Anthony Walker, an 18-year old college student, promising athlete, and devout Christian, was hacked down and killed by racist, Michael Barton. Where was God?
Dr Victoria Anyetei was stabbed in a frenzied attack in her own car before she left for work. She was a devout Christian. Where was God?
Gerry Tobin, 35, was killed with a shot to the back of the head as he drove his Harley-Davidson in Warwickshire. He was a member of Hell’s Angels but surprisingly according to the Times he was a Christian who used to hold Bible classes and prayer meetings and dreamt of being a missionary. Where was God?
A post mortem at Kingston Mortuary on Friday showed that 51-year old Egyptian born Christian Mrs Leila Rezk died from severe head injuries, and police say the killer may have murdered her with his bare hands. Where was God?
Failed asylum seeker Kamel Bourgass was jailed for 22 years for stabbing to death Detective Constable Stephen Oake. Constable Oake was a keen evangelical Christian. Where was God?
All these took place in peaceful England in recent months; in a supposedly Christian country where persecution is said to be a thing of the past.
It is worse elsewhere: Twenty-three South Korean Christians have been captured by the Taliban; two of them murdered; the rest held hostage.
Where is God in Afghanistan?
In Iraq it is horrible for everyone, but especially so for Christians. Assyrian Christians, who belong to the Syrian Orthodox Church and a number of other small, ancient Churches, worship in (and sometimes speak) the mother tongue of Jesus, Aramaic. The Allied intervention in Iraq has made the plight of the Assyrians infinitely worse but it was under the vile dictatorship of Saddam Husain that the ethnic cleansing of Assyrians began. "Saddam destroyed over 200 of our towns and villages, but with our very limited resources, we have rebuilt hundreds of homes," says a spokesman for the Assyrian Aid Society.
"When they cook a dish in the Middle East, it is traditional to put the meat on top of the rice when they serve it. They kidnapped a woman’s baby in Baghdad, a toddler, and because the mother was unable to pay the ransom, they returned her child – beheaded, roasted and served on a mound of rice. The infant’s crime was to be an Assyrian.
Since the invasion of Iraq, Muslim militants have bombed 28 churches and murdered hundreds of Christians. Last October, Islamists beheaded a priest in Mosul.
Where is God in Iraq?
It is not only Muslims who are terrorizing Christians: On June 2, police found the body of Isaac Raju just outside the state capital of Hyderabad in southern India. The independent church pastor had been missing since May 24. On May 21, the body of K. Daniel, a preacher from Kummarvadi, also was found on the outskirts of Hyderabad. Miliant Hindus are active in several parts of India.
Where is God in India?
Where is the God who could feed five thousand with a few loaves and fishes? Where is the God who walked on water, made the blind man see, turned water into wine, and raised the dead? We know and are convinced that the God of Abraham, Isaac and Jacob; the God who brought the Children of Israel out of Egypt; the God who defeated the prophets of Baal on Carmel; the God who saved the three lads from the burning fiery furnace in Babylon and stopped the mouths of the lions; the God who raised the Lord Jesus Christ from the dead, can work miracles. When He sees His church suffering in this way, why doesn’t He intervene?
In Mark chapter 13 we begin to see an answer. Jesus warned his disciples that something was coming to Jerusalem that would mean ‘days of distress unequaled from the beginning…until now, and never to be equaled again.’
Auschwitz was terrible; the Bible says this was worse. Hiroshima was awful; the Bible says this was worse. The trenches at the Somme and Ypres were horrible; the Bible says this was worse.
In April 66AD the Romans surrounded Jerusalem. The city was full; it was Passover time. Soon food grew short. People were eating dung. If they tried to escape the Romans crucified them. If they surrendered, they were cut open with knives as the Romans searched for hidden jewels and coins. If they stayed put they starved. Women began to kill and cook their children. Over one million one hundred thousand people died. A mere 92,000 survived to be sold into slavery. The city was razed to the ground. Why did God not intervene? But He did. He told them to pray that it would not happen in winter. The Christians prayed and their prayer was answered; it happened in summer. He warned them to flee. The Christians remembered and they fled. There were few if any Christians left in Jerusalem when the Romans arrived. And He shortened the days. There is no objective proof of that. But often when we complain that God has not intervened we may be unaware that He has shortened the days.
God has made an ordered Universe. The Law of Gravity is the Law of God. Boyle’s Law was God’s law first. God is not the Lord of chaos and disorder. The scientist of old used to say that they were ‘thing God’s thoughts after Him’. They would not have got far had He kept changing His mind as the measured.
Miracles are rare – even in Biblical times; just Joseph, Moses, Joshua, Elijah, Elisha, Jonah, Daniel, Jesus and the Apostles. He doesn’t feed our greed; He doesn’t pander to our pride; miracles display the Glory of God.
Despite what the tele-evangelists tell you, things will not be hunky-dory when you come to Christ. You won’t have an easy life if you slip $10 in an envelope and send it to Elmer Gantry Inc. No tented mission will make the blind see, the lame walk or the dead rise. False Christs and false prophets will appear and perform signs and miracles to deceive the elect – if that were possible. No, we are told that in this world we will have tribulation. This wasn’t a lame threat; it was a promise.
We must be prepared for trouble.
First we must understand the Bible. Verse 14: ‘Let the reader understand’ not an aside from Mark, but an instruction from Jesus. God has revealed Himself in scripture. We must read and understand if we want to know His mind.
Then we must do what we can. Don’t go on your roof when a storm is coming. If you were fleeing a burning building you would be mad to go back for your computer or a painting you liked. We might be persecuted but there is no need to invite trouble. Don’t go into a Mosque and condemn Muhammad.
Then we must pray. Don’t be a fatalist. God is moved by prayer; moved but not manipulated. Sometimes His ends will be achieved in a different way because we pray. He is a good God. We are sometimes blind to the hand of God in the affairs of Man. Who knows how many times he has ‘shortened the days’.
In the Second World War who stayed Hitler’s hand while 300,000 British and French soldiers escaped from the beaches of Dunkirk? Who provided the cloud cover that kept the attacking Stukas from bombing vulnerable men on the beaches? And how often has disaster ensued because no-one prayed?
How could ten Godly men have saved Sodom? They would have prayed. Why did Jonah take ship for Tarshish? Because he knew that if he preached to the men of Nineveh they might repent and God forgive them. God is like that. He is not willing that any should perish but that all should turn from their wicked ways and live.
In Nineveh there were one hundred and twenty thousand people who did not know their left hand from their right. Should our God not have compassion on them? How about the people of Kandarha or Khartoum or Basra or Baghdad or Hyderabad or Harare?
Tuesday, August 28, 2007
Friday, August 24, 2007
News from the Barnabus Trust
In the Dora region of Baghdad Iraqi Christians are being forced to pay jizya, a humiliating tax for being a Christian, or be forcibly converted to Islam. Three months ago Saif Isam Shamer (aged 19) was shot dead for refusing to convert.
On June 3rd a minister and three deacons were shot dead as they dove away from their church in Mosul.
Dr Rebekka Zakaria, Mrs Ratna Bangun and Mrs Eti Pangesti are currently serving 3 years jail sentences for allowing Muslim children to attend a Christian club that they ran in Indonesia.
Walter Fazal Khan a 79 year old Pakistani Christian has been arrested having been falsely accused by his Muslim nephew who covets his property of setting fire to a Qur'an.
Sumaira Rafiq Masih, a Pakistani Christian aged 14, has been gang raped by three influential Muslim landowners near Patoki. No action has been taken by the authorities.
Shamimu Muteteri Hassan 9aged 16) was murdered by her father on July 1st in western Uganda for converting from Islam to Christianity.
David Shestakov is imprisoned in a labor camp in Uzbekistan for 'incitement to religious hatred'. He had been preaching Christ and him crucified.
Please pray for Christians suffering under Islam
On June 3rd a minister and three deacons were shot dead as they dove away from their church in Mosul.
Dr Rebekka Zakaria, Mrs Ratna Bangun and Mrs Eti Pangesti are currently serving 3 years jail sentences for allowing Muslim children to attend a Christian club that they ran in Indonesia.
Walter Fazal Khan a 79 year old Pakistani Christian has been arrested having been falsely accused by his Muslim nephew who covets his property of setting fire to a Qur'an.
Sumaira Rafiq Masih, a Pakistani Christian aged 14, has been gang raped by three influential Muslim landowners near Patoki. No action has been taken by the authorities.
Shamimu Muteteri Hassan 9aged 16) was murdered by her father on July 1st in western Uganda for converting from Islam to Christianity.
David Shestakov is imprisoned in a labor camp in Uzbekistan for 'incitement to religious hatred'. He had been preaching Christ and him crucified.
Please pray for Christians suffering under Islam
August News
Newsweek has this.
China has banned Buddhist monks in Tibet from reincarnating without government permission. According to a statement issued by the State Administration for Religious Affairs, the law, which goes into effect next month and strictly stipulates the procedures by which one is to reincarnate, is "an important move to institutionalize management of reincarnation."
It is August.
China has banned Buddhist monks in Tibet from reincarnating without government permission. According to a statement issued by the State Administration for Religious Affairs, the law, which goes into effect next month and strictly stipulates the procedures by which one is to reincarnate, is "an important move to institutionalize management of reincarnation."
It is August.
Thursday, August 23, 2007
How many mutations are you allowed?
Legend of figure.
Figure 1. Comparison of survival in months of patients with CLL with different degrees of sequence homology for IgVH genes.
For both panels. represents < 97% homology, between 97% and 97.9%,
between 98% and 99.9% and 100%.
Panel A shows overall survival censored for deaths unrelated to CLL; panel B shows treatment-free survival.
Summary
The choice of 98% sequence homology for immunoglobulin heavy chains to distinguish between mutated and unmutated versions of chronic lymphocytic leukaemia (CLL) was arbitrary and was chose to account for supposed polymorphisms. Some authors chose 97% or even 95%. In this study we have examined survival curves for cohorts of patients with varying degrees of sequence homology. All patients with <97% homology behaved as if mutated. Those with 97-98% homology were more aggressive than the mutated cases, but less aggressive than those with >98% homology.
Introduction
Although the difference between chronic lymphocytic leukemia (CLL) with mutated and unmutated immunoglobulin variable region heavy chain (IgVH) genes is well established and this distinction is recognised as one of the most important prognostic variables (Damle et al 1999; Hamblin et al 1999), the choice of 98% sequence homology as the limit of the unmutated subset was arbitrary, based on possible polymorphisms that might produce that degree of variation (Matsuda et al, 1993). Some authors chose 97% (Krober et al, 2002) or even 95% (Lin et al, 2002) homology as a possibly more appropriate cut-off. When a comparison was made of IgVH gene homology in leukaemic cells and granulocytes from the same patient, it became apparent that even small numbers of mutations were caused by somatic hypermutation rather than polymorphisms (Davis et al 2003).
Individuals whose IgVH genes have only a few somatic mutations comprise a small proportion of CLL patients and until recently it has not been possible to study enough patients in this group to distinguish a different prognostic impact of choosing the threshold for unmutated status at >97% or >98% homology. The problem is further complicated by the fact this is an elderly population in which many deaths are unrelated to CLL, and this adds ‘noise’ to the system making small differences difficult to perceive. A final difficulty is the discovery that the use of the VH3-21 gene is associated with a poor prognosis whether of not there are somatic mutations (Tobin et al 2002). This is especially problematic because such cases frequently have between 96 and 99% sequence homology.
In order to resolve these difficulties we have made a retrospective survey of 310 patients with CLL who have passed through our hands in the past 30 years and who have had their IgVH genes sequenced. We have compared outcomes of patients with different degrees of sequence homology. There were only four whose tumor used the VH3-21 gene, none of which fell in the disputed area of 97-98% homology; two had 100% and two <97% sequence homology. Patients were observed until treatment was indicated because of symptoms or evidence of progression, and then treated according to best practice of the day; largely with chlorambucil prior to 1990 and increasingly with purine analogues or combinations including purine analogues since then.
Methods.
310 patients with CLL were studied. Of these 260 were local patients representing the normal referral pattern of a district hospital and 50 were patients referred from other hospitals for a second opinion. The diagnosis was based on standard morphological and immunophenotypic criteria. Local patients were followed closely by the authors; data on referred patients were assembled from the referring physician by letter or telephone call. In the cases of patients who have died, an assessment of whether or not the cause of death was related to the CLL was made independently by two of the authors (TJH and DGO) and any discrepancy resolved by discussion. Except in cases with bone marrow suppression, deaths from cardiac or cerebral events were regarded as unrelated to CLL unless an infective episode or thrombocytopenia was involved. Deaths from cancer were regarded as unrelated unless there was an obvious relationship to the CLL.
IgVH gene analysis
Prior to October 2004 IgVH genes were originally sequenced as previously described (Hamblin et al, 1999)1. The preferred source material was RNA. cDNA was synthesized and amplified by polymerase chain reaction (PCR) using a mixture of oligonucleotide 5’ primers specific for each leader sequence of the VH1 to VH6 families or a consensus 5’ FW1 region primer, together with either a consensus 3’ primer complementary to the germ line JH regions or a 3’ primer complimentary to the constant region. From 2004 onwards gDNA was extracted from whole blood using the QIAmp®DNA mini kits (Qiagen, Crawley, West Sussex, UK) according to the manufacturers instructions. gDNA was amplified in a single multiplexed PCR reaction consisting of 6VH framework 1 primers combined with one JH consensus primer (standardises BIOMED-2 primers) (van Dongen et al, 2003; Matthews et al, 2004). Clonal sequences were determined by sequencing amplicons from at least 2 independent PCR reactions. The majority of samples were sequenced directly using an automated DNA sequencer. Nucleotide sequences were aligned to EMBL/GenBank and current databases (V-BASE sequence directory IMGT/V-QUEST, using MacVector 4.0 sequence analysis software; International Biotecnologies, New Haven, CT, and Lasegene; DNASTAR, Madison, WI.). Percentage homology was calculated by counting the number of mutations between the 5’ end of FR1 and the 3’ end of FR3.
Statistical methods
Data were analysed using GraphPad Prism 4. Survival functions comparing patients have been estimated using the product limit method of Kaplan Meier.
Results
There were 99 patients with 100% sequence homology, 22 with between 98 and 99.9%, 22 with between 97 and 97.9%, 24 with between 96 and 96.9%, and 143 with <96% homology with germ line genes. There have been 139 deaths of which 79 were determined to be unrelated to CLL. Survival curves are shown in figure 1. The median survivals, censored for unrelated deaths, were 102 months for patients with 100% IgVH gene homology; 132 months for those with 98-99.9%, 184 months for those with 97-97.9% and not yet reached for those with 96% or <96%. The difference between 100% and 97-97.9% was statistically significant (p=0.002) as was the difference between 97-97.9% and <97% (p<0.0001). However, the differences between 100% and 98-99.9% and between 98-99.9% and 97-97.9% did not reach statistical significance. The survival curves for those with 96-96.9% homology and <96% were virtually identical.
Using treatment-free survival as an alternative end-point gave very similar results. Median times to treatment were 35 months for 100% homology, 36 months for 98-99.9%, 156 months for 97-97.9%, and 272 months for <97%. The difference between 100% and 97-97.9% was statistically significant (p=0.001) as was the difference between 97-97.9% and <97% (p=0.0003), but the differences between 100% and 98-99.9%, between 98-99.9% and 97-97.9%, and between 96-96.9% and <96% were not.
Discussion
The pattern revealed by this study is not a continuous gradation with survival increasing with increases in the number of mutations. Those with 97%-97.9% homology comprise a mixture of benign and malignant cases rather than a homogeneous group with moderate malignancy.
It is not understood how accumulations of somatic mutations affects prognosis in CLL. The initial explanation, that in those with mutated IgVH genes the cells had passed through the germinal centre while the cells of those with unmutated IgVH genes had not, seems unlikely to be true. Tumour cells from both types of patients most closely resemble memory B cells (Klein et al, 2001) and both express CD27 (Dong et al, 2002). Furthermore, among both mutated and unmutated CLLs there are now many examples of non-stochastic pairing of immunoglobulin heavy and light chains predicated by the sequences of the CDR3 of the Ig heavy chain, combining to form stereotypic antibody-combining-sites indicative of selection by as yet unknown extrinsic or self antigens (Widhopf et al, 2007). All these facts point to the clear conclusion that both types of CLL should be thought of as derived from antigen-experienced B cells.
Poor prognosis in patients with unmutated IgVH genes is particularly associated with those who acquire other poor prognostic factors such as CD38 (Hamblin et al, 2002), ZAP-70 (Rassenti et al, 2004) and chromosomal deletions at 11q23 and 17p13 (Dohner et al, 2000). It is not known why these abnormalities are preferentially acquired in patients with unmutated IgVH genes, nor whether those with between 97% and 97.9% homology are among those that preferentially acquire them.
One possible mechanism is that the mutator mechanism is impaired in CLLs with unmutated IgVH genes. The anomalously high expression of activation-induced cytosine deaminase (AID), an enzyme necessary for somatic hypermutation and Ig class switching, in cases with unmutated IgVH genes (Albesiano et al 2003; McCarthy et al 2003; Oppezzo et al, 2003) may be implicated. It has been suggested that high levels of AID may result in loss of substrate specificity and the development of mutations in c-MYC, PAX-5 and RhoH genes which are associated with more aggressive forms of the disease (Reiniger et al, 2006). It would be interesting to see whether the level of AID correlates with the degree of somatic hypermutation and whether this is a factor in the acquisition of other poor prognostic factors.
References
Albesiano E, Messmer BT, Damle RN, Allen SL, Rai KR, Chiorazzi N. (2003) Activation-induced cytidine deaminase in chronic lymphocytic leukemia B cells: expression as multiple forms in a dynamic, variably sized fraction of the clone.
Blood, 102, 3333-3339.
Damle RN, Wasil T, Fais F, Ghiotto F, Valetto A, Allen SL, Buchbinder A, Budman D, Dittmar K, Kolitz J, Lichtman SM, Schulman P, Vinciguerra VP, Rai KR, Ferrarini M, Chiorazzi N. (1999) Ig V gene mutation status and CD38 expression as novel prognostic indicators in chronic lymphocytic leukemia. Blood, 94, 1840-1847.
Davis ZA, Orchard JA, Corcoran MM, Oscier DG. (2003) Divergence from the germ-line sequence in unmutated chronic lymphocytic leukemia is due to somatic mutation rather than polymorphisms. Blood, 102:3075.
Dohner H, Stilgenbauer S, Benner A, Leupolt E, Krober A, Bullinger L, Dohner K, Bentz M, Lichter P. (200) Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med. 343, 1910-1916.
Dong HY, Shahsafaei A, Dorfman DM. (2002) CD148 and CD27 are expressed in B cell lymphomas derived from both memory and naive B cells. Leuk Lymphoma. 43,1855-1858.
Hamblin TJ, Davis Z, Gardiner A, Oscier DG, Stevenson FK. (1999) Unmutated Ig V(H) genes are associated with a more aggressive form of chronic lymphocytic leukemia. Blood, 94,1848-1854.
Hamblin TJ, Orchard JA, Ibbotson RE, Davis Z, Thomas PW, Stevenson FK, Oscier DG. (2002) CD38 expression and immunoglobulin variable region mutations are independent prognostic variables in chronic lymphocytic leukemia, but CD38 expression may vary during the course of the disease. Blood 99, 1023-1029.
Klein U, Tu Y, Stolovitzky GA, Mattioli M, Cattoretti G, Husson H, Freedman A, Inghirami G, Cro L, Baldini L, Neri A, Califano A, Dalla-Favera R. (2001) Gene expression profiling of B cell chronic lymphocytic leukemia reveals a homogeneous phenotype related to memory B cells. Journal of Experimental Medicine, 194, 1625-1638.
Krober A, Seiler T, Benner A, Bullinger L, Bruckle E, Lichter P, Dohner H, Stilgenbauer S. (2002) V(H) mutation status, CD38 expression level, genomic aberrations, and survival in chronic lymphocytic leukemia. Blood,100,1410-1416.
Lin K, Sherrington PD, Dennis M, Matrai Z, Cawley JC, Pettitt AR. (2002) Relationship between p53 dysfunction, CD38 expression, and IgV(H) mutation in chronic lymphocytic leukemia. Blood, 100,1404-1409.
McCarthy H, Wierda WG, Barron LL, Cromwell CC, Wang J, Coombes KR, Rangel R, Elenitoba-Johnson KS, Keating MJ, Abruzzo LV. (2003) High expression of activation-induced cytidine deaminase (AID) and splice variants is a distinctive feature of poor-prognosis chronic lymphocytic leukemia. Blood. 101, 4903-4908.
Matthews C, Catherwood M, Morris TC, Alexander HD. (2004) Routine analysis of IgVH mutational status in CLL patients using BIOMED-2 standardized primers and protocols. Leuk Lymphoma 45,1899-1904.
Matsuda F, Shin EK, Nagaoka H, Matsumura R, Haino M, Fukita Y, Taka-ishi S, Imai T, Riley JH, Anand R, Soeda E, Honjo T. (1993) Structure and physical map of 64 variable segments in the 3'0.8-megabase region of the human immunoglobulin heavy-chain locus. Nature Genetics, 3, 88-94.
Oppezzo P, Vuillier F, Vasconcelos Y, Dumas G, Magnac C, Payelle-Brogard B, Pritsch O, Dighiero G. (2003) Chronic lymphocytic leukemia B cells expressing AID display dissociation between class switch recombination and somatic hypermutation. Blood, 101, 4029-4032.
Rassenti LZ, Huynh L, Toy TL, Chen L, Keating MJ, Gribben JG, Neuberg DS, Flinn IW, Rai KR, Byrd JC, Kay NE, Greaves A, Weiss A, Kipps TJ. (2004) ZAP-70 compared with immunoglobulin heavy-chain gene mutation status as a predictor of disease progression in chronic lymphocytic leukemia.
N Engl J Med. 351, 893-901.
Reiniger L, Bodor C, Bognar A, Balogh Z, Csomor J, Szepesi A, Kopper L, Matolcsy A. (2006) Richter's and prolymphocytic transformation of chronic lymphocytic leukemia are associated with high mRNA expression of activation-induced cytidine deaminase and aberrant somatic hypermutation. Leukemia, 20, 1089-1095.
Tobin G, Thunberg U, Johnson A, Thorn I, Soderberg O, Hultdin M, Botling J, Enblad G, Sallstrom J, Sundstrom C, Roos G, Rosenquist R. (2002) Somatically mutated Ig V(H)3-21 genes characterize a new subset of chronic lymphocytic leukemia. Blood, 99, 2262-2264.
Van Dongen JJ, Langerak AW, Bruggermann M, Evans PA, Hummel M, Lavender FL, Delabesse E, Davi F, Schuuring E, Garcia-Sanz R, Van Krieken JH, Droese J, Gonzalez D, Bastard C, White HE, Spaargaren M, Gonzalez M, Parreira A, Smith JL, Morgan GJ, Kneba M, Macintyre EA. (2003) Design and standardization of PCR primers ad protocols for detection of clonal immunoglobulina nd T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia 17, 2257-2317.
Widhopf GF, Goldberg CJ, Toy TL, Rassenti-LZ, Wierda WG, Byrd JC, Keating MJ, Gribben JG, Rai KR, Kipps TJ. (2007) Non-stochastic pairing of immunoglobulin heavy and light chains expressed by chronic lymphocytic leukemia B cells is predicated on the heavy chain CDR3. Blood (prepublished online August 3, 2007; DOI 10.1182/blood-2007-02-073130
Wednesday, August 22, 2007
Sofa not so good
My daughter bought an apartment. Actually she bought a fully furnished apartment. It was brilliantly designed and decorated. The only thing she wasn't keen on was the white leather sofa. When she was able she decided to replace it with a dark grey one. When the new one was ready for delivery she arranged to have the white one transported over to our garage where it is now in residence (it has replaced her brother's derelict Triumph Stag, which we finally had removed for scrap, and the electric bike that I foolishly purchased thinking I was too decrepit to peddle unaided).
Here was the first problem. One of the metal legs of the white sofa had snapped off. Of course, the developers had long moved off site and an e-mail to them asking where the sofa had been purchased from led to a dead end. Never mind, I found the same legs on the Internet. They were manufactured by a factory in China. Unfortunately, this factory does not answer e-mails. Never mind, my daughter found the same legs on offer from an American company on e-Bay. They were only $3.75 each. Of course, she had to buy a set of four. She paid her money but they didn't arrive. Eventually an e-mail informed her that they had only charged her for overland transport. International orders would cost more.
Now I have heard it said that one third of Americans believe they could drive overland to Paris. Perhaps, because Tony Blair has been such a strong supporter of GWB, many Americans believe that England has become the 51st State? Perhaps, some Americans believe that the US is still a British colony? Perhaps it is that because we speak a language very similar to American that some Americans believe we are Americans. After all, Bill Clinton did list splitting the atom as an American first, and there was that film claiming it was an American rather than a British submarine that captured an Enigma machine from the Germans. A lot of American actors have featured as pilots in films about the Battle of Britain, and Winston Churchill was half American. Perhaps it is not surprising.
After paying the extra postage the legs were held up by the post office. Apparently there was duty to pay. This was surprising because it is permissible to import duty-free items costing less than $36. In order to release the legs she paid the duty and found that the American seller had written on the label of the parcel that the value of the goods was $112 rather than $20. Was this to make her feel she was getting a bargain? We are in the process of trying to reclaim the duty.
Worse was to come. She had bought the replacement sofa from John Lewis, a company with a high reputation. It was an elegant design. An 'L' shaped sofa that by some maneuvering would turn into a bed. It did not come in a flat pack. It seemed ideal. It comes as two pieces that fit together. But instead of a left hand end and a right hand end, they delivered two left hand ends that don't fit together. It seemed that someone somewhere has two right hand ends, but no, when we contacted the factory they told us that they would have to make another right hand end and that would take two months. We are still waiting. I find it very hard to believe that when it finally arrive that it will be the same color of wither of the two left hand ends we have.
What galls me is that, as doctors, if either my daughter or I had made these sorts of errors we would have been struck from the Medical Register, and have lost our livelihood. Standards are falling.
Here was the first problem. One of the metal legs of the white sofa had snapped off. Of course, the developers had long moved off site and an e-mail to them asking where the sofa had been purchased from led to a dead end. Never mind, I found the same legs on the Internet. They were manufactured by a factory in China. Unfortunately, this factory does not answer e-mails. Never mind, my daughter found the same legs on offer from an American company on e-Bay. They were only $3.75 each. Of course, she had to buy a set of four. She paid her money but they didn't arrive. Eventually an e-mail informed her that they had only charged her for overland transport. International orders would cost more.
Now I have heard it said that one third of Americans believe they could drive overland to Paris. Perhaps, because Tony Blair has been such a strong supporter of GWB, many Americans believe that England has become the 51st State? Perhaps, some Americans believe that the US is still a British colony? Perhaps it is that because we speak a language very similar to American that some Americans believe we are Americans. After all, Bill Clinton did list splitting the atom as an American first, and there was that film claiming it was an American rather than a British submarine that captured an Enigma machine from the Germans. A lot of American actors have featured as pilots in films about the Battle of Britain, and Winston Churchill was half American. Perhaps it is not surprising.
After paying the extra postage the legs were held up by the post office. Apparently there was duty to pay. This was surprising because it is permissible to import duty-free items costing less than $36. In order to release the legs she paid the duty and found that the American seller had written on the label of the parcel that the value of the goods was $112 rather than $20. Was this to make her feel she was getting a bargain? We are in the process of trying to reclaim the duty.
Worse was to come. She had bought the replacement sofa from John Lewis, a company with a high reputation. It was an elegant design. An 'L' shaped sofa that by some maneuvering would turn into a bed. It did not come in a flat pack. It seemed ideal. It comes as two pieces that fit together. But instead of a left hand end and a right hand end, they delivered two left hand ends that don't fit together. It seemed that someone somewhere has two right hand ends, but no, when we contacted the factory they told us that they would have to make another right hand end and that would take two months. We are still waiting. I find it very hard to believe that when it finally arrive that it will be the same color of wither of the two left hand ends we have.
What galls me is that, as doctors, if either my daughter or I had made these sorts of errors we would have been struck from the Medical Register, and have lost our livelihood. Standards are falling.
Tuesday, August 21, 2007
Not the Nine O'Clock News
This was the name of a BBC comedy program from 1979 that launched the careers of Rowan Atkinson (Mr Bean), Mel Smith, Griff Rhys Jones and Pamela Stephenson (Mrs Billy Connolly). I use it to set up a study of Mark Ch 13 because the first half of this chapter is very much about 'not the second coming'.
Mark was writing nearer to the event than Matthew, which is probably why he assumes that everyone will see the implicit enquiry in the disciples question. Jesus had just told them that the huge stones (some as big as a railway carriage) of the Jerusalem Temple would be thrown down, "Not one stone will be left upon another."
They asked, "When will these things happen? And what will be the sign that they are all about to be fulfilled?"
You might wonder about the use of the plural. What things? Jesus had just mentioned the destruction of the Temple. One thing. The answer, of course, as anyone there would have understood, was that the destruction of the Temple would signify the end of the world. Matthew's version of the story spells it out. In Chapter 24 v3 he reports the disciples' question as, "When will this (singular) happen and what will be the sign of your coming and of the end of the age?"
In one sense the disciples are not wrong. The destruction of the Temple does signify the end of the age, though not the end of the world. Note that the question was asked on the Mount of Olives. Jesus had left the Temple for the last time. He had declared Temple worship to be over. The old covenant had passed the new had come. No more would animals be sacrificed as a picture of redemption; the real thing had come. In a matter of days Jesus would be sacrificed on the cross as a once and for all sacrifice for sins past, present and future. But that is all about the first coming, not the second.
The destruction of the Temple would not signify the second coming, nor would wars and rumours of wars, nor earthquakes or famines. Jesus gives a specific warning about the destruction of the Temple, "Flee to the mountains!"
If Jesus had believed that this would mean His second coming, such an instruction would have been redundant. He would have said, "Don't be dismayed when all this happens, you don't need to run away, just gather on the Mount of Olives (or wherever) and watch me return." Clearly he didn't.
It would not be just wars, famine and natural disasters that would happen first; there will also be deception. JWs claim that Jesus returned invisibly in 1914. He didn't. There have been many occasions when certain sects have set a date for his return, It didn't happen. Mr Moon of the Unification Church claimed to be the returning Christ. He wasn't.
Matthew's version expands on this theme. "Many false prophets will appear and deceive many." Muhammad was the first and most impressive of these, but there have been many others including Joseph Smith.
There will also be persecution. "All men will hate you because of me."
Frances Lawrence was on the radio this morning. She is the widow of Phillip Lawrence, the headmaster who was murdered by Learco Chindamo the 15 year old schoolboy 11 years ago. She learned today that a panel of judges have decided that Chindamo (who was born in Italy) cannot be deported when he finishes his 12 year sentence because that would infringe his human rights. Here is the Wikipedia version of the murder:
The Wo-Sing-Wo gang, which was mainly Filipino, aspired to be a junior version of the Triads. Twelve of the gang's members, led by 15-year old Learco Chindamo, a pupil at another school who claimed to be a Triad member, went to St. George's school on 8 December 1995, to "punish" a 13-year old boy named William Njoh, who had quarrelled with a Filipino pupil. Lawrence saw them attack the boy with an iron bar and went outside to remonstrate with the gang. Chindamo punched him and then stabbed him in the chest, and he died in hospital that evening.
The Lawrences were keen Christians. "Should you not forgive this boy?" asked the radio interviewer. "I try," replied Mrs Lawrence, "but I have a visceral sense that it is not fair. Surely, the victim has rights too?"
Indeed it is not fair. In this world we will have tribulation.
A bit of silly doggerel goes:
The Lord makes it to rain on the just
And on the unjust fella
But more upon the just, because
The unjust man usually has the just man's umbrella.
He who stands firm will be saved.
Are you a TULIP person? It all depends what the 'P' stands for. Does it mean the final 'perseverance' of the saints or the final 'preservation' of the saints?
If we believe in human responsibility it is our responsibility to persevere. We have to stand firm. Yet we have also those texts that signify divine responsibility: He who began a good work in you will surely bring it to completion. Is it God's job to preserve you?
I believe in both human responsibility and divine sovereignty. Reconcile them? Why should they need reconciling? They are close friends.
We are called to obey God's commands, but are given the assurance that the Spirit aids us in our weakness. It is not enough once to have made a profession of faith and then hand over the reins to God as if to say, "It's your job, now." So we must persevere, even when the times are tough. And as we persevere, He will preserve us.
Mark was writing nearer to the event than Matthew, which is probably why he assumes that everyone will see the implicit enquiry in the disciples question. Jesus had just told them that the huge stones (some as big as a railway carriage) of the Jerusalem Temple would be thrown down, "Not one stone will be left upon another."
They asked, "When will these things happen? And what will be the sign that they are all about to be fulfilled?"
You might wonder about the use of the plural. What things? Jesus had just mentioned the destruction of the Temple. One thing. The answer, of course, as anyone there would have understood, was that the destruction of the Temple would signify the end of the world. Matthew's version of the story spells it out. In Chapter 24 v3 he reports the disciples' question as, "When will this (singular) happen and what will be the sign of your coming and of the end of the age?"
In one sense the disciples are not wrong. The destruction of the Temple does signify the end of the age, though not the end of the world. Note that the question was asked on the Mount of Olives. Jesus had left the Temple for the last time. He had declared Temple worship to be over. The old covenant had passed the new had come. No more would animals be sacrificed as a picture of redemption; the real thing had come. In a matter of days Jesus would be sacrificed on the cross as a once and for all sacrifice for sins past, present and future. But that is all about the first coming, not the second.
The destruction of the Temple would not signify the second coming, nor would wars and rumours of wars, nor earthquakes or famines. Jesus gives a specific warning about the destruction of the Temple, "Flee to the mountains!"
If Jesus had believed that this would mean His second coming, such an instruction would have been redundant. He would have said, "Don't be dismayed when all this happens, you don't need to run away, just gather on the Mount of Olives (or wherever) and watch me return." Clearly he didn't.
It would not be just wars, famine and natural disasters that would happen first; there will also be deception. JWs claim that Jesus returned invisibly in 1914. He didn't. There have been many occasions when certain sects have set a date for his return, It didn't happen. Mr Moon of the Unification Church claimed to be the returning Christ. He wasn't.
Matthew's version expands on this theme. "Many false prophets will appear and deceive many." Muhammad was the first and most impressive of these, but there have been many others including Joseph Smith.
There will also be persecution. "All men will hate you because of me."
Frances Lawrence was on the radio this morning. She is the widow of Phillip Lawrence, the headmaster who was murdered by Learco Chindamo the 15 year old schoolboy 11 years ago. She learned today that a panel of judges have decided that Chindamo (who was born in Italy) cannot be deported when he finishes his 12 year sentence because that would infringe his human rights. Here is the Wikipedia version of the murder:
The Wo-Sing-Wo gang, which was mainly Filipino, aspired to be a junior version of the Triads. Twelve of the gang's members, led by 15-year old Learco Chindamo, a pupil at another school who claimed to be a Triad member, went to St. George's school on 8 December 1995, to "punish" a 13-year old boy named William Njoh, who had quarrelled with a Filipino pupil. Lawrence saw them attack the boy with an iron bar and went outside to remonstrate with the gang. Chindamo punched him and then stabbed him in the chest, and he died in hospital that evening.
The Lawrences were keen Christians. "Should you not forgive this boy?" asked the radio interviewer. "I try," replied Mrs Lawrence, "but I have a visceral sense that it is not fair. Surely, the victim has rights too?"
Indeed it is not fair. In this world we will have tribulation.
A bit of silly doggerel goes:
The Lord makes it to rain on the just
And on the unjust fella
But more upon the just, because
The unjust man usually has the just man's umbrella.
He who stands firm will be saved.
Are you a TULIP person? It all depends what the 'P' stands for. Does it mean the final 'perseverance' of the saints or the final 'preservation' of the saints?
If we believe in human responsibility it is our responsibility to persevere. We have to stand firm. Yet we have also those texts that signify divine responsibility: He who began a good work in you will surely bring it to completion. Is it God's job to preserve you?
I believe in both human responsibility and divine sovereignty. Reconcile them? Why should they need reconciling? They are close friends.
We are called to obey God's commands, but are given the assurance that the Spirit aids us in our weakness. It is not enough once to have made a profession of faith and then hand over the reins to God as if to say, "It's your job, now." So we must persevere, even when the times are tough. And as we persevere, He will preserve us.
Friday, August 17, 2007
Regeneration
I have been reading Pat Barker's book, Regeneration. I saw the film with Jonathon Pryce and James Wilby several years ago. It is set in 1917 in an army mental hospital outside Edinburgh. Siegfried Sassoon, the war poet, has been sent there after making a protest against the continuation of the war. He comes under the care of Major Rivers, a gentle psychiatrist with an FRS for his studies on anthropology made in the South pacific. We meet several patients, among them Wilfred Owen, and explore their neuroses, all derived from the horrors of the front.
I was brought up on the war poets. They describe the horrors perfectly. I suppose you could ask why anybody is concerned about the 70 British soldiers killed this year in Afghanistan when in September 1917 102,000 British soldiers were killed on the Western Front. As I was reading the book I tried to think of what good came out of the first world war. I suppose you could say that the war poetry was one good thing.
Of course, many effective weapons first appeared or were significantly developed during this period: airplanes, tanks, bombing from the air, submarines and so on. But you could hardly think of these as great benefits for mankind. There were great advances in medicine, but proper blood transfusion and antibiotics had to wait for the second conflagration.
I've tried to think what good did arise. Here is my list.
Recognition that women could do the same sorts of jobs as men.
Social changes that made votes for women a reality.
The beginning of the end of the class system.
The recognition that war is hell.
Perhaps you, dear reader, can think of others.
I was brought up on the war poets. They describe the horrors perfectly. I suppose you could ask why anybody is concerned about the 70 British soldiers killed this year in Afghanistan when in September 1917 102,000 British soldiers were killed on the Western Front. As I was reading the book I tried to think of what good came out of the first world war. I suppose you could say that the war poetry was one good thing.
Of course, many effective weapons first appeared or were significantly developed during this period: airplanes, tanks, bombing from the air, submarines and so on. But you could hardly think of these as great benefits for mankind. There were great advances in medicine, but proper blood transfusion and antibiotics had to wait for the second conflagration.
I've tried to think what good did arise. Here is my list.
Recognition that women could do the same sorts of jobs as men.
Social changes that made votes for women a reality.
The beginning of the end of the class system.
The recognition that war is hell.
Perhaps you, dear reader, can think of others.
Monday, August 13, 2007
Radiation and CLL
Although ionizing radiation is a well known cause of leukemia, most papers alluding to the topic exclude chronic lymphocytic leukemia (CLL) from consideration since it is believed to be well-established that CLL is not caused by radiation [1]. Just how secure is this assumption?
The primary data come first from studies of atom bomb survivors at Hiroshima and Nagasaki [2-4]. Only ten cases of CLL were identified in survivors between 1945 and 1980, and of those ten, seven turned out to be acute T-cell leukemia/lymphoma (ATLL) when examined more closely. ATLL is endemic in the area around Nagasaki being associated with infection with the human T-cell lymphotropic virus type I (HTLV-1). These findings point out two of the hazards in interpreting the epidemiological data: CLL is an extremely rare diagnosis among those who were bombed (and indeed amongst the Japanese in general), and the definition of CLL has changed down the years. Many who would have been diagnosed as CLL in the past are now recognized as having different sorts of lymphoid malignancies, and since, even as recently as 1975, the diagnosis of CLL required a lymphocyte count of over 15 x 109/L [5], many low count cases would have gone unrecognized.
The second primary sources of data come from studies of patients treated with ionizing radiation for benign conditions. The initial study [6] of 14,000 British patients with ankylosing spondylitis treated with radiotherapy between 1935 and 1954 with an average bone marrow dose of 4,400 mSv showed an excess of acute leukemia and chronic myeloid leukemia in the first five years post-irradiation, but no excess of CLL. It is believed that CLL have a very long latent period, making a follow-up of less than two decades unacceptable, but later reports of this study in 1994 and 1995 [7, 8] found only seven deaths attributable to CLL, and while this was greater than expected, it was not significantly so. Similarly, a study of 12,955 women irradiated for benign gynecological disorders found no significant excess of CLL-related deaths [9].
These studies illustrate other difficulties in the epidemiological data. CLL is seldom recorded as a cause of death in patients who have been diagnosed with it. For many patients, especially those with mutated IgVH genes, it is a very trivial condition that never causes ill health. The traditional methods by which epidemiologists acquire cases – from death certificates and hospital admissions – are ineffective in CLL; many patients never require hospital admission and they die from causes unrelated to their CLL. In one series 75% of cases were diagnosed because they had a blood test for a different condition; presumably there are undiagnosed cases in the community who have not had blood tests.
A recent analysis of the Surveillance Epidemiology and End Results (SEER) database puts the annual incidence in the USA at 3.5 per 100,000 (males 5.0: females 2.5) [10]. However, the Leukaemia Research Fund Data Collection Study which gathered data from individual hematologists responsible for laboratories covering about one third of the population of England and Wales (rather than from death certificates and hospital admissions) found a higher incidence in the U.K. of 6.15 per 100,000, and even this concealed a variation between 1.3 and 13.7 per 100,000 in different health districts, largely dependent on how interested the local hematologist was in the disease. [11].
Although the US Energy Employees Occupational Illness Compensation Program refuses to acknowledge any claims that CLL is radiation induced [12], this establishment view has recently been challenged. Although they present no new data, Richardson et al [13] argue that the data are insufficiently compelling to make this assumption and that the molecular lesions in CLL are sufficiently similar to those in other leukemias, that the presumption should be that radiation can cause CLL unless there are convincing data to the contrary. They argue that the epidemiological studies are simply too weak to carry that burden. On the other hand it should be recognized that one of the co-authors of this paper is the Executive Secretary of the Preparatory Commission for the Comprehensive Nuclear-Test-Ban Treaty Organization and another is the recipient of the 2003 Nuclear-Free Future lifetime achievement award.
Relatively new data are available form a study of Czech uranium minors[14]. This study intended not to miss cases by looking at incidence rather than mortality, and ensuring that subjects had annual blood tests. An earlier abstract [15] from this group had claimed on the basis of 41 cases that the incidence among miners employed for at least one year underground was significantly greater than the general Czech polulation. But, then, the general Czech population does not have a blood test every year. This publication reports a higher incidence of CLL among those exposed to greatest quantity of radon. Unfortunately, the same study did not show a significant increase of myeloid leukemias asociated with a higher exposure to radon, which would have been more likely according to previous experience, nor a significant increase in cases of non-Hodkin’s lymphoma which would have fitted better with the hypothesis of Richardson et al [13].
In an upcoming issue of Leukemia Research Abramenko et al [16] report the first study of CLL in individuals exposed to radionuclides following the accident at the Chernobyl nuclear power plant. Previous published abstracts [17,18] have suggested CLL in Chernobyl clean-up workers occrred in younger patients and presented with more advanced symptoms, pursued a more aggressive course and was more resistant to standard agents than in patients not exposed to ionizing radiation. In this study 47 patients with CLL following exposure were compared with 141 patients without a history of exposure. The patients were examined more comprehensively than before and included the mutational status of IgVH genes among their investigations. Among the irradiated group 77.6% had unmutated IgVH genes, but surprisingly this was not significantly different from the non-irradiated group where the figure was 68.3%. Both were much higher than the figure of about 40% reported in most Western countries [19], and is probably explained by less assiduous screening in the control population and therefore the ommission of the more benign (and mutated) cases. In a sub-group among the clean-up workers who received the greatest dose of irradiation, all bar used germline IgVH genes and especially used the V1-69 and V3-21 genes that are associated with stereotypic B-cell receptors and poorer prognosis.
There was a significantly higher risk of second cancers and Richter’s syndrome among the irradiated group (as might be expected) and especially among those who received the highest dose of irradiation.
What do these new data amount to? They certainly do not establish that CLL may be caused or even made worse by ionizing radiation. On the other hand there is enough suspicion for the case to be sub-judice. Irradiation has been given a clean bill of health with respect to CLL with less than adequate evidence.
1. Zablotska LB, Ashmore JP, Howe GR. Analysis of mortality among Canadian nuclear power industry workers after chronic low-dose exposure to ionizing radiation. Radiat Res. 2004 ;161:633-41.
2. Finch SC, Hoshito T, Itoga T, Ichimaru M, Ingram Jr RH. Chronic lymphocytic leukemia in Hiroshima and Nagasaki, Japan. Blood 1969; 33: 79 – 86.
3. Preston DL, Kusumi S, Tomonaga M, Izumi S, Ron E, Kuramoto A. Cancer incidence in atomic bomb survivors. Part III. Leukemia, lymphoma and multiple myeloma, 1950-1987. Radiat Res 1994; 137: 68 – 97.
4. Ishimaru T, Hoshino T, Ichimaru M, Okada H, Tomiyasu T, Tsuchimoto T, et al. 1969. Leukemia in Atomic Bomb Survivors: Hiroshima and Nagasaki. TR-25-69. Hiroshima, Japan:Atomic Bomb Casualty Commission.
5. Rai KR, Sawitsky A, Cronkite ER, Chanana AD, Levy RN, Pasternack BS Clinical staging of chronic lymphocytic leukemia. Blood 1975;46:219-234.
6. Court-Brown W, Doll R. Mortality from cancer and other causes after radiotherapy for ankylosing spondylitis. Brit Med J 1965; 2:1327-32.
7. Weiss HA, Darby SC, Doll R. Cancer mortality following X-ray treatment for ankylosing spondylitis. Int J Cancer 1994; 59:327-38.
8. Weiss HA, Darby SC, Fearn T, Doll R. Leukemia mortality after X-ray treatment for ankylosing spondylitis. Radiat Res 1995; 142:1-11.
9. Inskip PD, Kleinerman RA, Stovall M, Cookfair DL, Hajimichael O, Moloney WC. Leukemia, lymphoma and multiple myeloma after pelvic tadiotherapy for benign disease. Radiat Res 1993; 135:108-24.
10. National Cancer Institute: SEER Cancer Statistics Review 1975-2001. Available at: http://seer.cancer.gov/csr/1975_2001/.
11. Cartwright RA, Bernard SM, Bird CC, Darwin CM, O´Brien C, Richards IC, Roberts B, McKinney PA. Chronic lymphocytic leukaemia: case control epidemiological study in Yorkshire. Brit. J. Haematol. 1987 56:79-82.
12. Department of Health and Human Services. $” CFR Parts 81 and 82. Guidelines for Determining the Probability of Causation and Methods for Radiation Dose Reconstruction Under the Employees Occupational Illness Compensation Program Act of 2000; Final Rules. Fed Reg 2002; 67:22295-314.
13. Richardson DB, Wing S, Schroeder J, Schmitz-Feurhake I, Hoffmann W. Ionizing radiation and chronic lymphocytic leukemia. Environ Health Perspect 2005; 113:1-5.
14. Rericha V, Kulich M, Reicha R, Shore DL, Sandler DP. Incidence of leukemia, lymphoma and multiple myeloma in Czech uranium miners: a case-cohort study. Environ Health Perspect 2006; 114:818-22.
15. Rericher V, Sandler DP, Shore DL, Solansky I, Hnizdo E Sram R. Non-lung cancer incidence in Czech uranium miners. [Abstract] Epidemiology 9:S99.
16. Abramenko IV, Bilous NI, Chumak AA, Davidova EI, Kryachok IA, Martina ZV, Nechaev SI, Dyagil IS, Bazyka DA, Bebeshko VG. Chronic lymphocytic leukemia patients exposed to ionizing radiation due to the Chernobyl NPP accident – with focus on immunoglobulin heavy chain gene analysis. Leuk Res 2008 (in press)
17. Klymenko V, Kryachok I, Dyagil I, Bazyka D, Bebeshko V. Some clinical and hematologic features of CLL in persons who suffered from the Chernobyl accident in Ukraine in 1986. CIII Int Workshop on CLL. Paris Oct 29-31 1999. Abstract book 1999:43.
18. Kryachok I, Polyshchuk O, Dyagil I, Abramenko I, Bazyka D, Bebeshko V. Comparative analysis of CLL in persons who suffered after Chernobyl accident and in unexposed CLL patients. Haematologica 2005; 90:454A
19. Montillo M, Hamblin T, Hallek M, Montserrat E, Morra E. Chronic lymphocytic leukemia: novel prognostic factors and their relevance for risk adapted therapeutic strategies. Haematologica 2005; 90:391-9.
The primary data come first from studies of atom bomb survivors at Hiroshima and Nagasaki [2-4]. Only ten cases of CLL were identified in survivors between 1945 and 1980, and of those ten, seven turned out to be acute T-cell leukemia/lymphoma (ATLL) when examined more closely. ATLL is endemic in the area around Nagasaki being associated with infection with the human T-cell lymphotropic virus type I (HTLV-1). These findings point out two of the hazards in interpreting the epidemiological data: CLL is an extremely rare diagnosis among those who were bombed (and indeed amongst the Japanese in general), and the definition of CLL has changed down the years. Many who would have been diagnosed as CLL in the past are now recognized as having different sorts of lymphoid malignancies, and since, even as recently as 1975, the diagnosis of CLL required a lymphocyte count of over 15 x 109/L [5], many low count cases would have gone unrecognized.
The second primary sources of data come from studies of patients treated with ionizing radiation for benign conditions. The initial study [6] of 14,000 British patients with ankylosing spondylitis treated with radiotherapy between 1935 and 1954 with an average bone marrow dose of 4,400 mSv showed an excess of acute leukemia and chronic myeloid leukemia in the first five years post-irradiation, but no excess of CLL. It is believed that CLL have a very long latent period, making a follow-up of less than two decades unacceptable, but later reports of this study in 1994 and 1995 [7, 8] found only seven deaths attributable to CLL, and while this was greater than expected, it was not significantly so. Similarly, a study of 12,955 women irradiated for benign gynecological disorders found no significant excess of CLL-related deaths [9].
These studies illustrate other difficulties in the epidemiological data. CLL is seldom recorded as a cause of death in patients who have been diagnosed with it. For many patients, especially those with mutated IgVH genes, it is a very trivial condition that never causes ill health. The traditional methods by which epidemiologists acquire cases – from death certificates and hospital admissions – are ineffective in CLL; many patients never require hospital admission and they die from causes unrelated to their CLL. In one series 75% of cases were diagnosed because they had a blood test for a different condition; presumably there are undiagnosed cases in the community who have not had blood tests.
A recent analysis of the Surveillance Epidemiology and End Results (SEER) database puts the annual incidence in the USA at 3.5 per 100,000 (males 5.0: females 2.5) [10]. However, the Leukaemia Research Fund Data Collection Study which gathered data from individual hematologists responsible for laboratories covering about one third of the population of England and Wales (rather than from death certificates and hospital admissions) found a higher incidence in the U.K. of 6.15 per 100,000, and even this concealed a variation between 1.3 and 13.7 per 100,000 in different health districts, largely dependent on how interested the local hematologist was in the disease. [11].
Although the US Energy Employees Occupational Illness Compensation Program refuses to acknowledge any claims that CLL is radiation induced [12], this establishment view has recently been challenged. Although they present no new data, Richardson et al [13] argue that the data are insufficiently compelling to make this assumption and that the molecular lesions in CLL are sufficiently similar to those in other leukemias, that the presumption should be that radiation can cause CLL unless there are convincing data to the contrary. They argue that the epidemiological studies are simply too weak to carry that burden. On the other hand it should be recognized that one of the co-authors of this paper is the Executive Secretary of the Preparatory Commission for the Comprehensive Nuclear-Test-Ban Treaty Organization and another is the recipient of the 2003 Nuclear-Free Future lifetime achievement award.
Relatively new data are available form a study of Czech uranium minors[14]. This study intended not to miss cases by looking at incidence rather than mortality, and ensuring that subjects had annual blood tests. An earlier abstract [15] from this group had claimed on the basis of 41 cases that the incidence among miners employed for at least one year underground was significantly greater than the general Czech polulation. But, then, the general Czech population does not have a blood test every year. This publication reports a higher incidence of CLL among those exposed to greatest quantity of radon. Unfortunately, the same study did not show a significant increase of myeloid leukemias asociated with a higher exposure to radon, which would have been more likely according to previous experience, nor a significant increase in cases of non-Hodkin’s lymphoma which would have fitted better with the hypothesis of Richardson et al [13].
In an upcoming issue of Leukemia Research Abramenko et al [16] report the first study of CLL in individuals exposed to radionuclides following the accident at the Chernobyl nuclear power plant. Previous published abstracts [17,18] have suggested CLL in Chernobyl clean-up workers occrred in younger patients and presented with more advanced symptoms, pursued a more aggressive course and was more resistant to standard agents than in patients not exposed to ionizing radiation. In this study 47 patients with CLL following exposure were compared with 141 patients without a history of exposure. The patients were examined more comprehensively than before and included the mutational status of IgVH genes among their investigations. Among the irradiated group 77.6% had unmutated IgVH genes, but surprisingly this was not significantly different from the non-irradiated group where the figure was 68.3%. Both were much higher than the figure of about 40% reported in most Western countries [19], and is probably explained by less assiduous screening in the control population and therefore the ommission of the more benign (and mutated) cases. In a sub-group among the clean-up workers who received the greatest dose of irradiation, all bar used germline IgVH genes and especially used the V1-69 and V3-21 genes that are associated with stereotypic B-cell receptors and poorer prognosis.
There was a significantly higher risk of second cancers and Richter’s syndrome among the irradiated group (as might be expected) and especially among those who received the highest dose of irradiation.
What do these new data amount to? They certainly do not establish that CLL may be caused or even made worse by ionizing radiation. On the other hand there is enough suspicion for the case to be sub-judice. Irradiation has been given a clean bill of health with respect to CLL with less than adequate evidence.
1. Zablotska LB, Ashmore JP, Howe GR. Analysis of mortality among Canadian nuclear power industry workers after chronic low-dose exposure to ionizing radiation. Radiat Res. 2004 ;161:633-41.
2. Finch SC, Hoshito T, Itoga T, Ichimaru M, Ingram Jr RH. Chronic lymphocytic leukemia in Hiroshima and Nagasaki, Japan. Blood 1969; 33: 79 – 86.
3. Preston DL, Kusumi S, Tomonaga M, Izumi S, Ron E, Kuramoto A. Cancer incidence in atomic bomb survivors. Part III. Leukemia, lymphoma and multiple myeloma, 1950-1987. Radiat Res 1994; 137: 68 – 97.
4. Ishimaru T, Hoshino T, Ichimaru M, Okada H, Tomiyasu T, Tsuchimoto T, et al. 1969. Leukemia in Atomic Bomb Survivors: Hiroshima and Nagasaki. TR-25-69. Hiroshima, Japan:Atomic Bomb Casualty Commission.
5. Rai KR, Sawitsky A, Cronkite ER, Chanana AD, Levy RN, Pasternack BS Clinical staging of chronic lymphocytic leukemia. Blood 1975;46:219-234.
6. Court-Brown W, Doll R. Mortality from cancer and other causes after radiotherapy for ankylosing spondylitis. Brit Med J 1965; 2:1327-32.
7. Weiss HA, Darby SC, Doll R. Cancer mortality following X-ray treatment for ankylosing spondylitis. Int J Cancer 1994; 59:327-38.
8. Weiss HA, Darby SC, Fearn T, Doll R. Leukemia mortality after X-ray treatment for ankylosing spondylitis. Radiat Res 1995; 142:1-11.
9. Inskip PD, Kleinerman RA, Stovall M, Cookfair DL, Hajimichael O, Moloney WC. Leukemia, lymphoma and multiple myeloma after pelvic tadiotherapy for benign disease. Radiat Res 1993; 135:108-24.
10. National Cancer Institute: SEER Cancer Statistics Review 1975-2001. Available at: http://seer.cancer.gov/csr/1975_2001/.
11. Cartwright RA, Bernard SM, Bird CC, Darwin CM, O´Brien C, Richards IC, Roberts B, McKinney PA. Chronic lymphocytic leukaemia: case control epidemiological study in Yorkshire. Brit. J. Haematol. 1987 56:79-82.
12. Department of Health and Human Services. $” CFR Parts 81 and 82. Guidelines for Determining the Probability of Causation and Methods for Radiation Dose Reconstruction Under the Employees Occupational Illness Compensation Program Act of 2000; Final Rules. Fed Reg 2002; 67:22295-314.
13. Richardson DB, Wing S, Schroeder J, Schmitz-Feurhake I, Hoffmann W. Ionizing radiation and chronic lymphocytic leukemia. Environ Health Perspect 2005; 113:1-5.
14. Rericha V, Kulich M, Reicha R, Shore DL, Sandler DP. Incidence of leukemia, lymphoma and multiple myeloma in Czech uranium miners: a case-cohort study. Environ Health Perspect 2006; 114:818-22.
15. Rericher V, Sandler DP, Shore DL, Solansky I, Hnizdo E Sram R. Non-lung cancer incidence in Czech uranium miners. [Abstract] Epidemiology 9:S99.
16. Abramenko IV, Bilous NI, Chumak AA, Davidova EI, Kryachok IA, Martina ZV, Nechaev SI, Dyagil IS, Bazyka DA, Bebeshko VG. Chronic lymphocytic leukemia patients exposed to ionizing radiation due to the Chernobyl NPP accident – with focus on immunoglobulin heavy chain gene analysis. Leuk Res 2008 (in press)
17. Klymenko V, Kryachok I, Dyagil I, Bazyka D, Bebeshko V. Some clinical and hematologic features of CLL in persons who suffered from the Chernobyl accident in Ukraine in 1986. CIII Int Workshop on CLL. Paris Oct 29-31 1999. Abstract book 1999:43.
18. Kryachok I, Polyshchuk O, Dyagil I, Abramenko I, Bazyka D, Bebeshko V. Comparative analysis of CLL in persons who suffered after Chernobyl accident and in unexposed CLL patients. Haematologica 2005; 90:454A
19. Montillo M, Hamblin T, Hallek M, Montserrat E, Morra E. Chronic lymphocytic leukemia: novel prognostic factors and their relevance for risk adapted therapeutic strategies. Haematologica 2005; 90:391-9.
The other Potter and Costner v Newman
Beatrix not Harry. A lot of people adored this film, but I rate it only OK. I have nothing against it. The performances are fine, the cinematography excellent, the animation very good and well integrated; it's just that the story was completely uninteresting. Perhaps those raised on Peter Rabbit and Jemima Puddleduck entered into this nice and twee world more readily; I was brought up on 'The tough of the track' and 'I flew with Braddock' and I want more grit.
'Message in a Bottle' was based on the best selling novel by Nicolas Sparks and those who've read the book think the movie a disappointment. Robin Wright-Penn plays a Chicago journalist who finds a message in a bottle from someone who has obviously lost his wife. Kevin Costner plays the youngish widower whom she eventually finds through the research department of the Chicago Tribune. Paul Newman plays his grumpy old dad. The first problem with the film is that even old and half asleep Newman acts Costner off the park. When Kostner is killed in a boating accident near the end, we are all mightily relieved. Wright-Penn can get back to being a half decent journalist, though she would have found hooking up with Newman, old though he is, more rewarding. Again this was a film that looked good, but the story didn't have the legs for more than two hours. Pity. The idea was good.
'Message in a Bottle' was based on the best selling novel by Nicolas Sparks and those who've read the book think the movie a disappointment. Robin Wright-Penn plays a Chicago journalist who finds a message in a bottle from someone who has obviously lost his wife. Kevin Costner plays the youngish widower whom she eventually finds through the research department of the Chicago Tribune. Paul Newman plays his grumpy old dad. The first problem with the film is that even old and half asleep Newman acts Costner off the park. When Kostner is killed in a boating accident near the end, we are all mightily relieved. Wright-Penn can get back to being a half decent journalist, though she would have found hooking up with Newman, old though he is, more rewarding. Again this was a film that looked good, but the story didn't have the legs for more than two hours. Pity. The idea was good.
Sunday, August 12, 2007
Watch and wait
There are eight times as many prophesies about Christ's second coming than his first, yet it is something that is hardly mentioned in polite society. Why is this? I suspect it is all to do with Mark chapter 13 v30. "I tell you the truth, this generation will certainly not pass away until all these things have happened." FF Bruce regards this as one of the 'hard sayings of Jesus'.
In chapter 13 Mark reports Jesus' teaching about two things: the destruction of Jerusalem and His return in Judgement. Verses 1-20 clearly refer to the destruction of Jerusalem and verses 24-27 clearly refer to the second coming. Verses 21-23 are about the second coming but only to warn against expecting it. Perhaps they are saying that just because Jerusalem is being destroyed, certainly a cataclysmic event in Jewish history, don't fall for stories that Christ has returned: "False Christs and false prophets will appear and perform signs and miracles." Jesus goes on to make it clear that when Christ does return there will be no mistaking it.
It is not clear from the disciples question in Mark Ch 13 v 4, " Tell us when will these things happen? And what will be the sign that they are all about to be fulfilled?", why Jesus brings in anything about the Second Coming. Their question had been prompted by Jesus's statement about the Temple that 'not a stone here will be left on another'. However, in the parallel passage in Matthew ch 24 v3 the disciples ask, "When will this happen (ie the Temple be destroyed) and what will be the sign of your coming and of the end of the age?"
It seems clear to me that the disciples associated the destruction of the Temple with the end of time. But in this chapter Jesus is at pains to disabuse them of this fact. He gives them plenty of signs about the destruction of the Temple, but about His Second Coming he says, "No-one knows the day or hour, not even the angels in heaven, nor even the son, but only the Father."
So verse 30 must mean that the destruction of the Temple would take place while this generation was still alive. Modern critics would have it otherwise, insisting that Jesus expected the Second Coming to be at the same time, but the text is plain: not even the Son knows when it will be.
In Matthew's account the point is rammed home with five parables which insist that we must watch and wait. The Second Coming will appear like a 'thief in the night', when we are not expecting it. He tells of the servants who get bored with waiting for their master's return and start to indulge themselves. Is that you? He tells of the wise and foolish virgins. Have you oil in your lamp? He tells of the Talents. Are you putting yours to use? He tells of the sheep and the goats. How are you for prison visiting lately? About as good as me I expect.
It's not enough to wait; we have to watch as well. And in the week following the centenary of the foundation of the Boy Scouts movement we must be prepared.
In chapter 13 Mark reports Jesus' teaching about two things: the destruction of Jerusalem and His return in Judgement. Verses 1-20 clearly refer to the destruction of Jerusalem and verses 24-27 clearly refer to the second coming. Verses 21-23 are about the second coming but only to warn against expecting it. Perhaps they are saying that just because Jerusalem is being destroyed, certainly a cataclysmic event in Jewish history, don't fall for stories that Christ has returned: "False Christs and false prophets will appear and perform signs and miracles." Jesus goes on to make it clear that when Christ does return there will be no mistaking it.
It is not clear from the disciples question in Mark Ch 13 v 4, " Tell us when will these things happen? And what will be the sign that they are all about to be fulfilled?", why Jesus brings in anything about the Second Coming. Their question had been prompted by Jesus's statement about the Temple that 'not a stone here will be left on another'. However, in the parallel passage in Matthew ch 24 v3 the disciples ask, "When will this happen (ie the Temple be destroyed) and what will be the sign of your coming and of the end of the age?"
It seems clear to me that the disciples associated the destruction of the Temple with the end of time. But in this chapter Jesus is at pains to disabuse them of this fact. He gives them plenty of signs about the destruction of the Temple, but about His Second Coming he says, "No-one knows the day or hour, not even the angels in heaven, nor even the son, but only the Father."
So verse 30 must mean that the destruction of the Temple would take place while this generation was still alive. Modern critics would have it otherwise, insisting that Jesus expected the Second Coming to be at the same time, but the text is plain: not even the Son knows when it will be.
In Matthew's account the point is rammed home with five parables which insist that we must watch and wait. The Second Coming will appear like a 'thief in the night', when we are not expecting it. He tells of the servants who get bored with waiting for their master's return and start to indulge themselves. Is that you? He tells of the wise and foolish virgins. Have you oil in your lamp? He tells of the Talents. Are you putting yours to use? He tells of the sheep and the goats. How are you for prison visiting lately? About as good as me I expect.
It's not enough to wait; we have to watch as well. And in the week following the centenary of the foundation of the Boy Scouts movement we must be prepared.
Media liberalism
How would you like to live in a country where every citizen has to carry identification papers, where all the newspapers are censored, as are all letters abroad, where general elections have been abolished; where there is a one-party state, where bombs are regularly blowing up houses, factories and the railways, and where the government has bankrupted the country because of its 'disastrous' foreign policy?
In this country the social system is at least as authoritarian as the political system. It is shocking for an unmarried couple to sleep together - no hotel would admit them - and a disgrace to have a baby out of wedlock. A homosexual act incurs a jail sentence. Violent young criminals are birched, older ones flogged and murderers hanged.
What country am I talking about? Zimbabwe? North Korea? Burma? No, this was the Britain I was born into in 1943.
Hardly surprising, then, that I should welcome in 1964, the first year that I was allowed to vote, the election of a Labor government. After years of elderly men in frock coats and walrus moustaches pontificating publicly about matters that did not concern us, while privately they were entertaining prostitutes and conducting financial deals based on inside knowledge; we were offered a choice between a creature who looked like a skeleton called the 14th Earl of Home (who incidentally had been Chamberlain's handmaiden at Munich) and a resurgent Labor party that offered us the 'white heat of technological revolution'.
Anthony Jay, one of the co-authors of the marvelous comedy program "Yes Minister" admits to being one of those who fell for the Labor advertising copy in today's Sunday Times. "We were not just anti-Macmillan," he says, "we were anti-industry, anti-capitalism, anti-advertising, anti-selling, anti-profit, anti-patriotism, anti-monarchy, anti-empire, anti-police, anti-armed forces, anti-bomb, anti-authority. Almost anything that made the world a freer, safer and more prosperous place – you name it, we were anti it." We were wrong.
Anthony Jay left the BBC in 1964. He has changed, but the BBC has remained the same.
Think 'Tesco' and the knee-jerk response is not 'providing the range of goods, the competitive prices, the food quality, the speed of service and the ease of parking that attract millions of shoppers' but 'exploiting African farmers and driving out small shopkeepers'. The police, the armed services, the courts, political parties, multi-national corporations, the church, senior doctors, anyone who owns anything, and farmers (unless they are victims of Tesco); these are the villains of the media liberals.
As more and more cases of media dissembling are uncovered (and the latest concern British adventurer Bear Grylls whose Discovery Channel 'Born Survivor' series featured dealing with "perilous situations" in the wild - now these 'perilous situations' are reported to have been faked for the cameras), as more examples of media dishonesty are uncovered, it is becoming apparent that there is no need to pay attention to what these people tell us.
The BBC pretends to be balanced, but as Anthony Jay tells us, "we achieved political balance by pitting the most plausible critics of government against its most bigoted supporters." The same tricks are used today. Everything is editorialized, and every editor is part of the same cohort, described by Jay as "they are that minority often characterized (or caricatured) by sandals and macrobiotic diets, but in a less extreme form are found in The Guardian, Channel 4, the Church of England, academia, showbusiness and BBC news and current affairs. They constitute our metropolitan liberal media consensus, although the word 'liberal' would have Adam Smith rotating in his grave. Let’s call it 'media liberalism'".
Clearly these people have their place - Zimbabwe, North Korea and Burma.
In this country the social system is at least as authoritarian as the political system. It is shocking for an unmarried couple to sleep together - no hotel would admit them - and a disgrace to have a baby out of wedlock. A homosexual act incurs a jail sentence. Violent young criminals are birched, older ones flogged and murderers hanged.
What country am I talking about? Zimbabwe? North Korea? Burma? No, this was the Britain I was born into in 1943.
Hardly surprising, then, that I should welcome in 1964, the first year that I was allowed to vote, the election of a Labor government. After years of elderly men in frock coats and walrus moustaches pontificating publicly about matters that did not concern us, while privately they were entertaining prostitutes and conducting financial deals based on inside knowledge; we were offered a choice between a creature who looked like a skeleton called the 14th Earl of Home (who incidentally had been Chamberlain's handmaiden at Munich) and a resurgent Labor party that offered us the 'white heat of technological revolution'.
Anthony Jay, one of the co-authors of the marvelous comedy program "Yes Minister" admits to being one of those who fell for the Labor advertising copy in today's Sunday Times. "We were not just anti-Macmillan," he says, "we were anti-industry, anti-capitalism, anti-advertising, anti-selling, anti-profit, anti-patriotism, anti-monarchy, anti-empire, anti-police, anti-armed forces, anti-bomb, anti-authority. Almost anything that made the world a freer, safer and more prosperous place – you name it, we were anti it." We were wrong.
Anthony Jay left the BBC in 1964. He has changed, but the BBC has remained the same.
Think 'Tesco' and the knee-jerk response is not 'providing the range of goods, the competitive prices, the food quality, the speed of service and the ease of parking that attract millions of shoppers' but 'exploiting African farmers and driving out small shopkeepers'. The police, the armed services, the courts, political parties, multi-national corporations, the church, senior doctors, anyone who owns anything, and farmers (unless they are victims of Tesco); these are the villains of the media liberals.
As more and more cases of media dissembling are uncovered (and the latest concern British adventurer Bear Grylls whose Discovery Channel 'Born Survivor' series featured dealing with "perilous situations" in the wild - now these 'perilous situations' are reported to have been faked for the cameras), as more examples of media dishonesty are uncovered, it is becoming apparent that there is no need to pay attention to what these people tell us.
The BBC pretends to be balanced, but as Anthony Jay tells us, "we achieved political balance by pitting the most plausible critics of government against its most bigoted supporters." The same tricks are used today. Everything is editorialized, and every editor is part of the same cohort, described by Jay as "they are that minority often characterized (or caricatured) by sandals and macrobiotic diets, but in a less extreme form are found in The Guardian, Channel 4, the Church of England, academia, showbusiness and BBC news and current affairs. They constitute our metropolitan liberal media consensus, although the word 'liberal' would have Adam Smith rotating in his grave. Let’s call it 'media liberalism'".
Clearly these people have their place - Zimbabwe, North Korea and Burma.
Friday, August 10, 2007
A Man Loves a Woman and the Family Stone
Alcoholism is a favorite subject for the movies. The first film that I saw that dealt with it was 'Days of Wine and Roses' with Jack Lemmon and Lee Remick. It won an Oscar and featured a poignant love story. Later I saw 'The Lost Weekend' with Ray Milland on television. This Billy Wilder film is a masterpiece and won 4 Oscars. On Wednesday evening we watched the 1994 film 'When a Man Loves a Woman' on DVD. You might think that this strand of movie making is sponsored by AA. This latest version draws attention to the effect of alcoholism on the significant other, and to that extent it is to be commended. Andy Garcia plays the unsuspecting spouse, who, as an airline pilot, is away so often that he doesn't realise that his wife, Meg Ryan, is drowning in vodka. There the unreality begins. Astonishingly, we are supposed to accept the idea that after a quart a day he wouldn't smell the stuff on her breath.
The stars are beautiful people, just like Jack and Lee were. Alcoholics are not. They don't wash; they don't do their hair; they don't dress well; they have food and vomit stains on their clothes; their skin is poor; they have cigarette burns on their clothes and skin. These films deal well enough with the psychological and emotional consequences of alcoholism but they don't deal with the physical. Alcoholics get cirrhosis. They vomit blood. They confabulate. They get violent. Their memories go. They get skin sores. It doesn't make nice viewing. This version had an unbelievable happy ending. Ugh! So not true. Basically a commercial for AA.
The Family Stone was one of those ensemble pieces with Clare Danes, Diane Keaton, Luke Wilson and Sarah Jessica Parker, who I gather has had some celebrity from a television series. She place an uptight Manhattan executive who is exposed to a 'Meet the Family' situation. It is nothing like as funny as 'Meet the Family' and not even as funny as 'Meet the Fokkers', which was a disappointment. Astonishingly, this was nominated for a Golden Globe. The parents have a liberal approach to life. One is reminded of the old joke: "My mother made me a homosexual." "If I gave her the wool would she make me one too?" Parker is unlikable. Redemption comes from a bit of bed-swapping and a bit of slapstick. Not true.
If you are thinking of watching either of these movies that both score 6/10 on the web, I wouldn't bother, though the first is marginally better for its emphasis on the suffering of the spouse, rather than the alcoholic. If you are looking for a really good film on alcoholism try the Billy Wider, But others worth a look include Leaving Las Vegas with Nicolas Cage and I'll Cry Tomorrow with Susan Hayward.
The stars are beautiful people, just like Jack and Lee were. Alcoholics are not. They don't wash; they don't do their hair; they don't dress well; they have food and vomit stains on their clothes; their skin is poor; they have cigarette burns on their clothes and skin. These films deal well enough with the psychological and emotional consequences of alcoholism but they don't deal with the physical. Alcoholics get cirrhosis. They vomit blood. They confabulate. They get violent. Their memories go. They get skin sores. It doesn't make nice viewing. This version had an unbelievable happy ending. Ugh! So not true. Basically a commercial for AA.
The Family Stone was one of those ensemble pieces with Clare Danes, Diane Keaton, Luke Wilson and Sarah Jessica Parker, who I gather has had some celebrity from a television series. She place an uptight Manhattan executive who is exposed to a 'Meet the Family' situation. It is nothing like as funny as 'Meet the Family' and not even as funny as 'Meet the Fokkers', which was a disappointment. Astonishingly, this was nominated for a Golden Globe. The parents have a liberal approach to life. One is reminded of the old joke: "My mother made me a homosexual." "If I gave her the wool would she make me one too?" Parker is unlikable. Redemption comes from a bit of bed-swapping and a bit of slapstick. Not true.
If you are thinking of watching either of these movies that both score 6/10 on the web, I wouldn't bother, though the first is marginally better for its emphasis on the suffering of the spouse, rather than the alcoholic. If you are looking for a really good film on alcoholism try the Billy Wider, But others worth a look include Leaving Las Vegas with Nicolas Cage and I'll Cry Tomorrow with Susan Hayward.
Thursday, August 09, 2007
Goodbye Barclays
I have decided to change my bank. After 45 years with Barclays they have riled me too much. 13 days after I wrote to them asking them to transfer some money to a missionary, they had still not complied. The telephone banking that they had me pay £10 a month for could not help - apparently they have changed the rules of engagement and not told me about them. The head office 200 miles away cannot be contacted by telephone. I apparently have a personal banker who has never contacted me, but he would not be able to do anything for me either. Despite my having banked with them for so long, and been a source of much profit for them they could not put themselves out to retain my custom.
I have moved to the Halifax. They have an interest bearing current account, a savings account that pays 2% more than Barclays £800 worth of 'goodies' in card protection, break down, mobile phone and travel insurance as well as £100 simply for changing. So goodbye Barclays and good riddance.
I have moved to the Halifax. They have an interest bearing current account, a savings account that pays 2% more than Barclays £800 worth of 'goodies' in card protection, break down, mobile phone and travel insurance as well as £100 simply for changing. So goodbye Barclays and good riddance.
Completing the circle
This from China
Perhaps the most remarkable burst of religious energy is in China's Pentecostal Christian population. At the time of the Communist takeover in 1949, there were roughly 900,000 Protestants. Today, the Center for the Study of Global Christianity, which puts out the much-consulted World Christian Database, says there are 111 million Christians in China, roughly 90 percent Protestant and mostly Pentecostal. That would make China the third-largest Christian country on earth, following only the United States and Brazil.
It is projected that by 2050, there will be 218 million Christians in China, 16 percent of the population, enough to make China the world's second-largest Christian nation. According to Chinese sources, there are 10,000 conversions in China every day.
With the abduction of South Korean Christians in Afghanistan and the murder of their leaders, we are perhaps seeing the same sort of martyrdom that characterized the early church and missionary activity ever since. Chinese Christians see it as completing the circle. They believe that Christianity has spread ever westwards. from Jerusalem to Europe, from Europe to America, from America to China and now from China back through Moslem lands to Jerusalem.
'Christianity is the great liquidator of traditional society, calling individuals out of their tribes and nations to join the ekklesia, which transcends race and nation' According to this source, it will not be secularism that breaks the grip of Islam on the middle east, but a resurgent Christianity emerging from the most populous land on the planet.
Wednesday, August 08, 2007
Bleak House
During the week we have been re-watching Bleak House on DVD. This has been one of best 'period' adaptations ever done by the BBC. From Gillian Anderson's Lady Dedlock to Phil Davis's Smallweed the acting has been wonderful. Charles Dance's Tulkinghorn was evil personified.
One of the problems with Victorian novels is that the heroes and especially the heroines are too good to be true, so I look for interesting character flaws. John Jarndyce was a kind and tolerant man, but his desire for Esther and his proposal of marriage after she was scarred by smallpox reveal his motives to be anything but pure. And why did he encourage Skimpole? Young Ada'a loyalty to Rick may seem commendable, but by capitulating to his will, she encouraged his slavish pursuit of the case in Chancery and hence his ultimate demise. Esther seems like an angel, but could she not have done more to encourage Woodcourt instead of allowing him to depart as a ship's surgeon. She also put herself in an invidious position by declaring she would have no secrets from Ada, but then having not one (her parentage) but another (her engagement). Even the saintly Miss Flite had the nasty habit of locking up song birds in cages.
What I particularly liked about the production was spotting well-known actors in minor parts. Ann Reid is of course Valerie Barlow from Coronation Street. Timothy West (married to Prunella Scales from Fawlty Towers and father of Sam West) is a famous Shakespearean actor and made a great Sir Leicester Dedlock. Nathanial Parker (Horace Skimpole) is Inspector Linley. Sheila Hancock (Mrs Guppy) was Mrs John Thaw). Joanna David (Mrs Badger) is Edward Fox's partner (Day of the Jackal). Richard Griffiths (Dr Badger) is better known as the star of the History Boys. Burn Gorman (Guppy) is now starring in the Dr Who spin-off, Torchwood. Pauline Collins (Miss Flite)started life as Sarah, the maid, in Upstairs Downstairs. The judge was played by the late Ian Richardson who was in Tinker, Tailor, Soldier, Spy and the Michael Dobbs' Francis Urquhart series. Johnny Vegas (Krook) is a well-known comedian and Alistair McGowan (Kenge) a well known impressionist. Even Joe the road sweeper was played by Harry Eden, who was the artful Dodger in Polanski's Oliver Twist. Alun Armstrong (Inspector Bucket) is currently an ex-cop in New Tricks (see it if you haven't found it yet). Warren Clarke (Boythorne) is, of course, Dalziel (from Dalziel and Pascoe). Finally, the footman, Mercury, was played by Richard Cant who is the son of Brian Cant, my all-time favorite presenter from children's television. (And doesn't he look like him!)
One of the problems with Victorian novels is that the heroes and especially the heroines are too good to be true, so I look for interesting character flaws. John Jarndyce was a kind and tolerant man, but his desire for Esther and his proposal of marriage after she was scarred by smallpox reveal his motives to be anything but pure. And why did he encourage Skimpole? Young Ada'a loyalty to Rick may seem commendable, but by capitulating to his will, she encouraged his slavish pursuit of the case in Chancery and hence his ultimate demise. Esther seems like an angel, but could she not have done more to encourage Woodcourt instead of allowing him to depart as a ship's surgeon. She also put herself in an invidious position by declaring she would have no secrets from Ada, but then having not one (her parentage) but another (her engagement). Even the saintly Miss Flite had the nasty habit of locking up song birds in cages.
What I particularly liked about the production was spotting well-known actors in minor parts. Ann Reid is of course Valerie Barlow from Coronation Street. Timothy West (married to Prunella Scales from Fawlty Towers and father of Sam West) is a famous Shakespearean actor and made a great Sir Leicester Dedlock. Nathanial Parker (Horace Skimpole) is Inspector Linley. Sheila Hancock (Mrs Guppy) was Mrs John Thaw). Joanna David (Mrs Badger) is Edward Fox's partner (Day of the Jackal). Richard Griffiths (Dr Badger) is better known as the star of the History Boys. Burn Gorman (Guppy) is now starring in the Dr Who spin-off, Torchwood. Pauline Collins (Miss Flite)started life as Sarah, the maid, in Upstairs Downstairs. The judge was played by the late Ian Richardson who was in Tinker, Tailor, Soldier, Spy and the Michael Dobbs' Francis Urquhart series. Johnny Vegas (Krook) is a well-known comedian and Alistair McGowan (Kenge) a well known impressionist. Even Joe the road sweeper was played by Harry Eden, who was the artful Dodger in Polanski's Oliver Twist. Alun Armstrong (Inspector Bucket) is currently an ex-cop in New Tricks (see it if you haven't found it yet). Warren Clarke (Boythorne) is, of course, Dalziel (from Dalziel and Pascoe). Finally, the footman, Mercury, was played by Richard Cant who is the son of Brian Cant, my all-time favorite presenter from children's television. (And doesn't he look like him!)
Sunday, August 05, 2007
Broadcast News
The 1987 James L Brookes movie is a delightful insight into how the media work. On one level it is a romantic comedy with Albert Brookes, the bright but unprepossessing reporter in love with effective and bright, Holly Hunter who falls for handsome but stupid newsreader William Hurt. The exposure of Hurt as a phony is what attracted me. Hurt has just received accolades for a report on some sob story (I forget what, it doesn't really matter). In the report there is a cutaway to Hurt who sheds a tear. Brookes suddenly realises that there had only been one camera at the shoot. The tear could not have been a reaction to the story, but was added artificially in the 'noddies' afterwards. A drop of gelatine melts down the cheek.
The story came back to me with the revelation that a TV documentary to be shown this week concerning the death of a man with dementia, would not, as advertised, show the final moments of the patient, but the edit would make it appear that it had done so. The patient's brother revealed on a blog that he had died several days after the cameras had left.
It has been a bad time for broadcasters. One of the money making schemes adopted by the television companies has been to invite viewers to take part in elementary quizzes, and phone in the answer on premium phone lines. Since the questions were so easy, they were simply partaking in a lottery. However, they continues to accept calls long after the winner had been chosen. In some cases there was no lottery at all, but members of the program staff posed as winners. In other words the programs were frauds.
As the studio bosses institute a root and branch investigation into what has been going on, other instances of deception come to the surface. We are drawn to the conclusion that broadcasters cannot be trusted. Documentary makers are particularly blameworthy. Their programs pose as fact but are nothing of the sort. They start with an agenda and then fake the evidence to support their case.
Give me fiction any time. It doesn't pretend to be fact.
The story came back to me with the revelation that a TV documentary to be shown this week concerning the death of a man with dementia, would not, as advertised, show the final moments of the patient, but the edit would make it appear that it had done so. The patient's brother revealed on a blog that he had died several days after the cameras had left.
It has been a bad time for broadcasters. One of the money making schemes adopted by the television companies has been to invite viewers to take part in elementary quizzes, and phone in the answer on premium phone lines. Since the questions were so easy, they were simply partaking in a lottery. However, they continues to accept calls long after the winner had been chosen. In some cases there was no lottery at all, but members of the program staff posed as winners. In other words the programs were frauds.
As the studio bosses institute a root and branch investigation into what has been going on, other instances of deception come to the surface. We are drawn to the conclusion that broadcasters cannot be trusted. Documentary makers are particularly blameworthy. Their programs pose as fact but are nothing of the sort. They start with an agenda and then fake the evidence to support their case.
Give me fiction any time. It doesn't pretend to be fact.
Foot and Mouth
Foot and Mouth again. It looks as though this outbreak has come from a breakdown in biosecurity at the Animal Research facility at Pirbright. Until a couple of years ago my brother worked there as a scientist. Of course, he says that the place has gone to pot since he retired. Whether this is true it sounds like something out of a science fiction story. On the same Pirbright site is a commercial vaccine producer. As the investigation proceeds it will be interesting to see whether the public or private sector has the better biosecurity.
Thursday, August 02, 2007
Alternative Medicine
Lines on Homeopathy.
Stir the mixture well
Lest it should prove inferior,
Then put just half a drop
In the whole of Lake Superior.
Every other day
Take one small drop in water,
You'll be feeling better soon
At the very least you oughter.
Bishop William Croswell Doane (1832–1913), first Episcopal bishop of Albany (NY).
Several correspondents have asked me to endorse their point of view that various 'alternative' or 'complementary' treatments are effective in CLL. I have already endorsed the clinical trial of green tea extract that is taking place in the Mayo Clinic, after I accepted for publication 4 anecdotes about its use in Leukemia Research.
The real problem with alternative medicine is that once any treatment is shown beyond doubt to be effective, it ceases to be 'alternative' and becomes just like any other part of medical knowledge. That means that 'alternative medicine' must consist entirely of unproven treatments.
Nevertheless, many patients are sure that they feel better after alternative treatments, and who are we to deny it? There are many such anecdotes, but the plural of anecdote is not data. How can alternative treatments be fairly tested?
It is believed that the effectiveness of many alternative treatments owes much to the placebo effect. In at least some people the placebo effect is quite real. It may be a genuine physical response, though one that does not depend in any activity of the drug, or other treatment. If placebo effects are real, it would be wrong to deprive patients of them, especially if there is nothing more effective available. For example, if terminal cancer patients say they feel better after having their feet tickled by a 'reflexologist', why should they not have that small pleasure? It follows, therefore, that it is our duty to maximise the placebo effect. Although there is no definite evidence that this is so, it seams reasonable to enhance the placebo effect by close attention from the therapist, kind words, soft lights and relaxing music, 'scientific' machines with flashing lights, pretty nurses and any other accoutrement that can be imagined. (Some might call it impressive mumbo-jumbo.)
Herein lies the dilemma: The whole trend in medicine has been to be more open with the patient and to tell them the truth. To maximise the placebo effect, it is necessary to lie to the patient as much as possible. Nothing is less likely to convince a patient of the benefit of a treatment than a forthright statement that clinical trials have shown that this treatment shows no benefit as compared to placebo. A recent comparison of acupuncture demonstrated that sticking needles into the skin does have a beneficial physiological effect, but it didn't actually matter where the needles were stuck - demonstrating that all that mumbo-jumbo about meridians and Qi force is irrelevant.
Although several British Universities (now called universities, though until recently they were colleges of further education) do offer courses in 'alternative' medicine, one wonders what they teach. Surely a course by the Magic Circle on prestidigitation or by an Advertising Agency on 'misleading the public' would be more useful.
I am indebted to Professor David Colquhoun for the information in this article. I also found this quote there which is a warning to all those who are in danger of being taken in by alternative treatments: "It takes a holistic approach to a client's financial affairs, seeking to rebalance them in the therapist's favour."
Stir the mixture well
Lest it should prove inferior,
Then put just half a drop
In the whole of Lake Superior.
Every other day
Take one small drop in water,
You'll be feeling better soon
At the very least you oughter.
Bishop William Croswell Doane (1832–1913), first Episcopal bishop of Albany (NY).
Several correspondents have asked me to endorse their point of view that various 'alternative' or 'complementary' treatments are effective in CLL. I have already endorsed the clinical trial of green tea extract that is taking place in the Mayo Clinic, after I accepted for publication 4 anecdotes about its use in Leukemia Research.
The real problem with alternative medicine is that once any treatment is shown beyond doubt to be effective, it ceases to be 'alternative' and becomes just like any other part of medical knowledge. That means that 'alternative medicine' must consist entirely of unproven treatments.
Nevertheless, many patients are sure that they feel better after alternative treatments, and who are we to deny it? There are many such anecdotes, but the plural of anecdote is not data. How can alternative treatments be fairly tested?
It is believed that the effectiveness of many alternative treatments owes much to the placebo effect. In at least some people the placebo effect is quite real. It may be a genuine physical response, though one that does not depend in any activity of the drug, or other treatment. If placebo effects are real, it would be wrong to deprive patients of them, especially if there is nothing more effective available. For example, if terminal cancer patients say they feel better after having their feet tickled by a 'reflexologist', why should they not have that small pleasure? It follows, therefore, that it is our duty to maximise the placebo effect. Although there is no definite evidence that this is so, it seams reasonable to enhance the placebo effect by close attention from the therapist, kind words, soft lights and relaxing music, 'scientific' machines with flashing lights, pretty nurses and any other accoutrement that can be imagined. (Some might call it impressive mumbo-jumbo.)
Herein lies the dilemma: The whole trend in medicine has been to be more open with the patient and to tell them the truth. To maximise the placebo effect, it is necessary to lie to the patient as much as possible. Nothing is less likely to convince a patient of the benefit of a treatment than a forthright statement that clinical trials have shown that this treatment shows no benefit as compared to placebo. A recent comparison of acupuncture demonstrated that sticking needles into the skin does have a beneficial physiological effect, but it didn't actually matter where the needles were stuck - demonstrating that all that mumbo-jumbo about meridians and Qi force is irrelevant.
Although several British Universities (now called universities, though until recently they were colleges of further education) do offer courses in 'alternative' medicine, one wonders what they teach. Surely a course by the Magic Circle on prestidigitation or by an Advertising Agency on 'misleading the public' would be more useful.
I am indebted to Professor David Colquhoun for the information in this article. I also found this quote there which is a warning to all those who are in danger of being taken in by alternative treatments: "It takes a holistic approach to a client's financial affairs, seeking to rebalance them in the therapist's favour."
Wednesday, August 01, 2007
Hope at last from Iraq
An op-ed piece in the New York Times by Michael O’Hanlon and Kenneth Pollack, two Democrats who supported the war but have been strong critics of the peace, shows the first evidence that the Iraq war might be won. Those who read Michael Yon's missives from the front have suspected that General Petraeus was leading a successful surge, but the significance of this report is its source. In the New York Times for goodness sake!
Here is the most important thing Americans need to understand: We are finally getting somewhere in Iraq, at least in military terms. As two analysts who have harshly criticized the Bush administration’s miserable handling of Iraq, we were surprised by the gains we saw and the potential to produce not necessarily “victory” but a sustainable stability that both we and the Iraqis could live with.
Today, morale is high. The soldiers and marines told us they feel that they now have a superb commander in Gen. David Petraeus; they are confident in his strategy, they see real results, and they feel now they have the numbers needed to make a real difference.
... for now, things look much better than before. American advisers told us that many of the corrupt and sectarian Iraqi commanders who once infested the force have been removed. The American high command assesses that more than three-quarters of the Iraqi Army battalion commanders in Baghdad are now reliable partners (at least for as long as American forces remain in Iraq).
A major factor in the sudden change in American fortunes has been the outpouring of popular animus against Al Qaeda and other Salafist groups, as well as (to a lesser extent) against Moktada al-Sadr’s Mahdi Army.
These groups have tried to impose Shariah law, brutalized average Iraqis to keep them in line, killed important local leaders and seized young women to marry off to their loyalists. The result has been that in the last six months Iraqis have begun to turn on the extremists and turn to the Americans for security and help.
It is very easy to criticise what has been happening in Iraq for the past 4 years. Having taken the decision to remove Saddam, which I supported, the ineptitude of the occupation has been almost unbelievable. In General Petraeus a proper professional is in control and things are looking up. Whether the harm that has been done to Western interests can be retrieved remains to be seen.
Here is the most important thing Americans need to understand: We are finally getting somewhere in Iraq, at least in military terms. As two analysts who have harshly criticized the Bush administration’s miserable handling of Iraq, we were surprised by the gains we saw and the potential to produce not necessarily “victory” but a sustainable stability that both we and the Iraqis could live with.
Today, morale is high. The soldiers and marines told us they feel that they now have a superb commander in Gen. David Petraeus; they are confident in his strategy, they see real results, and they feel now they have the numbers needed to make a real difference.
... for now, things look much better than before. American advisers told us that many of the corrupt and sectarian Iraqi commanders who once infested the force have been removed. The American high command assesses that more than three-quarters of the Iraqi Army battalion commanders in Baghdad are now reliable partners (at least for as long as American forces remain in Iraq).
A major factor in the sudden change in American fortunes has been the outpouring of popular animus against Al Qaeda and other Salafist groups, as well as (to a lesser extent) against Moktada al-Sadr’s Mahdi Army.
These groups have tried to impose Shariah law, brutalized average Iraqis to keep them in line, killed important local leaders and seized young women to marry off to their loyalists. The result has been that in the last six months Iraqis have begun to turn on the extremists and turn to the Americans for security and help.
It is very easy to criticise what has been happening in Iraq for the past 4 years. Having taken the decision to remove Saddam, which I supported, the ineptitude of the occupation has been almost unbelievable. In General Petraeus a proper professional is in control and things are looking up. Whether the harm that has been done to Western interests can be retrieved remains to be seen.