I have nothing in general against “traditional medicine” so long as it’s efficacious. But that’s the rub, for, as the old Q&A goes: “What do you call traditional medicine that works? Medicine.” Thus, if something is being touted, especially by the government, as a useful form of medicine, it should have been scientifically tested to ensure that it does what it does.
Many of our modern drugs do indeed come from plants, but not all of those were used in traditional or “indigenous” medicine: some were found simply by surveying plants by medical scientists looking for useful effects. And of course without testing—with the gold standard being double-blind testing—you can’t tell whether a plant-based drug is better than a placebo.
This lack of testing appears to be characteristic of Rongoā Māori (“RM”), the traditional healing used by Māori in New Zealand, as reported by the article from the University of Auckland shown first below. And that lack of hard evidence for efficacy, while it shouldn’t lead to the banning of Rongoā Māori, shouldn’t lead to its declaration as being equal to modern medicine, nor should it lead to the government’s funding of untested remedies. But it’s already too late.
Since this is New Zealand, testing of Māori claims isn’t needed: tradition and anecdotal health claims are enough. Indeed, criticism of such claims is seen as racist.
And so, as the article below reports, the Kiwi government is funding a $100,000 program to “support injury recovery through Rongoā Māori. The program is funded through the “ACC” (Accident Compensation Corporation), a government body established in the 1970s to oversee the provision of support, treatment and rehabilitation for people involved in accidents. What we have, then, is government support for traditional medicine used to heal accidents.
But this is only the camel’s nose, for as the article below implies, this is just the first step in insinuating traditional healing into regular medical practice guaranteed to all Kiwis by their government.
In fact, in several ways Rongoā Māori is similar to Mātauranga Māori, traditiional “ways of knowing” that I’ve written about at length. Both systems contain a mixture of theology, spirituality, and practical knowledge, both are imbued with fact claims that can’t be tested, and both are touted by their practitioners as deserving equal treatment with modern science.
It is the “equal treatment” that worries me, as neither MM or RM are coequal with science. Parts of MM can be considered empirical truths—”practical knowledge” like how to grow plants or catch eels—but I have no idea whether RM is efficacious in healing, at least beyond having a placebo effect. Finally, both MM and RM involve the ubiquitous valorization of the ways of indigenous people. Traditional customs should of course be taught as aspects of anthropology and sociology, important parts of New Zealand’s history, but shouldn’t be valorized to the point where they’re considered coequal to science or medicine.
What is involved in Rongoā Māori? The two articles below (click on screenshots), as well as the short video, give you an idea.
A shorter explanation of RM is here.
Here are the major components of RM, considered “holistic healing” with a big dollop of spirituality. This list comes from the two articles above and a few others.
a.) Traditional plant remedies. The second article above gives a list of which plants are used and for what ailments. They must be used in a proper way—not just in their preparation, but ensuring that they’re gathered in traditional ways. Here’s what the second article says
The use of plant remedies does not require regulatory approval as long as they do not contain a scheduled medicine. However, as some pharmaceuticals are derived from plants, it is possible that Rongoā may contain active ingredients. As long as these pharmaceuticals are not purposely added to a remedy no restrictions apply to the use of such plants. Note that some plants, for example St Johns wort, can interact with conventional medicines.
- Appropriate tikanga (customs and rites) must be observed during the collection, preparation and storage of Rongoā.
- Plant material must be correctly identified, gathered from non-polluted areas and prepared safely and hygienically.
- Plants are usually crushed or dried and mixed with water or ethyl alcohol.
- Plant remedies should only be prescribed and dispensed by Tohunga [traditional healers] to individual patients. Tohunga will advise on appropriate use.
- Plant remedies should not be labelled with therapeutic claims. Labels should contain the ingredient(s), instructions for use, date of preparation, expiry date and who the remedy is prescribed for.
But if they cannot make therapeutic claims, why is the government paying for them? The important question is whether all or any of the drugs are useful in healing the ailments they’re prescribed for. Before you say “they must be, as they’re based on tradition,” be aware that a lot of spiritually-based traditional medicines tested in the U.S. have been shown to be bunk.
I have found no mention of testing for any of these plants. While some of the traditional herbal medicines may be efficacious, I see no sign that they’ve been tested or compared to modern pharmaceuticals that must be and have been tested.
b.) Massage. Massage can be useful in temporary relief, and even chiropractic can be useful for back problems, but the idea of adjusting the body because it’s diseased or out of whack, as evidenced in the articles and the video above, is dubious (I’d say “bunk,” but I’m being kind here.) Look at the video and watch them adjusting the feet of a man with a lower back problem. This is called romiromi, or “body alignment”.
c.) Lunar calendar relationality (maramatka). I don’t know how this is implemented, but it’s a big red flag.
d.) Meditation. Your mileage may very, but I haven’t been prescribed meditation for any accidents I’ve had.
e.) Spirituality. This site at Health Navigator New Zealand explains that the spiritual side of RM is its most important aspect. A quote:
The most fundamental part of rongoā Māori is the traditional spiritual teachings, which can be seen as the basis of all traditional medicine. For Māori, rongoā is a part of the Māori culture from Tāne (God of the forest) who retrieved the three baskets of knowledge from Io (God) with the knowledge and teachings to guide us in this world.
As Māori, we believe we are part of the children of Tāne, along with the creatures of the forest such as the birds, trees and plants and, therefore, we have a strong connection to rongoā rākau. To learn rongoā, people have to become apart of the world of Tāne. They become connected and immersed in the forest, learning about a relationship far beyond the physical elements of the trees and plants. To utilise Te Oo Mai Reia, the healer must become immersed in ancient spiritual teachings while becoming a vessel to achieve the healing through Io alongside the use of physical touch to create balance and shift energies.
This is a form of shamanism.
Now this is all well and good, and if people want to use RM for diseases or healing from accidents, that’s their prerogative. I wouldn’t, but that’s my choice. But what I dislike is the insistence of these articles and practitioners that RM is just as good as modern medicine and should be offered coequally by the government. Here are two quotes from the University of Auckland article:
Located in Dance Studies in the Faculty of Creative Arts and industries, Ngākau Oho will provide a personalised recovery programme for 20 ACC clients and their whānau. In the process, the programme aims to reclaim and normalise rongoā Māori as a viable and everyday healthcare practice.
Recent efforts to address Māori health inequities across the health sector have focused on increasing the number of Māori health professionals and Māori access to culturally relevant rehabilitation services, says Dr Reihana.
Why is this in a dance studio? But wait—there’s more, and this is the worrisome part (my emphasis):
The programme will provide ACC with evidence-based insight on how rongoā Māori would be embedded within established healthcare services.
“We believe the approach we develop will be an innovation that can be used within the health system, and importantly, by Māori health practitioners, providers and whānau, helping ensure that rongoā Māori practices can be a real and easily accessed option for Māori in wellbeing and recovery,” says Dr Reihana.
This implies that RM will indeed become part of the government-funded healthcare system of New Zealand. But what is the “evidence-based insight” that is forthcoming, since there is no mention of controls?
Finally, Donna Kerridge, the RM practitioner shown in the video above, says this:
“I think the Western health and healing system is awesome; it’s not better, it’s not worse.”
This is the insistence on absolute equality that is ubiquitous in both MM and RM, and it’s just wrong. If you have diabetes, do you want traditional herbal medicine or insulin? If you have an infection, do you want plants or antibiotics? Now many Māori do avail themselves of modern medicine instead of or alongside RM, and those people are the savvy ones. But it seems risible to say that RM is exactly as good as modern medicine. It can’t be, because its “testing” is based on anecdotes instead of scientific studies with controls.
I want to add one bit about “alternative medicine” in the U.S. In 1991, the government established the National Center for Complementary and Integrative Health as part of the National Institutes of Health. Its goal was to scientifically study “alternative medicine”, using the kind of controls that all science-based medicine uses. As Wikipedia notes:
NCCAM’s mission statement declared that it is “dedicated to exploring complementary and alternative healing practices in the context of rigorous science; training complementary and alternative medicine researchers; and disseminating authoritative information to the public and professionals.” As NCCIH, the mission statement is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.”
Since the NCCAM’s founding, over two billion dollars have been spent testing stuff like coffee enemas, intercessory prayer, magnet therapy, and so on. Not one “alternative treatment has worked. You’ll be amused at the examples given in the article about the treatments tested and their outcomes. A screenshot is below (click to enlarge). NOT ONE WORKED! And for the others, no results were ever reported, which means that they didn’t work, either.
Two quotes from the article:
In 2012, the Journal of the American Medical Association (JAMA) published a criticism that NCCAM had funded study after study, but had “failed to prove that complementary or alternative therapies are anything more than placebos.” The JAMA criticism pointed to large wasting of research money on testing scientifically implausible treatments, citing “NCCAM officials spending $374,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer.” It was pointed out that the public generally ignored negative results from testing, that people continue to “believe what they want to believe, arguing that it does not matter what the data show: They know what works for them.” Continued increasing use of CAM products was also blamed on the lack of FDA ability to regulate alternative products, where negative studies do not result in FDA warnings or FDA-mandated changes on labeling, whereby few consumers are aware that many claims of many supplements were found not to be supported.
I’ll take my coffee in the other end, thank you.
And here’s a skeptical take (there are other criticisms given of NCCAM by doctors and scientists):
A 2012 study published in the Skeptical Inquirer examined the grants and awards funded by NCCIH from 2000 to 2011, which totaled $1.3 billion. The study found no discoveries in complementary and alternative medicine that would justify the existence of this center. The authors argued that after 20 years and an expenditure of $2 billion, the failure of NCCIH was evidenced by the lack of publications and the failure to report clinical trials in peer-reviewed medical journals. They recommended that NCCIH be defunded or abolished and the concept of funding alternative medicine be discontinued.
All I’m asking is that Rongoā Māori be tested the same way as the NCCAM tested its putative remedies. If RM treatments aren’t (and they surely aren’t), Kiwi taxpayers should be protesting loudly about wasting their money on subsidizing spiritually-based medicine
Well then, there may be a case for using psilocybin for alcoholism and depression, pre approved under Rongoā Māori…hmmm, but practitioners would have to cut the spirit-evoking practice (that could end badly) it could be a game changer especially if it amounts to good empirical research and results. Something similar to Johns Hopkins Medical Research does at the moment.
I simply can’t see our Indian and Chinese communities (let alone others) opting for Rongoā Māori over their own traditional methods if they are so inclined.
Doctors and nurses don’t have time for conjuring up spirit guides even if there is no charge for their services.
Utterly different, Iaingholm. No comparison whatsoever.
Psychedelics are backed by literally thousands (from memory 2,000) proper scientific studies – the original ones on alcoholism/addiction go back to the 1960s. All lab based, what educated people think of as “science” not just “another way of knowing” or indigenous sharmanism/astrology/wellness.
I’ve written articles about this which I think I’ve posted here.
D.A.
NYC
I’ve been following the studies on psychedelics, my point being since it’s not clear, that if they did (Maori health advocates) pursue the study and research as J Hopkins Medical Research do with psychedelics Maori health outcomes might be better off… especially as alcoholism and depression are prevalent in the population and they could be a part of this research. Can’t see that happening so I feel the need to mock anything that requires spiritual powers to cure but that will take some doing when it comes to things Maori.
I fully agree, money spent on investigating traditional medicine is not completely lost, sometimes (rarely, but still) it gives some positive results well above placebo.
Quinine used for malaria by pre-Colombian Indians is but an example. The opiates from poppies as a pain killer is centuries, if not millennia, old. Not to mention the traditional use of vinca for cancers. I guess there are dozens more.
It is important to separate the chaff from the wheat, and that costs money.
I routinely see comments from the drug industry that 80%-plus of our current pharmacopoeia is from materials of plant origin (if modified by lab studies to identify active regions, change absorption properties, reduce side effects and the other 15-20 years of lab work between “discovery” and having a procedure for production of the refined drug).
There are plenty of “traditional” treatments that give results well above placebo. The whole family of “massage + joint manipulation”, for examples. What hasn’t been demonstrated TTBOMK is that (massage + woo) is significantly more efficacious than (massage + placebo). (How would you test ? : randomise, say, non-Latin speaking patients between groups for “massage + woo (spoken in Latin)” versus “massage + language-like gibberish” ; look for a significant difference between groups in either direction ; commit to publish even if “massage + gibberish” seems more effective than “massage + being wooed in Latin”.)
What I wonder, is whether patients have recourse to malpractice claims in NZ. If you receive a little satchel of herbs and get chanted at, when what you need is dialysis, there are going to be a lot of negative but preventable outcomes.
… which is why a lot of the “alternative practitioners” offer “treatment” (which they can back up in court with appointment diaries, for example) rather than “cure” – which is testable by a more external set of criteria (not dieing, regression of tumour, growing a new arm).
I’m sure NZ has just as effective a set of malpractice investigation and punishment laws. Which is why “alternative therapy” purveyors are careful about how they describe their treatments. (The same goes for such practitioners in the UK, for sure. Probably in the US as well.)
“Medical treatments” which primarily boil down to placebo effects usually involve some sort of story or context which flatters the person who takes it. They’re open-minded; they’re spiritual; they’re sophisticated; they’re rejecting Big Pharma and artificial ways of doing things; they’re honoring indigenous cultures. Such patients then usually evaluate the effects as if they’re doing apologetics. They’re motivated to either find that it somehow worked — or it didn’t because of their own personal flaws or particular circumstances.
But if people don’t know the story and choose it anyway, that’s when they’re more likely to be disgruntled and sue. That’s one reason proponents consciously or unconsciously make clear that it’s an alternative and why it’s an alternative. The story is more important than the physical ingredients.
Very perceptive analysis. Thanks.
This annoys me on so many levels. While I find valorization of indigenous culture because it is indigenous, divisive, fake medicine (be it from anywhere: acupuncture, homeopathy, osteopathy, etc) REALLY irritates me. (see Center For Inquiry, they cover this).
Also as a lawyer I dislike consumer fraud.
D.A.
NYC
Oh dear! Where to start? Years ago I worked in research evaluation for New Zealand’s research, science and technology funding agency. We had to do a lot of diligence on the quality of proposed research and likely outcomes before funding anything.
A few years ago there was a kerfuffle in the New Zealand media when the Royal Society of New Zealand Marsden Fund provided funding for research on hip-hop. I guess that there was a point to that study (e.g. understanding its role in New Zealand’s youth culture), though arguably the money would have been better spent elsewhere. Confidentially – I would rather that the money had been spent on something else but nevertheless . . .
$100,000 on Maori therapies is not a lot but is still hard to justify, except as a sop. However, of course there is a real danger when the public chooses untested traditional therapies rather than proven medicine.
David Lillis
. .