Saturday, August 30, 2008

Saddam/Henry VIII

We have been watching two television series with strikingly similar themes. One is 'The Tudors' and the other 'House of Saddam'. The former takes great liberties with history and has far too many bedroom scenes for my taste; the latter has scenes of gruesome violence that are difficult to watch. What they have in common is a ruthlessness in pursuit of power. Because they are deeply rooted in a sense of family, critics have drawn attention to their resemblance to Mafia movies like 'Godfather' and 'The Sopranos' and this is apt. Another resemblance is the importance of religion to the central character.

Both series have good acting and high production values, but need to be watched carefully because these devices easily take-in the viewer. The writers and directors are not simply telling a story; they are putting over an opinion. Both Henry and Saddam were undeniable monsters, but their personal motives are just being guessed at. Henry, in particular, is a complex character. Athlete, musician, intellectual, theologian; Henry bestrode his world in a way that seems improbable. England was a small country on the periphery of the then world that had just come through a debilitating civil war. It should have been no match for Spain, France or the Holy Roman Empire. Both Wolsey and Sir Thomas More were smart cookies, yet they were no match for Henry. I don't think this Henry shows us hoe accomplished all that he did.

Saddam's faults are all to obvious. Ruthlessness and Hubris will get you so far, but they aren't going to work against shock and awe; you need a bit of guile as well.

Thursday, August 28, 2008

A good look at FCR

Although fludarabine, cyclophosphamide and rituximab (FCR) has long been standard treatment for CLL in America, there has hitherto been no evidence of its superiority to other treatments. While a large number of patients have been treated in an extended phase II trial at the MD Anderson Cancer Center in Houston, and the results of that study have been impressive, no randomized controlled trial data have been available. I am sure that this will be remedied at ASH this year since we know that the German trial comparing first-line FCR with FC has been completed, that at the first interim analysis it had met its primary endpoint, which was a significantly longer progression-free survival for one of the arms. It is possible, also, that the results of the REACH trial, an international trial comparing the same drug combinations as second or subsequent line treatment will also be announced, although this did not reach its primary endpoint at its first interim analysis, it is believed that it did so shortly afterwards at its final analysis.

I predict (with no inside information) that both will show that FCR gives a higher rate of complete remissions and longer first remissions than FC, though as yet there will be no difference in overall survival.

Which all makes the paper from Houston on the long term follow-up of patients treated with FCR all the more significant. It is published this week in Blood 2008; 112:975-980.

The headline results show a 95% response rate with 72% complete remissions. Even better they claim that the bone marrow was free of minimal residual disease in 82% by flow and 42% by PCR. These good responses are backed up long remissions. The actuarial overall survival at 6 years was 77% and the actuarial failure-free survival at 6 years was 51%. Among patients who achieved a partial response or better the median time to progression was 80 months with a projected progression free survival at 6 years of 60%.

These figures are so good that before we start jumping for joy, we need to ask whether there was anything unusual about the patients treated. Between 1999 and 2003 they treated 300 previously untreated patients. These were patients with symptomatic or progressive disease as defined by the 1996 NCI guidelines. 36% were Rai stage III or IV (Binet stage C), 61% were Rai stage I or II and 4% stage 0. Rai staging does not give quite the same measure of tumour bulk as Binet staging, so it is impossible to say how many of those stage I or II patients would have been Binet A or B. A patient who is stage 0 could have retroperitoneal glands, or symptoms or a rapid lymphocyte doubling time.

NCI guidelines are open to a degree of interpretation when such factors as fatigue, night sweats and lymphocyte doubling time are considered. It should also be remembered that the American patient population is very well informed of every new development and often has an eagerness to try anything new. Houston has a reputation for being go-ahead and innovative and certainly attracts such patients.

The median age of this group was 57 years and only 14% of patients were over 70. Although far more patients with CLL are over-70 (perhaps as many as two-thirds) many of these older patients die on other conditions while still on the watch and wait programme, so one would expect treated patients to be younger than the CLL population as a whole. In order to make an assessment of this, I looked at our own series in Bournemouth. For us the median age at first treatment was 64 (range 21-97) and 36% of those treated were aged 70 or over. We can conclude therefore that the Houston patients were rather younger than the patients that most people treat.

This was a group who were selected before most prognostic markers became available so there will be no data on IGHV genes, ZAP-70 or FISH. Conventional karyotyping was performed on 222/300 but since only 30% had clonal abnormalities, we can be sure therefore that the karyotyping was suboptimal. Nevertheless, 4% had abnormalities involving chromosome 17. Only 21% had a CD38 >30% and only 43% had a 2-microglobulin at more than twice the upper limit of normal.

I hope that in the near future we will be able to get access to the LRF CLL4 trial to compare the number of patients who had high Beta-2M levels, but I do not have that information on our own series.

Again I was able to compare this group with our own, in terms of CD38. In our series 64% had a CD38 >30%. From this is seems likely that the Houston group of patients had a less severe type of CLL than most people would find themselves treating. In the Houston series factors associated with a longer survival were age less than 70; Beta-2M levels less than twice normal; white counts less than 150; and the absence of chromosome 17 abnormalities.

How about the very impressive figures for absence of minimal residual disease? The flow method just looked at CD19/CD5 positive cells, which is very insensitive, picking up only 1 in 100; this compares with four colour flow, which has a sensitivity of 1 in 10,000 or even 1 in 50,000. Even the PCR method used here seems a bit insensitive, claiming a detection of 1 in 10,000 where others expect 1 in 100,000.

These results, therefore, come with a bit of a health warning. Others may not expect to obtain such encouraging results with FCR.

The good news is that they have looked carefully at other possible complications of FCR such as MDS and Richter’s syndrome. The actuarial risk of Richter’s syndrome was 2.5% at 6 years, little different to what has been seen historically. The risk of MDS was about the same. The major complication of FCR was prolonged cytopenia. Following completion of therapy 19% of patients had persistent cytopenia (neutrophils less than 1 or platelets less than 50) lasting more than 3 months. After recovery of counts recurrent late cytopenic episodes occurred in 28%, predominantly in the first year. These episodes did not presage the development of MDS in most cases. The risk of serious or opportunistic infection was 10% and 4% during the first and second years of remission respectively.

This paper is very helpful in letting us know what will happen when we start treating patients in the UK in large numbers with FCR. I anticipate that this might occur in late 2009 or early 2010.

Tuesday, August 26, 2008


We have been dog-sitting out daughter's rough collie, Jemimah (this is not she). Rough collies are very friendly dogs but wear a very heavy fur coat which may well be suitable for herding sheep in northern Scotland, but are distinctly de trop for sunny Bournemouth. Not that we have had much sunshine this summer, but even so it is warmish compared to Scotland.

She has settled down well in our family. At 9-30 am she is ready for her hour's walk on the golf course, and even before she has entered the course she has found a stick to be thrown for her to chase. The golf course is a public park so it is a favorite place for dogs to exercise (a euphemism for 'exercise their bowels') and the park has strict rules about cleaning up messes. It gives the term 'doggy-bag' a whole new meaning.

The other part of her routine is grooming. With such a long haired coat, tangles and tuggs are a common problem. These take a lot of brushing out and while she enjoys being brushed on her back and neck, anywhere else is likely to invoke a nip. So it is a two-handed job: one strokes her back and neck while the other attacks the tangles on her legs and tummy. Apparently they have sensitive skins so the combing out of tangles has to be very gentle.

When she has been groomed she is a very beautiful creature. She is a mixture of brown black and white with a shiny coat and an intelligent face. She is well aware of her beauty, indeed she is something of a princess. Over the golf course she is surrounded by other dogs who clearly appreciate her attractiveness, but she shows no interest in them. Indeed, I think that like Lorenz's ducks she thinks herself human and not canine at all.

I'm told that she sees herself as a man's dog, but that does not seem to be the state here. Her place in the household is as one of the privileged females, which she shows by lying at my wife's feet. She knows where her food comes from. As for the rest of the household, it seems to consist of a stick throwing machine.

Monday, August 25, 2008

In pursuit of excellence

One of the problems of allowing the Government to run anything is that they allow political biases to interfere with the smooth running of the organization. Take a look at these shocking statistics for the film and TV industries:

64% of production / script development are female
85% of camera technicians are male
85% of hair dressing / make-up are female
96% of sound / electrical technicians are male
80% of costume workers are female
97% of construction workers are male

How about these shocking statistics concerning race:
Animation is immensely popular among Japanese.
Black culture is strongly emphasized in the music industry.
Indian men as medical practitioners in the UK are proportionally ten times higher in comparison with white men.
Taxi drivers are over-represented among Asian men in the UK.
Waters in Chinese Restaurants are overwhelmingly ethnically Chinese.

As we have seen in the Olympics, sprinters are mostly black, divers are mostly yellow and swimmers are mostly white.

I post these facts because of a remarkable complaint by Rob Ager posted on his website

He applied for a training post at the BBC and was invited for an interview, only to be told when he showed up that there were no posts available. It turned out that the advertised posts were only for people from ethnic minorities. Strictly speaking positive discrimination is illegal in the UK under anti-discrimination law, but there are loopholes:

Targeting job training at people of particular racial groups, or either gender, who have been under-represented in certain occupations or grades during the previous 12 months, or encouraging them to apply for such work.
Providing facilities to meet any specific educational, training or welfare needs identified for a specific racial group.
Measures to provide training and special encouragement for returners to the labour market after a period of time discharging domestic or family responsibilities.
Special encouragement such as targeted advertising and recruitment literature, reserving places for one gender on training courses or providing taster courses in non-traditional areas.

The majority of the UK population is white (92%). The remaining 8% (4.6 million people) belong to other ethnic groups. What is striking is how the total UK picture differs from London. 7% of the national workforce is from a non-white background compared to 24% in London. However, in the film and TV industries, around 70% all employees work in London, but only 5% of the workers in this industry come from 'ethnic' backgrounds. Instead of targeting the 7% national figure, the industry seems to be trying to make the 30% London figure for ethnic employees. However, the film and TV industry is a national industry that just happens to be based in London. It does not have to rely on locals for its employees, any more than the Civil Service or the Stock Exchange do. All that racial discrimination does is deny opportunities to the whole of the population.

It is perfectly correct for there to be regulations that do not permit unfairness to operate in the market place, but we must be careful that we don't have regulations that prevent tall people from playing basket ball. I seem to remember a science fiction novel in which muscular people were forced to carry an 80 pound pack around, clear sighted people were condemned to wearing distorting spectacles and brainy people made to listen to disorientating music while they attempted to think - all in the cause of equality. Prizes were given for being average. If anyone remembers the novel let me know; I'd like to read it again.

BBC caught out again.

From this morning's Independent: "The BBC was forced to apologise yesterday after admitting that its flagship news bulletin had inadvertently misled viewers (my italics) over the withdrawal of the Chinese athlete Liu Xiang from the Olympics."

"The bulletins showed Liu withdrawing from the race - he had an Achilles tendon problem - then appearing to kick a mat in frustration. But the footage of the athlete in the warm-up zone was filmed before he had entered the Bird's Nest stadium."

I italicized the 'inadvertently misled viewers' because this is a repeat of the error that led to Peter Fincham losing his job as BBC1 controller earlier in the year. On that occasion they showed a video clip of the Queen apparently flouncing out of a photographic appointment because of the photographer's apparent impertinence. Careful editing had created a story where there was no story.

It is clear to me that the Liu Xiang was made to seem unsporting and a bad loser by piece of inventive editing deliberately to enhance a story. No wonder the BBC was not keen to publicize the attempts by Hezbollah to enhance their stories with photoshop editing last year. They clearly feel vulnerable on these techniques.

It is a sad day when the BBC's reputation for fearlessly telling the truth has been so besmirched of late by cheap tricks by post-modernist twerps who have no regard for right and wrong.

Saturday, August 23, 2008


The well known and popular leader of Hamas is Sheikh Hassan Yousef. The Christian press is full of the fact that his son Masab Yousef has converted to Christianity and has moved to California. Read his testimony on this link and listen to the Fox News interview here.

These stories do the rounds, but attempts by his family to re-convert him suggest that it is true.

I hope that this is a true conversion, although I would be more convinced were he living in Malawi than in California.

Friday, August 22, 2008


There is absolutely no truth in the rumour that most Americans think that the Georgia that the Russians have invaded is the one sandwiched between Florida and South Carolina. This is not why John McCain is suddenly ahead of Obama in the opinion polls. However, a real life cold-war confrontation has made many Americans plump for a Viet-nam veteran rather than the first-term senator from Illinois. If he chose Hillary as his running-mate would he fare better? Certainly the blue-collar vote does not seem enthusiastic about the eloquent egghead.

Wednesday, August 20, 2008

The Good German

Last night I watched Steven Soderbergh's The Good German on television. This is a remarkable film for several reasons. It is the only film that Tobey Maguire made during his manifestation as Spiderman. It is one of those serious collaborations between Soderbergh and George Clooney that they fund by making the silly Ocean's 37 series. It features a fantastic performance by Cate Blanchett and was nominated for an Oscar for its musical score. Mostly though, it is remarkable for Soderbergh's attempt to make a 1940's film noir using 1940's techniques: black and white film stock, boom microphones, studio and Hollywood backlots with projected backdrops, incandescent lighting and period lenses on the cameras.

The film is set in 1945 at the time of the Potsdam conference where Stalin, Truman and Churchill carved up Europe between them. The deal seemed to be you get Poland and we get Von Braun. The character of Bettmann is based on Arthur Rudolf who really was the major engineer of the V2 program and became a major production engineer at NASA, but lost his US citizenship because of suspicion that he was involved in the use of slave labor to manufacture the V2. The title character was Emil Brandt, secretary to Bettmann who wanted to spill the beans on Bettmann as a war criminal. Cate Blanchett plays his wife who is willing to do anything to get out of Berlin and Clooney plays her ex-boss and lover, a newspaperman/war correspondent who is posted back to Berlin to cover Potsdam. Unknown to him the OSS (CIA) is using him to get to Mrs Brandt to get to Emil. Tobey Maguire plays a nasty little pimp and black marketeer whose front is to be Clooney's driver.

Given the mix, the plot is quite predictable (after all we know up-front that America got a rocket to the moon). Clooney is very laid back, efficient and solid, but would he be a star if he wasn't so handsome? Maguire has a lot to learn and could do so by watching Banchett who must be one of the best screen actors on the planet. Soderbergh handicaps himself with all these gimmicks, but doesn't achieve another Casablanca, despite the imitative poster and the Dakota in the last scene.

I suppose it is worth a 6/10, perhaps 6.5. Worth seeing if you don't have to pay.

Tuesday, August 19, 2008

Praying to an Omniscient God - Psalm 139

This is the text of my sermon for Sunday morning.

Last Sunday evening we considered the difficulties we encounter in prayer and we thought about the majesty of God. How could an almighty God be concerned about the puny goings-on, on planet Earth? And we learned that here alone in the Universe was God disobeyed and that here alone He sent his son to redeem us so that we might be adopted as sons and become co-heirs with Jesus Christ. And just as Jesus prayed to his father, so should we.

This morning we are going to consider the problem of God’s omniscience; what is the point of praying to a God who knows everything?

Psalm 139 is a prayer that glories in God's omniscience. "You have searched me and known me," prays David. It is fashionable these days to sing songs about God's emotions, but one emotion God cannot feel is surprise. He knows the end from the beginning. When I was young and went to the cinema, the performances continued one after another without clearing the auditorium at every showing. You could, on a cold winter's afternoon buy a ticket for one and ninepence and sit in the cinema from 2 in the afternoon until 10 at night, watching several showings. More often than not I would arrive half way through the second feature and watch until the end, then see the news and a cartoon, then the first feature and then the second feature again until we reached the part where we had come in. "Let's go," we'd say, "we know how it ends." (My young brother on being taken to his first football match and realising that it had already started asked my father, "Can we stay on and see the bit we missed?")

It was Karl Marx who said that history repeats itself first as tragedy and then as farce, but God's omniscience doesn't come from having seen it all before. He sees the beginning and end simultaneously as if He were standing outside of time. He even knows what would have happened had we made a different decision. In I Sam Ch 23 there is an interesting story about David when he was battling against the Philistines and being hunted by King Saul. He had rescued the town of Keilah and was holed up there. He asks God, "Will Saul pursue me to Keilah and will the town surrender me to him?" When both answers came back in the affirmative, he left the town and Saul, on hearing of it, gave up the chase. God not only knows what happened, is happening and will happen, but also what would have happened. His omniscience is complete.

David Pawson tells a story from when he was an Air Force Chaplain based in the Middle East. His Arab servant was discovered hidden in a wardrobe scoffing a cream cake during Ramadan; he thought God couldn't see him if he hid. Verse 11 of our psalm says, “If I say, ‘Surely the darkness will hide me and the light become night around me,’ even the darkness will not be dark to you; the night will shine like the day, for darkness is as light for you. In fact, God could not only see him in the dark, he not only knew his hiding place, he knew the very moment when the idea hit him that he could secretly satisfy his hunger.

Are you worried about the government eavesdropping on your e-mails? About CCTV cameras? How about the DNA database that can trace you wherever you've been? The truth for a Christian is that there is nothing that he does that is unobserved. Not a single action. He knows when we sit and when we rise; when we go out and when we lie down. We can’t escape from him. Have you been following the case of the disappearing canoeist? He thought he was safe when he settled on the far side of the sea. He reckoned without the internet. All the time the canoeist was canoodling with his wife in Panama. But God didn’t need the internet to find him. He knew where he was there from the moment the thought formed itself in his mind that he would defraud the insurance company.

How about the case of Clark Rockefeller, who turns out nor to have been a Rockefeller at all. He is estranged from his wife and when his young daughter came to visit him he did a runner, prompting a manhunt. As the American authorities sought him, it turned out that Clark Rockefeller did not exist. It was just one of his many aliases. Apparently, he is a German, Christian Karl Gerhartsreiter, who moved to America in 1978 and is wanted for the murder of Jonathan and Linda Sohus in California in 1985. He may have thought he was under cover for all these years – but God, the all knowing has known about him; exactly who he was, where he was and what he was doing.

We have no secrets from God. Not a single word spoken. Not a single thought. "You perceive my thoughts from afar," writes David, "before a word is on my tongue, you know it completely." It is clear, then, that we do not need to pray aloud. Our unspoken thought may be a prayer.

But some may ask what is the point of praying? The Psalmist praises God for His omniscience: V19 “How precious to me are your thoughts, O God! How vast is the sum of them!” but can he change God’s mind? Rather than plead with God, he complains, “If only you would slay the wicked.”

If God knows everything about us, if he knows our needs, our worries and our desires, if, more importantly, he knows what's best for us, why pray? Are we not just making fools of ourselves, asking for what it is silly to ask for, exposing ourselves as idiots in the grand scheme of things?

Perhaps our prayers should just be praise? As for the future, perhaps we should just be fatalistic? God knows best; we must simply accept what comes our way.

As it happens we are given an example of a prayer that seems to change God’s mind.

Do you remember Abraham’s strange encounter with the LORD in chapter 18 of Genesis? These three visitors came to see him near the great trees of Mamre and after he had given them dinner they told him that his old (or should I say ancient) wife Sarah was going to bear him a son the following year. As they were leaving, the LORD said, "Shall I hide from Abraham what I am about to do?" and reveals to Abraham that He was about to destroy Sodom where is his nephew Lot lived with his family. Remember how Abraham argued that God would surely not destroy the righteous with the wicked. What if there are fifty righteous men in the town? Far be it from You! Shall not the Judge of all the earth do right?

God seems to back down as Abraham wheedles concession after concession out of Him and beats Him down like a second hand car dealer to just ten righteous people. I reckon that Abraham was calculating that Lot and his wife and two daughters made four. It was likely that the girls had boy-friends by now, so if you counted them and their respective parents there were likely to be ten.

In the end Sodom turned out to be worse than anyone suspected. Lot and his two daughters were saved, but no-one else. Even Lot's wife hankered too much after the sins of Sodom. So it turned out that God's original plan was accomplished. Sodom was destroyed. God did exactly what he said He would do. So what was all that negotiation about? It seems to me that it was all about Abraham approximating himself to God's will.

Later on Abraham would be more severely tested. At stake would not be the life of his nephew, but the life of his son - and not just any son; the son of promise. Out of Isaac would come many nations; yet Abraham trusted God. The letter to the Hebrews tells us that Abraham reasoned that God could raise the dead - so he had no compunction in offering his son as a sacrifice.

What transformed Abraham from a man who wanted to stay God's hand from destroying a wicked city to save his foolish nephew to a man who was willing to trust God to do the right thing even if it amounted to sacrificing his own son? It can only be a lifetime of prayer. A lifetime of listening to God and learning about His wisdom and justice.

Is this what prayer is meant to do for us?

Last Sunday evening we came to the conclusion that we should pray because we follow the example of our co-heir, the Lord Jesus Christ. If you read the prayers of Jesus, it is clear that he had an intimate, conversational relationship with his father. In John 11:42 at the raising of Lazarus, Jesus says, "Thank you that you have heard me. I knew that you always hear me, but I said this for the benefit of the people standing here, that they may believe that you sent me."

We find it harder to be certain that God always hears us. It’s very hard to carry on an intimate relationship with someone you can’t see or hear or feel.

Are you troubled by cold calling? Every day we get a call. Someone with a strong Indian accent wants to help us with our debts (we don't have any), or a recording tells us how much money we have locked up in our home, or someone offers us free double glazing if we allow our house to become a show-case for them to demonstrate their wares, or a man with a Birmingham accent thinks we are not getting the best return on our investments. Yesterday, a rather nice lady with a Yorkshire accent asked me, "Do you have trouble getting out of the bath?"

How do you deal with them? Some people just put the phone down on them. Others get abusive. One lady I know replies, "No, I don't have any money worries, but do you know where you're going when you die?" and then continues, "Let me tell you about the Lord Jesus Christ..."

In the days when we called it 'junk' mail rather than 'spam' David Frost had a good idea. Inside most junk mail there is a prepaid reply envelope, that is only paid if it is posted. He suggested that we sent it back empty. That would deter them.

On the same principle, one fellow I know, just puts the phone on the table and lets them talk away. After all they're paying for the phone call. There's nothing to say you have to listen. I wonder how long it takes before they get tired at the other end of getting no response? If you are a fan of Fawlty Towers you will know all about telephone responses. Prunella Scales' brilliant portrayal of Sybil with her "Oohhh, I knoooooooow" and her braying laugh, which her husband compares to "someone machine-gunning a seal" sent the verbal signals to her friend Audrey that someone was listening.

When we pray we lack those verbal reassurances. Not only is God invisible to us, but he does not reply, "I know" down the telephone. There are times when we feel God is very close. But at other times, as Philip Yancy says, God's baffling tolerance of the world's atrocities and my unanswered prayers, make me feel that I am talking to the ceiling.

The first thing to realise is that my feelings about the matter are not a measure of God's presence. Like the sun, he is always there though clouds hide his face. Wherever we go, not just in beautiful gardens or exhilarating mountain tops, God is with us. Think of the most disgusting place: a filthy prison without sanitation where the inmates are tortured by the guards or a 'hospital' in Africa without sheets or blankets, without medicine, where people lie waiting to die with undressed wounds and untreated fevers. It sounds like Hell - a place defined by the absence of God.

But listen to what Jesus said, "I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me."
Then the righteous will answer him, "Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?'
"The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.' (Matt 25:34-40)

When we visit such places He is already there. He is in the sick and hungry, the tortured and the oppressed, the weak and the lonely.

As the psalmist writes, "Where can I go from your Spirit? Where can I flee from your presence? If I go up to the heavens, you are there; if I make my bed in the depths, you are there. If I rise on the wings of the dawn, if I settle on the far side of the sea, even there your hand will guide me, your right hand will hold me fast. If I say, "Surely the darkness will hide me and the light become night around me," even the darkness will not be dark to you; the night will shine like the day, for darkness is as light to you. (Psalm 139:7-12)

We pray because Jesus prayed. A simple enough answer. Christians follow Christ. The Bible records more than a dozen of Jesus' specific prayers as well as his teaching and parables on the subject. We can see that it was his practice to pray regularly and for long periods. Five times the Gospels mention his practice of praying in solitude. He prayed in the Garden, he prayed on the cross. He seldom prayed for himself. The request that this cup be taken from him is perhaps the only occasion and that was modulated by "not my will, but thine." He often prayed for others: for children brought by their mothers, for the people by the grave of Lazarus, for Simon Peter whom Satan sought to sift, for those who were crucifying him. At times of special importance he intensified his prayers: at his baptism, all night before choosing his disciples (was it Judas that gave him so much trouble or was it Peter?), on the Mount of Transfiguration, and especially before his death. His prayer could be exuberant as when the 70 returned from their mission. He prayed that his disciples would receive the Counsellor; he prayed in his great High Priestly prayer of John 17 for all of us believers who would come after him.

Did he get everything he prayed for? Do we? The answer is no, it doesn’t seem so, or at the best, not yet. When I said he prayed for us, what did he pray for? He prayed for unity. John 17:20-21 "My prayer is not for them alone (that is, the disciples), I pray also for those who will believe in me through their message, that all of them may be one, Father, just as you are in me and I am in you." At the last count there were 34,000 distinct denominations and sects. Is that an answered prayer?

I suggest that on that long night before he chose the twelve, he prayed for Judas. He certainly prayed for Peter, that his faith would not fail. We know that Peter's faith failed him three times before the cock crowed. The Bible tells us that Satan has asked to sift him like wheat. As for Judas, Luke tells us that 'Satan entered Judas'. We are in spiritual warfare. We face supernatural forces. Sometimes Satan wins the battle. We know that he is a beaten foe, but he won't lie down just yet. He means to take as many casualties with him as he can.

Like his ancestor Jacob before him Jesus wrestled in prayer. We must do the same. Prayer is hard work. Despite our wish to be spared Satan's attacks, God permits them. We cannot fathom that. Why was Satan permitted to smite that good man Job? Why didn't Jesus restrain Satan when Peter slunk into the courtyard and warmed his hands by the brazier? He was bravely there when others had fled. Why wasn't he protected? And Judas? Are we allowed to say poor Judas? He had been Jesus' friend and companion those three years on the road. Why would he not spare his friend from this harrowing? Why did he allow this evil possession?

We know now why. We know why Jesus died. It seemed a cockeyed plan at the time, but Jesus had to die. He had to be betrayed. He had to be denied. No rescue plan could be allowed to interrupt the proceedings. The just must die for the unjust. There was no other way. There was no other good enough. God knew what He was doing.

We may be perplexed at God. Why doesn't He answer my prayers? Why doesn't He do what I want? Prayer reconciles us to the will of God.

If He is going to do what he wants anyway, why should we pray? I don't know. I only know that in some mysterious way his plans are accomplished because we pray. How do I know? Because Jesus prayed and even though his prayers appeared not to be answered, God's will was accomplished and millions were saved.

The other night I watched an old war film. The captured flyers had spent a year in a prisoner of war camp somewhere in northern Germany. Under the cover of a vaulting horse they had tunneled out of the Stalag and with forged papers they had crossed the country by train to the nearest port. They were holed up in a small hotel while trying to contact Swedish seamen. When they went out they realized that they are being followed. They tried to give him the slip, but he was still there. How would you pray in these circumstances?

The authorities are looking for you. You have managed to keep below the radar. Every night you sleep in a different bed and some nights in no bed at all. You have many loyal friends who support you, but only a very few who know where you will lay your head tonight. Although your position seems precarious, in reality you have enormous strength. Your father has ready and prepared thousands of crack troops who could rescue you from danger at a moment’s notice. All it needs is one radio call. This isn’t World War II with a crackly wireless and long and ponderous flights from England; this is instant access with communications loud and clear. This is ‘Beam me up, Scottie’ instant transportation.

You hear a crowd gathering. In the dark you see torches. The light glints on the body armor. There is no doubt about it; they have come to arrest you. One of your so-called ‘loyal’ supporters has blabbed. Here’s the decision: do you make the call?

The problem is this. You have invested three years in this mission. You always knew it might cost you everything. If you pull out now it would mean abandoning not only your friends, but all those you had come to liberate. Not to make the call means torture and certain death; and not a pleasant death either. This is no quick bullet in the back of the head or lethal injection. This is death by torment and humiliation. It will leave your followers shocked and in despair. If you pulled out they might seem better off. They could go about their business much as before. Some of them would go back to fishing – they were quite good at it. Some might farm, some might trade, and others would take clerical jobs. They would certainly be able to make a living, but they would be living under a malign Ruler who had their distress close to his heart. He would certainly know that he had won a victory, and won it without even a fight.

Well, as I am sure you have realized, Jesus never made that call. It was one of those prayers that Jesus never prayed. When Satan desired to sift Peter like wheat, Jesus never prayed that Peter be declared off limits for the Devil. He never prayed that Peter would be so strong as to resist the evil one. He prayed that his faith would not fail. It seemed to fail, as Peter denied his Lord, but the sifting got rid of Peter’s undesirable characteristics: his arrogance, his bombast, his violence, his boasting. The man whose vain bluster claimed that if all deserted, he would stay steadfast; the man whose violent temper struck off the servant’s ear; the man who swore blind that he never knew him, became the writer of the letter that recommends to his followers that they “live in harmony with one another; be sympathetic, love as brothers, be compassionate and humble. Do not repay evil with evil or insult with insult, but with blessing.” (I Peter 3:8)

God’s answers to prayers may not be intelligible to us. The atheist scoffs, “If your god were all powerful and all loving as you claim, he would not allow the suffering that we see every night on the ten o’clock news. Either he is all loving but powerless or he is powerful but doesn’t care. Or more likely he is a figment of your imagination.”

What do we say to the child sexually abused by her father? What do we say to the young mother whose breast cancer has spread to her bones? What do we say to the children of missionaries who have been hacked down in one of the world’s trouble spots? What do we say to the mother whose daughter has killed herself? That God could intervene but he tolerates evil? That he recognizes the arbitrariness of suffering but has to put up in it? That he understands wicked and oppressive regimes, but has to stand by and do nothing?

What do we say when they ask for a miracle? Pray that my handicapped baby will walk. Pray that my wife won’t die of her brain tumor. Pray that my brutal and abusing husband will love me again as he used to.

I believe in miracles, but they are miracles. They are rare exceptions to God’s laws that mean that up is up and down is down and that water flows from up to down and 2+2=4. Miracles can’t be turned on like a tap. If prayer worked like magic you would not dare put one foot in front of another in case someone, somewhere had prayed that paving stone in front of your footstep disappears. No, God’s answers must be altogether more subtle.

Has God done nothing to alleviate the suffering of the world? He gave us his Word to tell us how to live. He sent us his Son to cancel our sin. He sent us his Spirit to live in our lives. The foulest oppression; He has experienced it. The deepest deprivation; He has known it. The greatest disappointment, the most murderous torture, the most fearsome abuse, the most harrowing loss; He has shared in them all.

It was not on the cross where Jesus’ sweat was like drops of blood, but in the Garden beforehand. The writer of the letter to the Hebrews tells us, “he offered up prayers and petitions with loud cries and tears to the one who could save him from death.” (Heb 5:7)

That prayer was answered, but not in the way that you might expect. On the third day he rose again. He was saved from death but not from the suffering. We cannot imagine what transactions took place in those long hours in the Garden, but we know that they were vital. Was it some sort of negotiation? Was it a matter of Jesus reconciling his mind to that of the Father? Was that even necessary or possible? Was the Father rehearsing with Jesus what the final outcome of his suffering would be, for we are told, “for the joy set before him he endured the cross, scorning its shame”. (Heb 12:2)

Jesus continued to pray despite seeing wrongs un-righted. Everyone was looking for him. The previous evening, the whole town had gathered at his door and Jesus had healed many who had various diseases. Instead of starting work on healing the next lot, very early in the morning, while it was still dark, Jesus got up, left the house and went off to a solitary place and prayed. (Mark 1:35)

Jesus hasn’t stopped praying. “He is able to save completely those who come to God through him, because he always lives to intercede for them.” (Heb 7:25) “Christ Jesus, who died – more than that, who was raised to life – is at the right hand of God and is also interceding for us.” (Rom 8:34)

We live by faith not by sight. We pray in faith; not from telephone responses. Prayer is our lifeblood.

The psalm begins, “O LORD you have searched me and knw me.”
Listen to how it ends: Search me, O God, and know my heart; test me and know my anxious thoughts. See if there is any offensive way in me, and lead me in the way everlasting.

Sunday, August 17, 2008

Humility and how I achieved it. Psalm 131.

If you are a fan of Only Fools and Horses you will remember the episode about the communion wine. For those not favored with this memory I should tell you that the Trotters are a working class family from south London. Derek (Del-boy) and Rodney are ne'er-do-wells who sail close the wind when it comes to obeying the law. Del-boy makes his living as a market trader and his gormless brother Rodney is his witless assistant. In this episode Del-boy wants to do the local vicar a favor. I can't remember exactly why - it was either because he wanted to get his young son Damien baptized or because he'd just stolen the lead off the church roof. Anyway, he proposes a scheme to the vicar that they go into business selling 'already-consecrated' Communion wine. Del-boy imports cheap wine from Portugal by the truck load while the vicar sprinkles holy water on the truck as it parks in the road outside the church.

Since they are undercutting the market, the scheme goes very well until the purchasers discover that the wine is Portuguese white, not red, and ask for their money back, at which point Del-boy scarpers, leaving the vicar to find the money.

I tell this story in order to boast about some changes I brought in when I was an elder at my church. We were buying our (unfermented) Communion wine from an ecclesiastic supplier at an exorbitant price. Since it is just grape juice, I suggested we buy (red) grape juice from Tesco and use that. We saved a bit of money that could be used to spread the Gospel that way. Communion bread and wine were previously served by the deacons who sat prominently at the front of the church dressed in smart business suits. I initiated a change whereby around 70 volunteers would join a rota for serving the Communion elements, so that no-one would get puffed up about having an exalted position in the church.

And I tell this story to show how insidious pride is. They may have been good changes in the way we ran the Communion service, although they may have offended some members of the congregation, but why am I boasting about introducing them?

Psalm 131 is a prayer about humility. You won't find much written about humility - probably because writing about it suggests that you know how to do it. "Lifelong humility; and how I achieved it." sounds rather presumptuous. The truth is that anyone who stands up and preaches or sits down and writes about this (or any other)subject always has to battle with pride. A habit has arisen recently of applause in churches. I must say that I am uncomfortable with it. If the under-fives sing "Away in a manger" they need to be encouraged perhaps, but when a soloist performs a song or an instrumentalist plays some music, I wonder whether they are there to entertain us or to worship God. Am I being stuffy? Perhaps I am, but I battle so hard with my own pride (there we are, boasting again) that I fear that others should not be subjected to the same temptation. I should hate it if anybody applauded one of my sermons.

How to react to praise is always very difficult. Deflecting the credit to the Lord is apt to meet with the response that it wasn't that good. One reply I heard from a pastor who was told that he had just preached a wonderful sermon was, "Yes, I know. The Devil just told me the same thing."

Yet a false humility is also out of place. If an expert pianist is praised for his performance, it sounds false and even patronizing to reply, "Oh, no it wasn't; you must have missed all the wrong notes and the way I fluffed my opening." I think the only true response is simply to thank them for the compliment and change the subject. I am tempted to respond to praise by asking in what ways I am wonderful and milking the applause.

What did David mean by 'haughty eyes' in verse 1 of the Psalm? Matthew Henry adds, "Either to look with envy upon those who are above me or with disdain on those that are below me." Neither envy nor disdain have any place in the church, but how they sneak in.

There was a time when I was envious of other people being asked to do things in the church. If someone was leading the service or doing the Scripture reading or interviewing a baptismal candidate I would ask myself, "Why is he doing that? I could do it far better." There were some things that I recognized that I had no talent for like flower arranging or singing solos, but if there were things that i could do, I felt quite bitter about not being asked. Thankfully, the Lord loaded tasks upon me until I had to cry enough. Now I am quite happy to sit at the back and be grateful that so many people have the opportunity to serve. I will do what I am asked to do, but I have learned to rejoice in other people's gifts.

However, I don't think I am free from envy. There is a well known story of Spurgeon being told that his dinner guest was now quite free from sin; the 'old man' within him was finally dead. At this Spurgeon threw a jug of water over him, causing the man to explode with anger. "Ah!" said Spurgeon, "I thought as much. The 'old man' isn't dead; he was only sleeping. A drop of water soon revived him." It would certainly be possible to revive envy in me, and I know I am not free of disdain.

When I was very young, before I was converted, I looked down on black people, Jews, immigrants, women, people who weren't as clever as me, people who were born with a silver spoon in their mouths, people who weren't English (even Americans), people who didn't understand science, ugly people, cripples, Northeners, fat people and Roman Catholics. That was a whole lot of prejudice that needed cleaning out of my system.

One of the wonders of grace is that Jesus could love me enough to die for me while I was like that. I didn't have to get clean first. We often preach repentance to sinners. Chris Kelly gave me the remarkable insight that we repent after we are converted, not before. How could we repent when we were dead in our trespasses and sins?

In general I have been cured of most of my prejudices, but I still find it hard not to look down on people with poor personal hygiene and people who tow caravans behind them on the busy road. I still speak without thinking about the people who might be hurt by what I say, and I'm still prone to make a cheap joke about someone who suffers from a handicap (like being Irish, for example). (See what I mean).

When we are embarrassed we often try to dispel it with a joke. It is hard to really admit our pride. I have the following from Alister McGrath's textbook on Christian Theology. Apparently feminists think that even sins are gender-specific. The ones we hear about: pride, anger, arrogance, pomposity, self-importance are really sins that are male-specific; no woman ever feels like that. Female sins are those of slinking into the background, self effacement, thinking or themselves as nothing. The remedy, they say, is not less pride but more (only they call it self esteem). Doesn't sound like the woman of Proverbs 31:10-31 to me.

See how I digress when faced with my pride. It is hard to admit our failings and the truth is we are not required to enumerate them to the world, but we had better be honest before God (and our wives).

Verse 2 tells us to quieten our prattling. No, that's too harsh. The image is of a toddler who skins his knee or gets lost in a crowd. He wants his Mummy. And when he is enfolded in her arms, he is calm. He is quiet. He stops his sobbing. That's how we should be with God; like a hen gathers her chicks beneath her wings. When we quieten our soul and are content with God's will; then we know true humility.

O Israel, put your hope in the Lord both now and evermore. We don't rely on ourselves, on our own talents, on our wealth, on our intelligence, on our gifts, on our masculinity, on our race, on our silver spoon, on our connections, on our networking; we rely on the Lord, both now and evermore.

Saturday, August 16, 2008

It's not all you see.

The American media are full of someone called Phelps who has won a lot of gold medals at the Olympics. They don't seem to be interested in Rebbecca Addlington who has large headlines in the Times of London and other British newspapers. Normally British gold medals only occur in couch potato sports where we can win sitting down - sailing, rowing, canoeing, horse riding and cycling - though we may get some losers medals for sports where we an lose sitting down, like boxing. Miss Addlington, it seems, has won two gold medals for swimming - sport where you sort of lie down in the water, and in one race has broken the longest standing world record (held by an American, Janet Evans) by 2 seconds. It has got me thinking about fraud. Not, I hasten to add, because I think there was anything fraudulent about Miss Addlington's world record, not Mr Phelps's, but of course we don't really know because we were informed of these things by television.

These Olympics are been beset by simulation. The Opening Ceremony was apparently spectacular (I never watched it - too busy with real life) but we have since learned that the beguiling nine year old was miming to the words of 'China the Beautiful' or 'China uber alles' or whatever it was called (I don't understand Chinese) as they were sung by a seven year old with a beautiful voice, but too ugly to be put on display. If this has overtones of the movie "Singing in the Rain" it should not be too surprising since the weather also interfered with the Opening Ceremony; it was too foggy to see the fireworks at their best, so the world's media were fed a pre-recorded version, some of which were computer-generated. In addition the parade of the various regions of China with local ethnic groups waving their local flags was in fact populated by the majority Han tribe. Given that empty seats are being filled by yellow-shirted 'cheer-leaders' bussed in for the purpose; it is clear that the Beijing Games were following the Los Angeles experience - not the 1984 Games; I mean Hollywood.

I heard on the wireless this morning a spoof on the Opening Ceremony of the London 2012 Games. The spectacular display of flying by the Red Arrows Display team had been cancelled because of the price of fuel and had been replaced by a fly past of 20 Spitfires - all computer-generated. The trouble with such a spoof is that already someone will be working on the simulation and the story will be denied by government ministers, so that everyone will be certain that it is going to happen. And who's to say they will be disappointed.

We have lost the distinction between truth and reality. In part this is down to the post-modern movement which denies that there are absolutes; in part it is because of laziness; in part it is due to the ease with which the electronic media may be manipulated.

Photoshop allows scientists to fake pictures of gels in their experiments. Back in the 1980s. Consider this from a paper I wrote in 1981:

The latest shocking revelation concerns the spectacular Mark Spector and the respected biochemist Efraim Racker. Their work was so elegant and so important that it was tipped to win a Nobel prize. They seemed to have discovered a cause of cancer. They postulated that a viral gene incorporated unto the host DNA produces a protein kinase which awakens a dormant kinase cascade. This in turn amplifies the signal and causes the phosphorylation of cell mebrane ATPase. This then acts less effectively and the cell membrane assumes cancer cell characteristics. Alas it seems that Spector was cooking the experiment. Radioactive iodine appeared where radioactive phosphorus should be and Racker banished Spector from his laboratory

With Photoshop all that mucking around with radioactive chemicals would have been unnecessary. Peer Review of scientific articles is most unlikely to detect fraud. You naturally assume that they are not cheating. Unless you are doing the same experiments you are unlikely to suspect dishonesty. (A remarkable exposure of scientific fraud concerning global warming can be found on this link, however.)

A famous use of Photoshop occurred during the war between Israel and Hezbollah last year. Fake Israeli atrocities were generated that deceived the world's press (though not the blogosphere).

But I wander. Back to the Olympics. Since we mostly watch it on television, and television coverage is concentrated on the competitors of the same nationality as the broadcaster, it should be possible to by 2012 to broadcast tailor-made performances for each nation. By enlisting the help of Pixar we should be able to produce pictures of winners from any nation to order. Imagine sitting watching the Olympics on TV in a hotel in Astana. The reporter focuses on the swimming pool with the headline, 'Kazakhstan swimmer denies Michael Phelps his 29th gold medal'.

Tuesday, August 12, 2008

The Colorado Kid

I am a big Stephen King fan. It's not the horror I like; I can take that or leave it; it's his sheer ability at telling a story. I happened upon this novella somewhere and read it last night. It is a puzzle of the 'locked room' variety. A 40-year old man turns up dead on the beach of an island off the coast of Maine. He apparently died of natural causes, but who is he and how did he get there.

It is told as a discussion between a couple of old fellas who run the island weekly newspaper and a young woman journalism graduate who is doing a placement with them. For her it is a test - will she make the grade as a journalist; for them it is an interview - should they offer her a job.

After eighteen months an interesting fact (which I won't give away) enables them to identify the corpse and to do a good deed, but leaves them another puzzle: how did he get from Denver to rural Maine in six hours and why. They think of a how but the why is left to the reader's imagination.

If you know the story and if you have a good reason post it in the comments section. I have my own idea.

King is the king of small town America. My favorite story of his is 'Stand by me'.

Galatians 3:26 - 4:7

This is the second half of the sermon I am due to preach on Sunday.

And when we come to prayer we are apt to be dumb before him lest like Job we
“speak of things we do not understand; things too wonderful for us to know.”

Yet we are commanded to pray. How could we have the audacity to do so?

Someone once wrote:
I doubt a God with stars to see
Would ever deign to look at me.

We can sympathise with the feeling. Imagine the ant we are about to step on shouting up at us, “Don’t step on me!” Imagine the bacterium in our intestines saying at the top of its voice, “Don’t take that antibiotic!” Imagine a small fish at the bottom of the Pacific Ocean crying out to George Bush, “Save me from that shark!”

We are so puny and God is so great. How could He possibly care what we say.

Perhaps an illustration from medicine will help. Imagine a man with a small cancer. He looks normal. He behaves normally. No-one would ever know there was anything wrong with him. You are his doctor and he comes for a check up. You do all the usual things. You look at his tongue. You make him say, “Ah!” You listen to his chest. Nothing. You take his blood pressure. Normal. You feel his tummy. Nothing abnormal to feel. You look in his eyes with your ophthalmoscope. You peel back his lower lid. You look in his ears with your otoscope. You bang his knees and ankles with your patella hammer. You test his sensation with a hatpin. You do a blood test; in fact you do a range of blood tests. You test for hemoglobin and urea, white count, red count, platelet count; prothrombin time, liver function tests, kidney function tests, thyroid function tests. You test for uric acid, you test his immunoglobulins, you test his PSA, and LDH and CA125. They are all normal. Still you are not satisfied.

You order a CT Scan and an MRI scan and a PET scan. All you see on your computer screen are images in various shades of grey. Everything seems normal. Then you start looking inside with sigmoidoscope and gastroduodenoscope and colonoscope – but all seems normal. There is a cancer there – I told you there was, but it is so small that you cannot see it.

Finally, you take an anti-cancer antibody labelled with radioactive iodine and inject it into his body. Then you scan him with a gamma camera. On the cathode ray tube shining out for everyone to see is the cancer. It is tiny, but detected by the antibody it shines out like a flare at sea on a dark night.

It’s like God has an antibody to sin. My house is an insignificant dot on the map of England. In all the vast and mighty universe it is an infinitesimal spec. Yet sin beams out from it like a beacon across infinities of space. No wonder God notices it. Everywhere else in every galaxy God is obeyed. Here alone, on planet earth, is rebellion. Here alone was it necessary for God to send his son to redeem the lost.

In the passage we read from Galatians, Paul pictures us a slaves; the most insignificant members of a household. We count for nothing. We can be bought or sold on a whim. Our lives or deaths mean nothing. We can have no access to the head of the household. Our complaints are as nothing; our desires meaningless; our lives pointless.

It is when we see our smallness and God's greatness that we can begin to appreciate what Jesus has done for us. Do we see differences between ourselves? God sees none. I am greater than he; I am more important, I am cleverer, I am richer, I am more hard working; I am a man and she is a woman; I am white and he is black; I am a Jew and he is a Gentile; I am English and he is an immigrant. All God sees is a sinner in need of a savior.

And when we are saved he sees only His son whose blood has covered us.
"You are no longer a slave but a son; and since you are a son, God has made you an heir."

As a slave we could not pray. God was so remote. So 'up there' to our 'down here'. But as a son and heir we can say Father or even more intimately 'Abba' or 'Daddy' and know that he longs to listen to us.

For what father is not eager to hear his son speak? The idea that we have been adopted as sons is a wonderful blessing to us. Peter in his first letter, writing to husbands informs us that with our wives we are heirs together of the gracious gift of life to remind us to be considerate and treat them with respect. Why? So that nothing will hinder our prayers (I Pet 3:7).

Romans 8:17 tells us we are not only heirs of God but we are co-heirs of Christ.

Do you ever have difficulties in knowing how you should behave? If like me you came from a working class background, you might be hesitant about appearing in polite society. There is a story of a famous Lord eating dinner in a middle class household. He was perplexed to see silver circles at every place setting. "What are these for?" he asked his wife. She replied, "They are napkin rings. You thread your table napkin through them when you have finished your meal so that they are ready for the next meal." "You mean to say they re-use them!" he exclaimed.

His problem was quite the opposite of mine when I went to University. I didn't know which fork to use, when to sit and when to stand; all these posh people left me perplexed.

Do you know how to be an heir of God? How fortunate we are to have a brother heir in Jesus Christ. You can read about him in the Gospels. When you do so what is very noticeable is that he was often in prayer. You might think of all individuals who ever lived he would be most self sufficient, most able to stand alone. But no. He was often in prayer. And if he was so should we be.

The answer to the question, 'why should we pray?' is ultimately 'because Jesus did'.

Monday, August 11, 2008

Being made Holy

Theologians like big words. They like to analyze. They like to wrap things up in a system that covers all eventualities. There are big books of systematic theology that are read by Bible students. For most Christians such tomes are extremely boring and have no apparent relationship to their everyday life.

For most of us the instruction, “believe in the Lord Jesus Christ and you will be saved” (Acts 16:31) is good enough. We believe and we are saved.

If we are asked the question, “What do you believe about the Lord Jesus Christ?” we answer that we believe that he died on the cross to take away our sins. The theologians call this Justification. As an aide-memoir we often say ‘just-as-if-I’d never sinned’. In the Bible this is pictured by baptism – a good all-over wash.

One of the problems that we face is that although we may feel clean and changed after we are converted, we soon slip back into our old ways. Even those who seem to be going on very well in their Christian walk are conscious of the imperfection of their lives. We fall short of the standards of Jesus. In fact the Bible confirms that: “If we claim to be without sin, we deceive ourselves and the truth is not in us.” (I John 1:8). John is writing to Christians – it is clear that Christians go on sinning after conversion.

The way that the Early Church dealt with this was to take upon itself the care of souls. Minor sins could be dealt with by taking part in the communion service, major ones by confessing to a priest and performing a penance, thus receiving absolution. Later, certainly since St Augustine, this became formalized in what its disparagers call ‘priestcraft’. The priest was endowed with special powers: the power to turn the bread and wine into the body and blood; the power to forgive sins and give absolution; the power to say masses for the souls of the dead. Since these powers reside only within the Catholic Church, the Church becomes a secular power. It is the abuse of this power in the sale of indulgences – get out of jail fee cards – to the relatives of sinners to release their souls from purgatory to heaven that prompted Martin Luther to revolt, and attempt to reform the Church.

One of the great questions that the Reformers addressed was how believers are made holy. It is clear that the new creation pictured in Revelation as the New Jerusalem is a Holy place with no hiding place for sin: “Nothing impure will ever enter it, nor will anyone who does what is shameful or deceitful.” (Rev 21:27) If Christians remain prone to sin how can they ever enter heaven?

The first answer is in the theologians’ word “regeneration”. The English translation may be more familiar – “born again”. Jesus tells of its absolute necessity, “Jesus declared, ‘I tell you the truth, no-one can see the kingdom of God unless he is born again’ “. (John 3:3). Paul’s letter to Titus tells us that we were saved through the washing of rebirth and renewal by the Holy Spirit (Titus 3:5). The word ‘washing’ here has led some to believe that our new life is worked by baptism – one form of baptismal service has the words, “this child is now regenerate”. Baptism certainly symbolizes the new birth – going down into the water symbolizes death to the old life and coming out symbolizes being born again – but the new birth is ascribed to the Holy Spirit; only He can make it happen. However, Romans chapter 7 tells us of the continuing struggle within between the old self and the new self. Even St Paul was conscious of it.

The second answer is in the theologians’ word “sanctification” which means “made holy”. It should be plain by now that I have no truck with the idea that this is anything to do with priestcraft. No-one can be made holy by magic, whether it is by sprinkling on of holy water, attendance at mass, auricular confession, penance, or priestly absolution. Sanctification is also the work of the Holy Spirit. Paul writes to the Thessalonians, “May the God of peace sanctify you through and through.” (I Thess 5:23) and to the Ephesians, “I pray that out of his glorious riches he may strengthen you with power through his Spirit in your inner being.” (Eph 3:16).
His letter to the Romans puts it completely: “You, however, are controlled not by the sinful nature but by the Spirit, if the Spirit of God lives in you. And if anyone does not have the Spirit of Christ, he does not belong to Christ. But if Christ is in you, your body is dead because of sin, yet your spirit is alive because of righteousness. And if the Spirit of him who raised Jesus from the dead is living in you, he who raised Christ from the dead will also give life to your mortal bodies through his Spirit, who lives in you. Therefore, brothers, we have an obligation—but it is not to the sinful nature, to live according to it. For if you live according to the sinful nature, you will die; but if by the Spirit you put to death the misdeeds of the body, you will live, because those who are led by the Spirit of God are sons of God.” (Romans 8:9-14)

But while sanctification is the work of God, it is a work in which believers are required to co-operate. Notice the ‘you have an obligation’ in the passage from Romans. And in Romans 12:1-2 Paul tells us “Therefore, I urge you, brothers, in view of God's mercy, to offer your bodies as living sacrifices, holy and pleasing to God—this is your spiritual act of worship. Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God's will is—his good, pleasing and perfect will.”

As soon as we talk about our co-operation with the Holy Spirit we run the risk of boasting of our good works. You can see it: Jesus takes the blame and shame for our sins; we take the credit for our good works. It cannot be stressed too much; sanctification is the work of God. It is attendant on justification; without our first being justified we cannot be sanctified. Similarly, we cannot be made holy unless we have been born again. The indwelling of the Holy Spirit, who is the source of our new birth and our sanctification, occurs at conversion. We may be privileged to co-operate with the Spirit of God; we may be obligated to do so; but we can only co-operate with Him by virtue of the strength that the Spirit imparts.

Sanctification partly takes place in our subconscious life, but inasmuch as it takes place in our conscious lives it does so through the constant exercise of faith, which the Spirit provides, by the Study of the Word, which the Spirit interprets, in prayer which the Spirit aids and the association of other believers whom the Spirit indwells.

Sanctification is usually a lengthy process. For some death occurs immediately after conversion and for them we must assume that sanctification is complete at death, but for others it is not complete until death. James tells us that we all stumble in many ways (James 3:2). While Wesleyan teaching and that of others claimed that sinless perfection is obtainable in this life. That this is not so is borne out by experience of life and more importantly by St Paul’s own testimony near the end of his life, “Not that I have already obtained all this, or have already been made perfect, but I press on to take hold of that for which Christ Jesus took hold of me. Brothers, I do not consider myself yet to have taken hold of it. But one thing I do: Forgetting what is behind and straining toward what is ahead, I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus.” (Phil 3:12-14)

This is what I believe, but this life is not a course in advanced level theology and no-one gets to heaven by passing an examination in the subject. I am sure there are many Christians with a different understanding of theology – perhaps they have been brought up in a different tradition. What matters is how you work out your own salvation with fear and trembling (Phil 2:12) – not a reference to salvation by works, but to the expression of one’s salvation in spiritual growth and development.

Friday, August 08, 2008


I see that President Sarkozy has suggested that Britain and Ireland share a Commissioner at the EU. He is being absolutely true to his word when he said he would put no pressure on the Irish to reverse their vote on the Lisbon treaty.

Monoclonal B-cell lymphocytosis

We have known about monoclonal B-cell lymphocytosis (MBL) for some time now. In order to have CLL you need to have two things; a lymphocyte count of greater than 5000 per cu mm and a specific immunophenotype showing positivity for CD5, CD19, CD23 and weak positivity for kappa (or lambda, but not both) and CD79b. If you have the immunophenotype but not the lymphocytosis, and you don’t have an enlarged lymph nodes or spleen, then you have MBL. The astonishing discovery that 3.5% of the over-40 population has this condition was made by Andy Rawstron from Leeds in 2002. Now his group have published a more comprehensive investigation into this condition in the New England Journal of Medicine. They studied two cohorts of individuals. The first comprised 890 women and 630 men between the ages of 60 and 80 with normal blood counts (including normal lymphocyte counts) attending hospital for conditions other than blood diseases, cancer and transplants. 78 of these (5.1%) had MBL. Another 27 (1.8%) had a non-CLL monoclonal B-cell population.

The second cohort comprised 2228 subjects referred for investigation of a lymphocytosis that had occurred some time between 1995 and 2000 – even if the lymphocytosis had subsequently resolved. Generally this meant a lymphocyte count greater than 4000 per cu mm, though for some referring centers this meant greater than 4800 per cu mm. 1031 of these (46.3%) had CLL at the time of diagnosis. 309 of these (13.9%) had MBL. The rest (39.9%) had either a non-CLL B-cell abnormality or a reactive lymphocytosis.

185 of the 309 MBLs were available for follow-up and these did not differ from the remaining 124 who weren’t followed up. The average length of follow up was 6.7 years (range: 0.2 – 11.8 years). Progressive lymphocytosis occurred in 51/185 (28%), 31 of these developing a lymphocyte count of >30,000 per cu mm. Of the 51, 28 developed lymphadenopathy and 13 eventually required chemotherapy. Time to first treatment following diagnosis varied greatly (1.1 – 10.1 years) in this group and the median of 4 years is probably meaningless with such small numbers. Of the 13 treated patients 6 have died. In this age group people are expected to die, and of the 309 individuals with MBL, 62 have died. Of these 13 had progressive CLL, but CLL was noted as the cause of death in only four.

What of prognostic markers, how did they perform? There was not really enough blood to do these investigations on many of the individuals. Of the first cohort of 78, 38 had a partial FISH study. 39% had del 13q14 and 18% trisomy 12, and none had del 17p13 or del 11q23. Of the second cohort of 309, 33 had a full FISH cohort. 58% had del 13q14, and 21% had trisomy 12. Two individuals had del 11q23 and one del 17p13. Even fewer had IGHV mutations estimated – 20 of the first cohort and 20 of the second cohort. All bar five were mutated. The V genes used, 3-07, 3-23 and 4-34 are the same as are used by mutated CLL. Of the 58 in the second cohort who had CD38 levels estimated, only two had levels higher than 30%.

It is clear therefore that too few individuals had poor prognostic markers for these to be assessed as prognostic markers for MBL. In fact the only measurement that predicted progression in a multivariate analysis was the absolute number of B lymphocytes – the threshold being 1900 per cu mm.
They conclude that MBL is indeed a precursor to CLL, much as MGUS is related to multiple myeloma. Just as with MGUS progressing to myeloma, the risk of MBL progressing to CLL is about 102% per year. Just like MGUS, the majority will die from an unrelated cause, and age and Hb levels are the only independent predictors of unrelated death – just as they would be for old people without MBL.

The one prognostic factor which informs on the risk of progression to CLL is the absolute B-lymphocyte count. Lymphocyte doubling time is unhelpful.

They also suggest that the definition of CLL based on an absolute count of 5000 per cu mm is unhelpful, and that the diagnosis should be related to the absolute B-lymphocyte count.

Letters to Malcolm

I have been reading CS Lewis's last book "Letters to Malcolm - chiefly about prayer". Although CS Lewis is widely regarded as an orthodox Christian, I find that some of his beliefs differ quite strongly from mine. For example he believed in purgatory - though his idea of purgatory was quite different from how it was seen by the ancients. He thought that most Christians would go to heaven saved but poorly sanctified. Something more was needed for them to enjoy heaven and therefore he envisaged purgatory as a growth phase (as opposed to a purging process). He also has definitely Anglican views about Holy Communion and seems to be unsound about the Lord's return.

If he is so much in error why read him? In the first place because he is so readable. He writes so clearly, modestly and in such a winsome way. Second, because he never claims to be a theologian. Don't take advice from me on theology, he says. He gives us ways of understanding Scripture which work for him, but hastens to advise us to discard them if they don't work for us. The last thing he wants to do is unsettle Christians in their strongly held beliefs. Third, because he recognizes that no-one ever got to heaven by passing a theology exam. Fourth, because he advises us to read and understand what the Bible plainly says rather than extricating verses to wrap our systematic theology around. Finally, because there is so much common sense in his writings

The price of oil

Chatham house has predicted an oil crisis in which oil price will top $200 a barrel. Is this a real threat or is it a bubble?

'A "supply crunch" will affect the world market within the next five to 10 years, the Chatham House report said. While there is plenty of oil in the ground, companies and governments were failing to invest enough to ensure production, it added.'

In my view we are witnessing a bubble generated by speculators seeking to take advantage of attempts by various governments to interfere with the market. It looks as though the bubble may have burst. Gas prices are artificially tied to oil prices and following a recent price hike customers are being advised to fix their prices in forward deals that will hold until 2011. I was caught with a fixed mortgage at 13.5% back in the inflation crisis of the early 1990s. I'm not going to fix my gas price.

Thursday, August 07, 2008

Job 11:7-9

I am preaching at Southbourne Evangelical Church on the evening of the 17th. This is the first half of my sermon as currently drafted.

Everybody agrees that prayer is the lifeblood of the church. Read biographies of great Saints of the past like Robert Murray McShane and John Wesley and you will read of the many hours they spent in prayer. Read about the great revivals and you will learn that they were fuelled by prayer. Yet ask Christians about their own prayer lives and overwhelmingly they are dissatisfied. A Christian publisher conducted an internet poll – of 678 respondents only 23 were satisfied with their time spent in prayer. For the past few months I have been pondering over why our prayer lives are so unsatisfactory, so I feel that the Lord has laid on my heart that I should spend these two sermons considering the difficulties we encounter in prayer.

Have you ever met royalty? I have twice met Princess Anne and once Princess Margaret. I have been 20 yards from the Queen in a crowd. Princess Anne I found sharp with a mind of her own and Princess Margaret a heavy smoker and drinker who liked a joke. I've never met a famous politician, though our local MP, whom I have met once, is shadow minister for culture and sport. I was once in the same bank queue with Harry Redknapp but apart from him the only sports star I have met is Frank Bruno. I do know a member of a well-known rock band of the 1980s. Of course, I know a lot of doctors who are famous in their own circles, but I have never met anyone from the world of culture apart from a second violin in the Bournemouth Symphony Orchestra and Natalie Clein, the cellist, though I knew her parents rather better than her. I have met a few well-known journalists, both professionally and socially, though the ones I knew socially are both dead. Even in the world of the Church the people I have met are pretty small fry – the Suffragan Bishop of Swindon being the most exalted. If we put it the other way round and asked all these people, "Do you know Terry Hamblin?" they would mostly answer, "Terry who?"

Even compared to royalty the awesomeness of God is hard to contemplate. What does the second Psalm say about kings? He who sits enthroned in the heavens laughs; the Lord holds them in derision

One morning in church we sang this chorus:
Our God is an awesome God,
He reigns from heaven above,
With wisdom, power and love,
Our God is an awesome God!

Then we sang it again – in fact we repeated the same words five times. I was getting irritated at this 'vain repetition' but then it began to get to me. We need to realise just how awesome He is.

He is not Princess Margaret, Princess Anne, not even the Queen. Not Gordon Brown,Tony Blair, not even George Bush. Not Christiano Ronaldo, David Beckham or Mohammed Ali. Not Clint Eastwood or Robert Redford or George Clooney. Not Nelson Mandella, the Dalai Lama or the Pope. Their grandeur is a pale imitation.

This is the one who created the earth, the sun the stars.

Have you ever been on a long walk? In the past we have spent the day walking and covered perhaps 10 miles. On his great walks Ian Botham managed about 25 miles a day. That’s an easy drive to Southampton or Salisbury, but try driving to Scotland – it seems an awfully long way. The fastest I have travelled is about 600 miles an hour, but as you look out of the window of your airliner at the frozen wastes of Canada you seem hardly to be moving at all. 6000 miles to San Francisco is a very long way. The moon is not a few thousand miles away but a quarter of a million miles. Mars at its closest is 35 million miles away. The sun is 93 million miles away.

I travelled at 600 mph. Jet fighters can manage about three times that. Rockets that leave the earth have to travel at about 25,000 mph or 7 miles a second. Light travelling from the sun or radio waves traveling from the transmitter on the Isle of Wight travel much faster – not 7 miles a second but 186,000 miles a second. Light from the nearest star, Alpha Centauri, traveling at that enormous speed takes 4.3 years to reach us. Our own sun and the three suns rotating around each other that make up the system of Alpha Centuri are members of a Galaxy that we call the Milky Way (sorry if it all sounds like a load of chocolate bars). The Milky Way contains 500 thousand million stars. But that is only one of many galaxies. Observations through the Hubble telescope have led to an estimate of there being 125 thousand million galaxies in the universe. The nearest galaxy to ours is the Andromeda galaxy. Light from Andromeda travelling at that unimaginable speed takes 2 million years to reach us.

If what we see through the telescope is mind boggling, then what we see through the microscope is more so. In a teaspoonful of blood there are 25 thousand million blood cells. Down the microscope they look like simple red bevelled discs. But even with my best microscope which magnifies about a thousand times I can’t see what’s going on inside these cells. For that I need an electron microscope. These can magnify up to 2 million times. The increased resolution is due to the wavelength of an electron, its de Broglie wavelength, being much smaller than that of a light photon.

When we look down an electron microscope we enter a world that no-one had dreamed of until about 70 years ago. It is the strange world of the mitochondrion and the endoplasmic reticulum where reaction and interactions take place in a complex and almost incomprehensible way. The molecules there that do the work of life there are too small to see, even with an electron microscope – we know they are there by their effects. These processes are only partially understood by the greatest brains on the planet. Every day about two thousand scientific papers are published each trying to understand more about the world that we live in. About a quarter are concerned with understanding what goes on inside the cell. We understand so little yet what we do understand leaves us awestruck. Every type of cell in the human body cell is different, yet the information required for every type of cell is contained in the fertilized human egg.

And it’s the same for every type of bird or insect or mammal or lizard or fish or slug or tree or daisy or grass. I won’t even go into things smaller than molecules. Atoms I barely understand; subatomic particles: quarks and leptons, fermions and bosons, tachyons and hadrons, mesons and baryons; even their inventors are not sure whether they really exist or are just works of fiction. A couple of years ago I was invited to join the faculty of 1000 – the thousand most renowned scientists. If the other 999 understand as little as I do…

No wonder that Job’s comforter could chide him thus: Can you fathom the mysteries of God? Can you probe the limits of the almighty? They are higher than the heavens – what can you do? They are deeper than the depths of the grave – what can you know? Their measure is longer than the earth and wider than the sea.

No wonder that God himself can answer Job, “Where were you when I laid the earth’s foundation? Tell me if you understand. Who marked off its dimensions? Surely you know! Who stretched a measuring line across it? On what were its footings set, or who laid its cornerstone – while the morning stars sang together and all the angels shouted for joy?”

How awesome is a God who knows every hair on my head and cares for the raiment of the flowers of the field and holds the very sparrows in his hand. How tremendous He is who created this marvelous universe from the smallest electron to the mightiest star, who stands outside of time to see simultaneously a crystal form in Alpha Centuri and a murderous thought in the mind of a tribesman in the Kalahari.

Surely, like Job all we can say is “I despise myself and repent in dust and ashes.” As far as trying to influence God with our prayers we must agree with Job –“I know that you can do all things; no plan of yours can be thwarted.”

And when we come to prayer we are apt to be dumb before him lest like Job we
“speak of things we do not understand; things too wonderful for us to know.”

Wednesday, August 06, 2008

Negotiating with God.

We make much of Abraham's negotiation with God. You remember that strange encounter with the LORD when He said, "Shall I hide from Abraham what I am about to do?" and reveals to Abraham that He was about to destroy Sodom where is his nephew Lot lived with his family. Remember how Abraham argued that God would surely not destroy the righteous with the wicked. What if there are fifty righteous men in the town? Far be it from You! Shall not the Judge of all the earth do right?

God seems to back down as Abraham wheedles concession after concession out of Him and beats Him down like a second hand car dealer to just ten righteous people. I reckon that Abraham was calculating that Lot and his wife and two daughters made four. It was likely that the girls had boy-friends by now, so if you counted them and their respective parents there were likely to be ten.

In the end Sodom turned out to be worse than anyone suspected. Lot and his two daughters were saved, but no-one else. Even Lot's wife hankered too much after the sins of Sodom. So it turned out that God's original plan was accomplished. Sodom was destroyed. So what was all that negotiation about? It seems to me that it was all about Abraham approximating himself to God's will.

Later on Abraham would be more severely tested. At stake would not be the life of his nephew, but the life of his son - and not just any son; the son of promise. Out of Isaac would come many nations; yet Abraham trusted God. The letter to the Hebrews tells us that Abraham reasoned that God could raise the dead - so he had no compunction in offering his son as a sacrifice.

What transformed Abraham from a man who wanted to stay God's hand from destroying a wicked city to save his foolish nephew to a man who was willing to trust God to do the right thing even if it amounted to sacrificing his own son? It can only be a lifetime of prayer. A lifetime of listening to God and learning about His wisdom and justice.

Is this what prayer is meant to do for us?

Tuesday, August 05, 2008

How to get doctors to do what is right.

Although most people think of British medicine as 'socialized medicine' a proportion of healthcare in the UK works just like it does in the US - it is insurance based. Often the insurance is provided by the employer, but taking out a family policy is certainly within the means of a large proportion of the population. The same doctors who operate in the NHS spend some of their time operating in the insurance based sector (we call it private practice over here), and the NHS contracts allow them to do so. In this sector, there is no restriction of what medicines may be prescribed and no rationing. Waiting lists are virtually non-existent. Rates of pay for the doctors are much higher than in the NHS and many private practitioners earn well over $2 million a year. Of course, if you operate in a field like pathology there isn't much demand for your services.

The big difference between the UK and the US is that only about 20% of Brits are insured compared to about 80% of Americans.

Both countries have taxation-funded safety nets for those who are not insured. In America it is called Medicare, Medicaid, the VA hospitals and County Hospital ER units; in the UK it is called the NHS. The strange thing is that the 20% using these safety net provisions in the US costs the American taxpayer a greater proportion of the GDP than the 80% of the population using the safety net costs the British taxpayer.

That sounds impossible, but it is probably down to the method of funding which requires 20% of the cost to be attributed to administration in the US compared to only 6% in the UK. It is also down to the way that doctors are paid in the US - by item of service whereas in the UK they are paid a salary on a sessional basis.

I remember my time in private practice. Chemotherapy regimens used to have a 28 day cycle. I was paid by the insurance companies around $800 for all the chemotherapy I administered over a 28 day period. More intensive 21 day cycles then came in. It meant that 6 courses could be administered in 18 weeks rather than 24 weeks; but I would only be paid for 4 28-day periods instead of 6. Where was the incentive to give the more intensive chemotherapy, which would inevitably mean more work for me in supportive care but for a smaller fee?

At one time the $800 fee was only for intravenous chemotherapy; where is the incentive to give it by tablet? I could justify myself by saying that if I gave it intravenously I could be sure it had been taken, but this sort of thing left a nasty taste in my mouth (whereas the patient avoided the nasty taste).

Welcome to the world of perverse incentives.

The only type of physician to make a large income from private practice were those with a procedure. Gastroenterologists had gastroscopies and colonoscopies. Respiratory physicians had bronchoscopies. Cardiologists had cardiac catheterizations. Dermatologists had skin biopsies and liquid nitrogen therapies. The poor old geriatrician or pediatrician had none of these.

A recent Op-ed article in the New York Times was entitled "Paying Doctors to Ignore Patients". It gave the example of a patient check-up that included an X-ray, a urinalysis and a physical. Three procedures: three fees. Each fee covers not only the doctor's time and skill, but also his overhead. If he buys an expensive bit of kit like a CT scanner, once the thing is paid for, the high overhead fee attracted becomes pure profit. It pays him to do as many CT scans as he can. In fact the best way to make money is to do as many expensive procedure as possible and as few cheap ones (like simple consults) as he can get away with.

This year the spending on physician services in America will top $500 billion. Doctors who own their own CT scanning equipment order two to eight times more scans than those you do not own their own equipment. A good question to ask if you are offered one is, "Do you own the scanner?" A 2002 study suggested that doctors are ordering roughly $40 billion worth of unnecessary imaging tests each year.

One way of reducing costs is to pay doctors a standard stipend for each patient, graded according to the severity of their conditions. The incentive is then to do as little as possible for each patient and patients might suffer. There is a happy medium where the patient has the right number of tests to make the diagnosis without wasting money on unnecessary ones; but how do you incentivize doctors to do this?

A possible way is to look at outcomes. It turns out that this is quite complex. I spent a couple of years trying to devise outcome measures for hematological patients in the NHS. At the end of our committee's lifespan we decided it was impossible; there was just too much variation between cases. It's all very well for gall bladder operations - you could easily set a tariff for them, but every admission for AML is different. The cheapest way of managing it was to kill them off in the first week. Those who had a good CR could be reasonably inexpensive, but the cases that had short remissions and several courses of treatment including an allograft, cost the earth. You couldn't guarantee that any particular unit would have the same casemix as any other unit. A unit that had 67% long term survivors might actually be doing worse than a unit with 35% long term survivors because of differences in casemix. At that time we couldn't even differentiate between cases in terms of chromosomes, let alone flt3 or NAM status.

In another field, a famous study showed that the response to publishing the outcomes of cardiac surgery in new York Hospitals, was an unwillingness to accept referrals of more complex cases.

So what does incentivize doctors? You could publish outcomes but experience suggests that this is ineffective. Often the providers 'game' the system - that is manipulating practice to improve what is recorded without improving the quality of service. A good example would be the target of patients spending no longer than 4 hours in the ER, reached by redesignating the trolley that the patient is lying on as a 'bed' and the corridor where the trolley is parked as a 'ward'. However, even when gaming takes place there is a tendency for actual performance also to improve. If they take the risk in gaming the system, they have certainly been incentivized.

It might be thought that the wallet is the greatest incentive to better performance, but this is often not the case. We all know that in Canada it is a sense of altruism that makes doctors perform better - though most doctors for whom this motive predominates have already joined Médecins Sans Frontières. A sense of Professionalism might dominate - there is a sense that belonging to a professional group compels compliance with a set of values that does not depend on personal 'goodness'.

If outcomes are measured it does instill a sense of competition amongst providers. The cardiac surgery Olympics would be one where everyone would covet the gold medal. But as we know, there are bound to be some taking steroids. However, when an institution regularly performs in the top ten all sorts of rewards accrue from patient choice to recruitment of young graduates. Even those who can't be Harvard or Yale would seek to avoid censure.

There are individual incentives within an organization such as promotion to more responsible positions, better health insurance, better company car, longer holidays and less obvious benefits like less managerial oversight and more freedom to operate without constraint.

Outcome measurement is here to stay. The problem is that it is much easier to measure process than outcome and the measurers themselves certainly need to up their game.

What do patients really want? Very few want to be charging around the country seeking the Manchester United of oncologists, only to switch to Liverpool when they are top of next year's league tables. What they really need to know is that my local hospital is performing well, that it makes the right decisions, has access to the latest drugs and operations and that I will be treated well when I get there.

I thank my son Richard for his research in this area and for helpful discussion as I was thinking about this article.

Monday, August 04, 2008

The racist views of Charles Kingsley

Charles Kingsley, the author of "The Water Babies" was the first clergyman to support Charles Darwin. He tried to meld Darwinism with his own blend of Anglicanism and ended up with 'Muscular Christianity'. Kingsley taught that humans evolved from apes and later received a divine spark which enabled us to progress towards God's pattern of perfection - what Teillhard de Chardin called Point Omega. This idea led him to believe that some ape-like humans did not receive the divine spark and their evolution had ceased. Among these were the Australian Aboriginal who, exactly like the African Negro, could not take in the Gospel. All attempts to bring them to a knowledge of the true God had failed utterly. They were poor brutes in human shape.

These racist words upset John Paton, the missionary to the South Pacific islands. He knew these 'poor brutes' personally. He told how thousands of cannibals were transformed into wise, loving people by believing the Bible's message of salvation through faith in Jesus. Many went on to be preachers and teachers. They did not need to be dismissed as animals, they needed to know that they were created in the image of God, that sin had marred God's image in them, and that Jesus had come to save them from their sin.

Ironically, he said, those who seem least able to accept the gospel today are those with white skin. The gospel is the same for all. It teaches that all humans have the same origin. We are all created in God's image. We have the same origin and we have the same problem: "All have sinned and fall short of the glory of God". Our rebellion against God has defaced and defiled his image in us. If we all have the same problem we all have the same solution: faith in a perfect life, a sacrificial death and a divine resurrection. The Gospel embraces the rich and poor, genius and mentally disabled, infant and elderly, male and female of every nation or shade of skin. Scripture says we must all be saved by the blood of one man, Jesus Christ, the perfect image of God who is himself divine. With his blood he purchased men for God from every tribe and language and people and nation.

adapted from an article by Charles Whitworth.