Monday, September 29, 2014


I was asked to reply to an article that appeared in the Star yesterday entitled " The Art of Dispensing Drugs".

This is what I wrote. I would like to post it here.

There are currently 4 forms of heath therapy.
1.       Firstly there is Evidence Based Medicine ( EBM) . This is commonly called western medicine,  which has been extensively studied, has a lot of clinical data, with set training programs ( undergraduate and post graduate ) and with clinical practice guidelines for their use.
2.       Secondly there is alternative therapy. This refers to the use of approaches that are not part of EBM medicine but is used  as replacements for, rather than complements to, EBM.
3.       Thirdly complementary medicine. This refers to a group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine ( EBM ).  This Complementary Medicine is often  practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses. . Complementary medicine includes natural products, such as dietary supplements, herbs, and probiotics, as well as mind and body practices, such as meditation, chiropractic, acupuncture, and massage. This form of therapy is very common and is often used together with ( complements ) evidence based medicine.
4.       Fourthly, there is integrative medicine. Integrative medicine combines conventional and complementary approaches in a coordinated way.
      Number one we all know well and has proven itself to be safe and largely effective ( except for a few exceptions like certain malignant diseases.  As EBM physicians, we all have taken an oath that we will first do no harm, and so EBM is largely safe. Although it is true that we comfort always, relief often and cure sometimes. Sad to say, in this day and age, there are still many conditions that we do not yet fully understand, and some we cannot cure.
      Number 2, I shall dismiss by just reminding that it should NOT be undertaken except with advise from trained professionals, because it may do harm. Stage 1 Ca Breast, which in this day and age, is curable, may be fatal, if proper therapy is delayed because of the use of alternative therapy.
     Number 3 is where we will spend some time discussing.
Complementary medicine
This is gaining much popularity because it is often perceived to be safe with no side effects and since the marketing of these therapy is not regulated as strictly as conventional medicine, the advertisements are often too good to be true. Nonetheless, worldwide, there is an increasing trend. It makes money.
A few important  points must be emphasized and consumers are advised to take note.
  1. Firstly, this market is very poorly regulated. Any registered company  can manufacture and market a product.  Before we dwell into the issues of effectiveness ( clinical efficacy ) let us spend some time on safety standards. There is little  oversight  during the stage of manufacture. ( good example can be found in milk powder manufacture in China ). There is some oversight when it comes to the Ministry of Health  for approval. Besides paper documentation, there is also batch testing of the drug and also random testing post approval. However, as often the case, for batch testing for approval by the Ministry, the company will very likely follow  all the procedure but as for random batch testing, your guess is as good as mine. Thereafter, we depend on adverse reaction reports for the seller and customer.  Again, your guess is as good as mine. So there is a big question mark over safety. There have been many who have suffered renal failure, liver failure, occult malignancies, and of course, allergies with these medications. In some ways, all these batch testing steps are easier when you are dealing with chemical compounds known to science. What about those herbal preparations which appear in almanacs and past me down records, where the chemistry department do not even know how to analyse the main ingredients. How then can you predict the effects and side effects? How then do you know it is safe when we do not even know the herbal compounds?. Some like “cordiceps” we know. There are so many that we have no idea.
2.Secondly, there is the issue of effectiveness. Obviously, complementary medicine have almost no clinical data. No one will invest in doing medical trials on complementary medicines, because they cannot be patented. Many of these complementary medicines are natural  products  and belong to nature.  So if you try to do a clinical trial on a certain product, that you cannot patent, ( after spending millions and you prove  that the product effective, your competitor will just produce their version and sell. That is why, for example, no one wants to prove the effectiveness of Co-enzyme Q10, papaya leaves for dengue, snake grass for cancers, etc etc, ( except perhaps a non-profit organization, or a government agency ).
So effectiveness of complementary medicine is based very much on here say and also a theoretical basis. For example, normal brain function uses Omega 6 fatty acid, so the more I give a young child, the better the child’s brain. In a way, I appeal to reasoning and emotions of “helping my child”. Data is lacking. The body cells has enzyme Q10 for energy generation, so if I give you Co-enzyme Q10, it will benefit you. That is the kind of reasoning. No data.
3.Thirdly, the marketing strategy for these companies are usually very aggressive. They use direct selling and unethical advertisements, making all sorts of claims, usually half truths. Regulators are over stretched to cope with them and there are usually multiple government agencies overseeing their marketing techniques, and so unless there is a death, or a catastrophe, these companies get away scott free.
Evidence based medicine has evidence to support its used or tell us its dangers. In that sense, its use is safe and regulated. Alternative medicine should only be embarked upon with good medical advice. Complementary medicine has little medical data on safety and effectiveness and should not be simply consumed. Many have suffered from consequences of taking the wrong complementary medicine. Some have even died. Integrative medicine will have the benefit of medical advice because it still has an element of conventional medicine.

1 comment:

Anonymous said...

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