BMJ 2023 381 p475 [Help Offered To Mary Shaniqua]
Mary Shaniqua gives neither age nor phenotype. I applaud the description of her sickle cell crisis pain, and her definition of empathy as doctors listening to her and engaging her “in decisions about my treatment.” She is “much more than a sickle cell patient”  because sickle cell disease patients possess non-sickling genes that equip them for achievement. But what precipitates Shaniqua’s crises? 
SICKLE CELL DISEASE PATIENT ACHIEVERS (SCDPA) ELIMINATED CRISES BY PREVENTING CAUSES
I organized 3 international conferences – first at Royal Society of Medicine 1993, second in Accra 1995, and the third at Accra in 2010 for SCDPA [3-6] to commemorate 100th anniversary of James Herrick’s observation  of sickled erythrocytes in a Black anaemic patient suffering from the hereditary condition that Ghanaians had known for centuries [8-11] by onomatopoeic tribal names  reflective of Mary Shaniqua’s description – “stabbing, like knife in the bones”.
IRON OVERLOAD, HIP NECROSIS, AND EMBOLISM COMPLICATIONS
Mary Shaniqua’s three “very challenging symptoms and diagnoses”  occur in all 4 disease-phenotypes SS SC Sbeta-Thalassaemia SF-hereditary [9-11 13 14].
(a) Iron-Overload develops in regularly transfused Sickle Cell Anaemia (SS) patients [9-11]. Supervising the world’s largest Sickle Cell Clinic at Korle Bu Teaching Hospital in Ghana I never regularly transfused any “SS” patient [9-11 13-16]. Nor did Graham Serjeant running the world’s second largest Sickle Cell Clinic in Jamaica [17-23]. Indeed, Graham Serjeant’s never-been-transfused “SS” patient on holiday in the USA died there when doctors transfused her . Shaniqua’s listening doctor empathy-definition was reflected when more than once I obeyed this request: “My crisis comes when Hb is above 9 grams so please test and remove blood” [10 – Case History 21). Two world-class Consultant Haematologists I know may well write to BMJ to say they obeyed another patient of mine who pleaded for venesection when Hb approached 9 grams.
(b) Articular bone necrosis [24-26] occurred in 6.6% of my 563 sickle cell haemoglobin C disease (SC) patients and 2.8% of 583 sickle cell anaemia (SS) consecutive patients
reflecting SC phenotype’s higher blood viscosity with more mobility to greater disposition. [10 p 239] Shaniqua’s red-cell overload with articular bone necrosis suggests “SS” phenotype.
(c) Pulmonary Embolism  can occur in all disease phenotypes when haematocrit rises. Misdiagnosed as sickle cell crisis in an SC woman, diamorphine was given intravenously, and the patient died promptly .
KNOWING CAUSES OF CRISIS DIMINISHES HOSPITALISATIONS DRASTICALLY
No precipitating cause, no sickle cell crisis. [2 10 11 13]. I mentioned Blood Transfusion 58 years ago among 17 causes of sickle cell crisis  My SS-phenotype patient Case 21 among 133 Case Histories [10/11] had the exact complications Shaniqua had. Precipitating causes for his 5 crisis-admissions were pneumonia, typhoid fever, infected gallstones, pushing a car uphill, and thunderstorm. Crisis pain disappeared when he was hydrated and “treated with antibiotics, paracetamol, intravenous magnesium sulphate, and oral sodium bicarbonate” [10/11]. Graham Serjeant [21-23 30] and I [31-43] reject NICE’s recommendations on opiates, hydroxyurea, and regular transfusion. Prime Minister Gordon Brown’s NCEPOD Experts wrote: “In 2 years 9 out of 19 sickle cell crisis admissions died from overdose of opiates” [40-48].
RESPONDING TO FOLLOWING QUESTIONS WILL HELP SHANIQUA [49-85]
Cause of crises? Haemoglobin Phenotype? Transfusions? Opiates? Gall-stones? G6PD-Status? Pregnancies? Hydroxyurea? Numb-lower-lip (Kanumblll) Sign? Vitreous Bleed? Nosebleeds? Leg ulcers? Gnathopathy? Weather-Influence? Tummy-ache? Yellow-eyes? cocacola-coloured-urine? Osteomyelitis? Crizanlizumab? LentiGlobin? COVID-19 Vaccines?
Some SCDPA took “Aerobic Oxygen” drops between meals to prevent crises for decades  Would BMJ publish their stories too? What prevents UK licensing Aerobic Oxygen? [44-46]
Competing Interest: I am second of my Trait Parents’ 11 children, 3 of whom had sickle cell disease. I knew more about the sickle cell disease patient in my Manya Krobo Tribe in Ghana before I went to Medical School than most of my teachers in England did. Names of my family members suffering from sickle cell disease (HEMKOM = BODYBITING, similar description to Mary Shaniqua’s) are shown for every generation right back to 1670 AD [8-11]. Coming from a family with 3 Sickle Cell Disease siblings I find it very difficult to remain detached when the received wisdom in the management of these patients that was proven by NCEPOD to be harmful is still endorsed by NICE. Shaniqua says she needs help. The many detailed references are meant to help her join the SCDPA who have avoided many hospitalisations and have achieved a great deal in life. Clinical Experience, not Haematological experience or Genomic experience was what produced SCDPA by distinguishing the vital difference between “Treating Sickle Cell Disease” and “Managing Sickle Cell Disease Patient” [9-11 35]. When Dr Helen Ranney MD PhD, Professor of Medicine and Haematology at Albert Einstein University Medical College, New York, New York said (and published) “There is no single clinical experience in the United States comparable to that of Dr Konotey-Ahulu” [13 page 320] she was confirming my frequent claim that the DNA that made my patients become ACHIEVERS was good Doctoring, good Nursing, Good Anti microbials [10/11]. Clinical Experience made me criticise in England the received wisdom that “Sickle Cells Protect Against Malaria”. No, I said, when (in 1940) my younger brother would be running about naked aged 7 years, screaming with bodily pains and with priapism exposed to the world, our mother would calmly announce: “Tei has got malaria. Bring the bottle of Quinine quickly!”. Malaria always precipitated my brother’s sickle crisis with priapism. Malaria treated, and crisis disappeared. Prevent malaria and prevent major cause of sickle cell crisis in Africa. Prevent her noted causes of crisis and Shaniqua will visit hospital less often.
Twitter@profkonoteyahul firstname.lastname@example.org or www.sicklecell.md
Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(Hon UCC) DSc(Hon UH) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (Officer) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Director Ghana Institute of Clinical Genetics, Haemoglobinopathies Consultant Physician Korle Bu Teaching Hospital, Accra and Consultant Physician Genetic Counsellor in Sickle Cell & other, Cromwell Hospital London SW5 0TU and 9 Harley Street Ltd, Phoenix Hospital Group, London W1G 9AL [www.konotey-ahulu.com or..www.sicklecell.md
References [COMPREHENSIVE To Help Mary Shaniqua become an ACHIEVER too.]
1. Shaniqua Mary. Help me manage my sickle cell pain. BMJ 2023;381:P475 April 22.
2. Konotey-Ahulu FID. The Sickle-cell Diseases: Clinical manifestations including the Sickle Crisis. Arch Internal Medicine 1974; 133(4): 611-619. [PMID: 4818434 [PubMed – indexed for MEDLINE. http://archinte.ama.assn.org/cgi/reprint/133/4/611-pdf http://archinte.ama.assn.org/cgi/content/abstract/133/4/611
3. Konotey-Ahulu FID. The Sickle Achievers (1). Ghanaian Times, July 23, 2005 “I cannot think of a single Ghanaian family that did not have or know of someone with sickle cell disease – known by Tribal names”.
4. Konotey-Ahulu FID. The Sickle Achievers (2) Ghanaian Times. August 13, 2005 “Some time ago I coined the term for cold season Rheumatism which Europeans call Sickle Cell Disease … The ACHEACHE Syndrome – ACHE from each parent”. Makes it easy for Genetic Counselling.
5. Omaboe Letitia, Konotey-Ahulu FID. The Second International Conference on The Achievements of Sickle Cell Disease Patients. Accra 19th July 1995 Conference Brochure.
6. Amanor-Boadu Dorothy, Bruce-Tagoe Alexander, Konotey-Ahulu Felix. The Third International Conference On The Achievements Of Sickle Cell Disease Patients Accra – 19th July 2010. Adeko Ltd, Accra ISBN: 978-9988-1-3927-8 “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 remember 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’” [page 15] [Dorothy Amanor-Boadu was 59-year-old “SS” Nurse Oncologist]. Some ACHIEVERS took Aerobic Oxygen drops to stop crises.
7. Herrick James B. Peculiar, elongated and sickle shaped red blood corpuscles in a case of severe anemia. Archives of Internal Medicine 1910. Vol 6; pp 517-521
8. Konotey-Ahulu FID. Sickle Cell Disease In Nine Successive Ghanaian Generations For Three Centuries (Manya Krobo Tribe) 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.
9. Konotey-Ahulu FID. Pattern of Sickle Cell Disease in Ghana (A Study Of 1,550 Consecutive Patients) – A Thesis Presented For The Degree of Doctor of Medicine (M.D.) In The University Of London 1971 Awarded Feb 1972.
10. Konotey-Ahulu FID. The Sickle Cell Disease Patient. Natural History from a clinico-epidemiological study of the first 1550 patients of Korle Bu Hospital Sickle Cell Clinic. London & Basingstoke, Macmillan Press Ltd 1991/1992. Foreword by Roland B Scott MD, Howard University, Washington DC)
11. Konotey-Ahulu FID. The Sickle Cell Disease Patient. Clinico-epidemiological study of 1550 consecutive patients at Korle Bu Hospital, Accra. T-A’D Co, Watford 1996 http://www.sicklecell.mde/aboutscd.asp
12. Konotey-Ahulu FID. Hereditary qualitative and quantitative erythrocyte defects in Ghana – an historical and geographical survey. Ghana Med Journal. Vol 7; 118-9.
13. Konotey-Ahulu FID. Effect of environment on sickle cell disease in West Africa; epidemiologic and clinical considerations. Chapter 3 in SICKLE CELL DISEASE – diagnosis, management, education and research. Eds Ahramson, Bertles JF, Wethers Doris L; St Louis – CV Mosby Co 1973, pp 20-38 [Helen Ranney page 320: “There is no single clinical experience in the United States comparable to that of Dr Konotey-Ahulu”
14. Konotey-Ahulu FID. Patterns of clinical haemoglobinopathy. East Afr Med J 1969; 46: 149-156. (With tables that distinguish phenotypes clinically)
15. Konotey-Ahulu FID, Ringelhann B. Sickle cell anaemia, sickle cell thalassaemia, sickle cell haemoglobin C disease, and asymptomatic haemoglobin C thalassaemia in one Ghanaian family. BMJ 1969; 1: 612-614. [4 Haemoglobinopathy phenotypes] http://www.bmj.com/cgi/reprint/2/5648/48.pdf
16. Konotey-Ahulu FID. Definition of sickle cell trait and sickle cell disease. Ghana Med J 1972; 11: 417-419.
17. Serjeant GR, Richards R., Barbor PRH, Milner PF. Relatively benign sickle cell anaemia in 60 patients aged over 30 in the West Indies. BMJ 1968; 3: 86
18. Serjeant GR, Serjeant BE, Milner PF. The irreversibly sickle cell: a determinant for haemolysis in sickle cell anaemia. Br J Haematol 1969; 17: 527-533.
19. Serjeant GR. The clinical picture of sickle cell anaemia in Jamaica. MD Thesis, University of Cambridge, 1971.
20. Serjeant GR. Sickle Cell Disease. Oxford, Oxford University Press, 1985.
21. Serjeant GR. Sickle cell disease. Lancet 1997; 35: 725-730
22. Serjeant GR, Serjeant B. Sickle Cell Disease, 3rd Ed, Oxford, OUP, 2001.
23 Serjeant GR. Blood transfusion in sickle cell disease. A cautionary tale. Lancet 2003; 361: 1659-60
24. Konotey-Ahulu FID. Avascular Hip Necrosis: Sickle Haemoglobinopathy predominates worldwide. BMJ Rapid Response to Lamb JN et al 1 June 2019 Avascular necrosis of the hip. https://www.bmj.com/content/365/bmj.l2178/ BMJ 1 June Vol 365, p 325 (BMJ 2019; 365: l2178)
25. Konotey-Ahulu FID. Hip pain and radiographic signs of osteoarthritis: Sickle cell & other haemoglobinopathy differential diagnosis. British Medical Journal Rapid Response 8 January 2016 http://www.bmj.com/content/351/bmj.h5983/rr-2 to MJ Nieuwenjse and Rob G Nelissen BMJ 2015; 351 (Published 2 December 2015) http://dx.doI.org/10.1136/bmj.h5983 http://www.bmj.com/content/351/bmj.h5983/rr-2
26. Konotey-Ahulu FID. Hip disease in Africans. Lancet 1970; 1(7654): 999. http://www.biomedsearch.com/NIH/Hip-disease-in-Africans/4191955.html
27. Konotey-Ahulu FID. Pulmonary embolism, Lancet 17 July 2004 Vol 364 No 9430, pp 244-245.
28. Shoetan Cecilia. I lost my Sickle Cell Disease adult daughter minutes after being given Diamorphine intravenously when she could not breathe.
http://www.bmj.com/cgi/eletters/336/7654/1152-a#196520 BMJ June 3, 2008
29. Konotey-Ahulu FID. Sicklaemic human hygrometers. Lancet 1965; 1:1003 1004 [Listing precipitating causes of crises eg cold weather, sweating, transfusion etc] [http://www.pubmedcentral.nih.gov/picender.fcgi?artid=1846286&blobtype=pdf
30. Serjeant G. The case for dedicated sickle cell centres. BMJ 2007; 334: 477 “In Jamaican experience morphia or its derivatives are rarely used or necessary” and “the most painful crises may be treated in a day centre, the patient returning home in the evening”.
31. Konotey-Ahulu FID. Opiates for sickle-cell crisis? Lancet 1998; 351: 1438. [“The question that puzzles me is: why do west African and West Indian patients with sickle-cell disease who did without morphine in their countries have to be given morphine pumps during sickle-cell crises when they come to the UK?”]
32. Konotey-Ahulu FID. Opiates for sickle-cell crisis. Lancet 1998; 352: 651-652. [In response to David Bevan’s criticism (in Lancet 1998; 351: page 1965) of white physicians who agree with Dr Konotey-Ahulu that opiates have created addicts in their hospital – “When I say routine opiates for sickle crisis are not the way to bring out these patients’ best potential in the long term I am glad to hear white physicians say the same…White physicians who, at the risk of being misunderstood by Bevan, voice their displeasure at what they see happening on their wards deserve commendation, not condemnation.”]
33. Konotey-Ahulu FID. Opiates for pain in dying patients and in those with sickle cell disease www.bmj.com/cgi/eletters/335/7622/685#177986 BMJ Resp 11 Oct 2007
34. Konotey-Ahulu FID. Dedicated sickle cell centres. BMJ Rapid responses March 20 2007 http://www.bmj.com/cgi/eletters/335/7618/462#167455
35. Konotey-Ahulu FID. Management of patients with sickle cell disease. African Journal of Health Sciences 1998; 5: 47 [On Sally Davies and Lola Oni in BMJ 315: 656-60 “The Central Middlesex management protocol uses morphine infusions”] Response: “I fear Davies and Oni’s statement will make morphine the accepted drug for sickle crisis management. The consequences for such an approach are dire, especially when some UK hospitals are already making diamorphine their first choice”. And what did NCEPOD find in 2008?
36 Konotey-Ahulu FID Morphine for painful crises in sickle cell disease. BMJ 1991; 302: 1604 (Commenting on Professor Chamberlain’s recommendation of morphine in pregnancy in sickle cell disease – BMJ 1991; 302: 1327-30). “In obstetrics what happens too foetal respiration when morphine is used? http://www.bmj.com/cgi/reprint/302/6792/1604-c.pdf
37. Ringelhann Bela, Konotey-Ahulu FID. Haemoglobinopathies and Thalassaemias in Mediterranean areas and in West Africa: Historical and other perspectives 1910 to 1997. Accademia del Scienze Ferrara Atti, volume 74, Anno Accademico 174 1996-97, pages 297-307 [A Century Review] (Sickle Cell Disease is NOT just in Blacks)
38. Konotey-Ahulu FID. Management of acute painful sickle cell episode in hospital; summary of NICE Guidance is frightening. BMJ 2012; 344: doi:http://dx.doiorg/10 1136/bmj’e’4063 https://www.bmj.com/content/344/bmj.e4063/rr/599158 Sept 7.
39. Konotey-Ahulu FID. Management of sickle cell disease patient in the community. Rapid response 13 April 2014 [90 references] to Brousse V, Makall J, Rees DC: Management of sickle cell disease in the community, BMJ 2014; 348: g1765 doi: 10.1136/bmj,g1765 https://www.bmj.com/content/348/bmj.g1745/rr/694233 ,
40. NCEPOD – National Confidential Enquiry into Patient Outcome and Death. SICKLE: A Sickle Crisis? 2008 [Sebastian Lucas (Clinical Coordinator), David Mason (Clinical Coordinator), M Mason (Chief Executive), D Weyman (Researcher)/ Tom Treasurer (Chairman) email@example.com.
41. Mason S. Enquiry shows poor care for patients with sickle cell disease. BMJ 2008; 336: 1152 “In 2 years 9 out of the 19 patients with sickle cell disease who had 9ain on admission and who then died had been given excessive doses of opiods”
42. Konotey-Ahulu FID. Poor care for sickle cell disease patients: This wake-up call is overdue. http://www.bmj.com/cgi/eletters/336/7654/1152-a#196244 BMJ Rapid Response (May 28) BMJ 2008; 336: 1152 to Susan Mayor’s “Enquiry shows poor care for patients with sickle cell disease” on National Confidential Enquiry into Patient Outcome and Death (NCEPOD) REPORT “SICKLE: A Sickle Crisis? (2008)” http://firstname.lastname@example.org .
43. Konotey-Ahulu FID. Inquest into diamorphine deaths: Does NCEPOD sickle cell patients report warrant a similar inquest? BMJ Rapid Response March 7 2009 http://www.bmj.com/cgi/eletters/338/mar03_3/b903#210208
44. Goodman Elisabeth. Use of ketorolac in sickle cell disease and vaso-occlusive crisis. Lancet 1991; 338: 641-642. [Ketorolac not licenced in UK (See Ref 45)]
45. Liesner RJ, Vandenberghe EA, Davies Sally C. Analgeisics in sickle cell disease disease. Lancet 1993; 3411: 188. [Ketorolac not licensed but Diamorphine is in UK].
46.. Konotey-Ahulu FID. PAIN CONTROL: Don’t Pregabalin Patent Litigations raise basic Licensing Policy Questions? https://bit.ly/2zHTJky [Professor Elizabeth Goodman (Ref 44) found Ketorolac as good as Morphine with no respiratory depression in vaso-occlusive crisis but Lesner and Sally Davies said “Ketorolac has no product license in the UK for this indication” (Ref 45). How extraordinary that a drug that did not kill patients had no product license in the UK, BUT Morphine and Diamorphine that killed sickle cell disease patients as NCEPOD later confirmed [40 41] was, and still is licensed “for this indication”. Indeed, despite NCEPOD damning patients-dying-from-Opiate-Overdose Report NICE issued Guidelines advocating Diamorphine intravenously in sickle cell crisis 
47. Konotey-Ahulu FID. Current “hit and miss” care provision for sickle cell disease patients in the UK http://www.bmj.com/cgi/eletters/337/jul11_2/a/771#199135 BMJ
Rapid Response 16 July 2008. (Reference 31 describes how 2 Consultants in the same UK Teaching differ on prescription of opiates to sickle cell disease patients).
48.. Konotey-Ahulu FID. Clinicians facing conflicting recommendations. Use commonsense? http://ww.bmj.com/cgi/eletters/337/nov28_2/a2530#205377 December 2008.
49. Konotey-Ahulu FID. Valsalva vitreous haemorrhage and retinopathy in sickle cell haemoglobin C disease. Lancet 14 June 1997 Volume 349 No 9067, pp 1774.
50. Konotey-Ahulu FID. Gnathopathy – Grades 1, 2, 3. In chapter 14 of Ref 7 & 8 – The Sickle Cell Disease Patient – “Gnathopathy – a word coined by the author – (gnathos = jaw in Greek) to describe a peculiar overgrowth of the maxilla” commonest in ‘SS’ phenotype. Grade 1 is slight; Grade 2 is obvious. Grade three is grotesque – alsp seen in beta-Thalassaemua major. Which grade could Shaniqua have?
51. Konotey-Ahulu FID. Mental neuropathy, a complication of sickle ce3ll crisis. Lancet 1972; 2: 388. Been termed KANUMBLLL SIGN (Konotey-Ahulu Numb Lower Lip Lancet Sign – mentioned in next Lancet reference [47 below]
52. Konotey-Ahulu FID. Sickle cell disease and the patient. Lancet 2005; 365(9457): 382-383.
53. Konotey-Ahulu FID. Inferior Dental Nerve Symptomatology in Dental Practice Needs Exclusion of Sickle Cell Disease. Journal of Dental Problems and Solutions. Peertechz Publications 4 August 2022 https://www.peertechzpublications.com
54. Konotey-Ahulu FID. Epistasis from sickle cell disease must not be forgotten. BMJ Rapid response https://www.bmj.com/content/344/bmj.e1097/rr/576087 28 Mar 2012
55. Konotey-Ahulu FID. Torrential epistaxis associated with symmetrical facial skin ulceration in sickle cell anaemia. BMJ 1965; 2:859-860 doi:10.1136/bmj2.5466.859 http://www.bmj.com/cgi/reprint/2/5466/859.pdf
56. Konotey-Ahulu FID, Kuma Eunice. Skeletal crumbling in sickle cell anaemia complicated by Salmonella typhi infection. Brit J Clin Practice 1965; 19: 575-578. http://www.pubmedcentral.nih.gov/picender.fcgi?artid=1846577&blobtype=pdf
57. Konotey-Ahulu FID. Acute osteomyelitis in African children unmasks un-masks sickle cell disease with salmonellosis BMJ Rapid Response February 1 2014 http://www.bmj.com/content/348/bmj.g66?tab=response
58. Konotey-Ahulu FID. Gall stones in sickle cell disease. Page 175 in Refs 10 & 11
59. Archampong EQ. Biliary tract disease and sickle cell disease in Accra. In, Proceedings Gastroenterol Mex 1975; 40: 220.
60. Archampong EQ, Konotey-Ahulu FID. Biliary tract disease and sickle cell anaemia in Korle Bu Teaching Hospital in Accra. Ghana Medical Journal 1975; 13: 175-180.
61. Wosornu Lade, Konotey-Ahulu FID. Gastric secretion in sickle cell anaemia. Gut 1971: 12: 187-199. (Frequent abdominal pain is not always related to sickle cells).
62 Konotey-Ahulu FID. Leg ulcers in sickle cell anaemia Chapter 16 Sickle Cell Dermatopathy in Ghana, pages 196-198 in Refs 10 & 11 The Sickle Cell Disease Patient.
63. Acquaye CTA, Gbedemah KA, Konotey-Ahulu FID. Glucose-6-phosphate Dehydrogenase Deficiency Incidence in Sickle Cell Disease patients in Accra. Ghana Med J 1977; 16: 4-9 (Proper management must include establishing G6PD status. Treating urinary tract infection or pneumonia with a drug that exacerbates haemolysis and hepatopathy in the G6PD Deficient is bad medical practice, not only for Blacks but also for Greeks who have both sickle cell disease and G6PD Deficiency. [Reference 37]
64. Konotey-Ahulu FID. G6PD Deficiency in Ghanaians. How to recognise it. Click ‘BLOG’ on www.sicklecell.md and click on January 2008 for 20 answers.
65. Olujohungbe A, Cinkotal I, Yardumian A. Hydroxyurea therapy for sickle cell disease in Britain. BMJ Editorial 1998; 316: 1689. “Many patients are unwilling to take the drug and they vote with their feet.” (Dr Olujohungbe himself was “SS”)
66. Olujoungbe Ade. Bi-directional trust is needed in pain management in sickle cell disease. BMJ Rapid Response 2 July 1999 to Maxwell K, Streetly A, Bevan D BMJ 161.999; 318: 1585-1590.
67. Wise J. Crizanlimubab. Sickle cell disease: first new treatment in two decades becomes available in England. BMJ 4 Oct 2021;375: n2429 (Same therapeutic claim was made for Hydroxurea, but let those who have survived 15mg/kilogram bodyweight, ie 750 mg daily for a 50 kg person for 10 years write to BMJ. It is to be noted that the lead author of the BMJ Editorial Dr Ade Olujohungbe was a UK-trained Haematolgist who temporarily tried Hydroxyurea for his Sickle Cell Anaemia. (Reference 60 above). He honoured my Sickle Cell Disease Patient Achievers Conferences to prove that he had brilliant non-sickling genes that made him a post-graduate Specialist. Dr Samuel Charache MD, The Johns Hopkins University Specialist who introduced Hydroxyurea to the world was also at the International Conferences and expressed amazement at Ghanaian patients who had neither been transfused nor given Morphine or Diamorphine. What need have they for “Experimental life-changing drugs”?
68. Crizanlizumab UK National Haemoglobinopathy Panel – NHP Guidelines https://www.nationalhaemoglobinopathy-nhs.net Following NICE recommendation of Crizanlizumab as a treatment option for preventing recurrent crises (vaso-occlusive)
69. NHS UK News 5 Oct 2021 announces deal for lifechanging sickle cell treatment. “Crizanlizumab, the new drug will be delivered by a transfusion drip ‘’will help as many as 5000 people over the next three years to have a much better quality of life.”
70. NHS treats first sickle cell disease patients with life-changing drug. 24 Feb 2022 https://www.england.nhs.uk > nhs-tr (Total misinformation to call this “life-changing”).
71. West London HCC Adakveo (crizanlizumab) 10 mg/ml concentrate for solution for infusion. This is licensed for prevention of recurrent vaso-occlusive crises (VOC’s) in sickle cell disease patients aged 16 or more years. It can be given as an add-on therapy to hydroxyurea/Hydroxycarbamide (HU/HC) or as monotherapy in patients for whom HU/HC is inappropriate or inadequate. https://www.medicinesresources.nhs.uk https://www.westlondonhcc.nhs.uk (Licensed, but Ketorolac fraction the cost is not).
72 NHS. https://www.kch.nhs.uk > news 23 March 2022 [Photo of Black lady] King’s College Hospital: King’s patient is first to receive new sickle drug Crizanlizumab after it was approved for use across the NHS in November 2021 (How much does King’s College Hospital pay for opiates per year? And how much for this experimental drug?)
73. BBC https://www.bbc.com > news > health 24 Feb 2022 New sickle cell treatment given to first patients in England. Crizanlizumab, a monoclonal antibody, binds to a protein on blood cells, preventing them from clumping. Sickle cells mostly affects black people. (Discussing this with her doctor would Shaniqua agree to these injections?)
74. Konotey-Ahulu FID. Malaria and sickle cell: “Protection?” Or “No Protection?” – Confusion reigns. BMJ Rapid Response October 13, 2008 http://www.bmj.com/cgi/eletters/337/oct01_3/a1875#203067 [Felix Konotey-Ahulu’s brother Tei developed priapism (Ref 70) whenever malaria precipitated crisis]
75. Konotey-Ahulu FID. Sickle cell priapism. Chapter 19 (pp 226-235 / Refs 10 & 11)
76. Konotey-Ahulu FID. Comments on “Stem cells cure sickle cell anaemia in mice” http://www.sicklecell.md/blog/?=200712 Dec. 8, 2007. (Public Health Procedure?)
77. LentiGlobin – Experimental Gene Therapy Reverses Sickle Cell Disease for Years. Columbia University https://www.cuimc.columbia.edu > 13 Dec 2021 The new gene therapy called LentGlobin, blood-forming stem cells. Preventing them from clumping. Sickle cell mostly affects black people. (Would it be used on Greek patients too?) COVID-19 VACCINATION EFFECTS CAN AGGRAVATE SICKLE CELL DISEASE
78. Underdown M J, Nuss Rachelle. Thrombocytopenia in a teen with sickle cell disease following COVID-19 vaccination. Pediatric Blood Cancer 2021 Dec, 68;(12): 29271. Published on line 2021 July 31. doi: 10.1002/pbc.29271 PMCID: PMC8441926 PMID: 34331506 (Is it wise to prescribe COVID-19 vaccines for these patients?)
79. The BMJ https://casereports.bmj.com/content/15/5/e…Acute interstitial nephritis after COVID-19 vaccination WebA woman in her 70s presented to the hospital being generally unwell 8 days following the first dose of the AstraZeneca COVID-19 vaccination. She was in stage III acute kidney injury (AKI) with hyperkalaemia and metabolic …
80. NHS-https://www.nhs.uk/conditions/covid-19/covid-19-vaccination/ COVID-19 vaccines side effects and safety – NHS WebLike all medicines, the COVID-19 vaccines can cause side effects, but not everyone gets them. Most side effects are mild and should not last longer than a week, such as: You or …
81. PubMed https://pubmed.ncbi.nlm.nih.gov/35214760 New-Onset Kidney Diseases after COVID-19 Vaccination: A Case … Web16 Feb 2022 · In this study, we report the clinical courses and histopathologic findings of new-onset kidney diseases after COVID-19 vaccination as confirmed via kidney biopsy. Five patients aged 42 to 77 years were included in this study, and baseline kidney function was …
82.Underdown M J, Nuss Rachelle. Thrombocytopenia in a teen with sickle cell disease following COVID-19 vaccination. Pediatric Blood Cancer 2021 Dec, 68;(12): 29271. Published on line 2021 July 31. doi: 10.1002/pbc.29271 PMCID: PMC8441926 PMID: 34331506 (Is it wise to prescribe COVID-19 vaccines for these patients?) Keywords: COVID-19; IgA nephropathy; kidney biopsy; kidney disease; minimal change disease; thrombotic microangiopathy; tubulointerstitial nephritis; vaccination.
83. A case of fatal multi-organ inflammation following COVID-19 vaccination.Nushida H, Ito A, Kurata H, Umemoto H, Tokunaga I, Iseki H, Nishimura A.Leg Med (Tokyo). 2023 Mar 20;63:102244. doi: 10.1016/j.legalmed.2023.102244. Online ahead of print.PMID: 36990036 Free PMC article. A 14-year-old Japanese girl died unexpectedly 2 days after receiving the third dose of the BNT1262b2 mRNA COVID-19 vaccine. …In the present case, arrhythmia of atrial origin was assumed as the cause of cardiac failure and death. In sudden post …
84. Liver injury following SARS-CoV-2 vaccination: A multicenter case … Web31 Jul 2021 · Six patients had a history of chronic liver disease, including 4 (#6, 10, 11, 13) with autoimmune hepatitis (AIH) in treated remission (i.e., no medication changes or abnormal labs for a minimum of 6 months). Three patients had cirrhosis: 2 patients with …Author: Hersh Shroff, Sanjaya K. Satapathy, James M. Crawford, Nancy J. Todd, Lisa B. VanWagner
85. LIVER INJURY FOLLOWING COVID-19 mRNA VACCINE … WebBackground: The COVID-19 mRNA vaccines have been associated with infrequent reports of liver injury. The aim of this study is to describe the
presenting features, liver hist See more videos of Liver Failure After COVID-19 VACCINATIONLiver injury after SARS‐CoV‐2 vaccination: Features of … WebOne patient developed mild liver injury after a first dose of Pfizer‐BioNTech vaccine but presented with severe liver injury following a second dose of the same vaccine.
86. Coombes Rebecca. GMC challenged over anti-vax doctors. BMJ 2023;381: p1220 June 3, 2023 page 339.
NOTA BENE: Page 258 of my THE SICKLE CELL DISEASE PATIENT says “Whereas only 261 (44.2%) of 591 sickle cell anaemia (‘SS’) patients had no liver enlargement, a total of 77.8% of about the same number of sickle cell haemoglobin C disease (‘SC’) patients had no liver enlargement. [Refs 10 & 11]. If my assumption is correct that Mary Shaniqua is ‘SS’-phenotype, then she is likely to have some degree of hepatomegaly. Does she in fact? And was she ever advised to take a COVID-19 vaccine which we now know can badly affect the liver? If I advised (as I do now advise) that those with hereditary Erythrocytopathy (Sickle Cell Disease or/and G6PD Deficiency) should not be given COVID-19 Vaccines would I be in danger of being lumped into the so-called anti-vax doctors that Rebecca Coombes BMJ 3 June 2023, page 337 reports are being accused by some anonymous doctors of spreading Misinformation that needed probing by the GMC when they cautioned their patients against COVID-19 Vaccination? 
Tribute by Professor Felix I D Konotey-Ahulu
Ebenezer Mensah Tagoe was born on Ghana’s Independence Day 6th March 1957. Like 3 of the 11 children born to my own parents Ebenezer had Sickle Cell Disease the hereditary cold rainy season rheumatism that Ga people call Tswetsweetswe (Chwechweechwe) known to us long before Europeans called it Sickle Cell Disease.
Parents of chwechweechwe children passed on the ache code to the child even when they themselves may not have the “ache” problem, because it takes 2 codes of “ache”, one from father, one from mother to make the child ache with cold season rheumatism.
Like in my own family those of us 11 children receiving an ache code from one parent and the normal blood code from the other parent do not ache in the rainy season. In other words, parents who are NORM-ACHE type like my own patients pass on NORM or ACHE code to a particular child, never both.
Ebenezer, as well as my 2 brothers and 1 sister got ACHE code from both our parents to produce double ACHE which combination makes the blood cells thicken under certain conditions to cause joint and body aches characteristic of Sickle Cell Disease.
HOW EBENEZER TAGOE BECAME ACHIEVER WITH SICKLE CELL DISEASE
Although it was being taught that sickle cell disease patients did not live beyond thirty years of age, Ebenezer lived longer than twice of 30 years because he quickly learnt that only certain events produced the serious pains (called crises) which he learnt to avoided – things like being caught in the rain, fever, and infections. He attended and spoke at all The International Conferences of Sickle Cell Disease Patient Achievers that I organised in 1993 at Royal Society of Medicine in London, 1995 in Accra, and 2010 also in Accra where he told the audience to much amusement that he had avoided painful sickle cell crisis in the previous 20 years by drinking 4 Litres of water every single day provided he could find a suitable place to pass water. He used to educate doctors in England. Ebenezer had trained as a professional pharmacist and worked in a London University Teaching Hospital where a Consultant Haematologist could not believe he had sickle cell disease until he tested his blood to find he possessed double ACHE codes making him ACHEACHE. His parents, like mine were healthy NORMACHE capable of donating NORM or ACHE codes to their children.
Ebenezer married a lady who was NORMNORM so that none of their children would have double ACHE Chwechweechwe or Sickle Cell Disease.
ABORTING SICKLE CELL DISEASE PREGNANCIES IS WRONG!
By doing so well professionally as a Pharmacist in a London Teaching Hospital Ebenezer proved that the sickle cell code (S) or gene was not the only thing his parents gave him. He received from his Mum and Dad codes for beauty, brilliance, sympathy, and kindness as well as the sickle cell codes so teaching doctors how wrong it was that they should advise parents to abort a pregnancy that tested had shown would produce sickle cell disease. Doctors today, today, today are aborting sickle cell disease pregnancies unaware that they could be aborting geniuses.
The International Conferences I organised were attended by great ACHIEVERS in Nursing, Teaching, Businesses, Pharmacy, and other professions. If the parents had aborted Ebenezer, could his brilliant children have been produced through a wonderful wife who helped him in his hereditary illness? Where did these children, now adults, get their brilliant genes from? He invited me and my wife in 1994 to their 10th Wedding Anniversary in England, and I was greatly happy when he named one of his sons after me for looking after him at Korle Bu.
WE SALUTE THE MEMORY OF EBENZER MENSAH TAGOE
We indeed salute the memory of one who achieved great things through suffering. At a time when younger people than him had been taken out of this life Ebenezer Mensah Tagoe lived to 65 years, defeated his last Enemy Death, and has gone into the GLORY to enjoy LORD JESUS CHRIST. My heartfelt Condolences, and my wife Rosemary’s go to his dear mother Mrs Janet Gifty Tagoe-Quayle and his brothers Prince Nwojo Tagoe, Jonathan Adokwei Tagoe, and George Felix Ankamah Tagoe, and also to the larger family.
TRIBUTE BY PROFESSOR FELIX I D KONOTEY-AHULU
H E A V E N
O think to step ashore, and that shore Heaven,
To take hold of a hand, and that hand God’s hand,
To breathe a new air, and that air Celestial air,
To feel invigorated, and know it Immortality,
O think, to pass from the storm and tempest
To one unbroken smile,
To wake and find it GLORY!
My brother-in-law Emeritus Professor Emmanuel Quaye Archampong who has just woken up in GLORY having passed through the storm and tempest of this earthly pilgrimage was a Titan. Definition of Titan is “Person of super-human size or intellect or strength”. Allow me to tell the long story:
Right from Accra Academy, University College of the Gold Coast, which was then a University College of London University, then to University College of London proper (UCL) and through both Royal Colleges of Surgeons Edinburgh and London, Quaye Archampong shone very brightly. Sometimes so brightly, outshining all comers of different nationalities that he not only astounded his British Teachers but also brought up the very worst character in at least one English racist postgraduate teacher in an incident that is worth mentioning later to prove another side of Emmanuel Quaye Archampong, his attractive godliness.
1955: While in the middle of my pre-Clinical studies at the University College in London (UCL) I received an interesting letter from Legon. I noted the peculiar spelling of the surname “Archampong” of the writer who told me he had won a government scholarship to come to the same UCL to read MEDICINE. We began correspondence which resulted in him joining me the next year at the inter-Varsity Fellowship men’s hostel ALLIANCE CLUB at 2 Bedford Place, London WC1, just walking distance from UCL whose Anatomy Professor was none other than Professor J Z Young FRS (Fellow of the prestigious Royal Society), World-Number-One in Anatomy, and whose massive textbooks “The Invertebrates” and “The Vertebrates” were the ones used in every single university in the entire world.
1956: Archie as everybody called him began to top his Class of some 120 students from all over the world in Anatomy, Physiology, and Biochemistry the three major subjects for the 2-year Course that required studying and passing before “walking the Wards” of any medical school hospital to study the Clinical Medicine of learning what the patients were suffering from and how to treat them.
When the results of the “Second MB” at the end of the 2-year pre-Clinical Course came Archie did so well in each subject that the three professors (of Anatomy, Biochemistry, Physiology) were happy to invite him to stay on for another couple of years to do a SPECIAL DEGREE in their expertise. Archie chose to be with Professor J Z Young (Anatomy) with 10 other students – all White – picked from London University’s 9 other Medical Schools because they also excelled in the 2nd MB Examination.
That Incident: Although Professor J Z Young was “racially colour-blind” one of his senior postgraduate teachers so hated the idea that a Black African could outperform very brilliant White students that he did something that I can only describe as abominable. When Archie, totally shattered, was telling me this in The Alliance Club on returning from UCL in the evening he kept punctuating what he narrated with “Oh I can’t believe this!”, “I cannot believe what happened!” “Oh, I cannot believe this!”
He was more sad than angry, but I was more angry than sad. I asked him to report what happened to Professor J Z Young, but he flatly refused and looked forward to the next 3 years “walking the wards” at University College Hospital UCH) just across Gower Street. I had moved on from UCL to “walk the wards” at Westminster Hospital for my Clinicals while we both lived in the IVF Hostel Alliance Club in Bedford Place.
University College Hospital, Gower Street, London WC1
As a Clinical Medical Student Archie continued to shine remarkably in Medicine, Pathology, Surgery, Obstetrics and Gynaecology, and Psychiatry. After the 3 years of “walking the wards”, delivering babies, and visiting mental hospitals Emmanuel Archampong took the Final MB BS Exams with nearly a thousand other students from the 11 other Medical Schools comprising London University and was among the top 4 to be given Honours and Distinctions. To get Honours and Distinctions on graduating in a UK Medical School was (and still is) such a credit to the Medical School that “House Jobs” are guaranteed to those newly qualified doctors who brought such honour to the Medical School.
Professor of MEDICINE at UCH was then Sir Max Rosenheim, MD FRCP FRS President of the Royal College of Physicians, London, and Sir Max invited this Ghanaian genius to be his House Physician. Wao! Ghanaian getting what I considered the top House Job in all England?
Then what I consider a miracle happened.
Half-way through his 6-month House Job Dr E Q Archampong had a bleep call on his alert phone urgently to go and see a patient on the Private Wing of the hospital.
“Why?” Archie asked. “My Boss Professor Sir Max Rosenheim does not have a patient on the Private Wing”. The voice on the bleep insisted that it was the patient on the Private Wing that asked to see Dr Archampong urgently even though he was not one of the patients Archie was supervising.
Quickly he made his way to the Private Ward. As he entered the private single room, he saw a very ill man breathing heavily and beckoning from amidst the pillows. “Come close” he said. Archie recognised his voice. “Please forgive me, Archie. Forgive me. Some three years ago I deceived you and deprived you of a well-earned position. Please forgive me. I have carcinoma of the lung that has spread.”
“As soon as it happened, Sir, I realised what you had done. And I forgave you” Dr Archampong responded. The doctor sank back among the pillows. He died 2 weeks later. Archie was a staunch believer in The LORD JESUS CHRIST. He did truly forgive Dr XY the moment he realised the deception he inflicted on him.
Sunday Worship in London led to meeting future wife at Korle Bu
From The Alliance Club on Sundays, we used to go to All Souls Church, Langham Place, London W1 (Rev John Stott) in the morning, and to Westminster Chapel SW1 (Dr Martyn Lloyd-Jones) in the evening. Archie and I later settled at Westminster Chapel not only because Dr Lloyd-Jones had been a world-class Physician at St Bartholomew’s Hospital before he left to become preacher, but also because he was considered the greatest preacher of the 20th Century. Archie took brief respite from his busy house-job at UCH to attend the marriage ceremony conducted by Dr Martyn Lloyd-Jones on Easter Monday 1962 between Rosemary Moss and myself. The DOCTOR’s sermons so gripped and blessed us both that I brought hundreds of his tape recordings home to Ghana for weekly devotion in our home at Korle Bu on Tuesday evenings.
It was when my sister Catherine Awura-Atta was staying with us at 21 Slater Avenue on the Korle Bu Hospital Compound, and Dr E Q Archampong had returned from England as a Surgeon and wished to continue listening to Dr Martyn Lloyd-Jones’ sermons that the two of them met. And the rest is history.
GOD Almighty blessed Emma and Awura-Atta
She called him ‘Emma’ and he called her ‘Awura-Ata’. They were blessed with 5 children beginning with 2 adorable girls Eliz and Nana Ruth, plus 3 elegant boys David, Timothy and Ashirifi. Their mother Mrs Catherine Awura-Ata Archampong deserves FULL MARKS for raising 5 children through the most turbulent political periods in Ghana’s history with shortages of essential commodity. Queuing up for milk for the children? But difficulties did not derail her husband from hard work – teaching to produce doctors, operating sometimes far into the night, and being elevated to become Dean of the premier Medical School in Ghana.
Friends of The LORD JESUS CHRIST become enemies of GOD’s enemy – the devil. That was how I interpreted what happened soon after Emmanuel was made Dean of the Medical School. Suddenly a ferocious fire erupted in the Dean’s Office when he was not there. But for the timely arrival of Fire Engines, the entire Dean’s Block would have been burnt to ashes. Reminded me of what The LORD JESUS once said when something pernicious was done secretly: “An enemy has done this!” [Matthew chapter 13 verse 28].
Details of his monumental work in face of difficulties are mentioned elsewhere in other Tributes – University of London Master of Surgery, Fellowship of Royal Colleges of Surgeons of Edinburgh and of England, of Ghana Academy of Arts and Sciences, of West African College of Surgeons, Ghana College of Physicians and Surgeons, etc. The big Surgery book of over 1,300 pages he edited with Professor E A Badoe and Colleagues is a lasting monument for Africa. His contributions at International Conferences were enormous. As for teaching to produce doctors undergraduate and postgraduate, just look at the testimonies on WhatsApp to appreciate how highly Professor Archampong was regarded. He was rewarded with National and International Honours.
Compassion and Dedication to Duty.
When during one political upheaval with strikes and unruly soldiers invaded Korle Bu, harassing nurses and doctors many of whom fled their bungalows, as some very diligent doctors like Dr Dwomoa Adu and Dr Yaw Anim-Addo who initiated Artificial Kidney Service in the Medical Block, and Dr Ghosh of Maternity sneaked back quietly to monitor their patients, so Dr Archampong unnoticed by the soldiers would walk back from his parents’ home at Korle-Gonno to see patients he had operated upon. His compassion was proverbial. Whenever our young children were howling in pain after cutting themselves and bleeding playing in the garden at Korle Bu heard their mother say, “Uncle Archie is coming, I have called him”, miraculously all crying stopped, bleeding or no bleeding. Stitching wounds became painless. I had such confidence in him that when I was practising in London and rich Ghanaians flew across The Sahara asking me to refer them to the best surgeons for this and for that I sent most of them back to Archie in Accra with results of investigations. And they were extremely satisfied.
Family Man that will be hugely Missed
Amidst all the busy hectic routine – teaching, operating, meetings, conferences, writing articles and editing books, planning courses, administrative machinery of The Deanship, Archie found time for his family. Statement to me of Mrs Eliz Dadson, the eldest, the day their father left this Earthly Pilgrimage was as from all her siblings: Ruth Nana Anson, David, Timothy, Ashirifi, “Daddy was always there for us”. Indeed, he was. And my beloved Sister Catherine told me: “GOD called him!”
The pain is big, not only for the Archampong Family – Sister Victoria, Brother Augustus, and their families – but also for the Konotey-Ahulu Family – the families of Edna Soyannwo, Gritty Gboloo, Ruby & Jerry Djangmah, Helen & Emil Sachs, Ann and Kwesi Andoh, and my own family, Rosemary and Dawid, Carys and Lydia – we have all suffered this loss.
Archie’s Mother’s Perpetual Song – Trusting JESUS That is All
I knew Archie’s father played the organ for Church Service at Mamprobi Methodist Church, but I did not realise his mother was also musical. I can’t remember ever visiting their home in Korle Gonno without hearing his mother singing or humming this tune by Ida B Sankey [1840-1908] to words by Edgar Page Stites [1836-1921], which mysteriously came to me before I heard of Archie’s illness.
m: r f: m m: r d:- Simply trusting every day
d: l d: l sI d m r:- Trusting thru a stormy way;
m: r f: m r: d l:- Even when my faith is small,
sI d m sI: m m: r d Trusting JESUS that is all.
sI: m sI: m m: r r:- Trusting as the moments fly,
m: t d: d r: l t:- Trusting as the days go by,
d: d r: r m: m f:- Trusting HIM what e’er befall
sI: l sI m d m: r d:- Trusting JESUS that is all.
Ao, we do not weep like those who have no hope; we weep because we miss the very beloved husband, the Daddy, the grand Dad, the brother in law, the friend, the ..
We go on trusting The LORD JESUS CHRIST: That is all! 1 Corinthians 15 vs 18-19.
On May 20, 2022, I received a letter from University of Cape Coast, Ghana, hich began thus:
“Dear Sir, INVITATION TO SPECIAL AWARD CEREMONY AND LAUNCHING OF 2023-2027 UCC RESEARCH AGENDA AND UCC AT 60 INVOCATION REPORT
“The Times Higher Education 2022 World Universities Ranking adjudjed University of Cape Coast (UCC) as first in Ghana and West Africa, fourth in Africa and ranked first globally for citations. This great achievement of the University was made possible by dint of your scholarly contributions and commitment to the mission of the University.
“In showing appreciation, University Management has scheduled a special ceremony to award you for your invaluable support to the course of this institution … …”
MY CONTRIBUTION THROUGH BMJ FREQUENTLY CITED
My Acceptance Speech https://youtu.be/SewHhUBEkTo after being honoured on May 31 in Ghana included the great role BMJ played in my being more cited than any other to make “The Times Higher Education 2022 World Universities Ranking place University of Cape Coast where I am Kwegyir Aggrey Professor of Human Genetics “first globally for citations”.
EDUCATION comprises correcting errors as well as proclaiming new things and emphasizing important facts. I would like to think since 1965 when BMJ published three new things for me the five Editors in succession have enabled me to correct errors, challenge received wisdom, and even make known one invention (MPSI) I made in Clinical Genetics. How these Editors have helped me publications-wise is described here. Perhaps some aspects may help doctors half my age because some of what might be called “Minor Communications” contained such not-known-about-before information that they appeared in the CITATIONS.
My profound gratitude goes to Dr Hugh Clegg, Dr Martin Ware, Dr Stephen Lock, Dr David Smith, Dr Fiona Godlee, all who were very helpful to me in the past 59 years.
WITH EDITORS DR HUGH CLEGG 1963 TO DR FIONA GODLEE TILL 2021
My detailed publications, minor and major, reflect why some continue to be cited decades after they originally appeared.
DR HUGH CLEGG 12th BMJ Editor 1947 to 1965: My first BMJ Communication was 18 June 1963 [1a]. In 1965 Dr Clegg published my “Varicose veins in pregnancy” [1b]; Torrential epistasis associated with symmetrical facial skin ulceration in sickle cell anaemia” [1c]; Colleagues and I from London’s Royal Free Hospital described “peripheral neuropathy from dialysis in end-stage renal failure” [1d]
DR MARTIN WARE The 13th BMJ Editor (1966-1975) published for me January 27, 1966 [2a]. Year 1969 was when he invited me to write “PERSONAL VIEWS” and paid me £100 for each, equivalent to 3 times my monthly Ghanaian Physician Specialist salary.
I wrote three: (i) Superstition and Phenomena in Africa [2b] (ii) Genetic Counselling in Sickle Cell Disease [2c], (iii) in 1975 he published my PERSONAL VIEW “Tafracher” the Ghanaian vital devulgarizing word [2d] https://bit.ly/3mJBMfm
Two Medical Memoranda in 1969, Ghanaian Family of 14 and 15 with not a single Normal Haemoglobin gene [2e 2f] continue to be quoted today 53 years later. Then in 1970 came “Haemolytic anaemia in pregnancy in Nigerians” [2g] and in 1971 “Malaria and Sickle cell disease” [2h].
In 1972 Dr Martin Ware rang me in Ghana to discuss an article three British doctors published with erroneous information, and which he later made the authors withdraw. He published my reactions to the authors’ article [2i 2j]. FULL MARKS to him for pursuing authors for truth. Another communication came on 28 October 1972 correcting dangerously wrong detection of sickle haemoglobin S, cited last month 50 years later [2k].
DR STEPHEN LOCK CBE 14th BMJ Editor (1975-1991) had dealings with me when AIDS was raging. In those days, articles submitted, refereed, editors’ decision, and publication took ages. But when I submitted my detailed fact-findings soon after a 6-weeks’ tour of several African countries to study grassroots epidemiology of AIDS it took just 18 days from submission date for Dr Stephen Lock to publish my “Clinical Epidemiology, not sero-epidemiology, is the answer to Africa’s AIDS Problem” [3a].
Reprint requests poured in from everywhere, 567 in all because what I described happening on my Continent was entirely different from the Media Mantra “Scientists blame African Green Monkey for AIDS in Africa, therefore Wear Condoms!” http://www.bmj.com/cgi/reprint/294/6587/1593.pdf [3a]
Dr Stephen Lock did make my voice heard not a few times 1977 [3b], 1980 [3c 3d – MPSI],1981 [3e], 1982 [3f – Sickle cell disease survey], 1984 [3g – Ethical issues in prenatal diagnosis July 21], 1985 [3h Ethnic minorities and sickle cell disease, 3i – Tribute to Prof. Hermann Lehmann], 1986 [3j – Epidemiology Correctly Defined] 1991 [3k Kwashiorkor Ghanaian tribal word origin, 3l – Penicillin prophylaxis in sickle cell disease, 3m – Morphine queried for sickle cell disease patients] – all these appear in my 434 minor and major Publications listed on www.konotey-ahulu.com or www.sicklecell.md [3n]
But what I cherished most was when Dr Lock in 2001 published the Genetic Index I invented, “MPSI”, which proved mathematically that procreation-wise females can never be the equal of males [3d].
Funny enough, Dr Stephen Lock’s last year as Editor was when I met the elegant lady who later became BMJ Editor, Dr Fiona Godlee. I had gone to BMA House to donate copy of my newly published Magnus Opus “THE SICKLE CELL DISEASE PATIENT” [3o 3p] to the Editor as I had just done to Lancet’s Editor [3q]. It was to her I gave the book to pass on to Dr Stephen Lock who was glad to see me because we both had learnt much from Professor Hermann Lehmann MD FRS in Cambridge.
DR RICHARD SMITH 15th BMJ Editor 1991-2004 published my Tribute [4a] to the remarkable Professor Dame Sheila Sherlock, the then Liver Queen of the world who with the recommendation of her husband Dr Geraint James MA MD FRCP, Teacher for the MRCP Exam of Therapeutics at Royal Postgraduate Medical School Hammersmith Hospital for the MRCP Exam, made me Research Fellow in her Department of Medicine at the Royal Free Hospital to work on the Renal Unit of the kidney giant Dr Stanley Shaldon MA MD FRCP in 1964-1965. Outcome of my research was one of the 1965 BMJ articles still quoted in 2022 on dialysis for end-stage renal failure. [1d]
Dr Richard Smith also published for me four clinical experiences for which I coined the word supra-scientific, for so each of them was, and still are. [4b].
A remarkable article by Didier Fassin and Helen Schneider [4c] revealing scientific misbehaviour in South Africa as contributing to AIDS havoc in the Black Population prompted me to respond with a 7,000-word article and 70 References which Editor Richard Smith did not reject, but published on line in its entirety [4d], available on http://www.rethinking.org/bmj/response_30917.html even today. I was 30th of 835 Responders from the year 2003 to 2005 when Dr Smith handed the Editor’s baton to Dr Fiona Godlee.
ENTERS DR FIONA GODLEE [16th BMJ Editor 2005-2021]
As soon as Dr Godlee assumed reins of the BMJ she stopped all Rapid Responses on AIDS in South Africa. I was crest-fallen because Responders had been inching nearer and nearer to what Leonard G Horowitz brilliantly dissected in 598 pages of his “Emerging Viruses: AIDS & Ebola – Nature, Accident or Intentional?” [5a].
The Didier Fassin/Helen Schneider bombshell [4c] was full of Facts authenticated by Archbishop Desmond Tutu’s Reconciliation Exercise [5b] when scientists with Nazi proclivities confessed to wrongdoing. To halt Debate on an article that revealed “Parliamentarians rejoicing at how Blacks are dying from AIDS” [4a] caused Africans to mutter “Do we now have a Racist BMJ Editor?” But Dr Fiona Godlee was not at all racist. Two years on one Debate which could go on and on indefinitely? As former Editor of Ghana Medical Journal [5c 5d 5e 5f] I have admired the way Dr Fiona Godlee has navigated choppy journalistic waters. Paranoid African spectacles make me sometimes impatient with what I read in the BMJ, but as I put myself in her shoes, I admit freely she had done much better than I would have ever done. I gave her “Pluses” for making my voice heard very often in BMJ-on-line as indicated below:
ONE AFRICAN DOCTOR’S TESTIMONY TO DR FIONA GODLEE’S KINDNESS
I said EDUCATION involves correcting misinformation, teaching new things, underlining irrefutable facts, and challenging Received Wisdom.
“Kwashiorkor” – name we in my Krobo-Dangme-Ga mega tribe in Ghana [5g] have for centuries had for the childhood disease later described by Cicely Williams [5h 5i] – was the first article [224 in Publications List] of some 100 times in the BMJ that the Editor Dr Godlee permitted my voice to be heard from 14 May 2005 to 2021.
Researchers who cited me freely agree that the “List of Publications” found in www.konotey-ahulu.com or www.sicklecell.md [3j] reveals where Misinformation apart from that of Kwashiorkor in textbooks has been corrected.
For example, there has been widespread misinformation that sickle cells protect against malaria, when in fact malaria is known to be the greatest killer of children with sickle cell disease in Africa [3a 5k(284) 5l 5m].
I was born of Trait parents into a Sickle Cell Disease home with 3 sickle cell disease children of 11 offspring, enabling me as a doctor to place “The Sickle Cell Disease Patient” above “Sickle Cell Disease”. Malaria always brought on sickle cell crisis! To allow patients’ wellbeing, “Clinical Experience” which was with me from childhood was enhanced as a doctor to value it above “Haematological Experience” [5n].
Supernatural Phenomena, Darwinian Evolution, Public Health including Vaccinology form part of my publications list.
Dr Fiona Godlee continued to make my voice heard on several different topics allowing me to challenge Received Wisdom: Using my Publications List references to check, other articles are Human resources for health in Africa , Doctors as lapdogs to drug firms , Prenatal tests and abortion [261 331 334 417], Traditional Medicine , Stethoscope and Parkinson’s Kap’s sign [264 295], Sickle Cell Care centres , Four bodyguards for speaking scientific truth , Pharmacovigilance , Opiates for dying and sickle cell disease patients , Circumcision and alleged AIDS protection , Malaria [279 302 304 320], UK Sickle Cell Disease Patient mismanagement [280 293], Vaccines for genital warts , International Donors and conflicting interests [286 293], Conflicting Advice in Clinical Medicine [287 316], Haemodialysis, home and other [ 288 291 315], The soul is supra-scientific , NCEPOD Report Poor care of sickle cell disease patients in UK [296 300 357], Sickle Cell Disease Patient management [374 419], Internet Revolution , BMJ Archive and other [303 360], Genetic Testing HGC and Public Health [305 408], Blowing own trumpet , Fixed drug eruption [307
310], Abdominal aortic aneurysm , Free health care must demand responsibilities , Drug related deaths rising, and NICE [313 357 358], Honest nurses , Politics and Science , G6PD Deficiency , Genetic Code is supra-scientific , Editors and Peer review , Modern Genetics blind alley? , WHO and H1N1 Pandemic , Pain relief politics and economics , President Obama apologises over unethical Guatemala syphilis study , Nobel Laureate Robert Edwards , Physician Dr Geraint James , Ethics of gene replacement , Music and Tonal Language [339 340], Evangelical Christian appointment controversy , Scientific African Revolution through Facebook and Twitter , Belief in God ridiculed [301 344 345 346 399], Epistaxis , Wikipedia , NHS Hospital Delivery Care questioned , Pulmonary embolism [361 364], Liverpool Care and Assisted Dying [362 365], Clinical Guidance in Chemotherapy , Opiods in the UK , Osteomyelitis , Erectile Dysfunction , Ebola and HIV AIDS [384 385 386], Medical Ethics: Scientists abandon moratorium on germ line editing , Sickle cell hip pathology [388 421], Home Office VISA [391 392], Brexit and Democracy , International Medical Graduates and quality of care , Routine blood tests , International fraud and drugs , GOD mentioned in BMJ Editorial [409 410], Personal Faith , Aviation safety and scientific misinformation , Evidence, the human dimension , Transgenderism [424 424a], COVID-19 [427 428 429 432].
Is all this part of the reason almost every week, ACADEMIA (Oxford) and ResearchGate (Berlin) alert me that they have observed someone, somewhere, somewhen, has cited me in their publications?
It seems to me the only Minus I observed from Dr Fiona Godlee in a multitude of Pluses was when she allowed that tail-wagging-the-dog Editorial which suggested we replace sex-at-birth with gender later-on [424a]. Sharing in her huge success, I must mention Dr Kamran Abbasi (now Editor), Dr Peter Doshi, and Ms Sharon Davies. Well Done, Great Team, and Thank You!
1. Personal interactions in the past of an aged physician like myself (92 years on 12th July 2022) with a world class Medical Journal like the BMJ may well help in one way or other Consultants half my age, Registrars a third my age, House Officers quarter my age.
2. Tribal Information on Kwashiorkor, and Sickle Cell Disease Patients with Malaria, can expose scientific misinformation.
3. Received Wisdom must not just be accepted because it is trumpeted by so-called experts and accredited Committees and Organisations like WHO, NICE, and NIH..
4. It needs to be proclaimed to students and teachers that Science cannot be used by anybody however brilliant to explain everything.
5. That Science has no place for GOD has not prevented BMJ editorials on GOD.
6. Ethics is not part of science because lying scientists and scientific liars exist.
7. Editorial Integrity decade after decade has placed the BMJ top of the global Class.
8. Personal gratitude to the BMJ requires acknowledgement.
Conflict of Interest: None Declared, but Bias stems from longevity by the grace of GOD which has made my very first ever major article published in 1965 [Sicklaemic Human Hygrometers, Lancet 1965; 1: 103-104] cited in June and October 2022]
Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) DSc(UH) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics and at Cromwell Hospital London SW5 0TU, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL [www.sicklecell.md] https://youtu.be/41a1FZSpHd4 & https://youtu.be/SevUBEHhTo for Awards on video]
1a Konotey-Ahulu FID. “Case of lightning burns” BMJ 1963; 1: 1547. June 18 1963 doi:10.1136/bmj.1.5344.1547 http://www.bmj.com/cgi/reprint/1/5344/1547-apdf
1b Konotey-Ahulu FID. Varicose veins in pregnancy. BMJ 1965; 2: 1065. doi:10.1136/bmj.2.5469.1065 www.bmj.com/cgi/reprint/25469/1065.pdf
1c Konotey-Ahulu FID. Torrential epistaxis associated with symmetrical facial skin ulceration in sickle cell anaemia. BMJ 1965 Oct; 2: 859-860. doi:10.1136/bmj.2.5466.859 http://www.bmj.com/cgi/reprint/2/5466/859.pdf
1d Konotey-Ahulu FID, Baillod RA, Comty CM, Heron JR, Shaldon S, Thomas PK. Effect of periodic dialysis on the peripheral neuropathy of end-stage renal failure. BMJ 1965; 2: 1212-1215 (Nov. 20) doi:10.1136/bmj.2.5472.1212 http://www.bmj.com/cgi/reprint/2/5472/1212.pdf
2a Konotey-Ahulu FID. Epistaxis in sickle cell anaemia (12 References). BMJ 1966; 1: 234. doi:10.1136/bmj.1.5481.234-a (January 27)
2b Konotey-Ahulu FID. Personal View (Superstition and phenomena in Africa). BMJ 1969; 2: 48 doi:10.1136/bmj.2.5648.48 http://www.bmj.com/cgi/reprint/2/5648/48.pdf (April 15, 1969)
2c Konotey-Ahulu FID. Personal View (Genetic counselling in sickle-cell disease). BMJ 1969; 3: 235 doi:10.1136/bmj.3.5664.235 [Substitute ACHE for ‘bad’ and ‘wrong’, and NORM for ‘good’] http://www.bmj.com/cgi/reprint/3/5664/235.pdf
2d Konotey-Ahulu FID. Tafracher – Personal View. BMJ 1975; 1(5953): 329. (Feb. 8 doi:10.1136/bmj.1.5953.329 http://www.bmj.com/cgi/reprint/1/5953/329.pdf Ghanaian Devulgarising word https://bit.ly/3mJBMfm
2e Konotey-Ahulu FID and Ringelhann B. Sickle-cell anaemia, sickle-cell thalassaemia, sickle-cell haemoglobin C disease and asymptomatic haemoglobin C thalassaemia in one Ghanaian family. BMJ 1969 Mar 8; 1(5644): 607-612. doi:10.1136/bmj-1.5644/607 http://www.bmj.com/cgi/reprint/1/5644/607.pdf
2f Bentsi-Enchill KK, Konotey-Ahulu FID. Thirteen children from twelve pregnancies in sickle-cell thalassaemia. BMJ 1969; 3: 762 doi:10.1136/bmj.3.5673.762
2g Konotey-Ahulu FID. Haemolytic anaemia in pregnancy in Nigerians. BMJ 1970: 2(5701): 112 doi: 10.1136/bmj.2.5701.112-a (April 11)
2h Konotey-Ahulu FID. Malaria and sickle-cell disease BMJ 1971 June; 2(5763): 710-711 doi:10.1136/bmj.2/5763.710-d
2i Konotey-Ahulu FID. Sickle Cell Trait and altitude. BMJ 1972; 1(5793): 177-78 January 15 doi:10,1136/bmj.1,5793.177-a http://www.bmj.com/cgi/reprint/1/5793/177-a.pdf
2j Konotey-Ahulu FID. Sickle cell and altitude. BMJ 1972;2: 231-232. 2k Konotey-Ahulu FID. Detecting sickle haemoglobin. BMJ 1972; 4: 239.
3a Konotey-Ahulu FID. Clinical epidemiology, not sero-epidemiology, is the answer to Africa’s AIDS problem BMJ (Clin Res Ed) 1987; 294(6587): 1593-1594 (June 20 1987) doi:10.1136/bmj.294.6587.1593 http://www.bmj.com/cgi/reprint/294/6587/1593.pdf
3b 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/cgi/reprint/1/6076/1595.pdf
3c Konotey-Ahulu FID. English-speaking peoples. (Book Review: English Tests for Doctors by Dick Alderson and Vivienne Ward). BMJ 1980; 280 May 24: 1267-1268. doi:10.1136/bmj.280.6226.1267 http://www.bmj.com/cgi/reprint/280/6226/1267.pdf
3d Konotey-Ahulu FID. Male procreative superiority index (MPSI): The missing co-efficient in African anthropogenetics. BMJ 1980; 281(6256): 1700-1702 doi:10.1136/bmj.281.6256.1700 http://www.bmj.com/cgi/reprint/281/6256/1700.pdf http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1715685&blobtype=pdf |
3e Konotey-Ahulu FID. Problems of overseas doctors. BMJ Clin Research Ed; 282(6276 :1621-1622 doi:10.1136/bmj.282.6276.1621-a http://www.bmj.com/cgi/reprint/282/6276/1621-a.pdf 1981 May 16 1981
3f Konotey-Ahulu FID. Survey of sickle-cell disease in England and Wales. http://www.bmj.com/cgi/reprint/284/6309/112-a.pdf BMJ 1982; 284(6309): 112. doi:10.1136/bmj.284/6309/112a January 9, 1982.
3g Konotey-Ahulu FID. Ethical issues in prenatal diagnosis. BMJ Clin Res Ed 1984; 289(6438): 185. July 21. doi:10.1136/bmj.289.6438.185-a 6143955 http://www.bmj.com/cgi/reprint/289/6438/185-a.pdf
3h Konotey-Ahulu FID. Ethnic minorities and Sickle Cell Disease. BMJ Clin Res Ed 1985; 290(6476): 1214 http://www.bmj.com/cgi/reprint/290/6476/1214.pdf
3i Konotey-Ahulu FID. Tribute to Professor Hermann Lehmann CBE, MD, PhD, ScD, FRCP, FRCPath, FRSC, FRS. BMJ 1985; 291: 288-289. (July 27, 1985) doi:10.1136/bmj.291.6490.288
3j Konotey-Ahulu FID. Points: A boost for clinical research. BMJ April 1986, page 1081 “If, as I have always thought, the discipline of clinical epidemiology seeks to answer the questions How? Which? When? Who? What? Why? Where? Are we more likely
to get clearer answers in the north to questions relating to the south?” http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1340158&blobtype=pdf
3k Konotey-Ahulu, FID. Kwashiorkor. BMJ 1991, 302(6769): 180-181. Jan 19. (Explaining what this Ghanaian tribal word means) doi:10.1136/bmj.302.6769.180-chttp://www.bmj.com/cgi/reprint/302/6769/180-c.pdf
3l Konotey-Ahulu, FID. Penicillin prophylaxis in children with sickle cell disease. BMJ 1991; 302(6786): 1205-06. (May 18 1991) doi:10.1136/bmj.302.6786.1205-b (Commenting on paper by Cummins, Heuschkel & Sally Davies – Brit Med J 1991; 302: 989-90.) http://www.bmj.com/cgi/reprint/302/6786/1205-b.pdf
3m Konotey-Ahulu, FID. Morphine for painful crises in sickle cell disease. BMJ 1991, 302(6792): 1604. (June 29) doi:10.1136/bmj.302.6792.1604-c http://www.bmj.com/cgi/reprint/302/6792/1604-c.pdf (Comment on Professor Chamberlain’s recommendation of morphine in pregnancy in sickle cell disease – BMJ 1991; 302: 1327-30.)
3n Konotey-Ahulu FID. Website on Sickle Cell Disease Patient www.sicklecell.md and www.konotey-ahulu.com
3o Konotey-Ahulu FID. The Sickle Cell Disease Patient. The Macmillan Press Ltd.,1991 & Reprinted 1992. Republished 1996 by T-AD Co [See 3n below]
3p Konotey-Ahulu FID. The Sickle Cell Disease Patient. TETTEH-A’DOMENO COMPANY 1996, P O Box 189, Watford WD1 7NJ, England. ISBN 0-95- 9515442-2-
5 Foreword by Professor Roland B Scott MD, Howard University Center for Sickle Cell Disease. [643 pages]
3q Weatherall Professor Sir David FRS MD FRCP FRCPath. Lancet June 29, 1991 Volume 337 page 1590 says “The Sickle Cell Disease Patient” is a fitting tribute to a physician who has done as much as anyone to improve facilities to deal with this condition in Africa.
4a Konotey-Ahulu FID. Dame Sheila Sherlock’s Third World Dimension. BMJ rr 20 Jan 2002 http://www.bmj.com/content/324/7330/174.1.extract.reply#bmj_el_18859
4b Konotey-Ahulu FID. The supra-scientific in clinical medicine: a challenge for Professor Know-All. http://www.bmj.com/cgi/reprint/323/7327/1452.pdf Brit Med J 2001; 323(7327):14521453 Dec 22-29 doi:10.1136/bmj.323.7327.1452
4c Fassin Didier, Schneider Helen. The Politics of AIDS in South Africa: beyond the controversies. BMJ 2003; 326: 495 https://doi.org/10.1136/bmj.326.7387.495 March 1 2003.
4d Konotey-Ahulu FID. Wake-up call and need for paradigm shift. Brit Med Journal 2003 ‘Rapid E-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). [7000 words with 70 references] http://www.rethinking.org/bmj/response_30917.html
5a Horowitz Leonard G. Emerging Viruses: AIDS and Ebola – Nature, Accident or Intentional? Tetrahedron, Inc. Rockport MA, 1998 ISBN: 0-92350-12-7
5b Maharaj Akaash. Desmond Tutu was right. The Truth and Reconciliation Commission. Report submitted October 28, 1998.
5c Konotey-Ahulu FID. Toxoplasmosis. Ghana Medical Journal 1970; 9: 67-68 (Editorial – 7 references)
5d Konotey-Ahulu FID. Vitamin A in Cholesterol biosynthesis and pathogenesis of atherosclerosis (Editorial) Ghana Medical Journal 1972; 11: 3-4.
5e Konotey-Ahulu FID. An International Sickle Cell Crisis. Ghana Medical Journal March 1972; 11: 4-8 (Editorial)
5f Konotey-Ahulu FID. The Tyranny of Fashion in Medical Journals. Ghana Medical Journal [Editorial], 1972; 11: 168-172.
5g Konotey-Ahulu FID. Issues in Kwashiorkor. Lancet 1994 February 26, Volume 343, page 548. [Lancet published picture of Dr Cicely Williams and me in Oxford at Somerville College when I accompanied Ghana High Commissioner His Excellency Annan Cato and Vice Chancellor University of Ghana Professor Akilagpa Sawyerr to confer Honorary DSc on the remarkable lady who first described Kwashiorkor using the Krobo-Dãngme-Gã Tribal word for the malady in the world Medical Journals. Correcting widespread misinformation about what my tribal name Kwashiorkor means I said in this Lancet communication “Kwashiorkor is the result of a social Pathology before it is outcome of a biochemical pathology”. It does not mean red hair!
5h “Mechanism through which Hb S protects against malaria” on pages 94, 95, 96 of Konotey-Ahulu FID The Sickle Cell Disease Patient. The Macmillan Press Ltd.,1991 & Reprinted 1992. Republished 1996 by T-AD Co [See comment on page 94 last paragraph: “One obvious puzzling question is why sickle cell homozygotes do not show the same clinical resistance to falciparum malaria as sickle cell Traits.
5i Konotey-Ahulu FID. The Sickle Cell Diseases: Clinical Manifestations including The Sickle Crisis. Archives Internal Medicine 1974; 133; 611-619. [Comprehensive]
5j Konotey-Ahulu FID. Effect of environment on sickle cell disease Environment in West Africa: epidemiological and clinical considerations. In Sickle Cell Disease. Diagnosis, management, education, and research. Abraham H et al. C V Mosby o, St Louis, pages 20-38.
224 Konotey-Ahulu FID There is nothing mysterious about Kwashiorkor. BMJ 14 May 2005 Rapid Response http://www.bmj.com/cgi/eletters/330/7500/1095#106854
234 Konotey-Ahulu FID Human resources for health in Africa. Is it national or international policies causing the brain drain? BMJ Rapid Response November 7 to Editorial by Adetokunba O Lucas “Health resources for health in Africa” BMJ 2005, 331: 1037-1038 http://www.bmj.com/cgi/eletters/331/7524/1037#120815
260 Konotey-Ahulu FID. Doctors must not be lapdogs to drug firms even more relevant in the Third World. BMJ Rapid Resp. November 12 2006 http://www.bmj.com/cgi/eletters/333/7576/1027#149040
261 Konotey-Ahulu FID. Refusing to provide a prenatal test for reducing later termination of pregnancy can it ever be ethical? BMJ
http://www.bmj.com/cgi/eletters/333/7577/1066#149662 BMJ Rapid Resp. Nov. 20, 2006
262 Konotey-Ahulu FID Recovering lost knowledge of traditional medicine by searching historical herbal texts for potential new drugs. http://www.bmj.com/cgi/eletters/333/7582/1314#152179 BMJ Rapid Resp. Dec. 26, 2006
264 Konotey-Ahulu FID My stethoscope’s bell and discovery of a new Parkinsonian physical sign (Kap’s sign) in clinical medicine, BMJ Rapid Response 6 Feb 2007.
266 Konotey-Ahulu FID. Dedicated sickle cell centres. BMJ Rapid Response March 20, 2007 http://www.bmj.com/cgi/eletters/334/7591/477#
271 Konotey-Ahulu FID. Four bodyguards and the perils of unmasking scientific truths. BMJ 2007; 335: 210-211 July 28, 2007.
272 Konotey-Ahulu FID. Who should best pharmacovigilate in developing countries? 14 September 2007 http://www.bmj.com/cgi/eletters/335/7618/462#167455 Rap Resp to Editorial
273 Konotey-Ahulu FID. Opiates for pain in dying patients and in those with sickle cell disease. 11 October 2007 BMJ Rapid Resp. http://www.bmj.com/cgi/eletters/335/7622/685#177986
275 Konotey-Ahulu FID Male circumcision and alleged protection from AIDS. BMJ Rapid Response (Dec. 11) http://www.bmj.com/cgi/eletters/335/7631/1206#183100
276 Konotey-Ahulu FID. Ghana @ 50 UK Health Conference: A special report. Ghanaian Times Dec. 24, 2007, p. 24.
279 Konotey-Ahulu FID. Imported malaria in the UK: Unde venis? & Quo vadis?
http://www.bmj.com/cgi/eletters/337/jul03_2/a135#198874 BMJ Rap Resp 16 July 2008
280 Konotey-Ahulu FID. Current “hit and miss” care provision for sickle cell disease patients in the UK http://www.bmj.com/cgi/eletters/337/jul11_2/a771#199135 BMJ Rapid Resp. 22 July 2008
283 Konotey-Ahulu FID. Management of sickle cell disease versus management of the sickle cell disease patient. BMJ Rapid Resp.17 September 2008
284 Konotey-Ahulu FI D. Malaria and sickle cell: “Protection?” Or “No Protection?” – Confusion reigns. BMJ Rapid Response October 13 2008
285 Konotey-Ahulu FID. Vaccination for genital warts to prevent cervical cancer: principles first, please, before details. BMJ Rapid November 12 2008 http://www.bmj.com/cgi/eletters/337/oct23_1/a2186#204534
286 Konotey-Ahulu FID. Affordable Antimalarials: Do international Donors not have conflicting interests? BMJ Rapid Response November 25, 2008 http://www.bmj.com/cgi/eletters/337/nov12_1/a2495#205142
287 Konotey-Ahulu FID. Clinicians facing conflicting recommendations: Use common sense? http://www.bmj.com/cgi/eletters/337/nov28_2/a2530#205677 BMJ Rapid Resp. Dec. 5, 2008.
288 Konotey-Ahulu FID. Home haemodialysis just the thing for Africa’s wealthy patients. http://www.bmj.com/cgi/eletters/336/7634/3#186073 BMJ Rapid Response 8 January 2008
291 Konotey-Ahulu FID. But how much does maintenance haemodialysis cost in each country? BMJ Rapid Resp. 31 January 2008 http://www.bmj.com/cgi/eletters/336/7634/3#188633
292 Konotey-Ahulu FID. Domiciliary management is the way forward for AIDS management in Africa. [March 4 2008] Comment on “Reduced mortality with home-based HIV treatment in Uganda” Comment – Lancet 2008; 371: 703-705
293 Konotey-Ahulu FID. Do international donors genuinely desire to help solve Africa’s health problems? BMJ Rap Resp. 19 March 2008 http://www.bmj.com/cgi/eletters/336/7643/518#192285
294 Konotey-Ahulu FID. The soul is supra-scientific. BMJ Rapid Response 16 May 2008.http://www.bmj.com/cgi/eletters/336/7653/1132#195557
295 Konotey-Ahulu FID. The stethoscope is there for life and will remain for good. http://www.bmj.com./cgi/eletters/336/7653/1134#195928 BMJ Rapid Response May 28, 2008.
296 Konotey-Ahulu FID. Poor care for sickle cell disease patients: This wake-up call is overdue. BMJ Rapid Response May 28, 2008 BMJ 2008; 336: 1152 to Susan Mayor “Enquiry shows poor care for patients with sickle cell disease” on National Confidential Enquiry into Patient Outcome and Death (NCEPOD) REPORT “SICKLE: A Sickle Crisis? (2008) http://www.bmj.com/cgi/eletters/336/7654/1152a#196224 | http://email@example.com http://www.ncepod.org
300 Konotey-Ahulu FID. Inquest into diamorphine deaths: Does NCEPOD sickle patients report warrant a similar inquest? http://www.bmj.com/cgi/eletters/338/mar03_3/b903#210208 BMJ Rapid Response March 7 2009
301 Konotey-Ahulu FID. Martin Luther’s Protestant Reformation as a retrospective mirror for the present Internet Revolution. BMJ Rapid Response March 25, 2009
302 Konotey-Ahulu FID. Fighting Malaria: Isn’t the best approach through Environmental Hygiene and Public Health? http://www.bmj.com/cgi/eletters/338/apr20_2/b1627#212782 BMJ Rapid Response April 26 2009
303 Konotey-Ahulu FID. British Medical Journal Archive since 1840. http://www.bmj.com/cgi/eletters/338/apr29_1/b1744#213088 BMJ Rapid Response May 2 2009.
304 Konotey-Ahulu FID. Combating malaria: Try public health measures in Africa too. BMJ 2009; 338:b 1971 doi:10.1136/bmj.b1971 (May 20) PMID: 19457959
BMJ Rapid Response 27 June 2009
305 Konotey-Ahulu FID. Human Genetics Commission (HGC) and direct to consumer Genetic Tests, leading to Genetic Counselling. BMJ Rap Resp. May 27, 2009. http://www.bmj.com/cgi/eletters/338/may15_2/b1995#214256
306 Konotey-Ahulu FID. Blow your own trumpet and be thoroughly scriptural.
307 Konotey-Ahulu FID. Fixed drug eruption with Paracetamol. BMJ Rap resp. to Charles Quartey-Papafio in BMJ 2009; 338: b2582 http://www.bmj.com/cgi/eletters/338/jun30_2/b2582#216215
309 Konotey-Ahulu FID. Abdominal aortic aneurysm screening for men: Please acknowledge a genetic dimension http://www.bmj.com/cgi/eletters/338/jun24-_2/b2307#216519 BMJ 10 July 2009
310 Konotey-Ahulu FID. Fixed drug eruptions. More of fixed rug eruptions. http://www.bmj.com/cgi/content/full/bmj.b2924
311 Konotey-Ahulu FID. Free health care for world’s poorest countries without pre-conditions? BMJ Rapid response Aug 7 [In response to Zosia Kmietowicz http://www.bmj.comcgi/eletters/339/aug05_1/b3177#218219 | http://www.bmj.com/cgi/content/full/339/aug05_1/b3177 BMJ 2009;339.b3177
313 Konotey-Ahulu FID. UK drug related deaths are still rising: So where is NICE? Sept. 6 2009 http://www.bmj.com/cgi/eletters/339/sep01_1/b3536#219836
BMJ Rapid Response to Susan Mayor on “UK drug related deaths are still rising 2 reports say” .
314 Konotey-Ahulu FID. Doctor cleared of asking nurse to give fatal dose to dying patient: More honest nurses, please 17 Sept. BMJ 2009; 339: b3812
315 Konotey-Ahulu FID. High index of suspicion with timely haemodialysis for hyperkalaemic cardiac arrest. Rapid Resp.5 Nov 2009.
316 Konotey-Ahulu FID. Does rejecting a particular scientific opinion mean a rejection of science? http://www.bmj.com/cgi/eletters/339/nov04_1/b4563#224533 Rapid Resp.10 Nov. 2009.
317 Konotey-Ahulu FID. Harold Varmus and The Art of Politics and Science. http://www.bmj.com/cgi/eletters/339/nov17_3/b4848#225563 BMJ Rapid Response 20 November 2009
321 Konotey-Ahulu FID. Are patients with G6PD Deficiency to avoid eating prawns http://www.bmj.com/cgi/eletters/340/feb26_1/c1016#232266
323 Konotey-Ahulu FID. Malaria diagnosis and treatment in Ghana. BMJ Rapid Response 25 March 2010 http://www.bmj.com/cgi/eletters/340/mar05_1/c930#233389
324 Konotey-Ahulu FID. Peer review, yes, but good editors must have the last word. http://www.bmj.com/cgi/eletters/340/mar15_1/c1409#233845 BMJ Rapid Response April 2 2010
327 Konotey-Ahulu FID. Is modern genetics a blind alley? Not quite so in Europe, but probably yes i Africa http://www.bmj.com/rapid.response/2011/1102/modern-genetics-blind-alley-not-quite-so-europe-probably-yes-africa BMJ Rapid Response 19 May 2010
329 Konotey-Ahulu FID. WHO declares that H1N1 Pandemic is officially over: So do Ghanaians need to be jabbed with the vaccine? BMJ 12 Aug 2010 Rapid Resp.
330 Konotey-Ahulu FID. The politics (and economics) of pain relief in the West and Third World. 24 August 2010 BMJ Rapid Response to T Anderson http://www.bmj.com/cgi/eletters/341/aug11_2/c3800#240684 The politics of pain 11 Aug doi: 10.1136/bmj.c3800
331 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 Oct 12 2010 [32 references]
332 Konotey-Ahulu FID. President Obama apologises over Guatemala syphilis study: International cooperative research in jeopardy. BMJ Rapid response October 17 2010. [16 references] http://www.bmj.com/content/341/bmj.c5494.full/reply#bmj_el_243183
333 Konotey-Ahulu FID. Genius of Nobel Laureate Robert Edwards goes beyond IVF. http://www.bmj.com/content/341/bmj.c5533/reply#bmj_el_243005 | www.embryologist.org.uk BMJ Rapid Response Oct 14 2010 [3 references]
334 Konotey-Ahulu FID. Antenatal sickle cell disease haemoglobinopathy screening.
http://www.bmj.com/content/341/bmj.c5243/reply#bmj_el_243447 BMJ Rapid Respo Oct. 25, 2010
336 Konotey-Ahulu FID. David Geraint James: Great Champion of Overseas Postgraduates. 18 Nov 2010 [Resp. to BMJ 341:doi.1136/bmj.c6400] See Ref 170 on Dame Sheila Sherlock 20 Jan 2002 http://www.bmj.com/content/341/bmj.c6400.full/reply#bmj_el_244903 | http://www.bmj.com/content/324/7330/174.1.extract.reply#bmj_el_18859
337 Konotey-Ahulu FID. Ethics of mitochondrial gene replacement is also ethics of acquired genetic inheritance. BMJ Rapid Response 19 November 2010
339 Konotey-Ahulu FID. Music (and Tonal Language) and the art of being human http://www.bmj.com/content/341/bmj.c6965.full/reply#bmj_el_246612 BMJ Rapid Response Dec 20.
340 Konotey-Ahulu FID. Music (and Tonal Language) and the art of being human II. http://www.bmj.com/content/341/bmj.c6965.full/reply#bmj_el_246615 BMJ Rapid Response Dec 20.
341 Konotey-Ahulu FID. Music (and Tonal Language) and the art of being human III. http://www.bmj.com/content/341/bmj.c6965.full/reply#bmj_el_246618. BMJ Rapid Response Dec 20.
342 “New appointment of evangelical Christian to drug advisory body sparks controversy” Please spare us emotive headlines BMJ Rapid Response 6 February 2011 http://www.bmj.com/content/342/bmj.d624/reply#bmj_el_249481
343 Konotey-Ahulu FID. Facebook and Twitter in bid to create African Scientific Revolution “mizraimically” BMJ paid Response 5 March 2011
344 Konotey-Ahulu FID Only fruitcakes believe in GOD? http://www.bmj.com/content/342/bmj.d2642/reply#bmj._el_260425
[See Correction in Reference 301] BMJ Raid Response 11 May 2011.
345 Konotey-Ahulu FID. Only fruitcakes believe in in GOD? Correction of inverted inheritance of solomonic genius. BMJ Rapid Response 12 May2011. [See Reference 300] http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260496 BMJ Rapid Response 12 May2011. [See Reference 300]
346 Konotey-Ahulu FID. Is talking about God to be banned from clinical care? http://www.bmj.com/content/342/bmj.d3275/reply#bmj_el_261475 BMJ Rapid Resp. 2 June 2011.
353 Konotey-Ahulu FID. Epistaxis from sickle cell disease must not be forgotten www.bmj.com/content/344/bmj.e1097/rr/576087 BMJ Rapid Response 28 March 2012
356 Konotey-Ahulu FID. Should clinicians edit Wikipedia to engage a wider world web? At least two examples of inaccuracy dictate caution BMJ 14 August 2012 Rapid Response www.bmj.com/content/345/bmj.e4275/rr/598116
357 Konotey-Ahulu FID. Management of an acute painful sickle cell episode in hospital: NICE guidance is frightening1 Sept 7, 2012. www.bmj.com/content/344/bmj.e4063/rr/599158 [42 references]
358 Konotey-Ahulu FID. Almost a quarter of Royal College Fellows say their hospitals cannot deliver continuity care. And they boast of something called National Institute of Clinical Excellence? www.bmj.com/content/345/bmj.e4942/rr/601191 September 7, 2012 BMJ Rapid Response.
360 Konotey-Ahulu FID Bring back good quality paper in the print BMJ www.bmj.com/content/345/bmj.e6396/rr/610395 BMJ Rapid Response 23 October 2012
361 Konotey-Ahulu FID. Diagnosis and management of pulmonary embolism. www.bmj.com/content/346/bmj.f767/rr/633072 BMJ Rapid Response 26 Feb 2013
362 Konotey-Ahulu FID. Liverpool care pathway BMJ and Channel Four News: Majority expert choice does not mean best choice March 8 2013 BMJ Rapid Response to “Nine out of 10 palliative care experts would choose Liverpool care pathway for themselves” Krishna Chinthapalli BMJ 2013; 346: 1103 (March 2, pages 2-3) www.bmj.com/content/346/bmj.f1303/rr/634971
364 Konotey-Ahulu FID. Importance of history in the diagnosis of pulmonary embolism www.bmj.com/content/346/bmj.f1692 March 19 BMJ 2013; 366: F1692
365 Most religious followers support assisted suicide for the dying: Survey flawed through inadequate definition of “religious” and “terminally ill”. BMJ Rapid Response May 12 2013 www.bmj.com/content/346/bmj.f2855/rr/645095 – to Zosia Kmietowicz BMJ News www.bmj.com/content/346/bmj.f28555?sso 11 May: Most religious followers support assisted suicide for the dying.
367 Konotey-Ahulu FID. Opiods for chronic non-cancer pain – Chemotherapy – Clinical Guidelines: Where does ultimate responsibility lie? www.bmj.com/content/ 346/bmj.f2937/rr/651421 BMJ Rapid Response 25 June 2013
368 Konotey-Ahulu FID. Opiods in the UK: What’s the problem? Answer – Good Clinical Practice needs to cover all population groups including sickle cell disease patients. www.bmj.com/content/347/bmj.15108/rr/658208 BMJ Rapid Response 18 August 2013
370 Konotey-Ahulu FID. Acute osteomyelitis in African children unmasks sickle cell disease with salmonellosis http://www.bmj.com/content/348/bmj.g66/rapid-responses BMJ Rapid Response Feb. 1, 2014
371 Konotey-Ahulu FID. Erectile Dysfunction: Test, please, for Sickle Cell Disease. http://www.bmj.com/content/348/bmj.g129/rapid-responses Rapid Response to BMJ 2014; 348: g129 February 1,3 2014
374 Konotey-Ahulu FID. Management of sickle cell disease patient I the community BMJ Rapid Response 13 April 2014 [90 References] to Brousse V, Makali J, Rees DC: Management of sickle cell disease in the community. BMJ 2014; 348: g1765 doi:10.1136/bmj.g1765 http://www.bmj.com/content/348/bmj.g1765/rr/694233
378 Konotey-Ahulu FID. Perthes’ disease versus sickle cell disease hip. BMJ Rapid Response www.bmj.com/content/349/bmj.g5584/rr or http://bit.ly/1tGmuYm (18 Oct ) to Perthes’ disease by Peter Kannu & Andrew Howard, Brit Med Journal Oct 4 2014 Vol 349 pages 32-33.
384 Konotey-Ahulu FID. Ebola and Ethics: “Are vaccine trials going on somewhere in Africa?”. http://www.bmj.com/content/350/bmj.h2105/rr-5 BMJ Rapid Response 02 June 20
385 Konotey-Ahulu FID. Ebola and Ethics: Ghana Academy of Arts and Sciences and Ghana Government Suspend Ebola Virus Vaccine Trials. BMJ Rapid Response 14 June 2015 http://www.bmj.com/content/350/bmj.h2105/rr-7
386 Konotey-Ahulu FID. Ebola viewed through HIV/AIDS spectacles – What Africans think. BMJ Rapid Response. August 7 2015 www.bmj.com/351/bmj.h4142/rr-0 to Zosia Kmietowicz: Ebola vaccine trial results “extremely promising” says WHO. BMJ 351: h4192 July 31, 2015.
387 Konotey-Ahulu FID. Scientists call for moratorium on clinical use of human germline editing: A déjà vu of Ethical Caveat! www.bmj.com/content/351/bmj.h6603/rr-0 Rapid Response 16 Dec 2015 to Dr Michael McCarthy’s “Scientists call for moratorium on clinical use of human germline editing”. BMJ 2015; 351:h6603 http://www.bmj.com/content/351/bmj.h6603/rr-0
388 Konotey-Ahulu FID. Hip pain and radiographic signs of osteoarthritis: Sickle cell & other haemoglobinopathy differential diagnosis. British Medical Journal Rapid Response 8 January 2016 http://www.bmj.com/content/351/bmj.h5983/rr-2 to MJ Nieuwenjse and Rob G Nelissen BMJ 2015; 351 doI: http://dx.doI.org/10.1136/bmj.h5983 http://www.bmj.com/content/351/bmj.h5983/rr-2 (Published 2 December 2015)
391 Konotey-Ahulu FID. Will Home Office VISA Refusal Prompt West African Relatives To Vote Brexit? http://www.bmj.com/content/353/bmj.i3027/rapid-responses Rapid Response 10 June 2016
392 Konotey-Ahulu FID. Home Office VISA Refusal Prompt West African Relatives to Vote Brexit? Full Apology Now Received from Home Office. Rapid Responses June 22 2016 http://www.bmj.com/content/353/bmj.i3027/rapid-responses
393 Konotey-Ahulu FID. BREXIT: DEMOCRACY IS COUNTING HEADS REGARDLESS OF WHAT THE HEADS CONTAIN. http://www.bmj.com/content/353/bmj.i3551/rr-6 Rapid Responses June 30 2016
399 Konotey-Ahulu FID. The God Delusion title devalues sensible discourse. BMJ Rapid Response 19 October 2016.http://www.bmj.com/content/335/7629/1099.1/rr-0
401 Konotey-Ahulu FID International Medical Graduates and quality of care: What if quality of care in developing country is better than UK’s? BMJ Rapid Response March 1 in response to “International medical graduates and quality of care” by Aneez Esmail, Julian Simpson. 356:doi10.1136/bmj.j574 http://www.bmj.com/content/356/bmj.j574/rr-0
403 Konotey-Ahulu FID. Should we abandon routine blood tests? No, not when hereditary erythrocytopathy poses a real problem in a so-called multiracial population! BMJ Rapid Response to Alastair Faulkner et al and K. Siau on “Should we abandon routine blood tests?” No, do Abnormal Haemoglobin and G6PD tests routinely http://www.bmj.com/content/357/bmj.j2091/rr-15
404 Konotey-Ahulu FID. BMA AGM 2017 on Abortion – A damning verdict on my genetic defect and family members’ BMJ Rapid Response 30 June 2017 to Abi Rimmer and Rebecca Coombes on “BMA annual meeting: Doctors who carry out abortions should not face criminal sanctions, says BMA” 28 June 2017 BMJ 2017; 357: j1136 https://doi.org/10.1136/bmj.j3116 | www.bmj.com/content/357/bmj.j3116/rr June 28
406 Konotey-Ahulu FID. MEDICINES AND HARMS: Could international Fraud Unearthed In Ghana Be Happening Elsewhere? BMJ Rapid Resp 20 June 2017
408 Konotey-Ahulu FID. Genetic Testing and Counselling Towards Genetic Public Health. BMJ 2017;358:j4101 Dec 21 http:www.bmj.com/content/358/bmj.j4101/rr-0
Rapid Response to Allison Streetly 28 Sept 2017 A common definition on genetic testing – can we agree on one? Re: PRACTICE article by C Semsarian & J Ingles 21 September 2017 .http:www.bmj.com/content/358/bmj.j4101/rr-0
409 Konotey-Ahulu FID. Personal Answer to The Question “Do you believe in God?” [48 References] BMJ Rapid Response to Savros Saripanidis “Do you believe in God?” Re: Kevin Barraclough “Do you believe in God? BMJ 319; doi.10.1136/bmj.7214.929a http://www.bmj.com/content/319/7214/929.2/rr-0
410 Konotey-Ahulu FID. There but for the grace of God …– Fiona Godlee’s Sanctified Common Sense [FGSCS] Rapid Response to There but for the grace of God F Godlee BMJ 2018; 360:k485 http://www.bmj.com/content/360/bmj.k485/rr
411 Konotey-Ahulu FID. “So You Know Where I am coming from (SYKWIACF”) Prefaces My Religious Belief Competing Interest. June 1 2018 BMJ Rapid Response https://www.bmj.com/content/361/bmj.k1558/rr-4
418 Konotey-Ahulu FID. Aviation Safety: Ghanaians recall media disinformation deriving from scientific misinformation, BMJ Rapid Resp. https://www.bmj.com/content/364/bmj.l735/rr-7 Mar 1 2019 to Partha Kar: Applying aviation safety to healthcare; are we missing the fundamental? Partha Kar 364:doi10.1136/bmj.l735
421 Konotey-Ahulu FID. Avascular Hip Necrosis: Sickle Haemoglobinopathy predominates worldwide. BMJ Rapid Response to Lamb JN et al 1 June 2019 Avascular necrosis of the hip BMJ 1 June Vol 365, p 325 (BMJ 2019; 365:l2178) https://www.bmj.com/content/365/bmj.l2178/
423 Konotey-Ahulu FID. EVIDENCE – Do not forget the hidden human dimension. BMJ 07 August 2019 Re: Holger Schunermann et al Distinguishing opinion from evidence in guidelines. BMJ 2019;366:L4606 July 19 2019 BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4606 https://www.bmj.com/content/366/bmj.l4606/rr-11 |
424 Konotey-Ahulu FID. How-When-Where Does Common Sense Scream “The Transgenderism Emperor Has No Clothes”? British Medical Journal 18 October 2019 Re: Deborah Cohen and Hannah Barnes. Gender dysphoria in children: puberty blockers study draws further criticism. BMJ 2019; 366:l5647 https://doi.org/10.1136/bmj.l5647https://www.bmj.com/content/366/bmj.l5647/rr-5
424a Cohen Deborah, Barnes Hannah. Gender Dysphoria in children puberty blockers study draws further criticism. BMJ 2019; 366: L5647 https://doi.org/10.1136/bmj.l5647
427 Konotey-Ahulu FID. COVID-19: Treatment with CLOROQUINE or Intravenous Vitamin C Requires Prior Exclusion of G6PD Deficiency! April 8 2020. Re: Ferner Robin E, Aronson Jeffrey K. Chloroquine and Hydroxychloroquine in Covid-19. https://doi.org/10.1136/bmj.m1432 .https://www.bmj.com/content/369/bmj.m1432/rr-21 BMJ 2020; 369.m1432 April 8 2020.
428 Ayettey AS, Quakyi Isabella, Ayettey-Annie Hannah NG, Sagoe Kwamena W, Ayettey-Adamafio Mary NB, Newman-Nartey Merley, Ayettey Brew Ruth NA, Nartey Nii-Out, Amoah Albert GB, Konotey-Ahulu FID. COVID-19: A Case for Hydrogen Peroxide Mouthwash and Gargle to limit SARS-CoV-2 Infection. BMJ July 2 2020 BMJ 2020; 368: m1252 : Re: What Treatments are being investigated? Elisabeth Mahase https://www.bmj.com/content/368/bmj.m1252/rr-27 BMJ 2020; 368.m1252 March 26, 2020.
429 Konotey-Ahulu FID. COVID-19: “Few can doubt we need a covid-19 vaccine as soon as possible ..” Really? 22 August Re: Fiona Godlee, EDITORIAL. 22-29 August Vol. 370. Less haste, more safety. BMJ 2020; 370.3258 Konotey-Ahulu FID https://www.bmj.com/content/370/bmj.m3258/rr-2
432 Konotey-Ahulu FID..COVID-19: “WHAT WE EAT MATTERS ALL THE MORE NOW” SHOULD ANTICIPATE OTHER NON-VACCINE ADVICE. Re: Fiona Godlee. EDITORIAL. What we eat matters all the more now. BMJ 2020; bmj.m370 December 1, 2020. https://www.bmj.com/contact/370/bmj.m2840/rr-5 .
Sorry, your Registration Procedure was not geared to record my UK phone number so I could not join you to contribute something and to answer questions that could have cropped up. The following is rather lengthy.
My www.sicklecell.md shows how patients can overcome their Sickle Cell Disease and achieve great things in life. Introducing myself, listen to Professor Helen Ranney MD PhD of Albert Einstein University College of Medicine in New York: “There is no single clinical experience in the United States comparable to that of Dr Konotey-Ahulu”.
She observed that I always placed “The Patient” above “The Disease”.
My book “The Sickle Cell Disease Patient” with 643 pages including 133 Illustrative Case Histories plus thousands of References, and the Foreword by Howard University’s famous Professor Roland Scott MD, describes all that patients require to help them stay out of the hospital and to achieve great things in life. Not Gene Therapy. Order the book from my website, discounted to £30. It deals with The Patient.
My Johns Hopkins Visits
I am no stranger to Maryland. Your Professors Lemuel Conley and Samuel Charache of Johns Hopkins University Medical College had invited me to do Grand Rounds more than once with them at Baltimore.
On one occasion I showed a slide to their students and physicians on “Sixteen Causes of Severe Jaundice in Sickle Cell Disease” which so impressed Professor Charache that he asked me to give him a copy of the slide. Some of their students who heard him quiz me on those Grand Rounds may well now be your present Physicians and Haematologists.
You can find the list of Sixteen Causes of Severe Jaundice in Sickle Cell Disease on page 174 (Table 13.7) of my Textbook analysing 1,500 Consecutive patients with Sickle Cell Disease in Ghana. I am prepared to send you a signed Complimentary copy of my book because of the friendship of Professors Conley and Charache in the past. Tell me where to send it by DHL (Address plus phone numbers). We were together on the WHO Expert Advisory Panel on Haemoglobinopathies in Geneva.
I was once gratefully surprised when Professor Samuel Charache gave me $150 on the spot in the Emergency Room in Baltimore for diagnosing Right Middle Lobe Pneumonia in a Sickle Cell Anaemia (SS) lady in sickle cell crisis, using “HIPPA” – the 5 Cardinal things taught me at Westminster Hospital School of Medicine, the University of London, by Sir Richard Bayliss MA MD FRCP, Physician of Her Majesty Queen Elisabeth II..
HIPPA stands for “History, Inspection, Palpation, Percussion, Auscultation”. After I announced the diagnosis aloud for nurses and doctors to hear, the lady was wheeled away to be X-rayed. When the diagnosis was then displayed on the screen, confirmed, and the $150 thrust in my hands I was hugely grateful because that amount of One Hundred and Fifty Dollars was equivalent to my 3 months’ salary as a Physician Specialist in Inflation-burdened Ghana. It was then I realised why several of the doctors we trained at home in exactly the way we were trained in the UK, found their way across The Atlantic to acquire Dollars that they sent back home to help relatives. Brain Drain meant Dollar Influx! Diagnose without X-rays and you get Dollars?
In later years I invited Professor Samuel Charache to International Conferences of Sickle Cell Disease Patient Achievers – The First at The Royal Society of Medicine in London 1993, and the Second in Accra, Ghana, in 1995 when he saw adult Sickle Cell Disease Patients who had never been regularly blood-transfused, and who had graduated from universities. The Hydroxyurea that Prof. Samuel Charache popularized was, and still is, more Disease-oriented than Patient-oriented in that the drug aimed at producing Foetal Haemoglobin F to displace the Abnormal Haemoglobin S with the view to diminishing transfusion requirements. Our ACHIEVERS’ CONFERENCES were aimed at showing off adult patients who were never on regular transfusions as was commonly practised in the UK and the USA.
We have adult Sickle Cell Disease Patients in their Seventh and Eighth Decades of useful life. One Sickle Cell Haemoglobin C Disease (phenotype SC) grandmother, and Women’s Golf Champion, attained the age of 83 years before finishing her Earthly Pilgrimage. During her first pregnancy when repeated urinary tract infections precipitated sickle cell crises some physicians suggested she abort the pregnancy, as was often the practice abroad. She flatly refused, and I concurred with her decision in 1960 when Dr Fred Sai let me admit her to Ward A at Korle Bu Hospital. Being myself born into a Sickle Cell Disease family I knew relatives who carried pregnancies to term. We carefully nurtured Mrs L. O. till she was successfully delivered of Twins by Dr Kwesi Bentsi-Enchil our experienced Obstetrician Gynaecologist. The Trait Twins are now grandparents and successful professionals in their own thriving businesses.
MORAL: Sickle Cell Disease Patients can become ACHIEVERS without Management Practices involving Regular Blood Transfusions, Ante-natal Diagnosis and Terminations of Pregnancy, Morphine and Diamorphine for Sickle Cell Crisis Pain, Hydroxyurea daily to increase Foetal Haemoglobin Level, and Frequent hospitalisations. They can achieve great things right up to their Seventies and Eighties.
One ACHIEVER, D. A-B [SS (NORMACHE “AS” father x NORMACHE “AS” mother produced ACHEACHE)] trained to be a brilliant Nurse SRN in Ghana, went to Cold England to do Midwifery SCM, proceeded to the USA to specialise in Chemotherapy and wrote a Textbook. You can read the description of how she hydrated herself intravenously flying at over 30,000 ft more than once. See www.sicklecell.md BLOG “Lesson of the Week – Dorothy Amanor-Boadu SRN SCM – How I, a sickle cell anaemia woman, hydrate myself intravenously at 36,000 feet”
Her advice in bold letters to fellow Sickle Cell Disease Patients: “The moral for other patients reading this article is this: ANTICIPATE PROBLEMS, AND PLAN HOW TO COPE WITH THEM! If necessary, cancel agreed plans (like a flight) in order to save your life.”
Dorothy Amanor-Boadu attended all 3 SICKLE CELL DISEASE PATIENT ACHEVERS’ CONFERENCES in 1993 (London), 1995 (Accra), and in 2010 (Accra) for the Centenary of Herrick’s first description of Sickle Cell Anaemia in the USA. Great ACHIEVER that she is, she runs a Private Nursing Agency in Accra, and has authored a 186-page book entitled “CANCER CHEMOTHERAPY MANUAL” by DOROTHY S AMANOR-OWUSU. She was offered Bone Marrow Transplantation in the USA but refused. She does not think Gene Therapy is the answer either.
One hopes, GOD willing, Maryland Sickle Cell Disease Association can attend a 4th International Conference with their own ACHIEVERS. I was greatly saddened to learn that my good friend Professor Samuel Charache died on 29th January 2019 aged 89 years.
ANOTHER SICKLE CELL DISEASE PATIENT ACHIEVER:
Listen to me interviewing Mr Ebenezer Tagoe with Sickle Cell Anaemia (SS), a great ACHIEVER now in his 7th Decade of life (born on Ghana’s Independence Day 6th March 1957). In 1993 & 1995 Professor Samuel Charache heard Ebenezer testify at both our SICKLE CELL DISEASE PATIENT ACHIEVERS’ CONFERENCES in London and Accra. At www.sicklecell.md BLOG you can see him being interviewed live “Meet the Professor talking about Sickle Cell Disease patient live”. Mr Ebenezer Tagoe [SS=ACHEACHE (one S-ACHE gene from father, and another S-ACHE gene from the mother)] was counselled by me and he married an “AA=NORMNORM phenotype” lady. They had 2 “AS” Trait boys who graduated.
Ebenezer is now a qualified Pharmacist who had worked in a London Teaching Hospital, and now a successful businessman in Accra. While in London he was appalled by how many patients with Sickle Cell Disease were given Morphine and Diamorphine for Sickle Cell Crisis when he himself had never been introduced to it. He testifies that as he is a pharmacist, he has declined to take daily Hydroxyurea.
Ebenezer Tagoe is fortunate to have Doctors both in Ghana and England whom he described as “excellent” because they always listen to him. He was once going to be given Morphine after surgery in the UK to remove his gallbladder but he refused and asked to be given Ketorolac instead. At all 3 INTERNATIONAL ACHIEVERS’ CONFERENCES, Mr Tagoe announced that he avoided Sickle Cell Crises by drinking no less than 5 Litres of water a day. I now pass this information on to Maryland Sickle Cell Disease Association (MSCDA) members of which may like to contact him through me firstname.lastname@example.org and he will be delighted to answer your queries.
ANOTHER SICKLE CELL ANAEMIA (SS) ACHIEVER:
Miss A. K. who is in her 6th Decade of life with Sickle Cell Anaemia is glad to answer questions through me. The only partial blood transfusion she has ever had was for hip replacement (aseptic necrosis). She keeps very well with haemoglobin level always between 7.5 and 8.5 grams per Deci-Litre which she is very pleased with.
SEVENTYONE YEAR-OLD ADE SAWYERR (SC):
Mr Ade Sawyerr with Sickle Cell Haemoglobin C Disease will answer queries about how to avoid sickle cell crises. He has valuable tips and I have taken him with me to answer questions when I am invited for Grand Rounds. Write to him through me.
Glucose 6 Phosphate Dehydrogenase (G6PD) Deficiency
This is one of the 16 causes of Severe Jaundice in Sickle Cell Disease. All new patients I saw in Ghana or UK or in Howard University Washington DC had G6PD enzyme level checked. Some good drugs harm patients with G6PD Deficiency as shown in – https://bit.ly/2sukoPW “G6PD Deficiency in Ghanaians: How to recognise it”. Have all the patients in MSCDA been checked for G6PD Deficiency?
In a way, I am glad I could not join the webinar across The Atlantic because I could not have contributed a tenth of what I have just written.
Finally, GENE EDITING (CRISPR) is woefully unrealistic: How can this deal with the 34,000 babies born every quarter of the year with abnormal haemoglobin genes from both parents in West Africa? Genetic Counselling with Family Size Limitation [GCFSL] is more realistic. See my answer to the Sickle Cell Disease mother married to Sickle Cell Disease man in Tema, Ghana, and who had 13 children all receiving an abnormal haemoglobin gene from both parents causing hereditary disease in all of them. They continued having child after child hoping the next one will avoid hereditary disease but because each Parent had nothing but an aching gene to offer, all the 13 children ended up with ACHE from father, ACHE from mother to be ACHEACHE disease phenotypes. See on my website how I responded to Mrs D’s reasonable question: “But Doctor: How do we prevent this Nwiiwii (Sickle Cell Disease in Fante) coming in further pregnancies?” Study the answer I gave the parents from the Video on my website www.sicklecell.md My invented kanad cubes are given free with every copy of the book – “kanad” stands for KONOTEY-AHULU NORM ACHE DICE
Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) DSc(UH) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL www.konotey-ahulu.com and https://youtu.be/41a1FZSpHd4 which is Video with CITATION of Honorary DSc awarded me by the University of Hertfordshire.
DR REGINALD ADDAE: WATCHFUL CONSULTANT PHYSICIAN
TRIBUTE BY DR FELIX I D KONOTEY-AHULU
Another great Ghanaian Physician has left us for good, but not really forever because much of what he did in life will be remembered for decades to come. Those who read international medical journals will recall the role DR REGINALD ADDAE & DR FRANK T DJABANOR played in SAVING BLACK PEOPLE FROM HUMILIATION.
And these two Ghanaian London-University-trained doctors did this by revealing as TOTALLY FALSE an international medical report which advised that
“If on certain African routes, a Negro traveller must take an unpressurized aircraft it would be wise to ascertain the sickling status before departure”.
imagine you and I being pulled out of a queue boarding an aeroplane to be tested at the airport for sickle cells. The FALSE international publication was so significant that within a week, the world’s leading Science Journal NATURE, and the leading British Newspaper THE TIMES elaborated the original false article and made their own recommendations. THE TIMES Science Correspondent even went further to recommend that all Black Air Crews should be grounded immediately.
FLIGHT FROM KUMASI TO ACCRA
The FALSE medical report was based on a Ghanaian nurse flying from Kumasi to Accra and who during the 45 minutes flight developed tummy problems. On arrival in Accra she was operated upon by a non-Ghanaian surgeon at the 37-General Hospital now called The Military Hospital. The report in the Medical Journal by 3 non-Africans who had never been to Africa, said the Ghanaian nurse was Sickle Cell Trait proven by the standard test called Haemoglobin Electrophoresis. This report caught the sharp eyes of the two Ghanaian Physicians at the Military Hospital even though “Military Hospital” was not mentioned in any of the international publications. Reggie Addae was the first to write to the international Medical Journal asking for proof that the nurse
was sickle cell trait (Haemoglobin Electrophoresis “AS”). Next to write for proof of what was said to have been performed at our Military Hospital was Dr Frank Djabanor. Dr Reginald Addae gave at least 8 (eight) criteria later known as “ADDAE CRITERIA” to be honoured before any clinical condition could be attributed to the Sickle Cell Trait (“AS”). Meanwhile, Kennedy Airport grounded their Black Pilots and Air Crews.
“SCIENTIFIC FALSEHOOD” EXPOSED BY WHITE & BLACK EXPERTS
Professor Hermann Lehmann FRS of Cambridge University wrote to THE TIMES after reading its recommendation that all Black Air Crew should be grounded and pointed out that the Sickle Cell Trait “AS” did not constitute a disease phenotype, and that Sickle Cell Traits ran at the OLYMPIC GAMES at Mexico City, 7,000 ft above sea level, and thrashed the entire world. How could they have a disease? He began his letter of protest thus: “SIR – Your Science Report on December 9 1971 has suggested that all flight crews with SICKLE CELL TRAIT should be removed from flying duties and that all prospective Negro travellers should be screened for sickle cells”.
Dr Frank Djabanor whose protest letter followed Dr Reginald Addae’s said “Sickle Cells are not a Black Condition”, and that Europeans also had Sickle Cell Trait, sometimes “with higher percentages than anywhere in Ghana”. Listen to his logic:
“In some parts of Greece the prevalence of the Sickle Cell Trait is 30% (according to Professors Deliyannis and Tavlarakis, British Medical Journal 1955 volume 2 page 299); more than twice the prevalence in Northern Ghana.” Dr Frank Djabanor then continued with this telling point: “The forebears and descendants of these non-Negro possessors of the sickle cell gene are, doubtlessly, scattered over America and Europe today. How can we identify them, from their external features, to thrust upon them the ‘benefits’ of this advice?” If, “for their own safety” all Negro travellers should be screened, “Surely”, Dr Djabanor continued “the authors would not advocate that we
deny some sections of the world community the benefits of their suggestion”.
Dr Frank Djabanor went HOME to GLORY last year, and my TRIBUTE to him was titled: “Lt-Col [Retd] F FT Djabanor (1938 – 2019). Physician whose exposure of scientific falsehood saved Black People from humiliation. TRIBUTE: ACCRA & Odumase-Krobo 31st March 2019.
I made sure that his burial was marked in the British Medical Journal with a detailed account of what he and Dr Reginald Addae who now follows him to GLORY did for all black people. See https://www.bmj.com/content/364/bmj.I735/rr-7 Konotey-Ahulu FID.
“Aviation Safety: Ghanaians recall media disinformation deriving from scientific misinformation. British Medical Journal Rapid Response March 1 2019 to Partha Kar – Applying Aviation Safety to Healthcare – Are we missing the fundamentals? Partha Kar 364: doi 10.1136/bmj.I735
THIS TRIBUTE TOO LONG?
If some Ghanaians are inclined to think this TRIBUTE is too long, please remember what Dr Reginald Addae and his Colleague Dr Frank Djabanor achieved for us. One in every Five (5) of us Ghanaians reading this, or listening to it, is Sickle Cell Trait (“AS”). Scientists are continuing to claim that 20 percent of us have hereditary “DISEASE SICKLE CELL TRAIT. The British call it a “DISORDER”. The WHO IDM Chart calls it a “DISORDER”. White Experts who knew the truth, and who defended us Black people against Tafracher “scientific nonsense” (Hermann Lehmann, Bela Ringelhann, George Edington, etc) have died. Black Experts have also died (Alexander Boyo, Bill Laing, Teddy Christian, Komla Gbedemah, George Bonney, George Ankra-Badu etc). Now Frank Djabanor and Reggie Addae have also gone.
Those of us Ghanaians remaining who know both the scientific truth, and the “scientific lies” (Alexander Bruce-Tagoe, Joseph Kpakpo Acquaye, Samuel Kwadwo Owusu, Albert Amoah, Dwomoa Adu, Jehoram T Anim, Michael O Matekole, Adzei Klufio, E Q Archampong, Lade Wosornu, myself, etc) will continue to tell the world what Professor Hermann Lehmann FRS told the LONDON TIMES: “Sickle Cell Traits ran at the Olympic Games in Mexico City (where the Oxygen was thin) and beat the entire world”. We salute the Inseparable Duo Frankie and Reggie who have defeated their Last Enemy, Death, and arrived HOME in Heaven. Ao, Ayenyekoo!
Heartfelt Condolences to the loved ones – Sisters Regina, Amelia and adult children Gina, Wendy.
Oh think to step ashore, and that shore Heaven;
To take hold of a hand, and that hand God’s hand;
To breathe a new air, and that air Celestial air;
To feel invigorated, and know it, Immortality;
Oh think, to pass from the storm and tempest
To one unbroken smile,
To wake and find it GLORY!
Hundred-Year-Old Sickle Cell Trait Accesses Genetic Services to Predict Risk of Hereditary Disease in Future Generations
CONGRATULATIONS FROM BUCKINGHAM PALACE!
Dr Emmanuel Evans-Anfom FGA MB ChB FRCS(Edinburgh) FWACS DSc (Salford Univ. Hon) FGCPS DTMH(Edinburgh) who was 100 years on October 7 2019  was congratulated from Buckingham Palace. The Duke of Edinburgh Prince Phillip, PATRON of Ghana Academy of Arts and Sciences [GAAS] and its First President 1959 to 1961 when he was succeeded by Dr Kwame Nkrumah 1961 to 1966 as the Academy’s Second President, sent a message of Congratulations to Dr Emmanuel Evans-Anfom who was himself once 8th of the 19 Presidents of GAAS.
“HISTORY SURPASSES SCIENCE” LECTURE FOR CENTENARIAN.
With Professor Henrietta Mensa-Bonsu FGA the present 19th President of GAAS chairing the Proceedings in a most competent manner, I considered myself greatly honoured and privileged to deliver a SPECIAL LECTURE not only preceded by introductory remarks of Professor Samuel Boakye FGA, Executive Secretary of the Ghana Academy of Arts and Sciences, but also by the impressive statement of Dr Emmanuel Evans-Anfom himself who can be seen and heard on Thursday 30th January 2020 here https://youtu.be/hV8NZJh1pg .
CENTENARIAN SERENDIPITOUSLY REQUESTS GENETIC MARKERS
Day after the Lecture dedicated to Dr Emmanuel Evans-Anfom I visited the great man at home at Leonora Lodge surrounded by his family [demure wife Elise, elegant daughter Rachel and confident husband Dr Henry Baddoo, impressive sons Charlie and Nii Teiko] when, out of the blue, he said to me “Felix will you confirm my genotype?” – meaning would I find out if he was/is one of the 1 in 3 Ghanaians (like my parents) with an abnormal beta haemoglobin gene “S” or “C”? [References 3 to 32].
I asked Dr Henry Baddoo, Consultant Anaesthetist son-in-law to draw blood for me to bring back to the UK for examination in the only laboratory I know in Central London that will quantify not only haemoglobin fractions but also the level of Glucose-6- Phosphate Dehydrogenase red cell enzyme whose deficiency in Ghana is high, 1 in 4 hemizygote males XminusY, 1 in 6 to 1 in 8 females (heterozygotes XminusX and homozygotes XminusXminus ) – Partial and Full Deficiency [18 19 23 24 27 to 42]
PERMISSION TO PUBLISH FINDINGS
I considered it serendipitous to be asked to confirm haemoglobin “genotype” just when BMJ was publishing such articles as “Promises and perils of using genetic tests to predict risk of disease”  and “Communities that prefer close blood marriages need more help to access genetic services”.  In the reliable Central London Lab I requested my “Konotey-Ahulu Profile Number 2” consisting of (a) Sickling Test, (b) Quantitative Haemoglobin Electrophoresis, (c) G6PD Quantitative value, (d) Haematological Values & ESR, and (e) Blood Group. I know of no other laboratory in the UK – Teaching Hospitals included – that can do these 5 tests for less than £100 (One Hundred Pounds Sterling).
RESULTS: (a) Sickling Test POSITIVE (b) Haemoglobin Electrophoresis “AS” with ‘S’ 38.1% (Hb S level being in the highest range of the 3 known Sickle Cell Trait ranges of ‘S’=20-28%, ‘S’=26-33%, ‘S’=34-39% [17 23 24 45 – 50]. Haemoglobin A2 3.0%, Haemoglobin F is 0.5% and the rest Normal Haemoglobin A. Red cell Glucose-6 Phosphate Dehydrogenase Enzyme level was 6.0 U/g [Normal Range 5.6 – 11.2].
VERDICT: Dr Emmanuel Evans-Anfom is therefore SICKLE CELL TRAIT “AS” with NORMAL G6PD. He readily gave me permission to publish the findings not only to help counter Misinformation, if not Disinformation, pervading the Internet based on flawed publications allowed in the best scientific and medical journals, but also to make this finding in a very alert Centenarian a MEDICAL MEMORANDUM.
MISINFORMATION MAKES NONSENSE OF GENETIC COUNSELLING
The very well-thought-out articles of Ian Scott, John Attia, Ray Moynihan  and Naz Khan and Sarah Salway  do not adequately explain the sheer size and varying details of genetic epidemiology for which people worldwide request guidance to prevent hereditary pathology in their offspring. The former concentrate on genetic disposition to malignant conditions of breast, ovary, and prostate  while the latter concern themselves with genetic consequences of marrying relatives . The genetic epidemiological burden discussed by these authors [43 44] amounts to a tiny-fractional-tip of the global genetic iceberg whose huge base is in the Mediterranean countries, Middle East, Asia, Canada, USA, South America, the West Indies and, notably, Africa where genetic red cell defects, namely Haemoglobinopathy (qualitatively ABNORMAL haemoglobin genes), Thalassaemias (abnormal quantities of NORMAL Haemoglobin genes) and genes for G6PD Deficiency abound world-wide. [18 19 24 27 – 42 51 52 53].
UK’s GENETIC BURDEN IS BUT A FRACTION OF GLOBAL BURDEN
Can we also tackle this world-wide problem efficiently? In the UK 1 in every 25 people carries the Cystic Fibrosis gene. In Ghana 1 in every 3 of us carries either Hb S gene or Hb C gene (like my parents – father AC, mother AS just like Dr Evans-Anfom) with the result that 4 of 100 consecutive children born in Ghana suffer from hereditary aching disease ACHEACHE “SS”, “SC”, or “CC”. We proved this at Korle Bu Teaching Hospital genotyping 13000 consecutive births in a single year. , confirming the Hardy-Weinberg Equation [23 24(page 15)]. Yes, 1 in 3 of us in the Diaspora is Sickle Cell Trait “AS” or Haemoglobin C Trait “AC” needing tracing. . Both Professor Graham Serjeant  in the West Indies and Professor Sir David Weatherall FRS  in Oxford acknowledge this global hereditary burden. For further emphasis, Cystic Fibrosis Carrier State is more than 8 times less than Sickle Cell Carrier State yet, as I  commented on Pascale Allotey’s excellent book-review  on “ethnicity and access to health care”, Lancet’s 7-part-series on Genetic Epidemiology came and went  “and not once was it mentioned that one in three west Africans in the UK has a β-globin variant gene whose unsuspecting owner needs to be identified and helped with genetic counselling and family size limitation. I am sure that Ian Scott and colleagues  do not intentionally set out to create “the impression in our minds that genetic epidemiology, which has been my chief concern for decades [24 57-61] had little to do with us non-whites” , but a passing reference in their article to the African Diaspora situation  would not have been out of place.
HINDRANCES TO REALISTIC GENETIC COUNSELLING AFTER TESTING
Hampering realistic counselling is a combination of factors such as Poor Definitions (eg referring to “Trait” as “Disease” or “Disorder” as do the UK Genetics Council , Noke et al , NIH  plus Laboratory Errors like confusing Sickle Cell Trait with Sickle Cell beta-plus Thalassaemia [24, 53].
But chief of all culprits is Misinformation which if deliberate becomes Disinformation. This very important Misinformation Culprit was scrutinised comprehensively by me  when responding to the very instructive article of Semsarian and Ingles “A clinical approach to genetic testing for non-specialists”  together with Allison Streetly’s helpful comments  and needs not delay us further except to mention the remarkable opportunity
Centenarian Sickle cell trait Dr Emmanuel Evans-Anfom, the international hockey player who has flown hundreds of thousands of miles , has given us to debunk once and for all the “scientific” publications on Sickle Cell Trait that lack probity.
SCIENTISTS PERSIST WITH SICKLE CELL TRAIT MISINFORMATION
It is not clear how many of the following examples constitute Disinformation, that is Deliberate Misinformation, but students, doctors, and Science Correspondents of major International Newspapers, Radio Outlets, and Television reporting for the Media, and even GOOGLE and WIKIPEDIA need to look up every single published reference in the following examples so as to be aware of what has happened:
1. Sickle Cell Trait blamed for dying suddenly while exercising 
2. Broken bones in child from baby bashing put to Sickle Cell Trait 
3. Aggressive renal cancer “seen almost exclusively in young patients with sickle cell trait” [71 Elliott Vichinsky et al.]
4. “Complications associated with sickle cell trait” Tsaras et al  Flawed article!
5. Fifteen-year-old black girl sterilized because of sickle cell trait 
6. Black prisoners beaten to death in jail – Autopsy verdict “Sickle Cell Trait” 
7. “Fatal pulmonary infarction in sickle cell trait”. No electrophoresis done. .
8. Sickle Cell Disease (2 beta-globin gene variants) described with Sickle Cell Trait mentioned in the title of article 
9. Beware of symptomatic Sickle Cell Traits 
10. Flight from Kumasi to Accra (45 minutes) produces intestinal infarction in Sickle Cell Trait [77 to 86]
11. Sickle Cell Traits have their insurance loaded 150% ]
12. Pilot with Rhabdomyolysis from Sickle Cell Trait – no laboratory test 
Well did I object “Dangerously flawed diagnosis of sickle cell trait in compartment syndrome rhabdomyolysis”  and “Blaming sudden death on Sickle Cell Trait”?  For other references on Sickle Cell Trait Misinformation see References 91 to 94.
IF LAW MAKERS GET IT WRONG, CAN GENETIC COUNSELLING BE DONE?
Who guides American Insurance Companies when a Massachusetts Law has such a statement as “the disease known as sickle cell trait?”.. There really is no excuse for such scientific obfuscation when there are established agreed definitions in Haemoglobinopathy [96 97]. And Sickle Cell Trait continues wrongly to be written “SCT” by Noke  and the NIH  where National Foundation/March of Dimes of the USA invited me twice to do Grand Rounds in the days of Professor Rudy Jackson.
The only correct phenotype designation for Sickle Cell Trait is “AS”, never “SCT” – a confusion that Insurance Companies use to defraud people because “SC” is the known designation for Sickle Cell Haemoglobin C Disease. The Martin Luther King Jr Foundation protected me with 4 bodyguards in Philadelphia for my Keynote Address “Vital Difference Between Sickle Cell Trait and Sickle Cell Disease”..
THE GREAT RESPONSIBILITY OF INTERNATIONAL MEDICAL AND SCIENTIFIC JOURNALS: A SERIOUS APPEAL TO THE LANCET!
I appeal to the Editors of Lancet to pursue the authors Rhida A, Khan A, Al-Abayechi S, Puthenveetil V who published this: “Acute compartment syndrome secondary to rhabdomyolysis in a sickle cell trait patient” Lancet 2014; 384:2172  without a shred of evidence for Sickle Cell Trait presented, and this resulted in the article going viral on the Internet, frightening people on Facebook when Whiskey Delta Charlie wrote this (QUOTE):
“Here is what’s possible if you are a carrier of Sickle Cell Trait Sept. 224:21pm2016 #sicklecellawarenessmonth #sicklecelltrait #exertion #Rhabdomyolysis http://dhmi.org/sickle-cell-trait-story/ September is Sickle Cell Awareness Month. Awareness to Sickle Cell Trait the gene responsible for creating Warriors who live with Sickle Cell” (UNQUOTE) plus illustrated ghastly pictures of rotting muscles of Rhabdomyolysis .
LOSS OF JOBS FROM SICKLE CELL TRAIT MISINFORMATION
How many pilots might have had their job threatened Corona Virus or no Corona Virus by this flawed Lancet article is not known, but what is known is that previous Editors of Lancet pursued authors of an article supposedly proving that homosexuals and some central Africans shared a common gene Gc1f  the flawed Science of which I was the first to criticize as “leaving a lot to be desired”  until the authors withdrew it from publication with the confession “Erroneous data”. .
So why can’t the present Editors of Lancet pursue the authors of the “Sickle Cell Trait Rhabdomyolysis Pilot” article , ask them to produce the alleged “Sickle Cell Trait” pilot so we know exactly what happened? Are we likely to expect another “Erroneous Data” confession in the Lancet? 
Researchers that need to read about Sickle Cell Trait Misinformation and Disinformation are referred to the huge number of references on the subject [91-95 103].
LORD SOLLY ZUCKERMAN AND PRIDE AND PREJUDICE IN SCIENCE
It was not Black People who dared to mention Prejudice in relation to Science. To imagine that Genome Sequencing, for example, has the answer to everything including Genetic Counselling fails to take into consideration the human element in Science. During my SPECIAL LECTURE dedicated to Centenarian Dr Emmanuel Evans-Anfom  I drew attention to the remarkable article of Professor Sir (later Lord) Solly Zuckerman where he proved conclusively that there was much Prejudice and Pride in Science., and I went on to mention the widespread declaration of Nobel Laureate Professor James Watson that the current Global Sequencing exercise would soon reveal that Africans had inferior intelligence.  He subjected himself to Genome Sequencing only to find that he himself was African , and I could hardly resist the observation on 4th December 2009 that “Watson, still alive today in USA was brutally reminded not only that there is but one human race, but also that African genes contributed to the Nobel Prize.in ‘Medicine or Physiology’ which he jointly won with Francis Crick and Maurice Wilkins on the DNA Double Helix in 1962”. His ancestor was in Africa same time as my great-grand father Konotey-Adade?  There is, indeed, but one human race. 
GENETIC COUNSELLING IN THE AFRICAN MILIEU
In the African milieu Genetic Counselling has been done more from laboratory tests, and we must not rely on Genome Sequencing results from experts like Professor James Watson who know what they will find before they do the examination. Simple Haemoglobin Electrophoresis methods (Alkaline and Acid media) plus clinical acumen have helped us quantify our 1 in 3 genetic incidence and to describe new haemoglobins like Haemoglobin Korle Bu , Haemoglobin Osu-Christiansborg , and discover an adult African, a Nungua fisherman, with only foetal haemoglobin in his body , and also tell the world of a No-Enzyme-at-all G6PD Deficient man in Ghana. [33 34]. The colour test is unable to distinguish Sickle Cell Disease “SC” Phenotype from Sickle Cell Trait “AS”. . Terms like “Up-to-date” [71 (Vichinsky)] and “Novel Clinical Significance” [69 (Key and Vimal)] regarding Sickle Cell Trait are more reflection of imperfect knowledge than, as we are urged to think, discovery of new knowledge. Like “SCT” written for Sickle Cell Trait, they are fraudulent Insurance Companies’ delight.
CORONA VIRUS: SIGNIFICANCE FOR WHITES WITH SICKLE CELL TRAIT AND G6PD DEFICIENCY
1. One often heard “Sickle Cell Disease – the hereditary disease of Blacks”. The past week found 1872 Turks POSITVE for Coronavirus. We must expect about 300 of them to be Sickle Cell Trait phenotype because Aksoy found 15% Turks to be Sickling POSITIVE. Indeed, 18% of Eti-Turks in southern Turkey have Sickle Cell Trait. , Choremis et al reported a high 30% Sickle Cell Trait incidence in Greece where Lake Kopais once was . With 650 reported cases of POSITIVE COVID-19 just as one island was flooded with Greeks returning home, would it surprise anyone if about 150 of these white-skinned Greeks were Sickle Cell Trait “AS”. Thousands of relatives worldwide are Sickle Cell Trait “AS”. Like Ghana , there is also a high incidence of G6PD Deficiency in Turks, Greeks, Italians in the Mediterranean Region as a whole [ 30 42].
2. Reports from China claim that Vitamin C in large doses intravenously has had a remarkably beneficial effect on patients. Linus Pauling who won Nobel Prize for discovering the molecular structure of Sickle Haemoglobin S  popularised taking large doses of Vitamin C  for the common cold, and for cancer 117], a recommendation that was criticized because he was “just a PhD, not an MD doctor”.
A medically qualified doctor, Physician Dr Abram Hoiffer MD PhD FRCP (C) has given Linus Pauling’s Vitamin C anti-cancer claim respectability.  Professor Linus Pauling himself was present and listened approvingly when I gave the Keynote Address “THE VITAL DIFFERENCE BETWEEN SICKLE CELL TRAIT AND SICKLE CELL DISEASE” at the Dr Martin Luther King Jr Foundation Award Dinner in Philadelphia  I shook hands with the only person who got two (un-shared-with-anybody-else) Nobel Prizes. He did not seem to be a person who would have talked about Vitamin C through his hat. And, indeed, Vitamin C has been proven to kill tumour cells with hard-to-treat mutation .
But what has all this got to do with SICKLE CELL TRAIT in White people? ANSWER: Doctors in Europe who may follow Chinese intravenous Vitamin C therapy for Corona Virus must first find out which of their patients has G6PD Deficiency because such large doses of Vitamin C given intravenously can cause catastrophic intravenous haemolysis . Ghanaian doctors who may be adopting Vitamin C intravenous therapy are advised to check Glucose 6 phosphate Dehydrogenase enzyme level before proceeding. The New York Hospital that has started using i.v Vitamin C  will do well to take my advice because one undetected G6PD Deficient patient who collapses on Vitamin C drip will have the Food and Drug Administration come down on them heavily to stop what in my not-so-humble opinion promises to prove once again that Linus Pauling was far from being naïve. If the Chinese wondered why some who received intravenous Vitamin C recovered, while others on the same regime bled from every orifice, I suggest they henceforth do Quantitative G6PD estimation on every patient before treatment is commenced. Greek and Turkish Sickle Cell Traits with G6PD Deficiency, if given large doses of Vitamin C would be misdiagnosed as suffering from Sickle Cell Anaemia “SS” in haemolytic crisis when, in fact, they were Sickle Traits “AS” with anaemia.  The G6PD enzyme level of Dr Emmanuel Evans-Anfom is NORMAL.
I very much trust our British-trained Ghanaian Physicians to screen all admissions (as we used to do half century ago on Medical Floor Two Korle Bu Teaching Hospital) for G6PD Deficiency and administer to those found POSITIVE for COVID-19, immediately, 1,500 mg of intravenous Vitamin C. This is the advice of someone (myself) who shook hands with the Genius “Sickle Cell Linus Pauling” on Wednesday 31st May 1972 in Philadelphia. Take meticulous notes, and publish weekly progress promptly.
3. Africans receiving news from China that Blood Groups reacted differently regarding proneness/non-proneness to the present COVID-19 infection, namely that those with Blood Group A fared worse than O patients in their response to treatment, may confuse (as they have often done) “Blood Group A” with “Haemoglobin Type A” and draw wrong conclusions about how Haemoglobin variants (Hb “S” included) can dictate prognosis in COVID-19 illness We must be very careful about News Headlines when it comes to epidemiology.
SCIENCE NEWS HEADLINES CAN CAMOUFLAGE PREJUDICE
For example, after the “science” that homosexuals and some central Africans shared a common gene Gc1f had in Lancet on Saturday 2nd May 1987  the BBC broadcast the information in its “SCIENCE IN ACTION”  the very next day 3rd May GMT 09.15. My objections to Lancet followed just days later Lancet . But when the authors confessed their “Erroneous data”  some of us were waiting also for BBC to confess “ERRONEOUS SCIENCE IN ACTION.” We wondered why BBC WORLD SERVICE or the BBC HOME SERVICE Programmes did not carry Lancet’s withdrawal of the erroneous findings? Was this an example of BBC reflecting Lord Zuckerman’s diagnosis of “Pride and Prejudice”  in ‘Science In Action’? 
TWO FINAL CAUTIONARY PIECES OF ADVICE TO REMOVE CONFUSION
1. NEVER use SCT to stand for Sickle Cell Trait. It can be confused with “AS”; the “A” standing for normal Haemoglobin gene and “S” for abnormal sickle cell Haemoglobin, with “S” always less than 40% in the best laboratories. Facebook showed a man calling himself “Sickle Cell Trait” groaning from sickle cell crisis pain. When I commented “Ask your Doctor to do Haemoglobin Electrophoresis on you” he returned the next week to say he was “SC”, which is never Trait because “SC” is two Abnormal genes. Traits always have one normal beta-globin gene “A” plus one abnormal beta-globin gene. That is why I use the term “NORMACHE” for Traits, specifying what abnormal Haemoglobin gene the “ACHE” stands for. [See my “Competing Interest” below].
2. AVOID the term “Heterozygote” which just means 2 different genes. Sickle Cell Trait “AS” is Heterozygote, but so also is “SC” which, to avoid calling a disease “Trait”, is correctly designated as “Double Heterozygote”. [23 24]
THANK YOU VERY MUCH, CENTENARIAN DR EMMANUEL EVANS-ANFOM!
Let us thank Dr Emmanuel Evans-Anfom for enabling us to dismiss once and for all the fears of Professor James Bowman MD PhD, University of Illinois Professor of Medicine, Genetics, and Haematology when he lamented that “Persons with sickle cell trait will no longer be able to become ill or even die lest they find themselves subject of a case report” 
Competing Interest: I am the offspring of NORMACHE x NORMACHE Abnormal Haemoglobin parents (AS x AC) who had 11 children 3 of whom had sickle cell disease ACHEACHE (SC), 4 had Trait NORMACHE (2 AC & 2 AS) and 4 of us took no aching genes from our parents to be NORMNORM “AA” phenotype. Impossible it is to tell NORMACHE Traits from those of us who had no Hb gene variant except through blood test. Sickle cell disease phenotypes suffer hereditary cold-season Rheumatism – Tribal names Hemkom or Chwechweechwe – and are therefore physically identifiable. 
Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) DSc (UH) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL
1. Evans-Anfom E. To The Thirsty Land – Autobiography of A Patriot. Africa Christian Press Accra, Ghana 2003 ISBN: 9964-87-717-X
2. Konotey-Ahulu FID. HISTORY SURPASSES SCIENCE. Ghana Academy of Arts and Sciences 30th January 2020 SPECIAL LECTURE dedicated to Dr Emmanuel Evans-Anfom, Centenarian https://youtu.be/hV8NZJh1pg Video.
3. Edington GM. Sickle cell anaemia in the Accra district of the Gold Coast. Br Med J 1953;2:957 https://doi,org/10.1136/bmj.2.4843.957 October 31 1953
4. Lehmann H. The distribution of the sickle cell trait. J Clin Path 1953; 6: 329.
5. Edington GM. Sickle cell trait and sickle cell anaemia. BMJ 1954.1: 871
6. Edington GM, Lehmann H. A case of sickle cell haemoglobin C disease and survey of haemoglobin C incidence in West Africa. Trans Roy Soc Trop Med Hyg 1954; 48: 332-336.
7. Edington GM, Lehmann H. Expression of the sickle cell gene in Africa. BMJ 1955; 1: 1308-1311.
8. Edington GM, Lehmann H. Expression of the sickle cell gene in Africa. BMJ 1955; 2: 1328.
9. Edington GM and Lehmann H. The distribution of Haemoglobin C in West Africa. Man 1956; 34-36.
10. Edington GM, Laing WN. Relationship between Haemoglobin C and S and malaria in Ghana. BMJ 1957; 2: 143-1456.
11. Lehmann H, Nwokolo C. The River Niger as a barrier in the spread eastwards of Haemoglobin C. A survey of haemoglobins in the Ibo. Nature 1959; 183: 1587-1588.
12. Thompson GR. of Haemoglobins S, & C in Ghana BMJ 1962; 1: 682-685.
13. Thompson GR, Lehmann H. Combinations of high levels of Haemoglobin F with A, S and C in Ghana. BMJ 1962; 1:1521-1523.
14. Thompson GR. Malaria and stress in relation to Haemoglobin S and C. BMJ 1963; 2: 976-978.
15. Edington GM. Abnormal Haemoglobins in West Africa. Ghana Medical J 1963; 2: 83-87.
16. Edington GM, Watson-Williams EJ. Sickling, Haemoglobin C, Glucose-6 Phosphate Dehydrogenase Deficiency and malaria in Western Nigeria. In Abnormal Haemoglobins. Editors Jonxis JHP and Delafresnaye JF. Blackwell Scientific Publications, Oxford 1965, pages 393-401.
17. Lehmann H. Hemoglobinopathies. Abnormal Hemoglobins and Thalassaemias. In Health Problems in Developing States. Editors Prywe SM, Davies A. Grune and Stratton Inc., 1968, pp158-167.
18. Ringelhann B, Dodu SRA, Konotey-Ahulu FID, Lehmann H. A Survey for Haemoglobin Variants, Thalassaemia and Glucose-6-Phosphate Dehydrogenase Deficiency in Northern Ghana. Ringelhann B, Dodu SRA, Konotey-Ahulu FID, Lehmann H. Ghana Med J 1968; 7: 120-124. Sept. 1968.
19. Konotey-Ahulu FID. EDITORIAL Hereditary Qualitative and Quantitative Erythrocyte Defects in Ghana: An Historical and Geographical Survey. Ghana Med J 7: 118-119. Sept. 1968
20 Konotey-Ahulu FID and Ringelhann B. Sickle-cell anaemia, sickle-cell thalassaemia, sickle-cell haemoglobin C disease and asymptomatic haemoglobin C thalassaemia in one Ghanaian family. BMJ 1969 Mar 8; 1(5644): 607-612. doi:10.1 http://www.bmj.com/cgi/reprint/1/5644/607.pdf doi:10.1136/bmj-1.5644/607 March 8 1969.
21. Konotey-Ahulu FID. Patterns of clinical haemoglobinopathy. E Afri Med J 1969 Mar; 46(3): 149-156. PMID: 5800410 [PubMed – indexed for MEDLINE]
22. Ringelhann B, Konotey-Ahulu FID, Yawson G, Bruce-Tagoe AA, Miller A and Huisman THJ. Alpha Thalassaemia in West Africa. Symposium on Medical Genetics 1969, Hungary, page 81.
23. Konotey-Ahulu FID. Pattern of Sickle Cell Disease in Accra – A Study of 1,550 Consecutive Patients: A Thesis Presented 1971 for The Postgraduate Degree Of Medicine (MD) In The University Of London. [Awarded in 1972]
24. Konotey-Ahulu FID. The sickle cell disease patient: natural history from a clinico-epidemiological study of 1550 patients of Korle Bu Hospital Sickle Cell Clinic. Tetteh- A’Domeno [TA’D] Co 1996; Macmillan Education 1992.
25. Konotey-Ahulu FID. History of Sickle Cell Disease in Africa. Geographical Distribution and Population Dynamics of Haemoglobins S and C with special reference to West Africa. Ghana Med J 1972; 11: 397-412.
26. Lehmann H, Huntsman RG. Man’s Haemoglobins. North-Holland Publishing Company 1974. Amsterdam
27. Gbedemah KA, Acquaye CTA, Konotey-Ahulu FID and Reindorf CA. Haemoglobin phenotype patterns in more than 1,000 consecutive new-born babies in Ghana. Ghana Med J 1976; 15: 253-256
28. Konotey-Ahulu FID. The spectrum of phenotypic expression of clinical haemoglobinopathy in West Africa. New Istanbul Contribution to Clinical Science 1978 Dec; 12(3-4): 246-257.
29. Bonney GE, Walker M, Gbedemah K and Konotey-Ahulu FID. Multiple births and visible birth defects in 13000 consecutive deliveries in one Ghanaian hospital. In Proceedings of the Second International Congress on Twin Studies Part C Ed Nance W. Progress in Clinical and Biological Research 1978; 24 Pt B: 105-108.
30. Ringelhann B, Konotey-Ahulu FID. Hemoglobinopathies and thalassemias in Mediterranean areas and in West Africa: Historical and other perspectives 1910 to 1997 – A Century Review. Atti dell’Accademia dell Science di Ferrara (Milan) 1998;74: 267-307.
31. Acquaye CTA, Gbedemah KA, Konotey-Ahulu FID. Glucose-6-phosphate Dehydrogenase Deficiency Incidence in Sickle Cell Disease patients in Accra. Ghana Med J 1977; 16: 4-9
32. Konotey-Ahulu FID. Sickle Cell Disease as an International Problem. Annals Of The Research Institute Of Health Sciences (Annales De L’Institut De Researche En Sciences De La Sante) 1997; Volume 1 No. 1, pp 1 to 10
33. Owusu SK. Glucose-6-phosphate dehydrogenase (G-6PD) deficiency in the causation of disease in Ghana. Ghana Med J 1974; 13: 168-170.
34. Owusu SK, Opare-Mante A. Electrophoretic characterization of glucose-6-phosphate dehydrogenase in Ghana. Lancet 1972; 11: 44.
35. Owusu SK, Foli AK, Konotey-Ahulu FID, Janosi M. Frequency of Glucose-6-phosphate dehydrogenase deficiency in typhoid fever in Ghana. Lancet 1972; 1: 320.
36. Adu D, Anim-Addo Y, Foli AK, Yeboah ED, Quartey JKM. Acute renal failure and typhoid fever. Ghana Medical Journal 1975; 14: 172-174.
37. Owusu SK, Addy JH, Foli AK, Janosi M, Konotey-Ahulu FID, Larbi EB. Acute reversible renal failure associated with glucose-6-phosphate dehydrogenase deficiency. Lancet 1972; 1: 1255-1257
38. Owusu SK. Absence of glucose-6-phosphate dehydrogenase in red cells of an African. BMJ 1972; 4: 25-26
39. Owusu SK. Clinical manifestations of glucose-6-phosphate dehydrogenase (G-6PD) deficiency in Ghana. Ghana Med J 1978; 17: 235-239.
40.. Konotey-Ahulu FID. Glucose-6-phosphate dehydrogenase deficiency and sickle cell anaemia. New Eng J Med 1972: 287: 887-888.
41 Konotey-Ahulu FID. G6PD Deficiency in Ghanaians. How to recognise it. Or Twenty different ways G6PD Deficiency presents in Ghanaians Jan 2008 http://bit.ly/2sukoPW
42.Luzzatto Lucio. G6PD Deficiency frequency and sickle cell anaemia association on the African continent. INSERN 1975; 44: 229.
43. Scott Ian A, Attia John, Moynihan Ray. Promises and perils of using genetic tests to predict risk of disease. BMJ 2020; 368:m14 Feb. 22, p 285.
44.. Khan Naz, Communities that prefer close blood marriages need more help to access genetic services. BMJ 2020; 368 BMJ OPINION Feb. 15 page 243.Easton DF
45. Nance Walter E. Genetic control of haemoglobin synthesis. Science 1963; 141: 123-130.
46. Nance Walter E, Grove J. Genetic determination of phenotypic variation in sickle cell trait. Science 1972; 177: 116-118.
47. Brittenham G, Lozoff B, Harris JW, Barker J, Nayudu MV. Alpha globin gene number: population and restriction endonuclease studies. Blood 1980; 55: 706.
48. Lehmann H, Carrell RW. Nomenclature of the Alpha-Thalassaemias. Lancet 1984; 11: 552.
49. Konotey-Ahulu FID. Missing the wood for one genetic tree? In The First International Symposium on the Role of Recombinant DNA in Genetics. Chania, Greece, May 13-16, 1985, pages 105 to 116.
50.. Konotey-Ahulu FID. Alpha-Thalassaemia nomenclature and abnormal Haemoglobins. Lancet 1984; 1: 1024-25. May 5 [“Of 82 consecutive Sickle Cell Traits seen in London in 24 months 36 (44%) had just one quarter of the total Haemoglobin as Sickle Haemoglobin (Mean 25%, Range 20-28”). The three known peaks od Haemoglobin S proportion in the West African Sickle Cell Trait are around 25%, around 30.
51.Lehmann H, Kynoch Pamela A M. Human Haemoglobin variants and their characteristics. North Holland Publication Company. Amsterdam – New York – Oxford 1976; [Elsevier North-Holland Biomedical Press] ISBN 07204 0585 8
52. Serjeant GR. Sickle Cell Disease. Oxford University Press, Oxford 1992. 53. Weatherall DJ, Clegg JB. The Thalassaemia Syndromes. Blackwell Scientific, Oxford 2008.
54. Konotey-Ahulu FID. Need for ethnic experts to tackle genetic public health. Lancet 2007; 370: 1826 [doi:10.1016/50140-6736(07)61771-1] www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61771-1/fulltext
55. Allotey P. Ethnicity and access to health care. Lancet 2007; 370: 475-476
56. Hooper JL, Bishop DT. Population based-based family studies in genetic epidemiology. Lancet 2005; 366: 1397-1406.
57.Konotey-Ahulu FID. Haenoglobinopathy: The Genetics that touches you and me. http://blog.sicklecell.md/sicklecell/sickle-cell-and-allied-haemoglobinopathy-the-genetics-that-touches-you-and-me/ University of Cape Coast Golden Jubilee Message 2012] Konotey-Ahulu FID. Maintenance of high sickling rate in Africa: Role of polygamy. J Trop Med Hyg 1970 Jan; 73(1): 19-21 (38 References). [Traits who voluntarily restrict number of children they produce do diminish burden of abnormal haemoglobin disease (SS SC CC Sbeta-Thalassaemia Cbeta-Thalassaemia Thalassaemia Major SF CF Fbeta-Thalassaemia SKorle Bu SOsu-Christiansborg in the Ghanaian population. My MPSI shows that Males need more to heed this message for Voluntary Family Size Limitation].
58. Konotey-Ahulu FID. The Sickle-cell Diseases: Clinical manifestations including the sickle crisis. Arch Intern Med 1974; 133(4): 611-619 http://archinte.ama.assn.org/cgi/reprint/133/4/611-pdf
59. Konotey-Ahulu FID. Maintenance of high sickling rate in Africa: Role of polygamy. J Trop Med Hyg 1970 Jan; 73(1): 19-21 (38 References). [Traits who voluntarily restrict number of children they produce do diminish burden of abnormal haemoglobin disease (SS SC CC Sbeta-Thalassaemia Cbeta-Thalassaemia Thalassaemia Major SF CF Fbeta-Thalassaemia SKorle Bu SOsu-Christiansborg in the Ghanaian population. My MPSI shows that Males need more to heed this message for Voluntary Family Size Limitation].
60.. Bonney GE, Konotey-Ahulu FID. Polygamy and genetic equilibrium. Nature 1977; 265: 46-47 doi:10.1038/265046a0..n5589/pdf/265046a0.pdf http://www.nature.com/nature/journal/v265/n5589/abs/265046a0.html
61. Konotey-Ahulu FID. Male procreative superiority index (MPSI): The missing co-efficient in African anthropogenetics. BMJ 1980; 291: 170
62. Konotey-Ahulu FID. Survey of sickle-cell disease in England and Wales. BMJ 1982; 284(6309): 112. doi:10.1136/bmj.284/6309/112-a (Jan. 9 1982) http://www.bmj.com/cgi/reprint/284/6309/112-a.pdf7.
63. Human Genetics Commission (HGC-UK) and direct consumer Genetic Tests, leading to Genetic Counselling. BMJ Rapid Response May 27 2009. http://www.bmj.com/cgi/eletters/338/may15_2/b1995#214r56
64. Noke Melissa, Peters Sarah, Uiph Fiona. A qualitative study to explore how professionals in the United Kingdom make decisions to test children for a sickle cell carrier state. Europ Journal of Human Gentics 2016, 24: 164-170. 74. Noke Melissa, Peters Sarah, Ulph Fiona. A qualitative study to explore how professionals in the United Kingdom make decisions to test children for a sickle cell carrier state. Europ. Journal of Human Genetics 2016; 24:164-170. doi:10.1038/ejhg.2015.104 [Terms like “SC prevalence” and “not so benign nature of ‘SCT’” reveal ignorance of approved Terminology.
65. NIH (Bethesda) “ Sickle Cell Disease is the most common inherited blood disorder in the USA …” http://www.ghr.nlm.gov/condition/sickle-cell-disease [But as Sickle Cell Trait is written SCT when SC is known to be disease phenotype what interpretation do people in the USA put on the recently widely advertised NIH home-use-kit for checking for the gene? Especially when the commercial Haemoglobin S Test-Tube Colour-Test does not differentiate between Sickle Cell Trait “AS” (1 Normal gene + 1 Abnormal gene) and Sickle Cell Disease “SC” phenotype (2 Abnormal genes)?
66. Konotey-Ahulu FID. Genetic Testing and Counselling Towards Genetic Public Health http://www.bmj.com/contrent/358/bmj.j4101/rapid-responses BMJ Rapid Response 21 December 2017 to Semsarian C and Ingles J. PRACTICE [See below]
67. Semsarian C., Ingles J. A clinical approach to genetic testing for non-specialists. BMJ 2017; 358 doi: 10.1136/bmj.j4101. 28 Sept. 2017.
68. Streetly A. A common definition of genetic testing, can we agree on one? 18 October 2017 http://www.bmj.com/content/358/bmj.j4101/rapid-responses .
69. Key Nigel S, Derebail Vimal K. Sickle Cell Trait: Novel Clinical Significance. Hematology 2010: 418-422. “During exercise, Sickle Cell Trait appears to be a risk factor for sudden death and/rhabdomyolysis, particularly when the exercise is intense, and is performed at high altitude”
70. Kepron Charis, Somers Gino R, Pollamen Michael S. Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy. Journal of Forensic Sciences Volume 54, No.5, pp 1141 t0 1145 September 2009.
71.. Vichinsky Elliott P. Sickle cell trait. Literature Review UpToDate [Accessed 18 Feb 2011] http://www.uptodate.com/contents/sickle-cell-trait?view=print asserts falsely that “Renal medullary carcinoma is a rare and aggressive tumor that is seen almost exclusively in young patients with sickle cell trait.”
72. Tsaras, G, Owusu-Ansah A, Boateng FO, Amoateng-Adjepong, Y. Complications associated with sickle cell trait: a brief narrative review. American Journal of Medicine 2009; 122(6): 507-512. [The Ghanaian co-authors appear ignorant of what work had been done in Ghana (6 million Sickle Cell Traits) since 1953; See References 3 – 32]
73. Dyson Simon, Bosswell Gwyneth. Sickle Cell and Deaths in Custody. Whiting and Birch, London: June 2009; 230 pages “The misuse of Sickle Cell Trait to explain away sudden deaths”.
74. Malhotra Vinod, Ravi Prakash, Yeun Sook Choi, Bernard Chomet, Clifford G Pilz. Fatal Pulmonary Infarction in a Patient with Sickle Cell Trait. CHEST 1973; 64: 524-26. October 1973. “It is suggested that sickle cell trait should be considered in all Negro patients who present with suspected vaso-occlusive episode”. [Flaws in article: (a) How about the millions of white Greeks and Turks with Sickle Cell Trait? (b) Have the authors excluded Sickle Cell beta-Thalassaemia after quantitative electrophoresis? (c)
Is sickle cell haemoglobin C being referred to as Sickle Cell Trait. (d) Fatal pulmonary infarction occurs in Caucasian women on oral contraceptives. If a “Negro patient” was Sickle Cell Trait “AS”, and had been on contraceptives, why would she be prevented from having pulmonary infarction when white British women were also afflicted?]
75. Witkowska HE, Lubin BH, Beuzard Y et al. Sickle cell disease in a patient with sickle cell trait and compound heterozygosity for haemoglobin S and haemoglobin Quebec-Chori. New England Journal of Medicine 1991; 325: 1150-1154. [Note that the title of this article is incorrect: No human being can be said to have both Sickle cell trait and Sickle Cell Disease. The ‘AS’ pattern is sickle cell trait pattern, but this ‘A’ is not a true ‘A’ but the new haemoglobin called Quebec-Chori, producing a disease phenotype, not trait]
76. Konotey-Ahulu FID. World Sickle Cell Day 19h June 2014 http://bit.ly/1FuNXPi Beware of symptomatic sickle cell traits. Lancet, Feb 29, 1992, page 555. http://www.thelancet.com/journals/lancet/article/PII0140-6736(92)90377-F/fulltext
77. Green RL, Huntsman RG, Serjeant GR. Sickle cell trait and altitude. Br Med J 1971; 4: 593-595.
78. Addae R O. Sickle cell trait and altitude. BMJ 1972; 1: 53. [10 criteria (Addae’s Criteria) required to satisfy clinicians in regions where 1 in 5 people have the sickle cell trait that symptoms are due to the trait and nothing else.]
79. Djabanor F F T. Sickle cell trait and altitude. Brit Med J 1972; 1: 113
80. Konotey-Ahulu FID. Sickle cell trait and altitude. BMJ 1972; 1: 177-178.
81. Konotey-Ahulu FID. An international sickle cell crisis. [Editorial] Ghana Medical J; 1972; 11: 4-8 [A detailed account of how BMJ withdrew report]
82. Konotey-Ahulu FID. Sickle cell trait and altitude. BMJ 1972; 2: 231-32 April 22
83. Green RL, Huntsman RG, Serjeant GR. Sickle cell and altitude. Brit Med J 1972; 2: 294
84. Lehmann Hermann. Sickle cell and flying. The Times (London) 4 Jan 1972 That was when the “Science Editor” used false report on “Sickle Cell Trait and Flying” in BMJ to recommend grounding of all Black Air Crew.
85. Konotey-Ahulu FID. Aviation Safety, Ghanaians recall media disinformation deriving from scientific misinformation. BMJ Rapid Response March 1 2019; https://www.bmj.com/content/364/bmj.l735/rr-7 to Partha Kar: Applying aviation safety to healthcare – are we missing the fundamentals? Partha Kar 364:/doi10.1136/bmj.l735 :
86. Konotey-Ahulu FID. Lt-Col [Retd] Dr Frank F T Djabanor (1938 – 2019) Physician whose exposure of scientific falsehood saved Black People from humiliation. TRIBUTE. Accra & Odumase-Krobo 31st March 2019.
87. Konotey-Ahulu FID. Insurance and genetic testing. Lancet 1993, 341: 833. March 27 [See Reference 98 for when Dr Konotey-Ahulu was given 4 Body Guards in Philadelphia for stressing “Sickle Cell Disease is NOT Sickle Cell Trait and vice versa!” and thus upsetting Insurance Companies]
88. Rhida A, Khan A, Al-Abayechi S, Puthenveetil V. Acute compartment syndrome secondary to rhabdomyolysis in a sickle cell trait patient. Lancet 2014; 384:2172 [No evidence for Sickle Cell Trait was presented in this Lancet article].
89. Konotey-Ahulu FID. Dangerously flawed diagnosis of sickle cell trait in compartment syndrome rhabdomyolysis http://bit.ly/2d4t9Zd http://www.sicklecell.md/blog/index.php/2016/09/dangerously-flawed-diagnosis-of-sickle-cell-trait-in-compartment-syndrome-rhabdomyolysis-article/ [No evidence for Sickle Cell Trait was presented in the Lancet article (Reference 88)].
90.. Konotey-Ahulu FID. Blaming sudden death on Sickle Cell Trait? Flaws in article of Charis Kepron, Gino Somers and Michael Pollanen [Reference 37 above Exposed]. September 4 2011 www.sicklecell.md/blog/?p=105 or www.konotey-ahulu.com/blog/?p=105
91.Konotey-Ahulu FID. Sickle Cell Trait Misinformation and Disinformation. https://blog/sicklecell.md/sicklecell/sickle-cell-trait-misinformation-and-disinformation/ November 30 2011
92 Konotey-Ahulu FID. Further Communication on “Sickle Cell Trait Misinformation and Disinformation” and Sickle Cell Terminology: Disease or Disorder? April 6 2012 https://blog/sicklecell.md/sicklecell/further-communication-on-sickle-cell-trait-misinformation-and-disinformation-and-sickle-cell-terminology-disease-or-disorder/
93. Konotey-Ahulu FID. Sickle Cell Trait Confusion: Is it Deliberate? Or is this Ignorance? August 11 2017 https://blog.sicklecell.md/sicklecell/sickle-cell-trait-confusion-is-it-deliberate-or-is-this-ignorance/
94 Konotey-Ahulu FID. Sickle Cell Trait: As with statins when leading editors disagree please give principles same weight as details 20 September 2016 .http://bit.ly/2dy5fUJ/http://www.sicklecell.md/blog/index.php/2016/09/statins-when-leading-editors-disagree-please-give-principles-same-weight-as-details/
95. Beutler E, Boggs DR, Heller P, Maurer A, Motulsky AG, Sheehy TW. Hazards of indiscriminate screening for sickling. N Engl J Med. 1971 Dec 23;285(26):1485–1486 www.europepmc.org/articles/PMC178610 [Authors have commented on a Massachusetts Law which stated in part that “Every child, which the Commissioner of Public Health, by rule Law which stated in part that “Every child, which the Commissioner of Public Health, by rule or regulation, may determine is susceptible to the disease known as sickle cell trait or sickle cell anemia, shall be required to have a blood test”. [How on earth does one explain to the Americans that there is no such thing as “the disease known as sickle cell trait”? Making my African NORMACHE equal to ACHEACHE?]
96. Woodruff AW et al. Terminology of the Hereditary Haemoglobinopathies with haemoglobin variants. BMJ 1957; 1: 1235. .
97.. Boyo AE, Cabannes R, Conley CL, Lehmann H, Luzzatto L, Milner PF, Ringelhann B, Weatherall DJ, Barrai I, Konotey-Ahulu FID and Motulsky AG. Geneva WHO Scientific Group on Treatment of Haemoglobinopathies and Allied Disorders. (Technical Report) 1972; 509:83 pages. ]
98. Konotey-Ahulu FID. Four bodyguards and the perils of unmasking scientific truths. www.bmj.com/cgi/content/full/335/7612/210 doi:10.1136/bmj.39268.553021.47 BMJ 2007; 335: 210-211. [Day & Date: Wednesday 31st May 1972 – Philadelphia, Dr Martin Luther King Jr Foundation Award Ceremony for Outstanding Contributions in Sickle Cell Disease: Banquet – Dr Konotey-Ahulu’s Keynote Address was on ‘Difference between Sickle Cell Trait and Sickle Cell Disease’. Those also honoured present on the platform with me included Nobel Prize Winners Linus Pauling and Max Perutz, then Hermann Lehmann, Roland Scott, J V Neel, Bella Ringelhann, A C Allison, Bella Ringelhann, James Bowman, Helen Ranney, Charles Whitten, L Diggs, L Conley, Howard Pearson, Sam Charache, and Graham Serjeant.]
99. Whiskey Delta Charlie on Facebook 24 September 2016 If you are a Carrier of Sickle Cell Trait Here is what’s possible: #sicklecellawarenessmonth#sicklecelltrait #exertion #Rhabdomyolysis http://dhmi.org/sickle-cell-trait-story/ September is Sickle Cell Awareness Month. Awareness to Sickle Cell Trait the gene responsible for creating Warriors who live with Sickle Cell” (UNQUOTE) plus illustrated ghastly pictures of rotting muscles of Rhabdomyolysis.
100. Eales L-J, Nye KE, Parkin JM, Weber JN, Forster SM, Harris JRW, Pinching AJ. Association of different allelic forms of group specific component with susceptibility to and clinical manifestation of human immunodeficiency virus infection. Lancet 1987; 1: 999-1002.
101. Konotey-Ahulu FID. Group specific component and HIV infection. Lancet; 1: 1267.
102. Eales NJ, Nye KE, Pinching AJ. Group specific component and AIDS: Erroneous data. Lancet 1988; 1: 936.
103. Konotey-Ahulu FID. The Sickle Cell Disease Patient Website www.sicklecell.md
104. Zuckerman Sir Solly. Pride and Prejudice in Science. Aerospace Medicine 1974; 45: 638-347 (Also re-published with permission in Ghana Medical Journal 1975; 14 (No.1).52-60.105.
105. Professor James Watson: Verkaik Robert. Scientist who sparked racism has black genes. The Independent, London. 10 December 2007. [Re: DNA Nobel Laureate Professor James Watson]
106.. Konotey-Ahulu FID. There is but one human race. New African, London. December 2009, page 4. [Great-grandfather of Nobel Laureate Professor James Watson would have been on the African Continent exactly the same time as my own great-grand father Konotey-Adade born in 1820 (Generation V going back to 1670) . Could the ancestor of James Watson have suffered enforced migration across The Atlantic? Born in 1928, if he is still alive at 92 years of age, would he kindly oblige to have his Haemoglobin Electrophoresis done to see whether he has a 1 in 3 chance of being (like my father and mother) phenotype NORMACHE “AS” or “AC”?
107. Konotey-Ahulu FID. Sickle Cell Disease in successive Ghanaian Generations for Three Centuries (Manya Krobo Tribe). References [23 and 24, pages 6 to 20]
108. Konotey-Ahulu FID., Gallo E, Lehmann H, Ringelhann B. Haemoglobin Korle Bu (alpha2 beta2 73 Aspartic Acid –> Asparagine), showing one of the two amino acid substitutions of Haemoglobin C Harlem. Konotey-Ahulu FID., Gallo E, Lehmann H, Ringelhann B. Haemoglobin Korle Bu (alpha2 beta2 73 Aspartic Acid –> Asparagine), showing one of the two amino acid substitutions of Haemoglobin C Harlem. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1468514 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1468514
109. Konotey-Ahulu FID, Kinderlerer, JL Lehmann H and Ringelhann B. Haemoglobin Osu-Christiansborg. A new chain variant of Haemoglobin A (beta 52 D3 Aspartic Acid to Asparagine) in combination with Haemoglobin ‘S’. J Med Genet 1971; 8(3): 302-305 http://lib.bioinfo.pl/pmid:5097135http://pubmedcentral.nih.gov/picrender.fcgi?artid=146917&blobtype=pdf
110. Kamazura H, Ringelhann B, Konotey-Ahulu FID, Lehmann H, Lorkin PA. The gamma chain in a Ghanaian adult homozygous for hereditary persistence of Fetal Haemoglobin. Acta Hematologica; 51: 197-184. .
111. Konotey-Ahulu FID. Detecting Sickle Haemoglobin. BMJ 1972; 2: 239 Nov 11; 4(5836) 376 See a Massachusetts law quoted below by Dr Beutler et al. Ref. 
112. Aksoy M. Sickle cell trait in Southern Turkey. Lancet 1955; 1: 589-90.
113. Choremis et al.. Blood Groups of a Greek community with a high sickling frequency. Lancet 1957; 2: 1333-1334.
114. 91. Konotey-Ahulu FID. The Sickle-cell Diseases: Clinical manifestations including the sickle crisis. Arch Intern Med 1974; 133(4): 611-619 http://archinte.ama.assn.org/cgi/reprint/133/4/611-pdf
115. Pauling Linus et al. Sickle Cell Anemia, a molecular disease. Science1949; 110: 543-8.
116.. Pauling Linus. Vitamin C and the Common Cold. Linus Pauling Institute Oregon State University. 1970.
117. Hoffer Abram, Pauling Linus. Vitamin C and Cancer: Discovery, Recovery, Controversy. 1979. [ISBN-10 1550820788 & ISBN-13 978-1550820782]
118. Mongelli Lorenn. New York Hospitals are treating coronavirus patients with Vitamin C. New York Post March 24 2020 https://nypost.com/2020/03/24/new-york-hospitalsreatingcoronaviruspatientswithvitaminc/?fbclid=IwAR0rO7trfM0j4GE53xuAnclKreZOtCp72X9qBpDT4fBpXb036t0qorg..
119. BBC SCIENCE IN ACTION Sunday 3rd May 1987 Dr Anthony Pinching interviewed about article in Lancet on Saturday 2nd May explaining why AIDS virus was spreading faster Central Africa than in the USA and how a gene Gc1f was common to homosexuals and Central Africans. The findings were found to be false, and withdrawn from publication, but BBC kept quiet about the “Erroneous Data”.
120. Bowman James. Ethical. Legal, and humanistic implications of sickle cell programs. INSERM 1975; 44: 353-378.
The article in the British Medical Journal of Lamb JN, Holton C, O’Connor P, Giannoudis PV. Avascular necrosis of the hip. BMJ 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:I2178) mentioned a woman who had two pregnancies presenting with painful hip due to avascular necrosis of the hip, but the authors neither associated the pregnancy with the hip problem, nor did they mention the nationality of the patient. They listed sickle cell anaemia among the factors that could cause the particular hip problem of avascular necrosis but there was nothing to show that the lady the authors wrote about had sickle cell anaemia which is known to occur in white as well as black patients.
I wrote to the British Medical Journal responding to the article, and required more information about the nationality of the patient, and whether haemoglobin electrophoresis was done to prove “sickle cell anaemia” (SS) or sickle cell haemoglobin C disease (SC) which latter, I said, was more to be associated with hip necrosis than the former because the blood was thicker in the “SC” than the “SS”. But when the article was published my queries were omitted, and information that would assist GP’s in the UK and elsewhere appeared to have been excised inadvertently even though the references to the information were retained: Konotey-Ahulu FID. Avascular hip necrosis: sickle cell haemoglobinopathy predominates worldwide. June 1 2019 https://www.bmj.com/content/365/bmj.l2178 BMJ Rapid Response to Lamb JN et al 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:l2178.
I took advantage of BMJ publication a fortnight later June 15 asking whether MEDICAL FIRMS should come back – a “Firm” being the term used in the days I was a medical student over six decades ago to comprise a Team of doctors in a Teaching Hospital from Consultants down to House Officers and supporting staff in such a cohesive form as is missing today – I took advantage of this BMJ publication to bring back the sections that were missing in my June 1 article so that GP’s may see the true nature of hip problems in both black and white sickle cell disease women demonstrated admirably by Professor Malcolm Milne’s excellent Firm at Westminster Hospital on a postgraduate ward round in 1962.
DOCTORS PLEASE PAY ATTENTION!
Should we bring back THE FIRM? Yes, please! Firms Vary In Excellence: Pregnancy and Sickle Cell Hip Necrosis Revisited.
BMJ’s Cover Page question 15 June 2019 “Should we bring back THE FIRM?”  helps me to draw attention to Professor of Medicine Malcolm Milne’s Firm at Westminster Hospital same period as that of Professor Harold Ellis who says of those days “The firms were wonderful”?.. I totally agree. I knew both firms as a postgraduate chasing MRCP’s. In fact, Harold Ellis removed my appendix in August 1963, and you could hardly see the 1-inch long scar. Their Firms were remarkable; that was why I was peeved when the Grand Round of Professor Malcolm Milne that I described in response to Jonathan Lamb and Colleagues’ article on aseptic necrosis of the hip  was inadvertently removed. . I reproduce below those sections edited out by mistake, even when their references were retained. GP’s that Lamb et al had in mind for education need these facts about the hip in sickle cell disease. Doctors must think “multiple pregnancies” when an African woman walks into their consulting room with a limp. They must take a detailed history of how long they have been in labour because Lamb and colleagues mentioned two pregnancies , but nothing about length of labour which, with legs in prolonged abduction, compromises blood supply to the femoral heads doing worse damage to the high haematocrit sickle cell haemoglobin C disease (SC) and sickle cell beta-thalassaemia (Sbeta-Thal) patients than in sickle cell anaemia (SS) [5-8].
FIRMS OF PROFESSOR HAROLD ELLIS AND PROFESSOR MALCOLM MILNE WERE MORE EXCELLENT THAN SOME OTHER FIRMS.
Medical and Surgical Firms were not equally efficient. Which Medical Firm in the UK would assemble (like Professor Malcolm Milne’s did) the author of an article 8 years earlier (Joe Humble)  diagnosing sickle cell disease in a white lady (Greek), then ask an African postgraduate (myself) on Grand Rounds to examine her using clinical approach only (History, Observation, Palpation, Percussion, Auscultation) to arrive at a Clinical Diagnosis of “Sickle Cell beta-Thalassaemia with cholelithiaisis and avascular necrosis of humeral and femoral heads”, then turn to Dr Joe Humble: “Show us the Electrophoresis Strip”? That whole section of my Rapid Response a fortnight ago  was excised. I reproduce it so GP’s and others may learn from it. Read this together with my earlier response which stated: “the sickle cell gene frequency in some white people in Greece and in Eti-Turks is greater than that in my own country Ghana”. [4 7 8]. See the excised portion before “Jonathan Lamb et al list fewer conditions …”:-
These and their offspring are scattered around the world including the UK. A white woman was correctly diagnosed by me 57 years ago exactly on Professor Malcolm Milne’s Westminster Hospital Postgraduate Grand Rounds using just History (“I come from Greece”), Examination (icteric eyes, scar in right hypochondrium, loss of left shoulder contour due to angulation, and frequent joint pains) as (in my own words) “Sickle Cell beta-Thalassaemia disease with cholecystectomy for pigment stones, and aseptic necrosis of the left humeral head”. Haemoglobin Electrophoresis was produced on the ward round to confirm my clinical diagnosis by Consultant Haematologist Dr Joe Humble [8, page 240] who 8 years earlier had identified the same lady as having sickle cell Thalassaemia .Trained in London University in the 1950’s by the likes of Sir Richard Bayliss (Queen’s Physician) I was trained as it were for the bush in order that I could make diagnoses without X-rays. The luxury of MRI did not exist. Fortunately, there are some GP’s in the UK today who can make this kind of clinical diagnosis on History and Examination alone.
PREGNANCY & PROCREATION LIMITATION & HIP NECROSIS
Jonathan Lamb et al quite rightly mention pregnancy: “She had recently given birth to her second child”.  I would like to know how long she was in labour for because prolonged 2nd stage of labour we found in Ghana to be one of the precipitating causes of this condition in the multiparas. I once commented thus:
“The peculiar selection of the hip joint for such crippling pathology might have some eugenic significance [5 7 8]. Some of the Hb SC disease women with bilateral hip involvement complained of inability to separate their thighs for coitus, seriously endangering marital relationships, while many of the male patients with hip involvement find coitus impossible because body movement of any sort produces agonizing pain (Illustrative Case Histories 44, 46 and 48” [Ref 8 below].
I went on: “It seemed to me that in addition to priapism this is a further means that Nature has devised to limit dissemination of the sickle cell gene” [8, page 240].
FURTHER INFORMATION REQUIRED TO EDUCATE US, PLEASE
1. What is the nationality of this lady? Ringelhann and I described in some detail Mediterranean and West African Haemoglobinopathy and G6PD Deficiency. 
2. How long was she in labour for in both pregnancies?
3. What does the Haemoglobin Electrophoresis show? I once described two Sickle Cell Haemoglobin D disease girls with an English father (“AD” phenotype) and Ghanaian mother (“AS” phenotype) [Case History 133 in Reference 8]. The “SD” phenotype can be as severe as the “SS” (Sickle Cell Anaemia). Another reason why Hb Electrophoresis is important even when Sickling Test is Negative is that in my 36 consecutive homozygous Haemoglobin C disease patients in Ghana “the 35th presented with hip pain”. 
Jonathan Lamb et al list fewer conditions that cause aseptic necrosis of the femoral head than the 25 that J E Nixon  listed in 1983 in the Journal of the Royal Society of Medicine, but their article  has admirably succeeded in alerting clinicians about this condition which afflicts not just Africans and Caucasians but the entire world. We await answers to the 3 questions listed above, but note that Sickle Cell Anaemia “SS” is not the same as Sickle Cell Haemoglobin C disease “SC”. Sickle Cell Trait is “AS” phenotype.
Competing interests: None declared Twitter @profkonotayahul
F I D Konotey-Ahulu MB BS MD(Lond) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) DSc (Hon UCC) DSc (Hon UH) FGA FGCP FWACP FTWAS, ORDER OF MERIT (OFFICER). Kwegyir Aggrey Distinguished Professor of Human Genetics, Faculty of Science, University of Cape Coast, Ghana, and Former Director Ghana Institute of Clinical Genetics Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital Accra, and at Phoenix Hospital Group, 9 Harley Street, London W1G 9AL.
1 BMJ Front Cover. Should we bring back THE FIRM? 15 June 2019. [365 379-420 No 82003 ISSN 1759-2151.
2 Ellis Harold. “The firms were wonderful” quoted with portrait in Abi Rimmer The Firm: could it fix teamworking and morale? BMJ 2019; 365: 14105 June 15 2019.
3 Lamb JN, Holton C, O’Connor P, Giannoudis PV. Avascular necrosis of the hip. BMJ 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:I2178)
4 Konotey-Ahulu FID. Avascular hip necrosis: sickle cell haemoglobinopathy predominates worldwide. June 1 2019 https://www.bmj.com/content/365/bmj.l2178 BMJ Rapid Response to Lamb JN et al 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:l2178.
5 Konotey-Ahulu FID. Hip disease in Africans, Lancet 1970; 1: 99.
6 Konotey-Ahulu FID. Hip pain and radiographic signs of osteoarthritis: Sickle Cell and other haemoglobinopathy differential diagnosis. BMJ Rapid response to Nieuwenhhuisje MJ, Nelissen RG. Hip pain and radiographic signs of osteoarthritis. BMJ 2015; 351:6262 (03 December 2015) BMJ 2015;351:h5983
7 Konotey-Ahulu FID. Pattern of Sickle Cell Disease in Accra. A Study of 1550 consecutive patients. Dissertation presented to University of London for the Postgraduate Diploma of Doctor of Medicine 1971. Awarded MD(London) February 1972.
8 Konotey-Ahulu FID. The Sickle Cell Disease Patient: Natural History from a Clinico-epidemiological study of the first 1550 patients of Korle Bu Hospital Sickle Cell Clinic. The Macmillan Press Ltd, London 1991 & 1992 and T-AD Co Watford 1996.
9 Humble JG. et al. A family illustrating the double inheritance of a sickle cell trait and of Mediterranean anaemia. J Clin Path 1954; 7: 201-208.
10 Ringelhann B, Konotey-Ahulu FID. Haemoglobinopathies and Thalassaemia in Mediterranean areas and in West Africa: historical and other perspectives 1910-1997 – A Century Review. Atti del’Accademia dela Science di Ferrara Haemoglobinopathies 1998: 74: 267-307.
11 Nixon JE. Avascular necrosis of bone: a review. J R Soc Med. 1983; 76: 681-692.
The painstaking way (pun intended) that “a doctor, a pharmacist, and a patent attorney”  have analysed the 2013 to 2018 “on going disputes around pregabalin” (British Medical Journal June 9 2018, page 358) needs commendation. I don’t comment on particular details because “Supreme Court decision is due soon” , but pertinent questions need answers. This excellent account implies how powerful Drug Licensing Authorities are. It is only after drugs have been licensed that MHRA, NHS, NICE, or BNF issue instructions. Can we identify the composition of Licensing Bodies so we may hold persons to account individually when undesirable sequelae follow their decision to license a particular drug?
Adverse Clinical Consequences Following Licensing One Drug and Not Another
I realised over 20 years ago the power Drug Licensing had in the UK when I began pointing out that Morphine and Diamorphine, through respiratory suppression, killed sickle cell disease patients in painful crises. “If the patient dies” I said in Lancet “sickle cell crisis and chest syndrome will be recorded on the death certificate” [2 3]. When a UK Professor of Obstetrics & Gynaecology  advocated Morphine for sickle cell crisis patients in pregnancy, I said in BMJ: “The question that puzzles me is: Why do west African and West Indian patients with sickle cell disease who did without morphine in their countries have to be given morphine pumps during sickle cell crises when they come to the United Kingdom? In any case, in obstetrics what happens to foetal respiration when morphine is used?” 
Professor Elisabeth Goodman  found Ketorolac as good as Morphine with no respiratory depression in vaso-occlusive crisis but Liesner, Vandenberghe and Sally Davies said “Ketorolac has no product licence in the UK for this indication” 
How extraordinary that a drug that did not kill patients had no Product Licence in the UK, but Morphine and Diamorphine that killed sickle cell disease patients as NCEPOD later confirmed  was, and still is, licensed “for this indication”! Indeed, despite NCEPOD’s damning patients-dying-from-Opiate-Overdose Report NICE issued Guidelines advocating Diamorphine intravenously in sickle cell crisis .
Cecilia Shoetan’s heart-rending BMJ report of her breathless 32-year-old sickle cell disease daughter dying within seconds when Diamorphine (licensed for this indication) was given intravenously in a London hospital while she stood watching  makes frightening nonsense of the NICE Guidance .
NHS ENGLAND and NHS SCOTLAND differ on Pregabalin?
The July 2007 Scottish Medicines Consortium (SMC) advice regarding Pregabalin differs from its April 2009 directive . Meanwhile, NHS England had her own rules. Witness the extraordinary situation in which NHS instructed doctors to depart from their usual prescribing for pain [13 14]. Who best should instruct doctors on prescribing practice? When Dr Margaret McCartney asked “Why do we have to prescribe branded Lyrica for pain?”  whom was she addressing? Well may Dr Laurence Leaver ask “With friends like NHS England, GP’s do not need enemies” .
Just 9 months ago we read “UK government to reclassify pregabalin and gabapentin after rise in deaths” . Such reclassification is a forensic exercise. Disobey instructions and the Law could be after you. Can Freedom of Information identify individuals using “MHRA” or “NHS” or “The government” or “NICE” as cover to issue “not fit for purpose” guidelines?  Please investigate MHRA etc Competing Interest Declarations . Pharmacovigilance in a developing country like Ghana has as many as 6 levels of vigilance and each level has potential for corruption . Developed countries are no better, as Dr James Le Fanu exposes in his remarkable book recommended below.
The Le Fanu Legacy for Thoroughness
The name “Le Fanu” is music to Ghanaian ears. Korle Bu Hospital was planned and designed by Dr C V Le Fanu in the early 1910s in Colonial Gold Coast . The outstanding Governor Sir Gordon Guggisberg  in 1919 “gave it top priority in his government’s building programme”  and when he opened it on 26 October 1923 he wanted it to “acquire a reputation second to none in the medical world”. One of the remarkable members of staff was another Le Fanu, Dr G E H Le Fanu who in 1909 led his laboratory in carrying out “a successful experiment to manufacture active vaccine lymph, locally, for small pox vaccination” . Gold Coast Hospital, renamed Korle Bu Hospital, went on to do exploits including Dr Hideyo Noguchi’s Yellow Fever work. . Meanwhile Dr G E H Le Fanu and colleagues including Dr Albert Hawe continued to tackle Tropical Diseases in a most thorough way [21 23]. Today, a Third “Thorough Le Fanu,” James, whose masterpiece “TOO MANY PILLS” is a ‘Must Read’ for every doctor mentions eight Big-Pharma companies that were fined a total of $Billion10.813 Dollars “for corrupt and illegal practices 2007-2012”. [24, page 25]
PAIN and OPIATES in HOSPITAL DEATHS
“Hospital drugs left 456 patients dead” was Daily Telegraph’s front-page head-line Thursday June 21  plus an Editorial description of “fatal doses of diamorphine and other inappropriate drugs” in Gosport War Memorial Hospital. Note that when the NCEPOD Report of 2008 revealed that between January 2005 to December 2006 “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”  there were neither front-page newspaper-headlines nor calls for prosecutions as we hear today about Gosport.
Why the difference? ANSWER: Not because the victims were black, but because Morphine and Diamorphine are LICENCED “for sickle cell crisis indication” in the UK, raising this question: Does the whole area of Drug Licensing (Pregabalin included) not need looking into urgently? And when Dr James Le Fanu publishes in the BMJ that “Mass medicalisation is an iatrogenic calamity”  do we not wake up to the fact that the very first rung of the ladder to any medicalisation is DRUG LICENSING?
Finally: “Diamorphine has no accepted medical use in the United States” 
Competing Interest: I come from a sickle cell disease home: My Trait Parents had 11 children – 3 of us had sickle cell disease, hence my never-ceasing opposition to patient-management of pain that shortens life in anybody. [2 3 5 7 11 28 – 36].
Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL.
1 Smyth Darren, Goldacre Ben, Croker Richard. Pregabalin: what the patent litigation means for doctors and big pharma. BMJ 2018;361:k2318 https://www.bmj.com/content/361/bmj.k2318.full? BMJ June 09 2018
2 Konotey-Ahulu FID. Opiates for sickle-cell crisis? Lancet 1998; 351: 1438.
[“The question that puzzles me is: Why do west African and West Indian patients with sickle-cell disease who did without morphine in their countries have to be given morphine pumps during sickle-cell crises when they come to the UK?”]
3 Konotey-Ahulu FID. Opiates for sickle-cell crisis. Lancet 1998; 352: 651-652. [To David Bevan’s criticism (Lancet 1998; 351: p 1965) of white physicians who agree with Dr Konotey-Ahulu that opiates created addicts in hospital – “When I say routine opiates for sickle crisis are not the way to bring out these patients’ best potential in the long term I am glad to hear white physicians say the same…White physicians who, at the risk of being misunderstood by Bevan, voice their displeasure at what they see happening on their wards deserve commendation, not condemnation.”]
4 Chamberlain G. Medical problems in pregnancy: II. BMJ 1991; 302: 1327-30. (1 June)
5 Konotey-Ahulu, FID. Morphine for painful crises in sickle cell disease. BMJ 1991, 302(6792): 1604. (June 29 1991) (Comment on Professor Chamberlain’s recommendation of morphine in pregnancy in sickle cell disease – BMJ 1991; 302: 1327-30.) doi:10.1136/bmj.302.6792.1604-c
6 Goodman Elisabeth. Use of ketorolac in sickle cell disease and vaso-occlusive crisis. Lancet 1991; 338: 641-642.
7 Liesner RJ, Vandenberghe EA, Davies Sally C. Analgeisics in sickle cell disease disease. Lancet 1993; 3411: 188.
8 NCEPOD (National Confidential Enquiry into Patient Outcome and Death). Sickle: A Sickle Crisis? (2008) [Sebastian Lucas (Clinical Coordinator), David Mason (Clinical Coordinator), M Mason (Chief Executive), D Weyman (Researcher), Tom Treasurer (Chairman) email@example.com
9 NICE. Management of an acute painful sickle cell episode in hospital: summary of NICE guidance. BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4063 (Published 27 June 2012) BMJ 2012;344:e4063
10 Shoetan Cecilia. I lost my Sickle Cell disease adult daughter minutes after being given Diamotrphine intravenously when she could not breathe. BMJ Rapid Response 3 June 2008 http://www.bmj.com/cgi/eletters/336/7654/1152-a#196520
11 Konotey-Ahulu FID. Poor care for sickle cell disease patients: This wake-up call is overdue BMJ Rapid Response May 28 2008 BMJ 2008; 336: 1152 to Susan Mayor “Enquiry shows poor care for patients with sickle cell disease” on National Confidential Enquiry into Patient Outcome and Death (NCEPOD) REPORT “SICKLE: A Sickle Crisis? (2008) http://www.bmj.com/cgi/eletters/336/7654/1152a#196224 | http://firstname.lastname@example.org
12 National Formulary. Pregabalin. BNF 70. September 2015 – March 2016: p 400.
13 Byrne Paul AC. Doctors are warned not to prescribe generic pregabalin for pain control www.bmj.com/content/350/bmj.h1734 March 30 2015 (BMJ April 7 2015)
14 Barbour James Re: Margaret McCartney – Second use of patents – why do we have to prescribe branded Lyrica for pain? (July 8 2015) “recent direction from a member of NHS health authorities that pregabalin prescriptions for chronic pain www.bmj.com/content/350/bmj,h1724/rapid-responses
15 McCartney Margaret. Second use of patents: Why do we have to prescribe branded Lyrica for pain? BMJ2015;350:h2734. July 8 2015.doi:10.1136/bmj.h2734 pmid:25995105
16 Leaver Laurence B. With friends like NHS England, GP’s do not need enemies “pregabalin to change some to Lyrica, so that Pfizer can maximise their profits at the expense of NHS” www.bmj.com/content/350/bmj.h1724 (02 May 2015)
17 Hopkins H. UK Government to reclassify pregabalin and gabapentin after rise in deaths. (03 October 2017) www.bmj.com/content/358/bmj.j4441 Rapid Response to Gareth Laccobucci. UK government to reclassify pregabalin and gabapentin after rise in deaths BMJ 2017; 358: 4441 https://doi.org/10.1136/bmj.j4441 (Published 25 September 2017) BMJ 2017;358:j4441
18 Rost Felicitas, Wessely Simon. Depression in adults: campaigners and doctors demand revision of NICE guidance. BMJ 2018;361:k2681 [BMJ 23 June 2018, p 426] “The latest NICE draft guidelines on adult depression is misleading, invalid, not fit for purpose, and potentially harmful to patients”. BMJ 2018; 361: k2681.
19 Hurley Richard. Former MHRA chair takes job at cannabis investment company. Rapid Response Re: Cannabis, cannabis everywhere: UK to review medical cannabis policy as Canada plans imminent legislation for all uses. BMJ 20 June 2018 361:doi10.1136/bmj.k2695 “Sir Breckenridge will help Sativa Investments liaise with the Home Office and the Medicines and Healthcare products Regulatory Agency (“MHRA”), which he has chaired, for the legislation of medicinal cannabis in the UK”.
20 Konotey-Ahulu FID. Who should best pharmacovigilate in developing countries? https://www.bmj.com/rapid-response/2011/11/01/who-should-best-pharmacovigilate-developing-countries 14 September 2007 [ http://oW.ly/Dq8g30dSHe0 ]
21 Addae Stephen. Evolution Of Modern Medicine In A Developing Country: Ghana 1880 – 1960 Durham Academic Press, Ltd., 1 Hutton Close, Bishop Auckland, Durham 1996 [On Governor G Guggisberg and Le Fanu C V & Le Fanu G E H]
22 Goodall HB. Beloved Imperialist – Sir Gordon Guggisberg – Governor of The Gold Coast. The Penland Press Ltd., 1 Hutton Close, South Church, Bishop Auckland, Durham 1998.
23 Konotey-Ahulu FID. Some personal encounters with a remarkable physician (Tribute to Dr Albert Joseph Hawe. OBE CBE MD FRCP DTMH). Ghana Med Journal 1979; 18: 88-90.
24 Le Fanu James. Too Many Pills – How too much medicine is endangering our health and what we can do about it. Little, Brown Book Group, London EC4Y 0DZ.
25 Daily Telegraph. Hospital drugs left 456 patients dead”. Thursday June 21 2018 Front Page. Editorial “Fatal doses of diamorphine and other inappropriate drugs”.
26 Le Fanu James. Mass medicalisation is an iatrogenic calamity. Profligate prescribing has brought a hidden a hidden epidemic of side effects and no benefit to most individuals. [PROVOCATIONS] BMJ 2018; 361: k2794. June 30, page 494.
27 [NOTE WELL]: Ballas S K. Sickle Cell Pain. IASP Press. Seattle, USA, page 168: “Diamorphine has no accepted medical use in the United States”
28 Konotey-Ahulu FID. Management of patients with sickle cell disease. African Journal of Health Sciences 1998; 5: 47[ Commenting on article of Sally Davies and Lola Oni (BMJ 315: 656 -60) “what I feel is more important in the day to day management of patients with a view to keeping them out of hospital, is clinical epidemiology which includes the circumstances of crises. … I fear Davies and Oni’s statement that ‘The Central Middlesex management protocol uses morphine infusions’ will make morphine the accepted drug for sickle crisis management. The consequences of such an approach are dire, especially when some UK hospitals are already making diamorphine their first choice”.]
29 Ringelhann B, Konotey-Ahulu FID. Hemoglobinopathies and thalassemias in Mediterranean areas and in West Africa: Historical and other perspectives 1910 to 1997 – A Century Review. Atti dell’Accademia dell Science di Ferrara (Milan) 1998;74: 267-307
30 Konotey-Ahulu FID. Opiates for pain in dying patients and in those with sickle cell disease. http://www.bmj.com/cgi/eetters/335/7622/685#177986 BMJ 11 Oct 2007
31 Konotey-Ahulu FID. Management of sickle cell disease versus management of the sickle cell disease patient. BMJ Rapid Response 17 September 2008
32 Konotey-Ahulu FID. Inquest into diamorphine deaths: Does NCEPOD sickle patients report warrant a similar inquest? BMJ Rapid Response March 7 2009
33 Konotey-Ahulu FID. Opiods for chronic non-cancer pain – Chemotherapy – Clinical Guidelines: Where does ultimate responsibility lie? www.bmj.com/content/ 346/bmj.f2937/rr/651421BMJ Rapid Response 25 June 2013
34 Konotey-Ahulu FID. Opiods in the UK: What’s the problem? Answer – Good Clinical Practice needs to cover all population groups including sickle cell disease patients. BMJ Rapid Response 18 August 2013 www.bmj.com/content/347/bmj.15108/rr/658208
35 Konotey-Ahulu FID. Management of sickle cell disease patient in the community BMJ Rapid Response 13 April 2014 [90 References] to Brousse V, Makali J, Rees DC: Management of sickle cell disease in the community. BMJ 2014; 348: g1765 doi:10.1136/bmj.g1765 http://www.bmj.com/content/348/bmj.g1765/rr/694233
36 Konotey-Ahulu FID. Management of an acute painful sickle cell episode in hospital: NICE guidance is frightening1 Sept 7 2012 [42 references]] www.bmj.com/content/344/bmj.e4063/rr/599158