Tuesday, January 30, 2007

Gay adoption, the church and quality radio

The fuss about gay adoption has a simple solution. The Catholic Church should refuse the Government funding. Government has a right to dictate to the church about where it should place children who need adopting because it is paying for it. Whatever your views of whether homosexuals should be able to adopt children, you can hardly both take the money and exert control over how it is spent.

It is a perfectly reasonable and defendable stance to take, that children should be brought up wherever possible by a mother and father who stay together, but a government that provides the money to run adoption agencies has a right to say how its money is spent. Simple; the Catholic Church should pay for its own adoption agency and run things exactly as it pleases.

A people that relies on a government to do everything for it is suffering from a terminal sickness. We can only look longingly back at Mrs Thatcher who said to the sick man of Europe, "Take up your bed and walk." Private charities can do so much more than governments. Every year the government takes more and more of our money in taxation and intrudes more and more into our lives.

The Church has the great privilege that people can covenant money to them free of taxes. This just about amounts to the ability of Catholics to predicate their taxes to an adoption service that is Gay-free. All they have to do is work out how much of their tax payment was going to pay for adoption, and give an appropriate amount to their church with a note that such and such amount is for the Catholic adoption agency.

Richard D North, the political commentator has a similar plan for the BBC. The BBC is funded by a pernicious poll tax. My daughter, who is about to move into her new flat, found a missive from the TV licensing authority demanding that she attend a hearing to explain why she had not bought a TV license. It was dated before she had actually completed her purchase, let alone moved in. There was no television in the flat, and she hasn't decided yet whether to get one. It reminds me of a scene in the film of Dr Zhivago when Zhivago is called to appear before a People's Committee who have taken up residence in his own house. Only the appearance of his high ranking older brother saves him.

North recognizes that there are some good things in the BBC, like Radio 3 and Radio 4, which no commercial organization would ever run, and if it did we would be irritated to have to listen to the advertisements. The rest is mostly trash, indistinguishable from the rubbish served up by the commercial stations. It would be perfectly possible, says North, to set up a large charity like the National Trust or English Heritage to run quality radio and TV, and commercialize the rest. People are falling over themselves to visit National Trust properties - it cost our family less than £60 per year. There would be no shortage of takers for quality radio.

What about the quality TV programs like Morse and Pride and Prejudice? Actually Morse was produced by a commercial company, but I watch it on DVD, when I want to, without the interruption of commercials. It is probably available now, but if not, it will be shortly possible to download any program anywhere on a short term rental basis.

The Church on Mindoro

Here are some pictures of the rebuilding of the Church on Mindoro in the Philippines, which was recently devastated by the Typhoon there. They still need $2000 to complete the building.

I don't know if anyone saw the movie, "Pay it forward" starring Kevin Spacey. The idea concieved by the young boy in the film was that instead of waiting for someone to do you a good deed you did a good deed for someone in need. You didn't pay it back for something you received, you paid it forward. When they had received something, they would pay it forward to someone else.

I have been trying to pay it forward for some time now.

Monday, January 29, 2007


A Private Members Bill is currently before Parliament proposing to switch England on to European time. The effect would be that more of the daylight would be used than at present. Although we would get up in the dark in the winter, we would come home in the light. It is estimated that such a change might save us 1.5% of our energy bill.

This has been proposed before (by a Bournemouth MP, Sir John Butterfill) but has always been talked out by Scottish members as they would be worst affected - getting up in the dark and coming home in the dark. Come to think of it Scotland is mostly in the dark in the winter. One of the benefits of devolution is that the Scottish Parliament can decide for themselves whether they want to go along with it without affecting what we do in England.

Britain would then be like America - different parts of the country in different time zones.

Back in 1840 everybody told the time according to the sun, so much so that railway timetable when they were introduced had to specify that Reading time was 4 minutes behind London time and three and a half minutes ahead of Chippenham time. Greenwich Mean Time was introduced in 1880 and rapidly spread throughout the civilized world as a reference point. Only France held out, finally giving in in 1916, eight years after Britain had introduced daylight Saving Time for the summer. Even then GMT was too much for the French they called it Paris Mean Time retarded by 9 minutes and 21 seconds.

I looked up the debate in Hansard and it looks as though the Scotttish member are doing their best to talk it out again. If they succeed it will have ominous repercussions for the West Lothian Question. The debate resumes on February 2nd.

Sunday, January 28, 2007

The religious rights of communities

A Muslim doctors’ leader has provoked an outcry by urging British Muslims not to vaccinate their children against diseases such as measles, mumps and rubella because it is “un-Islamic”. Dr Abdul Majid Katme, head of the Islamic Medical Association, is telling Muslims that almost all vaccines contain products derived from animal and human tissue, which make them “haram”, or unlawful for Muslims to take.

This is not the view of most Muslim doctors in the UK. Dr Shuja Shafi, a spokesman for the health and medical committee of the Muslim Council of Britain, said: “In terms of ingredients in vaccines, there are so many things that are probably haram, but in the absence of an alternative we are allowed to take it for the sake of our health.”
However, it does raise the question of whether religious freedom should be limited, and if so how.

Francis Fukuyama has written about this topic in the current issue of Prospect in a piece adapted from an article in Journal of Democracy 2006; 17:2. I have abridged and quoted what I take to be his views.

Fukuyama argues that Hobbes and Locke insist that human beings possess natural rights as individuals — rights that can only be secured through a social contract that prevents one individual's pursuit of self-interest from harming others. It can easily be argued that Muslims insisting on avoiding vaccination harms others in the community. Because some in the community cannot be vaccinated because of another illness, and because in some the vaccination does not ‘take’, we rely on the phenomenon of ‘herd immunity’ for their protection. This means that should an infectious disease enter a community it does not become an epidemic because most of the exposed individuals are immune. Thus there is a social duty to be vaccinated.
We do allow some religious freedom in medical matters. Jehovah’s Witnesses are allowed to refuse blood transfusion on religious grounds. However, we draw the line at their imposing such beliefs on their children. The Courts would intervene if they tried because a child would be too young to take that decision fro himself. Using typically muddled thinking the British National Health Service provides erythropoietin to JWs who refuse blood transfusion even though it would be an acceptable medical treatment yet refuses it to patients with MDS for whom erythropoietin would be a more preferable treatment than blood transfusion, because it is more expensive. With the JW precedent the courts would probably agree to impose vaccination on children against the wishes of their parents, though in the present climate of don’t antagonize Muslims, the state would try and avoid confrontation.
The distinction between religious freedom and social responsibility is one that impacts on several issues currently in the public eye. Faith schools and gay adoption are currently prominent.
Fukuyama traces the problem to the Reformation. Martin Luther argued that salvation could be achieved only through an inner state of faith, and attacked the Catholic emphasis on works, that is, exterior conformity to a set of social rules. The Reformation thus identified true religiosity as an individual's subjective state, dissociating inner identity from outer practice. Rousseau, in the Second Discourse and the Promenades, argued that there was a big disjuncture between our outer selves, which were the accretion of social customs and habits, and our true inner natures. Happiness lay in the recovery of inner authenticity.
The American and French Revolutions swept away the old order of society and in their various accommodations with this, all Western democracies have followed suit. One's social status (or class in England) is now achieved rather than ascribed; it is the product of one's talents, work and effort rather than an accident of birth. One's life story is the search for fulfillment of an inner plan, rather than conformity to the expectations of one's parents, kin, village or priest.
Fukuyama identifies a gap in the political theory underlying liberal democracy. That gap is liberalism's silence about the place and significance of groups. He also identifies the Canadian Law 101 of 1977 as the first exploitation of that gap to the detriment of the whole community. He says that it violates the liberal principle of equal individual rights: French speakers enjoy linguistic rights not shared by English speakers. Quebec was recognized as a "distinct society" in 1995 and as a “nation” in 2006.
Increasingly it appears that universal recognition based on a shared individual humanity is not enough, particularly on the part of groups that have been discriminated against in the past. Hence modern identity politics revolves around demands for recognition of group identities, that is, public affirmations of the equal dignity of formerly marginalized groups, from the Québécois to African-Americans to women to indigenous peoples to homosexuals.
Multiculturalism, not just as tolerance of cultural diversity but as the demand for legal recognition of the rights of racial, religious or cultural groups, has now become established in virtually all modern liberal democracies. US politics over the past generation has been consumed with controversies over affirmative action for African-Americans, bilingualism and gay marriage, driven by formerly marginalized groups that demand recognition not just of their rights as individuals but of their rights as members of groups. A conflict has arisen between individual rights against group rights.
The question of identity does not come up at all in traditional Muslim societies, as it did not in traditional Christian societies. In a traditional Muslim society, an individual's identity is given by that person's parents and social environment; everything, from one's tribe and kin to the local imam to the political structure of the state, anchors one's identity in a particular branch of Islamic faith. It is not a matter of choice. Identity becomes problematic precisely when Muslims leave traditional Muslim societies by, for example, emigrating to Western Europe. One's identity as a Muslim is no longer supported by the outside society; indeed, there is strong pressure to conform to the west's prevailing cultural norms. The question of authenticity arises in a way that it never did in the traditional society, since there is now a gap between one's inner identity as a Muslim and one's behavior vis-à-vis the surrounding society. This explains the constant questioning of imams on Islamic websites about what is haram (prohibited) or halal (permitted). In Muslim communities these questions never arise.
In Canada, the US and Europe, cultural diversity was seen as a kind of ornament to liberal pluralism that would provide ethnic food, colorful dress and traces of distinctive historical traditions to societies often seen as numbingly conformist and homogeneous. Cultural diversity was something to be practiced largely in the private sphere, where it would not lead to any serious violations of individual rights or otherwise challenge the essentially liberal social order. Where it did intrude into the public sphere, as in the case of language policy in Quebec, the deviation from liberal principle was seen by the dominant community more as an irritant than as a fundamental threat to liberal democracy itself.
But out of a misplaced sense of respect for cultural differences—and in some cases out of imperial guilt—Europe, especially, ceded too much authority to cultural communities to define rules of behavior for their own members. Liberalism cannot ultimately be based on group rights, because not all groups uphold liberal values. The civilization of the European Enlightenment, of which contemporary liberal democracy is the heir, cannot be culturally neutral, since liberal societies have their own values regarding the equal worth and dignity of individuals. Cultures that do not accept these premises do not deserve equal protection in a liberal democracy. Members of immigrant communities and their offspring deserve to be treated equally as individuals, not as members of cultural communities. There is no reason for a Muslim girl to be treated differently under the law from a Christian or Jewish one, whatever the feelings of her relatives.
Some contemporary Muslim communities are making demands for group rights that simply cannot be squared with liberal principles of individual equality. These demands include special exemptions from the family law that applies to everyone else in the society, the right to exclude non-Muslims from certain types of public events, or the right to challenge free speech in the name of religious offence (as with the Danish cartoons incident). In some more extreme cases, Muslim communities have even expressed ambitions to challenge the secular character of the political order as a whole. These types of group rights clearly intrude on the rights of other individuals in the society and push cultural autonomy well beyond the private sphere.
The right to be excluded from vaccination clearly falls within this category. Britain should not be ashamed to deny it.

Saturday, January 27, 2007

Working with your hands

Today I put up two shelves in the kitchen. Our kitchen cabinets, which are more than 30 years old could really do with extra shelves, but where could I get them from? The manufacturers have gone out of business and measurements have changed from inches to centimeters. In the end it was surprisingly easy. I was able to buy lengths of Contiboard from B & Q which were near enough the same depth and width and a kind man serving there cut them to the right length. B & Q also sold plastic shelf supports that were slightly too large for the existing holes, but a bit of jiggling in the holes with my electric drill made the fit fine. The whole job was accomplished in 20 minutes.

At the same time we have a problem with a tea stain on my daughter's bedroom carpet. The internet tells me that Borax is the answer. But where to obtain Borax? Believe it or not there is a discussion on the Web on just that very subject. There are several sources available by mail order, but unless you want a ton of the stuff, the most economical is Boots the Chemist. You might expect that you might buy chemicals at a chemist, but, alas, Boots mostly retails wierd herbal remedies and beauty items.

However, Borax is available at Boots. Finding it on the shelves is a challenge, but if you go to the nappy area, it's not far away. There it is, next to allergy-free soapflakes, and only £2.19 for 750g.

At the time of the Apostle Paul, even the most intellectual of Jews had to learn a trade. He had to be able to use his hands. Paul was a tentmaker, Jesus a builder, Peter a fisherman.

I am a shelf putter-upper and carpet cleaner. Also a polisher of brass locks.

Wednesday, January 24, 2007

Why I believe the Bible.

Shortly after I was converted I was talking to an old lady at church. She was going on about the Great Flood that covered the earth at the time of Noah. I scoffed at her. "We don't really believe in Noah's flood these days," I said, "we know it was only a local flood that was exaggerated into a myth."

The Pastor of the church took my arm and invited me to a walk over Hengistbury Head, the site of a Roman Hill Fort and a local beauty spot. I remember the conversation as if it were yesterday.

On our walk he asked me, "How do we know anything about God?"

I answered, "Well we infer that there is a God from looking around at the world. Someone must have started the whole thing going. And then throughout history people have investigated about God and written what they have discovered down in books so that today we have the accumulated wisdom of the ages."

"And how do we know about Jesus?"

"I suppose that there must be contemporary records about him and there is a church tradition."

The Pastor thought for a minute, "There are probable brief references to Jesus in Josephus and in Pliny, but almost all that we know about Jesus is written in the Bible. Without the Bible we would know virtually nothing about him."

I protested, "But wasn't the New Testament written many years after Jesus? Isn't it just hearsay?"

"In fact, the earliest writings about Jesus date from about a decade after his death, certainly less than 20 years afterwards, and the whole of the New Testament was written within the lifetime of his disciples. Much of it was written by eyewitnesses or by someone who has taken evidence from eyewitnesses."

"OK, that's the New Testament," I conceded, "but what about the Old Testament?"

"But that's the very Bible that Jesus used. He was careful to quote from the very passages that people tend to doubt: Adam and Eve, Noah and the flood, Jonah and the whale."

I tried another tack, "Even so, we don't have the actual manuscripts do we? You know how these things happen. It's like Chinese whispers. Copying errors are bound to creep in over the centuries." Then I told him the joke about the monk who was copying an ancient manuscript. Monks weren't allowed to handle the precious originals so he was making a copy of a copy of a copy of a copy. One day he was allowed to look at the original, "Oh No!" he said, "It says celebrate not celibate!"

He laughed, "The earliest fragment of John's Gospel dates from 130 AD and is in the John Ryland Library in Manchester. The Gospel of John was probably written in 90 AD. There are many other copies of the New Testament dating from the second, third and fourth centuries. As a comparison, how many copies of Julius Caesar's Gallic Wars do we have?"

I guessed, "About a thousand?"

"Actually, there are ten and the earliest dates from 900 AD. In fact we have no manuscript copy of any of the Roman histories or Greek plays that dates before 850 AD. And as far as copying accuracy is concerned, if you compare all the ancient copies that we have of the New Testament, and we have over 10,000, only 400 words out of 200,000 are discrepant. In comparison for Homer's Iliad about 7000 of 150,000 are questioned."

I was surprised but still not convinced about the Old Testament.

"Until 1947 the oldest copies we had of the Old Testament dated from 916 AD, the so-called Masoretic text. In 1947 the Dead Sea Scrolls were discovered. They comprised everything from shopping lists to Scripture, but they did include passages from every Old Testament book bar one. The manuscripts dated from 200 BC to 68 AD. The differences between the Dead Sea Scrolls and the Masoretic Test were trivial. In one scroll of Isaiah chapter 53, of 166 words, only 17 letters are in question. Ten are a matter of spelling which does not affect the sense; four more are stylistic changes involving conjunctions. The remaining three letters are the Hebrew word for 'light' which is added to verse 11. It does not affect the sense and in any case is already in the Septuagint. In over 1000 years of copying that was the only change."

He challenged me, "Take your Bible home and tear out the pages that you don't think are authentic. Then tell me on what authority you have torn out pages."

Then he gave me two books to read, "Evidence that demands a verdict" by Josh McDowell and "The Genesis Flood" by Henry Morris.

Now these aren't Holy Scripture and you don't have to believe everything that's written there, but they will certainly set you thinking.

Monday, January 22, 2007

How I became a Christian

I was 30 years old. I had just been appointed as consultant hematologist in a beautiful seaside town. I had a wonderful wife and two lovely children. I was financially secure for the rest of my life. I was well on my way to making a name for myself as a research scientist. One day I was going to be famous in my field. I was moving into a circle of smart people with every material luxury. I could see that it would soon be mine.

And yet I was profoundly unhappy. Something was obviously missing in my life.

One day (these were the days when doctors did house calls) I visited a patient at home. As he opened the door to me, he greeted me with, “Hello, doctor, I’m a committed Christian, how about you?”

What an embarrassment. I muttered something about being sent to Sunday School as a child, but, in truth, I had given up on religion. I had taken home the message that if you went around doing good, or at least did your best, you would end up in heaven. I was honest enough to know that I couldn’t do good all the time, and indeed, much of the time I didn’t even do my best. Nevertheless, he sent me on my way with, “Why don’t you come to our church. You will find Francis Dixon a wonderful preacher.”

Six months went by and I did nothing. I was sinking into an ever deeper despair, particularly so as all the skills that I had relied on to answer examination questions were letting me down. I could get the diagnosis right and give the right treatment, but my leukemia patients still died.

Eventually my wife cajoled to me to going to my patient’s church. On the first Sunday I tried, I couldn’t find it so I returned home empty. I found it the second time, and looked around, expecting to see at least one friendly face. It was difficult because the church was absolutely packed with hardly a seat to be found, not the way I envisioned churches. The reason I couldn’t find him soon became apparent. He had died the previous Thursday. The sermon that Francis Dixon preached that day was clearly designed to console his widow.

His text was from John 11:25-26. It was the story of the raising of Lazarus. Remember the story, the sisters of Lazarus, Mary and Martha, had sent word to Jesus that their brother was dying. Rather than hurrying to Bethany, where they lived, Jesus stayed where he was across the River Jordan for two more days. Eventually he decided to go. When he arrived at Bethany Lazarus had died and had been in the grave for 4 days. Jesus had deliberately delayed because he was about to perform the miracle of raising Lazarus from the dead. When he arrived Martha scolded him, “Lord, if you had been here my brother would not have died.”

Jesus replied, “I am the resurrection and the life, he that believeth in me, though he were dead, yet shall he live, and whosoever liveth and believeth in me shall never die.” (In those days they used the KJV)

Jesus then asked Martha, “Do you believe this?”

And Francis Dixon points straight at me and asks, “Do you believe this?”

Martha replied, “Yes, Lord, I believe that you are the Christ, the Son of God, who was to come into the world.”

This was the pointed question I was asked. Did I believe that? Now was the time to stop pussyfooting around. This was the real question. Did I believe that Jesus was the Son of God, with power over Life and Death or was he just a prophet or a wise man or even just a good man? If I believed that he was the Christ I would live my life one way; if I believed he was not then I would live my life completely differently.

You cannot figure this out by logic or by examining the world or by any type of science. You have to make a decision, because in not making a decision that he is the Christ you are making a decision that he is not. People talk about a leap of faith. I never knew what that meant. But then I did. To believe that Jesus is the Christ means to live it and only by living it do you discover that it is true.

On that day, I trusted it was true and today I testify that it is true.

I later learned that my patient’s wife and two other women had been meeting every week to pray for the conversion of his doctor.

Wednesday, January 17, 2007


2007 is going to be a year of anniversaries. Two at least deserve mention. It is the 200th anniversary of the Slave Trade. To celebrate a feature film on the life of William Wilberforce is being released with the part of Wilberforce being played by that nice young man from Hornblower, Ioan Gruffudd.

It is also the 100th anniversary of the founding of the Boy Scouts by Baden Powell. This has a local connection, as they began on Brownsea Island in Poole, just a stone's throw away from here.

Brownsea is one of the few remaining habitats of red squirrels in England. A community was established in the island by 800 AD, but it is not mentioned in the Domesday book. By the sixteenth cemetery it had become a hideout for pirates. At the time of the Restoration it was owned by Robert Clayton MP, later to become Lord Mayor of London, and a castle built on the site of old reins in 1726 by the eccentric William Benson. It was improved by Sir Humphtey Sturt of More MP in 1765. In 1852 china clay was discovered on the island and pottery manufacture was begun employing 200 people. Alas the clay was not of sufficient quality to make fine porcelain and the making of sanitary ware could not sustain the industry so the business folded. Eventually the Island was accepted by the Treasury in lieu of Death Duties and the Island became the property of the National Trust, who still own it. This summer Boy scouts from all over the world will be camping on Brownsea in celebration of the centenary.

Tuesday, January 16, 2007

MSM v bloggers (part 2)

New York Times Caught in Abortion-Promoting Whopper - Infanticide Portrayed as Abortion
By John-Henry Westen

EL SALVADOR, November 27, 2006 (LifeSiteNews.com) - On April 9, New York Times reporter Jack Hitt produced what may be called a 'hit piece' against the pro-life movement in El Salvador. The piece, laden with scare tactics, culminates in his tale of woe of a woman who he says had an illegal abortion when she was 18 weeks pregnant and was sentenced to thirty years in prison. The only problem with the story is that the woman was found guilty of strangling her full-term baby shortly after her birth.

Writing in an editorial in one of the largest papers in El Salvador, Julia Cardenal, who was interviewed for the New York Times Hitt piece, excoriates the Times for false reporting. Referring to Hitt, Cardenal asks what the intention was of the NYT piece. "To cause indignation in the United States so that they will pressure us to legalize abortion?," she asks rhetorically.

Hitt described his visit to Carmen Climaco in prison. "I was there to see Carmen Climaco. She is now 26 years old, four years into her 30-year sentence," wrote Hitt. The New York Times article concludes, "She'd had a clandestine abortion at 18 weeks, not all that different from D.C.'s, something defined as absolutely legal in the United States. It's just that she'd had an abortion in El Salvador."

However, court records from the case, which have been obtained by LifeSiteNews.com, indicate that the case was actually one of infanticide rather than illegal abortion. While it was investigated on the suspicion of an illegal abortion, authorities found the dead baby hidden in a box wrapped in bags under the bed of Mrs. Climaco.

Moreover, forensic examination showed that it was a full term (38-42 weeks gestation) normal delivery, and that the child was breathing at the time of birth. The legal opinion of the cause of death was asphyxia by strangulation.

Cardenal also points out that the main source of information for Hitt came from a pro-abortion group called IPAS. She notes that the group stands to profit financially from the legalization of abortion in El Salvador since it sells vacuum aspirators used for abortion and incomplete abortion.

Evangelina Guirola, Julia de Cardenal's sister, who assisted in the research for the editorial responding to the New York Times, told LifeSiteNews.com that IPAS is running a campaign to free Carmen Climaco and bring her to the United States.

Yet another case of a lazy journalist being fed propaganda and not bothering to check the details because the 'story' accords with his prejudices.

Thankfully, the New York Times allows itself to be scrutinized by a person they call the Public Editor who acts on the readers' behalf, and this damning piece by BYRON CALAME appeared on December 31, 2006

The care taken in the reporting and editing of this example didn’t meet the magazine’s normal standards. Although Sarah H. Smith, the magazine’s editorial manager, told me that relevant court documents are “normally” reviewed, Mr. Hitt never checked the 7,600-word ruling in the Climaco case while preparing his story. And Mr. Hitt told me that no editor or fact checker ever asked him if he had checked the court document containing the panel’s decision.

Mr. Hitt said Ms. Climaco had been brought to his attention by the magistrate who decided four years ago that the case warranted a trial, so he had asked the magistrate for the court record. “When she told me that the case had been archived, I accepted that to mean that I would have to rely upon the judge who had been directly involved in the case and who heard the evidence” in the trial stage of the judicial process, Mr. Hitt wrote in an e-mail to me. So he didn’t pursue the document.

But obtaining the public document isn’t difficult. At my request, a stringer for The Times in El Salvador walked into the court building without making any prior arrangements a few days ago and minutes later had an official copy of the court ruling. It proved to be the same document as the one disseminated by LifeSiteNews.com, which had been translated into English in early December by a translator retained by The Times Magazine’s editors. I’ve since had the stringer review the translation of key paragraphs for me. The magistrate, Mr. Hitt noted, “had been helpful in other areas of the story and quite open.” So when she recalled one doctor’s estimate that Ms. Climaco’s pregnancy had been aborted at 18 weeks, he used that in the article. (The only 18-week estimate mentioned in the court ruling came from a doctor who hadn’t seen any fetus and whose deductions from the size of the uterus 17 hours after the birth were found by the three judges to be flawed.)

The magazine’s failure to check the court ruling was then compounded for me by the handling of reader complaints about the issue. The initial complaints triggered a public defense of the article by two assistant managing editors before the court ruling had even been translated into English or Mr. Hitt had finished checking various sources in El Salvador. After being queried by the office of the publisher about a possible error, Craig Whitney, who is also the paper’s standards editor, drafted a response that was approved by Gerald Marzorati, who is also the editor of the magazine. It was forwarded on Dec. 1 to the office of the publisher, which began sending it to complaining readers.

The response said that while the “fair and dispassionate” story noted Ms. Climaco’s conviction of aggravated homicide, the article “concluded that it was more likely that she had had an illegal abortion.” The response ended by stating, “We have no reason to doubt the accuracy of the facts as reported in our article, which was not part of any campaign to promote abortion.”

After the English translation of the court ruling became available on Dec. 8, I asked Mr. Marzorati if he continued to have “no reason to doubt the accuracy of the facts” in the article. His e-mail response seemed to ignore the ready availability of the court document containing the findings from the trial before the three-judge panel and its sentencing decision. He referred to it as the “third ruling,” since the trial is the third step in the judicial process.

The article was “as accurate as it could have been at the time it was written,” Mr. Marzorati wrote to me. “I also think that if the author and we editors knew of the contents of that third ruling, we would have qualified what we said about Ms. Climaco. Which is NOT to say that I simply accept the third ruling as ‘true’; El Salvador’s judicial system is terribly politicized.”

I asked Mr. Whitney if he intended to suggest that the office of the publisher bring the court’s findings to the attention of those readers who received the “no reason to doubt” response, or that a correction be published. The latest word from the standards editor: “No, I’m not ready to do that, nor to order up a correction or Editors’ Note at this point.”

One thing is clear to me, at this point, about the key example of Carmen Climaco. Accuracy and fairness were not pursued with the vigor Times readers have a right to expect.

An independent scrutineer has looked at the process and found it wanting. The editors are unwilling to accept the criticism, no doubt because they have been found out by a website of the religious right.

I seem to remember a reporter from the NYT being dismissed recently for making up terminological inexactitudes like this.

Monday, January 15, 2007

Bloggers versus MSM

Yesterday my son and I were discussing who was the more believable, the main stream media or the bloggers.

I don't know how many people caught this New Year's Eve piece in the Sunday Times.

Science told: hands off gay sheep
Isabel Oakeshott and Chris Gourlay

Experiments that claim to 'cure' homosexual rams spark anger

SCIENTISTS are conducting experiments to change the sexuality of 'gay' sheep in a programme that critics fear could pave the way for breeding out homosexuality in humans.
The technique being developed by American researchers adjusts the hormonal balance in the brains of homosexual rams so that they are more inclined to mate with ewes.

It raises the prospect that pregnant women could one day be offered a treatment to reduce or eliminate the chance that their offspring will be homosexual. Experts say that, in theory, the 'straightening' procedure on humans could be as simple as a hormone supplement for mothers-to-be, worn on the skin like an anti-smoking nicotine patch.

Apparently the research has caused outrage in the Gay Community.
Martina Navratilova, the lesbian tennis player who won Wimbledon nine times, and scientists and gay rights campaigners in Britain have called for the project to be abandoned.

Navratilova defended the 'right' of sheep to be gay. She said: "How can it be that in the year 2006 a major university would host such homophobic and cruel experiments?" She said gay men and lesbians would be 'deeply offended' by the social implications of the tests.

In fact, the whole article was a pack of lies and speculation. The estimable Ben Goldacre has exposed the whole article as a work of fiction.

Sunday Times: "The animals' skulls are cut open and electronic sensors are attached to their brains."
Goldacre: simply and rather bizarrely not true. There's no neurophysiology in these experiments. They don't even measure things from nerve cells: they measure mate preference, by watching the sheep choose a mate.

Sunday Times: "By varying the hormone levels, mainly by injecting hormones into the brain they have had 'considerable success' in altering the rams' sexuality, with some previously gay animals becoming attracted to ewes."
Goldacre: This is not just completely untrue, it is, in fact, the polar opposite of what the researchers really did. The only similar work completed and published by this team of researchers was about trying to make 'straight' animals 'gay' (although animal behaviour researchers avoid those terms) and in any case, that experiment was negative: it failed to achieve this aim.

Sunday Times: "Initially, the publicly funded project aimed to improve the productivity of herds"

Sunday Times: "The research is being peer-reviewed by a panel of scientists in America"

Sunday Times: "Scientists are conducting experiments to change the sexuality of 'gay' sheep in a programme that critics fear could pave the way for breeding out homosexuality in humans"

Goldacre: None of these statements is true. Nothing is currently under peer review, because nothing has been submitted for publication, because no current experiments are completed. There aren't even any grants under review. The scientists have been very clear that this is a basic science study, from animal behaviour researchers, aimed at gaining an understanding of the biology of sexual attraction.

Where did all this disinformation come from? Unsurprisingly it comes from PETA - People for the Ethical Treatment of Animals. It is bit of propaganda but out by the animal libbers and swallowed whole by the Deputy Political editor of the Sunday Times (though she has a reputation for grinding axes).

So much for the Main Stream Media, how did the bloggers fare? It turns out that the bloggers had the story since last August, and although some fell for it, it was quickly exposed as a PETA lie. A remarkable investigation of how the exposure of a lie can be halfway round the world before the Main Stream Media have got there boots on can be found at this site.

Saturday, January 13, 2007

MHS (not a typo)

This week's BMJ contains a debate over whether the NHS should have make special allowances for Muslims. Here is how teh BBC website deals with the qustion:

The NHS should provide more faith-based care for Muslims, an expert says.
Muslims are about twice as likely to report poor health and disability than the general population, says Edinburgh University's Professor Aziz Sheikh.
Writing in the British Medical Journal, he called for male circumcision on the NHS and more details over alcohol derived drugs.

Here are three previous stories on the same topic:

1: Some Muslims are undermining the battle to rid Britain’s hospitals of killer infections by refusing to wash their hands when visiting sick relatives.
Dispensers containing anti-bacterial gel have been placed outside wards at hospitals all over Britain in a bid to get rid of superbugs like MRSA and PVL.
It prevents people bringing in more infections. But some Muslims refuse to use the hand cleansers on religious grounds because they contain alcohol.
Health watchdogs are so concerned they intend to meet with NHS bosses in the New Year to try and hammer out a solution.
NHS care assistant Theresa Poupa, 46, became aware of the situation while visiting a sick cousin at the London Chest Hospital in Bethnal Green.
She said: “I could not believe it - the signs are large enough and clear enough but they just took no notice and walked straight onto the ward.
“I was there almost every day for three weeks and I saw it repeated dozens and dozens of times. When I raised the matter with the nursing staff they just shrugged and said that Muslims were refusing to use the gel because it contained alcohol.
“They said they couldn’t force visitors to use the gel and I understand that — but I was astonished that anyone who didn’t wash their hands was allowed onto a ward.
“I know the dangers that bugs like MRSA can cause. They kill hundreds of patients a year.”
Michael Summers, chairman of the Patients’ Association, said: “I have been made aware of this situation during discussions with nurses and it is a very serious state of affairs.”

2: Medical scandal surrounding a 17 year old male shepherd from Konya who was unable to receive proper attention at the Konya Testing Hospital due to the fact that two of the attending radiology doctors were women wearing headscarves, has grown.
The shepherd, referred to only as "A.G." in reports, arrived at the Konya Testing Hospital complaining of swollen testicles, and was sent to get ultrasound tests, but was refused service by two female doctors wearing headscarves. The shepherd later had to have one of his testicles removed by operation. Yesterday the Turkish Parliament debated the case, with opposition CHP Party members asserting that they would be following the case. Meanwhile, the Konya hospital's head of urology, Doctor Celal Tutuncu, said yesterday that he felt that the case was very "black and white," and that as soon as documents showing exactly which doctors had refused service to the shepherd were made clear, action would be taken.
A top CHP lawyer, Atilla Kart, spoke to Hurriyet yesterday, noting he was not "surprised" by the case, saying "This is the destruction wrought by religious references spilling over into public adminstration."
He went on: "This is the point at which Turkey's public administration has arrived. It is clear that that turbaned doctor was working with the full knowledge of the hospital administration.....But in fact the incident is not limited to the administration of the hospital; I believe it is also linked to the regional administration too. We see now what can happen when religious exploitation and religious references are carried over into our government....Konya is a photograph of the general situation in Turkey."

3: As France's national assembly neared the end of a four-day debate on a ban on religious emblems in state schools, the prime minister, Jean-Pierre Raffarin, said "similar legislation" was planned to stop hospital patients refusing to be treated by male doctors. Health administrators have reported cases of Muslim husbands who would rather their wives were denied treatment than be examined by a man. Women in labor have refused epidurals because the anesthetist was male.

Let's not go there.

My personal experience with Islam is quite different from this. Most Muslims that I have met have behaved impeccably.

What we are facing is a perversion of Islam that has gripped fairly ignorant people. While in the UK we have seen young men and women who have come under the influence of imams from Pakistan and Afghanistan who seem to believe that blowing themsleves up together with hundreds of fellow travelers serves the cause of God. I know that these outrages are not confined to Western countries.

The BMJ article was pleading for a health service with special consideration for Muslims. My point is that everybody must be treated equally. For example, take circumcision of young boys. Jews and Muslims believe it should be done as part of their faith. Christians believe it should be done only for medical reasons. My argument is that if Jews and Muslims want this extra service then they should make arrangements to have it financed. Muslim countries and Israel may wish to have this provided for them by the state - that is their business, but they can hardly expect a Christian country to provide it from state funds.

Jehovah's Witnesses refuse blood transfusions. Anemic patients have an alternative to blood transfusion, the drug erythropoietin. Unfortunately it is 4 times as expensive as blood transfusion, and it is unavailable to NHS patients. If Jehovah's Witnesses demand it then their church must pay for it and not expect it paid for by the taxpayer.

In many circumstances in the NHS it is possible for a patient to be seen by a doctor of the same sex, but we do not have the resources to guarantee it. On occasion it is necessary for a patient to be seen by a doctor of the opposite sex. The patient must be willing to accept this or go to a private physician of their choice.

Female circumcision is required by some Muslim comunities. In England this is seen as criminal assault.

As a Christian I deplore drunkenness. I am ashamed that British young people go to foreign countries and desport themselves in a lewd and drunken manner. Christians have things that we are ashamed of too.

After the bombings in London, New York, Madrid, Bali, Egypt, India, Kenya, Tanzania, and I am sure many more, all conducted by Muslim extremists the world has come to equate the words 'Muslim' and 'terrorist'. Obviously this is a gross oversimplification, but sane Muslims are the only people who can defeat these people. Muslims who behave as if it their God-given right to live in foreign countries under Islamic law deceive themselves. They are sowing antagonism against Islam and one day may reap a whirlwind.


In the Times today there is an interview with Sir Michael Rawlins that is well worth reading.

Sir Michael is the Chairman of NICE. Although NICE was established to advise the British Health Ministry on what it should and what it should not pay for, it is hugely influential wordwide. Last November, for example, there wer 9 million hits on their website.

Rawlins has interesting things to say about the comparison between the UK and US health services, but reckons that rationing is going to come to everybody. Much culd be done to limit health expenditure. For example, Omeprazole is a useful treatment for heartburn. Manufacturer's instructions suggest that the dose should be halved after the first month. It seldom is. Yet if it were it would save the British health service $80 million a year.

The biggest difficulty comes with the conflict between the patient in front of you and teh one in the waiting room next week.

If you spend a lot of money on a small number of people, you will end up depriving many other people of cost effective healthcare. And so that's why it's impossible, really, to leave it up to individual doctors to make these decisions, it's just too difficult, and I wouldn’t want to do it in that sense. It's much better to have an organization like NICE that does it in as fair a way, and in a way that reflects the aspirations of the society in which we live.

The cost of an extra year of good quality life is set at $60,000. If your new treatment can deliver that then the NHS will pay for it. If it comes to more then you could always find the money yourself.

...if one member of my family, my children or grandchildren, were unwell, yeah, I would do everything I can." But he said, "that's me and my grandchild, I can't expect society, necessarily, to do that, too." So, with finite resources, we have to use them in the best way that's equitable.

International incidents

I've had a couple of days in Rome this week. I stayed at the 'English' Hotel (d’Inghilterra) near the Spanish Steps in a meeting with a German, a Uruguayan, an American, several people from Switzerland and a single Italian who was from Sicily. We were discussing a clinical trial in which the majority of patients came from France, Poland and Russia, but in fact patients came from all over Europe and even New Zealand and Canada. We considered whether we should open it up to Brazil and Argentina. No-one should doubt that medicine is now truly international.

‘International participation in clinical trials is a bonus and it demonstrates the rigor of the pharmaceutical companies that they go to the expense of establishing data-collection services in so many countries to ensure that the data are truly representative.’

Or is it just that some countries seize on new drugs before they are licensed based on flimsy phase 2 results, making it impossible to conduct clinical trials in those countries?

Recently, the FDA has issued an alert about the risk of progressive multifocal leukoencephalopathy (PML) in patients with systemic lupus erythematosus in patients treated with rituximab. PML (which hematologists take as an abbreviation for promyelocytic leukemia) is in fact a fatal brain disease caused by reactivation of the JC virus (a polyoma virus) in immunodeficient individuals (especially in AIDS in which 5% of patients eventually succumb to it) and there have been 20+ cases in people on rituximab. The same facts did not prompt the European regulator to issue a similar warning, but the FDA were incensed that so much rituximab is used off-license. In fact over 60% of prescriptions for rituximab in the US are for unlicensed indications (principally CLL). No wonder the drug is worth $2.6 billion.

Rituximab is so widely used in America that it is often known as vitamin R. Many of the uses are without any evidence of benefit, and although I think it is a good drug that is likely to be of value both in B cell lymphomas and autoimmune disease, formal evidence for benefit in most indications has not been demonstrated. The worst offence is to do giant phase 2 trials without a comparator. This seems to be an excuse to profit from an unlicensed drug under the guise of ‘science’. Phase 2 trials seldom need to accrue more than 40 patients and should then be followed by randomized trials comparing the new treatment with the previous best. Had this been done with FCR for CLL then we should know for certain by now whether it was better than FC or FR. As it is, it is likely to be 2010 before we know. Comparisons with historical controls frankly do not cut the mustard.

Trials comparing FCR and FC, both as first line and salvage therapy, are currently being conducted. These trials will contain hardly any American patients; indeed, like the chlorambucil v Campath trial many of the patients will have come from Eastern Europe where medical conditions are not always to the standard of Western Europe and North America, and where the financial inducements to participate in trials may weigh more heavily than natural caution in selecting patients.

Monday, January 08, 2007


I have been meaning to write something about Campath for some time. I first started using this monoclonal antibody before it had been humanized, back in the mid 1980s. Then it was a rat IgM directed against CD52, an antigen present on all lymphoid cells and also on monocytes. It had marvelous complement killing activity and we were using it to lauder bone marrow in lymphoma autografts.

Subsequently, and IgG form has been produced and it has been humanized, though because it is now produced in Chinese Hamster Ovary cells, it does not have proper glycosolation (ie it does not have the correct sugar molecules attached) this is probably why it is not particularly good at penetrating large lymph node masses.

It was only when Campath got in the hands of Schering AG (Berlex in the US) that it was marketed as a treatment for CLL. It has several advantages. Most important, it is one of the few agents capable of killing CLL cells that have a damaged or absent p53. Second, it is capable of eliminating minimal residual disease from blood and bone marrow. Its major disadvantage is that it is very immunosuppressive, killing T cells as innocent bystanders, though not as permanently injurious as fludarabine. This makes it useful as a conditioning agent for bone marrow transplantation, but adds hazards when used to treat CLL.

Quite apart from its use as a drug to mop up residual disease and to treat resistant disease, Campath has been suggested as a first line treatment for CLL. At ASH last year Pete Hillmen presented the results of the CAM307 trial which compared Campath with chlorambucil as first line treatment for CLL. A total of 298 patients were randomized to receive one or other of the agents and the two groups were similar. The primary endpoint was progression-free survival and for this Campath was about 4 months better (p=0.0001). This was particularly true for patients with p53 abnormalities (10.7 months v 2.2 months) though for 11q deletions there was no significant difference. CR rate (24% v 2%) and overall response rate (83% v 55%) also favored Campath. Follow-up is too short to comment on overall survival.

Side effects were greater in the Campath arm, mostly infusion related (fever, chills, hypotension, urticaria) though giving it iv rather than sub q maximizes these effects. Chlorambucil caused more nausea and vomiting though giving it as a single dose once a month maximizes these effects. Asymptomatic CMV viremia occurred in 52% of the Campath patients and CMV infection in 16%. Grade 3/4 fever was commoner with Campath as was grade 3/4 neutropenia.

This really sounds good for Campath, but we have heard it all before. First, we have no evidence that the overall survival will be any different. Second, nobody has been cured. Third, the dose of chlorambucil used was 40 mg/sq meter, not the 70mg/sq meter that is normally given in the UK. Remember that the CALGB trial that showed fludarabine to be better than chlorambucil also used this low dose of chlorambucil, while the higher dose of chlorambucil used by the British CLL4 trial was shown to be equivalent in effect to that of fludarabine with fewer side effects. Also noteworthy is the fact that fludarabine and Campath or sold by the same company.
The final problem with this trial is that we do not know the long term outcome for these patients.

With this in mind Anders Osterberg has published some long term follow up results on 38 patients treated in Sweden with Campath as first line and compared the outcome with 75 historical controls from before the Campath era. These were treated with a variety of regimes including fludarabine, chlorambucil and CHOP. Demographically the two groups were very similar, although the Campath patients were slightly more likely to be stage III or IV. The results indicate a relatively high response rate to Campath compared to the various treatment the control group received, a significantly longer time to treatment failure and a rather lower (and not statistically significant) risk of infection. One important finding was the high rate of Richter's transformation in both Campath treated patients (16%) and historical controls (12%). Median overall survival was 28 months in the Campath treated group, compared to 17 months for the historical control group, although this was not significantly better.

As I have said before, when a regimen is introduced that produces a high rate of cure for CLL or a trial shows a better overall survival rate than what is achievable when starting with chlorambucil first line, then I will give it my backing. However, until that tile I believe in starting with treatment that does least harm to the patient’s immune system, and that treatment is not Campath

Sunday, January 07, 2007

Weekend movies

I have just watched a couple of unusual movies. One, "Junebug", was winner of a special jury prize at the Sundance festival. Madeleine, a sophisticated Chicago art dealer, takes a trip to North Carolina to meet the family of new husband George. This is not played for laughs like "Meet the Parents" but played out, sometimes with embarrassment as a clash of cultures. Career-dedicated Madeleine finds that real people have different values. Her husband is discovered to have a fine light tenor voice as he sings Sankey hymns as if the 1950s had never finished. Star of the show is Oscar nominee Amy Adams as heavily pregnant sister-in-law Ashley. Her garrulous dizziness smoothes over a multitude of dangerous moments. One of her statements, directed at her ne'er-do-well husband stayed with me. "God loves you just the way you are; but He loves you too much to let you stay like it."

The second, "Proof" is the opening up of the Pulitzer Prize winning stage drama of the same name, directed by John Madden who did "Shakespeare in Love". It has a stellar cast with Gwyneth Paltrow, Anthony Hopkins, Jake Gyllenhaal and Hope Davis (from About Schmidt). Quite difficult to follow because of the flashback structure this is not a film about math. Hopkins plays a mathematical genius who became schizophrenic. Again the topic is handled quite differently from "A Beautiful Mind". Paltrow is the daughter who stayed behind to look after sick father, while Davis is the daughter who left and became successful as both a career woman and mater familias. Gyllenhaal is the former student of Hopkins who has settled on a second-rate teaching career while remaining in awe of the genius mathematician. Paltrow is a competent mathematician; she has inherited some of her father's talents, but has she inherited his madness? She is certainly rather strange.

The action takes place around the father's funeral. The tensions are clear. Resentment at being left to look after an ailing parent, guilt at leaving, ambition to find an undiscovered masterpiece among the notebooks of the mad period, all come to the surface at the hypocritical funeral service when all the former colleagues are there to laud the early successes and to sweep under the carpet the neglect during the mad years.

Then a notebook is found containing an elegant proof about prime numbers. You don't have to understand the math. This could equally well have been a work of art, a novel, a poem, a symphony. The question is, “Who wrote it, the father or the daughter?” The daughter claims it, but who would believe her? Certainly not the sensible sister. How about the new lover? This is a story about real people who despite genius experience the same emotions of jealousy, guilt, resentment and forgiveness that we all feel.

Saturday, January 06, 2007


This weekend there are two interesting articles about trastuzumab (Herceptin), one in the BMJ and one in the Lancet.

The first of these is the experience of a consultant hematologist who developed HER2+ breast cancer at a time when it was difficult to get adjuvant Herceptin on the NHS. She was contacted by the Sun newspaper which was running a campaign championing Herceptin. As it was early in her chemotherapy she elected not to get involved in the campaign. Instead she decided to do some research for herself. Her concusion was that the "50% benefit" widely quoted in both medical and lay press actually translated into a 4.5% benefit for her which was equally balanced by the cardiac risk. Although the drug was not yet approved by NICE the (female) Health Minister had sent a pretty heavy signal to NICE that they had better approve it. Nothing sways government more than a campaign by the tabloids. The doctor was a clear steer that if she pushed for it she would get it. Nevertheless, she decided not to have Herceptin.

The second paper reviews the evidence. "The latest results show that the addition of trastuzumab reduced the absolute risk of death by 1·8% over 2 years and, at that stage, one extra woman will be alive for every 55 treated. However, an eighth of women randomised to trastuzumab died or relapsed over an average of 2 years." However, "trastuzumab will raise the absolute risk of symptomatic congestive heart failure by 2% at 2 years (up 0·4% from 1 year), and by 5% if subclinical harm is included." On cardiac damage they say, "the cardiologists we contacted were uncertain whether damage caused by trastuzumab is, as has been claimed, essentially short-term and reversible. Side-effects of the drug are additional to those caused by anthracyclines, drugs that by themselves can have serious outcomes 20 years after treatment. With anthracyclines, a statistically significant increase in harm is not enough to reduce the survival benefit at 15 years, but trastuzumab is from a different therapeutic class, with unknown long-term effects."

But on present evidence they conclude, "While there is cause for concern, perspective is needed: over 2 years, the risk of cardiac damage seems trivial compared with that of breast cancer recurrence. Unless catastrophic long-term side-effects emerge for trastuzumab, adjuvant Herceptin is good news for women with HER-2-positive early breast cancer and adequate cardiac function."

The group writing the review investigated the evidence for NICE to make a decision. They say, "Our work for NICE, with the 1-year median follow-up data, suggested that the adjuvant Herceptin schedule also represented value for money. We estimated that the regimen had an incremental cost-effectiveness ratio of around £18 500 per quality-adjusted life-year (QALY) gained, with two assumptions. First, survival benefits accrue over 5 years and are sustained thereafter (as with anthracyclines); second, that no cardiac events result in death (unlike with anthracyclines). If society were willing to pay £20 000 for an additional life-year with full quality of life, trastuzumab could be judged cost effective. With finite resources, the UK's National Health Service (NHS) would have to stop funding other treatments to provide trastuzumab (the opportunity cost), but the NHS could consider these cuts justified."

There is the rub. In real life money for health care is limited. Even the vast American economy is finding it so. Major corporations are facing financial meltdown because of health insrance costs. In the UK "Health trusts have been told that they have to invest in trastuzumab, and, to pay for the drug, they have to cancel services for populations who might be less vocal and well-organised than the breast cancer lobby."

"The cancellation of treatments by health trusts was not underpinned by the same kind of analysis as that which informed NICE's decision to fund trastuzumab, something that NICE's new disinvestment initiative (which helps the NHS identify and stop ineffective treatments), has to change if resource allocation is to be underpinned by procedural justice."

The point is that patient lobby groups are extremely influential, and none more so than the breast cancer lobbyists. But who will speak up for the Cinderella diseases? CLL suffers by comparison with breast cancer, but it is far better off than chronic granulomatous disease which hardly anyone has heard of, while unfashionable diseases like schizophrenia or manic depression, or diseases where the sufferer is thought blameworthy, like obesity, alcoholism or lung cancer, get a much less sympathetic press.

Another related issue in today's Lancet concerns direct-to-patient advertizing of drugs. This has been a feature of the American market since 1997, and there is an EU proposal to introduce it to Europe. A US government report
suggests that the practise is not working well in America. It found that FDA oversight was lax, "but their report also raises questions about the value of direct-to-consumer advertising and shows just how hard it is to regulate once this genie is out of the bottle. The investigators showed that from 1997 to 2005, industry spending on direct-to-consumer advertising grew on average nearly 20% per year, twice as fast as spending on drug promotion to doctors, reaching US$4·2 billion in 2005. By comparison, industry spent $31·4 billion on research and development. More than 50% of the direct-to-consumer spending went to advertisements for just 20 drugs, most for chronic conditions such as hyperlipidaemia, asthma, and allergies. Not surprisingly, these are the same drugs that drug companies are promoting directly to doctors with advertising in medical journals, drug-representative visits, and free samples. It's a smart dual-pronged strategy, because a doctor is more likely to provide a particular drug when a patient asks for it and when the doctor has free samples on hand. This is not to say that direct-to-consumer advertising does not help some patients. In many cases, patients may have been well served by advertisements that led them to discuss their concerns with their physicians. But the primary purpose of direct-to-consumer advertising remains clear: to sell lucrative, on-patent, brand-name drugs. Claims to the contrary just do not pass the straight-face test".

The paper concludes, "It would be better to fund independent information sources, free of industry influence, to provide the public with unbiased evidence-based information. If industry truly wants to inform the public, it should supply no-strings-attached funds to support such efforts. Even a small portion of the $4·2 billion being spent each year in the USA on direct-to-consumer advertising would do nicely."

I would like to put it on record that this blog receives no funding from the pharmaceuical industry and everything I say about the use of drugs is my honest opinion at the time based on my reading of the evidence without fear or favor.

But to get back to Herceptin. A recent paper in the New England Journal of Medicine reports on a Finnish trial of Herceptin as adjuvant therapy. Importantly, this trial used much smaller amounts of the antibody (20 mg/kg over 9 weeks rather than 110 mg/kg over a year). Naturally, this trial was not funded by the pharmaceutical company, but paid for by the Finnish government. The finding was as follows: "Within the subgroup of patients who had HER2/neu-positive cancer, those who received trastuzumab had better three-year recurrence-free survival than those who did not receive the antibody (89 percent vs. 78 percent; hazard ratio for recurrence or death, 0.42; 95 percent confidence interval, 0.21 to 0.83; P=0.01). Docetaxel was associated with more adverse effects than was vinorelbine. Trastuzumab was not associated with decreased left ventricular ejection fraction or cardiac failure."

This has particular resonance for CLL patients, particularly those who have been following Ron Taylor's work on antigen shaving. Is it possible to get an equal effect with less rituximab? You can hardly expect pharmaceutical companies to conduct trials that would result in their selling less of their product. But it is the interest of third party funders to pay for such trials. Funds for health care are limited. Lobbying for one treatment will inevitably mean that someone, somewhere will not get the treatment he needs. The market is not free, it is being manipulated.

Friday, January 05, 2007

Three detectives

One of my Christmas presents was a bundle of books by three of my favorite authors of detective stories. I am well into the third of them now.

Harry Bosch, the LA detective invented by Michael Connelly, is currently assigned to investigating cold cases. He is a man whose past has damaged him. Driven by empathy with the victims he disdains authority and rides roughshod over colleagues. Although attractive to women, his single-mindedness spoils all relationships.

Jack Reacher, the creation of Lee Child, is a simpler character. He is totally free of any commitment, owning nothing but tee-shirt, jeans and a very classy pair of English brogues. He goes around as an avenging angel with superman qualities. Although ex-army, he too cares nothing for hierarchies. This was the tenth novel. Advice to the author: he needs some character flaws.

John Rebus, Ian Rankin's Scottish detective is all flaws. He drinks too much, smokes too much, is far too fat; he has all the Scottish vices. Needless to say he mocks authority, ploughs his own furrow, yet comes up with results. He is now approaching retirement, though how he would cope with it is anybody's guess. With his unhealthy habits it looks as though he is trying to die in harness.

Monday, January 01, 2007

Coming second

I have just discovered that two of my papers have made the top 50 most cited papers published in Blood. One is the V genes paper, published in 1999. This came in at 22. The other is the International Prognostic Scoring System for MDS which was published in 1997, and which came 38th.

I'm not surprized by the V genes paper which is an important landmark in CLL research. The IPSS paper is highly quoted because it is one of those papers thatsets a standard that virtually has to be adhered to in all series in which MDS is treated. Peter Greenberg was the instigator of this paper, but I wrote the first paper that proposed a prognostic scoring system for MDS. This was the Bournemouth Score published in 1985 and itself highly cited. Following our example several other groups suggested other scoring systems, and what Peter Greenberg did was to gather us all together in Chicago, so that we could thrash out a system to which we could all adhere.

Coming 22nd and 38th doesn't sound much, but when one thinks of how many papers are published in Blood one is encouraged. I rememeber in my final year at school I came 13th in the cross country out of several hundred boys who ran. Ofcourse I was much bigger than many of them, and the previous year I had come 113th. It certainly makes England's performance in the Ashes series sound better. After all they came second.