Traditional Medicine In Hospitals ... Progress or Regress?

By Dr David Quek

The Minister of Health, YB Datuk Chua Jui Meng dropped a bombshell when he announced that very soon traditional medicine would be allowed to practice alongside allopathic (western) medicine in hospitals and clinics.

Datuk Chua said that the Health Ministry is drafting proposed amendments to the Medical Act 1971 to this effect. Contending that the proposed amendments are timely, he rationalized that "the prohibition of traditional medicine was a remnant of the colonial days when western medicine was thought to be superior" (New Straits Times, 8 March 1997). He claimed that doctors nowadays are more open to traditional medicines. He further commented that "traditional medicine had gained public acceptance because of its effectiveness", claiming that this combining of traditional and modern medicine was an accepted practice in other countries. "The ultimate objective is to cure the patient, regardless of whether it is modern or traditional", he added.

MMA President, Datuk Dr Abdul Hamid however, quickly rebutted that the medical profession views such a move as premature. He said that doctors in hospitals would be quite uncomfortable working with practitioners of traditional medicine. Furthermore, the areas of complementary benefits have not been identified. What is disturbing is that patients should not be made to suffer because of conflicts in treatment, he added (see Front Page Press Release).

The Editorial Board feels very strongly that such an unprecedented move to lend credence to traditional medicine is premature, reactionary and contrary to the progress made in scientific medicine in promoting and maintaining health, curbing illness, and prolonging life. It therefore views such a move with caution and alarm.

Of late, there has been many initiatives by individuals or groups with various interests, to question the scientific basis of our health and medical systems. It is true that worldwide, there has been a resurgence in interest in alternative medical practices, which are as disparate and as controversial as can be.

A recent "textbook" on Alternative Medicine, listed no fewer than a hundred types or systems of beliefs of such practices, ranging from the more acceptable acupuncture, acupressure, shiatsu, Chinese traditional herbal medicine, Ayurvedic Hindu practices, to such arcane and obscure tribalistic witchcraft as shamanism, bone-throwing, voodooism, bloodless surgery, black magic, etc. In between, are the better known, probably harmless, but still bewildering practices of Pollen B, Royal Jelly, colonic washout therapy, aromatherapy, homeopathy, osteopathy, and naturopathy. The common thread running through all these quagmire of practices is that the burden of proof that these actually work, is as flimsy as a few anecdotal case histories and testimonials.

Alas, at the risk of sounding arrogant, such hearsay evidence is never enough to satisfy even the most simplistic allopathic practitioner of so-called western medicine. This is because, we believe in more proof and more substantiation of cause and effect than this. It is thus, totally uncalled-for to label western medicine as a relic of colonialism. It is useful to remember that modern medicine owes a great deal of its rapid advancement, to the research and scholarship of countless doctors and physicians throughout the world from time immemorial, sieving out the best-tried and most efficacious remedies from the mythical and mystical chaff, and certainly not only from the west. Therefore, it is unfair to allude to this "western" bias as an undesirable colonial baggage.

We should not get unduly carried away with jingoistic ethnocentricity to decry as evil or bad whatever there arise from the west. Neither should we resort to backward practices which smacks of tradition and culture, just to try and come to grips with our own ethnic roots.

Otherwise, why are we embracing the information and technological age with such open arms? Why indeed, are we offering such an expensive exercise of creating a new era of cyber-connections (yes - western and modern) with the rest of the world by creating the world’s first Multimedia Super Corridor? Why are we including even telemedicine as one of the main thrusts of this new age, if not for its far-reaching and obviously beneficial and advanced methods and practices of health and medicine, which can be shared with, from one end of the earth to another?

In fact, in almost every modern and modernizing society, western or allopathic medicine, which is based on rigorous scientific methods, has been the least contentious benefit of development, often a left-over legacy of colonialism. It can be said without prejudice but with pride, that it is due to modern advances in our understanding of health and medical practices, that modern man has lived far longer than his forebears.

It is estimated that in Malaysia alone, since independence to date, our expected life-expectancy has increased by about a third from about 50-odd years to the present 72 years. Our infant and maternal mortality rates have declined dramatically, our infectious disease rates have fallen, and infections have also become less fatal, and we have eradicated smallpox not only from here but worldwide. We are now living so much longer that we are suffering the ravages of disorders associated with older age, such as coronary heart disease, strokes, Parkinsonism and cancers.

It is true that modern medicine cannot cure all ills. Neither can it claim to understand all that goes wrong with the human body and the many new ailments. However, there is no other system which has pushed the frontiers and understanding of health and medicine to such heights, that most treatment and management prescribed, are as carefully documented and as repeatable as allopathic medicine.

It is due to this extremely high and rigorous acceptance of burdens of proof that made modern medicine so complex. Allopathic medicine is replete with countless research studies and trials which can sometimes conflict with one another, such that the final word cannot yet be said for very many illness and treatment. As is requisite in the scientific method, further research study and experimentation is always necessary to move us one step by one step, further in our understanding of any branch of medicine or therapy. But in the long run, the benefits are there for all to see.

The sometimes slow and incomplete results from modern medicine are what may put-off and frustrate some patients who hanker for a quick cure. How many of our patients have pleaded with us to cure their hypertension, diabetes or heart disease, such that they would not require to take medicine any more? How many more want their cancers cured one way or another? How many more can understand that most chronic illness may require lifelong medication and perhaps some further surgery from time to time? These are some reasons why certain claims by alternative medicine sound and appear so attractive.

Consider hypertension which afflicts some 10 to 15 percent of our population. The promise of a cure for hypertension after a 2- to 3-month course of herbal medications clearly makes an understandably better choice for any patient. The trouble is that, in most instances, these do not work. It is as simple as that. Years later, how many of us physicians have seen the ravages of the disorder - the enlarged heart, the irregular rhythm, an unannounced stroke paralyzing a middle aged man or woman, a heart attack, or advanced kidney failure? But there are some patients who swear that they have been cured. This is not too difficult to explain, for even in modern medicine we do recognize that some 10 percent of hypertension patients may have this disorder for a short spell or whose blood pressure is labile and fluctuating. These are that number who would get "cured". But the unfortunate majority of others who decided otherwise can only respond with a shortened lifespan and suffer the consequence.

The other confounding aspect of our health system beliefs, is that of our multiethnic origins which juxtapose certain traditional medical practices with modern medicine. It is often said that many patients are more comfortable with their own choices of traditional medical system, partly because they can relate more easily with them (see Chinese Medical systems).

While it is not our intention to denigrate other systems of practices, as doctors, we cannot as yet accept any medical practice that is hitherto unproven to the degree that we can be satisfied or are accustomed to. There are just too little known facts, and many traditional practices which may appear sensible or even rational, remain unconvincing when put through the rigors of the scientific method. Our Medical Act clearly recognizes that such unproven medical systems and improperly trained and unlicensed persons cannot be allowed to practice medicine as we know it, within the ambiance of the law.

It is often in desperate and confused situations that patients turn to alternative medicines, often to be misled and disappointed. A patient with rectal cancer, domiciled in Canada, declined surgical therapy which could have cured her, but left her with a colostomy. She opted for herbal therapy introduced by some friends who claimed that this had cured some others. Several months later however, she became obstructed, and after exhaustive tests, doctors found that her cancer had spread making it inoperable by then. A defunctioning colostomy was performed, but this time only as palliation. She died a few months later. This tragic story shows that alternative therapies exist not only in Malaysia, but elsewhere.

The sad fact remains that ignorance and a gullible mindset shaped by desperation, often can warp even the most educated and otherwise sensible people. What more if many of our people are less educated and even more ignorant? That Malaysians spend some 1.3 billion ringgit annually on alternative medications and supplements (compared with only about RM 900 million for pharmaceutical drugs), attest to the magnitude of such an enigma. Should we lend weight to this already existing misplacement of trust, although it is manifestly a choice made by some people?

As a rapidly developing nation striving towards Vision 2020, we should guard against ignorance as a whole, which would include such sentimental and misguided beliefs, traditional and local as they might be. Unchecked we could be regressing into the primeval Dark Ages, where witchcraft and magic abounds. We shall indeed be taking many steps backward, thereby unhinging our very progress, scientifically and technologically.

The crux of the matter is that people need faith as they seek comfort or try to make sense out of a complex world. As doctors we can help make some more sense for our patients, and we urge that the Health Ministry facilitate this by encouraging safer, more careful, more scientific and more rational medical practices. We believe that traditional medicine and other alternative health practices should be subject to more rigorous scrutiny and study before they are accorded any further recognition. Amending the Medical Act to facilitate the practice of traditional forms of medical therapy is quite inappropriate and premature, at this time.

If need be, an Alternative Medicine Act clearly outlining the scope, limits and framework of such registered traditional medical practices as recommended by our President Datuk Dr Abdul Hamid, is perhaps the better approach. A clear policy from the Ministry would help stem the oversprouting of alternative therapies which now continue to play on the ignorance and gullibility of the common folk, and which has led to much confusion.

/March 97

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