By DATUK DR ABDUL HAMID ABDUL KADIR
TO understand the background to the debate on complementary and
alternative treatments, one has to look at the Medical Act 1971.
Section 34(1) of the Act, in the sub-section “Malay, Chinese, Indian or
other native methods of therapeutics”, states:
“Subject to the provisions of sub-section (2) and regulations made
under this Act, nothing in this Act shall be deemed to affect the right
of any person – not being a person taking or using any name, title,
addition or description calculated to induce any person to believe that
he is qualified to practise medicine or surgery according to modern
scientific methods – to practise systems of therapeutics according to
purely Malay, Chinese, Indian or other native methods, and to demand and
recover reasonable charges in respect of such practice.”
The Act does not restrict any person from practising
native/traditional/complementary medicine, so long as the person is not a
medical practitioner registered under the provisions of the Medical Act
1971.
Whether complementary and/or traditional medicine is included by
definition in the “system of therapeutics according to purely Malay,
Chinese, Indian or other native methods” is open to interpretation.
However, it is common knowledge that those practising non- Western
complementary system of therapeutics normally use herbs and additionally
some allopathic medications.
The use of allopathic medications by such practitioners is, in most
instances, for diseases and indications not usually or conventionally
employed in the practice of evidence-based medicine.
Some clarifications on chelation therapy: It is a series of intravenous
infusions containing EDTA (disodium ethylene-diamine-tetraacetic acid),
an organic chemical (amino acid), which may be used to treat iron- load
from multiple blood transfusions, lead poisoning and other heavy metal
poisoning.
EDTA, or its sodium salt, is a chelating agent, forming co- ordination
compounds with most metal ions, such as calcium, magnesium or copper. In
medical and laboratory practice, EDTA is used as an anti- coagulant
additive. When blood is taken for tests, EDTA is added to prevent the
blood sample from clotting, by scavenging the calcium from the sample.
After EDTA was found effective in chelating and removing toxic metals,
like lead, from the blood, some scientists postulated that hardened
arteries could be softened if the calcium in their walls was removed.
This formed the basis for claims that chelation therapy is effective
against atherosclerosis, coronary heart disease and peripheral vascular
disease.
Its supposed benefits include increased collateral blood circulation,
decreased blood viscosity, improved cell membrane function, decreased
arterial vasospasm, decreased free radical formation, inhibition of the
aging process, reversal of atherosclerosis, decrease in angina, reversal
of gangrene, improvement of skin colour and healing of diabetic ulcers.
It is claimed chelation is effective against arthritis, multiple
sclerosis, Parkinson’s disease, psoriasis, Alzheimer’s disease, and
problems with vision, hearing, smell, muscle co-ordination and sexual
potency.
These claims have never been tested by scientific methods or found
effective in the treatment of such a multitude of diseases.
There are instances to show that there indeed are early and late
complications with chelation therapy, like the heavy loss in the urine of
trace metals like zinc, which has an important role in strengthening the
body’s immune function. Loss of large amounts of calcium through
chelation is also believed to create loss of calcium from bones.
Registered medical practitioners, on the other hand, practise
evidence-based medicine. The system of treatment of their patients is
based on well-established and sound scientific studies and principles of
therapeutics, and their efficacy to control, treat or modify diseases.
The system of therapeutics so advocated can be and is being practised
safely universally with predictable results in the vast majority of
patients.
The medications used by allopathic doctors are very specific for
well-defined disease conditions, and the composition, use and adverse
reactions are monitored by authorities established for such specific
purposes. In Malaysia, we have the Drug Control Authority.
Chelation therapy with EDTA would come under the category of
complementary medicine because its widespread use by some registered
medical practitioners is not how it had been used originally on
evidence-based therapeutic criterion.
By prescribing various supplements like large amounts of Vitamin C and
several B vitamins during chelation therapy for treatment of diseases
where there has been no scientific evidence adduced for their
effectiveness and efficacy in such diseases, registered medical
practitioners are, in fact, practising complementary medicine.
The onus to prove that chelation therapy, and other similar
complementary me- dical practices, is a sound, repeatable system of
therapeutics rests heavily on the proponents of complementary medicine.
Anecdotal testimony from patients is not enough.
Medical practitioners who treat their patients with chelation therapy
would have to show scientific evidence that their patients have improved,
not in the short term but more importantly, in the long term.
They have to produce documented case reports with long-term follow-up,
and data from autopsies of former patients. Doctors practising chelation
therapy have published no such data.
The few well-designed studies that have addressed the efficacy of
chelation for atherosclerotic diseases have been carried out by medical
scientists in the US Food and Drug Administration, the American Heart
Association, American Medical Association, American College of Physicians
and the University of Calgary, to name a few. Without exception, these
studies found no evidence chelation worked. There are many patients in
Malaysia who claim to have benefited from chelation therapy and some have
written testimonials and have volunteered to give evidence in person.
Many others who have not benefited remain silent sufferers.
The Medical Act 1971 has no jurisdiction over non-registered or
non-medical persons who practise complementary medicine or native
medicine or traditional medicine. But registered medical practitioners
who practise such medicine would clearly be misleading the public; and
presenting themselves as trained, registered and certified to practise
all systems of therapeutics, thereby adding credibility to their
practice.
There may be a place in the future for “integrative medicine”, but let
us not ignore the fact that even in advanced countries where such
practice is finding a niche, there is widespread opposition which cannot
be dismissed simply as a professional turf war.
The Ministry of Health is “keeping an open mind” about the practice of
complementary and traditional medicine in Malaysia.
It is a fact that the ministry and the universities are looking into
ways and means of regulating traditional and herbal medicine practice by
analysing the hundreds of such medications being sold openly in this
country.
Members of the public have the right to choose whatever system of
treatment they prefer for whatever reason.
But it is also the mandated right of the ministry to set the standards
of health care, and to demonstrate its duty and responsibility to point
out to the public the various pitfalls in any system and the unpleasant
consequences.
DATUK DR ABDUL HAMID ABDUL KADIR
Ethics Committee chairman Malaysian Medical Council Ministry of Health
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