WHO’s Alarm Bells: Antibiotic Resistance Now a ‘Major Threat to Public Health’

The world’s leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.

Antibiotic Resistance_bacteria

In its first report on the issue ever, the World Health Organization (WHO) is sounding alarms about the issue of antibiotic resistance and the global public health threats it poses to our increasingly interconnected world.

“The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century,” the report states.

Antibiotic resistance occurs when bacteria no longer die when treated with antibiotics. As a result, doctors have to use stronger, more potent antibiotics, and the more those are used, the more resistance bacteria develop to those as well. The WHO is warning that we’re reaching a point in which the strongest antibiotics doctors have in their arsenal, the “treatment of last resort” drugs as they’re called, no longer work.

And in fact, it’s no longer just bacteria that are becoming resistant. The WHO has stopped referring to the problem as “antibiotic resistance” and now calls it “antimicrobial resistance,” to encompass other organisms, such as viruses and parasites, that no longer respond to the drugs of choice. Namely, treating the viruses tuberculosis and HIV, and malaria (a parasite), has become harder as these diseases become resistant to medications. Even H1N1, the so-called “swine flu” that reached pandemic levels in 2009, has begun developing resistance to potent antiviral drugs.

Resistance Is a Worldwide Problem

One of the major points of the report is that diseases that used to be restricted to certain locales are now spreading internationally:

Among their key findings:
• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumonia—carbapenem antibiotics—has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.

• Treatment failure to the last resort of treatment for gonorrhea—third generation cephalosporins—has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.

• People with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64 percent more likely to die than people with a non-resistant form of the infection. MRSA, which can cause septic bloodstream infections when exposed to broken skin, is one of the most common “community-acquired” resistant infections, meaning you’re likely to pick it up anywhere other people are—your gym, place of worship, a nearby park or even at schools. In the Americas, as many as 90 percent of staph infections are reported to be MRSA.

• There hasn’t been a new class of antibiotics developed since the late 1980s.

We Can’t Track What We Don’t Know

The WHO is calling on countries all over the world to step up their surveillance of these deadly infections, something that happens rarely, if at all. An investigative report, “Hunting the Nightmare Bacteria,” that ran on the PBS program Frontline in October 2013 revealed that public health officials in the U.S. have little to no data on the extent of antimicrobial resistance in this country. Healthcare facilities aren’t required to report outbreaks, the report found, and many don’t because they don’t want to scare people or have to deal with bad PR.

“It is frankly embarrassing that we as a country do not know where resistance is occurring, how bad the problem is for various organisms or who’s using what antibiotics when,” Brad Spellberg, MD, an infectious disease doctor at Harbor-UCLA Medical Center, said in the documentary.

The Centers for Disease Control and Prevention has estimated that antimicrobial resistant infections hit two million people a year and kill at least 23,000. But the WHO notes that in most countries around the world, including the U.S., often only the most severe infections are documented and minor community-acquired infections (which can get passed along repeatedly and wind up as a severe infection) go unreported.

Clean Up the Food Supply!

For quite possibly the first time, the WHO also called out the food industry for its contribution to antimicrobial resistance. ” The use of antibiotics in animal husbandry—including in livestock, poultry and fish farming—are leading to increasing recognition that urgent action is needed to avoid inappropriate use, and to reduce antibiotic usage in animal husbandry and aquaculture, as well as in humans,” the report states. In the U.S., 80 percent of antibiotics sold go into animal feed to prevent infections in healthy animals or to speed growth. And we’re not alone. “In many countries, the total amount of antibiotics used in animals (both food-producing and companion animals), measured as gross weight, exceeds the quantity used in the treatment of disease in humans,” the authors found.

The same classes of antibiotics used on these animals are the same as those given to humans. In particular, fluoroquinolones, antibiotics used widely in the poultry industry, are increasingly ineffective against urinary tract infections caused by drug-resistant E. coli bacteria, which have been detected on all forms of supermarket meat, and against MRSA soft-tissue and skin infections.

Numerous groups in the U.S. have sued the Food and Drug Administration to revoke its approvals in animals for antibiotics that are valuable for humans. The agency’s only response has been to set voluntary guidelines for the industry.

What You Can Do

Despite the damage factory farming has done to antibiotic effectiveness, the WHO and other public health officials insist that the first line of defense in controlling the problem of antimicrobial resistance is the healthcare setting: Stopping doctors from giving patients antibiotics for conditions they aren’t designed to treat, for instance, when you’re given antibiotics for a cold that’s caused by a virus, not bacteria.

• Don’t automatically ask for antibiotics when you feel sick and visit a doctor.

• If your doctor prescribes an antibiotic, ask if there’s an alternative before just accepting the advice. Some doctors feel compelled to offer the drugs to make people feel better, but asking for an alternative can open up a dialogue about other options.

• When you do need an antibiotic, take the full course, even if you’re feeling better.

• Wash your hands frequently to protect yourself from community-acquired infections, and keep your hands away from your nose, eyes and mouth, where infections can enter.

Contributed by  By EMILY MAIN

Where Health Meets Life

Alarm bells over antibiotic resistance 

Antibiotic Resistance_pills

The World Health Organisation’s most comprehensive report to date sounds a warning that we are entering a world where antibiotics have little effect.

THE World Health Organisation (WHO) has sounded a warning that many types of disease-causing bacteria can no longer be treated with the usual antibiotics and the benefits of modern medicine are increasingly being eroded.

The comprehensive 232-page report on anti-microbial resistance with data from 114 countries shows how this threat is happening now in every region of the world and can affect anyone in any country.

Antibiotic resistance – when bacteria evolve so that antibiotics no longer work to treat infections – is described by the report as “a problem so serious that it threatens the achievements of modern medicine”.

“A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” said Dr Keiji Fukuda, WHO assistant director-general who coordinates its work on anti-microbial resistance.

“Without urgent, coordinated action, the world is headed for a post-antibiotic era in which common infections and minor injuries which have been treatable for decades can once again kill.

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine.

“Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

The report, “Antimicrobial Resistance: Global Report on Surveillance”, shows that resistance is occurring in many bacteria causing different infections.

It focuses on antibiotic resistance in seven bacteria responsible for common, serious diseases, such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

What is especially alarming is that the bacteria’s resistance has also breached “last resort” antibiotics, which are the most powerful medicines that doctors resort to when the usual ones do not work.

When patients do not respond to the usual medicines (known as first-line or first-generation medicines), doctors prescribe newer (second line medicines) which also usually also cost more.

When these also don’t work, newer and often more powerful (but sometimes with also more side effects) antibiotics are used, and they are even more expensive.

If these third-line or “last resort” medicines are not available or too costly for the patient, or if they don’t work on a patient because of antibiotic resistance, the patient remains ill or dies if the infection is a serious one.

New antibiotics have been discovered in the past to treat infections when the old ones became useless due to resistance.

But these discoveries dried up in the past 25 years.

The last completely new classes of anti-bacterial drugs were discovered in the 1980s.

Pathogens that are becoming increasingly resistant including to the more powerful antibiotics include E. coli, K. pneumonia, S. aureus, S. pneumonia, salmonelia, shigella and n. gonorrhoeae.

Key findings from the report include:

> Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, K. pneumonia — carbapenem antibiotics — has spread worldwide.

K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients.

In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections;

> Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli – fluoroquinolones – is very widespread.

In the 1980s, when these drugs were first introduced, resistance was virtually zero.

In many countries today, this treatment is ineffective in more than half of patients;

> The sexually transmitted disease, gonorrhoea may soon be untreatable unless there are new drugs. Treatment failure to the last resort of treatment for gonorrhoea – third generation cephalosporins – has been confirmed in several countries; and

> Antibiotic resistance causes people to be sick for longer and increases the risk of death.

For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.

There are many cases of patients being infected by MRSA in hospitals.

The report also gives useful information on the worrisome building up of resistance in four serious diseases — tuberculosis, malaria, HIV and influenza.

A major factor accelerating resistance is in the animal husbandry sector, where there is a liberal use of antibiotics mainly to promote the growth of the animals used for food, for commercial purposes.

This builds up resistance in the bacteria present in the animals.

These resistant germs are passed on to humans who consume the meat.

The report has a small section on the animal-food chain, which has been identified as a major problem.

The European Union has banned the use of antibiotics as growth promoters in animals, but it is still allowed in other countries.

A WHO press release on the report calls for some actions. These include:

> Setting up basic systems in countries to track and monitor the problem;

> Preventing infections from happening in the first place to reduce the need for antibiotics;

> Only prescribing and dispensing antibiotics when they are truly needed, and prescribing and dispensing the right antibiotic(s) to treat the illness;

> Patients using antibiotics only when prescribed by a doctor and completing the full prescription; and

> Developing new diagnostics, antibiotics and other tools to stay ahead of emerging resistance.

Contributed by Global Trends by Martin Khor

Martin Khor is executive director of the South Centre, a research centre of 51 developing countries, based in Geneva. You can e-mail him at director@southcentre.org. The views expressed are entirely his own.

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Doctors have bad days too

AS a doctor I have always been asked questions by enthusiastic parents about the job.

Among the questions are: “How is it being a doctor?”, “What do you think if my children become doctors?” and “How much do you earn per month as a doctor?”

Despite an overflow into this profession, many parents are still willing to invest in their children pursuing medicine. Recently, there was an incident in my clinic that still remains in my mind.

There was a patient complaining of the bad attitude of another medical practitioner. He was unhappy and alleged that the doctor did not explain to him politely and treat him appropriately.

I was not present at that time to comment on it, but tried to resolve the misunderstanding amicably by saying doctors too had bad days.

To my surprise, the patient replied: “To me, doctors should always have good days.”

The doctor–patient relationship is unique. It’s like a weighing scale that needs commitment from both parties to maintain its balance.

Undoubtedly, a patient sees a doctor when he or she is unwell and all patients deserve tender loving­ care from their doctors.

But how many patients have done anything to show their appreciation for what their doctors had done for them?

This is a routine day for a doctor. In government/private hospital settings, a doctor has to do ward rounds every morning at 7am, usual­ly examining 30 to 50 patients, depending on “good or bad days”.

After the rounds, the doctor continues seeing follow-up patients at the Out Patient Department (OPD) and that would easily be around 50 patients and more before late afternoon.

After the OPD service, the doctor has to do ward rounds again to review the patients.

On average, a doctor will see around 80 patients per day (working from 7am–5pm). This is one patient every 7.5 minutes.

That is why it is very common to hear patients saying that they waited two hours in the long queue, only to be treated by the doctor in a few minutes.

There is always a tendency for doctors to divide the time unequally with every patient, on a case-by-case basis. In complicated or life-threatening cases, more time is spent with the patient.

In a general practitioner’s clinic, the conditions are no better. The general practitioner is virtually trapped in the small consultation room for a whole day, seeing patients with various ailments.

Like every human being, doctors also face obstacles in life, besides the challenges from career, family, friends, etc.

Long working hours, patient load, stressful working environment and poor quality of life are issues faced by doctors.

We cannot be smiling happily all the time. Sometimes, doctors may look cold and stern. Yet, we try our best to treat the illness of each patient in every possible way.

We uphold the Hippocratic Oath that we took before joining this sacred profession. The essence of the oath is “Above all, do no harm”.

Yes, you may be right that doctors earn well. To most of the doctors, the money that we earn is merely numbers in a bank account. We might not even have a chance to spend it all.

A word of thanks, a small card from patients will truly enrich our days.

By DR H.B. CHEE Muar

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Do You need jabs, antibiotics?


OUR population is getting more and more educated and knowledgeable. With the convenience of internet and smart phone, information can be assessed anytime and anywhere.

Facebook and Google have become the source of reference for most people. Many can now be “experts” in many specialised fields, including engineering, law and even medicine.

Nowadays, the medical practitioners enounter some patients who are so-called internet savvy, and refuse antibiotics and vaccines.

This issue arose due to the spread of such information in the internet, claiming antibiotics could lead to “superbug” and are associated with many adverse effects, while vaccines could cause autism or death.

Well, the risks of administration of both drugs are certainly debatable.What we know for a fact is that since Alexander Flemming discovered penicillin and the pox vaccine, many lives were saved.Nevertheless, I am not in the position to comment on the good and bad of both antibiotics and vaccines. But, it is more important for the general public to understand more about the need for antibiotics and vaccines.

Antibiotics or more specifically antibacterial, is a medicine indicated to kill (bactericidal) or inhibit the growth (bacteriostatic) of the bacteria.

There are various types of antibiotics with different mode of actions and indications. Strictly speaking, the mechanism of action for antibiotics is rather complicated.

However, it works mainly to counter attack the rapid reproduction of bacterial colonies, so that our immune system has enough time to defeat the illness.

Thus, the usage of antibiotics is strictly limited to the bacterial infection. In common clinical conditions, like acute exudative tonsillitis, abscess formation and urinary tract infection, antibiotics are strongly prescribed.

It must be understood that antibiotics have no role in curing diseases caused by fungus, virus or other parasites.

Therefore, it should not be overprescribed in cases like common cough and cold, flu and fungal infection of skin.

As for vaccines, they are biological preparations that help to boost immunity. Its primary focus is on disease prevention. It is always better to prevent a disease than to treat it.

Vaccines work by introducing the weakened form of “disease germ” into the body. The body will respond by producing antibodies to fight these invaders. At this stage, technically, the immune system is being sensitised. If the actual disease germ attacks the body, more antibodies will be produced to destroy the real enemy.

Vaccines are responsible for the control of many infectious diseases that were once common in this country and around the world, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, Hepatitis B and Haemophilus influenzae type b (Hib).

Many patients question the need for further vaccination as diseases such as diphtheria, pertussis are very rare these days.

Furthermore, there are people that do not get vaccination, yet able to live healthily until old age. This is the myth behind “herd immunity”.

Herd immunity serves as a preventive barrier as most of the population had been vaccinated, thus, the disease is contained from spreading. If herd immunity is compromised, the widespread of the disease may occur.

A piece of advice to all, a little knowledge is a dangerous thing. Before you start to tell doctors about the negative effects of antibiotics and vaccines, why not, give them a chance to explain to you before you make a decision.

Contributed by DR H.B. CHEE, Muar, Johor The Star/Asia News Network

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Malaysia’s healthcare system is one of the best in the world

Malaysia's health care

Country is third best and practioners ‘equal to or better than most Western countries

PETALING JAYA: The country’s achievement at being rated third best in the world for healthcare services is something to be proud of, said Health Minister Datuk Seri Dr S. Subramaniam.He also gave credit to the boom in the country’s medical tourism sector through strategic investments on good medical facilities and competitive rates compared to other parts of the world.

“Medical tourism has benefited the Government in terms of foreign direct investments and also spin-off effects in the hotel and shopping sectors,” he said yesterday.

The Star Online reported yesterday that a study by the American publication International Living rated Malaysia’s healthcare system as the third best out of 24 countries in its 2014 Global Retirement Index, beating Spain, Italy, Ireland and New Zealand, among other countries.

The index, which was recently released by the Baltimore-based magazine, praised Malaysia’s healthcare, which scored 95 out of a possible 100 points, as the medical expertise of Malaysian healthcare practitioners is “equal to or better than what it is in most Western countries”, according to InternationalLiving.com’s Asia correspondent Keith Hockton.

The top two countries, France and Uruguay, scored 97 and 96 points, respectively.

On the methodology of the index’s ratings, the magazine said both the cost and quality of healthcare were evaluated.

Another report in International Medical Travel Journal News reported that medical tourism receipts in Malaysia from foreign patients totalled RM509.77mil in 2011 involving 578,403 patients.

Dr Subramaniam added that Malaysia remained competitive with players like Singapore and Thailand and the focus was to consolidate the country’s position.

He said the key towards improving the overall healthcare sector would be to focus on the preventive and primary healthcare divisions.

Malaysia Medical Association (MMA) president Datuk Dr N.K.S Tharmaseelan also acknowledged the findings, saying that the country has one of the best healthcare systems in the world.

“The Health Ministry has become a massive seamless service provider in healthcare that has produced magnificent results over the years. Our statistics prove it,” he said, adding that this was despite general practitioners being the lowest paid in the world with their fees being regulated.

He added that impressive figures such as life expectancy for women reaching 80 years and about 72 years for men were reflective of the excellent healthcare provided by the ministry and the private sector.

By G. Surach The Star/Asia News Network

Five tech-powered changes in next five years, IBM predicted

IBM_five tech

Technology stalwart IBM on Tuesday predicted classrooms getting to know students and doctors using DNA to customize care are among five big changes on the horizon.

IBM said that its annual forecast of five ways technology will change lives in the coming five years was “driven by a new era of cognitive systems where machines will learn, reason and engage with us in a more natural and personalized way.”

And while software evolves to “think” in ways similar to the human brain, computing power and troves of data kept handy in the Internet “cloud” will enable machines to power innovations in classrooms, local shops, doctors’ offices, city streets and elsewhere, according to the firm behind the Watson computer that triumphed on US television game show Jeopardy.

“Over time these computers will get smarter and more customized through interactions with data, devices and people, helping us take on what may have been seen as unsolvable problems by using all the information that surrounds us and bringing the right insight or suggestion to our fingertips right when it’s most needed,” IBM contended.

Predictions for the coming five years included “classrooms of the future” equipped with systems that track and analyze each student’s progress to tailor curriculum and help teachers target learning techniques.
IBM_five tech_children
“Basically, the classroom learns you,” IBM vice president of innovation Bernie Meyerson told AFP. “It is surprisingly straight-forward to do.”

In another prediction, IBM sees retail shops large or small blending online and real-world storefronts with ‘Watson-like’ technologies and augmented reality.

Also, doctors will tailor treatments using patient DNA, according to Meyerson.

“Knowing your genetic make-up lets you sort through a huge variety of treatment options and determine the best course to follow,” he said.

“They don’t have to carpet bomb your body to treat cancer,” Meyerson continued. “There is the ability to tailor the attack to improve the efficacy against cancer cells while leaving healthy cells untouched.”

Smart machines tapping into the Internet cloud will also be able to serve as “digital guardians” protecting people from hackers by recognizing unusual online behavior, such as shopping binges at dubious websites, and spying scam email messages or booby-trapped links.

“The digital guardian will know you are not someone who goes to a poker site and tops off your account,” Meyerson said. “Not only does it shut down the behavior, but it tracks it back to who is doing it and passes the information on to authorities.”

The final prediction was that cities will weave social networks, smartphones, sensors, and machine learning to better manage services and build relationships with citizens.

“The city will help you live in it,” Meyerson said. “There is a new generation of leaders coming in who are extremely tech savvy and making good use of it.”

Sources: AFP-Times

Get ‘smart’ pill is just sugar! What science are they teaching in schools?

School smart pills
The ‘smart pills’ sold in school are nothing more than just sugar.

PETALING JAYA: The pill that can supposedly make children “smarter and more obedient” is nothing more than sugar, said the Malaysian Medical Association (MMA).

According to its president Datuk Dr N.K.S. Tharma­seelan, upon analysis, it was found that 95% of the pill marketed as Dimensi 108 consists of sugar and other carbohydrates.

Herbs constituted only 7.5mg, or 1.5%, of the 500mg pill, he said.

“Although some of the herbs have been used in traditional Chinese medicine, the amount in this pill is minuscule to be of any use.

“In conclusion, Dimensi 108 is just a sugar pill with a tinge of herbs,” he said in response to The Star’s Thursday cover story which reported that schools in several states have been pushing the pills to pupils.

Dr Tharmaseelan called for the sale of the pills to be stopped immediately until the manufacturer can substantiate its claims through proper studies.

The Dimensi 108 pills were alleged to be able to “alter” children’s behaviour to make them more obedient and resistant to illnesses, and its listed ingredients include red dates, water lily seeds, rock sugar and spirulina.

Tiga G Dimensi Satu Kosong Lapan Sdn Bhd’s managing director Omar Mohd Yusos had claimed that the pills supplied by his firm were safe, and that the product had been distributed to schools since 2010.

Consultant psychiatrist Dr Ting Joe Hang said the notion of popping pills to make children more obedient was preposterous, and there was no drug in the world that could do that.

– Contributed by  By YUEN MEIKENG  meikeng@thestar.com.my/Asia News Network

What science are they teaching in schools?

I REFER to “Schools push ‘magic’ pills” and “Get smart pills are safe to be consumed, says firm” (The Star, Aug 29 – Malaysian schools push ‘magic’ pills!)

I’m sure in the coming days the reports will elicit many and varied responses from all the concerned stakeholders.

I am disturbed in particular by the “explanation” by the firm on how the pills are supposed to work.

In loading some scientific terms in its “explanation”, I opine that it is making not sense but rather nonsense out of its defence.

Let’s abstract from the reports: “When consumed, the hydrogen and nitrogen in the tablets will go into the bloodstream and form a molecule chain that acts like a ‘bullet’ to destroy negative molecules and generate positive energy … This energy also works as a defense against bacteria or viruses that cause illnesses.”

What “defense molecule chain” is formed from “hydrogen and nitrogen” that can fight off “bacteria and viruses”?

And, what “negative molecules” and “positive energy”? What are these? I don’t remember coming across these in my studies of the sciences?

What is more alarming is we have school teachers and administrators who are buying into such arguments.

What sciences are we really teaching in schools nowadays?

It looks like not only the language of instruction and the pedagogy that need re-examining but also the contents of our science curriculum and syllabi. I cry for our innocent charges!

Indeed, our soon to be revealed Education Blueprint 2013-2025 and its implementation has a taunting and heavy task ahead, especially in the field of science education.


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 Stop distributing ‘magic pills’
From A CONCERNED MOTHER of Kuala Lumpur.

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Malaysian schools push ‘magic’ smart pills!

Malaysian schools push ‘magic’ smart pills!

School magic pills
So called food supplement supposedly makes pupuls cleverer

PETALING JAYA: Schools in several states have been “pushing” pills that supposedly make pupils cleverer.

The promoters also claim that the “get smart” pills, named Dimensi 108, which are marketed as food supplements, can alter children’s behaviour to make them more obedient and hard-working as well as resistant to illnesses.

Concerned parents from a school in Kuala Lumpur contacted The Star when the tablets were distributed to Year Six pupils earlier this week, saying their children were being forced to buy the pills.

One parent said she had asked her daughter to return the pills to the class teacher and refused to pay for them.

“When my daughter and a few of her friends returned the pills, the teacher told them not to blame her if they are tak pandai (not clever) in their UPSR (which starts on Sept 9).

“Can you believe that? The teacher is supposed to encourage the kids to work hard for their exams and not rely on some pills with so-called magical properties,’’ the outraged parent told The Star.

Another complainant, whose brother is studying at the school, has lodged a written complaint with the Health Ministry.

“A ministry official told me that they will look into the matter, and I have also sent pictures of the packaging of the pills with the ministry’s logo on it.

“I hope they will get to the bottom of this as quickly as possible because we need to know whether the product is legitimate or not,” said the complainant.

The school’s headmistress said parents had “misunderstood” the nature of the pills and it was not compulsory for pupils to buy them.

“We would not promote anything that is bad for the pupils … these are just like herbal supplements to help pupils concentrate and build energy for the upcoming examination.

“They have ingredients such as spirulina and red dates, which are known for their health-giving properties. I myself give them to my child near the examination period.

“The product also has the endorsement of the Malaysian Federation of the Council of Headmasters, meaning that it has been approved by the Health and Education ministries,” she said.

The headmistress claimed that the pills were supplied to the school by the council.

“One parent shared her concerns with me personally, and when I explained the situation, she was very supportive,” she added.

Some parents remained sceptical.

“Only RM5 for a behaviour altering drug? This is way too affordable for the best thing since the discovery of DNA,” quipped a parent on Facebook.

“Spend a few hundred bucks, behavioural issues solved … Where can I mass order? Or how to sign up to be an agent?” added another.

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