compared to this guy.

Also in Bukit Tinggi, my SIL and I decided to go for a full body massage accompanied with body scrub. When we were getting ready, changing into their robes, we were given ‘something’ to wear. When SIL asked me what it was for and whether we had to don it or not, I answered with a savvy tone, like a season spa-goer, “Oh, just cover your hair with it”, thinking it was to keep your hair in place. We had a good laugh when we found out that it was actually a disposable underwear!

Whatever, it is good to pamper yourself once in a while and indulge in a good session of body massage and foot work, immersing yourself in a balmy ambiance of sheer bliss!

Bukit Tinggi 2008

Great Wall 2009

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