So once more about that bitter pill

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Now that’s a hell of a thing to say, if you will pardon the language. That Minister of Health Keheliya Rambukwella might think it is a parlour game to play around with medicinal drugs and quibbles with words as he would do on a Scrabble board.

They are certainly not the kind of drug that abrasive State Minister Diana Gamage has been promoting for over one year in the hope the dollars will flow in while the Ganja flows out and we can all get together and say bye-bye to the IMF and invite some other robber barons as uncle Junius Richard Jayewardene did with some relish.

I refer to the drugs that can decide life and death. But does the voluble health minister care? Well, ask him while I quote one of his many quotes that one day will fill a book of the unpalatable.

You might recall that some days back speaking in parliament in defence of his stint at the Health Ministry and the questionable activities of his lackeys there, Rambukwella announced the remarkable discovery that people die in hospital.

Such was the tone that one would have thought he had discovered a new version of the Mahawamsa.

As though that was not enough of a revelation to arouse his Diyawanna Oya colleagues to cry out like the Roman citizens urging Mark Antony to read the assassinated Caesar’s will, Rambukwella’s addendum was the crowning moment of his speech.

As proof of his assertion, he said some had set up funeral parlours near hospitals because there was business to be had from the dead in hospital, or something to that effect.

His Churchillian moment in Diyawanna Oya oratory produced an outburst of public ire especially from the medical and clinical community in the health sector at the callous disregard for people’s lives.

He was not to be silenced by what was said of him or his management of the health sector. At a meeting of a parliamentary committee looking into the public outcry about deaths and injuries in state hospitals and suspected by medical professionals to have been caused by substandard drugs or bought from unregistered manufacturers, Minister Rambukwella told the committee that there is no official definition of inferior medicines.

Last week a columnist in this newspaper wrote about the several “doctors” in parliament. Apparently, Rambukwella is called doctor. Whatever he is doctor of it cannot be medicine like most of the others in parliament who wave the prefix “Dr” before their names raising questions about where the qualification came from.

Remember the Rajapaksa’s Rambo named Mervyn Silva who was awarded a “doctorate” ( for thuggery?) by somebody who probably did not want to be tied to a tree for failure to honour him and subsequently insisted he be called doctor. We do have nice politicians who will fix anything for a prefix.

When Rambukwella has to fall back on a defence-like definition one knows that he is as vulnerable as the impenetrable French “Maginot Line” during the last World War which Hitler’s Wehrmacht breached with ease.

Without playing with words looking for a way out of the current contretemps, he should have asked some of those ministry minions who carry a prefix before their names and are real doctors of medicine who have sworn to abide by the Hippocratic oath, subsequent amendments or changes to it, and more modern codes of ethics that underline non-maleficence, though they may have strayed from them in the course of their work.

Perhaps his time would have been more profitably spent doing some reading instead of looking for definitions. The WHO would have been a useful beginning for the education of Rambukwella though he is said to have attended my former school S. Thomas’ College. But then mistakes do happen in the best of schools.

In May 2017, that is two years after Sri Lanka established the National Medicines Regulatory Authority (NMRA), WHO adopted the term substandard and falsified (SF) in place of the previously used terms — spurious/falsely labelled/falsified/ counterfeit (SFFC).

According to the WHO substandard medical products, also known as “out of specification”, are authorised medical products that fail to meet to either quality standards or specifications or both.

Falsified medical products are products that “deliberately or fraudulently misrepresent their identity, composition or source”.

Also the WHO defines unregistered or unlicensed medicinal products as products that “have not undergone evaluation and/or approval by the national or regional regulatory authority for the market they are intended — such as Sri Lanka for instance. Such products can be removed from the supply chain by “product recall”.

So in case Dr Rambukwella is still in search of definitions let me repeat what the WHO has to say. The world body identifies substandard medical products — which obviously includes pharmaceutical drugs — as products which are authorised but fail to meet their quality standards and specifications.

Health Minister Rambukwella has said there is no definition for “inferior” medicines. He uses the word probably hoping to confuse. Now what does “inferior” mean? if he cares to turn the pages of a reliable dictionary, he would find that among others, it means lesser in quality.

If Rambukwella cares to look more closely while the WHO employs the word “quality” regularly in its reference to medical products, most authorities or agencies across the world that regulate the import of drugs or locally manufactured products constantly refer to quality and quality requirements and standards.

In the context of drug regulation quality means adherence to standards which have been set to ensure that appropriate standards are observed and maintained. Where they fail to do so or are found to have failed to do so under strict clinical testing, those drugs would be described as “substandard” for having failed to satisfy under laboratory examination.

Had Minister Rambukwella dug deeper into the drugs issue that has raised such an uproar to the point of a parliamentary “no confidence” motion calling for his ouster, and also perhaps into the English language, without quibbling with words in an exercise in obfuscation, he might have discovered that inferior means below accepted or acceptable standards.

If he looked further he might find that substandard means below standards means inferior to what is required and acceptable. So inferior would seem very much like a synonym for substandard.

If the Health Minister really wants to cry halt to what many suspect is corruption in the system and depending on bypassing the scientific testing process by relying on ‘emergency’ imports which now appears to have become the regular norm, he should make better use of the scientific laboratory testing facilities available and the professional advice emanating from it, instead of using fig leaves to cover up the deficiencies and the dubious doings of his ministry.

The transfer of more than 20 experienced pharmacists from the country’s Medicines Regulatory Authority where all the drug testing to identify, among other things, substandard or inferior drugs has been conducted, to the Health Ministry where such responsibilities seem to have been removed, says more bitter pills will be available to the citizenry.

Who cares if more people die? After all, there are funeral parlours near hospitals as the Health Minister reminds us with such astonishing candour touched with levity


(Neville de Silva is a veteran
Sri Lankan journalist who was Assistant Editor of the Hong Kong Standard and worked for Gemini News Service in London. Later he was Deputy Chief-of-Mission in Bangkok and Deputy High Commissioner in London.)



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