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Tuesday, November 5, 2024

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.2830 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

14 comments:

Anonymous said...

Perhaps a reasonable approach here is to say that each patient must have the right to choose, and that each system must remain entirely unsullied by incorporating elements of the other. That might sooner or later make it clear which system is most efficacious.

Anonymous said...

surprised Jerry hasn't given up on aotearoa - its a lost cause

Barend Vlaardingerbroek said...

The hocus-pocus might be cheaper than modern drugs and other interventions, though. Some people will feel better whatever is done so you can chalk them up as traditional medicine successes (um, what does 'placebo effect' mean? Never heard of it.......)
I remember when the govt went broke in PNG in 1994 the Health Dept sent letters to doctors and clinics advising them to refer patients to traditional healers. In the area of the Highlands where I lived much treatment revolved around blowing smoke onto the patient, the wood generating the smoke depending on the illness. Yeah, right, I'm sure that really helped most sick people.

Anonymous said...

a recent survey of aotearoa scientists reveals a major gender divide
“matauranga Māori should be valued on par with science”
75% women agree, 44% men

turkeys voting for xmas

https://www.wgtn.ac.nz/news/2024/10/majority-of-nz-researchers-see-maori-indigenous-knowledge-as-relevant-to-their-workbut-there-is-a-gender-divide

Anonymous said...

Embarrassing.

Anonymous said...

Is there any other western country seriously pursuing witchdoctory?!?

I thought we had a funding crisis is health? Perhaps less witch doctor and more medicine might free up some $$$

Robert Arthur said...

Maori medicine, as with most newly legislated topics, is seized upon as a new income source for many. Evades the complication of a serious qualification associated most other topics either to practice or to receive. It is unbelievable that ACC has become involved. Polak and Logan Campbel coverd the antics of tohunga, which explains why banned. The Ratana church had sussed; the caption at the main church referred.

Anonymous said...

Read Frederick Manning's description of tohunga and their immense power, control, manipulation and destructiveness. No different from witch doctors and medicine men, imho.

I support holistic medicine because of course the body is not made up of discrete units such as lego. None the less medicine needs to be based on research and real knowledge with a view to genuinely protecting the body ( and the mind within it).

Even medicine gets this wrong eg vaccines- but that does not justify reverting to hocus pocus.

Gaynor said...

Modern Medicine which is incidentally , largely not based in science ( it just makes use of some science findings) and needs to put its own house in order before outright ridiculing natural cures or even placebos.

I would rather have a placebo than be jabbed with the covid vaccine ..American surveys reveal the trust in conventional doctors recently in the US has plummeted from 70% to around 40% , as a result of the 'safe' covid vaccine scandal. Thirty percent of those at the 'naughty ' parliamentary protest two years ago were Maori. I support their stand.

I have had a number of apologies from specialist doctors who trot out the platitude 'there is no evidence for this natural cure' and I reply "that's because conventional medicine hasn't done and won't do the research because its ideology insists on non generic , patented medicines' . You see with a science degree and a few hours to spare I can find a reputable university in Japan or Brazil or elsewhere who are not so blinded by modern medicines constraints and have done rigorous research on the natural substance.

Nattokinase , from soybeans is just one example. Pomegranate juice taken with certain drugs produces a much better outcome for some cancer patients. I take natural thyroid medication which latest research has shown to be better than the synthetic patented version for a large proportion of people. The same with bio-identical hormones , made from soybeans for women . The amount of ridicule I have had to endure from mainstream doctors is shameful, in my endeavours to get natural products for myself which invariably more recent research supports. Every pharmaceutical product has a side effect.

Modern medicine from my experiences is frequently about control , power and money . Little better really than another priesthood, tohungas lauding it over you .


Anonymous said...

I don't get it. I have had doctors roll their eyes at me because I have told them I am a clinical herbalist. What makes this different?

nuku said...

As a New Zealand citizen and tax payer, I have to ask about how this RM business aligns with "following the money". A lot of health care in NZ is tax payer (government) funded. So does this "mutual respect" mean that public money is going to be allocated to RM practitioners? How are these people going to be vetted and accredited? Can any "self-identified" part-Maori (there are no pure blood Maori left in NZ, ALL are products of interbreeding with other races, primarily European) declare him/her/them as a qualified practitioner of RM and therefore get public funding?
A good deal of so called "Maori Renaissance" is all about extracting money from the public coffers by playing the victim/hard done by role in spite of the fact that billions of dollars have been given to Maori tribes as reparation. The smarter tribes (iwi) organize themselves as religious charities and pay low or no tax.
Pardon me for being a skeptic, but I actually live here and follow the politics. Many NZ citizens are very naive (woke) about what the Maori elite/academic radicals are up to. If you want to dig a bit deeper, take a look at the document "HePuaPua" that was commissioned by the Adern government and secretly withheld from its coalition partner NZ First until it was "outed". The document is a blueprint for Maori "co-governance". Essentially a raced-based rewriting of the NZ democratic system and installation of a parallel tribal-based government. Here's a good explanation of the document:
https://www.nzcpr.com/he-puapua/

Tinman said...

This Rongoa thing sounds like a great idea.

It should be made compulsory for every person identifying as maori to first use this medical avenue, no exceptions.

This should be implemented immediately!

Of course, once ronganoa has proved it's worth and the patient is dead, they may be permitted to seek human medical advice and treatment.

Joanne W said...

Aww, I'm just becoming allergic to opinionated Yanks. We don't tell them over there how to run things - although given their political system, someone needs to!

Anonymous said...

Snake oil is snake oil, which ever way you dress it up.