Only fruitcakes believe in GOD?

Rapid Response British Medical Journal 11 May 2001: Only fruitcakes believe in GOD?
Re:Re: Luc Montagnier … and Andrew Wakefield: living parallel lives
Felix ID Konotey-Ahulu, Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana
Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley St London W1G 9PF

Only fruitcakes believe in GOD? http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260425

Dr Mark Struthers (9 May) has a huge, huge problem. He said this: “I understand there are medical scientists – admittedly at the fruitcake end of the spectrum – who believe in God despite there being not a shred of scientific evidence, medical or otherwise of His existence” [1] Can Dr Struthers provide us with “a shred of evidence” that his brain is sharper than Blaise Pascal’s ever was?
THE GREATEST ACHIEVEMENT OF REASON
Pascal said “There are two excesses: to exclude reason, to admit nothing but reason. The supreme achievement of reason is to realize that there is a limit to reason. Reason’s last step is the recognition that there are an infinite number of things which are beyond it. It is merely feeble if it does not go as far as to realize that” [2]. And Blaise Pascal believed in God. He was no fruitcake.
DAVID MARTYN LLOYD-JONES
Or take Dr David Martyn Lloyd-Jones MB BS(Honours) MD MRCP who died the year Mark Struthers qualified from the University of Sheffield. Lloyd- Jones whom I knew personally, had a great brain, certainly not a fruitcake. His MD Thesis was on Sub-acute Bacterial Endocarditis after qualifying with Honours and Distinction from St Bartholomew’s Teaching Hospital. Lord Horder, Physician of King George and the Royal Household, and Consultant Physician at Bart’s picked Lloyd-Jones to be his Assistant, and they attended Royalty together. Dr Lloyd-Jones believed in God, and has more than 30 books in print – all of them on God. He was an amazing logician, orator, debater, with an unusual, analytical mind. He was no fruitcake.
KING DAVID
But I rather also admire that remarkably brilliant Hebrew King who reigned in Jerusalem. King David was brilliant, having clearly inherited what I have come to call “solomonic genius” from his father, the legendary King Solomon whose wisdom was proverbial, attracting people from the far corners of the earth to see and sample. King David has left us a treasure trove of wisdom in his Psalms, one of which (Psalm 119) contains 176 (one hundred and seventy six) verses. But the reason I name King David among those I am convinced are not fruitcakes, and yet believe in God, is this: King David is an amazing diagnostician. I sincerely advise Dr Mark Struthers to visit his local library and ask them to show him King David’s Psalms. The diagnosis the King makes in Chapter 14 verse 1 is spot on! (Even better than comparable diagnoses Sir Stanford Cade FRCS, Sir Richard Bayliss FRCP, Sir Arthur Bell FRCOG, and Sir Clement Price-Thomas FRCS, taught me to make when I was a medical student at Westminster Hospital School of Medicine in Horseferry Road, London SW1). Now, if after reading Psalm 14 verse 1, Dr Struthers wants a second opinion from King David, I suggest Psalm 53 verse 1.
SCIENTIFIC EVIDENCE
Dr Mark Struthers mentions “scientific evidence” [1] as if it was the pinnacle of all truth. My favourite Nobel Prize Winner in Medicine/Physiology is Professor Sir Peter Medawar. His book, “The Limits of Science” [3] is one that I suggest should be compulsory reading for those like Dr Mark Struthers approaching retirement from active Medical Practice and who think they “know it all” [4]
PRESIDENT BARACK OBAMA
By the way, does Dr Mark Struthers think President Barack Obama is a fruitcake? Cerebrally the man is head and shoulders above most people, quite apart from being a Nobel Laureate. And he believes in God.
Felix ID Konotey-Ahulu MD FRCP DTMH Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF
Conflict of interest: Nothing to declare
1. Struthers Mark. Re: Luc Montagnier … and Andrew Wakefield: living parallel lives BMJ Rapid Response 9 May 2011 http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260294
2. Pascal B. Pensees (1657). London: Penguin Books, 1966 (Translated by A Krailsheimer)
3. Medawar P. The Limits of Science. Oxford: Oxford University Press, 1985.
4. Konotey-Ahulu FID. The supra-scientific in clinical medicine: a challenge for Professor Know-All. BMJ 2001; 323: 1452-1453 22-29 December. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121901
Competing interests: None declared [See next article with Correction]
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Published 11 May 2011

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Facebook and Twitter in bid to create African Scientific Revolution “mizraimically”.

Observations: Medicine and the Media: The other Twitter revolution: how social media are helping to monitor the NHS reforms
• Martin McKee,
• Katie Cole,
• Louise Hurst,
• Robert W Aldridge,
• Richard Horton
BMJ 342:doi:10.1136/bmj.d948 (Published 16 February 2011)

Facebook and Twitter in bid to create African Scientific Revolution “mizraimically”.
o Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast Ghana Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley Street

The Twitter Revolution that Professor Martin McKee and colleagues (February 12) showed was “helping to monitor NHS reforms” [1] is but one example of the enormous potential of social networking. Since the Obama phenomenon which made use of this to spread critical information to a huge number of people in no time at all, social networking has been used to achieve the hitherto unachievable. In short, social networking has precipitated revolutions the latest of which is the Egyptian Friday 11th February 2011 Cairo’s Tahrir Square Revolution which achieved the hitherto unachievable through the organizational grass roots use of Facebook and Twitter.
AFRICAN SCIENTIFIC REVOLUTION ACHIEVABLE “MIZRAIMICALLY”.
The title of The 5th TWAS-ROSSA Young Scientists Conference (26th – 27th February 2011) which took place at the Hilton Hotel, Nairobi last week [2] was “Exchanging Knowledge on Climate Change Impacts and Vulnerability in Africa: The Role of Networking”. Summing up that remarkable Conference which covered subjects from climate change effects on agriculture, flood risk management, institutional networks for exchange of knowledge, cryobiology, local community knowledge of and adaptation to climate change, etc Dr Eng Shem Arungu-Olende, Executive Director of the African Academy of Sciences hit the nail on the head when he said “Promoting net working does not have to be formal … very exciting research can be communicated from individual to individual, from individual to institutions, and from institution to institution”. The exciting process, said Arungu-Olende, “can generate knowledge and disseminate that knowledge for quite awhile” [2]. This was also emphasized by Professor Mohamed H A Hassan, Executive Director Emeritus of the Trieste based TWAS (Academy of the Developing World) and President of the African Academy of Sciences. Networking that produces an unexpected and impressive result where despair existed before, is what I now describe as a revolution achieved “mizraimically”. Mizraim is what my Krobo tribes people call Egypt, a name originating from biblical times. [3] No where is such a revolution more urgently needed than in the most pressing health issue on the African Continent at the moment.
TACKLING THE SUB-SAHARAN HIV-AIDS MENACE “MIZRAIMICALLY”
(1) “Nearly 1000 babies are born every day in sub-Saharan Africa” is the British Medical Journal’s headline a mere 3 months ago. [4]
(2) “Children from Zevenfontein (South Africa) where 85 per cent of the community are HIV Positive” [5] – Financial Times, London.
To many outside Africa (and even within Africa) this situation produces reactions such as “Normal, of course”; “Not surprising at all”; “What else do you expect?” ; “If we in the Congo don’t change our sexual habits the Congo could be wiped off the map” [6], and “Africa left to the lions” [7] and so on and so forth. Therefore, I ask, does sex alone account for 1000 HIV Positive babies a day born to 1000 mothers a day who must be HIV Positive, and the implied 1000 a day HIV Positive men linked to these women? But to me, and to many fellow Africans the situation calls for a Revolutionary Approach, and hence our great fortune to have Facebook, Twitter, and LinkedIn to help begin this process “mizraimically”! I said as much during my Award Lecture last Saturday (26 February) in Nairobi. When TWAS-ROSSA (Academy of Sciences for the Developing World’s Regional Office for South Saharan Africa) announced last August in Hyderabad, India, that I had been awarded the “2010 TWAS REGIONAL PRIZE ON PUBLIC UNDERSTANDING AND POPULARIZATION OF SCIENCE” [8] I was told that when collecting the Award in Nairobi in February 2011 I would be expected to give a Lecture. Well, I thanked God and took courage, and gratefully announced that I would give the following Double Lecture, one after the other immediately on receipt of the Award:
Public Understanding and Popularization of Science as illustrated by (i) The most prevalent hereditary affliction in sub-Saharan Africa – Sickle Cell Disease and Other Haemoglobinopathies (ii) The most serious acquired affliction in sub-Saharan Africa – HIV/AIDS
Which was what I did last week when I used the first lecture to introduce my recent invention of the ‘kanad’ as a novel tool for genetic counselling and voluntary family size limitation (GCVFSL) in Sickle Cell Disease and Other Haemoglobinopathies [9]. The second lecture concentrated on Africa’s AIDS Catastrophe, and how Facebook, Twitter, LinkedIn could begin to spread the word round, alarm our kith and kin in the Diaspora, and begin a revolution.
SUMMARY OF AIDS LECTURE AT TWAS-ROSSA CONFERENCE NAIROBI
1. One thousand HIV Positive babies born every day in sub-Saharan Africa.
2. 85% of the Zevenfonteirn Community in South Africa are HIV- Positive
3. And this in spite of Global Funds into Africa?
4. In spite of our Ministries of Health and Colleges of Physicians and Surgeons working flat out?
5. Despite WHO’s thundering the “Wear Condoms” and “Stick to one woman” advice?
6. Have top to bottom (ie Globalisation) Health Schemes failed?
7. Was it not time to start a bottom-up (ie from grass roots up) health management approach using our Traditional Chiefs?
8. What happened to Professor Kihumbu Thairu’s grass roots upwards approach emanating from the impressive Symposium organised jointly by The Commonwealth Secretariat and the Kenya Medical Research Institute (KEMRI)? [10] Was Thairu’s approach tried and found wanting?
9. Meaningful Research: Is it not time for every one of us, especially the Young Scientists gathered here, to use Epidemiology
(a) to find out what is happening on our dear Continent to give rise to 1000 HIV Positive babies every single day and to determine how it is possible for 85% of the Zevenfontein Community in South Africa to be HIV Positive when Professor Metz had written to me from Pretoria less than 25 years ago that AIDS (or VIGS as he called it in Afrikaans) among the Blacks was virtually nil? [11] And
(b) To communicate such findings expeditiously by Facebook, Twitter, LinkedIn not only to our African Parliamentarians and Tribal Chiefs but to Africans abroad?
I defined ‘Epidemiology’ in the Nairobi Lecture exactly as I had done in the British Medical Journal after fact finding tours of Africa. Epidemiology, to me, is finding answers to the six questions What? When? Where? Which? How? Why? I told the Young African Scientists that armed with little more than a note book and pen, finding answers to these questions at the grass roots level will provide more information about our plight [12] than dissecting genes of baboons and humans in the laboratory. (I was referring to the misinformation/disinformation that two eminent Harvard University Professors came out with when they concentrated rather on splitting genes in the lab, namely that Senegalese prostitutes harboured antibodies to monkey virus in their blood [13], when in fact there was no truth whatever in their publication! It took another respectable Harvard Professor Carol Mulder to write an editorial to redeem the reputation of that great Institution: “A case of mistaken non- identity” [14]). Though Kenyan scientists have been known to be able sequence the genome of organisms very rapidly, our efforts should be directed rather towards using Epidemiology as I have defined above to arrive at truth very quickly.
10. The African Academy of Science [15] is without doubt a force to reckon with (being robustly supported by the Trieste based Academy of Sciences for the Developing World, TWAS [16], and it benefits from the Network of African Scientific Organisations (NASO). The Academy stands ready to use its “Quarterly Journal of Discovery and Innovation” to disseminate new information. It is ready to resume on-line publishing soon, so I urge that in keeping with the title of the Quarterly Journal the young scientists should aim at going on line immediately and, as I concluded my lecture, “aiming to publish new Ideas, new Findings, new Treatments, new Discoveries, and new Approaches which will command the attention of the rest of the world”.
MONITOR HEALTH PROGRAMMES AND DISSEMIATE INFORMATION
Professor Martin McKee and team [1] are using Twitter and other social media “to monitor NHS reforms”. We in Africa should similarly monitor everything from vaccinations, recommended drugs, official declarations from above, not to mention “Global Programmes”. I have queried why the Maasai in Kinyawa, Kenya, the Luhya in Wabuye, Kenya, and the Yoruba in Nigeria have been genome sequenced anonymously in the Global Sequencing Programme, and yet the international gene sequencers claim they got “informed consent” to do the work [17-20]. African scientists need to find out what exactly is happening. Have some African genes been patented anonymously yet “with informed consent” as the researchers claimed?
All foreign scientists do not have the same ethical calibre. [21] Some feel Africa’s pain; others do not, and we need to distinguish between the two, and work with those who identify with us. I once pointed out after Didier Fassin and Helen Schneider’s amazing article in the British Medical Journal on AIDS in South Africa [22] that scientists with Nazi proclivities did not disappear when Hitler did. [23]. Professor George Fraser and Dr Berno Muller-Hill said as much [24]. Matters that had been dismissed as Conspiracy Theories have now been proven to be Conspiracy Facts leading to open apologies by two living American Presidents, Bill Clinton and Barack Obama [25, 26, 27]. It is a most heartening fact that an increasing number of African Tribal Chiefs are computer literate and will be happy to be kept in the social networking loop. Their subjects prefer to listen to them to being fed top to bottom pronouncements – see how Ghanaian Health Officials were forced to come out to answer questions about serious side effects of Artesunate-Amodiaquine Combination Therapy [28]. Ghanaian market women and roadside vendors are all social networking, while Kenyans are doing their banking business through mobile phones, bypassing the conventional High Street Banks. Scientists in Africa need also to make use of these social networking media to create a health revolution on the Continent.
Felix Konotey-Ahulu MD(Lond) FRCP DTMH FGA FTWAS FWACP FGCP Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF.
1 McKee Martin, Cole Katie, Hurst Louise, Aldridge Robert W, Horton Richard. The Other Twitter revolution: how social media are helping to monitor NHS reforms. BMJ 2011; 342: d948 doi: 10.1136/bmj.d948 18 February 2011. http://www.bmj.com/content/342/bmj.d948.full
2 TWAS-African Academy of Sciences The Fifth Scientists’ Conference on “Exchanging Knowledge on Climate Change Impacts and Vulnerability in Africa: The Role of Networking” 26th – 27th February 2011 – Preceded by the NASAC-KNAW Conference on Impact of and Adaptation to Climate Change in Relation to Food Security in Africa 23rd – 25th February 2011. Hilton Hotel Nairobi, Kenya.
3 The Holy Bible. “And the sons of Ham: Cush, and Mizraim (Egypt), and Phut, and Caanan.” Genesis Chapter 10 verse 6. The King James Authourized Version, 1908 Edition – 60th Printing. B B Kirkbride Bible Co, Inc. Indianapolis, Indian, USA 1964.
4 Zarocostas John. Nearly 1000 babies a day in sub-Saharan Africa are infected with HIV. BMJ 2010; 341: c6937 doi: 10.1136/bmj.c6937. Dec. 1 http://www.bmj.com/content/341/bmj.c6937.full
5 Financial Times, London. AIDS in South Africa. Zevenfontein where 85% of the Community are HIV Positive. Friday 20th September 2002, page 14.
6 Finch Scott. The Ravage of AIDS in Africa. BBC World Service: Science In Action, Sunday 18 October 1987, GMT 09.15 to 09.45.
7 Veitch Andrew. How to avoid catching AIDS. The Guardian, London, November 21 1986, page 21.
8 TWAS (Academy of Sciences for the Developing World) Regional Office for sub-Sahran Africa – Announcement in Hyderabad 20 October 2010 http://twas.ictp.it/news-in-home-page/news/twas-regional-prizes-for-public -understanding-and-popularization-of-science
9 The ‘kanad’ in www.sicklecell.md/bio or www.konotey-ahulu.com/bio 2010. The kanad in genetic counselling and voluntary family size limitation (GCVFSL) in sickle cell disease and other haemoglobinppathies.
10 Thairu Kihumbu. Editor Symposium/Workshop Appropriate Technologies for AIDS Management in Africa 3-7 September 1990, Kenya Medical Research Institute, Nairobi with Commonwealth Secretariat SW1 London.
11 Konotey-Ahulu, FID. What is AIDS? Tetteh-A’Domeno Company, Watford, England, 1989, 227 pages ISBN: 0 9515442 0 9
12 Konotey-Ahulu FID. Clinical epidemiology, not seroepidemiology, is the answer to Africa’s AIDS problem. BMJ (Clin Res Ed) 1987; 294(6587): 1593-1594. http://www.bmj.com/cgi/reprint/294/6587/1593.pdf [PubMed – indexed- for MEDLINE (June 20 1987) doi:10.1136/bmj.294.6587.1593]
13 Essex Max, Kanki Phyllis. Comparison of simian immunodeficiency virus isolates. Nature 1988; 331: 621-22
14 Mulder Carol. A case of mistaken non-identity. Nature 1988; 331: 562-63.
15 African Academy of Sciences. http://www.aasciences.org P O Box 24916, Nairobi, Kenya. [Retriring President Emeritus is Professor Mohamed H A Hassan; Incoming President is Professor Ahmahdou Lamine Ndiaye]
16 TWAS. The Academy of Sciences for the Developing World is an autonomous international organization based in Trieste, Italy, that promotes scientific excellence for sustainable development in the South. http://www.twas.org [Retiring Executive Director Emeritus is Professor Mohamed H A Hassan to be succeeded on 28 February 2011 by Professor Romaine Murenzi]
17 Announcement: http://www.1000genomes.org/files/1000Genomes- NewsRelease.pdf International Consortium Announces the 1000 Genomes Project. Major Sequencing Effort Will Produce Most Detailed Map of Human Genetic Variation to Support Disease Studies. (Tuesday January 22 2008).
18 Wise Jaqui. Consortium hopes to sequence genome of 1000 volunteers. British Medical Journal 2008; 336; 237 doi: 10.1136/bmj.39472.676481.DB http://www.bmj.com/content/336/7638/237.1/full January 31 2008
19 Konotey-Ahulu FID. The Human Genome Diversity Project: Cogitations of An African Native. Politics and the Life Sciences (PLS) 1999, Vol 18: No 2, pp 317-322. [Invited Commentary on Professor David Resnik’s article: The Human Genome Diversity Project: Ethical Problems and Solutions.] PMID: 12561789 [PubMed – indexed for MEDLINE]
20 Global Genome Sequencing: Some Ethical Considerations. In Howard University National Human Genome Center Post-Inaugural Symposium on “1000 Genomes Project: On the Frontier of Personalized Medicine” at Ralph J Bunch International Affairs Center, Howard University, 2218 Sixth Street, NW Washington, District of Columbia, USA January 23, 2009. http://www.howard.edu/calendar/main.php?calendarid=medicine&view=event&eventid=1232140247442&timebegin=2009 -01-23
21 Konotey-Ahulu FID. Clinical Genetics: Ghanaian gratitude for British and Hungarian contributors – A personalised historical perspective Ghana Med J 2009; 43: 175-178. [Special Article December No. 4] http://www.ghanamedj.org/articles/December2009/Fina%20Special%Article%20Clinical%20Genetics.pdf
22 Fassin Didier, Schneider Helen. The politics of AIDS in South Africa: beyond the controversies. BMJ 2003; 326: 495-97 (1 March) http://www.bmj.com/content/326/7387/495.full doi;10.1136/bmj.326.7387.495
23 Konotey-Ahulu FID. Wake up call and need for paradigm shift. Brit Med Journal 2003 ‘Rapid Response’ to Didier Fassin and Helen Schneider’s article opened up for Education and Debate: – The politics of AIDS in South Africa: beyond the controversies. Brit Med J 2003; 326; 495- 497 (1 March 2003). http://bmj.bmjjournals.com/cgi/content/full/326/7387/495 or/& http://www.rethinking.org/bmj/response_30917.html
24 Muller-Hill Berno. Murderous Science: Elimination by Scientific Selection of Jews, Gypsies, and Other – Germany 1933- 1945 [Translated from German by George R Fraser] Oxford University Press, Oxford 1988.
25 Clinton President WJ. Apology on behalf of the American government to survivors of the Tuskegee Syphylis Experiment victims. Worldwide radio & Television. May 16 1997. Also Ken Getz; Tuskegee, a Cloud Over Research. The Washington Post. Tuesday, Sept 30, 2008. President Clinton publicly apologized to the eight surviving participants of the shocking and unethical study, saying “What the United States Government did was shameful”.
26 Tanne Janice Hopkins. President Obama apologizes to Guatemala over 1940’s syphilis study. BMJ 2010; 341.c5494 doi:10.1136/bmj.c5494 http://www.bmj.com/content/341/bmj.c5494.full October 9, page 750.
27 Konotey-Ahulu FID. President Obama apologises over Guatemala syphilis study: International cooperative research in jeopardy. http://www.bmj.com/content/341/bmj.c5494.full/reply#bmj_el_243183 BMJ Rapid Response Oct 17 2010
28 Amofah G. Furore over Artesunate-Amodiaquine Combiantion (ACT) Drug. Daily Graphic, Accra. Monday May 5, 2006, page 23.
Conflict of Interest: None declared felix@konotey-ahulu.com
Competing interests: None declared

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BMJ Rapid Response 6 February 2011 Evangelical Christian on Drugs Advisory Body

 Rapid ResponsesNews: New appointment to drug advisory body sparks controversy

  • Clare Dyer

BMJ 2011;342:doi:10.1136/bmj.d624 (Published 31 January 2011)

  1. http://www.bmj.com/content/342/bmj.d624/reply#bmj_el_249481

“New appointment of evangelical Christian to drug advisory body    sparks controversy” Please spare us emotive headlines!

  • Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana

Consultant Physician Genetic Counsellor in Sickle & Other Haemoglobinopathies 10 Harley St London W1

“New appointment of evangelical Christian to drug advisory body sparks controversy” Please spare us emotive headlines!

The term “sparks controversy” [1] in Clare Dyer’s headline (5 February, page 300) made me think (perhaps naively) that the article would describe something like a miniature Cairo’s Tahrir Liberation Square problem that demanded some extraordinary intervention to prevent catastrophe. Nothing of the sort, as it turned out.

ONE MAN PLUS ONE OTHER PERSON

It was just one man, Evan Harris, plus an “unnamed member of the council” who were not at all happy about Theresa May, the Home Secretary, approving the appointment of an “evangelical Christian” to the “UK Advisory Council Drug’s Council on the Misuse of Drugs” [1]. Perhaps I read too much into the headline, but I fail to see how the appointment of one, yes I mean one, “evangelical Christian”, to the Drugs Advisory Council with its 9 new members must be required to meet with the approval of Mr Harris. Cannot the other 8 new members over rule the “evangelical Christian” whenever they think the latter is talking (tafracher) nonsense? [2]

THE MERIT QUALIFICATION AND EVIDENCE-BASED VIEWS

Clare Dyer states that these appointments “were made under a code of practice that requires all appointments to be made on merit” [1].Can it be shown that Dr Hans-Christian Raabe is devoid of the merit that membership of such an important Drugs Council will benefit from? The Council “prides itself on basing all views on evidence” [1] Would Evan Harris cooperate with me in designing an epidemiological research project among teenagers in the UK and elsewhere to see what proportion of drug abusers were evangelical Christians, and what proportion were not, compared with the rest of the teenage population? Would the findings, significant to a ‘p’ value of 0.0001, prove anything to him and his like-minded colleagues? If a known chain smoker, as I once was, had been appointed to the Council by Theresa May would Harris have displayed similar misgivings?

PROFESSOR DAVID NUTT’s SACKING AND THE RESIGNATIONS

The British Medical Journal [3] conducted some research among its readers asking who agreed or disagreed with the sacking of Professor David Nutt by Mr Alan Johnson. As of 5th November 2009 443 respondents castigated Mr Alan Johnson for dismissing his Chief Scientific Advisor, while 83 (15.8%) agreed with his decision to sack him. Did Evan Harris think all these 83 were “evangelical Christians”? In my response to the discussion on that occasion I described two Fellows of the Royal Society (both of them alive today) who wrote best sellers on Human Genetics [4]. They both used the description in the BMJ of a genetic defect of mine in their text books, but while Professor Sir David Weatherall FRS emphasized the ethical point I was making about my Mendellian Dominant defect [5], the other Fellow of the Royal Society did not even mention the word Ethics once in his 347-page book, nor did he acknowledge the BMJ (and myself) as the source of his information, which proves that some brilliant scientists forget that Science is not the only criterion required in dealing with human situations. The Drugs Council may be packed with brilliant evidence-based scientists some of whom may be Fellows of the Royal Society, but I would not quarrel with Theresa May for including at least one new person who is an evangelical Christian. If some members want to resign because of this, let them. I trained in the UK, and I happen to know that Great Britain is not short of geniuses who can happily step into the shoes of “the departed”. Theresa May probably thinks there is an ethical dimension required in the advice given regarding addictive drugs and teenagers. In my opinion Theresa May deserves commendation, not condemnation.

Conflict of interest: I am a staunch believer in The LORD JESUS CHRIST.

Felix I D Konotey-Ahulu MD(Lond) FRCP DTMH
Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle & Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF

felix@konotey-ahulu.com

1 Dyer Clare. New appointment of evangelical Christian to drug advisory body sparks controversy. BMJ 2011; 342: d624 (5 February, page 300)

2 Konotey-Ahulu FID. Tafracher – Personal View. The invaluable Ghanaian word for devulgarizing succeeding words or phrases. BMJ 1975; 1(5953): 329. (February 8) doi:10.1136/bmj.1.5953.329 http://www.bmj.com/cgi/reprint/1/5953/329.pdf & http://www.ucc.edu.gh/node/258

3 Dyer Clare. Scientists want more protection after government adviser is sacked. BMJ 2009; 339.doi: 10.1136/bmj.b4563 (November 4)

4 Konotey-Ahulu FID. Does rejecting a particular scientific opinion mean a rejection of Science? BMJ Rapid Response 10 November 2009. http://www.bmj.com/cgi/eletters/339/nov04_1/b4563#224533

5 Weatherall DJ. Ethical issues and related problems arising from the application of the new genetics to clinical practice. Chapter 12 in D J Weatherall. The New Genetics and Clinical Medicine in Practice. Third Edition. Oxford, Oxford University Press 1991, pages 346-368.

Competing interests: None declared

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Published 6 February 2011

  1. http://www.bmj.com/content/342/bmj.d624/reply#bmj_el_249435

Controversy or just plain prejudice?

  • Trevor G Stammers, Programme Director in Medical Ethics

St Mary’s University College, London

As director of a centre for evidence based policy, Evan Harris should be well aware of the evidence that men who have sex with men do indeed have a higher incidence of drug misuse (1)(2)(3). Indeed if they do not, then surely Harris’ criticism of Dr Raabe’s alleged comments on homosexuality is entirely irrelevant to Raabe’s position on the Misuse of Drugs Advisory Council?

As for Mark Easton’s reported comments from an unnamed member of the Council threatening to resign over Dr Raabe’s appointment, these say so much about that member’s cowardice and lack of transparency that it may be best if they do resign. At least Dr Raabe has the courage to express his views openly.

1. Stall R, Wiley J. A comparison of alcohol and drug use patterns of homosexual and heterosexual men: the San Francisco men’s health study . Drug Alcohol Dependency. 1988;22:63-73.

2. Stall R, Paul JP, Greenwood G, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men’s Health Study. Addiction. 2001;96:1589-1601.

3. McCabe S et al Sexual identity and substance misuse among undergraduate students Substance Abuse 2003 24 77-91

Competing interests: I am also a Christian and former GP

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Published 6 February 2011

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Music (and Tonal Language) and the art of being human – III

Music (and Tonal Language) and the art of being human – III – Published 6 January 2011
o Felix ID Konotey-Ahulu, Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast Ghana

Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley St Lond
Dr John Matthews (Dec 11, p 1274) has shown that, contrary to popular perception, a doctor can have interests far beyond the consulting room. His most excellent review [1] of Philip Ball’s book covering music and the brain [2] deserves a 3-part response: Part I dealt with Music, the brain, and language. Part II tackled Origins and what it means to be human. Part III now suggests some meaningful research approaches.

MEANINGFUL RESEARCH APPROACHES
If Science is not equipped to determine how language originated, or how music inspires and gives balm to troubled minds, does that mean there cannot be meaningful research here? Not at all! What this means is that I should not spend my time investigating “how language evolved”, but rather relating what we already know in Music and Language, especially Tonal Linguistics, to what Dr Matthews indicates could be various brain responses through “functional magnetic resource imaging and positron emission tomography” [1], not to mention novel tools for probing the science of Glossogenetics.
Last year I discussed with Professor George Ebow Bonney and Professor Gloria Dunston of the Howard University National Human Genome Centre in Washington DC, USA, how an interdisciplinary project involving Tonal Linguistics, Music, Neurophysiology, History, Geography, Psychology, Anthropology, Glossogenetics, Genome Sequencing, Informatics, and even Egyptology [18] could be initiated. Professor Ayi Kwei Armah, the brilliant Ghanaian author and expert in Hieroglyphics has discovered that the ancient Egyptian name for parrot is “akoo” which is identical to what we call the bird in no less than 8 tribes in West Africa, from Yoruba land in Nigeria , right across to Ghana (Ewe, Krobo-Dangme-Ga, Twi, Fante) and up to Senegal [19]. We must research to find what other ancient Egyptian words are found in black African tribes. [18] Here is another interesting fact: Just the two letters ‘f’ and ‘a’ of the Ga alphabet can be used (with my sound colouring technique) to express reproducibly no less than 75 words, phrases, and sentences in the language, capable of being read by anyone who can sing Tonic Solfa [20]. The phenomenon of mid pitch arrest in Krobo-Dangme [3 4 6 18 20] and of lower mid pitch arrest in Ga [21] is not found in English, but I have discerned the former in Yoruba and in Kikuyu [20]. Research will reveal which other African tribes, or indeed ethnic groups world-wide display this phenomenon. How are they related genetically?
Is the Japanese genome related in any way to the Krobo genome because Nihongono phonates exactly like the Krobo-Dangme “e ji lolo” which means “she/he has not yet left”? When both are hummed, or sung, there is no acoustic difference whatever, and the Tonic Solfa of both is identical, s (low pitch) s (octave high) m m showing no difference between the Japanese and Krobo/Dangme intonations. [3 20]. Please try singing s (low) s (high) m (mid pitch) m (mid pitch) and you would have hummed Japanese and my native Krobo language. Any BMJ reader should be able to do this. It is that easy. These research projects in Linguistics/Tonal Linguistics could be as fruitful in shedding light on brain function, as those that Dr Matthews would like done in Music. If I phonated in my head (ie inaudibly) an arrested Krobo vowel in mid pitch (m) and then dropped 2 semitones to a Ga lower mid pitch vowel (r) would I be able to capture the vowels on a brain scan? Would it be possible to devise a “lie test” for interrogating a suspect who refused to answer questions, using a scan to detect silent tonal language sounds in the head? I can hum Tonic Solfa in my head, and arrest pitches at certain levels as I wish. In Krobo-Dangme the word ‘bo’ pronounced in mid pitch means cloth, but pronounced with low pitch means “to rub”. Will it be possible to record these pitches accurately even without phonating them aloud?
If, with Julie Andrews in “Sound of Music” [22], you can begin to sing “doe, a deer, a female deer…” you will, with the first note, have struck the invaluable 3rd mid pitch in Krobo/Dangme-Ga which, substituting a ‘y’ for Julie’s ‘d’, phonates exactly like the affirmative word “yes” in the language [20]. My colour for this 3rd mid pitch (d) which is also 2 semitones below lower mid pitch (r) is brilliant green [20]. When this particular pitch is arrested to sing Julie Andrews’ ‘doe’ (but with a ‘y’) the resulting word ‘yoe’ means ‘yes’ [20]. Which other tribes have a fixed, reproducible-in-tonic-solfa pitch for “yes”? Would the tribes be related genetically? The avenues for profitable research are protean [23]. Braille can be developed to discern pitch colour for the blind, and the coloured vowels for pitch are ideal for the deaf and tone-deaf. It can be truly said that my entire tribe has perfect pitch in more senses than one: anyone can go straight to a particular pitch in Tonic Solfa without reference to any preceding or succeeding note. Is this the reason why Aficans and African Americans are so musical?

CURRENT GENOME SEQUENCING CONSORTIUM AND LANGUAGE RESEARCH
The present on-going Human Genome Sequencing exercise which Professor George Bonney, Professor Gloria Dunston and I discussed last year [18] could be used to probe some of these aspects of language (and music), remembering at least 3 caveats:
(i) Researchers need to be careful not to miss the genomic wood for the DNA trees
(ii) Nature and nurture must be kept in perspective. There is what I call a quadrilateral interpretation of findings: (a) what is observed is due to nature (genes) alone (b) findings are the result of environment (nurture) alone (c) what you observe is due to both nature and nurture interaction (d) nature and nurture have little to do with the facts.
(iii) Avoid the mistake of deciding exactly what genome sequencing is going to reveal before the work is done [24]. To decide ahead that one tribe’s appreciation of music is more “civilised” than another is to make a serious mistake. This is why in African Anthropogenetics, with all the linguistic ramifications, to do genome sequencing anonymously as is happening now is not at all the right way forward. [25 26 27]

WONDER OF THE INTERNET
If you find all this difficult, take heart because youcan read, and see, and hear it all on line – free of charge. Fortunately, because of the internet anybody reading this can verify the truth of what I have been saying. One can read the colours of the sound pitches, and even phonate the Tonic Solfa of all 75 Ga words, phrases, and sentences formed with the letters ‘f’ and ‘a’ by just clicking http://bit.ly/bEdcc4. [20] One can also verify that the non-tonal English word “agriculture” which, though capable of being understood when pronounced entirely in monotones, nevertheless has 4 quantifiable pitches in Queen’s English; one is invited to down load the 42-page information with colour, free of charge. [20] Indeed, the internet allows me to demonstrate (vocally) to any reader of the BMJ what the Tonic Solfa of my Millennium Hymn [28] sounds like, and (visually) to see me in the flesh singing the hymn while the Tonic Solfa flashes on the screen. Readers may even see me piano-playing the Millennium Hymn all 7 verses of which appear on the screen by typing http://bit.ly/cRrZ0s [28]. As each of the verses ends with the word ” Bethlehem ” I take this opportunity to wish BMJ readers A HAPPY CHRISTMAS AND A HEALTHY NEW YEAR!
F I D KONOTEY-AHULU FGA MD(Lond) FRCP(Lond) FGCP DTMH(L’pool) FTWAS FAAS FWACP ORDER OF THE VOLTA GHANA felix@konotey-ahulu.com
18 Konotey-Ahulu FID. Global Genome Sequencing: Some Ethical Considerations. In Howard University National Human Genome Center Post- Inaugural Symposium on “1000 Genomes Project: On the Frontier of Personalized Medicine”. Washington , DC January 23 2009 http://bit.ly/gs65RD .
19 Armah Ayi Kwei. The Eloquence of the Scribes – a memoir on the sources and resources of African literature. PER ANKH 2006. Popenguine. Senegal (page 190)
20 Konotey-Ahulu FID. Tonic Solfa Is The Foundation Of Tonal Linguistics. DRUMSPEAK (Supplement) International Journal of Research in the Humanities. New Series Volume 3. No. 1, May 2010. Faculty of Arts, University of Cape Coast , Ghana . ISSN (0855-9945). [Lecture given on Monday 12 October 2009, University of Cape Coast in the Occasional Lecture Series during the 40th Congregation. [Publications Unit, University of Cape Coast, Ghana] http://www.bit.ly/bEdcc4 (Down load Free).
21 Konotey-Ahulu FID. Discoveries and New Insights into Tonal Linguistics Facilitate Reading of Mother Tongue: Introducing The Ephraim Amu Principle. The 10th Dr Ephraim Amu Memorial Lecture – Ghana Academy of Arts & Sciences at The British Council, Accra , 13th May 2010. [Report by Dr Doris Yaa Dartey: Ghanaian Times Friday 21 May 2010 “New insight into ‘Tonal Linguistics’ at the 10th Ephraim Amu Memorial Lecture in Accra by Dr [Konotey-Ahulu – ‘Colour the sounds to differentiate the pitches’ – Pregnant women need folic acid to prevent babies with cleft palate’ ]. Video is available.
22 Andrews Julie. The Sound of Music. Broadway Musical 1959. Film Musical 1965.
23 Konotey-Ahulu FID. The Human Genome Diversity Project: Cogitations of An African Native. Politics and the Life Sciences (PLS) USA 1999, Vol 18: No 2, pp 317-322. Symposium in PMID: 12561789 PubMed indexed for MEDLINE
24 Verkaik Robert. Revaled: Scientist who sparked racism row has black genes. The Independent, London , December 10, 2007.
25 Announcement: International Consortium Announces the 1000 Genomes Project. Major Sequences Effort Will Produce Most Detailed Map of Human Genetic Variation to Support Disease Studies. (Tuesday January 22, 2008). http://www.1000genomes.org/files/1000Genomes-NewsRelease.pdf
26 Wise Jaqui. Consortium hopes to sequence genome of 1000 volunteers. BMJ 2008; 336: 237, Feb. 2.
27 Konotey-Ahulu FID. There is but one human race. New African, London . Dec. 2009, page 4.
28 Konotey-Ahulu Felix ID. Millennium Hymn: Time Was Created. Words (7 verses) http://bit.ly/cRrZ0s
Competing interests: None declared
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Published 20 December 2010
3.
Music (and Tonal Language) and the art of being human – II
o Felix ID Konotey-Ahulu, Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast Ghana
Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley St Lond
Dr John Matthews (Dec 11, p 1274) has shown that, contrary to popular perception, a doctor can have interests far beyond the consulting room. His most excellent review [1] of Philip Ball’s book covering music and the brain [2] deserves a 3-part response: Part I dealt with Music, the brain, and language. Part II tackles Origins and what it means to be human. Part III suggests meaningful research approaches.

THE ART OF BEING HUMAN
A fundamental part of being human, as John Matthews and Philip Ball emphasize, is to have a brain that is capable of producing music and language. But as the nightingale also sings and the musical chatter of the black bird (Tardus merula) between April and September in the northern hemisphere is capable of being written down in Tonic Solfa as I have done annually in recent years, I can boldly say that producing language, even more than producing music, is the one most characteristic feature of being human. Animals, including birds, can make music, and communicate intelligently, but only human beings have language with all its five levels for communicating information, namely Statistics, Syntax, Semantics, Pragmatics, and Apobetics (thanks to the insight of such experts as Claude Shannon, Noam Chomsky, and Werner Gitt) [9-11]. This is why I have added in brackets “Tonal Language” to the title of Dr Matthews’ article which includes the term “being human”.

THE ORIGIN OF LANGUAGE
Dr Matthews states that “music could hardly be there by chance”. A greater truism is hard to find. He mentions “the perplexing problem of music’s origin” and goes on: “We do not know how or why music started, what the predisposing factors were, or even the form in which the earliest manifestations evolved.” [1] After looking for “a selection advantage” related to “community bonding” Dr Matthews concludes: “We are left surmising”. Well, I turn to 2 famous Nobel Laureates in Physiology/Medicine who, thinking scientifically, tackled the problem of “origins”. First, I turn to Sir Francis Crick (who better?). In a brilliant 13-page scientific exposition to crack “The origin of the genetic code”, Crick was out of his depth, and he admitted as much. [12] Like Dr Matthews, he was “left surmising” [1], so much so that 13 years later the great Francis Crick was constrained to write: “An honest man, armed with all the knowledge available to us now, could only state that in some sense, the origin of life appears at the moment to be almost a miracle. …”. [13]. Wow! Francis Crick has used the word “miracle”?
The other Nobel Prize winner in Medicine/Physiology who discussed origins is my favourite thinker. Writing in his book “The Limits of Science” Professor Sir Peter Medawar makes a comment that goes a long way to shedding light on Dr Matthews’ “perplexing problem of music’s origin”. Professor Medawar states that questions of ultimate origins are “beyond the explanatory competence of science” [14, page xiii], and this: “That there is indeed a limit upon science is made very likely by the existence of questions that science cannot answer and that no conceivable advance of science would empower it to answer” [14, page 68]. So here is one genius, the DNA genius, describing the origin of life (and hence of language, and music) as a “miracle”, while the other Nobel genius says Science need not even bother tackling ultimate origins because Science does not only not have the equipment to probe ultimate origins, but also that it will never have that equipment. In the BMJ I once described as supra-scientific 4 clinical facts in my experience that Science could not explain. [15]. I place the origin of Language and Music in the same supra-scientific category. As I also said in the Journal of the Royal Society of Medicine earlier this year “Origin of the genetic code is supra-scientific” [16], it becomes clear that the origin of music and language must also be supra- scientific.

THE ART OF BEING HUMAN IS ITSELF SUPRA-SCIENTIFIC
There must be aspects of Dr Matthews’ fruitful work with patients and music that do not admit of scientific dissection. It is possible for me to imagine some of his grateful patients with severe arthritis saying “the pain is gone suddenly”, after listening to some moving music, such as the Bulgarian National Choir singing that amazingly magnificent Chorus of the Hebrew Slaves. I would find that just as scientifically inexplicable as the case of the middle aged accountant I once described in the BMJ who suddenly lost his right upper quadrant abdominal pain and the Murphy’s sign of cholelithiasis when he was told “the stone has disappeared”, while in fact the gall stone was later shown by ultrasound to be well and truly still in situ. [15] Music be it enchanting or cacophonous, is indeed the art of being human, which itself is also beyond Science. Furthermore, although “music and the brain” equates to “music and the psychological”, that is not the same as “music and the spiritual” because the spiritual connotes a greater dimension for what it means to be human – a dimension I once showed also in the BMJ [17] to be so different from the psychological that Science has no tools to fathom it.
F I D KONOTEY-AHULU FGA MD(Lond) FRCP(Lond) FGCP DTMH(L’pool) FTWAS FAAS FWACP ORDER OF THE VOLTA GHANA felix@konotey-ahulu.com
9 Shannon Claude E. The Mathematical Theory of Communication. University of Illinois Press 1949 ( Urbana II).
10 Chomsky Noam. Linguistic Contributions to the Study of Mind (Future). Harcourt Brace Jovanovich 1968 http://bit.ly/egkZi1 “By pursuing the kind of research that now seems feasible we can acquire the highly specific way of interpreting phenomena that are in large measure beyond our consciousness and control and that may be unique to man”.
11 Gitt Werner. In the beginning was Information. Christliche Literatur-Verbretung e.V. Postfach 110135.33661 Bielefeld, Germany, 2001. [Professor Werner Gitt coined the word ‘apobetics’ to illustrate the highest of the 5 levels of communication in humans]
12 Crick FHC. The origin of the genetic code. J Mol. Biology 1968: 38: 367-379.
13 Crick FHC. Life itself: its nature and origin. Simon and Schuster, New York 1981, p 88.
14 Medawar Peter. The Limits of Science. Oxford . Oxford University Press, 1985.
15 Konotey-Ahulu FID. The supra-scientific in clinical medicine: a challenge for Professor Know-All. BMJ 2001; 323(7327): 1452-1453 (22-29 Dec). http://www.bmj.com/cgi/reprint/323/7327/1452.pdf doi:10.1136/bmj.323.7327.1452
16 Konotey-Ahulu FID. Origin of the genetic code is suprascientific. JRSM March 15 2010 http://www.sicklecell.md/blog/?p=46 Response to James Le Fanu “The disappointments of the Double Helix” Feb 2010.
17 Konotey-Ahulu FID. Personal View: The spiritual and the psychological in Clinical Medicine. BMJ 1977; 1: 1595. (June 15) doi:10.1136/bmj.1.6076.1595 http://www.bmj.com/content//1/6076/1595.full.pdf
Competing interests: None declared
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Published 20 December 2010
4.

Music (and Tonal Language) and the art of being human – I
o Felix ID Konotey-Ahulu, Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast , Ghana
Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley St Lond
Dr John Matthews (Dec 11, p 1274) has shown that, contrary to popular perception, a doctor can have interests far beyond the consulting room. His most excellent review [1] of Philip Ball’s book covering music and the brain [2] deserves a 3-part response: Part I deals with Music, the brain, and language. Part II tackles Origins and what it means to be human. Part III suggests meaningful research approaches.

MUSIC AND THE BRAIN
Dr John Matthews is right in stating “Music stimulates more parts of the brain than any other intellectual activity.” [1], and that these parts “are shared with other activities, such as language..”, especially, in my opinion, Tonal Language. I have proven that my Ghanaian language Krobo/Dangme-Ga can be read like music [3-5], and that the best way to evaluate Tonal Language is not through the piano, flute, violin, or organ but with Tonic Solfa.

TONIC SOLFA, TONAL LANGUAGE, AND THE BRAIN
Tonic Solfa is an extraordinary musical phenomenon. It was invented by Guido Arezzo, a musically talented monk who was born in 991 AD. Tonic Solfa was taught to my ancestors by the Swiss-German Basel missionaries who went to our tribe in 1828. When the British Colonial Government of the Gold Coast ( Ghana ) deported them during the First World War, Scottish Presbyterians took over the work, and continued teaching every pupil how to sing in Tonic Solfa. That was how I came to learn Tonic Solfa the marvel of which is that whereas any piece of music can be played recognisably in all the 12 keys of the piano there is just one way a particular piece of music can be sung in Tonic Solfa. [3-5] For example, the British national anthem “God save the Queen” can be played in 12 different keys (though traditionally Key G major ie F sharp is used), but the brain is so programmed that there is just one way it can be sung in Tonic Solfa: doe doe re ti doe re mi mi fa mi re doe re doe ti doe (d d r t: d r m m f m: r d r d t d). Similarly, my Mother Tongue can be phonated in Tonic Solfa one way only. Every vowel (without prolonging it) has at least 4 different ways of pronouncing it, giving 4 different meanings to the same consonant [3-5]. As nasalisation (quality) of the vowel at each pitch gives the word a different meaning, one can find that the word written ta (without prolonging the ‘a’) can mean, as I pointed out in the Lancet, chew, palm tree, war, giant ant, narrate, and fish out [6]. The brain of a Krobo child is capable of distinguishing the 6 different meanings of that word ta [6], a feat that defeats many a European expert in Linguistics. .

HUMAN SPEAKING VOICE SPANS AN OCTAVE
I have proven before that the normal speaking human voice spans an octave. One can say everything one wants to say (at least in Tonal Linguistics) using just an octave. Starting from d and going through the d r m scale to the next d is traversing an octave. Filling in the pitches between the 12 keys on the piano one can discern d de r ma me f fe s se la ta t d [13 keys], the space between each key is a semi-tone.[3 4 7] Using one particular phrase in The Hallelujah Chorus of Handel’s Messiah “For The Lord God Omnipotent reigneth” I have shown that the brilliant octaves that Handel introduced in that short phrase reflect exactly the octaves not only in tribal linguistics, but also in spoken English! [3 4 7] Just pronounce the English word “agriculture” (slowly) in Queen;s English. My African ear automatically discerns 4 pitches, a high pitch (‘a’), a low pitch (‘ture’), a mid pitch just below high pitch (‘gri’), and a lower mid pitch (‘cul’). These are fixed pitches that can be characterised as follows: high pitch is an octave above low pitch (just as Handel’s ‘God Om..’ is an octave), mid pitch is exactly 3 semitones below high pitch, and lower mid pitch is exactly 2 semitones below mid pitch.[3 4 7] This information is not in Professor David Crystal’s impressive 484-page book ‘THE CAMBRIDGE ENCYCLOPOEDIA OF LANGUAFGE’ [8]. The brain that is capable of recognising these pitch differences in order to discern one accent from another in the same language, or to distinguish one language from another, or to appreciate one piece of music more than another is remarkable to say the least. To facilitate appreciation of these pitch differences so that written text is correctly readable in Tonal Linguistics I decided to colour them to help even illiterates read their tribal language more easily than when the missionaries wrote them. [4 7]

COLOURING SOUND
I colour high pitch red. Using Key C major for convenience, high pitch corresponds to s or G above middle C, and mid pitch which is 3 semitones below high pitch, I make green, and becomes m or E above middle C. Lower mid pitch then becomes r ie 2 semitones below mid pitch (lime green), before descending to the low pitch s (G below middle C, ie an octave below the high pitch s), which I make blue. [4 7]. Anybody can be taught to pronounce “Agriculture” in Queen’s English by just associating the colours of the 4 vowels with the pitches. I have done the same with Japanese. [4 7] The pronunciation of “Japanese” in Japanese is Nihongono (‘Ni’ low pitch blue, ‘ho’ high pitch red, ‘ngo’ mid pitch green, ‘no’ mid pitch green) – see references 4 and 7 on line for a visual appreciation of these novel approaches to Tonal Linguistics.
F I D KONOTEY-AHULU FGA MD(Lond) FRCP(Lond) FGCP DTMH(L’pool) FTWAS FAAS FWACP ORDER OF THE VOLTA GHANA felix@konotey-ahulu.com
1 Matthews John A. Music and the art of being human. BMJ 2010; 341:c6965 http://www.b,j.com/content/341/bmj.c6965
2 Ball Phillip. The Music Instinct: How Music Works and Why We Can’t Do Without It. Bodley Head, pp 464. ISBN: 978-1847920881
3 Konotey-Ahulu FID. Mother Tongue: The Tadka Phonation Technique for speaking an African Tonal Language – Krobo/Dangme/G? of South-East Ghana . Watford 2001, UK . ISBN 0-9515442-4-1. [To facilitate tribal health education in the Mother Tongue]
4 Konotey-Ahulu FID. The Remarkable African Ear: Phenomenon of Mid Pitch Arrest in Krobo-Dangme-G? Tonal Linguistics of South East Ghana . African American Museum of Philadelphia Award Lecture May 5 2007 http://bit.ly/i5APah
5 Konotey-Ahulu FID. How To Avoid Losing Our Mother Tongue. Substance of Lecture given at the British Council Accra November 2007 for Ghana @50. Ghana Academy of Arts & Sciences – President Dr Letitia Obeng President chairing. Guest of Honour Nene Sakite II, Konor of Manya Krobo, – honours Professor Felix I Domeno Konotey-Ahulu with Citation Plaque of Klo Hingmer (Eye of Krobo). http://www.modernghana.com/GhanaHome/NewsArchive/news_details.asp
6 . Konotey-Ahulu FID. Black people’s red faces and AIDS prevention. Lancet 2000; 355(9214):1559. PMID: 10801206 [PubMed-indexed for MEDLINE]
7 Konotey-Ahulu FID. Social pathology of Cleft Palate in The African: Mathematical Precision of Pitch Gaps in Tribal Tonal Linguistics. Ghana Medical Journal 2008; 42: 89-91. (June 2008). PMID: 19180210 http://bit.ly/f8dVG3
8 Crystal David. THE CAMBRIDGE ENCYCLOPEDIA OF LANGUAGE. Cambridge University Press. Second Edition, 1997.
Competing interests: None declared

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Ethics of mitochondrial gene replacement is also ethics of acquired genetic inheritance

www.bmj.com Posted in British Medical Journal on November 19, 2010

Felix ID Konotey-Ahulu, Dr Kwegyir Aggrey Distinguished Professor in Human Genetics University of Cape Coast Ghana
Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley St London W1G 9PF

Annelien Bredenoord and Peter Braude (8 November) have placed readers of the BMJ in their debt not only by meticulously dissecting the ethical and other dilemmas associated with this particular frontier of genetic research and impending practice, but also by calling for “a transparent public debate” [1]. I join the debate by briefly commenting on (a) Consequences of mitochondrial gene replacement (b) Legality (c) Ethics (d) Informed Consent.
CONSEQUENCES
I coin the term “acquired
More…
Annelien Bredenoord and Peter Braude (8 November) have placed readers of the BMJ in their debt not only by meticulously dissecting the ethical and other dilemmas associated with this particular frontier of genetic research and impending practice, but also by calling for “a transparent public debate” [1]. I join the debate by briefly commenting on (a) Consequences of mitochondrial gene replacement (b) Legality (c) Ethics (d) Informed Consent.
CONSEQUENCES
I coin the term “acquired genetic inheritance” which normally does not make sense, except that what we are talking about is “irreversibility of germ line modification” [1] which is passed on to offspring after offspring, not initiated genetically but instantly inherited through an acquired process. An enlightened offspring is one day entitled to ask “Why was such and such acquired for me and my future children?”, where “such and such” could be any unanticipated genetic defect resulting from the process.
LEGALITY
The legal process that will allow mitochondrial gene replacement depends entirely on where this is done in the world. If the British Parliament votes for it then it will be legal; if not, it will be illegal to practise it in the UK . Laws are not static – one parliament may say “No”, while the next may approve. Society gets the law it deserves. “The deliberate creation of human embryos for research . . .is legally prohibited in many countries” say Annelien Bredenoord and Peter Braude [1], so one wonders what happens when the country is not democratic, and dictators can say what must happen and what must not happen, and to whom? Who enacted Germany ‘s laws during the Nazi regime? [2]
ETHICS
“Ethics” I once said at a Human Genome Diversity Project Symposium “is sometimes not the first thing considered in the excitement of advances in scientific endeavour” [3] but as the article of Bredenoord and Braude makes abundantly clear, what is considered unethical by one group of scientists makes others take a different view: “the deliberate creation of embryos for research should be allowed under strict conditions” [1]. But what are these “strict conditions” that Annelien Bredenoord and Peter Braude have in mind?
I was for many years on the Ethics Committee of a leading UK Private Hospital that gave In Vitro Fertilisation consultations. The Chair-person was a Judge who presided over 10 of us that included another judge, an Obstetrician Gynaecologist, 2 Family Practitioners, a Consultant Physician/Neurologist, a Rabbi, a Consultant Physician/Nephrologist, the Matron of the Hospital, and 1 African, myself (Consultant Physician/Genetic Counsellor). Many were the requests from clients who begged for things they wanted done, but which we turned down unanimously – requests that other Ethics committees in the UK might well have approved simply because they were not illegal. Twice a year we made trips to Cambridge to visit (now) Nobel Laureate Robert Edwards whom I mentioned recently [4] had convened a panel of 30 of us under the auspices of the World Council of Churches on 25 June 1973 in Zurich to thrash out the ethics of what he was then embarking on [5]. I wonder what Bob Edwards now makes of the galloping pace of what is happening at the frontiers of Human Genetics.
INFORMED CONSENT
“A third question” asks Bredenoord and Braude “is how to guarantee adequate informed consent given the complexity of technical information, high uncertainty, and competing interests”? [1] Quite so! Leaving the UK aside and moving to the Third World scenario, we are told by the International Consortium sequencing 1000 genomes globally that “A thousand volunteers have already been recruited from Africa, Asia, America, and Europe” [6] and that the African volunteers who had given informed consent were the “Maasai in Kinyawa, Kenya”, the “Yoruba in Ibadan, Nigeria” and “Luhya in Wabuye, Kenya” [7]. I would dearly want to know how “the complexity of technical information” surrounding the genome sequencing exercise was explained to my fellow African natives. Of course we cannot check any details of what was communicated to them because the whole exercise was officially done “anonymously” [6 7]. Bredenoord and Braude have been impressively transparent in marshalling their theses but could we say that about some researchers who, denied the opportunity in their own countries to do forbidden research, would not hesitate to go to Guatemala with plenty of money in foreign exchange to move mitochondrial gene replacement from bench to the bedside? [8 9].
LOOKING FOR THE PERFECT BABY?
I myself am a bundle of funny genes, one of which is the Mendelian dominant extra digits [10], which (before the Swiss Basel missionaries went to the Gold Coast in 1828) some tribes east of us the Krobo people had considered so reprehensible that affected babies were drowned [10]. So appalled I was when I came to England to study Medicine to find that babies that would be born with the same sickle cell disease phenotype as 3 of my siblings were also recommended routinely to be aborted here legally that I later wrote to the BMJ:
“I was born in the Krobo tribe with extra digits – a Mendelian dominant condition with a 1% incidence at birth in Ghana . Had I been born a few miles south east across the Volta River , there would have been great rejoicing because local tribesmen had it that I was destined to be rich. If my mother had given birth to me a few miles north-west beyond the hills, I would not be here to write to you – I would have been drowned soon after birth. Fortunately the Krobo’s were neutral to extra digits but until the government forbade the practice some tribal elders took it on themselves to decide which genes ought to be allowed to survive!” [10]. I went on “Now some scientific tribesmen in the UK ” were similarly deciding which genes should be allowed to remain and which not [10]. Even those with sickle cell disease have been found in Ghana to have other genes which enabled them to achieve great things in life [11]. Some parents do not lightly consider having a baby with a known pathology, of course they don’t, but if the modern attitude is to go to all lengths, including irreversibly changing the germ line of future generations through replacing mitochondrial genes then many reasonable people will consider that a step too far. As regards the great importance of public debate on this vital matter I conclude with the words of a wise man, Sir David Weatherall FRS:
“Whether by opening up public debate about the long-term possibilities of genetic engineering we can prevent its gross misuse, either politically or in other ways, is for future generations to determine. But there is no reason for not trying. One of the major concerns about human genetic manipulation is that our track record in the ethical aspects of human genetics is not entirely reassuring” [12]. In any case, Africans are scared stiff of genetic and genomic studies practised on them however carefully researchers explain exactly what they are doing and obtain “informed consent”. [3]
Conflict of interest: Nothing to declare
Felix I D Konotey-Ahulu FGA MD(Lond) FRCP DTMH ORDER OF THE VOLTA ( GHANA )
Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF felix@konotey-ahulu.com
1 Bredenoord Annelien L, Braude Peter. Ethics of mitochondrial gene replacement: from bench to bedside. BMJ 2010; 341:c6021 doi: 10.1136/bmj.c6021 http://www.bmj.com/content/341/bmj.c6021?papertoc= Nov 8
2 Muller-Hill Berno. Murderous Science: Elimination by Scientific Selection of Jews, Gipsies, and Others – Germany 1933-1945. [Translated from German by G R Fraser] Oxford , Oxford University Press, 1988.
. 3 Konotey-Ahulu FID. The Human Genome Diversity Project: Cogitations of an African Native. Politics and The Life Sciences (PLS) Volume 18 Number 2, September 1999, pages 317-322 [Symposium PMID: 12561789 PubMed indexed for MEDLINE]
4 Konotey-Ahulu FID. Genius of Nobel Laureate Robert Edwards goes beyond IV F. http://www.bmj.com/content/341/bmj.c5533/reply#bmj_el_243005 BMJ Rapid Response, 14 October 2010.
5 World Council of Churches. Genetics and the Quality of Life: Study Encounter Vol X, No 1 1974. Report of a Consultation: Church and Society, Christian Medical Commission, World Council of Churches, Zurich , June 1973, Switzerland (Chairman Dr Robert Edwards)..
6 Wise Jaqui. Consortium hopes to sequence genome of 1000 volunteers. BMJ 2008; 336: 237 (February 2).
7 Announcement: International Consortium Announces the 1000 Genomes Project. Major Sequencing Effort Will Produce Most Detailed Map of Human Genetic Variation to Support Disease Studies. (Tuesday January 22 2008). http://www.1000genomes.org/files/1000Genomes-NewsRelease.pdf
8 Tanne Janice Hopkins. President Obama apologises to Guatemala over 1940’s syphilis study. BMJ 2010: 341. c5494 October 9, page 750. http://www.bmj.com/content/341/bmj.c5494.full
9 Konotey-Ahulu FID. President Obama apologises over Guatemala syphilis study: International co-operative research in jeopardy. BMJ Rapid Response http://http://www.bmj.com/content/341/bmj.c5494.full/reply#bmj_el_243183 Oct 17 2010.
10 Konotey-Ahulu FID. Ethical issues in pre-natal diagnosis. BMJ 1984; 289: 185 http://www.bmj.com/cgi/reprint/289/6438/185-a.pdf
11 Amanor-Boadu Dorothy, Bruce-Tagoe Alexander, Konotey-Ahulu FID. The Third International Conference On The Achievements of Sickle Cell Disease (ACHEACHE) Patients, Accra – 19th July 2010. Accra, Adeko Limited. ISBN: 978-1-3927-8. [International Conference Centre – 22 pages]
12 Weatherall DJ. Ethical issues and related problems arising from the application of the new genetics to clinical practice Chapter 12 in The New Genetics and Clinical Practice D J Weatherall, Oxford , Oxford University Press, Third Edition 1991, page 362.
Competing interests: None declared

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Antenatal sickle cell disease haemoglobinopathy screening

Responding to

Antenatal haemoglobinopathy screening
by Judy Shakespeare
BMJ 341:doi:10.1136/bmj.c5243 (Published 18 October 2010) www.bbj.com

Rapid Response http://www.bmj.com/content/341/bmj.c5243/reply#bmj_el_243447

October 25 2010 by

Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast , Ghana  and Consultant Physician Genetic Counsellor in Sickle&Other Haemoglobinopathies 10 Harley St London W1G
The commissioned editorial [Reference 1] of Judy Shakespeare (18 October) is as comprehensive as the article [2] of Elizabeth Dormandy et al whose concerns the editorial underlined. My comments with references [3] on the Elizabeth Dormandy paper are therefore equally applicable to both articles, and will not largely be repeated here. But there are a couple of clarifications which readers would like to see made.  

CLARIFICATIONS NEEDED

What does the following mean? “Antenatal screening for sickle cell disease and thalassaemia is just the tip of a genetic iceberg and primary care needs to be prepared.” [1]. How can screening be the tip of an iceberg?
Nor is the following easily comprehensible: “In the United Kingdom , about 250,000 people are healthy carriers of sickle cell gene variants and 12,500 have the disease ..”

 What are healthy carriers of sickle cell gene variants? Does the author mean beta-globin gene variants? If as Judy Anderson states, her fellow general practitioners need to “raise their awareness and skills” to educate their patients are they likely to understand what “sickle cell gene variant carrier” means?

GHANAIAN BASIC TERMINOLOGY ACCEPTABLE TO EVEN ILLITERATES

Will UK General Practitioners countenance the terminology I use to instruct Ghanaian illiterates and fellow health staff with the message of sickle cell disease inheritance? For decades I have told them that all Ghanaians are divided into 3 broad phenotypes, using my own parents and their children [Reference 4] as examples: (i) ACHEACHE (those who have inherited an ACHE gene from both parents and therefore ache in the cold rainy season with sickle cell disease, like 3 of my parents’ 11 children) (ii) NORMNORM (no cold season rheumatism, like 4 of my parents’ children, having inherited no abnormal haemobglobin, and blood test shows no beta globin variant) (iii) NORMACHE (no cold season rheumatism, like the other healthy 4 of us but blood test shows one beta globin variant trait, like our parents). Every new patient of mine for several decades now has had Haemoglobin Electrophoresis done, confirming that 1 in 3 of West Africans is NORMACHE ie a Trait. In my experience, the assumption that identified NORMACHE x NORMACHE marriages will be queuing up to have prenatal diagnosis and selective abortion done when offered it is too presumptuous for the reasons already given in my earlier comments [Reference 3]. Many prefer genetic gambling, then stopping procreation after 1 or 2 children if they happen to avoid ACHEACHE phenotype. If a sickle cell disease offspring arrives, they do not panic because they know many adult ACHEACHE Achievers. [3]

SICKLE CELL DISEASE HAEMOGLOBINOPATHY IS DIFFERENT

 
Sickle cell anaemia, a qualitative molecular pathology ‘SS phenotype’, and beta thalassaemia major a quantitative molecular pathology are both, as Judy Shakespeare correctly points out [1] homozygous recessive, but their public health handling must be entirely different [Reference 3]. No where in the world is beta-thalassaemia minor, the heterozygote, 33.3% of the healthy population, whereas if one phenotypes West Africans anywhere in the world well above 35% of us will be NORMACHE, ie traits of abnormal haemoglobins (AC or AS), and we do not know it until we are investigated by Hb electrophoresis. Helping Ghanaians and Nigerians to make informed decisions in procreation does not lie in prenatal diagnosis and selective abortion as appears to be the case in Cyprus , but does lie in Genetic Counselling with Voluntary Family Size Limitation. [References 4 & 5]. And, take it from me, that works!

Felix I D Konotey-Ahulu MD(Lond) FRCP DTMH ORDER OF THE VOLTA ( GHANA )
Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast , Ghana and Consultant Physician Genetic Counsellor in Sickle and Other Haemoglobinopathies. [felix@konotey-ahulu.com]

 
Conflict of interest: My parents who were traits for abnormal haemoglobins, had 11children 3 of whom had sickle cell disease, 4 are traits and 4 have no beta globin gene variant.

1 Shakespeare Judy. Antenatal haemoglobinopathy screening. BMJ 2010; 341: c5243 (Editorial 18 October)

2 Dormandy Elizabeth, Gulliford Martin, Bryan Stirling, Roberts Tracy E, Calnan Michael, Atkin Karl, Karnon Jonathan, Logan Jane, Kavalier Fred, Harris Hilary J, Johnston TraceyA, Anionwu Elizabeth N, Tsianakas Vicki, Jones Patricia, Marteau Theresa M. Effectiveness of earlier antenatal screening for sickle cell disease and thalassaemia in primary care: cluster randomised trial. BMJ 341:doi:10.1136/bmj.c5132 (5 October 2010)

3 Konotey-Ahulu FID. Antenatal screening for sickle cell disease and beta-thalassaemia. http://www.bmj.com/content/341/bmj.c5132/reply#bmj_el_242914 BMJ Rapid response. 12 October 2010

4 Konotey-Ahulu FID. Sickle cell disease in successive Ghanaian generations for 3 Centuries. http://www.konotey-ahulu.com/images/generation.jpg 

In The Human Genome Diversity Project: Cogitations of An African Native. Politics and the Life Sciences (PLS) 1999, Vol 18: No 2, pp 317-322. [Invited Commentary on Professor David Resnik’s article: The Human Genome Diversity Project: Ethical Problems and Solutions] PMID: 12561789 [PubMed – indexed for MEDLINE]

5 Konotey-Ahulu FID. Sickle Cell Disease: The Case for Family Planning. Accra . ASTAB Books, Ltd 1973

Competing interests: My parents who were traits for abnormal haemoglobins, had 11 children 3 of whom had sickle cell disease, 4 are traits and 4 have no beta globin gene variant.

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The politics (and economics) of pain relief in the West and Third World

Feature: Pain control : The politics of pain
• Tatum Anderson
BMJ 341:doi:10.1136/bmj.c3800 (Published 11 August 2010) – www.bmj.com

The politics (and economics) of pain relief in the West and Third World
o Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast Ghana
Consultant Physician Genetic Counsellor in Sickle/Other Haemoglobinopathies 10 Harley St London W1G
The politics (and economics) of pain relief in the West and Third World
Tatum Anderson (14 Aug, p 328) wished pain relievers elsewhere could imitate the “Western world” [1]. His concern needs to be put into perspective. Referring to Armenia he quotes Dr Karfeptyan as saying “Finances remain a problem” [1]. Yes, Health Ministers decide which imported drugs have priority over others.

WHO RECOMMENDATIONS
Tatum Anderson mentions WHO recommendations on pain relief, but WHO
More…
The politics (and economics) of pain relief in the West and Third World
Tatum Anderson (14 Aug, p 328) wished pain relievers elsewhere could imitate the “Western world” [1]. His concern needs to be put into perspective. Referring to Armenia he quotes Dr Karfeptyan as saying “Finances remain a problem” [1]. Yes, Health Ministers decide which imported drugs have priority over others.

WHO RECOMMENDATIONS
Tatum Anderson mentions WHO recommendations on pain relief, but WHO guidelines are not accompanied by money. Useful on paper, they can nevertheless be ignored. Exactly 38 years ago WHO convened some of us to produce an 83-page Technical Report on how to tackle the problem of Sickle Cell Disease. [2]. It was ignored. .
But WHO makes other recommendations which do not rely on foreign aid. WHO knows Traditional Medicine which costs a fraction of what imported drugs cost is widely used [3 4], and aims to “support and integrate traditional medicine into national health systems” [4]. True, some Africans cannot afford imported opiates but “85% of Nigerians use and consult traditional medicine for health care” [5]. Indeed, the pain of my own circumcision when a little boy was managed by a Krobo traditional healer who also “knew about haemostasis” [6]. Neither the ground haemostatic herbs nor the pain killing tincture came from abroad. Did the oral morphine that the Ugandans in Tatum Anderson’s article were using come from abroad, or did they get it from their traditional healers as WHO would have approved of?

WESTERN NATIONAL INTERESTS FIRST BEFORE ANYTHING ELSE
Tatum Anderson writes as if “The Western world” speaks with one voice. Take his comment: “Also, many patients with conditions, such as sickle cell anaemia, …require relief but do not get it” [1] The UK uses Diamorphine for sickle cell crisis patients [7 8], while “heroin has no accepted use in the United States” [9, page 168]. Do these two countries not belong to “The West” and yet do they not differ in their use of this particular opiate? That national interests have more to do with choice of drugs in their Pharmacopoeia is shown by UK’s reaction to Professor Elisabeth Goodman’s finding in the USA [10] that the use in painful crises of Ketorolac was as efficient as morphine but without the latter’s respiratory depression: “Ketorolac has no product licence in the UK for this indication” [11]. Professor Graham Serjeant has stated: “In Jamaican experience morphia or its derivatives are rarely used or necessary” [12, page 204]. I agree [3].

GHANAIAN SICKLE CELL DISEASE ACHIEVERS
On 19 July 2010 The Third International Conference On The Achievements of Sickle Cell Disease Patients [14] was held in Accra, followed on 20-23 July by The First Global Congress On Sickle Cell Disease to mark the 100th anniversary of the first clinical description of Sickle Cell Disease. The Conference had sickle cell anaemia adults in their 7th decade tell us how they managed to achieve great things [14 15]. One known “SS” man with a PhD, who had never in his 63 years been transfused though Hb level was never above 8.8 g/dL and who had never been prescribed Hydroxyurea, astonished delegates when he announced “I do not know when I last took a pain killer for my sickle cell anaemia. Drink plenty of water, avoid malaria, and have a positive attitude to life” [14, page 15].

NATIONAL ENQUIRY INTO PATIENTS OUTCOME AND DEATH (NCEPOD)
The NCEPOD report [7 8] concludes that during 2 years “Nine out of the 19 patients with sickle cell disease who had pain on admission and who then died had been given excessive doses of opiods” [8], and this continues to happen [16 17] in spite of UK’s National Institute of Clinical Excellence (NICE) [18 19]. Is post narcotic administration death (pnad) the kind of relief that Tatum Anderson’s “West” is seeking for our patients, many of whom have become bread winners when their hereditary condition is managed properly? [20 21]

WHAT THE THIRD WORLD CAN AND MUST LEARN FROM THE WEST
There is plenty though The Third World can learn from the West, not least of which is ‘Discipline’ in personal and national affairs. We must learn that every privilege demands some responsibility. Why should it be implied [1] that Bill and Melinda Gates could supply us with free morphine? Why should we Africans expect help to come from outside when we refused to learn lessons like Singapore had done?
Next, we Africans need discipline against corruption. I described how a Lebanese, an Italian, plus a Ghanaian conspired and supplied the Ministry of Health in Accra with Ampicillin capsules stuffed with chalk and cassava powder as “500 mg Ampicillin” [22]. The then Commissioner of Health to whom I reported this, and who began to probe the racket was promptly removed from his post [22]. True, the Italian crook came from the “West” but, generally speaking, “The West” is ready to show us the proper means and ways to deal with situations like that [22]. Our envy of “The West” knows no bounds when we read of their ability to prosecute a French President, discipline a German Chancellor, investigate an Israeli Prime Minister, dismiss a Japanese Minister, and remove a sitting American President for “simply lying”. Twice in less than 3 years the BMJ has published articles on pain relief for Africans [1 23]. Can we also have articles showing how “The West” could help us prevent a Minister of Health from being removed for probing crooks in the pharmaceutical industry, and how we should not expect Bill and Melinda Gates to give us free antimalarial drugs when we have not covered open drains in our cities like Singapore and Trinidad have done? [24].
Felix I D Konotey-Ahulu MD(Lond) FRCP DTMH Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle and Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF felix@konotey-ahulu.com

1 Anderson Tatum. The politics of pain. Brit Med J 2010; 341: c3800 http:// www.bmj.com/cgi/content/full/341/aug11_2/c3800
2 Boyo AE, Cabannes R, Conley CL, Lehmann H, Luzzatto L, Milner PF, Ringelhann B, Weatherall DJ, Barrai I, Konotey-Ahulu FID, Motulsky AG. Scientific Group on Treatment of Haemoglobinopathies and Allied Disorders. (Technical Report) 1972; 509 – 83 pages.
3 WHO. Traditional Medicine Strategy 2002-2005. Geneva: WHO 2002
4 WHO. Traditional Medicine. Fact Sheet No; 134. http://www.who.int/mediacentre/factsheets/fs134;en
5 Adelaja Abiose. Nigeria boosts research into traditional medicine. Sci Dev Net Dec 6 2006 http://www.scidev.net/en/news/nigeria- boosts-research-into-traditional-medicine.html
6 Konotey-Ahulu FID. Male circumcision and alleged protection against AIDS. http://www.bmj.com/cgi/eletters/335/7631/1206# BMJ 11 Dec 2007 Rapid Response
7 NCEPOD (National Confidential Enquiry into Patient Outcome and Death). Sickle: A Sickle Crisis? (2008) [Sebastian Lucas (Clinical Co- ordinator), David Mason (Clinical Co-ordinator), M Mason (Chief Executive), D Weyman (Research), Tom Treasurer (Chairman) info@ncepod.org
8 Mayor Susan. Enquiry shows poor care for patients with sickle cell disease. BMJ 2008; 336: 1152.
9 Ballas S K. Sickle Cell Pain. IASP Press. Seattle, USA.
10 Goodman Elisabeth. Use of ketorolac in sickle cell disease and vaso-occlusive crisis. Lancet 1991; 338: 641-42.
11 Liesner RJ, Vandenberghe EA, Davies SC. Analgesics in sickle cell disease. Lancet 1993; 341: 188.
12 Serjeant GR. Sickle Cell Disease. Oxford. Oxford University Press, 1985, page 204.
13 Konotey-Ahulu FID. Morphine for painful crises in sickle cell disease. BMJ 1991; 302: 1604.
14 Amanor-Boadu Dorothy, Bruce-Tagoe Alexander, Konotey-Ahulu Felix. The Third International Conference On The Achievements Of Sickle Cell Disease (ACHEACHE) Patients. Accra – 19th July 2010. Adeko Ltd, Accra, Ghana. ISBN: 978-9988-1-3927-8.
15 The Second International Conference On The Achievements Of Sickle Cell Disease Patients, Accra 19th July 1995.
16 Dyer Clare. Inquest begins into deaths after concerns about diamorphine levels. BMJ 2009; 338: b903 [7 March]
17 Konotey-Ahulu FID. Inquest into diamorphine deaths; Does NCEPOD sickle cell patients report warrant a similar inquest? BMJ Rapid response 7 March 2010. http://www.bmj.com/cgi/eletters/338/mar03_3/b903#210208
18 Konotey-Ahulu FID. Poor care for sickle cell disease patients: This wake up call is overdue. http://www.bmj.com/cgi/elettres/336/7654/1152-a#196224 BMJ Rapid response 29 May 2008.
19 Konotey-Ahulu FID. Current “hit and miss” care provision for sickle cell disease patients in the UK. BMJ Rapid Response 22 July 2008 http://www.bmj.com/cgi/eletters/337/jul11_2/a771#199135
20 Serjeant GR. The case for dedicated sickle cell centres. BMJ 2007; 334: 477 (3 March)
21 Konotey-Ahulu FID. Dedicated sickle cell centres. BMJ Rapid response March 20 http://www.bmj.com/cgi/eletters/334/7591/477#162678
22 Konotey-Ahulu FID. Who should best pharmacovigilate in developing countries? 14 September 2007 BMJ Rapid Response to Editorial http://www.bmj.com/cgi/eletters/335/7618/462#167455
23 Logie Dorothy, Leng Mhoira. Africans die in pain because of fears of opiate addiction. BMJ 2007; 335: 685 http://www.bmj.com/cgi/content/full/335/7622/685 October 6 2007.
24 Konotey-Ahulu FID. Fighting Malaria: Isn’t the best approach through Environmental Hygiene and Public Health? BMJ Rapid Response April 26 2009 http://www.bmj.com/cgi/eletters/338/apr20_2/b1627#212782
Competing interests: None declared

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Third International Conference on the Achievements of Sickle Cell Disease Patients

The Third International Conference on the Achievements of Sickle Cell Disease Patients will take place at the Accra International Conference Centre on Monday 19th July, the day before the First World Congress On Sickle Cell Disease begins at the same venue. Attendance is free. Contact Co-Chairs Ms Dorothy Amanor-Boadu (elitens@yahoo.co.uk), Professor Alex Bruce-Tagoe (alexbt_2000@yahoo.com) and Professor Felix Konotey-Ahulu (felix@konotey-ahulu.com), and also the Local Chair for the World Congress Dr Ivy Ekem (ekem_ivy@hotmail.com)

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Current “hit and miss” care provision for sickle cell disease patients in the UK

Current “hit and miss” care provision for sickle cell disease patients in the UK

Following her article [1] on NCEPOD [2] Susan Mayor has, again, produced a succinct summary [3] of the recent publication of ‘Standards’ on the care of patients with sickle cell disease (scd) in the UK [4], written by a multidisciplinary working group chaired by Consultant Haematologist Dr Ade Olujohungbe. The public launch of the publication was on 9 July in the House of Commons where the Archbishop of York, Dr John Sentamu, said: “These Standards are another step in providing consistent care” [3].

HIT AND MISS CARE PROVISION

Hitherto, consistent care has not been UK’s strong point. The description by the ‘Standards’ Group’s chairman, Dr Olujohungbe who, in my opinion, has proved to be the most experienced Clinical Haematologist in the UK on the scd patient since Hammersmith Hospital’s Professor Lucio Luzzatto with whom Olujohungbe was closely associated, underlines what Graham Serjeant [5] and I have bemoaned for years. Olujohungbe said “The care provision for sickle cell disease is currently hit and miss, depending on the attitudes and experience of health professionals” [3]. This sad diagnosis by the leading UK haematologist on the scd patient was precisely why “NCEPOD found that many patients died of complications caused by excessive doses of opiods” [1, 2].

RESPONSE OF TEN DOWNING STREET

During the week when UK media (radio, television, & newspapers) were full of news that the Prime Minister was inviting personal phone calls and contacts on people’s concerns I took the opportunity to write to The Right Honorable Mr. Gordon Brown drawing his attention not only to the publication of the NCEPOD Report [2], but also to the international responses that were beginning to pour in [6]. The reply I got, dated 25 June 2008, from Ten Downing Street was encouraging: “Dear Dr Konotey-Ahulu – The Prime Minister has asked me to thank you for your recent letter and enclosures. Mr. Brown has asked that your letter be forwarded to the Department of Health so that they may reply to you on his behalf. (Signed) MR R SMITH”.

RESPONSE OF THE DEPARTMENT OF HEALTH

I looked forward eagerly to answers to the 3 questions I posed in my correspondence, namely (i) With respect to scd patients dying with overdose of opiods (heroin & morphine) in their blood “What kind of supervision led to this?” [6a] (ii) Why should West Indians and West Africans who did without morphine in their countries be put on morphine pumps when they were admitted to UK hospitals? [6a] (iii) To those UK haematologists who say “unbearable pain is unbearable pain, which must be treated with the most potent analgesic drugs known” I posed this third question, how many of them would prescribe diamorphine (heroin) monthly for their teenage daughters whose dysmenorrhoea was simply unbearable? [6a]. The Department of Health wrote back to me Ref; TO00000325139 dated 16 July 2008. Signed by “Shelley Wilson, Customer Service Centre”. All the questions were totally ignored. Would the National Institute of Clinical Excellence (NICE) now provide specific answers to these my 3 questions?

OUR GENETIC FUTURE

Africans, African-Caribbeans, and African Americans must wake up and realize that their genetic future depends on themselves, and not on any Department of Health. We must reduce the genetic disease burden, starting now, otherwise their children will continue to be subjected to “hit and miss” health care provision, ending up on heroin and morphine pumps. “Unless we Africans are involved in genetic counseling” and voluntary family size limitation (GCVFSL), I said not long ago “the genetic burden on the National Health Service will go up and up” [7]. What is more to the point, unless we take this very seriously our children and grand children will suffer greatly from scd [ACHEACHE syndrome], for “one in three West Africans in the UK has a beta-globin variant gene (ie NORMACHE) whose unsuspecting owner needs to be identified and helped with genetic counseling and family size limitation” [7]. Those who do not quite believe the enormity of the NCEPOD Report [2] should, please, start by taking a good look at how the rest of the world regards the “hit and miss” approach to the present care of sickle cell disease patients in the United Kingdom [6a-6j].

Felix I D Konotey-Ahulu MD(Lond) FRCP(Lond) DTMH(L’pool) – Kwegyir
Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Haemoglobinopathies, London W1G 9PF.

felix@konotey-ahulu.com

1 Mayor Susan. Enquiry shows poor care for patients with sickle cell disease. BMJ 2008; 336: 1152

2 NCEPOD (National Confidential Enquiry into Patient Outcome and Death) Sickle: A Sickle Crisis? (2008) [Sebastian Lucas (Clinical Co- ordinator), David Mason (Clinical Co-ordinator), M Mason (Chief Executive), D Weyman (Researcher), Tom Treasurer (Chairman)] info@ncepod.org

3 Mayor Susan. Group publishes standards for adult sickle cell disease to reduce number of unexplained deaths. BMJ 2008;337:a771

4 Sickle Cell Society (London) The Standards for the Clinical Care of Adults with Sickle Cell Disease in the UK. http://www.sicklecellsociety.org

5 Serjeant GR. The case for dedicated sickle cell centres. BMJ 2007; 334: 477 (3 March)

6a http://www.bmj.com/cgi/eletters/336/7654/1152-a#196224 [Felix I D Konotey-Ahulu 29 May 2008] Poor care for sickle cell disease patients: This wake up call is overdue

6b http://www.bmj.com/cgi/eletters/336/7654/1152-a#196359 [Kwabena Frimpong-Boateng 30 May 2008] Re: Poor care for sickle cell disease patients: This wake up call is overdue

6c http://www.bmj.com/cgi/eletters/336/7654/1152-a#196514 [Marianne Janosi 3 June 2008] “Poor care for patients with sickle cell disease” BMJ 24 May 2008 Volume 336.

6d http://www.bmj.com/cgi/eletters/336/7654/1152-a#196520 [Cecilia Shoetan 3 June 2008] I lost my Sickle Cell disease adult daughter minutes after being given Diamorphine intravenously when she could not breathe.

6e http://www.bmj.com/cgi/eletters/336/7654/1152-a#196631 [Frank Edwin 5 June 2008] Re: Poor care for sickle cell disease patients: This wake up call is overdue

6f http://www.bmj.com/cgi/eletters/336/7654/1152-a#196848 [Ivy Ekem 9 June 2008] Care for sickle cell patients

6g http://www.bmj.com/cgi/eletters/336/7654/1152-a#197301 [Mawunu Chapman Nyaho 17 June 2008] Poor care for the sickle cell disease patient: “Pain won't kill him, but Morphine could”.

6h http://www.bmj.com/cgi/eletters/336/7654/1152-a#197350 [Emmanuel Jeurry Blankson 18 June 2008] Sickle Cell Disease is managed, NOT treated.

6i http://www.bmj.com/cgi/eletters/336/7654/1152-a#197377 [Yolande M Agble 18 June 2008] Re: Poor care for sickle cell disease patients: This wake up call is overdue.

6j http://www.bmj.com/cgi/eletters/336/7654/1152-a#198669 [Akosua M Dankwa 11 July 2008] Sickle Cell patients deserve to live.

7 Konotey-Ahulu FID. Need for ethnic experts to tackle genetic public health. Lancet 2007; 370: 1826 (December 1)

Competing interests: I come from a sickle cell disease (scd) family, my parents were traits (NORMACHE), and I am actively involved in genetic counselling to reduce the burden of sickle cell disease (ACHEACHE) in future generations.

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