Regulating Traditional Medicine

In view of the lack of enforcement in alternative treatments, the Traditional & Complementary Medicine Bill is a much anticipated one.

TRADITIONAL and complementary therapies have mushroomed in recent decades and the Health Ministry’s Traditional and Complementary Medicine Division estimates that there are 15,000 traditional and complementary medicine (TCM) practitioners in the country.

Despite the numbers, there is no specific law governing these fields.

Last year, the Division received more than 30 complaints relating to unethical practises, overcharging, and cheating, but the numbers are likely to be more because people are too embarrassed to complain, says the Division’s director Dr Ramli Abd Ghani.

“Practitioners may claim that this or that herb can cure cancer, for instance, with no scientific proof,” he notes.

Dr Ramli says for cancer patients, it is better to get modern medical treatment because there is no alternative or traditional treatment that has been scientifically proven to cure cancer, for now. “They should go to a hospital and get themselves examined first, and if they want to go for traditional treatment, they can add that as an adjunct treatment, which must be monitored by qualified medical personnel,” he says.

Currently, the Health Ministry accepts TCM as adjunct treatment, not alternative treatment.

A total of 85 types of herbs imported from China are used in the Health Ministry’s Hospital Putrajaya, Hospital Sultan Ismail in Johor Baru and Hospital Kepala Batas in Penang in their TCM divisions. These herbs are not for cancer treatment. Instead, they are used to overcome chemotherapy side effects.

“When patients do not suffer from side effects, they are more likely to complete their chemotherapy. “That’s the best we can get out of herbs for now,” he says.

Private hospitals providing similar integrated services are the Lam Wah Ee in Penang, Tungshin in Kuala Lumpur and Hospital Putra in Malacca.

Government hospitals incorporating traditional treatments such as massage, acupuncture and Malay post-natal care include Hospital Sandakan, Hospital Sarawak and Hospital Sultanah Nur Zahirah in Trengganu.

Challenges in TCM

Many people who use TCM tend to think that the approach uses natural ingredients, and hence, there is no toxicity. Contrary to the perception, naturally occurring heavy metals as well as bacteria are found in herbs.

“Before they take it, they have to check if their liver and kidneys are all right, because if these are damaged, the use of these herbs will worsen the condition,” says Dr Ramli.

The concern is that there are more than 600 medical halls and they are not run by people who can monitor these conditions, he says.

On top of that, there are also concerns about steroids and adulterated drugs or chemicals added into the herbs, he says.

Former Malaysian Medical Association president Dr David Quek says that people should be cautious when using TCM.

“They tend to go for it because it sounds more promising. For example, on the verge of losing one’s leg, they tend to opt not to lose their legs if they can and will try other treatments instead of amputation because it’s catastrophic and frightening,” he says.

On patients who claim that they recover from diseases due to such treatments, Dr Quek says it can be due to the placebo effect, or even the fact that in a small number of cases, they recover no matter what they do or not do. Even in modern medicine, in rare cases, someone with a terrible heart condition, for instance, can live for years despite a poor prognosis, he observes.

While he says he will not object if patients want to try out some supplements, they should consult their doctors first to prevent any drug interaction.

Consultant breast surgeon and associate professor at Universiti Malaya Dr Nur Aishah Mohd Taib says some TCM researchers claim that certain products are anti-cancer based on tests in laboratories, but no clinical trials are carried out to prove the efficacy of the herbal products on humans.

“This is unacceptable,” she says.

Dr Nur Aishah urges the authorities to monitor all claims on cancer cures without proper clinical trials done on humans because it may not be effective and can be unsafe.

While the scientific community does not accept TCM as evidence-based or standard treatment, the TCM industry does not necessarily believe that TCM is only for complementing modern treatment as per the Government’s stance.

Federation of Complementary & Natural Medical Associations honorary secretary Tunku Badli Tunku Ibrahim says they usually ask the patient if he or she has seen the doctor and what the doctor’s advice is. “We take the case history and give our views, but the choice is the client’s and they can discuss with their family members,” he says.

He says traditional and Chinese medicine (T&CM) are recognised in many Western countries, and they are decades ahead of Malaysia when it comes to established qualifications. The level of practice in Malaysia needs a boost in terms of professionalism and stringent monitoring.

He says the problem is, there are many who attend courses (for a few days) and claim themselves to be practitioners while others may deceive customers with fake credentials.

Professionalism in practice

Dr Ramli says the Ministry hopes that the Traditional and Complementary Bill will be tabled very soon, since it did not get to be tabled in March, so that they can take disciplinary action against those who flout the law.

“Currently, our hands are tied because there is no specific law governing the activities or to compel practitioners to adhere to guidelines,” he says.

When the Act is in place, the Traditional & Complementary Medicine Council will be set up to look into the rules and regulations and matters pertaining to certification, he says.

Dr Ramli says that many TCM practitioners also misuse the title “Dr”, especially in homeopathy therapies, and this will not be allowed unless approved by the council.

Dr Ramli says the division is promoting voluntary registration of TCM practitioners in the country and 3,000 practitioners have registered themselves online.

“We urge all practitioners to register now because once the bill is passed in Parliament, we will vet through the registration and issue a certificate on a first-come-first-serve basis,” he says.

The Act will also ensure that those who wish to pursue TCM must have diplomas or degrees before they are allowed to practise.

Dr Ramli says they are collaborating with universities and the Malaysian Qualifications Agency (MQA) on proper places for the studies and also collaborating with the Human Resources Ministry’s Skills Development Department on getting spa therapists qualified.

As for bomoh practices, they will be guided based on Islamic principles and be given diplomas, he says.

Under the proposed law, practitioners have to adhere to a code of ethics, put patient safety first, refer them to the doctor if it is not their area of expertise, and ensure patient confidentiality, Dr Ramli explains.

The Division has categorised traditional medicine into Malay, Chinese, Indian and homeopathy, while complementary medicine has been divided into four groups – mind and body (music therapy), biological, energy medicine and manipulative therapy.

A therapy is considered a wellness programme if it is not evidence-based treatment, such as a spa programme, but if it is evidence-based, such as acupuncture or certain herbs that help with certain health problems, they are considered therapeutic, says Dr Ramli.

The Government is also collaborating with the government of China and India on traditional treatments, he says.

Every year, 10 to 20 Malaysian students study in three recognised TCM universities in China – Beijing, Shanghai and Nanjing, he says, adding that in China, a traditional medicine pharmacy degree course requires four years of study.

Malaysia has also signed a memorandum of understanding with India and the latter has offered short-term courses to Malaysians, he says.

Dr Ramli says the Ministry hopes that with the introduction of proper studies, more will move towards evidence-based research. “We want to promote clinical trials,” he says.

Since there is currently no law on TCM practices, patients going for these treatments do so at their own risk. For this reason, if they still want to use TCM, they should be properly monitored by qualified professionals or in hospital settings approved by the Health Ministry.

Source: The Star

This is a typical Chinese traditional medicine shop in Malaysia.

Traditional Chinese Medicine (中醫) refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and look back on a tradition of more than 2000 years, including various forms of herbal medicine, acupuncture, massage therapy, and dietary therapy. These practices are a common part of medical care throughout East Asia, but are considered alternative medicine in the western world. On can find shops similar to this in many parts of Malaysia especially in cities and town where there is a large concentration of Chinese. A Chinese traditional medicine practitioner in Malaysia is called a Sinseh.

This is a standard Jamu shop. Jamu is traditional medicine from Indonesia. It is predominantly herbal medicine made from natural materials, such as parts of plants such as roots, leaves and bark, and fruit. There is also material from the bodies of animals, such as bile of goat or alligator used.

Jamu, traditionally made by at home and sold by street hawkers in Indonesia are produced in factories by large companies such as Fountain, Nyonya Meneeror Djamu Djago, and sold at various Jamu shops in sachet packaging and bottles.

Legand has it that Jamu originated in the Mataram Kingdom some 1300 years ago. Though heavily influenced by Ayurveda from India, Indonesia is a vast archipelago with numerous indigenous plants not found in India.

Jamu is generally prescribed by indigenous Malay or Indonesia physicians (dukuns or bomohs). One can find a Jamu shop is many places in Malaysia occupied predominantly by Malay or Indonesia communities.

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