Measures taken in seeking medicine must align with and embrace Islamic legal principles known as Maqasid al-Shari ’ ah
Halal Pharma
16 The HEALTH | May-June . 2024
Treatment of ' superbugs ' infections
Measures taken in seeking medicine must align with and embrace Islamic legal principles known as Maqasid al-Shari ’ ah
ONE of the greatest public health challenges in the global world today is the threat of antimicrobial resistance ( AMR ). This AMR is estimated to have contributed directly to 1.27 million deaths worldwide in 2019 , more than HIV / AIDS or malaria ( Antimicrobial Resistance Collaborators , 2019 ).
The rapid rise of life-threatening infections caused by ‘ superbugs ’ and the decline of the new antibiotic research and development ( R & D ) pipeline necessitate appropriate and effective treatment strategies against the infections .
To fight against bacterial AMR infection , various strategies have been implemented and recommended , including prevention and control , vaccinations , and reducing exposure to antibiotics for other than human diseases . In treating infections , many factors determine the selection of appropriate drugs or antibiotics , but one of the major concerns is how to balance their efficacy and toxicity effects .
THE SUPERBUGS
According to Mayo Clinic , a superbug may be bacteria , viruses , parasites or fungi ( Mayo Foundation for Medical Education and Research , 2024 ). These so-called ‘ germs ’ become resistant when they no longer respond to many antibiotics , which puts treatment options at risk and makes them ineffective . In the case bacterial superbugs , Mayo Clinic listed some examples below : 1 . Some strains of the acinetobacter bacteria that may cause hard-to-treat urinary tract , bloodstream or wound infections
2 . The superbug Neisseria gonorrhoeae bacteria that can cause gonorrhea that leads to pregnancy complications
3 . Methicillin-resistant Staphylococcus aureus , also known as MRSA , can lead to surgery complications , pneumonia or bloodstream infections .
MAQASID AL-SHARI ’ AH AS A GUIDING PRINCIPLE
In Islam , it is obligatory to seek medicine when one is infected with a disease . Being ill and unhealthy has significant impacts on individuals , families , communities , and , on a larger scale , the country . Importantly , considering antibiotics ’ efficacy and toxicity , all measures taken must be aligned with Islamic legal principles , also known as Maqasid al-Shari ’ ah .
The principles provide a comprehensive ethical framework that ensures the treatment provided contributes positively to human well-being , balancing the benefits of medical advancements with the need to maintain Islamic moral and ethical standards . In addition , taking antibiotics or any pharmaceuticals for the treatment of AMR infection also concerns halal and toyyib requirements .
Maqasid al-Shari ’ ah , or the objectives of Islamic law , aims to preserve five essential values of an individual , which are religion ( deen ), life ( nafs ), intellect ( aql ), progeny ( nasl ), and wealth ( mal ). These objectives are significant in shaping various aspects of our daily lives , including matters pertaining to health and medical treatment .
Generally , these principles guide the ethical framework within which pharmaceuticals can be developed , prescribed , and used . This is applied in seeking treatment for MDR infections that satisfy the five principles of Maqasid
MOHD HAFIDZ MAHAMAD MAIFIAH
AND
BY YUMI ZUHANIS HAS-YUN HASHIM
International Institute for Halal Research and Training ( INHART ) International Islamic University Malaysia
al-Shari ’ ah and contribute to individuals ’ overall well-being and development .
The first rank of Maqasid al-Shari ’ ah is the protection of religion . The pharmaceuticals used including antibiotics , vaccines and others must be halal , ensuring that the ingredients and manufacturing processes are all from halal sources and are free from impurities ( or najs ).
For example , ingredients must be free from pork , human parts , and alcohol . Secondly , the protection of life . The pharmaceuticals must be effective and safe , with no or very minimal toxic effects on the body .
The treatment should ensure the protection of an individual ’ s intellect and progeny in which the pharmaceuticals must avoid substances or intoxicants that can impair mental and reproductive health . For the protection of one ’ s wealth , treatment should be fair , affordable and accessible to all individuals .
HALAL PHARMACEUTICALS AND THE SDGS
Guided by the principles outlined in the Maqasid al-Shari ’ ah , halal pharmaceuticals align well to achieve the notion of the United Nations Sustainable Development Goals ( SDGs ), particularly in the aspect of consumption . Maqasid al-Shari ’ ah supports the implementation of the SDGs by promoting for the Good Health and Well-Being ( SDG 3 ), Responsible Consumption and Production ( SDG 12 ), and Industry , Innovation , and Infrastructure ( SDG 9 ).
Complying with the halal standards means that the product must contain ingredients that are free from harmful substances , thus contributing to the overall health and safety of consumers as well as to the environment . By aligning with the SDGs , the halal pharmaceutical industry not only serves the needs of Muslim consumers but also promotes broader goals of health , equality , and sustainability .
HALAL PHARMACEUTICALS : MAXIMUM EFFICACY VS MINIMUM TOXICITY
The concept of halal and haram for pharmaceutical products is crucial in determining the appropriate and permissible approaches for the treatment against AMR bacterial pathogens . Halal ( lawful or permissible ) and haram constitute the important principles of Islamic law , or shari ’ ah .
The other important notion , toyyib , refers to a product that is pure , wholesome , hygienic , safe , not toxic , and efficacious , with those attributes reflecting its overall quality . Thus , in the case of drugs or antibiotics used for the treatment of AMR infection , they must be halal ( free of any haram element ) and toyyib ( with maximum efficacy and minimum toxicity ).
A hadith by Prophet Muhammad ( pbuh ) highlighted that materials or ingredients used as the treatment must be only from halal and toyyib sources , Narrated by Abu Hurayrah ,
“ The Messenger of Allah ( pbuh ) prohibited unclean medicine .”
Sunan Ibn Dawud 3870 ( Book 29 , Hadith 29 ) - Chapter Regarding the Disliked Remedies
Halal pharmaceuticals must be safe for consumption and should be non-poisonous , non-intoxicating , or non-hazardous to health according to the prescribed dosage . A drug that has good efficacy but has significant toxicity can be considered haram as its consumption can lead to the destruction of one ’ s life , as guided by Maqasid al-Shari ’ ah principles .
Since some drugs are very toxic , many Islamic scholars agreed that the rule , or hukm , is similar to that of liquor , which is considered an intoxicant , and that both can produce adverse health effects . In this case , the rule of reasoning by analogy ( qiyas ) has been adopted using the verse in the Holy Quran ,
“ O ye who believe ! Liquor ( intoxicants ) and gambling , ( dedication of ) stones , and ( divination by ) arrows , are an abomination – of Satan ’ s handiwork : eschew such ( abomination ), that ye may prosper ” ( Quran , Al-Maidah , 5 : 90 ).
In principle , all drugs or antibiotics are halal except those that are explicitly mentioned otherwise by the shari ’ ah ( for example , products that contain ingredients from swine and un-slaughtered halal animals ) and those that can cause mudhorat or harm in the form of toxicity when consumed . However , in the scope obtaining treatment thus the therapeutics and pharmaceuticals involved , rulings are not simplistic , nor unresolved .
Islamic scholars from different madhab ( sects ) classified such rulings into sunnah ( mustahab / encouraged ), mubah ( permissible ), wajib ( obligatory ) ( Jamaludin , 2023 ). Issues surrounding the rulings , therefore , must always be referred to the experts from both Islamic and scientific backgrounds to come to a just decision . For instance , a pharmaceutical containing najs could be allowed in certain situations in line with the principles of “ lifesaving ” in the Maqasid al-Shari ’ ah ( Jamaludin , 2023 ).
Realising the importance of complying with the halal criteria , the Department of Standards Malaysia established a national standard , MS 2424:2019 Halal Pharmaceuticals : General Requirements ( First Revision ) ( Department of Standards Malaysia , 2019 ). The first of its kind in the world , the MS 2424 provides general scopes and conditions for halal pharmaceuticals , covering aspects of halal and toyyib which have been instrumental in setting the development of shari ’ ah-compliant halal pharmaceuticals .
One example is the case of the polymyxins drug . Polymyxins ( polymyxin B and colistin ) are used in clinical settings as the last-line treatment options effective against AMR infections .
However , studies indicated that polymyxins can induce notable toxic effects , particularly nephrotoxicity , following the administration of a higher daily dosage . Therefore , the selection of polymyxins for the treatment of infection is only a last resort after careful consideration of its efficacy and adverse health effects . Maqasid al-Shari ’ ah is significantly applied in prioritising between a patient ’ s life and polymyxins effects ( Mahamad Maifiah et al ., 2019 ).
CONCLUSION
In conclusion , a comprehensive approach adhering to Maqasid al-Shari ’ ah principles and clinical guidelines can maximise therapeutic benefits while minimising adverse effects in selecting the best treatment to fight against AMR infection . Within the Maqasid al-Shari ’ ah , the halalan toyyiban elements and sustainability could be substantially converged for the benefit of all . – The HEALTH