EVIDENCE-BASED MEDICINE: Ensure traditional treatment is risk free

NST: letter by PROF DR RAYMOND AZMAN ALI, Medical Faculty UKM

THERE has been an acute increase in the number of complaints against the medical profession, and faith in faith-healers and complementary medicine.
People are entitled to complain about doctors. In fact, they may write to the Malaysian Medical Council if they think doctors are being negligent or unethical.
The public should communicate with their doctors and not be afraid of them. They should seek explanations if they have any doubts about the medical treatment given by the doctors.
Unlike doctors, there is no council, body or law to regulate the activities of faith-healers. For every complaint against a doctor, there will be 10 against a bomoh or faith-healer, but these do not come to public knowledge because such "non-medical" mishaps are often put down to "fate" or an "act of God".
Doctors have first-hand knowledge of the mishaps of traditional practitioners because patients go to them for treatment when complications occur or to be "rescued" from further mishaps. However, mishaps by doctors, ironically, are unfairly put down to "human error".
While the authenticity of a medical doctor could be checked with the MMC, it is not the case with a self-proclaimed complementary medical practitioner.
Before the government comes up with a Traditional and Complementary Medicine Legislation, the public must be made aware of the risk in "consulting" such practitioners. It is a gamble.
Of course, no doctor is perfect or free from errors in a clinical practice. This is expected for we are, after all, only human.
However, the MMC and the National Accreditation Board (LAN) ensure that doctors produced by our local medical schools and those from abroad possess the standards stipulated in the Medical Act and University regulations.
Doctors need to renew their practising certificates annually. Medical schools are accredited periodically. Such accreditation exercises are currently non-existent for complementary medical practitioners.
There is absolutely nothing wrong with complementary medicine, provided it has been proven to be effective and safe for human consumption.
There is nothing more important than the protection of the safety and rights of human beings. This is the basic principle that governs the ethics of the medical profession, be it in clinical practice or medical research.
One must realise that although drugs like digoxin and ginkgo extracts are derived from plants and herbs, they have gone through many years of research and are carefully monitored and regulated.
The relevant authorities had ensured that these drugs went through animal tests and human trials in line with international standards before they got to the market.
If potentially beneficial plants and herbs are subjected to proper animal and clinical trials, they (dignoxin and gingko, for example) will become standard or "modern" medicine.
Acupuncture is an example of complementary medicine that has gone through quality clinical trials, and accepted as the standard therapy for certain conditions.
Currently, tissue engineering, stem cell transplantation and brain-computer interfaces for quadriplegics (to name a few examples), are undergoing intensive research to determine whether they could be introduced as standard therapies.
Only through properly conducted trials will we know the side-effects and contra-indications of any therapy.
Modern drugs are not free from side-effects but doctors, unlike faith-healers and herbalists, are aware of these side-effects and know how to treat them should the need arise.
When people take a herbal treatment without knowing its contents and side-effects, they are venturing into the "unknown".
It is mandatory that doctors explain the contra-indications and side-effects of any new drug prescribed to their patients. But have you seen people who sell herbs and traditional treatments on the five-foot pathways explaining the side-effects of their treatment? Of course, not.
It is also through properly conducted trials that we will know whether the positive effects of a treatment are attributable to the treatment itself, or occurred by chance.
The bottom line in clinical practice (hopefully in other practices too) is that the practice must be evidence-based. If it is not evidence-based, it should not be practised. And this important principle is not restricted to the treatment of illnesses alone.
The teaching and assessment methods we disseminate to our medical students and the investigations we impose upon our patients must also be evidence-based.
This letter is not a debate about what or who is better. It is also not to undermine the rights of complementary medical practitioners.
I hope it will educate the public on their rights and safety, and the possibility of removing the dichotomy between "modern" and "complementary" medicine. If all medicine is evidence-based, then there is only one medicine, that is "medicine" itself.