Friday, 14 June 2013

On Al Zahrawi

Did you know that Al Zahrawi described normal and abnormal presentations and described instruments for craniotomy to deliver a dead fetus in case of obstruction? He also developed a vaginal speculum!!

Boleh tgk kat sini gambar speculum dia





Wednesday, 12 June 2013

The “Halalness” of Rotavirus Vaccines

The “Halalness” of Rotavirus Vaccines 
Dr Musa Mohd Nordin FRCP, FRCPCH, FAMM 
Cyberjaya University College of Medical Sciences (CUCMS) 

Pneumonia and diarrhoeal disease are the two top killers of children. UNICEF reports that these two diseases kill more than 2 million children each year. They make up 30% of childhood deaths under the age of 5 worldwide. 

In the management of diarrhea, key interventions include; encouraging infant breastfeeding, improving access to clean drinking water, rehydration solution and vaccination. 

Funding Pneumococcal Conjugate Vaccines (PCV) and Rotavirus (RV) vaccines could prevent another one million children from dying every year. 

In the hierarchy of the priorities of Islamic Jurisprudence (Maqasid as-Shariah); the preservation of life comes only second after the preservation of Deen. Life is a gift from Allah (SWT) and its protection and continuation is of utmost importance and urgency. 

The sanctity of human life is emphasized in the Quran as, “…and if anyone saved a life, it would be as if he saved the life of all mankind.” (5:32). 

The prophet (may peace be upon Him) related, "We are a people who do not eat until we are hungry. And if we eat, we do not eat to our fill." This narration among others is the backdrop to a powerful medical maxim “Prevention is better than cure”. 

This medical aphorism is further reinforced by the jurisprudence principle; “sadduz zaraik” – closing the doors of destruction. 

These back to basics rulings alone are sufficient justification for the permissibility of immunisations to save the lives of innocent children, notwithstanding the issues related to the “halalness” of the vaccines. 

The presence of porcine elements in the manufacturing process of the two available RV vaccines namely Rotateq (MSD) and Rotarix (GSK) has triggered some measure of alarm in the Muslim medical fraternity, the Fatwa Councils and by extension the lay public. 

This however is not a new issue because it has been addressed by Muslim physicians, scientists, public health experts and jurists (fuqaha) who are at the cutting edge of vaccinology and child survival strategies. 

The Oral Polio Vaccine (OPV) which has led to the virtual global eradication of polio utilizes small, virtually negligible amounts of trypsin derived from porcine origin, to disconnect the contiguous cells in the tissue culture. A similar technology is utilized in the manufacturing process of the RV vaccines. 

The European Council of Fatwa & Research in 2003 writes “Out of piety, some brother Muslim in various parts of the world, particularly in East Asia, have made the fatwa that it is not permissible to administer this vaccine to children, due to the fact that porcine trypsin is used in preparing it.”

They argued as follows: 
a) what God forbids is the partaking of pork, and trypsin has nothing to do with 
b) even if we admit that trypsin is forbidden, the amount used in preparing the 
vaccine is negligible, if one applies the rule that “when the amount of water exceed 
2 qillas, impurities no longer affect it” 
c) supposing that trypsin is unclean, it is thoroughly filtered, that it leaves no traces 
whatsoever in the final vaccine 
d) in case the three arguments forwarded are still insufficient, the haram (forbidden) are made 
permissible in cases of necessity. 
In their concluding remarks they emphasized, “The Council urges Muslim leaders and officials at 
Islamic Centres not to be too strict in such matters that are open to considered opinion and that 
bring considerable benefits to Muslim children, as long as these matters involve no conflict with 
any definite text.” 

Such is the latitude of rationale and magnanimity of our scholars (fuqaha) unlike some, in addressing the bigger picture of child survival strategies and the advocacy of life saving vaccines.

Tuesday, 11 June 2013

Good articles on VBAC ERCS and a few others

Patient information articles and good websites to check out:

Patient info by RCOG (Royal College of Obstetricians and Gynecologists) :-

-Birth after previous caesarean - information for you

-A breech baby at the end of pregnancy - information for you

-Turning a breech baby in the womb (external cephalic version) - information for you

-Understanding how risk is discussed in healthcare - Information for you

-When your waters break early: information for you

Info by :-

-VBAC Information and Support

-Breech Presentations

-Caesarean Section

-Prolapsed Cord articles/guideline by RCOG:




We had a recent discussion with our consultant during one of our usual ward round last weekend. What obstetrician generally practices before and how they thought about Vaginal delivery Vs Repeat Cesarean section might just skewed with the emergence of this recent Australian study.

Please read this article first before moving to the journal:

"Is Elective Repeat Cesarean Surgery Truly Safer Than Planned VBAC?"

This is actually an open access paper. So I guess, they want us to read this! :)

Saturday, 8 June 2013

Medicine and Islam

A few good reads that is worth digging in. I started reading about this when I was in 1st year medical school. It has been magnanimous on how I practise medicine to this day. And I hope to learn more insyaAllah

**and a few except from Prof Omar’s study for those who are wondering my references.

4.3 The Qur’an is not a text book of medicine but a book of moral guidance. It contains basic information and guidance on medical matters leaving the room open for humans to undertake research and fill in the details Confiding medicine to only the teaching in the Qur’an would make medical research teaching and practice very limited because the Qur’an is very selective in the coverage of details leaving the field open to human to observe, search for and understand Allah’s signs on earth.

5.5 Tibb Nabawi as reported to us did not cover every conceivable disease at the time of the Prophet (PBUH) neither can it cover all ailment today or in the future in the various parts of the world. This is easy to understand from the context that although the prophet (PBUH) practiced medicine, his main mission was not to teach medicine and he was not a full-time physician. The hadith of the Prophet (PBUH) should no be looked at as a textbook of medicine. They should be used for disease that they dealt with, The proper way to get additional medical knowledge is through research and looking for signs of Allah in the universe (43). We can conclude that Tibb Nabawi contribute to Islamic medicine but can not be on it’s own called Islamic medicine

6.4 We therefore conclude that this early Muslim medicine was “Muslim” and not “Islamic”. The ancestors achieved a lot in their time. The challenge is for us to achieve even more in our times. They had their achievement and we must have our achievement. We cannot copy what they did and use it in our times

(ps: TQVM Hanifah Riduan for sharing with me the initial reading material from Prof Omar. This has been most valuable! I've always been thankful to you for this!)


Paper presented at the Malaysian Medical Students Conference held at Kuantan on 17th June 2004 by Prof Dr Omar Hasan Kasule, Sr.

The roots of modern medicine can be traced to ancient civilizations of Egypt, Babylon, China, India, Persia, Greece, and Rome. There were also contributions from traditional medicine of many societies including the Pre-Islamic Arabian peninsula.

The practice of embalming the dead gave Egyptians a lot of knowledge about anatomy. They also developed various medical and surgical modalities. The babylonians knew nasal tamponade for bleeding, cataract couching. They used blood-letting as a treatment. They knew circumcision and we learn from the sunnat that the great patriarch Ibrahim (PBUH) was circumcised.

The saying ‘seek knowledge even if as far away as China’ is well known all over the Muslim world. Muslims learned a lot from the Chinese. Ancient Chinese medicine was well developed. The Chinese developed acupuncture and castration of males who became eunuchs. Chang Chon-Ching, who lived in the 2nd century M, was the most famous Chinese physician. He had famous medical writings and spread medical knowledge to Japan. In the 3rdcentury M the Chinese surgeon Hua Chu wrote about physiology, anatomy, pathology, anesthetics. After him Huang wrote about acupuncture. Tao Hung Ching (454-536 M) used acupuncture and had interests in internal medicine, anatomy, children and women diseases, obstetrics, dietetics, and drugs. Chao Yuan Fang (550-630 M) wrote a medical encyclopedia. Sa’ad Ibn Abi Waqqaas the commander of the conquest of Qadisiyyat (13H) and the founder of the city of Kufa (18H) was sent by Othman Ibn Affan on a diplomatic mission to China 620-640 M and is reported to have lived in the Chinese city of Canton. Thereafter contacts between Muslims and Chinese increased. A Chinese physician came to Al Razi (d. 313 AH/925 M) and requested to study under him for 1 year. He learned Arabic and translated medical books into Chinese. Muslims were in contact with Chinese physicians who visited Central Asia such as Yuan Chwang 630-645 M and I Tsung 675-685 M.

Surgical knowledge in India was very advanced and many surgical instruments were developed. The following operations were carried out by Indian surgeons: tonsillectomy, amputation, tumor excision, hernia repair, repair of harelips, removal of bladder stones, couching cataracts, nose repair, ceserian section. Indians knew the washing and bandaging of wounds. Hyoscamus (Henbane) and cannabis indica were used as anesthetics. In some cases hypnosis was used as anesthesia. The period 6-12th centuries M witnessed development of Indian medicine especially in the field of toxicology. Indian medicine reached Baghdad both directly and indirectly, through Persia. Muslims entered Sindh in 15H/637M led by the Omayyad military leader Muhammad Ibn al Qasim; a long period of contact with Indian medicine, trade and cultural exchange ensued. In the Abassid era the ruling Barmaki family were interested in Indian culture especially its medicine. Yahya bin Khalid al Barmaki, vizier of Harun al Rashiid, sent missions to Indiato learn its medical knowledge. He also invited Indian physicians to Baghdad. Some Indian medical texts were translated into Arabic in Baghdad. The physician Abi al hasan Ali Bin Sahal al Tabari in his book ‘Firdaus al Hikmat’ completed in 236H / 850M wrote about Indian medicine covering topics such as: importance of spiritual cures, treatment of metal disorders, importance of specialization, women diseases, obstetrics, internal medicine, dietary treatment, looking at the patient as one entity, diagnosis,  preventive medicine, anatomy, surgery, surgical instruments, and medical training. The Indian physician Kankah treated Harun al Rashiid and translated a book on poisons. The Indian physician Salih bin Baghlat was famous at the Abassid court. Urnda, Siddhayogar, and Ibn Dahn al Hindi were Indian physicians who served the Abassids and all worked at the Baghdad Hospital built in 187H/ 803M in the era of Harun al Rashid. Zantah was an Indian physician who wrote about poisons and their treatment. Ibn al Nadiim in his book ‘Al Fihrist’ mentioned Indian medical books that were translated into Arabic. Abubakr al Razi in his book ‘al Hawi’ depended a lot on Indian medical knowledge. Abi al Rayhan Muhammad bin Ahmad al Bairuni wrote about Indian medicine. He traveled in India and was very familiar with its people and culture.

Persian interest in Greek medicine was demonstrated when the King of Persia invited the famous Greek physician Hippocrates (460-377 BC) to help deal with diseases and epidemics in Persia. Hippocrates did not agree. When Alexander of Macedonia defeated Persia, he spread Hellenic civilization including its medicine. Greek knowledge was translated first into Persian then into Arabic. Hereafter many translations of medical works were made from Persian to Arabic especially at the time of the Abassids. Persian influence was very strong at the Abassid court in many areas including medicine.

Greek medical knowledge was picked up by the Romans and was spread in West Asia by the Byzantines. The famous Roman physician Galen closely followed Hippocrates. He in turn had a major impact on Byzantine medicine. Muslims learned a lot from Galen but also had access to other Greek sources. Complete reliance on Galen was not possible because Galen was selective in his copying from Hippocrates and other Greek physicians. Muslims played a big role in preserving early Greek medical knowledge, improving and enhancing it, and eventually passing it on toEurope during the renaissance. The Greek physician and father of European medicine, Hippocrates son of Heraclides (460-377 or 370 BC), introduced rational/scientific medicine. He introduced the theory of the 4 humors and the 4 elements of the body. The Hippocratic corpus consists of his writings and those of his students. Romans learned from the Greeks and developed advanced military hospitals called valetudinaria that were used to treat wounded soldiers on the battle-field. Three Roman physicians became famous: Celsus, Rofus, and Galen. Celsus described the cardinal signs of inflammation: rubor, tumor, calore, and dolore; provided  details of surgical procedures; and described ligation of blood vessels. He encouraged dissection. Rofus wrote 42 titles and made contributions to anatomy, surgery, and urinary tract disease. Claudius Galen (130-201 BC), a skilled Roman military surgeon, had great impact on Arab medicine. His writings were compiled by the Byzantines and were eventually translated into Arabic.

The Greek-speaking multi-national Byzantine empire, with its capital at Constantinople in West Asia, lasted over 1000 years after the fall of Rome and acted as a bridge to transfer Greek knowledge to West Asia and North Africa. The Byzantines compiled Greek knowledge from Hellenic and Roman books. The University of Alexandriawas the center of this activity. It continued functioning after the Muslim conquest of 642M and lasted until 719M. Johns Philoponus, the grammarian, was an Egyptian scholar in Alexandria who met Amre bin al ‘Aas. He wrote commentaries on the books of Aristotle and Galen. Palladius and Asclepius wrote commentaries on Hippocrate’s writings in the 6th century M. Paulinus, an expert in women diseases and obstetrics, was another Byzantine physician in Alexandria.

Medical knowledge in the Arabian peninsular before Islam was the folk medicine found in all human communities. We know a lot about the nature of this medicine from the many authentic hadiths on Tibb al nabawi. The prophet’s medicine was in most cases the medicine practised in Hejaz at that time. Pre-Islamic Arabs used cupping, hijamat;cautery, kayy, and branding with fire, wasm. They used a wide variety of herbal medicine. Among medical practitioners in the pre-Islamic era were: Ibn Huzeem, Nadr Ibn Harith, and Ramtha al Tamiimi. The harsh environment, isolation in the desert, the nomadic Bedouin life, and general illiteracy explain the low level of medical knowledge among Arabs before Islam. They sometimes confused medical practice with sorcery and magic.

Overview: The period under review covers the era of the Prophet (-13H to 10H), the era of the 4 rightly-guided khulafa, khulafa al rashdiin (10-40H), the Omayyad era (41-132H), and entry into Andalusia (starting 94H). The prophet;s teachings gave a big impetus to medicine. He taught that there were two branches of knowledge: ‘ilm al abdaan & ilm al adyaan. He taught that the body had rights and had to be cared for. He also taught that the intestine was the abode of disease and prevention was the head of all medicine. He taught a lot about personal and environmental hygiene. He practiced medicine and urged his companions to seek cures for their diseases. The start of rapid medical advance was in the Omayyad period. Translations of medical texts into Arabic started under the Omayyads. Prince Khalid Ibn Yazid rewarded translators lavishly.

Rufaidah bint Sa'ad, the nurse: is generally recognized as the first Muslim nurse. Rufaidat's full name was Rufaidat bint Sa'ad of the bani Aslam tribe of the Khazraj tribal confederation in Madinah. She was born in Yathrib before the migration of the Prophet Muhammad (PBUH). She was among the first people in Madina to accept Islam and was one of the Ansar women who welcomed the Prophet on arrival in Madina. Rufaidah's father was a physician. She learned medical care by working as his assistant. Her history illustrates all the attributes expected of a good nurse. She was kind and empathetic. She was a capable leader and organizer able to mobilize and get others to produce good work. She had clinical skills that she shared with the other nurses whom she trained and worked with. She did not confine her nursing to the clinical situation. She went out to the community and tried to solve the social problems that lead to disease. She was a public health nurse and a social worker. When the Islamic state was well established in Madina, Rufaidah devoted herself to nursing the Muslim sick. In peace time she set up a tent outside the Prophet's mosque in Madina where she nursed the sick. During war she led groups of volunteer nurses who went to the battle-field and treated the casualties. She participated in the battles of Badr, Uhud, Khandaq, Khaibar, and others. Rufaidah's field hospital tent became very famous during the battles. At the battle of the trench,ghazwat al khandaq, Rufaidah set up her hospital tent at the battle-field. The prophet Muhammad instructed that Sa'ad bin Ma'adh who had been injured in battle be moved to the tent. Rufaidah nursed him and carefully removed the arrow from his forearm and achieved hemostasis. The prophet visited Sa'ad in the hospital tent several times. Rufaidah had trained a group of women companions as nurses. When the Prophet's army was getting ready to go to the battle of Khaibar, Rufaidah and the group of volunteer nurses went to the Prophet Muhammad (PBUH). They asked him for permission "Oh messenger of Allah, we want to go out with you to the battle and treat the injured and help Muslims as much as we can". The Prophet gave them permission to go. The nurse volunteers did such a good job that the Prophet assigned a share of the booty to Rufaidah. Her share was equivalent to that of soldiers who had actually fought. Rufaidah's contribution was not confined only to nursing the injured. She was involved in social work in the community. She came to the assistance of every Muslim in need: the poor, the orphans, or the handicapped. She looked after the orphans, nursed them, and taught them. Rufaidah had a kind and empathetic personality that soothed the patients in addition to the medical care that she provided.

Other early nurses: The following nurses became famous for their nursing work both in war and peace during the time of the prophet: Rufaidat bint Ka’ab al Aslamiyyat; Amiinat Bint Qays al Ghifariyyat; Umm ‘Atiyyah al Anasariyyat; Nusaibat Bint Ka’ab al Maziniyyat & her family; Zainab from the tribe of Bani Awd an expert in diseases and surgery of the eye. History has recorded names of women who worked with Rufaidah: Umm Ammara, Aminah, Umm Ayman, Safiyat, Umm Sulaim, and Hind. Umm Ammara is also known as Nusaibat bint Ka'ab bin Amru bin 'Awf bin Mabdhool bin 'Amru bin Ghanam bin Mazin bin al Najjar al Ansariyat. She was the mother Abdullah and Habiib, the sons of Bani Zayd bin 'Asim. Nusaibat was assisted by her husband and her children in her nursing work. She participated in the covenants of 'Aqabat and Ridhwan. She was at the battle of Uhud with her husband and her son. She was also at the battle against Musailamah in Yamamah. She was injured 12 times in this battle, her hand was cut off, and she eventually died as a result of her wounds. She had gone to the battle of Uhud to nurse the fighters and provide them with water and when the battle turned against Muslims she took a sword and fought defending the Prophet. Amiinat bint Qays was reported to have helped in preapring Safiyat for her wedding to the Prophet (PBUH). Umm 'Atiyyah al Ansariyat al Khadfidhat treated women in Madina.

Physicians: Among the physicians of this era were: al Harith Bin Kaldat,  Rufa’at bin Yathri,  Ibn Athaal, Thiyadhuuq,  Abd al Malik Bin Sa’ied bin Hayyaan bin Abjar al Kinani , Abu al Hakam al Dimashqi,  Wahb bin Minyat (d. 112H /732M), and Ibn Juraih al Raahib (d. 130H). Abu Omar Bin Salal al Harith Bin Kaldat (d. 734M) of the tribe of Thaqaf from Taif was praised by the prophet as the best Arab physician of his day. The prophet ordered Sa’ad bin Abi Waqqaas to consult al Harith. His mother was an aunt, khaalat, of the prophet. Al Harith studied medicine in Khuristan in Persia and became famous as a physician in Persia. He then returned to Taif and entered Islam and lived until the Omayyad era. He used to advise people to take preventive measures against disease. On his death his work was inherited by al Nadhar bin al Harith. Rufa’at bin Yathri Abu Ramthat al Tamiimi lived at the time of the prophet and met him. Ibn Athaal, a Christian physician at the court of Mu’awiyah bin Abi Sufyan and an expert in medicines and poisons, was suspected in the death of many prominent people.Thiyadhuuq, said to have been a physician to the Omayyad governor Hajjaaj bin Yusuf, wrote a book with special interest on the relation between the patient and the physician and also wrote on dietary advice. Abd al Malik Bin Sa’ied bin Hayyaan bin Abjar al Kinani was a physician of the Khalifah Omar Ibn Abd al Aziiz (99-101 H) and had a famous saying: ‘leave the medicine alone as long as you can withstand the disease, d’i al dawaa ma ihtamala badanuka al ddaau’. Abu al Hakam al Dimashqi was a Christian physician with specialization in therapeutics and was physician to the second Omayyad Khalifah, Yazid Ibn Abi Sufyan. ‘Aailat Ibn Hakam al Dimashqi was a Christian physician for the Omayyad rulers. His son Abu al Hasan ‘Isa bin Hakam bin Abi al Hakam was also a physician and authored a medical book. Wahb bin Minyat (d. 112H /732M)  knew Greek physiology and believed that a person has 360 organs.

MEDICINE IN THE ABASSID PERIOD (132 H – 656H / 749 – 1258M)
This era was a time of translation and advancement in medical knowledge and technology. This was made possible by the general conditions of peace that pax Islamica had established allowing movement of people and ideas across the expanse of a large empire. The political leaders encouraged as well as patronized learning and science. They bought books and imported scientific brains. Al Ma ‘amun established Bayt al Hikmat which undertook translations of Greek knowledge. Hunain Ibn Ishaaq (808-873 M), one of the most famous translators, translated from Syriac to Arabic assisted by his son Ishaaq and his daughter’s son, Hubaysh al A’am, and Isa bin Yahya. They were joined in the translation project by Istafan bin Basil, Qusta bin Luuqa, and Thabit bin Qurrat al Harraani. The translators gave priority to books of Galen over those of Hippocrates; however the ideas of the latter were included in the writings of the former. They translated other books in pharmacy and medicine by Greek and Byzantine authors. Unfortunately they also translated books on magic and sorcery which created confusion in Muslim medicine later. The age of translation was soon followed by the age of innovation; Muslims were no longer passive consumers of knowledge; they started adding to it and enriching it. The process of translation strengthened Arabic as a language of science. The translators had to arabize many technical terms, ta’ariib al mustalahaat. Greek tenets and ideas were islamized for example translators would use alternative words in the place of pig and alcohol.

During the early abassid era, many measures of public health significance were undertaken. The abassid Minister Ali Ibn Isa asked the court physician Sinaan Ibn Thabit to organize regular visiting of prisons by medical officers. The first hospital was built by Harun al Rashiid in Baghdad. Khalifah al Mansur instructed his physician Isa bin Yusuf to examine all physicians to determine those who were competent; those who were successful were allowed to continue their work and the unqualified were expelled. Sinaan examined physicians in 319H.
The family of Bakhtishu’u made many contributions to the early growth of medicine. Jurjis bin Bakhtishu’u al Jandishapuri was a Syrian physician brought to treat the khalifah, al Mansur, in Baghdad. He cured the khalifah and returned to his hometown after 4 years. His place at the capital was taken by his son Bakhtyuush who later became a physician for Harun al Rashiid. Bakhtyuush was followed by his son Jibril bin Bakhtyuush who authored medical books. They were followed by others from the same family serving the rulers. The family served at the court for several generations and attained positions of influence, power, and wealth. Al Hakiim Yahya bin Bakhtyuush al Jandishapuri translated from Greek and Syriac to Arabic and died in Baghdad in 300H. Abu Sa’id Obaydullah bin Jibril from the family of Bakhtyuush wrote several books: nawadir al masail, manaqib al attibba (completed in 423H), al taharat wa wujuubiha, tadhkirat al haadhir wa zaad al musaafir, and rawdhat tibbiyyat.

The family of Masawayh made many contributions to medicine. Masawayh was a pharmacist who had two sons: Daud and Yahya. Daud became famous as a physician eloquent in Persian, Syriac, and a little Arabic. Abi Zakariyah Yohanna Ibn Masawayh (777-857 M), a physician to several abassid rulers (Al Ma amun, al Mu’tasim, al Waathiq, al Mutawakkil) and teacher of Hunain Ibn Ishaaq, was commissioned together with his sons by Harun al al Rashid to translate ancient Greekn medical books. The Khalifah al Ma amuun made him head of the Bayt al Hikmat.  He was supervisor of the hospital in Baghdad and was the first person to establish a faculty of medicine. He wrote many books on fevers, nutrition, headache, and sterility in women that were translated in Europe. One of his famous publications was a book ‘kitaab al kamala wa tamaam’ that covered several diseases. He was so interested in dissection that he had a special room for that purpose and had apes brought to him from Nubia in Africa.

Abu al Hasan Ali Bin Sahl Rabn Al Tabari, a physician to two abassid khulafa, was born a Christian in Persia in 810M. He embraced Islam at the hands of al Mu ‘tasim and died in Baghdad after 227H / 831M. He first lived in Tabarstan and moved to Baghdad in about 297H. He authored Firdaus al Hikmat, dedicated to al Mutawakkil and published in 850M, an encyclopedic work on medicine, philosophy, zoology, and astronomy greatly influenced by the writings of Hippocrates, Aristotle and Galen. The end of the book was a description of Indian medicine. Abu Yusuf Ya’aqub bin Ishaq bin Salih bin Ismail bin Muhammad bin al Ash’ath al Kindi the philosopher of the Arabs wrote a book on mental health titled ‘al Hiilat li Dafu’I al Ahzaan’ as well as other medical books. Qusta bin Luuqa al Ba’alabakki, born a Christian in 830M and died in 912M, was a contemporary of al Kindi. He translated many books into Arabic and wrote books on physiology and psychology. Mankah was an Indian who translated books into Arabic from Sanskrit including a treatise on poisons by the Indian physician Sanqah.

Thabit bin Qurrat al Harraani translated many medical books. Hunain Ibn Ishaq al Ibaadi aka Johanitius (194-260H / 810-873M) was a Christian who knew Syriac, Greek, and Arabic. He studied in Basra, Baghdad, Syria, and Byzantine. He translated Greek medical books including writings of Hippocrates and Galen. His work was continued after his death by his nephew Hubaish. He in addition wrote some books of his own the most famous being kitaab al aghdhiyat, al masail fi al tibb li al muta’alimiin, kitaab al madkhal fi al tibb, kitaab al maqqqlaat al asharat fi al saidalatAli Ibn Abbaas al Majuusi, a native of Ahwaaz from a Zoroastian family who died in 982 or 995M, authored a book on treatment of disease with single remedies, adwiyat mufradat, and another book on medicine called Kaamil al Sina’at al Tibiyyat that became famous after that as al Maliki and was translated into Latin and used as a reference in Europe. He was the first to explain that the fetus is expelled by the contractions of the uterus.

Ibn Abi Usaybi’ah was born in Syria and practiced medicine in Cairo. His major contribution was writing bibliographies of all physicians before him. Ibn al Quffi, whose full name was Amin al Dawlah Ibn al Faraj Muwafiq al Ddiin Ya'qub Ibn Ishaq Ibn al Quffi al Malaki al Karki, was born in 630H/1233M and died in 685H/1286M. He wrote a surgical manual ' al 'umdat fi sina'at al jarahat'. Dhia Al Addin Abdullah Ahmad BinAl Baitar was born towards the end of the 12th century and died in 1248M. He traveled widely. His most famous book was al Jamiu li Mufradaat al Adwiyat wa al Aghdhiyat. Abu Ibrahim Zain al Ddiin Ismail bin al Hassan bin Muhammad al Husayni al Alawi al Jarjaani (d. 531H / 1137M) authored three books in the Persian language: al Tadhkirat al Ashrafiyat fi al Sina’at al Tibiyyatal Ajwibat al Tibiyyat wa al Mabahith al ‘Alaniyat, andZubdat al Tabiib. Muwafaq Al Adiin Abd Al Latiif Bin Yusuf Al Baghdadi (b. 1162M d. 1231M) travelled to Cairo and Damascus. He started teaching medicine in Damascus in 1207 CE. Jurjus Bin Jibrail; Ibn Radhwan Al Masri; Alau al Ddiin Ali bin Abi al Hazm; Ali Bin Abbas Al Tusi.

Following the Tatar invasion and destruction of the capital of the khilafat in Baghdad, the Muslim world went into a period of decline. Medicine and medical knowledge also declined.

Medical knowledge spread in Europe from Andalusia. The famous Andalusian physicians were: Urayb bin Salad al Katib, Abu Zakariyyah Yahya Ibn Ishaq, Abul al Qasim al Zahrawi, Ibn Abayya, Ibn Tufail, Ibn Rushd, Ibn Zuhr, Ibn Khatimah, Ibn al khatib. Abu Omran Musa bin Maimoon al Qurtubi al Andalusi aka Maimoinides (529-605H / 1135-1209M) was a Jew born in Qurtuba in Andalusia in the year 1135M  who migrated to and settled in Egypt. He and his son, al Afdhal, after him became physicians to to Salah al Ddiin al Ayubi. He wrote the following books: dalaalat al hairiin, maqalat fi al sumuum, and al taharuz min al adwiyat al qattaalat. His most fampous book was al fusuul fi al tibb, aphorisms, that was extracted from writings of Galen.

Medical knowledge in the maghreb was an extension of the Andalusian medical knowledge.

Anatomy: Muslims largely dependec on the writings of Galen. They however made their own observations and corrected many mistakes made by Galen. The main contributors were: Ibn Masawayh, Ibn Abi al Ash’th, al Majusi, Ibn Habal, Ali Ibn Abbas, Ibn Sina, Ibn al Quffi, Ibn al Nafiis, Ibn Ruhd, Abdul Lateef Baghdadi, Zakariyyah Ibn Muhammad Ibn Muhammad al Cazweeny d. 683 AH). Al Razi encouraged dissection and study of physiology. Al Zahrawi insisted on knowledge of anatomy before any surgery. 

Physiology: Muslim physiological knowledge was influenced a lot by the Greek theories of the 4 elements, al asqaat: hot, cold, wet, and dry; the 4 humors, al alkhlaat: blood, phlegm, yellow bile, and black bile; the 9 temparaments, al mizaaj: 1 balanced and 8 out of balance; the pneumata, al arwaah: ruh tabi’I, ruh hayawaani, and ruh nafsaani. They also described the faculties, al quwaa: natural faculties, quwa tabi’iyat, animal faculties,quwa haiwaniyyat, psychic faculties, quwa nafsaniyyat; and procreative faculties, quwa al insaal. These Greek ideas had one very important and true concept, the idea of balance which is the forerunner of the modern physiological concept of homeostasis. Most of the details were however found by later research to be untrue and were discarded. The heart and circulation were described by Muslims as a mechanical pump. Ideas of food digestion were also known.

Infectious diseases: Al Razi was aware of air-borne infection when he made an experiment to determine the site of a new hospital in Baghdad by putting meat in the air and waiting to see the site where it putrfied soonest. Al Razi in his book, Kitaab al judri wa al hisbat described the symptoms of smallpox and measles. The concept of contagion waa known as early as the time of the prophet. Al Majuusi described contagious diseases like leprosy, elephantiasis, phrenitis, and trachoma. Ibn al Khatib and Ibn Khatimat described the symptoms of plague. Ibn Khatima had mentioned minute bodies causing disease in the 14th century CE.

Public health: the following wrote about public health: Qusta bin Luuqa, Ishaaq bin Omran, Ibn al Jazzaar, Ibn Sina, Fakhr al Ddiin al Razi, and Ibn al Quffi.

Blood circulation:  Ibn Nafees al Nafees described pulmonary circulation centuries before its ‘discovery’ by William Harvey.

Psychiatry: depression melancholia was related to organic factors. It was also realized that it could be caused solely by psychological factors. The symptoms of depression were described very well.

Metabolic/endocrine diseases: The symptoms of diabetes mellitus were described well. Urine examination was a very advanced art.

Allergy: Al Razi described rhinitis due to plant exposure centuries before similar descriptions by Europeans.

Dietetics: Muslims knew that diet is a method of treatment. The following wrote on diets: Hunain Ibn Ishaaq, Muhammad bin Zakariyyah al Razi, and Ibn Zuhr.

Muslims knew both simple and compound drugs. Among those who wrote about drugs were: Abu daud Sulaiman bin Hasan al Andalusi known as Ibn Juljul in the 4th century H / 10th century M; Ibn al Jazzaar, Ibn al Raihan al Biruni, Abi Obaid al Bakri, Ibn Baja al Idrisi, and Abd al Latif al Baghdadi.

Ophthalmology: (Ibn Hytham d. 1040 AD, Hunain Ibn Ishaq, Al Razi, Ibn Sina, Al Zahrawi, Ali Ibn Isa, Ibn al Rushd, Abu al Qasim Ammar). Ibm Hytham (965-1040 CE) in his book 'Kitaab al Manadhir' disproved the extromission theories of Euclid and Ptolmey and instead advocated an intromission view. He described the optic pathways and the point-to-point projection of the visual world into the  brain. He described how eye movements helped in visual perception. He also realised that several processes were involved in conscious visual experience. Jurjani (5th century H) wrote about ophthalmology in his book 'Nur al ‘Uyuun'. Al Zahrawi described many extra-ocular operations. Al Zahrawi described the posterior displacement of the lens in cataracts. He also discovered many instruments such as: hooks, eye speculum, conjuctival scissors for removal of panus, perforator and depressing needles for cataract surgery. Al Razi recommended tearing the capsule of the lens if it cannot be displaced and Ibn Sina described various needles that can be used for this. Ali Ibn Isa was another ophthalmologist who wrote the book 'Tadhkirat al Kahaliin'. Both Al Razi and Ibn Sina described a procedure for operative decompression of glaucoma.

Anesthesiology: Al Zahrawi performed many of his operations under anesthesia: opium or mandragora.

Obstetrics: Al Baladi (circa 380 H) wrote a complete discourse on midwifery called ' Kitaab Tadbir al Habala'. Al Zahrawi described normal and abnormal presentations and described instruments for craniotomy to deliver a dead fetus in case of obstruction. He also developed a vaginal speculum.

General surgery: The main contributors were: Ibn Zuhr, al Shirazi, Ibn Dhahabi, and al Zahrawi. The book al Tasrif By Al Zahrawi took 30 years to compile in 30 volumes. The last volume deals with surgery and is one fifth of the whole book. The volume on surgery is divided into three sections: (a) cauterization in 56 chapters (b) incisions, perforations, wounds & wound healing in 93 chapters (c) bones setting and joints in 36 chapters. The book contains anatomical details. It covered all branches of surgery. The book was used as a standard text in Europe and was translated into Latin in the 12th century M. Al Zahrawi performed thyroidectomy in 952 M. Al Razi was the first to use gut sutures for intestinal repair. Al Zahrawi is also reported to have used catgut and cotton sutures. Al Zahrawi recognized pain as a symptom and not a disease. Among operations performed by Al Zahrawi and described in his writings were: tracheostomy as an elective procedure and bandaging techniques. Al Zahrawi has 11 inventions credited to his name such as use of the syringe for bladder irrigation, the vaginal speculum, and plaster for bone setting. Al Jurjani (d. 1136 M) described the relation between goiter and exophthalmos

Traumatology & orthopedics: Al Zahrawi and al Quff described treatment of bone and joint trauma. Zahrawi wrote about osteomyelitis, amputations, and osteotomies for un-united fractures. He cautioned against above-knee and above-elbow amputations.

Wound treatment: The main contributors were: Ibn Sina, Al Zahrawi, Ibn Rushd, and Al Razi. Al Zahrawi taught the following methods of arresting hemorrhage: digital pressure, tourniquet, sponges, cauterization, hypothermia, ligation of bleeding vessels by sutures of thread. He also advised against tight bandaging. Al Zahrawi emphasied the imoortance of cleanliness in would treatment. Ibn Sina mentioned dry dressing. Al Zahrawi wrote about the drainage of abscesses describing in detail the site and shape of the incision, packing of the wound, excision of the skin edges, use of slow decompression of large cavities, dependent and counter drainage.  

Urology: Al Zahrawi described bladder irrigation. He also developed original methods of lithotromy for impacted stones. He introduced a fine drill into the urethra and was rotated gently to break up the stone into small pieces that could be washed away by the urine. He also wrote about using a bladder sound to locate bladder calculi, control of post-operative hemorrhage, and removal of clots from the bladder.

Gastro-enterology: Al Zahrawi used stomach tubes. He described paracentesis for ascites and intra-peritoneal abscesses. He mentioned use of trocar and cannula to drain liver abscesses. He also described the use a heated cautery to open liver abscesses. Ibn Zuhr (1113-1162 M) was the first to describe in detail the distinction between gastric ulcer and gastric malignancy. Ibn Sina wrote about colitis and its management by diet, drugs, and enema. Abu Imran Musa bin Maymun (1135-1204 M) wrote about hemorrhoids and the role of diet and surgery in their treatment. Mohammad bin Mahmood Al-Qusum (circa 1525 M) in his book ' Zad al Masir fi 'Ilaj Bawasir' wrote about treatment of piles. Ibn al Quff wrote about complications of hemorrhoidectomy and post-operative anal stricture. Al Zahrawi originated cauterization treatment of fistula-in-ano and was aware of the complications of this treatment.

Plastic surgery: Al Zahrawi described the cauterization treatment of harelip. He wrote that the edges must be freshened first before cautery.

Ear , Nose, and Throat: Al Zahrawi discovered the guillotine method of tonsillectomy as well as the complications of the operation. He described the tumors of the tonsil. Among discoveries attributed to al Zahrawi are: use of special osteotomies for nasal operations and polypectomy, use of a marine sponge with an attached string for removal of foreign bodied from the throat, removal of foreign bodies from ears, treatment of nasopharyngeal tumors by repeated excision and cauterization.

Dentistry: Ibn al Quff described making artificial teeth from bone. A Zahrawi described several dental operations: wiring of loose teeth, extraction of roots of broken teeth and broken pieces of the mandible by use of special forceps.

Thermal and chemical cauterization for syphilitic lesions were described by Ibn Sina

Tumors: The main contributor was Abdul Malik Ibn Zuhr (d. 484 H). Al Zahrawi and Ibn Sina recommended wide excision including healthy tissue in removal of tumors. Use of cautery and drugs in treatment of tumors was also described. 

Neuro-surgery: Both al Zahrawi and Ibn Quff described in detail the various intra-cranial and extra-cranial hemorrhages due to arrow wounds and their respective treatments. Al Zahrawi described symptoms and signs of skull fracture. He also described the depressed fracture in children and recommended treatment by removal of a bone. In cranial operations, the drill may accidentally perfotate the delicate intra-cranial structure; Al Zahrawi developed an instrument to prevent this accidental penetration. Al Zahrawi's craniotomy operations were remarkably like modern ones; using burr holes with a linking cut between them allowing to raise part of the cranial vault. Al Zahrawi described paralysis due to injury of the spinal cord. Haly Abbas described several types pof fractures: simple, comminuted, displaced, and hairline. Ibn Sina classified fractures of the skull into two types: closed fractures and open fractures. He described treatment of skull wounds by relieving hematomas or removing pieces of bone that could hurt the brain. Al Baghdadi described the depression fracture found in children. He also described meningoceles that remained after skull surgery and appeared during coughing. Samarkandi described treatment of brain edema following skull trauma and its relief using dehydration, venesection, and enema.

The Persian word bimaristan was used to refer to hospitals and is literally translated as the house of the sick. The first hospital in Islam was the hospital tent that the prophet ordered erected in the mosque of Madina during the battle of the confederates and Rufaidat used it to treat the wounded. The complete bimaristan was established in 88H for the lepers and the blind by the Omayyad Khalifat al Waliid bin ‘Abd al Malik. There were general bimaristans as well as specialized ones for prisons and schools. There were bimaristans for isolating patients who mad or those with chronic diseases like leprosy. The army has mobile bimaristans.

Hospitals were built in Baghdad, Cairo, Andalusia, and Damascus. Bimaristan al Adudi al Kabir was opened in Baghdad in 982 M. Bimaristan al Nuri al Kabir was established in Cairo in 160 M. The Salahi and Mansuri hospitals were built in Cairo and the Nuri hospital was built in Damascus. Muslim hospitals had separate sections for each type of disease. They had gardens. Fans were used to cool the hospital. Cleanliness was observed by workers in all areas of the hospital especially the kitchen and the pharmacy. Daily clinical rounds were carried out. Patients were given some money on discharge.

Mosques were first used for medical education for example Omar bin al Mansur (d. 824H) taught medicine at the Tulinid mosque, al jami’u al taaluuni, in Egypt. Abu Ja’afar al Mansur established Bayt al Hikmat in Baghdad that had become by the time of Ma amuun a research center in which medical books were translated. Among schools of medicine was the school of Abu Bakar bin Fuwruk al Asbahani (d. 406H). The Wazir Nidhaam al Mulk (408-486H) established medical schools in Iraq and Khurraasaan. Medical schools were also established at bimaristans such as the school of the al Muqtadiri Bimaristan in Baghdad established in 306H. Out of concern for proper medical education, Khalifah al Muqtadiri ordered in 319H that nobody would be allowed to practice medicine unless examined by Sinan bin Thaabit bin Qurra.

Al Qanun Fi Al Tibb was written by Abu Abdullah Ali Al Hussein Bin Abdullah Ibn Siina. Al Hawi was written by Muhammad Ibn Zakariyyah Al Razi, Kitaab Al Manadhir was written by Ibn Haytham. Al Tasrif was written by Al Zahrawi. The book al Tasrif that took 30 years to compile is in 30 volumes. The last volume deals with surgery and is one fifth of the whole book. The volume on surgery is divided into three sections: (a) cauterization with 56 chapters (b) incisions, perforations, wounds & wound healing 93 chapters (c) bones setting and joints 36 chapters. The book contains anatomical details. It covered all branches of surgery. The book was used as a standard text in Europe and was translated into Latin in the 12th century CE. Al Kafi was written by Abu Nasr Ibn Al Ayn Zarbi.Al Umdat Fi Sinat Al Jarahat was written by Abu Al Farag Ibn Al Kufi (1233-1286 M). The book consists of 20 maqalas of which maqala 17 is devoted to traumatology while maqala 19 discusses surgical problems and their treatment from head to foot. Al Jirahat Al Kaniya was written by Sharaf Al Dddiin Ali. Kamil Al Sinaet Al Tibiyyat was written by Ali Ibn Abbas. Kitaab Al Kulliyaat was written by By Ibn Rushd. Kitaab Zad Al Musafir Wa Quut Al Hadhir was written by Abu Yafar Ahmad Ibn Ibrahim Ibn Abi Hadir Al Jazzan. The Ten Articles On The Eye  was written by Hasan Ibn Ishaq. A Manual For The Oculist was written by Ali Ibn Isa.Al Taysir Li Man Ajaza ‘An Taliif was written by Abu Al Qasim Al Zahrawi. Kitab Al Shamil was written by Ibn Nafiis. Kitaab al Dhakhiirat was written by Ismail al Jarjani in Persian.

While Muslim medicine was flourishing in West Asia, Europe was in the ignorance and decline of its middle ages. There were three routes of knowledge transfer from the Muslim world to Europe: through Italy, through Andalusia, and by the crusaders. Constatine Africanus (d. 1087 CE) translated the most important medical books from Arabic into Latin. This gave new life to the Salerno (Italy) school of medicine. After him more books were translated. Many medical texts that had been lost in Europe were rediscovered thanks to the translations made by Muslims. Books by Hunain Ibn Ishaaq, al Razi, Al Zahrawi, Ibn Sina, and Ibn Zuhr were translated into Latin and were used in Europe as texts for many years. Europeans came to study at Muslim institutions in Andalusia and took back the knowledge to Europe. Crusaders in the Near East found themselves in a more advanced Muslim civilization and took back many ideas with them to Europe.

Following the golden era of medicine in the first abassid state, there was general decline in medicine. Isolated efforts continued but the rapid growth of the earlier times did not exist. The decline of Muslim medicine was inevitable even on methodologic grounds. Pre-Islamic bedoin medicine was empirical learning from trial and error. The Qur’anic methodological revolution would have turned it into a progressive evidence-based medical system. The interlude of Greek medicine that relied a lot on philosophical discourse and not practical observation delayed the growth of evidence-based empirical medicine among Muslims. The golden era of Muslim medicine during the early abassid period was due to a combination of translated Greek medical knowledge with the addition of empirical observations by Muslims. However Greek ideas became predominant and squeezed out the empirical and inductive approach taught by the Qur’an. This dealt a death to further development of Muslim medicine.

Post-renaissance: The growth of medical knowledge post-renaissance was phenomenal. We shall use surgery as an example. The renaissance witnessed rapid progress in surgical knowledge and practice. Leonardo da Vinci (1452-1519 M) dissected and described human bodies. Andreas Vesalius (1513-1564 M) dissected bodies and published De Humani Corporis Fabrica Libri Setem which corrected many anatomical mistakes. Ambrose Pare (1510-1590 M) was an army surgeon who stopped use of hot oil to treat gunshot wounds, invented surgical instruments, used ligatures instead of cauterisation of blood vessels in amputations, developed artificial limbs, and invented surgical instruments. Jean Baptiste Denis carried out the first successful blood transfusion in 1667 M using blood from a lamb. Obstetric forceps were developed by Peter Chamberlain in England in 1630 M. Santorio Santorio (1561-1636 M) developed the thermometer and measured body weight. Milliam Harvey (1578-1657 CE) rediscovered blood circulation that had been described centuries before by the Muslim physician Ibn Nafis. Marcello Malphigi (1628-1694 M) described capillary circulation. Athansius Kircher (1602-1680 M) and Anton Van Leewenhook (1632-1723 M) described micro-organisms seen under the microscope. Fransesco redi (1626-1697 M) disproved the theory of spontaneous generation. 

18th-19th Centuries M: Daniel Fahrenheit (1686-1736 M) developed the mercury thermometer. Stephen Hales (1677-1761 M) was the first to measure blood pressure. William Hunter (1718-1783 M) and his brother John Hunter (1728-1793 M) dissected bodies and taught anatomy and surgery. Rene TH Laennec (1781-1826 M) discovered the stethiscope. Claude Benard (1813-1878 M) introduced the scientific method in medicine. Herman Von Helmholtz (1821-1894 M) invented the ophthalmoscope. Joseph Priestly discovered nitrous oxide in 1776 M and it was later used as an anesthetic in operative surgery. Ignas Semmelweiss (1818-1865 M) insisted on hand-washing in obstetric practice to prevent spread of infection. Oliver Wendell Holmes (1809-1894 M) also wrote treatises on infections. Louis Pasteur (1822-1895 M) laid the foundations of modern bacteriology but Robert Koch (1843-1910 M) is considered the father of this discipline. William Roengten (1845-1922 M) discovered x-rays in 1895 M. Madame Curie and her husband Peter discovered radium and its ability to destroy malignant cells in 1898 M.

20th century: Paul Erlich (1854-1915 M) discovered Salvarsan in 1910 M. Alexander Fleming (1881-1955 M) discovered penicillin in 1929 M. In 1901 M Karl Landsteiner discovered blood grouping. In 1948 M Dr Papanicoulus discovered the PAP smear.

Eurpean powers started controlling large tracts of Muslim land in the 19th century M and introduced European medicine. In 1828M a European medical school was established at Abu Za’abel in Egypt and was transferred to Cairo in 1837M. A medical school was established in Teheran in 1850M. Robert Koch and Louis Pasteur came to Cairo in 1884M to investigate the cholera epidemic. A medical school was established in Istanbul at about the same time.

Muslim renaissance in Medicine started with the commencement of the new hijra century 1400 H/1980M. Medicine in the ummat is passing through a period of renaissance. There is pride in the past and a determination to excel in the present. This renaissance is manifesting as seminars, conferences, memorial buildings, books, and publications dealing with Islamic medicine. Islamic Medical Associations have been set up and are operating in the US, S Africa, Pakistan, Egypt, Sudan, and Jordan. Among their activities are: journals, bulletins, conventions, research, direct care services, medicolegal fatwas, advocacy, Islamic clinics and hospitals. There is research on remedies in tibb nabawi and traditional medicine, clinical trials of the use of honey in treatment (diarrhoea, ocular disease, and bladder schistosomiasis), chemical analysis of nigella sativa seed. experimental study of Qur’anic facts on menstrual hygiene, immunological and physiological properties of habba sauda by Dr Ahmad el Kadhi. immunological and physiological impact of tilawat al qur’an. use of dermatoglyphics to study hereditary disease. herbal drugs for intestinal infestations, analysis of herbal remedies mentioned by early physicians for pharmacological activity. Clinical trials of ancient remedies were undertyaken. In the practical arena Islamic relief agencies: medical services in war and devasted areas, medical services for the poor, medical services and dawa. Medico-legal fatwas: medico-fiqhi committees at Rabitat al ‘Aalam al Islami, Organization of the Islamic Conference, the Islamic Hospital in Jordan. Intenational Conferences on Islamic Medicine: Kuwait: 1980, 1982, USA, S. Africa, Egypt, Malaysia, and Pakistan.

The contemporary Islamic renaissance in medicine is expressing itself in many forms. One of them is the Islamization of medicine. The Islamization process of the 15th century will have to avoid the mistakes of the Islamization process of the 3rd century. A major lesson learned from the earlier Islamization experience was how Greek ideas stifled further medical development in the ummat.

Thursday, 6 June 2013

Medscape: How Much Should Doctors Really Make?

How Much Should Doctors Really Make?
Harris Meyer
Posted: 09/25/2012

The question of how much money physicians should make has long been a provocative topic. Even about 250 years ago, pioneering economist Adam Smith summarized the prevailing tone when he wrote, "We trust our health to the physician... Such confidence could not safely be reposed in people of a very mean or low condition. Their reward must be such, therefore, as may give them that rank in the society which so important a trust requires." (An Inquiry Into the Nature and Causes of the Wealth of Nations; 1776)

With today's focus on the need to control US healthcare costs and boost the number of primary care physicians, physician payment again is in the limelight.
Physicians are clearly fighting to maintain the incomes they -- often justifiably -- feel they deserve and for which they have paid their dues. But it's obvious that just about no one else in society is weeping over any potential decline in physician salaries.

Few experts think that US physicians overall are paid too little, especially compared with most American workers. Some say that US physician fees, income, and services overall are excessive, contributing to US medical spending that's by far the highest per capita in the world. Others argue that certain types of specialists, such as radiologists and orthopedic surgeons, are paid too much, while others, such as family practice physicians, pediatricians, and geriatricians, are paid too little.

A growing number of experts argue that the prices that physicians and other providers charge need to be curbed, along with wasteful and inappropriate care. That could lead to reduced physician incomes -- though no one wants to see the draconian Medicare sustainable growth rate cuts take effect.

However, many consider high physician incomes to be perfectly justified.

Another view is that the US free market more or less accurately determines how much money it takes to attract and keep talented people in medicine. In a country where the top 1% have an average pretax income of $380,000, not counting capital gains,[1] while the median household income is about $50,000, these observers say that it takes the promise of high and secure earnings to convince the brightest young people to choose a career in medicine rather than the potentially more lucrative fields of finance, management, law, and lobbying.

Shouldn't Doctors Be Happy With Their Incomes?
There's sharp disagreement among medical leaders, researchers, and policymakers about whether doctors, especially those in certain fields, should earn less, more, or about the same; how to implement such changes; and whether changes to physician pay would have any impact on total US healthcare spending. Physician services account for only about 20% of total costs -- much less than hospital services.

Still, no physicians earn as much from the practice of medicine as some hedge fund managers and other fantastically rich occupants of the 1% circle, who can make tens of millions a year. On the other hand, doctors earn a handsome return on their educational investment compared with people in most other occupations, says William Weeks, MD, a psychiatry professor at Dartmouth University who has studied physician incomes vs those of other professions.

"No doctor is making $250 million doing clinical work," says Dr. Weeks, citing corporate CEOs' giant stock option payouts. "But doctors have more job security and a confirmed high level of income, though they also have a ceiling. Compared with business, medicine attracts less entrepreneurial, more scientific people who want a stable, predictable life."

Isn't Life-and-Death Responsibility Worth More?
But is what US physicians earn fair and adequate given the life-and-death responsibilities they bear? Economists say yes, noting that physician income is clearly sufficient to attract plenty of qualified applicants to US medical schools, which turn away 10 times as many people as they accept. Still, is what US doctors make a "just" income -- one that grants doctors, in the words of Adam Smith, "that rank in the society which so important a trust requires"?

Uwe Reinhardt, PhD, a Princeton University economics professor, has suggested that doctors should earn enough after expenses to place them at or above the 95th percentile of US income -- $200,000 in 2011, according to the Tax Policy Center's breakdown of U.S. income distribution. Indeed, the median primary care physician compensation of $212,840 last year met that standard, while the median specialist physician compensation level of $384,467 placed specialists above the 98th percentile, according to the latest Medical Group Management Association (MGMA) physician compensation survey.

"Doctors should be among the best-paid people in society because we give them a great deal of responsibility," says Joseph White, PhD, a public policy professor at Case Western Reserve University who studies international healthcare systems. "But we have great income inequality in the US, and doctors use the high-level group as their reference point. That means the 95th percentile is further from the average worker than in Germany or Holland. That bothers me."

He notes that other advanced countries deliberately consider how much physicians should earn when setting payment levels, which runs against American free-market ideology. "What they come out with has to be seen as fair in terms of the overall income of doctors relative to each other and to the rest of society," says Dr. White.

Of course, international comparisons are tricky because US practice costs, including overhead and liability premiums, are much higher, and educational expenses for US physicians are considerably greater than in other advanced countries where medical school tuition costs are heavily subsidized. But the income differential for US physicians significantly exceeds those higher costs. According to an article in the September 2011 issue of Health Affairs,[2] the income difference after practice expenses between US and British orthopedic surgeons in 2008 was nearly 5 times the difference in education repayment costs, meaning that US physicians are earning compensation in excess of what they’d need to pay back medical school debt.

Better Outcomes Should Earn More, Too
Medical leaders contend that physicians who provide better value in terms of outcomes should be paid more. Still others say that physician pay is a nonissue because other factors have far greater impact on total healthcare costs. Other health sector players, such as hospital, health plan, and pharmaceutical executives, make even more money.

"There's no objectively right answer about what a doctor should make," says Dr. White.

It's no secret that different types of US physicians make hugely different amounts of money. According to the latest MGMA physician compensation survey, in 2011, geneticists earned median pay of $142,234, geriatricians $195,000, general pediatricians $203,948, family physicians doing obstetrical work $204,411, general internists $215,689, invasive cardiologists $472,446, invasive radiologists $486,764, and general orthopedic surgeons $520,119. Certain subspecialists earned substantially more, with neurologic surgeons earning $704,170 and cardiovascular-pediatric surgeons making $725,704.

Physicians owning ancillary facilities such as diagnostic imaging may actually earn more than the MGMA figures because what they reported may not have included ancillary revenues, according to the MGMA.

Where Are the Complaints?
Looking at those numbers, "it's hard for any [US] doctor to complain about income," says Glen Stream, MD, president of the American Academy of Family Physicians. "But our grave concern is the disparity between primary care and subspecialty income. That's a huge driver in medical students choosing specialties other than primary care. Attracting more people to primary care would make our healthcare system higher-functioning and more cost-effective."

Still, even US primary care physicians generally receive higher fees and higher incomes than their counterparts in other advanced countries, while US orthopedic surgeons and other specialists earn far more than their international colleagues, according to the aforementioned Health Affairs article.[2] Adjusted for purchasing-power parity, US primary care physicians in 2008 earned an average of $186,582 before taxes and after expenses, compared with $159,532 in the United Kingdom, $131,809 in Germany, and $95,585 in France. US orthopedic surgeons earned $442,450, compared with $324,138 in the United Kingdom, $202,771 in Germany, and $154,380 in France.

US medical specialty groups don't see their relatively high compensation as an issue, though some leaders favor shifting away from the volume-based, fee-for-service system to performance-based global payments for managing patients' conditions. Indeed, some think that high-performing physicians might make more money under that new system. "I could see a world where doctors are paid more for fewer services," says Kevin Bozic, MD, chair of the American Academy of Orthopaedic Surgeons' Council on Research and Quality.

"US doctors feel entitled to substantially higher incomes because of that training debt," says Gerard Anderson, PhD, director of the Johns Hopkins University Center for Hospital Finance and Management. "The problem with that argument is they make a lot of money and can essentially pay off that debt in 5 or so years, then they have another 20 years at much higher salaries than in other countries."

Even so, Dr. Anderson notes that because physician pay is only a small part of US healthcare spending, if US physician pay were reduced to international levels, it would only cut per capita annual US healthcare spending from $9000 to $8700, compared with about $4500 in other advanced countries.
No one disputes that US physicians are a relatively well-compensated group. According to a New York Times analysis last January,[1]more physicians are in the top 1% of US income -- 192,268 -- than any other occupational group. Physicians were followed by managers and administrators (192,096), chief executives and public administrators (161,069), lawyers (145,564), and accountants and auditors (61,033).

Other Pay Adjustments
Many experts would like to see the Medicare Relative Value Scale Update Committee (RUC) confront part of the issue by adjusting fees substantially to reduce the large disparity between primary care and specialty incomes, making primary care practice more attractive to medical students. Although RUC, composed largely of representatives from various medical subspecialties, has made modest adjustments over the years, they haven't been nearly enough to level out the income differences. But RUC says that's not its job.

Primary care physician leaders place modest hopes on the Centers for Medicare & Medicaid Services (CMS) proposed physician payment schedule for 2013, which CMS estimates will boost Medicare payments to primary care physicians by 7%. Private payers would be expected to follow Medicare's example.
"If we could narrow the income gap so that primary care income is not less than 70%-80% of subspecialty income, compared with 55% now, that would overcome the barrier," Dr. Stream says. "Then we'd get maybe 40% of the physician workforce into primary care, up from 32%." If the workforce ratio eventually rose to 50% primary care, as in other advanced countries, he added, that would significantly improve US health.

But Money Isn't Everything
Experts agree that money is important but that other changes are needed to make primary care practice more attractive. They say that this requires building a team around primary care physicians so that they have more support and aren't on call 24/7. That's a big reason why more primary care doctors are going to work for hospital systems and large medical groups. "Primary care doctors have a crappy lifestyle," Dr. Weeks says. "If you could attack the lifestyle issues, you could attract more people to primary care. More money wouldn't hurt."

Although primary care and subspecialist groups disagree on rebalancing physician payments through the RUC, both camps want more focus on eliminating inappropriate care. That's in line with the Institute of Medicine's recent report[3] which found that nearly one third of total US healthcare spending is wasteful. A growing number of major physician groups are participating in the national Choosing Wisely® campaign to reduce unnecessary tests and other services.

But how will this burgeoning effort to eliminate waste affect physician income and total healthcare costs? Some researchers are skeptical that it will have any impact. "We might see a reduction in a particular service, but doctors will substitute something else," Dr. Anderson says. "They aren't going to put their MRI machine into mothballs. They'll keep working 50- or 60-hour weeks and maintain their income."

And that doesn't particularly bother him. "There isn't anything we can do about how much doctors make in total," Dr. Anderson says. "It would require too much government intervention in the free market. Americans pretty much like their doctors. I don't think there's a lot of resentment about how much they're paid."

For further details on physician compensation, see Medscape's complete Physician Compensation Report 2012.

New York Times. The jobs with the most 1 percenters. [Analysis of University of Minnesota population data] New York Times. January 15, 2012.
Laugesen M, Glied SA. Higher fees paid to US physicians drive higher spending for physician services compared to other countries. Health Aff (Millwood). 2011;30:1647-1656. Abstract
Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. September 6, 2012. September 24, 2012.
Medscape Business of Medicine © 2012 WebMD, LLC

Sunday, 15 July 2012

My silent dua

All praise is due to Allah
There is no god but He,
the Living, the Just, the Manifest
The Eternal

O Allah, You mentioned that (65:2-3);
Whosoever fears Allah, He will appoint for him a way out,
and provide for him from where he does not expect,
Allah is Sufficient for whosoever puts his trust in Him.

Verily You rules from the Throne
You are of vast blessing, O Allah
You are Great and Supreme,You are Allah;
and there is no god other than Thee; Most Merciful.

O Allah! Please grant me the one
Who will be the garment for my soul
Who will satisfy half of my deen
And in doing so make me whole

Make him righteous and on your path
In all he’ll do and say
He'll guide me gently when I stray
Reminding me often to pray

May he earn from halal sources
And spend within his means
May he seek Allah’s guidance always
To fulfill all his dreams

May he always refer to Qur’an
and the Sunnah as his moral guide
May he thank and appreciate Allah
For the woman at his side

May he be conscious of his anger
And often fast and pray
Be charitable and sensitive
In every possible way

May he honor and protect me
And guide me in this life
And please Allah! Make me worthy
to be his loving wife

Make him abundant in love and laughter
In taqwa and sincerity
In striving for the hereafter
And always trying to be better

And finally O Allah, If I have found this 'one'
Guide him constantly to be
The one who IS in my silent dua
For I seek YOU first, above him and everything all

Wednesday, 18 April 2012

We're Not Young

Oh for cryin' out loud. Suck it up and exceed your potential!

Tuesday, 17 April 2012

Vampire Hunter D: Bloodlust (2000) ~FULL MOVIE~


Anyways...I hv always had a thing for vampires stories (minus twilight pls!)