I was 30 years old. I had just been appointed as consultant hematologist in a beautiful seaside town. I had a wonderful wife and two lovely children. I was financially secure for the rest of my life. I was well on my way to making a name for myself as a research scientist. One day I was going to be famous in my field. I was moving into a circle of smart people with every material luxury. I could see that it would soon be mine.
And yet I was profoundly unhappy. Something was obviously missing in my life.
One day (these were the days when doctors did house calls) I visited a patient at home. As he opened the door to me, he greeted me with, “Hello, doctor, I’m a committed Christian, how about you?”
What an embarrassment. I muttered something about being sent to Sunday School as a child, but, in truth, I had given up on religion. I had taken home the message that if you went around doing good, or at least did your best, you would end up in heaven. I was honest enough to know that I couldn’t do good all the time, and indeed, much of the time I didn’t even do my best. Nevertheless, he sent me on my way with, “Why don’t you come to our church. You will find Francis Dixon a wonderful preacher.”
Six months went by and I did nothing. I was sinking into an ever deeper despair, particularly so as all the skills that I had relied on to answer examination questions were letting me down. I could get the diagnosis right and give the right treatment, but my leukemia patients still died.
Eventually my wife cajoled to me to going to my patient’s church. On the first Sunday I tried, I couldn’t find it so I returned home empty. I found it the second time, and looked around, expecting to see at least one friendly face. It was difficult because the church was absolutely packed with hardly a seat to be found, not the way I envisioned churches. The reason I couldn’t find him soon became apparent. He had died the previous Thursday. The sermon that Francis Dixon preached that day was clearly designed to console his widow.
His text was from John 11:25-26. It was the story of the raising of Lazarus. Remember the story, the sisters of Lazarus, Mary and Martha, had sent word to Jesus that their brother was dying. Rather than hurrying to Bethany, where they lived, Jesus stayed where he was across the River Jordan for two more days. Eventually he decided to go. When he arrived at Bethany Lazarus had died and had been in the grave for 4 days. Jesus had deliberately delayed because he was about to perform the miracle of raising Lazarus from the dead. When he arrived Martha scolded him, “Lord, if you had been here my brother would not have died.”
Jesus replied, “I am the resurrection and the life, he that believeth in me, though he were dead, yet shall he live, and whosoever liveth and believeth in me shall never die.” (In those days they used the KJV)
Jesus then asked Martha, “Do you believe this?”
And Francis Dixon points straight at me and asks, “Do you believe this?”
Martha replied, “Yes, Lord, I believe that you are the Christ, the Son of God, who was to come into the world.”
This was the pointed question I was asked. Did I believe that? Now was the time to stop pussyfooting around. This was the real question. Did I believe that Jesus was the Son of God, with power over Life and Death or was he just a prophet or a wise man or even just a good man? If I believed that he was the Christ I would live my life one way; if I believed he was not then I would live my life completely differently.
You cannot figure this out by logic or by examining the world or by any type of science. You have to make a decision, because in not making a decision that he is the Christ you are making a decision that he is not. People talk about a leap of faith. I never knew what that meant. But then I did. To believe that Jesus is the Christ means to live it and only by living it do you discover that it is true.
On that day, I trusted it was true and today I testify that it is true.
I later learned that my patient’s wife and two other women had been meeting every week to pray for the conversion of his doctor.
Monday, January 22, 2007
Wednesday, January 17, 2007
Anniversaries
2007 is going to be a year of anniversaries. Two at least deserve mention. It is the 200th anniversary of the Slave Trade. To celebrate a feature film on the life of William Wilberforce is being released with the part of Wilberforce being played by that nice young man from Hornblower, Ioan Gruffudd.
It is also the 100th anniversary of the founding of the Boy Scouts by Baden Powell. This has a local connection, as they began on Brownsea Island in Poole, just a stone's throw away from here.
Brownsea is one of the few remaining habitats of red squirrels in England. A community was established in the island by 800 AD, but it is not mentioned in the Domesday book. By the sixteenth cemetery it had become a hideout for pirates. At the time of the Restoration it was owned by Robert Clayton MP, later to become Lord Mayor of London, and a castle built on the site of old reins in 1726 by the eccentric William Benson. It was improved by Sir Humphtey Sturt of More MP in 1765. In 1852 china clay was discovered on the island and pottery manufacture was begun employing 200 people. Alas the clay was not of sufficient quality to make fine porcelain and the making of sanitary ware could not sustain the industry so the business folded. Eventually the Island was accepted by the Treasury in lieu of Death Duties and the Island became the property of the National Trust, who still own it. This summer Boy scouts from all over the world will be camping on Brownsea in celebration of the centenary.
It is also the 100th anniversary of the founding of the Boy Scouts by Baden Powell. This has a local connection, as they began on Brownsea Island in Poole, just a stone's throw away from here.
Brownsea is one of the few remaining habitats of red squirrels in England. A community was established in the island by 800 AD, but it is not mentioned in the Domesday book. By the sixteenth cemetery it had become a hideout for pirates. At the time of the Restoration it was owned by Robert Clayton MP, later to become Lord Mayor of London, and a castle built on the site of old reins in 1726 by the eccentric William Benson. It was improved by Sir Humphtey Sturt of More MP in 1765. In 1852 china clay was discovered on the island and pottery manufacture was begun employing 200 people. Alas the clay was not of sufficient quality to make fine porcelain and the making of sanitary ware could not sustain the industry so the business folded. Eventually the Island was accepted by the Treasury in lieu of Death Duties and the Island became the property of the National Trust, who still own it. This summer Boy scouts from all over the world will be camping on Brownsea in celebration of the centenary.
Tuesday, January 16, 2007
MSM v bloggers (part 2)
New York Times Caught in Abortion-Promoting Whopper - Infanticide Portrayed as Abortion
By John-Henry Westen
EL SALVADOR, November 27, 2006 (LifeSiteNews.com) - On April 9, New York Times reporter Jack Hitt produced what may be called a 'hit piece' against the pro-life movement in El Salvador. The piece, laden with scare tactics, culminates in his tale of woe of a woman who he says had an illegal abortion when she was 18 weeks pregnant and was sentenced to thirty years in prison. The only problem with the story is that the woman was found guilty of strangling her full-term baby shortly after her birth.
Writing in an editorial in one of the largest papers in El Salvador, Julia Cardenal, who was interviewed for the New York Times Hitt piece, excoriates the Times for false reporting. Referring to Hitt, Cardenal asks what the intention was of the NYT piece. "To cause indignation in the United States so that they will pressure us to legalize abortion?," she asks rhetorically.
Hitt described his visit to Carmen Climaco in prison. "I was there to see Carmen Climaco. She is now 26 years old, four years into her 30-year sentence," wrote Hitt. The New York Times article concludes, "She'd had a clandestine abortion at 18 weeks, not all that different from D.C.'s, something defined as absolutely legal in the United States. It's just that she'd had an abortion in El Salvador."
However, court records from the case, which have been obtained by LifeSiteNews.com, indicate that the case was actually one of infanticide rather than illegal abortion. While it was investigated on the suspicion of an illegal abortion, authorities found the dead baby hidden in a box wrapped in bags under the bed of Mrs. Climaco.
Moreover, forensic examination showed that it was a full term (38-42 weeks gestation) normal delivery, and that the child was breathing at the time of birth. The legal opinion of the cause of death was asphyxia by strangulation.
Cardenal also points out that the main source of information for Hitt came from a pro-abortion group called IPAS. She notes that the group stands to profit financially from the legalization of abortion in El Salvador since it sells vacuum aspirators used for abortion and incomplete abortion.
Evangelina Guirola, Julia de Cardenal's sister, who assisted in the research for the editorial responding to the New York Times, told LifeSiteNews.com that IPAS is running a campaign to free Carmen Climaco and bring her to the United States.
Yet another case of a lazy journalist being fed propaganda and not bothering to check the details because the 'story' accords with his prejudices.
Thankfully, the New York Times allows itself to be scrutinized by a person they call the Public Editor who acts on the readers' behalf, and this damning piece by BYRON CALAME appeared on December 31, 2006
The care taken in the reporting and editing of this example didn’t meet the magazine’s normal standards. Although Sarah H. Smith, the magazine’s editorial manager, told me that relevant court documents are “normally” reviewed, Mr. Hitt never checked the 7,600-word ruling in the Climaco case while preparing his story. And Mr. Hitt told me that no editor or fact checker ever asked him if he had checked the court document containing the panel’s decision.
Mr. Hitt said Ms. Climaco had been brought to his attention by the magistrate who decided four years ago that the case warranted a trial, so he had asked the magistrate for the court record. “When she told me that the case had been archived, I accepted that to mean that I would have to rely upon the judge who had been directly involved in the case and who heard the evidence” in the trial stage of the judicial process, Mr. Hitt wrote in an e-mail to me. So he didn’t pursue the document.
But obtaining the public document isn’t difficult. At my request, a stringer for The Times in El Salvador walked into the court building without making any prior arrangements a few days ago and minutes later had an official copy of the court ruling. It proved to be the same document as the one disseminated by LifeSiteNews.com, which had been translated into English in early December by a translator retained by The Times Magazine’s editors. I’ve since had the stringer review the translation of key paragraphs for me. The magistrate, Mr. Hitt noted, “had been helpful in other areas of the story and quite open.” So when she recalled one doctor’s estimate that Ms. Climaco’s pregnancy had been aborted at 18 weeks, he used that in the article. (The only 18-week estimate mentioned in the court ruling came from a doctor who hadn’t seen any fetus and whose deductions from the size of the uterus 17 hours after the birth were found by the three judges to be flawed.)
The magazine’s failure to check the court ruling was then compounded for me by the handling of reader complaints about the issue. The initial complaints triggered a public defense of the article by two assistant managing editors before the court ruling had even been translated into English or Mr. Hitt had finished checking various sources in El Salvador. After being queried by the office of the publisher about a possible error, Craig Whitney, who is also the paper’s standards editor, drafted a response that was approved by Gerald Marzorati, who is also the editor of the magazine. It was forwarded on Dec. 1 to the office of the publisher, which began sending it to complaining readers.
The response said that while the “fair and dispassionate” story noted Ms. Climaco’s conviction of aggravated homicide, the article “concluded that it was more likely that she had had an illegal abortion.” The response ended by stating, “We have no reason to doubt the accuracy of the facts as reported in our article, which was not part of any campaign to promote abortion.”
After the English translation of the court ruling became available on Dec. 8, I asked Mr. Marzorati if he continued to have “no reason to doubt the accuracy of the facts” in the article. His e-mail response seemed to ignore the ready availability of the court document containing the findings from the trial before the three-judge panel and its sentencing decision. He referred to it as the “third ruling,” since the trial is the third step in the judicial process.
The article was “as accurate as it could have been at the time it was written,” Mr. Marzorati wrote to me. “I also think that if the author and we editors knew of the contents of that third ruling, we would have qualified what we said about Ms. Climaco. Which is NOT to say that I simply accept the third ruling as ‘true’; El Salvador’s judicial system is terribly politicized.”
I asked Mr. Whitney if he intended to suggest that the office of the publisher bring the court’s findings to the attention of those readers who received the “no reason to doubt” response, or that a correction be published. The latest word from the standards editor: “No, I’m not ready to do that, nor to order up a correction or Editors’ Note at this point.”
One thing is clear to me, at this point, about the key example of Carmen Climaco. Accuracy and fairness were not pursued with the vigor Times readers have a right to expect.
An independent scrutineer has looked at the process and found it wanting. The editors are unwilling to accept the criticism, no doubt because they have been found out by a website of the religious right.
I seem to remember a reporter from the NYT being dismissed recently for making up terminological inexactitudes like this.
By John-Henry Westen
EL SALVADOR, November 27, 2006 (LifeSiteNews.com) - On April 9, New York Times reporter Jack Hitt produced what may be called a 'hit piece' against the pro-life movement in El Salvador. The piece, laden with scare tactics, culminates in his tale of woe of a woman who he says had an illegal abortion when she was 18 weeks pregnant and was sentenced to thirty years in prison. The only problem with the story is that the woman was found guilty of strangling her full-term baby shortly after her birth.
Writing in an editorial in one of the largest papers in El Salvador, Julia Cardenal, who was interviewed for the New York Times Hitt piece, excoriates the Times for false reporting. Referring to Hitt, Cardenal asks what the intention was of the NYT piece. "To cause indignation in the United States so that they will pressure us to legalize abortion?," she asks rhetorically.
Hitt described his visit to Carmen Climaco in prison. "I was there to see Carmen Climaco. She is now 26 years old, four years into her 30-year sentence," wrote Hitt. The New York Times article concludes, "She'd had a clandestine abortion at 18 weeks, not all that different from D.C.'s, something defined as absolutely legal in the United States. It's just that she'd had an abortion in El Salvador."
However, court records from the case, which have been obtained by LifeSiteNews.com, indicate that the case was actually one of infanticide rather than illegal abortion. While it was investigated on the suspicion of an illegal abortion, authorities found the dead baby hidden in a box wrapped in bags under the bed of Mrs. Climaco.
Moreover, forensic examination showed that it was a full term (38-42 weeks gestation) normal delivery, and that the child was breathing at the time of birth. The legal opinion of the cause of death was asphyxia by strangulation.
Cardenal also points out that the main source of information for Hitt came from a pro-abortion group called IPAS. She notes that the group stands to profit financially from the legalization of abortion in El Salvador since it sells vacuum aspirators used for abortion and incomplete abortion.
Evangelina Guirola, Julia de Cardenal's sister, who assisted in the research for the editorial responding to the New York Times, told LifeSiteNews.com that IPAS is running a campaign to free Carmen Climaco and bring her to the United States.
Yet another case of a lazy journalist being fed propaganda and not bothering to check the details because the 'story' accords with his prejudices.
Thankfully, the New York Times allows itself to be scrutinized by a person they call the Public Editor who acts on the readers' behalf, and this damning piece by BYRON CALAME appeared on December 31, 2006
The care taken in the reporting and editing of this example didn’t meet the magazine’s normal standards. Although Sarah H. Smith, the magazine’s editorial manager, told me that relevant court documents are “normally” reviewed, Mr. Hitt never checked the 7,600-word ruling in the Climaco case while preparing his story. And Mr. Hitt told me that no editor or fact checker ever asked him if he had checked the court document containing the panel’s decision.
Mr. Hitt said Ms. Climaco had been brought to his attention by the magistrate who decided four years ago that the case warranted a trial, so he had asked the magistrate for the court record. “When she told me that the case had been archived, I accepted that to mean that I would have to rely upon the judge who had been directly involved in the case and who heard the evidence” in the trial stage of the judicial process, Mr. Hitt wrote in an e-mail to me. So he didn’t pursue the document.
But obtaining the public document isn’t difficult. At my request, a stringer for The Times in El Salvador walked into the court building without making any prior arrangements a few days ago and minutes later had an official copy of the court ruling. It proved to be the same document as the one disseminated by LifeSiteNews.com, which had been translated into English in early December by a translator retained by The Times Magazine’s editors. I’ve since had the stringer review the translation of key paragraphs for me. The magistrate, Mr. Hitt noted, “had been helpful in other areas of the story and quite open.” So when she recalled one doctor’s estimate that Ms. Climaco’s pregnancy had been aborted at 18 weeks, he used that in the article. (The only 18-week estimate mentioned in the court ruling came from a doctor who hadn’t seen any fetus and whose deductions from the size of the uterus 17 hours after the birth were found by the three judges to be flawed.)
The magazine’s failure to check the court ruling was then compounded for me by the handling of reader complaints about the issue. The initial complaints triggered a public defense of the article by two assistant managing editors before the court ruling had even been translated into English or Mr. Hitt had finished checking various sources in El Salvador. After being queried by the office of the publisher about a possible error, Craig Whitney, who is also the paper’s standards editor, drafted a response that was approved by Gerald Marzorati, who is also the editor of the magazine. It was forwarded on Dec. 1 to the office of the publisher, which began sending it to complaining readers.
The response said that while the “fair and dispassionate” story noted Ms. Climaco’s conviction of aggravated homicide, the article “concluded that it was more likely that she had had an illegal abortion.” The response ended by stating, “We have no reason to doubt the accuracy of the facts as reported in our article, which was not part of any campaign to promote abortion.”
After the English translation of the court ruling became available on Dec. 8, I asked Mr. Marzorati if he continued to have “no reason to doubt the accuracy of the facts” in the article. His e-mail response seemed to ignore the ready availability of the court document containing the findings from the trial before the three-judge panel and its sentencing decision. He referred to it as the “third ruling,” since the trial is the third step in the judicial process.
The article was “as accurate as it could have been at the time it was written,” Mr. Marzorati wrote to me. “I also think that if the author and we editors knew of the contents of that third ruling, we would have qualified what we said about Ms. Climaco. Which is NOT to say that I simply accept the third ruling as ‘true’; El Salvador’s judicial system is terribly politicized.”
I asked Mr. Whitney if he intended to suggest that the office of the publisher bring the court’s findings to the attention of those readers who received the “no reason to doubt” response, or that a correction be published. The latest word from the standards editor: “No, I’m not ready to do that, nor to order up a correction or Editors’ Note at this point.”
One thing is clear to me, at this point, about the key example of Carmen Climaco. Accuracy and fairness were not pursued with the vigor Times readers have a right to expect.
An independent scrutineer has looked at the process and found it wanting. The editors are unwilling to accept the criticism, no doubt because they have been found out by a website of the religious right.
I seem to remember a reporter from the NYT being dismissed recently for making up terminological inexactitudes like this.
Monday, January 15, 2007
Bloggers versus MSM
Yesterday my son and I were discussing who was the more believable, the main stream media or the bloggers.
I don't know how many people caught this New Year's Eve piece in the Sunday Times.
Science told: hands off gay sheep
Isabel Oakeshott and Chris Gourlay
Experiments that claim to 'cure' homosexual rams spark anger
SCIENTISTS are conducting experiments to change the sexuality of 'gay' sheep in a programme that critics fear could pave the way for breeding out homosexuality in humans.
The technique being developed by American researchers adjusts the hormonal balance in the brains of homosexual rams so that they are more inclined to mate with ewes.
It raises the prospect that pregnant women could one day be offered a treatment to reduce or eliminate the chance that their offspring will be homosexual. Experts say that, in theory, the 'straightening' procedure on humans could be as simple as a hormone supplement for mothers-to-be, worn on the skin like an anti-smoking nicotine patch.
Apparently the research has caused outrage in the Gay Community.
Martina Navratilova, the lesbian tennis player who won Wimbledon nine times, and scientists and gay rights campaigners in Britain have called for the project to be abandoned.
Navratilova defended the 'right' of sheep to be gay. She said: "How can it be that in the year 2006 a major university would host such homophobic and cruel experiments?" She said gay men and lesbians would be 'deeply offended' by the social implications of the tests.
In fact, the whole article was a pack of lies and speculation. The estimable Ben Goldacre has exposed the whole article as a work of fiction.
Sunday Times: "The animals' skulls are cut open and electronic sensors are attached to their brains."
Goldacre: simply and rather bizarrely not true. There's no neurophysiology in these experiments. They don't even measure things from nerve cells: they measure mate preference, by watching the sheep choose a mate.
Sunday Times: "By varying the hormone levels, mainly by injecting hormones into the brain they have had 'considerable success' in altering the rams' sexuality, with some previously gay animals becoming attracted to ewes."
Goldacre: This is not just completely untrue, it is, in fact, the polar opposite of what the researchers really did. The only similar work completed and published by this team of researchers was about trying to make 'straight' animals 'gay' (although animal behaviour researchers avoid those terms) and in any case, that experiment was negative: it failed to achieve this aim.
Sunday Times: "Initially, the publicly funded project aimed to improve the productivity of herds"
Sunday Times: "The research is being peer-reviewed by a panel of scientists in America"
Sunday Times: "Scientists are conducting experiments to change the sexuality of 'gay' sheep in a programme that critics fear could pave the way for breeding out homosexuality in humans"
Goldacre: None of these statements is true. Nothing is currently under peer review, because nothing has been submitted for publication, because no current experiments are completed. There aren't even any grants under review. The scientists have been very clear that this is a basic science study, from animal behaviour researchers, aimed at gaining an understanding of the biology of sexual attraction.
Where did all this disinformation come from? Unsurprisingly it comes from PETA - People for the Ethical Treatment of Animals. It is bit of propaganda but out by the animal libbers and swallowed whole by the Deputy Political editor of the Sunday Times (though she has a reputation for grinding axes).
So much for the Main Stream Media, how did the bloggers fare? It turns out that the bloggers had the story since last August, and although some fell for it, it was quickly exposed as a PETA lie. A remarkable investigation of how the exposure of a lie can be halfway round the world before the Main Stream Media have got there boots on can be found at this site.
I don't know how many people caught this New Year's Eve piece in the Sunday Times.
Science told: hands off gay sheep
Isabel Oakeshott and Chris Gourlay
Experiments that claim to 'cure' homosexual rams spark anger
SCIENTISTS are conducting experiments to change the sexuality of 'gay' sheep in a programme that critics fear could pave the way for breeding out homosexuality in humans.
The technique being developed by American researchers adjusts the hormonal balance in the brains of homosexual rams so that they are more inclined to mate with ewes.
It raises the prospect that pregnant women could one day be offered a treatment to reduce or eliminate the chance that their offspring will be homosexual. Experts say that, in theory, the 'straightening' procedure on humans could be as simple as a hormone supplement for mothers-to-be, worn on the skin like an anti-smoking nicotine patch.
Apparently the research has caused outrage in the Gay Community.
Martina Navratilova, the lesbian tennis player who won Wimbledon nine times, and scientists and gay rights campaigners in Britain have called for the project to be abandoned.
Navratilova defended the 'right' of sheep to be gay. She said: "How can it be that in the year 2006 a major university would host such homophobic and cruel experiments?" She said gay men and lesbians would be 'deeply offended' by the social implications of the tests.
In fact, the whole article was a pack of lies and speculation. The estimable Ben Goldacre has exposed the whole article as a work of fiction.
Sunday Times: "The animals' skulls are cut open and electronic sensors are attached to their brains."
Goldacre: simply and rather bizarrely not true. There's no neurophysiology in these experiments. They don't even measure things from nerve cells: they measure mate preference, by watching the sheep choose a mate.
Sunday Times: "By varying the hormone levels, mainly by injecting hormones into the brain they have had 'considerable success' in altering the rams' sexuality, with some previously gay animals becoming attracted to ewes."
Goldacre: This is not just completely untrue, it is, in fact, the polar opposite of what the researchers really did. The only similar work completed and published by this team of researchers was about trying to make 'straight' animals 'gay' (although animal behaviour researchers avoid those terms) and in any case, that experiment was negative: it failed to achieve this aim.
Sunday Times: "Initially, the publicly funded project aimed to improve the productivity of herds"
Sunday Times: "The research is being peer-reviewed by a panel of scientists in America"
Sunday Times: "Scientists are conducting experiments to change the sexuality of 'gay' sheep in a programme that critics fear could pave the way for breeding out homosexuality in humans"
Goldacre: None of these statements is true. Nothing is currently under peer review, because nothing has been submitted for publication, because no current experiments are completed. There aren't even any grants under review. The scientists have been very clear that this is a basic science study, from animal behaviour researchers, aimed at gaining an understanding of the biology of sexual attraction.
Where did all this disinformation come from? Unsurprisingly it comes from PETA - People for the Ethical Treatment of Animals. It is bit of propaganda but out by the animal libbers and swallowed whole by the Deputy Political editor of the Sunday Times (though she has a reputation for grinding axes).
So much for the Main Stream Media, how did the bloggers fare? It turns out that the bloggers had the story since last August, and although some fell for it, it was quickly exposed as a PETA lie. A remarkable investigation of how the exposure of a lie can be halfway round the world before the Main Stream Media have got there boots on can be found at this site.
Saturday, January 13, 2007
MHS (not a typo)
This week's BMJ contains a debate over whether the NHS should have make special allowances for Muslims. Here is how teh BBC website deals with the qustion:
The NHS should provide more faith-based care for Muslims, an expert says.
Muslims are about twice as likely to report poor health and disability than the general population, says Edinburgh University's Professor Aziz Sheikh.
Writing in the British Medical Journal, he called for male circumcision on the NHS and more details over alcohol derived drugs.
Here are three previous stories on the same topic:
1: Some Muslims are undermining the battle to rid Britain’s hospitals of killer infections by refusing to wash their hands when visiting sick relatives.
Dispensers containing anti-bacterial gel have been placed outside wards at hospitals all over Britain in a bid to get rid of superbugs like MRSA and PVL.
It prevents people bringing in more infections. But some Muslims refuse to use the hand cleansers on religious grounds because they contain alcohol.
Health watchdogs are so concerned they intend to meet with NHS bosses in the New Year to try and hammer out a solution.
NHS care assistant Theresa Poupa, 46, became aware of the situation while visiting a sick cousin at the London Chest Hospital in Bethnal Green.
She said: “I could not believe it - the signs are large enough and clear enough but they just took no notice and walked straight onto the ward.
“I was there almost every day for three weeks and I saw it repeated dozens and dozens of times. When I raised the matter with the nursing staff they just shrugged and said that Muslims were refusing to use the gel because it contained alcohol.
“They said they couldn’t force visitors to use the gel and I understand that — but I was astonished that anyone who didn’t wash their hands was allowed onto a ward.
“I know the dangers that bugs like MRSA can cause. They kill hundreds of patients a year.”
Michael Summers, chairman of the Patients’ Association, said: “I have been made aware of this situation during discussions with nurses and it is a very serious state of affairs.”
2: Medical scandal surrounding a 17 year old male shepherd from Konya who was unable to receive proper attention at the Konya Testing Hospital due to the fact that two of the attending radiology doctors were women wearing headscarves, has grown.
The shepherd, referred to only as "A.G." in reports, arrived at the Konya Testing Hospital complaining of swollen testicles, and was sent to get ultrasound tests, but was refused service by two female doctors wearing headscarves. The shepherd later had to have one of his testicles removed by operation. Yesterday the Turkish Parliament debated the case, with opposition CHP Party members asserting that they would be following the case. Meanwhile, the Konya hospital's head of urology, Doctor Celal Tutuncu, said yesterday that he felt that the case was very "black and white," and that as soon as documents showing exactly which doctors had refused service to the shepherd were made clear, action would be taken.
A top CHP lawyer, Atilla Kart, spoke to Hurriyet yesterday, noting he was not "surprised" by the case, saying "This is the destruction wrought by religious references spilling over into public adminstration."
He went on: "This is the point at which Turkey's public administration has arrived. It is clear that that turbaned doctor was working with the full knowledge of the hospital administration.....But in fact the incident is not limited to the administration of the hospital; I believe it is also linked to the regional administration too. We see now what can happen when religious exploitation and religious references are carried over into our government....Konya is a photograph of the general situation in Turkey."
3: As France's national assembly neared the end of a four-day debate on a ban on religious emblems in state schools, the prime minister, Jean-Pierre Raffarin, said "similar legislation" was planned to stop hospital patients refusing to be treated by male doctors. Health administrators have reported cases of Muslim husbands who would rather their wives were denied treatment than be examined by a man. Women in labor have refused epidurals because the anesthetist was male.
Let's not go there.
My personal experience with Islam is quite different from this. Most Muslims that I have met have behaved impeccably.
What we are facing is a perversion of Islam that has gripped fairly ignorant people. While in the UK we have seen young men and women who have come under the influence of imams from Pakistan and Afghanistan who seem to believe that blowing themsleves up together with hundreds of fellow travelers serves the cause of God. I know that these outrages are not confined to Western countries.
The BMJ article was pleading for a health service with special consideration for Muslims. My point is that everybody must be treated equally. For example, take circumcision of young boys. Jews and Muslims believe it should be done as part of their faith. Christians believe it should be done only for medical reasons. My argument is that if Jews and Muslims want this extra service then they should make arrangements to have it financed. Muslim countries and Israel may wish to have this provided for them by the state - that is their business, but they can hardly expect a Christian country to provide it from state funds.
Jehovah's Witnesses refuse blood transfusions. Anemic patients have an alternative to blood transfusion, the drug erythropoietin. Unfortunately it is 4 times as expensive as blood transfusion, and it is unavailable to NHS patients. If Jehovah's Witnesses demand it then their church must pay for it and not expect it paid for by the taxpayer.
In many circumstances in the NHS it is possible for a patient to be seen by a doctor of the same sex, but we do not have the resources to guarantee it. On occasion it is necessary for a patient to be seen by a doctor of the opposite sex. The patient must be willing to accept this or go to a private physician of their choice.
Female circumcision is required by some Muslim comunities. In England this is seen as criminal assault.
As a Christian I deplore drunkenness. I am ashamed that British young people go to foreign countries and desport themselves in a lewd and drunken manner. Christians have things that we are ashamed of too.
After the bombings in London, New York, Madrid, Bali, Egypt, India, Kenya, Tanzania, and I am sure many more, all conducted by Muslim extremists the world has come to equate the words 'Muslim' and 'terrorist'. Obviously this is a gross oversimplification, but sane Muslims are the only people who can defeat these people. Muslims who behave as if it their God-given right to live in foreign countries under Islamic law deceive themselves. They are sowing antagonism against Islam and one day may reap a whirlwind.
The NHS should provide more faith-based care for Muslims, an expert says.
Muslims are about twice as likely to report poor health and disability than the general population, says Edinburgh University's Professor Aziz Sheikh.
Writing in the British Medical Journal, he called for male circumcision on the NHS and more details over alcohol derived drugs.
Here are three previous stories on the same topic:
1: Some Muslims are undermining the battle to rid Britain’s hospitals of killer infections by refusing to wash their hands when visiting sick relatives.
Dispensers containing anti-bacterial gel have been placed outside wards at hospitals all over Britain in a bid to get rid of superbugs like MRSA and PVL.
It prevents people bringing in more infections. But some Muslims refuse to use the hand cleansers on religious grounds because they contain alcohol.
Health watchdogs are so concerned they intend to meet with NHS bosses in the New Year to try and hammer out a solution.
NHS care assistant Theresa Poupa, 46, became aware of the situation while visiting a sick cousin at the London Chest Hospital in Bethnal Green.
She said: “I could not believe it - the signs are large enough and clear enough but they just took no notice and walked straight onto the ward.
“I was there almost every day for three weeks and I saw it repeated dozens and dozens of times. When I raised the matter with the nursing staff they just shrugged and said that Muslims were refusing to use the gel because it contained alcohol.
“They said they couldn’t force visitors to use the gel and I understand that — but I was astonished that anyone who didn’t wash their hands was allowed onto a ward.
“I know the dangers that bugs like MRSA can cause. They kill hundreds of patients a year.”
Michael Summers, chairman of the Patients’ Association, said: “I have been made aware of this situation during discussions with nurses and it is a very serious state of affairs.”
2: Medical scandal surrounding a 17 year old male shepherd from Konya who was unable to receive proper attention at the Konya Testing Hospital due to the fact that two of the attending radiology doctors were women wearing headscarves, has grown.
The shepherd, referred to only as "A.G." in reports, arrived at the Konya Testing Hospital complaining of swollen testicles, and was sent to get ultrasound tests, but was refused service by two female doctors wearing headscarves. The shepherd later had to have one of his testicles removed by operation. Yesterday the Turkish Parliament debated the case, with opposition CHP Party members asserting that they would be following the case. Meanwhile, the Konya hospital's head of urology, Doctor Celal Tutuncu, said yesterday that he felt that the case was very "black and white," and that as soon as documents showing exactly which doctors had refused service to the shepherd were made clear, action would be taken.
A top CHP lawyer, Atilla Kart, spoke to Hurriyet yesterday, noting he was not "surprised" by the case, saying "This is the destruction wrought by religious references spilling over into public adminstration."
He went on: "This is the point at which Turkey's public administration has arrived. It is clear that that turbaned doctor was working with the full knowledge of the hospital administration.....But in fact the incident is not limited to the administration of the hospital; I believe it is also linked to the regional administration too. We see now what can happen when religious exploitation and religious references are carried over into our government....Konya is a photograph of the general situation in Turkey."
3: As France's national assembly neared the end of a four-day debate on a ban on religious emblems in state schools, the prime minister, Jean-Pierre Raffarin, said "similar legislation" was planned to stop hospital patients refusing to be treated by male doctors. Health administrators have reported cases of Muslim husbands who would rather their wives were denied treatment than be examined by a man. Women in labor have refused epidurals because the anesthetist was male.
Let's not go there.
My personal experience with Islam is quite different from this. Most Muslims that I have met have behaved impeccably.
What we are facing is a perversion of Islam that has gripped fairly ignorant people. While in the UK we have seen young men and women who have come under the influence of imams from Pakistan and Afghanistan who seem to believe that blowing themsleves up together with hundreds of fellow travelers serves the cause of God. I know that these outrages are not confined to Western countries.
The BMJ article was pleading for a health service with special consideration for Muslims. My point is that everybody must be treated equally. For example, take circumcision of young boys. Jews and Muslims believe it should be done as part of their faith. Christians believe it should be done only for medical reasons. My argument is that if Jews and Muslims want this extra service then they should make arrangements to have it financed. Muslim countries and Israel may wish to have this provided for them by the state - that is their business, but they can hardly expect a Christian country to provide it from state funds.
Jehovah's Witnesses refuse blood transfusions. Anemic patients have an alternative to blood transfusion, the drug erythropoietin. Unfortunately it is 4 times as expensive as blood transfusion, and it is unavailable to NHS patients. If Jehovah's Witnesses demand it then their church must pay for it and not expect it paid for by the taxpayer.
In many circumstances in the NHS it is possible for a patient to be seen by a doctor of the same sex, but we do not have the resources to guarantee it. On occasion it is necessary for a patient to be seen by a doctor of the opposite sex. The patient must be willing to accept this or go to a private physician of their choice.
Female circumcision is required by some Muslim comunities. In England this is seen as criminal assault.
As a Christian I deplore drunkenness. I am ashamed that British young people go to foreign countries and desport themselves in a lewd and drunken manner. Christians have things that we are ashamed of too.
After the bombings in London, New York, Madrid, Bali, Egypt, India, Kenya, Tanzania, and I am sure many more, all conducted by Muslim extremists the world has come to equate the words 'Muslim' and 'terrorist'. Obviously this is a gross oversimplification, but sane Muslims are the only people who can defeat these people. Muslims who behave as if it their God-given right to live in foreign countries under Islamic law deceive themselves. They are sowing antagonism against Islam and one day may reap a whirlwind.
NICE
In the Times today there is an interview with Sir Michael Rawlins that is well worth reading.
Sir Michael is the Chairman of NICE. Although NICE was established to advise the British Health Ministry on what it should and what it should not pay for, it is hugely influential wordwide. Last November, for example, there wer 9 million hits on their website.
Rawlins has interesting things to say about the comparison between the UK and US health services, but reckons that rationing is going to come to everybody. Much culd be done to limit health expenditure. For example, Omeprazole is a useful treatment for heartburn. Manufacturer's instructions suggest that the dose should be halved after the first month. It seldom is. Yet if it were it would save the British health service $80 million a year.
The biggest difficulty comes with the conflict between the patient in front of you and teh one in the waiting room next week.
If you spend a lot of money on a small number of people, you will end up depriving many other people of cost effective healthcare. And so that's why it's impossible, really, to leave it up to individual doctors to make these decisions, it's just too difficult, and I wouldn’t want to do it in that sense. It's much better to have an organization like NICE that does it in as fair a way, and in a way that reflects the aspirations of the society in which we live.
The cost of an extra year of good quality life is set at $60,000. If your new treatment can deliver that then the NHS will pay for it. If it comes to more then you could always find the money yourself.
...if one member of my family, my children or grandchildren, were unwell, yeah, I would do everything I can." But he said, "that's me and my grandchild, I can't expect society, necessarily, to do that, too." So, with finite resources, we have to use them in the best way that's equitable.
Sir Michael is the Chairman of NICE. Although NICE was established to advise the British Health Ministry on what it should and what it should not pay for, it is hugely influential wordwide. Last November, for example, there wer 9 million hits on their website.
Rawlins has interesting things to say about the comparison between the UK and US health services, but reckons that rationing is going to come to everybody. Much culd be done to limit health expenditure. For example, Omeprazole is a useful treatment for heartburn. Manufacturer's instructions suggest that the dose should be halved after the first month. It seldom is. Yet if it were it would save the British health service $80 million a year.
The biggest difficulty comes with the conflict between the patient in front of you and teh one in the waiting room next week.
If you spend a lot of money on a small number of people, you will end up depriving many other people of cost effective healthcare. And so that's why it's impossible, really, to leave it up to individual doctors to make these decisions, it's just too difficult, and I wouldn’t want to do it in that sense. It's much better to have an organization like NICE that does it in as fair a way, and in a way that reflects the aspirations of the society in which we live.
The cost of an extra year of good quality life is set at $60,000. If your new treatment can deliver that then the NHS will pay for it. If it comes to more then you could always find the money yourself.
...if one member of my family, my children or grandchildren, were unwell, yeah, I would do everything I can." But he said, "that's me and my grandchild, I can't expect society, necessarily, to do that, too." So, with finite resources, we have to use them in the best way that's equitable.
International incidents
I've had a couple of days in Rome this week. I stayed at the 'English' Hotel (d’Inghilterra) near the Spanish Steps in a meeting with a German, a Uruguayan, an American, several people from Switzerland and a single Italian who was from Sicily. We were discussing a clinical trial in which the majority of patients came from France, Poland and Russia, but in fact patients came from all over Europe and even New Zealand and Canada. We considered whether we should open it up to Brazil and Argentina. No-one should doubt that medicine is now truly international.
‘International participation in clinical trials is a bonus and it demonstrates the rigor of the pharmaceutical companies that they go to the expense of establishing data-collection services in so many countries to ensure that the data are truly representative.’
Or is it just that some countries seize on new drugs before they are licensed based on flimsy phase 2 results, making it impossible to conduct clinical trials in those countries?
Recently, the FDA has issued an alert about the risk of progressive multifocal leukoencephalopathy (PML) in patients with systemic lupus erythematosus in patients treated with rituximab. PML (which hematologists take as an abbreviation for promyelocytic leukemia) is in fact a fatal brain disease caused by reactivation of the JC virus (a polyoma virus) in immunodeficient individuals (especially in AIDS in which 5% of patients eventually succumb to it) and there have been 20+ cases in people on rituximab. The same facts did not prompt the European regulator to issue a similar warning, but the FDA were incensed that so much rituximab is used off-license. In fact over 60% of prescriptions for rituximab in the US are for unlicensed indications (principally CLL). No wonder the drug is worth $2.6 billion.
Rituximab is so widely used in America that it is often known as vitamin R. Many of the uses are without any evidence of benefit, and although I think it is a good drug that is likely to be of value both in B cell lymphomas and autoimmune disease, formal evidence for benefit in most indications has not been demonstrated. The worst offence is to do giant phase 2 trials without a comparator. This seems to be an excuse to profit from an unlicensed drug under the guise of ‘science’. Phase 2 trials seldom need to accrue more than 40 patients and should then be followed by randomized trials comparing the new treatment with the previous best. Had this been done with FCR for CLL then we should know for certain by now whether it was better than FC or FR. As it is, it is likely to be 2010 before we know. Comparisons with historical controls frankly do not cut the mustard.
Trials comparing FCR and FC, both as first line and salvage therapy, are currently being conducted. These trials will contain hardly any American patients; indeed, like the chlorambucil v Campath trial many of the patients will have come from Eastern Europe where medical conditions are not always to the standard of Western Europe and North America, and where the financial inducements to participate in trials may weigh more heavily than natural caution in selecting patients.
‘International participation in clinical trials is a bonus and it demonstrates the rigor of the pharmaceutical companies that they go to the expense of establishing data-collection services in so many countries to ensure that the data are truly representative.’
Or is it just that some countries seize on new drugs before they are licensed based on flimsy phase 2 results, making it impossible to conduct clinical trials in those countries?
Recently, the FDA has issued an alert about the risk of progressive multifocal leukoencephalopathy (PML) in patients with systemic lupus erythematosus in patients treated with rituximab. PML (which hematologists take as an abbreviation for promyelocytic leukemia) is in fact a fatal brain disease caused by reactivation of the JC virus (a polyoma virus) in immunodeficient individuals (especially in AIDS in which 5% of patients eventually succumb to it) and there have been 20+ cases in people on rituximab. The same facts did not prompt the European regulator to issue a similar warning, but the FDA were incensed that so much rituximab is used off-license. In fact over 60% of prescriptions for rituximab in the US are for unlicensed indications (principally CLL). No wonder the drug is worth $2.6 billion.
Rituximab is so widely used in America that it is often known as vitamin R. Many of the uses are without any evidence of benefit, and although I think it is a good drug that is likely to be of value both in B cell lymphomas and autoimmune disease, formal evidence for benefit in most indications has not been demonstrated. The worst offence is to do giant phase 2 trials without a comparator. This seems to be an excuse to profit from an unlicensed drug under the guise of ‘science’. Phase 2 trials seldom need to accrue more than 40 patients and should then be followed by randomized trials comparing the new treatment with the previous best. Had this been done with FCR for CLL then we should know for certain by now whether it was better than FC or FR. As it is, it is likely to be 2010 before we know. Comparisons with historical controls frankly do not cut the mustard.
Trials comparing FCR and FC, both as first line and salvage therapy, are currently being conducted. These trials will contain hardly any American patients; indeed, like the chlorambucil v Campath trial many of the patients will have come from Eastern Europe where medical conditions are not always to the standard of Western Europe and North America, and where the financial inducements to participate in trials may weigh more heavily than natural caution in selecting patients.
Monday, January 08, 2007
Campath
I have been meaning to write something about Campath for some time. I first started using this monoclonal antibody before it had been humanized, back in the mid 1980s. Then it was a rat IgM directed against CD52, an antigen present on all lymphoid cells and also on monocytes. It had marvelous complement killing activity and we were using it to lauder bone marrow in lymphoma autografts.
Subsequently, and IgG form has been produced and it has been humanized, though because it is now produced in Chinese Hamster Ovary cells, it does not have proper glycosolation (ie it does not have the correct sugar molecules attached) this is probably why it is not particularly good at penetrating large lymph node masses.
It was only when Campath got in the hands of Schering AG (Berlex in the US) that it was marketed as a treatment for CLL. It has several advantages. Most important, it is one of the few agents capable of killing CLL cells that have a damaged or absent p53. Second, it is capable of eliminating minimal residual disease from blood and bone marrow. Its major disadvantage is that it is very immunosuppressive, killing T cells as innocent bystanders, though not as permanently injurious as fludarabine. This makes it useful as a conditioning agent for bone marrow transplantation, but adds hazards when used to treat CLL.
Quite apart from its use as a drug to mop up residual disease and to treat resistant disease, Campath has been suggested as a first line treatment for CLL. At ASH last year Pete Hillmen presented the results of the CAM307 trial which compared Campath with chlorambucil as first line treatment for CLL. A total of 298 patients were randomized to receive one or other of the agents and the two groups were similar. The primary endpoint was progression-free survival and for this Campath was about 4 months better (p=0.0001). This was particularly true for patients with p53 abnormalities (10.7 months v 2.2 months) though for 11q deletions there was no significant difference. CR rate (24% v 2%) and overall response rate (83% v 55%) also favored Campath. Follow-up is too short to comment on overall survival.
Side effects were greater in the Campath arm, mostly infusion related (fever, chills, hypotension, urticaria) though giving it iv rather than sub q maximizes these effects. Chlorambucil caused more nausea and vomiting though giving it as a single dose once a month maximizes these effects. Asymptomatic CMV viremia occurred in 52% of the Campath patients and CMV infection in 16%. Grade 3/4 fever was commoner with Campath as was grade 3/4 neutropenia.
This really sounds good for Campath, but we have heard it all before. First, we have no evidence that the overall survival will be any different. Second, nobody has been cured. Third, the dose of chlorambucil used was 40 mg/sq meter, not the 70mg/sq meter that is normally given in the UK. Remember that the CALGB trial that showed fludarabine to be better than chlorambucil also used this low dose of chlorambucil, while the higher dose of chlorambucil used by the British CLL4 trial was shown to be equivalent in effect to that of fludarabine with fewer side effects. Also noteworthy is the fact that fludarabine and Campath or sold by the same company.
The final problem with this trial is that we do not know the long term outcome for these patients.
.
With this in mind Anders Osterberg has published some long term follow up results on 38 patients treated in Sweden with Campath as first line and compared the outcome with 75 historical controls from before the Campath era. These were treated with a variety of regimes including fludarabine, chlorambucil and CHOP. Demographically the two groups were very similar, although the Campath patients were slightly more likely to be stage III or IV. The results indicate a relatively high response rate to Campath compared to the various treatment the control group received, a significantly longer time to treatment failure and a rather lower (and not statistically significant) risk of infection. One important finding was the high rate of Richter's transformation in both Campath treated patients (16%) and historical controls (12%). Median overall survival was 28 months in the Campath treated group, compared to 17 months for the historical control group, although this was not significantly better.
As I have said before, when a regimen is introduced that produces a high rate of cure for CLL or a trial shows a better overall survival rate than what is achievable when starting with chlorambucil first line, then I will give it my backing. However, until that tile I believe in starting with treatment that does least harm to the patient’s immune system, and that treatment is not Campath
Subsequently, and IgG form has been produced and it has been humanized, though because it is now produced in Chinese Hamster Ovary cells, it does not have proper glycosolation (ie it does not have the correct sugar molecules attached) this is probably why it is not particularly good at penetrating large lymph node masses.
It was only when Campath got in the hands of Schering AG (Berlex in the US) that it was marketed as a treatment for CLL. It has several advantages. Most important, it is one of the few agents capable of killing CLL cells that have a damaged or absent p53. Second, it is capable of eliminating minimal residual disease from blood and bone marrow. Its major disadvantage is that it is very immunosuppressive, killing T cells as innocent bystanders, though not as permanently injurious as fludarabine. This makes it useful as a conditioning agent for bone marrow transplantation, but adds hazards when used to treat CLL.
Quite apart from its use as a drug to mop up residual disease and to treat resistant disease, Campath has been suggested as a first line treatment for CLL. At ASH last year Pete Hillmen presented the results of the CAM307 trial which compared Campath with chlorambucil as first line treatment for CLL. A total of 298 patients were randomized to receive one or other of the agents and the two groups were similar. The primary endpoint was progression-free survival and for this Campath was about 4 months better (p=0.0001). This was particularly true for patients with p53 abnormalities (10.7 months v 2.2 months) though for 11q deletions there was no significant difference. CR rate (24% v 2%) and overall response rate (83% v 55%) also favored Campath. Follow-up is too short to comment on overall survival.
Side effects were greater in the Campath arm, mostly infusion related (fever, chills, hypotension, urticaria) though giving it iv rather than sub q maximizes these effects. Chlorambucil caused more nausea and vomiting though giving it as a single dose once a month maximizes these effects. Asymptomatic CMV viremia occurred in 52% of the Campath patients and CMV infection in 16%. Grade 3/4 fever was commoner with Campath as was grade 3/4 neutropenia.
This really sounds good for Campath, but we have heard it all before. First, we have no evidence that the overall survival will be any different. Second, nobody has been cured. Third, the dose of chlorambucil used was 40 mg/sq meter, not the 70mg/sq meter that is normally given in the UK. Remember that the CALGB trial that showed fludarabine to be better than chlorambucil also used this low dose of chlorambucil, while the higher dose of chlorambucil used by the British CLL4 trial was shown to be equivalent in effect to that of fludarabine with fewer side effects. Also noteworthy is the fact that fludarabine and Campath or sold by the same company.
The final problem with this trial is that we do not know the long term outcome for these patients.
.
With this in mind Anders Osterberg has published some long term follow up results on 38 patients treated in Sweden with Campath as first line and compared the outcome with 75 historical controls from before the Campath era. These were treated with a variety of regimes including fludarabine, chlorambucil and CHOP. Demographically the two groups were very similar, although the Campath patients were slightly more likely to be stage III or IV. The results indicate a relatively high response rate to Campath compared to the various treatment the control group received, a significantly longer time to treatment failure and a rather lower (and not statistically significant) risk of infection. One important finding was the high rate of Richter's transformation in both Campath treated patients (16%) and historical controls (12%). Median overall survival was 28 months in the Campath treated group, compared to 17 months for the historical control group, although this was not significantly better.
As I have said before, when a regimen is introduced that produces a high rate of cure for CLL or a trial shows a better overall survival rate than what is achievable when starting with chlorambucil first line, then I will give it my backing. However, until that tile I believe in starting with treatment that does least harm to the patient’s immune system, and that treatment is not Campath
Sunday, January 07, 2007
Weekend movies
I have just watched a couple of unusual movies. One, "Junebug", was winner of a special jury prize at the Sundance festival. Madeleine, a sophisticated Chicago art dealer, takes a trip to North Carolina to meet the family of new husband George. This is not played for laughs like "Meet the Parents" but played out, sometimes with embarrassment as a clash of cultures. Career-dedicated Madeleine finds that real people have different values. Her husband is discovered to have a fine light tenor voice as he sings Sankey hymns as if the 1950s had never finished. Star of the show is Oscar nominee Amy Adams as heavily pregnant sister-in-law Ashley. Her garrulous dizziness smoothes over a multitude of dangerous moments. One of her statements, directed at her ne'er-do-well husband stayed with me. "God loves you just the way you are; but He loves you too much to let you stay like it."
The second, "Proof" is the opening up of the Pulitzer Prize winning stage drama of the same name, directed by John Madden who did "Shakespeare in Love". It has a stellar cast with Gwyneth Paltrow, Anthony Hopkins, Jake Gyllenhaal and Hope Davis (from About Schmidt). Quite difficult to follow because of the flashback structure this is not a film about math. Hopkins plays a mathematical genius who became schizophrenic. Again the topic is handled quite differently from "A Beautiful Mind". Paltrow is the daughter who stayed behind to look after sick father, while Davis is the daughter who left and became successful as both a career woman and mater familias. Gyllenhaal is the former student of Hopkins who has settled on a second-rate teaching career while remaining in awe of the genius mathematician. Paltrow is a competent mathematician; she has inherited some of her father's talents, but has she inherited his madness? She is certainly rather strange.
The action takes place around the father's funeral. The tensions are clear. Resentment at being left to look after an ailing parent, guilt at leaving, ambition to find an undiscovered masterpiece among the notebooks of the mad period, all come to the surface at the hypocritical funeral service when all the former colleagues are there to laud the early successes and to sweep under the carpet the neglect during the mad years.
Then a notebook is found containing an elegant proof about prime numbers. You don't have to understand the math. This could equally well have been a work of art, a novel, a poem, a symphony. The question is, “Who wrote it, the father or the daughter?” The daughter claims it, but who would believe her? Certainly not the sensible sister. How about the new lover? This is a story about real people who despite genius experience the same emotions of jealousy, guilt, resentment and forgiveness that we all feel.
The second, "Proof" is the opening up of the Pulitzer Prize winning stage drama of the same name, directed by John Madden who did "Shakespeare in Love". It has a stellar cast with Gwyneth Paltrow, Anthony Hopkins, Jake Gyllenhaal and Hope Davis (from About Schmidt). Quite difficult to follow because of the flashback structure this is not a film about math. Hopkins plays a mathematical genius who became schizophrenic. Again the topic is handled quite differently from "A Beautiful Mind". Paltrow is the daughter who stayed behind to look after sick father, while Davis is the daughter who left and became successful as both a career woman and mater familias. Gyllenhaal is the former student of Hopkins who has settled on a second-rate teaching career while remaining in awe of the genius mathematician. Paltrow is a competent mathematician; she has inherited some of her father's talents, but has she inherited his madness? She is certainly rather strange.
The action takes place around the father's funeral. The tensions are clear. Resentment at being left to look after an ailing parent, guilt at leaving, ambition to find an undiscovered masterpiece among the notebooks of the mad period, all come to the surface at the hypocritical funeral service when all the former colleagues are there to laud the early successes and to sweep under the carpet the neglect during the mad years.
Then a notebook is found containing an elegant proof about prime numbers. You don't have to understand the math. This could equally well have been a work of art, a novel, a poem, a symphony. The question is, “Who wrote it, the father or the daughter?” The daughter claims it, but who would believe her? Certainly not the sensible sister. How about the new lover? This is a story about real people who despite genius experience the same emotions of jealousy, guilt, resentment and forgiveness that we all feel.
Saturday, January 06, 2007
Herceptin
This weekend there are two interesting articles about trastuzumab (Herceptin), one in the BMJ and one in the Lancet.
The first of these is the experience of a consultant hematologist who developed HER2+ breast cancer at a time when it was difficult to get adjuvant Herceptin on the NHS. She was contacted by the Sun newspaper which was running a campaign championing Herceptin. As it was early in her chemotherapy she elected not to get involved in the campaign. Instead she decided to do some research for herself. Her concusion was that the "50% benefit" widely quoted in both medical and lay press actually translated into a 4.5% benefit for her which was equally balanced by the cardiac risk. Although the drug was not yet approved by NICE the (female) Health Minister had sent a pretty heavy signal to NICE that they had better approve it. Nothing sways government more than a campaign by the tabloids. The doctor was a clear steer that if she pushed for it she would get it. Nevertheless, she decided not to have Herceptin.
The second paper reviews the evidence. "The latest results show that the addition of trastuzumab reduced the absolute risk of death by 1·8% over 2 years and, at that stage, one extra woman will be alive for every 55 treated. However, an eighth of women randomised to trastuzumab died or relapsed over an average of 2 years." However, "trastuzumab will raise the absolute risk of symptomatic congestive heart failure by 2% at 2 years (up 0·4% from 1 year), and by 5% if subclinical harm is included." On cardiac damage they say, "the cardiologists we contacted were uncertain whether damage caused by trastuzumab is, as has been claimed, essentially short-term and reversible. Side-effects of the drug are additional to those caused by anthracyclines, drugs that by themselves can have serious outcomes 20 years after treatment. With anthracyclines, a statistically significant increase in harm is not enough to reduce the survival benefit at 15 years, but trastuzumab is from a different therapeutic class, with unknown long-term effects."
But on present evidence they conclude, "While there is cause for concern, perspective is needed: over 2 years, the risk of cardiac damage seems trivial compared with that of breast cancer recurrence. Unless catastrophic long-term side-effects emerge for trastuzumab, adjuvant Herceptin is good news for women with HER-2-positive early breast cancer and adequate cardiac function."
The group writing the review investigated the evidence for NICE to make a decision. They say, "Our work for NICE, with the 1-year median follow-up data, suggested that the adjuvant Herceptin schedule also represented value for money. We estimated that the regimen had an incremental cost-effectiveness ratio of around £18 500 per quality-adjusted life-year (QALY) gained, with two assumptions. First, survival benefits accrue over 5 years and are sustained thereafter (as with anthracyclines); second, that no cardiac events result in death (unlike with anthracyclines). If society were willing to pay £20 000 for an additional life-year with full quality of life, trastuzumab could be judged cost effective. With finite resources, the UK's National Health Service (NHS) would have to stop funding other treatments to provide trastuzumab (the opportunity cost), but the NHS could consider these cuts justified."
There is the rub. In real life money for health care is limited. Even the vast American economy is finding it so. Major corporations are facing financial meltdown because of health insrance costs. In the UK "Health trusts have been told that they have to invest in trastuzumab, and, to pay for the drug, they have to cancel services for populations who might be less vocal and well-organised than the breast cancer lobby."
"The cancellation of treatments by health trusts was not underpinned by the same kind of analysis as that which informed NICE's decision to fund trastuzumab, something that NICE's new disinvestment initiative (which helps the NHS identify and stop ineffective treatments), has to change if resource allocation is to be underpinned by procedural justice."
The point is that patient lobby groups are extremely influential, and none more so than the breast cancer lobbyists. But who will speak up for the Cinderella diseases? CLL suffers by comparison with breast cancer, but it is far better off than chronic granulomatous disease which hardly anyone has heard of, while unfashionable diseases like schizophrenia or manic depression, or diseases where the sufferer is thought blameworthy, like obesity, alcoholism or lung cancer, get a much less sympathetic press.
Another related issue in today's Lancet concerns direct-to-patient advertizing of drugs. This has been a feature of the American market since 1997, and there is an EU proposal to introduce it to Europe. A US government report
suggests that the practise is not working well in America. It found that FDA oversight was lax, "but their report also raises questions about the value of direct-to-consumer advertising and shows just how hard it is to regulate once this genie is out of the bottle. The investigators showed that from 1997 to 2005, industry spending on direct-to-consumer advertising grew on average nearly 20% per year, twice as fast as spending on drug promotion to doctors, reaching US$4·2 billion in 2005. By comparison, industry spent $31·4 billion on research and development. More than 50% of the direct-to-consumer spending went to advertisements for just 20 drugs, most for chronic conditions such as hyperlipidaemia, asthma, and allergies. Not surprisingly, these are the same drugs that drug companies are promoting directly to doctors with advertising in medical journals, drug-representative visits, and free samples. It's a smart dual-pronged strategy, because a doctor is more likely to provide a particular drug when a patient asks for it and when the doctor has free samples on hand. This is not to say that direct-to-consumer advertising does not help some patients. In many cases, patients may have been well served by advertisements that led them to discuss their concerns with their physicians. But the primary purpose of direct-to-consumer advertising remains clear: to sell lucrative, on-patent, brand-name drugs. Claims to the contrary just do not pass the straight-face test".
The paper concludes, "It would be better to fund independent information sources, free of industry influence, to provide the public with unbiased evidence-based information. If industry truly wants to inform the public, it should supply no-strings-attached funds to support such efforts. Even a small portion of the $4·2 billion being spent each year in the USA on direct-to-consumer advertising would do nicely."
I would like to put it on record that this blog receives no funding from the pharmaceuical industry and everything I say about the use of drugs is my honest opinion at the time based on my reading of the evidence without fear or favor.
But to get back to Herceptin. A recent paper in the New England Journal of Medicine reports on a Finnish trial of Herceptin as adjuvant therapy. Importantly, this trial used much smaller amounts of the antibody (20 mg/kg over 9 weeks rather than 110 mg/kg over a year). Naturally, this trial was not funded by the pharmaceutical company, but paid for by the Finnish government. The finding was as follows: "Within the subgroup of patients who had HER2/neu-positive cancer, those who received trastuzumab had better three-year recurrence-free survival than those who did not receive the antibody (89 percent vs. 78 percent; hazard ratio for recurrence or death, 0.42; 95 percent confidence interval, 0.21 to 0.83; P=0.01). Docetaxel was associated with more adverse effects than was vinorelbine. Trastuzumab was not associated with decreased left ventricular ejection fraction or cardiac failure."
This has particular resonance for CLL patients, particularly those who have been following Ron Taylor's work on antigen shaving. Is it possible to get an equal effect with less rituximab? You can hardly expect pharmaceutical companies to conduct trials that would result in their selling less of their product. But it is the interest of third party funders to pay for such trials. Funds for health care are limited. Lobbying for one treatment will inevitably mean that someone, somewhere will not get the treatment he needs. The market is not free, it is being manipulated.
The first of these is the experience of a consultant hematologist who developed HER2+ breast cancer at a time when it was difficult to get adjuvant Herceptin on the NHS. She was contacted by the Sun newspaper which was running a campaign championing Herceptin. As it was early in her chemotherapy she elected not to get involved in the campaign. Instead she decided to do some research for herself. Her concusion was that the "50% benefit" widely quoted in both medical and lay press actually translated into a 4.5% benefit for her which was equally balanced by the cardiac risk. Although the drug was not yet approved by NICE the (female) Health Minister had sent a pretty heavy signal to NICE that they had better approve it. Nothing sways government more than a campaign by the tabloids. The doctor was a clear steer that if she pushed for it she would get it. Nevertheless, she decided not to have Herceptin.
The second paper reviews the evidence. "The latest results show that the addition of trastuzumab reduced the absolute risk of death by 1·8% over 2 years and, at that stage, one extra woman will be alive for every 55 treated. However, an eighth of women randomised to trastuzumab died or relapsed over an average of 2 years." However, "trastuzumab will raise the absolute risk of symptomatic congestive heart failure by 2% at 2 years (up 0·4% from 1 year), and by 5% if subclinical harm is included." On cardiac damage they say, "the cardiologists we contacted were uncertain whether damage caused by trastuzumab is, as has been claimed, essentially short-term and reversible. Side-effects of the drug are additional to those caused by anthracyclines, drugs that by themselves can have serious outcomes 20 years after treatment. With anthracyclines, a statistically significant increase in harm is not enough to reduce the survival benefit at 15 years, but trastuzumab is from a different therapeutic class, with unknown long-term effects."
But on present evidence they conclude, "While there is cause for concern, perspective is needed: over 2 years, the risk of cardiac damage seems trivial compared with that of breast cancer recurrence. Unless catastrophic long-term side-effects emerge for trastuzumab, adjuvant Herceptin is good news for women with HER-2-positive early breast cancer and adequate cardiac function."
The group writing the review investigated the evidence for NICE to make a decision. They say, "Our work for NICE, with the 1-year median follow-up data, suggested that the adjuvant Herceptin schedule also represented value for money. We estimated that the regimen had an incremental cost-effectiveness ratio of around £18 500 per quality-adjusted life-year (QALY) gained, with two assumptions. First, survival benefits accrue over 5 years and are sustained thereafter (as with anthracyclines); second, that no cardiac events result in death (unlike with anthracyclines). If society were willing to pay £20 000 for an additional life-year with full quality of life, trastuzumab could be judged cost effective. With finite resources, the UK's National Health Service (NHS) would have to stop funding other treatments to provide trastuzumab (the opportunity cost), but the NHS could consider these cuts justified."
There is the rub. In real life money for health care is limited. Even the vast American economy is finding it so. Major corporations are facing financial meltdown because of health insrance costs. In the UK "Health trusts have been told that they have to invest in trastuzumab, and, to pay for the drug, they have to cancel services for populations who might be less vocal and well-organised than the breast cancer lobby."
"The cancellation of treatments by health trusts was not underpinned by the same kind of analysis as that which informed NICE's decision to fund trastuzumab, something that NICE's new disinvestment initiative (which helps the NHS identify and stop ineffective treatments), has to change if resource allocation is to be underpinned by procedural justice."
The point is that patient lobby groups are extremely influential, and none more so than the breast cancer lobbyists. But who will speak up for the Cinderella diseases? CLL suffers by comparison with breast cancer, but it is far better off than chronic granulomatous disease which hardly anyone has heard of, while unfashionable diseases like schizophrenia or manic depression, or diseases where the sufferer is thought blameworthy, like obesity, alcoholism or lung cancer, get a much less sympathetic press.
Another related issue in today's Lancet concerns direct-to-patient advertizing of drugs. This has been a feature of the American market since 1997, and there is an EU proposal to introduce it to Europe. A US government report
suggests that the practise is not working well in America. It found that FDA oversight was lax, "but their report also raises questions about the value of direct-to-consumer advertising and shows just how hard it is to regulate once this genie is out of the bottle. The investigators showed that from 1997 to 2005, industry spending on direct-to-consumer advertising grew on average nearly 20% per year, twice as fast as spending on drug promotion to doctors, reaching US$4·2 billion in 2005. By comparison, industry spent $31·4 billion on research and development. More than 50% of the direct-to-consumer spending went to advertisements for just 20 drugs, most for chronic conditions such as hyperlipidaemia, asthma, and allergies. Not surprisingly, these are the same drugs that drug companies are promoting directly to doctors with advertising in medical journals, drug-representative visits, and free samples. It's a smart dual-pronged strategy, because a doctor is more likely to provide a particular drug when a patient asks for it and when the doctor has free samples on hand. This is not to say that direct-to-consumer advertising does not help some patients. In many cases, patients may have been well served by advertisements that led them to discuss their concerns with their physicians. But the primary purpose of direct-to-consumer advertising remains clear: to sell lucrative, on-patent, brand-name drugs. Claims to the contrary just do not pass the straight-face test".
The paper concludes, "It would be better to fund independent information sources, free of industry influence, to provide the public with unbiased evidence-based information. If industry truly wants to inform the public, it should supply no-strings-attached funds to support such efforts. Even a small portion of the $4·2 billion being spent each year in the USA on direct-to-consumer advertising would do nicely."
I would like to put it on record that this blog receives no funding from the pharmaceuical industry and everything I say about the use of drugs is my honest opinion at the time based on my reading of the evidence without fear or favor.
But to get back to Herceptin. A recent paper in the New England Journal of Medicine reports on a Finnish trial of Herceptin as adjuvant therapy. Importantly, this trial used much smaller amounts of the antibody (20 mg/kg over 9 weeks rather than 110 mg/kg over a year). Naturally, this trial was not funded by the pharmaceutical company, but paid for by the Finnish government. The finding was as follows: "Within the subgroup of patients who had HER2/neu-positive cancer, those who received trastuzumab had better three-year recurrence-free survival than those who did not receive the antibody (89 percent vs. 78 percent; hazard ratio for recurrence or death, 0.42; 95 percent confidence interval, 0.21 to 0.83; P=0.01). Docetaxel was associated with more adverse effects than was vinorelbine. Trastuzumab was not associated with decreased left ventricular ejection fraction or cardiac failure."
This has particular resonance for CLL patients, particularly those who have been following Ron Taylor's work on antigen shaving. Is it possible to get an equal effect with less rituximab? You can hardly expect pharmaceutical companies to conduct trials that would result in their selling less of their product. But it is the interest of third party funders to pay for such trials. Funds for health care are limited. Lobbying for one treatment will inevitably mean that someone, somewhere will not get the treatment he needs. The market is not free, it is being manipulated.
Friday, January 05, 2007
Three detectives
One of my Christmas presents was a bundle of books by three of my favorite authors of detective stories. I am well into the third of them now.
Harry Bosch, the LA detective invented by Michael Connelly, is currently assigned to investigating cold cases. He is a man whose past has damaged him. Driven by empathy with the victims he disdains authority and rides roughshod over colleagues. Although attractive to women, his single-mindedness spoils all relationships.
Jack Reacher, the creation of Lee Child, is a simpler character. He is totally free of any commitment, owning nothing but tee-shirt, jeans and a very classy pair of English brogues. He goes around as an avenging angel with superman qualities. Although ex-army, he too cares nothing for hierarchies. This was the tenth novel. Advice to the author: he needs some character flaws.
John Rebus, Ian Rankin's Scottish detective is all flaws. He drinks too much, smokes too much, is far too fat; he has all the Scottish vices. Needless to say he mocks authority, ploughs his own furrow, yet comes up with results. He is now approaching retirement, though how he would cope with it is anybody's guess. With his unhealthy habits it looks as though he is trying to die in harness.
Harry Bosch, the LA detective invented by Michael Connelly, is currently assigned to investigating cold cases. He is a man whose past has damaged him. Driven by empathy with the victims he disdains authority and rides roughshod over colleagues. Although attractive to women, his single-mindedness spoils all relationships.
Jack Reacher, the creation of Lee Child, is a simpler character. He is totally free of any commitment, owning nothing but tee-shirt, jeans and a very classy pair of English brogues. He goes around as an avenging angel with superman qualities. Although ex-army, he too cares nothing for hierarchies. This was the tenth novel. Advice to the author: he needs some character flaws.
John Rebus, Ian Rankin's Scottish detective is all flaws. He drinks too much, smokes too much, is far too fat; he has all the Scottish vices. Needless to say he mocks authority, ploughs his own furrow, yet comes up with results. He is now approaching retirement, though how he would cope with it is anybody's guess. With his unhealthy habits it looks as though he is trying to die in harness.
Monday, January 01, 2007
Coming second
I have just discovered that two of my papers have made the top 50 most cited papers published in Blood. One is the V genes paper, published in 1999. This came in at 22. The other is the International Prognostic Scoring System for MDS which was published in 1997, and which came 38th.
I'm not surprized by the V genes paper which is an important landmark in CLL research. The IPSS paper is highly quoted because it is one of those papers thatsets a standard that virtually has to be adhered to in all series in which MDS is treated. Peter Greenberg was the instigator of this paper, but I wrote the first paper that proposed a prognostic scoring system for MDS. This was the Bournemouth Score published in 1985 and itself highly cited. Following our example several other groups suggested other scoring systems, and what Peter Greenberg did was to gather us all together in Chicago, so that we could thrash out a system to which we could all adhere.
Coming 22nd and 38th doesn't sound much, but when one thinks of how many papers are published in Blood one is encouraged. I rememeber in my final year at school I came 13th in the cross country out of several hundred boys who ran. Ofcourse I was much bigger than many of them, and the previous year I had come 113th. It certainly makes England's performance in the Ashes series sound better. After all they came second.
I'm not surprized by the V genes paper which is an important landmark in CLL research. The IPSS paper is highly quoted because it is one of those papers thatsets a standard that virtually has to be adhered to in all series in which MDS is treated. Peter Greenberg was the instigator of this paper, but I wrote the first paper that proposed a prognostic scoring system for MDS. This was the Bournemouth Score published in 1985 and itself highly cited. Following our example several other groups suggested other scoring systems, and what Peter Greenberg did was to gather us all together in Chicago, so that we could thrash out a system to which we could all adhere.
Coming 22nd and 38th doesn't sound much, but when one thinks of how many papers are published in Blood one is encouraged. I rememeber in my final year at school I came 13th in the cross country out of several hundred boys who ran. Ofcourse I was much bigger than many of them, and the previous year I had come 113th. It certainly makes England's performance in the Ashes series sound better. After all they came second.
Saturday, December 30, 2006
Warm weather
Thank God for the Gulf Stream Drift. Here we are at 51 degrees North and the temperature is 61 today (16 for the European Union).
In the garden Camelias, Cyclamen and Azalias are flowering.
In the garden Camelias, Cyclamen and Azalias are flowering.
Friday, December 29, 2006
Death penalty for Saddam
Saddam is about to be hanged. This is the time to consider my views on the death penalty.
The arguments for:
It is the ultimate sanction. Deliberately taking a life should result in your own life being taken.
It is the penalty demanded by Scripture.
It deters others from committing murder.
It concentrates the mind of the murderer so that if he wishes to repent he knows he has but a short time in which to do it.
It brings 'closure'.
The arguments against:
It turns the state into a 'murderer'.
The wrong person might be executed.
It does not really deter.
Life imprisonment is a just puniushment which removes the murderer from repeating his offence and gives him time to contemplate what he has done.
In the case of Saddam there are other arguments against:
It would turn him into a martyr.
The execution itself would be an occasion to foment a riot.
And arguments in favor:
While he is alive the possibility of freeing him remains alive.
Some time in the future a Sunni regime may decide to do exactly that.
The only argument against that counts with me is the possibility of executing the wrong man. Undoubtedly there have been miscarriages of justice in the past. But there seems no doubt that Saddam is guilty.
He deserves death.
Over the past 50 years there has been a movement to lessen the significance of evil. People make excuses for it. It was his upbringing or his genes to blame. There is a willful misinterpretation of Scripture. "Thou shall not kill" is not a blanket ban on killing. Even a cursory reading of the Bible demonstrates that God sanctioned both killing of the enemy in war and judicial killing of criminals. I know that people tend to say that that was the Old Testament and we have different standards in the New Testament, but that is also incorrect.
Luke reports the thief on the cross saying, "We are punished justly, for we are getting what our deeds deserve." and later relates the story of Ananias and Sapphira who were struck dead for witholding from God what they had promised to give. Again King Herod was struck dead by an Angel of the Lord in Acts Ch 12 v 23, for setting himself up as a god. In I Corinthians Ch 11 v 30 Paul clearly indicates that some have died because they abused the Lord's Supper. Undoubtedly, both Old and New Testaments take a severe view of sin, and certainly don't rule out the death penalty where appropriate. Those who believe that Christians ought to be against the death penalty are making up their own religion.
The arguments for:
It is the ultimate sanction. Deliberately taking a life should result in your own life being taken.
It is the penalty demanded by Scripture.
It deters others from committing murder.
It concentrates the mind of the murderer so that if he wishes to repent he knows he has but a short time in which to do it.
It brings 'closure'.
The arguments against:
It turns the state into a 'murderer'.
The wrong person might be executed.
It does not really deter.
Life imprisonment is a just puniushment which removes the murderer from repeating his offence and gives him time to contemplate what he has done.
In the case of Saddam there are other arguments against:
It would turn him into a martyr.
The execution itself would be an occasion to foment a riot.
And arguments in favor:
While he is alive the possibility of freeing him remains alive.
Some time in the future a Sunni regime may decide to do exactly that.
The only argument against that counts with me is the possibility of executing the wrong man. Undoubtedly there have been miscarriages of justice in the past. But there seems no doubt that Saddam is guilty.
He deserves death.
Over the past 50 years there has been a movement to lessen the significance of evil. People make excuses for it. It was his upbringing or his genes to blame. There is a willful misinterpretation of Scripture. "Thou shall not kill" is not a blanket ban on killing. Even a cursory reading of the Bible demonstrates that God sanctioned both killing of the enemy in war and judicial killing of criminals. I know that people tend to say that that was the Old Testament and we have different standards in the New Testament, but that is also incorrect.
Luke reports the thief on the cross saying, "We are punished justly, for we are getting what our deeds deserve." and later relates the story of Ananias and Sapphira who were struck dead for witholding from God what they had promised to give. Again King Herod was struck dead by an Angel of the Lord in Acts Ch 12 v 23, for setting himself up as a god. In I Corinthians Ch 11 v 30 Paul clearly indicates that some have died because they abused the Lord's Supper. Undoubtedly, both Old and New Testaments take a severe view of sin, and certainly don't rule out the death penalty where appropriate. Those who believe that Christians ought to be against the death penalty are making up their own religion.
Sunday, December 24, 2006
The Archbishop's Christmas Message
From the Times today this comment on Iraq.
Christians in the Middle East are being put at unprecedented risk by the Government’s “shortsighted” and “ignorant” policy in Iraq, The Archbishop of Canterbury, Dr Rowan Williams, says today.
In an extraordinary attack, Dr Williams accuses Tony Blair and the US of endangering the lives and futures of many thousands of Christians in the Middle East, who are regarded by their countrymen as supporters of the “crusading West
How strange! I have seen no news items about US or British troops hunting out Christians and shooting them. Oh, I see! It's the fanatical Muslims who are terrorizing the Christian Iraqis. But aren't they also terrorizing thousands of moderate Muslims too? People are suffering in Iraq because armed gangs are rampaging in the streets without the control of law. Indeed these armed gangs have been recruited into the law-enforcing agencies and are murdering their political enemies by masquerading as policemen.
What does the Archbishop of Canterbury suggest? That British and American troops should leave and allow the opposing militias to slug it out until the land is bare of infesting humans? I suppose he can claim Biblical precedence. Jesus taught his disciples to 'shake the dust off their feet' and leave any village that did not receive them. But there is another precedent. Abraham negotiated with God, not to destroy Sodom if there were to be found ten righteous men in that city. As we know only Lot could be found as an example of righteousness and it was easier to remove Lot than preserve Sodom. Are there not ten righteous men in Baghdad?
What Rowan Williams is offering is appeasement of a particularly craven sort. If I keep my head below the parapet and don't make a fuss, perhaps they will leave me and mine alone.
Let us be clear: the evil doers in Iraq are not Tony Blair and George Bush. However unwise the invasion of Iraq has turned out to be, however, maladroit has been the handling of the occupation, their instincts in removing Saddam were correct.
Saddam was an evil dictator with no concern for his own people or his neighbors. In the film "Lords of War" the Ian Holm character was accused of selling arms to both sides in the Iran/Iraq war. "Has it ever occurred to you that I wanted both sides to lose?" he replies. That was the attitude of a lot of people at the time, but undoubtedly Saddam's regime was utterly vile.
The invasion of Kuwait gave the rest of the world sufficient cause for restraining him, but fear of unleashing chaos in Iraq held Bush 41 back from removing him. Instead he was hemmed in by sanctions.
Sanctions seldom work. Those imposing them are accused of harming the poor and needy. Pictures of starving children and hospitals without medicines were used to justify the oil for food program, money from which was diverted from food to palaces. France, Russia and China all connived with Saddam to beat the sanctions. The UN, which employs some of the biggest crooks on the planet, turned a blind eye to corruption within and without.
The choices in 2003 were to give in to Saddam and allow him to resume his nuclear ambitions or to take him out by actually enforcing Resolution 1441. Some nations for very good pecuniary reasons wanted a UN fudge; other saw more clearly that the charade could not continue.
I see Bush 41’s error as similar to King Saul’s in 1 Samuel chapter 15. Saul failed to utterly destroy the Amalekites and George H Bush failed to utterly destroy Saddam. Bush 43 had an option in 2003. He might have crushed completely the Baathists and installed a puppet king; instead he trusted the Iraqis to sort out their own mess with a little aid and training. By committing too few troops he ended up with a worse mess than he started with. Nearly every savage Muslim in the world has descended on Baghdad looking for trouble, and worse, their partial success has been an efficient recruiting sergeant.
Parallels with Viet Nam are easily drawn. A military success is allowed to become a propaganda defeat. The fourth estate has become a fifth column. Potentially Bush had five years to win this war but he squandered the goodwill and by losing the mid-terms he has emasculated himself.
There was a time when Christians would stand up and oppose evil. Robert Raikes saw poor children unable to read and write and started Sunday Schools, the forerunners of public education. William Wilberforce saw the slave trade and campaigned for his whole life to abolish it. Lord Shaftsbury saw children in factories and fought to abolish the practice. William Booth saw drunkenness destroying families and founded the Salvation Army. John Howard and Elizabeth Fry and the prisons, Florence Nightingale and hospitals, Dr Barnardo and orphans; all Christians who saw evil and stood up against it. Rowan Williams sees the evil of murderous Muslims in Iraq and lies down before it. If we keep very quiet and very small they might pass us by and go and kill somebody else instead.
Christians in the Middle East are being put at unprecedented risk by the Government’s “shortsighted” and “ignorant” policy in Iraq, The Archbishop of Canterbury, Dr Rowan Williams, says today.
In an extraordinary attack, Dr Williams accuses Tony Blair and the US of endangering the lives and futures of many thousands of Christians in the Middle East, who are regarded by their countrymen as supporters of the “crusading West
How strange! I have seen no news items about US or British troops hunting out Christians and shooting them. Oh, I see! It's the fanatical Muslims who are terrorizing the Christian Iraqis. But aren't they also terrorizing thousands of moderate Muslims too? People are suffering in Iraq because armed gangs are rampaging in the streets without the control of law. Indeed these armed gangs have been recruited into the law-enforcing agencies and are murdering their political enemies by masquerading as policemen.
What does the Archbishop of Canterbury suggest? That British and American troops should leave and allow the opposing militias to slug it out until the land is bare of infesting humans? I suppose he can claim Biblical precedence. Jesus taught his disciples to 'shake the dust off their feet' and leave any village that did not receive them. But there is another precedent. Abraham negotiated with God, not to destroy Sodom if there were to be found ten righteous men in that city. As we know only Lot could be found as an example of righteousness and it was easier to remove Lot than preserve Sodom. Are there not ten righteous men in Baghdad?
What Rowan Williams is offering is appeasement of a particularly craven sort. If I keep my head below the parapet and don't make a fuss, perhaps they will leave me and mine alone.
Let us be clear: the evil doers in Iraq are not Tony Blair and George Bush. However unwise the invasion of Iraq has turned out to be, however, maladroit has been the handling of the occupation, their instincts in removing Saddam were correct.
Saddam was an evil dictator with no concern for his own people or his neighbors. In the film "Lords of War" the Ian Holm character was accused of selling arms to both sides in the Iran/Iraq war. "Has it ever occurred to you that I wanted both sides to lose?" he replies. That was the attitude of a lot of people at the time, but undoubtedly Saddam's regime was utterly vile.
The invasion of Kuwait gave the rest of the world sufficient cause for restraining him, but fear of unleashing chaos in Iraq held Bush 41 back from removing him. Instead he was hemmed in by sanctions.
Sanctions seldom work. Those imposing them are accused of harming the poor and needy. Pictures of starving children and hospitals without medicines were used to justify the oil for food program, money from which was diverted from food to palaces. France, Russia and China all connived with Saddam to beat the sanctions. The UN, which employs some of the biggest crooks on the planet, turned a blind eye to corruption within and without.
The choices in 2003 were to give in to Saddam and allow him to resume his nuclear ambitions or to take him out by actually enforcing Resolution 1441. Some nations for very good pecuniary reasons wanted a UN fudge; other saw more clearly that the charade could not continue.
I see Bush 41’s error as similar to King Saul’s in 1 Samuel chapter 15. Saul failed to utterly destroy the Amalekites and George H Bush failed to utterly destroy Saddam. Bush 43 had an option in 2003. He might have crushed completely the Baathists and installed a puppet king; instead he trusted the Iraqis to sort out their own mess with a little aid and training. By committing too few troops he ended up with a worse mess than he started with. Nearly every savage Muslim in the world has descended on Baghdad looking for trouble, and worse, their partial success has been an efficient recruiting sergeant.
Parallels with Viet Nam are easily drawn. A military success is allowed to become a propaganda defeat. The fourth estate has become a fifth column. Potentially Bush had five years to win this war but he squandered the goodwill and by losing the mid-terms he has emasculated himself.
There was a time when Christians would stand up and oppose evil. Robert Raikes saw poor children unable to read and write and started Sunday Schools, the forerunners of public education. William Wilberforce saw the slave trade and campaigned for his whole life to abolish it. Lord Shaftsbury saw children in factories and fought to abolish the practice. William Booth saw drunkenness destroying families and founded the Salvation Army. John Howard and Elizabeth Fry and the prisons, Florence Nightingale and hospitals, Dr Barnardo and orphans; all Christians who saw evil and stood up against it. Rowan Williams sees the evil of murderous Muslims in Iraq and lies down before it. If we keep very quiet and very small they might pass us by and go and kill somebody else instead.
Children's Christmas
Christmas is really
for the children.
Especially for children
who like animals, stable,
stars and babies wrapped
in swaddling clothes.
Then there are wise men,
kings in fine robes,
humble shepherds and a
hint of rich perfume.
Steve Turner's poem tell it all. We Christians would like to strip off the commercialism, the adverts telling us about Christmas food, special because they're M&S nauseatingly-rich, atheroma-inducing, mince pies; or Noddy Holder repeating incessantly, "But here it is, Merry Christmas, everybody's having fun"; or Business Report inviting us to shop harder because the retailers are missing out on their bonuses; or cheeky young kids who ring your doorbell and sing one chorus of Jingle Bells and expect to be tipped as carol singers, and when asked to sing a proper carol, can just manage, "Away in a manger la, la, la, la, la." before drying up. We could all do without the drunken parties and the parade of broken Nissans, Toyotas and young men left in their wake.
For most of us it takes us back to childhood. Christmas trees and fairy lights, dads dressed up like Santa, carols by candlelight, boys who want to be Joseph and girls who want to be Mary but both settling for third shepherd, Little Donkey and Little Drummer Boy. And babies.
I'm all for the sentiment, but it can mask what it's all about just as much as the commercialism.
The second stanza of Steve Turner's poem explains.
Easter is not really
for the children
unless accompanied by a
cream filled egg.
It has whips, blood, nails,
a spear and allegations
of body snatching.
It involves politics, God
and the sins of the world.
It is not good for people
of a nervous disposition.
They would do better to
think on rabbits, chicken
and the first snowdrop
of spring.
Or they'd do better to
wait for a re-run of
Christmas without asking
too many questions about
what Jesus did when he grew up
or whether there's any connection.
Everybody likes a baby, but let's not get mawkish. This baby came for a definite purpose; he came specifically to die. "But when the time had fully come, God sent His Son, born of a woman, born under the law, to redeem those under the law." (Galatians 4:4-5). Most of the Christmas hymns that we sing duck the issue except perhaps:
Who is he in yonder stall
At whose feet the shepherds fall?
Who is he to whom they bring
All their sick and sorrowing?
Who is he who stands and weeps
At the grave where Laz'rus sleeps?
Who is he on yonder tree
Dies in grief and agony?
Who is he who from the grave
Comes to rescue, help and save?
Who is he who from his throne
Comes to make the world his own?
'Tis the Lord! O wondrous story!
'Tis the Lord, the king of glory!
At his feet we humbly fall.
Crown him! Crown him Lord of all!
That's why this baby deserves such a welcome. That's why we give gifts at Christmas - to commemorate God's indescribable gift to us (2 Corinthians 10:15).
for the children.
Especially for children
who like animals, stable,
stars and babies wrapped
in swaddling clothes.
Then there are wise men,
kings in fine robes,
humble shepherds and a
hint of rich perfume.
Steve Turner's poem tell it all. We Christians would like to strip off the commercialism, the adverts telling us about Christmas food, special because they're M&S nauseatingly-rich, atheroma-inducing, mince pies; or Noddy Holder repeating incessantly, "But here it is, Merry Christmas, everybody's having fun"; or Business Report inviting us to shop harder because the retailers are missing out on their bonuses; or cheeky young kids who ring your doorbell and sing one chorus of Jingle Bells and expect to be tipped as carol singers, and when asked to sing a proper carol, can just manage, "Away in a manger la, la, la, la, la." before drying up. We could all do without the drunken parties and the parade of broken Nissans, Toyotas and young men left in their wake.
For most of us it takes us back to childhood. Christmas trees and fairy lights, dads dressed up like Santa, carols by candlelight, boys who want to be Joseph and girls who want to be Mary but both settling for third shepherd, Little Donkey and Little Drummer Boy. And babies.
I'm all for the sentiment, but it can mask what it's all about just as much as the commercialism.
The second stanza of Steve Turner's poem explains.
Easter is not really
for the children
unless accompanied by a
cream filled egg.
It has whips, blood, nails,
a spear and allegations
of body snatching.
It involves politics, God
and the sins of the world.
It is not good for people
of a nervous disposition.
They would do better to
think on rabbits, chicken
and the first snowdrop
of spring.
Or they'd do better to
wait for a re-run of
Christmas without asking
too many questions about
what Jesus did when he grew up
or whether there's any connection.
Everybody likes a baby, but let's not get mawkish. This baby came for a definite purpose; he came specifically to die. "But when the time had fully come, God sent His Son, born of a woman, born under the law, to redeem those under the law." (Galatians 4:4-5). Most of the Christmas hymns that we sing duck the issue except perhaps:
Who is he in yonder stall
At whose feet the shepherds fall?
Who is he to whom they bring
All their sick and sorrowing?
Who is he who stands and weeps
At the grave where Laz'rus sleeps?
Who is he on yonder tree
Dies in grief and agony?
Who is he who from the grave
Comes to rescue, help and save?
Who is he who from his throne
Comes to make the world his own?
'Tis the Lord! O wondrous story!
'Tis the Lord, the king of glory!
At his feet we humbly fall.
Crown him! Crown him Lord of all!
That's why this baby deserves such a welcome. That's why we give gifts at Christmas - to commemorate God's indescribable gift to us (2 Corinthians 10:15).
Thursday, December 21, 2006
Christmas is coming.
The cold weather has certainly come to Britain. I remember one Christmas, it must have been 1957, when we had a houseful of visitors at Christmas, so much so that I was sleeping with brother on a matress on the living room floor. On that room the curtains didn't reach the floor at the French windows. I woke in the middle of the night to see snowflakes falling, snow on snow, as the carol says. That was about 40 miles from the sea; here on the coast we seldom have a white Christmas. This year it will be white, but white with frost and white with fog, but I doubt it will snow
There has been chaos at the airports, with most domestic flights cancelled. Eventually one 747 gathered up those waiting at Gatwick and took them to Edinburgh. The roads have not been much better, with crashes and delays on most of the motorways.
I have been out walking into the shops, rather than take the car. Well wrapped up, I have managed to keep warm and bought lots of silly things to go in my grandchildren's stockings. This is an annual tradition. The big presents are under the tree, to be opened after church, but the smallest ones in the house have stockings full of nonsense on their beds . Last year the youngest was 25, but this year we have some children.
I have been watching Dekalog by Krzysztof Kieslowski. This is a series of Polish films, each one hour long, and each loosely based on one of the Ten Commandments. Made in 1987 they are all set around a dreary tower block in communist Poland. Being Catholic they omit the Commandment about graven images and split the coveting into two (your neighbors ass and his wife). I shall have something to say about them in a later blog.
I have also been building models for my grandson's model railway - so far a footbridge and a country church.
I am determined not to think about CLL this week. I have chalked it up as holiday.
There has been chaos at the airports, with most domestic flights cancelled. Eventually one 747 gathered up those waiting at Gatwick and took them to Edinburgh. The roads have not been much better, with crashes and delays on most of the motorways.
I have been out walking into the shops, rather than take the car. Well wrapped up, I have managed to keep warm and bought lots of silly things to go in my grandchildren's stockings. This is an annual tradition. The big presents are under the tree, to be opened after church, but the smallest ones in the house have stockings full of nonsense on their beds . Last year the youngest was 25, but this year we have some children.
I have been watching Dekalog by Krzysztof Kieslowski. This is a series of Polish films, each one hour long, and each loosely based on one of the Ten Commandments. Made in 1987 they are all set around a dreary tower block in communist Poland. Being Catholic they omit the Commandment about graven images and split the coveting into two (your neighbors ass and his wife). I shall have something to say about them in a later blog.
I have also been building models for my grandson's model railway - so far a footbridge and a country church.
I am determined not to think about CLL this week. I have chalked it up as holiday.
Monday, December 18, 2006
Murder in Ipswich
They have arrested a man for killing, in the past 2 weeks, five prostitutes in Ipswich, the county town of Suffolk, and a miserable place - at least that's what it seemed like the only time I drove through it. Previously, its only claim to fame was its football team, which won the First Division some 40 years ago when managed by Sir Alf Ramsay, later to manage England in its only World Cup Victory. Another Ipswich manager, Sir Bobby Robson, also went on to manage England, though his best effort was to reach the semi-finals of Italia 90. A former Ipswich player, Paul Mariner, was once England's center forward.
All five prostitutes were heroin addicts, on the streets to feed their habits even though they new that someone was killing the working girls. The murders have led to calls for the legalization of both prostitution and of heroin. A similar libertarian demand might as well call for the legalization of murder.
Prostitution is not one business. At the lower end of the market, most of the girls working the streets are drug addicts, though a few are teenage runaways. Social security payments are enough to live on, but they are not available to the very young, who ought to be back with their parents, nor enough to support a drug habit.
Some street girls and some operating from brothels are controlled by a pimp, who may control them by supplying heroin or cocaine. Increasingly there are illegal immigrants who have been seduced by offers of a job, which turns out to be in prostitution, yet the girls dare not go to the police for fear of deportation.
At the top end of the market, the girls dress well, behave immaculately in public, and make a large amount of money. Their choice of prostitution as a livelihood is not out of necessity, but out of greed. For them it is a way of maximizing their income. Some even like the lifestyle.
In between are any number of variations on the theme.
The argument for legalizing prostitution is to remove the criminality. Just as prohibition brought the mafia into the sale of alcohol, so, the argument goes, the sale of sex is only infiltrated by criminals because it is illegal. The same argument is used in favor of legalizing hard drugs. It has been suggested that heroin be provided for free on the NHS.
The NHS is one of the reasons why neither prostitution nor hard drugs are likely to be legalized in the UK. The argument that I can do whatever I like to my body as long as it harms no-one else doesn't work if somebody else has to pick up the tab for the damage done. But even in America the cost of health care for the underclass on drugs and infected with sexually transmitted diseases is picked up by the taxpayer. The only arguments that wash with the taxpayer are economic ones, not moral ones. So if it could be shown that decriminalizing drugs would lead to fewer robberies and burglaries, less street violence and fewer infections from shared needles, then it might be a runner. Experience tells us, though, that the criminals will find something else to make their money from.
Prostitution is not illegal in the UK. The offences are soliciting, kerb-crawling, living off immoral earnings and running a brothel. Private arrangements between consenting adults are regarded as nobody's businee but their own.
A story, apochryphal I'm sure, is told of Henry Kissinger dancing, as was his wont, with a tall statuesque blonde, and whispering in her ear, "Will you sleep with me for $100,000?"
After receiving an answer in the affirmative and after a few more spin turns he asked again, "Will you sleep with me for $10?"
Affronted, she slapped his face, "What do you take me for, a common prostitute?"
"Madam," he replied, "we have already established that. Now we are negotiating as to price."
It is probably impossible to separate sex and money; however pure the majority someone will always find a way of connecting them.
All five prostitutes were heroin addicts, on the streets to feed their habits even though they new that someone was killing the working girls. The murders have led to calls for the legalization of both prostitution and of heroin. A similar libertarian demand might as well call for the legalization of murder.
Prostitution is not one business. At the lower end of the market, most of the girls working the streets are drug addicts, though a few are teenage runaways. Social security payments are enough to live on, but they are not available to the very young, who ought to be back with their parents, nor enough to support a drug habit.
Some street girls and some operating from brothels are controlled by a pimp, who may control them by supplying heroin or cocaine. Increasingly there are illegal immigrants who have been seduced by offers of a job, which turns out to be in prostitution, yet the girls dare not go to the police for fear of deportation.
At the top end of the market, the girls dress well, behave immaculately in public, and make a large amount of money. Their choice of prostitution as a livelihood is not out of necessity, but out of greed. For them it is a way of maximizing their income. Some even like the lifestyle.
In between are any number of variations on the theme.
The argument for legalizing prostitution is to remove the criminality. Just as prohibition brought the mafia into the sale of alcohol, so, the argument goes, the sale of sex is only infiltrated by criminals because it is illegal. The same argument is used in favor of legalizing hard drugs. It has been suggested that heroin be provided for free on the NHS.
The NHS is one of the reasons why neither prostitution nor hard drugs are likely to be legalized in the UK. The argument that I can do whatever I like to my body as long as it harms no-one else doesn't work if somebody else has to pick up the tab for the damage done. But even in America the cost of health care for the underclass on drugs and infected with sexually transmitted diseases is picked up by the taxpayer. The only arguments that wash with the taxpayer are economic ones, not moral ones. So if it could be shown that decriminalizing drugs would lead to fewer robberies and burglaries, less street violence and fewer infections from shared needles, then it might be a runner. Experience tells us, though, that the criminals will find something else to make their money from.
Prostitution is not illegal in the UK. The offences are soliciting, kerb-crawling, living off immoral earnings and running a brothel. Private arrangements between consenting adults are regarded as nobody's businee but their own.
A story, apochryphal I'm sure, is told of Henry Kissinger dancing, as was his wont, with a tall statuesque blonde, and whispering in her ear, "Will you sleep with me for $100,000?"
After receiving an answer in the affirmative and after a few more spin turns he asked again, "Will you sleep with me for $10?"
Affronted, she slapped his face, "What do you take me for, a common prostitute?"
"Madam," he replied, "we have already established that. Now we are negotiating as to price."
It is probably impossible to separate sex and money; however pure the majority someone will always find a way of connecting them.
Sunday, December 17, 2006
Partition?
Here's an unwelcome fact. At the fall of the Ottoman Empire after the first world war, Britain had 410,000 troops in Iraq to control a much smaller population. America has 140,000 troops there now, and is considering withdrawing them. The Saudis are considering seriously funding the Sunni insurgents if the Iranians continue to fund the Shiites.
The Iraqi constitution was designed to allow the oil to be divided fairly between Sunni, Shiites and Kurds. If it comes to partition the Sunni will be the losers as there is little oil in the Sunni areas.
Although I doubt that the numbers of Iraqi dead are anything like the 600,000 estimated in the Lancet article, the numbers of Iraqis killing each other has grown and is growing.
Europe went through all this in the seventeenth century. Does no-one learn from other people's mistakes?
The Iraqi constitution was designed to allow the oil to be divided fairly between Sunni, Shiites and Kurds. If it comes to partition the Sunni will be the losers as there is little oil in the Sunni areas.
Although I doubt that the numbers of Iraqi dead are anything like the 600,000 estimated in the Lancet article, the numbers of Iraqis killing each other has grown and is growing.
Europe went through all this in the seventeenth century. Does no-one learn from other people's mistakes?
Saturday, December 16, 2006
My text is John 3:18
John 3:18
"Whoever believes in him is not condemned, but whoever does not believe stands condemned already because he has not believed in the name of God's one and only son."
For those who don't read the 'Comments' section I draw your attention to this question from a reader:
Terry, do you really believe yourself that non-christians are all condemned automatically, that it is more important to have the right caling card than being a good person? That sounds rather arbitrary and un-just.
This is how I replied:
What is good?
When I was at school I remember being examined in woodwork. The project that session was to make a teapot stand. I don't think that mine was fantastic, and it was certainly not anything I would give houseroom to, but the angles were accurate and it fitted together without nails or glue.
The schoolmaster was marking the students' work but was getting bored with it. Eventually there were only a few teapot stands left in the box. He sneered at what was left. "All the rest can have 5%" he said.
5%! I only needed 50% to be top of the class. I protested. Taking my stand together with one of the others in the box I complained to the schoolmaster. "My teapot stand is much better than his," I insisted. "His has nails sticking out and it isn't square."
"You're right," answered the master, "you can have 6%."
There is another way to get to heaven. Can you get 100% in everything you do? If you are perfect you will be admitted to heaven. That's the standard. Unfortunately, the difference between the best of us and the worst of us is the difference between those teapot stands - the difference between 5% and 6%.
But trust in your own righteousness if you want to; I would rather trust in Jesus.
Getting to heaven isn't difficult. We don't have to climb Everest or swim the Atlantic. Just trusting Jesus is all; it involves a bit of pride swallowing which can be daunting.
It would be nice to think that everybody could go to heaven on their own merits. What a perfect world we would have if that were true! Were it so then the crucifixion would have been unnecessary.
As it is, Jesus said, "No man cometh to the Father but through me."
I want to expand on this.
It is not simply a matter of having the right label. A verbal assent to God and a life of dissolute behaviour will not do. "Faith without works is dead," wrote James. Nor should we think that we are repaying God for our salvation - as if we could! Paul wrote, "It is by grace (grace means an act of undeserved mercy) you have been saved, through faith - and this not from yourselves, it is the gift of God - not by works, so that no-one can boast. For we are God's workmanship, created in Christ Jesus to do good works which God prepared in advance for us to do. (Ephesians 2:8-10.)
Does this mean that only Christians can do good things? Of course not! Christians believe in something called common grace. In his mercy God restrains evil and uses the good deeds of men, believers and unbelievers, to fulfill his will. And it is not his will that any should perish. Peter wrote, "He is patient with you, not wanting anyone to perish, but everyone to come to repentance." (2 Peter 3:9).
Christians are sometimes accused of exclusivity. It is believed that they think of themselves as an exclusive club - extraordinary people with special merit - with special rights of entry to heaven. The truth is quite the opposite. Entry to heaven is a free gift available to anyone, rich or poor, Jew or Gentile, black or white, clever or stupid, male or female, laborer or intellectual, child or old person, Democrat or Republican. It was available to Hitler and Stalin.
Of course, Heaven is not what everyone wants. If you revel in hatred, desire dominance, delight in the unkind put-down, enjoy cheating your boss, your wife or your neighbor, love a lie or think yourself a God, then Heaven may not be what you're looking for. If you were in heaven like that you would spoil it for everybody else. If Godly characteristics are not up your street there is a place from which God has withdrawn even his common grace.
Look around yourself. Do you see evil in the world? I do.
Look into yourself. Do you see evil there? I do.
Paul writes quoting the Hebrew Bible, "There is no-one righteous, not even one; there is no-one who understands, no-one who seeks God. All have turned away, they have together become worthless; there is no-one who does good, not even one." (Romans 3:10-12) and he adds his own comment, "All have sinned and fall short of the glory of God." (v23)
If you say this doesn't include you, your standards are too low and what is more the Apostle John says you make God a liar.
Do you know anyone else who offers a remedy for your sin?
But Paul continues about all those who have sinned and fall short (the old English word 'sin' is an archery term that means your arrow falls short of the target), he continues, "they are justified freely by his grace through the redemption that came by Christ Jesus. God presented him as a sacrifice of atonement, through faith in his blood. He did this to demonstrate his justice, because in his forbearance he had left the sins committed beforehand unpunished - he did it to demonstrate his justice at the present time, so as to be just and the one who justifies those who have faith in Jesus." (v23-26)
Christmas is celebrated all over the world because it marks the day that God intervened in the mess we had made for ourselves.
"Whoever believes in him is not condemned, but whoever does not believe stands condemned already because he has not believed in the name of God's one and only son."
For those who don't read the 'Comments' section I draw your attention to this question from a reader:
Terry, do you really believe yourself that non-christians are all condemned automatically, that it is more important to have the right caling card than being a good person? That sounds rather arbitrary and un-just.
This is how I replied:
What is good?
When I was at school I remember being examined in woodwork. The project that session was to make a teapot stand. I don't think that mine was fantastic, and it was certainly not anything I would give houseroom to, but the angles were accurate and it fitted together without nails or glue.
The schoolmaster was marking the students' work but was getting bored with it. Eventually there were only a few teapot stands left in the box. He sneered at what was left. "All the rest can have 5%" he said.
5%! I only needed 50% to be top of the class. I protested. Taking my stand together with one of the others in the box I complained to the schoolmaster. "My teapot stand is much better than his," I insisted. "His has nails sticking out and it isn't square."
"You're right," answered the master, "you can have 6%."
There is another way to get to heaven. Can you get 100% in everything you do? If you are perfect you will be admitted to heaven. That's the standard. Unfortunately, the difference between the best of us and the worst of us is the difference between those teapot stands - the difference between 5% and 6%.
But trust in your own righteousness if you want to; I would rather trust in Jesus.
Getting to heaven isn't difficult. We don't have to climb Everest or swim the Atlantic. Just trusting Jesus is all; it involves a bit of pride swallowing which can be daunting.
It would be nice to think that everybody could go to heaven on their own merits. What a perfect world we would have if that were true! Were it so then the crucifixion would have been unnecessary.
As it is, Jesus said, "No man cometh to the Father but through me."
I want to expand on this.
It is not simply a matter of having the right label. A verbal assent to God and a life of dissolute behaviour will not do. "Faith without works is dead," wrote James. Nor should we think that we are repaying God for our salvation - as if we could! Paul wrote, "It is by grace (grace means an act of undeserved mercy) you have been saved, through faith - and this not from yourselves, it is the gift of God - not by works, so that no-one can boast. For we are God's workmanship, created in Christ Jesus to do good works which God prepared in advance for us to do. (Ephesians 2:8-10.)
Does this mean that only Christians can do good things? Of course not! Christians believe in something called common grace. In his mercy God restrains evil and uses the good deeds of men, believers and unbelievers, to fulfill his will. And it is not his will that any should perish. Peter wrote, "He is patient with you, not wanting anyone to perish, but everyone to come to repentance." (2 Peter 3:9).
Christians are sometimes accused of exclusivity. It is believed that they think of themselves as an exclusive club - extraordinary people with special merit - with special rights of entry to heaven. The truth is quite the opposite. Entry to heaven is a free gift available to anyone, rich or poor, Jew or Gentile, black or white, clever or stupid, male or female, laborer or intellectual, child or old person, Democrat or Republican. It was available to Hitler and Stalin.
Of course, Heaven is not what everyone wants. If you revel in hatred, desire dominance, delight in the unkind put-down, enjoy cheating your boss, your wife or your neighbor, love a lie or think yourself a God, then Heaven may not be what you're looking for. If you were in heaven like that you would spoil it for everybody else. If Godly characteristics are not up your street there is a place from which God has withdrawn even his common grace.
Look around yourself. Do you see evil in the world? I do.
Look into yourself. Do you see evil there? I do.
Paul writes quoting the Hebrew Bible, "There is no-one righteous, not even one; there is no-one who understands, no-one who seeks God. All have turned away, they have together become worthless; there is no-one who does good, not even one." (Romans 3:10-12) and he adds his own comment, "All have sinned and fall short of the glory of God." (v23)
If you say this doesn't include you, your standards are too low and what is more the Apostle John says you make God a liar.
Do you know anyone else who offers a remedy for your sin?
But Paul continues about all those who have sinned and fall short (the old English word 'sin' is an archery term that means your arrow falls short of the target), he continues, "they are justified freely by his grace through the redemption that came by Christ Jesus. God presented him as a sacrifice of atonement, through faith in his blood. He did this to demonstrate his justice, because in his forbearance he had left the sins committed beforehand unpunished - he did it to demonstrate his justice at the present time, so as to be just and the one who justifies those who have faith in Jesus." (v23-26)
Christmas is celebrated all over the world because it marks the day that God intervened in the mess we had made for ourselves.
Friday, December 15, 2006
Tests
I suppose they are called test matches because they test the patience of the most loyal English supporter. It looks as though by tomorrow it will be all over bar the shouting and the Ashes will be back in Australia's hands. It is difficult to work out exactly what went wrong, although it has to be said that England's for since winning the Ashes has not been good.
Several of the better players are missing including the captain, and it seems that giving the capataincy to Flintoff was as big a mistake as giving it to Botham in 1981. They are similar sorts of players. Their cricket is instinctive rather than thought out, and captaincy requires a thinker. No doubt having to run the match threatens one's own form for a while, but a good captain is worth his place even if he averages 25 with the bat as long as he induces the other batsmen to average over 40 and the bowlers to take wickets. Captains who are tyros with either bat or bowl tend not to bring out the best in the rest of the team.
This England team is young and inexperienced, with too many not used to Australian wickets. Nowadays the tours are so short and the games so few that there is little time to bed into the pace of the ball of the wicket and, especially in Perth, to the bounce.
My son flies to Melbourne on Christmas day. It looks as though it will be a dead rubber byefore he arrives.
Several of the better players are missing including the captain, and it seems that giving the capataincy to Flintoff was as big a mistake as giving it to Botham in 1981. They are similar sorts of players. Their cricket is instinctive rather than thought out, and captaincy requires a thinker. No doubt having to run the match threatens one's own form for a while, but a good captain is worth his place even if he averages 25 with the bat as long as he induces the other batsmen to average over 40 and the bowlers to take wickets. Captains who are tyros with either bat or bowl tend not to bring out the best in the rest of the team.
This England team is young and inexperienced, with too many not used to Australian wickets. Nowadays the tours are so short and the games so few that there is little time to bed into the pace of the ball of the wicket and, especially in Perth, to the bounce.
My son flies to Melbourne on Christmas day. It looks as though it will be a dead rubber byefore he arrives.
Debunking Christmas
I brought my children up not believe what people told them without checking the facts themselves. I'm glad to see that my eldest son at least was listening. Over on his blog he does a pretty good job of debunking the impression that the secular world is out to destroy Christmas.
In my view just the opposite is occurring. Christmas has become a very secular holiday. The retail industry does a huge proportion of its business during the Christmas shopping period, and, whatever they say, it shows little sign of diminishing. Of course they won't get rid of Christmas. "Season's Greetings" and "Happy Holidays" represent a PC attempt to avoid giving offence by mentally challenged individuals who know next to nothing about any religion, but the number of people who really want to take religion out of Christmas is vanishingly small. They hit the headlines on slow news days.
Christmas in the West is full of recent accretions to a schmalzy version of the Nativity. The following played no part in the original Christmas story: Santa Claus, the Grinch, Jack Frost, Father Christmas, Rudolf, Jingling bells, 3 kings, camels, Kris Kringle, children, Bing Crosby, snow, sleighs, reindeer, Scrooge, pipers piping, Tiny Tim, 34th Street, Snowmen, fir trees, turkeys, mince pies, plum puddings, tinsel, pumpkins, Chestnut Stuffing, mulled wine or alcohol of any sort, colored glass balls, carols, holly, ivy, merry gentlemen, stable, December 25th, mistletoe, Slade, innkeepers, stockings, cards, nuts, chocolates, dates, cakes, three ships, figs, colored lights, oxen, donkeys, little drummer boys, scarlet ribbons, berries, Morcombe & Wise, robins, Frosty, Elves, The North Pole, Polar Express, Partridges, The Nutcracker, Mother Goose, Babes in the Wood, Jack and the Beanstalk, Cinderella, Alladin, Egg Nog, Hershey's Kisses, Yukon Cornelius, Home Alone, The Queen, Crackers, paper hats and Robin Goodfellow.
Angels were there and so were shepherds. Magi eventually turned up following a star. Nothing is said regarding the mode of transport of either the Magi or Mary. There were three gifts which makes people think there werte three Magi, but all we know is that they were plural. The inn is a mistranslation. Elsewhere the Greek is translated as 'the upper room'. In the house downstairs the animals lived, but we don't know what sort of animals they were. The manger (feeding trough) was probably made of stone not wood. Herod had all the babies younger than two slaughtered, so the magi finally arrived any time up to two years after the birth. Biblical scholars have calculated the birth date as 23rd September 4BC, but I doubt anybody could be that precise. Martin Luther was overegging it to say of the baby Jesus, "No crying he made." There were a lot of dreams.
The Puritans baned Christmas in England, though it didn't last for long. Later they banned it in America.
I like Christmas, despite the extras clinging to it like barnacles. They represent the artistic impressions of Christmas added by countless generations. Of course they are often fairly trivial, and individually we could do without this or that, but about this time of year when the tree is decorated and a CD of carols is playing on the Hi-Fi, and presents are being wrapped, and neigbors drop in, and children are excited, and the streets are festooned with lights, suddenly there is a moment of silence and we remember that God became Man at Bethlehem specifically to die in our place. Facing certain destruction we are suddenly rescued. No wonder we rejoice.
In my view just the opposite is occurring. Christmas has become a very secular holiday. The retail industry does a huge proportion of its business during the Christmas shopping period, and, whatever they say, it shows little sign of diminishing. Of course they won't get rid of Christmas. "Season's Greetings" and "Happy Holidays" represent a PC attempt to avoid giving offence by mentally challenged individuals who know next to nothing about any religion, but the number of people who really want to take religion out of Christmas is vanishingly small. They hit the headlines on slow news days.
Christmas in the West is full of recent accretions to a schmalzy version of the Nativity. The following played no part in the original Christmas story: Santa Claus, the Grinch, Jack Frost, Father Christmas, Rudolf, Jingling bells, 3 kings, camels, Kris Kringle, children, Bing Crosby, snow, sleighs, reindeer, Scrooge, pipers piping, Tiny Tim, 34th Street, Snowmen, fir trees, turkeys, mince pies, plum puddings, tinsel, pumpkins, Chestnut Stuffing, mulled wine or alcohol of any sort, colored glass balls, carols, holly, ivy, merry gentlemen, stable, December 25th, mistletoe, Slade, innkeepers, stockings, cards, nuts, chocolates, dates, cakes, three ships, figs, colored lights, oxen, donkeys, little drummer boys, scarlet ribbons, berries, Morcombe & Wise, robins, Frosty, Elves, The North Pole, Polar Express, Partridges, The Nutcracker, Mother Goose, Babes in the Wood, Jack and the Beanstalk, Cinderella, Alladin, Egg Nog, Hershey's Kisses, Yukon Cornelius, Home Alone, The Queen, Crackers, paper hats and Robin Goodfellow.
Angels were there and so were shepherds. Magi eventually turned up following a star. Nothing is said regarding the mode of transport of either the Magi or Mary. There were three gifts which makes people think there werte three Magi, but all we know is that they were plural. The inn is a mistranslation. Elsewhere the Greek is translated as 'the upper room'. In the house downstairs the animals lived, but we don't know what sort of animals they were. The manger (feeding trough) was probably made of stone not wood. Herod had all the babies younger than two slaughtered, so the magi finally arrived any time up to two years after the birth. Biblical scholars have calculated the birth date as 23rd September 4BC, but I doubt anybody could be that precise. Martin Luther was overegging it to say of the baby Jesus, "No crying he made." There were a lot of dreams.
The Puritans baned Christmas in England, though it didn't last for long. Later they banned it in America.
I like Christmas, despite the extras clinging to it like barnacles. They represent the artistic impressions of Christmas added by countless generations. Of course they are often fairly trivial, and individually we could do without this or that, but about this time of year when the tree is decorated and a CD of carols is playing on the Hi-Fi, and presents are being wrapped, and neigbors drop in, and children are excited, and the streets are festooned with lights, suddenly there is a moment of silence and we remember that God became Man at Bethlehem specifically to die in our place. Facing certain destruction we are suddenly rescued. No wonder we rejoice.
Wednesday, December 13, 2006
ASH
ASH is over for another year. I arrived back on Tuesday morning and spent most of the day falling asleep at inappropriate times. Today I spent in London at the Gene Therapy Advisory Committee. One of the applicants sent his apologies as he had just returned from ASH. I saw him on the same plane as me, so if I could make the effort why couldn't he? I had the longer journey.
This year I decided to remain on European time to try an avoid the jet lag. Tuesday was still a write off. I really can't remember much about it. Apart from the 158 e-mails that I answered.
I will blog later about the impressions that ASH made upon me, but here are a few thoughts.
Over 150 CLL abstracts, but was there really a need to put on oral presentations on CLL at the same time so that it was impossible to go to everything?
Orlando has new entertainment attractions since the last time I went, but there was no time to visit any of them.
I'm sure that paying £3000+ for business class is not worth it. It would be more sensible to fly via New York, sleep in an airport hotel and get the daytime flight across the Atlantic - total cost around £500. The seats that lie flat in business class are too narrow and very hard.
American food is vast and tasteless, but they do good sandwiches.
I suppose it must be time to prepare for Christmas.
This year I decided to remain on European time to try an avoid the jet lag. Tuesday was still a write off. I really can't remember much about it. Apart from the 158 e-mails that I answered.
I will blog later about the impressions that ASH made upon me, but here are a few thoughts.
Over 150 CLL abstracts, but was there really a need to put on oral presentations on CLL at the same time so that it was impossible to go to everything?
Orlando has new entertainment attractions since the last time I went, but there was no time to visit any of them.
I'm sure that paying £3000+ for business class is not worth it. It would be more sensible to fly via New York, sleep in an airport hotel and get the daytime flight across the Atlantic - total cost around £500. The seats that lie flat in business class are too narrow and very hard.
American food is vast and tasteless, but they do good sandwiches.
I suppose it must be time to prepare for Christmas.
Thursday, December 07, 2006
More Sword of Truth
I have just finished the ninth book in the Terry Goodkind "Sword of Truth" series. If you read the reviews on Amazon it seems that readers have got tired of the plot not moving on very much while being subjected to Goodkind's right-wing propaganda. I disagree. I think that in this book Goodkind tackles an important issue, that of pacifism.
I long ago decided that I was not a pacifist. As a teenager I flirted with the idea, declaring that although prepared to die for my country I was not prepared to kill for it. I grew to like my life too much for that. I am happy to live to benefit my country, and prepared to risk death if the cause is right, but rather than let an oppressor kill me in the hope that he would have it on his conscience, I would kill him first if I got the chance.
Goodkind propounds the view that the greatest danger to a community is the failure to recognize evil. To call evil misguidedness or lack of parental discipline or a deprived childhood or the consequence of poverty suggests that it is an illness that can be cured. Alas it is not so.
The Christian gospel offers redemption for sinners. Some liberal Christians believe that all will be saved and that Hell will be unpopulated (except perhaps for Hitler, Stalin and Menachem Begin). They believe that, even after death, unbelievers will be given a second chance. Some believe that good Jews or Moslems or Humanists are a sort of honorary Christians, and that the blood of Jesus was sufficient to redeem them even though they didn't know it and indeed had rejected the claims of Christ in their lifetimes. Some believe that there is always hope of a deathbed conversion and that no matter how wicked has a man been during his lifetime, we cannot know what interchange with God took place during the final moments of life.
From this premise they oppose the death penalty, they oppose war, and they oppose violence.
This view has elements of truth within it, but the end result is destructively wrong.
Jesus' blood is certainly sufficient to cover every sin, but it is not applied unless it is accepted. "God so loved the world that he gave his one and only son, that whoever believes in him shall not perish but have eternal life." Presumably those who do not believe in him will perish. Of course, because a couple of verses later we read, "Whoever believes in him is not condemned, but whoever does not believe stands condemned already because he has not believed in the name of God's one and only son."
We have so few of the actual words of Jesus that people are apt to make up their own Christianity, but here we have the actual words of Christ, and not some obscurantist words with alternative interpretations; these are words quoted now, always and everywhere as being Christianity in a nutshell. They are from John's Gospel Ch 3 verses 16 and 18.
The chapter continues, "Light has come into the world, but men liked darkness instead of light because their deeds were evil. Everyone who does evil hates the light for fear that his deeds will be exposed."
Jesus certainly recognized evil.
Would Jesus have opposed the death penalty?
He was himself subjected to the death penalty, and he confronted it when others were punished in the same way. It is interesting to view his response to the death penalty inflicted on two thieves who were crucified alongside him. Had he wished, he could have come down from the cross; he had that power. He could certainly have saved the two thieves. One of the thieves recognized this, "Aren't you the Christ? save yourself and us!" But when the second thief spoke to him like this, "Don't you fear God? (rebuking the first thief) We are punished justly, for we are getting what our deeds deserve, But this man has done nothing wrong. Jesus, remember me when you come into yours kingdom."
How did Jesus respond? "I forgive you, come down from the cross"? "This is the sort of injustice that you get with the death penalty"? "You have had a deathbed conversion, you don't need to be executed"? No. He says, "This day you will be with me in paradise."
Trying to make allowances for evil leads to appeasement rather than war. Appeasement is very popular at the time. Chamberlain was a popular man when he came home from Munich waving a piece of paper. True leadership requires toughing it out when life gets difficult. Churchill knew this. The foreign secretary, Lord Halifax, (he was the one who argued against bombing German munitions factories because they were private property) wanted an easy peace with Hitler. Churchill stood alone resisting the evil Hitler while everyone else had capitulated.
Margaret Thatcher knew this. After losing destroyers and her helicopters to the Exocet missiles sold to the Argentineans by the French and seeing soldiers burn to death on Sir Galahad, there were many advisors, not least the American Secretary of State, Al Haig, urging her to make peace with the evil oligarchy. She resisted the temptation and some rather tough soldiers marched, where they could not fly, across the frozen hills of the Falklands to take Port Stanley.
There is a lot of evil still out there.
In Goodkind's story the pacifists survived for many hundreds of years because of their remote location, but when finally invaded by brutal conquerors, they send for a hero to free them. But they view the hero as a savage; necessary to defeat the invader, but beneath their level of civilization, just someone to do the dirty work.
The hero refuses the task, recognizing that you can't defeat evil without the whole community steeling itself to resistance. It's like a viral infection in a CLL patient, get rid of this one and another will be along in a moment. Without stiffening the resistance there is no point to it.
An allegory for our time? You might think so, I could not possibly comment.
I long ago decided that I was not a pacifist. As a teenager I flirted with the idea, declaring that although prepared to die for my country I was not prepared to kill for it. I grew to like my life too much for that. I am happy to live to benefit my country, and prepared to risk death if the cause is right, but rather than let an oppressor kill me in the hope that he would have it on his conscience, I would kill him first if I got the chance.
Goodkind propounds the view that the greatest danger to a community is the failure to recognize evil. To call evil misguidedness or lack of parental discipline or a deprived childhood or the consequence of poverty suggests that it is an illness that can be cured. Alas it is not so.
The Christian gospel offers redemption for sinners. Some liberal Christians believe that all will be saved and that Hell will be unpopulated (except perhaps for Hitler, Stalin and Menachem Begin). They believe that, even after death, unbelievers will be given a second chance. Some believe that good Jews or Moslems or Humanists are a sort of honorary Christians, and that the blood of Jesus was sufficient to redeem them even though they didn't know it and indeed had rejected the claims of Christ in their lifetimes. Some believe that there is always hope of a deathbed conversion and that no matter how wicked has a man been during his lifetime, we cannot know what interchange with God took place during the final moments of life.
From this premise they oppose the death penalty, they oppose war, and they oppose violence.
This view has elements of truth within it, but the end result is destructively wrong.
Jesus' blood is certainly sufficient to cover every sin, but it is not applied unless it is accepted. "God so loved the world that he gave his one and only son, that whoever believes in him shall not perish but have eternal life." Presumably those who do not believe in him will perish. Of course, because a couple of verses later we read, "Whoever believes in him is not condemned, but whoever does not believe stands condemned already because he has not believed in the name of God's one and only son."
We have so few of the actual words of Jesus that people are apt to make up their own Christianity, but here we have the actual words of Christ, and not some obscurantist words with alternative interpretations; these are words quoted now, always and everywhere as being Christianity in a nutshell. They are from John's Gospel Ch 3 verses 16 and 18.
The chapter continues, "Light has come into the world, but men liked darkness instead of light because their deeds were evil. Everyone who does evil hates the light for fear that his deeds will be exposed."
Jesus certainly recognized evil.
Would Jesus have opposed the death penalty?
He was himself subjected to the death penalty, and he confronted it when others were punished in the same way. It is interesting to view his response to the death penalty inflicted on two thieves who were crucified alongside him. Had he wished, he could have come down from the cross; he had that power. He could certainly have saved the two thieves. One of the thieves recognized this, "Aren't you the Christ? save yourself and us!" But when the second thief spoke to him like this, "Don't you fear God? (rebuking the first thief) We are punished justly, for we are getting what our deeds deserve, But this man has done nothing wrong. Jesus, remember me when you come into yours kingdom."
How did Jesus respond? "I forgive you, come down from the cross"? "This is the sort of injustice that you get with the death penalty"? "You have had a deathbed conversion, you don't need to be executed"? No. He says, "This day you will be with me in paradise."
Trying to make allowances for evil leads to appeasement rather than war. Appeasement is very popular at the time. Chamberlain was a popular man when he came home from Munich waving a piece of paper. True leadership requires toughing it out when life gets difficult. Churchill knew this. The foreign secretary, Lord Halifax, (he was the one who argued against bombing German munitions factories because they were private property) wanted an easy peace with Hitler. Churchill stood alone resisting the evil Hitler while everyone else had capitulated.
Margaret Thatcher knew this. After losing destroyers and her helicopters to the Exocet missiles sold to the Argentineans by the French and seeing soldiers burn to death on Sir Galahad, there were many advisors, not least the American Secretary of State, Al Haig, urging her to make peace with the evil oligarchy. She resisted the temptation and some rather tough soldiers marched, where they could not fly, across the frozen hills of the Falklands to take Port Stanley.
There is a lot of evil still out there.
In Goodkind's story the pacifists survived for many hundreds of years because of their remote location, but when finally invaded by brutal conquerors, they send for a hero to free them. But they view the hero as a savage; necessary to defeat the invader, but beneath their level of civilization, just someone to do the dirty work.
The hero refuses the task, recognizing that you can't defeat evil without the whole community steeling itself to resistance. It's like a viral infection in a CLL patient, get rid of this one and another will be along in a moment. Without stiffening the resistance there is no point to it.
An allegory for our time? You might think so, I could not possibly comment.
Food for thought
I had my first Christmas dinner yesterday. This morning I topped the 200 pounds mark. This year has been a poor year for the Hamblin shape. Last year I was down below 190 having reached 210 in 2004. I even had 2 inches taken in from the waist of every pair of trousers.
I know the remedy. Eat less and exercise more. The problem is, I like eating and dislike exercise.
That's not entirely true. Exercise can be exhilarating. When I am fit, a brisk walk on the beach, a cycle through the forest or even a jog to the hospital sends the adrenaline zinging round the body and leaves me with a warm glow, but getting fit: there's the rub. I gave up my gym membership in 2005; my daily cycle trip was sufficient to keep me losing about half a pound a week while cutting out bread and limiting potatoes to one a day. Then came Christmas. I like nuts. Nobody else does. Someone had to eat them.
If you were brought up under post-war austerity you were taught to leave nothing behind on your plate. It is hard to drill yourself into tasting a bit of this and a bit of that and leaving the plate fairly full, especially at Christmas. But that's what must be done.
Today I am fasting. Tomorrow as I sit in the British Airways executive lounge waiting for my flight to Orlando I must avoid the smoked salmon sandwiches and the claret. I must eschew the free glass of champagne as I get on the plane. I must get up and walk around the cabin.
I must keep repeating this mantra: Let it go to waste or else it will go to waist.
I know the remedy. Eat less and exercise more. The problem is, I like eating and dislike exercise.
That's not entirely true. Exercise can be exhilarating. When I am fit, a brisk walk on the beach, a cycle through the forest or even a jog to the hospital sends the adrenaline zinging round the body and leaves me with a warm glow, but getting fit: there's the rub. I gave up my gym membership in 2005; my daily cycle trip was sufficient to keep me losing about half a pound a week while cutting out bread and limiting potatoes to one a day. Then came Christmas. I like nuts. Nobody else does. Someone had to eat them.
If you were brought up under post-war austerity you were taught to leave nothing behind on your plate. It is hard to drill yourself into tasting a bit of this and a bit of that and leaving the plate fairly full, especially at Christmas. But that's what must be done.
Today I am fasting. Tomorrow as I sit in the British Airways executive lounge waiting for my flight to Orlando I must avoid the smoked salmon sandwiches and the claret. I must eschew the free glass of champagne as I get on the plane. I must get up and walk around the cabin.
I must keep repeating this mantra: Let it go to waste or else it will go to waist.
Tuesday, December 05, 2006
CLL mistakes
How much do general haematologists know about CLL? I have just been consulted about a patient who died of complications of treatment and I identified three mistakes that seem to be quite commonplace.
Mistake 1] Late diagnosis. Nowadays people are having more frequent blood tests. The usual reason is to look for anemia in someone who is 'tired all the time'. Almost always the hemaglobin comes back normal, but modern blood counters give a lot of extra information. What should a hematologist do if the lymphocyte count count comes back greater than 3.5? In our lab we look at a blood film, and unless the extra lymphocytes are large granular cells, we do some simple immunophenotyping. We pick up an extra one or two cases of early CLL every week like this.
Does it matter? Most cases of CLL are fairly indolent and immunophenotyping is relatively expensive. So what if the CLL is not diagnosed until the lymphocyte count reaches 10? In 99% of cases it doesn't matter, but in the remaining one in a hundred there is a p53 deletion and late diagnosis can seriously harm the patient's health. A lot of money to pay for one in a hundred? Sure, but it's a lot of money if you get sued.
Mistake 2] Missing hemolytic anemia. Hemolytic anemia occurs in about 15% of patients with CLL. It can be severe and even fatal. The features are a rapidly falling hemoglobin and a positive direct antiglobulin test (Coombs test). This demonstrates that an autoimmune process is going on and that pretty big doses of steroids are needed. Autoimmune hemolytic anemia in CLL differs from other types in one particular, normally one would expect to find a rush of young red cells coming into the blood to replace those that have been destroyed. These young cells are called reticulocytes. In CLL this may not happen because the bone marrow is so stuffed with leukemia cells that there is no room to make new red cells. This can be a problem because you can get a positive Coombs test in CLL without hemolysis, so if there are no reticulocytes teh diagnosis is difficult to confirm.
If the anemia is very severe, it would be unwise to assume this is not hemolytic anemia. There are other tests that will help confirm the diagnosis. Looking at the blood smear you can see red cells that are spherical instead of flat discs. A protein called haptoglobin disappears from the blood because it is used up clearing released hemoglobin from the circulation, but the test that everybody forgets - probably because it is a urine test, normally done by nurses is a dipstick test for urinary urobilinogen. This is quick and easy, and an increase tells you that red cells are being broken down more rapidly than normal.
Mistake 3] Failure to recognise when CLL is drug resistant. The commonest cause of drug resistance is an abnormality of the p53 pathway. This is most easily detected by a FISH test for chromosome 17p.
p53 is required by most drugs to kill CLL cells, including chlorambucil, fludarabine, pentostatin, cladribine, cyclophosphamide, adriamysin, vincristine, rituximab and low dose steroids. The only drigs that we know work in p53 deficient CLL cells are high dose steroids, Campath and flavaperidol.
But you don't need sophisticated tests to discover the CLL is drug resistant; just give a couple of courses ofchlorambucil or fludarabine. If the patient is not by then in a partial remission the CLL is probably drug resistant.
These are not very difficult concepts to grasp: common sense really. Even if a hematologist is more interested in acute leukemia there is no excuse for not getting this right.
Mistake 1] Late diagnosis. Nowadays people are having more frequent blood tests. The usual reason is to look for anemia in someone who is 'tired all the time'. Almost always the hemaglobin comes back normal, but modern blood counters give a lot of extra information. What should a hematologist do if the lymphocyte count count comes back greater than 3.5? In our lab we look at a blood film, and unless the extra lymphocytes are large granular cells, we do some simple immunophenotyping. We pick up an extra one or two cases of early CLL every week like this.
Does it matter? Most cases of CLL are fairly indolent and immunophenotyping is relatively expensive. So what if the CLL is not diagnosed until the lymphocyte count reaches 10? In 99% of cases it doesn't matter, but in the remaining one in a hundred there is a p53 deletion and late diagnosis can seriously harm the patient's health. A lot of money to pay for one in a hundred? Sure, but it's a lot of money if you get sued.
Mistake 2] Missing hemolytic anemia. Hemolytic anemia occurs in about 15% of patients with CLL. It can be severe and even fatal. The features are a rapidly falling hemoglobin and a positive direct antiglobulin test (Coombs test). This demonstrates that an autoimmune process is going on and that pretty big doses of steroids are needed. Autoimmune hemolytic anemia in CLL differs from other types in one particular, normally one would expect to find a rush of young red cells coming into the blood to replace those that have been destroyed. These young cells are called reticulocytes. In CLL this may not happen because the bone marrow is so stuffed with leukemia cells that there is no room to make new red cells. This can be a problem because you can get a positive Coombs test in CLL without hemolysis, so if there are no reticulocytes teh diagnosis is difficult to confirm.
If the anemia is very severe, it would be unwise to assume this is not hemolytic anemia. There are other tests that will help confirm the diagnosis. Looking at the blood smear you can see red cells that are spherical instead of flat discs. A protein called haptoglobin disappears from the blood because it is used up clearing released hemoglobin from the circulation, but the test that everybody forgets - probably because it is a urine test, normally done by nurses is a dipstick test for urinary urobilinogen. This is quick and easy, and an increase tells you that red cells are being broken down more rapidly than normal.
Mistake 3] Failure to recognise when CLL is drug resistant. The commonest cause of drug resistance is an abnormality of the p53 pathway. This is most easily detected by a FISH test for chromosome 17p.
p53 is required by most drugs to kill CLL cells, including chlorambucil, fludarabine, pentostatin, cladribine, cyclophosphamide, adriamysin, vincristine, rituximab and low dose steroids. The only drigs that we know work in p53 deficient CLL cells are high dose steroids, Campath and flavaperidol.
But you don't need sophisticated tests to discover the CLL is drug resistant; just give a couple of courses ofchlorambucil or fludarabine. If the patient is not by then in a partial remission the CLL is probably drug resistant.
These are not very difficult concepts to grasp: common sense really. Even if a hematologist is more interested in acute leukemia there is no excuse for not getting this right.
Sunday, December 03, 2006
Christmas giving.
I doubt that it made many headlines in Europe or the USA but a couple of months ago a devastating typhoon that hit the Philippines south of Manilla.
For a while now we have been supporting a couple of Filippinos in this area in their work of reaching the lost for Christ.
Lourdes Manabat runs a Christian school on the mainland south of Manilla, the photograph shows some of her pupils. Her husband, Venancio, known as 'Boy', pastors a church on the island of Mindoro, which is a boat journey away. He also runs a free school for the Wawa people on the island.
The church on Mindoro recently celebrated its first anniversary on the Island. the picture here shows the entrance. In addition he has undertaken the pastoring of another church on the island.Recently, we received this e-mail from the Manabats.
"Two months ago, there’s a typhoon named “ Milenio “ a super typhoon strike Mindoro. Sad to say, that the church where our Brethren gathers, totally swept away. Now, they only gather in a four post with shade.
Here is an illustration.
The members in the church want to build it again, but they don’t have means to do it, for most of the members are farmers and selling charcoal that they get in the mountain. Now, as the steward of God in that place, we are burdened. We are praying and praying and think of means on how the church will be built again.
In San. Vicente, there is no Christian Church. Now, through the Grace of God, there will be a Christ Centered Christian Church in that place. Include us always in your prayers, that God will speed up the time in answering our prayers, to build a church building for the Glory of God. The estimated cost to build a simple church building is 3000,00 US dollars. It is not a concrete one, it will be made up of logs, woods and Galvanized Iron sheets. This Christmas, its our hope and faith that the church will be rebuilt again, so that they can worship God in a new sanctuary on Christmas eve.. And it will be a testimony to the community that our God is alive and can make a way, even there’s seems to be no way.
Since Ptr. Boy is pastoring two churches, 25km. Away from Wawa, we are praying for a motorcycle for him to use in taking care of the flock, transportation in going there is limited and there’s only a designated time for the tricycle to go there. We are praying for 1000,00 U$ to buy a motorcycle."
Today, we received another e-mail from Lourdes.
"Greetings in the Most Precious Name of our Lord Jesus Christ.
How are you? Its always our prayer that you are fine and always in good health and the whole family.
This week, the typhoon " Reming " strikes again the Philippines, specially the Province of Bicol Region, where hundrends of people died and buried alive by mud flows.
In Mindoro, our mission field was also strike by the typhoon. The mission House, where Pastor Boy leave was hit by a electric post and a tree. Praise God, for my husband transfer in the church before the post and tree fall down. In the church, he was not able to save the instruments used in Praise and Worship from water. The Church was being used now as an evacuation center,for the houses of the members were badly damage and needs repair.They are just made by nipa hut.
The church in Sn. Vicente... again...totally swept away for the second time. The members are so depressed. I dont know if where they held their worship service yesterday.
There are things that sometimes we dont understand. Christmas is coming, but before Christmas... disaster hit the Philippines, and most of our members were affected, not just their house, but even the Church. They really need prayers and to understand that all things work together for good....
Two days now, i dont have communication to my husband, i dont know now what is happening there, for theres a problem in electricity and communication.He mentioned to me last Friday that the tower of Globe telecoms fell down. But i trust God, that he is fine...
Remember us in your prayers, remember our brethren there in Mindoro. Their livelihood is fishing, but now...they cannot go out in the sea to catch fish to supply their needs.Help us in praying for a miracle blessings for them to survive and overcome all these things and become victorious in their christian life and with all these trials.
As their flock keeper, all we can do is to pray and ask for prayers, that miracles will happen. Some expect from us, but we expect God to move in a miraculous way.
Im so sorry for telling you every detailed of our ministry, you are also our prayer partner and this is also your ministry in the Philippines. You can share our situation and ask for prayers to our brethren, for we really need it... Through prayer, Gods hand move mightily.
God willing, the school permit will be released on the 6th of December. I already got the Mayors Permit.
Please,as Aaron's sponsor, dont be disappointed if Aaron stop in his schooling, we tried our best, but financially, we cant (Aaron is her son). We are disappointed also, specially Aaron, but we can do nothing but to accept it.the everyday expenses becomes our problem, not the entrance fees, because you provide it for them. Sir, i hope you understand. As parent, we want our children to finish their schooling..., but our present situation is our problem.... but i know...this is only TEMPORARY, for the Lord says..." for i know the plans i have for you, plan to prosper you and not to harm you, plan to give us hope..." As Christian, we need to pass this trials...and we will pass it, in Jesus Name.Amen."
We are obviously responding to her plea, but I have posted this message in the hope that others might like to share in this ministry. St Paul wrote this to the Church at Philippi, “ Not that I am looking for a gift, but I am looking for what may be credited to your account…” (Phil ch 4 v 17)
If anybody reading this has the opportunity to visit the Philippines you would be very welcome to help in this ministry of church building.
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