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970618L - ISLAMIC MEDICINE (Mafhum Al Tibb Al Islami)

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Lecture delivered to 1st year medical students at the Kulliyah of Medicine, IIUM, Kuantan, Pahang on June 18th 1997 by Prof Dr Omar Hasan Kasule, Sr. Deputy Dean for Research and Post-graduate Affairs, Kulliyah of Medicine IIUM


OUTLINE

SEMANTIC CONFUSION BETWEEN MUSLIM AND ISLAMIC
            MUSLIM = SELF IDENTIFICATION
ISLAMIC= STRICT CRITERIA

ISLAMIC MEDICINE: CRITERIA & VALUES
            CRITERIA:      EXCELLENT & ADVANCED
                                    FAITH & DIVINE ETHICS
                                    CONSISTENT & LOGICAL
                                    COMPREHENSIVE
                                    UNIVERSAL
                                    SCIENTIFIC

            VALUES:        ISLAMIC LAW, ETHICS, & MORAL TEACHINGS           

EARLY AND CONTEMPORARY TRADITIONAL MUSLIM MEDICINE
            EARLY MEDICINE
            UNANI MEDICINE

ETHICAL, MORAL, AND SOCIAL ISSUES
            BIO-TECHNOLOGY
            PHYSICIAN ETHICS
            SERVICES
            ADVOCACY
            SOCIAL REFORM

CONTEMPORARY DEFINITION OF ISLAMIC MEDICINE
ISLAMIC MEDICINE IS DEFINED AS MEDICINE WHOSE BASIC PARADIGMS, CONCEPTS, VALUES, AND PROCEDURES CONFORM TO OR TO DO NOT CONTRADICT THE QUR’AN AND SUNNAH

MISUSE OF THE CONCEPT OF ISLAMIC MEDICINE


1.0 SEMANTIC CONFUSION BETWEEN MUSLIM AND ISLAMIC
The concept of Islamic medicine has been understood to mean different things by different people at different times.  There has been a proliferation of writings on Medicine from an Islamic perspective by both physicians and non-physicians (Ullman 1978, Athar 1993, Said 1976, El Kadhi 1980, Madkhur 1987, Akkibi 1957, Nadvi 1983, Rahman, Kasule 1980 1981) as well as a general interest in health-related issues such as diet, lifestyle (Sakr, Ali et al. 1987).  Scientific research has been undertaken by Dr El Kadhi in Florida, USA.  Starting in the early 1980s international conferences and conventions on Islam and Medicine have been held in several countries (IOIM 1980, 1981).

The greatest confusion has been semantic with many dire practical manifestations.  ‘Islamic’ and ‘Muslim’ Medicine have been confused.   The terms ‘Islamic’ and ‘Muslim’ are used interchangeably as if they mean the same (Said 1976, Ibn al Qayyim 1993). Traditional medicine practiced by Muslim communities at some epochs in history or in our times has erroneously been called Islamic medicine. Najjar (1986) made a praiseworthy attempt to deal with the problem of semantics by referring to medicine in the early Muslim history as “Medicine in the Islamic State” instead of “ Islamic Medicine”.  He argued that talking about Islamic Medicine implies existence of non-Islamic Medicine.  Knowledge should be one and indivisible on the basis of religion.

The semantic confusion between the adjectives ‘Islamic’ and ‘Muslim’ need not continue.  ‘Islamic’ refers to values, ideals, guiding principles, and application of the Qur’an and Sunnah. ‘ Muslim’ refers to people who self-identify as Muslims as well as their activities and institutions.  They may not fully follow all the teachings of Islam.  Thus Islamic Medicine the ideal, is not the same as Muslim  Medicine, which is the actual historical or contemporary reality of Muslim societies (Kasule 1980).

Islam is objective and universal.  Islamic Medicine would therefore be the true and objective medicine that all people would accept irrespective of their geographical location, cultural or religious background. 

The continuing confusion in the minds of many Muslim physicians about what constitutes Islamic Medicine calls for this fresh attempt at definition and conceptualization of Islamic Medicine.

2.0 DEFINITION OF ISLAMIC MEDICINE BY OBJECTIVE CRITERIA & VALUES
Use of objective criteria: Ahmad El Kadhi presented a paper at the First International Conference on Islamic Medicine held in Kuwait in January 1980 (Athar 1993) and proposed 6 distinguishing criteria of Islamic medicine and using statistics and medical experience in the US argued that modern western medicine did not fulfill the criteria of being (a) excellent and advanced; (b) based on faith and Divine ethics; © guided and oriented, ie consistent and logical; (d) comprehensive, paying attention tot he body and the spirit, the individual and the society; (e) universal, utilizing all useful resources and offers its services to all mankind; (f) scientific. Two of the 6 criteria require a re-examination.  Criterion (a) should not be taken in an absolute way.  A medical system’s excellence or advancement is a relative assessment based on the knowledge and resources available at a particular time and a particular place  Medical systems are continuously improving making it virtually impossible to classify them at a particular point in time as excellent.  Criterion (e) about medicine being scientific could better be defined as based on objective research using all sources of knowledge available including revelation.  The word ‘scientific’ and ‘scientific method’ have been misused as representing objectivity when in practice we know that there are many in-built biases in today’s medical research that reflect subjective opinions, philosophies, and world views.  This is in addition to fraud and incompetence that are reported in the press.

Values and ethics: Use of values and ethics as defining characteristics was seen as an improvement on the definition of Islamic Medicine using operational criteria. The criteria are difficult to measure and compare across different systems of medicine. Dr. Omar Hasan Kasule, Sr. in a paper presented to the first International Islamic Medicine Conference Kuwait (Kasule 1980) argued that Islamic medicine can be defined only as values and ethics and not as any specific medical procedures or therapeutic agents.  This definition allows Islamic medicine to be a universal all-embracing concept that has no specific or particular time-space characteristics. A definition based only on values is however too general to be useful operationally.  Values can be very subjective and difficult to define exactly.

Need for a new definition: It is clear from the above that there is a need for a clearer definition.  In the following pages, 11 perspectives of what could be Islamic Medicine or its practical manifestations are explored critically and a synthesis is made ending with a proposal of a new definition.

3.0 EARLY AND CONTEMPORARY TRADITIONAL MUSLIM MEDICINE
Much has been written about Muslim contributions to medicine (Shahine 1971, Graziani 1980, Hunain 1985, Ullman 1978, Andalusi 1985, Dib 1979, Nadvi 1983, Najjar 1986, Said 1976).  Some is with justifiable pride.  Some is exaggerated and manifests a certain amount of an inferiority complex vis a vis the west.  We are trying to tell the west that even though our situation today is bad we were great in history and we taught them medicine.  Some claims are valid and provable whereas others cannot be sustained.  Ibn Sina was undoubtedly a great physician whose influence spanned many centuries.  The Claim that Al Zahrawi was the first surgeon in the world (Dib 1989) is preposterous. 

Old Muslim medicine passed through 3 stages.  The first stage, the school of commentators on Greek works (madrasat shurrah al ighriqiyin) lasted from the 7th to the 9th century AD.  It was a period of translation of foreign sources (Greek, Syriac, Hindi, Persian) into Arabic.  some of the existing Arab folk medicine was also incorporated (Hamaidan-no date).  The second stage, 9th - 13th centuries AD, was a period of original research to add to and enrich the translated material.  Hospitals and medical schools were established, medical procedures were refined, and physicians were licensed to make sure they had sufficient skill and knowledge. The third stage, after the 13th century, witnessed the decline of science and knowledge in general.  Some Muslim scholars preserved the knowledge they had and passed it on to Europe. 

Several factors contributed to the growth of Muslim Medicine.  The most important impetus and momentum for inquiry and scientific exploration from the golden era of the Prophet and the Khulafa al Rashidiin. Pax Islamica over a wide multinational empire with relative stability and rulers who patronized learning assisted the growth of medical knowledge.  However the environment in which that knowledge grew was already in decline especially in the political and moral spheres and it was only a matter of time before the medicine itself decline.  Decline in Muslim science and medicine accompanied the political problems that led to political weakness and the decline was essentially completed by 1350 AD. 

From very early times (as early as 3rd century AH), biographies of Muslim physicians were compiled and we know a lot about their activities and achievements (Hunain and Andalusi 1985).  The early physicians were encyclopedic in knowledge being competent in many different disciplines.  Some of them were not Muslims; others were recent converts to Islam.  Many were influenced by Greek philosophy then very current.  Ibn Sina was referred to as “al muallim al thalith” the third teacher-philosopher after Aristotle and al Farabi.  Al Razi was called the physician-philosopher while Ibn Sina was called the philosopher-physician (Najar 1986).  Some were very pious Muslims whereas others, being humans, had their personal weaknesses.  Some of the physicians were close to and served the rulers of the time who led regimes that were not fully Islamic.  It is therefore incorrect to generalize and treat every physician at that time as a model for Islamic Medicine. 

Can the medicine practiced in the early Islamic state be called Islamic medicine?  This medicine developed mainly because of the political conditions of a large and relatively stable empire whose rulers encouraged learning.  The rulers and governments of that time can hardly be described as fully Islamic.  The golden era of medicine (Abassid era) came a long time after the golden era of Islam (khilafat rashidah). Medical knowledge was translated from other societies and Muslims added to it.  Islamic principles had an impact on the developing medical knowledge but cannot be said to have been the sole guiding spirit.  It is noteworthy that the dean of early Muslim medicine, Al Shaikh al Rais Ibn Sina did not include an Islamic philosophic or ethical dimension when he defined medicine as ‘knowledge of the states of the human body in health and decline in disease: its purpose is to preserve health and restore it whenever it is lost” (Said 1977). We therefore conclude that this was Muslim medicine and not Islamic Medicine.  The ancestors achieved a lot in their time. The challenge is for us to achieve in our times. They had their achievements and we must have our achievements (2:139, 2:141).

Traditional medicine of modern Muslim societies: Traditional Muslim medicine, a remnants of the medicine practiced in the early Muslim state, has been looked at as Islamic Medicine.  It has changed considerably from what it was in the 3rd century AH. It has incorporated new treatment modalities and varies from country to country. Folk medicine of any Muslim people could also fit into this category of Muslim traditional medicine. Traditional medicine is practiced as folk medicine or as recognized and officially sanctioned alternative medicine such as the unani (Arab) medicine in the Indo-Pakistani Peninsular.  The Indian government recognizes 4 traditional medical systems: one of them is unani (Arab) the othes are: ayurveda, siddha,and yoga.

The current effort to revive ‘traditional’ Muslim medicine is part of a movement world wide that seeks to revive old remedies.  There are several reasons for this: failure of modern western medicine to reach a big proportion of people especially in rural areas, the realization that there are good things in the traditional systems, increasing assertiveness of third world countries vis a vis Europe and America, and cultural nationalism.  Traditional medicine systems have the advantage of being more human, little dehumanizing technology, and interest in the individual.

The World Health Organization passed a resolution in May 1977 that argued ‘interested governments to give adequate importance to the utilization of their traditional systems of medicine with appropriate regulations as suited to their national health systems”. The State of Kuwait is an example of the new interest in unani medicine.  It invited 2 Indian experts in unani medicine to visit Kuwait and explore the possibility and potentiality of reviving unani (Arab) medicine system in Kuwait (Ministry of Public Health 1977).  The 2 experts issued a 55-page report with 18 recommendations among which were: establishment of research institutes and libraries for unani medicine, publication of a journal, cultivation of medicinal plants in Kuwait or their importation from India, Schools and medical colleges to teach this system of medicine.
Two practitioners of unani medicine. Razzack and Umm Fazal (1977) argued that ‘The Arab system of medicine is as much scientific as any other branch of modern knowledge... if by medical science we mean that branch of knowledge which treats diseases and provides their treatment in a systematic manner following a definite method in its experimental research, employing observations in deducing principles, testing deductive and inductive conclusions by experiments, pressing into its service the accumulated experience of ages in the various branches of knowledge’. It is clear from the foregoing that there is nothing, Islamically speaking, to distinguish the unani system from any other traditional system of medicine. Razzack admits that the famous Greek physician, Hippocrates (460 BC) was the father of  unani medicine.  Arabs, Muslims and Indians added to it and developed it to what it is today.  It is not known to all Muslim societies. Some of the beneficial medicinal plants will not grow in other parts of the Muslim world.  It is confined to a particular time and particular place.  Islam and Islamic Medicine must be suitable for every place and every epoch. There is therefore no reason to label unani Medicine as ‘Islamic’.  The best it can be called is Muslim medicine or medicine of Muslim societies.

Non-homeopathic medicine: Some authors have looked at “Islamic Medicine” as a reaction to and a complete rejection of modern western medicine.  Other authors have looked at natural therapeutics (diet, folk medicine, Hakim’s medicine, chiropractic, allopathy, naturopathy, naprapathy, and homeopathy) from an Islamic perspective and have argued that they are encouraged by Islam and are alternatives to drug therapy that has several limitations (Ali et al 1993). Including alternative medicine among perspective of Islamic medicine implies that the mainstream medical  system to which it is an alternative is non-Islamic.

Superstition and magic: In the centuries of decline, the concept of Islamic Medicine has sometimes, in ignorance, been reduced to magical practices, fortune telling, amulets, and talismans.  Magic or sorcery have been mentioned in the Qur’an but the Qur’an is however very clear that magic cannot succeed (2:102, 21:3, 20:66, 113:4, 20:69, 36:77) and therefore cannot be beneficial medicine.  Some people have claimed powers to deal with and control the jinn for medical or evil purposes.  This is shirk and is rejected by Islam.

4.0 MEDICINE AS ETHICAL, MORAL, AND SOCIAL VALUES AND PRACTICES
Ijtihad on ethical, legal and moral issues in medicine: Biomedical technology has given rise to many issues that are of medico-legal or ethical importance: contraceptives, sterilization, abortion, euthanasia, organ transplantation, artificial organs, amniocentesis for sex diagnosis, eugenics, genetic engineering, articifial insemination/in vitro fertilization, sperm banks, surrogate mothers, and ova banks (Ebrahim 1993, Bar 1985).

Muslim physicians and fuqaha have been meeting to discuss these issues.  A seminar on Islamic views of some medical practices held in Kuwait in April 1978 and attended by both fuqaha and physicians discussed the following issues: sale of organs, cosmetic surgery, unfertilized ova, the length of the menstrual period and the length of gestation.  The Islamic Fiqh Academy of the Organization of the Islamic Conference (OIC) has in its past 6 sessions discussed the following issues:  transplantation (reproductive organs, brain and nervous tissue), life support in terminal cases, milk banks, family planning and birth control, use of fetal tissue and organs in scientific experiments and organ transplantation. The Fiqh Council of North America has resolved similar issues. The problem encountered is that the physicians and fuqaha have different education backgrounds making it difficult for them to communicate effectively. Resolution of medico-legal and ethical issues lies at the intersection/interface of medicine and Islamic shariah.  It is a legitimate occupation of a Muslim physician but cannot in itself be called Islamic medicine.
Ethics of physicians: There is an argument that you can get to Islamic medicine by ‘Islamizing” the physician especially during training.  Then you are sure that his research, work and practice will be in conformity with the teachings of Islam. Naqib (1984) proposed a complete Islamically-based education system for an aspiring physician starting from elementary to post graduate levels including describing attributes of a physician, his rights and obligations. Deep study of medicine with reflection shows the physician the majesty of the creator and this deepens and strengthens iman  (Jalabi 1974, Jalabi 1978, Kasule 1980).  A believing physician will be more ethical in his research and practice.

Ethics involves: making sure the physician has the appropriate level of knowledge and skill, charging reasonable fees for services, etiquette with patients especially of the opposite gender, treating patients after their consent. There have been several attempts to define medical ethics for a Muslim physician, ancient and modern.  Al Tabari described the Islamic code of medical ethics in 970 AD to include the following:  personal characteristics of the physician, obligations towards patients, obligations towards the community, obligations towards colleagues, and obligations to his assistants.  The Islamic Medical Association of the US and Canada adopted the Oath of a Muslim Physician in 1977 as an alternative to the Hippocratic oath.  The Islamic Code of Medical Ethics issued by the International Organization of Islamic Medicine Kuwait 1981.

Amine and El Kadhi (Athar, 1993) based medical ethics on the Qur’an when they wrote: “the physician must believe in God, and in the Islamic teachings and practice it in private and public life; be grateful to his parents, teachers, and elders; be humble, modest, kind, merciful, patient, and tolerant; follow the path of the righteous;  and always seek God’s support.  The Muslim physician must stay abreast of current medical knowledge, continuously improve his skills, seek help whenever needed, and comply with legal requirements governing his profession; realize that God is the maker and owner of his patient’s body and mind and treat him within the framework of God’s teachings; realize that life was given to man by God, that human life starts at the time of conception, and that human life cannot be taken away except by God or with His permission; realize that God is watching and monitoring every thought and deed; follow God’s guidelines as his only criteria, even if they differ with popular demand or the patient’s wishes; not recommend nor administer any harmful material; render needed help regardless of financial ability or ethnic origin of the patient; offer needed advice with consideration for both the patient’s body and mind; protect the patient’s confidentiality; adopt an appropriate manner of communication; examine a patient of the opposite sex in the presence of a third person whenever feasible; not criticize another physician in the presence of patients or health personnel, refuse payment for treatment of another physician or his immediate family; and strive to use wisdom in all his decisions”.

Ethics alone cannot change a medical system. The saying of Othman bin Affan is very relevant here ‘Allah can remove things through the ruler what is not removed by the Qur’an”.  Moral values alone may not be enough to change the reality.  The physician may be good and ethical but if the system he is working is in unethical, he will be ineffective.  We therefore cannot define a medical system by its ethics alone. It is not enough to say that Islamic medicine is what good Muslim physicians practice.

Providing services for the needy: Kasule (1982) in a paper titled ‘Islamic Medicine in Africa: New Perspectives and Challengers’ proposed and made a case for “a new dimension of Islamic medicine in its relevance to solving the health problems of the poor and least privileged people in the developing world”. Medical care fulfils one of the maqasid al shariah: preservation of life.  The Qur’an talks about the importance of life. (5:32).  It is part of caring for others ‘he who does not care about condition of Muslims is not one of them’. Providing services is just one function of Islamic Medicine and would not be called Islamic Medicine.  Any system of medicine could provide service for the needy.  Therefore this is not a unique distinguishing characteristic.

Advocating or lobbying for the less privileged: Poor health on a global or even local levels is not due to absolute lack of medical resources but their mal-distribution.  Some have too much whereas others no access even to the most rudimentary of services. Dr. Omar Hasan Kasule, Sr. (1982) argued that “the health conditions of the poor of the world are desparate... participation in efforts to change these conditions for the better is a relevant, contemporary and future role for Islamic Medicine.  With the present corpus of medical and scientific knowledge, most of the health problems can be solved.  What is lacking is the will and compassion on the part of the global community to enable benefits of that knowledge to reach the needy”. Assuring access to care is one of the functions of an Islamized medical system but is not a unique defining characteristics.

Elimination of social causes of ill-health: Modification of behavior and lifestyle could eliminate a big proportion of disease.  Malnutrition (excessive intake), alcohol and drug addition, sexual promiscuity are underlying causes of much ill-health both mental and physical.  Islam has adequate guidance on how to deal with these social problems through the injunction of amr bi al maruf and nahy an al munkar. Ordering good and forbidding bad is a function of all people and organizations. Therefore we cannot cite this as a distinguishing characteristic of Islam Medicine.

5.0 CONTEMPORARY DEFINITION OF ISLAMIC MEDICINE AS PARADIGMS, METHODOLOGY, & VALUES
The following definition of Islamic Medicine is proposed after consideration and rejection of the alternatives described above. Islamic Medicine is defined as medicine whose basic paradigms, concepts, values, and procedures conform to or to do not contradict the Qur’an and Sunnah.  It is not specific medical procedures  or therapeutic agents used in a particular place or a particular time.  Islamic Medicine is universal, all-embracing, flexible, and allows for growth and development of various methods of investigating and treating diseases within the frame-work described above. This definition calls for basic transformation of current medical systems.  Islamic Medicine thus becomes the result of an Islamic critique and  reformulation of the basic paradigms, research methodology, teaching, and practice of medicine. This process of conceptual transformation, also called Islamization of Medicine, is described below. The end-result of the Islamization process will not be a medical system for Muslims only but for the whole humanity because Islam is a set of universla and objective values.  Islamization is not theologizing, localizing of parochializing medicine but making it excellent for all.

The above-mentioned understanding of Islamic medicine is gradually changing the practice of medicine in the ummat. Islamic hospitals and clinics are being established in many Muslim and non-Muslim countries. There is increasing research inspired by the Islamic medicine movement. Medical faculties are being established on the same philosophy. In years to come, Muslim physicians will be able to make a marked impact on mainstream medical practice by introducing Islamic values to it.


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