First do no harm, Primum non nocere

Sudarshana syrup:

These are famous lines of high ethical and moral value which all physicians of allopathic system are expected to respect and adhere to.

Regardless of the system of medicine, all health workers’ final objective must be to care for the patients; for their betterment. In a broad sense, it goes beyond human, where all living beings, environment, etc.’ should be considered as in ONE Health Concept.

The earliest health systems were based on magic, witchcraft, superstitious beliefs, etc. With time, more refined systems, such as Ayurveda, and later allopathic, gradually replaced such early systems. At present, the allopathic system, based on empirical science, has been established throughout the world, in favour of other systems of health, over the past few centuries. However, it was the Ayurveda system, based mainly on herbs, which helped people look after their health needs, successfully, particularly in eastern cultures. 

In Sri Lanka, even at present, quite a significant population (10 – 15%) is heavily dependent on Ayurveda for their day-to-day health needs. Almost all people have taken medicines of herbal origin (e.g. coriander/Kottamalli, etc.) at some stage of their lives. Hence, the place for Ayurveda medicine is well established and never a doubt in Sri Lankan society. In fact, it is part of the Ministry of Health as the Indigenous Medicine Division.

The current COVID–19 pandemic is sweeping the entire world, in various proportions. With the initial successful containment of the epidemic, Sri Lanka is now suddenly confronted with a painful ground reality. Our country, and all concerned, were used to low numbers in terms of number of patients, and deaths, due to COVID–19, when compared to almost all developed countries. Therefore, the initial euphoria, enjoyed by all, is disappearing fast.

Under these chaotic circumstances, the integration of indigenous/Ayurveda system to local healthcare delivery system, needs to be recognized. Such integration is recommended by the WHO in 2014 (WHO Traditional Medicine Strategy 2014 – 2023, which is an ongoing activity).

As a government, it cannot ignore this need but has to work on a strategy to accommodate the integration. Under this context, Minister Channa Jayasumana’s attempt to introduce Sudarshana syrup to our system is justified and appropriate. In this endeavour, he has to be considered as a Minister, and not as a pharmacologist.  Hence, the unfair attack on Minister Jayasumana, on this matter, is not acceptable. The assault is beyond Minister Jayasumana and in fact the traditional Ayurveda system which has been trusted by many.

Also important to note is that the assessment tools used to assess allopathic drugs may not be suitable to assess the efficacy of Ayurveda medicines, due to two different bases of origin. I am certain that all pharmacologists are well aware of the ancient association between numerous allopathic drugs and herbs. A classic example would be the usage of Cinchona bark for fever for many centuries. Quinine, a drug which was used to combat malaria is extracted from Cinchona bark.

At this critical juncture, one has to be careful about our heeds and deeds; as such actions can undermine and discourage those who are tirelessly fighting hard the battle against COVID–19. If such deeds are responsible for breakdown of the system, the adverse consequences are not only to them but to all of us in the country, regardless of political parties, wealth, social class, ethnicities, etc. The ones who are unfairly critical could well and truly be the victims of the breakdown.

Therefore, all must be very genuine in their behaviour as the infection does not differentiate, based on the type of people in the country. The need of the hour is to stop all unfair attempts, which could hinder the preventive measures, and unite as one force to face this unprecedented challenge.  

Sri Lanka is now potentially facing a chaotic situation as our health sector and skilled human resources are struggling to cope up with the situation. It is very important to protect healthcare workers, particularly those who are involved in public health services (as the number is limited), security forces,   including the police, administrators and all others involved. Therefore, all precautions ought to be taken in order to minimize their exposure to the virus, as depletion in such human resources is not an option for our country. Under this circumstance, fresh thinking is essential with regard to the level of contact tracing as large numbers are reported on daily basis.  

 We have no time to go through all these time consuming and labour-intensive steps, during a crisis period of this nature, as human catastrophe is lurking. Edward Jenner, in 1796, would not have been able to vaccinate a child against Smallpox if he had to go through all steps for approval, before vaccination. It means the world would not have been able to eradicate Smallpox, in 1977. Another example would be the story of the Anti-Rabies Vaccination.  Louis Pasteur, in 1885, decided on his own, in good faith, and vaccinated a boy who was bitten severely by a rabid dog. The boy would have faced a certain death if not for the vaccination. He survived the episode to tell the story and work for Pasteur Institute later.

I fully agree that before carrying out research and giving drugs, present standard protocols, e.g. ethical clearance, etc., should be adhered to. But, at times of crisis or disaster, what is done in good faith is acceptable.   

Prof Ananda Jayasinghe

Professor in Community Medicine

Faculty of Medicine

University of Peradeniya