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by Professor Carlo Fonseka

(Text of talk given at the Annual Academic Sessions of the Ceylon College of Physicians, 2003)

Although the current President of the Ceylon College of Physicians, Dr. Sarath Gamini de Silva knows full well that I am an old fogey of the 'talk and chalk' era, he has been kind enough to invite me to give an overview of Alternative Medicine in Sri Lanka.

In this talk I propose to address six separate but related questions concerning Alternative Medicine in Sri Lanka.

First: What is alternative medicine?

Second: How did Western medicine become mainstream medicine in Sri Lanka?

Third: How and why did the current global enthusiasm for Alternative Medicine arise?

Fourth: What are the forms of Alternative Medicine practised in Sri Lanka?

Fifth: Why is there such a demand for Alternative Medicine at present?

Sixth: What is the future of alternative medicine?

To begin at the beginning: what really is Alternative Medicine? to ask such a question is only to provoke another: alternative to what? If something is an alternative to another, that thing can be used instead of the other thing. To members of the Ceylon College of Physicians Western medicine (more accurately called scientifically verifiable evidence-based medicine) is the most effective form of medicine available to humankind at the present day. In what sense is it the most effective? It is the most effective for preventing premature death and avoidable suffering. Even after political independence gained in 1948, Western medicine is the form of medicine that successive governments in Sri Lanka have, by budgetary allocations, implicity recognised as mainstream medicine. To regard Western medicine as mainstream, orthodox medicine, is to consign all other forms of medicine to the category of "Alternative Medicine". Thus in Sri Lanka today the straightforward answer to the question: "What is Alternative Medicine?" is "All forms of medicine other than Western medicine". In present day China, however, Traditional Chinese Medicine is mainstream medicine. In China, therefore, Western medicine is a form of alternative medicine. Even in Sri Lanka, before the British, who ruled the entire country from 1815 to 1948, made Western medicine the State supported system of medicine, Western medicine was a form of alternative medicine to the country's traditional system of medicine.

Thus, the most general answer to the question: What is Alternative Medicine? is to say that it all depends on the country one is thinking about and what the government of that country by budgetary allocations regards as mainstream medicine.

I come now to the second question: How did Western medicine become mainstream medicine in Sri Lanka? This is a historical legacy. Briefly, from 1505 to 1948, Sri Lanka saw the invasive presence of the Portuguese, the Dutch and the British, in that order. It was during this period of some 443 years that the people of Sri Lanka came into contact with Western medicine. Before that the principal forms of medicine in this country were the traditional Indian medicine called 'ayurveda' and a form of indigenous medicine called 'desiya chikitsa'.

Robert Knox

At this point it is perhaps interesting to recall what a Londoner called Robert Knox who spent 18 years in Sri Lanka in the 17th century and wrote a book titled An Historical Relation of the Island of Ceylon, published in 1681, had to say concerning the practice of medicine in our country. He wrote: "Here are no professed physicians nor surgeons, but all in general have some skill that way, and are physicians and surgeons to themselves".

That tradition dies hard. This was brought home to me most dramatically in 1961, when I was serving as a medical officer in the government hospital at Mihirigama. One day, a buxom, middle-aged, rather extrovert woman, with an infected lump in her head, came for treatment to the hospital. I asked the history and she told that me that she had a soft lump in her head for several years and at last a few days ago she had split it with a razor blade and put some "battery acid" into it. (That's some Alternative Medicine for you!). Then the following exchange took place between me and her in our mother tongue:

"Kauda oyata ema baytha karanda kiuway?" (Who asked you to do that treatment?)

"Pol mudalali kiuwa" (The coconut merchant told me to do so.)

"Ahenam oya dosthara balanda awey, pol ganan ahanda venna athi neda?"

(Then did you to see the doctor to check on coconut prices?)

She was not a bit amused by my last remark. The point I am seeking to make is that the village coconut merchant thought he was amply qualified to give her medical advice and she accepted the advice without any question. That proves beyond doubt, surely the justice of Robert Knox's acute observation.

To return however, to our topic: at the time Robert Knox wrote, and to this day, for many people in Sri Lanka "Western medicine: is a form of alternative medicine to be tried when indigenous forms have failed. The tables were officially turned when the British made Western medicine the mainstream medicine of the country in the 19th century.

Global enthusiasm

To come now to the third question: How and why did the current global enthusiasm for Alternative Medicine arise?

It probably began in the USA in the early 1990s when Tom Harkin, a Senator from Lowa who happened to be a strong believer in the curative powers of bee-pollen succeeded in foisting on the National Institutes of Health, the Office of Alternative Medicine (OAM). By now the OAM has disbursed millions of dollars investigating some 58 forms of Alternative Medicine. The one thing that has been firmly established is the value of acupuncture as an analgesic (pain-killer). During the past decade there has been an explosion of interest in Alternative Medicine in Sri Lanka. To the credit of the modern pioneer of Alternative Medicine or Medicina Alternativa in Sri Lanka, Dr. Anton Jayasuriya, Sri Lanka has fostered a systematic interest in alternative medicine for 41 years.

WHO support

In the year 2002, the World Health Organisation jumped on the Alternative Medicine bandwagon with the publication of a document titled: WHO Traditional Medicine Strategy 2002-2005. According to this document, 75% of the population of France, 70% in Canada, 48% in Australia, 42% in the USA and 38% in Belgium have had recourse to Alternative Medicine at least once in the recent past. There is now money in Alternative Medicine. During the past few years, Americans have spent $30 billion annually on Alternative Medicine. In Malaysia $500 million is spent annually on Alternative Medicine, compared to $300 million on Western medicine (in a country where the long-standing influential Prime Minister is himself a doctor qualified in Western medicine).

There is no doubt that there is widespread use of Alternative Medicine in both developing and developed countries. In developing countries it is mainly a matter of accessibility and affordability. In developed countries it has to do with such things as fear about the adverse effects of chemical drugs, and the unsatisfactory nature of the treatments available for many chronic illnesses.

Forms of alternative medicine

Let's now consider the principal forms of Alternative Medicine practised in Sri Lanka. Of the 58 forms of Alternative Medicine, about 15 are practised in our country. These include: Ayruveda and desiya chikitsa, Siddha, Unani, Homeopathy, Acupuncture, Yoga, Faith-healing, Traditional Chinese Medicine, Naturopathy, Dance Therapy, Hypnotherapy and Meditation. cures are claimed by all of them. Do cures occur? Without a doubt they do. How come? Dr. Franz Ingelfinger, when he was editor of the New England Journal of Medicine estimated that something like "85% of the illnesses doctors are called upon to treat are self-limiting". That is to say, the body is capable of curing itself most times even without any specific treatment. Their is no reason therefore, why the administration of any sort of medicine, provided it does no positive harm, cannot be associated with cure.

Reasons

The next question we must consider is why there is such a demand for Alternative Medicine at present. I can suggest several possible reasons:

1. Western medicine is very expensive, perhaps unconscionably so in a free-market economy.

2. Many doctors, pressed desperately for time, do not practice medicine competently, compassionately and caringly.

3. The public is ill-informed and gullible and is willing to try every well-advertised nostrum.

4. Western medicine freely admits that it has no satisfactory treatment for many chronic diseases. (Other systems too probably don't have satisfactory cures, but they don't know that they don't know).

5. Carelessly practised Western medicine is probably more hazardous than many forms of Alternative Medicine.

Future

Now to our final question: What is the future of Alternative Medicine? Those forms of Alternative Medicine, which become validated scientifically, will get incorporated into mainstream medicine. The rest will enter the dustbin of medical history.

One final remark is perhaps in order. In 1789, when a revolution was going on in France, in neighbouring England, Dr. William Withering ("the flower of British pharmacology") wrote a revolutionary sentence: "Poisons in small doses are the best medicines; and useful medicines in too large doses are poisonous".

This truth, freely admitted, is probably what drives misguided, scientifically mis-educated people, to untested Alternative Medicine with uncritical enthusiasm.

I have a friend qualified in Western medicine who is a very successful practitioner of many forms of Alternative Medicine. He has a delightfully droll sense of humour. He is a strong advocate of the virtues of Alternative Medicine. Once at the end of a lecture, having praised Alternative Medicine sky-high, he suddenly seemed to lose track and said: "Friends, despite everything I have been telling you about Alternative Medicine so far, if you fall seriously ill, go and consult a doctor highly qualified in Western medicine. Get a prescription from him. Pay him well because he must live. Take the prescription to a pharmacist and get it dispensed. Pay the pharmacist well, because he must live. On your way home, throw the drugs into the drain, because you must live."

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