Integrating modern and traditional & complementary medicine

  • Health
  • Wednesday, 22 May 2019

Dr Mohd Namazie notes that some people have implicit faith in T&CM, but advises patients to see a medical doctor first before seeing a T&CM practitioner if they wish.

Almost a third of Malaysians living in urban areas are consulting traditional and complementary medicine (T&CM) practitioners to treat their ailments.

In 2004, the Health Ministry (MOH) conducted a big scale study asking patients a general question: Have you ever tried any T&CM products or services?

A whopping 69.4% said they had used it at least once in their lifetime.

“In 2015, we incorporated this survey into the National Health and Morbidity Survey (NHMS) and asked: ‘Have you ever tried any T&CM products or services with consultation?’ – meaning did you consult a T&CM practitioner first before using the service ... 29.25% said yes.

“This is an important figure as more of the urban population are resorting to alternative treatment compared to the rural population.

“The result is not what we had expected,” says Dr Chai Koh Meow, principal assistant director of MOH’s Traditional and Complementary Division.

The survey also revealed that more females were using T&CM compared to males.

A third of respondents said they sought practitioners to treat various illnesses, while two-thirds of them said it was for overall wellness.

Their intention for use was primary, i.e. if they had a cough, they would seek traditional medicine, and if that didn’t work, then they would see a doctor.

Secondly, the intention was complementary, i.e. they used both.

And lastly, it was as an alternative treatment, i.e. the hardcore T&CM patients who refuse to see a medical doctor.

Dr Chai says, “People are using T&CM due to cultural and historical influences, such as in Korea and Singapore; as complementary therapy in Europe and North America; and as traditional medicine in many African countries, as it is one of their primary sources of healthcare.

“Many of these countries have more traditional healers than western doctors.”

The survey results are not surprising, considering the worldwide re-emergence of using our ancestral remedies, along with a widespread belief that modern medicines may be harmful in the long run and cause other problems while treating the disease.

“Some patients experience adverse effects from western medicines, so they opt for T&CM.

“Our existing system actually pushes the patient away to seek another form of treatment, so there are certain gaps in the mainstream healthcare system that need to be addressed,” he says.

Noting this, the ministry has been working on integrating T&CM into the national healthcare system, so that it can co-exist with modern medicine and contribute to enhancing the health and quality of life of Malaysians.

Presently, there are 15 T&CM outpatient units in local public healthcare facilities, and one hospital that offers services in Sungai Buloh, Selangor.

Blending perspectives

Malaysia’s T&CM policy was launched in 2001 and revised in 2007, following the World Health Organization’s (WHO) introduction of the guidelines on how to integrate T&CM into the modern healthcare system.

WHO member states are to design and implement the policy in accordance with their own circumstances.

“In 2007, we started providing services in government hospitals and launched the blueprint in 2018.

“One of the action plans in this blueprint is to propose a framework that is suitable for Malaysians.

“All the previous documents talked about integration, but they never told you what to do and how to do it,” says Dr Chai, who was instrumental in formulating the blueprint.

He was giving a keynote address at the 7th Seminar on Evidence-Based Medicine, themed "Integrative Medicine - Is it Relevant?", organised by the Malaysian Medical Association (MMA) on April 27, 2019.

Traditional and complementary medicine, TCM, alternative medicine, modern medicine, Dr Chai Koh Meow,
‘Many medical doctors have no or inaccurate information about
T&CM, while many T&CM practitioners have the wrong concept or misunderstanding about western medicine,’ says Dr Chai. — Photos: KAMARUL ARIFFIN/The Star

One of the challenges of the integration is the lack of knowledge practitioners from both sides have about each other’s practices.

“Many medical doctors have no or inaccurate information about T&CM, while many T&CM practitioners have the wrong concept or misunderstanding about western medicine.

“Medical doctors also demand scientific evidence as criteria for integration, but T&CM has existed long before science.

“Its philosophy and theories are unique and time-tested, but there are barriers to understanding the literature.

“The western medicine perspective is a relatively recent phenomenon, with basic theories and philosophies that are accepted internationally.

“The root issue in the integration is the inter-practise of medication,” points out Dr Chai.

We need to find a way using the best features of each system and compensating for certain weaknesses in each.

There are two pathways Malaysia can follow to integrate both systems.

He says, “Many of us do not know that traditional Chinese medicine, Ayurveda and Siddha (an ancient system of medicine prevalent in South India) practitioners take an active step to understand and incorporate a modern approach into their systems.

“For example, if they’re using acupuncture, they know how to locate the point, but they don’t know about the anatomical structure, so now they have developed a new syllabus – anatomical structure for acupuncture.

“They also use x-ray images to diagnose bone fractures, but in the past, they used functional tests using their hands to feel whether there is a fracture.

“Using the western medicine pathway, the medical practitioner can try to enlarge the scope of procurement by incorporating medical practices from other origins, e.g. using acupuncture for pain management.”

Once the western medicine and T&CM pathways are successfully integrated, it will lead to what Dr Chai calls “New Medicine”.

“I don’t know when this new medicine will come about, but it will be a few generations away!” he opines.

Enforcement underway

According to unconfirmed reports, there are around 15,000 to 20,000 T&CM practitioners in primary healthcare – 99% have their own clinics.

“We are trying to regulate them. On the tertiary and secondary healthcare area, there is currently only one traditional Chinese medicine hospital in Malaysia with less than 100 beds, and that is Tung Shin Hospital (in Kuala Lumpur),” says Dr Chai.

The Traditional and Complementary Medicine (T&CM) Act 2016 (Act 775), which governs T&CM practice and practitioners in Malaysia, was gazetted on March 10, 2016.

The act defines T&CM as traditional Indian, Chinese and Malay medicine, Islamic medical practice, homeopathy, osteopathy and chiropractic.

Malaysia is one of the very few countries to regulate the diverse practices and practitioners of T&CM.

The enforcement of the act will be conducted in phases.

At present, the MOH has embarked on enforcing Phase 1 of the act, where the T&CM Council has been formed and is currently making the necessary preparations for the enforcement of Phase 2, which will include registration of T&CM practitioners, as well as disciplinary proceedings.

The T&CM Council, which is to operate just like the Malaysian Medical Council (MMC) acts in governing doctors in the country, will also be equipped with its own enforcement team to give it more bite.

According to MMA president Dr Mohd Namazie Ibrahim, some people have implicit faith in T&CM.

Traditional and complementary medicine, TCM, alternative medicine, modern medicine, Dr Mohd Namazie Ibrahim,
Dr Mohd Namazie notes that some people have implicit faith in T&CM, but advises patients to see a medical doctor first before seeing a T&CM practitioner if they wish.

“Our advice to patients is to consult a registered medical practitioner first, and if you prefer to seek a T&CM practitioner later, make sure they are legit.

“There are many who are hired on a contract basis by MOH hospitals,” he says.

In the private sector, there is no integration as T&CM is not included in the Private Healthcare Facilities and Services Act 1998.

Current regulations do not allow MMC-registered medical practitioners to practise T&CM.

No dual registration is allowed, though there are medical doctors in private practice with T&CM qualifications.

Dr Mohd Namazie says, “There is a caveat there, and yes, there are medical practitioners who offer some form of complementary medicine as well, but once the T&CM Act is fully implemented, it prohibits non-registered practitioners from practising T&CM.

“You cannot practise both in the private sector.”

Since private hospitals do not have a T&CM unit, doctors in the private sector find it hard to refer patients who might want to seek alternative treatment to manage side effects, for example, from cancer.

Adds MMA’s T&CM chairman Dr Anil Kumar Kukreja: “I cannot refer patients directly to a T&CM practitioner, so I have to refer them to a MOH specialist, who can then refer the patient within that individual hospital setting.

“We don’t have a list of these T&CM practitioners, so unless that list comes out, we cannot refer patients.

“When we say practitioners, it’s a broad terminology – what the act is registering are bomohs, Chinese sinsehs, and Indian or Malay traditional healers, who have been practising in some village somewhere.

“The T&CM division has specific guidelines and practitioners must show evidence to the committee on whether they have inherited the knowledge or gone for actual diploma programmes.

“Presently, we have eight institutions in Malaysia providing such courses.

“In the future, a T&CM practitioner can only be registered with the council if he has paper qualifications, but not currently.”

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