Friday, 7 September 2012

'Quack' & Penjual Obat

"You mahu dengar nasihat saya ke (doktor pakar), atau quack (penjual ubat tanpa tauliah), terpulang pada you-lah, I dah separuh umur dihabiskan untuk dalami ilmu perubatan". - begitulah lebih kurang komen yang diberi seorang sahabat apabila saya tanyakan beliau beberapa perkara berkaitan fungsi badan manusia dan kemujaban ubatan alternatif.

Minum Air Batu

Sudah lama saya menderita sakit di bahagian belakang khususnya di kawasan pinggang. Telahan saya ialah disebabkan terlalu banyak duduk. Yelah, setiap hari memandu jauh ke tempat kerja. Kemudian pula, kerja pun hanya duduk di dalam pejabat. Makan pun duduk. Kemudian memandu lagi pulang ke rumah. Justeru, seharian itu dipenuhi dengan "kedudukan" sahaja.

Kata orang kepada saya, jangan minum air batu kerana ia adalah punca sakit urat dan besar kemungkinan itulah juga punca kepada sakit belakang yang sentiasa saya alami.

Soalan ini saya ajukan kepada sahabat yang menjadi doktor pakar, dengan PhD perubatan dari Universiti Oxford itu. Ini kerana semasa Summer BBQ itu saya perhatikan beliau sendiri gemar minum air sejuk/air batu.

Beliau adalah doktor pakar kedua yang gemar minum air batu (dan tidak merokok) selepas seorang lagi sahabat yang dahulu saya temui berkhidmat di Hospital Kuantan.

Kata sahabat itu, "Allah menjadikan tubuh kita cukup unik. Apabila benda sejuk masuk ke dalam tubuh (katakan salur kerongkong), sistem tubuh akan segera bertindak balas bagi menstabilkan suhu badan kita. Apabila kita telan sebiji ais, apabila ia melalui kerongkong, bahagian dalam badan akan segera bertindak balas dan mencairkan ais itu sebelum tiba ke dalam perut. Memang kita rasa sejuk tetapi hanyalah seketika sementara tubuh berfungsi menstabilkan suhu yang sepatutnya untuk tubuh manusia. Begitu juga dengan makanan panas yang dimakan, juga akan distabilkan tubuh melalui tindak balas tertentu bagi memelihara organ dalaman badan kita. Itulah kebesaran Allah yang menciptakan kita".

Tambahnya lagi "Saya tidak pandai bercakap dan kamu boleh dengar orang lain kata apa, tetapi saya boleh menjelaskan kepada kamu berpandukan kajian perubatan, kerana saya bukanlah seorang penjual ubat".

Bangga saya apabila orang terpelajar seperti beliau apabila bercakap mengenai perubatan dan kesihatan turut menyelitkan "kebesaran Allah yang mencipta tubuh manusia" - moga Allah memeliharanya.

Sesungguhnya kata-kata sahabat itu secara langsung mengajak saya supaya berfikir dan insaf melihatkan kebesaran ciptaan Allah taala - iaitu diri kita sendiri!

Tidak lama dahulu (agak lama juga sebenarnya), saya ada beli sebuah buku yang "sinis dan kelakar" bertajuk "SUCKERS - How alternative Medicine Makes Fools of Us All" tulisan Rose Shapiro (2009). Saya yakin para pembaca boleh memahami English yang mudah, justeru saya hanya "copy n paste" beberapa petikan menarik di dalam buku tersebut.

How to spot a quack

(p. 25 - 28) If it walks like a duck and it talks like a duck, you can be reasonably sure it is a duck.

quack! quack! here I come (google images)

Promoters of quackery and health fraud can be harder to identify. It is especially confusing when, as it so often the case, they offer a package composed of contradictory diagnostic or therapeutic methods.

The Oxford English Dictionary defines a quack as "someone who is an imposter in medicine or one who professes a knowledge or skill concerning subjects of which he is ignorant".

The word is derived from the Dutch "kwakzalver": one who prattles or boasts about their supposedly healing salves". It is more complicated than that though. Such definitions "suggest that the promotion of quackery involves deliberate deception, but many promoters sincerely believe in what they are doing".

But because they are likely to be offering the same type of diagnostic and treatment methods the difference between the two is largely academic - quackery is quackery regardless of the merits or otherwise of the practitioner's character.

The task of spotting quackery is made easier once you know that there are large areas of medicine in which it is never found. These are the ones that involve outcomes which are easily measurable, or where there is a risk imminent death.

There is no homeopathic contraceptive, for example. Nor will reflexology to be used following a stabbing, or Chinese herbs in the treatment of acute conditions like a broken leg, appendicitis or heart attack. Chinese Alternative Medicine (CAM) practitioners know better than to compete with mainstream doctors in the provision of trauma care. As one of American CAM provider says, "If you got hit by a truck there's nothing better than the modern medical system".

Instead, alternative practitioners are mostly to be found diagnosing and treating chronic conditions such as back pain, fatigue, and food intolerance or when, as one Bristol CAM provider describes it, people "feel unwell in themselves but are not 'ill' in the Western sense".

It is usually quite hard to measure what they do. When they claim to be able to 'rebalance energies' or 'correct yin/yang imbalance at cellular level' it becomes difficult to measure diagnostic accuracy and whether or how a treatment has worked.

There are a number of common identifying features which, once familiar, make the identification of quackery surprisingly straightforward:

1) the disclaimer (p. 28)

We start with what usually, almost as if it is an afterthought, comes at the end of nearly all dubious health claims or pseudoscientific information in newspaper, magazines and the internet. It will go something like this:

WARNING!!! The following information is not intended as a substitute for the advice provided by your own physician or health care provider of any health problem or disease. Before following any of these recommendations you should consult your GP (general practitioner) about any medical problems or special health conditions. You should not use the information as a substitute for professional medical advice when deciding on any health-related regimen, including but not limited to diet or exercise. Featured products are not intended to treat, cure or prevent any disease.

The disclaimer is the equivalent of the small print in financial adverts, warning that the value of your investment may go down as well as up and is usually the only truthful statement on the page. It is designed to protect both the author and the publisher from legal action when the CAM method fails to work or if a serious condition is left medically unattended because of bad advice.

2) the universal diagnosis (p. 29)

Holistic therapies are said to be able to treat 'the whole person' rather than the symptom or outward manifestation of disease. And because many alternative medicines claim to treat the whole of you, they can by definition treat everything. Or nothing in particular!

Conversely, they may promote a single remedy or therapy, promised to address a wide range of disparate conditions, making it a truly universal panacea!

3) it's based on centuries-old ancient wisdom and the method has not changed over time (p. 30)

It is curious to see what a virtue 'ancient wisdom' has become, especially considering the nature of many ancient cures.

Whilst it is true that a substance's relative safety might be suggested by the fact that people have used it for centuries, that doesn't necessarily mean it works. Sometimes the claim are breathtaking - "in this pages you will learn the health secrets that allowed out ancestors to live long, disease-free lives...etc."

4) the evidence of their discovery is anecdotal and supported only by testimonials (p. 34)

Personal testimony is NOT permitted in scientific articles or other approved evaluations of drugs or medical procedures, as it is a practice open to bias and abuse. It would be all too easy to round up satisfied patients who offer positive reports about a chosen treatment or procedure in letters or interviews. 

'Quacks' may not go in for presenting research evidence for efficacy, but they love to give a simple cure rate, which is frequently given at around 80 per cent - not too high to be thoroughly unbelievable, but high enough for the needy to find irresistible.

No details of the user group are given - not even the number of people surveyed. Such assertions could easily be fabricated and the patients don't even have to exist. Patient testimonials substitute for evidence throughout CAM. They are usually headed "Success Stories", "How I got my life back" or "What our customers say" and tell exhilarating tales of lives enhanced and prolonged. 

"In the three weeks leading up to my cancer operation, I consumed 100ml of Colloidal Silver per day. Day day before the operation, they performed a camera search inside of my bladder. The search revealed that the tumour had reduced significantly in size. The surgeon said to me whatever I had been doing, continue doing it, "that is truly a miracle". 

Such statements, attributed to an anonymous and mystified medic, represent an interesting subset of the testimonial genre.

5) it sounds too good to be true (p. 38)

Here we are really spoilt for choice. How about HeightMax (TM). Designed "for 12 to 25 year old height and health conscious consumers only. It is the only all-natural, completely safe nutrition supplement that enhances your height potential to the maximum your genetic composition will allow".

The HeightMax (TM) company has been heavily fined for making bogus claims for the product, even featuring a fictitious specialist and product inventor to appear in their advertising!

Penutup - beberapa perkara untuk difikirkan

Di Malaysia, kebajiran produk ubatan alternatif adalah terlalu banyak. Bukan sahaja produk yang "diimport" yang sememangnya mudah dirodok ke dalam kotak pemikiran orang Malaysia (yang mudah terpengaruh seperti gangnam), malah beribu produk tempatan yang 'dicipta menurut resepi turun-temurun'.

Apakah resepi kita itu diwarisi dari 5000 tahun yang lepas sebagaimana dakwaan pengamal rawatan akupuntur di China? Atau setidaknya 500 tahun yang lepas, tanpa terputus riwayat (ubroken chain of story), atau sekadar 50 tahun yang lepas? Atau ianya "warisan" sejak 5 tahun yang lepas? Ini kita sebagai pengguna kena perhatikan juga.

Bahan yang digunakan seperti Tongkat Ali memang diakui oleh rawatan perubatan moden berupaya mengurangkan beberapa masalah kesihatan. Tetapi itu tongkat ali yang diperoleh di dalam persekitaran yang asli, tumbuh di hutan tanpa campurtangan manusia. Namun, setelah dikomersilkan, tongkat ali ditanam secara ladang moden, dibaja dan dijaga untuk mempercepatkan proses pembesaran demi pengeluaran berskala besar. Apakah kandungan dan khasiatnya masih seperti yang tumbuh asli di dalam hutan? Ini pun kita sebagai pengguna ke fikirkan.

Di Malaysia, kadang-kala sebagai pengguna kita "tersepit" di antara produk "hasilan orang Melayu" dan "produk Sunnah", atau kedua-duanya. Tambahan pula jika di botol produk itu disekalikan rupa tok-tok guru dan alim ulama, lagilah "rasa bersalah" jika tidak mencubanya, sekalipun ianya tiada bukti secara kajian klinikal.

Kekurangan aspek pemantauan dan penguatkuasaan oleh badan berkaitan juga menjadikan tanggungjawab seseorang pengguna bertambah berat. Di bahu para pengguna sendirilah terletak inisiatif untuk mendapatkan kesedaran dan pendidikan yang berkaitan. Bukan sahaja pengguna perlu mendidik dan menyedarkan diri sendiri agar berhati-hati untuk memilih dan menggunakan produk alternatif, bahkan di bahu pengguna jugalah tanggungjawab bagi membuat pilihan yang mereka "rasakan" terbaik, tidak menipu dan selamat. 

Tidaklah saya menafikan ada di antara produk alternatif yang ditawarkan menepati janji mereka, namun kebanyakkannya masih "too good to be true".

Moga beroleh pencerahan dan manfaat!

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