Wednesday, May 28, 2008

Another “Ribena Girl”

This time the “Ribena girl” is only 13 and she appeared in the Wall Street Journal:

Detroit Politician Gets Lesson In Civility From a 13-Year-Old


The 13-year-old girl is Keiara Bell from Motown (Detroit City, U.S.A.)

“When Monica Conyers, president pro tem of Detroit's City Council, called the council president ‘Shrek’ during an angry exchange at a hearing in April, one city resident found the remark immature.”

At a panel discussion two weeks after the shouting incidence, the 13-year old school girl told the 43-year old president pro tem Monica Conyers,

“You're an adult. We have to look up to you. We're looking on TV and we're like, '”This is an adult calling another adult a Shrek?””

“That's something a second-grader would do.”

You may wonder what Ms Conyers actually said at that council hearing. The City Council President Kenneth Cockrel Jr. was in the process of questioning a witness, but he was repeatedly interrupted by Ms Conyers. Mr. Cockrel banged his gavel and requested her to be quiet while he had the floor. That was when she shouted at him,

"You not my daddy, you do that at home, not here. OK? Exactly. So treat me with respect because I'm tired of that. Be respectful. You may not do that at home but you gonna do it up here. Grow up. Control your house and you know how to treat other women better...Shrek."

When will they ever learn – indeed?
Those who are interested can see a video of the
Detroit City Council fight on YouTube.

Tuesday, May 27, 2008

It’s a Bird, a Reptile, a Mammal: It’s Platypus

Courtesy NSF

The fact that Australia has some of the
world’s strangely unique animals has always intrigued me. Being cut off from the evolutionary mainstream for millions of years, Australia specializes in really different plants and animals, the platypus being one such species. It is the platypus genome that recently created great excitement around the world.
Genome analysis of the platypus reveals unique signatures of evolution.

Nature 453, 175-183 (8 May 2008)

This study shows that platypus genes contain representatives from mammals, birds and reptiles.

When Captain John Hunter, the second Governor of New South Wales, sent to the U.K. a pelt of a platypus together with a sketch, the British scientists were at first skeptical and convinced that the duck-billed, otter-footed, beaver-tailed animal must have been a hoax produced by some Asian taxidermist. They even tried to look for stitches.

PLATYPUS (Ornithorhynchus anatinus)

Has anything changed? Lithium and Helicobacter pylori are the two main recent medical discoveries from Down Under that have taken time for the rest of the world to accept.

The Platypus is a monotreme, which is a mammal that lays eggs and only three such species currently exist, the platypus and long- and short-nosed
echidna (small hedgehog-looking animals also known as spiny ant-eaters).

The article in Nature informs us:

“Other special features of the platypus are its gastrointestinal system, neuroanatomy (electro-reception) and a venom delivery system, unique among mammals. Platypus is an obligate aquatic feeder that relies on its thick pelage to maintain its low (31–32 °C) body temperature during feeding in often icy waters. With its eyes, ears and nostrils closed while foraging underwater, it uses an electro-sensory system in the bill to help locate aquatic invertebrates and other prey. Interestingly, adult monotremes lack teeth.”

An electro-sensory system? Wow. Pentium or AMD, I wonder. We thought we were clever.


“Only a handful of mammals are venomous, but the male platypus is unique among them in delivering its poison not via a bite but from hind-leg spurs. Despite the obvious difficulties in obtaining samples, it is now known that platypus venom is a cocktail of at least 19 different substances.”

It could apparently kill a dog.

Spur for poison delivery in males(Photo:Cosmos)

Healesville Sanctuary in Australia has successfully bred Platypus. The twins are named Waddirrang and Burrun, to honour the Wurundjeri people whose lands encompass the area where Healesville Sanctuary is today. Both are second generation captive bred Platypus, the first to be bred anywhere in the world. Waddirrang, the name of the baby girl (pronounced “Woterang”), means platypus, and the name of the baby boy, Burrun, means dusk or night light.
For medicine, the genome discovery is important for our future understanding of genetic diseases in humans, as highlighted by the
National Science Foundation, who co-sponsored the project with other countries:

“But new research proves that the oddness of the platypus' looks isn't just skin-deep. Platypus DNA is an equally cobbled-together array of avian, reptilian and mammalian lineages that may hold clues for human disease prevention.
It was the first genome sequencing project of a mammal that lays eggs, confirming that platypus DNA also looks like something of a patchwork.
‘Their genomic organization was strange and a little unexpected,’ says Batzer. ‘It appeared much more bird-and reptile-like than mammalian, even though it is indeed classified as a mammal.’
Having the genome in hand is a huge step for scientists seeking new details about evolution and human disease. The fact that the platypus is an ancient animal that is relatively primitive and unchanged may be a scientific boon for researchers.”

The NSF article explains:

"DNA contains small 'mobile elements' that make copies of themselves and then are inserted elsewhere into the genome…… In reality, they cause insertions and deletions which can lead to genetic diseases in humans and they are also involved in the creation of new genes and gene families……We hope to, in time, identify the underlying causes and methods of disease prevention in humans."
You may wonder why the study was not funded and led by Australia, I wonder too and found the answer

“So why did Australia miss the bus so ignominiously? Maybe Government and their advisors thought that we can get it all for free, and some senior scientists hoped this ‘DNA stuff’ would go away so we can all go back to old fashioned biochemistry. What a blunder! Genomics is fundamental to biochemistry, medicine, pharmaceuticals, agribusiness, forensics, ecology and wildlife management.”

I seem to recall that some country in the old world has been as short sighted when it comes to research funding.

Nature Posts

Honey Money Money

Hong Kong: Humpback Whale

Tasmania: Whales & Dolphins-Mother & Baby

ECOLOGY: First Bees, Now Bats.

Monday, May 26, 2008

Picasso Medicine and Lloyds

Coming Soon

Trivia question: what is the link between Picasso, medicine and Lloyds (of London)?

© Museu Picasso of Barcelona

Lloyds of London© 2008 Am Ang Zhang/Bauhinia Press

Thursday, May 22, 2008

Senator Kennedy, Gliomas and Vesicular Stomatitis Virus (VSV)

Some Bugs May Be Useful

In The Cockroach Catcher:

“……Nature is of course not about beauty or beauty alone. Beauty is both deceptive and subjective. To love only the beautiful and good and dislike the ugly and bad is missing the point ……
Wildlife is just wildlife. Not good. Not bad.”

As most now know, American Senator Edward Kennedy has been diagnosed with

From the
New York Times:

“Mr. Kennedy’s glioma is in the parietal area in the upper part of the left side of his brain, above the ear. This area of the brain involves motor control and ability to understand language, among other functions.

Malignant brain tumors rarely spread elsewhere in the body. But like the root of a plant, cancerous brain tumors can invade nearby areas in the brain.

Gliomas are categorized by subtypes and by a numerical gradation based on how aggressive they appear. But the doctors did not provide these details or the tumor’s size, saying only that the diagnosis was made by removing a small piece of the cancer in a biopsy, which followed a series of other tests that began after Mr. Kennedy suffered a seizure on Saturday morning.”

A viral view: Researchers at Yale University have genetically engineered a virus (green) that specifically attacks brain tumors in mice (red). The virus kills the primary tumor masses (B) and migrating tumor cells (E), while leaving healthy tissue intact. Credit: Van den Pol/Yale University

I read about this in MIT’s Technology Review

Systemic Vesicular Stomatitis Virus Selectively Destroys Multifocal Glioma and Metastatic Carcinoma in Brain

The Journal of Neuroscience, February 20, 2008, 28(8):1882-1893

Here is a relevant extract from the MIT review:

“.....Now researchers at Yale University have found that a virus that's in the same family as rabies effectively kills an aggressive form of human brain cancer in mice. Using time-lapse laser imaging, the team watched
vesicular stomatitis virus (VSV) rapidly home in on brain tumors, selectively killing cancerous cells in its path, while leaving healthy tissue intact. What's more, Anthony Van den Pol, lead researcher and professor of neurosurgery and neurobiology at Yale, says that VSV is able to self-replicate and produce secondary lines of defense.
A metastasizing tumor is fairly mobile, and a surgeon's knife can't get out all of the cells," says Van den Pol. "A virus might be able to do that, because as a virus kills a tumor cell, it could also replicate, and you could end up with a therapy that's self-amplifying.
His search for a virus candidate began six years ago, when he and his colleagues tested the effect of different viruses on brain tumors in culture. Repeatedly, VSV came out "at the top of the heap." The team grew the virus through many generations, isolating strains that infected cancer cells quickly while having a slow effect on healthy cells. The researchers recently ran the most effective strain through a number of tests in live mice, and they've published their results in a recent issue of the Journal of Neuroscience.
In its experiment, the team transplanted glioblastoma--the most common and aggressive form of human brain cancer--into the brains of mice. Prior to transplantation, researchers genetically engineered the tumor cells to express a red marker, which, once inside the brain, would show up in laser microscopy scans. Similarly, Van den Pol inserted a green marker in VSV cells and injected the virus intravenously through the tail. Within a few days, researchers observed that the green virus found its way to the brain and selectively infiltrated red tumor masses and individual tumor cells, while avoiding normal cells. Van den Pol says that as the virus infects tumors, cancerous cells start to turn green, swelling up until they eventually burst.
…… It's not yet clear why VSV is such an effective tumor killer, although Van den Pol has several theories. One possible explanation may involve a tumor's weak vascular system. Vessels that supply blood to tumors tend to be leaky, allowing a virus traveling through the bloodstream to cross an otherwise impermeable barrier into the brain, directly into a tumor.
Van den Pol says that VSV may also target cancer cells because of inherent defects in a tumor's immune system. Typically, in the presence of a virus, normal cells launch an immune response by producing interferon, proteins that prevent viral infection in healthy cells. Tumors lack such strong viral defenses, providing an easy target for viruses.”

As this is still in the early experimental stage, it may not be an option for Senator Kennedy right now. Vesicular stomatitis virus (VSV) belongs to the Rhabdoviridae family, as does the well-known Rabies virus. It is worth remembering that in nature there is no bad or good, and biodiversity is going to prove important to our future health. There is every reason to preserve the most virulent bug on planet Earth and perhaps in the whole universe. Cockroaches, on the other hand, require no preservation. They just survive!


Tuesday, May 20, 2008

Libel and Thalidomide

“Only truth is libellous”, one of my Gurus told me when I was a Registrar in a psychiatric unit in a London District General Hospital, England. Before then, I always thought that if you told a lie about someone and he was “defamed”, or “hurt”, then that constituted libel.

Recently, there were some interesting exchanges going on in
Mental Nurse Blog and NHS Blog Doctor about people in public life and whether some top British politicians suffered from Aspergers Syndrome or not. Arguments arose as to whether some of the things said were libelous or not.

If you look at a few famous cases, you will begin to wonder.

Case 1 – Preying on Hope, Charlatan and Sharks
The libel action brought by a former consultant cardiologist in a leading London teaching hospital against Channel 4 over the programme
“Preying on Hope” (broadcast in 1994) eventually collapsed.
BMJ reported:

“A £2m libel action brought against Channel 4 by a former consultant cardiologist at one of London's leading teaching hospitals collapsed last week after he admitted that errors in scientific papers coauthored by him appeared to be 'more than an honest slip of the pen'.

Dr Peter Nixon, a consultant at Charing Cross Hospital until his retirement six years ago, withdrew his action and agreed to pay £765,520 in costs to Channel 4, which he claimed had branded him a charlatan, unfit to practise medicine.
Dr Nixon, who claimed that hyperventilation could cause a range of illnesses, including many heart attacks, Gulf War syndrome, post traumatic stress disorder and premenstrual tension, sued Channel Four, Mr Campbell, and his company Investigation and Production (TV) Limited over the programme "Preying on Hope," broadcast in February 1994. The programme secretly filmed and recorded a consultation with an AIDS patient, Ian Hughes, who died in 1996.”

BMJ commented:

“We all make the odd error, but to ascribe HIV associated lethargy to overbreathing and treat with valium is a little stranger than odd.”

After being landed with a bill of nearly £2m for this case, the Medical Defence Union announced that it would no longer defend libel action for its members as a matter of course.Case 2 – The MMR Autism scareDr Wakefield, who started the MMR Autism scare in 1998, sued Channel 4, 20/20 Productions, and the investigative reporter Brian Deer, who presented the Dispatches programme MMR: What They Didn't Tell You in November 2004. The programme criticised his methods and accused him of undisclosed conflicts of interest. His action was funded by the Medical Protection Society.
In 2007, he dropped his libel action, as reported by
BMJ.Case 3 – The Politician and his Paris hotel billThe most famous libel case in recent times must belong to, you have guessed it, a politician: Jonathan Aitken. The Guardian claimed that he (then Defence Minister) stayed at The Ritz in Paris at the expense of his Saudi friends, whilst he swore on oath that his wife paid the bill. He lost and was sentenced to 18 months for perjury. He once famously declared:

"If it falls to me, to cut out the cancer of bent and twisted journalism in our country, then with a simple sword of truth, and the trusty shield of traditional British fair play, then so be it."

In a BBC article on the retirement of the renowned libel lawyer
George Carman QC, the BBC commented:

“But Mr Carman's defence of the Guardian newspaper when disgraced former minister Jonathan Aitken took a libel suit against it, was one of his most celebrated cases.”

Case 4 – Defamation of McDonald’s?
What about defamation of big corporations? Can anything be bigger than
McDonald's Restaurants v Morris & Steel case? The English court action for libel filed by McDonald's Corporation against the two penniless environmental activists McDonald’s lasted seven years and was eventually declared by European Court of Human Rights (ECHR) to be in violation of the Convention on Human Rights.

Guardian reported:
“……two penniless environmental campaigners who were sued by McDonald's, the global burger chain, yesterday won a ruling at the European court of human rights……Despite the obstacles, the two campaigners won a ruling from the high court that some of the claims in the leaflet were true, in what was described as 'the biggest corporate PR disaster in history'. Mr Justice Bell ruled that the leaflet was correct when it accused the company of paying low wages to its workers, being responsible for cruelty to some of the animals used in its food products, and exploiting children in advertising campaigns.”

Notice the word “true”!
Case 5 – The Truth about ThalidomideGiven the lack of a constitution enshrining free speech, we do need some protection against frivolous libel actions and injunctions which try to prevent the truth from being revealed. Otherwise the truth about thalidomide would never have been told.

Luckily, the
European Court eventually ruled for The Sunday Times:

“The newspaper then decided to fight the injunction on its investigation into the origins and testing of the drug. The case went right through the British legal system and up to the European Court of Human Rights, which decided that the injunction violated the right of ‘freedom of expression’. The full story of thalidomide could eventually be told in 1976, revealing that both Grünenthal (the maker) and Distillers had not met the basic testing requirements of the time.”

I mentioned thalidomide also because in 2002 Gordon Brown, the then chancellor, attempted to tax the benefits payable through the Thalidomide Trust.


Monday, May 19, 2008

Fish “shepherding” in the Virgin Islands

My passion for snorkelling and underwater photography is well known among my friends. (Dr Am Ang Zhang’s early snorkeling experience was described in The Cockroach Catcher.) I have been asked often if I use a Nikonos to take my underwater pictures.

Alas, no. By the time I had a great deal of opportunity to take underwater pictures, digital had arrived on the scene and with it a number of well made underwater camera housings that were able to do the job nicely.

Digital Camera and Underwater Housing

Care must be taken to ensure that the blue O-ring is absolutely clean and greased by the grease provided. A clean finger will do the job better than anything else.

It may not be widely recognised that the Nikonos camera is based on a prototype designed by Jacques-Yves Cousteau and Jean de Wouters in 1963. Their "Calypso-Phot" was subsequently licensed by Nikon. Many Nikonos users are now reluctantly switching over to digital because of immediate accessibility and easy colour correction with most softwares such as Photoshop.

Water filters out a good deal of the low frequency side of the colour spectrum, giving in the raw a very bluish green picture. With Photoshop, the simplest trick is to just use Auto Colour Correction, which turns the picture into a vibrantly coloured one.

Of course the more advanced photographer might wish to create his own colour mask to achieve a more controllable result, especially if he needs to use a sequence for a slide show. Auto Correct may not give a consistent enough colour for such purpose.

Both the British and US Virgin Islands are wonderful places for snorkelling. The British Virgin Islands are less developed and therefore offer a more natural feel. It was there where for the first time I was able to witness fish “shepherding” in nature.

In Tortola (BVI) we encountered a few big tarpons (overwhelming in size of over four feet in length but pretty harmless unless provoked like after a long fight with an angler).

Tarpon "sheperding"

A couple of them were seen circling some small white fish, millions of them, as if they were “shepherding” them. Each tarpon was also seen with a few bodyguard-like fishes, which swam with the tarpon around its belly, way beyond the reaches of its mouth.

Tarpon (Megalops atlanticus) making the turn

In Peter Island (BVI) I was able to have a close-up view of a six foot barracuda. This also appeared to be rounding up lots of white fish, but I was not sure if the barracuda was “shepherding” them. There was a reasonable distance between them and the giant barracuda. I spotted the fish and its entourage at a distance, but all of a sudden, it appeared right in front of me.
Giant Barracuda (Sphyraena barracuda)
As I was snapping away with my underwater camera, it suddenly shot up straight into the air, plunged back into the water and disappeared. It was indeed a most memorable sight. Luckily I was not wearing anything bright like a ring or a chain, which would have attracted the barracuda’s attention.

The Virgin Gorda (BVI) snorkeling experience was equally unforgettable. The peculiar rock formation was stunning and provided shelter to make one feel safe to skin dive. The lights coming through the rocks and water was just mesmerizing.

St John of the USVI is a different story. Being a National Park, and one of the largest underwater national park in the world, it is very organised. The beach is pristine, the water crystal clear, and there is a labelled underwater trail for snorkellers.

When we were there, there were still plenty of soft corals which unfortunately were fast disappearing from other Caribbean Islands. Some people did not like it for being too organised. It was for me a great experience as the facilities were excellent.

All Photos: ©2007 Am Ang Zhang

Saturday, May 17, 2008

Care in the Community

In Dr Crippen’s Blog today, he reminded us of his account of Emma, which is not dissimilar to the experience of many Schizophrenics suffering under the current “Care” approach. He said then:

“The care of schizophrenics in the UK is a disgrace. It is a matter of national shame. The majority of psychiatrists take no interest and pretend that the GPs are looking after them. The majority of GPs take no interest and pretend the psychiatrists are looking after them. The few who do try to take an interest – and it is one of Dr Crippen’s areas of interest - get no support. Most of the work falls upon the community psychiatric nurses and there are not enough of them.”

From the Chapter called The Last Cook in
The Cockroach Catcher:

“......We were at a loss as to what was going on. We had never seen father but we knew he had a diagnosis of Schizophrenia and was on Modecate injection. Mother had always insisted that he was so ‘out of it’ that there would not be any point in the unit involving him. We did have reports from his day-hospital social worker and we left it at that.

I nodded.

‘But I cannot leave him. I have nowhere to go and I shall not get enough benefit money if I am divorced from him. He now goes to the day hospital. Fridays he gets drunk and beats me up. It is like a routine. I try not to get hurt and hide it from the girls. If I walk out, he will find me even if I have somewhere to go. I shall still get beaten up. Now at least I know when it will happen and I can live with that.’

I suggested that I should speak to him but she looked terrified.

She felt he might even kill her if I did and last time he threw a chair at a male nurse who tried to say something.

She was probably right. We often had no idea what people and particularly women put up with. It would be too easy for us to bulldoze in. We had to think twice before intervening unless we had something better to offer. His Schizophrenia diagnosis allowed for a higher level of benefit she would not otherwise get. Who would she meet up with next? Another violent man most likely.

Was it such a cop-out on my part?

Maybe it was, but in a strange way the girls stopped soiling after that one meeting I had with mum. The case left me with some unease - unease not just about what I did or did not do but about keeping patients in the community. Three other lives were affected here and who knows, one day he might go too far......”

Across the Channel, France has possibly the highest number of Psychiatrists per capita anywhere in the world and its Health Care system has been consistently nominated as one of the world’s best. France still keep most of their Mental Hospitals complete with Medical Superintendents, none of this business of having CEO from the non health related industry. A recent report in ABC News hailed:
“French Health Care: C'est Magnifique!

We need to bring the heart back to medicine and psychiatry in particular.

In an
article in European Archives of Psychiatry and Clinical Neuroscience in March 2007:

“Hospital-based care has still an overwhelming importance, and is associated with a marked under-development of community services and lack of sheltered housing for the most disabled patients.”

Please learn from us. Do not underestimate the value of hospital-based care for those mental patients who need it. Unfortunately for us, it might be too late as the new generation of psychiatrists have no idea what mental hospitals are like or could be like and many will have no chance of seeing one. I once visited one such hospital in Paris and I must admit I could see great possibilities for better care for mental patients. Homelessness and random violence will remain the public's top concerns. Unfortunately it is also the public's perception of the outcome of Care in the Community.

Friday, May 16, 2008

Loquat and Medicine

Sept. 1st 2009
Grand Round:
Loquat, Winter Melon & Sapote

A good friend who read my book The Cockroach Catcher said she wished I had written a lot more about the village. As a result of modernization, in one generation we have seen the passing of something that provided us with a uniquely enchanting experience that no modern developments with their charming “cool” shops can ever hope to match.

Are we being over-romantic to ignore the hardship many of us put up with during that period, not to mention the struggles of many of our parents to provide for us? Have we forgotten the leaking roof, the rudimentary toilet facilities and our constant battle with cockroaches and other pests, not to mention poisonous snakes and the like?

I have to say that on balance, it was still a sweet memory. Who can fail to remember the constant supply of fresh fruits and vegetables from our own land? The chickens we reared and their eggs poultry were just out of this world. I have conversed with a few friends and relatives about this, and they all seem to agree.

No so long ago, I mentioned the surprise and nostalgia brought on by a
Pompano that I caught near our vacation home. Yesterday, I plugged up courage and picked a fruit from one of the trees nearby.

Yes, I know of poisonous fruits and often warn people not to pick unknown berries, especially not the bright coloured ones, as the bright colour is a sign that fruit may be poisonous. I remember a visit to Avoriaz in the French Alps one August many years ago. There were these tiny shrubs in the Alpine hillside bearing small berries. We were not sure what they were and were certainly not tempted to try them until we saw some local boys picking and eating them. They were wild blueberries. Blueberries were not popular or so widely available in those days. Nowadays, the commercial varieties are bigger in size but alas the taste is nowhere as good as the wild ones we tasted in the Alps.

I decided to give the said newly discovered fruit the “alkaloid test”. To do this, you simply rub the fruit on your teeth and then try to lick it to see if you can detect an astringent bitterness. This is the taste of plant alkaloids you get from an unripe Persimmon. The antidote is indeed, dare I mention it: Coca Cola. So with Coca Cola ready, I tested the yellow plum shaped fruit. I had a suspicion, and the tasting confirmed it: Loquat it was.

Loquat (Eriobotrya japonica)

Loquat is in known as Pipa琵琶果in Chinese (more poetic, like the Chinese lute). Most botanical literature agrees that it is indigenous to southeastern China although Japan imported the seeds from China and has been cultivating the fruit for at least a thousand years. It was first planted in the National Gardens, Paris, in 1784; and plants were taken from Canton, China, to the Royal Botanical Gardens at Kew, England, in 1787. Now they are grown in the Mediterranean region, and in other countries such as India and Brazil. They have been subject to much horticultural breeding and many varieties are now commercially available for gardens and orchards. The fruits from the Chinese variety are said to have the best keeping qualities. Loquat may not be in the super-antioxidant category of fruits like pomegranate and blueberries. It is in the apricot (Rosaceae) family, and its yellow colour indicates a good level of beta-carotene.

In Traditional Chinese Medicine, Loquat has been incorporated into one famous cough preparation. A good friend of ours swear by it. Whatever it might be useful for, I turned some of the fruit into Loquat jam, with the addition of some lime to give it some bite. This goes well with homemade pancakes and waffles, as well as cheese.
New Post: Loquat, Winter Melon & Sapote

Other Posts:

Wednesday, May 14, 2008

Multiple Sclerosis Treatment – an Update

There is a recent comment posted to my blog of 18th February “
Multiple Sclerosis, Iguanas and Wrong Foot” that I would like to share with you all. The news that Sarah Longlands, the MS sufferer who was put on some pioneering drugs by her husband, is doing well is indeed heartening.

Sarah Longlands said ...

Dear Dr Zhang,My name is Sarah Longlands, the wife of Dr Wheldon, mentioned above. I found your blog by accident when looking up "David Wheldon" on Google, something I do from time to time to see who is linking to both our web sites.I thought I would give you a small update:nearly three years on again since the publication of "Ignoring the Evidence" I am still going strong, not having had an adverse MS event since starting treatment in August 2003. When I started I couldn't even hold a paintbrush but now I have worked through watercolours to acrylics and have now moved back to my favourite medium of oil paints and of no mean size. My progressive multiple sclerosis was so aggressive, I really shouldn't be here now, but I am.I have not seen my neurologist since being given the diagnosis. David has, since they work in the same hospital, but although at one point the man showed some interest, this soon passed and the man has never looked at my subsequent improved scans. In fact, he once ran out of the radiologists room exclaiming "I can't look at this!" He is obviously very good at saying "Never."There are always going to be people willing to put my recovery down to "spontaneous recovery" but I think it very odd that this should have happened within a few hours of downing my first ever doxycycline, after having my first multiple sclerosis relapse twenty years previously, age 24. Then and for many years it was untroubling, with few, easily resolved relapses. Over the years I had been able to forget about it, so I readily accepted the diagnosis of the orthopaedic surgeon. I have since discovered that David married me thinking I might well have MS, because of my clumsiness although by that time I has already decided that it couldn't possibly be the case.Since starting to recover, David has seen many patients abandoned by the neurological establishment and has written two papers with Charles Stratton of Vanderbilt University about chlamydia pneumoniae and multiple sclerosis. I started writing on, where a psychologist named Jim Kepner, a sufferer of another disease caused by chlamydia pneumoniae, saw me and started to treat himself. Two and a half years ago this led to him starting a wonderful site: where people from all over the world suffering from any of the many diseases in which CPn is implicated can come together for freely given help and reassurance.

Very best wishes,

Sarah Longlands. 12th April, 2008

Her neurologist reminds me of one well known psychiatrist who was very much against psychotherapy but prescribed ECT liberally instead. When asked about the correlation between straight ECT (electroconvulsive therapy) and fracture, his comment was something like: “I’ve never had a fracture, but I have never X-rayed any patient either.” You do not get what you do not look for – it is as simple as that!

In the meantime let the Iguana roam freely.

Buy the book: The Cockroach Catcher

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Tuesday, May 13, 2008

Illness and Morality

“It would not be a great surprise to anyone who has any inkling of the history of medicine that sooner or later any medical condition with an alleged aetiology of pure psychological origin will prove to have a non psychological cause. This is particularly true of those conditions classified by non-psychiatrists.

In the past, ignorance has led to belief that certain conditions are either punishment by god, visions of great religious significance or simply madness. Accordingly you might be burnt, become a saint or simply be given one of the psychiatric medications.”

Tuberculosis is one such condition that came to mind, more so as last Sunday we saw a production of La Traviata by one of opera’s grandest composers, Giuseppe Verdi.

In 1897, a young nun Thérèse Martin in a convent of Lisieux was dying of tuberculosis. She was essentially writing the equivalent of the modern day blog in the form of a diary. She was 24 then and had led an uneventful and sheltered life, taking the veil at only 15 and in contrast to most saints, she experienced and accomplished little. With her tuberculosis, her health deteriorated rapidly and she spent her last five years in the convent’s infirmary
, continuing to diarise her innermost thoughts and emotions up until her death. The convent published her writings as an autobiography: Story of a Soul. After her death, many miracles were attributed to her intervention. In 1925, she became Saint Thérèse of the Child Jesus and of the Holy Face, and during World War II, Pope Pius XII proclaimed her co-patron saint of France, along with Joan of Arc.

Yet not long before the Industrial Revolution, in folklore, tuberculosis had been regarded as vampirism. As people with TB often had red, swollen eyes, pale skin and coughing blood, stories abounded that the afflicted could only replenish this loss of blood by sucking blood.

All of this changed in the nineteenth century – Mimi in La Bohème, Violetta in La Traviata (from Murger’s Scènes de la vie de Bohème, and Alexander Dumas’ novel La dame aux Camélias) and of course Hugo’s Fantine in Les Misérables. Tuberculosis became the preferred cause of death for a certain type of female character.

Verdi at 38 began an affair with a singer who was later to become his wife. Many viewed La Traviata as Verdi’s own way of testing public opinion. His new wife was luckier than Violetta.

Verdi of course was an opera revolutionary and in a letter to his friend Cesarino de Sanctis early in 1853, he wrote, “For Venice I am writing La Dame aux Camélias, a contemporary subject. Another composer might not want to do it perhaps because of the costumes, the period, and a thousand other awkward scruples … But I am doing it with total pleasure. E
verybody screamed in horror when I suggested putting a hunchback on the stage. Well, I was happy to compose Rigoletto.”

He was not so lucky with Venice as they insisted on 1700 costume when Verdi wanted contemporary ones. In that production, Violetta was nowhere near consumptive although it might well be a reflection of sopranos of the time: big and fat.

Luckily for us, his threat to withdraw the opera completely was rescued by a second performance that fitted in with Verdi’s ideal and the opera world was blessed with one of the three most performed operas; La Boheme and Rigoletto being the other two. All three operas remain my favourites.

Carlos Kleiber’s Traviata starring Ileana Cotrubas and Placido Domingo has to be the all time best in my eyes (or more correctly to my ears), closely followed by Angela Gheorghiu’s amazing performance under Sir Georg Solti.

In 1993 we went to Boheme at the Met. A very beautiful and slim Mimi appeared and you could hear the silence in the audience as she started to sing. It was one of the best Boheme’s: Angela Gheorghiu’s debut at the Met.

Tuberculosis sells.

Opera in the end is still one of the best medium as Dumas is hardly known nor performed nowadays.

Monday, May 12, 2008

Dry Falls-Thinking Outside The Box

Ideas without precedent are generally looked upon with disfavor
and men are shocked if their conceptions of an orderly world are challenged.
Bretz, J Harlen 1928.

At the start of the new school term after the summer of 1960, we had a new geography teacher. Now if the truth be told, up until that time Geography was not up on the list of subjects even the diligent students found exciting. Geography often competed with Civics for the bottom honour of the least favoured subject.

Not any longer. We now had a bright young teacher straight from the University of Hong Kong; and from the first lesson we were spell bound. Yes, she was elegant and stylish, but I really did not think those were the only reasons for our newly discovered enthusiasm. She was able to capture our attention and made what we thought were boring subjects riveting. For the first time what happened millions of years ago fascinated us. Glaciers became hot.

Looking back now, I realised our understanding of Planet Earth was then in its infancy. Harry Hess of Princeton University was just formulating the Sea-Floor Spreading theory that is now generally accepted in the geological community.

We were so inspired that the Meteorology Club membership increased dramatically. A guided visit to the Royal Observatory (Hong Kong) further cemented our new found interest.

On my recent vacation in Washington State, I was reminded of our inspiring geography teacher. No, not many of us became geologists or meteorologists; but our interest in such matters stayed with us.

In Washington State we saw a geological puzzle that took over 40 years to solve: the Dry Falls.

The Dry Falls, Washington State, U.S.A.© Am Ang Zhang 2007

The Dry Falls in northeast Washington was once the world’s largest waterfall, with water plunging 400 feet over a 3.5-mile-wide cataract. To put it into perspective, Victoria Falls, arguably the biggest and grandest fall in the world is only slightly over a mile wide and has a drop of 360 feet. Iguazu Falls is wider at 1.67 miles although nearly half a mile of it is now dry. Its drop ranges from 210 to 269 feet. Victoria Falls has therefore the largest curtain of water. Niagara, is small by comparison: ¾ mile wide and a drop of only 167 feet. However, it is the most easily accessible of the three falls.

The Dry Falls was the result of a series of events and catastrophes starting from 17 million years ago. For 6 million years, enormous lava flow after lava flow engulfed the area. This was followed by a warping of the plateau and an uplift of the mountainous region in the north. Then the Ice Age began about 1 million years ago, resulting in the formation of glaciers, subsequent flooding and formation of huge waterfalls. When the ice eventually receded, the network of rivers and streams in the plateau were left high and dry several hundred feet above the Columbia River. Today Dry Falls overlooks a desert oasis filled with lakes and abundant wildlife.

(Those interested in the full details can read the transcript of Mysteries of the Megaflood.)

The theory of the colossal flood was first proposed by geologist J. Harlen Bretz of the University of Chicago. In the summer of 1922, he became intrigued by the maze of huge streamless canyons, dry falls and other strange geological features in this area. As the area had few roads, he had to cover much of the 3000 square miles by foot. He worked painstakingly for the next seven summers, documenting what he saw, and came up with his hypothesis: a catastrophic flood greater than geologists had ever recognized on earth. It was a bold challenge to the prevailing principle of "uniformitarianism," which held that geological changes occur slowly, through steady processes. To other geologists, the idea of a sudden, colossal flood was unthinkable heresy. They emphatically declared his theory ‘wholly inadequate,’ ‘preposterous,’ and ‘incompetent.’ Though warned, Bretz proceeded to publish his conclusions.

In 1965, the International Geological Congress toured the Channeled Scablands (name invented by Bretz) and finally sent Bretz a telegram stating, ‘We are now all catastrophists.’

Satellite photographs taken in 1974 confirmed Bretz’s theory beyond doubt.

In 1979, the 96 year old Bretz was awarded the Penrose Medal of the Geological Society of America, that nation’s highest geologic honour.

Friday, May 9, 2008

Lithium Bipolar and Nanking

Nanking Poster: THINKFilm

On July 2, 1996, the anniversary of Ernest Hemingway’s own suicide, Margaux Louise Hemingway, his grand daughter was found dead in her studio apartment in Santa Monica, California at age 41.

On November 9, 2004, Iris Chang (張純如), who was propelled into the limelight by her 1997 best-selling account of the Nanking Massacre “
The Rape of Nanking: The Forgotten Holocaust of World War II”, committed suicide. Earlier she had a nervous breakdown and was said to be at the risk of developing Bipolar illness. She was on the mood stabilizer divalproex and Risperidone, an antipsychotic drug commonly used to control mania. There was a detailed report in San Francisco Chronicle.

My sentiments about the treatment of bipolar illness are expressed in The Cockroach Catcher:

“I am a traditionalist who believes that Lithium is still the drug of choice for Bipolar disorder. Tara’s mother was well for ten years. She was taking only Lithium and no other medication.”

The anti-suicidal effect of lithium has been confirmed by a number of recent studies in both the U.S. and in Europe.

According to the results of a population-based study published in the 2003 Sept. 17 issue of The Journal of the American Medical Association (JAMA. 2003;290:1467-1473, 1517-1519), Lithium reduced suicide rates of patients with bipolar disorder but divalproex did not. Risk of suicide death was about 2.5-fold higher with divalproex than with lithium.

Another paper published in 2005
(Arch Suicide Res. 2005;9(3):307-19) reviewed the existing evidence.

“The article reviews the existing evidence and the concept of the anti-suicidal effect of lithium long-term treatment in bipolar patients. The core studies supporting the concept of a suicide preventive effect of lithium in bipolar patients come from the international research group IGSLI, from Sweden, Italy, and recently also from the U.S. Patients on lithium possess an eight- time lower suicide risk than those off lithium. The anti-suicidal effect is not necessarily coupled to lithium's episode suppressing efficacy. The great number of lives potentially saved by lithium adds to the remarkable benefits of lithium in economical terms. The evidence that lithium can effectively reduce suicide risk has been integrated into modern algorithms in order to select the optimal maintenance therapy for an individual patient.”

The JAMA paper highlighted the declining use of lithium by psychiatrists in the United States and observed that:

"Many psychiatric residents have no or limited experience prescribing lithium, largely a reflection of the enormous focus on the newer drugs in educational programs supported by the pharmaceutical industry."

One might ask why there has been such a shift from Lithium.

Could it be the simplicity of the salt that is causing problems for the younger generation of psychiatrists brought up on various neuro-transmitters?

Could it be the fact that
Lithium was discovered in Australia? Look at the time it took for Helicobacter pylori to be accepted.

Some felt it has to do with how little money is to be made from Lithium.

My questions are: Will the new generation of psychiatrists come round to Lithium again? How many talented individuals could have been saved by lithium?

Now back to the Japanese atrocities in the Nanking Massacre in 1937, one of history’s worst but relegated to obscurity. The impact of Iris’ book and her tragic death was such on Ted Leonsis, Vice Chairman of AOL, that he went on to produce
a film on the subject. The film, Nanking, premiered in Sundance Festival last year, was shortlisted in the documentary feature category of the Academy Awards, and won the Humanitarian award for documentary in the Hong Kong International Film Festival.

Mariel Hemingway, younger sister of Margaux, read the words of Minnie Vautrin in the film. Minnie Vautrin was an American missionary renowned for saving the lives of many women at the Ginling Girls College in Nanking, China during the Nanjing Massacre. In 1941, Minnie Vautrin committed suicide.

In July, 2007 the film premiered in Beijing. The
BBC said:

“It is doubtful, though, it will ever be shown in Japan, where historians claim the massacre has been exaggerated.”

Experts estimate the Japanese killed 150,000 to 200,000 people and raped more than 20,000 women and children, but a group of MPs from Japan's governing party recently said no more than 20,000 were killed.

Monday, May 5, 2008

Abuse Abuse Abuse

All is not well in this beautiful part of the OLD WORLD that is Austria.

Salzburg, Austria

Last weekend, Josef Fritzl, an engineer in his seventies was found to have kept his 42-year-old daughter locked in his cellar since she was 19. The woman, who bore her father seven children during her captivity, was discovered only after one of the children she had with her father fell into a coma in hospital.

Austria does not have the monopoly of family abuse.

The following are all extracts from The Cockroach Catcher:

Dr Am Ang Zhang experienced this in Hong Kong:

“……But the crunch really came when I had to deliver the baby of an eleven year old mother. Yes, eleven. It was a smooth event but the complex case situation of the uncle abusing her and so on probably sowed some seeds for my eventual move into child psychiatry……”

In Australia, Sara’s mother made a brave attempt to save her:
That her husband only served three months of a three year sentence for abusing his own daughter meant that she felt totally unsafe as soon as he was released. On top of that her belief in herself was totally destroyed or at least her belief in her own ability to judge character. He started stalking her and despite an injunction she did not feel safe and in desperation went to a refuge. Eventually she was advised to return to England.”

In England, Amanda could paint like Magritte:

“……Amanda was by then fourteen but her father had been abusing her since she was about eleven. Her mother worked night shifts and father would come to her bed room to tuck her in. This had been going on for as long as she could remember.
…… She was bleeding quite badly and told her mother, who told her that was what happened to girls when they grew up. She knew what menstrual period was but she said this was different; but mum did not want to know and gave her a box of sanitary pads. Then her period started and she started to worry about becoming pregnant. Her father said it was not a problem and asked ……”

Chris’ mother had breast implants paid for by her father:

“……She had been abused by her father from about the age of twelve and the awful thing for her was that she actually enjoyed the sexual side of things. It was an abuse she found hard to come to terms with. She could not hate her father because when she came out of hospital after her Anorexia, she had no breasts to speak of. Her father paid for implants, twice……”

Laura’s mother found it too much to bear

“……She had just taken a massive overdose of Paracetamol and her liver was thought to be too far gone to survive. She died a rather painful death and we were all deeply saddened.
Could we have done any better? Was the truth too much for her to bear? Would she still be alive if we had not discovered the sex abuse? We would never know. We might have rescued Laura from sex abuse but now she had lost her mother……”

I can only quote from Shakespeare:

And your experience makes you sad:
I had rather have a fool to make me merry
than experience to make me sad…..
(from: As You Like It - Act II, Scene 7)

Saturday, May 3, 2008

Adoption Adoption Adoption

In yesterday’s paper:

“Judges attack council over baby adoption”

“Senior judges have made an unprecedented attack on the "disgraceful" actions of a local council for rushing through the adoption of a child against the wishes of her father.

Lord Justice Thorpe said that East Sussex county council appeared more concerned with meeting a quota than the best interests of the family.”

Many will say that such adoption is of course in the best interest of the child. After over thirty years dealing with children and their emotional problems, I am never too sure if there is any foolproof way of placing children when such important matter such as parenting is involved. Some adoptive parents are extremely wealthy and well known world wide. Others are educated and in positions of influence and power. Do they make good adoptive parents?

We only need to look at one recent case in Hong Kong that hit World news:

“Diplomat 'dumped his adopted child because she did not fit in'”

Jade, a seven-year-old of South Korean origin, is the focus of an escalating dispute across two continents. At the age of four months she was adopted by a Dutch consular officer based in Hong Kong, Raymond Poeteray, and his wife Meta. But the couple have now surrendered Jade to the Hong Kong social welfare department for readoption, reportedly because the child could not adapt to Dutch culture.

The revelation has sparked protests amid claims that the couple were treating the child as if she were an unwanted present. She had been discarded like “a piece of household rubbish”, said the Dutch daily De Telegraaf.

The South Korean Consulate in Hong Kong said that Mr and Mrs Poeteray had complained that Jade was not adapting to Dutch culture or food. “That is the reason they gave for why they want to discontinue the relationship,” a South Korean official said.

This was met with incredulity. “They adopted her when she was a baby,” said Law Chi-kwong, a professor at the department of social work at Hong Kong University. “They are responsible for shaping the child’s mind and culture. How can you say that the child cannot adapt to the culture in which she was raised?”

Hopefully the child Lord Justice Thorpe talked about will fare better.

Adoption can go terribly wrong in other ways too. In Newsweek in December 2007 an article highlighted the problem of an adoptive mother serving a 19-year sentence for second-degree murder in a Virginia maximum-security prison.

Her story is awful—and rare—but sadly it is not unique. Adopting a child from another country is usually a positive, enriching experience for both the child and the parent. Over the last 20 years, foreign adoption has become more popular, and Americans now adopt about 20,000 children from Guatemala, China, Russia and other nations each year.

…… Since the early 1990s, the deaths of 14 Russian children killed by their adoptive parents have been documented.”

Russia has now stopped international adoptions.

But what was the reason for the rush in the UK case quoted earlier. Could money be the driving force?

It was reported that:

“Tony Blair set a
goal in 2000 for a 50 per cent increase in adoptions, to reduce the time children spent in foster care. In the last round of targets, councils were offered bonuses totalling £36 million for increasing the number and speed of adoptions.”

I decided to look again at the UNICEF
Convention on the Rights of the Child

Article 3
2. States Parties undertake to ensure the child such protection and care as is necessary for his or her well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures.
Article 9
1. States Parties shall ensure that a child shall not be separated from his or her parents against their will…… Such determination may be necessary in a particular case such as one involving abuse or neglect of the child by the parents, or one where the parents are living separately and a decision must be made as to the child's place of residence.
2. In any proceedings pursuant to paragraph 1 of the present article, all interested parties shall be given an opportunity to participate in the proceedings and make their views known.
3. States Parties shall respect the right of the child who is separated from one or both parents to maintain personal relations and direct contact with both parents on a regular basis, except if it is contrary to the child's best interests.

In the East Sussex case:

“The adoption proceedings began while the father was in hospital after a heart attack, but as soon as he was fit he instructed a solicitor to write to the council and ask that he be allowed to care for his daughter. The council reacted by placing the baby girl with prospective adopters the day before a court hearing at which her father intended to challenge the adoption.
Lord Justice Thorpe said: The council's failure to answer that letter and subsequent placement on the eve of the hearing give rise to the clearest inference that the council was out to gain its ends by means more foul than fair.”

Strong words indeed. However, the April 7 blog of Dr Crippen warned that such intelligent and educated judges might not be around for much longer:

Successive Labour governments have destroyed the English secondary education system. They are in the process of destroying the university education system by compelling the universities to admit under qualified students from sink comprehensives. They are destroying the NHS by undermining the medical profession so that they can be replaced with poorly trained but cheaper HCPs. It is only right and fair, therefore, that they should also destroy the English legal system.
English judges have traditionally been highly intelligent and have been educated at leading Universities. New Labour does not like that. So they are proposing to allow judges to be appointed from the Crown Prosecution Service, that well known bastion of legal mediocrity.”

Friday, May 2, 2008

Enron, South Africa and Carbon Trading

From the Cockroach Catcher:

“……Without a proper job, my father, who managed an airport in China before fleeing to Hong Kong, decided he would like to try his hand at poultry farming – ducks, pigeons, chicken and turkey. The farm was right by the river and so it was convenient for us children to be engaged in fishing or exploring the nearby ponds. At the time I had no idea that my school friends in the city did not have such activities and more importantly such fun
……The farm was to be closed rather unexpectedly. There was nothing wrong with the running of it; and business was good. But “Bird Flu” struck and it struck bad, literally wiping out our whole stock. No farm along the river was spared. The sight of dead poultry was horrible. I do not know how they were cleared, but cleared they were, probably by the government.
Thus my father’s little entrepreneurial venture came to an abrupt end. I do not think he really ever recovered from that as he never went into another business venture and became very cautious……”

How times have changed and if
Kyoto Protocol existed then, things would have been so different. The farm would have generated money not just from the poultry but from the methane generated by the poultry manure.

This is how it works:
36 industrial countries that signed the Kyoto Protocol agreed to reduce greenhouse gas emissions by financing “clean development” projects in the third world. So those companies who need them can offer to buy carbon credits (technically called Certified Emissions Reduction, or CER) from the likes of my father’s poultry farm, which say generates 3000 CERs per year @ €5 per CER, totally €15,000, until Kyoto expires in 2012. The farm owner then installs methane digesters. In doing so he generates electricity and can reduce his utility bill substantially by selling the surplus into the national grid. Also, he can still sell his poultry but now has a less smelly farm. But here is the fun bit. The one who pays €5 per CER can now sell the carbon credits say to a European Bank for €20. The bank might hold on to it as an investment as its price will most likely go up.

Of course the small farm owner only benefits in a small way. The ones who really benefit from the Kyoto Protocol and carbon trading are again the “big boys”.

So what has Enron got to do with all of this, you may ask.

Well, this is what I gleaned from the latest copy of
Fortune Magazine:

“For two centuries rum, molasses, and sugar were bought and sold at London's West India shipping docks. Today the gleaming office complex that towers over the docks, Canary Wharf, is the global nerve center of carbon finance. Barclays, Citibank, Credit Suisse, HSBC, Lehman Brothers, and Morgan Stanley all have trading desks here, and so here is where you find a pair of investment bankers - both 35, both alumni of Enron, both brainy and self-assured - who have emerged as two of the world's top carbon traders.

Louis Redshaw of Barclays Capital and Imtiaz Ahmad of Morgan Stanley (
MS, Fortune 500) have risen above the crowd for several reasons. First, they were early movers: Redshaw started the desk at Barclays in 2004, before EU trading began, and Ahmad traded emissions credits for BHP Billiton, the giant mining company, before joining Morgan Stanley in 2005. Second, their banks have relationships with utilities and industrials whose emissions are regulated by the EU. Third, they can navigate a market that is opaque and highly regulated, and offer insight into where prices are going.”

In the meantime I read that a new technology called “
coal gasification” provides a way to generate clean electricity with coal, which is plentiful. The gasification plant is cheaper to run, and it makes it easier to capture the carbon dioxide and inject it into a geological reservoir (sequestration), or even an oil well to help push the oil out of the wells. Oil produced from underground coal in this manner can cost as little as $55 per barrel compared to the OPEC oil price of $120. The only trouble is that if there is a big scale move to do that, OPEC will reduce the price to below $55.

South Africa during the sanction years managed to produce oil from coal, thank you very much.

Table Mountain, Cape Town, South Africa ©2004 Am Ang Zhang

“SECUNDA, South Africa -- Every day, conveyor belts haul about 120,000 metric tons of coal into an industrial complex here two hours east of Johannesburg.
The facility -- resembling a nuclear power plant, with concrete silos looming over nearby potato farms -- superheats the coal to more than 2,000 degrees Fahrenheit. It adds steam and oxygen, cranks up the pressure, and pushes the coal through a series of chemical reactions.

Then it spits out something extraordinary: 160,000 barrels of oil a day.”

The other benefits are that sulphur and mercury will not be released into the environment and we may one day be able to eat tuna and other seafood without mercury contamination and of course reduction of acid rain that destroys forests.

Unless we the people understand the science and of course the politics, we cannot win.

One thing is for sure: oil will run out; and it is time we support good clean alternatives.

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