Funds wasted on kidney disease research



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The Island of January 01, 2014 carried the headline news item that a spokesman of the GMOA had accused the government for allocating some Rs 350 million for research on the kidney disease to the National Science foundation(NSF). He argues that this money should not be spent on "unnecessary research" and the money should be re-allocated to the Epidemiology Unit of the Health Ministry for its research. Regrettably, it is a shortsighted statement.


As far as the writer is aware, the previous NSF funded research was carried out by a multidisciplinary team spearheaded by the WHO and comprising medical personnel from the Health Ministry and researchers from the universities and others institutions . I am told that there was a research committee and an oversight scientific committee that met regularly and discussed the results which were also analyzed by independent statisticians. Therefore, If the funds were a waste then the Health Ministry is also accountable. The WHO final report probably has some shortcomings and ambiguities which have been brought forth by the writer and several others in the media. Despite this, it is a good starting point, and evidence has been generated that pointers to the cause or etiology of the disease being multifactorial, and stretching beyond the realms of medical science. If so it has to be a multidisciplinary research thrust, implying that an independent governmental research fund management agency should handle the funds, and NSF is a good choice.


The hitherto implicated causal factors of the disease are: cadmium, arsenic, fluoride, agrochemicals ( fertilizers and pesticides), water hardness/ionicity(solutes), algal toxins, some aurvedic drugs, snake bite, dehydration and insufficient water intake, illicit/excessive alcohol consumption and genetics of the people. Therefore, the new research project to be undertaken should engage competent researchers in the fields not only of medicine and health but also of chemistry, soil science, geology, hydrology, geography, fertilizer and pesticides, population genetics, epidemiology and sociology . The research to be conducted should be identified, prioritized based on importance and resources available. A supervisory body of senior scientists and medical personnel should regularly review progress. The researchers should be accountable for the resources spent.


The GMOA spokesman also comments that Health Ministry has not implemented the WHO recommended "effective procedures to address the issue nor commenced "effective treatment procedures". Being not in the medical field , I cannot comment on the latter, but as regards WHO recommendations, provision of potable water to affected areas and regulation of pesticide use are key. Although belated, it appears that the government is investing in providing potable water through reverse osmosis technology. Polluted water not only affects humans but also animals. Then what about the latter? What is important is to mitigate all pollution. As regards the pesticides, the Registrar of Pesticides claims that the regulatory procedures are in place, but there is wide misuse largely through ignorance. Farmers obtain advice on pesticide from the pesticide sellers and hardly from extension workers. I once asked a farmer in Tambuttegama from where he gets advice on pesticides; "from the wasa beheth kade mudalali" was his reply! The field level extension system that has been devastated by bad politics should be restored as a matter of highest priority, to take the message of judicious and safe use of agrochemicals to farmers, apart from other mandated services. Organic/agrochemical- free agriculture is not yet a viable alternative to conventional agriculture to feed the world. Hence, unfortunately, the use of agrochemicals with their attendant hazards has to continue, but pollution should be mitigated by their safe use, and for it, there has to be far greater education of farmers and vigilant monitoring of pesticide misuse. It is unfortunate that the government has yet not been adequately resolute in addressing these issues.


One of the criticisms of the WHO report was that comparative samplings were not undertaken from the unaffected areas. For example, fertilizer and pesticide use is far more intensive in unaffected areas such as the upcountry than in Rajarata, but the disease is hitherto not reported there from. It is hoped that the new research would address this issue too.


Dr Parakrama Waidyanatha


 
 
 
 
 
 
 
 
 
 
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