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Can ‘alternative medicine’ do harm?

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By Dr Upul Wijayawardhana

Whatever the intervention, be it drugs, devices or surgery, it has the potential to do harm: this is an accepted dictum in science-based modern medicine. However, no intervention is recommended unless benefits far outweigh any potential harm. Further, there is continuing surveillance to spot any unexpected dangers, a higher degree of observation being mandated for any new interventions. In the British National Formulary (BNF), which lists all drugs approved for use, some drugs have a ‘black triangle’ to indicate that they are under enhanced surveillance. All drugs are dispensed in the UK with patient information leaflets. The most important method of surveillance used in the UK is the ‘Yellow card scheme’, which is run by the Medicines and Healthcare products Regulatory Agency (MHRA). Any adverse event can be reported to the MHRA, on this readily accessible system, by any healthcare professional, a patient or even a carer. MRHA monitors these adverse events and takes whatever action necessary which may amount, in rare instances, to even the total withdrawal of the drug.

Such safeguards, whether they exist in ‘alternative medicine’ or who applies them, is a moot point at the present time as many wonder drugs are being paraded a cure for COVID-19, which has snuffed out almost one and a half million lives around the world. Some may argue that ‘alternative medicine’ does not need such safeguards as they use natural products. But, are all-natural products safe? Not so! What is conveniently forgotten is that many plants have highly toxic compounds. After all, the belladonna plant, which belongs to the same family as tomatoes, potatoes and brinjal, is called deadly nightshade as it can kill. However, atropine extracted from it is widely used in modern medicine. Sweet potato, though called a potato, does not belong to the nightshade family and that is why we can enjoy a ‘mallum’ made out of the leaves though we cannot do the same with potato leaves. I dare not eat wild mushrooms that sprout in my garden as I lack the expertise to identify what may kill me! I can cite many more examples.

School holidays were what we longed for in our childhood although we had to undergo a ritual purge! My parents were teachers, but they were heavily influenced by Ayurveda, perhaps because one of my paternal aunts was married to an Ayurvedic physician. Ayurveda recommends cleansing the bowel, perhaps, due to the lack of understanding of the basic physiology that the normal bowel is always clean. We had to have a purgative, usually aralu infused king coconut water, at least once a year. Even the worst food poisoning I have had never produced such a violent diarrhoea. I still remember this unnecessary, misguided torture which could have killed us, but we survived, maybe because the human body has evolved to face dangers!

During my working life in Sri Lanka, I saw many patients who had complications, the commonest being jaundice, which may have been caused by Ayurvedic preparations but, unfortunately, there was no authority to report to and no action could be taken. I am sure many morbidities are simply overlooked due to the total lack of any surveillance.

I remember a patient whose heart was seriously affected by medication used in another ‘alternative medicine’ system. Before coronary angiography (taking x-ray pictures after injecting a radio-opaque dye to the arteries that supply blood to the heart muscle) was started in Sri Lanka and at a time when medicine in Singapore was not that advanced, one of my professional ‘risks’ was having to accompany VIPs and friends to London for this procedure. I had to take my own leave for these trips and I never charged a penny from any Sri Lankan but that is another story. This was a rich businessman who was married to a much younger beautiful woman. I was with him when his coronary angiogram was done in a private hospital in London, and it was normal except that heart muscle function was severely impaired. On detailed questioning he admitted to taking a medication which he said he obtained from a ‘native physician’ as he did not want to disappoint his young wife, in the pre-Viagra era! I could not investigate as he refused to divulge any further details.

As heavy metals can impair heart muscle function, my suspicion was that my friend was using a preparation with a compound of a heavy metal and advised him strongly to stop it, pointing out that if he continued, he would develop severe heart failure. He took my advice and the function of his heart muscle improved gradually, which I could demonstrate by serial echocardiography, a procedure using reflected ultrasound to produce a 2D picture of the heart. Over two years, his heart muscle function normalised and he was overjoyed. When I reviewed him a year later, I found that his heart muscle function to be impaired again. When I asked him whether he had started that again, his response was “How did you know?” Thus, there was no doubt that his heart muscle dysfunction was due to that particular drug.

Science-based modern medicine we practise has evolved from empirical systems of the past and uses many drugs but they undergo a process of rigorous testing. When a drug is considered to be useful, it undergoes testing in at least three phases, as I mentioned in my article, “Peddling snake oil” (The Island, 17 October). Therefore, I was taken aback when wide publicity was given in the media that an Ayurvedic physician had developed a drug that cured Covid-19. In fact, The Island of December 3 carried a photograph of our Health Minister tasting the decoction but I doubt anybody taking her seriously. After all, she is the one who kissed the Chinese lady off with COVID-19 and dropped pots in rivers at the behset of a faith healer. Rather than allowing experts, who have the knowledge of the behaviour of this deadly virus, to do their job, playing politics is not only laughable but dangerous. Media reports stated that this decoction was tested by some specialist physicians in the government sector and they found that PCR positive patients tested negative after this decoction. That simply is the wrong yardstick to use as all who recover would become PCR negative, as the body develops antibodies to get rid of the virus. After extensive trials, it was shown that the antiviral remdesivir may shorten the duration of the illness and that dexamethasone significantly reduced the death rate in hospitalised patients. To claim that any drug is a cure without testing it properly is the height of absurdity and supporting these wild claims only amounts to misleading the public. Compared to many other countries, Sri Lanka is still doing very well and the best way to fight this deadly virus is preventing its spread by physical distancing, wearing masks and washing hands, till an affordable vaccine becomes available.

Now it transpires that this ‘physician’ is just a kapuwa in a kovil! Are we living in a fool’s paradise?



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Sri Lanka’s rice conundrum: Time to stop managing crises and start fixing the system

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Prof. Ranjith Senaratne,
Emeritus Professor in Crop Science and former Vice-Chancellor,
University of Ruhuna and General President of the Sri Lanka Association for the Advancement of Science (2023) and
Prof. Prasad Jayaweera,
Dean, Faculty of Computing, University of Sri Jayawardenapura

Rice is not merely another crop in Sri Lanka. It is our staple food, an integral part of our history and culture, and a foundation of the civilisation that flourished around our ancient hydraulic systems. Revered as Buddha Bhogaya, the Buddha’s crop, rice has sustained our people for more than two millennia. Yet, remarkably, a country with such a profound relationship with rice continues to lurch from one rice crisis to another.

At one time, we have a surplus. At another, we face shortages. Prices rise sharply, consumers complain, farmers struggle to obtain remunerative prices, millers and traders become the focus of public attention, imports are hurriedly arranged, and governments announce yet another set of measures to contain the crisis. Then, after the immediate problem subsides, the matter recedes from the national agenda, until the next crisis arrives.

Why does this keep happening despite decades of agricultural research, policy interventions, expert committees and public debate?

Perhaps because we have been asking the wrong question. The fundamental problem is not simply how to produce more rice. Nor is it merely a question of prices, imports, fertiliser, farmers, millers or markets. The rice conundrum is a complex national systems problem.

We cannot solve a system by fixing its parts in isolation

Sri Lanka’s rice sector is an intricate web of interconnected systems involving agriculture, land, water, climate, technology, finance, energy, transport, markets, trade, governance, institutions and consumer behaviour. A decision made in one part of this system can have consequences, sometimes unintended, in another.

A change in fertiliser policy, for example, can affect productivity and production costs, which in turn influence farmer profitability, market prices and the need for imports. Irrigation decisions affect not only production, but also water availability, energy use and environmental sustainability. Guaranteed prices influence farmers’ cropping decisions, while import policies can simultaneously protect consumers and weaken incentives for domestic production. Likewise, market concentration can affect both the price received by farmers and the price paid by consumers. This is precisely why isolated interventions so often produce disappointing results. We keep treating symptoms while leaving the underlying system largely untouched.

For decades, we have generated valuable scientific knowledge on individual aspects of rice production and marketing. But knowledge generated within disciplinary and institutional silos does not automatically translate into solutions to complex real-world problems. What is needed now is a fundamentally different way of thinking.

From a “rice crop” to a “rice system”

The first step is to stop looking at rice simply as something that is grown in a paddy field.

The rice system begins with land, water, seed, inputs, technology and finance. It extends through cultivation, harvesting, drying, milling, storage, transport, wholesale and retail marketing, and finally to the consumer’s table. At every stage, there are different interests, incentives, constraints and actors: farmers, farmer organisations, input suppliers, machinery operators, millers, traders, wholesalers, retailers, financial institutions, government agencies, researchers and consumers.

And hovering over the entire system are climate change, changing consumer preferences, technological transformation and national economic conditions. A weakness anywhere in this chain can compromise the performance of the whole system.

Consider post-harvest losses. If significant quantities of rice are lost because of inadequate drying, storage or processing facilities, increasing production alone cannot solve the problem. Similarly, if farmers produce efficiently but face weak markets and poor bargaining power, productivity gains may not translate into improved livelihoods.

The question, therefore, should not be “How much rice can we produce?” but “How can we make the entire rice system work better?”

That requires us to see the connections.

The missing ingredient: reliable, real-time information

There is another fundamental weakness that deserves urgent attention: we still lack a comprehensive, integrated, interoperable and reliable national information system for rice. Information is scattered among different institutions, often collected using different methodologies and not necessarily available when decisions need to be made.

How much rice will actually be produced? How much is in storage? What is the likely demand? Where are the emerging production shortfalls? What are the stocks held by different actors? How are prices moving along the value chain? What are the likely consequences of climate conditions? Without timely and reliable answers to such questions, policymakers are forced to make critical decisions with incomplete information. This is not merely an administrative inconvenience. It is a national food-security vulnerability.

Sri Lanka should therefore seriously consider establishing a National Rice Intelligence and Decision Support System (NRIDSS), an integrated digital platform that brings together relevant real-time information from agriculture, meteorology, irrigation, markets, trade, statistics and other institutions. Such a system could support production forecasting, market monitoring, import decisions, early warning and evidence-based policy formulation. In an increasingly uncertain climate and volatile global economy, this should no longer be regarded as a luxury. It is becoming an essential component of national food-system governance.

The deeper problems cannot be ignored

A systems approach would also force us to confront some uncomfortable structural realities. Why does productivity remain relatively low despite decades of research? Why are so many holdings too small to achieve economies of scale? Why are modern technologies and precision agriculture not being adopted more rapidly? Why do farmers often have limited bargaining power? Why do substantial losses occur after harvesting? Why can market power become concentrated in a relatively small number of actors? Why are guaranteed prices sometimes announced too late to influence farmers’ production decisions? Why are policy interventions so often reactive rather than proactive? And how will droughts, floods, temperature extremes, changing rainfall patterns and emerging pests affect the stability of rice production in the years ahead? These are not separate questions. They are parts of the same system.

From crisis management to systems governance

Sri Lanka does not need another isolated discussion about rice. What is needed is a national policy dialogue and action forum that brings all relevant actors together, not merely to exchange speeches, but to develop a shared understanding of the system and agree on what needs to be done. Such collaboration must go beyond consultation or the exchange of views. The different parties need to work together from problem definition through to implementation, bringing their diverse knowledge, perspectives, interests and practical experience into a common process.

Farmers bring contextual and experiential knowledge; industry actors understand market realities and operational constraints; scientists contribute evidence and analytical capabilities; policymakers bring institutional and regulatory perspectives; while technology and data specialists can provide new tools for understanding and managing the system. When these different perspectives are brought together systematically, they can reveal interdependencies, challenge assumptions, identify feasible interventions and generate solutions that are evidence-based, practically implementable and socially acceptable.

This is the essence of a transdisciplinary systems approach: not simply working across disciplines, but bringing together multiple stakeholders and multiple forms of knowledge to co-create solutions and share responsibility for outcomes. The process should therefore go beyond presentations and speeches. It should involve systems mapping, causal analysis, stakeholder dialogue, scenario planning and the participatory identification of the critical bottlenecks and leverage points in the rice system. Most importantly, it should distinguish between what is urgent and what is important, and between interventions that merely alleviate symptoms and those capable of changing the underlying behaviour of the system itself.

We need an implementation roadmap, not another report

There is, however, one important caveat. Sri Lanka has no shortage of reports, recommendations and policy documents. What we often lack is sustained implementation. Any national initiative on the rice conundrum must therefore end not with another set of broad recommendations but with a prioritised national action roadmap. It should identify short-, medium- and long-term actions, assign institutional responsibilities, establish timelines and define measurable indicators of progress. The ultimate objective should be to move Sri Lanka from reactive crisis management to proactive systems governance.

A national opportunity

The rice conundrum may, in fact, provide Sri Lanka with an opportunity that extends well beyond rice to deal with other important crops. If we can demonstrate that a complex national problem can be addressed by bringing together science, policy, stakeholder knowledge, real-time information and systems thinking, the approach could become a model for addressing other persistent challenges, from climate resilience and water security to energy, food systems and disaster risk.

The choice before us is therefore quite stark. We can continue responding to each rice crisis as it emerges, adjusting prices, arranging imports, appealing to millers, reassuring consumers and supporting farmers, only to repeat the cycle later. Or we can step back and ask a more fundamental question:

What is it about the way our rice system is structured and governed that continually produces these crises?

That is the question that needs to be answered. Sri Lanka has the scientific expertise, institutional capacity and stakeholder knowledge required to do so. What is needed now is the willingness to bring these fragmented sources of knowledge together and examine the rice sector as one interconnected system.

Our ancient civilisation understood the importance of interconnectedness: land, water, agriculture and society were organised as parts of a larger whole. Perhaps, in confronting the modern rice conundrum, we need to rediscover that systems wisdom, this time supported by modern science, technology, real-time data and transdisciplinary thinking. The time has come to stop merely managing the rice crisis. It is time to fix the system that keeps producing it.

It is against this backdrop that the Sri Lanka Association for the Advancement of Science (SLAAS) proposes to convene shortly a “National Policy Dialogue and Action Forum on the Rice Conundrum in Sri Lanka”, bringing together the key stakeholders across the rice system. The Forum is intended to provide a platform for moving beyond piecemeal and reactive interventions towards a coordinated, evidence-based and transdisciplinary systems approach, one capable of generating lasting and pragmatic solutions to what has become an “island-shaking national issue”.

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This curse of partisan politics in Sri Lanka

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78 Years of Demagoguery, Not Democracy

by Brigadier Ranjan de Silva
rpcdesilva@gmail.com

On the 4th of February every year, we raise the lion flag and speak of democracy. We speak of 78 years of “self-rule.” But honesty demands we ask: what kind of rule have we actually had? It was not democracy. Democracy is government for the common good, constrained by law, informed by reason, and accountable to truth.

What Sri Lanka has had for 78 years is demagoguery — government by manipulation, by party, and by passion.

Defining the Curse:

The dictionary defines demagoguery as “political activity that seeks support by appealing to the desires and prejudices of ordinary people rather than by rational argument.” Its tools are simple: divide the people, promise the impossible, demonize the opponent, and govern for the next election, not the next generation. That is the political culture we inherited in 1948 and perfected since.

78 Years of Evidence:

The record is not ambiguous. Policy by Pendulum – 1948–2024. Instead of a national development plan, we got a partisan wrecking ball. 1956: The “Sinhala Only Act” was passed not after linguistic study, but as an election mobilization tool. 1970-77: The SLFP nationalized private enterprise and imposed import controls. 1977: The UNP reversed course with an open economy overnight. 2005-2014: Mega infrastructure was built on Chinese loans with no feasibility transparency. 2015-2019: Those same projects were called “white elephants” and stalled. 2020-2021: The organic fertilizer ban was announced as a populist “green” policy, reversed 6 months later after it collapsed agriculture and food prices. The Colombo Port City, Hambantota Port, and the Central Expressway all followed the same pattern: started, stopped, rebranded. The country pays twice. The party takes credit once. Economics as Election Candy. Demagoguery is expensive. 1960s: Subsidized rice to win rural votes, leading to the 1971 food crisis.

2005-2014:

Fuel subsidies and public sector hiring sprees that doubled the wage bill. 2019:

Unfunded tax cuts that removed Rs. 500 billion in annual revenue with no offset. By April 2022, external debt hit $51 Billion and we defaulted for the first time. The party that cut taxes was not in power to manage the IMF program. The party that inherited it was blamed for the austerity. This is the cycle. Institutions captured. A democracy needs referees. We turned them into party cadres. The 17th Amendment 2001 created independent commissions. The 18th Amendment 2010 abolished them. The 19th 2015 restored them. The 20th 2020 gutted them again. Police transfers, university vice-chancellors, and state bank chairmen have all been decided by party headquarters, not merit.

When the institution serves the party, the citizen gets leftovers.

Identity over Ideas: From 1956 to 1983 to 2009 to 2022, our elections have been won on fear, not spreadsheets. “They will erase your language.” “They will sell the country.” “Only we can protect Buddhism/the minorities/the nation.”

Rational debate on debt, productivity, or climate adaptation never wins a rally. Prejudice does. That is demagoguery by definition.

Party Interest subverted the National Interest. The core damage of 78 years of partisan politics is this: the nation became secondary to the party. Need power sector reform? Impossible, because our unions will strike. Need to cut 300,000 ghost employees? Impossible, because our voters will defect. Need a 20-year education and export plan? Impossible, because it won’t show results before the next election. So, we borrowed. We patched. We lied. The result: a railway system that still runs on 1950s engines, hospitals without paracetamol in 2022, and a brain drain of 300,000+ skilled workers since the crisis. The parties rotated. The country declined.

The Opposition’s Original Sin and here, all parties share guilt equally. In opposition, the job is not to govern. It is to destroy. The UNP in the 60s called the SLFP “communist.” The SLFP in the 70s called the UNP “imperialist.” The JVP called both “traitors.” The SJB, SLPP, and NPP today use the same script with new logos. Every tax is “anti-people.” Every reform is “a sell-out.” Every crisis is proof the other side is evil and must be removed at any cost. Then they win. And implement 80% of what they opposed. Because demagoguery has no principles, only positions. 78 years of unmerciful, bad-faith criticism has not produced accountability. It has produced cynicism. The public now believes all politicians are the same — because for 78 years, they have behaved the same.

Breaking the Curse:

Changing the party in power will not end this. We must change the incentives that reward demagoguery. Three reforms are non-negotiable: Bind future Parliaments to national policy. Pass 10-year frameworks for energy, education, and public debt with 2/3 majority protection. Infrastructure and fiscal rules should outlast one government, as they do in Chile and New Zealand. Depoliticize the state. Independent commissions for police, elections, public service, and bribery must have constitutional budgets and appointment panels that exclude MPs. No more 18th/20th Amendment style rollbacks. Demand better from voters We must stop rewarding the best slogan and start demanding the best spreadsheet. Town halls over rallies. Costings over promises. A 5-year plan over a 5-minute speech.

In 1948, we did not inherit democracy. We inherited an election. For 78 years we have used that election to choose our favourite demagogue. The prize has been debt, division, and decay. The curse of partisan politics will only end when citizens and leaders agree on one principle: Party second. Country first. Until then, February 4th will remain a ceremony, not a celebration.

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Developing markets for fruits, vegetables and flowers in the Gulf

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Image courtesy Export Development Board)

Export diversification – Missing the wood for the trees – Part II

by Gomi Senadhira

Sri Lanka established its diplomatic presence in the Gulf region only in the early 1980s. First, a small embassy was opened in Abu Dhabi, covering the UAE. Then in 1982, embassies were opened in Jeddah and Kuwait. The embassy in Jeddah covered Saudi Arabia while Kuwait was responsible for Kuwait, Oman, Qatar and Bahrain. Commercial Diplomats were also assigned to these two embassies. A senior private sector executive, with experience in marketing, was posted to Jedda as the commercial counsellor. I was posted to Kuwait as a second secretary (Commercial). Our instructions were very clear. Focus not only on traditional exports. Product diversification was a priority.

Developing Markets for Agricultural Products

At that time, Minister Lalith Athulathmudali had just launched his Export Production Villages (EPV) programme. He believed that the EPVs working closely with the exporters would provide an ideal opportunity for rural households to directly benefit from the government’s new open trade policy. Agricultural products, particularly fruits and vegetables, were a key component of this approach and the ministry thought that the Gulf countries, with large Sri Lankan communities, would have a ready-made market for these items. Thus, from day one we were compelled to explore the market for nontraditional exports; fruits and vegetables (F&Vs) were on the top of our priority list.

From cane baskets to cardboard boxes

Fortunately, the market for the F&Vs products in the region was at a very early stage of development. That provided an opportunity for Sri Lankan exporters, who were also inexperienced, to work with the importers and grow together. For example, in Kuwait, one of our first customers for F&Vs was a small supermarket where the manager was a Sri Lankan. After the first shipment arrived, he invited me to inspect the shipment. I visited the supermarket and was shocked by what I saw. While produce from other countries was packed nicely in cardboard boxes, our packaging mirrored transport to Manning market, cane baskets! As a result, fresh produce had suffered significant damage. A long report, with photographs, to the trade ministry produced an immediate response. After all, this was a pet project of the Minister. Within weeks, shipments were packed in cardboard boxes. Immediately afterwards, an expert on packaging from the Commonwealth Secretariat was sent to Kuwait with an official from the EDB to study the problem.

By then, we had also managed to develop a friendship with the management of the Salmiya supermarket, a large upmarket supermarket patronised by wealthy Kuwaitis and expats. It was a cooperative and the chairman was a Kuwaiti public servant. I could only meet him after 6 PM when his large office functioned as a diwaniya, a cherished cultural space in Kuwaiti society. Guests moved in and out the room. I had to spend time with them sipping many cups of tea. Though that meant at least two hours on each visit, it helped greatly to develop a close relationship. The general manager was an efficient and friendly Palestinian. After many visits we had succeeded in getting an order for F&Vs. The day after the first shipment arrived, I got an urgent call from the GM to come and inspect it. Once again, I was in for a surprise. Inside the cold room, the consignments from other countries were stacked neatly on top of each other, while vegetable boxes from Sri Lanka had collapsed once placed on top of each other, crushing the produce within.

Fortunately, our packaging experts arrived in Kuwait soon after this incident. They spent two days in the Salmiya Supermarket, studying the packaging from other origins. We were also successful in assuring the GM our packaging would improve. After that, packaging improved and exports moved smoothly. With that, Sri Lanka emerged as a small but reliable supplier to the mainstream market, not just the ethnic segment of the market.

Export of Fresh Vegetables by Sea

Towards the end of my tour, a Sri Lankan businessman requested me to find a buyer for cabbages, which he was prepared to export in large quantities by sea. I introduced him to the largest fruit and vegetable importer in Kuwait. Their regular suppliers of similar vegetables were Jordan, Lebanon and Syria. Luckily, the company was keen to diversify the supply sources. A few weeks later, the first container load of cabbages from Sri Lanka arrived in Kuwait. Immediately after the arrival of the container, I visited the company. They were pleased with the quality and the price and were looking forward to importing more fruits and vegetables. Unfortunately, that turned out to be a one-off event. Later on, when I was back in Sri Lanka, the exporter informed me that he couldn’t continue with it due to the problems with the local supply chains.

Floriculture

During the period I was asked by the EDB to explore the market for floricultural products, more particularly for cut flowers. At that time Kuwait was a relatively large importer of cut flowers and live plants. The main suppliers were the Netherlands and Colombia. Importers were also reluctant to move out of the established supply chain, particularly due to “snob value” associated with the product from Europe. However, after some difficulties, one importer agreed to place a pre-paid trial order. After the arrival of that shipment, he was impressed by the quality of the product and the orders expanded rapidly. As a result, by the end of 1985 Kuwait had become a major buyer of Sri Lanka’s floricultural products.

From village to global markets

As a result of the proactive promotional work undertaken by the EDB and the embassies in the region, by 1985, Sri Lanka had managed to acquire a small but significant share of the F&V and floriculture markets in the GCC countries. We had also identified domestic supply chain issues that hindered exports. All that was done, long before Southeast Asian or African countries even entered into that market. In fact, my Southeast Asian colleagues used to contact me often to reserve “durian” for them at the “Sri Lankan supermarket”.

Most importantly, a substantially large share of produce from Sri Lanka in Kuwaiti supermarkets originated in the EPVs. Of course, that didn’t just happen. The ministry (or the minister) using the carrot and stick approach “encouraged” exporters to buy the produce directly from the newly established EPVs. (The writer can be reached at senadhiragomi@gmail.com)

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