Features
More on postal runner Kalua of Bimbanda and another jungle walk

by Frederick Medis
(Continued from last week)
The postcript to this episode was that by some strange coincidence in the year 2000, as many as 53 years after my first meeting Kalua, I was recounting my experience one evening to a group of friends in Matale. There Mrs Punyakanthi Wijeratne of Matale, startled me when she described Kalua in detail, even to the missing joint of his little finger. She had been a Miss Aluwihare and came from the walauwa (stately home of the chieftain) at Rattota, where Kalua was the family’s trusted servant and factotum. She and her brother were children at the time, and whenever there were long distances to be covered over uneven roadways, it was Kalua who took them pick-a-back across his ample shoulders.
There came a time when her father arranged for his regular employment as a tappal – or postal-runner from Rattota post office to the jungle villages beyond Laggala, but he was provided with a small outhouse built for him near the walauwa. He was given food and shelter, and was cared for in his old age until his death about 20 years ago. Mrs Wijeratne remembered him with nostalgia and showed interest in knowing that I had met him in Rattota in 1947. She extracted from a family album of photographs a snapshot of a young boy, who was a cousin of hers, standing beside a puppy and the squatting Kalua. It was the identical Kalua I had met over a half century ago.
Incidentally, I believe I am now the only living person to have had the privilege of accompanying a tappal-runner through the jungles.
Estate bungalow
In the estate bungalow, after a late lunch, there was plenty of time to spend in conversation. Freshened after a sleep of two hours, followed by a wash, I moved to the dining room for tea and further pleasant conversation. The servants lit the large Hinx kerosene lamp with its round opaque glass globe, as well as smaller lamps in the hall and the rooms. There was no electricity, and in those days nobody bothered about refrigeration and the cold storage of food. Outside, in the distance, could be heard the howling of jackals and the hooting of owls.
We reassembled at dinner, which was a simple meal that was much appreciated. I expressed the wish to move into the jungle villages further on. My hosts were insistent that I should rest the next day after my long and tiring trek. They said they would arrange a tracker the day after. At the following day’s dinner, I was informed that a tracker has been arranged for the trip.
Another jungle walk
The next day, I was ready after an early breakfast when the tracker, whose name was Bimbanda, arrived. He was about 40 years old. He was given the necessary instructions. I had never used a gun before, but I was told it was needed for protection. Accordingly, I was given five minutes of direction in its use. My friends, who provided me with sandwiches, some sweets and a flask of tea in the haversack, saw me off.
We walked for about half a mile, and then left the rough and boulder-strewn road where it ended and entered the jungle. It was apparent the tracker was following an animal footpath. He assured me that within a few minutes we would emerge into easy terrain.
Childbirth
Soon we came across a human footpath, and in about half an hour we heard human voices. Then we saw them, a party of about 40 people, half of them being women. Bimbanda said they were Gam Veddhas from the villages. All the men had their long hair tied up in knots. They wore what I guessed were banians or vests or loose jackets.
The women wore short sarees about eight inches above the ankles. Nearly all of them, except the younger ones, had no blouse or jacket, but in the presence of men they threw the saree fall across their shoulders.
They were all of small build, with their hair parted in the centre. Some wore crudely fashioned gold-plated ornaments. On their hands they wore silver, twisted bangles with a 25-cent coin soldered in the centre.
The women carried on their heads heavy pillowcases filled with food and other pilgrim paraphernalia. These were balanced horizontally. They were apparently the beasts of burden, for the men swung their hands freely without any encumbrance, except when they carried a staff or short stick.
They had already cleared a small portion of a hillock under a large tree, and what was in effect a mattress had been made by spreading clothes over layers of leaves on the ground. I noticed a rope hanging from a low branch of the tree. A clay pot of water was being boiled on a tripod of sticks.
The tracker quickly got into conversation with the men, and I did likewise, but I needed his help, as certain words they used were strange and unknown to me. An old woman
and her son told us that they had halted in their trek from a distant village to Rattota, from whence they would take bus to Matale and then to Kandy to worship at the Dalada Maligawa, and witness the perahera.
This was an emergency stop, for a woman in the group was in labour, and until the child was born, they could not proceed. This old man and woman, after consultation, invited me to be of assistance. Probably my khaki uniform made them confuse me with a Health Department official. My only qualification was a war-time ARP (Air Raid Precaution) St. John’s Ambulance Brigade First Aid Certificate from London.
By now, under the tree there was much activity, and the older women stood round like a protective screen. There was whimpering, followed by subdued shrieks. The tracker and I together with the old woman and her son moved towards the ring of women. When we approached, they made way for us. Diffidently I moved into the ring. On the make-shift mattress, was a middle-aged woman in labour crouching on her elbows and knees. It was evident that the rupture of the amniotic sac had taken place.
I was informed that it was her fourth child. I noticed Bimbanda walking out of the group, while I remained with the old couple. The woman in front of us was obviously in pain, but the noises she made were stifled and restrained. She was naked and perspiring profusely. Even though in a prone position, in her hands she grasped with difficulty the knotted end of the rope. The tree-branch shook with her purposeful bearing-down, urged on by a frail, wizened old woman with her hair falling over her face.
She knelt beside the pregnant woman and muttered the same incoherent words over and over again, all the while running her scraggy fingers in a downward movement along the patient’s belly. The sight of coagulated blood and the stained cloth made me somewhat sick. I joined Bimbanda, who was outside, and we chatted with a group of men for a few minutes. The women, who were with them, did not speak, probably without permission from their men.
A little later, when I gained composure, I went back to the “emergency ward”. Before I entered, I could see at a respectable distance, two men who had come from the far side of the jungle. Another old woman met them and took the green and yellow bamboo branch which they held out to her. They helped her cut it into a strip about a foot long and slit it up to the node. She held it in both her hands over her head and walked in with the old man and me, all the while muttering some kind of incantation in a low tone.
Parturition had already taken place, and the infant, pink and slimy, was lying almost under the mother. Two women knelt down and held the child. The woman with the bamboo twig widened the split below the notch and placed it below the umbilical cord, after the two ends had been tightened with a creeper or twine (I could not see what it was). The severance took place cleanly and speedily.
The mother now assumed a supine position, while one woman applied light pressure on her abdomen, another gently moved the child to and fro till there were prolonged choky squeals. While one woman applied some medicinal preparation off a small glass bottle, they swathed the mother around the waist and the pelvic region with two or three folds of cloth. We then saw her face as she gave a frightened, primitive-looking smile.
Journey continued
Bimbanda and I did not want to stay longer. Besides we were getting late, and had a long way to go. On our return journey, we saw something moving clumsily into a narrow-mouthed hole close to the path we were treading. Bimbanda told me it was a kaballawa (scaly ant-eater), which moved like a monitor lizard except for its tightly curved tail. This, I learnt later, was an unusual sight even in the dense jungles.
Soon there were signs of a human habitation. We heard the thud of a flattening and levelling wooden implement, known as tappe mole, being used to strengthen the floor of a mud hut. Lying by the side was a much-worn hide of a spotted deer, with a coir rope attached for dragging on the ground. This was used to haul mud and stones for building purposes.
We had now come to a village of about 20 huts, where all were of wattle and daub except one, which had tall, white walls and a red-tiled roof. This was Illukkumbura post office. I was overjoyed, for philately, as well as coin collection, was my first love from the age of six years. My desire, therefore, was to meet the postmaster of the jungle village of Illukkumbura.
Just as the post office building was incongruous to the village, the postmaster too was different from others in the village. He told me he was the postmaster in this remote outpost for more than three years, and that he was lonely and far-flung from his small family. He readily obliged by applying the date-stamp cancellation marked “Illukkumbura” to a self-addressed 3- cent King George VI, green-stamped post-card he sold me. This was to add to my collection of out of the way post marks. He promised to send it in the tappal-runner’s bag the next day.
Along with the postmaster, we paid a visit to the headman. In the course of the conversation, he told us that Muslim traders came to the village every three months all the way from Matale and Rattota. They brought sugar, dried fish, salt, coconut oil and cloth on tawalam harak or pack oxen, which push their way through the jungle undergrowth. These traders used to barter their goods for poultry, eggs, dried venison, kurakkan and bees’ honey.
We left the headman and visited some huts in the village. The wells were open and unprotected. Stones and planks, usually of kumbuk , were placed in the far side of the well, away from the house. It was considered unlucky to draw water with one’s back to the house.
In an adjoining village, an elderly man explained the reason for this practice. In lonely village houses, he said, while the men folk and the older children were engaged in work in the chenas and fields, only older women were left to tend the infants and toddlers and prepare the food. So when they drew water from the well, it was advisable that they faced the house. This would enable them to overlook and protect the little ones against any outsiders and wild animals, such as serpents and monkeys. I noticed that there were no doors in all the huts we saw.
An hour’s walk brought us to Makumbura, which was a larger village. We had lunch consisting of rice and curry. As it was getting late, we moved on to Pallegama, which was a large village with some tiled houses. When we left Pallegama, we were again in dense jungle. It was dark and gloomy under the trees. Whenever there was a rustling noise, Bimbanda cocked his gun, ready to shoot. I had to restrain him many a time from putting an end to several hare, a miminna (mouse deer) and even a young spotted deer.
The sun had set in when we reached the estate and came to the bungalow, where my friends were waiting expectantly in the yet unlit verandah. I thanked Bimbanda and promised to meet him in the morning. Soon darkness covered us, and a hot bath was the best refreshment before fellowship and conversation at dinner.
Conclusion
I am thankful to many persons for this short jungle interlude in my life. It gave me a new perspective and opened up new vistas of experience where I came directly in contact with wild terrain and its concomitant forests and natural features.
I am now aware that Laggala is believed to be the scenario of an early civilization in our country’s pre- or even proto-history. However, that appears to me too far away from the present reality. Last year, in 2001, I travelled on the same route in a high-powered vehicle with friends from Matale and Kandy. I recalled the earlier scene as I traversed the broad, winding macadamised road through the still majestic and bewilderingly beautiful hilltops.
But now the land is cultivated and concreted with townships full of shops and rural banks, with the blare of radios and the screech of motor vehicles echoing through the dust. What matters to me now is that more than half a century ago, I was privileged to share the company of simple people like the pot-bellied headman, the wrinkle-browed postmaster and the unsophisticated village folk who had their homes in the unspoilt forest.
Above all, I am conscious of the part played by Kalua, Bimbanda and many others I met who are now resting forever in the soil under the shadowy trees of their beloved homeland – the jungle. To them, I shall always remain grateful.
(Excerpted from Jungle Journeys in Sri Lanka edited by CG Uragoda)
Features
Is Tax a Responsibility or a Burden? Part II

A critical policy misstep by the administration of President Gotabaya Rajapaksa was the substantial reduction in tax rates in late 2019, which significantly eroded government revenue. This drastic contraction in the fiscal base severely undermined public finance sustainability and contributed to Sri Lanka’s deepening fiscal and economic crisis in the years that followed.
The intended purpose of these series of major tax cuts aimed at boosting the economy, including slashing the VAT rate from 15% to 8% and reducing corporate and personal income taxes. Several other taxes—such as the PAYE tax, Nation Building Tax, Economic Service Charge, and Withholding Tax—were also abolished. While these measures were intended to encourage investment and ease the tax burden, they led to a sharp drop in government revenue, with total tax income falling by nearly 50% in 2020. Experts estimate that the country lost between Rs. 560 billion to Rs. 700 billion due to these cuts, severely weakening the government’s ability to fund public services and manage the economy.
Speechless NPP/JVP/AKD
Fortunately, the current government did not follow through on its election promise to remove taxes on essential goods such as food, medicine, and education-related items. Upon assuming office, they appear to have realised—albeit belatedly—that such a policy is neither fiscally practical nor compatible with the country’s economic realities. Moreover, adherence to International Monetary Fund (IMF) commitments and fiscal consolidation targets has likely influenced this course correction, reinforcing the need to maintain at least a minimal tax base on essential commodities.
Even the stalwarts of the National People’s Power (NPP), led by the JVP, are often left speechless when questioned by journalists about the feasibility of their campaign promises, particularly those lacking fiscal credibility. Similar to their eventual admission of responsibility for the 1988/89 insurrection and related violence, they now lack the courage to acknowledge their latest failure. After coming to power, they realised that the promises they made were neither practical nor sustainable—but instead of admitting their mistake, they continue to avoid accountability.
They also boast that they didn’t fail in six months as critics had predicted, but the truth is they would have undoubtedly collapsed had they kept the promises they made during the election. Their survival today is largely due to adopting centre-right economic policies—ironically, a complete departure from their own political ideology.
How Are Taxes Collected and Who’s Responsible?
The main agency responsible for collecting taxes in Sri Lanka is the Inland Revenue Department (IRD). They handle everything from registering taxpayers, to processing tax returns, and making sure that tax payments are made on time. The IRD also educates the public on how to comply with tax laws.
Alongside the IRD, other departments like Customs and Excise collect taxes on imported goods, fuel, alcohol, and tobacco products. These agencies work together to ensure the government receives revenue from different sources.
If you earn an income from an employment, rental properties, interest from fixed income earning securities such as fixed deposits/government bonds or run a business, it’s mandatory to register as a taxpayer. This involves submitting personal or business details to the IRD and receiving a tax identification number (TIN). Once registered, taxpayers must file returns (details of revenue and expenses) regularly, reporting their income and calculating the tax they owe.
However, many people find this process confusing, which is why the IRD runs educational programmes to help. For example, “Tax Week” is a special initiative where seminars, tax clinics, and registration drives are held to guide taxpayers through the process.
Challenges in Tax Collection
Collecting taxes isn’t always easy. Some taxpayers don’t fully understand their obligations, while others try to avoid paying taxes illegally. The IRD faces the difficult job of encouraging voluntary compliance while also enforcing penalties on defaulters.
To improve tax collection, authorities are investing in technology like online filing systems and digital payment options. These tools make it easier and faster for taxpayers to meet their obligations.
Efficient tax collection ensures that the government has the funds needed to deliver services and invest in development projects. When taxes are collected fairly and effectively, it builds trust between the public and the government.
Costs, Benefits, and Challenges of Collecting Taxes
It is very important to balance between spending money on tax collection and the revenue it generates. Collecting taxes might seem like a simple process — you pay, the government gets money. But behind the scenes, tax collection is a complex and costly operation. we’ll see how much it costs to collect taxes, why it’s worth it, and the challenges that come with the job.
Running a tax system isn’t free. The government spends money on staff, offices, technology, and systems to register taxpayers, process returns and enforce laws. There are also costs related to educating the public, handling disputes, and tracking down people who try to avoid taxes.
For instance, the Inland Revenue Department (IRD) of Sri Lanka has invested in digital platforms aimed at simplifying tax filing and minimising errors. Although these technological upgrades require significant upfront expenditure, they are intended to streamline processes and generate long-term cost savings. However, the full benefits of these investments have yet to materialise.
Balancing Cost of Administration/Tax Collection and Tax Revenue
A key challenge for tax authorities is balancing the cost of collecting taxes with the amount of revenue brought in. If it costs too much to collect taxes, it can reduce the net benefit to the government and society.
In some advanced countries like New Zealand, the tax collection system is known for its efficiency. The New Zealand Inland Revenue Department uses a mix of technology, clear communication, and fairness to keep costs low while maximizing revenue.
Despite the costs, effective tax collection is essential. It funds everything from hospitals and schools to roads and social welfare. More importantly, when people see taxes are collected fairly and efficiently, they are more likely to comply voluntarily. This voluntary compliance reduces enforcement costs and helps build trust between the government and citizens.
Tax authorities face ongoing challenges such as tax evasion, avoidance, and the complexity of tax laws. Educating taxpayers and simplifying tax processes are crucial steps in overcoming these problems. Not only is the transparency and fairness of tax law essential, but equally important is the way these principles are manifested in practice, as both are crucial for fostering taxpayer compliance and public trust. Therefore, we’ll look at recent cases of tax evasion and what they mean for Sri Lanka.
Why Fairness Matters
When it comes to taxes, fairness is one of the most important concerns for citizens. People want to know that everyone pays their fair share — and that the rules apply equally to all. But what exactly does fairness mean in taxation, and why does it matter?
A tax system is fair when it treats taxpayers equally and applies the law consistently. Fairness builds trust between the public and the government. When people believe the tax system is fair, they are more willing to pay their taxes voluntarily. On the other hand, if they think others are cheating or getting special treatment, compliance drops, and the government loses revenue.
Tax Evasion vs. Tax Avoidance
Many people confuse tax evasion with tax avoidance. Tax evasion is illegal — it means deliberately hiding income or falsifying information to pay less tax. Tax avoidance, on the other hand, uses legal methods to reduce tax liability, often by exploiting loopholes, treated as a legal way of “tax avoidance”, unethical though.
Until recently, Sri Lanka considered tax avoidance legal, while evasion was punishable by law. However, countries like New Zealand never treated aggressive tax avoidance as legal, closing loopholes through laws like the General Anti-Avoidance Rule (GAAR) to ensure fairness.
Recent Cases Highlighting the Importance of Fairness
Sri Lanka has witnessed a rise in high-profile tax evasion cases, underscoring the need for stronger enforcement mechanisms and clear legal frameworks to uphold fairness and protect compliant taxpayers. Notable cases include Randeniya Distilleries, fined Rs. 1.35 billion for deliberate tax avoidance, and W.M. Mendis & Co. Ltd., held liable for Rs. 3.55 billion in unpaid taxes, highlighting institutional efforts to curb evasion. However, the current campaign lacks robust enforcement strategies, risking reduced credibility if legal consequences are not consistently applied.
In contrast, New Zealand’s Inland Revenue Department exemplifies a balanced approach by integrating education with data-driven enforcement. Key legal precedents, such as Frucor Suntory (2022) and Penny and Hooper (2011), reaffirm the courts’ stance against tax avoidance schemes that undermine the intent of tax law. These cases demonstrate how transparent laws, and credible enforcement can foster compliance and trust in the tax system.
These cases illustrate New Zealand’s robust legal framework that deters tax avoidance through clear jurisprudence and the application of General Anti-Avoidance Rules (GAAR).
Learning from New Zealand
New Zealand’s tax system is often praised for its transparent, fair approach. The Inland Revenue Department takes a firm stance against both evasion and aggressive avoidance. Public education and consistent enforcement have helped maintain a high level of compliance and trust.
To improve tax fairness, Sri Lanka needs to update laws, increase transparency, and enhance taxpayer education. Fair application of tax law not only boosts revenue but also strengthens public confidence in the system.
The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the official policy or position of the institution he works for. He can be contacted at saliya.a@slit.lk and www.researcher.com)
Features
A glimpse into future cholesterol control: A time without daily pills perhaps?

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka. Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
For millions of people worldwide, the daily ritual of taking a statin or other drugs to manage cholesterol levels is a fact of life. These powerful medications have dramatically reduced the risk of heart attacks and strokes, thereby transforming cardiovascular healthcare. However, the hassle of having to take these medicines every day is a cumbersome infringement on life itself.
Now, imagine a future where the burden of daily pills for this purpose could be replaced by a single, or at most, a few injections per year. This is NOT science fiction; it is the audacious goal of a new frontier in medicine, with revolutionary drugs currently undergoing rigorous clinical trials. These cutting-edge therapies are designed to act directly in the liver, targeting the very genetic instructions or enzymes responsible for producing “bad” cholesterol, potentially offering a more profound and long-lasting solution than ever before.
This appears to be the dawn of a new era with medicines that employ gene-silencing and enzyme-neutralisation techniques. The excitement surrounding these new treatments stems from their innovative approaches. Unlike traditional statins, which work by blocking an enzyme involved in cholesterol production, these newer drugs go further upstream, interfering with the body’s internal machinery that regulates cholesterol at a more fundamental level.
Two primary classes of these emerging therapies are making waves at present:
1. PCSK9 Inhibitors: A Deeper Dive
There are a few currently approved drugs that inhibit PCSK9 gene. But they require injections every two to four weeks. These antibody-based drugs work by binding to and neutralising a protein called PCSK9 (Proprotein Convertase Subtilisin/Kexin type 9), which acts like a “destroyer” of LDL receptors on the surface of liver cells. These LDL receptors are crucial for grabbing “bad” LDL cholesterol from the bloodstream and bringing it into the liver for processing and removal. By blocking PCSK9, these inhibitors allow more LDL receptors to remain active on liver cells, significantly boosting the liver’s capacity to clear LDL cholesterol from the blood.
The truly groundbreaking development now is a group of medicines that aim to permanently or durably turn off the PCSK9 gene itself. Instead of needing regular injections to block the protein, a single treatment could, in theory, silence the gene that produces it, offering a lifelong reduction in cholesterol.
One such investigational drug is VERVE-102, developed by Verve Therapeutics. This is designed to be a single-course treatment. It uses a modified technology to make a precise “edit” to the PCSK9 gene in liver cells, effectively switching it off. Early data from clinical trials have shown promising results, with participants achieving significant reductions in LDL cholesterol. For instance, in one cohort, a mean LDL-C reduction of 53% was observed, with a maximum reduction of 69% in a single participant. The long-term durability of this effect is what truly excites researchers, with the hope that such a treatment could eliminate the need for ongoing regular daily medication.
2. ANGPTL3 Inhibitors: A Different Angle
Another fascinating target is the angiopoietin-like protein 3 (ANGPTL3). This protein, primarily secreted by the liver, acts as an inhibitor of two key enzymes: lipoprotein lipase (LPL) and endothelial lipase (EL). These lipases are essential for breaking down triglycerides and processing lipoproteins, including LDL cholesterol. When ANGPTL3 is inhibited, LPL and EL become more active, leading to a reduction in triglycerides, LDL cholesterol, and even HDL cholesterol.
A monoclonal antibody drug called Evinacumab (Evkeeza) is an example of an ANGPTL3 inhibitor already approved for a rare genetic condition called homozygous familial hypercholesterolemia (HoFH), requiring monthly intravenous infusions. However, research is ongoing into one-time or infrequent dose ANGPTL3-targeting therapies, potentially using gene-silencing technologies similar to those for PCSK9. Some of these medicines have shown significant reductions in ANGPTL3 and various atherogenic lipoproteins in preclinical and early human studies with a single dose.
It is absolutely vital to reiterate that these revolutionary treatments are still in various stages of clinical trials. These trials are meticulously structured processes designed to ensure that any new medication is both safe and effective before it can be made available to the public. Before human trials begin, new treatments are extensively tested in laboratories and on animals to assess their basic safety and potential efficacy. Then come Phase 1 Trials, which are the first human tests, typically involving a small group of healthy volunteers (around 20-100 people) or patients with the condition. The primary goal is to assess the drug’s safety, determine a safe dosage range, and identify common side effects. For gene-editing therapies, these initial phases are particularly critical to monitor for any unintended genetic changes or off-target effects.
Then, Phase 2 Trials follow. If a drug proves to be safe in Phase 1, it moves to Phase 2, involving a larger group of patients (typically 100-300) who have the specific condition the drug aims to treat. The focus here is to evaluate the drug’s effectiveness and continue monitoring for side effects. Researchers fine-tune dosages and study how the drug impacts the disease.
Then it graduates to Phase 3 Trial. This is the most extensive and crucial phase, involving hundreds to thousands of patients over several years, often across multiple international sites. In Phase 3, the new treatment is compared against existing standard-of-care treatments or a placebo (an inactive substance) to confirm its efficacy and safety on a larger scale. This phase generates the robust data needed for regulatory approval.
The final stage are Phase 4 Trials. Even after a drug receives approval and enters the market, Phase 4 trials continue. These are post-marketing surveillance studies that monitor the drug’s long-term effects, identify any rare side effects that may not have appeared in smaller trials, and explore new uses or populations.
For gene-editing therapies like VERVE-102, the journey through these phases is even more closely scrutinised due to the permanent nature of the genetic changes they induce. While early results are exciting, only successful completion of large-scale Phase 3 trials and ongoing Phase 4 monitoring will fully confirm their long-term safety and effectiveness. Companies like Verve Therapeutics are planning to move into Phase 2 trials for VERVE-102 in the second half of 2025, a significant step forward.
Will all these new developments lead to an “Economic Earthquake” and a Shake-Up for the Pharmaceutical Industry? The potential advent of one-time or very infrequent cholesterol treatments carries enormous implications, not just for patients but also for the multi-billion-dollar pharmaceutical industry.
Statins have been one of the most successful drug classes in history, generating immense revenues for pharmaceutical companies over decades, the so-called Statin Empire.. They are widely prescribed, often for life, creating a consistent market. The prospect of a single-dose cure could, in the long run, significantly shrink this market.
Developing gene-editing therapies and complex biologic drugs like these new cholesterol treatments is incredibly expensive, requiring massive investments in research, development, and clinical trials. To recoup these costs and generate profit, these drugs are expected to command extremely high prices, at least initially. Existing PCSK9 inhibitors, for example, were initially priced around $14,000 per year, though costs have since decreased. A one-time gene-editing therapy could potentially run into hundreds of thousands of dollars per patient.
Healthcare systems and insurance providers will face a monumental challenge in determining how to pay for such expensive, high-impact treatments. While a one-time treatment might be cost-effective over a patient’s lifetime compared to decades of daily pills, the upfront cost can be a major barrier. This could lead to intense negotiations between pharmaceutical companies and payers, and potentially restricted access for patients.
Pharmaceutical companies that have historically relied on chronic, daily medications might need to undertake a pivotal change in their business strategies. The focus could shift from high-volume sales of inexpensive pills to lower-volume, high-value, transformative gene therapies. This requires different manufacturing capabilities, distribution networks, and marketing approaches and most importantly, are likely to be very expensive.
Beyond the economics, the high cost raises significant ethical questions about equitable access. Will these life-changing therapies only be available to those with comprehensive insurance or significant financial resources, creating a two-tiered system of care? This is a critical societal discussion that will undoubtedly unfold as these drugs get closer to the perennial drug market.
Epilogue
This author believes that our attitude to all these promulgations will need to be one of “Hope on the Horizon, Caution in the Present”. The research into one-time cholesterol-lowering injections is undeniably thrilling. The idea of a treatment that could potentially offer lifelong protection against cardiovascular disease with minimal ongoing effort is a medical dream. They would represent a paradigm shift in how we approach chronic diseases, moving from symptom management to root-cause intervention through genetic or enzymatic targeting.
However, it is paramount and absolutely vital for the public to understand that this future is not here, not as yet. These drugs are still experimental, undergoing rigorous scrutiny in clinical trials to ensure their safety and efficacy over the long term. While the early data is highly encouraging, the full picture of their benefits, potential risks, and accessibility will only become clear in the coming years.
For now, the message remains consistent. Work closely with your healthcare provider to manage your cholesterol, using established, approved therapies and healthy lifestyle choices. But keep an eye on the horizon: the landscape of cholesterol treatment is on the cusp of a truly revolutionary transformation.
This article was written with some
assistance from Artificial Intelligence.
Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Features
UN’s challenge of selective accountability without international equity

Despite the prevalence of double standards in international practice, it remains in Sri Lanka’s national interest to support the principles and implementation of international law. The existence of international law, however weak, offers some level of protection that smaller countries have when faced with the predatory behaviour of more powerful states. For this reason, the Sri Lankan government must do all it can to uphold its prior commitments to the UN Human Rights Council and implement the promises it has made to the fullest extent possible.
The visit of UN High Commissioner for Human Rights, Volker Türk, later this month may possibly be overshadowed by the eruption of hostilities in the Middle East following Israel’s attack on Iran. The High Commissioner’s visit to Sri Lanka relates to the series of resolutions passed by the UN Human Rights Council over the past sixteen years since the end of the war. It will highlight the contradiction in the rules-based international order when geopolitical interests override legal commitments. These resolutions highlight the importance of protecting human rights during times of conflict and ensuring accountability for war crimes. They are part of the enduring legacy of international human rights and humanitarian law, as exemplified by the Geneva Conventions and the global post-war consensus that atrocity crimes should not go unpunished.
The High Commissioner’s visit is likely to provoke criticism that the United Nations is pursuing Sri Lanka’s adherence to international norms with greater zeal than it shows toward violations by more powerful countries. There appears to be acquiescence, indeed even tacit approval, by influential states in response to Israel’s military actions in both Iran and Gaza on the grounds of existential threats to Israel. Similar military actions were taken in 2003 by the US and the UK governments, among other international powers, to destroy weapons of mass destruction alleged to be in Iraq. One of the central arguments made by critics of the UN’s engagement in Sri Lanka is that double standards are at play. These critics contend that the United Nations disproportionately targets weaker countries, thereby reinforcing an international system that turns a blind eye to powerful countries and, in doing so, undermines the credibility and coherence of global human rights standards.
The arrival of the High Commissioner is also likely to reignite internal debate in Sri Lanka about the purpose and legitimacy of UN involvement in the country. The question is whether international standards effectively contribute to national transformation, or do they risk being reduced to symbolic gestures that satisfy external scrutiny without generating substantive change. There will be those who regard international engagement as a necessary corrective to domestic failings, and others who see it as an infringement on national sovereignty. The question of accountability for war crimes committed during the three-decade-long civil war remains a deeply divisive and sensitive issue. Sri Lanka, with its own complex and painful history, has the opportunity to lead by example by reckoning with the past unlike many other countries who justify their atrocities under the veil of national security.
International Breakdown
The modern international system emerged in the wake of two catastrophic world wars and the recognised failure of early twentieth-century diplomacy to prevent mass violence. At its core was a collective pledge to establish a rules-based international order that could maintain peace through law, institutional cooperation, and multilateral governance. The development of international human rights and humanitarian law was most pronounced in the aftermath of the mass atrocities and immense human suffering of World War II. The powerful nations of the time resolved to lead a new global order in which such horrors would never be repeated.
This vision of a rules-based international order as a safeguard against a return to the law of the jungle, where power alone determined justice was institutionalised through the United Nations, the Geneva Conventions, and the establishment of international courts such as the International Court of Justice and the International Criminal Court. However, this international system has come under increasing strain in recent decades. Recent events show that it no longer functions as originally envisioned. In practice, the consistent application of international law, regardless of the status or power of a state, is frequently compromised. The selective enforcement of legal norms, particularly by powerful countries, has eroded the legitimacy of the system and calls into question the universalism at the heart of international law.
At present, at least three major international conflicts taking place in Ukraine, Gaza, and now the confrontation between Israel and Iran, illustrate a sustained breakdown in the enforcement of international legal norms. These conflicts involve powerful states that openly defy legal obligations, with the international community, especially its more influential members, often remaining conspicuously silent. Only a handful of countries, such as South Africa, have chosen to raise issues of international law violations in these conflicts. The broader silence or selective rationalisation by powerful countries has only reinforced the perception that international law is subject to political convenience, and that its authority can be subordinated to geopolitical calculation. Earlier examples would include the ruination of prosperous countries such as Iraq, Libya and Syria.
Uphold Consistency
The Sri Lankan situation illustrates the importance of preserving an international legal system with mechanisms for credible and impartial accountability. Sri Lanka, so far, has been unable to address the issues of accountability for serious war-time human rights violations through internal mechanisms. However, the broader lesson from Sri Lanka’s experience is that international norms ought not to be applied selectively. If global institutions aspire to uphold justice by holding smaller or less powerful countries accountable, they must apply the same standards to powerful states, including Israel, Russia, and the United States. Failing to do so risks creating the perception that the international legal system is an instrument of coercion and selective punishment rather than a foundation for equitable global justice.
Despite the prevalence of double standards in international practice, it remains in Sri Lanka’s national interest to support the principles and implementation of international law. The existence of international law, however weak, offers some level of protection that smaller countries have when faced with the predatory behaviour of more powerful states. For this reason, the Sri Lankan government must do all it can to uphold its prior commitments to the UN Human Rights Council and implement the promises it has made to the fullest extent possible. In multilateral forums, including the UN, Sri Lanka must reassert these commitments as strategic assets that help to defend its sovereignty and legitimacy. At the same time, Sri Lanka needs to take up the challenge of using these international platforms to highlight the problem of selective enforcement. Sri Lanka can contribute to the broader call for a more principled and consistent application of international law by demonstrating its seriousness in protecting vulnerable populations and position itself as a responsible and principled actor in the international community.
Engaging with the past in accordance with international standards is also essential for Sri Lanka’s internal reconciliation and social cohesion. The principles of transitional justice—truth, accountability, reparations, and institutional reform—are not only universally applicable but also critical to the long-term development of any post-conflict society. These principles apply across all contexts and periods. If Sri Lanka is to evolve into a united, stable, and prosperous country, it must undertake this process, regardless of what other countries do or fail to do. Only by acknowledging and addressing its own past can Sri Lanka build a future in which its multi-ethnic and multi-religious character becomes a source of strength rather than weakness.
by Jehan Perera
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