I love the NHS but not their Ramadan health FAQs

The health care debate taking place in my homeland right now is immensely important. The outcome will affect all 300 million Americans, especially the 46 million that are uninsured, and if reform doesn't pass now, we probably won't get another shot at it for another decade or two.

It's also important to me, personally, as I do hope to repatriate one day. I am absolutely pro-reform and I find two aspects of the debate particularly infuriating:

1. the spread of outright lies about the proposed reforms by the small but very screechy anti-reform camp (debunked here), including the slinging of vast quantities of mud across the Atlantic at the UK's National Health Service
2. the sheer number of Americans--64%--who 'don't want to pay more taxes to expand health coverage to the uninsured'

As an American living in the UK, I feel it is my particular duty to counter the misinformation about the NHS that is circulating in the States right now. I've been counter-circulating as much information and testimonials by email and facebook as I can, and even have an 'I [heart] NHS' twibbon on my twitter avatar as a sign of my support.

I do, by the way. [Heart] the NHS, that is. It is difficult to overemphasize the peace of mind it gives me that those I love and I will never be unexpectedly refused coverage as a result of some policy small print about, for example, pre-existing conditions, nor financially ruined by a health problem. What a relief it is to be able to go to the doctor without having to fill out any forms or make any co-payments. Oh, and prescriptions are either free or £6.95 depending on whether you are capable of paying. I could go on but that's not what this post is about, and others have said it much better than me.

This post is about something the NHS did that has me pretty irked. I know, I know, given all of the above, maybe now isn't the best time to point out flaws in the NHS, but to that I say: a) this flaw has nothing to do with the general premise of the NHS or the health care they provide and b) I think it's right to be honest even when it's not politically expedient. Ahem.

So. The NHS has this website called 'Healthy Ramadan' which offers advice on staying healthy if you happen to have chosen to observe the daylight fasting that is part of the Muslim holy month of Ramadan. Of course, the word 'chosen' is tricky because it's difficult to quantify the extent to which religious indoctrination limits one's perceived if not real choices, but I digress.

The site seems like a pretty good idea: there are pages containing general advice on healthy fasting, suggestions on what to eat and what not to eat, and even a suggested meal plan. There's also an important section that lists the health risks that can be associated with fasting, and the site urges people to use Ramadan as an opportunity to quit smoking.

But then we get to the page, 'Ramadan health FAQs'. This page got my hackles up immediately with its introductory note that explains that 'the answers have been put together by medical experts and Islamic scholars and researchers'. I can see why Islamic scholars and researchers might help with devising the questions - after all, they are the experts on what the likely FAQs are going to be. But why should they be involved with putting together the answers? This is supposed to be health advice. It should come from the medical experts alone.

The first several Q&As about diabetes, migraines and blood pressure were okay, I suppose, though I was a little uncomfortable with how the questions were worded: each one was based around the question, 'should I fast?' when they really should have asked, 'is it alright to fast?' because then the answer would be less likely to be interpreted as prescriptive rather than permissive. But then I got to this one:

Is fasting harmful when a woman is expecting a baby? Must pregnant women fast?

There's medical evidence to show that fasting in pregnancy is not a good idea. If a pregnant woman feels strong and healthy enough to fast, especially during the early part of the pregnancy, she may do so. If she doesn't feel well enough to fast, Islamic law gives her clear permission not to fast, and to make up the missed fasts later. If she is unable to do this, she must perform fidyah (a method of compensation for a missed act of worship).

Let's just start with the question, shall we? 'Must' should never appear in front of or inside the phrase 'pregnant women fast', and certainly not on a national health service website. In fact the only time those two phrases should ever go together on any kind of government literature is if 'not' is inserted directly after 'must'.

The answer to the question starts out a bit better--using 'may' instead of 'must'--but then it all goes downhill. 'Islamic law gives her permission not to fast...' is useful information, as it may give uncertain women the religious argument they are looking for to give themselves permission not to fast (though of course that opens up a whole can of worms that I'm not going to go into today). But that last sentence is abhorrent. It's missing a big fat 'Islamic law says' before 'she must'. The way it is now, it looks like the NHS is the one telling her that she must perform fidyah!

I suppose one could argue that 'Islamic law' is mentioned in the penultimate sentence and therefore it is meant to indicate that Islamic law, and not the medical establishment, is the authority in both of the final two sentences. And I suppose that if this were the only problem with the website then I might have given them the benefit of the doubt. But two questions later it gets worse, and this time there's no qualifying 'Islamic law says' anywhere to be found:

From what age can children fast safely?

Children are required to fast from the age of puberty. It isn't harmful. Fasting before this age is tolerated differently depending on the child’s general health, nutrition and attitude. Fasting under the age of seven or eight isn't advisable. It is a good idea to make children aware of the practice of fasting and to practise fasting for a few hours at a time.

Look at that first sentence and tell me the NHS--the NHS!--didn't just say that children are required to fast during Ramadan!

The next few Q&As are okay, I suppose. They're about asthma, swimming and blood transfusions and there are occasional qualifiers like 'Muslim experts say...' and 'in their view...'. But I don't like how the answer to the asthma question contains an implication that it's somehow incumbent on Muslims to 'achieve good control' of their asthma ...as if it's some kind of personal failing if your asthma isn't under control. And I don't like that the answer to the transfusion question mandates fidyah with no qualifiers in sight. But I'm passing over these so that I can address this final doozie:

Does a breastfeeding woman have to fast?

No. Islamic law says a breastfeeding mother does not have to fast. Missed fasts must be compensated for by fasting or fidyah once breastfeeding has stopped.

As with the Q&A about pregnancy, the question itself contains an implication that the answer is mandataory rather than permissive. And again, missed fasts 'must' be compensated, no qualifiers, unless you count the one in the first sentence, but at this stage I'm not exactly inclined to give them a pass.

So, all you NHS web content editors out there, would you please do us all a favor and go in there with a red pen and change 'must' and 'should' to 'can' and 'could'? And while you're at it, add a liberal sprinkling of 'Muslim scholars say...' and 'Islamic law says...' before each sentence in which fasting is 'permitted' or fidyah 'suggested'? Oh, and could you please pay particular attention to those Q&As regarding women and children? Because I've noticed that those were most prescriptive and least qualified of all.

I'd do it myself, but I'm hungry.

Down syndrome research pop quiz: fruit flies 94, Sarah Palin zilch

This story has already been covered to death (or at least I hope so) on teh interwebs, but I must have my say. You see, when Palin dissed fruit flies...



...she didn't just diss fruit flies and the general and specific importance of model organism research (for which she is rightly and expertly skewered by Christopher Hitchens, Kevin Berger and others). She also dissed me.

As mentioned previously here and here, I did my PhD research on the fruit fly* Drosophila melanogaster. Specifically, I worked my butt off for six years to understand some of the myriad and complex functions of a fruit fly gene called Ras (the human counterpart of which plays a role in the onset and/or development of almost every kind of cancer) on the ovarian and embryonic development of the fruit fly, and how this has been modulated during fruit fly evolution.

That's right, friends, I am officially (and, it must be said, very proudly) on Sarah Palin's shit list: not only did I do research on fruit flies (booooo!) but I also did research on evolution (hissssss!).

But enough about me.

Almost unbelievably, Palin's sneer came directly on the heels of her own call to help families with special needs kids like her nephew with autism and her son with Down syndrome. See, in Palin's (surprisingly young) universe, it cannot possibly be fathomed that something as obscure as a fruit fly could help special needs kids. But a quick search on PubMed for 'Drosophila and "Down syndrome"' yields 94 peer-reviewed research articles including this one [my emphases]:

Dscam guides embryonic axons by Netrin-dependent and -independent functions.

Andrews GL, Tanglao S, Farmer WT, Morin S, Brotman S, Berberoglu MA, Price H, Fernandez GC, Mastick GS, Charron F, Kidd T.

Development. 2008 Oct 23. [Epub ahead of print]

Developing axons are attracted to the CNS midline by Netrin proteins and other as yet unidentified signals. Netrin signals are transduced in part by Frazzled (Fra)/DCC receptors. Genetic analysis in Drosophila indicates that additional unidentified receptors are needed to mediate the attractive response to Netrin. Analysis of Bolwig's nerve reveals that Netrin mutants have a similar phenotype to Down Syndrome Cell Adhesion Molecule (Dscam) mutants. Netrin and Dscam mutants display dose sensitive interactions, suggesting that Dscam could act as a Netrin receptor. We show using cell overlay assays that Netrin binds to fly and vertebrate Dscam, and that Dscam binds Netrin with the same affinity as DCC. At the CNS midline, we find that Dscam and its paralog Dscam3 act redundantly to promote midline crossing. Simultaneous genetic knockout of the two Dscam genes and the Netrin receptor fra produces a midline crossing defect that is stronger than the removal of Netrin proteins, suggesting that Dscam proteins also function in a pathway parallel to Netrins. Additionally, overexpression of Dscam in axons that do not normally cross the midline is able to induce ectopic midline crossing, consistent with an attractive receptor function. Our results support the model that Dscam proteins function as attractive receptors for Netrin and also act in parallel to Frazzled/DCC. Furthermore, the results suggest that Dscam proteins have the ability to respond to multiple ligands and act as receptors for an unidentified midline attractive cue. These functions in axon guidance have implications for the pathogenesis of Down Syndrome.

In other words, research on fruit flies is helping us to understand Down Syndrome better. The same can be said for almost all human biology, both pathogenic and 'normal' (whatever that means).

And here's where Palin's mocking is even more resonant: the reason fruit fly biology illuminates human biology is because our genomes are so similar and the reason our genomes are so similar is because we inherited them from the last common ancestor of humans and fruit flies [cue Sarah Palin's head popping off and steam shooting out].


*Though not technically correct, 'fruit fly' is the colloquial name for the monumentally important model organism Drosophila melanogaster. True fruit flies belong to the insect family Tephritidae and it was in fact a research project on these Tephritid flies that Palin was so gleefully skewering as wasteful earmark spending. Some have argued that this fact exonerates Palin-- i.e. that she was not mocking D. melanogaster research because she knows how important that is (right, as if Palin knows the difference between true fruit flies and model organism 'fruit flies') but rather she was mocking Tephritid fruit fly research. Problem is that the project she mocked is more applied to human benefit (in this case agricultural productivity) than most D. melanogaster research, not less, so there's that argument out the window.

In which I wake up to a sexist leaflet on my doorstep

In case there is anyone out there laboring under the impression that it is 2008, prepare to be disabused:

Puh-leeeze.

Giant's causeway digression

I just can't hold it in any longer. I've been over at the Beagle Project Blog writing my counter-response to the Causeway Creation Committee's reply to my 2007 post "Not just an American Problem (Part II)". I was really trying to keep the whole science vs. religion thing out of it, focusing instead on science vs. young-earth creationism. But when I read this:

"the philosophical view of the atheistic naturalist scientist (as opposed to the observational scientist) is that human life is of no more worth or value than a dust cloud or a black hole"

...it got personal. Paul, I am getting really, really tired of the claim that the ability to value human life must necessarily stem directly from a belief that human life was purposefully created by a big guy in the sky. It mustn't. In fact, often religiosity correlates with bad behaviour. Get over it.

Science spam

The daily barrage of Viagra, Microsoft software and Rolex rip-offs is bad enough, but recently I've noticed a category of specialised spam reserved just for us scientists. For example, today I received this:

Dear Dr. James,

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And keep the rest of the matter in mind:

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Tel: 1-732-885-9188 ext 128
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Sadly, it appears that even science spam is rife with bad English ("And keep the rest of the matter in mind") and innuendo ("sometimes ligation doesn't work", "unlimited mutations - at any position"). What do they think, that I'll be titillated by their promise to "deliver your gene in any vector" and do some impulse shopping at VWR?