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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

Reminiscences of Colombo University Arts Faculty and Library

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Whilst extending my felicitations to the University of Colombo on the centenary celebrations of the Faculty of Arts and the Library of the University, I would like to record my contribution towards these two units as the Registrar of the University.

It was during Prof. Stanley Wijesundera’s tenure as the Vice-Chancellor (VC) in 1980 that the proposals for the buildings in respect of the Chemistry Department, Physics Department, New Administration, Faculty of Law, Faculty of Arts and the Library were mooted and submitted to the Treasury. At that time it was the National Buildings Consortium that assigned the Consultants and the Contractors for the new buildings to be constructed. Within that year the Treasury allocated sufficient funds for the Chemistry, Physics, Faculty of Law and the New Administration buildings. However, no funds were allocated to the Faculty of Arts and only Rs. 7.5 million was allocated for the Library building.

With the funds allocated the Chemistry, Physics, Law Faculty and the new Administration buildings were able to get off the ground. The construction work in respect of the other two buildings could not commence due to non-allocation of sufficient funds, even though the consultants and the contractors and already been selected.

As the Minister of Finance at that time was from Matara, he was more interested in getting the required buildings for the newly established University of Ruhuna completed, which was in his electorate. This meant that the University of Colombo would not get any funds for new buildings other than those buildings where the construction work had already begun.

The university needed a building for the Faculty of Arts very badly as this Faculty had the largest number of students. The Vice-Chancellor requested me to draft a letter to the Minister of Finance. Accordingly, I drafted a letter and submitted to the VC for his signature. He told it was an excellent letter, and he signed without a single amendment and submitted same to the Minister. The Minister approved the releasing of the funds. Now the consultants to the building project studied the area required for the building and found that a small portion of land was necessary from the land of the Planetarium. My efforts to get the land from the person in charge of the Planetarium, the Senior Assistant Secretary and the Secretary himself were not fruitful. I told the VC of the position and that he would have to speak to the Minister in charge of the Planetarium, Mr. Lionel Jayathilaka. He got the Minister on line and addressing him by his first name and informed the Minister of the problem. The Minister immediately got it attended to. However, when the construction work started, they found that the additional land area was not necessary.

At that time, the payments to the consultants of building projects was 15% of the total value of the cost. So, in designing the building they tried to add various unnecessary items to jack up the cost. When the first phase was completed, the building looked monstrous and it was like a maze, as it was difficult to find your way out once you get in. I requested the architect to add some coloured tiles on the floors and the stairway and a few decorations on the walls. The university had a never ending tussle with the contractor as he was like Shylock asking for more, when everything had been paid. He tried various tactics but did not succeed in getting anything more as I was adamant not to give in.

When the second stage of the building project came up, I told the consultant to drop all the unnecessary items and have a straight forward building. This was done by the new contractor at much less cost to the university.

The Library building was the last of the buildings planned in 1980 that was awaiting construction. When Mr. Richard Pathirana became the Minister of Higher Education, I spoke to the two engineers who were assigned the task of supervising the building projects of the universities, and managed to get the funds passed by the Treasury for the construction of the Library building. When the Minister came on a visit to the university, he told me that the building that should have been done for Rs.7.5 million will cost Rs.253 million. I told him that the Treasury never gave any money after approving the initial funding of Rs.7.5 million. Anyway, I had achieved what I wanted to do and the building was successfully completed. Now the furniture for the Library had to be procured. When quotations were called the suucessful tenderer had brought a sample of the study tables. I rejected this as it was inferior to what I wanted and asked the officer concerned to get the design of the furniture from the library in the University of Peradeniya. This was done and the furniture was installed. The official opening of the new Library was arranged. By that time I had retired from the position of Registrar and was the Director of the Institute of Workers’ Education. Even though I was instrumental in getting the building done, I was not invited for the function. That is gratitude!!

 

H M Nissanka Warakaulle

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Opinion

Ali Sabry bashing

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Justice Minister Ali Sabry has appealed to his critics to spare him from the criticism that he was behind the calling of applications for the appointment of Quazis for Quazi Courts (The Island/23.01.2021). In my view, the allegations levelled against Justice Minister Ali Sabry are unfounded and uneducated. If you are an educated and unbiased citizen of this country, you’ll understand it better. The applications for Quazis for Quazi Courts have been called by the Judicial Service Commission, an independent Commission chaired by the Chief Justice of this country. If you aren’t happy with this decision, you have to take it up with the Chief Justice, not the Justice Minister. He has no control at all over the Judicial Service Commission. In a way, criticising that Justice Minister influenced the Judicial Service Commission, chaired by the Chief Justice, tantamounts to contempt of the Supreme Court. Moreover, Quazi Courts have been in existence for well over 70 years, and it hasn’t affected the Sinhalese or the Tamils nor has it been incompatible with the common law of this country. If there is any serious discrepancy, it can be rectified. But I wonder why the calling of applications for Quazis has now become an issue. I also wonder if the removal of Quazi Courts was promised as a part of the subtle 69 mandate. This is not the first time similar allegations have been made. When Rauf Hakeem was Justice Minister, Member of Parliament Pattali Champika Ranawaka  made serious allegations that more Muslim students were admitted to the Law College and led many protests and ultimately a group of monks stormed the Law College in protest. He had charged that Law College entrance exam papers were leaked and criticised the then Justice Minister Rauf Hakeem for it. He  knew very well that Law College came under the Council of Legal Education chaired by the Chief Justice and  Attorney General and two other Supreme Court judges among others were  members of this Council, yet he had made these allegations with a different motive. Amidst international outcry, Muslim Covid victims have been denied burial. To make the situation worse, some vindictive, venomous elements are now trying to create another bad scenario that Muslims can’t marry either according to their faith, and tarnish the image of this country internationally and drive a wedge between communities. Therefore I earnestly ask the law abiding and peace loving citizens of this country to work against these vindictive, venomous elements.  

 

M. A. Kaleel 

Kalmunai. 

 

 

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Opinion

What do Northern political parties seek?

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Political parties, based in the North, are reported to be getting prepared to attend the UNHRC sessions next month. For several decades, the only thing they did for their constituents is to spread feelings of hate among them, against the government and the people living in the South. Today, we have two important issues where India is involved – re. the Colombo Harbour and the death of four fishermen. There is another perennial issue of Indians fishing in our waters. Have these parties uttered a single word on those matters? What do they expect to gain, or achieve for the Northerners, even if they could prove SL war crimes allegations at the UNHRC? Can they honestly say that they were not a party to the LTTE and other terrorist outfits which looted, tortured and killed hundred or thousands of civilians, both in the North and the South?

Other than shouting about the rights of their people, have they done anything for the wellbeing of the people in those areas? Whatever was given to the people were those given by the Government on a national basis. Excellent example is the conduct of C V Wigneswaran, who held the high position of Chief Minister of the Northern Province for five years – had he done any significant service for the people? Those parties never complain about India for the killings, torturing and raping done by the IPKF, or the damage and loss due to the activities of Indian fishermen.

India too overlooks all that, and to keep Tamil Nadu happy, forces the SL government to grant whatever the Northern Parties demand.

 

K SIRIWEERA

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