Independent writing on medicine, public health and health policy — with a Malaysian and regional perspective.
Researched from primary sources and written by Dr Muruga Vadivale,
who has been writing about medicine online since 1995.
About Kerbside Consult and how I work →
Latest13/2026 · 12 September 2026
From Nipah and West Nile to H5N1 and antimicrobial resistance — thirty years of warnings, and the lessons we keep relearning. The next pandemic may already be circulating in animals, an unusual cluster of infections, or a resistant organism spreading quietly through hospitals. The question is whether surveillance, laboratories, and health systems will recognise the warning in time.
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All articles — 2026
13/2026 · 12 September 2026
From Nipah and West Nile to H5N1 and antimicrobial resistance — thirty years of warnings, and the lessons we keep relearning. Each outbreak taught something different: about spillover, ecological surveillance, watching transmission change, healthcare amplification, system resilience, and threats that advance without an obvious starting gun. The question is not which pathogen comes next. It is whether the systems to detect and respond to it are in place when the warning arrives.
We cannot know what comes next. But after nearly thirty years of warnings, we should know what to do when it comes.
12/2026 · 11 September 2026
The patient may still see the doctor. Increasingly, the consultation begins somewhere else. Generative AI has moved from novelty to clinical adjacency faster than medicine has moved to understand it. This piece examines what AI can do well, where it fails in ways that matter, what the clinical trials actually show, and what both patients and doctors should do when the machine has already had its say.
The information revolution has become an interpretation revolution. The question is not whether AI belongs in the consulting room. It is already there. The question is where it should sit.
11/2026 · 10 September 2026
Malaysia has demonstrated through RESET that it can build high-level political machinery — a joint ministerial committee, named insurers, a live pilot, regular progress reporting — around a difficult healthcare problem. The government’s Health White Paper, passed by Parliament with bipartisan support in 2023, is a comprehensive 15-year reform blueprint for the public healthcare system. It has not received comparable machinery. This piece asks why, and what the evidence from eight sections of primary sources looks like when placed alongside that question.
67% of hospital admissions and 83% of outpatient visits go through the public system. That is the system the Health White Paper is for. That is the system this piece is about.
10/2026 · 8 September 2026
Malaysia measures hourly PM2.5 concentrations at 68 stations. It publishes a composite index. It does not publish the underlying concentration in the unit that WHO guidelines, commercial apps, and Singapore’s own system use — and the gap between those two things has a clinical cost that is measurable in hours, not days. This argument has been made from this column since 1999. The previous version of it was eventually won.
The question is whether the next step takes another decade, or whether someone finds the courage this season.
9/2026 · 7 September 2026
Malaysia’s proposed Senior Citizens Bill is delayed again — now expected in early 2027. But the delay is the least of the problem. A law that passes without funding, enforcement machinery, community detection and care infrastructure will not protect elderly Malaysians. It will offer them rights on paper. Four million people aged 60 and above, at least five ASEAN neighbours with dedicated legislation already in force, and an Act that has been on the books since 2018 and has never once been brought into force.
The law is the beginning of the answer, not the answer itself.
8/2026 · 6 September 2026
Malaysia’s new government-backed base medical insurance product has a design problem. It is described by ministers as protection for people the private market fails. It is built, in its actual terms, as a fully underwritten voluntary insurance product. A comparison of six countries across the Asia-Pacific shows that the choice Malaysia has made in MediAsas is not the only available one — and a nationwide survey of 855 specialists reveals what happens when a guarantee letter exists on paper but not at the point of need.
A promise made at the point of sale — protection, if you need it — is not the same as protection delivered at the point of need.
6 September 2026
A practical one-page guide to disputing a denied, delayed or revoked health insurance claim in Malaysia — from getting the reason in writing to filing a free dispute with FMOS. Plain, practical, and printable.
A free, independent dispute body has existed since January 2025. Most patients still do not know to use it.
A Kerbside Reflection · 5 September 2026
Thirty years of building this without a budget, an institution, or anyone asking me to — and the question that Kerbside Consult has finally made it hard to avoid asking directly.
Whether the next ten years justify the same verdict is not mine to decide.
7/2026 · 4 September 2026
GP consultation fees frozen since 1992. Hospital non-professional charges unregulated. A public alternative running short of the workforce needed to deliver it. Malaysia regulates most tightly where costs are already lowest, leaves pricing freedom where bills are largest, and is underinvesting in retaining the doctors the low-cost option depends on.
The RM80 regulatory ceiling and the RM34 consultation rate a GP actually receives are not in conflict with each other. They coexist.
A Kerbside Reflection · 3 September 2026
What thirty years of guestbook correspondence actually recorded — who was using the site, why they had come, and what they did with what they found there.
People wrote back. That seems as good a measure as any of whether it was worth doing.
6/2026 · 31 August 2026
In 1997 I wrote about the computer a doctor would need to get online, and about a law that would let doctors practise medicine down a telephone line. The computer became obsolete on schedule. The law never started. What the evidence actually says about telehealth today, what already exists scattered across six different systems nobody has joined up, and what it would take to finish what was promised twenty-nine years ago.
Malaysia rebuilt a 1997 cyber law from scratch this year. Its sibling, passed the same year to enable telemedicine, has simply never been switched on.
5/2026 · 30 August 2026
The Bill has now missed five tabling dates, the carbon tax is under review, and the standard we are measured against is not law. What the evidence now says about heat and dengue, what the government has and has not done about it, and what the profession could do that it is not doing.
The consultation on the Climate Change Bill drew submissions from lawyers, business networks and think tanks. None that I can find came from a medical body.
4/2026 · 28 August 2026
What to do about dengue: mosquito control that actually works, the warning signs that mean see a doctor, the ones that mean go to hospital now, and one common home-treatment mistake that makes bleeding worse. One screen long, and printable.
The dangerous phase isn't while the fever is high. It's the day or two after it breaks — exactly when people stop paying attention.
3/2026 · 28 August 2026
A dengue vaccine is registered, available, and being bought privately in Malaysia. The question was never whether it works. It is what a cost-benefit analysis actually assumes, who decides, and why the same regulatory meeting can be reported two entirely different ways by two professional bodies who each took what they wanted from it.
Two doses run at RM400 to RM500 in private clinics. A family that can find that much is protected this month. A family that cannot waits for an analysis whose assumptions are not published.
2/2026 · 26 August 2026
What to do about the haze. Which mask actually works and which is theatre, why closing the windows beats wearing one, who in your household is really at risk, and when to stop managing it at home. One screen long, and printable.
Only an N95 or better does anything. Fit matters more than the rating. And the bad chest arrives three days after the smoke clears.
1/2026 · 26 August 2026
The same haze, the same diplomacy, and a surveillance system that registers its own success as an absence of disease. Twenty years after I wrote HAZE-OC, the sequel writes itself — and that is rather the point.
Malaysia's ambient air quality standard turns out not to be law. The Ministry reported no rise in illness on a day nine Sarawak districts sat in the unhealthy band.
About Kerbside Consult
A kerbside consult is the oldest instrument in medicine. You catch a colleague in the corridor, describe the problem in ninety seconds, and get an honest answer without a referral letter. No fee, no formality, and — the part that matters — no reason to tell you what you want to hear.
That is what this is going to be. Medicine, public health and health policy, with a bias towards Malaysia and the region — outbreaks, climate and health, road safety, licensing and regulation, and the recurring distance between what the evidence says and what gets announced at a press conference.
Who is writing
I am Dr Muruga Vadivale. Forty years in Medical Affairs across Asia-Pacific — Servier, Aventis and Sanofi across ASEAN, India and Korea; Celgene and BMS in haematology-oncology in Seoul and Taipei; most recently building the Asia-Pacific medical function at Novavax. I co-authored Malaysia's Good Clinical Practice Guidelines in 1999 and again in 2004, and founded the SITE cardiometabolic registry, which followed more than 18,000 subjects across eight states. There is more about me here, if you want it.
How I work
Claims get checked against the primary source, not against the newspaper's account of it, and not against a review's summary of a study. Where the evidence is genuinely contested, I say so rather than picking whichever side makes the tidier argument. These pieces are researched with AI assistance. Every factual claim is then checked by me against its primary source, and the sources are linked so you can check them too. The judgements, the arguments and the errors are mine.
Every piece ends with an annotated list of sources worth your own time. That habit is thirty years old and it is not going anywhere.
I have no commercial relationship with any party mentioned in these pages unless I say so in the piece itself. None of this is medical advice, and nothing here substitutes for your own doctor or for the judgement of the person actually treating you.
Corrections and right of reply
If you find an error here, please write to me. Every correction is checked. Where one is made, it appears at the foot of the article it concerns, with the date and a plain note of what changed. Corrections are not made silently. Anyone who points out an error is credited by name unless they would rather not be.
The same applies to anyone written about here. If you are named and believe something is wrong or unfair, write to me and I will look at it promptly. Where we simply disagree, I will publish your response alongside the piece, in your own words, provided it is signed.