Thursday, September 30, 2010


A major new paper has appeared in Blood about splenic marginal zone lymphoma (aka SLVL). A pan-European group which includes my old unit in Bournemouth have studied chromosomal abnormalities in 330 cases. As we had found before, in our own series, there is a very high incidence of abnormalities (72%) and more than half of which had complex karyotypes. The most common abnormalities were gains of #3 or 3q and 12q, deletions of 7q and 6q, and translocations involving 8q/1q/14q.

SLVL is one of the differential diagnoses for CLL, but it is usually CD5 negative. In this study, however, a quarter of cases were CD5+. Those who were CD5+ were significantly more likely to have trisomy 3/3q, del 6q and trisomy 18 than the CD5-ve cases. However, there was no suggestion that the CD5+ cases were more clinically aggressive. In particular TP53 deletion was not associated with CD5 positivity.

AS has been reported previously some cases of SLVL are mutated and some unmutated. In this series 41% were unmutated and there was an association of these cases with del 7q, but this did not have any impact on overall survival. There was a biased use of IGHV genes. In particular, IGHV1-2 was associated with del7q.

On multivariate analysis the only factors associated with poorer prognosis were age over 65 and hemoglobin less than 12 g/dl - non disease-related factors consistent with the fact that most people die with SLVL, not because of it.

Wednesday, September 29, 2010

The York Minster Fire

Early in the morning of 9th July 1984 it was discovered that York Minster was on fire. 150 fire fighters from across North Yorkshire took two hours to bring the blaze under control. Apparently, the cathedral was struck by lightning shortly after midnight. Bob Littlewood, Superintendent of works at the time, believes the fire was started when lightning earthed through an electrical panel in the roof void.

Because the exterior of the roof was effectively sealed with lead and the fire was well established at the only entrance to the roof void, it was impossible to tackle the fire effectively. The large quantities of tinder-dry oak in the roof burned hot. A great deal of stonework was seriously damaged, as was the famous Rose Window. It is known the Rose Window itself reached temperatures of around 450 degrees centigrade. The Rose Window, a stained glass masterpiece high in the South Transept of the Minster (though not the best example of such in the UK), was nearly lost after the lightning struck. IT was a very old window. The stonework was completed in the mid 13th century but the stained glass was not added until near the end of the 15th century to commemorate the end of the War of the Roses (1486) and honor the Tudor dynasty.

After fire destroyed the South Transept roof, inspection revealed that the stained glass in the Rose Window was severely cracked. The 73 panels, containing 7,000 pieces of stained glass had crazed into about 40,000 pieces. Miraculously, it was all still in place.

Craftsmen secured the stained glass with adhesive film before removing it, one section at a time. Special adhesives - which would mimic the refractive properties of the glass - had to be researched and were specially developed by the 3M corporation before the window could be restored. Each restored section is sandwiched between layers of clear glass and the whole is further protected by more sheets of glass. The stained glass restoration process, along with the restoration of the roof, took about four years and cost $4 million.

At the time there were speculations on how the disaster might have happened out of a clear sky. It was remembered that York Minster had just been used for the inauguration of David Jenkins as Bishop of Durham. Jenkins was a controversial figure who apparently did not believe in an actual resurrection. He called it "a conjuring trick with bones." Some Christians thought that the lightening bolt was an act of Divine retribution.

My knowledge of the Church of England is sketchy. Although baptised into it as a baby, I never attended C of E services, though I was once on an appointments committee for a C of E Chaplain at my hospital. I worried everybody by asking each candidate whether he believed in Hell. The other members of the interview panel were the hospital chief executive and a Rural Dean and an Archdeacon. They did something that I have only seen women do before. They got up and went to the 'bathroom' together. I followed them out and found that they were having a private meeting about whom they should appoint.

It was this encounter that gave me the character of the Dean in whose voice I have written this poem.

The Dean’s lament after the York Minster fire.

Did you really rain fire down merely for a doubt?
Really flame that antique, Gothic window out?
That is some pique! Because a bishop spoke
out of turn? It was a sort of joke
that ‘conjuring trick with bones’, a bit of wit,
only designed to get a headline hit.

Did you even think about the cost?
All those visitor takings that we lost.
Four mill for the repair and at 3Ms
research on plastics, the price condemns
poor curates to more penury, I fear;
no pay rise now for many another year.

What sort of God do you suppose we want?
An old-style, concentration camp commandant
deriving pleasure from unmaking art,
with us quaking, knees shaking, falling apart?
Some sort of vandal, mannerless and rough,
who then responds to scandal by talking tough?

No, God is love and meekness, kindness: who
shows complete, benevolent blindness to
our foibles. He forgives, forebears; does not
take notice when we sin. A big blind spot
to forty-wink at deviation, short-
falling, or reprobation. That’s the sort

of God. The kind who’d never make a fuss.
Now, more important matters to discuss:
the type of God we’d really like to see
would be more like the archdeacon or me;
I hope, sir, that my pleading words won’t chafe,
we must ensure that Sodom would be safe.

The end point of treatment in CLL

There has been an interesting exchange of letters in the correspondence columns of Blood (Blood 2010; 116:1187-8) between Ken Foon and Michael Hallek concerning the end-point of treatment. Confusion arises because what was published in the Guidelines in Blood in June 2008 was not agreed by all the authors and it had to be revised in the electronic records in December 2008.

The problem arose because the 1996 Guidelines were widely used for both clinical practice and for clinical trials, and these suggested that a complete response should mean that there were fewer than 30% lymphocytes in a bone marrow trephine following treatment. If the trephine showed lymphoid nodules then the type of remission should be categorized nodular PR. Since 1996 there has been evidence that a deeper remission than just <30% lymphoid cells in the bone marrow, might be more advantageous to the patient, and also that it is possible to distinguish whether a nodular PR comprises tumor tissue of just reactive lymphocytes.

In order to retain a comparison with older trials, the new Guidelines now suggest that the old (1996) criteria are retained, but that in trials aimed at maximizing CR rate, assessment should be made of minimal residual disease by 4-color flow and that lymphoid nodules should be assessed by immmunohistochemistry. Why should this not be done for all patients? I guess it is because the experts are not sufficiently convinced that attempts to wipe out all trace of discernible CLL is beneficial to the patient - witness the recent CALGB trial of post-treatment Campath.

The second point concerns the use of CT scans. The Guidelines suggest that CT scans are not required for either the initial valuation of follow-up in clinical practice. However, they recommended that they be used in clinical trials - one at the start of therapy and the other at first restaging after therapy if it had been previously abnormal. A second CT is not necessary if residual disease can be detected some other way - such as blood tests or clinical examination.

I think this is now clear.

Tuesday, September 28, 2010

Critical Christians

Should Christians be critical? Two texts suggest to people that they should not. At the beginning of John 8 is the story of the woman taken in adultery when Jesus utters the immortal line, "Let he who is without sin cast the first stone." and in the Sermon on the Mount, Jesus instructs us "Do not judge or you too will be judged." (Mt 7:1)

The picture emerges of a Christian who is not supposed to get involved in the wrongdoing in the world either to condemn or approve it. Above all we should be tolerant. This idea is reinforced by the apostle Paul who asks at the end of chapter 5 of his first letter to the Corinthians, "What business is it of mine to judge those outside the church?" (v12) But he does go on to say "Are you not to judge those inside?" In chapter 6 he goes on to suggest that disputes within the church should no suffer the disgrace of being decided by unbelievers in the general law courts, but to appoint 'even men of little account in the church' to settle this dispute.

I think that because of this train of thought, many Christians have got the emphasis wrong. First, with the woman taking in adultery, 'casting the first stone' is not about making criticism but about carrying out an execution. Jesus is the God of second chances. He came to save not to destroy. He did say, "Go and sin no more" to her, so he was well aware of her being in the wrong. Then on the 'Judge not' reference, what a judge does is to pass sentence. Again he wants to save rather than condemn. In 1 Corinthians 4:5, Paul tells us "Therefore judge nothing before the appointed time; wait till the Lord comes." There will be a time of judgement, and a terrible time it will be, but until things work out we will not know the outcome. To condemn a brother now for a particular sin or viewpoint is premature. However, we should be able to warn.

Jesus was not amiss in confronting the Pharisees or the priestly party of Saducees or even King Herod himself. Paul criticised many people - Demas, in love with this present world; Alexander the coppersmith; even the Apostle Peter when he sided with the Judaizers.

From my reading of Scripture there is no place for mamby-pamby, tolerate anything attitudes. There is a right way to address this issue. It is given in Matthew chapter 18:15-17 "If your brother sins against you, go and show him his fault, just between the two of you. If he listens to you, you have won your brother over. But if he will not listen, take one or two others along, so that 'every matter may be established by the testimony of two or three witnesses.' If he refuses to listen to them, tell it to the church; and if he refuses to listen even to the church, treat him as you would a pagan or a tax collector."

This is a matter of gentleness and kindness. You are not there to score one over on him. Listen to what he says. Perhaps you are in the wrong. If so, make haste to apologize. Church discipline is never easy, but if it is neglected a brother may be lost. I have no truck with the sort of thought control that some elders exert over their flock. There are many things over which Christians may legitimately differ. Nothing should be forced on secondary matters. We have a responsibility to teach and protect young believers, but we must also help the more mature believer to grow. Sometimes we come ac cross inflexibility so that we might cry out with Oliver Cromwell, "I beseech ye in the bowels of Christ consider that ye may be mistaken!" But we should be winsome, patient, considerate and kind with those who disagree with us. Our resource should be Scripture, not tradition or experience.

What about our rights? Paul certainly stood up for his in Philippi when he was wrongly jailed as a Roman citizen. But I a impressed by his attitude in 1 Corinthians chapter 6 where he tells us that it is better to be wronged or cheated than go to law. The gospel is what it is all about, not our dignity or pride. That said in our secular culture, Christians should stand up for the right to believe, to witness and to change our belief if that is what we need to do. Some of the legislation we have seen recently is a direct attack on the life of the Gospel.

But we should not go out of our way to manufacture issues and hit headlines. Some of the situations that have hit the press seem to me contrived and they could have been settled by negotiation or even a simple apology. It is almost as if the publicity were more important than the issue.

In a survey this week 71% of British people said that they considered themselves to be Christians. With that many people not clearly understanding their faith there is a harvest field waiting to be reaped without bothering arguing with a small number of verbose and attention seeking atheists.

Bribing patients

Yesterday, Sir Michael Rawlins, the head of NICE (what they call a death committee in America) was on the radio talking about whether to bribe people to stay healthy.

Once the public exchequer assumes responsibility for people's healthcare it has a financial interest in limiting its costs. Much healthcare expenditure is related to lifestyle choices - smoking, drinking, lack of exercise and doing drugs. True freedom would allow people do make these choices, though they can make the payment if they choose badly. But I don't want them doing it on my dollar. Even without government healthcare, I pick up some of the cost - spousal beatings, road traffic accidents, environmental health hazards, police, the courts, abandoned children etc.

There are studies that show that free gym membership, free self-help groups and the like can change bad habits and reduce later expenditure on treatment of coronary heart disease, diabetes and the like. So should government engage in a sort of libertarian paternalism to change people's habits?

There is a moral question. Should the honest, worthy poor pay for the feckless? And if we admit a carrot, when should we admit a stick?

Thaler and Sunstein would suggest a 'nudge' rather than money. One suggestion: a would-be non smoker opens a checking account. For every day the cost of her cigarettes goes in the bank. On any day there is no deposit, the bank empties the account into that of her least favorite charity - (Free Palestinians for example).

New Labour Leader but not Nu-Labor

Has Ed Milliband made a Faustian pact with the Unions in order to get himself elected? Union leaders have been all over the television - big, burly men, without sensitivity or charm. I must say that I am not attracted to this type of politics.

Trades Unions began not far from here in Tolpuddle, and no doubt they were essential for the progress of this country from feudalism to democracy. The solidarity that gave its name to the Polish Union movement essential to the downfall of communism has its place. It is a formidable weapon, but it can be misused. In the 1960s movies like I'm all right, Jack and The Angry Silence portrayed how terrible union power could be, and the era of Red Robbo at British Leyland showed how right Barbara Castle was to try and control the Unions and silly Jim Callaghan (IMHO even worse than Gordon Brown as a Prime Minister) was to oppose her. Thankfully Margaret Thatcher had the courage of her conviction to defeat Scargill.

We must never let the Unions reclaim power by bully-boy tactics. The Panda as they call Ed Milliband must declare his independence from them or Labor is in for more Michael Foot years.

Monday, September 27, 2010

BCL-3 in CLL

There are a lot of BCL genes - at least 10 that I know of. BCL-1 is involved in mantle cell lymphoma and BCL-2 in follicular lymphoma. BCL-3 is associated mainly with a rather rare type of CLL.

A paper published in Brit J Haematol (Rossi et al 2010; 150:702-4) brings us up to date on the subject. Several short series of case reports have identified that these cases with the t(14;19) translocation as being CLL with atypical morphology, tending not to express CD23, having a low Matutes score, being associated with trisomy 12, unmutated IGHV genes, and biased usage of IGHV4-39. There has also been a suggestion that such cases are more likely to transform to Richter's disease, but this has not been substantiated.

Rossi and colleagues have estimated the incidence of bcl-3 translocations as 1.8% of cases of CLL. It is almost always associated with trisomy 12 occurring in about 10% of trisomy 12 cases.

I have always thought that trisomy 12 CLL is a stand alone category of CLL. We have written in the past about the association of trisomy 12 and atypical CLL (Trisomy 12 defines a group of CLL with atypical morphology: correlation between cytogenetic, clinical and laboratory features in 544 patients. Matutes E, Oscier D, Garcia-Marco-J, Ellis J, Copplestone A, Gillingham R, Hamblin T, Lens D, Swansbury GJ, Catovsky D. Brit J Haem 1996 92: 382-8) and it is a fact that the gain of del 11q and del 17p are not trisomy 12 features. The surface Ig tends to be bright and so do CD20 and FMC7, and there are more prolymphocytes around tan you would expect.

So the interesting question is whether also having a bcl-3 translocation makes matters worse. Rossi et al have looked at this and the answer seems to be no. Treatment-free survival, overall survival and Richter's transformation were no worse fro the 10% of trisomy 12s that had the t(14;19) translocation than for the 90% who didn't. Of course the numbers are small and some difference might appear with a larger series, but the other point is that very occasionally a bcl-3 translocation appears without trisomy 12 and with normal morphology and markers. These cases behave benignly which makes me think that it is the trisomy wot done it.

Incidentally age, sex, stage, lymphocyte count, splenomegaly, lymph node enlargement, CD38 or Zap-70 were none of them associated with the acquisition of bcl-3 translocations. Only IGHV4-39 in its unmutated form.


I was the first person in my family to go to university. At the time, I did not know what to expect and to be honest I didn't make the most of it. I was disappointed by my head teacher's last comment on my school report - "He should have aimed higher."

I took it to mean that I should have aimed for Oxford where he had been.

As it was I went to Bristol, which had a name for taking Oxford rejects. Bristol is a fine university in one of the nicest parts of England and has had its share of Nobel prizes, but it also takes more than its fair share of Public Schools students - in England that means students whose (usually rich) families have paid for a private education.

When I got there I was overawed by these well-mannered young men with impeccable accents who knew how to behave in company. It made me shy and impaired my progress. I tended to become a joker, providing comic relief for the upper classes. Although, I could tell a good joke and write scurrilous verse, what endeared me to fellow students didn't wash with the academics. I don't think I ever quite shook off this reputation. One of my research fellows (now a distinguished professor) used to regularly scold me for my funny articles that I wrote for magazines like World Medicine.

I wrote a poem about ambition at the time, but in keeping with my task of revising my old poetry book I have brought it up to date and here it is:


Pushing through the holly-prickle teeth
of the quick, ambitious, climbing wind,
I trickle like a lock-gate shut beneath
the higher levels and the thicker-skinned.

I build my stickleback-nest short of where the best
grass grows, caught at not knowing who is known
and who knows. I am an item unaddressed,
tired of the mind and manners I have grown.


Those prison walls grow moss for mortar now;
the status of the prisoner: ‘long-unchained’.
To silver-spoons no need to still kow-tow,
that haughty hollowness was merely feigned.

A happy man must fit inside his skin,
content with his achievement and his loss.
If God and godliness are stored within
so much the better; all the rest is dross.

I Timothy 6:6

Sunday, September 26, 2010

Latest chemo

I am in the middle of my first course of the new chemotherapy. It started at 12-30 yesterday with a one-hour infusion of irenotecan and a two-hour infusion of folinic acid. Then I had a bolus of 5-FU followed by a 46 hour pump of 5-FU. The total dose of 5-FU is over 5 grams.

The irenotecan caused stomach cramps and I had to have atropine to counteract those. The anti-emetic was ondansetron plus a big dose of dexamethasone. The dex kept me awake all night which was unpleasant, but today I have been OK so far with no real side effects.

So far so good. Although we didn't want to risk church this morning for fear of galloping diarrhea, we were able to watch it via the Internet here. Roger Carswell was preaching about the Philippian jailer of Acts 16 and he asked the question of how we put ourselves into the position that people will ask us, "What must I do to be saved?" It was a very good service with the building bulging.

Saturday, September 25, 2010

Galatians chapter 1. Gospel direct not derivative

Paul's stress in Galatians chapter one is to insist that his is not a man-made gospel, but that it comes directly from God. This is a very modern criticism of Paul. You frequently hear about the historical Jesus who was very different from the theological Paul. Paul, they say, was an intellectual who systematized Christianity - turned it into a misogynist, Pharisaical, organized theology, when what Jesus had wanted was a free and easy relationship with the numinous.

Nothing could be further from the truth. The gospel that I preached, he said, is not something that man made up (v 11). I did not receive it from any man, nor was I taught it.

He received it by revelation from Jesus Christ. Paul's experience was unique. Other Apostles received the gospel directly from Jesus - in their years as disciples or the weeks as friends after the resurrection - but uniquely Paul received his gospel after the Ascension. It was a finishing touch of enormous power. It enabled Paul to rebut the charge of being derivative. The Gospel came direct.

This was an important strategy of God's. We know that the disciples had been given the Great Commission. As Jesus was taken up into heaven they were told that they would be his witnesses in Jerusalem, in all Judea and Samaria, and to the ends of the earth. Perhaps somehow this was not happening. Was there some impediment? Some Devilish activity sowing dissension rather than the seed of the Gospel? Perhaps the believers in Jerusalem were like the elders at William Carey's Northampton church, too concerned about not preaching to those who were not the elect? Whatever the cause there needed to be a fresh impetus and God was able to wield the Devil's sharpest tool, Paul, to use against him. Direct revelation to Paul was the answer. Appoint him apostle to the gentiles. (Later another kick in the pants got them out of their sinecure - Jerusalem was sacked in AD 70.)

A comment on that word 'revelation'. Don't think that you can happen on the Gospel by just thinking. So great is the Gospel that it has to be revealed. What would we know of Jesus except that he had been revealed. Paul tells us that we can recognize a creator from the creation, but the nature of grace, the fact that God is love, the person of Jesus Christ, his work upon the cross - all these must be revealed to us. How important then is Scripture! It is a miracle delivered by the Holy Spirit!

After his road to Damascus experience, Paul did not go up to Jerusalem to consult with the authorities so that his 'i's might be dotted and his 't's crossed. He went immediately to Arabia and later returned to Damascus. What he was doing in Arabia we can only guess at. Rest, prayer and meditation may have all been necessary after such a momentous experience. His return to Damascus we can follow in Acts chapter 9. I take it that his time in Damascus was interrupted by his sojourn in Arabia, which could have meant the hinterlands of what we now call Syria. Back in Damascus he began preaching in the synagogues in such a convincing way that all who heard him were astonished. He provoked opposition among the Jews so that he had to be let out of the city down the walls in a basket, since watch was kept on the city gates for him.

Eventually after three years he did visit Jerusalem, but this was a short private, fortnight visit to get acquainted with Peter and a brief visit with James, the Lord's brother. This was a time for touching base. It was not to obtain an endorsement. No doubt there was a two-way sharing of information. But the reaction was "He who formally persecuted us is now preaching the gospel of the faith which he was trying to destroy." A testimony to the power of God.

Friday, September 24, 2010

GTAC to go

I see in this morning's Telegraph that the QUANGO that I am a member of, GTAC, is to go. We had already lost our right to a first class ticket on the train to travel to the meetings, but now the whole thing is to disappear. Actually, it will simply revert to being an ordinary ethical committee for gene therapy trials and this will mean that the experts who have been recruited to study the trials will no longer be paid to do so. I suspect that they will find their time too much in demand to be able to volunteer it. For around 20 hours work per meeting, the fee was £150 - not much more than the minimum wage.

Home from China

After my line was successfully inserted on Wednesday, I was well enough yesterday to attend our first church home group meeting in several months. Three of the groups have been supporting a missionary family from Lansdowne who are working in China but home on furlough at present and they put on a presentation of their work for us all (30-40 of us).

They work in Chengdu in southwest China, the capital of Sichuan province. It is a city with a population of 11 million. Like many parts of China it has undergone rapid industrialization with a move from the country into the city. There is much heavy industry but also electronics and financial services to give employment, but smog (as we saw at the Olympics) is a great problem. Forty miles to the north is the Tibetan plain, but usually the mountains are hidden in the smog.

Although, still a communist country, China has undergone great liberalization and in most parts Christians who obey the civil law are in no danger. The recent bloody fighting between Han people and at least 1,000 Muslim Uyghurs in Ürümqi, the city of the Xinjiang Uyghur in northwestern China in which 197 people died with 1,721 others injured and many vehicles and buildings destroyed was quite atypical. It is to be hoped that there is not a backlash against all religions as a result of violence from the mad Mullahs.

The Church in China is either registered or unregistered. The Registered church, the Three-Self Patriotic Movement was an attempt to free China from foreign domination - Western Christianity was tainted by the Opium trade and the Boxer revolution. Today it is made up of mainly older women. But the real growth has been in the unregistered House Church movement with perhaps 50-100 million members nationwide. In Chendu there are many such house churches with congregations of up to 200. Western missionaries generally attend Western Churches that are permitted to exist by the state, but indigenous Christians tend to go to the House Churches. The twain do not mix much to avoid drawing attention to themselves. Keeping them from any flagrant demonstration or triumphalism is key to gaining acceptance from the secular state. Ostentatious displays are likely to draw the attention of the religious police.

What has been noticeable is the acceptance of the good works of the unregistered house churches by Communist Party members. In the earthquakes of 2008, the epicenter was only 48 miles from Chendu, but because of the quality of building construction in the city there was no more damage than was caused by a force 4 earthquake in Folkestone in Kent a couple of years ago. To the north of Chendu the damage was devastating, killing more than 80,000 people, including thousands of children who were crushed to death when their schools collapsed on them. More than 374,000 people were injured and millions left homeless when the 8.0 magnitude quake struck southwestern Sichuan province. Its epicentre was in the mountainous county of Wenchuan, where nearly 24,000 died or were counted as missing - about a fifth of the population.

China launched a massive aid operation immediately after the quake, sending in troops to rescue people trapped in rubble, organise evacuations and deliver aid. Scores of aircraft were also deployed. The quake marked the first time that China had asked for outside assistance to deal with a major disaster. But U.N. agencies and international groups played a relatively minor role - partly because China has significant resources and long experience in dealing with large crises.

My friend and many of the local Christians were prominent among those taking aid to the distressed and local officials did not fail to observe this. I am told that there were suddenly new words in Mandarin for 'donation' and 'volunteer'.

Being salt and light in the world is far better than bombs and bullets in influencing people. In the last year my friends have seen CP members trying to get their children into the free Kindergarten run by house churches for pre-school children. They want some of what they have for their children.

Persecution in Kenya

From the Barnabas Trust:

Kenyan Christians abducted, tortured and raped

Six Christian missionaries have been found alive but traumatised after suffering three days of unimaginable torture in Kenya.

Three men including Mr Y, the leader of a group of Kenyan missionaries supported by Barnabas, had travelled to Nairobi on the morning of Wednesday 15 September to help three Christian women to move out of their apartment to a safer location. The three men arrived safely, but when Mr Y’s wife called them later that day, she could not get an answer. By 9pm she began to realise something serious must have happened. Going to Nairobi, she found the apartment door unlocked but no trace of the missionaries.

The police began an investigation and at 4am on 18 September the group were found - dumped at the side of a main road. They all had their eyes and mouths tightly sealed with tape, and their legs and arms were bound, but they were all alive. The three women had been systematically raped and were deeply traumatised; still suffering from shock, they were not even able to talk. At the hospital they were given drugs to reduce the risk of their contracting AIDS. They will remain in hospital for two weeks of comprehensive care to help them recover from the physical, psychological and emotional distress.

The three men had been tortured and their bodies were covered in bruises; one man needs treatment for a dislocated shoulder after he was thrown “like luggage” into a truck. The men will remain in hospital for five days to receive counselling. But Mr Y’s wife said, “No matter the agony, they praised the Lord.”

Early in the ordeal, the Muslim men asked one of the women, “Who’s the saviour of this world?” When she boldly answered, “Jesus Christ is the Saviour,” they slapped and spat at her and shouted “You’re wrong, you prostitute, it’s Osama who’s the saviour.” When the group was finally released, they were told, “You’re lucky ... we’re directed to free you. We could have killed you this night. Maybe your Jesus saves you. But warning ... stop leading Muslims astray with your corrupt Bible. Nobody shall be worshipped but Allah and Muhammad is his prophet.”

Kenya has a strong Church, yet Christians face challenging opposition, and the situation of converts and women can be particularly difficult. In July, 18 converts from Islam met on a secluded beach to be baptised by Mr Y and his team, when they were suddenly attacked by a crowd of around 100 Muslim men who beat them with pipes and wooden clubs. Five had to be hospitalised for several days, including a woman who had been beaten unconscious and a man with a broken arm.

Barnabas Fund is covering the hospital fees of the missionaries and converts involved in both these incidents. To contribute visit this site

Lynette revision

My diurnal rhythm has been destroyed by the dexamethasone and for the second night running I am typing at 3 am when I should be sleeping.

I contacted an old school friend yesterday on Friends Reunited. Dom Darling was a brilliant scholar who read Physics or Maths at Imperial College, London. I had heard that he had dropped out because he was making too much money playing Poker, but that may be just gossip since he eventually had a successful career at IBM. Apparently, his retirement has been filled with Golf and Bridge; not how I expected him to end up when he defied the headmaster by buying an ice cream from Mr Whippy’s van over the wall of the school. For that he received several detentions, so I tend to believe the Poker story.

Another thing I associate with him, though, again, my memory may be playing me false, is the statement that poetry is appreciated by young girls and old men, but it is written by great men in their spare time. With this in mind I have been looking at my Juvenilia. I wrote about 80 poems between the ages of 16 and 23, some of which showed promise, but most of which were self-indulgent. I wondered whether they might contain a hint of talent that might be refined by experience.

This poem arose from an actual incident on the gynaecological ward round. A young girl had an ovarian cyst removed. Unfortunately, it turned out to be highly malignant. Those were the days of very little chemotherapy, though I expect that she had entirely inappropriate radiotherapy at the time. This happened as I was tail-end Charlie on a ward round. I called her Lynette, though that wasn’t her name – I was probably into Country and Western at the time.


She smiled at me,
Her fair and swinging
Straight hair hanging,
And wrinkled up her nose
Like a white soft rabbit
Culled from Alice.
She talked, an earnest seventeen,
Of God and Beethoven,
And pointed to her scar
And how it wouldn’t show
On next year’s beaches.
While I, who knew the worst,
Forgot my pretty speeches
Lest the bubble burst
And gaily smiled at her instead;
My laughter smothering the dread.

Actually the last two lines are a later revision, but even they were an improvement on the original.

Recently, I have begun to feel that pentameter is a better meter for me. I once enjoyed the concision of three- and four-feet lines, but I have become impatient with the contortion that this demands.

So here goes on the revision I have made for now. Please comment on the poem, its theme or its process.


She smiles at me, her fair and swinging straight
hair hanging. Rabbit-wrinkling up her nose,
she indicates that I, the trailing leg, should wait
while each attending white coat speaks and goes.

She talks, an earnest seventeen, of Grieg
and God and points to her bikini scar,
enlisting me, who knows the unsaid worst,
but briefly in her fabulous intrigue
to speak of next year’s beaches and there are
hiatuses in case the bubble burst.

Now forty years and more have gone, dispersed
Lynette, herself, to ashes or to dust.
My own white coat of armor has been shed,
I stand bareheaded as I was at first
and ask did I betray or underpin her trust
and that of others dead or long-time dead?

I ask for honesty from my white coats;
of fables, dreams and hopes I have enough;
don’t buoy me up with delicate misquotes,
I’ve learned to take the softness with the rough.

Thursday, September 23, 2010

A Touch of Frost

Some of you may be fans of David Jason's performance in A Touch of Frost, the long running detective series. Apart from the fact that he much to old and short to be a serving police officer and the series tends towards sentimentality - I enjoy it too.

So now that there are to be no more TV plays, I thought I would read one of the books that the series was based on - A Killing Frost by RD Wingfield.

It is clear that the books have a more rugged edge than the TV series. Frost is more exasperating and less lovable. He is an over-promoted detective sergeant who hates paperwork, relies on gut-instinct that is often wrong, performs searches without a warrant, longs for the days when he could beat a confession out of a suspect and has a heart of gold, especially where women and children are concerned.

He is foul-mouthed and sexually crude, offensive to authority, filthy in his habits and besotted with an earthier type of woman.

The books are 'poorly' written with short, verbless sentences and poorly presented in paperback with too few words on the page so as to make turning them a chore. They are however, very plot-dense, and the whole series of stories is neatly wrapped up in the denouement.

Frost as a genre is variably described by critics as a funny, frantic, utterly refreshing brew; as affecting, frightening and amusing; a crisp, confident, ripely-characterized novel, exciting, ingenious and roundly satisfying, multiple cases, multiple bodies, lashings of police-infighting. Fast furious and funny; Darker, funnier and more violent than the TV adaptation; a comic monster on the side of the angels; A cross between Rumpole and Columbo; More twists than a bucket of eels. And from the Guardian itself: A clever writer with an appealing line in cheekiness... Frost remains the most unattractive cop in mainstream crime fiction.

All comments are true in part.

Weatherall's Lasker

I was very pleased to hear that Sir David Weatherall has won the Lasker Prize for his work in Thalassemia.

I have known him (though not well) for the best part of thirty years. Many years ago I wrote a paper with him, having discovered a patient with beta thal trait and swiss type hereditary persistence of HbF, each inherited from a different parent.

He was quite excited by the discovery and sent his research fellow, Bill Wood, down to Bournemouth to do the necessary confirmatory tests on our primitive equipment. The paper was published as Heterocellular hereditary persistence of fetal haemoglobin (heterocellular HPFH) and its interaction with B thalassaemia. WG Wood, DG Weatherall, JB Clegg, TJ Hamblin, JH Edmonds, AM Barlow. British Journal of Haematology 1977 36: 461-473. and has been cited 35 times.

Wednesday, September 22, 2010


I am back from having my Hickman line inserted. I was one of five for this afternoon. I was sedated, so I knew little about it. he was able to insert in the same right external jugular that had been infected a year ago, so healing had taken place there. Also the thrombosed vein on the back of my left hand which resulted from a venflon while I was under the surgeons, had fully recovered and the was patent.

How wonderful the body is at healing itself!

Harvest mice

I don't have much cause to commend the Daily Mail, but because of the stunning pictures published today I certainly do. Well done!

New on MDS

Although most people associate me with CLL, I spent almost as much of my career on myelodysplastic syndrome (MDS). Even as a young man I was fascinated by this pre-leukemic condition and in my early twenties encountered three patients with what we would now call refractory anemia with sideroblasts who had chromosomal abnormalities (MM, AW and PS). In those days before chromosome banding, we could not identify individual chromosomes and just called them 'C' group chromosomes. In retrospect, chromosomes 7 and 8 were involved.

As a registrar and senior registrar I accumulated a series of unexplained cases, but it wasn't until Dr Mufti came to work for me as a fellow, having previously worked with the late, great, David Galton at the Hammersmith, that we set about identifying what was going on. We wrote an important paper that established that MDS was much more common than people had thought hitherto, and that most of it went undiagnosed. Myelodysplastic syndromes: a scoring system with prognostic significance
G. J. Mufti, J. R. Stevens, D. G. Oscier, T. J. Hamblin*. British Journal of Haematology 1985 59,425–433. We discovered that our hospital 76 cases had been misdiagnosed in the past 5 years. This was the first paper to offer a prognosis based on the initial diagnostic picture and it has since been cited in the medical literature 423 times. Later on we added our data to those of the French, Japanese, Spanish, Germans and a small American series to produce the International scoring system for evaluating prognosis in myelodysplastic syndromes P Greenberg, C Cox, MM LeBeau, P Fenaux, P Morel, G Sanz, M Sanz, T Vallespi, T Hamblin, D Oscier, K Ohyashiki, K Toyama, C Aul, G Mufti and J Bennett Blood 1997, 89, 2079-2088. which is one of the most cited papers in Blood with 1990 citations.

My main interest in MDS has been in diagnosing the very early forms of the disease. Barn door cases need to be distinguished from acute leukemia, but accurate diagnosis of the early cases depends on viewing very good blood films with an expert eye. Abnormalities of nuclear shape and structure, various cytoplasmic inclusions and granulation and overall cellularity are crucial. More can be done diagnostically by looking and the histology of bone marrow trephines and the disposition of the reactive tissue. Unlike CLL, you can't simply stick a sample on a flow cytometer and hope to get an answer. Though you may get clues.

There are certainly similarities between MDS and aplastic anemia, and one of the features of aplastic anemia is the presence of a clone of cells derived from this strange condition, paroxysmal nocturnal hemoglobinuria (PNH), in which the red cells are particularly susceptible to lysis by endogenous complement. It seems that cells lack GPI connected molecules on their surfaces that inhibit complement activity, particularly CD55 and CD59 and they can be tested for by flow cytometry.

The sorts of patients I am talking about are those that have a degree of isolated and unexplained thrombocytopenia, neutropenia or anemia (particularly with a raised MCV). The degrees of myelodysplastic features are too small to label the condition MDS (although Alan Jacobs of Cardiff used to call such cases NQMDS or NYMDS - not quite- or not yet- MDS). The international community has labelled such cases idiopathic cytopenia of undetermined significance (ICUS).

In this month's BJ Haem there is a letter from Japan (Ando et al 2010, 150: 705-707) reporting on PNH cells in ICUS. It is brief and probably premature, but it picks out 2 of the 11 ICUS cases that they studied and suggest that these who had small populations of PNH cells also had very low numbers of megakaryocytes - perhaps making them aplastic anemia forme fruste rather than MDS. However the numbers are too small to be statistically significant.

People complain that hematologists are poor at diagnosing MDS. True, but that underestimates the difficulty.

Tuesday, September 21, 2010

Health update.

I have had my pre-chemo work-up. I seem pretty fit though I am dry and thirsty - probably the result of the dexamethasone, which has again relieved my subacute intestinal obstruction. I managed 3 hour-long walks at the weekend, but now I have a sore calf. This may be the DVT giving me bother again, even though there is no swelling. I think I will go back on low molecular weight heparin prophylaxis against that for the chemotherapy that starts on Saturday. My BP was 130/72 despite the steroids, so I am happy about that. My weight seems steady at 182 pounds. Sleep is disturbed, probably because of the steroids again.

Tomorrow, I have my line in. I hope he gives me some sedation. It will go into the left external jugular, I expect, since the right was impaired by a line infection a year ago. The tunneling is quite an unpleasant experience.

My alternate weekends are going to be ruined for the next six months, but when you are retired you may as well shift your week on a couple of days - it makes no difference.

Thanks to all those who have been praying for me. Please don't stop. I am going to make every effort to get out and about during this period, but there will be times when I have to be at home. Lansdowne members, please try and visit. There are many of you who read the blog, but we don't know well and we would like to get to know you more. Ring first, 267156, but if I am in, I will give you a cup of tea (coffee, fruit juice) and a biscuit and have a chat. Don't be embarrassed or frightened of talking cancer - I would just as soon talk television or cricket or cars or especially about God. I am quite prepared to ring people up and invite them round, but I am sure you would prefer the initiative to come from you.

Sangin handover - a sanguine comment

Today, the British handed over Sangin province in Afghanistan to the Americans. The BBC has been portraying it as a British defeat and withdrawal and there have been many opinions on whether this is true. From a surprising source, though, one commentator insists that the 5 year operation has been a success.

In 2006, Britain's effectiveness in Helmand and Sangin was more than debatable. Isolated and sparsely populated, Sangin was not a priority when the overall number of Nato forces in Helmand was absurdly low. But the situation there has improved markedly over the last year, and especially in the last few months, and the pressure ISAF forces in Sangin have absorbed has allowed more rapid progress to be made in central Helmand, which is more densely populated. It took the better part of four years to get the process moving, but British forces finally succeeded in getting more of the local population to believe in – and work with – the Afghan government. How?

First, the continued presence of British troops in the district illustrated the fallacy of the Taliban's propaganda. Locals realised that UK forces were not out to murder them or take their land, but there to help. Second, the new governor Mohammed Sharif – who is literate and trusted by the population – has served as a legitimate interlocutor. British forces created the space for Sharif to govern effectively. In return, the locals have refused to blindly support the Taliban. Instead, they are engaged in a genuine dialogue with the Afghan government about what public services are required and how to deliver and oversee them. This, over and above any tactical military advantage, is surely the basis for any sustainable reconciliation.

One tangible result is that the Taliban have had to moderate their behaviour and make it easier for people to obtain seeds and irrigation from central government – which neither the Taliban nor the major narcotics barons had the interest or capacity to provide. This moderation is apparent in a revised code of conduct issued by the Quetta Shura around 18 months ago. People no longer support the brutality of the Taliban and have higher expectations of those who seek to govern them, which is why the Taliban shadow governor has been replaced a few times in the last year. The Taliban are still present, but they are no longer conducting business as usual.

The presence of the British in Helmand has been a constant thorn in the side of the Taliban. The region is extremely important for the cultivation and production of narcotics and the overall weakness of our presence there encouraged the Taliban to continue their onslaught. The paradox of this, however, is that it enabled more populous, central regions of Afghanistan to develop with less insecurity. The result is that places like Lashkah Gah and Nad Ali are much more likely to be handed over to Afghans in the near future.

Pope's visit

I have not commented on the Pope's visit to the UK. It has been all over television and readers can make up their own minds about it. I am not a Catholic and although in some areas I might be regarded as a co-belligerent, supporting some Catholic views, there are clear doctrinal differences between them and me.

What I will comment on, though, is the attempt by the BBC to hijack the visit for its own agenda as reported in this piece.

I will quote small extracts but click the link and find the whole story.

A parish in north London has complained over the way in which the BBC carried out an interview in their church. They say that although they were approached by a BBC reporter who asked to speak with parishioners about their views on the Pope's visit - in fact a service at the church was just used as a backdrop to an interview with someone from a campaigning group not based in the parish.

Penelope Middelboe, of the newly created Catholic Voices for Reform ( May 2010) was shown attending the service at St John Vianney’s, including a close-up, and being interviewed outside the church, giving the impression that she was a parishioner and supposedly a spokesperson for the parish. (I do not understand why she was brought to St John Vianney’s when the interview could have been held elsewhere.)

• When the reporter Robert Pigott was speaking, parishioners were shown in the background leaving the church. He said: “The poll shows that large numbers of ordinary Catholics are, by disputing important teachings on issues like celibacy and the role of women, prepared to challenge the Pope’s view on exactly what the church’s message should be”.

The report does not show any of our parishioners expressing their opinions. So this could be understood that those parishioners who were filmed leaving the church shared the views of what the reporter referred to as ‘ordinary Catholics’.?

It pains and saddens me that I now have to question the integrity of the BBC. It deceived our parish priest and did not do what it had explicitly received permission for, which was to seek the opinions of parishioners at St John Vianney’s.

I hope that the BBC will provide fair and honest reporting of the Pope’s historic visit. On a personal note, I thank our Queen for inviting the Pope to the nation. I look forward to your reply.

Monday, September 20, 2010

Obama doesn't do God

Towards the end of a speech on September 15 to the Congressional Hispanic Caucus Institute, President Obama began quoting the famous “rights” line from the founding document. The line is supposed to read: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

“We hold these truths to be self-evident, that all men are created equal. [Long Pause] Endowed with certain inalienable [sic] rights: life and liberty, and the pursuit of happiness.”

After the Reverend Wright Obama doesn't do God.

Galatians - duel fuels

I remember having a discussion on his blog with Ben Witherington III, the well known evangelical theologian who has an Arminian bent. Ben was going to buy a Toyota Prius having bought in to the global warming ideas. I argued that he should buy an old clunker since the carbon-cost of manufacturing a new Prius would outweigh what saving he would make on its running, but it got me thinking about duel fuels.

This week the Nissan Leaf is being launched in the UK. This is an all-electric car which does away with a petrol engine, but will only do 100 miles before it needs an 8-hour top-up from the mains electricity in your garage. This is fine in France where most electricity comes from nuclear sources, but in the UK the source of the electricity is mostly from coal, gas and oil, so it doesn't seem worth it putting £5000 of taxpayer's money into subsidizing the factory making them.

My only experience of duel fuels is when I put some petrol in my diesel Ford. I was convinced that I had at least ruined the catalytic converter, but it seems that petrol floats on diesel and will gradually dissolve in it, so that as long as I kept it topped up with diesel for a couple of weeks I should escape without damage. After all, you can run a diesel on chip-fat. The other way round would have been lethal. (Putting petrol in your diesel, not diesel in your chip pan, I mean.)

In Galatians chapter 1 Paul is inveighing against a duel fuels policy. Relying on keeping the Mosaic Law, when you have Jesus as a Savior, is not just wasteful, it is lethal. Suppose you go to buy your wife a golden ring. You have saved the correct sum and you know that you can pay the bill. But just in case you can't you borrow another £100 from a friend. What does it say about your savings? That you don't have full confidence in them. The same is true about Jesus's saving grace; do you have full confidence in that? Or do you need some plan B in case it isn't enough? If you do not have full confidence in Jesus then you doubt him. You are not confident on him. No wonder Paul is cross with them.

As he later writes to the Romans, "Therefore no-one will be declared righteous in his (God's) sight by observing the Law; rather through the Law we become conscious of sin." (Romans 3:20) The purpose of the Law is to let people know that they are sinners. Most of us sinking in the sea would know that we are in danger of drowning. We have a built in gag reflex that tells us so. We begin to panic.

Unfortunately, today people do not realize the danger they are in. They have been so sucked in to an easy lifestyle, comfortable homes, television on tap, food and drink supplied, warm, entertained and looked after, that they think it will always persist. And when they die they assume that it will all be taken care of for them. That is what the Law is about. It is a source of irritation. It says this is wrong and this is right. And you, my friend, cannot meet the Law's demands - not with all the labor of your hands.

Paul writes, "What advantage then is there being a Jew?" (Romans 3:1) The advantage is that they have the Law; they know what is right and what is wrong. They should know they need a Savior.

Jaguar gone - not gone.

It has been a busy weekend. My son David, the Formula 1 engineer, was here to stay before going out to the Singapore Grand Prix later this week. It is several weeks since we have seen him - I was just recovering from my operation.

David is the practical one in the family and likes to set about the household tasks that I would have attempted (badly) in days when I was fitter. His cottage in the country is part Grade II listed in a small village in Warwickshire and he is gradually restoring it to its former glory. He has become integrated into the village in the past few months mixing with farm workers, parvenues and aristocracy. He is in his element there. His dog finds her way to the pub and sets up his beer before he arrives. He turns out for the village cricket team and helps in the country churchyard with grass cutting and weeding. He has bought an old Land Rover for the winter when the village is likely to be snowed in and is restoring a VW Camper in his garage.

He sorted out my fax/printer/copier/scanner, which was not communicating well with my computer. We eventually bought a new Epson at about a third of the price of the HP which had failed after 3 years.

Then he sorted out the front door bell, that had been playing "Twinkle, twinkle little star" every time our next door neighbor opened their electric gates. By delving into the wall he has restored the original bell's wiring and we will now know know when our visitors are outside. Last week we had visitors from church waiting outside for us to return from the shops when the bell didn't work.

Then as an encore he straightened out the doors of our kitchen cabinets, by fiddling with some screws.

We also managed to pass on to him various tools that we have no use for, like duplicate saws, a plane, a leaf blower and a some wood for his wood-burning stove.

He also took me out for exercise. Three one-hour walks over the weekend - on the beach, over the golf course and over Hengistbury Head - gave me a sore calf but a general feeling of fitness while his dog, Flo, loved it.

Our main purpose was to dispose of the Jaguar, which is 11 years old and has done 92,000 miles. Recently it has become a bit of a money pit with the last 1000 miles costing nearly two dollars a mile to run (almost cheaper to take a cab). He drove it up to Warwickshire last evening with a view to selling it. After his journey he made a telephone call telling me that he couldn't bear to do it. It has been so much part of me for the past 7 years that he is emotionally attached to it. Instead, he will do the minor repairs and servicing that it needs himself and give it back to me next time he returns.

I do love that Jaguar.

Saturday, September 18, 2010

Jonathan Aitken

I have just finished reading Jonathan Aitken's autobiography, Pride and Perjury which was written in 2000, ten years ago. Aitken was one of those 'future Prime Ministers' who had his legs chopped from under him by the über-sinister press. He was a person of privilege. Tall and handsome, Eton and Oxford, rich with connections (moderately rich anyway - he could lay his hands on a couple of millions); he was a great nephew of Lord Beaverbrook, owner of the Daily Express and Minister of Aviation in World War II. His grandfather was British Ambassador to wartime Dublin, and Jonathan was raised in the Embassy because his father was a Spitfire pilot, horribly burned and a guinea pig at Archie McIndoe's plastic surgery unit at East Grinstead, while his mother served in the WRVS.

Not all went smoothly because as a young child he caught TB and spent 3 years with his legs in plaster of Paris, but nevertheless, he profited from his background, becoming a journalist in Viet Nam and Biafra, then a Merchant Banker and an author (he penned a biography of Richard Nixon after Watergate).

He became a conservative MP like his late father, and he was tipped for high office. He became a minister of defence under John Major and later as Chief Secretary to the Treasury he joined the Cabinet. But things began to go wrong.

He had friends in the Middle East which displeased Left Wing journalists at the Guardian and Granada TV. Articles and TV programs began to put it about that he was a Saudi plant in Parliament, that he had acted as a pimp for Arabs, that he took bribes and kick-backs on arms deals and that he ran a brothel (perhaps several).

It seems likely that all these accusations were outright lies and Aitken sued for libel. Despite the obvious veracity of his case he was caught out in a different lie. On a trip to Paris he allowed his hotel bill to be paid by a Saudi friend and then denied it, creating a conspiracy of lies to cover up his falsehood, involving his wife and daughter. The libel case collapsed, he lost his office, he became bankrupt, and his wife divorced him.

Yet he sees this as a journey of redemption.

Spiritually he was the sort of token High Anglican that you get from Public Schools like Eton, but when his wife questioned the shallowness of his Christian beliefs he did a dangerous thing. He put himself in the hands of the Living God. He was already Warden of St Margaret's in Westminster and he joined a Lenten series of meditation. He was asked to think about Isaiah chapter 43:
1 But now, this is what the LORD says— he who created you, O Jacob, he who formed you, O Israel: "Fear not, for I have redeemed you; I have summoned you by name; you are mine.
2 When you pass through the waters, I will be with you; and when you pass through the rivers, they will not sweep over you. When you walk through the fire, you will not be burned; the flames will not set you ablaze.
3 For I am the LORD, your God, the Holy One of Israel, your Savior; I give Egypt for your ransom, Cush and Seba in your stead.
4 Since you are precious and honored in my sight, and because I love you, I will give men in exchange for you, and people in exchange for your life.
15 I am the LORD, your Holy One, Israel's Creator, your King."
18 "Forget the former things; do not dwell on the past.
19 See, I am doing a new thing! Now it springs up; do you not perceive it? I am making a way in the desert and streams in the wasteland.
25 "I, even I, am he who blots out your transgressions, for my own sake, and remembers your sins no more.

Jonathan Aitken passed through deep waters, but God was with him. He had to forget the former things. His public life was lost. He was sent to prison for perjury in 1999 and served 6 months of an 18 month sentence. Before going to prison he attended an Alpha Course. He came to recognize that this was all necessary to cure him of his pride and arrogance. He emerged a much humbled man.

After graduating with Distinction in theology after two years at Wycliffe Hall, Oxford (2000-2002) he began a new career as a writer, lecturer, and broadcaster. He has completed a second autobiography about his time in prison, a biography of Chuck Colson, who greatly aided his Christian growth and a biography of John Newton.

His wider activities include being a director of Prison Fellowship International, executive director of The Trinity Forum in Europe; and Honorary President of Christian Solidarity Worldwide. In 2007 he was appointed Chairman of the Centre for Social Justice’s policy study group on Prison Reform. He has been a speaker at the Keswick Convention

As a Christian public speaker Jonathan Aitken is heavily in demand for lectures, talks, debates and after dinner speeches. He fulfils around 100 speaking engagements a year, many of them in the United States.

Friday, September 17, 2010

Galatians on circumcision

"I am astonished that you are so quickly deserting the one who called you by the grace of Christ and are turning to a different Gospel - which is really no Gospel at all?"

What was this different Gospel that Paul was so irate about?

In essence it was that Jesus was a Jew and that while these religious Jews were believers in the resurrection of the dead (all Pharisees were) they didn't see how this changed their conception of Judaism; it was just one more bit of evidence that they were right. The way to please God was to obey the Law of Moses. So they were insisting that new converts to 'the Way' should obey the Law of Moses and the first thing was to get circumcised.

Circumcision preceded the Law of Moses. It was given by God to Abraham in Genesis 17. It was the sign of a new agreement or Covenant between God and him. Abraham's name was changed from Abram to Abraham (not just father, but father of many) and Sarai's name to Sarah. In this agreement God gave the land of Canaan as an everlasting possession to Abraham and his descendants, and promised to be their God. Circumcision was to be the sign of the Covenant.

Circumcision was an entry into the Passover feast (Exodus 13:48) and part of the Levitical Law (Leviticus 12:3), but the practice lapsed and those born in the desert after the exodus had not been cut, so Joshua had to circumcise the nation again (Joshua chapter 5).

However, quite early in its history the prophets of Israel recognized that circumcision could become just a token bit of holiness like wearing a crucifix or having a fish on your bumper. After the golden calf incident Moses told the Israelites, “Circumcise your hearts, therefore and do not be stiff-necked any longer.” (Deuteronomy 10:16) and this was picked up by Jeremiah preaching to the wayward Jerusalem and Judah, “Circumcise your hearts … or my wrath will break out and burn like fire because of the evil you have done.” (Jeremiah 4:4).

This same expression is taken up by Paul in his letter to the Romans. (2:28-29) “A man is not a Jew if he is only one outwardly, nor is circumcision merely outward and physical. No, a man is a Jew if he is one inwardly; and circumcision is circumcision of the heart, by the Spirit, not by the written code. Such a man's praise is not from men, but from God.”

I guess that circumcision is not an issue with us today. In Africa, circumcision is recommended because it reduces the incidence of sexually transmitted disease. Researchers from Johns Hopkins University, found circumcision reduced the risk of herpes by 25%, and human papillomavirus (HPV) by a third. Three randomized trials in Africa have demonstrated the protective effects of male circumcision on HIV infection (transmission of HIV is reduced by as much as 60%) and Uganda has recently announced attempts to increase male circumcision.

In recent decades, most medical organisations in the west have deemed the practice not medically necessary, except in rare cases. The American Academy of Pediatrics has established a taskforce to examine its policy on circumcision and a similar investigation is underway in Australia but in the UK no review is planned. Why? The procedure is much more popular in the USA than the UK—65% of US men are circumcised (though it is much rarer in Blacks and Hispanics) versus 16% in the UK. In general in the UK it is regarded as an intrusive assault that is unnecessary.

So we shouldn’t use Galatians to justify or nullify a minor medical operation. Paul’s objection is not to the medical practice but to what is in the heart, and what that is about we shall see later.

Thursday, September 16, 2010

Taken to Star Trek

I finally got round to watching last years Star Trek prequel. I have had it on my hard drive for a few weeks, but was waiting for a listless day when I didn't feel creative. It was an exciting romp with no real depth, but well done. Eric Bana made a fearful villain and the real Leonard Nimoy reprised the old Spock do give it a bit of depth. There never were any deep sci-fi themes in Star Trek and in the end like an old John Wayne movie it ends up with a fist fight. Many bangs and whistles and a lot of CGI, but it takes your mind off things. Interesting to see Ben Cross, last seen in Chariots of Fire as Spock's father, and Simon Pegg from Shaun of the Dead as the new Scottie.

Also watched Taken, the Liam Neeson vehicle about what an ex-CIA agent does when his 17-year old daughter gets kidnapped into white slavery in Paris. He doesn't weep.

Nothing like mindless violence to pass the time.

Wednesday, September 15, 2010

Galatians chapter 1 - Why Paul was cross.

Why was Paul so upset? We have to remember his background. Here were these Judaisers coming to the Galatian Christians telling them that Paul’s Gospel was insufficient. In Acts chapter 22 Paul gives his testimony in Jerusalem, "I am a Jew, born in Tarsus of Cilicia, but brought up in this city. Under Gamaliel I was thoroughly trained in the law of our fathers and was just as zealous for God as any of you are today. I persecuted the followers of this Way to their death, arresting both men and women and throwing them into prison, as also the high priest and all the Council can testify. I even obtained letters from them to their brothers in Damascus, and went there to bring these people as prisoners to Jerusalem to be punished. “
Again in the letter to the Philippian church (Philippians 4:6) he declares, “If anyone else thinks he has reasons to put confidence in the flesh, I have more: circumcised on the eighth day, of the people of Israel, of the tribe of Benjamin, a Hebrew of Hebrews; in regard to the law, a Pharisee; as for zeal, persecuting the church; as for legalistic righteousness, faultless.”
Paul was a Pharisee, a religious group of Jews who were renowned for their strict keeping of the Mosaic Law. If the Law of Moses could save anyone it could have saved Paul. But something happened to him. On his way to Damascus to seek out Christians this: (Acts 22 again)
"About noon as I came near Damascus, suddenly a bright light from heaven flashed around me. I fell to the ground and heard a voice say to me, 'Saul! Saul! Why do you persecute me?' 'Who are you, Lord?' I asked. 'I am Jesus of Nazareth, whom you are persecuting,' he replied. My companions saw the light, but they did not understand the voice of him who was speaking to me.”
"'What shall I do, Lord?' I asked. 'Get up,' the Lord said, 'and go into Damascus. There you will be told all that you have been assigned to do.'”
Paul was constantly talking about his encounter with Christ. We first read about it Acts chapter 9. In Acts 22 and later in Acts 26 before Agrippa he relates his testimony. In Galatians chapter 1 he tells the whole story in letter form, filling out some of the details of what happened next and in 1 Corinthians 15 he refers to the event obliquely ‘and last of all he appeared to me also as to one abnormally born.’ (v 7). For Paul, this one event changed his attitude to religion. It ceased to be a matter of keeping the rules but instead what mattered was his relationship with Jesus Christ.
As a hint on evangelism: we are all required to witness, but we are not all required to be theologians. What can you tell your friends about Jesus? Tell them about your encounter with Christ. Give them your testimony. After all it convinced you.

Getting into Galatians - Paul is cross

Several years ago I was invited to go and lecture in Turkey. As part of the trip, between lectures I was taken on a tour of Cappadocia. It was a fascinating place. You can see from the picture these strange 'chimney-like' natural structures which are often hollow and on the inside were dwellings and churches. The churches often were adorned with Greek Orthodox icons, but others showed signs that icons had been removed by iconoclasts. In fact the underground dwellings far precede the Christian era and some say date from the Hittite days.

The second picture shows a map of the great underground city that I visited. It stretches more than 10 kilometers from side to side.

Before the expulsion of Christians from Turkey in the 1950s there was a large Christian population in Cappadocia, and it is probably to this population that Paul is writing to in the letter to the Galatians

Asia Minor was conquered by marauding bands of Celts and Gauls from Western Europe in 278 BC. It became the Roman province of Galatia in 25 BC

This was one of the first epistles written by the Apostle Paul, almost certainly less than 20 years after his Road to Damascus conversion. Paul wrote this letter as an angry man. You know that trick of putting an angry letter away in a desk drawer for 24 hours before you send it, while you cool off? Well, Paul was having none of that. Gone are the well-wishes from his fellow workers and the endearments to his recipients that characterize his other letters. He waltzes straight in.

“Paul, an Apostle – sent not from man nor by men, but by Jesus Christ.” He establishes his authority. His encounter with the risen Christ was such an awakening experience; the greatest event in his own life. Indeed who can claim a greater?

Paul is the greatest Gospel preacher and in his first sentence he declares the Gospel, the Good News, “by Jesus Christ and God the Father who raised him from the dead.”

Some people believe the Gospel is “Believe in the Lord Jesus Christ and you will be saved.” but that is your response to the Gospel; the Gospel nub is that God has raised Jesus from the dead.

The consequence of the Gospel is given in verses 3 and 4, “Grace and peace to you from God our Father and the Lord Jesus Christ, who gave himself for our sins to rescue us from the present evil age, according to the will of our God and Father.” Please note that we are not just rescued form wrath to come but from this present evil age.

So why is Paul so cross? He tells us in verses 6 and 7. “I am astonished that you are so quickly deserting the one who called you by the grace of Christ and are turning to a different gospel— which is really no gospel at all. Evidently some people are throwing you into confusion and are trying to pervert the gospel of Christ.”

That false Gospel is a return to the Law and next time I will explain why it is so dangerous, not just for them, but for us also.

Galatians - an introduction

When I first attended Lansdowne Baptist Church we used to go to a mid-week meeting called the 20-40 Group. Someone thought we should have a snappier name and someone else suggested that we name ourselves after the one of the young churches of the New Testament. We picked on the Galatians. When we told the Pastor he was distraught. “Don’t you realize that the Galatians were a disobedient church that went astray?

I must confess that all this talk of Judaisers and the Circumcision Party seemed so alien at the time that I couldn’t see what all the fuss was about. I am older and wiser now.

In fact the letter of Paul to the Galatians represents the big break between Judaism and Christianity and it is a major point of difference between many Christians today. The Ten Commandments are seen as the basis of Godly religion. They used to be a symbol of American justice. Tablets of stone used to be set up in American courtrooms. The Law of Moses was the basis of the Law of God. But should it be?

A few years ago a dear friend of mine, a pastor of many years experience, remarked on the film, Chariots of Fire, that the story of Eric Liddell, who refused to run on a Sunday had made it so much easier for young people to “Remember the Sabbath Day to keep it Holy”. But had it? And should it?

Martin Luther said, “The epistle to the Galatians is my epistle. To it I am as it were in wedlock. It is my Katherine (referring to his wife)” It has been called ‘the battle-cry of the Reformation’, ‘the great charter of religious freedom’ and ‘the Christian Declaration of Independence’.

Here it is that Paul first enunciates, quite plainly, that no matter how we try, we can’t make it on our own; that our salvation is not based on rules but relationships.

There are some doctrines, like infant baptism, or speaking in tongues, which are contentious and cause a lot of heat in the church, but in the end they are secondary that don’t affect our salvation; but failure to grasp the difference that the letter to the Galatians makes can not only cripple our Christian experience, but I dare to say it, may affect our salvation itself. The battle is with legalism. It is one that Jesus faced throughout his ministry and one that I have been conscious of throughout my Christian life. I have seen lives crippled by submission to it and pleasant people turn sour in its sway.

So this is an important series. You can follow how Chris Kelly dealt with it on the Lansdowne website, and I shall be drawing on his sermons, but I shall be going slower.

Tuesday, September 14, 2010


My older son is a health economist. He came to it via a degree in history then a spell as a hospital administrator, a researcher at the Kings Fund, then a time as a health care purchaser before joining the regulator, CHI as an analyst. As that has changed manifestations to the Healthcare Commission and finally the Care Quality Commission he has risen in the organization so that he is now Head of Intelligence (which sounds like 'M' in 007 movies). Earlier in the year he gave me 4 books for my birthday - I have reviewed 3 of them and I have just finished the fourth, Nudge by Thaler and Sunstein. These guys are behavioral economists from the University of Chicago who call themselves Libertarian Paternalists.

They react against the idea that governments should control from the center, but also recognize that free markets can be harmful because in a complex world they allow experts to con humans who don't have the time and perseverance to research their choices. In principle they believe that people should choose for themselves how they live (they are libertarian) but they also believe that we need psychological protection from our worst impulses (they are paternalistic).

As humans we jump to conclusions. Here is an example that they give. Together a bat and ball cost $1 : 10c. The bat costs $1 more than the ball, how much does the ball cost? Most humans, me included, immediately say 10c, when of course, the answer is 5c. Our brains have an automatic and reflective mode. The reflective mode easily works out the answer, but the instant mode jumps to a conclusion.

Here's another one. It takes 5 machines 5 minutes to make 5 widgets. How long would it take 100 machines to make 100 widgets? If you are in reflective mode you see at once the answer is 5 minutes. As a human you might reply 100 minutes.

On the other hand try and play a golf shot in reflective mode and you will shank it or play an air ball.

Like it or not, we are always going to be vulnerable to people who try to get us to use our automatic mode rather than our reflective mode. A good example would be supermarket owners who place chocolates for kiddies near the checkouts. If we are going to be vulnerable, why not frame our architecture of choice that nudges us to a good outcome? The classic example is of the male toilets at Schiphol Airport in Amsterdam. They engraved a black fly at the base of the urinals. It reduced spillage by 80%.

Perspicacious readers will now see that there are thousands of application for such psychological nudges, but everyone should read this book - Obama did, David Cameron did. It does not only apply to Left or to Right; both can learn from it. It works for increasing saving for your pension pot, for organ donation, for giving to charity, for choosing medical insurers, for making tax returns easier, for avoiding perverse incentives, like rewarding unmarried mothers with free houses, for losing weight, for stopping smoking, it allows people the freedom to ride motor-cycles without helmets (after signing up to the undoubted risks).

The beauty of the system is that it always defaults to freedom of choice. There may be warnings along the way, (Are you sure you want to delete this message?), but it lets you make a fool of yourself in a way that actual bans do not.

Read the book.

Where should you live?

Finding out where you should live is a question that all young professionals face at the start of their careers. My knowledge of Geography is based on the football results. I was only 2 years old when I began reading them in the News of the World on a Sunday. (See Sun readers: that is the reading age you need for Murdoch newspapers!) I soon learned where Leicester and Birmingham were, Manchester, Liverpool and Coventry held no fears for me, and while I was stumped for a while by Aston Villa, Everton and Port Vale, and never got to grips with Partick Thistle, Queen of the South and Stenhousemuir, away trips to Brentford, Queens Park Rangers, Chelsea and Leyton Orient soon familiarized me with the London clubs.

I was aware of Bournemouth, though. Permanently ensconced in the Third Division (South) I found it a pleasant place to visit, compared with Northampton or Watford and much nicer than Brighton, Portsmouth and Southampton. So when I was looking for permanent jobs and had my choice of London, Southampton or Portsmouth, it was Bournemouth I chose based on my experience of the football results.

I have never regretted the choice. I have been thrice head-hunted to go to teaching hospitals and each time, though I have seriously weighed up the option, I have decided that my original decision to come here was the right one.

My reasons are plain. First: it is a fine place to raise a family. We could afford a large house overlooking the golf course, ten minutes from the beach, five minutes from the railway station, (trains to London every half-hour), two minutes from the motorway (yet no sound from it), five minutes from the hospital, ten minutes from a fine shopping center and also from a really good church. The only thing missing is a good opera house.

Second: the schools were excellent. Bournemouth has retained selective Grammar Schools, so that a highly academic education was available for all four children without our having to pay a penny - all took advantage of it.

Third: a really excellent hospital - voted the best district general hospital in the country last year by the journal, THS. This included a complete new build, which I was involved in planning.

Fourth: wonderful surrounding countryside. To the south is the English Channel with views over the Isle of Wight. To the East is the New Forest (planted by William the Conqueror). To the West is the Jurassic Coast - a World Heritage Site and to the north is Salisbury, with the finest (and tallest) Cathedral in England.

Fifth: a professorial post in Southampton, which although a pretty dismal Sixties rebuild of a bombed-out port from WWII, does have some history and a splendid Department of Cancer Studies which has been responsible for some of the most important innovations in my field.

Monday, September 13, 2010


I have just finished reading the new CJ Sansom book Heartstone. This is the latest Shardlake adventure set in 1545. Those who know their history will immediately jump to the Mary Rose, Henry VIII's doomed galleon that went down in Portsmouth Harbor. Guess what? Shardlake was in it! Does he escape? There were only 35 survivors among 500 crew and soldiers.

This is yet another tour de force from Sanson's lawyer-sleuth. Many of the same characters are assembled and at over 600 pages it will keep you turmimg them for many an evening when you could have been watching televison.

Sunday, September 12, 2010

Treatment dates

I have now some dates for my treatment. I have a pre-chemo appointment on 21st September, my Hickman line insertion on 23rd and the first course on Saturday 25th. Thereafter, every 14 days for 6 months.

I expect to get pretty bored waiting, so if you live near Bournemouth I would love a visit.

Friday, September 10, 2010


Perhaps you heard of Emma Thompson. She is one of those people domiciled in gentrified parts of north London who support public funding for the arts, Greenpeace, global warming and dinner parties. She is – perhaps I might be allowed to coin a double-root neologism to describe her and her ilk – ‘über-sinister’ (it means ultra-left but sounds much more frightening). She is pushing her new film ‘Nany McPhee and the Big Bang’ at the moment. She was once married to the Shakespearean actor Kenneth Brannagh and is currently married to another thespian, Greg Wise. Her mother is actress, Phyllida Law (though she would say actor). Her father was Eric Thompson, most famous for his English script and narration of the French stop-motion puppet show ‘Magic Roundabout’. Her sister is also an actress (-or). If you look Emma up (she is all over Google so I can’t be bothered about a link) you will find that she attended a ‘posh’ London ‘lefty’ public school and Cambridge University. Unfortunately, this seems to have deprived her of an education. Her Wikipedia entry quotes her as misusing the word ‘refute’ in the sense of ‘deny’, but more important was her confusion of the Isle of Wight and the Isle of Man (a bit like confusing Hawaii with Kenya) (that was a jibe, Hawaii and Puerto Rico would be a better analogy).

On a late night chat show she traduced the Isle of Wight. When her host mentioned that he was soon to holiday on an island off the Californian coast “kind of like the Isle of Wight”, Thompson replied: “Oh, so they stone homosexuals there? Nice. I think they are still allowed to flog them, which of course some of them enjoy. I think they are allowed to shoot Irish or Scottish people if they arrive on the island – it is still in the rules. They are allowed to torture people. It’s lovely – you should go.”

The Isle of Wight is part of England. You can see it from Bournemouth beach. English laws apply there. The Isle of Man has never been part of the United Kingdom. It is a self-governing British Crown Dependency (a bit like the Falkland Islands), located in the Irish Sea between the islands of Great Britain and Ireland. Among those who were born or brought up there are the Bee Gees, Tour de France stage winner, Mark Cavendish, Nigel Neale, the author of Quatermass, and Frank Kermode, the recently deceased literary critic. Current or recent residents include racing driver Nigel Mansell, Rick Wakeman, the rock musician and Jeremy Clarkson the ‘Top Gear’ presenter. It is a tax haven and its politics are right wing so perhaps a legitimate target for the über-sinister. (The Isle of Wight is Left-of-Centre if anything, having frequently elected a Liberal-Democrat MP, though Queen Victoria did have a house there). Uneducated as Emma is she would be unlikely to know that on the Isle of Man homosexuality was decriminalized in 1992 and use of the birch ended in the 1970s. Shooting Scotsmen is an urban legend, though I believe it is still legal to kill Welshmen if you find one after dark in the English town of Shrewsbury! (or perhaps that's Chester,)

Emma Thompson, I am sure, is a very fine actress having won a couple of Oscars and BAFTAs for both acting and screenwriting. Which only goes to show that a cobbler should stick to his last. Just because actors are in the public eye it doesn't mean that they know anything at all about politics. Not that politicians know much about running a country. The middle verse in the Bible tells us not to put our trust in princes. The same applies to actors, politicians and pop-singers.


Best insult for a man who believed in anthropogenic global warming:

Bet he wears wellies marked 'L' and 'R' .

Markfour in The Independent

Thursday, September 09, 2010

Latest on health

The Flagyl clearly wasn't working and the symptoms were getting worse, so I had a CT scan on Tuesday. This showed very little change in the size of the original tumor, but some smearing in the peritoneal suggestive of secondaries. This seems to be the most likely cause of the symptoms. It is low volume disease, but obviously affecting gut motility.

I saw the oncologist this evening and we decided to try and alleviate the symptoms with dexamethasone and Maxalon, but to start 5-FU + Folinic acid + Irenotecan chemotherapy next week. I am waiting for a call from the radiologist to have a Hickman line inserted and as soon as that is done I hope to start the chemotherapy.

This has been a trying time of waiting for me and my wife. It was clear that something was wrong and it is a relief to finally have a decision. It is like being in opposition in Parliament. Without the responsibility of power you can come up with ever more fanciful explanations for what is going on. But when you are the ruling party you have to be realistic and get it right. That's why you have to have a doctor to look after you and not try and treat yourself.

Tuesday, September 07, 2010

Wretched wretch retching after chemotherapy

I wish people would learn how to pronounce English properly. The word 'retch' is pronounced 'reach' and it means to heave as if to vomit. It is not pronounced 'wretch' nor is it spelled the same way.

Burning the Qur'an in Florida

The Dove World Outreach Centre, a church in Gainsville, Florida, has announced that it will burn copies of the Qur’an on Saturday 11 September to mark the ninth anniversary of the 9/11 attacks. The stated purpose of this action is to raise awareness of the ideology and teaching of Islam and to warn against its dangers.

I can't imagine why it would want to engage in such a provocative action. It would be as offensive to Muslims as burning Bibles would be to Christians.

I yield to no-one in my belief that Islam is a false religion and that some interpretations of it are vicious and wicked. However, Muslims are human beings who, without Christ, are destined for God's wrath. The Biblical and Christ-like way to oppose Islam is by speaking the truth in the power of God’s love, and by extending that love to Muslim people even when they are hostile to us.

Already Muslim militants in Indonesia have promised to kill Indonesian Christians if Qur’ans are burned in Florida, and the history of anti-Christian violence in the country suggests that this is not an idle threat. Local Christian churches in other Muslim majority countries are likely to be threatened by this provocative action.

I urge the Dove World Outreach Centre and its supporters to refrain from burning Qur’ans on the anniversary of 9/11. Rather, all Christians should pray for our persecuted brothers and sisters throughout the world, and that the hatred and violence that endanger them may be overcome by the grace and love of Christ.

Latest health update

I had a poor week last week. For only two days out of seven was able to do anything apart from lie on the couch suffering. On the Tuesday I went for a walk for an hour along the side of Christchurch harbour and on Friday I went to a lecture at Southampton University. Otherwise I wasn't well. The problem was a return of the bloating, colic and what appeared to be steatorrhea (pale, loose and fatty motions).

Differential diagnosis is either a progression of the cancer or blind loop syndrome. Blind loop syndrome occurs after surgery when there is a loop of small bowel that goes nowhere. By creating an anastomosis between small and large bowel the surgeon has left a length of small bowel from the anastomosis to the stricture which is blind, a cul-de-sac. My Australian friends call it a bilabong. What happens is that large bowel bacteria creep back through the anastomosis and infect the blind loop causing bloating, colic and steatorrhea. The treatment is metranidazole or Flagyl and this is what I started yesterday. We will have to wait and see if it works.

I have a CT scan booked for the end of the month, but if my symptoms don't clear up this will have to be brought forward.

Monday, September 06, 2010


This is a clip from ER. It addresses the question of what you tell a dying person. When they are apparently going to a Christless eternity, should you just smother them with platitudes?

The chaplain is the classic fake Christian you’d expect to find in most theologically liberal churches today. I have twice been rebuffed when I shared my faith with dying patients. One complained to the surgeon who had referred her to me that she wanted a cure rather than Christian mumbo-jumbo. Alas neither was available to her. The other considered what I had said, but thought that as he had lived his life with no regard to God it would be dishonest to change now.

However, even evangelical Christians are reluctant to spell out to the dying that they are heading for Hell. I think the reason is that we hardly believe in Hell ourselves.

The modern take on Hell is that it is intolerable to think that a God of love would inflict eternal punishment on anyone no matter how terrible their crime. Like the Israelis God is being accused of a disproportionate response.

There are three views on Hell that are probably erroneous. First: Universalism; the idea that everyone will be saved eventually, though this might involve a spell in purgatory. Hell will therefore be empty (some people allow that Hitler and Joseph Stalin will be there).

Second: Anihilationism; the idea that those who die outside of Christ will eventually be annihilated, ceasing to exist. There are some Biblical arguments for this position: Philippians 3:19 - Their destiny is destruction, their god is their stomach, and their glory is in their shame. Their mind is on earthly things. 1 Thessalonians 5:3 - While people are saying, "Peace and safety," destruction will come on them suddenly, as labor pains on a pregnant woman, and they will not escape. 2 Thessalonians 1:9 - They will be punished with everlasting destruction and shut out from the presence of the Lord and from the majesty of his power. 2 Peter 3:7 - By the same word the present heavens and earth are reserved for fire, being kept for the day of judgment and destruction of ungodly men.

Not only that the image of fire suggests that they are completely consumed. Furthermore, the idea of eternal punishment for finite sinfulness seems to many to be unjust.

Third: the idea that Hell is the self exclusion of a person from the presence of God. CS Lewis put it this way: "The doors of Hell are locked on the inside." and "There are two kinds of people: Those who say to God, 'Thy will be done.' and those to whom God says, 'Thy will be done.'

This view describes Hell as complete separation from God. Thus in Matthew 7:23 God will say to sinners, "I never knew you. Away from me, you evildoers!" But there are problems with this position also. Hebrews 10:31 tells us that it is a fearful thing to fall into the hands of living God, and 12:29 tells us that our God is a consuming fire. The fires of Hell have been prepared by God (Matthew 25:41) while Revelation 14:9-10 tells us 'A third angel followed them and said in a loud voice: "If anyone worships the beast and his image and receives his mark on the forehead or on the hand, he, too, will drink of the wine of God's fury, which has been poured full strength into the cup of his wrath. He will be tormented with burning sulfur in the presence of the holy angels and of the Lamb."

This biblical picture does not seem to square well with the idea that Hell is simply 'self-exclusion from God'.

What is the Biblical position on Hell? The gospels refer to a real place. Jesus (who speaks about Hell more than anyone else) talks about being thrown into gehenna, or the valley of Hinnon. This was a smoldering rubbish dump outside the walls of Jerusalem where former generations had sacrificed their children to the Ammonite god, Molech. From readings in the Apocrypha we know that it had recognized as a place of devilment and heart-wrenching grief and had come to symbolize the place of everlasting punishment. Jesus uses gehenna as a metaphor for Hell. He describes a place that sinners are thrown into. In the parable of the rich man and Lazarus it is called a place of torment. Elsewhere he calls it a remote place - outer darkness. In Acts 1:25 we are told that Judas Iscariot went to 'his own place'.

Popular mythology thinks of Hell as the Devil's kingdom. In Bournemouth there are beautiful gardens stretching alongside the Bourne stream, from which the town takes its name. The Upper and Middle Gardens are beautiful with camellias, rhododendrons, azaleas, magnolias, exotic trees and shrubs and wonderful flowerbeds. The Lower Gardens are there for the tourists with a bandstand, crazy golf, a balloon ride, songbirds in cages, waterfalls and the Pavilion dance hall and theatre. Many people today can't abide the idea of heaven (which they see as sitting on a cloud in a nightdress plucking at a lyre) and would prefer the Devil's domain, the Lower Pleasure Gardens, where wine women and song are the order of the day, with slot machines and poker thrown in.

This is the Devil's lie. Hell is not like Las Vegas - though I think Las Vegas would be like Hell for me. It is not the Devil's domain. Like everywhere else in the Universe it is under God's sovereign rule. When in Matthew 10:28 Jesus says, "Do not fear those who can kill the body but cannot kill the soul. Rather fear him who can destroy both soul and body in Hell." he is not talking about Satan but about God. Do you remember in the popular film Ghost the villains were pictured as being sucked below the ground by some evil black slime? That is not how it works. The film is to be commended for showing that wicked people go to Hell, but their theology is all wrong. Likewise the various versions of the Faustian legend. It is God who throws people into Hell.

Lest we get carried a way by the metaphor of 'outer darkness' and see Hell as just remoteness from God (as some think CS Lewis is saying in The Great Divorce) we should also remember that it is a place of 'wailing and gnashing of teeth'. Hell is a place of pain and suffering. Plucking out an eye or cutting off a hand or foot would be preferable to going there. The fire there is unquenchable. The picture is of worms burrowing into the body. It is hard to imagine worms surviving fire, so we are allowed to think of these descriptions as symbolic, in the same way as we regard the pictures in the book of Revelation. But they are symbolic of unimaginable pain and anguish. You would not want to go there.

Hell is clearly linked to punishment. Modern prison reformers are apt to say that the punishment of prison is to be deprived of one's liberty. Older generations did not think so. Hard labor was part of the punishment, not color television and conjugal visits. In Matthew 25:46 Jesus tells us that unbelievers go away to eternal punishment. St Paul writes to the Thessalonians (2 Thess 1:6-10) "God considers it just to repay with affliction those who afflict you...those who do not know God...will suffer the punishment of eternal destruction".

The picture of Hell as 'separation from God' has some validity. The Thessalonians text continues "away from the presence of the Lord and from the glory of his might." and Matthew 7:23 has the Lord telling the wicked to "Depart from me." It is not the whole story to say the wicked exclude themselves from God. God also excludes himself from them.

Anyone who has unsaved relatives must shudder at the thought of God casting out from his presence people that we love to endure not just a lifetime, but an eternity of suffering. Perhaps because of this John Stott has espoused an anihilationist position. It is not a state that one would which on one's worst enemy, let alone on a parent or a child.

It should make us all the more urgent in our evangelism since the escape from Hell is quite easy this side of death. All we need to do is recognize our need of a savior and put our trust in him. There is now no condemnation for those who are in Christ Jesus.