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Chapter 1: Introduction Regulation of the Practice of Traditional Medicine in China, India, and Malaysia By Cheng Soon Goh Submitted in accordance with the requirement for the degree of PhD The University of Leeds School of Law March, 2012 The Candidate confirms that the work submitted is her own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. ii Acknowledgements I would like to record my gratitude to my supervisor, Professor Graham Dutfield, for providing me with his most valuable and generous help during the preparation of the dissertation. Professor Dutfield has guided and supported me throughout the course of this doctoral research. He has shown great patience in reading and commenting on the draft of this thesis. He has also introduced me to the “intellectual property rights” perspective of traditional medicine. I gratefully acknowledge the invaluable review comments from Professor Gerard Bodeker (University of Oxford), and his contacts in the Global Initiative for Traditional Systems (GIFTS) of Health, Oxford. Professor Bodeker has provided helpful criticism at various stages of my research and writing. Thoughts and ideas for improvements in the write-up have been stimulated. His constant encouragement and unbounded generosity on knowledge sharing are greatly appreciated. Moreover, I would also like to express my warm appreciation and gratitude to Professor Bodeker in directing me to the “policy” perspective of healthcare. Many thanks go to Dato’ Dr. Dorai Raja (President of Malaysian Association of Traditional Indian Medicine, Malaysia) for the many discussions on a variety of issues; to Antony Taubman (then Director of Global Intellectual Property Issues Division and Life Sciences Programme, WIPO) for his invaluable opinions, to Dr. Lalita Sinha and Lucille Santhadas for their support throughout; and my grateful thanks to Professor Liu Jian Ping, Dr. J.R. Raju, Ng Soh Bee, Yan Yu Feng, Han Wan Tong, and Wei Shi An who have kindly supported in the coordination of the case studies. I wish to thank the Ministry of Health Malaysia for financial support for the research. My gratitude also to the following bodies for allowing me to interview their officers: iii State Administration of Traditional Chinese Medicine, Beijing World Federation of Chinese Medicine Societies, Beijing Beijing University of Chinese Medicine Guang An Men Hospital, Beijing Beijing Tong Ren Tang Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy Department, New Delhi World Health Organization (WHO) Country Office for India, New Delhi Maharishi Ayurveda Hospital (MAH), New Delhi Tibbia College, New Delhi Rajiv Gandhi University of Health Sciences, Bangalore Foundation for Revitalisation of Local Health Traditions, Bangalore Traditional and Complementary Medicine Division, Kuala Lumpur Malaysian Medical Council, Kuala Lumpur Legal Unit, Kuala Lumpur Herbal Medicine Research Centre, Kuala Lumpur Intellectual Property Corporation of Malaysia, Kuala Lumpur Federation of Chinese Physicians and Medicine-Dealers Associations of Malaysia (FCPMDAM) Federation of Chinese Physicians and Acupuncturists Associations of Malaysia (FCPAAM) Malaysian Chinese Medical Associations (MCMA) Malaysian Association of Traditional Indian Medicine (MATIM) My great indebtedness to each of the interviewees for their time, helpful insights, and kind cooperation. On a personal level, I am grateful to my parents, Goh Sew Chuan and Yee Siew Mooy, for giving me life and a strong foundation. Their love and concern have iv sustained me through the many hours of work. Finally, thanks to my siblings for supporting me at all times and inspiring me every single day. Cheng Soon v Abstract The trend towards increased traditional medicine utilisation is a global phenomenon. Malaysia is a prime exemplar. However, the regulation of traditional medicine practice there has not kept pace with this trend. Malaysia plans to develop traditional healthcare policies and legislation to integrate traditional medicine into the current formal healthcare system. How this might be most effectively accomplished is the core concern of this thesis. Currently, the national healthcare policy on traditional medicine is being formulated and implemented, but legislation is not yet in place. The policy challenge is how best to cultivate a standard policy across the various traditional systems. This involves such issues as follow: The definition of legal power, The framing of rules and regulations, and The standardisation of a traditional medicine education system. In this study, the research questions are as follows: 1. How do India and China regulate traditional medicine practices? 2. What can Malaysia learn from the Indian and Chinese regulatory systems? 3. How can the intention to regulate be justified? 4. What would be the best way to achieve and oversee this regulatory system? To answer these questions, a comparative public policy analysis is conducted on traditional medicine in China and India, both of which have considerable experience in this area. The data is primarily gathered through in-depth interviews of three professional groups; policy makers, academics, and traditional medicine practitioners from the three countries. Both China and India have well-established traditional medicine systems and considerable legislative and regulatory experience, but have adopted radically vi different approaches. In China, traditional medicine has been integrated into the mainstream healthcare system. Indian systems of medicine are practised in parallel to modern medicine. The question arises of which strategy, or which components, Malaysia should adopt. While traditional medicine is scheduled for integration into Malaysia’s mainstream healthcare system, policy does not guarantee equality with modern medicine. Moreover, the policy of one country may not be suitable for another country. Malaysia could recast the models of China and India, and establish a comprehensive policy on traditional medicine. Integrating traditional medicine into the mainstream healthcare system would be facilitated by an inclusive, consultative and formalised process of professionalisation. vii Table of Contents Acknowledgement ii Abstract v Table of Contents vii Table of Cases xi Table of Legislation xi List of Tables xv List of Figures xv List of Abbreviation xvi Chapter One: INTRODUCTION 1.1 Background 1 1.2 History 5 1.3 Origins of ISM and TCM in Malaysia 9 1.4 Problem Statement 11 1.5 Objectives of the Study 11 1.6 Scope and Limitations 13 1.7 Significance of the Study 14 1.8 Organisation of the Thesis 14 Chapter Two: REVIEW OF RELATED LITERATURE 2.1 Introduction 17 2.2 Literature on Professional Development of Traditional Medicine 17 2.2.1 Professional Development of Traditional Medicine in China 18 2.2.2 Professional Development of Traditional Medicine in India 25 2.2.3 WHO on Professional Development 31 2.2.4 Summary 33 2.3 Comparative Studies in Policy and Law 35 2.3.1 Comparative Healthcare Policy 35 2.3.2 Comparative Law 39 2.3.3 W. Richard Scott in Comparative Studies 42 2.3.4 Summary 44 2.4 Global Overview 45 2.4.1 Policy and Regulation 45 2.4.2 Training 51 2.4.3 Integrated Medicine 53 2.4.4 Intellectual Property Rights and Confidentiality 56 viii 2.4.5 Summary 64 2.5 Literature on Traditional Medicine Policies in China and India 65 2.5.1 The National Healthcare System 65 2.5.2 Education and Training System 67 2.5.3 Summary 69 2.6 The Malaysian Experience 70 2.6.1 Training in Traditional and Complementary Medicine 74 2.6.2 Professional Regulation 75 2.7 Overall Summary of Literature Review 77 Chapter Three: METHODOLOGY 3.1 Introduction 79 3.2 Theoretical and Conceptual Framework 79 3.3 Definition of Terms 84 3.3.1 Regulation 84 3.3.2 Traditional Medicine 87 3.3.3 Integrated Medicine 88 3.3.4 Healthcare Policy 90 3.4 Methodology 93 3.4.1 Data Collection Design 93 3.4 2 Sources of Data 97 3.4.3 Data Collection Method 99 3.4.4 Logistics 100 3.5 Approaches to Data Analysis 101 3.5.1 Data Management 102 3.5.2 Data Classification 104 3.6 Validity and Reliability 108 3.7 Summary 108 Chapter Four: ANALYSIS OF THE FINDINGS IN CHINA 4.1 Introduction 110 4.2 Legal Regulations 110 4.3 Formal Organisations 120 4.3.1 Formation of the Professional Bodies for Traditional Medicine 120 4.3.2 Universities of Traditional Medicine 122 4.3.3 Integrated Healthcare Hospitals 138 4.4 Cognition and Support 151 4.4.1 Governmental Support 151 4.4.2 Traditional Support 153 4.4.3 Allopathic Support 154 4.4.4 Public Support 156 4.5 Recommendations to Malaysia 159 4.5.1 Experiences in the Establishment of Traditional Medicine ix Education 159 4.5.2 Experiences in Integrated Medicine 163 4.6 Summary of the Findings in China 165 Chapter Five: ANALYSIS OF THE FINDINGS IN INDIA 5.1 Introduction 169 5.2 Legal Regulations 169 5.3 Formal Organisations 178 5.3.1 Formation of the Professional Bodies for Traditional Medicine 178 5.3.2 Universities of Traditional Medicine 181 5.3.3 Integrated Healthcare Hospitals 192 5.4 Cognition and Support 200 5.4.1 Governmental Support 200 5.4.2 Traditional Support 208 5.4.3 Allopathic Support 210 5.4.4 Public Support 213 5.5 Recommendations to Malaysia 215 5.5.1 Experiences in the Establishment of Traditional Medicine Education 215 5.5.2 Experiences in Integrated Medicine 219 5.6 Summary of the Findings in India 220
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