Kerbside Consult

Too Good to Be True?

From traditional medicine to wellness technology — how do we know whether a treatment really works?

Cyberdoc — writing on medicine since 1995

Revisiting the early Cybermed archives, I came across two discussions that still felt familiar: traditional medicine in hospitals in 1997, and an electrostatic therapy machine I wrote about in 2005. Some of the evidence has changed. Some of our assumptions deserve correcting. But the question running through both remains useful whenever someone offers us a promising treatment: what should make us believe it works?

A question from 1997

In March 1997, Dr David Quek asked a pointed question in Berita MMA: “Traditional Medicine In Hospitals ... Progress or Regress?”

The immediate concern was a proposal to allow traditional medicine alongside conventional medicine in hospitals and clinics. David argued for proper scrutiny and a separate law defining the scope and limits of traditional practice.

Reading it again, nearly thirty years later, I would soften some of the language. But the underlying question remains reasonable: what evidence should a treatment bring through the hospital door?

His companion piece on traditional Chinese medicine offered a useful opening. We might struggle to reconcile an entire traditional system with modern physiology, yet still investigate individual treatments.

One example it mentioned deserves revisiting: artemisinin.

A traditional clue, a scientific discovery

In her Nobel autobiography, Tu Youyou describes returning to ancient medical literature after inconsistent results with qinghao. A preparation described by Ge Hong prompted her to investigate extraction at lower temperatures, rather than assume that conventional boiling would preserve the desired activity.

Experiments, purification, clinical investigation and collaboration across research institutions followed. She shared the 2015 Nobel Prize in Physiology or Medicine for her discoveries concerning a novel therapy against malaria.

Traditional knowledge supplied an important clue. Experiments and clinical studies established how it could become a useful medicine.

That success gives us reason to investigate traditional knowledge seriously. It cannot validate every claim made within traditional Chinese medicine.

The 1997 companion was cautious about artemisinin’s place in treatment. Evidence has moved on. WHO now recommends artemisinin-based combination therapies for uncomplicated P. falciparum malaria.

These are defined medicines and treatment regimens. Their effectiveness cannot simply be transferred to a herbal preparation containing the plant.

The RM17,000 question

In May 2005, eight years after David’s editorial, I found myself asking similar questions about something rather different.

In my May 2005 Cybermed article on electrostatic therapy, I described free treatment sessions at department stores and outlets. A pamphlet claimed benefits for diabetes, asthma, heart disease, osteoporosis and both high and low blood pressure, among other conditions.

The sessions were free. The machine, I reported, cost around RM17,000.

Cyberdoc checked the Internet.

My concern was whether those claims could withstand the “same yard stick for scientific credibility”. I also worried about false reassurance leading patients to stop their medication.

Twenty-one years later, that remains a useful starting point. A herbal capsule, prescription drug, electrical device or wellness treatment should have evidence for its claimed benefits and a clear account of its risks.

This is not a contest between traditional and Western medicine. Every treatment deserves the same critical questions. The evidence needed should match the claim being made and the risks involved.

“But I tried it and felt better”

I would not dismiss that response. Feeling better matters. It simply does not tell us, by itself, why someone improved.

Symptoms fluctuate. People often seek treatment when they feel particularly bad, after which improvement may occur anyway. Other treatments, changes in behaviour and the natural course of illness may also contribute. Research on placebo responses helps separate these changes from what the treatment itself caused.

Expectation and the circumstances of care matter too. As NCCIH explains, expectations and interactions with a healthcare provider can influence the response to treatment. That does not make the symptoms imaginary.

A small randomised asthma pilot study illustrated the distinction. Patients reported similar improvement after active albuterol, a placebo inhaler and sham acupuncture—a procedure designed to resemble acupuncture for comparison. Yet albuterol produced substantially greater improvement in measured lung function.

Feeling better and improving measured airflow were different outcomes.

The lesson is to measure both appropriately. A patient’s experience deserves attention; it cannot always establish that a disease has been controlled.

Doctors therefore have two responsibilities: provide effective treatment and provide the human attention that helps people through illness. We should be good at both.

Acupuncture deserves a careful answer

That asthma experiment does not answer whether acupuncture helps chronic pain. For that, we need to examine the pain studies.

A major individual-patient-data meta-analysis included 20,827 patients from 39 trials involving musculoskeletal pain, osteoarthritis, chronic headache and shoulder pain. Acupuncture performed better than both sham and no-acupuncture controls.

The advantage over sham was small on average. Benefits persisted over time, and the authors concluded that the effects could not be explained solely by placebo. They considered referral for acupuncture a reasonable option for chronic pain.

Results also depend on the comparison and follow-up period. A 2024 neck-pain review found some lasting benefits when acupuncture was added to treatment, but no significant advantage over sham for pain relief.

Which condition, comparison and outcome are we discussing? How large is the benefit, and how long does it last?

Evidence for selected pain conditions cannot be stretched into evidence for every disease, or confirmation of every traditional explanation.

The same discipline belongs in discussions about drugs and procedures. “There is a study” should begin a conversation, not end it.

Natural does not mean harmless

One sentence in the 1997 companion piece deserves reconsideration:

“The huge amounts purchased and used by Malaysians attest that they are at least harmless.”

Popularity cannot establish safety.

In January 2026, Malaysia’s National Pharmaceutical Regulatory Agency issued a safety alert concerning Garcinia cambogia and hydroxycitric acid, warning about a potential association with liver injury. It specifically advised against assuming herbal supplements are safe because they are natural.

At the time of the alert, NPRA was continuing its review. We should not turn a safety signal into certainty about every product or every user. But neither should we explain it away with the word natural.

We need to know the ingredients, preparation, dose and other medicines being taken. Malaysia’s 2026 T&CM Formulary includes safety considerations concerning herb–drug interactions.

Bring the bottle, packet or photograph to the consultation. And doctors should make that conversation easy. A raised eyebrow is a poor way to obtain an accurate medication history.

When the evidence reversed

Feeling better about a supplement is not the same as evidence that it works — and long-term clinical effects can diverge sharply from what shorter-term data suggested. Two well-conducted trial programmes illustrate this precisely.

In the 1980s, observational studies found that people who ate more β-carotene-rich vegetables had lower rates of lung cancer, which prompted two large randomised trials. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study gave high-dose synthetic β-carotene to 29,133 male smokers in Finland and found an 18% increase in lung cancer incidence and 8% excess overall mortality in the supplement group. The Beta-Carotene and Retinol Efficacy Trial (CARET) enrolled 18,314 people at elevated lung-cancer risk and found a 28% higher incidence of lung cancer and 17% higher overall mortality in the active-treatment group; the trial was stopped early. Both trials tested high-dose synthetic supplements in people already at elevated risk — the finding does not tell us that eating vegetables is harmful. What it does tell us is that a biological rationale and encouraging observational data are not sufficient: only the trial in the actual population, with the actual product, at the actual dose, can answer the question.

Vitamin E had a similar trajectory. It was plausible as an antioxidant, widely taken, and associated in observational studies with lower rates of heart disease. The Heart Outcomes Prevention Evaluation trial randomised 9,541 patients at high cardiovascular risk to 400 IU of natural-source vitamin E or placebo. After 4.5 years, there was no significant effect on the primary outcome of heart attack, stroke or cardiovascular death. The subsequent HOPE-TOO extension, following the same patients for a further 2.6 years, found that vitamin E significantly increased the risk of heart failure (relative risk 1.13; 95% CI 1.01 to 1.26) and hospitalisation for heart failure (relative risk 1.21; 95% CI 1.00 to 1.47). A harm that was invisible at 4.5 years became statistically significant at 7 years. These two examples are not arguments against research into supplements. They are arguments for why research — specifically randomised trials in the right population over the right duration — is necessary before confident claims can be made, and why the feeling of benefit during supplementation cannot substitute for it.

What Malaysia did next

Malaysia has moved well beyond the debate of 1997.

The Traditional and Complementary Medicine Act 2016, Act 775, and its regulations now provide a framework for practitioner registration and practising certificates. The transitional period ended on 28 February 2025; the regulatory details are listed in the references.

Selected services are now available in public hospitals. The 2026 MOH formulary records 16 T&CM units at MOH hospitals. Services include acupuncture, traditional Malay massage, selected traditional Indian therapies and herbal therapy as an adjunct for cancer patients.

That last description must not be mistaken for evidence of a herbal cancer cure.

David called for a defined legal framework. Malaysia subsequently developed one.

Practitioner registration and evidence for a treatment claim are separate questions. What evidence is required depends on how the product is registered and what it claims to do. NPRA’s July 2026 registration guidance makes these distinctions:

Registration therefore does not mean that every product has passed the same clinical tests as a new medicine. Registered for what claim, and supported by what evidence? Those are the useful questions.

WHO’s Global Traditional Medicine Strategy 2025–2034 similarly emphasises stronger evidence, appropriate regulation and integration of safe and effective interventions.

New packaging, familiar questions

Modern wellness claims deserve exactly the same attention. The questions apply when the product comes with a screen, an app or an impressive explanation of how it works. What was actually tested—and does that evidence apply to the device being sold?

Take detox programmes. In its review of “detoxes” and “cleanses”, NCCIH describes limited, generally low-quality research and no compelling evidence supporting detox diets for eliminating toxins or managing weight. Some approaches can also cause harm.

A promising result in a test tube or cell culture (in vitro) does not necessarily translate into the same effect in a living organism (in vivo). Nor does a result in animals, by itself, establish clinical benefit in people. These are useful steps in research, but we still need to ask what happens in patients.

A scientific-sounding word is an invitation to ask a more precise question. A prescription, a white coat or a sophisticated machine should not exempt a claim from scrutiny either.

For products regulated as medical devices, Malaysia’s Medical Device Act 2012 and Medical Device (Advertising) Regulations 2019 also govern advertising, including restrictions on misleading claims.

The FDA’s health-fraud guidance still identifies familiar warning signs: one product claiming to treat many unrelated diseases, dramatic testimonials, quick fixes and impressive but unhelpful jargon. Those concerns were already in my 2005 article.

None of this requires us to ridicule someone seeking relief. A person living with pain, fear or uncertainty deserves understanding. The seller’s confidence deserves scrutiny.

Before committing money or hope, ask about the expected benefit, evidence, risks, total cost and what happens if treatment fails. Ask whether necessary care will continue.

An honest practitioner should be able to discuss uncertainty without treating the question as an insult.

The same yardstick

We should recognise a useful treatment wherever it originates, and challenge a weak claim wherever it is sold.

Traditional or modern. Herbal capsule or RM17,000 machine.

Does it work? Is it safe? And where is the evidence?

Nearly thirty years later, that still seems a reasonable place to start.