Presentation to Science Communication Leadership Workshop during the First General Assembly of Association of Academies and Societies of Sciences in Asia (AASSA), held in Colombo, Sri Lanka, on 17 October 2012.

1. Mass Kidney Failure
& Mass Media Failure:
Insights from Sri Lanka
By Nalaka Gunawardene
Independent Science Writer & Columnist, Sri Lanka
www.nalakagunawardene.com
Presentation to
Science Communication Leadership Workshop
At First General Assembly of
Association of Academies and Societies of Sciences in Asia (AASSA)
Colombo, Sri Lanka: 17 October 2012

2. Contents: Chronic Kidney Disease of
Unknown aetiology (CKDu)
 CKDu: A Mysterious Disease in Sri Lanka
 Challenge to scientists & healthcare system
 Policy makers’ dilemma: best response?
 Mass media coverage critiqued:
 Structural & professional problems
 Advocacy journalism’s limits
 Hazards of moderate journalism
 CKDu as prism of Lankan society: reveals
issues, gaps & distortions
 All are my personal views!

3. CKDu: Reported in Sri Lanka’s
Dry Zone since early 1990s…
 CKDu: A Mysterious Disease
Infographic courtesy: Centre for Public Integrity, USA

4. CKDu: A Brief History…
 Dry Zone: Heart of
rice farming
 Mostly affected male
farmers, 30-60
 Started North-
Central Prov but
since spread
 Affected area: 17,000
sq km, home to 2.5m
(1/8 of Sri Lanka pop)
Map courtesy: BBC Online

5. CKD vs. CKDu
Infographic courtesy: Centre for Public Integrity, USA

6. CKDu: A National Emergency
 Over 15,000+ kidney patients
needing regular dialysis (2/week)
 Each dialysis session: ~USD 100
 Care costs LKR 350m (~USD 2.6m)
= 4.6% of annual public health
budget
 How many deaths? No reliable
figure; could be 100s/more
 Vast socio-psychological impacts

7. Part of a global trend?
 CKDu: Reported from Central America, India,
Sri Lanka
 Is there a shared causative factor?

8. Contents…
Photo courtesy Athula Bandara, IRIN News

9. Long search for causative factors…
 Genetic predisposition?
 Lifestyle-related exposure?
 Locally brewed liquor
 Ayurveda medicinal concoctions
 Environmental exposure?
 Excessive Cadmium or Arsenic
 High Fluoride in groundwater
 Aluminium utensils + Fluoride water
 Naturally occurring hard water
 Cyanobacterial toxins in water
 Bioaccumulation of pesticide residues
 Or something else?

10. WHO & Govt of Sri Lanka:
Studying CKDu from many angles
 Multidisciplinary study: started 2008
 Health Ministry’s Epidemiological
Unit with WHO
 10 teams: looking for curative &
preventive responses
 Study report  Health Min mid 2012
 NOT RELEASED TO PUBLIC: WHY???
 In its absence  confusion,
speculation, conspiracy theories
 Not good for PUBLIC TRUST in
science or govt healthcare system

11. CKDu & Agrochemicals nexus:
Suspected; on trial; or proven guilty?
 Mid 2011: Hypothesis: CKDu caused
by excessive Arsenic in imported
pesticides & chemical fertilizers, when
combined with calcium in hard water.
 BEFORE peer-reviewed papers or
scientific debate, info & opinions are
released to mainstream & new media
 One scientist claims: Divine
Intervention helped arrive at this
hypothesis  Controversy!

12. ‘Miracle’
Cartoon by
Sidney Harris

13. Divine-assisted Science?
Some LK media scepticism…
Cartoon by
Awantha Artigala
Daily Mirror (Sri
Lanka): 20 June
2011

14. Dig Deeper & Probe Further…
But proceed with CAUTION!
Ceylon Medical Journal review article, Dec 2011:
 “It is timely that the available, credible, scientific
evidence on CKDu (published in peer-reviewed
journals) is collated and analysed, and the
difficulties faced in establishing causality are
discussed.”
 Cause of CKDu might be “multifactorial”.
 Caution: Mere associations “should not be
considered to be of causal importance without
documented evidence of proof”
Full paper: http://tiny.cc/CKDuCMJ

15. Policy makers’ Dilemma:
What to do while scientists disagree?
“Different groups have studied some aspects and
described it without giving a holistic picture. The
matter became complicated by some so-called
scientists referring to God’s assistance to
diagnose the problem.
“Commercial interests, lack of coordination
among researchers, policy makers not willing to
disclose findings and take appropriate action –
all these have made the CKDu situation worse…”
- Dr Janaka Ratnasiri, senior physicist & public
intellectual (not involved in CKDu research)

16. CKDu: Media’s Challenges
 CKDu: A powerful story for media
 Mystery disease, suffering, fear, death
 No scientific consensus: debate, intrigue
 Activist allegations, speculation, conspiracy
theories!
 CKDu: Also a difficult story to cover
 Slow evolving tragedy: temporal
 Impacts only humans but not landscape
 No drama of a ‘contagion’
 Needs effort & skill to ‘connect dots’

17. CKDu is NOT a Fleeting Story…
Unsuitable for Breaking News!
 CKDu: A Mysterious Disease

18. CKDu media coverage in general:
Highlights LK media limitations…
 Many journalists lack science
background to critically examine
issues or ask the right questions
 Uncritically peddling info fragments
& opinions without clarity, context
or coherence
 Many media outlets don’t assign
sufficient resources for indepth or
investigative coverage (lack of
priority, not funds)

19. Mass Kidney Failure +
Mass Media Failure?
 Healthy kidney: filters
waste & excess water
 Healthy, vibrant media:
separates fact from
fiction; provides clarity
and context
 What causes mass
MEDIA failure in LKA?
 Is there a cure? Where?

20. Advocacy Journalism on Health &
Environment OK – but within reason!
“Journalists -- environmental or not
-- must be rigorous in their fact-
checking and field investigations.
They must provide balanced
analysis of issues, impacts, choices
and alternatives. They must also be
committed to sticking with
unfolding and evolving stories...”
- Nalaka Gunawardene, in
SciDev.Net Editorial, 20 April 2007
Full text: http://tiny.cc/SDNCOB

21. Advocacy Journalism:
around for decades,
went mainstream
circa 1989

22. CKDu coverage in LK Media:
Advocacy or Activist Journalism?
Advocacy Journalism Activist Journalism:
 Supportive of a public  Supportive of a public
interest cause
 Sustained coverage (story
interest cause
is kept alive)  Sporadic media coverage
 Journalists ask critical  Journalists become
questions, verify info ‘embedded’ & uncritical
 Accommodates diverse &
 Selective amplification of
dissenting views; no one
is blocked out by media info & opinions
 Creates an inclusive  Dissenting/divergent views
platform for debate, ignored/attacked
seeking solutions  Solutions???

23. 2012 Aug controversy: “WHO says” it
found “the cause” of kidney failure
 Aug 15: Activist group releases 3-page
document allegedly by WHO official (named)
 BUT document is an unsigned, unverified pdf:
No logo, reference or contact details
 Many mainstream newspapers rush to print:
“WHO says farm chemicals found guilty!”
 WHO in Colombo & Geneva: No reaction at all
 LK Ministry of Health: No comment of any kind
 Silence fuels suspicions; activist media claim
case is closed (“so banish the guilty party…”)

24. Too much finger pointing,
Too little reflection!
 TOO MUCH time & energy spent
looking for a ‘Villain’
 TOO LITTLE media attention on:
 Healthcare needs of those already
living with CKDu
 Economic, social & emotional needs
of affected families
 How to prevent more people falling
sick: need for safe drinking water
 NOT ENOUGH questions on
overall agro policies that heavily
favour high external inputs

25. LK Chemical Fertilizer Subsidy:
How did we became so addicted?
 State subsidy for chemical
fertilizer: started 1962 (Green Rev)
 Continued for much of past 50 yrs
 Since 2005: 90% subsidy for N,P, K My column 26 Aug 2012:
 Costs ~ LKR 50b (USD 380m)/year Watch out:
Everybody Lives
 2009 subsidy cost = 3% of total
Downstream!
govt budget = 0.6% of LK GDP
How Lanka became
 Too political to rationalise! addicted to cheap
 V. cheap fertilizer = farmers not chemical fertilizer & why
it’s hard to kick the habit
thrifty  massive runoffs
 Organics just can’t compete! http://tiny.cc/ELDS

26. So are agrochemicals causing CKDu?
We’re still waiting for firm evidence…
Photo courtesy: Amantha Perera, IPS

27. Public Communication of Risk:
CAUTION: Handle with care!
 CKDu: Emotions run high: anxiety,
suspicion, fear, anger, distrust…
 Affected & others looking for
empathy + support + solutions
 Need authoritative & trustworthy
persons to give clarity, assurance
 Media doesn’t have all the answers
 What media can do: ask right
questions; admit to gaps in
knowledge; seek short term relief;
advocate more study

28. Lankan public’s info sources on current
topics: Heavy reliance on media
Outdoor billboards, banners, etc 27%
Educational institutions 7%
Friends, neighbors, colleagues 52%
Public exhibitions, seminars,etc 13%
Mobile phone/SMS alerts 13%
Internet 9%
TV 94%
Radio 74%
Newspapers and magazines 70%
2010 survey covering 1,000 persons from all over Sri Lanka

29. Media as a Mirror: But what KIND of
mirror do our eco-activists want?
 Media as mirror of society:
show things as they are:
black, white & grey…
 Media cannot be a ‘Funny
Mirror’ distorting images to
impress a few
 Some SL activists seem to
expect public media to
reflect/amplify exactly &
ONLY what they want.
 Or else…!!!

30. Summing up 1:
CKDu as a ‘prism’ of Lankan society
 Applicability of indigenous knowledge
 Need for full disclosure in public science
 Lack of public TRUST in govt/official
sources
 Loss of public respect for scientists &
medical profession due to public spats
 Policy paralysis from single-issue activism
 Too few public intellectuals
 Even fewer NEUTRAL platforms for
debate

31. Summing up 2:
Headline Thoughts…
 CKDu: unfolding human tragedy
 Need for restraint, focus, compassion:
More than just a ‘good story’ for media
or ‘agitation point’ for activists
 Journalists: reassess their role: limits of
advocacy; need for balance
 Eco Activists: go beyond conspiracies,
villains & finger pointing
 Both: link ‘micro’ with ‘macro’; connect
the dots; keep an open-mind

32. Advice to scientist-activists…
“Scientists should first
establish themselves as
scientists, with a solid record
of peer-reviewed
achievement, THEN speak out
in their area of expertise
--loudly, if necessary.”
- Edward O Wilson
Harvard biologist, author

33. Thank You!
Blog: www.nalakagunawardene.com
Twitter: twitter.com/NalakaG
NOTE: Opinions expressed are entirely mine. These do not
represent those of any entities I am associated with. I welcome
open & dispassionate debate in the public interest.