Add the video to your site with the embed code above PUTRAJAYA: Datuk Seri Anwar Ibrahim will not receive any salary, both as Prime Minister and as Finance Minister, he has clarified. Cabinet ministers have also agreed to a 20% pay cut until Malaysia reaches economic recovery, he said.
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Rubbishing talk that he would be paid as Finance Minister although he had declined the salary for the top job, Anwar announced he would not be taking any form of government salary. This was in line with his promise made during the election campaign, he said. During the campaign, Anwar had said he would not take a salary if he was appointed as prime minister because the people themselves were struggling to cope with rising costs. “Some people say I’m not taking the Prime Minister’s salary because I am the Finance Minister. That’s not true. There is only one salary,” he said, laughing off such claims during a press conference here yesterday. ALSO READ:Budget to be enhanced with MOF, Cabinet views The Members of Parliament Act (Act 347) only allows one salary for ministers, deputy ministers or political secretaries. On the Cabinet ministers’ pay cut, he said this was their way of acknowledging the tough times faced by the people. “The pay cut will be implemented as long as Malaysia continues to recover economically. “It shows the ministers are also concerned about the livelihood of the public,” he said.Asked if the pay cut would be carried out throughout the government’s five-year tenure, he simply said that it could range from three to five years, depending on the situation.
Cabinet to take 20% pay cut
Prime Minister Anwar Ibrahim thanks his ministers “for their willingness to make some sacrifices” and said this was to show the government’s concern for Malaysians.
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.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.
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