Sunday, September 27, 2015

Dark Side: Mother threw own baby in fire!

Another Baby Murdered: 

“A mother stole a baby from a wealthy family. She proceeded to throw her own baby into a fire and bring up the baby from the wealthy family as her own.”

That was not another major Social Services blunder.

That was at the Metropolitan Opera on Sept. 25th 2015.

Verdi’s Il Trovatore is probably well known to most for its Anvil Chorus. For me it is about The Dark Side, the dark side of human nature.

The Dark Side:
“My hunch is that despite media coverage many of us still fail to grasp the dark side – the dark side of human nature. Until we do, we shall continue to read about child abuse, abductions and murders of the worst kind.”From The Cockroach Catcher.

Much has been written about training others to do the doctor’s work in an attempt to save health cost. What is not covered is the fact that there is training and there is a broader aspect of education. The ability to transmit culture external to genetic coding is what distinguishes Homo sapiens from other animal species on Planet Earth. Many bloggers are well educated in this cultural respect either by design, by choice or by accident. There is now an uncomfortable feeling of de-education in the Brave New World. Will the next generation of doctors, nurses and bloggers be as cultured? I do wonder!

In the mean time unnecessary deaths continued since Dennis O’Neill & Maria Colwell with millions spent on QCs holding public enquiries.            A Chronology of selected inquiries
Darker side:

Doctor suspended for blowing the whistle:

Dr Kim Holt was suspended from Great Ormond Street Hospital.

SOMEONE took a decision at the famous Great Ormond Street Hospital (GOSH), in Bloomsbury, to suspend a senior pediatrician, Dr Kim Holt, from her post.

We know why the good doctor was suspended on full pay.

These are the facts: Dr Holt, a specialist of 25 years  experience, started working in Haringey in a children’s department run by GOSH 
in 2004.

Two years later she started writing to her superiors complaining about the loss of staff, and the risk of a possible “disaster” at the child protection service in Haringey if more doctors were not attached to the department. This was a matter of “public interest” and should be “investigated”, argued Dr Holt. 

As readers will know, such a “disaster” occurred when a locum pediatrician was called in to see Baby P and made a mess of her examination. Two days after the examination Baby P died.

Was Dr Kim Holt patted on the back for her whistle-blowing?
No, someone, or a committee at GOSH, felt offended by Dr Holt’s interference – and suspended her.

Dark Side of The Opera:
In Il Trovatore, Azucena is the mother who killed her own baby and Manrico was brought up by her. Manrico is the brother of Count Di Luna that burnt Azucena’s mother for being a witch. Azucena had to avenge her mother’s death. How much hate can you hold. She had to throw her own child in the fire, bring up Manrico so that he would one day be killed by his own brother! Unbelievable! The full synopsis here. 

Well, that roughly is it, Verdi’s Il Trovatore  and the dark side. One of Verdi's best!

Most people were looking forward to seeing the Russian superstars take the stage for very different reasons. One hand there was Anna Netrebko, singing her first Leonora at the Met, a character that she has dominated in Europe. And on the other side of the bracket was the return of baritone Dmitri Hvorostovsky to the stage after months of battling a brain tumor. Safe to say that both stars were at very high levels, delivering nuanced and deeply poignant performances.

Tuesday, September 22, 2015

Ribena Girls of Diesel Engine: VW & GSK!


Black current? Honest!

Black Currant Studies © 2012 Am Ang Zhang

© 2012 Am Ang Zhang

Now the story of Ribena has to be one of those sweet (sorry) stories one remembers for a long, long time.
Anna Devathasan (left) and Jenny Suo, New Zealand
Photo by Martin Sykes

In 2004 a science experiment by two 14-year-old high school girls in New Zealand brought embarrassment to the world's second-largest food and pharmaceutical company, GlaxoSmithKline, whose Ribena sale is around $8 million a year.
"We thought we were doing it wrong, we thought we must have made a mistake," Anna said when they found negligible vitamin C level in the Ribena they tested. The company had promoted the product by claiming that blackcurrants had four times the vitamin C of oranges.
The girls got short shrift when they telephoned GlaxoSmithKline.
"They didn't even really answer our questions. They just said it's the blackcurrants that have it, then they hung up," Jenny said.
Well, that was very clever. Blackcurrants have it, but not Ribena. So, nobody is misleading the public. You can guess the “concentration” of blackcurrant in Ribena. Have you tried the Syrop de cassis from France? The flavour of blackcurrant just bursts in your mouth.
The question must be asked of the second largest pharmaceutical company in the world. If they did not know how to check for vitamin C level, what business did they have in producing drugs that are used by millions? If they knew about it then ……wow!
The 2007 New Zealand Commerce Commission Report did not mince their words:
"Health claims are big business in today’s market, and the Commission has targeted bogus health claims in recent years. It is very disappointing to see a major pharmaceutical and health products company like GlaxoSmithKline mislead the public in this way……….a massive breach of trust with the New Zealand public."

GSK pleaded guilty to 15 representative charges of breaching the Fair Trading Act by making misleading claims about the Vitamin C content of Ribena, was fined $227,500, and ordered to undertake a nationwide campaign of corrective advertising in newspapers to explain that some forms of Ribena contain no detectable level of vitamin C.
GSK were lucky that they did not get fined over Ribena in any other country including Australia. In Australia, they avoided the fine by undertaking to explain the true nutritional makeup of Ribena on its packaging, its website and in future advertising.
Knowledge is power and it is good to know that there are young Cockroach Catchers as far away as New Zealand.
The two girls must have the last words:
Every time I see the new Ribena ad, the one where they don't mention any vitamin C, I'm just like, "Oh, yeah".

Volkswagen scandal: how two campaigners exposed the 

world's biggest car company

 By Science Editor


Peter Mock and John German never intended to spark a huge crisis in the motor industry

When transport campaigners Peter Mock and John German began testing US car emissions early in 2014 it was with the sole intention of proving to Europe that it was possible to make clean diesels.

America had seemingly cracked the dirty fuel conundrum, its cars effortlessly passing pollution checks that were far stricter than across the Atlantic.
So enlisting the help of the West Virginia University, Mock and German, decided to drive a number of models 1,300 miles from San Diego to Seattle to show that emission-busting technology need not impact performance.

German and Mock
But when the results came back they made no sense. Despite sailing through lab tests, the Volkswagens were pumping out dangerous levels of toxins, some 35 times higher than the legal limit.
The pair had inadvertently stumbled upon one of the biggest automotive scandals in recent years.

John German and Peter Mock

Source: ICCT via Bloomberg
Photoshot. All rights reserved.
On the road the VW Jetta exceeded US nitrogen oxide emissions by up to 35 times. The Passat was up to 20 times higher.
The pair contacted the Californian Air Resource Board and the US  Environment Protection Agency who launched an investigation in May 2014.
There followed months of fencing by Volkswagen who insisted on repeating the tests themselves and claimed that the figures were the result of minor discrepancy software error which could be fixed easily with a recall.
It wasn't until the EPA and the CARB threatened to withhold certification for its 2016 diesel models that Volkswagen admitted its wrongdoing in early September.

Other teenage Paxil users were not so lucky. Jake Garrison, a 15-year-old who suffered from acne, was prescribed Paxil by his dermatologist for “body dysmorphic disorder,” a condition that leaves people feeling preoccupied with their own perceived physical defects. He took the medicine for a while, then stopped, and then, in September 2002, began taking it again. Three days later, he shot himself to death.

.....GSK also seemed to be manipulating data from its clinical trials to minimize the number of suicides or attempts that might be blamed on its pills—“cooking the books,” in the words of a former Navy lawyer who took on the British pharma giant.

As I read through company documents released by government lawyers, I began thinking about some of the victims I’ve interviewed during two decades of reporting on the pharmaceutical industry and its marketing of flawed, sometimes dangerous drugs—people like Angela Reich and the anguished parents of other children who died. I also thought about the statements made by Sir Andrew Witty, Glaxo’s chief executive officer, who expressed “regret,” said the company had learned from “the mistakes that were made” and asserted that under his leadership the company was now “putting patients first, acting transparently…and displaying integrity in everything we do.”

Times headline:        

No prosecution on suicide-risk drug.

“A report suggested that GlaxoSmithKline (GSK) knew about safety risks but failed to report them to the medicines safety watchdog for five years.”
The drug concerned is Paroxetine and in the UK marketed as Seroxat and in the US as Paxil.
“GSK submitted data from clinical trials to the MHRA in May 2003 showing that patients under 18 had a six or sevenfold increased risk of suicidal behaviour if they were treated with Seroxat than if they received a placebo. Data also showed that the drug was not effective for treating depression in children and adolescents. Leaked documents suggested that GSK had known about these results as early as 1998.”
Keen eyed bloggers would have noticed Paxil CR in a previous posting of mine about how GlaxoSmithKline had all their Paxil CR andAvandamet seized in the U.S.

Sunday, September 20, 2015

Faking: From VW to Caviar!

Looks like it is not only my patients that fake!

       18 September 2015

German carmaker Volkswagen has been ordered by US regulators to recall half a million cars because of a device that disguises pollution levels.

The "defeat device" allows cars to pass lab testing even though they actually emit 40 times the emissions standard.

The illegal system allowed cars to detect when they were undergoing smog emission test and lowered the rate of pollution. Those emission controls were then turned off during ordinary use.

Now how many would take up the recall as it has nothing to do with safety and if you remove the devise you are going to use more diesel.

Forbes thought the same too: read it here!

It was a device to mislead regulators and not consumers. It benefits consumers. 

Not quite, just like faked Kona Coffee, it is still caviar but a cheaper species.

Looks like the big boys are moving in as the pickings are better with the rich and famous who can’t tell their burgundies, coffees or now caviar.

I think I like to get my hand on those cheap stuff that could be passed off as fakes.

The Guardian:

Is fine dining having its Apollo 13 moment? I know it's not on the same scale as "Houston, we have a problem," but when Laura King had to call Fortnum & Mason and Harrods to say, "There might be a problem with the sevruga," it can't have been her easiest day at the office.

King is the founder and co-owner of the eponymous King's Fine Foods, the UK's largest supplier of caviar with a client list that includes Buckingham Palace, the Groucho Club and Claridge's, as well as the nation's poshest grocers.

Random DNA tests taken back in October at King's premises in Richmond have revealed that what was labelled as top-grade sevruga, the eggs from Acipenser stellatus sturgeon, was actually the roe ofAcipenser ruthenus, considered considerably less fine by those who know and care about these things.


The Cockroach Catcher has always been amazed that in a short time under pressure from consumer groups and the government, food manufacturers and supermarkets managed to produce detail analysis of the product they sell so that consumers can be clear what they are “consuming”!

What he was amazed was how healthy most foods were: sugar free, trans-fat free, cholesterol free. Even when the product has cheese.

Wow! Modern food processing technology! Or was it modern labelling technology!

Then he remembered Ribena. You can read about it here>>>>>

 Vancouver ©2012 Am Ang Zhang

I happened to be in one of the world’s most livable city and imagine my surprise when I read this in:

Tests unveil misleading food labels
Bad nutrients understated, good ones overstated

By Sarah Schmidt, Postmedia News April 20, 2012

Some of the world's biggest food brands and leading organic labels have understated the amount of bad nutrients — such as fat, sugar and sodium — in their products, or overstated the good ones, internal government tests show.

Kraft, Frito Lay, Unilever and Heinz are among the big names with a product that flunked Canadian Food Inspection Agency (CFIA) testing, conducted to see if nutrition claims on labels live up to their billing.

Loblaw's popular President's Choice brand had multiple "unsatisfactory" tests on products ranging from cereal to spaghetti.

Premium brands like Amy's Kitchen, Eden Organic, Natur-a, Kashi and Yves Veggie Cuisine also fell short on composition claims, as did Canadian food-makers like B.C.-based Sun-Rype Products Ltd. and Quebec-based Aliments Fontaine Sante.
No Sugar:

Among the breads and baked goods tested, Fenwicks "no sugar added" cookies (too much sugar)

In the snacks category, Krispy Kernels Inc.'s Island mixed nuts claimed to contain 90 per cent of the recommended daily intake of iron per serving. Samples tested by CFIA found contained a fraction of that: 10.5 per cent.

A sampling of other findings shows the huge discrepancies that can exist between labels and ingredients.

Some snacks boasting a "No cholesterol" message on their label showed levels ranging from 4.3 milligrams (Lays Smart Selections chips) to 10.5 mg (Barbara's Cheesepuff Bakes) per portion, according to CFIA tests.

(PepsiCo says its own tests on Lays chips, conducted after CFIA informed the company of the agency's eight unsatisfactory tests involving samples of three Smart Selections chip products, showed the claim was accurate.)

Kraft made the same no-cholesterol claim for its Ritz "Real Cheddar Cheese" crackers, but CFIA testing showed the crackers contained 3.2 mg per portion. Dare's cinnamon snap biscuits contained 4.9 mg, CFIA testing showed.

These discrepancies pale in comparison to the findings of two canned snail products picked up from Dollarama stores in Regina. The products of Indonesia, branded as "Beaver" and "Pacific Pride," contained 147 mg and 131 mg of cholesterol per serving respectively, not zero as claimed.

Canned foods from Unico (pizza sauce), Primo (vegetable soup), Stokely (pumpkin) and Amy's (refried beans, butternut soup) all fell short of their vitamin claims. So did Eden Organic's vegetable spirals, President's Choice organic pasta sauce, Fontaine Sante spinach dip and Island Farms yogurt.

Of the 40 products found to be overstating the amount of vitamins in their products, Yves Veggie Cuisine Ground Round (Mexican flavour) and a prepared pasta dinner by Olivieri Creations stood out for being wildly inaccurate.

The label on Yves Veggie Cuisine Ground Round, a product of the Hain Celestial Group, said each serving contained 80 per cent of the daily value of vitamin A, but CFIA testing showed 3 per cent. And a pre-packaged tortelloni and chicken dinner by Olivieri Creations claimed to contain 110 per cent of the daily value of vitamin C per serving, but CFIA found a serving contained only 1.1 per cent.

Sun-Rype, Oasis and Bolthouse Farms were among the juice brands that overstated — by about double — the amount of a vitamin.
Two juices from Dewlands fared worse; each boasted 35 per cent of the daily value of vitamin A, butnone was detected in either.

Omega acids:
Big-brand products that failed to live up to their omega-3 or omega-6 fatty acid claims included President's Choice Angus burgers, Kraft House Italian dressing and Country Harvest tortillas. Hellmann's mayonnaise under-delivered on the amount of polyunsaturated fatty acids, as did Kashi's honey almond flax cereal.

Specialty products that overstated one these so-called "good fats" include Natur-a soy beverages, So Good fortified soy beverage, Ruth's cereal, and Mom's Healthy Secrets cereal.

GoldSeal canned salmon, Ocean's canned salmon, Our Compliments salmon burgers and High Liner salmon were among the fish products that overstated the amount of omega-3 or omega-6 fatty acids.

Some products pitched as reduced in sodium didn't live up to their billing, including Heinz "25 per cent less sodium" Dora the Explorer vegetable and pasta soup, Eden Organic "low salt" canned green lentils, rice and beans, R.W. Knudsen Family "low sodium" vegetable cocktail, "50 per cent less sodium" President Choice crackers, and "low sodium" President's Choice tomato and roasted red pepper soup.

There were also "unsatisfactory" discrepancies in three different Bread Works Bakery "low in sodium" cracker products, with one containing 277.8 mg of sodium, not 70 mg, according to CFIA tests.

Two different cans of Unico artichokes, picked up four months apart, were found to be saltier than claimed on the Nutrition Facts Table.

"Light tasting" Nutriwhip testing showed 68 calories per portion, not 20 as claimed on the label. A green tea beverage from Tempest Tea claimed to contain just 5 calories, but testing showed 106 calories per portion.

If it could happen in Canada, do you think it could happen here?


First Posted as 

Food Labels: Real or Really? April 21, 2012.

Tuesday, September 15, 2015

Jacqueline Du Pré & Elgar: Nervous Goose or Multiple Sclerosis!

“Would you like to come and try the Davydov Stradivarius? If you like it, you can have it.”

It is not everyday that a young musician gets a call like that, and it is not often that some generous person would part with a few million pounds to give a cello to a young artist. As it happened, it was not this young cellist’s first Stradivarius, as she already had another previously given to her anonymously.

That of course was Jacqueline Du Pré. She went and played the Davydov and loved it. It became her instrument.

Anonymous philanthropy.

It is unusual nowadays to attend a concert (including the BBC Proms) with an all familiar programme. The Cockroach Catcher was happy to have been at the Royal Festival Hall on the 5th of June for the London Philharmonic Orchestra concert. This was his wife’s choice, and a relief after Lulu of the previous night.

I have in previous posts maintained that there is something “re-vitalising” listening to familiar music. La Mer and Beethoven 5th did the trick nicely helping the brain to re-generate some memory proteins.

The Elgar Cello Concerto was a totally different proposition.

One of my earlier collections of black vinyl disc is of course the Du Pré / Barbirolli recording of 
The Elgar Cello Concerto.

It was in the old analogue days of recordings and on the whole the engineers just made sure the system was not overburdened by the very loud passages. To this day I still prefer listening to old black vinyls.

It was a record and a piece of playing I treasure. Every time I listen, the music brings new insight into the young talent that was to be knocked down in her prime by Multiple Sclerosis.

In some way, the associated emotional memory has become a hindrance to listening to other performers, as one just feels that there is something not quite the same. The brain does not react in the same way as with other familiar pieces of music in your repertoire.

Just watch the vitality in the final bars of Du Pré’s performance of the Elgar.

Classical Archives

Torleif Thedeen, the cellist in the RFH programme, is not a name I know, but I was prepared to be open-minded. There was something different about his playing. I closed my eyes. Yes, it was a very gentle sort of interpretation and unfortunately at times he seemed overwhelmed by the orchestra.

No, he was no Du Pré, but perhaps I should be thankful as I am now more prepared to go to another Elgar Cello Concerto concert.

Barenboim first met Du Pré in 1964 at Fou Chong’s home, Fou Chong being the famous Chinese pianist and great interpreter of Chopin. Barenboim remembered it was not so much love at first sight as “Glandular Fever” at first sight, both of them being sufferers. Du Pré had it much worse, Barenboim remembered.

In 1971 when Du Pré complained to her doctor that her fingers were numb, she was told it was “stress”. She was on tour giving many concerts.

Then in February of 1973 she flew to New York for four performances of the Brahms Double Concerto with Pinchas Zukerman and Leonard Bernstein. At rehearsal she needed help to open her cello case and could not feel the strings with her fingers. She told Bernstein that she was unable to play.

"Don't be such a goose", he told her. "You're just nervous."

She only managed three of the concerts and was diagnosed as suffering from Multiple Sclerosis. It was not “stress” or “nervousness”. She never gave another cello concert again.

What fate! What a blow to the musical world! Could there be some connection between the Multiple Sclerosis and Glandular Fever? Multiple Sclerosis is something with which Medicine is still struggling. Whether a cure can be found, only time will tell. In the mean time Elgar’s Cello Concerto will always bring up images of the young and vibrant Du Pré: struck down in her prime. At least I still have the black vinyl record of old.

New advances in medicine and technology are always welcome. However, new is not always better. Think Stradivarius. Think Davydov. And Elgar.

Concert review: musicOHM Review

Cello Post:
Anorexia Nervosa: Bach

Multiple Sclerosis, Iguanas and ...

Observational studies suggest that adequate vitamin D nutrition may reduce the risk of MS and affect the course of the disease. Inherent limitations in these studies, however, preclude a causal interpretation. Randomized controlled clinical trials are the next step to addressing whether vitamin D prevents MS or can favorably affect the course and progression of MS. Here we briefly review the current literature on vitamin D and MS, both as a risk factor and potential treatment for MS with a focus on the issues and challenges in designing prevention and treatment clinical trials.

Proms & Yo Yo Ma: Bach Cello Suites & Anorexia Nervosa!


Jobbing Doctor said...
I never saw du Pre play in person, but she was a wonderful musician and an evanescent talent. The record you have of course has Janet Baker singing "Sea Pictures" by Elgar. Sea Pictures is not in the same musical league as the Concerto, and some of the poetry is doggerel, but Janet Baker is awesome, and I did see her once singing the Angel in Gerontius. That was an amazing experience.

Music can transport you to a special place, and the Elgar Concerto is for me (as an amateur 'cellist) the pinnacle, outshining any other concerto (including the Dvorak and the Walton)

Your post brought back happy memories,
Cockroach Catcher said...
Thanks JD

It is sad that there is not enough teaching of music in schools and we only have a limited supply of musicians from the old Eastern Bloc. Just check out the names of the musicians!!!

We will have to cling on to the old records.

Saturday, September 12, 2015

Proms & Yo Yo Ma: Bach Cello Suites & Anorexia Nervosa!

But that is what happened in this sold-out Prom, given by cellist Yo-Yo Ma in front of an audience who sat or stood in near total silence for close to three hours, with only a brief break in the middle.
Despite the size of the venue, Ma’s interpretation never sacrificed intimacy to the grander effect; instead, it drew the listener towards the sound itself. His varied tone – now grainy, now finely textured – sought out an individuality of character in each of the 36 movements while weaving each suite into an expressive whole.
During a magisterial survey of these complex, subtle compositions, Ma’s attention to detail was as notable as his grasp of the bigger picture. The playing was at times tender and introverted, at others bold and sonorous. Throughout, Ma held the measure of Bach’s organic, largely abstracted dance movements and unfolded them before the audience in a way that was intellectually satisfying and heartfelt.

 On BBC iPlayer until 5 October 2015

The Chinese-American cellist has lived with these pieces all his life, and already more than 30 years have past since his first, Grammy-winning recording of the suites. Like Pablo Casals, who first brought them to the world's consciousness through recording them 80 years ago, Yo-Yo Ma has played his part in popularising them, and few cellists today have the humanity and humility to inhabit this music with such expressive freedom.

Anorexia Nervosa & South Africa: Cello & Bach!!! -

Cape Floristic Region (CFR) of South Africa
 ©Am Ang Zhang 2005

The Cape Floristic Region of South Africa and South Western Australia are two of five areas on Earth with a Mediterranean-style climate which have been designated ‘biodiversity hotspots’ by Conservation International. The others are central ChileCalifornia, and the Mediterranean basin.

In The Cockroach Catcher I got my Anorectic patient to play the cello that was banned by the “weight gain contract”:

                 Jane got on well with me.

          She had to, as nobody understood that to her achieving was not a hardship but something she secretly enjoyed. She was no longer allowed to pick up her books as she had not put on any weight since her admission.
          Cello would be banned too, if her nurse was to have her way.

          For the unit to function the nurse must have her way. After all I was not there all the time to watch her. To watch if she was eating, vomiting, exercising or whatever else they did to avoid gaining weight.
          But I was determined that it would be the first privilege she would get if she put on half a gram.  Or any excuse I could think of.
          Brutal confrontation is often what happened in many adolescent units dealing with Anorexia Nervosa. The brutality is not physical.
          But these patients are intelligent and have such strong will power that confrontation generally fails and the failure can be a miserable one.  Yet it is the kind of condition that hurts. It hurts those trying to help. It hurts because these patients deserve better for themselves. It hurts because they are not drop-outs of society. 
          Was it too hard for Jane to keep at the top academically? Someone offered that as an explanation. Perhaps she should be moved to a state school.
          The idea horrified me.
          A fourteen year old non-smoking, non-drinking, non-drug taking, intelligent Audrey Hepburn look alike virgin turning up at your local comprehensive.  It sounded like a major disaster to me.
          I had to take the matter into my own hands. She did put on some weight and at the earliest opportunity I decided she should get back to the cello which had always been by her bed at the unit.

          She missed the cello, the only thing she could use to shut out her worries.

          Fourteen and carrying the burden of the world.

          Then she started playing.

          “Ah. The Bach G-major!”

          “So you know it.”

           Of course I do. The hours I spent listening to Yo Yo Ma and it was such amazing music, melancholic and uplifting at the same time.

          For a moment I forgot that I was her psychiatrist and she forgot she was my patient.

          “My grandma gave me Casals.”

          I knew Casals was even more emotional than Ma, but Ma is Chinese and he was less affecting, allowing the listener to tune in to his own mood.

She played from memory. What talent! What went wrong?”

          “I wish my dad could hear me.”

          It was the first time she could talk about her father. They had a very comfortable life in South Africa when father was alive. It was very difficult to imagine what he would have looked like. It was never clear what he did but he was involved in a number of ventures. The plantation Jane’s grandfather ran was sold when apartheid came to an end. He was involved in some private reserve and he was a photographer of sorts but my junior told me that mum started to cry when she talked about him so she did not pursue too deeply.

Read more:

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

A Brief History of Time: Anorexia Nervosa

Bach - Cello Suites:  Yo Yo Ma