Professor Jerry Coyne: Move over, modern medicine - it’s time to collaborate with Rongoā Māori

Rongoā Māori is the “indigenous way of healing”: a combination of herbal and spiritual medicine used by the Māori of New Zealand. As The Encyclopedia of New Zealand notes, there were both supernatural and human illnesses, with the former treated through spiritual means (e.g., prayers, dunking in water, and other treatments described below), and the latter through herbal remedies. Here, for example, are the supernatural maladies and remedies:

Mate atua – supernatural illnesses

Mate atua were supernatural afflictions, sometimes caused by malevolent spirits when a person had broken a tapu (religious restriction). Dealing with mate atua required a tohunga (priest). His first job was to determine the hara (transgression) committed, and to identify the spirit. The tohunga took a thorough case history of all the patient’s actions before they got ill, sometimes including the patient’s and family’s dreams.

A tohunga’s job

Tohunga were experts in various fields, including the arts, agriculture, fishing, warfare and healing. They were also seen as the earthly medium of the gods, and were intensively trained in whare wānanga (houses of higher learning). Tohunga held a position of authority and respect, but also had the huge responsibility of keeping their people healthy.

Finding the cause was the first stage of treatment, followed by exorcism of the spirit that had possessed the patient. The next stage was a whakahoro (purificatory rite) to remove the effects of the tapu. This usually involved dipping the patient in a stream while the tohunga performed a karakia (prayer) or incantation.

Mariunga

The Ngāti Porou leader Tuta Nihoniho described the mariunga – a wand of wood such as karamū, māpou or maire, which was touched to the body of an invalid and received their essence. It was then taken to a tohunga, who could tell whether the patient would recover.

Takutaku rite

Another rite, the takutaku, involved touching the patient with a karamū leaf, which was then floated downstream. The malevolent spirit would be carried to sea and then to Te Waha o te Parata (a huge whirlpool, caused by a great monster), and finally to the underworld. Freed of the spirit, the patient was then sprinkled with, or immersed in, water.

The site also lists a number of herbal plants used for “human” illnesses, although, as far as I know, none of them have been tested by the gold standard of modern medicine: controlled, randomized, and double-blind testing. I have no doubt that some of these plants do work, but in the absence of testing we won’t really know which ones, and how efficacious they are.

As Wikipedia notes, these forms refer. .

. . . . to the traditional Māori medicinal practices in New Zealand. Rongoā was one of the Māori cultural practices targeted by the Tohunga Suppression Act 1907, until lifted by the Maori Welfare Act 1962. In the later part of the 20th century there was renewed interest in Rongoā as part of a broader Māori renaissance.

Rongoā can involve spiritual, herbal and physical components. Herbal aspects used plants such as harakeke, kawakawa, rātā, koromiko, kōwhai, kūmarahou, mānuka, tētēaweka and rimu.

The practice of Rongoā is only regulated by the Therapeutics Products Bill in the case of commercial or wholesale production so that “Māori will continue using and making rongoā just as they have for generations.”

The Tohunga Suppression Act outlawed traditional medicine in favor of “Western” medicine, but, as the note above shows, the ban lasted just 55 years, and Rongoā Māori is now again legal, though its practitioners often realize that they need to send patients to modern doctors if a traditional cure doesn’t look propitious.

However, there seems to be a move afoot to make Rongoā Māori coequal to modern medicine, if not in curative properties at least in “deep mutual respect.” But, those two items are not independent, for how can a modern physician respect medicines that haven’t been properly tested, much less have any respect for supernatural cures?

What is bad about the attempt to get “deep respect” for indigenous medicine that hasn’t been properly vetted, is that with medicine, unlike with incorporating other indigenous ways of knowing into teaching (e.g., Māātauranga Māori), human lives and health are at stake, so I do have issues with the article below in the ANZ Journal of Surgery (click to read for free).


Click to view

This study is really an anecdotal one, and with a very small and geographically limited sample, too. The authors recruited four colorectal “Western” surgeons (WS) from the Christchurch region of New Zealand, all of whom had expressed interest in Rongoā Māori (RM). Likewise, the authors recruited seven Rongoā Māori practitioners, four of whom volunteered to be part of the study. Therefore we have a total of eight subjects, all of whom were asked their views about the medicine practiced by the other group. The interviews took place once, and were 30-60 minutes long. The actual study thus lasted a maximum of eight hours.

The upshot:

Western surgeons’ perspectives on RM

The results are no surprise: the doctors didn’t know much about RM. But they were “open to collaboration”, though it wasn’t clear what kind of collaboration. (I can understand that a Māori patient might want a Māori RM practitioner around, at least for solace and cultural comfort.) And of course the doctors thought that, in general, there needs to be better communication between practitioners of modern and of indigenous medicine. Finally, the surgeons cited “systemic barriers, such as bureaucratic hurdles and the absence of clear referral pathways” as impediments to collaboration or “integration”.

Rongoa practitioners’ perspectifes on modern medicine

The indigenous doctors “often feel overlooked within the healthcare system. And this leads to the article’s theme: that modern medicine must be infused in some way with indigenous medicine: a “genuine collaboration”. For instance we read this:

Rongoā practitioners often feel overlooked within the healthcare system. This highlights the need for initiatives that aim to raise the profile of Rongoā Māori within New Zealand’s healthcare system (Table 1). One practitioner mentioned ‘collaboration is minimal, at this stage like the non-Māori community certainly don’t even know that Rongoā exists or anything about it and so that’s not being referred’.

. . . Formulating a genuinely collaborative approach requires recognition of Rongoā Māori as a an option in the patient care journey. ‘Building relationships is key… maybe starting with shared learning experiences,’ one practitioner suggested, proposing foundational steps towards effective collaboration.

. . . . This perspective challenges the healthcare sector to move beyond tokenistic inclusion, advocating for a genuine integration of Rongoā Māori that honours its potential to contribute to improved health outcomes, particularly for Māori patients.

. . . Understanding Rongoā Māori in its full depth requires acknowledging and valuing its comprehensive approach to health, which integrates the spiritual, mental, and physical dimensions of well-being.

The problem here is that we do not know the potential of RM to contributed to improved health outcomes–not without scientific testing of RM remedies, especially the “spiritual” ones. The article refers repeatedly to “mutual respect” of the two types of medicine, as well as the advantage of RM in being “holistic” (presumably meaning it uses spiritual cures as well as medical ones).

The conclusion, which was inevitable, is that modern medicine should collaborate with RM in curing patients. I quote from the paper (bolding is mine):

As identified in the interviews, it is imperative that a curriculum for healthcare professionals encompasses not only the theoretical concepts but also the practical applications of Rongoā Māori. This requires a willingness to move beyond a cursory acknowledgement of Indigenous practices within the medical education system to embedding it as a vital component of healthcare training. It was proposed that an effective educational initiative could take the form of an immersive wānanga on a marae, where tauira (students) and tākuta (doctors) would have the opportunity to learn directly from Rongoā practitioners in a setting that honours the roots of the mātauranga.28–30 In addition to this, incorporating placement based learning would further enable Western practitioners to observe the holistic model of care first hand. This aligns with the insights from the interviews where it was emphasized that Rongoā Māori is dynamic in its practice and does not follow a prescribed regimen.17 By having the opportunity to experience this personalized approach, healthcare professionals can better appreciate the value of nurturing this collaborative relationship.

. . .Recognizing the immense benefits that a holistic model of healthcare offers, there is an unequivocal need to navigate and dismantle the systemic barriers that Rongoā practitioners are faced with. This necessitates a concerted push to ensuring Indigenous healing practices are formally recognized within healthcare frameworks to facilitate a collaborative coexistence with Western medical practices. Moreover, establishing structural support to facilitate funding and infrastructure is an essential component to enhancing the capacity of the current healthcare system to address a diverse range of health needs and allowing this to thrive. It is paramount that this collaboration is guided by Rangatira and Tohunga in this field to ensure the delivery of health services is culturally congruent and responsive. The move towards an inclusive healthcare system that respects the diversity of cultures aligns with Te Tiriti o Waitangi’s principles, honouring Māori sovereignty and self-determination over their health.

“Te Teriti,” of course, is the 1840 Treaty of Waitangi, which made England the sovereign government of New Zealand, conferred on the Māori British citizenship with all the attending rights, and allowed Māori to keep their lands and possessions. But there is nothing about health in that treaty at all, though of course anybody can “self determine” whether they get care, and whether they get RM care, modern medicine, or both. But the Treaty of Waitangi has assumed an almost sacred position in New Zealand culture, now viewed as mandating that all aspects of Māori culture and “ways of knowing” must be considered coequal in the country. Right now there’s a big battle about how far Māori “ways of knowing” are taught as coequal to science in schools, and the indigenous people seem to be winning that fight. This article is just a salvo in the battle for medicinal hegemony.

But before they win the Battle of Medicine, any RM-based cures, whether they be based on plants or supernaturalism, must be tested—and tested according to the best procedures of modern medicine, usually double-blind, randomized, and controlled trials. Without those trials, you simply can’t be sure that a treatment works. Saying “our tradition shows that it works” is not sufficient, nor is the claim “well, it worked for me!” We all know the power of confirmation bias and of the placebo effect, and the kind of testing described above is designed to eliminate these effects. (As Richard Feynman famously said, “You must not fool yourself, and you are the easiest person to fool.”)

So no: there cannot be deep mutual respect between indigenous medicine and modern (aka “Western”) medicine until indigenous treatments are tested according to the standards of Western medicine. It will not work the other way around.

I am heartened that some RM practitioners recognize when herbs and superstition won’t work, and summarily hand their patients over to modern doctors. But I don’t think RM should be integrated with modern medicine, or treated with great respect. Until it’s proven efficacious, the null hypothesis should be that the untested treatments of RM comprise quackery

Professor Jerry Coyne is an American biologist known for his work on speciation and his commentary on intelligent design, a prolific scientist and author. This article was first published HERE