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Opinion

Admission of medical students at the age of 18

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I am writing this in response to the news item in your paper of 26 January 2021 under the caption, “GMOA seeks university admission for medical students at the age of 18”.

This communication from me is practically from the horse’s mouth; from someone who, so many eons ago in 1965, benefitted by being allowed the privilege of joining the Faculty of Medicine, University of Ceylon, as a novice Medical Student, at the tender age of 18 years and two months.

I sat the GCE (A/L) Examination in December 1964, at the age of 17 years and five months, offering the four subjects of Physics, Chemistry, Zoology and Botany. In or around March 1965 we had the Practical Examination in all those four subjects at the University of Ceylon in Reid Avenue. I think the results of the examination were released around July or August 1965. There were around 250 vacancies for medical students, 150 in the Faculty of Medicine Colombo and 100 in the Faculty of Medicine, Peradeniya. There were only two Faculties of Medicine at the time. I qualified to enter the Colombo Medical School with just four simple passes in the four subjects. In fact, although there were vacancies for 250, there were only around 220 students who had got through all four subjects. Even those with three passes with a credit or a distinction had managed to enrol for medical education.

I qualified with MBBS 2nd Class Honours at 23 years and one month of age and started working as an Intern Medical Officer at the Colombo General Hospital at the age of 23 years and two and a half months. From then onwards after many postgraduate examinations I became a fully qualified Specialist Consultant at the age of 30 years. I was in England for my postgraduate studies when I cleared the final hurdle of the MRCP in 1977. I returned to Sri Lanka in 1978 and was posted as a Specialist Consultant Paediatrician to the Badulla General Hospital at the age of 31 years. Thereafter, I was most fortunate to be allowed the dispensation to provide my services to the hospitals at Badulla, Ratnapura, Kurunegala, Kalubowila and the Lady Ridgeway Hospital, all for 29 years, till my retirement at the age of 60 years.

I am not writing this letter as a manifestation of ‘monkey praising his own tail’. Far from it. I am doing so to firstly be ever so grateful to the education systems of our motherland that provided a child from a very ordinary lower middle-class family, which barely managed to make ends meet, the opportunities that

were perhaps the birth right of every child. We were all equal and given the chance of a lifetime to excel in our respective fields. Some of us at least, managed to make good use of it. I do hope that I have, at least even partly, fulfilled my obligations to the people of this country in return for what was given to me on a platter by them.

The 1960s were well before the advent of computers. Dedicated men and women of the Ministry of Education would have toiled, even burning the midnight oil, to organise the GCE Advanced Level Examinations, correct answer scripts, arrange the practical examinations, tot up the marks and then finally release the results, all within just about six to seven months. Everything had to be done by hand and even the results had to be entered by hand. Yet for all that, they did it with such tremendous devotion and commitment that benefitted all of us. There would have been thousands of files with neatly entered details. There was only a Ministry of Education. There was no Ministry of Higher Education. For the government of the day, education was education; higher or otherwise. Funding was also for education. All those fine people who worked in that ministry saw to it that the youth got a break. We were all very much like their own children.

As was quite rightly pointed out by the GMOA, the current set of doctors are only able to qualify with the basic MBBS in their late twenties or even early thirties. Most of their potentially productive periods of youth are spent waiting for results or twiddling their thumbs and doing nothing at home before they could either enter a medical school or waiting to be posted as doctors even when they finally qualify. So much of very valuable time is lost in the entire process of Higher and University Education. In fact, in the late seventies when I was posted as the Specialist Consultant Paediatrician to the General Hospital Badulla, there were junior doctors such as House Officers and Senior House Officers in the hospital, who were older than I. An indirect effect of these delays is also the necessary postponement of marriage and the starting of their own families for many doctors, male and female. The lady doctors of rather advanced age could even have problems of reduced fertility and the real risk of congenital defects of the babies that are related to maternal age.

All of this is indeed a crime. None in any government in living memory has even seriously attempted to redress this appalling situation. With the facilities available today and with some decent leadership and proper organisation of the systems, it would not be a huge big deal to take things back to what it was during the halcyon sixties. All it would need would be an iron-willed commitment, embellished by unwavering enthusiasm. I am quite sure that there are capable people around who could make a real difference in such a context.

I have been ever so fortunate to have been afforded the opportunities that I was provided right throughout my childhood and youth. I have written many times before, extolling my gratitude and veneration to people such as Dr C. W. W. Kannangara and other persona, who were the designers, architects, facilitators and perpetuators of our free education system. I would love to see the very same opportunities, especially in university medical education, which I had, being made available to the youngsters of today. We owe it to our people and our youth to do so in a gesture of obligation to the future of this resplendent isle.

The GMOA has reportedly written to the President and the relevant Ministers of Government regarding the topic under discussion. I hope very much that some acolyte would be kind enough to show this letter to the very same legislators who wield such power which would be able to make a difference.



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Opinion

Jeffrey: Cartoonist par excellence 

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If there exists a print media personality who does not receive the due recognition and appreciation he rightfully deserves, it undoubtedly is ‘Jeffrey’ of The Island newspaper. The works of many a journalist have been frequently highlighted and appreciated but the capabilities and efficiency of personnel of the calibre of ‘Jeffrey ‘ are, more or less, taken for granted.

In every sphere of life, professional or occupational, there are people who function, not necessarily from behind the scenes, but nevertheless perform an equally efficient service, which in all probability goes unnoticed.

To be frank, even before reading the headlines of the Newspaper, as is customary now, my eyes seek for the Cartoon of the day. Indeed, a sight for sore eyes each morning, the lovable ‘Jeffrey’ makes my day.

Suffice to say that a ‘Good Job done man’ type of occasional pat on the back, to a person who puts his very soul into his work, would touch the only place where it matters the most – his heart. If a smile could work wonders, then how much further would a word of appreciation go.

‘Jeffrey ‘ has, time and again through his  cartoons, aptly proven his innovative and creative skills to present factual depiction of current affairs, both local and global. His drawing pen effortlessly covers all boundaries, irrespective of whatever nature. On a previous occasion, too, I have openly commended his abilities, finding it difficult to fathom how he could convey pertinent incidents, normally requiring hundreds of words to express, with a single drawing.

To all intents and purposes, ‘Jeffrey ‘ ranks much higher and could be considered as a rare find when compared with the numerous others actively engaged in this particular field of professionalism.

In ‘Jeffrey ‘, The Island newspaper indeed has a Cartoonist par excellence!

Jeffrey, more power to your elbow!

WILLIAM PHILLIPSZ 

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Opinion

Anti-aging injection shows promise in re-growing knee cartilage

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Scientists at Stanford Medicine have reported a discovery that could change how arthritis and joint damage are treated. In experiments on animals and human tissue, researchers found that blocking a protein linked to aging can restore worn cartilage in the knee and prevent arthritis after injury. The treatment works not by adding stem cells, but by reprogramming existing cartilage cells to behave in a more youthful way.

In aging mice, an injectable drug rebuilt knee cartilage that normally thins with age. In mice with knee injuries similar to anterior cruciate ligament tears, the same treatment prevented the onset of arthritis, a condition that often follows such injuries in humans. A pill form of the drug is already being tested in early clinical trials for age-related muscle weakness, raising hopes that a similar approach could one day be used for joints.

Human knee cartilage removed during joint replacement surgery also responded to the treatment. When exposed to the drug in the laboratory, the tissue began forming new cartilage that resembled healthy, functional joint cartilage. These findings suggest that cartilage lost to aging or arthritis might eventually be restored through injections into the joint or even oral medication, potentially reducing the need for knee and hip replacements.

Osteoarthritis affects about one in five adults in the United States and costs tens of billions of dollars annually in direct health care spending. Despite its prevalence, there is no drug that can stop or reverse the disease. Current treatment focuses on pain relief, physical therapy and, in advanced cases, joint replacement surgery.

The new therapy targets a protein known as 15-PGDH, which increases in the body with age. The research team classifies it as a gerozyme, a type of enzyme that contributes to the gradual decline of tissue function over time. Previous work from the same group showed that rising levels of 15-PGDH weaken muscles with age. Blocking the protein restored muscle strength and endurance in older mice, while forcing young mice to produce it caused muscle loss.

Unlike muscle, bone or blood, cartilage does not rely on stem cells to repair itself. Instead, cartilage cells called chondrocytes can change their gene activity. By inhibiting 15-PGDH, researchers found that these cells reverted to a more youthful state and began producing healthy cartilage again.

“This is a new way of regenerating adult tissue, and it has significant clinical promise for treating arthritis due to aging or injury,” said Helen Blau, professor of microbiology and immunology at Stanford and a senior author of the study.

There are three main types of cartilage in the body. Elastic cartilage forms flexible structures like the outer ear. Fibrocartilage is tough and shock absorbing, found between spinal vertebrae. Hyaline cartilage, also called articular cartilage, is smooth and glossy and allows joints such as the knees, hips and shoulders to move with minimal friction. Osteoarthritis mainly affects this last type.

The disease develops when joints are stressed by aging, injury or excess weight. Chondrocytes begin releasing inflammatory molecules and breaking down collagen, the main structural protein of cartilage. As collagen is lost, cartilage thins and softens, leading to pain, swelling and stiffness. Articular cartilage rarely regenerates on its own, and attempts to find stem cells capable of rebuilding it have largely failed.

In the new study, researchers compared knee cartilage from young and old mice and found that levels of 15-PGDH roughly doubled with age. When older mice were treated with a drug that blocks the protein, either throughout the body or directly in the joint, their knee cartilage thickened and regained function. Importantly, the new tissue was true hyaline cartilage rather than weaker fibrocartilage.

The results were equally striking in injured joints. In mice with ligament injuries, repeated injections over four weeks sharply reduced the likelihood of developing arthritis. Untreated animals showed high levels of 15-PGDH and developed arthritis within weeks. Treated animals moved more normally and placed more weight on the injured limb.

Detailed analysis showed that the treatment shifted the balance of cartilage cells. Cells associated with inflammation and cartilage breakdown became less common, while cells responsible for producing healthy joint cartilage increased markedly. This change occurred without the involvement of stem cells.

When human osteoarthritic cartilage was treated in the laboratory for one week, similar changes were observed. Levels of harmful gene activity fell, and signs of cartilage regeneration appeared.

The findings are encouraging but still early. While safety trials of a 15-PGDH inhibitor for muscle weakness have shown promising results, clinical trials focused on cartilage regeneration have yet to begin. Even so, researchers are optimistic.

“Imagine regrowing existing cartilage and avoiding joint replacement,” Blau said. For millions living with joint pain and stiffness, that possibility now seems closer than ever.

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Opinion

Why is transparency underfunded?

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The RTI Commission has now confirmed what many suspected — although the RTI Act grants it independence to recruit staff, this authority is rendered toothless because the Treasury controls the purse strings. The Commission is left operating with inadequate manpower, limiting its institutional growth even as it struggles to meet rising public demand for information.

 This raises an uncomfortable question: if the Treasury can repeatedly allocate billions to loss-making State-Owned Enterprises — some of which continue to hemorrhage public funds without reform — why is adequate funding for the RTI Commission treated as optional?

 Strengthening transparency is not a luxury. It is the foundation of good governance. Every rupee spent on effective oversight helps prevent many more rupees being wasted through inefficiency, misuse, or opaque decision-making.

 In such a context, can one really fault those who argue that restricting the Commission’s resources conveniently limits disclosures that may prove politically inconvenient? Whether deliberate or not, the outcome is the same: weaker accountability, reduced public scrutiny, and a system where opacity is easier than openness.

 If the government is serious about reform, it must start by funding the institutions that keep it honest. Investing in RTI is not an expense — it is a safeguard for the public purse and the public trust.

A Concerned Citizen – Moratuwa

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