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Saturday, December 3, 2022

PM Anwar Ibrahim announced Malaysian new cabinet

PETALING JAYA: Datuk Seri Anwar Ibrahim has named Datuk Seri Dr Ahmad Zahid Hamidi from Barisan Nasional and Datuk Seri Fadillah Yusof from Gabungan Parti Sarawak (GPS) as Deputy Prime Ministers in his Cabinet line-up.

Anwar will also be the Finance Minister, and Fadillah will also be the Plantations and Commodities Minister.

The Pakatan-led unity government will see Datuk Seri Saifuddin Nasution Ismail helming the Home Ministry, while Anthony Loke will be the new Transport Minister.

Dr Zaliha Mustafa will be the new Health Minister.

The other names and positions in the newly-formed Cabinet line-up are:

Economy – Pandan MP Rafizi Ramli

Local Government – Teluk Intan MP Nga Kor Ming

Defence – Rembau MP Datuk Seri Mohamad Hasan

Works – Kapit MP Datuk Seri Alexander Nanta Linggi

Home – PKR secretary-general Datuk Seri Saifuddin Nasution Ismail

Digital Communications: Fahmi Fadzil

International Trade and Industry – Datuk Seri Tengku Zafrul Tengku Abdul Aziz

Higher Education – Kota Tinggi MP Datuk Seri Mohamed Khaled Nordin

Science and Technology – Tg Malim MP Chang Lih Kang

Women, Family, and Community Development – Batang Sadong MP Datuk Seri Nancy Shukri

Domestic Trade and Cost of Living – Pulai MP Datuk Seri Salahuddin Ayub

Law and Institutional Reforms (PM’s Department) – Pengerang MP Datuk Seri Azalina Othman Said

Natural Resources, Environment, and Climate Change – Setiawangsa MP Nik Nazmi Nik Ahmad

Foreign Affairs – Barisan Nasional secretary-general Datuk Seri Zambry Abdul Kadir

Entrepreneur Development and Cooperatives - Datuk Ewon Benedick

Tourism - Datuk Seri Tiong King Sing

Education - Fadhlina Sidek

Unity - Datuk Aaron Ago Dagang

Religous Affairs - Datuk Seri Mohd Na’im Mokhtar

Youth and Sports - Hannah Yeoh

Health Minister: Dr Zaliha Mustafa

Sabah and Sarawak (PM's Department) - Datuk Armizan Mohd Ali

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Malaysian EDUCATION

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How much is the pay to that MP in the Dewan ? At least RM25,700 per month each

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Inflammatory bowel disease can significantly disrupt a person's daily life

IBD Overview

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IBD comprises of two conditions: CD, which is inflammation of one or more parts of the intestines (left), and UC, which is inflammation of the large intestine. — Images: Prof IDA NORMIHA HILMI

Getting the occasional abdominal pain and diarrhoea is common for all of us, but if these symptoms consistently recur, do get yourself checked.

You could have inflammatory bowel disease (IBD) – a term used to describe two conditions: ulcerative colitis (UC) and Crohn’s disease (CD).

Like its name suggests, IBD patients have an inflamed gut, and present with pain at the site that is inflamed.

UC only affects the colon (large intestine), while CD can affect any or several parts of the digestive tract.

Other symptoms may include bloody stools and loss of appetite.

As the symptoms are non-specific, patients are normally treated for acute gastroenteritis or misdiagnosed as having irritable bowel syndrome (IBS) – a functional gastrointestinal disorder characterised by abdominal pain and altered bowel habits.

“IBD is an autoimmune disorder, where your immune cells attack your bowel.

“Our prevalence is low compared to Caucasian or East Asian populations, with less than 10 per 100,000 population; Australia has 125 per 100,000 population.

“But it is still a concern, in line with other growing autoimmune disorders,” says Universiti Malaya Medical Centre professor of medicine Dr Ida Normiha Hilmi.

The senior consultant gastroenterologist adds: “We don’t know why it happens or what triggers it, although there are many postulations.

“These include something in our environment, something we’re doing, changes in our diet that has become more Westernised, one too many courses of antibiotics, stress, smoking, pollution, lack of breastfeeding or a childhood virus.

“Or it could be related to the hygiene hypothesis.

“Your immune system is meant to be exposed to a lot of bacterial pathogens at an early age, but if the environment has been sterile, then it doesn’t know how to process all these things later on and processes them in an abnormal way.

“Once that occurs, it doesn’t switch itself off and there’s no way to reset it.”

One of Prof Ida’s colleagues in India has performed mobile colonoscopies in rural areas of that country and found no cases of IBD; however, the locals there had a lot of worms in their guts.

“Worms are protective against IBD – they sort of modulate the immune system and there is a symbiotic relationship,” she points out.

Late diagnosis

IBD a disease that is diagnosed in the young (ages 15 to 40), with a median age of 29; however, there is an increasing trend in the paediatric population.

.An endoscopic image of a normal, healthy colon.>>

It’s not always easy to identify whether the patient has CD or UC, although UC is more common than CD.

“If the doctors don’t know, these patients are placed in the IBDU (IBD unclassified) category,” says Prof Ida, whose youngest IBD patient is 12 years old.

“You’ll be surprised at how many people wait for a year or two before getting treated – the inconsistent pattern of pain often confuses patients and it is normal for them to lose up to 20kg.

“They may go to the general practitioner, get some antibiotics and don’t seek further help.

“Or after several episodes, they finally decide to go to a specialist – maybe all diseases are like that in Malaysia – hence, awareness is very important.

“What they don’t realise is that if the disease is not treated, there is an increased risk of developing colon cancer.”

UC patients can also experience back and knee pain, skin rashes, and liver abnormality – every system can be affected – while CD patients tend to have specific areas affected.

The IBD specialist explains: “The whole gastrointestinal tract is very long, and in a lot of cases, when a CD flare-up happens, it tends to be in the predominant location, i.e. the common location, which is the lower right side (terminal portion of the ileum) – almost the same area as the appendix, which initially raises the suspicion of appendicitis.”

She adds: “There is some old data that shows patterns where if you get IBD once, you will never get it again, but from my experience, it’s rare.

“The disease will recur without treatment.

“It’s not a cure, but with treatment, you can remain in remission.”

Therapy for life

Treatment involves two therapies: induction and maintenance.

This endoscopic image shows deep longitudinal ulcers in the colon of someone with CD >>

The induction therapy is intended to act fast to provide symptomatic relief, with the mainstay being steroids.

Prof Ida says: “It’s cheap, it works and it works fast, but there are long-term side effects – it thins your bones and causes obesity.”

She notes that the energy boost from the steroids also makes some patients feel better.

However, she adds: “Your adrenal glands that are producing your own steroids are suppressed with chronic steroid use and we have seen patients with Addison’s crisis, where the body is not able to produce steroids any more.

“We never want to give steroids as long-term therapy – we try to stop it within three months.

“If you taper it down and don’t give time for the other immunosuppressive drugs to work, especially slower-acting ones, the symptoms will return, so it’s a balancing act.”

For maintenance, a new group of drugs called biologics work well and have a good safety profile.

The drawback: they’re expensive and range from RM20,000 to RM50,000 annually.

“That’s the difficulty I face with my IBD patients,” Prof Ida laments, “because I’ve to think of costs all the time, especially for the ones without insurance.

“For this reason, I take part in a lot of clinical trials as that allows me to put patients on free drugs.

“Usually, when we get the drugs, we’re already on phase three trials and there are not many concerns as we are not guinea pigs.

“Or we seek funds from charities, non-governmental organisations, etc – that’s the reality.

“The Health Ministry hospitals also have their own free quota, e.g. five patients a year – the rest have to pay.”

For those on clinical trials, the good news is that they can get free drugs for quite a long while.

One of Prof Ida’s patients took part in a landmark IBD study and got free drugs worth about RM48,000 a year for a decade.

Most clinical trials entail a three-month induction and 12-month maintenance timeline.

Every patient usually wants to know when he or she can stop treatment; they think the diarrhoea should resolve with a course of antibiotics.

“The concept of long-term treatment is difficult for them to understand.

“I guess it’s hard when you’re young and have to be on drugs forever, but older people are more accepting,” she says.

“The patient’s function is very much affected as IBD occurs amongst young professionals in high-performing jobs, hence I try to normalise their lives as much as possible.”

For those who don’t succeed with medical therapy, they have to undergo surgery to resect their bowel.

In the past, the figure was 70%, but with better medications these days, the figure has gone down to about 20-30%.

What about foods?

“Before, we didn’t really know what to tell our patients in terms of diet, except to have a low-fibre diet, because when your colon is inflamed, the bowel is narrowed, and if you take too much fibre, it may block your passage.

“Now, we’re looking at anti-inflammatory diets, although we’re still far from anything concrete.

“My paediatric colleagues practise entero-nutrition (delivered into the digestive system as a liquid) for six weeks, but maintenance is difficult as you can’t be on liquid nutrition for the rest of your life,” says Prof Ida.

She suggests, however, that patients try to reduce pro-inflammatory foods, such as those with high fat content.

When it comes to herbs, she says turmeric might help, but the dose has to be right.

“If you have a bad case of UC, you still need biologics as turmeric is not going to save you.

“Everyone is also asking about probiotics.

“Not all probiotics in the market are medical grade, but if my patients want to take it and it makes them feel better, I don’t stop them.

“Our gut consists of trillions of gut microorganisms and taking a tablet or two a day is not going to touch the diversity or repopulate the microbiome.

ALSO READ: Think you know all about probiotics? Then take this quiz

“When the colon is inflamed, the pathogenesis is very complex – we think something is happening at the gut level, maybe a breach of some bacteria into your gut wall – and sometimes, the immune system goes awry.

“But there is also something else that is causing this and we can’t quite pinpoint it.”

The inheritance pattern of this condition is unclear, although some studies show that having a family member with IBD increases the risk of developing the condition.

However, Prof Ida has two sets of identical twin patients.

In one set, only one twin has UC, and in the other, only one twin has CD.

They grew up in the same environment, ate the same foods, and have the same genes, which indicates that some other factor is playing a role in the disease.

Our gut microbiome is developed by the time we’re one-year-old and that’s the one we keep, with minor alterations over the years.

She says: “When you go to another country, it may change a bit, but when you go back to your own country, it generally goes back to your original gut microbiome.”

ALSO READ: The good gut bacteria in our microbiome might be disappearing

Storing and transferring poo

Stool samples being processed for screening during the gut microbiome donation process. — Amili

Faecal microbiota transplantation (FMT) is the transfer of faecal material from a healthy individual to another person with the aim of treating a disease.

It can be described as a form of probiotics as it pumps in a much greater number and diversity of bacterial strains than any available probiotic.

The concept is not new and the use of FMT was first described in China in the 4th century by Ge Hong when “yellow soup” – a faecal slurry – was administered for the treatment of severe food poisoning and diarrhoea.

And in fact, this was a practice that continued for centuries.

Bedouin groups also consumed the stools of their camels as a remedy for dysentery.

“FMT is an option for patients with recurrent or refractory Clostridium difficile (an overgrowth of this bacteria, also known as C. diff) as it has a cure rate of over 90% and can repopulate the good bacteria.

“Sometimes, C. diff can be difficult to kill, especially in older patients – it causes inflammation, and in bad cases, even death.

“FMT can also be used as a therapy for IBD, but because it is unable to be sustained long term as your own gut microbiome returns after a while, the disease comes back,” explains Prof Ida.

FMT preparations can be delivered via capsules, colonoscopies, nasoenteric tubes and enemas.

In this region, Singapore is the only country that has a gut microbiome banking service, provided by a company called Amili.

According to Amili’s head of clinical affairs, product lead, Dr Saishreyas Sundarajoo, stool donors must undergo rigorous screening, which includes a lifestyle/health survey, interview with a clinician, blood testing and stool testing.

“In the final stool test, we screen for potential gastrointestinal bacteria, viruses and parasites.

“These include MRSA (methicillin-resistant Staphylococcus aureus), C. diff, SARS-CoV-2 and more.

“The good bacteria we screen for include Bifidobacterium longum, which helps break down food, absorb nutrients and fight off bad organisms that might cause diseases, and Bifidobacterium breve, as studies have linked its shortage to antibiotic-associated diarrhoea, allergies, gas and IBS,” he says.

Applicants who pass the stool testing are qualified FMT donors for a span of eight weeks.

The samples are periodically tested in between the eight-week cycle for quality assurance,

The donor stools are then cryopreserved in Amili’s partner company Cordlife’s facility and shipped to other countries when there is a request.

Once the stool arrives at its destination, the doctor will thaw it out just before administering it into the patient via colonoscopy.

Prof Ida concludes: “Patients need to understand that disease control is important, and if all therapies fail, surgery, despite its drawbacks, is the only option.” - By Revathi Murugappan

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Thursday, December 1, 2022

How much is the pay to that MP in the Dewan ? At least RM25,700 per month each

Here’s a look at the pay and allowances our elected reps get, and it’s a pretty sweet deal.

I AM writing this week’s column on Monday, a public holiday, courtesy of our newest Prime Minister, Datuk Seri Anwar Ibrahim.

We can thank YAB for it but let this be his last “playing to the gallery” crowd-pleasing act. It was a nice but unnecessary gesture. In fact, it was more disruptive, especially to businesses and schools, than helpful.

Not everyone’s happy with sudden public holidays

Instead, what we need from Anwar and his government is hard evidence that they will be able to effect changes that can finally bring about Malaysia Baru. And it starts with how he assembles his Cabinet which he assures us will be lean and mean. But we also want ministers who are people of calibre, intelligent, efficient and with integrity.

On that, everyone – from politicians, commentators, academics and NGOs to retired civil servants and the public – has his or her take on it. Whether Anwar has had the time to watch or read the deluge of advice, suggestions and even veiled threats is something else. He’s keeping it very close to his chest; we don’t even know who his closest and most trusted advisers are.

Anyway, Aunty here will refrain from joining the “can I advise you something” cluster. Instead, inspired by Anwar’s promise to cut his and his minister’s salaries and allowances, I will take a look at how much our elected representatives are worth in terms of pay and allowances.

This is an issue that’s been close to my heart ever since I wrote a feature article published in The Star on March 31, 1989, in which I compared the rewards given to politicians versus civil servants.

Politicians were not entitled to pensions or gratuities until the passing of the Administration and Members of Parliament (Pensions and Gratuities) Act 1971.

That Act was repealed and replaced by the Members of Parliament (Remuneration) Act 1980 [Act 237] which provides for pensions, gratuities, benefits and allowances.

Various people, including MP for Muar and former Youth and Sports minister Syed Saddiq Abdul Rahman, have raised the issue of pension entitlements and allowances for assemblymen, MPs and ministers, which Syed Saddiq claimed could exceed RM100,000 per month for some.

Both MPs and state assemblymen (adun) are paid salaries and enjoy many allowances and benefits. There is an even longer list of rewards for the PM, DPM and Cabinet ministers but due to space constraints, I will focus on what serving MPs get.

Now, there is no denying our elected representatives have a lot of work to do and they should be rewarded accordingly. But are they being over-compensated? What are these benefits and allowances?

You can find them in Statute Paper 235 of 1983 on the Official Portal of Parliament of Malaysia (bit.ly/malaysia_mp).

First off, an MP’s monthly salary is RM16,000. He/she also has a phone allowance of RM900 and a fixed travelling allowance of RM1,500 a month without the need to submit any claims.

An MP is also eligible to receive RM400 a day for attending Parliament and RM300 a day for official meetings, workshops, briefings, seminars, etc; a daily subsistence allowance of RM100 while on official duty within the country or RM170 outside Malaysia; food allowance of RM340 for every night spent outside the country; hotel charges of not more than RM400 a night, if the fixed allowance is not enough to cover all these claims.

There is also a “special payment” of RM1,500 a month for MPs who are not a member of the administration as defined under Clause (2) of Article 160 of the Federal Constitution, meaning he is not a minister, deputy minister, parliamentary secretary or political secretary.

If they travel by air on official business, they are entitled to business class seats and every month they get allowances for fuel (RM1, 500), toll (RM300) and entertainment (RM2,500).

They get a driver’s allowance of RM1,500 even if they don’t hire one, so they get paid for driving themselves. Extra benefits include getting a motor vehicle licence or a firearm permit FOC.

There are many other benefits like allowances for medical care, warm clothing, ceremonial and black tie attire; and loans for cars, housing and computers. All in, our MPs are pretty well looked after.

The above salary and allowances, which amount to at least RM25,700, while not really exorbitant, is still a very high income for most Malaysians. What’s more, MPs, after completing 36 months of reckonable service, get a pension after they turn 50.

That’s why it’s important we elect worthy persons to represent us in Parliament and state assemblies because we are their pay masters.

Besides, they are not expected to fork out any of this money to help their constituents. That’s where development funds and grants come in.

However, under both Barisan Nasional and Pakatan Harapan governments, whoever was in power discriminated against those in the Opposition in how funds for MPs were allocated.

In 2020, Pakatan government MPs reportedly received RM2mil for development, such as facilities for the community, another RM1.5mil for grants and donations, and RM300,000 to run their service centres. Sabahan and Sarawakian MPs got an extra RM500,000. Opposition MPs got a mere RM100,000 as development funds.

This is patently unfair. Citizens should not be punished for voting for who they want to represent them. Years ago, there were photos of roads being nicely paved in a Barisan constituency that ended right at the border of an Opposition-held seat.

That’s why there have been calls, including from Bersih chief Thomas Fann, that there should be equal constituency development funding. This can be institutionalised by new legislation to ensure the allocation of funds is dispensed by Parliament and not at the discretion of the Prime Minister’s Office.

One of the conditions of Datuk Seri Ismail Sabri Yaakob’s government’s memorandum of understanding with Pakatan, signed in Sept 2021, was equal funding for all MPs. That should be still honoured and implemented under Anwar’s government.

If that is in place, we can judge how fairly, responsibly and with full accountability our MPs spend these precious funds for the betterment of their constituencies.

They must also show their attendance record, what they have raised or spoken on in the Dewan Rakyat. We can do that by making it mandatory for MPs and assemblymen to publish their report cards just before the annual Budget session in Parliament.

From my years as a journalist covering Parliament meetings, many MPs are seat warmers who hardly ever speak on anything, spend more time in the cafeteria and lounges and even leave before the day’s sitting has ended. That’s why the hall is often very empty, barely making the quorum of 26 MPs from the total of 222.

Fortunately, there are representatives who do take an active part in the Dewan Rakyat; who study new Bills and debate them; raise issues important to their voters and national interest and are really service oriented; they are on the ground and readily available to attend to the needs of their constituents.

These are the kind of dedicated, selfless MPs with integrity we want and we have no qualms about paying them well. Probably the finest example we have is former MP for Bukit Bintang Tan Sri Lee Lam Thye. In the present generation of MPs, the one seen as Lee’s most likely successor is the much loved and admired MP for Segambut Hannah Yeoh.

I started this column by saying I won’t tell Anwar who to appoint. But in the best political tradition of backtracking, I will say I do want to see Yeoh appointed to a meaningful ministerial post in the Cabinet.

The views expressed here are entirely the writer’s own.

By June H.L. Wong

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Angry Malaysians are demanding ministers to take pay cuts as ...

One of the major reasons for this movement to even happen is the fact that many of these ministers - majority of them viewed as incompetent by Malaysians - have bloated salaries.

In 2020, it was revealed that on average, a Malaysian minister makes an average RM55,650 (US$12573) a month. Their salaries include travel, entertainment, housing, and car allowances. And if you're a people's representative, you enjoy additional salary increments.