Tuesday, August 24, 2010

Paid blogging?

Today I had an offer of $100 from a medical education site, to put a link from one of the pages on my last operation, to their site. Its the second similar offer I've had recently and in other circumstances it might be a way of earning a living. The problem is that people might suspect a blogger who gets paid, of adjusting their content to fit in with the needs of advertisers

Sunday, August 22, 2010

Yet another arrest

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Mr Abdulhadi Alsaffar, who attended one of our regular series of seminars at House of Lords on Bahrai, seen here at the seminar in December 2008, was arrested today. There seems to be a link between those who have attend our seminars and all the recent arrests. The message is that if you go abroad to express your opinion on Bahrain's political situation - which you can't do at home - there will be severe consequences. The security authorities have explicitly threatened that they will reach all of those involved in such activities.

Saturday, August 21, 2010

Bangladesh war crimes tribunal

David Bergman, editor of special reports for the website bdnews24.com, has started a new blog on the International War Crimes Tribunal in Bangladesh, see bangladeshwarcrimes.blogspot.com/

This is a useful initiative, as there is a lot of interest throughout the world in legal questions arising from the use of legislation passed in 1973, not entirely in conformity with international standards developed over the last four decades, exemplified by the Rome Statute on the International Criminal Court which came into effect on July 1, 2002.


Letter from Dr B, consultant physician in Department of Clinical Gerontology at King’s, to my GP

Diagnoses: EVAR repair (July 2010)
Past stage I MALT lymphoma
Ischaemic heart disease - coronary artery bypass graft (1995)
Barrett's oesophagus and gastritis (2001)
Colon injury from RTA - colostomy reversed (2001)
Peripheral vascular disease - angioplasty right leg
Osteopenia - fracture right hip (October 2009)

domperidone 10 mg mane
aspirin 75mg mane
Calceos two tablets od
bisoprolol 2.5mg - stopped
omeprazole 20mg mane
atorvastatin l0 mg nocte
zopiclone 3.75mg nocte

I reviewed this gentleman in the Outpatient Clinic this morning (August 9), three weeks after his aortic aneurysm surgery, when he temporarily went in to atrial fibrillation. I gather his blood pressure was a little difficult to control at the time of surgery but Lord Avebury thinks he was rather excessively sensitive to betablockers which were stopped at the time of his discharge. He has been monitoring his blood pressure at home and it is clearly high with systolics going up to 187 mm Hg. He himself is currently well and I note his pulse in clinic was regular, 55 per minute, blood pressure 143/57.

I have requested a repeat of his inflammatory markers as suggested in his discharge summary which are now normal: ESR 18mm/h, CRP <5.0, though his Hb is 8.5g, WCC low (3.53) and platelets high (581) and I know you are going to be reviewing him at the end of this week. His Hb was similarly low when checked last month. His notes show that he has been seen in the Haematology Department for previously unexplained anaemia while Mr R is seeing him shortly and I wonder if this drop in Hb is the result of his surgery. However he was remarkably asymptomatic for this degree of anaemia.

I have taken the liberty of giving him a prescription for bendroflumethiazide 2.5mg daily to start to address his hypertension. I was somewhat surprised that his discharge medication of 2.5mg bisoprolol had caused him problems and it is likely that he will need another antihypertensive agent to control his blood pressure adequately. Lord Avebury is not too keen to try bisoprolol or other beta blockers again; alternatives would be a calcium channel blocker or ACE inhibitor but 1 will leave that to your discretion.

He is due his next zolendronate infusion in March 2011 and has an appointment for review in this Clinic in four month's time.

Spoke to the GP on the telephone on Monday. He cancelled the bendroflumethiazide and re-prescribed bisoprolol, which has reduced the systolic to a maximum of 151 in the last two days. I am to ring the GP next Tuesday to confirm the current medication.

Maurice at the summit of Otau mountain near Auckland, last Sunday
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Thursday, August 19, 2010

Just taken 23.00 with my new webcam, a Logitech C300, £19.99 including post from Amazon. The picture's a lot better than my old Logitech, which I think I've had for about two years.
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Monday: a session at King's with the orthopaedics consultant, after x-rays of my right knee and left foot. The knee is seized up with arthritis and they offered a replacement if I felt that it was getting very painful. But it hasn't reached that stage, and they will see me again in a year's time. The lump on my left foot, neither the consultant, the senior consultant or the radiologist had ever seen anything like it before, but they said it could be removed in day surgery, or at the most I might have to stay in overnight just so they could keep an eye on me. That I accepted, and it should be done in a few weeks' time.

Tuesday, Rhoda came to tea and we reminisced about ancient times, ie the early 70s.

Wednesday I had lunch at the House with Ted Mott of Oxford Capital Partners and we talked about the role of providers of capital in funding advanced technologies. Many of the companies that were engaged in this business have given up, and the banks aren't interested. Ted's company has good links to Oxford's engineering department, but to other universities as well. He says there are still misunderstandings between some academics and entrepreneurs about the point at which scientists and engineers should look for outside capital to develop their lab ideas into businesses. He reminded me of Solly Zuckerman and his White Paper Technological Innovation in Britain of 1968, in which he sought to identify the stages between a blue sky concept and the full-scale launch of a new advanced product. I think in communications and electronics the overall time scale has probably shortened since the 60s.

JW went off to Barcelona. leaving Flodden Road at a quarter to four this morning. Lindsay took him to the bus station at Victoria to catch the bus to Stansted. The penalties you pay for cheap air fares are having to trundle out to Stansted and losing most of a night's sleep.

Today we had a visit from Salim and Mrs Malik, who brought greetings and a basket of fruit from His Holiness the Khalifa of the Ahmadiyya Muslim Community. The Community's aid agency Humanity First has been working to help the flood victims in Pakistan, but unbelievably, in Azad Kashmir the extremists have told aid workers not to help the Ahmadi victims, see article below. I wrote to the Secretary of State for International Development, Andrew Mitchell. asking him to express our concern about this treatment of the Ahmadis, which is especially ironic when you think of all the work Humanity First does in Pakistan, not just now on the catastrophe of the floods, but in the reconstruction after the earthquake, and many other emergencies.

The politics of relief: Aliens in their own land

500 flood survivors from Ahmadiya community denied shelter, relief goods

MUZAFFARABAD: The government and local clerics refused to shelter around 500 flood-affected families belonging to the Ahmadiya community in South Punjab’s relief camps. Not only that, the government also did not send relief goods to the flood-hit areas belonging to the Ahmadiya community,The Express Tribune has learnt during a visit to the devastated Punjab districts of Muzaffargarh, Dera Ghazi Khan and Rajanpur.

For its part, the government claims that all relief goods are being distributed among survivors without discrimination. And that all survivors have been sheltered in relief camps without distinction. The flood-devastated families from the Ahmadiya community have strongly criticised the government’s “discriminatory attitude” even at a time when the entire country is reeling from the ravages of the worst flooding in living memory.

Of the 500 Ahmadi families, 350 belong to DG Khan, 60 to Muzaffargarh and 65 to Rajanpur district. According to Ahmadiya community leaders, over 2,500 members of their community have been displaced and are now living with their relatives while some of them have left for Rabwah, the community’s headquarters.

Aziz Ahmad Khan, a local leader of flood victims from the Ahmadiya community in DG Khan, told The Express Tribune that all members of his family have complained of discrimination in DG Khan. He said 200 families from Basti Rindan and Basti Sohrani, 60 from Chah Ismaeel Wala, three from Rakh Mor Jangi, 18 from Ghazi Ghat and 12 from Jhakar Imam Shah of Ahmadpur. Khan alleged that 200 families, who have been displaced from Basti Rindan and Basti Sohrani by flooding, took shelter in a state-run school at Jhok Utra but within days the local administration forced them to leave the school. He said the local administration later told them that people from the surrounding areas did not want the Ahmadis in the relief camp. And that the administration could not allow them to stay at the camp as it could create a law and order situation.

“So we left our cattle and other belongings in the area and took refuge in the homes of our community members on higher grounds,” he said, adding that some of them even migrated to Chanabnagar.

Muhammad Iqbal Sohrani, a member of the Ahmadiya community told The Express Tribune that around 40 Ahmadi families who took shelter in a state-run school at Jhakar Imam Shah near Sumandri, some 40 kilometres from DG Khan, have not received any relief either from philanthropists or from the government. He alleged that relief packages were being distributed through local lawmakers who have been told by the district administration that the Ahmadis are not eligible for any support.

Saleem Chandia, another Ahmadiya community member, said that he along with 40 other community members rented a house but after two days their landlord was forced by local clerics to evict them. Chandia said they were offered help by their own community members after wandering for several days in search of shelter.

Mansoor Ahmad, a resident of Muzaffargarh, told The Express Tribune that over 800 members of the Ahmadiya community were displaced from Bait Nasirabad, Masroornagar, Hussainwala and Shahjamal. At least 100 members of the community, from Hussainwala and Masroorabad, were trapped at Shahjamal. He claimed that they had asked the district police officer (DPO) and the district coordination officer (DCO) to provide them a boat or to rescue the trapped people but they did not take notice.

Ahmad claimed that the trapped Ahmadis were rescued by their fellows on a broken boat. He said local clerics have issued an edict that the Ahmadis should not be provided help.

Naseem Ahmad, from Rajanpur, told The Express Tribune that their 500 community members from the areas of Basti Lashari, Basti Allahdad Dareeshak and from Basti Azizabad were displaced. Their houses were washed away and the government and local clerics ignored them. He said that they were not allowed to stay in state-run schools or in camps, therefore the majority of them were living on the rooftops of their inundated houses.

“The Ahmadiya community itself rescued trapped people and delivered relief to them,” community spokesperson Saleem-ul-Din told The Express Tribune by phone.

He said that the community did not want any relief package from the government for its members. However, the government should protect the property and livestock of the Ahmadis.

Hassan Iqbal, Commissioner DG Khan, told The Express Tribunethat he would check the situation. He asked the Ahmadis to directly approach him if they face discrimination anywhere in the district. However, DCO Muzaffargarh Farasat Iqbal said that the Ahmadis have not contacted him.

Published in The Express Tribune, August 18th, 2010.

Saturday, August 14, 2010

King's sent me a CD with the scans of my aorta. They use a proprietary viewer, Dacom, but there are free substitutes on the internet and the one I used was RadiAnt. There are 180 images in the set of horizontal sections of the abdomen and although there is a 'Browse' button it doesn't work. The only way of selecting a particular image appears to be to click on the Cine button and click on it again to halt the sequence at the one you want. Then you can use Ctrl PrintScreen to transfer the image into Paint or whatever, and load it into the blogger. There is a tool for measuring an object in RadiAnt, and the major axis of the ellipse is 58 mm.

I forgot I had an appointment with my GP, Dr Whitmey, late yesterday afternoon, and I needed to ask him to review the medication for my blood pressure, which is fluctuating, and higher than it should be. So I sent him a spreadsheet of my readings and asked if he could prescribe without a face to face consultation. Should be possible but I wouldn't be surprised if its against some rule.

After some differences of opinion about our holiday Lindsay and I have agreed on a week at a Quinta in Funchal. At least it should be restful because we're not hiring a car and will have to get around by bus. The hotel does have a 'courtesy bus' that goes into the centre of Funchal, but the last one is at 17.45 so if we eat out, we'll have to return by taxi. It seems that if you're over 65, the holiday companies tell you to look after your own insurance, and although neither of us has made a claim for years, I think all insurers charge through the nose for anyone over 65 driving abroad.

Had a good long talk with Maurice in Skype last night.

Wednesday, August 11, 2010

Savage sentences

The seven Baha’i leaders who had been detained in Tehran’s fearsome Evin prison for 20 months without charge have finally been sentenced to 20 years’ imprisonment after they were finally accused of espionage, propaganda against the Islamic order and establishment of an illegal administration.

These convictions were handed down after the defendants were allowed one hour’s consultation with their lawyer, and after several brief court appearances in which no evidence was presented on any of the charges.

The facts are at news.bahai.org/story/786, and the reaction of Human Rights Watch is at www.hrw.org/en/news/2010/08/10/iran-free-bahai-leaders. Lets hope there will be demands for the release of the seven from big hitters like Cathy Ashton, the EU High Representative for Foreign Affairs, and Navi Pillay, the UN High Commissioner for Human Rights. Ayatollah Ali Khamenei and his regime may have demonstrated repeatedly that they don’t give a toss for what the rest of the world thinks of their relentless persecution of the Baha’is, but it should be said that using secret trials on false charges to lock up the leaders of a small and harmless minority for a lifetime is gratuitously evil.

PS The Foreign Secretary, the Rt Hon William Hague MP, has issued the following statement:

"I was appalled to hear of the 20 year prison sentence handed out to the seven spiritual leaders of the Bahá’í faith in Iran. This is a shocking example of the Iranian state’s continued discrimination against the Bahá’ís. It is completely unacceptable.

The Iranian judiciary has repeatedly failed to allay international and domestic concerns that these seven men and women are guilty of anything other than practising their faith. It is clear that from arrest to sentencing, the Iranian authorities did not follow even their own due process, let alone the international standards to which Iran is committed. The accused were denied proper access to lawyers, and there is evidence that the trial was neither fair nor transparent.

I call on the Iranian authorities urgently to consider any appeal against this decision, and to cease the harassment of the Bahá’í community. I further call on the Iranian Government to ensure that the rights of all individuals are fully protected, without discrimination, and that it fulfils its obligations to its own citizens as set out in the Iranian constitution."

The news of a 'confession' on TV by Sakineh Mohammadi Ashtiani, almost certainly extracted by torture, has further horrified even Iran's allies such as Brazil. Ms Ashtiani had been held in Tabriz Prison for the previous four years, and had been sentenced to death by stoning for adultery but acquitted of murder before she was paraded on TV, in an obvious attempt to convince the outside world that she deserves the execution which is probably imminent. The regime has never attempted to justify the penalty of stoning to death for adultery, prescribed by one school of Islamic jurisprudence but only carried out in Iran. (www.bbc.co.uk/news/world-middle-east-10956520). This is an utterly hateful and inhumane law, and there is no authority for it in the Qur'an. In the Sunna there is a story about the stoning of two Jews who were found guilty of adultery, but that was the punishment dictated by the Torah at the time, and perhaps applied to Muslims for the sake of uniformity in Medina. Fortunately, the rest of the world has moved on from the standards of the 7th century, and its time for Iran to follow their example. See Mohamed S El-Awa, Punishment in Islamic Law, American Trust Publications, Indianapolis, 1982


Monday I saw the consultant at Dulwich who deals with osteoporosis. She reviewed the medication I'm taking, and prescribed bendroflumethiazide for fluctuating blood pressure (which I had been taking before the operation, but was replaced by a beta blocker in King's). Systolic had varied between 91 and 187 in the previous few days, and so far the spread since resuming the bendro etc has been 110 and 164. Unfortunately one of the known side effects is that its a diuretic, and I already have a problem having to get up several times during the night.

Monday evening we took JW and Maite to the theatre to celebrate his birthday. We saw Enron, which is coming to the end of its run but still attracting full houses. What I found most extraordinary was that Arthur Andersen, which was one of the 'Big Five' accounting firms, collaborated with the top Enron management in practices that were bound to result in disaster. Presumably the law has been tightened up in the US since then, to make it impossible for unscrupulous corporations to indulge in similar forms of accounting trickery.

What I didn't realise, and the play doesn't say, was that the consulting arm of Arthur Andersen split off at the beginning of 2001 as Accenture, now a Fortune Global 500 company, with over 190,000 employees in 200 locations in over 120 countries, generating net revenues of US$21.58 billion in its last financial year. Somebody should write a play about that.

Yesterday's visit from Bahraini friends

Just a few of the snapshots from yesterday's most welcome visit by colleagues and old friends from Bahrain, who work tirelessly for equality and human rights. The al-Khalifa hereditary dictatorship gets away with a policy of demographic engineering, by encouraging immigration from neighbouring Sunni states and granting the newly arrived immigrants citizenship, with a view to further marginalising the indigenous Shi'a population, already deprived of equality and opportunity. See the recent submission of the Bahrain Center for Human Rights and

the Cairo Institute for Human Rights Studies to the UN Human Rights Council's 14th Session under the title Bahrain's Universal Periodic Review: Broken Promises and Voluntary Commitments


The Universal Periodic Review is a grandiose name for a process that has no enforcement mechanism, though it could be a bit more effective if there was a thorough review of the undertakings entered into by states at the UPR 12 months later.

For an account by Karen Dobrowska of the very successful seminar on Bahrain, chaired by Kishwer Falkner, see www.mathaba.net/news/?x=62421

A week in Madeira

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Sunday, August 08, 2010

Bangladesh war crimes

It seems that one or two readers of my blog have illogically come to the conclusion that calling for the Bangladesh war crimes trials to be held under legislation that conforms with modern international standards means that I have no sympathy for the three million who were killed and 200,000 rape victims of the 1971 liberation war. On the contrary, I want the convictions and sentences of the perpetrators to be legally unchallengeable. The government of Bangladesh did not amend the International Crimes (Tribunals) Act 1973 in accordance with the advice given by the International Bar Association, reinforced by similar advice from Human Rights Watch last month. The letter from HRW commented:

While the International Crimes (Tribunals) Act may have been largely based on international standards at the time of its drafting, international criminal law has evolved significantly since, including with the adoption of the Rome Statute of the International Criminal Court (ICC) in 1998 and its coming into force after ratification by 60 states in 2002. The Rome statute and the ICC's corresponding jurisprudence reflect international norms, which Bangladesh, as a signatory to the Rome statute, should follow”.

Nobody accuses the IBA or HRW of lacking sympathy with the victims of 1971, and I hope even at this late hour that Sheikh Hasina’s government will amend the 1973 Act in accordance with the advice given by internationally renowned experts, so that the outcome of the trials will be unimpeachable.

Friday, August 06, 2010

Another picture of the meeting with Somaliland friends this morning.
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Third, barrister Muhammad Molla and Md Nazrul Islam, British supporters of the Jamaat Islami in Bangladesh, mainly to discuss the war crimes trials in Bangladesh. So far, five leaders of the JI have been arrested on blasphemy charges, and then charged under the War Crimes Act while they were in custody. The Parliamentary Human Rights Group had asked the International Bar Association to comment on the compatibility of the Act of 1973 with modern internationally accepted standards of war crimes legislation and they had recommended a number of amendments. The PHRG had drawn this to the attention of the Bangladesh government, asking them to consider these recommendations, and although they did so, no changes were made to the 1973 Act. Our discussion concerned mainly the possibility of getting international observers - and the IBA would be an obvious choice if they were willing - to observe the trials, and comment not only on the effects of sticking to the 1973 legislation, but also the rules of procedure and evidence which have been developed uniquely for these trials, and the conditions under which the defendants have been remanded for much longer than the three days stipulated by the law.

The PHRG is not against the trial of the 1971 war criminals, but wishes to ensure that the process should not be open to criticism.
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Second, my friend Tajammul Hussain, originally from Pakistan. We talked about the Prime Minister's reference to the links between the Pakistani intelligence body the ISI, and the Taliban, and agreed that although the connection had been discussed extensively in the media, the more so after detailed evidence had been published in Wikileaks, it was unwise of him to raise the subject while he was visiting India.

We talked also about the refusal of the Foreign Office to help secure fair compensation for his unfair dismissal by UNHCR, after he blew the whistle on their failure to audit expenditure of hundreds of millions of $. He used the UN appeals machinery, and although UNAT the appeal tribunal found in his favour, the paltry sum they awarded for totally inadequate compared with the ruin of his accounting career. The UN doesn't provide any mechanism for challenging the decisions of UNAT, analogous to the provision in English law for judicial review by the High Court of manifestly wrongful decisions of tribunals. How can this be remedied, when the victim's government point blank refuses to take up the cudgels on his behalf? That's what we have to consider.
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Three sets of visitors today. For the first, from the Somalilanders, I'm going to rely on the photographs they took, because our camera had a flat battery. The members were Mrs Lulu Todd, Khader Ali, Dr Ahmed Moh'd and Ahmed Kadleye (who took the photograph). We talked about what could be done to support the newly elected democratic government in Somaliland in meeting some of its development needs, and there was agreement on the need to set up a UK charitable trust for the purpose. Development of agriculture and fisheries would enable Somaliland to generate export earnings, and there would be markets for these products in Ethiopia and the UAE. But we would need to ascertain what are the new government's priorities, and see how best we can help pursue their goals. Re-recognition of Somaliland as an independent state would obviously help enormously, and the All-Party Parliamentary Group on Somaliland should explore the views of the Coalition on the strategy of working towards international recognition, following the success of the elections.

Thursday, August 05, 2010

This morning, a consultation with the surgeon Mr R at King's. I have to see him again in October after a scan, and he was emphasising again that following the EVAR procedure, its necessary to check the inserted piece of Dacron every few months to make sure that it isn't leaking where it joins the undamaged bits of the aorta itself. Mr R writes to my GP:

"I saw Lord Avebury today in my clinic. I am pleased to say that he has done extremely well following his EVAR operation two weeks ago. The plan is to see him again in two months' time with a duplex scan to make sure there is no endoleak from the operation......"

The literature actually defines five different possible types of endoleak:

  • Type I - Perigraft leakage at proximal or distal graft attachment sites (near the renal and iliac arteries)
  • Type II - Retrograde flow from collateral branches such as the lumbar, testicular and inferior mesenteric arteries
  • Type III - Leakage between different parts of the stent (at the anastomosis between components)
  • Type IV - Leakage through the graft wall due to the quality of the graft material
  • Type V - Leakage from unknown origin
Its not clear from a superficial Google search what treatment there is for these complications. The University of Michigan says encouragingly:

"For the present, as a result of the major complications that endoleaks cause, one may conclude that endovascular treatment of AAA is still an evolving field. It is to be hoped in the future that better patient selection and improved devices will result from proper recording and appropriate analysis of clinical data".

This afternoon I cycled to Brixton for a meeting with senior staff at the Refugee Council. They are doing a great job supporting refugees in the community, with specialists for instance on the problems encountered by children and women.

Baarbara Stapleton came to see us yesterday, as she comes to an end of a four-year stint in Kabul as political adviser to the EU Representative. What a great performance! Whatever happens in Afghanistan, it will have benefitted enormously from Barbara's wisdom.
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Sunday, August 01, 2010

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Visit by Ajahn Khemadhammo and Sister Khema. We had a walk round the park, listened to the brass band playing what started life as a Haydn string quartet, and discussed the current major problems encountered by monasteries in the UK on getting permission for visiting monks and nuns from overseas. When the current five-tier system for applications to enter the UK was introduced, we were told it was going to be a simplification, but in practice it has turned out to be so complicated for monks and nuns that mistakes are being made, and the heavy fees they now charge are being forfeited. Its a heavy additional burden on the resources of monasteries, and we need to develop guidance which will lead applicants through the process.
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