Opponent’s letter to read

(1) Probe integrative medicine’s dramatic claims L-F Ng, Dec 14, 05 4:25pm

In medical practice, when a treatment is effective, it outshines other competitors – real and bogus – and does not evoke any controversy. When something is dubiously or marginally effective, then practitioners have a duty to their patients to ensure that what is proposed is truly beneficial and that, if given the benefit is quantifiable, this should be weighed against the potential known adverse effects.

The Hippocratic principle of primum non nocere (first, do no harm) has been ringing through in the hearts of ethical registered medical practitioners throughout the world for ages and on this rests the imperative ethical difference in attitude between a registered and an non-registered medical practitioner. But, within modern medicine this divide has become somewhat blurred.

This is made worse in some modern, developing societies by medical practitioners of dubious quality being allowed to be registered. In such environments, doctors have to be wary of some of their colleagues and the methods they use. This is also further made more muddy by the commercialisation of medicine with a pure profit motive being foremost in the mind of a registered practitioner.

Dr Mohd Ebrahim Sulaiman, a Klang Valley-based private practitioner, has made some substantive and tantalising claims alluding to treatments which have been untested, or tested negatively within randomised controlled trials, and which are not in the data bases of evidence-based medicine – principally the Cochrane Library.

He also claims that the Health Ministry had given him permission to treat thousands of patients who had been ‘written off’ by heart and cancer specialists. A good randomised controlled rrial is the only scientific way to test a superiority (or non-inferiority, i.e. equivalence) of a new treatment and the designed is tightly controlled with an up-front declared required number of subjects to be recruited and statistical methods prospectively planned.

In some designs, placebos are tested against the purportedly beneficial treatment. One or several patients benefitting with the study treatment may be quite meaningless – as this may just represent a placebo effect. Just as with the saying that ‘one swallow does not make a summer.’

Dr Anantha Krishnan’s call for consideration of integrative medicine strategies to be incorporated is welcome but only with the caveat that such interventions will need systematic rigorous testing using established methods used in evaluating new and established therapies. Otherwise, they will not withstand the test of scientific credibility.

Similarly, if the methods described by Ebrahim do work, the world of peer-reviewed evidence based medicine would have discovered it too and evaluated it critically and published results for the benefit of humankind. But, the sad fact is that this is untrue.

Ebrahim (also known as Dr Maung) had created an uproar in a professional bulletin board by his claims in the second half of the 1990s. This was stimulating and superficially appealing when gleaned over by the uncritical scientist or practicing clinician.

In 1999, when I was based in Kuala Lumpur, I challenged Maung (and offered intellectual support to test his enthusiastic hypothesis), in my capacity as a consultant medical oncologist, to design and conduct a randomised clinical trial to prove or disprove his claims. He was unable or unwilling to do so.

Dr Maung even contacted me by telephone to discuss the design and insisted on incorporating a large heterogenous (biologically very different) mix of heart and cancer patients in the trial design – a strategy which I rejected for obvious reasons and the issue was dropped.

The closed debate in the professional forum continued for a while and when Maung became so heated that he threatened to sue another critic in that closed forum, he was expelled from that bulletin board by the administrator. All this can be all verified by the administrator of Malaysian Medical Resources (previously known as Dobbs or Doctors Only Bulletin Board System).

If we assume that Maung’s present claims are not misleading and completely true, it would be a distinct benefit for the world of medicine – not in Bolehland alone. If however, he has made premature, misleading and unwarranted claims then the Malaysian Medical Council and the Health Ministry should now awake from their slumber and conduct detailed inquiries. They should also register and monitor all health interventions which have potential to cause harm (even economic harm) whether they are allopathic or alternative.

The gullible public needs real answers and any dramatic discovery needs to be encouraged while a hoax quickly extinguished and eclipsed as with all other snake oils. I am particularly interested in the validation of the claim on how the ministry gave permission to Maung to treat his patients.

The follwoing letters can be read in WWW.malaysiakini.com/letters.

Healthcare system should not kill
04:09pm Tue Dec 13, 2005
Hypocritical oaths of private hospitals
12:10pm Mon Dec 05, 2005
Integrated medicine saved my wife
04:19pm Fri Dec 02, 2005
Health is the rule, disease the exception
03:02pm Fri Nov 25, 2005
Have quality rating scale for medical practices
03:30pm Thu Nov 10, 2005
Medical errors need to be checked, monitored
03:51pm Tue Oct 25, 2005