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Safety issue of ‘traditional’ and ‘complementary’ medicines




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:;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 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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Latest on IMF and debt restructuring- II



by Jayampathy Molligoda

Further to my article published in ‘The Island’ recently, IMF Executive board has just approved the EFF arrangement for Sri Lanka at its meeting held on 20th March ‘23. In the meantime, our Ministry of Finance and the Central Bank of Sri Lanka (CBSL) in consultation with the financial advisory group hired for negotiations have finalised the latest position of Sri Lanka’s Public Debt as at end 2022 just prior to commencement of debt restructuring negotiations with creditors. The financial advisory group, Lazard was hired by former President, Sri Lanka in May 2022, along with international lawyers Clifford Chance, to guide the government through the process of restructuring its debt, for which estimates range from $70- 90 billion. According to Reuter reports published last September ’22, Sri Lanka was expected to formally reach out to private creditors who hold about $15 billion in bonds. My understanding is ‘Lazards’ is now working on different permutations and combinations.

The purpose of this paper is to critically review the latest position on the debt restructuring negotiations, because various conditional requests and diverse views are being made by ISB bond holders, Bi -lateral creditors and other stakeholders. I hope our high powered ‘negotiators’ have the competence and commitment to seek ways of avoiding the adverse results stemming from the concerns expressed here that are likely to crop up in the debt restructuring process.

Latest conditional request from the group of bond shareholders:

Having perused the document uploaded to the Ministry of Finance (MOF website) recently, the total public debt stock has skyrocketed to US $ 83.6 Billion, which includes total foreign debt of US$ 45.6 billion and the local debt of 38 billion in US $ equivalent. The total debt as a % of GDP as stated in the above MOF doc is 128%.

Latest conditional request from the group of bond shareholders places a cap on domestic borrowing component in the overall gross financing need of the government budget @8.5%. And if the total deficit financing need is @ 13%, means a MINIMUM of 4.5% of foreign debt financing component. This places serious restriction to our earlier thinking of reducing the foreign borrowing component as well as indirectly places restrictions on earlier thinking of asking higher ‘haircut’ for foreign debt holders. Previously, there was no such requirement came from India and bilateral debt holders.

Resist touching banks’ domestic debt:

In the circumstances, my own view is we are reluctantly compelled to restructure local debt i.e.; TBs and, it’s inevitable that the local debt of US $ equivalent of 38 billion would also need to be taken into consideration for debt restructuring – otherwise there is no way of reducing the total public debt stock to the level that is required as per IMF conditions. This would create a serious issue for our ‘financial system stability’ and the deposit holders including pension funds are badly affected.

This cannot be allowed and therefore the government/MOF/CBSL/Lizards need to negotiate hard on this aspect. We need to convince through hard negotiations to try and get away without ‘haircuts for Treasury bills/bonds.

As far as Sri Lanka’s domestic debt is concerned, CBSL top officials view at that time was that they should be able to get away without ‘hair-cuts’. It could come in the form of re profiling debt, i.e., bundle up short term debt instruments to long term T Bonds and ask people to hold to Maturity-may be with a coupon payment; at least to be confined to CBSL debt, EPF plus ETF and Insurance holdings. They have to know fully resist touching banks’ domestic debt. Whether they can sell this to ISB and other debt holders is another matter.

‘Alternative economic approaches’ offered by eminent economists:

Having said all these negative narratives, my concern is whether we have any other viable and practical option as a solution except IMF supported programme? As stated in my article, former Chief Economist and Senior Vice President of the World Bank, and Nobel Prize winner, Joseph Stiglitz, has slammed the IMF for unleashing riots on nations the IMF is dealing with He has been a critique of IMF causing great damage to countries through the economic policies it has prescribed countries to follow, in order to qualify for IMF loans.

However, in my view, neither Stiglitz nor any other eminent economist has come out with a practical and alternative policy framework to overcome the most serious economic and financial crisis faced in the 75 years of Sri Lanka’s independence. Nevertheless, some contradictory views shared through ‘alternative economic approaches’ are that the only sustainable solution could have been based on domestic self- reliant effort supported by proper planning for accumulation, productivity growth and international competitiveness, supported where necessary by friendly nations. An eminent economist, having extensive knowledge on Federal Reserve banking/CB operations world over and development economics/finance has promptly responded to the writer that this question (alternative solution) should have been seriously considered before the decision to go for IMF assistance was taken and the pre-emptive declaration of the country’s debt default, but it is too late now. Social unrest is reaching the boiling point.

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Conflict resolution might be way out!



By Dr Laksiri Fernando

Sri Lankan crisis cannot be separated from the international crisis both in economic and political terms. This is a warning for the political leaders to resolve their differences and conflicts in an amicable manner. Holding (or not holding) of Local Government elections and the newly-introduced Advance Personal Income Tax (APIT) regime are the main contentious issues between the main political parties and their trade unions at present.

While there are only nine recognised parliamentary political parties in the Australian federal system, sixty-two political parties are recognised in the Sri Lankan parliamentary system giving rise to both superficial and unwarranted conflicts and competitions between them. As a result, there is no stability in the political party system. Where are the UNP, the SLFP, the Federal Party or the Ceylon Workers Congress today? All these main parties from the early years of independence have suffered crippling splits.

Conflicts and Conflicts

Intense political rivalries at the political party level are undoubtedly a reflection of the psychological mood and orientation of the public and the people. These rivalries are not uncommon to many other political systems including the developed democratic countries. France at present is one example while many parts of America have been inundated in this situation for a long time.

However, to my experience and observation, extreme politicisation and rivalries are much higher in the case of Sri Lanka. There has been a tendency among the people (both young and old) to look almost everything from a prism of politics. Even at social events or even family parties, mainly men, get involved in political debates. The drinking of liquor (excessively) at these occasions might be a contributing factor.

The world undoubtedly is going through a civilisational crisis. The war in Ukraine has become a mess and human disaster. The invasion by Russia was unwarranted even in terms security or prestige of its country. However, instead of resolving the conflict through peace and negotiations, the NATO countries and America have intensified the war through supplying arms and ammunition to Ukraine to continue a fight. The major failure has been on the part of the UN which has become hopeless in terms of conflict resolution and peace. There is a possibility of the war becoming a nuclear disaster.

This is not an isolated case. Humanity, civilisation, the so-called developed nations, and the UN have continuously failed to prevent war between Israel and Palestinians and many other wars and conflicts in the Middle East and Africa. These conflicts have given bad examples to many other developing countries like Sri Lanka, Myanmar, Pakistan, etc. Similar conflicts have continued in the Latin American nations. This is the civilisational crisis today. Although humans have developed in terms of science and technology, they have terribly failed in terms of human relations, justice, peace, and conflict resolution. This is also one reason for the natural disasters and environmental problems.

Facets of Economic Crisis

Sri Lanka should not be callous in addressing the present economic problems. The IMF does not have a magic wand while those who oppose the IMF are misled by old leftist arguments. Sri Lanka has been a member of the IMF since 1950. If there are disagreeable conditions from the IMF, those should be discussed and negotiated. I was surprised to observe that many international media reported that the last general strike in Sri Lanka was held in opposition to the IMF! While the trade unions undoubtedly have many grievances, they should sober their positions and slogans to suit an amicable resolution to the present crisis.

The emerging international signals are continuously worrisome. Two major banks in America, Silicon Valley Bank, and the Signature Bank, have completely melted down. The signal clearly is for a world recession sooner than later. The repercussions are now shaking the Credit Suisse bank (the second largest) in Switzerland. If the government leaders in the country are trying to give a rosy picture after obtaining a small amount of IMF loan, and restructuring the debt repayments, it is a complete distortion of the situation.

The loan taking during the last ten fifteen years have been completely irresponsible. There was no transparency. There were no discussions to reveal the plans and objectives and to take inputs from independent specialists and/or the people. The political leaders and the top bureaucrats were not even keeping the accounts or information properly. When it became revealed that Sri Lanka is not able to fulfill the debt obligations, it was a shock to everyone. That was the result of the irresponsibility of the political leaders.

Still they move in the same direction of duplicity. The so-called debt restructuring is often pictured as debt cancellation. These restructured debts must be paid later while the government is still taking loans from countries and multilateral institutions. Apart from debt restructuring, the country needs to restructure the economy. Although some measures have been taken, no clear plan or programme is put forward before the people. The people’s support is imperative for any economic recovery. This is where the conflict resolution is necessary.

Relevance of Conflict Resolution

The last year 2022 was a mess both in political and economic sense. According to reliable figures the economy had contracted by 8 percent. This will not significantly change this year. A global recession will adversely affect the Sri Lankan efforts to resuscitate the economy and develop the country. These are the matters on which the political parties, trade unions and civil society organisations should come to a common understanding. That is one aspect of conflict resolution. However, there are so many other aspects.

Although the open war is over, the Sinhala-Tamil conflict is still a major obstacle for the country’s development and peace. The failure to understand each other, and respect other people’s values and culture is common even among religious, language, cast, gender, professional, regional (up-country vs. low country) and other groups. Under such a situation, peace and conflict resolution should be taught to children from the beginning of school years. There can be a mass movement and a massive effort to fulfill this task transcending political parties, divisions, and groups.

Let us take few examples. On the advice of the IMF, the present administration has declared that over 40 loss-making state institutions would be closed. To my view, this is a necessary measure to manage the economy better, and the support of all groups should be sought. Although not overtly expressed, there can be conflict of views on this and other matters. What are these institutions? What kind of an economic position that they are engaged in? These facts and information should be revealed to the public to open a healthy conflict resolution discussion.

Strengthening Positives

This does not mean that the situation in the country is completely hopeless. The younger generations are quite skillful with modern ideas and views as revealed through social media and new social engagements. Although they are highly frustrated about the present situation, they could be mobilised and motivated for new ventures and paths. It is unfortunate that the present university students are disoriented and discouraged. While curricula should be changed to modern directions, the medium of instruction should be English for future prospects. Sri Lanka should be a modern country and old views, values and practices should be discarded.

During the last two decades, the development trajectory had taken a distorted form. While large infrastructure (ports, airports, major roadways) is a must to the country, they should have been the second priority, giving much prominence to industrial, entrepreneurial, and export-oriented enterprises. What are the main pillars of the economy? Traditional exports (tea, rubber, coconut) have not improved enough with value additions. New exports (textile, garments, gems, and labour) are also a fragile pillar without long term agreements or understandings with importing countries.

Of course, tourism is a promising area although affected by the Covid and political instability in the country. Unless the two major current issues of local government elections and APIT tax are remedied amicably through conflict resolution, the tourism sector also would be badly affected.

On the question of elections, the government is now playing with the idea of a presidential election at the end of this year. Although a presidential election could resolve the de-legitimacy of the present President, the logical step is to have the local government elections first to safeguard and preserve democracy. There can be negotiations, but soon. Even in resolving the tax issue, there should be negotiations and the government can easily reduce some percentage of the tax while trying to resurrect the abandoned files of the people who were excluded from the tax net under the last government.

It is not good for the country to have continuous strikes, protests, and demonstrations that could lead to violence and destroy not only the reputation but also the economic recovery of the country. It is my wish particularly for the universities to commence their sessions/teaching soon and for the students to study well and contribute innovatively to the economy, country, society, and democracy. There should be amicable conflict resolution in this sphere.

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Doctrine of immunity in Emperor’s Clothes




Ranil Wickremesinghe has emerged as the chief “dramatis personae” in the current constitutional deadlock drama. Whether the stars had foretold the event is not known. He was never a man in a hurry.  He was cool as a cucumber when he was sacked as Prime Minister by the latter and seeking the help of the apex Court regained the position. He has chosen to confront the Supreme Court in what appears to be a battle of wits as to who has the whip-hand – the Executive President or the Supreme Court. The SC ruling in respect of the release of funds for the local government (LG) elections has opened the door for many a fundamental issue, not the least being the question of immunity and that of effectiveness and priority for SC decisions. The presidential circular does not list election expenditure as an essential item.  Indeed, a direct confrontation prima facie.

Elections Commission

One does not need much grey matter to realise that as far as the government is concerned, it does not have an iota of interest in conducting the relevant election. The pointers came in very clear terms through the “machinations” of the Government Printer, the IGP and the Secretary to the Treasury.  And in this time-consuming and futile exercise, the EC through its own volition reduced itself casting away its so-called independence to be nothing more than a pen-pusher – a far cry from the Deshapriya’s lion roar of yesteryear asking violators of election laws to be shot at the head.  Fair enough  for the EC to write to  the Secretary to the Treasury (the custodian of state coffers)  but when it was clear that there was a questionable delay, it had  a duty and responsibility to bring the issue to the notice of court to which it is bound by ruling to hold the elections. The Secretary to the Treasury is bound by the Constitution to perform his duties under the direction and control of his Minister and has taken an oath to uphold the Constitution. He has no leeway to pass the buck or to treat a SC ruling as subordinate to any other source.  Nothing of the sort has happened before.  The Minister of Finance may hold the office of President substantively but that does not ‘ipso facto’ imply that he enjoys the immunity he enjoys in his substantive office while performing duties in areas other than those in Presidential office. If   not anything else, this episode has the potential to become a dangerous precedent. It has to be immediately resolved once and for all.

Immunity of Parliamentary Proceedings

The question arises as to whether the immunity prescribed is limited to parliamentary proceedings. There is also the relevant issue of “absolute”and “qualified” immunity which has to be examined and argued with due reference to authorities such as Erskine May, the SL. Constitution and other such Constitutions. And who else is qualified to do it but the relevant professions, including the legal fraternity?  The question arises whether the immunity is limited to parliamentary proceedings. If so, any action initiated or proceeded with by the Hon. Speaker in entertaining a motion of “Privilege” and any follow-up action thereon in tabling it, etc,. could be construed as “contempt of court”    We have had the sad and unfortunate episode of Shirani Bandaranaike, which nobody wants to repeat and make SC judges  the hunting ground  of  politicians of one hue or another.  No-one wants our judiciary to be reduced to being a plaything of politicians.  The judiciary expects unequivocally and requires no repetition of the treatment of Shirani B or Neville Samarakoon.

Legal Fraternity and the BASL

The BASL has proudly felicitated President Wickremasinghe on completion of 50 years at the Bar (yet not in practice).  The country would not certainly seek to deny him the accolade. Yet,  the BASL and the “Black-coated” gentry in particular,  who thought it opportune to invade the courts of justice in their hundreds unsolicited to defend the Aragalaya  demonstrators without a fee almost exercising undue influence vicariously in the course of justice,  and the frenzy  in which they  took to the streets demanding the ouster of Mohan Pieris, was conspicuous by its absence in strength vocally and otherwise except through a tame letter.

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