Global Governance to Take Over – Watch the Politics & Not the Planets –

Global Governance to Take Over – Watch the Politics & Not the Planets – Dr Lalith Mendis

One has to face the fact of emerging pressure for global governance (GG) is real & is predicted in the Scriptures. All forces are being harnessed to this end

  1. Pharaoh (global fuehrer, Machiavellian Prince) & his elite will make serfs of the populace & for this they need Taskmasters. You remember Pharaoh appointed taskmasters from among Israelites. Similarly GG will recruit National Leaders – politicians & Biz magnates to carry out their program.
  2. Global Warming which is fact, is made to be linked to human activity. Carbon print & legislation to subjugate National Governments is the reason for the push on reversibility of global warming.
  3. Concentrate the world’s wealth in the hands of a few. Electronic currency will facilitate this. Subvert National Govt with Black economy where more money runs through, outside the system of legal state governance. This is happening already
  4. International Protest Movement against “Old Order” to bring in Global Government – Syndicate of Fake press, Elite, Entertainment moguls – who create aggressive intolerant. public opinion.
  5. Recruit Heads of State who are pro Global Govt. Destroy Heads of State who are Pro Nation
  6. Massive drive to reduce population – LGBT, abortion, euthanasia & other methods of “Darwinian” social engineering.
  7. Massive drive to break up family authority & that’s why the LGBT agenda. So that children are accessible to state control
  8. Violate National Boundaries with war & migrant crises. Create seamless territories – violate cultures to create trans global culture. Human rights issues – after creating minority battles in nations & funding them
  9. Increase contentious child rights for govt to take over children E.g. Canada – take over kids if parents oppose gender change operations. Push for no sex identity for child at birth.
  10. Push e-learning & monolithic digital culture to facilitate digital global governance of the muppet society created by the ash screen
  11. Global humanistic religion to facilitate One World Order
  12. Fiddle with Health & Agriculture until global laws are made to look inevitable & much needed.

Don’t watch planets – watch the politics, economics & the Ecology. Noah (2500 BC) became famous with the Hollywood blockbuster (untrue to original Text). Noah’s time had Nephilim – those who fall violently on others. An Oligarchy like at Babel later (2000 BC). “Luk 17:26  And as it was in the days of Noah, so it also shall be in the days of the Son of Man”  It was predicted that when world’s time is winding down, it can be known by the rise of a similar oligarchy & Machiavellian Prince who will concentrate political power & economic hegemony in the hands of a few supported by a populist secularist religious leader. Destruction of the Nation State & establishment of the Global Economic order is “apocalyptic”. Don’t watch planets – watch the politics

Politics Spews out Dogs of War (With apologies to Martin Niemoller)

Psa 59:6-7  They return at evening, they howl like a dog, And go around the city.  (7)  Behold, they belch forth with their mouth; Swords are in their lips, For, they say, “Who hears?” Psa 59:15  They wander about for food And growl if they are not satisfied.

  • They came for politics & we cared not
  • They came for medics & we joined the fray
  • They came for my antagonist & I rejoiced
  • They came for me & there was none for me


Understanding the New Left Liberal (NLL)

These are today (July 8th 2017) on the streets of Hamburg, causing havoc, asking Governments of G 20 nations to “go to hell” – which hell they deny!!!   They are anti Govt, anti nation, anti capitalist, anti family, anti marriage, anti truth, anti establishment, anti boundaries, anti authority. The Old Left fought to save their nation from Imperialist expansionism. New Left fights to dismantle nation claiming any stand up for your nation as racist, demanding polity without boundaries – they serve the globalist expansionism – fake press their marketing evangelists & neo liberal economists their prophets. Digital screen plays a vital & destructive role on gender blurring – often heroes & monsters are sexless.


Raven Spirit

Pro 30:17  The eye that mocks a father And scorns a mother, The ravens of the valley will pick it out, And the young eagles will eat it.

Ravens turn a blind eye to what they eat – they feed on refuse. Increasingly a generation arise whose habits of consumption (sexually & otherwise) are voracious & unclean. Once you turn the ravenous eye to some refuse, it will recommend much worse & much worse will appear attractive – internet capitalizes on this consumption. All other birds know where to find their food – honey or fruit. So they quietly go about & joyfully sing when filled. Not so the crow. They crow much – for no reason or for little reason such as finding some refuse. Raven’s hunger is never satisfied – so the term ravenous hunger, roaming all day everywhere looking for the next refuse. They also drop refuse from one place to the other. They fight with each other for food – this is very rare with other birds. A generation arise who compete like ravens for a market portion. Many a bird nest will look like a work of art. Unkempt hair is likened in the vernacular to Crow nest. Matt 13:4 suggests that ravens pick out life giving words from those who pursue a wayward life. Raven left the safety of the Ark of Noah, preferring the refuse & carcasses that were floating after the flood. Raven left the mission on which its mater sent & joined the morass after the flood.

A generation whose sight is affected by Ravens – Pro 30:17  The eye that mocks a father And scorns a mother, The ravens of the valley will pick it out, And the young eagles will eat it.

  1. The application is reciprocally true – Ravens pick the eye & you can’t see who you should bless & from whom you can receive blessing. A generation that lost father mother blessing
  2. Noah’s raven didn’t return when it could feed on carrion – defiled flesh.
  3. Gossip is like refuse – carrying it hither thither is a raven spirit
  4. Much “crowing” (protest, competition) for nothing
  5. Fight for their market portion.
  6. Roam around with dissatisfied eye
  7. Increasingly blind eye that consumes increasingly filthy stuff – Once you turn the ravenous eye to some refuse, it will recommend much worse & much worse will appear attractive – internet capitalizes on this consumption.

Dogs of War in Political arena – we have to move in opposite spirit of shalom. We can’t for one moment react, retaliate, bad mouth, curse or pour vitriol – we lose on their turf. We do reconciliation & restore, bless & beam – shine light, We broke the fallow clods of our heart & called for rains of righteousness on the nation, body politic. We do not bear swords in politics. We bear the shield of forgiveness. We ask rain righteousness to dowse inflamed political passion such as in Hamburg with protesters or in US against Pres Trump or in UK barbs sent against PM Theresa May or in SL the dog fights of politics – all are amenable only to long duration righteous rain on her polity

We must not bear swords in politics or in broken relationships which once were dear. For most swords are words – cutting, piercing, biting, sharp, bruising, blood letting WORDS. Then as peace makers we can bear our shield. What can that shield be? Words of hope for our nation’s destiny – we know no other nation will treat us as well our SL. We can speak words of reconciliation, truth where lies multiply, cool where heat emanates. We bear the shield of forgiveness.



World Without Mind – Existential Threat of Big Tech – Franklin Foer

World Without Mind – Existential Threat of Big Tech – Franklin Foer

Fears about the “existential threat of big tech” usually focus on autonomous weapons and how to control superintelligence before it has the power to control us. That’s not so for Franklin Foer, The Atlantic staff writer and former New Republic editor-in-chief. His new book World Without Mind is out this week, and it’s about a different type of existential threat.

He thinks that the big tech companies — Google, Apple, Facebook, Amazon — are “destroying the possibility of contemplation” and making us turn away from the intellectual work that, he says, makes us human.

The Verge spoke with Foer about fake news, why there’s too much attention on Silicon Valley libertarianism, and how food can serve as a model for a cultural revolution.

This interview has been lightly edited and condensed for clarity.

What got you started thinking about the “threat” of Silicon Valley? I assume the book was written before the election. How much did the election change its message?

The ultimate genesis of this book was when Amazon had its big fight with the Hachette publishing group in 2014. Amazon was trying to renegotiate its contract with e-book vendors, and it was really, really aggressive in trying to set the terms. There was really no way of resisting, because their dominance over the book industry was so pervasive.

And then, things blew up at The New Republic with [Facebook co-founder] Chris Hughes. The confluence of those two things sent me down a road where I started thinking hard about Silicon Valley’s influence in the spheres of media, publishing, and culture.

I think I handed in my book on November 1st, 2016, so only a couple days later did I awaken and realize I’d written a book about fake news and the rise of Donald Trump. So I went back and I made amendments to take note of that.

The subtitle of the book, “The Existential Threat of Big Tech,” caught my eye. I’ve done some reporting on “existential risk,” and it usually refers to global catastrophic risk, like nuclear war or pandemic, not the types of threats you’re describing. What made you choose this subtitle?

Of course, what I’m describing is not as quite as apocalyptic and explosive as as nuclear war, but there’s a threat that challenges our very existence as human beings. What I worry about ultimately is that when we’re stripped of our privacy, when we’re stripped of free will, when we start to merge with machines in a more robust way, at some point, we’ll cease to be identifiably human. And therefore, I think our humanity is in some ways the thing that’s under existential threat.

There are people who love the idea of our humanity being augmented. They think it’s a good thing. More intelligent, stronger, and so on.

Author Franklin Foer. Photo by Evy Mages

They’re living in a science fiction fantasy world. The problem is that we’re not just merging with machines, we’re merging with the companies that make these machines.

It might be one thing if we were gaining intellectual powers that we had full control over, but we don’t. Right now, four or five big companies control the machines we’re using. It doesn’t mean their tools aren’t useful, but the danger is that the companies influence us in really subtle ways. If you think of data as kind of an x-ray of our soul, it’s this window into our minds that the company has possessed. It’s a very, very powerful x-ray for them to hold because the more that you understand about somebody, the easier it is to manipulate them.

And you think we’re being manipulated into giving up our privacy? The book mentions that Silicon Valley libertarianism gets all the attention, but you say that the “collapse of the individual” is actually the guiding ethos. How did you come to that?

To be clear, “Silicon Valley” is a fairly glib and imprecise term, so when I use it, I am referring to its elites, and to its thought leaders, not to the average engineer.

I started just watching every YouTube video I could get of a town hall meeting featuring Larry Page, Mark Zuckerberg, and so on. I started listening to what they were saying and it wasn’t a lot of screeds against government or celebrations of the heroic individual. What I found was this love of all things social. The network is the most fetishized concept in the valley, and as I listened, I began to think the real danger was the collectivism. They were so obsessed with achieving some sort of new global consciousness, and I found them to be completely immune to all reasonable anxieties about the state of the individual.

If supposed libertarianism is getting too much attention, which attitude do you think we’re not looking at enough?

Monopoly. When you listen to most people in Silicon Valley talk about the network they talk about it as a winner-take-all system. The idea of the network is that you make a bet on the right company and they capture the network and all the other market players disappear. I think that’s a very common way of thinking.

If you listen to the way that people like Larry Page talk about competition, they abhor the idea of competition. They think of it as something that’s almost beneath them. So rather than competing against Apple, or Uber, they would much rather focus on their moonshot ideas and doing something truly transformational, and this replicates language that we’ve heard throughout history.

Monopolists always defend their monopolies by arguing that competition is wasteful. When the railroad barons completed their monopoly, they argued it would be wasteful to have competing rail lines, AT&T said the same thing. But today, the size and scope of these monopolies is different. They just aspire to encompass the totality of human existence, and you see that in the current race to become our personal assistants. These companies never really want to leave our side over the course of the day.

And these are intellectual technologies, which is a little bit different. These aren’t transportation technologies, these aren’t industrial technologies, these are technologies that provide us with a filter for the world. There’s no care for authorship or intellectual property.

I don’t think that all of Silicon Valley is anti-intellectual. You’re always seeing these lists of “books that Bill Gates reads.”

In the epic war over Silicon Valley’s intellectual property, Bill Gates was on the side of licensing copyright and robust protections for intellectual property. He wasn’t on the side of the hackers, and he didn’t want information to be free. That information wants to be free is really at the core of the problem, because that too is kind of a utopian countercultural ideal that sounds awesome in the abstract and has a lot of problems that come with it.

And this has to do with the intellectual forebears of Silicon Valley? You link today’s attitudes fairly closely to the communes of the 1960s.

One of the great coincidences in history is that the counterculture and the technology industry grew up side by side in the San Francisco mid-peninsula and the two rubbed up against one another and rubbed off on one another. A lot of the early champions of technology in Silicon Valley were hoping to replicate the commune, and in the late ‘60s and early ‘70s, hordes of people retreated from the cities and from conventional lives to live in communes. The idea was that you’d go back to the land and you’d get some sort of new consciousness that would show how everything relates to everything else and that living in this collective sort of existence would make us all much better human beings.

If you look at the history of the network and the history of Silicon Valley, it’s really a way to try to capture all the wonderful things that were promised about the counterculture. The only problem with that vision is that all these countercultural concepts like “network” were soon captured by big firms who saw the biggest business opportunity in human history. The vision was less about a new consciousness than it was all about making money.

Reading the book, one sentence in particular grabbed me, which is “the tech companies are destroying the possibility of contemplation.” I think it seems to sum up the main argument. Did I understand correctly?

That’s exactly right, and I worry that when we’re always being watched we cease to feel comfortable thinking subversive, original thoughts. There’s a whole ecosystem of journalists and book publishers who are getting crushed in this new economy and it’s their words that are necessary to be contemplative human beings. We’re being dinged, notified, and clickbaited, which interrupts any sort of possibility for contemplation. To me, the destruction of contemplation is the existential threat to our humanity.

You said that after the election you realized that, in a way, you’d written a book about fake news. How so?

Facebook permits an ecosystem where we get the news and information that confirms our biases. We become less skeptical and more susceptible to charlatans who are trying to deliver us information that we’ll agree with. There’s a terrible feedback loop that Eli Pariser called the filter bubble, and that’s the thing that makes fake news possible. But to go even further, back to our discussion of contemplation, if we allow ourselves to exist in this haze where we subconsciously go from click to click, we don’t pause or slow down and think deeply. Then we’re all going to be less on guard against propaganda and fake news.

What’s your big-picture suggestion for avoiding this?

We need to have a bit of a cultural revolution to reset things. The most hopeful thing I can look at is food. For generations, we were fed processed crap, and only belatedly did we start to care about what we put in our mouth, and even then it was a very “elite” phenomenon. But it was significant because that’s a pretty good instance of people deciding that efficiency isn’t the most important thing and that we need to try to protect the people who actually produce the food we consume. The quality of what we consume in some ways is directly correlated to the way we treat the producers.

We need to treat culture as something that is incredibly important and incredibly worthy and incredibly virtuous. We should think of ourselves as better human beings, if we’re consuming the “right” intellectual goods. That’s a very elitist sort of attitude, but I think we need to have that sort of elitism in order to set the terms for the entire intellectual economy, and also it improves the culture. Our culture is only good if we have standards about what’s worthy and what isn’t and paying for things is a pretty good sign of something being worthy.

At the same time, it seems like people are blaming elitism and saying that we need to know “real Americans,” Elitism is not very popular right now.

I think a failure of elitism is the problem. People hate elites because elites have been not just asleep at the job — they’ve been championing the market in a really blind sort of way. People are right to resent them. I mean, this idea that people should get what they want, as I’ve said, is a very dangerous notion and elites have let so much go in this country. They do deserve a lot of blame.


Abortion – Surgical Solutions for Sociological Ills. Silent Holocaust

Abortion – The Child in the Womb Loves You & Knows You – Dr Lalith Mendis

Is the Foetus Protected by the Law of Persons or Property 

By the time your child in your womb is only 22 weeks she will not kick when you are asleep. She knows your sorrow & can recognise the last song you heard over the CD player. He already knows your heart beat. When you breast feed her, she will recognise that same heart beat. How can you think of destroying that child?  Legalising abortion for conception after statutory rape and for disabling congenital malformation seems a reasonable viewpoint for many. The issue is – who gives us authority to execute another person? Such execution and legalisation is unnecessary, since the “morning after pill” can effectively block conception after statutory rape. As the Sinhala proverb quips, “Why use an axe when a finger nail is adequate”.

The child in the womb from day one is another person. There is no way that a human conceived has to become more human as the pregnancy advances. Is the day one child in the womb, less human than the 20 week child? Is the 20 week child less human than the 40 week child? When mother claims rape will we legalise aborting the 39 week foetus?  If abortion for rape argument is valid, at any stage of pregnancy – even at 39 weeks child should be aborted. Then is infanticide of the new born (conceived after rape) also valid? If we approve abortion for the unborn because of congenital malformation, will that not validate infanticide for congenital malformation? What’s the logic that says murder in the womb is allowed and murder soon after birth is disallowed? What about those abortions over 24 weeks where the baby breathes on birth and is quickly strangulated? Or brain is damaged prior to delivery while the child is in the birth canal (euphemistically called cephalotomy) to prevent the embarrassment of the child breathing. All doctors know this is done. Alberto Giubilini of Monash University (Melbourne, Australia) and Francesca Minerva of the Oxford Uehiro Centre for Practical Ethics (UK), published a paper entitled, “After-birth abortion: why should the baby live?” And it was in the (grossly misnamed?) Journal of Medical Ethics. They argued that if abortion is OK, infanticide is also should be legitimized because the newborn is hardly human! If abortion is legalised abandonment of unwanted children will increase and murder of children congenitally deformed will happen.

Sociological Consequences of Legalising Abortion for Rape

  1. Teen pregnancies & sexual abuse of the under-aged will increase.
  2. Conservative contraceptive methods will be abandoned
  3. Infanticide will further increase – “if it is OK to kill the child in the womb why not kill the unwanted newborn” is how people already think.
  4. Any person wanting abortion will have a legal loophole
  5. Given our culture men will compel women to procure abortion rather than prevent conception
  6. We will be spilling more blood. Spilling of more innocent blood has moral consequences
  7. At present 90% of abortion is by married women


  1. Women who had abortions had experienced major depression within the last four years. That’s almost double the rate of women who never became pregnant
  2. Women who have abortions were twice as likely to drink alcohol at dangerous levels and three times as likely to be addicted to illegal drugs The risk of anxiety disorders also doubled
  3. Women who have abortions of unexpected pregnancies were 30 percent more likely to experience subsequent problems with anxiety than those who don’t have one.
  4. Women in the study who had abortions and suffered from general anxiety disorder experienced irritability, fatigue, difficulty sleeping, a pounding or racing heart, or feelings of unreality.
  5. Women having abortions face more than a doubled risk of future sterility
  6. Aborting women face a 50% increased risk of having a subsequent ectopic or tubal pregnancy. The risk was nearly twice as high (90%) for women having two or more previous abortions
  7. Decreased cervical resistance due to forced dilation may result in early cervical failure and the spontaneous abortion (miscarriage) of future pregnancies

Unwanted child” is the victim not of his own shortcomings but of those in a society attempting to solve its social, economic and personal problems by the sacrificial -offering of its children.

Concerned Professionals Forum –

Abortion ­ Who Should Decide and How?

Some argue that unplanned pregnancies incapacitate the woman and burdens society. The aged, the deformed and the mentally retarded burden the society. Should they too be eliminated? Should the depressed be provided with Kerkovan Euthanasia? What about infanticide for the unwanted newborn? When men begin to play God, some may decide that some races should be eliminated as Hitler did. The superpowers may think that some backward country should be their backyard for dumping nuclear waste.

Even desired and  planned  pregnancies incapacitate  the woman within and beyond the confinement. Abortions  are demanded for ‘unwanted’ pregnancies. Granting the abortion demand cannot  bring biological or social equality. If one views pregnancy and motherhood  as a social inequality created by nature, how will we go through desired and planned pregnancies? Has the mother got to be loaded with the  thought `oh  wretched me, I have to bear; not my husband’. No! We did not  think that way until depersonalization of 20th century man and moral relativism began to pervade our thinking. Thank God that the majority of Sri Lankan women do not think like that.


Secondly if men and women say, ‘we have a right over our body and wish to commit suicide’, will that too be granted?  Killing because the baby is unwanted will leave the door for the elimination of all kinds of unwanted persons. E.g. Old age, mentally retarded, some races.


Why was the Hippocratic oath liberalized? At a time when abortion was practiced secretively, Hippocrates thought it necessary to put his students on oath against it. Today the medical and legal professions are in the forefront of the pro-abortion debate. It is the common citizen who should decide on this, as it concerns all of society.


Hence the abortion – issue cannot be based on nature’s inequality – argument. A career woman or any other woman has only to plan her pregnancy and abortion cannot be a mode of contraception. Why have all societies initially been unwilling to legalize abortion and why did all cultures consider abortion undesirable and unethical? This is confirmed in the original Hippocratic oath in which the practitioner was required to say, ‘I will not aid a woman to procure abortion’.

What is not known by most is that many ancient civilizations had laws that proscribed abortion. An ancient Assyrian Law, dating between 1450 and 1250B.C.  recommended death sentence to those who procure abortion. (Middle Assyrian Law 53. Sumerian Laws 1-2, Lipit Islitar Laws III, 2-13, Code of Hammurapi 209-14, Hittite Law Code 17-18 similarly censured abortion). Among the Hebrews, the Bible laid down strict penalty for those who practiced abortion. Exodus 21:21-24.


Plato and Aristotle suggested that in their ideal societies abortion would be mandatory, chiefly to limit family size. Such thinking led to widespread abortions and also infanticide from exposure in the Greeco- Roman World. Even in such a context, Hippocrates clearly laid down a prohibition on abortion to his students. Hasting’s in his authoritative Encyclopaedia of Religions points out that, Christianity as it spread re-established the sanctity of the life of the unborn. Russia in 1920, legalized abortion for economic reasons. Roe Vs Wade decision in 1973 in the USA and UK abortion act of 1967, were completely against the flow of legal premises that obtained at that time. In both countries these landmark decisions have come under severe censure. We in Sri Lanka should be guided by our own premises of law making and not by erroneous precedent. Moral degradation of another country cannot be the basis of our lawmaking.


Right to the Body

Abortion must be viewed as an issue that concerns the very basis of life and society. Marriage was a social institution (a social contract) and not a private act. Sexual intercourse was meant to be a responsible contract within the MARITAL COVENANT. Two individuals by their free will initiate a new life, in the zygote. It has unique features, that neither father nor mother has.


Once fertilization has begun, one should know that he/she creates an irrevocable individuality. Neither (father nor mother) has the right to destroy the individuality. To create that new life is delegated authority from nature. There are many methods available to prevent fertilization. Once the unique potential life in the zygote is made by the will of two, who had socially contracted with the approval of society, then, no one individual should be allowed to destroy that life.


Abortion – think right!

Winds of Socio Political Change

  • Health of Woman after abortion
  • Fetal Pain
  • Sentience
  • Effect of IVF & Zygote destruction
  • Science & Sale of Fetal ATissue


Winds of Social Change

  • Original Oath of Hippocrates – “I will not help a woman to procure an abortion.
  • Changed in 1972
  • 1970 – Roe vs Wade decision in USA
  • 1967 – abortion legalised in UK
  • Abortion is illegal in Sri Lanka – but 1000 abortions a day in Colombo


Killing The Zygote

  • Destruction of excess zygotes after IVF
  • Destruction of Zygote at Pre-Implantation Genetic Diagnosis
  • Using zygotes for “Therapeutic cloning” to obtain Embryonic Stem Cells
  • Developing zygotes into fetuses in order to abort to obtain for fetal tissue for research

With the formation of the zygote a new life has begun. No one has authority to destroy that life.

Health of Woman

  • women who had abortions had experienced major depression within the last four years. That’s almost double the rate of women who never became pregnant
  • women who have abortions were twice as likely to drink alcohol at dangerous levels and three times as likely to be addicted to illegal drugs The risk of anxiety disorders also doubled
  • women who have abortions of unexpected pregnancies were 30 percent more likely to experience subsequent problems with anxiety than those who don’t have one.
  • Women in the study who had abortions and suffered from general anxiety disorder experienced irritability, fatigue, difficulty sleeping, a pounding or racing heart, or feelings of unreality.
  • Women having abortions face more than a doubled risk of future sterility
  • aborting women facing a 50% increased risk of having a subsequent ectopic or tubal pregnancy. The risk was nearly twice as high (90%) for women having two or more previous abortions
  • Decreased cervical resistance due to forced dilation may result in early cervical failure and the spontaneous

abortion (miscarriage) of future pregnancies


Increased Cancer Risk

Scientific Evidence of Abortion’s Impact

  • Thirteen out of 17 studies in the S. reported more breast cancer among women who chose abortion.36 A
  • 1996 meta-analysis of all published reports on the incidence of induced abortion and breast cancer appearing

in the Journal of Epidemiology and Community Health found, on average, a 30% increased risk.37

  • Link to Other Cancers
  • Abortion has also been associated with higher rates of cervical and ovarian cancer
  • Abortion & Breast Cancer
  • There is increasing evidence of the link between abortion and breast cancer… why aren’t women being told?
  • Professor Joel Brind has been researching this link between abortion and breast cancer for a long time.
  • His website documents the major research and studies: visit Coalition on Abortion/Breast Cancer
  • A recent major study also highlights the link – it was published by Patrick Carroll in the Journal of American Physicians and Surgeons, Volume 12, Number 3, Fall 2007.
    The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Other Risk Factors
  • His conclusion?
    “The increase in breast cancer incidence appears to be best explained by an increase in abortion rates, especially nulliparous abortions, and lower fertility.”


Welcome Changes

  • George Bush banned partial birth abortions in 2003 in the USA
  • Federal Funding for NGOO with abortion agenda in third world banned
  • Federal funding for embryonic stem cell research which kills abortions banned
  • This may have accelerated adult stem cell research producing over 70 successful cures


Unwelcome Changes

  • Obama in 2009 reverses Bush ban of federal funding for abortions & embryonic stem cell research
  • Efforts are underway to legalise partial birth abortion


Fetal Physiology

  • The first fetal movements are seen at seven weeks
  • over 20 different movement patterns have been described up to 16 weeks including hand-face contact, startle and sucking and swallowing movements
  • During the second trimester rest-activity cycles are observed
  • development of rapid eye movement (REM) periods starts at 23 weeks.
  • During the last three to four weeks complex and stable patterns of behaviour are apparent
  • Med Ethics 2001;27:ii15-ii20 doi:10.1136/jme.27.suppl_2.ii15 Medical paternalism and the fetus – John Wyatt University College, London


Fetal Development

  • first responds to sound at 20 weeks and subsequently develops more sophisticated auditory processing with the ability to discriminate different sounds.
  • Towards the end of pregnancy the mother’s voice can apparently be perceived clearly through the other sounds of the abdomen. Other responses include those to touch, changes in temperature and even the taste of the amniotic fluid.
  • From 25 weeks the fetus tries to maintain its position in space, as the mother moves around.
  • Complex cardiovascular and hormonal stress responses to invasive procedures have been detected from before 20 weeks gestation


Fetal Pain

  • As facial grimacing and aversive responses to
  • noxious stimuli can be seen in premature babies from before 26 weeks gestation, there seems to be prima facie evidence of a primitive form of awareness of pain in the fetus from this gestational age and possibly earlier.


Survival of PreTerm Infant

  • Survival at 23 and 24 weeks of gestation is now commonplace and occasional survival at 22 weeks and less than 500g birthweight has been described.
  • My own perspective, however, is that the current legal position in Britain, where late feticide can be performed, in theory, at any stage until the moment of delivery, is morally and practically unsustainable. It is remarkable that the current legal position has aroused such little public interest and debate. Surely these are issues which deserve wider discussion and debate.


Dr Anand on fetal pain

  • Dr Kanwaljeet Anand, an expert in Pediatric Critical Care Medicine and Anesthesiology, In 2005, he testified before Congress that a fetus as early as 20 weeks would experience abortion as “painful, unpleasant, noxious stimulation.” He argues that while the brain is still developing, the fetus receives pain signals in the subcortex.
  • ablation or stimulation of the sensory cortex does not alter adult pain perception, whereas thalamic ablation or stimulation does. The foetal thalamus develops in the second trimester, well before the cortex. If the sensory cortex is not essential for adult pain, why is foetal pain held to that standard?
  • Fully functioning sensory receptors appear in the skin around the mouth of the fetus at 7 weeks and spread to all skin and mucous surfaces before 20 weeks of gestation. Nerve fibers precede the appearance of these skin receptors and are capable of transmitting sensory stimuli from the periphery to the spinal cord at all times. For entire report by Dr. Kanwaljeet Anand


  • Highest Pain Receptor Density Before Birth
  • Between weeks 20 and 30, an unborn child has more pain receptors per square inch than at any other time, before or
  • after birth, with only a very thin layer of skin for protection.
  • Pain Inhibition Not Fully Developed Until Later
  • Mechanisms that inhibit or moderate the experience of pain do not begin to develop until weeks 30-32. Any pain the unborn child experiences before these mechanisms form is likely worse than the pain an older child or adult experiences

The neural pathways are present for pain to be experienced quite early by unborn babies.
   – Steven Calvin, Perinatologist, University of Minnesota
“At 20 weeks, the fetal brain has the full complement of brain cells present in adulthood, ready and waiting to receive pain signals from the body, and their electrical activity can be be recorded by standard electroencephalography (EEG)” – Dr. Paul Ranalli, neurologist, University of Toronto

Scientific evidence suggests abortion is excruciatingly painful for the unborn child.

An unborn child at 20 weeks gestation “is fully capable of experiencing pain… Without question, [abortion]is a dreadfully painful experience for any infant subjected to such a surgical procedure.    – Robert J. White, MD., Ph.D. professor of neurosurgery, Case Western R eserve University


Fetus 18 days – – Brain

  • The brain begins to take shape
  • only 18 days after conception. By
  • 20 days, the brain has already
  • differentiated into forebrain,
  • midbrain, and hind brain, and the
  • spinal cord has started to
  • (1)


Fetus 5 weeks Pain Receptors

  • Four or five weeks after
  • conception, pain receptors appear
  • around the mouth, followed by
  • nerve fibers, which carry stimuli
  • to the brain. By 18 weeks, pain
  • receptors have appeared
  • throughout the body. Around
  • week 6, the unborn child first
  • responds to touch.(2, 3)


Fetus 6 weeks – Cortex

  • In weeks 6-18, the cerebral cortex
  • By 18 weeks the cortex
  • has a full complement of neurons.
  • In adults, the cortex has been
  • recognized as the center of pain
  • (3)


Fetus 8 weeks – Thalamus

  • During weeks 8-16, the
  • thalamus develop s, functioning as
  • the main relay center in the brain
  • for sensory impulses going from
  • the spinal cord to the cortex.(1)



Fetus 14-18 weeks – 14-18 Wks – Nerve Tracts

  • In week 18, nerve tracts
  • connecting the spinal cord and the
  • thalamus are established, and
  • nerves from the thalamus first
  • contact the cortex in week 20.
  • Nerve fibers not routed through
  • the thalamus have already reached
  • the cortex by 14 weeks. (3,4)

Fetus 18 weeks – 18 Wks – Stress Hormones

  • As early as 18 weeks, stress
  • hormones are released by an unborn
  • child injected by a needle, just as they
  • are when adults feel pain. Hormone
  • levels in those babies decrease as
  • pain-relievers are supplied.(7)


Fetus Pain – Before 18 Weeks?

  • Even before nerve tract s are
  • fully established, the unborn child
  • may feel pain; studies show
  • anencephalic infants, whose cortex
  • is severely reduced if not altogether
  • missing, may experience pain as
  • long as other neurological
  • structures are functioning


Genetic Counseling for Disabilities
Over one third of a sample of obstetricians in England and Wales said that they generally require a woman to agree to terminate an affected pregnancy before proceeding with prenatal diagnosis.8 Several studies have shown that different ways of presenting risks of genetic disease result in different choices by parents.10 Similarly the identity of the person who provides counselling (obstetrician, geneticist, paediatrician, independent counsellor) seems to change the likelihood of opting for abortion.

Cow Human Embryos
in the United Kingdom cow ova (eggs) have been impregnated with human sperm (where thus far the ‘pregnancy’ is terminated before it gets beyond the two-cell stage). In the United States, 20,000 cow-human embryos are created each month, supposedly for testing male fertility.*

Dr J. Densen-Gerber, a speaker at the conference who has been asked by 11 American States to draft legislation in this area, and who hardly qualifies as the lunatic fringe, was quoted as saying: ‘If you don’t think there are Frankensteins sitting in the world’s laboratories playing God, I think you don’t really understand what’s going on.’


In Rethinking Life and Death, Singer takes the view that ‘newborn-infants, especially if unwanted, are not yet full members of the moral community’, and proposes a 28-day period in which the infant might be killed before being granted full human rights.



Avoiding nightmares in migraine management

Avoiding nightmares in migraine management

Dr Lalith Mendis1

Journal of the Ceylon College of Physicians, 1994,27,54-55

In a recent survey on migraine among medical

students and doctors I found some misapplications in

management which in some instances could make migraine


My letter will only attempt to highlight some management

points that may be helpful in relieving the migraine

sufferer, but are often missed.


The mind of many physicians is focussed on the

impressive array of drugs available for prophylaxis which

includes low dose aspirin, beta blockers, serotonin antagonists,

antidepressants, calcium antagonists (flunarizine),

and even feverfew (Tenacetum parthenium). In most

double blind trials clonidine has not proved to be of value1.

However the most important aspect of migraine prevention

should be the identification of trigger factors and

their elimination. The frequency of attacks can be reduced

by up to 50% by identifying and avoiding trigger factors2.

Well documented trigger factors are: foods containing

amines (eg. cheese, sausages, yeast extracts, meat

extracts), chocolate, citrus fruit, red wine, other alcoholic

beverages, peanuts, cadjunuts, food flavoured with mcnosodium

glutamate; consumption of large quantities of

tea, colas and coffee; odours emanating from cigars or

cigarette smoke, paint, diesel or petrol fumes, tar, perfumes;

bright light (TV watching); changes in barometric

pressure; excessive or inadequate amounts of sleep and

psychological stress; mental and physical fatigue; poor

posture (neck position) during office work or study should

be looked for and corrected. The menstrual period is a

well known trigger factor in women, as are oral contraceptives

and oestrogen replacement therapy after menopause.

Often, migraine appears during rest that follows

intense activity. Fasting must be avoided, regular meal

times are mandatory.

The clinician must take time to discuss the problem

with the patient and not limit himself to prescribing a new

drug every time a migraine attack comes on. The patient

must be helped to identify the trigger factors in his lifestyle

or food habits that aggravate migraine. It is important to

teach the patient how to reduce workload and to have

leisure times. A detailed history should be taken to identify

trigger factors and time should be taken to advise the

patient. Clearly the family physician is more adept at this

than the busy consultant. It is unfortunate that these

patients (even doctors and medical students) go through

so many drugs and numerous physicians without attention

to preventable factors.

Secondly a drug tried for prophylaxis is terminated

too soon, and a new one commenced, when the former

ought to have been prescribed at least for 4-6 weeks.

Longer the list of drugs available for treatment, greater

the risk of mismanagement ought to be a pharmacological

axiom. It must be noted that beta blockers with intrinsic

sympathomimetic activity (eg. pindolol, oxprenolol, acebutalol)

should not be prescribed, though this is not

uncommonly done. What could be prescribed are propranolol,

metoprolol, atenolol, nadolol and timolol3. A person

who may not respond to one beta-blocker may respond

to another. Trie dose of propranolol that may produce

the desired effect may vary from 20 mg to 240 mg/day


Thirdly, low dose aspirin therapy (300 mg/d) is useful

in prophylaxis4. In this dose aspirin blocks the synthesis

of thromboxane (agregatory factor) in platelets. Higher

doses of aspirin will block synthesis of prostacyclin (platelet

antiaggregatory factor) in arterial walls and may make

migraine worse. Hence it is unwise to prescribe repeated

doses of aspirin or other NSAIDS even for an acute attack.

The other drugs available for prophylaxis and their

schedules are well documented1. Aspirin 300 mg/D,

naproxen 500 mg twice a day, fenoprofen 200 mg thrice

a day have proved effective .in prophylaxis. Drugs are

recommended for prophylaxis when migraine headaches

occur more than two a month or when a single attack

causes significant loss of work days. Prophylaxis is

usually tailed off after six months1.

Treatment of the acute attack

The patient must be taught to recognise the prodromal

symptoms — dull heaviness of a side of the head,

food-craving, yawning and sleepiness. The activity that

brought this on must be stopped, (eg. heavy office schedule,

studying for an exam). A migraine attack is better

Avoiding nightmares in migraine management 55

prevented at this stage rather than allow it to fully blow

  1. The patient should be advised to take an effective

dose of a drug early. Taking aspirin 600 mg or paracetamol

500 mg with food and sleeping may be all that is

necessary.Topical counter — irritants viz. oil of wintergreen,

hot and icy cold fermentation, massage of the scalp

greatly relieve the patient and promotes sleep. An attempt

must be made to abort the attack completely. The patient

(often a busy professional or a student) must be made

to understand that resting with the first prodromata can

save many hours of unnecessary work loss. In my analysis

the major cause of rebounding migraine headaches

was inadequate leisure time given to recover from the

first attack.

Besides aspirin ibuprofen (1.2 – 1.8 g in divided

doses) and naproxen (750 mg at on set; 250 – 500 mg

every 30 to 60 minutes; upto 1250 mg/D) are extremely

potent in aborting acute attacks. Inducing vomiting before

swallowing the analgesic brings significant relief. The

patient discovers this by himself. The food taken with the

analgesic promotes absorption and reduces the nausea.

Lack of response could be due to vomiting; often metoclopramide

10 mg orally or by intramuscular injection promotes

gastric emptying and reduces nausea. In children and

young women domperidone is preferable because metoclopramide

is associated with dyskinetic reactions. Cyclizine

as an antiemetic is a cheeper alternative.

If vomiting is a problem indomethacin 50-100 mg or

diclofenac 50-100 mg as suppositories will be useful.

Many physicians do not adequately make use of the rectal

route before switching to other drugs. I make the point

that with whatever NSAIDS used an attempt must be

made to abort the attack with the first or second dose.

Continuing drug dosing is the chief cause that converts

an episodic migraine headache into a dull continuous

one1. With the wide variety of NSAIDS available for this

purpose opioid analgesics have no place, considering the

increased nausea and their addictive qualities. Though

the migraineur becomes familiar with many drugs, he

must be strongly discouraged from self-medication with

many combined preparations available over the counter.

If the first dose of simple analgesic fails to abort the

headache, it is best that he consults his family physician.

I would discourage the use of many ergotamine

tartrate combined preparations available over the counter.

Ergotamine preparations should not be tried till the

above NSAIDS have been tried with proper attention to

food, sleep and other preventable factors. I have encountered

patients ingesting a tablet of an ergotamine combine

preparation twice a day for a few days; the physician

had failed to warn the patient that the maximum for a

week should be 10 tablets (i.e. 10 mg) and that there

should be a four day hiatus after a day’s therapy with

ergotamine before anymore is administered. A patient

must not use ergotamine on the second day of a migraine

attack. The caffeine in some ergotamine combines can

prevent sleep and make migraine worse1.

Sedation promotes sleep and relieves anxiety. A

short — acting benzodiazepine (eg. lorazepam 1-2 mg)

for a short period is useful.

Sumatriptan (5 Hydroxy tryptamine-1 agonist) is not

available in this country for use. It is effective orally (100

  1. mg) and by subcutaneous injection (6 mg). Transmural

myocardial infarction has been reported with its use in

a woman who had no previous history of ischaemic heart

disease or Prinzmetal’s angina5.


  1. Lance JW. Treatment of migraine. The Lancet 1992; 339:1207.
  2. Blau JN, Thavapalan M. Preventing migraine: a study ol precipitating

factors. Headache 1988:28:481-3.

  1. Raskin NH. Headache. 2nd edition. New York: ChurchiD Livingstone,

1988; 176-81.

  1. Gilman S. Advances In Nurology New England Journal of Medicine


  1. Ottervanger JP, Paalman HJA, BoxmaGL, Strieker BHO. Transmural

myocardial infarction with sumatriptan. Lancet 1993; 341:861-62.

Vol. 27, 1994

Don’t Copy Cat – You are Original

Don’t Copy Cat – You are Original

  • Wait improves Taste
  • Haste makes Waste
  • Busting Up is Dumb
  • Be the Hero – rather than a fan
  • Ape none – You’ve got better Image
  • Save your body for the better morrow
  • Abuse follows a law of diminishing dividends
  • Thrills follow a law of higher threshold & higher risk
  • Generate the Glory within – Don’t Be Bill Boards & reflectors for other’s glory


  • Taste is best when time is Right. Taste before time is bitter. Wait for your time for maximum enjoyment of what God has for you in every season – Expect Much. Any fruit in its time is delicious. Where sin abounded grace abounds more

(Consume Now – turn stone to bread, more than you need, hastily, before your time, stolen bread – Stolen is Sweetest) –

  • Youth is Beautiful – We celebrate the youthful beauty given by God – Prepare to be God’s Temple . Beauty of character – attracted to beauty that fades not.
  • Heroic – You are the hero. God has a wonder. How great thou art. Dan 12:3. You look brightest with God.

(pleasant to Eyes, attraction, visibility, glamour, fame,

  • God’s Wisdom Soars High. God’s Wisdom is the Victory. Wisdom to Honour & exalt God. Wisdom exalts God. When God is the subject Glory comes. Prov 1:7, Jam3:15,16, Prov 8:13


  • Serve – Faithfully Serve the Lord in the Church
  • Mission – Bright Effective Bold witnesses in their Oikos
  • Accomplished – Skilled workmen in their chosen field
  • Romance – In due time Marriage in the Will of God
  • Testimony – Be Good role models for the younger

Beauty is God’s Gift

  • Beauty is a gift of God – honour God with your beauty
  • Make your beauty attract people to God – don’t use your beauty in a way that dishonours God.
  • Serve others with your beauty – make beauty part of leadership quality
  • Make friends with people who don’t look beautiful
  • Never abuse your beauty or entice with your beauty
  • Inward Beauty must be cultivated in order to balance external beauty 1 Pet 3:3 Prov 11:22

Ten Caveats of Beauty

  • I will Celebrate Beauty as a gift with gratitude & honour & never for dishonour
  • I will make my beauty attract people for good – not for evil.
  • I will Serve others with my beauty – make beauty part of leadership quality
  • I will make friends with people who don’t look beautiful
  • I will Never abuse my beauty or entice with my beauty
  • I will cultivate Inward Beauty in order to balance external beauty
  • I will Never allow others to sin by exposure – that will not be beauty as God gave
  • I will be attractive in everyway – External Beauty is not my only attraction
  • I will not pride on my beauty making comparison & looking down on others
  • I will not sell my beauty



MEDICAL ETHICS – (Seminar for New Entrants 1994 – Faculty of Medicine, Kelaniya).

MEDICAL  ETHICS – Dr. Lalith Mendis.


(Seminar for New Entrants 1994 – Faculty of Medicine, Kelaniya).

It is Rousseau- the French philosopher who said, “It would take gods to give men laws”. He recognized the need to transcend the human level in establishing norms for behaviour and man’s inability to do so. Whereas a law dernands obedience, an ethic compels conformity. Ethics need to come from within. It is appropriate that Prof. Carlo Fonseka has with commendable foresight thought of inculcating an ethical ingredient in the new Medical entrant at the outset of his or her career.

It is an open secret that a patient in Sri Lanka can no longer go to the average doctor completely trusting him. The patient no longer accepts that all what the doctor does is for his or her best. If this kind of seminar helps to dispel that ugly blotch that has come on our noble profession and by ethical instruction restore the fiduciary relationship (faith and trust relationship) between patient and doctor, it would be a great service to the profession and our nation.

Let me commence with a general approach to a work ethic. In work we serve others. I for one believe that all men are created equal by a Benevolent Creator. This means in work we serve others. Work is an institution designed to bring the best of altruism (sacrifice and service to others) in man. While we should and could advance materially and socially, because of our chosen field, that however ought not to be the primary goal of work. Especially the work of a professional cannot be for profit nor is it a business. Webster’s dictionary defines a professional as one who does not engage in trade. If our countrymen have come to think of the medical profession as a lucrative trade, it indeed is a tragedy.

In work we ought to serve others. This should be the chief end of our work as doctors. “The joy of comforting always., relieving often and curing whenever possible” is our noble and rewarding task.

There are three areas of medical ethics-namely:

(a). Doctor-patient ethics.

(b). Doctor-doctor ethics.

(c). Doctor and society ethics.

I would like to focus on a few common areas of present concern and some other areas of remote concern.


The medical student embarking on his\her career should not consider the 4 1/2 years in the medical faculty as the doorway to a lucrative business -a business more reliable and predictable than gemming. (after all gems are not found everyday but patients are). The financial difficulties that a medical student may encounter should not drive him in later life to mercenary (money making) attitudes. On the other hand those who have come from affluent backgrounds could want to preserve and even improve on what they already have and attempt to do so within a short space of time since passing out. Those of us who have felt the pangs of poverty should be the very ones who should be in the forefront of a movement amongst doctors for a more socially concerned orientation towards our patients. This is an important ethical consideration that we ought to bring to bear on our guranteed personal loan practice. If a poor patient who can ill-afford the money, is compelled to offer the D.M.O. his private practice fee (P.P.fee!) because he will be better treated, then we are indeed economic oppressors who use our priviledged profession-for which the country has paid-to fleece the sufferer. Even in consultation practice one needs to ask the question, “must I charge every patient I see? Is there anyway to ease the burden on the poorer patient?

A new generation of doctors needs to work together at all levels to prevent the financial drain on poorer patients in doing medical pilgrimages to the provincial capital-be it Colombo, Kandy, Galle or wherever.

1.         Our peripheral units and district hospitals. should have caring, capable and confidence-building doctors. Drugs in the DH should not get into the DMO’s private dispensary. There is today a total breakdown of the once efficient CD; PU, DH system.

2.         MOH should be active and conscientious in his\her M.C,H. (maternity and child health) and other preventive aspects of medicine. Often MOOH are occupied in private practice and have no time or concern for the improvement of primary health care. Each MOH and his team ought to be conversant with the preventable health problems of the area. In a village where we once had a free clinic the majority of the population was going blind with vit.A deficiency. We were able to. give them a month’s quota of vit.A (cost Rs. 3.60 per person). When we visited this community they were amazed no end that they were seeing better.

3.         Such mobile clinics should be arranged into the many inaccessible areas of the area by the DMO and the MOH. This could be done even weekly if one is motivated. Undetected medical problems can be detected and referred to thee nearest General or Base Hospital. Vitamin or mineral deficiencies can be corrected. Since our country has given us a free education right upto the MBBS degree, we owe our people this much of altruism. The AMO, DMO and the MOH can become a source of comfort to the people of the area. A grateflil people will remember. you as their benefactor.

4.         In arranging such clinics in your area you could .liaison with in any NGOO who will step in with other welfare schemes. What. the NGOO often lack is someone motivated and knowledgeable. It is unfortunate that knowledgeable people are often unmotivated and vice versa. Even free drugs are available through NGOO, if one can honourably use the same for free clinics and not for PP! Many are the occasions when hospital drugs find their way into the DMO’s private dispensary and even into the PP of the Apothecary and the Attendant!! The old Sinhala adage- “when the teacher performs a certain function standing, will not the pupils do the same running” is so true.

5.         Our infant mortality rate is rising and the birth weight is dropping, indicating a downward trend in our health services.

The Quality of Life Index of Sri Lanka which was the highest for countries with a low GNP in the seventy’s, (Prof. Carlo Fonseka; Towards a Peaceftil Sri Lanka;WIDER Research) may not long remain that impressive. While we spent 0.7% for defence and 5% of GNP for welfare in 1978, in 1988 we spent 5% GNP for defence and 0.7% GNP for welfare (Prof. Carlo Fonseka,. ibid.). The doctor closest to the grass-root level ought to be concerned about this decline.

6.         The municipality Medical Officers of the large cities see the worst effects of poverty on health-especially maternal and child health. A caring MO in the municipality can do much for the teeming multitudes that come to her.

7.         The GP, DMO, AMO can do much to offset the adverse effects poverty has on health. Vit.A and iron deficiency which contributes significantly to maternal and infant morbidity and mortality are easily corrected. Vitamin and iron supplements should be routinely prescribed. There are recent reports of decreased child and infant morbidity and mortality with vit.A supplementation. (BMJ vol.304: 25, Jan1992-207). Will it not weigh on our hearts that we as medical officers stand between poverty and death of our poorer patients? Should it not be a paramount ethical concern that we should do all in our power to prevent our patient’s poverty resulting in increased morbidity and mortality when the cause is preventable or correctable?

Can we merely blame lack of government resources? A tablet of iron costs 5-10 cents;  vit.A and D tab. costs 15-20 cents. Would a GP or DMO become poorer if they give a packet of 10 tabs. free to the mother who comes to them.

8.         The consultants ought to discourage their patients coming from far away places when they can ill -afford such expenses. Name-building and “channel Antics” leave patients poorer. Every ethically concerned Consultant attached to Base and General Hospitals should assure the poorer patients who come to them for channelled consultations, that the same care and treatment will be accorded them if they follow the government clinic of the same Consultant.. He should ensure that the follow up clinic cares for the patients and that the routine referrals from GPP., AMOO, DM00 should be honoured at the Clinic without pecuniary benefit. This was standard practice 15 years ago.

9.         Reduce the number of visits a patient has to make to you to the barest minimum. A bread-winner of a family (an accountant) went to four different specialists once in two weeks for three years, each time paying the fee. The disease was incurable and the drugs which could have been prescribed at a govt. clinic did not control the symptoms. Over the three years the patient was not given a diagnosis card, nor referred to a govt. clinic though all the four specialists were attached to govt. hospitals. The patient cannot work and his wife supports the family working as a stenographer Until I discontinued the habit they were paying the fortnightly fee. Incredible?

10.       Prescribe the least number of drugs at the cheapest price. Iron is available at 10 cents per tab. and at Rs. 4 a cap. prescribe thee least costly, appropriate antibiotic, at the minimum needed dosage, for the period required. Do not get taken in by the attractively designed documents with impressive clinical trials. Please remember that the Companies paid for the clinical. trial with all the fringe benefits available to the researchers who fiddle the trial to achieve the desired end. Know your Pharmacology better than the drug rep.

11.       Ask only for the most essential investigations. Simple viral or bacterial bronchitis needs no investigation. In fact viral bronchitis should not be treated with antibiotics. Kotthamalli is adequate! WBC/DC or ESR will cost a patient Rs. 20 or more. Dysuria and fever can be treated without a urine FR; go for a culture and ABS if your first line treatment with a cheap antibiotic, such as Nitrofurantoin fails. Accusations are afloat that doctors have shares in firms that offer investigations. The temptation is very real for the GP or DM0 who has his own lab. The patient should. not be treated as a goose that lays the golden egg.

12.       There is a tendency to recommend admission to private hospitals because the doctor can earn more from the hospital visit or the operation. The patient is often made to feel that he may not get the best unless he is admitted to a private hospital. In an emergency govt. hospitals still offer the best care.

13.       The patient needs to come to a doctor for the least number of visits. The old family doctor of would not charge a patient for the second visit for the same ailment.

14.       Preferential treatment to channelled patients, quicker operations for them. Seeing only the channelled patients, are accusations often levelled at the profession.

15.       Many interns are tempted to do “locum”. This is illegal.

16.       Money for beds, quick operations, for bottle of saline, for false medical certificates are among   other modes of illegal solicitation (bribery).

It may be appropriate to quote a composition by the late Professor K.Rajasuriya.


1 One should not undertake to treat a patient who rightfully falls into another’s speciality. e.g. migraine should be treated by a physician and not a neuro-surgeon.

2 There have been reports in the press of doctors taking sexual advantage while examining female patients. One has to hold a strict control on one’s self to make certain that such physical examination should never be the means of sexual gratification. This applies to medical students too, who should be courteous to the patient they examine, obtain their permission, be respectful in undressing, always have a female colleague when examining a female patient, respect privacy.

3 There seems to be a very real danger of consultants becoming mechanized in seeing so many patients per hour. Adequate care is not given. One who is under constant pressure to clear numbers quickly can miss out on vital diagnoses and loose the science of rational diagnosis arid therapy.

4          Under such. pressure there. could. be no time to update one’s knowledge. Undergraduate and post-graduate teaching wilt be neglected. The next generation of medical students will inevitably suffer. The teacher would have worked froin 4.00 a.m. to 8,00 a.m. and again from 4.00 p.m. to 10.00 p.m. Will he be fit to work or teach between 8.00 a.m. and 12.00 noon. The Establisliment Code has a clause which says that permission should be obtained from the Head of the departinent to work for money after official duty hours. This was a wise statute to ensure maximum performance during official duty hours. Legalization of chanelled practice has invalidated this clause.

5          One shoud be on his guard regarding.nursing staff. A doctor should not take undue advantage of a professional relationship without long term commitment.

6   Competition and personal promotion should be avoided. There is a specific measurement recommended for the name board, Criticism of colleagues and methods of advertisement are to be avoided. Professionals ought not to compete as traders do..

3.         Abortion is illegal in Sri Lanka other than in certain strict medical circumstances. However illegal abortions are a lucrative trade. Those who call for liberalization of abortion do not present facts against their case. Proliferation of abortion opportunities tends towards the neglect of more conventional methods of contraception. Abortion entails definite morbidity risks to the mother. In countries where abortion is legalized it has become a thriving business enterprise to the doctor and to the clinics. Even in Sri Lanka “menstrual regulation” is the euphemistic term under which illegal abortions are performed. I would strongly recommend an attitude of reverence to life, even unborn life. It is to be remembered that one line of the Hippocratic oath is-

“and especially I will not aid a woman to procure abortion.” The International Code of Medical Ethics has the following~ “. …I will maintain the. utmost respect for human life from the time of conception;”

4.Informed consent – prior to operations or any other procedure; patient must have satisfactory knowledg of possible consequences. A medical officer can be charged for damages if lack of informed consent can be proved.

5.  Professional secrecy-a doctor at no time should use confidential information gathered from professional relationship pecuniary or other advantage.

6.  Integrity as an expert witness-gratification should not prejudice the opinion of the doctor as an expert witness.

Remote Concerns .

1. The blood trade -extreme poverty may drive people to donate low Hb% blood which makes profits for private blood banks.

2. The organ trade for organ transplantation – in Calcutta (and probably other major cities of India Dobs caste is employed by agencies to recruit the diseased who are dying to offer their organs for transplant for remuneration. A sum is agreed upon and an advance is paid to the prospective donor.

Upon death the body of the donor provides kidneys, cornea, hair, teeth, skeleton for an extremely lucrative business. The West can look upon third world countries for a cheap harvest of organs that feed a multi-million dollar business.

3.The vast expenses incurred for organ transplantation or coronary surgery facilities could be a drain on the meagre resources of an impoverished developing country. The question arises whether such investments should not go into primary health care thus profiting thousands.

4.Foetuses (abortuses) obtained by surrogate pregnancy are used for plastic surgery and for research. Is this cannibalism?

5.The issue of euthanasia.

6.Genetic engineering should one experiment with human zygotes? What will the end result be? Is it right to attempt to produce high IQ foetuses? (fertilize the ovum with high IQ donor sperms). Has man the right to determine the composition of the future human society? Will genetic engineering produce monsters?

7.Research programmes are sponsored to promote the product of a company with. financial benefits to the researchers.

8.Economic exploitation of the third world by the first world drug companies-royalty rights; ever increasing cost of western drugs. eg.insulin fiasco- “Boots” of India produced a vial of Lente insulin at Rs. 60. Since a western syndicate bought them over the vial has shot up to Rs. 160 and we are under pressure to convert to the even more expensive human insulin.

9 Ethicality and legal issue that may ensue between the genetic mother and the uterine mother in surrogate pregnancies.

10.       Stringent conditions for ethical committees to supervise research.

11.       Campaign against cigarette smoking and its promotion.

12.       Medical patents

13.       Avoid plagiarism.



It is a fact that in today’s Pharmaceutical World there are so 1 hour money loan many manufacturers that when a doctor prescribes by the generic name, it will be the Pharmacist (qualified or unqualified) who will decide what the patient will actually get. Even if the doctor prescribes amoxicillin SPC, Pharmacist may give what they have stocked and what gives them the highest commission. It has been observed that some cheaper amoxicillin brands do not produce the characteristic smell of ampicillin in the urine even after 3 days. This smell is usually observed when 5 doses of amoxicillin with good bio-availability is prescribed. Furthermore there was the instance when SPC did their own brand with paracetamol (pettha pottha controversy) and that would be contrary to Prof Bibile doctrine. Furthermore, one cannot expect generic producers to be more altruistic than brand producers and their intention would also be profitability. So they could adopt ruses that give them greater profit. This would be obviated if a Government begins to manufacture drugs with strict quality control procedures. SPMC is a step in the right direction. The dire need is proper quality control checking for generics or brands that would be approved. As I said at the beginning, when a doctor now prescribes generic what the patient gets is an unknown brand.

Danger of Changing Brands

There are also drugs like phenytoin used for epilepsy with historic examples where changing the manufacturer (brand) has resulted in severe adverse effects or return of seizures depending on the additives in the new brand which could increase the available phenytoin strength causing toxicity or reduce available phenytoin  resulting in seizures. One would ask an epilepsy patient to always stick to one brand for the above reasons. This problem arises with drugs that operate in a narrow therapeutic window where slight increase of drug level causes toxicity and slight drop causes loss of therapeutic effect. With such drugs any sane practitioner would prescribe a trusted brand.

Ethical Issues of Brand Prescribing

Yet there are problems in brand prescribing that only doctors can rectify. It is not only a doctor’s political hue or NGO employment that raises issue with certain brand prescription patterns.

While I was in my previous academic post, I observed that a brand of piroxicam was aggressively pushed and was freely prescribed. Piroxicam is an aspirin like drug with far more adverse effects than aspirin. I have produced material and published in the Ceylon Medical Journal and Kandy Medical Journal to prove that, with the exception of ibuprofen in doses less than 20mg per kg body weight per day, aspirin remains the safest and most effective non steroidal anti inflammatory drug (NSAID) for joint disorders. This was demonstrated by a well designed trial conducted by UK Committee for Safe Medicine in 1985. Yet far more expensive drugs (NSAIDS) are prescribed which are less effective and more toxic. Even with ibuprofen the effective antirheumatic dose is often more than the safe dose. Bayer has recognized the safety of aspirin and recently produced a cherry flavoured expensive brand of aspirin.

Co-amoxyclav (Augmentin) is another over-prescribed drug when amoxicillin alone is sufficient. Cost difference is huge and the former has more side effects. It would be unethical to prescribe co-amoxyclav when amoxicillin is sufficient for most upper respiratory bacterial infections.. Brand prescribing of ibuprofen syrup for fever is another undesirable practice considering the many side effects of the drug. There is evidence that anti-inflammatory drugs prolong the viraemia in simple fever. There are scientific reasons to give only paracetamol for viral fever even in adults. Similarly pushing Panadol syrup for fever is another unacceptable brand pressure practice which may end up with a child getting more than six hourly doses which would be toxic. Recent study ascertained that 40% of childhood allergies are traceable to overuse of paracetamol which modulates immune response. Vitamins in expensive brand prescription – especially the dubious benefits of vitamin E (except the proven benefit to reduce incidence of breast cancer in combination with Primrose oil), impoverish the already poor.

Internationally too, there were instances where brand pushing made room for fraud. A well known recent instance is when the results of a drug trial (Rofecoxib) was published only for the first six months because serious adverse effects appeared in the next six months. Results were suppressed and the drug appeared on the market being prescribed as an antirheumatic drug with minimal gastric problems. Patients got heart attacks and the drug was withdrawn.  A journalist of New York Times exposed the fraud. Details can be found on

It is also true that in pushing brand drugs many glossy promotional materials quote statistical data without statistical significance to “prove” the superiority of a drug.

Generic or Brand

There is no simple solution to the issue.

  1. Reliable generics must be available; quality control is must. In the present scenario even the most socially conscious doctors may be reluctant to prescribe generics because of unreliability.
  2. With manufacturers producing generics under some name, the difference between generic and brand that Prof Bibile identified is at present artificial. The solution is for government sponsored quality drug manufacture. Like the transport system and water supply, drug supply cannot be left in the hands of the Private sector alone.
  3. An essential drugs list even today will prevent poor people having to buy unnecessary drugs
  4. When prescribing Drugs with narrow therapeutic window, it is inevitable that doctors will prescribe a trusted brand
  5. Expensive drugs get prescribed when cheaper more appropriate drugs are available.
  6. Expensive drugs get prescribed when there is no medical indication E.g. antibiotics within first 24 hours of viral fever.
  7. Unscientific poly-pharmacy for reasons other than medical.

The Lancet (2003;361:573-574) under the title “Effect of ibuprofen on cardioprotective effect of aspirin” documents how NSAIDS interferes with the cardio-protective effect of low dose aspirin. I documented this ten years previously in 1993, in The Ceylon Medical Journal (1993. 38:145-146) under the title “Do NSAIDs interfere with the action of low dose aspirin.

I cite this issue only because I also documented the factual status of aspirin in analgesia and as an anti-inflammatory drug being probably superior to many recent NSAIDs including ibuprofen. ( Mendis, B. L. J. 1995. Joint disease, aspirin and NSAIDs. Kandy Medical Journal, 5: 1-3. Mendis, B. L. J. 1994. Avoiding nightmares in migraine management. Journal of the Ceylon College of Physicians, 27: 54 – 55. Mendis, BLJ. 1996. Aspirin::friend or fiend. Ceylon Medical Journal. 41:76-77.)

Since The Lancet has concluded as I did on the effect of NSAIDs on the action of low dose aspirin, I am hopeful that my colleagues would seriously consider the conclusion of the aforementioned articles, namely, that soluble aspirin is equal or superior for joint disease and headaches compared to the branded preparations that are much prescribed though expensive, have no proven higher therapeutic efficacy and have more side effects.

I am aware that what I am suggesting sounds incredulous but is based on sound documentation. E.g. soluble aspirin instead of piroxicam. Please take the trouble to read the articles cited in the above references. Should we not be ethically concerned to give the patients a better deal – medically and economically? Drug companies at present do not include aspirin in comparative trials. You are probably aware how a research on COX2 inhibitors was contrived to hide the truth of adverse effects until a journalist on the Washington Post brought it to light. You may read Therapeutic Letter Issue 43 on this.

  •  NSAIDS in any dosage will interfere with the anti-platelet action of low dose aspirin. This is because low dose aspirin selectively inhibits thromboxane synthase produced by platelets whereas NSAIDS inhibit cyclo-oxygenase thereby blocking beneficial prostacyclin produced by prostacyclin synthase of the capillary wall. If you are prescribing NSAIDS for a patient on low dose aspirin for that duration a different anti-plaetelet drug is needed. You have warn the patient on low dose aspirin about indiscriminate use of NSAIDS as is common. I first reported this in the CMJ in 1993 and was later confirmed by Lancet in 2003. CMJ Volume 38, No.3, September, 1993 – aspirin  low dose

•  Levodpa absorption is inhibited by Lysine in rice. If on-off phenomenon is troublesome in Parkinson patients on levodopa, the rice meal should be taken in the night. Patient can manage on potatoes or bread for the day.  This will significantly improve levodopa absorption.

CMJ Volume 38, No.4, December, 1993- ldopa, rice

•  It is to be noted that Asians may have different Pharmacokinetic interactions   with anti-epileptic drugs. A survey done in 1998 showed that Sri Lankan population may need lower doses especially in combination. (Scientific Sessions SLMA – 1998)

•  An older study in 1985 proved that aspirin remained the most effective and safe NSAIDS. Aspirin is no more included in drug trials for NSAIDS as drug companies only include their branded products in trials. I did a survey of drug trials on NSAIDS and drew this conclusion.

I have proven elsewhere that aspirin remains the safest and most effective non steroidal anti inflammatory drug for joint disease (unless when ibuprofen is prescribed in doses less than 80 mg per kg per day).

Mendis, B. L. J. 1995. Joint disease, aspirin and NSAIDs. Kandy Medical Journal, 5: 1-3. Mendis, BLJ. 1996. Aspirin::friend or fiend. Ceylon Medical Journal. 41:76-77.)

•  We discovered the serotoninergic basis of relationship between Migraine and IBS in 1979 in a survey done in the Prof Medicine Unit of Colombo. This means that drugs used for Migraine may be effective for IBS. It was also documented that 50% of Migraine sufferers respond well to non-medical methods of treatment.

Mendis, B. L. J. 1994. Avoiding nightmares in migraine management. Journal of the Ceylon College of Physicians, 27: 54 – 55.

•  It is irrational to prescribe Augmentin when the cause of non-resolving bronchitis is PBP mutations of bacteria. Increased doses of amoxicillin is the answer

Article on Resistance to Penicillin G in Streptococcus pneumoniae by L Temime and others (Emerging Infectious Diseases vol 9 no 4 April 2004 p 415)

•  Appendix long thought of as useless vestigial organ (according to evolutionary thought) has been proved to be a valuable reservoir to colonise gut with commensals after a bout of diarrhea. Bollinger et al, Journal of Theoretical Biology 249(4):826-31, 2007