Padraig Colman

Rambling ruminations of an Irishman in Sri Lanka

Guinea Pigs International

This article appeared in Lakbima News on Sunday October 24 2010.

Recent revelations that American “researchers” deliberately infected unsuspecting Guatemalans with syphilis and gonorrhoea show us what “science” can mean in the real world of medicine and pharmaceuticals.

Some time ago, I started a discussion about cholesterol and statins on a blog frequented by many medical doctors. I said that I was in favour of science and rational argument and instinctively against hippy-dippy, new-agey unsubstantiated nonsense. The problem is, science says one thing is good today, another thing is good tomorrow.

One blogging MD told me: “Alternative medicine purports to have access to ancient ‘truths’ or ‘wisdom’ that has not changed over centuries or millennia, but there is no such thing as ancient truth or wisdom.” One might retort that if something had been effective for centuries without ill-effects, why knock it?

She also said: “Doctors have had extensive, intensive and expensive training. They also keep up with the latest research and developments. They know more than the layman. In order for anyone to determine whether a treatment has merit or is a fraud, they MUST have a good working knowledge of science and statistics (or trust someone who does). Otherwise, they simply cannot accurately evaluate the alternatives.”

What does all this talk about modern medicine being more scientific than alternative medicine amount to? In an ideal world it would mean that modern remedies are superior to traditional ones because they have been subjected to rigorous scientific tests to ensure their efficacy and safety.

Does this happen?

In the US, the FDA (Food and Drug Administration) regulates about a quarter of the nation’s domestic economy, including medical treatment. The Center for Drug Evaluation and Research (CDER), is the part of the agency that regulates prescription drugs. Before a drug company can sell a drug, it must sponsor clinical trials to prove to CDER that the drug is reasonably safe and effective.

CDER’s basic requirement is simply that most new drugs need to be proved to be better than nothing. The drug trial only compares the new drug with a placebo not with existing drugs. The drug companies pay fees for each drug reviewed, so it is in the agency’s interest to review as many drugs as possible as quickly as possible. This method of funding means that the FDA/CDER sees Big Pharma rather than the pill-guzzling public as the client. In 2003, the Health and Human Services inspector general found that 18 % of CDER reviewers felt pressured by their superiors to recommend approval of drugs against their better judgment.

We patients who want to trust our doctors and those dedicated scientists labouring to improve our health might still have in our minds the fantasy that drugs are tested in hospitals and universities by saintly white-coated, Mekon-domed boffins.

Today’s reality is somewhat different. One way or another it is the pharmaceutical industry that funds testing. The old way has proved too expensive and clinical testing has been privatised and out-sourced. About 70% of clinical trials now take place in the private sector, often in the offices of private physicians or at dedicated sites. Contract research organisations (CROs), such as Parexel, Quintiles, PPD and Covance, have built themselves into corporate giants. SFBC was named one of the best small businesses in America by Forbes magazine. For ten years it was paying immigrants to be test subjects at the largest testing centre in North America in a dilapidated former Holiday Inn in Miami with a record of numerous safety and fire-code violations. There are also offshoot businesses like patient-recruitment agencies who supply the human guinea pigs.

A contract researcher does not come up with original ideas, or design research protocols, or analyse research results, or write them up for scientific publications. The pharmaceutical company does all that stuff. A contract researcher earns big bucks for few hours. A part-time contract researcher conducting four or five clinical trials a year can earn an average of $300,000 in extra income. In 2000, a full-time clinical trial site earned an average of $1.6 million.

The raw material is not research intellect or even the drugs, it is the people who are “ready-to-recruit”, in the industry jargon. Ready-to-recruits are often sick people who are also very poor. A WHO official estimates that 20,000 clinical trials are initiated each year. The guinea pig pool in the west is becoming depleted because everybody is already on some medication. ‘Treatment-naive’ subjects are easier to find in the developing world. Between 1991 and 2005 the number of clinical trials conducted in the developing world rose from 10% to 40%.

The drug companies do not encourage their Eastern European testers to come up with bad results. One physician said she had done a clinical trial on a drug that appeared dangerous. The sponsor ignored her and successfully submitted the drug for approval. The drug was later withdrawn from the market. “We never got a contract from that manufacturer again”.

Industry-sponsored trials published in medical journals consistently favour sponsors’ drugs. Negative results are not published, positive results are repeatedly published in slightly different forms, and a positive spin is put on even negative results. Thirty-seven of thirty-eight positive studies of an anti-depressant were published. Of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome.

There have been more general criticisms, some of them reported by a Parliamentary committee, of the MHRA, the UK equivalent of the FDA. As with the US system, problems arise because funding is provided by the pharmaceutical companies, which leaves much room for conflicts of interest.

Bioethicist Art Caplan is concerned that CROs are often told by pharmaceutical companies to “just get us the data on the deadline”, and “don’t get asked questions on how that’s being done.” The Association of CROs boasts that CROs conduct clinical trials 30% more quickly than the pharmaceutical companies that hire them.

In the November 2008 issue of Prospect magazine, Jim Giles wrote about Merck’s painkiller, Vioxx: “It is no surprise that marketing divisions spin results, but we expect scientists to be objective. This assumption is dangerous. The company’s scientists did not receive an edict from the board demanding a cover-up, or an e-mail suggesting the deaths of patients be ignored. The problem was that so many scientists at Merck stood to gain if Vioxx did well. When it came to judging risks, risks that in many cases were borderline and could be ascribed to other causes, they were unable to make the right call.”

Forgetting to Forgive – Amnesia, Forgiveness or Revenge?

This article appeared in Lakbima News on Sunday June 5 2011

 

Always forgive your enemies – nothing annoys them so much.  Oscar Wilde

 

In cyberspace no-one can hear your virtual scream. There is blood on the blogosphere. I have been contributing to a US-based blog site for the past three years. Mostly, it has been a pleasant experience because there have been a lot of smart, cultured and knowledgeable people putting in their two-cents’ worth. I am trying to extricate myself now because I have attracted the attention of a paranoid stalker who persistently misunderstands and bad-mouths me.

 

One good thing that has come out of this is that someone I had a battle with a couple of years back has leapt to my defence and we have become firm friends.

 

The film critic Mark Cousins has noted the current prevalence of vengeance as a theme in Hollywood movies. One of the questions of our time is how a tribe that has been harmed finds peace. Movies which show returning harm to those who harmed seem to give comfort by ventilating an audience’s feelings of impotence. Blog-warriors get some satisfaction by keeping anger alive and espousing vengeance as if life were a movie.

The poet, Charles Simic, wrote about the genocidal crimes of the Croat Ustashi in the 1940s and the crimes of the Serbs in the 1990s: “Many the world over believe this is the only way; that the survival of their people justifies any crime they commit. They find the scruples of those who cringe at the shedding of innocent blood in pursuit of some noble cause naive and repugnant”.

Events in Sri Lanka in 2009 prompted a friend in the UK to write to me: “Why can’t they forget race and religion and just get on with each other?” People often say similar things about Northern Ireland. Ordinary people generally do want to get along and often succeed in doing so. Unfortunately, there are economic factors and historical myths stoking conflicts.

The non-violent civil-rights protests in Northern Ireland were hi-jacked by the Provisional IRA who appointed themselves protectors of the Catholic community and hitched the issue to their own nationalist agenda of a united Ireland.

On a visit to Northern Ireland the Dalai Lama said: “Some differences, some conflicts will always be there. But we should use the differences in a positive way to try to get energy from different views. Try to minimize violence, not by force, but by awareness and respect. Through dialogue, taking others’ interests and sharing one’s own, there is a way to solve the problems”. He put his arms around a Catholic priest and a Protestant minister and tugged their beards.

Irish nationalists have long memories about the crimes of Cromwell. Gloucester builder, Fred West, and his wife Rosemary murdered an uncertain number of young women in the basement at 25 Cromwell Street. He was charged with eleven murders but there were probably many more. Most of their victims were waifs and strays, but one was from a middle class family, an art student from a loving family who happened to be in the wrong place at the wrong time. Lucy Partington, the cousin of writer Martin Amis, was waiting for a bus when Fred and Rose offered her a lift. Lucy’s sister, Marian, writes movingly about Rosemary West: “Her story seems to be about the impoverishment of a soul that knew no other way to live than through terrible cruelty. A life deprived of truth, beauty or love. I imagine that the deviant ignorance that fed her sadistic, egotistical crimes was rooted in her ruined, crooked childhood.”

 

I don’t know if I could be forgiving in such circumstances. There is a good deal of research which shows that forgiving is good for the health.[i] When people think about forgiving an offender, it leads to improved functioning in their cardiovascular and nervous systems. The research of Dr. Fred Luskin of Stanford University shows that forgiveness can be learned. In Northern Ireland, Luskin found that people who are taught how to forgive, become less angry, more optimistic, self-confident. His studies show a reduction in experience and physical manifestations of stress, and an increase in vitality.

Harold Good was President of the Irish Methodist Church 2001-2. Both Jonathan Powell’s book Great Hatred, Little Room and Deaglán de Bréadún’s, The Far Side of Revenge, mention Harold’s discreet but vital role in the Northern Ireland peace process. It was Harold who announced, as spokesman for General de Chastelaine’s decommissioning body, that the war was effectively over and that the IRA had laid down their arms.

Harold served the poor in the Dublin City mission in the 1950’s. In the 1960s he was in Ohio and later served in the largely black Methodist church in Indianapolis. Back in Northern Ireland he witnessed the horrors of the Troubles. “I wasn’t isolated in an ivory tower. I know the pain inflicted by terrorists.” In spite of this, he has referred, in a personal e-mail to me, to his “friend Martin McGuinness” , former IRA Derry Commandant and now government minister. Harold worked closely with both Republican and Loyalist prisoners with a view to their resettlement. He was the Director in the 1970s of the Corrymeela community, a centre for reconciliation between the communities. He was chair of NIACRO (Northern Ireland Association for the Care and Resettlement of Prisoners) and part-time prison chaplain at Crumlin Road prison. A key part of the Good Friday agreement was the release and rehabilitation of all political prisoners.

In his acceptance address to the Gandhi Foundation when receiving their 2008 Peace Award, Harold quoted a child who wrote: “I want to grow up in a Northern Ireland where you can look at a sunset without wondering what they are bombing tonight.” Harold commented: “Today our children see sunsets instead of bombs. As a community we have faced and accepted realities; engaged in dialogue; achieved consensus; accepted compromise and witnessed the signs and symbols of peace.”

Seamus Heaney wrote:

 

“once in a lifetime

The longed-for tidal wave

Of justice can rise up,

And hope and history rhyme.

 

So hope for a great sea-change

On the far side of revenge.

Believe that a further shore

Is reachable from here.”

 

My new blogfriend and I  studiously avoid returning to the matter of our previous dispute. We talk about different nuances of American and Asian English. We talk about his experience as a black man in the USA and in the US Marines and the LAPD. If we started to get nostalgic about our old fight, there might be trouble. When I lived in London, I walked to the train station every morning at the same time. Most days I would encounter a mother taking her small son to the kindergarten. One day she was scolding him for  fighting with a little girl. He defended himself by saying: “she hit me back first”. My blogfriend and I don’t want to go into who started it. I doubt if he will accept that he was wrong and I sure as hell know I was damned right. Forget about it!
Is amnesia more conducive to reconciliation than truth?

 

 

[i] http://www.forgiving.org/campaign/research_indiv_1.asp

Riots, Witches and Yakas

This article appeared in Lakbima News on Sunday August 21 2011

For the past couple of weeks, there has been much excitement in our Sri Lankan neighbourhood (near Badulla). Villagers are convinced that there is a serial killer on the rampage. The elderly ladies, Tewanee and Meenaachi, who work for us have been telling us that they know for a fact that women have been raped and killed in this vicinity, their breasts bitten off, their hearts torn out. Tewanee’s dogs were killed by having their throats slashed.

The fear is real. We have been told two men have been watching our house, one man dressed all in white, another dressed all in black. There have been reports of two strange men hiding in a drain near our house. A male worker who sometimes does jobs for us told us to be careful. He said the yakas jump from trees. Some might be suspicious about that worker himself. The husband of one of our workers has been expressing fears about our safety but did not worry about going away to work on lorry without telling his wife that he was going. Police have been calling at his house looking for him. His neighbour has three young daughters and his wife is always away working in the Middle East. The man is rarely at home and leaves the daughters to fend for themselves. The girls, aged from five to thirteen, are very scared by the stories of yakas.

Villagers are roaming the roads around our house with sticks and knives and setting fire to the jungle to flush the miscreants out. Strangers come under suspicion. We phoned the police one night when there were shouting mobs roaming the roads. The local police fobbed us off but we later heard that they did come to investigate. One villager said a policeman pleaded, “Please don’t hit me son. I’m a policeman. Hit the Yaka if you catch him. Kill him with your stick if you like but don’t hit me. I’m a police officer!” It does not seem that villagers suspect their own – the emphasis is on fear of strangers – but there is potential for the settling of old scores as in the Salem witch hunts and Guantanamo. The belief that the police are releasing culprits adds to the vigilante frenzy.

It is quite touching that Tewanee has invited us to stay at her home out of fear for our safety. Our neighbours are related to the people living below them. There is no love lost but they insisted that they all stay with them for safety.

We heard of an attack at two-mile post another at seven mile post. We heard that a man had been chased by a mob with sticks and knives and he had hidden in the jungle near the Tea Research Institute. We asked a doctor friend who works in Badulla near the general hospital if there was any truth in these rumours. He said there had been attacks but he had not heard of any deaths. Sightings got closer to our home. We phoned the local police chief. At that very moment he was in a meeting with the manager of the tea estate next to the one on which we live. The OIC (Officer in Charge) told us there was nothing to worry about, These were just wild rumours. He said there was no truth either in stories that children were being abducted from the lines (the estate accommodation for tea pluckers and labourers).

The manager on another tea estate, someone with whom we often socialise, also pooh-poohed the idea of attacks on women. However, later in the conversation, he admitted that he had taken a woman to hospital after she had been attacked on an estate road and badly scratched She had been with another woman who ran away.

The attacks are being blamed on bhuthaya, grease yakas or grease devils. Historically, a “grease devil” was a thief who wore only underwear or went naked and covered his body in grease to make himself difficult to grab if chased. Lately, the “grease devil” has become a night-time prowler who frightens and attacks women. Some of the reported attacks around here have been in daylight.

The name ‘Grease Devils’ was used in connection with the killings of seven elderly women in Kahawatte, near Ratnapura. On July 5, 2011, about 2,000 people protested about the ineffectiveness of the police. According to human rights campaigner Basil Fernando: “The most attractive aspect of policing in Sri Lanka today is no longer investigation into crime and serving the people. It now appears to be the improvement of one’s own position, and to make money. There are many avenues open to senior police officers to do just this which makes worrying about criminal investigations an inconvenience…the authorities are more concerned about damage-control rather than trying to arrest the culprits. After the scandal goes away it will be business as usual, meaning that criminal investigation will remain no one’s business, as before.”

A man was arrested on Friday July 7 in an operation conducted by a special police unit assisted by the CID and the Ratnapura police. He broke the necks of these women before he raped them and dumped the bodies in jungles around Kahawatte. The suspect is a 35-year-old  army deserter known as Dhananjaya. The killing spree began in 2008. It is said that the suspect is mentally impaired, having had a bullet graze his skull whilst serving at the front during the war. He deserted from the army while stationed at Vedithilathiv and moved to Kahawatte. He started by stealing women’s underwear and later peeped at women asleep in their beds or taking showers. This escalated to forcibly embracing women. “When I look at young women I am not attracted to them. But when I look at middle-aged women, I am sexually aroused,” Dhananjaya had told the police during interrogation.

There have long been rumours about feral bands of army deserters living in jungles and swooping on remote villages to plunder and rape.

Initially, there was not much in the newspapers despite accusations by the authorities against “the media” about distortion and panic-mongering. All the news was by word of mouth. There were rumours of incidents all over the country. A friend of ours, an Englishwoman who lives in the Kalutara area on the west coast, told us that on three separate occasions she has been scared by three different men staring in through her windows. One of them was naked.

A 16 year-old boy who posed as a ‘Grease Yaka’ and attempted to rob a house in the Badulla area was arrested. The youth along with another friend had rehearsed for the robbery and captured his own photograph on his mobile phone before he was detained by the villagers and handed over to the Police.

Ushanar Marzuka, 31, a mother of two living in a remote area in Valaichchenai in the east, was accosted by two men clad in T-shirts and shorts with faces painted black. One of them cut her with a sharp object he carried in his hand. More than 100 villagers, some of them armed with clubs started searching for the two men. They caught a man and beat him up. He had said he was visiting one of his relatives.

A masked man who was terrorising people in the Sigiriya-Dambulla area was arrested by police on August 13. Police said the 34-year-old suspect was hiding inside a wooded area on the Sigiriya border when he was apprehended around 7.30pm. The police were led to the suspect’s hide out on a tip-off provided by local villagers. At the time of his arrest he was in possession of a bag loaded with women’s under wear.

There have been deaths. Police said that two unfortunate men killed at Thotalagala estate in Haputale, not far from us, were two travelling rug salesmen, though villagers identified them as ‘Grease Devils.’ The police identified the victims as Somasundaram Mahendran (29) and Sylvester Dias Jonny Peter (35). Fifty Special Task Force personnel had been deployed at the Thotalagala Tea Estate. Earlier in the day in the villagers had assaulted two men apparently in the presence of police. This led to a clash between the police and villagers, in which the OIC and a constable were injured. Because of this police had delayed about five hours reaching the scene at Thotalagala estate.

In Daulagala, near Kandy a 23 year old youth who was among a group of villagers giving chase to a suspicious person got entangled in a live electrical wire set to a trap wild boar and was electrocuted.

 

A mob attacked the navy camp in Kinniya, Trincomalee after assuming that a suspect had taken refuge inside the premises. The mob believed the suspect was a man with grease on his body. Over 500 people gathered around the navy camp, pelted it with stones and also set fire to a jeep which arrived at the scene with police reinforcements. The Sri Lankan police said that at least three people including a police officer were injured in the attack and 25 people were later arrested.

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