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

Painful hip in Black and White Sickle Cell Disease Women

The article in the British Medical Journal of Lamb JN, Holton C, O’Connor P, Giannoudis PV. Avascular necrosis of the hip. BMJ 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:I2178) mentioned a woman who had two pregnancies presenting with painful hip due to avascular necrosis of the hip, but the authors neither associated the pregnancy with the hip problem, nor did they mention the nationality of the patient. They listed sickle cell anaemia among the factors that could cause the particular hip problem of avascular necrosis but there was nothing to show that the lady the authors wrote about had sickle cell anaemia which is known to occur in white as well as black patients.

I wrote to the British Medical Journal responding to the article, and required more information about the nationality of the patient, and whether haemoglobin electrophoresis was done to prove “sickle cell anaemia” (SS) or sickle cell haemoglobin C disease (SC) which latter, I said, was more to be associated with hip necrosis than the former because the blood was thicker in the “SC” than the “SS”. But when the article was published my queries were omitted, and information that would assist GP’s in the UK and elsewhere appeared to have been excised inadvertently even though the references to the information were retained: Konotey-Ahulu FID. Avascular hip necrosis: sickle cell haemoglobinopathy predominates worldwide. June 1 2019 https://www.bmj.com/content/365/bmj.l2178 BMJ Rapid Response to Lamb JN et al 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:l2178.

I took advantage of BMJ publication a fortnight later June 15 asking whether MEDICAL FIRMS should come back – a “Firm” being the term used in the days I was a medical student over six decades ago to comprise a Team of doctors in a Teaching Hospital from Consultants down to House Officers and supporting staff in such a cohesive form as is missing today – I took advantage of this BMJ publication to bring back the sections that were missing in my June 1 article so that GP’s may see the true nature of hip problems in both black and white sickle cell disease women demonstrated admirably by Professor Malcolm Milne’s excellent Firm at Westminster Hospital on a postgraduate ward round in 1962.

DOCTORS PLEASE PAY ATTENTION!

Should we bring back THE FIRM? Yes, please! Firms Vary In Excellence: Pregnancy and Sickle Cell Hip Necrosis Revisited.

BMJ’s Cover Page question 15 June 2019 “Should we bring back THE FIRM?” [1] helps me to draw attention to Professor of Medicine Malcolm Milne’s Firm at Westminster Hospital same period as that of Professor Harold Ellis who says of those days “The firms were wonderful”?.[2]. I totally agree. I knew both firms as a postgraduate chasing MRCP’s. In fact, Harold Ellis removed my appendix in August 1963, and you could hardly see the 1-inch long scar. Their Firms were remarkable; that was why I was peeved when the Grand Round of Professor Malcolm Milne that I described in response to Jonathan Lamb and Colleagues’ article on aseptic necrosis of the hip [3] was inadvertently removed. [4]. I reproduce below those sections edited out by mistake, even when their references were retained. GP’s that Lamb et al had in mind for education need these facts about the hip in sickle cell disease. Doctors must think “multiple pregnancies” when an African woman walks into their consulting room with a limp. They must take a detailed history of how long they have been in labour because Lamb and colleagues mentioned two pregnancies [3], but nothing about length of labour which, with legs in prolonged abduction, compromises blood supply to the femoral heads doing worse damage to the high haematocrit sickle cell haemoglobin C disease (SC) and sickle cell beta-thalassaemia (Sbeta-Thal) patients than in sickle cell anaemia (SS) [5-8].

FIRMS OF PROFESSOR HAROLD ELLIS AND PROFESSOR MALCOLM MILNE WERE MORE EXCELLENT THAN SOME OTHER FIRMS.

Medical and Surgical Firms were not equally efficient. Which Medical Firm in the UK would assemble (like Professor Malcolm Milne’s did) the author of an article 8 years earlier (Joe Humble) [8] diagnosing sickle cell disease in a white lady (Greek), then ask an African postgraduate (myself) on Grand Rounds to examine her using clinical approach only (History, Observation, Palpation, Percussion, Auscultation) to arrive at a Clinical Diagnosis of “Sickle Cell beta-Thalassaemia with cholelithiaisis and avascular necrosis of humeral and femoral heads”, then turn to Dr Joe Humble: “Show us the Electrophoresis Strip”? That whole section of my Rapid Response a fortnight ago [4] was excised. I reproduce it so GP’s and others may learn from it. Read this together with my earlier response which stated: “the sickle cell gene frequency in some white people in Greece and in Eti-Turks is greater than that in my own country Ghana”. [4 7 8]. See the excised portion before “Jonathan Lamb et al list fewer conditions …”[4]:-

These and their offspring are scattered around the world including the UK. A white woman was correctly diagnosed by me 57 years ago exactly on Professor Malcolm Milne’s Westminster Hospital Postgraduate Grand Rounds using just History (“I come from Greece”), Examination (icteric eyes, scar in right hypochondrium, loss of left shoulder contour due to angulation, and frequent joint pains) as (in my own words) “Sickle Cell beta-Thalassaemia disease with cholecystectomy for pigment stones, and aseptic necrosis of the left humeral head”. Haemoglobin Electrophoresis was produced on the ward round to confirm my clinical diagnosis by Consultant Haematologist Dr Joe Humble [8, page 240] who 8 years earlier had identified the same lady as having sickle cell Thalassaemia [9].Trained in London University in the 1950’s by the likes of Sir Richard Bayliss (Queen’s Physician) I was trained as it were for the bush in order that I could make diagnoses without X-rays. The luxury of MRI did not exist. Fortunately, there are some GP’s in the UK today who can make this kind of clinical diagnosis on History and Examination alone.

PREGNANCY & PROCREATION LIMITATION & HIP NECROSIS

Jonathan Lamb et al quite rightly mention pregnancy: “She had recently given birth to her second child”. [3] I would like to know how long she was in labour for because prolonged 2nd stage of labour we found in Ghana to be one of the precipitating causes of this condition in the multiparas. I once commented thus:
“The peculiar selection of the hip joint for such crippling pathology might have some eugenic significance [5 7 8]. Some of the Hb SC disease women with bilateral hip involvement complained of inability to separate their thighs for coitus, seriously endangering marital relationships, while many of the male patients with hip involvement find coitus impossible because body movement of any sort produces agonizing pain (Illustrative Case Histories 44, 46 and 48” [Ref 8 below].
I went on: “It seemed to me that in addition to priapism this is a further means that Nature has devised to limit dissemination of the sickle cell gene” [8, page 240].

FURTHER INFORMATION REQUIRED TO EDUCATE US, PLEASE

1. What is the nationality of this lady? Ringelhann and I described in some detail Mediterranean and West African Haemoglobinopathy and G6PD Deficiency. [10]

2. How long was she in labour for in both pregnancies?

3. What does the Haemoglobin Electrophoresis show? I once described two Sickle Cell Haemoglobin D disease girls with an English father (“AD” phenotype) and Ghanaian mother (“AS” phenotype) [Case History 133 in Reference 8]. The “SD” phenotype can be as severe as the “SS” (Sickle Cell Anaemia). Another reason why Hb Electrophoresis is important even when Sickling Test is Negative is that in my 36 consecutive homozygous Haemoglobin C disease patients in Ghana “the 35th presented with hip pain”. [8]

Jonathan Lamb et al list fewer conditions that cause aseptic necrosis of the femoral head than the 25 that J E Nixon [11] listed in 1983 in the Journal of the Royal Society of Medicine, but their article [3] has admirably succeeded in alerting clinicians about this condition which afflicts not just Africans and Caucasians but the entire world. We await answers to the 3 questions listed above, but note that Sickle Cell Anaemia “SS” is not the same as Sickle Cell Haemoglobin C disease “SC”. Sickle Cell Trait is “AS” phenotype.

Competing interests: None declared Twitter @profkonotayahul

F I D Konotey-Ahulu MB BS MD(Lond) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) DSc (Hon UCC) DSc (Hon UH) FGA FGCP FWACP FTWAS, ORDER OF MERIT (OFFICER). Kwegyir Aggrey Distinguished Professor of Human Genetics, Faculty of Science, University of Cape Coast, Ghana, and Former Director Ghana Institute of Clinical Genetics Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital Accra, and at Phoenix Hospital Group, 9 Harley Street, London W1G 9AL.

1 BMJ Front Cover. Should we bring back THE FIRM? 15 June 2019. [365 379-420 No 82003 ISSN 1759-2151.

2 Ellis Harold. “The firms were wonderful” quoted with portrait in Abi Rimmer The Firm: could it fix teamworking and morale? BMJ 2019; 365: 14105 June 15 2019.

3 Lamb JN, Holton C, O’Connor P, Giannoudis PV. Avascular necrosis of the hip. BMJ 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:I2178)

4 Konotey-Ahulu FID. Avascular hip necrosis: sickle cell haemoglobinopathy predominates worldwide. June 1 2019 https://www.bmj.com/content/365/bmj.l2178 BMJ Rapid Response to Lamb JN et al 1 June 2019, Vol 365, p 325 (BMJ 2019; 365:l2178.

5 Konotey-Ahulu FID. Hip disease in Africans, Lancet 1970; 1: 99.

6 Konotey-Ahulu FID. Hip pain and radiographic signs of osteoarthritis: Sickle Cell and other haemoglobinopathy differential diagnosis. BMJ Rapid response to Nieuwenhhuisje MJ, Nelissen RG. Hip pain and radiographic signs of osteoarthritis. BMJ 2015; 351:6262 (03 December 2015) BMJ 2015;351:h5983

7 Konotey-Ahulu FID. Pattern of Sickle Cell Disease in Accra. A Study of 1550 consecutive patients. Dissertation presented to University of London for the Postgraduate Diploma of Doctor of Medicine 1971. Awarded MD(London) February 1972.

8 Konotey-Ahulu FID. The Sickle Cell Disease Patient: Natural History from a Clinico-epidemiological study of the first 1550 patients of Korle Bu Hospital Sickle Cell Clinic. The Macmillan Press Ltd, London 1991 & 1992 and T-AD Co Watford 1996.

9 Humble JG. et al. A family illustrating the double inheritance of a sickle cell trait and of Mediterranean anaemia. J Clin Path 1954; 7: 201-208.

10 Ringelhann B, Konotey-Ahulu FID. Haemoglobinopathies and Thalassaemia in Mediterranean areas and in West Africa: historical and other perspectives 1910-1997 – A Century Review. Atti del’Accademia dela Science di Ferrara Haemoglobinopathies 1998: 74: 267-307.

11 Nixon JE. Avascular necrosis of bone: a review. J R Soc Med. 1983; 76: 681-692.

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

The painstaking way (pun intended) that “a doctor, a pharmacist, and a patent attorney” [1] have analysed the 2013 to 2018 “on going disputes around pregabalin” (British Medical Journal June 9 2018, page 358) needs commendation. I don’t comment on particular details because “Supreme Court decision is due soon” [1], but pertinent questions need answers. This excellent account implies how powerful Drug Licensing Authorities are. It is only after drugs have been licensed that MHRA, NHS, NICE, or BNF issue instructions.  Can we identify the composition of Licensing Bodies so we may hold persons to account individually when undesirable sequelae follow their decision to license a particular drug?

Adverse Clinical Consequences Following Licensing One Drug and Not Another    

I realised over 20 years ago the power Drug Licensing had in the UK when I began pointing out that Morphine and Diamorphine, through respiratory suppression, killed sickle cell disease patients in painful crises.  “If the patient dies” I said in Lancet “sickle cell crisis and chest syndrome will be recorded on the death certificate” [2 3]. When a UK Professor of Obstetrics & Gynaecology [4] advocated Morphine for sickle cell crisis patients in pregnancy, I said in BMJ: “The question that puzzles me is: Why do west African and West Indian patients with sickle cell disease who did without morphine in their countries have to be given morphine pumps during sickle cell crises when they come to the United Kingdom? In any case, in obstetrics what happens to foetal respiration when morphine is used?” [5]

Professor Elisabeth Goodman [6] found Ketorolac as good as Morphine with no   respiratory depression in vaso-occlusive crisis but Liesner, Vandenberghe and Sally Davies said “Ketorolac has no product licence in the UK for this indication” [7]

How extraordinary that a drug that did not kill patients had no Product Licence in the UK, but Morphine and Diamorphine that killed sickle cell disease patients as NCEPOD later confirmed [8] was, and still is, licensed “for this indication”! Indeed, despite NCEPOD’s damning patients-dying-from-Opiate-Overdose Report NICE issued Guidelines advocating Diamorphine intravenously in sickle cell crisis [9].

Cecilia Shoetan’s heart-rending BMJ report of her breathless 32-year-old sickle cell disease daughter dying within seconds when Diamorphine (licensed for this indication) was given intravenously in a London hospital while she stood watching [10] makes frightening nonsense of the NICE Guidance [11].

NHS ENGLAND and NHS SCOTLAND differ on Pregabalin?

The July 2007 Scottish Medicines Consortium (SMC) advice regarding Pregabalin differs from its April 2009 directive [12]. Meanwhile, NHS England had her own rules.  Witness the extraordinary situation in which NHS instructed doctors to depart from their usual prescribing for pain [13 14]. Who best should instruct doctors on prescribing practice? When Dr Margaret McCartney asked “Why do we have to prescribe branded Lyrica for pain?” [15] whom was she addressing? Well may Dr Laurence Leaver ask “With friends like NHS England, GP’s do not need enemies” [16].

Just 9 months ago we read “UK government to reclassify pregabalin and gabapentin after rise in deaths” [17]. Such reclassification is a forensic exercise. Disobey instructions and the Law could be after you. Can Freedom of Information identify individuals using “MHRA” or “NHS” or “The government” or “NICE” as cover to issue “not fit for purpose” guidelines? [18] Please investigate MHRA etc Competing Interest Declarations [19]. Pharmacovigilance in a developing country like Ghana has as many as 6 levels of vigilance and each level has potential for corruption [20]. Developed countries are no better, as Dr James Le Fanu exposes in his remarkable book recommended below.

The Le Fanu Legacy for Thoroughness

The name “Le Fanu” is music to Ghanaian ears. Korle Bu Hospital was planned and designed by Dr C V Le Fanu in the early 1910s in Colonial Gold Coast [21]. The outstanding Governor Sir Gordon Guggisberg [22] in 1919 “gave it top priority in his government’s building programme” [21] and when he opened it on 26 October 1923 he wanted it to “acquire a reputation second to none in the medical world”. One of the remarkable members of staff was another Le Fanu, Dr G E H Le Fanu who in 1909 led his laboratory in carrying out “a successful experiment to manufacture active vaccine lymph, locally, for small pox vaccination” [21]. Gold Coast Hospital, renamed Korle Bu Hospital, went on to do exploits including Dr Hideyo Noguchi’s Yellow Fever work. [21]. Meanwhile Dr G E H Le Fanu and colleagues including Dr Albert Hawe continued to tackle Tropical Diseases in a most thorough way [21 23]. Today, a Third “Thorough Le Fanu,” James, whose masterpiece “TOO MANY PILLS” is a ‘Must Read’ for every doctor mentions eight Big-Pharma companies that were fined a total of $Billion10.813 Dollars “for corrupt and illegal practices 2007-2012”. [24, page 25]

PAIN and OPIATES in HOSPITAL DEATHS

“Hospital drugs left 456 patients dead” was Daily Telegraph’s front-page head-line Thursday June 21 [25] plus an Editorial description of “fatal doses of diamorphine and other inappropriate drugs” in Gosport War Memorial Hospital. Note that when the NCEPOD Report of 2008 revealed that between January 2005 to December 2006 “Nine out of the 19 patients with sickle cell disease who had pain on admission and who then died had been given excessive doses of Opiods” [9] there were neither front-page newspaper-headlines nor calls for prosecutions as we hear today about Gosport.

Why the difference? ANSWER: Not because the victims were black, but because Morphine and Diamorphine are LICENCED “for sickle cell crisis indication” in the UK, raising this question:  Does the whole area of Drug Licensing (Pregabalin included) not need looking into urgently?  And when Dr James Le Fanu publishes in the BMJ that “Mass medicalisation is an iatrogenic calamity” [26] do we not wake up to the fact that the very first rung of the ladder to any medicalisation is DRUG LICENSING?

Finally: “Diamorphine has no accepted medical use in the United States” [27]

Competing Interest: I come from a sickle cell disease home: My Trait Parents had 11 children – 3 of us had sickle cell disease, hence my never-ceasing opposition to patient-management of pain that shortens life in anybody. [2 3 5 7 11 28 – 36].

felix@konotey-ahulu.com              Twitter@profkonoteyahul

Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL.

www.sicklecell.md

1 Smyth Darren, Goldacre Ben, Croker Richard. Pregabalin: what the patent litigation means for doctors and big pharma. BMJ 2018;361:k2318 https://www.bmj.com/content/361/bmj.k2318.full?   BMJ June 09 2018

2 Konotey-Ahulu FID. Opiates for sickle-cell crisis? Lancet 1998; 351: 1438.
[“The question that puzzles me is: Why do west African and West Indian patients with sickle-cell disease who did without morphine in their countries have to be given morphine pumps during sickle-cell crises when they come to the UK?”]

3 Konotey-Ahulu FID. Opiates for sickle-cell crisis. Lancet 1998; 352: 651-652. [To David Bevan’s criticism (Lancet 1998; 351: p 1965) of white physicians who agree with Dr Konotey-Ahulu that opiates created addicts in hospital – “When I say routine opiates for sickle crisis are not the way to bring out these patients’ best potential in the long term I am glad to hear white physicians say the same…White physicians who, at the risk of being misunderstood by Bevan, voice their displeasure at what they see happening on their wards deserve commendation, not condemnation.”]

4 Chamberlain G. Medical problems in pregnancy: II. BMJ 1991; 302: 1327-30. (1 June)

5 Konotey-Ahulu, FID. Morphine for painful crises in sickle cell disease. BMJ 1991, 302(6792): 1604. (June 29 1991) (Comment on Professor Chamberlain’s recommendation of morphine in pregnancy in sickle cell disease – BMJ 1991; 302: 1327-30.) doi:10.1136/bmj.302.6792.1604-c

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

6 Goodman Elisabeth. Use of ketorolac in sickle cell disease and vaso-occlusive crisis. Lancet 1991; 338: 641-642.

7 Liesner RJ, Vandenberghe EA, Davies Sally C. Analgeisics in sickle cell disease disease. Lancet 1993; 3411: 188.

8 NCEPOD (National Confidential Enquiry into Patient Outcome and Death). Sickle: A Sickle Crisis? (2008) [Sebastian Lucas (Clinical Coordinator), David Mason (Clinical Coordinator), M Mason (Chief Executive), D Weyman (Researcher), Tom Treasurer (Chairman) info@incepod.org

9 NICE. Management of an acute painful sickle cell episode in hospital: summary of NICE guidance. BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4063 (Published 27 June 2012) BMJ 2012;344:e4063

10 Shoetan Cecilia. I lost my Sickle Cell disease adult daughter minutes after being given Diamotrphine intravenously when she could not breathe. BMJ Rapid Response 3 June 2008 http://www.bmj.com/cgi/eletters/336/7654/1152-a#196520

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

12 National Formulary. Pregabalin. BNF 70. September 2015 – March 2016: p 400.

13 Byrne Paul AC. Doctors are warned not to prescribe generic pregabalin for pain control www.bmj.com/content/350/bmj.h1734 March 30 2015 (BMJ April 7 2015)

14 Barbour James Re: Margaret McCartney – Second use of patents – why do we have to prescribe branded Lyrica for pain? (July 8 2015) “recent direction from a member of NHS health authorities that pregabalin prescriptions for chronic pain www.bmj.com/content/350/bmj,h1724/rapid-responses

15 McCartney Margaret. Second use of patents: Why do we have to prescribe branded Lyrica for pain? BMJ2015;350:h2734. July 8 2015.doi:10.1136/bmj.h2734 pmid:25995105

16 Leaver Laurence B. With friends like NHS England, GP’s do not need enemies “pregabalin to change some to Lyrica, so that Pfizer can maximise their profits at the expense of NHS” www.bmj.com/content/350/bmj.h1724 (02 May 2015)

17 Hopkins H. UK Government to reclassify pregabalin and gabapentin after rise in deaths. (03 October 2017) www.bmj.com/content/358/bmj.j4441 Rapid Response to Gareth Laccobucci. UK government to reclassify pregabalin and gabapentin after rise in deaths BMJ 2017; 358: 4441 https://doi.org/10.1136/bmj.j4441 (Published 25 September 2017) BMJ 2017;358:j4441

18 Rost Felicitas, Wessely Simon. Depression in adults: campaigners and doctors demand revision of NICE guidance. BMJ 2018;361:k2681 [BMJ 23 June 2018, p 426]  “The latest NICE draft guidelines on adult depression is misleading, invalid, not fit for purpose, and potentially harmful to patients”. BMJ 2018; 361: k2681.

19 Hurley Richard. Former MHRA chair takes job at cannabis investment company. Rapid Response Re: Cannabis, cannabis everywhere: UK to review medical cannabis policy as Canada plans imminent legislation for all uses. BMJ 20 June 2018 361:doi10.1136/bmj.k2695 “Sir Breckenridge will help Sativa Investments liaise with the Home Office and the Medicines and Healthcare products Regulatory Agency (“MHRA”), which he has chaired, for the legislation of medicinal cannabis in the UK”.

20 Konotey-Ahulu FID. Who should best pharmacovigilate in developing countries? https://www.bmj.com/rapid-response/2011/11/01/who-should-best-pharmacovigilate-developing-countries 14 September 2007 [ http://oW.ly/Dq8g30dSHe0 ]

21 Addae Stephen. Evolution Of Modern Medicine In A Developing Country: Ghana 1880 – 1960 Durham Academic Press, Ltd., 1 Hutton Close, Bishop Auckland, Durham 1996 [On Governor G Guggisberg and Le Fanu C V & Le Fanu G E H]

22 Goodall HB. Beloved Imperialist – Sir Gordon Guggisberg – Governor of The Gold Coast. The Penland Press Ltd., 1 Hutton Close, South Church, Bishop Auckland, Durham 1998.

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

24 Le Fanu James. Too Many Pills – How too much medicine is endangering our health and what we can do about it. Little, Brown Book Group, London EC4Y 0DZ.

25 Daily Telegraph. Hospital drugs left 456 patients dead”. Thursday June 21 2018 Front Page. Editorial “Fatal doses of diamorphine and other inappropriate drugs”.

26 Le Fanu James. Mass medicalisation is an iatrogenic calamity. Profligate prescribing has brought a hidden a hidden epidemic of side effects and no benefit to most individuals. [PROVOCATIONS] BMJ 2018; 361: k2794. June 30, page 494.

27 [NOTE WELL]: Ballas S K. Sickle Cell Pain. IASP Press. Seattle, USA, page 168: “Diamorphine has no accepted medical use in the United States”

28 Konotey-Ahulu FID. Management of patients with sickle cell disease. African Journal of Health Sciences 1998; 5: 47[ Commenting on article of Sally Davies and Lola Oni (BMJ 315: 656 -60) “what I feel is more important in the day to day management of patients with a view to keeping them out of hospital, is clinical epidemiology which includes the circumstances of crises. … I fear Davies and Oni’s statement that ‘The Central Middlesex management protocol uses morphine infusions’ will make morphine the accepted drug for sickle crisis management. The consequences of such an approach are dire, especially when some UK hospitals are already making diamorphine their first choice”.]

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

30 Konotey-Ahulu FID. Opiates for pain in dying patients and in those with sickle cell disease. http://www.bmj.com/cgi/eetters/335/7622/685#177986 BMJ 11 Oct 2007

31 Konotey-Ahulu FID. Management of sickle cell disease versus management of the sickle cell disease patient. BMJ Rapid Response 17 September 2008

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

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

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

33 Konotey-Ahulu FID. Opiods for chronic non-cancer pain – Chemotherapy – Clinical Guidelines: Where does ultimate responsibility lie? www.bmj.com/content/ 346/bmj.f2937/rr/651421BMJ Rapid Response 25 June 2013

34 Konotey-Ahulu FID. Opiods in the UK: What’s the problem? Answer – Good Clinical Practice needs to cover all population groups including sickle cell disease patients. BMJ Rapid Response 18 August 2013 www.bmj.com/content/347/bmj.15108/rr/658208

35 Konotey-Ahulu FID. Management of sickle cell disease patient in the community BMJ Rapid Response 13 April 2014 [90 References] to Brousse V, Makali J, Rees DC: Management of sickle cell disease in the community. BMJ 2014; 348: g1765 doi:10.1136/bmj.g1765 http://www.bmj.com/content/348/bmj.g1765/rr/694233

36 Konotey-Ahulu FID. Management of an acute painful sickle cell episode in hospital: NICE guidance is frightening1 Sept 7 2012 [42 references]] www.bmj.com/content/344/bmj.e4063/rr/599158

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

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

EDITORIAL INTEGRITY OF BMJ & LANCET – PERSONAL EXPERIENCE

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

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

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

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

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

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

RETRACTION NOT MENTIONED IN WORLD PRESS

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

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

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

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

References

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

2 Konotey-Ahulu FID. Clinical epidemiology, not sero-epidemiology, is the answer to Africa’s AIDS problem BMJ (Clin Res Ed) 1987; 294(6587): 1593-1594 (June 20 1987)
http://www.bmj.com/cgi/reprint/294/6587/1593.pdf doi:10.1136/bmj.294.6587.1593

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

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

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

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

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

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

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

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

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

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

SOCIAL PATHOLOGY OF CLEFT PALATE IN THE AFRICAN

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

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

TERMINATION OF PREGNANCY FOR CLEFT PALATE?

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

IF GHANAIANS COULD DIAGNOSE PRENATALLY WOULD THEY ALSO ABORT?

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

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

DISCUSS WITH AFRICANS WHAT UK LAW ALLOWS BUT ETHICS DISALLOWS

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

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

Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL. [www.sicklecell.md]

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

12 Bonney GE, Walker M, Gbedemah K and Konotey-Ahulu FID. Multiple births and visible birth defects in 13000 consecutive deliveries in one Ghanaian hospital. In Proceedings of the Second International Congress on Twin Studies Part C Ed Nance W. Progress in Clinical and Biological Research 1978; 24 Pt B: 105-108.

13 Konotey-Ahulu FID. Ethical issues in prenatal diagnosis. BMJ Clin Res Ed 1984; 289(6438): 185. July 21. doi:10.1136/bmj.289.6438.185-a 6143955

http://www.bmj.com/cgi/reprint/289/6438/185-a.pdf

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

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

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

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

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

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

September 5th 2018 at St Albans Cathedral

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


https://youtu.be/41a1FZSpHd4

CITATION HONORARY DEGREE OF DOCTOR OF SCIENCE (DSc)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lord Salisbury, Prof. Felix Konotey‐Ahulu, Lord Ribeiro
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Who will tell pre-teenagers that, Tafracher, Abnormal Sex is highly dangerous?

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

BREAKING NEWS

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

DEFINITION OF “ABNORMAL SEX”

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

WHY DO AFRICAN PROSTITUTES CHARGE MORE FOR ABNORMAL SEX?

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

TAFRACHER GONORHOEA OF THE THROAT!

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

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

DEVELOPING COUNTRIES LEARNING FROM DEVELOPED UK AND USA?

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

OFFICIAL ENDORSEMENT OF ABNORMAL SEX FOR CHILDREN?

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

HEALTH ADVISORS MUST DECLARE COMPETING INTERESTS

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

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

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

Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL. www.sicklecell.md

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

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

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

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

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

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

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

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

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

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

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Do You Believe in God?

Do you believe in God?

Personal Answer to The Question “Do You Believe in God?

Mentioning God 4 times in headlines June to December 2017 [1-4] the BMJ is clearly not scared of ridicule from the author of “The God Delusion” and “The Greatest Show on Earth: the evidence for evolution” Richard Dawkins [5 6]. Numerous publications demolish the “scientific” foundation of his militant atheism [7-22]. Reading Professor David Berlinski’s excellent book “THE DEVIL’S DELUSION: ATHEISM AND ITS SCIENTIFIC PRETENSIONS” [23] I discern a vast difference between his Princeton PhD-reasoning and Dawkins’s Oxford University DPhil-cogitations. Thankfully, Oxford University has at least 3 other DPhils who believe in the GOD Dawkins denies: Dr Jim Packer’s “KNOWING GOD” is gem of a Classic [24]; Professor John Lennox outshines Professor Richard Dawkins [25 26] in Public Debates, and Dawkins’s previous fellow atheist Professor Alister McGrath writes: “There are many who are deluded about God, and I used to be one of them” [27]. His bestseller “THE DAWKINS DELUSION? Atheist fundamentalism and the denial of the divine” [27] states (page 64) “The God Delusion is a work of theatre, rather than scholarship -….” Alister McGrath and his wife Joanna Collicutt McGrath conclude their book with this question: “Might atheism be a delusion about God?” [27]

TO WHOM IS THIS QUESTION DIRECTED? [1]
The “you” of Modern English is ambiguously singular and plural. I prefer “thou” and “ye” of yesteryears, and I split the question into “Dost thou acknowledge God’s existence?” and “Dost thou believe in God?” Answering “Yes!” to both I rest my confidence on 3 supra-scientific Facts: History, Miracle (properly defined), and Personal Experience.

HISTORY
Historical events that cannot be fathomed through Science are often either dismissed as myths (never happened) or explained away somehow. Professor Know-All’s comments in the BMJ on 4 historical events in Clinical Medicine that I called “supra-scientific” prove my point [28]. The fourth event I described was when my robust younger brother announced on Friday 16th December one year that he had a week to live, and the following Wednesday 21st December as our mother was baking cakes for Christmas he said none of us would be eating cakes that Christmas and we laughed him to scorn; then playing football with him on Friday 23rd December we were both struck by lightning which killed him instantly, and left me with a facial burn [29]. Not only did Jerry have “a week to live”, but also no one ate cakes at Christmas 1949 in Odumase-Krobo while Rev D A Konotey-Ahulu’s second son lay unburied on Christmas Day. Professor Know-All’s “scientific” verdict was “Your brother was accident prone!” [30].

Moses saw the burning bush that was not consumed and, advancing to investigate, heard “Moses, Moses! Draw not nigh hither: Put off thy shoes from off thy feet, for the place whereon thou standest is holy ground”. He was petrified when the voice said “I AM THAT I AM …Thus shalt thou say unto the children of Israel ‘I AM hath sent me unto you’” [31]. Truth of this historical event baffles atheists. That Moses went on to deliver his people from slavery in Egypt is sheer history [32].

When I date my cheques 20th January 2018 I am proclaiming that 20 Centuries ago The Lord Jesus Christ said in Jerusalem “Before Abraham was I AM” [33], the very name that Moses heard at the burning bush. I do not appeal to Science for help in validating the historicity of The Lord Jesus Christ who said 40 times in Apostle John’s Gospel that he was sent [34]. His origins and deeds can only be described as miraculous.

WHAT IS A MIRACLE?
December 1958 to March 1959 was a bad winter for this African in London. Weeks before Final Exams in April 1959 to graduate as a doctor I was admitted with virus pneumonia to Westminster Hospital in Horseferry Road under Dr (later) Sir Richard Bayliss, Queen’s Physician. If I recovered there was no way I could pass the exam because my revision plans were ruined. Discharged in time to sit the Finals, I passed.

My friend Richard Alderson, brilliant English Teacher, and fellow member of Dr Martyn Lloyd-Jones’ Westminster Chapel [35], later saw me and asked how I did. His immediate response when I said “I passed. It’s a miracle!” taught me the correct meaning of the word: “If you had the brain of a hedgehog that would be a miracle”. Exactly! True miracles are way beyond the merely supra-scientific. The hedgehog-brain-answering-exam-questions-on-placenta-praevia type of historical event that defies scientific explanation, is what some scientists deny ever happened. But Nobel Prize winner Sir Peter Medawar published “The Limits of Science” [36]. Lesser-brained scientists disagree, claiming (like Professor Know-All) to have answers for everything.

Well then, “Crucified, dead, and buried; the third day The Lord Jesus rose from the dead” is not Science so it is not History either? Does History not confirm mysterious truths which Science cannot fathom? [37 38]. I knew some Resurrection deniers who hated The Lord Jesus Christ. Their “OK, Jesus rose from the dead, so what?” revealed much. Were they God haters rather than just atheists? Are we really in a “Post-Truth World?” [39].

PERSONAL EXPERIENCE
“GOD is a SPIRIT, and they that worship Him must worship Him in spirit and in truth” [40] – words of The Lord Jesus Christ once quite meaningless to me. Science had/has no definition for “spiritual things” [41-43]. But on Friday 24 October 1952, alone in my university rooms in Ghana reading other words of The Lord Jesus [44] HE miraculously revealed Himself to me. There’s no scientific explanation for what happened that night. Subdued and tearful, I went next-door to tell fellow student James Mustaffah: “Felix will never be the same again!” [45]. I was never the same again. Similar experiences described in Eric Metaxas’s remarkable biographies of Bonhoeffer, Wilberforce, and Luther [46-48] demonstrate this divine intertwining of History, Miracle, and Personal Experience. For me to understand spiritual things now is a Miracle. O Thank GOD!

Competing Interest: Believer in The Lord Jesus Christ [Nuntsɔ Yesu Kristo]
felix@konotey-ahulu.com Twitter@profkonoteyahul

Felix I D Konotey-Ahulu FGA MB BS MD(Lond) DSc(UCC) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) FGCP FWACP FTWAS ORDER OF THE VOLTA (OFFICER) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL. Website: www.sicklecell.md

1 Saripanidis Savros. Do you believe in God? 24 August 2017 BMJ Rapid Response http://www.bmj.com/content/359/bmj.j4669/rapid-responses Re¨Kevin Barraclough Do you believe in God? 319:doi 10.1136/bmj.319.7214.929a

2 Burridge Stan. Three forms of identification and a letter from God.
BMJ 25 Oct 2017. 359: j4669. doi: 10.1136/bmj.j4669 pmid: 29070597.

3 Donne J. Hymn to God, My God, in My Sickness | BMJ Supportive & Palliative spcare.bmj.com/content/bmjspcare/7/3/273.full.pdf June 27 2017.
John Donne’s sonnet ‘Death be not proud’ is a favourite reading at funerals; but his ‘Hymn to God, My God, in My Sickness’ is one of the great poems in the language.

4 Keown Daniel. What God forgot to tell surgeons: the science of acupuncture Review http://aim.bmj.com/content/acupmed/31/3/345.full.pdf by Anne-Marie Marlow. Downloaded on December 8, 2017.

5 Dawkins Richard. The God Delusion. London – Transworld Publications 2007.

6 Dawkins Richard. The Greatest Show on Earth. Free Press, New York, 2009

7 Sarfati Jonathan. The Greatest Hoax On Earth? Refuting Dawkins On Evolution. Creation Book Publishers. Atlanta Georgia, USA 2010. ISBN 978-0-949906-73-1 [333 pages]

8 Evolution’s Achilles Heels – 9 PhD Scientists explain evolution’s fatal flaws – in areas claimed to be its greatest strengths. Foreword by Carl Wieland. Creation Book Publishers, Powder Springs, Georgia USA 2014. ISBN 978-1-921643-82-8 [272 pp]

9 Sarfati Jonathan. Refuting Evolution. Amazon.com: Books 9780949906731 htpps://www.amazon.com/Refuting.Evolution-Jonathan-Sarfati/dp/0949906735
https://creation.com/refuting-evolution-index [A handbook for students, parents, and teachers countering the latest arguments for evolution]

10 Sarfati Jonathan. Refuting Evolution 2. A sequel that comprehensively counters arguments that support evolution (as presented in TV Documentaries and Scientific American) www.amazon.co.uk/refuting+evolution+2 2004 ISBN: 0-949906-27-1 [235 pages]

11 Penner JG. Evolution Challenged by Language and Speech. Minerva Press, London W1R 7YB. 2000 ISBN 0 75411 092 3. [403 pages]

12 Gitt Werner. In the beginning was Information – A Scientist Explains the Incredible Design in Nature. Master Books (New Leaf Publishing Group) AR 72638 USA ISBN-13: 978-0-89051-461-0 & 10: 089051-461-5 (264 pages).

13 Gitt Werner. Did God use Evolution? Christliche Literatur-Verbreitung e.V. Postfach 11 01 35.33661 Bielefeld Germany 2nd Edition 2001. [160 pages]

14 Sanford J C. Genetic Entropy. FMS Publications (FMS Foundation) USA, Fourth Edition 2014. ISBN 978-0-9816316-0-8 [271 pages]

15 Wieland Carl. One Human Family. The Bible, Science, Race & Culture. Creation Book Publishers, Atlanta, Georgia, USA 2011 www.onehumanfamily.us [378 pages]

16 Andrews Edgar. Who Made GOD? Searching for a Theory of Everything. EP Books, Pistyll Hall, Pistyll, Holywell, CH8 7SH www.epbooks.org 2009 (324 pp).

17 Rendle Short John. Green Eye of the storm. Controversy between Science and Christianity in the lives of Arthur Rendle-Short (1880-1953); Philip Henry Gosse (1810-1888); George John Romanes (1848-1894). The Banner of Truth Trust, Edinburgh/Pennsylvania 1998. ISBN 0 85151 7277 [294 pages]

18 Hoyle Fred. The Intelligent Universe. Michael Joseph, London, 1985, page 25 “Why has the Darwinian theory of evolution by natural selection managed for upwards of a century, to fasten itself like a superstition on so-called enlightened opinion? Why is the story still defended so vigorously?” [This from a Cambridge University Professor, & a Fellow of UK’s prestigious Royal Society FRS]

19 Sarfati Jonathan. By Design – Evidence for Nature’s Intelligent Designer – The God of the Bible. Creation Book Publishers 2008 Atlanta Georgia, USA www.creationbookpublishers.com [260 pages]

20 Konotey-Ahulu FID. The God Delusion title devalues sensible discourse. BMJ Rapid Response www.bmj.com/content/335/7629/1099.1/rr-0 October 19 2016.

21 Blanchard John. Does GOD believe in Atheists? Evangelical Press 2001, USA P O Box 84, Auburn, MA 01501, USA ISBN 0 85234 460 0 [656 pages]

22 Blanchard John. Is GOD past His Sell-By Date? Evangelical Press 2007. P O Box 825, Webster, NY 14580 & Faverdale North Industrial Estate, Darlington, DL3 0PH, England. [268 pages]

23 Berlinski David. The Devil’s Delusion: Atheism and Its Scientific Pretensions. Basic Books (Perseus Books Group) 2009; 387 Park Avenue South, New York, NY 10016-8810. ISBN: 978-0-465-01937-3

24 Packer JI. KNOWING GOD. Hodder and Stoughton. London 1973 [256 pp].

25 Has Science Buried God? Dr. Richard Dawkins vs. Dr. John Lennox …
983thesnake.com/has-science-buried-god-dr-richard-dawkins-vs-dr-john-lennox-the-…18 Nov 2015 – In this fascinating debate, Dr. Richard Dawkins and Dr. John Lennox discuss the question of whether science has buried God.

26 The God Delusion Debate: Richard Dawkins and John Lennox …
www.trentarwine.com › Atheism › Debates19 Jan 2017 – In Birmingham, Alabama, Professor Richard Dawkins and his Oxford University colleague, Professor John Lennox, engaged in a lively debate over what is arguably the most critical question of our time: the existence of God. The debate centred on Dawkins’ views as expressed in his “The God Delusion”.

27 McGrath Alister with McGrath JC. The Dawkins Delusion? Atheist Fundamentalism and the denial of the divine. SPCK, 36 Causton Street, London SW1P 4ST. 2007 ISBN 978-0-281-05927-0.

28 Konotey-Ahulu FID. The supra-scientific in clinical medicine: a challenge to Professor Know-All. doi:10.1136/bmj.323.7327.1452 Brit Med J 2001; 323(7327): 1452-1453 (22-29 Dec) http://www.bmj.com/cgi/reprint/323/7327/1452.pdf

29 Konotey-Ahulu FID. Case of lightning burns. BMJ 1963; 1: 1547. June 8. Doi:10.1136/bmj.1.5344.1547 http://www.bmj.com/cgi/reprint/1/5344/1547.apdf

30 Konotey-Ahulu FID. Superstition and phenomena in Africa. Personal View. BMJ 1969; 2:48 http://www.bmj.com/cgi/reprint/3/5664/235.pdf April 15 doi:10.1136/bmj.2.5648.48

31 Holy Bible: Exodus chapter 3 verses 1-10. [Moses commissioned to go and lead Israelites out of Egypt].

32 Holy Bible: The Passover. Exodus chapter 12 verses 1 to 51. [Verse 51 “And it came to pass, …, that The LORD brought the children of Israel out of the land of Egypt according to their armies” [A supra-scientific historical event]

33 LORD JESUS CHRIST. “Most assuredly, I say unto you, before Abraham was I AM”. St John chapter 8 verse 58.

34 Konotey-Ahulu FID. MILLENNIUM Hymn – TIME WAS CREATED (Verse 3 of the 7 verses emphasises 40 times The LORD JESUS said in St John’s Gospel He was sent into the world and why – http://bit.ly/cRrZ0s (0 is zero, not o) 2000
Video with music http://www.youtube.com/watch?v=4hconD91uNs

35 Murray Iain. Life of Martyn Lloyd-Jones 1899-1980. Banner of Truth Trust, Edinburgh [See Reference 24 of http://bit.ly/2igdDg2 for more details on him]

36 Medawar Peter. The Limits of Science. Oxford University Press. 1985.

37 Konotey-Ahulu FID. History versus Limits of Science: Is Solomonic Genius a Y Chromosome Phenomenon? J Genet Disorders Genetic Reports 2014; 3: 2 http://bit.ly/1wyq5H5

38 Konotey-Ahulu FID. “Private Thoughts: There is no evidence that I was born on a Saturday. Postgraduate Medical Journal of Ghana 1: 32-33” [which often proved the superiority of history over science in arriving at truth] 2012.

39 Konotey-Ahulu FID. Evidence in a post-truth world: Scientists’ Misinformation and Disinformation http://bit.ly/2igdDg2 Response to Dr Margaret McCartney’s “seams of multiple misinformation” pervading the scientific world – “Evidence in a post-truth world”. BMJ 2016; 355: 16363, November 28, 2016.

40 LORD JESUS CHRIST. To the Samaritan woman at the well: “GOD is a Spirit; and they that worship Him, must worship Him in spirit and in truth”. St John’s Gospel chapter 4 verse 24.

41 Lloyd-Jones DM. Spiritual Depression: Its Causes and Cure (Amazon’s Book Store www.amazon.co.uk>Spiritual-De ISBN 9780802813879 [One of top 100 Millennium Books]

42 Konotey-Ahulu FID. The spiritual and the psychological in Clinical Medicine. (Personal View) BMJ 1977; 1: 1595 www.bmj.com/cgi/reprint/1/6076/1595.pdf doi:10,1136/6076/1595 June 15 “There is a vast area of man’s experience called the spiritual realm which neither Freudian psychoanalysis nor the scientific method can fathom…Approaches to scientific truth and spiritual truth are different. One scientist will read Dr Lloyd-Jones’ ‘Spiritual Depression: Its Causes and Cure’ (Reference 41 above) with much profit while another, with the same qualifications, will find it unintelligible”

43 Lloyd-Jones DM. Conversions Psychological and Spiritual. (Critique of Dr William Sargant’s “Battle for the Mind”) https://www.amazon.co.uk>uk 9780851100098 December 1 1959.

44 LORD JESUS CHRIST. For I am not come to call the righteous, but sinners to repentance. St Matthew’s Gospel chapter 9 verse 13. [Reading of which at about 8 pm 24th October 1952 alone in my university rooms in Legon, Ghana, seemed to switch on spiritual eyes that changed me for good]

45 Barker Peter, Boadi-Siaw Samuel. Changed by the WORD – The Story of Scripture Union in Ghana. Scripture Union Ghana, P O Box AN 7388, Accra-North, Ghana. ISBN 9964-87-800-1 “Felix will never be the same again” – p. 18.

46 Metaxas Eric. BONHOEFFER – Pastor, Martyr, Prophet, Spy. Thomas Nelson USA, August 2011 (626 pages).

47 Metaxas Eric. AMAZING GRACE. Biography of William Wilberforce. Authentic Media, USA, October 2013 (344 pages).

48 Metaxas Eric. MARTIN LUTHER: The Man Who Rediscovered GOD and Changed the World. Viking Press, USA, October 2017 (416 pages).

Competing interests: Competing Interest: Believer in The Lord Jesus Christ [Nuntsɔ Yesu Kristo]

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Facebook Enquirer November 2017

Facebook enquiries

Look at www.sicklecell.md for correct terms.

What do you mean by sicklecell?
Sickle Cell Trait (Normal gene + Abnormal gene)? Or do you mean sickle cell disease (Abnormal gene + Abnormal gene)?
To simplify things, I call Normal gene NORM and Abnormal gene ACHE because it takes 2 Abnormal genes (ACHEACHE) to make someone ache with the pain of sickle cell crisis. So, sickle cell trait is NORMACHE.

On my www.sicklecell.md Home Page you will see the kanad I invented to explain what happened when my Trait father NORMACHE married my Trait mother NORMACHE. They had 11 children of whom 3 had ACHEACHE, suffering sickle cell disease. Four of us were NORMACHE like our parents (no problems) and 4 also had no problems with NORMNORM.

It is important that readers of this Facebook each find out what Haemoglobin genes have been inherited from their parents. If, like my 3 siblings, any has inherited abnormal (ACHE) haemoglobin gene from each parent then there is no NORM gene to protect from body ache under certain circumstances. I never advise a person with ACHE Haemoglobin gene not to marry someone else, remembering that my parents would have been advised not to marry as some American States are keen to legislate.

Study the kanad video, and come to your own decision. People with sickle cell disease (ACHEACHE) have inherited some brilliant genes from their parents, like beauty, elegance, brains, and become ACHIEVERS in life as we have seen in Ghana. Visit my website, and take time with my Genetic Counselling and Voluntary Family Size Limitation (GCVFSL) http://bit.ly/1w3BuvM
Please get back to me if you can’t access it.

Finally, Sickle (S) is not the only aching gene we can be born with. The second commonest abnormal Haemoglobin aching gene is “C”. Test for “S” alone (Sickle Cell Test) is not enough. I always test for other genes, not just for Sickle Cell Trait. You can be Sickle Test Negative (that is No “S”) and yet be “C” Positive, enabling you and your Sickle-Positive-“S” spouse to have a child who has two aching genes “S” + “C” to produce Hereditary Rheumatism (Sickle Cell Disease), never ever to be called “SC Trait”, but only to be known as “SC Disease”. Sickle Cell Trait is “AS”, never “SC”.

I was born surrounded by both so I know the difference. Note that Sickle Cell Disease ‘SS’ is the only phenotype known as Sickle Cell Anaemia. These terms which are not “Konotey-Ahulu terms”; but from WHO which does not recognise the term “Sickle Cell Anaemia Disease”. If you have ‘S’ from both parents you have “Sickle Cell Anaemia” (SS). If you prefer to say you have “Sickle Cell Disease” then you need to add the phenotype and say “I have Sickle Cell Disease (SS)”. If a lady has Sickle Cell Disease (SC) and develops severe anaemia from heavy periods doctors are not entitled to say she has Sickle Cell Anaemia. She is still “SC” and not “SS”. She has Sickle Cell Disease (SC) with Anaemia, but not “Sickle Cell Anaemia Disease”. [Please read this again!].

Be the one to teach your doctors if they are confused about these terms. I once mentioned how I referred a lady to have her gall stones removed by a world class Surgeon to whom I wrote this: “Please help this Sickle Cell Anaemia (SS) lady”. Less than one hour later in the same hospital he said he called and said to me: “Thank you Felix for sending me that delightful Sickle Cell Trait lady”. So even world-class Specialists don’t know WHO definitions of who has Trait (1 Normal Haemoglobin gene) and who has Disease (No Normal Haemoglobin gene).

TERMS EXPLAINED:

Sickle Cell Trait (1 Normal Gene A+1 Abnormal Gene ‘S’) I call NORMACHE which never gives Hereditary Aches. For Sickle Cell Disease (1 Abnormal Gene ‘S’+any Abnormal Gene ‘S’ or ‘Other’) I prefer ACHEACHE as S+S, S+C, S+D, S+K, S+Korle Bu, S+Osu Christiansborg, S+FPersistence, S+O, S+Kwahu, are all aching Sickle Cell Diseases. It takes 2 ACHES to cause ache.

NOTE CAREFULLY: Normal Haemoglobin ‘A’+Abnormal ‘S’ is Sickle Cell Trait (AS). Normal ‘A’+ Abnormal ‘C’ is Sickling Negative Haemoglobin C Trait (AC).

Haemoglobin gene ‘A’ is NOT to be confused with BLOOD GROUP ‘A’. These 2 genes labelled “A” have nothing to do with each other. To check for Abnormal Haemoglobins ask for “Haemoglobin Type”, not Blood Group.

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Sickle Cell Trait and Sickle Cell Disease

SICKLE CELL TRAIT and SICKLE CELL DISEASE

On Facebook 15th November 2017 responding to something on a site which described itself as “Sickle Cell Anemia Disease”, I wrote this:

“Please get your correct definitions of sickle cell disease and sickle cell trait from www.sicklecell.md Let no one deceive you re sickle cell trait. Study and learn”

I then got this message: “You know I have heard from people with sickle cell trait get pain once a year or something it’s not serious but I hear they still can have symptoms I mean it is blood line you know”.

Visiting www.sicklecell.md proved to some doctors that sickle cell disease has often been wrongly called sickle cell trait, and vice versa, with serious consequences.

“Pain once a year” is no proof of sickle cell trait. Millions of people around the world who do not have sickle cell trait have pains more than once a week!

Doctors writing SCT for sickle cell trait imply that “SC” is a Trait, which is wrong because “SC” is 2 Abnormal Haemoglobins – a disease phenotype. The Trait must have NORMAL Haemoglobin A plus S, and the “A” fraction must always be greater than the “S”. Sickle Cell Trait is written “AS Trait”, not SCT. If Electrophoresis shows “AS” (1 Normal gene A greater than S) and the person has symptoms like sickle cell disease then the person may well have Sickle Cell Quebec-Chori disease, with Hb Chori behaving like “A”. See [Konotey-Ahulu FID. Lancet February 29, 1992, page 555 http://bit.ly/2d18oOL

Beware of symptomatic sickle cell traits. Lancet, February 29, 1992, page 555.

http://www.thelancet.com/journals/lancet/article/PII0140-6736(92)90377-F/fulltext]