Tembeling 2.0

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  • Why Vaping Is More Dangerous Than Cigarette Smoking And Why We Must Act Now

    Introduction

    Vaping was once promoted as a safer alternative to smoking. However, emerging evidence indicates that electronic cigarettes (e-cigarettes) may pose equal or even greater health risks compared to traditional cigarettes, particularly among youth. Unlike conventional tobacco products, vape liquids often contain a complex mix of chemicals, heavy metals, and flavouring agents that can bypass detection and regulation. Their sleek designs, enticing flavours, and the misconception of being “less harmful” have made vapes a gateway to nicotine addiction for a new generation.

    In Malaysia, the removal of nicotine from the Poisons Act in 2021 created a legal loophole that allowed unregulated vape products to proliferate. Although the Control of Smoking Products for Public Health Act 2024 was gazetted to address this issue, enforcement remains challenging. The health costs of inaction are escalating and may soon surpass the damages caused by traditional cigarettes.

    What Makes Vaping More Dangerous Than Cigarettes

    1. Rapid Uptake Among Youth and Stronger Addiction

    Vapes appeal to adolescents with thousands of flavours, sleek devices, and a strong presence on social media platforms. Many vape products contain higher nicotine concentrations than traditional cigarettes, delivered via nicotine salts that are more readily absorbed and less irritating, enabling deeper and longer inhalation (Benowitz & Fraiman, 2022).

    In Malaysia, data from the National Health and Morbidity Survey (NHMS) 2022 indicated that 14.9% of adolescents aged 13–17 were current e-cigarette users, with a higher prevalence among males (23.3%) compared to females (6.2%) (Institute for Public Health, 2022). Alarmingly, nearly half of these users initiated vaping before the age of 14.

    2. Exposure to Unregulated Chemicals and Aerosolised Toxins

    While cigarettes have known contents, vapes deliver poorly characterised chemical cocktails. Scientific studies have identified harmful substances in vape aerosols, including formaldehyde, acrolein, lead, cadmium, and nickel. These compounds can cause DNA damage, inflammation, and systemic toxicity (Olmedo et al., 2018).

    Additionally, some compounds in vape aerosols, such as vitamin E acetate and benzyl alcohol, have no history of safe inhalation use and have been implicated in severe lung injuries.

    3. Acute Lung Injuries Not Observed in Cigarette Smokers

    Traditional cigarette smoking is associated with chronic lung diseases developing over the years. In contrast, vaping has been linked to acute, life-threatening lung injuries, such as E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), occurring after weeks or months of use. Patients suffer respiratory failure requiring ventilation, and some have died (Chand et al., 2023). Such rapid-onset pulmonary toxicity is virtually unheard of with cigarette smoking.

    4. Systemic Health Effects Beyond the Respiratory System

    Vaping has demonstrated harmful effects across multiple organ systems, including the gastrointestinal tract, brain, oral cavity, kidneys, and reproductive system. Studies indicate that vaping alters brain structure and impairs memory, attention, and mood, especially in adolescents (Lopez-Ojeda & Hurley, 2024). Animal models have shown that vaping disrupts intestinal barriers and triggers inflammation (Sharma et al., 2022).

    5. Increased Risk of Smoking Initiation and Dual Use

    Rather than replacing cigarettes, vapes are creating a new generation of dual users, individuals who smoke and vape. Adolescents who vape are more than three times as likely to start smoking cigarettes (Soneji et al., 2017). This trend undermines the potential harm reduction benefits of vaping and perpetuates nicotine addiction.

    6. Unproven Efficacy as a Smoking Cessation Tool

    While some trials suggest that nicotine-containing e-cigarettes may aid smoking cessation, real-world studies show mixed results. A Cochrane review noted low certainty of evidence for sustained cessation and highlighted a high risk of relapse and dual use (Hartmann-Boyce et al., 2022). Most adult vapers do not quit smoking; instead, they continue using both products.

    7. Environmental and Secondhand Exposure Risks

    E-cigarette waste, including cartridges, pods, and lithium batteries, contributes to environmental pollution. Aerosol residues accumulate on indoor surfaces, exposing non-users, especially children and pregnant women, to passive vaping. The World Health Organisation has declared secondhand exposure to e-cigarette aerosol unsafe (Jankowski et al., 2019).

    Conclusion

    Scientific evidence confirms that vaping poses serious health risks across the respiratory, cardiovascular, neurological, and gastrointestinal systems. Youth are disproportionately affected, and the claimed benefits of vaping, especially for smoking cessation, are not supported by strong data. Enforcement difficulties undermine regulatory measures, and the mounting health and environmental consequences are a concern. A comprehensive ban on vape products is a necessary and urgent public health action.

    References
    • Benowitz, N. L., & Fraiman, J. B. (2022). Clinical pharmacology of electronic nicotine delivery systems (ENDS): Implications for benefits and risks in the promotion of smoking cessation. Journal of Clinical Pharmacology, 62(1), 1–14. https://doi.org/10.1002/jcph.1982
    • Chand, H. S., Muthumalage, T., Maziak, W., & Rahman, I. (2023). Pulmonary toxicity and the pathophysiology of electronic cigarette, or vaping product, use associated lung injury. Annals of the American Thoracic Society, 20(2), 177–185. https://doi.org/10.1513/AnnalsATS.202209-796ST
    • Hartmann-Boyce, J., McRobbie, H., Lindson, N., Bullen, C., Begh, R., Theodoulou, A., Notley, C., Rigotti, N. A., Turner, T., Butler, A. R., & Hajek, P. (2022). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, (11). https://doi.org/10.1002/14651858.CD010216.pub7
    • Institute for Public Health. (2022). National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey Highlights. https://iku.gov.my/images/nhms-2022/Report_Malaysia_nhms_ahs_2022.pdf
    • Jankowski, M., Brożek, G., Lawson, J., Skoczyński, S., & Zejda, J. E. (2019). E-cigarettes are more addictive than traditional cigarettes—A study in highly educated young people. International Journal of Environmental Research and Public Health, 16(13), 2279. https://doi.org/10.3390/ijerph16132279
    • Lopez-Ojeda, W., & Hurley, R. A. (2024). Vaping and the brain: Effects of electronic cigarettes and e-liquid substances. The Journal of Neuropsychiatry and Clinical Neurosciences, 36(1), A41–A45. https://doi.org/10.1176/appi.neuropsych.20230184
    • Olmedo, P., Goessler, W., Tanda, S., Grau-Perez, M., Jarmul, S., Aherrera, A., Chen, R., Hilpert, M., Cohen, J. E., Navas-Acien, A., & Rule, A. M. (2018). Metal concentrations in e-cigarette liquid and aerosol samples: The contribution of metallic coils. Environmental Health Perspectives, 126(2), 027010. https://doi.org/10.1289/EHP2175
    • Sharma, A., Lee, J. S., & Dela Cruz, C. S. (2022). E-cigarettes compromise the gut barrier and trigger inflammation. iScience, 25(2), 103818. https://doi.org/10.1016/j.isci.2021.103818
    • Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., Yang, J., Primack, B. A., Andrews, J. A., Miech, R. A., Spindle, T. R., Dick, D. M., Eissenberg, T., Hornik, R. C., Dang, R., & Sargent, J. D. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics, 171(8), 788–797. https://doi.org/10.1001/jamapediatrics.2017.1488

  • Separating Prescriptions and Medicines: Can It Reduce Healthcare Costs?

    Healthcare costs in Malaysia are rising, and one of the main reasons is the high price of medicines. A policy that is often discussed as a possible solution is dispensing separation (DS). This means doctors will only diagnose and prescribe medicines, while pharmacists will be the ones to supply the medicines.

    Right now in Malaysia, especially in private clinics, doctors can still give medicines directly to patients after a consultation. But many believe this system can lead to doctors prescribing more than necessary, as they also profit from selling medicines. In many developed countries, DS has already been in place for years to make healthcare more transparent and safe for patients.

    What Happened in Korea and Taiwan?

    South Korea introduced DS in the year 2000 to reduce overprescribing and the rising cost of medicines. After the policy was introduced, the cost of medicines per visit went down. However, other charges such as consultation fees and dispensing costs increased. In the end, the total cost of healthcare for patients did not go down.

    Taiwan started DS around 1997. Studies showed that the number of medicines prescribed and the cost per visit went down, especially in clinics that did not have their own pharmacy. But again, the total cost of healthcare remained mostly the same. These cases show that while DS can reduce the cost of medicines, it does not automatically reduce the total cost of care unless other changes are made.

    What About Malaysia?

    If Malaysia wants to introduce DS, there are some important points to consider. Right now, many patients only pay one fee at private clinics. This includes both the consultation and the medicine. With DS, patients may have to pay twice – once to see the doctor and again to get their medicine at a pharmacy. Without price control or proper insurance coverage, this can make treatment more expensive for patients.

    Small clinics, especially in rural areas, depend on income from selling medicines. If DS is introduced without financial support, some clinics may not survive. This will make it harder for people in remote areas to access healthcare.

    Another issue is that some pharmacies now offer health screening and even give medicines without proper prescriptions. If this continues without control, it can lead to wrong treatments and higher long-term costs due to complications. So, there must be stronger enforcement to ensure only qualified doctors make medical diagnoses and that more medicines can only be given with a proper prescription.

    A Policy Made in Desperation?

    There is growing concern that the push for DS may be driven less by long-term healthcare planning and more by political pressure. When the cost of living goes up, people expect the government to act. In such times, introducing a policy like DS may be seen as a quick way to show that something is being done to help reduce costs, even if the real effect on total healthcare spending is small. While the intention may be good, hasty implementation without a full understanding of the consequences can make things worse.

    What Can Be Done?

    DS is not the only way to control healthcare costs, but it can help if introduced correctly. It must come with other changes such as:
    • Clear and fair consultation fees,
    • Strong rules to ensure only doctors can diagnose,
    • A longer list of prescription-only medicines,
    • Better healthcare financing, like insurance or subsidies,
    • And more pharmacies in both cities and rural areas.

    Conclusion

    Separating prescriptions and medicine supply is not an easy step, but it is worth thinking about for a better, safer, and fairer healthcare system. We can learn from countries like Korea and Taiwan, but we must adjust the plan to fit our local needs. If done carefully and supported by proper policies, DS can bring long-term benefits for patients and help improve the whole healthcare system in Malaysia. But it must be done for the right reasons, not just as a quick response to public pressure.

  • The Evolution of Research on Vape

    The increasing prevalence of vaping, particularly among adolescents and young adults, has sparked significant research interest in its potential health implications, especially regarding mental health and addiction. This synthesis aims to chronologically highlight the progression of research on the dangers of vaping by organizing studies according to emerging questions and findings.

    In early studies, concerns were primarily centered on nicotine dependence and the health risks associated with e-cigarettes. (Foulds et al., 2014) conducted a foundational study emphasizing the need for systematic data collection to understand e-cigarette use patterns and their health impacts. This study initiated a series of research questions related to user characteristics and product safety, culminating in a growing recognition of the unique health risks posed by e-cigarettes, especially among young populations (Foulds et al., 2014).

    Midway through the 2010s, findings increasingly linked vaping with psychological disorders. (Becker & Rice, 2021) highlighted how vaping among adolescents correlates with mental health issues, suggesting that physical and behavioral health risks emerged alongside the rising tide of e-cigarette popularity (Becker & Rice, 2021). Furthermore, (Javed et al., 2022) underscored the connection between vaping culture and adverse mental health outcomes, specifically noting the appeal of flavored e-cigarettes to school-aged youths (Javed et al., 2022).

    This period raised critical questions regarding whether e-cigarette use functioned as both a gateway to traditional smoking and a contributor to existing mental health struggles.

    As research continued to evolve, the impact of vaping on both mental health and substance use behaviors became clearer. Studies like those by (Morean et al., 2015; and Becker et al., 2020) explored how e-cigarettes were used by high school students for both nicotine and cannabis, raising alarms over polysubstance use and its potential to exacerbate cognitive deficits and other mental health issues (Morean et al., 2015; Becker et al., 2020). The growth of such usage patterns provoked inquiries regarding the adequacy of current health policies and intervention strategies aimed at youth tobacco control.

    By 2020 and beyond, researchers began to focus on dual vaping behaviors, assessing the interplay between nicotine and cannabis use among adolescents. (Lanza et al., 2020) reported that the prevalence of dual-use further complicated health outcomes, attributing risks such as cognitive impairment and increased substance dependence to this behavior (Lanza et al., 2020). This segment of research established critical precursors to understanding the holistic ramifications of vaping on adolescent health, emphasizing the need for nuanced public health messaging.

    Current research emphasizes the role of psychological factors as significant predictors of vaping uptake and continuation. Studies by (Jongenelis et al., 2024; and Oliver et al., 2023) have demonstrated that perceptions of harm and existing mental health symptoms significantly influence both vaping intentions and behaviors among youths (Jongenelis et al., 2024; Oliver et al., 2023).

    These findings have led to increased urgency in addressing vaping from a preventive health perspective, raising questions regarding the effectiveness of educational interventions and health promotion strategies within school systems (Thomas et al., 2024).

    The evolution of research on vaping highlights a complex interplay between substance use, mental health, and public health implications. As vaping continues to rise among youth, ongoing studies will need to address the changing landscape of both products and user behaviors, ensuring that health initiatives effectively mitigate the risks associated with e-cigarette use. This synthesis underscores the dangers of vaping as evidenced by existing literature and encourages further exploration into tailored interventions that address the unique challenges posed by this rapidly evolving public health issue.

    References

    Becker, T. and Rice, T. (2021). Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations. European Journal of Pediatrics, 181(2), 453-462. https://doi.org/10.1007/s00431-021-04220-x

    Becker, T., Arnold, M., Ro, V., Martin, L., & Rice, T. (2020). Systematic review of electronic cigarette use (vaping) and mental health comorbidity among adolescents and young adults. Nicotine & Tobacco Research, 23(3), 415-425. https://doi.org/10.1093/ntr/ntaa171

    Foulds, J., Veldheer, S., Yingst, J., Hrabovsky, S., Wilson, S., Nichols, T., … & Eissenberg, T. (2014). Development of a questionnaire for assessing dependence on electronic cigarettes among a large sample of ex-smoking e-cigarette users. Nicotine & Tobacco Research, 17(2), 186-192. https://doi.org/10.1093/ntr/ntu204

    Javed, S., Usmani, S., Sarfraz, Z., Sarfraz, A., Hanif, A., Firoz, A., … & Ahmed, S. (2022). A scoping review of vaping, e-cigarettes and mental health impact: depression and suicidality. Journal of Community Hospital Internal Medicine Perspectives, 12(3), 33-39. https://doi.org/10.55729/2000-9666.1053

    Jongenelis, M., Gill, M., Lawrence, N., & Wakefield, C. (2024). Quitting intentions and behaviours among young australian e‐cigarette users. Addiction, 119(9), 1608-1615. https://doi.org/10.1111/add.16530

    Lanza, H., Barrington‐Trimis, J., McConnell, R., Cho, J., Braymiller, J., Krueger, E., … & Leventhal, A. (2020). Trajectories of nicotine and cannabis vaping and polyuse from adolescence to young adulthood. Jama Network Open, 3(10), e2019181. https://doi.org/10.1001/jamanetworkopen.2020.19181

    Morean, M., Kong, G., Camenga, D., Cavallo, D., & Krishnan‐Sarin, S. (2015). High school students’ use of electronic cigarettes to vaporize cannabis. Pediatrics, 136(4), 611-616. https://doi.org/10.1542/peds.2015-1727

    Oliver, A., Kossowsky, J., Minegishi, M., Levy, S., & Weitzman, E. (2023). The association of vaping with social/emotional health and attitudes toward covid-19 mitigation measures in adolescent and young adult cohorts during the covid-19 pandemic. Substance Abuse, 44(1-2), 73-85. https://doi.org/10.1177/08897077231165860

    Thomas, L., McCausland, K., Leaversuch, F., Freeman, B., Wolf, K., Leaver, T., … & Jancey, J. (2024). The school community’s role in addressing vaping: findings from qualitative research to inform pedagogy, practice and policy. Health Promotion Journal of Australia, 36(1). https://doi.org/10.1002/hpja.895

  • Sang Tabib Yang Setia

    Wahai anak muda yang berjiwa mulia,
    Jadilah engkau tabib yang setia,
    Bukan kerana mahkota dunia,
    Bukan kerana kemewahan yang fana.

    Langkahkan kaki di jalan derita,
    Jangan mengharap hamparan permata,
    Berjalanlah dalam sabar dan duka,
    Kerana syurga itu mahal harganya.

    Tidur malam pendek dan resah,
    Bangkit siang penuh lelah,
    Demi satu senyuman yang pulih megah,
    Demi satu nyawa yang kembali cerah.

    Jangan kau dambakan sanjungan manusia,
    Kerana ia umpama buih di lautan dosa,
    Carilah redha Tuhan Yang Esa,
    Itulah nikmat yang tiada binasa.

    Bersihkanlah niat di lubuk dada,
    Berbaktilah semata-mata kerana Dia,
    Tanganmu menyeka derita dunia,
    Hatimu menadah rahmat yang mulia.

    Sembuhkanlah luka dengan penuh kasih,
    Bisikkanlah doa dalam setiap langkah,
    Moga setiap denyut yang kau pulihkan,
    Menjadi saksi di alam yang kekal dan indah.

    Wahai tabib, insan pilihan,
    Engkau bukan sekadar perawat badan,
    Engkau penyambung harapan insan,
    Engkau suluh dalam gelap perjalanan.

    Jadilah engkau sebaik-baik hamba,
    Digunakan Allah di bumi yang fana,
    Moga setiap langkah, setiap bicara,
    Menjadi pahala yang tiada tara.

  • Training Critical Thinking and Logical Thinking in the Age of AI for Biostatistics and Epidemiology

    The arrival of generative AI tools like ChatGPT is changing the way we teach and practise biostatistics and epidemiology. Tasks that once took hours, like coding analyses or searching for information, can now be completed within minutes by simply asking the right questions. This development brings many opportunities, but it also brings new challenges. One of the biggest risks is that students may rely too much on AI without properly questioning what it produces.

    In this new environment, our responsibility as educators must shift. It is no longer enough to teach students how to use AI. We must now teach them how to think critically about AI outputs. We must train them to question, verify and improve what AI generates, not simply accept it as correct.

    Why critical thinking is important

    AI produces answers that often sound very convincing. However, sounding convincing is not the same as being right. AI tools are trained to predict the most likely words and patterns based on large amounts of data. They do not understand the meaning behind the information they provide. In biostatistics and epidemiology, where careful thinking about study design, assumptions and interpretation is vital, careless use of AI could easily lead to wrong conclusions.

    This is why students must develop a critical and questioning attitude. Every output must be seen as something to be checked, not something to be believed blindly.

    Recent academic work also supports this direction. Researchers have pointed out that users must develop what is now called “critical AI literacy”, meaning the ability to question and verify AI outputs rather than accept them passively (Ng, 2023; Mocanu, Grzyb, & Liotta, 2023). Although the terms differ, the message is the same: critical thinking remains essential when working with AI.

    How to train critical thinking when using AI

    Build a sceptical mindset

    Students should be taught from the beginning that AI is only a tool. It is not a source of truth. It should be seen like a junior intern: helpful and fast, but not always right. They should learn to ask questions such as:

    What assumptions are hidden in this output? Are the methods suggested suitable for the data and research question? Is anything important missing?

    Simple exercises, like showing students examples of AI outputs with clear mistakes, can help build this habit.

    Teach structured critical appraisal

    To help students evaluate AI outputs properly, it is useful to give them a structured way of thinking. A good framework involves five main points:

    First, methodological appropriateness

    Students must check whether the AI suggested the correct statistical method or study design. For example, if the outcome is time to death, suggesting logistic regression instead of survival analysis would be wrong.

    Second, assumptions and preconditions

    Every method has assumptions. Students must identify whether these assumptions are mentioned and whether they make sense. If assumptions are not stated, students must learn to recognise them and decide whether they are acceptable.

    Third, completeness and relevance

    Students should check whether the AI output missed important steps, variables or checks. For instance, has the AI forgotten to adjust for confounding factors? Is stratification by key variables missing?

    Fourth, logical and statistical coherence

    The reasoning must be checked for soundness. Are the conclusions supported by the results? Is there any step that does not follow logically?

    Fifth, source validation and evidence support

    Students should verify any references or evidence provided. AI sometimes produces references that do not exist or that are outdated. Cross-checking with real sources is necessary.

    By using these five points, students can build a habit of structured checking, instead of relying on their instincts alone.

    Encourage comparison and cross-verification

    Students should not depend on one AI output. They should learn to ask the same question in different ways and compare the answers. They should also check against textbooks, lectures, or real research papers.

    Practise reverse engineering

    One effective exercise is to give students an AI-generated answer with hidden mistakes and ask them to find and correct the errors. This strengthens their ability to read carefully and think independently.

    Make students teach back to AI

    Another good practice is to ask students to correct the AI. After finding an error, they should write a prompt that explains the mistake to the AI and asks for a better answer. Being able to explain an error clearly shows true understanding.

    Why logical thinking in coding and analysis planning remains essential

    Although AI can now generate codes and suggest analysis steps, it does not replace the need for human logical thinking. Writing good analysis plans and coding correctly require structured reasoning. Without this ability, students will not know how to guide AI properly, how to spot mistakes, or how to build reliable results from raw data.

    Logical thinking in analysis means asking and answering step-by-step questions such as:

    What is the research question? What are the variables and their roles? What is the right type of analysis for this question? What assumptions need to be checked? What is the correct order of steps?

    If students lose this skill and depend only on AI, they will not be able to detect when AI suggests inappropriate methods, forgets a critical step, or builds a wrong model. Therefore, teaching logical thinking in data analysis planning and coding must stay an important part of the curriculum.

    Logical planning and good coding are not simply technical skills. They reflect the student’s ability to reason clearly, to see the structure behind the problem, and to create a defensible path from data to answer. These are skills that no AI can replace.

    Ethical use of generative AI and the need for transparency

    Along with critical and logical thinking, students must also be trained to use generative AI tools ethically. They must understand that using AI does not remove their professional responsibility. If they rely on AI outputs for any part of their work, they must check it, improve it where needed, and take ownership of the final product.

    Students should also be taught about data privacy. Sensitive or identifiable information must never be shared with AI platforms, even during casual exploration or practice. Responsibility for patient confidentiality, research ethics, and academic honesty remains with the human user.

    Another important point is transparency. Whenever AI tools are used to assist in study design, data analysis, writing or summarising, this use should be openly declared. Whether in academic assignments, published articles or professional reports, readers have the right to know how AI was involved in shaping the content. Full and honest declaration supports academic integrity, maintains trust, and shows respect for the standards of research and publication.

    Students should be guided to include a simple statement such as:

    “An AI tool was used to assist with [describe briefly], and the final content has been reviewed and verified by the author.”

    By practising transparency from the beginning, students learn that AI is not something to hide, but something to use responsibly and openly.

    Building a modern curriculum

    To prepare students for this new reality, we must design courses that combine:

    Training in critical thinking when using AI outputs Training in logical thinking for building analysis plans and writing codes Training in ethical use and transparent declaration of AI assistance

    Students should be given real-world tasks where they must plan analyses from scratch, use AI as a helper but not as a leader, check every output carefully, and justify every step they take. They should also be trained to reflect on the choices they make, and on how to improve AI suggestions if they find them weak or incorrect.

    By doing this, we can prepare future biostatisticians and epidemiologists who are not only technically skilled but also intellectually strong and ethically responsible.

    A new way forward

    Teaching students to use AI critically is not just a good idea. It is essential for the future. In biostatistics and epidemiology, where errors can affect public health and policy, we must prepare a new generation who can use AI wisely without losing their own judgement.

    The best users of AI will not be those who follow it blindly, but those who can guide it with intelligence, knowledge and ethical care. Our role as teachers is to help students become leaders in the AI age, not followers.

    References

    Ng, W. (2023). Critical AI literacy: Toward empowering agency in an AI world. AI and Ethics, 3(1), 137–146. https://doi.org/10.1007/s43681-021-00065-5

    Mocanu, E., Grzyb, B., & Liotta, A. (2023). Critical thinking in AI-assisted decision-making: Challenges and opportunities. Frontiers in Artificial Intelligence, 6, Article 1052289. https://doi.org/10.3389/frai.2023.1052289

    Disclaimer

    This article discusses the responsible use of generative AI tools in education and research. It is based on current understanding and practices as of 2025. Readers are encouraged to apply critical judgement, stay updated with evolving guidelines, and ensure compliance with their institutional, professional, and ethical standards.

  • Epidemiology and Biostatistics in the Light of Divine Unity

    In the Islamic worldview, knowledge is not categorised into ‘Islamic’ and ‘secular.’ There is only one knowledge — al-‘ilm — bestowed by Allah, whether discovered through divine revelation (wahy) or human reason (‘aql). All beneficial knowledge should ultimately draw us closer to Allah, the All-Knowing. This article explores the field of epidemiology and biostatistics through this lens of divine unity, affirming that scientific inquiry and statistical reasoning are not merely technical disciplines, but pathways to understanding the patterns and wisdom embedded in Allah’s creation.

    John M. Last (1988) defined epidemiology as “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” This definition highlights three core components: distribution, determinants, and application. Distribution refers to patterns — who is affected, where, and when. Determinants delve into the causes, risk factors, and protective factors. Application demands action — the use of findings to prevent and control diseases.

    In Islam, observation of patterns in nature and society is encouraged. The Qur’an repeatedly invites reflection (tadabbur) on signs (ayat) in the universe and within ourselves. Understanding patterns of disease aligns with this call to contemplation and action. Epidemiology, therefore, becomes a means of fulfilling the Islamic obligation to protect life (hifz al-nafs), one of the five higher objectives of Shariah (maqasid al-shariah).

    Sir Austin Bradford Hill (1965) introduced a set of principles to guide causal inference in epidemiology. His criteria — strength, consistency, temporality, biological gradient, plausibility, coherence, experiment, specificity, and analogy — serve as guides rather than strict rules.

    Yet, we must recognise the epistemological humility within our methods. In regression models, confidence intervals, and Hill’s criteria, there is always an element of uncertainty. This aligns with the Islamic view that human knowledge is inherently limited. As Allah reminds us: “And you (O mankind) have not been given of knowledge except a little.” (Qur’an, Al-Isra’, 17:85)

    Hence, we strive to understand cause and effect through careful observation and reasoning, but ultimately, we acknowledge that true causality is known only to Allah. Our frameworks are approximations — tools to aid, not final truths.

    Historical accounts during the time of the Prophet Muhammad ﷺ and his companions demonstrate the application of outbreak control principles. One notable example is the plague (ṭā‘ūn) during the rule of Caliph Umar ibn al-Khattab. When the plague broke out in Syria, Umar decided not to enter the area, and advised others not to leave or enter — an early form of quarantine.

    The Prophet ﷺ said: “If you hear of a plague in a land, do not enter it; and if it breaks out in a land where you are, do not leave it.” (Sahih al-Bukhari, Hadith 5728; Sahih Muslim, Hadith 2219)

    This hadith reflects core outbreak control principles such as isolation, movement restriction, and collective responsibility — key strategies in modern epidemiology.

    Islam strongly advocates prevention. The Prophet ﷺ advised moderation in eating: “The son of Adam does not fill any vessel worse than his stomach. It is sufficient for the son of Adam to eat a few mouthfuls to keep him going. If he must do that (fill his stomach), then let him fill one-third with food, one-third with drink, and one-third with air.” (Sunan Ibn Majah, Hadith 3349)

    This guidance is preventive in nature and closely aligns with public health nutrition. Islam connects overindulgence and lack of restraint to the whispers of Shayṭān. Preventive health, therefore, is not just a matter of science, but a matter of spiritual discipline.

    Islamic rituals incorporate hygiene into acts of worship. Ablution (wudu’), performed five times daily before prayer, involves washing the hands, mouth, nose, face, arms, head, and feet — the very areas associated with microbial transmission.

    The Prophet ﷺ also instructed: “Cover your utensils and tie your water skins, for there is a night in the year when plague descends, and it does not pass an uncovered utensil or untied water skin without some of that plague descending into it.” (Sahih Muslim, Hadith 2014)

    These teachings reflect divine wisdom in infection prevention, centuries before the discovery of microbes and germ theory.

    Biostatistics provides us with essential tools to summarise data and draw meaningful inferences about populations from sample observations. Among its most powerful techniques is regression analysis, which allows us to explore and quantify the relationship between an outcome (dependent variable) and one or more explanatory (independent) variables.

    The general form of a multiple linear regression model is:

    y = β₀ + β₁x₁ + β₂x₂ + … + βₖxₖ + ε

    In this equation:

    • y represents the outcome or response variable we aim to predict or explain,

    • x₁ to xₖ are the predictor variables that we believe influence the outcome,

    • β₀ is the intercept, the expected value of y when all predictors are zero,

    • β₁ to βₖ are the regression coefficients that quantify the effect of each predictor on the outcome, and

    • ε is the error term, capturing the variability in y that the model cannot explain.

    This error term is more than just a technical component; it is a profound acknowledgment of the limits of human understanding. Even with the most refined models and abundant data, there will always be elements of unpredictability — due to omitted variables, imprecise measurements, biological variation, or other unknown factors. The presence of this uncertainty is a built-in reminder that our knowledge is partial and conditional.

    From an Islamic perspective, this aligns beautifully with the concept of epistemic humility. As Allah states in the Qur’an: “And you (O mankind) have not been given of knowledge except a little.” (Qur’an, Al-Isra’, 17:85)

    Thus, while biostatistics helps us make informed decisions and uncover meaningful relationships, it also teaches us to recognise the boundaries of what we can know. The error term symbolises the divine reality — that ultimate knowledge lies only with Allah. It invites us to pursue knowledge responsibly, with sincerity, but never with arrogance.

    This concept is further reinforced in the Qur’an: “And above every possessor of knowledge is one [more] knowing.” (Qur’an, Yusuf, 12:76)

    Every estimate, statistical model, and inference must be grounded in this awareness. We can model, measure, and approximate, but only Allah knows the unseen, the future, and the full complexity of creation. Biostatistics, therefore, is not only a scientific tool but also a spiritual exercise in recognising our role as seekers of knowledge, always dependent on the One who knows all.

    Epidemiology and biostatistics, when viewed through the Islamic perspective of tawḥīd (oneness of Allah), are not detached from faith but are deeply connected to it. These sciences offer not just understanding but also tools to protect life, serve society, and fulfil the trust placed upon us as khalifah (stewards) on Earth. By unifying rational inquiry with spiritual awareness, we find that knowledge — whether derived from revelation or observation — is ultimately from the same source. Through this lens, our pursuit of health knowledge becomes a journey toward Allah.

    References
    1. Last, J. M. (1988). A Dictionary of Epidemiology (2nd ed.). Oxford University Press.
    2. Hill, A. B. (1965). The Environment and Disease: Association or Causation? Proceedings of the Royal Society of Medicine, 58(5), 295–300.
    3. The Noble Qur’an, Surah Al-Isra’ (17:85), Surah Yusuf (12:76).
    4. Sahih al-Bukhari, Book 76, Hadith 5728.
    5. Sahih Muslim, Book 39, Hadith 2219; Book 23, Hadith 2014.
    6. Sunan Ibn Majah, Book 29, Hadith 3349.
    7. Al-Ghazali, I. H. Ihya Ulum al-Din – On the virtues of knowledge and its relation to action and worship.
    8. Nasr, S. H. (1992). Science and Civilization in Islam. Harvard University Press.

  • A Decade Too Soon: Uniting Tawhid and Public Health for Malaysia’s Future

    Jamalludin Ab Rahman

    Malaysia is facing a silent but accelerating epidemic. Cardiovascular disease (CVD) is not only the leading cause of death in the country, but it is also affecting Malaysians a decade earlier than in advanced nations (APAC CVD Alliance, 2024). Nearly one in four CVD patients was under the age of 50 in 2019, and the largest increase in stroke incidence occurred among those aged 35 to 39. Ischaemic heart disease is 1.6 times more prevalent in men, while stroke affects more women—showing no demographic is spared. Malaysia now records one of the highest rates of heart failure in Southeast Asia, with hospitalisation rates of 10 percent and 30-day readmission rates reaching 25 percent. Worse, heart failure in Malaysia is diagnosed six to ten years earlier than in other countries.

    Behind these clinical realities lies a lifestyle in crisis. Nearly 50 percent of adults are overweight or obese, with women slightly more affected (54.7 percent). Three in ten Malaysians suffer from hypertension, and one in five has diabetes—often without knowing it. Salt intake remains well above the WHO recommended limit, while the intake of fats and sugars has increased by 80 percent and 33 percent respectively over the last 45 years. The consequences are severe: Malaysia incurs USD 1.68 billion annually in direct and indirect costs from premature CVD mortality and disability (APAC CVD Alliance, 2024).

    These are not just numbers—they are warnings. And the root cause is not simply medical, but spiritual and behavioural. The overconsumption of food, physical inactivity, and dependence on chemical cures without lifestyle transformation are symptoms of deeper imbalance. It is in this light that Islamic teachings and ethical models of care must reclaim their place—not only in public health planning, but in the consultation room, the community, and the curriculum.

    Islam offers profound guidance on eating and health. The Prophet Muhammad (peace be upon him) said, “The son of Adam does not fill any vessel worse than his stomach. It is sufficient for him to eat a few bites to keep his back straight. But if he must, then one-third for his food, one-third for his drink, and one-third for his breath” (al-Tirmidhi, Hadith 2380). Likewise, the Qur’an instructs, “Eat and drink, but do not be excessive. Indeed, He does not like those who commit excess” (Qur’an 7:31). These teachings embed moderation, gratitude, and accountability within the act of eating—turning what we consume into a reflection of our spiritual consciousness.

    Public health models, such as the Health Belief Model (HBM), help explain why people change or fail to change behaviour. The model shows that individuals are more likely to adopt preventive actions when they perceive a personal risk, understand the severity of the disease, believe in the benefits of change, and encounter minimal barriers (Becker, 1974; Champion & Skinner, 2008). In Malaysia, however, these elements must be delivered within local, spiritual, and cultural frameworks. That means moving beyond posters and pamphlets to engaging communities through trusted voices—especially doctors, religious leaders, and educators.

    Doctors have a unique and sacred role. They are not only healers but also leaders, educators, and examples. Every consultation is an opportunity not just to prescribe medication, but to prescribe a lifestyle. Patients with hypertension, diabetes, or obesity must be advised on dietary change, physical activity, spiritual discipline, and fasting—not merely given chemical interventions. Lifestyle prescriptions must become part of routine clinical practice, not optional or secondary. Hospitals and clinics must transform from treatment centres into wellness institutions.

    This responsibility begins with doctors themselves. Their credibility is strengthened when they live the lifestyle they promote. A doctor who fasts regularly, avoids gluttony, walks or cycles, and maintains balance in diet and conduct offers a silent but powerful form of da’wah. Islamic hospitals and medical faculties should reinforce this vision, ensuring that doctors are seen as moral exemplars and not merely technical experts. Their example can shift norms and inspire communities to follow a path of moderation.

    To make this sustainable, preventive health education must be strengthened at the foundation. Medical schools should embed modules that combine behavioural science, nutrition, spiritual wellness, and Islamic ethics. Students should be trained to give khutbahs, lead community dialogues, and understand the social determinants of health from a tawhidic worldview.

    Tawhidic epistemology gives this approach its moral clarity. It asserts that all knowledge—whether biomedical or behavioural—must lead to Allah. The body is a trust (amanah), and health is a blessing that demands stewardship. Healing, therefore, is not limited to the removal of symptoms but must also serve to realign the human being with divine balance (mizan). As articulated by Bakar (2021, 2025), tawhid integrates rational and revealed knowledge to ensure that science and healthcare are spiritually accountable. By embracing tawhid, we move from seeing the patient as a consumer of treatment to a servant of the Creator, responsible for preserving his or her own body and influencing society.

    Malaysia’s battle against early-onset CVD will not be won in hospitals and pharmacies alone. It will be won in the hearts, homes, and habits of the people. By combining the insight of the Health Belief Model with the moral depth of tawhidic epistemology—and empowering doctors to lead through both words and example—we can return to the prophetic path: to eat moderately, to live purposefully, and to heal with meaning.

    References

    APAC CVD Alliance. (2024). Malaysia: A call for cohesive action—Redefining cardiovascular care in the Asia-Pacific. https://apac-cvd.org/publications/

    al-Tirmidhi, M. I. (n.d.). Jamiʿ at-Tirmidhi (Hadith 2380)

    Bakar, O. (2021). Tawhid and science: Essays on the history and philosophy of Islamic science (2nd ed.). UBD Press.

    Bakar, O. (2025). Defining the core identity of a 21st-century Islamic university. In The Muslim 500: The World’s 500 Most Influential Muslims (2025 Edition) (pp. 70–73). The Royal Islamic Strategic Studies Centre.

    Becker, M. H. (1974). The Health Belief Model and personal health behavior. Health Education Monographs, 2, 324–473.

    Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 45–65). Jossey-Bass.

    The Qur’an. (n.d.). Surah al-Aʿraf, 7:31

  • BEV Battery Consumption Efficiency

    Model Brand Battery Size (kWh) Energy Consumption (kWh/100 km)
    Neta V Neta 38.54 10.1
    Proton eMAS 7 Prime Proton 49.52 11.0
    Proton eMAS 7 Premium Proton 60.22 11.5
    GAC Aion Y Plus (Standard Range) GAC 63.2 12.9
    GAC Aion Y Plus (Extended Range) GAC 68.3 13.2
    BYD Dolphin BYD 44.9 13.8
    Xpeng G6 Xpeng 66 14.0
    MG4 EV (Standard Range) MG 51 14.0
    MG4 EV (Extended Range) MG 64 14.5
    BYD Atto 3 (Standard Range) BYD 49.92 14.5
    BYD Atto 3 (Extended Range) BYD 60.48 14.8
    Tesla Model 3 (Standard Range Plus) Tesla 54 14.9
    Tesla Model 3 (Long Range AWD) Tesla 82 15.2
    MG ZS EV MG 44.5 15.2
    BYD Seal (Standard Range) BYD 61.4 14.2
    BYD Seal (Extended Range) BYD 82.5 14.5
    Hyundai Kona Electric (Standard Range) Hyundai 39.2 14.3
    Hyundai Kona Electric (Extended Range) Hyundai 64 14.7
    Tesla Model Y (Long Range AWD) Tesla 75 15.7
    Hyundai Ioniq 5 (Standard Range) Hyundai 58 15.7
    Mercedes-Benz EQS 450+ Mercedes-Benz 107.8 15.7
    Hyundai Ioniq 5 (Extended Range) Hyundai 72.6 16.1
    Tesla Model Y (Performance) Tesla 75 16.2
    BMW iX3 BMW 80 17.6
    BMW i4 eDrive40 BMW 83.9 16.1–19.1
    Volvo EX30 (Standard Range) Volvo 51 17.1
    Volvo EX30 (Extended Range) Volvo 69 17.1
    Nissan Leaf Nissan 40 17.1
    Mercedes-Benz EQA 250 Mercedes-Benz 66.5 17.7
    BMW i7 xDrive60 BMW 101.7 18.5–22.3
    Mercedes-Benz EQB 350 4MATIC Mercedes-Benz 66.5 18.1
    Lexus RZ 450e Lexus 71.4 18.7
    Volvo C40 Recharge Volvo 78 19.8
    Volvo XC40 Recharge Volvo 78 20.0
    Porsche Taycan 4S (Standard Battery) Porsche 79.2 20.0
    Porsche Taycan 4S (Performance Battery Plus) Porsche 93.4 21.0
    Volvo EX90 Volvo 111 21.1

  • Proposed Tawhidic Epistemology Principles in IIUM Medical Curriculum

    The proposed Tawhidic Epistemology (TE) framework provides a holistic and integrated approach to education, ensuring that knowledge acquisition, application, and dissemination align with Islamic values, ethics, and social responsibility. Rooted in the concept of Tawhid (Divine Unity), TE emphasises the harmonisation of revealed (naqli) and rational (aqli) knowledge, fostering an educational system that not only produces competent professionals but also ethical and spiritually conscious individuals.

    Key Principles of Tawhidic Epistemology

    1. Unity of knowledge (wahdatul ‘ilm)

    TE views knowledge as a single, unified entity, rejecting the artificial division between religious and secular sciences. The integration of Islamic ethics with modern scientific advancements ensures that education produces professionals who are both technically competent and morally guided.

    2. Knowledge as a trust (amanah)

    Education is an ethical responsibility (amanah) that must be pursued and applied with integrity. Both educators and students must uphold honesty, fairness, and accountability in the acquisition and dissemination of knowledge.

    3. Purpose-driven learning (maqasid al-shariah)

    Education should align with the higher objectives of Islamic law (maqasid al-shariah), ensuring that knowledge serves the protection of faith, life, intellect, lineage, and wealth. This principle ensures that education contributes to individual and societal well-being.

    4. Critical thinking with ethics (ijtihad & adab)

    Students must develop the ability to think critically, analyse data, and make informed decisions while maintaining ethical boundaries and intellectual humility. TE encourages inquiry and reasoning (ijtihad) but insists that it is guided by respect, discipline, and Islamic etiquette (adab).

    5. Compassionate education (rahmatan lil ‘alamin)

    TE emphasises the role of compassion (rahmah) in learning and practice, encouraging educators to act as mentors (murabbi) who guide students in developing both technical skills and strong moral character.

    6. Application of knowledge for social good (ilm nafi’)

    The purpose of knowledge is to benefit humanity, addressing real-world challenges while ensuring ethical responsibility. Research, innovation, and education should contribute to societal development and well-being.

    7. Continuous improvement (tazkiyah & ihsan)

    TE promotes lifelong learning, self-improvement (tazkiyah), and the pursuit of excellence (ihsan) in education and professional practice. This principle ensures that students and educators engage in continual self-reflection and strive for ongoing growth.

    Implementation in IIUM MBBS

    TE PrincipleObjective OutcomeExpected OutcomeExample in MBBS
    Unity of Knowledge (Wahdatul ‘Ilm)Integrate Islamic and scientific knowledge into all academic disciplines.A holistic, interdisciplinary curriculum where students apply both revealed and rational knowledge in problem-solving.Teaching medical ethics by integrating Islamic bioethics with contemporary medical practices (e.g., end-of-life care, organ donation).
    Knowledge as a Trust (Amanah)Instill responsibility and ethical awareness in students and faculty.Graduates and faculty uphold academic integrity, honesty, and social responsibility in education and research.Emphasising the duty of care in medical practice, ensuring honesty in patient management and research integrity.
    Purpose-Driven Learning (Maqasid al-Shariah)Align teaching, research, and policies with the higher objectives of Islamic law (maqasid al-shariah).Education fosters moral character, social justice, and professional ethics, contributing to the well-being of society.Ensuring that clinical decisions consider the protection of life (hifz al-nafs) and intellect (hifz al-aql), e.g., balancing patient autonomy with Islamic ethical considerations.
    Critical Thinking with Ethics (Ijtihad & Adab)Encourage analytical reasoning while upholding ethical conduct.Students and faculty engage in critical thinking and innovation while maintaining humility, respect, and ethical considerations.Teaching evidence-based medicine while ensuring students approach medical uncertainties with humility and respect for diverse perspectives.
    Compassionate Education (Rahmatan lil ‘Alamin)Foster a culture of compassion and ethical leadership in education.Graduates develop strong interpersonal and professional ethics, ensuring human-centred, compassionate decision-making.Embedding compassionate patient care in clinical training, focusing on bedside manner, empathy, and ethical communication.
    Application of Knowledge for Social Good (Ilm Nafi’)Promote research, teaching, and innovation that serve the needs of society.Education produces graduates who actively contribute to solving real-world challenges with ethical and sustainable solutions.Encouraging community-based research on health disparities and disease prevention in underserved populations.
    Continuous Improvement (Tazkiyah & Ihsan)Encourage lifelong learning, self-improvement, and striving for excellence.Students and faculty cultivate a mindset of ongoing growth, self-reflection, and commitment to continuous excellence in learning and service.Incorporating reflective practice in medical training, encouraging students to assess their own performance and continuously seek improvement.

    Conclusion

    The Tawhidic Epistemology framework provides a structured approach to education that balances academic excellence with ethical and spiritual growth. By integrating Islamic principles with modern scientific disciplines, TE produces graduates who are not only skilled professionals but also compassionate, ethical, and socially responsible leaders.

    At the International Islamic University Malaysia (IIUM), these principles act as guiding frameworks for curriculum design, faculty development, research priorities, and student mentorship. By integrating these core values into teaching, research, and governance, TE ensures that education remains meaningful, impactful, and aligned with the greater purpose of serving humanity.

  • The Silent Weight

    They turn to me with hopeful eyes,
    Believing I hold the answers wise.
    From halls of knowledge to matters of gold,
    From guiding the young to fulfilling the old.

    A leader, they say, must always stand,
    With strength unshaken, a steady hand.
    No room for weakness, no time to break,
    Yet how much more can this heart take?

    The burdens rise, the days grow long,
    The weight of right, the fear of wrong.
    To solve, to lead, to forge the way,
    Yet who will hear if I go astray?

    But even the strongest seek a light,
    A whisper of hope in the darkest night.
    And though a leader must not fall,
    I know my strength is not my all.

    Ya Allah, my refuge, my guide,
    In You alone my fears subside.
    Let me lead with faith, not pride,
    And trust in You, side by side.

    For I am not meant to walk alone,
    Nor bear this weight as if my own.
    The path is Yours, the plan is true,
    I lead the best when I trust in You.