Opinion
Safety issue of ‘traditional’ and ‘complementary’ medicines
By CHANDRE DHARMAWARDANA
Every country has a lore of “traditional medicine” in addition to the mainstream medical system, which today is based on a rigorous system of institutionalized medical education based on science. Even the WHO has recently recognized and attempted to give formal structure to such Traditional and Complementary (T&C) systems of medicine (see: https://apps.who.int/iris/handle/10665/312342;jsessionid=4ADD7EEB300760DC10D0C42745ABDC31).
Thus, the WHO defines “traditional medicine” as:
“The sum total of knowledge and practices, whether explicable or not, used in diagnosing, preventing or eliminating physical, mental and social diseases. This knowledge or practice may rely exclusively on past experience and observation handed down orally or in writing from generation to generation. These practices are native to the country in which they are practiced. The majority of indigenous traditional medicine has been practised at the primary healthcare level”.
Traditional medicine, and other so-called complementary systems of medicines, tend to be far less institutionalized, with the methods of treatment traditionally handed down from a teacher to a student, who becomes part of the teacher’s “family”. This is the “guru-kula” system, where the teaching is retained as a family secret and handed down. Nevertheless, as these systems progressed and received state patronage, institutionalization and open publication of medical practices began to appear. The Mahavansa alludes to hospitals even for animals in ancient Lanka. In India, too, Sanskrit texts like the Charaka Samhitha and the Sushrutha Samhitha of Ayurveda, record the level of surgery as well as methods of treatment available to the ancients.
Nevertheless, every physician was supposed to keep his/her “Guru-mushti” (what the teacher holds in his fist), i.e. secret knowledge that the teacher revealed to the pupil, only at his deathbed. They claim that such medical practices have been confirmed by use “down the ages”, and the epithets “prathyaksha” in Sanskrit, and “ath-dutu” in Sinhala are often used to indicate safe and “well tested” medications.
No record keeping of the treatment and their outcomes, adverse effects, etc., were practised until the rise of modern medicine. Hence the claim that these preparations are “ath-dutu”, or “prathyaksha” is unjustified. Case histories that can be scrutinized by independent investigators are lacking.
Even today, when individuals propose “new” treatments for Covid-19, they make claims that the treatment is based on “ath-dutu” ancient herbal lists ,etc., as if that is all there is to it. Others, e.g., the “Hela Suvaya” team, claim that their herbal prescriptions are guided by God Natha. When a person from Hettimulla, Kegalle claimed to have created a Covid-19 treatment, to be given “free”, it attracted massive crowds! Supporters even question the need for double-blind clinical tests or chemical analysis of the new product. Politicians rush to swallow the medicine in public, while the educated public can only groan in silence.
The traditional medicine that existed in Europe in medieval times, prior to the rise of modern scientific medicine, included traditional medicine from Indian, Greek and Arab sources, together with alchemy, which was the search for a means of transforming lead into gold. Many alchemists were also medical physicians who kept their medical as well as alchemical knowledge secret.
The rise of modern scientific medicine can be attributed to the recognition, during the renaissance, that secrecy must be replaced by openness and sharing of experience to ensure objectivity. It was recognized that one’s own observations or once own experiences can be highly unreliable. How one feels, or what one sees, depends on many factors besides the level of alcohol in the blood!
Learned societies like the Royal Society (November,1660) were created for open discussion and public proof. A claimant of a “new discovery” has to reveal all details in public, at a meeting of the learned society. The tradition of holding onto “secret knowledge” or “Guru-Mushti” was thrown out. Record keeping, use of quantitative data, and repeating the experiment or test in front of everybody were key features of the methods of empirical science put into practice by the Royal Society.
So, all claimants of “new” Ayurvedic or Traditional cures for Covid (or Dengue) must release carefully recorded case histories that the claimant can use to prove that there is a preliminary case for what is claimed. It is not enough to make claims of “paran-paraa-gatha vattoruvak” (herbal list handed down from generation to generation). The quality of the herbs used must be recorded, and weighed ingredients must be indicated in grams rather than in terms of some traditional ambiguous unit. A medical body should examine the case histories and decide if there is a case for undertaking further confirmatory studies. That is, bogus claims must be eliminated at the outset. In the scientific method, any claim has to be independently verified by repeating the process, using the same prescribed medications.
Purity and consumer protection are very important and unfortunately lacking in many T&C medications (See https://dh-web.org/place.names/bot2sinhala.html#herbal). Chemical analyses of commercial Ayurvedic preparations have revealed toxic ingredients like Lead (Pb), mercury (Hg), harmful alcohols like methanol, propanols, and other ingredients, as well as extreme variation in amounts of active ingredients. Some contain admixture of potent western drugs although this is illegal. So chemical analysis of proposed T&C drugs is necessary for consumer protection.
An attractive but dangerous feature of T&C medical systems is that they can become “personal health prescriptions” (PHP) that an individual may administer without going to a physician. Modern mega-Vitamin therapies are also PHPs from “complementary” or “alternative” medicine. They become “home remedies” that people swear on, although they may not have kept records of how the PHP worked for them. Patients lack the equipment and laboratory facilities to monitor their condition. In effect, a PHP is a herbal prescription, or the use of some exotic root, fruit or “Vitamin”, without a proper case record, evolved by oneself, or “given” by a “trusted Vaidya” or medical savant. The PHP may have been adopted from some old book or an “ola-leaf” record.
St. Jerome who lived to a very ripe age in the 4th century had his own PHP for good health.
“From his 31st to 35th year he had for food six ounces of barley bread, and vegetables slightly cooked without oil. But finding that his eyes were growing dim, and that his whole body was shriveled with an eruption and a sort of stony roughness he added oil to his former food, and up to the 63 rd year of his life followed this temperate course, tasting neither fruit nor pulse, nor anything whatsoever besides”.
Today, no one would recommend such a diet free of fruits and pulses, and yet, for many centuries, many Christian monks followed St Jerome’s diet claiming it to be a “proven” healthy diet.
In India, Vagabhatta and Nagarjuna were two great teachers who prescribed the use of “Rasaindur”, which turns out to be mercury sulfide. Although these authors prescribed many such metals in their “Rasha-shasthra”, today we recognize them to be toxic and dangerous to health if ingested even at a few parts per million. The Sanskrit text “Rasatarangani” prescribes preparations containing lead, mercury, gold, silver and many other metals which are cooked with lime and herbal juices (e..g, from Nuga, the banyan tree). Well known Ayurvedic texts like the Charaka Samhitha and the Sushrutha Samhitha recommend preparations containing substances now recognized to be toxic. So the “Rishis” failed to notice the toxic effects, probably because there was no recording of case histories and studying them objectively.
Unfortunately many T&C medications are taken over by individuals who transform them into personal health prescriptions (PHPs), without the knowledge to adequately control the quantities used. For instance, “polpala” (Aerva lanata) may be taken as a herbal tea but frequent use may have serious adverse effects on the urinary tract. Similarly, individuals may use “Thebu” (Costus igneus) to control blood sugar, but end up with hypoglycemia and other side effects.
In an earlier epoch, people used to relieve their bowls in their own backyards, near paddy fields (or on the beach!). Hook worm and other intestinal-parasite infections became common as people also walked barefoot in the same land area, or in the fields. Thus there was also a tradition of taking a purge, containing mainly Aralu (Terminalia chebula) at least every six months. This was “a good health practice” recommended by T&C medicine. However, as this was administered as a home remedy, the amount of “aralu” was never properly controlled, leading to dangerous purging in some cases, and no effect in other cases. Furthermore, the purge has little effect on hookworms and such parasites, but it dangerously disturbs the gut microbiome of the person taking the purge.
So, in conclusion, at least the following steps are needed to make T&C medicine safe:
1. Every new claim must be supported by well recorded certified case histories and clinical records that are needed to justify further trials.
2. The prescription must quantitatively specify the full formulation and be subject to a chemical analysis to ensure that no known toxins are contained in the product.
3. Marketing of the product must be done ensuring product-uniformity and product standards to ensure consumer protection.
4. T&C medications must NOT be adopted as home remedies as self-medication is always dangerous.
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By Dr Laksiri Fernando
The 46th Session of the UN Human Rights Council started on 22 February morning with obvious hiccups. The Office, to mean the Office of the UN High Commissioner for Human Rights, finally decided to hold all sessions virtually online, only the President of the Council and the assistants in the high table sitting at the UN Assembly Hall in Geneva. The President, Ms. Nazhat Shammen Khan, Ambassador from Fiji in Geneva, wearing a saree, was graceful in the chair with empty seats surrounding.
In the opening session, the UN General Assembly President, UN General Secretary, UN High Commissioner for Human Rights, and Head of Foreign Affairs, Switzerland (as the host country), addressed remotely the session. In fact, there was no need for Switzerland to have a special place, as the UN is independent from any host country. Switzerland is fairly ok, however, if this tradition is followed, the UN General Assembly may have to give a special place to the US in New York.
Initial Addresses
UN General Secretary, Antonio Guterres’ address could have been quite exemplary if he gave a proper balance to the developed and developing countries. He talked about racism and fight against racism but did not mention where racism is overwhelmingly rampant (US and Europe) and what to do about it. Outlining the human rights implications of Covid-19 pandemic, he made quite a good analysis. It was nice for him to say, ‘human rights are our blood line (equality), our lifeline (for peace) and our frontline (to fight against violations).’ However, in the fight against violations, he apparently forgot about the ‘blood line’ or the ‘lifeline’ quite necessary not to aggravate situations through partiality and bias. He never talked about the importance of human rights education or promoting human rights awareness in all countries.
His final assault was on Myanmar. Although he did not call ‘genocide,’ he denounced the treatment of Rohingyas as ethnic cleansing without mentioning any terrorist group/s within. His call for the release of Aung San Suu Kyi and other civilian leaders undoubtedly should be a common call of all. However, he did not leave any opening for a dialogue with the military leaders or bring back a dialogue between Aung San and Min Aung, the military leader. With a proper mediation, it is not impossible. Calling for a complete overhaul as the young demonstrators idealistically claim might not be realistic.
High Commissioner Michelle Bachelet’s address was brief and uncontroversial this time without mentioning any country or region. It is clear by now perhaps she is not the real author of the Report against Sri Lanka, but someone probably hired by the so-called core-group led by Britain. Her major points were related to the coronavirus pandemic trying to highlight some of the socio-economic disparities and imbalances of policy making that have emerged as a result. The neglect of women, minorities, and the marginalized sections of society were emphasized. But the poor was not mentioned. As a former medical doctor, she also opted to highlight some of the medical issues underpinning the crisis.
Then came the statements from different countries in the first meeting in the following order: Uzbekistan, Colombia, Lithuania, Afghanistan, Poland, Venezuela, Finland, Fiji, Moldova, Georgia, Kazakhstan, Equatorial Guinea, Vietnam, Belgium, and Morocco. The obvious purposes of these statements were different. Some countries were apparently canvassing for getting into the Human Rights Council at the next turn perhaps for the purpose of prestige. Some others were playing regional politics against their perceived enemies. This was very clear when Lithuania and Poland started attacking Russia.
But there were very sincere human rights presentations as well. One was the statement by the President of Afghanistan, Mohammad Ashraf Ghani. He outlined the devastating effects that Afghanistan had to undergo during the last 40 years, because of foreign interferences. The initial support to Taliban by big powers was hinted. His kind appeal was to the UN was to go ‘beyond discourse to practice’ giving equal chance to the poor and the developing countries to involve without discrimination.
Controversial Presentations
China’s Foreign Affairs Minister, Wang Yi, made his presentation almost at the end of the first day. This is apparently the first time that China had directly addressed the Human Rights Council. Beginning with outlining the devastating repercussions of the coronavirus pandemic he stressed that the world should face the challenges through ‘solidarity and cooperation.’ He broadened the concept to human rights solidarity and cooperation. His expressed views were quite different to the others, particularly to the Western ones.
He frankly said that what he expresses are the views of China on human rights without claiming those are absolute truths or forcing others to believe or implement them. There were four main concepts that he put forward before the member countries. First, he said, “We should embrace a human rights philosophy that centres on the people. The people’s interests are where the human rights cause starts and ends.” Second, he said, “we should uphold both universality and particularity of human rights. Peace, development, equity, justice, democracy, and freedom are common values shared by all humanity and recognized by all countries.” “On the other hand,” he said, “countries must promote and protect human rights in light of their national realities and the needs of their people.”
“Third,” he said, “we should systemically advance all aspects of human rights. Human rights are an all-encompassing concept. They include civil and political rights as well as economic, social, and cultural rights.” He then emphasized, “Among them, the rights to subsistence and development are the basic human rights of paramount importance.” Fourth, “we should continue to promote international dialogue and cooperation on human rights. Global human rights governance should be advanced through consultation among all countries.”
It was on the same first day before China, that the United Kingdom launched its barrage against several countries not sparing Sri Lanka. The Foreign Secretary, Dominic Raab, delivered the statement from top to bottom attacking alleged violating countries on human rights. But there was no mentioning of Israel for the repression of Palestinians or the systemic racism rampaging in the United States, including the 6 January attacks on the Capitol by extremist/terrorist groups.
His first sermon was on Myanmar without acknowledging the British atrocities or mismanagement of this poor and diverse country during the colonial period. He was quite jubilant over implementing sanctions and other restrictions over the country. Many sanctions, in my opinion, are extortions. Undoubtedly, Aung San Suu Kyi and other leaders should be released, and democracy restored. This is a task of the whole council and when one or two countries try to grab the credit, there can be obvious reservations of others.
His further scathing attacks were against Belarus, Russia, and China. Some appeared factually correct but not necessarily the approach or the motives genuine. The following is the way he came around Sri Lanka. He said,
“Finally, we will continue to lead action in this Council: on Syria, as we do at each session; on South Sudan; and on Sri Lanka, where we will present a new resolution to maintain the focus on reconciliation and on accountability.”
‘Action’ to him basically means repeatedly passing resolutions, of course imposing economic and other sanctions. He said, “as we do at each session”; like bullying poor or weak countries at each session. Can there be a resolution against Russia or China? I doubt it.
What would be the purpose of presenting a resolution against Sri Lanka? As he said, “to maintain the focus on reconciliation and on accountability.” This will satisfy neither the Tamil militants nor the Sinhalese masses. But it might satisfy the crafty Opposition (proxy of the defeated last government). This is not going to be based on any of the actual measures that Sri Lanka has taken or not taken on reconciliation or accountability. But based on the ‘Authoritarian and Hypocritical Report’ that some anti-Sri Lankans have drafted within the Office of the High Commissioner for Human Rights. This what I have discussed in my last article.
In this context, successful or not, the statement made by the Sri Lanka’s Minister of External Affairs, Dinesh Gunawardena, in rejecting any resolution based on the foxy Report of the Office of the UN High Commissioner for Human Rights, in my concerned opinion, is absolutely correct.
Author
Dr Tilak Siyambalapitiya
Dr Janaka Rathnasiri laments (The Island 19 Feb 2021) that the Power Ministry has ignored the President’s directive to draw 70% of energy from renewable sources by 2030. I saw the approved costs of electricity production for 2019, published by the Public Utilities Commission (PUCSL).
PUCSL has also approved the prices to sell electricity to customers. Although various customers pay at various “approved” prices, the average income from such “approved” prices in 2019 was Rs 17.02 per unit. It is not only the Ministry, according to Dr Rathnasiri, ignoring the President; PUCSL is also breaking the law, which says prices and approved costs should be equal.
So there is already an illegal gap of Rs 21.59 minus 17.02 = Rs 4.57 per unit of electricity sold. If electricity prices are not to be increased, as stated by many in the government and PUCSL, let us say the following: Distribution costs should decrease by 0.57 Rs per unit. Generation costs should decrease by Rs 4.00 per unit.
PUCSL also published the approved cost of purchasing or producing electricity from various sources for 2019. The actual energy values were different to what was approved, but let us stick to PUCSL approved figures:
I suggest Dr Rathnasiri fills-up the following table, to show how much electricity will cost in 2030 to produce and deliver, if the President’s 70% target is to be achieved and for PUCSL to abide by the law. Let us assume that electricity requirement in 2030 will be double that of 2019.
Since PUCSL has to save Rs 4 from 13.92, the average selling price for energy should be Rs 13.92 minus 4.00 = Rs 9.92. With a target network loss of 7% (in 2019 it was 8.4%), the average cost of production has to be Rs 9.27 per unit. Eight cages have to be filled-up by Dr Rathnasiri.
In 2012, PUCSL approved the energy cost of electricity produced from coal power to be 6.33 Rs per kWh. In 2019, PUCSL approved 9.89 (56% increase). For renewable energy, it was 13.69 in 2012, and 19.24 in 2019 (a 40% increase, but double the price of electricity from coal fired generation). In 2012, rooftop solar was not paid for: only give and take, but now paid Rs 22, against Rs 9.89 from coal. There seems to be something wrong. The price reductions of renewable energy being promised, being insulated from rupee depreciation, are not happening? Either Sri Lanka must be paying too little for coal, or it may be renewable energy is severely over-priced?
On coal we hear only of some corruption every now and then; so Sri Lanka cannot be paying less than it costs, for coal.
Enough money even to donate
vaccines
Another reason for the Ministry of Power to ignore the President’s directive may be the Ministry’s previous experience with similar Presidential directives. In 2015, the President at that time cancelled the Sampur coal-fired power plant, and the Ministry faithfully obliged. That President and that Prime Minister then played ball games with more power plants until they were thrown out of power, leaving a two-billion-dollar deficit (still increasing) in the power sector. Not a single power plant of any description was built.
Where is this deficit? You do not have to look far. In the second table, replace 24.43 with 9.89, to reflect what would have happened if Sampur was allowed to be built. The value 12.79 will go down to 8.55, well below the target of Rs 9.27 per unit to produce. Not only would CEB and LECO report profits, but the government too could have asked for an overdraft from CEB to tide over any cash shortfalls in the treasury. All this with no increase in customer prices. Producers of electricity from renewable energy could enjoy the price of 19.24 Rs per unit. And that blooming thing on your rooftop can continue to enjoy Rs 22 per unit. The Minister of Power, whom Dr Rathnasiri wants to replace with an army officer, would have been the happiest.
In the absence of Sampur (PUCSL’s letter signed by Chairman Saliya Mathew confirmed cancellation and asked CEB not to build it), PUCSL approved electricity to be produced at Rs 21.59 and sold at Rs 17.02 per unit. The annual loss would be Rs (21.59 – 17.02) x 15,093 = Rs 69 billion per year of approved financial loss. Sri Lanka has a Telecom regulator, an Insurance regulator, a Banking regulator, who never approve prices below costs. Sometime ago the telecom regulator asked the operators to raise the prices, when operators were proposing to reduce prices amidst a price war. But the electricity industry regulator is different: he approves costs amounting to 27% more than the price, not just once but, but continuously for ten long years !
That is 370 million dollars per year as of 2019, the economy is spending, and for years to come, to burn oil (and say we have saved the environment). Did the Minister of Health say we are short of 160 million dollars to buy 40 million doses of the vaccine? Well, being a former Minister of Power, she now knows which Presidential “order” of 2015 is bleeding the economy of 370 million dollars per year, adequate to buy all vaccines and donate an equal amount to a needy country.
Prices are the production costs approved by PUCSL for 2019. The selling price approved by the same PUCSL was Rs 9.27 per unit.
Author
If you listen to politicians and journalists here, you will hear of that curious creature rajya novana sanvidane, a Non-State Organization (NSO). Where do you get them? In the uninstructed and dead minds of those who use those terms. In the real world, where politicians and journalists have developed minds, there are Non-Governmental Organizations (NGO). The United Nations is an organization set up by state parties, not by governments. It is true that agents of states, governments, make the United Nations work or fail. Governments may change but not the states, except rarely. When Eritrea broke away from Ethiopia, a new state was formed and was so recognised by the United Nations. However, the LTTE that tried to set up another state was crushed by the established state that it tried to break away from, and the UN had nothing to do with them.
This entirely unnecessary confusion, created out of ignorance, is so destructive that organizations completely loyal to the existing state, are made to be traitorous outfits, for they are ‘non-state organizations’ within the state. There are citizens of each state, but no citizens of any government. Government is but an instrument of the state. In most states there are organizations, neither of the state nor of government: religious organizations including churches. But none of them is beyond the pale of the state.
Those that speak of rajya novana sanvidane give that name partly because they have no idea of the origin of non-governmental organizations. NGOs came into the limelight, as donor agencies, noticed that some governments, in East Africa, in particular, did not have the capacity and the integrity to use the resources that they provided. They construed, about 1970, that NGOs would be a solution to the problem. Little did they realize that some NGOs themselves would become dens of thieves and brigands. I have not seen any evaluation of the performance of NGOs in any country. There was an incomplete essay written by Dr. Susantha Gunatilleka. NGOs are alternatives to the government, not to the state.
Our Constitution emphatically draws a distinction between the government and state, and lays down that the President is both Head of Government and Head of State (Read Article 2 and Article 30 of the Constitution.) It is as head of state that, he/she is the Commander of the Armed Forces, appoints and receives ambassadors and addresses Parliament annually, when a prorogued Parliament, reconvenes. He/she presides over the Cabinet as head of government. The distinction is most clear, in practice, in Britain where Queen Elizabeth is the head of state and Boris Johnson is the Prime Minister and head of government. However, in principle, Johnson is the Queen’s First Minister appointed by the sovereign, and resigns by advising her of his decision to do so.
In the US and in India the term ‘state’ has special significance. In India there is a ‘rajya sabha’ (the Council of States) whose members represent constituent States and Union Territories. Pretty much the same is true of the United States. In the US, executive power is vested in the President and heads the administration, government in our parlance. The Head of State does not come into the Constitution but those functions that one associates with a head of state are in the US performed by the President of the Republic. The US President does not speak of my state (mage rajaya) but of my administration, (mage anduva). Annually, he addresses Congress on the State of the Union. Our present President must be entirely familiar with all this, having lived there as a citizen of the US for over a decade. It is baffling when someone speaks of a past state as a traitor to that same state. It is probable that a government was a traitor to the state. ‘Treason against the United States, shall consist only in levying war against them, or in adhering to their (States’) enemies, giving them aid and comfort’. That a state was a traitor to the same state is gobbledygook.
Apart from probable confusion that we spoke of in the previous paragraph, it is probable that a president and other members of a government, including members of the governing party here, find it grandiloquent to speak of his/her/their state (mage/ape rajaya), rather than my government (mage anduva) or Sirisena anduva’ and not Sirisena state; it was common to talk of ‘ape anduva’ in 1956; politicians in 1956 were far more literate then than they are now.
When translating from another language, make sure that you understand a bit of the history of the concept that you translate. A public school in the US is not the same as a public school in the UK.
MAHADENAMUTTA
