The appointment of Terawan as the new health minister has sparked controversy following the circulation on social media of a document from the IDI ethics council regarding his disciplinary record.

The document, dated Sept. 30, three weeks prior to Jokowi's new Cabinet announcement, was made in response to an article published in a news outlet containing six potential names for the health minister post, which included Terawan, a former director of Gatot Subroto Army Hospital (RSPAD) and a presidential doctor during Susilo Bambang Yudhoyono’s administration.

"If allowed, we would like to recommend that from the potential names, Bapak President would not appoint Terawan Agus Putranto as the health minister. The reason behind our recommendation is because Terawan is currently undergoing sanctions for breaching medical ethics," according to the letter, signed by ethics council head Broto Warsito.

The ethics violation was related to Terawan's “brain-cleaning” method, which he had been promoting as the most effective treatment for stroke patients. The case attracted public attention and sparked debate among health professionals in early 2018 after the IDI ethics council suggested that Terawan had violated the IDI’s code of ethics by adopting and promoting a method of therapy that had not yet been clinically proven to be safe and effective in treating patients.

The ethics council then slapped Terawan with a one-year IDI membership suspension and termination of his medical practice permit recommendation, which according to ethics council deputy chairman Pukovisa Prawiroharjo was still in force.

Pukovisa, however, declined to disclose the timeline of the sanctions, stating the issue "was supposed to be an internal affair" and not for public knowledge.

Meanwhile, President Jokowi appeared to dismiss concerns surrounding Terawan's ongoing sanctions, suggesting that the minister had exhibited good management capabilities during his time serving as the RSPAD director.

"He was also the head of the world's military doctors. This means that his experience cannot be doubted, including his field experience in handling disasters and endemic threats, because we're [prone to] disasters and endemic threats. And from what I've seen [...] his orientation is preventive measures, meaning that they revolve around a healthy diet and exercise, instead of relying on illness-recovery efforts," Jokowi told reporters at the State Palace in Jakarta on Thursday in defense of his Cabinet choice.

Jokowi was possibly referring to Terawan's appointment as the organizing committee chairman of the 41st World Congress of Military Medicine held in 2015 in Indonesia and hosted by Indonesia's Defense Ministry and the International Committee of Military Medicine (ICMM), as previously reported by the Post in 2015. Terawan's name is also listed as vice-chairman of the 2019 ICMM on the committee's website.

Responding to questions on the ethics council's recommendation letter, Terawan said on Wednesday that "it was a given" that his appointment to a political position would trigger a variety of responses. He gave an assurance on a separate occasion that the issue would not affect the Health Ministry's cooperation with the IDI.

"We will always [work together with the IDI]. We all have to work together, otherwise we can't build a healthy Indonesia. We shouldn't be divided," he told reporters after the ministerial position handover ceremony in Jakarta on Thursday.

Pukovisa of the IDI ethics council said that the sanctions on Terawan were the result of a thorough, interest-free process to uphold the ethical values of the medical profession and to ensure patients' safety, but he insisted that both the recommendation letter and the sanctions should not have been revealed to the public in the first place.

He insisted that the council remained respectful of the President's decision to appoint Terawan, highlighting the need to separate his profession as a doctor and his appointment as health minister.

"We respect the President's decision as we believe the President has his own share of considerations. We believe that the President also pays a great deal of attention to our profession," he told the Post.

"Of course, we'll continue to work with the Health Ministry. Our profession is based on compassion, so we'll not take any counterproductive measures. If the people become victims of this issue, such as through delayed decision making [...] we wouldn't want that. We've always separated the person from their position," he added.

IDI chairman Daeng Muhammad Faqih said that the case should have been closed, noting the need for collaboration to solve the many problems in the country's health service.

The brain-cleaning method, also known as intra-arterial cerebral flushing, is a method combining conventional treatment used for stroke patients; digital subtraction angiography (DSA), an imaging X-ray technique to visualize blood vessels and heparin injection as an anticoagulant, also known as a blood thinner, to prevent blood clotting before surgery and to treat blood clotting.

Since stroke is commonly caused by the narrowing of blood vessels due to a build-up of plaque on a vessel’s inner wall, Terawan used heparin as an anticoagulant to clean out the plaque by injecting it into the patient’s thigh. Terawan said he had used the method since 2004 and had treated at least 40,000 patients until April 2018, charging at least Rp 30 million (US$2,137) for the treatment.

However, no scientific evidence exists to date to underpin heparin’s efficacy in stroke treatment. Despite the questioned credibility, some public figures have voiced their support as former patients of Terawan, including the new Coordinating Political, Legal and Security Affairs Minister Mahfud MD.

University of Indonesia (UI) public health expert Hasbullah Thabrany said the IDI was an important stakeholder for the Health Ministry to work with in the health sector, which still has a great deal to achieve.

"I hope that both parties can accept each other, separating their individual practical interests and the policy management in the public interest. Don't let personal affairs affect the public. This is for both the IDI and Minister Terawan," he said.

He expressed the hope that Terawan, with his military background, could make some "badly needed breakthroughs", specifically in regard to ministerial budgeting and the national health insurance.

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