Professor Felix Konotey-Ahulu

British Medical Journal – 11 May 2013 Volume 346, p 3 – NEWS

Most religious followers support assisted suicide for the dying

Zosia Kmietowicz     www.bmj.com/content/346/bmj.f2855?sso=  

Most religious followers supported assisted suicide for the dying: Survey flawed through inadequate definition of “religious” and “terminally ill”.

Those who “said that they followed a religion” were regarded as “religious followers” [1] and their opinions about “a change in the law to allow assisted suicide for people who are terminally ill” recorded in a survey which I consider deeply flawed because of inadequate definition of “religious” and, when Palliative Care Experts are not themselves unanimous [2] in agreeing on who can be called “terminally ill”, how was the term explained to the “nearly 4500 adults” in the survey? [1]

CHURCH OF ENGLAND QUERIES SURVEY

While it was claimed that there was “strong support for a change in the law” from 72% of 1519 Anglicans in the survey organised by Linda Woodhead, Lancaster University Professor of Sociology of Religion, the Church of England spokesman, quite rightly in my view, said such an important subject “cannot be effectively conducted through the medium of online surveys” – a criticism that Professor Woodhead apparently dismissed on the grounds that she was better placed to define who an Anglican follower was than the Church herself.

ETHICS, NOT SOCIOLOGY, IS CRUX OF THE MATTER

The second flaw in Professor Linda Woodhead’s survey is a lack of distinction between legality and ethics when it comes to questions of assisted suicide. To assume that “the Law” is all that needs consideration in this matter is grossly mistaken. I have previously pointed out in the BMJ how two brilliant British Professors of Genetics, both FRS, treated the ethical principle surrounding a genetic defect I had described in the BMJ, in two entirely different ways in their well known textbooks of Genetics. One FRS used my story to underline the importance of Ethics in Clinical Medicine. The other FRS, also publishing details of my story, did not even mention the word “ethics” in his Genetics book. Assisted suicide is bigger than sociology of religion. Any survey done without highlighting the ethical dimension, regardless of the brilliance and reputation of the organisers of the survey, is deeply flawed.

RELIGION IS BROADER THAN CHURCH, MOSQUE, SYNAGOGUE

Third Flaw: Professor Linda Woodhead needs no reminding that there are atheists who are deeply religious. Some of my brilliant atheistic friends and acquaintances worship Scientific Humanism. If they are also labelled as religious (as they need to be) then does the thrust of the survey with the message it seems to convey not become meaningless?

FACE-TO-FACE SURVEYS PREFERABLE IN CONTROVERSIAL MATTERS

In controversial matters it is always good policy to demand face to face interviews where the interviewer can be asked questions such as: (i) “What is your definition of ‘religion’?” (ii) “Have some terminally ill patients not been known to improve unexpectedly and gone home?” (iii) “Why was the present law on assisted suicide acceptable a decade ago, but not now?” (iv) “If Assisted Suicide is made legal in the UK does that make it ethical?” (v) “Does Hitler’s Nazi Germany have nothing to teach Great Britain?”

Felix I D Konotey-Ahulu MD(Lond) FRCP DTMH [felix@konotey-ahulu.com]

Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street Ltd, Phoenix Hosp[ital Group, London W1G 9AL

Competing interests: I am Christian but I do not refer to myself as “religious”.

1 Kmietowicz Zosia. Most religious followers support assisted suicide for the dying. BMJ 201`3; 346: f2855 (11 May, page 3) www.bmj.com/content/346/bmj.f2855?sso

2 Konotey-Ahulu FID. Liverpool care pathway BMJ and Channel Four News: Majority expert choice does not mean best choice.www.bmj.com/content/346/bmj.f1303/rr/634971 March 8 Rapid Response to “Nine out of 10 palliative care experts would choose Liverpool care pathway for themselves” Krishna Chinthapalli in BMJ 2013; 346: 1103 (March 2, pages 2-3) 

Competing interests: None declared

Article appeared in the BMJ - www.bmj.com/content/346/bmj.f2855/rr/645095

by Felix I D Konotey-Ahulu (May 12 2013)

For World Sickle Cell Day 19th June 2012 it is worth reminding ourselves of the 4 consecutive articles I wrote for New African (London) in Jan/March/June/September 2001.

Click to view PDF Document

Further Communication on “Sickle Cell Trait Misinformation and Disinformation” and Sickle Cell Terminology: Disease or Disorder?

From: An Appreciative and Concerned Reader [Email details withheld]
Sent: 12 December 2011 09:20
To: felix@konotey-ahulu.com
Subject: Sickle Cell Trait Misinformation and Disinformation

Dear Professor Felix Konotey-Ahulu,

First I would like to thank you for publishing such an authoritative article on the topic of Sickle Cell misinformation and the dangerous consequences to African people.

I would like your permission to reproduce the article on our website [details withheld]

However if I may make one suggestion and request for an editorial adjustment. It is the belief of our organisation that, at least in the UK the institutional reference of Sickle Cell Disorder as a ‘disease’ is also a contributory factor to the stereotypes and the detrimental prejudicial treatment African people receive in the medical field when the topic is being raised or researched.

As such we identify Sickle Cell (SS or SC) as a genetic blood disorder and not a ‘disease’.

Whilst Sickle Cell may be accurately classified as a genetic variation, in the case of AS and in some instances of SC there are no or very little adverse effects to qualify it as a substantive impairment of normal physiological functioning. Clearly the label ‘disease’ is redundant in this instance.

We appreciate that the definition is fluid and traditionally includes disorders but the labelling of those with Sickle Cell in this manner also adds significant and to our mind unnecessary adverse social and psychological factors.

Including unwarranted fears of transmission as if it were a virus.

Your thoughts on this matter would be greatly appreciated.

Peace

[Name & address mentioned but not published here]

Dear [Writer]

Thank you so much for writing. Your comments are important, very important, but as one who has lived with siblings who had inherited a beta globin gene variant from both our parents I cannot agree that what my parents called “this hereditary disease”, and my siblings themselves also called “this aching disease” should now be called “not a disease”.

On the contrary, in all the 3 International Achievers Conferences that I conducted (First at the Royal Society of Medicine in London 1993, Second in Accra 1995, and Third Accra 2010) the participants were glad to state that although they had/have an hereditary disease (ACHE gene from mother and ACHE gene from father, making them ACHEACHE), they had been able to achieve in life and do extraordinary things – sometimes better than their brothers and sisters who did not inherit ACHEACHE.

You have probably seen how I traced the sickle cell affliction or ailment (if we must avoid the word “disease”) in my own family for 9 successive generations from 1670 AD – http://www.konotey-ahulu.com/images/generation.jpg or http://www.sicklecell.md/images/generation.jpg Now, Writer, if my parents and ancestors of my Krobo Tribe in Ghana had refused to call Chwechweechwe/hemkom a disease, how would they have been able to name every single sufferer for more than 3 Centuries? Just look at the internet link yourself, and see the names of my 3 siblings with “the disease” (Generation VIII centre columns marked ‘R’ for Rheumatism inherited). The Tribal names (for example Aromolegun or Lakuregbee in Yoruba) describe the “disease” in West Africa. If some people do not want to use “disease” we can use the Yoruba “Aromolegun” but how many nurses and doctors in Europe will know what we are talking about? And if you say “Sickle Cell Blood Disorder” are many UK Doctors not calling Sickle Cell Trait a “Blood Disorder”?

I agree that although Diabetes is a disease, a sufferer would prefer to be said to “have Diabetes” to “suffering from Diabetes Disease”. I grant you that, so would my Patient Achievers prefer to be said to “suffer from Sickle Cell Anaemia”? Well, genetically, the term “Sickle Cell Anaemia” is reserved for “SS” where both mother and father donate the sickle cell gene “S”. The term “Sickle Cell Anaemia” cannot be used for someone who gets Haemoglobin “C” (an ACHE gene) from one parent, and sickle cell gene “S” (another ACHE gene) from the other parent, even though they too suffer severe cold season rheumatism. We call them “SC” phenotype, while Sickle Cell Anaemia persons are “SS” phenotype.

Looking after well over one thousand patients who ached in the cold rainy season in Ghana, it was clear that not all of the aching genes were “S”. Some were “C”; others were “D”, “F-hereditary”, “beta-Thalassaemia”, and so on but when inherited together with “S” from the other parent, those who suffer the aches, possess TWO aching haemoglobins, not one as in Sickle Cell Trait. Possessing one ACHE ‘S’ gene and one NORMAL ‘A’ gene does not cause the NORMACHE ‘AS’ person to have cold season rheumatism attacks called sickle cell crises.

So, Writer, as “A” is the Normal Adult Human Haemoglobin Type (never to be confused with Blood Group A), if it is inherited with “S” the person becomes “AS” (Sickle Cell Trait) which is neither a disease nor a disorder. If Normal Haemoglobin gene “A” is not present, then whatever other combination is inherited from the parents becomes “Hereditary Disease”, like ‘SS’, ‘SC’, ‘SD’, ‘Sbeta-Thalassaemia’, ‘CC’, and so on.

Each of these phenotypes has its peculiar characteristics but what is common to them is that they ALL ache in the cold rainy season. The peculiar characteristic of the “SS” is severe anaemia (inadequate blood level), this is why it, and it alone, is the phenotype called “Sickle Cell Anaemia”. A lady with “SC” phenotype cold season rheumatism who, because of heavy periods becomes severely anaemic is not called “Sickle Cell Anaemia”. She is said to have “Sickle Cell Disease ‘SC’ phenotype, with anaemia”.

The peculiar characteristic of the “SC” is not severe anaemia, but eye problems and bleeding into the eye. Sbeta-Thalassaemia persons suffer hip problems as well as cold season rheumatism. Now, in order to help my Ghanaian patients understand what I am just trying to explain to you, way back in 1973, I coined the term ACHEACHE to describe anyone who had inherited an ‘ACHE’ Haemoglobin from both parents, like three of the 11 children of my NORMACHE parents did.

Those of my patients who may not want to say things like “I have Sickle Cell Disease” do quite happily describe themselves as “I am ACHEACHE ‘SS’” or “ACHEACHE ‘SC’”. Other Achievers, some of whom became international lawyers were content to describe themselves as “I have Sickle Cell Anaemia ‘SS’” or “I suffer from Sickle Cell Disease ‘SC’”. They less prefer to be told they have a “Sickle Cell Disorder” – a term that unscrupulous Insurance companies love to extend to the Trait parents of ACHEACHE patients. No one has a just reason to look down on a person suffering from any disease, hereditary or otherwise.

If we change the terminology to “Sickle Cell Disorder”, as they do in the UK, the confusion is even greater. Many, many doctors whom I have met in the UK do a sickle cell test on someone and when the person turns out to be “AS” (Sickle Cell Trait), they then say things like “So and so has the Sickle Cell Disorder”. That kind of statement leads to the kind of misguided recommendation that “Negro travellers be tested for sickle cells for their own safety”. I hope this lengthy explanation helps a bit.

In conclusion, with “Abnormal Haemoglobins” genetically, we reserve the term “hereditary disease” for TWO ACHING HAEMOGLOBINS. The term “Sickle Cell Disease” is a Genetic Definition [Two gene variants or 2 abnormal haemoglobin genes] which can never be applied to the Trait [one gene variant]. As soon as “Disorder” comes into common use then if the blood test shows “Sickle Test Positive” the Trait (One ‘S’ gene) is considered (wrongly) as much a “disorder” as the two gene variant possessor.  One sickle cell gene plus one normal ‘A’ gene does not turn the owner ‘AS’ into a sufferer. Indeed, in Africa, the child with ONE aching gene is healthier than both the one with no aching genes at all (the “AA”) and the one with two aching genes (“SS”) because the ONE ACHE gene possessor does not get cerebral malaria in childhood as do the NO ACHE possessor (“AA”) and the two-ACHE possessor “SS”). This is the phenomenon known to produce what is called Balanced Polymorphism.

Go to my FAQ (Frequently Asked Questions) on my website www.sicklecell.md or www.konotey-ahulu.com to read the reason why the “AS” phenotype is so tough. How else could we have 100 million of them in Tropical Africa? Why have they not died out if they have a “blood disorder”?

And now to your final question: Do you have permission to re-publish my article on the “Misinformation and Disinformation on the Sickle Cell Trait”?

The answer is “Yes, on condition that you also publish your query on the use of the term “Sickle Cell Disease”, and adding this response of mine above to it which forbids you from altering “Disease” to “Disorder”.

Two further points:

(a) The burden of Sickle Cell Disease (ACHEACHE) in Greece, Turkey, and other Mediterranean Countries is huge. If the White population in those countries call the hereditary condition a disease, but we Black ACHEACHE people cannot be said to have a disease, what term do we suggest for doctors, and nurses, and health workers to understand what we are talking about? If the Sickle Cell Trait is called in NHS publications “blood disorder” how do we distinguish the Sickling Positive ACHEACHE “SS” sufferer from the Sickling Positive NORMACHE “AS” non-sufferer?

We should rather aim at treating the ACHEACHE persons properly (No Morphine; No Heroin) to have them achieve their full potential in life so they can say things like; “I am the best in my Class of 50, even though I suffer from Sickle Cell Disease”.

[My own personal fact: I am the second of 11 children of my NORMACHE parents. My immediate younger brother Jerry Tei was ACHEACHE (he took Papaa’s ACHE and Mamma’s ACHE genes) yet when it came to Mathematics he was far better than I was, and I myself was extremely brilliant at the subject, scoring the second highest ‘A’ in the Achimota School Cambridge School Certificate Additional Maths Exam in those days of 120 students in the exam. Therefore far from being ashamed of being told he had Sickle Cell Disease, my brother could always say “I shall thrash you at Arithmetic, Hemkom or no Hemkom” [‘Hemkom’ meaning Sickle Cell Disease]. Why can’t British patients also take that attitude? Why can’t they take the attitude which shows that this hereditary blood disease (affliction, disorder, ailment) is no barrier to excellent academic achievement?]  

(b) The more serious point is how publications in Britain label the Sickle Cell Trait a “Blood Disorder”. The question to ask is “How could a person with “blood disorder” compete with the rest of the world (as they did in the Olympic Games in Mexico City where the air was/is thin, and beat the whole world without dropping down dead?” The fact that experts in the UK can say the “Sickle Cell Trait” is a blood disorder is the reason why those of us from Africa who have seen more sickle cell traits than they have ever seen or ever can see in the UK (and lived with them in the same homes) need to continue speaking up and educating people. At least I am on record in the British Medical Journal May 27 2009 (Rapid Response) for criticising NHS material purporting to teach lay people about Sickle Cell Trait, but misleadingly referring to the NORMACHE phenotype ‘AS’ as a ‘Blood Disorder’. We can do no more than continue to point out misinformation and disinformation.

Yes, you can republish my material, but you do not have permission to editorially correct what I have said. Sure you can say “We do not agree with calling the inheritance of two abnormal haemoglobin genes ‘Sickle Cell Disease’”. But before you say that, Writer, remember that these definitions of what is ‘disease’ and what is not ‘disease’ were laid down by an International Committee.

“When in 1957 the Colonial Medical Research Committee Working Party on sickle cell trait and sickle cell anaemia recommended the use of the term ‘sickle cell disease’ the Committee meant it to denote any pathological condition that is in part attributable to sickling of the erythrocytes …including sickle cell anaemia, sickle cell Haemoglobin C disease, sickle cell Haemoglobin D disease, sickle cell beta-Thalassaemia, …” [Woodruff and Colleagues: Terminology of the hereditary haemoglobinopathies with haemoglobin variants. British Medical Journal, 1957 Volume 1, page 1235].

So, Writer, we do not unilaterally have a right to state that the term “sickle cell disease” should not be used, nor does the NHS Instruction Manual have a right to decide unilaterally to use the term “Sickle Cell Disorder” for Sickle Cell Trait. My ACHEACHE patients do not like the term ‘Disorder’. They would rather like to be said to have a hereditary disease than “blood disorder” even though our Geneva Committee used the word “disorder” to cover disease (ACHEACHE) phenotypes. They never meant it to be used for Sickle Cell Trait as the NHS Manual uses it. Well, whatever terms your ACHEACHE patients prefer to use, please use them, but point out that the cardinal confusion that arises from using “blood disorder” is that the vast majority of British Health workers will include “Sickle Cell Trait” (NORMACHE) in the “Blood Disorder” Group, which is the whole point in the first place of my “Misinformation/Disinformation” article. One wonders how many Sickle Cell Traits (NORMACHE) have also been aborted in the UK because these foetuses are officially categorized as possessing “Sickle Cell Disorder”.

But not even modern day haematologists (or patients) can change what was decided in 1957, and what we confirmed in Geneva in 1972. By “we” I mean the following: Professor Alexander Boyo, Professor Raymond Cabannes, Professor Hermann Lehmann, Dr P F Milner, Professor Bela Ringelhann, Professor D J Weatherall, Professor Italo Barrai, Professor Arno Motulsky, and Dr F I D Konotey-Ahulu [Special Expert Scientific Group on Treatment of Haemoglobinopathies and Allied Disorders, - Technical Report 1972, Volume 509, 83 pages]    

My advice for all intelligent Africans is to cultivate the use of the term ACHEACHE plus the phenotype, and NORMACHE plus the phenotype. So, taking my own family, my Trait parents were NORMACHE ‘AC’ x NORMACHE ‘AS’, and their 11 children receiving variously a NORM or ACHE from them became ACHEACHE ‘SC’ (3 of us), NORMACHE ‘AS’ (2 of us), NORMACHE ‘AC’ (2 of us), NORMNORM ‘AA’ (4 of us). It is up to us to educate our doctors to many of whom all this is very strange.

When you carefully go through all my publications from 1965 to 2011 http://www.sicklecell.md/publications (or http://www.konotey-ahulu.com/publications and you decide to republish anything let me know. You may always comment on the original publications but you do not have my permission to alter what I have said.

Press on with the good work.   

Have a Blessed Christmas! See my perennial Christmas Message http://bit.ly/cRcZ0s   

Felix Konotey-Ahulu MD(Lond) DSc(UCC) FRCP(Lond) DTMH(L’pool)             

Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley St., Phoenix Hospital Group, London W1G 9AL.

Sickle Cell Trait Misinformation and Disinformation
F I D Konotey-Ahulu MB BS MD(London) FRCP FGCP FWACP FTWAS DTMH

Just google or wikipediate “sickle cell trait” and you get a mixture of truth and error which latter has led to (i) selective abortion (ii) insurance injustice (iii) social humiliation (iv) sports ban (v) employment exclusion (vi) clinical mismanagement and (vii) coroners’ perversion of truth. When misinformation turns “sickle cell trait” into “sickle cell disease” the consequences can be dire. Disinformation is deliberate misinformation. When terms like “congenital-abnormality” and “genetic-defect” mean different things to different people, confusion reigns. Wrong ethics plus wrong definitions of congenital or genetic defect make me revisit “abortion for sickle cells” and the Sickle Cell Trait Controversy.

WHO DEFINES “CONGENITAL ABNORMALITY” THAT NEEDS ABORTION?

“When fetal congenital abnormalities are present abortion is a valid therapeutic medical procedure” [1] was Dr Saripanidis’ response to Helen Watt who found it “heartening that so many medical students show at least some unwillingness to carry out abortion, a procedure which lethally affects the health of the fetal child (congenitally abnormal or otherwise”) [2]. Saripanidis’ “congenital abnormality” may be different from others’. Watt was responding to Zosia Kmietowicz who had reported “a fifth of medical students object to abortion for congenital abnormality” [3].

ETHICS DIVIDES EQUALLY BRILLIANT EXPERTS

I once described my Mendellian Dominant extra digits as being of no consequence, but which for a tribe east of us a child born with them was, to our disgust, promptly drowned [4]. Two Fellows of the Royal Society read my likening British doctors who advised prenatal diagnosis and selective abortion for sickle cell disease to “scientific tribesmen” behaving in a way that we Krobo people found reprehensible. Publishing my case in their Genetics books Sir David Weatherall mentioned the ethical implications in a chapter on ETHICS [5]. The other professor did not bother to mention Ethics in relation to Genetics [6]. My own position is well known. [4, 7-12] Pregnancies have been terminated for cleft palate. Extra digits are liable to be prenatally detected and fetus aborted. Making sickle cell trait a disease exposes it to an abortion programme because the received wisdom in the UK is prenatal diagnosis with advice for selective abortion.

SICKLE CELL TRAIT CONFUSED WITH SICKLE CELL DISEASE

Sickle Cell Trait (1 normal ß-globin gene ‘A’ plus 1 ß-globin variant gene ‘S’) is being confused with Sickle Cell Disease (2 ß-globin variant genes at least 1 of which is the sickle cell gene ‘S’). Look at these statistics:

(a) Among over 170 million Nigerians more than 35 million have Sickle Cell Trait ‘AS’.

(b) Ghana’s population of 25 million has 5 million sickle cell traits ‘AS’

(c) Of 6000 medically qualified West African doctors (Nigerian 4,500 and Ghanaian 1,500) working in the USA 1,500 have Sickle Cell Trait (‘AS’)

(d) One in 5 of Nigerian, Ugandan, and Ghanaian doctors in the UK are sickle cell trait.

(e) Korle Bu Teaching Hospital in Accra sees over 100,000 patients annually of whom 20,000 are Sickle Cell Trait (‘AS’)

(f) One in 5 diabetics, 1 in 5 hypertensives, 1 in 5 liver failures, 1 in 5 kidney failures, 1 in 5 suddenly-dropped-down-deads, and 1 in 5 stammerers have the sickle cell trait “AS”, because 1 in 5 of the southern Ghanaian healthy population is sickle cell trait “AS”.

Against this background we have:

(a) Elliott Vichinsky: “Renal medullary carcinoma is a rare and aggressive tumor that is seen almost exclusively in young patients with sickle cell trait” [13].

(b) Charis Kepron, Gino Somers, Michael Pollanen: “Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy” [14]

(c) Nigel Key, Vimal Derebail: “During exercise, Sickle Cell Trait appears to be a risk factor for sudden death and/rhabdomyolysis, particularly when the exercise is intense, and is performed at high altitude …” [15]

(d) Tsaras G, Owusu-Ansah A, Boateng FO, Amoateng-Adjepong, Y: “Complications associated with sickle cell trait: a brief narrative review”. [16]

So 100 million African sickle cell traits, millions in southern Turkey (1 in 5 Eti-Turks are ‘AS’), Mediterranean people with millions of ‘AS’ Trait [17-20], plus millions in India’s Madhya Pradesh and Orissa with 43% ‘AS’ Trait [21] are in some danger? Insurance injustice apart, the next step would be to advise aborting any fetus with Hb ‘S’ in it.

“UP-TO-DATE” AND “NOVEL” INSIGHTS ARE OUT OF DATE

Forty years ago exactly the then BMJ Editor Dr Martin Ware helped to retract a sickle cell trait inaccurate publication that caused furore [22-29]. No author has mentioned the 10 Addae’s Criteria required to be fulfilled before someone attributes symptomatology to sickle cell trait [24]. Witkowska et al published that sickle cell trait and sickle cell disease co-existed in the same person [30]. Elliott Vichinsky [13] failed to pick up the genetic heresy of 4 ß-globin genes in one person. I had warned that Witkowska’s patient did not have sickle cell trait but ‘Sickle Cell Haemoglobin Quebec-Chori’ disease [31] which “made it vital for clinicians to probe further any case of sickle cell trait where the symptoms suggest sickle cell disease” [31]. To provide excuse to include the sickle cell trait phenotype in an abortion programme is frightening.

CLINICAL EXPERIENCE MUST SUPERINTEND HAEMATOLOGICAL EXPERIENCE

My views here are not those of a novice. Professor Helen Ranney once said: “There is no single clinical experience in the United States comparable to that of Dr Konotey-Ahulu” [32]. Our family named sickle cell disease patients from 1670 Anno Domini http://www.konotey-ahulu.com/images/generation.jpg correctly identifying phenotypes Chwechweechwe/Hemkom (Sickle cell Disease) “SC” as “pi-gbagblaa”, and “SS” as “gbagblaa” [33 34 38]. Directing the largest Sickle Cell Disease Clinic in the world [34], I could guess the 4 sickle cell disease phenotypes correctly (‘SS’, ‘SC’, SF’, SßThal’) without haemoglobin electrophoresis [34 35]. That was how Haemoglobin Korle-Bu and Haemoglobin Osu-Christiansborg were discovered [36, 37]. We even knew that the commonest cause of severe sickle cell crisis was malaria [34 39], yet erroneous statements like “Sickle Cell Disease protects against malaria” persist.

HISTORY BEHIND CONFUSION WITH SICKLE CELL TRAIT DEFINITION

When Itano discovered Haemoglobin C in 1951 [40], the riddle was solved of seeing sickle cell disease symptomatology in someone who was wrongly routinely referred to as “Sickle Cell Trait” (1 ß-globin gene variant ‘S’ plus 1 normal ß-globin ‘A’) because the blood of one of the parents of the “SC disease phenotype” (2 ß-globin gene variants) did not sickle. Moreover when the ‘AS’ pattern represents 2 abnormal genes as in Sickle Cell ß-plus Thalassaemia, or as in Sickle Cell Haemoglobin Quebec-Chori disease, clinical experience more than haematological experience is what is required to prevent wrong interpretations. [Read that again, and again, please]
Furthermore, the sickle cell colour test does not distinguish between Sickle Cell Trait ‘AS’ and Sickle Cell Hb C disease ‘SC’ [41], and has thus wrongly attributed death to Sickle Cell Trait. I was once guilty of rushing to publication only to be corrected by Dr E J Watson-Williams who advised Family Studies [34, p. 364]. I then discovered to my shame [42] that the man who had died in London during a minor eye operation was “SC phenotype”, not sickle cell trait “AS” phenotype.

IMPLICATIONS FOR SICKLE CELL TRAIT REDEFINED AS SICKLE CELL DISEASE

ABORTION ADVICE is one consequence. INSURANCE PUNISHMENT is another. I was given 4 body guards in Philadelphia for my Keynote Address at The Martin Luther King Jr Foundation Award Ceremony. The title was “Difference between Sickle Cell Trait and Sickle Cell Disease” [43]. Insurance companies wanted the difference blurred. Approached by Professor Bowman in the USA about the Sickle Cell Trait [44] they admitted to loading the trait’s premium. [44] “It is my understanding” says Bowman “that insurance companies test only Blacks for the sickle cell trait” [45]. Did these authors (13-16) exclude Hb Quebec-Chori masquerading as normal Hb ‘A’? Was Hb ‘S’ quantified in all their publications? How many patients had G6PD quantified as 1 in 5 Ghanaian males and 1 in 16 females have total G6PD Deficiency [46 47 48] which affects the kidney adversely [49 50 51]? How many Family Studies were done?

IN SPORT ARE ALL NATIONALITIES PHENOTYPED “FOR THEIR OWN SAFETY”?

Are white skinned Americans included in sickle cell screening before sports? Nobel Laureate Professor James Watson’s great grand parent was an African. [52 53] As 1 in 3 West Africans had a ß-globin gene variant ‘S’ or ‘C’ [10] could Watson have either? Regarding advice given [22] to screen “Negro travellers” at airports for sickle cells for their own safety Dr Djabanor asks regarding White sickle cell traits: “How do we identify them from their external features to thrust upon them the benefits of this advice?” [23]

HAEMOGLOBIN ‘S’ IN TRUE SICKLE CELL TRAIT IS BETWEEN 20% AND 39.7%

Of 82 consecutive sickle cell traits that emerged out of over 400 consecutive West Africans I saw in London that Professor Hermann Lehmann phenotyped for me the 3 known bands of Hb ‘S’ percentages were clearly demonstrated, with the highest percentage less than 40%, and the lowest haemoglobin ‘S’ value was as little as 20% [54]. Are these the levels of Hb S that we are told millions around the world stand in danger from? Writing to The London Times exactly 40 years ago Lehmann confirmed that sickle cell traits competed in the Olympic Games in Mexico City at 7000 ft above sea level and no sudden deaths occurred. Chicago University’s Professor James Bowman said : “Persons with sickle cell trait will no longer be able to become ill or even die lest they find themselves subject of case report” [55], and a Black man beaten to death by police was claimed by the Coroner to have died from sickle cell trait. Professors Simon Dyson and Gwyneth Bosswell recount similar experiences [56]. Social humiliation resulted with suggestion [22] that “Negro travellers” be tested at airports for sickle cells before flight “for their own safety”. Acute appendicitis was misdiagnosed as abdominal sickle cell crisis because sickle cell test was positive, and employment was refused on the grounds of “sickle cell trait”. I found 15 flaws [57] in the article on the 5-year old boy who died and was found with “multiple inflicted injuries” and aspiration pneumonia, only to be published as “Sickle cell trait mimicking multiple inflicted injuries” [14]. My Sickle Cell Trait chapter [34 pp 349-371] deals comprehensively with similar anomalies.

BALANCED POLYMORPHISM AND AFRICAN ANTHROPOGENETICS

We know that the true ‘AS’ [NORMACHE] can be tougher than phenotype ‘AA’ [NORMNORM] because in the toddler age group we find no cerebral malaria child with sickle cell trait [58], which fact is the basis of the Balanced Polymorphism phenomenon [34 pp. 91-108], about which there is so much ignorance [59]. To assess the Hardy Weinberg Equation of gene frequencies without reference to the genetic index ‘MPSI’ that I once invented, and to polygamy [60 61 62], is to ignore African realities.

TRANSPARENCY AND ABSENCE OF PREJUDICE REQUIRED

Why all of a sudden such concern that “for their own safety” sickle cell traits should not be allowed to run competitively? And has there been an attempt to find out why Black families are increasingly refusing prenatal screening in the UK? [63] Is this reluctance related to the rumour that a Teaching Hospital screened a West African mother who refused abortion when told baby would be ‘SS’ but when born was found to be ‘AA’, and “Laboratory Error” was claimed as reason for the misinformation 7 months previously? [63] Medical Practice is known to have been marred in time past by racial prejudice [64 65 66 67], so one needs to ask what proportion of the medical students “object to abortion for congenital abnormality” [1 2 3] not just for ethical reasons but also because they are from ethnic minority groups that harbour suspicions?

Competing interests: I not only carry a congenital abnormality, Mendellian dominant extra manual digits, but I am also one of 11 children of parents both of whom were Traits for beta-globin variant genes [NORMACHE], resulting in 3 siblings born with Sickle Cell Disease [ACHEACHE], 4 with Trait [NORMACHE] and 4 with “AA” [NORMNORM] – see www.konotey-ahulu.com/images/generation.jpg

Felix I D Konotey-Ahulu MD(Lond) FRCP DTMH Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street, Phoenix Hospital Group, London W1G 9AL [E-mail: felix@konotey-ahulu.com
Website: http://www.sicklecell.md]

1 Saripanidis Stravos. Abortion is a valid therapeutic medical procedure. BMJ Rapid Response 30 October 2011. Re: BMJ 2011; 343.doi: 10.1136/bmj.d4717.1

2 Watt Helen. Doctors should not refer for harmful elective procedures. Rapid Response 26 July 2011. Re: BMJ 2011; 343.doi: 10.1136/bmj.d4717.1

3 Kmietowicz Zosia. A fifth of medical students object to abortion for congenital abnormality. 22 July 2011. BMJ 2011; 343.doi: 10.1136/bmj.d4717.1

4 Konotey-Ahulu FID. Ethical issues in prenatal diagnosis. BMJ Clin Res Ed 1984; 289(6438)185 http://www.bmj.com/cgi/reprint/289/6438/185-a.pdf July 21 doi:10.1136/bmj.289.6438.185-a

5 Weatherall D J. Ethical issues and related problems arising from the application of the new genetics to clinical practice. Chapter 12 In The New Genetics and Clinical Practice. Oxford University Press (Third Edition) Oxford 1991, pages 347-48.

6 Jones Steve. The Language of Genes; Biology, History, and Evolutionary Future. Flamingo 1993, London, page 285.

7 Konotey-Ahulu FID. Ante-natal diagnosis of haemoglobinopathies. Lancet 1977; 1: 597-598.

8 Konotey-Ahulu FID. Ethics of amniocentesis and selective abortion for sickle cell disease. Lancet 1982; 1(8262): 38-39. January 2.

9 Konotey-Ahulu FID. Missing the wood for one genetic tree? The First International Symposium on the Role of Recombinant DNA in Genetics – Proceedings – Chania, Crete, Greece, May 13-16 1985. Eds Loukopoulos D, Teplitz RL; Athens, P. Paschalidis 1986, pages 105-116.

10 Ringelhann B, Konotey-Ahulu FID. Hemoglobinopathies and thalassemias in Mediterranean areas and in West Africa: Historical and other perspectives 1910 to 1997 – A Century Review. Atti dell’Accademia dell Science di Ferrara 1998; 74: 267-307 Milan

11 Konotey-Ahulu FID. Antenatal screening for sickle cell disease and beta-thalassaemia. http://www.bmj.com/content/341/bmj.c5132/reply#bmj_el_242914 BMJ Rapid Response Oct 12 2010

12 Konotey-Ahulu FID. Antenatal sickle cell disease/haemoglobinopathy screening. BMJ Rapid Response http://www.bmj.com/content/341/bmj.c5243/reply#bmj_el_243447 October 25 2010

13 Vichinsky Elliott P. Sickle cell trait. Literature Review UpToDate [Accessed 18 Feb 2011] http://www.uptodate.com/contents/sickle-cell-trait?view=print

14 Kepron Charis, Somers Gino R, Pollamen Michael S. Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy. Journal of Forensic Sciences Volume 54, No.5, pp 1141 t0 1145 September 2009.

15 Key Nigel S, Derebail Vimal K. Sickle Cell Trait: Novel Clinical Significance. Hematology 2010: 418-422.

16 Tsaras, G, Owusu-Ansah A, Boateng FO, Amoateng-Adjepong, Y. Complications associated with sickle cell trait: a brief narrative review. American Journal of Medicine 2009; 122(6): 507-512.

17 Aksoy M. Sickle cell trait in Southern Turkey. Lancet 1955; 1: 589-90.

18 Atlay C, et al. Haemoglobin S and some other hemoglobinopathies in Eti-Turks. Human Heredity 1978; 28: 56-61.

19 Choremis C et al. Sickle cell anaemia in Greece. Lancet 1951; 1: 1147.

20 Choremis et al. Blood groups of a Greek community with a high sickling frequency. Lancet 1957; 2: 1333-34.

21 Roy DN, Chaudhuri RSK. Sickle cell trait in the tribal population in Madhya Pradesh and Orissa (India). Journal of Indian Medical Association, 1967; 49: 107-112.

22 Green RL, Huntsman RG, Serjeant GR. Sickle cell trait and altitude. Br Med J 1971; 4: 593-595.

23 Djabanor F F T. Sickle cell trait and altitude. Brit Med J 1972; 1: 113

24 Addae R O. Sickle cell trait and altitude. BMJ 1972; 1: 53. [10 criteria required to satisfy clinicians in regions where 1 in 5 people have the sickle cell trait that symptoms are due to the trait]

25 Konotey-Ahulu FID. Sickle cell trait and altitude. Brit Med J 1972; 1: 177-178.

26 Lehmann Hermann. Sickle cell and flying. The Times (London), 4th January 1972.

27 Konotey-Ahulu FID. An international sickle cell crisis. [Editorial] Ghana Medical J; 1972; 11: 4-8

28 Konotey-Ahulu FID. Sickle cell trait and altitude. BMJ 1972; 2: 231-32 April 22

29 Green RL, Huntsman RG, Serjeant GR. Sickle and altitude. Brit Med J. 1972; 2: 294

30 Witkowska HE, Lubin BH, Beuzard Y et al. Sickle cell disease in a patient with sickle cell trait and compound heterozygosity for haemoglobin S and haemoglobin Quebec-Chori. New England Journal of Medicine 1991; 325: 1150-1154. [Note that the title of this article is incorrect: No human being can be said to have both Sickle cell trait and Sickle Cell Disease. The ‘AS’ pattern is sickle cell trait pattern, but this ‘A’ is not a true ‘A’ but the new haemoglobin called Quebec-Chori, producing a disease phenotype, not trait.]

31 Konotey-Ahulu FID. Beware of symptomatic sickle cell traits. Lancet 1992; Feb. 29, p 565. [Re: The enigma of Haemoglobin Quebec-Chori]

32 Ranney Helen M. Summary of Symposium. In Sickle Cell Disease, Editors H Abramson, J F Bertles, Doris Wethers [C Mosby Co., St Louis] 1973, p 320.

33 Konotey-Ahulu FID. Sickle cell disease in successive Ghanaian generations for three centuries. Chapter 2 pp 6-20 in The Sickle Cell Disease Patient: Natural History from a Clinico-epidemiological study of the first 1550 patients of Korle Bu Hospital Sickle Cell Clinic. Macmillan Press Ltd, London 1991 & 1992 and T-A’D Co Ltd Watford 1996.

34 Konotey-Ahulu FID. The Sickle Cell Disease Patient: Natural History from a Clinico-epidemiological study of the first 1550 patients of Korle Bu Hospital Sickle Cell Clinic. Macmillan Press Ltd, London 1991 & 1992 and T-A’D Co Ltd Watford 1996

35 Konotey-Ahulu FID. Patterns of clinical haemoglobinopathy. E Afri Med J 1969 Mar; 46(3): 149-156. PMID: 5800410 [PubMed – indexed for MEDLINE]

36 . Konotey-Ahulu FID, Gallo E, Lehmann H, Ringelhann B. Haemoglobin Korle Bu (alpha2 beta2 73 Aspartic Acid –> Asparagine), showing one of the two amino acid substitutions of Haemoglobin C Harlem. J Med Genet 1968 June; 5(2): 107-111. & http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1468514 An example of intra-genic cross-over [Also see G-Accra http://lib.bioinfo.pl/pmid:5722880 ]

37 Konotey-Ahulu FID, Kinderlerer, JL Lehmann H and Ringelhann B. Haemoglobin Osu-Christiansborg. A new chain variant of Haemoglobin A (beta 52 D3 Aspartic Acid –> Asparagine) in combination with Haemoglobin S. Journal of Med Genet 1971 Sep; 8(3): 302-305. http://pubmedcentral.nih.gov/picrender.fcgi?artid=146917&blobtype=pdf or http://lib.bioinfo.pl/pmid:5097135

38 Konotey-Ahulu FID. The Sickle-cell Diseases: Clinical manifestations including the Sickle Crisis http://archinte.ama.assn.org/cgi/reprint/133/4/611-pdf . Arch Intern Med 1974; 133(4): 611-619.

39 Konotey-Ahulu FID. Malaria and sickle-cell disease BMJ 1971 June; 2(5763): 710-711 doi:10.1136/bmj.2/5763.710-d http://www.bmj.com/cgi/reprint/2/5763/710-d.pdf

40 Itano HA. A third abnormal haemoglobin associated with hereditary hemolytic anemia. Proc Nat Acad Sci (Washington) 1951; 37: 775-84

41 Konotey-Ahulu FID. Detecting sickle cell haemoglobin. Brit Med J 1972; 4: 239

42 Konotey-Ahulu FID. Blushing in the black skin. (Invited Editorial) Journal of Cosmetic Dermatology April 2003; 2 (2), 59-60 [PMID: 17156057 PubMed]

43 Konotey-Ahulu FID. Four bodyguards and the perils of unmasking scientific truths. BMJ 2007; 335: 210-211. http://www.bmj.com/cgi/content/full/335/7612/210 (July 28)
doi:10.1136/bmj.39268.553021.47 Print http://www.bmj.com/cgi/reprint/335/7612/210.pdf
[Day & Date: Wednesday 31st May 1972 – Philadelphia, Dr Martin Luther King Jr Foundation Award Ceremony for Outstanding Contributions in Sickle Cell Disease: Banquet - My Keynote Address was on ‘Difference between Sickle Cell Trait and Sickle Cell Disease’. Those also honoured present on the platform with me included Nobel Prize Winners Linus Pauling and Max Perutz, then Hermann Lehmann, Roland Scott, J V Neel, Bella Ringelhann, A C Allison, James Bowman, Helen Ranney, Charles Whitten, Samuel Charache, L Diggs, L Conley, Sam Charache & Graham Serjeant].

44 Konotey-Ahulu FID. Insurance and genetic testing. Lancet 1993, 341: 833. March 27

45 Bowman James. Ethical, legal, and humanistic implications of sickle cell programs. INSERM 1975; 44: 353-378.

46 Ringelhann B, Dodu SRA, Konotey-Ahulu FID and Lehmann H. A survey for haemoglobin variants, thalassaemia and Glucose-6-Phosphate Dehydrogenase Deficiency in Northern Ghana. Ghana Med J 1968; 7: 120-124.

47 Konotey-Ahulu FID. Hereditary qualitative and quantitative erythrocyte defects in Ghana: An historical and geographical survey. Ghana Med J 1968; 7: 118-119 (Editorial 35 references). [First time Chwechweechwe and other tribal names were identified as Sickle Cell Disease]

48 Owusu SK. Glucose 6 Phosphate dehydrogenase (G6PD) deficiency in the causation of disease in Ghana. Ghana Med J. 1974; 13: 168-70

49 Owusu SK. Absence of glucose 6 phosphate dehydrogenase in red cells of an African. Brit Med J 1972; 4: 25-26

50 Owusu SK, Addy JH, Foli AK, Janosi M, Konotey-Ahulu FID and Larbi EB. Acute reversible renal failure associated with glucose-6-phosphate dehydrogenase deficiency. Lancet 1972 June 10; 1(7763): 1255-1257.

51 Adu D et al. Acute renal failure and typhoid fever in Ghana. Ghana Med J 1975; 14: 172-74.

52 Verkaik Robert. Scientist who sparked racism has black genes. The Independent, London. 10 December 2007. [Re: DNA Nobel Laureate Professor James Watson]

53 Konotey-Ahulu FID. There is but one human race. New African, London. Dec 2009, No. 490, page 4.[Re: James Watson who with Francis Crick won Nobel Prize on DNA]

54 Konotey-Ahulu FID. Alpha-Thalassaemia nomenclature and abnormal haemoglobins Lancet 1984; 1: 1024-25 May 5 [“Of 82 consecutive sickle cell traits seen in London in 24 months 36 (44%) had just one quarter of the total haemoglobin as sickle haemoglobin (mean 25%, range 20-28%) ..The three known peaks of haemoglobin S proportion in the West African sickle cell sickle cell trait are around 25%, around 30& and around 38%”)

55 Bowman JE, Bernstein S. Caution about preliminary reports. Pediatrics 1977; 59: 639-40.

56 Dyson Simon, Bosswell Gwyneth. Sickle Cell and Deaths in Custody. Whiting and Birch, London: June 2009; 230 pages “The misuse of Sickle Cell Trait to explain away sudden deaths”.

57 Konotey-Ahulu FID. Blaming sudden death on Sickle Cell Trait? Flaws in article of Charis Kepron, Gino Somers and Michael Pollanen Exposed. September 4 2011. . www.sicklecell.md/blog/?p=105 or www.konotey-ahulu.com/blog/?p=105

58 Commey JOO. Absence of sickle cell trait in 30 consecutive cases of cerebral malaria in Ghana when 6 expected. [Observations in 1986 see Reference 33, page 95] See also Konotey-Ahulu FID. Balanced polymorphism and other factors relating to hereditary qualitative and quantitative erythrocyte defects. Chapter 8, pp 91-108 in Reference 34, and also Chapter 30 Percentage values of haemoglobins S, F, A2 C, A, in various sickle cell phenotypes, and a consideration of the sickle cell trait pp 349-370]..

59 Konotey-Ahulu FID. Malaria and sickle cell: “Protection?” Or “No Protection?” – Confusion reigns. http://www.bmj.com/cgi/eletters/337/oct01_3/a1875#203067 BMJ Rapid response 13 October 2008

60 Konotey-Ahulu FID. Male procreative superiority index (MPSI): The missing co-efficient in African anthropogenetics. BMJ 1980; 281(6256): 1700-1702 http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1715685&blobtype=pdf doi:10.1136/bmj.281.6256.1700 December 20 – 27 1980 http://www.bmj.com/cgi/reprint/281/6256/1700.pdf

61 Konotey-Ahulu FID. The Male Procreative Superiority Index (MPSI): its relevance to genetical counseling. In FIFTY YEARS OF HUMAN GENETICS A Festschrift and liber amicorum to celebrate the life and work of GEORGE ROBERT FRASER Edited by Oliver Mayo and Carolyn Leach. Wakefield Press 2007 (www.wakefieldpress.com.au) 1 The Parade West, Kent Town, South Australia 5067)

62 Bonney GE and Konotey Ahulu FID. Polygamy and genetic equilibrium. Nature 1977; 265: 46-47 (January 6 1977). doi:10.1038/265046a0

http://www.nature.com/nature/journal/v265/n5589/abs/265046a0.html

63 Konotey-Ahulu FID. Konotey-Ahulu FID. Refusing to provide a prenatal test for refusing later termination of pregnancy can it ever be ethical? BMJ Rapid Response November 20 2006 http://www.bmj.com/cgi/eletters/333/7577/1066#149662

64 Muller-Hill Benno. Murderous Science. Elimination by Scientific Selection of Jews, Gypsies, and Others – Germany 1933-1945. [Translated from German by G R Fraser] Oxford, Oxford University Press, 1988.

65 Clinton President WJ. Apology on behalf of the American Government to 8 survivors of the Tuskegee Syphillis experiment victims. World-wide radio and television PBS News Hour Newsreel Announcement (Jim Lehrer and Charlayne Hunter-Gault) May 16 1997

http://www.pbs.org/newshour/bb/health/may97/Tuskegee_5-16.html

66 Tanne Janice Hopkins. President Obama apologizes to Guatemala over 1940s syphilis study. BMJ 341: doi:10.1136/bmj.c5494 October 4 2010

67 . Konotey-Ahulu FID. President Obama apologizes over Guatemala syphilis study: International co-operative research and practice in jeopardy. Rapid response BMJ 17 October 2010 http://www.bmj.com/content/341/bmj.c5494.full/reply#bmj_el_243183

Blaming sudden death on Sickle Cell Trait?
Flaws In Article Of Charis Kepron, Gino Somers and Michael Pollanen Exposed.

Felix I D Konotey-Ahulu MD(Lond) FRCP(Lond) DTMH(L’pool) FGCP FWACP FTWAS

Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, Ten Harley Street, London W1G 9PF. [Founder & Co-Director of KÁGÈ SICKLE CELL FOUNDATION www.sicklecell.md & felix@konotey-ahulu.com]

“Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy” is the title of an article published in the Journal of Forensic Science ¹. I do not know which expert reviewed and passed this article for publication but the 20% of healthy Ghanaians with sickle cell trait have good reason to protest at such a flawed article masquerading (as the authors Charis Kepron and others put it) “the first to describe sickle cell trait pathology as a mimic of a non-accidental injury”¹.

The defects of this article are very many:

(i) Mentioning sickle cell disease (scd) and sickle cell trait (sct) in the same breath betrays clinical ignorance. References 1 and 2 on “sickle cell disease” quoted by Kepron and colleagues in support of a “sickle cell trait” article are therefore totally irrelevant.

(ii) Ponder the following statement of the authors: “Sudden unexpected death in a 5-year old child due to pulmonary complications of sickle cell trait in whom the pattern of bone lesions seen at autopsy mimicked multiple inflicted injuries”.¹ Now, 1 in 5 of all Ghanaian children at home and abroad who may be found to be traumatised and left with broken bones will be found to be sickle cell trait because 20% of the rest of the healthy Ghanaian population are also sickle cell trait ‘AS’. So does that mean the bone defects seen in this Ghanaian child in Canada can be attributed to sickle cell trait?

(iii)   The child had complained of a painful leg, and was said to have had “mild tissue swelling” and yet the X-ray films were not “retrospectively reviewed”.¹ Why?

(iv)   There was no family study of sickling in a case report of such importance. What were the levels of Haemoglobin ‘S’ in the mother and/or the father?

(v)   The haemoglobin electrophoretic report is flawed. Add up the various fractions quoted in the publication and you get 100% [Hb A = 74.9%, Hb S = 23.2%, Hb F = 1.9%], but where is Haemoglobin A₂? How could reputable haematologists, paediatricians, and pathologists forget Hb A₂ in such an electrophoretic report?

(vi)   Autopsy showed the Right lower lobe of the lung to be (in their own words) “pale, congested, consolidated, and focally haemorrhagic”.  The question is this: Are these pneumonic changes never seen in children who do not have sickle cell trait? In other words, does sickle cell trait have to be invoked to explain such pathological changes?

(vii)   “A layered dissection of the posterior para-spinal muscles of the neck” say the authors “showed focal areas of soft tissue haemorrhage”¹ and yet they blame these changes on sickle cell trait, ruling out child abuse?

(viii)   The authors Charis Kepron, Gino Somers and Michael Pollanen report that “Both lungs contained foreign material in keeping with aspiration of gastric contents”, the classical residue for an aspiration pneumonia that could kill a child instantly, yet the sudden death was attributed to sickle cell trait by these authors?

(ix)   Staphylococcus aureus was cultured from both lungs, and yet complicated staphylococcal pneumonia was not suggested as the cause of sudden death, but the sickle cell trait with just 23.2% of sickle cell haemoglobin ‘S’ ?

(x)   The authors state that the sickle cell trait “can be a cause of acute complications normally associated with sickle cell disease including the acute chest syndrome”.¹ This ex cathedra statement is simply not true. The sickle cell trait ‘AS’ had run at Olympic Games at Mexico City over 7000 ft where the air is thin and oxygen concentration is lower than at sea level, and these sickle cell traits ‘AS’ (or NORMACHE as I call them) had competed with and beaten the whole world. And the authors couple this ‘AS’ phenotype with Sickle Cell Disease phenotype (ACHEACHE)? Moreover, people of all nationalities without sickle cell trait die suddenly from aspiration pneumonia, so why should a sickle cell trait child behave differently?

(xi)   Invoking acute chest syndrome as cause of death in a sickle cell trait child stems more from ignorance of what has been termed “acute chest syndrome”. The term was coined only in recent decades to explain breathing problems in sickle cell disease patients. This diagnosis assumed huge proportions only when Morphine and Diamorphine constituted the recommended prescription to treat pain of sickle cell crisis in the UK and the USA². The NCEPOD Report of the United Kingdom revealed that  “Nine out of the 19 patients with sickle cell disease who had pain on admission and who then died had been given excessive doses of opiods” (meaning morphine and diamorphine)“ ^{3, 4, 5}. Now, for Kepron and colleagues to invoke the acute chest syndrome as contributory to the Ghanaian child’s sudden death in Canada was just scraping the barrel to link sickle cell trait to the sudden death. Quoting Vichinsky and colleagues ⁶ in support of their acute chest syndrome proposition was a mistake because Vichinsky’s paper failed to diagnose the devastating role of opiates (Morphine and Diamorphine) in the causation of the chest syndrome due to the opiods’ respiratory depressive effect on the very patients who needed oxygen to survive. ⁵

(xii)   The authors’ references 11 and 12 in the article that they cite to blame acute chest syndrome on sickle cell trait failed to take cognisance of the ten Addae’s Critreria ⁷ which must be met before serious symptomatology is blamed solely on sickle cell trait. For instance, the sickle cell trait must not be blamed for serious symptomatology without quantification of Hb A₂ and yet Kepron and colleagues did not even mention Haemoglobin A₂ let alone quantify it.

(xiii)   It is quite surprising how facts that should have made Kepron and colleagues look elsewhere, rather made them fixate on sickle cell trait because they were determined to do just that. Take for example their statement “Although the clinical information required for a diagnosis of acute chest syndrome was missing …” histologic findings were used by them to “prove” acute chest syndrome, and they stated that “acute chest syndrome was felt to be the major contributing factor to the cause of death”.¹ Does the phrase “was felt” have any place in scientific discussion? Should we be concerned with how we “feel” when debating scientific topics, or should we rely on facts alone?

(xiv) The final statement of their inauspicious article says it all; it betrays a deliberate desire to link the un-linkable: “Although Sickle Cell Disease/Sickle Cell Trait is not one of the classic mimickers of child abuse, unusual orthopaedic pathologies can and do occur, and may appear as  inflicted injury on skeletal survey”¹.

(xv)   The authors Kepron, Somers, and Pollanen fail to do their home work in the country that discovered Haemoglobin Quebec-Chori. This haemoglobin masquerades as normal adult Haemoglobin ‘A’ but which when tagged on to sickle cell haemoglobin does not produce sickle cell trait ‘AS’ (ie NORMACHE by my terminology), but rather sickle cell disease (ACHEACHE). This was how I put it in The Lancet in a communication entitled ‘Beware of symptomatic sickle-cell traits’: ⁸

“With the sickle cell population increasing yearly in the UK, the finding by Witkowska and colleagues⁹ of sickle cell Haemoglobin Quebec-Chori genotype producing a sickle cell disease phenotype masquerading electrophoretically as a sickle cell trait makes it vital for clinicians to probe further any case of sickle cell trait where the symptoms suggest sickle cell disease.⁹ Many individuals with true sickle cell trait ‘AS’ (betaA3[⁶Glu; betaA3[⁶Glu à Val]) with ‘A’ greater than ‘S’ have been victimised in respect to employment and life insurance because of substandard medical reports in journals”. ^{10, 11}

The authors of this present article do not appear to have read about Haemoglobin Quebec-Chori which was first discovered in their own country Canada.⁹

LESSONS DRAWN FROM THIS ‘JOURNAL OF FORENSIC SCIENCE‘ ARTICLE

1. Battles that have been fought and won in the Sickle Cell Trait controversy can suddenly be resurrected, so there is need to be vigilant. Forty years ago, based on a false report by authors who had never been to Ghana, on a Ghanaian sickle cell trait during the 45-minute flight from Kumasi to Accra it was suggested that for their own safety “Negro passengers” should be tested at airports for the sickling phenomenon “for their own safety”¹² Ghanaian experts exposed not only the falsehood of the report¹³, but also were instrumental in reversing draconian measures that were being taken world wide based on that false report. Black pilots and air crew had been grounded at Kennedy Airport in the USA because of the false report. It was Ghanaian expertise that restored them to flying duties, and forced the case report publication in the British Medical Journal to be withdrawn.¹⁴ [See the detailed account in FAQs – Frequently Asked Questions on my website www.konotey-ahulu.com or www.sicklecell.md] ¹⁵

2. University of Illinois Professor of Medicine and Pathology Dr James Boweman MD and Dr S. Bernstein observing the spate of journal articles linking all kinds of symptoms with the sickle cell trait were forced to exclaim when a Black man beaten to death in police custody was found to be sickle cell trait, and the death was then attributed to the sickle trait: “Persons with sickle cell trait will no longer be able to become ill or even die lest they find themselves subject of a case report”.¹⁰ This prediction of Boweman and Bernstein in 1977 regarding bogus articles has sadly been fulfilled through this flawed case report of Charis Kepron and colleagues.¹

3.   New attempts are being made presently (in this year of 2011) to ban sickle cell traits from competing in athletics because sudden death has been linked (spuriously) to the sickle cell trait phenotype as recounted in my book.¹¹ My website FAQs have dealt with the flawed articles cited in this respect. If someone who does not sickle dies from exercise, that is considered natural, but when sickle cell trait is found in the person, then it is not considered “natural” – it must be due to the sickle cell trait. Banning 20 per cent of all Ghanaian international athletes (and Black competitors in general) from global athletics “for their own safety” is seriously being considered by some scientists of World Bodies. Some of them talk about “Black Sickle Cell Traits” forgetting that 1 in 6 of the White people in southern Turkey ^{16, 17} and up to 30% of the white people in Greece around where Lake Kopais was had been shown to have the sickle cell trait (‘AS’) ^{18, 19} leading Ghana’s Dr Frank Djabanor once to ask in the British Medical Journal: “How can we identify them by their external features to thrust upon them the benefits of this advice”? ²⁰, namely the advice that Negro passengers should be tested at airports for sickle cell trait “for their own safety” ¹² The term “Black Sickle Cell Traits” must be banned, because there are millions and millions of “White Sickle Cell Traits”. Insurance Companies, and International Sports Federations need to take note of that. If they do not, they must be held to account. Indeed I once pointed out ²¹ that when contacted in the USA by Professor James Boweman “about the harmless sickle cell trait”, 41% of 39 insurance companies admitted to loading the trait premium. “It is my understanding” added Boweman “that insurance companies generally test only Blacks for the sickle cell trait”.²²

4.   What I have said above is no joking matter. African doctors should be aware of global trends that are inimical to their welfare. Articles like that of Kepron et al encourage Insurance Companies to load the premium of Sickle Cell Traits because of the unjustified and unscientific published statements like “Complications of Sickle Cell Disease/Sickle Cell Trait are not usually on the differential diagnosis of traumatic injury”.¹

5   Articles such as we find here in the Journal of Forensic Science are likely to be quoted by inexperienced clinicians and pathologists in support of their equally flawed findings. This must not be allowed to happen. Fortunately, wise editors such as are found for The British Medical Journal and The Lancet in England always go back to correct errors in previous publications whenever these were later pointed out to them. “We therefore wish to withdraw this case”¹⁴ was how Green, Huntsman and Serjeant removed the unsubstantiated “sickle cell trait intestinal infarction” case from publication. Family studies have shown that a case I once thought was sickle cell trait (NORMACHE), was in fact the Ghanaian sickle cell haemoglobin C disease patient (ACHEACHE) who was a banker and who died under anaesthesia in a London hospital during eye surgery. I challenge the editors of Journal of Forensic Science, in the light of what has been said above, to state that the case for child abuse in their case report of the second autism child that they described could not be dismissed, and I urge that these authors’ conclusion that their findings could be attributed to sickle cell trait be dismissed forthwith.

6   There are huge financial interests involved if the true sickle cell trait ‘AS’ (NORMACHE) who beat the whole world at athletics is equated with sickle  cell disease pathology, allowing insurance companies to benefit at the expense of healthy people. As Cambridge University’s Professor Hermann Lehmann, the doyen of Abnormal Haemoglobin research in the UK, wrote to the London Times when the false sickle cell trait story was published on December 9 1971 advocating the removal of sickle cell traits from flying duties: “The sickle cell trait is, in some Africans much more rare than in the population of, say Crete or Coimbatore” and he went on to say that “sickle cell carriers competed without ill effect at the Olympic Games at Mexico at an altitude of 7000 ft”²³ Fancy then a Black athlete coming down from Mexico City to New York at sea level and be told that his Health Insurance premium would go up to 150% because some researcher had published that exercising at 4000 ft had caused death in a sickle cell trait! For the world to be told at the Martin Luther King Jr Foundation Award Ceremony in 1972 in Philadelphia in the presence of Abnormal Haemoglobin Nobel Prize winners Linus Pauling and Max Perutz, that Insurance Companies in the USA were benefiting unfairly from the “Sickle Cell Trait sudden death at 4000 ft” story – a story that lacked scientific veracity – for the world to be told this -  was too much of a risk to take so the organisers of the Award Ceremony provided me whom they had invited to give the Keynote Address on “The difference between Sickle Cell Trait and Sickle Cell Disease” with four body guards for all the time I was in Philadelphia. Read the full story in the British Medical Journal.²⁴

7   Finally, please wake up to the fact that modern researchers fail to recognise and quote thorough work that had been done decades ago. Any modern author that relies on a MEDSEARCH that contents itself with going back only 25 years is deceiving not only themselves but also the rest of us. Professors George M Edington and Hermann Lehmann did such meticulous Abnormal Haemoglobin research in the Gold Coast (Ghana) nearly 60 years ago as has hardly been equalled in thoroughness. ^25-29 What these giants of Abnormal Haemoglobin Research said about Sickle Cell Trait and Sickle Cell Disease all those decades ago has not been bettered by any subsequent work that I know of. Yet modern authors like Kepron and colleagues not only do not refer to them, but rather claim to have discovered new insights into how sickle cell traits present. Professor Bela Ringelhann and I have summarized (with no less than 225 references) much of this and subsequent work.³⁰ Ignoring this material because much of it was published decades ago is doing a great deal of disservice not only to Medical Science but also to us West Africans 1 in 3 of whom is carrying a beta-globin gene variant (NORMACHE).

References

1   Kepron Charis, Somers Gino R, Pollamen Michael S.             Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy. Journal of Forensic Science Volume 54, No.5, pp 1141 t0 1145 September 2009.

2   Konotey-Ahulu FID. Morphine for painful crisis in sickle cell disease. Brit Med J 1991; 302: 1604

3   Mayor Susan. Enquiry shows poor care of patients with sickle cell disease. Brit Med J 2008; 336: 1152

4  NCEPOD (National Confidential Enquiry into Patient Outcome and Death) .. produced an 84-page report entitled ‘SICKLE: A Sickle Crisis? (2008)’ The Report (www.ncepod.org) ‘reviews the circumstances around deaths of in-patients with Haemoglobinopathies – sickle and beta-thalassaemia in the 21^st Century in England, Wales, Northern Ireland, and the off-shore islands’…’Nine out of the 19 patients with sickle cell disease who had pain on admission and who then died had been given excessive doses of opiods’’.  Death that was put down to “Acute Chest Syndrome” clearly was due to respiratory depression from the drugs which further produced in vivo sickling.

5   Konotey-Ahulu FID. Poor care for sickle cell disease patients: This wake up call is overdue BMJ Rapid Response May 28 2008 BMJ 2008; 336: 1152 http://www.bmj.com/cgi/eletters/336/7654/1152a#196224 to Susan Mayor “Enquiry shows poor care for patients with sickle cell disease” on National Confidential Enquiry into Patient Outcome and Death (NCEPOD) REPORT “SICKLE: A Sickle Crisis? (2008) info@ncepod.org

6   Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, et al. Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. New England J Medicine 2000; 342(25): 1855-66.

7   Addae RO. Sickle cell trait and altitude. Br. Med J 1972; 1: 53.

8   Konotey-Ahulu FID. Beware of symptomatic sickle cell traits. Lancet 1992; February 29, p 555.

9   Witkowska HE, Lubin BH, Beuzard Y et al. Sickle cell disease in a patient with sickle cell trait and compound heterozygosity for haemoglobin S and haemoglobin Quebec-Chori. New England Journal of Medicine 1991; 325: 1150-1154. [Note that the title of this article is incorrect: Sickle cell trait cannot also be referred to as sickle cell haemoglobin Quebec Chori disease. The ‘AS’ pattern is sickle cell trait pattern, but the ‘A’ here is not a true ‘A’ but the new haemoglobin called Quebec-Chori, producing a disease phenotype, not a trait phenotype].

10   Boweman JE, Bernstein S. Caution about preliminary reports. Pediatrics 1977; 59: 639-640.

11   Konotey-Ahulu FID. “Percentage values of haemoglobins S, F, A₂, C, A in various sickle cell phenotypes, and consideration of the Sickle Cell Trait”, In The Sickle Cell Disease Patient: Natural History from a Clinico-epidemiological study of the First 1550 patients of Korle Bu Hospital Sickle Cell Clinic. Macmillan London 1992 & T-A’D Co Watford 1996, Chapter 30, pages 349 to 371.

12   Green RL, Huntsman RG, Serjeant GR. Sickle cell and altitude. Br Med J 1971; 4: 593-595.

13   Konotey-Ahulu FID. An International Sickle Cell Crisis. Ghana Medical Journal 1972; 11: 4-8.

14   Green RL, Huntsman RG, Serjeant GR. Brit Med J 1972; 2: 294

15  Konotey-Ahulu FID. Frequently Asked Questions (FAQs) in www.sicklecell.md or www.konotey-ahulu.com 2001 – 2011.

16   Aksoy M. Sickle cell trait in Southern Turkey. Lancet 1955; 1: 589-590.

17   Altay C, et al. Haemoglobin S and some other hemoglobinopathies in Eti-Turks. Human Heredity 1978; 28: 56-61.

18   Choremis  C et al. Sickle cell anemia in Greece. Lancet 1951; 1: 1147

19   Choremis C et al Blood groups of a Greek community with a high sickling frequency. Lancet 1957; 2: 1333-34

20   Djabanor F F T. The Sickle Cell Trait and Altitude. Brit Med J 1972. 1: 113.

21   Konotey-Ahulu FID. Insurance and genetic testing. Lancet March 3 1993, page 833.

22   Boweman J E. Ethical, legal and humanistic implications of sickle cell programs. INSERM 1975, 44: 353-378.

23   Lehmann Hermann. Sickle cell and flying. The Times (London), 4^th January 1972, editorial page.

24   Konotey-Ahulu FID. Four body guards and the perils of unmasking scientific truths. Brit Med J 2007; 335: 210-211, July 28.

25   Edington GM. Sickle cell anaemia in the Accra district of the Gold Coast. A review of 20 cases. Brit Med J 1953; 2: 957-961

26   Edington GM, Lehmann H. Expression of the sickle cell gene in Africa.  Brit Med J 1955a; 1: 1308-11

27   Edington GM, Lehmann H. Expression of the sickle cell gene in Africa. Brit Med J 1955b; 2: 1328

28   Edington GM, Lehmann H. The sickle cell gene. Am J Clin Path 1956a; 26: 553-56

29   Edington GM, Lehmann H. Sickle cell trait in Africa. Bull WHO1956b; 15: 837-852

30   Ringelhann B, Konotey-Ahulu FID. Hemoglobinopathies and thalassemias in Mediterranean areas and in West Africa: Historical and other perspectives 1910 to 1997 – A Century Review. Atti dell’Accademia dell Science di Ferrara (Milan) 1998; 74: 267-307.

Acknowledgements: I thank Professor Simon Dyson for drawing my attention to the article of Charis Kepron and colleagues. Professor Dyson has done much to alert people to the harm that unfair publications on sickle cell states can do. I recommend his websites for study.

Simon Dyson is Professor of Applied Sociology

Room 1.27 Hawthorn Building

De Montfort University

Leicester LE1 9BH

+44 (0)116 257 7751

sdyson@dmu.ac.uk

http://www.tascunit.com

http://www.sicklecelleducation.com

http://www.sicklecellanaemia.org

See for instance his book: Sickle Cell and Deaths in Custody

http://www.amazon.co.uk/Sickle-Deaths-Custody-Simon-Dyson/dp/1861771150

—————————————————————————————–

Re:Re: Luc Montagnier … and Andrew Wakefield: living parallel lives
Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast Ghana
Consultant Physician Genetic Counsellor in Sickle Cell & Other Hemoglobinopathies 10 Harley St London W1G 9PF
Only fruitcakes believe in God? Correction of inverted inheritance of solomonic genius
British Medical Journal Rapid Response 12 May 2011 http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260496

In my rushed rapid response to Mark Struthers’ remark (9 May) that believers in God were/are fruticakes [1] I made King David of Jerusalem the recipient of solomonic genius, when he was in fact the father of the legendary King Solomon. Sorry about that. David’s Psalms are still worth reading as they are full of extraordinary wisdom, including his published diagnostic observations in Psalm 14 verse 1, and Psalm 53 verse 1. Some will say King Solomon inherited the brilliance of his father, but Scripture implies something more profound, indeed something suprascientific. [3]
F I D Konotey-Ahulu MD FRCP DTMH
Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana
and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF
felix@konotey-ahulu.com
Conflict of interest: Nothing to declare
1. Struthers Mark. Re: Luc Montagnier … and Andrew Wakefield: living parallel lives BMJ Rapid Response 9 May 2011 http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260294
2. Konotey-Ahulu FID. Only fruitcakes believe in GOD? BMJ Rapid Response 11 May http://bmj.com/content/342/bmj.d2642/reply#bmj_el_260425
3. Second Book of Chronicles, Chapter 1 verses 7 to 12.
Competing interests: None declared
Submit rapid response
Published 12 May 2011

Rapid Response British Medical Journal 11 May 2001: Only fruitcakes believe in GOD?
Re:Re: Luc Montagnier … and Andrew Wakefield: living parallel lives
Felix ID Konotey-Ahulu, Dr Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana
Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley St London W1G 9PF

Only fruitcakes believe in GOD? http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260425

Dr Mark Struthers (9 May) has a huge, huge problem. He said this: “I understand there are medical scientists – admittedly at the fruitcake end of the spectrum – who believe in God despite there being not a shred of scientific evidence, medical or otherwise of His existence” [1] Can Dr Struthers provide us with “a shred of evidence” that his brain is sharper than Blaise Pascal’s ever was?
THE GREATEST ACHIEVEMENT OF REASON
Pascal said “There are two excesses: to exclude reason, to admit nothing but reason. The supreme achievement of reason is to realize that there is a limit to reason. Reason’s last step is the recognition that there are an infinite number of things which are beyond it. It is merely feeble if it does not go as far as to realize that” [2]. And Blaise Pascal believed in God. He was no fruitcake.
DAVID MARTYN LLOYD-JONES
Or take Dr David Martyn Lloyd-Jones MB BS(Honours) MD MRCP who died the year Mark Struthers qualified from the University of Sheffield. Lloyd- Jones whom I knew personally, had a great brain, certainly not a fruitcake. His MD Thesis was on Sub-acute Bacterial Endocarditis after qualifying with Honours and Distinction from St Bartholomew’s Teaching Hospital. Lord Horder, Physician of King George and the Royal Household, and Consultant Physician at Bart’s picked Lloyd-Jones to be his Assistant, and they attended Royalty together. Dr Lloyd-Jones believed in God, and has more than 30 books in print – all of them on God. He was an amazing logician, orator, debater, with an unusual, analytical mind. He was no fruitcake.
KING DAVID
But I rather also admire that remarkably brilliant Hebrew King who reigned in Jerusalem. King David was brilliant, having clearly inherited what I have come to call “solomonic genius” from his father, the legendary King Solomon whose wisdom was proverbial, attracting people from the far corners of the earth to see and sample. King David has left us a treasure trove of wisdom in his Psalms, one of which (Psalm 119) contains 176 (one hundred and seventy six) verses. But the reason I name King David among those I am convinced are not fruitcakes, and yet believe in God, is this: King David is an amazing diagnostician. I sincerely advise Dr Mark Struthers to visit his local library and ask them to show him King David’s Psalms. The diagnosis the King makes in Chapter 14 verse 1 is spot on! (Even better than comparable diagnoses Sir Stanford Cade FRCS, Sir Richard Bayliss FRCP, Sir Arthur Bell FRCOG, and Sir Clement Price-Thomas FRCS, taught me to make when I was a medical student at Westminster Hospital School of Medicine in Horseferry Road, London SW1). Now, if after reading Psalm 14 verse 1, Dr Struthers wants a second opinion from King David, I suggest Psalm 53 verse 1.
SCIENTIFIC EVIDENCE
Dr Mark Struthers mentions “scientific evidence” [1] as if it was the pinnacle of all truth. My favourite Nobel Prize Winner in Medicine/Physiology is Professor Sir Peter Medawar. His book, “The Limits of Science” [3] is one that I suggest should be compulsory reading for those like Dr Mark Struthers approaching retirement from active Medical Practice and who think they “know it all” [4]
PRESIDENT BARACK OBAMA
By the way, does Dr Mark Struthers think President Barack Obama is a fruitcake? Cerebrally the man is head and shoulders above most people, quite apart from being a Nobel Laureate. And he believes in God.
Felix ID Konotey-Ahulu MD FRCP DTMH Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF
Conflict of interest: Nothing to declare
1. Struthers Mark. Re: Luc Montagnier … and Andrew Wakefield: living parallel lives BMJ Rapid Response 9 May 2011 http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260294
2. Pascal B. Pensees (1657). London: Penguin Books, 1966 (Translated by A Krailsheimer)
3. Medawar P. The Limits of Science. Oxford: Oxford University Press, 1985.
4. Konotey-Ahulu FID. The supra-scientific in clinical medicine: a challenge for Professor Know-All. BMJ 2001; 323: 1452-1453 22-29 December. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121901
Competing interests: None declared [See next article with Correction]
Submit rapid response
Published 11 May 2011

Observations: Medicine and the Media: The other Twitter revolution: how social media are helping to monitor the NHS reforms
• Martin McKee,
• Katie Cole,
• Louise Hurst,
• Robert W Aldridge,
• Richard Horton
BMJ 342:doi:10.1136/bmj.d948 (Published 16 February 2011)

Facebook and Twitter in bid to create African Scientific Revolution “mizraimically”.
o Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast Ghana Consultant Physician Genetic Counsellor in Sickle Cell & Other Haemoglobinopathies 10 Harley Street

The Twitter Revolution that Professor Martin McKee and colleagues (February 12) showed was “helping to monitor NHS reforms” [1] is but one example of the enormous potential of social networking. Since the Obama phenomenon which made use of this to spread critical information to a huge number of people in no time at all, social networking has been used to achieve the hitherto unachievable. In short, social networking has precipitated revolutions the latest of which is the Egyptian Friday 11th February 2011 Cairo’s Tahrir Square Revolution which achieved the hitherto unachievable through the organizational grass roots use of Facebook and Twitter.
AFRICAN SCIENTIFIC REVOLUTION ACHIEVABLE “MIZRAIMICALLY”.
The title of The 5th TWAS-ROSSA Young Scientists Conference (26th – 27th February 2011) which took place at the Hilton Hotel, Nairobi last week [2] was “Exchanging Knowledge on Climate Change Impacts and Vulnerability in Africa: The Role of Networking”. Summing up that remarkable Conference which covered subjects from climate change effects on agriculture, flood risk management, institutional networks for exchange of knowledge, cryobiology, local community knowledge of and adaptation to climate change, etc Dr Eng Shem Arungu-Olende, Executive Director of the African Academy of Sciences hit the nail on the head when he said “Promoting net working does not have to be formal … very exciting research can be communicated from individual to individual, from individual to institutions, and from institution to institution”. The exciting process, said Arungu-Olende, “can generate knowledge and disseminate that knowledge for quite awhile” [2]. This was also emphasized by Professor Mohamed H A Hassan, Executive Director Emeritus of the Trieste based TWAS (Academy of the Developing World) and President of the African Academy of Sciences. Networking that produces an unexpected and impressive result where despair existed before, is what I now describe as a revolution achieved “mizraimically”. Mizraim is what my Krobo tribes people call Egypt, a name originating from biblical times. [3] No where is such a revolution more urgently needed than in the most pressing health issue on the African Continent at the moment.
TACKLING THE SUB-SAHARAN HIV-AIDS MENACE “MIZRAIMICALLY”
(1) “Nearly 1000 babies are born every day in sub-Saharan Africa” is the British Medical Journal’s headline a mere 3 months ago. [4]
(2) “Children from Zevenfontein (South Africa) where 85 per cent of the community are HIV Positive” [5] – Financial Times, London.
To many outside Africa (and even within Africa) this situation produces reactions such as “Normal, of course”; “Not surprising at all”; “What else do you expect?” ; “If we in the Congo don’t change our sexual habits the Congo could be wiped off the map” [6], and “Africa left to the lions” [7] and so on and so forth. Therefore, I ask, does sex alone account for 1000 HIV Positive babies a day born to 1000 mothers a day who must be HIV Positive, and the implied 1000 a day HIV Positive men linked to these women? But to me, and to many fellow Africans the situation calls for a Revolutionary Approach, and hence our great fortune to have Facebook, Twitter, and LinkedIn to help begin this process “mizraimically”! I said as much during my Award Lecture last Saturday (26 February) in Nairobi. When TWAS-ROSSA (Academy of Sciences for the Developing World’s Regional Office for South Saharan Africa) announced last August in Hyderabad, India, that I had been awarded the “2010 TWAS REGIONAL PRIZE ON PUBLIC UNDERSTANDING AND POPULARIZATION OF SCIENCE” [8] I was told that when collecting the Award in Nairobi in February 2011 I would be expected to give a Lecture. Well, I thanked God and took courage, and gratefully announced that I would give the following Double Lecture, one after the other immediately on receipt of the Award:
Public Understanding and Popularization of Science as illustrated by (i) The most prevalent hereditary affliction in sub-Saharan Africa – Sickle Cell Disease and Other Haemoglobinopathies (ii) The most serious acquired affliction in sub-Saharan Africa – HIV/AIDS
Which was what I did last week when I used the first lecture to introduce my recent invention of the ‘kanad’ as a novel tool for genetic counselling and voluntary family size limitation (GCVFSL) in Sickle Cell Disease and Other Haemoglobinopathies [9]. The second lecture concentrated on Africa’s AIDS Catastrophe, and how Facebook, Twitter, LinkedIn could begin to spread the word round, alarm our kith and kin in the Diaspora, and begin a revolution.
SUMMARY OF AIDS LECTURE AT TWAS-ROSSA CONFERENCE NAIROBI
1. One thousand HIV Positive babies born every day in sub-Saharan Africa.
2. 85% of the Zevenfonteirn Community in South Africa are HIV- Positive
3. And this in spite of Global Funds into Africa?
4. In spite of our Ministries of Health and Colleges of Physicians and Surgeons working flat out?
5. Despite WHO’s thundering the “Wear Condoms” and “Stick to one woman” advice?
6. Have top to bottom (ie Globalisation) Health Schemes failed?
7. Was it not time to start a bottom-up (ie from grass roots up) health management approach using our Traditional Chiefs?
8. What happened to Professor Kihumbu Thairu’s grass roots upwards approach emanating from the impressive Symposium organised jointly by The Commonwealth Secretariat and the Kenya Medical Research Institute (KEMRI)? [10] Was Thairu’s approach tried and found wanting?
9. Meaningful Research: Is it not time for every one of us, especially the Young Scientists gathered here, to use Epidemiology
(a) to find out what is happening on our dear Continent to give rise to 1000 HIV Positive babies every single day and to determine how it is possible for 85% of the Zevenfontein Community in South Africa to be HIV Positive when Professor Metz had written to me from Pretoria less than 25 years ago that AIDS (or VIGS as he called it in Afrikaans) among the Blacks was virtually nil? [11] And
(b) To communicate such findings expeditiously by Facebook, Twitter, LinkedIn not only to our African Parliamentarians and Tribal Chiefs but to Africans abroad?
I defined ‘Epidemiology’ in the Nairobi Lecture exactly as I had done in the British Medical Journal after fact finding tours of Africa. Epidemiology, to me, is finding answers to the six questions What? When? Where? Which? How? Why? I told the Young African Scientists that armed with little more than a note book and pen, finding answers to these questions at the grass roots level will provide more information about our plight [12] than dissecting genes of baboons and humans in the laboratory. (I was referring to the misinformation/disinformation that two eminent Harvard University Professors came out with when they concentrated rather on splitting genes in the lab, namely that Senegalese prostitutes harboured antibodies to monkey virus in their blood [13], when in fact there was no truth whatever in their publication! It took another respectable Harvard Professor Carol Mulder to write an editorial to redeem the reputation of that great Institution: “A case of mistaken non- identity” [14]). Though Kenyan scientists have been known to be able sequence the genome of organisms very rapidly, our efforts should be directed rather towards using Epidemiology as I have defined above to arrive at truth very quickly.
10. The African Academy of Science [15] is without doubt a force to reckon with (being robustly supported by the Trieste based Academy of Sciences for the Developing World, TWAS [16], and it benefits from the Network of African Scientific Organisations (NASO). The Academy stands ready to use its “Quarterly Journal of Discovery and Innovation” to disseminate new information. It is ready to resume on-line publishing soon, so I urge that in keeping with the title of the Quarterly Journal the young scientists should aim at going on line immediately and, as I concluded my lecture, “aiming to publish new Ideas, new Findings, new Treatments, new Discoveries, and new Approaches which will command the attention of the rest of the world”.
MONITOR HEALTH PROGRAMMES AND DISSEMIATE INFORMATION
Professor Martin McKee and team [1] are using Twitter and other social media “to monitor NHS reforms”. We in Africa should similarly monitor everything from vaccinations, recommended drugs, official declarations from above, not to mention “Global Programmes”. I have queried why the Maasai in Kinyawa, Kenya, the Luhya in Wabuye, Kenya, and the Yoruba in Nigeria have been genome sequenced anonymously in the Global Sequencing Programme, and yet the international gene sequencers claim they got “informed consent” to do the work [17-20]. African scientists need to find out what exactly is happening. Have some African genes been patented anonymously yet “with informed consent” as the researchers claimed?
All foreign scientists do not have the same ethical calibre. [21] Some feel Africa’s pain; others do not, and we need to distinguish between the two, and work with those who identify with us. I once pointed out after Didier Fassin and Helen Schneider’s amazing article in the British Medical Journal on AIDS in South Africa [22] that scientists with Nazi proclivities did not disappear when Hitler did. [23]. Professor George Fraser and Dr Berno Muller-Hill said as much [24]. Matters that had been dismissed as Conspiracy Theories have now been proven to be Conspiracy Facts leading to open apologies by two living American Presidents, Bill Clinton and Barack Obama [25, 26, 27]. It is a most heartening fact that an increasing number of African Tribal Chiefs are computer literate and will be happy to be kept in the social networking loop. Their subjects prefer to listen to them to being fed top to bottom pronouncements – see how Ghanaian Health Officials were forced to come out to answer questions about serious side effects of Artesunate-Amodiaquine Combination Therapy [28]. Ghanaian market women and roadside vendors are all social networking, while Kenyans are doing their banking business through mobile phones, bypassing the conventional High Street Banks. Scientists in Africa need also to make use of these social networking media to create a health revolution on the Continent.
Felix Konotey-Ahulu MD(Lond) FRCP DTMH FGA FTWAS FWACP FGCP Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 10 Harley Street, London W1G 9PF.
1 McKee Martin, Cole Katie, Hurst Louise, Aldridge Robert W, Horton Richard. The Other Twitter revolution: how social media are helping to monitor NHS reforms. BMJ 2011; 342: d948 doi: 10.1136/bmj.d948 18 February 2011. http://www.bmj.com/content/342/bmj.d948.full
2 TWAS-African Academy of Sciences The Fifth Scientists’ Conference on “Exchanging Knowledge on Climate Change Impacts and Vulnerability in Africa: The Role of Networking” 26th – 27th February 2011 – Preceded by the NASAC-KNAW Conference on Impact of and Adaptation to Climate Change in Relation to Food Security in Africa 23rd – 25th February 2011. Hilton Hotel Nairobi, Kenya.
3 The Holy Bible. “And the sons of Ham: Cush, and Mizraim (Egypt), and Phut, and Caanan.” Genesis Chapter 10 verse 6. The King James Authourized Version, 1908 Edition – 60th Printing. B B Kirkbride Bible Co, Inc. Indianapolis, Indian, USA 1964.
4 Zarocostas John. Nearly 1000 babies a day in sub-Saharan Africa are infected with HIV. BMJ 2010; 341: c6937 doi: 10.1136/bmj.c6937. Dec. 1 http://www.bmj.com/content/341/bmj.c6937.full
5 Financial Times, London. AIDS in South Africa. Zevenfontein where 85% of the Community are HIV Positive. Friday 20th September 2002, page 14.
6 Finch Scott. The Ravage of AIDS in Africa. BBC World Service: Science In Action, Sunday 18 October 1987, GMT 09.15 to 09.45.
7 Veitch Andrew. How to avoid catching AIDS. The Guardian, London, November 21 1986, page 21.
8 TWAS (Academy of Sciences for the Developing World) Regional Office for sub-Sahran Africa – Announcement in Hyderabad 20 October 2010 http://twas.ictp.it/news-in-home-page/news/twas-regional-prizes-for-public -understanding-and-popularization-of-science
9 The ‘kanad’ in www.sicklecell.md/bio or www.konotey-ahulu.com/bio 2010. The kanad in genetic counselling and voluntary family size limitation (GCVFSL) in sickle cell disease and other haemoglobinppathies.
10 Thairu Kihumbu. Editor Symposium/Workshop Appropriate Technologies for AIDS Management in Africa 3-7 September 1990, Kenya Medical Research Institute, Nairobi with Commonwealth Secretariat SW1 London.
11 Konotey-Ahulu, FID. What is AIDS? Tetteh-A’Domeno Company, Watford, England, 1989, 227 pages ISBN: 0 9515442 0 9
12 Konotey-Ahulu FID. Clinical epidemiology, not seroepidemiology, is the answer to Africa’s AIDS problem. BMJ (Clin Res Ed) 1987; 294(6587): 1593-1594. http://www.bmj.com/cgi/reprint/294/6587/1593.pdf [PubMed - indexed- for MEDLINE (June 20 1987) doi:10.1136/bmj.294.6587.1593]
13 Essex Max, Kanki Phyllis. Comparison of simian immunodeficiency virus isolates. Nature 1988; 331: 621-22
14 Mulder Carol. A case of mistaken non-identity. Nature 1988; 331: 562-63.
15 African Academy of Sciences. http://www.aasciences.org P O Box 24916, Nairobi, Kenya. [Retriring President Emeritus is Professor Mohamed H A Hassan; Incoming President is Professor Ahmahdou Lamine Ndiaye]
16 TWAS. The Academy of Sciences for the Developing World is an autonomous international organization based in Trieste, Italy, that promotes scientific excellence for sustainable development in the South. http://www.twas.org [Retiring Executive Director Emeritus is Professor Mohamed H A Hassan to be succeeded on 28 February 2011 by Professor Romaine Murenzi]
17 Announcement: http://www.1000genomes.org/files/1000Genomes- NewsRelease.pdf International Consortium Announces the 1000 Genomes Project. Major Sequencing Effort Will Produce Most Detailed Map of Human Genetic Variation to Support Disease Studies. (Tuesday January 22 2008).
18 Wise Jaqui. Consortium hopes to sequence genome of 1000 volunteers. British Medical Journal 2008; 336; 237 doi: 10.1136/bmj.39472.676481.DB http://www.bmj.com/content/336/7638/237.1/full January 31 2008
19 Konotey-Ahulu FID. The Human Genome Diversity Project: Cogitations of An African Native. Politics and the Life Sciences (PLS) 1999, Vol 18: No 2, pp 317-322. [Invited Commentary on Professor David Resnik's article: The Human Genome Diversity Project: Ethical Problems and Solutions.] PMID: 12561789 [PubMed - indexed for MEDLINE]
20 Global Genome Sequencing: Some Ethical Considerations. In Howard University National Human Genome Center Post-Inaugural Symposium on “1000 Genomes Project: On the Frontier of Personalized Medicine” at Ralph J Bunch International Affairs Center, Howard University, 2218 Sixth Street, NW Washington, District of Columbia, USA January 23, 2009. http://www.howard.edu/calendar/main.php?calendarid=medicine&view=event&eventid=1232140247442&timebegin=2009 -01-23
21 Konotey-Ahulu FID. Clinical Genetics: Ghanaian gratitude for British and Hungarian contributors – A personalised historical perspective Ghana Med J 2009; 43: 175-178. [Special Article December No. 4] http://www.ghanamedj.org/articles/December2009/Fina%20Special%Article%20Clinical%20Genetics.pdf
22 Fassin Didier, Schneider Helen. The politics of AIDS in South Africa: beyond the controversies. BMJ 2003; 326: 495-97 (1 March) http://www.bmj.com/content/326/7387/495.full doi;10.1136/bmj.326.7387.495
23 Konotey-Ahulu FID. Wake up call and need for paradigm shift. Brit Med Journal 2003 ‘Rapid Response’ to Didier Fassin and Helen Schneider’s article opened up for Education and Debate: – The politics of AIDS in South Africa: beyond the controversies. Brit Med J 2003; 326; 495- 497 (1 March 2003). http://bmj.bmjjournals.com/cgi/content/full/326/7387/495 or/& http://www.rethinking.org/bmj/response_30917.html
24 Muller-Hill Berno. Murderous Science: Elimination by Scientific Selection of Jews, Gypsies, and Other – Germany 1933- 1945 [Translated from German by George R Fraser] Oxford University Press, Oxford 1988.
25 Clinton President WJ. Apology on behalf of the American government to survivors of the Tuskegee Syphylis Experiment victims. Worldwide radio & Television. May 16 1997. Also Ken Getz; Tuskegee, a Cloud Over Research. The Washington Post. Tuesday, Sept 30, 2008. President Clinton publicly apologized to the eight surviving participants of the shocking and unethical study, saying “What the United States Government did was shameful”.
26 Tanne Janice Hopkins. President Obama apologizes to Guatemala over 1940′s syphilis study. BMJ 2010; 341.c5494 doi:10.1136/bmj.c5494 http://www.bmj.com/content/341/bmj.c5494.full October 9, page 750.
27 Konotey-Ahulu FID. President Obama apologises over Guatemala syphilis study: International cooperative research in jeopardy. http://www.bmj.com/content/341/bmj.c5494.full/reply#bmj_el_243183 BMJ Rapid Response Oct 17 2010
28 Amofah G. Furore over Artesunate-Amodiaquine Combiantion (ACT) Drug. Daily Graphic, Accra. Monday May 5, 2006, page 23.
Conflict of Interest: None declared felix@konotey-ahulu.com
Competing interests: None declared