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On Charcoal Trial, Colombo Medical Faculty assures the Kurunegala public
Prof. Risvi Sheriff Professor of Medicine Colombo Medical Faculty, with three other doctors - Dr. Alahakoon, Dr. Gunasekera, Dr. Senanayake and Dr. Eddleston in a statement to the Health Watch on the media report (not in the Lake House group) of a recent death of 2 patients in the Kurunegala Teaching Hospital where a Colombo Medical Faculty conducted trial is under way of treating poison ingested patients with activated charcoal, state.
"The patient concerned in the media report had ingested a pesticide called Dimethoate - a very dangerous pesticide which kills three out of every ten people who drink it, a far higher number than occurs with some other pesticides. Clinically the patient died of this pesticide poisoning and not from the charcoal administration".
The statement adds.

Activated charcoal

* Activated charcoal treatment for positioning is not "experimental". It has been used across the world since the 1820s and in Sri Lanka for some patients since at least the 1950s. Unfortunately, we do not yet know whether it actually benefits patients when given in hospital.

* The brand being used, Carbomix, is used in many countries worldwide. It differs from the charcoal being used in Sri Lankan hospitals only in being twice as effective.

* Charcoal has an excellent safety record - it is an inert substance and there have been no deaths reported from its safe administration into the stomach. Hundreds of thousands of patients have received activated charcoal safely.

* The patient in question had ingested a pesticide called dimethoate- a very dangerous pesticide which kills three out of every ten people who drink it, a far higher number than occurs with some other pesticides. Clinically, he died from his pesticide poisoning, not from the charcoal.

* He was admitted in an unconscious state and was treated by an English medical registrar (with MRCP and SLMC registration) and two pre-intern doctors. His condition was stabilized and he made a good recovery in the first 12-24 hours. Unfortunately, he subsequently developed delayed respiratory failure, a well recognized and highly dangerous complication of pesticide poisoning, and died on his second day in hospital.

* Throughout his time in hospital, he was under the care of one of the hospital's consultant physicians. Although initially treated by the study team, he was subsequently seen regularly by the Kurunegala medical doctors. He received all treatments normally given to pesticide poisoned patients.

* The study has ethical clearance from the Universities of Colombo and Oxford. It is being carried out with the full support and cooperation of the Ministry of Health and WHO.
Ethical permission was taken from the patient's relatives. The purpose of the trial and the risks and benefits to the patient were carefully explained by the two pre-intern doctors and the relatives were given time to think about their decision. They chose after five minutes deliberation to allow their relative to enter the trial.
Pesticide poisoning is a massive problem in Sri Lanka - in Kurunegala District, in particular. Only 3 months ago, media itself carried an article, quoting the same Coroner that over 4000 pesticide poisoned patients had been admitted to hospital in the district during 2001. Over 1000 died - a 25% death rate which emphasizes the severity of the problem. We simply do not know the best way to treat pesticide poisoned patients.
Something needs to be done to reduce this loss of life. We have set up a study with the Ministry of Health to find out how best to treat these patients. Our long-term ambition is to halve the number of deaths from pesticide poisoning in Sri Lanka - saving thousands of lives in the process.
We have so far recruited over 1600 patients to the trial of charcoal in three hospitals. The death rate for patients who present unconscious and are entered into the trial by their relatives is half that of patients who do not enter the trial. The trial is already saving many lives - the information it supplies will be used by the Ministry of Health to save many more in the years to come.
We were disappointed that some newspapers not Lake House group published these accusations without checking with either the Consultant responsible for the patient or the Director of the hospital. We believe that the Coroner was misled by inaccurate statements made to him by doctors not involved in either the study or the care of this patients.
The people of Kurunegala District can be reassured that they will not be 'experimented on' in their Teaching Hospital. Poisoned patients will receive care that is of an international standard if they chose to enter the trial. The information gained from the trial will not only benefit people of Kurunegala but also people throughout Sri Lanka and the rest of the world where pesticide poisoning is a problem.
The statement has been issued by Prof. R. Sheriff, Professor of Medicine, Colombo University.
Dr. Alahakoon, Consultant Physician, Kurunegala Teaching Hospital.
Dr. A. Gunasekera, Director, Kurunegala Teaching Hospital.
Dr. Senanayake, Judicial Medical Officer, Kurunegala Teaching Hospital. Dr. M. Eddleston, Honorary Research Fellow, Colombo University