To Sickle Cell Education Day in Maryland USA May 15, 2021

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.

EXAMPLES

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 felix@sicklecell.md 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/2sukoPWG6PD 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

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.

HEAVEN

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!

Centenarian Sickle Cell Trait Genetic Testing

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 [1] 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 [2].

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” [43] and “Communities that prefer close blood marriages need more help to access genetic services”. [44] 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 [43] and Naz Khan and Sarah Salway [44] 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 [43] while the latter concern themselves with genetic consequences of marrying relatives [44]. 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. [29], 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. [54]. Both Professor Graham Serjeant [52] in the West Indies and Professor Sir David Weatherall FRS [53] 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 [54] commented on Pascale Allotey’s excellent book-review [55] on “ethnicity and access to health care”, Lancet’s 7-part-series on Genetic Epidemiology came and went [56] “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.[54] I am sure that Ian Scott and colleagues [43] 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” [54], but a passing reference in their article to the African Diaspora situation [62] 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 [63], Noke et al [64], NIH [65] 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 [66] when responding to the very instructive article of Semsarian and Ingles “A clinical approach to genetic testing for non-specialists” [67] together with Allison Streetly’s helpful comments [68] 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 [1], 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 [69]
2. Broken bones in child from baby bashing put to Sickle Cell Trait [70]
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 [72] Flawed article!
5. Fifteen-year-old black girl sterilized because of sickle cell trait [24]
6. Black prisoners beaten to death in jail – Autopsy verdict “Sickle Cell Trait” [73]
7. “Fatal pulmonary infarction in sickle cell trait”. No electrophoresis done. [74].
8. Sickle Cell Disease (2 beta-globin gene variants) described with Sickle Cell Trait mentioned in the title of article [75]
9. Beware of symptomatic Sickle Cell Traits [76]
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% [87]]
12. Pilot with Rhabdomyolysis from Sickle Cell Trait – no laboratory test [88]

Well did I object “Dangerously flawed diagnosis of sickle cell trait in compartment syndrome rhabdomyolysis” [89] and “Blaming sudden death on Sickle Cell Trait”? [90] 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?”.[95]. 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 [64] and the NIH [65] 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”.[98].

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 [88] 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 [99].

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 [100] the flawed Science of which I was the first to criticize as “leaving a lot to be desired” [101] until the authors withdrew it from publication with the confession “Erroneous data”. [102].

So why can’t the present Editors of Lancet pursue the authors of the “Sickle Cell Trait Rhabdomyolysis Pilot” article [88], 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? [102]

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 [2] 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.[104], 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. [105] He subjected himself to Genome Sequencing only to find that he himself was African [105], 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”.[106] His ancestor was in Africa same time as my great-grand father Konotey-Adade? [107] There is, indeed, but one human race. [106]

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 [108], Haemoglobin Osu-Christiansborg [109], and discover an adult African, a Nungua fisherman, with only foetal haemoglobin in his body [110], 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”. [111]. 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. [112], Choremis et al reported a high 30% Sickle Cell Trait incidence in Greece where Lake Kopais once was [113]. 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 [114], 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 [115] popularised taking large doses of Vitamin C [116] 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. [117] 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 [98] 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 [117].

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 [41]. 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 [118] 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. [24] 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 [100] the BBC broadcast the information in its “SCIENCE IN ACTION” [119] the very next day 3rd May GMT 09.15. My objections to Lancet followed just days later Lancet [101]. But when the authors confessed their “Erroneous data” [102] 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” [104] in ‘Science In Action’? [119]

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” [120]

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. [24]

felix@konotey-ahulu.com Twitter @profkonoteyahul

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

Website www.sicklecell.md or www.konotey-ahulu.com

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) [107]. 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. [95]

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.

FOR EDUCATION OF DOCTORS: Painful Hip In Black And White Sickle Cell Disease Women

Painful hip in Black and White Sickle Cell Disease Women

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?” [1] 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”?.[2]. 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 [3] was inadvertently removed. [4]. 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 [3], 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) [8] 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 [4] 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 …”[4]:-

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 [9].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”. [3] 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. [10]

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”. [8]

Jonathan Lamb et al list fewer conditions that cause aseptic necrosis of the femoral head than the 25 that J E Nixon [11] listed in 1983 in the Journal of the Royal Society of Medicine, but their article [3] 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.

PAIN CONTROL : DON’T PREGABALIN PATENT LITIGATIONS RAISE LICENSING POLICY QUESTIONS?

The painstaking way (pun intended) that “a doctor, a pharmacist, and a patent attorney” [1] 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” [1], 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 [4] 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?” [5]

Professor Elisabeth Goodman [6] 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” [7]

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 [8] 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 [9].

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 [10] makes frightening nonsense of the NICE Guidance [11].

NHS ENGLAND and NHS SCOTLAND differ on Pregabalin?

The July 2007 Scottish Medicines Consortium (SMC) advice regarding Pregabalin differs from its April 2009 directive [12]. 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?” [15] whom was she addressing? Well may Dr Laurence Leaver ask “With friends like NHS England, GP’s do not need enemies” [16].

Just 9 months ago we read “UK government to reclassify pregabalin and gabapentin after rise in deaths” [17]. 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? [18] Please investigate MHRA etc Competing Interest Declarations [19]. Pharmacovigilance in a developing country like Ghana has as many as 6 levels of vigilance and each level has potential for corruption [20]. 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 [21]. The outstanding Governor Sir Gordon Guggisberg [22] in 1919 “gave it top priority in his government’s building programme” [21] 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” [21]. Gold Coast Hospital, renamed Korle Bu Hospital, went on to do exploits including Dr Hideyo Noguchi’s Yellow Fever work. [21]. 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 [25] 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” [9] 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” [26] 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” [27]

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@konotey-ahulu.com              Twitter@profkonoteyahul

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.

www.sicklecell.md

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

http://www.bmj.com/cgi/reprint/302/6792/1604-c.pdf

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) info@incepod.org

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://www.info@ncepod.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

http://www.bmj.com/cgi/elettrs/337/sep08_1/a1397#202088

32 Konotey-Ahulu FID. Inquest into diamorphine deaths: Does NCEPOD sickle patients report warrant a similar inquest? BMJ Rapid Response March 7 2009

http://www.bmj.com/cgi/eletters/338/mar03_3/b903#210208

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

My PERSONAL VIEW on Research Integrity: When scientists confess to lying

My PERSONAL VIEW on Research Integrity: When scientists confess to lying
Dr Francis Crawley writes in the British Medical Journal 6 November, 2018: “The retraction of scientific articles based on fraudulent representations of science is damaging to science”. [1]. The terms “Research Integrity” and “Fraudulent Science” hide underneath a human umbrella of “Lying Scientists” or (using polished language) “Scientific Liars”.

EDITORIAL INTEGRITY OF BMJ & LANCET – PERSONAL EXPERIENCE

Great credit to these British Editors who pursued authors until they confessed uncomfortable truths leading to published articles retracted. I happened to be partly instrumental in unmasking in both these celebrated medical journals articles which (using Prime Minister Winston Churchill’s phrase) were full of “terminological in-exactitudes”, but which the Ghanaian in me would simply call “lies”.

In the BMJ example the then Editor rang me at Korle Bu Teaching Hospital to issue what amounted to an apology and to reassure me that the published fictitious Case Report would be withdrawn. This was done after the authors confessed to lying. What they said had happened in their Case Report had in fact not happened, because there was no Case(to)Report!

The second example of scientific erroneous data I was instrumental in unmasking was when the AIDS pandemic engulfed the world. The day my suspicions surfaced was when BBC WORLD SERVICE in its SCIENCE IN ACTION Programme May 3 1987 broadcast that the reason AIDS was rampant in Central Africa was that people there had inherited a new genetic factor that predisposed them and homosexuals to the virus. I had just finished touring the worst afflicted areas of my Continent at my own expense to study AIDS at the grassroots. I did the 16-countries’ trip expressly to study the epidemiology of the new disease at the village level. Both BMJ [2] and Lancet [3] published articles I submitted to them. No less than 4 other British International Journals including Journal of Royal Society of Medicine which even invited an Editorial [4], carried my novel epidemiological findings.

In my publications I told the world exactly why and how AIDS became rampant on my Enigmatic Continent, especially in my own Ghanaian Krobo tribe. Then, suddenly, there came a team of scientists from London University claiming that homosexuals and Central Africans shared a common gene that they blamed for the pandemic. I could not sit idly by when laboratory scientists could broadcast to the world what I considered to be false. The SCIENCE IN ACTION programme claimed The Lancet to be the source of its information. I read, and re-read the paper, and wrote to The Lancet whose august Editorial Team then comprised of Robin Fox, Imogen Evans, and David Sharpe. I called them “The Magnificent Trio” because I was invited to Lancet’s Offices 7 Adam Street, The Strand in London for interview to substantiate my African findings.

Mine was the very first correspondence in Lancet to criticize “the new research”. Stung by my statement that their research “leaves a lot to be desired” the authors wrote back to more or less rubbish what I said: “Konotey-Ahulu’s interpretation of our conclusions is at fault”. I kept quiet, and just let others continue with correspondence in Lancet. Some supported the homosexual/Central-African-gene “finding” while others including Dr S S Papiha from Newcastle University disagreed, supporting me. Professor A G Dalgleish from London University also commented. Meanwhile, the media had a field day. Science Editor of The Times (references available) went on, and on, about the genetics of why Africa was being decimated by AIDS.

Then, exactly 11 months and 3 weeks after the Lancet publication about which “The Magnificent Trio” allowed much correspondence doctors were amazed to read that because of “ERRONEAOUS DATA” (the authors’ own words) the article linking Central Africans and homosexuals was being retracted forthwith. Frankly, after decades writing in international journals, I have come to the conclusion that British Editors are head and shoulders above the Americans when it comes to retracting scientific misinformation. I once wrote to the USA correcting something about G6PD Deficiency occurring together with Sickle Cell Disease in the same patient, but it took more than 6 months for the New England Journal of Medicine to publish my concerns [5], by which time the original misinformation had taken root.

RETRACTION NOT MENTIONED IN WORLD PRESS

What was hugely worrying for us Africans was that although the scientists confessed to wrong doing in both the BMJ case and The Lancet, the media did not find it necessary to correct what had been said in SCIENCE IN ACTION or The Times. Indeed, it took Professor Hermann Lehmann FRS of Cambridge University writing to The Times (January 4 1972) to rebuke its Science Correspondent and ask why when misinformation had been confessed and withdrawn from the BMJ should articles continue to appear as if nothing had happened? The Times Correspondent (references available) continued also to publish the falsely claimed genetic proclivity of homosexuals and Central Africans to AIDS after the “Erroneous Data” confession.

It appears we Africans cannot win? Wrong! The number of cell phones pervading the Dark Continent is mind boggling! Refuse to correct Misinformation or Disinformation (defined as Deliberate Misinformation), and be sure to find it corrected on the Internet, and African drivers reading about it while filling their car tanks with petrol. The Media World has changed. Africans have handed in questions to be answered on Facebook “Meet the Professor talking about Sickle Cell Disease Patient Live” [6]. Those who miss the live programme can access the hour-long session later on YouTube. Let conventional media “forget” to correct confessed scientific in-exactitudes that had been retracted, and Twenty-First Century Social Media will NOT forget! Professor Lord Solly Zuckermann [7] and previous BMJ Editors Stephen Lock and Richard Smith [8 9] have written extensively about this very important matter.

[NOTE: References of names of authors who confessed to “erroneous data” after being challenged and have had articles withdrawn from BMJ and Lancet are withheld.]

Competing Interest: Having been Past Editor of Ghana Medical Journal for many years taught me to discern when authors’ research articles “left a lot to be desired”. [3]
felix@konotey-ahulu.com Twitter@profkonoteyahul
F I D Konotey-Ahulu MD(Lond) FRCP(Lond) DTMH(L’pool) Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, and Director Ghana Institute of Clinical GeneticsKorle Bu Teaching Hospital, Accra, Ghana and Phoenix Hospital Group, 9 Harley Street, London W1G 9AL [ www.sicklecell.md ]

References

1 Crawley Francis P. Research Integrity, Open Science, and Health Policy. BMJ Rapid Response 6 November 2018 https://www.bmj.com/content/363/bmj.k4309/rapid-responses

2 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)
http://www.bmj.com/cgi/reprint/294/6587/1593.pdf doi:10.1136/bmj.294.6587.1593

3 Konotey-Ahulu FID. AIDS in Africa: Misinformation and Disinformation. Lancet 1987; 2(8552): 206-208. July 25.

4 Konotey-Ahulu FID. An African on AIDS in Africa [Guest Editorial] The AIDS Letter – Royal Society of Medicine 1989 Feb/March, pp 1-3.http://www.konotey-ahulu.com/aidsinafrica/konoteyahulu/art1_cvref113.htm

5 Konotey-Ahulu FID. Glucose-6 phosphate dehydrogenase deficiency and sickle cell anaemia. New Eng J Med 1972; 287: 887-888. http://www.bmj.com/cgi/reprint/1/5793/177-a.pdf

6 Konotey-Ahulu FID. Meet the Professor talking about Sickle Cell disease patient live! Thursday 4th August 2016 7 pm On Line
https://www.facebook.com/events/1840398749523659/ | https://www.youtube.com/watch?v=TR-IENhqh5k

7 Zuckerman, Lord S. Pride and prejudice in Science. Aerospace Medicine 1974; 45: 638-647. [Describes a catalogue of frauds in Science over several decades]

8 Lock Stephen. Misconduct in medical research: Does it exist in Britain? BMJ December 10 1988, Volume 297, page 1531.

9 Smith Richard. Should research fraud be a criminal offence? The BMJ Opinion. December 9 2013 https://blogs.bmj.com [“A systematic review has shown that research misconduct is common, terrifyingly common. Anybody who is sceptical about research fraud should sign up to the brilliant Retraction Watch that will bring you several cases every week of scientific misconduct”]
9AL.

Folic acid in Pregnancy: Birth Defects: Speech Embarrassment: Why abortion?

Tiny Folic Acid in pregnancy prevents huge African Linguistic Embarrassment too, but is abortion for prevention warranted?

In addition to the “birth defects such as spinal bifida and anencephaly” (BMJ 20 0ctober 2018) that “flour fortified with folic acid” [1 2] is expected to prevent when given in early pregnancy, I did state ten years ago that “a mere 500 micrograms daily is known to prevent cleft palate” [3] – a seemingly minor defect but which in the tribal setting constitutes a formidable social pathology [3 4].

SOCIAL PATHOLOGY OF CLEFT PALATE IN THE AFRICAN

How would any BMJ reader feel if when saying “I have scrubbed”, what is heard is “I have passed wind?” The extraordinary thing about this state of affairs is that the speaker is quite unaware that what was just heard was tantamount to blasphemy in Krobo/Dãngme-Gã Mother Tongue where every vowel not only has at least 3 reproducible pitches but also 2 distinct qualities – non-nasal and nasal [5]. Cleft palate phonates nasal and, coupled with any of the 3 distinct pitches, imparts 6 different meanings to the same consonant. I say that again: a vowel in my Tribal Tonal Language imparts 6 different meanings to the same consonant depending on its pitch and quality. [3-6]

“Osa” in Krobo/Dãngme (“Osha” in Gã) [Low High vowel-pitch sequence] means “you scrubbed”. Nasalise the second vowel, same pitch sequence, and you have said “You passed wind” [Osã and Oshã respectively]. Even using the tribal devulgarising prefix “Tafracher!” [7] can never excuse the utterance of such a thing in public. The embarrassment is complete. “It is, therefore” I once remarked “a social disaster of enormous proportions if when an African wants to say she has scrubbed, she is rather heard to say unmentionable things because of cleft palate. The need for early correction of this defect cannot be overemphasized. Any African baby with cleft palate stands in great danger of being ostracised in later life, and should be helped immediately” [4, page 10].

TERMINATION OF PREGNANCY FOR CLEFT PALATE?

Nicholas Wald of the Wolfson Institute of Preventive Medicine at Queen Mary University of London is quoted by the BMJ as saying if it is officially confirmed that within weeks flour will be fortified with folic acid “the UK is taking an important step in preventive medicine and helping to avoid disability or termination of pregnancy” [1]. In a Parliamentary Written Question 114833 “Abortion: Cleft Palate” Jim Shannon (Strangford) asked the Secretary of State for Health on 21 November 2017 “how many abortions there were in each of the last 15 years in which the fetus had a cleft palate (a) palate or (b) lip, …” by residents in England and Wales [8]. Answering, Jackie Doyle-Price said that for all gestations there were 9 in 2013, 10 in 2014, 11 in 2015, and 9 in 2016.

IF GHANAIANS COULD DIAGNOSE PRENATALLY WOULD THEY ALSO ABORT?

Certainly Not! At least for one interesting reason: Dr Albert Joseph Hawe MD FRCP OBE CBE was the most well-known white Colonial Doctor the Gold Coast (now Ghana) had ever known for 50 years [9]. He was the doctor stationed at Akuse 10 miles from where I was born in Odumase Krobo, and it was he who so expertly looked after me in the early 1930’s when I was often sickly that my first words in English were “When I grow up I shall go to England. When I grow up I shall be a Dorkita like Dorkita Hor”. His contemporary in our British colony was Dr Cicely Williams who first described Kwashiorkor in my tribe [10 11]. I was amazed when I discovered that the white “dorkita” who had looked after me as a toddler was one of the two Consultants (the other was Ghanaian Dr Silas Dodu) whom I was assigned to work with as Medical Officer on my return from the UK after registration.

My second discovery was that the heavily nasal diction of Dr Albert Hawe was due to Cleft Palate/Lip the scar of repair of which was a prominent feature of his physiognomy! If this remarkable Englishman had been aborted he would not have been in Colonial Gold Coast to work in my tribe and help save my life. But in order that it might not be construed that cleft palate abortion practice in England and Wales had no equivalence in Africa thus proving our superior ethical stance in these things I, born with extra-digits deformity (Mendelian Dominant 1% incidence in Ghana) [12], need to mention what I once said in the BMJ [13] which Professor Sir David Weatherall FRS drew attention to in his excellent textbook “The New Genetics and Clinical Practice”[14]: My Krobo Tribe in south east Ghana cared little about extra digits which they just tied firmly at birth and watched them atrophy and fall off. My stubs are there for all to see today. The tribe east of us beyond the Volta River would rejoice at the sight of a new-born baby with extra digits – destined to be rich. The tribe west of us beyond the hills would drown a baby so deformed until the practice was stopped by missionaries and the Colonial government. The UK “scientific tribesmen” as I described them in the BMJ [13] might have suggested I be aborted alongside pregnancies with cleft palate and sickle cell disease’

DISCUSS WITH AFRICANS WHAT UK LAW ALLOWS BUT ETHICS DISALLOWS

Cleft-palated Dr Albert Hawe for over half a Century treated Ghanaians who then came to England and were told that it would soon be legal to terminate an up-to-term pregnancy because cleft palate had been unmasked through ultrasonography. A procedure that was legal by UK Law would be interpreted in the African mind as perfectly alright. Indeed, it is taught that haemoglobinopathy may be diagnosed prenatally and termination suggested to parents when some of my patients were far brighter than their siblings. [15]. World Class Clinical Geneticists Professor George Fraser [16] and Professor Sir David Weatherall [14] have always emphasized ETHICS in these considerations.

Competing Interest: Born with extra digits – a defect for which termination has been done in the UK [17] Twitter: @profkonoteyahul

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. [www.sicklecell.md]

 

1 Limb Matthew BMJ Flour to be fortified with folic acid within weeks, say reports. BMJ 2018; 363:k4348.(20 Oct.) BMJ 2018; 363 doi  https://doi.org/10.1136/bmj.k4348     (16 Oct 2018)

2 Campbell D. Folic acid to be added to UK flour in effort to reduce birth defects.Guardian 14

Oct 2018 https://www.theguardian.com/society/2018/oct/14/folic-acid-to-be-added-to-flour-in-effort-to-reduce-serious-birth-defects.

3 Konotey-Ahulu FID. Social pathology of Cleft Palate in The African: Mathematical Precision of Pitch Gaps in Tribal Tonal Linguistics. Ghana Medical Journal 2008; 42: 89-91. (June 2008).

http://www.ghanamedassociation.org/ | http://www.pubmedcentral.nih.gov.articlerender.fcgi?artid=2631266 PMID: 19180210 [PubMed – indexed for MEDLINE] (vowel coloration omitted on this NIH site).

4 Konotey-Ahulu FID. Tonic SolFa Is The Foundation Of Tonal Linguistics. DRUMSPEAK (Supplement) International Journal of Research in the Humanities. New Series Vol 3. No. 1, May 2010. Faculty of Arts, Univ. of Cape Coast, Ghana. ISSN (0855-9945).http://bit.ly/bEdcc4

5 Konotey-Ahulu FID. Black people’s red faces and AIDS prevention. Lancet 2000; 355(9214):1559. PMID: 10801206 [African vowel has at least 6 meanings with consonant]

6 Konotey-Ahulu FID. The Remarkable African Ear: Phenomenon of Mid Pitch Arrest Phenomenon in Krobo-Dangme-Gã Tonal Linguistics of South East Ghana. African American Museum of Philadelphia Award Lecture May 5 2007

http://blog.konotey-ahulu.com/blog_archives/2007/5/5/301434.html

7 Konotey-Ahulu FID. Tafracher – Personal View. BMJ 1975; 1(5953): 329. (February 8)  http://www.bmj.com/cgi/reprint/1/5953/329.pdf         http://bit.ly/2bRQ7B1

8 UK Parliament. Abortion: Cleft Palate: Written question – 114833    (21 Nov. 2017)

https://www.parliament.uk/business/publications/…questions…question/…11…/114833/

9 Konotey-Ahulu FID. Some personal encounters with a remarkable physician. (Tribute to Dr Albert Joseph Hawe, OBE, CBE, MD, FRCP, DTMH). Ghana Med J 1979; 18: 88-90.

10 Williams Cicely. D. Kwashiorkor – a nutritional disease of children associated with a maize diet. Lancet 1935; ii: 1151-1152.

11 Konotey-Ahulu FID. Issues in Kwashiorkor. Lancet 1994, February 26, page 548.

12 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.

13 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

14 Weatherall DJ. Ethical Issues and related problems arising from the application of the new genetics to clinical practice. In: The New Genetics and Clinical Practice. [Third Edition] Oxford University Press. Oxford 1991.

15 Konotey-Ahulu FID. Antenatal sickle cell disease haemoglobinopathy screening. BMJ

http://www.bmj.com/content/341/bmj.c5243/reply#bmj_el_243447  Rapid Resp. Oct 25 2010

16 Fraser GR. FIFTY YEARS OF HUMAN GENETICS – A Festschrift and liber amicorum to celebrate the life and work of George Robert Fraser. Wakefield Press, 1 Parade West, Kent Town, South Australia 5067 www.wakefieldpress.com.au

17 Yeoman Fran. Babies are aborted over an extra finger or club foot. The Times. May 29 2006.

UNIVERSITY OF HERTFORDSHIRE (CHANCELLOR LORD SALISBURY) HONOURS PROFESSOR FELIX KONOTEY-AHULU

September 5th 2018 at St Albans Cathedral

Prof. Felix Konotey‐Ahulu, Lord Salisbury
Prof. Felix Konotey‐Ahulu
Award Scroll


https://youtu.be/41a1FZSpHd4

CITATION HONORARY DEGREE OF DOCTOR OF SCIENCE (DSc)

Chancellor, ladies and gentlemen, it is my pleasure to read the citation for the presentation of the honorary award of Doctor of Science on Professor Felix Konotey-Ahulu.

Science is, in essence, a search for the truth. It is this search for truth that has driven Felix to make very significant discoveries in the area of sickle cell disease. As a scientist, he is not afraid to challenge conventional wisdom if it conflicts with his own discoveries. But this has landed him in hot water at times, not least when he was assigned no fewer than four bodyguards when he was the keynote speaker at the Martin Luther King Jr Foundation’s award banquet in Philadelphia 1972!* His pointing out the vital distinction between sickle cell trait and sickle cell disease was going to have huge implications for insurance companies, and the organisers were more than a little concerned for his safety.

Felix’s research in the area of sickle cell disease has been groundbreaking. He is the only known scientist to have traced hereditary disease in his own family all the way back to 1670 AD. Having grown up in a family where sickle cell disease was present, his knowledge of the disease even before he went to medical school in the UK was significant. His parents had sickle cell trait, which resulted in his siblings having the disease, although he himself has neither.
Felix’s personal experience and observations therefore qualified him well to question conventional thinking about the causes of sickle cell trait, and seeing the pain and struggles of his siblings has greatly informed the way he views people with the condition. The sickle cell clinic in Ghana of which he was the
Director, at the Korle Bu Hospital, was the largest in the world. In addition, he established the Konotey-Ahulu Genetic Epidemiology Sickle Cell Foundation in 2011 to provide counselling for sufferers, as well as education and research.
The importance of asking questions is something Felix has always been very keen to pass on to his own students – encouraging them to learn ‘how to think’ rather than simply learning ‘what to think’ in order to pass exams. This ties in with his passion for medical ethics, particularly in the area of genetics. Indeed, one of his caveats is, ‘Medicine without ethics is dangerous!’

Although this honorary doctorate is being awarded for Felix’s involvement in the area of sickle cell disease, he has contributed significantly to other areas of work, including AIDS research, medical ethics and tonal linguistics. He has been very widely published, and a number of his articles have become the definitive studies in their field.

Felix has also authored two books. Of the first, What is AIDS?, Professor Maya Angelou said that it is ‘Compulsive reading. I could not put it down.’ His second, The Sickle Cell Disease Patient, has been described as ‘a commendable addition to the medical literature’.

The contribution of Felix has been publicly acknowledged many times, among which was inclusion in a list of ‘The 100 Greatest Africans of All Time’. In this list he keeps esteemed company, with names such as Nelson Mandela, Martin Luther King and Kofi Annan. Among many other distinguished awards, he has received the Dr Martin Luther King Junior Foundation Award for outstanding research in sickle cell anaemia, and the African American Museum in Philadelphia Humanitarian Award in 2007, in recognition of his exceptional contribution to the people of Africa and to the world.

Felix says that he has a soft spot for St Albans, as his second job after qualifying as a doctor at London University’s Westminster Hospital School of Medicine was as house surgeon in 1960 to three eminent surgeons at St Albans City Hospital. He remembers this fondly as a most memorable period in his career. Twenty years later, the hospital was privileged to count Felix as a locum physician in medicine for the elderly in the 1980s. He is now resident in Hertfordshire.

And Felix has a very diverse range of other talents too. If you have a moment, do search the internet for the millennium hymn he wrote – it’s called ‘Time was Created’ and available on YouTube, and is well worth a listen!
Chancellor, in recognition of outstanding achievement I ask that you confer the honorary award of Doctor of Science upon Professor Felix Konotey-Ahulu.

*See British Medical Journal 2007, July 28 Volume 335, page 210
“Four bodyguards and the perils of unmasking scientific truths” by F I D Konotey-Ahulu http://www.bmj.com/cgi/content/full/335/7612/210

UH Hon. DSc Acceptance Speech Sept. 5 @ St Albans Cathedral

Lord Salisbury, Chancellor of the University of Hertfordshire, Lord Ribeiro of Achimota and Ovington and Past President of the Royal College of Surgeons, Graduates, Distinguished Guests, Ladies and Gentlemen! Hearty Congratulations to those who studied Allied Health Professions including Midwifery and have emerged so successful. Very Well Done! I sincerely wish you well for your future endeavours.

Regarding myself, ever since I got the letter of the Vice-Chancellor inviting me to receive an Honorary Doctor of Science Degree one word has been uppermost in my head – and that word is GRATITUDE. Allow me explain: Exactly one week after leaving Achimota School on completing my Cambridge School Certificate Exams in the Gold Coast (Ghana) my brother Jerry and I were struck by lightning on the football field. He was killed instantly. I was spared, with just a facial burn. Jerry was 17 years of age, I was 19. Why Jerry? And not me? I will never know the answer to that question, but one thing I do know, GOD Almighty has His hand on me. And my gratitude to HIM knows no bounds.

Three and half years after the lightning bolt I did the 12 days’ voyage by Boat (Elder Dempster Lines) to England to study Medicine. Can you believe that I was taught by the best of the best? At London University’s Westminster Hospital School of Medicine Clinicians of Royalty were my teachers notably Sir Richard Bayliss who became Physician of Her Majesty the Queen. Any bedside manners I possess I was taught by Sir Richard. You had better have bedside manners with the Head of the Commonwealth. My first job as a doctor was in London at Bethnal Green Hospital. Walking into Ward B3South I introduced myself to the nurse. “Hello, I am the new doctor, Felix”. Quick came the response “Hello. I am Sister Moss”. “So, what can I call you?” I asked hopefully. “You can call me Sister Moss” she replied. Actually, her name was Rosemary. I remember that Monday morning June 15 1959 as if it was yesterday because on Easter Monday 23rd April 1962 Dr Martyn Lloyd-Jones married Felix and Rosemary Moss at Westminster Chapel. She is a staunch believer in The Lord Jesus Christ. We have 3 children, 11 grandchildren, and 2 great grand-children. Just Google “Felix and Rosemary” and you’ll see our 50th Wedding Anniversary 2012 clip. Darling I thank GOD for you! You are just as beautiful today as when I cast eyes on you 59 years 3 months ago. I don’t know how I could have achieved what I have done without you.

GRATITUDE: I stress this again as I end. I owe so much to more people than I have time to mention; people who made sacrifices for me like Professor Hermann Lehmann (Cambridge University), Professor Bela Ringelhann the Hungarian, Dr Kobla Gbedemah (Ghanaian Laboratory Expert) – men who have been long dead but whom I shall never forget. Also, Institutions that put their weight behind me like Ghana Cocoa Marketing Board, Ghana’s Managing Trustees of The VALCO Fund, and University of Cape Coast in Ghana.

Dear Graduates, when you see someone struggling in life and you reach down and lift them up, and you tell them “I will help carry your load”, you have an impact beyond anything you can imagine. One big thing I learnt coming to England in the early 1950s was that every privilege carried a responsibility. Never forget, Ladies and Gentlemen, that you have had privileges in life. Please, please, learn to help those less privileged than you. If I have achieved anything it is because I have been enabled by others to stand on the shoulders of giants. It has been a privilege to share this occasion with you. Lord Salisbury, I thank University of Hertfordshire for this honour done me. And I thank GOD Almighty in whose hands my very breath is for longevity.

Lord Salisbury, Prof. Felix Konotey‐Ahulu, Lord Ribeiro

Who will tell pre-teenagers that, Tafracher, Abnormal Sex is highly dangerous?

A Ghanaian African worth his salt cannot adequately communicate the message below without employing the aid of “Tafracher”, that invaluable tribal word I first introduced to medical parlance in the British Medical Journal some 43 years six months ago [1]. Please start by reading that BMJ page here https://www.bmj.com/content/1/5953/329 before proceeding to what I have to say about vaccinating 12 to 13-year old boys in order (experts say), to prevent them getting cancers of both ends of their ALIMENTARY CANAL, throat and anus. Please, I beg you, do NOT proceed to read what I have written below until you have read this article https://www.bmj.com/content/1/5953/329 possibly twice over. I’ve warned you!

BREAKING NEWS

UK Government’s announcement: “Boys in England to get HPV vaccine from next year” [2 3] was so startling that it was “BREAKING NEWS” world-wide [ 4 – 11]. Some items contained the information that the HPV vaccine “can guard against oral, throat, and anal cancers”. Not a word about what constitutes “Abnormal” Sexual Practice.

DEFINITION OF “ABNORMAL SEX”

I turn to those I consider to be the world authorities on abnormal sexual practice for clear definitions of “normal sex” and “abnormal sex”. I do not know how many other physicians besides me have interviewed more than 120 international prostitutes (alias sex workers) on duty or in their homes in Africa when, with a chaperon, I examined some of them very carefully for extraordinary pathological features, and published findings in at least six British medical and scientific journals [12-24] and elsewhere [25-29]. The cardinal thing that these ladies taught me far beyond what experts like Professor Michael Adler [30] and Dr W F Owen of San Francisco [31] revealed in their publications was that only peno-vaginal sexual intercourse constituted “normal sex”, and anything other than that like (Tafracher) anal sex and variations there-from or (Tafracher) oral sex i.e. fellatio and variations there-from constituted “abnormal sex,” and the girls demanded double or triple what they charged for normal sex.

WHY DO AFRICAN PROSTITUTES CHARGE MORE FOR ABNORMAL SEX?

So why did African sex workers charge double or triple when clients demanded what the girls considered abnormal sex? Quick came the answer from the most articulate of the women I invited to lunch with me in a Mombasa hotel in Kenya: “But you are a Dorkita and you do not know? Very dangerous, I tell you, Dorkita!” [14 20 24 25 29]. Abnormal sex is harmful – the very word used on the front page of Monday’s UK Daily Telegraph July 30 2018: “Growing number of primary school children are exhibiting harmful sexual behaviour as a result of the internet” [32]. One Burundi prostitute told me she knew abnormal sex was very dangerous “Mais je leur demande une grande somme d’argent” (But I demand from them a huge sum of money) [25 page 36]. Abnorma;l sex, the girls told me can be both quantitative (Tafracher, over 20 coital acts in one day in their trade) and qualitative as when clients demand abnormal sex as well. Together, these quantitative and qualitative acts produced what I described as “perineal devastation and disintegration” [14 25 29] enabling invasion of microbes.

TAFRACHER GONORHOEA OF THE THROAT!

I once described palatal echymosis from fellatio in a housewife who admitted on my questioning that (and I quote) “my husband was rather rough last night”, but the sore throat that she presented with in one London hospital turned out to be “Gonorrhoea of the throat!” [15]. The question I have for the UK Government lining up 12 to 13-year old boys for HPV vaccination to prevent oral cancer is this: “Will the vaccine protect them against gonorrhoea of the throat?”

The experienced Dr Joginder Anand (previously of UK Public Health) once asked “Public Health England whether the doctors who are remunerated for this vaccination could be required to spell out to the children being vaccinated the precise mechanical route of transmission of the virus” [33] Who, pray, will teach these children the relative health hazards of the different sexual practices, as the African prostitutes rehearsed to me? What if some of these pre-teenagers decide: “Right, marvellous, I can be as promiscuous as I like. I am protected.”? How does one teach our children and grand-children, and great-grand-children sexual discipline? Aren’t we heaping problem after problem on our young people and the health services?

DEVELOPING COUNTRIES LEARNING FROM DEVELOPED UK AND USA?

One doctor from Mauritius [34] reacting positively to the BMJ news “Boys in England to get HPV vaccine from next year” [2] says that because his country’s Minister of Health and Quality of Life had in 2016 “announced a new vaccination program for females who are aged between nine and thirteen” due to “150 new cases of cervical
cancer reported annually and about 50 deaths also” [35] he sincerely hoped “that the same system of vaccination follows for the boys in the country” [34]. And this despite the fact (he says) that “Parents in Mauritius are very hesitant to allow their children to be vaccinated as they believe that they are not sexually active at such a young age and it is an unnecessary vaccine” [34]. It appears parents’ wishes in Mauritius were subordinated to practices from developed country Britain because “While we gained independence from the United Kingdom in 1968, we still value the examples set by the country in terms of prevention, law and order, and medical care” [34]. There you have it: Great Britain does it, so ex-Colonies must follow suit! The USA is not different: “The CDC’s Advisory Committee on Immunization Practices Recommendation issued in 2009 was permissive, meaning providers could give the vaccine to boys … (and) The three-vaccination series can start as early as age 9 years” [36]. Will HPV vaccine protect the children against rectal syphilis? Are parents told answer to that question?

OFFICIAL ENDORSEMENT OF ABNORMAL SEX FOR CHILDREN?

The British Medical Journal Editorial of Professor Margaret Stanley and colleagues (August 2 2014, p 6) [37] gives little convincing reason why “all 12 to13 year old boys” should also be vaccinated against HPV, the virus that causes cervical cancer, which results “in an estimated 90% of cases of anal cancer in the UK” [37], and which also causes “oro-pharyngeal cancers” [37]. A UK Government initiative headlined “Oral sex lessons to cut teenage pregnancy” [38] elaborated thus: “Encouraging school children to experiment with oral sex could prove the most effective way of curbing teenage pregnancy rates, a government study has found” [38]. Then this headline in UK’s Daily Telegraph “Children aged 5 get sex education” [39] also has an article stating plans “to cut teenage pregnancy and sexually transmitted diseases” with not a single caveat that (Tafracher) Oral Sex has been found to produce HIV-AIDS [40 41 42]. Indeed, I once asked in the BMJ “Would the sex education material include information on gonorrhoea of the throat? Would the children be told of the risks to which phallic bruising of the palate exposes them with oral sex?” [43] Please read again my BMJ concerns where I reiterated the fact that “people who do different things with their mouth can pass on Chlamydia through a harmless pastime like French kissing” [43]. Why must we keep such information from teenagers? I myself saw Kaposi Sarcoma
in the mouth of a Burundi prostitute. Do Clinicians in Developed Countries take an oral sex history when they observe a sarcoma of the neck?

HEALTH ADVISORS MUST DECLARE COMPETING INTERESTS

I strongly suggest that those sitting on Committees of NICE, NHS Licensing, etc advising the UK Government and United States Government about mass vaccinations and drugs must, like the rest of us do when we air opinions on health matters, declare what financial and other interests they may have, for example like links with Big Pharma. Don’t we also have to know what those we vote for in General Elections think about asking children to experiment with Abnormal Sex? And we must never forget the astonishment of the tribal chief I described in Ghana who, acutely aware of the main cause of AIDS among his subjects, was told that The Europeans and Americans were developing a vaccine for AIDS. “What?”, he screamed “You mean they are going to prick us with needles so we can do what we like?” [25, page 146].

Competing Interest: My book “WHAT IS AIDS?” [25] is on sale with detailed accounts of what the African international Sex Workers revealed to me regarding Abnormal Sex.

Email : felix@konotey-ahulu.com
Twitter : @profkonoteyahul

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. www.sicklecell.md

  1. Konotey-Ahulu F I D. Tafracher – Personal View Tafracher – Personal View. BMJ 1975; 329: 1(5953): 329 (Feb. 8) The Ghanaian de-vulgarising prefix www.bmj.com/cgi/reprint/1/5953/329.pdf
  2. Kmietowicz Zosia. Boys in England to get HPV vaccine from next year. BMJ 2018; 362; doi: https://doi.org/10.1136/bmj.k3237 July 24 2018
  3. UK Government HPV vaccine to be given to boys in England – GOV.UK
    https://www.gov.uk/…/hpv-vaccine-to-be-given-to-boys-in-england Boys aged between 12 and 13 in England will be given a vaccine to protect
  4. New Scientist www.newscientist.com https://www.newscientist.com/…/2174940-hpv-vaccine-to-be-offered-to-all-children-in-england-not-just-girls/
  5. Centres for Disease Control CDC USA. Mar 26, 2018 … The U.S. Centers for Disease Control and Prevention (CDC) recommends that all boys and girls aged 11 to 12 should receive the HPV vaccine … HPV | Who Should Get Vaccine | Human Papillomavirus | CDC Jun 29, 2018 … Get answers to common questions about HPV vaccines here. … All kids who are 11 or 12 years old should get two shots of HPV vaccine six to … If your child is older than 14 years, three shots will need to be given over 6 months. … Teen boys and girls who did not start or finish the HPV vaccine series when … https://www.cdc.gov/hpv/parents/vaccine.html
  6. MIRROR UK. HPV vaccine will be offered to ALL boys aged 12 and 13 to help … https://www.mirror.co.uk/news/…/hpv-vaccine-offered-boys-aged-12972538
  7. ABC News. https://abcnews.go.com/Health/…offer-hpvvaccination…boys…/story?id vaccine can guard against oral, throat, and anal cancers.
  8. The INDEPENDENT. HPV vaccination to be introduced for all teenage boys in UK … https://www.independent.co.uk/…/hpv-vaccination-teenage-boys-uk-introduced-girls-cervical-cancer-risk-a8461376.html
  9. The GUARDIAN. Call to extend HPV vaccine to boys as cancer rates soar | Society …https://www.theguardian.com/…/mar/…/hpv-vaccine-boys-cancer-rates
    Mar 31, 2018 … HPV vaccine. Call to extend HPV vaccine to boys as cancer rates soar … In the UK, all schoolgirls are offered the vaccine from the age of 12 or… Call to extend HPV vaccine to boys as cancer rates soar | Society … The human papillomavirus (HPV) vaccine, which can also guard against oral, throat and anal cancers, will be offered to boys aged 12 to 13 in …
  10. The TELEGRAPH. Girls and boys should be given HPV jab at primary school, doctors say https://www.telegraph.co.uk/…/girls-boys-should-given-hpv-jab-primary- school-doctors-say/ Jun 25, 2018 … Girls and boys should be given the HPV jab while at primary school, … of a motion which called for the vaccination to be offered to “all school …
  11. COSMOPOLITAN.COM. Doctors Aren’t Regularly Offering HPV Vaccines to Boys, and That’s … https://www.cosmopolitan.com/sex…/why-boys-need-hpv-vaccine/ Mar 27, 2018 … Doctors Aren’t Regularly Offering HPV Vaccines to Boys, and That’s almost every sexually active person gets HPV at some point in their lives.
  12. Konotey-Ahulu FID. Clinical epidemiology, not sero-epidemiology, is the answer to Africa’s AIDS problem BMJ (Clin Res Ed) June 201987; 294(6587): 1593-1594 6587 doi:10,11.36/bmj.294.6586.1593 http://www.bmj.com/cgi/reprint/294/1593.pdf [Question 2 “What type of ‘abnormal sex‘ did the one girl have and the other not?”
  13. Konotey-Ahulu FID. Group specific component and HIV infection. Lancet 1987; 1: 1267
  14. Konotey-Ahulu FID. Origin and transmission of AIDS. Journal of Royal Society of Medicine 1987; 80: 720.
  15. Konotey-Ahulu FID. Extensive palatal echymosis from fellatio – note of caution with AIDS at large. British Journal of Sexual Medicine 1987; 14: 286-287.
  16. Konotey-Ahulu FID. Surgery and risk of AIDS in HIV-positive patients. Lancet 1987; 2(8568): 1146. November 14 1987.
  17. Konotey-Ahulu FID. AIDS in Africa: Misinformation and Disinformation, Lancet 1987; 2(8552): 206-208. July 25.
  18. Konotey-Ahulu, FID. AIDS in sub-Saharan Africa. Lancet 1988, 2(8603): 163-164.
  19. Konotey-Ahulu, FID. HIV-2 in West Africa. Lancet 1989. 1(8637): 553.
  20. Konotey-Ahulu FID. An African on AIDS in Africa. (Guest Editorial). The AIDS Letter – Royal Society of Medicine 1989, No 11, Feb/March 1989, pp 1-3. http://www.konotey-ahulu.com/aidsinafrica/konoteyahulu/art1_cvref113.htm
  21. Konotey-Ahulu FID. Slowing HIV contagion among Africans. International Journal of STD & AIDS 1991; 2: 139. Mar-April (Stressing the need to link local preventive measures of AIDS to known epidemiologic factors which differ from one African country to another).
  22. Konotey-Ahulu, FID. HIV antibody positive sub-Saharan African patients in UK. Lancet 1990, 335: 46-47. (Response to S Murphy et al Nov 18, p1225 that “all
    patients who have lived in or worked in sub-Saharan Africa in the past ten years should be offered HIV antibody testing”.) http://www.aegis.com/news/ads/1990/AD901693.html
  23. Konotey-Ahulu, FID. African AIDS through African eyes (Guest Editorial). AIDS Analysis Africa 1991; March/April 1991. (The first invited Editorial of this new companion to AFRICA ANALYSIS).
  24. Konotey-Ahulu, FID. AIDS in Africa: Another Perspective. International Pharmacy Journal 1992, 6: 92-99 (English & French). (Invited Paper.)
  25. Konotey-Ahulu, FID. What is AIDS? Tetteh-A’Domeno Company, Watford, England, 1989, 227 pages ISBN: 0 9515442 0 9 [Reprinted 1996] http://www.konotey-ahulu.com/aidsinafrica/konoteyahulu/whatisaids.htm
  26. Konotey-Ahulu FID. Some thirty features of AIDS in Africa. Annales Universitaires des Sciences de la Santé 1987; 4: 541-544. [French and English]
  27. Konotey-Ahulu, FID. AIDS in Africa. Policy Review (Heritage Foundation Publication, Washington DC) Fall 1990; No 54: 78-9. (Invited comment on Professor Peter Duesberg’s thesis in the Summer Issue that HIV is not the cause of AIDS.)
  28. Konotey-Ahulu, FID. The AIDS crisis in Africa: a survey. In: Appropriate Technologies for AIDS Management in Africa Editor Kihumbu Thairu, 3-7 September 1990 Kenya Medical Research Institute, Nairobi. Commonwealth Secretariat London pp 24-27.
  29. Quartey JKM, Konotey-Ahulu FID. The domiciliary management of AIDS in a rural community in Africa. In: Appropriate Technologies for AIDS Management in Africa Editor Kihumbu Thairu, 3-7 Sept 1990, Kenya Medical Research Institute, Nairobi. Commonwealth Secretariat London pp 42-44.
  30. Adler Michael. Diseases in the homosexual male. London 1988. Ed Tinker J. Bloomsbury Series in Clinical Science (204 pages)
  31. Owen WF. The clinical approach to the male homosexual. Med Clinics of North America 1986; 70: 499-535.
  32. Donnelly Laura. Children aged five carrying out sex abuse seen on social media. Daily Telegraph – Front page Monday 30 July 2018.
  33. Anand Joginder K. HPV vaccination. Is that the only prevention? BMJ Rapid Response July 30 2014 www.bmj.com/content/349/bmj.g47839
  34. Ramphul Kamleshun. Following the path set by the others in HPV prevention. https://www.bmj.com/content/362/bmj.k3237/rapid-responses BMJ Rapid Response July 31 2018 to Kmietowicz Z. Boys in England to get HPV vaccine from next year. BMJ 2018; 362: k3237.
  35. Yasin Karimbocus. Cancer du col de l’utérus: le vaccin ‘Human Papilloma Virus’ introduit dans les écoles. 2016. https://defimedia.info/cancer-du-col-de-luterus-le-vaccin-human-papillom…(accessed July 31, 2018).
  36. HEALIO – Infectious Disease News, November 2011. ACIP: HPV vaccination recommended for 11- to 12-year-old boys https://www.healio.com/infectious-disease/vaccine-preventable-diseases/news…..campaign=Healio…TrendMD
  37. Stanley Margaret, O’Mahony Colm, Barton Simon. HPV vaccination – What about the boys? BMJ 2014;349:g4783 (2 Aug) doi:http://dx.doi.org/10.1136/bmj.g4783 (29 July 2014)
  38. Townsend Mark. Oral sex lessons to cut to cut rates of teenage pregnancy http://www.guardian.co.uk/uk/2004/may/09/society.schools – 72k The Guardian/The Observer Sunday 9 May 2004.
  39. Paton Graeme. Children aged 5 to get sex education. Daily Telegraph. London Thursday, October 33 2008.
  40. Goldberg DJ, Green ST, Kennedy DH, Emslie JAN, Black DJ. HIV and orogenital transmission. Lancet 1988; ii: 1368.
  41. Rosenbaum W, Gharakahanian S, Cardon B et al, HIV transmission by oral sex. Lancet 1988; ii: 1395.
  42. Spitzer PG, Weiner NJ. Transmission of HIV infection from a woman to a man by oral sex. New England Journal of Medicine 1989; 320: 251.
  43. Konotey-Ahulu FID. Vaccination for genital warts to prevent cervical cancer: principles first, please, before details. BMJ Rapid Response Nov 12 2008 www.bmj.com/cgi/eletters/337/oct23_1/a2186#204534

Male Procreative Superiority Index (MPSI)

Male Procreative Superiority Index (MPSI): 500 children born to just 17 sperm donors

The mathematical Genetic Index that I invented more than 30 years ago “Male Procreative Superiority Index (MPSI)” [British Medical Journal 1980 Volume 281 (6256) pages 1700 to 1702] was meant to explain not only the very high Sickle Cell Trait frequency in certain populations through Polygamy, but also to indicate male superior contribution to what the Daily Telegraph Science Editor (May 7 Front page & page 7) called other “defective genes” in her article “500 children born to just 17 sperm donors”.

But in another article in Journal of Genetic Disorders & Genetic Reports May 13 2014 “History Versus Limits of Science: Is Solomonic Genius a Y Chromosome Phenomenon?” I went further to show that since 1901 Nobel Prizes have been awarded to more than 800 individuals of whom at least 180 (22%) have been recipients of genes from King Solomon – wisest man on earth – who “had seven hundred wives, princesses, and three hundred concubines” [1Kings chapter 11 verse 3]. His MPSI was enormous. The fact that Jewish women’s Nobel Prize winners is a whopping 38% among the world’s females is, I said, “not that solomonic genius resides in the Y chromosome, but that it allows many more offspring than the female”.

Talk these days of Gender Equality is misplaced. Nine seconds and the male’s contribution to baby formation is complete. Females require 9 months! Any reader of this post on Facebook or Linked-In can, by using known relatives like male-female adult twins, prove conclusively that the male twin has in many cases and in any society more children than his sister, thanks to the menopause that halts further female procreation.

Take in Europe even, the divorced male twin who may marry again, and again, and again, does he stop having children with a younger wife simply because his twin sister had her menopause a decade ago? Or take my own Africa, how many women have the same number of children as the man who made them pregnant? Gender Equality makes no procreative sense either in Europe or in Africa. The mathematically minded among us may Google my article “MPSI” and study how the Index can be derived. Also read “History versus Limits of Science: Is Solomonic Genius a Y Chromosome Phenomenon?” to appreciate that the particular gene in question does not have to be in the man’s Y chromosome, but (as I said in the article) “it allows many more offspring than the female”.

Two further points (a) and (b) arise from my MPSI which did not escape one world-class geneticist. In his 2007 book “FIFTY YEARS OF HUMAN GENETICS – A Festschrift and liber amicorum to celebrate the life and work of GEORGE ROBERT FRASER” Oxford University’s world-class Geneticist Professor George Fraser (Remember Fraser Syndrome?) thought my MPSI important enough to include it as one chapter in this 568-page book under the title: “The Male Procreative
Superiority Index (MPSI): It’s relevance to genetical counselling ion Africa”. What was the point I made that has eluded many scientists?

(a) In that chapter I pointed out that something like Prostate Cancer that textbooks mention as having a genetic preponderance among Africans at home and in the Diaspora can be explained with the African’s generally high MPSI. I said (page 49): “As Africans are living longer, the husband with common diseases compatible with lifespan of appropriate length, such as essential hypertension, diabetes mellitus, gout, and even prostate cancer, might in the same way account for more genetic pathology in future generations than would be passed on by any of his wives”. Could Chinese low incidence of prostate cancer be due to the men once forced by Law to have just one child?

(b) Has present severe pressure on African countries for same sex marriage not got more to do with Population Control than Human Rights? MPSI would be meaningless!

Felix I D Konotey-Ahulu, MD FRCP DTMH, Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana.