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ISLAMIC MEDICAL EDUCATION RESOURCES-03

0206-ECONOMICS OF PREVENTIVE MEDICINE (A Critique of the Biomedical Model) (PART II)

Paper presented at the 4th International Scientific Meeting of the Islamic Medical Association of Malaysia in Conjunction with the 19th Council Meeting of the Federation of Islamic Medical Associations in Shah Alam, Selangor, 4-7th July 2002 by Professor Omar Hasan Kasule, Sr. MB ChB (MUK), MPH, DrPH (Harvard), Deputy Dean for Research, Kulliyah of Medicine, International Islamic University, PO Box 231 Kuantan, MALAYSIA. Fax 609 513 3615. EM: omarkasule@yahoo.com

DIFFICULTY OF MEASURING COSTS IN HEALTH ECONOMICS

Production costs: Specific cost terminology is used in economic analysis. The components of cost may be described as direct costs or indirect costs. They may also be described as fixed costs, variable costs, and marginal costs. The direct health care cost of an intervention is the actual monetary expenditure for that intervention and includes the costs of test, drugs, supplies, rent, and equipment maintenance. The direct non-health care costs include patient transportation costs and patient time costs. The indirect costs are overhead expenditures. Total cost (TC) is the sum of fixed costs (FC) and variable costs per unit (VC) x number of units. Allocation of various costs to their categories is not easy in practice. Discounting of future health costs is used in economic analysis but it is often difficult to determine the appropriate discount rate.

 

Intervention costs: Costs of interventions are of various types: cost of the medical and surgical procedures, costs associated with the adverse effects of the intervention, and cost associated with the adverse health condition that is averted, and resource costs. Costs medical or surgical procedures include hospital/facility costs, administrative costs, pharmaceutical costs, equipment and supplies costs, health care provider costs (cost of health care provider time with time assessed by direct observation, random observation, use of time diaries, patient records, and special surveys), costs of patient/participant time (traveling, waiting, and time for actual health care), participant costs (travel, child care, out of pocket payments etc). Costs associated with the adverse effects of the intervention are obtained from literature review or are based on views of experts. The costs of the adverse health condition averted include direct medical costs and personal costs. The personal costs are assessed using the human capital approach of the willingness to pay approach. The human capital approach is based on computing loss of income due to the health condition. The willingness to pay approach basically answers the question ‘ what are you willing to pay to avert the adverse health event?’. Units of medical care are difficult to measure because they are intangible, are inseparable, and are of varying quality. Documenting and valuing all intervention costs is not easy in practice.

 

Opportunity cost: The concept of cost is different from that of opportunity cost. The concept of opportunity cost is used by economists in their analyzes. It is based on the concept of scarcity and is akin to the saying that you can not eat your cake and have it at the same time. Scarcity of resources requires that getting something means foregoing something else. Opportunity cost of a resource is its total value in another use. For example when funds are used for vaccination they cannot be used for education. Thus the opportunity cost (or cost of lost opportunity) is a true refection of health costs. Also included among costs are family or home caregiver costs or cost of lost wages. The concept of opportunity cost is is a better measure of the true costs of an intervention that the dollar amounts paid for equipment, supplies, and labor.

 

Assessment of costs: A major weakness of economic analysis in health is the inability to identify, document, and value all costs. Many of the costs are intangibles like pain or foregone pleasure and there is no way of putting a dollar figure on them.

 

MEASUREMENTS OF OUTCOME IN HEALTH OUTCOME

Types of health outcomes: Health outcomes can be clinical end-points, physical functional status, psychosocial function status, role function status, general well being and satisfaction with care, quality of life, and service utilization. Clinical endpoints are signs and symptoms of disease, complications of disease, complications of medical care, laboratory assessments, survival, and health status measures (life expectancy; mortality; morbidity; years of healthy life YHL; years of healthy equivalent, YHE; and years of potential life lost, YPLL. Life expectancy, usually measured for ages 0, 40, and 60, is a widely used outcome measure computed as ex = 1/ dx where ex = life expectancy at age x and dx = mortality rate at age x. It is possible to account for quality of life by adjusting le for quality of life. Mortality is measured as infant mortality rate, perinatal mortality rate. Morbidity is measured as rates of absenteeism, accidental injuries etc). General wellbeing, a non-specific outcome measure, includes health perception, energy, fatigue, pain, and life satisfaction. Satisfaction with care includes access, convenience, financial coverage, and quality of care.

 

Valuation of human life: Putting a monetary value to life is very difficult and no one method has been found to be perfect. Generally three approaches are used: the human capital method, the marginal cost per life saved, and willingness to pay. The human capital method values life of an individual as equal to the present value of expected future earnings. Thus the value attached to a medical intervention that ‘prolongs’ life for 10 years is equivalent to discounted expected earnings for 10 years. This approach has a weakness that it is a measure of livelihood and not a direct measure of life. Valuing life by the marginal cost per life saved involves administering a questionnaire and asking respondents to indicate their preferences of various marginal costs to achieve given prolongations in life. The willingness to pay method is a direct question of what amount of money an individual would be willing to pay to achieve a given prolongation of life.

 

Measurement of the quality of life: Health has two dimensions: duration of life and quality of life. Both must be considered in the assessment of health outcome. A prolonged life with low quality is not a highly desired goal. It may be better to have a shorter life of higher quality. Duration of life is easy to measure using life expectancy. Quality of life is a less tangible entity difficult to measure accurately and includes disability, functional status, and generic measures of health status. The Quality-Adjusted Life Years (QUALY) is an outcome measure that has been used in conjunction with economic analyses in health economics. QUALY it is a measure of utility that combines morbidity and mortality. It can be linked to cost via cost-utility analysis. In general the intervention with the lowest cost per QUALY is selected. QUALY is criticized on several methodological grounds. QUALY is based on hypothetical situations. It reflects quality as seen from the perspective of a good quality becoming bad on falling sick and ignores the more important perspective of bad quality getting better with medical intervention. It is affected by the duration of the disease with chronic conditions being associated more with higher QUALY assessments. QUALY is based on surveying many persons and the answers depend on the way questions are posed and reflect a local rather than a universal perspective. QUALY does not measure the full benefit of health care for example it has no room for things like costs averted because of the medical intervention. QUALY scores are not reliable because they are derived by clinical experts in experimental settings that are not related to actual market conditions. In a free market the willingness to pay varies by individual.

 

Assessment of outcome: We can conclude from the above expositions that assessment of outcome and benefits of health care is neither easy nor accurate. Methods used are tentative and cannot give definitive conclusions.

 

ECONOMIC ANALYSIS

The purpose of economic analysis is to evaluate projects. There are 4 basic types of economic evaluation in health: cost minimization, cost benefit analysis (CBA), cost effectiveness analysis (CEA), and cost utility (CUA). Cost minimization is the easiest of the economic evaluations because it uses monetary units directly to make a decision. It is choice of the least costly of 2 or more interventions that have the same effectiveness or outcome. Cost benefit analysis is economic appraisal that addresses allocative efficiency. It compares marginal benefit to marginal cost. Cost effectiveness analysis addresses meeting given objectives at least cost. CEA minimizes costs and is the first stage of CBA. Interpretation must take into account general background data such as population, total employment, and gross domestic product.

 

Cost benefit analysis, CBA, compares monetary costs with monetary gains. It measures the costs of an intervention and the benefits of the intervention in the same monetary units. Nett benefit = (Total benefit + averted costs) – total costs = total benefit – (total cost + averted cost). If we take present value of money into consideration, Nett benefit = t=1t=T (Bj – Cj) / (1 + r)t where r = discount rate. The Cost-benefit criterion can be computed as {t=1t=T [Bj / (1 + r)t] }/ {t=1t=T [Cj / (1 + r)t] } CBA is a type of marginal analysis that compares increase in cost with increase in benefit. CBA is undertaken because there are no market mechanisms to determine when marginal cost = marginal benefit. It rests on the principle that society’s welfare will be improved if the benefits of a health intervention exceed its costs. The intervention is allowed to go ahead if benefits exceed costs. It is stopped if costs exceed benefits. CBA is necessary for making efficient allocation decisions because resources are limited. CBA has three main problems: complete identification of all relevant costs and benefits, assigning monetary values to benefits and some of the costs, and determining the appropriate discount rate for projecting monetary values into the future. Health expenditures are mainly of three types: hospital expenditures (wages, equipment, and supplies), community expenditures, and others like ambulances. Benefits include the cost of life saved but no consensus has ever been reached on valuing human life. The future income stream is empirically used to measure value of life but it has many disadvantages. The reluctance of health professionals to put a monetary value to life has made them avoid CBA and resort to CEA and CUA. CBA is used for evaluation (screening programs, alternative treatment procedures, and technology), selecting policy alternatives, medical research, and setting regulatory measures. CBA enables making a choice between two or more interventions with different outcomes and effectiveness. For example in the case of polio vaccination the cost of the vaccination program is compared to the amount of money saved by not hospitalizing and taking care of polio victims. It is however difficult to put a dollar value to intangibles like value of life, suffering, and quality of life. Cost benefit analysis addresses the issue of allocative efficiency that answers the questions: ‘is it worth achieving this goal?’ and ‘ are the costs higher than the opportunity costs?’. It is not easy to assess the benefits of health intervention because they are not directly measurable and measures used may not be complete or objective. Three indirect measures are used for health benefits: the human capital approach, willingness to pay, and cost savings. The human capital approach assumes that a healthy individual is an economic asset and his economic productivity (earnings) can be measured and can be attributed to the health intervention. The willingness to pay uses the health consumer as the judge of the worth of a specific intervention. The amount of money that a consumer in a free market situation is willing to pay for a specific health intervention can be used as a measure of the benefit of that intervention. The cost savings approach computes the benefit of the intervention as the difference in health and other costs with intervention and without intervention. In some cases the benefits may be delayed for years after program implementation. It is also difficult to allocate savings benefits between the consumer and the provider. Benefits today may have to be discounted in order to compare favorably with future benefits; the formulas used are not always exact. Benefits have also to be considered in view of the priority of the program. Some issues have higher priority than others.

 

Cost effectiveness analysis (CEA): Cost effectiveness analysis measures technical efficiency of an intervention. Costs are computed in monetary terms and benefits are expressed in their natural units. CEA is used instead of CBA because it does not involve monetary evaluation of benefits which is very difficult. Cost effectiveness is computed as nett costs / benefits. The nett costs are the intervention costs + costs of side effects – direct medical costs saved. A ratio of cost to health effects is computed for each intervention. Cost effectiveness analysis enables a comparison of costs alternative disease control strategies with benefits of each alternative measured in the same units. For example for HBV we may compare the costs of three alternative approaches: no vaccination, universal vaccination, and vaccination preceded by screening. The cost of each alternative is computed and the cheapest is adopted. Cost effectiveness analysis evaluates benefits against an acceptable cost. The cost of saving a life-year is estimated. Most sophisticated analysis may involve adjusting for quality of life. Cost effectiveness analysis has several limitations that must be taken into account while making public health decisions. Cost data is difficult to obtain. Often charge data is used but it is not a good substitute because what is charged is either below or above the actual cost depending on market factors. The health effects of an intervention are not easy to measure accurately and because unquantifiable value judgments are involved. Life expectancy and QUALY are sometimes used but they are not considered perfect.

 

Cost utility analysis (CUA): Cost utility analysis values benefits of health services in terms of utility. The most commonly used measure of utility is the number of years of life gained due to the health intervention. Cost utility analysis enables making a decision which of 2 or more interventions is better per cost unit when the outcome measure reflects the values and preferences of society. Since CUA is based on consumer preferences, it is of limited application due to its many value-laden assumptions. Cost utility analysis uses years of health as a measure of outcome. The most popular are: Years of Potential Life Lost (YPLL), and Healthy Years Equivalent (HYE). Quality of life is measured as years of healthy life (YHL), quality adjusted life years (QALY), and Disability adjusted life years (DALY).

 

Assessment of economic analysis: The sophisticated economic analysis tools described above suffer from the basic problems of inability to measure costs and outcomes accurately. Thus results of economic analysis cannot be anymore reliable than those of cost or outcome assessment. Economic analysis assuming a biomedical model can produce some results albeit defective for the reasons given above. It produces false and incomprehensive conclusions if used under the assumptions of a holistic view of health discussed at the beginning of this paper.

 

 

APPENDIX #2: THE ISLAMIC INPUT CURRICULUM

 

KULLIYAH OF MEDICINE

INTERNATIONAL ISLAMIC UNIVERSITY, MALAYSIA

ISLAMIC INPUT CURRICULUM

 

FIVE MAIN OBJECTIVES, ahdaaf asaasiyyat

A. FUNDAMENTAL CONCEPTS AND PARADIGMS

The first objective is the introduction of Islamic paradigms and concepts in general, mafahiim islamiyyat ‘aamat, and as they relate to medicine, mafahiim Islamiyat fi al Tibb. The Muslim physicians must have some general concepts deriving from Islamic teachings that can guide their work and research. These concepts can be grouped in five major categories: the Islamic creed, aqidat Islamiyyat; general concepts of knowledge and epistemology, ‘ilm & marifat; civilization, ‘imarat al ardh; concepts of life and health, hayat & sihhat; and structure and function of the human organism, tarkiib wa wadhaif al a’adha. The historical perspective of medicine in Muslim communities was discussed under the section on knowledge. The medical student and future physician must understand medicine in the ummah from historic and futuristic perspectives, tarikh wa mustaqbal al tibb. The medical student is motivated and inspired by appreciating the medical heritage of the Muslim civilization. Knowledge of the evolution of medical knowledge and practice since the first century of hijra and achievements of Muslims in medicine have been ignored by western scholars and have been poorly documented by Muslims. This knowledge is an indispensable component of the Islamic intellectual heritage. Few Muslim physicians know the medical and intellectual heritage of medical knowledge in the Qur'an, tibb qur’ani, and the hadith, tibb nabawi. Islamization of medical sciences is a challenge that does not aim at producing different knowledge but at producing medical and scientific knowledge within an ethical and moral context.

 

B. MEDICINE and REVELATION

The second objective is strengthening faith, iman, through study of Allah’s sign in the human body. Medicine and medical knowledge have been described as the altar of faith, al tibb mihrab al iman. Study of medicine leads to the conclusion that there must be a powerful and deliberate creator because such a sophisticated organism could not arise by chance. Contemplation of the structure and functioning of the human body lead a normal person to appreciation of the power of the Creator and to believe in Him. This is achieved by contemplating the perfection, optimality, and sophistication of human biology starting from the sub-cellular to more sophisticated structures like tissues and organs; contemplating the order, harmony, and purposiveness of human growth and development; contemplating human senses and organ systems as a gift from Allah; and contemplating the tauhidi integrating paradigm as reflected in the well coordinated body physiology  and interaction of the human organism with the eco-system.

 

C. MEDICINE and the LAW

The third objective is appreciating and understanding the juridical, fiqh, aspects of health and disease, al fiqh al tibbi. There is a close interaction between injunctions of Islamic law, shariat, and medical practice. Muslim physicians must be aware of the general concepts so that they can give preliminary advice to the patients. Diseases and their treatment interfere with the patient’s duties to Allah and also to other humans by limiting legal rights and obligations. Difficult and fine choices must be made. Well-trained physicians should be able to understand the various options available and to explain them well to enable the patient make an informed decision. Legal aspects of medicine can be categorized in five groups: medical and health issues of the physical acts of worship such as salat,saum, zakat, & haj; normal physiological processes of breast-feeding, menstruation, pregnancy, excretion of body wastes, nutrition, sleep, and reproduction;  the impact of disease on ibadat obligations and the impact of disease on human and social obligations; medical aspects of applying the Law using medical and forensic evidence. Included under the rubric of the Law is a group of issues that constitute medical ethics in Europe. The physician is the first recourse to patient and their families in trying to make an informed decision when confronted by an ethical issue. The physician is not expected to make a legal ruling, fatwa. He must however know and understand the issues involved from Islamic and medical perspectives and guide the patients to the most appropriate choices. Controversial legal issues arise in medical care and medical research which involve serious violations of human and animal rights.

 

D. SOCIAL ISSUES

The fourth objective is understanding the social issues in medical practice and research, al qadhaya al ijtima’iyat fi al tibb. Medicine is not taught or practiced in a social or ethical vacuum. Good physicians must understand how social problems and issues impact on health, disease and medical treatment. They also must appreciate how medical practice can create or solve social problems. The physician must know societal institutions and how they affect disease occurrence and disease management. He must be able to identify social causes of disease from the context of a social system to be able to plan the eradication of social root causes of disease.

 

E. PROFESSIONAL ETIQUETTE, adab al tabiib

The physician carries a heavy trust, the amanat of being professionally competent. He must know the proper etiquette of dealing with patients and colleagues. He must understand that medicine is a service vocation and not a way to self-enrichment.

 

CHARACTERISTICS, khususiyyat al manhaj

A. TAUHIDI HOLISTIC COMPREHENSIVE APPROACH

The curriculum is written from a holisitic tauhidi paradigm that does not look at medicine as a science and art isolated from the rest of society and human endeavours. When medical issues are discussed, reference is made to relevant social and spiritual aspects. A basic paradigm of this curriculum is that medicine and medical treatment are comprehensive involving physical, psychological, social and moral aspects. It therefore tries to be inclusive and discuss all factors that directly or indirectly affect human wellbeing or ill health. This paradigm is a practical consequence of the integrative tauhidi paradigm that is the basis of the Islamic civilization. The curriculum aims at universality and integration. Medicine is not a collection of sub-specialties but an integrated whole. Medicine in integrated with other disciplines in a multi-disciplinary approach to solving human problems. Disease and its treatment at seen from the context of the whole eco-system. Lack of integration with the eco-system leads to new problems being created while solving old ones. The medical curriculum for which this curriculum is prepared aims at producing a well-rounded physician who is not only skilled in scientific medicine but also understands the spiritual and social aspects of disease. Such a physician looks at the patient as a whole person living in a social and spiritual milieu and not just as a collection of symptoms and signs. The physician’s approach to medical problems is not only scientific and technical. It  extends to other aspects of the patient’s life that affect overall well-being.

 

 

B. INSTRUCTIONAL APPROACH

The curriculum is primarily a text book to be used in the Kulliyyah of Medicine at IIUM.  It covers the approved Islamic input portion of the undergraduate medical curriculum. It contains all the information that the student and the lecturer need. It has comprehension questions, discussions and exercises. The curriculum is user-friendly. An attempt has been made to make the curriculum easy to read and use. The vocabulary, style of writing are selected in such a way that the curriculum is easy to read and to translate into other languages as well as to adapt for interactive computer-based instruction and educational multi-media. Illustrations in the form of computer-generated line drawings and tabulations have been used liberally to ease understanding. The curriculum has been written for a wide and varied audience in such a way that it can be used by nursing, dental, pharmacy, and other allied medical professions in addition to practising physicians, jurists, fuqaha, and other non-medical persons who have a general scientific background. Simple vocabulary has been used, medical terminology has been simplified to make the curriculum easy reading for the non-medical specialist. Summarized background information on anatomy, physiology, and pathology of diseases is included. The medical specialist can skip the background sections that are included for the non-specialist. Islamic terminology has been used liberally. One of the instructional objectives of the curriculum is to introduce as much Islamic terminology as is possible into the ordinary professional and conversational vocabulary of the reader. As a consequence many Arabic terms are used being translated the first time they are encountered and left untranslated subsequently.

 

C. MODULAR STRUCTURE:

The curriculum is organized in 3 volumes each containing 5 modules and each module consiting of 5 units. Each unit is self-contained, can be studied alone, and has enough material for a 2-hour class room session. The unit is divided into 5 sub-units. It has at its end: a listing of key words and terms, Discussion questions and exercises, relevant texts from the Qur’an and hadith to be analyzed, references, recommended additional readings, and end-notes. An outline at the start of each unit gives the main issues covered in a point form that can be used as transparencies or slides during presentations. These transparencies and slides are provided separately as ancillary instructional material. The main body of each unit can be the basis of a 1-2 hour lecture presentation on the topic. It is written in easy-flowing prose almost conversational so that it can be recorded on a video casette or audio cassette for use in instructional programs. The list of key terms and key words is provided to aid memory and recollection. References to the paragraphs in which the term appears are given to facilitate review and discussion. These key words are used in searching for particular information in the computerized version of the curriculum. The ‘discussion’ section consists of issues for further discussion especially involving practical applications of concepts introduced in the unit. The ‘texts’ section is a collection of verses of the Qur’an, hadiths, and sayings of the companions of the Prophet that relate to the subject being discussed are presented to help drive home the concepts being presented. The Arabic original is placed alongside the translation. This spares the reader the trouble of looking up reference material in another volume.  A bibliography of basic ‘references’ used in preparing the material is provided. An attempt is made to povide a complete bibliographic citation where possible. An attempt has been made to include as many relevant Muslim writings as possible. A list of ‘recommended additional readings’ is provided for those interested in more advanced understanding. This list will be continually up-dated. Endnotes give sources of texts used. In case of verses of the Qur’an, the occasion of revelation, sabab al nuzul,is given and an explanation of how it relates to the subjects is given unless it is an obvious case. Commentaries on both Qur’an and hadith from the most reliable and famous commentaries are provided. Other explanatory notes are also given on all sections of the unit. An index and glossary is provided at the end of each volume: ‘Indexes’ of ayats, hadith, proper names, subject are provided for easy reference.

 

D. USE OF ORIGINAL SOURCES IN QUR’AN AND SUNNAT

The curriculum is written using original sources from the Quran and Hadith as well as established medical knowledge.  It is considered so important that the student interact directly with the basic sources, Qur'an and sunnat, that many excellent writings by ancient and contemporary scholars have deliberately not been quoted. Verses of the Qur’an relevant to various issues were identified from the Index of the Meanings of the Verses of the Holy Qur’an, al mu’ujamal mufahras li ma’aani al qur’an al kariim, and the Index of the words of the Holy Qur’an, al mu’ujam al mufahras li alfaadh al qur’an an kariim by Muhammad Fuad Abd al Baaqi. Books of tafsir through reports, tafsir bi al ma’thur, were used to interpret verses: Jami’u al bayaan fi tafsir al Qur’an by Abu Ja’afar Muhammad bin Jariir al Tabari (d. 311 AH/923 AD) and Tafsir al Qur’an al “Adhiim by ‘Imad al Ddiin Abi al Fida Ismail bin Kathir al Qurashi al Dimashqi (d 774 AH). Hadiths relevant to specific issues were identified using Miftaah Kunuuz al Sunnat by I.Y. Vinsk and Muhammad Fuad Abd al Baqi and the hadiths were studied in the 9 recognised compilations of hadith. The majority of hadiths were quoted from 4 books: Sahih al-Bukhari (d. 256 AH/870 AD), Sahih of Muslim (d. 262 AH/875 AD), Sunan Abu Daud, and Muwatta Malik (d. 179 AH/794 AD). Published English translations were used where available but they were always checked against the original Arabic. Where necessary references were made to hadiths in the following books: Sunan al Tirmidhi, Sunan Ibn Majah, Sunan al Nisae, Musnad Ahmad (d. 241 AH/855 AD), Sunan of Aldaylami, Kitab Al Sunana Al Kubrah of Bayhaqi, and Musnad al Darimi. The following hadith commentaries on Sahih Bukhari were consulted: Fath al Bari  by Ibn Hajar al Askalani, Umdat al Qari Sharh Sahih al Bukhari by Shaikh Badr al Ddiin al Olayni. It has been assumed throughout the writing of this curriculum that each generation produces its own corpus of fiqh by interpreting the revelation and making ijtihad in the context of its spatial and temporal situation. The fiqh of the great scholars of Muslim history was the best for their times and would not always be relevant to our times. We therefore have gone back to the original sources, Qur’an and sunnah, and looked at them from the problems and challenges of our times. Very few of the conclusions of ancient writings have been quoted. However their methodology of analysis has been most useful and has been employed.  The following books of fiqh methodology were used: al Mahsul for ‘Ilm Usul al Fiqh by Fakhr al Dddiin al Razi (d. 606 AH), al Wajiiz fi usul al fiqh by Dr Abdul Karim Zaydan, al Muwafaqaat fi usul al shari’at by al Shatibi. The curriculum relied on the Shafite legal manual ‘Umdat al saalik wa ‘uddat al naasik’ by Ahmad Ibn Naqib al Masri (d. 769 H/1368 CE) for rulings on various fiqh issue from the shafite school which is predominant in South East Asia. An attempt was made to find hadiths that are the bases of such legal rulings using the book ‘Buluugh al Maraam min adilat al ahkaam’ by Al Hafidh Abu Hajar al “Asqalani (773 – 852 H).

 

 

E. METHODOLOGY

The curriculum has followed a consistent methodology in analysis of medical phenomena in the light of the Qur’an and sunnat. Biological phenomena are presented as a miracle of the human body. The student is led to appreciate the majesty of Allah’s creation by pointing out the following recurring patterns in all organ systems: parity, symmetry, reserve functional capacity, functional adaptation, harmony and coordination. Fiqh and ethical issues are analysed based on original sources in the text (nass) of Qur’an and hadith as well as two Purposes of the Law (maqasid al sharia) and Principals of the Law (al qawaid al fiqhiyyat al kulliyat) that are directly derivable from the primary textual sources. In analyzing ethical issues arising out of modern developments in biotechnology, the curriculum has gone beyond the technical and narrowly legalistic framework to consideration of social roots and consequences of disease. Abortion, for example, is not analyzed only as a case of feticide but in its wider implication of facilitating sexual promiscuity by providing a way out of an undesired and unplanned pregnancy. The curriculum is highly selective and does not have the slightest pretension to cover all the details of all Islamic aspects of medicine. It provides basic principles and guidelines upon which further developments can be built. This curriculum is selective. It reflects the author’s experience, reading, and competence. Included are issues that the author considers important. There may be other issues that are equally important but have not been included because the author either has no knowledge or experience of them. No attempt is made to expose, compare, or discuss different points of view as is customary in academic papers. The curriculum is a basic textbook that provides only consensus opinions. The material in this curriculum has to be supplemented and has to be continuously adapted to changing circumstances.

 

APPENDIX #3: SCHEDULE OF THE ISLAMIC INPUT CURRICULUM

KULLIYAH OF MEDICINE

INTERNATIONAL ISLAMIC UNIVERSITY, MALAYSIA

SCHEDULE OF THE ISLAMIC INPUT FOR THE ACADEMIC YEAR 2002-2003

YEAR

BLOCK 1

BLOCK 2

BLOCK 3

BLOCK 4

YEAR 1

 

THE CREED

(10Jun-17Aug)

KNOWLEDGE

 (09 Sep – 16 Nov)

CIVILIZATION I

 (09Dec-15Feb)

CIVILIZATION II

(10Mar-03May)

21Jun: Tauhid I:  Prof Omar

18Oct Nature of Knowledge I: Dr Hasan

20Dec Creation of the Universe I: Dr Ahmad Fadzil

14Mar Muslim Civilization I: Prof Omar

28Jun: Tauhid II: Prof Omar

01Nov Nature of Knowledge II: Dr Hasan

27Dec Creation of the Universe II Dr Ahmad Fadzil

28Mar Muslim Civilization II: Prof Omar

05Jul:‘Ubudiyyat: Dr Abd al Wahab

08Nov Crisis of Knowledge: Prof Tahir

03Jan Creation of the Human I: Dr Burhanuddin

04Apr Muslim Civilizatrion III: Prof Omar

12Jul: Usul al ddiin I: Prof Tahir

15Nov Methodology of Knowledge Prof Omar

10Jan Creation of the Human II: Dr Zainab

11Apr Muslim Civilization IV: Prof Omar

19Jul: Usul al ddiin II: Prof Tahir

13Sep Classical Islamic Sciences: Prof Omar

17Jan Khilafat I: Dr Yusof

18Apr Cycle of Civilization I: Prof Omar

02Aug: Tazkiyat al nafs: Dr Azmi

10Sep History of Med. Sciences Prof Pakeer

31Jan Khilafat II: Dr Azmi

25Apr Cycle of Civilization II: Prof Omar

15Aug: Ithm & ghufran: Dr Yusof

27Sep Islamization of Med Science Prof Omar

25Jan Common Human Civilization Prof Kamal

26Apr Islamic Civilization in SE Asia  Prof Kam

10Aug Religion in Modern Society Pro Kamal

12Oct Revelation and Intellect: Prof Kamal

 

 

 

 

 

 

YEAR 2

CIVILIZATION II

(10Jun – 03Aug)

LIFE & HEALTH II

(26Aug – 19Oct)

STRUCTURE & FUNCTION I

(11Nov – 04Jan)

STRUCTURE & FUNCTION II

(27Jan – 22Mar)

14Jun: Muslim Civilization I: Prof Omar

29Aug Intra-uterine Life: A/P Emad

15Nov Perfection and Optimality: A/P Emad

The Alimentary System: Dr Fauzi

28Jun: Muslim Civilization 2: Prof Omar

13Sep Infancy & Childhood Dr Abd al Wahab

21Nov Control & Homeostasis: Prof Mazidah

14Mar Musculoskeletal System Dr Ahmad Hafiz

05Jul: History of Medicine: Prof Omar

20Sep Youth: Dr Abd al Wahab

29Nov Interaction with  the Environment Prof Pakeer

07Feb Protective Systems: Dr Anis

12Jul: Muslim Civilization 4: Prof Omar

27Sep Middle Age: Prof Pakeer

20Dec Pathological Processes: Dr Naznin

31Jan The Sensory system: Dr Magdi

19Jul: Cycle of Civilization 1: Prof Omar

04Oct Old Age: Prof Pakeer

27Dec The Genito-Urinary System: A/P Nasser

14Feb The Nervous System: Dr Emad

26Jul: Cycle of Civilization 2: Prof Omar

12Oct Duality: body & Soul Prof Kamal

31Dec The Cardio-Respiratory System: Dr Rathor

28Feb Intellect, memory, & Emotion: Dr Umeed

Islam & Modernization in SE Asia Prof Kamal

 

30Nov Islam and Secularism: Prof Kamal

07Mar Al Ghazzali & Ibn Taymiyah: Prof Kamal

YEAR 3

(Plenary

Sessions)

FUNDAMENTALS OF THE LAW

(10Jun-06Jul)

TRADITIONAL JURISPUDENCE

(30Sep – 30Nov)

MEDICAL JURISPUDENCE I

(23Dec – 22Feb)

MEDICAL JURISPUDENCE II

(17Mar-17May)

15Jun: Over-view: Prof Omar

O5Oct: Physical Acts of Ibadat I: A/P Emad

28Dec: Reproduction 1: Dr Anisah

22Mar: Legal competence: Prof Omar

22Jun: Medical Ethics & the Law I Prof Omar

12Oct: Physical Acts of Ibadat II: A/P Emad

04Jan: Reproduction  II: Dr Anisah

29Mar: Pleas & evidence: A/P Emad

29Jun: Medical Ethics & the Law 2 Prof Omar

19Oct: Marriage I: Dr Naznin

11Jan: Hygiene: Dr Imad

05Apr: Punishments: A/P Hasan

29Jun: Medical Ethics & the Law 3 Prof Omar

26Oct: Marriage II: Dr Naznin

18Jan: Foods & Drinks: Dr Quazi

12Apr: Forensic Evidence: A/P Khurshid

06Jul: Medical Ethics & the Law 4 Prof Omar

02Nov: Inheritance: Dr Hasan

25Jan: Activity, Rest, and Sleep: Dr Ariff

Morality in Islam: Prof Kamal

Shari’at, Custom, and Culture: Prof Kamal

09Nov: Transactions: Dr Burhanuddin

Application of Sharuri’at Today: Prof Kamal

 

 

16Nov: Crimes: A/P Hasan

 

 

 

Tajdid & Islah: Prof Kamal

 

 

YEAR 3

(Posting

Sessions)

MED  JURISPUDENCE III (MED)

 

MED JURISPUDENCE IV (SURG)

 

MED JURISPUDENCE V (PED)

 

MED JURISPUDENCE VI (OBS-GYN)

 

Investigation & Management: Dr Fauzi

Investigation & Management: Dr Azmi

Investigation & Management: Dr Abd al Wahab

Investigation & Management: Dr Anisah

Gen. Systemic Conditions: Prof Tahir

Genito-urinary disorders: Dr Junaini

Infant Conditions: Dr Zainab

Menstrual Disorders: Dr Anisah

Nervous/Mental Conditions: Dr  Maung Ko

Gastro-intestinal disorders: A/P Nasser

Childhood Conditions: Dr Amir

Contraceptive Practice: Dr Anisah

Cardio-respiratory disorders: Prof Tahir

 

Adolescent Conditions: Dr Fadzil

Pregnancy & Delivery: Dr Anisah

Conditions of Old Age: Dr Rathor

 

 

 


 

YEAR

BLOCK 1

BLOCK 2

BLOCK 3

 

YEAR 4

(Plenary Sessions)

BIO-TECH JURISPUDENCE I

(10Jun-17Aug)

BIO-TECH JURISPUDENCE II

(16Sep-23Nov)

SOCIAL JURISPUDENCE

(23Dec-01Mar)

 

15Jun Psych. Illness: the community Dr Hj Ismail

21Sep: Animal Research : A/P Nasaruddin

28Dec: The Woman: Dr Naznin

 

29Jun: Life Support and Termination 1: A/P Ariff

28Sep: Human Research I: Prof Tahir

04Jan: The Family 1: Dr Naznin

 

06Jul: Life Support and Termination  2: A/P Ariff

05Oct: Human Research II: Prof Tahir

11Jan: The Family 2: Dr Naznin

 

13Jul: Transplant Technology: Prof Kamaruzama

12Oct: Research Practice: Dato Mahathevan

18Jan: The Community: Dr Norfadzilah

 

20Jul: Change of fitra: Prof Omar

Research as Ijtihad: Prof Kamal

25Jan: The State: Dr Azmi

 

Technology Transfer: Prof Kamal

 

01Feb: Wealth (Economy): Dr Ariff

 

 

 

Islamic Social Structure: Prof Kamal

 

YEAR 4

(Posting  Sessions)

MED JURISPUDENCE VI (ORTHOPEDICS)

 

MED JURISPUDENCE VII (SPECIAL)

 

SOC JURISPUDENCE (COM HLTH)

 

 

Investigation & management: Dr Yusof

ENT Conditions: Dr Ailin

Addictions to drugs: Dr Norfadzilah

 

Connective tissue disorders: Dr Kamarul

Patient under Anesthesia: Dr Basri

Accidents & Violence: Prof Kamaruzaman

 

Traumatic Conditions: Dr Ahmad Hafiz

Ophthalmological Conditions: Dr Adnan

Ethico-legal issues of the Doctor in the Workplace: Dato’

 

Disabilities & handicaps: Dr Burhanuddin

Dermatological Conditions: Dr Anis

Ethico-legal Issues in Hospice Care: Dato’ Mahathevan

 

 

 

 

 

 

 

 

 


YEAR 5

(Plenary Sessions)

PHYSICIAN FORMATION

(10Jun-03Aug)

PHYSICIAN ETIQUETTE

(12Aug-05Oct)

LEADERSHIP (optional)

(14Oct-07Dec)

MANAGEMENT (optional)

(16Dec-08Feb)

SOCIAL ACTION (optional)

(17Feb-12Apr)

15Jun Motivation Prof Tahir 

17Aug Patients & Families I Dr Fauzi

19Oct Leadership Prof Omar

16Nov Strategic Mngmt Prof Omar

22Feb Dawa Prof Omar

22Jun Med Education Prof Tahir

24Aug Patients & Families 2 Dr Fauzi

26Oct Model Leaders Prof Omar

23Nov Plan & Implement Prof Tahir

01Mar Amr & Nahy Dr Burhanud

29Jun Spiritual Dev Prof Omar

07Sep The Dying Dr Basri

02Nov Communication Prof Omar

30Nov Decisions & Problem Dr Falah

08Mar Social change Dr Azizi/Rafidah

06Jul Intellect. Dev Prof Omar

14Sep Health Care Team I Dr Azian

09Nov Negotiation Prof Omar

07Dec Resource Mgmt I Prof  Kamaru

15Mar Civil society Dr Azmi

13Jul Social Dev Prof Humairah

21Sep Health Care Team 2 Dr Azian

Value-based Leadership: Prof Kamal

14Dec Resource Mgmt II Prof Kamaru

22Mar Leadership Trng 1 Prof Omar

Roles of the University: Prof Kamal

28Sep Legal Issues Prof Omar

 

21Dec Org. & Personnel Mgmt Prof Kamaru

29Mar Leadership Trng II Prof Omar

 

05Oct: Misconduct Prof Omar

 

Quality Culture: Prof Kamal

Dawa: Malaysian Perspective Prof Kamal

 

Islamic  Etiquette, adab: Prof Kamal

 

 

 

YEAR 5

(Ethics Debate)

DEBATE #1 (optional)

 

DEBATE #2 (optional)

 

DEBATE #3 (optional)

 

DEBATE #4 (optional)

 

DEBATE #5 (optional)

 

26Jul: Reproductive Rights Dr Anisah

04Oct: Life Support A/P Ariff

06Dec: Life Termination: Dr Fazdil

07Feb: Consent: Dr Anis

13Apr: Organ donation: A/P Nasser

 

 

 

 

 

 

 

 

 

 

 

APPENDIX #4: CURRENT HOLISTIC APPROACHES THAT CAN BE ISLAMIZED

Behavioral modification:  The objective of behavioral modification is largely achieved by empowering the individual to make positive decisions about health. The individual can be influenced by education (information and skills), persuasion (communication & social reinforcement), motivation (reward and punishment), and facilitation (access and availability). These four influences are affected to a large extent by public policies and the economic system.

 

Environmental control: Intervention is possible against air pollution, water pollution, soil contamination, and food contamination. Environmental control is not cheap. It involves regulation of industry and costly environmental clean-up. This is one area of primary prevention that does not come cheap.

 

Socio-economic upliftment: There is a strong link between socio-economic status and health. The experience of the some countries and some specific projects proved that social mobilization can effect major improvements in health even with few resources. Social intervention could be by improving income or education. Overall improvement in health was experienced in : China, Cuba, Kenya (Machakos project), and India (Kerala state). The social intervention could also be for a specific disease as in the following projects: the Cardiovascular Disease Project in Finland, Keralia; the Multiple Risk Factor Intervention Trial in the US, and the Onchocerciasis Control Project in West Africa. Social intervention requires community participation for success.

 

Holistic Primary Health Care: Primary health care (PHC) was defined by the World Health Organisation in 1978 as essential health services universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and the country can afford. WHO declared that PHC rests on 8 elements: health education, food supply and proper nutrition, safe water and basic sanitation, maternal and child health services including family planning, immunization against major infectious diseases, prevention and control of locally endemic diseases, appropriate treatment of common diseases and injuries, and provision of essential drugs. Some components of the PHC (nutrition, safe water, and sewage disposal) were non-medical interventions that led to falling mortality and morbidity in 18th and 19th century England before the dominance of biomedicine.

 

Health promotion: This refers to activities that improve personal and public health such as health education, health protection, risk factor detection, health enhancement, and health maintenance. In 1986, the Ottawa Charter defined health promotion as a process of enabling people to increase control over and improve their health. The charter identified pre-requisites for health as peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity. Five strategies of action were identified for health promotion: healthy public policy, supportive environment, community action, personal skills to control own life, environment and health, and reorientation of health services from the narrow clinical perspective to address total needs of an individual as a whole person. Health promotion has a wide scope including physical activity, nutrition, control of addictions (tobacco, alcohol, and drugs), family planning, mental health, and health education.

 

Health protection: Health protection includes accident prevention, occupational safety and health, environmental health, food and drug safety, and oral health

 

Preventive services: Preventive services include Maternal and Child Health, screening, clinical preventive services, and immunization.

Omar Hasan Kasule Sr July 2002