I have on previous occasions answered questions on Elken products from patients and close friends. I am happy and extremely proud of the two Maldivian NGOs, Maldivian Medical Association and Diabetes and Cancer Society of Maldives, for taking a stand and making their positions very clear on the medicinal use of Elken products in the Maldives.

As a clinician I have been witness to patients who have had their clinically proven treatment discontinued purportedly due to aggressive and unethical marketing of the Elken products by their Maldivian marketers and promotional materials. Patients with chronic and long-term illnesses are the most vulnerable. It is my personal experience that these patients, having discontinued their rational and proven therapies, suffer complications of the illness for not receiving the necessary treatment. This is particularly true for patients with Juvenile Diabetes Mellitus on Insulin therapy.

We as clinicians are at least partly responsible for our patients testing and trying the different alternative therapies. This is not to say that aggressive and unethical marketing has not played with the emotions and fears of the vulnerable patient population, but we clinicians need to improve our communication with the patients to minimise the risk of similar situations in the future. A significant amount of time need to be spend on educating our patients and their families on the illnesses and treatment strategies. Working at public hospitals, where the administration hopes to increase quantity rather than quality and where communication and health education is labeled as "sweet-talk", we are increasingly exposed us to various avoidable problems. We must challenge and improve the situation if we are to realise our dreams and aspirations of quality health care in the Maldives.

I would like to also touch on one of the claims used by product marketers; the use of Elken products in feeding young infants. The promotional material being distributed in Maldives show the use of the product as a breast milk substitute and claims it to be equivalent to breast milk in some way. A video shows the product being mixed in milk and being given to an infant as an improved milk feed. This is a very dangerous and misleading promotional tactic. I strongly recommend against use of any product, whether from Elken or any other company, in this way.

The Elken products may possibly have nutritional supplement value. They are, nevertheless, not to be used as a replacement or alternative to treatment of proven benefit. The benefit and adverse effects of modern medical products are rigorously tested and their research peer-reviewed to gain the trust of clinicians and patients. The same is not true for some of the many nutritional supplements that have been wrongly marketed as alternative therapies based on poorly conceived and executed studies. These studies fail to generate even reasonable level of clinical evidence necessary for recommending them as alternative treatments. Until properly planned and executed trials and research show clinical evidence of benefit in specific clinical conditions there is no place for them in modern medicine.

It is encouraging that senior figures within Elken have held talks with MMA in recent days. They have reportedly distanced themselves from the misleading marketing strategies and claims made by some local promoters. I believe that the situation also requires the company reining in rogue marketers using such inappropriate strategies and re-evaluating the promotional material being circulated. I hope that the concerned authorities and responsible figures within Elken would look into the matter and address the the situation appropriately.