Malaysia: I NEED your help. I need to know how far we should go in being politically correct. How much should we accommodate cultural practices? In polite society, how do we solicitously push the science agenda?
What happens when traditional and complementary medicine (TCM) cause grievous harm to patients? Do we keep our peace for fear of exposing 'the emperor's new clothes'? Or do we speak up and advocate good science and positivist philosophy?
An educated urbane woman in her mid-40s was aware of a breast lump two years ago. A biopsy confirmed that she had breast cancer. The cancer was early and potentially curable. She was fearful of surgery. She had misconceptions regarding chemotherapy and radiotherapy. She instead underwent homeopathic treatment exclusively. The cancer grew relentlessly.
She saw me a fortnight ago in a piteous state. She was in great pain. Her breast, armpit and neck were fused together by a hard infiltrative tumour. This caused her neck to be stiffly held at a grotesque angle to her shoulder.
I started her on treatment which comprised chemotherapy, analgesics and sedatives. As I write, she has improved appreciably. However, her distant future is perilous as the tumour load is high and the cancer had time to acquire mutations which made it more aggressive.
Practitioners of traditional and complementary medicine (TCM) claim that they tell their patients they "complement" and not substitute evidence-based scientific medicine. Here is one example where either they did not tell or that the patient was not listening. I do not blame the patient if she was not listening. She was after all offered an alternative that was purportedly harmless and effective.
And unless the practitioners of TCM are truly forthright about their inability to treat cancer by TCM alone, patients will be tempted to forsake scientific-based medicine.
It is so easy in our cultural milieu to selectively hear the good that TCM can do. We forget the caveat (usually uttered softly, reluctantly and without emphasis by the practitioners of TCM) that we should not abandon conventional science-based medicine when we take TCM.
Six months ago, a woman in her mid-40s felt that her abdomen was bloated. She was not one to avail herself of 'western' medicine (I could hear her extolling 'natural cures') and all its perceived nasty side effects. She tried 'holistic' medicine. Unfortunately, her condition worsened. After five months, her resolve broke. She sought help from a gynaecologist. Last week, she underwent surgery to remove a very advanced ovarian cancer. Unfortunately, try as my colleague did, he could not remove most of the tumour mass. A chance at early diagnosis and potential cure was lost here.
TCM can cause the diagnosis of cancer to be made rather late. It can also result in patients delaying treatment for early cancer (even after it is confirmed) until the cancer progresses to an advanced incurable stage. Ironically, TCM is less dangerous when practised in a 'western' society. There, it is hardly used alone when treating cancer.
TCM can cause patients to go into a malnourished state because it usually comes with many food taboos and proscriptions. Further, there are many harmful interactions between TCM preparations and mainstream proprietary drugs. I could go on about the harm of TCM. But then that would be, to some, being gratuitously offensive.
I mentioned positivist philosophy earlier in this essay. This is a philosophy that states that the only authentic knowledge is scientific knowledge. It was developed in France by Comte in the middle of the 19th century. All scientists are positivists by implication.
We reject metaphysics and speculation. What do the data tell us? Do they fit in with our hypothesis and our mathematical model? For example, in oncology, early results from testing a new drug in a small number of patients make us think. What if we test this drug in a large number of patients and compare it to a standard drug? Would this new drug eventually be the standard treatment for a subset of cancer patients?
Political correctness is very much dependent on geography. What is correct here may not be so in central Africa and vice versa. At least, science is consistent and transcultural.
We are told not to be impolitic in approaching sensitive issues. We are exhorted to navigate the cultural minefield with care. Should we not respect 'tradition'? How can 6,000 years of history be wrong? Dare we question time tested and faith-based practices?
