'Brain wash' stroke treatment under scrutiny in Indonesia after inquiry

Indonesian Medical Association committee members Errol Hutagalung (left), Razak Thaha (centre) and Ilham Oetama Marsis attending a press briefing on the suspension of Major General Terawan Agus Putranto, who has been suspected of a medical-related ethics violation. PHOTO: THE JAKARTA POST/ASIA NEWS NETWORK

JAKARTA (THE JAKARTA POST/ASIA NEWS NETWORK) - A medical inquiry into a popular but unorthodox treatment for stroke patients - dubbed "brain wash" therapy - has produced more questions than answers as details of the internal inquiry found their way to the public.

Major General Terawan Agus Putranto, the director of Gatot Subroto Army Hospital (RSPAD) and a presidential doctor during Susilo Bambang Yudhoyono's administration, is in the spotlight after the ethics board of the Indonesian Medical Association (IDI) issued a recommendation to suspend him for a year over an ethics violation for practising the "brain wash" method.

The matter has sparked controversy and raised questions about the treatment method, which has reportedly cured tens of thousands of stroke patients.

Terawan promoted his method as "brain wash", also known as intra-arterial cerebral flushing, which sets out to treat stroke patients with a combination of digital subtraction angiography (DSA) and heparin injection.

He repeatedly claimed his method was the most effective treatment for stroke patients, a claim that led the IDI's ethics board to recommend his suspension for 12 months for violating three articles of the Indonesian Doctors Ethics Code late last month.

The articles allegedly breached are Article 3, which requires doctors to maintain their integrity and professional independence; Article 4, which forbids self-advertisement; and Article 6 on causing public disturbance by implementing a new medical treatment without proper clinical tests.

The public, meanwhile, has come to his defence, with hashtag #SaveTerawan becoming popular on social media platforms.

Influential figures, including former Constitutional Court chief justice Mahfud MD and Golkar Party politician Aburizal Bakrie, have joined the bandwagon, speaking up for the doctor as former patients.

DSA and heparin are used in conventional medical treatment of stroke patients. DSA is an imaging X-ray technique to visualise blood vessels, while heparin is used as an anti-coagulant, also known as a blood thinner, to prevent blood clotting before surgery as well as to treat blood clotting. Heparin is administered by injection into a patient's vein.

Since stroke is usually caused by the narrowing of blood vessels due to a buildup of plaque on a vessel's inner wall, Terawan used heparin to clean out the plaque by injecting the anticoagulant into the patient's thigh.

However, no scientific evidence exists to date to underpin heparin's effectivity in stroke treatment.

Terawan has used the method since 2004. He said he had treated at least 40,000 patients until now. He would charge at least Rp 30 million rupiah (S$2,858) for the treatment.

On Monday (April 9), the IDI announced that the association had postponed Terawan's recommended suspension as hospital director and medical practitioner.

"We are still verifying and gathering additional evidence regarding the recommendation," said IDI chairman Ilham Oetama Marsis in Central Jakarta. He said the final decision would depend on the additional evidence gathered.

Ilham confirmed that the inquiry was supposed to be an internal matter and that the suspension has not been carried out yet because of the ongoing ethics case in the organisation. The association failed to provide answers on doubts surrounding the method's legitimacy.

"Terawan's 'brain wash' method has sparked debate among doctors and potentially confused the public. However, we cannot comment further on the legality of his method, because the IDI is only authorised to discuss ethics breaches," Ilham said.

Speaking at the same event, the chairman of IDI's expert council, Abdul Razak Thaha, explained that the Indonesian Medical Disciplinary Honorary Assembly (MKDKI), an institution under the Indonesian Doctors Council (KKI), was the only organisation authorised to decide on the legal aspect of Terawan's medical activity.

"However, the MKDKI cannot conduct any investigation if no one files a complaint (on the method)," Abdul told The Jakarta Post.

Previously, Health Minister Nila F. Moeloek had suggested that the IDI solve the problem internally.

"This is an organisational problem. Let them find a good solution among themselves first," Nina said, as quoted by tempo.co over the weekend.

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