Defining a role for integrated medicine

NST: AT Lam Wah Ee Hospital in Penang, Western-trained and Chinese traditional doctors practise in separate buildings and do not refer patients to each other.
At Tung Shin Hospital in Kuala Lumpur, they operate in different wings in the same building where some patients are treated by both.
And at pilot projects next year in Putrajaya and Kepala Batas, the government will introduce some Traditional and Complementary Medicine (TCM) into public hospitals.
In April this year, Health Ministry parliamentary secretary Datuk Lee Kah Choon said government hospitals in Putrajaya, Kepala Batas and Johor Baru had been chosen to combine modern and traditional treatments as "integrated medicine".
But director-general of Health Tan Sri Dr Ismail Merican stresses that integrated medicine will only be introduced on a larger scale if the pilot projects succeed — and with adequate safeguards.
Physicians such as the head of the Chinese Medical Department at Tung Shin, Professor Zhao Tian Yong, claim the efficacy of traditional medicine has been proven over the past 1,000 years.
But Western-trained doctors, including the medical superintendent of the Western division at Lam Wah Ee Hospital, Datuk Dr Yip Kok Thye, want their traditional counterparts to be trained at recognised schools and registered, and to have a code of ethics, disciplinary procedure and indemnity insurance.
They also want more information and clinical trials on traditional medicine and treatments. Traditional medicines should be registered, just like the medicines which Western doctors prescribe, and their chemical composition, safety profile and efficacy should be well documented.
Dr Ismail promises all this will be spelled out in the Traditional and Complementary Medicine Control Bill to be tabled in Parliament next year.
"We must get the right and credible practitioners to work. They must have gone through an approved training programme, and must be accepted by their association and community," he explains.
The Malaysian Medical Association (MMA) supports the plan to run the integrated medicine pilot project only after the Act comes into force.
"The pressure of consumer demand and of moving forward towards a holistic approach must be weighed against the many case histories of patients with cancer and other serious ailments being led up the harmful path of non-evidenced based medicine," says its president Datuk Dr Teoh Siang Chin.
For now, the Medical Act 1971 prevents registered medical practitioners from associating with non-qualified, non-registered practitioners in treating patients.
They have to stick to the "modern" treatments for which they are trained and registered. But, notes Dr Ismail, they can use "evidenced-based" TCM, such as acupuncture, for pain and various other health conditions.
And if anyone wants to use a traditional product to replace the current form of treatment, they must show evidence of clinical trials.
Tung Shin’s Zhao says the government allows three associations to supervise and confirm the qualifications of traditional Chinese physicians — the Federation of Chinese Physicians and Medicine Dealers Association of Malaysia, the Malaysian Chinese Physicians Association and the Federation of Chinese Acupuncturist Associations of Malaysia.
The government should set unified standards for traditional physicians and approve their qualifications, he urges.
Since 1998, the Ministry of Health Standing Committee on TCM has begun registering traditional practitioners and is drafting a college-level training module for them, adds Datuk Dr Lee Yan San, the MMA’s representative to the committee.
The ministry is identifying TCM training centres around the world, especially in Indonesia, China, India and America, where interested doctors and practitioners can attend courses.
It is also urging local universities to offer courses in TCM. There are no training centres for bomoh but there are schools for ayurvedic practitioners and sinseh.
The first Chinese medical school opened 40 years ago in Penang and another has been set up in Butterworth. Tung Shin plans to set up its own college.
Zhao calls for more such schools to be set up and for the government to stipulate the courses needed to graduate.
"As far as I know, traditional Chinese medicine colleges in Malaysia have yet to standardise their courses. They have their own syllabus but have not referred it to the Ministry of Higher Education or the Ministry of Health."
Integrated medicine still has a long way to go in Malaysia, says the traditional Chinese physician, and the government should play a bigger role.