There is a lot of nonsense talked about flat-earthers. It is used as a stick to beat people who disagree modern scientific theories like climate change and evolution. In fact nobody has believed the earth was flat since the start of the iron age except in 17th century China and Terry Pratchett fans. The misconception that educated people at the time of Columbus believed in a flat Earth, and that his voyages refuted that belief, has been referred to as "The Myth of the Flat Earth". (Members of the Historical Association (1945). Common errors in history. General Series, G.1. London: P.S. King & Staples for the Historical Association. , pp.4–5. The Historical Association published a second list of 17 other common errors in 1947.) As early as the venerable Bede (c.672 – 735) the common view among Christians was that the earth was an orb.He wrote in his influential treatise on computus, The Reckoning of Time, that the Earth was round ('not merely circular like a shield [or] spread out like a wheel, but resembling] more a ball'), explaining the unequal length of daylight from "the roundness of the Earth, for not without reason is it called 'the orb of the world' on the pages of Holy Scripture and of ordinary literature.
Flat-earthism became the province of weirdos and mad Americans. For example: In 1956, Samuel Shenton set up the International Flat Earth Research Society, better known as the Flat Earth Society, as a direct descendant of the Universal Zetetic Society, just before the Soviet Union launched the first artificial satellite, Sputnik. He responded to this event "Would sailing round the Isle of Wight prove that it were spherical? It is just the same for those satellites." His primary aim was to reach children before they were convinced about a spherical Earth. Despite plenty of publicity, the space race eroded Shenton's support in Britain until 1967 when he started to become famous due to the Apollo program. His postbag was full but his health suffered as his operation remained essentially a one-man show until he died in 1971.
There is a portion of the earth that is flatter then it ought to be; I mean at the two poles; the earth has flattened head and feet making it officially oblate rather than absolutely spherical. How did they discover that?
I obtained this from the current New Scientist.
In 1671, France sent astronomer Jean Richer to South America to map the skies of the southern hemisphere. Richer, whose work helped the French navy navigate the world, took with him two pendulum clocks. Though they had been carefully calibrated in Paris, he was dismayed to find that they lost 2 minutes 28 seconds per day in French Guyana compared with local clocks.
Upon his return home in 1673, this discrepancy caused an international scientific uproar. Isaac Newton declared that the clocks beat more slowly near the equator because the force of gravity was less there, and that gravity was less because the planet bulged at its waist due to the centrifugal force generated by its rotation. French scientists rejected Newton's oblate Earth, maintaining instead that the planet is pointed, rather than flattened, toward the poles.
Both sides realised that measuring the length of a degree of latitude at various points – especially near the equator and poles – would reveal the true shape of the Earth. An expedition needed to be sent to the equator to survey a line, as nearly north-south as possible, hundreds of kilometres long.
In 1733 a Franco-Spanish team of scientists, naval officers, device-makers and servants was assembled. In Measure of the Earth, Larrie Ferreiro tells the story of their adventures. They set sail in 1735, expecting to spend three or four years taking measurements in the viceroyalty of Peru. Instead, it would be nine years before any of them would see Europe again, and several would never make it. Their surgeon died by the sword, the youngest succumbed to malaria, while two were marooned in the New World for lack of money.
The team did measure the surface distance of one degree of latitude in what is now Ecuador. They found it to be 56,753 toises (a French unit of measurement at the time) – just 50 metres off today's value – proving Newton right. Ironically, by the time they reached Paris, another French team had gone north to the Arctic circle and taken measurements confirming the Earth to be oblate, ending the debate.
Measure of the Earth, by Larrie D. Ferreiro, Basic Books, £15.99/$28.
Saturday, June 18, 2011
Health report
I have had a few days when I have not been so well with increased bloating and discomfort. I had thought it might have been triggered by more fiber in my diet (I switched form cornflakes to shredded wheat) but even going over to a liquid diet didn't seem to fix it, so on Thursday I doubled my steroid dose and by Friday I began to feel much better.
How could steroids make such a difference? The conventional explanation would be because the steroids reduced swelling in the bowel and this may be the correct explanation. However, as well as an improvement in the bloating I have also noticed an improvement in the peripheral neuropaty in my feet which was caused by oxaliplatin between March and August 2009. After two years this is still a problem.
The explanation for neuropathy after oxaliplatin is complex. There is an acute problem occurring in 80% of patients in which cold triggers a painful peripheral neuropathy. This is very transient and is managed by keeping the hands warm duirng treatment. I used to wear gloves for several days when I was receiving it.
This is the official explanation of oxaliplatin neuropathy: Oxaliplatin produces prominent acute neurotoxic symptoms following infusion. Accordingly, following oxaliplatin infusion, sensory and motor axons demonstrate acute changes in recovery cycle parameters. Such findings would be consistent with oxaliplatin administration producing an acute ‘functional’ channelopathy of axonal Na+ channels. In experimental models, oxaliplatin administration slows Na+ channel inactivation kinetics, shifts the voltage dependence of activation and inactivation and reduces overall Na+ current. A change in Na+ channel properties may predispose to ectopic activity, producing symptoms of paraesthesia and fasciculations. Cold exposure will further affect Na+ channel kinetics and accordingly, Na+ channel mutations have been described which are functionally aggravated in cold temperatures, a feature that commonly develops in acute oxaliplatin-induced neurotoxicity. However, the present findings provide no support for a separate effect of oxaliplatin on potassium (K+) channels, despite the presence of neuromyotonic-type discharges which are typically associated with K+ channel dysfunction.
The link between acute and chronic manifestations of oxaliplatin-induced neurotoxicity has not been fully defined. However, acute modulation of Na+ channel properties in both motor and sensory axons influences the final severity of oxaliplatin-induced neurotoxicity. In further support, preliminary trials of potential neuroprotective agents in oxaliplatin-treated patients have suggested that acute and chronic presentations may also be linked. As a putative mechanism, acute modulation of axonal excitability may induce chronic sensory axonal degeneration via disruption of Na+ channel function, ultimately provoking a cascade leading to excess Ca2+ influx and axonal degeneration. The prominence of sensory symptoms in chronic
oxaliplatin-induced neurotoxicity may suggest greater susceptibility of sensory axons to damage in the typical oxaliplatin clinical dose range, although potentially the relatively greater exposure of sensory cell bodies in the dorsal root ganglia may further predispose sensory axons to toxic damage.
Chronic peripheral neuropathy does not need a cold trigger. Papers tend to report this as occuring in 10-15% of cases and then only in in those who exceed the threshold cumulative dose of about 800 mg/sq m. But at least one study showed that at follow-up, 79.2% of patients reported residual neuropathic symptoms, with distal loss of pin-prick sensibility in 58.3% of patients and loss of vibration sensibility in 83.3% of patients. Symptom severity scores were significantly correlated with cumulative dose. There was no recovery of sensory action potential amplitudes in upper and lower limbs, consistent with persistent axonal sensory neuropathy. Sensory excitability parameters had not returned to baseline levels, suggesting persisting abnormalities in nerve function. The extent of excitability abnormalities during treatment was significantly correlated with clinical outcomes at follow-up.
Some (but very few) patients will experience autonomic neuropathy, which occurs when autonomic nerves, both sympathetic and parasympathetic, are damaged. Symptoms can include bowel obstruction, severe constipation, postural hypotension and cardiac dysfunction (heart rate variability, tachycardia) and urinary symptoms both of incontinence and retention. I certainly sufered from postural hypotension and now my previous hypertension needs no drugs to control it. I also had bowel symptoms that would fit and unexplained tachycardias. Recently I have had some urinary symptoms as well. But none of this explains my response to steroids.
Steroids are anti-inflammatories and usually work by stabilizing macrophages which limits their effect as effector cells. I have little doubt that I have some sort of immune process going on, as evidenced by the faint maculo-papular and steroid sensitive rash that I keep getting on my forehead. An immune response against my cancer could be the explanation of why I am surviving so long with metastatic disease and when I follow this line of thought this whole episode could have been triggered by the horrendous journey back from EHA last week. One could construct stories that the initial cold sensitive damage released an antigenic stimulus of apoptotic proteins that continues in a smaller proportion of patients, but there is no experimental evidence to support this.
Anyway, I seem to have stumbled on a way of controlling my symptoms and that will have to do. For the sake of long term steroid side effects I will have to reduce the dose shortly but I will be circumspect about how I do it.
How could steroids make such a difference? The conventional explanation would be because the steroids reduced swelling in the bowel and this may be the correct explanation. However, as well as an improvement in the bloating I have also noticed an improvement in the peripheral neuropaty in my feet which was caused by oxaliplatin between March and August 2009. After two years this is still a problem.
The explanation for neuropathy after oxaliplatin is complex. There is an acute problem occurring in 80% of patients in which cold triggers a painful peripheral neuropathy. This is very transient and is managed by keeping the hands warm duirng treatment. I used to wear gloves for several days when I was receiving it.
This is the official explanation of oxaliplatin neuropathy: Oxaliplatin produces prominent acute neurotoxic symptoms following infusion. Accordingly, following oxaliplatin infusion, sensory and motor axons demonstrate acute changes in recovery cycle parameters. Such findings would be consistent with oxaliplatin administration producing an acute ‘functional’ channelopathy of axonal Na+ channels. In experimental models, oxaliplatin administration slows Na+ channel inactivation kinetics, shifts the voltage dependence of activation and inactivation and reduces overall Na+ current. A change in Na+ channel properties may predispose to ectopic activity, producing symptoms of paraesthesia and fasciculations. Cold exposure will further affect Na+ channel kinetics and accordingly, Na+ channel mutations have been described which are functionally aggravated in cold temperatures, a feature that commonly develops in acute oxaliplatin-induced neurotoxicity. However, the present findings provide no support for a separate effect of oxaliplatin on potassium (K+) channels, despite the presence of neuromyotonic-type discharges which are typically associated with K+ channel dysfunction.
The link between acute and chronic manifestations of oxaliplatin-induced neurotoxicity has not been fully defined. However, acute modulation of Na+ channel properties in both motor and sensory axons influences the final severity of oxaliplatin-induced neurotoxicity. In further support, preliminary trials of potential neuroprotective agents in oxaliplatin-treated patients have suggested that acute and chronic presentations may also be linked. As a putative mechanism, acute modulation of axonal excitability may induce chronic sensory axonal degeneration via disruption of Na+ channel function, ultimately provoking a cascade leading to excess Ca2+ influx and axonal degeneration. The prominence of sensory symptoms in chronic
oxaliplatin-induced neurotoxicity may suggest greater susceptibility of sensory axons to damage in the typical oxaliplatin clinical dose range, although potentially the relatively greater exposure of sensory cell bodies in the dorsal root ganglia may further predispose sensory axons to toxic damage.
Chronic peripheral neuropathy does not need a cold trigger. Papers tend to report this as occuring in 10-15% of cases and then only in in those who exceed the threshold cumulative dose of about 800 mg/sq m. But at least one study showed that at follow-up, 79.2% of patients reported residual neuropathic symptoms, with distal loss of pin-prick sensibility in 58.3% of patients and loss of vibration sensibility in 83.3% of patients. Symptom severity scores were significantly correlated with cumulative dose. There was no recovery of sensory action potential amplitudes in upper and lower limbs, consistent with persistent axonal sensory neuropathy. Sensory excitability parameters had not returned to baseline levels, suggesting persisting abnormalities in nerve function. The extent of excitability abnormalities during treatment was significantly correlated with clinical outcomes at follow-up.
Some (but very few) patients will experience autonomic neuropathy, which occurs when autonomic nerves, both sympathetic and parasympathetic, are damaged. Symptoms can include bowel obstruction, severe constipation, postural hypotension and cardiac dysfunction (heart rate variability, tachycardia) and urinary symptoms both of incontinence and retention. I certainly sufered from postural hypotension and now my previous hypertension needs no drugs to control it. I also had bowel symptoms that would fit and unexplained tachycardias. Recently I have had some urinary symptoms as well. But none of this explains my response to steroids.
Steroids are anti-inflammatories and usually work by stabilizing macrophages which limits their effect as effector cells. I have little doubt that I have some sort of immune process going on, as evidenced by the faint maculo-papular and steroid sensitive rash that I keep getting on my forehead. An immune response against my cancer could be the explanation of why I am surviving so long with metastatic disease and when I follow this line of thought this whole episode could have been triggered by the horrendous journey back from EHA last week. One could construct stories that the initial cold sensitive damage released an antigenic stimulus of apoptotic proteins that continues in a smaller proportion of patients, but there is no experimental evidence to support this.
Anyway, I seem to have stumbled on a way of controlling my symptoms and that will have to do. For the sake of long term steroid side effects I will have to reduce the dose shortly but I will be circumspect about how I do it.
Wednesday, June 15, 2011
A closer look at Bendamustine in CLL
Have I been too hard on Bendamustine? This alkylating agent is more than 30 years old and was discovered in communist East Germany, where it has been used for all that time. It has now been introduced to the West as if it were a new drug with all the attendant costs. What made me cross about it was the randomized clinical trial which compared it to chlorambucil. There seemed to me to be some chicanery involved in the trial. The median progression-free survival in the chlorambucil arm was only 8.8 months which compared with the almost 2 years that we found in LEF CLL4. The explanation was clear; they had used a smaller dose of chlorambucil; but more than that they had concealed how much smaller. The LRF CLL4 trial had used 70mg per sq m per month, whereas the bendamustine trial had used 0.8 mg/kg twice monthly. Hidden in the methods section and not spotted by anyone except me was the fact that this was not actual weight, but 'ideal weight'. I am sure that everyone is aware that most people's ideal weight is less than their actual weight and this would therefore have led to relative uderdosing.
Still, I should not remain in a huff about it but try and look objectively at whether it is a good drug for its target diseases. I therefore turn to a new review of Bendamustine published in a supplement to Seminars in Hematology, by Rummel and Gregory (2011, 48:S24-S36). A word of caution - Supplements to major journals seldom have such a high standard of peer-review and may indeed have been paid for by the Pharmaceutical industry.
The first point they make is that rituximab sensitizes CD20+ B-cell lymphoma lines to chemotherapy-induced apoptosis in vitro. This includes Bendamustine induced killing as well as a variety of other agents. It is also important to make the point at this stage that Bendamustine is not a simple alkylating agent. As I have written before it does have other useful properties, though the fancied resemblance of its chemical structure to fludarabine does not mean that it behaves like a mixture of alkylating agent and purine analog. Those claims have not been born out by experimental data.
The earliest study of bendamustine as a single agent in CLL was a phase II study of 23 patients (10 relapsed or refractory, 13 untreated) with a total dose of 250-300 mg/sq m every month. The overall response rate was 75% with 36% CRs. At this dose it was myelotoxic with 51% Grade 3/4 leukopenia and 3 deaths from sepsis. Four subsequent phase I/II studies with doses ranging from 140 to 300 mg/sq m/month had response rates between 56 and 93% (overall 69%) and CR rates between 7 and 29% (overall 14%).
The optimum dose depends on how much previous treatment has been given. Treatment naive patients can safely receive 200mg/sq m/m whereas those who are heavily pretreated especially those who have had previous fludarabine should receive no more than 140 mg/sq m/m. Nevertheless the first randomised phase 2 study in previously treated patients (who had mainly had chlorambucil) received 200mg/sq m/m. This was compared with fludarabine 125 mg/sq m/m. In this study Bendamuctin outperformed fludarabine (ORR 78% v 65%; CRR 29% v 10%; PFS 83 weeks ve 64 weeks) but grade 3/4 leukopenia was worse in the Bendamustine arm, though not the infection rate.
The same dose of Bendamustine was used for treatment naive patients in the pivotal study used for FDA approval (this was the comparison with chlorambucil that I have already referred to). The overall response rate was 68% (31% CR) and the PFS was 54 months v 8.8 months. The rate of infection was approximately three times as great in the Bendamustine arm which reflected the much higher grade 3/4 hematological toxicity (40% v 19%).
There have also been trials of Bendamustine in combination. A trial of escalating dose of Bendamustine (80 to 240 mg) with mitozantrone (8 to 10 mg) had an overall response rate of 86% (CR 27%) but even at 150 mg the grade 3/4 neutropenia was 89% suggesting that a smaller dose is required for previously treated patients. A phase 1/2 of Bendamustine 160, mitozantrone 10 and rituximab 375 was tested in 54 patients with various B cell tumors. Treatment was continued only until there was an objective response. Among 21 patients with CLL 95% got an objective response (the majority within 2 cycles). The CR rate was 23%.
Subsequently there has been a German phase 2 study of Bendamustine 140 + rituximab 375-500 in 81 patients with relapsed/refractory patients. Only 12% got grade 3/4 nutropenia, but 3 died of infection. The response rate was 77% (14.5% CR). Significantly there was a 44% response rate in del 17p patients and a 78% response rate in fludarabine refractory patients. However we are still waiting for response duration and late complications of this trial.
A similar study in 117 previously untreated patients uses a slightly higher dose of Bendamustine (180 mg/sq m/m) with the same dose of rituximab. The ORR was 91% (31% CR) with 76% still in remission at 18 months. Three of seven patients with del 17p had a PR. Grade 3/4 neutropenia was present in 6.5% of cycles and grade 3/4 infections in 5% of cycles though 2 patients died of infection.
There are ongoing phase III studies of this regimen compared with FCR in 550 previously untreated patients in Germany and another comparison of BR with CHL-R in 600 previously untreated patients. At MD Anderson there is a FBR trial in previously treated patients and several other studies of combinations of Bendamustine with rituximab, ofatumumab and alemtuzumab.
There is preclinical evidence of synergy between Bendamustine and Fludarabine.
So in summary, despite my misgivings about how Bendamustine has been brought to the market, it does seem to have an advantage over standard alkylating agents in producing rather more CRs and a higher response rate. Dosing is crucial, however, The haematological toxicity is much higher than is seen with chlorambucil. Some years ago there was a trial of chlorambucil in Yugoslavia, which pushed the drug to toxic levels and produced results that were superior to those of fludarabine. This may be what we are seing with Bendamustine. In previously treated patients the maximum tolerated dose is 140 mg/sq m/month and in untreated patients it is 200 mg/ sq m/month. In combinations with other chemothereutic drugs this should be reduced.
It does have some activity in del 17p disease but there are better options and it should certainly not be first choice.
Bendamustine has to be given iv which is a disadvantage over chlorambucil, cyclphosphamide and fludarabine.
Still, I should not remain in a huff about it but try and look objectively at whether it is a good drug for its target diseases. I therefore turn to a new review of Bendamustine published in a supplement to Seminars in Hematology, by Rummel and Gregory (2011, 48:S24-S36). A word of caution - Supplements to major journals seldom have such a high standard of peer-review and may indeed have been paid for by the Pharmaceutical industry.
The first point they make is that rituximab sensitizes CD20+ B-cell lymphoma lines to chemotherapy-induced apoptosis in vitro. This includes Bendamustine induced killing as well as a variety of other agents. It is also important to make the point at this stage that Bendamustine is not a simple alkylating agent. As I have written before it does have other useful properties, though the fancied resemblance of its chemical structure to fludarabine does not mean that it behaves like a mixture of alkylating agent and purine analog. Those claims have not been born out by experimental data.
The earliest study of bendamustine as a single agent in CLL was a phase II study of 23 patients (10 relapsed or refractory, 13 untreated) with a total dose of 250-300 mg/sq m every month. The overall response rate was 75% with 36% CRs. At this dose it was myelotoxic with 51% Grade 3/4 leukopenia and 3 deaths from sepsis. Four subsequent phase I/II studies with doses ranging from 140 to 300 mg/sq m/month had response rates between 56 and 93% (overall 69%) and CR rates between 7 and 29% (overall 14%).
The optimum dose depends on how much previous treatment has been given. Treatment naive patients can safely receive 200mg/sq m/m whereas those who are heavily pretreated especially those who have had previous fludarabine should receive no more than 140 mg/sq m/m. Nevertheless the first randomised phase 2 study in previously treated patients (who had mainly had chlorambucil) received 200mg/sq m/m. This was compared with fludarabine 125 mg/sq m/m. In this study Bendamuctin outperformed fludarabine (ORR 78% v 65%; CRR 29% v 10%; PFS 83 weeks ve 64 weeks) but grade 3/4 leukopenia was worse in the Bendamustine arm, though not the infection rate.
The same dose of Bendamustine was used for treatment naive patients in the pivotal study used for FDA approval (this was the comparison with chlorambucil that I have already referred to). The overall response rate was 68% (31% CR) and the PFS was 54 months v 8.8 months. The rate of infection was approximately three times as great in the Bendamustine arm which reflected the much higher grade 3/4 hematological toxicity (40% v 19%).
There have also been trials of Bendamustine in combination. A trial of escalating dose of Bendamustine (80 to 240 mg) with mitozantrone (8 to 10 mg) had an overall response rate of 86% (CR 27%) but even at 150 mg the grade 3/4 neutropenia was 89% suggesting that a smaller dose is required for previously treated patients. A phase 1/2 of Bendamustine 160, mitozantrone 10 and rituximab 375 was tested in 54 patients with various B cell tumors. Treatment was continued only until there was an objective response. Among 21 patients with CLL 95% got an objective response (the majority within 2 cycles). The CR rate was 23%.
Subsequently there has been a German phase 2 study of Bendamustine 140 + rituximab 375-500 in 81 patients with relapsed/refractory patients. Only 12% got grade 3/4 nutropenia, but 3 died of infection. The response rate was 77% (14.5% CR). Significantly there was a 44% response rate in del 17p patients and a 78% response rate in fludarabine refractory patients. However we are still waiting for response duration and late complications of this trial.
A similar study in 117 previously untreated patients uses a slightly higher dose of Bendamustine (180 mg/sq m/m) with the same dose of rituximab. The ORR was 91% (31% CR) with 76% still in remission at 18 months. Three of seven patients with del 17p had a PR. Grade 3/4 neutropenia was present in 6.5% of cycles and grade 3/4 infections in 5% of cycles though 2 patients died of infection.
There are ongoing phase III studies of this regimen compared with FCR in 550 previously untreated patients in Germany and another comparison of BR with CHL-R in 600 previously untreated patients. At MD Anderson there is a FBR trial in previously treated patients and several other studies of combinations of Bendamustine with rituximab, ofatumumab and alemtuzumab.
There is preclinical evidence of synergy between Bendamustine and Fludarabine.
So in summary, despite my misgivings about how Bendamustine has been brought to the market, it does seem to have an advantage over standard alkylating agents in producing rather more CRs and a higher response rate. Dosing is crucial, however, The haematological toxicity is much higher than is seen with chlorambucil. Some years ago there was a trial of chlorambucil in Yugoslavia, which pushed the drug to toxic levels and produced results that were superior to those of fludarabine. This may be what we are seing with Bendamustine. In previously treated patients the maximum tolerated dose is 140 mg/sq m/month and in untreated patients it is 200 mg/ sq m/month. In combinations with other chemothereutic drugs this should be reduced.
It does have some activity in del 17p disease but there are better options and it should certainly not be first choice.
Bendamustine has to be given iv which is a disadvantage over chlorambucil, cyclphosphamide and fludarabine.
Galatians 5:23 ...self-control...
The fruit of the Spirit is ...self-control...
Elsewhere we are told not to be controlled by wine but by the Spirit and many have interpreted this as meaning speaking in tongues, singing with hands in the air and generally "Letting go and letting God".
But the fruit of the Spirit is self-control. Is that control of self or control of self? The word used in the Greek means 'keeping oneself in check'. There is a happy balance to be obtained between being as dull as ditch water and going over the top. One must know how and when to show enthusiasm, innovation and imagination, without giving offence by one's behavior. Living with the consciousness of the Holy Spirit every day engenders that balance in us.
Elsewhere we are told not to be controlled by wine but by the Spirit and many have interpreted this as meaning speaking in tongues, singing with hands in the air and generally "Letting go and letting God".
But the fruit of the Spirit is self-control. Is that control of self or control of self? The word used in the Greek means 'keeping oneself in check'. There is a happy balance to be obtained between being as dull as ditch water and going over the top. One must know how and when to show enthusiasm, innovation and imagination, without giving offence by one's behavior. Living with the consciousness of the Holy Spirit every day engenders that balance in us.
John 4: 39-42. Encounter, testimony.
Many of the Samaritans from that town believed in him because of the woman’s testimony, “He told me everything I ever did.” So when the Samaritans came to him, they urged him to stay with them, and he stayed two days. And because of his words many more became believers. They said to the woman, “We no longer believe just because of what you said; now we have heard for ourselves, and we know that this man really is the Savior of the world.”
We cannot all be evangelists. We are all called to be witnesses. The woman had given her testimony to the other villagers who then had their own encounter with Jesus. You can't be saved by second-hand hearsay evidence. Everyone needs his own encounter. The evangelistic pattern is encounter, testimony, witness, encounter, testimony; and it should continue exponentially.
We cannot all be evangelists. We are all called to be witnesses. The woman had given her testimony to the other villagers who then had their own encounter with Jesus. You can't be saved by second-hand hearsay evidence. Everyone needs his own encounter. The evangelistic pattern is encounter, testimony, witness, encounter, testimony; and it should continue exponentially.
Tuesday, June 14, 2011
Chronic fatigue syndrome not due to a mouse virus
Two years ago, Vincent Lombardi at the Whittemore Peterson Institute in Reno, Nevada, reported a possible cause of the tiredness and muscle pain of Chronic Fatigue Syndrome (CFS) after discovering a mouse virus called xenotropic murine leukaemia virus-related virus (XMRV) in blood samples from 68 of 101 people with CFS compared with just eight of 218 samples from healthy volunteers.
Now Jay Levy's group at the University of California, San Francisco have evaluated blood samples from 61 patients with CFS from a single clinical practice, 43 of whom had previously been identified as XMRV-positive. Their analysis included polymerase chain reaction and reverse transcription polymerase chain reaction procedures for detection of viral nucleic acids and assays for detection of infectious virus and virus-specific antibodies. They found no evidence of XMRV or other Mouse Leukemia Viruses in these blood samples. In addition, they found that these gammaretroviruses were strongly (X-MLV) or partially (XMRV) susceptible to inactivation by sera from CFS patients and healthy controls, which suggested that establishment of a successful MLV infection in humans would be unlikely. Consistent with previous reports, they detected MLV sequences in commercial laboratory reagents. Their results indicate that previous evidence linking XMRV and MLVs to CFS is likely attributable to laboratory contamination.
In another study, Vinay Pathak at the National Cancer Institute in Frederick, Maryland, suggested that XMRV originated in lab mice between 1993 and 1996 – after many of the people in Lombardi's study were diagnosed with CFS – and so cannot be the cause. Pathak said that researchers grew cancers in mice without immune systems in order to make prostate tumour tissue for study. The tumour cells picked up two leukaemia viruses which combined to form XMRV. The strains in Lombardi's samples are so similar to this “recombinant” virus that it is unlikely to have another source.
Now Jay Levy's group at the University of California, San Francisco have evaluated blood samples from 61 patients with CFS from a single clinical practice, 43 of whom had previously been identified as XMRV-positive. Their analysis included polymerase chain reaction and reverse transcription polymerase chain reaction procedures for detection of viral nucleic acids and assays for detection of infectious virus and virus-specific antibodies. They found no evidence of XMRV or other Mouse Leukemia Viruses in these blood samples. In addition, they found that these gammaretroviruses were strongly (X-MLV) or partially (XMRV) susceptible to inactivation by sera from CFS patients and healthy controls, which suggested that establishment of a successful MLV infection in humans would be unlikely. Consistent with previous reports, they detected MLV sequences in commercial laboratory reagents. Their results indicate that previous evidence linking XMRV and MLVs to CFS is likely attributable to laboratory contamination.
In another study, Vinay Pathak at the National Cancer Institute in Frederick, Maryland, suggested that XMRV originated in lab mice between 1993 and 1996 – after many of the people in Lombardi's study were diagnosed with CFS – and so cannot be the cause. Pathak said that researchers grew cancers in mice without immune systems in order to make prostate tumour tissue for study. The tumour cells picked up two leukaemia viruses which combined to form XMRV. The strains in Lombardi's samples are so similar to this “recombinant” virus that it is unlikely to have another source.
Galatians 5:23 ...gentleness...
The fruit of the Spirit is ...gentleness...
Jesus was the meekest man who ever lived. Before you run away with the idea of a milksop in a white nightdress, 'meekness' has the meaning of strength under control. The other night while I was stranded at various railway stations on the Southern Region I watched a huge Diesel locomotive inch its way into a platform. Had I gone up to London on the Friday as I had planned I would have found my journey disrupted again. Someone stepped off Southampton platform into the path of an oncoming train. The huge locomotive utterly destroyed that frail human body. But the same sort of engine was inching into the station under fingertip control early on Friday morning.
Jesus was meek but he had immense destructive power in his hands. Yet he was gentle. He was gentle with the woman it the well. He was gentle with the woman taken in adultery. He was gentle with the children that the disciples would have turned away. Gentleness is one of the fruits of living with the Spirit.
Jesus was the meekest man who ever lived. Before you run away with the idea of a milksop in a white nightdress, 'meekness' has the meaning of strength under control. The other night while I was stranded at various railway stations on the Southern Region I watched a huge Diesel locomotive inch its way into a platform. Had I gone up to London on the Friday as I had planned I would have found my journey disrupted again. Someone stepped off Southampton platform into the path of an oncoming train. The huge locomotive utterly destroyed that frail human body. But the same sort of engine was inching into the station under fingertip control early on Friday morning.
Jesus was meek but he had immense destructive power in his hands. Yet he was gentle. He was gentle with the woman it the well. He was gentle with the woman taken in adultery. He was gentle with the children that the disciples would have turned away. Gentleness is one of the fruits of living with the Spirit.
John 4:35-38 Harvesting
Don’t you have a saying, ‘It’s still four months until harvest’? I tell you, open your eyes and look at the fields! They are ripe for harvest. Even now the one who reaps draws a wage and harvests a crop for eternal life, so that the sower and the reaper may be glad together. Thus the saying ‘One sows and another reaps’ is true. I sent you to reap what you have not worked for. Others have done the hard work, and you have reaped the benefits of their labor.”
Yesterday I had a busy day actually doing some work on a conference call so I posted something on evangelism from my archives, but it was relevant to our passage for today.
Songs of Praise on Sunday cam from Nottingham where several large city-center churches provided a strong evangelical witness in the city. In Bournemouth, Lansdowne Baptist Church was once by far the largest congregation, but today we have churches taking over Bingo Halls, Theaters and DIY warehouses. I detect the Holy Spirit moving in the UK this Pentecost. Jesus tells his disciples to "reap what you have not worked for". The Holy Spirit has done the work; we are the harvesters.
Yesterday I had a busy day actually doing some work on a conference call so I posted something on evangelism from my archives, but it was relevant to our passage for today.
Songs of Praise on Sunday cam from Nottingham where several large city-center churches provided a strong evangelical witness in the city. In Bournemouth, Lansdowne Baptist Church was once by far the largest congregation, but today we have churches taking over Bingo Halls, Theaters and DIY warehouses. I detect the Holy Spirit moving in the UK this Pentecost. Jesus tells his disciples to "reap what you have not worked for". The Holy Spirit has done the work; we are the harvesters.
Monday, June 13, 2011
Faith versus works
I guess everyone knows the exciting story of Rahab, the prostitute, who sheltered the Israelite spies when they entered Jericho; who lied to the city authorities; and who helped the spies escape safely back to Joshua. (If you don’t, read about it in Joshua Chapter 2). However, have you ever thought about the pivotal role she plays in the argument between those who insist on salvation by faith alone and those who argue for salvation by works.
In the great chapter in Hebrews which tells of the heroes of the faith, she is only woman mentioned by name as such a hero (Hebrews Ch 11 v 31). By faith the prostitute Rahab …was not killed with those who were disobedient. She was certainly a believer. “I know,” she says, ”I know that the LORD has given you this land.” (Joshua Ch 2 v 9).
But in that famous ‘epistle of straw’ (Martin Luther’s words) James uses her as an example of salvation by works. You see a person is justified by what he does, and not by faith alone. In the same way was not even Rahab the prostitute considered righteous for what she did? (James Ch 2 vv24-25).
Of course the conflict is not a real one. Suppose Rahab, having given the spies the assurance that they wanted had immediately ratted on them and betrayed them to the authorities. How then would we have regarded her faith?
In the great chapter in Hebrews which tells of the heroes of the faith, she is only woman mentioned by name as such a hero (Hebrews Ch 11 v 31). By faith the prostitute Rahab …was not killed with those who were disobedient. She was certainly a believer. “I know,” she says, ”I know that the LORD has given you this land.” (Joshua Ch 2 v 9).
But in that famous ‘epistle of straw’ (Martin Luther’s words) James uses her as an example of salvation by works. You see a person is justified by what he does, and not by faith alone. In the same way was not even Rahab the prostitute considered righteous for what she did? (James Ch 2 vv24-25).
Of course the conflict is not a real one. Suppose Rahab, having given the spies the assurance that they wanted had immediately ratted on them and betrayed them to the authorities. How then would we have regarded her faith?
Reaching the lost
The Bournemouth-Poole-Christchurch conurbation is the eleventh largest in Britain. More than that, it is the largest non-industrial conurbation in Europe. More than 480,000 people live here. Although, it is especially notable for the numbers of elderly people (over 30% of the populations of Bournemouth and Christchurch are over 60), we should not neglect the fact that there are many youngsters too. For men the average age is 19! You don’t believe me? It is true. But it is a special kind of average. Mathematicians recognise three different types of average age: the mean - which means all the ages added up and divided by the number of people; the median - which means the age at which 50% are older and 50% younger; and the mode which is the age that comes up most frequently. For men the modal age in Bournemouth is 19 and for women it is 74.
Of that 480,000 how many are Christian? 5%? 10%? 15%? Say it is as many as 15%, this is after all the Bible belt. That still leaves over 400,000 people in this area who are not Christians. What is going to happen to them when they die?
Some modern theologians argue that when you die, you rot. They believe that life for the unbeliever ends in extinction. What a comfortable doctrine that is! We need not be concerned for our friends or relatives who resist the gospel. We need not worry about Muslims in Iraq or animists in Brazil. When they die - extinction. They may not know heaven, but at least they won’t have to suffer for it.
The trouble is that the Bible knows nothing of this. A man is destined to die once, and after that to face judgement (Hebrews 9:27). We must all appear before the judgement seat of Christ, that each one may receive what is due to him for things done while in the body, whether good or bad (2 Cor 5:10). Because of your stubbornness and your unrepentant heart, you are storing up wrath against yourself for the day of God’s wrath when His righteous judgement will be revealed (Romans 2: 5).
Some scholars find an ultimate universal salvation in the New Testament, but this can only be done by ignoring the teaching on Gehenna. This is the word that is translated ‘Hell’ in the AV. It is derived from a Hebrew word which means the ‘valley of Hinnon’, located outside the walls of Jerusalem, where children had been sacrificed by fire to Molech (2 Chron 28:3; 2 Chron 33:6). Jesus talks more about ‘Hell’ than any other in the NT. God has the power to cast both body and soul into hell (Luke 12:5; Matthew 10:28). It is a place of eternal and unquenchable fire (Matthew 18:8; Mark 9:43).
Revelation pictures the final punishment as a lake of fire. It is the destination not only of the beast and the devil, but of the unsaved (Revelation 20:15).
If only the Bible were not so uncompromising. If only there were some hint of a second chance after death. But all have sinned and fallen short of the glory of God (Romans 3:23) and The wages of sin is death (Romans 6:26). We all stand condemned under the same charge. Praise God then that The gift of God is eternal life in Christ Jesus our Lord! (Romans 6:26b). But Salvation is found in no-one else, for there is no other name under heaven given to men by which we must be saved (Acts 4:12). There is only one way.
Although I don’t recommend it, you can understand how rulers of old forced the conversion of their people at sword point. It was not because they were tyrants but because they could not bear their people going to hell. You can even understand why they burnt heretics at the stake. To lead people to hell was a greater sin than murder.
Today we know that everyone must come to Jesus individually, that ritual counts for nothing in salvation and that conversion is the work of the Holy Spirit. But we are all called to be witnesses (Acts 1:8). Since we know the truth, how can we keep it to ourselves?
Several years ago I wrote, “If men and women are going to hell and we do not warn them, either we do not believe it or we do not care.”
The challenge is still the same.
What do we lack as Christians? “A commitment to Evangelism”. But as good physicians, we are not simply concerned with symptoms, we have to discover the underlying disease. Is it, I wonder, that we have no concern for the plight of the lost? Is it that we don’t believe that they are really lost? Or is it that we don’t know how to witness? Are there other more pressing priorities? Are we locked into our very Englishness, our reserve and politeness?
How would you politely shout “Fire!” in a burning building? How would you leave yourself untrained in a smallpox epidemic if only you were immune? What priorities would you put before the lifeboat on a sinking liner?
We need to challenge ourselves over our concern for the lost. Earlier in this article I quoted three texts on judgement. The second one has nothing to do with the judgement of the lost. It refers to the judgement of Christians, on how we perform in the body. We will be judged on our service. How will you face Jesus and tell him, “I knew the way, but I kept it to myself. Being English, I was never so ill-mannered as to thrust it upon those who did not want to hear. I would have done better, but there was so little time.” In this last excuse there is an element of truth. Why are there so many old people in Bournemouth? People move into the area to spend their last few years before they die. But one out of one dies. For each of these there is so little time.
Of that 480,000 how many are Christian? 5%? 10%? 15%? Say it is as many as 15%, this is after all the Bible belt. That still leaves over 400,000 people in this area who are not Christians. What is going to happen to them when they die?
Some modern theologians argue that when you die, you rot. They believe that life for the unbeliever ends in extinction. What a comfortable doctrine that is! We need not be concerned for our friends or relatives who resist the gospel. We need not worry about Muslims in Iraq or animists in Brazil. When they die - extinction. They may not know heaven, but at least they won’t have to suffer for it.
The trouble is that the Bible knows nothing of this. A man is destined to die once, and after that to face judgement (Hebrews 9:27). We must all appear before the judgement seat of Christ, that each one may receive what is due to him for things done while in the body, whether good or bad (2 Cor 5:10). Because of your stubbornness and your unrepentant heart, you are storing up wrath against yourself for the day of God’s wrath when His righteous judgement will be revealed (Romans 2: 5).
Some scholars find an ultimate universal salvation in the New Testament, but this can only be done by ignoring the teaching on Gehenna. This is the word that is translated ‘Hell’ in the AV. It is derived from a Hebrew word which means the ‘valley of Hinnon’, located outside the walls of Jerusalem, where children had been sacrificed by fire to Molech (2 Chron 28:3; 2 Chron 33:6). Jesus talks more about ‘Hell’ than any other in the NT. God has the power to cast both body and soul into hell (Luke 12:5; Matthew 10:28). It is a place of eternal and unquenchable fire (Matthew 18:8; Mark 9:43).
Revelation pictures the final punishment as a lake of fire. It is the destination not only of the beast and the devil, but of the unsaved (Revelation 20:15).
If only the Bible were not so uncompromising. If only there were some hint of a second chance after death. But all have sinned and fallen short of the glory of God (Romans 3:23) and The wages of sin is death (Romans 6:26). We all stand condemned under the same charge. Praise God then that The gift of God is eternal life in Christ Jesus our Lord! (Romans 6:26b). But Salvation is found in no-one else, for there is no other name under heaven given to men by which we must be saved (Acts 4:12). There is only one way.
Although I don’t recommend it, you can understand how rulers of old forced the conversion of their people at sword point. It was not because they were tyrants but because they could not bear their people going to hell. You can even understand why they burnt heretics at the stake. To lead people to hell was a greater sin than murder.
Today we know that everyone must come to Jesus individually, that ritual counts for nothing in salvation and that conversion is the work of the Holy Spirit. But we are all called to be witnesses (Acts 1:8). Since we know the truth, how can we keep it to ourselves?
Several years ago I wrote, “If men and women are going to hell and we do not warn them, either we do not believe it or we do not care.”
The challenge is still the same.
What do we lack as Christians? “A commitment to Evangelism”. But as good physicians, we are not simply concerned with symptoms, we have to discover the underlying disease. Is it, I wonder, that we have no concern for the plight of the lost? Is it that we don’t believe that they are really lost? Or is it that we don’t know how to witness? Are there other more pressing priorities? Are we locked into our very Englishness, our reserve and politeness?
How would you politely shout “Fire!” in a burning building? How would you leave yourself untrained in a smallpox epidemic if only you were immune? What priorities would you put before the lifeboat on a sinking liner?
We need to challenge ourselves over our concern for the lost. Earlier in this article I quoted three texts on judgement. The second one has nothing to do with the judgement of the lost. It refers to the judgement of Christians, on how we perform in the body. We will be judged on our service. How will you face Jesus and tell him, “I knew the way, but I kept it to myself. Being English, I was never so ill-mannered as to thrust it upon those who did not want to hear. I would have done better, but there was so little time.” In this last excuse there is an element of truth. Why are there so many old people in Bournemouth? People move into the area to spend their last few years before they die. But one out of one dies. For each of these there is so little time.
Sunday, June 12, 2011
Snippets from the news
Has the "Peace Process" worked in Northern Ireland? Things are undoubtedly better than they were, but don't kid yourself that everything is cured. Look at these figures:
There are still more than 1,100 people who are on terrorist death lists in Northern Ireland who are being allowed to carry guns for their own protection.
Terrorist bombing incidents are at their highest level in eight years – 100 in 2010-11 (and no, it's not Islamists).
Terrorist attacks are seldom solved – 12 of 272 such attacks between 2008 and 2010 have been successfully detected.
People are still being driven from their homes. The number rose by a third in 2009-10. Terrorist and sectarian intimidation was cited in 85 per cent of these cases.
Sectarian incidents rose from 1,595 in 2008-09 to 1,840 in 2009-10 – a 15 per cent increase. Sectarian crimes in the same period went up from 1,017 to 1,264 – a 24 per cent increase.
British people cannot give blood in America because of BSE. People from America cannot give blood in Europe because of West Nile Virus. There is apparently an ‘epidemic’ of West Nile Fever in North America. The United States has a population of 311 million. Last year, the entire country had 629 serious cases of this virus – 144 of them fatal encephalitis. In 24 of the 50 states, there were no deaths at all. Five states had only one death each; another five only two. There were precisely no cases of West Nile in this country in 2004, 2005, 2008, 2009 and 2010. There was one in 2006 (from Canada) and one in 2007 (also from Canada).
Nobody in this country has any discretion or control over this rule, because it was made by the EU (our real government). Directive 2004/33/EC of March 22, 2004, over which you, I, the Blood Service and Parliament have no control, demands this concrete-headed regulation.
Why does the Archbishop of Canterbury (in his new guise of Left-wing politician) speak as if it was obvious that we should treat people who can work, but won’t, in the same way as we treat those who are truly in need?
In St Paul’s first epistle to Timothy, Chapter 5, we read: ‘If any provide not for his own, and specially for those of his own house, he hath denied the faith, and is worse than an infidel.’
In his second epistle to the Thessalonians, St Paul rubs it in, in that way he has: ‘This we commanded you, that if any will not work, neither shall he eat.’
Germany has decided to close its nuclear power stations in case they get hit by a tsunami or an earthquake. Germany’s dirty secret is its unfashionable and un-green attachment to coal. Because Germany has oceans of the stuff, and because Germany’s coal miners are better organised and led than ours were and mostly because German coal is conveniently near to the surface meaning it can be strip mined by a bloke on a bulldozer, Germany never fell out of love with the black stuff the way we did (a lot of it is a very soft and very dirty type of coal). As a result Germany still make a great deal of its electricity (nearly half) by burning coal, a major source of the 830m tonnes of CO2 the Federal Republic emits annually. That total figure amounts to about 10.15 tonnes of CO2 for every German compared to 9.25 tonnes in the UK and 6.4 tonnes in France where they are more dependent of nuclear.
About a quarter of Germany’s electricity comes from nuclear power and so the dramatic closure of all of Germany’s nuclear plants in the next decade will push up emissions dramatically. In fact, German energy-industry emissions are about 355mt a year, so the nuclear shortfall could result in a 70-million-tonne increase in carbon emissions every year if the balance is taken up by fossil fuels. Perhaps, like me, the German government secretly does not really beieve in CO2 being the driving force behind climate change.
The outrages in Syria get worse. The supposed 120 security forces killed in Jisr al-Shughour has never rung true. From other sources we hear that many in the Syrian Army mutinied when ordered to fire on unarmed civilians. It was these mutineers who were killed by the military secret police. After so much faking of evidence by the Libyans earlier and by Hezbollah a couple of years ago, I never automatically believe anything that an Arab Muslim tells me. However, to give the other side of the story (also from an Arab Muslim) Sergeant-Major Ali Hassan Satouf claims to have deserted. When he was sent to the port refinery of Banias to fight “terrorist armed groups” he did not hesitate — until he realised that he had been deceived. “We didn’t find any terrorist groups,” he said in a video released last week. “We found only peaceful demonstrations." The sergeant-major describes how soldiers broke into homes in a village and stole private property before arresting dozens of men, prompting women to pelt them with stones. “In response to the stone-throwing, we were ordered to open fire ... and we had a massacre. Four women were killed.” (Only a small massacre then).
A senior Turkish official said 4,300 Syrians had crossed into Turkey. “All the accusations of residents sheltering gangs are false,” said a man from Jisr al-Shughour. “And we never asked the army for help or to enter our town. It is them firing on us.” The regime has sought to play down a video that shows Syrian soldiers beating shackled prisoners and placing weapons on corpses which appear to have been shot at point blank range.
Also in the Muslim world Pakistan was in shock today after two explosions in the northwest city of Peshawar killed at least 34 people and left a further 100 injured, many severely, in one of the deadliest attacks since last month's US mission which ended in the death of Al-Qaeda figurehead Osama Bin Laden. The explosions occurred in a neighbourhood of the city which houses military personnel and has many political offices, and which has been the site of bomb attacks in the past. The first blast took place shortly after midnight and was the smaller of the two. As emergency services made their way to the scene of the attack, a suicide bomber rode a motorcycle carrying 10kg of explosives to the site and detonated his deadly payload.
The head of Al-Qaeda in east Africa, who was accused of playing a key role in the bombing of two American embassies in 1998, has been killed in Somalia, police said yesterday. Fazul Abdullah Mohammed was reportedly shot last week after an exchange of fire at a police checkpoint. He had been travelling on a fake South African passport. Mohammed had spent 12 years on the run after the bombings in Nairobi, the capital of Kenya, and the Tanzanian city of Dar es Salaam, which had killed more than 240 people and brought Bin Laden and Al-Qaeda to world attention.
What with the slaying of Al Qaeda's Ilyas Kashmiri in a drone attack in Pakistan, Western force seem to be getting more successful. Perhaps because of intelligence gathered from the attack on Bin Laden?
There are still more than 1,100 people who are on terrorist death lists in Northern Ireland who are being allowed to carry guns for their own protection.
Terrorist bombing incidents are at their highest level in eight years – 100 in 2010-11 (and no, it's not Islamists).
Terrorist attacks are seldom solved – 12 of 272 such attacks between 2008 and 2010 have been successfully detected.
People are still being driven from their homes. The number rose by a third in 2009-10. Terrorist and sectarian intimidation was cited in 85 per cent of these cases.
Sectarian incidents rose from 1,595 in 2008-09 to 1,840 in 2009-10 – a 15 per cent increase. Sectarian crimes in the same period went up from 1,017 to 1,264 – a 24 per cent increase.
British people cannot give blood in America because of BSE. People from America cannot give blood in Europe because of West Nile Virus. There is apparently an ‘epidemic’ of West Nile Fever in North America. The United States has a population of 311 million. Last year, the entire country had 629 serious cases of this virus – 144 of them fatal encephalitis. In 24 of the 50 states, there were no deaths at all. Five states had only one death each; another five only two. There were precisely no cases of West Nile in this country in 2004, 2005, 2008, 2009 and 2010. There was one in 2006 (from Canada) and one in 2007 (also from Canada).
Nobody in this country has any discretion or control over this rule, because it was made by the EU (our real government). Directive 2004/33/EC of March 22, 2004, over which you, I, the Blood Service and Parliament have no control, demands this concrete-headed regulation.
Why does the Archbishop of Canterbury (in his new guise of Left-wing politician) speak as if it was obvious that we should treat people who can work, but won’t, in the same way as we treat those who are truly in need?
In St Paul’s first epistle to Timothy, Chapter 5, we read: ‘If any provide not for his own, and specially for those of his own house, he hath denied the faith, and is worse than an infidel.’
In his second epistle to the Thessalonians, St Paul rubs it in, in that way he has: ‘This we commanded you, that if any will not work, neither shall he eat.’
Germany has decided to close its nuclear power stations in case they get hit by a tsunami or an earthquake. Germany’s dirty secret is its unfashionable and un-green attachment to coal. Because Germany has oceans of the stuff, and because Germany’s coal miners are better organised and led than ours were and mostly because German coal is conveniently near to the surface meaning it can be strip mined by a bloke on a bulldozer, Germany never fell out of love with the black stuff the way we did (a lot of it is a very soft and very dirty type of coal). As a result Germany still make a great deal of its electricity (nearly half) by burning coal, a major source of the 830m tonnes of CO2 the Federal Republic emits annually. That total figure amounts to about 10.15 tonnes of CO2 for every German compared to 9.25 tonnes in the UK and 6.4 tonnes in France where they are more dependent of nuclear.
About a quarter of Germany’s electricity comes from nuclear power and so the dramatic closure of all of Germany’s nuclear plants in the next decade will push up emissions dramatically. In fact, German energy-industry emissions are about 355mt a year, so the nuclear shortfall could result in a 70-million-tonne increase in carbon emissions every year if the balance is taken up by fossil fuels. Perhaps, like me, the German government secretly does not really beieve in CO2 being the driving force behind climate change.
The outrages in Syria get worse. The supposed 120 security forces killed in Jisr al-Shughour has never rung true. From other sources we hear that many in the Syrian Army mutinied when ordered to fire on unarmed civilians. It was these mutineers who were killed by the military secret police. After so much faking of evidence by the Libyans earlier and by Hezbollah a couple of years ago, I never automatically believe anything that an Arab Muslim tells me. However, to give the other side of the story (also from an Arab Muslim) Sergeant-Major Ali Hassan Satouf claims to have deserted. When he was sent to the port refinery of Banias to fight “terrorist armed groups” he did not hesitate — until he realised that he had been deceived. “We didn’t find any terrorist groups,” he said in a video released last week. “We found only peaceful demonstrations." The sergeant-major describes how soldiers broke into homes in a village and stole private property before arresting dozens of men, prompting women to pelt them with stones. “In response to the stone-throwing, we were ordered to open fire ... and we had a massacre. Four women were killed.” (Only a small massacre then).
A senior Turkish official said 4,300 Syrians had crossed into Turkey. “All the accusations of residents sheltering gangs are false,” said a man from Jisr al-Shughour. “And we never asked the army for help or to enter our town. It is them firing on us.” The regime has sought to play down a video that shows Syrian soldiers beating shackled prisoners and placing weapons on corpses which appear to have been shot at point blank range.
Also in the Muslim world Pakistan was in shock today after two explosions in the northwest city of Peshawar killed at least 34 people and left a further 100 injured, many severely, in one of the deadliest attacks since last month's US mission which ended in the death of Al-Qaeda figurehead Osama Bin Laden. The explosions occurred in a neighbourhood of the city which houses military personnel and has many political offices, and which has been the site of bomb attacks in the past. The first blast took place shortly after midnight and was the smaller of the two. As emergency services made their way to the scene of the attack, a suicide bomber rode a motorcycle carrying 10kg of explosives to the site and detonated his deadly payload.
The head of Al-Qaeda in east Africa, who was accused of playing a key role in the bombing of two American embassies in 1998, has been killed in Somalia, police said yesterday. Fazul Abdullah Mohammed was reportedly shot last week after an exchange of fire at a police checkpoint. He had been travelling on a fake South African passport. Mohammed had spent 12 years on the run after the bombings in Nairobi, the capital of Kenya, and the Tanzanian city of Dar es Salaam, which had killed more than 240 people and brought Bin Laden and Al-Qaeda to world attention.
What with the slaying of Al Qaeda's Ilyas Kashmiri in a drone attack in Pakistan, Western force seem to be getting more successful. Perhaps because of intelligence gathered from the attack on Bin Laden?
Galatians 5:22 ...faithfulness...
But the fruit of the Spirit is ...faithfulness...
Great is thy faithfulness, Oh God my Father. God promised Abraham that he would be the father of many nations. His promise is true. Despite regular rebellions by the Jews he kept constant watch over his chosen people. Like the adulterous wife of Hosea they were always going after other gods that were no gods. Yet he was faithful.
Christians often backslide; yet God is faithful. He is the God of seconds chances. And third, and fourth, and fifth...
The Holy Spirit is God. Today is Pentecost Sunday; the day when the Spirit came. Faithfulness is one of his most precious gifts. Note, though, it is described here as a fruit. Like the other fruits in this passage it is something that results from the longstanding presence of God the Spirit in our lives. Stay strong; stay faithful; stay Spirit filled.
Great is thy faithfulness, Oh God my Father. God promised Abraham that he would be the father of many nations. His promise is true. Despite regular rebellions by the Jews he kept constant watch over his chosen people. Like the adulterous wife of Hosea they were always going after other gods that were no gods. Yet he was faithful.
Christians often backslide; yet God is faithful. He is the God of seconds chances. And third, and fourth, and fifth...
The Holy Spirit is God. Today is Pentecost Sunday; the day when the Spirit came. Faithfulness is one of his most precious gifts. Note, though, it is described here as a fruit. Like the other fruits in this passage it is something that results from the longstanding presence of God the Spirit in our lives. Stay strong; stay faithful; stay Spirit filled.
John 4:31-34 Giving
Meanwhile his disciples urged him, “Rabbi, eat something.” But he said to them, “I have food to eat that you know nothing about.” Then his disciples said to each other, “Could someone have brought him food?” “My food,” said Jesus, “is to do the will of him who sent me and to finish his work.
Even the disciples have fallen into the trap of literalism. Jesus is speaking metaphorically. Yet he has a clear message for us as missionaries and evangelists. The word for men's minds and hearts is more important than food for their bellies. With so much Christian aid going on disaster relief how much is going on telling others about the food that really satisfies and the water that never needs replenishing. I know Spurgeon said, "If you want to give them a tract, make sure it's wrapped in a sandwich," but the point is that a sandwich satisfies for a couple of hours but a tract can satisfy for life.
Big secular charities like OXFAM and Christian Aid are better than governments at aiding the needy but they don't reach into their real requirements. I have recently adjusted my giving to agencies like Barnabas Trust, Open Doors, and Samaritan's Purse and away from charities like OXFAM, Red Cross and UNICEF. Tear Fund is one worth watching. I'm not sure that in its desire to be one of the big boys it has kept close to its evangelical origins.
Even the disciples have fallen into the trap of literalism. Jesus is speaking metaphorically. Yet he has a clear message for us as missionaries and evangelists. The word for men's minds and hearts is more important than food for their bellies. With so much Christian aid going on disaster relief how much is going on telling others about the food that really satisfies and the water that never needs replenishing. I know Spurgeon said, "If you want to give them a tract, make sure it's wrapped in a sandwich," but the point is that a sandwich satisfies for a couple of hours but a tract can satisfy for life.
Big secular charities like OXFAM and Christian Aid are better than governments at aiding the needy but they don't reach into their real requirements. I have recently adjusted my giving to agencies like Barnabas Trust, Open Doors, and Samaritan's Purse and away from charities like OXFAM, Red Cross and UNICEF. Tear Fund is one worth watching. I'm not sure that in its desire to be one of the big boys it has kept close to its evangelical origins.
Saturday, June 11, 2011
EHA was more of a problem
I had my trip to EHA. I went to London on Thursday afternoon having had a major computer crash. I lost three quarters of my files following an attack by a Trojan. Fortunately, I had everything backed up on a separate hard drive.
The meeting was fine. I met some of my old friends including Michael Hallek, Emili Montserrat, Estella Matutes, Claire Dearden, Richard Rosenquist, Freda Stevenson, Federico Caligaris Cappio, Paulo Ghia, Kostas Stamatopoulos, Christian Giesler, Aaron Poliak, Eva Kimby Ted Gordon Smith, David Linch and Andy Rawstron. Four talks on the B cell receptor were excellent.
It was going home that the problem arose. Waterloo Station was more crowded than normal and the indicator board showed no trains leaving. Apparently there had been a signal failure the other side of Woking. It later turned out that there had been an attempted theft of copper cabling that had inactivated the signals.
On the station I met Pipril Pete, aka Peter Mainprice who had helped me organize a series of scientific meetings in the 1970s. He suggested that we could by-pass the blockage by going through Reading from Paddington. And so we did. It meant four separate and very slow and crowded trains, but I finally made it home at 1-30 am Friday.
I was so exhausted by the experience that I abandoned plans to go up to London yesterday and today.
The rail network has issued an apology and told us that next time they will do better at communication. Communication! There are several areas that they need to do better at. They could do better at protecting their signaling. I read in the paper yesterday that another attempted-copper-cabling-thief is in hospital having suffered third degree burns from the 22,000 volts that were passing through the cables.
They can use their brains. Signaling is to signal. It conveys the message that the line ahead is clear (or not). Modern trains can communicate with signal boxes by radio. Why did they not use this other means of signaling that the track was clear?
Finally, even if they had to rely on the signals, why not hire buses to bridge the gap between Woking and Farnborough where there were no signals? I am afraid the train company has got itself a very poor reputation. Some passengers were kept on a stationary train for 2 hours and eventually took the law into their own hand and broke out before walking along teh track to the next station.
Some sad news. Daniel Catovsky's daughter was knocked over and killed by a motor bike on London Bridge last week. Our thoughts and prayers are with Daniel and Julia at this time.
The meeting was fine. I met some of my old friends including Michael Hallek, Emili Montserrat, Estella Matutes, Claire Dearden, Richard Rosenquist, Freda Stevenson, Federico Caligaris Cappio, Paulo Ghia, Kostas Stamatopoulos, Christian Giesler, Aaron Poliak, Eva Kimby Ted Gordon Smith, David Linch and Andy Rawstron. Four talks on the B cell receptor were excellent.
It was going home that the problem arose. Waterloo Station was more crowded than normal and the indicator board showed no trains leaving. Apparently there had been a signal failure the other side of Woking. It later turned out that there had been an attempted theft of copper cabling that had inactivated the signals.
On the station I met Pipril Pete, aka Peter Mainprice who had helped me organize a series of scientific meetings in the 1970s. He suggested that we could by-pass the blockage by going through Reading from Paddington. And so we did. It meant four separate and very slow and crowded trains, but I finally made it home at 1-30 am Friday.
I was so exhausted by the experience that I abandoned plans to go up to London yesterday and today.
The rail network has issued an apology and told us that next time they will do better at communication. Communication! There are several areas that they need to do better at. They could do better at protecting their signaling. I read in the paper yesterday that another attempted-copper-cabling-thief is in hospital having suffered third degree burns from the 22,000 volts that were passing through the cables.
They can use their brains. Signaling is to signal. It conveys the message that the line ahead is clear (or not). Modern trains can communicate with signal boxes by radio. Why did they not use this other means of signaling that the track was clear?
Finally, even if they had to rely on the signals, why not hire buses to bridge the gap between Woking and Farnborough where there were no signals? I am afraid the train company has got itself a very poor reputation. Some passengers were kept on a stationary train for 2 hours and eventually took the law into their own hand and broke out before walking along teh track to the next station.
Some sad news. Daniel Catovsky's daughter was knocked over and killed by a motor bike on London Bridge last week. Our thoughts and prayers are with Daniel and Julia at this time.
Galatians 5:22 ...goodness...
The fruit of the Spirit is ...goodness...
God is good. Since the Holy Spirit is God, he is also good and brings out goodness in those who follow him. What does it mean to be good? It means always doing what is right. It menans being god like. It means not being compromized. But this is just about not being bad. Being good means more. It is generosity, kindness, thoughfulness, lovingkindness, care, taking time, patience, love, forgiveness, watchfulness, looking after, saying the right word, being there, bravery, standing up to be counted and staying. All these are encompassed by goodness and many more.
God is good. Since the Holy Spirit is God, he is also good and brings out goodness in those who follow him. What does it mean to be good? It means always doing what is right. It menans being god like. It means not being compromized. But this is just about not being bad. Being good means more. It is generosity, kindness, thoughfulness, lovingkindness, care, taking time, patience, love, forgiveness, watchfulness, looking after, saying the right word, being there, bravery, standing up to be counted and staying. All these are encompassed by goodness and many more.
John 4:30. They will come
They came out of the town and made their way towards him.
We are often intimidated by the evangelistic task before us. The Samaritans must have seemed and infertile ground for evangelism to Jesus' disciples, but if the message is right the crowds will come. The message is always right if we tell people that Jesus loves them and died to save them.
If you build it he will come. This was the message of the Kevin Costner baseball movie "Field of Dreams" and it is the message of evangelism. If we build our outreach the converts will come. This is the promise of teh Holy Spirit whose responsibility it is to convert them.
We are often intimidated by the evangelistic task before us. The Samaritans must have seemed and infertile ground for evangelism to Jesus' disciples, but if the message is right the crowds will come. The message is always right if we tell people that Jesus loves them and died to save them.
If you build it he will come. This was the message of the Kevin Costner baseball movie "Field of Dreams" and it is the message of evangelism. If we build our outreach the converts will come. This is the promise of teh Holy Spirit whose responsibility it is to convert them.
Restricting alcohol.
In Australia there have been increased governmental restrictions on the availability of alcohol. Perhaps as a result between 2008 and 2010 teh number of serious injuries retrieved by teh Royal Flying Doctor Sevice has fgallen from 30 per 1000 to 14 per 1000. The rstrictions were introduced in 2003 and reinforced in 2008.
Another Christian sacked for her beliefs?
Of course we don't always get the whole story from the newspapers but on the face of it there is yet another Christian martyr in the Daily Telegraph. Margaret Forrester shared with a fellow worker a booklet that questioned the belief that women who have an abortion are not psychologically scarred. This has been a matter of polarized debate recently in the medical journals, so it is at least a matter for which there is legitimate debate. My own view is that some women are and some are not. However, Ms Forrester was a psychological wellbeing practitioner in Westminster, central London. Her managers found out about her views and suspended her from her duties at Central North West London Mental Health Trust. Last month, after a series of lengthy hearings and an unsuccessful appeal, she was sacked. The ultimate reason for her dismissal was her refusal to work in a new role in a different mental health team, to which she was transferred as a disciplinary measure. Ms Forrester accepted the job verbally but claimed she was give insufficient information and lacked training.
Is this another case of persecution of Christians for their beliefs or a stroppy woman making trouble? For myself I would sack all psychological wellbeing practitioners. This looks to me to be a bloated public sector funding non-jobs for people who prefer talking to working. Employment in the public sector is not a platform for declaring your beliefs. If you don't believe in abortion (and I don't) then try and spread your belief in your own time, not when you are paid to do something else. If you don't agree with the ethos of a particular employer then don't work for them. By all means campaign against the taxpayer being asked to fund an outlandish policy, but don't do it like this. It does not win hearts and minds.
Is this another case of persecution of Christians for their beliefs or a stroppy woman making trouble? For myself I would sack all psychological wellbeing practitioners. This looks to me to be a bloated public sector funding non-jobs for people who prefer talking to working. Employment in the public sector is not a platform for declaring your beliefs. If you don't believe in abortion (and I don't) then try and spread your belief in your own time, not when you are paid to do something else. If you don't agree with the ethos of a particular employer then don't work for them. By all means campaign against the taxpayer being asked to fund an outlandish policy, but don't do it like this. It does not win hearts and minds.
Friday, June 10, 2011
War crimes in Eritrea
Eritrean Christian refugees have fled the brutal regime of their homeland to Egypt where hundreds are in prison or taken hostage for ransom, and subjected to torture, beatings and sexual assault.
They risk their lives escaping Eritrea, which can be regarded as the second worst place in the world to be a Christian, after North Korea. Christians, particularly evangelicals, are tortured and imprisoned in notoriously horrendous conditions for their faith; they are viewed as a threat to national unity because they give their ultimate allegiance to God and not to the state.
Those who manage to escape often flee to Egypt, where hundreds of refugees arrive every month, with the aim of crossing its border into Israel. Channel Four’s Unreported World highlighted the desperate plight of Eritrean refugees on Friday (3 June). The programme, “Breaking into Israel”, exposed how they are forced to put themselves in the hands of people-smugglers and make the arduous 900-mile journey across the Sinai desert. Some die along the way; others are shot dead as they attempt to cross the Egypt-Israel border; and those who are caught are sent home to almost certain torture and death.
The majority of Eritrean refugees are Christians. Many end up in Egyptian prisons or being held hostage for ransom by Bedouin Muslim nomads, who work with the traffickers, in the deserts of Sinai. There are currently around 500-600 Eritrean prisoners in Egyptian custody and an estimated 100-200 in the hands of traffickers, who have been less restricted in their criminal activities since the Egyptian revolution in January. The hostage-takers are now demanding up to US$20,000 per person for their release; if their families don’t pay, the hostage is killed and there are unconfirmed reports that the captors are turning to forced organ harvesting, especially if the ransom is not paid. Unwary Eritreans are also being kidnapped from UN refugee camps in Sudan.
The refugees suffer inhumane treatment, including rape, sexual harassment, torture, beatings and slavery at the hands of the Egyptian authorities or the Bedouin gangs. Those in prison are denied medical care, suffer malnutrition as a result of meagre daily rations such as a piece of bread and a tomato, and have restricted access to visitors. Christians receive more severe treatment than Muslim prisoners because of their faith. Some have consequently adopted common Muslim names in an effort to alleviate their suffering.
NATO is fighting against an oppressive government is Libya and the EU has instituted sanctions against Syria. In both cases the cause is crime against its own people. Why has there been no similar action against Eritrea
They risk their lives escaping Eritrea, which can be regarded as the second worst place in the world to be a Christian, after North Korea. Christians, particularly evangelicals, are tortured and imprisoned in notoriously horrendous conditions for their faith; they are viewed as a threat to national unity because they give their ultimate allegiance to God and not to the state.
Those who manage to escape often flee to Egypt, where hundreds of refugees arrive every month, with the aim of crossing its border into Israel. Channel Four’s Unreported World highlighted the desperate plight of Eritrean refugees on Friday (3 June). The programme, “Breaking into Israel”, exposed how they are forced to put themselves in the hands of people-smugglers and make the arduous 900-mile journey across the Sinai desert. Some die along the way; others are shot dead as they attempt to cross the Egypt-Israel border; and those who are caught are sent home to almost certain torture and death.
The majority of Eritrean refugees are Christians. Many end up in Egyptian prisons or being held hostage for ransom by Bedouin Muslim nomads, who work with the traffickers, in the deserts of Sinai. There are currently around 500-600 Eritrean prisoners in Egyptian custody and an estimated 100-200 in the hands of traffickers, who have been less restricted in their criminal activities since the Egyptian revolution in January. The hostage-takers are now demanding up to US$20,000 per person for their release; if their families don’t pay, the hostage is killed and there are unconfirmed reports that the captors are turning to forced organ harvesting, especially if the ransom is not paid. Unwary Eritreans are also being kidnapped from UN refugee camps in Sudan.
The refugees suffer inhumane treatment, including rape, sexual harassment, torture, beatings and slavery at the hands of the Egyptian authorities or the Bedouin gangs. Those in prison are denied medical care, suffer malnutrition as a result of meagre daily rations such as a piece of bread and a tomato, and have restricted access to visitors. Christians receive more severe treatment than Muslim prisoners because of their faith. Some have consequently adopted common Muslim names in an effort to alleviate their suffering.
NATO is fighting against an oppressive government is Libya and the EU has instituted sanctions against Syria. In both cases the cause is crime against its own people. Why has there been no similar action against Eritrea
How to care for the elderly?
How to care for the elderly?
A story is told of a community of Native Americans. Grandfather was becoming very old and forgetful and was really a lot of trouble to the tribe. One day, son says to grandson, “It’s time to take grandfather to meet the ancestors.”
Grandson replied, “Is he dying?”
Son says, “No, but it’s his time.”
Son and grandson put grandfather on a litter and carry him up to the high place where there were many wooden constructions decorated with feathers. There were tepees and strange bundles wrapped in animal skins, but no people. Son showed grandson how to sit grandfather up in one of the tepees. Grandson asked son, “Where are the ancestors?”
Son replied, “They are all around. They will come for grandfather shortly.”
Son and grandson began to make their way down the mountain.
Grandson says to son, “I’m really glad that you brought me with you today, Dad, because when it is your time I shall know where to take you.”
Son says to grandson, “You know what? Perhaps it isn’t grandfather’s time quite yet. Let’s go back and fetch him home to the village.”
Euthanasia is one way of dealing with Alzheimer’s disease, but most physicians do not support this as a way out, and despite the Assisted Suicide Bill regularly appearing before Parliament, it is always soundly defeated.
Although we see old age as one of the most difficult problems faced by any health care system, it is really a sign of the success of modern medicine. People used to die of infection, heart disease, pneumonia and the rest with an average longevity when I was young of 68 years; now they go on living into their 90s. They go on living until their brain breaks.
How do you deal with a broken brain living in a healthy body?
Might there be a medical solution? If there is we are probably a decade away from discovering it. About 10% of patients with dementia have a remediable condition – vitamin B12 deficiency and thyroid deficiency are the commonest causes but there are others. Perhaps another 10% have incurable dementia but also have a remediable condition such as pneumonia or heart failure that has recently made them worse. These problems should be looked for and treated. However, it is very important that these investigations are done by the primary care physicians while the patient is in his or her own home. The worst possible thing that can be done for patients with Alzheimer’s disease is to admit them to a ward of a general hospital.
When I was younger and inspecting a London teaching hospital, I was astonished to hear that 30% of the acute beds of the hospital were filled with what they called ‘bed-blockers’. These were patients for whom the hospital had done all it could and now wanted to discharge. Many of these patients had dementia and the relatives quite correctly determined that they could not cope at home. The only sensible alternative was a nursing home and to pay for this would involve selling the family home. But this was the kid’s inheritance and they were resisting the sale. They were doubly incensed because prior to the admission to hospital, Mum was managing at home reasonably well.
It is quite clear that when an elderly mildly demented patient is admitted to hospital, the disorientation involved frequently leads to an exacerbation of the dementia.
Apart from the factors I have mentioned, dementia is not really a medical problem and doesn’t have a medical solution, yet it is one of the reasons that the government gives for requiring 20% efficiency savings from the NHS in the next four years.
It is hard to credit it now, but when I was young, one woman in seven became a nurse. Of course, they didn’t all become State Registered Nurses (SRNs, what RGNs used to be called) with qualifications, but the type of nurse that we train now is a specialized creature, able to administer complicated drug regimens, to do ‘procedures’ like erecting a drip and passing a nasogastric tube. Most nurses didn’t do that and still don’t. They may be called ‘Health Care Assistants’, but the public knows them as nurses and they do the sort of tasks that nurses have always done. They wash and feed patients, they make beds, they wipe their bottoms, they take temperatures, pulses and blood pressures, they take blood samples, they dress wounds, they help patients out of bed and back into bed, and they generally make life a lot more pleasant than it would otherwise be. Many of them are also male. Quite a lot of what a demented patient needs is included in the above list. They seldom need an RGN but they do need the aid of health care assistants.
My sister works for a private company that provides these services in a person’s own home. It is funded mainly by the taxpayer and includes among its ministrations some element of entertainment like trips out and attendance at day-centers. My sister has no nursing training but she has been a mother and she has run her own small business. She knows how to organize things and is able to manage the other ‘home-helps’ as they used to be called. The point is that most people with mild dementia, or indeed mild failure of other bits of their bodies, can and ought to be helped to remain living in their own home. It is not costly to do so and it is worth the public investing in this resource. Of course, there is a place for family and church to contribute to this enterprise and there really is a ‘Big Society’ out there already doing it.
My mother is 91 and although she has all her marbles, she is inevitably slowing down and a little off her legs. My siblings do her shopping, tend her garden and clean her house. We do our part as much as we can, living much further away. A lady from her church lives around the corner and, although in her 80s, is a great help. Other people from her church provide transport to three church meetings every week. For Mum, life is worth living because of the support she gets.
Unfortunately, however good the support, dementia patients cannot always be kept in their own home. Often the main carer is a spouse of the same age and when the spouse gets ill someone must take over. If the children have the responsibility of caring, the care is often shared out unequally. High flying sons are too busy and their trophy wives don’t see why they should be involved. They may provide some money, but often this lifestyle is only maintained on tick. Other children may live too far away to get involved. On many occasions it is the youngest daughter who happens to live locally who has to give up her job or neglect her own family. Resentment is easily engendered.
For many the answer is a nursing home. But how to pay for it? In Scotland and Denmark the governments have decided that the general taxpayer should pay. Scotland has the advantage of a generous subsidy from England and Denmark has a basic tax rate of 53%. Joan Bakewell, who was advisor on old people to the last Labour government thought that the old person should sell his or her large house to pay for it.
The Dilman report has suggested that there should be a cap of about £50,000 on how much old people should pay towards their nursing home care. If they have total assets of less than £23,000 they are currently not expected to pay anything. £50,000 barely pays for 2 years in a nursing home – the average stay for a demented patient is about 18 months. Down south and in London £50,000 can often be found from income alone. Up north £50,000 often represents a person’s total assets, house and all. However, since the taxpayer picks up the rest of the tab and the biggest taxpayers are down south, there is a sort of equality about it.
Southern Cross, the largest provider of nursing home care in the UK is in financial difficulty. It sounds as though it has made an unwise investment, but it looks as though 32,000 individuals in Southern Cross Care Homes are going to find that their nursing homes are no longer secure. Nursing Homes are usually large houses that have been converted, Sometimes several houses are knocked into one. However they could be converted into flats of be used for other purposes. This very flexibility is a danger since it is price-sensitive. With the house sale market static there is a great demand for rented properties and some landlords have felt that nursing homes are not as profitable as flats.
There does not seem to be an easy answer to the conundrum, which is perhaps why the Labour Party has cried, "No contest" and has offered to work together with the government on a joint approach. For me the lesson to be learnt is that more people are going to have to work as carers and that the qualities that these people are going to need are patience, kindness and faithfulness. Rare qualities indeed!
A story is told of a community of Native Americans. Grandfather was becoming very old and forgetful and was really a lot of trouble to the tribe. One day, son says to grandson, “It’s time to take grandfather to meet the ancestors.”
Grandson replied, “Is he dying?”
Son says, “No, but it’s his time.”
Son and grandson put grandfather on a litter and carry him up to the high place where there were many wooden constructions decorated with feathers. There were tepees and strange bundles wrapped in animal skins, but no people. Son showed grandson how to sit grandfather up in one of the tepees. Grandson asked son, “Where are the ancestors?”
Son replied, “They are all around. They will come for grandfather shortly.”
Son and grandson began to make their way down the mountain.
Grandson says to son, “I’m really glad that you brought me with you today, Dad, because when it is your time I shall know where to take you.”
Son says to grandson, “You know what? Perhaps it isn’t grandfather’s time quite yet. Let’s go back and fetch him home to the village.”
Euthanasia is one way of dealing with Alzheimer’s disease, but most physicians do not support this as a way out, and despite the Assisted Suicide Bill regularly appearing before Parliament, it is always soundly defeated.
Although we see old age as one of the most difficult problems faced by any health care system, it is really a sign of the success of modern medicine. People used to die of infection, heart disease, pneumonia and the rest with an average longevity when I was young of 68 years; now they go on living into their 90s. They go on living until their brain breaks.
How do you deal with a broken brain living in a healthy body?
Might there be a medical solution? If there is we are probably a decade away from discovering it. About 10% of patients with dementia have a remediable condition – vitamin B12 deficiency and thyroid deficiency are the commonest causes but there are others. Perhaps another 10% have incurable dementia but also have a remediable condition such as pneumonia or heart failure that has recently made them worse. These problems should be looked for and treated. However, it is very important that these investigations are done by the primary care physicians while the patient is in his or her own home. The worst possible thing that can be done for patients with Alzheimer’s disease is to admit them to a ward of a general hospital.
When I was younger and inspecting a London teaching hospital, I was astonished to hear that 30% of the acute beds of the hospital were filled with what they called ‘bed-blockers’. These were patients for whom the hospital had done all it could and now wanted to discharge. Many of these patients had dementia and the relatives quite correctly determined that they could not cope at home. The only sensible alternative was a nursing home and to pay for this would involve selling the family home. But this was the kid’s inheritance and they were resisting the sale. They were doubly incensed because prior to the admission to hospital, Mum was managing at home reasonably well.
It is quite clear that when an elderly mildly demented patient is admitted to hospital, the disorientation involved frequently leads to an exacerbation of the dementia.
Apart from the factors I have mentioned, dementia is not really a medical problem and doesn’t have a medical solution, yet it is one of the reasons that the government gives for requiring 20% efficiency savings from the NHS in the next four years.
It is hard to credit it now, but when I was young, one woman in seven became a nurse. Of course, they didn’t all become State Registered Nurses (SRNs, what RGNs used to be called) with qualifications, but the type of nurse that we train now is a specialized creature, able to administer complicated drug regimens, to do ‘procedures’ like erecting a drip and passing a nasogastric tube. Most nurses didn’t do that and still don’t. They may be called ‘Health Care Assistants’, but the public knows them as nurses and they do the sort of tasks that nurses have always done. They wash and feed patients, they make beds, they wipe their bottoms, they take temperatures, pulses and blood pressures, they take blood samples, they dress wounds, they help patients out of bed and back into bed, and they generally make life a lot more pleasant than it would otherwise be. Many of them are also male. Quite a lot of what a demented patient needs is included in the above list. They seldom need an RGN but they do need the aid of health care assistants.
My sister works for a private company that provides these services in a person’s own home. It is funded mainly by the taxpayer and includes among its ministrations some element of entertainment like trips out and attendance at day-centers. My sister has no nursing training but she has been a mother and she has run her own small business. She knows how to organize things and is able to manage the other ‘home-helps’ as they used to be called. The point is that most people with mild dementia, or indeed mild failure of other bits of their bodies, can and ought to be helped to remain living in their own home. It is not costly to do so and it is worth the public investing in this resource. Of course, there is a place for family and church to contribute to this enterprise and there really is a ‘Big Society’ out there already doing it.
My mother is 91 and although she has all her marbles, she is inevitably slowing down and a little off her legs. My siblings do her shopping, tend her garden and clean her house. We do our part as much as we can, living much further away. A lady from her church lives around the corner and, although in her 80s, is a great help. Other people from her church provide transport to three church meetings every week. For Mum, life is worth living because of the support she gets.
Unfortunately, however good the support, dementia patients cannot always be kept in their own home. Often the main carer is a spouse of the same age and when the spouse gets ill someone must take over. If the children have the responsibility of caring, the care is often shared out unequally. High flying sons are too busy and their trophy wives don’t see why they should be involved. They may provide some money, but often this lifestyle is only maintained on tick. Other children may live too far away to get involved. On many occasions it is the youngest daughter who happens to live locally who has to give up her job or neglect her own family. Resentment is easily engendered.
For many the answer is a nursing home. But how to pay for it? In Scotland and Denmark the governments have decided that the general taxpayer should pay. Scotland has the advantage of a generous subsidy from England and Denmark has a basic tax rate of 53%. Joan Bakewell, who was advisor on old people to the last Labour government thought that the old person should sell his or her large house to pay for it.
The Dilman report has suggested that there should be a cap of about £50,000 on how much old people should pay towards their nursing home care. If they have total assets of less than £23,000 they are currently not expected to pay anything. £50,000 barely pays for 2 years in a nursing home – the average stay for a demented patient is about 18 months. Down south and in London £50,000 can often be found from income alone. Up north £50,000 often represents a person’s total assets, house and all. However, since the taxpayer picks up the rest of the tab and the biggest taxpayers are down south, there is a sort of equality about it.
Southern Cross, the largest provider of nursing home care in the UK is in financial difficulty. It sounds as though it has made an unwise investment, but it looks as though 32,000 individuals in Southern Cross Care Homes are going to find that their nursing homes are no longer secure. Nursing Homes are usually large houses that have been converted, Sometimes several houses are knocked into one. However they could be converted into flats of be used for other purposes. This very flexibility is a danger since it is price-sensitive. With the house sale market static there is a great demand for rented properties and some landlords have felt that nursing homes are not as profitable as flats.
There does not seem to be an easy answer to the conundrum, which is perhaps why the Labour Party has cried, "No contest" and has offered to work together with the government on a joint approach. For me the lesson to be learnt is that more people are going to have to work as carers and that the qualities that these people are going to need are patience, kindness and faithfulness. Rare qualities indeed!
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