Thailand's Drug registration needs overhaul

Consumer advocates say the present system allows potentially harmful medications to stay on the shelves indefinitely, with no restrictions on their sale

When her young daughter had a fever, Suda (not her real name) would buy cheap medicine in a small shop in her village. With a picture of a child on its packaging, she assumed that the medicine was safe for children. One day she looked at the small print on the label, however, and saw a warning not to give the medicine to children under 18 years of age. Unfortunately there are a number of medicines registered as safe and effective on the shelves of local Thai pharmacies when in fact they may not be safe for children, and in many cases for adults either. Consumer advocates argue that warning labels are often ineffective because people don't bother to read them.

Part of the difficulty in choosing the right medicine lies in the sheer number of products on the market. As of April last year, a total of 25,026 drugs were registered with the Food and Drug Administration (FDA). Of the total, 19,462 are locally made and 5,544 are imported.

Under the Drug Law (1967), the FDA withdraws a drug formula registration only when the drug is proved to adversely affect health, or after a manufacturer stops producing a product for two years.

According to Dr Niyada Kiatying-Angsulee, director of the Social Research Institute and manager of the Drug System Monitoring and Development Programme under the Faculty of Pharmacology at Chulalongkorn University, the drug formula registration system is flawed because the registration never needs to be renewed.

''It can stay forever. Many drugs have been registered since 1983 and they remain on the market,'' she said. Prior to 1983 the law required that a drug's registration had to be renewed every five years. In 1979 there was a change in the 1967 Drug Act to abolish the drug renewal system, which went into effect in 1983.

According to FDA reports, a total of 230 drug formulas still on the market were registered in 1983. Dr Niyada said that those ''old medicines'' might not be suitable today, in part because since then there have been advancements in treating many illnesses.

Dr Niyada proposed that drug registrations should be renewed every five years as before.

''Most countries renew drug registrations every three to five years so as to pull out the unsuitable drug formulas before they cause irreversible damage,'' she said.

She added, however, that this move alone wouldn't solve the problem of dangerous or inappropriate medicines on the shelves, and urged the FDA to establish an efficient post-approval safety evaluation system to thoroughly review a product's safety and efficacy records.

''The FDA needs sufficient information to support decisions on whether to renew or not to renew medicines,'' she said.

While the authorities are not shy about approving drug formulas _ 1,241 remedies were approved in 2000 _ they are slow or reluctant to seek withdrawals of registration, even after receiving complaints or reports of significant harm to consumers. Dr Yaowaluk Amsiriampai, of the Faculty of Pharmacology of Silpakorn University, wrote in a report on drug evaluation that just 17 registered drug formulas had been withdrawn from 2002 to 2008.

Dr Niyada cited the example of one locally produced drug, Anapromine syrup, which is used as an appetite stimulant for children (see sidebar). The product was linked to abnormal sexual organ development in two patients, a four-year-old boy and a two-year-old girl. A doctor at Ramathibodi Hospital exposed the problem to warn the public.

However, rather than withdraw the syrup, the FDA required that the manufacturer list its ingredients and dispense it by prescription only.

Consumer advocate groups disagreed with this solution and strongly demanded that the FDA withdraw the formula. In June 2009 the FDA ordered a withdrawal of the registration.

This case points to another major and very real problem with the Thai system. Despite the fact that the registration has been withdrawn, the drug has remained on the market because of a lack of monitoring and enforcement by authorities. The FDA warns that 13 other withdrawn drugs _ including diet pills, pain killers and antibiotics _ probably remain on the market as long as there are supplies available.

WHAT HAZARDS AWAIT?: A typical drug store has a staggering number of drugs and medical treatments. Under the present system there is no established procedure to review their efficacy and safety records.

Dr Niyada, a member of the National Drug Committee, said: ''We can work more aggressively to protect the public.'' She praised FDA officials for working more systematically to serve the public's interests in recent years. Last year a number of drug registrations were withdrawn for safety reason, and during the past two years the FDA has ordered drug companies to pull lots, or batches, of some 30 drugs from the market because of substandard ingredients.

DANGEROUS DRUGS

Following a survey in communities in ten provinces _ Samut Prakan, Chiang Mai, Chiang Rai, Uttaradit, Khon Kaen, Yasothon, Chaiyaphum, Surat Thani, Tak and Chachoengsao _ the Rural Pharmacist Society (RPS) said it had found a large number of medicines in shops and even in hospitals that were unsafe or ineffective. The society and its network took four months to do the survey last year.

''In rural communities we can find drugs which people in big cities like Bangkok have never heard of,'' said Darin Jeungpattavadee, a pharmacist in Loei province who chairs the society. ''Actually, a large number of drugs found during the survey raise our concerns. Different areas have different problems, with varying levels of severity. Therefore, we need new approaches.'' She added that a number of registered medicines contain mixtures of ingredients that should not be taken together.

''For instance, an anti-tussive [cough suppressant] drug is mixed with a medicine for head cold symptoms. Each of them has a different therapeutic quality. The anti-tussive will ease coughs and act as an expectorant. The anti-cold medicine makes sputum condense, leading to acute coughing symptoms,'' Ms Darin said.

The group identified four medicines which it says should be pulled from the shelves immediately. ''We have a list of unsuitable drugs or medications that includes some banned from the market in at least five countries and others which are not approved for registration in some countries,'' said Ms Darin.

''There is enough medical and scientific information to support our assertion that their potential risks outweigh their claimed potential benefits.''

The four medications are an antidiarrhoeal combination, an antibiotic powder, a widely used tablet for kidney problems and common aspirin _ which the RPS says should never be given to children.

ANTIDIARRHOEAL COMBINATION: The World Health Organisation suggests using oral rehydration salts to treat diarrhoea. Antibiotics are not recommended since they have no proven efficacy for the treatment of diarrhoea. Besides, they may cause side effects and result in antibiotic resistance, which is at present an important public health problem in Thailand and around the world. However, antidiarrhoeal combinations, in both tablet and syrup forms, are easily found on pharmacy shelves and even in small community markets. The RPS says these medicines normally are comprised of four or five chemical compounds and each of them may cause side effects such as fever, rash and nausea, as well as hinder the absorption of important nutrients. One of the chemical compounds commonly found in these medications is furazolidone, which has been shown to cause cancer and induce abortion in mice.

AMOXYCILLIN POWDER: The antibiotic powder is promoted for the treatment of infections of the respiratory tract, stomach, bladder, intestine and kidney. The RPS objects to placing the antibiotic in the bag, as it says this makes it difficult to manage. For example, the label states that a child up to two years old should be given only half of the amount in the bag. But in practice few people weigh or meter out the exact amount of powder as recommended. Consequently, there is a possibility that the patients do not receive a proper dose of medicine, leading to overdose or treatment failure.

Another problem, said Ms Darin, is that the powder in the paper bag will not stay stable and will probably decompose before its expiration date. What's more, a number of registered amoxycillin powders also contain ''inappropriate ingredients''.

A small bag containing amoxycillin in pow der form with the trade name ''Ka Ou Lin'' and two parrots on a cup as its trademark is a very old and recognisable medication in Thailand. In fact the manufacturer has discontinued the product, but according to the RPS surplus stocks of the product can still be found in many shops in rural Thailand.

As noted above, according to regulations, if the manufacturer stops producing a medication its registration will automatically expire. Ms Darin said this is an ineffective procedure as it allows for abuse of the system.

''It would be better if the authorities withdrew the formula to make sure that it will not resurface under a different brand name,'' she said.

KIDNEY TABLETS: The RPS says that because of unclear efficacy and a high risk of overdose, these tablets should be withdrawn from the market. The drug is claimed to improve kidney function, reduce backaches and improve urination. The best selling brands in Thailand are Cystosin, Marwitt and Zoro.

The survey team talked to 43 persons who regularly take the pills and 29 shop owners who sell them. Most of the users were working people who said they took the medication once a day for back pain and trouble urinating. Many reported side effects including nausea, vomiting and blue urine.

ASPIRIN FOR CHILDREN: The RPS says children should never take aspirin. Studies have linked the use of aspirin or aspirin-containing medications to development of Reye's syndrome _ a disease which most often strikes children or teenagers, and sometimes adults as well, during or soon after a viral disease. It affects all body organs, the liver and brain most seriously. The main symptoms include persistent vomiting, lethargy or sleepiness. In the later stages those stricken may exhibit irrational behaviour, confusion, severe weakness and loss of consciousness.

In 2007, the FDA issued a regulation for aspirin-containing medications to print warnings or recommendations on package labels. The warnings prohibit the use of the medication for children under 18 unless it is prescribed by a doctor. They also prohibit use by any persons who are suffering or recently recovered from a viral disease such as influenza, dengue fever or chicken pox. Treatment for body pains and aches is prohibited, as is use by pregnant and breast-feeding women. Moreover, the FDA warns against long-term use because of the risk of bleeding in the stomach, asthma and liver and kidney damage.

The RPS and its network are upset with the authorities' solutions, as they feel safety information and recommendations on the label won't solve the problem.

''The authorities cannot rely on labelling precautions to resolve the safety concerns. People who use aspirin are often simple workers or farmers and their children. They do not read the recommendations. They understand that the drug can be used to treat children with fever because pictures of children are displayed on the packaging,'' said Ms Darin.

''Besides, it is difficult to read the companies' tiny printed warnings and recommendations.''

In 2008, the Ministry of Public Health issued another regulation saying that aspirin can be used for juvenile rheumatoid arthritis and for Kawasaki disease. Ms Darin said that those who have these illnesses need to be treated by doctors who will prescribe the appropriate medicines.

The RPS submitted its proposal to withdraw the four medications to the Ministry of Public Health last November. ''We asked the authorities to take three months to review the proposal and then to withdraw the four drugs to protect the people,'' said Ms Darin.

A PROLONGED WITHDRAWAL

In 1989, the Ministry of Public Health ordered the withdrawal of two medicine formulas for safety reason. One was a combination of the anabolic steroid methandienone, vitamins and/or cyproheptadine, an antihistamine which is sometimes used to promote weight gains. The other formula contained the anabolic steroid as a significant ingredient and was used as an appetite stimulant for children.

In 1990, the ministry revised its earlier order, saying that it only applied to formulas used for children. A formula administered for adult sufferers of diabetes or bone disease was exempted.

In 1993, a medicine formula combining methandienone and cyproheptadine in syrup form under the brand name Anapromine was registered with the FDA. However, it was classified as a prescription drug.

In 1999, a doctor at Ramathibodi Hospital and faculty member of the hospital's medical school, Assistant Professor Patt Mahachoklertwattana, gave a report to the FDA of a two-year-old girl suffering from abnormal sexual organ development after she had taken Anapromine syrup. He suggested the formula's registration should be withdrawn. However, the FDA insisted that since it was sold only by prescription it was already adequately controlled.

In December, 2007, Prof Patt reported another case, this time of a four-year-old boy suffering the same symptoms after he had taken Anapromine syrup.
To warn the public he decided to call a press conference in which the child's mother said that the syrup had been a popular appetite stimulant for children for a long time.

Again, the FDA insisted that the syrup was regulated as a prescription drug and therefore would not be approved for children.

In January, 2008, consumer advocate groups submitted a letter demanding the withdrawal of the formula after it was discovered that despite the FDA prohibition it was being sold over-the-counter and children were continuing to use it.

In May, 2008, the National Drug Committee agreed that the FDA should withdraw the medicine formula. However, it took a year, until June, 2009, for the FDA to issue an announcement to withdraw the drug formula. Besides Anapromine, two other medicines use the formula _ Cetabon tablets and Azolol plus.

After the announcement was issued it took another two months to publish the order in the Royal Gazette.

About the author

Writer: Tunya Sukpanich

Position: Reporter

Ban Mankong: Slum solution or a fiasco?

Secure housing schemes were supposed to alleviate the problems of slums, but are they working?

In the world of low-income housing, the concept of Ban Mankong (Secure Housing Scheme) in Thailand is understood to be a solution to the slum problem. Under this concept, security of land tenure is delivered to the dwellers and a lot of assistance programmes are undertaken.

DAILY GRIND: A woman stands in the doorway of her home as she cooks breakfast in a slum adjacent to a railway track in Bangkok.

There is one Ban Mankong slum located along the banks of an old irrigation canal that has received many awards and seems to have become the prototype for dealing with this type of problem. However, there is some doubt as to whether it is a genuine success or simply a case of propaganda.

There are a number of reasons that support this view:

The slum does not really demonstrate a general solution to slum problems; it can be seen to make neither efficient nor effective use of public funds;

the development that has occurred resulted only through heavy investment of public funds;

these public funds have been spent only on certain community groups and this has resulted in disparity between peoples.

INEFFICIENT USE OF LAND: This land, located within the city proper, comprises approximately 16,000 square metres of land and contains around 250 housing units. For a site of this size and location, it would normally be expected to have been developed at residential densities which would allow the provision of around 1,600 apartment units; this form of development would have provided substantial benefits in housing low-income groups in the community.

However the land is exclusively occupied by a group of squatters who have illegally occupied public land for more than 50 years without providing any payment or compensation in return for their occupation.

This is 6.4 times the existing density and could provide housing for some 1,350 households. Even if these squatters were to be allocated two units each as some sort of privilege, approximately 1,100 less-privileged households could still be housed on the site. It can be seen that the utilisation of the land is at a much lower level than should be accepted in cities such as Bangkok.

POOR RETURN TO THE PUBLIC: If the potential 1,350 apartment units were built in order to rent them to other low-income groups at 2,000 baht per month, the revenue produced would be 32.4 million baht per year. Instead, the public budget has been used for many development projects for this privileged group of 250 households.

In addition, each household is also subsidised at 80,000 baht per year from public funds. Altogether, this represents a budget allocation of some 20 million baht. Yet, each household is eligible to get a loan of some 100,000 baht for housing construction at a very generous rate of interest.

THE 'PRIVILEGED POOR': If this piece of land could be developed for some alternative use, the value could be 12,500 baht per square metre. The total value of the land could have been 200 million baht. If it could be leased at a return of 4% per year, the annual income would be eight million baht.

The government could then spend this amount of money for the benefit of the public at large instead of supporting the living conditions of a relatively small group of slum dwellers by using the official budget supported from the taxes of fellow countrymen.

In this model slum the total value of assets being used by each slum draw is significant; each household occupies a site with a potential land cost of 240,000 baht, builds a new house at 200,000 baht, and roughly receives development funds of some 60,000 baht. This represents a total of 500,000 baht per household, which amounts to 125 million baht for all of the 250 privileged slum households.

UNREAL SAVINGS: It has been mentioned that one success factor demonstrated by this project is the development of a savings programme in the form of a saving co-operative in the community. This seems to be promoting the idea that success has not come from the injection of mainly public funded resources from outside the community.

In looking at this issue in detail, it is noted that the savings is five baht per day or 1,825 baht per year.

At this rate of savings, 22 years would be needed in order to save enough to be able to purchase economical home furnishings at a cost of 40,000 baht. However, in fact, the squatters save for only a very short period of time prior to achieving eligibility to borrow the money.

This reinforces the view that the emergence and development of this project has depended largely upon a huge injection of resources from outside the community, not from the savings of the residents.

THE REPEAT OF MISTAKES: There is a conventional belief that poor people have poor land tenure; therefore, there is a view that they should be provided land without considering whether or not they can afford the true cost. In the case of non-slum households, when they want to buy a house, the budget constraints require them to purchase a small condominium unit or a small low-rise townhouse far away from the city centre, and that results in their having to sacrifice a lot of time to commute to work. The security of property tenure available for the poor should be re-examined in view of the likelihood of producing disparity among people.

In a particular slum in 1996, only 16% of the households were earning below the poverty line. Some 23% of them would have been able to afford to purchase a house in the open market. It is very likely that this situation has improved up to the present. Therefore, there are some well-to-do households that do not even like the minimum standard housing provided because they can afford something better.

There are also some exceptionally poor households that cannot afford even a very highly subsidised housing unit. These households are likely to sell their right of stay and squat somewhere else. The provision of prototype tenure for all households without considering these differences in economic standing is thus inappropriate.

For more than 20 years, there have been a number of land sharing projects that have been showcases of success. However, they are rarely mentioned today. Many of the households did not want to pay their housing loans. Arrears accumulated to such an extent that the authorities decided to write off their debts, simply giving them the land. In another community where the land lease was only 33 baht per month, many occupants are still in arrears. They believed that the government should give the land to them for free.

UNTOUCHABLE? Sometimes, when authorities deal with the so-called poor, they seem to regard them as being untouchable. Realistically, slums in the city should all be rebuilt in order to pave the way for rejuvenated and intensified land use. If land is efficiently and effectively used in the city, sporadic or haphazard growth would be minimised. Infrastructure would not need to be expanded endlessly at a very high cost to the public. Pragmatically it would be a sound policy for most low-rise inner city slums to be demolished and redeveloped for high-rise dwelling units. In this way the land could be used to accommodate more people or could be reallocated for commercial premises for planned urban development.

However, in an anarchist environment, it seems that any action that might disturb the poor is anathema. In Thailand, it is very difficult to relocate slums, in contrast to Singapore, Malaysia, Vietnam and other neighbouring countries; however, people should understand that things have to change over time. A more sensible treatment of slum redevelopment should be accepted because no planner can foresee or plan city development without some rearrangement of the use of the land in the city.

There is a good example that demonstrates the more effective use of land. The present location of the Ministry of Foreign Affairs, Mahidol University, and Rama Hospital in the Phaya Thai District of Bangkok was formerly the site of a large slum of around 1,500 households.

It was the largest slum in Bangkok at that time. The government relocated the people and paved the way for better land use for the public good. If that slum had not been removed and the squatters were still living there, would it have been better for anyone? This case shows that substantial benefits can be derived from the redevelopment of slums.

In conclusion, any successes of the Ban Mankong scheme are exceptions, rather than the norm. And to build on the number of successes might create a perceived disparity among the poor, both inside and outside the slums.

Providing security of tenure for slum-dwellers where land is scare, and too expensive for others to afford, should be reconsidered. In fact, slums can be relocated to provide better use of land for the slum-dwellers themselves, for other members of other poor communities and for other people in the city without creating disparity.

---

Dr Sopon Pornchokchai is the president of the Thai Appraisal Foundation. He conducted a survey of slums in Bangkok in 1984, and another nationwide in 1996. He has been a consultant to different organisations of the UN in this field.

About the author

Writer: Sopon Pornchokchai

Position: Writer

Allah's other cheek

Attacks on churches have stoked the flames of religious intolerance

As evening approaches, life in the Malaysian capital blossoms and bustles on the streets in and around Bukit Bintang. Here the catch-phrase that sold a country to the world - "Malaysia Truly Asia" - has found a home.

Malays, Chinese and Indians mix easily with tourists and expatriates from Africa, the Middle East and the West. Muslims mingle with Christians. Buddhists, Hindus and Sikhs are plentiful.

Everybody eats at the same table.

Among them is Father Lawrence Andrew, an urbane man of the cloth who divides his time between journalism and tending the spiritual needs of his flock, from his office behind St Anthony's Catholic Church.

He is rarely flustered and holds the same smile he wore when meeting Pope John Paul II. A photo hangs on the wall behind his desk.

However, Father Andrew's patience, along with the vast majority of Malaysians - regardless of creed - has been sorely tested in recent days by a spate of fire-bombings that erupted amid government efforts to ban non-Muslims from using the word Allah.

"It is unfortunate, it is irresponsible and there is no respect for the rights and property of others," he says.

"They should approach the proper channels and not flex their muscles on the people. It is becoming the law of the jungle right now and they should stop this."

As editor of the weekly Catholic newspaper The Herald, Father Andrew has led the legal fight against a three-year government ban on the use of the word Allah for God by non-Muslims.

The use of three other words - Kaabah for Islam's holiest shrine in Mecca, Solat meaning prayer and Baitullah, or House of God - were also banned under the literary laws.

The ban was imposed on The Herald when its annual publishing licence was renewed amid claims use of the words could lead to confusion and conversions among members of the Islamic faith.

Court challenges followed and Father Andrew was confident. The ban, he says, defeats logic.

Then on New Year's Eve the High Court ruled in his favour and overturned the law.

The vast majority of people were delighted, the Home Ministry was irritated, and hard line Islamic elements outraged.

Nine Christian Churches and a school have since been fire-bombed or vandalised, a Sikh temple - where the word Allah is also used - was stoned, law offices for the Catholic Church have been burgled and ransacked and the High Court has suspended its verdict pending an appeal.

Father Andrew says the word Allah is part and parcel of religious teachings within Christian churches around the world. It was introduced to the Malay Peninsula and Borneo just over 370 years ago by Arabic traders when no other word for God existed there.

This held particular ramifications for Malay-speaking indigenous tribes living in Sabah and Sarawak on Borneo, who are the main readers of The Herald's Malay-language edition.

Catholic officials say "Allah" is still the only word they know for God.

"We have been using this word for centuries. It is not a new word. It is not something we have just thought about. So that's why we say that it is not so much a question of language here," he said, while producing a Dutch-Malay-Latin dictionary published in 1631 using the word Allah for God.

"It is also a cultural heritage of our Christian people that has been challenged by prohibiting us from using the word Allah," he said. "There is no precedent about us trying to manipulate or cheat people."

He says fundamentalists within and close to government who claim the word could be used by Christians to induce conversions are wrong.

"I do not see how we are a force against the government. No, we are collaborating with the government, but there are some elements in the government and some zealots outside who think we are trying to convert. Certainly not."

Father Andrew says it is against the law for any religion to interfere with the internal affairs of another, However, Muslim groups consistently and actively attempt to convert believers of other faiths.

Such behaviour is also questionable under the constitution.

"There have been Malays who came to me and said: 'Father I want to become a Christian - baptise me.' And my answer to them is: 'No way, we will not baptise you. You know the law of the country. We cannot convert you.'

"Now this law of the country has been in existence for 50 years, and it is part of the constitution and we wouldn't want to go against this constitution."

About 60% of Malaysia's 28 million people are Malay Muslims, while the rest are ethnic Chinese, Indians and indigenous tribes. The minorities follow Christianity, Hinduism and other religions.

Malaysia has kept racial tensions under control since race riots hit the country in the late 1960s.

However, in the past few years, minorities have increasingly complained of government discrimination and that their constitutional right to practise religion freely has come under threat. They argue that the nation's Sharia court, which rules on family matters for Muslims, is unfair to them.

Disputes in recent years have involved the demolition of Hindu temples illegally built on state-owned land and the seizure of Malay-language bibles. The government denies any discrimination.

The first-floor office in the three-storey Metro Tabernacle Church was worst hit, destroyed in a blaze a little after midnight. There were no injuries in any of the attacks.

Police have urged Muslims not to take part in planned street demonstrations. Protests by Christians in Sabah were called off because of fears of a government crackdown and claims that police were being dispatched in force.

Deputy Inspector-General of Police Tan Sri Ismail Omar said the images of several men who set fire to the Metro Tabernacle Church at Taman Melewati were captured on a close-circuit TV camera.

"We now have leads to the case. We have the physical attributes of the suspects and hope it can help us trace them, although more accurate information is needed," he said, adding police believed the men were acting on their own accord and did not represent any particular group.

However, he also complained that witnesses were not coming forward but were reporting their accounts on blogs and social networking websites like Facebook.

Ronnie Klassen, a spokesman for opposition leader Anwar Ibrahim in Sabah, was an organiser of the planned protest. He said there were genuine fears for the safety of the demonstrators.

"We decided to call it off because of the two to three hundred people that were there, there were many elderly people around and we felt that we didn't want any one of the elderly people to be injured or anything of that sort."

Meanwhile Tan Kong Beng, the Executive Secretary of the Christian Federation of Malaysia, added that Malaysian Christians were expecting change in Malaysia, but on a positive note.

"They want to see a better Malaysia for their children and that means better relationships among the various religions, specifically with Islam," he said.

Father Andrew says Muslim elements within the government were trying to bolster their influence by attempting to assert Islam over the diverse ethnic and religious mix that makes up Malaysia.

"We can call them Zealots, but I think we have to take a step back."

The United Malay National Organisation (UMNO), which has controlled political life in Malaysia since independence, has suffered a reduced majority in parliament and waning public support.

Some observers have suggested elements within the party were out to appease hard line Islamic demands in the northern states of Peninsula Malaysia in return for votes at the next election and also by increasingly linking the Malay race with Islam.

Father Andrew said such issues never existed before 1980, but since then a political battle had emerged between UMNO and the pan-Islamic party Parti Islam Se-Malaysia (PAS), with each trying to trump the other's Islamic credentials. That political battle, he said, "was there to establish that someone is more Malay, more Muslim, than the other".

"In order to strengthen your own identity and establish your own niche and stake in this place you have to create a kind of uniqueness about you, and this uniqueness can only come about if we can now say it is Islamic to the race - we are Malays because we are Muslim and we are a kind of pure breed."

This was the attitude driving the attacks and the assertion of a harsher brand of Islam.

Across Malaysia non-Muslims are being urged to turn the other cheek, not to retaliate in the wake of the fire bombings, and they are obliging.

However, whether Malaysia's cherished and well crafted image of a secular state - where the multitudes of different race and creed can live and play under a truly Asian umbrella - can survive, remains to be seen.

About the author

Writer: Luke Hunt

Position: Writer