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Safety issue of ‘traditional’ and ‘complementary’ medicines

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By CHANDRE DHARMAWARDANA

Every country has a lore of “traditional medicine” in addition to the mainstream medical system, which today is based on a rigorous system of institutionalized medical education based on science. Even the WHO has recently recognized and attempted to give formal structure to such Traditional and Complementary (T&C) systems of medicine (see: https://apps.who.int/iris/handle/10665/312342;jsessionid=4ADD7EEB300760DC10D0C42745ABDC31).

Thus, the WHO defines “traditional medicine” as:

“The sum total of knowledge and practices, whether explicable or not, used in diagnosing, preventing or eliminating physical, mental and social diseases. This knowledge or practice may rely exclusively on past experience and observation handed down orally or in writing from generation to generation. These practices are native to the country in which they are practiced. The majority of indigenous traditional medicine has been practised at the primary healthcare level”.

Traditional medicine, and other so-called complementary systems of medicines, tend to be far less institutionalized, with the methods of treatment traditionally handed down from a teacher to a student, who becomes part of the teacher’s “family”. This is the “guru-kula” system, where the teaching is retained as a family secret and handed down. Nevertheless, as these systems progressed and received state patronage, institutionalization and open publication of medical practices began to appear. The Mahavansa alludes to hospitals even for animals in ancient Lanka. In India, too, Sanskrit texts like the Charaka Samhitha and the Sushrutha Samhitha of Ayurveda, record the level of surgery as well as methods of treatment available to the ancients.

Nevertheless, every physician was supposed to keep his/her “Guru-mushti” (what the teacher holds in his fist), i.e. secret knowledge that the teacher revealed to the pupil, only at his deathbed. They claim that such medical practices have been confirmed by use “down the ages”, and the epithets “prathyaksha” in Sanskrit, and “ath-dutu” in Sinhala are often used to indicate safe and “well tested” medications.

No record keeping of the treatment and their outcomes, adverse effects, etc., were practised until the rise of modern medicine. Hence the claim that these preparations are “ath-dutu”, or “prathyaksha” is unjustified. Case histories that can be scrutinized by independent investigators are lacking.

Even today, when individuals propose “new” treatments for Covid-19, they make claims that the treatment is based on “ath-dutu” ancient herbal lists ,etc., as if that is all there is to it. Others, e.g., the “Hela Suvaya” team, claim that their herbal prescriptions are guided by God Natha. When a person from Hettimulla, Kegalle claimed to have created a Covid-19 treatment, to be given “free”, it attracted massive crowds! Supporters even question the need for double-blind clinical tests or chemical analysis of the new product. Politicians rush to swallow the medicine in public, while the educated public can only groan in silence.

The traditional medicine that existed in Europe in medieval times, prior to the rise of modern scientific medicine, included traditional medicine from Indian, Greek and Arab sources, together with alchemy, which was the search for a means of transforming lead into gold. Many alchemists were also medical physicians who kept their medical as well as alchemical knowledge secret.

The rise of modern scientific medicine can be attributed to the recognition, during the renaissance, that secrecy must be replaced by openness and sharing of experience to ensure objectivity. It was recognized that one’s own observations or once own experiences can be highly unreliable. How one feels, or what one sees, depends on many factors besides the level of alcohol in the blood!

Learned societies like the Royal Society (November,1660) were created for open discussion and public proof. A claimant of a “new discovery” has to reveal all details in public, at a meeting of the learned society. The tradition of holding onto “secret knowledge” or “Guru-Mushti” was thrown out. Record keeping, use of quantitative data, and repeating the experiment or test in front of everybody were key features of the methods of empirical science put into practice by the Royal Society.

So, all claimants of “new” Ayurvedic or Traditional cures for Covid (or Dengue) must release carefully recorded case histories that the claimant can use to prove that there is a preliminary case for what is claimed. It is not enough to make claims of “paran-paraa-gatha vattoruvak” (herbal list handed down from generation to generation). The quality of the herbs used must be recorded, and weighed ingredients must be indicated in grams rather than in terms of some traditional ambiguous unit. A medical body should examine the case histories and decide if there is a case for undertaking further confirmatory studies. That is, bogus claims must be eliminated at the outset. In the scientific method, any claim has to be independently verified by repeating the process, using the same prescribed medications.

Purity and consumer protection are very important and unfortunately lacking in many T&C medications (See https://dh-web.org/place.names/bot2sinhala.html#herbal). Chemical analyses of commercial Ayurvedic preparations have revealed toxic ingredients like Lead (Pb), mercury (Hg), harmful alcohols like methanol, propanols, and other ingredients, as well as extreme variation in amounts of active ingredients. Some contain admixture of potent western drugs although this is illegal. So chemical analysis of proposed T&C drugs is necessary for consumer protection.

An attractive but dangerous feature of T&C medical systems is that they can become “personal health prescriptions” (PHP) that an individual may administer without going to a physician. Modern mega-Vitamin therapies are also PHPs from “complementary” or “alternative” medicine. They become “home remedies” that people swear on, although they may not have kept records of how the PHP worked for them. Patients lack the equipment and laboratory facilities to monitor their condition. In effect, a PHP is a herbal prescription, or the use of some exotic root, fruit or “Vitamin”, without a proper case record, evolved by oneself, or “given” by a “trusted Vaidya” or medical savant. The PHP may have been adopted from some old book or an “ola-leaf” record.

St. Jerome who lived to a very ripe age in the 4th century had his own PHP for good health.

“From his 31st to 35th year he had for food six ounces of barley bread, and vegetables slightly cooked without oil. But finding that his eyes were growing dim, and that his whole body was shriveled with an eruption and a sort of stony roughness he added oil to his former food, and up to the 63 rd year of his life followed this temperate course, tasting neither fruit nor pulse, nor anything whatsoever besides”.

Today, no one would recommend such a diet free of fruits and pulses, and yet, for many centuries, many Christian monks followed St Jerome’s diet claiming it to be a “proven” healthy diet.

In India, Vagabhatta and Nagarjuna were two great teachers who prescribed the use of “Rasaindur”, which turns out to be mercury sulfide. Although these authors prescribed many such metals in their “Rasha-shasthra”, today we recognize them to be toxic and dangerous to health if ingested even at a few parts per million. The Sanskrit text “Rasatarangani” prescribes preparations containing lead, mercury, gold, silver and many other metals which are cooked with lime and herbal juices (e..g, from Nuga, the banyan tree). Well known Ayurvedic texts like the Charaka Samhitha and the Sushrutha Samhitha recommend preparations containing substances now recognized to be toxic. So the “Rishis” failed to notice the toxic effects, probably because there was no recording of case histories and studying them objectively.

Unfortunately many T&C medications are taken over by individuals who transform them into personal health prescriptions (PHPs), without the knowledge to adequately control the quantities used. For instance, “polpala” (Aerva lanata) may be taken as a herbal tea but frequent use may have serious adverse effects on the urinary tract. Similarly, individuals may use “Thebu” (Costus igneus) to control blood sugar, but end up with hypoglycemia and other side effects.

In an earlier epoch, people used to relieve their bowls in their own backyards, near paddy fields (or on the beach!). Hook worm and other intestinal-parasite infections became common as people also walked barefoot in the same land area, or in the fields. Thus there was also a tradition of taking a purge, containing mainly Aralu (Terminalia chebula) at least every six months. This was “a good health practice” recommended by T&C medicine. However, as this was administered as a home remedy, the amount of “aralu” was never properly controlled, leading to dangerous purging in some cases, and no effect in other cases. Furthermore, the purge has little effect on hookworms and such parasites, but it dangerously disturbs the gut microbiome of the person taking the purge.

So, in conclusion, at least the following steps are needed to make T&C medicine safe:

1. Every new claim must be supported by well recorded certified case histories and clinical records that are needed to justify further trials.

2. The prescription must quantitatively specify the full formulation and be subject to a chemical analysis to ensure that no known toxins are contained in the product.

3. Marketing of the product must be done ensuring product-uniformity and product standards to ensure consumer protection.

4. T&C medications must NOT be adopted as home remedies as self-medication is always dangerous.



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Opinion

Senator A. Ratnayake: An appreciation

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A. Ratnayake

It is with great pride that I write to commemorate the 47th death anniversary of a distinguished patriot of Sri Lanka, the late Senator A. Ratnayake – Cabinet Minister of Food and Cooperatives, Minister of Home Affairs in the post independent Ceylon (now Sri Lanka) and the last President of the Senate.

Son of P.B. Ratnayake, a stalwart of the Kandy Temperance Movement and Mrs Dingiri Amma Ratnayake. Educated at Dharmaraja College, Kandy and Royal College, Colombo, he entered Ceylon University College and obtained BA (London) degree. Thereafter Mr. Ratnayake started teaching at Ananda College and in 1924 was appointed by the late Anagarika Dharmapala as the Principal of Mahabodhi College. Subsequently he studied law and qualified as an Advocate in 1931. His first love, however, was politics. For 40 years he represented the Dumbara electorate in the first and second State Councils of Ceylon and Wattegama seat in the First Parliament of Ceylon in 1948.

It was Mr. Ratnayake as a member of the Special Committee on Education in the State Council, who introduced a motion that education should be free from Kindergarten to University for all. Though there were many obstacles, Mr. Ratnayake was instrumental in persuading the special committee to implement his proposals on Free Education for All.

In 1947 Mr. Ratnayake became the First Minister of Food and Cooperatives in the post independent Cabinet. He developed the Cooperative Movement which he advocated to be managed by the people. He inaugurated the Cooperative Federal Bank, which later became Peoples Bank, providing credit to rural folk who otherwise had to depend on money lenders.

Under Prime Minister Sir John Kotalawela, he was the Minister of Home Affairs. It was then that Mr. Ratnayake proposed to the government to commemorate 2,500 years of Buddha Parinibbana in 1952 a promise he made to his mentor, the late Anagarika Dharmapala. The translation of the Tripitaka to Sinhala, an encyclopedia on Buddhism in English and the restoration of the Dalada Maligawa were all carried out during his period as the Minister of Home Affairs.

It is imperative that the younger generation know the achievements of Mr Ratnayake, his determination to provide education for all from kindergarten to university which has benefitted generations of Sri Lankans and continues to do so today. In addition, his contributions to uplift religion, language and culture in the post independent era is worthy of recognition.

I have no doubt when the history of this period is written, the name of A Ratnayake will be written in golden letters as a true patriotic son Sri Lanka.

Maneesha Seneviratne
Attorney at Law

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Opinion

Mrs Hemamali Kanthi Jayasinghe

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Mrs. Hemamali Kanthi Jayasinghe known by all her friends and relations lovingly as ‘Bunchi’, left us on August 20, 2024, leaving an unfillable void for her husband Lal, daughter Chanika and grandchildren Isurika and Pavith. I know from Bunchi’s narratives related to me of their success stories in Australia. her grand- children Isurika and Pavith had a special place in her heart. This is natural, and as should be.

Bunchi was a rare individual who left a void in all groups whom she came across in life- both among her friends and relations. It was especially true for her sister-in-law and family, her aunts, cousins and their spouses. Bunchi and Lal were a couple who never abandoned their cousins in good times or bad. The two of them were all-weather relations. She had an open house for her friends and relations, and a sympathetic heart that inwardly motivated her to be helpful to others.

We live in Kelaniya. Over the last so many years, whenever there was a public warning about floods in Kelaniya, like a prayer, a call would come from Bunchi- ‘Aiya if there is any threat of floods, both of you, please come and stay with us’; usually this invitation is also repeated by Lal. About four months ago, when a flood warning was issued to all major river basins, Bunchi even though sick, gave us a call followed by Lal, and invited us to come over to Kadawatha. Although she was ill and weak, she did not forget to offer help to others.

Lal was the family doctor for all families of Bunchi’s cousins and aunts. When a call came for help, if it was found to be medically necessary to visit, Bunchi always accompanied Lal to their relations’ homes. Lal looked into the medical side, while Bunchi’s concern and ‘recuperative words’ provided psychological help to the sick. So, in most instances it was the doctor accompanied by his wife, who came to the patient instead of the patient going to the doctor. The service was totally free.

I still vividly remember this day in, I guess 1984, I was getting ready to go to USA on official duty. Our elder daughter complained of a severe stomach ache. I phoned Lal who examined her and said that there was some tenderness, but asked me to go as planned and that even if surgery was needed, he would arrange everything including showing our daughter to a surgeon and following up. Bunchi told me ‘we will look after everything – you just go’. This was one instance of help that Bunchi and Lal did for us. It was a great responsibility that they decided to shoulder to help a cousin. And I know that some other cousins or relations of Bunchi can also relate such magnanimous instances of offering help.

Bunchi and Lal were well known among friends and relations for giving dinners at their Kadawatha home. Their home was well- equipped for such occasions. Her mother Irene who was also living at Bunchi’s (Irene ‘nanda’ to us) also helped in bringing out culinary delights.

I am bringing the above entertainment story in order to highlight another deep- seated side to Bunchi and Lal that was perhaps only known to their close relations and cousins. At the ‘Mathaka Vastra pinkama’ this was well articulated by the two Nayaka Theros who conducted the religious ceremony at her funeral. Bunchi and Lal were both religious and Bunchi helped Lal to continue with all the traditional ‘Pinkamas’ that Lal’s parents had been conducting for so many years. Bunchi also started new ‘Pinkamas’. And in these merit acquiring activities they involved their daughter and grandchildren and nephew and niece from their young days to inculcate in them the importance of spiritual reinforcement in addition to practicing their vocations.

It was heartening to note that Chanika and Lal (despite being handicapped without Bunchi’s support) continued to participate in the’ Katina pinkama’ of the Bimbaramaya Temple, Kadawatha, by preparing some items for the ‘dana’ at the ‘Katina Pinkama’. I believe there were about 70 bhikkhus at the alms-giving.

When they were at home, Bunchi and Lal would do the morning and evening ‘Buddha Puja’ and other worship without a break. Lal now continues with the tradition by himself.

However, they were also open to the modern world and its necessities and responsibilities. They were a very cosmopolitan couple; they had close friends belonging to all religious denominations, both in Sri Lanka and abroad. They kept in close contact with them. What they accomplished over a substantial period of time through their diverse relationships and hospitality, was an important sociological need for Sri Lanka- that is to go forward in unity while being diverse. Lal also worked for many years for NHS in UK, and both of them were happy to receive friends and relations from Sri Lanka at their Lincoln home. They decided to return home to be with their aging parents.

Another positive aspect of Lal and Bunchi was the sincere, helpful, and long-standing- relationship they had with their domestic aides. The domestic-aides in turn were strongly loyal to Bunchi and Lal.

Throughout Bunchi’s some-what long illness, Lal and Chanika looked after Bunchi with love and tenderness.

Hemamali Kanthi Jayasinghe was the daughter of the late Dr. Gilbert Gajanayaka and the late Mrs. Irene Munasinghe Gajanyaka. She was the sister of the late Mr. Gamini Gajanayaka.

May Bunchi attain the Supreme Bliss of Nibbana.

Lakshman Wickramasinghe

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Opinion

Significance of Tamil vote in 2024 general election

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Apart from the resounding victory by the NPP, the most significant election outcome is the remarkable change in the voting pattern of the Tamils in the North, the East, and the Central province not to mention Colombo that brought defeat to most of the Tamil political stalwarts like Sithatharan, Sumanthiran, Palani Thigambaram, Mano Ganeshan et al. This is the first time that such a change has happened in a general election where usually the ethnic political parties hold sway over minority votes. It is of vital importance for everybody including Tamil politicians, the present government, international community, hegemonic powers, ultra-nationalists and separatists to understand and correctly interpret this change in the Tamil political fabric.

The decisive factor that was apparent in the pre-election period was the need for a change which manifested in a weaker form at the presidential election that brought in a new president with 42% of the national vote with the majority of Tamils voting against the NPP candidate. In less than two months the whole picture had changed and a majority of Tamils who did not vote for the NPP at the presidential election took the unprecedented step of going against their own ethnic parties and voted for the NPP. Although it appears to be a sudden change of attitude obviously such changes on such a wide scale cannot happen overnight. The need for a system change must have been slowly and steadily growing in the minds of Tamils over a period of time, like it had in the Sinhalese. The latter was obviously weary of suffering under the governments of the two major political parties since independence. The former however had hitherto been loyal to their ethnic parties who pursued divisive communal politics appealing to the ultra-nationalist sentiments of the Tamils. What was the reason for the Tamils to change in this manner?

Presidential election may have shown the Tamils that the Sinhalese had decided to bring about a radical change. This would have been the cue for them to come out into the open and demonstrate the change that has been slowly taking place in their minds. The change that appeared to have taken place in less than two months was probably catalyzed in this manner.

Tamils suffered during the thirty-year war. It is probable that the new generation of Tamils have realised the futility of war and confrontation and decided to chart a different course and deviate from the main sociopolitical stream from the time of independence though there were times of convergence and cooperation albeit of short duration. Independence and universal franchise have driven a wedge between Sinhala and Tamil leaders which was rather unfortunate for they were together in the struggle for Independence. Tamil politicians enjoyed parity of political power and suddenly they realized that their privileged position was in danger due to universal franchise which would make them a minority in the parliament. They could not reconcile with the fact that they were representatives of a minority community. What is most unfortunate is that they could not see the opportunities that were there for them to play a vital role in the development of the whole country. The mistake the Tamil leaders committed at that time was to abandon the opportunity that was available to jointly participate in the central government and contribute to the development of not only the Tamils but also the whole country and instead choose the narrow parochial path of communal politics. This blunder has continued to plague the country and even caused the birth of terrorism and a bloody war.

These historical mistakes must have dawned on the new generation of Tamils who, like the Sinhalese want a change in their lives which could come with economic development rather than ultra-nationalist dogma. Further they may have realized the fact that Tamil ultra-nationalism was flawed, unjust, parochial and does not belong in the modern world. Communal barriers have to be breached to achieve connectivity, interaction and networking which are capable of opening new vistas in the modern electronic era. All communities who have made Sri Lanka their home must unite and develop their country. The absence of this unity may have been one of the reasons for the country to lag behind in economic development and finally end up being bankrupt which would have affected all communities alike. In this regard the Tamils have taken the first step and it is now up to the other communities to suitably respond.

The government must know that the Tamils have significantly contributed to their massive victory. The government must understand what these Tamils who have rejected their own political parties and leaders want. They, too, like the Sinhalese are affected by economic mismanagement and poverty. Their problems are same as those of the Sinhalese majority. All communities are in the same boat. Tamils have realised this truth and would want urgent attention to their immediate needs. Their nutrition, health and education should receive immediate and sufficient attention. Tamils have abandoned their own parties and embraced the governing party expecting urgent redress to their burning problems.

There is a lesson for the international community as well, especially for the imperialist western powers. The latter had made use of the lack of unity among the communities to destabilise the country in pursuance of their geo-political ambitions in the Indian Ocean region. The LTTE was a tool in their hands, and after the demise of its leader, other separatists moved in to fill the vacuum. The western powers must realise the futility of such policies in view of the radical changes taking place within the mind-set of the Tamils. Tamils may no longer see the Sinhalese as their oppressors and the Sinhalese may not harbour the fear that Tamils are demanding a separate country.

It is hoped that the time may come when the Tamils realise that the whole country belongs to all communities and it is their duty to participate in the development of the whole and not just the North and parts of the East. True Tamil national leaders may emerge who would want to share power at the centre rather than at the periphery and contribute to the governing of the whole country. It is hoped that this is the end of divisive communal politics and the beginning of a new era of unity and prosperity.

N. A. de S. Amaratunga

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