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ISLAMIC MEDICAL EDUCATION RESOURCES-03

0208 - HOLISTIC vs. BIOMEDICAL MEDICINE

Paper presented at the Kampung Baru Medical Center on 24th August 2002 by Professor Omar Hasan Kasule, Sr. MB ChB (MUK), MPH, DrPH (Harvard), Deputy Dean, Kulliyah of Medicine, International Islamic University, Malaysia EM: omarkasule@yahoo.com

1.0 INTRODUCTION

A comparison of Islamic holistic and biomedical models of medical practice could give a misleading impression that there are differences in the technology and instruments used. The essential difference lies in the underlying paradigms, basic philosophical assumptions, attitudes, and values. The technology used may be used in the same but the manner of its use and the therapeutic and overall health improvement may be different for the two approaches. This paper presents the concepts and practice of bio-medicine. It then presents Islamic concepts on which holistic practice can be based: the Islamic concepts of life, health, disease, treatment and prevention of disease. A comparison is made of the two models and recommendations are made about introducing holistic concepts in medical practice.

 

2.0 THE BIOMEDICAL MODEL

PHILOSOPHICAL BACKGROUND

Understanding of the underlying biomedical model is necessary for assessing health policy alternatives. Current medical practice is based on the biomedical model. Biomedicine has achieved a lot in prevention and treatment of many diseases but is being challenged by chronic non-communicable diseases and the rising costs of curative medicine not accompanied by corresponding improvements in health. The biomedical model is the culmination of philosophical developments in Europe over the past 500 years that have transformed metaphysical medicine into scientific medicine. The philosophical changes were a materialization of life (empiricism), marginalization of spiritual and other considerations in health (secularism), and physical reductionism (ie understanding by breaking up into components).

 

BASIC CHARACTERISTICS OF THE BIOMEDICAL MODEL

Biomedicine is empirical. Empiricism is the basis for cause-effect relations. It uses the empirical methodology to minimize subjectivity. It considers facts and not dogmas. It relies on reason and not faith or myth. The empirical basis is accepted by Islam. Islam encourages empirical observation as the basis for evidence-based knowledge. It shuns all forms of superstition in medical practice.

 

The materialist background of biomedicine contradicts Islamic concepts. Materialism leads to consideration of health as a commodity that can be bought with money. The materialist background dehumanizes and demystifies the body and treating it like a ‘machine’, a ‘thing’ or a ‘physico-chemical phenomenon’. Besides dehumanization, it depersonalizes the patient who is looked at as a case of pathology and not as a human. It is more interested in the disease and not the person. A technical relation replaces the human physician-patient bond. Patients do not get emotional and psychological satisfaction from encounters with physicians even if their pathological disorders are resolved satisfactorily. Biomedicine relies exclusively on the scientific disease theory which asserts that symptoms reflect specific disease entities and that each disease entity has a unique cause and a unique therapy[1]. It asserts that disease is due to either pathological anatomy[2] or patho-physiology[3]. It assumes that causes of disease disturb the equilibrium and the purpose of medicine is to restore equilibrium. Biomedicine does not readily accept other causes of disease outside anatomical and physiological derangements. It therefore bases its diagnosis exclusively on physical assessments[4]. It does not consider any other ways of defining and diagnosing disease. Definition of abnormality in biomedicine is inadequate since it focuses on biology and ignores culture and psyche. Biomedicine has no fixed criteria for distinguishing the normal from the abnormal in body structure and function. It relies on statistical measures to define the norms. It also considers points of equilibrium as the norm. Despite the claims of scientific objectivity, the biomedical model has not always been able to operate away from subjectivity in practice. Subjectivity can not be avoided in diagnostic and treatment decisions. Reality depends on the starting point.

 

Biomedicine is not holistic. It ignores cultural, social, spiritual, and psychological aspects of illness and concentrates only on somatic aspects. It de-emphasizes overall wellness and welfare and narrowly focusses on pathological anatomy and patho-physiology. Biomedicine has failed to handle psychosomatic disorders that have no obvious anatomical or physiological origin. In its approach to factors of disease it marginalizes environmental medicine[5] and behavioral medicine.  Biomedicine equates illness with disease. Illness is wider and more holistic than disease. Illness is affected by both somatic and non-somatic factors whereas disease is affected by somatic factors alone. The elderly may for example be ill but with no specific disease. In the same way people with serious pathological conditions may not be aware of them or may not be concerned and they feel that they are in good health. Biomedicine fails to distinguish illness from disease because it concerns itself with the body and not the mind. It rejects the body-mind dualism that human traditions have accepted throughout history. It also rejects the dualism of soul and matter that is the unique characteristic of humans.

 

Biomedicine is not flexible. Biomedicine has not been able to respond effectively to the epidemiological shift from acute to chronic disease and the demographic shift from younger to older population distributions. Biomedicine is more applicable to acute than to chronic diseases. It has been very successful in curing acute infectious diseases by use of specific anti-microbials. It has not been flexible enough to performed equally well in cure of chronic and degenerative diseases

 

Biomedicine seeks to predict, control, and regiment. Biomedicine is not democratic. It gives all decision-making power to the physician and leaves the patient powerless. It has medicalized human life. It has distorted relations between humans and medicine. Pre-biomedicine humans controlled medicine and used it as they like. Post-biomedicine medicine controls human life and behavior.

 

FRAGMENTATION AS A MANIFESTATIONS OF THE BIOMEDICAL MODEL

Biomedicine is characterized by narrow specialization and fragmentation. Physicians know more and more about less and less. The trend toward specialization in medical practice has strongly influenced medical educators to diminish the practical content of the crowded undergraduate program and transfer some of it to post-graduate or vocational training. A new graduate from medical school is therefore unable to treat a patient on his own until he becomes a specialist. Specialty practice however has the great disadvantage of fragmenting patient care among several specialists such that there is no one doctor to care for the whole patient. The fragmentation of medicine is reflected in the balkanization of administration (by department), stages of education (pre-medical, pre-clinical, and clinical) and by discipline or specialty. Separate curricular tracks for research and practice have even been suggested. In many cases each department teaches independently of others. Specialist physicians find it difficult to teach students who are just being introduced to medicine.

 

The following attempts have been suggested to overcome the problem of fragmentation: interdepartmental or inter-disciplinary programs, integration of clinical and basic sciences, generalist and not specialist medical practice, vertical integration (linking early with later years in the same discipline), horizontal integration (linkage between different disciplines), teaching by organ systems, and using the problem-centered approach.

 

The concept of integration has been well accepted and propagated but not understood well when it came to practical application. Attempts at integration are a response to a felt problem and are certainly a step in the right direction however they have not solved all the problems; they even succeeded in creating a few new ones. Uncoordinated integration has succeeded in producing a hypertrophic curriculum. There is pressure from each discipline to ‘integrate’ its material into the curriculum. New disciplines such as genetics, statistics, epidemiology, demography, anthropology, and sociology are at the door claiming their share of the undergraduate curriculum. New disciplines have been created to ‘integrate’ or bridge the gap between pre-clinical and clinical disciplines e.g. clinical biochemistry, clinical pathology, and clinical epidemiology. Interdisciplinary teams have been used as a tool of ‘integration’ in community medicine.

 

If each of these demands and approaches to integration were to be fulfilled, the undergraduate medical curriculum will require a life-time to complete! There are, however, defenders of a crowded undergraduate curriculum. They argue that students should be exposed to all disciplines to enable them be informed choices about their future specialties. This reminds us of the story of an ’accomplished’ lawyer who knew a bit about every subject including law. The process of continuous additions to and pruning from the curriculum is going on and has been dramatically described as integration, re-integration, and disintegration.

 

Fragmentation is a reflection of an underlying European world-view and did not come about in medical education by accident. This world-view started with the renaissance when religion was separated from public life and science. This set in motion centripetal forces that continually separate, fragment and sub-divide. The body was separated from the soul. The mind was separated from the body. Science was separated from art in medical practice. Each disease or organ was isolated and was dealt with in isolation. It must however be recognized that specialization has been responsible for much of the progress in scientific medicine because of the concentration of the researcher’s energy on a narrow focused issue. It is not surprising that in a context of increasing fragmentation, the concepts of ‘total health’, ‘total disease’ are not easily accepted. It is not the ‘total human’ who gets sick but his organs or tissues. It is however very surprising that Claude Bernard’s concept of a harmonious ‘milieu interieur’ and the appreciation of the biochemical unity of all life did not motivate practice of ‘total medicine’. Many physicians in the west have recognized that fragmentation is a major problem and have set about attempting to achieve integration in medical treatment and medical education. Some of these attempts were described above.  Their limited success is due to lack of a guiding vision.

 

Integration is not just putting two or more disciplines together. It is a fundamental philosophical attitude based on a vision and a guiding paradigm. Only Islam can provide this paradigm. Criticism of the fragmented medical curriculum is actually criticism of the underlying European non-tauhid world-view. The fundamental reason for failure of integration efforts is that the European world-view is atomistic; it is good at analysis and not synthesis. It is incapable of synthesis because it lacks an integrating paradigm like tauhid.

 

LACK OF BALANCE AS A MANIFESTATION OF THE BIOMEDICAL MODEL:

Lack of equilibrium is a secondary manifestation of lack of integration. A lot of human illness is due to lack of balance and equilibrium; for example excessive intake of some foods leads to disease just as inadequate intake leads to ill-health. The Qur’an calls for observing the equilibrium, al wastiyyat. Violating the rule of the golden middle is associated with many problems and lack of balance is condemned.

 

Ancient Muslim, Indian, Chinese, Greek medical systems understood the concept of equilibrium. Modern European medicine lacks the concept of equilibrium or balance. It is replete with examples of overdoing a good thing beyond the equilibrium point and creating even bigger problems. Some therapies are worse than the disease they are supposed to cure. The quality of life of terminal cancer patients is made worse by chemotherapy and radiotherapy than the original disease perhaps they could have been left to die in dignity. Pesticides were used to eradicate malaria but they led to human disease. The best treatments of yesterday are known causes of malignancies today. Some physicians trained in the European tradition recognize the problems of balance and integration but they can not propose a comprehensive solution because of lack of an underlying paradigm. A European symposium called for balance between technological development and social change within an integrated system, education and skill acquisition, general and specialized training, science and behavioral disciplines. The conference did not however have a comprehensive solution or paradigm.

 

3.0 ISLAMIC CONCEPTS OF HOLISTIC MEDICINE

CONCEPT OF LIFE

Life is a complex phenomenon with biological, chemical, and spiritual components. Life on earth has a definite time span, ajal. No human endeavor including the most advanced medical procedures can shorten or extend this time span. The whole purpose of medicine is to exert maximum efforts to improve the quality of remaining life since Allah alone knows the timing of the ajal. Humans do not know ajal, jahl al insaan bi zaman al mawt. They have no means of foretelling in a certain way the moment of death. They can predict or extrapolate from their empirical observations and experience but this remains at best an approximation. Death occurs immediately when the appointed hour strikes, majiu al ajal & buluugh al ajal. The hour of death is fixed ajal musamma, ajal ma’aluum. It can not be advanced or forwarded. Humans naturally want to live for long. This may be because they want to enjoy the earth as long as possible or for fear of the unknown after death. Some humans desire a long life to be able to make a maximum contribution to improving themselves and the earth on which they live.  Human life must have some quality. It is not enough to eat and breathe or maintain the vegetative functions only. A human can not live like a plant or an animal. The quality of life can be defined in physical, mental, or spiritual dimensions. The physical criteria are: absence of disease, comfortable environment, and basic necessities. The mental criteria are: calmness, absence of neurosis and anxiety, and purposive life. The spiritual criterion is correct relation with the creator.

 

Each human has an inalienable right to life from Allah, haqq al hayat. This life cannot be taken away or impaired by any human being except in cases of judicial execution after due process of the law. Life is sacred and its sanctity, hurmat al nafs is guaranteed by the Qur’an[6]. The life of each single individual whatever be his or her age, social status or state of health is important and is as equally important as the life of any other human[7]. Protection of life, ‘ismat al hayat/hifdh al nafs, is the second most important purpose of the shariat coming second only to the protection of the diin. Legal compensation for bodily damage or homicide is replacement of lost earnings and not paying for the value of life. The compensation is a legal provision to provide sustenance to surviving relatives in case of death. It also provides sustenance to the person whose organ was severed and therefore cannot work to support himself. Every life is as important as any other life. Destroying the life of one person is equivalent to destroying the life of all humans[8].

 

CONCEPT OF HEALTH

The prophet said that good health, sihhat, and afiyat are two bounties that many people do not enjoy. Few people are healthy in all their organs and at all times. Health is a positive state of being and not just absence of disease. The traditional view of health looked at it as the absence of disease. Before the development of scientific medicine, few diseases were curable. With increasing ability to cure disease we find that people may not be in optimal health and well being even if all physical ailments were eradicated. This has led to the realization that good health is an independent entity that can be defined and handled independent of disease. Stated in other words, individuals who are disease-free may not be healthy. The components of good health are spiritual health, sihat ruhiyyat; physical health, sihat al jasad/rahat jasadiyyat; psychological and mental, sihat nafsiyyat/rahat nafsiyat), and social health. Spiritual health is maintaining correct relations with the creator that in turn orders relations with other humans and with the environment. Health in the biological sense is maintaining physiological function in the optimal situation. Psychological health is being aware of and at peace with the self as well as the social environment around. Health in the social sense means harmonious functioning in the social milieu involving give and take relations. The various components of health are inter-related and closely inter-dependent such that a problem in one can easily lead to disequilibria in others. Islam looks at health in a holistic sense. If any part of the body is sick the whole body is sick, mathal al jasad al waahid idha ishtaka minhu ‘udhuwun tadaa’a lahu saairu al jasad bi al sahar wa al humma. If a member of a family is sick the rest of the family are affected emotionally and psychologically. Any sickness in the community will sooner or later have some negative impact on all the members. The holistic outlook also means that physical, emotional, psychological, and spiritual health are considered together. A person who is spiritually sick will sooner or later also become physically sick. The reverse is also true unless the iman is very strong.

 

Health is relative and subjective. It varies by age, place, norms, gender, and state of iman or tawakkul. A physical state that is healthy in an elderly person may not be so in a younger one. The conventions and norms, aadat, of what is good health vary from place to place and even in the same place may vary from era to era. The subjective feeling of good health varies among individuals and groups of people. Those with strong iman and trust in Allah, tawakkul, may feel subjectively healthier than those who do not have these attributes. Health is often assessed subjectively using terms such as ‘good health’, ‘healthy’, ‘poor health’ and ‘unhealthy’. There are measurable statistical indicators of good health that are useful for a group of persons since they describe the average or the range of the normal. Health status of  a community is usually measured by morbidity, mortality, and disability. For the individual, the assessment of health is very individualized and cannot be summarized as indices or statistical measures. The indices of health are limited in that they indicate only the final state of health and do not take into account the intermediate stages. They also cannot measure the intangible spiritual and mental components of good health. The best index would be one that includes both spiritual and physical parameters. Such an Islamic index has not yet been constructed to our knowledge. This index would also include criteria that reflect relations with Allah, with the self, with other humans, and with the environment.

 

Keeping the body in good health is a responsibility, amanat. The Muslim must keep his body physically fit to be able to undertake the functions of istikhlaf and isti’mar.  Poor health not only deprives society of the contributions of an individual but also creates a burden for others. Neglect of one's health is a sin. It is a religious obligation, fardh, for the sick to seek treatment. It is also obligatory to undertake disease-preventing measures such as dietary regulation, general and oral hygiene, avoiding violence, avoiding diseases of the qalb that precede mental illness, or in general avoiding anything that impairs good health. Good health is a gift from Allah, ni’mat al sihat wa al faragh.

 

The concept of community health was not recognized widely until the last quarter century. It is however a very old concept found in the Qur'an. The Qur'an has told us about many communities in the past as lessons for us. Good, al balad al taib and safe, al balad al amiin are adjectives that the Qur'an has used about some communities. Some of them were blessed and lived in peace and plenty. Makka was described as a city of peace and general welfare. The Qur'an also told of communities that were victims of collapse, khiraab, those that were punished by famine, or were destroyed by Allah, ihlaak. The physical destruction was due to moral deviations like batar[9], transgression, dhulm, and corruption, fasaad. No community is destroyed or is punished until it receives a warning from Allah.

 

CONCEPTS OF ILLNESS and DISEASE

Health is a condition in which all of the body functions are integrated and are being maintained within the limits of optimal design[10]. A distinction must be made between disease as a pathological manifestation and illness that is a subjective feeling. Disease is divergence from the normal, gaussian mean, but not all deviation is disease because of the reserve capacity and ability of the body to adjust to variations. The demarcation between pathology and normal physiological variation can be fine. The definition of disease is very relative. A high blood pressure in an elderly person does not have the same implication as the same level in a younger person. Temperature levels have different interpretations in neonatal and adult infections. Adolescent behavior that may be normal would be considered illness in adults. There are changes in the body that should be accepted as normal processes of ageing and not as diseases. There is a space-time variation in definition and perception of disease depending on the culture, beliefs, attitudes, and prevalence of diseases. In localities where the burden of major diseases is high, some minor ailments may be ignored whereas in other places they are taken as serious diseases. There are diseases that may be associated with social status. One socio-economic group may perceive them as serious whereas another one does not. Some diseases become reclassified with changing public opinion and perceptions. New diseases continue to be defined due to changes in the causative agents, host factors, or new scientific knowledge. Today's disease entities may be redefined and re-classified in the future. Definition of disease considers several dimensions that may operate singly or in combination: moral or spiritual, biological or pathological, psychosocial, or normative statistical.

 

Overall disease is a state of dis-equilibrium, khuruuj al badan ‘an al i’itidaal. Loss of spiritual equilibrium is a disease in itself and soon leads to physical disease. Appreciation of this fundamental principle distinguishes a believing from a non-believing physician. Most diseases involve disturbances in the equilibrium of the normal body physiology. These biological disturbances may be within the range of normal physiological variation or may be clearly pathological. The psychosocial dimension of disease is associated with loss of equilibrium and may precede or follow physical disturbances. The normative or statistical dimension of disease is the most confusing. Sometimes people are branded ill because they fall at the extreme end of the health-illness spectrum as measured biochemically or physically. In the final analysis it is the perception of disease by the victim, the family or the health care givers that defines disease. The underlying pathology need not correspond with the victim’s disease complaint; perception operates in between.

 

Diseases may also be classified by cause as diseases of the heart, amradh al qalb, and diseases of the body, amradh al badan. Diseases of the heart include: lahw, ghaflat, ghill, ghaidh, kibr, and nifaq. These diseases of the heart lead directly or indirectly to somatic diseases. There is a relation between diseases of the heart, amradh al qalb, and diseases of the body, amradh al badan. The mental and spiritual disease of kufr leads to a lot of human cruelty like genocide because of lack of moral restraint. Diseases of the heart such as jealousy lead to violence and even death. Failure of appetite control leads to obesity and other attendant diseases. Addiction to alcohol leads to many physical and mental derangements. Loss of sexual self-control leads to promiscuity and sexually transmitted diseases. Protein energy malnutrition of the poor manifests social injustice in the community. Lack of spiritual equilibrium leads to inability of handling the normal stresses of life. This is often followed by addiction to alcohol and psychoactive substances. Physical diseases may cause so much depression and loss of hope that they develop diseases of the heart.

 

NATURE OF DISEASE

Disease is both reaction and adjustment. A patho-physiological disturbance is normally a response to a biological, physical, or chemical insult or injury to the body. Thus most disease manifestations including their symptoms and signs are a reaction to the injury and an attempt to re-adjust.

 

Disease as a bounty: In an Islamic context, disease does not always connote a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. Falling ill may be Allah’s way of forcing the person to take a desired rest or care for the body before it can deteriorate further. Death from some diseases was said by the Prophet to be martyrdom, shahadat. The pain due to disease is a reminder of the punishment and suffering that the evildoers will suffer from in hell. Disease can be an opportunity for personal redemption by expiation/atonement for previous sins, al maradh kaffaarat ‘an ba’adhi al dhunuubi. Disease may enable a person return to the due equilibrium in life. Falling sick may at times be Allah’s blessing in disguise that a person is incapacitated and thus is prevented from pursuits that could prove more dangerous for him. While a person is sick and is not busy with the routines of life he may have time to reflect and remember Allah. Disease is a trial: The trials that one goes through and the eventual patience can be rewarded by Allah’s forgiveness. Patience with chronic disease/disability is associated with high reward. The prophet (PBUH) talked about rewards for epileptics and the blind. Patience in the face of severe illness is a reason for entering paradise, jannat.

 

Disease as punishment: Some diseases are due to disobedience. Acts of disobedience may be followed by epidemic disease or by disease in an individual. The disease may be directly related to the sin such as liver cirrhosis due to chronic alcohol consumption or there may be no direct relationship. The prophet taught that when communities commit inequities, Allah sends them diseases unknown in their ancestors. Many of the diseases of industrialized societies are related to lifestyle and may be Allah’s punishment for various transgressions.

 

Causality in disease: According to the Islamic perspective every phenomenon in life has an immediate cause, sabab, that humans can search for and find. However behind all these causes is the power and majesty of Allah who alone is the source of all causes, musabbib al asbaab. When all the factors that produce a certain pathological condition exist, we say that there is a sufficient cause of disease. However humans can never know for sure that there is a sufficient cause because Allah’s divine will, qadar, is involved. There are many cases when all the humanly known factors of a disease exist but the disease does not occur. This is because of the unknown factor attributable to Allah alone. There are empirical factors that must operate for a certain pathological condition to occur. These are referred to as necessary causes. For example the tubercle bacillus is a necessary cause for the disease of tuberculosis. Humans must know the necessary causes of diseases. Denying their existence is denying the cardinal principle of sunan Allah fi al kawn and is akin to superstitious belief.

 

Multi-factorial causality of disease: Human diseases, like the human organism, are complicated and usually several factors are involved in their causation. Humans may know some of the factors and ignore others. It is not necessary to know all the factors in order to treat a disease. Since the factors usually act in sequence, knowledge of only one may be sufficient to interrupt the causal pathway.

 

Pre-determination, qadar, in disease: The causation, progression, and resolution of disease are in the hands of Allah and are part of qadar. It is Allah’s pre-determination that a person falls sick. Humans try to understand disease processes in order to reverse them. This is not contradicting or opposing Allah’s will. All what a physician does is with Allah’s permission and is therefore part of pre-determination. Treatment and prevention of disease are not against qadar but are subsumed under the principle that qadar can reverse another qadar, radd al qadar bi al qadar. In the end all cure is from Allah and not the human.

 

TREATMENT and CURE OF DISEASE

Every disease has a treatment. The prophet Muhammad (PBUH) said in an authentic hadith that Allah did not reveal any disease, bau, without also revealing its cure, dawau. Humans are encouraged to seek treatment, al hatthu ‘ala al dawaa. The Qur’an described cure, shifa. The Qur’an is itself a cure[11]. Honey is described in the Qur’an as a cure. Some people may know the cure and others may ignore it but it nevertheless exists. The Qur’an described disease in prophet Ayyub (PBUH) and its eventual cure. The Qur’an described how Isa cured chronic diseases. Humans try, but it is Allah who cures, Allah huwa al shafi. Humans should not be arrogant by attributing cure to themselves and not Allah. In the same way humans cannot refuse to take measures to cure disease claiming that Allah will take care of it. It is true that Allah cures but in some cases that cure operates through the agency of humans. Sometimes the measures that humans take to cure a disease may not be sufficient on their own to alleviate the condition; it is Allah’s divine intervention and mercy that brings about the complete cure. Disease treatment is part of qadar[12]. Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadr. The principle that applies here is reversal of qadar by another qadar , rad al qadr bi al qadr.

 

Curative medicine may be invasive or non-invasive. Where possible non-invasive approaches are preferred because invasive disease treatment whatever its nature involves some element of risk to the patient. A non-invasive approach that aims at helping or assisting the body to fight the disease is the best. Many physicians forget the tremendous potential that the body has to take care of itself and cure disease with the help of Allah. Medical treatment in most cases should be supportive to the body’s natural healing processes.

 

Among spiritual approaches to disease management is use of dua from the Qur’an[13]  and hadith as ruqiy. Dua was reported to have been used for madness, dua min al junoon [14] and for fever[15]. The formulas for ruqy reported from the prophet, al ruqiy al mathuur, consist of the following chapters of the Qur’an: al fatihat, al falaq, al naas, ayat al kursi, and the various supplications reported from the prophet, dua ma’athurat. The Qur’an is the best medicine[16]. Dua is medicine[17]. Asking for protection from Allah, isti’adhat, is medicine. A strong iman and trust in Allah, tawakkul, play a role in the cure of diseases. Salat is a cure[18]. The spiritual approach to cure is mediated through the physical processes. Psychosomatic processes affect the immune functions and other metabolic functions of the body. A believer who is spiritually calm will have positive psychosomatic experiences because he or she will be psychologically healthy and at ease. Faith can change the very perception of disease symptoms. Pain is for example subjective. A believing person who trusts in Allah may feel less pain from an injury than a non-believer with the same injury.

 

Among physical approaches to disease management are: diet, natural agents (chemical, animal and plant products), manufactured chemical agents, surgery, jiraha, and physical treatment e.g. heat. All therapeutic agents and procedures are allowed unless they contravene a specific provision of the law. This provides a wide scope for the practice of medicine. Bad medicine is forbidden[19]. Bad medicine causes more harm than benefit. While seeking treatment, the moral teachings of Islam must be respected. The end never justifies the means. Haram material is not allowed as medicine except in special circumstances where the legal principle of necessity, dharurat, applies. Alcohol is for example not an accepted cure for any disease; it is actually itself a disease. The side effects of medication must be considered alongside the benefits. Harmful treatments are not allowed in situations in which the cure is worse than the disease. Choice of what treatment modality to use should involve a careful weighing of benefits and possible harm or injury. It is a principal of Islamic Law to give priority to preventing harm over accruing a benefit.

 

4.0 CHANGE FROM BIOMEDICAL TO HOLISTIC

 Need for reform: Many thinkers and physicians are aware of the limitations of the biomedical model. Efforts have been made to correct its deficiencies by adding missing dimensions. A bio-psycho-social model has been proposed to take care of psychological and social aspects. Spiritual aspects have so far not been recognized widely. Radical changes to the biomedical model will only occur if the philosophical background is re-examined. European materialism, secularism, modernism, and post modernism are the dominant philosophical tenets in medicine. No major changes can occur until these are examined critically. Unfortunately Muslim physicians have been very complacent in accepting without challenge most of the European philosophical under-pinnings of biomedicine. This is the lizard hole phenomenon that the prophet (PBUH) warned his community. The European concepts have to be replaced by Islamic ones.

 

Three Islamic concepts: tauhid, wasatiyyat, & shumuliyyat. The concept of tauhid motivates looking at the patient, the disease, and the environment as one system that is in equilibrium; thus all factors that are involved with the three elements are considered while making decisions. The concept of wasatiyyat motivates the need for moderation and not doing anything in excess. The concept of shumiliyyat extends the tauhidi principle by requiring an overall comprehensive bird’s view of the disease and treatment situation. The argument is not that biomedicine is good or bad. The science and technology are good and needed. The problems are the philosophical pre-assumptions that limit medicine to biomedicine and reject other necessary components of medical care. The Islamic concept of tauhid will give medical science and medical technology the appropriate conceptual context.

 

Tauhid is the main paradigm in Islamic civilization that forms a backbone of all intellectual discussion of medical education. Tauhid al rububiyyat motivates the appreciation that there is only one creator and that thee is unity, harmony and useful interconnections among different forms of life and the physical environment. Tauhid al uluhiyyat motivates the appreciation that the creator has definite purposes from creation and that human life must fulfill those purposes. This implies that there are certain laws that lead to a fulfilling life. Obeying those laws is associated with a healthy high-quality life-style. The tauhidi paradigm implies integration and harmony of matter and soul, body and mind, parts and the whole.

 

The physician should be trained to practice medicine as a total holistic approach to the human in the social, psychological, material, & spiritual dimensions and not an attack on particular diseases or organs. The example of the early Muslim physicians is worth emulating. They were well rounded in their education and their practice of medicine. They were also integrated in the sense that their medical practice fitted in well with other social activities. Al Qadhi Abd al Razaaq used to teach medicine and mathematics in the mosque in Bukhara until his death. Muwaffaq al Ddiin Abd al Latiif al Baghdadi taught medicine in the Azhar mosque during his stay in Egypt. Thus the context and the environment in which the teaching was carried out was integrative. It integrated medicine with the mosque and worship.

 

Al Faruqi[20] described tauhid as the source of truth, cosmic and social order. It ensures unity of truth and therefore prevents contradictions between different disciplines of knowledge. Tauhid is a world wide view that can guide not only medical education but also all endeavors of building a civilization. The Islamic social order is totalistic and Islam is relevant to every aspect of human endeavor. The tauhidi approach to integration is putting medical knowledge, teaching and practice in a larger context to making sure it is in harmony and is well coordinated with other related medical or non-medical phenomena. It is therefore possible to envision a very ‘integrated’ doctor who at the same time is very specialized. Such a doctor will approach the patient as a whole human and not just as organs or tissues.



[1]  This assertion is seriously challenged by chronic diseases

[2]  Disease is due to anatomical anomaly

[3]  Disease is due to deranged physiological or biochemical function

[4]  Clinical examination for signs, medical imaging, and medical chemistry

[5]  Environmental medicine asserts that disease is related to the physical and social environments

[6]  2:84-85, 4:29, 5:32, 6:151, 17:33, 18:74, 25:68

[7]  5:32

[8]  2 5:32

[9] 16:112, 17:16, 28:58, 34:34, 43:23

[10] Bowman p. 4.2: Textbook of Pharmacology

[11] 17:82

[12] Tirmidhi K26 B21, K30 B12, Ibn Majah K31 B23, Ahmad 3:421, Ahmad 5:371

[13] 17:82

[14] Ahmad 1:302

[15] Tirmidhi K45 B36, 111, 118, Zaid H349, 350

[16] Ibn Majah K31 B28, Ibn Majah K31 B41

[17] Ahmad 2:446

[18] Ibn Majah K31 B10, Ahmad 2:390, Ahmad 2:403

[19] Tirmidhi K26 B7, Ibn Majah K31 B11, Ahmad 2:305, Ahmad 2:446, Ahmad 2:478

[20] al Faruqi, Raji Ismail. Islamization of Knowledge. IIIT Reston VA 1982

Omar Hasan Kasule, Sr August 2002