Artificial intelligence (AI) in healthcare has come to stay and is a well-recognised development over the last decade or so. AI has now progressed on to even the ability to execute quite a few tasks and manoeuvres that were once the sole duties of doctors. Certain AI programmes are now designed to make tricky diagnoses, offer mental counselling, detect drug interactions, read and diagnose images, forecast results, and review scientific articles, to name a few amongst other capabilities. As the aptitudes of AI increase, the roles of doctors are likely to change. In the future, there is a real possibility that physicians would increasingly be placed in supervisory roles in semiautonomous systems, while retaining responsibility but with reduced independence.

Philosopher Walter Benjamin, in the 1930s, wrote that photography and cinema would have a telling effect on paintings and painters. It was argued that the introduction of visual images would render painting and painters quite obsolete. Many belittled the artistic value of photographs, just as today, many ask whether AI can truly understand illness or empathise with discomfort. The opponents of photography theorised that original works of art, such as paintings, had a so-called aura and that there was something special about an original artwork compared to a reproduction as a photo image, and that the painting echoed its singular history and unique trajectory through time, space, and social meaning.

Today’s doctors have something comparable. Their professional authority was grounded in their unique training, the practical wisdom that they had accrued, their face-to-face presence with patients, and their nuanced clinical judgment. Like an original painting, medical expertise appeared singular and inseparable from the clinician who exercised it rather than from the tools or institutions that supported the physician’s practice.

Now enters the latest AI initiative in healthcare. As documented in the Journal of the American Medical Association (JAMA) on the 13^th of April 2026, it is the very first AI DRUG PRESCRIBER. It originated in the state of Utah of the United States of America, which is the 45th state admitted to the Union on the 4^th of January 1896, and is well-known for its unique geography, including the Great Salt Lake and its “Mighty 5” national parks: Zion, Bryce Canyon, Arches, Capitol Reef, and Canyonlands.

In January 2026, the State of Utah publicised a first-of-its-kind partnership with an AI company to develop an AI-based programme to prescribe medications without physician involvement. The AI prescriber package sold by the company Doctronic is claimed to conduct a “comprehensive medical assessment” that “mirrors the clinical decision-making process a licensed physician would follow“. Originally, it was intended to focus on prescription renewals, and the software is designed to prescribe almost 200 drugs, including corticosteroids, statins, antidepressants, hormones, and anticoagulant agents. It has the potential to develop into an autonomous system that could even provide original prescriptions without the involvement of doctors.

There are perceived advantages to AI prescribing in a world facing shortages of primary care physicians, as well as certain specialists. The public health goal is to make sure that patients have access to safe, effective drugs and continue receiving them for as long as it is appropriate. There are documented scientific studies in Western countries on non-adherence, failure to take the drugs of a first prescription, and failure to get refill prescriptions. True enough, AI could reduce pervasive medication errors, enhance process efficiency, and free physicians to focus on complex diagnostic tasks or human-to-human interactions.

Yet for all that, technology-driven revolutions can also cause damage, create waste, and even destabilise the medical connection. They could reduce the patient-clinician encounters and substantially reduce the prospects for physicians to spot other problems and for patients to raise anxieties and ask questions. Doctors have to go through a rigorous process of training and demonstration of clinical fitness to be allowed to practice medicine. AI prescribers face no equivalent safety process. AI companies generally do not openly reveal the precise operational details of the software’s abilities to make medical decisions. In the Utah deal, generalisations were offered, including that the AI prescriber is “trained on established medical protocols,” and that its algorithm continues to progress through “feedback loops.” However, they are far from the absolute detailed guarantees that training of a physician offers.

In the American System of Governance, most states have long maintained foundational laws for dispensing medicines, positioning licensed physicians and pharmacists as essential caretakers and even as gatekeepers. Federal Law requires that any drug that “is not safe for use except under the supervision of a practitioner licensed by law” must be dispensed only “upon a written prescription of a practitioner licensed by law“. AI prescribers are not licensed “practitioners” of medicine, and here, Utah has waived state requirements. It has waived State Laws for businesses with novel ideas deemed potentially beneficial to consumers.

Under the main FDA statute, an AI prescriber comes under an “instrument, apparatus, implement, or machine clearly intended for use in the cure, mitigation, treatment, or prevention of disease,” which makes it an FDA-regulated medical device. The 21st Century Cures Act of 2016 created exemptions for software involving administrative support, general wellness, or electronic record storage. For clinical software, the FDA has generally exercised enforcement discretion only for tools that aid physician decisions. By design, AI prescribers remove the physician, meaning that FDA oversight is required.

However, in the Utah deal, the company has apparently not attempted to approach the FDA about the technology, thereby working on the presumption that the FDA does not regulate the practice of medicine. True enough, Federal Law and the FDA itself express that the FDA does not regulate the practice of medicine. However, Federal Law also emphasises that medical devices and drugs must be legally sold and used within a legitimate patient-clinician relationship. Federal Law does not permit the replacement of physicians with unlicensed computers.

The scientific aspects of the conundrum imply that the current political administration appears to be disregarding some of the federal oversight. Since its 2025 inauguration, the executive branch of the current administration has rescinded previous AI governance orders, encouraged the removal of policies that might impair innovation, and issued an executive order aimed at reducing federal funds for states that strictly regulate AI. The USA Commissioner of Food and Drugs has clearly emphasised the need for AI innovation. Given this antiregulatory environment for AI, the prospect of federal intervention against initiatives like AI prescribers appears to be quite slim.

As federal and state regulators retreat, private parties have stepped in. The Joint Commission (TJC), a private, non-profit organisation that functions as the primary accrediting body for healthcare organisations, recently released non-binding guidance urging healthcare organisations to establish internal AI governance structures and rigorously measure outcomes. The success of AI prescribers will ultimately depend on the acceptance of health systems, which should demand robust evidence of safety and effectiveness, optimally in the form of clinical trials.

Tort law, a branch of civil law that deals with public wrongs such as situations where one person’s behaviour causes some form of harm or loss to another, remains a potential avenue for addressing patient harm because Utah’s agreement leaves such remedies intact. However, injured patients face significant hurdles. Courts will have to determine whether AI could be held to the same standard of care as a human physician. A product liability lawsuit would typically require a plaintiff to show that there was a reasonable alternative design, a challenge for AI black-box technologies. Furthermore, companies might argue that patients “assumed the risk” of using the AI prescriber. However, that is not a complete defence.

AI prescribing would be safest under concurrent state and federal oversight. Yet Utah has granted a state waiver, and FDA compliance has not been demonstrated. Other companies may take the lesson that they can bypass federal safety standards, and they may race into the market to ensure they are not left behind.

Some examples beg for caution. The FDA fell behind in regulating flavoured e-cigarettes, which are now ubiquitous and have contributed to a youth e-cigarette epidemic, which has even reached Sri Lanka. The sheer scale of the unauthorised market and the subsequent legal tactics used by tobacco companies turned premarket requirements into a mere technicality. If AI prescribing becomes the industry standard before safety and liability frameworks are established, the power problem may render future regulation infeasible.

Although AI offers the promise of increased efficiency and expanded access, the evasion of legal obligations by early movers raises profound concerns. The company that is marketing the AI Prescriber is operating in a unique legal “grey zone” that has sparked intense debate among regulators and medical associations.

Incorporating AI into modern health care must be evidence-based and responsible. Physicians and health systems should insist that AI technologies should not be allowed to bypass long-standing and proven legal guardrails governing medical products. That needs to be the axiom that should apply not only to the Western nations but to the whole wide world.

by Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

An Independent Freelance Correspondent.

The Geathiswaran Chapter:

Dr. Ganesanathan Geathiswaran, Sri Lanka’s Deputy High Commissioner in Chennai is in hot water, dragging in with him the Foreign Ministry as well as the Sri Lanka government into a worthless controversy. It stands as a classic example of a misplaced political appointment to a sensitive public position paid for by hapless Sri Lankan taxpayers. And that too by a government that came to power promising not to politicise appointments.

Why would a meeting between a Sri Lankan diplomat and a group of fishermen in South India in the last week of March 2026 be controversial? After all, illegal fishing in Sri Lankan waters by South Indian fishermen from the Tamil Nadu area, which negatively impacts the livelihoods of mostly Tamil-speaking Sri Lankan fishing communities, is a perennial problem that neither Sri Lankan nor Indian governments have been able to resolve. This is also a consistent political issue in Tamil Nadu politics. In this context, a Sri Lankan diplomat meeting local fishermen might well be within his job description. But the issue is how and where such a meeting should take place. The bottom line is that it should not be a public event.

Speaking to The Hindu on 5April 2026, Geathiswaran insisted his presence in the meeting was a “routine visit” and that the event was not organised by any political party. He also said, “I’m not here to do politics” and “I have nothing to do with politics.” He further insisted, “I did not take part in any political campaign. It was in an open area along the seashore. The meeting was not on a stage and in a public area.” These utterances show both Geathiswaran’s naivety, woeful lack of experience and understanding of the nature of politics in the region where he is our country’s chief diplomat.

Be that as it may, let us look at the optics and substance of the said event. According to information circulating in the media in both Sri Lanka and India, the Deputy High Commissioner attended a meeting with local fishermen in Puducherry. It was not a closed-door meeting. It appears, the Sri Lankan diplomat was invited to the event or it was coordinated by Jose Charles Martin, the leader of the newly formed political party, Latchiya Jananayaga Katchi (LJK). Though launched only in 2025, the LJK has been making inroads into Tamil Nadu politics mostly funded by the business interests and funds of Martin’s father, the well-known lottery tycoon, Santiago Martin. LJK joined the BJP-led NDA in the ongoing Puducherry Assembly Elections of 2026. Moreover, as indicated in the photographs in circulation, one can easily see the presence of several BJP politicians including V. P. Ramalingam, BJP’s Puducherry president and a candidate in the Raj Bhavan constituency.

Members of Martin’s family are craftily aligned with different Tamil Nadu political formations. Jose Charles Martin himself is contesting the Puducherry electoral area as a BJP ally, while his mother is contesting from the AIADMK, and his brother-in-law is contesting as a candidate of the Tamilaga Vettri Kazhagam (TVK) party.

Therefore, Geathiswaran’s assertion that the event was not organised by a political party is blatantly false. Further, the event does not become non-political just because of the absence of a stage just as much as a stage does not provide political attributes merely because of its higher elevation. It is unacceptable that a diplomat hand-picked by the Sri Lankan President for the important station of Chennai, thereby depriving the appointment of a senior career diplomat with years of work experience and awareness of political nuance and optics, can be allowed to be this naïve.

It is in this context that Pawan Khera, a senior leader of the Indian National Congress, complained in an X post on 4 April tagging the Indian External Affairs Minister noting that Geathiswaran’s participation in the meeting was “a gross violation of the 1961 Vienna Convention on Diplomatic Relations”, according to which “diplomats ‘have a duty not to interfere in the internal affairs of that State.’” He also noted in his post that the diplomat was invited by the leader of the LJK and also referred to the presence of senior BJP politicians. Leaving aside the overemphasis of the Vienna Convention, which in this instance makes no sense, the issue at hand is the complete lack of common sense on the part of the Sri Lankan diplomat that allowed this controversy to arise in the first place. Despite his insistence on not engaging in politics, which in the case is likely true, this was very clearly a political event, politically conceived, perceived and packaged, organised by a political party, and conducted in the presence of allied politicians who were contesting in a local election. As a foreign diplomatic representative, Geathiswaran should have the cerebral wherewithal to make the distinction or at least seek guidance from his superiors at the Foreign Ministry in Colombo.

Diplomats need not shy away from controversy if it makes sense and benefits the nation. But the incident under reference is purely nonsensical from any perspective. This brings me back to Geathiswaran’s appointment as Sri Lanka’s Deputy High Commissioner in Chennai, itself. What unique experiences did he bring to the post? Of course, he is Tamil-speaking. So are hundreds of thousands of other citizens in the country including potentially competent, well-trained, intelligent and experienced career diplomats. I am not saying that political appointments are necessarily unfavourable, though not ideal unless they bring to the service expertise that the Foreign Service does not have. But what quality and qualification does Geathiswaran possess for the position that is lacking in a career foreign service officer?

Does he bring in access to the different segments of Tamil Nadu political landscape that no one else has? If so, should this controversy not have arisen in the first place, owing to the good connections to the entire political spectrum? In short, he brings absolutely nothing to his office and the country he represents. He also does not have any diplomatic or any other public or private sector experience that would have injected sense and nuance into the present posting. His only qualification is the close political connection to the NPP through family.

This fiasco brings to mind some ideas I presented in 2024 in the government’s own newspaper, the Observer two weeks before the NPP government was established and about one month after President Dissanayake assumed office. Since those conditions still remain valid and the present incident raises the same alarm I raised then, I think it is worth reflecting on them yet again:

“During the last three decades, particularly during the Rajapaksa administration, Sri Lanka’s Foreign Service saw a significant nosedive … In real terms what this means is, the Foreign Service has been encroached by individuals purely based on their political and nepotistic connections, with little or no regard for requisite qualifications, expertise or experience. This is observed not only at ambassadorial level, but also right down to the junior levels in our overseas missions … The main reason for the sorry state of the Sri Lanka Foreign Service is that it has been problematically and parochially politicised over a long period of time, without any pushback … Political appointments are a serious problem. Due to the appointment of completely unqualified individuals on political patronage, there are very few intelligent and well-trained personnel in our embassies in the major cities of the world who are able to proactively work in the country’s interest, when problems arise at the global level. Furthermore, it is also not apparent if there are officials in the Ministry who can advise their unenlightened political superiors without fear and stand their ground on principle. This situation has come about as a matter of simple personal survival and bread-and-butter purposes, owing to which both the larger interest of the Service and self-respect of officers have been clearly compromised.”

Is this not what the Chennai incident also indicates? Geathiswaran being a wrongful appointment is one matter. But it also appears that he did not even have the common sense to seek advice before the meeting in Puducherry or such advice was simply not forthcoming or heeded, as political appointees are generally considered a know-it-all bunch who have the ears of the political hierarchy, and therefore above the norms and regulations that apply to mere career officials.

For many of us the advent of the NPP to power signified the dismantling of the culture of political patronage in which diplomatic postings were rewards for loyalty and friendships. It took less time for the present government than others to go against its own repeatedly stated pre-election positions and to stuff the Foreign Service with incompetent individuals. The present fiasco authored by one of these appointees exemplifies the consequences of this continuing malpractice.

Let me leave readers and government apologists with the words of Tom Nichols, former professor at the U.S. Naval War College about Trumpian ambassadorial appointments, as this applies to our country too: “[With some of his ambassador choices], Trump has elevated diplomatic incompetence to an art.”

Sri Lanka just might outdo the mighty US President on this score.

Friday 17th April, 2026

Chinese Foreign Minister Wang Yi is reported to have told his Iranian counterpart, Abbas Araghchi, in a telephone conversation, that reopening the Strait of Hormuz is a unanimous demand from the international community. He has stressed that Iran’s sovereignty, security, and legitimate rights should be respected as a littoral state of the Strait of Hormuz, but the freedom of navigation and safety through the strait should be ensured. One cannot but agree with the Chinese Foreign Minister.

A prolonged closure of the Hormuz Strait will only aggravate global economic woes and therefore be counterproductive. Tehran has a lot to gain on the diplomatic front; even some staunch allies of the US have taken exception to US-Israeli military aggression against Iran. It ought to take the shifting dynamics of the conflict into consideration and change its strategy accordingly.

The Chinese Foreign Minister has rightly noted that the current situation has reached a critical juncture between war and peace and the window of peace is opening. Iran must seize this opportunity. Araghchi has informed Wang Yi that his country is willing to continue to seek a rational and realistic solution through peaceful negotiations. It is hoped that the fragile ceasefire will be extended, and Pakistan will be able to bring the warring sides to the negotiating table again and help work out a compromise formula.

The US has imposed a naval blockade on Iran, targeting ships that enter or leave the Iranian ports, especially though the Hormuz Strait, through which about 20% of world oil supply passes. It has already turned back several ships that sought to enter Iran. Ironically, the US is doing what it has condemned Iran for—restricting international navigation through the Hormuz Strait. With its naval blockade, Washington is likely to incur more international opprobrium. It still has no way of forcing Iran to allow all ships to sail through the strategic chokepoint freely. However, the US naval blockade is likely to have a crippling impact on Iranian oil exports. With both Iran and the US using the Strait of Hormuz as a strategic lever, the countries that have nothing to do with the conflict have to sail between Scylla and Charybdis in the Gulf region.

Some experts are of the view that the China-Iran railway will help mitigate the impact of the US naval blockade and counter Washington’s efforts to isolate China and Iran, but this option could give rise to unforeseen logical and geopolitical issues.

About one-third of global seaborne trade in fertiliser reportedly passes through the Strait of Hormuz. The Gulf countries are key producers of nitrogen fertilisers. They also manufacture about 20% of phosphate fertilisers and 25% of global Sulphur. Urea prices have increased by 25% in the US, and the American Farm Bureau Federation has written to President Donald Trump, warning that production shocks will threaten national food security. The situation is far worse in the developing world. Sri Lanka is running out of its fertiliser stocks, and farmers are up in arms. Máximo Torero, the Chief Economist of the Food and Agriculture Organization of the United Nations, has warned that the ongoing disruption to the Strait of Hormuz trade corridor has triggered “one of the most severe shocks to global commodity flows in recent years, with significant implications for food security, agricultural production, and global markets”.

Meanwhile, Sri Lanka is playing politics with its national energy conservation strategy amidst a global crisis while all other countries are strictly enforcing regulations in place to curtail fuel consumption. The suspension of the QR-based fuel quota system on account of the traditional New Year celebrations must have led to a huge increase in fuel consumption for non-essential purposes, as evident from the record revenue from the expressways. What should have been done was to increase the fuel quota instead of suspending the rationing system so that the public would be compelled to consume fuel sparingly during the festive season. The West Asian conflict is far from over, and the crisis management strategies must not be compromised.