New website - "The Medicine Box"

In the past week, I have launched a new website called "The Medicine Box".

The Medicine Box is a weblog devoted junior medical officer, especially those in the first couple of years after graduation. There is, unashamedly, a strong Australian bias to this site. It is a treasure trove of tips, tricks and cheats; and hopefully within, a few pearls of wisdom.

Any doctors out there wanting to contribute any tips or hints to "The Medicine Box", please contact me by e-mail.

Another vitamin hypothesis debunked

Vitamin supplements - probably ineffective

A recent large Australian study has demonstrated that giving vitamin C and vitamin E supplements did not prevent pre-eclampsia in pregnant women or help the babies. The results have been published in the most recent issue of the New England Journal of Medicine (Vol 354:1796-1806).

It had previously been hypothesised that the use of these agents could help decrease the risk of pre-eclampsia, which is a potentially life-threatening form of hypertension in pregnant women. Pre-eclampsia also frequently leads to intrauterine growth retardation in the foetus as well as premature birth, something that the vitamin supplements were hoped to help prevent as well.

Unfortunately, in the study of 1900 Australian women in the University of Adelaide, it appears that there is no beneficial effect.

The past several years have not been good evidence-wise for the proponents of the “vitamins for health” crowd, with a number of large studies finding supplements in general to be useless in the otherwise healthy individual.

• A large meta-analysis last year illustrated that despite “common wisdom”, mega doses of vitamin C does not help prevent the common cold.
• The seminal “Heart Protection Study” which had an antioxidant arm definitively showed that taking a battery of antioxidants (vitamin E, vitamin C and beta-carotene) made absolutely no difference to cardiovascular endpoints or all cause mortality.
• Two trials looking at using beta-carotene supplements as a protective agent (against cancer) in smoking showed that take they actually significantly increased the rate of lung cancer!
  

With the results of the latest study, there is even less evidence for the usage of vitamin supplements.

The evidence for vitamin supplements in vitamin replete individuals is scanty. At best, the usual vitamin tablets work as a placebo and are usually harmless (though the beta-carotene studies should send a shiver down every smoker’s spine). The average person should aim to get their vitamins and minerals from a varied and healthy diet and save the money spent otherwise on mostly useless supplements on something else.

Source articles:
New England Journal of Medicine: Rumbold A., Crowther C., et al.
Vitamins C and E and the Risks of Preeclampsia and Perinatal Complications. NEJM Volume 354:1796-1806 April 27, 2006 Number 17

From: The Sydney Morning Herald
No effect from extra pregnancy vitamins (excerpt)
April 28, 2006 - 5:09PM

...Giving extra vitamins C and E to pregnant women does not prevent high blood pressure problems or benefit their babies, Australian researchers have found...

...They found that treating pregnant women with vitamin supplements did not help their babies nor stop them developing pre-eclampsia.

Pre-eclampsia, which affects about six per cent of women in their first pregnancy, is a disorder that occurs in the second half of pregnancy and is characterised by hypertension and protein in the urine.

It carries the risk of serious complications and death to both mother and baby, including premature birth and poor intrauterine growth.

Study leader Caroline Crowther said pregnant women at risk of developing pre-eclampsia had previously been treated with vitamins C and E.

Dr Crowther said such treatment had also previously been thought to have kept babies healthy and reduce the risk of them not growing...

..."We do not recommend that women take these extra supplements...."

“Holy grail” of neonatal immunology

American researchers have discovered a method that may make vaccinating at birth a possibility.

Although some vaccines can (and are) given at birth, for the vast majority of vaccinations, this is not feasible. The problem is the immaturity of the neonate’s immune system. If the baby is unable to mount an adequate immune response to the constituents of the vaccine, then the vaccination would be ineffective.

Immunologists from the Children’s Hospital, Boston, have discovered a remarkable property in a molecule dubbed “Toll-like receptor 8”. The toll-like receptors (TLR) normally detect foreign proteins (e.g., for bacteria and viruses) and then trigger an immune response. In babies, however, this process is inhibited, probably to prevent the immune system from attacking the mother while in utero. Nevertheless, it appears that TLR-8 is the exception to the rule and can be stimulated with a number of different compounds.

It is suggested that if these compounds are added to vaccines, then they could be given in the neonatal period as well. The greatest interface that a baby has with the health system is in the immediate days after birth. Neonatal vaccination could help prevent the somewhat erratic vaccination rates in children. Furthermore, it would also allow for the babies to be protected from these diseases in the first few months of life.

Says Dr Ofer Levy (lead researcher in the study):

“We have stumbled across the molecular holy grail of neonatal immunology.”

I never knew that a field as specialised as neonatal immunology could have a “holy grail”, but all the same, this is a finding that could potentially revolutionise the administration of vaccines in children.

From: BBC News

Vaccines at birth a possibility (excerpt)

...Currently, most immunisations are given to babies at two months of age because they are unable to mount an immune response to the majority of vaccines.

But US scientists have found a way to stimulate an immune response in newborns, following the discovery of a type of molecule present at birth...

...Newborn babies have an immature immune system. This, coupled with their reduced response to most vaccines, leaves very young babies vulnerable to infections...

...But immunologists from the Children's Hospital, Boston, say they have found a molecule, called Toll-like receptor 8, which could be stimulated to boost immune responses and enable vaccination...

And God takes the innocent faithful

I recently wrote an article about the vengeful nature of God. Yesterday, a terrible and tragic incident provides credence to such a supposition.

Five Mexican children were killed while praying before a large metal cross when it was struck by lightning.

Lightning, is the archetypical manifestation of the wrath of god. The god “Zeus” of Greek antiquity wielded the “thunderbolt” as his weapon of choice. The Norse god “Thor” wielded the magical lightning hammer “Mjolnir”. The chief Norse god “Odin” carried the spear “Gungnir” which is also a representation of lightning.

If we are to suppose that the god that the children were worshiping did in fact exist and is omnipotent in the characterisation of the Christian religion, what are possible conclusions from this act of divine retribution?

1. God is cruel and/or sadistic and/or vengeful;
2. or God is unwilling to intervene to be merciful to even his most pious and innocent of devotees.
   

Or perhaps the “real” God is not the god of the Christians and is punishing the children for being infidels in a twisted reversal of Mark 16:16 (“He that believeth not, shall be damned”). In any case, the same two characterisations apply to this non-Christian god.

Such an event brings forth the “Ockam’s razor” application on the existence of God. The question: is it more likely that God is vengeful or uncaring, or that there is no God and this was simply an awful and tragic accident – explainable by bad luck and the fact that lightning is attracted to metal.

I believe in the latter.

Religious devotees will use their god or religion to explain the fortuitous and happy events in their life. If God exists, however, the same system of application must also explain all the misery and injustice. He is either vengeful, blind, irrelevant or doesn’t exist.

Morals, ethics and virtue are not the exclusive domain of any particular religion or the religious in general. Truth is not diminished by the lack of a supernatural authority. Indeed, it is enhanced.

From: MSNBC

Lightning kills 5 Mexican children in prayer (excerpt)

...Five Mexican children were killed when a large metal cross they were praying at was struck by lightning in central Mexico, local media reported Monday.

Five children between 9 and 16 years old died and several others suffered burns when lightning struck a white-painted metal cross set on a hill in the town of Santa Maria del Rio early on Sunday...

...A photo showed charring on the cross’s turquoise-painted cement base, although the cross was still standing.

Several families had been participating in a midnight ceremony as part of a local religious festival that centers around the cross...

New antibiotic discovered in wallaby milk

New antimicrobial found in the milk of the Tammar wallaby

Australian researchers discovered the compound AGG01 about a year ago in wallaby milk and have since learnt more about its properties. It appears to a potent antimicrobial that is active against a range of organisms including fungi, and bacteria such as E. coli, salmonella, Pseudomonas spp. and of particularly interest, MRSA, the multi-drug resistant form of golden staph.

It is relatively uncommon for a single compound to be active against such a wide range of bacteria.

Assuming that it is safe in humans, this new compound could potentially make a huge contribution to our dwindling number of effective antibiotics.

From: The Sydney Morning Herald

Wallaby's milk beats super bugs (excerpt)
By Orietta Guerrera
April 24, 2006

...The team from the Victorian Department of Primary Industries was examining the ingredients of wallaby milk when it identified the super-potent compound, and its potential to combat a range of bacteria and fungus, including E.coli, salmonella, and the hospital super bug, golden staph.

The team's leader, Ben Cocks, yesterday said the discovery could have a profound impact on both animal and human health.

"We made the first observation a bit over a year ago, and since then we've got much more information about it, about how it's made, the range of bacteria that it's active against, and how potent it is," Dr Cocks said. "And from a biological, evolutionary perspective it's very interesting because there's no equivalent in humans or in cows. It seems as if the placental mammals … lost the gene for this anti-microbial."

Wallabies are born without a proper immune system, and rely on nutrients in their mother's milk until they begin to develop antibodies at 100 days old...

Religious insight from South Park – God is vengeful

Chef and Stan

A short conversation between “Chef” and “Stan” from the cartoon “South Park” offers a firm theological argument that God is vengeful and malicious. The content of this article was inspired from an entry in “DuVernois Blog”.

William of Ockam was a logician and Franciscan friar in 14th century England. He is credited with the famous maxim, “Ockam’s razor”. It states in Latin, “entia non sunt multiplicanda praeter necessitatem” which means, “entities should not be multiplied beyond necessity”. The meaning? States Wikipedia:

“…the explanation of any phenomenon should make as few assumptions as possible, eliminating those that make no difference in the observable predictions of the explanatory hypothesis or theory.”

From episode 78 of South Park, “Kenny Dies”, Chef and Stan have the following dialogue:

Stan: “Why would God let Kenny die, Chef? Why? Kenny’s my friend. Why can’t God take someone else’s friend?”

Chef: “Stan, sometimes God takes those closest to us, because it makes him feel better about himself. He is a very vengeful God, Stan. He’s all pissed off about something we did thousands of years ago. He just can’t get over it, so he doesn’t care who he takes. Children, puppies, it don’t matter to him, so long as it makes us sad. Do you understand?”

Stan: “But then, why does God give us anything to start with?”

Chef: “Well, look at it this way: if you want to make a baby cry, first you give it a lollipop. Then you take it away. If you never give it a lollipop to begin with, then you would have nothin’ to cry about. That’s like God, who gives us life and love and help just so that he can tear it all away and make us cry, so he can drink the sweet milk of our tears. You see, it’s our tears, Stan, that give God his great power.”

Stan: “I think I understand.”

If we take the assumption that God exists, a question often asked is why “bad things happen to good people”. The standard response (a good example) usually involves the invocation of God blessing humans with “free will”; or the more ineffable “he loves us all” but “works in mysterious ways”.

Ockam’s razor would seem to suggest a simpler answer, and the “truth” is revealed in the profound if puerile script of the aforementioned episode of South Park. This, furthermore, should not be particularly surprising. States the holy texts of the Christian religion:

Exodus 20:5: For I the Lord thy God am a jealous God, visiting the iniquity of the fathers upon the children unto the third and fourth generation of them that hate me.

Leviticus 24:16: And he that blasphemeth the name of the Lord, he shall surely be put to death.

Exodus 31:15: Whosoever doeth any work in the Sabbath day, he shall surely be put to death.

Exodus 21:15: He that smiteth his father, or his mother, shall be surely put to death.

Exodus 21:17: He that curseth his father or his mother, shall surely be put to death.

Leviticus 20:10: And the man that committeth adultery with another man's wife, the adulterer and the adulteress shall be put to death.

Mark 16:16: He that believeth not, shall be damned.

and one of my personal favourites…

Malachi 2:1-4: And now, O ye priests, this commandment is for you. If you will not hear, and if ye will not lay it to heart to give glory to my name, … behold, I will corrupt your seed, and spread dung upon your faces.

If the Christian God is real He will punish innocent children to the third and fourth generation for the sins of their fathers. His preferred method of punishment generally involves death – even for the “crime” of working on a Saturday. From this perspective, it is perhaps not surprising why someone like Pat Robertson, a TV evangelist (i.e., fundamentalist) would believe that Ariel Sharon’s stroke was the result of divine retribution for leaving the Gaza Strip.

Although it is ironic as Ockam was a Franciscan friar, his eponymous razor is frequently applied in the existence of God. From Wikipedia:

“…if the concept of God does not help to explain the universe, it is argued, God is irrelevant and should be cut away (Schmitt 2005). While Occam’s razor cannot prove God’s non-existence, it does imply that, in the absence of compelling reasons to believe in God, unbelief should be preferred.”

This is the essence of the justification for “weak atheism”. With the reductionist slice of our favourite logician’s tool, we can conclude that if God exists, then He is vengeful and cruel; that or He doesn’t exist to begin with.

Source articles:
DuVernois Blog: Religion from South Park
Wikipedia: Occam’s razor
Wikipedia: Kenny Dies
Positive Atheism: Which Ten Commandments?

Visoko – potential site of a European pyramid

Does a pyramid lie beneath?

The town of Visoko in Bosnia-Herzegovina lies at the base of a large pyramidal hill, the “Visocica”. Bosnian archaeologist Semir Osmanagic hypothesised in October 2005 that underneath this hill lay a step pyramid.

Illustration of old town Visoko in Turkish rule

Yesterday, researchers at the site unearthed geometrically cut stone slabs of which they claim form part of the sloping surface of the ancient pyramid. If this is true, then this would be the first ancient pyramid discovered in Europe – an amazing archaeological discovery in an age where advanced satellite imaging is available to the home user (unfortunately, Google Earth images of this area are rather low resolution).

From: Yahoo! News

Experts Find Evidence of Bosnia Pyramid (excerpt)
By AMEL EMRIC, Associated Press Writer Thu Apr 20, 12:03 AM ET

...VISOKO, Bosnia-Herzegovina - Researchers on Wednesday unearthed geometrically cut stone slabs that they said could form part of the sloping surface of what they believe is an ancient pyramid lying beneath a huge hill.

Archaeologists and other experts began digging at this central Bosnian town last week to explore the team leader's theory that the 2,120-foot hill covers a step pyramid, which would be the first ever found in Europe...

..."We can see the surface is perfectly flat. This is the crucial material proof that we are talking pyramids," he [Semir Osmanagic] said.

Osmanagic believes the structure will prove to be 722 feet high, or a third taller than Egypt's Great Pyramid of Giza.

The huge stone blocks discovered Wednesday appeared to be cut in cubes and polished...

...Earlier research on the hill, known as Visocica, found that it has 45-degree slopes pointing toward the cardinal points and a flat top. Under layers of dirt, workers discovered a paved entrance plateau, entrances to tunnels and large stone blocks...

Laboratory grown bladders successfully transplanted

Doctors have successfully grown new urinary bladders from patient’s own cells and transplanted them.

“Tissue rejection” is a difficult problem in organ transplantation. Not only is the availability of organs for transplantation (very) limited, the vast majority of those organs are unsuitable for any one patient. The simplistic notion of “blood group” for organ transplantation seen in some television shows and popular movies (e.g., Muggers) has distorted the public mind on the difficulty of finding a match.

The human immune system is remarkably good at detecting “foreign” substances and “tissue rejection” occurs when the host immune system attacks the “donor” tissue or organ. This detection is mediated by the “major histocompatibility complexes” – a set of molecules which are on the surface of cells. A close match between the donor and host lowers the risk of a rejection reaction. A perfect match would be extremely rare, except in the case of a transplant from an identical twin – or self-transplantation (e.g., in the case of skin grafts).

Usually, a slight mismatch in the MHC must be tolerated and powerful anti-rejection drugs used indefinitely. Even so, the risk of tissue rejection is ever present, potentially leading to organ failure within hours to years after the transplantation. The anti-rejection drugs work by suppressing the immune system, significantly increasing the risk of serious infections and cancer.

The inherent problem of organ transplantation with “allografts” is the driving force behind stem cell and tissue regeneration research. The best transplant tissue or organ to use, after all, is an “autograft”.

It was revealed earlier this month that researchers have grown complete urinary bladders from the patient’s own cells and transplanted them into seven young patients with spina bifida. Apparently, these have been working well – for an average of four years in the patients.

Due to a disruption in the spinal cord in spina bifida, the bladder often lacks the usual control and coordination. High pressures inside the bladder lead to recurrent urinary tract infections and kidney damage. This is an important cause of illness and death in people with spina bifida.

The transplanted bladders do not function as in people without the condition as that would involve neuronal regeneration as well. Nevertheless, by increasing the capacity of the bladder, they reduce the risk of high pressures, infection and incontinence. The “neo-bladders” represent a tremendous advance in the field of tissue engineering.

From: The Sydney Morning Herald

Bladders grown from patients' own cells (excerpt)
By Rick Weiss
April 5, 2006

...RESEARCHERS have grown complete urinary bladders in a laboratory and transplanted them into patients, improving their health and achieving the first cultivation of working replacements for failing solid human organs...

...The organs have remained free of the many complications that bedevil the conventional practice of surgically constructing bladders from other tissues.

Researchers said they hope some day to offer patients more than a dozen other homegrown organs, including blood vessels, partial kidneys and perhaps even hearts...

...Experts applauded the work as a coming-of-age for the long-struggling field of tissue engineering and as a possible way to bypass some of the controversy over embryonic stem cells.

Because the replacement bladders were made from patients' own cells, they did not stimulate an immune-system reaction...

Cole inquiry in cartoons

Wickedly biting set of cartoons by Alan Moir, the editorial cartoonist of The Sydney Morning Herald:

Pour me a glass of Synthehol thanks!

Real Klingons don't drink synthehol

Alcohol is probably the most commonly used psychotropic drug in society. It is legal; it comes in wondrous variety, and has been part of human civilisation since we “came down from the trees”. However, there is a downside to alcohol as well. Liver disease, addiction, social dysfunction, not to mention the many deaths each year from traffic accidents are things that we have taken for granted.

In the fictional world of “Star Trek”, “synthehol” is an artificial substitute for alcohol. States Wikipedia:

“It allows the drinker to experience intoxicating effects without any adverse after-effects such as hangovers; also the intoxicating effects themselves can be dispelled easily, apparently simply by the intent to do so.”

As I can well imagine in real life, no one is too keen in the Star Trek universe on “synthehol” but it is to regular drop on a starship.

So how realistic is an alcohol substitute? According to psychopharmacologist David Nutt, “there is no scientific reason why it could not be made right now”.

Alcohol exerts most of its effects on the brain through GABA-A receptors, though more strongly to some particular subtypes. Nutt states that partial agonists of GABA-A receptors already exists. Alcohol in addition inhibits NMDA receptors and similarly, NMDA antagonists are also available. According to Nutt the right mixture of these drugs would be able to deliver the pleasurable effects of alcohol without some of its side-effects.

Now, if these could be delivered in a palatable liquid form that works well with mixers, then we’ve got a winner. Ignoring the obvious ethical dilemma of producing a new designer psychotropic drug, not to mention the huge backlash from the existing beer, wine and spirits industries, “synthehol” may yet still become a reality.

I can see it now. In a hundred year’s time, a group of old men huddled over their schooners of synthehol-beer reminisce over the good old days when wine was made from grapes and beer was made from hops. And no one will believe that vodka was ever actually made from potatos.

From: New Scientist

All the pleasures of alcohol, with no downsides (excerpt)

• 11 April 2006
• Exclusive from New Scientist Print Edition
• Graham Lawton
  

...CASUAL drinkers are unlikely to have raised their glass to the news last month that most people who suffer severe alcohol-induced liver disease are social drinkers not alcoholics. Nor to the finding that moderate drinking might not, after all, help prevent heart disease.

There may, however, just be a solution to our drinking woes - one that will allow us to go to a bar and drink as much as we want; get merry, not legless; wake without a hangover; and never have to worry that one of our favourite pastimes may be killing us. It's a cocktail of drugs that mimics the pleasurable effects of alcohol without the downsides. The idea is only on the drawing board, but there is no scientific reason why it could not be made right now, says psychopharmacologist David Nutt of the University of Bristol in the UK.

Alcohol exerts its effects on the brain mainly by latching onto signalling molecules called GABA-A receptors. There are dozens of subtypes of these, some of which are associated with specific effects of alcohol. Memory loss, for example, seems to occur because alcohol binds to a subtype in the hippocampus called alpha-5. Nutt says it would be possible to design molecules that bind strongly to the good subtypes but more weakly to the bad ones...

...Alcohol also inhibits NMDA receptors, which are part of a general excitatory signalling circuit, so a second ingredient of the alcohol substitute would be an NMDA antagonist...

...The trick pharmacologists need to pull off is to make a mixture of molecules that deliver alcohol's pleasurable effects, notably relaxation and sociability, without the aggression, nausea, loss of coordination and amnesia that can cause drinkers and those around them so much grief. Long-term problems such as cirrhosis of the liver could also be eliminated, says Nutt, who publishes the idea next month in the Journal of Psychopharmacology, (vol 20, p 318)...

A sleazy affair: Downer and the AWB

Alan Moir: Arrival of the porkies

The Australian Foreign Affairs Minister, Alexander Downer has been exposed in what I can only describe as a truly “sleazy” affair with the Australian Wheat Board (AWB).

The Howard Government continues to maintain a lack of knowledge of the oil-for-food scandal and the kickbacks that the AWB were paying to Saddam Hussein’s regime – at least, at a ministerial level. However, unless Downer is truly dense, it is almost ridiculous to believe that he was not aware of these “arrangements”. Today, a former UN customs official, Felicity Johnston, alleged that “she explicitly warned Australian officials six years ago that AWB might be paying trucking fees to Iraq in breach of UN sanctions”. She claims that these allegations were raised back in January 2000 with an Australian diplomat and also passed to Australia’s trade commissioner in Washington. She states:

“It would have been unthinkable for me as a person who comes from an investigative customs background that I would … not have mentioned the most salient point of the allegation. It’s something that could not and would not have occurred.”

Nevertheless, the denials by the Howard government continue. The government has persistently attempted to obstruct the UN inquiry and continues to support the AWB. Just recently Downer was quoted to have told AWB’s executives that “he saw it his responsibility to defend” the wheat exporter.

The “rabbit hole” is deep and murky. That the Australian government would cover up bribes to Saddam Hussein for sale of Australian wheat (while engaged in a war to oust him for power no less) is an insult to all Australian wheat farmers and all Australians in general.

From: The Sydney Morning Herald

UN official's claim blows a hole in wheat story (excerpt)
By David Marr
April 10, 2006

...A FORMER United Nations customs official has dropped a bombshell on the Howard Government by saying she explicitly warned Australian officials six years ago that AWB might be paying trucking fees to Iraq in breach of UN sanctions.

This shock development comes as the Trade Minister, Mark Vaile, and the Foreign Affairs Minister, Alexander Downer, prepare to take the stand at the Cole inquiry today and tomorrow.

The allegations by Felicity Johnston, to be broadcast on ABC TV's Four Corners tonight, put in doubt testimony to the inquiry by several Australian diplomats.

It is understood Ms Johnston, a British customs official seconded to the UN during the oil-for-food program, will be called to give evidence this month.

Since the scandal broke, Government ministers have said they never knew the monopoly wheat exporter was paying trucking fees and had no reason to suspect so. But Ms Johnston says she specifically raised trucking fees with the Australian diplomat Bronte Moules in January 2000 after Canadian diplomats alleged AWB was breaching sanctions.

She said: "It would have been unthinkable for me as a person who comes from an investigative customs background that I would … not have mentioned the most salient point of the allegation. It's something that could not and would not have occurred."

Ms Johnston says she also passed allegations about the kickbacks to Australia's then trade commissioner in Washington, Alistair Nicholas. She has told Four Corners she had absolutely no doubt she mentioned trucking fees to him. "I can't imagine that I wouldn't have. I can't see any reason why I wouldn't have..."

...AWB eventually paid nearly $300 million over three years in kickbacks to Saddam Hussein's regime. The commissioner, Terence Cole, QC, has heard no evidence of Australian government officials investigating the payments in these years, despite Ms Johnston's intervention and the dozens of AWB contracts with Iraq that cover "inland transportation" of wheat...

Capital punishment and the medical profession

The last person to have been executed in Australia was forty year old man Ronald Ryan for the murder of prison guard George Hodson during a prison escape in 1967. He was executed by hanging in Pentridge Prison. Under Commonwealth law, the death penalty was abolished in 1973 by Section 4 of The Death Penalty Abolition Act.

The etymology of “capital punishment” comes from the Latin word “caput”, meaning “head”; in reference to decapitation as a method of execution. The term has since come to refer to state sanctioned executions in general. Although decapitation is still used as a form of capital punishment in some nations, there has been a worldwide trend toward less other less gruesome methods including electrocution, gassing, and particularly lethal injection.

Within Australia, the ethical dilemma faced by the medical profession towards execution is thankfully moot. However, the same is not true for doctors within the United States where the death penalty is still used. Of the methods of execution available, the Eighth Amendment to the US Constitution is notably relevant:

“Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.”

Since the 1976 case of Gregg vs. Georgia where the US Supreme Court legalised capital punishment, lethal injection has been the most commonly used method and in the current day is probably the only one which satisfies the Eighth Amendment requirement of “nor cruel and unusual punishments”. Lethal injection “medicalises” the process. Indeed, of the 38 states which allow the death penalty, 35 explicitly allow for physician participation and 17 require it.

Regrettably this is in direct contradiction to the American Medical Association’s (AMA) Code of Ethics. States Article 2.06 (excerpts):

“A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution. Physician participation in execution is defined generally as actions which would fall into one or more of the following categories: (1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner.

Physician participation in an execution includes, but is not limited to, the following actions: prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution.

In the case where the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel.”

Despite these professional prohibitions, there are nevertheless physicians willing to participate in executions in a professional capacity. In March 2006, Professor Atul Gawande of Harvard Medical School and Harvard School of Public Health published an excellent article exploring the history and ethics of physician involvement in executions. Exceptionally eye-opening are the number of interviews that Gawande relays within the article.

Whenever someone within a debate tries to invoke the “slippery slope” argument, I have always viewed it with suspicion. Nevertheless, one of the interviews within the article demonstrates the danger of the “slippery slope”:

“The warden complained of difficulties staffing the prison clinic and asked Dr. A if he would be willing to see prisoners there occasionally. Dr. A said he would. He'd have made more money in his own clinic … but the prison was important to the community, he liked the warden, and it was just a few hours of work a month. He was happy to help.

Then, a year or two later, the warden asked him for help with a different problem. The state had a death penalty, and the legislature had voted to use lethal injection exclusively. The executions were to be carried out in the warden's prison. He needed doctors, he said. Would Dr. A help? He would not have to deliver the lethal injection. He would just help with cardiac monitoring…

…he [Dr. A] felt torn… “I do not have a very strong conviction about the death penalty, but I don't feel anything negative about it for such people either. The execution order was given legally by the court. And morally, if you think about the animal behaviour of some of these people.” … Ultimately, he decided to participate, he said, because he was only helping with monitoring, because he was needed by the warden and his community, because the sentence was society's order, and because the punishment did not seem wrong.

At the first execution, he was instructed to stand behind a curtain watching the inmate's heart rhythm on a cardiac monitor. Neither the witnesses on the other side of the glass nor the prisoner could see him. A technician placed two IV lines. Someone he could not see pushed the three drugs, one right after another. Watching the monitor, he saw the sinus rhythm slow, then widen. He recognized the peaked T waves of hyperkalaemia followed by the fine spikes of ventricular fibrillation and finally the flat, unwavering line of an asystolic arrest. He waited half a minute, then signalled to another physician who went out before the witnesses to place his stethoscope on the prisoner's unmoving chest. The doctor listened for 30 seconds and then told the warden the inmate was dead. Half an hour later, Dr. A was released. He made his way through a side door, past the crowd gathered outside, and headed home.

In three subsequent executions there were difficulties, though, all with finding a vein for an IV… The technicians would stick and stick and, after half an hour, give up … Dr. A had placed numerous lines. Could he give a try?

OK, Dr. A decided. Let me take a look.

This was a turning point, though he didn't recognize it at the time. He was there to help, they had a problem, and so he would help. It did not occur to him to do otherwise.

…In one [patient] … he could not find a vein … He felt responsible for the situation … The doctor decided to place a central line.

...Only one case seemed to really bother him. The convict … weighed about 350 pounds. The team placed his intravenous lines without trouble. But after they had given him all three injections, the prisoner's heart rhythm continued… the team looked to Dr. A. His explanation of what happened next diverges from what I [the author] learned from another source. I was told that he instructed that another bolus of potassium be given. When I asked him if he did, he said, “No, I didn't. As far as I remember, I didn't say anything. I think it may have been another physician.” Certainly, however, all boundary lines had been crossed. He had agreed to take part in the executions simply to pronounce death, but just by being present, by having expertise, he had opened himself to being called on to do steadily more, to take responsibility for the execution itself. Perhaps he was not the executioner. But he was darn close to it.”

The narrative is all the more chilling as it is not only real, but seems perfectly understandable.

Professor Gawande concludes in his article:

“The public has granted us extraordinary and exclusive dispensation to administer drugs to people, even to the point of unconsciousness, to put needles and tubes into their bodies, to do what would otherwise be considered assault, because we do so on their behalf – to save their lives and provide them comfort. To have the state take control of these skills for its purposes against a human being – for punishment – seems a dangerous perversion. Society has trusted us with powerful abilities, and the more willing we are to use these abilities against individual people, the more we risk that trust…

The doctors’ and nurse’s arguments for competence and comfort in the execution process do have some force. But however much they may wish to be there for an inmate, it seems clear that the inmate is not really their patient. Unlike genuine patients, an inmate has no ability to refuse the physicians’ “care” – indeed, the inmate and his family are not even permitted to know the physician’s identity. And the medical assistance provided primarily serves the government's purposes – not the inmate’s needs as a patient. Medicine is being made an instrument of punishment. The hand of comfort that more gently places the IV, more carefully times the bolus of potassium, is also the hand of death. We cannot escape this truth. The ethics codes seem right.”

Despite that I have some differing background thoughts on the use of capital punishment, I am forced to agree totally with Professor Gawande’s above conclusions. The professionalism of the medical fraternity is predicated by the observance of agreed and universal ethical standards. These are not flexible and cannot be conveniently ignored for the sake of political and social expedience. Though there may be some compelling arguments for physician participation in execution in those states and nations where it is legal, it nevertheless breaches several core ethical principles. States the AMA Code of Ethics under the “principles of medical ethics”:

“(I) A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights…

(III) A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient…

(VIII) A physician shall, while caring for a patient, regard responsibility to the patient as paramount…”

Regardless of the debate and social acceptance of capital punishment, the medical profession must not be subsumed into the role of a de-facto executioner.

Source articles:
The New England Journal of Medicine: Gawande, Atul. When Law and Ethics Collide – Why Physicians Participate in Executions. Volume 354:1221-1229, March 23, 2006
Australian Institute of Criminology: Trends & Issues in Crime and Criminal Justice, No. 3, Capital Punishment
Wikipedia: Ronald Ryan
AMA: Code of Ethics, E-2.06, Capital punishment
AMA: Code of Ethics, Principles of medical ethics

Install Windows XP on an Intel Mac

iMacs now run Windows XP too

Apple Macintosh computers have “traditionally” used the PowerPC architecture for their CPUs. “Windows” PCs on the other hand use the x86 architecture – most commonly the Intel Pentium processors (but also the AMD Athlon processors as well). As these CPUs were not compatible at an instruction level, this precluded the installation of Windows on a Mac and similarly the installation of Mac OS X on a PC.

This all changed however, when Steve Jobs announced that the Macintosh was migrating to the Intel platform. Specifically, the new Macs would use the new Intel “Core” processors (codename Conroe). In essence, the new “Intel” Macs are very similar to a standard PC or notebook from a hardware perspective.

Nevertheless, there were a few crucial differences that prevented the installation of Windows XP on an Intel Mac. Specifically, Macs use EFI (extensible firmware interface) rather than standard BIOS during the booting process. Windows XP does not natively support EFI.

This didn’t stop the public from trying, however. Colin Nederkoorn launched a competition earlier in the year to encourage hackers to develop a reliable method of installing Windows XP onto an Intel Mac. Prize money was gathered through donations. By March 2006, approximately one month ago, this prize was claimed by two hackers with the nicknames of “narf2006” and “blanka”. The prize pool had grown to an impressive $US14,000.

At this time, this news was met with interest from the PC world, with many users secretly lusting after the polished hardware of a Mac, but unable to leave a Windows environment. Interestingly, it was also met with derision by most Apple “fanboys”. Microsoft and Apple were notable in their silence.

The penny dropped today with Apple’s announcement and release of a public beta of “Boot Camp”, which allows Windows XP to be installed and to run natively on the Intel Macs. In essence, Intel Macs now have the best of both worlds; able to run Windows like any other PC and being the only machines that can run the excellent Mac OS X. Instantly, Apple Macs have become a direct competitor to Dell, HP, Toshiba, Sony, and all other branded PC producers. Indeed, the new MacBook Pro is probably one of the best Intel Core Duo based laptops ever produced. The previous major disadvantage of it not being able to run Windows is no longer the case.

I envisage that this announcement will allow Apple to have a major increase in its market share in the consumer market, and by stealth, increase the market penetration of Mac OS X. Now, if Jobs suddenly announces that he would allow Mac OS X to be installed onto “commodity” PC hardware, Microsoft would have an enormous fight on their hands.

From: Apple Website (excerpt)

...Boot Camp Public Beta provides a straightforward means of letting your Mac run Windows. Here’s how it works:

• First, you need to make sure your Intel-based Mac has the latest version of Mac OS X and the latest firmware update. These provide technologies that make Boot Camp possible. It’s also wise to print out the Installation & Setup Guide.
• The Boot Camp burns a CD with the drivers Windows needs to recognize Mac-specific hardware. It is very important to do this before starting the Windows installation.
• The software also helps you set aside hard drive space for the Windows installation, without moving any of your Mac files around. Just drag the intuitive slider to choose the size that’s right for you. Boot Camp also helps you remove the Windows partition, should you so desire.
• Next, insert your Windows installation disc, restart and follow the Windows installation process. The only tricky part is selecting the C: drive manually. Be sure to get this right, or you could erase your Mac files accidentally. Remember, Apple Computer does not sell or support Microsoft Windows.
• After the installation process is complete and your Mac has booted Windows, you’ll need the Macintosh Drivers CD you burned previously. When you insert the CD, it will automatically install the drivers. Follow the instructions in the Installation & Setup Guide for helpful hints.
• Don’t forget to follow best practices for updating and protecting your Windows system...
  

No prayers for the heart

The idea of “prayer power” is a powerful concept within the minds of the devout. It gives one a sense of empowerment; the power to cure or treat a friend or family member from their illness with the power of God alone.

“Prayer power” (especially the Christian kind) was given a big boost in the past decade with a number of trial purporting a statistically significant effect. As always, these trials were poorly performed with authors who were on the loonier side of “devout”.

The American Heart Journal has published on-line the latest study of 1800 patients who underwent coronary bypass surgery. There where three groups: (i) one group received no prayers, (ii) one received prayers and were told that they were receiving prayers, and (iii) the third received prayers but were told that they may or may not be receiving prayers. The study looked then at the complication rates between the groups at 30 days.

There was no significant difference between the “no prayer group” and the group that received prayers but were not sure if they did.

There was, however, a significant difference in the group that received prayers and knew that they did. Unfortunately for the “prayer power crowd”, the difference was not in favour of prayers. Rather, that group of patients had a higher rate of complications (59% vs 51%) and a higher rate of major complications of heart attack and stroke (18% vs 13%).

It was postulated by the authors that the prayer group who knew that they were receiving prayers may have suffered from some form of “performance anxiety”. The possibility that it was a chance finding was left open (though the study design was reasonably good).

Dr Harold G Koenig, director of the Centre for Spirituality, Theology and Health at the Duke University Medical Centre, who was not affiliated with the study says:

“There are no scientific grounds to expect a result and there are no real theological grounds to expect a result either … There is no god in either the Christian, Jewish or Moslem scriptures that can be constrained to the point that they can be predicted.”

I agree entirely, though this sobering lesson would be much welcome if it was produced when the “prayer power” enthusiasts beat their drum.

Warning: start sarcasm
Furthermore, the authors of the study seem to be missing on obvious (though facetious) supposition on why the prayer group did poorly; as per the religion’s own holy texts (Old Testament), the God of the Christians is a jealous and vengeful god, demonstrating his wrath at those who would dare question his authority on life and death.
End sarcasm

From: The Sydney Morning Herald

Secret to a speedy recovery: no prayers, please (excerpt)
By Benedict Carey in New York
April 1, 2006

...PRAYERS offered by strangers had no effect on the recovery of people undergoing heart surgery, a large study has found.

In fact, patients who knew they were being prayed for had higher rates of post-operative complications, perhaps because of the expectations the prayers created, the researchers findings have suggested.

Because it is the most scientifically rigorous investigation of whether prayer can heal illness, the study, begun almost a decade ago and involving more than 1800 patients, has for years been the subject of speculation.

At least 10 studies of the effects of prayer have been carried out in the last six years, with mixed results. The latest study was intended to overcome flaws in the earlier investigations...

...Prayers were performed by members of three Christian groups in monasteries and elsewhere - two Catholic and one Protestant - who were given written prayers and the first name and initial of the last name of the prayer subjects. The prayers started on the eve of or day of surgery and lasted for two weeks.

Analysing complications in the 30 days after surgery, researchers found no differences between those patients who were prayed for and those who were not.

But a significantly higher number of patients who knew they were being prayed for - 59 per cent - suffered complications, compared with 51 per cent who were uncertain. The authors left open the possibility this was a chance finding. But they said being aware of the strangers' prayers may also have caused some patients a kind of performance anxiety.

The study also found more patients in the prayer group - 18 per cent - suffered major complications, like heart attack or stroke, compared with 13 per cent in the group that did not receive prayers...

A lesson in American-style democracy

“Democracy” has been the catch cry of the US Administration in the twenty-first century. Revisionism tells us that we went to war in Iraq for “democracy” and “liberation of the Iraqi people”. In his State of the Union speech this year, Bush hoped that America would one day be a close ally of a “free and democratic Iran”. The obvious imputation is that Iran is not democratic.

So what exactly constitutes a “democracy”?

States Wikipedia:

“Democracy (from Greek (demokratia), (demos) the common people + (kratein) to rule + the suffix (ia), literally ‘the common people rule’) is a form of government where the population of a society controls the government … The word ‘democracy’ has acquired a highly positive connotation over the second half of the 20th century …”

Though there are many forms of democracy, the power ultimately rests with the people. Most democracies are “representative”, in that members of the public are elected by the people to run the government on their behalf. It would generally be impractical for every decision to be made by a consensus of a nation’s citizens.


Election of Bush (2000) vs. Ahmadinejad (2005)

Let us then look at and compare the elections of the President of the United States of America, George W Bush and the election of the President of the Islamic Republic of Iran, Mahmoud Ahmadinejad.

Both were appointed by a public election.

The “strength” or “confidence” that one has with an electoral result is a function of the “turnout rate” of the population. Simply, if the populace has confidence in the election and the electoral process, more people will participate by casting their vote. In elections with low overall turnout rates, the result can furthermore be skewed if some sections of the population are particularly poorly represented. This is most often true for the people with the least power within society.

The turnout rate for the Iranian election of 2005 was 60%. The turnout rate for the American election of 2000 was only 51%. Moreover, there is a significant class gap in the participation rate in the American elections with “the turnout rate at the bottom of the income and education scale only half that of the top, a pattern unheard of in Europe and found elsewhere only in less developed countries”.

Of the primary votes, Ahmadinejad received a surprise win of 62% of the vote. That is a clear and decisive victory and he won nearly twice that of his rival. Bush, however, had actually fewer votes than his rival Al Gore! In the popular vote, Al Gore won about half a million more votes from the American public. However, with how the American electoral system is run (and much behind the scenes influence from the Bush family), Bush was eventually named the winner.

Both elections were mired by accusations of impropriety and lack of fairness. The difference, however? The main critic of the Iranian election of 2005 was the US State Department, obviously unhappy that an outspoken critic of the United States was elected as the President of Iran. The main critic of the US elections of 2000 was the American people, not to mention the people of the greater part of the Western World. George Bush’s brother, Jeb Bush, the Governor of Florida was instrumental in securing his victory in a few vital seats in Florida – actions which would have been considered fraudulent in any other Western nation.

Bush and the US Administration’s insinuation of the “non-democratic” nature of Iran is at best, “the pot calling the kettle black”.


The new “democracies” of the Middle East

The election of a representative government in a true democracy is subject to the will of its people. Unfortunately, for the people of Palestine and post-war Iraq, it seems that they have learnt their lesson in democracy a little too well. Despite the lip-service that the US Administration has for democracy; the “Bush doctrine”:

“…that democracy inoculates nations from the hatreds and madness which lead to war.”

… the United States is less interested in the political processes but rather the production of compliant, pro-American leaders. If that happens through a democratic process, then so much the better – though that is hardly necessary. The continued support for President of the Islamic Republic of Pakistan, Pervez Musharraf is evident proof.

Musharraf overthrew the democratically elected government in a coup in 1999 and has since extended his rule for 5 years by a heavily rigged referendum (2002). During this period, Pakistan announced itself as a nuclear power, contrary to the nuclear non-proliferation treaty (NNPT). Although its “wrongs” are an order of magnitude worse than Iran, there has been no war-mongering on the part of the United States. Indeed, Musharraf has cultivated a close friendship with the US Administration and is a “partner” in the “war on terror”.

For the Palestinians, their expression to vote out the former corrupt and ineffectual leaders was democratic power in its purest form. The will of the people won out over the old regime. However, the choice of Hamas was a lack of understanding of American intent. Again, the US wants compliant client states. States Bush in his usually doublespeak:

“We support the election process, we support democracy, but that doesn't mean we have to support governments that get elected as a result of democracy.”

Similarly, control of the Iraqi Government has started to slip out of American fingers – and Administration acted to express its displeasure in an incredibly blatant form of political interference. The US ambassador to Iraq, Zalmay Khalilzad told the head of the main Shiite political bloc in a meeting to pass the “personal message from President Bush” to the interim Prime Minister Ibrahim al-Jaafari:

“[Mr Bush] doesn’t want, doesn’t support, doesn’t accept [Dr Jaafari as the next prime minister].”

Al-Jaafari won the election that the United States had held to be “fair” and as a model of social and political progress at the time.

States Wikipedia:

“Most contemporary political ideologies include at least nominal support for some kind of democracy, no matter what they do support.”

How very true.

Source articles:
SMH: Bush wants Jaafari to resign, says MP
Yahoo!: US cuts off contacts with Hamas-led government
BBC: Bush hopes for a democratic Iran