Sunday, 18 October 2009

59. Medical Gloom

This week's BMJ contains an excessive dose of sad or worrying news. And a lot of the problems are insoluble.

It begins with an editorial on obesity. Fat people suffer more anxiety and depression, and depressed or anxious people get fatter. Antidepressants cause weight gain - and the manufacturers do not warn of this, as it would reduce their sales.

We are all aware of cases of sudden infant death syndrome - SIDS. There have been some notorious cases, including the enigmatic statements in court by professor Meadows. Yet mothers remain ignorant: they continue to sleep together with the baby, especially on a sofa; they smoke, and they drink. Avoiding these factors would reduce SIDS by more than half. Furthermore, mothers' smoking during pregnancy increases stillbirths by 38% and infant deaths by 31%. Perhaps, at the funerals, the priests should tell the parents that it was their fault?

Fraud and greed in medical research is frightening. All journal editors have just agreed on a stricter honest and transparent disclosure of their competing interests'. But greed is likely to continue.
The bribes involved are enormous. For example, the US government compelled manufacturers of prosthetic hip and knee joints to declare all payments to doctors in 2007. They compared this with the payments from these manufacturers that were declared by orthopaedic surgeons at their annual meeting in the following year, when these products were discussed. Sixty doctors concealed payments of 12 million dollars in total !

In Germany, another scam is being used. Drug companies pay GPs up to £1,000 per patient for prescribing their new drug - and providing them with documentation of its effect. It is estimated that 25% of all
German GPs take part in such 'trials', on more than 200 drugs. The patients are not aware, that they are being used as guinea pigs without their consent; and that they are providing the GP with a lot of extra income. Furthermore, the patients, or their insurers, have to pay for these often expensive drugs - they are not donated by the manufacturers.

Corruption goes deeper still. Dr Hurlstone, an award-winning consultant gastro-enterologist at Sheffield university, has just been discovered falsifying results and forging the signatures of co-authors in 3 published papers since 2007. Such dishonesty does not emerge suddenly: How was he not unmasked during more than ten years of his career progression?

And inevitably, fraud by drug manufacturers continues. GlaxoSmithKline are being sued in Philadelphia. They appear to have concealed their research findings, that the antidepressant Seroxat caused serious birth defects in infants of mothers who took it during pregnancy. Remember Thalidomide?
Sometimes the fraud is discovered almost by chance.
GlaxoSmithKline (the same) manufacture 'ready-to-drink' Ribena in cartons. They boast that it contains 'four times as much vitamin C as oranges'. Two girls aged 14 in a school experiment found that Ribena in cartons contained almost no vitamin C. They received a 'brush-off ' from GSK but went to a newspaper and a TV company. They won, and in court GSK were fined a hefty sum. The two girls have now been voted New Zealanders of the Year.

Among all this gloom, there is one column-inch of good news. Recently a kind and caring nurse exposed poor standards of care at the Brighton and Sussex university hospitals NHS trust. She was tricked by television to give some innocent particulars. For this, the nursing and midwifery council struck her off: she lost her income and her career. [Later addition: I have just watched this council's spokeswoman explain their verdict: the bitch was brazenly defending the cruelty and incompetence of the Brighton hospital management's mistreatment of these helpless old people!]
So I was delighted to read that after appealing to the high court, the nurse has been allowed to return to work.

I know what I think of
the nursing and midwifery council... and of the drug manufacturers... and of some academic researchers... and greedy German GPs... and of some members of our parliament...

Friday, 2 October 2009

58. Bible Names, Translations and Transliterations

Reading Hebrew is complicated by the fact that its basic spelling, as it appears in the Torah, and in modern books and newspapers, has no vowels. One has to decide from the context, for example, whether the word 'DG' should be understood and pronounced as 'dig', 'dog', or 'dug'.
The rabbis exploited this feature to create their midrashim - as I did in my post #52. Their midrash might claim, for example, that during repeated copying of the sacred text the letter 'N' got omitted by accident. The complete word was actually 'DGN' pronounced 'dagan' - wheat, or 'Da
gon' - the Philistine deity.

When I started to use an English translation of the Bible, a further obstacle appeared: translators misunderstood the Hebrew meaning. One classical example is the description of mining in Job chapter 28. The translators were quite ignorant of the technique of loosening by fire the quarried rock-face. But the earliest misleading translation originates from the Septuagint - see details of Jonah below.

Many of the personal names in the Old Testament have symbolic explanatory meanings, that are lost in translation. Thus we are told that
Adam was formed 'from dust of the ground' - because earth is adamah in Hebrew. Without knowledge of Hebrew, this will not be apparent. Moses is Moshe in Hebrew and originates from 'limshot' - to pull out of water - he was pulled from the Nile by Pharaoh's daughter.
Some names have a meaning that is not immediately obvious:
one has to search the background. The Hebrew meaning of Bathsheba is 'daughter of a vow'. She was the wife of Uriah the Hittite, and her name reminds us that she broke her marriage vow to commit adultery with king David.
Sometimes the name's meaning was clearly derogatory, such as the son of king Saul:
Ish Boshet means man of shame, or man of genitals. That must be an editorial insertion by the opposition. Likewise the name Naval, which means villain. He was the miserly and wicked husband of the clever and beautiful Abigail - and she did explain his name to David.
Some women were never given a Biblical name at all: the
wife of Lot - who disobeyed instructions, looked back at Sodom and turned into a pillar of salt; Lot's two daughters, who each committed incest as well as rape with their drunken father; and the wife of Potiphar, who tried to seduce Joseph.

The names of places often also have Hebrew meaning: Babylon - Bavel in Hebrew - derives from balal - 'mixing' - which refers to the confusion of languages that stopped the builders of its tower. Bethlehem is named after its principal crop - Beit lechem means house of bread. The river Jordan - Yarden in Hebrew - derives from yored - to descend - referring to its descending course. Jezreel - Yizreel in Hebrew means 'God will sow'. Usually, none of these explanations are included in our translated Old Testament texts.

The earliest important translation of the Old Testament was into vernacular Greek. The Septuagint - the 'seventy' in Latin - was created in Alexandria from the 3rd to the 1st centuries BCE by seventy-two Jewish scholars. But these scholars were not botanists. In the book of Jonah we read that a plant grew to provide shade for Jonah: a
'KIKAYON'. The scholars decided to 'translate' this into a similar-sounding Greek word - 'colocynthis' - gourd.

So since the 3rd century BCE, Jonah's
kikayon is erroneously translated and illustrated as a gourd. But in fact, it is the castor-oil plant, Ricinus communis in Latin. Castor oil is a powerful remedy for constipation; and a protein extract of the castor bean is one of the most potent poisons known - Ricin. It was injected in Fulham in 1978 by a KGB agent as a pellet from a modified umbrella into the thigh of Georgi Markov, a Bulgarian dissident. He died after 3 days.

The Septuagint has caused another major problem, that has also penetrates the English translation of the Old Testament: the Greek hardly uses the Hebrew consonants for 'V' and 'W'.
Avraham becomes Abraham - thus losing the meaning of 'father' for the 'Av'; Naval and his wife Avigayil (mentioned above) become Nabal and Abigail; Batsheva becomes Batsheba, and there are scores more examples.

But these distortions are aggravated further by arbitrary British mutilations of the Hebrew names and their pronunciations. So Biblical
'Yerushalayim' becomes 'Jerusalem' and king 'Shlomo' becomes 'Solomon'. The pronunciation of the town of Lachish has been changed by eminent British scholars to sound like 'Lake-ish'. I grew up in Palestine and I am fluent in the Hebrew Bible. During lectures and in texts, I find it difficult to follow these anglicised pronunciations.

Orthodox Jewish publications tend to avoid these English mutilations. They will refer correctly to the prophet Eliyahu, rather than the anglicised Elijah. And the Israeli post office are making an effort for correctness in their printed cancellations of place names: For some time now, they have been using the correct Hebrew-sounding 'Yerushalayim'.
But at other times the post office are still struggling. To sound like Hebrew, the anglicised
'Safed' should probably be spelled as 'Tsfat': but I have noticed three other versions in their handstamps: CFAT [1.8.51]; SAFAD [1.9.54]; and ZEFAT with underlined 'Z' [30.9.57] - and there may be more. They resort to a hook above the 's' to signify 'sh', and an underlined 'h' to signify 'ch' [as in loch]. The transliteration committee are aiming to design a race horse - but so far they have produced a camel.

The latest attempt at Hebrew transliteration appears in the new Reform prayer book, issued last year. It requires a detailed preliminary study of its rules of correct pronunciation. Once you have mastered this, you can struggle with these transliterated passages - while everybody else in the congregation follows the Hebrew prayers. And by providing this aid, the children do not have to learn to read Hebrew any longer. The consensus is that this is an expensive unnecessary edition - an ego trip for its editors, that was forced on some communities against their majority votes.