Saturday, April 30, 2011

John 2:3-6

When the wine was gone, Jesus’ mother said to him, “They have no more wine.” “Woman, why do you involve me?” Jesus replied. “My hour has not yet come.” His mother said to the servants, “Do whatever he tells you.” Nearby stood six stone water jars, the kind used by the Jews for ceremonial washing, each holding from twenty to thirty gallons.

The first miracle was recorded at a wedding. Marriage was clearly an important institution for Jesus. Mary and Joseph had an unusual marriage in which a non-judgemental love was taught by the Holy Spirit. Marriage is a pattern for Christ's relationship with the church. Jesus held that divorce was only permitted because of the hardness of heart of the participants.

I suspect the whole village was invited because Jesus' newly acquired companions were invited with him and a huge amount of water was changed into wine.

Don't be offended by Jesus calling his mother, "Woman"; it was a term of respect, but he was also telling her that there was to be a separation between his time at home and his time in his ministry.

Jesus was not an ascetic; he drunk the wine that was part of the staple diet. It was undoubtedly fermented, but it was not the strong wine that we are used to today. Getting drunk was not Jesus' style.

Friday, April 29, 2011

John 2:1-2

On the third day a wedding took place at Cana in Galilee. Jesus’ mother was there, and Jesus and his disciples had also been invited to the wedding.

Appropriately, the passage for today, the day of the Royal wedding, is the wedding at Cana. Weddings are a good thing. The Royal couple had been an 'item' for 8 years and had known each other for ten. I'm not sure that I like the idea of putting off the wedding until your late twenties or early thirties, which is today's fashion. But it is only a fashion. In Victorian times the bride was much younger than the groom who would be expected to have earned enough to support a wife and children. In William's grandmother's time the groom was a couple of years older than the bride, who would usually be late teens of early twenties. The Bishop of London gave a good homily and if they follow his advice they won't go far wrong. The Queen's marriage has lasted for over 60 years. Let us pray that William's and Catherine's lasts as long.

Jesus was invited to the wedding at Cana; from what we heard of the service at Westminster Abbey he was invited there too. I hope that he went to the wedding and stayed for the marriage.

Thursday, April 28, 2011

John 1:47-51

When Jesus saw Nathanael approaching, he said of him, “Here truly is an Israelite in whom there is no deceit.” “How do you know me?” Nathanael asked. Jesus answered, “I saw you while you were still under the fig tree before Philip called you.” Then Nathanael declared, “Rabbi, you are the Son of God; you are the king of Israel.” Jesus said, “You believe because I told you I saw you under the fig tree. You will see greater things than that.” He then added, “Very truly I tell you, you will see ‘heaven open, and the angels of God ascending and descending on’ the Son of Man.”

The fig tree is a symbol of Israel. The story of angels ascending and descending refers to Jacob's (ie Israel's) ladder.

I suspect what was happening was that under the fig tree, Nathanael was discussing the story of Jacob's ladder. Jacob was notorious for his trickery. He had tricked his father and his brother by stealing the birthright and then having been tricked by his uncle Laban managed to trick him back. This would explain why Jesus called Nathanael 'an Israelite in whom there is no deceit'. And why Nathanael was so astonished and beguiled by Jesus.


As every schoolboy knows, the First World War was started by the assassination of the Austro-Hungarian Archduke Franz Ferdinand and his wife, Sophie Chotek, Duchess of Hohenberg by the Serbian, Gavrilo Princip in Sarajevo.

The question I ask is why when there were so many other assassinations in the Twentieth Century, did this one end up with the wholesale slaughter of millions on the battlefield?

In 1900, the King of Italy was assassinated by an Italia anarchist, in 1901, the American president, William McKinley was shot by an American anarchist, in 1902, the Bulgarian Minister of Public Instruction, was assassinated by a sacked schoolmaster and the Russian Minister of the Interior was killed by a student, but the King of the Belgians escaped unhurt when he was shot at.

In 1903 a provincial judge and a couple of police spies in Russia were murdered. In Serbia there was a night of slaughter when the King and Queen were murdered in their beds together with the Prime Minister, Minister of War, the Queen's two brothers an army general and twelve men of the palace guard. This Serbian assassination did not lead to a world war, but Britain broke off diplomatic relations for the next three years. In 1905, the Tsar's uncle, Grand Duke Serge was assassinated in Moscow; in Finland a student assassinated the Procurator of the Senate.

In 1906, lots of Russians were assassinated including a leading member of the Duma, several policemen and army officers including General Minn, and many provincial governors. The Prime Minister escaped, but two of his children were severely injured and thirty of his visitors killed by a bomb at his summer residence. In 1907, the Prefect of St Petersburg and the Procurator-General of the Russian Empire were both assassinated and in Georgia, Prince Chavchavadze later in the year. In 1908, the Turkish General Shemsi Pasha was assassinated in Salonika while in Turkey itself the former military governor of Pera was killed. In Austria-Hungary the Governor of Galicia was murdered by a Ruthenian student and in Portugal the King and Crown Prince were murdered in Lisbon.

In 1909, Colonel Karpov, Chief of the Secret Police was blown up by a bomb in Moscow. It was not confined to Europe, the public prosecutor for Bengal was shot by a student in India and then an aide-de-campe of the Secretary of State for India was shot dead in London. Although the assassin was executed, an Englishman in India was killed in a revenge attack. The Japanese Prince Ito, three times Prime Minister, was assassinated in Manchuria by a Korean. In 1910, the Prime Minister of Egypt, Boutros Ghali (yes it's his grandfather) was assassinated by Inrahim Wardani, a chemistry student. In 1911, the Prime Minister of Russia was killed by an anarchist While in British India a bomb killed both British and India officials.

In 1912, two Prime Ministers of Spain were killed within a week of each other by anarchists. In 1913 King George of Greece was killed by a 'drunken Greek degenerate' according to the Times and the Turkish Grand Vizier, Shevket Pasha was shot and killed.

The question is what kept the assassins at bay in 1904?

Wednesday, April 27, 2011

John 1:43-46

The next day Jesus decided to leave for Galilee. Finding Philip, he said to him, “Follow me.” Philip, like Andrew and Peter, was from the town of Bethsaida. Philip found Nathanael and told him, “We have found the one Moses wrote about in the Law, and about whom the prophets also wrote—Jesus of Nazareth, the son of Joseph.” “Nazareth! Can anything good come from there?” Nathanael asked. “Come and see,” said Philip.

So the disciples are assembled. Notice that Jesus doesn't wait for people to come to him, he finds people and calls them. Only Philip and Andrew have Greek names and it is noticeable that when some Greeks wanted to see Jesus they approached Philip.

It will be immediately apparent that this story of the calling of the disciples differs from that given in the synoptic gospels. You can attempt a harmonization, but you will find no support for it in Scripture. Again, Simon was called Peter much later in the synoptics. It has to be recognized that various books in the Bible were written for different purposes. John's gospel was probably an aid to evangelism. Chapter 20:30-31 says "Jesus performed many other signs in the presence of his disciples, which are not recorded in this book. But these are written that you may believe that Jesus is the Messiah, the Son of God, and that by believing you may have life in his name." The gospel should not be read as a straight narrative as if it were the six o'clock news. The whole gospel is constructed around certain signs and certain 'I am's' and concentrates especially on the last week of Jesus' life, in order to present an incomplete yet 'whole' picture. In a sense John's gospel is a work of art; he is constructing a whole that puts the reason for believing in Jesus in an attractive and winsome way.

We should not be afraid of presenting the gospel to sceptics; Nathanial was one such. He was probably the same person as Bartholomew in the synoptics, Bar-tholomew is a surname. He was someone well versed in the Scriptures, hence his scepticism over Nazareth. This was not just inter-town rivalry. He knew that the Messiah should be born in Bethlehem according to prophesy so Philip's description, "the one Moses wrote about in the Law, and about whom the prophets also wrote" found in Nazareth immediately raised his hackles.

Philip's reply was the one that Jesus gave, "Come and see."

There is no room for bluster or theological argument, the witness of one's eyes should be enough.

Tuesday, April 26, 2011

History of the Twentieth Century: Up to 1913.

I'm continuing to read The History of the Twentieth Century and have so far reached 1913 which seems a sensible place to stop and have a think.

History was dominated by the machinations of the Great Powers - Britain, France, Germany, Russia, Austro-Hungary, Turkey, the United States and Japan. Between them they owned practically the whole world. There were small Portuguese and Belgian Empires, but the Spanish Empire had been lost to the United States. The sick man of Europe was undoubtedly Turkey. The Ottoman Empire, which included the Arab lands and the Balkans had once extended to the Gates of Vienna, but nationalistic fervor in Bulgaria, Serbia, Montenegro, Bosnia and Albania had meant that it had to withdraw its hegemony in the Balkans. Serbia, in particular, protected as it was by Russia as a fellow Slav state, was keen to gain its independence. Roumania did not involve itself in the first Balkan war but managed to mop up territory when it ended. The Greeks were the biggest gainers winning part of Macedonia, Thrace and many of the islands.

Austro-Hungary was itself beset by nationalist uprising. Poland and Czechoslovakia were weary of being part of the Empire. Meanwhile the Empire saw itself as protector of Roman Catholics outside its borders, so that Croatia and Slovenia sought protection from Turkish Muslims and Serbian Orthodox alike. They have long memories in the Balkans so that after the death of Tito the same towns involved in the 1900s were again prominent in the news; towns like Pristina and Sarajevo.

In Africa, the German colonies continued to be a drain on their economy, the British colonies were well controlled apart from South Africa, which was now running itself and had adopted racist policies of which Britain did not approve. Gandhi had emerged as a champion of both black and Indian races in South Africa, but after the Boer war Britain was reluctant to send troops on behalf of the Blacks. France had its own troubles in North Africa. While Egypt was under control, the same could not be said for the rest of North Africa. Morocco saw a succession of assassinations requiring French troops to restore order. In Libya the Italians sought an Empire of their own by fomenting discontent in both Tripoli and Benghazi, then as now, the centers of two different tribes.

In Russia the attempted revolution of 1905 left the Tsar in autocratic power. The Duma was a talking shop without much influence. It allowed subject nations like Poland, Finland, and the Baltic states to have their say without anybody listening.

Meanwhile the United states was growing in power so that its manufacturing output by 1913 exceeded that of Britain, France and Germany combined.

John 1:40-42

Andrew, Simon Peter’s brother, was one of the two who heard what John had said and who had followed Jesus. The first thing Andrew did was to find his brother Simon and tell him, “We have found the Messiah” (that is, the Christ). And he brought him to Jesus. Jesus looked at him and said, “You are Simon son of John. You will be called Cephas” (which, when translated, is Peter.)

Or nowadays we might translate it as 'Rocky' for cephas means 'rock'. Notice finding Peter was the first thing that Andrew did. What was the first thing that you did when you were converted? I think the first person I told was a fellow consultant, Bill Tattersall. He was rather embarrassed (disarmed, in tatters even). We must not be deterred by that. We are all doomed on this little planet and we Christians have been given a means of escape. Are we so callous that we should keep it to ourselves?

Monday, April 25, 2011

Careless hymns

There can be no doubt that the charismatic movement was responsible for a great proliferation of new Christian music. However, some of the new hymns were doctrinally doubtful. Take this one, for instance, written in 1976:

Father, we love You
We worship and adore You
Glorify Your name in all the earth
Glorify Your name
Glorify Your name
Glorify Your name in all the earth

Jesus, we love You
We worship and adore You
Glorify Your name in all the earth
Glorify Your name
Glorify Your name
Glorify Your name in all the earth

Spirit, we love You
We worship and adore You
Glorify Your name in all the earth
Glorify Your name
Glorify Your name
Glorify Your name in all the earth

Obviously, the Holy Spirit had been very neglected in Christian teaching prior to this time and this is an attempt to restore the Spirit to His full trinitarian position. I think the author fails in this, it sounds too much as if we are worshipping three separate Gods; just what the Muslims accuse us of. Worse than this in singing to the Spirit to glorify his name we do our utmost to embarrass him. The Spirit's role is glorify the name of Jesus; he is there to draw attention to Jesus, to make him known throughout the earth, not to glorify himself. In any case he is the Spirit of Jesus as well as the Spirit of the Father and as Jesus says, 'I and my Father are one'.

I remember that when we sang this in the seventies we changed the words of the third verse to Glorify his name in all the earth.

John 1:35-39

The next day John was there again with two of his disciples. When he saw Jesus passing by, he said, “Look, the Lamb of God!” When the two disciples heard him say this, they followed Jesus. Turning around, Jesus saw them following and asked, “What do you want?” They said, “Rabbi” (which means “Teacher”), “where are you staying?” “Come,” he replied, “and you will see.” So they went and saw where he was staying, and they spent that day with him. It was about four in the afternoon.

Here is John's version of the calling of the first two disciples. They were originally disciples of John the Baptist and they were prompted to follow Jesus by John's pointing him out as the Lamb of God.

I wonder what they understood by that phrase. They couldn't have seen it as a sacrificial lamb, because at that stage they did not understand that the Messiah had to die to ransom his people. The previous day, John had called Jesus, the lamb of God who is taking away the sin of the world. They would be familiar with Isaiah 53:7 'led like a lamb to the slaughter' but throughout Christ's ministry they didn't believe that he had to die. Perhaps they saw the lamb as the ram, a more combative figure? The popular picture of sheep often neglects to inform us that they are all female. Shaun the sheep would have to have been a young ram. CS Lewis pictures the Christ figure as a lion. The popular picture of the Messiah at the time was of someone that would break the yoke of Rome. These were young men and young men baulk at authority. We know that one of Jesus' disciples was one of the party of Zealots who favored an armed uprising. One of the two disciples called here was the Apostle John himself who had the nickname Boanerges or 'son of thunder'.

Jesus invites them to come and see. What would they see? Jesus had no home to show them, but what he did show them would really open their eyes. Jesus made the blind to see but this was a metaphor for making the spiritually blind to see. John and Andrew called him 'Teacher' which seems to say that he had already begun his teaching ministry. Presumably he already had a following, but these two were among the twelve that he chose to train. Thousands followed him, so many that he was pushed into the water and had to teach from a boat moored a little off shore on at least one occasion. But twelve were especially chosen to be church leaders of the future. How important is that! I remember as a young man be called by the pastor of my church for special instruction. Every one of those few chosen went on to become leaders of this or another church.

They spent the day with Jesus. Have you ever done that? What a privilege! Sometimes celebrities are asked with whom would they like to spend an evening and they choose someone like Gandhi or Mandela or David Beckham. Silly people! Who would be better than Jesus? Yet we can do this. Retire to a quiet place with your Bible and begin to pray.

Sunday, April 24, 2011

What is fair?

What is fairness? Far from believing the Marxist cliche, "From each according to his ability; to each according to his needs." a survey commissioned by the thinktank, Policy Exchange and conducted by YouGuv has concluded that people should be rewarded according to how much they put in to society. The poll, shows that a startling 80 per cent of all voters think that people who have been out of work for 12 months should have to do community work before they get benefits - as long as they are physically and mentally capable of working.

The unemployed are not looked on kindly by the majority of British voters. 49 per cent believe that those on Job-seekers Allowance who refuse job offers or interviews should lose half their benefit; 21 per cent say they should lose it all. Perhaps it is a sign of our straightened times that loss of half their benefit is seen as fit treatment for claimants who are single, have a criminal record, are "serial" claimants or are drug users by at least a third and sometimes as much as a half of all respondents.

A third of those questioned thought the main reason for unemployment was that benefits are too generous.

There was not much sympathy either for those who plead that they have to support large families. Two thirds of voters believe parents with three children should not get additional payments if they have a fourth; 59 per cent believe the government should actively discourage people from becoming lone parents.

When ordinary people use the word "fair", they mean that you should get out of life pretty much what you put in, or something for something, rather than something for nothing. Poverty is not society's fault and therefore it's not society's responsibility to deal with it. Poverty, they say, is a consequence of lack of effort or self-control – and, therefore, the individual must accept the consequences. The idea of "workfare" schemes, in which the long-term unemployed must undertake services to the community such as litter collection or graffiti removal if they are to continue receiving benefits, is hugely popular. If you pay people not to work (or to be poor) then they are likely to stay out of work (or remain poor). More surprising, perhaps, is the robust demand that those who could work, but won't, should have their benefits cut or stopped altogether – even if they have children. There is little sympathy for the argument that the children of the workshy should not be penalised for their parents' fecklessness.

This echoes St Paul's directive in his letter to the Thessalonians, "He who will not work, neither shall he eat."

This is the common thread throughout this survey: overwhelmingly people reiterate their belief in individual responsibility. Their insistence is that those who are able should be prepared to support themselves and any children they produce. This should not be thought of as mean-mindedness or lack of compassion. There is a clear message that those genuinely unable to make their own way should be helped. Rather, it is an acknowledgement of the value of self-respect and self-determination: an understanding that being a grown-up means taking responsibility for yourself, and that not having such expectations of people demeans them.


One hundred years ago there were riots in South Wales. They came on the back of dock strikes in London, Liverpool and Manchester which had spread to the carter's unions and the railways. Riots began in the mining town of Tredegar and had a distinctly anti-Semitic quality. Tiny numbers of Jews lived in Tredegar yet (untrue) rumors had spread that the Jews were profiteering and exploiting their position as landlords. The rioters were no deterred that one one Jew in Tredegar was a landlord. Widespread rioting and looting, especially from Jewish shops began in Tredegar and spread throughout the valleys of South Wales. The Riot Act had to be read and troops charged the rioters with fixed bayonets to disperse the crowds.

The Riot Act was an Act of the Parliament of Great Britain that authorized local authorities to declare any group of twelve or more people to be unlawfully assembled, and thus have to disperse or face punitive action. The Act, whose long title was "An act for preventing tumults and riotous assemblies, and for the more speedy and effectual punishing the rioters", came into force on 1 August 1715, and remained on the statute books until 1973. The act also made it a felony punishable by death without benefit of clergy for "any persons unlawfully, riotously and tumultuously assembled together" to cause (or begin to cause) serious damage to places of religious worship, houses, barns, and stables. The Act was repealed on 18 July 1973 for the United Kingdom by the Statute Law (Repeals) Act 1973 (by which time riot was no longer punishable by death). The Public Order Act 1986 abolished the common law offences of riot and introduced the statutory offence of riot.

The wording that had to be read out to the assembled gathering was as follows:
"Our Sovereign Lord the King chargeth and commandeth all persons, being assembled, immediately to disperse themselves, and peaceably to depart to their habitations, or to their lawful business, upon the pains contained in the act made in the first year of King George, for preventing tumults and riotous assemblies. God Save the King!"

Riots occurred last week in the center of Bristol, a large city just across the Suspension Bridge from South Wales. They were caused by protests at the opening of a Tesco Supermarket nearby. Police had been informed that inhabitants of a building near to the supermarket had been making Molotov cocktails with which to set the supermarket ablaze. This building was a derelict house that had been occupied by 12 illegal squatters. The arrest of four of them led to a riot and 160 police were drafted in to control it. 8 policemen were injured and had to go to hospital. The rioters were chanting, "The Streets are ours."

The rioters were Green anarchists. They object to supermarkets on the grounds that their very cheapness puts local traders out of business and that they exploit farmers by forcing prices down. On the other hand their customers love them for producing affordable food of good quality and freshness.

If they want to live in a state where anarchy rules, I suggest that they decamp to Libya.

John 1:34

I have seen and I testify that this is the Son of God

How many of us can stand up and say the same as John? On this Resurrection Morning we have more revelation that had John the Baptist. The man Christ Jesus has been executed on a cross and has risen from the dead. John had heard a voice from heaven declare, "This is my son, whom I love, with whom I am well pleased", but we have the historical record and the testimony of millions that Jesus Christ is risen from the dead. Alleluia!

Notice that it is not 'a' son of God, but 'the' Son of God. Jesus is unique. He is pictured as the sacrificial lamb without blemish in hundreds of years of Jewish sacrifices. Now that 'picture' is realized. The lambs stayed dead after sacrifice, but He is risen! This signifies that the sacrifice is enough in the way that the blood of bulls and beasts could never be. No animal was ever raised from the dead since none of those sacrifices was ever enough. But now! None of us need be still in our sins, since sufficient price to redeem us has been paid.

Saturday, April 23, 2011

John 1:33

And I myself did not know him, but the one who sent me to baptize with water told me, ‘The man on whom you see the Spirit come down and remain is the one who will baptize with the Holy Spirit.’

John repeats his ignorance of the fact that his cousin was the Messiah. But he lets on that he has received a message from God that will allow him to identify the Messiah. Jesus will baptize with the Spirit. Water baptism was the sign, Spirit baptism was the thing signified.

Although Jesus' ministry is not particularly associated with baptism, John ch 3 tells that Jesus did baptize early in his ministry. But the way that Jesus conferred the Spirit was by his death and resurrection. In Romans ch 6 Paul tells us that we are baptized into his death and are buried with him through baptism in order that just as Christ was raised from the dead we too may live a new life. The new life can only be lived in the Spirit. In the book of Acts, when a believer was baptized in water he was also baptized by the Spirit and received in his flesh the gifts of the Spirit to work out his own salvation and display in his life the fruits of the Spirit. Nowadays, baptism, whether of infants or believers, is seldom accompanied by those spectacular gifts - speaking in tongues, miraculous healings; why is this?

Baptism is not essential for salvation; the thief on the cross was not baptised and many in the Quakers and Salvation Army are saved without baptism. Yet it is the Lord's command, "Repent and be baptized, every one of you."

However, baptism is the sign not the substance. The Spirit is conferred when we believe.

Frank Whittle

It was a German designer, Hans von Ohain, who got the first jet-powered prototype off the ground in 1939. But it was more of a manned firework than a viable design.

At the end of next month is the 70th anniversary of the first flight of the Gloster Pioneer, the first 'proper'flight of a jet plane. Frank Whittle, a serving officer in the RAF during WWII, built the first jet plane from his own patented designs for a jet engine. The patent was issued in 1930, when von Ohain was still a schoolboy. The Third Reich was good at building roads, invading Poland and stealing ideas. Whittle never received a penny in royalties from the German designs for fighter airplanes based on his patent nor from the Americans whose dominance in aviation is based on his designs. After the war the Whittle designs were given to America by a grateful British government along with penicillin and nuclear technology.

Whittle was a remarkable man. He was certainly lauded in my childhood but he now seems almost forgotten. There are plans for enormous celebrations in London for Yuri Gagarin, there were headlines in national newspapers about the Brixton riots of 40 years ago, and there has been a Hollywood film about the creator of Facebook, but the only celebration of Whittle's achievement will be a drinks party in the Officer's Mess at Cranwell where he studied. He was later to achieve a first class honors degree at Cambridge where he completed his degree course in two years rather than the usual three and was given the highest accolade that Britain can offer, the Order of Merit,by the Queen. He died fifteen years ago.

Friday, April 22, 2011

When scientists speculate beyond their observations

Francis Galton died just 100 years ago and this anniversary is commemorated in today's Lancet. His theories of “racial types” and long association with the Egyptologist Flinders Petrie today leave a bitter taste. As a proto-geneticist, Galton's abiding passion was individual difference, but how he measured these differences and the theories he espoused were plainly crazy. His measurement and theorising of mental difference, which were based on a mixture of craniometry and the confidence that he could scientifically identify and classify intellectual ability across cultures and centuries were risible. It is his founding (and naming) of eugenics as a science that has made Galton such a controversial figure today. Today's collective memory of the Nazi death camps and their justification in the racist science of Germany's leading geneticists, made the word eugenics almost synonymous with evil.

What is often conveniently forgotten is the extent to which Galton's ideas were shared widely by the cultural elite of his time, which encompassed people of various political persuasions, including conservatives, liberals, and socialists. His interest in racial types, stimulated by his early expeditions to Africa and the Middle East, was of a piece with his assumption of the natural superiority of the European “races”. It made Petrie, the younger and poorer man, an ideal associate. Galton funded Petrie's Egyptian archaeology, with the instruction that he prepare photographs and papier-maché casts of the faces in the carved tomb and sarcophagus bas-reliefs. He and Petrie then classified these into racial categories—Egyptian, Hebrew, Aryan, and others—on the basis of the profiles. Galton experimented with making composite faces by merging photographs to reveal ideal types. As with his eugenicism, Galton's and Petrie's racism reads uncomfortably to modern ears.

It is just over 100 years ago that Ernst Haeckel founded the Monist League, the main object of which was to promote the idea of Eugenics with a view to achieving 'racial improvement'. The race which the Monists considered superior to all the others, in physique and intellect, was the white race; and among its most impressive manifestations, the Germanic people.

Most people have heard of or been taught the idea that the human embryo goes through (or recapitulates) various evolutionary stages, such as having gills like a fish, a tail like a monkey, etc., during the first few months that it develops in the womb. I was taught this as a Biology student. This idea (called embryonic recapitulation) was vigorously expounded by Ernst Haeckel from the late 1860s. Lacking the evidence, Haeckel set out to manufacture the data. He fraudulently changed drawings made by other scientists of human and dog embryos, to increase the resemblance between them and to hide the dissimilarities.

Haeckel’s German peers (notably, in 1874, Wilhelm His, professor of anatomy at the University of Leipzig) were aware of this fraud and extracted a modest confession from him, in which he blamed the draughtsman for blundering—without acknowledging that he himself was that draughtsman. Heckel was charged with fraud by five professors and when convicted by a university court at Jena admitted that he had altered his drawings. One writer reports his saying, "A small percent of my embryonic drawings are forgeries; those namely, for which the observed material is so incomplete or insufficient as to compel us to fill in and reconstruct the missing links by hypothesis and comparative synthesis. I should feel utterly condemned and annihilated by the admission, were it not that hundreds of the best observers and biologists lie under the same charge. The great majority of all morphological, anatomical, histological and embryological diagrams are not true to nature but are more or less doctored, schematized and reconstructed.

Recently, Michael Richardson has attempted to repeat Haeckel's work and further exposed the fraud. His team collected embryos of 39 different creatures, including marsupials from Australia, tree-frogs from Puerto Rico, snakes from France, and an alligator embryo from England. They found that the embryos of different species are very different. In fact, they are so different that the drawings made by Haeckel (of similar-looking human, rabbit, salamander, fish, chicken, etc. embryos) could not possibly have been done from real specimens.

He is quoted in the Times as saying, "This is one of the worst cases of scientific fraud. It’s shocking to find that somebody one thought was a great scientist was deliberately misleading. It makes me angry … What he [Haeckel] did was to take a human embryo and copy it, pretending that the salamander and the pig and all the others looked the same at the same stage of development. They don’t … These are fakes."

Despite the obvious fraud, Haeckel still has his defenders. He was perhaps too assertive, he was generalizing, he was basically correct just over-enthusiastic.

Haeckel and Galton both had the same grand idea. It's amazing what you can convince yourself of when a great idea grips you.

John 1:32

Then John gave this testimony: “I saw the Spirit come down from heaven as a dove and remain on him".

The Spirit has no bodily form and we cannot see him, but as the synoptic Gospels make clear, the baptism of Jesus was accompanied by an actual dove alighting on Jesus and remaining for a little while. This is a symbol for the Spirit's anointing, pointing out that Jesus was in fact divine. It isn't clear why God chose a dove to represent the Spirit, though secular humanists today often make use of the dove to represent what they mean by spirituality.

When Jesus began his ministry he quoted from Isaiah 61:1-2 The “The Spirit of the Lord is on me, because he has anointed me to proclaim good news to the poor.
He has sent me to proclaim freedom for the prisoners and recovery of sight for the blind, to set the oppressed free, to proclaim the year of the Lord’s favor.”

This anointing meant both that Jesus had been chosen by God to carry out a specific task and that he was qualified to do so.

Thursday, April 21, 2011

John 1:30-31

This is the one I meant when I said, ‘A man who comes after me has surpassed me because he was before me.’ I myself did not know him, but the reason I came baptizing with water was that he might be revealed to Israel.

Amazingly John was not in on the secret. Even though he was a cousin of Jesus he did not know who he was. Undoubtedly he recognized him as his cousin, but he never knew him as the Christ until he baptized him. In some of the apocryphal gospels Jesus is reported as doing miracles as a child. For example, making a pigeon out of clay and then making it come alive. These stories do not carry the ring of truth and John would certainly have thought his cousin a bit out of the ordinary if they had have been.

John's message was to Israel, but Israel didn't listen.

Wednesday, April 20, 2011

Then and now.

I have been reading Martin Gilbert's three volume History of the Twentieth Century. So far I have reached 1906. The century opened with Britain at war on two fronts. Then as now it was in a multi-nation coalition in the far east. This time in China fighting against the Boxers who had the tacit support of the Chinese Empress. They were also, as now, fighting in Africa, this time against the Boers.

The Boer war has a bad press, not least because the British invented concentration camps to intern Boer women and children under severe conditions. Far more internees died than Boer troops on the battlefield. It should be remembered, though, that the war was started by the Boers invading the British Cape Colony and Natal and not the other way round, and it was the descendants of the Boers who instituted the vile regime of Apartheid.

The Boxer revolution in China was a nationalistic one, typical of many in the Twentieth Century. The Great Powers, Britain, France, Germany, Japan, Russia and the United States had established trading settlements on the Chinese coast and were exploiting cheap Chinese labor (plus ca change...). The Boxers believed that they could not be killed by Western bullets. They were mistaken in that.

Nationalism was pulling the great empires apart. This was chiefly seen with the Austro-Hungarian Empire, but the Russian, Ottoman British, French and German Empires were all subject to the same attack. By defeating Spain in the Spanish American war, the United States had accidentally acquired and empire in Cuba, Puerto Rico, the Philippines, Hawaii, Samoa, Guam and several islands in the Pacific and West Indies. Teddy Roosevelt was just the man to run it in the European way. The Colonial powers were not an absolute disaster. They tended to bring a measure of civilization to many of the colonies. These 'countries' were not exactly idyllic before the Westerners came and have not be havens of harmony since they left. Undoubtedly, the colonial powers inflicted terrible atrocities too, at least judged by Twenty-first Century standards. The worst by far were those inflicted by King Leopold of the Belgians, who ran the Congo as a personal fiefdom. In putting down an insurrection he demanded an amputated hand for every Belgian bullet fired (he left them one hand with which to harvest the rubber). There were 6000 bullets spent...

The Belgian Empire was run at an enormous profit. The German Empire in Africa always ran at a loss. It comprised part of the Cameroons, South West Africa (now Namibia), Togoland and Tanganyika. The Germans had instituted many social welfare programs at home, including old-age pensions, but the Kaiser was a very nasty piece of work and a less oppressive ruler would have served Germany well, since it was in a position to rival the USA as the successor to Britain as the most powerful nation. An alliance with the UK was certainly possible in the early years of the century.

Queen Victoria's grandsons certainly developed autocratic characteristics. The Tsar, faced with insurrection and rebellion in his vast empire continued to rule as an autocrat and found virtue in the concept. He goaded his opposition into more and more extreme positions. Luckily for Britain, Victoria's son and grandson, were only constitutional monarchs and its democratic tradition allowed gradual change. Nevertheless, Ireland wanted to be free and many of the colonies required a gunboat or two.

Then as now the artificially constructed countries were the site of religious wars between Christian and Muslim. Just yesterday I received news of conflicts in Nigeria and the Ivory Coast. The same countries were involved then.

The other thing that was similar between now and then were the numbers of natural disasters. In 1900, an earthquake in the Caucasus killed 1000 Georgians, in Texas a tsunami hit Galveston, killing 4000, a fire in Ottawa left 14,000 homeless, 200 German sailors were killed by a fire sweeping through three ships in New Jersey. In Hong Kong, a hundred people a week were dying of bubonic plague and in India famine had killed 2 million. In 1901, 100 people were killed by a fire in a chemical factory in Frankfurt and a hundred died in a heat wave in New York. Two and a half million died in a single month from famine in China. In 1902, an earthquake in the Caucasus killed 2000, and a volcano on Martinique killed 30,000 and one on St Vincent killed 2000. In Egypt, 20,000 died of cholera and in India 1000 died in a hurricane. In 1903, 100 were killed in a train crash in Spin and 84 in a fire on the Paris Metro. 600, mainly women and children, were killed in a fire in a Chicago theater. In 1904, several hundred Americans were killed in a fire on board a steamer in the East River, New York and in 1905 1.25 million Indians died of bubonic plague. The figure had been close to a million every year of the century. In areas where the British had control of medical practice - the Indian Railways and the prisons, the number of deaths was 123. However, attempts at immunization to other Indians were rebuffed by the indigenous population. Nowadays, polio would have been eliminated from the planet had the indigenous populations of Northern Nigeria, Pakistan and Afghanistan agreed to be inoculated.

John 1:29

The next day John saw Jesus coming towards him and said, "Look, the Lamb of God who takes away the sin of the world!"

If he does that, why is there so much sin in the world? I looked today on the second most visited news website in the world and found the following headlines: Muslim fanatics to burn effigies of royal couple and turn wedding into 'a nightmare'; Married man's affair stays hidden to protect teenage children; Vile thugs hurl brick in four-year-old girl’s face after her father tells them to stop kicking football at his van; Four girls of 16 caught with five bottles of vodka, three of cider and four alcopops...

And there is much, much more. The truth is there is so much sin in the world because the world (and that means individual men and women) cling on to it. Jesus is the lamb of God - surely a reference to his atoning sacrifice for ours sins, but no-one is forced to buy into this. Cleansing from sin is a free gift to all who believe in him, but there is no cleansing from sin if we continue to hold on to our favorites.

Tuesday, April 19, 2011

interferon in CLL

Many years ago alpha-interferon was trumpeted as wonder drug for cancer. I remember the government stumping up £8 million to buy the entire stock of Wellcome's interferon to treat some desperate child dying of cancer. We now know that interferon has very little, if any, place in cancer therapeutics, but in the test tube interferon certainly acts as a tumor suppressor.

Workers in Toronto have demonstrated that in some cases of CLL interferon may be associated with aggressive disease.

Interferons normally suppress tumor growth by phosphorylating and activating STAT1, but also briefly activate STAT3 (STAT stands for signal transducer and activator of transcription). In CLL with poor prognostic features like del 17p and del 11q, the duration of STAT3 activation is prolonged. This activation is associated with an increase in cell size and number. There was also an association with high levels of reactive oxygen species.

Interferons are produced in response to viral illnesses and this phenomenon could account for deterioration in some cases of CLL in association with a viral illness. TYK2 inhibitors or anti-oxidents given with alpha interferon might have a place in the therapy of aggressive CLL.

NICE changes

There are considerable differences between the British and American health services, although the differences are not so great as is sometimes made out. In both countries the greater proportion of care is paid for by the taxpayer (surprisingly the American taxpayer pays out a greater proportion of GDP than the British taxpayer). In both countries there is a system whereby a third party insurer is left with the bill. The proportion paid for by the private insurer and the taxpayer certainly varies in both countries, but not by as much as you would think. In both countries a regulator decides whether or not a particular treatment is licensed (the FDA in America; the MHRA in the UK). What is different among other things is the organization known as the National Institute for Health and Clinical Excellence or NICE which has a regulatory role in the UK.

NICE has been a matter of particular ire for some of my American correspondents who have warned that should such an organization be part of Obama's plans, it would be tantamount to the introduction of 'death committees'.

This is to misunderstand how NICE works. Before NICE it was left to local conglomerates to decide whether the taxpayer would pay for a new drug that had been licensed by the MHRA (which generally makes very similar decisions to the FDA). The local conglomerates were very arbitrary about how they chose one drug over another - the cancer doctor might shout louder than the dementia doctor or vice versa. This resulted in what became known as 'postcode prescribing'. If you lived in one district you might get the drug but a mile up the street you might not.

NICE was introduced to counter this unfairness. If a drug was regarded as cost-effective for a particular condition, then a local health authority was obliged to provide it, however, short their budget might be and no matter how loudly a particular specialist shouted. NICE had no power to say a particular drug should not be prescribed, but if the budget was tight, market forces would prevail. Health authorities limited their prescribing to what they must provide and pay for. If the drug was not NICE approved, it was always possible to get it paid for through a private insurance company, but they would not let you join a scheme just when the need became apparent. The point about insurance is that it is take out before your house catches fire. Unfortunately, only about 20% of the population has private insurance. A third option is to put the money that could have bought a health insurance policy into a savings scheme and pay for your drugs yourself.

In the current austerity governments are bound to look at what they spend on healthcare to see whether they get value for money. For this reason among many American authorities are looking at NICE to see whether the template can be adapted for American use. An article in last week's New England Journal of Medicine from experts at John Hopkins explores the subject.

NICE finds itself changing its nature as the government moves to what it calls 'value-based pricing' of pharmaceuticals in 2014. Currently, NICE's decision-making process uses a cost-effectiveness threshold, based on the number of quality-adjusted life-years (QALYs) gained with a particular drug for a given cost (between 20 and 30,000 pounds, ($32,000-$48,000)- the goal being to secure as much public health benefit as possible within a specified budget determined every 2 years. Other social values are not formally reflected in this threshold, but NICE's decision-making committees are expected to consider them in their deliberations, and in practice they do affect outcomes. I wonder what would be the result if there were a disease that only affected university professors or CEOs of large companies; would the threshold be different.

This strictly utilitarian approach does not fit easily with people's ideas of fairness and to circumvent this, the government have introduced a special cancer fund to help sufferers who might fall foul of the £30,000 maximum. Value-based pricing offers a new approach to incorporating values. It would begin with a basic price threshold, expressed as cost per QALY and retain NICE's central role “both in undertaking pharmacoeconomic assessments and in providing advice to the NHS on the relative clinical and cost effectiveness of treatments.” But the new approach, says the Department of Health, will better reflect “all the components that contribute to a treatment's impact on health and quality of life,” including “important factors that patients and society value.Under the new system, the Health Ministry would negotiate prices for new drugs with manufacturers, but prescribing decisions would be left to individual doctors who are given a capitation-based budget by the government and need not follow particular decision-making processes. And although NICE would continue to provide advice on the optimal use of new drugs, that advice is unlikely to translate as now into a constitutional right to access.I'm not completely clear how these changes would operate in practice. I suspect that they are merely there to allow more flexibility into the system that will allow the middle classes with 'sharp elbows' to get things that other people will be denied. In other words it will keep the Daily Mail off our back.

Although the British and U.S. health care systems differ, some policy experts in both countries see improving health care value propositions as one solution to the conundrum of sky-rocketing costs and limited resources. The U.S. Affordable Care Act explicitly rejects Britain's National Health Service model, with its global budgeting and public acceptance of prioritization and consideration of costs. Nevertheless, the British experience may carry important implications for U.S. health care reform.NICE's history and the British government's new turn demonstrate that, as a political if not a moral matter, the value of health care cannot be defined solely in terms of comparative clinical effectiveness or health outcomes. But clearly it is hard, politically and technically, to define value, even for an organization that has pioneered approaches to expanding the meaning of value in healthcare.

John 1:28

This all happened at Bethany on the other side of the Jordan, where John was baptizing.

This is not the Bethany near Jerusalem where Mary and Martha lived with their brother Lazarus. We do not know precisely where this was, but presume that it was somewhere near where the Sea of Galilee empties into the River Jordan. Some think that it was an alternative spelling for Batanea (called Bashan in the Old Testament). Don Carson suggests that John uses to alternate spelling for symmetry - showing that Jesus' ministry began and ended at Bethany (albeit a different one).

Monday, April 18, 2011

John 1:26-27

"I baptize with water," John replied, "but among you stands one you do not know. He is the one who comes after me, the thongs of whose sandals I am not worthy to untie.""

Water baptism is only the sign of Spirit baptism, just as animal sacrifices were only a sign of the sacrifice of the Messiah. John was telling them that the Messiah was already among them and they had not recognized him. Among the people John already had a fine reputation. They were talking of him as a new Elijah or a new prophet like Isaiah or Jeremiah or Daniel. John on the other hand knows that he is a little man, minuscule next to Jesus.

There is a famous comedy sketch by John Cleese, Ronnie Barker and Ronnie Corbett, who represented different British classes. The tall Cleese says, "I'm upper class; I look down on these." The medium sized Barker says, "I'm middle class; I look up to him, but I look down on him." The short (tiny even) Corbett simply says, "I know my place."

John the Baptist knew his place. Do we know ours? I saw an interview with a young person on TV yesterday. When asked what interested her most in the world; what she gave most importance to, she replied, "Myself." No-one chiefly interested in themselves can enter into the kingdom of heaven. You'd be surprised how many supposed Christians would have the same interest.

Sunday, April 17, 2011

John 1:24-25

Now some Pharisees who had been sent questioned him, "Why then do you baptize if you are not the Christ, nor Elijah, nor the Prophet?"

The Pharisees were the super-spiritual sect. More than to anyone else the idea that they should be baptized was an affront. Why did they need washing?

I have sometimes interviewed candidates for church membership who are affronted that they should be baptized as believers. They were 'done' as babies. Didn't that count?

Why do they protest? Are they ashamed? Do they think that they would make a fool of themselves? Are they too proud?

Following the Lord's command should make us joyful not ashamed. Only the humble can enter the kingdom of heaven. Following the rules will never get us home. It's like playing snakes and ladders and ending up on square 99 and not being able to throw a 'one' on the die because it has been obliterated. There is no way to get home by simply obeying the rules. In golf there is a device known as a 'gimme' where your opponent does not require you to hole your ball of you are sufficiently close to the hole. In truth, the only way home for all of us is a 'gimme'.

Saturday, April 16, 2011

John 1:23

John replied in the words of Isaiah the prophet, "I am the voice of one calling in the desert, 'Make straight the way for the Lord.'"

This must have taken them by surprise. What could it mean but that a King was coming? The anointed one. John's preaching about the need for repentance linked with the instruction to clear a path for the coming king must have struck them with terror. They may not have understood what the Messiah was going to do, but John's universal call for repentance to Pharisee and Sadducee as well as to tax collectors and sinners must have frightened them. The Messiah was coming and John was telling them that they weren't ready.

Would we be ready for the Lord's return? He will come as a thief in the night when we are least expecting him?

30 years since the riots

It is thirty years ago that rioting began in Brixton in south London. It was triggered by a black man who had been stabbed by another black man running into the arms of a policeman and covering him with blood. Then a rumour spread that the police were killing black men at which 3000 young men of Caribbean origin took violent action against householders and the police as a front for looting of TV shops and jewelry shops, often owned by their own parents.

This is what Mrs Thatcher had to say at the time, "What aggravated the riots into a virtual saturnalia was the impression gained by the rioters that they could enjoy a fiesta of crime, looting and rioting in the guise of social protest. They felt they had been absolved in advance. These are precisely the circumstances in which young men riot, and riot again."

At the time the government asked a left-wing judge, Lord Scarman, to report on the causes of the riots and the Scarman report led to a soft pedalling of police activity in Afro-Caribbean areas. As a result, the stabbings continue, gun crime is rife and the whole thing is fueled by the use of illicit drugs.

I remember bumping into Lord Scarman. He was traveling on a crowded London Underground train. These days Left wing leaders travel with more style. The current Labour leader was interviewed on a train. The leader's aides carefully removed the anti-macassars from the seats before filming began lest the poor public should realize that he was traveling first class.

Friday, April 15, 2011

End of treatment.

I saw the oncologist today. My scan showed no change from last time. There is still a mass in the right iliac fossa which is unchanged, but no evidence of peritoneal or liver secondaries.

What am I to make of this. The mass is a combination of thickening of the wall of the cecum plus enlarged lymph nodes. As it is unchanged I have to assume that it is as small as it can get and that it consists of fibrous tissue. Being a hollow viscus the cecum has a certain diameter and won't shrink down to nothing. Tumors smaller than 5mm cannot be seen by CT so anything left is below the limits of detection. Until something larger appears I must rely on symptoms to alert me to the presence of cancer.

How are the symptoms? Well I still have a noisy stomach as food rattles through new passages made by the surgeon. I still get stomach cramps, but these are lessening day by day and I think are still the last stripes of the chemotherapy. My bowels haven't quite settled down yet to their normal rhythm.

If there is no change since November's scan, did I need to have all that extra chemotherapy? I guess so. In hematology we would call it consolidation. I trust that the chemo was killing undetectable disease and reducing the number of cancer cells remaining in the body. We know that when we get a complete remission in acute leukemia, there may be as many as 1 billion leukemia cells left in the body, and unless we go in consolidating, we will have a relapse within a few months. I guess it is the same with solid tumors.

Anyway, I should have my line out next week and be able to spend teh summer unencumbered.

Vitamin D and cancer

The current New England Journal of Medicine contains an article by Manson, Mayne and Clinton on Vitamin D and cancer prevention. They all served on the Institute of Medicine Committee which recently raised target levels for Vitamin D for the prevention of bony disease. The committee concluded that for outcomes beyond bone health, including cancer prevention, the evidence available is inconsistent and inconclusive. No cause-effect relationship can be established. There has been no randomized controlled trial conducted where cancer has been the primary end point. Most evidence is derived from laboratory studies, ecological correlations, and observational studies. Low vitamin D levels are also linked with confounding factors that are themselves associated with high risk of cancer; for example: obesity, lack of physical exercise, dark skin pigmentation and diet.

Reverse causation may also be a problem - poor health can lead to less sun-exposure or a poorer diet. Vitamin D is like many micronutrients that have been linked with cancer such as beta carotene and selenium; randomized clinical trials for these have been uniformly negative.

The theory that vitamin D can help prevent cancer is biologically plausible. The vitamin D receptor is widely expressed and test tube studies demonstrate that vitamin D can promote cellular differentiation, inhibits cancer cell proliferation, and has anti-inflammatory, proapoptotic and antiangiogenic properties. This might suggest a role in cancer prevention, but, of course, proves nothing.

There have been three vitamin D trials including one that compared vitamin D + calcium to calcium alone that addressed the occurrence of new cancers or cancer mortality as secondary end points, but the results showed no difference. A trial at Oxford of 2686 individuals 833 U/day showed a relative risk of 1.09 (CI 0.86-3.36), a trial in Nebraska of 1179 postmeopausal women showed a relative risk of 0.76 (CI 0.38-1.55) and a big American study of 36,282 postmenopausal women showed a relative risk of 0.98 (CI 0.91-1.05). One study showed that women with the lowest intakes of Vitamin D had the lowest incidence of breast cancer and those with the highest intakes had the highest risk of cancer and in this study both the figures were statistically significant.

For colorectal cancer, observational studies do support a link. A meta-analysis of 5 studies suggests that patients with serum levels of 25-hydroxy vitamin D of 33 ng/ml or higher had only half the risk of colorectal cancer of those with levels below 12 ng/ml. There have been two studies since; a European prospective study found a similar association, but a Japanese study did not find such an association. Randomized trial evidence is limited. A British study did not find a change in incidence in individuals treated with vitamin D and the WHI trial of vitamin D plus calcium similarly found no reduction in incidence or reduced mortality.

Observational studies for prostate cancer have not supported the idea that vitamin D deficiency is associated with prostate cancer and nested case control studies similarly have been non-supportive of the hypothesis. There has been a large scale Vitamin D pooling project for rarer cancers. These show no association between higher levels of vitamin D and reduced risk of endometrial, esophageal, gastric, pancreatic, or ovarian cancer or NHL. Indeed there are suggestions that higher vitamin D levels might be associated with an increased risk of pancreatic cancer.

The Committee concluded that despite widespread enthusiasm for the idea, the evidence is inconclusive and inconsistent. There are new trials assessing moderate-to-high vitamin D supplementation and these should give us an answer in 5-6 years time.

John 1:22

Finally they said, "Who are you? Give us an answer to take back to those who sent us. What do you say about yourself?"

Even at this stage the ruling council of the Jews were worried. This delegation had been sent to John because he was behaving strangely and drawing crowds. Baptism had no tradition in the Old Testament, though it was practised at Qumran. Some authorities think that John had spent some time there but there is no evidence to support this theory.

Some authorities think that they had been sent on a mission to root out false prophets or like the Spanish Inquisition to seek out heretics. However, at this stage of his ministry John had a lot of popular support and could not be arrested without an uprising. The delegation had to tread carefully, hence the polite questioning - compare this with the treatment that Jesus received when questioned. Torture was as prevalent then as it is now.

Thursday, April 14, 2011

Mrs Thatcher

I have been reading Thatcher's Britain by Richard Vinen. It is now more than 30 years since Mrs Thatcher came to power and I guess it is history for most people rather than news. It might be a suitable time to assess her influence. She is a woman of the same generation as the Queen and Marilyn Monroe. who broke through the glass ceiling, despite being on the 'wrong side'. For the left she is a figure of bile and spleen; for the right she is a heroine, but someone who was never 'one of us'.

Like Obama she attracts accolades for being the first of a kind, but unlike Obama, she has actually done something. The first thing she did was to rein in public spending, risking a recession in order to control the money supply. 364 economists wrote to the Times saying she was crazy; but it worked. Her policies are being repeated now by the current coalition government with the same predictable results.

She then was called upon to fight a war that stretched logistic possibilities. There were many who thought that it would have been cheaper to pay the 1800 Falkland Islanders £1 million each and resettle them in rural Scotland than send and Armada to the South Atlantic. There is no doubt that previous leaders like Wilson and Callaghan would have crumpled. Had she done so Great Britain would have had as much influence in the future as Austria or Greece. She had luck on her side in that in Galtieri, Argentina had a brutal right-wing dictator whom nobody wanted to side with and she therefore had covert aid from both America and France. She also was pitting a volunteer army against a conscripted one and this really showed itself when the helicopters were lost when the transport ship Atlantic Conveyor was sunk by an Exocet, having been mistaken for an aircraft carrier. Paratroopers coined a new word when they 'yomped' across the island and fought a battle uphill against dug in troops.

Although a messy little war of only moral significance, it did a great deal for British morale and confidence. Perhaps it was this that spurred her to take on the miners. The National Union of Mineworkers (NUM) were the leaders of industrial labor. Immediately after the war there had been nearly a million of them and by 1883 there were still over 100,000. They had taken on the Heath government and defeated it. It was a long running sore for Conservatives. Who ran Britain? The Unions or Parliament?

Truth to tell, the miners were fighting a losing battle. Coal could be produced more cheaply in Poland, South Africa and Australia and in any case it was a dirty fuel that killed miners with pneumoconiosis and residents of towns with polluted air. And then there was North Sea oil and gas. I used to quip, "What do Lord Shaftesbury and Lord Hestletine have in common?" "The first got women and children out of the mines and the second got the men out." Although people admired miners for the filthy job they did and the sacrifice of their health to bring us energy, no-one really regrets that there is no longer any significant coal mining in the UK.

The Miners were badly led by Arthur Scargill who tried to avoid holding a strike ballot. Even his Union friends hated him and gave covert help to the government. Help from other unions was not forthcoming and the strike was called at an inopportune time when the power stations had plentiful supplies of coal with the warm weather coming up. Peter Walker, the very un-Thatcherite Minister in charge played a very straight bat throughout (perhaps because he was a Heath crony and wanted his own back on the miners.)

The Conservatives had enacted stringent restrictions on Union power and it is noticeable that the Blair/Brown governments have not reversed them. The same is true of that other great plank of Thatcherism - Privatization. Thatcher inherited a socialist country. The railways, the Post Office, British Airways, the airports, the gas industry, the water industry, the electricity industry, the telephones, radio-isotope production, the steel industry, and the major car producer were all owned by the government which ran them very badly. It could take 6 months to get a phone at a time when increasing numbers of people wanted to be contactable. The very houses that many people lived in were owned by the state and rented out. There were few private landlords and those that there were, were often crooks.

Thatcher changed all that. The Labor Party were committed to taking even more things into public ownership and the government's response to failing industry had hitherto been to nationalize it and provide it with a heavy subsidy at taxpayers expense. Most of the privatizations have been successful. It is hard to think what the government would have done about cell phones. It would probably take 6 months to get one! The railways is the glaring exception. They are still inefficient and expensive in private hands (but then it was her successor that privatized them, probably using the wrong business plan). The post office is still a nationalized industry but successive governments have shied away from this fence.

The sale of council houses at a discount has been a great success in England; the Welsh and Scots still think the English owe them a living and they remain socialist republics with the Union. Hardly anyone votes Conservative in these 'countries'. They certainly need a dash or private enterprise to shake them out of their torpor. There are middle aged men in Wales who have never worked and don't intend ever to work. They just father children that the State pays for. Independence for Scotland and Wales is what is needed. A few years ago they envied the 'tiger' economy in Ireland. Not now.

Northern Ireland has always been a subsidized state. Monetarism never took hold there. The subsidies were political to keep the Protestants from being unemployed and having to emigrate like the Southern Catholics. In truth tourism, horse racing and farming cannot support even the small population that lives there. It is a fine place for the landed gentry, but there is no future in that even in England.

Nationalism had its heyday under Thatcher. She really was despised by the other nations of the Union. She was hard nosed about public subsidies, but she could not bring herself to jettison the minor countries of the Union. Much of England's success came from the Big Bang, the deregulation of the City of London, which made it the financial capital of the world. This particularly benefited London and the South East and compensated for the decline in manufacturing industry that was taking place in the rest of the country. The government enticed Japanese auto manufacturers to South Wales, the North East and the West country, but not to Scotland. The two Scottish banks (Bank of Scotland and Royal Bank of Scotland) certainly benefited from the Big Bang, but most of the jobs they created were in London with only poorly paid call-center jobs in Scotland.

But Irish nationalism was her greatest enemy. She was blown up by an IRA assassination attempt and two of her closest associates, Airey Neave (who had escaped from Colditz) and Ian Gow, were assassinated. She was not the sort to give in to threats and seemed to regard Gerry Adams as a lesser form of Argentinian. Not for her the more emollient tones of her successors John Major or Tony Blair.

Yet in foreign policy it was she who saw in Gorbachev, 'a man with whom we could do business'. With Ronald Reagan, a man with similar political ideas but a much softer manner, she won the Cold War by holding her nerve. She would have made a fine poker player.

Yet all political careers end in failure and she was deposed by an internal dissatisfaction in the Tory Party. She never lost an election, but in the end she did not win well enough. She had her favorites, usually good-looking younger men who were nor really up to the job, yet she was not well-liked. Even her staunchest supporters in the difficult years, Nigel Lawson and Geoffrey Howe, deserted her. She lacked collegiality. Her legacy remains. Tony Blair and David Cameron would really have been her kind of boys, though neither of them would be up to the job in her eyes. She would have loved to be still in charge, reliving 1980 in 2007. She wouldn't have let Obama withdraw his aircraft from Libya in 2011.

John 1:21

They asked him, "Then who are you? Are you Elijah?" He said, "I am not." "Are you the Prophet?" He answered, "No."

Malachi 4:5 See I will send you the prophet Elijah before the dreadful day of the Lord comes.

Deuteronomy 18:18 I will raise up for them a prophet like you from among their brothers; I will put my words in his mouth, and he will tell them everything I command him.

The scribes were harking back to these Old Testament prophesies. We know that John was fulfilling these prophesies, but not in the literal way that the Jews were expecting. Luke 1:17 tells us that John would be in the spirit of Elijah and he was called Elijah by Jesus himself (Matt 17:12). There have been many prophets who have fulfilled the Deuteronomy text, not least Elijah himself, but also Isaiah, Jeremiah, Ezekiel and many more. John the Baptist is but one and the mythology of the prophet was a construction of those who spend too much time with their heads in books.

Wednesday, April 13, 2011

John 1:20

He did not fail to confess, but confessed freely, I am not the Christ.

The literal Greek is 'and he confessed and denied not and he confessed' I am not a Greek scholar so I assume this is a figure of speech meaning he denied vehemently that he was the Christ (or Messiah). To John it would have been blasphemy to claim to be such. With great vehemence he denies it. Remember how the Apostle was shocked when the Gentiles wanted to worship him. No man should claim to be God and should anyone imply such a thing we should shrink from it with alacrity.

Tuesday, April 12, 2011

Health check

It has been a little while since I have given a health check. Today would be the day that I would have started my next course of chemotherapy if it had not been stopped after last time. I am feeling much better in myself, though the bowel side effects of the treatment have not quite abated. I shall be seeing the oncologist on Friday when I hope for good news from my scan.

We have been enjoying some fine early Spring weather recently with temperatures in the low seventies. The garden is looking particularly fine with 34 types of plant in bloom and 10 different species of birds living there. We seem to have blue tits in our nesting box and at least 4 different squirrels visiting every day. The lilac is blooming and three magnolias and 5 camellias are flowering. We have apple and plum blossom on the trees, though the cherry is finished. The rosemary and chives are in full bloom. Violets have sprung up and the first bluebells are echoing the carpet of grape hyacinths. Pansies and cyclamen and laurel continue from the winter.

Tomorrow I expect to take a long drive in the Jaguar; my first for many months.

John 1:19

Now this was John's testimony when the Jews of Jerusalem sent priests and Levites to ask him who he was.

John's activities were certainly causing a stir. He was behaving like an historic Nazarene in his dress and diet and he was calling people everywhere to repent and be baptized. Jews and even pharisees were being told that they needed to have their sins washed away. He must have presented a problem to the Jewish leaders. He was dressed like some sort of wild man; he was obviously a Holy Man; was he some sort of prophet? Prophets had been thin on the ground for generations. He had something special about him and they were supersticious enough not to want to offend him. They did what governments do when they don't know what to do. They set up a committee of enquiry. Lets go and ask him who he was, the committee decided. So they did.

Monday, April 11, 2011

Banning Burkas

The first two women in France have been arrested for wearing a burka. The British Home Secretary has said that such a law would not be enacted here although other countries in Europe have also banned or are about to ban the burka. Who is right? In one sense people ought to be allowed to wear whatever they like in a free country but as an article in today's Times puts it:

There are certainly circumstances in which women (or men) should not be allowed to cover their face fully: where it makes communication difficult, corrodes trust, or masks identity. When teaching children, for instance; or serving as a judge or as a jurist in a courtroom; or for either doctor or patient in a surgery consultation; or when passing through security checks; or entering a bank; or driving a car.

Apparently there are only 2000 women in France who wear a burka, so the law might seem a sledgehammer to crack a nut. The law as enacted applies to anyone covering his or her face in public, so it would catch out motor cyclists and in cold weather those wearing scarves over their faces. It would also, if applied in the UK, have caught out the rioters in London who were wearing balaclavas.

In France there is a strong tradition of keeping religion out of politics, and everybody from communists on the left to fascists on the right was in favor of the ban. There is also a strong tradition of freedom of expression, but the burka is seen not as freedom, but oppression. It's the men who enforce its use that the law is aimed at. The penalty for making a woman wear a burka is far greater than the penalty for wearing one.

To allow Muslims to express their religion by wearing a burka speaks of extreme tolerance that is very much at odds with a woman losing her job for wearing a crucifix. There is a strand in both UK and US society that goes to inordinate lengths to allow Muslims to do what they like. Is it because our leaders are afraid?

Early treatment for poor-risk patients

I am grateful to Beth Fillman for drawing my attention to this paper which I missed when it first came out in 2008.

In about 2002 I was gave a number of lectures in America, promoting the use of prognostic markers in CLL. One of the ideas I had was for the early treatment of patients with poor risk markers with some of the new, less toxic agents that were then becoming available. There was a great deal of resistance to the idea since a number of published papers had seemed to say that there was no point in treating patients early since their overall survival was not affected. My counter was that I certainly agreed that there was no point in treating all comers since a large proportion would never need treatment, but now we could predict those who would eventually need treatment why not start when the tumor burden was low. In addition, the old studies had been done with chlorambucil, which was less effective than some of the treatments now available.

However, there were some legitimate arguments that deterred any trial taking place. One was that early treatment might select out a drug resistant population and change the natural history of the disease. Another problem was that the only real reason to do such a trial was that it might improve overall survival, but if it did, the end-point would be in the distant future and which drug company would be prepared to fund such a trial.

However, it seems as though Clive Zent and Neil Kay and their colleagues at the Mayo Clinic did do such a trial and the results have been published in Cancer.

Patients to be included in the study fulfilled the 2008 Guidelines (more than 5000 monoclonal B cells per cu mm) and they had to be high risk with either 1] del 17p, 2] del 11q or 3] unmutated IGHV genes plus at least one of ZAP-70+ or CD38+.

My only quibble over these selection criteria is that we now know that some patients with del 17p have a smoldering disease that does not require treatment in the short term and probably should not be treated up from. Almost all of these patients have mutated IGVH genes, so it would probably be wise to insist that this trial was confined to patients with unmutated IGVH genes.

The inclusion of del 17p patients was justified by the choice of therapy, which included sc alemtuzumab combined with rituximab. The treatment lasted only 31 days with the alemtuzumab being given three times a week and the rituximab once a week.

30 patients were recruited: 20 men and 10 women. 25 had unmutated IGVH genes, 9 del 17p, 8 del 11q, and 13 the other poor-risk factors.

Toxicity was minimal. mild skin redness and itchiness at the site of alemtuzumab injection was common, but only one patient had mild 'shake and bake' from the rituximab. One patient had symptomatic CMV infection that was successfully treated with foscarnet and two others had asymptyomatic CMV activation requiring valganciclovir. Two patients had fever and rash due to Bactrim prophylaxis and there were three other minor non-hematologic toxicities. Neutropenia was mild except in five patients and there were no neutropenic infections. There was no grade 3 or 4 anemia or thrombocytopenia. Low monocytes were common. T cell levels also fell and recovery of CD8 levels took longer than 6 months and of CD4 levels longer than 12 months.

There were 27/30 responses (11CRs, 10 nodular PRs and 6 PRs. 6 had no detectable disease by immunohistochemistry of the bone marrow and 6 were MRD negative. 19 patients showed disease progression and one has died following a stem cell transplant. The median duration of response was 14.4 months. There was no selection for more malignant clones and no clonal evolution. Nine patients have required subsequent therapy with varying regimens. Overall, there have been 4 CRs, 3 PRs and 2 progressive diseases following chemotherapy.

I'm not sure what to make of these results. They tell us that if you treat patients with bad risk markers with an unusual regimen containing no chemotherapy, there will be a high response rate without much toxicity, but the responses will be shortlived at about 14 months. There will still be the odd patient that does very badly. Does such an approach confer any long term benefit? It is hard to tell and in order to find an answer, the authors dredged up a comparison cohort from their records, consisting of 117 patients. They were similar in age, stage and prognostic markers. The median time to first chemotherapy was 4.4 years in the trial group and 1.9 years for the comparison cohort. Looked at another way, at 4 years 60% of the treated patients were chemotherapy free, but only 30% of the untreated cohort.

I think this has to be regarded as a failed trial. treating early (at least with this very non-toxic regimen) does not produce a majority of patients with MRD negative disease who might be cured. Although double the number of patients remained chemotherapy free at 4 years, we do not know whether this would translate into longer life. It does confirm what others have found, namely that patients who achieve MRD negativity have the longest remissions. The options for further study in this field are to use this regimen for longer in the hope that more treatment would produce a greater effect for no more toxicity; or to make a more serious attempt to achieve MRD negativity with something like FCR followed by Campath; or perhaps the use of an agent like lenalidomide which interferes with the engine room of the disease - the tissue phase.

The reason for early treatment would only be the possibility of cure for some patients and this could be recognized only by a prolonged phase III study. However, a treatment that produced MRD negativity in a substantial proportion of patients for a substantial length of time might be an effective surrogate.

John 1:18

No-one has seen God but God the one and only, who is at the Father's side, has made him known.

I and my Father are one, says Jesus later in this Gospel. How silly that some people assume that God cannot be known. Among the many reasons that we have Jesus in Scripture is to make God Known. Only Jesus has this information. If you want to know God, study Jesus. From him we know that God is love, long suffering, kind - with a special affection for children, but also witty, imaginative, creative, good with people, wise, and though sometimes angry, always compassionate, powerful, valient for the truth and a hater of evil; concerned for his friends while not being blind to their faults, capable, confident, charismatic; giving gifts to those who don't deserve it out of mercy and grace.

So ends the prologue to John's Gospel. This is the poem that I wrote as a summary:

But Jesus was not Jesus then, no more
The Virgin Mary’s son; He was the Word,
With God, the three in one, in rapt rapport
Held fast by love. The Holy Three conferred
And made the sky, the earth, the sea; His hand
In each creative act. The Spirit soared
Above the seas before that great command,
“Let there be light!” He was the Light; adored
By angels. Darkness could not comprehend.
Then there was life, of countless, teeming kind.
In Him was life and His that life to lend;
The light of men; for Man he had designed
To hold His image and when thus constrained
To free from bondage those whom sin had stained.

Sunday, April 10, 2011

John 1:17

For the law was given through Moses; grace and truth came through Jesus Christ.

I almost said, "Just read Galatians." Jesus has been found worthy of greater honor than Moses, says the writer to the Hebrews (3:4) so grace is much superior to the law. The law points out where we are going wrong but is unable to save anyone. To rely on the law would be like trusting in a picture of a fire engine while you lock out the fire brigade when your house is on fire. We cannot earn our salvation we have to accept it as a grace gift. And that's the truth.

Saturday, April 09, 2011

John 1:16

From the fullness of his grace we have received one blessing after another,

In the Greek it is grace upon grace that we have received from his fullness. Jesus has a never-ending supply of unmerited favor. We see the echo in the question, "How many times shall I forgive my brother?" Until seven times". "Until seventy times seven!" This does not mean 490 times, for love keeps no record of wrongs. There is an unlimited supply of grace. Jesus is full of it; grace is overflowing. Past sins, present sins, future sins; all are forgiven; paid for by Christ's death on the cross; signed off on by the resurrection.

Friday, April 08, 2011

Assisted dying

I remember the BBC reporting on Margot MacDonald's Bill in the Scottish Parliament supporting assisted suicide but I can't remember hearing the outcome of the vote. No wonder! The Bill was overwhelmingly defeated by 85 votes to 16. There is a strong pro-euthanasia lobby amongst the liberal establishment which is supported by the BBC.

Now Lord Falconer has established a Commission on Assisted Dying under the auspices of the left-wing think tank, Demos. Falconer was the leading lawyer in Nu-Labour's failed administration. He got the job by being Tony Blair's room mate when he was a lawyer (how did we put up with Tony's cronies?)

Falconer has been adamant that he wanted to hear evidence from all sides, but 6 out of the first 11 invitees have refused to give evidence. Why is this?

First because there have already been a comprehensive recent examination of 'assisted dying' by a House of Lords Committee and three parliamentary votes in the past 6 years, all strongly rejecting a change in the law. Second. because of the 12 members of the Commission nine are already committed to a change in the law and the chairman, Lord Falconer, has already sponsored a Bill in the House of Lords to change the law. Third, none of the members of the Commission has been required to declare their conflicting interest. There is one disabled person on the Commission who is not a member of any of the five major disability rights organisations in the UK (RADAR, UKDPC, NCOL, SCOPE and Not Dead Yet). Why? Because all 5 oppose a change in the law. 95% of palliative care doctors and 65% of all doctors oppose a change in the law yet Falconer has chosen for his Commission four doctors who hold a contrary position.

It's a free country an Lord Falconer can do what he likes, but nobody should pay much attention to what his Commission will report.

Christian sacked from Drugs Advisory Council

Hans-Christian Raabe is a Christian GP who was appointed in January to the Advisory Council on the Misuse of Drugs (ACMD), an unpaid post. On 7 February he was dismissed as it has emerged that he had previously co-written a study linking homosexuality to pedophilia.

The paper he had written was a review of peer-reviewed publications in scientific journals, one of which had been quoted approvingly by the Home Office itself. It is a matter of scientific fact that homosexual pedophilia is relatively more common than heterosexual pedophilia, by a factor of 6 times. So it appears that he has been dismissed for stating a scientific fact that happens to be politically incorrect.

There is of course more to it than this. The ACMD is a controversial body that lost its chair, Professor David Nutt when he resigned over the government's decision top reclassify cannabis from a class C to a class B drug. He re-entered the debate by criticising Dr Raabe's appointment since Raabe supported a policy of total abstinence for drug addicts rather than harm reduction with methadone. If the advisory body is going to exclude one point of view on the advice of a dissident chairman, it suggests that someone at the Home Office is trying to fix the committee.

The other voice calling for Raabe's dismissal was that of the pernicious Dr Evan Harris, a Liberal MP who lost his seat at the last General Election. Harris is a Dawkins-type atheist who objected to an Evangelical Christian having a post on such a committee. He blogged about the old publication. What Raabe's views on homosexuality, which are those of the Church of England and the Roman Catholic Church, have to do with his ability to advise on drug policy is beyond me. Nor is it clear why he should be expected to declare them at interview. I certainly didn't declare my views on homosexuality when I was interviewed for membership of the Gene Therapy Advisory Committee. I can't think of anybody who has been.

BBC bias on AV

We are shortly to have a referendum on how we vote for our parliamentarians. The choice is between the present first past the post and the alternative vote system whereby where there are several candidates the voter may rank them. In the event of no-one achieving 50% of the votes, the candidate coming last is eliminated and his votes transferred to the second preferences, and so on until someone has 50% of the votes. If the second preference has already been eliminated then the third preference receives the votes. One obvious possibility is that someone gets elected whom nobody really wants.

I am in favor of sticking with what we've got. I am sure that any change will have unforeseen consequences and lead to coalition governments whose agreed program will not have featured in any Manifesto.

The greatest beneficiary will be the Liberal Party, who, being in the middle, will always be kingmakers after nearly a century without being able to muster a majority for themselves.

The newspapers have taken sides and so has the BBC while pretending to be neutral. Newspapers should nail their colors to the mast, but the BBC is supposed to be impartial by Statute. An example of their supposed neutrality can be seen from the Today program's take on it yesterday morning. This is their flagship political program and quite properly they invited a participant from both sides of the argument. The interviewer was James Naughtie. The first to speak was the supporter of the status quo. He was interrupted by Naughtie from his first sentence and barely able to make his case. When the supporter of AV spoke he was not interrupted at all by Naughtie and at the end of his spiel Naughtie asked his opponent whether that was not a convincing case. Naughtie is a long-time left-winger (like the majority at the BBC - appointments for the BBC are only advertised in the Guardian). At the end of the interview, Naughtie, conscious perhaps that he needed to be seen as impartial, offered the last word to the status quo supporter - and then allowed the AV supporter to answer him and get the last word himself.


The British government has changed the law on no-win/no-fee medical negligence cases. Under legislation drawn up by New Labour, claimant's lawyers could claim double their normal costs if they win a case. (Tony Blair was a lawyer). They can claim their usual fee plus a success fee of 100%. The whole package is payable by the losing defendant. The defendant is also liable to pay an insurance premium that the claimant takes out to insure against the possibility of losing. This system leaves the losing defendant paying out more in legal costs than they do in damages so that defensible cases are often settled rather than incur high legal expenses. In 2008-9 the NHS paid £312m in damages and £465m in lawyer's fees.

Under the new system losing claimants will no longer have to pay the winning defendant's costs so there will no longer be a need for insurance against losing. A losing defendant will pay the claimant's costs, but not a success fee, which will become the responsibility of the winning claimant, who will pay it out of damages won. The success fee will be capped at 25% of general damages.

The new regulations were welcomed by the Medical Defence Union which recently reported a case where the damages were £8000 and the lawyer's fees, £62,000.

Health and faith

Is there a link between faith and health? There have been over 1200 studies addressing this problem and 400 reviews. 81% of the papers showed a health benefit and 4% harm. For example an American study followed 21,204 Americans over 9 years, correlating various sociological data with death rates. Strangely, income and education were not independent prognostic factors, but those who attended church regularly had a life expectancy 7 years longer than those who did not. For black Americans the difference was 14 years (Hummer at al, Demography 1999; 36:273-85.)

Of course there are good reasons why church going might be conducive to longevity: fewer divorces, less alcohol and drug abuse, less cigarette smoking, less likely to be involved in violence and so on. But is there more than this?

Religion is often seen as a refuge for the weak-minded, but on the contrary churchgoers are more likely to cope well with mental illness. Religious involvement is correlated with well-being, happiness and life satisfaction; hope and optimism; purpose and meaning in life; higher self esteem; better adaptation to bereavement; greater social support and less loneliness; lower rates of depression and faster recovery from depression; lower rates of suicide and fewer positive attitudes towards suicide; less anxiety; less psychosis and fewer psychotic tendencies; lower rates of alcohol and drug abuse; less delinquency and criminal activity and greater marital stability and satisfaction. (Koenig et al. Handbook of Religion and Health. OUP 2001)

There have been reports of harm, particularly relating to extreme sects failing to take advantage of modern medicine, such as the Amish refusing vaccination or Jehovah's Witnesses refusing blood transfusion or Christian Scientists avoiding medical care, but these are rare.

Christians should not promote health benefits as the primary reason for coming to faith in Christ. Jesus came into the world to work a far deeper transformation of human lives than merely curing disease. Early Christians had a very high mortality, in fact, and Christians in many atheistic and Muslim countries experience the same today.

John 1:15

John testifies concerning him. He cries out, saying, "This was him of whom I said, 'He who comes after me has surpassed me because he was before me.'"

This verse raises a question of tenses. John 'testifies' not 'testified' (martyrei). This is not an error of translation of the NIV as far as I can tell and it implies that John had access to the written synoptic Gospels when he wrote his own, for the Baptist was long ago murdered by Herod. As today, it's 'Scripture Speaks' not 'scripture has spoken'.

Then we have the question of who came first. We don't have the same reverence for seniority that Eastern cultures do. We have no difficulty is asserting that Johann Strauss fils is a better composer than Johann Strauss pere, or that Queen Elizabeth the First was an incomparably better monarch than her older sister Mary Tudor.

The Baptist was an older cousin of Jesus and Jesus showed him due respect. He called him 'more than a prophet'; there was 'among those born of women no-one greater than John'. (Luke 7:26-28) But John witnessed to the fact that Jesus was before him because as the second person of the Trinity he had always existed.

Thursday, April 07, 2011

John 1:14

The Word became flesh and made his dwelling among us. We have seen his glory, the glory of the one and only, who came from the Father, full of grace and truth.

I have been dreading how to unpack this verse. There is so much in it to ponder. First, it affirms the incarnation. If it were not obvious by now, the Word is Jesus. God in human form. There is no nativity narrative in John's Gospel, but he undoubtedly had those of Matthew and Luke before him.
Second, the word 'became' should not be taken to mean a metamorphosis, like a tadpole becoming a frog or a caterpillar becoming a butterfly. It really means adding something to what was there already. He added humanity to divinity. He only laid aside his Majesty.
Third, he made his dwelling among us - like pitching a tent. It was a temporary affair, unlike his humanity. He gave up his dwelling among us when he ascended into heaven, but he didn't give up being human. He still feels for us.
Fourth, his glory. I wondered if John was thinking about the Mount of Transfiguration. He was one of the privileged three who witnessed the appearance of his face changing so that it shone like the sun and his clothes becoming as bright as a flash of lightning, dazzling white, whiter than anyone in the world could bleach them, when a voice came from a cloud proclaiming, "This is my son, whom I love." Was that the glory that John meant? Or was it the glory of his wonderful life, death and resurrection?
Fifth, what does it mean, 'the one and only who came from the Father'? The KJV has 'the only begotten of the Father'. This seems to be the natural meaning and the change is only to give wriggle room to those who object to the idea of Jesus as the son of God. His sonship derives not from his miraculous conception and birth, nor was the title conferred upon him as recognition of his atoning sacrifice. He was the Son by his nature and from eternity. He is the beloved Son in whom the Father is well pleased. Son of God may be offensive to Moslems; they are repelled by the idea of a God having sex with a woman, like some Zeus from Greek mythology. It is rather, a metaphor for the intimate relationship between the first and second persons of the Trinity.
Sixth, full of grace and truth. Grace because the message he brought and the blessing he procured were of unmerited favor for the guilty. Truth because he was the final reality; the truth behind all the shadows that preceded him.

Wednesday, April 06, 2011

Splenic lymphomas

My source for this article is Iannitto & Tripido, Blood 2011; 17:2585.

The causes of splenomegaly are many. Infections can cause (usually transitory) splenomegaly and include brucellosis, EBV and CMV infections, Leishmaniasis and viral hepatitis. Myeloid neoplasms can be responsible including chronic myeloid leukemia, polycythemia rubra vera, chronic myelomonocytic leukemia and myelofibrosis. Various types of hemolytic anemia, especially AIHA, thalassemia, sickle cell disease in children, certain hemoglobinopathies and hereditary spherocytosis may be the cause. It can be a feature of some inflammatory diseases like SLE, rheumatoid arthritis (Felty's syndrome) and sarcoidosis. It is a feature of portal hypertension caused by cirrhosis of the liver, (always reminds me of a gin palace type of pleasure cruiser called Cirrhosis of the River), or thrombosis of splenic, portal or hepatic vein. There are rare tumors: Littoral cell angiomas, hemangiomas, lymphanghiomas, spindle cell angiomas and various metastases, particularly from melanoma. Then there are some weird diseases like Gaucher's and Amyloidosis.

Most of these have other manifestations as do some lymphomas that affect the spleen like follicular lymphoma, mantle cell lymphoma and Hodgkin's disease, but there is a rare group of lymphomas that cause isolated splenomegaly - perhaps with some effect on the blood and marrow. The splenic lymphomas include splenic marginal zone lymphoma, Hairy Cell Leukemia, Hairy Cell variant, splenic diffuse red pulp B-cell lymphoma, lymphoplasmacytoid lymphoma, primary splenic follicular lymphoma, B- and T-PLL, LGL leukemia and hepatosplenic T-cell lymphoma.

Investigation will always include whole body CT scan to determine if the disease truly is confined to the spleen, and whether it is focal or diffuse. A blood film and flow cytometry will be essential to recognize certain types of lymphoma and bone marrow biopsy with chromosomal as well as cytological and histological examination are essential.

If no diagnosis is obtained or if a high grade lymphoma or mantle cell lymphoma is still a possibility then a diagnostic splenectomy should be performed, but it can be avoided if its only purpose is to distinguish between splenic marginal zone lymphoma, splenic diffuse red pulp B-cell lymphoma and lymphoplasmacytoid lymphoma, since the therapeutic action to any of these diagnoses is likely to be watch and wait, though if the possibility of mantle cell lymphoma persists or the patient has signs of an aggressive lymphoma, (B symptoms, high LDH or Beta 2M) then diagnostic splenectomy should go ahead. It should be remembered that laparoscopic splenectomy, though safer and less traumatic to the patient, will fragment the spleen and make histological examination more difficult.

The treatment of common lymphoma of the spleen should not necessarily be different from the nodal versions of the disease. Splenic follicular lymphoma should be treated with immunochemotherapy with or without splenectomy. Mantle cell lymphoma of the spleen is often more indolent, having a greater likelihood of mutated IGHV genes. After splenectomy, some patients do well with watch and wait. DLBCL is the same dread disease whether or not it is confined to the spleen and requires aggressive therapy.

Nearly 80% with isolated splenic lymphoma have either splenic marginal zone lymphoma or splenic diffuse red pulp B-cell lymphoma. These mainly occur in the elderly and commonly pursue an indolent course with roughly 70% of patients alive at 10 years. Some patients seem to have their disease secondary to an HCV infection and for these treatment with Peg-interferon and Ribavirin is indicated. For others watch and wait until the disease becomes symptomatic or progressive when splenectomy might become applicable. As an alternative, treatment with rituximab might be ventured. It can be very effective and has proved its worth in the closely related cold hemagglutination syndrome. Treatment should be started if Hb <10g/dL, platelets <80,000 of a rising LDH, or if the splenomegaly becomes symptomatic. There is a prognostic scoring system which considers as risk factors a Hb <12 g/dL. a raised LDH and an albumin <3.5 g/dL. If no risk factors are present the overall 5-year survival is 83%, if one, it is 72% and if two or more, it is 56%.

For patients unwilling to consider splenectomy, those with a rapidly rising lymphocyte count, those with abdominal lymph nodes or extranodal involvement and those with AIHA or other autoimmune complications chemotherapy may be indicated. The choice of agent is unclear and there are advocates for FCR, FR and bendamustine.