Back pain treatments “useless”

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Most treatments for low back pain simply do not work, an international team of scientists writing in The Lancet has warned. The condition is now the world’s leading cause of disability: an estimated 540 million people are affected and that number is growing as populations age.

But back pain is not properly understood, the scientists say, and is being widely mismanaged, with many patients prescribed aggressive treatments including spinal injections, powerful opioids and surgeries that are of “dubious benefit” and may in fact do harm. They advise that for most types of back pain, the best advice is simply to remain active and remain positive: a positive attitude and job satisfaction are some of the strongest indicators of whether back pain will turn into serious disability, they say. Current NHS guidelines recommend exercise and therapy. However, this not what patients always want to hear, putting doctors under pressure to offer them non-existent cures. Many patients are sent off for scans that lead to surgery – although in most cases, surgery is no more effective than non-invasive treatments and it risks leaving patients worse off. A third are prescribed potentially addictive opioid painkillers, but there is evidence that these can make back pain worse. (The Week 31 March 2018)

Yes, I agree.  I have had back pain for six months and so far nothing has worked.  The last thing you need are painkillers, especially opioids.  At best they simply disguise the pain, and temporarily at that. I suggest an exciting detective movie or reading the last ten years of postings on this blog.  At least the latter will give you to a nice long sleep.

Signs of old age

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To the New Statesman
I can confirm Peter Wilby’s observation that old age creeps up unnoticed from my reaction on being offered a seat on the Tube by a stranger for the first time. The overwhelming emotions are those of surprise, indignation and insult, with gratitude a long way behind.
Some years later, I still try to avoid eye contact on a full Tube, so that no one makes what I continue to regard as an unnecessary offer. (Dr Graham Mott, Bishop’s Stortford, Hertfordshire)

No, no, no! That’s silly. It’s really nice to see young people (usually women, also American servicemen) proffer their seats for old people. It shows they are thoughful, well-mannered and well brought-up. Mostly, and understandably, they stand up for my wife, and get a nice smile and a big thank-you. There are not enough little human gestures like this. Glad Dr. Graham Mott is not my doctor!

Some thoughts from Emperor Marcus Aurelius, Epicurean

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Here are some thoughts, called “The Decent Life”, from the philosopher Emperor, whose beliefs were Epicurean:

Honour and revere the gods, treat human beings as they deserve, be tolerant with others and strict with yourself. Remember, nothing belongs to you but your flesh and blood – nothing else is under your control. 5.33

Make sure you remain straightforward, upright, reverend, serious, unadorned, an ally of justice, pious, kind, affectionate, and doing your duty with a will. The only rewards of our existence here are an unstained character and unselfish acts. (6.30)

The only thing that isn’t worthless is to live this life out truthfully and rightly. And be patient with those who don’t. (6.47)

Four principles:  ……Truth, justice, self-control, kindness…. (7.63)

Nothing is good except what leads to fairness, and self-control, and courage, and free will. And nothing bad except what does the opposite. (8.1)

Accept the things to which fate binds you, and love the people with whom fate brings you together, but do so with all your heart

Read more at: https://www.brainyquote.com/quotes/marcus_aurelius_148749

Is do-it-yourself gene editing wise and ethical?

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CRISPR, the cheap and easy technique for making precise changes to DNA, has researchers around the world racing to trial its use in treating a host of human diseases.

But this race is not confined to the lab. Last month, Josiah Zayner, a biochemist who once worked for NASA, became the first person to edit his own genes with CRISPR, in order  to remove the gene for myostatin, which regulates muscle growth, even though it might have led to  unintended consequences, such as  tissue damage, cell death, or an immune response that attacked his own muscles.

Other people are now starting to use gene modification for a variety of maladies such as colour blindness,  or implanting a gene for  a rare genetic mutation called tetrachromacy that is sometimes found in women and allows them to see in the ultraviolet spectrum.

Biohackers, as they are called, believe it is a basic human right to access and edit one’s own genome. “I am of the opinion that your genome is your own,” said one. “I think that it is important that people have the ability to choose what kind of gene expression they want for themselves. This ethos of “my body, my choice” is used to underpin arguments for health, reproductive and disability rights, but should it extend to the right to edit our own genes? What about the potential unintended effects of using untested technology? And will allowing broad access to CRISPR risk creating a group of “superhumans” with enhanced senses and abilities?

Is there a moral difference between gene editing for medical therapy versus enhancing ordinary abilities?  Some, like John Harris, a bioethicist at the University of Manchester, UK,  does not believe there is a significant difference. He thinks the biohackers could hasten the safe use of CRISPR in humans.”There is a long and noble history of both doctors and scientists experimenting on themselves,” says Harris. “It has proven tremendously valuable in the public interest.”

“At home” gene editing is not at the moment illegal, (except in Germany, where CRISPR kits have been banned), and  none of the biohackers are actually practising medicine on anyone else.  Moreover , most people agree that  genome editing is not ready to be offered for sale to the general public.

The World Anti-Doping Agency is banning all forms of gene therapy, or gene doping, from international competitive sports from 2018. However, gene editing is very difficult to detect. Ishee  Günes Taylor, who also works with CRISPR at the Francis Crick Institute in London, believes that successful gene editing will be more difficult than the biohackers think, although there could be scientific benefits to monitoring how biohackers modify their bodies, giving us more information about how CRISPR works in humans. But the potential for harm implies that this would be unethical, and DIY experiments should be more heavily regulated.

At the moment the truth is that the biohackers are going to do it anyway, and in any case it’s hard to write regulations for people playing around with science in their garages. The biohackers believe it is a matter of choice, helping make genome editing safe and accessible for the wider public.

But how can we, the public, make sure the experimenters are responsible and that they acknowledge the possible consequences of spreading CRISPR widely?  The horse is virtually out of the stable, for good or evil.  Let us hope good prevails. It has a tough time in other areas of life.    I tend to think that Epicurus would say that the gene editors are playing god, and are not to be trusted, and that is scary.

(Based on an artcle by Alex Pearlman in New Scientist, but heavily edited for length)

War is not conservative: The hypocrisy of Trump and May

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Being politically conservative is a vague, hard to define notion that depends heavily on the context in which the term is used. To be a conservative in an Islamic theocracy is very different to being conservative in a communist dictatorship or a liberal democracy. Even within a country, the meaning of conservative can change over time. In Britain in 19th century, conservatives were avid protectionists. Nowadays, British conservatives champion free trade, with most scepticism of free trade deals coming from the left.

But conservatives have some general, if flexible principles. They are opposed to revolutions or radical change, preferring incremental reforms informed by the wisdom of the past. They value tradition, order and stability, particularly with regards to the family. Conservatives tend to be proud of their countries and their national cultures. Property rights, the freedom to do business and particularly in the English-speaking world, a small state, are paramount.

It ought to be obvious that war is not conservative. War is highly disruptive to society, rapidly changing it and in often unpredictable ways. Families become weaker as fathers go off to fight, and are permanently broken if those fathers die. The economy becomes weaker as taxes and borrowing rise to fund the war. The state becomes larger, more powerful and more intrusive. Traditional institutions are disrupted. Global trade becomes more difficult. It’s no surprise that after WW2, Britain elected Labour in a landslide. The people were so accustomed to socialism in wartime, they wanted it in peace as well.

Britain and America are both led by people who self-identify as conservatives. Yet their decision to bomb Syria is anything but. The bombing campaign will only prolong the civil war, which Assad will win. Civilian casualties will increase. More people will be made refugees. The Syrian nation, which has already endured catastrophic losses, will only crumble further. It will cost us money, increase anti-Western sentiment in Syria and the rest of the Middle East, and lure us closer to direct confrontation with Russia and Iran. Our leaders have no implementable vision for Syria. With the failure of the Iraq War now obvious, any attempt at regime change is politically impossible. Their only hope is that the bombing serves as an exercise in damage limitation: that Assad will stop using chemical weapons. But even if he did, he could still use more conventional methods to kill civilians. The air strikes could result in more dying than if we hadn’t intervened. Not intervening is the least worst option.

It goes without saying that the actions of the Syrian government, backed by Russia and Iran, are reprehensible. Assad should make Syria a democracy, gives the Kurds their own state and end the civil war. Being opposed to intervention doesn’t mean taking the other side. The non-interventionist view is the patriotic, conservative one- the view that keeps our economy, society and political life the healthiest. If the Syrian bombing campaign, conducted by the Right, goes badly wrong, Britain and America will move decisively leftwards.  The Vietnam War resulted in the hippie movement and draft-card burning. The Iraq War resulted in Obama and a Democratic landslide. This time, opposition to war could put a radical socialist in the White House and Jeremy Corbyn in Number 10. May and Trump should look at recent events, and think again.