SLMA News 2013 12 by Sri Lanka Medical Association

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December 2013, VOLUME 06 ISSUE 12

Glycaemic indices (GI) and...

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Tobacco Control and...

NIROGI Maatha Centre... www.slmaonline.info

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THE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION

Desember 2013 Volume 06 Issue 12

Contents

President's Column Dear colleagues and friends,

Page No.  Bring on the chocolate!

It is a much bandied cliché that all good things must come to an end. In that context, this is the final time that I will be addressing you as the President of this much hallowed institution that is the Sri Lanka Medical Association (SLMA).

 Annual General Meeting – Sri Lanka Medical Association

 Glycaemic indices (GI) and factors affecting the GI of Sri Lankan foods

An Advocacy Programme on Capacity Development of Palliative Care in the Sri Lankan Setting was held on 2nd December 2013. It was organised by the NCD Committee of SLMA with the Cancer Control Programme of the Ministry of Health. Several foreign specialists in Palliative Care took part in the deliberations.

 Tobacco Control and the Industry Interference: The more we try the nastier they get 12-13

 Anatomy Block Centenary Commemoration – Faculty of Medicine, University of Colombo

We had a Symposium on “Guidance on developing guidelines”, in collaboration with the South Asian Cochrane Centre on the 9th and 10thof December 2013. On the 14th December 2013 we had a Joint Clinical Meeting with The Avissawella Clinical Society, which incidentally was the final Continuous Professional Development Activity during my tenure of office.

 The Mobile: The Great Leveller

On the same day, the 14th December 2013, we had the Annual General Meeting of the SLMA at Wijerama House where a new Council and a new set of Office Bearers were elected. The list of the new officials is given elsewhere in this Newsletter. Dear friends., it has been a singular honour and a much coveted dispensation for me to have been the President of the SLMA in 2013. My team and I have tried very hard to consolidate the gains of last year and our mission has been to take the activities of the SLMA, far and wide, to the periphery of our land as well. We have also tried to institute some new ventures with the ultimate aim of taking this august institution, the SLMA, from strength to strength. The responses from all over, to all our overtures, have been nothing short of complete appreciation and absolute cooperation. In that sense, we remain content in the belief that we have achieved what we set out to do at the beginning of our tenure of office. However, you are the Jury and the Judge and it is the ultimate judgement of our members and colleagues that really matters. I personally would love to hear from you on exactly how we managed to live up to your expectations. If you are so inclined to let us know, please feel free to write to me at bjcp@ymail.com Our team at the SLMA joins me in wishing each and every one of you, the very best compliments of the season. May you have good health and eternal happiness. Dr B J C Perera President, Sri Lanka Medical Association, No.06, Wijerama Mawatha, Colombo 07, Sri Lanka

 NIROGI Maatha Centre of excellence at DMHW

 NIROGI Paadha MoU

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Desember, 2013

Bring on the chocolate! Dr Ashwini de Abrew Lecturer, MEDARC Faculty of Medicine, Colombo

he good news continues for all chocolate lovers this festive season! In 2012, Medscape published a compilation of the best research findings on chocolate and health1. This year, the compilation has been expanded to add sweetness to 2014. The fermented, dried, roasted and ground seeds of Theobroma cacao have been used by South American civilizations to produce chocolate beverages for over three millennia, and later adopted by the Europeans in early 16th century2. It has since been recognized as “more than a confection, more than a dessert, more than a delightful pleasure”3, with benefits reported for cardiovascular, neurological and mental health. Alkaloids such as theobromine, phenethylamine and caffeine are present in cocao solids, and cocoa seeds also contain potent antioxidant and anti-inflammatory flavonoids4.

The benefits of chocolate as reported in 2012 and 2013 are as follows: • European Heart Journal: Chocolate acutely improves vascular function in patients with heart failure5 • Archives of Internal Medicine: Frequent consumption of chocolate was associated with reduction in body mass index6 • BMJ: Daily consumption of dark chocolate can reduce cardiovascular events by 85 per 10,000 population7 • Hypertension: Flavanols may contribute to vascular health by reducing the postprandial impairment of arterial function8 • NEJM: The more chocolate consumed in certain countries, the higher the number of Nobel laureates9 • Neurology: Chocolate consumption causes acute changes in cerebral

vasomotor reactivity, independent of metabolic and hemodynamic parameters, and regular consumption may reduce risk of stroke10

Anecdotal evidence suggests that chocolate consumption in the ward setting is a relatively common occurrence. A multi-centre prospective covert observational study published in the BMJ reports that the mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes and the median survival time of a chocolate in the ward setting was 51 minutes11. The highest percentages were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%)11. Given the short half-life of chocolates, the authors recommend that frequency of chocolates delivered to wards needs to be increased to ensure that all healthcare staff obtain benefits from consistent chocolate consumption.

Interpretation of the above studies It is recommended that the above data is interpreted with caution. In a commentary on Medscape, author Henry Black states "What does that mean to us? Does it mean that we should start eating chocolate? Does it mean that we should prefer dark chocolate instead of milk chocolate or white chocolate? Perhaps. If we are going to recommend eating chocolate, we would like to be sure that we get the right kind. It is possible that there's something here that we actually like to do. We have to make sure that we watch the calories, that we don't gain too much weight, because we're pretty sure that eating too much isn't good for you either1." It is also acknowledged that the strong association between national chocolate consumption and the number of Nobel laureates per country9 is tongue in cheek. In fact, it has been emphasized that this is an over-inter-

pretation of correlations12,13. Before we start consuming chocolate by the ton, it is prudent to await more research - preferably large randomized controlled trials - to definitively establish the impact of cocoa products on hard cardiovascular and other outcomes14,15.

References 1Black H. Chocolate Epic Continues, With a Nobel Prize at the End? Medscape. Nov 14, 2012, available at http://www. medscape.com/viewarticle/774070. 2Hurst WJ, Tarka SM Jr, Powis TG, Valdez F Jr, Hester TR. Cacao usage by the earliest Maya civilization. Nature. 2002;18;418(6895):289-90. 3Grivetti LE. From Aphrodisiac to Health Food: A cultural history of chocolate. Karger Gazette. 2005;68:1–8. 4Borchers A, Keen CL, Hannum SM, Gershwin E. Cocoa and chocolate: composition, bioavailability, and health implications. J Med Food 2000; 3: 77–105 5Flammer AJ, Sudano I, Wolfrum M, Thomas R, et al. Cardiovascular effects of flavanol-rich chocolate in patients with heart failure. Eur Heart J. 2012;33:2172-2180 6Golomb BA, Koperski S, White HL Association between more frequent chocolate consumption and lower body mass index. Arch Intern Med. 2012;172:519-521. 7Zomer E, Owen A, Magliano DJ, Liew D, Reid CM. The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model. BMJ. 2012;344:e3657. 8Grassi D, Desideri G, Necozione S, et al. Protective effects of flavanol-rich dark chocolate on endothelial function and wave reflection during acute hyperglycemia. Hypertension. 2012;60:827-832. 9Messerli FH. Chocolate consumption, cognitive function, and Nobel laureates. N Engl J Med. 2012;367:1562-1564. 10Walters MR, Williamson C, Lunn K, Munteanu A. Chocolate consumption and risk of stroke: A prospective cohort of men and meta-analysis. Neurology. 2013;12(80):1173-1174. 11Gajendragadkar, P.R., Moualed, D.J., Nicolson, P.L.R., Adjei, F.D., Cakebread, H.E., Duehmke, R.M., Martin, C.A. The survival time of chocolates on hospital wards: covert observational study. BMJ 2013;347:f7198. 12Maurage P, Heeren A Mauro Pesenti M. Does Chocolate Consumption Really Boost Nobel Award Chances? The Peril of Over-Interpreting Correlations in Health Studies. J. Nutr. 2013;143(6):931-933. 13Dunstan F. Nobel prizes, chocolate and milk: the statistical view. Pract Neurol 2013;13:206-207. 14Arranz S, Valderas-Martinez P, Chiva-Blanch G, Casas R, Urpi-Sarda M, Lamuela-Raventos RM, Estruch R. Cardioprotective effects of cocoa: Clinical evidence from randomized clinical intervention trials in humans Molecular Nutrition & Food Research. 2013;57(6):936–947. Stebbing J, Gajapathy V, Lowdell C. Chocolate: Delicious beauty or harmful beast? The Lancet Oncology. 2013;14 (6):457-458.

SLMANEWS

Desember, October, 2013

Annual General Meeting – Sri Lanka Medical Association

he annual general meeting of the Sri Lanka Medical Association was held on the 14th December 2013 at 7.00 p.m. at the Lionel Memorial Auditorium, Wijerama House, Colombo 7. President, Dr B J C Perera chaired the meeting. He thanked the Council, members and the staff of the SLMA office for their contributions towards making the activities of the SLMA a success. He summarised the achievements and short comings during the year and stressed the need for continuing improvement. Dr Samanmali Sumanasena tabled the Annual Report 2013. She thanked the President, the Council, members of the Association, and the staff of the SLMA. Following SLMA members were elected as the office bearers of the SLMA Council for the year 2013. President: Dr Palitha Abeykoon President Elect:

Prof Jennifer Perera

Vice Presidents:

Dr Indika Karunathilake

Dr Lasantha Malavige Secretary: Dr Ruvaiz Haniffa Assistant Secretaries:

Dr Navoda Atapattu

Dr M Shihan Azeez Dr Asela Olupeliyawa Dr Dinesha Jayasinghe Treasurer: Dr Gamini Walgampaya Assistant Treasurer:

Dr Samanthi de Silva

Public Relations Officer:

Dr Deepal Wijesooriya

Social Secretaries:

Prof Vajira HW Dissanayake

Dr Preethi Wijegoonewardene Past President’s representative:

Dr Malik Fernando

Council Members: Dr Dennis J Aloysius

Dr Iyanthi Abeywickreme

Prof Srinath K Chandrasekera

Dr Kalyani Guruge

Dr Padma Gunaratne

Dr Lucian Jayasuriya

Prof Saroj Jayasinghe

Dr Gumindu G A K Kulathunga

Dr Niroshan Lokunarangoda

Dr Chiranthi K Liyanage

Dr J B Peiris

Dr Shayamali Samaranayake

Dr Sudarshi Seneviratne

Dr Pramilla Senanayake

Dr Rikaz Sheriff

Dr S D Dharmaratne (Central Province)

Dr Indira P Kahawita (Sabaragamuwa Province)

Dr V Murali (Northern Province)

Dr Sunil Seneviratne Epa (Southern Province)

Dr W M Arjuna Wijekoon (North Western Province) Ex-officio members of the Council: Dr B J C Perera (Immediate Past President) Dr Samanmali Sumanasena (Outgoing Secretary) Prof Janaka De Silva (Co-Editor CMJ) Dr Anuruddha Abeygunasekera (Co-Editor CMJ) Dr Palitha Abeykoon thanked the members for electing him as the President of the SLMA and requested everyone’s help to make SLMA activities in 2014 a success.

SLMANEWS

Desember, 2013

Glycaemic indices (GI) and factors affecting the GI of Sri Lankan foods Sagarika Ekanayake (Ph D) Dept of Biochemistry Faculty of Medical Sciences University of Sri Jayawardenepura Nugegoda

Energy from dietary carbohydrates and glycaemic response Carbohydrate intake in Sri Lankan adults is reported to be over 14 portions of starch and 3•5 portions of added sugars daily and the fat consumption is reported to be modest (15-18%). Almost over 70% of the study population exceeds the upper limit of the recommendations for starch intake with very little vegetable and fruit intake. Since carbohydrates are a major contributor to energy in the majority of Sri Lankans, the quantity as well as quality of carbohydrates in a diet need to be considered carefully as both play a major role in controlling the energy intake thus development of obesity and non communicable diseases. The quality of carbohydrates in a food/diet is expressed by the Glycaemic Index (GI). The quantity of glycaemic carbohydrates in an edible portion is expressed by the Glycaemic Load (GL).

Glycaemic Index (GI) GI categorises starchy foods according to their potential to raise the postprandial blood glucose levels (Figure 1). The GI concept is generally applied to foods providing 15-20g of glycaemic carbohydrates per portion or serving size. All digestible carbohydrates in the foods or the diet that are converted to glucose contribute to the transient increase in the blood glucose following a meal, which is reflected by the GI of a particular food. Considering the GI value for non starchy vegetables and foods

Figure 1: Glycaemic responses following ingestion of low and high GI foods with increased fats or proteins can be misleading when giving dietary advice. E.g. Carrot is categorised as a high GI vegetable. Calculation of GI requires a person to consume 575 g of carrot which is about 9 carrots. Thus, consuming carrot as a curry will not contribute to an undue increase in the glycaemic response. Most vegetables and fruits contain about 80% water and many other nutrients necessary to maintain health. Carbohydrates in foods are digested at different rates releasing glucose into the blood at different rates. Low GI foods are digested slowly releasing glucose in to the blood stream slowly after a meal leading to a lower glycaemic response/lower glucose peak, while high GI foods are digested faster and release glucose rapidly. Thus, depending on the blood glucose raising potential of different foods containing the same amount of digestible carbohydrate (50g), when compared to the rise with a glucose solution (50g), foods are classified as Low (GI ≤55), Medium (GI =56-69) or High (GI ≥70) GI foods. The rate of increase and the level of the rise in blood glucose after ingestion vary for different foods depending on a number of factors.

The amount of protein, lipid, dietary fibre (undigestible carbohydrates), starch granule structure, entrapment of starch of foods and method of processing are some major factors.

Glycaemic Load (GL) When the GI of any food is determined, the portion size ingested should contain 50g of digestible carbohydrate of that particular food. Sometimes, this portion can exceed the normal serving size of a meal and vice versa. Glycaemic Load (GL) concept was introduced to apply the GI concept to a normal serving size of a meal (carbohydrate in the serving size).

GL = GI x (weight of carbohydrates in one normal serving portion)/100 High > 20 or higher; Medium 11 -19; Low < 10 or lower Thus, some foods that give a high GI but when taken in normal portion sizes, would give rise to a lower glycaemic response. Thus, it is more practical to use both GI and GL to guide the food choices. GI values are primarily used to guide selection of foods for diabetic patients but is also beneficial for healthy individuals. Contd. on page 06

SLMANEWS

Desember, 2013 Contd. from page 04

Glycaemic indices... The FAO suggested the intake of low GI foods for hyperglycaemic, hyperlipidaemic, obese as well as healthy persons. Diabetes, which is considered as an age related disease can be prevented by consuming a diet with special emphasis on the GI/ GL starting from an early age, and also during pregnancy in order to give birth to a healthy child.

Rice GI and factors affecting GI The GI, GL of a 50g carbohydrate portion and GL of an edible portion size of some rice varieties available in the market and of mixed rice meals were analysed. Results are given in Table 1. When considering rice, the major contributor to carbohydrate and energy in a Sri Lankan diet, raw (kekulu) rice irrespective of the variety; red raw, white raw, red or white basmati, produced a high glycaemic response when given alone or just with coconut sambol only. This is apparent when

Figure 2. Glycaemic Responses of different rice varieties compared to glucose

the GIs of red raw (rathu kekulu) rice, white raw (sudu kekulu) rice, red and white basmati are considered. These were given to determine the GI with minimum of accompaniments. However, the glycaemic load for a normal portion size of red basmati would be lower when compared to the white variety that was under study (Table 1). Thus, among basmati, red variety would be a better choice due to high fibre, which in turn will decrease the

carbohydrate load in an edible portion. The carbohydrate load (GL) was high in the portion given to determine the GI in all rice varieties. This portion is equal to a portion an individual could eat except in red basmati. In contrast, the white basmati (Samurdhi) portion given was considered not adequate (low moisture, low fibre) and thus would give a high carbohydrate load. Raw samba (keeri samba) produced a medium GI with a high GL. Thus, among the raw rice varieties, a better metabolic response was obtained with Samba rice. The naturally occurring dietary fibre in whole grains is not adequate to affect the glycaemic response and thus when given alone or with minimum accompaniments, the GI of any raw (kekulu) rice variety would be high or medium, as seen above. Among the rice we studied, parboiled (nadu) rice elicited the lowest GI, as reported in other studies done elsewhere. A lower peaking (Figure 2) was seen even when given with only coconut sambol, thus indicating the suitability of parboiled rice in the dietary regime of individuals with chronic non communicable diseases or for that matter any individual. The dietary fibre content of parboiled rice was higher than any of the above raw varieties.

Table 1. GI and GL of some rice meals

Contd. on page 08

SLMANEWS

Desember, 2013 Contd. from page 06

Glycaemic indices... However, when rice is consumed the typical Sri Lankan way with many different accompaniments (curries), the GI decreased significantly (39%), compared to raw red rice with kirihodi only. Further, the mixed meal was categorized as low GI. Glycaemic load and the glucose peak also reduce compared to the rice given only with kirihodi. GL of a normal portion was also less, as two thirds of a portion was adequate due to addition of other accompaniments (Figure 3). This highlighted the importance of other accompaniments to a starchy base when trying to control the glycaemic response. The accompaniments provide dietary fibre and proteins which help reduce glycaemic response and in addition lower the quantity of starchy base that we can consume. The rice mixed meal had the most desirable GL indicating the suitability of mixed meals in controlling the glycaemic response. However, the quantity of rice portion (starchy base) has to be taken into account when consuming rice. The beneficial effect of the mixed meal would not be seen, if a large portion of rice is consumed with small quantity of energy dilute accompaniments (vegetables, green leaves) as part of the meal. When the GI and insulin index of red rice mixed meal were determined in diabetic individuals, higher values (64; medium GI) than obtained with healthy individuals were observed for the same meal but indicating good glycaemic control. Thus a balanced rice meal irrespective of the variety would induce a lower glycaemic response. However, among rice, parboiled rice would be a healthier choice of a rice variety due to high fibre. Research also proved that increased addition of vegetables containing high dietary fibre (same mixed meal with an additional portion of kohila sambol) contributes to

Figure 3. Glycaemic responses of rice only and mixed rice meal

lowering the GI to a certain extent. However, beyond 16 g dietary fibre/ portion failed to elicit a significant effect on the GI. When milk rice was made with white raw or red basmati, the GI was high (72 and 70). However, when green gram was incorporated in to milk rice (green gram milk rice 1 – GI 65), the GI declined. There was a corresponding decrease in the GI with increasing content of green gram incorporated in to the milk rice (green gram milk rice 2 – GI 55). This clearly indicated the suitability of milk rice made with green gram over milk rice in controlling the glycaemic response. When the proximate nutrient content was considered, the green gram milk rice had more protein and less fat compared to milk rice made without green gram irrespective of the variety. GL for portion also decreases as green gram contributes protein and dietary fibre to a portion thus decreasing the carbohydrate in the edible portion. Thus, consumption of any rice variety as a mixed meal with as many accompaniments that contribute dietary fiber (vegetables, green leaves, legumes) and adjusting the rice portion to suit individual energy requirement (remember BMR declines after 40 years) will help control the glycaemic response and insulin response. Among rice any parboiled rice variety would be a better choice.

References Beals K A (2005) The Glycemic index: Research meets reality – A

special publication of the United Sates Potato Board, USA. Hettiaratchi U. P. K., Ekanayake Sagarika, Welihinda Jayantha. (2009) Do Sri Lankan meals help decrease blood glucose response? Ceylon Medical Journal 54 (2) 39- 43. Hettiaratchi, U.P.K., Ekanayake, S.,Welihinda, J. (2011) Sri Lankan rice mixed meals: Effect on glycaemic index and contribution to daily dietary fibre requirement. Malaysian Journal of Nutrition 17(1): 97-104. Jayawardena Ranil, Nuala M Byrne, Mario J Soares, Prasad Katulanda and Andrew P Hills (2012b) Food consumption of Sri Lankan adults: an appraisal of serving characteristics. Public Health Nutrition FirstView Article, pp 1-6. TemaNord 2005- 589; Glycaemic index; From research to Nutrition recommendations? Nordic Council of Ministers, Copenhagen 2005. Somaratne R M N U and Ekanayake S. (2011) Glycaemis indices of some selected rice varieties. Annual Scientific Sessions of the Nutrition Society of Sri Lanka 2010 (January 2011). p5. Wathupola A, Ekanayake S & Welihinda, J (2013) Glycaemic responses and glycaemic indices of rice and milk rice made with sudu kekulu and red basmathi rice. Annual Scientific Sessions of the Nutrition Society of Sri Lanka, 2-3 February 2013. p WHO (World Health Organization) (2005) Preventing Chronic Diseases:

SLMAN

October, 2013

Tobacco Control and the Ind The more we try the nastier they get

Dr. Mahesh Rajasuriya Consultant Psychiatrist and Senior Lecturer in Psychological Medicine Faculty of Medicine, University of Colombo

serious harm to the health and economy of the people.

obacco kills one of its two users when used as advised by the manufacturer. No other product causes death to that extent. Although fast food, alcohol and television are close competitors they are yet to be widely recognised as clear health hazards. Tobacco has definitely passed that stage and no one argues anymore that tobacco poses serious harm to health of people.

To exorcise such a powerful evil, we need an equally powerful exorcist. Finally the exorcist has metamorphosed in the form of Framework Convention Tobacco Control(FCTC), Framework Convention on Tobacco Control. This is a legally binding treaty of countries of the world fully backed by the World Health Organisation. Following historical and selfless commitment of many individuals and organisations, the FCTC entered into force in 2005. The then DirectorGeneral of WHO, Dr Gro Harlem Brundtland, was instrumental for the FCTC. It should also be emphasised that Sri Lanka was the fourth country in the world to ratify the treaty.

However tobacco industry is still allowed to manufacture, market and promote their deadly products. This is largely due to the financial wealth of the industry and the resultant political lobbying and media power. According to the Tobacco Atlas, the total revenue of the tobacco industry in the last year is nearly USD 500 billion, which is almost four times the GDP of Sri Lanka. The CEOs of the six major tobacco companies individually earn up to USD 24 million a year. The industry can, and do invest in measures to make sure that their legal right and the societal permission to manufacture, market and promote their deadly products is continued. It is time to identify these unethical agents of

Framework Convention on Tobacco Control

The main provisions of the FCTC are: 1. Protection Against tobacco industry interference 2. Protection of the environment and health of tobacco workers 3. Research, Surveillance, and Exchange of information on tobacco products 4. Support for a. Economically viable alternative activities b. Legislative action to deal with liability 5. Regulation of

a. Contents, packaging, and labelling of tobacco products b. Prohibition of sales to and by minors c. Illicit trade in tobacco products d. Smoking at work and in public places 6. Reduction in Consumer Demand by a.Price and tax measures b. Comprehensive ban on tobacco advertising, promo tion, and sponsorship c. Education, training, raising public awareness, and assistance with quitting Now almost the whole world is involved in FCTC, with 168 countries signing the treaty so far. Given the extent of the support and the comprehensiveness of the treaty, it holds great promise for the future of all of us.

How Tobacco industry fights FCTC The tobacco industry did everything possible to prevent the creation of FCTC. Since the time FCTC came into force, they have been trying to undermine FCTC in many ways. Dr Margaret Chan, the Director-General of WHO, sums up their strategy: “Tactics aimed at undermining anti-tobacco campaigns, and subverting the WHO Framework Convention, are out in the open and are extremely aggressive... the industry has much money and no qualms about using it in the most devious

ways imaginable.” A WHO publication, ‘Tobacco Industry Interference a Global Brief’ recognises six of these ‘tactics’:

Manoeuvring to hijack the political and legislative process The tobacco industry monitors the political process and takes swift action when needed. If a governmental department or an individual politician is attempting to develop effective tobacco control measures, they quickly attack the relevant body. For an example, British American Tobacco was successful in Cost Rica in creating a rift between the Minister of Finance and Trade and the Minister of Health when the former attempted to initiate tougher tobacco control policies. Costa Rica ended up

October, 2013

NEWS

dustry Interference: earnings every year”. Not surprisingly the document they used to substantiate this argument was a report by the International Tobacco Growers’ Association, an organization created by tobacco companies.

Manipulating public opinion to gain acceptability for the industry

having very weak tobaccocontrol policies.

Exaggerating the economic importance of the tobacco industry Tobacco companies are very keen to highlight their contribution to the tax revenue of a country and the job market. They never refer to the economic and health losses attributable directly and indirectly to tobacco smoking. The tobacco industry has been able to create an image, even among learned people in a country that the economy would collapse if the tobacco industry is to fall. For an example, the Malawian tobacco control body known as Tobacco Control Commission of Malawi argued in 2000 that ‘‘WHO’s global campaign would chop at least 10 per cent off Malawi’s tobacco

It is important for tobacco companies to gain public approval in order to continue their deadly trade. Hence they do various activities to create a positive picture in the mind of the public. They give money to poor farmers and elderly people, they build police stations and hospitals and so on. They heavily involve the media in these promotional attempts. Moscow Times reported one such project of a tobacco company in Russia in the following manner: “It is very hard to attract funds to projects that seek to help the elderly, the homeless and the mentally ill, Tobacco companies give particularly large sums to initiatives that support old people.”

Fabricating support for the industry through front groups Tobacco industry never appears as an opponent of the tobacco controllers. They always manipulate other agents to speak on behalf of them. They turn the battle

to one between smokers and the health personnel by suggesting that it is the rights of the smokers that are at stake, not the profits of the tobacco companies. Internal documents of Phillip Morris made available to the public after the land mark court rulings in the USA in late 1990s, known as the Master Settlement Agreement , reveal their strategy: “sometimes we will need to speak as independent scientists, scientific groups and businessmen; at other times we will talk as the industry; and, finally, we will speak as the smoker.”

Discrediting proven science related to tobacco, its harm and control The tobacco industry knows that a lie repeated many times becomes the truth. They always try to discredit the well-known scientific basis of health hazards of tobacco smoking. Once a Vice-President of Phillip Morris wrote: “Let’s face it. We are interested in evidence which we believe denies the allegation that cigarette smoking causes disease”

Intimidating governments in implementing tobacco control measures with litigation In a 2012 news release to mark the World No Tobacco Day Dr Margaret Chan

states: “In recent years, multinational tobacco companies have been shamelessly fuelling a series of legal actions against governments that have been at the forefront of the war against tobacco. The industry is now stepping out of the shadows and into court rooms.” The industry intimated legal action directly as well as indirectly. Libertad Inc, a not-for profit organisation set up and fully funded by the tobacco industry in USA, host events and seminars in exotic vacation destinations for legislators, bureaucrats and judges. Some judges who attended these seminars pending cases related to product liability of tobacco companies later made those rulings in favour of the tobacco companies.

Our Responsibility as the Health Sector The hard truth is it is a battle between the tobacco industry and health advocates. The tobacco industry has been making all possible attempts, mostly unethical and frequently illegal, to undermine the fight against tobacco. Above are a few of the numerous examples from all over the world. It is time for us to examine the Sri Lankan scenario to unearth such practices by the Sri Lankan tobacco industry. Only then we would be able to upgrade our strategies to counter theirs.

SLMANEWS

Desember, 2013

NIROGI Maatha Centre of excellence at DMHW

he NIROGI Lanka Project of Sri Lanka Medical Association is a charitable project funded by the World Diabetes Foundation. NIROGI Maatha being component 1 of NIROGI Lanka Project Phase II is committed to improving the quality of maternal diabetic care in Sri Lanka. It further aims at empowering communities to be responsible for the prevention of Diabetes from conception through pregnancy and thereafter. This approach will ensure optimal protection of the next generation. We mainly encourage Multidisciplinary care in the curative sector by joining hands between the tertiary and primary health care settings. We ensure that all categories of health care professionals form effective teams with the focal point being the Family Health Bureau, Ministry of Health Sri Lanka. As a part of our project the Medical Clinic of the De Soysa maternity Hospital for Women has been fully

refurbished to act as a Centre of Excellence for mothers and their offspring. The NIROGI Maatha project in liaison with the Director of the De Soysa Hospital remains open throughout working hours to help pregnant mothers and their families to be provided the much required education on diet, lifestyle and blood sugar control through insulin self-injection and selfmonitoring using glucometers. This also provides a valuable setting for training other personnel in Sri Lanka with problems related to diabetes and other NCDs (particularly high blood pressure) related to pregnancy.This facility also ensures that Mothers affected with gestational diabetes and their babies are followed up long term at intervals of 6 months to a year. This data is maintained as a data-

base â&#x20AC;&#x201C; a novel concept for Sri Lanka. This NIROGI Maatha Centre at De Soysa Maternity Hospital for Women was formally inaugurated by First Lady Madam Shiranthi Wickramasinghe Rajapaksha on 9th December 2013 in presence of other dignitaries such as Dr. Amal Harsha de Silva, Dr. B.J C Perera President SLMA, Dr Dhammika Jayalath Director DHSW, Dr. Neel Seneviratne, Dr. Dodampahala and staff members of DMHW

NIROGI Paadha MoU

IROGI Paadha is a subcomponent of NIROGI Lanka Phase II, NIROGI Lanka Project, Sri Lanka Medical Association (SLMA) through which we hope to address the important area on developing a nationally relevant model of quality diabetic foot care, provision of appropriate footwear island wide for diabetes patients and amputation prevention through an ulcer prevention/ healthy foot promotion approach that is expected to cascade towards a sustainable programme in the entire island. One of the projectâ&#x20AC;&#x2122;s objectives is provision of appropriate footwear for Diabetics Island wide. This was initiated with efforts of Dr Palitha Karunapema Director Ragama Rehabilitation Hospital and Mr Chandrasiri

Sumanasekara of DSI group. As an initial step, with the technical expertise from the DPTF of SLMA suitable low cost Diabetic foot wear was designed and developed. They are now in the process of finalizing the mass production of Diabetic foot wear. This foot wear will be officially launched to the public in the near future. This is a CSR project of DSI, which is also committed to providing appropriate health education at the points of sale. A Memorandum of Understanding was signed between the Sri Lanka Medical Association and the DSI group (Pvt) Ltd on the 3rd of December 2013 at SLMA Board room by Dr B.J.C. Perera (President SLMA) , Dr Sam Rajapaksa (Chairman DSI Samson Group (Pvt) Ltd) in the presence of Mr Nandadasa Rajapaksa

(Chairman D. Samson & Sons (Pvt) Ltd), Dr Samanmaali Sumanasena ( Secretary SLMA), Mr Chandrasiri Sumanasekara (Business Development Manager), Prof Chandrika Wijeyaratne (Chairperson, NIROGI Lanka Project) . As another objective of the NIROGI Project, a training on custom made foot wear production will be given to 10 senior workshop technicians and Prosthetics and Orthotics (PnO) officers from the Sri Lanka School of Prosthetics & Orthotics, Ragama, hospitals island wide and 2 workshop technicians from the DSI group at two centres of excellence in South India. The Ministry of Health has extended their fullest support in this novel initiative. Compiled by Nirogi Team

SLMANEWS

Desember, 2013

Anatomy Block Centenary Commemoration – Faculty of Medicine, University of Colombo

he Department of Anatomy, Faculty of Medicine, University of Colombo celebrated its hundredth anniversary on the 3rd of November 2013. The “Block”, as the Anatomy building is well known, was opened in 1913 by Sir Robert Chalmers, the then Governor of Ceylon. Since then generations of medical students have passed through its doorways and taught by eminent academics. The Anatomy Block Centenary Commemoration was a celebration of this architectural monument and heritage of scholarship. The Commemoration was organized by a team of academics, non-academics and medical undergraduates led by the Head of the Department of Anatomy, Dr Madhuwanthi Dissanayake, under the patronage of Prof. Rohan Jayasekara, Senior Professor of Anatomy and Dean Faculty of Medicine, Colombo. The event was graced by Prof Kshanika Hirimburegama, Chairperson, University Grants Commission. Retired senior academics of the Department of Anatomy, Professors, Deans and Administrative Officers of the University of Colombo and academic and non-academic staff representing all departments of the Faculty, students, Members of Sri Lanka Medical Association(SLMA), the Colombo Medical School Alumni Association

Prof. Kshanika Hirimburegama, Chairperson University Grants Commission being welcomed to the Anatomy Block Centenary Commemorations by Prof. Rohan Jayasekara Dean Faculty of Medicine, University of Colombo

(COMSAA) and many other distinguished invitees were among the participants.

us the courage to face the present with confidence and the future with expectancy. ”

The Sunday morning event started with the Welcome Address delivered by the Head of the Department of Anatomy Dr. Madhuwanthi Dissanayake. This was followed by the Keynote Address by Professor Rohan Jayasekara who was introduced to the gathering by Dr. Ajith Malalasekara, Senior Lecturer, Department of Anatomy. Professor Jayasekara recounted the significant milestones achieved by the department over the last 100 year in his Keynote Address titled “100 years and Beyond”. Along with the illuminating details of history retold, a few inspirational thoughts were expressed and are as follows :-

A Centenary Souvenir with extracts of the Keynote Address and many interesting contributions from the alumni received from distinguished medical professionals, medical students and well wishers was launched on that day by Dr Madhuwanthi Dissanayake, Head, Department of Anatomy, University of Colombo and Dr Nirmala Sirisena, Lecturer Department of Anatomy and Head Souvenir Editorial Committee. The Souvenir is a precious collection of memories shared in the form of prose, poetry and photographs, a collector’s item of over 90 pages.

“Our Centennial offers us not only the occasion to celebrate our distinguished history, but also provides a window through which we can begin contemplating our future.” “This year, as we celebrate the centenary of this department and as we launch into its next millennium, the dignified maturity and the firm spirit of initiating, innovating and implementing has never burned so bright.” He concluded with the words, “This Department basks in the glory of a rich past. Today, faith has given

Prof. Rohan Jayasekara Senior Professor of Anatomy and Dean Faculty of Medicine, Delivering the Keynote Address

The day was filled with remembrance of pioneering Professors of the Department who worked for the Department, Faculty and the Nation. The Anatomy museum, which contains specimens meticulously dissected through the years, was dedicated on this day to the memory of the late Prof P.S.S. Panditharathne, Chair of Anatomy from 1975 to 1998. Many of the specimens seen in the museum were dissected by him and placed in the museum for the learning of generations of students. His citation was read by Dr. D. J. Anthony, Senior Lecturer, Department of Anatomy, Faculty of Medicine, Colombo.

A section of the audience present at the Anatomy Block Centenary Commemoration

Contd. on page 18

SLMANEWS

Desember, 2013

Contd. from page 16

Anatomy Block... The Sunday morning event started with the Welcome Address delivered by the Head of the Department of Anatomy Dr. Madhuwanthi Dissanayake. This was followed by the Keynote Address by Professor Rohan Jayasekara who was introduced to the gathering by Dr. Ajith Malalasekara, Senior Lecturer, Department of Anatomy. Professor Jayasekara recounted the significant milestones achieved by the department over the last 100 year in his Keynote Address titled “100 years and Beyond”. Along with the illuminating details of history retold, a few inspirational thoughts were expressed and are as follows :“Our Centennial offers us not only the occasion to celebrate our distinguished history, but also provides a window through which we can begin contemplating our future.” “This year, as we celebrate the centenary of this department and as we launch into its next millennium, the dignified maturity and the firm spirit of initiating, innovating and implementing has never burned so bright.” He concluded with the words, “This Department basks in the glory of a rich past. Today, faith has given

us the courage to face the present with confidence and the future with expectancy. ” The Department of Anatomy conducted an Educational workshop titled “A Journey through the Human Body” in August of this year for G. C. E. Ordinary and Advanced Level students as part of the centenary celebrations of the Department. The motivating idea behind this was to instill in school children an enthusiasm and curiosity about the Anatomy of the human body and hopefully promoting enthusiasm towards a career in medical and allied health specialties. This event was a collaborative effort of the academics of the department, research assistants, non- academic staff and medical students. During the Block Commemoration Ceremony the service rendered by the non- academics, research assistants and medical students were duly recognised by presenting them with certificates of appreciation. Following the Vote of Thanks proposed by Prof Vajira Dissanayake, Professor in Anatomy, the participants of the Centenary Commemoration had the opportunity to relive

Invitees of the Anatomy Block Centenary Commemoration visiting the Old Anatomy Lecture Hall/ Amphitheatre

their past as medical students of the Block, through a guided tour of the Old Anatomy Lecture Theatre by two senior lecturers of the department, Dr. Mirna Kumaradas and Dr. Hemali Goonesekara. Declared a Historical monument by the Conservation Division of the Archeological Department, this amphitheatre is currently in the process of being renovated. The commemoration concluded mid-morning with many participants being immersed in the glorious past; listening to inspiring speeches, meeting their fellow batch mates, recounting tales of student days and wandering through the Old Anatomy Amphitheatre. Dr. Madhuwanthi Dissanayake and Dr. Dulika Sumathipala Reproduced with the permission, CoMSAA News, Volume 3 Issue 1.

The Mobile: The Great Leveller

Those were the days when we had no phone Hence from a neighbour, a man well known, To book or receive an urgent call We had to, almost on bended knee, fall.

The husband forgets to take the front door key Wife too leaves, to supplement income, family An SMS says 'the key is under the potted plant three' I kept it there where nobody can see!

Advances in telecom tech. at a fast pace Wiped out the difficulties we had to face Today mobile phones have come to stay No more from a neighbour a favour to pray.

At an inconvenient time when one seeks doctor's attention To avoid embarrassment or sometimes confrontation The ruse adopted is 'I have an urgent call' I have to go- a fractured leg after a fall!

Even the coconut plucker on top of the tree Asks the landlady 'Am I to pluck any more?' No, says she; when obtained 'free' The cook will waste or pass to next door!

An office clerk meets a long standing friend Shall we over a drink, some time spend? To avoid an anxious wife's many a query

Says 'urgent office work to attend, don't worry'! The handy gadget is a friend indeed Used unwisely-you pay for the misdeed! Kids using it may go astray If parental supervision is in disarray! So you see this marvel of a phone Will keep you company even when you're alone Whether rich or poor it gives a quality service When misplaced or 'low' battery, how i sorely miss!

Dr. Nanda Amarasekera

Brand of paracetamol

Assuring our continous support for the medical profession

SLMANEWS

THE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION

If undelivered return to: Sri Lanka Medical Association. No. 6, Wijerama Mawatha, Colombo 7 Registered at the Department of Post Under No: QD/27/NEWS 2014