Old ideas for the new age

Old ideas for the new age

Traditional healing practices have been used for centuries, but some say they are at odds with modern medicine. Priya Kulasagaran looks into the evidence to see if there really is a clash of ideas, or whether our ancestors may actually inform contemporary science.

After suffering from the side-effects of chemotherapy for a few months, S. Rajashri decided to try less mainstream methods of dealing with the pain and fatigue.

The 39-year-old admitted herself in Tung Shin Hospital in Kuala Lumpur, where doctors blend both modern medicine and traditional Chinese medicine.

“I used to be a complete sceptic of alternative therapies – to me, they all just seemed like old wives tales, and stuff of magic,” said Rajashri.

“But I trusted the doctors there, because I knew they based their practice on science and were qualified professionals.”

Rajashri said that alongside her chemotherapy treatment, doctors prescribed herbal remedies to help ease the effects of the cancer drugs.

“My doctor was careful about what sort of complimentary treatment I should undergo. He explained that they need to make sure the chemo and herbal medicines don’t react to each other. And I have to say, it really did work for me; I felt so much energised compared to before,” she added.

With the plethora of traditional treatments available in Malaysia, Rajashri’s experience may well be a familiar one.

According to the Health Ministry’s National Health and Morbidity Survey 2015, almost 30% of Malaysians have sought out alternative treatment at some point in their lives.

An earlier study conducted in 2009 meanwhile, found that the prevalence of using traditional medicine among Malaysian was as high as 69%.

What counts as alternative

The art of healing is as old as humanity itself, with most cultures having some form of traditional medical practice.

Even now, traditional and alternative therapies are widely used, not just in rural communities or developing countries, but increasingly in more ‘modern’ contexts as well.

There is no universal definition of what alternative or traditional medicine is, with different countries adopting their own descriptions of what it should be.

In Malaysia, the National Policy of Traditional and Complementary Medicines states that it is
“is a form of health-related practice designed to prevent, treat, and/or manage illnesses and/or preserve the mental and physical well-being of individuals and includes practices such as traditional Malay medicine, Islamic medical practice, traditional Chinese medicine, traditional Indian medicine, homeopathy, and complementary therapies, and excludes medical or dental practices utilised by registered medical or dental practitioners”.

This mouthful of a description aside, traditional and complementary medicine generally refers to treatments or therapies which fall outside conventional modern medicine.

Practices such as homeopathy, acupuncture, urut and meditation would fall under this umbrella.

A simplistic contrast between such traditional methods and modern “Western” medicine is that the former take a more holistic approach to treating the body, while the latter breaks down the study of medicine to smaller and more targeted parts.

The current trend seems to indicate a greater integration of traditional approaches with modern treatment.

The placebo effect

In 1996, researchers at the University of Connecticut, carried out a curious study on some 56 college students.

The students were told they were testing out a new painkiller called trivaricaine; a brown, medicinal smelling lotion to be applied onto the skin.

Each student had trivaricaine painted on one index finger, while the other index finger was left alone.

Students then had their index fingers, in turn, squeezed in a vice; the students reported significantly less pain in the finger treated with trivaricaine.

The catch was that trivaricaine was a fake painkiller, comprising only water, iodine and thyme oil – but how does this explain the students’ responses?

The experiment is now held as a simple example of the placebo effect; where belief and expectation in a treatment can garner some very real results.

While research on the placebo effect has shown it may be useful in managing pain, critics of traditional and complementary medicine are quick to point out that such alternative treatments only work in the mind of the patients and have no basis in modern science.

However, a more recent analysis on the effectiveness of acupuncture yielded even more puzzling results.

Researchers from the Memorial Sloan-Kettering Cancer Centre in 2012 conducted a systematic review of randomised and controlled experiments on acupuncture, involving almost 18,000 patients.

Overall, these trials collectively had three different groups of patients; those had regular hospital care; those who underwent acupuncture therapy; and those who subjected to ‘sham’ acupuncture, where needles were replaced with non-penetrative devices or not placed on the required pressure spots.

When comparing patients without acupuncture treatment to those who received some form of it, the severity of pain was reduced by 50% with the use of acupuncture.

However, when comparing real acupuncture therapy to a sham one, the reduction of pain severity was only 20% – not as remarkable, but still statistically significant.

On one hand, this still makes the case for the usefulness of acupuncture; but at the same time, it is interesting to note that believing one is experiencing the real deal was good enough for some people.

While scientists debate over what these results really mean, does it really matter to the patient if he or she feels better with a treatment that does not come from the addictive and sedative qualities of typical pain relief drugs?

Natural doesn’t mean safe

Avid supporters of traditional remedies often tout the benefits of having a more natural and ‘chemical-free’ approach to health.

Turmeric for instance, is a widely recognised folk remedy for treating bruises and wounds as it has natural antibiotic properties.

And sometimes, scientific research simply backs up what our ancestors have been using for years – or yield even more remarkable results.

A study jointly conducted by the Malaysian government and the Massachusetts Institute of Technology carried out last year found that Tongkat Ali extract may help boost the immune system of middle-aged adults.

While the plant has been more commonly used for its aphrodisiac properties, the randomised controlled trial found that it also significantly increased the number of immune cells compared to a placebo.

But ‘natural’ does not always mean that it is the best course of treatment if not properly administered or researched.

After all, even water can be dangerous in excessive doses, and plenty of conventional drugs were also derived from plants.

An example of the potential danger of ancient herbal remedies may be deduced from contemporary research on aristolochic acid and its effects on the renal system.

Aristolochia is a herb traditionally used in various cultures for a range of reasons including as an aid for child birth, alleviating joint pain, and aid wound healing – it is also potently toxic for the kidney, particular with long-term use.

In the 1990s, Belgian doctors started noticing that dozens number of otherwise healthy women were being admitted to hospitals with late-stage renal failure; half of these women required surgery to remove their non-functioning kidneys.

These women were also clients of a medical clinic which had been prescribing Chinese herbs to help them lose weight, which apparently contained aristolochic acid.

The relatively poor regulation and lack of manufacturing oversight when it comes to herbal supplements also adds another layer of risk for consumers.

A study carried out by Curtin University, Murdoch University and the University of Adelaide in 2015 found that half of 26 widely available traditional Chinese medicines contained toxic metals, prescription medications, and stimulants – none of which were listed on the products’ labels.

Some even contained over-the-counter drugs such as ibuprofen, blood thinners, and steroids.

Similarly, a 2008 study funded by the National Centre for Complementary and Integrated Health in the United States (US) found that 21% of 193 Ayurvedic products made in either the US or India contained higher than acceptable levels of lead, mercury and arsenic.

In Malaysia, traditional and herbal medicines have to be registered under the Control of Drugs and Cosmetics Regulation 1984, to ensure their quality, efficacy and safety.

Even so, it would seem that unregistered products are still readily available for willing customers — sometimes with dire results.

The Health Ministry last year (2016), had to issue numerous warnings against various purportedly traditional supplements after they were found to contain dexamethasone, a corticosteroid medicine that appears to be commonly found in unauthorised traditional products.

Consumption of inappropriate amounts of dexamethasone without proper medical supervision can cause an array of adverse health effects and lead to Cushing’s syndrome, a metabolic disorder.

In some cases, the ministry was alerted following complaints – and hospitalisation – of those who took unverified ‘health’ products like Za’faran, Snake Powder Capsules, JC Gold and Tu Cho Pan Chi Pian.

Blending science with tradition

One of the main criticisms of complementary medicine is relative lack of rigorous research and evidence compared to modern medicine.

This is partly due to the cost of undertaking such a credible evaluation of a drug or a form of treatment.

For example, a conventional drug is required to go through several phases of tests before it can be made available to the public.

After promising tests on animals, trials of the drug are carried out on humans to see if it is safe for consumption.

This is followed by tests on whether the drug actually works in the way it is supposed to.

Finally, the drugs is tested against a current treatment or a placebo.

Comparing the drug with a placebo is particularly important, because some patients may well recover from their illnesses without any treatment at all – researchers will have to prove that the drug is the true cause of the cure.

This process of testing also helps document if the drug has any side-effects, both in the short- and long-term.

Another challenge of testing traditional medicine, particularly herbal products, is determining the effective chemical compound within a blend of herbs.

However, with greater scientific advancement and funds being poured into researching traditional medicine, there may be ways around these hurdles.

Harvard University for instance, has collaborated with several universities in China to develop a ‘natural extract database’ to isolate and determine the quality of various types of herbs.

Chinese scientist Youyou Tu’s win of the 2015 Nobel Prize in Physiology or Medicine is another example of how ancient knowledge can inform current science.

Tu, who is based at the Chinese Academy of Traditional Chinese Medicine in Beijing, received the prize for her work in advancing malaria treatment.

Having spent her entire career researching traditional Chinese medicine, Tu first the first to extract an active component called Artemisinin from the Chinese herb qinghaosu, and document how it worked.

This result means that Artemisinin can now be clinically studied and produced for better malaria treatment.

Better regulation

On the local front, integration seems to be the direction the Health Ministry wants to head towards, along with better regulation.

The government introduced traditional medicine into the public healthcare in 2007, with Hospital Kepala Batas in Penang being the first hospital in the country to have a traditional and complementary unit.

As of December 2015, a total of 14 such units have been established in various hospitals nationwide.

Among the services available at these units are traditional Malay massage and acupuncture for stroke patients; post-natal care; herbal treatments for cancer patients; and Ayurveda treatments for patients suffering from chronic pain, insomnia, headaches and anxiety.

Keeping in the mind the need to keep a balance between proven modern medicine and possibly

While the ministry established its Traditional and Complementary Medicine Division in 2004 (after almost a decade as just a unit), the division now has more regulatory powers than before thanks to the Traditional and Complementary Medicine Act 2016.

In effect since August last year (2016), the Act provides for Traditional and Complementary Medicine Council and made it mandatory for all practitioners to formally register their practice.

Those who fail to register with the council face a fine not exceeding RM30,000 or a jail term not exceeding two years, or both.

Prior to this, some 13,000 practitioners had voluntarily registered with the ministry.

The Act also requires registered practitioners to adhere to a professional code of conduct, as well as penalties for breach of the council’s rules.

While modern science is an important tools in maintaining the quality of healthcare, the holistic view of traditional approaches may well push the boundaries of the way we look at health and well-being to greater heights.

What do these terms mean?

While many tend to use words like ‘holistic’, ‘traditional’ and ‘alternative’ interchangeably, there are some key differences between these types of treatment.

Traditional medicine refers to a therapy or health practice that has developed over centuries within a particular culture. It is usually formed around a particular belief system.

Examples include traditional Chinese medicine, Ayurveda, and Islamic medicine.

Complementary medicine means a treatment that is used alongside modern medicine. It is generally used to help patients feel better with their existing treatment.

Alternative medicine is where a therapy is used to replace conventional medical treatment.

While modern medical treatments are required by law to through rigorous testing for quality and safety, many alternative therapies have not been subject to the same level of scrutiny and tend to not have scientific proof. Some types of alternative therapy may even cause harm, particularly if conventional treatment has been abandoned.

Examples of complementary treatment

Homeopathy

Homeopathy is a form of alternative medicine that claims to stimulate the body’s own healing process to combat diseases.

This is done through specially prepared and highly diluted medicines.

Homeopaths say they aim to treat the whole person, taking into account personality, lifestyle and hereditary factors, as well as the history of the disease.

The effectiveness of homeopathic preparations is highly disputed by medical science, and scientists question how a highly diluted substance could bring about any effect.

Reiki

Developed in the 19th century, reiki is a Japanese form of therapy that aims to increase energy levels and promote relaxation.

Reiki is applied through non-invasive, non-manipulative gentle touch.

The underlying philosophy of reiki is that if a person’s energy is low, they are more likely to be unwell or stressed.

If it is high, however, they are more capable of being happy and feeling well.

Reflexology

Reflexology is a form of complementary therapy which aims to promote overall wellness – through the feet.

Modern reflexology is based on the principle that the foot has ‘reflex’ points that correspond to the various structures and organs throughout the body.

Reflexology practitioners believe that by massaging or stimulating the reflexes using specific techniques, there will be a direct effect on the corresponding organ.

However, reflexologists generally do not diagnose specific conditions, and foot problems themselves such as corns and bunions are not usually within their scope of practice.

Naturopathy

Naturopathy is a holistic approach to wellness, based on the importance of having a healthy diet, fresh water, sunlight, exercise and managing stress.

A range of non-invasive therapies are used to support a patient’s individual; such as diet and lifestyle advice, massage, counselling and herbal medicine.

What to look out for with traditional and complementary treatments

If you’re thinking of trying out complementary medicine or therapy, here are some things to take note of.

1) Check if your health practitioner is registered with Health Ministry

The Health Ministry has required foreign practitioners to register their practice for some time now. Thanks to the Traditional and Complementary Medicine Act 2016, it is now mandatory for local practitioners to do the same.

The ministry also recognises several practitioner bodies representing various types of alternative therapies in the country, and as well as the practising certificates issued by these bodies.

2) Make sure any treatments or medications prescribed are certified

Aside from a registration number, regulated products must have a hologram sticker on their packaging or on the products themselves.

You can also check whether a product is genuine by visiting http://portal.bpfk.gov.my/bpfk.

3) Don’t be too impressed by titles

Only registered medical professionals registered under the Medical Act 1971, and those with post-doctoral degrees, can legally use the title “Dr” in front of their names.

Similarly, just because someone calls themselves a ‘sifu’ or ‘master’, it may not necessarily mean they are qualified to prescribe medical treatment.

Investigate their credentials before placing your health in their hands.

4) Be wary of grandiose claims

Does a product or therapy claim to cure all your ailments with a single quick fix?

Or is a new form of alternative medicine being touted as a treatment for all sorts of diseases, from cancer to the common cold?

If yes, chances are that this miracle cure is too good to be true.

There is a reason why modern medicine is subjected to numerous tests and clinical trials before being introduced to the wider public – to ensure quality, safety and efficacy.

Responsible traditional and complementary practitioners also do not tout fantastical cure-alls, and will instead focus on improving your overall well-being

5) Consult a medical professional alongside traditional treatment

Talk to your medical doctor about any complementary treatment or supplements that you are considering, particularly if you are already taking medication.

Some traditional or herbal remedies may adversely react with your current treatment, so it is best to seek professional advice.

Be wary if a complementary health practitioner tells you to completely stop receiving modern treatment.

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